From The Director of THE EMS

http://rescuingprovidence.com/the-ems/

Beginning today, and extending forever, the practice of calling 911 to have emergency services personnel dispatched to your restaurant, convenience store, doctor's office or any public place of gathering for any of the following…

Having a person who fell and is uninjured "checked"

Having a person who has ingested alcohol "checked" before allowing him/her to drive

Requesting we "check" to see if the person who was choking will be okay

Checking a person's home when they do not show up for work

Checking a person's blood pressure

Documenting a slip and fall

The EMS is not in the "checking" business.

THE EMS is no longer accepting responsibility and/or liability for things that happen on your property.

Failure to adhere to this new policy will result in THE EMS issuing a fine not to exceed $500.00 and mandatory enrollment in the "How to act like a responsible person and not dump your problem on people who respond to medical emergencies" class.

That is all. Carry on.

It's not the uniform, it's the person who wears it. That little gem of insight came to me yesterday as I drove to work while listening to the Red Sox game. Tim Wakefield was in the booth talking between pitches. I found my self lost in a bit of nostalgia as they talked about the World Series wins, the records and the joy of baseball.

Tim mentioned how they make rear view mirrors little things in a big windshield, and how driving while looking backward not such a great way to go, the view forward so much more interesting. I had to laugh as I checked my own mirror and windshield and agreed with the old knuckleballer.

When Wake said that he was proud to wear the greatest uniform in the world I gave an automatic, cynical chuckle, and thought how delusional sports stars are, when people in "real" uniforms patrol our streets, fight our fires, respond to medical emergencies and protect our country.

Heroes. Uniforms. Sports stars?

Cops. Soldiers. Firefighters. EMT's and Paramedics, now those are the real uniforms!

Or maybe not. Maybe a sports star can be a hero, with just as much to give to the world as the "other" uniforms. Maybe their contribution to the world has just as much value, maybe not in a life and death way, but valid nonetheless.

I've gotten far more enjoyment watching sports, and have far more fond memories, and great times surrounding a sports event that I ever did when surrounded by the police. (that only happened once or twice, and I didn't do it.)

People are people, and what they do is just as important to them as what I do is to me. If Tim Wakefield wants to believe that the Boston Red Sox uniform is the best uniform in the world, he deserves to feel that way, and has every right to. Just like everybody else who wears their uniform proudly, be it the suit and tie, the scrubs, the machinists dickies, the cooks whites or a pair of pajamas.

We all have our own niche, and how we choose to live our lives, and handle the daily grind our own business, and if we choose to wear that uniform heroically, well, good for us!

"Rescue 3, Respond to The Johnny Lydon Elementary School for a knee injury."

"Rescue 3, responding."

It's nine, I'm hungry, fourteen hours deep into a twenty four. Haven't eaten since five, when I wolfed down a bowl of leftover gruel from the lunch I missed. It was cold, and difficult to eat while driving from Rescue 5 to Rescue 3, but the best thing I had all day. Overtime is an evil thing, with it I get a little breathing room at the end of the month, without it I sink in a sea of bills.

As much as I hate to admit it, I'm tired, too. Ten hours to go, feels like an eternity. A kid with a knee injury is the perfect call right now, a simple scoop and run, drop off at the children's hospital and back the quarters for another round of gruel.

Mind you it never occurs to me that school's out, and all the little kids are home and in bed, or should be.

A few people wave us down and lead us to a side door of the building, where the gymnasium is. In the distance, I see the ever present crumbled heap, just below the basketball net. It's a big heap, as far as my blurry eyes can tell. We wheel the stretcher over, and as the patient comes into focus I see that this is not a child at all, rather a large grown man, whose leg juts out at a 90 degree angle from his knee. He's lying face down, soaked with sweat and chewing on a towel.

"Greg, get some splints, towels, a backboard and a few rolls of tape," I tell my partner for the overtime shift. He's a newer guy, detailed to the rescue division six weeks ago. Every Providence Firefighter is EMS trained, and they are sent to man the city's six rescues at six month intervals. Every now and then, one of them stays, but they normally serve their sentence and return to the greener pastures of their engine or ladder companies. I think Greg has had it already, but he's a tough kid, determined to make the best of his six month tour, and willing to learn.

