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.

Monday, September 9, 2013

Of Wind and Ice and Ryan Waters

Walking away is not easy. To do so is to accept that harshest of human preoccupations: failure. Above 8,000 meters, however, failure must compete for your attention.

Oxygen deprivation, frostbite, avalanches. The quiet but ever-present threat of death from exposure. It is respect for these competing forces – along with the superlative competency that keeps mountaineers alive – that has Ryan Waters rooted in place.

It’s mid-August 2006 and Waters, an experienced high-altitude climber, guide and Wheeler graduate, is at Camp 3 on K2. At 8,611 meters, K2 is the world’s second tallest mountain and arguably the most difficult to climb. Waters and his team have long trained for this moment and now find themselves one day away from a push to the summit. But nothing is going right.

After an assault of Broad Peak, another of Pakistan’s 8,000-plus-meter peaks, the team is exhausted. During the climb of Broad Peak, they reached the summit ridge before deciding they could go no further. In one of the most poignant moments of his career, Waters decided to push on.


Hours later he stood on top of one of the world’s great peaks, a young man in complete control of his element.

Such exuberance, however, must be tempered. Those who know say mountaineers either grow bold or grow old, but not both. That fortunes can change is something Waters knows all too well. In 2005, after two previous successful summits of Everest, he was forced off the world’s tallest mountain by a severe respiratory infection. To spend five days walking away from a trip that had dominated months of his life was more than a stinging slap.

And therein lies the crux of high-altitude climbing: tempering the audacity to push ahead with the wisdom to walk away when defeat comes calling. Because sooner or later it will.

As such, K2 perfectly sums up the dizzying, oxygen-depleted world of high-altitude climbing. Despite its highly-technical and challenging final stages, it remains unknown to the world at-large. As attention and accolades are heaped on its slightly taller but less challenging cousin, Everest, K2 waits for the unsuspecting, the unprepared. K2 has the patience of Job and a voice from hell itself can be heard in the winds whistling off its peak. Underestimate me, it croons, at your own peril.

The decision to turn back or push on is never easy and, after a tortuous night, Waters and his team decide to continue. Ignoring their screaming muscles and seared lungs, they make a run at Camp 4. But extreme conditions rarely send subtle signs and shortly after they get underway a falling rock tumbles toward them, smashing into Waters’s knee.

Still, it’s never an easy decision. “There always a piece of you that says ‘what if’,” Waters says. “But you gotta be able to walk away.” And so, under the mountain’s indifferent glare, the team descends. They are beaten but not broken. K2 will always be there.

Waters will move on to other mountains, other feats. He and a friend will complete the first unassisted ski traverse of Antarctica. But the allure of the unconquered is strong and in 2008 members of the failed expedition, minus Waters, will make a second challenge of K2. Once again things will go horribly wrong and, after spending two nights above 8,000 meters – the fabled death zone – some of them will die. Acknowledging the tragedy has cast a shadow over the mountain, he adds, “but it’s certainly a risk I have accepted.”

Risk, reward, failure, death. These are the constants of high-altitude mountaineering. They are truths to be accepted and, for the bold, they are rewarded with gifts that time or loss cannot tarnish. But those rewards, in mountaineering as in life, can be collected only by those with the wisdom, on occasion, to walk away.

Smoke and Magic Inside the Box

The South is a place of magic.

Tales of mysterious beasts and wild, half-crazed heroes roll clear down to the lowlands like mist from the Smokies.
Voodoo bubbles up from the mudflats in a whisper as black and syrup-slow as the waters of the bayou. It’s no wonder the stomping shuffle of buck dancers and the lonely moan of the slide guitar were perfected in the Southern night. Crowded by the song of Katydids, it is a darkness where the forsaken are rumored to find salvation in music.

So it was for Mike Snowden. Burned out by a lifetime of playing in bands – the endless travel, the constant in-fighting, the search for something that wasn’t there – he put down his bass guitar and walked away from music. In the seven years that followed he had a child, got a day job and settled into a calm that had previously eluded him.

But magic never dies. It merely waits. Five years ago, he realized his daughter had never heard him play. Never seen music swell up and flow from her father the way it can for only those who truly love it. But his bass carried too much baggage, was too complicated to be pure in a child’s eyes. So he picked up a banjo, then the drums, but neither fit.

“And then I came across a picture of a guy playing a cigar box guitar,” Snowden says. “I knew I had to try it.”

Snowden happened to have a friend who worked at a cigar store and had given him a handful of old boxes. The East Cobb resident had long been intrigued by the smell of the wood, the exotic cities stamped into the side. He knew there had to be another use for them and finally it struck. That old Southern magic.

Snowden made a guitar. Three strings and a plug. Varnish. Wood. Something so simple it reaches the purity of truth and carries a unique sound all its own. He started to play music again. First for his daughter, then for anyone who would listen.

