We wheel her into the cardiac room. It takes them several attempts to get the tube, but they finally get it.
They work her five minutes and call it.
At the desk, a nurse notices the Band-Aid on my neck. “You cut yourself shaving, then go out and save lives,” she says.
“I’m not having much luck at that,” I respond.
I feel again that overwhelming burden of failure that I try to ignore for fear the sheer weight of it will crush me to the ground.
I get back to the office to pick up Glenn and finish resupplying, only to find the word of our “cluster fuck” has preceded me. The basic crew has been telling everyone how badly the call went.
“What do you mean, you couldn’t find the epi?” Glenn says to me.
“Get out, we found the epi. The rider didn’t know where it was, and I had to tell him while I was trying to tube, and it took a minute for him to get it out. Give me a break. Don’t they have anything better to do?”
Daniel Tauber, the chief paramedic, calls me into his office. He is somewhat of a legend, having been a paramedic for nearly a decade and done just about everything. His competence is unquestioned. “Two things,” he says, closing the door. “The pediatric call. I want you to know you did everything perfectly. Vinny Cezus of Hartford Hospital called yesterday upset that the kid hadn’t gone directly to Hartford, but you were entirely appropriate to go to Saint Francis. Your scene time was excellent. So don’t worry about that.”
We talk about the call and my questions about whether I should have tried to tube at the scene, but he reassures me of my choices, and I am grateful for his support.
“How did the code go?” he asks now, shifting from the good news to the bad.
I hesitate. “It went all right. I learn from every call I do. I have never done a perfect call. I guess I was in the house too long, and I spent too much time trying to get the tube. I had a rider with me, and he did real well. He was good. He missed the tube, but so did I and they had a hard time with it at the hospital. He got a difficult IV and generally knew his stuff. I’d do it differently if I had it to do over.”
He is silent for a moment, sizing me up. “Well,” he says finally, “as long as you learn, that’s important.”
He assigns the rider to another paramedic for the day. I understand.
I walk out of the office and feel people’s eyes on me.
When
Glenn and I get sent to Charter Oak Terrace for an asthma. I am glad to be getting a call. After the botched code I want to prove myself. We get in the apartment and see a little girl playing with a doll and a young woman sitting on the couch smoking a cigarette. We look around. We don’t see anyone having an asthma attack.
“Who’s sick?” I ask.
“She is.” The mother points at her kid. The mother is maybe seventeen. She has short hair and a sneer that I don’t think ever changes.
“She doesn’t look sick,” Glenn says.
“She got a sore throat and hasn’t been eating all her food. They saw her last week and she isn’t any better.”
“Did you take her temperature?” Glenn asks.
“I don’t got a thermometer.”
I feel her skin. It is normal. Her lungs are clear.
“You take her to the Charter Oak Clinic?” I ask, referring to the community health center located about two blocks from her apartment.
“No, I don’t like them there. I go to Hartford. Take us there.”
I drive. All the way I think about the kid hit by the car and then the code and not getting the tube and the basic crew saying it was a messed-up call.
When we get to the hospital, Glenn says, “Where was your mind at? You were tossing me all around the back with your stop and go.”
“Sorry, I guess I wasn’t paying attention.”
“Yeah,” the mother says, sneering at me. “I got a headache from it.”
I feel my temper flare. I almost say, “If you want a smooth ride, take a fucking cab or a limo, and quit abusing the system.”
She has brought a stroller with her, which she lets the little girl push. The girl pushes it into the ED, and the nurses smile at her. Glenn gives a quick rundown, and they say just go on down to the pediatric clinic. The little girl putters all the way down the hall. Watching her makes even me smile. I look at her, then I look at the sneering mother, then back at her. What happens? When does the change occur? How do you go from being so wide-eyed and wondrous to having a cold sneer? Is it taught or does it just sink in through the skin?
I think about another recent story in the news that happened just off Farmington Avenue on South Marshall Street. The first reports were of a mother gunned down in cold blood while walking back from the candy store with her two small children. Then the real story comes out. The mother, walking back from the candy store, sees two rival drug dealers cruising by in a car. In front of her children, she pulls out a knife and confronts the rivals for being on her turf. They pull out nine-millimeter guns and blow her away. The paper said she made it home to collapse on the kitchen floor of her own mother’s house, her dying words, “Help me, Mommy.”
I watch the little girl push her stroller down the hall, everyone smiling at her. We stop at the nurses’ desk. She just keeps puttering on alone.
Whose Kids Are These?
I have just read this book, Amazing Grace, by Jonathan Kozol. It is about the life of children in the South Bronx, one of the poorest sections of the country. Kozol wrote a book about unequal education called Savage Inequalities, which I quoted for Weicker’s speech on ending the segregation in the state’s inner-city schools.
“We are children only once,” Kozol writes, “and after those few years are gone, there is no second chance to make amends. In this respect, the consequences of unequal education have a terrible finality. Those who are denied cannot be ‘made whole’ by a later act of government.”
