The career archive of a NYC paramedic

Month: April 2021

My First Baby Delivery

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

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.

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