Wednesday, September 18, 2013

A Corpse In Limbo

I did nothing to save the first person who died in front of me. I simply stood watch, quietly, and let her go. She was old and white and wasting away in a nursing home, her dress covered in splotches the color of solid food that’s been run through a blender. Her death was unceremonious but quiet and I was the only witness, earth’s final sentry, there to do nothing more than close the gates after she slipped through.

There are two types of ambulance roaming your streets right now. Obviously there are the 911 ambulances: Two-man crews waiting to respond to emergencies real or imagined. But there are also the others: Private ambulances whose sole purpose is to take the infirmed to and from appointments. To work for a private service is to spend your professional life wandering through dialysis clinics and nursing homes, neither of which is pleasant. Dialysis clinics are sterile white rooms filled with the tang of bleach and the soft whirring of machines that slowly drain your blood like calibrated vampires so it can be scrubbed and then pumped back in. Nursing homes you know, though perhaps you’re not familiar with the smell—how the air is flat-out humid like the wrapper of a rotten Slim Jim, and heavy with the stink of dirty diapers, reheated food and unwashed bodies.

The hierarchy between these two very different ambulance services is clear—children don’t dream about growing up to be the guy who totes dehydrated lizards out of a nursing home. And yet which one you work for, private or 911, is occasionally a matter of luck. My particular type of luck turned out to be bad—when I finished EMT school the 911 service in my area had just hired a couple dozen people and the recruiter told me to call again in the summer. The private service hired me on the spot. I was only 25 and already I’d lived two lives—one as a failed salesman, the other as a published novelist and reporter in exile. Now, I was about to start my third. The first person to die before my eyes did so in early 2004, centuries ago, and looking back it’s hard to believe that it’s real, that at one point in my life it was so normal to be witness to something so strange. Like much of my EMS life the memory is fuzzy, soft light filtered through gauze, but the details are sharp as a hot razor. Combine the two and what you have is more sensation than recollection, more feeling than anecdote.

This is how it feels to me now.

It’s my second or third night and I’m partnered with a guy who never goes home. He’s a firefighter in the next county but he’d do anything for money and works a handful of part-time jobs. When he isn’t here or at the fire station he flips burgers at McDonald’s. Just before ten we are called to a nursing home for a sick woman. Technically, this is a job for the emergency service, but every so often the lines become blurred. Calling 911 suggests an emergency—something, anything, that couldn’t be handled by the nursing staff. This raises questions they’d rather not answer. But calling a private service, a non-emergency service, suggests a small but concerning problem, something caught and handled early.

My partner is tired. He walks slowly, eyes to the floor, as we push the stretcher off the elevator and wander down the long hall to the patient’s room. We ease alongside her bed. A nurse hovers in the background saying the woman didn’t eat dinner, isn’t acting herself and needs to be seen. I take her blood pressure, her pulse, count her breaths. Her eyes are closed, her skin—white and crinkled like parchment paper—is dry and hot. My partner asks for her papers. You never leave a nursing home without papers. Most people in a nursing home can’t talk and those that can don’t make sense so even a question as straightforward as Who are you simply doesn’t yield usable results. So you get the papers, a thick manila envelope stuffed with everything from medical problems to next of kin. More importantly, it is in this packet that you find insurance information and whether or not there’s a do not resuscitate order.

All your boss cares about is the insurance information. All you care about is the DNR. Simply put, there are uncomfortable questions that absolutely must be answered. What if she loses consciousness? Or if she stops breathing? Do I go all the way—CPR, electric shocks, slip a tube down her throat, drill a hole in her leg for medication. Or do I simply let her go? What does her family want? What would she want? The existence of this simple piece of paper, even its absence, means a lot. To everyone. At the hospital, the nurses will ask about it and the doctors won’t even look at you until you’ve answered. At her age, in her condition, everyone will agree resuscitation, beyond futile, would be cruel. So does she have a DNR? The nurse says she does, that it’s atop her packet, the first page in the stack. She walks out to go get it.

