The Top Step

“Rescue 5 and Engine 3, respond to Dorrance at Westminster for an MVC, public bus involved.”

“Rescue 5, responding.”

Great. A mass-casualty incident to end the shift. How do I know a mass-casualty waits? Just you wait and see. In the 24 hours I’ve been in charge of an advanced life support vehicle in the city of Providence, the only advanced life support I have given was the two bucks I gave to Moriarty, one of my regulars, who no doubt will use the loot to advance his drunken condition.

“Engine 3 to Fire Alarm, on scene, minor collision, bus vs. car, no visible damage, five victims.”

“Rescue 5, received, on scene. Send two more rescues, I’ll keep you advised.”

“Roger, Rescue 5, at 1715 hours.”

Told you so. The radio clacks away, dispatching more resources to the scene. Rush hour in Providence is no picnic, and a confluence of fire and police vehicles in the heart of downtown will do nothing to alleviate that situation.

The driver and occupant of the vehicle the bus tapped into are out of their car and denying injuries. The firefighters are in the bus doing patient assessments. Two of the guys have one victim packaged, and they carry him out the side door and bring him to Rescue 5. I do a visual triage, see the wounded in various stages of posturing, decide the toe tags can stay in the box and make my way back to the rescue.

Rescue 5 to Fire Alarm, have those additional rescues respond Code C.”


I’m back in my seat, my patient is waiting.

He’s homeless, lying backward on a spine board with a cervical collar around his neck, looking up. I’m employed, sitting in a captain’s chair, facing backward and looking down on him. This is just another run for me, one of thousands. It’s his second time in a rescue. The first time, he fell when a stairway in a seaside mansion he and some employees from his company were restoring collapsed. They had loosened the risers so they could get behind the steps and remove a hundred years of paint that had accumulated. Time moved on, days then weeks, and eventually the loose stairs let go, with him on the top step. Sixteen feet to the concrete basement. A few spikes in the leg didn’t slow the descent, but they did take his Achilles tendon.

Disability followed, then drug addiction. Then his wife was diagnosed with breast cancer. Then he took care of her, though their money was gone. He sold the Harley. Then the truck. Then what was left of the business. She never knew the depths he’d sunk to, and she died thinking he’d be OK.

He’s not OK. He lives in a homeless shelter and hopes this accident will be the break he needs—a couple grand for pain and suffering, maybe a Percocet of two for his troubles, and a fresh start. His calf muscle had atrophied; he showed me what was left before we arrived at the hospital. It was ugly. Medicaid wouldn’t cover a cadaver graft, he told me; it isn’t a life-threatening condition.

It may not be life-threatening, but it certainly is life-altering.

A fall from the top step.

I had stopped looking down at him by the time we reached the hospital. I never should have been looking down to begin with.



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