He gave up on playing anything else, focused solely on this strange, three-stringed

“I sold or threw out all my old equipment,” he says. “It was liberating.”

He played festivals, recorded music, put out albums and, of course, made more guitars. Almost 500. Aerosmith’s legendary guitarist Joe Perry bought one. So did Audioslave’s Tom Morello. Sugarland’s Christian Bush gives them as gifts.

Snowden didn’t invent cigar box guitars, rather he reintroduced them to us. They first appeared in the 1840s when cigars stopped being packed individually in crates. Civil War soldiers made them. So did Bo Diddley. And Jimi Hendrix. Then, for a moment, they all but disappeared.

The internet is the modern day Crossroads, a place where magic floats in the ether like a blown kiss. It’s where Snowden saw his first cigar box guitar and it’s where the world first saw him – video of the wounded cry of a slide easing its way down the slender neck of his black Cohiba guitar went viral. People took note.

“There’s a whole underground scene of guys who play these things,” he says.

In September Snowden will play a series of shows in the UK culminating in Manchester’s fourth annual Boxstock Festival. Once again on the road, but this time with less trouble, fewer complications.

After that he’ll return home. To his family. To a place where the heavens speak through three strings and a twelve-inch box.

Simple maybe, but nothing short of magic.

Welcome to the Food Chain

Maybe it’s just a possum. You will say this in the dark, when the stars have been blotted out and you can’t see far enough to know where your sleeping bag ends and the great unknown beyond your tent begins. It is a prayer wrapped in a whisper, a childlike hope that what you don’t know can’t eat you. But that tingle in your spine, evolution’s genetic heirloom, disagrees. When you strip away wit, ambition, boredom, hatred of injustice and a love of baseball, you’re simply two hundred pounds of meat. In bear country.

Welcome to the food chain.

Before you receive a back country pass at Yellowstone National Park you must watch a video on bear safety. The video’s sole purpose is to convince you bears are not like Yogi. It suggests you clap every so often to make your presence known – pity the fool who surprises a bear. You watch dispassionately until the moment they show you a grizzly, and then you’re frozen in your seat. In abject terror, you’ll take a map from the ranger and ask about bear activity in the area. He’ll laugh and say none has been reported, but how quaint of you to ask.

As you hike in – alone because tourists at Yellowstone don’t leave their cars – you’ll clap before entering stands of trees. That evening, having not seen a single bear, you will confidently make a fire, cook dinner, sip whiskey and bask in the sublime realization that you are miles from anyone. Eventually it’ll be time for bed. Though you went before, you’ll have to pee again. And somewhere in the darkness a creature sniffs your tent.

So you tell yourself it’s just a possum. Until morning. When you get up, step out and find your camp dotted with bear tracks. Only then will you admit it wasn’t a possum. That you are alone. In bear country. Just another part of the food chain.

A horrifying realization. But exhilarating. Viva Yogi.

Saturday, December 18, 2010

Zen and the Art of Tying Knots

I was only four months into EMT school the first time I was attacked by a patient.

Looking back on it, EMT school was really just a warm-up for the fourteen-month-long paramedic course, the place where pre-hospital care advances from mere first aid to actual medicine. But at the time, as someone uninitiated into the world of public safety, it seemed to me an entree into a very strange and exciting world. We were taught to recognize imminent life-threats like strokes and heart attacks and given a crash course in anatomy and physiology. We learned CPR, the Heimlich, how to immobilize patients with possible spinal fractures, and how to apply tourniquets and pressure dressings.

In fact, after hour upon hour of practicing skills and studying books, we could, in those early months, recognize and respond to any number of critical long as the victims were mannequins.

That’s an odd disclaimer to place upon a group about to enter the world with the purpose of saving or at least preserving human life but none of us had yet laid eyes on a single living patient. The longer class went on and the closer we got to finishing and heading out into the real world to treat real people, the more this began to weigh on my mind. The word trauma was absolutely terrifying and conjured up images of flashing lights and motorists dying on the side of a highway. Yes, I knew the buzzwords and the techniques but I had no idea if I’d be able to translate that information into the practical skills that actually save lives.

All that changed one day when our instructor walked into the classroom and rather cavalierly informed us that before finishing the course and being released to take the National Registry Exam – passing which allows you to work as an EMT anywhere in America – we had to ride on an actual ambulance. And see actual patients.

This was as thrilling as it was nerve-wracking. Our instructor had arranged for us to ride with Grady EMS, the 911 provider for the City of Atlanta. Grady EMS is part of Grady Hospital, one of the largest public hospitals in the southeast and a place known the world over for having first-rate trauma care. A reputation, of course, that was earned the hard way.

