Morton’s Fork 2/2

Kevin navigates the residential streets to St. Closest while I’m in the back with the sergeant tracking respirations and the fire medic helping me by taking vitals. My new patient, who was dead just a few minutes ago, is actually doing pretty well. He’s got a decent blood pressure, reactive pupils, 12-lead is clear, and he’s got some spontaneous movement in the extremities. I decide not to put him on ice (therapeutic hypothermia) based on his increasing level of consciousness and the knowledge that the ED at St. Closest wouldn’t continue with the procedure over the next 24 hours.

We move him over to the bed at the ED and I give a report to the MD and nurses who are going to continue treatment. They seem a little crestfallen as they are surprised by the level of consciousness of the patient. It’s not like anyone is sad to see a resuscitation but it’s so uncommon for someone to go from asystole to having perfect vitals and be sitting upright in a bed and staring at you that they are at little bit of a loss. Unlike in the movies, where they seem to bring people back from asystole all the time, in real life a flatline most often means game over.

I’ll check back in a few minutes but right now I have a mountain of paperwork to do in documenting all of the things we did and how the patient responded. I walk out of the ED towards the rig so I can start typing on my computer.

Two EMTs from the Inter-Facility Transport division are walking in and one of them catches my eye. “Hey, did you have Brian’s dad?”

“No, I had a code-blue with a resuscitation.” I’m just a little proud of myself for pulling off an improbable field save. They look a little bit confused but continue into the ED. I’m walking to the rig when it finally hits me. Fuck ME! The son was Brian!

I didn’t recognize him out of uniform. He’s been working as an EMT in the county forever, long before I got here. He’s a career EMT in the Inter-Facility Transport division so I seldom see him on the streets or at the ED. I’ve only talked to him a few times and I knew he looked familiar – but I just couldn’t place him.

I’m actually shaking as I tap away at the computer to document the call. I’ve never worked up the family member of someone I know, much less pulled them back from the dead. And having pulled off a minor miracle I took him to the one hospital in the county that none of my co-workers would ever want to go to – much less send their recently dead father to. I feel like I let him down, however paradoxical that feeling may be. I just can’t shake the torment in my mind.

Having finished my paperwork I drop it off in the room and see that Brian’s father is sitting up, talking to staff and family, and upon glancing at the monitors I see that every vital sign in well within normal limits. The other son and his wife thank me as I try to get out of the ED. I’m starting to feel like I need to vomit. I need to move on to the next call and shake this out.

Kevin’s waiting for me and he’s also trying to digest the news as I jump in the driver’s seat and put my hand on the key. I look up through the windshield to see Brian sitting on a bench being comforted by his girlfriend, crying tears of grief with his face buried in his hands. Try as I might, I physically can’t start the engine. I have to bring this full circle and talk to Brian even in his grief stricken state. I’m not sure if he’s going to take my head off or thank me but I have to see this to the end and do it right now. I have never felt so bad after saving someone’s life before and I can’t really come to terms with the emotional upheaval that’s ripping me apart.

Brian stands up as he sees me walking towards him and his girlfriend backs off to give us some room. I’m seriously expecting him to punch me in the throat and I know that if he does I’m just going to stand there and take it – I might actually deserve it.

“Brian, man, I’m so sorry, I had to come here, you know I did…” We’re both crying now standing just a foot apart.

“Thank you! You saved him. Thank you so much.” His huge arms envelop me in a tearful hug. Oh, thank god! I don’t need an ambulance…

“No, you saved him. You kept his heart going until we got there. It was all you!”

The emotional turmoil that I attempt to convey in this retelling may be difficult for those outside of EMS to fathom. It may seem strange but even on a successful field save we try to get out of the hospital before the family members arrive. I don’t want praise for a life saved and I definitely don’t want blame for a life lost. Speaking for myself, though I think other first responders feel the same, I must preserve my emotional detachment so I can make the right decision at critical times without hesitation. I know I did the right thing in my transport decision. But in retrospect I’m glad that I didn’t recognize Brian while on-scene. I may have hesitated longer or possibly even gone against my training. I’ll never know what I would have done but I know I’m now better prepared if the situation ever comes up again – and I have no doubt it will. 

That night Brian’s father was transferred to his hospital of choice with no deficits. After being surrounded by family members for two days he coded on the nursing floor and was pronounced dead. Our resuscitation bought him and the family some time together. Sometimes that’s enough – but in this case I wish the outcome was different.

