Paramedic

by Peter Canning

  It is a song by Alan Jackson.

  “Living that honky-tonk dream!” the man sings along off-key.

  “Yeah!” I say.

  * * *

  We do BS all the rest of the day and all the next, but I am in a good mood. I get to speak Spanish with a little girl with a fever whose mom took her to a community health center. The PA at the health center gives us the history and says the little girl needs to be seen at the Hartford pediatric clinic to rule out pneumonia. She says the woman took her little girl to another hospital and they told her she wasn’t sick enough to be seen. The PA has arranged for the child to be seen at Hartford. The PA compliments me on being able to speak Spanish, though I know that a Spanish woman has been laughing at me for the broken phrases I have been using. No doubt I have been saying something like, Do I hurt when you breathe? At Hartford I take the girl and her mother through triage, then back to the pediatric clinic, where I help her register. I say good-bye, and the little girl waves at me.

  Out in the parking lot I stop off at one of the cars to say hi to the crew. The paramedic, who is newly cut loose, is upset about a call she did that went badly. They got called for a possible suicide attempt—a man allegedly drank some insecticide. They tried to get him to go to the hospital, but he denied he drank it and said he wouldn’t go to the hospital. That was his right. A half hour later they were called back to the same address where the man was having a seizure and in flash pulmonary edema. They rushed him to the hospital, where he was now in critical condition. Several people—including a doctor—had been critical of them for getting a refusal on their first visit. I couldn’t have kidnapped him, she says. I asked the cops on scene to commit him, but they wouldn’t do it. What more could I have done?

  I tell her not to worry too much about it and not to let the second-guessing bother her. No one who wasn’t there can judge her. I tell her about the carbon monoxide call I did, and say if I had to do that again, I would come as close to kidnapping the man as I could, but there is only so much you can do. I say, in retrospect, both she and I could have called medical control, told them our situations, and made them share responsibility. I tell her the fact that the call is bothering her is good; the outcome was bad, so it should bother her. She wouldn’t be any kind of a paramedic if it didn’t. It is not an easy job. You are not going to succeed every time. All you can do is your best and learn from each call. She thanks me for what I say, but my words are not particularly original—I am just saying what others have said to me, what she herself will say to another paramedic down the line.

  It is about time for us to get off, so they give us a BLS transfer—a man with hip pain going back to the Jefferson House in Newington from the ER. We get the man settled into his nursing-home bed, and Glenn asks if he is comfortable. The man says if we could pull him up a little more, that’d be great. “Thank you, you’re nice fellas,” he says.

  We wheel our empty stretcher through the hall, take the elevator down, and go past the fish tank out the main door to our awaiting ambulance, which will take us back to the office, where we will turn in our paperwork, hand over the keys to the next crew, and head home. We are both in good moods. I think that one of the nice things about this job is that you get so many chances to be nice to people—not that you always are, but when you are, which hopefully is often, it makes you feel good. There is more to the job than just giving people IVs and medical care. Sometimes I forget that. And as much as I like throwing in an IV or even better, sinking a tube, I like being nice to people. Lifting them up lifts me up.

  Shoot-out on Amity Street

  I come out of the Farmington Avenue office to find Glenn and two guys from another crew watching two police cars whiz past. “You just missed a car chase,” Glenn says.

  “Huh?”

  They tell me a gold Cadillac just raced past with a caravan of cars in pursuit.

  A moment later we hear the click of the HPD portable and the call for 453. “Four-five-three, respond to Park and Amity. A shooting. On a one.”

  Four-five-three is over at Saint Francis, but Shawn is precepting a medic, so they have been getting funneled many of the good calls. I am not even disappointed.

  “Change that,” the radio crackles. “Four-five-one, you’re closer. Park and Amity.”

  “Yes!” Glenn says.

  We jump in 451 and hit the lights and sirens. I strap in.

  Three minutes later, we’re out. I grab the blue bag and duck under the police tape. I have never seen more police cars. There must be fifteen or twenty. I see a crew from the news already on scene. “Where’s the shot guy?” I ask.

  “Over by the car,” a cop says.