Grady Memorial Hospital looms large in Atlanta’s consciousness. It is a place of horror stories and ghost stories, of lawless halls seen only by the poor, the crazy and the critically ill. My first view of it came in the dark of a November morning as I awaited the start of a 4am third ride. The giant lighted cross atop the 16-story building glowed red in the dark sky, and steam from a pair of smoke stacks slowly rolled out like a blanket of fog, softening the orange glow of the street lights.

The original hospital still stands, as do a handful of other nineteenth century buildings and between the fog from the steam plant and the crumbling, century-old buildings, a large moon in the otherwise empty sky, the whole thing resembled to my wide eyes a scene from Jack the Ripper’s London. Somewhere in the distance a lonely siren wailed.

The knowledge that at any second, without warning, you will be called upon to deal with an emergency creates an anxiety which, if you stick with this long enough, is eventually reduced to a low-grade form of nervous anticipation. But in the beginning, for me, the thought was all-consuming. Waiting for the crew I’d been assigned to, I paced back and forth, wondering what I’d see, what I’d be asked to do and how I’d respond. Once they arrived things began to move very quickly and before I knew it, before I was ready, I was sitting in the back of an ambulance rumbling through the heart of a sleeping city.

All ambulances carry the same smell, a dizzying cocktail of disinfectant, plastic and diesel fuel tempered by the menagerie of scents leaking in from the outside world. But there’s something else, a smell you can’t quite put your finger on and, in truth, doesn’t even exist. It comes not from any physical source but from the knowledge that people have sweated, bled and died in there. This knowledge that so much has happened in so small a space will immediately dispel the notion that those who die in violent or sudden circumstances forever haunt the site of their demise. An ambulance, at its most spacious, is a ten-square-foot rolling memorial to the suddenly and tragically dead. How many have slipped away in any one of them is simply unknowable and yet not one story exists of lonely and angry specters rattling chains or whispering threats to frightened paramedics.

That said, the crew I was assigned to that day were specters in their own right and had Charles Dickens been there he may well have called them the ghosts of EMS Past. The job has changed a good deal over the years and Pike and Wooten came up in the brawling Wild West days when Atlanta was the murder capital and surviving the daily parade of shootings and stabbings required a hard-bitten and ruthless approach. Pike was a wiry, rangy guy with a thick goatee straight out of the Civil War who chain-smoked cigarettes, pounded coffee from a beat-up silver thermos and had the manic energy of a guy who never slept. Wooten was silent and bitter, his thickness a testament to the poor diet so common among public safety workers. While Wooten sat silently in the passenger’s seat, Pike drove like a madman, talking without stop, without prompting. “This whole area, everything you see,” he said, waving his arm indiscriminately at everything we passed, “fucking shit hole. I hope they raze it all.”

The shithole he was referring to was an area known locally as The Bluff – five square miles of drug houses, flop houses, abandoned buildings co-opted by the homeless, drugs, violence, desperation and the constant woop-woop of sirens. The Bluff is Atlanta’s answer to Compton, to Chicago’s Southside and to the Heartland’s countless and nameless meth-riddled trailer parks. It is where all of Atlanta’s heroin is sold and most of its crack is consumed. People here live in aging projects or derelict bungalows and, Pike said, when they weren’t getting into trouble they were calling 911.

“And for no damn reason at all,” Pike said, stomping on the gas and tearing open the air with a long, loud burst of siren. “Wake up, motherfuckers!”

My father-in-law spent a year of his life in Vietnam, an experience that has affected him deeply and about which he is generally tight-lipped. There are some topics, however, he is willing to discuss, one of them being the futile efforts of the 1960s-era Army to prepare its conscripts for jungle warfare. For instance, he loves to tell you how he trained with an M-14, never even laying hands on an M-16 – the weapon with which he was expected to win a war – until after he was already in Southeast Asia. And he’ll laugh as he describes the WWII-style combat tactics taught to him by his drill instructors, men who’d never seen a jungle and who never once addressed the unique difficulties and strategies of jungle warfare. Any skills he’d eventually acquire for keeping himself and his friends alive would come from the war-weary nineteen-year-old kids who’d gotten there a week or two before him.

EMS training is nowhere near so inadequate but the very nature of practicing medicine in streets or bathrooms or living rooms or elevators or construction sites, renders obsolete many of the rigid procedures drilled into our heads during school.

That first morning, while Wooten napped in the ambulance, Pike chain-smoked cigarettes and rattled off a list of techniques learned in school that were not only poorly-suited for the streets but could, in some cases, get me or my partner hurt. As he spoke, flicking ashes and pacing back and forth, I felt like Charlie Sheen in Platoon – a crumpled and useless FNG watching Willem Defoe dig through my backpack and discard all the items I didn’t need and which would only slow me down.

