She showed up an hour after the shooting and left an hour before the mass casualty and fatality on the highway.  She’s considering pursuing a career in EMS, and needed ride time.

Our first call with her on board was for an intoxicated male on Pine street. We found him sitting in a doorway, empty fifth of vodka next to him. As far as street bums go, he was one of the better ones. He was polite, and actually managed to flirt with Ashley. As he tried to stand, he stumbled, and his bag opened, spilling hundreds of condoms onto the ground. “I”m HIV+, he explained, stuffing the things back in.

We took him to the hospital, and before we left answered another call for another intoxicated male, this one at a pay phone on Broad Street.

“Oswaldo” stood next to the phone, holding it to keep from falling. Usually animated and affable, today he was soaking wet, depressed and freezing. His New York Yankees cap hid his eyes until he sat on the bench seat, shivering, and looked up. Right at Ashley.

“I’m so cold,” he said, and tears streamed down his face, and he curled up in a ball, and lay on the bench as I covered him with some blankets. He stayed there, on the bench during the ride, shivering, saying how he didn’t want to do this anymore, and begged for help. His despondency filling the little space, transcending the air making it impossible not to feel his despair.

We spent some time back at the station, Ashley was quiet, introspective, I think. Mike showed her the truck, and went over the equipment and meds and talked about the shooting and how she just missed a “good one.”

An hour or so later a twelve year old called 911 because his grandmother had fallen. We arrived on scene to find an intoxicated fifty-five year old lady, nearly incoherent and highly volatile who was entrusted with her two grandchildren for the night. The eight year old cried as her grandmother yelled at us, and tried to get us to leave her house. The boy who called hid upstairs, a little more aware of what was going on and embarrassed.

We contacted the kid’s father, who showed up fifteen minutes later and took the children home. We took Grandma to detox. Ashly stayed quiet, taking it all in. The atmosphere in the house was oppressive while we waited, the little girl was brave as she tried to console her inconsolable grandmother who sobbed, and moaned, and shrank into her couch.

An hour after that a call came in for a man unconscious in his car. We arrived, and quickly discovered that he was not only unconscious, he was also dead. Ashley stood to the side and watched. Running a code in the streets in nothing like anything an eighteen year old EMT student has ever seen, absolute chaos to an inexperienced onlooker, just plain old chaos to those doing the job.

The man died eventually, but we considered it a “good job.” We found a pulse less, asystolic man dead in his car and delivered a pulse less man with a treatable rhythm to the ER, IV’s going, intubated with narcan and some cardiac drugs on board. Excellent CPR was performed in the field giving him a chance of full recovery if the ER team got his heart going. We difibrillated three times- if he didn’t come back the outcome was out of our hands long before we had arrived.

I know this, and most of the people who worked on him knew this, I wasn’t so sure about Ashley. I remember my first encounter with the death of a patient. I thought everybody survived until then.

She left at around 0200, smiled bravely, said thank you and drove home. An hour later all hell broke loose on the highway.

“Too bad Ashley missed the good ones,” said Mike, who just so happens to have a black cloud firmly attached to him around every time I work with him.

She did see the good ones, I thought to myself. The shootings and catastrophic wrecks  don’t tell the true story. I knew what Mike meant, but think Ashley benefited far more from seeing the the day to day misery we encounter that chips away your morale and leaves disillusionment in it’s wake.

EMS is a difficult road, one with more hidden potholes than people new to it could ever imagine.

As my partner worked to establish an IV, and the police fanned out looking for the gunman, I searched his body for more bullet holes, the ground was littered with 9mm casings.

“Buddy, how many times were you shot?”

He raised an eyebrow, considered this question, furrowed his brow as he thought. Then he looked me in the eye, grinned, and said:

“This is my first time.”

A guy opened his window when he heard somebody banging on the glass. The person banging on the glass opened fire. He was shot, and is now in the OR.

A fifty eight year old man stopped at a red light and never moved again. We worked him for a while, got a rhythm, but it didn’t last. He died.

A lady swerved off the road, sheared off a fire hydrant at its base, then sheared off a wooded telephone pole at its base.  She lived.

A woman got on the highway going the wrong way.  She hit three cars, critically injuring four people. Then she died.

As bad as it was responding to these calls, I’d rather be me, going home.

Overheard in the front, after another run. New guy on board

“How come everybody at the hospital likes you?”

“First, not everybody likes me.  But they don’t dislike me either. It’s not that hard, and anybody can do it, even you. They don’t care if we are good looking, we’re not. They don’t care if we’re funny, we definitely are not. They don’t care if we are clever, or brilliant, or bring them coffee, but that doesn’t hurt.  They’re really not all that interested in our interpretation of the 12 lead, or our opinion on how to treat the patient once they sign off.  They  want  somebody who gives a good, clear and concise report, and does an IV when it’s needed, and follows the protocols. Competency is more important than personality. And be consistent, and don’t be miserable, there’s plenty of that, you don’t need to add to it. Do that and you’ll be fine.”

“That’s it?”

“One more thing. Treat your patients well. Show them respect. Bring them a blanket now and then. Know the patients name when you give the clear concise report. That above all else is what they notice.”

