Paramedic

by Peter Canning

  “What do we have, gentlemen?” Daniel says.

  I give him the report, and he joins in, passing me the drugs, then helping us get the patient on a board and out to the ambulance. He comes with me for the ride to the hospital. “You’re shaking,” he says to me as I’m doing compressions and he’s ventilating. Normally I ventilate, and whoever comes with me does the compressions, but he is the chief paramedic and has earned the right to sit, while I pump up and down.

  “I haven’t eaten anything yet today. Been on the go. I shake when I don’t eat.” I will not tell him that I am shaking because he makes me nervous, that I do not want to fail in front of him.

  “He could probably use another line. Mind if I do an EJ?” he asks.

  “Go right ahead.”

  He pops a fourteen in the large external jugular vein that runs alongside the man’s neck. “A little more fluid can’t hurt. I haven’t done one for a while. I was hoping to get the tube.”

  “Beat you to it, I’m afraid.”

  “You did a good job.”

  “Thanks.”

  I keep pumping away on his chest, pausing only to slam more epi and atropine in the line. The man is not going to make it, and while our talk may be light, we give our best and never stop trying. The effort is as much for his family and for those who will lie on this same ambulance stretcher in the future—for society—as for his departed soul. It is the assurance that people will get the best effort, and that is a comforting thing for all of us.

  But as always in this work, there are those calls that keep you humble. I respond to Newington for a woman not feeling well. She is lying on her bed, having a hard time breathing. Her husband says she’s been sick for a couple of weeks, coughing up yellow phlegm. I am thinking pneumonia. Her skin is warm. I listen to her lungs. She has some wheezes. I give her a breathing treatment. Maybe she has bad COPD. Her pressure is 138. Her pulse 132. The Newington volunteers arrive and we carry her down the stairs on a chair. In the back I put in a line and we take off to the hospital. Her pulse is now 140. Her pressure 128 by palpation. I listen again to her lungs and they are filling with fluid. Though she has no history of heart or lung problems, I am thinking heart failure now. I give her some Lasix, start another treatment, and give her some baby aspirin on the outside chance she is having an MI. She has no chest pain, but she just can’t seem to get a breath. Her pulse goes up to 150 with no ectopy. She starts to feel clammy. Nothing I am doing is working. Her pressure is falling. When we hit the ED doors, her heart is going at 157 on the monitor and she is ice cold. They rush her into Room 14. I give my report and the doctor calls for a chest X ray. When I am done writing my report, I stop by the room and see them doing CPR on her. They revive her. She is in third-degree heart block. She codes again. When I come back with another patient an hour later, she is dead. The doctor thinks it might have been a pulmonary embolus. She shows me the X rays, which I cannot decipher, and the twelve lead EKGs which show minor changes in leads I and III, possibly indicative of an embolus. I ask her what more I could have done. She says not much. I think I could have been quicker. An autopsy later shows a massive MI. I could have given nitro, not that it would have helped. And besides, by the time her lungs started filling up with fluid, her pressure was starting to crash. They said her arteries were closed shut. Still, it was not a call to boast about. Her family called for help and I couldn’t provide it. She was alive when we were there and she didn’t make it.

  Every few months I get together for lunch with old Weicker friends. They get me to tell my stories, and we have some good laughs. I tell them about the three-hundred-pound guy with the stomachache who ate the kielbasa that had been sitting out on his dresser for three days in one-hundred-degree heat. I tell them about the woman who claimed her boyfriend had assaulted her, and when I went to touch the strangle marks on her neck, pink makeup came off on my gloves. “Tell that one about shocking the guy,” my friend Rick says. “The one where his last words are ‘You guys are killing me.’ ”

  I tell it, although reluctantly.

