streetstoriesems

The career archive of a NYC paramedic

Page 3 of 6

Holes in Unusual Places

It’s not uncommon for people in movies or on television to tuck their guns into their waistbands. It seems to be done for the expediency of the storyline. Often these characters are in a big hurry and need their hands free to, perhaps, climb their way to safety or find an important document in a file cabinet. It usually works out well enough in the world of crime dramas which is probably why it was emulated out in the streets of Brooklyn. Unfortunately, this amateurish approach to firearm safety coincided with a popular trend of wearing pants so large they sagged well below the waistline. It was a terrible combination that led to a rash of unusual injuries in sensitive areas. Some people learn the hard way, the importance of storing things properly, and how to keep the things you love safe.

We were stopped at the traffic light when there was a sudden banging on my door. Both of us turned to see two teenagers yelling at us through the window I was reluctant to roll down. They had concerned, almost frantic expressions on their faces.

“We called,” they were saying. “We’re the ones who called!”

“You called for an ambulance?” I asked skeptically. The radio had been unusually quiet that night and we had heard nothing come over in our area.

The young men looked at us like we were complete morons. “Yes! We called!” They looked healthy and OK. Would they be directing us to an emergency elsewhere? “Aren’t you here for us?” they asked.

Actually, we were there because our favorite Tex/Mex place was just a few blocks beyond this traffic light. I was working with Orlando, who had more facial expressions for frustrated contempt than there are tacos on the Super Taco mix and match menu. This one clearly said ‘I guess we aren’t eating tonight, let’s see what these two healthy looking guys want’. He indicated to them that they should get out of the street so that he could pull our truck over.

The teens went to the sidewalk and began talking to each other as we let the dispatcher know we had been ‘flagged down’. The dispatcher reacted as if we were telepathic since a call from that location had just popped up on his screen as soon as we mentioned it.

The young men were still engrossed in their intense interaction as we got out of our truck and opened the door to the rear compartment. Their conversation involved a lot of looking around along with suspicious glances at us. We waited patiently for a whole minute and a half before we reminded them that we were standing by. They gave us that wait-a-minute finger that induces people to sigh and roll their eyes. Another half minute went by and Orlando let them know they could call back when they were ready as he started to close the door.

The teens, who appeared to be either 17 or 18 years old, quickly ended their negotiation, with the one in the black hoodie handing the one in the grey hoodie an obvious firearm that he removed from the several-sizes-too-big pants he was wearing.

The young man in the grey hoodie made a quick look around and took off running as best as his fashion choices allowed while the kid in the black hoodie finally made his way to our open ambulance. We stopped him before he got in, asking if there were any more dangerous weapons he was hiding elsewhere in his ensemble. He looked at us like were were crazy since it must have been impossible for us to have witnessed their not-so-subtle transfer only seconds ago. My partner gave him another one of those priceless facial expressions as he asked him point blank if he was carrying. A police car, with it’s flashing lights was speeding to our corner and abruptly stopped as the teen sheepishly told us that he had nothing else on him in the vague-est way possible.

Our black hoodie’d patient stepped in and sat on the bench as a police officer came over. “This is the shooting?” he asked.

“Shooting?” my partner responded. “We were flagged down. You are here for a shooting?”

“Yeah,” he answered. “That’s how we got it. Dispute with a firearm.”

One officer got into the ambulance and sat down in the captains chair as my partner remained on the steps of our side entrance. The patient seemed comfortable and not in any distress at all. We asked the young man what happened to him and rather than present any kind of injury or trauma, he began what was a long tale reminiscent of an action/spy thriller.

Using colorful language, the youth told a story of young love that had soured.

He had decided to end a relationship several months before, after realizing that being with only one woman was far too restrictive. While he was out there enjoying his new playboy lifestyle his former paramour had gone “bat-shit crazy”. She started stalking him and bad-mouthing him to everyone in the neighborhood. He understood that it must have been devastating for her to be kicked to the curb by someone of such high desirability but for a time she harassed him, and any woman he had an interest in, with a high degree of vengeance. But soon he found out that his ex had a new man in her life and he thought he could breathe a little easier. He was happy that she had found someone else to nag and finance her diva lifestyle.

Unfortunately, he discovered that she had taken up with a rival entrepreneur whose business enterprises conflicted with his own. He felt that she wasn’t all that interested in his pharmaceutical competitor. It was his opinion that this was all just an attempt to drive our patient crazy with jealousy and anger. Of course it didn’t work, he had already moved on. But he developed some sympathy for the new man in her life, being manipulated by this shrewd woman. It must not have been easy to be compared to her ex all the time, given she still had a thing for him.

We started growing impatient with this long story that didn’t explain the need for an ambulance, when finally he told us what had happened on that day, specifically.

Our patient had been spending a casual evening with friends. The young man looked up randomly and saw his adversary on a fire escape nearby. He believed that the constant pressure of being unfavorably compared to his girlfriend’s former partner had finally taken its toll. He could distinctly see a gun aimed at him, in fact, it was aimed directly at his ‘junk’, probably because it was yet another area that he couldn’t compete, in our victim’s reasoning.

“Where did he get you?” we asked.

The teen undid his large jeans and they effortlessly crumpled to the floor. He then slowly lowered his rusty red-stained boxer briefs to reveal blotchy sections of mangled genitalia. The 17-year-old wouldn’t look down but I could see him watching the horrified facial expressions on the men behind me.

“This doesn’t hurt?” I asked skeptically, because it definitely looked like it should hurt. One side of his penis was bloody and ripped apart near the base with chunks of flesh unfolded outwards. His penis seemed to have been hit unevenly but there was a distinct round hole to one of his testicles where the bullet appeared to have lodged. There were small pieces of bloody flesh adhered to the boxer briefs. Despite this there was not much active bleeding.

The man shrugged as I uncomfortably tried to bandage or rather, just pack everything together, in his genital region. It’s not something they teach you in the academy, although they probably should. This was not an uncommon occurrence.

Many a newbie gun enthusiast has forgone safety in favor of style. I had already had several patients who had injured their buttocks by ‘securing’ guns into their rear waistbands and several others who had injured the more sensitive real estate in the front. Proper holster usage could have gone a long way in preventing some of this. The accessory was in need of a fashionable comeback.

Guns accidentally discharging into the gunslingers pants often come with incredible stories to explain the unintended holes in their reproductive organs. One prior patient came up with an explanation that actually seemed genuinely plausible. He told us that his enemy had found him at a vulnerable moment, urinating. Other aspects of the story didn’t really line up, like the lack of urine and the angle of the bullet hole (right through, from top to bottom, with no bleeding thanks to the seared edges of the clean little hole). But it was a good story and gave me a interesting chief complaint and narrative for my paperwork: “He shot the pee right out of me.”

Today’s version of not admitting to accidentally shooting their nether regions was the first we had heard with such dramatic lead in. It also, conveniently, took care of the patient’s rival. My partner leaned out the door and surveyed the buildings with the other cop who was still outside.

“That seems like spectacular marksmanship,” he said. “The nearest building with a fire escape is more than a full block away.”

“He knows how to shoot,” our young victim agreed.

“His accuracy is truly amazing,” my partner nodded. “With a handgun, not a rifle, right?” The cop who was in the back with us looked out of our truck as well and then just sat back down with a smirk, shaking his head.

“That was definitely some impressive aim,” I agreed. “He totally bypassed your pants. Not a hole anywhere. You can wear these jeans home when you get out of the hospital.”

“Well, you see,” the man explained. “I like to wear my pants big and well, they were kinda low when he got me.”

“He didn’t damage your underwear either. Were you exposing yourself?” said the cop with a tinge of sarcasm.

“No, no!” said the teen, getting a little nervous about his story unraveling. He assured us that physics existed somewhere that could verify his accounting of events. To get off the topic of his shooters pinpoint accuracy, he gave his assailants name to the police officer with a directive to, “make sure you get him.”

If the sniper-with-CIA-skills story didn’t convince us he was lying, the fact that he gave up his shooter did. Having spent much time in violent neighborhoods we knew that gang members never give up information on their assailants to the police, choosing instead to retaliate themselves. But our victim was very enthusiastically telling the police his name, address, and the locations and times where he could be picked up.

The cop rolled his eyes. “Why don’t you just admit your gun discharged in your pants. Everyone here knows it. You’re not convincing anyone.”

The young man put on his best look of fake-not-so-fake outrage. “What?! You think I’m lying? I’m not lying. I saw a man shoot me and I even know who did it. I will testify in court. This is an easy job, man. This could be your ticket to detective. I think you just don’t want to do your job so you SAY I’m lying. Well, can you believe that? Everyone I know says PD is lazy, but not me. I’m always out there saying PD got a tough job, PD out there putting their lives on the line… then I turn around and see this, that they’re all right about you. Cutting corners, not investigating anything. I may need to contact the review board.”

We were all kind of smiling during his tirade, even the cop, and when it was finished, even the kid. But he still wasn’t going to say it out loud and wasn’t going to recant his version of events. His version was far more spectacular, I’ll admit.

An Unsung NYC Hero

It was a warm Saturday in July and crowds of revelers were everywhere in the newly gentrified streets of Bushwick. Both the older dance clubs and the newer bars had crowds of young people congregating around them. Not a single seat was empty in the outdoor seating areas of the new trendy bistros that had opened up. Friends walking and talking greeted each other with loud, celebratory platitudes as if reconnecting after long periods of time apart. Traffic was at a crawl as their passengers took it all in on the way to their destinations.

We had no where to go and my partner was enjoying the plentiful eye candy of scantily dressed women as we drove around. I was focused on women who had put obvious time and effort into the way they looked walking hand in hand with men who were wearing the same stained t-shirt and jeans that they had probably rolled out of bed in. My partner and I would point out people that matched our interest despite knowing the other was only truly looking at our own particular fixation. There was much to watch and see, while we made our way down the long blocks of eateries and bars, appreciating the lives of people who didn’t have to work on weekends, or at 1 am.

We eventually found our way onto a long avenue of popular social activity. We trailed behind a souped up car whose two male occupants had decided to provide commentary to every woman walking nearby.

