Overheard in the front of Rescue 1. Very late at night.

“I wonder why we never get sick.”

“Because we already are sick. There’s only so much sickness to go around.”

“Yeah, but we’re surrounded with sick people all the time. We touch them, breathe their air and all that, you would think we would get sick more often.”

“You think too much.”

“And why do we carry people with back pain down three flights of stairs when our backs are worse that theirs?”

“Because we can.”

“So can they.”

“The difference is, they know WE can.”

“But we know THEY can.”

“You think too much.”

“I guess.”

We’re on our way to Cranston on mutual aid, a call for a possible CVA. I’m not sure where it is.

“Providence Rescue 1 to Cranston Fire Alarm, do you have a break number off Pontiac?”

“Roger Providence 1, 365. Be advised CPR in progress.”

“Roger that, expediting.” I put the mike back in the cradle.

“CPR?” Brian focuses a little more on the road before us as I put on some gloves.

We leave Providence and cross the border into Cranston. Usually it’s the other way around, Cranston comes to Providence for mutual aid ten times more often than we go there.

“I hope it’s the same guys,” I say to Brian as we speed down Pontiac Ave.

“Yeah, they’re pretty good.”

Working a code is difficult enough with people you are familiar with.  In a  different city, with different people, and different ways of doing things and things get a little crazy. The last three times we went to Cranston the same crew responded with us. Things went smoothly then.

We stop in front of the address  we had been given, pulling up behind Cranston’s engine company. The door is open, Christmas decorations litter the front yard, the job only half done.  I wonder who would finish my yard if I had to leave half way through.

I take a backboard from the rear compartment, Brian gets the blue bag and we enter the house. A fifty year old woman paces and pulls her hair with one hand, smokes a cigarette with the other.

“He’s in there,” she says. “Is he going to be alright? I was just talking to him.”

It’s the same crew. They have a defibrillator on him, it’s busy analyzing as I approach. The officer gives me the rundown; no cardiac history, was seated in front of his computer without a pulse when they arrived, two shocks delivered, CPR going , they were about to attempt a tube and IV when we showed up. I put the board next to the man, the crew gets busy. While I gather some basic information from the man’s wife the guys continue CPR, deliver another shock, secure him to the backboard and have him moving out the door.

He said he was tired, then he threw up. He was an insulin dependent diabetic and hadn’t taken his insulin yet. He came in from outside, went into the bathroom, then stumbled out a few minutes later and collapsed in his chair by the computer. I gathered his medications, found his date of birth and name and followed everybody out. The wife stayed, she was waiting for her son who would take her to the hospital.

One of the guys from Cranston drives our rescue, and one stays in back to help. The officer drives the engine. An IV is established, I don’t attempt the tube, a few rounds of Epinepherine and another shock enroute. The man is a fighter. He goes from asystole, to pulse-less ventricular tachycardia,  a few moments of pulseless electrical activity and then v-tach with a pulse.

The guys from Cranston hang around for a while, hoping for a good outcome. We managed to get a pulse, and he was breathing on his own when we arrived at the ER, but after two hours with the best cardiac team in the area his heart finally stopped. I didn’t find out until the next day when I asked one of the ER doctors about it. He gave me the whole rundown, he was quite a challenge for everybody. They thought they had him as well, only to have to let it go.

It was nice thinking we made a difference for once, too bad it didn’t last.  He was fifty-seven.

I hereby declare a state of emergency! Who am I to declare such a thing? I’m the person that answers the 911 call for these so called emergencies on a daily basis. I’ve seen the criteria for an “emergency” be cheapened to absurdity. We now provide a watered down version of Emergency Medical Services that is a ruse utilized by municipalities to shake down insurance companies, and state and federal government for compensation, and an insurance policy against a lawsuit happy populace looking or any and every angle to prove somebody other than themselves is negligent when an accident or illness pervades their lives.

We really do not “have to blame somebody.” Sometimes, there simply is no blame. Sometimes, everybody does all they can, and what is best for the community as a whole. Public Safety agencies are not foolproof. A certain amount of personal responsibility is required to exist. We pay taxes to provide emergency assistance when needed. How often, and for what end those agencies are needed is the question.

A Fire Department that provides Emergency Medical Services does so because the utilization of manpower already strategically placed makes perfect sense. Funding a fire department is not cheap, but the tangible results make the money well spent. Lives and property protected, insurance rates kept low and teams of emergency responders ready willing and trained to respond to any and all emergencies are what we expect. We get what we pay for.

The call volume on typical day for an ambulance in Providence, RI sends the crew to fifteen “emergencies.” A lot of the people who call need medical assistance. A lot of the people who need medical assistance need an ambulance to get them to an emergency room as quickly as possible. Most do not. An astonishing amount of people who call 911 do not need an emergency room at all. In some systems, 90% of the emergency calls are for non-emergencies. The insurance companies pay for these transports; those without insurance are billed. Low income people are either covered by Medicaid or Medicare, and the providing transport agency paid by the taxpayer.

As things stand, we are paying our highly trained personnel to give free rides to people who just cannot seem to let a good system go to waste. In their world, a resource is there for them to use because if they don’t, somebody else will. It is a pervasive attitude, one that is crippling what should be a highly efficient emergency response system. Fire Department budgets simply cannot sustain the added cost of more ambulances. Cities are sacrificing firefighters to staff ambulances. The safety of the firefighters is compromised; the effectiveness of the firefighting crew diminished and the taxpayer left with less protection.