“Really? That’s it?”

“That’s it.”

I’ve given the “That’s it” speech often over the years. Some of the people I’ve given it to even listen.

It’s the top of the second, I’m hitting clean-up. Three up and three down in the first. The patient is a tough kid, nineteen years old and having an allergic reaction to peanuts. She’s really struggling, panicking, and her throat is about to close. The pitch comes in, I take a big swing and hit her with .3 mg of Epi. A minute later the crisis is over, she’s breathing easier. An IV and some oxygen and we’re on our way.

Single

Forth inning. We’re down a run. I step up to the plate, the pitch comes in. A diabetic this time, blood glucose 22. He’s out cold, lying on the floor of his bedroom, his wife looking on, concerned. We start an IV, administer 25 grams of D-50 and he’s back in the game a few minutes later.

Double

I’m up again, seventh inning, still down by a run. A heroin addict overdid it, he’s in the drivers seat of an old Chevy Impala, barely breathing, ready to code. A few balls come by, I take them. The next one is right down the middle, 2 mg of narcan, IM in the triceps. He’s up and at em in less than a minute.

Triple

Ninth inning, tie game, two outs, nobody on. This time it’s a forty-five year old whose heart is beating at 220 beats a minute. I tap the bat, take a few practice swings, get the Adenosine ready, then the 20 ml saline flush. It’s a curve, I take a mighty swing, push the 6 mg quicker than the eye can see, then follow through with the flush. The ball takes off, the rhythm on the monitor staggers, slows and goes flat. A few moments later it starts again, and resumes a normal sinus rhythm.

Home Run!

Epi, D-50, Narcan and Adenosine, all in a nine hour shift. In all the years I’ve been doing this its the first time I’ve ever hit for the cycle.

Some days are just better than others!

If you get sick of my ramblings, (and who wouldn’t, I’m actually sick of myself) give The Insomniac’s Guide to Ambulances a try, if you haven’t already.

http://insomniacmedic.blogspot.com/

Of course, his last post linked directly here, but dig deeper, and you will find some of the best writing about our proffession out there. Plus, he comes from Great Britain, and it’s amazing to read how similar people are, on both sides of the flashing lights, no matter from where we come.

10 Questions before dialing 911:

The people who bring you 911, in an attempt to streamline and improve our public service commitment have developed the following questionnaire. Please post in a conspicuous place, preferably next to the phone. In the event of a true emergency, disregard this, and CALL 911!

One or more “yes” answers means DON”T CALL!

10- I don’t have a ride

9-  I get in faster if I go in the amb-u-lance

8- They let me lay down while we drive

7- I’m “not sure” if I’m bleedin

6- I just want to be “checked.”

5- Pretty lights and sirens make me happy

4- I need the stitches out-cast off-wrapper unwrapped

3- My ‘pointments at ten, the ER will give me a pre’pointment

2- I “think” I’m shot

and the number one clue that you probably didn’t need to call 911

1- “I ain’t going to “that” hospital. Take me to “this” hospital or I ain’t goin!

Strange days are upon us. I’m with the workers.

http://www.dropkickmurphys.com/2011/02/22/take-em-down-the-dropkick-murphys-stand-with-wisconsin/

Seventeen years ago he was shot in the back of the head during a carjacking. He recovered, got married and got on with his life. Today, things caught up, he developed a severe headache, blurry vision, then started to seize, then lost control of his bowels. He tried to speak but could only slur. We managed to wrap him up in blankets, tie him to a stairchair and get him into the rescue. His wife came along, and worried, and tried to help. He had been working on a car in his driveway yesterday, but had to stop because he didn’t feel right.

We got him to the ER, where he started to talk. He repeated the same thing over and over, then shouted a name, then emphatically tried to talk his way out of his restraints. He shouted the name again. There was a cadence to his words, a meaning that only he understood. It wasn’t English, or Spanish, or Portuguese, or Russian. It sounded ancient, perhaps a long forgotten language that was stored in the 90% of his brain that under normal circumstances would never be tapped.

The more I know, the more I realize how little I know. He’s getting an EEG, Ct Scan and probably an MRI, and we will learn nothing from those tests I’m sure.

Thank you for all the comments yesterday, greatly appreciated and a big reason why I continue this blog. It’s all good. A little hairy now and then, but good.

Twenty years ago I thought I would do this job forever. I had a dream, work in Providence till I was sixty and they threw me out, then move to somewhere where they have a volunteer fire department and put my experience to good use. The department offered a 50% pension after twenty years, we contribute 9 1/2 % of our pay toward the fund, the city contributes the rest. “That’s nice,” I thought, never considering I would actually leave after twenty.

Time marches on, and twenty years passed in the blink of an eye. The person I was when I started is long gone, a different, more somber, at times cynical person has taken his place. People who walked in my shoes fought for the twenty year pension deal, knowing from experience that twenty years in firefighter time is a long, long time. They knew, as only one who lived the life will ever know, that for some, twenty years is enough. They knew that at forty-five or fifty, starting a new career is not that easy, or starting a business when everybody else had a twenty year head start challenging to say the least.

