The call was for a seventeen year old pregnant girl with trouble moving. We were greeted at the door by the seventeen year old girls two year old son. Another teen girl led us upstairs into a bedroom where our victim rested. She said her neck was stiff and she couldn’t walk. I had her move her head from side to side, then up and down. She did it but said it hurt when she moved and had to go to the hospital for some muscle relaxers. I have given up arguing with people. “Where are your shoes,” I asked. She reluctantly walked down the stairs of her rent subsidised apartment. During the two block ride to Rhode Island hospital I copied her information from the State medical card she gave me. I noticed on the lower left edge of the card her co-pay arrangement. Emergency room co-pay, $0. Prescription co-pay, $0. Office visit copay, $0. Taxi ride to the emergency room by an advanced life support rescue, dispatch of Engine 13 with four firefighters to assist with a potentially serious problem, $0. I asked her why she didn’t have friends of family take her to her doctor’s office. She stared at me with a blank expression and ignored me. The states RITECARE program provides full healthcare for children and their caregivers until the child turns eighteen.

Later that night we were sent to Route 95 North at the Thurbers Avenue Curve for a vehicle into the jersey barrier. A car has lost control on the wet, slippery highway while navigating the tough curve in the road. The car was totaled, both air bags had deployed. Standing in front of the wreck was a twenty year old girl, covered in glass and holding the back of her head. We got her into the rescue. I automatically assumed we would take her to the Emergency Room, she adamantly refused. “Why?” I asked. “You might have a concussion.” “I don’t have health insurance,” she said. Rachel was driving home from work, travelling from New Haven to New Bedford after her shift. She was tired from working twelve hours and commuting two. Her employer didn’t offer health care. She was out of school, living in an apartment with her friend and barely making ends meet. The car was her roomates. She should have been seen that night at the emergency room but knew the bill collectors would be relentless in their pursuit of payment. I had her sign a form stating she refused transport against medical advice, then led her to a State Police car. They got her off the highway to a safe place where she waited for a ride home.

We have six rescues in Providence, a city of 175,000. On the best days the pace is unbearable, days like today are truly impossible. At 0852 Rescue 2 responded to the north end for an overdose. They found a naked man screaming next to the railroad tracks. He had been doing coke all night and decided to climb one of the high tension electrical towers that power Amtraks high speed trains. In the dead of night, probably around three or four he touched the wrong wire. He was knocked unconscious, his melted skin fused to the nylon warm-up suit he had been wearing. Nobody saw him until the morning. He was out of his mind when help arrived. The rescue crew had to wrestle him to the ground and restrain him. They were covered with his dead, smoldering skin for their troubles. They were being treated at the same hospital as their victim for exposure to whatever disease the man was carrying. Rescue 5 went out at 0910 for an emotional woman who was acting violent toward her family. They managed to get the woman into the rescue. Moments later she vomited into the bucket Teresa had just handed her. Among other things she has Hepititis-C. The vomit sprayed from the bottom of the pan into Teresa’s eyes. She was treated at the same hospital as the woman, hard plastic lenses attatched to her eyes while they flushed them with sterile saline from an IV bag. The process took three hours leaving us with four rescues. Another rescue went out for repairs for the morning, leaving us with three. The calls for help were non-stop, rescues from surrounding towns called into Providence to pick up the slack. Some people waited thirty minutes and more for help. Sadly, today was much like every other day in the city.

Vacation is almost over, I’m looking forward to getting back to work. This week went too fast. Providence managed to survive without me. Thursday will be here soon enough, we’ll start over then.

Every day the news comes home, “American Soldiers killed in Iraq or Afganistan.” Every day some poor soul’s family confronts the fear they have kept hidden, their loved on is gone forever. Most of us watch from the sidelines as somebody’s son, brother, wife of husband boards the plane toward war. We watch from the safety of our living rooms the everyday heroes who fight this war for us. My brother is a member of the 1207th Transport Company of the Rhode Island National Guard. It’s his turn. His wife and four kids will wait until next September for him to come home from Iraq. There are some long days ahead. Be safe, brother.

“Engine 11 to Rescue 1, bring some sheets and the stair chair.” I keyed the mike and answered, “Rescue 1 recieved, on scene.” The apartment house used to be a one family place in what used to be a prestigious part of Providence. Peeling paint covered the ornate entryway which protected the carved oak doorway from the weather. We passed under the scrollwork, through the doorway toward our victim. Residents peered from the cracks of their partly opened and chained doors lining the hallway. The guys from Engine 11 had opened the windows inside forcing the putrid air down the stairs we were climbing. I pulled my t-shirt over my nose and mouth and entered apartment 6. Anna waited, lying in a pool of urine, her legs covered with feces. “I fell off the toilet she told me.” I asked her how long she had been on the floor. “Just a couple of days.” I checked for any bleeding or gross deformity before trying to move her. The clean white hospital sheet I placed over her was a sharp contrast to her underthings, years old and yellowish grey, whatever color the material once held washed away. We managed to get her onto the stair chair, a long a laborous ordeal inside an enviornment we found reprehensible yet Anna called home. The guys carried her into the fresh air toward the rescue as I took note of her living conditions. Refrigerator empty. Closets empty. Floors and walls covered in filth, rat and mice droppings swept to the corners, displaced cockroaches scurrying for cover, no room to hide in walls already full. Anna begged me not to take her away from her home. She told me she just needed to tidy up and get some rest. I felt like I betrayed her when I put on my report that she needed intervention, her living conditions unfit for humans.

