A Day in the Life

I was standing outside my car, filling it with gas in the rain, when I looked at my reflection in the side window. My face looked hollow and somber, and the rain running in rivulets down the glass panes created the impression that I was drowning in tears. I had just finished an intense 24-hour shift as a paramedic. It was the day before Christmas, but I felt strangely distant from the festive decorations and holiday ambience that was apparent everywhere.

We had experienced a busy shift of one life-or-death call after another. While one might expect emotions to run high under such drastic conditions, I was desperately trying to gain a more positive understanding of the realities I had witnessed that day.

A Routine Beginning

Our first call seemed routine enough: an elderly man who appeared to have suffered a stroke. His wife met us at the door, rather distressed, explaining that her husband was “at it again.” While I’d expect her to display grief, this looked more like anger. The man was seated on a kitchen chair and his skin had that waxen pale look of someone not doing well. She must have recognized this: We’d been summoned by her 9-1-1 call. The man couldn’t speak, only moan and sigh. His face was contorted, with the left side in an obvious slump. His hands responded weakly when I asked him to squeeze mine, and his blood pressure was low.

The wife continued to appear miffed that he had chosen this day to “act up,” and was unable to answer the most mundane questions about his medical history or condition. One of my crew went with her to look at medications in the bathroom with the hope that we might be able to learn more. We gave the husband oxygen, started an IV with fluid and looked at his basically normal heart rhythm on the monitor. He still appeared to be a simple stroke patient who would require a hospital stay, medical direction and treatment, and probably rehabilitation, depending on the severity of the stroke.

His wife came back in the room and apologized for the mess in the house. I looked around and saw that everything was immaculate except for her husband, who had been draped over the table, and now was being unceremoniously moved onto our stretcher. I asked her if she would like to ride to the emergency department with us, but she informed us she had to clean up first, and added that she had been cleaning up after him for quite a few years now. I told her that we would take good care of him and she looked directly at me and said, “Yes, I know that you will,” with an assured tone of voice.

We moved inside the ambulance and the man’s heart suddenly slowed, as if triggered by his escape from the house. He stopped breathing and we began the familiar sequence of efforts known as the “crazy code shuffle” with one paramedic and three EMTs in the back of our small ambulance. We worked steadily with practiced form to establish a secure airway and administer the proper medications to save the old man.

Our concentrated efforts were interrupted by rapid knocking on the ambulance compartment’s back door. Outside was the patient’s wife with freshly applied makeup and a determined look upon her face.

I asked one of my partners to open the door and tell her we would be delayed.

“I don’t want to talk to her,” he said. No one looks forward to telling a family member about this sort of thing.

The wife spoke loudly through the doors. “Young men, you have to move your vehicle if I am to be able to move my car.” Billy reluctantly opened the back door a crack and told her we were working to help her husband breathe and would be moving shortly. The wife looked up in exasperation and proceeded back to her house.

At the ED, it was utter chaos, with the Christmas rush of people in all forms of illness. I had radioed to advise that we were coming in hot with an arrest, and barely got a response. We transferred the man—whose heart rate was being paced with energy from our cardiac monitor, with little success.

The doctor was a young woman whose face reflected the fatigue and apprehension of one with tremendous responsibility, limited resources and all of humanity beating on her doorstep. She quizzed me regarding the particulars of this matter and my crew continued assisting the hospital staff in trying to save the man’s life. It was to no avail.

When it was over and efforts to revive him ceased, I noticed his wife in the waiting room as I was giving a copy of my report to the admissions secretary. She came over to me and wanted to know how long it would be before she could take him home, as she had an appointment in the afternoon.

I looked at an imaginary spot just above her hairline—as I always do when I am forced to communicate cheerless information—and told her the doctor was attending to her husband and would be out soon to speak with her. I don’t think she read my face with the sentiment I expected it to deliver; she just shook her head, disgruntled, and went back to her chair amidst the overflow crowd of unhappy faces, each in a lone crisis.

I departed quickly and joined my partners to clean our equipment and go back in service to deal with what was fast becoming a banner day.

We were then called to a retirement home, where a woman in her 90s had fallen, incurring several small skin tears on her leg. The retirement home manager was adamant that we take her to the hospital. He was standing right next to the patient but he spoke to me about her in the third-person, as if she wasn’t there. I had already examined her leg wounds, which did not appear to be suturable and certainly did not constitute a medical emergency.

I asked her point blank, “Do you want to go to the hospital, ma’am? I can bandage your leg here and have the home nurse change your dressings in the morning.”

She was a small lady, barely 100 lbs. She looked at me, clearly upset, and said, equally clearly, “I’m 90 years old and have been around for a lot more than this.”

She redirected her gaze to the manager and stated, “I do not wish to go to the hospital.” She ended this statement with a flourishing gesture and lost her grip on the dented walker, nearly falling again.