I remember sitting in at a critical incident debriefing a few hours after I held two dead infants in my arms. My latex gloves melted into their skin their bodies were so hot as I tried unsuccessfully to revive them with my new CPR skills. I bagged the one year old – Savannah was her name I found out later, while doing compressions on the other, John. It was rough, but it was what I had signed on for. The guy that brought the babies from the fire to me was a twenty year veteran firefighter, a tough guy by all accounts. When it was his turn to speak he filled with tears, and couldn’t. He hung his head and valiantly tried to express his feelings, but couldn’t. He left the room. A few months later he was gone. Retired. He told me much later that it wasn’t necessarily that call that did it, it was all the calls leading up to and including that one that finished him. He simply could not do it again.

I should have learned a lesson that day, but mired in the arrogance of youth I hadn’t lived enough to sense my own frailty. I was invincible. I thought of him the other day, as I drove home from what I thought was an unremarkable tour. As I neared my street, I thought of the little girl who claimed to have injured her knee and refused to move from the gymnasium floor. Her mother looked on from a distance, annoyed as I tried to figure out what was wrong. No bleeding or deformity, swelling or anything really. She showed me her other knee as a comparison, and I noticed bruises, weeks old on both legs, and both arms, and a haunted look on her face. I let it go, we can’t save everybody, and she probably is just an active kid who bruises easily. Or not.

I turned onto my street, and had to stop the car. Where was the little girl now? Was she home, in her room, reading or watching TV, or was she being punished for being a crybaby, like the kid a few weeks ago whose mother called us because her son “fell” from his bed. Fell and had severe head trauma and curling iron burns on his legs.  It took ten minutes for me to pull myself together before I could walk in my door and not bring twenty years worth of memories with me.

I haven’t been sleeping. It’s been going on for months now, every night that I’m home I’ll go into a fitful slumber around midnight, only to be fully awake at around two. I toss and turn for hours, finally getting some relief from my spinning mind at sunrise, only to be back up an hour later. I grab an hour here and there as time permits but have no idea what a full nights sleep feels like, unless it is drug induced, but I try to avoid that.

What runs through my mind is probably similar to every other person my age, are the kids really okay, will the bills get paid, am I truly happy or is this just an illusion, is that spot on my back the cancer that will kill me or just a mole. Then I get the ghosts.

-the baby that was run over by the eighteen wheeler as it turned the corner on North Main and Doyle, dead in the middle of the street, the baby carriage twisted and crushed one hundred feet from the body

-the guy that was buried alive at sunset on Dorothy, and his lifeless arm that was the first thing we dug up

-the twenty year old guy and his twenty year old friend, dead in the front seat of their Mustang at the Atwells Ave off ramp

-the fifty-five year old guy who was new at motorcycle riding who tapped a rear view mirror, lost control on 195, flipped over the jersey barrier and was crushed by a Toyota Camry full of kids. We found his foot later, still in his boot

-the eighteen year old tattoo artist found hanging in his basement by his roomate

-my friends brother found hanging in his bedroom closet

-a RISD student found hanging from the wrought iron fence at Prospect Park

-the kid found hanging off the side of his house on New Years Eve

-the fifty-five year old who told his wife he was going golfing, started his car, didn’t open the garage door and died next to his clubs

-the forty year old who held up traffic while he considered jumping from the overpass, then did as the crowd that had formed cheered

-the college kid who fell eighty feet to his death the week before Christmas

-the baby who rolled himself into his blanket and suffocated, while his dad was napping on the couch

-my friend Kenny who had a heart attack at his third building fire of the day, and had to be defibrillated, and came back to life but not the job

-the seventeen year old girl who bled to death in the front seat of a car that had struck a tree while eluding police as her friends picked her pockets of the crack vials they were selling

-the baby born dead and put into a hefty bag

-the woman dead in her kitchen with a bullet hole in her forehead and her three children sitting on a couch in the next room

-the two babies that broke the veteran firefighter

-the eight year old deaf girl who broke my heart when I learned she had been prostituting for her foster parents

–the twenty-year old dancer dead in her car after taking all of her pills, and the vomit covered note on her lap

-the family dead behind the front door as the fire burned out of control behind them

-delivering a baby in the back of the rescue and having the mother yell get that fucking thing away from me when I handed it to her

-watching blood gush from a hole in a man’s head while doing compressions

There are dozens, hundreds more, all waiting for that delicate twilight between sleep and consciousness to come uninvited into my mind. More join the parade every day that I come to work. Just this week a twenty three year old hit and killed while waking home from a nightclub, a thirty year old guy shot in the head, back and legs who walked to the rescue then collapsed.

I am not a machine. I am a simple person who signed on to do a job, and have done it well. If I choose to leave this year, I will do so with my head held high, regardless of what the Republican and Conservative movement has to say about us greedy union pigs who are taking from the children to fill our pockets.

She sat on a stool by the back door of a downtown restaurant, holding her head in her hands, rocking back and forth, nearly toppling the stool.

“What’s the matter?” I asked the crowd that surrounded her, all kitchen help from the look of their whites. Some had checkered pants, some plain white. A few wore chef’s hats. Samantha wore a do-rag with a baseball cap over it.