She didn’t want to come out of the bathroom. I could hear her wheezing from behind the closed door. Her husband talked her out finally, we gave her an albuterol treatment to help her breathing. She had been crying. As the medicated mist began to work and her airway opened she began to relax. She forgot her inhaler at her friends house where they had spent the evening having a few drinks and some laughs. I tried to get her to go to the hospital but she didn’t want to go. They had a great night with their friends but as often happens with married folks on a Friday night a stupid argument got out of hand and it looked like their night would end badly. During the argument she had an asthma attack. Her husband called 911 because he didn’t know what elso to do. Me and Renato sat at their kitchen table as she finished the medication. We talked a while and had some laughs, by the time we left the couple had ended their fight and couldn’t wait to get rid of us so they could “get down to business.” As we drove away I saw the lights go down in their tiny second floor apartment.

Days like this must be endured. My first run sixteen hours ago was for an eighty year old woman with cold feet. Her husband called 911 at rush hour. It took us fifteen minutes fighting heavy traffic to get to her house. The patient was used to be waited on. The first thing she said was “give me a blanket.” She refused to assist us as we picked her out of her wheelchair, placed her on the stretcher and wheeled her out the door. Inside the box she told me to turn on the heat. I lowered the air conditioning and drove her two minutes to Roger Williams Medical Center. The staff there grimaced when they saw her, well aware of her routine. They signed the papers and I was free. Minutes later a man with diareah since the morning called. That was followed by a two year old with a fever. The baby’s father followed us in his car the three blocks to Hasbro Children’s Hospital. The fever was 99.8. They didn’t give the baby any medicine because they didn’t have any.
A car accident followed. There was no visible damage to either vehicle but the three occupants of the cars all were suffering from neck and back pain. Two rescues were needed to get them to the hospital. One car was stopped at a traffic light and the other struck it from behind at about five MPH. All the “patients” were unable to stand. They were extricated from the cars, put in cervical collars, placed on backboards and taken away. A woman had trouble with her new blood pressure machine next. At midnight an intoxicated man called 911 because he was intoxicated and wanted a ride to the hospital. At three a.m. a guy called from across the street from Rhode Island Hospital and said he was having chest pain. When we got there he told us that they refused to treat him at Rhode Island hospital and demanded to be taken to another hospital. I put him in the truck and renato drove back up the ramp. We found out he had assaulted a nurse who said somethind about the crack he had been smoking all night contributing to his chest pain. At six a lady called from a phone booth to say she couldn’t walk. I worked overtime at Rescue 5 all day and things remained the same. Thanks if you read this far, I know I’m whining but it feels good. I’ve got twelve hours to go. I hope something good happens.

She was getting ready to close for the night when a man wearing a hooded sweatshirt appeared suddenly at the drive-thru window. Instead of stepping back, the girl tried to stop him from prying open the window with a screwdriver. She failed. He forced the window open and went for the cash drawer. Again she tried to stop him. He grabbed a handful of her hair, pulled her head toward the window and stabbed her in the face with the screwdriver. Luck was all that saved her left eye. She will be scarred for the rest of her life. She saved the company about eighty dollars with her heroics. The thug got away with the fives and ones, tens and twenties littered the floor, covered with her blood. There is true evil walking among us. I see it all too often.

A guy my age dressed only in boxer shorts was lying on the bed in a puddle of vomit, a couple of syringes next to him. The person who called us stopped CPR when she saw us and walked out of the room. Renato got the bag-valve device, hooked it up to the portable oxygen tank I had carried to the forth floor and started bagging. I got the IV set-up ready. The tourniquet should have made his veins stand out but didn’t. I fished around his left arm for a while, didn’t find anything and pulled the needle out. As soon as I did blood leaked from the site. I guess I had a vein but didn’t realize it because his heart had stopped pumping. Narcan negates the effects of narcotics. I would rather administer it through an IV, but IM or subcutaneous does the trick. I pinched the skin near his tricep, drove the needle home and pushed the plunger. Two milligrams usually does it. The guys from Ladder Four and a Providence Police officer joined us in the room. Renato kept bagging. A few minutes later the man started breathing on his own. He denied drug use but the evidence was overwhelming. I let him get dressed and walked him to the truck. On the way to the hospital he told me he was going away to re-hab on Thursday to get some help. I told him he was seconds away from death. Thursday was almost too late.