In Amazing Grace, he talks about kids in school being taught to drop to the floor when they hear gunfire. He describes the death of a boy killed falling down an elevator shaft in a grimy apartment building, and the parents being blamed for letting him play in the hallway. He points out they don’t let him play outside where he might get shot. He talks about how the brightest kids in school dream of becoming X-ray technicians or security guards, for these are truly great jobs where these kids come from. And how can a teacher put down these limited aspirations when to do so would put down their entire world?
The world he writes about is grim—urine-drenched, rat-infested apartments; no jobs; numbing bureaucracy where you wait all day in line only to be told you need another piece of paper that sends you across the city for another all-day wait in line; toxic-waste dumps being put in the neighborhood; decayed schools; drugs and gunfire—and these bright little kids have to grow up in it.
The current rage in America today is to come down hard on welfare, and I see many reasons for doing so. You see healthy young men sitting on stoops, drinking out of bottles inside paper bags or dealing drugs. You go into apartments where a woman is smoking cigarettes, and her kids all have asthma, and you give them a two-hundred-dollar ambulance ride rather than saying walk the four blocks to the hospital or take a cab for two dollars.
When I worked for my friend Brad, who was running for Congress as a Republican, I wrote a press release for him calling welfare “a morally bankrupt system that erodes personal responsibility and contributes to the breakdown of family and the rise in crime.” His plan called for requiring all healthy welfare recipients to work thirty-five hours per week in a private- or public-sector job, replacing cash payments with services like child care and health, requiring mothers to establish paternity to receive benefits, denying additional benefits for more children, tracking down fathers who do not support their children, aggressively pursuing welfare fraud, and instituting random drug testing of welfare recipients.
Here in Connecticut, they are now requiring people to pick up their checks rather than sen
ding them through the mail. I have seen the lines—they are enormous, snaking out of the building and stretching across a school athletic field, old people and mothers standing with children. Medicaid patients are now being required to join HMOs that they must call before going to the Emergency Room. When the patients show me their state cards, I ask them if they have contacted the gatekeeper at their HMO. Most, even those who now have an HMO, have no idea what I am talking about. I explain how it is okay now, but in the future they will have to get permission to go to the emergency room. While I think it is a great idea, just sending these people a letter in the mail is not going to get the message across. Many can’t read or don’t speak the language.
When Weicker ran for governor, he had a great ad about kids, in which he said that the state really belonged to them, and they were the ones for whom we should be working. In his first year, he raised taxes by $1 billion and cut services by $1 billion to balance the state budget. In the next year he cut taxes for business in an effort to stem the exodus of businesses from the state and the resulting decline in the tax base, and started a modest number of programs for kids, including expanding school-based health centers, childhood lead screening, Head Start, and extended-day kindergarten—programs he called a cost-effective investment in the future. He used to say unless you were fiscally sound, you couldn’t do anything for your people. In the following years he offered more programs for kids but never at the levels he wanted. In the speech about desegregation, he talked about how the average cost of keeping someone in prison was twenty thousand dollars a year, enough to provide a Head Start program for ten kids.
When I worked for Brad, we put out a release about the need for more prisons. “The average violent criminal serves on average only thirty-seven percent of his term. The median time served for murder is five and a half years, for rape three years, for assault fifteen months. Three point two million convicted felons are out on parole or probation rather than in prison. Sixty-two percent of these prisoners will be rearrested within three years of their release. According to a 1990 U.S. Department of Justice study, if fifty-five percent of the eight hundred thousand violent criminals now in state and federal prisons served eighty-five percent of their terms, 4,400,000 crimes would be prevented every year. The costs of incarceration are small compared to the $452,000 a year the Heritage Foundation estimates a violent criminal costs society on the street in terms of law enforcement, property damage, and human terror.”
So what do you do? Put the money in kids’ programs, build more prisons, or cut taxes for business? Ideally you would do all three, but you don’t have the money.
In his book, Kozol has a conversation with a mother about why the city is cutting back on services. He tells her the idea is to keep taxes down so people won’t flee to areas where they would be taxed less. He says they complain that the taxes are killing them. The lady replies, “There’s killing and there’s killing.”
I guess the reason why becoming a politician lost its appeal to me is that I don’t have the courage or gall to say I know the answer. In my mind the real answers are too painful and controversial and may not, in the end, be answers at all (and most assuredly wouldn’t get me elected).
What is so unsettling about Kozol’s book and about what I see in the city every day is the children. They are like all children to start with—happy, wide-eyed, hopeful—but you know it will get beaten out of them.
