Paramedic

by Peter Canning

  The motel office manager directs us up the stairs to the second floor.

  A cop meets us at the top of the stairs. “She’s conscious but sleepy,” he says. “She took some pills.”

  I enter the room. There is a rack of dresses against the wall, and below them perhaps thirty pairs of high-heeled shoes. A large woman wearing dark sunglasses sits on one of the beds with her head down. I notice her long legs, and full hard breasts. She is wearing a blouse and tan pants.

  I reach for the woman’s pulse. It is strong at a rate of 90. “How are you feeling, ma’am?”

  “Sleepy,” she says.

  A shorter older woman hands me a prescription bottle of Klonopin. “She took fifty-eight of these.”

  Klonopin is an antianxiety drug that is often prescribed for sleeplessness. I read the name on the bottle. “Daniel-Mary Williams.”

  “These are someone else’s?” I ask.

  “No, they are hers. Donna-Mary,” the woman says.

  “Why did you take all these pills? Were you trying to hurt yourself?”

  “I wasn’t trying to kill myself,” she says. “I just want to sleep.”

  “She’s been depressed,” the other woman says. “She just got this prescription yesterday. She took one last night, and I found one on the floor. That leaves fifty-eight she took.”

  “Can you walk?” I ask.

  She nods.

  “The ambulance is just outside. I’ll help you if you feel dizzy at all.”

  She walks out to the ambulance with us. As she gets in, I have her lie on the stretcher and put her on the heart monitor, then take her arm to give her an IV. I notice Glenn looking at me. He mouths the words, “Is she a man?”

  I look at her more closely now. The thought hadn’t even occurred to me. Her complexion is clear and smooth, but her features are large for a woman’s, too large. Her arm is huge—the arm of a linebacker. I look back at Glenn and nod.

  En route, I do my secondary survey, which is required on all patients—a full body assessment. As I listen to her lung sounds I am reminded of the paramedic student we had the day before, who told an attractive female patient he had to unbutton the top buttons of her blouse to listen to her lung sounds. I glance at the woman’s breasts. They are well shaped and look hard as rocks. I skip down to palpate her abdomen, which is soft and non-tender. I glance at her crotch, but cannot tell what may lie beneath. Again I skip down to her ankles to check distal pulses, which are fine. I buckle the stretcher strap, just beneath her breasts. I fight the urge to brush my hands against her breasts to ascertain their texture.

  In the hospital, as I am labeling the blood tubes in her room, the nurse comes in and closes the curtain behind her. “I’ve got a hospital gown. We’re going to have to get you undressed.”

  I am facing the back wall, and suddenly I feel very uncomfortable. I see my patients naked every day. It’s part of the job, and there is no embarrassment about it. But this is different. I don’t want to turn around for fear of what I might see. I don’t want to turn around because I don’t want to be a pervert. And I don’t want to turn around because I really want to see what her chest looks like and whether her boobs look as good naked as they do under her blouse. But as I am an ethical man, I avert my eyes as I exit the room.

  Cowboy

  Glenn likes to drive fast. He is sort of a modern-day cowboy type. When we have female riders, Glenn often turns up his country-music station and sings along to the rodeo songs as if they were written about his life. The ambulance is his horse and he likes to be known as the guy who can handle the fastest ones.

  We get a call for a man having chest pain at a nursing home. His first words are “I’m having a heart attack.” I am inclined to doubt anyone who tells me he is having a heart attack, but this man does not look well. He is pale, diaphoretic. He has only one leg due to diabetes. He says he had a heart attack two months ago. Today is his first day in the nursing home. I put him on oxygen by a nonrebreather mask and take his vitals. He is tachycardia with a pressure around 110—a little too low for a nitro tab. He has a normal sinus rhythm on the monitor. I get his medical form from the nurse and we move him to our stretcher and take him out to the ambulance. I get in the back and tell Glenn I’ll do the line en route. We are on the Bloomfield/Hartford line and are going to Hartford Hospital on the far side of the city. “Take it on an easy two.” I say.

