Paramedic

by Peter Canning

  The city is quiet. We do a call for an elderly man with asthma who feels better after a breathing treatment. We get called for a possible seizure on Broad Street, where we find an Audi parked at curbside, engine running, and a well-dressed man with a cellular phone in hand standing over a homeless man, who we’ve transported often before for drunkenness and seizures. The man with the phone tells us he saw the man fall to the grass and begin seizing. Though he has stopped seizing, he says the man should be seen at the hospital. We tell him we know the man and thank him for calling. The homeless man, who is coming out of his postictal state, refuses to go to the hospital with us. He says he hasn’t taken his Dilantin, his antiseizure medicine, for two days. We tell him he’s going to end up seizing again and we’ll end up taking him. We say why don’t you just come to Hartford Hospital with us. It is cold out, and they’ll have something warm for you to eat. He says he doesn’t care. He’s not going. We can’t take him against his will. An hour later another crew responds for a seizure, and they have to give him Valium to break it. He ends up at Hartford.

  At eleven-thirty we go to Stop and Shop and buy a pumpkin pie and an apple pie, which we bring back to the office in West Hartford, where Laura Howe, the dispatcher, is preparing a feast for the road crews who will be rotated in for a Thanksgiving meal during the course of the day. We eat turkey, corn, mashed potatoes with gravy, stuffing, fresh fruit, cookies, rolls, and pie. Later when we are back in the city, we throw a football around.

  Around five, we respond to a cut foot on Blue Hills Avenue. A twenty-six-year-old woman has dropped a pair of scissors on her foot, causing a small puncture wound. You can see Mount Sinai from her front door. She limps out to the ambulance, refusing to be assisted. I drive her down one block and across the street to the emergency entrance, where she limps in through the doors. They put her in the waiting room.

  While Glenn is writing his report, Windsor ambulance radios ahead that they are bringing in a code. I meet them as they pull in the driveway and help them unload. Joe Stefano is the medic, and he has the patient tubed and being paced. A bag of saline is running through an IV in her jugular vein. I take over the CPR as we wheel her into the emergency department, where Joe gives his report. His other crew members, Fred and Susie Averill, both work for us. Susie says she knew it was just Joe and Fred on duty, so when the call came over the scanner as a cardiac arrest, she left her family at the dinner table to help them out. The woman is declared. Joe shocked her five times, gave her six rounds of meds, and paced her, but her time had come. They’d transported her two weeks earlier for a stroke.

  I go home at seven, having done only four calls. Michelle has a plate of turkey, sweet potatoes, mashed potatoes and gravy, peas, and rolls from her mother’s waiting for me when I get home. I heat it up in the microwave and wash it down with a cold beer.

  Meanwhile, back in the city things start to heat up. As the holiday stress mounts, ambulances fly about the city—assaults, asthmas, chest pains. At eleven a man who had been barred from seeing his family the day before accompanies them to Thanksgiving dinner at a friend’s apartment. He and his wife begin to fight. He pulls out a gun and pumps bullet after bullet into her body.

  When Shirley Lessard and John Buvelle arrive in 875, they declare the mother at the scene. Then they are directed to the car, where they discover the children. A two-year-old girl, shot in the head, is not breathing and has no pulse. The five-year-old boy has agonal respirations. He has been shot through the right hand, through the head, and out through the left hand, as he tried to block out the horrible noise. Shirley has two young kids at home. They race to the hospital, lights and crying sirens.

  Respect

  Sometimes I think it is all about respect. Wars have been started over loss of face. Millions killed. Today in the ghettos people shoot each other just because someone disses them or they just don’t like the way someone looks at them.

  I asked before when it is that a smiling child becomes a sullen youth. I think now it may be in the passage from the hope we are all born with to the despair in understanding that there are two worlds, one held up and the other put down. When the child sees, time and again, the lack of respect for him and his world—whether it comes from the outside or inside his own community—it can’t help but sink in and poison.

