Monday, March 31, 2008

The Boy Who Went Swimming

The boy was six or seven years old. His eyes were open. He was staring at me. His arms were outstretched and bent at the elbows. It was as if he was going to shout boo to try and scare me, the way you did to your little brother or sister. But he did not say boo. He did not say anything thing. He was underwater.

The call came in as drowning in Station 7’s territory out on the west side of town. Rescue 1 was the only unit with dive gear, divers and the rescue boat. I was the only diver on the truck that day I would have to go into the water.

I jumped into the back of the to dress out as we pulled out of the station. I was tossed from side to side as I tried to get out of my uniform and into swim trunks and the dive gear. It was summer and with no air conditioning in the back of the truck, I was soon dripping sweat in the oppressive Florida summer heat. I struggled into the air tanks shoulder straps, pulled on the weight belt and grabbed my fins and mask. I was ready, but we were still minutes away from the scene. I sat down on the bench seat in the back of the rescue. All I could do now was to wait until we reached the scene.

Engine 7 was already on the scene when we arrived. The lake more correctly an overgrown pond was back in the woods behind some houses. The kind of pond that kids in poor neighborhoods find to cool off on a sweltering Florida summer day.

When I opened the back door to finally get a look at what we had, all I saw were small single story concrete block homes that make up so much of Florida’s poorer neighborhoods. Someone yelled “this way” so I followed them between the homes. I trotted past lawn chairs and chain link fences to reach a well-worn path that lead into the woods behind the houses. The weight of the tank and weight belt began to take its toll as I struggled to keep up the firefighter leading the way.

When we reached the pond we found the guys off Engine 7 were already in the water free diving. I yelled where should I start as I pulled on my fins and mask. They told me somewhere near the middle of the pond. I pulled on my mask and began to swim toward the center of the lake. The water was bathtub warm and the green of most the small lakes in Florida. The visibility was not bad; I could see ten to fifteen feet, for a body of water fed by rainwater runoff that was good. I had been in the water no more than thirty seconds when out of the greenish water those eyes appeared.

I had heard from other guy’s stories of bumping into drowning victims underwater. The face emerging from the gloom and taking them by surprise even though they were looking for them. Those open eyes were so startling. While he did not say boo, he certainly scared me. I grabbed his arm and started swimming toward the shore.

I pulled my mouthpiece out long enough to yell.

“I got him.”

They guys off the engine began to swim to shore with me.

As I swam through the water pulling him behind me I kept thinking of those open eyes. I kept thinking that he looked surprised that I had found him.

I got him to the shore of the shore of the little pond. The guys from Station 7’s rescue were waiting for me. The pulled him out and began to work on him. I pulled off my mask and flippers and stood up. He looked like any other kid in the summer in Florida. All he had on were some shorts. He was in the skinny little boy phase when they are all energy and no muscles yet.

Then I saw his leg. Before I realized what it was. I thought an alligator must have gotten him. One leg was comprised of only his skin over his femur (thigh bone), no muscles, just skin over bone. There was nothing below where his knee should have been. His other legs and arms were normal. Then I realized the skin was intact over the bone, but there were no muscles.

How had a one legged boy gotten to this tiny pond to drown? What string of actions and circumstances had occurred that led someone so obviously incapable of swimming to go swimming? There were no other boys on the scene. In fact we were the only people around. Why did this death have to happen? Did other boys goad him into swimming? Was he trying to prove something to himself or others? I watched as the Engine and Rescue crews worked feverishly over the boy with little success. I walked back to the truck through the peaceful little piece of pinewoods into someone’s back yard. I was tired. I wondered why he had to die. Like so many of the people I worked on, the why was never part of my experience. He was pronounced at the hospital. I never heard the story of why he was in the pond.

She Done Fell Out

The call came in as a woman down. There was no more information. We arrived on the scene to find a small house set well back from the street. The only light came from the open door framing a man standing in the doorway.

            “Hurry, hurry.” He shouted. “She done fell out.”

            We had an extra guy riding with us on the rescue that night. So I was able to head to the house as the other two got the equipment. I felt nervous walking into the darkness alone, but it had come in as a woman down and not as a scene of violence. When I walked in the front door and past the frantic man, I found a woman in her twenties sprawled across a couch. Frank blood was pouring from her nose and mouth. She was not breathing and she had not pulse.

            “I don’t know what happened to her. She just done fell out.” The man said. He kept repeating the phrase as if he were practicing it, as he moved around the room very agitated.

            The other two guys off the rescue arrived as I pulled the woman onto the floor so we could work on her. I could not figure out what was causing this kind of bleeding. But she was coded and we knew what we had to do. I got on the radio and requested an Engine to assist with manpower. My partner started to tube her as the third guy off the truck started compressions.

            Her face was covered with blood, but I thought I saw something on her cheek. I stopped looking for an IV site long enough to wipe her cheek off with a 4x4. There was a bullet hole that had been covered with coagulated blood.

            The guy was walking a couple of feet behind us muttering. “I don’t know what happened she just fell out.”

            That is when I got real nervous. I made the wild guess that this was probably the guy who had given her this bullet hole that made her “fall out”.

            I got on the radio and said.

            “Rescue 1 to dispatch we need code 8 (police) on the scene.”

            “Check can you advise the nature of the request?”

            Now here was this guy who was more than likely shot this woman, pacing the floor three feet in back of us, and the dispatchers wants to know why we need the police. I try and whisper so he won’t hear me.

            “Possible homicide.”

            “Check.” Her replay blares over all our radios. “Possible homicide.”

            I wanted to crawl under the coach. I waited for this guy to go nuts. But he just keeps pacing and muttering. The Engine company arrives, followed closely by the cops. I am feeling safer now with all the company. Soon the ambulance arrives and still more cops. The small house is filled with first responders. The guy keeps muttering.

            “I don’t know what happened she just feel out.”

            The guys off the engine knew the neighborhood and took one look at the patient and began to look for a weapon without saying a word. The guys off Engine 2 were experienced hands who went to scenes of violence with us regularly. They no more wanted to get caught in the middle of a gunfight between the suspect and the cops than we did.

            Finally one of the cops asked the Engine guys.

            “You find a weapon?”

            “We looked for a weapon but could not find one.”

            Our guy suddenly stopped pacing and looks up and says.

            “Gun what gun.”

