“What breaks my heart,” I say, “is the plant care in some of the nursing homes we go into. Hellholes, I tell you.”
Just then my radio calls. They send us to Windham, a forty-minute ride out of town. A basic transfer. As we hit the outskirts of town, I hear two chest pains go out to basic units.
Stress
Car 884 is dispatched to an unknown on Hampton Street. A moment later we’re told to head to New Britain General Hospital for a transfer. As soon as we get on the ramp to I-84 West we hear our company dispatcher asking, “eight-eight-four, are you all right?” There is static. “What’s going on?” Simultaneously, HPD dispatches another car. “We have a ten-ten, ambulance rollover.”
Both Arthur and I want to spin around and race to the scene, but we’re on another call, plus every other ambulance is asking to head that way. Dispatch tells cars to stay clear. “We have one ambulance headed to the scene and two supervisors in eight-four-zero rushing to back them up.” Rick Ortyl and Shannon Pratt are in 884. I can hear Shannon through the static saying, “We’re okay,” but her voice sounds shaken. The fire department is dispatched for extrication.
We’re quiet as we head away from the city, listening, waiting.
One ambulance goes to Hartford on a priority two, the other on a priority three.
When we get to New Britain, we call the office to ask for an update. Information is sketchy, but Rick and Shannon were both alert and talking at the scene. Shannon may have a hand and shoulder injury. Rick will probably be okay; he is just banged up.
Later we get the story. As they were going lights and sirens through the intersection of Chapel and High, a car that did not yield clipped them in the back by the passenger side and sent them over on their side. Rick fell down onto Shannon. The fire department had to take out the front window to get them out. In the article in the paper the next day, the police department will deny sending the ambulance on a priority. But unknowns are always priority two. Always go lights and sirens. Often HPD dispatches a call without giving a priority, but we go based on what it is. A shooting you go priority one. Same with chest pain. A drunk you go on a three.
Arthur is always mad when they don’t give a priority, and I’ll say, “It’s an asthma, go on a two.”
“But they’re supposed to give a priority,” he’ll say. He’ll call back and ask for a priority, and they’ll say priority two. To me it’s a waste of time, but he says if they don’t give you a priority you’re in trouble if you get in an accident.
“Yeah, right,” I’ll say, “If they dispatch us to a baby not breathing and don’t give a priority, we’re in trouble if we don’t go on one. Common sense.”
“They’re supposed to give a priority,” he’ll say. Well, here’s a case where he is right. The article in the paper makes the “ambulance drivers” look at fault.
Accidents are common in this business. They tell you if are in an accident and it’s your fault, it’s your fault. And they tell you if you get in an accident and it’s not your fault, it’s still your fault. All of our ambulances have a sign on the front dashboard that says we are required to come to complete stops at all red lights, intersections, and yield signs when using our lights and sirens. It’s a good risk-management practice, but try stopping at thirty deserted intersections when you are going priority one for a child not breathing. In the various towns we respond to, we have contracted response times. The company is fined if we don’t make the times.
At Saint Francis, I’m writing up my paperwork for the previous call and Arthur is resupplying the ambulance when we get called out to do a call deep into West Hartford for a chest pain. The dispatcher keeps coming over the radio to ask us how we’re doing. “Just fine,” Arthur says.
“I mean where are you?” the dispatcher says.
“Albany Avenue. We’re doing our best.”
When we get back to the office that night, a supervisor wants to know which of us was driving. Someone in management saw our car blow through a yellow light at a high rate of speed and was quite upset. “Let him come down here and tell us that to our face,” I say, suddenly upset. “You haul us out of the hospital, send us deep into West Hartford for a chest pain, hound our butts all the way to the call—Where are you? Where are you? Howya doing? How far out?—worried about the response time, and you expect us to come to a complete stop at every intersection. Come on. Let him come down here and say it to our faces.”
“I’m just passing on the complaint,” the supervisor says.
Arthur is unconcerned about it. It is the last day of our rotation. “Time for me to get naked,” he says, running his card through the punch clock.
Meat in the Seat
With the company about to be bought by a large national company, we are all concerned about what may happen. In nonunion companies bought by the corporation, the company has come in, fired everyone, then rehired whomever they wanted, often at lower wages. I have been reading stories from across the nation on an on-line EMS bulletin board. Paramedics who worked two twenty-four-hour shifts a week at sixteen dollars per hour, and worked part-time jobs on their days off are fired and offered new jobs working five eight-hour shifts at twelve dollars per hour, working three days on, a day off, two days on, a day off.
We are all worried. Some talk of finding work elsewhere. The problem is that there are few other places to work. The new company has also bought up much of our competition. They dominate the market.
We take a wait-and-see approach. Some of the things the new company is talking about sound good. They plan to put a paramedic in each car, which would be great for patient care. During my paramedic class I rode with an ambulance service before and then after it was bought by the company, and I have to say, the new company cleaned the place up, instituted a dispatch system that improved response, and thoroughly professionalized the operation. I hope that whatever changes they institute here will be for the better.
I talk to an employee who is worried he will lose his management job in the new company. “You don’t have to worry about your job as a medic,” he says to me. “They are always looking for meat in the seat.”