I don’t take for granted the things I have, my beautiful wife and kids, family and friends, good health and all that goes with it. I am more fortunate than most. That it could all end suddenly as it did for those poor souls five years ago is something I will never forget. Their lives ended that day, and a little of me went with them. We are never truly safe, it could all be gone in an instant. I still have this instant, and in honor of those who perished I’ll make it the best moment of time that I can.

“Is that French?” I asked my patient. “Oui,” he replied. “Did you learn that in Haiti?” I asked, making assumptions because of the color of his skin and prior experience. “No, Montreal.” His eyes rolled back in his head and he started shaking. “He’s seizing,” I told Renato who had to pause his attempt to establish an IV. Slowly the tremors ceased and he opened his eyes. This time he spoke Russian. “Is that Russian?” I asked with a smile. “Of course, comrade.” He then spoke Swedish, which I recognized from my Grandmother who came directly from there two generations ago. “I know how to ask for toilet parer in ten languages,” he laughed. During transport I learned that he was a successfull actor who did a lot of TV work in the seventies and some movie and stage stuff since. If you watch TV Land and catch a re-run of Good Times or Laverne and Shirley you will see him. I wondered why he landed in a methadone clinic. The answer was not what I expected. He has end stage liver cancer and will die soon. His doctors suggested methadone as pain relief. We had a nice conversation while travelling the five miles to Roger Williams Medical Center. I used to tread gently around dying people but have learned from them that they have no time or patience for bullshit. He told me if not for his Christian beliefs he would have already committed suicide. I understood. We shared our opinions of the afterlife and a special bond was formed. When we arrived at the hospital I said goodby. Sometimes I feel like the luckiest person alive.

It appears that Kellie may pull through. She has beem extubated and woke up for a little while. She knew who she was and where she was but wasn’t quite sure what had happened. She is lucky. Her roomates made her seek medical attention instead of going to sleep, which is what she wanted to do. The infection was caught before doing irrepairable damage. Six firefighters and about forty staff and students were given antibiotics as a precaution. Her roomates saved her life. I love a happy ending and hope things continue to improve.

The chief called at 2200hrs and told me to report to Roger Williams medical Center. Kellie has Bacterial menningitis and I was exposed. I had hoped she didn’t have a bleed in her brain but I never expected this. Viral menningitis is bad, but not deadly. Bacterial menningitis kills. It seems every year I read in the paper some poor kid who came to college and caught this bacteria somehow and died. Kellie’s family is with her in the Itensive Care Unit. She is intubated and fighting the infection, but is in critical condition. I’ll find out tommorow if she lives or dies. As for me, I’ve taken a big dose of Cipro and should be allright. The medicine makes me sick, but not as bad as Kellie. I’m staying on duty until the morning.

She looked sick, but then so many of them do after a long weekend. Providence College has it’s fair share of parties. Inside the health center Ladder 3 finished taking vital signs and gave me the preliminary report. Nelson, a firefighter who came on the job fifteen years ago with me and still looks a lot like Wayne Newton gave me the story. “She’s 21, started throwing up last night at midnight. No medical history, doesn’t take medications and has no allergies. She seems a little confused.”
Usually our college age patients walk to the rescue, not her. Her name is Kellie, her Irish name as beautiful as her face. She tried to answer my questions but her words were garbled. I became worried about her condition; we transported her immediately to Roger Williams Hospital. Renato drove in his usual way, I never felt a bump or turn in the road. En-route Kellie started to have seizure-like activity. As she vomited I handed her a basin. She didn’t understand what it was and threw up on herself instead. She shook as I held the basin to her face, then fell back on the stretcher when I let her go. Her eyes couldn’t focus on mine. I put her on a non-rebreather with high flow 02 and let her rest. I felt that her skin was cool and damp as I swept the hair from her eyes.
The nurse at the hospital took my reportand immediately got her into a room where she was seen by the Doctor on call. I heard them mention a bleed as I washed the sweat and vomit from my hands. I had just taken off my gloves to do the report when she got sick. Five people were working on Kellie as I left. The Doctor said it is probably a head bleed from an injury or menninjitis. I hope it’s menningitis and whatever got on me has been washed away.

When she regained consciousness, he tightened the noose . Then he punched her in the face and waited for her to pass out. She did. A few minutes later he tightened the noose again. Eventually he grew bored and let her go, telling her she would never leave him. She called her mother, who called us, 911. I found her standing outside a three-decker in South Providence. Her two year old was crying hysterically in her grandmother’s arms, screaming for her mother. I walked her toward the rescue, my partner met us with the strecher. She layed on it, too dazed to speak, cry or anything. She had been held captive for four hours and tortured. Outside her apartment life went on. The sun was bright, kids enjoyed the last few days of their summer vacation, construction workers worked on a stone wall a few houses down, oblivious to the horror a few feet away. I took her to the hospital. I hope she recovers.