            Well since no one had even so much as mentioned a shooting or a gun or even what we suspected had happened to the victim, this statement came as something of a revelation to say the least. The room got kind of quite for minute as everyone looked at the guy. The firefighters got busy again working on the patient, while the cops suddenly showed a lot of interest in our little guy.

We loaded our patient and transported her to the hospital. It turned out that the bullet had splintered as soon as it had entered her cheek and severed both her carotid arteries and jugular veins. She was dead the minute he shot her.

            I read about his trial months later in the paper. He was convicted of her murder and sentenced to life in prison. It turned out that he had shot her once before, and spent time in prison for the crime. When he was released and she had let him back into her life.

Sunday, March 30, 2008

Crack Baby

When we turned onto Barlow, it was as if we had made right turn to the mean side of things. The side where baby’s are born in the dark, with little joy or hope. Where the father lies passed out on the couch. And the mother cries through her agony alone. It can take much of the joy of a birth away, but never completely. It is too much of a new life beginning with all that can mean. The date of birth was 4/28/88 at 2311. It was a small concrete block dark house with no rugs on the concrete floors, and no air conditioning on a short sandy dirt road. There had been a murder on this same street just recently. The front door was wide open. There was no one there to greet us and there were no lights on in the house. Jeff and I approached the door cautiously.

“Fire department!” I said.

“In here.” A female voice yelled.

We found a woman laying on a dirty double bed with the phone lying beside her. There was no other furniture in the room. Only a black light like those used in the sixties light the room.

“He came. He already came. Is he all right?” she said.

She still had her shorts and panties on, but there was a large bulge visible. As Jeff and I cut her shorts and panties off we questioned her.

“How many babies that lived have you had?”

“Six. The doctor said this one was late. May or June. I thought it was late April or May. Is he all right?”

When we had cut off her shorts and panties we could see the baby. He was so small. Almost too small to be believe he was a real baby. He looked like a crack baby. A full term baby that weighed less that three pounds. The umbilical cord still ran back into the mother.

The baby was not breathing. Jeff started to clean the baby off hoping to stimulate his breathing. Nothing. He began thumbing his finger on the soles of his tiny feet to get him breathing.

I dove into the emergency childbirth kit. Actually a very fancy word for a cardboard box with a bag for sterile gloves, paper sheets, bulb syringe, umbilical clamps, scalpel and paper blankets. I tore open the bag and handed him the bulb syringe so he could suction out the baby’s mouth.

Next I dug for the two clamps for the umbilical cord. You place two clamps on the cord and cut in the middle. Six inches from the vagina you place the first clamp, then two inches and you place the second. The clamps keep the mother and baby from bleeding out after the cord is cut. They both have large blood vessels within the cord. It is how the baby is supplied with blood, oxygen and nourishment during gestation. If you just cut it without a clamping it with two clamps you would lose both the baby and the mother. But I could only find one clamp. One clamp. How is world do I end up with the only kit in the world with only one clamp?

Jeff was working frantically to stimulate the little boy to breath, but was till having no luck.

The only light in the bedroom was a black light, a black light why were these births always in the dark. The black light made my hunt for the second clamp in the kit even more difficult. Jeff and I are holding our mini-mag flashlights in our mouths to keep our hands free. So was we talked our words a jumbled around the flashlights. If it was such a serious situation it would have been very funny.

“He is not trying to breath we need to get that cord cut.” Jeff says.

A baby will not try and breath on their on, as long as they remain attached by the umbilical cord. We needed to cut the cord to stimulate the baby’s breathing.

“I can’t find the other clamp.”


The engine company who had been dispatched with us has just arrived.

“We need another child birth kit.”

One of the firefighters turns and runs out to the engine to get the other kit. Jeff continues stimulating the baby thumping his finger repeatedly on the soles of the baby’s feet. He is starting to respond to Jeff’s stimulation. He has a good heartbeat but he is still not breathing well. The firefighter runs back into the room and hands me another kit. I tear it open and find a second clamp.

“Six inches from the baby.” I recite to myself.

I place the clamp.

“Two more inches.”

I place the second clamp.

I tear open the package containing the sterile scalpel and cut the cord between the two clamps. Blood flies everywhere. Suddenly I am very aware of the blood. The mother is obviously someone with the types of behaviors that could lead to AIDS. Now I am going to have to worry about an AIDS exposure if I am not careful, even with our gloves and goggles on. But there is no excessive bleeding. Good then the clamps worked.

Once the cord was cut the baby begins to try to breath, but he not moving much air.

“We are going to have to try and tube him.” Jeff says.

He grabs the lyrnascope, and a pediatric blade. I pull out a pediatric tube and compare its size against the baby’s little finger. That is the rule of thumb for the size he will need. It takes the smallest tube we have. Jeff tries to insert the blade into the baby’s mouth.

“He trying to bite the blade.”

Jeff reapplies the oxygen and again stimulates the baby by thumping the soles of his feet with his finger, the baby’s breathing gets much better. He pinks up nicely, showing he is oxygenating well. His color finally begins to look normal.

It is time to run for the hospital before any more problems crop up. But the ambulance still has not arrived.

“Rescue 7 to Dispatch can you give me an ETA for the ambulance.”

“Rescue 7 check standby.”

We begin to package up the mother and baby to get them ready for transportation when the ambulance gets there.

“Dispatch to Rescue 7 they are advising a six minute ETA.”

Jeff and I look at each other. Without a word passing between us we know that could mean a lot more time than six minutes. We do not want to wait that long.

“We going to have to transport.” I said.


Jeff is busy with the baby. So I grab a guy off the engine and we go out to the rescue. While we can transport a patient, but the rig is not ready. We have our fire gear on the floor in addition to other gear on the stretcher. I pulled the Thumper, an automatic CPR device and throw it on the bench seat. I pulled the backboard off the stretcher and cram it on the floor. I jam our firefighters bunker coats, pants and boots into the corner. I can finally pull the stretcher out of the back of the rig.

The firefighter and I are able to get the stretcher into the tiny apartment, but we could not make the turn into the bedroom. The father is finally starting to wake up with all of the commotion around him. He sits up groggily on the couch. We run over his bare feet with the stretcher, but he says nothing as he sits rubbing his eyes.