But we send the rescue vehicles. Common sense is gone. Fear of litigation keeps the trucks rolling, and the money flowing. One missed call has the potential to cost the providing agency millions of dollars in lawsuit settlements. Instead of combating the fear of litigation with a common sense approach to dispatching crews, policy dictates we send crews to anybody who calls, for whatever reason. Once on the scene, it is up to the responder to decide whether or not to transport. That responder is beholden to the same fear of lawsuit as the municipality, and the risk is squarely upon him if he chooses to leave the person with the sniffles at home. It is simply easier to give in, put them in the truck and take them to the hospital. It is what the patient is used to, what they expect, and increasingly what they demand.

When you hear sirens in the distance, and pull to the side as the sound gets closer, and let the emergency vehicle pass, you are following the law, and simply being a decent person. The person driving the ambulance is required to run the lights and sirens during “emergency” calls. The person who is claiming to be having the emergency sits back, enjoys the ride and goes to the front of the line, where he thinks he belongs. Where he actually belongs is right back at home, drinking a cup of hot tea, maybe some chicken soup and taking some aspirin for his aches and pains. All too often a person having a “real” emergency is left waiting because the closest help is far away, catering to a person who thinks he is beating the system.

The system is being beaten, it is beating itself. While lawyers wait for somebody to die due to perceived negligence by an EMS agency that provides 911 service so they can prove negligence, true negligence is perpetrated thousands of times a day by citizens who have forgotten what it means to be a responsible member of society, and to let those truly in need go first.

In case anybody missed it, here is Chapter 1 of Night and Day. I’ve been challenged to get 1500 pre-orders before the publisher goes forward. As of now, just over 1000, and counting!

Getting Closer. Thank you!

Night and Day, the sequel to Rescuing Providence is tantalizingly close to landing a major book deal. Skyhorse Publishing, http://skyhorsepublishing.com/ is ready to move forward with the publication process, with a Trade Paperback to be released in the fall of 2011. I’ve spent the last six months in negotiations with Tony Lyons, the publisher, who agrees with my contention that books centered around the people who deliver Fire protection and Emergency Medical Services are not only of interest to those of us who do the job, but to the general population as well.

The publisher has one request before moving forward. An order for 1500 books.

I know a lot of people visit here, and am blessed with a core group of dozens of daily visitors and people who take the time to leave a comment. I believe in this blog, and the value it has in promoting Fire and EMS. Not everybody agrees with my style or opinions, and that is completely understandable; I sometimes can’t believe the things I do, but I swore when I started this to tell it like it is, because I believe in us, and though not perfect, I’m proud to be part of the community.

Bottom line…I need you! It took a long time to get somebody to take a chance on this book, the publisher of Rescuing Providence, who took a chance a few years ago and are happy they did is now focused exclusively on how-to books and military titles. They enthusiastically promoted the sequel, and remain good friends.

If you are interested in pre-ordering a copy, which I will gladly sign, mostly because I get an enormous kick out of doing so, please leave a comment on this post. Just your name for now, and a hello is always nice. I have no idea how to find anybody’s e-mail when they comment so you need not worry about my bugging you later. When I figure out how, I plan to move this post to the side bar, and continually update it. I should know by Christmas what, if any, demand will be.

That’s about all, not much else to say. I’m leaving the future of a manuscript that has sat finished in the bottom drawer of my desk for longer than I like to admit in your hands. It’s 70,000 words and 220 pages.

Here’s the first chapter.

Night and Day

I am the rescue guy. People call me during their worst moments. When things go badly I take them in, patch their wounds, calm their fears and help them breathe. I stop their bleeding and keep them alive. At least I try.  My time with them is short, usually ten minutes or less. In that period of time I learn a lot, and sometimes teach a little, but always leave with a better understanding of the human condition.

They think I help them, and I do to some degree, but more often than not it is they who help me. Every person who crosses my path teaches me a little more about things, some great, others small, but always something.

Chapter 1

Daylight. The blinds obscure the sun’s rays, but the dawn of a new day is impossible to hide. I think it’s about nine. If that is true I’ve been out for ten hours. From the look of the covers I haven’t moved much. Nothing like a thirty-four hour shift to put you into death sleep.

Cheryl made dinner for us, I remember eating, forcing myself to stay awake. I failed miserably at pleasantness; she must have put me back to bed after a little while. I tried to stay up when I got home but fell asleep while sitting on the couch. I snored for a few hours, according to all reports, but I’m sure the nature of the noises emanating from me is grossly exaggerated.

For years now I’ve worked the overtime between shifts. That makes a great schedule nearly impossible. Rather than two ten hour days followed with two fourteen hour nights, I now do two marathons, a thirty-four, twenty-four off followed by a thirty-eight. I’m headed for the thirty-eight in a few hours.

Why?

It started as a challenge. I enjoyed the chaos, the sleep deprivation, pushing my mind and body to the extreme, yet still performing. I think it was my ego that started the whole thing, I did it because I could. It’s difficult, and not many thrive, but I was one of the few that did. Or so I thought. It’s a simple thing to go to work, put everything else away and worry about only yourself. It has taken a while, but slowly I’ve learned that without everybody else, myself just ain’t that great.

