EMS World

 

 

EMS World

 

February 19, 2015

She Takes Care of Us

The PA system hums for a moment, then the tones go off, followed by the dispatcher’s voice:

“Rescue 2, a still alarm, Rescue 2.”

We have a few moments to drop what we are doing, tune our ears into the message coming from the speakers and head for the ambulance. The Hartford Avenue firehouse is two stories, the living quarters above the apparatus floor. I take the pole. Before my feet hit the ground the rest of the message is transmitted.

“Rescue 2, respond to The Projects, on the first floor, apartment 1001 for an elderly female who is vomiting.”

We leave the station with the hum of the speakers still in the air and turn left toward the address. I can sense the place before I see it, gloom and oppression ooze from the walls of the run-down apartments, chain link fencing, chains and giant locks are everywhere, bars cover the first floor windows making the place look more like a prison than a place to live and raise a family. But somehow kids keep filling the apartments here, more often than not left to run the place as they choose with little or no parental supervision. Gangs run the show, and the kids who choose to not participate live their lives in fear.

We find the apartment. It is a tiny first floor place, one bedroom, one little bathroom and a kitchen connected to a sitting room. It is full of stuff, but immaculate. Three teens have gathered in that little sitting room, two girls and a boy. One of the girls pets a scruffy little dog that looks at me as I enter, cocks his head and wags his tail. The girl holds him tightly, and tells me he’ll try to run out the door if she lets go.

Another teenage girl stands outside the bathroom, the door cracked a little. She appears to be the eldest, and in these projects that usually means she is in charge.

“I think she has food poisoning,” she tells me. “She ate some fish at a restaurant an hour ago and can’t stop throwing up.” She whispers, so the others won’t hear, “and she has diarrhea.”

A little old lady sits on the toilet, soaked with sweat, one end in a bucket, the bottom full of vomit, the other end on the toilet, which she reaches back to and flushes. She looks like death warmed over. The three kids stay in the living room, the old lady vomits some more and the other girl tries to help.

The old lady asks the girl to have the other kids step outside for a minute. They do without a complaint

“She has HIV,” the remaining girl tells me, softly so the other kids won’t hear. “And she can’t stop going to the bathroom.”

“Does she speak English?” I ask.

“Just a little.”

“Tell her it’s okay, we’ll take care of her.”

The girl says something to the old lady while Brian gets a few sheets and lines the stretcher with a chuck. She appears to relax a little, and submits to her fate.The other kids come back in, and gather around. We wrap the old lady first in her robe, then in some sheets and walk her through the crowded apartment and onto the stretcher.

“What is her date of birth?” I ask.

All four kids answer at the same time. The lady lies there, on the stretcher looking miserable. The kids are concerned. Genuinely concerned. They are polite, respectful and worried.

“Is she your grandmother?” I ask.

“No, she takes care of us.”

I look around me, and what I see is remarkable, considering what lies on the other side of the door:

-The dog

-The food in the kitchen

-A little TV in the corner

-Little rubber matching bracelets on the kids’ arms

-Their clothes, clean and almost new.

I feel the oppression melt away as the impromptu honor guard forms around the stretcher, and we wheel the little old lady with the heart of a lion into the cruel world outside her little oasis. The clean little apartment in the heart of the projects where murder, mayhem and misery normally rules is a beacon of hope in a violent place, a safe place where young people don’t look like thugs, have manners and actually care enough about a little old lady to know her birthday without thinking.

They surround the stretcher as we wheel it toward the ambulance. One of them, the oldest, comes with us; the sick little old lady leaves her door open so the rest of the kids have somewhere to go.

 

June 21, 2013

The Throne

“Rescue 5 and Engine 3, respond to Dorrance at Westminster for an MVC, public bus involved.”

“Rescue 5, responding.”

Great. A mass-casualty incident to end the shift. How do I know a mass-casualty waits? Just you wait and see. In the 24 hours I’ve been in charge of an advanced life support vehicle in the city of Providence, the only advanced life support I have given was the two bucks I gave to Moriarty, one of my regulars, who no doubt will use the loot to advance his drunken condition.

“Engine 3 to Fire Alarm, on scene, minor collision, bus vs. car, no visible damage, five victims.”

“Rescue 5, received, on scene. Send two more rescues, I’ll keep you advised.”

“Roger, Rescue 5, at 1715 hours.”

Told you so. The radio clacks away, dispatching more resources to the scene. Rush hour in Providence is no picnic, and a confluence of fire and police vehicles in the heart of downtown will do nothing to alleviate that situation.

The driver and occupant of the vehicle the bus tapped into are out of their car and denying injuries. The firefighters are in the bus doing patient assessments. Two of the guys have one victim packaged, and they carry him out the side door and bring him to Rescue 5. I do a visual triage, see the wounded in various stages of posturing, decide the toe tags can stay in the box and make my way back to the rescue.

Rescue 5 to Fire Alarm, have those additional rescues respond Code C.”

“Roger.”

I’m back in my seat, my patient is waiting.

He’s homeless, lying backward on a spine board with a cervical collar around his neck, looking up. I’m employed, sitting in a captain’s chair, facing backward and looking down on him. This is just another run for me, one of thousands. It’s his second time in a rescue. The first time, he fell when a stairway in a seaside mansion he and some employees from his company were restoring collapsed. They had loosened the risers so they could get behind the steps and remove a hundred years of paint that had accumulated. Time moved on, days then weeks, and eventually the loose stairs let go, with him on the top step. Sixteen feet to the concrete basement. A few spikes in the leg didn’t slow the descent, but they did take his Achilles tendon.

Disability followed, then drug addiction. Then his wife was diagnosed with breast cancer. Then he took care of her, though their money was gone. He sold the Harley. Then the truck. Then what was left of the business. She never knew the depths he’d sunk to, and she died thinking he’d be OK.

He’s not OK. He lives in a homeless shelter and hopes this accident will be the break he needs—a couple grand for pain and suffering, maybe a Percocet of two for his troubles, and a fresh start. His calf muscle had atrophied; he showed me what was left before we arrived at the hospital. It was ugly. Medicaid wouldn’t cover a cadaver graft, he told me; it isn’t a life-threatening condition.

It may not be life-threatening, but it certainly is life-altering.

A fall from the top step.

I had stopped looking down at him by the time we reached the hospital. I never should have been looking down to begin with.

Talking to patients is dangerous. Seeing them for whom they are, not whom I want them to be, forces me to be kind and compassionate and takes me down from the throne it took me an entire shift to build. A cynic can laugh his way through just about anything, and the job becomes just that, a job, something to do to make money.

Losing that attitude and realizing that the trip from the palace to the gutter could begin at any moment is sobering, and the perfect way to end a shift. My family deserves to have the same person who left for work come home at the end of the day.

We’re not that different, the people who call and the people who respond. Not that different at all, when you stop and think for a minute. Think, and listen.

 

September 3, 2015

Today’s Heroes, Yesterday’s Quotes

“To know one life has breathed easier because you have lived. This is to have succeeded.” —Ralph Waldo Emerson

“Engine 10 to Rescue 1, eighty year old female, respiratory distress, possible CHF.”

“Rescue 1, received.”

We turned the corner onto a narrow dead end street. The door of the last house on the left was open with frenzied activity just beyond the threshold.

“Get the chair,” I said to Adam and entered the home.

“230/115, pulsox 68%,” says Ted, as I approached the patient. She was struggling to breathe, as her lungs were full of fluid. The oxygen mask covered the bottom half of her face, and her eyes were panicked.

Adam set the chair up next to her. The guys from Engine 10 picked her up from the couch and got her ready to move. Seven or eight family members stood nearby, some worried, some afraid and some near panic.

“What is her name?” I asked.

“Auriela,” one of the women answered.

I took a nitro from the bottle I had in my pocket and had the woman tell Auriela to put it under her tongue and let it melt. She struggled for a while then understood. A minute later we were in the rescue. Ted was applying EKG leads, and Adam was starting an IV. I  was preparing an albuterol treatment.

“I’ll give you a driver and an extra set of hands in back,” Frank, the officer of Engine 10 says, closing the rear doors of the rescue.

“Let’s roll.”

We began our journey toward Rhode Island Hospital with three of us in the back with the patient, a firefighter from Engine 10 driving the rescue and Frank and Paul following with the engine. Another nitro en route, 40 ml of Lasix and the albuterol treatment seemed to be effective. Auriela’s eyes stopped darting, her breathing slowed as her lungs cleared and she managed a little smile. The frantic activity in the back of the rescue slowed in rhythm with our patient’s breathing. There wasn’t much more to do but comfort her and let her know she would be all right. She didn’t speak a word of English, and we barely spoke a word of Spanish, but all of us knew she was out of the woods.

We arrived at the hospital. The rear doors of the rescue opened and there stood one of our guys, an off duty firefighter from Engine 11. I looked at him for a moment, confused.

“That’s my grandmother,” he says as he helped us wheel her in.

Twenty minutes later he shook my hand as we were preparing to leave.

“Thanks, Mike, you guys were incredible,” he says.

I can’t imagine a more satisfying job than the one I have.

How do you like them apples, Ralph Waldo Emerson.

And speaking of Ralph, here’s another;

Every man is entitled to be valued by his best moments.”

Entitlement and reality are far different entities. While I’m in a scholarly mood, I figured I would mention William Shakespeare addressing reality in a speech from Julius Caesar;

“The evil that men do lives long after them, the good is oft interred with their bones.”

So it is in the fire and EMS business. We are only as good as our last act. Today’s hero is tomorrow’s villain, and tomorrow’s villain will still be a villain even if the day after tomorrow he becomes a hero.

It takes time to erase a major mistake. For some strange reason we love nothing more than to focus on people’s shortcomings. Perhaps we feel better about ourselves when others are exposed as having human frailties.

Just keep in mind, everybody gets a turn, and ours is coming. It’s just the way it is. So relish those moments when everything goes as planned, and savor the fleeting seconds when you can bask in your own greatness. Keep striving to do great things, and maybe you will be valued by your best moments, and the dumb things we do will be interred with our bones.

 

July 26, 2013

Birth

The bottle was wet and sticky, and I knew in an instant it was definitely something I’d have been better off not touching. I dropped it back into the plastic shopping bag and looked back in, this time a little more closely. The clear vial, a spice container in another life, lay on its side, spices gone, something else in their place, stuck to the bottom. The essence of cloves escaped from the bag when I opened it, but even that scent and the fond memories it conjured, holidays and things cooking in the oven as the family gathered for a feast, could not mask the revulsion I felt.

I looked at my hand, mesmerized, my fingertips glistening from the contact with the vial. I sat there looking at it like the disembodied hand of somebody else as the rescue sped toward Woman and Infants Hospital a few miles away. I moved my fingers as if in a trance, and the dim fluorescent lighting flickered a little, snapping me out of my reverie. My stomach rolled, a little vomit tried to make its way from the bottom of my stomach. I forced it down. The vial of hand sanitizer was just out of reach, over near the heart monitor. I leaned on the back of the stretcher, and the stretcher tilted back, toward me, and the lady on it never moved. I grabbed it, pumping 10 or 12 times, filling my palm with the antiseptic lotion, then rubbing my hands together as we rode in silence.

My patient was stable for now, crying softly to herself in the stretcher as one of her sons, a young man of 10—in a household that has no English-speaking adults, 10-year-old boys quickly become men—looked on. He came with us to act as an interpreter, only no words needed to be translated. He just looked at his mom, then the floor, then shyly at me, then the floor again. I dried my hands on a towel, wiped the back of the stretcher and closed my eyes.

We backed into the rescue bay at the ER; the truck stopped, the sobbing did not. The patient’s other son, husband and 8-year-old daughter waited for us outside the rescue, greeting us when I opened the rear door. Only the 8-year-old girl smiled. She put her hand on the stretcher as we wheeled her mom in.

The nurse working triage asked what we had. I explained the story to her quietly, trying to keep the confidentiality intact.

“We were called for a woman having abdominal pain following an abortion. She was lying on the couch when we arrived. Her husband handed me this.” I opened the bag and showed her.

The nurse looked at the blob of tissue drying in the bottom of the bottle. It had resembled a fetus prior to spilling in the bag and onto my hands. She closed the bag, signed my report and took the patient in the back. I washed my hands again and said good-bye to the family.

I have held babies in my arms, pumped on their chests, intubated them, defibrillated them, watched them die, seen children abused by their parents, bandaged their broken bones, dressed their burns, comforted them the best I could, pulled critically injured kids out of demolished cars and pulled their lifeless bodies out of burning buildings, but nothing affected me as profoundly as the unborn fetus that accidentally spilled onto my skin. Long-held opinions concerning reproductive rights were questioned, my belief that life does not begin until birth was questioned, and my long-standing ability to separate my emotions from the job that needed doing was destroyed, all by a little tissue at the bottom of a vial. That the tissue was undeniably an unborn fetus, complete with a head separate from the body and what I swear was an eye, probably had everything to do with my reaction.

In a different home on the other side of the city a 40-year-old woman was having contractions. When the time between them grew closer, she called 9-1-1. When we arrived, she was quite concerned, and told us that she was going to have her baby any minute.

“When is the baby due?” I asked.

“I was just at my doctor’s yesterday,” she said, and grimaced. I looked at my watch. Two minutes. “She said everything is fine, my due date isn’t for two weeks.”

The patient insisted on walking to the ambulance, and did so quickly.

“I’m having this baby now!” she told me as she stepped in.

“Impossible,” I said, clinging desperately to every last chance that I would not have to deliver on the stretcher. “Your due date is in two weeks. They are never wrong about that.” I sounded so certain that I actually believed it was true.

“Now!” she shouted, and off came her sweat pants, and on went the gloves, and sure enough, the crowning head of an infant appeared.

“You’re having this baby now,” I told her, as if I knew it all along. My attempt to trick her into waiting for two weeks, or at least until we arrived at the hospital had failed miserably. She gave me a perfect motherly look of admonition and pushed.

I placed the palm of my hand on the baby’s head, applied a tiny bit of pressure, then for some inexplicable reason rubbed her belly in a circular motion, almost like her abdomen was a genie lamp, and the infant would simply appear and say, “Your wish is my command!” Instead, she groaned and then my hand, arm and shoulder were inundated with bodily fluids and a baby was between her legs on the stretcher.

Some suction, a clamp here, another there, a cut, a dry-off and then a handoff, and I sat back on the bench seat, closed my eyes for a moment and realized that it doesn’t matter what I think or how I feel; life comes at you at all speeds and directions.

“It’s a boy,” I told the beaming mother, who held her baby like she would never let go.

I changed shirts and washed up a while later, and only then did it occur to me that I had just been covered with 100 times the amount of bodily fluid as I had before, and it didn’t bother me a bit.

 

June 15, 2012

Old Man’s Body

A middle-aged man in an old man’s body shuffles into the back of the rescue, groans, and then sits heavily on the bench. I follow and take my seat in the captain’s chair. He’s 53, looks 75, and has been vomiting blood for two days. This isn’t the first time I’ve taken him in for similar problems, but it may be the last. He’s about done.

“You have to stop drinking.”

“I been good for two months, just a couple a day.”

“That’s too many, you have cirrhosis of the liver.”

“My doctor said I could have a drink now and then.”

“When was that, 1968?”

He looks away, first out the rear window, then at the floor. His vitals are stable, amazing how little vital signs actually tell us. He is dying. I look at him as we ride in silence toward the emergency room, knowing that within a month or two he will be dead. For now he maintains that strange fearless optimism, thinking he can go on drinking forever, as if the party will never stop. His body has quit, his mind never really got going.

Good luck, David, I say to him as we leave the hospital. He nods and looks around the ED, looking for somebody to talk to.

In a few hours he will be released, back into the city, back among his “friends.” Those friends dissipate as the money dries up, and are completely gone when it disappears. Life on the streets is a lonely one; the lack of a roof over one’s head, or walls to give room definition, is more oppressive than any confined space could ever be. It’s too big, simple as that. Walls offer intimacy, family and safety. Living in the “Great Outdoors” is overrated.

We ride back to the station in silence, lost in our thoughts. I have no idea what Adam is thinking, I’m sure the faces of dozens of similar people with similar stories are not running through his head. As the years add up, the body count rises, people who gave up, let their disease win and died alone. Adam hasn’t witnessed the parade yet, but he will. It is inevitable. In a few years, he will have seen his share come and go; for now, I envy his status as a “new guy.”

Few make it out of their fifties. The ones who do end up in a state-run nursing home, with wet brain, dead liver, heart problems, diabetes or any number of ailments that resulted from hard-lived lives.

If I did not know these people personally and saw them as people with a can on the off-ramp and a cardboard sign that says “Will work for food,” it would be much easier. They would just be gone, and I would never have known. But I do know them, and it kills me to see them kill themselves slowly, and there isn’t a damn thing I can do about it. I take them to the ED for detox, and they get the same treatment they did yesterday. They ignore the same doctor’s orders and wait for a bed in a psych unit to open up, but those beds seldom open for homeless alcoholics.

