Another medic I respect quits unexpectedly. I meet him for a beer one night and he tells me why he couldn’t go on. “I get called for an unknown. I find the lady—forty years old—lying in bed in her underwear. Nothing’s wrong with her other than her wrist’s sore. She says she’s not ready to go yet. She has to call her sister to come watch her kids, and she’s got to get dressed, and she can’t find her medical card. I said, what do you mean you’re not ready to go. You called nine-one-one. You called nine-one-one! I came here lights and sirens, and you’re not ready to go!” He shakes his head in disbelief. “For this I spent five years of my life, working all kinds of bad hours.” He drinks his beer. “I quit. I quit a long time ago.”
Shit Rising
The woman is four hundred pounds, lying on the kitchen floor, with brown puke flowing out of her mouth like lava. The woman is in cardiac arrest. She is not breathing and has no pulse. Her son is doing chest compressions and mouth-to-mouth ventilations on her. I try not to look at the puke stains on his face and shirt. I tell Bob Anderson to run down and get the suction. She is going to be hard enough to tube, having no neck. I tear her dress open. Her breasts are like two giant watermelons. I apply the monitor to her and she is asystole. Flatline. The family last saw her up fifteen minutes ago. She is only forty-nine, but at her size, she is not a healthy woman. High blood pressure, diabetes, they say. I am thinking about all the puke that is going to be in her throat when I open it up. That and how hard she is going to be to tube and how she looks like she doesn’t have a visible vein on her, much less a jugular in her nonexistent neck. With all the puke in her mouth, I cannot get any air in with the ambu-bag, even with an oral airway. Bob is back quickly with the suction. I lay down on my belly and fight not to retch. I open her mouth, and the puke erupts again, dribbling down her eyes and ears and chin, puddling at the base of her head. I put a pillow under her back and stick the steel blade in, sweeping her tongue aside. It is like I am looking into the first floor of a house flooded up to the ceiling by a muddy river. I stick the suction in and listen to its slurpy whir. The water level slowly lowers and I can finally see the white vocal cords. I pull the suction out and grab for my tube, but the puke water level rises back to the ceiling, obscuring my view. I suction, the water goes down to reveal the cords, but again as soon as I remove it, the crappy water rises back up. “I can’t believe all this puke,” I say aloud. “I can’t see a fucking thing.” No matter how much I suction, the shit keeps rising back to the top. Suction. Rise. Suction. Rise. I say screw it, I take the tube and jab right where I know the cords are. I feel the tube pass through. I inflate the balloon, check my lung and stomach sounds. More on the right than the left. Nothing over the stomach. I pull back on the tube a little till I hear the sounds equal on the left, then secure the tube. We fire drugs down the tube. Epi. Atropine. But the woman stays flatline. We try pacing—applying a steady electrical beat to the heart—but get no response. More epi. Atropine. Still nothing. We slide a board under her and secure her with three belts, still doing CPR. I look over my shoulder and see several family members watching us openmouthed, including two girls about eight or nine years old. “Why don’t you take them into the other room?” Missy Young says. She and Chaz Milner have arrived to assist us.
“That’s their grandmother,” someone says.
“Please. We’re going to need room to get by.”
I didn’t even know they were standing there. I should have been watching my language. Bob is trying to move the stretcher over, but the family won’t get out of the way. “Please,” he says.
I take the head end of the board and try to lift, but she is so top-heavy, I can’t even budge it. Bob has to grab the side and help me. We stumble backward and finally get the board on the stretcher. A family member trying to help nearly topples me off balance.
I think if they wanted to help, they could have kept the fried chicken and pork chops out of her hands. This thought, at least, I keep to myself.
We wheel her down the hall in the low position. I realize her breasts are still exposed, but there isn’t a sheet handy, and besides, she really isn’t even a she to me anymore. She is a corpse. Flat on the monitor. Squeeze the ambu-bag. Compress the chest. If the family hadn’t all been there, I might have called medical control and asked permission to call her dead right there on the floor. There is no bringing her back.
