“Do you have a brother named Kevin?” I ask.
“No.”
“You look like this guy I know.”
“I don’t know, maybe I do. I may have more brothers and sisters than I know about.”
“How’s that?”
“My mother only had eleven kids,” she tells me.
“Only eleven?”
“Yeah, but my father had nineteen that he know about.”
“Nineteen!”
“So maybe if there’s one unaccounted for, maybe I might have a brother named Kevin. I don’t know.”
“Nineteen. Is he still out there putting them out?”
“No, he’s a paraplegic. He fell off a ladder a few years ago.”
“Oh, I’m sorry.”
“No, don’t be. He get around good. He got one of them carts.”
“That’s good, I guess.”
She smiles a beautiful toothless smile. “He still flirt,” she says.
THE JOB
This is still the best job on earth because we get to do what we love: answer calls.… It’s just my partner and me and the patient. And we do what we are good at. Help people.
Thanks
Arthur and I are sitting in our ambulance in a park across town, while we wait for our number to be called. Arthur reads the paper. I watch the young mothers play with their kids on the swing sets. “So the head of EMS resigned,” he says. “I thought you saved his job.”
“We did,” I say. “But they took his responsibilities away and gave him a broom and told him to sweep all day. He had enough, so he quit in protest.”
Arthur grunts.
“There’s an editorial in there about it,” I say.
He turns to the page I point out. It’s titled: HEALTH COMMISSIONER’S END RUN?
He reads part of it aloud. The gist of it is, despite the fact that our rally at the capitol convinced the legislature to stop the budget cuts, the health commissioner has gone ahead and dismantled the Office of Emergency Medical Services through other means, prompting the resignations of the EMS head and his second in command.
“The commissioner shouldn’t be allowed to abuse his power like that.”
“It’ll come back to haunt him. I have no doubt he’ll get his. In the meantime people will suffer.”
Arthur shakes his head. “Typical government.”
“Tell me about it.”
The Commissioner may have gotten what he wanted today, but he has set himself up for a fall. Someday someone important is going to die and, rightly or wrongly, people will question whether or not the EMS system failed them. There’ll be newspaper headlines, public outcry, and investigations. The legislature will react as they often do, making dramatic, but not always well-thought-out changes, when what is needed now is calm deliberation and forethought. Fix the system today, don’t wait until the disaster to react.
I am disappointed by what has happened at the state. I thought we had done something great and succeeded beyond our expectations, but while a citizen can stand up and be heard, unless you have power on the inside looking out for your interests—keeping your gains is another story.
Across the field, I notice an older couple walking hand in hand, coming our way, and the sight cheers me a little. Isn’t that nice. In our job you see so much sickness and dying, it is good to see people happy, people healthy. The couple nears, and I notice they are looking at us, actually coming up to talk to us. “You remember me,” the man says.
“No, I don’t,” I say, but to keep them from feeling bad, I say, “You look familiar.”
“You came and got me on Prospect Avenue when I was having my heart attack.”
“You boys saved my Fred’s life,” his wife says.
“Oh, yeah, I remember now,” I say. “How are you?”
“Doing great. Out walking every day.”
“You look well.” Arthur says.
“He was in the hospital for two months. But he’s home now and doing great, aren’t you, Fred?”
“Never better,” he says.
“Isn’t that nice. That’s great.”
“Thanks again,” he says.
“God bless you both,” the woman says.
They wave and walk off, still hand in hand.
“Remember him?” I ask.
“No.”
“Me, neither.”
“They remembered us.”
“I guess that’s not hard to do. A big guy like you.”
“And an old man like you.”
“That’s something we don’t hear every day.”
“Yeah, it was almost out of TV land. Amazing.”
“I was thinking the same thing.”
“Except where were the TV cameras and the picnic spread? They always get a picnic on TV.”
“You can’t have everything.”
“I know.”
“Nice couple.”
I look up the call later that night. I keep copies of all the run forms I have done, thousands. At first every name meant something to me, now they are all a blur: chest pains, diabetics, strokes, motor vehicle accidents, cardiac arrests. At least I have the address to go on. I find it. The run form is shorthand, abbreviations.
67 y/o male with crushing substernal chest pain x half an hour. Onset while at rest with diaphoresis and nausea. Prior history MI, HTN. A-0X3, skin, pale, cool, clammy. Anxious. Positive JVD, rales in bases, ab soft non-tender, pedal edema. BP-102/56 P-96 R-28, Pulse Sat-92%. Sinus with ST elevation in Leads II and III and multifocal PVCs.
O2 at 15 lpm via nonrebreather. IV # 18 in L FA Saline Lock. 162 mg ASA PO. 80 mg Lasix IVP 4 mg NTG SL. Extricated via stair chair.
Medical control contacted. Orders received for additional 40 mg Lasix IVP and 4 mg MS IVP provided pressure stays above 90 systolic. 2nd IV # 16 in R AC NS KVO.
PVCs diminished with O2. Meds given as above. Vitals reaccessed. Substernal pressure slightly improved after 2nd .4 mg NTG and 4 mg MS IVP. Lungs improved post Lasix. Pt calmer. Still some pressure in chest. SAT 99% with O2. Vitals on arrival BP 100/60 P-88 R-22.
