My Mountaintop Blog

One of the most challenging non-patient related issues in EMS is bad weather. Driving a five-ton, high profile vehicle in a snow storm can fray even the steeliest of nerves. I wouldn’t say my nerves are steely to begin with, so put me in an ambulance in the middle of the night during a blizzard, and my nerves can turn to goo pretty quickly.

We were in the midst of one of the worst blizzards I can remember. It was Biblical, and no pun is intended. It had been snowing hard for over twenty-four hours and just when I didn’t think the wind could get any stronger, I would be proven wrong. City snowplows were out en force but within minutes of clearing a street, the wind would howl and the streets would drift shut again.

The dispatch center had gone into the severe weather emergency mode which meant that each request for an ambulance was being carefully evaluated. In some cases, people were being told they would have to wait until the storm passed. For example, if someone  had been experiencing knee pain for the last three weeks but decided they suddenly needed to see an ER doctor, they were told they would have to wait or find their own way to the hospital. If a person called and said that someone had a knife protruding from their forehead, an ambulance would be dispatched immediately.

I am not sure why psych problems fall into the category of needing an ambulance in the middle of a blizzard, but they do, and my truck was graced with one such call. We were dispatched to a Catholic church at around 3 AM. The update was pretty vague…a pysch problem and PD was already on scene. The drive to the church took twenty minutes and by the time we got there, my jaw hurt from grinding my teeth.

The church was an older, musty-smelling building and it was pitch black when we walked inside. We fumbled our way in the dark toward voices and found everyone in the sanctuary in front of the altar. Two cops were standing off to the side and the only light was coming from their flashlights as they shined them on the patient. The patient was a middle aged Hispanic woman. She was kneeling at the altar and rocking back and forth. Her brother was sitting next to her and trying to console her. The patient’s daughter was standing off to the side with her head down and her hands folded in front of her.

As we walked up the isle to this incredibly bizarre scene, my partner lagged behind. I turned to him and asked, “What’s the matter?”

“This place is giving me the creeps,” he whispered.

I haven’t really bought into this whole demon thing, at least not the way Hollywood likes to portray it. I’m sure there are demons in some shape or form. But, like ghosts and UFO’s, until I see it, I don’t necessarily believe in it. Simplistic, I know, but it helps explain everything that I don’t understand.

I was amused at my partner’s reaction. He didn’t remind me of someone that was afraid of much. He was the quiet, burly type, so seeing him cower like this was rather comical. I was SO tempted to yell “BOO!” and see if I could make him involuntarily pass gas, or worse. I let professionalism prevail, however.

I told my partner, “If she doesn’t have any medical issues, we will turn this over to PD and we can leave.”

As we got closer to the patient, I could hear her mumbling something in Spanish. “Yo soy el diablo.” She chanted this many times as she rocked back and forth.

I noticed the brother had a very frightened look on his face. The daughter was looking equally concerned. The two cops seemed twitchy and on edge.

“Do you know what she is saying?” I whispered to my partner.

“Something about the devil,” he whispered back and then actually shivered.

“What’s going on?” I asked one of the cops.

“She woke up screaming and the brother brought her here,” a cop answered nervously.

“They walked here in the middle of a blizzard?” I asked.

“We live across the street,” the daughter answered.

Why, when someone has just spoken to me in perfect English, I would ask this, I don’t know. But I did. “So, you speak English?”

The girl gave me a puzzled look. “Yes.”

I quizzed her about her mother’s medical history, which included absolutely nothing. I delicately asked if her mother had ever experienced ‘emotional’ problems, and the daughter said no, never.

The patient was still mumbling, so I asked the daughter, “What is she saying exactly?’

“I am the devil,” the daughter said.

“For real?” I asked with surprise.

“Yes,” the daughter answered.

The woman had her back to me. I walked up a little closer and as I approached, the brother put his arms around the patient, as if to restrain her. That should have been a clue.

“Ma’am, can you turn around and talk to me?” I asked.

The woman stopped mumbling and ever so slowly turned her head to look at me. Her eyes were wide. Her mouth was contorted. She had drool dripping from the corners of her mouth. Without warning, she snarled and lunged at me, and tried to bite my leg. I jumped out of the way. The brother pulled her back.

“Holy buckets!” I said, astounded that diablo girl had tried to take a bite out of me. I recovered quickly and got mad. “Okay, knock it off!” I scolded. “What the heck is the matter with you?”

