streetstoriesems

The career archive of a NYC paramedic

Non-Viable

April 22, 2024 /

Many people famously ask paramedics and EMTs “What’s the worst job you’ve ever had?” There is usually never just one job and it’s often not the kind of thing non-EMS people expect. It’s rarely about gore and mangled body parts but it does often involve severely tragic circumstances.

This story, about one of my ‘worsts’, stands out because it was entirely unnecessary, in my opinion. It was also peppered with several ‘firsts’ for me, which helped in locking it into permanent memory.

The young woman who answered the door was cheerful as she welcomed us into her tidy, well-decorated home in a run-down, derelict building. Her apartment was cozy and comfortable, painted in muted hues of sage and sienna with contrasting moldings. Throw pillows embroidered with phrases like “Live and Love”, “Have a blessed day!”, and “Home is Where the Heart Is” could be found on every seat. Interesting art was arranged in eclectic collections on her walls. We walked past a bureau where a large wedding photo was prominent, showing that she was married to a much older-looking man.

“I did it all myself!” she said proudly after we complimented her surroundings. “The general rule here is that if I didn’t find it, I made it! I like to paint and shop at thrift stores. I also made the pillows and reupholstered the furniture.”

We thought she would jump into the reason for her call to 911 but she went on about her accomplishments regarding the decor. My partner and I were both impressed by all she had done. It said a lot about the tiny woman in front of us to have made such an interesting living space in such a decrepit building. 

We noticed that she kept a protective hand on her abdomen as she moved around. When she saw us looking, she told us she was a little over four months pregnant with her first pregnancy. We congratulated her and she quickly showed us the baby nursery she had set up for the impending newcomer.

The same dedication and creativity she had utilized for the rest of the apartment had also been put into the baby’s room. It was a pale yellow with cartoon animal stickers on the walls. Empty shadowboxes were hung up on them as well; each waiting to be filled with first shoes, a favorite rattle, and locks of hair. The crib had been found on a street corner, in the trash, she said. She’d fixed it herself and painted it to blend with everything else.

As she pointed out details of the room, she suddenly bent over in pain. She became unsteady and we helped her into a comfortable chair where she curled up, clenching her fists and squeezing her eyes shut.

“When you’re ready,” we told her, “please let us know what is going on.”

“Well,” she said hesitantly, “the first thing I need to tell you is that we HAVE to go to St. John’s.” 

Immediately stipulating a transport hospital is off-putting to most of us in EMS. Aside from relegating us to taxi drivers, it immediately impedes our interview process. We can’t grant certain requests without knowing whether a specialty center may be needed or if the desired hospital is diverting patients. The information for an informed transport decision relies on the current needs of the patient but a variety of other factors as well. In general, however, if the patient is receiving pre-natal care at a specific hospital it is almost always where we will take them.

We told her we could probably accommodate her request, depending on the underlying problem. St. John’s was a bit of a distance, but not entirely unreasonable. It was unusual, however, because she lived near two larger, highly renowned hospitals. Those larger hospitals were often requested by patients who lived near St. Johns, which was frequently described as a ‘shithole’ by our amateur reviewers.

Relieved that her choice would probably be honored, she told us her husband would be meeting us there and that she’d had a few bad experiences at the larger facilities. She said that incidents at these other hospitals had been connected to her current complaint.

She told us her pregnancy was “high risk” and that most doctors didn’t seem to be familiar with her unique set of complications. 

“That’s why I need St. John’s,” she told us. 

As my partner took her vital signs, I asked her the usual pregnancy-related questions: last menstrual cycle, anticipated due date, and the like. She told me there were papers on the desk in the living room from her various exams and hospitalizations that might be helpful in understanding what was going on so I went to retrieve them.

On the desk, I found a folder with the words “Baby Beginnings” written in beautiful calligraphy on the cover. When I flipped through the paperwork, I became perplexed and unsure of how to proceed.

She had discharge papers from almost every hospital in the borough. Each of them proclaimed that her pregnancy was ectopic and lodged near her ovary.

Ectopic pregnancies occur when the fertilized egg attaches itself to an area outside of the uterus. Usually, they become stuck in the fallopian tubes on the way to the uterus and remain there but they can also attach themselves in the abdomen and even, rarely, in the ovary.

Ectopic pregnancies are not “high risk”, they’re not viable.

An ectopic pregnancy will never result in the birth of a baby and no procedures exist to change that outcome. The improperly implanted embryo needs to be removed or the mother’s life becomes at risk should it burst.

The paperwork in our patient’s file attested to the critical need to remove the ectopic embryo. In capitalized and underlined words, the doctors had clearly advised our patient of this diagnosis and the urgency with which to proceed with surgery, especially given the advanced progression of the condition. They expressed alarm and dismay that she was disregarding their advice for “religious reasons”.

There was even a legal document in the pile, from one of the hospitals, advising the patient of the expected consequences of ignoring their recommendations and relieving the hospital of any litigation when (“not if”) that occurred. The patient signed it, and all the other AMA (Against Medical Advice) documentation with not only her name but also the words “In God’s name all things are possible.”

One of the doctors from one of the larger hospitals she refused to go to had written beneath her statement: “GOD KNOWS THIS ISN’T A VIABLE PREGNANCY!”

I brought the file back to the nursery with me to find the patient, again, doubled over in pain. She was holding the hand of my partner and they were praying together. 

The man I was working with wasn’t my regular partner but I considered it a somewhat divine intervention to have him here with this patient. I knew he was a man of faith who went to church regularly and read the Bible in his spare time. Perhaps, a like-minded believer could persuade her to save her life by removing the ectopic pregnancy. I was, of course, naive in not considering that it was a tactic that had already been tried by the chaplains who worked at the various hospitals she’d been to.

When the painful episode had passed, I watched as our patient studied my expression to see what I thought of everything I had read.

I didn’t exactly know what to say. This was a somewhat unusual situation I had never encountered before. If I simply reiterated what the doctors had already told her she wouldn’t trust my opinion and probably would shut me out of any confidence or assistance. Hopefully, I thought at the time, my partner would be successful in convincing her to take care of this life-threatening condition. He was a man of faith who also understood the gravity of the situation. I was sure that if she heard his faith-backed advice, she would acquiesce.

In the meantime, I merely stated rather sheepishly, “It seems all the doctors have come to the same consensus.” 

“Those so-called doctors want me to KILL OUR BABY! They’re secularists who want everyone to have abortions! They have no faith! They don’t understand how miracles work!” she said bitterly. Her friendly smile had instantaneously evaporated, never to be seen again.

I handed the folder to my partner who quickly saw the words ‘ectopic’ and ‘non-viable’ and his smile also disappeared. He continued to read through the various forms and releases with growing concern.

“Ma’am,” he began slowly, “we have to get you to the ER right away!”

“Well, that’s what I called you for!” she said, rolling her eyes. “As long as we’re not seeing an abortionist, my baby will be OK.”

I decided that it would probably be a good idea to get moving. She wanted to go to the hospital, we wanted to take her. Let this new hospital try to talk her into the procedure.

After flipping through a few pages in her file, my partner, the holy grail of my hope, announced in an incredulous voice, “That baby needs to come out”.

I winced in resignation.

With no chance of the ectopic embryo ever coming to fruition, I felt the imagery that was invoked with the word “baby” made the situation worse. Her whole life was currently centered on awaiting the very thing he kept saying needed to be removed.

This sweet, friendly woman who transformed garbage into stylish home furnishings suddenly morphed into an entirely different personality. She became defensive and infuriated. My partner was not a man of God, after all, she proclaimed. He followed a false prophet and was working on behalf of the devil. Nothing would convince her otherwise.

I tried to change the subject by requesting another set of vital signs.

She agreed but would only allow me to do it. Then, she had another episode of extreme pain. I told my partner to set up the stair chair we would use to get her down all those steps. We wanted to get her out of there as soon as possible. 

At the time, I didn’t know what the likelihood of an ectopic pregnancy bursting at 17 weeks was but I didn’t want to be around if it happened. It turns out that at 17 weeks, she was overdue for a life-threatening event related to this rouge, fertilized tissue somewhere near her ovary.  

After what I felt was an excruciating long interval of securing all of the things she wanted to take to the hospital and putting her in our stair chair, I breathed a sigh of relief that we were on our way. Then, the phone rang.

Our patient was within arm’s length of the telephone and she picked up the receiver. Her husband was calling to be sure that we were taking her to St. Johns. He asked to speak with us.

Her husband had a heavy southern drawl, the kind that makes everything sound so friendly, even when they’re telling you off. He immediately thanked us for taking our wife to the hospital where “my two angels can finally get the care that they need”. 

“Sir,” I asked, “are you familiar with what an ectopic pregnancy is?”

“I understand that the baby hasn’t made his way to where he needs to be. Hopefully, with the assistance of our specialist at St. Johns, we can get the little fellow to the right place.”

“I feel there are unrealistic expectations that are keeping her in danger.”

The man sighed and seemed to be gathering up his patience with me. “Our expectation is to not have our child murdered.”

“Your wife’s life is in jeopardy,” I pleaded. “I’m sure your church has exceptions for this kind of thing.”

“Considering I am the head of my own congregation, I think it’s a bit presumptuous of you to decide what lives God wants to be saved or know what the one and true Almighty has in mind for any of us. God has blessed us with a beautiful future. Sure, he’s testing us with a high-risk situation but we are people of faith. We trust Him far more than the agenda of some of these so-called medical establishments.”

I was tired. I was frustrated. I didn’t understand their line of reasoning and I just wanted to get going. “Your wife’s life is on the line here, that’s our priority. Look, we have to go. Say goodbye to your wife.”

I gave the phone back to our patient who looked as if she was considering what I had said. She no longer appeared defiant and cautiously got off the phone.

Our carry-down went slowly but we successfully maneuvered down those broken steps and got her into the back of our ambulance. I was driving that day but I asked the woman if she’d prefer to have me with her and she nodded. 

Before we left, however, I asked my partner to assist me in putting on the MAST trousers. Anti-pneumatic shock trousers, or MAST were designed for cases of massive blood loss. MAST was a large device that looked like actual pants but could be inflated with an air pump. They worked on the premise of shunting blood from the extremities to where it was needed most: the heart and brain. They have since fallen out of favor but at the time it was a standard of care. I intended to have them on and ready should something happen.

Almost immediately after we began our drive to the other side of the island of Manhattan, our patient had another episode of severe pain. It subsided quickly but it was followed by another that caused her to cry out. She told me she thought she was bleeding. I opened the top section of the MAST pants to see a small red circle of blood on her pants.

I quickly took her blood pressure and was scared to see it falling. Her pulse was also racing and she was pale and sweaty. The change was faster than I could have imagined. This was a terrible situation and it had never happened to me before up until that point.

It wasn’t that difficult to inflate the MAST trousers, but the crashing of a formerly stable patient is extremely traumatic from a psychological standpoint, at least it was for me. Most of our calls involve someone who is stable or already in dire straits. Watching a person transition from the former to the latter is extremely distressing.

I told my partner in the front and he notified the dispatcher that we were diverting to the closest hospital, a trauma center, which happened to be one of the big, multi-specialty hospitals our patient had already gone to. I told her we couldn’t go to St. Johns and she didn’t seem too concerned about it.

“I’m going to die, aren’t I?” she said.

This was disturbingly chilling because even in my limited experience, I knew that when patients said things like this, they were often right. 

“We all are,” I told her.

“You know what I mean,” she said weakly. “I should have done it. All the doctors told me I’d never have this baby, that it was more like a miscarriage. I wanted so badly to believe that God wouldn’t do something like that to me.”

I didn’t know how to answer that. I just told her that it was good she was going to be treated quickly and that the hospital we were going to was excellent.

