Unresponsive, at shortly after 6am, is a thing. It’s the time of day lots of folks wake up and find the spouse isn’t breathing, or moving, or generally not like usual. Unresponsive, at shortly after 6am, is a special kind of horrible thing for a medic who is deep into sleep. Waking thickly in a panic as the tones sound overhead, stumbling feet into boots while pulling sweater overhead, fumbling for glasses, tucking in shirt while hurrying to the garage. Unplugging the shore line, zipping boots, hitting garage door opener, blinking at early morning while shoving the seatbelt home to a crisp click. Blinking and reaching for the mike, putting the truck in drive and activating siren and lights while listening to the repeated dispatch info. Glancing at the Navigator screen on the tablet for the address, merging into early morning caffeinated and showered drivers while still valiantly mentally joining the rest of the world.

Unresponsive male and odds are he’s been down a while so not likely we’ll get a ROSC and then the day starts with witnessing another human being’s heartbreak. It is what it is, but what it always is, is a losing proposition against the usual amount of time down at shortly after 6am.

We arrive about the same time our mental clarity reaches normal percentages, and the small house with the magic numbers above the door appears deceptively benign. No movement outside except the lights revolving silently on the fire rescue parked at the curb. My partner has care so I’m mentally reviewing the checklist for intubation as we grab the kit and monitor, and head for the front door. Is it just me or are our footsteps dragging a bit? Conversation en route was minimal. Unresponsive shortly after 6am is a conversation stopper.

Front door’s open and a lady’s sitting on the floor. There’s a fireman at her side, a new one on the rescue – third one since my shift started 22 ½ hours ago. A man in a recliner is visible at the rear of the house and there’s another firefighter somewhere in the middle. My partner stops, looks from lady on the floor to man in the recliner. The near (freshly showered) fire fighter says, “she’s the patient” and shortly after 6am gets a whole lot less depressing.

The story emerges through patient report and patient interjections. She woke up sick. He needs to go to dialysis and she has the GI bug like you can about imagine. He yelled at her from the rear recliner and she was working on keeping the groceries down, wasn’t feeling too chatty so didn’t answer. He called 911, she tossed the groceries and now here we all are.

She clearly states she does not want to go to the hospital, and after vitals check out, my partner clears fire. I razz the original firefighter about going thru three partners in 24 hours and he laughs. They leave; we turn to each other and get to work.

The husband needs to get to dialysis. The wife shakes her head weakly when asked if there is anyone who we can call to help get him there. It’s clear she won’t be driving anywhere. My partner gets on the phone and starts calling; the dialysis center, our dispatch center, wheelchair van. I go update the man in the recliner who is hard of hearing. I ask if he’s taken his insulin yet and he says yes – but when I ask if he ate, he shakes his head. I find a pear in the fridge, cut it up, spread some peanut butter we find on a roll, and serve him a plate of make-do breakfast.

My partner is meeting bureaucratic barricades. The social worker at the dialysis center isn’t at work yet. The dialysis nurse is unwilling to comp a wheelchair or taxi ride. Wheelchair van won’t take insurance. I feed the enormous, sleek orange cat talking earnestly up at me while winding around my ankles. He’s soon happily scooping out wet food with a paw, and licking it neatly off. He’s clearly practiced at the art of culinary enjoyment.

My partner finally calls the emergency room social worker who is basically part of our work family. He’s immediately assured the the emergency room can gladly supply a voucher for the taxi ride to dialysis & back. I’m sitting in the rear keeping the man in the recliner company and hearing his tales of Vietnam. He tells me Agent Orange did horrible things to the nerves in his legs, and I’m struck by the matter of fact way he tells me of his life post-war. He displays no self-pity, and he is truly glad for his peanut butter/pear breakfast. I put his shoes on as my partner updates the taxi company on the situation. I find his coat, and help his wife onto the couch with a throw blanket.

In the end, everyone was squared away and the cat was purring his way thru a bath on the kitchen floor. Last time I saw him, he had a paw lopped up over one ear and squinched up, happy eyes. Taxi was on it’s way and I grabbed the garbage by the door on my way out to the truck. Dropping the bag into the wheeled container at the curb, I stopped and looked up. The sun was out finally, and the snow was glittering in a triumphant win over the Christmas lights, still dimly visible up and down the block.

I climbed behind the wheel and looked at my partner. Bad boy sunglasses on and blue hat pulled on tight, his goatee split in a huge grin as he looked at me and said, “that’s some community paramedic stuff right there!” I laugh, and we pull away from the curb in search of coffee.

Life is a whole lot better at shortly after 7am.

The husband leads us to the basement, where she’s sitting. Trendy sweatpants and a shell shocked expression are my first impressions. He’s keeping the small ones at bay as they try to see around him, wondering “what’s wrong with Mommy?” Mommy’s stomach hurt and she was closer to the basement restroom when she sat down and she hasn’t gone far. There’s a small throw rug in front of the toilet that matches the shower curtain and the valance at the small half window. A hand towel, in keeping with the scheme, lies folded in half a short distance away. My partner, a male, steps outside at my nod and begins to get demographics. The pt and I regard each other, then the towel. 14 weeks, she tells me. She’s still processing, and her eyes are dry as she tells me she just had a stomachache, she had no idea. This was their third. I hear my voice saying I lost a baby at 14 weeks too and she suddenly hugs me. We do vitals, we stand up and find a towel for the sweatpants and then she turns to walk out to my truck, leaning on her clearly heartbroken husband. She asks if I can bring the towel, and then I’m alone. I pick up the towel like it’s a precious jewel – because it is. The small form inside is nearly weightless and I feel almost unworthy as I carry it past the first responders in this rough fabric. When I get to the truck she asks me if it’s too early to tell if it’s a boy or a girl, and I nod. She asks if I looked and I say no, she says “me either”. She asks me if I will look with her, and as we back out of the driveway, backup alarm beeping, we regard the small still form. She whispers, “I love you” and I think I haven’t seen anything so awful and beautiful in months.