My chastising seemed to make the woman calm down a little. She whimpered, “Tengo terinta. Necesito agua.”

“What did she say?” I asked the daughter.

“She’s thirsty and wants some water.”

Normally I wouldn’t let a patient drink or eat anything, but this wasn’t your normal patient, and I already knew she wasn’t going to see the back of our ambulance. I turned to ask my partner to find some water but he was nowhere to be found. He had gotten so spooked that he went outside and was sitting in the ambulance.

“Be right back,” I told the cops and walked to the back of the sanctuary and into the foyer. The daughter followed me.

There was a drinking fountain with a paper cup dispenser. I pulled one of the cups out of the dispenser but the drinking fountain didn’t work. I noticed a metal jug, for lack of a better term, on a ledge across the foyer. I walked over and started to fill the paper cup. The girl started to say something but I cut her off. I was getting agitated. I was 30 hours into a 36 hour shift and I was crabby. Why the police hadn’t just cuffed the woman and taken her to behavioral health was beyond me. I should have been back at the station dozing on the couch instead of dealing with an obvious psych issue in the middle of the night during a blizzard.

I walked quickly to the front of the sanctuary and handed the cup to the brother. The girl tried to say something again and I ignored her. The brother held the cup to the patient’s mouth and slowly tipped it back.

The woman took a sip, jerked her head back, and then knocked the cup out of his hand. She let out out a blood curdling scream and started yelling, “Estoy en el fuego!! Se quema!!.”

With annoyance, I turned to the daughter. “Translation?”

The daughter was clearly shaken and could barely speak. When she did, her voice was nothing more than a squeak. “I am on fire. It burns.”

“Oh, for crying out loud,” I protested. “Why would she be on fire?”

The woman continued to theatrically cry out and hold her face as if she were in immense pain. I was expecting Peter Blatty, producer of the Exorcist, to jump out from behind the altar and yell, “Cut, cut cut! Do the scene over!”

The daughter grabbed my arm and said emphatically, “You gave her holy water, you idiot!”

“I what?”

“The cistern you got the water from is holy water! I was trying to tell you that!”

I’m not Catholic, therefore I have a plausible defense as to why I would serve up a glass of holy water to a self-professed diablo and burn her gullet. I’m not even sure what holy water is used for, come to think of it. Obviously, it isn’t meant for drinking.

“Oops,” was the only thing I could come up with.

One of the cops reached for his radio. I could tell he was at the end of his rope. “I’m calling for a priest,” he said.

“Seriously?” I asked. “Why not just call an exorcist?”

The woman was back to announcing that she was el diablo. The brother was crossing himself, looking skyward, and mumbling a prayer. The daughter was staring at me with venom in her eyes. I had obviously lost control of this scene.

“Okay, enough already!” I shouted, and the sanctuary went quiet. I looked at the patient. “You are NOT the devil so knock it off!” I looked at the cop. “She doesn’t need a priest, she needs an evaluation at behavioral health!” I paused to see if anyone was going to argue with me. When no one did, I added, “You people need to watch more Mickey Mouse and less Satan.”

I have to admit, the first few moments after I lashed out I had a little tingle along my spine from the fear that all the evils in the universe were going to suddenly engulf my mortal soul and I was going to be able to see behind me without turning my shoulders. Nothing happened, so I left and let the cops handle it.

As we were making the white knuckle drive back to the station, I said to my partner, “I could have used you back there.”

“I was about ready to crap myself,” he said quietly.

“Are you Catholic?” I asked him.

“Yes.”

“Then you could have advised me not to give el diablo holy water as a refreshment,” I scolded him.

“You gave her holy water? What happened?’

“She started screaming about being on fire. It was weird.”

My partner shivered so hard I think I felt the truck vibrate. “Oh my God!”

I rolled my eyes. “Have you seen the Exorcist?” I asked him.

“Both of them.”

“Poltergeist?”

“Both of them,” he repeated.

“Damien? Children of the Corn?”

“Yes and yes,” he answered.

“I thought so,” I said. We were quiet for several moments, and I just couldn’t resist. “BOO!” I yelled suddenly. And yes, I do think he involuntarily passed gas.

