The Mute Medic Volume III

Stereotype -/ˈsterēəˌtīp/- a widely held but fixed and oversimplified image or idea of a particular type of person or thing

My eyelids felt like sandbags as I embraced the vibration of the high idle on the truck murmuring like grasshoppers on a summer evening. We had parked in an abandoned lot away from the streetlights, hoping that the unforgiving night would grant us some reprieve. Three hours left of our twelve hour night, and this was the first time we had made it to a post. After  a swig of lukewarm coffee, I folded my hands in my lap and attempted to drift away anywhere other than where I really was. The sibilating noises from the passenger seat unnerved me. Lucky bastard. I’ve done 90% of the work and he’s the one napping.  After several minutes of squirming and attempting to adjust the position of my incommodious seat, I decided that it was a lost cause and retreated to the patient compartment to stretch out. Throwing a blanket down over the bench seat, I was overwhelmed by the stench of booze, vomit, and coagulated blood from the last road scholar we had just transported. Fumbling around in the dark through my cargo pocket, I produced a jar of Vick’s. Finally, I could breathe again. With the exhaust fan humming in the background, I was able to pass into a light sleep that lasted for roughly ten tantalizing minutes. Static came over the radio, followed immediately by an unwelcome transmission.

“Ambulance 41.”

Ugh. Are we the only ones working tonight? “Go ahead,” I grumbled, making my annoyance apparent.

“Ambulance 41, assist police and fire on a shooting at a nightclub.”

“Cleeaaaaarrrr.”

To this day, I am still amazed at how fast utter exhaustion can lift after hearing those words. Swearing under my breath, I quickly tossed the blanket out of the back of the ambulance, launching myself into the driver’s seat. My somnolent counterpart didn’t stir. In a moment of testosterone overload, I punched him in the shoulder as hard as I could.

“Wake up, dude! We just got a shooting!”

“Are you serious?!” With the energy of a sloth on Ambien, he struggled to sit his seat upright, while wiping drool from the corner of his mouth. “Was I snoring?”

“Sounded like a freakin’ artillery barrage.”

As we neared the scene, the chaos was palpable. Teenagers running in every direction, and only three officers attempting to keep at least thirty unsettled bystanders back. Despite the excitement from the crowd there some optimistic statements from onlookers saying, “She’s gonna make it”.. There was a crater in the left side of her head with obvious brain matter and a pool of blood under her. Fighting the bounding of my own pulse, I reached under her jawline only to confirm that she did not have one. My partner went back to the ambulance to grab a sheet, when I began to hear murmurs from the crowd, inferring that our pronouncement was based on her ethnicity and that if she were Caucasian, then we would no doubt be working to try to save her. As the grumblings spread, drunken belligerence became the overall attitude. In the span of twenty seconds, we went from saviors to oppressors. My partner and I need not say anything to each other; our decision had been made for us. As he rapidly exchanged the sheet for the wheels, I ducked as a beer bottle grenade went soaring over my head and landed on the ground with a ferocious explosion. As did another. And another. A simple pronouncement had just became a public relations mission to avoid a riot. With stretcher now present, firefighters assisted my partner and I in hoisting the hefty young woman onto the pram as we darted for the ambulance. Gunfire erupted down the street as well more screaming and shouting. We locked ourselves inside and took off for the hospital, hearing projectiles ricocheting off of the bus.

“Ambulance 41 en route emergently to Memorial with one patient, condition Charlie minus.” My voice cracked and wavered. I tried to hide the excitement in my voice, but anybody that knows me knows that I speak a million miles a minute when I’m stressed. Immediately I called the receiving trauma center that we were about twenty minutes away from and explained the circumstances of why we were transporting a traumatic arrest to begin with. I knew that this was against our policy, but frankly I couldn’t care less at the time. As we progressed closer to the hospital, I could see the half-assed nature of work the other crew members were doing. Lazy, sporadic CPR with long intermissions between crew members as well lackluster ventilations.