  In a small parking lot off the street there is a separate taped area, where I see a gold car, its windows shot out. One cop is standing with his hands in his pockets. I see a body slumped on the ground a few feet from the open driver’s door.

  I duck under the tape and kneel by the man. He is pale but breathing. I see blood in his hair. He is handcuffed. His pulse is rapid. I look for bullet wounds. “Where’s he shot?” I ask the cop. There is no bullet wound in his head, just blood in his hair.

  “Let him fuckin’ die,” the cop says. “He tried to run an officer over.”

  I notice a bullet wound through his hand, and a finger shot off. There is another wound in his wrist. I check his legs and see his femur is shattered. The leg is like jelly.

  “Uncuff him,” I say.

  “No, I don’t got the keys,” the officer says. “You guys got any alcohol wipes? I got some blood on my finger.”

  “Uncuff him.”

  Glenn has the stretcher there now with the board and a cervical collar.

  I am cutting his clothes off with my trauma shears looking for other wounds.

  A captain comes over and pointing his finger at me says, “This man is going to the hospital cuffed. He assaulted officers and has tried to flee. He’s going cuffed. End of story.”

  Glenn says, “Look at his leg, He’s not going anywhere like that.”

  I let him argue with the cop. I get an oxygen mask on full and put the collar on his neck.

  Another officer appears with the keys. We get the man on the board and we race in low position, under the tape, past the police cars and TV crews, and lift him quickly into the back of the ambulance. “Drive!” I say to Glenn.

  He drives and gives the radio patch to the hospital while I work on the patient. There are no other wounds, but his pressure is only 90, and he is tachycardic. I tape head rolls to better secure his c-spine. I spike a bag of saline, strap a tourniquet on his left arm, and rifle in a sixteen. I get the flash, connect the line and it runs fast. I hook the monitor up. Sinus tachycardia. I put a tourniquet on the right arm, spike another bag of saline, and pop in another sixteen. I get the flash and hook up the line. The line runs. We’re out at Saint Francis. Another crew helps us unload. “Two lines, good job,” I hear someone say.

  We burst into the trauma room, where the trauma team is waiting. I give the report. We switch him onto the table, and they take over. His pressure is up, but he is still tachycardic. I got almost a full liter into him in a few short minutes.

  We later hear the story. It appears the man was observed doing drugs in his car when approached by an officer. He sped off, partially dragging the officer. He then led cops on a ten-mile police chase on and off the highway before he was cornered on Amity Street. He sped toward the police barricade, then at the last second swerved sharply to the right into the parking lot. The cops riddled his car with bullets. Over twenty shots were fired. A lot of jokes are made about their marksmanship and whether they should have shot or not, but I don’t know. If a car were coming right at me sixty miles an hour and I had a gun in my hand drawn and ready to fire, I think I’d pull the trigger, too. As far as not wanting to uncuff the guy, if I was a cop, I’d probably want to keep him cuffed, too. But I’m not a cop. I’m a paramedic. I have to do my job. We got him uncuffed. Got him boarded, got him
to the hospital fast, and I hit both of my lines on the fly.

  Shots of Glenn and me are on the news at noon, six, and eleven, and again the next morning and evening as they do follow-up stories.

  “You look good,” people say.

  I feel it.

  HEARTBEAT

  Heartbeat

  In this last year in the city, I have seen many disturbing things that make me worry about the future of the city and grieve for its children. I sometimes think the circumstances of life in the city are so brutal, any energy that might go to loving has to go to living just so a person can get by. But as discouraging as the child abuse, the rampant drugs, the poverty, and random gunfire can be, there are times when I see things that give me a reason—no matter how small—to believe again. People are strong and love is hard to kill even in the darkest corners of the city.

  It is night. They send us to Mark Twain Drive, an older housing project off Albany Avenue, for a priority-one chest pain.

  We go to several buildings looking for the right address. When we find it, the door is locked. As we call the police department on our radio to check the number, I hear a banging on the window to the right of the door. An old woman lying on a hospital bed pushes a cane through the bars on the window. Her keys dangle on the end.