It doesn’t take long for another one to call. It’s another familiar face, in the same spot as always. We help him into the truck, Adam gets in front to drive, and I stay in back and try again.

“Barry, you’re nearly 60, you have to stop drinking.”

He had been lying on the sidewalk, empty vodka bottles next to him, his painter’s pants soaked with his piss.

“I’m trying.”

“There’s no time for trying. You have to stop.”

He gave me a lopsided grin, and the sparkle in his eye was all I had to see.

“You have no intention of stopping.”

“I said I was trying.”

I worked with his brother. They were brought up in the same home with the same parents, went to the same schools, had the same friends. They drank together, got in trouble together, got older together. But Greg grew up; Barry stopped growing when he took his first drink. Something grabs hold of an alcoholic and doesn’t let go until that alcoholic lets it.

“Barry, let it go. You still have time. Call your brother, maybe he can help.”

He looked at me like I was crazy.

“My brother? He don’t have nothin’ to do with me. Big-shot fireman, got all the breaks. I got nothin’.”

“Nobody gave your brother anything, he worked for it.”

“Yup, and I drank my life away.” He laughed at that, not a healthy laugh; rather the cynical snicker of a person who thinks the world is not a fair place.

“No, Barry, you’re drinking your life away. You still have time. Do you want people to remember Barry the Bum, or Barry the man?”

“I been Barry the Bum so long I forgot who Barry the man is.”

He looks down at the floor of the rescue, the sparkle in his eye extinguished.

Sometimes I hate getting through to them. Sometimes I wish I could just keep my mouth shut and let them go on in their alcohol-fueled haze, living on the streets, begging for money and dying before they get well.

But I can’t. One of the most important things keeping an alcoholic sober is helping other alcoholics. Even if that means breaking them.

But a broken man who knows he is broken can start to rebuild. One who doesn’t see it doesn’t have a chance.

I help him into the ED. The tech has him stand in the crowded room while she gets some sheets and a chock to put on the wheelchair so that his piss doesn’t seep in.

 

October 23, 2013

Listening

 

She reached into her purse, dug deep with shaking hands and found what she was looking for.

“You’ve been very nice, I want you to have this.”

I looked around, made sure nobody was looking and conspiratorially took her offering.

“I really shouldn’t,” I whispered; “We’re not supposed to take gifts.”

“You deserve it,” she said, then sat next to her ninety-three year old sister, who we had just brought into the ER. Another sister stood at the foot of the hospital bed, watching everything. We had just left their home, the one they had lived in since birth. Their father built the place, in the North End, back when the family garden took up two lots. Now, those fertile fields are filled with more houses, and more people, most of whom don’t give “the old ladies” the time of day.

“Make sure you give some to the other man,” she said. “He was nice too.”

Back in the truck we split up the bounty. There were five altogether; I took three and gave John two. Rank has its privileges.

“What’s this?” he asked.

“A token of appreciation from a person that time has forgotten.”

“No, really.”

“One of the little old ladies gave them to me. She told me to tell you that you were nice.”

“That was nice.”

“Yeah it was.”

I live for those moments of grace that happen when I least expect it. What could have been a mundane call for a routine transport turned into a trip down memory lane for three nice ladies who came from a different Providence than I now occupy. The patient was stable, but needed medical attention, and still managed to join her sisters as they described their home and how it was “back in the day”—when boys would try to date them but their father forbade it, and they would walk Charles Street together and people would greet them kindly, and men in carts sold fruit, or meat, or even rags. What had started as a ride to the hospital became something else entirely, and the three ladies were transformed from their tired, old selves into three energetic, mischievous people with some great stories to tell. They loved telling them, and having somebody to listen attentively made all the difference.

Listening is easy, when you take the cotton out of your ears and put it in your mouth, as a different “old-timer” once told me when I couldn’t hear what he was saying because I was too busy talking. Having three sisters who had lived a total of nearly three hundred years in my company was the perfect opportunity for me to let them be heard, and appreciated.

It never fails to amaze me how beneficial listening is to people who may not have a lot of people left in their lives to talk to. Simply listening attentively as the ladies went back and forth improved the patient’s condition considerably; her back pain from a previous fall may have still been present, but her vitality had returned in the brief time that we were together. She started moving her hands as she told me about the roller skating rink that used to be where a rundown apartment building now stood.

The radio clicked to life, taking me away from my reverie.

“Rescue 1; respond to Elmwood Avenue for an elderly female with a dog bite.”

“Rescue 1 on the way.”

She never heard the dog coming as she rummaged through the trash, looking for something, anything of value. She’s been at it for years, one of those characters that make the inner city so colorful. She doesn’t bother anybody, and everybody knows her, but nobody knows her name, or where she rests at night, or if she has family close by. She’s a ghost, maybe, one that simply appears, finds some things to keep her going, and then slips back to where she came from.

The dog didn’t believe in ghosts. He got hold of her leg, twisted and shook, took a big chunk of her calf with him, and spit it out on the ground next to where she lay. For such a little lady she sure held a lot of blood. The German Shepherd was simply doing what dogs do, defending his turf. He gave the lady a warning bark, which she ignored—not because she wanted to, but because she is deaf and mute, which is something I didn’t know until I had her as a patient and she couldn’t tell me anything about herself or her injuries.

I calmed her fears the best I could, John gently cleaned and dressed her wounds, and we smiled at each other as we rode the bumpy streets toward the ER. I wasn’t able to find out much—no name, no date of birth, no pertinent medical history—but I did manage to make her comfortable, and she was able to relax somewhat as we took her away from the streets, which were more than streets to her; they were her home. A Cambodian interpreter at the hospital fared no better. I guess there is no such thing as Cambodian sign language, just the universal kind that is understood by people who understand that way of communicating. I didn’t know that there is only one official way to do sign language; it never occurred to me and I always assumed that there was Spanish, Russian, Chinese and every other language represented by the hand movements.

I do know that when I peeked into her room an hour or so after I brought her in, she recognized me and smiled, and pointed to me and then the door, and nodded her head up and down. I think she wanted me to take her back to where I found her. I tried to listen some more, but the doctor and social worker came in, and she stopped smiling. They closed the curtain, and she was gone. But her smile remained for the rest of the shift. I heard that, loud and clear.

 

September 6, 2012

Familiar Place

Two years ago, at midnight, I entered a house on a busy street in one of the roughest neighborhoods in Providence. Inside was a wonderful couple, him sick with congestive heart failure and other ailments, her taking care of him. He was a big man, nearing the end of his time. He was lying in a bed in a room at the rear of the 100-year-old place, confused, combative and soaked with sweat. Evidence of the life they shared was everywhere—pictures of family covering the walls, dishes drying in the sink, half a loaf of bread on the counter, a half-folded basket of laundry off to the side.

Combative ailing people don’t bother me much. There generally isn’t much venom behind their anger; most often it’s the result of an underlying medical cause. “Harvey” refused to let us take care of him, refused to leave his bed and had refused to eat or drink for a few days prior to his desperate wife calling us.

“He won’t even eat the bread,” she said, exasperated. Women, especially wives, usually have the power to make their mates bend to their wishes. This time she met a stiff wall of resistance. “He’s a longshoreman,” she explained. “Stubborn as a mule and dumb as a post.” She stood there looking at him, arms crossed, in the home they had shared for decades, where they’d raised a family and lived their lives together, the sparkle in her eye still alive. He looked back. A light went on in his fevered mind, and some clarity snuck in, and he simply said, “You win. I’ll go.”

My partner had the stair chair ready, but Harvey adamantly refused to be carried from his home. Somehow he found the strength to walk the 50 steps to his front door, then allowed us to help him down the steps, then up the steps into the rescue. I questioned my decision to let him walk—it went against everything I believed in. Having people who shouldn’t walk walk out of their homes to the rescue is simply bad form. Unless the sick person is Harvey, and he had a premonition, and nothing I said or did could stop him.

I think I made the right decision. We took the couple to the hospital, she chatting all the way, him holding her hand and smiling when she mentioned something good. We dropped them off at the ER. His condition warranted a critical care room, as we suspected. His temperature was 103ºF, blood pressure 210/124, oxygen saturation in the low 90s, and respirations shallow and rapid. Our IV, the nitro and the Lasix we passed through the line, along with the albuterol treatment administered en route, helped a little but not enough.

Other patients waited. We said our good-byes, handed care off to the emergency room team and went back into the city for more.

A few hours later I returned to the ER with somebody else but took the time to visit Harvey and his wife. He was lucid now; she smiled as I shook his hand and deflected the genuine thanks he offered, saying the usual “It’s my job” things. I don’t remember now what caused his confusion; I do remember them telling me his blood work was way out of whack, and the IV fluids from us and whatever else they gave him at the hospital worked wonders. He was funny and kind and appreciative. So was she. I was happy to have helped them. It was a “good” call.

I saw his picture on the obituary page two days later. He died that night. At least he walked under his own power out of the place where he raised his family and into whatever awaited.

“Rescue 5, respond to 898 Finnegan Street for a cancer patient with difficulty breathing.”

“Rescue 5, responding.”

Sometimes I think there isn’t a house in Providence I haven’t been to. Some I’ve been to more than once. We entered the familiar place and found our patient. We helped her into our stair chair and carried her out and into the rescue. Her daughter came with us.

“Was your dad a longshoreman?” I asked the 40-ish lady who now occupied the same bench seat her mother did two years ago. Now her mother lay in her father’s place on the stretcher, battling lung cancer, bald, skinny, feverish and sick from radiation.

“He was,” she replied, curious.

“I knew it was you as soon as you walked in,” said the little lady on the stretcher, smiling. “You are a good man.”

“So was your husband. He made me laugh. I’m sorry he died.”

“You came to his wake.”

“I did.”

The funeral home is in Rescue 5′s district. Something possessed me to pay my respects. A large crowd of people attended. One hundred black people and one big white guy. I went through the line, the woman now dying on my stretcher taking the time to introduce me to nearly everybody there, even the funeral director. They treated me like royalty. Must have been the uniform. I’m glad I went.

Brian started an IV, took her temperature and got some vital signs. “The IV fluids will help the rapid heart rate,” I explained to the daughter as her mom rested.

We rode peacefully through the tired neighborhood toward the hospital. This was the final call for Brian and me of a particularly brutal 38-hour shift. In a city full of characters reside people who possess more character than many could imagine, and live quiet, productive, satisfying lives in little houses in rough neighborhoods.

When we had been dispatched at 0612, the sun had just broken the horizon. Now I sat in the captain’s chair and felt the familiar roadway under our tires and closed my eyes. The sun shone through the dingy rear windows, and I rested, knowing that the woman and her daughter found comfort in my presence, and I in theirs.

 

October 12, 2012

Repeat Visitor

A little break in the action, just in time. I’ve been running since 0700 hours. No downtime today, a steady stream of people needing help.

“Without all these people this job would be a piece of cake!” I once joked with a partner. In reality, without all these people there would be no cake at all. It’s “the people” who make it possible to work the long shifts with so little rest. They come and go for me, most forgotten as soon as the folks at the ER take over, but some stay on my mind for hours, even days after they leave. A special bond forms between the sick and injured and the people taking care of them, if you let it, and much can be learned simply from sharing the experiences of those we treat.

My head hits the pillow, and I’m gone, sweet blackness, no dreams, no tossing, no turning, just me and unconsciousness. I call it death sleep. I’ve never actually been dead, but days like this lead me to believe it might be preferable to consciousness.

My body has melted into the bunk, and the mattress, bought after the blizzard of ’78, feels like a priceless feather bed, not the plastic-coated, springy thing it is. It is amazing what 30 hours of constant awareness does to a person’s needs. I could sleep on anything now, and as the minutes of unconsciousness add up, the body begins to recuperate.

Blinding light wakes me. I’m not certain how long I’ve been out, but it must have been a while. I’m refreshed and ready to roll. The tones are far better than the bells that would rattle my bones all those years ago. It seems like yesterday, my bunk directly under the Gamewell Giddyup, lying on top of the bunk, more tense than the spring in the bell, waiting, waiting, waiting…

Some nights it never went off, and I actually would doze off and on till shift change, but it took me years to relax enough to fall asleep under that thing. A veteran firefighter once told me there was nothing we couldn’t handle, so relax and get some rest. It took me years before I believed him and stopped imagining the unimaginable things that could happen on my watch and how best to respond. He was right: Whatever happens, we can handle. We may not always save the day or somebody’s life, but we do what we do with what we have, and go as far as our training allows us, and we do our best.

Twenty years goes by in a blink of the eye, and I rub the sleep from mine. The digital clock on the dash reads 4:23. Little birdies start their chorus early this time of year, and their song escorts us out of the building and into the predawn solitude. Nobody is on the road, not a soul. A few lights burn low in the houses we pass; a stray dog, some rats and a gentle breeze pushing the previous day’s litter away from the curb are our only companions.

It’s Gayle who called. She lives on a folding chair next to an abandoned building. Sometimes her niece lets her stay with her, usually at the beginning of the month, when the disability check makes its monthly appearance. Her niece spends the $700 on men, booze and lottery tickets, according to Gayle, and when the money dries up, she’s out, back to her chair.

She sits there most of the day and into the night, occasionally shuffling into a store for a bite to eat or to get warm for a minute, but she is a large woman, and homely, and wears the aroma of street living. The proprietors of the shops quickly dispose of her, giving her something to keep her quiet, because if they don’t, she will make such a fuss the police will be needed.

The cops don’t know what to do with her, so they call us. She’s a hard woman, mean as a snake and bigoted beyond belief, calling me “white boy cracker” and my Asian partner “the walking wonton.” She is not fond of the Latino population either, and continually ridicules her fellow African-Americans, calling them Uncle Toms or worse.

She likes me. I have no idea why. Other than the white boy stuff, which she says out of habit more than vitriol, she’s polite and cooperative. But she’s also 400 pounds, and her home is broken, the tiny legs finally giving up and collapsing under her weight.

We lift her onto our stretcher, my own tiny legs nearly collapsing, and she starts to cry. Bearing witness to the surrender of a person so used to hardship is nearly impossible to watch. She’s obese, ugly, mean and alone. None of the area hospitals give her more than the bare necessities, and rightly so; she has burned all of her bridges in the city.

The hospital waives their restraining order for tonight, but additional security is needed to keep an eye on Gayle while she’s treated for her phantom chest pain. People who live on the streets know the buzzwords that will get them in. Chest pain, difficulty breathing and suicidal work much better than alone, tired, hopeless and cold.

Once she’s comfortable, perched on her stretcher in the triage area, off the streets, her demeanor changes once more, and the glint returns to her eye, and her eyes dart back and forth, waiting for somebody to engage her. She’s wound up tight, much like the springs in my mattress and the one that used to wind the alarm bell so long ago. We make eye contact just before I turn to leave. No words are spoken, just the acknowledgement of familiarity that to me means little but to her means much more.

At 0500 I’m back in my bunk, the plastic mattress feels like a fine feather bed once more. I close my eyes, and blackness takes over.

 

April 26, 2013

Compassionate Care

I spent nearly an hour in her home, talking with her friend, learning why she refused to get out of bed, refused to stop drinking and refused to join the rest of us in life. Her boss had been there earlier, poured two bottles of vodka down the drain and left with her wallet so she couldn’t get more. She had no family to speak of, just a brother in Maine whom she didn’t speak with; parents dead, and her husband of 20 years dead since August.

A giant black German shepherd cried incessantly at the rear door during what I call negotiations; eventually I let him in and befriended him. You can read a lot from the look in a dog’s eyes, and this big guy was inconsolable. I think that may have been the breaking point—she showed some signs of life once the being closest to her showed concern. She got out of bed, threw on some clothes and gave in.

“I’ll go.”

Her friend closed up the house, promised to take care of the dog and simply looked relieved as this drama seemed to be heading in the right direction. A friendship with an alcoholic is trying, disappointing and frustrating, but ultimately worth the trouble once the disease is put on hold. A cure is unlikely; remission of symptoms and effects are the best one can hope for. Remembering that this is not a bad person trying to be good—but a sick person trying to get well—puts things into perspective, and lets some hope for recovery seep in.

What had started as a seemingly hopeless standoff actually looked like it might have some sort of happy ending. I’ve done this a few times, and it’s never easy. Somebody is refusing to take care of themselves—drinking, not eating, not bathing and just waiting to die. I cannot make them get help if they don’t want to. Just because somebody else thinks it’s in their best interest to get on with things is no reason to drag somebody from their home and force them to rejoin society. It’s still a free country. We are free to thrive, or not.

That being said, I’m free to use all of my powers of persuasion to make a difference. It’s one of my strengths as an EMT. Some of us are great clinicians, others born to teach. I’m more of a therapist. Every now and then I get the tough stick or impossible tube, but talking has always been my strong point. Even if it’s just talking to the dog that makes the patient pay attention, get dressed and get in the rescue. Whatever works.