“We all know what the outcome is going to be, guys, but could we at least make it look like we care and we tried?” I suggested. “There’s a reason everyone was upset back there, and it’s because they expected us to not care.”

“No. It’s because they’re all a bunch of animals. Those friggin’ monkeys belong in a zoo. Sick of dealing with their n****r bullshit.” The lieutenant fired back at me.

“Excuse me?” I retorted noticing the Confederate flag tattoo he  sported proudly on his right arm.

“You heard me. I’m just saying what we’re all thinking.”

“Don’t give yourself that much credit.”

“If you ask me, we should throw ‘em all in a stadium, load ‘em up with a bunch of guns, and watch ‘em all take each other out. Might even pop some popcorn and make a night of it.” He sneered.

“Why don’t you shut up before you become the second unresponsive person back here.” I could feel my blood boiling.  Our eyes locked, and in a moment of clarity I saw the real enemy in this situation. The bus slowed rolling unsteadily over a few speed bumps and came to a halt. We unloaded the pram continuing CPR on the way into the trauma bay. After a short handoff report and fifteen minutes of mopping the blood out of the back of the rig, I noticed my crimson footprints leading back out to the truck. I walked through the grass hoping that the early morning dew would clean them up. Trotting through the lawn, I recalled an excerpt from The Merchant of Venice.

“If you prick us, do we not bleed? if you tickle us, do we not laugh? if you poison us, do we not die? and if you wrong us, shall we not revenge?”

The engine crew had departed and only my partner and I were left. I could hear the squawking of my radio in the background. The impatient dispatch crew was harassing us to get back in service to take a non-emergent abdominal pain call around the corner. After a less than gracious reminder that we needed to return the scene to sign the crime log, we bought a few extra minutes before heading back.

0402. A gentle breeze started to blow and a soft rain began to fall. In a few minutes, it progressed into a full-fledged storm that sounded like pebbles bouncing off of a tin can. Our wipers couldn’t keep pace with the droplets that struck the glass. As we approached the area, fluorescent yellow tape and psychedelic flashes of blue and red filled the night sky. Sauntering over to the crime scene station, we ran into our esteemed colleagues from the fire station holding the metal clipboard, begrudgingly adding their names to the list. Slamming the notepad into my chest, the lieutenant grumbled, “Here you go Mr. Bleeding Heart.” I suggested he attempt an anatomically impossible procedure as we parted ways. Watching the ink run off of the paper, I handed the crime log back to the attending officer.

Maybe I’m different than most medics, or maybe I’m just more vocal about how I feel after difficult situations. I spent the entire drive home sitting in disbelief. I just couldn’t accept that in the 21st century someone could be so calloused about another human’s death. Not only that, but attributing ill motives and wishing harm to an entire group of people. Working in an urban setting, I will admit that I was surprised at first to hear someone attribute ulterior motives to me claiming that my performance could ever be based on racial stereotyping, but now I feel differently. Having not grown up as an African-American in Midwestern America, I admit that I was skeptical when I first heard cries of racism and bigotry in the workplace. It had never really affected me personally, and the obvious human response is to believe that movements that we aren’t invested in lack legitimacy. That night changed my mind forever. When I hear people in the field rush to denounce things like Black Lives Matter or immediately claim there is no such thing as systemic racism within our society, I shake my head and only think about how much further we have to progress. If we are honest with ourselves, we all have our stereotypes. Even if it’s not about race, it could just as easily be about socioeconomic classes, genders, or geographic regions. I can’t imagine what it must be like to wake up every day expecting to be treated in an inferior manner just because of the color of my skin. Empathy requires us to move past our own realities and embrace what someone else’s is. Just a thought…

There is no reconciliation until you recognize the dignity of the other, until you see their view- you have to enter into the pain of the people. You’ve got to feel their need.”- John Perkins

The Mute Medic Volume II

Fatigue -/fəˈtēɡ/- extreme tiredness, typically resulting from mental or physical exertion or illness

I, like many others before me, looked in the mirror today and said “to hell with this life”. It wasn’t the pay. It wasn’t the hours. It wasn’t the autonomy. Maybe it was the fact that I had to strip my uniform off in the laundry room before heading upstairs because I was afraid of tracking in the last drunk’s vomit or having my kids see blood on my uniform from the 19 year-old that was shot in the head in a drive by…

As much as you try to turn off the camera in your mind, the internal hard drive can’t be erased. Why didn’t anyone warn me about this before I became a paramedic? I almost gave it up today. I was teetering on the precipice of futility and purpose. That makes it sound like I emerged victorious. I didn’t, but I came away reminding myself that I can get through one more day. Maybe help one more person. The truth is, every shift is a choice.

