Dispatches from the Street

Here's to you Nick

2009-10-19T09:25:00.000-07:00

They took him off life support today. We went to high school together, then it being 1967 he went into the army and I went into the Marines. We both joined the department in the 1970's and retired about the same time. He was one of the first medics. Fought more fire than most. Now he is gone. When the shit was deepest, you would look around and there stood Nick getting it done. He was one of the best. Anyway here's to you Nick, there are damn few of us left.

The Old Days

2009-09-30T07:06:00.000-07:00

This is a great little documentary about the early days of EMS. If you can stand some of the editorial comments and it is slow at times it is a real look back. I became a EMT in 1974 and a paramedic in 1977. The names of the physicians and early programs were considered cutting edge. I think it is important to understand how far we have come since those years. I had forgotten just how controversial it all was in the beginning.

The Twenty Percent Rule

2009-09-29T09:15:00.000-07:00

A doctor once told me that 40% of the patients I would see in EMS would die no matter what I did, another 40% of the patients would live no matter what I did, but there would be 20% where what I did would make a difference. He told me to hold on to that 20% because it was all you were going to get and it would have to be enough.

What Separates Us

2009-09-28T06:20:00.000-07:00

A fire station is a unique environment. It is connected to the nervous system of the community it serves. A nervous system that finds every trash fire, car fire, house fire, woman not breathing, child hit my a car, accident with injuries, shooting, stabbing, overdose, difficulty breathing, drowning, cardiac, asthma attack and every other type of personal disaster imaginable. It exists outside the bubble of safety that it helps create for everyone else. When we walk into the station we become part of the nervous system. We become part of all the bad things that happen in our community. We gain knowledge that few outside the station understand exists.

Even if it is not your call, there is this constant litany of emergencies over the radio as other units are dispatched. We stand in the open bay doors and watch children play and ride their bikes in front of the station, while you are listening to units at a shooting on the west side of town. Or you are having breakfast as Engine 6 and Rescue 6 have a woman not breathing. You are cleaning the truck as Engine 2 and Rescue 2 have a stabbing. Then your tones go off and you have your own emergency to manage.

Civilians are the people who live that bubble. That sphere of safety created by us in stations across the city. The bubble where they went to work, ate, slept and played and nobody got hurt or died. Where they felt safe and secure knowing that help is only a phone call away no matter what the emergency. Where they could walk around and not worry about anything except what their own self interest, because when that bubble burst they knew that with a simple phone call we would come and fix whatever was wrong. Our job was to create the bubble and when it burst it was up to us to try to put it back together.

So while we sit in the station in the midst of all of the peace and quite of the neighborhood around us, we are part of this nervous system. We are no longer part of the peaceful world. We are part of the nervous system that can jerk us into the midst of any emergency imaginable. Our job is to create a perceived bubble of safety for our community that protects it no matter what happens. No matter how bad the situation we respond and try and put the pieces back together so people can feel safe again. Can feel protected again. Our job is to try to keep the bubble intact.

When we go to work somebody usually dies, maybe not in fire but in small ways like the auto accident, the drowning, the cardiac, the shooting, the stabbing, or just the end of living a good long life. But somebody died, we live in a world where the unthinkable can and does happen, a world where people die sudden and sometimes ugly deaths. They all had lives and they were over now. Where things are not nice and neat. Where life seems to leave a lot of loose ends. Loose ends that most people only deal with once or twice in a lifetime if they are lucky. These small personal tragedies are our job.

So we enter the real world where actions had terrible consequences. We live with a profound truth that had been lost in our modern society, that death is very near to all of us and it doesn’t take much to cross that line. The great “they” have forgotten it. Modern society seems to try and convince everyone that death is somehow this unusual event. This news-making story of horror. Death is in all our futures in one-way or another. No amount of exercise, diet, drugs or laws will change that ending. Yet in today’s society everyone is so shocked when death does come close.

The nightly news anchors always frown and show concern when they report one of our incidents before moving on to the next story. Secure in the knowledge something so terrible could not happen to them, because they occupy the most protected part of sphere that money, fame and privilege provides. But when it happens to one of them watch their faces. Everything is more real to them. Suddenly it could happen to them and people they know it. But those of us who climb onto the trucks, we have the knowledge. We know how close it is. We think we are smart enough, tough enough and lucky enough to dodge the chances we take on the job long enough to die peacefully in bed.

Because we take that knowledge away from the station, we live with it everyday, it is ground into us. We see life through this new prism. When we walk down the street, go to the beach, go out to eat, we see things that others don’t. We walk in the sphere with the others, but we are always looking for the cracks or leaks that if you are not careful, could make you an accident victim.

We feel separate and apart from those without the knowledge. It is why we spend so many of our off hours with one another. No one else understands. When we tell a story the other guys laugh when they should and shake their heads when they should. It can put up a permanent wall if you let it. This reality pushes you from other people. Friends ask “What happened lately? Do you have any good stories?” But to us, these people are not just stories. They are people who bleed. Who cry. Who die. So you answer “Ah, nothing much happened.” Because when we tell a story if it is for the vicarious thrill of somebody, it diminishes the pain of the victim and our efforts.

What we did is not a story. What we did was a desperate attempt to beat back the inevitable in many cases. But it is our job to try. Certain events stuck in our mind the way signposts draw you attention on the Interstate. They are turning points. Point of reference. Many times they are turning points in our own lives. What we did. What we saw. What we heard. What we tried to do. How we tried to help sometimes can fundamentally change who we are, and how we view the world. And yet none of these events make the headlines. They are the little articles on page two in the local section of the paper, but we carry it around with us each day for the rest of our lives. It separates us from those around us who don't have the knowledge who don't understand. It is the reason that even after thirty years when I see someone I served with we shake hands, smile and ask how they are doing, but there is always a moment that we exchange a glance, a recognition of someone else who knows, who understands, who has the knowledge. The knowing makes us part of a brotherhood. A brotherhood that separates us from those around us and places us the outside the bubble we created.

Memories

2009-09-17T07:16:00.000-07:00

I hear the sirens and air horns now, especially the air horns. Not every time I hear them, but sometimes. Suddenly I am back on the trucks. Pulling on my bunker gear. Looking up a street on the map. Shouldering the straps to my air tank. Pulling up my three quarter boots. Putting on my gloves. I am back in it. I am back on the street. I can almost hear the radio traffic.

“Engine 1, Engine 51, Tower 1, Rescue 1, District 1 house fire….”

“Engine 7, Rescue 7 shooting. OPD is not on the scene….”

“Rescue 1, Rescue Boat 1 respond to assist Engine 7 and Rescue 7 with a drowning….”

“Engine 6, Engine 4,Crash 6, Rescue 6, Tower 1, District 1 plane down…”

“Engine 3, Rescue 3 person not breathing…”

“Engine 10, Tower 10, Rescue 7 District 2 accident with injuries involving entrapment…”

I can almost feel the adrenaline rush. See the red lights of the trucks. Hear the roar of the diesel. Then dispatch would give the report that always meant you had something serious.

“We are receiving multiple calls.”

“We have reports of people trapped.”

“CPR is being performed.”

Then I find myself listening for the reports from the first units to arrive.

“Engine 1 to dispatch we have heavy fire showing from a single story wood frame structure. We are pulling an inch and three quarter line.”

“Engine 6 to Orlando we have a single engine plane down in a tree. No fire. But we do have a fuel leak. Be advised the passenger and the pilot are trapped.”

I am back on the street. That mystical place I named so long ago, the other reality that exists just outside most people’s everyday work a day lives. It is a place that seems to exist in parallel to daily existence. Yet it is only a car accident or cardiac away for everyone.

The street was more than a physical place. It was a place where all of the safe guards end, and my job begin. It is a place filled with excitement, fear, tragedy, horror, sadness, despair, joy, and laughter. It was a place where everyday decisions had terrible consequences. I am going to the grocery store, or I will fix the wiring fixed next month. Where people died or were horribly injured because of these simple daily decisions. It was terrible place, or maybe it is reality. It was where I worked.

The street existed in the poorest homes in Orlando, and in the richest. It existed in back alleys and the main streets. It existed in brush fires, house fires, shooting, stabbings, hangings, cardiac’s, codes, drowning’s, and a thousand other emergencies. It was everywhere. I have houses or intersections that had been scenes and now were signposts in my life. That house is where I pulled the woman out of the fire that afternoon. I pass the intersection where all those people died on that Thanksgiving night when I go to the YMCA. I can see where I had the double shooting from the East/West Expressway. I can see where we tried to save a mother and three children that night in that fire, each time I get on the interstate. Across the street from those apartments is where we found that body that had been undiscovered for three days in the Florida heat. The reminders of the street and the years I spent on it are everywhere around me, like some kind of map of my life. A map that marks life-changing event for me and those I tried to help. Even now, thirty years later, the memories they produce are as strong as ever.

Street Wisdom

2008-05-27T11:06:00.000-07:00

"The longer I am on the street the fewer answers I have. You lose your illusions. Your view of things leaves little room for wanna be’s or should have’s. People with answers still have too many illusions. Reality leaves no room for illusions."

Written my a much younger me, circa 1980's.

Suicides are Not Painless

2008-05-25T08:20:00.001-07:00

Suicides are painless. That line from the MASH TV show theme ran through my head the other day and I thought of the man with no face. Suicides are not painless. In fact they inflect more long lasting pain than they relieve. I discovered this the night a man put a shotgun under his chin and pulled the trigger. I had been to many attempts and successes over the years but this is the one that stands out above the others.

The only furniture in the apartment was a single chair. There was no TV, no table, nothing but this single chair in the apartment. The man had placed the chair in the center of the room and put the shotgun under his chin and pulled the trigger. When we arrived we found him still sitting up right appearing normal for all intents and purposes except he had no face. It looked as if someone had taken an ice cream scoop and scooped out his face leaving behind dried blood, broken bone and torn tissue. He had left no note or explanation for this last act. A faceless man sitting in a chair in the middle of an empty room, with not explanations, it had to be some kind of reflection of the life he had led, of the things he had done or had been done to him that led him to this end.

There was nothing for us to do but call him and wait for the cops. We loaded the gear back on the truck and waited. The cops, not wanting to do the paper work, were avoiding the call so we had to sit there with the person who had found the body and called. It was his son. He sat on the curb saying nothing for sometime. We stood around trying to give him some space. He finally began to talk maybe not to us as much as to himself.

He kept asking why but did not have any answers that gave him any peace. The pain of his loss was palpable. But the burden that he was going to have to carry was what struck me. The image of that single chair and the faceless man sitting in an empty room with the ceiling covered in gore would be etched in his mind for the rest of his life. With no note he could only guess why someone would do such a thing. It was as if he had done it to his son as well as to himself. He must have known it would be his son who would find him. It seemed such a cruel act to others more than relief for his pain.

I had seen how suicides were treated in the ER’s over the years. The doctors and nurses treated them derision and medical treatment that bordered on cruelty. When I would bring overdose that attempted suicide to particular one doctor he would always smile and order the largest NG tube he could, the “garden hose” as he would say. I never understood their feelings until that night, when I saw the impact it has on those around them. I never saw terminally ill patients who had real choices to make just people acting out, crying for help. I would always talk to them and try and “help” them during the time I saw them.