Now, I’m stuck with the overtime. Circumstances change, needs arise, one thing leads to another and before you know it what once was a challenge becomes business as usual.

Nobody in bed with me, no cats no dogs no wife. Alone again. You get used to it. I’ve got Friday and Saturday night in the city to look forward to, and Saturday all day as a bonus. Thirty-eight strait, and I’m going in with one eye open. And leaving my family on their own again. Easter Sunday is coming, lots to do, not enough time to do it. As the day approaches the tension mounts. I know that somehow we’ll pull it all together, and we’ll have our holiday, and a great dinner, and somehow the manicotti will appear along with the ham and potato croquettes. I just hope I’m awake to enjoy it.

And so it goes…

You take all of your experience and memories with you on every call. What we present is the culmination of every one. The learning never stops, the growing never ends. My twenty-four hours is up, time to get back at it.

1630 hrs

“Bye, babe.  See you in a couple of days.”

“Be careful.”

I smile and walk out the door.  “Be careful” is the last thing I like to hear before heading into the city.  It’s been that way going on sixteen years now.  Maybe I’m superstitious but I worry if I don’t hear those words.

My bag is filled with the necessities; a few changes of clothes, a big bag of peanut M&M’s, a book, a few magazines and the usual assortment of overnight things.  I hang my spare uniform, still warm from the iron and smelling faintly of starch onto the hook in the backseat, open the door and get in.  With any luck in forty hours I’ll be right here again, worn out but satisfied, with four days of peace and quiet ahead.

I wave to Brittany as she speeds past me as I pull onto the pavement.  “Slow down,” I say out loud to the empty car.  It’s chilly, she’s wearing a winter hat, the kind that ties on the bottom and has earflaps to keep you warm. She doesn’t have a care in the world, and that makes me happy. I long for those days but for me they are gone forever. That’s probably a good thing, without worries we would have no experience of things to worry about and go through life thinking everything is fair and safe. It’s not, but at least for my kids it will be for a little while longer.

Traffic is slow and heavy, the streets and roads full of people coming home after a long week at work.  As I approach Providence the traffic clears a little, at least on my side of the road.  Most people are leaving the city. I’m going in.

About 180,000 people officially live in Providence, a lot more if you count the undocumented immigrants.  Thousands more commute from the neighboring cities and towns, spend their time in the Capitol City then leave for their suburban retreats.  I turn on the radio and check in on the local talk shows.  Nothing new today, high taxes, corrupt politicians, failing schools and on and on.  No mention of the firefighters.  The FM dial is a little more interesting, Blue Sky by the Allman Brothers sticks, I take my finger off the seek button and settle in.

I like to drive.  I find the routine, mechanical movements relaxing.  I know the road to work so well the car could drive itself.  It gives me time to think.  An incident from last week comes to mind, though I try to push it away.

It had been quiet for about an hour, the only sounds I could hear came from the open window of my office as the late night bar crowd straggled past the station on their way home.  A few drunken shouts, tires squealing, bottles breaking on the pavement as people cleared out their pre-club empties before heading home.  I turned the portable off, hoping to sneak a few hours sleep in before the next run.  It had been a long shift, thirty or so calls so far with six hours to go.  At one time most of my time was spent being on call, now, it seems all of my time is spent on calls.  Almost, but not all.  I hit the bunk and was out cold before my head touched the pillow.

0230 hrs

Rescue 5 and Ladder 4, Respond to 1 Providence Place for a woman who has fallen.

Ladder 4 was out of the building before I made it to the rescue.  Tim waited for me, the engine running. He saw me from the rear view mirrors and turned the engine over.  The piercing wail from the truck’s siren scattered the people lingering in front of the station as we rolled pat them, closing the overhead door behind us.   As we passed Water Place Park, the officer of Ladder 4 gave his report.

“Ladder 4 to Rescue 5, twenty-five year old female, fell approximately forty feet, massive head injury.”

“Rescue 5, received.”

I hung the mike back in its cradle and put on some gloves. 1 Providence Place is an enormous shopping mall located in Downtown Providence.  The building takes up four blocks of real estate, big enough to warrant its own zip code.  Tim made his approach, stopping behind the ladder truck, in front of the north entryway.  Most of the stores were closed at this hour.  A movie theater and restaurant occupied the upper levels and stayed open late. We loaded the stretcher with a long spine board and med bag and made our way into the mall.  A lone security guard stood outside the entrance.  I asked if he knew anything about the incident.

“Somebody fell.”

We walked past him, up the ramp toward the elevators.  The mall is a confusing place when shopping, worse when seconds count.  Overlooking the balcony next to the elevators I saw the guys from ladder 4 two floors below me, working on a young woman.  A dark shadow outlined her head.  We walked into the elevator car, stopped and looked at the buttons.

“LL, 1, 1M, GF, 2, 2M, 3L, 3, 4.”

“Which floor?” I asked Tim.

“First.”

