Paramedic

by Peter Canning

  Later on the news that night it is the lead story. They show the woman being taken by Life-Star helicopter. I can see a Professional Ambulance on scene but do not see any of our people. The newscaster says the woman’s leg was amputated on scene by paramedics to save her life. She is in serious condition at Saint Francis. The other woman was taken by ambulance to Hartford and pronounced dead on arrival. They devote most of the newscast to determining whether or not the driver of the dump truck who backed over the ladies, and who was hospitalized for shock, had any previous driving violations.

  On Tuesday I am in the EMT room at Hartford Hospital writing a run form when I hear one of our paramedics, Sandy Balboni, talking about the call. She says the driver backed over the ladies, then hearing everyone screaming and yelling at him, pulled forward again, and basically ran over them twice. She was the first medical responder. The one woman was dead, the other’s leg was hanging on only by skin. There was blood everywhere.

  “Hey,” a medic says, “I hear they are going to offer you a surgical residency here. Didn’t you see the doctors talking about you in hushed tones as you passed? She’s the one who saved the woman’s life. She amputated at the scene.”

  She shakes her head and laughs. “I know. I was into my third beer last night when the news came on, and all of a sudden I heard them saying I amputated the leg—the truck did that. I looked down at my beer and said I may have had too many of these.”

  “I heard you performed neurosurgery last week and saved two lives by performing a kidney transplant on scene. You may not even have to do your residency. They’re talking about just making you an attending [physician] here. Some of the residents are upset by it, though.”

  She laughs and then lets out her breath. She is quiet a moment then says, “In ten years of doing this job, it was one of the worst things I’ve seen. The supervisors wanted to know all the details and my scene time and why I’d called Life-Star. None of them asked me how I felt about it.… It was a tough call.”

  We are all quiet.

  “You did good,” another EMT says softly to her.

  She nods. Her eyes are faraway.

  Another Code

  We’re dispatched for a man down not breathing. A few minutes later, we get an update. The fire department is on scene and it is a cardiac arrest.

  When we arrive, we see a ten-year-old boy standing on the front steps, crying and holding the door open for us. We learn later he went out on a walk with his father, and when they returned he went into the kitchen to get something to eat. When he came back to the living room, he found his father on the floor. He called 911 and asked for help.

  The fire department is doing a good job of CPR. The man has been down about seven minutes. He has a history of multiple bypass operations. I attach the defibrillator pads and turn on the monitor. He’s in v-fib. “I’m going to shock him,” I say. Everyone backs off. I hit the yellow charge button, then press the red fire buttons. A jolt of energy goes through the man. He’s in asystole, or ventricular standstill, where only the atrium beats. I hand Glenn the med box. “Get a line,” I say. To the firemen, I say, “Continue CPR.”

  I set up my intubation gear. I unzip the kit. I stare at the selection of metal blades and plastic tubes. For a moment, I feel panic coming over me. I haven’t had a tube for two months. I wonder if I can do it. I hear this voice in my head saying, “Give it up. Quit. Zip up your bag and walk out the door.” I grab the laryngoscope handle, attach the number three miller blade, snap it into place. The light is on. I set it aside. I take a number eight endotracheal tube and stick in the aluminum stylet, which is bent and gives me a little problem shaping it as I curve the tube into a hockey-stick shape. I attach a ten cubic centimeter syringe to the port so I can inflate the cuff once I am in.

  “Okay,” I say to the fireman doing the bagging. “I’m going to tube.”

  The man’s face is gray with a blue tint. His eyes are open, fixed, and dilated. He has a white beard and protruding upper teeth. I spread his jaws apart, sink the blade in, sweep the tongue to the side and lift up. Lying on my belly, I look into his throat. It is clear of puke or secretions. I see the cords hanging down silently. I slide the tube in the mouth and move it forward, watching it pass through the cords. I hold the mouth open longer, making sure I am seeing what I am seeing. I am in. I pull the blade out and go to pull the stylet out, but it is stuck. I yank, and finally get it out. I attach the bag valve to the top of the tube. I reach for my stethoscope to check for lung sounds to verify placement, but it is not around my neck. I look to Glenn, but he doesn’t have his stethoscope with him either. I reach back into the blue bag and pull out bloodpressure cuffs, but no stethoscope. I yell to a fireman to go out and get my scope from the front seat of the ambulance. I put my ear under the man’s arm and listen. I hear lung sounds. I know I am in. A firefighter returns with the scope, and I check again. Positive sounds under the armpits, nothing in the stomach. I secure the tube with tape and wrap it around the man’s head.