Snowstorm
We’re in Bellevue Square in the middle of a blizzard. The access road to the public housing project has been plowed only once, and by a plow not much bigger than our ambulance. In the back we’ve got a guy who had surgery on his jaw a few days ago; he has run out of his medication so he called 911 for a ride to the hospital. The access road turns to the left. I shout hold on, because I don’t think the road is wide enough to make the turn. I gun the engine, hoping the speed will get us through, but the wheels catch in the snowbank and the back spins out. We’re stuck. I get out and look at the ambulance. It’s cold and the snow is still coming down. We’re backed up with calls all over the city. My partner tries to push, but we can’t quite break free. I don’t want to call dispatch. This would be the second time this winter I’ve gotten stuck at the same location. The door opens up, and our patient steps out. My partner and I look at each other. The patient looks at the wheel and shakes his head. He swears.
“You want to help push?” I say.
He shakes his head but puts his shoulder to the back corner.
I get in the front and hit the gas as they rock the rig back and forth. It breaks free, fishtails a moment, then finds purchase on the road. They get in back, patient and EMT, and we continue on to the hospital.
Priorities
I am on line working with Kelly Tierney. We are parked by the graduate center just off Main Street. The police dispatcher gives us a call for an assault on Standish, way down off Wethersfield Avenue. Priority three. Two minutes later, the police dispatcher gives a priority one unresponsive call at the graduate center to 903, a basic car just coming on line. I ask Kathy Poulin, our company dispatcher, if she wants us to divert, switch calls with 903. “You can try the police,” she says. “I was going to suggest that but their dispatcher hung up on me.” The police dispatcher on duty is the o
nly one who continually gives us a hard time. While many of the dispatchers there do an excellent job, this particular woman has no business being in her line of work.
“HPD, four-seven-one,” I say. “We’re at Main and Gold. Would you like us to divert to the graduate center?”
“No,” she says emphatically.
“Just thought I’d suggest it,” I say. “We’re only a couple blocks away.”
“So much for patient care,” Kelly says. “She’s too lazy to switch calls on the board.”
Five minutes later we call out on Standish. A man under arrest by HPD has a cut finger. He is HIV-positive. The cops don’t have anything to clean his hands with, so we take some saline and sterile dressings and start to clean the cut and the blood off his hands. On the radio we finally hear 903 put out. A few minutes later, they come on the radio screaming for a paramedic. They have to call four-seven-two out of Saint Francis to respond. They are just arriving on scene when we clear our call.
“Nobody cares,” Kelly says. “It’s as simple as that.”
Another ten minutes later, 903 with the 472 medic leave on a priority to Hartford Hospital.
A forty-year-old Hartford man suddenly stops breathing while at the dinner table. No paramedic crew is available. When the basic unit arrives, he is not breathing. They try to ventilate him with the ambu-bag. They get some air in but not enough to fully expand his chest. He is now in full cardiac arrest. They do CPR. When the man is brought into the hospital, the doctor goes into his mouth with the laryngoscope to intubate and sees a giant piece of meat wedged deep in the windpipe. Using his Magill forceps, he removes the meat. The airway now clear, he intubates the man and works feverishly with the hospital staff to restore a heart rhythm. The man doesn’t make it. Forty years old. Choked on a piece of meat. Too deep in his airway for the Heimlich manuever to work. A paramedic with a laryngoscope and Magill forceps—standard paramedic equipment, not issued to basics—responding to the 911 call could have saved his life on the spot. He might not have even needed to go to the hospital. But where were the paramedics? Doing transfers. Doing B.S. An avoidable death. A system failure. A system that everyone knew was broken. Hartford police department. The company. Medical control. Me.
Mean Streak
Priority one. Bus accident involving children in the parking lot of a high school.
“It’s bullshit, I know it’s bullshit,” I say. “What kind of accident can you have in the parking lot?”
“Somebody could get backed over,” Art says.
I’m thinking in my gut he might be right. I feel it’s bullshit, but you never really know.
Another car responds with us.
We’re just down the street when the PD dispatcher radios, “Slow it down, minor injury.”
When we arrive, the cop tells us there is only one person hurt, an eighteen-year-old kid lying on the ground outside the bus with a Walkman on. A couple of his friends are standing over him, laughing. The buses barely touched, the cop says, this kid walked off the bus, lay down, said his back and neck hurt. It’s bullshit, the cop says.
Greg Berryman, the other medic, and I walk over to the kid. The kid is wearing a Tommy Hilfiger shirt, baggy jeans, and a pair of Air Jordans. Styling. Jiggy.
“What’s the matter, kid?”
“I hurt all over,” he says. “The buses collided, and I banged my head.” He tries to suppress a giggle.
“Okay,” I say. “We’re going to have to C-spine you. That means putting a collar on your neck and strapping you to a board. Are you sure you’re hurt?”
“Yeah, I’m hurt. Look at them laughing at me. Man, I’m hurt. All over. Neck, back. Nearly busted my head.”
Okay.
We C-spine him. The whole routine. Heavy tape over the eyebrows. Get him in the back of the ambulance.