Morton’s Fork 1/2

mor·tons fork

1 : a choice between two equally unpleasant alternatives

2 : also known as; between a rock and a hard place

3 : 1889, in ref. to John Morton  (c.1420-1500), archbishop of Canterbury, who levied forced loans under Henry VII by arguing the obviously rich could afford to pay and the obviously poor were obviously living frugally and thus had savings and could pay, too.

Each player must accept the cards life deals him or her: but once they are in hand, he or she alone must decide how to play the cards in order to win the game. 

~Voltaire

“Damn! This might be a real call…”

We pull up to the house just as the fire engine stops and three firefighters bound out – headed for our rig to grab the house bags. It’s one of those tribal customs that we all follow and no one ever knows when or how it started. If we use our bags in the house we don’t have to restock the fire department’s bags so when we arrive at the same time as fire, they always walk back to our rig and carry our bags into the house as we bring the gurney. But it’s more the haste of their movements that I’m reacting to at the moment. If this call were just the call for the altered seventy year old that my MDT told me it was, they wouldn’t be moving so fast. I’m thinking there might be a little more to this than my dispatcher led me to believe.

Kevin and I walk up to the front door with our military EMT ride-along in tow. Standing in the small foyer of the house I see the fire medic bent over and feeling for a carotid pulse of a man who is laying in the back hallway. “Yeah, it’s code-blue – bystander CPR was in progress until just a second ago.” Okay, cardiac arrest – looks like we’re working a code today. It’s my call so I ask them to move my new patient to the foyer so we have some room to work. As they carry the very large lifeless body my direction, I open up the drug box and set up the monitor. I’m going to work everything here in the foyer and see where we go from there.

Working a code is something like the altered reality of visiting the Twilight Zone for a few minutes. I have an omni-present yet tunnel visioned perception of the world where I’m acutely aware of minute detail yet still processing and interacting with my peripheral surroundings. While attaching the monitor I’m handing a BVM (bag valve mask) and NPA (nasal pharyngeal airway) to the military ride-along. For now I’ll keep him on the head to manage the airway and breathing for the patient. Later on I’ll switch him to compressions, but I want the experienced firefighter doing the first few – all too important – rounds while I figure out IV access, spin up some drugs, and evaluate the monitor for any shockable rhythms. With my mind prioritizing all of these tasks I delegate to the crew and somehow manage to listen to some random family member standing behind me, who’s telling me that he saw his father collapse and did CPR until we arrived.

Kevin thinks he has a good shot at a vein and goes for it while I have them stop CPR so I can feel for a carotid pulse and check out the monitor – no pulse and the flat line of asystole on the monitor. “Resume CPR.” I hand the OPA (oral pharyngeal airway) to the camouflaged sergeant who’s breathing for the patient right now. There was a day when I would have immediately laid down at the patient’s head and intubated while holding CPR to get that all so important tube, but the recent data seems to de-emphasize the intubation so I’ll cross that bridge in a few minutes when I figure out where this code is going. Besides, I wanted the sergeant to get the feel of inserting the nasal and oral airway adjuncts as they will be the primary ones that he uses in the future and it’s the right thing to do for the patient at this stage in a code.

Kevin looks up in frustration. “I didn’t get it, the vein collapsed on me.” After only five minutes of down-time, even with CPR, the blood volume in the vein has reduced making it deceptively hard to hit with a needle.

“No worries, I’ll drill him.” I pull out the bone drill and sterilize my target area on the lower leg where I’ll be using the electric drill to drive a metal catheter into the bone marrow and give us access to my new patient’s veinous system for drug administration.

While I drill, Kevin cuts off clothing, the rhythmic bounce of CPR rocks the lifeless body beneath me, and the army sergeant squeezes the bag every few seconds, providing life-giving oxygen. I can still hear the man’s son in my ear talking about how his father wasn’t feeling too well today and how he has a lot of medical problems – surreal Twilight Zone.

