The Street Saint: Emergency at the Emergency Services

THE STREET SAINT

THE STREET SAINT EMERGENCY AT THE EMERGENCY SERVICES

Chuck Purdy

Algora Publishing New York

© 2002 by Algora Publishing. All Rights Reserved. www.algora.com No portion of this book (beyond what is permitted by Sections 107 or 108 of the United States Copyright Act of 1976) may be reproduced by any process, stored in a retrieval system, or transmitted in any form, or by any means, without the express written permission of the publisher. ISBN: 1-892941-80-5 (softcover) ISBN: 1-892941-81-3 (hardcover) Library of Congress Card Number: 2002011331

Purdy, Chuck. The Street Saint : Emergency at the Emergency Services / Chuck Purdy. p. cm. ISBN

1892941805 (softcover) 1892941813 (hardcover)

1. Emergency medical technicians—United States—–Biography. 2. Emergency Medical Technicians—Personal Narrative. 3. Attitude of Health Personnel— Personal

Narratives.

4.

Burnout,

Professional—Personal

5. Emergency Medical Services—Personal Narratives. I. Title. RA645.5 .P87 2002 362.18/092 B 21 2002011331

Printed in the United States

Narratives.

Table of Contents

Chapter 1. “OUCH!” Chapter 2. Going home Chapter 3. Where did it begin? Chapter 4. Talks with another “old fogey” Chapter 5. “Ready” is a state of mind Chapter 6. A.S.S.U.M.E. Chapter 7. God? What did I do today to make you turn on me? Chapter 8. Boy, have the times changed Chapter 9. We’ve created a monster Chapter 10. Those were the days, my friend Chapter 11. The Blockhead wins Chapter 12. My Dad’s a paramedic Chapter 13. If his Dad were there Chapter 14. What’s in a name? Chapter 15. If you can’t beat ’em . . . Move on Chapter 16. Age and wisdom Chapter 17. The good, the bad, and the ugly truth Chapter 18. It ain’t all bad, it just looks that way Chapter 19. It’s so sad, it has to be funny Chapter 20. So, you thought that was funny? Chapter 21. Are we having fun yet? Chapter 22. Happy New Year Chapter 23. New year, new millennium. What happened? Chapter 24. Fool me once, shame on you; Fool me twice, shame on me

1 12 17 19 24 27 31 39 44 49 53 66 73 80 88 94 104 106 111 120 127 132 138 142

Chapter 25. “I see,” said the blind man 149 Chapter 26. Who you callin’ a fool? 152 Chapter 27. Out of the mouths of babes . . . 160 Chapter 28. New century, new attitude 163 Chapter 29. Let’s look at this again, without the rose-colored glasses 167 Chapter 30. It’s not the load; it’s the straw that breaks the camel’s back 173 Chapter 31. The dawning 180 Chapter 32. The proof is in the pudding 190 Chapter 33. He’s always been crazy, but that’s what’s kept him sane 193 Chapter 34. To be or not to be? Ah, that’s too deep! Just do it! 199 Chapter 35. To make an omelet, you have to break a few eggs 212 Chapter 36. The end; and the beginning 218 Chapter 37. Hurt me once, shame on you; Hurt me twice, shame on me 227

CHAPTER 1. “OUCH!” The pain and numbness in his hip had become constant. The aging paramedic shifted his weight on the examining table while he thought of the thousands of patients he had left on beds just like this one, so that the care he had initiated could be continued. He thought, too, of trips he had made to the morgue . . . not very pleasant . . . never got used to that . . . not his job. Emergency Medicine is about saving lives, not putting human beings into refrigerators. It was impossible to remember all of the patients he had seen. He had sat with his girlfriend one rainy day and roughly calculated that he had answered the call for help 100,000 times. He shifted his weight as another muscle spasm made him grunt. “This is bull! Twenty three years of lifting drunks who passed out on the street . . . 1000pound patients . . . 300-pound crazies coming at me out of the dark, and now this.” His young EMT, driving too fast, had collided with an unlicensed driver who was drunk and on drugs. Now he sat, waiting to see if his career as a paramedic, as “the street saint,” had finally ended. He had seen the accident coming and went through it again in slow motion. The other car had started to do a Uturn into their path. He distinctly remembered his left hand switching tones on the siren while his gloved fingers lay on the electronic air horn. His partner simultaneously stepped on the real one. He saw the other driver stop; his partner slid their heavy ambulance gracefully to another lane. Then he looked on with disbelief as the idiot driving the other car continued on his original course, right into the path of the oncoming emergency vehicle. He never said anything about how his young partner had frozen at the wheel. He never told anyone that he never took his foot off the accelerator, even after colliding with the drunk’s car. His foot remained in position, feeding the diesel that pushed both vehicles down the street, over the curb and into the

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The Street Saint doorway of a business. He didn’t say he knew the kid was driving about 60 mph on a city street — because he knew that he would ultimately be held responsible. Not in a court of law, but by his boss and by his peers. That’s one of the great things about being a veteran paramedic: anything goes wrong, and you are responsible. He distinctly remembered seeing the door of the car cave in as his rescue wagon tore its way into the metal, squashing the driver where he sat. He remembered the two vehicles hurtling on, jumping the curb and slamming into the building — an impact more violent than the initial one. His knee hit the dash . . . he didn’t think anything of it. He cussed, as might be expected, at the thought that his truck had finally struck another vehicle. After a lifetime of emergency responses, there he was in the middle of the ghetto with a cocky EMT who now stared, frozen, straight ahead behind the wheel. The unlicensed drunk was trapped behind his steering wheel. His blood spurted into the air like some ridiculous cartoon character that had been shot a thousand times but didn’t discover it until he drank a glass of water. Consternation and chaos . . . the EMT didn’t stop the siren; he didn’t shut off the engine. To make matters worse, the Secret Service and hordes of police were watching the whole incident because they were waiting for the President of the United States to arrive. The President had been scheduled to dedicate a new building there and to talk about changes being made in the blighted urban area. “My God, if you’re going to meet the President, couldn’t it be for something other than an accident that should have never happened?” he thought. Thank God, the President was late! On top of all the embarrassment, the saint was at least saved having the President witness the event. If he had been anywhere else, with anyone else, he would’ve slapped the drunk, but not there; too many eyes. The crowd that had gathered didn’t fluster him . . . he pulled together his emotions and thoughts. He turned off the sirens. Then he heard the fan blades as they tore into the oversized radiator. He didn’t say, “Hey, you OK?” Or, “I’m OK, how about you?”, but “Turn the engine off!” The sinner had taken control. His driver suddenly snapped out of his shock. Not the other driver. Blood ran down the car’s smashed windshield. Bloody hands flailed inside the crumpled car as the passenger bailed out through the side window and began limping away from the car, seemingly OK. “Gotta forget how angry I am and help this idiot!” he thought, as he regained his composure. He would never make the call he had been responding

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Chapter 1. “OUCH!” to. That 70-year-old man was probably still unconscious and not breathing, but he would have to be saved by someone else today. Unit 46 was history. As he tried to exit the truck to assist his new patient in the car, he realized he was history, too. His right hip wouldn’t respond and, as he tried to move, he knew it was out of place. The bone felt jammed up somewhere near his wallet, padded with McDonald’s coupons and night nurses’ phone numbers he never had the inclination to use. “Cripes!” He grabbed the mike to the 800 MHz radio. “46, Dispatch!” “Go ahead, 46,” the dispatcher answered, not expecting this. “We’re involved in a 10-50. Send an ALS unit. Notify the supervisor on duty. Medic down; medic in need of assistance. One other ALS patient on scene; partner OK.” Now the pain was really here! The sciatic nerve he’d injured a couple of times before reminded its owner where it lived. Pain in his right butt, knee on fire — from the hit or from sympathetic pain to the sciatic nerve? The bottom of his foot hurt. It was a dull, numbing, sickening pain that continued over the next three months and eventually sent him to the examining table. He groaned as he slammed his shoulder against his jammed passenger door and it opened with the scream of bent metal. “What dey gonna do, just sit dare?” He heard the “ebonics” lingo and remembered that his crew was white on white, in the ghetto. “Dat man don’t make no sints. Da mudder fugger was drunk, I says!” Ah. So at least one in the crowd was on his side. That was a good sign. A mob won’t form if they can’t agree with one another. Hopefully, the witness wasn’t referring to his own driver. “Keep it together, man,” he said to himself. “Don’t be stupid, for once. You’re hurt; lie back; help’s on the way!” Then he looked into the mangled metal and splintered glass and saw again the driver’s flailing arms. The saint recognized the signs of someone who couldn’t breathe. By then, the passenger had grabbed the building, as if for support, and continued to watch the spectacle. The saint ignored him, but moved into the kind of action people expected from the saints in white coats at times like that. “Ah, I’m going to regret doing this!” He grabbed the dash and the top of the doorway and snapped his body to the side. He was trying to slam his displaced femoral head back to where it belonged. With a groan heard across the street, he slid his duty boots from the truck to the antifreeze- and diesel-slicked pavement below.

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The Street Saint “God, that hurts!” He took his first step towards trying to save one more life. He almost fell the first time he reached for Mother Earth with his right foot. “Steve! Dammit, man, my right hip was out . . . My leg feels inches shorter than the left!” He reached the door of the damaged car more to rescue himself than the patient who bled before him. He felt a blood-soaked shirt and had to physically restrain the patient to keep him from hurting himself further. The man was unconscious, most likely from an injury to his head, but the stench of alcohol and marijuana coming from the car indicated that his altered consciousness may have been substance induced. He deftly pulled his trauma sheers from their pouch and the front of the driver’s shirt was snipped and ripped in a blink. The chest was crushed. A paramedic can swear a blue streak on scenes like this. The words add to the flavor of the incident, but no one seems to remember them. “Steve! Get me the jump bag! I need it quick!” He could have tried to get it himself, but he would never have made it. Steve was in one piece. He was talking with the passenger, who stood drunkenly against the building and complained about a scrape on his right knee. Steve was asking all the young EMT questions, as he should, but the eye of the old paramedic only saw a scraped knee and knew no emergency treatment was needed. The complaining was more lawsuit-driven than anything else. He had seen men with similar injuries run from the police, and only complain of injury after capture. “Steve . . . STEVE!!! I need that kit! “Yea, I know, but he’s hurt!” Steve had followed the normal mode of triage. Nothing about that scene was “normal,” however. “Forget him, right now! He can whine to his lawyer later! This guy is about dead! I’m going to have to decompress a chest, if I hear what I think I’m gonna hear, and Dammit, I’m hurt! Get Over Here and help me!” Without warning, someone grabbed the saint from behind and pulled him from the car. Not a smart thing to do to a medic in pain, in the ghetto, working with a dying man whose stupidity and drunkenness could have killed them all just moments before. The saint reeled from the pain, from the adrenaline, from the rush of standing too quickly, and from forgetting the effects of his bifocals. He came face to face with a wire-rimmed white guy in a suit who shouted in his face, “What do you need me to do?”

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Chapter 1. “OUCH!” No matter how skilled a paramedic thinks he is, when he has a call like this, he hopes a doctor will come along. Not because a doctor necessarily knows more about medicine as the medic practices it in the field, but because the law says that a doctor can assume care of the patient. The responsibility that the scene imposed came with that assumption. For a moment, he hoped the white guy was a young democratic doctor in town to see the president. Using the voice reserved for backing down dogs and guys with knives, he said, “Depends who you are!” “United States Secret Service, sir . . . we saw everything. What do you need?” “A doctor and a god-dammed different ambulance!” The saint quickly wished he could retract what he just said, but then again, with the verbal explosion came relief from stress. Then he could cope. He returned to a professional mode that better suited the situation, “Sorry, not a good day, and not the right time.” The saint pushed his sinner out of the way, but understood his frustration and pain. The secret service agent understood, also. The saint continued, “If you would, I need that blue bag with the star of life on the side, in the side door. This guy’s chest and head are messed up and I’m going to have to do some work here before the other truck arrives.” The saint tried to turn back to the patient. The agent tried to stop him. “Hey sir, you’re hurt; you need to come with me and sit down.” The agent tried to move him to the side of the truck which by then, to the injured medic, seemed a million miles away. No way could he walk that far, and no way was he going to sit down and give up. Tomorrow, or the next day, his pain would be gone and then, he knew, he would have to live with the drunk’s ghost for the rest of his life. He would wonder if the guy would have lived if he hadn’t quit. He wasn’t much of a hero; he just didn’t want to be the goat. “Never mind me. I need a few minutes, that’s all, and then another truck will be here. I just need the equipment.” The saint insisted on treating. He hoped the agent knew enough to help. He didn’t remember the bag arriving; it was just there. He didn’t remember opening it; it was just open. He was back in the driver’s window trying to start the IV . . . he had listened to the lung sounds . . . they were there . . . the chest felt soft and mushy, “chicken liver in a baggy.” If you’ve ever fished for catfish, you may understand.

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The Street Saint This guy needs fluids, he thought. The man must be bleeding somewhere other than the river that ran down his arms and from the wounds to his head. The fluid had to be replaced at three times the patient’s lost volume or other problems would begin; still, the fluid did nothing but keep up the pressure, and with a head injury that isn’t any good. Teams of doctors would collaborate on this patient within the next few hours, but until then, his job was to stabilize. If he erred, the doctors could blame him, for his work in impossible surroundings against desperately negative odds. The saint had to do something, if for no other reason than for his own emotional well-being. With an arm mangled at the wrist and drenched in blood, the drunk clutched at the white chest of the saint who was trying to save him. The saint’s sinner didn’t like the intrusion, the physical limitations, or the contamination, so he bent back the thumb of the patient to maintain control of the arm. He secretly enjoyed giving pain to the man who had injured his pride, as well as his person, and destroyed his truck, which now squatted behind him, hissing like an angry cat. “Hey, wad the fug?” the drunk was awake. “Wa d’you think you be doin’ to me? I was jigs turnin at the fuggin lights!” He tried to sit up, but the powerful arms of the saint held him in place — to keep him from injuring himself further. Meanwhile, he also tried to keep the unsecured IV in place. “You turned in the middle of the block and we nailed you!” the sinner boomed back. In the confined interior of the car, his voice rang loud. The insurance company wouldn’t like that statement, but he felt sick to his stomach and didn’t care. Was it anger? Was it the pain he had been living with now for five or six minutes? Or was it the obnoxious odor of a drunk who probably hadn’t had a bath in a month, accentuated by the affects of hundred-degree heat? Mingling with the other odors he smelled blood. Certain smells warn of underlying conditions, and he often recognized them before he saw the patient. He knew the smells of the street and of people’s homes. Those familiar odors were not known in the clean, antiseptic, surroundings of a hospital. A patient who passed digested blood had a pungent odor that was unmistakable. Those who were weak of stomach often vomited. Then they knew. Cancer often emitted the sweet smell of rotting meat, and that smell was ever present with people in the terminal stages. A nasty tennis-shoe odor oftentimes indicated gangrene. Somewhere, on a diabetic patient’s foot, might be a rotted spot of flesh — a foot that concerned the patient, because of the pain, but one that the saint knew wouldn’t be there much longer.

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Chapter 1. “OUCH!” After a while, he had learned to identify the booze by its label after smelling a drunk. Marijuana, exhaled on the breath, and the sickening sweet, almost burned-coffee odor of crack cocaine were prominent in many places, even outside the ghetto. Identifying odors was not part of his training. He wasn’t allowed to diagnose. But, he liked to point out signs and symptoms that indicated a diagnosis. Personnel that were good at their jobs encouraged him and asked for his opinion. Those full of pride, or ignorant of his abilities, wrote him off as overbearing, and/ or stupid; their actions often delayed a diagnosis. Unfortunately, with the state of emergency medicine in the new era, those delays sometimes caused a death. Death had become something that was easier to document and more easily accepted by the staff. The saint had an open mind. He had to tolerate and attempt to understand his patients. He believed substances inside patients’ bodies were their own business and should be kept confidential, unless their pleasure interfered with the rights of others. The car reeked of vodka or gin, the sweet smell of marijuana, and what could be BO. He smelled antifreeze — or was it crack cocaine that sweetened his nostrils? The saint struggled to complete his assumed responsibilities, much to the dismay of the confused patient. The sinner would just as soon have seen the man die. He would rather snap his neck like an offending twig than withstand the pain and the contamination he had endured. But while in uniform, he would never allow his personal feelings, or prejudices, to interfere with his responsibility to a patient. Prejudices? Yes, he was prejudiced when it came to drunk drivers, child abusers, those who pushed drugs to kids, and those who used the system for immediate gratification. He did not care about the color of their skin — this man bled like any other man he had ever seen bleed. It was the man’s actions and what those actions represented that were disgusting. The sinner thought, “I’d love to transport this guy, and if he becomes a little more unruly, I’d like nothing better than to add a little more to the trauma on his head.” With that thought, the guy jerked, cleared his vein of the catheter that the saint had tried so hard to secure, and sent a new river of blood running down his forearm. “Hold still!” A white-shirted arm grabbed the man through the window. It belonged to one of the other young medics. “You almost killed us, and we’re not

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The Street Saint going to let you kill yourself! You’re going to jail!” The young medic’s “sinner” was coming along nicely. Great defense mechanism. The rest of the incident was a blur. He remembered making it back to the side of his unit with one leg shorter than other. He remembered telling his supervisors about the shortened leg; none of them commented. They were medically trained, but they were techs who had opted for the power and pay of management. The damaged truck and possible workman’s comp case took precedence in their minds. Ignoring an injury was their best legal maneuver. Discussion regarding the saint’s injury would be limited. The black cop on the scene didn’t acknowledge the saint’s report of the intoxicated driver. At other times, cops had told the crew to place the patient on a police hold until the patrolman could get to the hospital to effect an arrest. The patient would become a prisoner after being discharged; thus, the city would avoid paying the hospital bill. If he’s charged after being released, the prisoner pays. The medic heard his partner briefly argue while the officer gave his EMT a ticket for illegal lane usage. The sound of the doctor’s voice as he came through the examining room door brought the saint back to his new status as a patient. The doctor asked him about the treatment he had received and the saint thought to himself, “Yeah, the son-of-a-bitch didn’t have insurance. I got an X-ray and an Ibuprofen.” A workman’s comp claim against the ambulance service was nasty business. The office was always happy to see the saint turn in a bill after he had hauled a workman’s comp case. It paid well. But, when a 100-pound female rescuer lifted a 300-pound man onto a 100-pound cot, her back injury was called “easy money.” EMS and “easy money,” that’s an oxymoron like “military intelligence.” He explained to the doctor that he wasn’t there for “easy money;” he wasn’t there to get out of work. He just wanted the constant pain to stop. He wanted to be able to stand up for more than five minutes so he could work and pay his bills, minimal as they are. Why did he have to explain all of this? He was hurt on the job. Wasn’t he the same as every other worker in the United States? Before the accident, he had been a dedicated medic and now he was a guy who the boss thought was trying to hurt him. This was the medic the boss had described the year before as the “model employee”; now he was the crook who robbed the company. The saint had refused trauma packaging and rode to the hospital in the front seat, his seat, of the unit that responded to his call for help. He insisted on

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Chapter 1. “OUCH!” entering the emergency room via wheelchair. The pain wouldn’t allow him to walk, but he refused to accept the helplessness of the gurney. It was true that he’d been seen in the emergency room, but the “professionals” there didn’t screen for secondary injuries that could have occurred when a 250-pound man hit a dashboard. Paramedics are trained to provide immediate post-trauma care at the scene of an incident, even if it is sometimes a little rough, so that hospitals, with all their sophistication, have a live patient to work with; he and his peers had been trained to assume secondary injury. But emergency room personnel have seen too many pseudo-complaints from motor vehicle accidents that are better treated by lawyers. The saint had been grouped into that category. The registration girl hopped on the side of his bed after he was placed in a room generally reserved for psych patients, the one that was out of the way, so that he might not be noticed by others. The room was not equipped to treat trauma patients. Student nurses stood in the hallway and watched as his uniform was removed. They seemed to be amazed that paramedics wore underwear. By “normal” standards, their suspicions might have been correct. They saw him on duty at all hours. He was never far away from a critical patient. The details of horror stories at the hospital always seemed to have his name attached. That, obviously, was the only life he had. When he realized he had an audience, he looked for a way to tease the girls. He loved playing with student nurses’ minds. It was one of the simple pleasures that life had to offer. It would seem that, with the good pay that workman’s comp offered medical providers, at least the saint would have been examined by a doctor. Instead, a physician’s assistant examined him. If he really had been hurt, he would have been brought in on the stretcher, not in a wheelchair. If he really had been hurt, he would not have walked, at the scene, or been able to treat a patient as he had done. The wheelchair is a politically-correct offering for those who don’t need to be admitted to the ER and definitely don’t need to be transported by an ambulance. Walking a patient to registration is the only way a paramedic can make a statement. Putting the would-be patient in registration without first being seen by a triage nurse announces the arrival of the “ambucab.” Patients are admitted to the ER in droves, but few of them need to be there; and most of those whose bills are paid by the government don’t need treatment in the emergency room. He had arrived in the same manner as the typical 911 abuser, and was treated the same. If he wanted to live like a hero, he would have suffer like one.