  Glenn has the line in and bloods drawn. We slam in an atropine and an epi. I look back at the monitor. The man is in v-fib. I shock again. Back to asystole. We do another round of drugs.

  A second crew has arrived. With the help of the fireman we get the man on a board and strapped down, and carry him out of the house and down the steps, past the crying boy, across the lawn, and over to the ambulance.

  They lift the man into the back. I recheck the lung sounds and they are less audible on the left side now. The tube has slipped into the right main stem of the lungs. I have Glenn listen as I pull back and retape. I shout to one of the EMTs to drive. I look at the monitor and the man is back in v-fib.

  We shock him at three-sixty. The charge zaps the man and there is the smell of smoke, from singeing the hairs on his chest. The man is still in v-fib.

  I push lidocaine and another epi, then go back to bagging while Glenn keeps up the compressions. We really need a third hand. The man is still in v-fib, so we shock again. He’s still in v-fib, so we give another lidocaine. I recheck the lung sounds, and while I am hearing them in the left, they are still fainter than the right. I pull back and retape. We’re at the hospital now. The man is dead, lifeless, purple from the shoulders up. We hook him to the portable oxygen, pull the stretcher out, and wheel him into the ER. Glenn is standing on the stretcher rail doing CPR. I’m bagging as the others steer, but just looking at the guy, I wonder what the point is. As we go through the ER, everyone turns to look. They shake their heads as we pass. The man is beyond saving.

  I give the report as we enter the cardiac room. “Down about thirty minutes. He’s been back and forth between v-fib and asystole. We’ve given him three epis, two atropines, and two lidocaines.”

  We transfer him onto their table. The respiratory therapist says to me, “I’ll take over,” as she attaches her own bag to the tube. The doctor checks lung sounds and says, “Equal lung sounds.”

  They make a halfhearted effort to work the guy, who clearly has no chance at this point. We stand watching.

  They call it.

  No one says anything to us.

  ATTACHMENTS

  Change

  “You’re taking her to the hospital,” the daughter says.

  “I’m fine. I’m not going anywhere,” says the woman sitting on the shag carpet with her back against the couch.

  “Yes you are,” the daughter says. “You don’t have a choice. Tell her you’re taking her,” she says to us.

  “Hold on a minute,” I say. “I need to examine her. If she doesn’t want to go, I can’t take her against her will. That’s kidnapping.”

  “That’s right,” the mother says. “I don’t have to go.”

  “She needs to go,” the daughter says.

  “I am not going, you ungrateful daughter. I’ll never do anything for you again.”

  “Let’s just calm down,” I say. I kneel by the woman. “What happened? How long have you been sitting here?”

&nbs
p; “Just a few minutes,” she says, avoiding my eyes.

  “She has not,” the daughter says. “She’s always falling. She’s been there all day.”

  “Just hold on,” I say.

  “Bitch,” the mother says. “Get out of my house.”

  Glenn takes the daughter into the kitchen. I examine the woman, who I discover has not seen a doctor for ten years. She has an irregular pulse and sores on the bottoms of her legs. She tells me she falls a lot, but she is okay and can take care of her house better than her ungrateful daughter can. She says she has only been on the ground a little while and enjoys sitting here. She turns and looks at her cat sitting on the stairs watching us through the railing. “Come sit with me, Stanley,” she says. “Give Momma some company.”

  The cat doesn’t move. I can hear the daughter telling Glenn that the mother was on the floor on Sunday when she came and wouldn’t get up then either. She can’t take care of herself, she says. She crawls around all day on the floor.

