Rescue 471

by Peter Canning

  I look at Arthur, and we both raise our eyebrows.

  “There you are, little pretty,” he says to Rebecca. “My savior. What’s your name? I’m going to write a letter to your boss.”

  He is stable all the way to the hospital.

  We are together a month, and after a while, it is like I am not there. She is competent, she gets all her IVs, and the job is becoming routine. What we are waiting for is a cardiac arrest, a requirement to complete precepting. I try to trip her up, by taking stuff out of the equipment, and seeing if she finds it. After nailing her a few times—no ambu-bag, no BP cuff—she gets on to me. Then one day I put a note in the spare equipment box, which says Hey, Rebecca! How’s the checklist going? I ask her if she checked the spare box, and she says she did. I ask her what she found and she hems and haws. “You didn’t check it,” I say.

  “I did, but—”

  “You didn’t check it.”

  “I did. I did. I didn’t find anything. What did I miss?”

  At the end of the day I give her her first bad evaluation. Rebecca continues to do well with her assessment, skills, etc. The lack of challenging calls is hindering the conclusion of her precepting, and it raises the question of her ability to maintain focus. The improvements she needs most to make are within herself in terms of day-to-day commitment to all the standards of a professional, mature paramedic and person.

  After she reads it, she gives me a half-glare, half–hurt look and then punches out. When I say, “We’ll get them next week,” she says nothing but keeps going out the door.

  The next week, we climb into the back of a volunteer service ambulance just off the highway. The man on the stretcher has a huge stomach and is breathing at a rate of six a minute. Unresponsive. Fifty years old, found on the couch by his daughter, a history of heavy drinking. The volunteers called for a medic as soon as they arrived, loaded him, and hit the road for the intercept point. They are bagging him, breathing for him by squeezing a plastic bag attached to the oxygen supply. Still, he is blue from the neck up—he needs an airway. Rebecca goes to the head to intubate, while I put him on the monitor. After looking all over for a vein, I feel one in his hand and hit it on my first try. Rebecca’s having trouble with the tube. The man has a squat neck, and his mouth is filled with bloody secretions. She tries to pass it, but it goes in the stomach, not the trachea. We have to pull it. She goes in again with the laryngoscope, struggling to lift up the tongue and sweep it to the side so she can get a view of the cords. She suctions to see. A wave of fetid blood comes out, and I can see her fighting back the urge to vomit. She wants the tube so bad, but she can’t get it.

  “We need to bag him,” I say.

  She pulls out and we ventilate.

  I give him some dextrose, while Rebecca draws up some Narcan, which we also push through the IV, but neither works.

  I notice the man’s stomach seems to have gotten bigger. It was large and distended when we got in.

  “It’s been getting bigger since we found him,” one of the volunteers says.

  “Let’s get out of here now,” I say. I don’t know if it’s the air from bagging him or if he has some major abdominal bleed, which is probably more likely given the dark blood in his mouth. And if it is a bleed, we’ve wasted valuable time at the intercept point. He needs a surgeon.

  As we bounce and hurtle toward the hospital, Rebecca tries again for the tube, but she can’t get it. I switch places and try myself, but we are almost there, and I can’t see a thing amid the dark blood and vomit in his mouth. We suction and keep bagging. His stomach keeps swelling.

  At the hospital, he isn’t in the cardiac room five minutes before his heart rate plunges and he codes—flatline. They fire epi and atropine into the IV line, while a nurse does compressions on his chest. They call an anesthesiologist to come down and intubate him. The anesthesiologist looks at the patient and shakes his head. He suctions the airway, then passes the tube on his first attempt, but by now it is too late. They work him another ten minutes, but he is gone.

  Later, after I have washed my hands, I walk by the cardiac room and see Rebecca in there alone, standing over the gurney looking down at the man’s body. Standing next to her now, I know what she is thinking. I have thought it myself many times. I failed you. Your life was in my hands. I let you down. You died because of my failure. Her eyes are wet. I know just what she is thinking. What she is feeling.

  I put my hand on her shoulder. “Come on,” I say.