The manager, who was pacing in circles and seemed more than ready to have this “liability” removed from his care, exclaimed, “I told you she would not want to go!”

Now, it seems to me that anyone who doesn’t want to go to the hospital is pretty normal. While this woman might not have been ready to run down the hall, she could certainly move about in the freedom of her own apartment, and I told the manager so.

“I can’t make her go anywhere she doesn’t wish to go, her injuries can be tended to by the staff nurse tomorrow, and we are outta here once we finish dressing her leg.”

I had just made a friend for life with my patient, who looked at me with thanks and glared bullets at the manager.

I noticed an elderly man in the room whom I had not seen before, and he spoke out, “I’ll look after Edith until tomorrow; we’re neighbors.” He took a step toward my patient and nearly lost the grip on his cane. The manager muttered something, shook his head and left the room, as I helped Edith’s friend into a chair.

I spoke to both of them: “Take it easy and slow today, okay?” They each had a determined look as they eyed the hall entrance leading to the living room of the apartment. The hallway walls were covered with pictures of faces from long ago, a gallery of their pasts that they must pass through to get from this room to the promise of relative freedom in the living room at the other end. The thought occurred to me that with Edith and her friend’s ages totaling something like 180 years, they’d be covering a lot of distance in the short walk to it.

You Laugh or Go Blind

We weren’t even out of the retirement home when the portable radio blared tones for another emergency in our district. A choking person required assistance and the nearest ambulance was over 10 minutes out—the dispatcher wanted to know if we could take the call. Racing to the unit and roaring out into holiday traffic, I heard the “first in” engine crew, with their two EMTs, radio that they had reached the scene. Shortly thereafter, they sent two more words on the air, “Please expedite.”

My driver and I proceeded to a location where we found neighbors doing the all-too-familiar “Something’s Awful Wrong” jig in front of the house.

We made our way through them, back to the pool deck, where we could see our engine crew on their knees working next to another elderly man positioned supine on the ground. Billy, one of the first responders, looked up with an expression that pretty much confirmed there was something awfully wrong, and announced that the patient was choking on food, but moving air.

The man’s wife was standing to the side and said that he had been acting “funny” all day, then reached out holding a vial of pills that she said were his only medication: Paxil.

This is a pretty strong antidepressant medication and I wondered if the patient had taken a few too many. He was now cyanotic and gasping in short puffs, flailing his arms everywhere. He had ripped the oxygen mask off his face and looked like he wanted to scream, but couldn’t.

Billy straddled the patient, facing him, and manipulated the man’s jaw from either side with his fingers to keep his mouth open, while I probed with a laryngoscope. I looked inside a mouth that was full of gristly saliva and other unknowns and saw the tail of something globular in the throat. I pulled out a chunk of meat the size of my thumb with my forceps. The man gasped for air and made a sound like squawking geese, but immediately appeared to improve from what initially was a poor condition. I flung the chunk of meat across the pool deck.

We loaded the patient onto our stretcher and into the ambulance. He had been receiving little air for at least 4–6 minutes before our arrival, and still appeared to be in mild respiratory distress. Our patient tolerated the short ride to the ED fairly well—riding lights and sirens in Christmas traffic is an event anyone should receive an award for.

The same young doctor was there to take my report. She still had the look of one fully involved with the immediate environment; all the rooms were full, a respiratory technician was treating a wheezing asthmatic in a hall bed, and nurses were racing madly about, each determinedly fixed on their missions. We were just one more sideshow in a multi-ring circus of death-defying acts.

She asked me, “So what was this guy’s down time?”

I told her 4–6 minutes, adding that his oxygen levels were lower than they should have been on the ride in.

“Call for x-ray and get Respiratory in here now,” she called out to the room, and magically a few nurses appeared from the confusion to help us with the patient.

After finishing the lengthy documentation in the ED’s ready room, I made my way to the duty nurse to give her my report and saw the wife from the first call we’d had earlier in the day, with her husband still in the cardiac room where we had placed him. The room was also still in disarray, with IV tubing coming down from an upright stand leading to his body. The cardiac monitors had been turned off and their screens were dull and gray, adding to the dismal climate. The room was further cluttered with wrappings from IV bags and other resuscitative supplies, creating an unkempt environment in stark contrast to the home from where we had picked up the patient.

I saw the lady sitting by the hospital table holding her husband’s lifeless hand. She looked up at me as I passed by and I could see her mascara had run down her cheek to the corner of her mouth with her tears. I couldn’t meet her gaze. Instead, I escaped to the sanctuary of my ambulance, hoping to return to the station and watch some TV.

But the work was steady over the next few hours, with a few more fallen geriatric patients, a number of fire alarms (as it had started raining with thunder and lightning, which loves to incite fire alarm systems) and one or two cancellations en route. By later that evening, I was several reports behind and typing away when a call came in for an 18-year-old obstetrical (OB) patient with abdominal pain.