We rode to the hospital, me and this desperate 44-year-old widow. She was still reluctant to give up the life she had been living since her husband’s death. But she had the courage to get going, this being the first step. I did my best to explain the procedure at the ER—how it can be cold and impersonal at first, but when she gets to her room and wakes in the morning the healing can begin, for real. I think she believed me.

I had her on the stretcher because she really couldn’t walk that well. We wheeled her into the busy ER. The triage nurse barely glanced in our direction.

“Can she get off the stretcher?”

“Not really.”

“What do you mean, ‘not really?’” A look of disgust from the RN.

“She’s hurting.”

“We don’t have any beds. Put her in a chair and throw her in the waiting room.”

Throw her. I swear to god that is what she said.

When you lose perspective and compassion, it’s time to find a new job. Maybe administration, maybe retirement, I don’t know, but get the hell out of the ER.

Perhaps if she had spent an hour in this patient’s home—seen the wedding pictures over the mantle; the notes from her dead husband still on the refrigerator; the dog, well taken care of and still mourning the loss of his master; the NASCAR posters and cars in the living room; the man’s sneakers still in their spot, only unfilled for five months now (probably longer, considering he fought a two year battle against cancer)—she wouldn’t have said, “throw her in the waiting room.”

After explaining the situation, and seeing my words fall on deaf ears, I realized the RN actually would have left her there, alone, to rot.

I swear I will never be that kind of person, no matter what comes my way.

I stayed with her until I found another nurse, and a compassionate registrar, and made sure she was OK.

Her friend walked in and I left the hospital; all I can do is hope for the best. People make our healthcare system work. When some of those people are broken, the entire system suffers. A broken link in the chain of patient care can throw all the good done up until that point into the trash, rendering everything we’ve done useless.

 

August 6, 2014

More Than a Transport

It’s Sunday, 1230 hours, and we’re dispatched to a home on Wickenden Street for an emotional female. We arrive on scene to find a female crying on the front stairs. She points to a door. It leads to a basement. At the bottom of the stairs, next to the washer and dryer, is a boy hanging dead from the ceiling joist. He has only been dead for a short time.

It’s Sunday, 1258 hours—the same day, just a few minutes later—and we’re dispatched to a home on Potters Avenue for an emotional, suicidal teenager.

Did I take the threat seriously? You bet I did. And every one that followed. It helped me to have a plan.

Strategies for Helping a Suicidal Person

When called for a suicidal person, my main objective is to get them from wherever they are to where they need to be—a hospital with psychiatric facilities. The only training I had for dealing with suicidal patients came at the end of ropes, neckties, extension cords, bullets, bridges, opiates, razors and trains. And poison. Seeing the result of a person’s decision to take their own life prompted me to do anything and everything I could to learn how to be of help to somebody who’s suicidal. Seeing the bodies of people for whom help never came made the threat real, immediate and very much a possibility.

A person contemplating suicide needs professional help. By calling 9-1-1 they, or the concerned party who made the call, expect that help to arrive. They do not expect an EMT or paramedic to respond with little or no idea how best to help, or a provider whose own ideas about suicide cloud their ability to assess, treat and transport that suicidal person. They do not need a person who is there simply to get them from point A to point B. They deserve somebody who cares, somebody who understands the gravity of the situation, somebody with a plan. I do not want anybody to die by their own hand, and the small amount of time I have with a suicidal patient may be the time that matters to the person thinking about doing it.

Here are a few ideas I’ve developed into a working plan, based on resources I found at Helpguide.org and Suicide.org, in an effort to learn all I could about saying the right things to suicidal persons:

Listen: Never act shocked or disapproving.

Comfort: “You are amazing, unique and awesome; I like you, a lot of people like you.”

Respond: “Ending your pain and ending your life are very different courses of action.”

Ask:

  1. Are you “suicidal?”
  2. Do you have a “method?”
  3. Do you “have what you need?”
  4. Have you figured out “when?”

Connection Counts

Let the person know you’re deeply concerned. Do not be afraid to talk about suicide, and let the person vent, shout, swear, cry, tell you their plan—anything but be alone.

Find a way to convey this simple fact, which may keep them alive: you have witnessed suicide and felt its repercussions, you have helped family and friends who have discovered the bodies, and you, as the person behind the uniform, still feel the effects of the devastation each and every person you’ve responded to who successfully committed suicide has left behind. Let them know how you feel, even as a stranger to the people who gave up, and that you mourn the loss of their presence and the life that could have been lived had the proper help arrived in time.

Perhaps your voice will be the one that makes the difference, turning the switch in their heads back to living. Our words and actions are incredibly powerful. We may be outsiders but we have the opportunity to be perceived as confidantes, and maybe even a person who truly understands.

 

March 5, 2013

A Hundred Years from Now

 

I scramble around, working like a fool—thousands of EMS calls a year, every year for 20 years, trying to make a difference, thinking I have, hoping it isn’t all for nothing. I know that in 100 years every person living now, at this moment, will be gone and all new people will inhabit Earth. The overpowering urge to do something that matters dominates my thoughts when I think of things like that, how fleeting our time here actually is and how soon we will be forgotten.

That I am a rescue captain on one of the busiest ALS vehicles in the country counts for something, I think. At least I tell myself so. Some days things all come together, like there is some cosmic plan where everything makes sense. Other days, not so much:

Dim lighting illuminates the living room turned bedroom. A commode sits by the window, recently cleaned. The smell of Lysol mixes with the smell of dying, the familiar aroma that stays with us as we journey through the years. The couch is pushed to the side for now, but it will be back in position where the hospital bed now sits—tomorrow, maybe; definitely by week’s end. She’s tired, sick and ready, waiting to go, but life is funny, those that wish and pray for it to end must wait while others never get a chance to know the peace and satisfaction that comes from a life well-lived. The family is prepared and the vigil is underway; I’d be surprised if there isn’t a schedule somewhere, making sure she won’t die alone.

A light rain falls in the inner city, freshening the decay that coats the gutters, bringing with it a much-needed rinse. The rain mixes with oil that has accumulated on the roadways since the last rainfall four weeks ago, the combination turning the street into a skating rink. The kids in the car don’t know enough to be careful; they haven’t lived long enough to experience a rain slick road on a lazy afternoon. The fact that the cops are on their tail and they have a grand in the glove box and a bag of rocks under the seat throws caution out the window as the driver hits the gas, skids through an intersection, sideswipes an innocent person’s car, then slides into a little tree, its trunk barely five inches in diameter, but enough to encroach the passenger compartment and kill the teenage girl who wanted so badly to sit in the front seat. She never had a chance, never thought it would end before it got started, never grew up, or old, or learned that it could all change in an instant.

She’s in the bathroom of her rented third floor apartment, bleeding; a lump in the toilet floats. The pain in her abdomen seems miniscule now that her heart is broken. It’s her third miscarriage, her husband is at work and has no idea. She’s alone, truly alone now that their child is gone. She fishes it out of the bowl, wraps it in a facecloth, calls 9-1-1, and sits on the bathroom floor to cry. We arrive and have no idea the turmoil going on inside her, or what she carries in her facecloth. We only know that she is bleeding and needs us. She sits on the stretcher as we ride in silence toward the Emergency Room, wondering if she will ever have a family, if the immortality that creation brings will visit her, or if her legacy die with her and her empty womb.

Another girl screams as we wheel her into Woman and Infants. She’s crowning. The baby’s head pokes out just as we transfer her from our stretcher to theirs; seconds later another baby is born in Providence. The nurses take over, and I wipe my brow and thank the rescue gods we made it in time as the umbilical cord is cut. The new mother turns her head and tells the nurse to “get that thing away” from her. She will be smoking crack within the hour, now that she got rid of the curse in her belly. Not that the curse stopped her from smoking before; she was high as a kite when we picked her up from a condemned building that was littered with addicts and their paraphernalia.

He’s building a fence, been digging for a few hours. His chest hurts but he ignores it, keeps on digging. A neighbor finds him unconscious next to a pile of dirt and calls us. The neighbor knows CPR and starts, and we continue, doing our thing, and get a pulse. In the hospital they continue and get him breathing on his own. We consider it a victory and get back to work, where another guy is sitting watching TV, feels chest pressure, takes a nitro and calls us. He has two stents and a history of open-heart surgery—and he’s a diabetic who eats bags of chips, drinks bottle after bottle of Coke and weights almost 400 pounds. He goes to the cath lab, then home and back to his chair, and his chips. The man digging holes for his fence posts goes to ICU where he stays for a while, then dies, never regaining consciousness. He was 51.

We deliver babies, pull people from wrecked cars, administer the right drugs at the right time and truly make a difference, most of the time. It’s funny how we tend to dwell on the other times, when all we can do is wonder.

It’s a crazy world we live in, but at least everybody will be different 100 years from now.

 

March 1, 2014

Home

The Shift takes readers through a typical 24-hour shift in a busy urban fire-EMS department.

It’s 2015 hours. “Yours is the one without cheese,” says Okie as we join the crew. The firefighters have made plates for us, covering them with tinfoil and placing them on top of the oven.

“Thanks, Okie.”

We have no problem making fun of each other. Bad haircuts, bad dates, blown streets, white socks—you name it, we’ll have something to say. But underneath the incessant banter lies a kinship like no other. Okie is a member of Special Hazards and one of the best and fittest firefighters in the entire department. EMS is not his forte, and his outward demeanor toward those in the department who choose the path of EMS borders on scorn. But he left the cheese off my chicken parmigianino, remembering I’ve been dairy free for a while, and that small gesture says more than a thousand good-natured insults.

There is no mention of the body on the highway during dinner, which is uninterrupted by the tones. We finish eating. “Rescue 4 in service, clear of decon,” I say into the mic, and the division chief raises an eyebrow but remains quiet. He knows that if a call had come over the airwaves, we probably would have taken it.

Jared goes his way, and I go mine. I have two reports to do and like to stay up on them before they get out of hand. Before I dig in, I call home.

“Hello.”

“Hi, it’s me.”

“How are you?”

“Dead guy on the highway.”

“You OK?”

“I’ll survive. I have to.”

We talk for a few minutes, the cadence of our conversation flowing naturally, nothing deep, just two people staying connected while they are physically apart. Some people use my frequent calls to and from home as a subject to ridicule, but I honestly believe their criticism is born from jealousy rather than scorn.

The conversation ends, and the paperwork begins. Almost.

“Rescue 4, respond to 168 Broad Street for an intoxicated female.”

“Rescue 4, responding.”

“At 2032 hours.”

Back down the stairs and into the truck, where Jared waits. It’s Donna, and she’s sloppy. The shelter is packed, perhaps a hundred people clamoring for position, setting up their possessions on the floor in what they call the common room. The smell of unwashed humanity assaults my senses, clings to my skin and permeates my uniform.

“I’m not going,” says our patient, and “the chorus” chimes in.

“You gotta go, girl, you had a seizure,” says one.

“You fell and hit your head,” emphatically states another.

 

“You drunk on your ass,” comes the truth from Winston, who lies nearby in his sleeping bag, keeping one eye on the festivities and the other on his things. I see the usual familiar faces joined by the constant barrage of new ones as the train of homelessness brings people in and out of this place. Some of the regulars try to help, others just stare, most make no eye contact at all and stay to themselves, their eyes downcast, trying to disappear into the asbestos tile floor. The newcomers shuffle along, uncomfortable in their surroundings, lost in repose, wondering how on earth they ended up here.

Jared is a fast learner and leans close to Donna and lends a hand, which she takes, and we help her to her feet and assist her as she walks out of the shelter and into Rescue 4. Without asking, my partner helps her onto the stretcher, straps her in, obtains the necessary vital signs and goes to the front to drive. We arrive at the hospital in a few minutes, wheel our patient close and wait in line. The triage area is packed, ambulances from all over fill the bay, the crews assigned crowding the cramped doorway and corridor with their cargo lying on their beds, watching, sleeping, trying to escape or barely breathing. The worst go first, the rest wait. A drunken man pisses on the floor, a college kid vomits in his stretcher, a trauma victim is rushed past, accompanied by a crew from Massachusetts, one of whom bags the victim while another stands on the stretcher rail doing compressions.

More units arrive, and Jared, Donna and I wait our turn.

I feel at home here in the ER and watch the familiar faces do their things, the ambulance crews dressed in blue, the hospital staff in their colorful scrubs, security in black and patients wrapped in white sheets or blankets. All of us have a place. I look at Donna, drooling on my stretcher, lost and alone. Life is funny. A wrong turn here, a missed opportunity there or a tragic accident like the one that happened to Donna decades ago can change everything. The car she was driving while intoxicated crashed, and her daughter was killed, and she lost her home, her hope and her dignity as a result.

It occurs to me that it could be me, or any one of us, on the stretcher and not standing next to it, and instead of having three places where I feel at home, I very easily could have none.

“But for the grace of God, there go I.”

 

June 5, 2014

Legs

“Rescue 1 and Engine 13, respond to The Highrise for an emotional, suicidal female with a knife; stage for police.”

The cops got there first.

“She needs to get those legs looked at,” said one of the three officers who stood in the corridor outside the patient’s apartment. She was in the corridor as well, sitting in a wheelchair, a bloody towel on her lap. A little ankle biter barked non-stop inside the apartment; I peeked in and saw him, inside his cage, protecting his territory as best he could.

“She’s not going to want to go with you guys. I hope you can talk her into it,” said one of the officers, his demeanor making it clear he would prefer to be anywhere but here.

I walked toward the wheelchair bound person, crouched down and made eye contact. Then I looked over my shoulder at the circus behind me. Three cops and four firefighters had responded to the call, along with me and Brian. Then I looked back at her, a 24-year-old lady with tiny legs, clean clothes, highlights in her shoulder-length hair and a half smile on her face. She was amused with all of the commotion she had caused.

“Strong work,” I said, and grinned.

Her smile grew.

“What happened?” I asked.

“I was frustrated after arguing with my boyfriend last night. He wouldn’t leave me alone, or leave my place. I can’t throw him out,” she glanced down, “I don’t know why, but I did this.” She lifted the bottom of her pants, pulled them over her knee and rolled the material back. First one, then two lacerations stretched from one side of her thigh to the other. They were deep enough to require stitches.

“You have to come with me and have those looked at,” I said, keeping the shock out of my voice, and eyes, I think.

“Why?” she asked.

“Because those are serious wounds, and they’re self-inflicted, and you need some help.”

“I manage just fine.”

“What happened to your legs?” I asked. They were half the size they should have been, atrophied and useless.

“Spina bifida,” she said, bravely, as if it were just an annoyance.

“Do you have feeling in them?”

“A little.”

“Did you feel it when you sliced them open?”

“Not really.”

“How about when you stitched them closed?”

The wounds on her thighs had been savagely stitched together with sewing thread and needle. A dozen pinpricks—covered by red welts waiting to fill with pus as infection invaded—bordered each side of the sliced flesh, and bloody thread held the skin together.

“I didn’t do that. My boyfriend did. He wouldn’t leave me alone until I let him.”

“Did it hurt?”

“Oh yeah,” she winced. “It hurt a lot.”

Her boyfriend had taken a needle and thread, and sewed her up. Just like a torn pair of jeans. The pain would have been unbearable to most, but her life of pain had made this latest injustice bearable.

“That leg will get infected, and you might lose it,” I told her. She gave me the strangest look when I mentioned she might lose a useless leg.

“I’ll go,” she said after giving it some more thought, and likely realizing that she was going whether she agreed to go or not. Then she me the most genuine smile I’ve seen in a while when I let the police and firefighters go. We took her to the ER and she told me about her “boyfriend” of six months, who stitched her leg and told her not to call anybody, because he would take care of her.

“And where is Mr. Wonderful now?” I asked.

“Out taking care of my disability check.”

Her home has become a prison, her body making escape impossible without help. The only person she has to help her is too busy helping himself to be of any use to her, but he is all she has and she will let him back into her life, and suffer in silence. I left her at the ER. It took dozens of calls and dozens of patients before I was able to clear her from my mind and move forward, admittedly not as quickly as I once did, or as easily.

 

April 9, 2015

Be Kind

Here you are, week one of what you hope will be a rewarding career. The tests are over—or have they just begun?

EMS can be a satisfying career. Advancement is more possible now than at any time in the history of EMS. Community paramedicine programs have the potential to lengthen careers and build stronger relationships between EMS and the rest of the healthcare world. With expanded EMS roles comes expansion of opportunity. Nobody knows for certain where EMS’s future lies, but I believe that the future is looking bright.

But what about right now, you may ask.

My advice? Right now is exactly where you are supposed to be. You will be inundated with patients whose emergency is far from what you visualized when the idea of becoming a paramedic or EMT materialized. You have two options:

  1. Fight;
  2. Survive.

Fighting every borderline patient is a waste of energy. Finding the path to a fulfilling career will not be achieved with frustration, conflict and animosity. Being diplomatic will reduce stress for you and the patient, improve relationships between you and the hospital staff and give to you what I have found to be one of the most important pieces of the EMS survival puzzle:

Control equals survival.