Jeff has wrapped the baby in everything the kit carries to keep him warm. The bundle seems too tiny to even be a doll much less a real baby. We load the mother onto the stretcher and struggle past the still groggy father. He says nothing as we leave with the mother and the baby.

I jump in the front of the rescue and Jeff jumps in the back with the baby and the mother. One of the firefighters off the engine jumps in the back to assist Jeff on the ride to the hospital.

I the radioed the hospital that we were en-route and what we had what appeared to be a crack baby. It was silent ride to the hospital and the mother rested and Jeff monitored the baby. When we pulled into the portico and unloaded the stretcher a physician and nurses from the pediatric intensive care waiting for us. We handed the mother and the tiny baby over to the waiting team. They rushed them into the emergency department.

We followed the team into the hospital. Walking into the emergency department was a startling contrast to the dark black light lit dirty apartment. It was a bright modern hospital with all of the best equipment and trained personnel waiting for the baby. We had jerked him from the poverty and hopelessness and thrown him into a high tech world waiting to try and save him so he could go back to the dirty black light lit apartment.

Jeff and I stood there watching as they work on this tiny human baby whose life was just begining. He turned out to be a crack baby, full term yet weighing only two and half pounds. Mom was a crack addict. Despite the circumstances I still felt a sense of joy at a new life starting, but it was colored by the realization of just what kind of life he was going to face.

Jeff and I watch them work on him for a while, then did our paper work. We re-stocked our supplies and went out to the rescue to put it back together for the next run. We had several more before we got off duty the next morning. I never check on him or how he did. I had learned the hard way over the years that did not always lead to any good answers. I still think about him and it has been almost exactly twenty years as I write this. I wonder how his life turned out.

Tuesday, March 25, 2008

Mostly at Night

You finally get back to the station sweaty and exhausted. You just came back from a shooting, stabbing, accident with injuries, take you pick. All you can think of laying down before you get another run. You fall on you bunk not even bothering to take off you clothes. You just luxuriate in the in the wonderful feeling of being in bed.

As soon as you close your eyes your right back in it, a series of black and white close ups of the scene fill your head. Always closes ups. Other times it is a slow motion reply, again and again rolling through your head. A running commentary goes as the scene gets played back in your head. “What did I miss?”. Could I have started the IV faster? Put the tube down faster? Should I have scooped and run instead of getting the IV first? Should I have checked the breath sounds sooner? But it is always the pictures. Blood matted eyelashes. The man with no face after he put a shotgun under his chin. Two bunker coated arms thrusting out of a smoke filled window a still smoking baby cradled in the hands. The house blowing fire out of all the windows. The half open eyes of someone you know is dead but who you still have to work. The images never go away. Sometimes they won’t let you sleep. You get up and wander into the ready room and stare at the TV but not really watching, people are laughing at some joke on the Tonight show. You stare the TV not really watching it until 3am when no matter what you finally might be able to go to sleep. So you stumble over to your bunk and fall into a semi sleep. Hopefully those images don’t follow you home but some do. Some stay fresh for years. And now for decades. They crawl out from behind the wall you construct. It is mostly at night. 

My Felony Arrest

Charlie and I had just finished a run at one of the shopping malls. We were driving away from the mall, when two men suddenly burst out of a store. Their arms are piled high with suits. Two store personnel follow closely yelling and gesturing wildly. Apparently those two guys were trying to get away with a snatch and grab, but there was no getaway car in sight. So these guys were trying to do a world record sprint with 25 suits in their arms. They are leaving the store employees in their dust when they look up and see us and the rescue truck.

            Once they see us they throw away the suits, and take off across the parking lot. Now my partner and I aren’t quite sure what to do. I finally said “follow those guys.”

So we turned on the light and sirens and started to follow these guys across the parking lot. I got on the radio and advised the dispatcher we were in pursuit of two possible robbery suspects and we needed law enforcement as soon as possible before we caught these guys. What were we going to do with them once we caught them?

You have got to picture a large rescue truck with two guys sitting in air conditioned comfort chasing/following two guys frantically trying to out run the truck. These two guys kept looking over their shoulders as if to say “What in the fuck is going on? We can’t even do a simple rip off right.”

            We continued to follow these guys as they ran across the parking lot and around a bowling alley, where they finally stopped exhausted. Now the worst happened. They stopped. Now what. The cops were still not there.

            Charlie and I jump out and stand by the truck. The guys were about thirty feet away. I thought that was close enough. So I gave them my best police officer pose, hands on hips, leave my sunglasses on and try to look tough.

            “All right now you guys just stay right there. The cops will be here any minute.”

            Well these guys start to catch their breath. The begin to realize that here are two dummies with nothing but radios and paramedic scissors on their belts telling them to wait so they can be arrested and carted off to jail. This does not seem like a very good idea to one of them. He takes off running.

            I figure one out of two ain’t bad for two unarmed paramedics. I am satisfied. But Charlie is off like a flash and grabs this guy and throws him back with his partner. I cringed, Jeeze Charlie don’t make him mad.

            “Now stay put.” Charlie yells.

            They look at one another then at us. You could see them trying to decide if they were going to stand for this. I mean two paramedics, who is afraid of a paramedic.

But before they could come to a decision a cop coming rolling up and jumps out of the car. If you think the looks the robbers were strange. you should have seen the look this cop gives us as he pats down the suspects.

            When we pulled into the station we into the station the word had already gotten out. We got a hard time about trying to be cops for a long time. There was even a cartoon in the department newsletter. It showed Charlie grabbing the guy while I stood with my hands in my pockets. The caption was “count me out.” I was known for sometime as Count Me Out Huder.

O2 and Transport

We received a call one night for a miscarriage. The addressed turned out to be a dilapidated rental house in a poor section of town. We found a sixteen-year-old girl lying in a huge pool of blood. A single bare light bulb illuminated the scene. She lay in this rectangle of harsh white light, her blood black in the light. It was as if someone had staged a stark black and white picture of the life that led up to this. A tiny fetus still attached to the umbilical cord that lay between her legs. She laid half in and half out of the tiny bathroom.

            She was only dimly conscious. Her pulse was barely discernable and I was only able to palpate a blood pressure. I immediately got on the radio. We were going to need orders if we were going to do any good for this girl. We needed orders to start any type of advanced life support and that is exactly what she needed. I talked to medical communications and they got me through to the hospital.