  Glenn and I are sent on a call for a pediatric with abdominal pain in the north end. The mother and the child, a roly-poly nine-year-old in a Michigan football jacket, meet us at the door, all set to go.

  “Where’s the sick one?” I ask, already knowing it is the kid.

  “He is,” she says. “He got stomach cramps at school and the nurse said he had a temperature of ninety-seven point eight.”

  “You have your state card?” I ask.

  “I’m not on state,” she says, a touch of anger in her voice at my presumption. “I don’t got insurance. Does that mean you won’t take me?”

  “No,” I say. “Just if you have state, you’re supposed to call your HMO and get permission to take an ambulance. It’s a new policy. If they don’t think it’s serious, they’ll have you take a cab instead. It costs two hundred dollars to take an ambulance.” I know the price won’t make her bat an eye. She has no intention of paying it. She called the ambulance to save herself a five-dollar cab ride. The bill will go uncollected like so many others.

  “He’s got cramps,” she says.

  “What’s he been eating? A lot of junk?”

  “No.”

  “You’ve got to serve him vegetables,” I say.

  “Oh, he gets his vegetables. I cook him greens twice a day. I make sure he eats his vegetables.”

  While I am talking to her, I notice the boy looking intently from me to his mom and back to me. There is some worry in his eyes, and I think he senses that I have power over him and his mom and that I don’t approve of them. He sticks close to her.

  I ease my hard stance. “Okay, ma’am,” I say, “which hospital would you like us to take you to?”

  “Saint Francis,” she says.

  “Okay.”

  Walking to the ambulance, I sense even Glenn has picked up on it. He helps the woman into the back and calls the boy, “Little tiger.” He is good to them as we ride in.

  Lift Me Up

  I arrive at work twenty minutes early every day. The morning supervisors, Chris Chausse and Christian Schmeck, give me the ambulance keys and a set of radios, and I go check out the rig. Other medics and EMTs sit in the office waiting for their ambulances to come in off the road or finishing their paperwork from the night’s calls. A new medic unstraps his bulletproof vest and says to his partner, “I can’t stand a medic who says it’s my way or the highway. I’m a medic, too, and they ought to take into consideration that I may have a valid point. I hold him personally responsible for a man’s death. Remember that call we did that night? He wouldn’t listen to me.”

  It is commonplace for EMTs to criticize others. Every morning I hear people putting down those who aren’t there. I have done it myself over the years—it is hard to avoid—but I try not to engage in it. I believe that people criticize others because this is a tough job and they are unsure of their own skills and the only way to reassure themselves is to sit with others and put someone else down. It means that they are better than those people, and by criticizing them and not being challenged, then they are unchallengeable. I have heard EMTs putting others down and then I have worked with the talkers and not been impressed with their skills. I have found that whenever I put someone down, it turns around and whacks me on the butt. If I say I can’t believe so-and-so missed an IV on that person, then sure enough, I blow my next IV. If I make fun of a nursing-home nurse, damn if I don’t do something to make an ER nurse make fun of me. I try to keep my thoughts to myself now. If a partner of mine screws up, I try to let him know in a noncritical way. If I screw up, I talk about it and how I can avoid it the next time.

  We get called to an MVA by a basic crew that needs a medic for
a patient pinned in a car having chest pain at the intersection of Sigourney and Asylum. Two cars are locked together facing in the same direction. The basic crew sends me to the second car. The passengers are a Hispanic woman who is crying out excitedly and her husband who is holding his chest. I lean in the window and check them out. One of the EMTs is in the backseat and gives me a report. The windshield is starred in two places. Neither of the passengers lost consciousness. The EMT has put cervical collars on both of them. Both their vital signs are stable. The man has had open-heart surgery and is having pain. I ask him to point to where it hurts. I press on the right side of his chest and he screams. He tells me it hurts more when he breathes. I am convinced it is a muscle-skeletal problem, not cardiac. The woman says her butt hurts.