The guy with the collapsible knee is in 10/10 pain, moving him without medication a cruel, unnecessary task. I start an IV and send some relief through the line. As the morphine kicks in, and my brain wakes up I see the need for more help.

"Rescue 3 to fire alarm, send a company for assistance."

"Roger Rescue 3."

Engine 12 is dispatched and will arrive in about four minutes. I've formulated a plan, and begin to implement it. I'm going to roll the injured onto his back while the folks from Engine 12 keep the knee from moving. Then I'm going to build a pyramid of sorts with the blankets, splints  and towels, develop a Teepee, invert it, tape the pyramid to the Teepee with his immobilized knee between the two structures, bring two of the firefighters in the back with me to keep it from toppling over and administer more morphine enroute.

It's a brilliant plan.

I tell the Engine company how things are going to go when they arrive. The officer, Bo, raises an eyebrow, nods his head, and mentions that I might want to simply slip a backboard under the guy, stuff some blankets and towels around the injured leg and take him to the hospital.

Idiot.

Fifteen minutes later we arrived at the ER, my patient comfortably lying on his stomach on a backboard, his leg enshrined in blankets and towels and completely immobilized.

Alfred Lord Tennyson in Ulysses observed that  "I am a part of all that I have met."

Thanks for the assistance, Bo.

And I'm sure the patient thanks you as well.

If this post gets 1000 "likes" I'll pick one of the "likers" at random and send them a signed copy of "Responding."  And, I just found out, I'll also pick another at random and send them a signed copy of "Rescuing Providence."

If it doesn't get 1000 "likes" I'll set a copy of "Responding" on fire and stand naked in the middle of Broad Street, burning book in one hand and cardboard sign saying "will write for food" in the other.

So hurry up and hit the "like' button already, sheesh, it doesn't cost anything!

Dedication

I dedicated "Responding" to John and Kellie.  Both were students at one of Providence's colleges. I'll never forget either of them.

John,  Chapter 1, from  "Rescuing Providence."

http://www.paladin-press.com/product/Rescuing_Providence/Action_Careers

http://www.amazon.com/Rescuing-Providence-Michael-Morse/dp/158160629X/ref=sr_1_1?s=books&ie=UTF8&qid=1336927519&sr=1-1

0230 hrs

“Rescue 1, are you available?”

“Roger, what have you got?”

 “Respond to Providence College for a student who has fallen off of a roof.”

  “Rescue 1, on the way.”

     We were worn out, finishing a thirty-eight.  Lori hit the lights and siren and changed direction, driving toward the incident.  

     It only took a minute to get there.  The campus was quiet, most of the kids slept or crammed for finals.  Lifeless soccer fields, empty administration buildings and classrooms led us toward the brick seven story dormitory building.   Twenty-five years ago ten girls jumped to their deaths from one of the dorms here, trying to escape a fire that started when some Christmas decorations lining the walls ignited.  The girls couldn’t wait for the ladders that would have rescued them, flames burned their backs as they leaned further and further out their windows.  Some crashed to the ground in front of their rescuers, seconds away from salvation.  In terms of number of lives lost, it was the worst day in the history of the Providence Fire Department.  We have had our share of bad days.

       A security guard directed us up a hill to the base of St. Joseph’s Hall.   Another guard held a struggling student in his grasp, his primal screams echoed off of the surrounding buildings. 

      At the crest of the hill, near the base of the building, lying in a crumbled heap was our victim.  I got out of the rescue and walked closer, hoping, but knowing better, that this was some bizarre prank.  It wasn’t. 

     I am a firefighter.  People look to me when they need help.  The crumbled heap was a kid named John.  He looked at me through eyes that had popped from their sockets yet miraculously still focused on my own.  He tried to speak; blood and teeth flowed from his mouth in place of words.