I guess you could say that this inner monologue started a few months ago. It was 0300. I woke up, drenched in sweat. Hyperventilating. I was there again. Like it just happened. She was 25. I remember standing over her flaccid body, staring at the tube in her mouth wondering what I could have done differently. The monitor illuminated the room, the apnea alarm shrieked like an animal caught in a trap. Nothing. No pulse. No breathing. No soul. Her eyes were wide and pupils dilated, like she could see everything we did. Everything we tried to do.

As the wind drifted through the cracked window, I could almost hear her whisper, “Why couldn’t you save me?”

A disheveled shadow came out from another room. His burnt fingertips continued to feed through his hair as his eyes darted back and forth. The Pink Floyd shirt he wore was tattered and had numerous stains on it. The stench that followed him around was a mixture of bleach and tobacco. With tremulous hands he reached for his pockets, and then continued to fidget with his hair.

“Any of you have a light?”

My partner and I shook our heads and continued about our business. The lanky man stepped over the fluorescent red bio-hazard bag and reached into the lifeless woman’s pocket.

“Hey, what the hell are you doing?!” I yelled.

Retrieving a pack of cigarettes and tie-dyed lighter, the man turned and winked at me. “These will do.” The hairs on the back of my head stood up straight like soldiers waiting at attention. A few officers stopped him and began to question the sordid figure about his involvement with the girl. My partner was speaking with the coroner on the phone, while I went back to picking up the Epi vials and wiping the emesis off of the defibrillator cords. I heard two small voices downstairs. A younger officer came up to me.

“They want to see their mother.”

Two unkempt children climbed the narrow staircase. The boy was maybe five and the girl around seven. Their hair oily and teeth crooked and yellow. It was 1230 in the afternoon, and they were getting hungry for lunch. Mom hadn’t fed them all day long, probably because there was no food in the house. The children’s grandparents had dropped the kids off that morning at the dilapidated residence. What we found out later was that the children’s grandparents were actually their legal guardians. After several heroin related arrests, their mother had her parenting privileges revoked. She pleaded with the grandparents to let her see her children. After months of begging, they agreed to let her have a “trial day”. Instead of buying food for her children, a “friend” came over and the mother disappeared. As the children’s stomachs grumbled, they went in search of their mother, and they found her…

“Is she going to wake up?” the boy asked.

I fought back the tears trying as hard as I could and tried to cushion the truth. “No… She’s not going to wake up…” I didn’t know what else to say. Never in my absurdly short training period did anyone ever cover explaining death and grief to school-aged children to me. I escorted them back downstairs and sat them on the couch. Clicking on the remote, Dora the Explorer emerged on to the t.v. screen. Both of them sat their. Silently. I rummaged through the cabinets and the refrigerator only to add to my disappointment. Running out to the bus, I grabbed my lunch box and came back in with a cheese stick, apple slices, and half a sandwich. Before the next commercial break, all that remained were plastic baggies that the kids had wadded up and thrown on the couch.

A green station wagon pulled up to the front of the house and both of the kids bolted out the door. An officer and I followed them out, as they piled into their grandparent’s vehicle. A few minutes later, they turned off down the street and on their way back to what I can only pray was a reprieve from the insanity that they had just experienced.

A few minutes later, our equipment was organized and thrown back into the ambulance. Maybe it was a blessing in disguise that we worked for a high-volume urban service and didn’t have time to think about what we just witnessed. Maybe that’s why I’m thinking about it now. For the rest of the shift, my partner and I played the nursing home shuffle and ran a few other minor medical calls. It was quiet, though. None of the normal chatter that we bandied about most days.