  As soon as the fire department arrives and pries the cars apart, I take out the man on a longboard, get him in the back of the ambulance, and start working him up. Glenn has already helped load the patient in the second ambulance, then helps the basic crew with the woman before joining me to drive to Hartford on an easy two. I give my report and my patient is put in Room 2. When I am writing my report in the EMT room, I hear over the intercom, “We have a second Room One.” When I walk by, I see the room is crowded and wonder what Life-Star brought in. Then I see one of the basic EMTs walking out of the trauma room and hear that both of the patients they brought in were put in Room 1. It turns out the lady in the second car, whom I talked to but I never even looked at, had a flail chest, where three or more of her ribs were broken, causing her chest to sink when it should rise. I am upset with the basic for not triaging me properly, but I am more upset with myself for not checking each of the patients. It is my responsibility. I walk out to the ambulance, feeling worthless. Glenn tells me the basic crew didn’t notice the flail chest until they were almost to the hospital. Maybe I wouldn’t have noticed it either. She wasn’t in evident distress at the time and her vital signs were stable. But I should have assessed her thoroughly, and if I’d done that—if I’d done my job—I would have noticed it.

  When I see Rick Ortyl he asks me how it’s going, and I say, I’m not being a very good paramedic, and tell him the story. He tells me a similar one that happened to him, not that it makes me feel any better. It is not that I killed anybody. They all got to the hospital and got the care they needed in a timely fashion. It’s just that the potential for damage was there. I didn’t do my job well.

  * * *

  We get called to a nursing home for an unresponsive patient. The nurse says he is normally alert but confused. He has a long medical history. He is breathing okay, but has rales in the bases of his lungs. He has a fever. His blood pressure is high, and his pulse is around 100. On the monitor, he is in atrial fibrillation. He doesn’t respond to my commands but seems to have equal grip strength. I can’t figure out what is going on with him. It could be a transient ischemic attack (TIA), heart failure, or the onset of sepsis. I put him on oxygen, put in an IV line, and take him to the hospital. His condition is not clear-cut enough to give him any medications. He’s just an old guy who is not with it anymore. I give my report at the hospital and they put him in a room, where eventually a doctor will see him. I go out on another call and never find out what was wrong.

  I do ALS all day, but all just basic—put them on the monitor, give them oxygen and an IV. Maybe a nitro for chest pain, or a breathing treatment for asthma or chronic obstructive pulmonary disease (COPD). I am feeling like a robot.

  Right before we get off duty we do an MVA where we are the first ambulance in. The car in the middle of the road has the passenger side of the windshield punched out in the shape of a head. Two young men lie on the side of the road under blankets. I check them both out. They are both alert, though one has a nasty cut on his forehead. We call for a second ambulance. I take the guy who pushed out the windshield. On the three-minute trip to Saint Francis, I have time only to throw in an IV and get the man’s name and birth date. I do not call for the trauma room because the patient is stable, but I ask for a doctor to look at him, given the mechanism of injury. The doctor checks him out briefly at triage, is unimpressed with the injury and my description of the windshield, and sends him to the main ER in back.

  I am depressed when I get home. I recap my day to Michelle and tell her about missing the flail chest—how I feel I am not thorough enough and how I feel like I don’t know as much as I should. All I seem to do is put the patient on oxygen, give them an IV, and put them on the monitor. She says I know more than I think I do. I say I have a hard time even remembering the names of the bones in the body, which is basic EMT material.

  “What’s this?” she asks, touching my knee.

  “The knee,” I say. “The patella.”

  “What pulse is this?” She touches the inside of my ankle.

  “The posterior tibial.”

  “What’s this?” She touches the side of my ribs.

  “The costal margin.”

  “How about this?” She touches the side of my hip.

  “The pelvis.”

  “What’s the bone called?”

  “I don’t know. The sacrum?”

  She starts laughing.

  “The greater trochanter,” I say.

  She is laughing so hard I am afraid she will fall off the bed. “You’re killing me,” she says. “You’re so funny.”

  “The ilium, the ischium.”