~*~*~*~*~*~*~*~*~*~*~*~

He was dizzy, and she was worried. He didn’t feel any medical need, he was more interested in finding some pants as his living room suddenly housed strangers at one am.  My partner began the assessment and she began giving me patient information. She was 89, he was 92. She interrupted herself as she saw him beginning to feed a foot thru a cuff. “Leave ‘em off, Dad, so I can look at ya” – and she leers, wiggling her eyebrows. He flushes, grins and we all laugh. God, a love like that – those words remain with me, nearly five years later, as my favorite ever comment on a call.

~*~*~*~*~*~*~*~*~*~*~*~

He’s called twice so far and ultimately refused transport each time. He’s constipated, I’ve given him the spiel about increased water intake and stool softeners from the corner drugstore five blocks away. This time he shows me the pink bottle of GI upset fixer, and asks why it’s not working. I advise that helps diarrhea, and remind him it’s been less than fifteen minutes since we spoke. He shrugs and says, “I want to go now, take me”. We walk to the truck in silence. En route the four blocks to the emergency room, I ask if he walked to get the stool softeners. He scoffs, “I can’t afford them”. I give report and as I hang up the mike, he says with relish, “this I don’t have to pay for – you do.”

~*~*~*~*~*~*~*~*~*~*~*~

The directions are vague and the destination is what’s colloquially known as the hobo camp. My partner parks by a footbridge marked by two deserted squad cars, red and blue lights the beacon we followed to this far removed wooden bridge. We take the cot, kit and monitor, lock the truck and begin to walk. The pitch blackness around us is unrelieved by any streetlights – we’re too far out in the woods. I’m in front and I regret heartily my active imagination. We emerge from the woods and the bridge to a group of people, fire and law enforcement, gathered around a very loud and angry individual. He tried to run from law enforcement after a domestic incident and he was stopped by the taser. The barbs remain in him, and as my partner removes them, the skin tents and his howls increase. I realize my toes are curling in my boots and looking around, every face is wincing. He’s on our cot after enough posturing to ensure his opposition to all uniforms, then he settles down except for the occasional insult hurled back over his shoulder at the officers, as we set off for the pitch black footbridge thru the trees. This time I push the head of the cot, and let my partner go first, pulling the feet. It’s arguably worse, letting the darkness follow you. Hairs on the back of one’s neck are not a euphemism.

~*~*~*~*~*~*~*~*~*~*~

Her accent is England, her jacket I help her into is Prada, and I compliment her, saying I’ve never had a better dressed patient. Her current indignity forgotten, she smiles and the sun comes out from behind the scowl she was wearing. I nod at the Louis Vuitton luggage and she asks, “doesn’t everyone?” and I shake my head in regret. She looks at my navy blue EMS pants, sweater, boots -  tips her head and without irony says “so sorry, love”.

~*~*~*~*~*~*~*~*~*~*~

Difficulty swallowing and coming thru the door, my step slows to a normal pace as I see the relaxed body language of fire on scene, patient side. Patient report received, patient was woken by a feeling of throat pain. He’s been feeling ill, had some post nasal drip. Sounds relatively minor and I turn to my patient. He is full on terrified. Jerky body movements on the 1970s couch, eyes darting around the room frozen in time. He can’t be much older than I but he is non stop chattering, asking if I think he’s going to be ok. Throat shows some minor swelling in the tonsil area, negative obvious swelling of neck glands. He’s producing saliva and swallowing easily in his loop of recounting awakening with the pain. I ask if he lives alone and he nods. Asking again if I think he’s going to be ok, he heads for the ambulance. We drive the eight blocks and I keep my body language open and relaxed as I face him, hoping he’ll follow suit. I keep my voice light and tell him the even adults can have swollen or infected tonsils, that I’ve been watching and he is swallowing ok. I tell him I had my tonsils out and maybe if he’s lucky he’ll get some ice cream. Earnestly, he nods, “uh huh, uh huh, oh I hope it’s nothing serious.” Walking to the ER bed, he recounts yet again his terror of awakening in such a manner.

~*~*~*~*~*~*~*~*~*~*~

She’s apologizing for bothering us, and as my eyes burn, we reassure her that she is certainly not bothering us. One leg is visibly shortened and it’s rotated outward. By the smell of things, she’s been here awhile. I ask gently how long she’s laid on the floor before calling, and she answers “since early Sunday morning.” It’s 9am on Monday now, and as we go to address pain management and consider extrication, my heart cracks a little when she explains “I waited until the work week would begin and you kids wouldn’t be bothered in the middle of the night”.

~*~*~*~*~*~*~*~*~*~*~

Setting the new PR materials up, I adjust a few times and then stand back – admiring. The new materials are an improvement, but the gist of the morning will follow the same as it has for the past five years.

We’re at the area conference center. In one hall are the colleges and recruiters. Set up over here in the other hall are the “trades”. Welders, nursing instructors from the area technical college, fire fighters and police officers, musicians and veterinarians – we all have our own partitioned off space and folding chairs. A few partitions over are the other public service professionals and we’ve exchanged greetings and caught up already. I see across the walkway that the welder has a TV and video set up, and I smile. Outclassed again, new display notwithstanding. The firefighters usually have a power point, and the turnout gear and halligan are great conversation starters.

The overhead voice alerts us in a deafening blast that the students are coming, the students are coming – two minutes out! And my heart rate kicks up a bit. Four years prior I’ve done this and every time it’s the same. In the weeks prior, I always consider typing up handouts, I think of visual aids. In the end, I put my trifold handouts on the table in front of my seats, and I wait.

The ambient noise increases, and here they come. Dressed in business casual, these high school juniors flock to their chosen trades, giving us 25 minutes of their busy young lives. A side benefit is that I have the opportunity to see how old I am, how far my fashion sense is from the trendy looks sported by these blithe young people. Today, of course, I stand in my navy blue uniform and my feet are primly encased in black boots laced neatly over wool socks. The small diamond studs and wedding ring are my only nods to femininity – and since my 13yr old daughter and I had a mommy and daughter day, my nails are pink and sparkly. Eeek. Maybe no one will notice.

