I wasn’t involved in the day-to-day handling of developing the regulations. That task was assigned to Marie Wilson of the OEMS staff, who worked diligently with Dr. Jacobs, Dr. Phillip Stent, the state’s medical director, and others to craft the final package. I wanted them to be finished before I left the department, but it did not happen. Despite being pressed to the front burner, it still took another four years and many setbacks to come about, but it was worth the wait.
Now if a patient is critically injured, the ambulance crew is trained to bypass closer hospitals for trauma centers. Or depending on the proximity of the hospitals, the smaller hospital will immediately transfer the patient by helicopter to a Level I or Level II center, which has the experience to handle major trauma. Everyone injured in the state will have data on their injury and care input into the system, which will be a gold mine in terms of research information that can be used to improve treatments and for preventive measures.
It is a nice feeling to see something in which I played a role reach the street. But the legacy I hoped to leave from my years at the health department is being threatened in other ways. I had the support of Governor Weicker and Commissioner Addiss in pushing for change in the EMS system. Today, there are both a new governor and a new commissioner in town. When I came to the health department in 1991, OEMS was located figuratively and literally in the basement of the health department. The then acting director of OEMS, Paul Connelly, reported to the bureau chief for regulation, who reported to the deputy for administration, who reported to the commissioner. While the bureau chief was a proficient administrator, he had no particular interest in EMS, which was consequently a low priority for the department. After I had been there a year, we moved the office out from under regulation and gave it independent reporting authority to the commissioner, created a statewide advisory committee, and launched a national search for a permanent director to fill the position that had been open for three years. I remember the day OEMS broke free, how happy everyone was to be liberated. All except Paul Connelly, who said to me, “Who is going to protect us when you’re gone?”
In July, the new governor named the bureau chief commissioner of the health department. One of his first acts was to put OEMS back under the bureau of regulation. He eliminated Paul’s job as deputy director, has been slow to refill vacant positions, and has floated a plan to entirely dismantle the office. He offered Michael Kleiner, the man we selected as the new OEMS director, a raise if he would accept a three-year temporary position to complete the overhaul of the EMS regulations. Kleiner, a savvy former director of paramedics in San Francisco with ten years of street experience and experience as a labor negotiator for his union, turned him down. Eliminating the office will require a change in law—the key will be to prevent the language from being tucked into a bill during a midnight session.
I occasionally run into people I dealt with, and they express dismay at what is happening. A few have said they miss me. But I don’t miss it, and I know that I am not irreplaceable. Mike Kleiner can hold his own, and if he loses, he will have fought a good fight for the people in the street. I am confident of that. And I do know that my power base came from the fact that people knew the commissioner and the governor stood behind me. Without them, I couldn’t have done anything.
I am at Hartford Hospital when the intercom announces Life-Star is landing on the roof with a Room 1 trauma. Minutes later, they come through the doors with the patient c-spined to a board, two lines of fluid running, the patient intubated. The flight nurse delivers a crisp report as the patient is transferred over to the trauma table, where the gowned team descends on him. Ten minutes later, he is whisked out to the operating room, where a surgeon will save the man’s life.
We get a call for a pedestrian struck. We race down Washington Street, past the health department. I look up at the large window on the third floor where I had my office. I used to sit with my feet up on my big desk and, looking out the window with binoculars, watch Life-Star land on the roof at Hartford or watch the ambulances whiz by. I am glad to be down below now on the street.
Celebrities
We go to Hartford Hospital to take a seven-year-old with a deformed spine and lung problems to Newington Children’s Hospital. He is on his side, watching TV. The nurse introduces him to Glenn and me.
“This here’s a professional basketball player,” Glenn tells the boy, gesturing to me.
The boy holds up his hand for me to shake, which I do. “How are you?” I say.
“Good, sir,” he says in a tired voice.
“He’s a good kid,” the nurse says.
“Newington’s a good place,” I say. “I used to live there for a while myself.”
“Did you hear that?” the nurse says.
He nods.
It is not entirely true. I spent three days there after having a knee operation when I was ten. My roommate had been born with his organs outside his body and lived upside down in a bed that he was connected to through a steel pole in his head. In the hallway, there were all sorts of strange disabled kids with no feet and other weird things. The place gave me the willies big time, and I was glad to get out, though now I see what a wonderful place it is for kids.
When we get to Newington, we have to wheel our little friend into the waiting/playroom while they prepare his paperwork. They have giant stuffed animals, and Glenn and I get a kick out of playing with them and the kid. There is a hundred-gallon fish tank that he is watching. I get a five-foot-tall Tony the Tiger doll and stick his face on the other side of the tank. The fish scatter. The boy giggles.
Upstairs, we help him to his room. His nurse comes in and makes him smile by calling him the Big B.
In the hallway, a boy in a wheelchair with twenty balloons attached to the back is looking at me. “Are you a paramedic?” he says.