She gave me an eerie, subtle smile as if she were protecting me from a secret. Then, she simply said, “Thank you for everything. Tell your partner I’m sorry for what I said before and that I’m thankful for him as well.”

“You can tell him yourself,” I said.

For the time being, our MAST pants were doing what they were purported to do, which was raise the blood pressure. The hospital was less than a minute out. I thought we’d be OK.

We got to the ambulance bay where several doctors and nurses were waiting. At least one of them was familiar with our patient and knew what had probably happened.

Strangely enough, for a trauma hospital, there were several physicians who were not familiar with MAST trousers, probably because they were so rarely used. The protocol was to provide IV fluids and certain drugs that would raise the blood pressure before removing the air from them incrementally.

Unfortunately, that’s not what happened. In the generally hectic atmosphere of a trauma slot, the staff immediately began cutting away her clothes and also, our MAST trousers. The MAST pants had different sections and for a known pregnancy, even an ectopic one, we didn’t inflate the abdominal section. They could have just opened that part up and left the legs inflated, but they didn’t. The whole thing was quickly cut away and discarded, without an IV in place.

The woman’s blood pressure bottomed out, she lost consciousness, and within minutes the staff was doing CPR. They were never able to revive the woman.

It was difficult to unravel the emotions I felt at the time, and sometimes still continue to think about them. Seeing the life of a vibrant young woman extinguished is always a tragedy. I was both angry and extremely sad for so many reasons.

The husband made a complaint about us going to the ‘wrong hospital’ and tried to sue. I’m unsure how his lawsuits worked out but I had two days of pay taken away by the disciplinary arm of my agency. 

Our disciplinary department acknowledged that we had done everything correctly. We followed our protocols exactly and they even commended us for prophylactically putting on the MAST pants for the transport. They said they took issue with the way we didn’t honor our patient’s religious ideology sufficiently.

We argued the point with our union rep and I never felt they satisfactorily explained what we did wrong. It doubled the blow of this tragedy to be forced into a disciplinary hearing as a result of it, especially when, in their own words, we had done everything correctly. I went back and forth with the officials but in the end, it felt like I was David fighting Goliath only I didn’t have any rocks.

The Taxi Equivalency

April 12, 2022 /

[Please note that I am in no way an expert on billing or ambulance services across the country. This rant is just based on my experiences and the limited research I’ve done. Information on billing practices changes frequently and is something that should probably be addressed in the ongoing public debate about our healthcare crisis]

There’s nothing that causes a mass convergence to ambulances to a particular location faster than an interesting trauma job. It’s not the gory details that so many seem to assume is the appeal but the opportunity to do something worthwhile for a patient that encompasses the training and skills we are taught but do not often use.

Given the countless other calls we respond to, for the most mundane things that often don’t even require a cab, much less an ambulance, the chance to make a difference is at the heart of every adrenaline junkie. For every man with a limb caught in a machine, there are thousands of toothaches, cough/cold/flu, common rashes, headaches, and attempts to get a prescription renewal through the ER. It’s so incredibly frustrating to imagine how people will complain about waiting 8 minutes for an ambulance because they need to go back after an antibiotic they received (when you brought them two days before), has not cured their complaint yet but they will quickly jump into a taxi for something we can actually do something for.

Despite having a vague idea of what his daughter did for a living, my father drove himself to the hospital during each of his three heart attacks. He felt it an unnecessary expense. It’s not that he didn’t have insurance that would have covered the cost, he absolutely did. He just didn’t think that anyone should pay such outrageous prices, not even the large for-profit corporation he was paying 35% of his fixed retirement income to for his Medicare supplement. But this wasn’t some frivolous add-on as I desperately tried to explain to him.

The entire motivation to create paramedic units was to provide critical cardiac care, an area where timing is the difference between life and a diminished quality of life or death. A paramedic crew, in addition to providing provided pain relief and supportive care, could have evaluated his EKG to determine which artery was blocked and sent that information to a STEMI specialty hospital where he would have been sent to immediately clear the obstruction, saving valuable heart tissue. The necrotic atrophy he suffered as a result of waiting caused him to become a ‘cardiac cripple’, where the most basic tasks left him breathless and exhausted. Each subsequent infarction lost him more freedom, just because he felt $1,200 was too much for an insurance company to payout for a “ride”. [my dad lived in a different city but their ambulance services and pricing mirrored NYC’s almost exactly].

But insurance companies don’t work like that anyway. It’s not as if the bill says X amount and they send off a check for that exact amount. Their payments are based on a complicated formula agreed upon by the health care provider and the insurance company.

I remember the bill one of my patients, who had Medicaid, showed me. A municipal ambulance usually showed up at her door each time she called 911, which was fairly regularly, and we charged roughly $1,200.00, at the time. But one time she called, a contracted provider in our service took her to the hospital and that bill was over $2,000. Medicaid paid out $16 for us and $22 for the private hospital provider even though we were advanced life support and the private was basic life support. She was extremely upset by the disparity that she wasn’t paying for and wrote letters to Medicaid saying that we, the municipal providers, deserved the extra $6.

It’s another issue altogether, how calling the same number for the same service results in different prices, particularly when you didn’t specifically request one provider over another. I’m not sure how the different providers operating in the same 911 system, where calls are randomly assigned, can charge different prices. I can see their need for it, but it doesn’t seem fair for the average citizen who makes the call to 911 not knowing that the billing isn’t uniform.

Healthcare billing practices in general leave plenty of reasons to be anger inducing. Good luck trying to research how they come up with pricing and payouts. It’s a secretive system that lends itself to distrust and fears of corruption The only people who are generally charged the listed amount are people with no coverage, people who I can very much understand fearing the burden of an ambulance bill added on to an already massive ER bill.

I often see on social media posts (and my family and friends tag me to see even more) how ridiculous it is that an ambulance transport costs so much when a taxi is only a fraction of that expense. “We only went two miles!” and “I was charged $2,000 for an 8 minute ride!” The taxi equivalency is incredibly frustrating as it reduces our training and equipment down to a vehicle whose sole purpose is simply to get a person from point A to point B. If a taxi would have sufficed, you probably didn’t need an ambulance.

People with a hefty co-payment or those who fear having to make explanations and justifications to an insurance provider generally don’t use our service as a taxi equivalent. But many, many people do. It’s frustrating to be used as free transportion to the hospital for someone who will spend six hours waiting in an ER for a free bottle of Tylenol because they didn’t want to pay $6 at a pharmacy. It is especially heartbreaking when the call before it involved discussions with a different, critical patient over their very valid fear of an outrageous bill which kept them from getting the critical care you know they needed.

There was once a well-publicized shooting in the area I work, of a child hit by gunfire. To be clear, everyone races to a child in distress call. Units that don’t normally join in the rush towards trauma will run towards a critical child. Even though the first unit arrived less than three minutes after the shooting was reported (because many units monitor the police frequencies), the child had already been put in a neighbor’s car to be taken to the nearest ER. “He was hit by a bullet,” they said. “What were we supposed to do?” They also told us that “the neighbor works for Uber, so he knows where he is going.”

Sadly, the Uber driver didn’t know that the closest hospital wasn’t a trauma center, which is a place equipped to provide the immediate surgery critical to saving life from traumatic injuries. Pediatric trauma centers are another specialty altogether. All the hospital they went to could do for that child is provide the same kind of stabilizing care a paramedic unit was capable of (and would have done en route), and transferred him, by ambulance, to one of the few pediatric emergency rooms in the city. The delay was detrimental and tragic.

Hospitals are not all the same and while most provide similar care for most categories there are dozens of designated specialties that are unique to different facilities. Specialty centers go to great expense to maintain a detailed list of requirements for that specialty certification. Trauma centers, for example, are required to have an operating facility fully staffed at a moments notice. Keeping an operating room ready on stand by is an expense that most hospitals will not recoup from insurance payouts from individual trauma patients, it’s why there are so few of them. There are also specialty burn centers, stroke centers, cardiac catherization, limb replantation centers and several others. And there are no hospitals in NYC that have every specialty. Also, not all specialty centers are able to accommodate the constant influx of that specialty and will go on ‘diversion’ for that specialty should they become overwhelmed.

How would anyone know all this if they were in an Uber? They wouldn’t, but we would, thanks to a state of the art mobile data terminal that all ambulances in the 911 system are equipped with. It provides real time updates of availability and hospital acceptance.

How does a municipality pay for this, and the (pitiful) salary of the EMTs and paramedics using them, along with the thousands of dollars of monitoring equipment, supplies, communications (along with salaries of dispatchers and 911 call takers), the rotation of medications, vehicles and maintenance, facilities, software, and the thousands of other surprising things that go into a 911 ambulance? In part, by sending a $1,200 bill.

If you want to give yourself a headache figuring out billing practices, here are some links:

https://time.com/198/bitter-pill-why-medical-bills-are-killing-us/

The Predator in the Wall

November 23, 2021 /

This story takes place long before Killer, our station cat, moved in.

There was a large fire in my area and I was assigned as the Staging Officer. It was late into my tour, which meant I’d be stuck long after I should have gotten home. At one point during the incident, a firefighter, holding a box, moved past at least eight other EMS people and handed it to me. There was a cat inside, he told me, and he hoped I could take care of it.

I will always wonder why this stranger gave me, of all people, the cat. It’s as if he knew I had a bag of cat treats in my command car and cat food in my locker.

I brought the cat to the command car and slowly opened it. Inside a pair of wide eyes glared at me in fear. The all-black cat blended into the darkness of the box. I dug out my cat treats and dropped a few in the box. I also cut down my water bottle to make a little bowl out of what was left in it. The cat looked OK, no burns or breathing issues. He let me pet him cautiously. I tried to reassure him with the soft, cat baby talk that makes my own kitties know I’m wrapped around their manipulative, fluffy paws.

I closed up the box again, poked a few holes, and resumed my location at the fire as I tried to figure out what I was going to do with kitty. Taking him home was not an option. My house was already overflowing with furry and feathered housemates as a result of my terrible record of keeping animals ‘temporarily’ until other situations materialized.

It was an early Saturday morning and any rescues I knew of only had their answering machines on for the weekend. I was exhausted, had to be at work again in a few hours, and didn’t need a new project added to my day. I decided to bring him to my station, set him up in one of our large, empty storage closets, and postpone my rescue mission until the next day when I would be off. I let the day supervisors know of my plan and put a note on the door warning of the small predator inside.

The closet I put him in was a meter room. It was about 5 feet x 5 feet and the only things in it were meters mounted on the left wall and some pipes in various places. The pipes and tubing were mostly thin and vertical and the meters were at least 5 feet off the floor. The room could only be accessed with a key on the lieutenant’s key chain.

I didn’t see the point in telling our new captain of this small development because the cat would be gone before she came back in. I rationalized that she would, of course, be OK with it if she did know. At any rate, I ascribed to the philosophy of it being easier to beg for forgiveness than ask for permission.

That evening when I came back to work, the station was abuzz about the cat in the closet. Back in those days, an animal at the station was a real novelty. Everyone was interested in him and it seemed that throughout the day many people had opened the door to get a peek at our visitor. But when I opened the door to check him, he was missing.

“What happened to the cat?” I asked one of the EMTs walking by.

“I don’t know. He was in there before. He was real mean,” he told me.

I asked who had taken him out. No one knew.

I continued to ask when I saw another EMT who seemed to know.

“I went to check out the cat,” he said. “He looked scared and he jumped on the pipe. I think he’s feral. He kept climbing.”

“But where is he now?”

“I think he kept climbing,” he shrugged. What was that supposed to mean?

I gave the closet another look. Most people would assume that the ceiling and the walls were attached. It looked that way from the ground. Between the ceiling and the wall was steel beam that, from the ground, looked like it was attached to the wall. But could there be a gap? We got a ladder and discovered that, yes, there was about one foot of space between the ceiling and the wall.