There’s too much fat on the leg and my drill never even reaches the bone. I stifle the automatic profanity that comes to mind – family members are standing over us and they don’t need to see frustration on our faces as we attempt a resuscitation. Reaching back into the drug box I pull out the bariatric bone needle and attach it to the drill. While I drill his leg a second time I explain what we’re doing to the son who’s floating over my shoulder. With the larger needle secured in the bone I attach the bag of fluids and inflate the pressure bag to force saline into the veinous system. I turn around to hand the bag to the son – I want to give him a job so he feels like he’s doing something. He did a good job by providing CPR until we arrived so I want to include him in the process. Looking up at him for the first time I’m momentarily stunned. Damn! He looks familiar but I can’t place him. I’m fairly certain I’ve never been in this house before. Whatever; work the code.

The second round of CPR is done and I do a pulse check while staring at the flat line of asystole on the monitor again. “Resume CPR, first Epi going on-board.” I inject the drug into the line and pump up the pressure bag a few times to push it into the system. I help Kevin in cutting off clothing and spin up the next drug so I’m ready to inject it at the next break in CPR. The firefighter who’s been doing compressions sits back on his haunches, after his latest two minute cycle, as I put two fingers to the patient’s neck. I’ll be damned! That’s a faint pulse. I look over at Kevin, “Confirm that pulse for me.” As I put fingers into the femoral artery and Kevin feels at the neck. A quick glance at the monitor shows a string of perfect complexes marching across the screen. Kevin and I lock eyes and simultaneously nod to each other: confirmed! The sergeant looks up at me, “He’s breathing by himself!”

Looking at the sergeant, “Track him with assisted breathing but don’t force it.” To the other two firefighters, sweat pouring off of my very competent CPR go-to guy, “Let’s get a board and some straps in case we have to resume and let’s get transporting. I’ll be going Code-3 to St. Closest.”

The voice of protesting anguish comes from behind me as the son is in tears. “Oh come on man, anywhere but there, don’t take him to that death trap!!” Okay this guy’s face is really starting to bug me, I know I’ve seen him before, but I can’t place it. And he knows our system because that ED is known for its less than stellar performance.

“Look, he’s got a pulse and I can’t risk losing it by driving too far. St. Closest is less than a mile away and I can’t bypass it by four miles – doing Code-3 – to get to Hilltop. You’ve got to believe me – it’s the only option!” I actually considered it for just a half a second but if I lost pulses during transport I will have put this patient in serious jeopardy and I’d have a lot of explaining to do to my medical director. I just can’t risk it.

The son is distraught but he’s not going to go toe to toe with me on the subject. I feel a little bad for forcing the issue against his wishes but I’ve got a dozen other things to do right now that take precedence so we carry on with the transport.


Traffic 2/2

As I push the gurney through the sally port towards the ambulance with our police escorts, I’m able to have a few moments to myself to ponder the situation. I’ve transported many prisoners in the past and often pick up violent offenders off the streets fresh from a well deserved police “attitude adjustment” requiring a trip to the ED. But somehow this is different. This isn’t a random act of violence or even a simple premeditated crime. This man is potentially the perpetrator of organized subjugation of innocent children. The level of pure evil that spawns this behavior is unfathomable to me and I’m having a bit of a hard time with the whole situation.

I load the gurney into the ambulance and tell Kevin that I’m just going to fire off a quick 12-lead and we can start transporting. It won’t affect my transport decision as the police requested a hospital that is also a cardiac receiving center, but I need to know if this warrants alerting the cath-team if my new patient actually is having a STEMI (S-T Elevation Myocardial Infarction – heart attack). Given his skin signs and level of distress, though, I highly doubt he is.

With the 12-lead complete – normal as expected – the police cruiser pulls in behind us for an escort to the ED as we start transporting. The rote task of taking vitals and applying the monitor to a patient that I can’t talk to gives me a few more minutes to contemplate my emotional state. On the one hand I may have evil incarnate strapped to my gurney, sitting only inches from me, and that brings a flood of emotions to the surface that I’m entirely uncomfortable experiencing. On the other hand, this is a patient and I’m a Paramedic – end of story! My job is to treat the problem in front of me and be an advocate for a patient who can’t even convey his needs due to a language barrier. Conflicting emotions and logical arguments fly through my head at synaptic speed – like strobes on an ambulance – and quickly resolve in the blink of an eye.