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The Street Saint Workers in the emergency room are overworked, yet not underpaid for their services. They use the “treatment on demand” patient to stave off work, by allowing that patient to spend hours in bed. A new patient means more assessment and paperwork. They didn’t have to accept that he was injured; they only had to treat him. That forced them back to work. (He had always noted how people who shared his title referred to work as “duty,” while those in the emergency room were “at work.”) He got a towel to cover the blood on his shirt and an Ibuprofen for his pain. His pretty girlfriend showed up soon thereafter, concerned to have received a call about a serious accident, and was surprised to learn that he had been returned to duty within 45 minutes. Why did he complain, later, about continuous pain? He wasn’t hurt! The hospital and his boss had said so. Now, finally being examined, the saint explained the entire situation to the doctor while walking around the examining room. He didn’t relish being the object of attention, in his weakened condition. He talked more for the sake of stress release than the information that he hoped to share. “You appear to be dragging your right foot?” The doctor broke his silence, after listening to the story. “Yeah, I do that when I’m tired, sometimes; I sort of trip on stuff, too.” He knew he had described signs of sciatic nerve damage commonly referred to as “foot drop.” “OK, sit back up here, a minute.” The doctor had recognized the signs, and pulled out his reflex hammer. “You know, I sort of like this guy — he’s actually examining me,” the medic thought. He didn’t know yet that the reason the boss had sent him to this doctor was because his claim to fame was ferreting out fraudulent complaints. He would then write reports that no other doctor would contradict. But it wasn’t the same, this time. The doc sensed something was genuinely wrong, and the tension in the room subsided. The “malingerer” had turned into a patient who needed care. The hammer struck the saint’s Achilles tendon. No response. The doctor struck his knee; nothing. He struck the same areas on the saint’s other leg. The doc sat for a moment with his hands on his thighs, and said, “You don’t have any reflexes in your legs.” “Do you want me to move them when I see you hit me?” A paramedic’s humor is often misplaced, but it does keep him from crying. “Close your eyes!” the doctor barked.

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Chapter 1. “OUCH!” He felt the doctor sway the ankle in his hand and knew that the doctor still didn’t believe what he had felt. If you tighten the muscles in the leg, they will not respond to the tapping of a nerve. The surprise attack began, as the doctor struck one sensitive spot and then another. Still no response. The medic knew it. The doctor recognized the absence of what he was looking for, and for the first time looked at the medic with sympathy. There were no reflexes in either leg. He was walking from memory. He was reacting from experience. Maybe years of working without sleep had prepared him for the day when he would work without the full use of his legs. “Let me know what you feel.” The doctor softly stroked several spots on both legs. “Tickle” . . . “Numb” . . . “Tickle” . . . “Numb”. “What’s this numb stuff?” the sinner thought. He knew about dermatomes, but not many medics did. There was a lot of study and experience under his thick graying hair. He was not like the new guys who had learned enough to be called paramedics, by the new standards, but who were not much better than the ambulance jockeys of years gone by. The saint knew his stuff and would have spotted the symptoms in a patient immediately. He suspected sciatica, but the doctor said he might have blown a disc. The X-rays taken later that day showed three discs had moved. The diagnosis caught him by surprise. “I want you off work, now . . . and until I find out how bad your back is, there’s no more lifting!” The doctor expected his recommendation to be well received by an employee. “Oh Doc, come on! I’ve only missed four days of work in 23 years. Three of them were for funerals and the other I had a kidney stone . . . signed myself out and was on duty the next day. I don’t want to miss work.” He fought hard to keep from being forced off work. He wasn’t concerned about the loss of income; he had never been paid what his services were worth anyway. Saving a life was priceless, while his income barely kept him at or below the poverty level. “But you can’t lift!” The doctor tried to use the most basic of all ambulance functions as a reason to keep him sidelined. “Yes, I can, I’m as strong as a bull! I’ve been working since the accident. It just hurts!” Not even a doctor was going to tell him what he could and could not do with his body. “OK? What if you can’t lift a patient because he’s too big?” the doctor continued. Unfortunately, he isn’t used to dealing with the bullheadedness of a paramedic.

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The Street Saint “I’ll call for help, like everyone else . . . I’m the third biggest guy in the service, and I don’t call for help very often.” “What if your back gives out and you hurt your partner?” The ortho-man was almost pleading now. “What if his back gives out and he hurts me?” “What if you have a critical patient and you can’t get him out of the house?” Grasping for straws. “I stay on the scene and treat until we figure something out . . . Doc, I had the fire department cut the back off a mobile home one time . . . and tear a rotten porch away that we would’ve fallen through, another time . . . That’s part of my job. I can still do it!” That was the final word from the paramedic. The sinner was being stubborn. The saint waited for a few minutes while the doc made some notes and thought about what his patient had said. “All right, you’re the paramedic and you know your job.” The saint had won that battle. The doctor had granted him that professional courtesy. Now the doctor demanded his. “But I want an MRI as soon as possible, and that will be the judge.” That was the final word from a doctor, and the medic knew not to push. He slid off the table and flirted with all the nurses as he left, never once showing how shocked he was with the doctor’s findings or how scared he was with the possible prognosis. He was a paramedic. He would show no fear. He would show no concern for himself . . . He flirted with the nurses on his way out and, yes, he flirted with every nurse. It was expected. He was everyone’s hero. He was not real; he was a saint of the street. CHAPTER 2. GOING HOME The exam was done. The argument, for now, had been won. The saint returned to duty, and climbed into the truck that was waiting for him outside. How ironic that today he had been paired with another old geezer. In the right context, of course, “old” means “experienced,” and signifies respect. “Newbies,” who were now called EMTs, had quickly devolved into “Wannabes”; they called themselves medics so they could share in the glory of their more accomplished seniors. Paramedics share with firefighters the most respected professions in the United States, but few people know what a paramedic really is. At one time,

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Chapter 2. Going home 40% of DOAs (dead on arrival) could have been prevented if a little knowledge and common sense had been applied. Once that was proven, there was an immediate demand for a cadre of specialists with just that knowledge. During the Sixties, the rapid development of technologies and the proliferation of government funds made it possible for someone with a high school education, an EMT license and another year of extensive training to save lives. EMTs provide basic life support; that is, they control bleeding, splint possible fractures, give oxygen and do CPR. But the paramedic is a whole emergency room. There are no specialists that he can call upon. EMTs load and go, firemen tell the ambulance to “expedite,” and doctors call on the underpaid and often neglected paramedic to get patients to them alive or again to assume the responsibility of keeping a patient stable during transfer after the doctor has exhausted the limits of his own facility. “Paramedic” means in place of, or next to, the doctor. There are many life saving procedures that may only be implemented legally by a physician or a paramedic. Some of these techniques include, but are not limited to, endotracheal or nasal intubation, external jugular, saphenous venous access, interosceous infusions, chrycothyrotemy, defibrillation, external cardiac pacing, and prescribing medications in emergency situations without the benefit of testing procedures that constitute a diagnosis. Nurses work on delegated authority and must receive a direct order from a physician in order to administer medications. Many nurses insist that those orders be in written form before they will act. Paramedics work on standing orders, act when necessary, and talk about it later. When the saint had been a newbie, his paramedics used to set the rules. They wore what they wanted, did what they wanted, basically worked when they wanted. If a newbie got in their way, he was dismissed. Everyone needed the paramedics for grants, and to protect the ambulance district’s position in the community. Losing the district was bad because elected officials would lose their positions. The takeover by a private service or an aggressive neighboring tax-based service may have benefited the public — but the public wasn’t aware of that. Television programs featuring emergency medicine created a hype that brought would-be heroes to the profession. Many of them would have preferred careers with the police or fire departments, but lacked the necessary physical or mental attributes and opted for the Emergency Medical Services instead. Many of them showed their insecurity by calling the veterans “old fogeys.”

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The Street Saint “Hey old man, the next time you respond to a nursing home, why don’t you stay there?” That hurt. Fear of the unknown and fear of a degenerating physical condition brought this distant future much too close, much too quickly. He had seen the horrid conditions of those places, and wondered at the misuse of public funds. As he knew from his daily work, here in the richest nation in the world, some people are routinely pampered with inappropriate and unnecessary medical care — but we apparently cannot afford to care for our elderly. We, the people who put a man on the moon, have one of the developed world’s highest infant mortality rates. Meanwhile, we allow babies to have babies, and collectively we pay for their upbringing. We who keep the world at peace haven’t got the courage to tell people that they don’t always need to go to an emergency room. We sacrifice our nation’s sons out of fear of losing our position in the world, but we allow the emergency medical services to spin out of control, out of fear of losing a vote. As a paramedic, the saint had to stay in line, in everything that he did, to hold onto what little prestige he had. Would-be patients given free medical care made him a political pawn. He transported paying customers to the hospitals designated by their insurance carriers, while Medicaid allowed indigent patients to demand treatment at the facilities of their own choice, whether they needed it or not. He wondered whether some of the people he had saved, in years past, would have lived if he had been trained like the newcomers today. When the saint was a newbie, he was expected to know the book better than those already in the field. Today, new recruits haven’t been taught as much, and often are forced to make up what they need to survive. It is easier to make fun of one’s elders and to handle emergencies with a fast ride than to learn what one needs to know. Insecurity makes them unwilling to listen to an older colleague’s experiences; they tell their own stories, and amaze themselves. Their older colleagues just listen. The competition from the street, the horrors of bad calls and the emotional walls made it hard for the old saint to make friends, and he had quit trying to do so. Many of those whom he had liked didn’t stay long, and it hurt when they said good-bye. The new ones were young wolves. They took the weaknesses he shared with them in a moment of confidence, the shortcomings he had revealed or even the slowing of his aging body, and threw them back in his face. So now, being paired with an oldster was frightening, in a way, because they knew that their youth, strength, speed, and eyesight were not what they

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Chapter 2. Going home should be. On the other hand, it was good to have a partner who wouldn’t hurt him. “I wanted to thank you for today.” Dave started a conversation that brought the saint out of his thoughts. The saint realized that he should not be concerned with his problems — for Dave’s sake. “The supervisor has been calling me every five minutes to see if you were done. I think they wanted me to hold your hand,” Dave said with a grin. (His look hinted, “You don’t have good news, do you, Bud?”) “After all the years, do you think it was worth it? Did you think you’d go out this way?” The smile also said they knew they couldn’t ignore the obvious. The saint sat quietly, but Dave’s experienced eye saw that he was upset. By trying to show that he wasn’t worried, he proved to Dave that he was. The saint had turned himself off the same way he did when he consoled a family. That was how he had learned to handle bad news. The young bull on the street often had difficulty with that. In his immaturity, he couldn’t handle life’s problems because he had no point of reference. The saint could console the families of the overdosed, or those that had committed suicide, while he hid his disgust and disappointment. The compassion the saint felt was for the family, not for the ones who had taken their lives. But it was harder to console the wife of a drunk that had wiped out an entire family. Her husband was dead, true; but she hadn’t seen the dead father with the steering wheel embedded in his chest. She hadn’t seen the mother’s blue-tinged mask, killed when her neck snapped over the dashboard while she innocently slept. The killer’s wife hadn’t tried to rescue a 19-year-old girl with a hole in the side of her head that had destroyed her beauty; she hadn’t just left the trauma room where the young woman, nude and exposed, died minutes after arrival. The wife didn’t have to deal with the knowledge that her efforts had failed. Had he stayed too long? Could someone younger have done it quicker? Would the young girl have made it, if he had pushed the envelope and taken her to a level-one facility? Surgical teams were there, just waiting for that type of emergency. They house every specialty known to modern medicine and those teams are ready or can be paged into service within minutes, at any time of day. He had a level-one facility just seven minutes away, but the politics and the economics of the area dictated that the patient first be taken elsewhere. Those were just some of the thoughts he dealt with while the drunk’s wife sobbed on his shoulder. He felt her pain, but in his anger he wanted to tell her exactly what the son-of-a-bitch she was so upset about losing had done. Maybe

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The Street Saint if her old man had hit a telephone pole or had driven off of a cliff, the medic’s compassion could have been higher. But still, compassion he showed her, for the benefit of those who watched. He saw no reason to mourn her loss, but her pain was still real and she needed help. After the horror ended, she would have to face the knowledge that her loved one had torn the life out of a family; the saint would be forgotten. He would feel sorry for her tomorrow, after the slaughter he had just seen slid into the crevices of his mind. Like so many other images, he could bring it out when needed, but by then it would be blurred, the colors muted, to protect him. But now, the two seasoned veterans knew the truth. The diagnosis wasn’t pulled muscles. He would have gone to a doctor, for that. For a moment, he knew how family members felt when he pulled their loved ones pulseless from their homes. Keeping himself and others calm permitted the task of raising the dead to proceed. The intubation tube he had placed was secured. Oxygen gushed from its tank, through the tube. He never commented when he felt ribs crack while he was doing chest compressions. He knew his efforts were for naught, but the family needed to see the saint sweat for the sweat that their loved one had shed for them. Still, he never gave false hope. When he looked into their eyes, they knew. He didn’t need to tell them that the fight had been lost before it was even begun. He hated telling someone there was nothing he could do; he felt guilty. He had to decide quickly whether to explain the medical reasons why any attempts were useless or to reason that the patient was in God’s hands. He used what he thought the family would best accept. Sometimes, he could have tried but didn’t. Fatigue limited his number of attempts, after handling ten to fifteen calls in an 8hour shift and as many as thirty in a 24-hour shift. And he knew that the hospital was always busy, and transporting a code would do nothing but create more paperwork. The overworked doctor would pronounce the patient dead, without even taking a pulse. How would the saint’s overworked doctor tell him the truth, when he himself had sugar coated so many truths before? “We’re doing the best we can,” isn’t convincing to the veteran. It sounds like bad news. His days as a saint were numbered. Sometimes, the doctor seemed disappointed when the paramedic said, “Doc, he’s got a pulse.” People who had sworn to extend life, people who had been drawn into a career that served others, were disappointed that the patient was alive? The exhaustion they endured triaging and treating hundreds

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Chapter 3. Where did it begin? of patients a day that didn’t need to be seen had changed their heart. The medical abuser sucks the very soul out of the people we depend on to go the extra mile when we need them most. He had temporarily fought off being pulled from the line-up. His knowledge and experience would be lost. There is no position for used-up paramedics. He and his partner knew the future as well as the family who watched Grandpa being carried, thumbs tied together, eyes glassy and pupils blown, to the ambulance for his last trip alive. The end was there. Denial would do nothing more than make a fool out of him and possibly make him do things for which he would have to later apologize. He had rarely apologized for his actions, and never for his emotions. Since grade school he had fought for others who didn’t know how to fight. He had always thought there was nothing he couldn’t overcome. But, this was out of his hands. For the first time, he would fail himself. No amount of will was going to help him. This was the end. But where had it begun? CHAPTER 3. WHERE DID IT BEGIN? The saint wanted to enjoy the trip into his past. His head rested against the high-backed captain’s seat that had carried him home, after dealing with other people’s problems. He was tired and aching. Now, the seat supported him with an upholstered hug like the ones his arms had given to so many others. And, just like when he was on scenes, even in a crowd, the saint was emotionally alone. He hadn’t grown up wanting to be a paramedic. That job didn’t even exist at the time. His aspirations were like those of any other young man raised in the Fifties: football player, fireman, policeman; but he finally decided on being a teacher. Then he had to leave college, and that was that. Still, why EMS? The urge had been present long before. In Boy Scouts, he couldn’t get enough first aid training. He loved it, and even went to the woods near his parent’s house and practiced splinting and carrying younger children. At the age of twelve, while suffering a bout of heat exhaustion, he was sitting in the shade and watching over his diabetic younger sister as she swam. He had seen her often in hypoglycemic episodes, and had seen simple things like the flu almost claim her life. He had felt helpless then, and abandoned, when his Dad told him that the doctors said his sister wouldn’t be with him much longer. He hated that feeling of helplessness. Right now, his sister wasn’t having any problems, so his attention was drawn to a chubby boy about his own age, who

