Paramedic

by Peter Canning

  They say if you stay in EMS long enough, you will see everything once. They also say everything is unique; you never see anything twice. When you are sitting in the ambulance and you hear a good call go out or sitting in the EMT room writing your report and another medic tells you about his interesting call, you feel a little twinge of jealousy that you missed that one. On the other hand, sometimes circumstances dictate that you get that special call. When it comes you try to be ready for it. No matter what the call, extraordinary or mundane, you try to be a good paramedic and never let your guard down. Any call can make or break you.

  We’re called for a chest pain on Martin Street. A man with dreadlocks meets us at the door. “Who’s sick?” I ask. “You?”

  He nods. “I’m feeling a little weak. I had some discomfort in my chest earlier. I just don’t feel quite right.”

  He walks out to the ambulance with us, and I have him take a seat on the stretcher. I tell him that since he’s complaining of chest pain, I am going to do a full workup, put him on the monitor, give him some oxygen, put in an IV and draw bloods. I help him take off his jacket. The man is quite dirty and smells.

  I take his pressure and find it elevated at 200/120. I ask him again if he is having any discomfort in his chest and he says a little. After I get the line, I give him a nitro, which helps ease the pain. He is a normal sinus rhythm going about 90 on the monitor. I get a complete history from him en route to the hospital. When we get out of the ambulance at the ER I keep him on the monitor, even though his discomfort has abated. It is awkward to carry the monitor and the IV bag. Sometimes medics will disconnect the person from the monitor in the rig because they will soon be hooking them up to the hospital’s monitor. I keep it on. Wheeling him in the door, I watch his rate start to climb: 120, 130, 140, 150. I have a different patient. They take his pressure: 240/120. He goes to the cardiac room. I think I would have looked like an asshole if I had reported his pulse at 90 when the triage nurse felt it at 150. I did my job.

  The forty-two-year-old woman from the north end of Hartford with a history of gastrointestinal problems and diabetes has been vomiting since four in the morning, but just a few minutes ago vomited blood. She called her physician, who told her to call an ambulance and go to Hartford Hospital. He’d call and let them know she’d be coming in. She is a thin, emaciated woman. Her pressure is 130/80 both lying down and sitting up, which is a good sign, but her heart rate is 130, a bad sign. I want to put in a precautionary line, but she has no veins and tells me they’ll have to go in her neck or groin at the hospital. I do a finger stick to check her blood sugar and find it almost 800. While driving to the hospital, I ask her if she has been checked for TB or HIV. She says no. She doesn’t have them.

  When we get to Hartford Hospital, there is a slip on the bulletin board with a message from her doctor. I take it off and hand it to the triage nurse. I give my report. I hear Glenn say, “I thought so,” as the nurse writes on his form. I look at him and he points to the notation “HIV positive.” After we unload the patient, he says she looked like she had it. I tell him I asked her and she said no. This startles him. “It’s against the law for a person to lie to us about that.” I’m not certain if he’s right about that, but I am bothered by it. Normally, I have found that white homosexuals have been the most elusive about their HIV status, but no one had ever denied it when I asked about it point-blank. Most minorities or IV drug abusers have no problems telling me. Often it is the first thing out of their mouths. I think about making a notation on my report that I asked and she denied it, and I think about asking her again and giving her the business for lying to me, but I don’t. When I go in, she is on her side. She looks so tired and weak there, the sheet giving her no warmth at all. I put a blanket over her and ask if that is better.

  “Thank you,” she says.

  We get called for an unconscious in West Hartford. Before we arrive we get an update—the person inhaled gasoline. When we arrive, both West Hartford medics are already on scene along with a police officer. The medics are kneeling by a man lying on the grass. He is a disheveled man with a dirty T-shirt and jeans, and bits of grass and debris in his tangled hair. “He’s not really out,” the female medic says. She rubs her knuckles on his sternum, and he jerks awake.

  “Leave me the fuck alone!” he says.

  “Calm down,” she says to him. “You have some scissors?” she asks me.

  “In the ambulance,” I reply.