“Yo, Mami! Let me put a baby in you!”

We figured out early on that offers of semen denoted rare approval while most of their loud yelling was reserved for those they were unwilling to reproduce with in their current state. The unasked for critques were exclusively devoted to women. The men wearing stained T-shirts and sporting unruly beards would have to seek unbiased assessment elsewhere.

“Is that a bird’s nest? Your hair looks like a bird’s nest. I’m telling you that I don’t like your hair.”

“It’s a shame all of that thickness is around your belly and not your ass where you need it.”

“That face is mad ugly but it’s ok, girl, I can’t still bang you from behind and I won’t have to look at it.”

With all this charm and personality it was hard to imagine these two men were single and their car wasn’t being swarmed with multitudes of attractive women begging for their attention.

Eventually they took advantage of our tailgating ambulance by incorporating it into the statements directed at unsatisfactory women.

“Even the medics can’t fix what trauma happened to your face.”

“Maybe the ambulance can fix what that ugly stick did. I doubt it, though.

We felt it was important to follow them proactively since we felt it likely that one of them was going to get punched in the face eventually. I at least hoped that one of them would get punched in the face. It might even be helpful from a medical perspective if we were nearby for that..

Much of the crowd were speechless, regarding the comments with shocked looks of outrage. Some of the recipients of the harsh critiquing made hand gestures or shouted back expletives, which made the motorists howl with laughter. Here and there, individuals smirked or outright laughed. The two men in the car seemed to take great enjoyment from their audience.

There was a steady stream of yelling until another woman caught their attention. She was by herself with a serious expression on her face and seemed to be determined to reach her destination. The men became laser focused on this one woman who failed to inspire any sexual desirability in either of them. The loudmouth in the passenger seat decided to let her know why.

“Holy cow, girl! That outfit may have been cool 30 pounds ago but now you gotta put that back in the closet until the Slim Fast kicks in!”

She didn’t even glance in his direction and just kept walking.

“Hey girl, I like my women thick but you really pushing the envelope!” Shockingly, she didn’t seem to be too interested in being one of his women and just kept going in the same purposeful way of walking that she always had.

They continued yelling stupid things at her. Everyone was looking in her direction and waiting to see what she did. But she did nothing, just kept walking. Some other women were also walking nearby but the two men decided to devote their efforts on the one who ignored them.

She made it to a corner where a food cart had been set up. She stopped there and appeared to order something. The car in front of us paused at the green light there and used the opportunity to harass the woman further for getting something to eat.

“Man, you just can’t help yourself, right? No man wants you so you eat, and then no man wants you because you eat so much. That’s your problem.”

They laughed and laughed ignoring the honking of horns and the toot of our siren.

She received her order very quickly and emerged from behind the food cart with a huge oversized plastic plate piled high with food. She also had a large paper cup with a cover loosely placed on top. In the beam of the streetlight I could see the steam coming off whatever was on that plate.

The passenger in the car made some snarky comment about the super-sized order and how her clothes wouldn’t be able to handle any extra expansion.

What followed was a spectacle worthy of media broadcast on the level of the moon landing. I think I join every other person in the vicinity who was witness to it in remembering all the details about that time and date, what we were wearing, our exact location, and who we were with.

It happened relatively quickly. Walking purposefully over to wide open window of the passenger side, the woman threw the plate and everything on it, directly onto the vocal man in the passenger seat. Up until the moment the food was airborne the man had maintained a stream of demeaning commentary. Perhaps he was distracted, thinking of more insults to hurl before he could figure out what was happening. But instead, she had turned the tables on hurling things. She also thrust the contents of the large cup at the driver, tossing the empty container onto the hood of the car, where leftover contents oozed and began to solidify, thanks to the heat of the engine. Then she simply turned and walked away. The woman’s face never once deviated from the purposeful, serious expression she had started out with. My hero of the day disappeared into the crowd of awestruck pedestrians, vanishing forever.

It had been done with such purpose, as if evening the score with misogynists had been her intention all along. It was unlikely given the randomness of those two men out at that particular time but I’d like to believe the universe had a plan that day. My heart beamed in admiration for this wonderful, anonymous woman who had bested these crude and nasty men.

I cheered something out my window that I hoped the woman would hear and I started clapping. I was joined in my applause by a few other women on the block but mostly everyone else just stood around stunned, but also smiling. I was so proud of this courageous woman who had returned the unfavorable feedback the men had been dishing out. It was a beautiful moment of well-deserved vengeance.

Very soon public attention was redirected at the men covered in hot ethnic street foot. Fingers were pointed and loud laughter could be heard from far distances.

The passenger door of the car opened and I watched as food rolled down the man’s chest and lap and onto the street as he got out and stood up. The tossed components still emanated with fresh-from-the-grill steam.

The driver was even more infuriated. He got out much quicker, looking at his chest and flicking off whatever had adhered to his white linen shirt as if it were poison. He removed the cup from his car and tried to wipe away the congealing food before thinking better of doing so with his finger.

The passenger looked directly at me and yelled “Did you see that? You saw what happened right? Look at me!” He called the woman a rude expletive, considered by many to be gasp-worthy, and rather than try to find and confront the woman who had made him the object of ridicule and mirth, he marched over to me.

The astonished man presented me with his right arm which was covered in a thick, brownish red sauce with little pieces of rice and lettuce still stuck here and there. The combination smell of the food and a very powerful men’s cologne wafted into the cab of our vehicle and made me a little nauseous, but also a little hungry.

“Look! Look! I’m burned!” he told me.

His arm was slightly red but it was difficult to tell underneath the generous helping of an unknown culinary specialty. The brown/red sauce was on his face and chest. His shirt, formerly, mostly white and made of linen, was covered in spackled colors of Asian food. There were long noodles stuck along the low V created by the few buttons on his club-wear that were closed. His particularly long chest hairs made an ideal trap for the smaller sized ingredients to adhere to. I wondered what kind of dish had both rice and noodles. It also contained a generous helping of an unusually smelly chili-type soupy sauce. The noodles alone quickly had me craving carbs and I made a mental note that I would have some before the shift was finished. But for now I had an irate man demanding something be done for the injury underneath his spilled entrée.

We went to the back of our ambulance where I doused the man with some of our water. After his face and arms were wiped down there didn’t appear to be any significant injury but the man insisted that he had been scarred. He searched his skin for evidence that his flesh was not peeling away.

His friend came by and remarked that he thought the food that was flung at him had been chili, but it smelled different. He was angry that the car he kept impeccably clean was now covered in unknown food from what he presumed was an unsanitary, unregulated cart. He began musing about how soon he could get his vehicle detailed and wondered if the smell could ever be fully eradicated.

His friend was outraged. “I’m burned and all you think of is that car. I could be scarred for life. Disfigured, even.”

“That’s really awful,” I sympathized. “You know how scars affect your attractiveness. Big, big turn off for women. Almost nothing worse. What will all the ladies say behind your back?”

The man considered my sarcasm with a serious aura of disappointment, and possibly nervousness. He continued to mutter curse words about the devil-woman who was now the bane of his existence. Despite his protestations the man did not seem to have any kind of burn. But he insisted on being taken to a burn center for evaluation. We didn’t mind because the hospital he requested was surrounded by many still-open take-out places where we could find some Asian noodles of our own.

So we headed to the burn center where the mostly female staff there had many amusing things to say about his imperceptible burn and about their shared loved for Asian cuisine.

Help Me Fulfill My Fantasy

It was the first warm day of spring and my partner was driving. I knew she would make her way over to the water so we could enjoy the beautiful weather people watching, as we sat by the walking path along the East River. Despite not having a small screen to stare at, here there was much for two young EMTs to see during their downtime between calls, including helicopter flyovers and ships passing along the river. The sun had brought out many of its worshipers, grateful to experience a spring thaw after a long, harsh winter.

My partner was a vivacious, happy woman who exuded friendliness. She waved and smiled at passersby, occasionally cheering on runners with an encouraging “you can do it!’ and blowing kisses at babies being wheeled by in carriages. A man walked by, taking his shirt off, and she called out an appreciative “looking good!” She spent much of the morning being an excited cheerleader for midtown Manhattan’s river walking public. I didn’t have my partner’s endless energy but I joined in for the occasional wave and clapped on the runners struggling during their first foray outside after what I assumed was a long sedentary winter. I would look up from my novel or magazine or whatever it was we entertained ourselves with, back before the internet took over everything, and added to a double thumbs up or an encouraging cheer. When the’ looking-good’ guy came back on his return trip I joined her in a wave of encouragement. He acknowledged us with a big toothy smile.

We were lucky to have a slow morning. Our only assignment had been cancelled even before we had put the vehicle in drive. It was a lovely, lazy day and I was happy that humanity was finding ways to enjoy it that didn’t cause them to need an emergency room. But then, we finally did get called for a job nearby. It came in as an ‘unknown’. The caller had hung up before contacting the dispatcher who would have asked some questions to better prepare us for what was on the scene. We pulled up to a building that we later found out was staff and student housing for a local university. After taking out our minimal equipment requirement at the time, we headed inside for one of the most bizarre events of my career.

We knocked on the door and at first I didn’t recognize him, but my partner did. “Oh wow! We just saw you by the water!” she told our still shirtless ‘looking-good’ guy. “What’s wrong? What happened?”

We walked into the apartment and noted that a small table had been set up with two place settings. “Hi,” he told us. “I’m Dave, by the way. Nothing’s wrong, actually. I hope you don’t mind that I called 911 under false pretenses. I thought you pretty ladies deserved a nice homemade lunch. I just wanted to surprise you, and do something nice for two of our hardworking civil servants.”

Well, that is a surprise,” said my partner. She was much more outgoing than I was. I didn’t really know what to make of this. Quite honestly my internal creep detector alert was starting to ping. By the look on her face I felt my partner’s was pinging as well. But she was very cool about it, as always. I learned everything about remaining calm under pressure from her. She looked at the neatly set up table with its sparse offerings. “So you really made us lunch?” she said cautiously, looking around and studying the surroundings, as I was.