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The Street Saint couldn’t swim well. The boy would dive off the diving board and then dog paddle to the side. While the saint watched, the boy made one too many dives, and could not reach the side of the pool. He called once for help, the saint saw the panic on his face, and then the boy slipped beneath the surface. The fledgling saint, with his doctor’s warning about over exertion still ringing in his ears, pulled off his shirt, grabbed the top of the fence, vaulted it, and entered the water in one athletic move. He found the exhausted boy on the pool grate, grabbed his hair the way he had been trained to do, and pulled him to the surface. Others helped the youth from the water, but the young saint did not remember how he got out. He was just on the side with bystanders slapping him on the back and telling him how brave he was. And that was the birth of the saint. He remembered his first slap in the face. He was a lifeguard for The Boy Scouts of America and the man in charge of the camp had a daughter, a little older than the saint, who loved to jump into the lake. She didn’t know how to swim, but isn’t that what lifeguards are far? She would position one of them in the water and then drop in feet first so the guard could catch her. He would then tow her back to the raft so that her fun could be repeated. One time, she jumped a little to the side and the saint missed. She swam like a rock and quickly reached the mud bottom thirty feet down. The saint, her chosen life jacket and tugboat, surface dived, found her in the murky water, grabbed her by the hair and pulled her to the surface. The young rescuer used a cross-chest carry, just like the book said to do. He had done his job perfectly. He should have been called a hero. Instead, she blamed him for her error in judgment. She would never forgive him for the scare she had caused herself. And she slapped him in the face for squashing her ample young breast with his developing arms. She ran off and told Daddy of the young scout’s impudence. Dad never said anything to the reliable scout, but the boy was embarrassed each time the camp director’s eyes met his. He had done his best, but had been slapped for his efforts. He didn’t understand for a long time what the problem was. Those firm breasts had felt good under his forearm, but he had been too young to understand that, either. He now thought the slap in the face was an omen of things to come. He remembered how surprised he had been to hear that he needed a license to work on an ambulance. When he was young, the attendants had been undertakers. He also learned that, besides an advanced first aid card, he would need a

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Chapter 4. Talks with another “old fogey” teamster’s card. Why? People always just flashed their headlights, like his Dad did when he was racing his daughter to the emergency room. He didn’t understand the need for medical training. An ambulance was nothing more than a fast ride to the hospital. His dad, and others, would say, “Why take an ambulance? It takes too long to get one and they’re just going to run for the hospital and charge you $35 to do it!” Even now, the public lacks a basic understanding of what goes on in emergency medicine. The new medic today has no idea what the job should really be, because most of the time they have to do things that their profession was not intended to do. CHAPTER 4. TALKS WITH ANOTHER “OLD FOGEY” He looked towards the back of his ambulance, while still deep in thought. He had lived within those thoughts like an actor absorbed in his role. The “back” was his office. This vehicle had only lasted five years and the replacement cost would be close to $80,000. Areas that are low on crime, low on trauma, and have medics who generally sat idle in their stations usually had new equipment. Funds were not equitably shared across different jurisdictions. The public gets what it pays for, and few pay for the ambulance. Along with the condition of the truck in which he ran 4,000 calls a year, he pictured the $40,000 worth of equipment. Extravagant by anyone’s taste, but nothing compared to what the truck could offer. Most of the time, people used the truck as a taxi, and he knew the medical world was not ready to see new medical procedures performed by a lowly paramedic. He zeroed in on the cot. He thought about its history. No matter what the level of care an ambulance offered, the cot was the center of its being. No matter what changes were made, that fact would never change. The cot was the place of suffering, of birth, but to him, never the place of death. Before his profession was born, ambulances used to deliver DOAs that his profession had helped eliminate. No one died in an ambulance anymore. Even those who were placed there without a pulse were considered salvageable. That rationale brought out every drop of adrenaline and every ounce of concentration that the saint had. It was for those moments that he lived and had been trained. It was those for moments that he and his brother saints were known. Unlike the saints of the church, the saints

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The Street Saint of the street do not welcome death. They fight it until it is abundantly clear that a higher order has made His final prognosis. The saint knew he could be better armed, but until that day came he fought with what he had. “Hey, Dave!” He wanted to rid himself of morbid thoughts and regain some of the playfulness of his youth. “Do you remember when every woman we dated, we tried to get to join the Code Three Club?” The saint had remembered another use for the cot. “No,” Dave said. “I only remember the ones who joined.” They both laughed. The Code Three Club was a descendent of the mile high club. In those days the only way a female could get into an ambulance was by being a patient, or by succumbing to them on the ambulance cot. The partner would drive with the ambulance’s lights flashing and its siren blaring: running “code three.” Dave and the saint both knew that the membership was far more limited than it was sometimes made out to be. “Boy, the best days were when we were ‘Mother, Jugs, and Speed’,” Dave said. “Yeah, that was a pretty good flick, but then everyone knew what we were up to.” It felt good to remind someone that he was an “elder,” without being ridiculed for it. At one time, saints patrolled looking for patients to provide income. When the police kicked a high-paying call like a car wreck, every ambulance within range responded. The saint had fought over patients and had stories to tell about rides to scenes that today would scare him. The government finally allocated districts, and scanner jumping, for the most part, became a thing of the past. The movie that Dave had referred to had helped expose “the ambulance wars.” “Did I ever tell you that I threw a guy’s cot off the bridge once, in the ambulance wars?” “No!?” the saint was surprised at Dave’s confession. The saint saw Dave as compulsively “correct,” and his confession was hard to believe. The man was always meticulously dressed and even showered in the middle of shifts. He wore black horn-rimmed glasses; his hair showed no gray and was never out of place. But Dave had admitted that he was guilty. “Yeah, the guy got there after me and I had already used my short and long board to get this fat bitch out of her car. He told me to put her on his cot, and I told him what he could do about that. It was my board and I was there first. He

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Chapter 4. Talks with another “old fogey” said yeah, but I got my cot here! So, I threw it off the bridge and went and got mine.” “Oh, you didn’t?” the saint asked. He knew old guys had a tendency to exaggerate, but usually the exaggeration emphasized a point. “Sure did! His boss about flipped. Called my boss and said my boss had to pay for the cot. My boss told him to either get a scuba tank, a new cot, or go to hell, whichever he preferred, and hung up on him!” Dave pounded the steering wheel while he talked; both had begun to feel the vim and vigor of their youth. The saint had to match the tale or lose the battle of war stories. It was one of the rules. “Well, I never did anything like that.” the saint said. “Oh no, not you!” Dave’s grin said he knew the saint wasn’t always saintly. “No, I never destroyed property — because with my luck, the boss would make me pay for it.” “That’s what I thought, too, but it didn’t happen that way.” The saint baited him. “When I met up with a greedy son-of-a-bitch like you, I would help you load patients into your truck.” “Oh, now, that’s sweet of you! My boss would have pulled you in on the carpet.” Dave could never have taken the compassionate route. “Yeah, and while I was helping you, my partner would take them out the side door and put them in my truck.” The sinner had proven who the master was. “You!” Dave didn’t like the implication that he would have fallen for something that stupid. “That would only work once, and then they’d know what you were up to.” “So,” the saint showed how it worked. “You sit in your truck guarding your one patient, while my partner and I are still outside. While your partner is packaging a patient that needs transport, we load the walking wounded. We tell them that you’re only interested in the big-ticket patients and that everyone should be ‘checked out’ after being in an accident.” The sinner had won, but couldn’t resist adding: “Then we’d stop by the hospital and steal your equipment.” He laughed. “You son-of-a-bitch, that’s what happened to that stuff? I thought the nurses threw it away.” Dave was shocked that he had been that stupid. “You never heard me complain about missing equipment, did you?” The sinner laughed again. Dave’s feelings were hurt, so the saint changed the subject. “Hey, remember when the girls would come to the base?” Women were something they would be happier talking about.

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The Street Saint “Yeah. If those walls could talk.” Dave’s mood changed immediately. “I remember having a girl with me at the base and the phone would always ring at the wrong time.” Dave shook his head, remembering another of the frustrations of his younger days. “I’d have to hope she was still there when I got back.” Dave snapped his head up when he remembered more pleasant times. “Hey! Remember how they knew when pay day was, and came knocking at the door?” The saint stared at Dave in total disbelief. It was bad enough to hear the confession about the cot, but now his principled friend had just confessed to being a whoremonger. At this rate, he was afraid Dave would soon be telling him that there wasn’t any Santa Claus, and ruin every recollection he had of happier times. “Yeah, and now we wear gloves because we’re afraid we might catch something!” Dave brought his story back to the present. They both laughed. The saint would worry about the future of Santa Claus another time; he was starting to enjoy the conversation. Then the saint reflected on other uses for the cot, “Hey, Dave, what do you tell someone when he tells you he’s going to die?” “Bull.” Dave answered. He preferred the livelier topic. “No, really,” the saint persisted. “What do you tell someone, when he looks you in the eye and calmly say ‘I’m not going to make it this time’?” Funny they had never talked about that. None of them do. It’s too emotional, too personal. Saints aren’t supposed to have those kinds of feelings. Death isn’t part of their job. It’s too hard to accept. It means failure. Once it occurs, all the decisions have been made. The medic just calls the coroner and writes a report. They accept death, the way a batter accepts the man in front of him striking out, with the bases loaded. But they’d rather snatch people from death’s grasp. Some patients sensed their impending doom and warned them, and experience had taught both medics that those people knew. Their words were not the begging, “Don’t let me die!” Not the crying, “I don’t want to die!” It was the cold, angel-driven voice that said “I’m going to die, it’s OK; don’t be upset,” that always chilled a saint. They learned to prepare, without showing the patient that the patient was likely to prove to be correct. He felt cold when he reminded himself of that voice. It’s a voice from beyond, an echo that sounds from the grave to those who still walk the earth. It is the voice of a soul that is leaving a body, a voice that apologizes for its departure and asks you not to feel bad. It comes from a person brave enough to face death, to take its hand and walk away from this life.

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Chapter 4. Talks with another “old fogey” But with a saint around, the departure was not that unremarkable. “I just tell them, bull, you aren’t going to die!” Dave said, while he adjusted his seating. “It’s weird though, isn’t it? They say it, and then they prove themselves right.” The saint was somber again. “Yeah, well, you aren’t going to die!” Dave thought his partner was getting extreme. “That’s what I tell them, too . . . You aren’t going to die in my truck, causes too much paperwork!” the saint said matter-of-factly and then turned a sideways glance at Dave. Dave looked at him and the saint smiled. Then they laughed, silly laughter. “A laughing man never dies,” crossed both of their minds. The career of a saint was in critical condition, and laughter was the best medicine. “What do you tell a guy. . .” the saint said, while still laughing, “who fell asleep on his arm: that it’s not a stroke . . . his hand’s asleep?” They both roared. Dave had to match. “How about the mother who says her baby’s not breathing, and you find that the kid’s nose is stopped up, but she doesn’t know, after six kids, that a baby can’t breathe with a nose full of snot?” The saint was well aware of that type of call and proved his experience with a related one. “I had one that thought the little blue bulb was to give the kid enemas with.” “Oh, come on?” Now he had topped Dave. “No really, that’s what she told me. She looked at me real strange when I put it up the kid’s nose and sucked the mucus out.” Dave cautiously offered a thought, “You know, they’re stupid, but that’s our job too; to teach them?” “Sure is, Bud, but these young dudes look down on people like that, and most people aren’t looking for a simple solution; they want special treatment at the hospital.” It was far too serious a thought for the moment, but he knew he could have never had a similar conversation with the wannabes, because they didn’t want to hear his war stories, or understand that the stories served a purpose. The saint had always listened to them and had seen how he could learn from them, even while he was breaking in the creases on his squad pants. He wasn’t going to be able to cure ignorance, and besides, the sinner had been awakened. Dave and he continued their game of war stories until their unit was called on the radio. They broke their mood and once again proved how fast they could respond. They could awaken and be in a truck in less than two minutes. They could gorge

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The Street Saint themselves on a buffet and be back in the truck in ten. They could do thirty minutes of ER work in half that time, and rarely err. They could switch to a better mood in seconds but, unfortunately, the reverse was usually the rule. Arriving at work was often enough to send a good mood scampering like a kid running from the neighbor’s dog. The new breed is different. They aren’t required to learn as much before they show up on the job. He couldn’t remember the last time a student had failed to be licensed. He knew the screening process wasn’t good and that there weren’t many people emotionally, mentally, and physically qualified to do his job. The selection process had to be made easier, in order to get a medic in every truck while the number of requests for help kept going up. He blamed politics for trying to provide advanced life support to every community, before his profession was ready. He blamed his own profession for giving up on the advances in pre-hospital care, thereby reducing his service to a rough-riding taxi trip that costs more than a chauffeur-driven limousine. Respect and authority and everything that should be a driving force for the young were gone. They assumed the titles and reputations without a sense of having to earn them. As one newcomer said, “I got a license; experience will come later.” They hid behind the ignorance of the public, and most of the medical profession, who didn’t know what was possible. In the eyes of the public, someone sharply dressed with a belt and pockets packed with supplies, pagers hanging from epaulets, looks like the knowledgeable one. In truth, the one with the old shirt and faded pants, unkempt, grumpy, and unshaven, who waited in the truck for his order while his young partner braves the line at McDonalds, was the one that was needed. The young one was useful if an expandable screwdriver or a spare battery for a pager was needed. The elder used the strength, stamina, and speed of the young in exchange for his experience and calm, steady hand. The younger ones should be passing this on to their successors, the way the system was designed, but the chain had been broken. CHAPTER 5. “READY” IS A STATE OF MIND Maybe it’s the instructors. Many are appointed without proving competence in the field; some instructors have virtually no street experience. They tell story after story of how the “experienced medic” will wrongly guide the student; and that kind of rhetoric intimidates other instructors. Certainly, some of the

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Chapter 5. “Ready” is a state of mind less able teachers are there to avoid the demands of working in the field. They would be better suited for dispatch positions or directing traffic, not for training others who ultimately will be responsible for someone’s life. He had to think hard to even remember most of his training. He hadn’t used a lot of it in a long time: hundreds of things he thought he would never need, and he had used them to save a life. He used to point to a patient’s condition. Many of them were still walking the streets because of that insight. He had been given the responsibility of taking the place of a doctor, in an emergency, and he took that responsibility seriously. The saint told students that while they might expect their life in EMS to be lights and sirens, and blood and guts, but “You’ll only make a difference on 5% of your calls and of those, only 5% are going to be trauma. Most of your career is going to be spent hauling Grandma to the hospital because she hasn’t had a bowel movement in a week, and then back again. There are many such stupid reasons to use an advanced life-support ambulance.” He knew that when those barely passing, under-trained, never-pushed students were in that 5% situation, they would fail. Their work was not evaluated by what they accomplished prior to arrival at the hospital door, but by the time it took to get to there; just like the Cadillac of yesteryear. The young would still succeed the 95% of the time, when anyone with a driver’s license could do just as well. 95% is an “A,” and anyone disputing that should be run out of the system. So said the majority. Even a doctor once called him an “overpaid truck driver.” Not to his face, mind you. His rambling thoughts had brought him back to a mood too skeptical to allow him to work, so he took responsibility for getting himself back in a better frame of mind. “Hey, Dave!” The two veterans forced a return of their once giddy mood, and continued their idle chatter until their dispatcher interrupted them. “50!” he called. “50, go ahead.” The saint answered, trying not to sound like he minded. “Respond eastbound 64; 10-50; tractor trailer on top of a car.” “Clear, Dispatch.” He then parroted their assignment, and began the process of incident command, without thinking. He knew the people he was responding to were probably dead already, but he had to consider alternatives. 911 reports were rarely correct, and dispatchers sometimes condensed calls for help and categorized them inappropriately.

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The Street Saint “You’re it, Bud. Everyone’s out of town on transfers. Psych patient to the state hospital . . . dialysis patient needs a ride . . . and a fall out at a bar going BLS across town.” The dispatcher had broken the regular ten-code format and showed her frustration over not having anything available. Everyone knew that the transfer was a necessary evil, for without it, they’d be out of business. “Damn! There isn’t going to be another truck available for a half hour.” The saint surrendered. “I hope they’re all dead! I am not going to stand by while someone dies. I sure am not going to try to explain to a family why we watched over dead people, to save me from an abandonment suit,” he said, while he stuffed a pair of gloves under Dave’s bottom and then pulled a pair for himself. He put them on and then reached for a cigarette that was his signal that he was ready for the call. “Don’t sweat it, Dude, let’s just grab the live ones and run! The dead ones can kiss daisies and my backside!” Dave ignored the obvious. “Oh, yeah?” the sinner asked. “Did you hear about the medic who did that and is getting sued for abandonment?” The real world out there ignored what was obvious to a paramedic. “Yeah, I know, let’s just wait till we get there . . . maybe it isn’t that bad.” Dave knew better, but they both acknowledged that neither of them could be upset when they arrived on the scene. The sinner ignored the opportunity of serenity, “Yeah, and maybe my back will quit hurting because you laid hands on me.” “You’d like that, wouldn’t you?” Dave had his tough-guy going. It hid the images of horror that might be awaiting them. “In your dreams, Big Boy, in your dreams,” the saint said, with a cigarette hanging from his mouth. He had assumed his “I don’t care if your brains are between your feet, it don’t bother me” look of an inbound paramedic. The only thing left for them to do was to get there in one piece and face the unknown. They had donned their professional image, the way people expected them to look. The “tough guy” chatter continued while fingers clicked switches and brought the big unit’s 35 amps of electrical power to life. The siren screamed. The truck hesitated, to allow the traffic to adjust to its presence, and then its 600 horses lunged forward. Dave put his left foot on the air horn to warn idiots. He thought of the pain his friend had suffered because of just such an incident.