I hit the 1 button and slammed my fist into the panel when the elevator started going up.  I was a little tenser than I realized.  The elevator wouldn’t stop until it made it to the first floor no matter how many times I pushed the LL button.  After an eternity it stopped, then reversed direction.  At 1M the elevator stopped again, the doors opening to an empty floor.  Gaining control of my emotions I pushed LL and felt the box begin its decent, agonizingly slow.  Finally, the doors to the elevator opened.

John Morgan, a truck mate of mine from another part of my career held the girl’s head in his hands while I tried to apply a cervical collar.

“It’s soft,” he said, cradling the back of her head while I wrapped the hard plastic around her neck.  I reached around back and felt the crushed skull, like jelly where there should have been bone.  I checked her pupils, shining light into her eyes hoping to see a reaction.  There was a reaction, though not in her eyes.  A sick feeling started in the middle of my chest and worked its way through my body.  “She’s my daughter’s age,” I said out loud.

“Fixed and dilated.” I stood and stepped back while the crew from Ladder 4 and Tim immobilized her, assisted ventilations and put her on the stretcher.  They had all been around long enough to know the girl’s chances for survival were none and none.  Off to the side a young couple and a solitary young man stood watching, ashen faced.

“Will she be all right,” asked the young guy who stood alone.

“We’re doing everything we can,” I replied, again, knowing that all we could do would never be enough.  The girl was gone; the best we could do was keep her heart pumping and hope for a miracle.  Somewhere, somebody waiting for a kidney or a liver just hit the lottery.  The thought made me sick so I pushed it aside.

“What happened?” I asked.

He pointed up to an area of escalators, three stories above us.

“She fell.”

The stretcher was moving now, a group of firefighters pushing the stretcher toward the elevator, bagging and picking up the mess we made with our equipment.  We all fit into the elevator.  As the doors closed the only thing that remained was a little Spider Man doll, tossed to the side of the floor, and a dark red stain on the mall’s new carpet.

“Slow down,” I said again, as much to myself as to Brittany.  I found out a few days later that the girl had planned on being married next month.  She was a single mother, for now, and was about to get a degree from a local community college. She was out celebrating her birthday.  She won the spider man doll at the nightclub where she spent her last night on this earth and planned on giving it to her four-year old son in the morning.  I hope somebody picked the doll up from the mall floor and gave it to its rightful owner.  Reading the obituary is worse than living through the experience, there is nothing to do but read about the person who died on your watch, and think about what could have been…

1707 hrs. (5:07 p.m.)

Friday afternoon.

I take the portable from Tim and get ready for a long shift.  I know that I’ll be working overtime tomorrow which means thirty-eight hours strait.  The radio comes alive.

“Rescue 1, Respond to 1044 Broad Street, nature unknown.”

“Rescue 1, responding.”

“Do you think it’s Junior?” Mike asks as we wheel out of the station and into the South Providence neighborhood.

“Maybe. Might be Darryl.”

“Might be somebody having a heart attack.”

“You never know.”

Junior and Darryl are two of our regular customers who haunt the 1000 block of Broad Street. A lot of homeless people linger in a field at 1035 Broad Street. It is a convenient location; a liquor store is on one corner, a convenience store on the other and a pay phone across the street. A typical day for these folks consists of panhandling money from the convenience store customers, buying a half pint of cheap vodka at the liquor store, drinking it, then stumbling across the street to the pay phone and calling 911 for a ride to the emergency room because they are intoxicated. It drives me crazy that they get away with it, but it works for guys like Darryl and Junior. These guys are survivors, whatever works.

The usual suspects are lined up on a bench next to the liquor store.  Five or six people have gathered there, Junior and Darryl among them. Mike stops the rescue, I lower the window and ask, “who’s going?”

“We’re all set,” says somebody from the crowd.

“Over there,” says Junior, pointing across the street.

A man in his forties stands outside a storefront clutching his chest, another man helping him stand. We open the back doors of the rescue, grab the stretcher and cross the busy street, dodging cars along the way.

“What’s going on?” Mike asks.

“His chest hurts,” answers the man who is helping the patient stand. We lay him on our stretcher and cross back to the rescue. Junior stumbles to his feet and opens the rear door of the rescue for us.

“Thanks, Junior,” I say to him as we lift the stretcher.

“You’re my boy, right,” he says, extending his hand to shake.  I take the offering then pat him on the back and step inside.

“I’m you’re boy, Junior,” I say and close the doors.

Our patient is around my age, healthy looking and in obvious pain.  He clutches his chest and looks around the rescue, frantic, while we get to work.

“What happened,” I ask him.  He doesn’t answer.

“He doesn’t speak English,” says his friend.

“Do you know what happened?” I ask the other guy.

“We were working in the store,” he says, pointing across the street at an empty storefront. “Ramon was sitting on the floor doing paperwork. Suddenly he grabbed his chest and said he couldn’t breathe.”

“What was he doing right before this happened?” I ask as Mike gets the leads ready.  I’m filling the reservoir of a non-rebreather, getting ready to put the mask over the patients face.  Supplemental oxygen is basic protocol but incredibly helpful to a person having a heart attack.

“We are getting ready to open a barber shop.  Just moving boxes and things.”

