Paramedic

by Peter Canning

  I walk carefully down the stairs.

  Art has the stretcher set up and a bag of saline spiked. I set the kid down on the stretcher—he is still seizing—and toss Art my narcotics keys.

  I strap a tourniquet around his arm, then reach up to turn the interior lights on high, while Art unlocks the narc box and takes out the sealed package of drugs.

  I see no veins, only tanned skin. He is a fat kid. I feel with my fingers, searching for the softness of a vein below the surface. Nothing in the hand or the forearm. In the bend of the elbow, I think I feel something. I touch lightly, feeling for the springiness of a vein and not the tautness of a tendon. I think I feel one. I close my eyes and touch softly. Yes. It’s there. I swipe the spot with an alcohol wipe, take out a twenty-gauge needle, and hold it over the skin. My hand is unwavering. I focus on what I am doing. I try to become one with the vein. I go in. Flashback. Sweet Jesus. Thank you, Lord. I watch the blood slowly flow back into the chamber. Now I have to advance the catheter. It is an easy spot to blow it. If I’m not in all the way I can shear the vein when I advance. I can burst through the other side or run up against a valve. Please. Oh please. Let me advance. I push forward with the tip of my finger. The catheter slides in smoothly over the needle, going in up to the hub. Perfect. “Line,” I say to Art. He hands me the line and I plug it in. “Open it up. How’s it running?”

  “Like gangbusters,” he says.

  I grab the portable radio. “C-Med North Central four-five-one Alpha one requesting a patch to SF Hospital with a doctor.”

  “Med eight.”

  As I’m waiting to be connected, Jackie Lackey and Janice Mihalak, our relief, arrive. “You need anything?” Jackie asks.

  “Yeah, someone to drive.”

  Janice gets in and starts us on a two.

  “This is SF go ahead.”

  “SF, this is four-five-one Alpha one-nine-nine. We’re on scene with a five-year-old in status epilepticus. History of seizures, but he has not been taking his medication. Vitals. We’ve got him on oxygen and an IV in place. We found him cyanotic and vomiting with question of aspiration. He’s been going again now about five minutes. I’d like to give him one milligram of Valium.”

  “Have you done a glucose?”

  “No, but I’m doing that now.” I nod to Art to do a glucose off the needle.

  “If he’s over one hundred, give up to three milligrams.”

  “Okay up to three, I’ll push it slow.”

  I break open the seal and take out the Valium, which comes in a preloaded two cubic centimeter syringe. I use a one cubic centimeter syringe to draw three milligrams out of the back of the syringe. My hands are now shaking. I have trouble sticking the needle into the hub on the line.

  “Here goes,” I say to Art.

  I push one cubic centimeter, but the seizing continues. I push the second and third cubic centimeter, and he stops cold. His entire body relaxes.

  “It worked,” Art says. “How ’bout that?”

  I let out my breath, then a moment later I say, “Art …”

  “What?”

  I’m staring at the kid’s chest. “Art, get the ambu-bag out. He’s not breathing.”

  “Where is it?”

  “In the pedi box.”

  Valium is a respiratory depressant, and a paramedic has to be prepared to assist with ventilations if the breathing goes down too low. Art gives me the ambu-bag and I hold it sealed tight over the boy’s nose and mouth. Art hooks it to the in-house oxygen and cranks it full. I squeeze the bag, and air rushing into the boy’s lungs causes his chest to rise. The bag fills again, and as the chest settles I squeeze another breath into him.

  He begins to pink up. His pulse SAT reads 100 percent.

  At the hospital we wheel him in still bagging him, but he has begun to breathe again on his own. In the code room we transfer him to the hospital gurney, and I give my report to the doctors and nurses. “He was cyanotic when we found him, vomiting, question aspiration upper right lobe. Best we can tell, he seized for five or six minutes, was out for five, then started back up again. I gave him three of Valium, which knocked out his respiratory drive along with the seizing. Blood sugar was one-sixty, by the way. He’s starting to breathe on his own now. Sketchy history. Just moved here from Colombia. Apparently has a seizure history, but not taking any meds now.”

  They keep bagging him. His pulse SAT is 100 percent. When he starts to seize again, they give him some more Valium, then intubate him.

  I go out to the ambulance where Art is cleaning up.

  We look at each other. Both of us are drenched with sweat. I also have vomit and urine on me.

  “Good work,” he says.

  “Thanks, it went well. Sorry I was giving you two and three orders at the same time. You were great.”

  “That’s all right, we got the job done. It went well.”

  “You know,” I confess to Art, “when I walked in that room, I thought that kid was dead.”

  He laughs. “Me, too. He looked dead.”

  “I thought, oh, fuck, this kid is dead.”

  “He was blue.”

  “He was. But I felt his little heart beating and said thank you, God.”

  We laugh nervously grateful, relieved, exhausted.