I find it odd that three years after this call happened, I can still remember every detail. I remember the rank smell of cat urine and the tobacco stains on the rug. I remember the holes in the planks going up the stairs and the obscenely dark room with no functional lights. The overflowing toilet that sat there stagnantly for God only knows how long. I’ve had calls like this before, but this is the one I remember. This is the one that wakes me up in the middle of the night. The one that I think about on Father’s day, wondering if those kids will ever have a steady figure in their lives to help them sort out the hell they’ve lived through.

0315.

I went out to the couch and sat down. Hunched over the coffee table, a bowl of Frosted Flakes in tow, I needed an escape. The television flickered in the background as I turned down the volume hoping to not wake anyone up. There had to be something on this late to take my mind off of my dreams. I stumbled upon an older episode from Batman: The Animated Series. Perfect. Childhood nostalgia was what I needed, but I got more than what I bargained for. What I had hoped for was that Batman would swoop in and save someone in distress while simultaneously pounding his adversary into oblivion. Because that’s how the real world works. In this episode, however, Batman was struggling with his sense of efficacy. In a rare moment of utter humanity, he sat dejected in a chair by himself in the Batcave. As his butler, Alfred, approached they had this conversation:

Alfred: Master Bruce, are you alright, sir?

Batman: I’m tired, Alfred.

Alfred: Well I shouldn’t wonder, you’ve taken no meals today, and I can’t recall when you last slept.

Batman: A weary body can be dealt with, but a weary spirit, that’s something else. Sometimes, old friend, I wonder if I’m really doing any good out there.

Alfred: How can you doubt it? The lives you’ve saved, the criminals you’ve brought to justice.

Batman: I’ve put out a few fires yes, won a few battles, but the war goes on Alfred, on and on…

The rest of the episode went on to validate Batman’s calling to protect those around, and to the seven year old me, I’m sure it would’ve been awe-inspiring. This time it was different. This time I sat alone in the dark just like my childhood idol wondering what fires I was going to try to put out…

The Mute Medic Volume I

Hero -/ˈhirō/- a person, typically a man, who is admired or idealized for courage, outstanding achievements, or noble qualities

She walked up to me and gave me one of the hardest hugs I have ever gotten from someone. Her husband patted me on the back with tears welling in his eyes. “You saved her life; I don’t know what I would have done without her.” Their daughter was in that awkward pre-teen phase with multi-colored hair trying to emulate the hipster movement with her thick-rimmed glasses and ironic mismatched clothing. Her son brought his toy ambulance with him and continued to blare the siren while crashing it into my foot. I didn’t know what to say. When you become a paramedic, there is this twisted fantasy you have about doing something daring and risky and receiving praise when it’s over. Today was different, though. My partner and I had quite literally saved this woman’s life, but I felt numb to the adoration. This woman continued to hug me while crying, expressing her heartfelt gratitude over and over again, but the only thing I could muster was, “glad everything worked out, okay.”

Who the fuck says that?

My chief came into the room, camera in hand, and asked if he could get a group picture. After several minutes of arranging and rearranging, he seemed content with the set up, and snapped a few photos. My mind continued to wander off to that fateful day. I tried not to come off as a deer in the headlights, but I am confident my acting skills were not up to snuff that day, as the woman continued to try to engage me in conversation. In the background, I listened to my partner over-dramatize his involvement in the run and make it sound like he was a stunt car driver in a chase scene instead of just transporting a patient in the back of the bus. Inwardly I rolled my eyes; four months of exaggerated war stories were taking its toll on my stomach, adding to the ulcer that was already there.