     “It’s bad,” I said to Lori as she wheeled the stretcher close.  With help from Engine Co. 12 who had been called to assist we immobilized our patient then loaded him into the truck and headed for the trauma room at Rhode Island Hospital, the area’s only Level 1 trauma center.  John fought for life all the way.  His broken bones were hinged in multiple places, as he moved his shoulders and hips the limbs went in opposite directions.  The hat he wore, a light brown wool cap with earflaps that tie if you want finally fell from his head onto the blood-splattered floor of the rescue.  I remembered hats like from my childhood, when mothers and grandmothers would bundle their kids up before sending them into the cold.  They have regained their popularity with older kids; it’s funny how things come and go.  I picked it up and placed it on his chest, the only part of his body that didn’t appear outwardly broken.  Inside, his vital organs were a scrambled mess.  He somehow gathered the strength to grasp my wrist as I tried to keep him from moving.  I was amazed both by the power still exuding from his broken body and the emotional response his desperate gesture had on me.  The mangled mass of flesh and bone became more to me than I had intended, my quest to distance myself from the emotional carnage that lay ahead destroyed.  His grip on my arm went directly to my heart, breaking once we become more intimate.  I wondered to myself, who am I to be present and in charge as this drama unfolds?  I’m just a regular guy who a few years ago couldn’t manage his own life, never mind leading a team of firefighters in this grim effort. 

     I put aside my self-doubt and marched on, no time for indecision when a life hung in the balance.  The responsibility is sometimes overwhelming, but worrying about it doesn’t help anybody.

     I’m certain the look on the faces of Lori and the guys from Engine 12 mirrored my own. I saw horror and pity mixed with revulsion in their expressions as we worked.  We did all we could, started IV’s, gave oxygen and tried to comfort our patient while we endured what for some of was is the longest ride of our career.   

     An hour after we handed what was left of John over to the emergency room staff I sat on the floor outside the trauma room, state report on my knees, the empty spaces waiting to be filled.   My hand held a pen that I couldn’t get going.  The guys from Engine 12 were in the barn waiting for the next alarm.  Lori was with the triage nurses who were busy with the kid who had witnessed his best friend fall eighty feet from the slippery dorm roof. 

     The boys had finished cramming for their exams and were sneaking onto the roof for a smoke.  A window in a janitor’s closet provided access to the roof if you were careful.  This wasn’t the first time the window was used.  A beautiful view of the city was the reward for those daring enough to make the trip.  The first boy made it onto the roof then waited for John.  Something happened; he slipped and started sliding down the roof toward the edge.  It happened fast.  John’s friend witnessed him go over, he then somehow made it back through the window, out of the closet and down the stairs to the first floor.  He ran out the front door of the dorm to see if he could help.  He was the first to see the result of an eighty-foot fall onto frozen ground.  John was critically injured, his friend’s life forever changed by what he saw.  I can only hope he gets the help he needs and doesn’t push it away as guys his age are prone to do.   

     From the corner of my eye, a priest appeared at the end of the long corridor we call “trauma alley.”  The hospital’s six trauma rooms line the narrow hallway, filled with the most advanced medical equipment available.  At a moments notice these rooms can be filled with trauma teams consisting of doctors, nurses, respitory experts and support staff.  Now, most were empty.   One of the rooms showed signs of activity; a lone janitor mopping buckets of blood from the floor.  John had been taken upstairs to surgery.

     Two people joined the priest and they made their way toward me under the bright fluorescent lights up trauma alley.   They were my age, dressed is sweatshirts and sweatpants, things found at a moments notice, no coats.  They clung to each other, the man holding the woman up, supporting her as they made the long walk toward an uncertain future that seemed so bright when the fell asleep hours before, now shrouded with uncertainty and fear.  I knew why they were here and the bad news that awaited them, hoping beyond hope that everything would be as it was they struggled past me.   I cowardly looked down at my empty report and pretended to write, not wanting to see up close the effects of this tragedy any more that night.

     They were a close, religious family from a nearby Massachusetts town, Mom, Dad and three kids.  They sent their son to a Catholic college hoping he would be safe.   They walked past, never knowing it was me who peeled their son off of the curb at the bottom of his dorm and held him together through the ride to the hospital.  I know he would have died on the pavement if not for our intervention.  I get some satisfaction knowing his parents will have the opportunity to hold their child once more while life flows through his veins.  Whether that will be enough in the hard years to come I will never know.  I don’t think he will make it much longer.