  The Meaning of Work

  My friend Susan Swift was the best speechwriter Weicker ever had. She sometimes put into his speeches the Martin Luther King, Jr., quote about excellence: “If it falls your lot to be a street sweeper, sweep streets like Michelangelo painted pictures, like Shakespeare wrote poetry, like Beethoven composed music; sweep streets so well that all the host of Heaven and earth will have to pause and say, ‘Here lived a great sweeper, who did his job well.’ ”

  You have to be able to hold your head up. It is hard sometimes. I’ve worked some jobs where I wondered what the point was other than to bring in a paycheck. I felt my life was passing me by and that nothing I did really made any difference. Worse, I knew I wasn’t working hard. I had no pride in what I did. I felt that way a good part of the time when I was working at the state health department. I had some good ideas, but not the energy or patience to apply my all to it. I was ashamed of myself. Some afternoons, I’d put my beeper on and go play golf. It seemed only the generous paycheck and the occasional chance to write a big speech for Weicker kept me on as long as they did.

  One of my favorite jobs was being a cabdriver in Alexandria, Virginia. After Weicker won in 1982, I quit to write and see the world. Anchored for a while by a reunion with my college sweetheart, whom I had broken up with after living together for a year in Washington following graduation, I stayed in the area. The cab job was great. I arose at five-thirty and was in my cab by six. I lived ten miles south of Alexandria and usually got a call to take someone into the city, pocketing ten bucks just for driving in. The way cab driving worked was I paid thirty-four bucks a day to the cab owner and pocketed everything I took in. By noon, I had paid my car rent and gas for the day. Every hour I worked was more dough in my pocket. Sundays were free if I paid the other six days. I worked hard, and every night came home hot and tired with pockets full of bills and change. I met interesting people and had access to lives and areas that were denied the average person. One hour I was helping an old woman carry her groceries into her row house, where her old man sat at the table in his T-shirt drinking vodka. Her son scowled at them both before heading out to the streets to hang with his gang on the corner. The next fare I was dropping off a man in a suit and briefcase at the White House gates.

  But driving a cab didn’t quite have the status of being a Senate aide, and my hours were long, and my girlfriend and I had problems, so soon I was on my way west, riding a bus to Iowa with only a sleeping bag, a knapsack, and a portable typewriter. When I was in college I had a writing teacher named James Alan McPherson, who as a young man wrote a book of short stories called Hue and Cry, which came out in 1969 and was greatly praised by Ralph Ellison. He later won the Pulitzer Prize for
his second book of stories, Elbow Room. I spent a lot of time talking to him about life and writing. He told me writing was a noble way to live, and I felt that that was true, and his words stuck with me. He was out in Iowa now, so it was sort of a holy place for me, a journey I needed to make to find out about myself. I got a job working in a restaurant kitchen as a line cook, and I fancied myself like Sir Gareth in King Arthur, who works in the kitchens of Camelot for a year before becoming a knight.

  Iowa City was a place where being a writer gave you a special status, which was nice for a while but could make you forget about the world at large and being a member of it. I have always liked new experiences and places. After a couple of years in Iowa I moved up to Saint Paul with my new girlfriend, Barbara, and her fourteen-year-old son, Jason, and we lived there together while I worked in factories and on assembly lines. I wanted to be like Joe Magarac—the man of steel—the greatest worker ever who one day saved his plant by stepping into the furnace and melting himself down to the finest quality steel. When I was working the line at a meat-packing plant, my job was to tear racks of barbecued-cooked beef ribs off a tree—a huge two-tiered cage that hung on rollers from the ceiling. Each layer held fifty hooks with two racks of beef ribs on each hook. I’d pull them out by the hooks, tear the ribs off the hooks, and throw them onto a table, where my partner, Nacho Soto, cut them in two with a huge knife. A woman then dipped the ribs in more sauce and dropped them into the plastic bags that five other workers moving in a circle would open, then close, and drop on the line for heat sealing and labeling by other workers before grabbing another long plastic bag. The ribs continued down the line, getting sealed, boxed, weighed, stacked, and carted out to the waiting trucks. The women complained that Nacho and I, who wore yellow raincoats and were covered in barbecue sauce, worked too fast. “Que dicen ellas?” Nacho would say to me in Spanish. “What are they saying?” I would tell him they said we were the best workers ever and when we died they would put us into the meat and sell us. He would laugh. “En la carne con nosotros,” I would say. “Into the meat for us.”

  On the way home, I would be afraid to go into the liquor store because I had so much barbecue sauce on me—in my hair and on my jeans and boots—they would think I murdered someone. On payday I used to get a twelve-pack of Grain Belt beer for $2.99, and at home, tired and beat, Barbara and I would drink and listen to music and dance till exhausted. Then we’d go to bed and exhaust ourselves some more. Even though I was making four dollars an hour, I felt like I had worth.

  Still, time was pressing in on me and I didn’t know where I—or we—were going. Weicker was coming up for election again soon, and I thought it might be my last chance to get on board with him. So I left Saint Paul and I went back to work for him, writing speeches and statements and sharing an office with Susan that was right on the corner of Constitution Avenue and C Street. Our window looked out on the capitol building. We ate lunch together every day and had good conversations. We helped each other with our writing. Sometimes we made fun of our boss, as all underlings do, but we admired him deeply and loved our jobs. When I went up to work on the campaign, Barbara moved east and we lived in an apartment in Springfield, though I didn’t see her much with all the time I spent on the campaign. Losing was tough. It was unexpected, and it filled me with guilt. If only I had worked harder, I alone might have been able to turn things around. It was only five thousand votes out of a million cast. Something I could have done better would have made a difference.