I fall into the sequential tasks of treating my non-English speaking patient for chest pain; aspirin, oxygen, vitals, IV, nitroglycerine, vitals, nitro, etc… “Here, chew this up, don’t swallow,” I tell him as I make a chewing motion with my mouth and move my hand like a hungry sock puppet and hand him the aspirin. “Did you take any Viagra today?” Stupid question, he’s in jail, I’m a little off my game here. He shrugs in non-comprehension. I spray the nitro in his mouth. Whatever, if I crash his blood pressure out I’ll try to fix it and apologize to the docs at the ED.

The ambulance comes to a stop on the freeway as there is an accident in front of us. We heard it get dispatched as we responded to this call but I guess Kevin is a little off of his game as well since he didn’t use surface streets to bypass the congestion. I can see the police escort sitting just behind us – in the stopped traffic – through the back window of the rig.

Pulling the stethoscope from my ears after the latest check on vitals my patient turns to look me square in the eyes. In heavily accented broken English he speaks to me in a quiet voice. “I can see that you a very nice man. Is all a mistake. They not my bitches, they my sisters… I have much money. I give you. You let me go!”

  • Child trafficking is one of the fastest growing crimes in the world.
  • There are 2.5 million child sex slaves in the world today, some as young as 4 and 5.
  • More than 1,000,000 children worldwide will become victims of child trafficking this year.
  • Over 100,000 children in the U.S. are currently exploited through commercial sex, and 300,000 children in the U.S. are at risk every year for commercial sexual exploitation.
  • Investigators and researchers estimate the average predator in the U.S. can make more than $200,000 a year off one young girl.
  • The global market of child trafficking is over $12 billion a year.
  • The total market value of illicit human trafficking is estimated to be over $32 billion a year.
  • An estimated 14,500-17,500 foreign nationals are trafficked into the U.S. each year.
  • Approximately 80% of human trafficking victims are women and girls and up to 50% are minors.
  • 600,000-800,000 people are bought and sold across international borders each year; 50% are children, most are female.  The majority of these victims are forced into the sex trade.
  • There are open sex slavery cases in all 50 states.
  • U.S. citizen child victims are often runaway and homeless youth.
  • Runaways, orphans and the poor are targets for sexual predators.
  • Approximately 80% of trafficking involves sexual exploitation, and 19% involves labor exploitation.
  • There are more slaves today than ever before in human history.

Information from various sources ~ U.S. Dept. of Justice, U.S. Dept. of State, UNICEF, UN, UNODC

As long as the mind is enslaved, the body can never be free. Psychological freedom, a firm sense of self-esteem, is the most powerful weapon against the long night of physical slavery.

Martin Luther King, 1967

Traffic 1/2

traf·fic

1 : the passage of people or vehicles along routes of transportation; traffic congestion

2 : dealings, business, or intercourse

3 : social or verbal exchange; communication

4 : buying and selling; barter; trade, sometimes of a wrong or illegal kind

5 : to carry on trade or business, especially of an illicit kind; human trafficking

The lock on the heavy jail cell door releases and the door slides open with mechanical precision, making a loud clunk which reverberates off of the austere concrete walls of the sally port (a double-door safety system that they have in prisons. From the outside, you go through one door, and when it closes and locks, the second door opens to let you into the interior). Standing in front of me is the fire captain who’s taking information from the jail’s processing officer – he looks up long enough to point us down a hall. We continue walking down the hallway of holding cells and I see freshly processed prisoners, still wearing their street clothes, sitting on benches in their cells watching the procession of uniforms glide past their limited view through the bars. In the open cell at the end of the hall I finally see my patient – a man in handcuffs, leg shackles, and an orange jump-suit – sitting on the bench with firefighters taking vitals and four very large officers keeping an eye on things.

Finally, I see a friendly face – the fire medic stands up to give me a quick report. “Hey KC, so it’s your basic incarceritis. Forty-eight year old male, chest pain by three hours, vitals normal, no primary symptoms. That’s about all we have unless you speak Mandarin.”

“Sweet! No problem.” I step around the medic and address the prisoner. “Ni hao ma?” In perfect intonation I ask him how he’s doing in a typical Mandarin greeting. Fortunately I grew up in the Chinese community of my home city and know enough Chinese to order dinner, get my face slapped, and yell like a drill sergeant at a class full of kung-fu students. Unfortunately, it’s all in Cantonese and I just exhausted my Mandarin repertoire.

The prisoner stands up with a hopeful look on his face and fires off an excited string of Mandarin. “好. 这些人不相信我. 我有胸部疼痛.”