     Somehow I finished the report, helped Lori clean the rescue and limped back to the station.  All quiet there.  The engine and ladder company didn’t turn a wheel all night.  In my office a stack of reports waited to be logged into the computer.  Thirteen runs, I had three hours to go.  I hadn’t slept in days; was exhausted, depressed and dirty.  Too tired to shower or log the reports into the computer system, I collapsed onto my bunk.  Mercifully I slept until my relief woke me at seven.  After an hour doing reports I was on my way home.  I turned on the radio, hoping to hear some music and clear my head.  It was the top of the hour; my favorite station does a five-minute news segment at this time on weekdays. The story of the student who fell from the seventh floor of his dorm led the news.  He was reportedly still in critical condition.  I listened to the details, amazed at how cold and generic the information sounded when recounted by somebody who was just reading the news.  My mind was still full of every minute detail, the smell of blood mixed with diesel fumes from the truck’s exhaust, similar to charred meat cooking on a propane grill, tension from the rescuers, horror from the witnesses and the victim’s pain all mixed together forming a cloud of desperation that can be felt only by those who were there.  You could tell the story a hundred times and the people hearing the story will never feel it, can never appreciate what goes on.  Only those unfortunate souls who live through such experiences bear the full weight of the memories.

Kellie, The Epilog from "Responding."

http://www.emergencystuff.com/9781887321143.html

http://www.amazon.com/Responding-EMS-It-Happens-Now/dp/1887321144/ref=sr_1_1?ie=UTF8&qid=1336927374&sr=8-1

     He must have been sleeping; the phone rang for a long time before he picked it up.

     “Hello.”

     “Nado, it’s me, are you sleeping.”

     “Not any more.”

     “Sorry to wake you up but this is important.  Do you remember that sick girl we had this morning?”

     “The one from PC?”

     “Yeah, her.  The chief just called me.  Turns out she had bacterial meningitis and we were exposed.  They want us to report to Roger Williams immediately for treatment."

     “Wow, it she all right?”

     “They read her last rights, it doesn’t look good.”

     “Shit.”

     “I know.  Want us to come by and get you, I’m working overtime, Rescue 6.”

     “Nah, I’ll drive, it’s right around the corner."

    “All right, see you there.”

     Rescue 6 was added to our miniscule fleet of Advanced Life Support vehicles about a year ago.  It hasn’t helped us out much, just kept the surrounding communities at bay for a little while.  They still come to Providence on mutual aid in disproportionate numbers.

     I snapped my phone closed and sat back in my chair, closed my eyes and let the news sink in.  Earlier in the day we had responded to Providence College for a “student vomiting”.  It was Tuesday morning, the day after a three-day weekend.  I’d have bet the rescue that this was a call for a kid with a hangover.  It took about five minutes to make the trip from the Allens Avenue Fire Station to the Providence College Campus.  Renato was at the wheel as he had been for the last couple of years, filling in for Mike who left the rescue division for a spot on Engine 15 in the Mount Pleasant section of the city.  I still see Mike occasionally on calls, at least he stayed on the same platoon.  He’s the same, always on, always making me laugh no matter how miserable I might be.

     Ladder 3 had been dispatched along with Rescue 1 and gave me their report as we turned into the campus.

     “Ladder 3 to Fire Alarm, advise Rescue 6 we have a twenty year old female dizzy and disoriented, have them bring the stretcher.”

     “Rescue 1, received.”

     Most of the time the students are able to walk to the rescue.  This kid must be pretty sick, I figured.  I helped Renato get the stretcher from the back of the truck and walked toward the Health Center, located just below the dormitory where a student fell to his death a while ago.  I pointed to the spot that he landed.

     “That’s where the kid fell,” I said to Renato.

     “I know,” he said, probably tired of me telling him again but wise enough to not to remind me that I tell him the same story every time we come to PC.  That is one of the many reasons I thank the Rescue Gods every day that he was transferred to Rescue 1 a few weeks after Mike left.  Sometimes things have a way of working out.

      She looked sick, but then so many of them do after a long weekend.  Providence College has its fair share of parties. Inside the health center Ladder 3 finished taking vital signs. Nelson, a firefighter who came on the job years ago with me and still looks a lot like Wayne Newton gave me the story.