  We walk down the hall silently. It is a walk that we take many times a day without even noticing it, but this time the hall seems longer, darker, like a runway out of the stadium after a big game we have lost. You feel great, you feel confident, then wham, you get knocked down so low you can’t stand it. Darkness closes in on you. Doubt is all-consuming. Others start to say “hi,” but they can see it in our faces now, and they know not to talk.

  We reach the automatic doors, go outside, and sit down on the curb.

  “I thought I was ready,” she says. “It was all coming so easy. This sort of set me back, shook me to reality. He needed a tube, and I couldn’t get it. There was nothing more we could do. It was horrible knowing there was nothing. Unless I could have gotten the tube.”

  I have taught her several things in our time together—to be thorough, to do your assessment, to take nothing for granted, to be in tune with your patient’s emotional as well as their medical needs, to let your patients talk and to listen, but this is the most difficult lesson.

  “Let me tell you a secret,” I say. “You’re never going to be ready. You’re going to have calls that kick your butt, and this one kicked ours. It’s what being a paramedic is about. You learn no matter how good you are, it’s often not going to be enough.”

  “If only I’d gotten the tube.”

  “We didn’t get it. You don’t always get it. And it feels bad. It should feel bad. You understand what I saying?”

  “Not really.”

  “What we do matters, so when we fail it hurts. The bad calls never go away—they live with you. That guy is going to make you better, and he’ll be with you, they’ll all be with you, helping you when you’re performing miracles, when you’re saving people you have no right to save.”

  “Yeah?”

  “Yeah, and you didn’t kill this guy—he was on his way out before we even got there. You are going to save lives. You’ll save them because you are a paramedic and a decent one. Trust me on that.”

  She looks up at me as I stand. She blinks, wondering maybe if what I say is true, wanting to believe.

  “Now, finish up your paperwork. We have some good to do yet today.”

  “Okay,” she says. “Thanks.”

  “You did all right,” I say.

  As I walk away, I think, she’s just like me.

  We get our code at a nursing home in Bloomfield—a ninety-four-year-old man last seen awake an hour before. CPR is in progress when we arrive. Everything goes like clockwork. Rebecca gets the tube, I get the line. She runs through the algorithm, epi and atropine. We get a rhythm back on the way to the hospital, but no pulses. Outside the hospital, I let Rebecca do an EJ—an external jugular vein IV—which she does perfectly.

  I recommend that she be able to ride alone with me now. Arthur gets shipped out to work a BLS transfer car. Rebecca does great. We intercept with a crew for an unresponsive male, and it’s like I’m not even there. Rebecca assesses the patient, gets the line, checks the blood sugar, and fires in some dextrose, and the man is awake and talking.

  My job is to drive, remake the stretcher after every call, clean and restock the ambulance. I never realized just how much physical labor is involved in being a paramedic’s partner. We go into a call and assess the patient, then she tells me to get the stair chair. I have to lug the stretcher out by myself, set it up, get out the stair chair, carry it upstairs, help her carry the patient down, gather the rest of the equipment, and then while she works on the patient, put the stair
chair back in. One habit she hasn’t improved is she makes a mess in the back. IV wrappers and four-by-fours all over the place. Blood on the floor, which I have to spray down and wipe clean with serious elbow grease.

  I see Arthur bringing in a transfer. “How’s it going?” he asks.

  “She’s working me like a dog,” I say. “Like an animal.”

  “Now you know how the rest of us live,” he says.

  It’s 6:50 and Rebecca wants to head in so she can prepare for her date that night. “We’ve got another call left,” I say. “Shooting on Albany Avenue, another ten minutes.”

  “Yeah, right,” she says.

  At 6:55, the HPD radio crackles. “Four-seven-one.”

  “Four-seven-one.”

  “Four-seven-one, on a one, Homestead Avenue for the shooting.”

  “You were right,” she says.

  “Off by a street.”

  We arrive to a chaotic scene. Hundreds of people have gathered. To the left I can see a body on the ground by the hedges. Yet several people shout, “This way, in the house.”