As I sat there with the son letting him talk I began to feel the real pain a suicide inflicts on those around them. It was going to change the son’s life in so many ways. It would change everyone’s life connected to him. It would add to the burdens in their own lives. The man suicide was so much like dropping a stone in a pond but the ripples were those close to him pain. Those ripples would be felt for the rest of their lives. The cops came, we loaded on the truck and left the scene. But that the guy with no face and his son on the curb never really left me.

After the man with no face I changed. I saw those attempted who suicide the same way that the doctors and nurses did. As an act that inflects much more pain that it ever relieves. I was abrupt and unsympathetic with attempted suicides. I made sure I followed standing orders to the letter and got them to the hospital as soon as possible. In my ways I think I provided better care than before. They got to the hospital quicker and got the help the really needed a psychiatrist or psychologist. I don't know if I was right or wrong in my approach, all I know it is the way I did it. As with most challenges on the street in the early days this one came with no handbook. So each of us was left to work our way through them on our own.

Nursing Home Nightmares

2008-05-04T06:43:00.000-07:00

We received a call to one of the local nursing homes. Orlando seems to have more than its share and I always hated calls to them. The level of care and the quality of care was almost universally less than it should have been. We were always faced with difficult and complex problems that rarely fit into any set of standing orders. Like the patient who had been seizing for an hour before they finally decided they should call us. Or the patient who had not had a bowl movement in a week and the staff had waited until the patient stomach was so distended it was causing them to have difficulty breathing and only then to call us. It had come in as a difficulty breathing. Yeah a little O2 was going to fix that one.

This one came in as a patient not breathing. It was that 3 am hour that I always hated in a 24 hour shift. I knew this one would be something nursing home staff always seemed to wait until the middle of the night to call. We arrived to find a coded emaciated patient in their 80's. I took one look and asked the staff if this patient had a Do Not Resuscitate order. They said no. As we began to work on the patient I asked them again to check their records I had a feeling that this patient just had to have a DNR. They again said no this patient did not have a DNR. They appeared perturbed that I had asked.

So we worked the code and this time we brought the patient back. The patient had a heartbeat and was breathing on their own when we delivered them to the hospital. I was out at the truck refilling the drug box and airway kit when my partner came out. He told me that the patient did have a DNR after all. When the hospital had notified the family and they had been furious, sad and god knows what other kinds of emotions when you are told your loved one would continue to suffer. The amount of pain we were part of putting that family through still haunts me. I know, all we can do is go by the orders we have but we are part of the system. I did not report it because there was no one or nothing to report to. It was just another one of those wide awake nightmares we all seem to have in EMS.

It's Okay We're Here Now

2008-04-30T12:19:00.000-07:00

In the early days we never worried about blood bore pathogens. The rule was he who had the most blood on them won. Because he had been in there the deepest, getting it done, not standing back. No one wore gloves or any other type of protection. The doctors and nurses in the emergency rooms did not wear gloves, except when they did a specific type of procedure that called for a very sterile technique. In training they never taught us about hepatitis B or any other blood born diseases. We were the second class of paramedics in our county and this was back in the 70’s and I think they simply forgot or did not have the time to squeeze it into our training.

When AIDS first began to be reported we still did not change our procedures. It was not until they understood how it was transmitted that things began to change. Suddenly we had to wear gloves for every patient. The doctors and the nurses in the ER were wearing protective gear. It was still a distant threat. Something that happened in the big cities, not in little Orlando.

About this time is when we began to see the first AIDS patients. They were suffering terribly. With no real treatment regiments developed, the best they could do was treat the symptoms. They were emaciated skeletons slowly dying. It was an awful way to die. It scared us all to think we could catch it from our patients. But the chances were slim. So we took precautions and continued to treat our patients.

I remember it well. It was Christmas day. I was working out of Station 7. We had a call for a seizure. No big deal. We arrived to find a male who was unconscious after a seizure. He had no previous history of seizures. We were unable to rouse him, so according to our standing orders we were to use the protocol for an unconscious patient with no obvious medical reason for their state. This meant starting an IV and administering some drugs. Something I had done a thousand times.

My partner had taken a vacation day to be with his family. So I was riding with another medic. We had not worked together much. We both knew that the IV and other procedures were probably not needed, but we had to go through the protocol. He was finding other things to do. So I set up and started the line. When I held out my hand for the tubing from the IV bag my partner was talking to someone and not paying attention to what I was doing. The cap was still on the tubing. He should have been handing it to me with cap off so I could hook it to the catheter.

Instead I grabbed it out of his hand and took the cap off with my mouth. Something I had done hundreds of times before AIDS. When I took the cap off I tasted blood. I knew that I had just ingested some of the patients blood from my gloves. That is really a very minor exposure. Something that could be argued was not an exposure at all. But I had burnt the roof of my mouth the night before eating something. I had actually blistered it and it was raw and sore. It was a perfect way for AIDS to enter my blood stream. If this guy had AIDS.

You know how in the movies the camera will suddenly zoom rapidly on into a close of someone's face to emphasize the moment. That is exactly how I felt. I felt as if I suddenly had to face a new and much more scary threat. I had come to terms with the risks at fires, scenes of violence, accident with injuries but suddenly I was confronted with something I had not prepared myself for. The possibility of dying the way I had seen those AIDS patients die.

I finished the shift and tried to forget what had happened. It was such a long shot that I should not even worry about it. I mean just because I tasted blood off my gloves. But I became obsessive about it. The patient had the type of history that could indicate AIDS. He had just gotten out of jail and it was reasonable to suspect he was a drug user. Both of those facts could lead to AIDS. I wanted to ask that he be tested so I could know if there even was a threat, but in the early days of AIDS we could not request the hospital to test the patient for AIDS. The laws had not been changed. So I had no real way of knowing if this patient was an exposure or not. Finally after a couple weeks of letting this fear get in the way of my professional and personal life. I made an appointment to see my doctor.

At the time my personal doctor was also the EMS Director for the county, he was intimately familiar with the job and AIDS. So I went to his thinking he was going to tell me not to worry about such a minor incident. I was letting my imagination run wild. I went to his office looking forward to having this monkey off my back. Then he said.

“I think it is best if we go ahead and test you.”

“What?”

“Yeah, we are going to test you now as a base line. Then in seven months you will come back and we will test you again. By then it will show up in the tests.”

“But..”

“If I were you I would not have sex with my wife until we determine if you do have AIDS.”

I almost feel off the exam table. This appointment was supposed to make me rid me of my anxiety not up the ante through the roof. They drew my blood and sent me home. A week or so later they called to let me know I was free of AIDS now, but now I had to wait for seven months then return to be tested again. Then we would know. Back then there were no rapid tests and what constituted a real exposure was still being identified. So see you in seven months.

I did not handle this well. This was not what I had signed up for. I understood the dangers at a fire. Give me a good clean flashover or building collapse to this. This is not how I wanted to die. And it was all because I wanted to save the world . I wanted to become a paramedic. To help people. Now those same people could kill me in the most awful way imaginable. This was not fair. It was coloring my professional and personal life. There were almost daily stories of doctors or nurses quitting their professions because of their fear of exposure. I was not sure if they weren't the smart ones. Remember very little was know about the disease or its transmission at this point.

Naturally I tried to put up a front at work. I continued to go on runs and treat my patients. I tried to shove it into the background but it would not go. I began to resent the people I was supposed to help. I started to see them as a threat no matter what their age or condition. It was going to be a long sevens months in a lot of ways.

We all talked it about it at the stations as more and more stories came out in the press. There was a lot of hype and wild stories. While the county and city provided us with training, what was known about AIDS and how easily or difficult it was to transmit was still not well understood. There were stories of nurses contracting it from a single contaminated needle stick. That was less than what I had ingested. I was beginning to question why I was a paramedic. After all of the ups and downs, after coming to understand and accept my role in a patients care, I began to wonder if it were worth it.

We got a call for a woman struck by a car. It was near the large Baptist church near a very busy highway. When arrived we found an elderly black woman lying in the street. A car at angle nearby, skid marks marking where the driver had slammed on the brakes. I put on my gloves and grabbed the equipment. I was the first one to her. She was dressed up in a black dress with matching hat and veil. She wore black gloves. I remember thinking how sad it was to see her in her best church going clothes lying broken in the street. I knelt next to her. She reached up and took my hand. Fear etched her face. I looked down and said.

“It’s OK. We here now. We going to take good care of you.”

Squeezed my hand and some of the fear left her face.

“I will be right back. I have to get some more equipment from the truck.”

I stood up and was trotting back to the truck when I felt as if a weight had been lifted off my shoulders. When I said it would be OK we were here now and saw the look on her face something I had lost was found. Why I had come on the fire department and became paramedic came back to me in a rush. I had done it for her and all of those like her. She and those like her was the reason that I did the job. The AIDS exposure was just one more price that had to be paid. You take your ticket and you take your chance. It was part of the job now. Just like a flashover or building collapse. If I did not like it then I needed to get out and do another job. But being able to say those words to someone like her was worth the risks. It was worth it all.

I grabbed the equipment and ran back to the woman. We treated her and transported her to the hospital. Seven long months later I went to the doctors office and had my blood drawn. It took me a week to get up the courage to call and get the answer. I was clear. I never again let the threat of AIDS or any other communicable disease take away the satisfactions that the job provided. That is not to say I never worried about it or took precautions, because I did. But the fear never again drove me. I was able to drive that fear.

Make a Wish Trip

2008-04-25T07:01:00.000-07:00

I was on Engine 10 when it happened. Engine 10 was the closest company to Disney and it territory was filled with hotels and tourists. We were dispatched to a child down in one of the hotels. We arrived at the hotel and rode the elevator up to the floor. Security escorted us to the room. We found a child around ten years old lying coded on the floor. The child was emaciated and bald. The crew started CPR immediately as I began to question the family. They were begging us to stop. They were down in Orlando on a Make a Wish trip. Their child was dying of cancer and had always wanted to go to Disney. The Make a Wish organization had organized and paid for the trip and now this happened.

At this time in our local EMS system the standing orders had not developed to the point we could stop CPR in spite of the situation. I looked at the other paramedic, Kathy Johnson. I said.

"I am going to get this thing called."

"Yeah. Let get it done."

I first got on the radio and talked to the local hospital. The doctor on duty said he would like to help but at this point he could not call a code over the radio.

"What do I do?"

"You could get the patients personal physician to call it. That would stand up."

I got the number of the personal physician from the family and called. The patient was from out of state, so it took some time and explanation but I finally go her on the phone.

"Doctor my name is Roger Huder. I am a paramedic for the Orlando Fire Department we arrived on scene to find the patient coded. We initiated CPR but have not started ALS. Because of the patient history given by the family I would like permission to stop the code. But my local doctors will not do it. They said it would have to come from the patient's physician."

There was real sadness in her voice when she said.

"Yes, I will call the code."

"I have to ask you to repeat that to my partner."

"Sure."

Kathy came over and the doctor repeated the order.

"You can call the code guys."