The public is looking for somebody to lead when they call for assistance. The patient can’t be in control; they depend on competent, confident people to arrive. The family expects you will be able to take care of their loved one. Control has nothing to do with power. It has nothing to do with bullying. It has everything to do with calmness, competency and kindness.

Here are a few ideas that may help you when presented with the daily grind:

Called for an infant with a fever at 3 in the morning?

Say “Hello, little baby,” and take her temperature the way you would your own kids’, or your mother took yours: by actually touching the child, and putting your hand on her forehead and feeling if she’s warm or not. Most parents love you for it.

Neck and back pain from a fender bender?

Immobilization drill!

An elderly lady vomiting?

Bring a towel. When you arrive, after asking family members her name, wet the towel in the sink and wipe her face before putting her in the chair. It works miracles, trust me.

Intoxicated, uncooperative college student?

Immobilization drill with enhanced police relations!

Intoxicated homeless man?

Tell him, again, that all is not lost, that redemption is as close as the decision to not drink today. Just one day, and life will improve immediately and continue to get better. It may seem like a waste of time, but who knows?

Cancer patient who wants to go to the farthest hospital at shift change?

Make a rule, and plant it in your brain: Cancer patients get whatever they want.

Twentieth call in 20 hours?

Suck it up, buttercup. If this were easy, everybody would do it!

Excelling in all things will make you a better provider, partner and person. EMS needs excellence in all aspects of our operations, and you, the newbie, are just as important in realizing our potential as is a dinosaur like me, the chief of EMS or the CEO of the company. Do your best, and everybody wins.

 

April 4, 2014

The Shift

A Small but Vital Part

It’s 2045 hrs. The radio chatter is relentless as the city begins its nightly reawakening.

Sometimes things get quiet between 7 and 11, but tonight is not one of those nights. Five of our six rescues are in the rescue bay, mingled with 10 or 12 from surrounding communities. The ramp was designed for a dozen or so units; it is a marvel of personal ingenuity how we manage to squeeze so many trucks into so small a place, especially considering the urgent nature that exists when we arrive.

Another ambulance joins the gang, this one from our neighboring city, Cranston, and the driver leers at me as he passes. He sees five Providence ambulances sitting idle and wonders why he had to come to Providence on mutual aid. It is a nightly struggle trying to keep up with the calls, and at times we may stretch our time at the ER, knowing that as soon as we go in service, another call will come in.

“Rescue 4 in service,” I say into the mic as soon as Jared returns to the truck with fresh linens for the stretcher.

“Roger, Rescue 4, respond to 243 Sassafras Street with Engine 11 for a 78-year-old male, possible CVA.

“Rescue 4 responding.”

Jared begins to maneuver the rescue out of the bay, slowly at first, with only inches to spare as we weave our way out, then he sees daylight and hits the lights. We wait until we are clear of the hospital grounds before turning on the siren. Rescue 3 comes in service and is immediately sent to the east side for an assault, Rescue 2 jumps in for a report of a pedestrian struck, and another mutual aid company responds to Providence, this time for a reported shooting. There was a time when the Providence crews would scramble to get in service for a shooting, or anything “good,” but the troops are tired and have seen enough. Plus, it’s good to let the “out of towners” in for a good one now and then, and not stick them with all the mundane ones.

“Engine 11 to Fire Alarm, 78-year-old male with right-sided weakness, establishing vitals.”

“Rescue 4, received, on scene.”

Jared retrieves the stair chair from the rear compartment, I grab the blue bag, and we enter the home. Our patient is sitting in a favorite chair, eyes watery, looking dazed and breathing into the nonrebreather the firefighters from the 11s have put on his face.

“Less than an hour,” says Miles, the officer in charge of Engine 11.

 

The firefighters and Jared wrap “Jim” in a sheet and lift him onto the stair chair, while I get some important information from his wife, who is standing close, worried. I listen to her answer my questions and mechanically write notes on my pad (When did he last appear normal? What medical history? Does he take any medications?), but my subconscious takes in much more. There is a magazine on the coffee table, a book lying facedown next to it, the television is still on, their favorite show or maybe just the next one that happened to be on when things got scary. There are dinner dishes drying in the kitchen sink, a pleasant garlicky smell lingers, and pictures of people from a few generations are everywhere, behind magnets on the refrigerator, hung on walls, yellowed photographs behind framed panes of glass propped on top of the TV. I am an intruder in their home, and this might be the last moments they spend together in it.

I’ve worked with Miles for years and know he has done a thorough evaluation and don’t want to waste any time, so we load Jim onto the stretcher, help the missus into the back and get moving. One of the firefighters drives the rescue, and Jared joins me in back and assists while I establish an IV, recheck vitals and inform the ER that we have a 78-year-old male with a history of hypertension experiencing sudden right-sided weakness and slurred speech with a significant facial droop, 180/110 with a pulse ox of 98% with O2, event began at 2050 hours, ETA five minutes.

Jim is in the stretcher, his wife leaning as close as she can. Jared sits next to her, and I’m in the captain’s seat, keeping an eye on things, watching the drip, seeing the bag fill, then empty, then fill again. I have been invited into their life, and hopefully I’ve done my part well and given them the chance to continue living together.

A team is waiting for us at the ER; I give my report, and they are whisked away, my memory of them already fading, their lives their own, and my small but vital part in theirs over.

The ambulance bay has emptied, the radio gone silent, but it won’t be long before the next wave hits.

 

October 10, 2014

Safety Pins

She pulled the safety pin out of her arm and handed it to me. Blood poured out of the hole, running from inside her elbow to her wrist. I handed her a few 4×4s.

“Thank you,” I said. “You’re going to get blood on your sweatshirt.” It was a New York Yankees sweatshirt, but still.

She took the gauze pads from my hand and placed them on top of the hole in her arm as I placed the pin into the sharps container. Her other wrist showed old wounds. She is a cutter. Now she is self piercing as well.

We had left the group home minutes before, after the police had escorted her out following some behavioral issues. She was on fire then, full of anger, still hot from whatever had happened inside. It wasn’t my first time with her.

“You look sad, Shantee,” I tried to get through. “Not mad, like usual.” She stared into space, stone face in place, not blinking, not showing any of her true thoughts, but the mask had grown tired, her facial muscles giving in to the true feelings she tried desperately to cover with her self-mutilation. “What happened?”

“Is it everybody there, or just the lady working tonight?” I asked. It was always the same attendant whenever I was called to take her away.

“I don’t like any of them,” she finally spoke, breaking the uncomfortable silence.

“Have you tried to leave?”

“I have nowhere to go.”

“Another group home maybe.”

“Nope.”

“You need a plan.”

“I have a plan.”

“And what is that?”

“I plan to die.”

The way she said it stunned me—no emotion, no drama, just the facts. I’ve seen more than my share of hanging bodies and overdoses to not take her at her word. At one time I thought that a person ready to take their own life was at a dramatic, crisis-fueled moment in their existence, and made the final choice as an act of desperation. Now I know that for the person who takes their own life the end is no more significant than a sneeze.

“That is a terrible plan.”

I had to try. She wasn’t talking to me, so I began talking to myself, out loud.

“I wouldn’t want to be 18 again for all the money in the world. A lot of people feel the same way. It sucks. And those kids on TV and at school, all cool and everything, without a care in the world, going through life without a problem, two parents, maybe a car and a boyfriend? It’s bullshit. It’s a lie. Everybody hurts, they are just better at hiding it. There is always sadness; it’s in all of us. Some just get a little more.”

I looked at her and noticed she was looking back.

“But there’s another side and you can find it—and you will, just don’t give up.”

The truck was backing in to the ER now, my time was nearly through.

“I’ll tell you one more thing,” I said as we walked out. “At least you’re honest. That’s a lot more than most of us have, so busy trying to look happy and all that bullshit. Stay honest, and don’t let anybody lie to you, and I hope you will be OK.”

Nothing. She followed me in, and sat in “the chair” and stared into space, lost again, wherever she goes.

Two hours later I brought another patient in. Shantee was still sitting in the same spot. She didn’t expect to see me, and when she did, the most genuine smile I have seen in a long, long time brightened her face. She kept it for a few seconds, met my eyes, and then looked away. It was completely spontaneous and totally honest.

And it made all the bullshit go away—made me realize why I’m here. I just may have saved a life tonight, and it didn’t take any meds, defibrillators or rapid interventions, just good old emotion and honesty.

It felt good to be alive.

 

May 16, 2014

Benjamain

Our patient lived above a busy restaurant on Wickenden Street, one of the more hip spots in Providence. Traffic was heavy; the sidewalk cluttered with people who shopped and relaxed at the many coffee shops, art galleries and antique stores that line the street. We had to block the travel lane when we arrived. As soon as we stopped, three Japanese sushi chefs escorted an older guy from the doorway of their place.

Benjamin owned the building and rented the space below his apartment to the popular Japanese restaurant. From the concern showed by his tenants, he was a well-liked landlord. I knew right away I was going to enjoy this call; the guy had character written all over his craggy face. He hobbled up the rescue steps—no easy task for somebody half his age with two good wheels—and sat on the stretcher.

“What’s the matter?” I asked him.

“My leg is swollen, and my toe hurts. It’s been going on for weeks. I’m leaving for Europe tomorrow; I hope I can make the trip.”

I took a look at the leg and toe. His left calf and shin were twice the size of the right, and his big toe was bright red.

“How are you going to get around Europe on that?” I asked.

“Don’t know. Can you take me to the VA?”

He thanked his escorts, who appeared reluctant to leave, but Benjamin insisted he would be OK and dismissed their concerns with a casual wave and mischievous grin. The chefs returned to their work, we took his vital signs and got moving.

He was a Navy man and a disabled WWII vet. He was there at Normandy on D-Day, lost some friends as wave after wave debarked from his ship into the slaughterhouse. When that job was done, he went to the Pacific and was training to parachute into Japan when the bomb was dropped and the war ended. He spent a lot of the war escorting the Merchant Marines, a group that suffered staggering losses.

Benjamin survived the war. Sadly his brother did not. He told me about him:

“He was a gifted musician and brilliant Brown grad whose life was cut short in the Black Forest during the Battle of the Bulge,” he explained as we traveled the bumpy streets toward the VA. I thought of my own brother, who had fought the war in Iraq, then a year later Afghanistan, and the loss my family would have suffered if he didn’t make it home.

“My father is a Navy vet, Korea, and my brother spent a year in Iraq and another in Afghanistan,” I mentioned. He paused for a moment, sensing the distance between us had closed and that I needed a little time to regain my focus. Seventy years had passed since his loss, yet Ben’s eyes still filled up when he mentioned his brother. I made a mental note to call mine.

We talked a little more during the trip to the VA. Thankfully for us Ben lived through the war. He taught art at RISD, displayed his work at galleries throughout Providence and became a successful restaurateur. His brother’s contributions to humanity ended on a battlefield. I can only imagine the magnitude of gifts that have been lost, greatness unknown and words unspoken. How much more music will we never hear, art will we never see, or lives will we not be able to share and enjoy before the world makes peace with itself?

I got a wheelchair from the lobby and helped him into the VA’s emergency department and past the latest generation of disabled veterans. I gave my report to the person in charge of patient intake, shook my patient’s hand and thanked him for his service. Then I walked through the waiting room, past all of the rest and into the brisk sunshine of a relentless winter, zipped my jacket, mumbled something to my partner and rode in silence back to the station.

 

May 24, 2013

Pulseless

The kid was alive when Engine 3 arrived but died a few minutes later. The radio transmission was cold, lifeless and heartbreaking.

“Engine 3 to Fire Alarm, 11-year-old male, code 99.”

“Rescue 1, received.”

I put the mike down and put on the gloves. My new partner, Adam, picked up the pace, instinctively knowing this was the real thing. We arrived on scene 30 seconds later and entered the home. Two firefighters knelt on the floor, one doing compressions, the other bagging the lifeless body of an 11-year-old kid.

“He was breathing when we got here, then he stopped and went pulseless,” said the officer of Engine Co. 3 as his crew performed the mechanical movements that kept the blood flowing. If the little guy was breathing a minute ago, and CPR started right after a witnessed arrest…I let myself believe. Years of unsuccessful resuscitation efforts that ended the same way they started—a pulseless patient—had taken their toll on my optimism. Some made it a few days, some a few weeks, one even walked out of the hospital and sent us a letter. Most did not. I was beginning to take it personally.

We put him on a backboard, continued CPR, picked up our equipment and the patient and carried him out of his home and into the rescue. The boy’s mother sat in the front, peering back as we worked. The monitor showed asystole, no shock advised. Joe worked like a madman trying to find a vein while Donna and Adam continued CPR.

“Does he have any medical problems?” I asked his mother, trying to keep my voice steady.

“A neurological disorder that causes seizures. He was at the doctor’s today for trouble breathing.”

She sounded calm; I think she was in shock. Joe found a good vein and sank the IV.

“Go,” I said to the firefighter who was now driving Rescue 1. He sped toward Hasbro Children’s Hospital while we continued to work. One round of epi, still pulseless. We tried an atropine; nothing. I attempted to tube him, the potholes made it difficult; I failed, then picked up the phone.

“Rescue 1 to Hasbro. I have an asystolic 11-year-old male, CPR in progress, IV established, ETA two minutes.”

The doctor on the other end of the phone asked a few questions. I gave the best answers I could, then hung up the phone. Another round of epi was ineffective; we brought him into the ER and transferred care to the medical team that had gathered. I gave the story and stood back, watching them work. Watching the team do their thing on a patient I no longer was responsible for was far different than working on him.

Before becoming a Providence firefighter, I wondered how I would handle death and trauma, and honestly didn’t know if I could. It wasn’t long before I found out. I didn’t have a choice—things happen fast and frequently here. I developed a coping strategy that lasts to this day: I tell myself that the events transpiring around me, no matter how dramatic or horrific, happened without my consent, permission or anything to do with me. What happened happened, and would have happened whether or not I was in the middle of it.

Obvious? Yes. Simplistic? Absolutely. Effective? For some reason, very. I don’t have to detach, block things out or suffocate them. I am able to work with the knowledge that no matter what the outcome, my presence on the scene is the result of somebody’s misfortune and not the cause of it.

Five minutes passed. More epi, atropine and then sodium bicarb. I gave up hope. The room was a flurry of activity, noisy, a little chaotic. I saw the boy’s parents outside the door, the mom now crying, stunned, the father numb yet hopeful.

Through the chaos a voice rose above the others.

“We’ve got a pulse!”

The room went still. Sure enough, a rhythm appeared on the monitor, sinus tach. A few minutes later I saw my patient open his eyes and look around the room.

It’s kind of strange what happened next. I was fully prepared for him to die. What happens happens, right? Whatever it is we have inside us that makes it possible to do this job was in full operation. I didn’t feel anything—not sadness, despair or frustration. I knew we did our job and the outcome was out of our hands. I was at peace with that.

Whatever it is that allows us to do this job disappeared as soon as I heard he had a pulse. When I saw him open his eyes, my own eyes filled with tears. It was strange, but I’ll take it over emptiness any day.

It’s good to know I still have a heart.

 

January 15, 2015

The Key

We are called to a house on Elmwood Avenue, a boarding house, not known for the upscale clientele. We trudge up the stairs to one of the rooms, heavily fortified and completely unsanitary to find a 59-year-old male hunched over in an easy chair. His body is obviously wracked with pain.

“What’s the matter?” I ask.

“I slept in my chair, now my back hurts,” he responds.

“Get up and stretch,” I say, a little annoyed.

“Can’t. Broke my ribs,” he groans.

“Well, sit and stretch,” I suggest, a little less annoyed.

“Can’t, broken vertebrae.”

I take a closer look. The visor on his black baseball cap lays low on his forehead. A handsome man looks up at me through eyes filled with pain.

“Come on, we’ll get you to the hospital,” I say, embarrassed with my annoyed behavior.

“My doctor is at St. Farthest.”

Here we go again. I begin to tell him there’s no way I’m going to take him across the city, past two perfectly fine hospitals, when I see his medications. He is HIV+.

“How long have you had HIV?”

“Since ’83. I’m an addict.”

St. Farthest has a program where they do great work with AIDS and HIV+ patients. A cross-town trip won’t kill me. We load him up the best we can—broken ribs and vertebrae are tough injuries to work around. He’s a trooper, only complaining a little.

Inspiration comes from the strangest places. This time it’s in the back of Rescue 1, two guys from different worlds talking about the Celtic and Laker years of the ’80s. He’s a Laker fan, me the Celtics. Doesn’t matter, it’s as if Magic and Bird are in the ambulance with us.

“I remember when I heard about Magic,” I say, referring to his HIV diagnosis. “I thought he was a goner.”

“I thought I was a goner,” he smiles, and we reminisce. Magic Johnson. Larry Bird. Kareem Abdul-Jabbar. Robert “The Chief” Parish. Worthy, Johnson and all the rest. I feel like I’m with an old friend, just watching the game and having a beer.

