Thursday, December 13, 2007

The Smoking Baby

I still think about her. Even though it has been close to thirty years, I still think about her. When I am off guard, the question tries to slip past the walls I’ve built, a question that has no answer. A question that I struggled with over the course of my twenty-six year career through hundreds of runs like hers.

            It happened in the early years. When I had not learned the harsh math of the street, the math that sometimes multiplies the outcome. When I thought I was going to save them all, and did not know how many shades of misery could be crammed into a single call. As I said it was in the early years, and I did not know the realities of the profession. It was a late afternoon in February. We were in the station when the call came in.

            “Engine 1, Engine 51, Tower 1, Rescue 1, District 1 house fire 2212 E. Livingston. Engine 1, Engine 51, Tower 1, Rescue 1, District 1 house fire 2212 E. Livingston.”

            Everyone in the station headed for their trucks. The apparatus bay was filled with noise as the flaps on the fire poles slammed open when men slid from the second story, truck doors slammed as each driver climbed into the cab of his truck, and diesel engines were started with a roar. It was the fire station din of a house fire. Red lights for each truck snapped on. Then to the sound of five sets of sirens the trucks pulled out of the station and into the street. Engine 1 lead out followed by Engine 51, then Tower 1, I was in Rescue 1 and we pulled in behind the Tower with the District behind us. The trucks formed a conga line of fire apparatus as we weaved our way through rush hour traffic. Close to fifty red lights flashings and multiple sirens blaring, a full alarm assignment out of one station bursting with building fire adrenaline. No sooner had we left the station than the radio blared.

            “Engine 2, Engine 7, Rescue 7, Snorkel 2, District 2 house fire 2212 W. Livingston. Engine 2, Engine 7, Rescue 7, Snorkel 2, District 2 house fire 2212 W. Livingston.”

            The Dispatchers were sending another full assignment to the same address on the west end of the street. There must be some mix up with the address. We worked our way through traffic to the address. When we arrived we found nothing, just a row of houses with no sign of a fire.  The District got on the radio and said.

            “District 1 to Orlando. Nothing showing. Investigating.”

            “Orlando check. Be advised we are receiving multiple calls on this. It is apparently at the west address you can cancel.”

            “District 1 check.”

            “Orlando to Rescue 1 respond with units to the west address. Rescue 7 you are cancelled.”

            We were still closer than Rescue 7, who would have to come from the west side of town. We flipped the lights and sirens back on and headed west on Livingston. As we worked our way through traffic the radio blared over the sirens.

            “Engine 2 to Orlando we have heavy smoke in the area.”

We had something and the adrenaline goes up another notch. Then Engine 2 arrived on the scene.

            “Engine 2 to Orlando. We have heavy fire showing from a single story wood frame structure. Taking in one pre-connect.”

            “District 2 on the scene. Engine 7 bring in a line.”

            Engine 2 would be attacking the fire off the five hundred gallon water tank on their engine and would need a supply line from a hydrant as soon as possible. Using a pre-connect they would only have a few minutes of water to fight the fire.

            “Engine 7 check.”

            We still had blocks to go. We worked our way through the dense afternoon traffic. As we neared the scene, both sides of the street were lined with parked cars and the center of the street was filled with fire equipment. We parked at the end of the line of fire apparatus. My partner and I jumped out and scrabbled into the back to the truck to put on our bunker gear and tanks. As we were donning our tanks another report blared over our radios.

            “Dispatcher to all units we have reports of children trapped inside.”

             It was my first fire with victims trapped. It was the first time that I felt the real responsibility of being a firefighter. Because I rode the rescue, it would be my responsibility to find anyone trapped. If I did not do it then it would not get done. The responsibility was mine. This type of responsibility was why I had joined the department. I had wanted this. Now it was here. I had felt it on medical calls, but now I felt it for the first time on a fire call. This responsibility meant I would push myself to the limit someone else’s life would depend on it. If I did not then I would not live up to the oath I had taken when I came on the department. It would be up to me now. It would include risking my own life if necessary. It was my duty. I wore the badge. It was what this job was about, the risking of your own life for others. It is why I signed up. It was the time to do the deed. To see if I was up to the real thing.

Not waiting to completely dress out, we both grabbed our tanks and ran for the house, frantically donning our tanks on the run. The house was small white wood frame structure, the entire front of the house blowing smoke and flame out all of the doors and windows. The only part of the house that wasn’t blowing smoke and fire was a single window in back of the house. Suddenly out of that window two bunker coated arms appeared. They cradled a baby who could not have been much more that six months old. The baby was smoking. Smoke rose from the baby’s skin and clothes.

            A firefighter off the Tower grabbed the baby from those bunker-coated arms and started running toward us. He handed the very still body to my partner. Donny immediately began CPR. I turned and ran for the truck and the medical gear we would need.