     "She's 21, started throwing up last night at midnight. No medical history, doesn't take medications and has no allergies. She seems a little confused."
     Usually our college aged patients walk to the rescue, not her. Her name was Kellie, her Irish name as beautiful as her face.  She tried to answer my questions but her words were garbled.  I became worried about her condition; we transported her immediately to Roger Williams Hospital.  Renato drove in his usual way, I never felt a bump or turn in the road.  En-route Kellie started to have some seizure-like activity.  As she vomited I handed her a basin.  She didn't understand what it was and threw up on herself instead.  She shook as I held the basin to her face, and then fell back on the stretcher when I let her go.  Her eyes couldn't focus on mine. I put her on a non-rebreather with high flow 02 and let her rest.  I felt that her skin was cool and damp as I swept the hair from her eyes.
     The nurse at the hospital took my report and immediately got her into a room where the Doctor on call saw her.  I heard them mention a bleed as I washed the sweat and vomit from my hands.  I had just taken off my gloves to do the report when she got sick.  Five people were working on Kellie as I left.  The Doctor said it is probably a head bleed from an injury or meningitis.  Rather than a head bleed, I hoped it was meningitis and whatever got on me had been washed away.

     The chief called at 2200 hrs and told me to report to Roger Williams Medical Center.  Kellie had bacterial meningitis and we were exposed.  I had hoped she didn't have a bleed in her brain but I never expected this.  Viral meningitis is bad, but not deadly.  Bacterial meningitis kills.  It seems every year I read in the paper some poor kid who came to college and caught this bacterium somehow and died.  Kellie's family was with her in the Intensive Care Unit.  She was intubated and fighting the infection, but was in critical condition.  I had to wait until morning to see if she would live or die.  As for me, I took a big dose of Cipro and let it work. The medicine made me sick, but not as bad as Kellie.  I stayed on duty until the morning, poking my head into Kellie’s room whenever I had the chance.

     After a long couple of days I got word that Kellie might pull through.  She had been extubated and woke up for a little while . She knew who she was and where she was but wasn't quite sure what had happened.  She was lucky.  Her roommates made her seek medical attention instead of going to sleep, which is what she wanted to do.  The infection was caught before doing irreparable damage.  Six firefighters and about forty staff and students were given antibiotics as a precaution. Her roommates saved her life.  I love a happy ending and hoped things continued to improve.

     As things turned out, things did improve.  After multiple seizures and days of uncertainty, then weeks in bed, then months in therapy Kellie made a full recovery. 

     One day, months later I found an envelope addressed to me in the top drawer of my desk at Rescue 1.  It was from Kellie’s family, thanking me for my part in saving their daughter and sister’s life.  I must have read the note inside the card a hundred times, then a few more.  This job has the strangest way of grabbing you by the throat when you least expect it.  When I heard how sick Kellie actually was, after I had taken the mega dose of Cipro and was back at the station, alone in Rescue 6’s office I had what I now call a mini-meltdown.

     It is said that every critical incident we live through takes a little piece of our heart.  We are able to keep all of the pieces stored somewhere, hoping to put everything back together some day.  Kellie’s incident took a bigger part of my heart than I realized.  Maybe hers was the piece that was holding the rest together.  I sat in the office that night, in between Cipro furnished runs to the bathroom and wondered, after all these years, if I was going to be able to hold on for many more.  Maybe it was the memory of John falling eighty feet to his death from the roof above us when we carried Kellie out, maybe it was the knowledge of my own two girl’s frail existence on this earth or maybe I had just had enough.  Had she not pulled through I doubt if I would have stayed on the Rescue, I had just seen too much.  While she fought for her life in a hospital room three miles from my location, I fought nausea, diarrhea and severe depression in a cramped temporary office at the Atwells Avenue Fire Station.

     I can’t say that I prayed to God or the rescue gods or even asked for any intervention at all; I will say that by night's end, I managed to sort things out enough to let it all go and let nature, or whatever, run its course.

     I met Kellie and her family on her graduation day from Providence College.  She’s going to be a teacher.

     She’s off to a great start.

Ann Elizabeth Morse

January 13, 1938  –   December 14, 2004

My mother had a massive head bleed in June of 1997, or 1998, I find it hard to believe now, but I honestly don't remember when, it might  have even been 1996. Or even July or August. She fought it for about a year, then gave in. A lot of people would have never fought so hard, but she wasn't like that. She gave it everything she had, till there was nothing left but a shadow of what she once was. Then, the waiting began.