Now comes the fun part. The stairs or the elevator. “I’m not taking the stairs,” I say.
“She won’t fit in the elevator,” Chaz says.
“Yes, she will.”
The elevator door opens, and I have Bob help me lift. We lift the stretcher up so it is standing on end, the woman facing the back of the elevator door, standing for the last time. It fits perfectly. I hit first floor. “See you down there,” I say.
The ride doesn’t take long. I stand there looking at the stretcher and the obese dead woman strapped to it. I am as out of breath as if I’ve been moving a piano. And that’s what it feels like to me. A moving job. I know that is not right. That is not what I should feel, but it is how I feel. I look at my pants and my shirt and see puke on them. I am damp with sweat. I am tired. I keep thinking, Why did you eat all that bacon and sausage and fried food? Couldn’t you get a salad or go out for a jog instead of stuffing your fat face? Then I think about the dead woman sharing the elevator with me, standing for the very last time, her feet on the floor, her belly, which is most of her, pressed against the wall of the elevator. Have some respect.
The elevator hits the ground level, and we lower her out, continue our CPR out to the ambulance, where it takes four of us to lift her in back, then we continue on down the street to the hospital. Ventilate. Compress. Flatline.
They call her dead in the cardiac room.
Burnout
I’m working overtime in the city and it has been a busy, hot day. I’ve done two room-one traumas, including a man out of his mind on cocaine who leapt out of a third-floor window and broke both his legs—nasty bilateral open tib/fib and foot fractures. It took four cops and me to wrestle him onto our stretcher. It was impossible for us to properly immobilize him to protect his spine. The cops had to handcuff him to the stretcher. Two cops rode with me in the back; I was unable to do anything for him. With his face he fought the oxygen mask that I tried to press against him. He spat and cursed. He was completely out of his mind.
Now we’re sent for a pedestrian struck north on Main Street. There is a huge crowd in the street, always the sign of something bad. People are shouting, pushing each other. A woman lies in the middle of the road. Someone says she was struck by a car going forty and thrown twenty feet. She has a small hematoma on her head and pain in her ribs and says she hurts all over. I tell my partner, “Let’s just get her out of here.” We get her on the board and head to Saint Francis on a priority. I give a patch and ask for the trauma room. Then I spike a bag and put a tourniquet on her arm. “What are you doing?” she screams. “I ain’t getting no needle. You ain’t giving me no needle.”
“Hold still,” I say. “This won’t hurt much and it will be over before you know it.”
She swings her arm wildly. “No, no, I hate needles. You ain’t giving me no needle.”
“Listen,” I say. “You need this. Hold still.”
“I’m getting out of here. You stop the ambulance and let me out.”
I lie to her. “If you don’t get this needle, you could die.”
“I don’t care, I don’t care.” She sits up straight, breaking loose from her immobilization.
She is screaming at me. It is sweltering hot in the back.
“What the fuck is wrong with you? You want to die? You want me to help you or not?”
“Just don’t give me a needle. I hate needles. Please let me out of here, I want to go home.”
I am thinking, Here I am dripping with sweat, I’ve called for the trauma room for a patient who I am thinking now is not nearly as hurt as I thought. I don’t have her C-spin
ed, she’s not on oxygen, and I don’t have an IV. What am I doing busting my butt for these people who don’t care?
“Why are you yelling at me?” she says, crying. “Why are you yelling at me?”
“I’m sorry,” I say. “It’s because I want to help you.”
“Just don’t give me no needle, please don’t give me no needle.”
I just sit the rest of the way wondering what is happening to me.
Shame
It is six at night, the end of another long day. We’re sent crosstown for a difficulty breathing postsurgery. Priority one. Franklin Avenue, second floor.
We pull up outside the address. It is a nice three-story apartment house. A large man in a New England Patriots T-shirt comes down the stairs and waves at us. “I bet it’s an old lady,” I say to Arthur as I reach for a pair of gloves. I step out of the ambulance. I fasten the HPD radio to my belt. I stuff the gloves in my pocket. Then I open the side doors, and take out the heart monitor and the heavy blue house bag. Arthur has gone around to the back to pull out the stretcher. “Let’s just see what we have,” I say.