            “This is paramedic Huder number 104. We have a sixteen-year-old patient who aborted an approximately two-month fetus. She is conscious, cool and diaphoretic to the touch. The patient has lost approximately 1000cc’s of blood and is still bleeding frank blood from her vagina. The fetus is still attached to the umbilical cord appears to be attached to the uterus.

            Blood pressure is 50 palpable, her pulse is 120. We have her on six liters of O2. I would like permission to start 2 IV’s of lactated ringers before transport to your facility.”

            I waited for the hospital to reply. This was the type of call I had become a paramedic. We could help. We could make a difference. She needed fluid replacement. It would help stabilize her before we got her to the hospital. Every second counted.

            “Standby.” The voice on the radio said.

            Standby what in the hell do I need to standby for, just give me the order and lets get this show on the road.

            “ Rescue 1. Place your patient on O2 and transport immediately.”

            “ Repeat.” I couldn’t believe it.

            “Place your patient on O2 and transport immediately.”

            My partner and I just looked at each other. The wrong doctor was on duty. He never gave orders. We called him O2 and transport. Now he was pulling his shit on this little girl.

            What in the hell was I out here for? Why had I gone through all the training? Why was putting up with all the shit from the other firefighters. If we were not going to be able to do the job, then lets stop playing around with people’s lives. I never knew if or what kind of orders I would get when I called the hospital, but this…

            My partner and I carefully loaded her up as quickly as possible into the ambulance when it arrived. It was a silent ride into the hospital. All we could do was hold her hand and try to say a few comforting words and wonder why we were out on the street.

A few minutes later the ambulance pulled under the overhang at the hospital. We carefully unloaded her and rushed her into the room where the nurses directed us. We stood there alone with the girl for several minutes. We had not been guided into the trauma room, but instead we had been shown into a normal room. There was no team waiting for us.

A nurse finally walked in and took one look at our patient and us. She immediately turned and rushed off to find the doctor. Apparently they had not believed our radio report. After all we were just paramedics. When he arrived he immediately ordered two IV’s and called for the trauma team.

We could have given her those IV’s twenty minutes ago. I turned and walked out of the room without saying a word. I couldn’t watch. She needed those IV’s when I called for them. These were the early days and this was the game. You never, ever questioned a doctor. If you did there was a real chance that the next time you needed an order you wouldn’t get it. Even if you didn’t get one this time, you truly never knew what would happen the next time out. The nurses thought we were after their jobs and resented our pay which at the time was better than theirs. Many of the doctors did not trust us, we were too new. One call you would get the orders you needed. The next time there were no orders. So you kept your mouth shut and hoped for the best. Maybe next time. But it didn’t help the 

Still the same

I have discovered the EMS blogging world in the last weeks. I have read a number of the blogs. There are new medic blogs, old medic blogs, funny blogs and sad blogs. All the stories, all the concerns and challenges they face every shift. It is as if I wrote them thirty years ago. So much has changed but so much remains the same. Worrying about putting a tube down. Working as a paramedic by yourself for the first time. Working on patients who die no matter how hard you work on them. It is all the same. I have experienced every single emotion and challenge I read about in those blogs. The street does not change. It still presents everyone with the same challenges it did in the 1970's. The equipment and training are better but the patients and the challenges they present are the same. We were making it up as we went back them. Even with all the experience and training of todays medics the street still demands that a good medic be able to make it up when something new and off the wall faces them. The struggle to become a good street medic continues through out your career. You struggle to care about your patients after you seen the same thing a thousand times. You try and steel yourself against seeing people die but you can end up walling yourself off from your patients. The challenges will always be there. It never gets easy or routine. Every time I got to feel comfortable think I had it all wired the street had a new surprise for me. The man with no arms (run over by a train). The plane crash in a tree with patients trapped. The man with no throat (a cancer that had "burst") for lack of a better term. Double shootings. Children with a gunshot would to the forehead where the bullet did not penetrate the skull.  Some many codes with so few saves. And so many more I have begun to forget them. Now after retirement it is good to know that there are good young people who are carrying on where us early guys left off. How do I know they are good because they are struggling with the right things. They are trying to get it right. They care. In the end that is all there is, the only things that counts is getting it right. The outcomes don't matter. The saves don't matter. What matters is getting it right. If you can treat each patient to best of your abilities and know you did your best then that is all there is. It was a difficult lesson for me, one that I cared too much for too long and it cost me. Eventually after much effort, I got so I could feel good about a call even after I had lost a patient, because I knew that I had provided the absolute best care that I could. I had given that patient the best possible chance of surviving. But they were too sick or too injured to save no matter what I did.  I demanded that level of care of myself and everyone else on the scene. I was a professional. If I was able to help someone, save someone then that was icing on the cake. The real challenge and it never slackens is to provide the best care possible. It is never easy. 

Thursday, March 20, 2008

Things Could Creep over the Wall

It was just another possible Code 7 (dead) call. We responded to these types of calls regularly. It was in a high-rise condominium for the retired that dot the downtown landscape. We found a woman in her eighties lying half in and out of her kitchen. She was cold and stiff. She had been dead for some time. We cancelled the Engine and ambulance and requested the police and the coroner. My partner went downstairs to show the cops to the condo. I was left alone with the body.

As I sat there I could she what her last minutes had been like. She had vomited on the counter in the kitchen. You could see where she tried to clean it up. Then she had vomited again, this time she did not try to clean it up. People frequently vomit during a cardiac. She had staggered out of the kitchen and fallen. Her last moments were laid out so clearly. I could almost see her trying to clean it up. Scared. Not sure what was happening. Then feeling that crushing pain of a cardiac, staggering then falling. People don’t necessarily die instantly from a cardiac. There was a good chance she had laid there for some time by herself. Half conscious. In pain. Having trouble breathing. It was all there in front of me.

She had lain there for God knows how long with no way of summoning help. What were her thoughts during those last minutes? Did she think back on her life? Did she remember an old love? Or think of the regrets one has over what might have been? Or was her last minutes filled with the terror of dying alone and uncared for.

I was alone with body for some time. I squatted down and leaned against the wall. The security Guard who had let us into the condo had told us that she had lost her husband of some fifty years just two months prior. I had seen this happen a number of times. A wife or a husband would die and the other would soon follow, many times with no history of significant illness. They died from the weight of their own lives, without someone to share the load. It just was not worth it anymore. The loneliness and isolation of old age were some of the deadliest of diseases.