“Backboarding,” he said, referring to the practice of strapping patients with suspected spinal injuries to a long, hard board. “Do it like they show you, straps running crosswise over their body? Fuckers’ll slide right out.”

“Slide out?”

“What happens when you got them strapped like that and you try carrying them down stairs?”

“They slide out?”

“They fucking slide out.” A heavy drag, a long, languorous exhale. “Run those straps between their legs and crisscross them over their chest. Fuckers aren’t going anywhere.”

On and on it went, my head spinning as I tried to collect and organize all of the advice into its appropriate mental folder.

“When it comes to fighting patients you—”

“Wait, what?”


“Fighting? You said fighting?”

He laughed. “You think all these fuckers are glad to see you? That they’re gonna hop on out to the ambulance for a quiet ride to the hospital? Think again. Four, maybe five times a year I end up in full-on brawls.”

I asked what would cause someone who, presumably, had called for my help in the first place to attack me upon arrival. Pike shook his head as though I was almost too dumb to help then ticked off a list that included seizure patients, drug overdoses, violent psychs, drunks, head injuries, pissed off family members and those who, for no good reason, were simply pissed off at the world and to whom I represented a great place to start exacting revenge. It was all how I approached them, Pike said, the way I asserted my authority – a tricky blend of rigidity and leniency – where I drew the line and what I did the moment they crossed it that would determine the direction these calls would take. “Handle it properly and you’ll be fine. Fuck it up and you’re in for a long afternoon.” He grabbed a pack of patient restraints and asked if I knew the proper way to restrain a patient. I shook my head and just as he was opening the pack we caught our first call.

“We’ll deal with that later,” he said, tossing the restraints back on the shelf.

People often wonder how it is that we deal with the sight of critically injured patients, how we are able to move beyond the grotesque and set our minds to the task before us. The answer I give is that it’s one thing to see someone hit by a car and have to watch, helplessly, as they bleed on the sidewalk. It’s another thing altogether to show up in an ambulance with the equipment, experience and knowledge to get that person help. There is also a time-space thing at work, where empty-handed witnesses have nothing to do but focus on the horrific details. We, by contrast, can occupy our minds with the long list of tasks that need tending to prior to our arrival at the hospital. Typically it isn’t until the whole thing’s over and the patient is in the hospital and out of our care that we even begin to consider what had just happened. The result of this is that things move much more quickly for us and twenty minutes pass by like two, while for the bystander each second ticks loud in their head, time moving excruciatingly slow.

These factors combine into a defense mechanism of sorts and allow us to finish a call and head straight for lunch. On that first morning, as I watched from the close and inescapable confines of an ambulance, my inexperience put me in the unique position of being both frightened observer and busy rescuer. It also made me utterly useless. There are countless reasons why work in an ambulance, no matter how critical the patient, is almost always a two-person job, not least of which being there simply isn’t room for a third person. Toss in that extra body and you get in each other’s way and, more importantly, on one another’s nerves. Attach, then, to this third wheel a complete ignorance of what he should be doing and you see why most medics hate third riders. I’m not sure Wooten even knew I was alive but Pike’s willingness to deal with me certainly began to fade as the day wore on.

For my part, I was mesmerized. We picked up a child with a fever, dropped off a woman with abdominal pain and bandaged a man who’d been sliced open by his girlfriend during a domestic dispute. Twice. The first time we dropped him off at Grady he stayed long enough for them to stitch half of his wound before leaving. Naturally, he headed straight home and resumed beating his girlfriend. The second time he was transported by the police and as I bandaged his still-bleeding arm, his girlfriend poked her head out of the back window of a police car and pledged her undying love for all to hear.

The day continued like this, calls going out in projects and high-rises and on the litter-strewn shoulder of I-85 until mid-afternoon, when we finally got some downtime. There are no breaks in EMS, no lunch hours or nap times and when it’s busy there’s scarcely a spare moment to use the bathroom. So you eat what you can when you can. That afternoon we ate greasy chicken from a fast food restaurant whose health rating couldn’t have been higher than 80 and then immediately fell into a stupor. The cool morning air had finally warmed up and we all became sleepy and content and as I sat alone in the back of the parked ambulance I drifted off to sleep. I was floating somewhere in that half-dream, half-awake state where the real-life sounds around you become part of your dream when the ambulance suddenly started moving.

“We got a call,” Pike yelled.

I hadn’t yet shaken off the fog of grease when the ambulance jerked to a halt and, for the first time that day, I heard Wooten’s voice.

“Holy fucking shit.”

There are strange things that happen in the world and one of them happened that afternoon. A man none of us had ever seen before and would never see again had spent the previous night binging on an interesting cocktail of drugs known as a speedball. A speedball is a mixture of cocaine and heroin – one drug to cut the trail for you, another to send you down it. Heroin being what it is, calms while the cocaine fuels.