They file in and like they’re in church, they fill up the back rows first. I started out with maybe 20 chairs my first year and now they allot me around 50. The area high schools attending this career fair spend part of their time here in visiting colleges/recruiters, and then they’re allowed to attend two career sessions with a presenter. They choose in advance and the amount of chairs correlates to how many wide eyeballs I’ll be talking to today. I’ll have multiple groups throughout the morning and into early afternoon.

I make eye contact, keep my stance open and make small talk as they file in. The veterinarian and the sports medicine presenters aren’t here and so I’m inheriting extras. They sit in groups, schools together, and cliques together. The omniscient overhead voice alerts us that we may begin. The students quiet, turn toward me and I’m on. Here we go. Maybe I should’ve had a handout/power point/video? Nah.

I start easy, covering the requested information, weaving in some of my personal spin. Educational requirements, career growth, range of pay, advancement, etc. I weave in the things I want them to take away the most – try what interests you, never be afraid to start anew. I tell them I was 31 when I stepped foot in my first paramedic curriculum class. I make them laugh as I describe the moment I was informed I was a non-traditional student, and asked to be a spokesperson for that demographic. I describe the challenges and opportunities of clinicals, the various environments and some snapshots of the people I met along the way. I describe the rural area I began to volunteer in, some smaller school students nod as I describe where I’m from.

I touch on prerequisites and linger on the importance of CPR. I slow it down as I describe how, often, the life you may save with CPR is most likely to be a friend or family member. I describe our urban environment, connecting with the larger school students as I explain system status management, and ask who’s seen us at the mall area, or posting in the parking lot by the YMCA. I open it up to questions and answers, and with a little nudging and encouraging smiles, the questions begin to come. Slowly at first, then in a flood.

Always, hidden in there and generally early on, comes the one question I dread. Someone always wants to know, “what’s the worst thing you’ve seen?” Of course I don’t tell them, I generally sidestep it but this first group today presses. They really want to know. So we take a moment and discuss one of the side effects of the job; the things we see and carry, the importance in life – no matter what the profession – of having a support network. People you can talk to, healthy ways to decompress. I tell them that the worst call I’ve seen was personal to the patient, the family and those of us called to help. I tell them we are just doing the job. I tell them that some days the job takes a little more – oh, but some days! Some days the job gives you the uplifting lilt of a grandma’s smile, the hand reaching out, the hug or joke of thanks. And some days, some days the job can take your breath away.

Some students want to be heard, to tell of a day the ambulance came to their house. I listen, we listen, we honor this moment of sharing and of remembered fear or grief. Sometimes it’s a funny story. A boy in the rear row is leaning forward now, despite his earlier demeanor of grudging attendance, he’s drawn in. He was inherited from the sports medicine booth, and he was too cool for my booth at first. Now, eyes lit up, he raises his hand. I nod and he asks, “What’s the best call you’ve ever been on?”

Easy. I lean against the table and I take them back in time. I tell of the night me and my “little brother”/tall partner were new medics, diverted from a “nausea, vomiting, diarrhea” call to an “imminent delivery, caller states he sees a foot” call. I have them laughing as I describe the organized chaos of two newer medics hurrying across a front yard carrying all the accoutrements they might possibly need. I tell of how we can’t say we delivered the baby, how my partner caught the baby in the tub as it neatly delivered itself, head first after all.

I have their full attention as I describe asking my partner if he wanted the mama or the newborn, as we now had two patients and no first responders yet. I describe searching for the scalpel, catching my breath as I look down into the new little face and see obsidian eyes open and look around in wonder. I tell them frankly that it was as close as I’ve ever been to touching the face of God, to see this little man take an enormous breath and pinken up beautifully.

There’s a Spanish teacher in the back row on the left and I realize there are tears streaking down her face. So I lighten it up a bit and describe how the cord cutting reminded me a little of cutting thru a thicker piece of asparagus with a fork. How my partner made a “gurk” sound and when I looked over, the placenta had slithered onto his boot, where he was still in the dry tub with the mother. I wrap it up with a synopsis before the session must end. I tell them that we don’t do this for the money, we don’t do it for the occasional life saving moment we are blessed to be an instrument in.

I tell them, we do it for the people. I speak then for myself. I tell them that there are jobs with more glory, jobs with more fun tools and authority and yes, even videos and power points. But I look them in the eye and I tell them that this job, for me, is priceless. When people don’t know what else to do, they call us. When they’re scared or afraid or in pain or sometimes just lonely, they call us. They throw up on us, they hand us their children, and they bring us to the back bedroom where their mother or father or spouse isn’t breathing anymore.

And they trust us. I explain to these young adults that often in life when you give, you receive. And sometimes, you give more than you thought you had in you. But sometimes, you receive more than money can buy. Moments that are golden and babies that look up at you with brand new and age old eyes that see you with infinite wisdom.

The voice tells us it’s time to disburse. Students cluster around, handouts disappear at a rapid rate and many ask about ridealongs, CPR certification, job shadows. Stories rush out, cliques are gone and students are involved in group discussions.

At lunch time, the musician comes over for our yearly lunch. Carrying the sack lunch provided, she says, “well, my daughter that sat in your session is taking the Health Science Academy. She follows you on Tumblr and PAAW. She says your job is the one she wants because no one talks of their job like you do. What do you say?”

I grin and say, “I just let them walk with me for 25 minutes. They seem to like it.”

“Roll every available ambulance you got to this location.”

Radio traffic from that day tells volumes, just in timbre of voice and speed of speech. Initial businesslike dispatch information and incident command is matter of fact. Then “it is confirmed, repeat, this is a terror attack” ratchets up the stress inside the voice of the man asking for help for a scene none of us could have imagined. Asking for every ambulance available, at some point it dawned on the men and women in uniform that this day was different as far as we would be responding to our own.

Shift after shift, the bloody becomes commonplace and the heartbreaking becomes something we often have no luxury to withdraw and mourn – not for hours. The banal and the rote are comforting and the non-emergent is most often our reality.  We accept, we treat and transport with dignity. We all know we don’t see horrific very often, or if we do, it’s in spurts. Then the bread and butter of transfers and invalid assists help us get some distance and square up our shoulders again.