“She  started shaking and grabbing her chest, she won’t tell us what’s wrong.”

“Has she ever done anything like this?”

“I’ve known her for years, never seen nothing like this!” said another worker, similarly dressed.

We rolled the stretcher up the narrow ramp to the kitchen door, the help returned to the line, it was the lunch rush, orders up, no time for fallen comrades. Samantha stood, then sat, then stood, then lie on the stretcher and thrashed around, and wouldn’t let us use the seat belts, and wouldn’t walk, and wouldn’t sit still. Then  she jumped from the stretcher and grabbed her neck.

“HELP! MY NECK!”

“Whats wrong with your neck?”

“It needs a brace! Wrap it up! Put something on it!”

“Did you fall? Did you twist it? Is it hurt?”

“No! It’s inside! Please!”

I looked at her friend. She looked concerned and completely bewildered. My partner also looked bewildered. I probably looked bewildered, but not for long.

“Get on the stretcher, we’ll get you into the truck and apply the necessary device.”

She squeezed her neck , hopped onto the stretcher which sagged under the weight, and it creaked back down the ramp toward the rescue and “the device.”

Once inside the truck, she started thrashing again, causing the rescue to rock back and forth along with her weight.

“Squeeze my neck!” she cried.

I put my hands around her neck, and pushed through the considerable flesh but was constricting her airway. She needed the device. I grabbed a no-neck cervical collar from the upper compartment, wrapped it around her neck, and applied pressure to each side.

“Harder!”

I pressed harder.

“Harder!” she cried.

I put almost every bit of strength I had into it. She relaxed, and stopped thrashing, and lay down in the stretcher. I let up on the pressure slowly as we rolled toward the ER.

The patient was resting comfortably when we arrived at triage. I didn’t have a clue what to tell them. But I’m considering modifying cervical collars and marketing them as “Magic Ginzu Neck Relievers,” or something like that

Whatever works.

Management of Violent Patients                                                                      Page 64-1

MANAGEMENT OF VIOLENT PATIENTS

INTRODUCTION

Never transport these patients without police presence. When transporting these patients without police presence use of the following protocol is permitted. Patients often present with bizarre and unpredictable signs and symptoms. These patients must be handled with extreme care. One moment calm and serene, suddenly violent and out of control, or worse, sorrowful and weeping. Occasionally these patients change form from human to extraterrestrial. Note that these patients may be at risk of mutating, shape shifting or morphing into creatures of the night.

RECOGNITION

Patients whose color changes rapidly, grow fangs or claws or simply disappear fit into this category. Do not rule out drooling, leaking or other bodily emissions as potential weapons. Occasionally, these patients rip seat belts from stretcher and flop on floor of rescue vehicle. Some levitate. Some attack.

TREATMENT

1.          Perform a primary survey. Handle patients gently, sudden movement may provoke them.

1.1       Tie combative patients to stretcher using whatever means available, preferably face down. If one of these patients breaks loose,         use of a sheet as a safety net is permitted. Throw sheet over escaping patient, temporarily confusing them. Beat them with a loaded clipboard if necessary. Gently resecure patient to gurney.

1.2      Use of retrievable portable radio may be used to stun escaping patient. Hold microphone section of radio and use body as a projectile. Aim for the back if running away, between the eyes if approaching. Repeat as necessary.

1.3      Teamwork is recommended when volatile patient attempts to elope from rescue. Driver must monitor progress as is prudent. If patient manages to escape from restraints, quick starts and stops should incapacitate patient. Team member in rear of truck may utilize safety net (see 1.1) Planting foot behind subdued patients neck and firmly pressing to floor should alleviate the situation.

1.4       Consider abandoning vehicle.

2.        Obtain Vital Signs

2.1      From safe distance see if patient is breathing. If so, no further treatment is necessary. Transport immediately to appropriate medical facility

2.2      If Patient is not breathing follow all appropriate protocols

2.3      If patient remains conscious, repeat above until desired effect is attained

3.      Document all incident information, except for all of the above, by completing the RI EMS Ambulance Run Report

On our thirteenth or so run today, my partner, who also hasn’t slept in thirty hours asked how we were going to make it through the next shift. This is what popped into the old noggin. Figured I’d share it here because it cracked me up. As long as I can amuse myself, everything will be just fine…

What makes a king out of a slave?

Courage.

What makes a flag on a mast wave?

Courage.

What makes the elephant charge his tusk in the misty mist or the dusky dusk?

Courage.

What makes the muskrat guard his musk?

Courage.

What makes the Sphinx the seventh wonder?

Courage.

What makes the dawn come up like thunder!

Courage.

What makes the hot in hot so hot?

What puts the ape in apricot?

Courage.

What do they got that I ain’t got?

COURAGE!

Sometimes I don’t know how I even get back on the truck. Twenty-four hours in, twenty-three calls, fourteen hours to go. I’m going to need a lot more than courage to pull this one off. Bring on the Red Bull and Espresso!