I sat there for some time with her waiting for the cops to show up. I did not look around the apartment. I did not want to know too many details of her life. Her death was sad enough for me. I hoped that she knew that there was someone who mourned her and was saddened by the loneliness of her death.

When the cops showed up they were laughing and talking loudly. It did not seem right, they were defiling the scene. But I had done the same thing countless times and would do so in the future. They had their walls up. I had just happened to let mine down that night for what ever the reason. I said something about how she had died alone. They looked at me a little strangely as I left. I guess I could not blame them. 

Sunday, March 16, 2008

I took the gun away

            We had a shooting one afternoon. It was a beautiful sunny, spring day. I could never understand violence on days like that. We arrived with Engine 2. A man was sitting quietly on the front porch of a rundown shanty. We almost walked past they guy, until I saw the blood on his shirt. As usual the police are nowhere insight.

            I began to exam him. He had been shot three times in the shoulder and chest. He was conscious, alert and showing no real signs of distress. The engine company and my partner begin to bandage his wounds. I set up an IV. I was looking for a vein when I heard the patient say.

            “I shot him do you want the gun?”

            I almost put the catheter through the patients arm. I looked back to see my patient handing a pistol to the Lieutenant off the Engine. The Lieutenant smiles and says.

            “Sure. I think that would be a good idea.”

            We finish patching they guy up and load him into the ambulance. His vitals remain stable. I ride in to assist the ambulance paramedic. As we head for the hospital the patient is still sitting up talking in stable condition showing no signs or symptoms of being shot three times except for the three holes in his body. He looks at me and says.

            “You know I didn’t think that little motherfucker was serious after the first shot. Shit when he shot me two more fucking times I thought “this little motherfucker is tryin to kill me.”

            I almost fell of the bench seat in the ambulance.

            “So I took the motherfuckin’ gun away from him.”

            “But…” I sputtered. Somehow I did not ask how the other guy got the gun back. 

            What was there to say. This was one tough guy. I treated him with great respect the rest he way to the hospital. The more you see, the more you don’t know.              

Just another Code 7

            It was just another possible Code 7 (dead) call. It was in a high-rise condominium for the retired that dot the downtown landscape. We found a woman in her eighties lying half in and out of her kitchen. She was cold and stiff. She had been dead for some time. We cancelled the Engine and ambulance and requested the police and the coroner. My partner went downstairs to show the cops to the condo. I was left alone with the body.

As I sat there I could she what her last minutes had been like. She had vomited on the counter in the kitchen. You could see where she tried to clean it up off the cabinets. Then she had vomited again, this time she did not try to clean it up. People frequently vomit during a cardiac. She had staggered out of the kitchen and fallen.

She had lain there for God knows how long with no way of summoning help. What were her thoughts during those last minutes? Did she think back on her life? Did she remember an old love? Or think of the regrets one has over what might have been? Or were her last minutes filled with the terror of dying alone and uncared for.

I was alone with body for some time. I squatted down and leaned against the wall. The security Guard who had let us into the condo had told us that she had lost her husband of some fifty years just two months prior. I had seen this happen a number of times. A wife or a husband would die and the other would soon follow. Many times with no history of significant illness. They died from the weight of their own lives, without someone to share the load. It just was not worth it anymore. The loneliness and isolation of old age were some of the deadliest of diseases.

I sat there for some time with her waiting for the cops to show up. I hoped that she knew that there was someone who mourned her and was saddened by the loneliness of her death.

When the cops showed up they were laughing and talking loudly. It did not seem right, they were defiling the scene. But I had done the same thing countless times and would do so in the future. They had their walls up. I had just happened to let mine down that night for what ever the reason. I said something about how she had died alone. They looked at me a little strangely as I left. I guess I could not blame them. 

I am going to die aren't I?

It was just after noon on one of those scorching hot Florida summer days. I was on Rescue 1 with Mike Mahoney. He had been traveled in to ride with me. My normal partner was on vacation. We got a call for a shooting. A child was involved.

I worked Rescue 1 through traffic to a small ramshackle wood frame house. All the doors and windows were wide open. It had no air conditioning. We found a young boy about twelve lying on the couch. He had a hole the size of my fist just below his clavicle. He was staring up at us with frightened eyes. Silent. He did not cry or ask for help he just laid there.

It seems he and his brother or cousin, I never got he story straight, were playing with a 30-06 rifle. Somehow it went off. The rounded entered his back just below the shoulder. When it exited, it blew a hole large enough to put your fist in just below the clavicle. A huge artery runs just under your clavicle, if the bullet had lacerated that artery there would not be much we could do for him, but there was almost no blood from the wound. He was pale, cool and diaphoretic.

He was conscious and alert as Mike and I began to work on him. We bandaged his wound as best we could. With a wound as large as his was it was difficult. The best way to bandage a wound is to wrap it and get some pressure on it as you tighten the wrapping. We could not wrap it. It was too big, and in the wrong place to get a good purchase with the Kling.

By now the house was filling up with responders. Engine 2’s crew was there to help us. The normal noise of the organized chaos found at a shooting scene soon filled the house, as firefighters and police officers work side by side on completely different planes. Fire and police radios were blaring. The Engine Company and the ambulance crew were working around everybody and getting things organized enough for transport. The cops asking questions and looking for weapons while firefighters moved equipment and furniture around as we worked on the boy.

We started two IV’s to try and replace the blood he had lost until they could get some whole blood in him at the hospital. He remained conscious through out the treatment, watching us with big frightened eyes that seemed to realize just how badly he was hurt. So I started to talk to him as we worked on him.

“Look partner we are going to get you bandaged up and ready to go to the hospital.”

“ I am going to start an IV now. There is going to be a pinch, so get ready.”

“You need another IV in the other arm get ready again.”

He just watched everything with those big frightened eyes.

With no air conditioning in the small house and the dead of a Florida summer, we were all soon dripping sweat. I called the hospital on the telemetry and gave a report.

“He’s missing a finger.” Mike said.


“Yeah, the bullet must have taken it off as it exited.”

Mike doing a good secondary examination of the boy found something that had been missed in the initial exam. It was something I was not really worried about given; he was not going to die because of that finger. But if we could find the finger, it could be re-attached.