*Click*

As the room was buzzing with the chatter of awkward strangers, my chief meandered around the room snapping pictures. There was a natural decline in conversation, and as the topics grew stale, the woman handed my partner and I two boxes and a couple of thank you cards. Inside, were baked treats; everything from chocolate-covered strawberries to cookies to cannolis. The selection was overwhelming, and you could tell that the family spent a pretty penny on all of the bakery options that were presented to us. The supervisors were in the middle of shift change, and kept filing in and out of the room. There were big smiles and attaboys flying around the room at unprecedented rates. It was nauseating. After three years of hard work, bad hours, and poor sleep, I was being recognized by a patient for a job well done. This was the first time I had heard a word from my management team, though. The woman gave me one last hug and a quick kiss on the cheek thanking me for my 45 minute contribution to her life.

“I owe my life to you.”

Those words reverberated off of the walls in my head, and I knew that I couldn’t live with them. My mind continued to drift elsewhere; mainly the day that I met this woman.

It was late March. There was dew on the grass and still had that spring nip in the air. I knew it was going to be a bad day at work. For the last two weeks, my partner and I had been attempting to bridge up an EMT trying to become a paramedic. It had been very painful, and I could feel my patience becoming increasingly thinner. As we were finishing our truck check that morning, I heard dispatch come over the air.

“Medic 23.”

“Go ahead for Medic 23.”

“For your information, the paging and mapping system are down today. You’ll have to use your mapbooks and call into dispatch for your call times.”

Could we have one fucking day where something actually works?

“Medic 23 is clear, thank you.”

I was driving while my partner was taking his morning nap on the bench seat and the EMT we were cross-training rode shotgun. This was the fourth time this EMT was attempting to become a paramedic; she had failed every other time, and this time wasn’t going much better than the previous ones. Her phone rang once, and she proceeded to let it ring.

That has got to be the most annoying ringtone I have ever heard.

“You going to answer that?”

“It’s my daughter.”

“You going to answer that?”

I think she finally got the hint that she either needed to answer the phone call or shut her ringer off. I am not a morning person, but still, there wasn’t enough coffee in this world to make that bearable. After five minutes of bickering and occasional yelling, she hung up and there was a long pause.

“Trouble in paradise?”

“I need to go home.”

“What’s going on?”

“My daughter just got into a wreck and my son’s about to get arrested.”

Ladies and gentlemen, I present another episode of Young and the Restless.

“Mmmmkay. I’ll let the supervisor know.”

I called my supervisor and informed dispatch over the radio that we needed to turn back around to the base. After dropping her off, I yelled back to the patient compartment to see if my partner was still alive. I saw the lights flicker on while my partner stumbled around as if he were reenacting Frankenstein. He sulked in the front seat.

“I’m tired, and I don’t feel like doing anything.”

“Join the club.”

“No… I’m really, tired.”

“I have two kids, a full-time job, and I’m going to school. Sympathy is in short supply today.”

I felt like an asshole responding like that, but I had already filled my complaint quota for the day and we hadn’t even made it to our first post. My stomach was growling, and all I could hear was coffee and a breakfast burrito calling my name. Wrong again.

“Medic 23.”

“23, go ahead.”

“We’ve got an emergency call on a pregnancy just around the corner from you.”

Dispatch gave us the address as well as some additional directions into the subdivision.

Too fucking early for babies…

I flipped on the lights and sped up to the house. It was a well-kept subdivision; a pleasant break from the dilapidation we normally worked in. My partner and I unloaded our gear and strolled up to the house. We knocked on the door with no answer.

“EMS. Paramedics.”

I knocked one more time, and then turned the door handle. The door wasn’t locked and opened into a full living room. There was hardwood everywhere as well as modern art and sculptures. The house was clean and free of the normal debris that we normally had to navigate through. As I cleared the door and turned to my right, my stomach sank.

Shit.

There she was. Lying on the floor with her pants around her ankles in a puddle of blood. Sweeney Todd kept a cleaner barber shop. Blood covered the floor and had saturated her pants. Her skin was a translucent gray and her voice quivered.

“I think I waited too long to call.”

I grabbed for a radial pulse and felt nothing. My partner and I quickly exchanged looks and came to the same conclusion. We were behind the eight ball. The woman whispered to me that she had had a miscarriage days ago and hadn’t gone to the doctor for follow up care. I had to take my ear piece out to hear her as her faint voice said that she had soaked five pads and passed five large clots. I fumbled with the automatic blood pressure cuff.