But to realize, looking at black smoke and hearing the shrieking alarms of the firefighters within – to realize, that is our family in there. Today we are going to walk and search and frantically try to save our own brothers and sisters in uniform. I think the initial numbness would be a blessing. I cannot imagine the days and weeks ahead. Seeing the families at the services. Families you’ve laughed with over potlucks and company events. Spouses who knew the demands of the job and selflessly carried on at home, just like your own spouse.  Children who ran and played with your own.

I think we operate out on the edges, and that’s where most of us feel comfortable. Out on the edges you can see forever, and life is sharper, more in your face. But we don’t walk alone. We walk those edges with our brothers and sisters - in grey, blue, brown, you name it. The patches are different and the faces change, but we are one family, and we all bleed when one of us is wounded. I cannot imagine the empty chairs at the station tables, the forgotten personal belongings on a dresser or an end table in living quarters.

Most of all, I can’t imagine the next time the tones go off. Walking out to the garage, climbing into the apparatus, engine, or ambulance, and facing a world, which has suddenly become more horrible than any of us could have dreamed in any nightmare. If we had the capacity, would we be able to feel any riders with us, no longer able to work but still drawn to the job?

9/11 is so many things. For me, it is a day members of our family went into a scene of terror and horror, ran in and without a thought gave their lives in the service of strangers. Just doing the job – oh, but doing the job with no reserve or holding back.

As a nation struggles with division, as law enforcement, fire and EMS continue to find our way in a world where the only constant is change – I think of those in uniform that day and I am grateful for the example they gave us. Forward. Wisconsin’s motto and the only way to live life, whether out on the edge or not.

Strong work, rest in peace. We’ve got it from here.

Forward.

The dispatch wasn’t unusual. Poignant, but not unusual. Sent to a private residence out in the county to bring a male in to a hospice center.

Summer sunlight flickered thru the green leaves, hanging limp in the weighty humid air. Summertime in Wisconsin is an uncommon joy, like a quiet classmate who one day stands up in class to read a paper, and knocks your socks off. So much of the year our social lives are within pods of warm light, refuged inside airtight dwellings. The icy wind literally hurts your face, and except for the hardy few, most dash betwixt homes and cars, cars and businesses with a definite sense of purpose. Ah, but summer! Summer we emerge, blinking, soaking up the warm air and embracing life outdoors. Humidity presses close as a needy lover, and we accept her because that’s the way it is. The coldest nights and the muggiest days, our state knows no prejudice.

So fields lie on either side of this country road we’re following to our pickup. Hay is being cut and baled on one side. We pass a small general store and a fat cat is lying outside, slowly licking, lazy in his midday bath. The road undulates in front of our bulky shadow; up and down, no center striping – or white lines on the shoulders either, for that matter. We’re too far out in the country for those things.

As always on these hospice pickups, I’m remembering the words one of my FTOs told me early on. He said people call us when they don’t know who else to call. I’ve come to repeat that to myself on many a call. These hospice transfers are the days these families will remember for a very long time. It’s the day Grandpa or Mom or Aunt Helen left home for the last time. All those years and all those memories predicating this event, grind to a screeching halt when the ambulance pulls into the driveway. Up until now, family members have cared for the patient, in living room or bedroom, generally in a rented hospital bed. The decision to call us is never an easy one. It’s admitting that outside help is needed, that a new plateau has been reached. Strangers we are, walking into hallowed ground. The energy is heavy, dark, and there are almost always tears of grief streaking down faces of those gathered to meet us. It isn’t something we exactly look forward to, I’ll tell you that. In a profession of aiding those in need, this kind of a trip seems to me like an intrusion on private grief. I generally try to work into my introduction of myself and my partner, what an honor this is, to take this loved one for this trip. I feel the need to let those who are hurting know that we honor their grief and their love.

The house comes into view, designated fire number evidencing that we are at the right home. It’s a farm; genteel white frame farmhouse surrounded protectively by a very well maintained number of outbuildings. Peeling off the main drive is a second driveway leading to a newer style home, with a fire number one digit off. The front porch door opens and a slight woman emerges, and then stands motionless, waiting.  Parking in front, we get out. I make my way to her, casually glancing over her shoulder for the rest of the family. It’s just her.  I hold out my hand, take her soft and smooth hand in mine. I tell her my name, and introduce my partner.  Her eyes are wells of pain, and she speaks and moves carefully. Her grief is almost palpable and after offering her name, she says “he’s in here.” 

The patient is sitting in a recliner which is in perfect condition, just as it must’ve been when it left the showroom sometime in the 70’s. The living room is immaculate and it seems time has stood still within this room. A small dog is frantically attempting to get my attention somewhere down around my right knee, and a smile lights up the patient’s face. We meet and greet, and my partner engages with the patient further. I turn to the wife, inquiring if she will be riding with us today, or if she prefers to drive.

Her face falls. Looking at her sensible lace up shoes, she tells me how she told the hospice nurse on the phone that she would be following us in, but now she cannot. Her tire is low and she needs to wait until her son returns from work and can “air it up some”. I look at my partner, the pink and animated face of the patient, and my partner nods. I ask her if there is an air compressor on the farm, and she nods. I tell her I can gladly put air in her tire, and her eyes fly up to mine. “Really?” I assure her that us ladies can handle this, and she leads the way out of the house.

Walking companionably up to the old garage, I ask her how she’s doing.She stops, turns, looks at me with those eyes and says,

“I’m hollow. Just...hollow. I don’t even know....” her voice trails off, and she resumes walking. I keep my trap shut and we arrive. She opens the door, and my sudden, sharp intake of breath brings an enormous grin to her face.

“You like?” she laughs. I do like. Sitting in the shadows next to the air compressor is the car of my dreams. Nose in, high rear end is the first thing I spy of a beautiful Generation One Camaro. Without being aware I’d done it, I walk to the left rear bumper and look up at the front quarter panel on the driver’s side. Sharp crease tells me what I can’t believe I’m seeing. It’s a 1969 Camaro, in what looks to be mint condition. Time stands still in this garage, as well. I’m aware of the slowly dancing dust motes in the sunlight coming thru the window over the air compressor. They seem smug in the knowledge of the beautiful creature parked there.