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Chapter 6. A.S.S.U.M.E. Neither was ever ready; they only looked that way. To help calm their nerves while they maintained a safe level of adrenaline, their hands threw switches and pulled gloves. They lit cigarettes that they knew they would never finish. It was part of their routine. It was something constant in a world that never presented things the same way twice. But that was what they lived for. To them it was fun and exciting. They had opened the books of experience in their minds and waited for what they would find. CHAPTER 6. A.S.S.U.M.E. Their chatter continued, but the tone had changed. They tracked the movement of cars two blocks away; and commented on, or screamed at, those closer. The pressure had to be let off before they got on scene. Saints don’t talk about the feelings they have when they respond. None shows the fear of failure that weighs heavily on their minds. None wants it known that they are addicted to the adrenaline rush and need it as badly as any junky needs his fix. The adrenaline rush raises the blood pressure — there is no high like saving a life. To a reporter they may say, “I love to take care of my fellow man”; or “It’s my way of serving the community.” But it is mostly the rush that draws them and keeps them on their job. “What if I fail?” He never said it, but he thought it every time he slipped on a pair of gloves. If that fear ever left, he would change professions. Over the years he grew confident that he could handle anything, but the fear stayed with him. For some, though, the fear and the thrill had left and they quite frankly no longer cared. Every call for help had become a nuisance that they’d just as soon avoid. To those who were still dedicated, even though frustrated, there was a little rush of success every time they accomplished a difficult task. To them, testing their skills and beating the devil was still seductive. Fear is good, but it has to be controlled. Fear of not arriving in time must not be allowed to cause unsafe driving practices or lack of concern about a dangerous scene. Fear of failing cannot be allowed to delay a critically-injured trauma patient’s arrival at the hospital. Better to arrive quickly with protocols not yet accomplished than to complete the job for a dead patient. The facility itself was also a concern. The staff’s response times and the quality of the nurses and attending physicians had to be considered. The good

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The Street Saint medic said he’d rather spend an extra five minutes on scene than watch a hospital waste twenty minutes doing the same job. He had watched patients die while he stood by, quiet, and ethically restrained, knowing full well that his patient could have lived if he had treated as he had been taught and rushed to somewhere he knew would do better. He had done it before. “Remember this emergency room, next time,” he would think, while driving away from another bad experience. He then dismissed the poor treatment he had witnessed and worried about the next patient. He treated them one at a time, dumping them out of his mind and into the hospital bed. Tension was thick in the air while Dave and the saint prepared for the unknown and the responsibility they had taken on. Their minds had become selective. The sirens no longer pierced their ears. Without turning up the volume, the dispatcher’s voice seemed to increase. Counter traffic from the police and fire departments became audible, when moments before they had been only bothersome background noise that interrupted a punch line. It took a combination of fear, the pleasure of success and the rush of adrenaline to quickly put his mind into the proper mode. “50, Dispatch.” “Go ahead, five-oh.” “We’re 23, one vehicle on its side. No obvious injuries, will advise.” “10-4. 1337.” The scene wasn’t anything like what he had been dispatched to and “a pup” would have blamed the dispatcher. The saint knew better. Maybe, someday the general public will at least know how and why to dial 911. Dave and he had to dump their adrenaline. They might transport someone with a scratch. The saint had assumed. “ASSUME: makes an ASS out of U and ME”; that is never truer than in an emergency worker’s life. While he once had thought his patients wouldn’t cause trouble, he had learned to never turn his back on them. If he ever commented on how quiet the day had been, he knew he would shortly be surrounded by alligators. If he thought he was going to have a fun shift, his partner would arrive hung over, or crabby from fighting with his old lady. For some reason, these were common phenomena in EMS. Scene safety was his first concern. He no longer looked for danger, he sensed it. His first responsibility was to himself. He then watched out for his partner and then his truck and supplies. The public he served was usually a

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Chapter 6. A.S.S.U.M.E. nuisance and often a danger. They sometimes overreacted while others selfishly were annoyed about the inconvenience the emergency had caused them. Everything here looked alright. There was just a van lying on its side and a couple of folks standing by the side of the road. “50, Dispatch.” “Go ahead, five oh.” “We’re secure. It looks like a couple of walking wounded. You can cancel the other units.” They approached the small clan of people. “Anybody need to go to the hospital in the ambulance?” When there were no obvious injuries, he had learned to ask if anyone had to go to the hospital in an ambulance. If he asked if anyone was hurt, he’d transport at least twice as many as needed. “Not us, man. Check out the people inside the van; we just stopped to watch.” “What? In the van?” His adrenaline surged again. He kicked himself for assuming. Wrecks are either bad, or bull. He knew that when a van went on its side at 70 mph and still had people inside, it wasn’t bull. “50, Dispatch!” “Go ahead five oh.” “We’re approaching a van that’s on its side. Bystanders say that there are still people inside. Tell the units to hold their position but get the Fire Department heading this way!” He released the button on his radio and increased his stride towards the van. If it were bad, he wanted firemen crawling all over him instead of wishing that he had their tools, while they cooked chili at the firehouse. Much can be done on the scene where patients are trapped, but a badly-injured patient needs a surgeon. Therefore, not only did the saint have to protect himself, his partner, and those on the scene but he also had to plan the future for the critically injured. “Review” considered the time rescuers spent on the scene, but the patient’s “golden hour” began the moment the van flipped. He wanted to move faster, but he had a rule. Don’t run on the scene. He told younger partners if he ever ran . . . run. Don’t ask questions . . . just run. He told them, “At my age, if you see me running, it means someone has a gun or there’s a really big dog.” He knew that running was a sign of fear. Fear resulted in panic. Panic caused loss of control and with the loss of control went the scene. Losing a scene cost respect, and more important, possibly a patient’s life or his own. Inexperi-

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The Street Saint enced saints had been mugged or beaten, had their ambulances taken away, etc. Most injuries could have been avoided if caution had been heeded. It was ridiculous for a rescuer to need rescuing. He ducked the cars, and then looked for other hazards. There was nothing to be concerned with . . . just a van on its side. He approached it from the rear, instinctively checked it for stability, and then used the drive shaft to climb onto its side. He opened the passenger door, and even though the sun shown brightly through the windshield the van’s interior looked cluttered; dark and forbidding. His eyes adjusted to the dimness and then he saw two bodies, one on top of the other. Others must have sensed his presence, and called out. He answered their call for help with one of his own, “Dave, I’ve got a mess in here! Get me some help!” It was now his call and his responsibility. “What you got in there, old man, a drunk?” Dave asked, but knew that “get me help” did not come easily from his friend. The saint’s words meant it was bad. “NO! I got people in here and it sounds like a lot of them. Get me everything we got and get it now!” The saint didn’t want to give orders. He wanted to think about what he needed to do, but he had to give orders or time would be wasted. He had just ten minutes on the scene before questions would be asked. It was not possible to think things through. He had to do what he felt was best, knowing he would be critiqued by all for days to come. The saint wasn’t sure how to proceed. He knew he needed help with extrication. There were more people than his ambulance could transport, and his other units were out of town. He knew his buddies, who had heard Dave’s call for help, were jealously playing out the scenario with him. He knew they lived for moments such as he was living then and hated even more the mundane calls they had been sent to handle. He needed time that such situations never gave him. His time was not registered in minutes but by every beat of a heart that sent more blood onto the ground or deeper into a body cavity. It was time that allowed every breath to bring more fluid into a damaged lung or more blood into a skull where it squeezed a soul from a body. He needed to be inside, to learn more. He once again had to say “to hell” to his own safety. Maybe they weren’t injured, but just couldn’t get out. Maybe all but a few were dead. How many, how badly hurt, and what facility should they be transported to — if any? He needed to either expedite the rescue of the year,

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Chapter 7. God? What did I do today to make you turn on me? or stop the multitude of oncoming emergency vehicles before he would be laughed at for weeks. That was his fear; he couldn’t let anyone die. That was his anguish; he couldn’t over-react. He slid off the side of the van, looked in through the windshield, and saw for the first time the horror he had feared. CHAPTER 7. GOD? WHAT DID I DO TODAY TO MAKE YOU TURN ON ME? He had already postured himself to prevent over-reacting to whatever he would see or feel. He had to be ready for anything. He had no tools, but a Department of Transportation man was on the scene — a tow truck driver, used to clearing scenes rapidly, without much concern for the vehicle’s condition at the end of the tow. The saint found himself in a similar situation; the windshield needed to disappear. He turned things over to his sinner, who loved tearing things apart, and to the man who threw cars around for a living. Dave had the fire department en route, but “en route” wasn’t there; there was no time to wait. From the sound of the voices inside, he had more to do than should be expected of one man, and waiting was their worst enemy. He turned to the DOT guy and said, “Get me a crowbar and your cable. We gotta move.” The big yellow-green wrecker crawled backwards into position and the crow bar appeared from under the driver’s seat. The saint knew it was there more for protection than mechanical leverage, but now it was going to be used to save a life, not bust a head. “Get me that cable over here and get ready to snap it,” he called to the driver. He knew he was in harm’s way. He knew he could serve future patients better if he was healthy, but those patients were people he hadn’t met yet. The voices he heard in the van were his people, now. He used the crowbar to smash two fist-sized holes. He put the cable in through one and out through the other, and then hooked it back on itself. It was an improvisation of an old technique used to pull windshields with a blanket. He sometimes thought a lazy paramedic must have invented the tilt steering wheel. Since their introduction, the technique was rarely used and more rarely taught. The DOT man put on his gloves and pulled out slack for the cable. He revved the winch, the slack whipped back onto the reel, and the windshield burst free. The saint, bearing in mind the list of problems he might encounter,

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The Street Saint tried to enter the van to check on a woman who lay on top of the driver. He groaned aloud as the pain in this back froze him for a moment. “Not now!” he said aloud, and then thought, if you’re going to go . . . do it on a nursing home transfer, not now! Another grunt helped the upper part of his body to reach the pair. The woman was about 40, dark skinned but not black — possibly Hispanic. “Hey,” he tried to get her to respond. She didn’t. As he put his knuckles to her chest to stimulate her, he got a sickening feeling. He could sense death. He knew it when he touched it, and that was what he felt. He reached to check her carotid pulse and felt nothing. He pressed a little harder to determine if the pulse was actually absent and her neck moved with an awkward, crunching, sensation. As he concluded that her neck was broken, Dave laid a gloved hand in the small of the saint’s back and asked, “What you got?” “10-79, Dave,” the saint calmly said. He hoped the authorities outside would keep the body away from the media and the news of the death from the family trapped just a few feet away. “Let’s get her out of here, her old man is unconscious and I can’t get to him. I hope you’ve got everything coming, there’s a bunch of people in here.” He said as he looked for a logical position for a backboard. Her condition was no longer important; he would leave her privacy to the well-meaning group outside. “Got you, Bud.” Dave had acknowledged the decision the saint had made. The woman was “fresh” but they didn’t have help — so the woman was dead. Dave had the foresight to have a board lying close by, so he didn’t have to leave. Officers pointed their flashlights into the van. Problem was, the saint had to move into the beam to see. It would have been better if they had given him the light, but the saint knew that he who has the light is in control. Ancient tribes in Africa thought that missionaries with flashlights were the sun god; much the same sense attaches to the holder of a mag light. “Holy S---!” He said, when he finally got a glimpse into the rear. “There’s a crowd in here!” he yelled, hoping Dave could hear. “Get me at least five ambulances . . .” He trailed off the last part of his order, because the troopers and a couple of DOT guys had started to pull out the woman. An experienced DOT driver had gotten a sheet from the ambulance and had spread it wide so the rubber-neckers wouldn’t get their thrills. Then the makeshift curtain would become a shroud. The hardened sinner knew that drivers

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Chapter 7. God? What did I do today to make you turn on me? crept along and looked at what they would later tell others they hadn’t wanted to see. And they’d drive right into the back of another idiot who had slowed down so he could see what a bad accident looked like. The man underneath was alive, but he was covered in blood. Whose blood? If it was his, how much longer would it flow? Blood that ran or squirted was the sign of a beating heart. When the heart stopped, so did the blood flow. “Hey, Buddy, can you hear me?” The man didn’t respond, and immediately became “critical” in the saint’s mind. The man was breathing, his lungs were clear, and he moved an adequate amount of air. “Unresponsive, with a patent airway and spontaneous respirations,” was how the saint would later document it. The saint’s job was to make order out of chaos. Assessment and reassessment had been drilled into him during his training and it had become second nature. He didn’t like surprises, most of the time. The man’s radial pulse was present, but it was thready and weak. The saint wondered if he was unconscious because of shock, or if he had a head injury bad enough to place him close to death. There could have been an underlying medical problem that may have caused the accident, in the first place. The findings of the incomplete assessment only made the saint move faster. He would look for more definitive answers later, if he had time. “Dave!!” The saint called to his lifeline. “Get me a short neck and a backboard. We’ve gotta move!” It seemed stupid to say, “We gotta move,” but those were words that said, This is bad. “Get him out on the first truck in.” The absence of bad external bleeding, a clear chest, soft belly, and femurs intact told him the man had a bad head. Whatever the cause for the dropping blood pressure, the man needed definitive care or the coroner would decide the cause of his unconsciousness. The saint didn’t want to learn what he had “missed.” Hopefully, the first medic in would not be too wet behind the ears and could work en route. No one had ever proven the “Golden Hour” to be anything more than a time window someone once hypothesized about, but the saint was going to put the man through that window. Committed to the ghetto level, the two hospitals that were just a few minutes away looked good on paper, but the 30 minutes to an hour it would take for the trauma team to arrive and then the time needed to fire up a cold operating room weren’t going to help this patient. Level Twos have no emergency team immediately available, while Level Ones have staff on standby, round the clock. Delay on the scene was an excuse the surgical team could use if the man died, and the saint wasn’t going to give them that privilege. The surgeon could say

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The Street Saint that the paramedic had “played” too long. “If I could’ve gotten to him sooner . . . ” was not something any medic wants to hear later, during review. The saint knew the ER wouldn’t call the trauma team until after the ER doctor assessed the patient. No radio report or advance notice would help. How could a paramedic be trusted to decide if a patient is in bad shape? An error adversely affected payroll. “Put the board in upside down, we’re going to take him out backwards and face down.” The saint ordered how the patient was going to be moved. He was grateful that no one argued. He would have accepted a better suggestion, but they must have agreed or had decided that he was going to be held solely responsible for the activities on the scene. He wanted to get to those behind him, but he couldn’t without first clearing the driver. Then he thought, “Oops. Have someone try the back doors.” He had missed that option in his haste to get to the critically injured people he had seen through the windshield. “Hey, somebody try the back end!” Dave echoed from the outside, and then his eyes briefly met with the saint’s. They both knew they hadn’t thought of the obvious. There was no harm in forgetting to do something, unless it was forgotten completely. Anyone there could help the saint with the driver. It would just take muscles. Dave could work in the back, if he could get in. Someone hollered, “It’s locked!” “Dave, the crowbar is out there by you; bust the glass. Hit it in a corner; it’ll crumble.” The saint yelled orders while he looked for a way to get to the back of the van. He was then thinking of egress for his patients. Dave already knew where to hit the glass, but the saint’s words didn’t upset him. He had learned long before that his companion often called out his thoughts. Unlike the young, Dave could live with someone thinking the saint had to tell him what to do. The senior paramedics felt it was more important to work together. Conversation, no matter how it transpired, was better than none at all. The saint could hear little voices and knew he was dealing with a family. They obviously didn’t know, and that was good, that the woman up front, probably their mother, wouldn’t be there to help them through the healing process. By the looks of the only adult male in the van, they might be alone to suffer from more than their injuries. He hoped that just opening the door would allow them to crawl out, uninjured, but he had to be ready to pin those whose move-

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Chapter 7. God? What did I do today to make you turn on me? ments might aggravate an injury. He had to control their panic. It could explode in seconds when the passengers realized their freedom lay just through the door. He tried to recall some high school Spanish, long since forgotten. He hoped the youngsters had acclimated to their new country and had adapted to the language and customs. He hoped that the sight of his uniform would not evoke distrust and fear. As anticipated, the board came to the saint backwards and he had it redirected. His prescribed plan of action was not the “best” way to extricate the man, but the best way took about fifteen minutes, and the equipment that would be needed was still minutes away. Perfectly packaged dead patients did no good except to prove that young paramedics and EMTs could do what they feared was impossible while they practiced the skills in class. The elder saint believed in saving lives. His patient had obvious indications of a brain injury. A bad brain with good nerves, bones, and muscles wasn’t on his list of things to produce that day. A siren whined its death wail and the saint knew another ambulance had arrived on the scene. “Dave, if that’s a BLS unit, grab some gear and go with them. It’s going to be a few minutes until another truck arrives and this guy’s level one. These kids lost one parent tonight and I’ll be damned if it’s going to be two.” He grabbed the 200-pound man by the belt, rolled him over the steering wheel and out the makeshift entrance. He used the strategically placed piece of plywood as a ramp. The flaccid body of the driver rolled from the seat and up the ramp to the men who waited outside. Movement to his spine had been minimal, and with his deteriorating condition, the work the trauma team would do for him was much more important than the documentation of perfection the saint usually demanded. “Yeah, don’t lift, right?” “Don’t worry, Doc, I’ll call for help if I need it,” he remembered saying to his doctor as the unconscious man’s foot clipped the sides of his bifocals. With that, the patient had been taken from him. Part of him didn’t want to let the man go; part of the saint went with him. Call it a prayer, call it dedication, but it went. He sometimes wondered if he ever got that piece of himself back. The patient may live with the saint’s decisions and actions for the rest of his life, but for the saint . . . it was over. Through those brief encounters, though, there was always a life-long attachment. It was as if the saint had touched their souls and absorbed a part of them. He didn’t remember faces. But blue lips, the

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The Street Saint feel of cold clammy skin or, more often than not, the look in the eyes stayed with him. His attentions were drawn back to the scene. The scene was his job and the patient heading for the wagon had just been a part of it. The man was in the hands of others who should be equally trained, equally dedicated, and equally aware of the consequences of delay. He knew that wasn’t likely to be the case, but he had to block that from his mind. He just hoped one of the better medics had arrived to care for the man and he hoped Dave was still out there waiting for him to call orders. Dave was like a rescue rope to a caver. The rope was attached to the saint’s mind. Dave was one of the best. The saint heard the loud tinkling of breaking glass. He knew the door would soon be open, so he pulled himself through the front seats. The side of the truck served as a makeshift floor. He crawled through the garbage that was once someone’s snacks and pushed away the overturned kitchen chairs that had once held the occupants. Their position on the side of the van made for an unnatural, eerie, unstable, sharp edged obstacle course, in the nightmare not yet fully revealed. “We’re in!” Dave hollered from the rear of the truck. He was glad to hear Dave’s voice. The help he could provide now outweighed his concern for the patient who should be halfway to the hospital. The saint stood up, and with his first step he heard a small voice scream from under his boot. He looked down, and saw the image of a small, dark-headed girl. She lay motionless near the side window she had once used to share the view with her mother. He bent to investigate further. He had frozen where he stood, accepting the damage his unseeing boot had wrought but refusing to inflict further damage on his tiny, unseen patient lying under foot. Her arm was outside the window, under the truck, and was pinned there. “Dave, we’re going to need some air bags. Her arm’s trapped under the van.” He had ordered the van to be lifted. They both had a tough job. Being on the outside, Dave was bound to the orders given from within. On the inside, the saint just had to deal with what he found. “Hey, Bud?” Dave used a voice that was too soft to be audible under the conditions. The quietness made the saint listen. “Don’t worry . . . we’ve got it. A fireman gave it to me,” Dave said, almost apologizing for breaching the subject. The saint, on the inside, was thinking air bags. “Well, stick it under here, by the window, lift her up . . . get the kit, a pede’s collar and a back board. Get a line spiked. This kid’s going to need fluids when we lift the truck.” The medic’s

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Chapter 7. God? What did I do today to make you turn on me? mind was flying. He knew he had to free the arm before the little girl could be extricated and he had to protect the limb from further damage. He had to prepare for uncontrolled bleeding and the reaction of the patient when she saw the condition of her arm. He had to protect her spine and slide her to a backboard before she could bleed to death. He wondered if he should ignore his boss’s wishes and head for the pediatric level-one less than ten miles away. He didn’t have much room to ponder in the three minutes it would take to have her out of the van. He had been medically correct to consider the specialty hospital, but what was best for the patient was not all he had to consider in the rapidly expanding big business of emergency medicine. Whatever he decided, it had to done immediately, even though he would live with the outcome for the rest of his life. “Just feel around.” Dave followed the age-old practice of making statements only a counterpart would understand. “You won’t free it if you look . . . A cop’s got it . . . It’s at the hospital now . . . We’ll find the owner later?” The last statement, expressed as a question, finally sunk in. Dave’s simple phrasing had gotten his message across. There was no arm to be freed. “Little girl’s?” the saint asked, feeling sick. “Yeah,” the saint felt the compassion in Dave’s voice. He didn’t know if the compassion was for the tiny patient or for him. “Her name is Belinda,” Dave said, “It was on one of those little bead things on her wrist. “Belinda?” the saint asked. “Mama?” she answered. “Belinda, do you speak English?” He didn’t know what to do. Another moment he would never forget. It was another time when all the classes in the world would not help him. His best chance was to react and hope it was the right decision. The saint delayed his assessment to deal with himself. The little one was conscious. That magic little word that could be understood in any language had proved that. He was no longer a medic, he wasn’t a saint, and the sinner himself felt his heart well up. He was not even a father of five. He was a human being and that took precedence. He was glad she was conscious, but it would have been better if she weren’t. She had already attacked his emotions by using the word that neither saint nor sinner wanted to hear. The one they had no defense for; the only word that could stifle even the sinner: “Mama.” If you love her, do it right, the saint thought as the medic roared back onto the scene.

