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.

            “Remember?”

            “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 4^th 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.