The rest of the crew stopped CPR and covered the body. Kathy took the family out in the hall.

"Doc. down here if someone dies outside of the hospital there has to be an autopsy. That means the family would have stick around for several days. Would you be willing to notify the local coroner of your decision so we can get the family out of here."

"Sure can you get me his number."

The Lieutenant got on the radio and got the coroners number from the dispatchers. I gave it to the doctor.

"Thanks doc."

"Sure." Her voice sounded as sad as I felt.

While I was finishing up the medical end of things, Kathy had been working with the hotel staff. They had called the airlines and arranged for the family and the body to be flown home that day. A funeral home would take the body to the airport.

When we left the scene I felt a mixture of sadness and pride in what we had been able to do for the family. We could have just as easily worked the code and let the system do the rest. Instead we had pushed the envelope and pulled off the best solution for a family that needed it.

That has to be over twenty years ago now and that run still comes back to me. Each time I think of it, I feel pride in what we did. Sometimes doing less is doing more.

Keeping Your Balance

2008-04-25T06:36:00.000-07:00

The day after we had pulled the baby from the house fire (see Smoking Baby post) and before I learned the outcome, I was at a party with friends. The television was on and the local news was running footage of the fire. I stood there watching myself with the emotions still fresh from the day before. There I was with Donny working fractically on the baby. In the background the house still burned furiously. It was such a startling perspective. I was now looking over my own shoulder. Firefighters were pulling hose lines and police officers were trying to hold back neighbors. It seemed even more dramatic now that it was on TV.

My friends began to kid me that about being a media star. They said I needed an agent. I tried to join in the kidding but I could not take my eyes off the screen. There I was in bunker gear kneeling over the child working with Donny. I did not remember the news crew being there.

It was as if someone had plucked the whole scene out of my memories and thrown it on the screen. It brought the reality back in a rush of emotions. I felt the pressure of getting everything done right as quickly as possible, all the while fighting back the emotions of working on a baby. My friends tried a few more jokes then realized I did not know any jokes about this one.

It was one of the first times I realized just how different the world I worked in was from theirs. When they went to work nobody died. They did not have to risk their health or their lives when they were at their jobs. It was one of the first time I began to feel distance between myself and those who did not do the job. The job was beginning to separate me from people who did not experience what I did each day. That separation would grow over the years until I was leading two separate and parallel existences. One filled with poverty, dying, illness and violence and the other filled with family and friends. My friends and family were not in the business. So there was no bridge between the two worlds, no one on the family side to talk to about the job and to help keep the balance. That proved to be a problem with no bridge there was no balance. There were times when the scales were weighted much more one way than the other. The intensity of the job would tip the balance of the scale. The job would color everything in my life.

The job would weigh me down at home with left over images or fatigue and no easy way to get rid of them. This was long before today's understanding of what that type of stress can do to relationships. It was one of my biggest mistakes over the years, never to have found a way to balance the job and home. It lead to some difficult years in my marriage. We hung on somehow but I have colleagues with three and four marriages to their credit. I have a friend who dropped dead one day off duty in his forties. I had another friend who after 19 1/2 years on the job called up and said he could not do it anymore and he quit. The department was able to get him a medical retirement so he did not lose his retirement but the street claimed another victim. He was one of the strongest and most respected of us. We had a saying that we would follow him into hell with a booster line if he asked because we believed and trusted his courage and judgement.

Out of the twenty something members of my paramedic class 2 of us lasted as paramedics until retirement. Some quit the department abruptly, a number simply gave up being paramedics and went back to firefighting, and a couple were pensioned out with medically. In the early days there was no safety net. The hidden dangers of the job were not understood either by the department or those of us out on the trucks. The job can demand a high price. If you understand that and are prepared to fight for the balance you need, then you stand a good chance of surviving it's pitfalls. If you ignore them you do so at your own peril.

Sometimes it is the simple solution that is the best.

2008-04-24T12:38:00.000-07:00

I was being used as a traveling medic. I would fill in on what ever engine or rescue that needed a firefighter or paramedic. I was sent an engine near our local trauma center. It was a single engine company station near downtown. It was a busy station but that shift it had been quite most of the day. We had nothing to speak until one in the morning. The call was at the Trauma Center. It was for a person with their hand trapped in a dishwasher. I pictured a mangled hand in the mechanism of the dishwasher. We would have to dissemble the dishwasher to free his hand. Why else would the Trauma Center call the fire department.

We arrived and were escorted into the bowels of the facility. We found a mentally challenged man with his hand crushed between a cafeteria tray and the edge of the large automatic dishwasher. His fingers were crushed completely flat. He was in tremendous pain. A number of medical and facility maintenance personnel stood by trying to reassure the poor man. The Lieutenant assessed the situation and immediately got on the radio.

“Engine 5 to Orlando. Respond Tower 1 with the wizzer tool.”

The wizzer tool was a small high-speed drill that could cut through metal or plastic with ease. It would be perfect to cut the tray away from the man's hand. The Tower was the nearest truck to carry the tool. I don’t remember any conscious decision making process as I stood there. I just remember reaching for the cafeteria tray with both hands. I grabbed it and leaned back with all my body weight. The cafeteria tray bent and the man immediately removed his hand. Everyone stood there and stared at me for several moments, as if to say why didn't I think of that. A couple of RN's put the man in a waiting wheel chair and took him immediately to the ER.

The Lieutenant just looked at me, then canceled the Tower. We went back to the station and slept the rest of the night. Sometimes the simple solution is the best, don't get caught up in the equipment.

I was still traveling when they sent me to a station near the airport. It sat just off one of the busiest highways in the city. Late that night we were dispatched to an accident with injuries involving a motorcycle. It was not a good scenario, heavy fast moving traffic and a motorcycle it is never a good mix. There was a good chance this was going to be something.

We arrived on the scene to find a motorcycle on its side in the middle of the six-lane highway. A van was stopped behind it. The rider was nowhere in sight. Then bystanders pointed under the car. I lay down on my stomach. The rider was rolled up under the car. Bystanders told us that he had been weaving in and out of traffic and caught the side mirror of the van and lost control. He had fallen off his motorcycle and was rolled under the car.

I could see him clearly under the car. He was lying on his back completely under the car. He was in perfect anatomical position with his helmet almost out from under the car. I could not tell if he was coded. I could not reach anything to check. We had to get him out from under the car fast. The Lieutenant immediately got on the radio.

“Engine 8 to Orlando. Request Rescue 1 for air bags.”

The air bags are large rubberize bags that are inflated with air. They can lift thousands of pounds easily and quickly. But it would take at least fifteen to twenty minutes for Rescue 1 to respond from downtown. I did not think this patient had fifteen minutes while we waited for the air bags. We needed to get him out now. As I lay on my stomach I realized nothing was trapping him under the car. It was as if he had just laid down under it to check out the underside of the car. That is when I said.

"Lieutenant we can get him out if we just lift the car."

He looked down at me for a second and said.

"Do it."

“All of you guys grab the front of the car and lift when I tell you.”

The some of the crew and several bystanders grabbed the front of the van. I said.

“Lift.”

Together they lifted the van up enough for me to control the patient cervical spine while two other crew members carefully slid him out from under the car. He was clear. We immediately began to work on him. The Lieutenant just looked at me then said.

“Cancel the Rescue. The patient has been freed.”

Sometimes the best solutions are simple ones.

It Could Get Festive 3

2008-04-16T13:52:00.000-07:00

We had a shooting at the Dixie Doodle. It was a innocent, almost silly sounding name for one of the most dangerous bars in Orlando. Countless assaults, shooting, stabbing, cuttings and robberies had occurred at this one small single story concrete block building. It was one of the places that the predators and the desperate did their dance. We were invited to the dance there more than anywhere else. I had been there more times that I could count on all matter of mayhem over the years. I had been traveled into Station 2 to ride Rescue 2 that night. We received a call for a shooting. The station is only a few blocks away and the dispatcher told us to stage in the station until OPD could secure the scene.

I should have known securing the scene at the Dixie Doodle was going to be a challenge to say the least. The building could never hold all of the patrons on any given night and they always spilled out into the parking lot. I had seen as many as two hundred people outside the building, milling around drinking and partying. We went to the trucks to wait for the dispatch. It was not long before we were told the scene was secure and it was safe to go on in. We arrived to find the usual chaotic scene the Dixie Doodle always produced. There were hundreds of people milling around excitedly in the parking lot of the little structure. I was not driving that night so I was on the passenger side of the truck. I went to the compartment on my side of the truck to grab the drug box and airway kit. Just as I turned around to find the victim. Four shots rang out.

I have never seen so many people disappear so quickly in my life, Including the other members of the Engine and Rescue. They had ducked behind the Engine and the Rescue. But I was on the wrong side of the truck to do that. The only other people in sight was the victim, an ambulance attendant who had just arrived and police officer with his gun drawn standing next to them. I figured I would head for the only friendly face with a gun I could find. So I hustled over there in a crouch, holding the boxes up so I felt as if I had a little protection. The Lieutenant off the Engine said I looked really funny running and trying hide behind the boxes. I told him it did not feel that funny at the time.

The patient had single gunshot wound to the chest. He was coded. The ambulance attendant and I began to work immediately. The Engine crew, my partner and I worked frantically to package the patient and get out of there as soon as possible. As we bagged him, got an IV, and bandaged his wound with Vaseline gauge, the scene around us began to deteriorate. There simply were not enough officers on the scene to secure the area with literally hundreds of people milling around. We were soon surrounded by an angry and excited crowd. They were now jostling and threatening us and the police. As we worked we heard breaking glass. They broke out the drivers side window on the ambulance. As long as we were there the police were not going to be able to secure the scene. The cop who I originally ran to for cover, stayed with us to keep the crowd back as best he could.

We finally got the victim on a backboard, onto the stretcher and into the back of the ambulance. In spite of the broken window and the crowd the ambulance driver eased us through the crowd and out of there. It was a short and busy ride to the hospital as we tried to finish stablizing the patient. The Engine and Rescue left immediately after we did clearing the scene so the cops could concentrate on controlling the crowd.

Once we returned to the station from the hospital,the guys kidded me about how funny I looked trying to hide behind the drug box. I must have really looked funny trying to get my two hundred pounds behind a tackle box. I asked them how they were able to see me since they were under the trucks. I did not think they could see much past the trucks tires.

It turned out that another victim had been shot inside the building. Something I was never told. The second victim was pronounced dead there at the scene by another paramedic off another ambulance. My patient died. Apparently the two had gotten into an old fashioned gun fight and ended up killing each other. I never heard officially what the four shots I heard as I got off the truck were about, but my guess was that someone had fired them into the air to clear the scene. It was not one of the cops so it must have been one of the patrons.

The city closed the Dixie Doodle after this incident as a public nuisance. The patrons just found a new place to shoot and stab one another.

It Could Get Festive 2

2008-04-15T07:42:00.000-07:00

It was a Friday night and the Saturday Night Specials always came out. It came in as a shooting at Concord and Paramore. Paramore had a liquor store on the corner a block or so north of this address called Liquor World. Our nickname for it was Murder World. Paramore was the center of the rough side of things where desperate people mixed with violent predators in a vicious dance. We were asked to the dance anytime the two connected.

