The Things You Can Never Forget

The other night I saw something I'm never going to forget.
It started not three minutes into my shift on the Squad. My partner Mike, an EMT Intermediate with years of experience, and I were dispatched to a residence for an elderly woman vomiting blood. Internal bleeding for sure, and our regular truck was out of service. We didn't have a suction unit on the Ford Explorer that we were responding in, just a manual powered turkey baster type device.
When we pull up the whole house is dark, but thats nothing new. We grab our truama and O2 gear and hike up a steep set of icy stairs to the front door of a decript old cottage. I briefly think that its gonna be a bitch wrestling this woman down to the coming ambulance.
A gastro intestinal bleed has a smell quite unlike any other imaginable. Its kind of a mix between rotting dead skin and shit mixed with blood, which is exactly what it is. As soon as we get in the front door, that awful order assualts our noses and we become mouth breathers for the remainder of the time in the house.
The woman is a fragile, her skin so alabaster its nearly transulucent and from the look of her shes already dead. Sitting on the toilet, covered in her own black blood in a most undignified pose.
We waste no time, Mike gets her under the armpits and we drag her into the kitchen, propping her up in a time worn chair just as the ambulance arrives outside. Her blood pressure is about 60, way too low for her to be concious but in order to make a liar out of the medical books, she babbles about how the dinner she made is going to burn. Her husband just watches as I try to get a pulse and lung sounds.
The medics show up and tell us we should probably get her in the bus.
No shit.
We wrap her in sheets and white towels in order to protect her from the twenty something degree night. As I'm carrying her down in a stair chair with an AMR medic, she closes her eyes and her face took on the most peaceful and serene look I have ever seen. When we transfer her to the gurney to load her into back of the ambulance her eyes flutter a bit and the smile remains, gingerly her frail old wax hands pull a towel up around her head like a nun and she lays back in the gurney.
I thought for sure I had watched her die, we all did. That peacefull look was just too strangely calm not to be staring into the face of angel. When we went back to the station I kept catching whiffs of that horrible smell, the GI blood. I found a splotch on my pants and went after it with alcohol wipes, trying to wash out the scent of death.
The next day my cell phone rang. Mike had talked to one of the doctors and found out that the woman hadn't only lived but was doing remarkably well for someone who lost nearly a third of their blood.
Maybe we got there just in time to get her to the hospital for a blood transfusion, by all laws and medical rules, she should have been dead. But for some reason the eighty some odd year old lady was thriving the last I heard.
That look, the look of utter peace and serenity is something that I will always remember. I'm certain she was looking down the tunnel, into the light. They say you often see the faces of loved ones and hear their voices when looking into that tunnel. Maybe some long lost relative of hers was smiling down on her soothingly, his voice gently telling her: "Not yet."