  When I come back with them and the oxygen, she has already gotten a pair from the other medic and is cutting the man’s sleeve so she can take his blood pressure.

  He swings his right arm and connects with her jaw. In an instant, we are on top of him. They hold his arms down, and I put a knee on his chest, a little harder than I intend to, as I feel the air go out of him.

  He is spitting and swearing at us. I put an oxygen mask on his face. He tries to bite me, but I keep my fingers clear. I lift his head up and strap the mask around him.

  “Get this goddamn mask off my face!”

  “It’s a felony to hit an EMT,” she tells him bluntly.

  “I don’t care. Get the fuck off me.”

  “We need to check you out, so be still,” I say.

  “You ain’t doing nothing to me!”

  “We’ll leave you alone if you answer a few questions we have to ask you.”

  “I ain’t answering nothing!”

  “What day is today?”

  He gives me the date properly except that he is shouting it at me.

  “Where are you?”

  He shouts out the address.

  “Who’s president of the United States?”

  “Bill Fucking Clinton! Now get off me!”

  We hold him down until the tension in his muscles subsides. With the help of a police officer, we get him up.

  “You think I’m crazy. You afraid of me?” he says to me.

  “No,” I reply.

  “How tall are you?”

  “Bigger than you,” I say. “Now would you be still enough to let us check you over?”

  “I ain’t talking to you.”

  The man jerks his arm at the cop, who tightens his grip on him. We all move closer, ready to pounce on him if he strikes the cop.

  The other medics try to reason with him. I ask a friend of the man what happened. He says he was working with a gas saw in the basement and came out every fifteen minutes to get away from the fumes. The last time he came out he lay down on the grass and they couldn’t get him up. He tries to talk to the man, who is shouting at the officer. But that just gets the man more upset. “You all leave me the fuck alone!” he screams. “Get out of here and let me be. I ain’t going nowhere.”

  “You’re coming with us or the officer is going to arrest you,” the female medic says. “You’ve already broken the law by swinging at me.”

  “I don’t give a good goddamn. You think I’m crazy?”

  He looks like a complete madman.

  “You have to be checked out,” the officer says. “Let these people do their job.”

  The man goes into a tirade.

  “Look,” I say to his friend, “we’re trying to figure out whether he inhaled something that is making him act like this or if he’s just being an asshole.”

  “He’s being an asshole,” his friend says.

  “You’ve seen him like this before?”

  “Yeah,” he says, then starts toward the man. When he can’t get him to calm down, he tells the officer to just leave them alone for a minute. The officer tells him to back off or he’ll arrest him, too.

  “Let me just talk to him. Let me reason with him. There’s no need for this.”

  The officer calls on his radio for backup.

  The scene is getting out of control. More officers arrive. One of them takes out his pepper spray, which causes us to back off, not wanting to get sprayed by accident. I think that maybe if I were alone with the man, I might be able to calm him down, but then ag
ain, he is all hyped up and my few attempts have failed. I still want him to come in and get checked out, but as long as he knows where he is and what day it is, we can’t take him against his will.

  The cops eventually cuff him and lead him off to the cruiser as he swears and cusses at us all. The female medic says she will press charges against him for hitting her. The guy’s friend just stands there shaking his head.

  When we clear the scene, I think that a week rarely goes by that one of my patients doesn’t take a swing at either me or Glenn. I’m usually good at deflecting the blows and calming the patient down. I wonder if the day when I truly get socked is ahead. I have heard of EMTs getting the shit kicked out of them. (The worst I ever got hit was by an old lady, who slapped me and grabbed my hair when I was trying to give her an IV.) You have to be ready to fight or at least not let on that you’re scared if it comes to a fight, but you can’t initiate one either. At least half the EMTs in the company wear bulletproof vests. I don’t. Maybe I’m foolish to believe I don’t need one, that even though I look like a cop in my paramedic uniform I feel the fact that I am a paramedic shields me like a white flag in the middle of a battle zone.