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The Street Saint “Dave, throw me the pedes collar . . . let’s get a board in here . . . and give me a bulky dressing. Have a cravat or a BP cuff ready. Give me the crowbar, too . . . and can I please have a flashlight in here?” The medic was there and the sinner had assumed a defensive posture. His tiny patient was coming out . . . she’d be cared for . . . protected . . . and survive. God bless anything that stood in his way. He quickly looked her over for critical injuries. There was no hemorrhage from the stub. Her whimpers and her “Mama” had told him that her heart was beating, she was breathing, and that she was well-enough oriented to call for her mother. That was a primary survey and that was all that was needed. “Dave? Can we get this kid out of here, over the others?” He checked to see if his plan would work. He thought, if Dave says he doesn’t know, I’ll slap him. For an instant he was angry with Dave’s delay. He took the initiative and didn’t wait for an answer, “Slide a board over ’em Bud, little bit here isn’t more than thirty pounds . . . they can take it.” He threw trash and chairs to a safer place to aid her departure. A board came in. Good, the guys on the outside were working. “OK, slide her out . . . didn’t dress the arm . . . it’s a clean cut . . . very little blood back here.” He put pressure on the board and showed what direction he wanted her moved. The rest of the incident wasn’t bad, other than the cluster he joined outside. He saw the old saints working. Others flew around, helping in little ways, sometimes pushing the privilege of patience. Police tried to collect statements and identifications, instead of waiting a few minutes to get the same information the ambulance and the hospital would get. Thank God the media wasn’t there. He knew he could depend on them to put the wrong things on the air. He knew that if the mother’s body hadn’t been immediately removed from the scene, it would have been broadcast throughout the metropolitan area. If it was a slow national news night, the dead mother’s body would provide entertainment to families while they ate dinner. It took three ambulance companies to transport the whole family. The family had migrated from Mexico and the children had to be held down, because they couldn’t understand the staff. He never learned what caused the accident. Dad recovered from his concussion. His little girl would be fine, but the saint wondered if the medical opinion that it would not be possible to reattach her arm would have been different if he had transported her to the pediatric center. He would never know.

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Chapter 8. Boy, have the times changed His truck could use more equipment. His company was owned by the hospital and would only buy equipment if the state mandated it. As a ghetto hospital, they said they didn’t have the money, but they did pay the family’s hotel bill and buy them food. He shook his head when he heard that. He still found some things too ridiculous to think about. When he heard that the hospital footed the bill for thirteen airline tickets he shook his head, chuckled, and went to the garage for a cigarette. It released him from the stupidity that he saw and the lack of common sense that he could no longer handle. Every time he needed to know a patient’s O2 saturation and wished he had the equipment to test it, he thought of the positive press the hospital received for donating services to patients — patients who had no choice what hospital they were transported to and who weren’t responsible for their bill anyway. The equipment he needed would help save lives and it cost less than the hotel bill. In other areas, where tax dollars are squandered, saints have $100,000 ambulances that are replaced every three to five years; they only make 300 calls a year. His company would do almost 300 calls in ten days. The wealthier areas spent tax dollars on equipment that was left sitting in storerooms, some never opened, and all rarely used. But, even in those areas, the last thing considered on the annual budget was pay for the people who saved the lives. But, how does one pay a saint? Ask a saint; he’ll tell you how much civic leaders say he is worth. The next time someone dials 911, would they think how much the saint has given, or what he is worth? CHAPTER 8. BOY, HAVE THE TIMES CHANGED Older saints enjoy telling “the pups” about how it was back in “my day,” in hopes that those new to the industry will realize what life had once been, and how the new rescuer took advantage while they were being taken advantage of. They tell heroic stories, ones they refer to as “the circus,” and ridiculous reasons why they are asked to respond. The young can’t believe that undertakers once ran the ambulances and hoped to find a dead patient because bodies meant more money. Much of the 911 abuse today can be attributed to practices that originated in the old days. Grandma was encouraged to call if she needed a ride to the doctor. She wasn’t charged for the service, and when she died, the family used that funeral home. When ambulances became medically oriented, the funeral homes got out of the business. Drivers joined unions and often made more than

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The Street Saint the paramedics. The senior member of the crew became the driver and the practitioner was discounted as an evil necessity. That mentality remained. The older workers talked about changes in equipment, like how cots sat on wheels and were pulled like wagons. Puppy paramedics can’t picture ambulances without oxygen or how “air-conditioned” units attracted more attention and were more appreciated by the public. Once, only a physician could order defibrillation, but today, civilian CPR cardholders can defibrillate. However, most people still haven’t learned CPR, even fewer practice it, and the majority of the public believe that paramedics can save everyone no matter how long it takes to get there. The MTV generation cannot fathom that an EMT could have volunteered his services to prove that someone without a college degree could save a life. (The need for rapid intervention was never disputed; it was that a paramedic could perform that intervention that was questioned. While their viability was questioned, 18-year-old medics in Vietnam proved that a critically wounded soldier stood a better chance of survival than someone injured on our highways.) The saint now shares his ambulance with a videogame generation whose apathy, arrogance, ignorance, and selfishness may well take us back to the way things were. Many of them welcome the diminished training, the down-sized treatment modalities, and the resulting down time. Due to the impetus to reduce operating costs, EMS units find that their supplies and equipment are reduced. They have indeed become overpaid truck drivers whose job it is to “taxi” the poor to facilities whose administration can rape the country of its resources, while those who truly need service often don’t fare as well as they did when the saint started working, almost thirty years ago. Thus the older saints have watched the dream of their profession melt like a snowman on a warm March morning; and there is nothing they can do to stop it. Back in the days when gasoline cost less than a dollar a gallon, paramedics were tapped to perform tasks that would save nurses some work; now, if those tasks aren’t done regularly and correctly, the nurses may insist on taking those tasks back in. And some workers agree — “nurses get paid more, anyway.” While the shortage of nurses might have led hospitals to staff the emergency room with those members of the medical profession trained specifically in emergency medicine — paramedics — nurses control much of hospital policy and they cannot be expected to give up that much territory willingly. Paramedics haven’t spent years studying psychology, sociology, or English. They only know how to save lives. Nurses won’t recognize them as equals, and they’re not. In emergency medicine, paramedics are vastly superior; but the nurses are in

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Chapter 8. Boy, have the times changed control. “Hey, not my job, Bud,” the naive newer paramedics chant. “I get paid for taking people to the hospital, not for doing a nurse’s job or playing doctor.” “Paramedic” means supplementing a doctor, but perhaps no one ever explained that to them. The younger ones don’t understand why they aren’t automatically granted the respect given to their counterparts in movies and on television — the respect that lured many of them into the profession — and they don’t realize how hard it is to earn it. By their own attitude, they render themselves no longer necessary. The advent of “Treatment On Demand” suddenly required many additional workers, and it was naive to think that quality could exist in large numbers. When major league baseball expanded, power teams were lost, great pitching waned, and the game suffered until new talent was found. Similarly, when the emergency medical services expanded, less-qualified people had to be accepted. The public didn’t think of that. The industry should be at a point where two paramedics ride the ambulance while a third was being trained, an inexperienced crew is often sent to face God knows what, alone. Today, some areas are requiring a two-year degree to become a paramedic. There is little more medical knowledge transmitted; just general studies. Enrollment is falling off. The young may be ignorant to the ways of the street, but seeing $8/hour versus what a nurse’s salary — for the same length of schooling — helps them make up their minds pretty quickly. This problem must be faced, or the system will crumble. Medics know the cause, but they are not invited to comment on what would help them do their job. The industry has set nurses with classroom ideologies to control the workings of the field. They use “professionals.” Few of us have really thought about what it means to be a “professional”; and by those standards, paramedics do fall short. But so do all associate degreed nurses and most others whom we recognize as professionals. Most don’t have an extensive university background. A BSN administrator once told the saint that her advanced degree meant absolutely nothing when it came to patient care, but it afforded her the opportunity to move into management when she got tired of dealing with the public. The paramedic was “trained,” rather than “educated,” but that training was what saved lives. Still, if the patient is not an emergency, the paramedic becomes a taxi cab driver. Near the end of the saint’s career, he was threatened with fines if he didn’t file the proper paperwork, or if he drank or ate in his truck. Never mind that he had sacrificed meal and bathroom breaks to respond to the never-ending

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The Street Saint nuisance calls. Several times he was almost killed while on duty, but he accepted that; what he found unacceptable was that someone who had never set foot in an ambulance should tell him how to do his job. Paramedics like being thought of as saints, and they are so busy enjoying the “rush” that they don’t mind being used without reward. Ask any paramedic why he doesn’t have an organization that stands up for his rights and inform the public as to his state of preparedness. Ask him why he had never received a degree for his training. Paramedics are among the few medical workers that are required to do hundreds of hours of continuing education to keep their licenses. Ask him what good the classroom hours are to a man pinned at his waist under a steering wheel. What difference would a degree make, when a man is choking on his own blood? No care plan needs to be written up; a paramedic with guts and experience is what can save his life. Ask a paramedic how often the hospital staff with impressive degrees accepted the patient he had kept alive, then allowed him to die. Ask how many times he had started IVs for the emergency room, restrained a belligerent patient, or re-stabilized a patient after transferring him away from a facility where the degreed staff had let the patient deteriorate. The answers are shocking. Even more shocking is the realization that paramedics are forced to offer mere “transport” (when they should be available to save lives), because of how the industry is financed. If EMS workers organized and insisted on only handling emergency calls (as was the intent when they were originated), for one day there would be such turmoil that their demands would have to be met. No one thinks of the bed-bound who have to be moved by the thousands every day. No one thinks of the doctor’s visits that would be missed. No one thinks of the trips back to the nursing home and the number of patients who would have to live in the hospital (at hospital expense) until a strike was over. Who would transport the minor injuries from car wrecks? Who would respond to the millions of calls for help, every day, from people who have been taught that they have a “right” to a free ride? Would the doctors, who have used emergency services for years to benefit their businesses, hop in the ambulance and drive their own taxis? Would the politician who has bought his votes from constituents that he has never seen volunteer to provide such services? In fact, they would not be allowed to. Those who have controlled the saints for years made licensure requirements so strict that, in many states, a registered nurse or even a doctor cannot take the place of a

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Chapter 8. Boy, have the times changed paramedic. Yet, in most states, a veterinarian can test to be a paramedic without any further education. A good medic reacts quickly to situations and forces protocols to meet them. He sees, hears, and feels what is needed, and then he acts. There’s no time to refer to another department’s specialist if you are stumped; just adapt and overcome. Later, the nurse can decide if paperwork was done properly. If the public were made aware of the real workings of EMS, they would demand that the system live up to expectations. If they were more aware, the number of lawsuits would oftentimes match the number of critical patients admitted to a facility. The threat of a lawsuit was held over his head daily, but the saint has never met a paramedic who has been sued. He has seen hospital staffs shake their heads at treatments he has been performing for decades, because they didn’t understand what it was that he had done. Fewer than one per cent of his patients died under his care; but he had grown accustomed to seeing a family mourn a loved one, one he had saved thirty minutes before, who died soon after. The retrograde activities of the business have made many of the most qualified leave the profession. Most become nurses and quickly found new jobs because of their EMS experience. They are often hired by the same emergency rooms that, before they graduated nursing school, forbid them to do that work. Like the scarecrow in The Wizard of Oz, the parchment gave them a brain. The hospital administrations’ actions prove they know the paramedic’s capabilities; they just refuse to acknowledge him. The saint could have opted for a management position, but that would mean politics, and ignoring his skills. The security of a well-lit desk and scheduled lunch hours sets up a friction between doing business and getting the job done. Typing and going to meetings would be more important than patients. He stayed in the field doing the impossible and accepting the occasional thank you, a package once a year for EMS appreciation week, and if he was lucky, a $20 Christmas bonus. He rarely got the meal discounts that firemen and police officers enjoy. The manager of an inner city filling station once told him, while she collected money from behind bulletproof glass, that she needed the police but not paramedics. The saint gladly paid for his drink. Maybe if she had been mortally wounded, she would have accepted his well-honed abilities, his $80,000 “taxi” and his $40,000 worth of “toys.”

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The Street Saint In earlier days, when he carried a radio as a volunteer fireman in a rural area, he was given a 50% discount for meals. Carrying the same radio in ambulance uniform, he paid full price. He was working 120 hours a week and was paid $950 a month. Ambulances were once blamed for 40% of the deaths they brought through emergency room doors, but as the profession developed, they were able to revive 20% of all the “dead” patients they came upon. Now, the saint was beginning to see ambulance DOAs again (“dead on arrival”) because the young medics were reverting to providing nothing more than the rapid transport the funeral home once gave. Medical directors used to demand that he constantly learn new skills; now, he didn’t get to talk to his medical director unless he was accused of wrongdoing. Bosses demanded more paperwork, to help support their billing practices, and states imposed impractical requirements while they tried to cut spending for pre-hospital services, because the public demanded too much. By today’s standards, the saint was an idiot. He, too, had tired of responding to spurious calls and working with partners who avoided doing the job. He had to wade through patients’ complaints, separating the bogus from the legitimate, even though he wasn’t supposed to. And he had to limit how much energy he expended in appeasing those who believed his only job was to give people a ride. CHAPTER 9. WE’VE CREATED A MONSTER There was a time when most emergency rooms only had two beds and a nurse whose shift was usually boring. At night, she was often pulled from the ER to work somewhere else, and only returned if a patient registered. There were no ER doctors, because everyone in town had his own doctor. Emergency room patients were seen immediately after their doctor arrived. Doctors were accessible, and even made house calls if the patient was too ill to come to the office. The ambulance was a last resort. “Take two aspirins and call me in the morning” came from those house calls; now, patients demand an ambulance because their doctor is too busy to see them and the two aspirins are substituted by at least two EMS workers, an expensive ambulance and a battery of tests that wouldn’t have been run years ago. Treatments for most of the patient’s complaints remain unchanged. The aspirin has been replaced by Tylenol or Ibuprofen. Both can be purchased over the counter but a prescribed

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Chapter 9. We’ve created a monster dosage is given at the time of discharge so the government will pay for the medication. The doctor of yesteryear, black bag in hand, made diagnoses without testing. That was when the medical field was the most efficient and cost effective, and people were the happiest with it. Today, a competent paramedic can carry diagnostic equipment into a house and transmit information to the ER, where the same tests would take much longer to perform. Things have changed. Experience and common sense could dictate who needs transport, but in the medical/legal mumbo-jumbo of today, common sense has been disallowed. A paramedic can’t tell the patient he doesn’t need the emergency room, but he can tell a nurse he is putting the patient in the waiting room, where it may be hours before the patient will be seen. Outbreaks of influenza and pneumonia rarely occurred in the past, because patients stayed home and were treated with common sense and a phone call to a doctor. Today, people spread germs to hundreds of other people by running to the emergency room to collect their free Tylenol; but spreading germs is good business for some. In the past, nurses were rigorously trained and then supervised, sometimes for years, before they independently cared for patients. Their first job was never in the emergency room or the intensive care unit. Today, that is commonplace. It’s dangerous. Emergency rooms always triage patients but too many patients add “chest pain,” “I can’t breathe,” or “hemorrhage” to their list of complaints in order to make sure they are seen sooner. Inexperienced nurses are often assigned to triage, because they don’t know how to treat. They’re educated to the standard that’s prescribed in books and the classroom but are not trained or experienced in “hands on,” the way the paramedic was. They are chastised for listening to the patient’s complaints, and before long, frustrations cause them to send patients with life-threatening warning signs to the waiting room. Only 2% of patients appearing at the emergency room need emergency care. Most have already been assessed by a paramedic in the ambulance. That means the triage nurses cannot err, because they rarely triage emergencies. Emergency rooms now have become clinics, and ambulances are taxicabs. Those doing the billing like it that way. It’s a “money-maker.” Doctors are not readily available to patients on Medicare or Medicaid, and many patients have learned to declare an emergency when they want care — or just attention. The government spends huge sums treating the absent doctor’s patients; if those sums were charged back to a doctor’s practice, the saint believed doctor’s office

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The Street Saint hours would lengthen; they would again make house calls, or at least come to the phone. Hotels and casinos pay to bring their customers to them; why was the medical business different? Many doctors today tell patients to dial 911, and they are allowed to bill without ever seeing the patient. The saint was transporting people complaining of conditions for which he would never have seen a doctor; the government blindly paid. Those on the government dole can call whenever they wish. The only profession trained to rapidly assess and identify life-threatening conditions is not allowed to stop the charade; they have to transport these callers into a system that is required to react, based on its standard of care. Those who try to instill common sense are called “prejudiced.” Sometimes, if the doctor in the emergency room says “nothing’s wrong,” the “patient” calls another ambulance and goes to another facility. Even the police resort to ambulances to haul away drunks, instead of putting up with a difficult customer in the patrol car. Sometimes they call to have large patients moved by ambulance, and the saint has been asked to transport a person in custody to the city jail to spare the policeman from dealing with the suspect. And in bad weather, officers tell those involved in motor vehicle accidents to go to the hospital — where the policeman will take a report in the comfort of the ER. It’s not just those receiving government benefits who abuse the system. It’s become a way of life and, to the medical professional, it is good business to find something wrong with the patient. Politicians are often elected for the benefits they promise, and hospital administrators show their facility is needed. The “need” keeps their six-digit salary intact. Such practices warp judgment and endanger us all. The budget that is being unnecessarily depleted was supposed to care for us all. The onslaught of patients has forced the system to confer licenses on people with the barest of training and forces those who are already overworked to train them. The profession had two options to stay in business and remain profitable. Cut the number of practitioners, or increase the number of patients. Seeing those who don’t need to be seen generates income and positive statistics, while it perpetuates a reportable loss to substantiate the need for more money. Nowadays, emergency rooms advertise services on television. That is how commercial the system has become. Our lives are in danger. People depend on the finest trained medical profession in the world, but that profession no longer exists. Field treatment for a heart attack was once done with lights and sirens and breakneck speed, and the patients were told to take it easy for as long as

