I keep my back to him, not wanting him to see my eyes. “No, it’s okay,” I say. I fight my emotion, and by the time we are out on the street, nothing betrays me.
Body Count
We respond to a shooting. As we approach, an officer radios, “Just have the medic come in.” I know what that means. It is a crime scene and the patient is probably dead. There are at least six police cars parked along the long driveway. I get out and bring the monitor and the in-house bag.
The officer meets me at the door. “He’s been dead for a while. He looks all bled out. You’ll see.”
I walk through the house to the garage. In the garage a shirtless man lies on his side in a fetal position against the door, a shotgun in his hands. He looks to be about thirty. There is a lake of red blood around his head that has grown out in grotesque inlets and coves and dried sticky. His skin color is translucent white. His bare feet are blue-purple where they touch the cold floor. From the kitchen I can hear a woman wailing. He is beyond any attempt at resuscitation. I look at my watch. “Presumed three-fifteen,” I say.
We’re called for an unknown on Hamilton Street. When we arrive an old man meets us on the street. “My wife, she’s in the basement,” he says.
“Which door?” I ask.
“Over there,” he points. “I got up this morning.”
He moves too slowly for us. There is a story he wants to tell us, but I am impatient to get to his wife.
I go through the door and down the basement steps. I see her then, a small tiny lady in her seventies, hanging from a wood beam, her neck bent, a milk carton by her feet. Her skin is cool. I put the monitor on, the leads on her hands and left ankle. She is asystolic. I look at my watch and mark the time.
The man is in the house now. Two officers have arrived, and I have shown them the body. “Is she all right?” the old man asks. “I got up this morning and she had a roll out for me, but she wasn’t at the table.”
“Come sit down over here,” the officer says.
The two women are shaking and crying as we come through the door. In the bathroom lies a man, a bottle of nitro on the floor a few inches from his outstretched hand. He is cool, his jaw is stiff. Down a couple hours. They had gone out shopping.
“I’m sorry,” I say, after I have run the required six-inch strip of asystole for documentation on my run form. I put the strip in my pocket. “I am sorry.”
Tears run down their faces. They are Russian immigrants, in the country just a few months. Husband, brother, provider dead. They wail and tremble.
A truck driver, cold and stiff in the cab of his semi, a needle still in his hand. A sixty-year-old woman on the toilet, her mouth and eyes open staring at the ceiling, her jaw stiff. A young male, naked, lying facedown on the cold cement behind an abandoned building, his chest and head bludgeoned. Others. Many.
I look at my watch and record the times.
I run my strips.
BURNOUT
I just sit the rest of the way wondering what is happening to me.
Booking Off
To book off is to not come to work. People book off for many reasons—they are stressed out and need an unscheduled break, they have tickets to a baseball game, a crisis has arisen in their family, or they are too sick or hungover to get out of bed. I have never booked off. It helps that I work Tuesday, Wednesday, Thursday, seven in the morning to seven at night, and so I have a four-day weekend every week if I choose not to come in for overtime, which is plentiful. Still there have been days when I have thought seriously about booking off, when the last thing I wanted was to be at work. But a job like this, for me, anyway, requires discipline and routine. I fear that if I book off once, then it will be easier to book off the next time. Then I will start to slip, my whole manner will loosen, and I will stop caring. It may sound silly, but being dependable, being able to be counted on when my name is on the book to work, is part of my armor. It protects me from the dangers that are out there. It says nothing can rattle or break me. It makes me strong. It says I like my job even when it is weighing me down.
Dead-icated
A new dispatch system is in place in Hartford. The standard practice has been for all cars to sign on with the Hartford Police dispatcher in the morning, giving the dispatcher the car number and the area of town they will be covering. HPD has now informed the company they want six “dedicated cars”: two advanced life support (ALS) cars, and four basic life support (BLS) cars that go on line with them in the morning, stay under their control all day, and cannot be yanked to do transfers or calls in other towns. Sounds good to them, will make their lives easier. The problem is not apparent to them but soon becomes very apparent to us.