Taken priority one and turned over to ER staff with full report.
Words on paper. They don’t convey the fear in their eyes, the touch of our hands, the whirl of minutes, the beat of hearts. For so many of our calls we never find out what happens, unless we read their names in the obits. It can give us a tough slant on the job. It is a good lesson to remember the ones we help, even if we won’t recognize them on the street. I think about the file cabinets I have filled, the thousands of sheets of paper, all that medical terminology—the record of what I have done. They are not just forms, but people who walk the earth, and whom we were there for in their moments of crisis. It is so easy in this job to forget the basics of what we do and how much we help people. They, the patients, the people, they are what makes it all worthwhile. They are who we have to remember when we find our spirits lagging. They are what it is all about, from the one-on-one contact between paramedic and patient to the efficient running of the entire EMS system. They are what we fight for. They are what makes it worthwhile.
Exeter
My friend Brad finally drags me to Exeter, the prep school we attended, for the annual football game with the school’s archrival, Andover. He says I owe him for not going to our twentieth reunion. I had wimped out at the last minute, not wanting to go back to the school I had hated, where I had struggled constantly, never feeling that I met its standards. When Brad is badgering me to go, I tell him I have three conditions—one, that we have a designated driver as I will need alcohol to fortify me; two, that if I choose not to set foot on the campus, he cannot make me, and will have to meet me at a bar after the game; and three, that he hound me daily until the day arrives, as I am apt to back out from fear of returning. He agrees to all three conditions.
Shortly after I park my car in his driveway, our driver arrives and takes us up there. “Feeling it in the pit of your stomach?” Brad asks as we hit the town limits.
/> “Not yet,” I say tensely.
Our driver lets us off by the academy building, a huge ivied and marble brick building where we took most of our classes and sat in thrice-weekly assemblies in the giant hall. As we walk through the campus and out to the athletic field, I feel oddly detached. It is like I am walking through the set of an old movie I only vaguely remember. I am not the person now that I was then.
We walk over the river and take our seats in the stadium, the stone coliseum. Brad played football here; this is the first time I have even been to the stadium. It is cold and windy. The football team is terrible and we leave at half-time with the score Andover 21, Exeter 0.
We go to a bar in town and drink pitchers of beer and talk. I tell Brad about my big playoff hit in my last softball game of the year—a bases-clearing triple to tie the score with two outs in the bottom of the last inning. “Winter was coming down,” I say. “Then the pitch came in. The second baseman broke for the middle, anticipating my predictable drive over second, but I saw him move out of the corner of my eye. I shifted my shoulder slightly and drove the ball right to where he had just been—a cruise missile that gapped the outfielders all the way to the fence as I ran around the bases, ran like the wind, like Mercury, like a man chased by wolves.”
“Did you win?”
“No, I got stranded, then pitching, I gave up six runs in the top of the first extra inning, and we lost by six.”
“So you weren’t really the hero.”
“No, but I almost was.”
Brad has had a hard go of it lately. He lost his election for county sheriff in the Democratic landslide. Boston newspapers headlined his opponent’s smear campaign claiming that Brad left the county bankrupt, in spite of Brad’s vehement denial. Months later when an auditor’s report cleared him, there was only a small article in the Boston Herald, and not a word in the Boston Globe, which had run a photo of his opponent holding a shredder. Politics is a dirty business, he has learned, but he wants to keep at it, despite a large personal campaign debt he is struggling to pay off. He wants to prove you can be an honest person and an effective officeholder. We talk about other things as well. His oldest boy, William, is turning into quite a good hockey player. His daughters, Liza and Catherine, love soccer, and his youngest, Charles, is just starting hockey. He loves his wife, Susan; their marriage is strong and she has stood by him through his two heartbreaking election losses.
I think of the letter I received from our close classmate Brad Lown, who was one of our most gifted athletes, now a lawyer in New Hampshire, who himself had run for public office in his state. He wrote about Brad Bailey, “He, as do you and I, hankers to be a big shot someday, and maybe he will be in some sense. But as I have gotten older the allure of being a big shot has waned, and I’m not sure that being a good father, husband, and an honest lawyer isn’t the very best way to make my mark on the world.”
When we leave the bar, we go to a market and buy a six-pack of tallboys—the same market we’d buy beer from, or think about buying beer from, when we were students. It is dark and we wander about the campus. I head off by myself to my old dorm, and stand outside in the darkness looking for a glimpse of my old self in the window, studying at my desk, sitting in a chair reading a history assignment, or just lying on my bed, looking up at the ceiling, dreaming. But I am no longer there.
We meet in the academy building and go up to sit in the great assembly hall. I find the portrait of William Ernest Gillespie in the back with the inscription from his commencement address in June 1967. It reads: “It is nearly time for you to be off, you have a lot to do. This is no time to concern yourselves with nostalgia. As a matter of fact I don’t believe anybody has ever claimed that Exeter is a warm nest, but I hope and I expect that when you find yourselves involved in skirmishes, on the frontiers of barbarism, which are not very far away, you’ll strike some shrewd blows in favor of civilization. Some day you’ll come back to show us your trophies and your scars, and we’ll be glad to see you.”