“If somebody can find it. That would be great.” I said loud enough for the firefighters and cops to hear. There was suddenly change in the clamor and they began to look for the missing finger. Mike and I continued to package the boy up so we could transport him to the hospital. We had him on oxygen, his wound had been bandaged as best we could, we had two IV’s and he was stabilized on a backboard. We needed to get moving.

“Anybody find the finger?” I said.

A number of no’s and negatives came back from the firefighter and cops.

“We got to go. If you find it send it to ORMC.”

Mike and I loaded the boy into the back of the ambulance with the ambulance crew. I jumped into the back of the ambulance to ride in case any other treatment was necessary. I remember it as an initially a silent ride. He just watched the ambulance paramedic and I as we double checked his blood pressure and monitored his IV’s.

“How ya doing?” I asked

He just looked up at me. I made the sure the IV’s were still in place and the fluids were running wide open into his veins.

“We’re going to be at the hospital in just a minute. So hold on.”

He looked up at me with those big frightened eyes, IV’s running into each arm and a huge bandage on his shoulder and said.

“I’m going to die aren’t I?”

What the hell was I supposed to say to a 12-year-old kid with a bloody great hole big enough to put your fist into his shoulder? I did not know if he was going to die. But I said.

“Look your badly hurt, but your not going to die.”

He had caught my moment of hesitation. He knew I was either lying or I did not know.

“I am going to die aren’t I. Damn it.” He said. He was mad I was trying to lie to him.

Suddenly I was mad too. I was mad at whoever it was that left a 30-06 with some kid who did not know what he was doing, so he could blow a bloody great hole in his shoulder. I was mad at the kid for asking me if he was going to die. How in the world did I know? I was just a new paramedic trying to do my best to keep him alive. I’m not god. I’m not a doctor. I was mad because he caught me in my hesitation. He had seen through me. By catching me he had opened me up. He knew I was as scared for him as he was for himself.

“Listen goddamn it. You are not going to die.” I said. “You stay mad. Do you understand? If you stay mad and fight you won’t die.”

I believed it. I had seen it work enough to believe it. I only hoped the kid would believe me. We rolled him into the Trauma room. He was soon lost in a crowd of doctors, nurses and technicians. I pulled the doctor aside after he had examined the boy and ordered the procedures and tests necessary.

“Doc is he going to live?”

“Probably but that shoulder. That round made a mess of that shoulder. Most of the muscle has been destroyed, I don’t know what kind of use he will have of it.”

I said thanks and left him to the doctors and nurses. Mike and I restocked the truck and replaced the IV’s and administration sets we had used. We got back on the truck and went off to finish our shift. But that boy has stayed with me all of these years.

I never found out what happened to him. They shipped him up to surgery and he disappeared. I called a week or so later but the hospital was unwilling to give out information out patient information to paramedics. So he disappeared like the vast majority of my patients. The only one’s whose outcomes we knew for sure were the one’s who died when we were there.

But he had taught me something. Something that I would use for the rest of my career, that was to never to exaggerate or lie to a patient, if they were going to survive they would going to have join the fight. Tell them as much of the truth as you know it. I had seen enough to know that patients died who I had thought would live, and patients lived who I thought would die. So I decided it was not my call to tell them but if asked I would tell them the same thing I had told the boy. We were there trying to help, we were going to deliver them to the hospital who will continue that fight so join us in that fight.

Four Codes

            I did something that night that I had never done before or since. It started like any other shift. We were busy with the normal man down, accidents with injuries and cardiacs. But I felt something coming; something big. We were standing in dispatch after one of our calls getting our times for our report when I could not get over the feeling and I said.

            “We going to have something big tonight. I can feel it.”

            It’s funny because I remember that instead of laughing at me, there was kind of a moment where everyone just kind of looked at me. Then we all just moved on with our jobs. I did not know how right I was. I still don’t understand where the feeling came from. I was very new and everything was very intense. Maybe that intensity somehow provided the instinct to sense the thing that was waiting for us. The thing that we would have to deal with. The thing that changed my life and many of those who responded that night.

 The call had come in as smoke in an apartment building. We arrived with the full first alarm assignment arrived at the apartment building. Nothing was showing, nor was there anyone to meet us. It looked like another false alarm or a pot on the stove.

So at three in the morning I am dressing out slow and walking to the two story concrete structure with the other firefighters. I listened to the radio as the various units walked around the small apartment building trying to find the origin of the smoke. It was a small two story concrete block apartment complex with a sand parking lot. Nobody was finding the origin of the smoke order.

I was just behind Lieutenant Baker when he stopped in front of a window.

“Here it is.”

The window was completely obscured by smoke and condensation. We pulled on our masks. Lt. Baker crawled through the window first.

When Baker crawled through the window he looked right. When I crawled through the window I looked left. That’s when I saw the young woman lying on the floor just short of the door.

“I got a victim!” I yelled through my mask. I crawled over an overstuffed chair and bent down to pick up the woman. The door flew off the hinges. The guys off the Tower had heard me and had forced the door. Gary Woodward off Engine 2 grabbed the woman’s legs while I picked up her upper body and we moved her out onto the bare concrete outside the door. Tower and Engine firefighters rushed past us into the apartment as we laid the woman down.

            I pulled off my mask and helmet and put my ear next to her nose and mouth and felt for a carotid pulse in her neck. Gary had his hands poised above her chest waiting. She was not breathing and she did not have a pulse. I leaned down and gave her two quick breaths, still nothing.

            “OK, start.” I said and Gary began compression’s on her chest. No bag valve mask this time, it was skin to skin. Each time I gave her a breath I felt her cheeks expand against my own. I could feel the coolness of her skin against my own. She wasn’t that old, very close to my age.

            “One-one thousand, two-one thousand, three-one thousand, four-one thousand, five-one thousand,” Gary counted as he gave compression’s. I gave a breath.

            Suddenly I had time to think as I waited for each fifth breath. Until now everything had happened too fast, now there were seconds when a whole world of impact could sneak in and it came in from all sides. I was smelling her. It was the unique dirty, greasy smell of a house fire, that clung to her now as I waited my mouth an inch from her own.

            “Five one thousand.” I gave a breath. Her cheeks expanded against my own as her chest rose. The house fire smell filled my nostrils. She was covered in the greasy sooty ash a fire leaves on people, but the smell is what I remember.

            “Somebody get my gear.” I yelled. I need all of our ALS equipment from the truck.