I am one of the on-line dedicated cars. I’m stationed in the north of town. The other five cars are all on calls. A call for a difficulty breathing comes in two blocks from Hartford Hospital—a five-minute response during rush hour. Two off-line paramedic cars are at Hartford Hospital. They are not allowed to respond. I clench the dashboard as Arthur hurls us across town, air horn slamming. The patient, who is cyanotic, his lungs filling with fluid, waits anxiously. I get an IV, put him on oxygen, and give 80 milligrams of Lasix, two nitros, and a Ventolin treatment. At Hartford Hospital, they intubate the patient.
I am an off-line paramedic sitting at Saint Francis, talking with Shawn Kinkade, another off-line paramedic, when the call goes out for chest pain on Homestead Avenue, two blocks away, and HPD dispatches a basic ambulance from Hartford to respond. We are not allowed to go to the call, even though the patient has chest pain and needs a paramedic who can arrive five minutes earlier than the basic, who has only oxygen for the patient. “Can we head over that way?” I ask dispatch.
“No, I want you to take one out of Saint Fran radiology going back to Alexandria Manor.” Shawn is dispatched to pick up Mrs. Greenberg at Mount Sinai dialysis. When I come down with our patient, we see the basic crew bringing the patient in with another BLS crew, CPR in progress. The patient is blue from the neck up, vomit around his mouth and on the stretcher. Sixty-two years old. No medic available.
“This is ridiculous,” I say to Shawn later when I tell him the chest pain turned out to be a code. “I don’t see how they can let this continue.”
Shawn just shakes his head. He is dispirited. “Nobody cares,” he says.
The world is turned upside down. It is a surreal system. Basics doing codes; medics doing transfers.
The company is reluctant to dedicate more medics because we need to be able to pull the medics off-line, if we have to meet contracts in other towns. If a 911 call goes off in Newington, we are contractually bound to send another paramedic car to Newington. If all the medics are dedicated to Hartford, they can’t go to Newington or Windsor or West Hartford. So while the company is supposedly keeping us off-line to save us for the contracted towns because all the basic cars are now on-line, the medics end up doing the most basic nonemergency transfer calls.
The dispatching system is a disaster. Cars pass each other going lights and sirens to opposite ends of town. The Hartford Police Dispatch is dramatically understaffed. The lone dispatcher allocated to EMS is unable to interview 911 callers for any meaningful length of time; consequently we are sent priority one for a difficulty breathing that turns out to be a four-year-old boy who has had a runny nose for two weeks and his mom wants to take him to the doctor, or for a severe bleeding that turns out to be a twenty-four-year-old man who cut himself shaving and wants a Band-Aid. Often we are sent to calls and told by the caller on our arrival that they didn’t want an ambulance, they just wanted the police. Some suspect HPD is using us to check out calls because all the police officers on duty are tied up on other calls. It is not uncommon for an EMS crew to be sent for a head injury or cut hand and walk in unaware to a full-blown assault in progress, and then to be unable to raise the police on the portable radio because the EMS dispatcher is on the phone taking another 911 call. Chris Carcia and Mike Carl call a “10-0,” crew in distress, when a patien
t turns on them. Three ambulance crews respond before the first police officer can get there. Fortunately, Mike has taken the man down, and is pinning him, arm behind his back, face pressed against the carpet.
We are told our company has offered to take over all EMS dispatching for the city. From the company’s point of view, it makes sense. Unlike the police dispatchers, our dispatchers are all medically trained, and having the ability to control our entire fleet—at times over twenty cars—rather than just the six dedicated cars, will improve response time and get paramedics to the calls where they are truly needed. HPD wants no part of the offer. They don’t trust the company to watch over itself. While they need a way to hold us accountable, there has to be a better system. The company is leery of upsetting HPD because while we have the state designated Public Service Area (PSA), giving us the legal right to respond to all 911 calls, Hartford can attempt to take the designation from us, and the rumor is they want to give part of the town to another company with political connections. We can’t afford to upset them, or so the story goes. One day there are no medics on-line. The company puts two Intermediate cars on to meet the ALS requirements. Intermediates, while called ALS, are only able to do IVs and insert a combi-tube in a nonbreathing patient, an airway adjunct not as effective as an endotracheal tube. They cannot give meds and do not even carry semiautomatic defibrillators.