“I guess that if you are a Guatemalan gay man who likes to gamble and smokes marijuana, you probably think we’re onto some good ideas here.” ~ House minority leader Robert A. Watson

Rep. Watson delivered this line at a Greater Providence Chamber of Commerce meeting. He was referring to Rhode Island’s  General Assembly agenda, which is focusing on gay marriage, in-state tuition fees for children of illegal immigrants, medical marijuana and legalizing gambling tables at the state slot parlors. The state is facing huge deficits, unfunded pension liabilities and a shrinking tax base. His point was the assembly’s misguided focus. His delivery was regrettable, ill conceived and completely out of place. The Guatemalan people have every right and reason to be outraged.

The local talk show circuit is having a field day with all of this. Guatemalan immigrants are being accused of everything from bringing head lice to local schools to being the cause of the downfall of democracy. I listen now and then, and hear host after host, then caller after caller deliver their diatribe.  The talk show  crowd can’t seem to grasp the idea that an elected official delivering a speech to business leaders in the capitol city of Rhode Island was completely and indefensibly wrong.

Now the circus is in town, blowing a little thing way out of proportion.

How hard is it to simply state, I’m sorry, that was out of line. Apparently too hard for the minority leader, and the brainwashed public that is so infuriated with the illegal immigration problem that they have lost sight of reality.

I work in the middle of reality. The inner city is where most newly arrived Guatemalans live. They live in houses that were built and were inhabited by our parents, and grandparents. They work hard, doing jobs “Americans won’t do.” They are here to work, and make money, and live a better life than the one from where they came. I don’t know their immigration status, and I honestly don’t care. I go to their homes when somebody is sick, or injured and treat them the same I would anybody else.

They are trying to learn the language. A lot already have. They are good people gaining a foothold in America. I’m sure there are  undocumented people mixed in with the general population. If they get caught, send them back. Enforce the law as it is written. Punish employers who hire illegals. But for god’s sake, stop treating these people like the scourge of the earth. They are people, and have the same drive, ambition, feelings and pride as everybody else who landed here and suffered through unnecessary bigotry and hatred.

I’m ashamed to be part of a society that refuses to see how a “little joke” causes so much harm. If the people we elected to lead us can’t see it, then we are obligated as the people who run this show we call America to get rid of them.

If they won’t say it, I will.

” I hereby apologize to the Guatemalan community, and any other person who found Representative Watson’s remarks at the Greater Providence Chamber of Commerce meeting offensive. It was a dumb joke told at the wrong place and time.”

Please send the circus home.

http://newsblog.projo.com/2011/02/guatemalans-demand-watson-apol.html

“I know-lets hook up, you get pregnant, I’ll show up when it’s convenient for me, maybe once a week, maybe twice, maybe not at all, you can be my baby momma, I’ll be the baby daddy, we’ll get RITE care for the baby, and you until the baby is eighteen, or if you have more illegitimate kids, until they are eighteen, I’ll stop by for a booty call now and then, unless I’m with my other baby mommas, but I’ll text you if that’s the case, we’ll drop the kid off at your mom’s house on the weekends and hit the club, or I’ll hang with my boys and you can hit the club and hook up, it’s okay as long as I don’t know.”

Fatherhood. It’s a piece of cake. What are all these old guys bitching about.

I wish I was making this stuff up.

Providence is full of single mothers. EMS is used to take children from single parent homes to emergency rooms for free medical care. I have no idea what happened, but we need to turn it around before it’s too late.

“Fire Alarm to any available rescue….”

Fire Alarm to any available rescue…”

“Any Rescue to clear…”

There are no rescues to send to the pedestrian struck because you just sent Rescue 2 for an intoxicated male, Rescue 3 for an emotional six year old at the elementary school, Rescue 4 to the thirty-three year old who has been vomiting for three days, Rescue 5 is OOS for the State inspection, Rescue 6 is on the way to the ER Parking lot for an intoxicated person who fell and Rescue 1 is changing over from one junk to one slightly less of a junk.

That’s it. No more. We’re done, you’ve got nothing and nobody to send to the first real emergency in hours. Great job, whoever is in charge of these things.

Who is in charge of these things?

“Police and firefighter jobs are not even it the top ten for dangerous occupations!” – some asshat on the linked video

Good.

I have no intention of dying on the job. I don’t expect to suffer a disabling injury. I don’t even think I’ll be inconvenienced by minor injuries. I’m certainly not heroic, nor do I do heroic things. Simply put, I have the aptitude and physical ability to do a difficult job, and the desire to do it.

I don’t want my pay and benefits judged by some “danger scale.”  What I do is dangerous, but a lot of people do dangerous things. I am compensated for my knowledge, and ability to perform under stressful situations, and come out in one piece, emotionally and physically. There is a reason that of the thousands that apply for police and firefighter positions, and only a small percentage make it. Applicants go through rigorous physical and psychological testing before consideration for employment.

It doesn’t make us better people, or stronger, or smarter, or more reckless. It just makes us better suited for the requirements of the job. Add to that the fact that a lot of us get killed in the line of duty due to circumstances beyond our control and you start to get the picture. It happens, but we do everything in our power to try and make sure it doesn’t.