VIEWPOINTS
Two Calls
We’re at Mount Sinai Hospital when we get dispatched to a difficulty breathing call on the far side of East Hartford. It is a private call, meaning the person picked up a phone book and called for an ambulance from the Yellow Pages rather than dialing 911. We are dispatched to too many difficulty breathing and chest pain calls that turn out to be nothing to get excited by this call. We use lights and sirens, but it takes us twenty-three minutes to navigate through Hartford out onto I-91, then take I-84 across the river to Route 2, get off at an exit, and race out past Pratt and Whitney Aircraft to arrive at the street where the call was made.
The son meets us in the driveway. “He wasn’t feeling well and was going to go see the doctor. But he got so tired walking, I thought I should call for an ambulance,” he says almost apologetically.
We get into the house and find the man sitting on the couch. He says he has been having pain in his upper stomach since last night. His voice is very weak. His pulse is thready. He is pale and sweating and says he vomited a half hour ago. I take his blood pressure. It is 88/60. I put him on a 100 percent oxygen mask, and we lift him onto the stretcher and move quickly toward the ambulance.
I put in a sixteen gauge in his AC and run a bag of saline wide open. His heart is beating fast and irregularly. Glenn drives lights and sirens.
I am thinking he is either in cardiogenic shock or has an aortic abdominal aneurysm that is leaking. His stomach is only slightly distended and I can feel no pulsing masses. I check his ankles for distal pulses but can’t feel any. The road is rough and the sirens are loud. I try for another blood pressure but can’t hear above the sirens. I keep asking the man how he is feeling. He nods to me, mumbles okay.
I call the hospital and tell them what I am bringing them.
I try again for the blood pressure and can’t hear anything. I can’t even feel a pulse, but he is still conscious. When we arrive at the hospital and are parked, I feel again. Nothing.
We hurry him inside, where he is triaged to the cardiac room.
Using a Doppler stethoscope, they get a pressure of 50, which soon drops to 30. The man is barely responsive. They run more fluid and call for dopamine, a vasopressor to contract his veins to increase his pressure. They intubate him. I leave the room to write my report and when I return they are doing CPR. They get a carotid pulse back, but five minutes later, they lose him again. He has suffered a massive infarction. His old heart is so beaten up, it just can’t pump enough blood to keep him alive. Even though he is intubated, the color in his head and extremities slowly turns cyanotic. After half an hour they quit working on him.
This is a call where the system failed. The guy should have called as soon as he felt the pain. First of all, people need to know if you’re having pain, don’t deny it. Call an ambulance or get to the hospital and get checked out. Second, they should have called 911. The East Hartford Fire Department paramedics could have been on the scene at least eighteen minutes faster than we were. Another eighteen minutes and maybe he would have been stable enough to get to surgery for an angioplasty to clear the blockage in his heart. It might have kept him alive. When the call came to our company for difficulty breathing, we should have passed it back to East Hartford. The problem is, so many people cry wolf that our level of skepticism is very high. I can’t tell you how many difficulty breathings I’ve been to where the person has turned out to have a runny nose or to be hyperventilating about something, how many chest pains are just colds, and how many severe bleedings are cuts not worthy of a Band-Aid. Doing calls like this old man too proud to tell anyone he’s in pain, too proud to call 911, and who only calls for an ambulance when he can’t take another step—these are the calls that you think about when you get called for BS, for someone too lazy to make a doctor’s appointment, or who wants to save cab fare so they call an ambulance that their state card pays for. Sometimes the system sucks.
Later that day we get called for an unknown in the south end. On the second floor we find an elderly woman complaining of abdominal pain and a headache. Her granddaughter translates for us. She went to the doctor a week ago for the same problem but doesn’t know what the doctor told her. She has no apparent medical history. She has been in Connecticut just two weeks, coming from Puerto Rico. Glenn tries to find out why she called for an ambulance instead of just going back to her doctor. She is sick, the granddaughter translates. Glenn is upset. The woman is not in any acute crisis. She is all dressed up ready to go, holding her pocketbook. We walk down to the ambulance.
En rout
e I try to find out her birth date. “Nineteen seventy-eight,” the granddaughter tells me.
“Not yours. Hers.”
“Nineteen seventy-eight,” she says.
“Try again.”
She asks the grandmother then says to me, “Nineteen sixty.”
“I don’t think so,” I say. “She would be younger than me.”
The granddaughter looks at me blankly.
I ask for any ID that might give me the answer. She hands me her shiny new state medical card. It is less than a week old.
I should be nice to all my patients, but I am in a rotten mood. They are playing dumb with me. They know I disapprove of them, but they don’t care. They are getting their ride to the doctor and it is not costing them a penny.
Over the radio we hear a basic car dispatched for a man down. A few minutes later, a panicked voice comes over the air. “Four-six-three. We need a medic. We’ve got a working one hundred.”
I hear Glenn swear in the front.
“No medics available,” our dispatcher says. “You’re going to have to do it on your own. Sorry.”
We continue crosstown. I say nothing more to my patient and her granddaughter. We stare at each other coldly. I write my run form.
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