The problem is that the heroin has a shorter lifespan than cocaine and so, out of nowhere, BAM! Your smooth and mellow, yet inspiringly vivid, high suddenly becomes all sweat and frustration and grinding teeth. Generally speaking, heavy users don’t deal well with this transition. Our patient certainly fell into this category and, after his buzz turned sour, he spent the afternoon homicidally racing his car through the streets before running down a ravine and crashing into a tree.

He’d hopped out before our arrival and so we found him, confused and combative, running around the street. The sight of a big, sweaty, drugged out lunatic running through traffic wasn’t what caused Wooten to finally speak, however. For a medic who’d been on the street for a decade, that alone would’ve been somewhat routine. What stood out immediately as cause for, if not concern then at least his first verbal reaction of the day, was that the man had broken both of his legs below the knees. Badly. Your lower legs are made of two bones. The larger of the two, the tibia, is essentially what holds you up below the knee. The fibula is smaller, runs parallel to the tibia and is what you feel when you reach down and grab what’s referred to as the shin bone. It’s not all that uncommon for these bones to break but it is uncommon for those thus inflicted to walk, let alone run. Our patient, strung out on the souring effects of a speedball binge, didn’t seem to notice his legs were broken. Hence the running.

And it was this running, or rather the resulting injuries, that caused Wooten to shout. When the man had gotten out of the car, the broken bone ends immediately poked through the skin so that now, with each step, the upper and lower sections were jutting out in a grotesque sort of crisscross pattern. I stood next to Pike and Wooten in front of the ambulance – heart-pounding, pupils dilated – partially horrified, partially hypnotized and totally unsure of what to do. Wooten swore under his breath. Pike spat in the street. A passing car honked. And then it was on.

Pike hopped up in the ambulance and grabbed our box of narcotics and a syringe. As I watched, he drew up five milligrams of versed and another five milligrams of haldol, a potent mixture of sedatives that rarely misses its mark. With me following close behind, they slowly approached our patient in much the same way a zookeeper might approach an unruly bear. When the guy saw us coming he turned and ran back into traffic and the world was instantly drowned in a flood of squealing rubber and blaring car horns. With nowhere to go, he turned back toward us. For an instant we froze. In that tiny space of time, certainly less than a second, he sized us up like a cornered bull and decided we presented the path of least resistance. Pike and Wooten quickly recognized what was happening. I was a little slow in arriving to the party.

They both jumped out of the way. Not me. I stood frozen as the patient – wild eyes, hulking mass, broken and scissoring leg bones – charged me. I’d like to say it all happened in slow motion but it didn’t. It happened so fast I never reacted. Steps before the guy plowed me over, Wooten, much more agile than his rumpled largesse suggested, appeared out of nowhere and knocked him down. Pike piled on top. I stood watching as the three of them rolled around until Pike screamed out in pain, wailed the guy with a wild elbow and yelled, “Grab the needle!” Somehow in the tussle he’d dropped the sedative and it was now out of his reach. This, finally, snapped me out of my daze and I grabbed the syringe, popped off the top and, with Pike’s direction, jabbed it into the man’s ass.

Then I backed up. Pike and Wooten slowly untangled themselves from the patient and watched as the drugs worked their magic. Within seconds the patient, still flat on his back in the middle of the street, was snoring. Pike grabbed the stretcher and the three of us snatched him up and loaded him into the ambulance. Once the doors were closed, Pike and Wooten exchanged a wary glance and laughed. It had been ugly but they’d gotten the job done. Wooten took out a pair of scissors and cut off the man’s pants to get a look at how much damage he’d done to his lower legs while Pike and I set to work on tying restraints.

Tying someone’s hands and feet to a stretcher with soft restraints is as much art as science, with special consideration needed for different patients. If they’re strong, for instance, you want to restrain one arm at their waist and the other above their head, thus separating their major muscle groups and making it that much harder to break out. You also need to be careful about what type of knots you tie.

To this day I know very little about knots other than that the type I tied that day should never be used to tie a patient’s hands. But, as is so often the case with acquired knowledge, this is something I had to learn the hard way.

Back in the ambulance we had the patient’s legs stabilized and bandaged, his vitals checked, IV lines running and – we thought – the restraints securely fashioned, so we started for the hospital. Pike was behind the wheel and Wooten and I sat in the back observing that awkward silence usually reserved for perfect strangers in an elevator. One thing about sedatives is they affect each patient differently and you never know how yours will act until after you’ve sedated him. If, for instance, a patient has been given that particular combination of drugs before he’ll have built up a tolerance and they’ll either last a shorter period or simply sedate him to a lesser extent. Other complicating factors exist, of course, including what else your patient has in his system. Large amounts of certain drugs, cocaine being among them, simply make it hard for sedation to truly set in. And so, after a few minutes on the road, our patient began to stir.