I take his blood pressure. I squeeze the balloon hard, pumping it up: 200, 300, around again to 100, 200. I look at his hand now. It is slowly turning white. I press against his nail beds. His capillary refill is delayed. “You’re going to need an IV,” I say. “Capillary refill delayed. That’s a bad sign.”
“What?” the guy says.
“Large-bore IV,” Greg says. “Maybe dual fourteens.”
“Definitely. Could be eternal bleeding.”
“Pupil check,” Greg says. I glance at him and see he has the spotlight in his hands. This is the spotlight that can burn a hole in the floor of the ambulance, if accidentally left on. “Constricted,” Greg says, without shining it in his eyes; if he did, it would leave the boy seeing spots for weeks.
“Why are you all laughing?” the kid says.
“You need laughter in this job to mask the horrible things we see. You’re injured. We’re going to need to do an IV if there is any chance at all.”
“What?”
“No need to be too concerned. Yet.”
“I just hurt; I ain’t sick.”
“Cut his clothes,” I say.
“What are you doing? That’s my shirt.”
“You’re hurt, we’ve got to expose you fully to make sure we don’t miss anything. It’s protocol. It’s our job.”
“Oh, man.”
We make quick work of the Hilfiger jacket and jeans. Cut the laces of the sneakers.
“Looks okay, no obvious deformities. I guess we can take it on a three.”
“I can’t believe you cut my clothes, man. Who’s gonna pay for that?”
I shrug.
“Man.”
“How’s your neck?”
“Huh?”
At the hospital, we put him in the back hall and tell him not to move until he is cleared. He protests, but I tell him any insurance claim is void if he gets up. But he has to take a leak, he says. I tell him I’ll bring him a urinal.
I see the nurse and give the report. Complete bullshit, I say. I tell her he needs to take a leak. “I’ll bring him the urinal,” I say. I know she is busy.
“Man, I got to pee,” I hear him say as I walk past. “I ain’t kidding. You going to get me something so I can pee.” I keep walking on down the hall and out the door.
“You know, buried beneath all the nice guy stuff you really do have a mean streak in you,” Arthur says when I get in the ambulance.
“Teach him to fuck with the system.” I am still angry.
Roles
A crew is dispatched for a seizure. Just as they turn the corner, they are canceled; the police have transported. That night on the news the story makes the cops look like heroes for “saving the baby’s life.” The baby, by the way, is released from the hospital hours after being brought there. The diagnosis—a febrile seizure—is a common, rarely life-threatening event for babies. A week later, on TV, the cops are given a plaque by the baby’s mother and a commendation by the department. No one asks the hospital for their opinion of the officers’ actions—that indeed if the child truly weren’t breathing, they endangered him by driving him to the hospital, taking it away from the immediate lifesaving care of the paramedics who could put a tube into the child’s trachea and breathe air back into his lungs, keeping his brain cells alive.
A number of years earlier, an EMT was called to the scene of a shooting. He arrived to see the getaway car pull away. To the horror and dismay of his coworkers, he chased after the car and radioed its location and description to the police. He received a commendation from the state’s attorney. Meanwhile medical control wanted to yank his certification for abandoning the scene before doing his job: checking to see if anyone was hurt. And his coworkers, who have to treat the lawful and the unlawful equally and without judgment, faced the threat of gang payback.
In both cases, the people flagrantly disregard their duty and possibly endanger patients. In both cases they get awards.
State Card
The call is for chest pain. A man will be standing at the corner of Collins and Woodland. We’re covering area three—Saint Francis. We’re parked in the ER lot at the corner of Collins and Woodland.
I see a guy come out of the waiting room and walk over to the corner. We pull up. I look at him through the passenger window. He motions for me to roll the window down. I do.
“I called for the ambulance,” he says. “I got chest pain. For two weeks. Hurts like hell when I breathe.” He has alcohol on his breath.
“The hospital’s right there,” I say. I point to the ER door.
“Take me to Hartford Hospital. I got no use for Saint Francis. I’m tired of waiting. I been waiting there for four hours. They said it’s my fault I was sleeping when they called my name. They could of had the courtesy—they could of had the courtesy to wake a brother up now, couldn’t they? Ain’t my fault I been waiting so goddamned long. My chest is killing me, man. Coughing up green shit all damn day long. Here’s my card.” He holds out his state medical card. Holds it like it is cab fare, which it is.
“Get in,” I say.
When we get to Hartford, they put him in their waiting room.
Quit
A paramedic I really respect comes into St. Francis with a patient from a car accident, a young woman who is actively seizing. He is upset because the extrication took too long and he couldn’t get a line. The young woman is badly injured, and she needed Valium to stop the seizing. He is exhausted, spent. There is blood on his shirt, his hair is mussed. He walks back from the trauma room, looking defeated. Half an hour later, I see him coming down the hall from upstairs, carrying three balloons and a plant, pushing the stretcher on which a woman sits. Her daughter says to him, “Be extra careful with her, her back is sore.” He just nods, an unhappy look on his face.
I am talking to his partner a few weeks later, and I say how I think he is one of the medics I really look up to. “You haven’t been riding with him the last couple months,” she says. “He’s burnt.”
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