  The talk of Weicker running for president has died down. A poll in Connecticut found only 17 percent of the state’s voters thought he should run. The other day there was an item on the news about his supplementing his six-figure income as president of a health research firm by taking a sixty-thousand-dollar-a-year position as a member of the board of directors of US Tobacco, a Connecticut company whose main product is chewing tobacco. The pundits on a local Connecticut-politics TV show say this effectively shows he won’t run for president because being a health advocate and taking tobacco money makes him look like a hypocrite. One of them says Weicker doesn’t see anything wrong with it, and knowing Weicker I agree with the pundit’s observation. But I don’t see how anyone other than Weicker could see it differently. There is a price to everything, and the sixty-grand pocket change for attending a monthly meeting doesn’t come for free. Tobacco and health care don’t go together. Tobacco kills.

  I respond to a cardiac arrest. A fifty-year-old man has collapsed under a large table in his law office. He is lying on his side, his face cyanotic, blood dripping down the side of his mouth from biting his tongue. I turn him on his back. He is not breathing. I rip his shirt open and attach the defib pads to his chest. He’s in v-fib. I shock him at 200 J. He’s still in v-fib. I hit him at 300 J. He goes asystole, but ten seconds later is back in v-fib. I shock him the third time at 360 J. This time he stays flat line. My partner, Jim Devaney, pulls him out from under the table. I lie on my stomach and insert the laryngoscope blade. My muddy boots knock over a pile of typed reports on the floor. I search for the cords. Jim applies pressure on the throat, which drops the cords down into view. I pass the tube, then push an epi and an atropine down the tube, but get no change in rhythm. The fire department arrives and helps us get the guy out onto the stretcher. They do compressions as we wheel him through the office past his horrified coworkers. In the back of the ambulance I get an IV line and push more epi and atropine, while Jim manages the airway and a firefighter drives. I call Saint Francis. They have an ER tech out front to help us unload. In the cardiac room Dr. Reidecker checks lung sounds and orders another round of drugs. Because the man is only fifty, they work him a little longer, but there is no change, and she reluctantly calls him. She tells us we did a good job and thanks us.

  We go out in the hallway and thank the firefighters. Then we head back to the ambulance to begin the cleanup. In the middle of the floor is a pack of Camels—the dead guy’s smokes. They must have fallen out of his shirt pocket. I think about bringing them into the cardiac room and leaving them with the paperwork but wonder what his wife will think when she sees them and imagine them heightening her trauma and grief. I toss them in the trash where they belong.

  Life is short. You have to take care of yourself and the people you love. I need to be more careful myself. I don’t always wear gloves when I do IVs. Sometimes I lay the bloody needle on the bench, not able to pivot and drop it in the sharps box during the heat of the call. “Sharp on the bench,” I call to my partner so he knows to be careful if I forget to dispose of it before getting to the hospital.

  I respond to a woman having an allergic reaction. When we arrive she is lying on the floor gasping for breath. I try for an IV line but miss. I set the needle down. Her breathing is so bad I hold off on the line and jump right to giving her some epinephrine subcutaneously. It improves her breathing slightly, but I still want to get her moving down to the ambulance. As my partner Cary Gray readies the stair chair, I reach to pick up the IV wrappers and feel a sharp stab in my finger. I have stuck myself with the discarded needle. I swear and stare at the blood seeping out of the wound. We get the woman downstairs. Eric Brescia, another medic backing us up on the call, gets the IV line while I draw up some Benadryl. The woman is fine by the time we get her to the hospital. I clean my wound, then contact the office. I have to be seen at the hospital, and the next day I go to Industrial Health Care to have blood w
ork drawn and get two gamma globulin shots in my butt. I need to be more careful. The risks out here are real. It is not a playground.

  I look at myself in the mirror as I wash my hands after a Room 1 trauma from a motor vehicle accident. I note a crease in my forehead, tiny lines coming at the corners of the eyes. Thirty-seven years old. Is this what I really want to be doing? Going out into the street to battle sickness, injury, danger, the unknown? Yes, it is. I flash myself a smile. A boyish thirty-seven, I think. I’m ready for the next call.