What kind of misfit put this place together? What was the point of that gap? And how did the cat know?

I shined a light into the gap and heard a hiss. Once again I saw those eyes peering up in the darkness. I had no idea how the cat had made it up there. Most of the piping was vertical. The horizontal areas of pipe were very, very high up. This cat had skill. I stuck my hand in the gap to reach the cat and got scratched. It was going to be a long night.

Two other women whose shifts had ended came over to help. Behind the wall, there seemed to be a square made out of cinder blocks that the cat was in. It was about one foot below the top of the wall.

We took turns injuring our hands by trying to lift the cat out of the cinder block square. He was either stuck or didn’t like the idea of being rescued, or both. It took a terrible angle to get our arms in a position to pick up kitty and when we did he fought us. We tried wearing gloves to minimize the blood loss but he would slide out of our hands with them on. Things were getting desperate after more than an hour of trying.

I decided to go in naked, no gloves. I was going to take my bites and scratches and just get the cat out once and for all. I figured that I would just deal with the injuries. How bad could it be?

I stuck both arms in. I felt the cat and got my hands around him. I suddenly felt hot pain in my hands as the cat scratched me. I held on. I started to lift him up and felt him clamp down with his razor-sharp teeth, the ones that are designed to kill things. The pain was unbelievable. But I held on. I felt my hands get wet with my own blood. I almost had him over the wall. Then he squirmed and I lost him. The cat won.

I pulled my bloody hands out of the gap. It was worse than I thought. They were completely red with blood and swelling. Parts of my hands were blue. I could barely move my fingers. Blood continued to pour as I wrapped my hands in some trauma dressings. A small crowd had gathered for the rescue event and now they gathered around the spectacle of my injuries.

The mob told me I had to go to the hospital. I agreed to go though I stalled for a time, wanting to know what the game plan for the cat would be.

A collective decision was made to get in touch with ESU. The Emergency Service Unit of the NYPD is a specialty unit designed to handle unusual situations. They have all kinds of special tools and tactics. Surely they could help us with the cat.

We called them unofficially, at the precinct, to see if they could stop by and give us advice or loan us something that could help. They came over quickly and told us they would be taking over the rescue operation. There was no way, they told us, that cat was not going to be rescued.

One of them saw my hands and told me that I should have worn gloves. I told him about the friction issues and he assured me they had gloves that would be able to grip the cat. I was skeptical but they had experience with situations like this, probably. I was just grateful that people with actual tools were going to work on this. That cat was in good hands. I decided to walk up the hill to the hospital that was next to our station.

It was an eye-opening experience to be at the hospital for an extended period of time, instead of the shorter intervals we normally spend there.

The hospital by our station, on a weekend, is a madhouse of all kinds of mayhem. I witnessed an entertaining argument between two people who didn’t speak the same languages. I saw stitches being given to someone with a gash down the entire length of her leg, and I watched another family demand that their adult son be transferred to a ‘better’ hospital despite getting excellent, attentive care.

I was parked in the minor trauma area, far away from the influx of madness but close enough to watch. I sat in a comfortable chair with my hands wrapped in loose, bloody bandages awaiting my tetanus, rabies, and antibiotic injections.

I had been waiting a long time when I noticed one of the ESU officers walking into the ER. His hands were covered in trauma dressings as well and they were becoming red. The hospital staff parked him next to me.

“There’s no friction with those gloves,” he said. I nodded and showed him my hands again.

As we sat and waited, the officer told me that they do many animal rescues. He said it’s much easier dealing with dogs rather than cats because even though dogs are more dangerous they are also more predictable.

“All bets are off with felines,” he told me. I understood.

It was just the two of us for a short time until a third set of bloody hands made their way into our now-exclusive section of the ER. One of my coworkers had given the gap one last shot before they started using power tools to break down the wall.

“They’re breaking down the wall?” I asked, somewhat horrified. Good Lord, what was the new captain going to say?

This whole operation had my name all over it.

I spent much time sitting there waiting and imagining the various scenarios. I pictured myself giving our Captain an explanation of how her meter room had been dismantled. None of them ended with “Why Nancy, that was a great idea!” The pain in my hands lessened under the weight of what was to come.

It turned out, the remaining cop had only to remove two cinder blocks for kitty to be liberated. One of the women took him home. She planned on taking him to an animal rescue organization she helped out at.

In the meantime, three uniformed people sat in a row in the trauma room. Six bloody hands loosely wrapped in bandages awaited treatment. We looked as if we had all been victim to a horrific razor blade attack. People walking by would look at us with concern asked what terrible disaster had transpired.

“Cat,” we’d answer in unison.

One small cat had done all of us in.

ceiling gap with cinder blocks removed

September 13, 2001

September 8, 2021 /

On September 13, 2001, I was sitting in my union’s office with several coworkers, from different Brooklyn stations, awaiting transportation to Ground Zero. We were collectively living in a strange kind of haze after the biggest terrorist attack on our nation, and our city. We had been told to report to our union office if we wanted to assist in the rescue and recovery mission but no one there that day knew what to do with us at the moment. There was a row of telephones on a long table and one of them began to ring. I was the closest, so I picked it up.

“Howdy!” said the friendliest voice I had heard in many days. “We’re from a local in western Montana and we just need for one of you to give us the go-ahead to put our truck into drive.”

Was this a wrong number? Who were they trying to get? What were all these phones for anyway?

“Excuse me?” I asked. “I’m sorry, I’m just waiting here and picked up the phone. Who were you looking for?”

“Well, howdy again, ma’am,” he said. He slowed his speech a little and his enthusiasm went down slightly, but only slightly. “Your brothers and sisters in western Montana have loaded up an 18-wheeler, don’t ask us how we got it, we ain’t telling. We’ve got supplies and a few extra humans to help out our friends in NYC. Now, we’ve got this behemoth pointed east. Joe here, assures us he knows how to drive it. I’m not asking for the paperwork. All we are looking for is the go-ahead to move this thing forward.”

He had put a huge smile on my face but I just automatically started crying. I was actually bawling if we are being honest. I’ll admit I was quite a bit sleep-deprived, which makes it fairly easy to turn on the tear spigot but that, I’m sure, only played a partial role. I was mostly filled with an overwhelming sense of love and gratitude towards this stranger on the other side of the country who had assembled supplies, volunteers, and even a very large truck under auspicious circumstances, apparently, just to help out people he had never met. I’m not sure what he thought when he heard me crying.

“Don’t worry, darling,” he told me quietly. “Love always wins. It might take a while before the light gets shined upon it, but evil always takes a backseat to good.”

I thanked him profusely for that, and for the mission he had set up. I told him I was in no position to authorize anything, and that maybe he should call back later. But he didn’t care. He felt that my answer indicated that his truck needed to hurry up and get to New York. They were just going to head east until they found us. He wanted us to know that help was on its way.

I will never forget that phone call.

***************

When the two airplanes struck each of the buildings of the World Trade Center I was working my other job at a cardiac monitoring service on Long Island. (Most of us work an additional job to support the job we are addicted to.) When news came that something huge was going on in downtown Manhattan, my boss rigged a television up and we all watched it together. Everyone there knew what I did at my other job and they all just looked at me quietly.

My then-boyfriend/future husband was working EMS and on the clock while all this was going on. I had some trouble getting in touch with him but our lieutenant (we worked at the same station at the time), told me he was ‘probably’ safe.

Me visiting ‘the city’ 8/29/01

I was able to get a hold of my partner, who lived close to the cardiac monitoring place, and he came and picked me up in his car. We drove to the city together.

Most of the roads towards the city had police roadblocks and we had to keep flashing our ID cards for much of the ride. We had ideas of picking up our equipment and heading to Manhattan, even though we were scheduled to work our unit that evening but first, went to our station to see what was being done from there.

Everything was up in the air. I don’t know what kind of planning was going on for that evening or the days ahead because it seemed that anyone in charge was in lower Manhattan and inaccessible. We weren’t sure what to do, no one was.

For the time being, our lieutenant told us, we were to stand down. A city bus was on its way to take us to Manhattan. They were working out the scheduling and the logistics.

Eventually, the bus arrived and we got on it. And then it was canceled. No more people would be going to Manhattan, the lieutenant told us. Too many units were there and not enough were covering the regular 911 needs of the city.

So on the evening of September 11, 2001, my partner and I worked our usual truck.

It was a strange time to be doing your regular job. The entire city was in shock, as were we. I remember most things as if they happened in slow motion. Reports floated their way to the station of the names of people we might know, people who were missing. The call volume was higher than average but quite a few of them were calls of anxiety. Many people were hearing things, seeing things that turned out to be unfounded. We took some drunks to the hospital, many of whom didn’t even know that a major disaster had taken place a few miles away.

I wondered about my sister, an air traffic controller, who must have worked her tail off to land all those planes. It’s a stressful job to begin with, but on that day everything that was flying had to land, immediately or as soon as possible. You can find real-time air traffic images online to see just how daunting a situation that was.

The air traffic on 9/11/01 at 9 am

We did our regular job again the next day too. Everyone was still feeling the effects of this major devastating event, even more so since more was known about it. So many people were missing, coworkers were missing. Several people I knew had already been confirmed dead.

It’s difficult to do your job when you’re an emotional tinderbox. There are drug dosages to be calculated and protocols to remember. You’ve got to pay attention when you’re driving. All the while you had to hold it together for everyone else, despite more and more information pouring in, more names of the missing, more buildings.

There were countless stories about people jumping off those buildings to avoid burning to death inside. You could only try to imagine the kind of desperation that takes. At the time, it was thought that hundreds could be trapped in the rubble. To think about those poor people, desperately waiting for help, was heartbreaking.

Our unit had developed a friendly relationship with Squad 252, which was in our area. We even had the code to the door, which surprised the firefighters that had been sent there to cover the firehouse. We went over to see how they were doing but the looks on the faces of the men there told us everything.

And yet I was still picking up drunks and people were still calling for colds that their antibiotics hadn’t cured in three days. Normally those calls don’t bother me. I often find them entertaining and they are a nice balance to the ‘real’ calls that involve suffering. But at that time there was nothing redeeming about calls like that, and there were so many of them, during the aftermath of a terrorist attack. Didn’t they even watch the news?

Back then, I like many others, had no landline. I was living with a friend and the only phone line in the house was dedicated to dial-up internet. My then, high-tech brick of a phone had no service for more than a day after the attack and when it finally did come back it had a very limited range. I desperately wanted to get in touch with my family. I was able to call my mother in Florida after a few days but my dad in Hawaii would have to wait much longer. It was like we were back in the days before the industrial revolution. Most people were having difficulty with phone service and yet others were still able to call for an ambulance because their foot had a rash.

I cannot describe how maddening this all was to me. When you deal with the onslaught of pain and suffering fairly regularly one of the biggest coping mechanisms is knowing that you tried and that you were able to help. Sometimes your efforts fail but the simple knowledge that you did everything you could makes all the difference in the world.

There is also something to be said, something important, about keeping busy. But nothing we were doing was satisfying. Nothing seemed like ‘helping’. It seemed like everyone wanted you to forget what was going on and just do what you used to do as if nothing had changed forever.

So, on my first day off I wanted to head to lower Manhattan and dig. But you couldn’t just drive over with your shovel and helmet. There must have been some organized efforts I could join, I thought. Or I would be one of the medical volunteers somewhere, I hoped. Anything. I would do anything.

But on the days previously, when I had been working, information about how to go about doing so was spotty and constantly changing. Initially, we had been signing up for extra ambulance shifts that would be dedicated to lower Manhattan but they had been canceled. I had tried to go over after and before my regular shift. (And I still had to pick up my car and the stuff I had left at my other job in order to try and accomplish these things).