The word “shrewd” I hadn’t remembered. I believe Brad and I have struck blows, but they haven’t been shrewd blows, anything but. More like blind thrusts. We have our scars, our struggles are written in the lines of our faces and in the hidden sorrows of our hearts, but we have survived.
We sit in the back of the empty hall, raise our beers and toast the boys we were then and the men we are now.
“Father,” I say to Brad, “husband, friend, public servant, Red Sox fan.”
“Paramedic,” he says to me.
“Softball hero,” I add.
“Legend in your own mind,” he says.
“Legend nonetheless,” I say.
When we leave, we walk down the marble stairs, and startle a janitor who is locking up. I momentarily think to hide the beer can in my hand, but then don’t. “We were just revisiting old times,” I say to the man. “Reminiscing.”
He growls and points out the side exit, which he hasn’t locked yet.
Outside we raise our beers again, one last time. “Here’s how they do it in Hartford,” I say. And we take a drink, then tip our “forties,” pouring the beer into the earth to share it with our ghosts, our memories.
Our ride is waiting in the driveway and we head home, back to our lives.
Asthma
We’re two blocks away from the call when HPD dispatches us to a difficulty-breathing asthma on Martin Street. The woman meets us at the curb. She is leaning against the fence, unable to move. I can see the panic in her eyes. I unwrap my stethoscope from around my neck and listen to her lungs as she holds herself up. No air movement. Nothing. Nada. I shout at Arthur to pull the stretcher. We set her on it and quickly lift her into the back. “Ever been intubated before?” I ask. She nods fearfully. She is using all her accessory muscles to breathe. Arthur is putting a treatment together. She reads 64 on the pulse SAT. Pulse of 140. I don’t even try for a blood pressure. I am immediately on the mike to the hospital asking for medical control.
“Approximately thirty-year-old female, history asthma, including intubation, no audible air movement at this time, really straining, pulse one-forty, SAT sixty-four, giving her a treatment, would like orders for point-three milligrams epi SQ.”
The standard practice is at least two treatments before the epi, but the treatments aren’t going to get it done. As I’m talking to the doctor, her respirations seem to be slowing. She is exhausted, on the verge of respiratory arrest.
“Go ahead,” the doctor says.
I flip open the biotech and reach for a one cc syringe and an ampule of epi. “Get out the thing,” I say to Arthur. I break the glass ampule with an alcohol wipe, draw up .3 cc.
“Here’s the thing,” Arthur says, laying the ambu-bag on the bench along with my airway kit.
I jab the needle into the woman’s arm on an angle and push it in. “This should help,” I say.
She is no longer focusing. I fear I am losing her. I reach for my intubation kit. I unzip it, take out a 7.0 tube, and the number-three MacIntosh blade, which I snap into the laryngoscope. She is turning blue. I will not fail this time. I will not fail. “I’m going to put it in your throat,” I say, spreading her teeth apart. She is going out on me. I thrust the blade in and sweep her tongue out of the way. The light illuminates her throat. Her arms come up as she starts to gag. I get a glimpse of the cords straining for air. I push the tube down her throat. I’m in. Arthur hands me the bag and I attach it to the tube and start ventilating. The air goes in. I see her chest rise. “Easy, easy,” I say. Suddenly she is reaching for the tube, fighting against the foreign object in her throat.
I try to hold the tube, and block her arms with my elbows. Arthur grabs her arms. “Easy, easy.” Her eyes are open, looking about wildly. “Let me breathe for you. I’m breathing for you.” Sweat from my forehead lands on hers. Her color is coming back. “Let me breathe for you,” I say.
Her eyes are fixed on me now. “Are you okay?”
She nods.
>
“I had to do this, you were going out.”
She nods.
“I didn’t want to lose you. We’ve got to keep the tube in there for now.”
I keep squeezing the bag, synchronizing the squeezes with her own efforts to breathe. We breathe as one. On the pulse oximeter now she is up to 99 percent. The epi is in and now with the tube forcing air into her lungs, we’re getting the job done.
Arthur takes us to the hospital.
“For a minute, I thought it was Nicki Joyner all over again,” I say to Arthur as we walk back out to the ambulance.
“But we were there this time,” he says.
“Yes, we were. By the way, thanks for getting the thing out.”
He pats me on the back. “My pleasure,” he says.
In the ER, they give the woman several breathing treatments down the tube, IV fluid, and steroids. They will keep her in the hospital for a couple days, then she will go home to her family.
Later, driving through the city, I think there are days when the city seems sharper, more colorful. You see people’s faces, their individual smiles. Amid the din of sounds, you hear human voices, laughter. You feel a part of the life.
“You all right?” Arthur asks.
“Yes, I am, I’m fine,” I say.
Change
The company gives us a new schedule. Instead of three twelve-hour shifts, we are all to work two twelve-hour shifts and two eights. That means another fifty-two days of the year I have to go to work. We rebid the schedule. Partners who have worked together for years are broken up. I lose my shift with Arthur and end up moving to nights.
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