  Having your ass kicked gives you perspective when you get back on top. When Weicker won the governorship, I knew dog days would come again, so I enjoyed the victory for what it was and lorded it over no one. Today doing 911 calls—lugging my gear and stretcher—sometimes in and out of buildings where I used to preside in meetings doesn’t bother me. I am no less who I was then, maybe I am even more so. I like to think that at thirty-seven, having earned my scars in life, work, and love, I can still stand as straight as my tired back will let me. I’ve screwed up before and will again, but on most days I think I’m doing okay.

  Around six every night it gets very busy. We clear the hospital and are the only ambulance available in the city, and the dispatcher says to us, “You are covering the world.”

  I think I may not be a senator, or the right fielder for the Red Sox, or a rich man, but here I am covering the world. And no matter who gets sick, whether a poor man in the projects or the governor in his mansion, when they call for help, I will come through the door. A grandfather feels a twinge in his heart, a young man hits the brakes hard to avoid another car, a toddler climbs out on the window ledge. But thankfully, tonight, the twinge passes, the cars do not strike, the toddler crawls back inside and finds the warm arms of his mother.

  The dispatcher tells us to come on in for the crew change. Shawn Kinkade, Victoria DeNino, and Adam Waltman are in. Ransford Smith is next in line after us. Alan Goodman, Annette O’Callaghan, Joe Stefano, and Shirley Lessard are already on the road. At the base, I hand my narc keys over to Adam Fleit, who will take 451. The changing of the watch.

  As I look around at my coworkers winding down after a long day or readying for the night, I think of all the medics I have known—the ones here and others across the state. The Tom Harpers, John Pelazzas, Chris Huppes, Jose Matises, Butch Fetzers, and others—they are not names well known to the public, but they are every bit as worthy of respect as the mayor, the schoolteacher, the policeman, the hometown sports hero, or the U.S. senator marching in the Main Street parade. You may never need them, but they are there looking out for you, in every city and town.

  “Have a safe night,” I say to Adam.

  “Thanks. See you in the morning,” he says.

  As I drive home, my headlights illuminating the road, I think about my day. I took an expectant mother, whose water had already broken, to the hospital. In my arms I carried a man dying of cancer down two flights of narrow stairs to our waiting stretcher. I gave a man in his forties two nitro to relieve the pressure in his chest, gave a breathing treatment to a woman with asthma, and checked out a four-year-old’s cut elbow while joking with his multiple brothers and sisters, ages three, five, six, eight, nine, and ten. Where was number seven? I asked. They giggled and said there was none. Come out, come out, wherever you are, I said. And they all laughed.

  When I get home I park and walk into my building and down the long hall to my apartment. Behind the door I can smell chicken cooking. The room is warm. I set my briefcase on the table and say hello to Michelle, who is in the bedroom sitting at the desk studying physiology for her PA class. I ask her about her day—she did well on the test that she had been worried about—and she asks me about mine. I had a full day, I say, and not a bad one. I get a beer and put on the stereo. The Grateful Dead plays a slow country song called “Brown-Eyed Woman” that has a wonderful line in it about the bottle being dusty, but the liquor being clean.

  I sit down on the couch and take my boots off. I enjoy my beer.

  To all my partners, past, present, and future.

  And to my best friends, Barbara Lynne

  Danley, Ross Wheeler, and Brad Bailey.

  Your faith in me means the world.

  “Those friends thou hast,

  And their adoption tried,

  Grapple them to thy soul

  With hoops of steel.”

  — WILLIAM SHAKESPEARE

  By Peter Canning

  Published by The Random House Publishing Group

  PARAMEDIC: On the Front Lines of Medicine

  RESCUE 471: A Paramedic’s Stories

  My name is Peter Canning. I am a paramedic who responds to 911 calls in the city of Hartford and surrounding towns in Connecticut. A paramedic is the highest level of emergency medical technician (EMT)—a person capable of performing advanced medical assessment and treatment in the field, including endotracheal intubation, cardiac defibrillation, and the administration of over thirty emergency medications such as morphine and
epinephrine. In 1995 at the age of thirty-six I left my job as a speechwriter and a top health department aide to Connecticut Governor Lowell P. Weicker to work as a paramedic on the city streets. The book is about my first year on the job as a paramedic, my struggle to make good, the calls I did, the scenes I witnessed, and how I felt about it all. While there are many drawbacks to being a paramedic—the low pay, the danger, respect rarely given but at an arm’s length—it is meaningful work. It challenges you and sometimes rewards you, though often it knocks you down hard. It is about life. The events are true. I’ve changed only a few details and names to protect patient confidentiality. This is my story about finding my place in the world, and it is the story of the patients I met and the city in which they live.