The Talker

It became painfully clear to me after one car ride that the guy I car pool with to the academy every week loves to here the sound of his own voice. At nineteen years old, he tells stories of saving the water supply for all of Western Mass, having blood and brains run through his gloved fingers and saving numerous colleagues from burning to death as a product of their own stupidity durring training burns.
His stories have the cocky air of a B grade movie hero recounting tales of derring do to a new commer in the field of heroism. Every word is carefully chosen in order to sound self assured and confident of his abilities as a firefighter.
In reality, this guy is as green as freshcut grass in the middle of July. His stories of gore and heroism are just stories because he mistakenly views firefighting as a job where personal glory is the goal. Anyone in the class will say that they have heard his stories and that they silently wish for him to shut up but feel it would be rude to tell him off. After all, we're all brothers.
The point is that he is trying too hard. Theres no shame in the fact that he's never done half of the stuff that he claims to do. Hollywood scriptwritters haven't even dreamed up some of his outlandish creations. His fabrications hurt the emergency service community because when lay people hear someone babbling on and on about brains and gore they think we're sick people who do it for the glory of telling our stories to starry eyed girls at the bar.
People who have actually seen that stuff, dealt with human suffering and death, don't take it lightly. They don't talk about it flippantly with their co workers. Theres the occasional dark joke or sick remark but they don't constantly regale each other with tales of terrible car accidents and dead children.
All of the bad things that we see (if we actually see them) go in to a sort of mental vault. We know they are there and we remember them vividly-- the sights, smells, our own almost parlyzing fear that we won't be able to do what we were trained to do-- but we don't boast about them. In a way those moments when we see people in pain, dying or dead are like praying. On the most basic and primal level, you are witness to the effects of a power much greater than yourself. Call it God, fate or whatever but you are present durring something so powerful that telling stories of it afterwards cheapens the whole experience. When it becomes about you "I did this.....I did that.....My first move was to....." the point of why you are doing your job in the first place is totally lost.
I'm not saying he's a bad guy, far from it, he's actually kind of funny sometimes, but he's too caught up in the image of the hero tough guy. Listening to country music and strutting around talking about your achievements is just going to get you laughed at. Because anyone who actually does emergency work looks on those experiences as their own, if people outside the job want to know about them, then they can ask. Most of the time, the answer will be "I don't wanna talk about it." Because its something that you don't show off, its your own private experience and to put it out as a boast makes it less than what it was.
Theres a big difference between bragging and keeping a record for your own sanity. When trying to deal with the disturbing events of emergency service, it is often recomened that the rescue worker keep a journal or a diary. Many of those journals are later published as a sort of tribute to the patients and people who the rescuer encountered. I like to think that my articles are a tribute to the people I have met and come into contact with.
The job I do is not about me, its about everyone else. I do what I to help people, not to make myself look cool. Emegency work is not about glory, its fullfillment comes not from having people listen to your stories but self knowlege you had experiences that few are privilaged to have. My job takes me to some very interesting places, I see some very disturbing (and some very uplifting) scenes but you don't have to hear about all that.
When I'm working on a patient, its me, my partner, the patient and God. My partner and I can work as hard as we want but in the end God decides whether our efforts are enough. When one of my patients lives, its because of God's blessing. I'm not overly religious, I went to a Catholic high school and the whole thing pretty much turned me off to organized religion, but I do believe that there is a deity. I wouldn't do this job if I didn't. So when I am blessed enough to help someone live through their ailment of the hour, I see it less as my victory and more as the will of a higher power.
People don't get that. Some people involved in this line of work don't even get that. The ones who know what the work is about tend to be quiet about their jobs. Those who don't understand that their work is not about them, they talk.