Turns out he’s a Vietnam-era, combat-wounded Special Forces veteran. He doesn’t mention that, one of the security guards at St. Farthest served with him and tells me. I wonder if the folks at St. Farthest see a destitute former addict with HIV and fail to see the man under the visor.

I hope not. I nearly missed an opportunity to connect with another human being because of my preconceived ideas based on where he lived. I could spend a lifetime administering medications, bandaging and splinting, doing CPR and working trauma codes, and would never feel the satisfaction I get from simply being with another person and sharing our common humanity. EMS is more than a job—it’s an everyday opportunity to grow as a person and provider. Paying attention to the people I treat is the key to understanding that.

 

March 12, 2014

Control

I could see from the bottom of the stairs that he didn’t look right. When babies don’t look right, something is definitely wrong.

His mother cradled his limp form in her arms and tried to explain what happened as I scanned the apartment, quickly assessing the situation as I approached them. She flinched when I reached for her child, pulled back and cradled him closer.

“We heard a crash from the bedroom, he was under the dresser,” she explained, frantically.

I looked into the bedroom in question. A full-sized dresser leaned against a wall; its drawers open and a big, heavy TV smashed on the floor in front of it. The baby’s eyes rolled in his head; he was breathing normally but remained unresponsive.

“Did he cry when it happened?” I reached again for the child; again she pulled back.

“He didn’t make a sound.”

We were on the third floor.

“Get the papoose ready, we’re coming down,” I relayed to the crew from Engine Co. 14.The baby’s mom held on tight, unable to let go. The story of King Solomon came to mind, and rather than getting involved in a tug-of-war I let her carry her child to the ambulance. She knelt next to the stretcher while we worked around her; it wasn’t that hard and well worth the trouble. The baby cried a little while we restrained him, and struggled with the restraints, but remained unconscious with a grayish-blue tint to his skin.

“Let’s roll,” I said as soon as we had him secured on the stretcher and his mom on the bench seat, close but unable to touch him. It must have been unbearable. A firefighter joined us in back, while another drove the ambulance.

Jermaine hit the gas and we were on our way to the trauma room at Hasbro.

“Do something! Hurry up!” said the boy’s mom from the bench seat, frantic as she watched her son lying motionless.

“We all have kids of our own, we’re doing everything we can,” said Ariel, my partner for the overtime shift. He said it gently, looking the mother in the eye. It worked, and she relaxed.

The baby needed an IV. Ariel is not normally assigned to EMS; his usual spot is as a firefighter on Engine 11. I didn’t think he had started many IV’s on adults, let alone a baby. I’ve worked with him a few times; he’s calm, competent and more than willing to do the job. Asking somebody to start an IV on an unresponsive infant in a moving truck in front of a panicked mother is not something I do lightly. Alas, we all have a job to do, and I couldn’t do mine if I were doing his.

“I need an IV.”

“I got this,” said Ariel.

I moved from the infant’s side, sat on the Captain’s chair and called the ER at Hasbro.

“Providence Rescue 6, we have an eighteen month-old male, semi-conscious, responds to painful stimuli, no obvious deformities with a heart rate of 140 and 128/96, respiration’s 40 and shallow, pulsox 98% with blow by 02.”

From my seat behind the patient I watched as Ariel and Hans, another firefighter from Engine 14 who had joined us, established the IV better than I could have—and I’ve established more than I can remember. Early in my career I would have grabbed the baby from his mother, wasted time doing the hands-on things myself and thought I had done my job. But to do my job, I needed to give up control of all the little things that need doing, let capable people do their jobs and let the big picture come into focus, much like a director on a movie set.

“IV established, he’s restrained, BG of 184, ETA four minutes.”

“See you in four.”

The baby stopped breathing. I stopped breathing.

“Is he alright?” asked the mom.

For what seemed an eternity the little guy lay on the stretcher, motionless. Ariel gently shook him, I squeezed his little hands, pulled back his eyelids—nothing. As I reached for the pedi bag-valve mask and got ready to have my crew start CPR, the most beautiful sound filled the back of the rescue; a baby crying. Not loud, not in earnest, but crying nonetheless.

“He’s okay,” I told the mom. “He is injured, but things are under control. We’ll be at the hospital in a minute.”

A minute later we backed into the bay at Hasbro. The trauma team was ready, I gave my report and they took over.

Then I started to breathe.

One of the hardest, but most important lessons I’ve had to learn is that the best way to keep things under control is by giving some of it away.

 

November 26, 2014

Giving Thanks

In a two-room apartment on the twelfth floor a man sits on the floor, smoking, popping pills and trying to figure out how he will get the money for booze not just for today, but tomorrow as well. The first is a week away; he’s been running on empty for days. He considers panhandling, and looks at the cardboard box that holds his old records, but doesn’t have a marker to make the sign. His bottle of vodka is nearly empty, only three packs of smokes left in his carton and nothing in his wallet.

Hours creep by, the TV drones on but he isn’t watching, only three channels and nothing on. He’s too depressed to listen to his music, that just brings him down, reminds him of the days when he was somebody.

He was a roofer, worked hard by day, drank hard by night, he had friends, or drinking buddies anyway, and some women now and then. His daughter is in Florida, doesn’t hear from her much, but that’s okay, as time went on and he saw and thought of her less and less it didn’t hurt as much. Didn’t hurt at all once he had a few, but therein lies the problem; Thanksgiving is tomorrow and he’s got nothing.

Time drags by, the solution to his problem remains elusive. He’s alone, truly alone, a situation of his own making. Most days it’s okay, but today the loneliness is unbearable. He begins to feel sick. Then his chest starts to hurt, a broken heart perhaps, more likely a phantom symptom brought on by self-loathing and an overwhelming desire for some human contact. He pulls some old jeans over his dirty underwear, throws a Patriots sweatshirt over his dirty hair and scrounges up a quarter, forgetting that he doesn’t need it, and leaves his prison and walks to the pay phone in the lobby and calls 911.

Then he shuffles back to his apartment and waits for somebody to show up, and take his pain away.

At this time of Thanksgiving, I’d like to give thanks to the City of Providence and the Providence Fire Department for giving me the opportunity to be that somebody, and to offer some hope and comfort to people whose circumstances have brought them to a place where my presence matters.

 

September 16, 2013

Frustration

“Rescue and Engine 10, respond to 392 Whitmarsh Street for an emotional female out of control.”

“Rescue 1, responding.”

I replaced the mic to its clip on the dashboard and leaned back in my seat as Brian hit the lights and sirens and changed direction. The air conditioner struggled to keep the cab under eighty, and I fiddled with the vent as we sped toward the scene, windows up, keeping the sounds of the sirens and street noise out.

A few cops lingered outside the address, and the crew from Engine 10 waited by the front door. I walked past them, wondering why there are so few screen doors in the city, where flies are in abundance and come and go as they please.

Esther sat on a chair in a dingy kitchen, angry, sweating, her breathing rapid, arms crossed in front of her, and completely lost in her own thoughts. The adults in the house talked and yelled, and pointed fingers and completely ignored the little girl in the chair, while the police who were called looked on, stone-faced, and the social worker that was assigned to the case filled me in.

“She hasn’t been taking her meds, refuses to listen to her stepmother and locked herself in the bathroom.”

“That’s it?” I asked. He looked at me as if I had forgotten how the game is played and needed to be reminded.

“That’s it. She’s going to Hasbro Children’s Hospital for a psych eval.” He handed her file to me, and Esther was all mine.

She stormed ahead of me, past the row of police cruisers and into the rescue. I followed. Brian assessed her vital signs as we sat in the hot truck, all of us sweating, all of us miserable. We were in this together, it seemed, and might as well make the best of it.

“Nicely done, Esther,” I said, looking out of the window as six cop cars, a fire truck and the social worker cleared out of the busy street. “And it’s not even seven o’clock.” I gave her a conspiratorial grin, nonchalantly tossed her file onto a stack of reports, leaned back in my chair and asked her what the heck was the matter with all those people in there.

She looked at me—through me, really—sizing me up the way only somebody who has learned that people are not all that great can do. Thirteen years old, brown eyes so deep they were nearly black, olive skin, dark curly hair and years of pent-up frustration stuffed into a 4-foot-11-inch bundle of nervous energy sat in front of me, and when she realized that I asked what was wrong with the people inside of the house, and not what was wrong with her, she let go of the act and softened, just a little. But she held on to her anger, and her eyes still blazed. Tears waited behind those defiant eyes; tears of anger, sadness and frustration.

“What’s wrong?” I asked, gently.

“They don’t want me.”

We had been called here for an emotional, out of control female. The little girl in my truck was certainly emotional, but far from out of control.

“Why?”

“My mother won’t let me come home. I’m staying with my father and stepmother but they have kids and they don’t like me. They fight with me. They take my clothes. I hate it here. And I hate it there. I hate it everywhere.”

 

 

I have felt that frustration. I think everybody who has lived past thirteen years of age has felt it. My life in suburbia was a breeze, yet still I rebelled. Esther lives on a street where crack addicts hustle all day, and the sound of gunfire and sirens has taken the place of bullfrogs and crickets at night.

The tears started. We sat in silence, a few feet apart, but thousands of miles away; two people from far different worlds and generations connected by frustration. She desperately needed to connect with somebody who cared and at least tried to understand, and I was just her ride, the person to bring her to the professionals who would do the psych eval, find out that she’s a 13-year-old girl with 13-year-old problems who happens to live in a horrible place, and then release her back into that place, where the problems will continue and get worse. And there was nothing I could do.

“You can’t cry in the rescue, it’s a rule.”

“Then why are you crying?”

“No I’m not.”

What can I say; I have two girls of my own and hate it when they cry. Kids need an adult or two around with half a brain to take care of them. We have been in their shoes, and have the advantage of living through the frustration and confusion that comes with growing up. Everything can’t be a battle; we have to allow them to be angry, and let it out once in a while in a safe, understanding environment. Calling the cops shows our kids that we cannot handle our own affairs, and if we can’t even do that, how in the world can we take care of them?

She shook her head a few times and wiped her face clean.

“I’m good.”

“Me too.”

I looked at Esther. She gave me a little smile. I gave her one back.

“They have to listen to my side of the story, don’t they?” she asked, trusting me, I think.

“I’ll make sure of it.” I said as the truck backed into the rescue bay.

 

August 20, 2015

The People I Would Have Never Met

Outside her apartment, city life flourished. An intoxicated man stumbled across the street, and kids in gangs strolled the sidewalks slowly. Litter blew past, along with airborne grit that had been dumped onto the pavement by sand trucks during the brutal winter just now giving way to spring. Somebody had unlocked the door at the street level, two doorknobs and a deadbolt. We walked the stairs, another unlocked door with double locks waited. I knocked; a voice from behind the door welcomed us in.

She was on the couch next to the door, dressed in a coat and wearing gloves. It was freezing in her apartment.

Nothing hung from the walls. The place was immaculate. A fine lace tablecloth covered the dining room table, and a matching one sat atop a little table in front of the couch she occupied.

“What’s wrong?” I asked.

“You see that table?” she asked, pointing toward the dining room. I noticed that it leaned to one side.

“Last night I fell on that table and it pushed to the side, my back is hurting something terrible.”

Her voice had a lyrical quality to it, beautifully spoken, almost like a song.

We helped her to the truck and started toward the hospital. I asked her the usual questions, one answer stuck out, she had an allergy to chlorine.

“Chlorine?” I asked, having never heard of that allergy before.

“It’s for the malaria,” she explained.

“Did you ever have malaria?” I asked. I never knew anybody who did.

“I did, and it’s awful,” she replied.

She came from Gabon, Africa. It’s a small, beautiful, country nestled between Congo and Cameroon, on the South Atlantic coast she told me. She spent a dozen years in a refugee camp. She didn’t tell me why or how she ended up in south Providence.

“It’s much warmer in Africa,” she said, wistfully. “My family is still there. Perhaps some day we will meet again.”

The sadness in her voice and faraway look in her eye transcended the few feet between us, and I felt a small part of her pain for a brief moment before the gloom lifted. She smiled then and silence descended upon us, but after a few moments it passed. Communication need not be through spoken words or gestures, sometimes a moment of silence says more than volumes of books.

Before long we were at the hospital, but not before she insisted on making us some Jollof rice someday to thank us.

I had never heard of Jollof rice until that moment. I had never heard of Gabon, Africa, for that matter. If I hadn’t become an EMT there are a lot of things I never would have heard of.

Once the classes and lectures were done, the training evolutions were over and the simulations through, the education that feeds my soul began. People’s medical problems are pretty much universal. It’s their stories that make this work fascinating.

Of course, not everybody offers us something to eat. Some of our patients offer us the opportunity to test our human relations skills instead:

“You were bit by a mouse?”

“Right on my foot.”

“Did you see the mouse?”

“No, but I know it was a mouse.”

“How do you know?”

“Because my cat chased him into the box.”

“Did the cat follow him in there?”

“No, he didn’t fit.”

“Why did you put your foot into the box if you knew there was a mouse in there?”

“I didn’t think mice bit.”

“Maybe it was a rat.”

“No, it was a mouse.”

“Are you sure?”

“Positive.”

“Baby rat?”

“Mouse.”

“Get in the truck.”

Job satisfaction can be found in ways you never expect. For me, it’s the people I would never have met, and their stories of struggle and triumph that matter most. That I have the ability, training and resources to help them feel better, sometimes heal them and often simply listen when they have nobody else is something I will always be grateful for.

 

January 25, 2013

Ladies Night

Three stories from a night on the town:

Show Is Over

She spent hours at the gym, had her nails done, a pedicure, her hair was perfect, and she spent a few hours getting ready for a fun night out dancing in Providence with her friends. She was beautiful and looked fantastic, and people noticed, and she didn’t mind, as long as they weren’t creepy about it.

Some moron crashed into their car at 2 in the morning, spoiling a great night. She’d had a few drinks but was far from intoxicated and wasn’t driving anyway. She was hurt in the accident and needed to be seen at the ER for some stitches and x-rays.

Sometimes all we can do for our patients is make them feel better during transport. The high-tech equipment and highly trained EMT were reduced to performing one of the simplest, kindest and most ancient of all medical techniques: I covered her with a blanket. Her anxiety level dropped in half. The beautiful body she showed off earlier in the night, and did so with class and style, was no longer on display.

Party Is Over

The party was in full swing for most of Thayer Street, not so for Marissa. She sat on a curb in front of Starbucks, the shoes that once matched her party dress now splashed with mud and vomit. “I just want to go home. Take me home,” she said to the guys from Engine 9.

Whether she was aware we were there to help her is unclear; I imagine all she could see was a blur. Fortunately for her, we showed up to take her “home” rather than somebody whose intentions were not so noble. She was defenseless. We carried her onto the stretcher, gave her a bucket and a towel and drove toward Rhode Island Hospital, where she would join 20 or so other intoxicated college kids. As I searched her small black bag for some ID, I found a fancy silver flask, empty now, but carefully filled earlier with the cause of all of her troubles. Her ID lay under the flask. The picture on it—showing a beautiful California student—was a sharp contrast to the drunken wreck thrashing on the stretcher. “I’m sorry, I’m sorry,” she said over and over. I covered her with a hospital blanket, but she kept pushing it away, unaware that her dress, which cleverly covered her when sober, now left nothing to the imagination. I wrapped her up as best as I could before wheeling her into the ER.

Like the Fish

It would have been better if she was what I expected. It would have been a lot easier if she was some drunk, crazy, screaming lunatic, filled with booze and hate, fighting with some other girls about whatever it is they fight about. It would have been just another call if she just cooperated, and was obnoxious and demanding and thought the world revolved around her, and ignored me and paid more attention to her phone. That would have made it easy.

But it wasn’t easy.

She was adorable and sober and dressed for a night dancing with her boyfriend. She was worried her mom would be mad she got hurt. She wasn’t drunk; she didn’t even drink. She was in the line of fire, that’s all. The wrong place at the wrong time. She was in the way when a drunk, crazy, screaming lunatic threw a bottle, and her face broke the intended path, and more glass started to fly, and fists and kicks started, and when it ended her beautiful face was sliced up, and her teeth were broken, and her eyeball gouged, and a four-inch laceration bled from the top of her breast and soaked her dress with blood.

I wish she hadn’t smiled through the mask of blood, and then winced with pain when the jagged edges of her skin moved, and her lip separated when I asked her name.

And most of all I wish she hadn’t told me, with another painful smile, that her name was Marlin. Marlin, like the fish, she said, and asked me if her face would be OK.

Not everybody who ends up in ambulances on Friday and Saturday nights is out of control, vomiting and intoxicated. Those who are, though, are experiencing a change of mental status, which is most definitely a medical emergency. After a lot of years and a lot of vomit, I’ve learned that people are people, and sometimes they need us. I try to act as if it were my daughter on the stretcher and treat the patient accordingly. Too bad I don’t get to yell at them in the morning. (Except Marlin—her I would hug.)