Some nights, when I am lying in bed and it is very quiet, i.e. when my dog hasn’t starting snoring yet, I think about some of the ‘bad’ calls that I have been on: the cardiac arrest at a family reunion; a child who drowns in a lake while on family vacation; a baby who can’t be awakened by young parents…and I swear I can hear the collective cries of anguish and grief, and the pleas for us to do something…..anything…to bring life back when life has already left the victim’s earthly body. Calls like this are, at least for me, the hardest part of the job. I will never grow accustomed to those heartrending voices.

Early one evening we were called for a possible cardiac arrest. When we arrived on scene, we found an elderly gentleman splayed all over his recliner. He was unconscious, and with gasping respirations. His skin was pale and diaphoretic. The house was full of people and virtually all of them were in the living room as we tried to assess the patient. There was a continuous chorus of pleading, crying, and imploring for us to bring life back into their loved one.

The patient’s wife told us that they had been celebrating his birthday and that at some point he went unresponsive. She emphatically denied that her husband had been drinking, and he had not complained of anything all day. She indicated that he had a history of hypertension, high cholesterol, and that the doctor had started him on a new medication a few days ago. She thought it was a steroid of some kind.

The crowd was growing impatient to the point of becoming antagonistic.  One guy that I assumed to be a son even suggested calling for a different ambulance because it didn’t appear that we knew what we were doing. We had been on scene less than five minutes.

The patient did have a weak pulse and once his head was tilted back and his airway adjusted, the gasping stopped. I am not a big fan of trying to perform in front of a crowd, let alone one that is escalating toward a lynch mob mentality, so I made the decision to get the patient out of the house and into the back of the truck.

Once we got the patient situated, we went to work putting him on oxygen and hooking him up to a cardiac monitor with ‘quick patches’ in case we needed to defibrillate. He was in a normal sinus rhythm, his blood pressure was normal, and his oxygen saturation was in the upper ninety percent range.  The patient didn’t have a history of diabetes but as with all unresponsive patients, I checked a blood sugar. It was in the 20’s, and then everything started making sense. He had started a new medication and one of the contraindications of this medication was a sudden drop in blood sugar.

After starting an IV and pushing an amp of D50, the patient regained consciousness and was alert and oriented within a few minutes. I explained to him what had happened and he confirmed that his doctor had warned him of the possibility that his blood sugar could drop after taking the new medication. He also flatly refused transport to the hospital. After getting his billing information and a signature, I escorted the patient back into the house. I opened the front door and walked in first. The entire family was still packed into the living room. They had their coats on because everyone was heading to the hospital, but before they left they were going to pray. A few were on bended knee. Others were standing with their heads bowed. The wife was leading the group in a tearful prayer…imploring God to watch over her husband.

The patient walked in behind me and when the wife looked up and saw him, her mouth dropped open and she abruptly stopped praying. The rest of the family all turned and there was a collective gasp of disbelief, as if they were witnessing a miracle, because the last time they saw their loved one it looked like he was circling the drain. I half expected the skies to open, an inviting light to shine, and angels to start singing. I was expecting the patient to sprout wings and float over to his adoring family. But he didn’t.

“What the hell are you all looking at?” the patient asked gruffly, and went back to his recliner. “Someone get me a piece of cake. The paramedics said I need to eat a lot of calories.”

The skies closed, the heavenly light disappeared, and the angels stopped singing. I explained to the wife what I thought had happened and she gave me a little hug of appreciation. Then she went into the kitchen to get her revived husband a generous slice of birthday cake.

On this night, at least in the eyes of this family, we snatched one back from the jaws of death, and in my eyes, that means we exceeded their expectations. Yay for us. Yay for not adding to the collection of voices that haunt me at night when it is very quiet, and my dog hasn’t started snoring yet.

Cardiology is one of those incredibly complicated, intricate subjects that can make your head implode if think about it for too long. Cardiologists go to school for something like 50 years to earn the right to be called a cardiologist, and I have a great deal of respect for what they do. In the food chain of cardiology, though, medics are really the bottom feeders. For the most part, we get to see the patient first after acute changes occur in what a person’s heart is supposed to be doing, which usually results in chest pain, shortness of breath, sudden weakness, and sometimes sudden cardiac arrest. Our job is to stabilize the patient, treat the acute changes if we can, and then drive really fast to the hospital. From there, the cardiologist can perform their seemingly paranormal magic and then bill the patient about a million dollars.