  Completing my run form, I fill out the section that grades a patient’s level of consciousness based on eye opening, muscle response, and verbal response. Under verbal response, I check “obeys commands,” but write the prefix “dis” in front of “obeys.”

  “He was an asshole,” Glenn says.

  “An asshole who’s going to jail.”

  We’re sent to the Newington VA Hospital for a stat transfer to John Dempsey Hospital for a woman who needs a pacemaker installed. Most patients we transfer are relatively stable. In most cases the patients are going for cardiac catheterization and are on nitro and heparin drips that keep them pain free. This woman has passed out four times in the last hour. The nurse claims she went into cardiac arrest once and CPR had to be done for two minutes to revive her. She shows me the cardiac strips. The woman goes into a rare rhythm called torsades de pointes, an abnormal beat of the lower heart chamber that produces a rhythm that looks at first glance like ventricular tachycardia but is not. And unlike ventricular tachycardia, if you give the person lidocaine, it will kill them. The treatment of choice is magnesium and ventricular pacing. It is a rare rhythm that you may never see.

  The woman passes out again, and just as the nurse gets ready to start pumping on her chest, she revives by herself. I ask if they can spare someone to accompany us. If she is an imminent code, I will need the extra hand. The company sends us another EMT and the VA gets a doctor to come along.

  Glenn drives to John Dempsey with lights and sirens.

  “I think I feel one of those things happening,” the woman says, then passes out. I look at the monitor. She is in torsades.

  “Let’s wait,” I say. “Just a little. She’ll break on her own.”

  I reach to hit the monitor record button to preserve the episode. From the history the nurse gave of the woman passing out repeatedly for the few preceding days and the one event I witnessed in the ICU, I believe she will come around. I don’t know if the supposed two-minute cardiac arrest was real or not. It may have seemed like two minutes to the nurse. But given the woman’s rhythm, banging on the chest might knock the rhythm into ventricular fibrillation, which is much harder to recover from. I wasn’t there, so I can’t judge. I just have a hunch it will break. After fifteen seconds she hasn’t broken the rhythm, so I reach to attach our external pacemaker. A moment later, she opens her eyes, and the rhythm clears.

  I keep her on the monitor at the hospital. We go directly to the ICU. As we are getting ready to move her over to the bed, she goes into the rhythm again. This time I hit the record button right at the start and capture the entire episode, which lasts for thirty seconds. A group of doctors and nurse practitioners crowds into the room. The doctor traveling with us gives his report, and I make copies of the strip for them, which they are all interested in.

  Later I show the strip to several other medics. They all say v-tach on first glance. I explain what it is and point out the changing amplitude of the rhythm that distinguishes it from v-tach. I say I don’t think I would have been able to call it right if it had just popped up on the monitor on a 911 patient I found at a private home. I might be too quick to shock or give lidocaine. Now that I have seen it, I will know what to look for. Every call teaches you something you save for later use.

  When I see Michelle that night—she is studying for a big test in her physician assistant class—I show her the strip and ask her to guess the rhythm.

  “Torsades,” she says.

  “I’m impressed.”

  Later when I recount my day, I tell her, “I was a good paramedic today. I treated my patients with dignity and respect. I kept the monitor on.”

  “I know you’re a good paramedic,” she says.

  “Well, there’s a lot that I don’t know, but I try hard.”

  “Yes, you do,” she says, and goes back to studying her book.

  In the morning, we’re parked outside of Saint Francis when we see Daniel Tauber and Mike Riggs, one of the supervisors, park in Medic Three. They get out and come over toward us, which I regard as an ominous sign.

  Daniel is all business. “You know that call you did yesterday,” he starts.

  “The lady with torsades,” I say.

  “No, the one in West Hartford,” he says. “Your patient was Life-Starred to Norwalk. He had near-fatal carbon monoxide levels.”

  “You’re kidding,” I say.

  “No. You, the other medics, the company, the PD, and I, because I am in charge of your medicine, all stand to be sued. Did you write a run form on it?”

  “Yeah, but it was real short because we were canceled by the officer once he arrested the man.”

