Deliverance

Sweating beneath a knee-length plastic gown, goggles fogging up, rubber gloves slick with goo, the high-pitched screams of a natural child birth drowning out the sound of my own voice, I reached between the woman’s legs and grabbed her baby’s head, which, to my horror, immediately exploded.

There are a number of reasons people get into EMS. Some are called by a desire to help others. Some see it as an entrée into the world of medicine – which would make sense if a high-stress, work-all-hours-of-the-night, throw-your-back-out-while-carrying-fatties job that offers mediocre pay is your idea of a good way to dip your toe into the raging sea that is emergency medicine. Others are answering the adrenaline call of the sirens, blood and guts types who yearn to be characters in those horribly misleading television shows like Trauma.

Some, like me, are tourists. I simply want to observe the truly strange up-close. Much in the same way normal people go the zoo and stare into the gorilla enclosure, I hop on an ambulance and stare – popcorn in hand – at the weirdoes among us.

There are other reasons for pursuing a career in EMS of course including, I hate to admit, that a young man wakes one morning to find a GED and a clean driving record are his only marketable qualities. But fear not. Turds like this are weeded out after a bungled call or two which, I guess, when you really think about, is reason to fear.

Drive carefully.

Whatever path led us to this odd little world, it’s safe to say a desire to deliver babies in stairwells and cars and cluttered little bedrooms was not one of them. For all the time I spent in training – six months for EMT and another fourteen when I upgraded to paramedic – very little of it was dedicated to the slippery skill of delivering babies.

Perhaps as justification, my EMT instructor said some of us would never have the privilege of bringing another life into this world and to those who would he offered this: ‘You don’t deliver babies. Mothers do. You simply help.’

Rather flippant, I thought at the time. What happens when the baby comes out not breathing? Or when a blue arm pops out first? This, I thought, was something we should spend a great deal more time on. After all, delivering babies is a specialty. Whole hospitals are dedicated to the enterprise. But, like so many other aspects of EMS, it is yet another skill we would be expected to master with little training or experience.

So I set out in the hopes of being one of the lucky medics never called upon in such moments. My hopes were quickly dashed. In my first day on the job my partner and I were dispatched to a motel for a woman with abdominal pain. We walked through the door to find ourselves staring down a howling, sweating expectant mother, stripped bare at the waist.

Strange things happen to the human body during child birth. Even stranger things come out of it. Noises and liquids and pungent, alien smells – and all this before the child even considers sneaking out.

That particular child shot out like a greased watermelon and, before ever arriving at a hospital, had been suctioned, stimulated, cleaned, snipped free of his umbilical cord, wrapped in warm blankets and named. All this (with the exception of the last part, honestly I would never send a child out into the world with a name like Que’Shawn) by two young men armed with little more than their wits and a scalpel.

In the years since I have been present for a good many deliveries. Most of them have been easy, a few totally bewildering and one or two tragic to the point of criminality. That a mother can deliver a child in three feet of water and leave him submerged for six minutes because ‘he’s been breathing in water for the last nine months’ without spending the rest of her life in jail is truly mind-blowing. But it happens.

Today I’m experienced enough that should a woman ever find herself in the unfortunate position of delivering a child in my house I would be able to provide excellent, if not ecstatic, assistance. But it wasn’t always so, which brings us to the aforementioned exploding head.

Way, way back. Years ago, actually, when I was a brand new EMT I spent a few months under the tutelage of an experienced but rather burned-out medic. My own partner had recently shipped out to Saudi Arabia and his replacement was…how to say it?

He was good at his job. Honestly, if everyone approached their job with the same fervor as this man the world would be a better place. The problem was he had the expensive habit of getting tangled up with loose women. Though this may sound fun, the day inevitably comes when she asks you to take on a second job. ‘To buy a house,’ she says. Of course, buy a house is code for ‘I need time to bang another man,’ and so begins your misery.

For my partner it meant taking on a second EMS job. Since both of his jobs followed the one day on, two days off schedule, he worked two days in a row and was home only every third day. Think about that. You work forty-eight hours straight, go home for twenty-four and then return to work for anther forty-eight. And on and on for eternity.

So he was tired. And burned-out. But he got lucky in that I was in paramedic school, which meant not only was I desperate to get wrist-deep in every call but that he, technically, could allow it. So long as he was there to supervise. Which he was, in his own sleepy, grumpy way.

And so on a blistering hot August day we were bouncing down the road en route to a woman in labor. For the record, every call we get involving a pregnant woman comes out as ‘Woman in labor’ or ‘Imminent delivery’ or ‘Contractions less than one minute apart.’

Of course, we usually arrive to find a girl sitting quietly and happily on the couch, in no noticeable distress who felt ‘a little pain about twenty minutes ago.’ So when my partner offered to let me run the show if this was the real thing, I quickly agreed but did so without much hope of it being the real thing.

All that changed the second I walked through the door.

Two steps beyond the threshold and a horrible scream like someone being disemboweled came from an upstairs – Upstairs! Naturally! – bedroom. We hustled up, gear in hand, and were met at the top step by a rather strange and squirrely figure.

I’m not sure if he was the father of the child, the father of the woman in labor, a neighbor, friend or some combination thereof but he refused to give us any information. At all. In fact, during the entire time we were there the only thing he ever said was ‘Man, I need to go.’ Which he repeated every thirty seconds.

But he met us at the top step and motioned toward the bedroom. There were, of course, no lights. If you’ve been keeping score, you’ll notice that most of these stories take place in houses missing at least one of the basic utilities. Could be chance, but I doubt it.