  “No, over here, over here,” a woman shouts, pointing to the guy on the ground.

  “Check him out,” I say to Rebecca.

  I get on the radio. “We need another ambulance. We’ve got one victim on the street, and they say there’s another in the house.”

  Rebecca is kneeling by the man, who lies facedown on the pavement. His baggy pants have fallen down around his knees, his butt is bare to the sky.

  “He’s dead,” she says.

  I’ve brought the stretcher and long board, and we roll him onto the board. A woman is screaming, “Is he all right? Is he all right?”

  His face is bloody, but I can’t see a bullet hole, though one nostril looks a little bigger than the other. He is not breathing and has no pulse. We get him on the board and lift him onto the stretcher.

  “Come with me,” another woman shouts, pulling at my sleeve. “He’s in the house. He’s bleeding.”

  “There’s another ambulance coming,” I say.

  We wheel him low and fast back to the ambulance. “You tube him, I’ll get the line,” I say to Rebecca.

  We get him in the back, and while Rebecca goes for the tube, I cut off his clothes, looking for bullet holes, but find none. I stick a fourteen in his left AC, press against his Adam’s apple as Rebecca passes the tube. On the monitor he is in an agonal rhythm. On the radio I hear them scrambling to get a third ambulance. “We need help,” Rebecca says. “Anyone.”

  “You’re doing this by yourself,” I say. I open up the biotech and pull out the epi. “We’re just a couple minutes from Saint Fran. Bag, drug, CPR. You can do it.”

  I jump out and get in the driver’s seat. The ambulance has been taped in by police tape. I swing around and yell at a cop to move his car so I can get through. I break through the police tape and head out lights and sirens. I pass the second, then the third ambulance. I patch to Saint Fran. “Approximately twenty-year-old male, gunshot to the head, in traumatic arrest, patient intubated, line in place, CPR in progress. Out in one minute.”

  They have help out front for us. I open the door to see the police tape is hanging off the ambulance in streamers; it looks like a limo carrying newlyweds. We get the patient into the trauma room where the full team is waiting. They inspect him, while taking over CPR. “How do you know he’s shot?” a surgeon asks.

  I really don’t know what to say to that. We got sent for a shooting, there were a hundred people there, shouting about people shot. This is a twenty-year-old male, otherwise healthy, lying facedown on the ground, with a mask on, his butt naked to the sky, not breathing, no pulse. No wounds other than blood on his face. I don’t think he died of old age. “One nostril looks a little bigger than the other,” I say. “There could be two more victims coming in.”

  I shake Rebecca’s hand. “Good job.”

  “I can’t believe I did it myself.”

  “We couldn’t wait around.”

  Fifteen minutes later, the other ambulance comes in with the other victim—there is only one other—who has a bad leg wound with arterial bleeding and no blood pressure. They have four people in the back with them. He codes in the trauma room, but they get him back.

  The families converge on the hospital, holding each other, wailing. I tell Rebecca, “Look at them. Sometimes you think these people are scumbags, but they all have families and are loved.”

  “I know, I almost cried when we got there. That was his mother standing over him.”

  I didn’t even notice that. All I was thinking was here is this young gangbanger who died bare butt to the sky, baggy pants around his knees—a drawback of the latest fashion. I didn’t even think that the woman was anybody but a person getting in my way. Rebecca knew it was his mother. I look at her and she has tears in her eyes. I look back at the family and am ashamed that I feel nothing. Here I am trying to teach a lesson of compassion, which is hollow because my own is gone. I look at Rebecca and see what I have forgotten.

  In our final days together while we wait for Rebecca to ride with Debbie or Daniel to get final clearance, I try to get back to what a paramedic is really about. She has all the skills and medicine down. We help a cancer patient’s family work through an insurance problem so the patient can get transported to the right hospital. Even though it takes almost an hour on scene, we get the problem solved. We help an old woman who has fallen and can’t get up by herself get back into bed, then get her some food and rearrange her furniture to make her life a little easier. Another woman fell in the bathroom and defecated on herself. We clean her up and get her in fresh clothes, rather than dumping her on the stretcher in what she was wearing.