As we neared the scene we were stopped by the police. They told us to hold up that shots were still being fired at the scene and near the scene. They were wide eyed and wired. We fed off their adrenaline as we sat there waiting. Cop cars would race by lights flashing as other officers responded. It was enough to crank up the volume. To get things really humming before we went in. Finally after what seemed an eternity we got the all clear and we were told the scene was safe and to go on in.

We drove the short few blocks and bailed out of the truck. When we arrived to find to find a single victim. A huge male illuminated in the flashlights of several cops. In the hard light of the flashlights and our headlights the whole scene looked like a black and white picture.

The victim was large enough that he looked like a professional football lineman, he had a single .22 caliber gunshot wound to the left chest.

The scene was chaotic. Police were running around with their guns drawn and eyes wide shouting at someone down the street. The ambulance had arrived with us and the four of us got right to work. He had no perceptible pulse but his heart still showed a rhythm.

More loud shouting by the cops as we did our assessment. Then we heard gunshots nearby. Still more shouting as the police tried to figure out what was going on and who was shooting at whom. They were not the one firing their weapons. Things were getting very festive at this point. We were frantically trying to get this guy ready for transport so we could get the hell out of there. We got a line, put on the MAST suit, got him on 100% O2 and on a backboard. It took all four of us to lift the backboard onto the stretcher. There was a black and white picture of us the next day in the paper.(See above) We were all black silhouettes framed in the headlights of one of the trucks. We are on our knees bent over the patient trying to start IV’s. The lead to the story was help arriving in the midst of shooting. It is exactly how I remember that scene in black and white silhouettes framed in the headlights. We finally got he patient packed and ready to be transported. It took all four of us to load the patient onto the stretcher. It was time to to get out of there. So we loaded the patient and got him to the hospital. He died in the emergency room. This story is from the early days, around 1977 or 1978. Most of it I wrote at the time it happened. I have left the wording as much intact as I could.

Random Thoughts

2008-04-15T07:10:00.000-07:00

These are few of the random thoughts I have written down over the years. I have not changed them since I wrote them over twenty years ago.

The Street is always just below the surface. Scratch me and I bleed a story.

There is a rhythm to the street. After a while you can tell with it is going to be a busy day. (Written on the back of a old set of standing orders sitting in the jump seat of Engine 10 on a busy day I had felt coming).

I’ve had babies die in my arms and some who lived who I wished had died, after the mess we left them in. I’ve had it come out bad so much of the time that I am always surprised and happy when it all works. When everything somehow falls into place. Not much like the TV shows.

It is difficult to understand how something that effects you so profoundly can be thought of as so trivial. That a meeting of the County Commissioners holds more important than what you had seen and what you had gone through and is front page news. While someone's tragic death is buried on page ten.

We make people nervous. When they see our little equipment laden safari moving through their office or a restaurant, they always smile and make some sort of nervous joke about us. As if they the only way to deal with something going wrong is to minimize it. “Nothing serious”, they say as we leave so they can be reassured. And when something does go very wrong they ignore what is going on altogether. I worked a code in a restaurant once. We were in the middle of the floor. People around us continued to eat, as if ignoring what is going on will make it go away.

You Never Know When you Might Make a Difference

2008-04-11T02:10:00.000-07:00

I was traveling at the time. Traveling is being used to fill in where ever someone is out sick or on vacation. I was riding with Gary out of Station 6. We got a call to a man cut. Nothing more just a man cut. We arrived to find a well taken care of small middle class home. A mother and a son lived there alone. The son was in his twenties and had a debilitating disease. He was constantly in pain and the disease was slowing eating away at his body and his life. Out of frustration during an argument with his mother he had put his fist through a window. No big deal here just a laceration that I quickly bandaged.

But as I bandaged his wound, Gary and I listened to them talk. He and his mother had been arguing over something trivial and he had exploded. As they talked it became clear that he was angry at his disease and not his mother. Here was a young man in his twenties watching his life slowly being taken from him. He would have no girlfriends. He would not hang out with his buddies at the bar. It would not be long before he would be confined to wheelchair. He could see all of this life around him. He could see the pretty young women. He could see the young men with the life he wanted, but was not going to have and he could do nothing but watch.

As he talked it startled me because for the first time I saw life through eyes of someone who only wanted a simple normal life, yet was never going to have one. To see it so close yet not to be able to have it. I was not sure I would not be putting my fist through windows if I were in his shoes.

Gary and I where old hands at the time. We both were had become paramedics early and had close to fifteen years on at that time. We had survived the busy trucks and were still medics. If we had had this run years before we might have just bandaged the guy up and left. Just a couple of tough guy medics who had their armor on. Nothing got to us. On to the next one. But we had survived that stage and this time without saying a word between us, we began to talk to them. His mother only wanted to help him through his pain. He only had his mother to lash out at in his frustration. He was punishing the only person in the world who was trying to help him.

The son did not want to go to the hospital. Gary and I knew if he went they could see a social worker at the hospital they might be able to help them. I talked to the son and he talked to the mother. After a few minutes we were able to convince the son to let his mother take him to the hospital. They loaded up and drove off. Gary and I got back on the truck and went back to the station. Nothing to it. Just another social work call. Gary and I had been to thousands of them over the years. Not what we were trained to do, nor were we trying or wanting to be social workers. We were just trying to "clean it up" so we would not have to come back. I traveled to another station the next shift day and did not think about it again until Gary called me a few weeks later.

Gary had a call and was returning to the station in the rescue when the mother flagged them down. She was thrilled when she saw it was Gary on the truck. She wanted to thank him for what we had done for them that night. When they went to the hospital they had seen the social worker. They had been referred to a consular and were getting help. She told Gary that we had changed their lives. Her son was more at peace with his disease and no longer had outbursts. She had someone she could talk to her about her own issues with helping her son. They now had someone to help them and it was working.

Changed their lives. That still rings through me when I thing about it. At the time we had both seen enough to be as cynical as anyone. We had seen it all between us, but for whatever the reason that night we put our cynicism aside and simply talked to a couple of people and it changed their lives. You just never know.

The Little Ones

2008-04-04T12:08:00.001-07:00

When I remember the street now, I always remember it at night, as if that were the only time there ever was on the street. The only time when things would happen to people, and I would have to pick up the pieces. But not just night, but middle of the night, that 3 in morning time when only the cops, the drunks and us are left to prowl around in some kind of three way dance, the kind of dance that leaves people lying in the gutter bleeding. My partner and I are heading back to the station after the 20th call since we had come on duty at 8 am the morning before. Not one of the calls serious, just another long shift filled with sick lame and lazy. The kind of shift that makes you question why you are a paramedic. Where are the people that need the saving, the world seems to be made up drunks and squirrels who think that calling the fire department will solve almost any real or imagined medical or personal problem.

Just another night on Rescue 1 where your life seems to shift into fast-forward the moment you step on the truck in the morning. The experiences move by so fast, as you race from run to run, you could almost put your hand out the window let it surf through the them as they rush past. Like you did when you were a kid and used to stick your hand out of the window of the car as your parents drove home at night.

With the first run of the morning to the last run you just finished you get the same adrenaline shot each time. So by 3 in the morning the twenty or so adrenaline rushes leaves you exhausted and used up. You lean against the door of the Rescue, feeling as if you did lean against something to prop yourself up, you would fall over and go to sleep. It is as if someone presses the button on your life and the fast forward drops into standard play.

Suddenly in the Florida heat your uniform is damp and sticks you from the constant sweat of driving the streets of a Central Florida town with no air conditioning. Add to the mix lots of left over stress, that combines into this tired buzz, and you have truly unique physical feeling. Your head is fuzzy and aches, your stomach trying to eats it’s way out after the 20 hours on duty and adrenaline rushes have emptied your tank of anything you ate today or yesterday. The only lights are the bronze halogen streetlights that cast an eerie light that is somehow depressing. Your eyes feel as if someone has put a whole sand box under them each time you blink. All you want to do in the world is to lie down and go to sleep for just an uninterrupted hour. Just one silent quite hour. Then through all of the fatigue, physical discomfort and just plain I don’t want to do this the radio in the truck blares.

“Rescue 1 can you take another call.”

You want to run screaming away from that radio to get away from another run, but you pick up the mike and say “Check”.

“Unknown illness to a child. 1492 Paramore.”

“Rescue 1 responding.”

Through all the fatigue you flip on the lights and turn on the siren and head for the address. The box lights reflect off the windows of the stores and buildings of downtown as you head for the wrong side of things. Where you are the doctor to those that do not have the money or insurance for real doctors. It almost seems too melodramatic, red lights flashing on this night as the truck rushes through the empty streets.

When we turned on Amelia and went under the Interstate it was as if we had entered another reality one where you could almost taste the hopelessness, the anger and the frustration of these people who were so close to the money yet so far away. If any sense could capture the feeling of the poverty it was the sense of smell. It is the reek of garbage in all the dimly lit hallways and outside on the dirt yards or the stench of urine in all back upped toilets. Poverty stinks and it can get in your nostrils and under your skin so even when you go home in the morning it ground into your so won’t come out.

We find the address in front of a small two story apartment building. No lights are on, and everything seems locked up tight. We cross the grey dirt strewn with beer cans and trash and walk up to the second story of the apartment on the concrete stairs. When we reach the apartment we each stand on either side of the door. You never stand in front of a door, you never know who is on the other side.

“Fire Department. Did someone call?” I yell as I knock on the door.

A girl immediately opens the door. She is somewhere in her late teens. She is holding a crying baby in her arms. A look of real concern is on her face.

“What seems to be the problem?” I asked.

“He’s running fever and coughing. I..”

She handed me the baby and I looked down at him, I was immediately reminded of my own son at home. He felt exactly the same in my arms. The baby was hot to the touch, but not anymore than my own son the last time he ran a fever. We examined him and it looked as if the worst thing he had was a cold.

“He’s fine. Looks like he has a cold. Do you have any Tylenol? It would make him sleep better tonight and you could take him to the doctor tomorrow?”

“I don’t have any Tylenol?” her voice and the look on her face showed real fear.

The concern and fear in her face let me know that what was really happening as much as anything. Here was a young girl all-alone with her first child and no one to go the drug store to get the Tylenol. She was out on a limb doing the best she could taking care of the baby by herself and had run out of energy dealing with the baby and herself. She needed some help. The apartment was clean and well furnished. It was obvious she was doing a good job no matter what her support system was day to day.

“Look he is going to be fine he just need some Tylenol and some antibiotics. Do you want to go to the hospital with him?”

“What do you think?”

“Yes, I think that would be a good idea. We have an ambulance on the way do you want to go by ambulance?”

“Yes. Yes I do.” the relief on her face was enormous. She just needed someone to help her solve a problem that had gotten too big for her to solve alone.