I wrote the following during the time between her death and her funeral. That was a strange time, mourning her loss while happy it was finally over. I had prayed for it to end for years, when it finally did, profound sadness filled the space where I thought would be relief. I felt I owed her something, some token of appreciation, acknowledgement of her life, and her personality that I was never able to convey while she lived.

 The priest at the church where we had the service wasn't very happy with my insistance on giving the eulogy. Things like this get out of control, he said, and the flow of the mass is interrupted. I think if he knew my mother, and realized he was dealing with my mother's son, he would have been more accomodating. In the end, we prevailed.

I hope she heard it, and wish I had said it when it mattered.

I struggled  whether on not to post this, but in the end figured it's about her, not me, and maybe her memory will give somebody a smile. Maybe even her…

Happy Mother's Day, Ma. We miss you.

December 18, 2004

     Though she waited a long time, I’m sure our mother is at peace.   When she was well, she lived her life with a passion few of us will know.  She was unpredictable, a little bit wild and brutally honest.  I always knew exactly where I stood with her, she never, as she was fond of saying, “beat around the bush.”  If there was a problem she let you know it, usually by saying, “I’ve got a bone to pick with you, then engaging in some heated discussion.  She loved a good fight, and fought to the end, never surrendering.  But she always fought fairly, and when the smoke cleared she harbored no resentments.  She was very forgiving.

     She taught her children that nothing worth anything was free, and to succeed you had to take matters into your own hands.  There were no free rides in life.  Whining was unacceptable, and tattletales faced worse punishment than whoever was being tattled on.

     She taught us to fight our own battles, at first this was a difficult lesson to learn, but by learning that lesson she did her job as a mother got her children ready to take their place in the world, and be prepared to face an uncertain future.

     She loved her family.  Every day the phone would ring and I would hear the familiar response, “hello, how are you?” and knew it was one of my aunts or my grandmother calling for the daily update.  They shared a closeness that became a part of our home, it was very comforting to know and feel the love and concern they had for each other.     

     There were many friends over the years, but her family kept her centered.  She loved having company and treated her guests well.  I always knew from the compliments I overheard that my mother was one of the best cooks and the most gracious hostesses there was. I was proud that she was my mom. 

     She had a sharp wit and was ready to argue her political beliefs and could hold her own with anybody.  Her love of literature, especially the classics such as Wuthering Heights and Gone with the Wind enhanced her personality and helped to make her articulate.  The closeness she held with her family, and the bonds they formed with each other over the years are what made her last few years on earth bearable. 

     Jean, Kathy and Eileen visited every week, brought her things and provided comfort to what otherwise would have been a dreary existence.  Brian read to her, every week and helped keep her focused.  Because my mother was unable, it is my privilege to say thank you for her.  You are fortunate to have each other.   

     She listened to her own advice well.  The stroke that crippled her and ended her life as we knew it, slowed her down but never broke her spirit.  I marvel at her ability to adjust to life as we last remember her.  She could have been impossible, a real Sarah Bernhard as I have been told she had a tendency to be when she lived on Aberdeen Ave.  Instead, she handled herself with remarkable courage and dignity.  I know that she spent her last years on this earth heartbroken and frustrated, yet her willingness to accept her fate made thing easier on her family.

     She was the perfect match to my father.  “Ann & Bob” were so well liked by everybody words never had to express it.  I always felt that the party started when the Morses showed up, and was pretty much over when we left.  I loved that about my parents.  They were larger than life, and I miss them. 

    I can’t help but think of my mother as my father’s other half.  Since his passing, there hasn’t been very much joy in my mom’s life.  They were inseparable, each only half without the other.  They are gone now, but will never be forgotten.  They accomplished some great things during their stay on earth, and had much more to do. 

     Sadly, they ran out of time.  I like to think they are whole again, and can see that their lives had a great impact on those they left behind, and their memory and spirit will live with us forever.  

Overheard at Home

"You don't look so hot."

"I don't feel so hot."

"What' s the matter?"

"Just sick."

"You never get sick."

"I'm getting old."

"Doesn't matter."

"Had a call the other night, guy dead in an alley. It was freezing, and raining and I forgot my jacket. It took forever to get him into the truck. He was hypothermic, not breathing, looked like he'd been in a bathtub too long."

"Why didn't you wear a jacket?"

"Forgot it."

"I worry about you."

