Paramedic

by Peter Canning

  “I don’t want to go.” She turns to her friend. “Millie, you will look after me, won’t you?”

  “Yes, I’ll go with you.”

  “I’m awfully afraid,” she says.

  “Don’t be. These young men will take good care of you.”

  She looks at us. “What are you doing in my bedroom?”

  “We’re here to take you to the hospital, ma’am.”

  “It’s okay,” her friend says.

  “I’ve always been fond of young men, and I’ve known many in my life.”

  “You look familiar,” I say. “You sound familiar. Haven’t I seen you somewhere before?”

  “I don’t know. Have you?”

  “You sound like Katharine Hepburn. You look like her, too.”

  “You’re complimenting me, I take it.”

  “Yes, I am.”

  “Oh, dear, how dreadful it is to be old.”

  We lift her sheets across to our stretcher. “Will I be coming back, Millie?” she asks.

  “Yes, hopefully, after the doctor checks you over.”

  She looks about her apartment, then her eyes fix on me. “You’re taking me by ambulance?”

  “Yes, ma’am,” I say. “But we’ll go in nice and easy. There’s no need for lights and sirens.”

  “Oh, dear. I’ve always liked the sound of sirens. They make a nice ending, don’t you think?”

  “I don’t know, ma’am. I suppose we could put them on for you if you like.”

  Once we have her loaded in the ambulance, Glenn sits in back with her while I drive. I pull out onto the road nice and easy, then I hear Glenn calling up to me, “Put the sirens on.”

  “Huh?” I say.

  “She’d like to hear the sirens.”

  “Okay.” I hit the red lights and turn on the sirens. I drive slowly and alternate the sound from siren to phaser to wail. Two cars pull to the right, making way.

  “Yes, ma’am,” I hear Glenn say. “They are.”

  Sometimes when we’re parked waiting for a call, I step outside the ambulance and look at the city all around us—the playgrounds, the apartment buildings, the office towers, the highways—and I hold my arms out. This is my city, my church, my garden. What life swirls around us.

  He stands in the middle of the alley. A tall muscular Puerto Rican with a broad smiling face. His left arm is bloody red. He pounds his fists together and shouts joyfully. “Come back and fight, you fuckin’ asshole. I’ll kick your ass. I’ll kick your ass all over town, you fuckin’ fairy.”

  He spots us walking slowly toward him and turns to face us. “Hey, tough guys!”

  We step back. Glenn removes the HPD portable from his belt and asks for a squad car.

  The door to the apartment building has been smashed, punched out. The glass is shattered with a large hole in the middle big enough for an arm to go in and come out, pulling more shards of glass with it.

  A crowd stands at a safe distance, watching the scene.

  “I showed him who’s the tough guy. He may be a Solid, but I’m the tough guy.” He shouts down the street, “Keep running! Keep running!” He laughs.

  A friend approaches him and starts to walk him toward us. The man’s smile, which borders on crazy, does not seem threatening. I get some five by nines and saline water from the ambulance and inspect the wound. “You really should come to the hospital with us,” I say. His arm is covered with blood, but there is no arterial bleeding. In the bend of his elbow, there is a deep wide cut through which I can see tendons and bone. It is a space big enough to drop a set of car keys in. He has another gash on the side of his wrist.

  “You were fighting with the Solidos?” Glenn says. Los Solidos are one of the most violent gangs in the city.

  “I don’t care,” he says. “I like to fight. I’m the tough guy here. I kick his ass.”

  He winces a little when I pour the saline water on his arm, before wiping the blood off with a five by nine.

  “You got any beer in the ambulance?” he asks.

  I wrap a trauma dressing around the wound.

  “I like to fight.” He smiles broadly. “And I like to drink beer.”

  We’re sent to a tenement address in the south end for a difficulty breathing. An old woman answers the door. She has on a nasal cannula hooked with lengthy tubing to a home oxygen supply. “You think you’re coming for me, huh?” she says. “Not today. Hah, hah, hah. Not today. It’s him you’re looking for.” She points up the stairs. “It’s him. Earl! Earl! They’ve come for you! Get down here! He’s got pneumonia. Get him out of here before he gives it to me. Hah, hah, hah.”