Code

When you work for an EMS provider, its only a matter of time before someone you are treating clinically dies in your care. In EMT jargon, this is known as a code, short for Code Blue, in other words, your patient will be turning blue because he's not breathing.
My first code, well the first code I worked as a primary care giver, occured last Wednessday. I was working a medical detail at Disney On Ice, a sort of icecapades meets every Disney movie ever made. From our little medical room in the basement of the Providence Civic Center, or the Dunkin' Donuts Center, whatever they call it now, we can hear an assortment of music that makes your fillings rattle and your eyes water.
I was working with two other basics, one a North Providence firefighter, the other an out of work actor who had appeared as "Irish Dockworker Number 2" in several episodes of The Sopranos and an EMT Cardiac. Cardiacs are a Rhode Island creation that spend only 140 more hours in class than Basics but can perform more procedures and adminster more drugs than paramedics in some states.
While some announcer told the kids in the audience that they were going to watch a hundred years of Disney play out before them, a doctor in the audience was pointing out the spotlights in the rafters to his kids. By some strange twist of fate, the man pointed to a light run by an 85 year old man with an internal defribulator in his chest. At the precise moment the doctor looked up, the man collapsed, clutching his chest like something out of an old episode of Rescue 911, you could almost hear William Shatner's voice giving a cheesy dialogue.
The doctor flagged down security who for some reason did not radio us in the EMS room. Instead, several rigging workers came sprinting down to our little bunker and told us. "One of our guys went down, we need help." I grabbed a jump bag, a small medical bag with bandages, vital signs equipment and an airway kit. Bill, the Cardiac grabbed his own jump bag and we tore off after the riggers for an elevator.
"So," I ask while we're waiting for the car. "This guy got a history"
"Oh, yeah, a big one," is my only response.
"You wanna elaborate on that?" I ask and the guys tell me he's 85 years old, has an internal defribilator and will tell us "Oh I'm fine."
When the elevator doors open, I'm looking at a spiral staircase that seems to climb to the heavens. My partner and I take off running, two, three steps at a time as Disney music blares from the stage several stories underneath us. Its then I realize that our patient might already be dead and all we have with us is two bags of bandaids and blood pressure cuffs.
The man is hunched over on yet another set of stairs, several coworkers are around him, trying to calm him since he is still concious. His skin is the color of old newspapers, and covered in a film of greasy sweat.
"Sir," my partner asks him as I get my vitals kit out and ready. "Can you tell me what happened?"
"I'm fine," the guy mutters. Suddenly he stiffens and his eyes roll back in his head, his internal defribilator picking up an irregular heart rhythm and shocking him. His head rockets back toward the steps."
"Shit," Bill curses realizing he's working his first code too. "Shit."
I drop my bag and we pull him to the floor, getting him on a hard service and ready for the seemingly inevitable CPR. Bill's cutting away his shirt as I go for a pulse on his wrist.
"No pulse, I can't get a radial, " I go for his jugular. His blood pressure might be too low for a distal pulse but his heart might still be beating. No pulse in his neck. "Fuck, nothing there either."
I get on my radio to call for our defribilator/monitor. "EMT-7 to Detail Command. We got a guy going to code, bring the monitor and stretcher." An affirmative reply crackles back and I realize that we're going to have to rush this guy all the way to the other end of the building. "EMT-7 to EMT-8," the Irish dockworker. "Bring 21 around to Eborne street so we can load and go for a dirrect shot to the Rog." We were going to transport him to the same hospital I took my EMT class at several months prior.
Bill's getting the guy's teeth out and I'm pulling an oral airway so we can start CPR when he stiffens again. The whole body bounces and miraclously the man's eyes pop open. Bill starts trying to talk to him when another rigging guy starts tries to push past us.
"I need to get to his spotlight." The rigger was taking the show must go on a bit too far, kicking our bags out of his way. "Move guys, I need to get to that spotlight."
Just then the patient starts convulsing again and the rigger complains further. I rage as I prep the guy for a blood pressure, as he sputters back to life.
"Fuck off, we're busy," I tell the over ansy rigger as he climbs over the railings to get around us.
"Shit," Bill curses again as we loose our guy.
Arthur, the North Providence firefighter arrives with our monitor and we hook the guy up, trying to figgure out how much juice his own defribilator has left. No blips, just a flat line. Arthur and Bill get the guy between them and the three of us rush down the stairs. While they get him on the stretcher, his defib goes off and he comes to. "I'm fine, I just don't feel well." He tells us.
I'm hooking up his oxygen mask and spinning the dial to full when he codes again.
"We gotta go." Arthur announces calmly as I throw the monitor between the guy's legs and we hustle him out a door to the crowded front entrance of the Civic Center. A trio of security gaurds, one with dread locks like the Predator, flank us and we push out to the ambulance. Bill's getting ready to start with ches compressions and I've got the bag for ventalation when the guy's eyes pop open.
"I don't feel well. Where are we?"
"Sir, we're taking you to the hospital. You ran into a bit of heart trouble. We're going to Roger Williams."
"Oh, I like them, my doctors...." He codes again and his defib shcoks back. "...are there." He died, shocked back and remembered where he was in midsentance.
Arthur tosses me the keyes to the medical room and tells me to get back down there with the other basic, he'll dirve and we need two people at the Civic Center to man the other ambulance. Bill muscles the stretcher through the front entrance and I calmly collect all of spent medical rubbish we left strewn all over the main lobby.
A guy in a button down shirt with a little girl looks down at me on my knees in the middle of a circle of people. "Is that guy gonna be okay?" His voice has an almost childlike innocence and on my knees in a sea of used electrode patches and spittle soaked 4x4s I see that no less than fifty parents and children are staring at me. They want me to tell them they didn't just see someone die on their big day out with the kids. They want me to tell them its all okay.
"He's going to a good hospital and those two guys are gonna take real good care of him on the way there."
I hope thats true as I stuff whats left of the ordeal into a bright red biohazard bag.
Two hours later a security guard and the head of the rigger's union come down to our little medical bunker. One has tears in his eyes and can barelly choke out what he tells us.
"You saved our guy....he just called from the hospital, told us to get back to work. You guys...." his voice trails off and I can only nod in response. The joy and the relieve come later, right then I could only sit and quiver as the adrenaline faded and the sweat on my forehead crystalized.