In unison the firefighters and officers look at me to see if I can tell them what’s going on. “Sorry man, that’s all I got, let’s go to the hospital.” I motion to the gurney as he does the shackled penguin waddle out of the holding cell. Kevin and I put on the leather hand restraints as the officer takes off the handcuffs. I’ll need access to his arms to treat him, yet he’s still in custody.

As we’re walking past the rows of holding cells I’m asking one of the officers what’s going on. “Yeah, we used the translation service on the phone, he said he has chest pain and knows that no one will believe him so we called you guys.”

“What’s he in for?” I always ask as I want to get an idea of how dangerous someone is – it doesn’t affect my treatment but it’s nice to get a heads up if I’m going to be sitting in close proximity to a violent criminal.

“We picked him up yesterday on a sting-op. Busted about a dozen brothels in a couple different counties. These guys were trafficking young girls from Asia on container ships and forcing them into prostitution. This guy was pimping out girls as young as thirteen! I tell ya’, right now, I hope he is having a heart attack – he deserves it!” Damn!

 



 

Service 4/4

As I open the back doors of the rig I see the two extra firefighters in the back of the patient compartment. CPR is in progress and having extra people to help out is always better so the medic took a few riders. We help them unload the patient while keeping an eye on IV lines and monitor cables. I hand the monitor to Brittany and tell her to keep close as we roll the gurney into the waiting team of doctors and nurses. One of the fire fighters is “riding the rails” – he’s standing on the bottom rail of the gurney, one hand holding on and one arm applying as much of a compression to the patient’s chest as is possible on a moving gurney.

As the paramedic is giving a verbal hand off to the medical team we disconnect the monitor leads and transfer the patient over to the bed. A flurry of motion ensues as the hospital staff go to work picking up the code where we left off. I take Brittany to the corner of the room where we are out of the way and I can explain what’s happening as the team administers more drugs and shocks the patient a few times.

After ten minutes it’s obvious this person isn’t going to come back to the living. They are going through the last few motions of working a code – throwing the “Hail Mary” drugs at him in the hopes that something was overlooked or an underlying unknown condition is preventing the resuscitation from working. The ED tech doing compressions is a friend of mine and he’s getting a bit fatigued from doing CPR for the last five minutes.

“Hey Nick, you want some relief? My ride-along needs the practice.” Nick gives an exhausted nod of his head as drips of perspiration land on the pale patient below him. Brittany bounds up to the step stool at the side of the bed and trades off with Nick without missing a beat. I coach her on hand placement and compression rate as she furiously puts all of her heart into keeping this man’s heart working.

While Brittany continuously pumps on the man’s chest, I’m standing next to her explaining some of the things she’s feeling and giving pointers. “Don’t worry about the broken ribs, keep pushing, he’s got bigger problems. Give the chest a full recoil, let it inflate after every compression.” I push my fingers into the man’s femoral artery. “Push a little harder, there you go, now I can feel his pulse in the femoral from every compression.”

After two rounds Brittany is completely exhausted but she’s still pushing for all she’s worth. Nick catches my eye as we stand behind Brittany. “They’re about to call it, you want me to take the last round?”

I pull Brittany from the stool as Nick jumps in for the final round of CPR. Nick’s a good man – he knows that we were all just going through the motions on this one but Brittany doesn’t need to be the last person doing CPR when they decide to stop. She did a great job and it’s best to leave on a high note rather than a depressing coast out.

This was our last call of the day and as we take the quiet roads back to the deployment center Brittany has a flurry of questions and observations from her day on the streets. Kevin and I have quiet smiles on our faces as we discuss the day and her performance. Her enthusiasm is contagious and we were just happy to provide her some experiences to help prepare her for the unknown that awaits her overseas.

Back at the deployment center I’m filling out Brittany’s evaluation form where I give her high marks in all categories. Brittany puts her form in the camouflage backpack and joins her camouflaged classmates in the lounge as they compare stories of their day in the Big City. I suspect Brittany has some of the best stories of the group today.

She’s a shining example of the young people that are making sacrifices for our country every day. These are young men and women from across the country who take an oath, put on a uniform, and deploy across the world. Many of them will find themselves in dangerous situations, and maybe some of the things they learned in our Big City will be of use in future deployments.