“It’s mine”, the wife states proudly. “I put all 92 miles on her”. My jaw drops, she modifies “well you know - 92,000.”

I ask if I can look, and by God if I don’t feel reverent. I tell her I’m a gear head, and I’ve owned multiple Camaros but never a Generation One. She laughs in delight and says go ahead and look. I walk around the sides and rear of this car and she begins to talk. Slowly at first, then faster. She tells of the brother who gave it to her. Of the sentimental value and love this car embodies to her. At some point I come to, and remembering why we’re out here, unwind the air hose. She pulls up her SUV and I end up topping off three of her tires. We check the air pressure with a gauge she finds, and while I’m working on this, she tells me of the statue of Mary the Virgin Mother she kept on the dash. She is animated now, and as I finish the third tire, I look up to answer and see a woman, transformed. She’s dropped 20 years in age and worry from her face. She’s chattering a mile a minute now.

Winding up the hose, I stop and look at the car, one last time. Standing next to me, she nudges me in the ribs with an elbow.

“You know Camaros? What engine does she have?”

“That’s easy, she’s a RS so she’s gotta have a 327!” I replied instantly.

She throws back her head – throws it back! – and roars with laughter. She looks at me with twinkling eyes and she says “we’d have been friends, you and I.”  She asks if I have “one of them fancy phones” and I nod. She asks if I want to take a picture and I assure her that I really, really do. She tells me to go ahead and I snap a quick photo. She opens the drivers side door to spotless perfection frozen in time and urges, “well get one of the interior, too!” I gape at the pristine condition and take a second photo.

We return inside and as we enter, the patient meets my face and grinning says to my partner, “told you. She was showing her the Camaro!”

We loaded our patient, we led the small two vehicle procession to the hospice center and eventually we took our leave of the couple. Driving away, my partner is talking and I’m a million miles away. I’m thinking how a frail lady was hollow walking toward that garage, and a few minutes later, I met the young lady who drove one of the finest muscle cars ever made.

Oh, the ways that time stands still – and if we’re lucky, and the moment’s right, we might catch a glimpse of back when we were kings.

I’m from a small town in Wisconsin, where no one locks their doors and your neighbor may show up with underwear on their head as part of a dare and ask to borrow a bottle of ketchup. (This is a true story). I graduated from a class of just over 40 kids – in the whole grade. Current grades in my alma mater high school sometimes don’t reach the lofty populace of even 20 kids. Lush fields of green corn stretch deep and verdant under the summer sun, rolling along the ridges and winding through the coulees. Cows chew complacently on their ever-present cud as they survey vehicles passing by on the two lane country roads. Miniature donkeys can be observed rolling joyfully on their backs in dirt, kicking up clouds of dust in their simple happiness. Down between the farms on the back township roads, you can see the bright winks of the mighty Mississippi River shining up at the farmers working the fields. Chickens scratch in the dirt like they are meant to, and children are known to playfully ride on the backs of big sow pigs. Winter brings furry ponies and dairy cows with hoar frost forming on their whiskers, born from the warm hay scented breath and fed on the icy air. Barns are warm oasis points then, yellow lights marking the refuge from the bitter cold. Cats drinking extra milk and cow tails switching in a metronome of agriculture.

When I put on the navy blue of EMS and the oh so glorious boots of my chosen profession, I drive “to town”. Where the coulees lead me to the less bucolic realities of urban existence. College town equals some interesting nights and some new knowledge for this small town medic. Cars and homes are generally locked, neighbors aren’t always as involved in one another’s lives. I have seen things I had previously never heard of, and I’ve driven home disillusioned more than once. I’ve also seen the shining beauty of the human spirit exemplified over and over again. What I’ve learned more than anything is that humans have both an incredible capacity to heal the souls of others, as well as the heartbreaking ability to crush and devastate their fellow man.

But the animals. Sometimes on a scene, a small kitten tumbles out of nowhere to bat at my boot, or a regal old dog leans a head against my leg. I’ve met the world’s biggest guard dog (I swear it seemed so), standing silently steely eyed over the unconscious body of its diabetic owner. I’ve had a monkey reach out and pull my hair as I made my way past his cage to the still breathing body of its owner.  On one of the more memorable scenes, two beautiful brindle dogs lay silent, shot by their owner before he turned the gun on himself. Those dogs are still the first thing I think of when I see a brindle dog.

No matter the walk of life from which we all hail, the animals are our common bond. I’ve walked a Pekingese before its elderly owner would let us take her to the hospital, where she definitely needed to be seen. I wondered what the cars driving by that four lane thought, a uniformed lady walking a small dog on a bedazzled, sparkly pink leash while in the driveway the ambulance rumbled in high idle. Firefighters have joined in an operation on one scene that I drew some comparisons to the team penning activities I used to do full speed on horseback. In that case, it was the panicked horde of nearly feral cats inside a residence that were making it virtually impossible to tend to the patient’s needs properly.

Owners, be they old or young, male or female or any other variable, they for the most part love those pets like children. I’ve found common ground with gruff men who did not call the ambulance, do not want to talk to the ambulance lady, and are certainly NOT going to the hospital. Petting the dog on two such occasions made the glare of recalcitrance fade from their eyes, and they eventually went with me for the medical care that they too, so definitely needed. In the case of one terminally ill woman up in an idyllic coulee, I promised that if she went in with me and were to unfortunately pass away from her illness, as she feared, I would adopt her Shith zhu, which bore a striking resemblance to mine.