  I try now to pick up as many overtime shifts as I can. While I am working, when I am doing calls, I feel alive. Sitting here in my apartment, I feel like I am just waiting to go back out there. There is definitely a hormonal change, a feeling of withdrawal I undergo in my days off. Writing helps ease it. When I’m writing well, I feel alive then, too. I want to write about what we do out on the street, get it right, make it permanent, make it lasting, give it meaning outside of the dark apartment or garbage-strewn back street where it occurred, meaning outside of our own mortal lives. I want the public to rise up and honor those who have toiled on these streets for years before me—the Doug Savellis, Daniel and Paulette Taubers, Jack Gartleys, John Andersons, and Michelle Gordons—as well as those hitting the streets for the first time, and those who will come in the future.

  Whenever Weicker was given an award—a bright shiny plaque—he’d thank his audience, saying all the appropriate things, and then toss the plaque in the backseat of his car as we drove away. Later I’d retrieve it and put it into the attic with all the other dusty awards that had been lavished on him but held no real worth. At our Christmas banquet, Joe Stefano gets the award for Paramedic of the Year. Kim Butler gets EMT of the Year. Rick Domina, who was nominated by his longtime partner, gets the “Above and Beyond” Award for the consistent quality of his care and the respect with which he treats his patients. Meg Domina gets a special award for her heroism in trying to save the construction worker crushed and drowned in the ditch accident. She gives a gracious speech, in which she shares the award with Mike Lambert and all the others who were there at the scene. Each one of these awards given to my coworkers will hang in honored places in their homes.

  * * *

  I read an article about how the average head of a corporation makes two hundred times what the average employee makes, and the trend is only getting worse. This angers me. Why shouldn’t paramedics make the same amount as bank presidents, defense lawyers, and teachers? There aren’t many jobs where you routinely put your life, your body, your health at risk for people you don’t even know. It ought to be worth more. But I know the world doesn’t work that way.

  We’re downtown one night, hanging out by the Civic Center with the crew of 463. A side street is blocked off. A giant klieg light pans the sky. There is a podium in front of one of the new city buses that is painted with various sights of Hartford. There obviously has been some kind of ceremony here earlier in the evening. The four of us, in uniform, carrying our radios, approach. Three neatly groomed men in expensive suits stand in front of the podium talking. The paramedic with me asks them, “Hey, what’s going on here tonight? Do you know?” One man turns and gives him an icy stare that says, “Can’t you see I’m talking with someone, plebeian?” then returns to his conversation. The paramedic shrugs, and we walk off.

  In another couple of months, while carrying someone’s family member, the paramedic, a veteran of these streets, will injure his back, requiring major surgery, and likely ending his career.

  Seizure

  Glenn has gone off to paramedic school at Yale, so Art Gasparrini is my new full-time partner. Art is fifty-three, a former salesman, race-car driver, volunteer fireman, and weekend nudist, who has changed shifts to have his Fridays through Mondays off so he and his wife can enjoy the Rhode Island sun at their campground. Though he carries a bottle of ibuprofen with him, he looks in his middle forties and has the strength of a twenty-five-year-old. I have been with him just a few weeks, and we have been getting hammered, including five cardiac arrests in a six-day period.

  It is the end of our shift and the end of our week. We’re outside the area nine office on Farmington Avenue waiting for our relief to come out and replace us. We normally do crew shifts back at the home base in West Hartford, but it has been busy in the city, and they need to keep cars on line. Anticipating our relief, I have put my personal gear into my blue backpack. I’ve opened up the narcotics box and signed for the narcs so all I will have to do is hand the keys over to Jackie Lackey, the night medic, when she arrives.

  While we have been doing a lot of tough calls lately, today—while high in volume—has been low in challenge. This morning I did two simple ALS calls—a general weakness and a stroke—but I missed my IVs on both of them. This afternoon has been all BLS—minor motor vehicle accidents, kids with runny noses. I am still kicking myself for missing the IVs. Every now and then I find I don’t concentrate, and then when I miss, I rush the second one in anger at myself for missing the first. It keeps me humble, but I don’t want to be humble.