In reality, this isn’t all that uncommon and generally it’s not much of a concern if your patient has been properly restrained which, as I’ve alluded to, ours wasn’t. So I sat on the bench seat and watched this rather herky-jerky reanimation process with a pit in the bottom of my stomach. It was the very same feeling I got as a child while helping my step-father in the garage. He’d be underneath the car when suddenly oil would begin pouring out and in his fury he’d scream for me to hand him something in a voice so garbled by the car and the excitement that I wouldn’t be able to understand him. I’d freeze knowing that at any second, madder than ever, the problem worse than before, he’d poke his head out only to find me standing there empty-handed.

“Uh…he’s coming around,” I said after the patient opened his eyes.

Wooten shrugged. “He’s tied down.”

My hands began to sweat as the patient twitched, then jerked, a wild animal caught in a snare. He turned to me and shook his head in fury, then flopped back, sat up, kicked his legs and blew out a lungful of hot anger. Breathing heavily, he lifted his head and pulled against the restraints. His right hand, the one Pike had tied to the stretcher near the patient’s right ear, didn’t budge but the left hand, the left hand was clearly a problem. Already it was loosening and when he ran his fingers over the shoelace-style knot I’d tied it was clear all he’d have to do is tug on the right strand and it’d unspool. The patient and I locked eyes, both of us coming to the same realization at the same time, and I swear he smiled. Maybe he did, maybe he didn’t, but before I knew it he was untying the knot.

I yelled for Wooten but it was too late. Before either of us could react, the patient had freed his left hand and was reaching for the right. Wooten, again surprising me with his feline quickness, grabbed a sheet and yanked it hard over the patient’s face, if not fully restraining him then at least blinding him. Feeling useless following my knot-tying failure, I jumped up and tried to grab his free arm when a paralyzing pain shot right through me – the patient, half-restrained, partially-sedated, a little bit blind and totally out of his mind – reached up and grabbed my nuts.

It’d be nice to say I reacted firmly. That I endured the pain, swatted away his hand and set to work on regaining control of the situation. That would be nice but the scream I let out – terrified and desperate and too high-pitched to be mine – says otherwise. I don’t remember Pike stopping the ambulance. I don’t remember him getting in the back and properly restraining the patient. I hardly remember the trip to the hospital. What I do remember is a blinding, searing pain and my long, quiet period of huddled convalescence.

At some point we dropped the patient off. At some point we went back out and ran more calls. At some point the day ended and I went home and whatever I told my wife or my classmates of that first day was, in all likelihood, edited for content. Did I claim to be a hero? No. But did I own up to the scream? I doubt it.

Of course, there were other third-rides, more classroom hours. More quizzes and, in December, the national registry exam. I did fine on my rides, took the quizzes and passed the exam. I received my EMT certification in the mail and was prepared to begin my career. But I did all of those things with the knowledge that knots are knots, patients can turn on you and when all hell breaks loose, I’ll get the job done – but I’ll scream like a girl as I do it.

Friday, September 3, 2010

The Innocent Don't Run

Strange things go through your mind when you watch someone get shot. Matters of life, death, vengeance, punishment, redemption and mercy all swirl around in the blurry stew that is your sub-conscious mind.

For instance, you will recall in those first dizzying moments the old saying that there's no such thing as an innocent victim. That somewhere between crime and punishment reside certain truths, wrapped as they are in mystery. The lone man – whatever his intentions – who runs into trouble on the wrong side of town knows this all too well.

But it's not until it's all over – when the dust has settled and the blood has dried – that your thoughts turn to the aggressor. You will wonder, perhaps for the first time in your life, if, just maybe, the victim got what he deserved.

Bearing witness to violence raises a lot of questions and I’m not sure I have any answers. What I do have is a story.

It all started in a K-Mart parking lot. Understand, the store in question isn’t as classy as your typical K-Mart. And I say that with all the reverence of a man whose first job was running a cash register at one of these fine places. Trust me when I say you haven’t properly rung in the Fourth of July until you’ve had a monstrously fat woman hand you a soggy twenty that had spent the afternoon wedged between her bra and left breast.

Anyway, I was sitting in the parking lot eye-balling whores. One hundred percent true. The K-Mart on Cleveland Avenue resides between the interstate and a worn-out crack motel called the Palace Inn. Believe me, I have been to some places. Dirty and dangerous, rank with the stench of death and desperation, but I have rarely been somewhere as bad as the Palace Inn. But still, the whores there had a good deal. Situated as it was near the highway, all they had to do was wander around the parking lot and wait for the depraved, and a smattering of truckers, to come calling.