I have noticed a tendency with fresh-out-of-school medics to get too focused on some of the more minute details going on with a person’s heart, while forgetting what our real job is. I have tried to encourage these new medics to zero in on what we can change and not stew over all the infinitesimal nuances that we cannot change.

What I would really like to tell these new medics, but don’t dare, is that I believe our hearts beat primarily due to unexplained divine intervention. Yes, yes, yes, I know about the scientific description of the cardiac conduction system. But let’s face it, our heart is an amazing organ and sometimes we run out of explanations as to why it keeps ticking.

I was working a shift with a brand new medic and I could tell immediately this person was very, very smart. On our very first call, we picked up a patient that had experienced a fainting spell. One of our routine treatments with unexplained syncope is to do an EKG. Once the strip printed off of our LifePac, I gave it a quick glance and didn’t see anything acute. I handed it to my new medic partner and he studied it long and hard.

“Possible prolonged Q-T interval. This might be Ward-Romano Syndrome.”

“Is that a fact?” I said, and looked at the patient. She was conscious, alert, and breathing normally. Her vital signs were normal. Her skin was warm, pink, and dry. She was not experiencing chest pain or pressure. In fact, she was voicing no complaints at all. But, she did have a concerned look on her face now, and rightfully so. My partner was getting her all worked up by ruminating about some rare cardiac syndrome.

My partner shoved the EKG strip in front of me. “See how long the . . .” he started and then stopped mid-sentence when he realized I wasn’t paying attention. “What?” he asked.

“What would you like to do?” I asked, and subtly nodded at the patient.

“Um, go to the hospital.”

“Emergent or non-emergent?” I asked.

“Non-emergent,” he answered sheepishly.

I think he got my point.

I told that story to lead into this one. We were dispatched to a business for a ‘man down.’ Man down calls can mean anything from sudden cardiac arrest, to a stroke, to a seizure, to a gunshot, to a drunk that has passed out, to someone lying in the grass at a city park taking a nap. It could be anything. (Who am I fooling? Nine times out of ten when we get dispatched for a man down, it is for a drunk.) But not this time. The update from dispatch indicated that bystander CPR was in progress.

We arrived on scene, rushed into the business, and found a man lying near the bathroom. He was unconscious and didn’t appear to be breathing. Bystanders indicated the guy walked in off the streets to use the toilet and then collapsed as soon as he came back out of the restroom. Bystanders were still doing CPR.

My partner and I went into crisis mode. We connected the patient to our cardiac monitor/defibrillator and had the fire department take over CPR. The initial rhythm on the monitor was ventricular tachycardia.

I charged the defibrillator to 200 joules. “Gonna shock. Stand clear,” I announced but before I released the charge, I instinctively looked at the monitor again. “What the hell is that?” I asked in reference to the cardiac rhythm that had appeared on the screen. Instead of the easily identifiable ventricular tachycardia that we had seen first, the rhythm had changed into some convoluted mess that resembled nothing I had ever seen before. I checked the patient for a pulse and found a weak one. “I’ve got a pulse with that.”

My partner, a fifteen year, grizzled veteran, took a look at the monitor. The baffled expression that creased his face gave me a tingle in my belly that this call was going to end up in the memorable category.

“I don’t know what the hell that is,” he said.

I felt for a pulse again to make sure I hadn’t mistakenly felt one before. It was still there…weak and thready… but definitely a pulse. We took a blood pressure. It was low, but at least the patient had one. I looked at the cardiac monitor again and tried to apply the basic mechanics of what I knew about cardiology to try and understand what I was seeing.

There appeared to be runs of ventricular tachycardia followed by sinus beats, only the QRS complexes were low amplitude and wide. There were P-waves but not with every beat. The rhythm was regular. The height of the T-waves exceeded the QRS complexes, but the T-waves were not peaked. It was like trying to interpret a Van Gogh painting with a really bad hangover. I thought about the brand new medic that liked to get mired down in the minutia of cardiology, and wondered if he would recognize this rhythm and even have a name for it. Maybe it was another one of those rare syndromes.

“What should we do?” I asked my partner. “Pace, cardiovert, or nothing?”

He looked at the cardiac monitor again. “Damn,” was all he muttered.

The cardiac rhythm we were witnessing did not look like a rhythm that could sustain life, yet the patient had a pulse and a blood pressure. And then he moved his arms and moaned, which startled me. Sudden improvement wasn’t something I was expecting.