Rescue 1 is equipped with a Lifepack 10, which only lets us know a patients heart rhythm.  I spent weeks in EMT cardiac school learning how to analyze different rhythms and their underlying cause.  We practiced identifying and interpreting everything from a normal sinus rhythm, premature atrial contractions, paroxysmal supraventricular tachycardia, atrial fibrillation, junctional rhythms, PVC’s, V-tack, asystole and many more.  Mike has finished connecting the leads, runs a strip and hands it to me.  I look it over, analyze the p-wave, QRS complex and elevated t-waves and give my diagnosis to Mike.

“He’s fucked.”

I’ve narrowed all of the rhythm’s I learned in school down to two.  Fucked and Not Fucked.  This guy is fucked. ST elevations mean a myocardial infarction, or death of the heart muscle. Every second we spend on the street means loss of heart muscle. “Get an IV and go,” I say to Mike who has already started looking for a vein.  I give the patient four baby aspirins to chew or swallow, then a nitroglycerine tablet to place under his tongue. Oxygen, EKG, Aspirin, IV, Nitro and Go is the best course of action here; we finish our tasks and are moving in less than five minutes.

Rhode Island Hospital is only two and a half miles away. I pick up the phone and let them know we’re coming in.

“Rhode Island ER,” answers Gary from the triage desk.

“Providence Rescue 1, forty year old male, possible heart, elevated ST’s, pulsox 88 on room air, 180/110, IV established, 10 liters 02 by mask, aspirin and nitro on board, ETA two minutes.

“See you in two.”

I get the patients information from his friend and business partner during the short trip to the ER. Both are recent immigrants who plan to open a barbershop on Broad Street. My patient is holding on, the nitro and oxygen helping immediately.  Mike backs into the rescue bay and opens the rear doors and we wheel him in.

Gary waits at the door and leads us to one of the trauma rooms. A medical team is in place, another IV started, a 12-lead EKG run and meds administered through our IV line. Gary signs my report and we back out of the room, letting the best medical team anywhere take over his care. Ramon’s friend waits outside the trauma room. He stops us, shakes our hands and gives us a very sincere thank you.

Before we leave the ER Ramon is transported to the cath lab. There blood flow to his heart will be restored using the most advanced medical technology and procedures to be found anywhere in the world.  I stop and look around the ER, take note of the dozens of people seeking medical care and the people there to give it to them. It looks like and sometimes is absolute chaos but shining through all of that is the ingredient that makes me come back day after day, week after week and year after year. The people I work with make this the greatest job in the world.  The firefighters, EMT’s, housekeepers, nurses, technicians, secretaries, security and doctors all make me proud to be a part of this. Even Junior has a part.

“Still want to go to Engine 15?” I ask Mike as he puts the truck back together and I finish my report. We’ve spent the last three years working together, Mike and I. He’s ten years younger, full of wit and sarcasm and a seemingly inexhaustible supply of energy. I see more of him than I do my family. During our previous shift, Mike told me he plans on transferring from Rescue 1 to Engine 15. Life on the rescue beats you down if you let it, Mike has had enough. I have no idea how I manage, necessity, I guess.

“If all the calls were like this I might change my mind,” he says as he hangs an IV set-up in its place over the stretcher. “That guy was having a heart attack!”

“He still is but it looks like he’ll be all right.”

We finish our tasks and get ready for more. I take the mike out of its cradle, hold it in my hand for a while, and then press the key.

“Rescue 1 in Service.”

Thank you for considering pre-ordering a copy.

Michael Morse,

28 Nov 10

1815 hrs.

There they sat, the nurse and the patient, in a parking lot within eyesight of their destination.

“What’s the matter?”

“She has back pain.”

“Why didn’t you take her to the hospital?”

“She needs to be seen right away.”

“It doesn’t work that way.”

“Don’t tell me, I used to work in the ER”

“Then you  should know better.”

“She feels dizzy, too”

She did know better. Silly me.

Somebody had unlocked the door at the street level, two doorknobs and a deadbolt. We walked the stairs, another unlocked door with double locks waited. I knocked, a voice from behind the door welcomed us in.

She was on the couch, next to the door, dressed in a coat, wearing gloves. It was freezing in her apartment, which held the couch she lay upon, two chairs that didn’t match but were in good shape, an old color television, funny how big they look now that flat screens have invaded everybody’s homes, a newer DVD player sat on top of that, and a modest dining room set.

Nothing hung from the walls, no pictures of family, favorite prints or anything. The place was immaculate. A fine lace tablecloth covered the dining room table, and a matching one sat atop a little table in front of the couch she occupied.

“What’s wrong?” I asked.

“You see the table?” she asked, pointing toward the dining room. I noticed it leaned to one side.

“Last nigh I fell on dat table and it pushed to da side, my back is hurting something terrible”

Her voice had a lyrical quality to it, beautifully spoken, almost like a song. I didn’t tell her that, I did once a long time ago and the Nigerian people I told  thought I was making fun of them.

We helped her to the truck and started toward the hospital. I asked her the usual questions, one answer stuck out, she had an allergy to  chlorine.

“Chlorine?” I asked, having never heard of that allergy before.

“It’s for the Malaria,” she explained.

“Did you ever have Malaria?” I asked. I never knew anybody who did.

“I did and it’s awful.”

She came from Gabon, Africa. It’s a small country, beautiful, she told me, nestled between Congo and Cameroon, on the South Atlantic coast.

“It’s much warmer there.”