58/20.

Goddammit.

My partner grabbed the EKG cables and place them on the patient’s arms and legs. She was bradycardic and profoundly hypotensive. We both reached for the tourniquets trying to find a place with a palpable vein. I knew I was only prolonging the inevitable. I scanned her neck for an EJ and saw nothing. I didn’t have a choice. I rummaged through the first-in bag and took out the IO kit. I depressed the trigger for a second and heard the whirl of the drill. As I prepped my needle and saline lock set, I reached for the lidocaine.

Why the fuck isn’t there any Lidocaine in my IO kit? You’ve got to be fucking kidding me… Could resupply for one fucking day do their jobs!?

I thought I was going to have an aneurysm, but I couldn’t convey that. My partner at the time, God love him, fed off of every bit of chaos and uncertainty that he saw and heard. I so much as said the word “problem” and there was instant panic. As calmly as I could, I asked him to check the drug bag for Lidocaine. Goose egg. Despite my deeply pessimistic tone, I do believe in divine intervention. Our supervisor was making his round that morning and just so happened to be heading to that very same run. With Lidocaine. Simultaneously, our supervisor and the woman’s husband walked in the door.

No pressure.

I explained to the patient and her husband what I had to do. I was going to have to place an IO in her tibia because she had no veins that I could start an IV on. I prepped the site and said the infamous line.

“You’re going to feel a little pressure.”

I could feel the grinding of the needle into her bone. Her screams reached near animalistic tones as I had to repetitively coach her to lie flat on the ground until I was done. I pulled back on the syringe and saw bone marrow. I was in. With every milliliter of Lidocaine and saline that I pushed in came more screaming until she was hoarse. I couldn’t sedate her because of how unstable her vital signs were. My partner got up front and drove. Correction. He flew. Like a bat out of hell. It was as if I was auditioning for a program at NASA trying to construct something in an anti-gravity simulator. The OB/GYN specialty center was at least twenty minutes away and I was alone for all of them. For 19 minutes I worked my ass off. I was a sweaty mess at the end of them. From hanging saline and TXA to running 12-leads to calling the hospital…I felt drained. There was one minute though, where I stopped and recollected my thoughts. She reached out her hand and asked if she could hold mine.

“I’m scared.”

So am I. “I’m not going to let anything bad happen to you back here.”

It was a promise said with utmost confidence. One I knew that I couldn’t keep. Despite hawk-like vigilance, there was no guarantee I could make to her or her family that everything was going to be okay, and I knew it. All of us want to be in control, and loathe the times that we feel we can’t be. I felt out of control, though. We rolled into the emergency department and while passing off report to the nurses there, they treated my report with zero sobriety.

“Thank God for ambulance drivers,” one of the nurses echoed.

Thank God for doctor helpers.

*Click*

She took one more photo with me before the clan climbed into their SUV and drove off. She rolled down her window and signaled for me to come closer.

“You were my hero that day.”

She teared up, put on her seatbelt and their vehicle backed out of the lot and faded away down the street. I felt the pain in my stomach sharpen…

Hero. Not by a damn shot…

Growing up, I idolized Atticus Finch, Bruce Wayne, and Matt Murdock. They were my heroes. While all fictional, they never compromised their values and continued to fight social injustice and human suffering. I can honestly tell you I don’t feel like I fit the bill and will continue to feel that way. For all of the successes in my career, I feel like there are just as many, no, more failures. If we are honest with ourselves, none of us are heroes. Heroes don’t have to go home and drink just to feel normal. My heroes never screamed at drunks or practiced punitive medicine… Compassion fatigue and cynicism were never traits of my heroes, but if I am truly introspective, they are qualities that I possess. Maybe one day, my sons will hear the stories I have lived through and think I am a hero. I hope they don’t. I hope they never have to witness or imagine the things I see daily. Maybe one day there won’t be a need for heroes…