“Yes, I am,” I say. I go over and shake his hand. “How are you today?”
“Good,” he says. “You go to car wrecks and save people’s lives?”
“We try.”
“I’m going to be a paramedic someday.”
“You’ll be a good one, too,” I say.
Some other kids come by and gather around us like we are celebrities. We shake their hands and joke with them. They look up at us like we are heroes. The nurses stand back, smiling.
Off Duty
It’s my day off. I sit around the house. I’ve cleaned. I’ve eaten. I’ve worked out. I’ve written. I’ve watched TV. I’ve read. I’m anxious. I’m bored. I want to be at work. I want to be doing calls.
THANKSGIVING
Changing Seasons
It is the last day of our rotation again, a cold overcast day. Glenn is back at work after being out sick yesterday. He doesn’t look well and says he’d just as soon not drive today, which is not at all like him. Our morning is quiet, so he sleeps in the back for an hour or so but doesn’t feel much perkier. Our first call is for a person passed out at the bank on North Main. Welfare checks were distributed yesterday so the line at the bank is long. The guard tells us the woman is okay and doesn’t want to go to the hospital. She is putting her money into her pocketbook as we approach. She is a young woman, five months pregnant, with a baby in a stroller. She looks pale and sweaty. I ask her to come sit in one of the bank chairs so I can examine her. Her skin is cool and clammy. Her pressure is 90/60. Her pulse is 76. Everything else checks out okay. She isn’t in any pain. She was just tired. I ask when she last ate and she says yesterday. I tell her we’d be happy to take her into the hospital to get checked out. She signs a refusal and says she’ll go to the community health center after she gets home. She says she’ll take a bus. A friend who is with her says she’ll watch out for her. “Make sure she gets something to eat,” I say.
Driving back to sign on-line in the downtown area, I tell Glenn I was surprised that the woman was so insistent on not going and on later taking a bus. “Are we jaded in our view because all we deal with are those who abuse the system?” I ask.
“Or is there a larger world of people out there like her who don’t take advantage?”
“She’s the exception. They’re mostly all dirtballs.” He launches into a critique of the welfare system. “They ought to just end it. Sure you’ve got to help those who can’t work, but most of them can work. Put them to work cleaning the streets. I mean, look at the litter in this part of town.”
“They’re starting to clamp down,” I say. “They’re going to impose a time limit on how long you can be on welfare.”
“Until it’s no days, it’ll be too long,” he says.
We do an accidental sleeping-pill overdose and a Cancer Center round trip, then are quiet for the entire afternoon, sitting down by the train station, under the highway overpass. Another crew comes by to talk for a bit. Brian Brown and Dave DiFlumeri. They haven’t done anything all day either. Dave is precepting Brian and they are just waiting for Vinny Cezus of Hartford Hospital to ride with them to cut Brian loose.
“Did you do that call at City Place?” Brian asks.
“No that was Harper. Cerebral hemorrhage. Thirty-four-year-old lady. They tried to nasally tube her, but her septum was deviated. Her jaws were locked up. Pupils pinpoint.”
They shake their heads.
“Happens just like that,” Dave says.
We talk for a while about not much, then they head off to get something to eat.
“One of these days they’re going to call you up and have you precept,” Glenn says. “How long have you been on your own now?”
“Eight months. I think I’d be okay at it. I’m close enough to it to know what the preceptee needs, but I haven’t done enough real bad ones yet. I don’t have a nasal tube, and I could use some more regular tubes. It should be second nature before I precept someone.”
Glenn is going to be starting medic school in January. I say maybe I’ll precept him when he gets out. “We’ve done enough calls already, I could check you off quick. Done that. Done that. Yup, done that.”
“That’d be good,” he says.
I sleep in the back this time, and Glenn conks out in the front. We keep the engine running because we’ve got the heat on. Both radios are dead quiet.
I hear a knock on the front window and suddenly worry if maybe our radios went out and the company has come down and found us both asleep, but it is a man asking Glenn directions. Sorry to wake you up, he says.
After that Glenn can’t sleep. He is singing along to the country music, and I can tell he is bored. I get up and get in the driver’s seat. Jerk woke me up, he says. I gave him bad directions. Didn’t mean to, he says, just wasn’t awake.
Down the street by the railroad bridge I see a tall panhandler walking with a man in an overcoat. The man takes some change out of his pocket and gives it to the panhandler, then hurries off toward the fenced-in parking lot. The panhandler sees me looking at him. He comes over and gestures for me to roll down the window.
“Busy today?” he says.
“No, slow.”
“That’s good.”
“Not really,” I say. “We’re sort of bored. Day goes by too slow.”
“Oh, I get it,” he says. “It’s like the undertaker. You got to have business to get paid.” He laughs.
“Sort of,” I say.