Nobody thinks the system will last, but week after week it is still in place. At least the company, at the EMTs’ prodding, abandons the Intermediates and replaces them with two medic cars. I get on-line once a week, while the rest of the days are a mix of nursing home emergencies, transfers, and an occasional 911 in a neighboring town or an intercept with a volunteer service. Some days are all transfers.
Arthur and I are sent to pick up Mrs. Greenberg at her home in an exclusive section of West Hartford. The maid meets us at the door and leads us down a hallway with gold-framed paintings and marble statues on teak tables. In the back library we find Mrs. Greenberg sitting in a wheelchair, reading a book, Death and Suffering. She has wrinkled skin and dark suspicious eyes. She is probably seventy.
“Who are you? You’re new. I’ve never seen you before.”
“Well,” Arthur says, “I’ve worked here for seven years, my partner for three. We’ve never seen you before.”
“Well, you’re new to me. I don’t like it when they send new people.”
“Well, we go where we’re sent,” Arthur says. “We’re not allowed to choose.”
“You know how to get there?”
“Yes.”
We lower the stretcher, move it next to the wheelchair.
“I’ll get her arms, you get her legs,” I say to Arthur.
“What are you doing?” she says. “That’s not how the others do it.”
“This is how we do it,” I say.
I reach under her arms from the back and grasp her forearms, while Arthur holds her under her legs. We lift her up and over to the stretcher.
“Ow,” she says. “You’re hurting me. Ow! Stop.”
She is already on our stretcher now.
“I’m very sorry,” I say.
“You hurt me.”
“I’m sorry. I didn’t mean to. I don’t like to hurt people. I try to avoid hurting people.”
“Well, you hurt me. It still hurts.”
“Like I said, I’m very sorry.”
“I told you not to hurt me. I don’t like new people.”
“Ma’am. I have apologized three times, I don’t know what else I can do.”
“Make it stop hurting.”
I nod and say nothing. Arthur laughs at me as we wheel her out of the house and carry her down the four front steps. I smile at Arthur as we load her into the ambulance, then I hold the door open for him to get in back with her. I’m driving.
All the way to the dialysis center, I hear her in the back. “He hurt me. He’s so strong. I thought he was going to break my arm, that big terrible man, he hurt me.” Arthur apologizes again and again. On the radio calls go out. Gunshot, asthma, chest pain. BLS units responding. All priority one. I turn off the HPD radio. I don’t even want to hear it.
One day Arthur and I do eight transfers in a row without a break.
At two in the afternoon we clear Hartford dialysis, and Arthur asks on the radio, “Can we get a one-oh-three,” meaning a lunch break.
“No, take one out of Hartford ER, going to Salmon Brook in Glastonbury, no specials, then you can get a bite.”
Arthur starts to fume. I see his face turn red, he unleashes a stream of swear words, then grabs the mike, and says, “Yeah, maybe we can get a tray!” then slams the mike down.
He’s angry, but I am laughing. And I will learn that all over the city, medics and their partners are rolling in their seats. “Did you hear what Arthur said? ‘Maybe we can get a tray.’ ”
Busting our butts all day long and only being able to eat by begging a cafeteria tray of food from a nursing home kitchen.
It kills me. “That was good, Arthur, ‘Maybe we can get a tray.’ That was funny. That was really funny.”
“Fucking dispatch,” Arthur says.