  A young man comes down the stairs. He has a nasty cough and looks awful. He says he wants to go to Hartford Hospital.

  As we start out the door, we see a social worker coming up the walk. The woman sees him and smiles. “Thought they were coming for me, huh?”

  “Seeing the flashing lights of the ambulance gave me a start,” the man says.

  “Hah, hah, hah. Not today. Not today,” she says. “They ain’t taking me today. Hah, hah, hah.”

  HEROES

  TV

  Now that the new TV season has started I try to watch “ER” on Thursday nights. I think it’s a great show and for the most part truthful to the overall feeling of the world of emergency medicine, though missing many of the real-life qualities and details that don’t work too well on TV. For instance, dying or severely injured patients need oxygen in high concentrations, something which is best attained through masks. The problem with masks is the patient can’t speak clearly to make a moving dying speech, so on TV they tend to opt for the nasal cannula. In the TV world the doctors tend to spark out a little too much (meaning they get overly excited), sweating and shouting, which is needed for the drama, but in real life, with the exception of new residents, the trauma teams are much more professional and calm about their work.

  In the episode I watch tonight, the plot starts to include some prehospital people as the alluring Nurse Hathaway goes for a paramedic ride-along as part of her recertification. It seems she has a thing for one of the paramedics. The first call they go on is for a shooting. They find the patient in traumatic arrest. They get the tube on scene, then get the patient in the ambulance. Instead of climbing in the back to help the other paramedic work on the critically injured patient, the nurse climbs in the front with the guy she likes so he can say to her, “Welcome to hell.” Then when they arrive at the hospital and get the patient in the trauma room, the patient conveniently goes into v-fib and develops a tension pneumothorax so they can start shocking him and needle decompressing him, even though he has been down forty minutes. If this was going to happen to him, it is far more likely it would have happened in the street and the medics would have done it.

  The nurse and the medic are walking out of the room, both depressed after the new resident has pissed everybody off by making the correct decision to end the code, and Nurse Hathaway says back to the medic, “Welcome to hell.” Then a prostitute walks by and a doctor notes she has pelvic inflammatory disease. The medic cringes at the sound of the disease and says, “I just bring them in; I don’t need to know what they have.” This is a terrible thing for a professional to say. Paramedics want to know everything about a patient because it is their job. A good medic will bring that patient in and will tell the nurse or the doctor that his clinical impression—based on physical assessment, patient history, and vital signs—is that the patient has pelvic inflammatory disease, which is characterized by abdominal pain and painful puslike discharge and is often accompanied by a fever. Imagine how upset nurses would get if a nurse said, “I don’t care what they have; my job is just to hold their hands and clean their bedpans.” Or how upset doctors would get if a doctor said, “I don’t care what they have just so long as they can pay their bill.”

  I’m being a little touchy here again, but I think it’s important that paramedics are recognized as professionals. I’d hope this character would have
a chance to redeem himself, in addition to possibly getting more seriously involved with the lovely Nurse Hathaway. As it turns out, they do become involved, but they split up when he is revealed as a racist burnout, unable to cope with the death of his partner and people he thinks are abusing the system.

  Anyway, I do like “ER.” I will never forget the episode where the good Dr. Greene has to manage a problem pregnancy in the ER that is complicated by the patient’s suffering from eclampsia. He makes a couple of mistakes, and that—combined with vicious bad luck and lack of help from the attending staff—results in his saving the baby but losing the mother despite his best efforts. The young intern Carter tells him, quite movingly, that he thought Dr. Greene was heroic. But that doesn’t help Dr. Greene. His grief is too great. Tortured, he goes out and gets on a subway and just rides. Whether you are a doctor, a nurse, or a paramedic, the bad calls stay with you, and nothing anyone says can make them go away. You have to deal with them yourself, alone.

