Tagged: best of

Surreality

It’s been raining all day. It’s December, and we’re supposed to have a snow storm, but the Eastern Front receives only rain and wind. Horizontal rain, but still rain. I hear it’s been snowing out in West, but here at Medic 9 it’s just cold and wet.

Just after dusk, the rain stops briefly and the temperature rises. We clear Local Suburban Hospital in shirt sleeves and return to our district through a light fog. Seemingly all at once the street lights awake. The wet pavement reflects their sodium orange light into vectors which point the way home.

RP finds an unmarked CD someone left in the console and pops it into the player. We are treated to the mellow sounds of Pink Floyd’s Division Bell.

The night erupts in blue-white as lightning silhouettes the city, and we head east into surreality.

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Everest

We miss the address on the first try.

As we come back the wrong way up the one-way street, we find it. Maybe. A tiny silver number resides on a black mailbox, in the weeds and bushes, at the foot of something that might be a driveway.

This has to be it. The numbers on one side are too low, and on the other side too high. The narrow strip of black asphalt climbs precipitously, rounding a corner and disappearing from view. There is precious little to indicate that there may be a house up there; just the mailbox and a ramshackle railing made of steel pipe. And darkness. Lots of darkness.

It could be our destination. It could be Frankenstein’s Castle or the Pearly Gates, too. There’s only one way to find out. I point the nose of the Medic 9 up the hill and slip the brakes. I expect the rear bumper to drag on the street, and it does.

We drag the bumper on inclines all the time; I mash the throttle to pull through the drag. Six tons of American steel crawls forward a foot, then stops. The wheels begin to spin.

I quickly let off the throttle, knowing we can’t pull through this one. I once saw a fire engine get stuck attempting a similar maneuver, and I have no desire to emulate their embarrassment. Thankfully we are able to reverse back down into the street.

Plan B, then. RP and I grab the stretcher and our gear and begin our Alpine climb. My small pocket flashlight does little to force back the darkness. At the top we do find a house, with a frantic family member waving from a deck, yet another story above us. RP heads inside with the gear while I attempt to find a way to secure our stretcher. Not only do we not want to lose it, but it would cause significant damge to the Medic 9 parked at the bottom of the hill.

Belated but welcome, our sherpas arrive in the form of four firemen. Like good sherpas everywhere, they come equipped with extra oxygen tanks. “Don’t you want the ambulance up here?” their Lieutenant asks.

I explain the problem. “I think we can back it up here,” he replies, scowling back down the hill to where the blinking LEDs of our now-invisible rig illuminate the treetops.

I leave him to it while one of his men secures our stretcher, and I head inside to assist RP.

From inside I can hear the beeping of the reverse alarm and the roar of our struggling diesel, and I wonder how much paperwork they’re going to cause. There’s no sense worrying, as it’s all in the name of patient care.

As we come back outside, I immediately note that the illumination is much better. Medic 9 sits at the top of the driveway, merrily blinking away. Her diesel roars into the night; and a set of large, black rubber wheelchocks hold her in place, one to the front and one to the rear of the tires, joined with rope like a fighter plane on ready alert.

Thank you, Lt. I’m sorry I ever doubted you.

Now to get back down.

Grace

The vast lobby of Big City Memorial Hospital bustles in the early fall afternoon. The revolving glass doors let sunlight and visitors in, while keeping the fall chill outside. The atrium soars three stories above; the hospital designers seem to have placed a roof over the space between two buildings, and then decided, “Hey, this would be a good place for a lobby!”

 

A hundred people pass to and fro within my field of view; doctors in white coats, nurses and technicians in hospital scrubs, maintenance people in green uniforms, one or two uniformed security guards, dozens of patients and visitors in all types of dress. They swarm up and down the stairs and escalators; they wait patiently at the elevator bank. A huge insect colony in motion, each member with a purpose, part of the whole.

 

Fifty feet away, behind two walls, my patient clings to life in her own cell of the giant hive.

 

I stand to one side, safely at the edge of the stream of humanity, the only one with patches on his shoulders. As life flows past, a harpist whom I had overlooked begins to play ‘Amazing Grace.’

 

Life goes on, and so must I.

 

 

Knowing

Smile!”

As a parent, I spend the year on the lookout for cute photo opportunities. The best shots go into the family calendar for next year and make good Christmas gifts. Beth has appeared in the living room in full princess regalia, and this is too good to pass up.

In the corner, the fire scanner mumbles. I keep the volume low, but years of experience have trained my ears. Neighboring Smalltown has been dispatched for a car crash.

But the dispatcher is using THAT voice.

My readers in public safety will understand. There is a tone of voice which says the dispatcher knows something that you don’t. He may not have concrete evidence himself, but something has led him to believe that this is The Big One.

Click. Click. “Smile again.” Click. “Let’s try one with your doll.” Beth is a ham; it’s impossible to take just one photograph.