“Yes!” said our excited friend, giving us his biggest, toothy smile. “Sit down. I hope you like tuna fish. Who doesn’t like tuna fish sandwiches? I’ve got a secret recipe for the mayo. Don’t tell anyone, but my special ingredient is chili powder. Tell me if you like it.”

My partner and I traded suspicious expressions. There was no way I was eating that sandwich.

Thankfully she took the lead because I was seriously paralyzed by indecision and the thousand different thoughts that were racing in my head. “How did you know you would get the two of us?” she asked. “I mean, they could have sent any unit here, not just ours.”

“Well, I thought of that,” he said, proudly. “If a different ambulance showed up I would have told them that the person I called for had left already. Then I’d wait a little while and call back for you guys. Come on, sit down. I’m dying to hear your opinion on the chili powder.”

My partner cautiously sat down for some reason, as did I. I felt that we were employing the same technique we use with violent psychotics, making them think we are comfortable and pretending to go along with everything. The man had positioned himself between us and the door and I felt that it was probably the smart thing to do for the time being, given the circumstances.

“The dispatcher is paying attention to our unit. We can’t really just go and have lunch at someone’s apartment,” I told him. “And we have to fill out paperwork for all our assignments. So I have to ask, are you going to want to go to the hospital?” Look at me, being ever the true medical professional.

“Nah,” he said. “Give me your A. C. R. [ambulance call report] I’ll sign the R. M. A. [refusal of medical assistance] See, I’ve done a little research.” Now that was a bit stalker-ish and disturbing, especially given the inability to instantaneously Google things in those days. He came over and took my paper that I had held out for reference. He flipped over the pages, folded it down, and signed his name with a flourish at the exactly correct area on the form. Then he sat down on a recliner and folded his hands on his stomach. He smiled at us proudly. He had covered so many of the bases. What else had he thought of?

“You don’t think this is all a little strange?” said my partner. She seemed to be losing her patience.

“Well,” said the man, slowing down his speech pattern now that he was comfortably seated. “I don’t think it’s all that unusual. There’s a long list of fantasies that start out this way. Haven’t you ladies ever thought about something like this? A good-looking guy calls 911 but he’s not really sick or injured, he’s just interested in the hot chicks driving the ambulance…”

His research wasn’t as thorough as he made it seem. The nerve, giving us that insulting “ambulance driver” title. How many times do we have to explain it? Look here, asshole, we are medical professionals. We do more than just ‘drive’ the ambulance.

“So you’re just looking to fulfill some kind of twisted EMT fantasy?” my partner spoke to him the way I imagined she spoke to her children when they misbehaved or did something stupid.

“Yeah! Now you’re getting it! Come on. You can’t tell me you’ve never thought about it. Here’s your chance. I set it all up for us. I’ll go any way you want it.” He started undoing his belt. I started thinking about the emergency button on our radio. I also considered how our chair would make a formidable weapon. Maybe this was how porn videos started but it was also the way slasher/killer/horror scenarios played themselves out as well.

We both stood up and I started inching my way to the door. My partner, however, moved closer to him so she could berate him while looking down at him. I’m not sure if it was intentional, but it was an excellent psychological technique.

“I can’t believe you think all you have to do is call 911 and we’d just jump on top of your junk. Has this ever worked for you before? Have you experimented with other porn genres? Cleaning ladies? Pizza delivery?”

I didn’t think she was really looking for an answer but he interrupted her with a big, resounding “YES!” He told her that he had called for a maid, through a cleaning service, and specifically requested that she wear that silly outfit which makes actual scrubbing and dusting cumbersome and difficult. The cleaning service had the last laugh though, because they sent over a 65 year old balding woman with a thick Slavic accent, who was 6 foot 10 inches and weighed 280 pounds. She came wearing the specified silly outfit. And even so, he had considered it. He though she was into him and probably would have gone for it.

“Well, I’m sorry Mr. Fantasy Man. I’m sorry that you don’t have anyone special that you can act these things out with, someone who you can trust and share a real life with. We are going to have to turn you down. This isn’t something you should have expected to happen. We are going to go now. Please don’t try to bother another crew with this same idea. This was really kind of sick on your part. Maybe there’s something wrong with you. You could probably set up this kind of scenario with someone if you went about it the right way. There are professional prostitutes that specialize in this.”

“Are you kidding?” he told her. “There’s a virus going on. Prostitutes are a really irresponsible choice.” It was the height of the AIDS epidemic. I’m glad he had given it some consideration in his thought processes.

“Or you could get a girlfriend,” my girl continued. “But maybe your obsession with fantasy creeps women out and keeps you from finding a real partner. I hope you get the help you need.”

She followed me out the door and when the door closed we ran down the hall and all the way down the stairs. Once in the lobby we laughed. All day long we talked about what had happened hysterically.

“Wanna get lunch?”

“Anything but tuna fish.”

We laughed as I wrote up the paperwork. I remember filling out the ACR with a semi-accurate representation of what had actually happened. I even think the ‘chief complaint,’ which was a big bold box at the top of the form, stated something like “Help me fulfill my sexual fantasy.” It just proved to me that nobody really reads those things.

Even now, when I see her occasionally, we bring up the “tuna fish man” and it causes us to laugh automatically. What had made him decide on tuna fish? It seemed like an unusual option. It hadn’t been all that appealing, despite his secret ingredient. Just a thin layer of that smelly fish on white bread and no accompanying chips. I don’t even think he offered us a beverage.

We were very grateful that it had been a pretty benign experience and could have ended much worse. I wonder how many other female crews have had to deal with this as well.

About two or three weeks later we were parked somewhere, not by the water, and Dave, our fantasy porn guy, tapped on our window.

“Hi ladies,” he said. “Any change of heart?”

“I can’t believe you’re here,” my partner told him, shaking her head. “What made you knock on this window? Why wouldn’t you just keep on walking?”

He just smiled slyly. When he didn’t say anything she continued telling him how hopeless his idea was, what a pervert he was, how inappropriate that ‘lunch’ had been, how she felt sorry for him. She went on for a few minutes, waited for a response and got none. Finally she said, “Well? Are you just going to stand there and be humiliated? Don’t you have anything to say?”

“What if I told you I enjoyed being humiliated? I especially liked having you do it, the way you did it… What if I said that I had never been so turned on when someone humiliated me? And don’t get me wrong, being humiliated by a woman I’m sexually interested in, that’s high on my list of turn ons, but you’re better than anyone at telling a man off. You really are. Your tone, your face, you didn’t even have to mention my penis and I was already hard. Seriously, you’re even better than my mom and I’ve got some weird ideas about her too…”

“Good Lord,” she said, as she rolled up her window.

“YOU SHOULD BE FLATTERED!!” he yelled as we drove away.

The Newly Divorced Man

Earlier that day, George had been at his lawyer’s office finalizing his divorce from the “shrew who sucked the youth out of me”. He had gotten married later in life, after what he remembers as a pretty successful bachelorhood. His family and friends, female family and friends he noted, had hounded him for most of his life to settle down and when he got older he admitted that getting married sounded like the right thing to do. But George was a free spirit and matrimony had too many restrictions. The dissolution of his unhappy marriage had been a long time coming.

He decided to spend his first night of legal freedom by spending some of the money had hidden in a safe deposit box he acquired shortly after he was married. He felt that his wife was far too vigilant about his spending so when he had a little extra he would hide it and, subconsciously knowing that divorce was in the cards, he built up a little freedom fund. Now that he was single again, single for good, he planned a long evening of good food, hard drinking, and some gambling-all things his wife had hated. He also used a website his card-playing buddies had told him about, to find a temporary lady friend.

At some point in the early hours of the next day he woke up to paramedics and the hotel manager looking down at him at his residency hotel. He was naked on the floor and handcuffed to a pipe attached to the baseboard heater. There were random specks of glitter on his oiled body and he smelled of alcohol and urine. There was also a slight scent of seared flesh. His shoulder and part of his upper arm had been leaning against the heater for so long he had developed second degree burns. The shoulder was also severely deformed by an obvious dislocation.

His date had called 911 for someone having multiple seizures at the hotel. She had described him as an elderly 70 to 75 year old man, although George was only 56. She also robbed him, apparently, taking George’s watch, jewelry, and cash, even his lotto tickets. The hotel manager recalled seeing a “working girl” leave more than an hour before. He offered to go to his office to get a handcuff key that they kept for situations like this one. “It happens more often than you can imagine,” he told us quietly with wide eyes and eyebrows raised. The manager also approved of our latex gloves, saying that housekeeping services were sporadic and not very consistent.

“It was a night to remember!” George told us triumphantly, when asked about what happened. The diamond in his gold front tooth sparkled as he gave us his big wide smile. Unfortunately though, he didn’t remember many of the details. But despite being handcuffed to a heater, robbed, burned, and experiencing what looked like a painful dislocation, George was in good spirits. He conceded that he probably did have a seizure since he was incontinent and his seizures usually coincided with nights of heavy drinking. His blood pressure was also very high, and he told us he did suffer from hypertension. When asked what he took for it, he simply said “blood pressure pills.” He didn’t know what kind because his wife had always picked up his prescriptions from the pharmacy and when she did, she arranged them into multi-day containers with the days of the week listed on the sections. He hadn’t taken any of his medications since he moved out, more than four months ago. He also didn’t know anything else about his medical history besides the seizures and high blood pressure. “My wife was the one who kept dragging me to doctors and made me take take all those pills,” he said distastefully, as if it were yet another terrible thing his divorce lawyer had liberated him from.

I wondered how the ex wife was celebrating as I looked around the dismal room George was living in. The manager had told us the hotel had an assortment of leasing arrangements. “Some stay an hour, some stay a day, and other stay longer,” he told us. Although George had a dresser, it looked like he hadn’t unpacked, as he appeared to be living out of two suitcases that were open and set up on stands. The queen sized bed mattress was covered in a yellow stained zipped up covering. It was bare except for a disheveled sheet and two pillows. The walls were covered in a dark wood-like paneling and the floor was covered in a stained, green low pile carpet. George had a small refrigerator and a hot plate. On a small shelf he had a bottle of ketchup, a bottle of hot sauce, two boxes of Capt’n Crunch, and a loaf of white bread, the kind I thought they had stopped making after I left grammar school. On the nightstand he had a few bottles of liquor with various levels of liquid in them, several dirty glasses with cigarettes extinguished in them, and a dirty fork.