  I take the keys and unlock the outside door, then unlock the door to her apartment. She is a huge woman, an invalid with all her worldly needs within her reach. There is a portable toilet next to her bed. On the table to her left is a small refrigerator, small TV, phone, and coffee cans filled with water and washcloths. I approach her and take her pulse as I ask what is wrong. She says she has a pain in her chest that goes into her throat and makes it hard for her to breathe. Her pulse is slow and slightly irregular. Her breath is a little short, but her lungs are clear. Her arms are too big to take a blood pressure. The pills by her bedside indicate she has asthma, angina, and diabetes.

  “What hospital do you want to go to?”

  “Can’t you give me anything here?” she says. “To make this heartburn go away.”

  On the heart monitor, she is very bradycardic—a slow pulse, a rate of 48. She has a condition known as sinus arrhythmia, in which her heartbeat is affected by her respirations. When she gets anxious and breathes more quickly, her heart rate picks up. She calms and it slows in time with her breaths.

  I tell her I am concerned about her description of the pressure in her chest. Elderly patients can often suffer heart attacks with minimal outward signs. They need to be taken to the emergency department and evaluated.

  “You can’t give me anything for my heartburn?” she says.

  “You really should go to the hospital,” I say.

  She tells me she doesn’t like hospitals and hasn’t been for over a year.

  The phone rings. It is her daughter. I ask her about her mother’s condition.

  “She ain’t been right since last Christmas. One of her grandsons was killed. She’s been having trouble all year, but she won’t go. She won’t see a doctor, and she won’t leave where she’s at. We all losing patience.” She sounds disgusted with her.

  After I hang up, I say to the woman, “I know this home is very special to you. Your family wants you to go, I want you to go. We’re all concerned about you. It’s important you see the doctor.”

  She tears up. She is wringing her hands. She looks about the clutter of her room—at a rocking chair, at a picture of her family on the wall, a colorful shawl on her bed. I will learn later she has lived there for forty years after migrating north from South Carolina.

  I put my hand on her arm. “Take your time,” I say. “We don’t need to go lights and sirens. We’ll just take a nice slow ride to see the doctor and hopefully have you back here soon, but feeling better.”

  “My dear home,” she says, dabbing at her eyes.

  “I know.”

  She sobs quietly.

  We wheel her toward the ambulance. A young boy, maybe fourteen, comes across the yard out of the darkness. “Grandmother,” he says.

  She looks up, surprised to see him. “Robert. You come to see me?”

  “You okay?”

  “You shouldn’t be out,” she says quickly.

  “Mama said you were sick.”

  “You shouldn’t be out. The streets aren’t safe for young boys like you.”

  “I just came to say good-bye.”

  Her face softens. “You a good child. Give me a hug.”

  He bends over her and they embrace.

  They hold each other.

  She releases him. “You go home now,” she says. Her eyes are wet. “Get yourself home.”

  He stands back. He holds his wool knit cap in his hands.

  “You promise me you go right home.”

  “Yes, Grandmother,” he says.

  We bend our knees, grasp the bottom railings of the stretcher, then straighten our legs and lift her into the back of the ambulance. She waves good-bye to her grandson. My partner closes the door. I put a tourniquet on her arm and draw blood and put in an IV. I talk softly with her in the dimly lit back. We drive through the darkness. The green line on the heart monitor beats slowly as she breathes.

  End of the Year

  They put Christmas decorations up on Main Street. We have our first snowfall. I have been in the city almost a year now. Each shift I grow more confident. Some days are slow, others they bust us all day long. In between the runny noses and the drunks, and in between the nurses calling us ambulance drivers and having to carry luggage, plants, and get-well balloons for patients on heart monitors, I have some decent moments.

  I respond to a woman not feeling well in the city. She meets us at the curb, gets in the back, and says her heart is racing and her chest hurts. There is a look in her eyes that tells me this is not BS. I put her on the monitor. She is cranking at 220 beats a minute. I’m going to take care of you, I say. I throw in a line and push adenosine. The rhythm breaks. She goes down to 112. The pain in her chest is gone. “You should be in the hospital,” she says, batting her eyes at me. “The way you make me feel better.”