Years ago, though, I met the be all and end all of animals. His name was Mr. Whiskers, and he was having a very bad day. The tones had gone off just as we sat down to supper. I was a volunteer then, and the accident scene was closer to my home than the station. I stuffed my feet into boots at the door, threw on my jacket and made my way up the road about seven miles. On scene were a couple of passersby and one officer arrived just after me. Taking my kit from the trunk with its bare necessities, I made my way up to the driver’s side door. Seatbelt still in place, the driver looked exactly like the lady who owns Sylvester and Tweety. She had slid off the road and rolled the car once, landing back up on her wheels. Glass had spider webbed and everything within was in disarray. Aside from the smaller details however, she was not bad off. She had a few banged up places on her face and head, and one wrist was almost certainly broken. However, calm and collected she was, and after I punched an ice pack and handed it to her, we began to be acquainted. I dabbed blood and she told me the story. Halfway thru her recounting of the reason for her trip through our neck of the woods, I heard it. A low, small but businesslike growl from just behind where I was now seated in the passenger seat.

“Oh, that’s Mr. Whiskers”, my patient said with a grin. “He’s a good boy, he wouldn’t hurt a soul. I think he’s scared.”

I do not doubt he was. In the country, it takes a bit here to get an ambulance and when one arrived, the patient was appropriately immobilized – back then and definitely there, selective spinal immobilization was unheard of. Having been capably bundled in the KED, she called my name in sudden panic.

“What will happen to Mr. Whiskers?!”

I looked at him, sitting stoically in the backseat. I heard myself volunteering to take him home and return him to her upon discharge from the ER, only 20 minutes away. She agreed. I reached for Mr. Whiskers.

He promptly sunk all of his pearly white tiny teeth into the fleshy area adjacent to my thumb. I yelped, she assured me as her voice faded, being placed onto the stretcher and carried away, that not to worry, Mr. Whiskers was an angel. I surveyed him; he surveyed me, growling again. I realized that the commotion, the smell of blood, his owner’s vulnerability and my presence soon after the rollover had clearly made him draw conclusions in his furry cute head which did not include warmth and love for me.

Ultimately, I had to put a blanket over him and carry him, vociferously furious, to my car. As I drove home, he emerged after a brief fight with the blanket. Seated on the passenger seat, he glared. Clearly I had lived up to his bad expectations and now he was in a vehicle that smelled unfamiliar and his beloved owner was nowhere in sight. Returning home, I could not get near him with the blanket. My husband went out to the vehicle and carried him inside without incident, getting chin kisses the whole way. He expressed profound disbelief that such a lovable furry little dog was quite the meanie I’d experienced. Mr. Whiskers slept at his feet that night and was eventually returned to his owner the following morning. I kept my distance.

Now when I approach a patient with a pet, I always pause and think of Mr. Whiskers.

Scene safety. That’s all I’m saying.

It was hot, summer, and nighttime. The air was muggy and familiar, like the embrace of a well-known relative. It hugged my skin, smothered my hair, and did everything but swirl in the headlights of the ambulance as we made our way thru the city streets.

It’s a college town and even when the students are home for the summer, downtown is a busy place on a hot summer night. The truck I was on back then commonly staged downtown between certain hours. Tonight we pulled up to our customary spot, engaged the parking brake, turned off our headlights and got comfy. Notified dispatch we were staged, the particular cross streets, and commenced to people watching.

Anyone who’s ever sat in an airport or any busy place knows that people watching far surpasses most things found in any magazine. My partner and I had this dorky game we’d developed somewhere along the way, born of hours of living in the cab of an ambulance. We’d notice a couple of people and we’d begin ad-libbing their dialog.

A young man and young lady making their way down the street. Heading for the parking ramp next to our staging spot, she is purse-lipped and booking it. Her head is down and her footsteps are sure. She isn’t dressed to go out, unlike the young man. He’s clumsily doing his level best to keep up with her, but it’s apparent he’s not at the top of his game. He’s dressed with a little more care than she is, and he’s gesticulating. This does not help his attempts at speed walking.

My partner: “baby, she’s just a friend! I swear!”

Me: “whatever. And your cell phone is broken??”

Partner: “I didn’t know you called. I didn’t even know you were back in town tonight!”

Me: “clearly! I’ve had it!!”

Et cetera. You get the point. We amuse ourselves in this fashion for a while with various passersby. Our windows are up, our truck is in high idle, we aren’t rude about it. We’re just two people passing time, trying to be unobtrusive about sitting randomly on a corner in a very large white vehicle and reflective stripes. We get our share of inebriated folks stopping to talk, or laugh, their reactions as varied as you can imagine. Most, though, are too wrapped up in their own realities to notice us.

Then the tones go off. Undulating up and down, up and down, we snap upright and re-click our seat belts home. Disengage the parking brake, put it in drive and wait to see where we’re heading.

There’s a street fight with reportedly upwards of 40 individuals. Requesting medical to standby until law enforcement arrives. We stage a few blocks back, and as a newish medic with maybe a year and a half under my belt, it’s the largest group of intoxicated people I have dealt with. Multiple squad cars arrive and park, their pulsating lights adding to the drama of the scene. Groups are separated and individuals are questioned.

“Send in medical, officers on scene advise safe to enter.”

My partner takes the big bag and I grab the monitor. We head in. A few people are down on the ground and we each begin to assess. There’s one officer who remains with his back to us the entire time, and what catches my attention is that he stays very much next to us.  He positions himself roughly halfway between us but very close to our space. I attend to my patients and my partner to his. We radio MedComm for additional run numbers and explain to each patient their right to transport as well as their right to refusal of such, when they deny need to be seen in the ER. We explain that they may have injuries that are underestimated by them, due to intoxication or adrenaline not worn off yet. We examine and explain and call physicians to get medical clearance for refusal of treatment. They sign, each of them, we have vitals recorded.

This takes some time, as you can imagine, and I’m sure as most of you reading this know. The entire time this officer remains with his back to us. Standing there, face impassive. He’s an older gentleman and his chevrons indicate that perhaps he isn’t familiar to me because he’s not one of the young officers we deal with often on our night shifts.

When it’s all over, mumbling young people are drifting home or to parts unknown, and we’re packing it up. I thank the officers in my proximity. This officer begins to walk toward a squad car and I can’t resist. I ask him his name and introduce myself, saying I’ve never had the pleasure of meeting him before. He’s very kind and I finally just blurt out in some undoubtedly ungraceful manner, asking him why he kept his back to us the whole time and was just kind of by us.