George seemed genuinely content, despite the current situation. Not once did he complain about the pain to his arm or shoulder or the IV we gave him in case he had another seizure. He expressed some intermittent discomfort when we splinted his shoulder and when we went over bumps on the way to the hospital but he assured us “it’s not your fault.” He was even sympathetic towards the woman who robbed him. “At least she called you guys,” he said. ” Who knows how long I would have been laying on that floor for if she hadn’t?”

We chose a burn center to go to because it was also a trauma hospital but it was a little bit of a longer ride. Along the way George told me about his happy outlook for the future and how he’d never get married again. I implored him to follow up this hospital visit by going to all the doctors his wife had previously dragged him to. I tried to appeal to his motivations by suggesting that he didn’t want to give his ex the satisfaction of seeing him in a wheelchair if he had a stroke. He considered it a salient point and I was hopeful. I also suggested that he get tested for STDs and he gave me a sly wink and a smile.

At the hospital the nurse asked George how he had damaged his arm. With a big smile that showed off the diamond on his front tooth he said, “By living the freestyle life of a single man!”

Free Onion Rings

A large, unconscious man had wedged himself in the corner stall of the woman’s bathroom of a White Castles restaurant. He was barely breathing and a needle was still in his arm. He wasn’t rousable and we wanted to fix his respiratory effort sooner rather than later. The hope also was, that if we get could wake him up with Narcan, he would be in a better position to unwedge himself, or at least assist in the process. Narcan (naloxone) could reverse the effects of the heroin he had just shot himself up with. As the smaller partner, my larger partner had rationalized, it would be better if I was the one to try and maneuver the way in to provide the transformative drug.

In those days there was no aerosolized, nasal naloxone, as there is now, and the only way to administer it was through an IV or with an intramuscular injection. I went in, syringe in hand, to try and access his shoulder. I wrestled with his clothes to clear a path for my needle and did my best to create a sterile field. It was a cramped space and I was trying very hard not to touch anything I didn’t have to. I was ready to hit him with the naloxone when I was suddenly distracted by a commotion behind me. A woman had shoved her way into the bathroom and my partner was arguing with her.

“But I gotta GO!” she yelled angrily.

“You’re gonna have to wait. We’re busy in here.” he answered.

“Well, can’t she move over?” she pointed towards me. My legs were extended into the connecting stall, impeding her intended use.

“Are you kidding me?!” my partner yelled exasperatingly.

“Am I being asked to move?” I asked. “Because I’m not going to. Look, he should be out of here shortly, just give us a few minutes.”

“I don’t HAVE a few minutes! I got to GO!” she yelled. “That man isn’t even supposed to be in here. This is the ladies room. Why is this my problem?”

I went back to lining up my bullseye and my partner continued arguing with the woman. Eventually the manager stepped in and was able to lure the woman a few feet away, but only for a few minutes, with the promise of free onion rings. She stayed nearby however and watched what we were doing, the whole time bouncing around as if her bladder were to imminently explode.

We were able to get our patient awake and breathing. When he started to come around he became the object of the woman’s derision. The onion ring promise only applied to us, my partner and I. If she was going to leave the patient alone more items from the dollar menu would have to be thrown into her take out order.

“Didn’t you see the SIGN?” she yelled at him. “Ladies room? See the girl in the picture, she’s wearing a big wide dress.”

Our patient didn’t know what to say. He’d just been whipped back to reality against his will, a reality he’d tried to escape not so long ago.

“The men’s room is right next door,” she continued. “Was it too far of a walk?”

The man looked at me for assistance. I had none to offer in this situation.

“You junkies, always gotta use the ladies room,” she continued. I had to admit she had a point. I don’t remember giving naloxone to anyone passed out in the men’s room, though I probably did. There were so many fast food restaurants and so much naloxone being administered there, who could remember them all?

“There’s never a line in the men’s room,” she said to me, and again she was right. Whether at the airport, a concert, a rest stop, or a fast food restaurant there is always a line, while the men in our lives just waltz right in to their area and emerge while we’re still waiting. It a source of frustration for me too. I’ve never parlayed this into free food but I was going to see if there was a way sometime.

“Why they gotta use OUR room? They got like 20 urinals and 10 stalls and all we get is like, TWO. Anywhere you go, men get all these toilets and all these urinals and we get TWO. There’s something going on. The people who design these bathrooms hate women.”

We were getting into conspiracy-theory territory here. I encouraged our patient to get up and start moving.

I had to internally give some kudos to this woman. There was a good possibility, based on experience, that our patient would have directed some of his irritation at having his high eliminated on us. Her wrath at being inconvenienced had redirected his attitude around and he was very cooperative with us, even agreeing to go to the ER. Perhaps he was just trying to escape this woman. Hopefully he made a mental note to use the mens room next time he wanted to get high in a burger establishment. It’s unlikely he’d get an argument there.

“You know I’m right!” she continued yelling as we made our way out.

Overdoses in fast food restaurants are a dime a dozen but many other call types find their way into franchise eating establishments. Fried food lends itself to medical emergencies but usually the cause and effect isn’t so immediate.

Not very long after that we were called to a seizure in a different hamburger franchise. He had collapsed in front of the cashier and the fact that he was still seizing when we got there was very concerning. It was a true emergency.

But one hungry couple couldn’t wait for us to pack up and leave and went over to the register to order a meal. The woman behind the register was dumbfounded.

“I ain’t waiting on those long lines while you’re open,” the woman said. The cashier indicated that she wasn’t “open”. “Then what are you doing now? You ain’t EMS.” There was a certain logic to it, but we were EMS and she was most certainly in our way.

“We’re working here, you need to get out of our way,” my partner had a great tone that he used. It was a mixture of condescension and exasperation.

“I don’t think you understand how hungry I am. I got to eat. Now, or else you’ll be taking me when I pass out!” Apparently his tone wasn’t going to be enough in this situation. Maybe because of her persistence we really could understand how hungry she was. But we really didn’t care.

Our patient having the seizure was difficult to manage. With his constant movements picking him up to put on our stretcher was an arduous endeavor. We had quickly started an IV and were attempting to get medicine to stop the seizure. In those days it involved calling a doctor on the phone (these days there are standing orders for giving it).

I suggested she or her boyfriend, who had retreated, could help by holding one end of the stretcher to keep it from moving. “I don’t work for you,” she said. But then she reconsidered. “If I help them will you give me a free onion rings?” she asked the cashier. When the cashier agreed she also asked for two shakes and large fries. Her request was granted. It was almost enough to make you cry in laughter, if you weren’t already exhausted from trying to lift a heavy person having a grand mal seizure. The woman got on one side of the stretcher and held it. She congratulated herself for keeping our stretcher from rolling away and got her prize. “You should hire me!” she said.

Yes, because you’ve been so helpful.

As we rolled our stretcher away I could hear her arguing with the staff again. She said that her entire order should be free, because of the great assistance she had provided. She thought the chain restaurant would reward her with everything she wanted. She had risked her health, for heaven’s sake. They should be bending over backwards to make her feel special. Her picture should be on the wall and she didn’t even work there. For heavens sake, she had just saved the life of a man in their restaurant and they couldn’t give her a free meal?

I’ll Meet You Upstairs

I learned how poor the range of our radios was the first time I got stuck in an elevator. We were only trapped for about 10 minutes or so but in those 10 minutes I learned I had a crippling case of claustrophobia. Being trapped made that tiny little room feel like a coffin. The only scenarios I could imagine involved never getting out, as if we had gotten stuck because of an apocalyptic event that had also wiped out any possibility of rescue. You don’t even need an apocalyptic event to be frantic. One woman in China died because she had gotten stuck in an elevator and no one had looked for her.

Not long after, I watched an old French movie called Elevator to the Gallows which has a malfunctioning elevator as a central theme. After these two experiences I decided to do some research on elevator mechanics, vowing to always carry the tools with me that could get me out of a broken elevator. To my horror, I discovered that there is nothing I could bring that would be of any help. Not even that occasional hatch in the ceiling could be an option as it can’t be accessed from the inside (now you know too). You are completely at the mercy of your rescuers. This is terrifying to a new self-diagnosed claustrophobe in a city of tall buildings.

Now that I’m a lieutenant, unless there’s a pressing need for me to hurry, I’m taking the stairs whenever possible. My crews know when I enter a lobby and they’re waiting for the lift that I’ll meet them upstairs. Many believe it has to do with the Fitbit on my wrist and my obsessive need to get my steps in, but the real reason is irrational fear, mostly. Especially now, since technology has greatly improved the capabilities of our radios and cellphones so that the conditions that led to most of my fears have been alleviated, although some still do exist.

Not long after I watched the French movie, I was on a call in a tall building. I had gone back downstairs to get some things from the ambulance. The patient was probably going to RMA [refuse medical assistance] and we wanted another EKG. We had needed inconsequential things, like more electrodes and another PCR (pre-hospital care report, which in those days was paper). I had grabbed nothing important that could have been used as a tool or a weapon. I was in the elevator by myself pushing the ‘close’ button when a man got in as the doors were closing. He gave me a dirty look and said “I saw you hit the close button on me.”

“I didn’t see you,” I said.

“I don’t believe you.” When he got in, despite all the available room, he chose a spot right next to me. I moved away.

He then started looking at me in a way that made me very uncomfortable. As he stared at me through his thick glasses I noticed he had a large red stain on his grey shirt that was hard not to look at questionably. He stared at me as if he had tasted something awful and was considering spitting it out. I looked ahead and hoped it wasn’t the blood from a previous victim on that shirt.