Stay safe. And don’t let people insult you with their pandering, self-serving rhetoric concerning our professions. They don’t have a clue.

http://statter911.com/2011/02/12/fighting-back-msnbc-host-ed-schultz-takes-on-those-willing-to-cut-firefighter-pensions/

* I wrote this yesterday after watching the video. I may have understated the inherent danger of the job. It is definitely a dangerous job, I just find it condescending when people assume I’m willing to die for it. If that happens so be it, but I’m certainly not looking for it.

Then there’s the little girl whose life has unravelled before she had a chance to live it. Her father is sick, and living in a hi-rise, only he is not embracing his existence, flawed as it may be, he’s thinking only of himself, and his drug and alcohol addiction, and smoking, and drinking his days away while his daughter wanders lost through the streets of Providence.

She’s walked for hours. She’s cold, lonely and afraid. And she’s dangerously depressed, but nobody knows that, least of all her father because she is afraid of upsetting him. Eventually her solitary journey leads her to the highway. She walks up the  on-ramp, not really knowing why, only knowing that she needs to keep moving.

Cars pass her, spray freezing water and road salt onto her clothes and skin as they speed by. The on-ramp has a railing, about waist high. As the world moves on around her, she leans on it, then leans over it and falls thirty feet, and crashes onto the pavement below her.

“Rescue 1 and Engine 10, Respond to Broad and Prairie for a person who has fallen off an overpass, injuries unknown.”

We’re in the truck in seconds, and on scene in a minute. As we approach, I see a number of people on the overpass, looking down. Thirty feet below them is a crumbled heap. Horrified onlookers form a semi-circle around the heap, but nobody goes near it. Police cars converge, and Engine 10 is heard in the distance, approaching fast. We glove up, and go to work.

She is screaming, but miraculously still conscious. There is no gross deformity, no hemorrhaging. The primary assessment is unremarkable, I gently turn her, and straighten her, and roll her and secure her to the board. I take off her earrings and necklace, matching silver angels, and place them next to her head. We get her into the truck, cover her with blankets and cut off her wet clothes. Still no blood, except for a finger that appears scraped.

Maybe I should leave the angels on.

Before we leave the scene I take another look at the place she fell. People are still on the highway looking down. I stand on the railroad tracks that are immersed in the pavement, calculate the distance best I can and come up with the same number-at least thirty feet, maybe forty. I can’t believe she’s alive. The police have talked to people on scene and they confirm the girls story. She definitely jumped, and fell, and should have died.

I talked with her hours later as she sat in the trauma room, waiting for test results. She fractured her pelvis and tailbone. The pain medications loosened her up enough to tell me what had happened and why. I only spent a few minutes with her before the x-ray people came in for some more pictures. She took my hand before I could leave.

“Should I tell them I might be pregnant?”

“You need to tell somebody.”

She’s only eighteen, and has nobody. Her father couldn’t be reached.

I’d like to reach her father. I’d reach over and wring his worthless little neck until his eyes bulged out of their sockets, then maybe he would see more than his own miserable little world, and start acting like a man.

I have no idea what possessed me to stick my hand into the bowl, little white pebbles were sitting next to a candle, luminescent, perfect and drawing me in.

“Are those edible?” I asked, then stuck my hand in. Too late I realized it was a water candle. I’m glad the apartment was dimly lit as I felt the blood rush to my face.

The patient thought it was the funniest thing he had seen all day, so did his roommate and the three firefighters from Engine 15. So much for my grand entrance. What can I say, it had been a long day.

“Robert” had been having trouble breathing for about a week, suffered from COPD and was also HIV+. He was thin, and frail, and not at all well.

“Can I go to Miriam?” he asked.

Miriam Hospital was the furthest hospital of the city’s five, but was also the most appropriate facility, considering his history. Considering I had just stuck my ham sized hand into his water candle, it was the least we could do.

“Of course.”

He lived with a roommate in one of the public hi-rises in the city. Their space was dignified, graceful and perfectly suited for them. It was comfortable, tastefully decorated and serene. We loaded him up and started the fifteen minute journey toward the ER. He told me that my hand in the water trick was the first thing to make him laugh in a long, long time. He had a dignified air about him. Born in South Carolina he had never lost his Southern charm, even though the job he had in his previous life took him all over the world. He lived in San Diego, Texas, Chicago, Jamaica and his favorite by far, Malta. A friend of his still owned an oceanfront villa there, and he planned on visiting soon.

The HIV medications that saved his life also cost him the things in life he thought most precious. His homes-he had two, one on each coast and a few timeshares scattered around the globe; he sold his Mercedes, his stocks and bonds, his “things.” His once vast accumulation of possessions now fit into a three room apartment in a run down facility filled mostly with people scraping by on social security checks. Yet he seemed happy.

“What good is a big house when you can only sit in one room at a time?” he asked. “Who needs a Mercedes when there are gardens, and woods, and city streets, and the stars with their infinite possibilities.  What more can I ask from this life than what I have at this moment, which is a nice conversation with another person who is not afraid to stick his hand into a stranger’s water candle?”