  “You have a very nice house here,” I say. “But I think it’s best if you come with us to the hospital and get checked out. Then you can come back and live here healthier than you have been. You’re not going to be able to stay here if you keep falling.”

  “Fuck you, I’m not leaving. Not today. Maybe tomorrow. I don’t want to go now. Leave me alone.”

  A police officer has come and he tries to persuade her.

  “I don’t have my makeup on,” she says. “And look at me. No, I’m not going. Maybe tomorrow, but not now, please. I’m quite happy here.”

  “Make her go,” the daughter says. “Look at her.”

  “Get out of my life, you ungrateful daughter! All you cause me is misery in my old age.”

  Glenn pulls the daughter back into the kitchen.

  “If you can stand up by yourself, then we’ll go,” I say. “But if you can’t, then we’ll take you to the hospital and get you checked out so you can come back here, okay?”

  “No,” she says. “I’m not going today. Look at me.”

  “You look fine. So we’re going to bring our stretcher in and get you comfortable and we’ll take a nice easy ride to the hospital. No lights. No sirens.”

  “All the neighbors will be looking at me.”

  “No, no. It’ll be fine.”

  “Not today, I’ll go tomorrow.”

  Glenn brings in the stretcher, and we each take an arm and lift her up. “Unhand me, fucking goddamn assholes.” She can’t stand on her own without our holding her. “Get your cotton-pickin’ hands off me. I can’t believe I have these boys here in my house, not that I don’t like boys or haven’t had my share of them once upon a time.”

  “I bet you did. I bet you were a looker,” I say as we ease her down onto the stretcher.

  “You should see the pictures of me then. But look at me. I can’t go out without my makeup. Really, I don’t need to go. Please leave me alone.”

  “Yes, you do, Mother,” the daughter says.

  “Bitch,” she says. “You’ll get nothing from me. Nothing from me, you hear.”

  I have taken two photos off the bookcase and show them to the woman. “Is this you?” I ask.

  “Yes, that’s me and that’s my husband. He died a year and a half ago. Forty-two years we were married.”

  “You were a looker,” I say. The photos are black-and-white and she looks like a long-legged beauty from a 1940s movie. “Beautiful. You have any bathing-suit pictures?”

  She slaps my hand gently. “You’re very kind. I was a beauty, though, and I had lots of fun. Frank was a good husband. He was handsome, too.”

  “You made a nice couple.”

  “We did,” she said, “we did.”

  Glenn tucks the blanket in around her and carefully buckles the straps.

  “This is all so unnecessary,” she says.

  “We’ll drive in slow, then the doctor will check you out, and hopefully, you’ll be back here soon, at this lovely home of yours.”

  She looks around. “It is a nice home, isn’t it?”

  “Yes it is, ma’am,” I say.

  We wheel her out to the ambulance. The neighborhood is quiet. “I do all my own gardening,” she says.

  The bushes need some trimming. The grass is getting a little long.

  “It’s very nice, ma’am. Well kept.”

  “I’ve worked hard,” she says. “I really don’t need to go. This is so unnecessary.”

  Fear

  If there is one thing that has affected me in EMS it is dealing with old people. Before I started this I didn’t think too much about getting old—it was too far off—but here you can’t escape it. You go down the hall of a nursing home and see the people lined up—the Os, the Ms, and the Qs—and you know that you are going to end up there someday. (The Os have their mouths open perpetually. The Ms go mmmmm all day. The Qs are Os with their tongues hanging out of the corner of their mouths.)

  I lived with a woman twelve years older than me for almost ten years. She was smart and beautiful, could grow a garden of bright colored flowers, read two books a day, talk baseball like a pro, cook a killer steak, and despite being five three and a hundred and ten pounds, she could match me beer for beer. We’d party till four in the morning and end up standing on the couch singing along to Elvis’s “Suspicious Minds.” She was as healthy as a horse, but she chain-smoked and had a bump on her collarbone that she wouldn’t have checked out. She wouldn’t ever go to a doctor. We broke up for lots of reasons, good and bad, but I always worried what I would do if she got sick and old.