Service 3/4

After the call I’m driving through the hood so Brittany can see some prostitutes as our last call brought that into the conversation. With Brittany squealing with excitement after watching a young woman get into a car with a complete stranger I’m passed by the Big City PD who’s moving fast.

“Brittany, you might actually get a real call today. PD just passed us and another one is coming up behind us.” We get used to the driving patterns of PD as they have a particular mode of travel when going to a real call. Despite the cop shows that depict officers traveling Code-3 to every call our local PD tends to just light up at intersections and occasionally hit the air horn to get someone’s attention. They are the urban land-sharks of the hood that gracefully slide through traffic following the scent of blood to the crime scene.

A few seconds later the radio comes to life. “Medic-40, respond code-3 for the GSW at the corner of really bad street and even worse street, please stage out, your scene is not secure.” Brittany has her gloves on before the dispatcher finishes the sentence and wearing her camouflage battle dress uniform all I can see in the rear view mirror are her bright shiny teeth in a big smile. I light up the rig and head in the direction that PD was going.

Just as I’m thinking about shutting down to stage and wait for the officers to secure the scene the dispatcher comes back and clears us to proceed. We arrive to find police cruisers blocking the street and yellow tape being rolled out to keep the crowd back. There’s a cluster of officers standing next to a young man who’s collapsed on the sidewalk with a small pool of blood forming under him. It’s Kevin’s tech so he’s first out and walks up with the fire crew that just arrived. Brittany is staying with me as I’m getting the equipment out of the rig.

I hand her a set of trauma shears and motion towards Kevin who’s kneeling by the young man. “go on – get in there and cut some clothes off.” I don’t think I’ve ever seen anyone skip in combat boots yet that’s pretty much what it looks like as Brittany joins the others in cutting clothes and looking for bullet wounds.

It’s the perfect textbook scenario for rapid assessment and treatment of a trauma victim. Four minutes from the time the call went out to arriving on scene with fire and EMS pulling up at the same time. Seven minutes spent on scene stripping clothing off, controlling the bleeding, and putting the patient on a back board. He has two entry wounds, one in the neck and one in the upper chest. Both appear to be small caliber and bleeding from the chest wound is controlled with a chest seal to reduce the possibility of developing a collapsed lung. We decide to use a hard back board because of the close proximity of the neck wound to the spinal column.

With strobes flashing and siren wailing, I make the five minute Code-3 drive to the trauma hospital with my police escort just behind me. Kevin’s reassessing for neurological deficits and starting IVs as Brittany is doing her best to take vitals in the back of an ambulance running Code-3. She’s using all the techniques we showed her on the previous non-emergent calls: slipping the bell of the stethoscope under the cuff so you can corroborate the auscultation by feeling the palpated systolic pressure with the other hand, and supporting the arm on your leg while lifting the heel of your boot to isolate noise and vibration. She’s a quick study and is keeping her cool on a highly stressful call. Seventeen minutes after getting the call we are pushing the gurney into the trauma bay, which is already crowded with the trauma team of doctors and nurses. By the time Kevin is finished with his paperwork the young man was already headed for the operating table.

Brittany is helping me clean up the ambulance as another rig comes in to the trauma bay. I could hear the siren from a few blocks away and see their lights flashing as they entered the parking lot. Brittany and I change gloves so we can help out the crew – they are bringing in a critical patient.

Service 2/4

As we drive from call to call and post to post in the Big City, Brittany is a constant source of questions and enthusiasm. Despite the poverty stricken streets that are ripe with urban violence, gangs, drugs, and everything else – I actually like my Big City and enjoy the opportunity to play tour guide to the underbelly of urban street life.

This is Brittany’s first visit to this state and only the third state she’s ever been in. Having grown up in Maine, she lived a rather sheltered life up until now. She’s loving every minute of the day even though we are getting the less than emergent – some might even say annoyance – calls all day long. We call it “third man syndrome” – it seems that every time we get a rider we get the nuisance calls and seldom get the dramatic high profile calls that the rider is hoping for.

Brittany was a good sport when we got called for the fifty year old lady who had a headache for the last three days. There’s really nothing to treat here yet it was a chance for Brittany to practice taking a history and get used to the frustrating reality of how difficult it is to take vitals in a moving ambulance.