  I don’t think there are many politicians who have been in Congress for twenty years, running up deficits and building up million-dollar pensions for themselves, who have ever had to truly face the consequences of their votes in terms of the effects on real people. When George Bush was asked in a presidential debate how the national debt affected him personally, his answer was “I don’t get your question.” Most politicians live only with the political consequences of political decisions. Saying “Read my lips; no new taxes” won the election for Bush in 1988. Raising taxes during his first term cost him the election in 1992. I don’t believe he saw the effect of those political decisions on real people’s lives. Robert McNamara and his cronies weren’t thinking about real human lives when they were having this country play around in Vietnam. And for all their latter-day mea culpas, they still aren’t looking into the eyes of veterans in VA hospitals. Few politicians live with ghosts.

  The hard part about EMS is that for all the BS runs, there are times when the patient is dying in front of you, and no one can really say whether or not the person is savable or whether death has already embraced them. You have to believe they are savable, and you do your best, but unlike TV, where only occasionally they lose, you almost always lose. And that is never easy. The consequences of your actions are inescapable.

  I’ve just gotten off from working an overtime shift in the city and am driving through Bloomfield; I plan to stop at the ambulance bay where Michelle is working. Some nights we’ll have dinner together, and if the shift is not full I may sign on with her and work till eleven. Since she is going to PA school full-time, in addition to working Friday, Saturday, and Sunday overnights, it is one of the few times I have to see her. Besides, I learn when I work with her. She is an excellent paramedic.

  I try a new route, cutting from West Hartford into Bloomfield. I am going up a country road approaching a stop sign when I see the orange-and-white box ambulance of Bloomfield come flying along the street, lights and sirens pulsing. I am annoyed that I have missed her and the call. I turn left, thinking the bay is in that direction. In my rearview mirror, I see the lights of another ambulance coming up on traffic. I pull to the side and see it is an L&M ambulance. A little further down the road I see the lights of police cars, fire trucks, and a second Bloomfield ambulance. A car is wrapped around a telephone pole. Jeff Quinn, the L&M medic, is out leaning into the passenger seat of the car. I think about pulling over and offering a hand, but there are more than enough people on the scene. I turn around and head in the other direction. When I get to the ambulance bay, the door is locked. I calculate the time. It will be at least an hour before Michelle is back. I decide to head home. I’ll call her from there, and if she hasn’t eaten, I’ll drive back and bring some dinner and maybe work the night shift with her.

  It is three hours before I finally talk to her. “So you did the big bad one,” I say.

  “Yeah,” she says. She sounds tired, depressed.

  I tell her that I went by the scene and saw the car. She says her patient had pulses when she took him out of the car, but they lost pulses in the ambulance and started doing CPR. He had an indentation in his forehead that you could fit a roll of quarters into and a broken neck. He was a big man with a moose tongue and when she tried to tube him, he vomited and she got splashed with blood. He didn’t have any track marks on his arms, but the other passenger did. She couldn’t get a line, and they called him at the hospital as soon as they rolled in. The other passenger, whom Jeff brought in, looked like he would make it. She was worried about getting splashed with the blood and questioned whether she should have taken the patient she did and not the other one. She is upset she didn’t get the tube or a line, though at the hospital they said the patient would have been nearly impossible to tube given his build and the size of his tongue. She is worried that working in Bloomfield, where the call volume is lower than in the city, has dulled her skills and instincts. She wishes that she had worn a face shield. She talked with a doctor for over an hour at the hospital. The doctor was wonderful, she says, reassuring her about her decisions and skills, and saying while she would make certain they got blood results from the autopsy, the likelihood of getting infected from being splashed was relatively low.

  She’d done another code early that morning and hadn’t gotten the tube then either. It was on an elderly woman whom they’d found on the kitchen floor.

  “You okay?” I ask.

  “I just need to sleep,” she says.

  “I’m proud of you,” I say.

  “It makes me rethink why I’m even still doing this.”

  “You do it because you’re good at it,” I say. “You do it because you’re the best.”