The next week we are sent to a nursing home in Bloomfield to take a nonverbal ninety-year-old patient with Alzheimer’s and two broken legs to her doctor’s office in Hartford. She is on oxygen, breathing about twenty-eight breaths a minute. She looks like she is about to expire. We get to the doctor’s office, but they have no place to put her and no oxygen, so we have to wait there with her. They say they will try to hurry things along for us, and rather than make us wait in the waiting room with the other twenty patients, they let us wheel her into a small examining room, where we sit with her for two hours, reading magazines. I haven’t brought the HPD portable, which is good because I would be getting annoyed at all the calls going out to basic units, all the cries for medics. I sit by the window, watch the rain pour down, and hear an ambulance wail past on the street below. I read a Scientific American about gamma rays from distant galaxies blowing up. I read a Sports Illustrated article about playground legends. Arthur reads a car magazine. “Oh, my God,” Arthur says.
“What?”
“Nothing, I just wanted to make sure she was still breathing.”
I look at her. She is still plugging away.
I ask how the O2 is.
“Another hour and we’ll have to go get a spare tank.”
Finally, we take her across the hall to X ray, where Arthur is recruited to wear an iron apron and hold the lady’s legs while they take X rays.
I turned down the offer, volunteering Arthur because he already has his share of kids. “I’ll be across the hall,” I say.
“Four-seven-one,” the company is calling on the portable.
“Four-seven-one.”
“Four-seven-one, how are you doing?”
“We’re in X ray now,” I say cheerfully. “Art’s wearing an iron apron, and holding the patient’s leg in place.”
“Okay,” she says tiredly.
After the X rays are done, we wait another half an hour for the doctor to come in, which he does, bursting into the room, looking at the lady, and grunting to Arthur, who says hello. He examines her, then leaves the room.
“Charismatic guy,” I say.
“Yeah, let’s invite him to the pig roast,” Arthur replies.
He comes back with a cast cutter, and Arthur and the nurse hold the lady’s leg while he uses the saw to cut the cast open. He has a long tie that I keep hoping will get in the way and get sawed in half. He gets the cast off, then uses some bandage scissors to cut the cotton dressing inside. The woman has some nasty decubitus, pressure sores inside, which he wraps with more gauze. Then he puts on a soft splint.
He cuts some of the cast off the other leg, but leaves most of it on. He looks around for his bandage scissors but can’t find them. Arthur offers him his trauma shears, which he takes again with just a grunt, then sets on the table when he is done.
H
e leaves the room again. I pick up the trauma shears and hand them to Arthur. “Thanks for lending them to me,” I say.
“You’re quite welcome, doctor. I’m happy to be of service.”
I spot the bandage scissors on the chair, under the cast cutter, and I am thinking about swiping them or maybe just hiding them when the nurse comes back in to collect all the instruments. The doctor pops his head back in and says, “You can take her to the front window and they’ll schedule a follow-up appointment.”
Okay.
The receptionist asks how a month from today is.
Arthur looks at the lady on the stretcher. We both study her. “I don’t know,” Arthur says.
“She may have bridge that day,” I say.
“Why don’t you call the nursing home?” Arthur asks. “They keep her schedule.”
“Have them call us,” she says.
Arthur nods.
“Can I have one of these pens?” I ask, pointing to the cup of pens with the doctor’s practice on it.
“Go ahead, and take one for a friend,” another receptionist answers.
“I will,” I say, handing one to Arthur. “For you.”
A week later, the pen runs out of ink halfway through a run form.
I am talking with Debbie Haliscak and Greg Berryman about the new citywide EMS protocols. “We need one on houseplant care,” I say.
“I always keep my trauma shears handy,” Greg says, “for clipping the brown leaves before they spread disease.”
“What do you water them with, normal saline or lactated ringers?”
“Normal saline. The lactate makes the leaves droop.”
I tell him about my method of using the nebulizer we use for asthmatics to moisten the leaves.
“I’ll have to try that.… How about epi?” he asks.
“Do not give epi to Venus’s-flytraps,” I say. “I read on the Internet that a medic in New York state lost a finger to a combative plant.”
“Cardiology is hard, but plant care is much more demanding,” Greg says.
Rescue 471 Page 16