            I remember what a long run it was in boots, bunker gear and an air tank. The image of that smoking baby kept fighting it’s way through the adrenaline, and the thousand and one things I had to organize in my mind. I kept seeing the dirty smoke smudged skin. The babies half open eyes.

I reached the truck and threw off my gear. I started pulling the various medical boxes and equipment we would need. The airway box. The oxygen box. The drug box. The trauma box to bandage her burns.  Before I left the truck I called and received a medical channel so we could communicate with the doctor as soon as possible. I also had them notify the hospital we would be bringing them a pediatric code even before we contacted them on the medical radio.

            As I ran back carrying the equipment I could see Donny sitting with the baby cradled in his arms calmly doing picture perfect CPR. A small group of people surrounded him. When I reached Donny he gently laid her on the ground as I threw open the boxes so we could begin to work on her. When Donny laid her down she started to breath on her own.

            “That’s it girl breathe.” I said as I attached the EKG dots to her chest.

            Donny attached her to the O2. I put the stethoscope to her chest and listened to her lungs. Surprisingly they were clear. I put the dots on her chest. Her EKG was normal. She was continuing to breathe on her own.

She was sloughing skin badly around her face and upper chest. It was coming off in sheets as we worked on her. That meant those areas were in probability third degree burns. Those third degree burns on her face and chest meant we had to suspect she had breathed super heated air from the fire. That super heated air would damage her trachea and lungs. We still had to suspect the damage even though her lungs sounded clear. The ambulance arrived. We covered her burns put her on the stretcher and loaded her into the ambulance.

            Donny and I climbed into the back of the ambulance. She looked so tiny on the adult sized stretcher. Her dirty smoke smudged body was so very still.  But she continued to breathe on her own. Her heart beat was regular and strong.

The smell of her burnt skin and house fire filled the back of the ambulance. We could do little more than had already done. We monitored the oxygen and listened to her chest. Bandaged her burns. It was a short ride to the hospital, with sirens blaring, and the ambulance swaying.

We pulled under the portico and unloaded the stretcher. They were waiting and had the doors open for us. We pushed the stretcher into the trauma room. I gently lifted her limp body and placed her on the hospital stretcher and backed away.  Again she appeared even smaller on the hospital gurney. She was so helpless and dependent. She disappeared behind a wall of doctors, nurses and technicians as they began their examination and treatment. I turned and walked out of the trauma room.

Since we both had ridden in the ambulance with her we were going to need a ride back to the scene to pick up our truck. The departments Chaplin gave us a ride back. It was hard to remember when I felt so much pride in my newfound profession. The system had worked. We had lost so many, but this time the system worked. I can’t remember feeling as good about my job, or the young system that we were all trying to so hard to develop. The exhaustion and how badly she was hurt would hit me later, right now all I could think of was the simple fact that she was alive. It was a great ride back. We had saved her. She would have been given up for dead just a few years before but we saved her with our new skills. It felt great.

            I waited for a week before I checked on her at the hospital. I wanted to find out she was doing. On TV it was always all smiles and congratulations on a great job by the hospital staff. I needed a little of that kind of reinforcement at that point. Successes were rare.

            “Yeah, I wanted to check on the little girl we brought in about a week ago with burns.” I told the burn unit nurse.

            “Sure we sent her to the Shiners Burn Hospital.”

            “Great then she is going to make it.”

            “Yes, but she going to be badly disfigured…blind and deaf.”


            “Yes. Her brain was without oxygen just too long when she coded.”

            I thought I was having a nightmare. What was the point of it all? James English risking his life to rescue her in that tinderbox of a house. The EMS system that worked so hard to save her and for what. What kind of life did we give her? I wasn’t sure we had not done her more harm than good.

It was as if someone had reached in and pulled out my professional life. I felt as if someone had literally kicked me in the stomach. What was the point of all the training and technology if we could not only save this girl; but give her a life worth living. I had saved drunks with their throats cut, but when it counted I couldn’t give a little girl a life. Every shift we helped the people who did not take care of themselves, who had given up and were drinking themselves or drugging themselves to death, but we could not give this little girl a decent life.

            I remember walking back out to the truck in a daze. Neither Donny nor I said anything. In fact I don’t we ever talked about her again and we worked together on and off for twenty more years. What was there to say? We had twenty-two more hours on duty. If we thought about it, if we thought that might be another one like her waiting for us today, I think I might have just gotten out of the truck and gone home. There were no good answers to this one. There were only bad feelings and confusion. Confusion over what my job really was about. Why were we out here? What was the point?