The best lead I had was to go to the union office as I had heard they were bringing groups of EMTs and paramedics to work ad hoc posts that had been set up. I had spent less than five hours at home in three days and I couldn’t wait to go to Ground Zero because I was desperate to assist in some way, anything, to feel useful because driving people to the ER for anxiety wasn’t doing it.

A little ragtag group had assembled at the union office that day. I clearly had not been the only one who had heard this was the place to go. But the two people in charge at the office didn’t know what to tell us either. Their information was also constantly changing.

My then-boyfriend/future husband had gone to a different location where EMTs were being picked up to work at medical outposts that were being created. Paramedics were excluded, we were told, because paying us was too expensive (ridiculous, given the sparse difference in our salaries). It seemed they didn’t care that they had ‘volunteers’ who were willing to do things for ‘free’. This just added to the outrage, that in the middle of a nationwide tragedy, the same silly nickel-and-dime rules were applying. There was just so much to be angry about.

But then the phone rang, and I spoke to my new friend from western Montana.

I told the small group about the call and it empowered us to get up and go together. The union gave us a placard and we got into someone’s vehicle and made our way downtown, shovels in hand.

Along the way the roads were lined with hundreds of well-wishers holding signs of encouragement, handing out water and snacks at traffic stops, and cheering us on. My hope for humanity was returning again.

Lower Manhattan was surreal. It had been two days after the attack and the air was still thick with a big white fog of particulates. It was really overwhelming and surprisingly quiet.

Maybe it’s just my slow-motion way of remembering it, but sounds seemed dull, the way your neighborhood feels when it’s covered in a blanket of snow.

We parked in an area where other vehicles had been assembled, ones that had been recently used, as opposed to the ones covered in white dust and debris. As we walked towards what was left of the Trade Center we would often see a random person, almost everyone was wearing some kind of uniform, and they would give you a somber nod that you would return in kind.

I was struck by the lack of “stuff” in the debris. It seemed to be mostly building material, steel, and rubble. Two major office buildings had come down and there was a surprising lack of office equipment, crushed or in pieces. There was also no glass. I assumed it was a large part of what was making up the white fog.

The air had a strange, acrid smell to it. After only a block or two, our uniforms were already covered in dust. At the first makeshift station we passed, we were handed an N95 mask, the kind I used to drywall my living room. At some point, later on in the day, I was warned by someone in a state uniform that my N95 mask was wholly inadequate and that I needed to get something better.

“Where?” I had asked.

“Oh, we don’t have any. Nobody does. But what you’re wearing, it’s not enough,” he told me. He’s the only one who said anything about it on any of the days I was there.

Everything’s good, here’s your mask, you probably don’t need it, air quality is fine…

We walked around seeing different people in different places. It was comforting to see familiar faces of friends you hadn’t been able to get in touch with. For this reason alone, I was glad to be there.

We spent a good while walking around, taking in the new landscape. I snapped a few photos with my disposable film camera. It was numbing to see what was still standing and what had been crushed.

At some point, I volunteered at a medical station that had no medical people at it. Someone there begged me and one of my group to stand by until they found a dedicated crew. It was in the lobby of a partially destroyed building. About an hour later, there was a sudden call to evacuate due to the instability of that building. My friend and I took off and went to look for someplace else we could be useful.

Much of the day consisted of stopping by, assisting, and then leaving when different orders came or new groups arrived. The amount of work ahead was, of course, insurmountable and it didn’t feel as if we had accomplished anything of significance but it felt much better than pretending nothing was wrong and following the same routine we had been doing.

The one thing that does stand out among all the sadness and shock was the massive number of people who came to help. They too, I believe, felt that doing something was an important way to get past the helplessness one feels when something terrible has happened.

So many individuals were donating their time, services, and resources. Massage tents had been set up, catering of all kinds was going on, tables were set up with all sorts of donated articles- t-shirts, gloves, flashlights, socks, helmets, climbing gear, and so many other things, it overwhelms me to remember.

And there were also the crowds, lining the roads leading to lower Manhattan. Access was blocked for most people and yet they found a way to participate and help. Their encouragement and positivity were a wonderful window of light in the dark room of our collective mental anguish.

I went to the site a few more times over the next several months. Over time, things became more organized. There were specific areas you could work, and eventually, Ground Zero became coordinated into a routine with procedures to follow and ways for things to be cataloged. The outpouring of love and appreciation from the public continued for a long time as well.

I never found out who the caller was on that day in the union office. I hope that he knows how uplifting his voice and his message were and how it meant far more than all the supplies they had managed to assemble in that short period of time. He was 100% correct about evil taking a backseat to good and he was definitely part of the ‘good’.

The GSW and the UTI

June 30, 2021 /

The woman who jumped into the back of our ambulance was gripping her crotch uncomfortably. She sat down on the bench and slid over to the middle, all the while her left hand maintained a vice-like grip on her privates. She looked at us with desperate pleading eyes.

“IT BURNS SO BAD WHEN I PEE!”

Even from a relative distance, I could smell the distinct, pungent odor of stale alcohol on her breath as she spoke. It was mixed with a faint odor of urine coming from her clothes.

“I’m DYING, you just don’t understand!” she continued. “I gotta pee all the time but then I don’t!”

Only a few minutes earlier, my partner and I had been following a police car going lights and sirens. There was information coming over the PD frequency that a shooting had occurred nearby and when the police car raced past us, we joined them. We notified our dispatcher that we were on the way to a potential GSW [Gun Shot Wound] and gave the location we were headed towards. We arrived before we were even finished telling the dispatcher about it.

There was a block party going on and aside from the street being cordoned off, numerous cars and scooters were double-parked along the roads leading towards it. Unable to make it down the street due to barriers, we stopped at the intersection and parked haphazardly behind the police car which was also somewhat askew.

Ah, trauma…

Most EMS personnel love a good trauma call. Its adrenaline-inducing fast pace can provide a sensation similar to a runner’s high. It’s just enough euphoria to keep you interested, not too much to cloud your judgment. As a sporadic weekend athlete, I can attest that the endorphin reaction from trauma has a marked edge over the experience that happens after a satisfying run.

It was a hot summer night and we pulled up to mayhem. Shots had been fired into a block party crowd and people were running and screaming all around. Although several police cars were already at the location, we were the only ambulance and people immediately shouted directions at us.

“He’s over there!”

“That way!”

“He’s lying in the street!”

Everyone was indicating the same particular location in the disorganized chaos down the road. It was obvious that we definitely had one patient, perhaps there were more. We requested additional units from dispatch.

After collecting our trauma bag and a backboard we opened the large doors at the rear of our truck in order to take out the stretcher. That’s when the crotch-clutching woman clad in fuchsia hopped in.

“IT BURNSSSSS!” she cried.

“Lady,” my partner began. “You gotta get out! Someone’s been shot here!”

“I don’t care!” she said. Her look of desperate pleading took on a more angry expression. “My pee is on FIRE! I need a hospital!” She wasn’t asking.

My partner and I looked at each other in disbelief.

“Ma’am, please,” I tried. “More ambulances are coming, but for now, you’ve got to get out. Someone is in critical condition over there.”

“This ain’t critical? It’s been going on now for, like, TEN DAYS!”

Was this supposed to make us more sympathetic? Because to us, it sounded as if she could endure the fire in her pants a little bit longer if she’d already been dealing with it for ten days.

People were still yelling at us and pointing down the block. They wanted us to hurry, he’d been shot in the chest, the consensus seemed to be saying.

A GSW to the chest?

That was EMS gold. It was a priority trauma job, something we could actually do something for. There was a real chance to make a critical difference for a victim of terrible violence. It was everything we had raced over here for.

But first, we had to send the pink tracksuit woman on her way.

One of the police officers on the scene wondered why we weren’t already running down the block with our stretcher and came over. He noted our dilemma and told us, “Go. I’ll take care of this situation.”

We grabbed our gear and rolled the stretcher past groups of frightened and panicked party-goers. We quickly found a young man, he couldn’t have been more than 20, lying in the street near a table covered with spilled-over food items. He was using his fingers to plug up a hole on the left side of his chest.

“They got me,” he told us, gasping and out of breath.

The wound was fairly large, indicating a large caliber bullet. There didn’t appear to be an exit wound but we could tell there were some other bullet holes located on limbs which, at the time, didn’t concern us as much. We would have to work quickly to mitigate the anticipated blood loss.

“I GOT SOMETHING TOO!”

We turned around to see that the woman holding onto her genitals for dear life had followed us to the patient, the critical patient.

Good job, there, officer.

Well, at least he’d gotten her out of our truck.

“You’ve got to be kidding me,” said my partner.

“This ain’t no joke!” she replied angrily. “I saw you first. Plus, like, MY issue been going on longer. Ten days at least. TEN DAYS! You know what it’s like to pee FIRE for TEN DAYS? Let him get the next one.”

“That’s not how this works,” I answered. “If this has been going on for ten days, ten more minutes aren’t going to make much of a difference but for this man, ten minutes is a really big deal!”

It’s called the Golden Hour of Trauma. Studies have shown that the faster a trauma victim gets to an operating room, the better his chances of survival. There were things we could do on scene and/or en route, important things, but getting to an OR within an hour’s time was the critical factor.

The woman ignored me and laid herself down on our stretcher. The growing crowd came to our assistance as we worked to stabilize the man.

“EXCUSE ME!” screamed a bystander. “That bed is NOT for you!”

“Can’t you see that boy is bleeding from a HOLE in his CHEST? What is WRONG with you?”

“I’m the one who called 911!” said another. “And I sure as hell didn’t call for no ‘ho with gonorrhea.”

The woman quickly jumped up off our bed and got in the face of the bystander who had accused her of sexual improprieties. Her hand had finally released its grip on her genitalia and was now clenched into a fist directed at him.

“This is no STD! You don’t know what my problem is. Mind your own business.”

Another police officer quickly intervened. As he separated them, the pink-clad woman screamed up at the sky, “I’m a victim too, you know!”

The crowd responded with insulting remarks about the woman’s sexual history.

“No, the real victim is anyone who pays you $6 for a blow job.”

The woman wearing neon pink was prepared to fight each and every one of them but the police officer was able to steer her away before more violence ensued on Vernon Avenue.

It was obvious to even our lesser-trained bystanders that our 20-year-old GSW had serious, life-threatening injuries. He had been shot three times and it seemed that one bullet had pierced the air space around his lungs, causing pressure in his chest and increased pain while breathing. We were able to rapidly insert a needle into his chest cavity to release some of the air. Our patient expressed some momentary relief. He needed an operating room and a surgeon as quickly as possible.

As we started to rush our patient to the ambulance we were eventually joined by the intoxicated woman in pink again. I have no idea how she kept escaping the watchful eye of anyone who volunteered to keep her away from us. She seemed to have lightning-fast abilities in catching up with us.

My partner got on the radio and requested an ETA [Estimated Time of Arrival] for any incoming units. Simultaneous trauma jobs in our vicinity had all available units tied up on other jobs. There would be a wait.

The voice over the radio was loud enough for the woman to hear.

“Well?” said the woman, who had now resumed her impenetrable grip on her privates. She was hunched over now and limping. This woman who had evaded every law enforcement officer and bolted down the block to find us had suddenly deteriorated into a frail person who could hardly walk.

“I GOTTA GO! You can’t leave me here!”

When we reached our ambulance and loaded our actual patient into the vehicle, the usual discussion among the NYPD began as to who was going to escort the patient to the trauma hospital. With the added impediment of the complaining woman dressed in pink, a potential delay was gearing up to become even longer. Our patient needed to go right away.