  The man’s left arm is in a sling, so I have to lean over him to put a tourniquet on his right arm. He has a visible AC vein, so I swab it with alcohol and get out an eighteen gauge catheter. I try to time my stick with the bump and jerk of the ambulance. The man screams as I stick him. I have no flashback. I’m off to the side of the vein. I adjust my angle under the skin and press forward. The blood flows into the chamber. I advance the catheter, press off the vein with my finger as I remove the needle, and go to apply the vacutainer to the hub through which I will draw bloods.

  Glenn takes a corner like Mario Andretti and I am thrown against the bench. Blood is flowing from the catheter out onto the man’s arm and sheet. I quickly lunge forward, clamp off the vein again with pressure from my hand, and insert the vacutainer. My gloves are covered with blood, so I must change them. “Nice corner!” I shout to Glenn, but he can’t hear me as he has his country-music station turned up.

  I am drawing my third tube of blood, when the ambulance swerves sharp left, then back again right. Again I am thrown. The vacutainer comes loose.

  “Slow down!” I shout, moving to stem the blood flow. I need to use a towel to clean things up. Everything I touch with my bloody gloves gets contaminated with blood. I change them again, and finally get the blood drawn and hook up the line of saline. As I go to tape it down I am thrown on top of the patient, who is screaming because I have knocked the monitor on his leg. I try to get up but the g-forces have me pinned. When I finally regain my balance, I see the catheter has nearly slid out of the skin so I have to readvance it delicately into place. Finally, it is secure. I am drenched in sweat. There is a huge blood spot on the man’s sheet under his arm.

  “Slow down and watch the turns!” I shout to Glenn.

  He glances back. “You said an easy two; that’s what I’m doing.”

  I shake my head. Goddamn cowboys.

  Occasionally I get testy with Glenn, and he gets frustrated with me just as often. Still he is a decent partner. I trust him. He is a smart kid. I can consult him if I am leaning one way or the other and need a push. And he keeps me calm, simply because I don’t want to appear nervous in front of him.

  We go to a call for a baby who has fallen down the stairs. “Settle down,” he says to me as I fumble with the blue bag taking it out of the side door after we’ve pulled up.

  “I’m calm,” I say.

  “Yeah, sure you are.”

  I take an extra breath and then enter the apartment where everyone is shouting and crying. I get the baby in my arms, see it is alert and breathing, and comfort it, as Glenn orders everyone in the room to quiet down and quit screaming.

  He has been in the city a year and a half and knows all the streets, so I don’t have to worry about getting lost on the way to a chest pain or difficulty breathing. I can concentrate on what I’m going to do when I get there. I hate broken bones, so he does all the splinting of isolated fractures, concocting state-prize-winning contraptions that take a while to do, but win praise from the patients for comfort and from the physicians at the hospital for ingenuity. (I consider buying a Polaroid so we can put on a gallery display: “Splinting by Killion.”) Every now and then, he teaches me a trick I didn’t know.

  A man in his twenties is passed out on the steps of a bakery in Hartford’s south end. As we approach he is not moving. The proprietor of the bakery, an old man, says, “I find him a few minutes ago and call the police. He don’t look to me lika he’s breathing.” A woman with an apron around her waist stands by him with her hands tensed together.

  Glenn and I kneel by the downed man. I
feel a pulse and note his breathing. Glenn rubs his sternum, but he does not move.

  “Is he dead?” another woman asks. A small crowd has gathered.

  Glenn reaches into his pocket and takes out a small green package of ammonia inhalants. He breaks three together in his hand and places them under the man’s nose.

  The man squirms and moves his hands to push Glenn’s hand away, but Glenn keeps it under the man’s nose. The man turns and uses his hands to help himself to his feet. His eyes are bleary and I can now smell the alcohol on his breath.

  “Are you okay?” I ask.

  He mutters and starts staggering off down the street.

  Our audience breaks into applause.

  “Wow, howa abouta that?” the proprietor says to the woman in the apron. “Thank you. Thank you so much,” he says to us.

  “Anytime,” Glenn says.

  The women are smiling.

  “That was impressive,” I say.

  “All in a day’s work,” he says.

  We watch the man stagger down the street. He makes it to the end of the block and turns the corner. We clear ourselves from the call.