By now my partner and I were joined by not only the patient and the Mystery Man but also by four firefighters. As a general rule firefighters abstain from touching women in labor. Probably some sort of fire rule they have; a code perhaps that dictates they stand as far as possible from the offending orifice and stare, mouths open, any time someone asks for their assistance.

If that is indeed so, these guys were doing a fantastic job. But of course, I was new and inexperienced and eager – a dangerous combination – and I wasn’t looking for help. I was looking to make things happen.

I turned to the Mystery Man and asked how long this had been going on, got no answer, then asked the same thing of the patient and received only a howl. She was clearly quite pregnant and evidently in distress of some sort so I asked her if she could make it downstairs with our help?

She howled and shook her head.

‘What if we carry you?’

Another headshake, much to the relief of the firefighters.

‘Man, I need to go,’ the Mystery Man said, though he didn’t.

I turned to my partner, who suggested we deliver here. Of course he also didn’t move, making it clear ‘us’ meant ‘me.’

So I opened our bag and yanked out the OB kit. I slipped on the plastic gown, put on the goggles and slid my hand into the rubber gloves which, unlike our regular gloves, extended halfway up the forearm.

I guess I was prepared, I was certainly hot, but I didn’t really know what to do next. A thousand things were swirling around in my mind. Things I’d learned in class, things I’d seen in movies, stories I’d heard about the birth of family and friends. But I’d never been in charge before. Where do you start?

Best, I decided, to start at the beginning.

‘So, uh, can I take a peek?’

That’s probably not the most medically sound way of telling a woman deep into a long and painful natural childbirth that your next move is to see if the baby is crowning but it worked. She grunted, howled and, with a violent heave, tossed the sheet on the floor.

All eyes turned to me as I silently cursed every medical text book I’d ever read. All the drawings and pictures and descriptions, the cocky reassurance of my EMT instructor that I’d simply be a spectator, all proved useless as I stared at the enormous tangle of undergrowth.

I couldn’t see a child, but then again I couldn’t see the entrance from which said child would emerge. In my head I pictured a machete-wielding Michael Douglas chopping his way through the Columbian jungle in Romancing the Stone.

I looked to my partner for guidance and received none. I looked to the firefighters for help but they were retreating faster than the Mystery Man who was mumbling, yet again, that he had to get the hell out of there. I cleared my throat, wholly unsure of what to do when the woman screamed, bucked up on the bed and flung her legs out.

There was simply no time to think so I didn’t. I stepped forward and called for someone to grab her right leg. Miraculously, someone did. I called out again and someone else grabbed the left leg. The woman was screaming now, her eyes bulging out, mouth open, neck veins about to burst.

‘Push!’ I yelled.

She pushed.

‘Keep pushing!’

She kept pushing.

‘Maybe a little more of the pushing…’

Yes, that one was a little flat but I was running out of things to say.

Suddenly, there it was. A head. Or, at least, a bulge. Movement, anyway. Once again my mind swirled with contingencies. Suction, a voice in my head screamed. Start with the mouth, then the nose. Check for meconium, don’t drop him, stimulate him if he’s not breathing, put him on the mother’s belly, cut the cord but make sure you do it at the right distances. Do you remember when to start CPR and how fast to do it?

A thousand steps, each committed to memory months and in some cases years before, rushed through my head in the seconds following that first sighting of what maybe, perhaps, was a head.

Of course, as I was thinking I was also doing. The bulge continued to emerge and I slid my hands down, like a catcher, curved just so, prepared to usher this young man into the world.

I’ll stop here to say, again, that this was a long time ago. As I’ve said, since this day I’ve helped deliver a number of babies and many of those doubts careering through my mind that day have since found purchase on the solid ground of experience. Things you should look for, prepare for. What to expect and, also, what to ask.

Simple questions, but important all the same. Like has your water broken yet?

But of course, I didn’t know these things then and so, when the bulge – disguised, as I’ve noted, by an inhuman amount of hair – emerged I reached for it.

My partner saw what I was about to do and tried to stop me. The firefighters closed their eyes. The Mystery Man, from his vantage point across the room, reiterated his need to leave.

But, surging with adrenaline, I reached for what I took to be the child’s head and grabbed it. And it exploded. I remember a moment of confusion as hot liquid blasted into my hands, rushed up my arms and splashed onto the plastic gown.

Somewhere deep inside I wondered what in hell had just happened.

But the outside world, the real world, had already figured it out. The delicate but quite full sack of fluid had slipped out during a push and rather than allowing it to break on its own I had ruptured it with an ill-advised reach-in. And it exploded.

Seriously.

I immediately jumped back, peeled off the soaked gloves, tossed the speckled goggles away and yanked off the soaked gown. As I recovered my senses and frantically checked for any fluid infiltration, my partner stepped in and rather effortlessly delivered the child.

Imagine. There I was cowering in the corner while the baby – the real one this time – crowned and then squeaked out. Requiring no assistance whatsoever, he simply opened his eyes and started crying. Before I could even put on another pair of gloves he’d been dried and the cord cut.

It was to be my first delivery and I’d missed it.

We packaged mother and child for transport and took off, leaving behind the firefighters and a suddenly-content-to-be-at-home Mystery Man.

Immediately thereafter, anytime water was spilled my co-workers would laugh and shout ‘Look out, Hazzard!’ Or ‘Go get your goggles!’

To make the world smile is itself a gift, right?

Since that day whenever I have a patient in labor I think back to my EMT instructor. His comments, suddenly not so flippant, accompany the realization that we do not deliver babies. We’re just along for the ride. And for an EMS tourist like me, that’s not such a bad thing.