We shared an awkward silence until the elevator jumped slightly and then refused to move. Panic immediately set in. My new roommate gave me another look of disgust, as if I were to blame. I tried very hard to pretend I wasn’t imagining that this loser was going to be the last person I would see before dying of starvation when no one came to get us. I tried hitting the button for the floor we were on but nothing happened. I hit a few other buttons on the wall (not all together, another tip I had learned). None of them did anything. The emergency button did, however, produce a short lived alarm. There’s supposed to be a phone in the elevator panel somewhere that you can use to summon help but this one didn’t seem to have one. The man, I suppose it’s human nature, also tried hitting some of the buttons. When he tried the emergency button there was no alarm. He gave out a big “oh that’s great” and looked at me as if my attempt had broken it. I tried calling someone, anyone, on my radio but there was no success. He stepped sideways to get closer to me. I stepped forward to get away.

He got directly in front of me, seriously invading my personal space. I could smell his awful breath. “I’ve got asthma,” said the man.

“Congratulations,” I replied, backing off.

“No really,” he said. “Right now. Look.” He proceeded to hyperventilate. He was a little taller than me and overweight. He had browinish-blond hair in a strange kind of wave pattern all over his head. His thick glasses had wire frames and the little nose pieces were dirty enough for me to see, thanks to his incessant need to stand close.

“You’re hyperventilating,” I told him.

“No I’m not,” he said in a perfectly non-breathless sentence. “No, it’s asthma. Do something. Give me some of that stuff.” He gave me a look that said he meant business.

“I don’t have my bag,” I said, pointing out the obvious. “It’s upstairs.” He immediately stopped hyperventilating. The uncomfortable creepy vibe he gave off was setting off alarm bells with my already heightened fear instincts. I didn’t want him to think I was afraid and holding it together was maddening given how the stuck elevator situation was more than enough stress for me without having to worry about who I was trapped with.

He then moved slightly closer to me. I jumped away. “What the hell!” I yelled. “Stop it. You stay over there, and I’m going to stay over here.”

I took my radio and tried again. I switched channels and also tried using the point to point feature. I used every frequency. Nothing worked. I had a cell phone but the range in those days was also questionable in such a small space and I had no signal. But signals varied depending on carriers and I could see a phone sticking out of my neighbor’s pocket.

“Try your phone,” I asked.

“I don’t have one,” he snipped at me, using a very different voice. “You’re some real privileged bitch if you think everyone has a phone. Fuck you.” I was mortified.

“What’s that in your pocket?” I asked.

“My phone.”

I felt that I was starting to hyperventilate myself so I tried to concentrate on a fixed point on the wall. I tried to reassure myself that my partner upstairs wouldn’t leave me here, that he had probably already called the firemen who would be here in no time to break open the door. People must be waiting in the lobby who would also call. Help must be on the way, right? I just needed to keep my eye on the crazy person I had no way of getting away from. No possible way of escape. I told myself that I was pretty strong. I could take him, I thought to myself. I knew the idea was a bit inaccurate. For some reason, crazy people, when they’re fighting you, possess an unfathomable amount of strength that has nothing to do with their size or conditioning. I have had a lot of experience in these matters. I remembered a 16 year old girl on my first EMT rotation, who weighed possibly 95 lbs at most, who put three police officers and one of the EMTs I was riding with in the hospital with serious injuries. This guy was taller than me. What would I do if he tried something? I had a rolled up piece of paper and some electrodes. Oh wait, I also had my pen, my beloved gel pen in my pocket. Could I use it as a stabbing instrument if he attacked me? It would probably break. It was plastic, cheap disposable plastic. Everything is made to break and be disposable, what a sign of our times. I wondered what he was capable of. What about that stain? Yes, what about the stain…Had he just returned from killing someone? No, you’re just imagining that. It’s more likely a food stain. A very large food stain. Because he’s a big doofus and he always spills things, probably. He gets stains on himself because he stands too close to people with food and it ends up on him when he invades their personal space. He invades everyone’s personal space, not just mine. Right?

Suddenly he started screaming. He screamed the way a person does when they’re on a roller coaster or running from an ax murderer. But his screaming had a distinct feminine tone to it. Was he mocking me? What kind of psychological games was this guy playing?

Then, he suddenly stopped and in the most casual way he turned to me, as if he had just thought of a great idea and said, “If I pick you up, you can get out through the hatch! All you’d have to do is climb the wires to the next floor and get help!” He stepped over to me a little.

“It’s not going to work,” I told him as I stepped away. “I watched this French movie once, about an elevator and…”

“You just don’t want to.” He cut short my movie synopsis and lead in about the futility of self rescue in an elevator.

“Well, yeah, that too. But still, it wouldn’t work. Plus there’s no hatch.” The idea of this guy picking me up made me cringe. He had better not try.

He looked up. “There has to be a hatch. Every elevator has a hatch to escape from.”

“No,” I told him. “Only in the movies.”

He looked at me in disgust again. Good. Stay away, creep. I checked my watch. Seven minutes had elapsed. Seven stupid minutes. My God, how long would I be trapped? I tried my radio. Nothing. Ugh. There has to be some way to get through. The creepy guy took out his phone.

“Oh,” I said snarkily. “Look at that. A phone. What a privileged life you lead.”

He ignored me as he punched some buttons. “Yeah,” he said loudly. “I’m stuck in an elevator with this mean, nasty paramedic girl. Yes, she’s a bad person. A real bad person. She won’t climb the wires to get us out of here. Real selfish. She doesn’t care. A real meany. Meany, meany, meany.” It was obvious to me he hadn’t talked to anyone. Not anyone human, anyway.

“Who’d you call? Your kindergarten teacher?”

He glared at me. “I was right though.”

“You are.” Hopefully he thought I was dangerous too. “Usually I am very nice.” I let him know.

“Yeah, right. And I’m normal.” He really said that. At least we were both on the same page with that.

We stood awkwardly around for a few minutes when our stupid dance started again, where he invaded my personal space and I got it back.

“I think you should climb the wires and get help. It’s obvious no one is coming to save us.”

“Hold on, there. It’s only been a few minutes. And I don’t know how to explain this to you but there is no hatch. Look up. Where do you see a hatch?”

“There’s got to be a hatch. I’m sure the ceiling is like a panel that is covering it. Come on, I’d do it myself but I don’t think you can lift me. There has to be a hatch. There has to be a way out. What if there was a nuclear attack and all the rescuers were dead. How the hell would we get out?”

Yeah! He gets it! This kid was on my wavelength with me! Again! We were both imagining claustrophobic scenarios! It changed nothing, actually, about his creepiness but it made me feel a little better, somehow.

And then, as if our similar thought patterns had meshed and created an electrical field large enough to revive the elevator, we felt a few more bumps and it started moving again!

A massive sigh of relief fell over us as the doors opened to my floor. The man got out too, despite having pressed a button for a floor higher. I felt that he too would become a stair-walking enthusiast.

As he opened to the door to the fire exit he asked me, “What’s the name of that movie?”

“Elevator to the Gallows,” I told him.

“Thanks,” he said. “And I’m sorry. I’ve got claustrophobia.”

“No problem. So do I.”

“So that’s why you were so nasty. I understand.”

“Thanks,” I told him. “Sorry.”

I got back to the apartment where our job was, with my stupid, useless electrodes and my stupid, useless PCR. I walked through the door feeling a little drained, a little relieved. I wondered if my partner would be there. I figured he’d be in the lobby waiting for the firemen. I guess we could cancel them now. But he was there, nonchalantly sitting with the patient.

“What took you so long?” my partner asked. A few more minutes and I was going to go downstairs and get the stuff myself.”

Please note, the movie, Elevator to the Gallows provides no meaningful solutions for escaping a stuck elevator, at all. But it’s an interesting movie on it’s own.

Here are some links about being trapped in an elevator:

https://abcnews.go.com/GMA/man-trapped-elevator-41-hours/story?id=4693690

https://www.huffpost.com/entry/woman-dies-in-elevator-china_n_56dd2134e4b0ffe6f8e9d56c

https://www.nydailynews.com/life-style/stuck-elevator-article-1.2696361

Over My Dead Body

My partner and I had just pronounced a man dead. The cause of death wasn’t obvious, as he had been found in bed, but there were some signs it could have been a suicide. The building manager had let us into the apartment after calling 911 because mail and newspapers had been accumulating for the apartment. He knew the person as a “good man, kind man” and was sad to find that he had died. We had some paperwork to fill out while we waited for the police to come.

As I wandered around the home looking for ID, I tried to learn more about the enigmatic man who had died by studying his tastes and possessions. It was a difficult endeavor as his house looked as if it had been cleaned out of many items. There were outlines on the bare walls where framed pictures or art had been. There were empty areas that appeared as if furniture had been removed. A cabinet with a display case was empty. His refrigerator contained half a container of orange juice and an egg. There was exactly one plate, one fork, and one knife in the kitchen.

We found a box of papers full of medical bills and hoping to get some information on our Mr. Peterson, we flipped through it. The papers, though were all his wife’s. They were from various medical institutions across the country. The Petersons, it appeared, had traveled far and wide to find a cure for the rare cancer that Mrs. Peterson had been diagnosed with. It also appeared to have been unsuccessful.

There were some scattered photographs showing the couple in happier times, and some photos showed what the apartment had looked like with art on the walls and more furniture. There were photos of the attractive couple at several parties and fundraisers. They had hosted several parties themselves where people were dressed in formal wear and holding up champagne glasses to the cameraman.

Mr. Peterson had received an award from a place called H. L. Financial and he appeared in one photo dressed as Santa for the H. L. Financial Christmas party. As sad as it was to see these brief glimpses into his life it made him more human and substituted for the personality that we would never meet.

The building manager came back, bringing the police with him. He told us the story of a man who had everything and then lost it. “When his wife died, so did he, he was never the same.” He told us that the Petersons were a nice couple who tipped well and gave good bonuses at holidays.

But when Mrs. Peterson was diagnosed with cancer they tried everything to save her. The building manager told us that Mr. Peterson missed a few weeks of work and even though he had been a top earner, they fired him the first chance they got and replaced him with a relative of his manager. He told us that Mr. Peterson believed they were looking for the first excuse to get rid of someone in his position so they could install the nephew. “Just evil, those people are,” he told us, shaking his head. When he lost his job he lost his health insurance. As the bills piled up he sold everything he could. “Then his wife died and he became depressed. He had a hard time getting a job. All his friends left him alone. That made him more depressed. And now this.”