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Chapter 9. We’ve created a monster they lived. The ride to the hospital increased the patient’s anxiety and blood pressure and raced them closer to death; those were some of the 40% who died. After the advent of paramedicine, patients were kept calm, were stabilized, and were pain free and stable at ER arrival. Paramedics can utilize telemetry, including twelve lead assessments, and send it to hospitals or even a cardiologist hundreds of miles away. That means that Thrombolitic therapy, once given in intensive care units after emergency room diagnosis, can be started immediately. The patient treated thus often returns to a life more active than he had lived before the incident. A paramedic too young to vote, with less than two year’s training, and in most states too young to drink can be weighted with that responsibility. The saint saw it work; he was one of them. But he had had time to practice, had talked with doctors, had volunteered at the hospital and had proven his abilities. Now, there is no time. Other calls are left hanging as a 911-abuser demands immediate gratification by adding “shortness of breath” to a complaint. Lawyers have been allowed to advertise and create the impression that every fender bender might lead to a life of leisure. Medicaid recipients are not told that any funds collected become property of the State; of course, the lawyer gets paid. The heart attack patient is again being treated with lights and sirens, and often spends the maximum number of Medicare days in intensive care before being sent for cardiac cath lab; three days after infliction, instead of thirty minutes, as would have been done in a hospital not dependent on government monies. There is no time for study or practice. Paramedics read nurses’ nametags not to know who they are but what they are. Now, he sometimes had to spell the words that describe conditions and offer explanations so they could document or relay the patient’s condition to the doctor. He often wondered if they relayed the information that he felt was important. Once they gained a little moxie (a few weeks was usually long enough), they exploded in his face and demanded to know who he thought he was. The next time he saw them, he gave a simple report and left. This did not benefit the patient; it was self-preservation. The public shouldn’t blame the paramedics. The public is to blame. We, as a public, get what we pay for. Communities spend money in the name of reducing crime, but there is no correlation between money spent on law enforcement and the reduction of crime. It is good personnel and the public’s attitude that keep statistics reasonable. The war on drugs has been lost; drugs can be purchased more readily than homegrown vegetables, and the best way to protect a home is still with a big dog

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The Street Saint and bright lights; not an army of police. Policemen are like paramedics: putting more on the street doesn’t improve anything, unless they are good. Paramedics have to lock their ambulances so the vehicle and its equipment won’t be stolen. They park their cars off the street so a drunk won’t hit them. They get weekend rushes when people drive drunk and shoot, stab, maim, and beat one another. Saints watch buildings burn along with the budgets of fire departments. A nine-volt battery in a smoke detector saves more lives than firemen do. Sprinkler systems would save more and cost less than putting out a fire. Public agencies, like the police and fire departments, can report details of contacts they have with the public; EMS can’t. Most of the public wouldn’t be interested in the work they do: like hauling drunks off the street because the policeman didn’t feel like doing his job. Fire chiefs report the number of men and equipment used, the gallons of water pumped, the cause of the fire, and how much was lost and whether the owner was properly insured. The police do the same thing, and anything difficult to categorize is conveniently handled as an “ongoing investigation.” No one knows what it takes to be a paramedic, and paramedics won’t tell. Forget the grotesque scenes he had to witness and the strain under which he functioned. Paramedics are the last ones considered for civic funding and people think unpaid ambulance bills somehow fund the ambulance corps Yet, people would scream if Grandma was forced to sell her house to pay for what the family should have done for her, instead of calling the ambulance. The little brotherhood of EMS is going broke. They are being forced to once again give a fast ride to the hospital (which is often too little, too late, anyway). EMS is bound by patient confidentiality and ethics. Because of the media, the public believes fire departments save lives and the ambulance gives rides. Maybe that presumption was why the saint’s advanced life support ambulance was often referred to as an “ambucab.” Rescue programs on television mislead the public severely. In reality, assaults are placed on the bench, the drunk is given the trashcan to vomit in, and enough information is gathered so a radio report can be made; then the paperwork is begun. Since the shows often feature rescues of animals, people have taken to asking paramedics if do mouth-tomouth resuscitation on dogs. As the saint reflected, he no longer saw a future for EMS. Needless numbers of lives would be cut short. He watched, in his mind’s eye, the future that once provided such warmth die out, turn cold, collapse into dust, and return to the soil from which it first sprang up.

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Chapter 10. Those were the days, my friend CHAPTER 10. THOSE WERE THE DAYS, MY FRIEND He had just taken his first job in EMS and was trying to explain to his young wife why he needed to spend more money they didn’t have. “Yeah, Honey, I know we’re about broke, but I need a stethoscope and a blood pressure cuff because the service doesn’t have the money for them.” She hadn’t argued, but he could tell she didn’t think all the studying and the time he would spend away from home was worth the $2 an hour he was going to be paid. She had faith in him, but wondered if it was wise for a man to work 100 hours a week and still live below the poverty level. When she asked if he could work that many hours he said, “Hey, no problem. I can go home at night, so, I’ll actually be paid for sleeping with you. You see, someone knows where my real talents lie.” He laughed and kidded her, after his fashion. They hadn’t been married long. He was twenty-one and she was four years older. She had three children from her first marriage and he had taken on the task of raising them as his own. He had a degree in broadcasting and was about to lose his low-paying job writing radio news. He had pursued an EMT license after being promised that EMS was an exploding industry. He told her that a 100-hour week would be easy for him because, for the most part, ambulance personnel just sat around. And at the outset, that was true, but today a 24-hour shift means a response on the average of every 45 minutes. He had to do it like that, because it couldn’t be done the way it was supposed to be done. His first assignment in EMS was to write newspaper articles that encouraged calls. Three decades later, he tried to think of ways to keep people home with the Tylenol they should have given themselves. When he started out, he was told he needed experience to work in the inner city where there was a level-one trauma center in almost every neighborhood. In the countryside, he would be the only paramedic for 900 square miles, and would have to transport patients to the hospital in the next county. Getting a job there was easy; all he had to do was show them his license. He looked at the move as more than just the start of a new career. The inner city was going bad. He wanted to get his children out of there before they were corrupted — an additional benefit to taking a job in the rural Midwest. His wife asked how much the equipment would cost them. Money was something that would often be discussed and often missed in their life in EMS, but she loved him; she was proud to see him part of it. She knew his heart, and he would be a

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The Street Saint great paramedic. She just didn’t know how severe the money concern would always be. She knew he had always felt a calling to help. She thought nursing was the answer, and believed nurses better served both the patient and the pocketbook. She didn’t understand what a paramedic was capable of doing, and she had not been with him when the factory reps had shown him what the near future would bring. Her opinion was based on what her mother, a nurse supervisor, had told her about ambulance drivers in the 1960s. She, like most other people, used the words “ambulance” and “paramedic” interchangeably. In later years he would say, “You know, if someone says they need an ambulance, I’m going to park one in their driveway and throw them the keys.” Ambulance once meant a fast ride to the hospital. Today, “Paramedic” was what people called for. Overcoming her ignorance was his first hurdle in educating the general public. Instructors, the media, and factory reps had led him to believe he was entering a field that was about to explode and he would be there when the profession grew. Those on the ground floor would break the “ambulance driver” mystique and benefits would follow. The new breed he had become part of had to give professional, accurate assessments that others could depend on. They were going to have to accurately do jobs, on the move, that nurses sometimes had trouble doing standing still. They would have to confirm medical emergencies or be prepared to accurately defuse the alarm. They would have to do it with little or no pay, long hours of work, and in the face of constant second-guessing. He was warned that many nurses would not understand the medical terminology he was told to use, and that some doctors would deny his existence. He did his job the way he had been taught. He lived long enough to see “newbies” do exactly the opposite. The nurses he had intimidated, when he was young, ran the emergency rooms by the beginning of the new millennium. They taught the younger medics to use common language and less medical terminology. They drummed into the young medic’s head that he/she was only trained and not degreed. They helped wipe away the confidence that had been pumped into the saint when he was young. Those nurses said that the best thing the paramedic could do was to throw the patient in the ambulance and run for the hospital — just what he had been trained to avoid doing, three decades before. The young followed their tutorage. He should have made his wife happy and listened to her, back in the beginning.

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Chapter 10. Those were the days, my friend But he didn’t have the money to go to nursing school and being a nurse then was so popular that it took a couple of years just to get in to a good nursing school. She knew that much, but she thought that if they could afford the paramedic training, then they could afford nursing school. He showed her where her rational was wrong; he had believed the same thing, at first. “The government has no money for the paramedic training,” he told her, “so the schools can’t over charge.” His initial paramedic training cost him $600 and that included the books. Nursing school would have cost $12,000, and he wouldn’t have learned as much. Federal financial support was available for nursing school. It didn’t take a genius to see why the tuition was higher. Nursing schools seemed to retaliate against those who opted for paramedic training. When paramedics tried to move into nursing for its financial rewards, they were not allowed credit for any of their prior education. EMT and paramedic training cannot be credited towards a nursing degree, but nurses can take their classes as electives. Terry, his first boss a couple of decades before, had told the young saint that he wanted him to work for the service because of his size, his intelligence, and his state testing scores. The new boss, a registered respiratory therapist, wanted the new medic to teach, to “Bring the service out of the dark ages,” he said. The residents still called the funeral home back then when they needed an ambulance, and the employees thought their job was to cover up Grandma when she needed a ride from the nursing home to the doctor’s office; some even sewed quilts or crocheted afghans for that purpose. “Rescue” was a television show but its efficiency was limited to California, or fantasy on television. It was not needed where neighbors and friends, people who went to school and church together, worked for the ambulance corps. He heard often from new bosses, “Help us get better,” but there were always the same number of employees who wouldn’t accept it. They had a license and saw no way their job could be done better. To them, it was absurd to think that they could do a job that the hospital couldn’t. The hospital sent the critical cases on to the university, and if the ambulance needed help they could call the university’s helicopter. They all agreed that things were as good as it could get. To the new saint, who was full of the possibilities promised him in school, their antiquated beliefs seemed like the sun revolving around a flat world. While checking his truck the first day on the job, he heard, “What’s that?” from an EMT with 20 years’ experience. She asked about the equipment he had

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The Street Saint been checking. Equipment should be checked at the beginning of every shift; something modern day medics rarely have time to do. The saint didn’t mind the interruption and was glad to see that one of the “born again Christians” had trusted him enough to ask. “It’s an airway we can use.” “Why?” she asked. She remained stone-faced and the young medic misinterpreted her glare as a “learning look.” “Well,” he appreciated her eagerness, but he thought he had already answered her. “It’s actually easier.” He decided to start at the beginning. “You know how it works, don’t you?” She shook her head. He was glad he had asked. They had told him about “assume” in school. “Did you ever see one before?” Maybe an instructor had omitted a lesson or had covered it in a class that she had missed. “When did you go through your last refresher course?” he asked, trying to put a timeline on where she was in her education. “I don’t.” She said frankly. “I run with the fire department and take CEUs (continuing education units) there. I volunteer time at the hospital and I get CEUs for that; I re-license through CEUs.” He saw where her education fell short. Her refresher training at the fire department repeated first responder techniques and did nothing to bring her up to date. She had twenty years of experience but most of her training came from a volunteer fire chief who taught what he viewed to be important from a firefighter’s perspective. Every three years, she looked over a collage of questions that other EMTs had written down immediately following the state written test, and she scored high enough to keep her license. He knew then what Terry meant when he asked the saint to “bring them out of the dark ages.” At least she had been smart enough to ask her medic. Terry hadn’t said anything about formal training sessions; he had just said to teach. So the saint thought his first class had begun. He moved to the cot so she could sit on the squad bench. She stayed put, so he continued to demonstrate while she stood outside. He showed how it was superior to the equipment they had been using and how it was also a fail-safe for a paramedic if he couldn’t get a patient intubated. When he finished, he offered her the tube to look at. “What do we need them for?” she asked without touching the tube. The medic sat dumbfounded. He didn’t understand the question. “Terry says they’re

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Chapter 11. The Blockhead wins about $35 a piece.” She never changed expressions and after stating the cost, and stood defiantly waiting for an answer. “Well, they’re a piece of equipment.” He hadn’t expected her to question things that would make her job easier, if she would take the two minutes to learn how. “It’s something that we can use if we need to.” He didn’t know what else to say. “I thought that’s why we hired paramedics, so we wouldn’t have to use all this stuff!” Her face looked as though it had been starched. “True,” he said, shocked by her attitude and ignorance, “if we have a medic on board, then he should intubate and they won’t be used; but if he can’t get them tubed then he can use this or an EOA, or if need be, an oral airway.” Their service had a variety to offer their patients. In her eyes, the service’s money was being spent on worthless paramedics and equipment that wasn’t needed. She wanted carpeting in the office, and curtains for their quarters. She had a pattern and was going to sew them. Terry had said the carpeting and the curtains would have to wait because of the equipment the new paramedic said they needed. She was not pleased. He learned a lesson that day. The EMT never learned about the tube. Thinking about it again, he decided that covering the windows would have kept them hidden from the public; maybe he should have told Terry to go ahead and order the curtains. CHAPTER 11. THE BLOCKHEAD WINS Personnel can ignore training if they stick together. Usually, they tolerated about one session of the saint’s additions and then said, “He thinks he’s a doctor!” . . . “He’s teaching us stuff we don’t need!” . . . “I’m not going to listen to him.” The boss wanted to fire them, but it’s not easy to find people who have a license and will work long hours for low pay. The saint began to wonder if he could justify the work he had imposed on himself and if others should be made to do the same for people who only wanted a ride to the hospital. “We only need paramedics in cardiac arrests and bad trauma.” That was the one way of saying the old ways were good enough. He knew most of those patients died, and the staff knew it too, so why use medics at all? The more he argued with them, the more he appeared self-serving.

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The Street Saint Some of their logic was true. Medics are actually only needed about 10% of the time and can only could make a difference on about half of those. It was fair to question why all the changes were being made, all the egos forced to surrender and all the money being spent when paramedics weren’t needed 95% of the time. There was no way of knowing if the patient would have died if the paramedic hadn’t instituted his care, but to say that he couldn’t make a difference only demonstrated ignorance of what the medic was capable of doing. Attitudes he couldn’t share with co-workers made him move from job to job. He made some friends, but he also alienated many who called him a “knowit-all” and accused him of being “too aggressive.” Sometimes those who falsely accused him were intimidated when doctors shook his hand and complimented him on his aggressiveness and/or skills. The handshakes were reported as “brown nosing” by his co-workers. “How can I be too aggressive when someone is dying?” He asked his wife, and others who would listen. Unfortunately, the ones who listened were not the ones who could have supported him. “Who can say they’re not serious, when they say they have chest pain, or they can’t breathe, or they say their stomach hurts?” He knew some might exaggerate complaints, but there were also those who didn’t complain when they were in pain; like his mother. He’d ask his accusers whether deciding a patient wasn’t serious was a diagnosis. “Isn’t that a doctor’s job?” But, “diagnosing” was what they accused him of doing. Common sense was credited for his or her method of reasoning, and common sense dictated that not everyone with a belly ache was going to die. Training manuals, commonly called “the book,” cautioned about those types of warnings that signaled danger in otherwise non-emergent complaints. Common sense was never mentioned. To ignore a patient’s complaint was “negligence,” and not acting on it, even though an assessment denied its presence, was a “diagnosis.” It was strange that no one in the medical field ever thought of not doing anything as an action. It spoke as loudly as any action given after days of diagnostic testing. Today, “ruling out” by common sense is done every day in every ambulance in every part of the country. It has to be done for emergency medicine to remain somewhat efficient. In the beginning his training and his common sense told him that if a patient called the ambulance, he had declared an emergency and it was the ambulance team’s duty to act on those complaints. That was before people began to lie about symptoms to expedite their care. Even though he had cautioned

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Chapter 11. The Blockhead wins against it, the day would come when he had to look at patients and determine their level of severity. He ended up doing the same thing as his accusers had once done, but his decisions were based on decades of service and education, not on the desire to say everything was baloney. It didn’t take long to realize that his success was directly related to the efforts put forth by the public he served. On a local level, he had made spine boards out of plywood and sanded them by hand. He had made cervical immobilization devices out of foam rubber and trash bags. His first jump kit was an old gym bag and he sewed his first functional jump kit, something that would later become a common tool. He believed that if he showed what he was capable of doing for others, only a fool would deny the importance of his fledgling profession. He was in on the ground floor and would be there when the profession exploded. But it didn’t explode, it imploded, and now many of the young “professionals” lack assessment skills or the education to formulate an opinion. Though they are not short of opinions, by any means. Most of their patients didn’t need professional care, and that lack of need helped the rescuers slip into apathy’s deep abyss. They eventually stopped taking equipment to the scene because they knew that 90% of the time it would be carried back to the truck unused. The saint was eventually rewarded for his years of dedication by earning not much more than a crew leader at a fast food restaurant and by hearing his work denigrated by those who were his colleagues. So much for the dream. He could no longer tell the young recruits that their future would take them somewhere. He openly encouraged them to leave the profession and find something more lucrative. He didn’t want good paramedics with the right attitudes to one day wake up and learn they had wasted their lives, as he had begun to think he had done. He had lived for the opportunity to save people, and had ignored the mundane calls in honor of those limited times when he could shine. In those encounters, the whole world seemed to be bathed in a light that only a paramedic ever saw. He had become tired of the foul atmosphere. The glow he had often felt he hadn’t felt in a long time and when those infrequent moments did present themselves something, or someone, usually robbed him of the pleasure. The law required the he be schooled again and retested every few years to make sure he, as a paramedic, was well versed in nationally-accepted treatment