Before long we were at the hospital, but not before she insisted to make us some Jollof Rice someday, to thank us.

I think there are sixteen floors, I can’t remember. It’s one of the older housing units in the city, a recent makeover helped but it is tired. A lady called from the seventh floor, history of COPD and a multitude of other health issues. The call was dispatched as an ALS run, Engine 3 and Rescue 5 to respond. My overtime shift at R-5 was nearly over, what was the worst that could happen?

Ladder Company 1 was on the air at the time and took the call for Engine 3. They arrived on scene, took the elevator to the seventh and did an assessment of the patient. She was a sixty-six year old, complaining of increased shortness of breath which started a few days ago. She was wheezing, with some jugular vein distention and really struggling, SPO2 in the low nineties. The guys from Ladder 1 put her on 02 and started to get some vital signs.

Rescue 5 arrived on scene, gathered our gear and headed for the lobby. I opened the outside door and was greeted by a frantic maintenance man.

“There’s heavy smoke in one of the apartments!”

“Pull the box,” I told him, noticing that the fire alarms had yet to be activated. I radioed fire alarm and gave a preliminary size-up, report of smoke, location to follow, box manually activated.

“What apartment?” I asked the maintanaince man.

“205.”

“Is there anybody in the apartment?”

“I don’t know, the smoke is too thick.”

Great. People were milling around the lobby when the fire alarm finally activated. Rather than making a nice evacuation, they pushed the elevator buttons, angry that they were disabled.

“What’s wrong with the elevators?” they asked.

“Fire alarm. Everybody out!” I said.  I was the Incident Commander after all.

They either stood there, pushing the elevator buttons, or headed for the stairs. Nobody evacuated, or even considered it.

I’m now the Incident Commander at a high rise fire, The EMS sector of pre mentioned fire, stranded below the fire floor with inactive elevators and a patient in possible CHF on the seventh, and a crowd of unruly residents.

What’s the worst that could happen?

John, my partner for the day took to the stairs with the med bag while I stayed in the lobby. Ladder 1 had the patient stabilized, and sent half of their four man crew down the stairs to investigate the fire. A heavy smoke condition was declared, fire in Apartment 205.

The first fire companies arrived on scene, I gave the chief a brief size-up, then commandeered some elevator keys from one of the guys and activated one of the cars, taking it above the fire floor toward the victim I was aware of. In the meantime, The fire was extinguished before it could really get going, thankfully nobody was in the apartment, and John had made it to the patient on the seventh floor.

We packaged her up, calmed her down,  made it to the elevator, to the lobby, past the firefighters and into the rescue, back where I belong.

God I love this job!

Overheard in the back of Rescue 1…

Lt: “You can’t call us every night, go to a shelter!”

Homeless Man: “They don’t have what I want there.”

Lt:  “And what could that possibly be?”

Homeless Man: “Open Bar. And lots of broads.”

Lt:  “You know The Hospital Hotel costs $1000.00 a night.”

Homeless Man: “I got insurance.”

Lt:  “Yeah. Me.”

Homeless Man: “No, not you. The government.”

Lt:  “I am the government.”

Homeless Man: “Then why don’t you get open bar and broads in the shelters?”

Homeless Man – 1

Lt -  0

She reached into her purse, dug deep and found what she was looking for.

“You’ve been very nice, I want you to have this.”

I looked around, made sure nobody was looking and conspiratorially took her offering.

“I really shouldn’t, we’re not supposed to take gifts.”

“You deserve it,” she said, then went to sit next to her ninety-three year old sister, who we had just brought in. Another sister stood nearby, watching everything.  We had just left their house, the one they had lived in since birth. Their father built the place, in the North End, back when the family garden took up two lots. Now, those fertile fields are filled with more houses, and more people, most of whom don’t give “the old ladies” the time of day.

“Make sure you give some to the other man,” she said. “He was nice too.”

Back in the truck we split up the bounty. There were five altogether, I took three and gave John two. Rank has its privileges.

Peter Canning, http://medicscribe.com/2010/12/night-and-day/a Paramedic whose work I’ve admired for a decade, then Kelly Grayson http://ambulancedriverfiles.com/2010/12/night-and-day/ have both written posts not only supporting my book, but also offering some pretty nice compliments to boot!  Burned Out Medic, http://burnedoutmedic.com/2010/11/night-and-day-by-michael-morse/ put up a post which helped spread the word as well.

A person needs mentors to succeed, in just about every aspect of life. Peter and Kelly were there before I started my blog, and provided a lot of the inspiration for Rescuing Providence. Having them take the time to recognize my own work is quite simply, amazing. Burned-Out Medic, and Greg Friese http://medicalauthorchat.com/ who has invited me to appear on his show, Medical Author’s Chat are among the many great people whose web presence I’ve just recently found.