How could her fate so affect me? Where did this come from? It is not like I had not seen death and dismemberment before. I had. It is what I had become a paramedic to do. I wanted to go to the bad ones. I wanted the responsibility. So where was this coming from and why? Why did I care so much about her? Was it my own naiveté being crushed, with the thought that I was not going to save them all? That I was not going to be some kind of hero. Was it more about my own loss than of hers? I do know I was never the same after her. Something began to break that day and would eventually break completely, some part of me that cared too much for my own survival.  The part of me that made me want to become a paramedic. It had to die in order to continue to do the job. At least it did for me. It would be the only way I could survive.             

I thought a lot about quitting for a while. I didn’t and I not sure I can give a specific reason why I did not or how I held on, but things were never the same after her.  I would realize eventually how to manage these types of tragedies that seem to make up the street. The twists and turns of the street left few outcomes clean and neat. They always seemed to have this little nasty twist at the end, especially on the ones where you wanted so badly to make a difference. It was as if there is just no way you can get a clean win. The street always had to win either through blunt force or trickery. The math just never did add up. There was always some sort of subtraction going on, or if you were unlucky like this one, some real multiplication.  But she was my first. She was my first multiplier. There would be many others but she was the first and therefore the biggest. Her math had too many zeros behind it to count. The street had played her first trick on me.

            I could not think about her for a long time, without feeling as if I were walking along the edge of a very deep drop off and if I was not careful I would loose my balance slip and fall. I was not sure where I would land. I had to find an answer to or I would end up slipping and falling.

            So what is a success on the street? How could I measure when I made a difference? If I were going to last on the street I would have to have an answer, maybe not the answer, but my own answer.  An answer that would allow me to go to work and climb on a truck everyday. Without an answer the job would become impossible, shifts were filled with the kind of calls that left no clear-cut outcomes, the math was always off somehow. It would break me if I didn’t have a way to understand them. I saw others who were not able to come up with their own answers and they did not last.

The answer did not come in a day or a week but in years. Years, in which I saw other paramedic’s burnout, quit the program, quit the department, abuse alcohol and drugs to forget. The answer came when I finally lifted my head up and looked at the passage of time and the long string of patients, some of whom I helped and many who I had not. Only by looking back did the perspective of distance begin to give me an answer. And the answer was not one that gave me immediate peace of mind. Instead it only gave me understanding. The answer was a simple one; there is only the doing, the satisfaction that comes with doing the job, not with the outcomes. Do the best you can, and you stop caring about the outcome.

It was the only way I could continue. Others may have been stronger but for me it was the only way. Some may call it professionalism; maybe it is I don’t know. But I do know when you work with people who desperately need your help, it takes some real work not to judge your success or failures by through their living or dying. There is a price to pay for this distance. To loose the distance is to loose the caring piece of you. You loose a piece of yourself. It was the piece that got me into the profession in the first place. This distance you keep can creep like a cancer into other parts of your life to affect the people you love. You become hard in a way that is not always good for you or your family.

The only satisfaction I could find was knowledge that I did try and I had enough of what it takes to climb back on the truck, week after week, month after month and year after year. Trying each shift and every shift to keep getting it done. Knowing full well that there were going to be other smoking babies out there waiting for me. Who no matter how hard I tried, would close the professional distance I worked so had to keep, but who will crawl up close and make me feel the impact again. That old kicked in the stomach, hollowed out feeling. If there is courage in this job, it is the knowing what you will face more smoking babies and still keep showing up and doing the job. She taught me the biggest and most difficult lesson there was to learn out there, one that you can only understand if you can hold on long enough to learn it.

The price you pay for continuing is a large one, because you end up with a long string of smoking baby’s waking you up at and night. Slamming intrusive images into your off duty life. Is it worth it? That is real question each of us must answer, and the answer can change from shift to shift. That would be my struggle through out my career. Was the price worth the service? It was a steep price that at times that did not seem worth it. Each of us had to choose where to draw our lines, when would the price become too much. When was there nothing left to pay the bill the street demands.

The street and those that occupy it, continues no matter how many you times you leave the station, it is a war without end or truce talks, without an armistice or peace. It will always be there. My direct participation has ended, but the profession I helped create continues after I had worn out. Others have stepped forward to take on the fight in that profession. It will extract a high price from each of them. Some will last and some will not. Some will be pensioned out through injuries Others will die in the line of duty.. Yet they continue to step forward to do the job me and those like me helped invent back in those fast hot, exciting, frightening days and nights on the street.


In all the years I spent on the department I never called to find out the out come of another patient.

1 comment:

Anonymous said...

I can't believe no one has commented on this post yet!

Thank you so much for sharing your wisdom and writing so clearly. Although I'll never truly understand it until I go through the same things myself over the years, I feel reading your experience will help me to prepare for it better.

This is a post bookmarked for multiple re-readings!

Thank you for saving the lives of your fellow Paramedics