“Sir!” I yelled. Somewhere along the way I formed the opinion that sick people lose their hearing. Don’t ask me why, but for some reason the sicker they are, the louder I talk. The patient moaned again. “Sir, what is your name?” I asked. He didn’t answer but he did open his eyes and start to look around. “Okay, let’s get out of here,” I said, getting exasperated with my indecision as to how we should treat this guy. He was conscious now, and becoming more alert. Why mess with success? He was improving and we hadn’t done a damn thing other than show up.

While he was being packaged for transport, I did a secondary assessment. I didnt find any signs of trauma. I didn’t find any needle marks on his arms or feet that would be indicative of drug use. His pupils were equal and normal sized so it didn’t appear to be a narcotic overdose or a head bleed. His lungs were clear, his belly wasn’t distended, and he did not have peripheral edema. We did a quick check of his blood sugar, and that was normal, too.

I looked at the cardiac monitor again as he was lifted onto the cot. It was the same peculiar rhythm that defied any of the laws of cardiology that I knew. But the patient still had a pulse and was still looking around. This was an anomaly. Anomalies can put the fear of God into a medic. Little did I know.

During the emergent transport to the hospital, I gave myself a headache looking back and forth from the patient to the cardiac monitor because I just couldn’t convince myself that the mess I was seeing on the screen was keeping the guy alive. The patient looked around the ambulance but never uttered a word. When we arrived at the hospital, we took him to a cardiac room and I gave report to the cardiologist, which really consisted of me babbling on about how weird things were on scene. When I was sure I had convinced everyone in the room that I was a complete idiot, I handed the cardiologist the rhythm strip with the weird tracing. The cardiologist held it up to the light, turned it over, folded it in half, turned it upside down, then held it up to the light again. Finally, he tossed it to the side. I figured that he didn’t know what it was, either.

The patient was sitting up in bed and looking around the room. One of the nurses asked, “Sir, can you tell me your name?!” She was shouting, so she must have concluded that sick people go deaf, too.

The room went silent as everyone waited for an answer. Finally, the patient said, “I am Jesus Christ, son of God.”

The cardiologist approached the bed suspiciously, took a look into the patient’s eyes, then turned to a nurse. “I need a psych consult.”

I wasn’t so sure.

Whenever I get dispatched for an emergent call, there is still a little voice in the back of my mind trying to convince me that maybe the patient really is having a difficult time speaking between breaths, or the bleeding from the finger truly is uncontrollable, or that the patient really is changing color. (Side note: Whenever dispatch indicates that a patient is ‘changing color,’ I have the urge to to ask if they could advise as to what color the patient originally was. I digress….) I haven’t been doing this job long enough to have attained the status of fully jaded yet so I still get a tingle when we are going to something that sounds emergent.

We were driving lights and sirens for a stabbing and requested to standby until the police could secure the scene. (Exactly. Hurry up and wait). The address was a home for mentally disadvantaged people. That, in and by itself, made this call intriguing. Mentally disadvantaged people were rarely aggressive, let alone violent.  The update indicated a forty year old woman with possible stab wounds to her arms.

From a block away I could see about a dozen people milling around in the front yard of this home. No one was lying on the ground. It didn’t appear that anyone had a knife impaled in their back. No one was bleeding. The cops showed up and within seconds they waved us over. My attitude started shifting toward jaded. I sent the fire guys packing, as I realized there would be no need to apply direct pressure to anything other than my mouth.

We walked up to the gathering and one of the cops pointed to a forty-some year old woman with a towel wrapped around one of her arms. She appeared to be a very quiet, shy, and demur person. She was looking at the ground and shifting her weight from one foot to the next. When I introduced myself to the patient, she looked at me like I had just vomited on her shoes. There was another woman standing next to her that turned out to be the patient’s case worker.

“This is Mary,” (not her real name) the caseworker said.

“Is Mary injured?” I asked.

“She stabbed herself on the arm,” the caseworker replied.

I looked at Mary and with as much empathy as I could muster, I asked, “May I see your arm, please?”

Mary hesitated, still looking at me like I had puked on her. Then she looked at her caseworker. The caseworker nodded approval, and Mary removed the towel. I leaned in to look. Nothing. Just a couple of small indentations on her forearm.

I looked at the caseworker with puzzlement. “What did she stab herself with?” I asked.