Success is a funny thing. Right now, I feel like I’m on top of the world, at least in my writing endeavors. But I always keep in mind how quickly it could all go away. Writing a blog on a daily basis is like walking through a minefield. At any moment, I could write something that violates patient confidentiality, or some hotshot paramedic or instructor could read one of my more honest posts and decide to put an end to things by making life difficult. It happened to Mark, at Medic 999 http://999medic.com/ . Some bloggers do so anonymously, Insomniac Medic being one of the best. http://insomniacmedic.blogspot.com/ The Happy Medic revealed his identity last year, and the entire EMS world is a better place for it. http://happymedic.com/

Come to think of it, just being in the Emergency Medical Services is quite a risk. The calls alone are potential disasters. Even when we do everything right things don’t always end up the way we would like. People die on our watch, and that is a difficult thing, no matter how many years you have done this. Then there’s the boring routine, which takes up more than 90% of our time. Staying sharp and focused is a daily battle. It only takes one second and all is lost. One bad move, a dumb mistake and our career is over. I’ve seen it happen too many times, and read reports of it far more.

But for now, everything is right in my world, and I plan on savoring every second. The list of people in our field, EMT’s Paramedics and Firefighters that took the time to leave a comment and offer support has made all of the risks well worth it. I’m nearing the end of a twenty year career in EMS, and firefighting, and to be able to come to work every day knowing I have the support and respect of so many is humbling to say the least. It is my honor and privilege to tell these stories, and have people not in the trenches with us get a more clear idea of what we do, and how we do it. Each and every one of us has strengths and weaknesses. Half the people I work with are better medics than I am.  I was blessed with a knack for writing, and I will continue to do so for as long as you folks have my back.

Oh, and as of this writing, between here and some book stores I’ve managed to get nearly 900 copies of Night and Day committed to.

Who’s better that Us!

http://www.youtube.com/watch?v=3f-mzWy-lT0&feature=related

Rest in Peace, Hamada.

A car full of kids and their mother crashed into another car full of kids on a side street in Providence. We arrived, found one car pushed into a fence, air bags deployed, and the mom and her five children out of the vehicle, talking to some neighbors. The other car had fled. The occupants denied injury, a quick assessment confirmed that. They were good people, coming home from a day of Christmas shopping.

As we prepared to clear the scene, I noticed a person three houses away waving us down. We took the rescue to that location and found the other car, hidden in the back driveway. The driver had run away, and left three kids, six months, a two and a three year old with their mother, who just happened to live at the house with her mother. The guy did manage to take the plates off the car before he fled.

The grandmother wanted her kids “checked.” I spent about three minutes in stunned disbelief, amazed at the audacity of these people, completely ignorant of the law, common decency or the rules of civilization. The way I saw it, they were responsible for a hit and run accident, and refused to take responsibility for their actions, and with no regard for anybody but themselves then wanted their kids taken to the hospital for something they caused. There were a few cop cars, a crowd of onlookers, a crushed fence, firefighters-complete chaos-and a disgruntled rescue Lieutenant pacing back and forth trying to make sense of it all. My anger may have gotten the best of me, I don’t know, I was angry at the time.

Then, in a moment right out of The Grinch, Little Cindy Lou Who appeared in the doorway of the house. She was crying uncontrollably, and nobody even looked at her, all alone in the middle of a nuthouse.

The Grinch’s heart grew three times that day.

Everything stopped, in my mind anyway, and I walked past the people insisting we take their uninjured kids to the hospital and held out my arms. And she came to me, and I lifted her up, and held her,then sat on the top step and let it all go.

I wasn’t much older than the girl in the picture when I first saw it, and the image has been etched in my mind ever since. Kids stuck in the middle of madness not of their own creation, their personalities, values and future altered by things out of their control. I couldn’t help that girl, and have always wished that I could.

It’s three in the afternoon in Providence, sunny, a little cold, a few weeks before Christmas. For me, this was a magical time, days spent looking through the Sears catalog, making a list to send to Santa, writing dumb little Christmas stories, drawing pictures of reindeer and cutting little designs from the colored construction paper at my grandmothers, making holiday things to hang on the fridge. My favorite time of day was dusk, when somebody had to turn on the window candles. I loved that job, we used orange bulbs, and the house simply glowed. Add the colored lights from the Christmas tree and it was pure heaven.

Cindy Lou Who wasn’t in heaven. She was in a doorway, alone and crying. Cops and firefighters were everyehere in front of the house, the car she had been in a few moments ago stashed behind it, the alleged man of the house on the run and her guardians acting like a bunch of fools. But while we sat on the top step, and she stopped crying, and I stopped spinning, everything was alright.

We loaded the kids and their mother into the resuce, took their vital signs, had a little fun and took them to the hospital.

I think the Providence Fire Department’s Santa Express might have another stop on their annual Christmas foray through the neighborhoods.

It’s Saturday Night, big city. Gunshots echo through the alleyways, people are beaten, robbed and stabbed. Our victim is on the third floor parking garage at the downtown mall, outside Dave and Busters, an amusement themed restaurant and video game arcade. The police have been dispatched but have not yet arrived to secure the scene. I’m on their channel, listening. It’s two am, the bars are out, drunken revelers join the hoodlums as Bedlam takes over. More shots fired, a brawl erupts behind a nightclub, sexual assault in the West End. Mayhem.

The cops arrive, we follow them in. It takes a while, the elevators are slow. All the way up the radio continues its chatter. They get to the stabbing victim first and assemble some facts. The radio sparks:

“Twenty year old male stabbed in the abdomen,  have the rescue expidite. Be on the lookout for six males heading east on foot, mixed race, early twenties, most dressed in hoodies, one carrying a large stuffed animal.”