There is some dispute over the issue of patient abandonment which factored into our last-minute decision to take the woman along with us. Aside from the fact that our adrenaline stores were starting to wane, breaking down our wall of resistance, a very real question about whether or not we were violating our certification came into play.

Several legal terms were quickly considered, including “duty to act”, “abandonment”, and “nonfeasance”. There continues to be a debate as to how these issues are applied when more than one patient presents and one of those is critical. At that moment, it was easier to just take the woman with us than deal with unwanted consequences later or be delayed in any way by her removal.

The woman sat on the bench again, along with an officer. A notification was given to the nearest trauma center, which in our case, was in another borough. The woman was displeased with our hospital choice.

“Queens?” she made a face indicative of the ingestion of a sour foodstuff. “Queens? Really? We ain’t got no hospitals in Brooklyn you approve of?”

“We’re going to a trauma center,” I patiently explained as I adjusted the IV and prepared for another.

“I know my infection is hurting but I wouldn’t say it’s traumatic. I’m sorry if I was being a bit over-dramatic.”

Was that an apology?

“We need a surgeon for this guy!” I said, no doubt my exasperation audible to this woman oblivious to the bleeding guy on the stretcher. The cop just shook his head. It was useless trying to explain, his telepathy told me.

I shook my head in agreement and took another blood pressure on the guy with all the bullet holes.

The woman resumed her tale of woe regarding the ongoing urinary tract infection [UTI]. She was familiar with them, had experienced them before, and wondered why she was cursed with them repeatedly.

Our gunshot patient interrupted his facial expressions of pain and suffering to say to me, “Is she being serious?”

I had no answer to give him.

We made it to the hospital in the vast reaches of Queens County very quickly. The staff was there, ready and waiting outside, to receive our GSW. As soon as the door opened, however, they met our UTI first.

“Ain’t this a nice surprise? I can’t believe you’re all here!” she remarked with a big smile. “The hospitals in Brooklyn don’t do this! I’m going to Queens from now on!”

There was some momentary confusion but everyone mostly ignored her as they focused on our young man on the stretcher. They circled around him, asking questions and shouting instructions to each other. They grabbed onto the stretcher and we all raced him down the corridor to the entrance.

The woman watched as the staff left her alone and she wasn’t happy about it.

She walked slowly, hand on crotch, and with a significantly more pronounced limp, behind us. My partner stayed back with her but she felt abandoned, yelling out “What about me!” at least once.

No one listened. Our guy was wheeled into the trauma room and they got to work on him right away.

“Was that the family?” one of the registration people asked. When I told her that she was another patient she gave me a sour expression, similar to the one the UTI lady had given me before. Apparently, these situations never occurred in Queens.

My partner escorted our UTI patient to the triage area and asked her a few questions for the paperwork we would have to do for our additional patient. She was indignant the entire time, wondering why not one of the many people who had greeted us as the doors of our ambulance opened, couldn’t have devoted their attention to her.

Since the triage nurse was in with our GSW, no one was around to listen to her complaints at the main triage desk. After waiting less than five minutes, she got up and started walking around the ER demanding a bed.

A hospital police officer quickly came over to mitigate the disruption to the busy ER.

“I need a bed! I gotta pee but I can’t!” she pleaded with him.

He looked around and directed her to the restroom.

“NO!” she yelled. “I gotta pee but I need a bed!”

“You want to urinate on a stretcher instead of a toilet?” he said, dumbfounded. “That’s the first time someone admitted it outright.”

At that point, our GSW was wheeled out of the trauma room for his trip to the operating room. He was surrounded by a large team of doctors and nurses as they quickly walked to the elevator. This enraged the woman even further. The critical trauma victim had gotten a team of specialized medical personnel and she, suffering from an infection in need of an antibiotic, was still waiting for a stretcher. It was outrageous, apparently.

The woman became very angry, shouting some derogatory words at the hospital police office and threatening to inflict violence on anyone who disrespected her ‘again’. The officer called for assistance at this perceived threat and the woman was handcuffed and restrained onto a stretcher.

She had gotten her bed at last.


Two Idiots Change a Tire

June 8, 2021 /

Not long after starting my new job on the ambulance, I was partnered with another graduate of the Bureau of Training’s Cadet 6 class. At best, we had only about five shifts between us, all with more experienced partners, at least. Although the ink had barely dried on our EMT certifications, we were handed the keys to a $250,000 vehicle and set loose on the residents of Manhattan. It was a glorious time to be in EMS.

When I first started, it was not uncommon for two people from the same class to work together immediately after graduation. There were some lieutenants who frowned upon it and tried to divide established partners for a shift so they could impart their knowledge on us novices, but more often than not, they’d cave to the objections of people who did not want to be split up to “babysit” the newbie.

It’s probably good that our service moved towards an internship type of system that would have prevented this, but back then the impetus was really more on filling vacant seats with anyone they could get. The patients would probably be OK, they reasoned. We were both EMTs, they reminded us, so we should know what we are doing. And as new EMTs, our knowledge was even better than our seasoned cohorts because it was still fresh in our minds.

At the start of our shift, we loaded our brand-new helmets and pristine, newly-stocked tech bags onto, possibly, the worst vehicle in the fleet.

It spewed black smoke out of the tailpipe. The then-standard carpeting on our center console was covered in long-expired foodstuffs. Since the cabinets in the patient compartment slid open as if they had been greased, our supplies were all over the floor. But we checked and cleaned up our ambulance and headed out for what ended up feeling like the longest shift in eternity.

We decided to take turns driving because none of our other partners had let us do it before and we had no idea when we ever would again. Our ambulance for the day had terrible handling and seemed to veer toward the left all the time. It was also incredibly loud and would randomly backfire. Now that our service has switched over to diesel vehicles, it’s one feature I look back on fondly.

Our first patient was a 19-year-old man who lived with his girlfriend on the top floor of a four-story walk-up. (This kind of building dynamic would become a standard theme for me for the next 30 years).

The man’s neck was hurting after sleeping in an uncomfortable position in a drafty room. For some reason, we ended up carrying this guy down those four flights of stairs on a backboard with a cervical collar. The board and collar was standard procedure for a neck injury but technically, some trauma should have been involved.

I remember him clutching his teddy bear the whole way down those grueling stairs. I don’t know what we were thinking. Days and months later, whenever we saw each other after this shift, my Cadet 6 partner and I would always bring up how stupid we were for doing this.

“Remember the teddy bear carry down?” one of us would say. “Why didn’t you stop me?”

We did all kinds of stupid things that day, things we would never think to do three months later when we would officially pass the delineation point where we could finally be called “seasoned” EMTs.

We took patients to the hospitals they insisted on, even if the hospital they wanted didn’t have the services they needed. (There were no computer terminals in our vehicle that gave us up-to-date information on hospital availability back then.) And we spent far too much time trying to park in ways that wouldn’t inconvenience other motorists.

As the day went on, it became more and more difficult to ignore the wheel issues that were plaguing our driving efforts. So we got out and did something much more idiotic than carrying a teddy-bear-clutching 19-year-old down four flights of stairs for no legitimate reason. We went out mechanical for a flat tire.

The tire, we figured out later, had probably been flat for weeks, having been conveniently overlooked by the more experienced (smarter) crews. But because we were stupid, we called for the tire truck.

The way the procedure was meant to go was that a tire truck would arrive at your location and hand you the tire and the tools. Then he’d lean against his truck and watch you change the tire while he smoked a cigarette and thumbed through pornography.

I remember the fat, bald, “Tire Mechanic” snickering as he handed me the tire iron. Part of me wanted to show him up. In my head, I thought “Fuck you asshole, just because I’m a girl doesn’t mean I can’t do it!”

I had changed tires on my own car a few times; I knew I was capable. But the other part of me was thinking about how the “mechanic” was making three times my salary and he was just going to stand around and watch. I seriously considered ways I could mess the whole operation up.

It wouldn’t be hard to screw up the tire procedure, I quickly learned. I was pretty sure I zoned out during the tire-changing demonstration during our Emergency Vehicle Driver Training class anyway. Hopefully, my partner had paid attention.

It was a hot June day and we were getting filthy and tired. But we muddled our way through it. It was arduous work just to get the lug nuts off. It had been ridiculous to equivocate my car tire-changing skills with this behemoth. It wasn’t like changing a regular tire because they were bigger and two of them were loaded onto one axle.

Then, when we started loading the new tire on, the fat, bald guy suddenly noticed that he’d given us the wrong kind. He had to put down his Hustler magazine and go through his stock again.

Since we had inconvenienced him, he made some snarky comments under his breath as he went through his supply. After he gave us the new, correctly sized tire, he resumed his leaning position on his truck and found the previous spot in his porn rag. He made sure that I could see what he was looking at and gave me a disgusting wink. I had no doubt that this man’s only sexual outlet was porn.

One important thing I did learn, finally, was the art of time management. At one point, I reminded my partner what time it was and how much time was left in our shift. He instantly understood that we were going to make sure this activity would be the last thing we did on our shift together.

So, we took our time and worked to ensure that everything we did was done methodically, slowly, and re-examined. Our tire truck guy kept checking his watch with a sigh as if we were delaying an impending meal break. He stopped giving me snickering winks and started getting impatient, which gave me some inner satisfaction.

When we were finished, our white shirts, which had already gotten a little dirty earlier, were now covered in grease and soot. They would never be truly white ever again. My hair had a new shape and had expanded further outward (it was the 80s). My partner’s hands were cut up and his glasses were askew. Our new cavalier attitude towards our appearance did not go unnoticed by our coworkers.

“But you survived, didn’t you?” they said.

Exact Words (part one)

May 24, 2021 /

Every three years, EMTs and paramedics in New York state need to renew their certifications. This involves attending a refresher course and then taking a written and a practical exam. Refresher set up has changed several times over the years, but in it’s best incarnation it involved three weeks at the Bureau of Training. During that time we would review for the state exam, practice skills, and go over new policies that may have changed since the last refresher. It was also a great time to meet coworkers from other parts of the service and share stories.

One refresher year, I was reunited with a friend I had gone through paramedic school with. At that time he was working in the Office of Medical Affairs [OMA]. Among other things, the people who work in OMA review random pre-hospital care reports. They generate statistics and monitor the quality of care patients are getting.

The call report has also gone through many changes over the years. Although now they are completely digital, for my entire career in the streets they were paper. They changed tiny spaces for the narrative into larger spaces, sections were added for billing purposes, the refusal area has seen it’s language changed, and other sections have been moved and changed over time. Even the report itself has gone from being an ACR [Ambulance Call Report] to being a PCR [Pre-Hospital Care Report] to now having that little ‘e’ in front of PCR [ePCR] to emphasize our jump to digital.

At the time I was taking refresher with my colleague from OMA, call reports started being scanned into a computer, as opposed to being stuffed into an envelope and mailed to OMA. I was under the assumption that they spent less time reading them now and more time analyzing the statistics generated by the computer, which were based on the filled in boxes.

Despite thinking that I had no audience, I still took great pride in writing my call reports. I tended to go beyond the dull narratives and a one-size-fits-all approach to writing them by adding details that would help me remember a specific call if I were ever questioned about it, either in an OMA review or in court. My favorite, and the favorite part of everyone who worked on my unit, was the “Chief Complaint”, which in those days, was a long, wide box on the top of the paper. It’s purpose was to explain why the ambulance had been called. I regarded it as the title of everything else that followed.

From the very first day we learned how to fill out the form, it had been reiterated to us over and over again that we are instructed to use the patient’s exact words. Most people ignored this directive, given the prevalence of foul language and extraneous sentences people tended to use when telling the story behind their phone call to 911. The majority of EMTs and paramedics made an effort to summarize the words that patients actually used, to gear it more toward what was actually going on, but not us. While others were editing those exact words to something more concise (“I have diarrhea”), my partners and I would delight in waiting for the patient to utter just the right sentence that described things the way he felt them (“My ass is like a fountain.”)