 

December 12, 2012

Bloody Reports

It must be easy sitting in an office somewhere, reading a run report for a repeat 9-1-1 caller, with another report stapled to it making the case against sending ALS units to care for intoxicated people. Simply rubber-stamping the same old “change of mental status requires transport to an emergency facility” response on the paperwork that some disgruntled EMS worker submitted after another shift full of the same faces with the same demands is better than depositing it into the circular file, I suppose. Day after day, week after week and year after year, we respond to the same pay phones and street corners for the same intoxicated people. One dies, another joins the party. It’s the circle of life on the streets of Providence.

I’m hoping tomorrow’s report will stand out. It’s about how a guy was struck by an auto in front of the fire station where, 12 minutes prior, the rescue was sent to a pay phone a mile away for a regular who claimed he was intoxicated and wanted detox. It was his third such call in the last 24 hours, his 40th this month and well over his 100th this year. That report might get some attention. Somebody might actually read it and feel the desperation and frustration in the words, the anger barely disguised by formality, and sense the growing disintegration of morale among the people providing emergency medical services at the street level.

But probably not.

It’s a little different sitting in a quiet, safe, warm office, reading about delayed responses and traumatic head injuries and trauma codes, than it is to leave an intoxicated patient at the ER, paperwork half done, and fly toward the radio report of a guy your age fighting for his life while the nearest ALS unit is tied up, and that ALS unit is you, then arriving on scene, 100 yards from the door you left 20 minutes ago to get the same old intoxicated male, and seeing a 20-foot blood trail, and at the end a crowd of horrified people standing safely away from a crumpled form with his head smashed in, his larynx crushed, his teeth lodged down his throat, his eyeballs popped from their sockets, his respirations at 6, his BP crashing and a desperate need to be in the operating room 10 minutes ago. But 10 minutes ago you had “Michael” in the back of the truck—“Michael,” who is pleasant enough and simply doing what we allow him to do. He uses the system to his benefit, as any self-respecting homeless man with nothing else to do would do. The choice of a cold night in the bushes or a warm bed in the ER is an easy one, and salvation a simple phone call away.

It’s not easy to wheel the guy who was struck by an auto at 40 mph and is now a trauma code past the homeless guy who uses the system as a means of survival, even though his survival system has in all likelihood cost a different man his life. It’s not easy to watch him sit comfortably on a stretcher in his nice, warm bed for the night and know he doesn’t give a shit because he tells you so every night, and know the report you plan on typing up and sending to headquarters will look nice and pretty, and end up in the pile with all the others trying to make sense of all this.

Perhaps I should send the report I had started in the rescue, the one covered in the victim’s blood and brain matter, and send that one upstairs. Maybe a little reality would sink in. But by then the blood will have dried, the brain matter will mean nothing when the person it once belonged to is far away, and these thoughts will never enter the mind of the person who eventually looks at the report and barely skims it and puts it on the pile with all the rest. Like I said, it’s a little different upstairs.

I tear up the bloody report and start a new one. It looks nice and clean when I’m through, but it says all the same things, and the urgency is gone from my words, the rage that fueled the original tamped down to a mere flicker of what it should be.

Before I put it in the outbox, the tones go off, and I respond to a pay phone for an intoxicated male seeking detox.

January 30, 2014

Room 6

A car skidded into hers, tapping her bumper. She drove home, sat in her driveway and then called 9-1-1. She gave us the license plate number of the car that hit her, and then said the pain in her neck and back was too much to bear and she couldn’t walk. We brought the stretcher over to her, put a collar around her neck, put a backboard under her and extricated her from her vehicle. She grunted and groaned and put on quite a show. It didn’t bother me too much; I was numb, and this call was business as usual in the city. If I let things get to me I’ll be in the nuthouse before long. This is the meat and potatoes of EMS… the kind of thing we do day after day.

We brought her to the ER. She told the triage nurse she was now having severe abdominal pain. That bought her a trauma room and a full work-up. I’m not being cynical, just honest by telling you there was nothing whatsoever wrong with this woman; she was simply padding her case. In a few years, maybe less, she will get a check from her insurance company or the hit-and-run driver for a few thousand dollars, if she gets lucky. Not bad for an afternoon’s work.

I wheeled her into Trauma Room 5, left my report on the desk and walked out. I figured it was a fairly simple thing, nothing new; the same thing happens dozens of times per week. Stable vitals, no sign of trauma, no visible damage to the vehicle…just people following protocol and not a damn thing we can do about it. My autopilot was at full throttle. It had to be.

A few minutes went by; somebody told me that the trauma team in Room 5 was asking for more information. Apparently my written report was sparse on detail. I walked in and a roomful of grim-faced doctors and nurses waited. I told them the details; they listened politely and got to work. I watched for a few minutes as they did their thing, asked all the right questions, ordered all the right tests, cleared her from the board and moved back to the girl in the room that adjoined. The girl that an hour ago I had brought into Room 6.

The patient in Room 6 lay on her bed, bandaged, IV’s running, not moving. The trauma team had done their thing, ordered the right tests, administered the right medications and notified the right people. She was unconscious, intubated and had no feeling in the lower half of her body after smashing into a jackknifed tractor-trailer on Route 95 and being crushed in half, her spine broken and her cord irreparably damaged. She was nineteen years old and the back seat of her car was full of nursing books, and she had a nursing school sticker on her back window—the only one that wasn’t shattered.

My autopilot was stuck in neutral. I tried to get into drive but failed, and stood there at the foot of her bed, and couldn’t move.

In an out-of-body experience I saw myself rip my other patient off her backboard, drag her across the hall and plant her in front of the kid who will never be a nurse, and tell her that this is what a trauma room is for; I tell her to appreciate the life she was given, her health and the hope of a future that doesn’t include a wheelchair; and I tell her that her puny little lawsuit and the puny little people who go along with it—the ones who look the other way or  “follow protocol”— should be ashamed of themselves.

Then I returned to my body, responded to an MVA in a parking lot and put a guy in his twenties complaining of neck and back pain following a minor collision onto a backboard. I put a collar around his neck, took his vital signs and brought him to the ER where he will be treated like a real patient.

I don’t know how they do it. Come to think of it, I don’t know how I do it.

 

May 23, 2012

Fleeting Greatness

One minute you’re on top of the world; the next, the world is on top of you.

The latest meeting of the mutual admiration society was in full swing as we drove through the East Side. Adam and I talked about how fabulous we were, knowledgeable, dashing lifesavers with no equal, here or anywhere. Why we had to share the same earth with lesser beings escaped us as we cruised Thayer Street, searching for that elusive, perfect cup of joe worthy of such brilliant EMTs.

Our previous job went off without a hitch. A 59-year-old female was found slumped at her desk. She had been alert and conscious five minutes beforehand, according to her friend in the next cubicle. Every time I’m called to one of these mazes I’m reminded how fortunate I am to have the freedom of movement and the ability to interact with hundreds of different people every day.

A call was made to 9-1-1, and the closest fire company arrived promptly and did a primary assessment. Rescue 1 arrived from the opposite end of the city in eight minutes.

The patient reported for work, said hello to co-workers, poured herself a cup of coffee and walked to her little space in the vast office. Thankfully, a few minutes later her friends noticed her slumped over and recognized a problem. It was unusual for her to be anything but alert and conscious and, according to her supervisor, productive.

The firefighters from Engine 2, all trained EMTs, found the patient disoriented with a moderate left side facial droop. A preliminary neurological exam indicated left side weakness, leading them to suspect a CVA. She was hypertensive and agitated. A blood glucose test showed within normal range.

Rescue 1 arrived on scene, listened to the report from the officer of Engine 2 and got to work. With her coworkers and others looking on, a non-rebreather was attached to the patient’s face and the flow set at 10. A 20-gauge IV was established in her left forearm and the flow set at a KVO (keep vein open) rate. She was gently moved from her comfortable office chair onto our stair chair, strapped in and made as comfortable as possible. Each member of our team had a role and did it expertly, with very few words exchanged between us. We gathered her things and moved her outside.

Five minutes after our arrival at the office building, the patient was sitting comfortably on our stretcher, IV established, 02 administered, history obtained, vital signs documented, closest stroke center notified and we were ready to roll. The crowd of anxious onlookers parted as Rescue 1 departed, taking their friend and co-worker away, confident she was under the care of trained professionals and receiving the best medical care available.

Every now and then a call goes perfectly, the patient is given prompt, efficient treatment with a hopefully positive outcome, and the onlookers and friends fall over each other trying to touch us as we leave, or even share the same space, hoping some of what we have might rub off on them. We casually bask in the glory, accept the accolades as our right and privilege, and wait for the next cry for help from the citizenry we are sworn to protect.

It never takes long…

 

 

A 60-year-old man has fallen and struck his head on a tile floor. He had been waxing a floor at a local elementary school and slipped on the shiny surface. We respond. An engine company arrived prior to our arrival and began treatment. The patient is a small man, lying supine with a large cervical collar around his neck. “It’s the only one we had,” I’m told by one of the guys from the engine company.

Adam gets a backboard from the rear compartment and I assess the patient. Last night’s crew neglected to replace the straps on the backboard with matching sets. We fumble around for a while as the patient moans in agony and finally immobilize him, only after nearly suffocating him when the large collar slips from his chin and blocks his airway.

We recover nicely, get the proper-size c-collar in place, lift the board with the patient firmly attached and put our package onto the stretcher. Backwards. The patient’s co-workers are now very concerned about the welfare of their friend, and begin questioning our heroes. The patient himself violently shakes his head, freeing himself from his restraints and joins the chorus, verbally attacking his rescuers. So much for c-spine immobilization.

With our capes firmly stuffed between our legs we attempt to right the situation, explaining that his feet are at the head of the stretcher and his head is at the foot. “It happens,” we say, and spin him around.

Somehow we get him to the rescue without paralyzing him, lift him inside and then botch three IV attempts. Add mangled arm to his list of injuries. An air leak has rendered the truck’s suspension useless; it feels as if we’re riding a hay wagon down a rocky trail on our way to the hospital. What began as a fall with a minor head laceration and no loss of consciousness is now a Level 1 trauma.

Our patient survives transport and his co-workers and family wait for us at the ER, forming a gauntlet as we wheel their loved one past. I swear some are holding pitchforks and torches. Our heroes pass the patient over to the ER staff and slink out of the hospital, avoiding eye contact with the angry mob.

Fortunes change quickly here in the city streets. Another call for help comes in as we adjourn the latest, and hopefully last, meeting of the mutual admiration society.

Good thing there were only two members.

 

October 5, 2013

Twenty Years of Ghosts

Twenty years ago I thought I would do this job forever. I had a dream: work in Providence till I was 60 and they threw me out, and then move to somewhere where they have a volunteer fire department and put my experience to good use. The department offered a 50% pension after 20 years; we contribute 9.5% of our pay toward the fund, and the city contributes the rest. “That’s nice,” I thought, never considering that I would actually leave after 20.

Time marches on and 20 years passed in the blink of an eye. The person I was when I started is long gone; a different, more somber, at times cynical person, has taken his place. People who walked in my shoes fought for the 20-year pension deal knowing from experience that 20 years in firefighter time is a long, long time. They knew, as only one who lived the life will ever know, that for some, 20 years is enough. They knew that at 45 or 50, starting a new career is not that easy, or starting a business when everybody else has had a 20-year head start is challenging, to say the least.

I remember sitting in at a critical incident debriefing a few hours after I held two dead infants in my arms. My latex gloves had melted into their skin as their bodies were so hot as I tried unsuccessfully to revive them with my new CPR skills. I bagged the one-year-old—Savannah—while doing compressions on the other, John. It was rough, but it was what I had signed on for.

The guy who brought the babies from the fire to me was a 20-year veteran firefighter, a tough guy by all accounts. When it was his turn to speak he filled with tears and couldn’t. He hung his head and valiantly tried to express his feelings, but couldn’t. He left the room. A few months later he was gone. Retired. He told me much later that it wasn’t necessarily that call that did it; it was all the calls leading up to and including that one that finished him. He simply could not do it again.

I should have learned a lesson that day, but mired in the arrogance of youth I hadn’t lived enough to sense my own frailty. I was invincible. I thought of him the other day, as I drove home from what I thought was an unremarkable tour. As I neared my street, I thought of the little girl who claimed to have injured her knee and refused to move from the gymnasium floor. Her mother looked on from a distance, annoyed as I tried to figure out what was wrong. No bleeding or deformity, swelling or anything really. She showed me her other knee as a comparison, and I noticed bruises, weeks old on both legs, and both arms, and a haunted look on her face. I let it go. We can’t save everybody, and she probably is just an active kid who bruises easily. Or not.

 

I turned onto my street and had to stop the car. Where was the little girl now? Was she home in her room reading or watching TV, or was she being punished for being a cry baby like the kid a few weeks ago whose mother called us because her son “fell” from his bed—fell and had severe head trauma and curling iron burns on his legs. It took 10 minutes for me to pull myself together before I could walk in my door and not bring 20 years worth of memories with me.

I haven’t been sleeping well. It’s been going on for months now. Every night that I’m home I’ll go into a fitful slumber around midnight, only to be fully awake at 2 a.m. I toss and turn for hours, finally getting some relief from my spinning mind at sunrise, only to be back up an hour later. I grab an hour here and there as time permits, but have no idea what a full night’s sleep feels like, unless it is drug-induced, but I try to avoid that.

What runs through my mind is probably similar to every other person my age—are the kids really okay, will the bills get paid, am I truly happy or is this just an illusion, is that spot on my back the cancer that will kill me or just a mole. Then I get the ghosts…

  • The baby run over by the 18-wheeler as it turned the corner on North Main and Doyle, dead in the middle of the street, the baby carriage twisted and crushed 100 feet from the body.
  • The guy buried alive at sunset on Dorothy and his lifeless arm the first thing we dug up.
  • The 20-year-old guy and his 20-year-old friend dead in the front seat of their Mustang at the Atwells Avenue off-ramp.
  • The 55-year old guy who was new at motorcycle riding who tapped a rear view mirror, lost control on 195, flipped over the Jersey barrier and was crushed by a Toyota Camry full of kids. We found his foot later, still in his boot.
  • The 18-year-old tattoo artist found hanging in his basement by his roommate.
  • My friend’s brother found hanging in his bedroom closet.
  • A RISD student found hanging from the wrought iron fence at Prospect Park.
  • The kid found hanging off the side of his house on New Year’s Eve.
  • The 55-year-old who told his wife he was going golfing, started his car, didn’t open the garage door and died next to his clubs.
  • The 40-year-old who held up traffic while he considered jumping from the overpass, then did as the crowd that had formed cheered.
  • The college kid who fell 80 feet to his death the week before Christmas.
  • The baby who rolled himself into his blanket and suffocated while his dad was napping on the couch.
  • My friend Kenny who had a heart attack at his third building fire of the day and had to be defibrillated, who came back to life but not the job.
  • The 17-year-old girl who bled to death in the front seat of a car that had struck a tree while eluding police as her friends picked her pockets of the crack vials they were selling.
  • The baby born dead and put into a hefty bag.
  • The woman dead in her kitchen with a bullet hole in her forehead and her three children sitting on a couch in the next room.
  • The two babies that broke the veteran firefighter.
  • The eight-year-old deaf girl who broke my heart when I learned she had been prostituting for her foster parents.
  • The 20-year-old dancer dead in her car after taking all of her pills, and the vomit-covered note on her lap.
  • The family dead behind the front door as the fire burned out of control behind them.
  • Delivering a baby in the back of the rescue and having the mother yell get that thing away from me when I handed it to her.

There are dozens, hundreds more, all waiting for that delicate twilight between sleep and consciousness to come uninvited into my mind. More join the parade every day that I come to work. Just the other week a 23-year-old hit and killed while walking home from a nightclub, a 30-year-old guy shot in the head, back and legs who walked to the rescue and then collapsed.

I am not a machine. I am a simple person who signed on to do a job, and have done it well. If I choose to leave this year, I will do so with my head held high and hope that the pension that didn’t matter to me 20 years ago, but has become my lifeline, is still there.

 

January 1, 2014

The Shift

Perception

There are the best of systems, there are the worst of systems. EMS is an ever-evolving entity; providing quality care to the populace is the goal, the means vary greatly.

The equipment quality and vehicle safety and comfort matter, but the most critical is invisible to the eye. We are EMS. At the end of the day, when the truck is clean, the reports finished and the patient passed on, or over, all we have is ourselves. How we act, perform and think matters more than what we carry. By carrying yourself well, and providing medical care and patient comfort to the best of your ability, any obstacle can be overcome. If you or somebody you know is struggling, a simple shift in perception makes the difference between a fulfilling career and a dead-end job.

The shift starts now…

A new guy was working with me, fresh out of the academy and already pulling an overtime shift on Rescue 4, the busiest of the Providence Fire Department’s six ambulances. The people assigned to the division are a different bunch; relentless calls and lack of support from the department takes its toll on a crew of passionate people, potentially reducing them to shells of their former selves. Yet somehow many stay with it, some for their entire careers, and find satisfaction in the seemingly bottomless pit of need from an increasingly needy public.