As I stood there with the crying baby I could feel the relief in her as she gathered things for her diaper bag she would take to the hospital. She had the support she needed, it did not matter that it had came in a red rescue truck, she had someone to ask what to do and then they had the means to solve her problem. Not a big problem in scheme of things, but it was everything to her. When the ambulance arrived we walked her out to the rig and helped her into the back. It was not the type of problem the system was designed to handle, but it was the type of problem we faced daily. I resented these calls back then, because they took so much from you when you so little left in your tank. I was so tired and so ground down I would miss the meaning of them much of the time. But not this time, this time it stuck. No great skill needed or some show off medical decision-making, it took no special training just a willingness to help. It strange because now those are the ones that come to mind first when I think of the street now twenty-six years later.

The little ones that I thought I would forget as the big one piled on top, but its the little ones that come back. Only through years on the Street did I realize that maybe these have as lasting impression as the big ones. There were a lot more of these than the big ones, maybe why this one and the other little one stuck in the memory is the genuine appreciation for the help that was so apparent. With so many of the others the scenes were filled with anger at the system, resentment the of authority you represented, or frightening abdication of personal responsibility for even the most basic human survival skills, it was hard to glean out the fact that they did needed your help. So when these pure crystal clear moments happened they stand out through it all. The street does give back to you, but it buries them under the bad ones, the drunks, and the crazies, so if you are not paying close attention you loose them in all of the bullshit calls.

I am Writing this to Remember

2008-04-02T06:18:00.001-07:00

I am writing this to remember, to understand, to document things, the things that I did and the things that others did. It is about the war we fought. Not in some far off country but in our hometown. It is about a war that is fought everyday in every hometown by men and women just like me. It is like the Stineyman said one day.

We were at some kind of training, a bunch of paramedics punching out some training requirement ticket between real runs. I don’t remember what the training or how our conversation got on the topic, but Stineyman summed it up best I ever heard. Steiner was a big rambling bear of a man who moved with the grace of a natural athlete. He used to make bets that could out run much smaller and slimmer men at a local track. He usually won. Anyway in the midst of this training he said “we fight death when we come to work.” That was the truth.

We came to work to fight it. To fight it when we were new and young and thought we would save them all. We fought death when we were older, wiser and more experienced and knew we only save a few. We fought death when it did not seem we would ever save anyone again. We fought death when we finally understood that the point was not how many you saved but that you fought the fight. That you went to work and did what you did because that is what mattered and that is all that mattered. You continued the fight because that is what you did. The saving or not saving did not matter as much as showing up and doing it the best you could.

You did it day after day, week after week, month after month, year after year, decade after decade until you looked up and you could see the end of things. Retirement. You could feel the end in your knees as they ached and hurt most days. You feel the end was near in your back where it would hurt in exactly the place it used to kill you after working CPR for a long time. You felt the end in your should where you tore your rotator cup when you dislocated your shoulder years before throwing a ladder. You felt the end was near, when a partner dropped dead of cardiac at home one day after coming home from his second job. You could see the end was near when other guys quit, retired out with injuries, like Larry, Ray or DJ with wires in his back because they could not stop the pain any other way. You knew the end was near when you saw younger men and women come and go long before their time. But the fight continued. You still climbed onto the red trucks and fought the fight. It is a war with no end, no truce, and no sympathy. People continued to die not naturally but stupidly or carelessly and it was up to you to pick up the pieces. To fight the fight.

You finally after decades began to get some perspective, some wisdom from all the pain and suffering. You begin to under stand your role in a lot of the tragedies. It had been what you signed up for all of those many years ago whether you understood it or not. You became part of something few understood. As the end neared you wondered. Wondered if had been a good fight. If it had been worth it. If all that you saw and did really mattered or were like Stineyman in his races running in a circle real fast to show off.

Then you are sitting at a desk one day and it is 9/11. You watch the towers fall. You know that are hundreds of firefighters in those towers and you feel this huge rush of sadness. It had been a huge tragedy when six guys were killed in Massachusetts. This was so much bigger you could not get your mind around it. Maybe a hundred guys. Then you heard the first reports of two hundred guys. Two hundred guys like me. Then three hundred and finally the number reaches 343. Three hundred forty three guys. Jesus. Then the sadness is replaced by pride. Pride to even be in the same profession as these guys. Guys who responded when the bell went off. No other priorities, no other goals. It was their job and they had signed on. To even be a part of a profession that produced such men was suddenly a source of huge pride. They were not extraordinary men, they were ordinary men who did an extraordinary thing. That is what made what they did so significant. Ordinary men called to an extraordinary thing and to a man stepping up and doing it.

They were just firefighters who went to work to fight death. That day they saved thousands as they died. In their death they made you realize just what you and all the others had done. Why the fight was important even in the small tragedies you saw every day. They made you proud of what you had done. They gave to you something that had gotten lost. They gave you understanding.

There were guys on their last shift and they went. They were guys on their first shift and they went. There were guys who called home to tell they families they loved before they went. There were guys who left notes to their families and they went. They went knowing that there was a good chance they were not coming back. They went because it was their job and if you signed up then you did the deed. No raise if you went. No bonuses. They went because they were there to fight death. To fight the fight, no matter what. And because they went they gave back to you something that had been lost, something that you needed back.

We all did it for our own reasons. But to me they gave me back why I had done it. And in so doing they gave back to me the smoking baby, the man with no arms, the drownings, the cardiacs, the accident with injuries, the shootings, the stabbing, the fires and all the rest with perspective. I had done it to fight the fight, day after day, month after month, year after year, decade after decade. No more and no less than that, to be there when someone called. To stand with men and women who no matter what, went when the bell hit. That was something. That mattered. And that is all that mattered.

The Boy Who Went Swimming

2008-03-31T15:17:00.001-07:00

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

2008-03-31T14:02:00.000-07:00

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.

Crack Baby

2008-03-30T09:10:00.000-07:00

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.”

“Great!”

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.

“Yeah.”

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.

Mostly at Night

2008-03-25T23:22:00.000-07:00

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

2008-03-25T23:12:00.001-07:00

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

2008-03-25T22:43:00.000-07:00

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

2008-03-25T11:12:00.000-07:00

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.

Things Could Creep over the Wall

2008-03-20T07:33:00.001-07:00

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.

I took the gun away

2008-03-16T15:18:00.000-07:00

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

2008-03-16T15:17:00.000-07:00

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.

I am going to die aren't I?

2008-03-16T13:58:00.001-07:00

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.

“What?”

“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

2008-03-16T13:48:00.001-07:00

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.

The Knife and Gun Club

2007-12-14T13:37:00.000-08:00

Station 7’s nickname to those stationed there was the knife and gun club. It was small of single story cinder block building that was showing it’s age. It served a predominately poor neighbor on the west side of town. It was not unusual for the convenience store next door to be robbed on a reasonably regular basis. On New Years Eve you could walk out on the apparatus floor and listen to the gunfire at midnight as everyone celebrated. Every once in a while the single shots were interrupted by automatic gunfire bursts.

In an attempt to decorate the place in keeping with the neighborhood a large stuffed rattlesnake was kept in the kitchen. One of the guys had left it for the station years ago and it had become a fixture. It sat in a large glass enclosed case on top of the TV. The concertina wire that wound through the fence enhanced our view outside the kitchen window. So the station had it own ambiance about it.

Maybe the easiest way to describe Station 7 is with a story. One night I had just fallen asleep. It was close to three am and we had been busy for most of the day and night. It was the first time I had been able to lay down. I was in that strange place between sleep and consciousness when thought I heard the doorbell to the station ring. It was not unusual for people to walk up and ask for help anytime day or night. I sat up in bed and looked around. No one else was up or awake. Maybe I had just dreamed it. The bell did not ring again, but I thought I should check the front door.

I pulled on my pants and walked to the front door and looked out through the peephole. It was a good one, and gave me the 360 view of outside. There was no one there. I thought I had been dreaming and went back to the dorm and got a couple of hours sleep.

I was the first one up the next morning and opened the bay door to get the paper. I walked out on the apron and pictured paper. It was a beautiful Florida morning. When I turned around I saw on the front door of the station two bloody handprints and a long smear of blood. Oh shit. Another firefighter had come out front too. We both did a frantic search of the bushes for a body, we were afraid what we would find. Nothing. No sign of anyone. Why didn’t the person ring the doorbell again? We could not figure it out. So we washed the blood off the door and went inside to have our morning coffee, just another shift at the knife and gun club.

We were dispatched to an apartment fire. When we arrived we found light smoke coming from a second story apartment. The apartments were concrete block. All of the apartments doors opened to the outside. The second floor apartments doors opened to small balcony that ran the length of the second floor. A metal handrail ran the length of the balcony. I followed the Engine crew up the stairs. We got a whiff of the smoke and knew immediately it was a pot on the stove. There is no other smell like the smell of burnt food mixed with hot metal.

The door was open so we did not have to use forcible entry. When we walked in to find moderate smoke in the apartment. I looked to my right and found a male somewhere in his twenties sound asleep on the couch. He continued to sleep even with all of the noise and commotion going around him. So my partner and I picked him up and carried him out of the smoke filled apartment. He did not move or wake up as we carried him outside.

We laid him carefully down outside the apartment on the balcony. I had turned around to see what needed to be done next when I felt someone grab me by the tank and my coat and try and throw me off the balcony. The victim without saying a word had turned on me. Now no one ever accused me of being skinny. Back then I was somewhere just over two hundred pounds. With my air tank, bunker gear, boots, helmet and other equipment I must have weight close to two seventy. So when he tried to throw me off the balcony I did not budge.

I turned around and wrestled him to the ground. My partner lay across his lower body but he continued to struggle. We were face-to-face rolling around on the balcony with the boot of the Lieutenant off the Engine suddenly appeared. He very carefully but with enough force to make his point bounced the victims head off the concrete.

“Stop it.” He said quietly.

The victim immediately stopped. My partner and I got off of him and let him up. He walked off with ever saying a word.

We received a call for an assault. It was that wonderful three in the morning time when such interesting things seem to happen. Since it was an assault only the rescue respond. We found the apartment complex and wound our way to the building we had been dispatched to. As we came to a stopped we saw a man and woman framed in the headlights. The woman had a knife and was swinging it wilding at the man. He was unusually calm for such a situation. Since we weren’t armed we thought it was not a good idea to get between people with weapons. So I got on the radio.

“Rescue 7 to Orlando. Expedite OPD we have a knife fight going on.”

“Orlando check.”

So we sat there watching this bizarre scene in our headlights. The woman would stop swinging and the man would seem to try and calm her down. But she was not having any of it. She would start swinging the knife again. She never really got near cutting him throughout this whole time. Instead she just swung wildly. Finally OPD arrived. We got out of the truck with the police. The cops seemed to know the two. The cops easily took the knife away from the woman.

“What is going on here?” I asked the male.

“She is trying cut me.”

“I can see that. Are you hurt?”

“Yeah. I am.”

He proceeds to take off his shirt and turn around. He had a long professionally applied bandage on his back.

“When did this happen?” I asked.

“Last night. She cut me last night and I got stitched up at the hospital.”

“But she did not cut you tonight?”
“No. I am fine.”

One of the cops asked.

“Do you want to press charges?”

“No. No I don’t.”

The cops looked at us and we looked at the cops. The cops kept the knife. And we all turned and left them standing in the street. The street has a real sense of humor sometimes.