He replied, “Large fights like that can be unpredictable, sometimes they break out again. You two were busy, so I watched your back.”

Feeling like an idiot, I thanked him again and shook his hand. Grinning, he said, “just doing my job, anytime.”

*~*~*~*~*~*~*~*~*~*~*~*~*~*

The media can play up stories of officer brutality. TV can air footage of experts who dissect police officers in America today. I could tell you handfuls upon handfuls of stories where officers had tears after a child call, when their CPR made it possible for us to effectively go to work upon arrival. Stories of officers denigrated and ridiculed by subjects in custody so awfully that my breathing quickens and my stomach clenches; still they are polite in return.  I’ve seen officers give everything they’ve got to myself and my partners, the citizens they protect, the fire department personnel.

The brave men and women of law enforcement face more than personal danger from offenders on the street. They face a mounting sentiment in our society, perpetuated by many avenues of public opinion and a few over-hyped cases. A sentiment of resentment and disrespect, blatant bias and sometimes outright threats. Yet when we drive the city streets on hot summer nights, when we walk into homes with our heavy bags and cardiac monitors, when we kneel in the middle of a just-ceased street fight, they have our backs. They embody the inter-jurisdictional and multi-departmental safeguards, which let all of us do our jobs without fear. Often at great cost to their own safety, home lives, mental health and other ways we’ll never know.

So, from the safety of a cab in a white box with reflective stripes, I thank them for letting me know I can safely do my job. They have our backs. We who are in EMS ought always to recognize them, thank them on a scene, respect them and speak up when the integrity of their profession is not recognized.

We are honored to work with the men and women of law enforcement, and God forbid they ever need us, we have their back as well.

We’re driving down the road and in the front of the truck, it’s just the two of us. There was some small talk but it’s fizzled out. It’s hard to compete with the siren anxiously wailing above our heads.

He’s maybe sixty, tops. Married for over thirty years, he told me that part.  I’m watching traffic because cars who notice a lot of flashing lights and noise behind them behave predictably – in their unpredictability.  So I’m swiveling eyeballs between mirrors and windshield and I’m plenty busy at it. He’s staring straight ahead doing a passable job of keeping it together, last I glimpsed.

She’s in back and she’s got company. Plenty of it, and that’s not good in our world. Generally one medic in back with you is sufficient but if the crew takes along a couple firemen, like now, well.  That’s another story.  And there are two back there with my partner. The patient is my companion’s missus, and their thirty-plus years spiraled downward about a half hour ago.

I got the tube on the first try and although I was satisfied at my first intubation in the field going so well, his silent presence brought it home to me that there was nothing to celebrate here. They’d just had lunch when things turned. She failed to answer his question in conversation and when he turned to see the reason for her silence, he saw her slumping over. Helping her to the floor, he called 911 and a few minutes later that kitchen was full of strangers bent over the body of the mother of his children. IV access, compressions, intubation, medication administration – the choreographed dance of resuscitation. I saw him in the corner looking like someone had just sucker punched him, right before I clicked the laryngoscope blade home and bent down to take a look. Made me blow out a pursed-lip breath and gather myself – no pressure.

When we left the driveway we had ROSC – return of spontaneous circulation. She was doing the important things on her own and we were breathing for her through a protected airway. Anti-dysrhythmia drugs dripping into her veins and fire fighters along just in case things worsened en route.

We just went by our main parking lot posting station when the muffled sounds and then the rhythmic squeaking behind me made my heart sink. Funny what you can hear over sirens, and I’m just wondering if he can hear it too when he asks, “what’s that sound? How’s she doing?” followed almost instantly by “is that CPR again?”

And because honesty is one of the four gifts I believe in most wholeheartedly in our profession, I answer truthfully that yes, it is. In a voice I can remember clearly as I type this, he says “oh, love….” And turns his head to the window.  The next four or five minutes will be with me as long as I live. For he began to talk to her.

He started off by telling her that he always thought he’d be holding her hand when she crossed from this life over to the other side. He told her how infinitely loved she had always been by him and he praised the way she raised their babies. He thanked her for the life they’d had, and for the joy she’d always been to him. He told her he was always surprised that a woman like her loved him so much and so well.

Then he began to pray. He asked if I would pray with him and I told him that I would in spirit but the cars and the traffic and the red lights needed my whole attention. He bowed his head in my periphery I could see him as he poured his heart out to his God. Telling him that this wasn’t how he thought it would be, how he always hoped he’d go before her, but thanking him for this gift of a wife he’d been given this long. He prayed for strength to tell the children, and asked for peace and comfort for the family.

I can’t tell you all of it beyond that, and I can’t explain how there, in the front cab of that ambulance I have spent countless hours in, how I felt like I was on sacred ground. I felt like an eavesdropper and I bit my lip pretty badly to distract myself from the tears building up in my throat. What a priceless treasure, to see even a little bit of a love like that!

He seemed to know that she was gone, he never questioned it and although efforts did not cease until sometime after we had left them both in the emergency room, he was right. She was gone.

The world may romanticize celebrity couples and novels can elaborate at length, but one of the greatest living examples of love I’ve ever seen entered my life on a sunny fall afternoon in a kitchen.  The woman I never had the privilege to speak with was loved with a depth Hollywood will never capture. What an honor, what an unspeakably breathtaking moment to witness.

I wonder if she heard?

There are things we just don’t say. I don’t care what tv depicts.

“Everything’s going to be ok.”

“He passed on.”

Because often, very often, things are not ok. They may never be ok again. For this family, this woman, on this night, in this sunny living room or this ditch in the rain or in the back of two ambulances parked along the roadside – the world ended. Their life, as they knew it, just stopped and no matter how many classes I’ve taken or how hard we try – it will never resume to the same beat, in that key. It will go on, with a void or with a painful knot in the throat. It will heal over that wound but the scar lives forever.

We can’t fix that. We can give all the drugs and do all the things in the right order and we can pray fervently under our breath or in our mind or not at all because we’re too busy or don’t believe in it. But sometimes the fact is, it is not going to be ok. And he didn’t pass on.  He died. Before you called or while I was with him or sometime during the drive.