Sadly some of our best people leave the division disillusioned and bitter, and choose to spend their entire careers in the fire service anywhere other than the Rescue Division. It can be a dirty, thankless job, and for many it is. It’s also a vital, challenging, gratifying and honorable job. Perception is the key.

“Rescue 4, respond to 1035 Broad Street for an intoxicated male.”

The overhead door opened, then closed behind us as we left the rest of the crew in the station and headed for Broad Street. More than half our calls will be alcohol-related tonight, as they are most nights for Rescue 4, part of the fun of being quartered downtown, where many homeless alcoholics converge. Between the homeless and the college kids living away from home for the first time, the fun never ends. Those experimenting with drinking mix with those whose entire experience relies on it, and the result is often the same: Rescue 4 bringing them to the ER for detox.

“Rescue 4 on scene.”

“Roger, Rescue 4, at 1827 hours.”

“Arthur” stood at one of the two remaining public pay phones in the city and hailed us as if we were a taxi cab and he needed a ride to his next meeting.

“I don’t know how you deal with all these drunks,” said my new partner. “The police should lock them up.”

“It’s a medical call, not a criminal act,” I replied automatically. Impaired consciousness is most definitely a medical condition and is treated as such when I am in charge. My partner had been tainted by the incessant firehouse chatter and had preconceived ideas concerning the patients we would encounter during our shift. It was up to me to clarify things.

“Come on, Arthur, let’s go,” I said, and helped him into the truck.

“All set?” said the new guy, ready to roll.

“I need a set of vitals and a glucose test,” I said. He looked at me like I was crazy.

“For a drunk?” he asked, well within earshot of Arthur.

One of the hardest things to overcome while working in the inner city is the urge to judge a person and treat him or her based on what you see. We see the drunken man, the filthy clothes, the plastic shopping bag with the bottle inside, and immediately switch to autopilot and get rid of him as quickly as we can. There is a person in that shell—why not make the effort to bring him out and perhaps save a life in a way you had never envisioned?

We treated him with kindness, and though that kindness was unrequited, it mattered. It mattered to me, and by doing so I managed to not chip away at my own humanity. If the time comes that a person becomes less than human, and just a means to an end, it is time to stop working with the public.

We brought Arthur to the ED, and the people at triage gave him a blanket and a sandwich and a warm place to sit. There was no drama, no trauma, no excitement; just one opportunity to show a new guy that success in EMS involves much more than dragging drunks to the emergency department.

We had a long shift ahead of us, and a lot of people to treat.

And teach.

 

July 17, 2014

James

“Rescue 1, respond to Swann Street, possible shooting.”

“Rescue 1, responding.”

A car was stopped in front of the address at Swann, motor running, all four doors open, windows shattered. Police cruisers dominated the scene, and officers searched frantically for shooters and victims. Moms quickly escorted their children away from the house, while party balloons floated peacefully, tied to a porch railing. Our patient sat on the steps, holding his upper arm.

“Where’s James?” he shouted, frantic, his street cool shattered.

“I don’t know,” I replied honestly. “Stay still, I need to stop this bleeding.”

“I don’t care about that,” he said, shoving my hands away from the wound near his biceps. It looked like the bullet missed anything major, probably just a flesh wound.

“Do that again and I’ll break your fingers,” I replied. There is a way of threatening to do bodily harm that puts patients at ease. What can I say? I guess it’s a gift. It helps being seasoned when dealing with gang members. They don’t feel threatened by somebody old enough to be their dad. If they even had one.

“It hurts.”

“I’ll bet,” I said, and cleaned the wound, applied pressure and wrapped his arm with gauze. “What happened?” I asked as we walked toward the ambulance.

He was reluctant to talk, but once his words began to flow it was hard to stop him.

“We came from the north end for my niece’s birthday party,” he explained. “We was just parked in front of the house, not doin’ nuthin’, when these gangbangers from the southside pull up and start firing. They was chasin’ James last I saw—where is he?”

“I’m listening to the police radio, looks like James got away; the scene is secure.”

“Whassat mean, secure?”

“It means the guns are all gone.”

His sneer returned, and what might have been a handsome face returned to the arrogant contemptuous mask that had formed during his 16 years of life. With his fear alleviated, his friend apparently safe and his wounds not life-threatening, the boy vanished and the thug returned. I wondered when the first transformation began—10, 11 years old, maybe younger. Perhaps the only moments of serenity he ever knew were while in the womb, when his environment truly was secure, and the outside world had yet to invade.

He insisted on walking into the emergency department, GSW and all, and I let him. I’ve learned that sometimes it does far more harm trying to make them conform and put up a fight while we try to get them to lie on the stretcher. A bullet wound, even a “flesh wound,” is serious, and there is no sense making it worse with a struggle. The kid just got shot; he’s had enough to deal with. It also helps being seasoned while dealing with the triage team at the desk. The raised eyebrows diminish as the years progress, and the people on the inside know and appreciate that those of us on the outside have a better understanding of what it takes to get a patient in without doing further harm.

“You’re going to be okay,” I said to my patient, while leading him to one of the gurneys. I like to believe that for the briefest second the boy returned, but sometimes I delude myself.

“You aiight,” he said as I walked away, my portable radio coming to life as the distance between us increased and any connection I had hoped to establish with him was gone.

“Rescue 1; respond back to Swann Street, possible DOA.”

Damn. I keyed the mic as I walked into the bright Sunday afternoon sunshine.

Rescue 1, responding.”

James was in the backyard. One of his sneakers was on one side of a six foot stockade fence, the other still on his foot. They caught him next to the pool. Bullets had pierced the wall, and streams of water  poured out of the holes, soaking the bloody ground where I knelt next to him, feeling for a pulse that I knew was not there.

 

February 1, 2014

The Shift

Copper

We rode through some of the roughest streets in Providence when we left the ER, not by choice; rather, it was the quickest route home.

Rescue 4 is quartered at the Providence Police and Fire Department headquarters, along with Engine Co. 3, Ladder Co. 1, Special Hazards and Division 1, the shift supervisor. The crew was preparing the night’s meal, and it might be “All HOT!” I certainly hoped so; mealtime is my favorite time of day.

“Rescue 4, are you available?” barked the radio speaker.

“Roger, clearing Rhode Island ER,” I replied.

“Rescue 4 and Engine 3, respond to Route 95 south at exit 17 for a reported pedestrian struck.”

I keyed the mic. “Rescue 4, responding.”

“Roger, Rescue 4, at 1922 hours.”

Jared looked a little confused, so I gave him some direction and settled in. It is imperative to know the streets in the city, and most people spend countless hours studying maps, but no matter how well you know the streets by map, responding from the middle of the city is far different from leaving the familiar ground of the station.

It doesn’t matter how long I’ve responded to emergencies, I find every one brings with it a certain level of excitement. I rue the day it just doesn’t matter. A pedestrian struck on an interstate has the potential to be catastrophic. I reached into the box between the seats and grabbed some gloves, knowing that if indeed a person was struck, there would be multiple glove changes. I gave Jared a handful.

The breakdown lane was mercifully open, and we moved toward the incident. As we closed in things became clear. I saw from the activity on scene and the lifeless form in the low-speed lane all I needed to know.

“Rescue 4 on scene with police, cancel Engine 3.”

“Roger, Rescue 4. Nature?”

“DOA.”

“Grab some sheets,” I told Jared and walked slowly past the troopers toward the body. We covered the remains with sheets as white as the skin on Jared’s face.

“Rescue 4 to fire alarm.”

“Go ahead, Rescue 4.”

“On scene at 1927 hours. Time of death, 1927.”

“Roger, Rescue 4. Are you in service?”

I looked toward my partner and responded. “Negative.”

The first body I saw, other than one in a casket, had been struck by a train. I dodged blobs of humanity scattered across the railroad tracks as I approached the carcass; quarter-size chunks of meat that moments before were held together by a suicidal man’s skin squished under my shoes the closer I got. My world began spinning, and I thought I was going to faint. Nausea crept into me and stayed as an aura of unreality enveloped me. The coppery smell that filled the air nearly overwhelmed me.

“Suck it up, kid,” was all I got from my officer.

So I did. And I remember every second of that call to this day, and it haunts me still.

“You OK?” I asked Jared as we left the highway and the smell of copper.

“Fine,” he said.

“These things happen whether we’re there or not,” I said. “Because we weren’t there, it doesn’t mean it didn’t happen. That guy was going to be dead whether we declared him so or not, and there wasn’t a thing we could have done to change it.”

 

 

It wasn’t much, but it was all I had. Maybe he would be OK, maybe not, but I didn’t want to leave him hanging.

“What do you think happened?” he asked after a few minutes had passed.

We talked about it all the way back to the station; it didn’t take long before words were flowing, and feelings previously trapped were allowed to escape, and some sort of sense was made of the tragedy. It helped me to talk about it, and it helped him. The wave of nausea had returned as soon as I saw the scene in the distance and knew the lifeless form in the high-speed lane was another body. I suppressed it and did my job and had no intention of letting the image, sounds and smells that accompanied the event lie dormant inside of me, like a insidious disease waiting to attack.

“Rescue 4 to fire alarm, hold us out of service for decon,” I said into the mic as we backed into quarters. As we climbed the 22 steps from the apparatus floor to the living quarters, the station PA crackled, and the words “all hot!” filled the air.

“You hungry?” I asked Jared.

“Starving,” he replied and gave me an uncomfortable grin, and we joined the firefighters just sitting down for the night’s meal.

 

May 30, 2014

The Shift

Intoxicating

2256 hrs.

“Rescue 4 and Engine 8, respond to Chapin Street for a domestic assault, stage for police.”

The lights blind me, the echo from the PA rings in my head, and I’m rising from the dead sleep that followed my body into the bunk in Rescue 4’s office. I’d managed to get a stack of reports finished and filed before calling the missus to say goodnight. It was the first time since 0600 that my body was horizontal, and likely would be the last till tomorrow morning. My shoes are still on, the radio clipped to my belt, the portable mic lying on my chest.

Rescue 4, responding.”

I’m too tired to slide the pole. The stairs are the safe alternative to reach the apparatus floor, and I walk them slowly, the overhead door creaking open, Jared waiting, engine running, warning lights activated and ready to go.

“Nice break,” he says, looking refreshed as only a 20-something-year-old who just worked 16 hours with eight to go can, and a pushing-50 rescue captain cannot.

We head west, toward Chapin Street and the incident.

“I hope it’s a police matter,” I say.

“I wouldn’t mind a little action,” replies my partner.

We approach the scene slowly and stop behind Engine Company 8, lights off, motors idling. People are wandering the streets; dealers, their customers, drunks and hookers for the most part. The cops are nowhere in sight, and the house in question is quiet. Minutes pass, still no police.

“Think we should investigate?” asks Jared.

“We’ll wait for the cops,” I say, stifling my own desire to find out what’s going on. Inside the house anything could be happening. Most of the time it’s not life-threatening; kids fighting with parents, parents fighting with each other, husbands beating their wives, wives beating their husbands, but you just never know. I hate thinking somebody is being abused and we’re sitting a few blocks away, waiting.

“You have kids?” I ask.

“Boy and a girl, 7 and 9,” Jared replies.

“Miss them?”

“Of course I do, but it is nice coming to work sometimes.”

Coming to work is easy. We get to leave it all behind every week and play hero in the big city, leaving the little things for our other halves. Little things like paying the bills, caring for the children, shopping, laundry and making our houses homes. If we are not careful, the hours away from home can become the time we find ourselves living for; the escape from the mundane, a break from the monotony, no feeding the pets, no hearing the din from the kids, a respite from dealing with the people in our lives who matter most.

“Mppphh,” I grunt in reply.

I want to tell him, but like the rest of us, he’ll have to find out for himself. The job is intoxicating. The only responsibility we have is answering the calls for help from strangers, and there is no emotional risk, no compromise, no fighting or nagging and nobody to be accountable to. But we always have to go home. When going home becomes less desirable than going to work, that’s a problem.

We like to blame our ridiculously high divorce rate on the stresses of the job, the things we see and the strain of being a firefighter, cop or EMT, but that’s only half the story. The other half we bring upon ourselves by not being present where we are needed most. Even when we are home, the draw of the job is never far from our hearts and minds. It’s as if we lead double lives, and the balancing act wears you down after a while.

Two cruisers speed past us and stop in front of the house on Chapin Street. We sit silently and monitor the radio.

 

 

“Engine 8 and Rescue 4, police matter; you can go in service.”

“Too bad,” says Jared as we drive away from the scene. “I think I’m starting to like this EMS stuff.”

“Really?” I respond, surprised and more than a little pleased that he admitted it.

“Yeah, it’s kind of addictive.”

I know exactly how he feels. Some people never understand how satisfying the simple things in the fire/EMS field can be, and how important it is to leave it at work. It took me a long time to figure that out, and to appreciate that I have the ability to do what I do, the opportunity to do it in a wonderful place called Providence, and the experience to know that what matters most begins at the end of the shift.

“Rescue 4 and Engine 8, respond back to Chapin Street for a shooting.”

“Rescue 4, responding.”

But that is a long time from now.

 

March 29, 2013

Overdose

We’re in the basement of a triple-decker in a run-down neighborhood, on scene with a man down, strong pulse, respirations 6 a minute. The house appears abandoned. It’s dark down there, rays of light creep through filthy windows, spiderwebs cast eerie shadows against the walls, mortar crumbles, dust mites abound.

The person who called for help is gone; it’s just us, the bugs and a man about to die. I put the pulse-ox monitor on his finger, 82%, and then key the mic.

“Rescue 1 to Fire Alarm, send a company to 2143 Elmwood for assistance.”

“Roger, Rescue 1. Nature?”

“Overdose.”

“Received. Will police be needed?”

“Roger that.”

Better to have more help on scene than not enough. You never know how these things will pan out.

A firefighter has been detailed from Ladder Company 8 to Rescue 1 for the night tour. He’s a good guy, trained as an EMT-Cardiac, which in Rhode Island is equivalent to an EMT-I: more training than a Basic but not as much as a paramedic. I have the same training but years of experience as well. This is Henry’s second shift on the rescue.

“We need to bag him,” I tell my partner while I fish through the med bag for the goodies. I hand the meds to him and open the bag-valve mask, attach the face piece, fill the reservoir, place it over the patient’s nose and mouth, and squeeze. Henry looks at me, waiting for instructions.

“What do you see?” I ask.

“A guy dying in a basement,” he answers.

“Look harder.”

I’m not at all comfortable with this scenario, but I’ve got a potentially good Cardiac with me, great attitude, a willingness to learn and a knack with people. A little confidence and some more experience, and we might just have another good rescue guy to add to the dwindling ranks of people who want to be part of the EMS division of the Providence Fire Department. We can use all the help we can get; the burnout rate on the rescues in Providence is critical.

“His 02 sat is going up as you bag him. His pulse is strong and steady. Track marks on his arm. Probably an overdose,” Henry ventures, his body language indicating he’s taken a lead role in the treatment plan.

Precious time ticks, but it is imperative that Henry think for himself. I’ve treated more overdoses than I can remember and am fairly certain I have things under control.

“OK, what now?”

“Nasal Narcan.”

“Don’t have any.”

“Really? It’s in the protocols!”

“Optional. What next?”

“Start an IV and push 2 mg.”

“That will work, but he’s crashing. What if you blow the IV?”

My heart rate is increasing; I can feel the pressure in my head rising. All I want to do is pass the bagging over to the new guy, draw up the meds and give them to the patient IM. Easy as pie.

“I can administer 2 mg IM,” he says, and I feel the pressure recede. A little.

“Perhaps you should do so.”

He fumbles through the compartment where we keep the syringes and needles, agonizingly slow, opens the packaging and connects the needle to the syringe. I’m bagging away, monitoring the heart rate and pulse ox. The heart rate is increasing, but the pulse ox stays steady at 96%.

I can’t keep the memory of a similar situation from flashing through my mind. I was a new guy, second or third shift on the rescue. The medic I was working with had seen it all, done it all and wanted to do as little as possible until he retired. We had the patient on the stretcher and were transporting to the ER. I asked why he didn’t give the Narcan, and he replied, “Because they puke.”

Henry flips the top off the vial.

“What’s the date on that?” I ask.

He’s nervous but slows down.

“November 2013.”

“Good. Are you sure it isn’t Lasix?”

“Narcan.”

“Excellent.”

 

He gets ready to plunge the needle into the vial.

“Is that clean?”

He stops; stress and annoyance begin to seep in. We’re in a filthy basement in an abandoned house working on an addict with numerous track marks and probably hep C and who knows what else, but he rips the alcohol prep open and wipes the top, pushes the needle in and tries to fill it. I think I’m going to flip out if I have to watch this excruciatingly slow turn of events, but I take a deep breath and ask, “Do you know how much of that to administer?”

“Yup, 2 mg. It’s 0.4 mg per ml, so 5 ml.”