            “Your partner’s gone for it.” someone yelled.            

            I gave another breath.

            “Will someone get my gear” I yelled again. I felt so helpless. I was railing at the situation more that just yelling for equipment. It had happened so fast, with none of the usual-flame-showing-get-in-there-and-find-a-victim buildup. No it was as if I climbed through a window and fell off the edge of something into the middle of this.

            I could hear glass breaking and furniture being turned over as the crews searched the rest of the apartment. My partner showed up carrying the equipment. I moved away from the woman so he could put an endotracheal tube down to control her airway.

            “We got another one.” someone yelled.

            I looked up to see another firefighter coming out of the apartment with the small limp body of a child. He was doing CPC with the child cradled in one arm.

            “I got another one.” Another child was handed out to one of the Lieutenants standing outside. He immediately began CPR.

            Somebody had brought Circle D lights off one of the trucks and the area was suddenly brightly lit by glaring lights. It was as if someone had turned the world into a black and white photo essay. Suddenly all the color had been washed out of the world, because I remember the next minutes in a series of black and white still images.

            The firefighters bent over the small still bodies. The baby’s arms hanging limply as one of the guys cradled the limp body close, pressing its chest with two fingers and blowing gently into its mouth. A police trainee in his tan uniform accompanying one of the cops looked on with stunned horror on his face. He seemed lost, as if he were wondering how in the world he had ended up here. I knew how he felt, I wondered if I looked the same.

            As I continued CPR it was as if someone had connected my emotions to the cable then started to slide through the channels. Each channel brought up a different, completely separate set of emotions, and each new emotion created a different impact.

One moment I had to fight the urge to turn my head and vomit. The body odor of the woman mixed with the stench of the smoke created a totally unique smell I would never forget. Then the unseen hand changed the channel on me. Tears this time, it was all such a goddamn waste, a nothing fire and all this death. Panic surfaced next, what in the hell were we going to do with three codes.

            “The ambulance is here.” someone yelled.

            It brought me out of my reverie. I gave a last breath then turned over my place doing CPR on the mother to another firefighter. I jumped up and ran to the unit.

            “We’ve got three codes working.” I told the paramedic off the ambulance, ”Two of them ped’s. We’ll work the woman here and transport the ped’s to the hospital.”

            The paramedic off the ambulance jumped out with his equipment and ran for the apartment house. I was close behind. I would stay behind with my partner and the paramedic off the ambulance.  We would work on the woman I pulled out of the apartment. The ped’s codes are best worked at the hospital, and it was only five minutes from the scene. We could work the mother through another hospital on the radio. Three pediatric codes were going to stress that one hospital enough, without working the mother too.

            When I got back to the scene. The Assistant Chief for the shift looked at me and said.

            “What do you want to do?”

            “We’ll work the woman here and transport the codes.”

            “Sounds good.”

            I do not know how I decided to take kids to one hospital, and leave the woman for the three of us to work. It was as if some computer somewhere separated from my emotional turmoil had been fed this information and spit out the answer. I did not know where it came from or how I arrived at the answer, but it was the right answer. By the time enough rescues and ambulances could be summoned to the scene to work all the codes, we would have the patients in the hospital.

            Just as I ran up to the scene behind the ambulance paramedic a rookie fireman stepped out of the apartment with another child cradled in his arms. He was not doing CPR, he stood there with a completely stunned and horrified look on his face.

            “Give her to me.” I said.

            He handed the small limp body to me, she was less than a year old, I cradled her in my arms as I started CPR. Small breaths from my cheeks, two fingers on the little chest.  I felt that ever so soft baby skin against my own as I blew into her nose and mouth. The smell of baby and smoke all mixed together, the taste of smoke on her skin, the sounds breaking glass, radios blaring, firefighters moving past into the apartment, all combined into an overwhelming whole. I had to again fight through it all and keep working CPR. We needed to get out of there and get the kids to the hospital.

            “We taking the kids to ORMC. Let load up.” I said between breaths.

 The two other firefighters working codes on the other two children walked out to the waiting ambulance with me, all of us continuing to work on the children. The feel of that little limp body in my arms, I had never felt a body so limp before. I struggled to keep my composure.

She was limp in a way that only a dead child can be. It was the first time I felt that weight. It would not be the last time, but it was the time that took me across the line that separates us from those that have not felt that weight. Those that do not carry that weight for years the rest of your life after you have picked it up for the first time.

 We all climbed in the back of the unit. It was a very silent, no sounds except for the occasional hushed words of someone counting to himself under his breath, counting chest compression’s . No sirens needed this time of night, the street were deserted. Again the kaleidoscope of emotions, washed over me as I worked the little girl. I fought back tears as I stopped to wipe some of her burnt skin from around my mouth. Her half-open eyes stared up, the stare that said what made that person who and what she was no longer there. Those half-open dead eyes, that somehow reached deeper into me that eyes of living person. 

            It was a short quick ride to the hospital. A security guard opened the back doors and the three of us with our small still burdens piled out. We ran into the ER where three teams of physicians and nurses waited for the children. I laid my little girl down on the gurney and backed away. She looked so small on the large stretcher. So alone on that big white streatcher. Soon she was lost behind a wall of hospital personnel as they worked frantically over her. Another doctor rushed in to help. He asked one of the nurse’s what happened.

            “It was a fire. They found them after.”

            “No, we didn’t.” I exploded. How someone could say we found them after the fire infuriated me, it was as if she were saying we were waiting until it were safe to go in and look for victims. “I never saw the fire. We had them out before we even put water on the fire.”

            Somehow this was important as if would have made a difference. When I knew it would not have really.

            The doctors and nurses worked frantically as the three of us stood staring. Three guys in bunker gear smelling like a fire. Part of the real world smelling up their professional environment. We said nothing to one another or to the doctors or nurses. We just stood there watching. What was there to say? We all knew somewhere what the outcome would be. I don’t think we could say anything. Then one by one they stopped. It had been too late. No responses from any of them. They were all gone.

            We remained silent as the ambulance driver rounded us up and said he would take us back to the scene. We rode back with just the creaking of the rig breaking the silence. For the next twenty years I would see one of those men and that night would come back strong. We would just look at each other, sometimes we would say.


            “Yeah. Yeah I do.”

            That would be it.