We talked about life, and what it means, and how to handle loss, and failing health. I did something that I seldom, if ever do. I told him a little about myself, and my life, and the big home we used to live in, but could no longer keep because of my wife’s illness. I let him know about the heartache we felt when we lost the pool, the cabana, the gardens and friends, then the dogs, then the second house that turned out to be all wrong, and the rental, and how each move chipped a little bit of our soul, and tested the very fabric of our marriage.

As we backed into the ER bay, we agreed that through loss much is gained. That what is essential is invisible to the eye. What matters cannot be bought, we all need to live and find happiness with what we have, because through it all, we have a lot to be thankful for.

He asked me to put his coat over him before we wheeled him out of the back. It was cold outside, and an icy mix rained down from the starless sky. I picked up his coat, and grinned.

“Mink,” he said as we rolled him out of the truck. “I didn’t give up everything.” He looked to the starless sky, felt the cold, freezing rain fall on his face and smiled.

And so did I.

The patient is in respiratory distress, lying in a nursing home bed, diaphoretic and semi-conscious. Each breath she takes requires monumental effort, and that effort isn’t enough to supply her body with enough oxygen to sustain her. Even with the non-rebreather and 10 liters of supplemental 02 her SPo2 is 85% Her lungs are full, blood pressure 180/100 with a heartrate of 128. Three firefighters are in the room with her, one hands me the paperwork. Thre rest of us move her from the hospital bed to our stretcher.

She is sixty-one, her name is Kathleen. The report is vague, history of MS, found unrespo0nsive this morning, difficulty breathing, EMS called. The nursing staff is conspicuously absent, the hall is empty, no aids, no dietary technician, nobody home.

There is a nursing station near the elevator, I find somebody, finally.  She is alone at the desk, phones ringing, a stack of orders in front of her, nearly overwhelmed. I take a deep breath, and assess the situation, and instead of demanding a more cohesive report simply ask her  her opinion regarding the patient.

“I think she has pneumonia, she’s normally talkative and alert, this is highly unusual for her. Thank you for asking.”

She returned to the mountain of work, we continued on.  An IV, an EKG that was unremarkable and a ride to the ER for an evaluation and that was that. Later, I found out that she had pneumonia.

In a perfect world, nursing homes would be properly staffed and nurses would not be overwhelmed. I hear a lot of people in our field ridicule the people at these places. Theirs is a world far different from ours. They know the patients far better than we do. Their input is valuable. I think we may have worn them down by treating them poorly when everything isn’t as we would like it. By simply asking this person her opinion in a friendly way, I was able to better figure out what was wrong, and treat the patient accordingly.

And as a bonus, I got to feel better about myself by treating a colleague who needed a boost with some respect.

Overheard in front of Rescue 1 (following twenty-four hours of free rides to the ER for non-emergencies)

“How are we supposed to thrive as a society when all of these people refuse to help themselves?”

“They help themselves all right, more every day.”

“It’s hopeless. They can’t even wipe their own asses!”

“No it’s not hopeless. It’s not like this everywhere. There are places where people don’t call 911 for toothaches, where there aren’t drunks on every corner and people on third floors expecting to be carried to the hospital because they threw up. Think of it this way. Providence is the asshole of the universe. The rest of the universe works, we’re just in the middle of the shit.”

“What about Hartford, and New London, St. Louis, Boston, New Orleans-those places can’t be much better.”

“The universe is full of assholes.”

“You got that right.”

“I guess.”

No news on the book, Night and Day, other than an e-mail last month from the publisher stating that he hopes to get this project going “soon.” Thanks again for all of the support.

This is an e-mail I sent earlier today. Hopefully I’ll have some good news soon and a book to sell!

Hello Tony,

My apologies for the e-mails, I know you have a lot going on. Anyway, I wanted to pass this on, I’ve been thinking a lot about the book.

I managed to nearly singlehandedly sell well over 2000 copies of Rescuing Providence, despite being completely unknown outside of my little world, through a publisher, Paladin Press that didn’t want to release the title to mainstream outlets, rather preferred to sell the title exclusively to their catalog customers, whose core group is more interested in “How to Make an Atom Bomb from Potato Peels” that an emotional narrative non-fiction look at everyday people in extraordinary circumstances brought together by an ordinary man doing extraordinary work.

I even managed to get Borders Bookstores to pre-pay Paladin Press for copies of the book to put on their shelves due to high demand.

Imagine what we could accomplish?

I’ve got 1500 pre-commitments, all during the busy holiday season during a crummy economy for something that does not yet exist. People are bugging me for news, and my wife is ready to divorce me because I’m acting like a man possessed.

That’s all. No it’s not, I forgot, my blog, www.rescuingprovidence.com finished second in The Fire/EMS Black Diamond Boots Blog of the Year Contest. And, I finished #2 on The Providence Fire Department’s Captain’s promotional list (big deal in the fire service, not so much for everybody else, but it was a tremendous effort to pull off.) I’m thinking all of these things will help sell books.

If I can finish # 2 on your fall list I’ll consider my year of #2′s a smashing success. Who needs #1 anyway?

Best,

Michael

She handed me the phone.

“Talk to my sister, she’ll tell you. I’m not crazy.”

I took the phone from her, carefully. Those things hurt when you get whacked with them.