  “Stop it,” she says. “You’re making me laugh too hard.”

  She thinks I’m kidding.

  On Wednesday it is a nice day, bright and clear but cool enough to wear a windbreaker. Our first call is for a fall in West Hartford. We see a man sitting on the side of the road leaning against the legs of a police officer. A woman stands by him. “I was driving down the street when I saw him fall,” the officer says. “He went down on his face.”

  The man’s face is dirty with a few abrasions and a bloody nose. He looks disoriented.

  “He has Alzheimer’s,” the woman says. “He was walking to church.”

  I check him out. He knows his name and where he is. He says he wasn’t knocked out. “I’ve got to get to church,” he says.

  “Will he fall if you move your legs?” I ask the officer.

  “He’s unsteady,” the officer says.

  “He doesn’t have good balance,” his wife says.

  We help him up, and he is able to stand, though he does sway some. We have a discussion about whether he should go to the hospital or not. The officer, who saw him fall, tells the wife he really should be checked out. She says he falls all the time, and that they end up waiting at the hospital for ten hours only to be told he’s okay, and they go home. She doesn’t want to take him. He does best at home. The officer says his nose looks swollen. I touch it but it does not cause undue pain. I tell the woman I understand what the officer is saying and that we always urge the patient be checked out, but I also understand what she is saying. It is her choice, and she can best judge how he seems to her. If she wants to take him home, we will help her since it is just down the street, and if she changes her mind, we will be happy to come back. “I want to keep him at home,” she says. “This is where he belongs.”

  “Okay,” I say. “I understand.”

  We help him into her car, where we first clean his face with sterile water and four by fours, then follow in the ambulance. With the officer, we help him out of the car and into the house. She wants him to sit in his lounge chair. The officer, who has been to the house before, directs us down the hallway toward the back den. We get the man settled in his armchair. “Thank you very much,” the wife says. “Thank you for your understanding.”

  “Sure,” Glenn says. “Don’t hesitate to call us. We’re just three numbers away.”

  “I will,” she says. “Thank you again.”

  That afternoon, we are sent to Park and Broad for a drunk. A cop is on scene, standing next to a man lying against the building. The man doesn’t want to get up. When Glenn holds an ammonia
inhalant to his nose, he takes a swing at us.

  “Take it easy, take it easy,” I say.

  “Get that thing out of my face. Fuck you, bastards. Leave me alone.”

  “You have to come with us or the officer here will take you to jail.”

  “Fuck off.”

  We get him up. Glenn calls to see if he is banned from ADRC. They say they’ll take him, but before they’ll admit him we have to take him to Saint Francis for a Dilantin check. He doesn’t want to go to Saint Francis. “I’ve been taking my Dilantin.” He pulls his prescription out of his pocket and shows me. “I’ve been taking it. I don’t want them taking no blood from me.”

  “It’s come with us or go to jail,” Glenn says, grabbing his arm.

  He swings his arm loose. “Fuck off.”

  The officer goes to get his cruiser, which is parked across the street.

  “Last chance,” I say. “He’s coming back to arrest you. Come on, we’ll take you to Saint Francis.”

  “I don’t want to go there.”

  “They’ll check your blood, and then it’s on to ADRC, where they have a clean bed waiting for you, hot food, too.”

  I keep talking to him in a low, steady voice. The cop has his car at the curb now and is getting out. The patient starts stepping up into the back.

  “We’re all set,” I say to the cop.

  “You want me to follow you?”

  “No, we’ll be all set.”

  I get the man in the back and keep him calm.

  Glenn is hobnobbing with the cop. The back door is closed, and the man’s alcoholic breath is starting to overwhelm me. Finally, Glenn gets in the front to drive.

  He has the country music on just low enough to hear.

  “Good music,” the man says.

  “You like that?”

  “Country!”

  “Turn it up,” I say to Glenn.

  “What?”

  “Turn it up. The man likes it.”

  Glenn cranks it.

  “Yeah!” the patient says. He starts playing air guitar.