We go through the front gate, then up the stairs to the porch, where the man, who is sweating heavily, stands anxiously. “I guess you’re not like they are on TV.”
“How’s that?” I say.
“You’re moving so slow. My son’s having trouble breathing.” He starts up the stairs, and I climb up behind him. It is a young man, which means it is likely to be B.S., but he seems concerned so maybe it is real. Then I start thinking, I am not going to let him talk to me and put me down like that. I’ve been busting my butt all goddamned day. You can’t go running up every set of stairs, lugging this equipment. As we move into the apartment now, through a cluttered living room to the back hall, I finally let my frustration out. “I can’t run with all this crap on the floor.”
The man stops at the hallway entrance and looks back at me, and for a moment, I am thinking, Oh, I did it now. He’s going to deck me. “You weren’t even up here when you pulled in, so you didn’t know there was anything on the floor and still you’re moving slow. Please, my son.” He turns and heads down the hall.
I follow.
“In here,” he says.
On the bed there is a large young man in athletic shorts and T-shirt, lying on the bed, gasping. A pretty young woman sits on the bed comforting him.
“Excuse me, please,” I say.
She is slow to get out of my way, and I think of commenting, but I hold my tongue, angry at myself for losing my temper.
I look at the boy. His eyes are closed and when I ask him what hurts, his lips move in a whisper that is inaudible. With his hand, he motions toward his chest. I put him on the pulse oximeter, then feel his pulse. His rate is regular, strong. The oxygen saturation reads 100 percent.
“He got out of surgery this afternoon and now he can’t breathe,” the man says.
“Well, he’s getting oxygen just fine,” I say. “One hundred percent. That’s better than I’m doing.” I listen to his lung sounds on both sides. Nice and clear. “Where does it hurt?”
Again, he does his inaudible mumble.
“What kind of surgery did he have?”
“A hernia operation. They knocked him out and had him on a ventilator.”
I take his blood pressure: 110/70. Again fine. This is a healthy nineteen-year-old, who is probably just feeling nauseated from his surgery, playing his dad and his girlfriend for sympathy.
“He’s okay,” I say. “This is not life threatening.”
“He’s my boy. I’m his father and his mother, too. I didn’t know what to do.”
“Look, I’m sorry I snapped at you,” I say. “We’ve had a long day. They train us not to run. If we fall and hurt ourselves carrying this gear, or miss something in the scene, then we’re no good to anyone. I shouldn’t have snapped. I was tired. It was unprofessional. I’m sorry.”
“That’s okay,” he says. “I understand. It was just my boy wasn’t breathing right.”
“I understand. What hospital do you want to go to?”
“Hartford Hospital. It’s where he had the surgery.”
“Okay, let’s go. Get up,” I say to the boy.
“I don’t think he can walk,” the father says.
“He didn’t have the operation on his legs,” Arthur says. “He ought to be able to walk.”
“He’s too big to carry,” I say. “It’s safer for him to walk.”
We each grab an arm and start pulling him up. He resists a bit, but we grab under his arms and get him up. He walks with his eyes closed, leaning on me.
Arthur takes the gear downstairs and I walk with the boy. His father also holds his arm. As we reach the top of the stairs, he starts to lean harder on me. I stand in front of him, so he won’t fall down the stairs. At the bottom of the stairs, the boy starts to puke. His father and I hold him. He gives his weight up to us, so that if I drop him, he will fall. The puke, just watery juice, splashes by my boots. Art is at the car, his back turned to us, putting the gear in and getting the stretcher out and making it.
“Arthur,” I call.
He doesn’t turn. It is taking all my strength to hold the kid up.
“Arthur.”
“He can’t go on,” the father says.
“He’s okay,” I say. “He’s just nauseated from the surgery.… Arthur!”
Arthur finally turns and sees me holding the kid at the top of the outside stairs.
