Checking Out

“Suicide was against the law. Johnny had wondered why. It meant that if you
missed, or the gas ran out, or the rope broke, you could get locked up in prison
to show you that life was really very jolly and thoroughly worth living.”
--Terry Pratchett

Christmas Night.
I was just washing up the last of the dishes when my pager went off. "Stand by at your stations; call the center for details." I pulled on my coat as I dialed county dispatch. I really didn't have to call the center for details; I could have just gone down to the station, but I wanted to know what, exactly, was going to mark my first on-duty Christmas. "You've got a drug overdose, with alcohol, the patient is being a little combative so we're getting the state police over there before you go in."
Aces. Just aces.
When I got to the house, the rest of the crew plus ALS and a former member home for the holiday greeted me and we rolled, party of five. I was happy there were so many of us since I didn't know exactly what 'combative' was going to mean. The first thing I saw was a quart bottle of Yukon Jack on the counter, and most of it was gone. Nice little place, dish out for the cat, Christmas tree, and a man in a recliner flanked by two staties who are explaining to him that he needed to get his shoes on. While he was doing this, his daughter asked him if he was planning to leave any kind of a note. "Nope!" he said cheerfully. He pulled on his shoes, tossed an afghan at the cat, and came smiling into the kitchen, where he scooped up his coat and stared in wonder at the number of people in the house. The crew chief made introductions and he greeted us all with a broad smile. "Jeez! All these people!" as if he just walked into a surprise birthday party. We walked him to the ambulance and in the course of questioning I learned that he took two whole bottles--pain medication and sleeping pills. He kept explaining how he just wanted the world to leave him alone and he just wanted to die, and this news is delivered with the same magnanimity as everything else he said. The paramedic drew blood, we monitored his vitals, and he asked each one of us in turn if we are having a good evening.
After assessing the relative happiness of each of our Christmases he demanded of one of the crew "Do you know the true meaning of Christmas?" The crewmember gave him a quick answer of neutral, professional benevolence, something that conveyed "We'll be at the hospital soon, just hang in there."
Our very medicated patient declared "Its when God sent his Son Jesus Christ into the world to save sinners," in a way that made me expect him to recite Luke 2 in its entirety. We got him into the ER, and when I stopped back with paperwork a good while later, the entire group of family, frends, and neighbors who followed us to the hospital were still clustered together, waiting. I looked at the varying expressions on their faces, while they came to terms with what brought them there on a night that is not supposed to be spent in a hard plastic chair in a brightly-lit hallway, and all I could think of was "And Mary kept all these things, and pondered them in her heart". She had an initially fearful but eventually hopeful Christmas to ponder in dark times. I sincerely hope these people will too.