And they did. Day and night these skinny, worn-out white women would wobble down the hill, pick up a John, lead him up to the Palace Inn and then return, thirty minutes later, for another round. I couldn’t get enough. I’ve spent hours watching this parade of second-hand sex march on by, all honking horns and dancing clowns, happy as can be.

The downside to whores, of course, is that they attract the unsavory.

Drugs, drugs dealers, drug users and those who understand that, just as smoke precedes fire, money precedes drugs.

So I was sitting in the parking lot feeding stray dogs and bearing witness to the decline of an entire segment of the population when two men began arguing. I’d been vaguely aware that someone in overalls was standing about twenty yards to our right but paid him little mind.

I paid him even less when the argument started. Mainly because arguments, or at least the injuries they create, make up a huge part of our day. Say two guys are remodeling a house. Neither is making much money, both have marital problems, drinking problems, drug problems and one guy drops his end of the piece of plywood they’re carrying. An argument ensues and one of them pulls out a box cutter and slashes the other across the chest.

Or, perhaps, it’s two drunks hanging out at a liquor store. Best friends, known each other all their lives, when an argument starts over a lotto ticket or a half-finished pint of gin and before anyone knows it someone’s been slapped over the head with a hunk of concrete.

In both cases the loser will throw up his arms, his face streaked with tears, and claim to be an innocent victim. Will I help him? Naturally. Will I feel terrible for him? Probably not.

And anyway, it’s best to keep clear of arguments in-progress. Tammy and Darryl taught us that. So, my partner and I were talking when we heard a soft, harmless POP. Movies have given you the wrong impression. Guns, with the exception of really big ones, do not sound as though they’re firing a chunk of molten lead capable of ruining or even taking your life. They sound, well, harmless. So much so that even though I saw it, I still turned to my partner and said, ‘Did he just shoot that guy?’

The answer to that question, by the way, was yes. The guy in overalls, the one who’d been standing not twenty yards to our right, had shot the second man. Right in the throat. There was a brief pause as I, my partner, the victim, hell even the damn shooter, all froze as though trying to process what had just happened.

Finally the moment passed and the victim, in a funny, hobbled sort of way, started running. I turned to my partner. ‘Where’s he going? He got shot. Where’s he going?’

You would think, given that we’re an ambulance and probably exactly the sort of help he was hoping for that he’d be running our way. Nope. He was running sort of willy-nilly across the parking lot. Left hand over his throat, right hand flailing out to his side, he darted past the exhausted whores and the horny Johns, totally unnoticed by everyone except the stray dogs who in their weird animal kingdom way knew something was definitely wrong.

I knew, obviously, that we should be helping this man but our status as witnesses to the crime opened up a whole new world of possibilities. Mainly, would the shooter try to shoot us? I have a friend who worked for years on an ambulance in Compton. Of all places. Compton, home to Snoop Dogg and Ice Cube, birthplace of gangster rap – which, I’d like to say for the record is far superior to the Puff Daddy-inspired sample-happy crap that came around in the mid-90s. Compton, even real estate agents admit, is a bad place.

Anyway, my friend said one night he and his partner were driving around when they stumbled upon a guy who’d been shot. Being paramedics, they hopped out and were getting ready to start working the guy when a voice from the shadows said, ‘Y’all best let that motherfucker die.’ They quickly hopped back in the ambulance, drove off and radioed dispatch to have the police come and investigate a murder.

I myself have spent tense moments barricaded inside an apartment while an angry boyfriend pounds on the door trying to get in and finish the beating his girlfriend so rudely interrupted when she cracked him with a pan and fled to a friend’s place to call 911.

As we watched the victim flee, it was my partner who first raised the question.

‘Why do you think he did it?’
I laughed. ‘Hell, I’d run too.’
He shook his head. ‘The shooter, I mean.’

Quite frankly, until that moment I hadn’t even considered motives. There are, I’m sure, a million reasons to shoot someone but it seemed to me at the time there were more pressing questions – just how far our future patient was going to run pretty much topping my list. Not so for my partner.

It was all strange me to me. ‘Which part?’
‘Look at him. He’s not even running.’

By ‘him’ he meant the shooter and sure enough, he wasn’t running. He simply tucked his little .25 back into the bib pocket of his overalls and took a seat on the back bumper of his van. This, if you’re keeping score, is the cue we needed that our intervention wasn’t likely to draw any fire so we put the truck in gear and eased across the parking lot.

As we pulled up alongside the patient I unrolled the window and entered into one of the strangest conversations I’ve ever had.

‘Hey buddy. How, uh, how you doing?’ Come on, what do you say to a guy who’s been shot in the throat and is running for all he’s worth across a parking lot packed end-to-end with scrawny crack whores and jittery sex-starved truckers?