About that time, a cop walked up. “This,” he said and held out a butter knife. I could tell the cop was thoroughly disgusted. That, or thoroughly disappointed. They liked ‘good’ calls, too.

I looked at the butter knife, then the caseworker, then Mary, then at the cop. Before I could utter a single syllable, the caseworker must have been reading my mind. She asked, “You don’t honestly think we are going to have real knives around our residents, do you?”

Direct pressure to your mouth, I reminded myself, because I had about five good comebacks and none of them were appropriate. “Um, I suppose not,” I finally said. “So, why did she, ah, stab herself?”

“I didn’t see it, but I was told she got really upset.”

I glanced at Mary again. She seemed so quiet and it was difficult to imagine her ever being upset. “Upset about what?” I asked.

“No one knows for sure,” the caseworker answered.

“Does Mary really need an ambulance?” I asked.

“I would like her evaluated,” the caseworker stated.

“What exactly do you want her evaluated for?”

“She just snapped,” the caseworker said. “This isn’t like her at all.”

Direct pressure, direct pressure, direct pressure. Damn. Damn. Damn. Mary was looking down at her feet again. The caseworker wouldn’t meet my gaze. My partner had already lost interest and was taking our equipment back to the truck.

As delicately as possible, I said, “If Mary needs a psych evaluation, you might have to  transport her yourself. We rarely, if ever, take patients directly to behavioral health.”

“I think she should go the ER. Something isn’t right,” the caseworker said.

I stared at the caseworker for several long seconds, knowing that once again EMS resources were being wasted. Rather than argue, though, I just decided to get on with it.

“Okay, but you will need to come with us,” I said. If the caseworker was going to waste my time by insisting that someone that wasn’t sick or injured be transported by ambulance, then I was going to waste her time and insist that she come with us. I led Mary and the caseworker to the ambulance. When we walked up beside the truck, my partner looked at me like I was some kind of circus freak. I just shrugged.

I put Mary on the cot and had the caseworker sit on the jump seat. As I was getting a set of vital signs, I asked Mary, “So, what were you doing today?”

In a soft, delicate voice, and with the mentality of about a five year old, Mary said, “We got some mooovies….and caaaaandy….and soooooda pop.”

“Wow, that sounds really fun,” I said. I leaned in a little closer. “Mary, why did you try and hurt yourself?”

Mary hesitated and her face scrunched up into a frown. In the same sweet little voice, she started, “I was giving eveeeeryone hugs and then Bill-wouldn’t-hug-me-and-I-got-mad-and-I-wanted-to-kill-everyone!!!!!” Mary’s voice had changed to throaty and definitely demented.  I was wondering if I would need a priest. She was squirming around and trying to get off the cot. “Waaaaaaaaaaaa!” she wailed.

“Okay, okay,” I said as soothingly as possible. “Don’t think about that. Think good things.” I had to restrain Mary by pinning her shoulders back. I looked at the caseworker. “Has this happened before?”

The caseworker looked peaked, and truly frightened. “I don’t think so,” she answered meagerly.

Mary stopped struggling to get off the cot. She was mumbling and whimpering.  I made a quick call to the hospital to let them know we were coming….and to have a sedative ready.

“Are you doing okay now?” I asked Mary.

She nodded innocently, but then the eruption began again, “We were watching mooooovies and eating caaaaaaandy and I just wanted Bill-to-hug-me-and-he-wouldn’t-so-I wanted-to-kill-him!!! I-want-to-kill-everybodyyyyyy!!!!!”

“Holy crap,” I said, and had to restrain her again.

“I-want-to-kill-him!!” she said in her demon voice, struggling to get up.

The caseworker grew agitated. “Mary! Bill doesn’t have any arms!”

“What?!” I asked incredulously, snapping my head around to look at the caseworker.

“I-want-to-kill-everyone!!” Mary screamed.

“Bill doesn’t have arms?!” I asked again.

“Bill doesn’t have any arms!” the caseworker scolded Mary. “How was he supposed to hug you?!”

“I want Bill to huuuuug meeeeee!” Mary whined, sounding like an alley cat in heat.

In unison, the caseworker and I said to Mary, “Bill doesn’t have arms!”

“Waaaaaaaaaaa,” Mary cried.

I sat back on the bench seat and practically had a stroke trying to keep myself from laughing. When I gave report at the hospital, I left the part out about the guy with no arms because I knew I would never make it without breaking down. As I was leaving, the caseworker stopped me.