We received a call for man down in the street. It was the middle of the afternoon and it hardly a time you expect the type of call we would find. When we arrived on the scene we found a large man standing in the middle of the street waving his arms and acting strangely. He was covered in blood and grass stains. There was a crowd around him watching the show. Something was going on here and I did not like it. So I reached for the radio.

“Rescue 7 to Orlando respond OPD to our location.”

My partner Alba had gotten out of the truck and grabbed the trauma and airway kit. He approached the man and said.

“Are you hurt? Can I help you?”

“You know I like your body. But your face has go to go.”

With that he swung and hit Alba in the face with his fist staggering him backwards. I dropped the radio and ran around the front of the truck. Trying to reach the guy before he hit Alba again. As I rounded the front of the truck I did my best imitation of professional football linebacker. I tackled him knocking him away from Alba. I tackled him so hard that when we finally landed we were in the dirt beside the road. We sailed one full lane in the air. We rolled around for a moment until Alba was able to recovery and get over to help me. Our attacker was stunned enough to allow me to reach for my radio. As I straddled the man, I very carefully changed the channel on the radio and said.

“Rescue 7 to Orlando we are in a fight and need help.”

That is all I got out before this guys started to struggle again. It was all Alba and I could do to hold him down. The crowd, thank goodness was enjoying the show instead of deciding to join in on the fun. I hoped that my message had gotten through. I knew they would be there as fast as they could to back us up.

Just then a sheriff deputy arrived. Without hesitation he dove into the melee. We were still struggling when I looked up to see the engine rounding the corner lights flashing and siren blaring. The crew bailed off the truck joined in. We were able to finally subdue the guy. We were all on the ground working to keep the guy calm until the ambulance arrived and we could load him up and get him to the hospital. That is when OPD arrived. Two officers got out of their car and strolled up. With a smirk one of them said.

“You guys need any help.”

They literally had their hands in their pockets. I was afraid to say what I was thinking. I had over the years pulled more than one their officer’s ass out of the fire by helping one of them when they were in a fight and this is how I got repaid. It wasn’t first or last time I ran into this attitude. I will never understand them. Or the way they view the world where even a firefighter is on another side. From then on I called the Slow PD. They never failed to disappoint.

We loaded our friend into the ambulance and sent him to the hospital. I never learned if it was an overdose or he was just crazy that caused him to attack us. Alba went to the hospital he had a black eye and this glasses broken. Me I just got dirty. We were lucky that day it could have been much worse.

We got a call for a man down. It was almost in the same spot where we were attacked. This time we found a male standing and waiting for us. He was holding his exposed penis in a death grip. He faced showed real fear.

“Something crawled up my dick.”

“What?”

“Something crawled up my dick. If I let it go it will crawl higher.”

This was not covered in any training I ever had. We looked at him. Then looked at each other. I could think of nothing that we could do to help him. I had a man once who said something had crawled in his ear. He was in terrible pain. We sent him to the hospital. The ambulance crew told me later that it had been a roach. They had to drown it with alcohol then pull it out piece by piece. No thank you.

“Are you sure?

“Do you want to go to the hospital?” I asked trying not to think of what might have crawled up him penis. All sorts of small insects were coming to mind. None of which made me feel any better.

“Yeah man please.”

That is how we sent him to the hospital. Penis in hand. I never found if there was anything really up there. I am not sure I want to know.

We got a call for a shooting one night. We responded with engine to find a small concrete block home. The police were not on the scene but we decided to go on in. The door to the carport was open and a light was on. We walked up to the door and stood on either side.

“Fire Department.” I yelled.

I stepped through the door first to find a man standing there in his shorts.

“Somebody been shot?” I asked.

“Yeah me.”

“Where?” I did no see any blood and he did not appear to be in shock.

“Here.” He pointed to his penis. Before I could move everyone else had taken a step back. I looked back and could see a couple of them smirking. I knew I was stuck. So I knelt down in front of him and lowered his underwear. A twenty-two caliber bullet fell into my hand.

“Here give this to the cops.” I said and handed it back to the guys.

The victim had a through and through bullet hole through his penis. It was remarkable given how vascular the penis is but there was almost no bleeding, just this bullet hole. So I carefully wrapped the man penis and we sent him to the hospital. The jokes did not stop for quite a while.

Things Could Get Festive

2007-12-14T13:16:00.000-08:00

The Street was filled with many kinds of violence. Most of the time it was not directed at us. But every now and then the street decided to reach out and try and take a bite out of you. It might be a bullet or a knife or just a big crazy, but she would try. It was not enough that she ground at you everyday; she wanted a bigger piece if she could get it, maybe the whole thing if she got lucky. These were the kind of runs that gave you an adrenaline rush on the scene, but made you sit in the corner stare off into space when you got back to the station, and realized just how close it had been. You could almost hear her laughing, maybe next time there cowboy. Sometimes we were the intended targets, other times we were simply too close to the real target. I used to say that things got festive, when we had these types of calls. I could not put enough adjectives together to properly describe the intensity, so I went with understatement. It was the middle of the day, a normal assault call with the police on the scene. My guard was down. We were not being careful. Everything is under control. I was examining the back of the patient’s head and did not see the pistol drawn. Jeff the medic off the ambulance did and yelled. “Gun!” We had been dispatched to the ABC Liquor at Gore and Paramore for an assault. We were advised that OPD was on the scene and the scene was secure. We arrived to find the victim sitting in a chair while two police officers standing nearby writing their reports. As we began to exam the man we realized that he had been badly beaten. His face and head were grotesquely swollen. This indicated that he probably had multiple fractures in his face and skull. He could not answer our questions coherently. He was in serious condition. He was beaten about as badly as I had ever seen. He obviously did not know what was happening to him. We needed get him packaged and to the hospital. I stood behind him examining his head. My partner Larry knelt in front of him examining him for additional wounds. Jeff, the paramedic off the ambulance, stood to my left and the patient’s left. The two cops stood to our right busily writing their reports. That is when Jeff had yelled. “Gun.” Larry’s head snapped up in time to stare down the barrel of the pistol the patient was holding. All I saw was Jeff pulling the patients arm out and away bending his wrist backward. As he did he peeled the gun out of the patients hand. It was a police technique. Jeff was in the middle of police standards training. He wanted to be a cop. He disarmed the patient just the way they had taught in the weeks before. The two cops who had been standing there writing their report were now standing there with their mouths open. They had never searched the patient. They knew how close we had all come. The patient obviously thought he was still being attacked. Jeff broke open the pistol and dumped six rounds into his hand. He just looked at the cops, they did not say a word, they just looked sheepish. If Jeff had not grabbed the gun, I am convinced the patient would have shot Larry before anyone could have reacted. Then things would have gotten messy, with us in the line of fire of the cops and the patient. So Jeff saved Larry’s and my life in my opinion that day. When we got back to the station just how close we had come that day really hit me. Being in the middle of a gunfight was not in any training manual I had read. We were finding ourselves on more and more scenes of violence. The department at point was still sending rescues by themselves to scenes of violance. Just two unarmed paramedics. I had been trying to convince them to send an Engine with us if for nothing else protection, and for the extra hands. So I went to my Captain and told him what happened to us. He looked at me and said. “That is what you get paid for.”

Most of the officers considered us more of pain than an asset. There were not that many of us in those days and they were always having to scramble to keep the rescues manned each shift. None of them were paramedics; in fact few if any were EMT’s at that point. So they did not understand what we did or faced and did not care to learn. We were inventing this profession with little or no official help and that included the street survival skills. It was the middle of the day, a normal assault call with the police on the scene. My guard is down. We were not being careful. Everything is under control. I was examining the back of the patient’s head and did not see the pistol drawn. Jeff the medic off the ambulance did and yelled.

“Gun!”

We had been dispatched to the ABC Liquor at Gore and Paramore for an assault. We were advised that OPD was on the scene and the scene was secure. We arrived to find the victim sitting in a chair while two police officers standing nearby writing their reports.

As we began to exam the man we realized that he had been badly beaten. His face and head were grotesquely swollen. This indicated that he probably had multiple fractures in his face and skull. He could not answer our questions coherently. He was in serious condition. He was beaten about as badly as I had ever seen. He obviously did not know what was happening to him. We needed get him packaged and to the hospital.

I stood behind him examining his head. My partner Larry knelt in front of him examining him for additional wounds. Jeff, the paramedic off the ambulance, stood to my left and the patient’s right. The two cops stood to our right busily writing out their reports. That is when Jeff had yelled.

“Gun.”

Larry’s head snapped up to stare down the barrel of the pistol the patient was holding. All I saw was Jeff pulling the patients arm out and away bending his wrist backward. As he did he peeled the gun out of the patients hand. It was a police technique. Jeff was in the middle of police standards training. He wanted to be a cop. He disarmed the patient just the way they had taught in the weeks before.

The two cops who had been standing there writing their report were now standing there with their mouths open. They had never searched the patient. They knew how close we had all come. The patient obviously thought he was still being attacked.

Jeff broke open the pistol and dumped six rounds into his hand. He just looked at the cops, they did not say a word, they just looked sheepish. If Jeff had not grabbed the gun, I am convinced the patient would have shot Larry before anyone could have reacted. Then things would have gotten messy, with us in the line of fire of the cops and the patient. So Jeff saved Larry’s and my life in my opinion that day.

When we got back to the station just how close we had come that day really hit me. Being in the middle of a gunfight was not in any training manual I had read. We were finding ourselves on more and more scenes of violence. The department at point was still sending rescues by themselves to scenes of violance. Just two unarmed paramedics. I had been trying to convince them to send an Engine with us if for nothing else protection, and for the extra hands. So I went to my Captain and told him what happened to us. He looked at me and said.

“That is what you get paid for.”

It was a Friday night and the Saturday Night Specials would always come out. It came in as a shooting at Concord and Paramore, just a few blocks north of the incident at the ABC. Paramore also had a liquor store on the corner a block or so north of this address called Liquor World. Our nickname for it was Murder World. Paramore was the center of the rough side of things where desperate people mixed with violent predators in a vicious dance. We were asked to the dance anytime the two connected.

As we neared the scene the we were stopped by the police. They said shots were still being fired at the scene and near the scene. They were wide eyed and wired. We fed off their adrenaline as we sat there waiting. Cop cars would race by lights flashing as other officers responded. It was enough to crank up the volume. To get things really humming before we went in.

Finally after what seemed an eternity we got the all clear and we were told the scene was safe and to go on in. We drove the short few blocks and bailed out of the truck. We arrived to find to find a huge victim illuminated in the flashlights of several cops. In the hard light of the cops flashlights and our headlights the whole scene looked like a black and white picture. The patient looked like a professional football lineman he was so large, it was the first time I had seen someone so large felled by a single .22 caliber gunshot to the chest. I would later learn, as I saw more shootings, just how lethal small caliber weapons were. Small caliber rounds bounce around once they enter the body, lacerating and penetrating all sorts of vital structures and doing much more damage that the big round. With bigger caliber weapons the round generally plows through the body in a straight line. It does not have the velocity to ricochet off bone. Many times it does less damage. So the Dirty Harry’s of the world should be carrying 22 instead of their big 44’s.