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The Street Saint patterns. But the law couldn’t make doctors comply and it allowed them to “practice” as they deemed fit. The smaller, out of the way hospitals often refused the treatments he had to know to get a license. In the past, he had argued with doctors who hadn’t attended update training but could refuse his request for orders. Such treatments were welcome at the University Hospital, if the patient survived treatment at the smaller hospital. His mandatory training, it seemed, was to make sure he understood what it was that he wasn’t going to be allowed to do. He had worked in a state that had passed a paramedic-practices act. The paramedic followed preset protocols and the doctor in the emergency room was only liable after giving orders to the paramedic. He had also worked in a state where he was limited to doing specific things before contacting the doctor. In the state where he ordered his own treatments, he carried a 60% clinical save rate. In the state where he followed on-line medical control, his save rate was below the national average. Had he become stupid, or was it that people across state lines had a different anatomy? He proved the same proficiency in the rural and inner city communities, but those abilities seemed inadequate when he stepped across a state line. The secret to emergency management is those first few minutes — and the good doctor knows he cannot be there. Doctors have testified that they can’t do anything for a patient that is dead on arrival. That rationale was what gave birth to the paramedical profession; but doctors’ egos remain. For some reason, the most talented physicians are usually the ones with the most understanding of the life the paramedic leads. In the beginning many doctors didn’t have confidence in the new medical professional, the paramedic. If they were honest, they’d admit their ego wouldn’t allow someone with a high school education to show them new and improved ways of doing things. The saint would never compare his education to a physician’s; but the saint dealt only with emergencies. The difference between life and death usually came within the first few minutes. That’s where the saint was the pro. He had saved lives in the time it took a hospital to register a patient. The doctor who is insulted by the paramedic’s actions always seems lost, as are many of his patients. Just like paramedics, half of doctors graduated in the bottom half of their classes; unfortunately, many of those are found “practicing” in ERs. As the number of patients who really needed them dwindled, so did the number of competent ER doctors. Building more emergency rooms did not

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Chapter 11. The Blockhead wins create more competent professionals. There are more drunks than doctors, for sure. Corporations put anyone with letters behind their names on emergency room staffs and some facilities actually required a quota of admissions per ER shift. “Rent-a-docs” improve “customer service” with fast-food tactics. Emergency room patients occupy the same bed numerous times a day, inflating the patient count; administrators want more of them. The doctor is supposed to treat, save lives, protect the integrity of the hospital, and above all, make it money. Practitioners use tests to get breaks. The busy staff hides behind care while they ignore monitor alarms and call lights. Judging from what is going on, the hospital’s accountant can tell who doesn’t need treatment and should be discharged so that another “patient” can be handled. The hospitals get away with the “sleight of hand”; even special reports show administrative officials telling “investigative reporters” about “life-saving techniques” that are no more than diagnostic procedures. No one ever investigates the definition of “intervention.” Attempts at reducing the number of people who came through the revolving door have been blamed on laziness or prejudice. Without patients, there are no jobs. Thus, to emerge as a hero, the practitioner must wade through the mire. Some doctors used to learn the medics’ voices and grant orders to those who had proven their knowledge; and it didn’t take him long to learn the doctors’ voices. He knew which to contact and when to act on his own. But that usually can’t be done today; too many different doctors and paramedics. He hadn’t been thinking of the future of his profession when he looked over the inside of his first truck, that first day on the job. He laughed at the cabinet full of teddy bears stored there for pediatric patients. Then he felt queasy. He knew his pede’s training barely scratched the surface of what he needed to know. There was only so much time allotted to train paramedics and learning about pedes, obstetrics, and psych patients was something that had to be glossed over. He hoped the teddy bears would be enough when he had a child in the ambulance; he suddenly feared the times when he would have to transport those who really needed his ambulance. He only treated three children during his first job. One was an adolescent who died shortly after he loaded her into his truck. Her father drove the local school bus, and she would run out every evening to meet him. He often stopped and bought her ice cream or some other treat. It was her time with Dad. His bad heart had almost taken him from her already, and moments they spent together

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The Street Saint were special. She appreciated life as not many her age did. Just a few days before the accident, the paramedic had spoken with her and her family and, because of Dad’s heart surgery, the topic of organ donation had come up. Until just about that time, the funeral home would have sent “ambulance drivers” to help her. But, the funeral home had refused the upgrade needed to obtain advanced life support licensure and the public had elected an ambulance board comprised of citizens who wished to be part of the modern medical marvel they had seen on television. They knew nothing about emergency medicine. Instead of hiring a paramedic to assist them, they used their elected powers to buy the equipment the salespeople said they needed. They didn’t have the money or the experience to manage what they had been elected to run. The man to whom they subcontracted the service would soon go bankrupt, trying to provide extra service for people who used to be happy riding to the hospital in a hearse. The most intelligent man of the lot was the undertaker, who got out of the business and enjoyed the leisure he was given, now that he only had to pick up dead people. The ambulance was updated and so was the county road it responded along. That led to faster speeds: faster and smoother rides for the ambulance, and for the Cadillac driver who struck the young girl. Working on someone that young would have been horror enough for the young paramedic. He didn’t realize he would soon be treating a girl he knew, and one that his youngest son had fledgling affections for. They were in junior high school, and while the saint had seen in their eyes wisdom beyond their years, he had failed to recognize the “puppy love” that was growing there as well. She was still tomboy enough to run gracefully out to the main road to meet her Dad. She had sprung out of the dark field; her hair flew as she ran, and then she bounded onto the elevated highway. Because of her angle of ascent, she didn’t see the oncoming Cadillac traveling at 70 mph. The driver couldn’t see her either, until it was too late. The driver never hit the brakes and only saw the young girl after she was knocked into the air. Her sneakers were found about 50 feet from where her broken body lay: where her feet had last touched the ground. The saint was working with barely trained and inexperienced country folks and was told from the get go that he shouldn’t intimidate them. He had already learned his first lesson; don’t try to change things. Unless, of course, they thought of it first. The EMT who hadn’t understood the importance of the new

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Chapter 11. The Blockhead wins airway had bought little gold angels and gave them to others so they would have “angels on their shoulders.” He wondered if St. Michael, the patron saint of medical people, was supposed to swoop into his blood-splattered truck and save the life of the child. The only presence he felt was that of the young lady who had just fought with a speeding Cadillac and lost. He hadn’t recognized her, thank God. Squashing most of the major organs in the human body deforms God’s temple. In the big city, where medics couldn’t spit without hitting a level-one facility, they often transported without stabilizing. In the city, even funeral homes could swoop and scoop patients and have them in the hands of a surgeon before the patient bled to death. Yet there, close to help, EMS administration had placed experienced people, while those with no experience worked on patients they would have to stabilize and transport farther. When a helicopter wasn’t available, the inexperienced rural medical people did whatever they could do. (Even today, medics transport rapidly if they’re close to a hospital, but they can “stay and play” with if they have an extended ETA.) Hospitals think hospitals react quickly. The saint has timed them. They need time to prepare; they’re not ready to go, as he is. He did as he was trained. He quickly assessed and packaged her so he could “load and go.” But where was he to go? To an emergency room that had a bell that summoned a nurse from the floor but no doctor on duty? He was a hard-driving 45 minutes away from the closest level-one, and the law said that he had to stop at the closest; the hospital without a doctor. Common sense told him to consider the delay at that hospital and transport her directly to the level-one, but that’s not common sense in the medical field. It would be years before he realized that those stops generated a bill for the patient’s attending physician, another for both emergency rooms, and two for the ambulance. Degreed individuals got their of the ego and the money. He couldn’t have gone anywhere, anyway; his driver was outside leading the prayer meeting. His first words after he saw the girl were, “Get me a chopper!” He was so nervous he could hardly breathe, but still, within minutes, he had her packaged. She died shortly after the other crewmembers had huddled outside and began praying. He had to dig for the equipment he would need. The crews had refused to be trained by him, and for that reason, couldn’t have helped anyway. He had been trained to function on his own; obviously, someone had anticipated such a situation.

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The Street Saint He enjoyed television shows of “real life” rescues, but wondered why they never showed the work the paramedic did. They sometimes showed the bent metal, blood on the people still trapped, the ambulance arriving, and the firemen pulling bodies from the wreckage. But the next thing they always showed was the helicopter arriving at the trauma center. They never showed what the paramedic went through; no one should have to see that. He successfully resuscitated her with CPR, but she died again shortly after he intubated her.He was scared, alone, and overwhelmed. He forced from his mind the acronyms he had learned just months before. “Never memorize pediatric drug dosages,” his instructor had said. He understood the reasoning for not memorizing them, but the state had insisted that he recite them from memory. It was better to take time to calculate and use charts that are available in hospitals, but paramedics don’t have that much time. That part of the training has not changed and neither has the reasoning behind it; the real world stayed the same. The medic must react while nurses and doctors can look things up, have a colleague do the math, and have another start an IV, while the doctor thinks. The medic does it all . . . and quickly. Not one person in the world would have wanted to be in his shoes, but regardless of the outcome he knew the wolves would be howling at his door to tell him how they could have done it better. Review, in itself, does not make a good paramedic but, to the conscientious one, the fear of its findings does. He could’ve dumped the responsibility by opening the doors and hollering, “Praise the Lord, I confess my sins! Help me Lord Jesus, she’s dead and I’m just a stupid sinner!” Those outside would have accepted him for seeing the light and realizing he was as ignorant as they. They had decided the girl was dead anyway, and were treating her soul instead. That thought sickened his stomach and angered him. His sinner took over. “You can’t have her, God. She’s mine!” He growled as he reached for the Epi 1:1,000, estimated her weight, and then converted it to kilograms so he could calculate the dosage to enhance the abilities of her heart. He didn’t know her exact weight, and ET administration called for double the normal dosage, so he said, “She’s getting the whole milligram!” He dumped the whole ampule of adrenaline down the tube. He squeezed the rubber ambu-bag and nebulized the medication into the tiny air sacs of her lungs so her body could absorb it. He looked at the old defibrillator that the board had bought. It was an antique, but allowed them to afford the prettier trucks that had caught their eye.

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Chapter 11. The Blockhead wins The machine’s vertical green hash marks showed evidence of electrical activity. He felt her carotid for a pulse; it was weak, rapid, and thready, but it was there. “She’s alive! I got her!” He had fought for life and won; she was his. The saint’s confidence was born and with it came the crazy, egomania of the sinner. The little wicked one was on the saint’s shoulder and egged him on. All he had to do was breath for her. He squeezed the bag a couple of times, laid it on her chest to free his hands, and then ripped the IV bag from its plastic wrapper. He counted to himself, one-one-thousand, two-one-thousand, and three-one-thousand, out loud while he worked, so he knew when to breathe for her again. Those who prayed outside relied on angels, but the “angels” he waited for were jet fueled and on the way. Once she was in the helicopter, he would gladly accept the wrath of a jealous God who allegedly would rather have seen him praying than saving a young girl’s life. The medic did what mattered, impudent son-of-a-bitch that he was. That attitude, though, was why people called him a saint. His blasphemy made Godfearing people shrink, but they still called for his help and he believed God tolerated his impudence. The idea of starting IVs on kids scared him, but it was not as bad as he had thought. He had just started to relax when she died again. Her heart fibrillated; he would have to do more than CPR or administer drugs. He dug deeper into the crevices of his already stressed brain to get what he needed. He thought of his little-practiced skills while trying to stay calm. “Children are not little people,” he remembered the battle-scarred emergency room nurse instructor saying. “They are treated differently.” He started to look for pede’s paddles and then remembered that the machine his service had purchased wasn’t the one he had been trained on. It was the grandfather to the one that he needed. The politicians had opted to spend more money on lights and paint jobs; he would have to adapt. He ripped her blouse down the front. His trauma sheers made her little training bra disappear. She lay bloodied, scraped, and bruised. He talked to her, “Honey you’re going to drive the boys wild when you grow up!” He knew she heard and hoped she would forgive the burns the big paddles were about to give her. He placed them, knowing he had no choice. He pressed the charge buttons and watched the needle climb until it read 60 joules. That was less than a third of where he would have started with an adult, but right for her weight; at least he could compensate that much for her.

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The Street Saint He shocked, and the little woman’s muscles contracted and her back arched. He looked at the screen and saw that the nervous, snake-like line, returned; ventricular fibrillation remained. The can of worms that was now her heart was unable to push blood. If that were not corrected soon, she would die. He hit the charge buttons again and increased the joules to 120 and then again, released it. Her body contorted, equaling the doubling of the electrical current. She was still in fib. He was so scared he had to concentrate to maintain control of his bladder. “OK, she’s going to die, alright, I admit it, but dammit, I can’t panic when I’m needed. They’re waiting to see me sweat and I’m not going to let them!” He ignored his fears. “OK, she’s not going to hold long . . . maybe a few minutes . . . that’s the max . . . and she’s fubared anyway” . . . he rationalized. He couldn’t be concerned with aftermath or review; he contended with the obvious. He charged the machine to its maximum 400 joules, and then released the power. He said, “My God!” when the child’s body reacted to the electrical stimulation. Then she collapsed, limp, back onto the spine board. She lay still, under the straps that he had so quickly placed over her. He expected to see a flat line that signaled his radical efforts had been wrong, but instead, he watched as the isoelectric line recovered from its spike and he then saw the normal complexes of a sinus rhythm. He found a pulse as strong as he had ever felt on her. “God Dammit, I did it!” He cried aloud and fought back tears for the first, but not the last, time in his career. He checked his IV and said, “Hang on sweet thing, it isn’t blood, but we’re going to fill you up, baby, the chopper will be here soon.” He relished the rush that rightfully followed and then remembered the medication that would help prevent fibrillation from returning. He pushed an appropriate pediatric dosage and then hung the drip. He started to set another line when the back doors opened and one of the angel-epauletted rescuers asked, “Is she gone?” “No. No thanks to you!” He hadn’t taken his eyes off his work and the Christian ambulance driver quietly closed the door. The sinner wondered if it was because of his comment, but he also remembered that the EMT once said that he would never cut the clothes off a woman because he might see bosoms. He wondered if that might have been the reason for the would-be rescuer’s quiet departure. The saint hoped it was embarrassment at his own lack of action that had made him shrink.

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Chapter 11. The Blockhead wins “Guess he doesn’t want to see your boobs, sweetheart . . . Well, let’s not show him.” He chuckled when he thought of something that should have made her laugh. “I’m going to sing for your wedding, and if that don’t wake you up, I don’t know what I’m going to do!” His laughter momentarily released him from the nightmare he had so far escaped. He was talking to himself; or was he? Those praying outside would say she couldn’t hear him, because she was dead, even though they prayed for her soul hovering above her. They called him a hypocrite? He had nothing more to do until he heard the chop of the helicopter blades. He thought of her innocence, then, and now whenever he delivered a baby from a girl of similar age. Big changes had occurred during his years of service. Some of his changes in attitude had been caused by those changes in society. Girls of twelve, when he treated them twenty years later, were not assumed virginal. His senses were so piqued that night that he heard the oxygen rush from the green tank housed in the wall and into the bag that he held in his cramped hand. He heard it again when he pushed it into her lungs. The steady beep, beep, beep of the cardiac monitor felt at home to the drummer that still lived within him. He checked her from head to toe for any profuse bleeding, and called that an assessment. He watched fluid run from the IV bags and disappear at the catheter’s hub. He occasionally monitored her lung sounds for indications that he was over-hydrating her — a lethal condition for pediatric patients. Light flooded the truck. He thought of his recent impudence towards God; maybe the Archangel had paid him a visit. Then he realized that the helicopter had landed. He was amazed at how close the pilot had placed the craft. He respected the pilot’s skill, but he also thought that landing that close might border on stupidity. The rotor’s wash rocked his truck; that’s how close they were. He expected his doors to blow open and for all hell to break loose when the crew entered, but they opened the door easily and smiled. The calm they presented made him want to cry and hug them. They said, “Good evening, sir, everything alright? What would you like us to do?” He felt like an oaf when he said, “Take her to the hospital.” They chuckled and said, “Well, let’s get some equipment set up first . . . Can you give us a report?” The nurse smiled while she worked, and rarely took her eyes off him. He started to lie and recite the textbook to prove he had not erred. But the girl was alive, and he felt that he had done OK. He talked fast and the crew

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The Street Saint remained quiet. He spoke to the crewmember that kept eye contact with him. The nurse finally questioned the burn marks on the girl’s tiny chest. “Did you defibrillate?” “Oh, yeah.” He was surprised he had forgotten the part that had upset him so much. “She coded once after we got her in here; I tubed her.” “What size?” the nurse asked. “Six, I think, and I dumped a milligram of Epi 1:1000 down the tube, and she came back.” “Good,” the nurse said, while she checked the size of the ET tube and its metric markings and its proximity to the teeth. Then she ausculated the lungs and confirmed the tube’s placement. “Why the Lidocaine, then?” Her professionalism did not intimidate him at all. “That’s a lot,” the nurse said.“She coded again . . . just as I got a line started. So, I defibrillated at 60 joules, then 120, and well, I said, ‘What difference could it make?’ and zapped her with 400.” He hoped he wouldn’t be yelled at for doing the wrong thing. “Yeah! But it worked. What was I going to do, kill her?” he asked — first as an excuse and then out of spite. With that answer, the sinner learned to speak his mind. “Well,” the flight medic said, “it worked!” The saint would never again allow people to question his decisions. Prove him wrong, and he would change instantly, but he never allowed his thought process to be questioned. He had to fight through the horrors of scenes; his environment was not like the one in which the calm questioner operated. His attitude, born that night, never changed. They got their instruments, some the saint had never seen, attached. A portable oxygen-powered vent replaced the squeezing of his aching hands. An automatic blood pressure cuff, EKG leads, and pulse oxymetry were also placed. “I’m not reading any SaO2,” the medic said (referring to the oxygen saturation his machine should have recorded), adding, “but she’s shocky.” Hypothermia, a state of shock, or carbon monoxide poisoning can prevent an adequate reading. “Yeah, well, we got a pressure,” the nurse commented, and then to the saint said, “Good job, sir! We’ll take her from you now, if you like?” The nurse had extended professional courtesy to him. He liked that.

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Chapter 11. The Blockhead wins He didn’t want anyone to take the girl. A weakness came over him and an overwhelming urge to cry — a reaction he would experience many times, after the rush of the adrenaline wore off. She would be in good, calm hands, and he just nodded his head “yes,” and looked at her for the last time. His little girl was then pulled from the truck and laid on the flight gurney outside. Those who had spent their time praying stepped up to help carry. “The look” was born that night also, and it stopped them in their tracks. He said, “No. We’ve got it. Go back to what you were doing.” The flight crew lifted her, with the saint’s hand still on the gurney. His hand was only needed by the soul that was connected to it. It otherwise served no purpose. He walked with her to the chopper and pushed her into the tight confines. The pilot signed the saint’s trip sheet and, handing it back, said, “There you go, sir. We’ll do our best to get her there,” and swung up into his seat, nodded the direction for the saint to run, and twisted the craft’s throttle. The saint didn’t know how the pilot could have known what was on his mind. How did he know that he had adopted her, in the truck? His girl died two more times, but the budding EMS system saved her both times. Then she arrested, on the operating table. He tried to remember rule number one: people die. And everything had been done, by the finest people. Rule number two: when everything has been done, to current standards, in a professional and expedient manner, and the patient still died . . . remember rule number one. Her family offered, without being prompted, to donate her body. They said they remembered what the saint had said just hours before their daughter was taken from them. The harvest team tried to comply, but all the girl’s organs were too damaged. Only her corneas were harvested and sent on to a child who needed them. It wasn’t till later, after the police had identified her, that the saint actually knew who she was. Not knowing whom he had worked on would be his only solace. He gave his son the grim news. Grim too was the trip a couple of days later that he and his family made to the funeral home. Grim was mother who introduced the saint to the body. “Baby, you remember him? He came to the house, he’s Jason’s dad. He was the one that saved you, Sweetheart.” Grim was listening to the father repeatedly ask the saint, “Are you OK?” Grim was the saint’s inability to comfort the people who needed it so desperately. Grim was the depression for which he knew he couldn’t seek help.