From the corner, the voice of the first arriving firefighter is breathless. “Car 68 to Fire Alarm, dispatch another paramedic unit and the helicopter.” The adrenaline in her voice is apparent.

The photo shoot finished, it’s off to bed. As Beth heads upstairs, I can still barely hear the radio in the other room. The helicopter crew requests the age of the patient. “Eighteen,” comes the reply.

After the teeth brushing, stories, and lullabies, it’s time for my chores. As I load the trash cans into my truck, another update: “Command to Fire Alarm, we have CPR in progress with no shock advised.”

I slowly drive to the end of my driveway, listening to NSFD attempt to make order from the chaos. I swing the cans to the curb, then I notice the sky. It’s a beautiful fall night; cool, clear, and starry. I pause to lean on my truck and stare into the heavens, somehow taking comfort from the familiar vibration of the diesel behind my shoulders.

To an observer, I am just another suburban guy taking out the trash.

But I know.

"It’s 9 o’clock. Do you know where your children are?"

The big Sikorsky emerges out of the setting sun with a roar. Every head outside the hospital swivels to follow its gravity-defying progress as it circles above the helipad. Paradoxically, the sound of the twin turboprop engines increases as it slowly approaches the ground and the single waiting ambulance.

The ‘bird’ touches its wheels lightly to the ground, then ponderously settles onto its shock absorbing landing gear. Gravity gradually takes over from aerodynamic lift, tethering it once again to the earth. The whine of the twin jet engines diminishes, but the rotors never stop turning.

After 30 seconds which seems like an eternity, the door opens and the flight crew jogs to the waiting ambulance, using a peculiar hunched gait. This is a big helicopter, and it’s not necessary to duck under the rotors. Human instinct, however, will not allow the head any closer to those lethally spinning blades than absolutely necessary.

The crew disappears into the back of the ambulance, and the scene becomes a still life in motion. The ambulance with its blinking red lights and the helicopter with its wildly spinning rotors sit frozen alone on the tarmac, with not a soul in sight.

Inside the ambulance is a parent’s worst nightmare. He needs angels; the best we have to offer is a helicopter.

Shortly the ‘bird’ will reverse the drama of its arrival. The paramedics will retreat to the safety of their ambulance as the flight crew locks their own doors. The turboprops will increase their ferocity from whine to roar, and the parking lot will be swept clean of any remaining sand, leaves, and debris. This time there will be no dramatic circling; as soon as the wheels are clear of the treetops, the pilot will tilt the nose and begin a full-throttle run across the setting sun, directly for Big City Trauma Center. Hopefully the angels can keep up.

Somewhere tonight, a parent’s worst fear will come true. Johnny won’t come home for dinner. His parents will call his cell phone but not get any answer. They will wait a while and probably gently curse him for being so irresponsible. Then the doubt will begin. A phone call to his best friend, to Grandma, to the school. No answers. The doubt will slowly turn to fear. Eventually there will be a 911 call to report him missing, followed by a police officer and perhaps a priest arriving on someone’s front doorstep. Hopefully it will not be too late.

I resolve to hug my wife and daughter when I get home in the morning.

Just keep squeezing. . .

The ambulance lurches as we leave the parking lot of Local Suburban Hospital. Partner du Jour looks at me with resignation in his eyes. “You know how this ends?” he asks.

“Yeah, I know.” I squeeze another bagful of oxygen into the patient’s lungs.

**SQUEEZE**

The patient fell last evening, tripping over a child’s toy. He’s apologetic for calling, but he’s done this before and knows his medications make him susceptible to internal bleeding. He doesn’t know that he has called at shift change and that my partner should be halfway home by now. We don’t tell him.

He’s very nice and wants to walk down the stairs to the ambulance.

**SQUEEZE**

Behind the wheel, Supervisor knows exactly what we need. She strives for the perfect balance between smoothness and speed. At this time of night, the quickest route to Big City Trauma Center is straight through the heart of the city, then up onto the highway. She does a good job, missing most of the potholes and making decent speed.

**SQUEEZE**

The patient identifies herself as pregnant, but doesn’t show it. She felt dizzy in the sun and almost lost consciousness. She leaned against the front wall of the supermarket and then slumped to the ground, scraping her face against the bricks.

She tells us that she doesn’t know who her doctor is, but her mother knows.

**SQUEEZE**

The patient’s blood pressure begins to drop. We infuse saline though his IV in hopes of raising it.

**SQUEEZE**

The patient sits on the floor of the gym, holding his knee and grimacing in pain. It was a simple foul shot gone horribly wrong. He’s been injured before, but never with this level of pain. He’s a tough guy, but today he’s near tears.

We splint his knee as gently as possible. En route to Local Suburban Hospital, we give him his first dose of morphine, but it doesn’t even begin to touch the pain.