  Glenn’s views and outlook are clearly different from mine, but the combination of the two of us seems to work.

  The man is sitting in a chair in a gas station on Albany Avenue. He is in his late thirties. He’s about six two with a strong frame. His eyes are bloodshot. He is wearing an army jacket and has a clear trash bag with a small amplifier in it along with some clothes. He is eating saltine crackers. “I called. I’m ready to come in from the elements for a few days.”

  Glenn puts his “drunk gloves” on. “Okay, buddy. Let’s go,” he says.

  “Hey, man, no need to be throwing an attitude my way.”

  “You called, so let’s go.”

  “Damn,” the man says to me, as I help him with his bag.

  “What have you been drinking?” Glenn says.

  “Couple fifths. Smoked a few bags of dope. Did some cocaine. I ain’t eaten for four days, except these crackers.”

  “Well, where’d you get the money to buy your drugs?”

  “I sold things. I can always get stuff to sell.”

  “Then why didn’t you buy food?”

  “Damn, who are you? My mother?”

  He wants to go to ADRC, but it’s closed. He says to take him to Blue Hills, but we can only take him to one of the city hospitals. He chooses Saint Francis, where he is a regular. I drive. Glenn rides with him in back and fills out the run form.

  At the hospital, I get a wheelchair for him and help him with his bag.

  “Sit in the chair now,” Glenn says.

  “Why you giving me the good guy, bad guy routine?”

  “Just sit in the chair.”

  Glenn goes to the triage desk, while I stand by the man who sits in the chair, still eating his crackers.

  Glenn says, “Alcohol and drug abuser.”

  The man looks at me. “He don’t have to say it like that. That’s cold. Why doesn’t he say intoxicated or the man looking for some counseling. Drug abuser—that sounds like I’m a man who’d jump off a bridge or some crap like that.”

  I nod.

  “Hey, you dropped twenty dollars out of your pocket,” he says to Glenn.

  Glenn looks down at the ground.

  “Hah, got you!” the man says.

  Glenn looks at him and just shakes his head, then returns to talking to the nurse.

  We exchange winks.

  A security guard walks by. “What’s happening, man?” he says to him.

  “Hey, Kenny, how you doing?” the guard says.

  “Hanging on, man. Yourself?”

  “Getting by.”

  We take him back to Room 12.

  All the way down the hall, he’s nodding and saying hello to people.

  “Kenny’s back,” a nurse says.

  “He just wants a meal,” Glenn tells her. “He says he hasn’t eaten for four days.”

  “He was here last night.”

  “If I was, I don’t remember,” he says.

  “Spends his money on drugs and liquor. He ought to spend it on food, I told him,” Glenn says to her.

  I get him set in his room.

  “They’ll get you something to eat in a little bit,” I say.

  He nods. He knows the routine.

  Glenn comes in to drop off the run form. “I hope you get into Blue Hills,” Glenn says.

  “Okay, thanks, bad guy,” the man says, offering his hand, which Glenn shakes.

  “Thanks, good guy,” he says to me.

  “Good luck.”

  “You two take care of yourselves now,” he says as we leave.

  HIV

  I learned a great deal from Weicker over the years, most of all the importance of being true to your view of yourself. Weicker was a hero because he believed that was his role, so he did heroic things that other men wouldn’t have bothered with because they held no significance for them. I remember picking up a newspaper back in 1984 when I was living in Iowa and reading about Weicker’s standing up for more funding for AIDS when most people didn’t even know what it was. He would go on to become a leading advocate for AIDS research and treatment, and as governor, support a controversial free needle-exchange program to help prevent the spread of AIDS, none of which was particularly popular as the country turned conservative. He saw AIDS not in terms of politics but in terms of individual lives. He saw people without a voice, who needed a champion.

  We get a call to the Charter Oak projects for a woman not feeling well. She meets us at the door, with her jacket already on. She has huge blisters about her mouth.

  “What’d you call us for?” I ask.

  “I couldn’t get a ride. I gotta go to Mount Sinai and see a doctor. I haven’t been feeling well.”

  We open the back door and have her take a seat on the bench. I take a blood pressure and pulse and listen to her lungs, which are junky, then take her name and medical history while my partner drives to the hospital.