I worry about both of us. It's just a dead guy in an alley, I suppose, but once upon a time that was more important than forgetting my jacket.

Sometimes something makes it through the cracks in the cement, and reaches for the sky, oblivious of the litter and broken glass surrounding it

Somehow, it  manages to grow, and avoid being trampled by the hundreds of footsteps that  blindly pass

An opening appears, some light and warmth breaking through the concrete, and it takes off, not knowing how high it will reach

Or if it will be destroyed without ever being noticed

To reach for the sky, feeling  nothing but life, growth and well-being,

Surrounded by litter and broken glass, and the errant footstep that could kill me

And move, and breathe, and connect with the people whose lives cross my path as I continue to reach for the sky,

And avoid those that want to crush me

On purpose. or just by chance

Now that would be something

It's a bit chilly, a steady drizzle adds to the misery and I have forgotten to bring a jacket. The day was just so nice it never even occurred to me. As night fell, and the tempature dropped, making things miserable I regretted my lack of foresight even more.

Anonymous male didn't forget a jacket. He simply forgot to drink his two halfs somewhere out of the rain. He was clever enough to stay out of sight as he drank, choosing a secluded spot at the foot of a thirty story building, a spot where smokers go during business hours.

It was well past midnight when the cleaning man looked out of the twenty-forth floor window, and saw what might be a body lying on the ground. Lucky for anonymous male, the cleaning guy had keen eyesight. He would have been dead by morning. Maybe within the hour.

Alone, soaked to the bone, hypothermic and barely breathing is how we found him, lying on his back in a puddle, his half pints by his side, and an uneaten sandwich, still wrapped in foil. It didn't come from a restaurant, somebody made it, and gave it to him. Somebody cared.

Somebody else cares as well, the strangers from the fire department that were called for the twentieth time that day to the area for a "man down."

He's a big guy, cutting his clothes presented a problem. With the heat cranked to a hundred it was sweaty work. His temp, according to our super duper ear probe is 90 degrees, and his symptoms confirm that number, his heart rate is about 100, not quite tachycardic but that's coming, he's hypertensive and hyperglycemic. His respirations are steady at six a minute with an SP02 of 83%.

We covered him with all the blankets we could muster, cleared his airway, got ready to bag and intubate if needed, fumbled around his constricted veins looking for an IV site and put him on oxygen.

Then we left the little courtyard where hundreds people will congregate in a few hours, smoking, talking, and taking a break. The man who nearly died where they will stand, or sit if the weather breaks will be recovering at the hospital, and they will never know he even exists.

They wouldn't know either way, whether he died there, or did his drinking and left.

Life goes on. Or not.

Sherlock Holmes sat at his desk, in the easy manner in which I had become accustomed, his hand lazily roaming over the mousepad, his eyes half closed. It appeared that he was dozing. Nothing could be further from the truth. Having just returned from the field after successfully solving the Siberian Potato Mystery, Holmes was simply doing what he does best; nothing.

"Nothingness is an art in and of itself," the inspector once told me as we traveled home from the City of Pawtucket, after transporting a kindly old man to the hospital there. "It is the idleness between action that fertilizes the soul."

The inspector was doing a grand job of fertilizing when the bell tipped, and we started a new adventure.

"Rescue 5 and Engine 7, a still alarm," blared the loudspeakers, alerting the brigade of an emergency. The overhead flourescents came to life, filling the gloomy quarters with brilliant light. We had no time to bask in the brightness, however.

"Come Dr. Watson!" said Sherlock, as full of enthusiasm as he was the first day we met, some twenty-one years ago. "There's a game afoot!"

"Rescue 5 and Engine 7, respond to The Providence mall, for a request for medical aid, nature unknown."

"A mystery to go along with the emergency. Splendid!" my old friend said, instantly alert. He doffed his hat, stashed his pipe in his inside pocket and slid the long brass pole that began at the second story ceiling and ended at the base of the apparatus floor, next to our vehicle.

Through the afternoon crowd of workers we traversed, dodging pedestrians and pushing vehicles to the side with our lights and sirens. The mall is a stately building, covering an entire city block. The land once housed a prison, and it is said that the last man executed in Rhode Island was hanged on the very spot. Perhaps his ghost roams these grounds, the place has see a fair amount of tragedy over the years.