I think the basement actually brightens. Sirens break the eerie silence, penetrating the late afternoon atmosphere, closing in, help is on the way. Henry has checked the med, the expiration date and the dosage, has drawn the Narcan and is ready to go. He pinches the flesh of the patient’s triceps area and gets ready to stick him.

“Is the skin clean?” I ask. He opens another alcohol prep, wipes an inch of skin, turning the pad a sickly brown, pinches again and sticks the needle in, then depresses the plunger. He pulls the needle out and glances at me.

“You should have had a 2×2 ready.”

Engine 10 arrives on scene, the firefighters assigned there descend into the dingy basement. I stop bagging. The patient opens his eyes, sits up, looks around and swears at us.

I feel the tension leave my body, thanking the rescue gods this didn’t end like the other one, where the burned-out medic pushed the Narcan as we rolled into the rescue bay at the ER, only that patient didn’t respond. He never did, because he’d a heart attack, either before or after he’d overdosed. He died, and may have lived had his treatment begun when it should have.

Some people never learn. Thankfully, others do. Henry was beaming when our patient walked out of the basement.

 

February 1, 2013

Five Stages of Grief

0415 hrs. The tone sounds in the station and the blow lights fill the space with harsh fluorescent light. “Rescue 1, respond to 160 Broad Street at Crossroads for a female with tooth pain.”

  1. Denial
    “Tooth pain? Surely they jest. This must be a mistake. I’ll just lie here, pull the blanket over my eyes, wait for the lights to go out and it will go away.”

“That’s Rescue 1, respond to 160 Broad Street for a 22-year-old female complaining of tooth pain.”

  1. Anger
    The grumpy rescue officer sits at the edge of the bunk, finds his shoes, throws his shirt over his head and shuffles toward the pole.

“Tooth pain! This is bull! You have got to be kidding me! Call a cab! Get a bus! Get over it! Tooth pain, she’s going to have tooth pain I when get there all right. No, she won’t have any teeth when I get there! Tooth pain. 9-1-1 for tooth pain…”

  1. Resentment
    As our heroes roll toward their fate they commiserate.

“Can you believe this bull? Toothache! We’re the only truck in the city doing anything. Must be nice to work in a normal city with normal people who don’t call at 4 in the morning for a toothache! Why do they even send us? What’s the matter with those dopes at fire alarm? Toothache. Unbelievable!”

  1. Acceptance
    Rescue 1 arrives on scene to find a 22-year-old girl standing alone outside of the homeless shelter holding her chin with both hands, crying. She looks miserable.

“Did you call for a rescue? You did? What’s the matter? Toothache. Come on, we’ll take you to the hospital.”

They help her into the side door of the rescue, make her comfortable, get some vitals and transport.

  1. Closure
    At the hospital they bring their patient to the waiting room, say a few polite hellos and get back into the truck and drive toward home.
    “Rescue 1 in service.”

 

October 12, 2013

Tradition

The bagpipes, the dress blues, the stories of friendship, of sacrifice, of bravery, camaraderie and accomplishment; these are the things that drew me to the fire service. The bucket brigade, Jakes and Pikemen, then Laddermen and Hose Jockeys, horses in the barn pulling the steamers, Dalmatians, bells and whistles, air horns, sirens, flashing lights and everything that ties us to the past and brings us into the future have a solid place in my heart, and always will.

I am a fireman. My kids know it, and their children will know it, and with any luck, their kids will too. My helmet will probably hang on a hook in a garage not yet built, gathering dust until a child finds it, and puts it on his head, and begins the journey that I have taken. I wish him well.

Tradition.

For the last nine plus years I’ve worked in the Providence Fire Department’s EMS division. It isn’t often now that I have the opportunity to don the turnout gear, and put the helmet on my head. I miss it. But I have no regrets.

EMS traditions are not as glamorous, or colorful, or respected by most. They never will be. Funny thing is, I’m more proud of the nine years spent on a rescue than I am the 10 I spent on engine and ladder companies. There is something about the personal nature of this job that attracted me to it and a few traditions that mean more to me than anything else.

Professionalism. Compassion. Competence. Excellence.

Every time, without fail, that a family member or friend needed an EMS response, those responders were excellent. Not good, not adequate, but exceptional. My father, who in the final stages of cancer would hallucinate and become unmanageable at home was treated by EMTs from the Warwick Fire Department not like a nuisance, or a silly old man, but like a Korean War Veteran, and engineer, and son and father who needed help in his last hours. My mother, who was the victim of a massive stroke while visiting family in North Carolina. By all accounts the EMTs who responded acted the same way, and managed the scene with grace and dignity. The EMTs from the air ambulance that flew her home, with me on board, exuded such expertise I never worried about a thing. They helped my parents, and in doing so helped everybody whose lives they had touched.

I often hear about people who were involved in a car accident, or had an allergic reaction, or whose grandmother was choking at the restaurant, or the million different reasons we are called. One thing remains the same, by all accounts. The EMTs were simply awesome.

Tradition.

Big boots to fill. I’m proud to fill them.

My wish is that some day, when the kids find my old helmet hanging in the garage, one of them sees the old jacket, the one with the Providence Fire Department patch on one sleeve, and the EMT patch on the other, and I hope he puts it on.

And I hope he never looks back.

 

November 9, 2012

Last Battle

The sun has yet to break the horizon as we approach the two-family home in the heart of South Providence. This is my kind of moment: The normally hectic and loud streets succumb to the dead of night as the phosphorescent light envelops everything, blanketing all the noise and activity until daybreak. A house isn’t a home but for the people who live within its walls, and I suspect a lot of living has happened here. Places like this are everywhere in the city’s neighborhoods, well-kept multifamily homes, some dated, others freshly painted with ornate metal fences and gates offering some level of security and place to the people who make the best of their inner-city places of residence.

A trend has reappeared in this neighborhood, a wonderful resurgence bringing and keeping generations of family close together. Somebody buys a two- or three-family home, mom and pop live on the ground floor, the kids who own the place occupy the second and, if it’s available, the third apartment is rented, sometimes to another family member, to help foot the bills. The roots of my family were planted in much the same fashion generations ago, until time and prosperity divided the old from the young and single-family homes became the norm.

There is no gate here, no fence marking territory, just an old Ford parked next to the house. Paint has peeled from the siding, some windows need to be reglazed, and the old wooden steps give when bearing my weight. I notice the license plate as we walk past the car, a special issue from the state of Rhode Island that simply says Wounded Combat Veteran.

I walk into the home. An elderly couple lives on the first floor. It looks like they’ve lived here for decades. The space above them is empty—if anybody had lived up there, they were long gone, and nobody took their place. They are alone.

Slumped in a kitchen chair is our patient, an 89-year-old veteran named Joe. Engine 11 has arrived first, and an IV is already established, vital signs taken and high-flow oxygen is being delivered through a nonrebreather. Joe had tried to take a sip of his morning coffee, felt sudden weakness and spilled it all over his crisp white t-shirt. There is obvious facial droop and no strength on his left side when he squeezes my hands.

His wife of 50 years stands by, nervously wiping the spilled coffee from the green linoleum floor. “He goes to the VA,” she says.

As my partner, Adam, and the guys from the 11s help Joe into the stair chair, strapping him tight so he won’t tip to the left, I take his wife to the side. I hate doing it.

“When did you notice something different?” I ask.

“Right before I called you, about 10 minutes ago. He was fine, drinking his coffee like he does every day. But then he dropped it and couldn’t tell me what was wrong.”

“Joe is having a stroke,” I say as gently and quickly as I can. “If we get him to the proper facility, the damage can be stopped. We can help him, but the VA isn’t the best place for something like this.”

 

 

She starts to argue—insurance reasons maybe, familiarity more likely—but sees the urgency in my gaze and relents. Sometimes those closest to you refuse to allow the evidence of something terribly wrong into their minds until the last possible moment, holding out hope that everything will be OK. Subconsciously the truth cannot be so readily discarded. Joe is in very big trouble and likely will never come home.

“I’ll stay here and clean up,” she replies, nervously wiping the kitchen table where the coffee-stained paper sits, open to the sports section. There are no kids upstairs—where they went and if they ever existed, I’ll never know; my time with my patients is limited, and small talk is not an option with so much to do and no time to waste. I think of the new immigrant families who have taken so many of these houses over, teeming with kids, generations of people nearby, taking care of their elderly and starting their lives in their new country. I wonder if in a few generations they, too, will be alone, with empty floors above them.

In the truck Joe’s in the stretcher, listing to the left.

“Let’s go.”

I reassess his vital signs and try to get him to speak. He tries valiantly but is frustrated and unable to articulate his thoughts.

As we speed to the ER, I give him the news. A wounded WWII vet deserves the truth.

“Joe, you are having a stroke. There are treatments available, and we’re within the time frame. We can stop the damage; you’re not done fighting just yet.”

His right hand grips mine fiercely; he makes eye contact, then closes them. We ride to the hospital in silence—him lost in his thoughts, me hoping I’m not witnessing his last battle. I look out the rear windows, and as the city speeds past me backward, I think of all the uncles and aunts from my own family who live quiet lives without much fanfare. What they did all those years ago is simply remarkable. Lives were put on hold to fight a war, families were separated, some for good, but the most remarkable thing of all is how they lived once it was over.

I think I’ll call my Uncle Tony. Last year I found out he was awarded a Bronze Star for his actions during some fierce fighting in Italy when he was with the 10th Mountain Division.

He might even tell me what he did to earn it.

 

December 20, 2013

Working at Home

The patient is in respiratory distress, lying in bed, diaphoretic and semiconscious. Each breath she takes requires monumental effort, and that effort isn’t enough to supply her body with enough oxygen to sustain her. Even with the nonrebreather and 10 liters of supplemental 02, her SpO2 is 85%, her lungs are full, her blood pressure 180/100, with a heart rate of 128. Three firefighters are in the room with her; one hands me the paperwork. The rest of us move her from the hospital bed to our stretcher.

She is 61, her name is Kathleen. The report is vague. Included with the interfacility transport page, the patient’s history and medications is the narrative: History of MS, found unresponsive at 0430 hrs., difficulty breathing, sat 80%, BP 160/80, HR 120, resp. 28. EMS called.

The nursing staff is conspicuously absent. The hall is empty—no aides, no dietary technicians, no doctors or visitors. There seems to be nobody home at the nursing home, except for rooms filled with people sleeping or staring at the walls, waiting for something to happen. A few peered at us as we rolled the stretcher past their rooms, no doubt wondering for whom the bell tolled this time, and when it would be their turn to be wheeled out.

This isn’t a fancy place, with privacy, pretty paintings and an abundance of staff. It’s a state-run facility operating with the bare necessities, two patients to a room and one RN for too many patients.

There is a nursing station near the elevator, and there I find somebody, finally. She is alone at the desk, phones ringing, a stack of orders in front of her, nearly overwhelmed. I take a deep breath and assess the situation and, instead of demanding a more cohesive report, simply ask her opinion regarding the patient.

“Good morning. Can you tell me something about Kathleen beside her vital signs?”

She looks up from her reports, leans back in her chair and regards me. It only takes a second, but I know when I’m being sized up. She is ready for confrontation.

“I think she has pneumonia and maybe a UTI. She’s normally talkative and alert. This is highly unusual for her. She wasn’t feeling well when my shift started; she normally asks about my daughter, but she didn’t tonight. Thank you for asking.”

 

 

She returns to the mountain of work, we continue on. I have no interaction with the person on my stretcher. She doesn’t know, will never know or ask about my daughter, or I hers. Her life story is a mystery to me, her presence in my life fleeting and soon forgotten. An IV, an EKG that’s unremarkable and a ride to the ER for an evaluation, and that is that. Later I find out she has pneumonia.

In a perfect world nursing homes would be properly staffed and nurses would not be overwhelmed. I hear a lot of people in our field question the competency of the staff at these places. Theirs is a world much different from ours. They know their patients far better than we do. They share their lives with them. We have no idea what it takes to spend eight, 10 or 16 hours with a patient, a week, a year or a lifetime. They do. They will be there for their patient’s final days, or hours, and experience suffering and death time and time again. They offer the people under their care far more than emergency medical treatment. Their input is valuable. I think we may have worn them down by treating them poorly when everything isn’t as we’d like it, and demanding better reports, better documentation, some intervention or, worse, simply ignoring them.

The nurse on duty did the bare minimum, but probably not out of laziness or lack of compassion. She too was trying to survive in a difficult environment. The clues were there, waiting for me to put the puzzle together. I could easily have treated Kathleen for congestive heart failure and subjected her to unnecessary treatment. By simply asking the nurse who knew the patient better than I her opinion in a friendly, nonconfrontational way, I was able to figure out what was wrong and treat the patient accordingly.

As a bonus, I got to feel better about myself by simply treating a colleague with a little respect.

 

August 2, 2012

Glimmer of Hope

I see the neighborhood mostly through the rear windows of Rescue 1, the images traveling past me going backward. Glimpses of city life witnessed through fleeting glances, snuck between patient care and the paperwork that goes with it. We travel these roads often, cut-throughs between Providence’s busy main thoroughfares, shortcuts learned from years of taking people to hospitals. To us they’re just streets—tools, if you will; means of travel. For the people who live on them, they’re home, often disturbed by speeding rescues and piercing sirens. Sometimes gunfire precedes these interruptions.

As we rush to the scene of a child struck by an auto, I think of the last time I was on this particular street. That time it was for a kid from the neighborhood who didn’t make it out. The last time I saw him, I was standing in the pouring rain in somebody’s backyard. He had a bullet hole in his head. Rain thinned the trail of blood that ran down his chin and onto his t-shirt, making it look fake. I felt for a pulse, felt the skin cold at my fingertips—no radial, no carotid, nothing. His eyed rolled back in his head. I wanted to close them like they do in the movies, but it was a crime scene. I backed out, careful not to trip over the gun that fired the bullet that ended his life.

A few days later I saw his face again. I had to look twice at the picture; he didn’t belong on the obituary page. He was a young guy, long braided hair, his mother dead, raised in foster care. He left his foster mother, a brother and two kids without a father. It was strange, but the picture on the obituary page didn’t differ much from the mental image I had from the day I saw him dead. Going through the motions of life is far different from living.

Life for the rest of us goes on. As we passed the house where he died, different people sat on the deck, enjoying the summer five feet from where a young man ended his life. I looked out the side window and remembered, then focused on the kid who needed us more.

They had put her in the grass, 20 feet from the road where a slow-moving car had run her leg over. She had been playing, enjoying the day with about 20 people, grill fired up, cold drinks full, an inflatable bouncy tent in one of the backyards. A crowd had formed around her; we had to squeeze our way through as her relatives slowly gave ground. Her father had to be moved away from his daughter so we could do our work. He reluctantly let his baby go and watched a bunch of strangers tend to her. She screamed in fear and pain while we splinted her lower left leg, crushed, bleeding and swollen. But she said, “It’s OK, daddy,” her own pain secondary to her worries about her distraught father, as we lifted her onto our stretcher and rolled her away.

A crowd had formed, as it often does in the inner city when flashing lights and the trucks that run them make an appearance. More times than not something violent has preceded it. This time there were no hostilities. It’s a little different when the victim is an innocent 7-year-old and the injury an unfortunate accident rather than an act of aggression or revenge. The crowd stood by respectfully, watching as we did our thing, stabilized the patient, calmed her fears and tried to ease her pain.

There are differing philosophies regarding family members in the treatment area during emergencies. My own is to let the family in and have them close by to offer comfort, especially when children are involved. The little girl’s mother entered our ambulance through the side door and sat on the bench seat, watching as we got ready to go. The leg had been packaged; only some gauze was visible under the blanket that covered the child.

 

“What is her name?” I asked the mom.

“She doesn’t speak English,” from the little girl, calm as could be.

“Well, then, what is your name?”

“Magneline.”

“Madeline?”

“No. Magneline. M-A-G-N-E-L-I-N-E.” Talk about grace under pressure.

She told me her date of birth, her correct address and everything else I asked her. And she told me she was worried about her father. “Where is he? Is he OK?”

We got rolling, Hasbro Children’s Hospital less than a mile away. Her father followed. Once inside the hospital, the nurses took over. In the small treatment room, with the girl’s mother still close by, they undid our packaging. When the mom saw the injuries, she broke down.

“Don’t cry, mama,” said Magneline, soothing her mom, letting her know it would be OK. Then her father joined them, and little Magneline comforted him too.

Then they administered morphine, and little Magneline rested.

I cannot imagine Magneline sinking into the same black hole that draws so many of the inner-city kids into nonproductive existences. The allure of quick money, street cred and popularity takes initiative away and replaces it with instant gratification that cannot be maintained and often ends violently, sometimes with a bullet in the head.

Some of the most promising children are tempted to join gangs, live on the fringes and develop contempt, anger and mistrust of society. Others have a certain something and manage to overcome the allure, stay focused and in school, and make something of their lives. In doing so, they help the rest of us see that even in the bleakest of places, there is always a glimmer of hope.

Thank you, Magneline.