  “I been getting night sweats and having diarrhea.”

  “Coughing up anything?” I ask.

  “Yeah, brown and black stuff. I’m worried I got the HIV. My brother had it and he died. I’ve been good. I’m a one-man woman.” She has purple welts on her throat and huge blisters on her mouth. Her eyes are sinking into her head. She has a fever.

  “How long you been coughing stuff up?”

  “Couple months. I’ve been getting the night sweats real bad this last week.”

  We go to an apartment building on Oak Street, two blocks from the capitol. A thirty-seven-year-old woman with beautiful corn-rowed hair is sitting on the bed, trying to get the energy to put on her shoes. There is a crucifix on the wall and an open Bible on her unmade bed. The police are there, helping her two grandchildren get on their snow jackets and gloves. The woman hasn’t been feeling well for the last couple of days. She had pneumonia last month, but it really hasn’t gone away. Her skin is hot, her lungs are full of fluid, with decreased sounds in the bases. She says she’s been coughing up brown phlegm. We help her down to the ambulance.

  I can’t take a blood pressure in her right arm because she says she has plastic veins from being shot ten years ago. “Any other medical history?” I ask.

  “HIV,” she says quietly.

  In a bargain jewelry store on Park Street, a forty-seven-year-old man is sitting in a chair, unable to get up. “He did some heroin,” the proprietor tells us. “He’s got the HIV.”

  The man is hot. His arms are shaking. It hurts to touch him, he says. He is skinny with sunken eyes and blisters on his mouth. His lungs sound junky even without a stethoscope. He has a fever. His pupils are pinpoint. We help him up and walk him slowly to the ambulance.

  “You’ve got your needle on you?” my partner asks him. “Give it to me now. I don’t want to get stuck unexpectedly.”

  His hands shake as he moves them slowly, almost like a crane, to his poc
ket, where after half a minute of fumbling, he produces a small syringe, which we deposit in our sharps box.

  His hand swings over to the other pocket. He fumbles some more and he removes a stainless-steel spoon with a small amount of burned residue in its bowl.

  Weicker used to tell the story of a woman who had come before his subcommittee. She had contracted AIDS from a blood transfusion, and one day after she swam in the town pool, her neighbors had the pool drained. She told his committee, “America is not a very good place if you’re sick or different.” Weicker would thunder, “It’s my job to make America a great place if you are sick or different. Since when in this country does it matter how you got sick? All that should matter is that you are sick, and it is our job to help.”

  We pick up a young man on Washington Street within sight of the Health Department. He is shivering, and he has to lean on me to step up into the ambulance. At the hospital, the triage nurse looks to me for the story. “Twenty-seven-year-old male,” I say. “Homeless. Not feeling well. Fever. Coughing up brown sputum. Tender abdomen. Diarrhea for a week.”

  “HIV?” she says.

  I nod.

  “Put him in the waiting room,” she says.

  Glenn wheels him into the crowded room. He tucks a thin blanket around him, touches him on the shoulder, and says good luck. Across the room, a woman in a heavy army jacket sits in another wheelchair, looking down, holding her arms together. She has sunken eyes and blisters on her mouth.

  The TV plays “All My Children.”

  The Tube

  We pull out onto Albany Avenue behind ambulance 902. It pulls to the side of the road. I grab the monitor and airway kit. Glenn takes the med box. I go in the side door. Glenn goes in the back.

  They have a fifty-year-old-male in cardiac arrest. An EMT is doing compressions. A firefighter is doing ventilations with an ambu-bag.

  The monitor shows the man is in an agonal rhythm almost flat line.

  I get out the laryngoscope and an endotracheal tube. Glenn goes for the IV line.

  I sweep the man’s tongue to the side and look for the white cords. There is pink sputum in the airway obscuring my view. I am thinking that if I don’t get this in, I will never do another call. If I put it in the esophagus, they will take away my medical control, and I am done. I have enjoyed being a paramedic, but this is it. It’s over. I got the tube twice before, but I missed in my only attempt in the city, and Tom had to get it for me. This is my first chance on my own. I’ve got to get it. Got to prove I can do it. I see the cords, pass the tube.