In an effort to make a notification the police decided to play Mr. Peterson’s answering machine messages. There were 47 of them.

“Mr. Peterson, your payment is two months past due. Please call us about making a payment.” Several messages were from random companies requesting payments. But interspersed with those requests for money were requests from H. L. Financial, who apparently financed his mortgage.

“Mr. Peterson, Joe, this is Tony, look I used the money I owed you to pay down some of the payment. Please, just send something, anything and I can hold off Mr. Thomas.”

“Hey, Joe..this is Tony again. Mr. Thomas isn’t having it. Please call me at home.”

“Mr. Peterson, your application to refinance was rejected. Please make a payment as soon as possible.”

“Joe? It’s Tony again. Please call me, I tried to talk to Mr. Thomas again but he’s submitting the papers. I know it’s messed up. I’m sorry. I tried.”

All the calls were demands for money. No friends called to check in. No family members asked how he was doing. It was just bill collectors and most of them were from the company he had worked for. He had won awards earning money on their behalf and they couldn’t cut any slack to the guy they fired when his wife got sick. With my partner and I and the two cops we just silently listened to the messages, passing looks of disgust between us. Things got worse when we heard the messages from Mr. Thomas himself.

“Joe. Come on. At least call. Ignoring this isn’t going to make it go away.”

“Joe, my hands are tied. We have to move forward.”

“Look, Joe, I don’t want to say I told you so but eight months of chasing these specialists, what were you thinking? You should have listened to me. I at least told you the truth. These doctors told you differently and now what? All they did was cost you millions of dollars for nothing. Pathetic.” Wow. Who were these people? Were people really this cruel?

“Joe? It’s Lee again. Look, I’ll delay the paperwork for two weeks. Two weeks, it’s the best I can do. I’m only doing it because everyone here is giving me a hard time about my nephew, but that’s not the reason and you know it. Bet you’ll need to call me now. Well, you’re welcome.”

“Come one, Joe. Not one dime! Call me up. I need to tell you what’s going on.”

There were only a few more messages left on the machine when the phone suddenly rang. We all looked at each other. My partner smiled and without hesitation, picked up the phone. He put it on speaker.

“Joe? Joe? Is that you?” It was Mr. Thomas.

“Yeah, it’s me,” said my partner pretending to be our DOA. “You’ve got a lot of nerve calling me. With all I did for you. And now your ‘hands are tied’. You’re just an evil little man.”

“What? Joe? Come on, you were great, I told you as much. But you took all that time off and we were falling behind our numbers. If only you had just stuck it out. I get that you think your wife needed you but we needed you too, probably more.” He sounded almost apologetic.

My partner continued the offensive, on behalf of Mr. Peterson. “And how’s it working out now, Lee? That nephew of yours, he’s doing just great isn’t he? Everyone knows he’s going to run your division down to the ground. You know it too, you admitted as much. All because you couldn’t give me time with my DYING wife. You know how that makes you look?”

“We sent flowers! Didn’t you get them?”

“Yeah, Lee. We got them. That’s so much better than a refinance offer. Or a job. My dead wife says thanks a lot. Look here, Lee. You’re not taking my house. Just back off”

“I can’t stop the foreclosure. It’s too late. You should have listened to me,” he quickly sounded smug.

“Well, there, Lee. Good luck. The only way you’re gonna get this place over my dead body.”

Lee Thomas seemed to hesitate a moment.

“Do you hear me, Lee?” yelled my partner. “Over my dead body.”

We all applauded as my partner hung up. I liked to imagine the scenarios in my head of Mr. Thomas finding out the circumstances of the foreclosure and being filled with guilt and remorse at last.

A Dead Man Walking (and Arguing)

Every paramedic gets the same types of medical scenarios in their certifying course or refresher class. There’s the grassy field where a bee will have been involved, causing an anaphylactic reaction. Another one will involve an elderly person at home in the summer with closed windows where your detective skills will surmise that a heat stroke has most likely led to his change in consciousness. And if there’s heart attack scenario it will usually involve someone shoveling snow.

Shoveling snow is considered to be such a cardiac risk specific mention of it is made in many cardiac journals and as a warning to patients who have had myocardial infarction (MI), or heart attacks, in the past or are at risk for it. The combination of sudden strenuous labor and the cold air that is already constricting your blood vessels make it especially dangerous for someone who is already compromised.

When you’re being tested on these scenarios, either acting them out with mannequins or describing what you’d do to an instructor one on one, there are rarely curve balls thrown in to confuse you. The instructors aren’t interested in your clever abilities in finding a hidden medication bottle or poking holes through the family’s story about how the event happened. They just want to know that you can remember the protocol and apply it properly.

Rarely in real life are scenarios this cut and dry. Real patients lie to get out of going to the hospital or exaggerate to get seen faster. Sometimes medication bottles, or a drug habit, are well hidden and require real sleuthing skills. Or sometimes the patients list of symptoms is so long it’s difficult to figure out what the real problem is. But once in a while everything is exactly the way it is in the textbooks, probably the reason why they’re used as examples.

It was a snowy, winter day that my partner and I had made our way to the far off corners of Brooklyn thanks to limited unit availability and the far away hospital requests of several patients. We enjoyed leaving the confines of our assigned area which gave us opportunities to eat better and deal with completely different hospital staffs. We now found ourselves assigned to a predominantly Russian-speaking area of the borough where my partner had worked as an EMT. He knew the streets well so we didn’t have to spend large amounts of time flipping pages in our paper map book trying to find the address.

When we got to the apartment our patient, a large dark haired man with a Russian accent, was exhibiting the classic ‘Levine sign’. It’s a sometimes subconscious act of holding a fist on the chest near the heart. If this were part of a training scenario it would be the first thing that would alert the paramedic to think ‘heart attack’ or ‘myocardial infarction’ (MI). The man seemed a bit preoccupied, one could describe it as anxious (#2 for sign and symptoms), and he said he had no patience for us. He was a busy man and would not be going to any hospital. His wife had been foolish to call.

The wife appeared annoyed but was also clearly worried. “Just let them check you. Please. If it’s nothing they can go,” she said. The man grew more irritated but he decided to appease the wife and get checked out, possibly just so he could show her what a waste of time this all was. He rolled up his sleeve and demanded that we take his blood pressure so his wife would see how healthy he was.

His skin was pale (#3), cool (#4), and very sweaty (#5). When I took his blood pressure it was high, very high (#6). Impatiently, he demanded that we should take it again, we must have gotten it wrong. But it was still high the second time. He rolled up his other sleeve. He now told us that his left arm was numb (#7) so the pressure couldn’t be accurate in that arm. A try with the right arm was really no different. The wife gave a smug nod that infuriated the patient.

He insisted that he was a strong person, physically and mentally. As the building manager, he had a very active schedule and many things were left to be done. He couldn’t rely on anyone else. The people of the building had become accustomed to things being fixed correctly and they knew he was the only man for the job. That morning, when other building managers would have slept in, waiting for the impending snow to actually fall, our man was out there salting the roadways ahead of time. Once we heard that he had done all the shoveling (#8), with an actual shovel and not even a snowblower, when the snow had finally came, we didn’t even need an EKG. This guy was having an MI.

But we put our patient on the monitor anyway, of course, and it showed a rapidly evolving, life threatening MI. When we presumptively diagnose a heart attack we are usually only looking for tiny incremental changes in the EKG. It’s often only a small, two millimeter height difference on the graph paper. But his were so high they didn’t even need to measured. We could see them from across the room. The shapes of his complexes are even called “tombstones”.

None of this convinced the patient however. He was fine, he told us. He wasn’t one of these “sissy-boys” who needed to see a doctor for every ache and pain. He would lay down for a few minutes and then, when his chest pain subsided, he would get back to work. More snow was coming. He had heard it on the news.

We told him in every way possible that he was having a heart attack and it was progressing. One or more of the vessels supplying his heart was clogged, which was depriving more and more areas of his heart of oxygen. With current treatments available this problem could very potentially be reversed if we got him to a STEMI center quickly. They would quickly put in a stent and blood flow could be restored. His heart would most likely function the way it had before. But he had already waited some time and it looked as if it was going to take even longer to convince him.

We explained about cardiac death and the whole ‘time equals muscle’ philosophy, meaning that the longer the heart goes without oxygen the more muscle mass that dies. He would not hear any of it. His chest hurt because he was sore from shoveling snow. We were stupid to not see that. Didn’t we know how strenuous it is to shovel snow? He had shoveled around the whole building, down pathways and parts of the parking lot. Of course he was sore, he had exerted himself the way he always does, giving 110% to his residents. Couldn’t we see how strong he was to be able to accomplish all he did today? We had probably never shoveled snow or we would have understood the muscle soreness.

He thought that we had taken his wife’s side in this argument. He would need to placate us, he felt, in order to get rid of us. So when he was offered a spray of nitroglycerine under his tongue he accepted. He also took the aspirin we gave him. We continued to watch his EKG and continued to take vital signs.

Shortly after the nitroglycerine his face lit up. “The pain. It’s gone. All gone,” he told us happily. “See? You cured me. Now you can leave.” It was hard to know if the pain was actually gone but saying that our spray had worked bolstered our argument that his pain was cardiac. Nitroglycerine wouldn’t have worked for regular muscle soreness. The building manager was frustrated that he had been tricked.

We spent a considerable amount of time trying to break through his wall of defensiveness. The internet existed back then and the couple had a computer so we had the man look up his signs and symptoms. We asked him to look up the EKGs of people having heart attacks and compare them to his. The best example we were able to Google had much smaller tombstone complexes. “Look,” he told us. “Mine are better!” The larger complexes, he explained, were due to his superior physical conditioning. The person with the EKG on the internet probably wouldn’t be able to shovel miles of snow the way he had.