And that’s when it happens. Before my partner—who’s leaning against the wall—coaxes his mass into action. Before I pull back the sheet. Before anyone even addresses her directly. She opens her eyes—milky and unfocused—and tilts her head forward. Her lips part and then, without ceremony, she relaxes. Her last breath escapes. A single tear runs down her left cheek.

I know instantly what’s happened. But is it really that simple? That easy? The nurse has just said the patient has a DNR so that drilled-into-my-head-during-school compulsion to act doesn’t kick in. Instead, I spend the first few seconds staring into her vacant eyes, tracing the arc of that single tear—her final corporeal act—and marvel at this woman. Moments ago she was something to pity, bed-ridden and in a diaper. Suddenly she is a sage, plucked from her stained night gown to be cloaked in the wisdom of the ages. While I stood there, change jingling in my pocket, a little hungry, hoping my wife hadn’t given in to the temptation of watching the Sopranos season finale without me, this woman got the answer to it all. She knows why we’re here and, more importantly, what’s next. And if it’s not the black nothingness we’ve feared since acquiring self-awareness, then how small we must look to her now. In dying she has crossed over. Or hasn’t.

My partner, oblivious, has finally come to life and motions for me to grab the other end of the sheet so we can move her onto our stretcher. I need to tell him, let him decide what comes next but I don’t trust my own instincts. I’m brand new at this, I’ve never watched someone die. My experience with the dead—recent or otherwise—is limited. If he doesn’t notice then perhaps she’s not dead. The woman was hardly moving when we arrived and now, except for the trail left by her tear, she looks no different. With a yank we slide her over. He covers her with a sheet, buckles her in, starts pushing. I stare at her chest, her face, looking for signs of life I know deep down I will not find. We grab her packet and sure enough the DNR is stapled to the top. We ride the elevator, step out into the cool night. With a sharp metallic click the stretcher is snapped into the mount on the floor of the ambulance.

I think she’s dead.

My partner stops. He looks not at her but at me.

I tell him I don’t think she’s breathing.

He steps up into the ambulance, looks, feels, deflates. In the absence of the DNR he might do something but it’s not absent. It’s right there and this document, drafted and signed with the sole intention of clarifying this woman’s final moments, instead obscures our next move. Had she died in the nursing home, my partner says, we’d simply leave her but she’s here now. She died on our stretcher. In our ambulance.

We have drifted into murky water.

He calls the nursing home. We’re in the parking lot, he says. Your patient has died. She’s in your ambulance, the nurse tells him, she’s yours now. I stand outside while they argue. Our patient lies in state. What to do with her? The hospital doesn’t take dead bodies, nor does the nursing home. This woman has died and now no one wants her. She is a corpse in limbo. My partner hangs up. Fumes. He goes back in to explain, to plead, to threaten. I’m not sure why but he leaves me in the back with her.

I sit in the ambulance and stare into the woman’s half-open eyes. I grab the packet and flip through. If we are to keep one another company I should at least know her name. Her birthday. Turns out she is eighty-eight.

There aren’t many things you can do in the back of an ambulance with a dead woman. My cooler sits in the corner but no. I could talk to her but frankly, she is so recently dead, so unchanged from before, it feels as if addressing her directly will wake her. Well, not her but the ghost of her, which is even worse. This may sound foolish but I can assure you that only the most gruesomely killed or severely decomposed look as if they will not sit up and begin talking at the slightest provocation.

Are you still awake?

My wife, at the other end of the call, says she is. She broke down and started watching The Sopranos. You’re gonna love it. When I say nothing she asks if I’m mad and after a second I tell her where I am. Tell her that I’m alone with a woman I’ve watched die and who has become, thanks to my indecision, something of a refugee.

She asks how the woman died and even though I know this isn’t what she means I say peacefully.