“Bring the stretcher over, please.”
He gets the stretcher over; the boy takes the last four steps, then we set him on it. We lift him into the back of the ambulance. He must weight two hundred and forty pounds.
“We’re not going to go lights and sirens,” I say to the father, “and we’re going to do a couple things in the back first.”
I tell Arthur to spike a bag. I put a tourniquet around the boy’s arm. He doesn’t really need an IV, in my opinion, but his complaint, chest pain and difficulty breathing, coupled with the vomiting, qualify for one under the protocols. I am giving it to him for those reasons, and because of house rules. You can’t walk on your own, you get an IV. I take out a fourteen—the biggest size we carry. I unwrap it, and though his eyes are closed, he jerks awake, and pulls his arm back. Spying on me, I think.
“Hold still,” I say. “You need an IV. It’s just a little poke.”
I jab the vein. Blood flashes back. I draw four tubes of blood, then attach the IV. I tell Art we’re all set to go. En route I put him on the monitor, give him a little oxygen.
“Feeling better?” I ask.
He nods.
In triage, while I am telling the story to the nurse, a clerk comes over and asks the name of our patient. She says his father is here. They let him in.
“This is the father,” I tell the nurse.
“And his mother, too,” the man says. “And I got another boy at home.”
“Good for you,” Arthur says. “He’s a fine-looking boy. You must be doing a good job with them.”
“I’m doing my best. They are good boys.” To the nurse, the father says, “He had me worried, but he’s looking better now. These young men made him better.” He nods to us. “Thank you.”
I smile back, but behind it, I feel shame. It was a B.S. call—the kid was just nauseated from his surgery—but that doesn’t give me the right to act like I did.
I am better than this.
Flat Line
I recognize what is going on. It is not the first time I have felt this way. It is an occupational hazard. It comes in waves. Sometimes it hovers like a fog, a haze. I try working through it. Maybe a good call will change it. But the more I work, the worse it grows. I try taking time off. Getting out of town. Maybe a day at the beach, feeling the sun burn my face, riding the Atlantic ocean saltwater waves, drinking beer and eating clams into the night, looking at the stars and the moon, feeling the sea breeze, nestling in tight with my girlfriend.
But it sta
ys longer this time. I get out here and it is all bullshit. I stop reading the educational journals. Stop carrying my medical books. Stop following up on patients. Even the good calls don’t excite me. I go through them like a robot, doing my job, but not caring, sometimes not even introducing myself. No longer face to face. It’s vein to vein. Run form to run form. Just barely legible scribble on the page, followed by my signature on the bottom. A P followed by a C that turns into a long flat line.
SHAMAN
Will I be a good teacher? Will I be someone to look up to? … Will I soar above the city or will I crash in flames?
Reason
I talk to Debbie Haliscak, the EMS Coordinator at Saint Francis. “Debbie, I yelled at this lady the other day. I just lost it.”
“You, yelling at a patient? I don’t believe it.”
“I just snapped. And it isn’t the first time.” I tell her how I am feeling, how it seems that what I do doesn’t really matter. Driving priority one all the time, for what? Cut fingers, hyperventilation, bullshit. When I do use my paramedic skills, it is nothing that another paramedic couldn’t do, but most of the time these days I am just a taxi service. And the system we have now doesn’t even recognize my value. A transfer comes in and it doesn’t matter if I am a medic or not, I get sent. Dialysis, basic transfer, even long-distance, out-of-town trips. It makes no sense. Basics doing codes while I am carrying flowers and balloons. And when I am on line, HPD doesn’t care whether I’m a medic or not. “I’m in a deep rut,” I say. “I keep waiting for it to change. But I can’t get out of it. It’s affecting me. I’m worried I’m going to stop caring. I can see it happening.”
She listens. She has heard what I am expressing before. It’s a symptom of the job. Common. She knows I will be back, excited to tell her about some great call. Or just as easily, one morning I will walk in and tell her I am leaving the field. Done. Nothing would surprise her.
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