OB calls are not uncommon in severe low-pressure weather systems—something about the falling barometer apparently induces labor. I told my partner, John, that delivering a baby was an EMT skill and I’d be letting him handle this one.

He replied, “No way.”

We arrived on scene and could hear screaming from outside the house. Again, a crowd had gathered from the neighborhood by the front door, which was open, and as if on cue for the non-existent TV show, one person yelled out, “Do something!”

We found the patient lying on the couch. She seemed like such a young girl. Her name was Sally and, in between loud, oppressive shrieks, she managed to tell us this was her first pregnancy and that she was close to seven months along. Judging from her obvious pain, I did not conduct an extensive assessment but moved quickly into the rescue. Her husband was maybe 20 and looked to be trying to grow his first mustache. Unsuccessfully.

Sally was screaming, “Peter, don’t leave me!” I told her that her husband would be riding in the front seat and would be with her at the hospital.

It was all I could do to get an IV in her hand, as the road was bumpy and the back of the ambulance was rolling around like a small boat in a big sea. I was by myself this time and had to complete the IV setup, get Sally on oxygen, hook her up to the cardiac monitor and prepare the obstetrical kit. I feared I was losing control and asked John to slow the truck down and drive by a fire station to pick up another medic or EMT to help out.

Sally was now screaming, “Here it comes!” I gently looked down under the blankets to see that fluid had saturated the sheets.

“Sally, I have to remove your pants and see what’s going on,” I told her. She was beyond answering me, her face contorted with urgency, and I knew impending matters were taking over. The unit suddenly stopped in traffic and I was thrown forward next to her head. The back door opened and another medic climbed in, who happened to be passing by in another ambulance and heard our call for assistance. He took one look and could see I was up to my ears in “it’s hitting the big fan,” and helped me remove her pants. Sally’s groin, thighs and legs were saturated in blood, and more blood appeared on the stretcher by the base of her buttocks. The ambulance was rocketing on in the rain, Sally was yelling that the baby was here, and I realized she could have just miscarried her child.

We were almost to the hospital and I could only place a sterile trauma dressing over her lower section, open the IV wide and hold her hand while trying to keep my own feelings in check. The extra medic was on the radio with the ED nurse, who advised that we were to direct-admit into Labor and Delivery.

Sally was holding a bloody hand in the air and was crying silently as I told her, “Hang in there, girl; we’re almost there.”

We unloaded in the ambulance bay and passed through the ED section to go to the elevators that would take us up to Labor and Delivery. The nurses saw the blood all over the stretcher blankets and Sally’s hands. Their faces turned quickly away as we passed.

Later, back at the station, I finished the reports that were due and watched a few minutes of television. No one mentioned the incident concerning Sally and her baby, and, fatigued, I went to bed.

Final Call

The station buzzer sounded for our last call just after 7 a.m., and we responded to the report of an unconscious person. We arrived to an apartment complex where there was a young female outside waving a white cloth.

Inside, there was an older man, who told us that his wife would not wake up, but that he had spoken to her earlier in the morning. The patient was found in a hospital bed wearing an adult-style diaper for incontinence. It appeared that she had been bedridden for a while. She was lying on her stomach with her arms crossed beneath her face, and I had one of the EMTs escort the husband to another room, so we could roll her over without him present.

There was a picture above the bed showing the husband and his wife in younger years holding hands under a tree. It was a closeup shot, and the woman in the picture was strikingly beautiful, sunshine casting shadows across her face.

As we turned her over on the bed, there was no likeness to the younger female in the picture. Death had already visited much earlier in the day and the shadows in the photograph had been replaced with swelling and discoloration. The cardiac monitor was showing a flatline when the husband burst into the room, asking if we had saved her. There was no avoiding it, so I searched for that imaginary line on his hairline, but he forced eye contact upon me as I said, “I’m sorry, sir; your wife has died.”

I saw hope leave his eyes, and he walked over to the bed to grasp her hand. “We have been married 47 years,” he cried softly. “What am I going to do now?”

This was the final call of the day for me and I was glad to end this shift. I have seen the splendor of birth before, but not during the past 24 hours. I always hope to recognize the inherent value of death as well, but right now, I was having trouble grasping it.

The nozzle clicked off, interrupting my thoughts and bringing me back to the pres­ent: filling my car at a gas station after a very challenging day. I realized I needed to focus on the hours ahead; my wife had plans for us together on Christmas Day, and I desperately wanted to go home and rest up for it.

An evergreen wreath hung next to me on a support column near the pump, and someone called out, “Merry Christmas!”

I could still see my face with its empty expression reflected in the window and I became aware it had stopped raining. Still, there appeared to be droplets of water on the image, and I touched my face with my hand, only to find the tears were real.