  “Four-five-one. Four-five one, answer the radio. Please.”

  Art grabs the microphone. “We’re trying to answer if you’d give us a second.”

  “Four-five-one, we have a five-year-old boy not breathing. Priority one. Chadwick Street.”

  “Four-five-one copy,” Art says. Then to me, “Where’s Chadwick Street?”

  I flip quickly through the Arrow guide, which lists cross streets. “Head over to New Park.”

  He flips on the lights, I strap on my shoulder belt, and we pull out.

  We’re crossing Park Street when the dispatcher updates us.

  “Four-five-one, we’ve got a callback. They’re panicking. He’s still not breathing.”

  “Great,” I mutter. I get my stethoscope and trauma shears out of my backpack and set them on the dashboard along with a pair of latex gloves. I glance back at the map and tell Art, “It should be the second left up here.”

  It is an apartment building on a narrow street. We stop quickly out front. I put the scope over my neck, tuck the scissors in my back pocket, and grab the gloves. From the side door, I grab the monitor and blue bag, which I hand to Art. “Let’s see what we got.”

  We enter the building. From the stairwell I hear someone calling. “Up here, up here, hurry!” A fat woman in her twenties is crying and looks panic-stricken. I see several small children all with fear in their eyes. They run up the stairs with me as if their speed will hurry me along. “Fuck,” I mutter under my breath, knowing what I am about to find will not be good. The door to the apartment on the third floor is open. More children stand in the doorway. A boy about ten is jumping up and down and waving us in. He is crying. “It’s my brother. It’s my brother, you have to help him.”

  I am directed into the bedroom, where there is a big mattress on the floor, and I see a body on its side. The light is low. I see his face. It is bluish gray. I surge forward, dropping the bag on the floor, and I grab two hands around the boy’s chest. He is cool and clammy. As I touch him vomit spits from his mouth. I’m thinking this kid is dead. But I feel a heartbeat, his little heart banging away in his chest between my hands. “He’s got a heartbeat!” I call out to Art, who has been on my heels. “Get the oxygen out.”

  The boy vomits again. He is completely unresponsive and barely breathing.

  Art hands me a nonrebreather hooked up to the tank.

  “What happened?” I ask, fastening on the mask and keeping him on his side.

  “He just started shaking, then he stopped breathing and went blue. I called nine-one-one. Did I do all right? Is he going to live? Is he going to live?”

  “Does he have a seizure history? Has he done this before?”

  “Not like this.”

  “Has he ever had a seizure before?”

  “In Colombia.”

  “Does he take medication?”

  “He left it in Colombia.”

  “Wh
o are you?” I ask the older woman who is crying and holding her hand to her mouth.

  “The baby-sitter.”

  “What hospital does he go to?”

  “None. They just got here.”

  “Where are the parents?”

  “Out.”

  I listen to his lungs and, hearing some junk, fear he may have aspirated.

  Just then he starts seizing again. It starts with his head and neck, then his arms, and then his whole body is shaking.

  “What can I do for you?” Art says. “You want another car to help us?”

  “No, just take our equipment down and set up the stretcher. We’ll work him down there. I’ll carry him.”

  He needs Valium to stop the seizure, and to get that he needs an IV. He doesn’t look like he has any veins I can see in here and the light is too dim. Plus I have to call medical control for permission to give the Valium, which is locked down in the ambulance. “We’ll work him down there.”

  I lift him in my arms. He is slippery and covered with vomit and urine. His body shakes forcefully, and he is turning blue despite the oxygen around his face. When someone seizes they frequently stop breathing. “Carry the tank,” I say to the babysitter, “and walk with me.”

  “Can I go with you? Can I go with you?” his brother says, running half circles around me.

  “Sure,” I say, “but you have to come now.”

  “Okay, okay. Is he going to be all right?”

  “Yeah,” I say, worried that I might be lying. “You did well, but we have some more taking care of to do.”