The scene was chaotic. Police were running around with their guns drawn shouting at someone down the street. The ambulance had arrived with us and the four of us got right to work. He had no perceptible pulse but his heart still show a rhythm.

More loud shouting by the cops. Then we heard gunshots nearby. Still more shouting by the police as they tried to figure out was going on and who was shooting at whom. They were not doing the firing. Things were getting very festive at this point. We were frantically trying to get this guy ready for transport.

There was a black and white picture of us the next day in the paper. We were all black silhouettes framed in the headlights of one of the trucks. We are on our knees bent over the patient trying to start IV’s. The lead to the story was help arriving in the midst of shooting. It is exactly how I remember that scene in black and white silhouettes frame in the headlights.

We finally got everything done we need to do so we loaded the patient on the stretcher. It was time to load and go. So loaded the patient and got him to the hospital. He died in the emergency room.

Not far from both of those scenes again on Paramore we had a shooting at the Dixie Doodle. It was a innocent, almost silly sounding name for one of the most dangerous bars in Orlando. Countless assaults, shooting, stabbing, cuttings and robberies had occurred at this one small single story concrete block building. It was one of the places that the predators and the desperate did their dance. We were invited to the dance there more than anywhere else.

I had been there more times that I could count on all matter of mayhem over the years. I had been traveled into Station 2 to ride Rescue 2 that night. We received a call for a shooting. The station is only a few blocks away and the dispatcher told us to stage in the station until OPD could secure the scene. I should have known securing the scene at the Dixie Doodle was going to be a challenge to say the least. The building could never hold all of the patrons on any given night and they always spilled out into the parking lot. I had seen as many as two hundred people outside the building, milling around drinking and partying.

We went to the trucks to wait for the dispatch. It was not long before we told the scene was secure and to go on in. We arrived to find the usual chaotic scene the Dixie Doodle. There were hundreds of people milling around excitedly in the parking lot of the little structure. I was on the passenger side of the truck. I went to the compartment on my side of the truck to grab the drug box and airway kit. Just as turned around to find the victim. Four shots rang out.

I have never seen so many people disappear so quickly in my life. Including the other members of the Engine and Rescue. They had ducked behind the trucks. But I was on the wrong side of the truck to do that. The only other people in sight was the victim, an ambulance attendant who had just arrived and police officer with his gun drawn standing next to them. I figured I would head for the only friendly face with a gun I could find. So I hustle over there in a crouch, holding the boxes up so I felt as if I had a little protection. The Lieutenant off the Engine said I looked really funning running and trying hide behind the boxes. I told him it did feel that funny at the time.

The patient had single gunshot wound to the chest. He was coded. The ambulance attendant and I began to work on him immediately. The Engine crew and my partner and we tried to get this guy packaged and out of there as soon as possible. But there were not enough officers on the scene because we were soon surrounded by the crowd that disappeared earlier. Since the shooting had stopped they had returned and were now jostling and threatening us and the police. As we worked they broke out a window on the ambulance. We got the victim on the backboard and got him into the back of the ambulance. In spite of the broken window and the crowd the ambulance driver got us out of there and to the hospital. The engine and rescue left soon after we did clearing the scene so the cops could concentrate on controlling the crowd. The guys at the station gave me a hard time about trying to hide behind the drug box. I must have really looked funny trying to get my two hundred pounds behind a tackle box. I came real close though.

It turned out that another victim had been shot inside the building and was pronounced there at the scene by another paramedic off the ambulance. My patient died. So it turned out to be a double homicide. As I remember the two had gotten into a gunfight and killed each other. The city closed the Dixie Doodle after this incident in an effort to begin to clear up the neighborhood.

My First Code

2007-12-14T12:55:00.000-08:00

The first time I had to deal with death on the job was Christmas Eve morning 1974. I was only weeks out of training. Death would become my adversary on the street in an almost a daily battle. We fought in the homes of cardiacs, on shooting and stabbing scenes, in car accidents and even baby cribs. He was my enemy. He won a lot more than he lost in our battles. But I won some. It is what the whole thing was about.

I had been assigned to Engine 3 out of training. It was a company in a quite residential neighborhood. The station was filled with old timers putting in their last years on the job before retirement. They were uniformly big, loud World War II veterans who had worked 24 hours on and 24 hours off for most of their careers. They all smoked like chimneys and drank like fish. Good men who knew their jobs and had seen it all after twenty five years, men who were happy if we never left the station on a run during a shift. But I was eager for action. I would learn that I did not have to be eager for action, it would find me soon enough.

We were into our usual end-of-a-shift morning ritual of sitting around groggily sipping coffee waiting for our relief so we could go home. You cannot leave until your relief is in the station and has his gear on the truck. So you sit there in the kitchen sipping enough coffee to keep awake, just long enough so you could go home and crawl back to bed. I was just trying to balance the caffeine level.

The tones came in and the bell went off. The Dispatcher’s voice came over the loud speaker. I ran to the truck as the older guys walked.

“Engine 3 woman down.”

It was cool beautiful Florida December morning. The Engine was an open cab so the run there was almost pleasant. I grabbed the oxygen kit off the Engine and one of the other firefighters grabbed the first aid kit.

The address was the old American Legion Hall a crumbling landmark at the edge of our territory. It was seedy rundown place with small apartments. We moved through a maze of dark halls and dirty apartments until we found our victims apartment. The room was small and dirty. A middle-aged woman lay in the middle of the floor. I knelt beside her while Charlie checked for a pulse and breathing. He shook his head.

I tore open her nightgown and put two fingers on zypoid process, then placed the heel of my hand. It stuck me how cold her skin was. The complete limpness was so different than anything I had ever felt in another human being before. Her half closed eyes stared unseeing at the ceiling. She seemed smaller somehow, as if the something that had made her who she was, was gone. The essence of whatever made her had left her body and left it smaller and deflated. It was as if it took up space, and made that person larger, vibrant and whole was gone. That fact in some unconscious way effects you the first time you see it.

I thought about what I was supposed to do. Fingers up off the chest so you don’t break ribs. Heel of the hand on the sternum. I was worrying about all of the things I was supposed to worry about. Because that is what I have to worry about. I can’t take in all of these other impressions until later. The later is what is more difficult to deal with, than actual physical action required to perform CPR. I worked very hard to remember all of the things I was supposed to do.

One one-thousand. Fingers up off the chest so I don’t break ribs. Two one-thousand. I feel the ribs break anyway. She is very frail. It feels like little pops in her chest with each compression. Three one-thousand. Keep the heels of my hand on her sternum. Four one-thousand. Five one-thousand. I pause for a fraction of second to let Charlie give a breath. One one-thousand. Two one-thousand. Three one-thousand. Four one-thousand. I counted to out loud so Charlie can time the breaths. Five one-thousand. And so it goes as you work. You settle into a rhythm. After a while your back will start to ache. It is a very awkward position. You are leaning over someone without any support. One one-thousand. I can hear the ambulance approaching.

“Huder. Check out the other one in the bed.” The Lieutenant said.

Other one! What is he talking about? I give up my place to another firefighter and turn to the small bed. There buried beneath the covers is a small woman somewhere in her seventies. Her eyes have the same half open stare as the woman on the floor. I gingerly reach down and place two finger where her carotid pulse should be. She is much colder than the woman on the floor. She is stiff.

“She is cold and stiff Lieutenant.”

I am stunned. Not one code but two. What in the world happened here? Two women dead. One code was enough, but a code and a dead body together on Christmas Eve morning. We continued the code on the woman on the floor. Since the woman was cold and stiff we did not try and work her. The other firefighter was counting out loud.

“One one thousand. Two one thousand. Three one thousand. Four one thousand. Five one thousand.”

Charlie gave another breath. And so it went as we waited for the ambulance.

I helped around the edges for the rest of the call. I kept glancing over at the women in the bed. Still trying to take it all in. The ambulance arrived and we loaded the patient onto the stretcher. The EMT off the ambulance took over compressions. Charlie rides in to help with the code.

A man suddenly shows up looking confused and stunned, apparently one woman was his wife and the other his sister, and both had just died on Christmas Eve. What can you say to someone like that? I wanted to say something but could not begin to think of what. So I moved around and helped carry out equipment back to the truck. We left the scene with the police to take care of the other body and went back to the station.

We head back to the station. I ride in the jump seat. So I sit in the sunshine on a beautiful Florida morning with the images of two dead women rolling around in my head. It was introduction to the juxtaposition of death and normality. Of living and dying so close together. I had lived in a protected bubble my whole life until then. I had lost my father and grandparents but not like this. That bubble had burst and now I was aware of how close death was to all of us.

I kept thinking about the family. Such a loss on Christmas Eve morning would be staggering. I had seen codes in during my EMT training in the emergency room. I had observed them. I had never participated.

What struck me was we did not have the cool sterile environment of the hospital emergency room as protection against the tragedy of it all. We worked in the code in the their bedroom. I saw the second woman in the bed she had gone to sleep in the night before. Their personal belongs surrounded us. The dinginess of their lives had rubbed on me and made me feel their poverty. It was the little realities that were making the experience so personal. The feel of their skin. The feel of her ribs breaking as I did CPR. They said it would happen in training, even when you did it right. But the reality. The little pop you felt is was all very close up.

Our relief was waiting and pulled our gear off the truck. I had a cup of coffee and sat at the table in the kitchen. A ritual I would repeat thousands of times over the next years but this was the first time after something that was so changing. We talked about what we were going to do for Christmas, nothing profound, just men getting off work talking to one another before they went home to their families. We told the on coming shift about the call and got a couple of “you have got to be shitty me’s”. They understood. They would just shake their heads; the street always had something up her sleeve to throw you.

The ambulance dropped Charlie off. The woman we worked did not make it. The drive home is lost somewhere as I tried to sort through all of the emotions and memories. I felt a huge sense of pride that I had performed well in the face of someone needing my help so desperately. I felt inadequate that I had to struggle mightily with my emotions. I kept remembering the half open eyes. I struggled with the death of two people I had never known but were now such a large part of me. All of these emotions, memories, and impressions swirled around changing my mood as fast as they ran through my head.

I had done it. I had gone to a call where lives were on the line and I had performed. There is always the question until you do it. No big call just the first of the thousands of small personal tragedies that I would be a part of over the next years, a small very personal sadness that becomes some small part of you. You were part of someone’s death. You were the last to try and save them.

Firefighter/Paramedic

2007-12-13T16:24:00.000-08:00

“Engine 1, Engine 51, Tower 1, Rescue 1, District 1 house fire….”

“Engine 7, Rescue 7 shooting. OPD is not on the scene….”

“Rescue 1, Rescue Boat 1 respond to assist Engine 7 and Rescue 7 with a drowning….”

“Engine 6, Engine 4,Crash 6, Rescue 6, Tower 1, District 1 plane down…”

“Engine 3, Rescue 3 person not breathing…”

“Engine 10, Tower 10, Rescue 7 District 2 accident with injuries involving entrapment…”

I can almost feel the adrenaline rush. See the red lights of the trucks. Hear the roar of the diesel. Then dispatch would give the report that always meant you had something serious.

“We are receiving multiple calls.”

“We have reports of people trapped.”