**SQUEEZE**

The patient’s blood pressure continues to drop. We have to stop the anesthesia to keep him alive. After a few minutes he begins to show spontaneous movement, but he doesn’t wake up.

**SQUEEZE**

We pound on the door of the house, with 4 firemen and a police officer behind us. The woman who answers looks completely surprised. The call came from a third party, whose friend left a message on his voicemail asking him to call 911 for her, two hours ago. When called back the friend isn’t sure about our patient’s address. It might be in the next block.

The house in question has multiple apartments, and no one answers any of the doors. After circling twice, the firemen hear a faint call for help from the second floor. We try the most likely door and find it locked. One of the firemen goes for the tools while we study the locks. As he returns, the door opens.

Our patient, too weak to dial 911, has walked downstairs to meet us.

**SQUEEZE**

We wheel into the critical care area of Big City Trauma Center and are met by the trauma team. “Is this the patient coming from Out of State Hospital by helicopter?”

Umm, does this look like a flight suit? “Nope, we’re from Local Suburban Hospital by ground.”

**SQUEEZE**

The patient is unresponsive in bed, with evidence of copious vomiting. He doesn’t fit into any of our easy diagnoses. We do everything we can in the bedroom, rule out anything easily fixed, and roll for the hospital.

**SQUEEZE**

We exchange one trauma team for another, just as the helicopter crew from OSH arrives. We give report to our team, transfer the patient to their care, and after one final

**SQUEEZE**

we melt away into the night.

Olive Oyl

The patient lay emaciated in her own bed, propped up on pillows, with her head lolled to one side and her mouth wide open. I had to look twice to see if she was breathing. The firefighters said they couldn’t hear a blood pressure, and I wasn’t surprised.

Her husband was a wiry and determined looking little guy who only came up to my shoulder, a Popeye without the cartoon muscles. He told us the story. She had been diagnosed with an incurable degenerative condition almost a year ago. As we questioned him further, a picture began to emerge.

My initial feeling was that this poor woman belonged in a nursing home. She had had little or no outside medical care in the intervening months. The home was clean and orderly, but it bore none of the signs of a chronically ill patient. There was no hospital bed, no medical supplies, no chart or folder for the visiting nurse, no shoebox of pills, no commode by the bedside.

What she did have, however, was one incredibly dedicated caregiver. Her husband had seen to her every need, helping her to the bathroom and feeding her for as long as he could. Her degeneration had progressed to the point that he had to carry her upstairs to the toilet, yet he continued single-handedly. I began to realize that while I didn’t see much to the medical side of her care, he had been providing personal care at a level nursing homes can only dream about.

As we loaded her into the ambulance for the short ride to the local hospital, I wondered if she would survive the trip. We brought her husband along in the front seat, and I silently prayed we would not have to resuscitate her within his earshot.

He stayed right by her side as long as possible, all the way into the bay at the emergency room. He joined me in the hall as I made up my stretcher, standing in the doorway and staring back at his wife.

I was there when the doctor came out to discuss intubation, lifesaving measures, and Do Not Resuscitate orders. I will never forget his answer, “Doc, you do whatever is in her best interest.” And then I saw the spark in his eyes begin to fade.

Some necessary medical procedures are best not witnessed by family or friends; when the curtain was drawn across the doorway he suddenly looked like a lost, scared little boy. I led him to the special family waiting room, sat him down in a comfortable chair, and found a newspaper I knew he wouldn’t read.

I shook his hand, wished him all the best, and silently wished I could do more. When I left he was staring out the windows at the ambulances arriving and departing.

I made sure to give a small wave and nod as we drove out

Mommy

The room is dark and quiet. The other three patients stir in their corners, startled by our raucous arrival among them. They quickly settle, realizing as we make our way to the fourth bed that it is not their time.

Our patient starts awake as we approach. He is small and frail, a mere shadow with physical form. He looks at me with fearful eyes, and recoils when I touch his arm. The staff member says they called because he was hypotensive, but she cannot provide any more information. She hands a stack of papers to my partner.


Demographic sheet, valid Do Not Resuscitate orders, list of medications, and a notation that the patient has dementia.


The patient shows signs of dehydration; the staff admits that he hasn’t been eating or drinking well lately. I prepare to give him IV fluids, and I explain each step of the process. The patient returns a blank, interested stare, like a dog listening to its master.


When the needle penetrates the skin of his arm, he screams out; whether from pain or fear I cannot know. “Mommy! Help me!” We speak soft soothing words, calming him again.


Downstairs in the ambulance, he begins to communicate with me. He asks me where we are going and why. I explain, and he seems to comprehend. For ten seconds. “Mommy! Where are you, Mommy?” I explain again, and again, and again; he seems to understand for a few seconds.


“Mommy! Mommy! Please help me.”

I try a different tack, gently touching his shoulder and asking him where his Mom is.

His eyes focus on me for a second. “She’s dead. Why?”


My heart breaks a little more.