“We did everything we could but all our efforts were unsuccessful and he died. I’m sorry for your loss.”

And then we pack up the debris of organized chaos and we make necessary phones calls as the case may be. Wait with you until family arrives. Look at our boots because we want to give you privacy but we don’t want to leave you alone in your suddenly alien surroundings with the huge new gaping loss screaming silently. And someone comes and we again express our condolences and then we leave. We put our equipment back in our truck or apparatus and we drive down the street, up the lane, out of your life.

But we carry you with us. We carry a hush in our footsteps for a few minutes or hours. Maybe we think of our parent or spouse or child. We push those thoughts out of our heads because even our own mortality isn’t as horrible to think about as that of those we love.

The biggest kindnesses in this job, to me, will forever be these: a silent hand on the shoulder, anti nausea medicine, pain medication, and honesty. I won’t draw out your hope any more than I will dig for an IV if there is no palpable vein.

Everything may not always be ok, but we will come when you call, we will do everything we know how to do and we will do it for as long as there is a possibility of success. And when we can do no more, we will explain it to you simply and honestly.

In those moments of sobering humanity, the best thing we can offer you is ourselves. We will be there, we will give another patient and another family and another worst day all we have.

That is our promise. It is an honor. And one day – everything will be mostly ok again.

We know, because we are mostly ok.

The t-shirts and the bumper stickers don’t get it right. The bravado inherent in the station stories misses the mark. The loudest talkers in the bunch have no idea. The quiet, weathered eyes of the senior medics are too kind to correct them.

The life of a working medic isn’t about lights, sirens, diesel therapy, saving lives, screaming down the road. It has elements of those things, but that’s like saying having a child is just about Play Doh and no more tears baby shampoo.

The job is the most demanding taskmaster you have ever met, the most strident girl friend, the most caring grandparent and the twinkle of stars on nighttime water. The job pushes you when you simply think you can’t give any more. It asks more, and you give it. When you’re reeling from something witnessed that is harder than usual to file away, it gives you a small child who, being carried into the ER, nestles their head in the hollow of your neck. It’s balm to your soul when you wheel the gurney into the home warm with lights on a winter’s night, family lining the rooms as the hospice patient comes home for the last time, grips your hand and says “thank you.”

It’s my heart pounding in my ears as I feel for a pulse, mentally pushing away the crying children and shrieking girlfriend of the gentleman unfortunate enough to have been walking underneath a large tree limb as it fell. It’s mapping at three am when I blink and struggle to focus on the name of an unfamiliar road in a township I’ve been to maybe once. It’s a phone buzzing silently in my pocket as I search for vocal cords on a cancer patient whose spouse can’t remember if there’s a DNR order and all I can think is, my elderly mom’s ill and is she ok?

It’s the hot dark city streets in the summer when the bistros close and the hipsters are home in bed and the alter ego of the city comes alive. It’s streetlights at one am passing overhead as my partner and I slow and stop, seeing a man picking a female off the sidewalk, looking around furtively and heading off with her over his shoulder. It’s the wordless nod of hello from an ERT member still outside in full gear as we arrive on scene to deal with a respiratory distress in an elderly female whose family member was the object of the sudden, explosive entry. It’s a fire captain protectively pushing me behind him into a corner when a suddenly not-seizing-anymore male erupts from the floor of a residence in a sketchy neighborhood, roaring in fury, the needle and syringe falling to the floor as he advances. It’s the burly dog, growling low in her throat, standing guard over a seizing diabetic patient as I enter a duplex – and freeze.

It’s holding a newborn baby boy, slick and wet in my hands and being struck dumb with awe and wonder, ok, and panic. Searching back in my memory for how many inches apart the ties are supposed to be for the cord and wishing he’d cry and then….then his obsidian eyes blink open and look solemnly up at me, and I swear I’ve seen the face of God in this tiny human entering the world.

It’s jerking awake in panic as the tones go off for the sixth time in an endlessly long night, stuffing my feet into boots and staggering to a brightly lit garage, mindful of the time it takes to activate. It’s being so tired I crave sleep as if it were a tangible thing to hold and cherish. Drinking coffee that hasn’t been warm for hours and never was anything more than low class – but still holds magical properties. It’s stinking, knowing you stink, and dealing with it ok until you give report to some freshly showered RN who was probably born the year I learned to drive a stick shift – and she has perky, clean shoes. It’s arriving in my own garage and reaching for a radio microphone to tell someone where I am and what my miles are. It’s sitting in a parking lot in an ambulance, posting as the sun goes down on a family event evening where everyone is present – and my chair’s empty, again.

Putting on the uniform and walking into a building where we all look the same and we’re all so very different. Climbing up in the cab and signing on the mobile data terminal, putting our names and signatures into the tablet. Informing MedComm our crew is updated and “assignment please”? Pulling out of the garage and heading down the street one more time. Not knowing what the shift will hold – but knowing you and your partner across the cab will face whatever it is, together.

It will change me, and it will mold me. Differently than he, or she, not as much as some and infinitely more than others. It’s a career, it’s my chosen profession, it’s exhausting and uncompromising and it’s the real deal.

It doesn’t get any more stark, any more frontlines, any more adrenaline charged and yet unglamorous than this.

That’s what the t-shirts can’t tell you, and the bumper stickers are clueless to explain. When you live it, you know.

It’s boots on the street, sweat, blizzards and thunderstorms, vomit and beautifully crying children with intact airways, grandpas with no pulse palpable as the sound of weeping fills the room. Toothaches for a week at two am, migraines, stomach aches , avulsions , hands caught in snowblowers. Requesting mutual aid, firemen standing knee deep in icy creek water next to me, walking a patient’s dog before she’ll consent to transport and an 86 year old female earnestly asking my partner if he thinks the problem might be that she’s pregnant.

It’s professional emergency medicine – compassion combines with proficiency, and  autonomy whispers “we’re here.”

“Can you take what you need but take less than you give?
Could you close everyday without the glory and fame?
Could you hold your head high when no one knows your name?”

-Bryan Adams

“Never Let Go”