You have to take your joy where you can find it. If our service wanted exact words, then damn it, that’s what we were going to give them.

As I was sitting next to my friend in refresher, his department-issued cell phone rang while we were on a short break. Not long into the call, I heard my friend say, “…Oh yeah, she’s sitting next to me right now. Sure I’ll put her on.”

I reluctantly took the phone thinking, of course, that I was in trouble. No one from OMA just wants to say hello.

“Hello, is Nancy on 37V?” I said yes. “Hello, this is Dr. Andrews, in charge of OMA.” I knew Dr. Andrews as one of our doctors who took our telemetry phone calls and did some of our CME [Continuing Medical Education] classes. I didn’t know he had become the MD in charge of OMA. Despite the friendly tone in his voice,I was leery. It couldn’t be good if they knew your unit.

“I just wanted to let you know how much we enjoy reading your pre-hospital care reports over here.”

“You do?” I asked cautiously. I still wasn’t sure if this was a trap of some kind.

His voice remained friendly, “Oh yes! Not just yours but everyone on your unit. Reading these forms gets pretty tedious because they’re usually boring which is why we look forward to the ones from your unit. “

“Really?” I answered. “We were kind of under the impression that no one really reads them. It’s nice to know someone appreciates them as much as we enjoy writing them.”

“Oh you have no idea!” gushed Dr. Andrews. “We love them. We have a board where we write down the latest chief complaints from your unit. We put a star next to the ones where we recommend reading the comments as well.”

“No way!” I was flattered.

“Oh yes,” he told me. “It’s the 37V board. No one uses the chief complaint section the way you guys do. My personal favorite is ‘They sent two hot ones straight to my juice, yo!’ ” He was talking about the chief complaint for a man who had been shot twice in the testicles. It was a personal favorite of mine, as well. That one probably had one of those stars next to it.

He ran through a list of a few others they had enjoyed and told me to let my partners know that their pre-hospital care reports were appreciated as well. He said to keep up the good work and I thanked him again. As I handed the phone back to my friend I still couldn’t shake the thought that I had been set up in some way. But our PCRs did make for a fun read. He hadn’t been the first person to tell us.

Over the years we had written many of our best chief complaints down, to share with our coworkers and friends, and also for ourselves, to make us smile when there seemed to be little to smile about. My list includes:

“God wants me to suffer.”

“People tell me I smell bad so I want to make sure it’s not a disease before I take a shower I don’t need.”

“They beat me like a pinata.”

“I didn’t think I needed to read the directions that came with my new saw.”

“My foot is a new shade of green.”

“Cheap vodka makes me drive like an asshole.”

“I broke my arm on this shampoo bottle.”

“I’m just a loser. Take me to the hospital.”

“I am the great Mephistopheles of legend and lore. I inhabit this body now. Take me to your governing elders.”

“The aliens gave me an implant and I want it removed.”

“I’m just in it for the lawsuit.”

“You can’t brainwash someone who doesn’t understand and yet here I am.”

“He planted it in my rear end so hard, now my neck is crooked.” (this call concerned a car accident where the the driver of the front car claimed whiplash.)

“I just found out about ass cancer and I don’t want it.”

“When you’re a playa, penicillin is just part of the regimen.”

“A demon told me to stab myself but all I had was a pen.”

“My girl tried to give me a salmon named Ella with her warm-ass soup”

“My brother is in the hospital having a heart attack so I must be having one too because we’re twins.”

“I used to love eggs but now I don’t anymore.”

“My new girlfriend’s mother told me she didn’t like the way I looked. Do you think I look sick too? I don’t really feel sick.”

“I’m pretty sure I have a sexually transmitted disease. I deserve to have a sexually transmitted disease.”

“My goldfish gave me gonorrhea.”

“My asthma boy had a seizure.”

“There ain’t no kind of juice that ain’t coming out of that man’s leg.”

“WebMD says I have cancer.”

“That bish put a curse on me and I need it removed.”

“I went on a bender I don’t remember and now it hurts when I pee.”

“The hairs growing out of my mole are turning gray, like my beard.”

“My love juice is looking kinda green these days.”

“I got mascara in my eye.”

“My ex is a demon and I’m scarred by her love.”

“I made my boyfriend break my nose so I could get free plastic surgery.”

“My scalp is peeling off! I got these white scalp flakes on my shoulders!”

“I’m running out of reasons to go. You just write down anything you want.”

“Prostate cancer runs in my family.” (this was from a young woman who was very concerned over information discovered at a family BBQ)

“I can’t reach my toenails to cut them and they keep getting caught up in my socks.”

“I made a pact with tequila and now it’s coming to collect.”

“The peoples in the commercials for eczema medications looks so happy and I want to be like them. Tell them I have eczema.”

“This might look like a mosquito bite but it was from the government.”

“No one can touch me, I’m made of fruit.”

“My skin is dry but when I drink a lot of water all I do is pee, it completely bypasses my skin.”

“I know now that I can’t trust my dealer’s idea of a ‘good time’. “

“The roaches have it in for me. I see them watching. And plotting.”

“My face looked very puffy in this picture my mom took.”

“Take me to any hospital with a microwave that I can use on this food someone gave me that was cold.”

“I spilled orange juice on this paper cut and it must be seriously infected because it hurt like hell.”

“The bread machine sliced off my finger and it got lost in the dough.”

“The evil voice in my head learned how to play the drums.”

“It all started with a bad banana.”

“I got beat with a Slim Jim. The snack not the car opener.”

“There’s a bug in my ear and he talks too much.”

“I think I’ve got a disease.” (this guy would not elaborate as to what disease or why he thought he had one).

“I broke my tooth eating pudding.”

“I’m really into that hot nurse at Bellevue. I’m just going to get her attention.”

“The drugs they prescribed make me pee a lot.” (he’d been prescribed a diuretic, which tends to do that).

“I think I’m smelling too many things. This needs to be stopped.”

“I want the doctors to stop me from sweating.”

“The things I do in the bathroom ain’t right.”

“On my planet, eating paper doesn’t make your stomach hurt.”

“He been falling since the sugar ate his toes.”

“I wanna vomit so bad I could cry.”

“Every time I take tequila I wake up and everything is spinning.”

“I got a itch that makes me less of a man.”

“My cred got busted.”

“My eyes need to switch places. It’s gotta be done by Monday.”

“I don’t think crack is good for my heart.”

“He can’t stop wheazaling.”

“The gremlin I met when I was on mushrooms said I was going to die if I didn’t go to Methodist hospital and see someone called Dr. Joseph.” (strangely enough a Dr. Joseph was on duty that night)

“I need a bed and a woman.”

“There’s a smelly, yellow glue coming out of a hole in his head.”

“I was shot in the leg six years ago and today its thumping like a drum.”

“Someone needs to change my diaper.” (60 year old man)

“My hand smells. The left one.”

“I can’t reach this itch in the middle of my back.”

“I need a shrink to tell me why I attract crazy women.”

“I went to heaven in my dream but I know I’m going to the other place.”

“I gassed my face with roach spray trying to kill a mosquito.”

“The man on TV says I might have carbon monoxide in my home.”

“Women just don’t find me attractive.”

“My husband smells like pee, he must have sugar.”

“My big toenail is the same shade of yellow as my teeth.”

“I need a clean bathroom.”

“None of the doctors believe me when I tell them I’m pregnant.”

“My heart used to go ‘rum tum tum’, now it goes ‘boom boom boom'”

“I thought I could fly.”

“This tumor has it’s own zip code.” (this was for a large pimple, not an actual tumor)

“I want a doctor to prescribe me those new blue pills that will make me a hit with the ladies again.”

“I think I ate my tooth.”

“I beat the s**t out of someone, now my hand hurts.”

“Ny Quil made me have some scary dreams.”

“He beat me with my own [prosthetic] leg.”

“The old lady I tried to rob sprayed oven cleaner in my eyes.”

“God told me to cut off my hand because I didn’t need it anymore. But now I think it was probably the devil.”

“The pencil got stuck when I used it to stab the bug that lives in my ear.”

“This mole needs to come off. It’s the reason I can’t have babies.”

“God is the landlord who shut off the spigot.” (he had problems urinating)

“When they say not to put a fork in an electric outlet, they’re right.”

“That whiskey didn’t smell right but I drank it anyway.”

“My psychiatric drugs are making me crazy.”

“There’s a party going on in my ass.”

“My boy baby daddy stabbed my girl baby daddy in the ear with a skewer.”

“I don’t know man, I’ve been tired for like 30 years.”

“My stomach hurts when I eat a lot.”

“My driving instructor was right. I don’t know what I’m doing.”

“I took the Tylenol like they said but nothing happened and it’s been almost a half an hour.”


cheesecake, table, dessert

My First Baby Delivery

April 4, 2021 /

I was sitting in my doctor’s waiting area perusing through piles of long-expired magazines. It was 40 minutes past my appointment time and there were others who had waited longer. The staff told us that the doctor was running late, she had an emergency delivery at the hospital. We were offered to reschedule but I preferred to get my visit over with, as did most of the others, apparently.

Eventually, the door opened and my doctor hurried in. As she took the scarf off her head, she apologized to the staff and everyone sitting.

“Thank you for waiting,” she said. “It was a difficult delivery but there’s another beautiful baby boy out there today!” Everyone clapped and the extended appointment times were quickly forgiven.

Not long after, my name was called. I put down the April 1999 edition of Mother and Baby and headed into one of the exam rooms. When she came in and saw it was me she exclaimed, “Oh! Now here is someone who will appreciate my hectic morning!” (and I did). “It was a problematic pregnancy, the numbers were off, there were issues at the hospital but it came off OK and now mother and baby are doing well.” She seemed so relieved.

“That must be the greatest experience,” I told her. “Presenting a happy mom with her healthy baby…”

She knew I was a paramedic and we had often shared interesting medical conversations interspersed with the usual chit-chat as she scraped my cervix. She was my favorite doctor by far. I had met her own kids at the office and she frequently gave me what she called “Standard Jewish Grandmother Advice” about love, baking, and getting older, even though she was not much older than I was.

“You’ve never delivered a baby?” she asked me, surprised. “You need to intercept all of those cab drivers who are doing it. They’re all over the news.”

“I’ve delivered babies,” I told her. “But I’ve never had a happy, normal delivery.”

She looked concerned, as is everyone I tell this to, especially my new coworkers who have yet to have a baby delivery under their belt. Her look turned to horror when I elaborated on the handful of delivery experiences I had. I am grateful there aren’t that many.

Often, it’s not so much the delivery but the circumstances around it. I am incredibly happy that I have not encountered any serious issues during the process itself. The mothers really do all the work, usually. You just guide the little one out, suction, flick the feet, place 2 clamps on the umbilical cord, and cut in between. Easy, right?

Not exactly, it is a bit nerve-wracking for me, for some reason. It would probably be good to do all this in a controlled environment but that has never been my experience. It’s always occurred in inconvenient and less-than-ideal areas where you’re groping about for all the little things that get scattered when you rip open an OB kit nervously.

None have ever been delivered in the back of my ambulance, which would have been a more controlled setting. But I’ve seen ambulances where a baby had been born and the aftermath made it appear as if a serial killer had brutally tortured several people with a knife so it probably isn’t as controlled as I would like to imagine it is.

The circumstances that made my delivery experiences PTSD invoking had more to do with speculation about the series of events that would happen after. All of my baby births have involved underweight, drug-addicted little infants who were quickly handed off to the social service agencies of our city. It’s difficult to process the feelings of hopelessness you experience when you assist in the arrival of someone who immediately needs help from our overburdened bureaucracies, in addition to the Neonatal Intensive Care Unit.