Shoppers scattered as our team hastily made way toward the victim, led by a private security officer of the mall's employ.

"She's a lively one, she is," he told us with a wink. "You'll have your hands full. And don't get too close, or so will she!"

Our patient sat in a chair in the corner in the security office of a large department store, an anchor store if you will. She was a portly woman, her clothing unwashed, and her hair bedraggled.

"What is the problem, Miss," said Sherlock.

"You ain't close enough," she hooted, and reached toward the inspector with grimy mitts. "Come here, big boy, I got somethin' for ya!"

"I think not," said Holmes, "though I am flattered, I never mix work with pleasure."

"She said she was having chest pains," said the security man, his face flushed. "She was a bit frisky with her hands, I might add!"

Sherlock Holmes stood there then, and watched our patient. He has a way of seeing things while doing so that the untrained eye cannot detect. When he spoke, the gathering had no choice but to listen, his was a commanding voice.

"You are Esmeralda, are you not?" he asked.

"How you know my name?" replied the patient with a look of shock and worry upon her dirty face.

"That is none of your concern. This is the simplest of cases, It appears." Sherlock was in his glory as he addressed the crowd that had formed.

"You came to the mall to fill your purse with merchandise that you had no intention of paying for. Prior to your shoplifting trip, you met an old acquaintance and shared with him a jigger of brandy. Inside your purse are a pair of socks, and a pair of jockey shorts with the price tag from this very store firmly attached. You are not having chest pain now, nor were you ever, you grew anxious that yon security man witnessed the theft. Feigning an illness to divert the attention of the constablary is a doubly heinous crime, the punishment quite severe," admonished the inspector.

"I didn't mean no harm, sir, i was jus funnin. I wasn't gonna take them socks, they jus lookt so purdy a settin there on the shelf, they found their way into my purse!"

The security man reached into the purse, and removed the socks in question.

"And the undies?"

"I got no idea how they got there!" she howled with delirium. "Imagine that, mens undies in my purse!"

"We'll be taking her off of your hands, Inspector," the guard said. "And thank you for cracking the case."

"I'm afraid not my good man. This is a wily one. Her attorney is likely on retainer, and she will claim we caused her chest pain to increase until she could no longer breath. Sadly, we must take her to the infirmary to be medically cleared."

With that, and the help of the men from the fire engine, we put her on the stretcher and were gone. The fight had left Esmeralda as soon as we removed her from the store, and the crowd had dissipated. She certainly was colorful until that time, and at times some harmless play can be good for the spirit.

We brought her to the closest hospital, where they knew her well, and transferred care to their capable hands.

Just like that, we were back where it all began, in the office on Baker Street.

"Tell me Dr. Watson, what did you see upon arrival on scene?"

"I saw an elderly lady who may have been homeless sitting in a chair stating she was having chest pains."

"As did I," said Holmes. "But I also saw that she wore no socks under her shoes, and noticed the unmistakable aroma of ginger brandy on her breath."

"Moriarity!" I exclaimed. "The only man within the city limits who still drinks that wretched brew!"

"Elementary, my Dear Watson. The same Moriarity who charms the ladyfolk into doing things they would rather not. When we last saw our erstwhile friend he had been released from the hospital after falling into a ditch, Do you remember his words as he left the lot?"

"I do. He said they cut off his underwear!"

"They may be wretches, Dr. Watson, but they are human beings," said Holmes, his hand back on the mouse and his eyes half closed.

"Until the next one," I said, letting myself out of his office, leaving my friend alone to fertilize his soul.

I've yet to figure out how he knew her as Esmerelda. But that is another mystery for another day.

They're kids, barely out of high school. She said she had fallen into the water, struck her head and sank to the bottom. He says it's true, thought she wasn't coming back. She's shivering, asks for a blanket. I wrap her up and listen to her story. It goes on for a while, a rambling recollection of how she slipped and fell, then was underwater.

"You're dry," I said. "And there is no injury to your head."

"Nobody ever believes me," she replied and started to cry.

It's midnight, and these two kids have nowhere to go. They're homeless, they tell me, but the shelter won't let them in because they don't like them.

"Where is your home?" I ask.

"We have a no contact order at my sister's house, my parents threw us out and we don't have any friends."

He sits next to her and says nothing.

I take them to the ER because they have nowhere else to go.