  They have assigned me for the day out in Bloomfield, working as the medic with the volunteers. We get a call for a difficulty breathing and arrive to find a man sitting out on the porch in his bathrobe. Even though it is near freezing out, his struggle for air has driven him out of the house. His pressure is high. I pump the cuff up to 260 and it is beating at that level. His lungs sound like a washing machine. Pink froth comes from his mouth. His head looks like it is about to explode. His veins are bulging out of his neck. It is dark on the porch. There are two cars in the narrow driveway, blocking our route to the ambulance. He looks like he can’t take a step. Normally in Bloomfield, there is a crew of three to assist the medic, but tonight, because it is just before crew change, I only have Annie Worshoufsky. She has been an EMT a long time and knows this is a dire situation—the man is in pulmonary edema. We manage to get him out to the ambulance. We have 100 percent oxygen going through a nonrebreather. I shout at her to get my nitro and Lasix out of the biotech. I throw a tourniquet on his arm. He has only a tiny, spidery vein on his arm. I am not supposed to give him a nitro until I can get a line, but he needs it, and I need to get the line. “Give him one,” I say to Annie, and she pops the tiny white pill under his tongue as I jab his arm. “Yes!” I get a flashback but can only advance the catheter a little way before it meets resistance. “Saline lock,” I say, and she has it for me. “Eighty of Lasix,” I say. “Put it in a ten cc syringe.” To the patient, “Hang on, sir.”

  I screw in the lock and take the syringe of Lasix. I stick its needle through the rubber lock and pull back. Blood flows back through the catheter into the syringe. I know I’m in the vein, and slowly now I push the Lasix in. The nitro will dilate the man’s veins, causing fluid to pool in his legs, easing the load on his heart. The Lasix will diaphorese him and let water escape into his kidneys and out through his ureter. “Give him another nitro,” I say,
as I check his pressure. Still over two hundred.

  But now he is breathing easier. “How are you doing?”

  He breathes a few deep breaths then says, “Better.”

  A moment later he looks at me and says, “I thought I was going to die.”

  I glance at Annie. She makes a face at me that says, Yeah, me, too. I give her a look back: No kidding.

  His pressure comes down to the 170s. His lungs are clear except for some wheezing. The sheets are soaked through with his urine. “Don’t worry about it,” I say to him. “It happens a lot when we give Lasix. At least you can breathe. That’s the main thing.”

  By the time we get to the hospital he is a new man and says he is ready to go home. I give my report to a doctor, who is moonlighting there, and he looks at me skeptically when I describe the state we found him in. He is unimpressed—he sees no signs of pulmonary edema. He listens to the man’s lungs and says, “I’m concerned about his wheezes.”

  “I guess you had to be there,” I say.

  Back in the ambulance, Annie and I slap high fives. “We kicked butt on that one,” she says.

  “No shit,” I say. “Good call. You were great.”

  “So were you,” she says. “We knew what we had to do, and we did it.”

  “Amen,” I say.

  Back working in the city, I am dispatched to a possible cardiac arrest. A moment later, Daniel Tauber, who is in the city in his fly car, comes on the air and says he’s going to back us up. I think Daniel secretly loves to get to cardiac-arrest scenes and get the tube before the medic does. “Let’s have him shocked, tubed, IVed, meded up, and out of there before Daniel gets there,” I say to my partner. I am nervous about Daniel’s coming. The call is in a bank off Main Street. We go through the door, and I see the man sitting in a chair, head on his chest. We are told he has been there for twenty minutes while his son conducted business with a bank officer. He is gray and as still as death. I grab him by the collar and whirl him down onto the floor. He is not breathing. I rip off his shirt, apply the monitor. Idioventricular. I go to the head, insert the laryngoscope, see the cords, slide the tube in, pump air in, lung sounds solid. I secure the tube, then strap a tourniquet on the arm. He doesn’t have much for veins, but I feel a slight sponginess in the forearm. I bang a twenty in, get the flash, just as Daniel walks in the door. “Line’s in,” I say.