Everything short of shadow puppets had been used to try and convince our patient to seek help at the hospital for an ongoing event that could very likely kill him. We tried to understand his fear of the hospital which he denied was the reason. We even offered to take him to a different hospital, one of his choice, but he was not interested. And he had every right to refuse. If he didn’t consent to go we couldn’t force him. The patient knew that we couldn’t force him.

“This is America. Not Communist Russia. No one can just come and force me to gulag. You understand gulag, correct?”

Yes we understood. But because he had an evolving, life-threatening event going on he would be required to speak to our doctor on our taped line and tell him that he was refusing. Perhaps even, our MD could convince him to go. We called up our telemetry number and told the physician what was going on. He initially thought we were doing a routine STEMI presentation so that he could notify the hospital. By going through this procedure the patient pretty much goes directly upstairs to the catherization lab, saving time and muscle. “OK, I’ll contact them immediately. What’s your ETA?” he asked.

“He doesn’t want to go,” we told him.

“Doesn’t want to go? That’s crazy. He will die.”

“Yup.”

We put the patient on the phone and heard him get defensive less than a minute into the call. We could hear the doctor patiently explain the entire thing, going into great detail about the heart and how it was being damaged and what would happen if he didn’t go. But none of it mattered. He wasn’t going. No one could make him. He was not having a heart attack. OK you think it’s a heart attack, big deal. I don’t care if it is, he told him. He was fine. He understood the risks. He told the doctor about the gulags of communist Russia. If anything changes he understood he could call back. He handed the phone back to us.

“Well, we did our best. Take the RMA (refusal of medical assistance)”

The patient breathed a big sigh of relief. Finally we were leaving. His personality did a complete turnabout now that the pressure was off. He was gracious and friendly as he signed our paper. He hoped we hadn’t been greatly inconvenienced. He was happy we could finally go out and help all the people who really needed us.

It’s so surreal to look at someone who is dying and know what is happening. You try to look for something different, maybe an aura. Or you try to feel something, to perhaps boost your intuitive powers so that the next time you get someone like this, but without the telltale signs, you’d know, you’d recognize that feeling. But there was nothing, no aura, no unusual sensation. On the outside, he was just a regular guy with elevated vitals who was turning a little gray. It makes you feel more helpless than ever. You can’t even learn from the experience. The one big thing that helps EMTs and paramedics to cross over a psychological hurdle, when you’ve got someone critical, is the knowledge that you can actively do something to help. Even if it doesn’t work in the end, you tried and you can console yourself with that. Knowing that you have it in your power to help stop the cascade of medical disasters occurring in that person but are unable to provide it makes you feel useless and small.

We asked again before leaving to please reconsider. His wife was crying and begging him to go. But he just happily opened the door and bid us good-bye.

After the call we went to the nearby station my partner had done his EMT years at. He said hello to some people he knew and used to work with and introduced me. Our radios were tuned to a different frequency because we belonged to a different section of the city, so we normally would not have heard the call go out for a cardiac arrest at the address we had just left from. But because we were talking to people who did work in that section we heard it come over on their radios. We just looked at each other sadly and shook our heads. It had been less than an hour. Shortly after that we heard the crews that responded give a signal indicating that resuscitative efforts had failed and that the patient had been pronounced on scene.

“You guys RMA’d that guy?” someone asked. “I guess you guys are in trouble now.” They looked at us as if we had happily taken his signature as soon as we walked in.

“No,” explained my partner to the young EMTs. “We tried. But this isn’t communist Russia where we can just haul you off to the gulag.”

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Warning: there’s some profanity ahead. You can’t write about Liz without vulgarity being part of the dialog.

It had been a cold and stressful morning for Liz Moreno. An aggressive and violent woman, she had done far more ‘ass-kicking’ than usual that day. She had a black eye and several bruises. Her right arm was also severely painful. She tried to deaden the pain with alcohol, more alcohol than her usual allotment, but it had not done anything significant to help. If Liz felt the need to smack someone else today that disrespected or inconvenienced her, she would be at a disadvantage. Normally she was very quick to utilize the city’s ambulance resources but today she had some errands to do before she would spend more of her valuable time in a hospital. She also decided to turn over a new leaf by getting involved with a new religious philosophy.

Liz had never been one to embrace any religion or spiritually. Religion was for suckers she’d often say. With all it’s talk of being kind and good, it was just a way to keep people in their place. Turning the other cheek was for the weak and those who didn’t know how to fight. But her last stint in prison had taught her that churches and temples were good for more than just a free meal or a place to sleep. She had learned many things from another woman there, one who had fashioned her crucifix into a shank. Religious articles were less likely to be taken away. If they did, you could sue, claiming religious persecution, she had told her. Liz couldn’t believe she hadn’t known about this before. So much time had been wasted being unaffiliated.

She went to a second-hand store with a crucifix in mind. She was hoping to fashion a far more superior weapon than the one her mentor in prison had shown her. But the secondhand shop was low on religious articles. It seemed people didn’t like to part with their weapon making materials. The trip had not been wasted, however. She was able to find a Buddha figure and it was made out of a nice heavy concrete type of stone. As she fished around in her bra for the cash necessary to make the purchase, the cashier remarked that her arm didn’t look too good and suggested that she get it checked out. Liz suggested she mind her own fucking business and paid for her new religious representative. But after walking out the store and trying to hold her heavy new acquisition with her damaged limb she had a change of heart and asked the woman to call 911 for her.

“Look! I found God!” she laughed as she got into the ambulance. The crew who was familiar with the perpetually angry woman were a bit leery of this rare display of joy and the newfound love for heavy concrete objects in the hands of a perpetually angry woman. They splinted up her arm and took her to the hospital where she repeatedly told everyone with glee that she had “found God, his name is Buddha.”

Sometime after getting out of the hospital and enjoying her new prescription pain medications, an ambulance was again called for her when she was found unresponsive and barely breathing. “Where’s my Buddha?” she quickly asked when she awoke from her opioid reversal, via Narcan (naloxone). Her new spiritually had already become ingrained into her psyche.

The ambulance people had destroyed her high and she felt justified for lashing out at them. Even thought she always berated them for various perceived infractions this one was very different. She didn’t want to hear anything about ‘barely breathing’. Her prescription was LEGAL. They couldn’t do anything about it. Sure she had taken far more than the bottle instructed but it wasn’t the point. A doctor had given her these medications. She hadn’t gotten high off of something purchased from a man named Angel on the corner of Decatur and Wyckoff. She had done nothing wrong and didn’t deserve to be punished for it with Narcan.

As she argued with the crew she was comforted in knowing she now had two weapons-her concrete Buddha and her nifty new cast. “Look,” she showed the paramedics. “It’s like I got concrete stone on my arm too!”

“Nice little advertising billboard, you’ve got there,” said the paramedic.

What was he talking about? She looked to where he was looking. It took some contortions but she could tell something was written on her brand new cast. She studied it with her head bent at an uncomfortable angle.

“BLOW JOBS 75 CENTS – broken arm sale.”

It had been written in large lettering with a thick black marker. And the words faced outwards, like advertising, just as the man had said. You could practically see it from three blocks away. “What? The fuck? Man!” she screamed. Her cast had been on her arm less than 24 hours and someone had already vandalized it.

“When you’re passed out on Oxy worse things can happen,” said the medic, trying to console an inconsolable Liz.

“Shut the fuck up!” she told him. She was going to raise up her concrete Buddha as a warning but she couldn’t grab it in time. The crew had taken it away, out of her reach.

“You’ll get it back at the hospital,” they told her.

Didn’t they know it was a religious article? She was allowed to hold it. Her prison mentor had told her all about it.

“You know, there are some who say that Buddhism isn’t a religion. There’s no deity. It’s really more of a spiritual philosophy. I don’t know if it fits the same parameters,” one of the medics told her.

“What was she saying? What’s a parameter? Can I still sue if they take away a spiritual philosophy figure made out of heavy stone? They must just be fucking with me. If only I had my Buddha, I’d show them,” she thought. But there were other things to worry about. Who had defaced her cast? Who was she last with? That person was going to feel the full, literal weight of her spiritual philosopher.

Liz spent a few hours at the hospital, mostly being lectured about the right way to take pain medication. When she asked for more they gave her Tylenol. Tylenol! Didn’t they know that’s not the same?

The same paramedic crew found Liz a few days later. Someone had called for her when they saw her bleeding and laying on a street corner. Those paramedics thought they were going to her hit with the Narcan again, she laughed, but the joke was on them. She was just drunk. A battered and bruised Liz made her way to the ambulance anyway. At least at the hospital she could get some rest.

The crew had never seen Liz so battle-worn and that was saying something. She looked tired and had cuts and abrasions everywhere. Another tooth was gone from the already sparse lineup and one of her eyes was swollen. They asked her what happened. She showed them her cast. The “BLOW JOBS 75 CENTS- broken arm sale” had been mildly scribbled over with a blue ball point pen. You couldn’t even see that it had been crossed out unless you looked closely.

“I’ve never beat up so many people in my entire life,” she told them. “I got all kinds of mens coming over day and night with their one dollar bills, asking me for change. Fuck them! Who charges 75 cents for a blow job? I do a blow job I want a bag of tar or some blow! You keep your fucking dollar bills to yourself. Fucking assholes. They be throwing quarters at me! Quarters! You believe that? Buddha cracked a couple of skulls, I tell you. That thing is heavy but it do the job. Last thing they worry about now is their pee-pee.”

Buddha too, had gone through some physical changes. A few chips and scratches seemed to under line the story Liz told of her recent encounters. With all the violent karma she had been dishing out lately, Liz’s new religion hadn’t provided her with much peace.

And Somewhere Along the Way, She Was Shot

This is one of those “worst” jobs.

Trying to find the address the dispatcher sent us to had us searching a desolate, poorly illuminated street. Most of the industrial buildings appeared to have been abandoned but the presence of new gates and security cameras indicated some of them probably were not. It was difficult to locate a number on most of these buildings even using our fancy vehicular spotlight. We asked the dispatcher to verify the address and try the callback for a better location. Our “Unconscious” in bed person didn’t seem to live here, no one did. The area had at least ten more years to go before the first loft apartments would start gentrifying the neighborhood.

