The children outside are curious, playing but in a sense of studied nonchalance. Not that any of them look old enough to know the nuance of the word, but innate in them as in all of us lays the gist of the word’s implication

The fire apparatus is already curbside ahead of us, lights silently announcing to anyone watching that activity is happening within this building, this day. My partner takes the cardiac monitor from me and I keep the jump bag over my right shoulder. Dropping their pretense of play, the children fall still, openly checking out our accoutrements. One brave boy calls out, “hey, whatcha got there? What’s that big bag for?” My partner returns, “helping people”. Simplified, yet valid.

Inside, a middle aged man with an air of importance around him meets us, gives us a short layman’s report.  It is remarkably succinct, and with nearly all necessary components I could’ve asked for if making a list. We continue on in the direction indicated, where ahead a small group of people can be seen gathered in the cafeteria. It’s after hours, at this school, and yet the gathering is modest. I see fire ahead, and a slight woman with grey hair barely visible in the middle of the navy shirts, suspenders attached to turnout pants, and male muscles.

I greet the lieutenant by name and make my way around the far end of the cafeteria tables arranged in neat rows. The patient has the gathering of firemen around her as well as a couple elderly ladies and amidst all of these, a few more assorted small humans, watching with grave interest. The lieutenant was a new fireman when I was a new medic and he gives report after greeting me by name.

“Patient was getting up, caught her sneaker” <I remember thinking, “Jimmy said sneaker, who says sneaker? Have to tease him later on at some point”>  “on the bench and fell, hitting her head. She did lose consciousness. Her blood pressure is low; she was very pale when we got here. Her heart rate is very slow, blood sugar is 92.”

The patient is discussing her last meal, her certainty that she is just fine, and I make my way over to her side. Seating myself on the bench of the cafeteria table so that we are near one another, I introduce myself. I speak quieter than is necessary, in this big echoing space full of people and conversations. She quiets, to hear me. Excellent. I need her to divert her attention now to the things I must know, some of them repeats of what fire have told me. This helps me to ascertain that she is remembering and maintaining not only the events about which I will ask, but that she continues to give the same version of events. I’m ruling out not only an obvious injury with this method, but also considering the all too often seen brushing under rugs of significant events by patients who fear a loss of independence. My concern in the here and now is her welfare and immediate medical issues. Independence and living arrangements, while not likely to be impacted by this event, are always concerns on the far horizon, handled by other professionals. We am mindful always, however, as this fear in the mind of a patient can result in a skewed version of events as relayed to us on scene.

She is clear on her events, clear in her gaze, and calm in her recitation of events just as the lieutenant described to me. While I ask and listen, I place cardiac monitor on her and am greeted by a sedate normal sinus rhythm out for a Sunday drive at the slow pace of 52. She’s still hypotensive, but not as markedly as fire’s initial vitals. We go over past medical history (not much to speak of, hypertension for which she is compliant with her medication regimen), and the regular familiar rolling questionnaire of intake, output, new medication changes recently, dizzy or weak before the fall, syncope of falls within the last few months, symptoms now, any pain, day, year, president and so on. She denies anything of note during all of this, her answers accurate and remaining oriented.

A few minutes later we have her on the cot, I’m handing for her purse near her when she asks me for her Bible. I spy it on the table, zipped neatly in the black leather case that is exactly like the ones in which my dad and mama always kept their Bibles. I pick it up, and the reassuring familiar heft of it is like an old friend. I grin at the familiar comfort of a memory as old as my childhood here in this moment, and ask her if they were having Bible study here. She shakes her head and with a smile, tells me as we walk to the truck about the program they have with the children here, points awarded for verses memorized. The children watch solemnly as we walk out, the man who I’m now almost certain is a pastor finalizes disposition of the patient’s car, and soon we are at the back of my truck. Opening the doors is a senior fireman who I haven’t seen in a while, and I feel the glad smile on my face. He says, “how ya doing, Crystal? Up here on the north side, tonight!” and we chat briefly while my partner loads the patient with the new power load cot. Then the back doors shut, I climb in the side door and it’s us ladies, in the back. I reattach the cables and begin another blood pressure.

She sighs, then, smiles and says to me, “all of this….” Her voice trails off. I nod and respectfully offer that we do need to think of the implications of things like a loss of consciousness after hitting a head, especially as we think of ages when our bodies don’t handle injuries as they once did. Cervical spine was cleared on scene, she has no obvious outward injuries and we pull away from the curb after she politely declines an IV. En route to the hospital, she checks in on a lady who she has taken in, tells me earnestly of her story. She elaborates on the program with the children, and when I enter the demographic data into my patient care report, I double check the date of birth in surprise. She assures me that I am correct, and with a twinkle in her eye tells me she works out.  In fact, she prefers weight training the most. I cock an eyebrow and tell her perhaps the heart rate in the mid- 50s isn’t quite as out of the norm in her case.

Report given, signature obtained, we walk into the bright lights of the emergency room, wheeling the cot. Two care techs I’ve never seen help us transfer the patient, and a nurse I’ve never met takes report. I walk down the hall a few minutes later, thinking of ladies who lift weights at twice my 40 years, and the equally preservative nature of small humans, taken once weekly, q Wednesday night. Repeat as needed for a life of service and happiness.

And wear sneakers, no matter the age.