“CPR is being performed.”

Then I find myself listening for the reports from the first units to arrive.

“Engine 1 to dispatch we have heavy fire showing from a single story wood frame structure. We are pulling an inch and three quarter line.”

“Engine 6 to Orlando we have a single engine plane down in a tree. No fire. But we do have a fuel leak. Be advised the passenger and the pilot are trapped.”

I am back on the street. That place I named so long ago, the other reality that exists just outside most people’s everyday work a day lives. It is a place that seems to exist in parallel to daily existence. Yet it is only a car accident or cardiac away for everyone.

The street was more than a physical place. It was a place where all of the safe guards end, and our job begin. It is a place filled with excitement, fear, tragedy, horror, sadness, despair, joy, and laughter. It was a place where everyday decisions had terrible consequences. I am going to the grocery store. Or I will the wiring fixed next month. Where people died or were horribly injured. It was terrible place. Or maybe it is reality. It was where I worked.

The street existed in the poorest homes in Orlando, and in the richest. It existed in back alleys and the main streets. It existed in brush fires, house fires, shooting, stabbings, hangings, cardiac’s, codes, drowning’s, and a thousand other emergencies. It was everywhere around. I have houses or intersections that had been scenes and now were signposts in my life. That house is where I pulled the woman out of the fire that afternoon. I pass the intersection where all those people died on that Thanksgiving night when I go to the YMCA. I can see where I had the double shooting from the East/West Expressway. I can see where we tried to save a mother and three children that night in that fire, each time I get on the interstate. Across the street from those apartments is where we found that body that had been undiscovered for three days in the Florida heat. The reminders of the street and the years I spent on it are everywhere around me, like some kind of map of my life. A map that marks life-changing event for me and those I tried to help.

When I remember the street I always remember it at night, as if that were the only time when bad things would happen to people, and I would have to pick up the pieces. Not just night, but the middle of the night on old Rescue 1. Those early adrenaline filled nights. Where you were wired to every bad thing happening in the city through the radio. That three in morning time when only the cops, the drunks and us are left to prowl around in some kind of three way dance. The kind of dance that leaves people lying in the gutter bleeding from a head wound, with the stunned how did this happen look on their face.

My partner and I are heading back to the station after the 20th call since we had came on duty at eight am the previous morning. It had been one of those shifts where none of the calls were serious enough to need our help. A long line of people who fall through the social net and end up using us to solve their small or imagined problems.

Just another long shift filled with sick, lame, and lazy who made me question why I became a paramedic. Where are all the people that needed saving? The world seemed to be made up drunks and squirrels that think that calling the fire department will solve almost any problem. The drunk we just ran on was lying in the street with one shoe off, waving his foot at us. “I hurt my foot” he said. The woman who after careful questioning and a through physical exam chief medical complaint was she “felt foolish”. The drunk being arrested by the cops who cursed us out as we tried to bandage his head.

Just another night on Rescue 1 where my life seemed to shift into fast-forward the moment I stepped on the truck in the morning. The fires, shooting, stabbling, assaults, man downs came at me so fast, that I thought I could put my hand out the window let it surf through them as they rushed past. Like I did when I was a kid and stuck my hand out of the window of the car as my parents drove me home from a day out.

With each of the runs I got the same adrenaline shot that I did when it turned out to be life threatening. Then someone presses the button on my life and the fast forward drops into standard play. The twenty adrenaline rushes have left me exhausted and used up. Suddenly in the Florida heat my uniform is damp and sticks to me, from constantly sweating as we drive the streets of Central Florida with no air conditioning. I lean against the door feeling as if I did not lean against something; I would fall over and go to sleep.

My head is fuzzy with fatigue and aches with a dull throbbing. My stomach is trying to eat its way out. All the adrenaline rushes have emptied my tank of anything I ate today or yesterday. My eyes feel as if someone has put sand under them each time I blink. All I want to do in the world is to lie down and go to sleep for just one uninterrupted hour, just one silent quite hour. All of this rolled together became what I used to call the Rescue 1 Blues. A physical and mental state that was truly unique and miserable.

The only lights are the bronze halogen streetlights that cast an eerie light that is somehow depressing. Then through all of the fatigue, physical discomfort and just plain, I don’t want to do this, the radio in the truck blares.

“Rescue 1 can you take another call.”

I want to run screaming away from that radio, but I pick up the mike and say,

“Check”.

“Unknown illness to a child. 1492 Paramore.”

“Rescue 1 responding.”

I flip on the lights and turn on the siren and we head for the address. The red box lights reflect off the windows of the stores and buildings of downtown as we head for the wrong side of things. Where we are the doctors to those that do not have the money or insurance for real doctors. Tonight it seems too melodramatic, red lights flashing as the truck rushes through the empty streets. We know by the dispatch is going to be some minor.

When we turn on Amelia and go under the Interstate, it was as if we had entered another reality. One where you could almost taste the hopelessness, the anger and the frustration of the people who were so close to the money yet so far away.

We find the address in front of a small two-story apartment building. No lights are on and everything seems locked up tight. We cross the grey sand front yard, strewn with beer bottles and trash. Larry and I walk up to the second story of the apartment on the bare concrete stairs. When we reach the apartment we stand on either side of the door. You never stand in front of a door, you don’t know who is on the other side or what they might have in mind.

“Fire Department. Did someone call?” I yell as I knock on the door.

A young girl opens the door immediately. She is in her late teens, a crying baby is in her arms. She has a look of real concern on her face.

“What seems to be the problem?” I asked.

“He’s running fever and coughing. I..”

She handed me the baby. I looked down at him as I cradled him my arms, just like I did with my own son at home. The baby was hot to the touch, but not anymore than my son had been the last time he ran a fever. We examined him and questioned the mother. It looked as if the worst thing he had was a cold.

“He’s fine. Looks like he has a cold. Do you have any Tylenol? It would lower his temperature and make him sleep better tonight. You could take him to the doctor tomorrow?”

“I don’t have any Tylenol?” her voice and the look on her face showed real fear.

The concern and fear in her face let me know that what was happening as much as anything. Here was a young girl all alone with her first child and no one to go the drug store to get the Tylenol. She was out on a limb doing the best she could to take care of the baby by herself. She had run out of energy dealing with the child and herself. She needed some help. The apartment was clean and well furnished. It was obvious she was doing a good job no matter what her support system was day to day.

“Look he is going to be fine he just needs some Tylenol and some antibiotics. Do you want to go to the hospital with him?”

“What do you think?”

“Yes, I think that would be a good idea. We have an ambulance on the way. Do you want to go by ambulance?”

“Yes. Yes I do.” the relief on her face was enormous. She just needed someone to help her. Nothing fancy, nothing dramatic, just someone to share the load of being a parent. Not something I thought I would be doing when I went to paramedic school.

As I stood there with the crying baby, I could feel the relief in her as she gathered things for her diaper bag she would take to the hospital. She had the support she needed, it did not matter it came in a red rescue truck. She had someone to ask what to do, and then they had the means to solve her problem. Not a big problem in scheme of things, but it was everything to her.

When the ambulance arrived we walked her out to the rig, and helped her into the back. It was not the type of problem the system was designed to handle, but it was the type of problem we faced daily. No sophisticated medical skill needed here. No special training. It just took a willingness to help. These types of calls would sometimes fill a shift. Back then they were forgotten as soon as I finished the paper work. But now they are the ones that come to mind first when I think of the street twenty-six years later. Not the Smoking Babies, those only came up through some unrecognized trigger that throws me back on the scene.

The little ones come to mind now, the ones I thought I would forget as soon as they were over and the big ones piled on top of them Only through years on the street did I realize that maybe these would leave as much of a lasting impression as the big ones. There were a lot more of these than the big ones, maybe that is why this one, and others like it stuck in my memory. The genuine appreciation for the help given that was so apparent.

With the Smoking Babies the multiplier emphasized the absolute horror way beyond any understanding of your role in what happened. Or with so many of the others, the scenes were filled violence or hopelessness, with anger at the system, resentment the of authority you represented, or frightening abdication of personal responsibility for even the most basic human survival skills, that it was hard to glean out the fact that they did need your help.

So when these pure crystal clear moments happened they now stand out through it all. The street does give back to you, but it buries it under the violence, the stupid deaths, the drowning, the senseless deaths, the shootings, the hangings, the stabbings, the cuttings, the accident with injuries, the fires, the plane crashes, the drunks, and crazies. So if you are not paying close attention you loose them. You loose them to the big calls where no matter what you did everyone was going to die anyway. You loose them to the mental and physical fatigue that comes with seeing so much. So I now try to hold onto those good simple ones because the big ones are too big to understand so much of the time.

I spent twenty-six years in the fire service. That is over half my life. Not half my adult life but half my as a whole. What you do in this world shapes you, changes you. On the street what you see and do changes you in a way few other professions do. Adrenaline rushes, fear, elation, sadness all can happen on a single call that is part of a twenty run marathon of life, death and a lot of in between. It is all rolled up into single twenty-four hour shift that can cram more profound experiences than someone does in years of regular eight to five living. Combine the years and decades of those shifts and it changes you, and shapes you into something and someone else. Someone you weren’t when you started. It is ground into your skin, like a good mechanic, who no matter how much he washes his hands still has dirt under his fingernails. I still have the street under my fingernails. It will not wash off. If you scratch me I will bleed a story. I am a firefighter/paramedic. Even after years of retirement, it is who I am. How do you come to a job that shapes you into something you were not before?

We all come to the job for a variety of reasons. Some came because their father was a firefighter. Some came because of the excitement. Some came because it is a steady and reliable paycheck. And why did I make the decision to be become a firefighter? Me, I spent twenty-six years in the fire service because of a couple of television shows and a book.

It seems aimless of me to let popular culture drive my professional choice, but I am a product of the first television generation. Popular culture is the creator of myths in our society. And like the storytellers of old those myths are meant to provide guidance.

I loved the television show M*A*S*H. I never missed an episode. One night as I watched the opening scenes of the nurses and doctors running up the hill to the landing pad, their faces filled with intensity and purpose, it struck me that while they were actors that had really happened. There had been people whose job provided that challenge and purpose. I wanted a profession that provided that kind of intensity. That provided that kind of challenge, but I had no idea of what that looked like.

I knew I didn’t want to be a doctor, but I had no idea where I could find that combination of danger, intensity and service. I knew the military was not what I wanted. I did not want a profession whose object was to kill people. I had seen what that did to men close up during my own years in the service.

Then I read a book, Report from Engine Company 82 by Dennis Smith a New York City firefighter. Still the single best book about firefighting and the fire service ever written. It was a gritty account of his firefighting experiences on one of the busiest engine companies in the world. It had all of the everyday heroics and dedication I was looking for in a profession.

This was also about the time that a new television show aired. It was Emergency. It was based on the first fire department paramedics on the Los Angeles fire department. It was cheesy and hokey but I loved it. They fought fires and provided emergency medical services in the field. They saved everybody. It was great. I guess I needed the visuals to convince me. I joined the Department when I graduated from college.

The Smoking Baby

2007-12-13T08:50:00.000-08:00

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.”

“What!”

“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.