“Thank you,” she said.

“I really didn’t do anything,” I replied.

“Thank you for not laughing at Mary. You would have hurt her feelings.”

I paused for a long time, and then said, “I can’t even imagine how bad Bill must feel right now.”

With that we both started laughing so hard that we had tears running down our cheeks.

“Whadaya think?” I asked my partner.

He scratched the stubble on his chin. “I dunno. Doesn’t look like much to me.”

“Me, either,” I answered. But we continued to stare for some reason.

My partner leaned down and put his hands on his knees to get a closer look. I was already too close for my liking. I was having one of those ‘ah-ha’ moments. You know, when the last twenty years of your life flash through your mind and you realize what it is that brought you to where you are today?

I had spent the vast majority of my adult life in a suit and tie, preying on prospective buyers in the telecommunications market. At the time it was easy money. After a few years I attained the status of sales director, and made even more money. I lived in a big house on the golf course, drove luxury cars, and bought new fitted shirts when the old ones got dirty. Sales and marketing wasn’t exactly an honorable profession. But, I worked pretty much the same hours as most of the rest of the civilized world, and I got my handicap down to 4.3.

My decision to become a paramedic was rooted namely in a desire to become a part of the solution. As drippingly sappy as that sounds, there came a day when I realized that duping people into buying a product or service wasn’t exactly something that I could look in the mirror and feel good about. So, I took the plunge and went to paramedic school.

Going back to school at the age of 47 was tough. I am not, nor have I ever been, classified as smart. My parents were convinced that I would be sweeping out buses for a living. I thought for sure that anatomy and pharmacology would do me in, but I made it through on sheer determination, and the fear of how embarrassing it would be to have to tell people that I left a cushy job to become a paramedic but couldn’t pass the exam.

I really do not recall what my expectations were when I graduated from paramedic school. I suppose I held some of the same illusions as the mere children that were in my class: Excitement, adrenaline rushes, an element of danger, looking all macho while driving lights and sirens, satisfying my morbid curiosity as to what a person really looked like after their car rolled ten times.

Once I started working, I learned post haste that our education and training does make a difference when a call is truly critical. We have ‘worked’ patients back to life after sudden cardiac arrest, delivered babies, and passed a life-saving tube into the trachea of a patient with severe inhalation burns. We have yanked children out of swimming pools and breathed life back into their little bodies. We have pulled people out of mangled cars and kept them alive so they could go into surgery. We have treated stab wounds and gun shots, patients that tried to hang themselves, and patients that washed down a bottle of pills with drain cleaner. It seems every week we learn all the new ways that humans can abuse themselves and be in a position of needing an ambulance.

Regardless of my expectations, there is definitely an element of excitement with this job, and adrenaline rushes, and it can be dangerous sometimes. The jury is still deliberating as to whether I look macho while driving lights and sirens. Personally, I think I look pretty intimidating with a scowl on my face and mirrored sunglasses. Seeing what a person really looks like after their car rolls ten times has happened way too many times.

My partner straightened up and asked, “I’ve seen enough. Shall we flush?”

“That would probably be the polite thing to do,” I answered, and pushed down on the toilet handle. The bowel movement that we had been staring at disappeared.

That’s right. We were examining a guy’s bowel movement. We had been called emergent for a hemorrhage. The patient had been constipated and while straining to move his bowels, he apparently tore an ‘o-ring’ and passed a little bit of blood. I’ve bled more from a cut while shaving. The patient had become worried (freaked out, actually) when he did the ‘paperwork’ and saw a streak of blood on the toilet paper. Ask-A-Nurse said to call 9-1-1. And I was having my ah-ha moment, which had led me from living in the lap of luxury; driving nice cars, wearing tailored clothes, flying first class, and sleeping in on Saturdays; to forging my way through eighteen months of classroom hell, countless clinical shifts, and 300 hours of an internship…to standing in someone’s bathroom and studying their doo-doo.

This is the real world. Not every call is about life and death. Ask-a-nurse is still a puzzlement to me. But, I assured the guy that he was not dying, that he might want to try some stool softeners for a few days, and drink a lot of water. Once he was sufficiently convinced he was not bleeding out, a look of relief spread across his face. I will never tire of seeing that look of relief on people’s faces. And my ah-ha moment concluded with a feeling that this job was still worth it.