Evidently, you say nothing because he gave me a single glance – sort of a cross between thirsty man in a desert and cornered possum – and kept on running. I turned to my partner who just shrugged. I leaned out a little further.

‘How far do you plan on running because I’m really thinking we should get you in here and get you some help. Maybe even take you to the hospital. You know, being shot and all.’

He turned to me now as though seeing me for the first time and finally stopped. I’ve never knowingly been in the crosshairs of a rifle but I can imagine what it’s like. There was a strange tingle at the base of my neck as I stepped out and grabbed the patient’s arm. Somewhere not far behind us was the man who’d shot this guy and for all I knew he was presently drawing down with his .25 – a gun if not exactly feared for its earth-shattering firepower, known the world-over for being woefully inaccurate.

We quickly hustled him into the back of the ambulance and began conducting what you’d call triage. Basically all that means is you give the guy a once-over, identity life threats and determine which one poses the biggest threat. His wound being straight in the throat and an open and working airway being the most important part of maintaining a living patient, we didn’t have to do much triage. After a little poking around I learned the bullet had passed through his throat, just below and to the left of his Adam’s Apple and exited through his right shoulder blade.

‘Do you feel you can breathe alright?’
He nodded.
‘Can you talk?’
Another nod.
‘Can you do it? Just so I can see?’
‘Yeah.’ A little breathless, maybe a little desperate but he had been shot in the throat.
‘You hurting anywhere else?’
‘Okay. What happened?’
‘Fucker shot me.’

Seriously? That’s what you’re gonna say? I think, of all the variables, that part we got.

‘I know but…why?’
‘No fucking reason. Shit, I was askin’ him if he needed some help and next thing I know he shoots me in the neck.’

Perhaps not the most plausible explanation but people have done worse for less. Years ago I was called out to a house late at night. Since people tend to get squeamish when talking about injuries to children I’ll spare you the details but I will say that when it was all over I walked out of the children’s hospital to find my partner – a man with over a decade of EMS experience – standing quietly in the parking lot. He was staring off to the east, smoking and watching the first blue streaks of dawn creep into the sky. After a minute, he flicked his cigarette across the lot, turned to me and said, ‘There are some brutal motherfuckers out there.’

Though our patient was breathing and talking and appeared to be, all things considered, the luckiest person alive, I figured it best to get him to the hospital sooner than later. My partner nodded and soon we were rumbling down the highway, weaving around the afternoon traffic with the sirens blasting as I cut off his shirt, checked for other holes, listened to his breath sounds and started an IV.

A few minutes later we were in the trauma bay where chest x-rays proved what we had already suspected – despite being fired into our patient’s throat at pointblank range the bullet had somehow missed not only the numerous vessels running up and down his neck but also his rather large and incredibly important trachea.

Medically speaking, the questions had been answered. Practically speaking, nothing had been answered.

Who was he and what was he doing there? Did he live in the motel? Was he a pimp, a John, an addict or was he just a guy who showed up at K-Mart hoping to grab something on blue light special only to get shot in the neck?

Why was he shot? Who shot him? And did he really not see the ambulance?

I was unsatisfied.

As we headed outside I saw a cop car pull up near the ambulance bay. The cop got out and wandered over, casual as can be, and said ‘You guys just bring in a shooting from the, uh, you know, K-Mart?’ Yup. He started to ask if the guy was gonna live, what his name was. Blah, blah, blah. I wasn’t having any of that.

‘Did you catch the guy who shot him?’
‘I’m not sure catch is the right word. He was sitting there waiting for us.’

But the cop was just as impatient to get answers to his questions as I was and continued on. I followed him.

‘What happened?’
‘Guy says he was standing by his van when your friend came wandering down from the Palace Inn and tried to rob him with a screwdriver.’
‘A screwdriver?’
‘Yeah. So he shot him.’
‘Yeah that part I got. Did he say what he was doing there?’
‘Say why he didn’t run?’

At this the cop finally stopped walking. He turned to me with a look that suggested I was perhaps too dumb to understand, but he was willing to try anyway.

He said, ‘You don’t run if you’re innocent.’

After that he disappeared. No doubt he headed straight into the trauma bay and slapped a pair of handcuffs on our patient.

My partner and I got into our ambulance and drove off but the whole thing kept swirling around in my brain. The whores, the shooting, the victim running away while the perpetrator casually tucked his gun away and awaited the arrival of the police. The stray dogs who from the very start had identified the victim as the guilty party.

I’ll never know why that man was at the K-Mart. Maybe it doesn’t matter. Someone tried to rob him and he did what so many of us have wanted to do so many times – he took the law into his own hands.

Was he guilty? I don’t know. But he sure as hell didn’t run.

Friday, June 25, 2010


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 entrĂ©e 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.


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.