The first baby I assisted in delivering was to a homeless woman in a small park flanked by tall office buildings. The park was not very big and she was right in the middle, sitting on some newspapers on the floor next to a bench.

She was naked from the waist down with her legs spread wide. She had not gotten prenatal care and wasn’t sure how far along she was. When we got there, the baby was just about to rear his tiny head. She couldn’t be moved.

As the baby was coming out, I looked up to see hundreds of people looking down at us from the floor-to-ceiling windows of the buildings surrounding us. We used a sheet to create something of a tent but they probably knew by now what was going on. It was a harrowing experience for a first-time OB call and I was far more nervous than the mom.

When the baby was born, he was really tiny. The mother smiled when we gave him to her and she rubbed his small face with her finger. She seemed a bit distant and not at all happily overwhelmed as I expected her to be.

I look back and wonder if she were trying not to get too attached to a baby that would probably be taken away and put into foster care. I had assumed she was exhausted from giving birth without an epidural.

She had told us she had given birth once before. “Another boy,” she had said, somewhat wistfully.

She told us he was in foster care, explaining that in NYC babies weren’t allowed to live on the street with homeless mothers. She expected to be given a placement in a family shelter now that she had this child. She hoped that when that happened, she could try to get her first child back. It hadn’t occurred to me at the time that she probably could have gotten into a family shelter with the first child, with that policy, and yet her child was still presently in foster care.

Not long after arriving at the hospital, the baby was quickly whisked away into an incubator. We found out that he was only 5 pounds and would probably be going through some alcohol withdrawals.

People at the hospital berated us for not keeping the baby warm enough, despite using our last sheet and blasting the heat in the ambulance in the summer. This was the same hospital that was stingy with their one-for-one policy with bedsheets. We now have swaddle blankets for infants that do a better job of conserving body heat, but at the time we were at the mercy of the hospitals for sheets and blankets which were used for so many things, including blocking the view of unwanted onlookers and keeping newborns warm.

When we returned again a few days later with a different patient we were told that the mother had snuck out of the hospital, leaving her baby. She had given us all a fake name.

Once again we were treated harshly for “not checking her ID” as if we had technology that can detect fake Medicaid cards. They had fallen for the same ID but it was easier to lash out at us, I suppose.

I asked (someone else) about the baby and they said he was still in the pediatric ICU and would be placed in foster care. We were able to see him for a brief time. Surrounded by other tiny babies he looked rather healthy and very cute and also very vulnerable. I couldn’t imagine someone running out on this little one. His first experiences in this cold, harsh world had already been cold and harsh.

I was initially filled with anger towards the mother. But I understand that she was an addict and addiction-thinking is governed by instincts that become redirected toward everything substance-related. Perhaps, I reasoned, she had left him for unselfish reasons, knowing that she couldn’t give him what he needed.

It filled me with tremendous sadness, thinking about that poor little baby starting out so alone. What would life be like for him? Would he ever see his mother again? Would he meet his brother? Would he get adopted by a nice family?

Whenever I think about this call it becomes a long list of negative thoughts: of the lonely baby, the mother so substance-addicted that she chose a life on the street with her drug of choice over this little boy, the hospital with their petty need to take things out on us that we had no control over, and those office workers with their horrified faces. I imagined the story the gawkers would tell their friends later and how the story would be told.

I also wondered about all the blood that had been left in the park. We didn’t have any kind of resources to clean it up and I remembered the police officers, who had been on the scene with us, leaving at the same time. An average person walking their dog through the little area would probably assume someone had been murdered.

I never saw the mother again. It’s a little strange for EMS people to not run into the same homeless people in the area. They become our regulars and we develop a rapport with them. We even get to know the ones we don’t transport on a regular basis, waving to them as we drive around the neighborhood. Maybe she had found some other place to go or had gone into treatment, prompted by the birth of a baby she had left at the hospital.

When my story, and my exam, was finished my MD said little. I felt terrible for taking away the high of her successful morning and tried to steer the conversation toward other things. Afterward, I went over to the office staff to give them my copayment and take the usual card they hand out, which reminds you to make another appointment at a specific date. This time, I was also handed a prescription. No medications had been discussed and I was a little surprised. But it wasn’t for medication. It had the address of a bakery nearby. She had written on it, with a smiley face, “Get yourself some cheesecake. (a small one). Doctors orders”

The Long Distance Girlfriend Experience

April 3, 2021 /

The ads on late-night television imply that for about $5 a minute you can speak with an eager nymphomaniac clad in sexy lingerie and writhing about on the satin sheets of her king-size bed. “They’re definitely over 18!” many of the adverts proclaim. The callers probably assume the woman they’re sharing sexual secrets with is doing so from the private comfort of her own home. How romantic (or hardcore) would it be to hold an intimate conversation in a cubicle next to 30 other cubicles?

The phone sex industry exploded in the 1980s with the emergence of 1-900 phone lines. 1-900 phone numbers charged exorbitantly higher rates than regular phone numbers, usually by the minute, and seemed tailor-made for carnal interplay, or psychic readings. Despite the best efforts of puritan government agencies and the later development of technology that delivered porn to your phone, sex chat lines continue to endure to this day. There is a lucrative appeal, apparently, to engage in naughty talk with an anonymous stranger. It provides an outlet for men to engage in a soft-porn fantasy: the long-distance girlfriend experience.

One day I was shipped out to work with someone in downtown Brooklyn and I ended up having one of those “nymphomaniacs” as a patient. It was where my innocent eyes were opened to the elicit world of landline love.

We were sent to an office building in the business district. When the doors opened up on the 6th floor, it looked much like the typical office settings I assume most people work in, though there were some notable differences. The cubicles were larger than any of the cubicles I’d seen elsewhere and the dividers seemed to be covered in a thick soundproofing material. Large billboards near the ceiling, holding messages about bonuses and incentives, had images of shiny, red-painted lips talking into phone receivers held by hands that had shiny, red-painted fingernails.

None of the employees resembled the woman in the pictures hanging overhead. No one wore lip gloss and any manicures were subdued. The uniform of the day appeared to be sweatpants and unmatched leisurewear. There wasn’t a teddy to be found, though there were plenty of hiking boots and flannel shirts. Aside from the relaxed dress code, another thing that let us know we weren’t in the standard American workplace included the two large and very intimidating security guards at the entrance.

A friendly woman greeted us immediately and told us she’d take us to the patient. The woman wore a lanyard around her neck attached to two pieces of official-looking ID proclaiming her name to be “Bambi”, quotation marks included. A quick glance at the other lanyard IDs revealed that a name ending in “i” was likely a prerequisite for employment. We were surrounded by a number of Rikki’s, Tammi’s, Freddi’s, and Toni’s.

As we walked down the path towards the patient we listened in on snippets of raunchy phone interactions. The women vocally expressing their enthusiasm for deviant sex acts did so while filing their non-red nails, thumbing through magazines, and various other multi-tasks. One woman’s attention was intensely directed towards a birdhouse she was building out of popsicle sticks, while at the same time feigning believable interest in bondage. Her face lit up when we admired her handiwork as we walked by.

The whole time we were walking, we were followed by a young man, dressed in a suit and tie, holding something. When we reached our patient, whose lanyard gave her name as “Candi”, quotation marks included, the man propped a prosthetic leg against the wall of the cubicle. He gave a polite nod and left.

“My leg!” shouted “Candi” with delight. “Thank you so much!” She was a fairly large, middle-aged woman with a haircut that resembled a crew cut. It looked as if a tremendous effort was being expended to breathe.

“Bambi” told us that when “Candi” started complaining of difficulty breathing they moved her into a bigger cubicle that had a window, which they opened so she could get some air. “Bambi” proudly told us that “Candi” was their most consistent Gold Star employee and hoped we’d give her Gold Star treatment. Going by the billboards near the ceiling, it meant that she was receiving the highest bonuses.

My partner asked what we were both thinking, “What gets someone a ‘Gold Star’?”

“Call me and you’ll find out,” “Candi” said through labored breaths but with a wink and a sly smile.

“Candi” was sweaty and very pale. Our visual medical impression told us something serious was going on. We got to work quickly putting her on oxygen and assessing her vital signs. When we asked her about her medical history she dumped the contents of her large handbag onto the desk. She dug around through the pile that included her wallet, some keys, a lighter, a pack of cigarettes, a few candy wrappers, and a very large rubbery dildo, to hand us her medication bottles. They indicated she had hypertension, diabetes, high cholesterol, and a thyroid condition. She also told us she had renal failure and was under the care of a cardiologist. For someone who was only 45, she had an extensive medical history.

She opened up her flannel work-shirt so we could put on the little pasties for our monitor and we listened to her lungs, which were clear. When I mentioned this to our patient, whose other ID said her name was Mary Robles, she gave a somewhat resigned expression. “Then it’s my heart,” she said.

She pantomimed the cardiac monitor paddles from the days of old, imitating the recoil of being shocked by a jolt of electricity, as her thumbs pressed imaginary buttons. She’d obviously been through this before, apparently with machinery using 1970s technology. When I told her we used sticky pads now, not the old-school paddles, she nodded sadly, knowing as we all did, that the pads did not hold the same dramatic effect.

Our modern cardiac monitor indicated that her heart was beating erratically and very fast. At the time we didn’t carry any drugs that would fix it. As Mary/”Candi” understood, a dramatic jolt of electricity was the only thing we could do. But we did have some drugs that would help our patient with the pain of the procedure. We just had to call our MD to get approval.

“Bambi” waved over to the phone on the desk and told me I could use it to make the call. She went over to help “Candi” put her stuff back into her purse without telling me about the numerous assortment of buttons on the phone. It was hard to stifle a laugh as we watched her try to wrestle that dildo back into the overflowing purse. My partner turned his head as he attempted the easier job of starting an IV. Making the phone call turned out to be far more challenging.

For the youngsters who have never used a landline I’ve provided this video:

I had some difficulty figuring out how to get an outside line with their phone. I couldn’t find a button that produced a dial tone so I started randomly hitting each one. It seemed that each button I tried gave me access to the phone calls being made from the cubicles around me. Each call I inadvertently eavesdropped on was long past any foreplay discussion and some involved heavy moaning. It was rather eye-opening conversation and when “Bambi” noticed my reactions as I quickly hit other buttons, she stepped in to assist me.

Laughing, she explained that we were in a “Quality Control Cubicle” and a regular assignment at this office was listening in on phone calls. “If the customers only knew…” she said.

With her assistance I was able to get in touch with our telemetry doctor who gave us permission to use Valium to sedate Ms. Robles. He and I both expressed some concern over the procedure we were going to do, given the overall precarious health of the patient, but the MD admitted there was no other option. The patient, herself, wasn’t the least bit worried, however.

“Bring it on, I’m ready!” she said, loud enough for the MD to hear.

“Looks like everything will be fine,” he told me.

Cardioversion is a heart-stopping experience, quite literally for the patient, but also for paramedic caregivers as well. After you sedate the patient and charge up the machine, there’s usually a bit of apprehension before hitting the button that will deliver a few joules of electricity through the benign-looking pads we use now, instead of the familiar paddles seen on screens large and small. Interrupting the abnormal electrical activity going on in someone’s heart carries the risk of stopping it permanently. It has never happened for me yet, at least in someone who was sitting and talking to me, but there’s a first time for everything.

In the case of Mary Robles, sending those 100 joules of electricity to her heart did nothing but cause her to utter a loud, prolonged, moaning-type of yell, which fit in quite well with her current surroundings. I’m sure the soundproofing material of those cubicle walls did nothing to block the sound to her fellow moaners nearby. Except Mary/”Candi” wasn’t faking it, this time.