From the mouth of babes come the rational observations, and Brittany made a very apt one after the call as we’re cleaning up the rig. “Why didn’t she just take an aspirin?” I don’t have any good answers for that one except to say that calling 911 is a learned pattern from her environment and when someone demands that we take them to the hospital we are obligated to do just that.

As if to hammer the point home our very next call is to an address that I am familiar with as I’ve been there many times. It’s a woman with every chronic problem you can imagine, taking all the regular medications, with the same complaint every time. Yet today we’re here for her twenty two year old daughter – I’ve never transported her before.

It turns out she has a back ache because she slipped yesterday. Of course she’s wearing five inch stilettos – my keen diagnostic abilities tell me they may have contributed to the slip. Dressed like a prostitute in tight pants, high heels, and a skimpy halter top she struts to the gurney and plops down so we can transport her to her favorite hospital.

It’s an interesting situation that boarders on scamming the system. Her mother is considered disabled by the state due to so many chronic illnesses. In conversations with her over the years I come to find out the daughter is listed as her “home health care provider” despite having no medical training. The state pays her $800 dollars a month to live at home with her mother. And the daughter has apparently learned from the mother that you call 911 whenever you have a problem because it’s cheaper to let Medi-Cal pick up the tab than to call a taxi – and a taxi is exactly what we are on this call.

Service 1/4

ser·vice

1 : of or relating to the armed forces of a nation

2 : work done for others as an occupation, business, or calling

3 : services, such as free medical care, provided by a government for its disadvantaged citizens, often used in the plural

4 : the act of a male animal copulating with a female animal

Consciously or unconsciously, every one of us does render some service or other. If we cultivate the habit of doing this service deliberately, our desire for service will steadily grow stronger, and will make, not only our own happiness, but that of the world at large. ~Mahatma Gandhi

“Prostitute at five-o’clock, look out the back window to your left.”

“Really!!?” Brittany scuttles to the back of the rig and peers out the rear windows like a ten year old looking under the tent flap at the circus.

“See the bored looking guy with the baggy pants, about twenty yards up the street? That’s the pimp.”

“Oh my god!! She just got in the car!” Brittany is actually squealing with excitement.

The back of the rig is dark and I can just barely make out Brittany’s silhouette in the rear-view mirror as her digital camouflage fades her into the background.

I met Brittany this morning as I was checking out my equipment from the deployment coordinator and he told me I have a ride-along today. Looking behind me I see a young woman in military digital camouflage; her hair is pulled tight into a bun at the back of her head and she’s standing in the corner holding a matching backpack, curiously looking around at the ambulance bay and the bustle of other crews stocking their rigs.

We often get EMT student ride-alongs in this county – it’s a mandatory component of graduation to ride with an ambulance crew on the streets. Some ride-alongs are from the military while others are from the local schools, and they span the full range of personalities and competency. For many of the local students, this is just a necessary yet annoying stepping stone on the way to the elusive job in a fire department. Some will make it that far but most will fall by the wayside. The military ride-alongs take it much more seriously, and as a result I much more enjoy having them. We get riders from the Army, Marines, Navy, and Coast Guard. These tend to be dedicated young men and women who are disciplined, motivated, and courteous. Because of the constant state of war over the last decade these young people know that the skills they learn in EMT school could vary well make a difference in future deployments. They tend to be very motivated, ask lots of questions, and are respectful to patients and personnel from the other agencies that we work with throughout the day. The military commanders know that the best chance of seeing domestic urban warfare happens to be on the streets of my Big City so we tend to get a lot of riders from the different branches of the military.

As I’m introducing myself to Brittany and handing her my computer to carry to the rig I hear another military ride-along nervously talking to the deployment coordinator. “Are you serious, you don’t issue flack jackets?” Brittany’s eyes get big and round at that question – a look that I see repeatedly throughout the day.

Brittany helps Kevin and I check out the rig as we explain where all of the equipment is stored and promise to get her as much hands on experience with patients as possible. As we clear the deployment center and notify dispatch that we are available for the Big City, Brittany looks down at the body armor poking out of my gear bag and her big round eyes meet mine in the rear view mirror.

“Don’t worry about it, we’ll keep you safe. We haven’t lost a rider yet.”

“So you’re not counting the last guy?” Kevin comes back at me with our well rehearsed schtick.

“Nah, he doesn’t count, he was an idiot! Brittany’s much smarter than him.”