The units were still on the scene as we crawled out of the back of the ambulance. My partner had gone with the woman to another hospital by a second ambulance. Everyone was standing around with little to do. It had been a tiny fire, some clothes left on an ironing board. But the fire had slowly produced enough toxic gases to kill everyone. Apparently the mother had awakened and tried to get to the front door where I found her. The three children were in the back, the room of the fire’s origin, they never had a chance. So much tragedy rolled up into a small apartment.

            Larry came back and we were standing with the other firefighters trying to get some control over all that had just happened, when the radio blared.

            “Rescue 1 can you go available for a call?”

            I reached for my radio to reply.

            “Check.” Incredulous I looked over at the Chief you had just answered for us.

            “We got it you go ahead and go available.”

            I felt no more capable of handling another run than I did of running a marathon. If you shook me then I would have rattled, there was nothing left in my tank emotionally or physically, I was running on empty. Back then the stress of these types of runs was not recognized. There was no Critical Incident Stress team to help you sort your way through these tragedies that effected you, almost as much as it effected the victims, you were on your own.

            “Rescue 1 respond to a cardiac....” the dispatcher droned.

            It was a short run and we made it in a couple of minutes. We found a man in his sixties experiencing chest pain and shortness of breath. We both were fumbling with equipment and having a hard time doing the simple physical tasks necessary to take the blood pressure and begin to start an IV. We had accomplished little by the time the ambulance arrived. I was never so glad to see someone in my entire life, we let them take the lead with the cardiac.

            We got back to the station and found everyone up, and sitting around drinking coffee. We did the same, no one was talking, there wasn’t anything to talk about. There really wasn’t a fire to speak of just this bizarre turn of events that lead to the deaths of four people. There was none of the usual talk after a fire there was only this emptiness. We had a new role, where our actions could not have made a difference. Our only role in this tragedy was to experienced it’s consequences, without any of the satisfaction that can come from trying to make a difference.

            There is a cleanness, a straight forwardness, to firefighting, that is pure and satisfying. There is a fire and it is destroying something, your crawl into it with a hose line and you do battle, you put it out. This had none of that, there was nothing clean about this, this thing had so many twists and turns it looked like a maze. One that I might never find my way out of. No one told me about these, no one said there were going to runs that would change your life. We were going to save them all, we had the equipment, we had the training, and we had the system. What was the point, why were we out there if I could not help one of those four people. Why climb on the truck everyday and stumble home exhausted if you could not help three babies and their mother when it counted the most? What was the point in this anyway? I began to ask questions that we all eventually had to answer for ourselves if you were to stay on the Street.

            I was burnt out and up after this one, I felt empty, flat no affect, as if someone had poured my emotions out and left nothing to react to life with. The Street had been exacting it’s toll on me. It was as if a bucket had been lowered into my emotional well and drawn out the last of what it takes to do the job. Each run had taken a little more out of that well, until it began to run low. This one took the last of my reserves, left a dry well. I felt as if I had no emotional reserves left, nothing to get you through even the next shift, nothing to draw on.

Burnout, had an emotional and physical feel to it.  It dulled everything, as if some sort of filter was straining out the joy and laughter and left only the sadness. It was a filter that would change my life and how I viewed it. It would take years and a lot of work to regain my perspective.

This wasn’t what I had signed up for. I was supposed to save their lives. Instead I seemed to be some highly trained witness, who was along for the ride.  Nobody had told me about this. Nobody warned us as we went through fire school. Nobody told us anything during paramedic training. We were supposed to make a difference. We were supposed to save people.

I felt lost after that. I had come to love what I was doing. Love in a way that made it a calling and not just a job. But it was tearing me apart. I was having to face the realities of the street and I had no tools to fight it.

One morning not long after the fire as I was getting ready for work, shaving and showering. The Today Show was on as I was getting my uniform ready.  They were interviewing some actor or actress who was plugging their latest “growth experience/lousy movie”.

I am putting my uniform on. Sticking my tourniquet, stained with blood from the shooting last shift, in my back pocket. Slipping my paramedic pouch on my belt with my scissors, hemostats, and penlight in it. Nothing different or unique about the morning but suddenly it hit me. When these people go to work nobody dies. That’s right, they go to work and make believe people die. But whey they say cut everybody gets up and heads for the coffee truck.

I changed the channel and they were talking to one of the new mavens of Wall Street. They would go to work and sell stocks or bonds and make a lot more than I will during my whole career. The Masters of the Universe as they were being celebrated throughout the media, leading this merger or that buy out.  And not once will they have to make a life and death decision.

Not once will they go over a scene in their head for the umpteenth time wondering if they had done all they could for a stranger. They won’t have to be a part of the little tragedies that make up so much of life for so many people. They won’t have to risk their lives treating some drunk on the highway. No, they will just to the office, make some phone calls, play some office politics and head for home around six or seven. By then I won’t have even hit the down side of the shift. I will still have fifteen hours left. While they made money I treated a cardiac or a code. While they had lunch I will probably be on an accident with injuries. While they sell off their holdings in a stock, I will be cleaning the blood off a backboard from the accident. 

            So that morning when I drove into the station, I noticed the men and women in the other cars. They are dressed in nice suits. They are all heading off to an office. Looking at them and imagining their world I feel as if I live on another planet. All of these people are somehow different from me. Sheltered from all of the shit the street produces. Protected by me and the others like me in stations across the county. Safe in the knowledge that if they call we will come, while completely unaware what that safety feeling demands of those of us who provide it.   While I am out there hanging my ass out in the wind, they sit safe, sound and unaware.

Some mornings that feels good because I knew that there is nothing else I would want to be doing. What I do means something. When I go to work I help people. No nine to five for me. No, I am living life to fullest. I deal with life as it really is; no hiding for the kid.

            But there are other mornings when I would give everything I had for a quite nine to five job, safe and secure from all the pain and suffering out in those streets. Nothing to worry about but how much money I can make. No working Christmas, Thanksgiving and the 4th of July in the same year. Suddenly all of those neatly dressed people in all those cars are to be envied. Maybe playing the money game is the real world. Maybe playing in the streets is for the suckers, who don’t know money is the reality of the world not helping people.

            But I pull into the parking lot at the station and I hear the radio blaring, the men laughing in the kitchen as  yesterday’s shift is relieved. I walk into the station put my gear on the truck and do it again.