Her heart went right back to the very fast, erratic, and inefficient way it had been beating before. This meant we would be pushing that button again, this time with a slightly higher dose of electricity.

Our patient was unfazed. “Fire away!” she said after we shot her up with another round of Valium.

We were far more nervous than Ms. Robles when we pushed the button a second time. Once again, we delivered the jolt which brought forth another yelling type of moan. It was also followed with a relieved kind of “Whew!”

We all carefully watched the monitor with anticipation. Thankfully the jumbled electrical patterns organized themselves into a regular rhythm. Our patient knew what this meant even before we told her and she raised her arms and yelled a triumphant, “YES!”

She told us she felt much better and her vital signs reflected it as well. As she grabbed her prosthetic leg she told me that losing her leg made her better at her job. I gave a confused look and she just smiled. I still wonder what that meant.

As we headed to the hospital, she told me that many of the employees there were customers of hers. I asked her how she knew but she just gave me another wink and a smile.

microwave, electronic, oven

Bleeding Hearts

March 12, 2021 /

Almost immediately after receiving our job for an “unconscious in front of a deli”, another call went out to a different unit, alleging that a person with “severe abdominal pain” was on the same corner. Two more ambulances and a fire truck were dispatched to a “Cardiac Arrest” at an address with cross streets strongly implying that they too were headed towards the same intersection.

The EMS equivalent of the Cavalry converged upon that one corner, which had a large deli at its crossroads. A disheveled man was sitting outside on an overturned milk crate. He had a dirty beard and the clear flask of a well-known brand of vodka dangled, somewhat, out of his jacket pocket. Though he glanced at us when we arrived, he made no effort to flag us down. The man was very much awake and seemed to be comfortable. We all assumed he was probably the intended target of all these 911 calls; people often call for strangers who have no idea that someone thought they were in need of emergency care. But we made a good effort to check around and inside the store to make sure there wasn’t someone else, someone with a true emergency, in need of medical personnel.

The man became angry with our efforts to locate patients who might have matched the medical complaints we had been summoned for (seizing, unconscious, and/or in cardiac arrest) and finally announced that he had called 911, not just once, but several times, for himself. He berated our unprofessional-ism for not recognizing that his non-distressed demeanor and lack of effort in announcing himself obviously meant that he was the person in cardiac arrest/having a seizure/experiencing severe abdominal pains.

“I hadda call THREE times! Three! It took you guys almost FIVE minutes. What if this was an emergency?”

“So you’re admitting this isn’t an emergency needing an ambulance?” we asked.

He backtracked a little. “Well, it most certainly IS an emergency. But not the dying kind.”

We let the other crews, who were getting off duty shortly, know that we could probably handle this medical enigma on our own. They thanked us and wished us luck.

The man walked over to our ambulance carrying a large plastic shopping bag that he was very protective of. A diverse bouquet of pungent body odors wafted towards me as stepped into our vehicle.

“Your entire agency should be dissolved by the city. Waste ‘a money. They just need taxis. Free taxis for everyone. No one needs these big trucks.”

We pointed out how our service is designed for medical emergencies and that we are supposed to handle life-threatening conditions.

“For what? They can go to the hospital if they have a medical condition.”

It was no use explaining.

Once inside, the man immediately demanded that we take him to a hospital that was not the close one nearby. He was geared up for an argument but he got none. The hospital he wanted wasn’t unreasonable, although it meant I’d have to try to block the smell a little longer.

“Them nurses there are NASTY!” he told me, as he shook his head. “Ugly too. But that’s the hospital it’s gotta be.” He looked sad but determined, as if he had resigned himself to a task for which he’d be martyred for.

He refused to answer my routine questions about his name and birthday. He was ready for another argument, explaining how I wasn’t entitled to any of his personal information. He went on a long diatribe about privacy issues but I had already put “unknown/refused” on my paperwork. When I asked to take his vital signs he also refused, telling me he’d “sign the paper”, meaning he understood how this all worked. He flipped my paperwork over to the correct section and signed the name he told me I wasn’t entitled to know.

When I asked him about his reasons for going to the hospital he seemed comfortable revealing some of his medical history. He told me he had high blood pressure but he wasn’t taking his medicine because it made him “less of a man”. He said he was “healthy as a horse, and hung like one too”. A big wink, in my direction, accompanied that information.

I also received a very long list of every injury that had ever befallen him. He had TMJ from being slapped by his ‘ex’, he lost a tooth by biting into a biscuit from a large fast-food chain he was currently under litigation with, and he fell down some stairs when he was drunk, which injured his hip. He ended his story by telling me that his last MRI showed he had bulging discs.

I just wanted something halfway relevant to give to the triage nurse. “Am I telling the ER that you have back pain?” I asked.

“No, Moron, I’m telling you I ALWAYS have back pain,” he shook his head again. The torture I forced him to endure…

He called me several other names and titles that illustrated his frustration with our procedures. I was a “bureaucrat” for requesting an exam and interviews instead of just taking him to the hospital where he “needed to be right away”. I was also a “lazy union drone”, an “idiot”, and my favorite, “a feminazi” because I was doing a “man’s job”. He told me I had foolishly “bought into that whole women’s rights nightmare” because I was a “man-hater”.

He went on to complain about my partner as well, for not refusing to work with a woman (“it takes the masculinity away from all of us”). He told us how much he hated the entire 911 system, the city itself, the shelter system, and he went on and on about our previous mayor, who he believed was still “running the show”. He hated “bleeding hearts” and the socialists who were destroying our city. He also complained about the city services he wanted but did not exist, like free taxis. He complained about the amount of money he received from his federal Supplementary Security Income, telling us a monthly total that was more than my partner and I took home with our regular salaries.

“You can’t live on that in this city!” he screamed.

I know man, I know…

One person, in particular, he decided to vent his frustrations about, was the woman who had purchased food for him from the deli. She was another “MORON” for not understanding that he’d been asking for money for food, not actual food.

“Maybe I wanna make my own choices,” he said. Then he referred to her with a really bad slur for a female. “She was like ‘I don’t want my money being used for alcohol. My religion is against alcohol. I don’t want to support any bad health habits…’ blah blah blah. Fucking bleeding heart…Those people are the ones destroying everything.”

As he was berating the woman who bought him the contents of his bag, he took everything out of it to rearrange the items. She had given him a large bottle of water, a big can of iced tea, an assortment of baked goods, a package of socks, a package of t-shirts, tissues, a small bottle of pain relievers, a few bagged snack items, cold cuts, and two large Styrofoam containers of food. She certainly was an evil monster.

“This asshole didn’t even have my food heated,” he told me with all seriousness. “You know, they let you reheat the food from the food counter in there. She must have known, there’s a sign right there on the sneeze-guard. I would have gone in to heat it myself but I’m banned from the store. I spit in a few of their food trays once. I didn’t like their choices and I had a right to express myself when they didn’t take my concerns seriously. Bunch-a bleeding hearts…” It seemed to be his favorite insult.

“Cold food. Can you believe it?”

As someone who ate between calls and on the run, sadly, I was all too familiar with room temperature sustenance.

We had just reached the ER when he was finished fixing the bag up the way he wanted it, with the food containers near the top. He promptly undid his seat-belt, slid over to the back doors, and expertly opened the back lock. Then he made his way over to the hospital entrance without waiting for either my partner or myself. Now that he had reached his intended destination, he no longer needed to have anything to do with us.

He punched the ‘secret’ code into the panel that opened the electronic doors and proceeded to walk past the triage area. A security guard followed him, telling him he needed to wait for the nurse.

“I don’t need a nurse,” he told him. “I know where I’m going.”

The security guard didn’t seem to know what to make of that but decided to just let him continue rather than pursue him any further. Our patient walked right over to a small, closet-sized room that the nurses used as a kind of lounge. It contained a locked bathroom, two chairs, and there was a microwave on a counter.

He opened the door to the microwave, put in the first of his two containers, and pressed the button for “potato”. The man had concluded his ultimate errand.

The entire ER came to a standstill as every nurse in the vicinity noted what was happening. Each face expressed disbelief and anger. They looked around at each other to see who was going to act first. Oh boy, were they outraged!

The nurse who was supposed to triage me marched right over to the small room with resolute determination. She was fuming. “Sir, this room is off-limits to patients.”

“I’m not a patient,” he told her matter-of-factly. “I’m just here to heat my food.”

“Sir! This is a restricted area. You need to leave! You can’t just come in and start heating your potato.”

“It’s not just for potatoes. I’ve got pork that needs to be heated to a specific temperature or I might get sick. There’s also some mac and cheese, some green beans… ‘Potato’ is the most efficient setting on a microwave. You don’t even know how to use this thing, do you?”

“This microwave does not belong to you. You can’t use it. You don’t belong in here.”

“Sure I can. My taxes paid for this microwave.”

“Sir, you don’t understand. You need to leave and get back over to triage,” she said as she pointed to the triage desk. You could tell that her patience had reached its limits.

“No, you don’t understand. This is the whole reason I came here, to use the microwave. I’m not sick. And if I were, I sure as hell wouldn’t come here.” He looked around the ER. “This place SUCKS!” He seemed surprised at everyone’s reaction as if he’d said something perfectly reasonable and they were all getting angry for nothing.

“Security! Security!” the nurse started yelling.

At the same time, another disheveled looking man, who was on a stretcher in the hall took a moment to defend the hospital. “Ahhhh, it’s not so bad…”

A different patient decided to tell our guy, “you don’t even pay taxes.”

“Yes I do,” he answered. “I pay taxes every single day on alcohol. Do you know how much the liquor tax is in this state? It’s robbery. I coulda bought 10 microwaves by now with all the cash I’ve given to this bleeding heart state.” Bleeding heart was, by far, his favorite term.

The security guard, now forced to contend with the disruption he might have intercepted earlier, simply parroted what the nurse was already saying. “Sir, you have to leave…”

“Hold your pie-hole,” said our patient as he dipped his dirty finger into different sections of his Styrofoam container. “I’ll be out of your hair in just three more minutes. Your appliance needs servicing, by the way. For 1000 watts, ‘potato’ should have done the trick by now.”

The bald officer decided to get to the root of the problem. Looking around, he asked, “Who brought this man here?”

I raised my hand.

“What’s wrong with him?” he asked me.

“I don’t know,” I replied honestly. “He refused to provide any information.”

“What? Are you all stupid?” announced the guy I had brought in. “I CAME HERE TO USE THE MICROWAVE.” He yelled each word slowly as if reprimanding a room full of misbehaving children who did not understand. Then, his mood switched over suddenly to humor us. “Now that I’m here, maybe I’ll lay down on one of these stretchers when I’m done. Probably have the ‘itis in a few minutes…” He laughed, seemingly oblivious to the unchanged demeanor of the crowd.

The nurse, who despite her constantly annoyed expressions was one of my favorites, became more of my hero when she decided to take control after giving a disgusted look to the security guard. She shoved past the foul-smelling man and took his food out of the microwave.

“The Jo-velle Deli on Louisiana and DeKalb. Excellent buffet. Smells great, right?” Our guy gave high marks to the establishment that banned him.

The nurse took the food and started marching with it, towards the electronic doors. Our man followed her, although he seemed to be confused about what was going on. When she got outside, the Styrofoam container was semi-tossed onto a broken stretcher in the ambulance receiving bay and she wordlessly went back inside.

After she signed our paper, which was accompanied by a “look”, we went back outside to find our man eating the food that terrible woman had purchased for him. He looked up at us and smiled, pointing to his meal.

As we got in our truck, he yelled at us to wait for him. He would be needing to microwave his other Styrofoam container soon and there was only one other hospital we could take him to now that he was banned from using the microwave at this one.

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