Finally a man appeared, seemingly out of nowhere. He was thin, about 50ish, and his stubble was mostly grey. He had become very annoyed by the 911 people calling back over and over again to ask about a location that he felt should have been obvious to find. We told him we would follow him.

He led us down a short alley to the padlocked side entrance of one of the buildings that was, actually, abandoned. There was no way we would have found this patient without a guide. The entire area seemed eerily bleak and unusually quiet. Yet despite our unease, we still followed the strange man for some reason.

The man showed us a large hole in the wall that had once been a window and pointed to where the patient was. We shined our two flashlights into the darkness. A large figure lay on what could hardly be considered a “bed”. It had possibly once been a mattress but now it had completely become one with whatever the floor was.

“Is this the only way in?” we asked. The man nodded. We looked at each other with a smile as we shined our flashlights around the entire space contained behind the ‘window’. Many rodents scattered. The area was filled with garbage, so much garbage. There were extra piles of garbage on top of the floor which was covered in garbage. We had more than a few safety concerns. We looked at the ceiling to see if it would hold for the duration of time we would possibly be in there for. It’s not like we know anything about building construction but I thought it would hold. There weren’t any other people around, except for the inconvenienced man and the individual on the other side of the room.

My partner nodded over to the person on the ‘mattress’. “What’s going on with that one over there?” he asked.

“I can’t wake her up!” he said. The man went on to explain that he had found the woman, who he was familiar with and called “Flo”, on what he called his bed. He wasn’t really sure what her real name was. They had had “relations” and then afterwards they shared some drugs and took a nap. Now he wanted her to leave. This was his hangout and she was only a visitor, in his telling of it. He tried rousing her but she never responded.

One after another, we athletically hopped up to sit on the open window ledge. We swung our legs around to the other side of the opening and shined our lights below us before hopping down. Every step we took was done carefully as we made our way over to the woman. The floor was littered with drug paraphernalia and the air smelled of death and every kind of rot imaginable.

The woman was completely naked. She was initially on her side and when we turned her over we discovered that she was pregnant. My partner and I exchanged the first of many knowing glances toward each other, glances that we could easily interpret despite the darkness of this filthy area.

Her pupils were pinpoint and her breathing was slow and irregular. “How much did she have?” I asked her companion.

The man had no idea. It turned out that when he said they had ‘shared’ drugs what he really meant was that he had shared her drugs with himself. Whatever she had taken, she had taken it before he found her. It became clear he had had “relations” with the woman while she was in this unconscious state. I was even more disgusted.

We asked him where her clothes were and he said he didn’t know. He had found her like that and taken it as an invitation. He had found a needle in her foot and without knowing what was in it, used what was left on himself. There was nothing unusual about any of this, in his world. He had no idea how long ago that was because, as he told us, he doesn’t wear a watch. He was just a free spirit.

We hit the woman with some naloxone (Narcan) and gave her oxygen in the hope it would reverse whatever chemicals she had shot into her foot. But even though her breathing got a little better it did nothing to change her unconscious status. We started ventilating her with our BVM (bag-valve-mask) and called for EMT back up to assist us.

“I’m not really into working her up in this hell hole,” my partner said to me. The man became somewhat confused and visibly insulted. What hell hole? This spacious warehouse loft that smells of death? Why, in a decade or so hipsters will be paying thousands of dollars for this place that he now lives in for free.

But we opened the drug bag to see what we could accomplish until the BLS got there to help us get her out. We needed multiple little pads of alcohol to swab her arms clean while searching for a vein to stick, which was a monumental endeavor since most of them had been destroyed from years of injecting chemicals into them with unsterilized needles. I’m going to pat ourselves on the back for the success in getting this difficult IV in the darkness, illuminated only by shaky flashlights that don’t have the LED capability they have now, in modern times.

My low lumens flashlight is the EMS version of I walked 5 miles to school in the snow.

While running the flashlight up and down her limbs in search of a usable vein we noted an injury to her upper left shoulder. It looked like a bullet hole. The man knew nothing about it and was as surprised as we were.

We heard the sirens of our back up and we sent the man out to show them how to find us. In the meantime we gave “Flo” more naloxone, to no avail. This certainly wasn’t just an overdose. Whatever she had taken had also been injected into the arm of our guide and it didn’t seem to be affecting him as profoundly, although she certainly could have taken significantly more.

As our EMTs made their way through the ‘window’ we yelled across the abandoned room for them to be careful, as if they couldn’t see for themselves the danger inside. I loved them for having brought a hospital sheet with them, as so many don’t. It would be a tremendous help in moving her since she had no clothes to grab on to. The crew moved right to the top of my most favorite EMT list when they noted our nice clean IV with admiration.

“Where’s her rapist?” I asked.

“Oh, I don’t know. He pointed to where you guys were and he took off and left,” one of them told us. He looked at the patient. “Wait, is she pregnant?”

“Yes, and it looks like she’s been shot as well,” said my partner. This was like one of the ‘mega-codes’ we train on at the academy, except they usually just stick to either trauma OR medical, not both at the same time.

As we balanced ourselves on top of piles of garbage we managed to get our patient onto a carrying device so we could get her out. We then slowly made our way over to the hole in the wall, stepping over crack pipes and needles, every kind of trash, and the long dead corpses of rodents who did not survive. We luckily made it without falling. We then carefully passed our patient through the hole in the wall onto an awaiting stretcher.

I was never so grateful to make it to the clean, controlled environment of our ambulance. We could finally make a better assessment of our patient. But taking a good look at our patient made me incredibly sad. This woman’s body told the story of a hard and rough life. What kind of messed up circumstances had this woman lived under, what stories could she tell? She was a tall woman who looked to be in her forties, although that was purely a guess. She had scars everywhere. There were track marks where I never thought there would be track marks. She was missing most of her teeth and her nails were either really long or gone altogether.

Her gunshot wound had a clear entrance and exit wound but did not seem to be causing any significant bleeding. We would probably be going to a trauma center even though the gunshot was the least of her issues at the moment. Her vital signs remained fairly stable. Since we didn’t know the onset of the symptoms, of what appeared to be a stroke, going to a ‘stroke center’ would not have been useful. There is a definite timeline that stroke procedures require and we had no way of knowing when everything started.

We intubated her and hooked her up to our monitor. She seemed to be slightly responsive to painful stimuli, which was a good step in the right direction.

“Umm, guys,” said one of the EMT’s tugging at my shirt. “I think the baby might be coming.” He was noting what appeared to be water breakage on a particular area of the sheet covering her.

I’m sure we all looked similarly terrified. An OB kit was pulled from the cabinet and more sheets were utilized, just in case.

What kind of notification would we be giving?

We tried to give the basics to prepare the trauma center without being too long winded. If we told the whole story we would be at the hospital by the time we were finished. We tried to downplay the gunshot but that’s all you have to hear for it to make it to the top of the interest hierarchy. We were also requesting that an incubator be standing by.

It was mayhem inside the hospital. Thanks to our notification dozens of trauma related people were standing by along with others not sure why they had been summoned for a gunshot notification. I guess when you hear that a patient has a gunshot wound all the other information gets drowned out. You could tell they were gearing up to get mad about something. And nobody listens to the whole synopsis.

There were so many people throwing out questions at us from all directions. We tried very hard to tell our patient’s story in one cohesive storyline but it kept getting interrupted by questions we had no answers to. Didn’t you give naloxone? Why isn’t she breathing on her own? How many months along was she? How long ago did the gunshot happen? Where are the police? What kind of medical history does she have? What did she take? Did you give the naloxone? Why did you take off all her clothes? Does she take any medications? What’s that smell? Is this her first pregnancy? Did the father come along? Is there any weakness on a particular side? Did she say anything? What kind of gun was it? She’s obviously on something, why didn’t you give naloxone?…

This seemed to be a hospital far too comfortable with having everything taken care of beforehand. Had they never gotten a patient before that didn’t arrive with a complete medical history? They continued with their demands for answers we didn’t have and they never stopped bringing up naloxone, as if we hadn’t already given her our entire protocols worth. I was starting to get annoyed at all of them in their nice clean environment. They didn’t have to step over crackpipes and rotting fast food to get to their patient. They didn’t have to contort their body into a small width of space between the captains chair and the back of the stretcher in order to insert a tube down the patient’s throat. They didn’t have to hold their breath for minutes at a time to deal with the overwhelming stench of different things dying and decaying at different rates around them . I doubt they could have gotten an IV the way we had. Was anyone even noting the stroke that we had given as the first priority of our notification?

The EMTs and I were feeling a little overwhelmed when my partner used his charm and wit to put some perspective into the hoard of questioners and complainers.

“Look,” he yelled, surrounded by the angry faces of a crowd demanding answers. “She was found in a garbage dump. The only person with her told us that he fucked her and then stole her needle and ran off somewhere. That’s all the information we were given, now it’s all the information you have. And somewhere along the way the woman was shot.”

We brought another trauma patient to that hospital a few hours later. It was somewhat insulting and also somewhat useful that no one seemed to remember us at all. It was a different nurse doing triage and she apologized for a delay in finding us a stretcher. “You’re not going to believe this but some EMS crew brought in this lady who having a stroke, and she was shot too. AND she had a baby in the ER! Can you believe it? They delivered a baby in the ER!”

“That IS crazy!” I replied.

“They were going out of their minds around here when I came in. And the OB floor took their time sending down an obstetrician so an ER doctor had to do it. They were lucky it wasn’t a C-section.”

I found out that is extremely rare for comatose women to give birth unassisted but our patient had, for the most part. No one had to tell her to push and no one had to do an epidural. She delivered a small, underweight baby girl who had a long road ahead of medical treatments.

The incompetent EMS people who brought her in had not provided any of the necessary information, such as the number of pregnancies she had previously, when her due date was, where she was getting her prenatal care, none of it.

“I guess you had to ask the patient herself, then,” I surmised.

“How could we do that?” she looked at me like I was crazy. “The woman was unconscious. She couldn’t tell us anything.”

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