  Race in America

  The O. J. verdict is due in at 1:00 P.M., ten minutes from now. I’m sitting in the waiting room at Saint Francis, writing my run report, and glancing up at the TV. There are eight other people in the room, all blacks, either patients waiting to be seen or relatives and friends of patients back in the Emergency Room.

  As the minutes draw closer the room begins to fill with other EMTs, nurses, and security guards. O. J. and his lawyers stand to hear the verdict. Everyone is holding his breath. When I hear the words not guilty, I feel disappointment, then disgust. I watch the others in the room. A young black woman, who has been sitting forward in her chair, says to herself, “Yes! I knew it.” Two other blacks look at each other and smile. They look like they want to stand and holler, but they are outnumbered in the room. A white nurse shakes her head and says, “Can you believe that? That sucks.” “He’s gonna walk. They’re going to let him walk,” a white security guard says. The room empties out, leaving only the original occupants.

  I drive down Albany Avenue and see a shirtless black man sitting on a car, holding a cardboard sign that says, “O. J. is Free.” A few others stand by dancing and waving their arms. Cars honk as they pass by.

  Later in the day, we transport a sixty-year-old white male down to New Haven where he will undergo a heart bypass. He is disgusted with the verdict. “It’s an outrage,” he says. When we wheel him into his room, his roommate is also a middle-aged white male, who says, “It’s a travesty.”

  I talk to Michelle about it on the phone that night. I tell her I fear that the decision will harm race relations in the long run. The best thing would have been for the black jury to find him guilty because whites would have been pleased to see that blacks could put race aside. It would defy their expectations and give them pathos. But to see blacks standing and cheering will only further inflame the angry white males who have been fueling the country’s turn to the right.

  Michelle, who also thinks he is guilty, tries to explain to me why blacks are celebrating. Do I know what it is like to be stopped on the street and frisked for no reason? Do I know what it is like to go into a department store and be followed around because of the color of my skin? Do I know what it is like to overhear people who are nice to my face refer to me as a “nigger” behind my back? They are ce
lebrating because America is acknowledging that racist cops are bad and won’t get away with it anymore. It doesn’t have anything to do with O. J. It is a different kind of justice. I am grouchy and say, but he’s guilty. That’s not the point, she says. No, I say, my point is he’s guilty and it’s going to hurt blacks in the long run. They shouldn’t be celebrating. Our conversation ends without its usual warmth, and I wonder whether or not I am underestimating the effect of race on our own relationship.

  A week later, I am sitting in the ambulance with my partner for the day when an EMT comes up and they start telling jokes. “Did you hear about the nigger who …”

  “Please stop,” I say. “I find this offensive.”

  They look at me, stunned.

  “Okay, can we finish the joke anyway?” one of them says.

  “I’d really rather you didn’t.”

  They go around to the side of the ambulance and finish the joke.

  My partner, whom I have never worked with before, apologizes and says she is not a racist. A joke is a joke. It’s like a Polish joke or a blond joke.

  I tell her that I have told black jokes many times before, but that they bother me now. Maybe if she’d said black instead of nigger, I say, I might not have objected, although I would have tried not to laugh if I found it funny. I tell her my girlfriend is black and these jokes bother her, so they bother me.

  She tells me some of her best friends are black. She admits if her daughter came home with a black person, she would be upset. While she would be happy her daughter found love, she would be unhappy and wouldn’t want her daughter to suffer from society’s reaction. She isn’t sure what she would do. After working with her for the whole shift, I feel that she is a good, decent person. I think about my old friend, Barbara, who I lived with and loved for ten years. When she was in high school in the Midwest in the 1960s, she went out with the captain of the football team, who happened to be black. She had a cross burned in her yard for it. Though she and I did not work out in the long haul, I came to admire her over the years as I have admired few in my life—for the way she saw things as they were but lived them as they should be, for the way she listened to children, for the way she raised her own son, and for the way she enjoyed a cold beer and good songs on the jukebox. She lived an extraordinary life with verve. It is not always easy or safe to be more than just good and decent.