  We take a man from the hospital to a nursing home where he will undergo rehabilitation for a stroke that has left him with some partial right-sided weakness. He is a big man—six feet three, in his late sixties, with distinguished gray hair and the solid jaw of a corporate leader. He is wearing blue flannel pajamas. His wife is in her late thirties, an attractive well-dressed blonde. She seems very uncomfortable around him. We have barely gotten him into his bed at the nursing home when she says a brief good-bye from the door. I see his jaw tense, then loosen. He looks toward the window, but his gaze is not fixed. I hear a wild moan in the hall from one of the residents, the elderly woman in the wheelchair we passed on our way in, a woman with a permanent O shape to her mouth.

  As we wheel our empty stretcher out the main door, I see our patient’s wife in a crimson BMW pull out into the street. The back wheel kicks up sand as she accelerates in front of a moving station wagon. Soon she is gone from sight.

  Mothers

  We respond to Newington Children’s Hospital for a person having seizures outside the front door. When we arrive we see several nurses and doctors kneeling and standing over a young woman who lies flat on her back, her eyes staring straight up. She is crying and shaking. They have her attached to a blood pressure cuff and pulse oximeter. A crash cart is by her head. She is on an oxygen mask. A nurse is writing the latest set of vital signs on a chart.

  “What’s going on?” I ask.

  A doctor says he is not sure, but he thinks this might be a psychological crisis. In a hushed tone, he tells me she has just been told that her child is suffering from adrenoleukodystrophy, a terminal disease. “A very lethal disease,” he says. He says she walked out of the hospital, then passed out. I ask if she had a seizure. He says no.

  I kneel by the woman. She is looking straight up. Her body is tense, on the verge of breaking out into full-scale trembles. I ask her to squeeze my hands, which she does.

  “Her vitals are stable,” the doctor says. They are in fact perfect: blood pressure 120/80, pulse 80, and respirations 20 with a pulse saturation of 99 percent. Her pupils are dilated, but they react to light.

  We lift her onto our stretcher. I tell her in soft tones that we are taking her to Hartford Hospital, where they will have someone she can talk to. A nurse hands me a sheet of paper that has the woman’s name and number and another sheet of paper that records the entire course of the code blue they called for
her.

  En route to the hospital she begins to shake again, her jaw quivers, tears flow from her eyes. She wails, a piercing flesh-tearing wail. The sound is primal, a deep, chilling, inconsolable grief. I think if there is a God, he must be hearing this sound, and parting the clouds in heaven to look down on our ambulance, moving north on Route 15.

  We have been briefed in advance. The fourteen-year-old boy’s best friend committed suicide two months earlier by hanging. The boy has been distraught and increasingly difficult to deal with. The mother is afraid he is going to harm himself. When she suggested that he get help, he said he did not want to talk to anyone and would run away. She has made the decision to have him committed to the Institute of Living (IOL). Because she has worked with me on the ambulance, she has requested that I be the one to take him. Glenn is out sick, so Toniah Abner from the night crew stays over to do the call with me, while they try to find me a partner for the day.

  We arrive at the house in Newington, a modest three-bedroom on a quiet street. The boy’s mom comes to the door and leads us into the kitchen. The boy is sitting at the breakfast table. He is thinly built with weirdly cut hair and wearing a Megadeth T-shirt. “I’d like you to meet some people,” she says. “This is Peter. He’s a paramedic. He goes out with Michelle.”

  That causes him to take a second look at me. “Cool,” he says. “Are you going to marry her?”

  “We’re not quite at that point yet,” I say.

  We shake hands.

  “This is my partner, Toniah,” I say.

  And they shake.

  The boy’s father is also there, and he also shakes our hands as we exchange introductions.

  “Christopher, there’s something I need to tell you that’s going on,” his mom says. “Remember how I asked you if you wanted help, and you said you’d try to run away?”

  “Yeah, I don’t need help,” he says. “I’m not talking to anyone.”