It takes a hard hearted criminal to hold onto the giant Tigger with one hand and a murder weapon in the other.

Our victim survived. The Tigger weilding assailants are still on the loose.

I’ve been sitting in front of this keyboard waiting for something clever and witty to pour out. Sometimes I’m just not that clever. Or witty. Sometimes honesty is the best way to go, and sincerity, and gratitude.

I’m honestly, sincerely grateful to everybody who replied to my post, http://rescuingprovidence.com/2010/11/28/night-and-day-2/ concerning the new book. The response was overwhelming.

I have this dream that I’ll leave this job in the near future, my back just won’t hold up much longer and my insides are pretty much chewed up from all the ibuprofen and meloxicam, and write things to supplement my retirement. Every comment brings that dream closer to reality, and gives me the confidence to go forward.

Now, back to the story…I just have to wait for something blogworthy to happen.

We get so wrapped up in the minutia, our everyday routine, our difficulties, disillusionment and simple exhaustion that the big picture is often overlooked.

The drunks that will freeze to death if we don’t peel them off the sidewalk.

We are all they have.

The little old ladies that drive us crazy at two in the morning with, “chest pressure.”

Imagine sitting, alone, with no hope of anybody coming over until the weekend, and that’s a long shot, and looking at the medic alert alarm that your family set up for you so they could sleep at night, and feeling something strange in the middle of your chest, and hoping that it goes away by morning, but honestly-how many more mornings can you expect at eighty-eight years old…

We’re all they have.

The guy at Dialysis whose blood pressure dropped dangerously low.

Three days a week for four hours he sits in that chair, bored, sleeping, annoyed and anxious. The lady at the center tells him his pressure is dangerously low. In his mind, that means many things. Possibly the end of the road. He waits there, and the people from the ambulance show up. He may or may not know them, but they treat him nice, and take care of him, and bring him to the ER, where more needles and things await.

We could be the highlight of his day.

The lady who cracked up her car and “wants to be checked.” You know, and I know that in all probability there is nothing wrong with her. But, and and it’s a big but, she doesn’t. We do this for a living, and see more in a day that she does in a decade.

She’s counting on us.

I’ve become so cynical that sometimes refer to patients as “Them,” and us as, well,  “Us.”

A lot of people are counting on us. The people who call don’t care about our day, or our lousy pay, or excessive overtime, or the crummy truck and cranky partner. They care about one thing at that moment, and one thing only. They are worried about themselves. And when we are with them, that is all we should be concerned with as well.

Now and then I need to remind myself that without “Them,” there is no “Us.”

It really is all about “Them.”

The baby was only days old, and a few weeks premature to boot. Her mother handed her to me, and let me carry her down the stairs and into the rescue. She had spit up, then choked a little. The mother panicked and called 911. I tried and failed to convince the mother that this is nothing new, and her daughter would be fine. She didn’t buy it, so off the the hospital we went. I must admit, though the trip to the ER was a bit unnecessary I didn’t mind a bit, newborns have a way of melting the most hardened heart.

The next infant was only a few months old. She had been fine all day, but suddenly started to seize, with no prior history. She was still seizing when we arrived. Chris from Engine 13 established an IV and got some Tylenol on board, Ryan manned the 02, Brian got the vital signs and I wrote it all down and called the ER while Mom watched, and cried. There is no mistaking a postictal infant, their color is all wrong, they don’t respond to anything and they just are entirely helpless. Job satisfaction comes in tiny packages, Little Johanna was pink, and crying by the time we arrived.

Another newborn didn’t fare so well. She was born at home, then stuffed into a plastic bag and tossed under the bed. Her mom went to the hospital because she was bleeding heavily. And the infant lived and died all in a matter of minutes under the bed in a tiny bedroom in a triple decker in South Providence.

http://www.projo.com/news/content/INVESTIGATION_01_12-01-10_DVL81LQ_v6.396c633.html

“Who’s that?”

“It’s Bumblebee.”

“What’s he do?”

Nathan looked at his toy, twirled him around, tipped him upside down and frowned. Then he held him horizontally and said, “he flies.”

“That’s it?”

“He shoots things too but I lost the bullets.”

“Cool. Where did you get him?”

“McDonald’s.”

I couldn’t tell if his mom was strung out on heroin or high on crystal meth. She sat next to her son on the bench seat in the back of the rescue, bouncing around, never making eye contact, anxious one minute, crying the next. When I asked her her name Nathan answered. When I asked her date of birth, Nathan answered, where they lived, Nathan answered, never taking his eyes off of Bumblebee.

They had been parked outside of a house in South Providence for over two hours. Neighbors notice things like that, especially when the mother continually gets out of the car and bangs on the door of the suspected neighborhood drug dealers. They called the police, who called us.

The plan was to remove the mother and son from the scene, bring them to the hospital, notify DCYF (Department for Children, Youth and Families) get the mother a psychiatric evaluation and drug screen, then detox and place Nathan in temporary foster care.

Every now and then there would be a love fest in the back of the rescue, when mom remembered her son, then she would go back to her crying and self pity, and Nathan back to Bumblebee.

When they took mom away, Nathan didn’t look twice, his eyes focused on his toy, imagining some heroic Transformers mission.

He didn’t have any bullets, but he could still fly.