Breakdown

Wednesday night. Second duty section of the week.
I'd hoped to get to the ambulance building, execute my little side job cleaning it, and whip out some tripsheets before any tones dropped. That is, after I had a leisurely supper that I'd pick up on the way in.
What is the saying, man schemes, and God laughs?
As I was making my final approach to town from work at about 17:25, tones. Patient to be transported directly from a Dr.'s office to a hospital 65 miles away. I step on it and get my phone out to call our crew chief, to tell him to wait, that I'm 5 minutes out.
He answers. "Hey! Howya doing!"
I say, "I'm almost there, so wait for me."
He says, "I'm in (town an hour away), and I'm just leaving. And (our other crew member) is just leaving work in (town an hour in the other direction)."
I say. "Okay then, I'll just go and see who comes."
Well, five different departments get paged out. No one is available. I should mention that the roads are borderline crap, its cold, and its snowing. We were supposed to have flurries all day. Its been flurrying with a lot of determination for hours. Finally one of the paramedics from the hospital pops in and offers to drive. We grab the second-line ambulance (the first line ambulance is OOS because of some problem with the air-system-dealie-thing ) and go.
The patient is alright, he isn't super excited about the transfer and he is so reluctant to admit he feels like crap that it takes about 30 minutes of good cop/gooder cop interrogation to get him to say he hasn't been 'quite right' for about a month. (He has some not-good things going on with his heart, he shouldn't feel good.) But he's stable. Away we go, bouncing into the night.
This ambulance isn't exactly a smooth ride. Heck, any ambulance makes you question the structural integrity of your bras, but this one seems especially swingy.
I'm chatting with the patient, and two things happen at the same time. Neither of them are good.
One, the patient starts doing this funny thing with his lips. That funny thing means "Gee, I feel an awful lot like I might throw up. I wonder if I should say something." Or in this man's case, "I feel like I'm going to throw up but damn if I'm going to admit it." I ask him, are you all right? We elevate his head. He is offered the good drugs to make it stop. He refuses them. We scramble for the Magic Barf Cones. We can't find any. I put a towel across his chest and offer him the only thing I could find; a scroungy looking red plastic bag. He looks at it, and looks at me. I smile, apologize, and wait for the wave.
Two, the ambulance starts to smell. Its subtle at first, like maybe we drove by someone's trash burning. Then it gets a little worse. Then it smells like the stretcher is parked on top of a smoldering tire fire. I mouth to the paramedic "What's burning?" He does a quick check, and shrugs, but I can see 'slightly worried' battling 'professional and calm' for real estate on his face. We check on the patient. He's still doing the lip wiggle but still doesn't want drugs. We find a Magic Barf Cone and swap him the red plastic bag.
About 20 minutes from our destination, there is a terrific bang, the ambulance lays down a blanket of smoke about 18 feet wide, and it feels like we're driving over half a cord of firewood.
We stop, the driver and paramedic grab flashlights, and look underneath. All tires are intact, and we haven't hit a rock, a deer, or a toolshed. There is talk of us 'losing our rear end'. Not being a gearhead I have no idea what that means. The patient gives me a slightly exasperated half-smile that clearly conveys the degree to which he believes we are idiots. We ask him if he feels better and he says he's "A damn sight better now that we ain't movin' no more." The Magic Barf Cone stands down.
The paramedic calmly conveys to county that we are dead in the water and another ambulance is called (and comes almost immedately, bless them) to take the patient to his destination. We limp the ambulance, which now creaks and sways like a wagon pulled by a drunken horse, to a well-lit parking lot to await a tow. Our chief comes to collect us and I finally get the dinner I never had and a much-coveted chance to pee. And bonus; no more calls for the rest of the night.

Au Revoir, Les Enfants

My experience is limited. I was licensed in the Spring so its been not quite a year, I'm still having 'first experiences'. Saturday was my first psychiatric emergency. A few months ago I had my first infant arrest. Someday there'll be so many different things that I'll have to give the experiences different names, but for now, that infant arrest is referred to in my house as 'that baby'.
'That baby' presented with severe difficulty breathing. His mother, suspecting something was wrong, didn't put him in his crib that night. She was sitting in a chair holding him, and put her head back, but when she heard him make a little squeaking sound, she looked down to see frightened, staring eyes and purple skin. She did rescue breathing. He settled into a startling purple-yellow and she got going calling EMS.
He was only a few days old, and premature. When she got onto the ambulance with him he looked like a doll the color of an old bruise. They fought for hours to stabilize him, flew him to another hospital, where it was discovered that he was septic. He ended up elsewhere and a liver transplant was considered, but ultimately his little body wore out and he died.
I wanted to write about that baby before. Lots of things came to mind but most of it sounded hollow. Its a hard old world sometimes and not everyone gets a happy ending. There is hope, for sure, but sometimes invoking hope in the face of wordless grief cheapens both.
I'm thinking about him today because the other day I saw his mother. The last time I saw her, she was exhausted. She hugged me before she left the ER and I was hit with a wave of heat from the raging fever that would hospitalize her as well, later that day.
This time, I saw her smile. She didn't recognize me, and I was glad. I was hoping she was having one nice day and a break from the memory. He's just 'that baby' to me and there is an empty place in my heart that I am okay to carry. I hope that what she carries is a burden she can shoulder though I do not pretend to understand how.