  I go in on a Friday to pick up my paycheck and see Daniel Tauber, who mentions that he will be riding with Rebecca on Tuesday to give her clearance. I almost call Rebecca to give her a heads up, but then think she’ll enjoy the weekend more without worrying about how she’ll do. I am confident she’ll do fine.

  On Tuesday, I am back with Art. “She wore me out.”

  “I’m glad you know what it’s like to be a paramedic’s partner,” he says.

  “Yes, it was good. I learned a few things. You can be quicker if you don’t wash your hands. And taking a pee costs you probably ninety seconds, so I’m going to institute new rules for you.”

  He laughs.

  “It’s good to be back together,” I say. “Not that I didn’t enjoy it, but I was getting a little rusty.”

  “Yes, it is,” he says.

  We listen over the radio and hear Rebecca and Daniel go out to a difficulty breathing, and later a chest pain. I see her in the afternoon and things are going well. She gets cut loose—a paramedic in her own right.

  “I feel like a father,” I say to Arthur.

  “You did well,” he says. “She’ll make us proud.”

  A Paramedic Again

  It’s nine o’clock and we’ve already done two calls when we get sent to back up 866, another medic unit, on a Macing. Five police cars, an ambulance, and a fire truck are on scene. I get out and ask Todd Beaton, the medic, what we can do for him. His eyes are red. I see now that his partner, Shawn Wood, and their paramedic student rider also have red eyes. “You have any more saline?” he asks.

  Are you guys the patients?” I ask.

  He shakes his head. “No, we’re all right. The patient’s in the police car. We couldn’t get in. The cops broke down the door. The guy looked postictal, like he was coming around from a seizure, and he came at one of the cops, and we all ended up getting Maced.”

  “You all right?”

  “We’re better now.”

  I go over to the police car, where I see a handcuffed bare-chested man with eyes swelled nearly shut and drool all over his face and chest. Two cops are standing by the car. “What do you want us to do with this guy?” I ask.

  The female cop says, “I want you to treat him.” She opens the door.

  “You’re g
oing to have to uncuff him,” I say.

  “No, I’m not, he’s under arrest.”

  “He’s not going in my ambulance cuffed unless you’re coming with me.”

  “You can treat him in the police car.”

  “No, I can’t treat him in the police car. He had a seizure. He needs to go to the hospital.”

  “What if he escapes? Are you willing to be responsible?”

  The other cop comes over.

  “Look,” I say. “These medics, who I trust, say he appeared postictal, indicating he had a seizure. He needs to go to the hospital. I can’t take him cuffed, unless one of you is going to ride in the back with me.”

  “He had a seizure?” the cop says.

  “Yes, I believe so.”

  “Then he’s all yours. That’s all I want to know.” He pulls him out of the car and hands him over to me.

  “He needs to be uncuffed.”

  “She’ll get the key.”

  Todd and Shawn are feeling better now, so I turn over the patient. The cop gets in their ambulance and uncuffs the patient. Once he’s on the stretcher, Shawn pours saline in the patient’s eyes.

  I say to Todd, “And you were complaining about not getting on line. Welcome back to the city.” The company finally responded to our complaints, and while the “dead-icated” system is still in place, they have increased the number of paramedic cars on line, and have reiterated their goal to put a medic in every car as soon as possible. Three new sets of medic gear—monitors, drug boxes, airway kits, appear at operations.

  “How do you like it now?” I say to Todd.

  He just shakes his head.

  I learn later that the patient had wrestled with the cop and was reaching for his gun when Todd grabbed him. Then the cop Maced him, the spray nipping Todd and everyone else in the room.

  We’re sent for a car accident on West Service Road, which is a circular road off I-91, just north of the city. The dispatcher says he thinks its down by the old Howard Johnson’s. We get off Jennings Road and head left to where HoJo’s is, but when we get there, we find it’s been flattened. Nothing but rubble, a few bright orange tiles visible amid the brick and dirt. It looks like Oklahoma City. “Oh my God,” I say, pretending to speak into the mike, “Mayday, Mayday.”