“Hello, this is Lieutenant Morse, Providence Fire Department. I’m concerned about your sister.”

“Y’all should be concerned, that bitch keeps callin her all night, y’all need to be gittin to her house and arrest her and get her to leave my sister alone! And them people who keep knocking on her door…”

“Never mind.”

I clicked the off button and put the receiver on a table, a safe distance away. Two Providence Police officers, three firefighters, a man from Veterans Affairs me, my partner and Patricia filled the tiny apartment. A flag, neatly folded and forever enshrined in an oak and glass case sat on a bookshelf, with various medals and certificates. Patricia’s name was on most of them. Second generation veteran I figured. Probably her dad’s flag, or husband? Maybe a friend.

“Why did you hang up?” she asked.

“Because your sister from Alabama is supporting your delusions.”

“Delusions! Who the fuck are you to tell me about delusions!”

“I’m Lieutenant Morse, with the Providence Fire Department. I was called here to help get you to a hospital because you haven’t been taking your medications and you are in a manic stage of bi-polar disorder.”

I made that up, but was pretty sure I was right.

“You call them delusions!” she pointed to a window. The blinds were open, nobody was there.

“There is nobody there.”

“Not now but they’ll be back! Thirty, forty of them, as soon as you leave. They keep knocking on my door, and calling on the phone, I haven’t slept in three days! Who are you again?”

“I’m Lieutenant Morse with the Providence Fire Department.”

She snapped off a crisp salute. I returned it, and she put her arm down.

“I’m an honorably discharged Navy Veteran, sir. Twenty years.”

“Thank you for your service, Patricia, but right now you are not acting accordingly.”

“Accordingly to who? You all just stand there and and listen, and let me tell you what is going on. This bitch…”

“Patricia, it is my opinion that you are manic right now and need to get to a hospital.”

Visions of grandeaur and an audience to boot. There was no way I could let this go on. Everybody else was content to let me continue, Miles from Engine 11 had tried for a while, the police figured it was a medical call and the Veterans Affairs guy had been at it for three days. It was my turn.

“You interrupted me!”

“I had to. We have to go.”

“I’m not going anywhere.”

The Old Mexican Standoff, and I was knee deep in the shit. The guy from Veterans Affairs had called us for help getting her to the VA, she wouldn’t go willingly but had been calling his office, and home for three days hourly complaining about people not leaving her alone. Her apartment was in chaos, dirty clothes thrown everywhere, all of the closet doors and kitchen cabinets wide open as if she were looking for intruders behind the closed doors. I’m sure that is exactly what she had been doing before any of us got there.

I tried an End Around.

“Patricia, I’m authorised by the medical director of the State of Rhode Island to remove you from these premises and get you to the nearest medical facility. We will do it whether you want us to or not.”

“Bullshit.”

She may have been manic, but she was far from stupid. She recited the day of the week, the date next Wednesday, the pre-amble to the Constitution, her birth date, Ronald Reagan’s birth date, where she was, who she was and every other answer to every question I asked.

“I’m not going anywhere.”

So she didn’t. I failed. I knew she was in need of help, but had no authority to take her out of her home against her will. She was just lucid enough to dodge my attempts to get her going of her own free will. I thought I had her, but she wore me down. The man from Veterans Affairs was disappointed, but acknowledged the fact that neither we, nor the police could do anything…yet. He was waiting for commitment papers and an evaluation from his staff psychiatrist, but there was some delay.

That’s the kicker-I knew she was going to snap, and soon. And there wasn’t a damn thing I could do about it. Out of town rescues were busy covering our calls, dispatch was asking if any rescues could clear. I keyed the mike.

“Rescue 1 in service, signed refusal, what have you got?”

The radio answered.

“Rescue 1, Respond to 263 Broadway for an emotional female locked in a bedroom with a knife, stage for police.”

“Rescue 1, responding.”

“In Russia they say, “You run from the wolf to meet up with the bear !” comment from Lynda MO

PUBLIC SERVICE ANNOUNCEMENT # 3

Ice is slippery.

That is all.

Five of the seven calls so far today have been for people who slipped on ice and fell. One was for an MVA involving black ice. The seventh was for an intoxicated male. I think he had today’s vodka “on the rocks.”

Which is better, youth and ambition or age and experience? I wish I had the get up and go I had twenty, even ten or five years ago, but I just don’t.  I’m surrounded by people half my age doing the same job I do, most doing it as well or better. I’ve seen a lot, done a lot and nothing gets me too excited, but I’m not sure if that is a good thing. If I were on the receiving end of patient care I think I would prefer somebody eager and excited about their job rather than somebody going through the motions like he had done it a thousand times.

Of course, if I were about to die, maybe that old guy without the look of panic on his face might be reassuring.

I don’t know, a mixture of youth and ambition with age and experience would be nice. Some days I feel like I just started, others like I’ve been around too long. Then there are  days like today when everything feels just right. Must be something in the air, either that or the Cafe’ Tobe* my partner brought me this morning has me firing on all cylinders.

*Cafe’ Tobe is a lovely little miracle in a cup, French Roast with a shot of espresso.