“Well, let me ask you something,” he says, suddenly becoming serious. “I’m a homeless man just out of the shelter, and I’m trying to round up some money to get a room at the YMCA. It’s First Thursday tonight, and the cops don’t take well to my kind being on the street with all the suburban folk in town, so I just want to get a warm room, and get out of the way. Could you help me out some?”
“I don’t know,” I say. “Payday isn’t until tomorrow.”
“I’m not talking dollars here, I’m just talking change.”
“How much is a room?”
“Sixteen dollars and sixty cents,” he says without hesitating a second.
I don’t know if he’s bullshitting, but it sounds good.
“How much you got?” Glenn says.
“Thirteen dollars and seventy-five cents.”
I am surprised to see Glenn reach into his pocket and pull out a quarter. I reach into mine and give him a Susan B. Anthony silver dollar I got in change from the Charter Food that morning when I was buying my grape juice, pecan spin, and newspaper. “How do you like this quarter?” I say.
“Why, it’s a Susan B. Anthony dollar. I’m no fool. I thank the both of you. Have a good day now. I hope it isn’t too slow for you.”
“Just so we’re not picking you up,” I say.
“I can go along with it,” he says. “Good afternoon now.” He starts walking up the hill toward Garden Street.
“You gave him a buck?” Glenn says.
“Well, I couldn’t believe you were giving him money.”
“Yeah, but I was going to say, ‘Here’s a quarter; now get fucking lost.’ ”
“You notice which way he’s headed?”
“Yeah, the Y is back that way.”
“What the hell. He had a good answer about the rent.”
“Let’s go drive around. I’m bored sitting here.”
We spin around the downtown, looking as we always do for beautiful women, but the streets are nearly deserted. Those leaving work, all wearing coats, hurry toward their cars. No one is sitting in the windows of the Union Street bars.
A Heart History
We’re covering downtown this morning when we are sent on a one up to Windsor for a possible cardiac arrest. It is a long drive, so I get in the fast lane and press the accelerator all the way to the floor. We’re halfway up there when we get an update; it looks like it will just be a presumption. We should cut down to a five: lights and sirens until we are in the vicinity, then a quiet approach.
It is a nice house on a cul-de-sac, the kind of neighborhood I grew up in myself, safe for kids to play in the streets, yards to mow for five bucks. Two cops and a Windsor EMS volunteer are standing outside. “She’s got rigor mortis with dependent lividity,” the EMT tells us. “A heart history.”
We enter the house. A large man wearing only his pants sits at the kitchen table talking with an officer. He looks at us. His eyes are bleary. “Hello,” he says, choking on his words. “Come right in, gentlemen.”
A cop points us down the hall. “Last bedroom on the right.”
We walk down the hall. There are two beds. One is unmade; a sheet is pulled over the body in the other bed. I pull the sheet back. A woman sleeps on her side, her head on the pillow, her arms tucked in as if she were holding the sheet up to her neck to keep her snugly warm. She is cold; her face is mottled blue. Her arms are stiff and stiffened into position. She is long gone. I listen to her heart with the stethoscope but hear no sound. I apply the monitor and run a six-second strip of flat line. I detach the monitor and unstick the electrodes, which I put in my pocket. I pull the sheet back up and tuck it up to her neck. Glenn pulls the sheet the rest of the way over her head.
We go back to the kitchen. The man stands as we enter. “I am sorry for your loss,” I say. He nods as we shake hands.
“I need to ask a few questions.”
“By all means,” he says. He fumbles to pull the chair out for me. “I apologize for the state of the house. I had just given our dog an egg carton to play with. I’d turned the TV on and gone in to wake up Jennie so she could watch Kathie Lee and Regis as she does every morning.” He starts to cry and moves a fist to his mouth.
“How long were you married?”
“Forty-one years.”
“That’s a long time. Kids?”
“Seven. Two are no longer with us.”
“Grandkids.”
He smiles. “Their pictures are up there.” He points to the refrigerator. “The officers were looking at them.”
“Great,” I say. “I just need to get a few things for my report.” I ask for her full name. He gives it to me and also tells me her maiden name in case I need it. I get her med
ical history.
“She had a weak heart,” he says. “And seizures. She was pregnant with twins and had toxemia.”
“Did the twins survive?”
He smiles. “They are both big strapping boys today.”
I nod.
I get the list of medications then ask when he last saw her alive.
“Ten o’clock last night,” he says. “I got her in bed and wished her good night.” He fights back more tears.
“Well,” I say, “thank you. The officers will take care of things from here.”
He nods.
We look at each other, then I say, “Forty-one years. It sounds like you had a good life together.”
“We did,” he says.
I stand and he thanks us again and shakes both of our hands.
I walk out to the ambulance. I stop for a moment in the yard and, though the street is quiet, I picture kids playing, a Good Humor truck, a mother ringing a dinner bell. The neighborhood seems as large as the world. It is a good place.
Thanksgiving
Paramedic Page 28