  “You ought to write a detailed incident report, documenting everything.”

  “He was alert and oriented.”

  “They will say you should have known he was under the influence of carbon monoxide, had him restrained, and taken to the hospital.”

  “I’ll write a report.”

  “Make it good.”

  When something bad is happening to me, I am pretty good at keeping it at a distance. I grow quiet and shut down the feelings, but my mind sometimes runs a little wild. I wish that I hadn’t been assigned this call. After all, with all the calls that go out, it is a fluke which ones you get. I could have been on a colds and flu when this one came in and I wouldn’t be worrying about this now. Or I could have been delivering a pair of healthy bouncy twins, and right now I would be passing out cigars, rather than contemplating my ruin. I wish I had malpractice insurance. I had it for a while as a condition of my internship in Bridgeport, but I let it lapse. Not that I own a house or anything, and my car is old and dented and has a rope holding the hood down. I do have some savings, and I have a computer and a stereo, and over three hundred books and four hundred CDs and records that I treasure. I imagine having to go to court, and seeing the guy there, who instead of being dressed like a complete wildman is wearing a three-piece suit, with a trimmed beard and mustache. He’s talking in a clipped Yorkshire accent, and he’s represented by O. J.’s lawyer, Johnnie Cochran, who will say, “The way my client was treated by this man—why, Judge, it was an outrage! He was treated like an animal, not the fine upstanding citizen he is now, sporting that finely tailored Pierre Cardin suit, which he worked hard for, despite having to battle discrimination and rogue paramedics ever since he was a little baby boy in his sweet mother’s arms. Why, this man who denied him proper care, if you trimmed his mustache and shrunk him down a few sizes, he’d look just like the author of Mein Kampf. This is an outrage, Judge.”

  All during the O. J. trial I thought any one of those lawyers could put any paramedic on the stand and drill them on any call and find fault with them in some way. It is like putting a running back on trial and finding fault with him for not scoring an eighty-yard touchdown run ev
ery time he is given the ball. “Why, judge, this man has a record. He killed a little baby, and he killed a little boy he found lying in the middle of the road, and he killed all those people who had just a little bit of chest pain. They lay down and closed their eyes and waited for their constitutional right—for the heroes of Rescue 911 to come in and save their lives—but this man failed. He has a record of failing. Why, his days are littered with sick people and dead bodies. He’s got no business being out there on the streets. This is an outrage, Judge.”

  I think, let him take everything. Maybe that way I’ll find true freedom. I will pack up my most precious belongings—my sperm-whale tooth, my Tony Conigliaro baseball card, a dog-eared paperback copy of the Odyssey, and a tape of Elvis Presley singing “Kentucky Rain”—wrap them in a polka-dot bandanna and tie them up on the end of a stick, and start walking along the railroad tracks that have always run by wherever I have lived since leaving home as a teenager. I’ll go to New Mexico, or Oregon, or Alaska, or somewhere in America where they will give a hardworking stranger a chance. At least till my face appears on “America’s Most Wanted” and they tree me with a pack of dogs.

  * * *

  We are sent out to cover Newington, and I stop at an ice cream parlor and go in for a cone. I haven’t had a cone for years, but think I should start enjoying life. They have piña colada ice cream, and I think what the hell, I might as well go for the experience. It’s not bad—it tastes like a cold piña colada. I eat it purposefully as if I am saying go ahead and try to take the ice cream cone from my hand, you weaselly scumbag lawyer. I feel better about not having amassed a fortune, and having squandered my money on more immediate pursuits of women, beer, and good times.

  That night I tell Michelle about maybe being sued, but she says I have nothing to worry about. I can’t do blood gases in the field. As long as the guy was alert and oriented, I couldn’t take him in. I tried to initiate treatment, but he refused. I imagine sitting in court and Johnnie Cochran saying, “Isn’t it a fact that you could have had this innocent man taken to the hospital under protective custody and gotten him the health care that he needed to live a free life as is his constitutional, God-given right, whether he is white or black or whether you like his face or not? Isn’t that right?”