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The Street Saint The last trauma code he had worked before the accident that sent him to the doctor’s office was on an 18-year-old male who shot himself in the head over the loss of a job. A young Afro-American male who was trying to dig his way out of the ghetto through hard work had ended his life because he thought the setback would keep him ghetto-bound. He had done it in the street, so everyone could see. The saint and his partner, Steve, in fact, arrived and swooped, scooped and ran. The saint worked in the rear. Seasoned, this time, the paramedic intubated the young man with relative ease. Bystanders said, “They just don’t give up, do they?” Epi (Epinephrine) down the tube and then again in the line, a pulse returned. It was fourteen minutes from the time they received the call until they were at a level-two trauma center, with a revived patient, trauma packaged, intubated, a blood pressure, two IVs, and a cardiac monitor. That’s what he had been trained to do. The scene time was the only thing that concerned his reviewers. The doctor in the emergency room said that anyone who was shot in the head will die, and unplugged the vent; he proved himself right. Fifteen minutes later the saint’s report was written and his truck had been restocked. He was on his way upstairs to transfer a patent to the nursing home. Both calls were a part of his job; the latter paid better. When his friends seemed disappointed that he wasn’t upset over the young man, he said, “May write about it in a book someday.” Other than that, it had become just another call. Boy, times had changed. CHAPTER 12. MY DAD’S A PARAMEDIC “Boy, Dad, I was out by the pond yesterday and you ought to see the deer tracks! Some of them might be cows, but either way they’re big, and I saw what might be some rubs, but it might be where the bull was scratching his back. I was thinking, maybe we could build a stand over by the bean field and one by the dam. We could put Mom up in the old barn, because she’s afraid of heights, and you know she gets cold and she wears that perfume and the deer will smell that, so if we can get her up on the ladder she’ll be OK. I went up it. It’s real strong, so she won’t fall. Can we go out there when I get home from school? I want to show you what I found. I think we’re going to get a big one this year!” Obviously, his twelve-year-old son, the Goob, was excited. It was deer season. Whitetail deer

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Chapter 12. My Dad’s a paramedic hunting season was the time of year when he and Dad got to sit and talk about “the big buck.” Even when Goob had children of his own, the saint and he would sit together and look out over the woods. Their life and their love were encapsulated in those thirty minutes. The two “boys” talked about would-be deer and impossible shots, deer that got away and, finally, confessions of deer reported that were never seen. Those thirty minutes or so were all they needed to express the unspoken. The years of shared good thoughts, the best wishes, the love of a father and a son; respect from a firefighter to an aging paramedic. The season after the saint’s accident, the Goob, by then a father himself, had found a place for the saint to sit where he would be safe; where he could tolerate the pain and his ego would not notice; a place not to insult the man who still resided inside the pain-filled body, the body of the man that still desired the action of his youth. The son had matured and was careful not to offend the aging saint, but the boy in him still needed those ten days when Dad and he could dream. This was the time of year in the small farming community when men of modern times became pioneers of yesteryear whose main purpose in life was feeding their families. The wives were asked about freezer space and sharp knives. The smart wife said, “Yeah, you’ve got as much as you had last year.” “Well, Goob,” he had said that day, long ago, while he gathered his pocket necessities, “I’ll try to be there, but you know I’m on duty today.” “Again?” Why was his dad always gone? Short question, but it demanded a lengthy explanation. “Yeah, well, maybe I can bring the unit by for supper and you and I can slip out there and take a look.” The saint offered a compromise, but a compliment soothed his son. “I trust you, Bud, if you see deer signs, then I know it’s there.” He picked up his radio and stuffed his pockets with supplies he hoped not to use. The saint knew the thought of bagging a trophy buck was a bond between the two of them. Their conversations were so intense, and the dream so real, that the boy often fabricated stories. His son liked a break from the constant EMS talk. It needed to be worked out in his Dad’s mind, but a break was refreshing. Deer stories, made up or real, were his way of gaining Dad’s attention. It was “the good times.” “Try not to go overboard this year. I put some money aside, but it’s pretty well gone,” his wife warned again, while she straightened the fast food restaurant cap she wore on her job 45 minutes away.

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The Street Saint “Goob, I gotta go, hurry up or you’re going to miss the bus and Dad won’t have the car today . . . “ She omitted telling her son that Dad was going to be picked up later that afternoon, so he could cover for someone who had to start cooking for tomorrow’s big hunt. “You off, Dad, Great! You be ready when I get home and I’ll show you, OK?” It made Goob’s day, and his Dad couldn’t tell him he wouldn’t be there. “Hey, sounds good, Bud, but if I get called in, you look for a funnel, OK? We want to find them coming from water to bed, OK?” Mom kissed both her men and knew she had lost them for the next week and a half. She still had the wrapping paper she’d bought four years before. If it wasn’t enough, she would think of something, the same way she paid bills and bought food for them when her talented husband only cleared about $600 a month. But she was proud of him. She was also proud that her son had shown an interest in helping others. She loved her man in uniform, but when she was depressed and had downed the last beer of the day, she slipped into a drunken sleep, wishing for an easier life. When she heard his voice on the scanner she would ask herself, “How can I complain, when he’s not doing anything wrong?” She left in the 10-year-old, four-cylinder car for her long drive to work. As she pulled out of the driveway, with her saint still in his squad pants, she waved good-bye to the Goob, who tore past en route to his school bus. Goob wiped his breakfast on his coat sleeve and yelled, “See you later, Dad! Can we take the guns? Maybe we can drop one early?” He didn’t wait for an answer. He knew how Dad felt about obeying the law; but he also knew his Dad wouldn’t stop him. “Yeah, Bud; we don’t want anyone else gettin’ him, do we?” Dad waved to them both. He liked being the head of a family. Like many other young lads, the saint had fantasized about being a rescuer, but that was long before his profession existed. Now, in uniform, he dreamt of spending evenings with his wife and weekends with his children. Where many others sought excitement, his dream was to be bored, with his family, at home. He couldn’t do it. It was one of the sacrifices expected of a saint. The stress, the hours, the lack of pay, and the physical and mental toll of the profession claimed many victims. There aren’t many veterans who are married, and those that are often live separate lives. He turned back into the house and teased his puppy. The ball of fur sported legs that were too short and a belly that was too big to let him clear the step into

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Chapter 12. My Dad’s a paramedic the old farmhouse. The saint had rented it from the dead girl’s family. Strange, he only thought of her when he was alone. Different furniture, but he could still see her sitting in the armchair where she had sat when he had spoken with her and her family just days before her death. A pleasant way to remember her. Most would have remembered the casket, but only he had seen her battered, broken body with bulged eyes. He would rather remember her gangly legs and her freckled and smiling face. He stared for an instant at her corner and then turned quickly away, singing while he went. He hated the silence. He clicked on the television as he passed. He didn’t care what was on, because he was going to be in the bathroom. Better to have some noise around. He intended on having the good constitution that days on duty prevented him from having. He had no sooner sat on his porcelain throne than his radio squawked; “Unit 14!” It broke the silence and his thoughts. Surprised to hear his number called, when no call was under way, he said, “Unit 14, go ahead.” “Yeah, you got your PMV?” (private motor vehicle). “No, the wife just left for work,” he answered. He never thought to lie over the radio. It was as if it was a spiritual communication that demanded sovereign truths. “Disregard, then,” the voice said. He hated having his interest perked and then being told to never mind. He had heard the squall of sirens in the background and the tightness in Gayle’s voice. The EMT with her was the one that didn’t know about airway adjuncts. He said into the radio, with a question in his voice, “Unit 8?” “What do you want?” the EMT had the mike. Now he heard the sirens live, as they came down the two-lane highway where his gravel drive ended. “Do you need something?” he asked, giving them a chance to ask for help. “Not now, we needed the other unit. We’re responding to a head on . . . supposed to have two people hurt really badly. We thought you might be able to get the other truck.” She mentioned two people hurt badly, but her “truck driver’s mentality” thought only of trucks; not the paramedic who would tend the patient. “No, I can’t get to the other truck, but slow down and I’ll run up and catch you.” He looked quickly for something to wear. The only thing that could be quickly donned was the next day’s insulated coveralls and a pair of five-dollar slip on boots he had purchased for hunting. They kept his feet dry and held in

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The Street Saint human odors; his neighbors used them for slopping hogs. Barefooted, he slipped into the boots after he stepped into his coveralls. He grabbed his radio and bag, ran out the door and trotted up the gravel drive. It had been a long time since he had footed a half-mile and he had never done it in slip-on boots without socks. Within 100 yards of the highway, he saw the ambulance and yelled into the radio “Hey, slow up!” “Sorry,” the young female medic said, “We’ve got to get there.” Get there with what? She couldn’t have considered two critical patients, one ambulance, and an EMT that was going to be little use. He turned and slowly started the walk back down the road. He knew he was needed, but he had no way to get there. He hadn’t walked twenty yards when he heard the unit go on scene. “Unit 8, Dispatch.” It was the curtain-making EMT. “Go ahead, Unit 8,” boomed the voice of the secretary. During the day the office answered the radio. On nights, weekends, and holidays the sheriff’s department dispatchers volunteered to do the job. They didn’t know the needs of EMS, but they got directions and dispatched the crews unless they were tending to prisoners in the jail, eating lunch, or going to the bathroom. Then no one helped the ambulance. “We’ve got a head on . . . send the fire department . . . we’ve got two trapped.” The stress in the EMT’s voice was excruciating. Country people are stoic but stress can be heard if one knows what to listen for. He couldn’t take it. He turned and retraced his steps. He knew his help was needed, even if it hadn’t been asked for. As he ran he said, “Unit 14, Dispatch.” “What do you want?” She could have called hogs the way she hollered. “Get a chopper!” he yelled while he trotted. “Ok, I’ll try to get it . . . I’ll let you know,” the secretary said. “Love people getting on the radio that haven’t the slightest idea what’s going on,” he said aloud as his cheap rubber boots hit the asphalt of the two lane and he continued east. He maintained his even-paced jog for another quarter mile and then heard the pumper. He waved to its driver, but it roared past. Volunteer fire fighters were racing to get on a scene where they didn’t know what to do. It was going to be a good story to add to the deer hunting tales. He had gone only a few more yards when another distant siren was heard. He didn’t know how far he had to go and he wasn’t going to be exhausted and useless when he got there. He stepped onto the road and waved his arms; they’d have to run over him to get by without him this time. He hadn’t been around volunteer firemen . . . maybe it wasn’t a good idea. But the truck did stop.

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Chapter 12. My Dad’s a paramedic He decided to use some of the authority he had been told to use in school. When the tanker stopped, he opened the door and in an almost disinterested voice said, “I’m a paramedic, let’s go!” It worked. “You guys heard anything, yet?” He tried to catch his breath without showing any signs of exertion or anticipation. “Nah, they just said they needed the fire department.” The man who drove the truck drawled while he took another drag on his cigarette. He had been closer than he thought and the ride was over almost immediately. He could have run the rest of the way — but the warm truck and the chance to rest for a minute restored his breath and took the load off of his pounded feet. The textbooks and the training films had not prepared him for what he saw through the dawning light and the fog of a cold November morning. He saw a steaming pile of metal barely distinguishable as vehicles. Something that he finally recognized as a camper shell sat like a cap on a hissing monster. The saint thought to himself, My God, can people be inside of that? Even the sinner had no quirks available to steady his nerves. He swung from the truck and noted that the crew was pulling a woman from the pickup truck. They were dragging her like a sack of potatoes, but in the beginning he had trusted everyone with a license, so he didn’t intervene. In the years that followed, he extended only a minimum of professional courtesy to others; they had to earn the rest. Very few had impressed him, so it became easier for him to rationalize that not all patients were his and ignore some the things he saw. He didn’t question others, and in return demanded they leave his decisions just that. He turned to the second vehicle. To his horror, he recognized it as a fullsized Cougar that had been reduced to about eight feet in length. The dashboard and the windshield were precariously close to the front seat. The passenger’s side was gone, the dashboard had overtaken it; and the roof was crinkled and deformed like an old accordion whose bellows had been carelessly tossed into a trunk. A steering wheel was in there somewhere but the chest of a dark haired young man hid it. His face was deformed, blue, and so fractured that it did not look human. He breathed like a fish on a riverbank and with every expiration came a mist of blood that rained onto the dashboard and windshield, and eventually dripped onto the asphalt.

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The Street Saint The air was thick with the smell of gasoline, radiator fluid, and blood. The fluids on the ground melded together and made an eerie river that flowed to the side of the road. The saint wanted to turn away, ashamed to watch a human being take his last breaths. The scene was filled with firefighters, state policemen, and motorists who had stopped to gawk. They stood around until the new saint, whose pride had just been bruised by his human element, took over. The picture disappointed him, because it showed volunteer firemen cleaning up the scene while Gayle and he stood watching. There were a lot of volunteer firemen in a rural community and their families bought newspapers. The impression the picture gave was that the firemen had done all the work and the ambulance people hadn’t had anything to do, because they hadn’t given the patient a ride. “OK, we’re doing too much looking, and not enough moving,” he stated. “Let’s get that windshield out and those A posts cut, I want that steering wheel rolled up and away from this kid but don’t move it till I give you the word.” The door was sprung open. “I can work from here and I think we can take him out of the top faster. Get a hold of that bird; I want it on the ground fast. Get me a C collar, Back Board, MAST pants, and portable suction. We’ve got to move, guys, no time to stand here taking pictures.” The picture comment only came to mind because he had remembered seeing a woman who was taking pictures along side of the road. He didn’t know that she was a reporter and the picture that she had taken would be on the front page that evening. Access to the slim-bodied youth was limited. It was difficult suctioning the blood from his throat and giving him oxygen. The windshield disappeared quickly; it was pulled with the same logic he later used on the van with the family inside. EMS workers are trained in extrication, but rarely practice the art. Their knowledge of extrication, coupled with the needs of the patient, makes the EMS professional responsible for directing the process, much to the chagrin of fire officials. In some areas there are teams of firemen who are specialists in extrication. The medics tell the captain which patient to get out, or in what order or direction, and then shut up and protect the patient. That requires accompanying the patient in the car. Meanwhile, they treated and explained what was going onto those who could hear the loud, destructive sounds outside. Nothing of that sort happened this time. The rescuers were barely trained and unpracticed, and nothing larger than a cheese sandwich would have fit

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Chapter 13. If his Dad were there inside the car. The saint did what he could do while he knelt in the fluid that dripped from the vehicle and its driver. He turned once to look for something . . . what? He didn’t know, but he hoped to see something he could use that would make the rescue move faster. Maybe something would give him a hint, something small . . . maybe a look from someone in the crowd would give him confidence. The color of his patient’s skin continued to change from the hue of a Midwestern Caucasian to that of a resident of the hereafter. His scan landed on Goob’s school bus. The bus had merged with the rural traffic jam and had been trapped in the accident’s aftermath. Some of the boys had left their seats to watch the goings on. The father-turned-rescuer wanted to wave, but didn’t think it proper. He didn’t have time for his family; he knew Goob understood. His son was expected to understand. He had to. His Dad was a paramedic. CHAPTER 13. IF HIS DAD WERE THERE Seeing his son standing next to the bus calmed the saint and made him feel good, but he had work to do. He had to forget about his family and worry about someone else’s. Again, he had adopted someone else’s child and his “new son” was unresponsive, even when a twelve-inch long younker was placed down his throat. The medic alternately suctioned the boy’s throat and then applied oxygen from a mask that he held by hand. The mask had an oxygen reservoir bag in case the patient took a deep breath, but it never moved. The entrapment wouldn’t allow for more than a minimal movement of the lungs and the saint didn’t even know if there was much lung left to inflate. The firemen and their antiquated “come along” pulled the car’s steering wheel to a standing position. The saint palpated the boy’s anterior chest wall and with auscultation he heard, as feared, adventitious sounds that told him that the boy’s lungs were filling with blood. It had either been sucked there before he could clear the young man’s airway or the delicate tissue was bleeding. The young usually fight for life, while the elderly sometimes let it slip away. Maybe death for them answered a silent prayer to end anguish and/or loneliness. The young had too much life to live and rarely, conscious or not, surrendered without a fight; but this time, it appeared as though the saint was the only one that was fighting.

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The Street Saint Knees and crumpled thighs were pushed up and inwards. The position made palpation of the boy’s belly impossible. A firm belly on a middle-aged person might indicate abdominal hemorrhage, but on someone this age it might only be the result of lean eating and good conditioning. Palpation of abdominal organs was beyond a medic’s level of training but the youth’s belly felt odd, under his firm muscles. There was no seat belt around the youth and it was evident that the boy’s face had slammed into the windshield, while his chest and belly had eaten the steering wheel. The firemen finally cut the post that held the windshield and supported the roof. They then tried to crease the roof so they could fold it back like the end of a Cracker Jack box. A fireman stood on each side of the car and held the ends of a long metal pole that had a fireman’s ax on one end. “One, two, three,” counted one of the firemen, and then they lightly tapped the roof with the pole. “One, two, three, again,” said the same fireman and again they tapped the roof. The light tap made the process never ending. The saint remembered that the roof edge, where it curved before forming the flat portion of the car’s top, must be cut before the roof will fold. “You guys need to cut the edge of the roof right here,” the saint said while he pointed to the spot. “Use your K-12 and cut it through . . . get a line charged . . . we got too much stuff on the ground for the sparks that it throws.” He was quickly learning the art of giving orders, but the firemen moved slowly. They didn’t like an ambulance driver telling them what to do and they didn’t know for sure what it was he had told them to do. The sinner lost his temper and abandoned his patient long enough to bring the firemen up to rescue speed. “Like this!” He quickly assembled the equipment and then barked, “Now, if you can’t cut the damned thing, get out of my way and I’ll do it!” and then went back to his patient. He was not proud of his actions, but the life of a boy was about to be taken from him and the sinner wouldn’t tolerate that. He was taught to maintain command and accept responsibility. Firemen are trained the same way. “Ambulance drivers” had never questioned the firemen’s position before. He had stepped over boundaries and on toes. He would hear about both, later on. Firemen are given the work of extrication because of the protective clothing they wear, their numbers, and their ability to carry large pieces of equipment. They may be medically trained but cross training has its shortcomings and primary interests usually win out over the education required to do a secondary job. For that reason, the firemen are delegated the hard labor. To the

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Chapter 13. If his Dad were there untrained eye, they are saving the patient. No one sees the medic inside the crumpled metal, doing his job. Inside the crumpled metal he works under a blanket while he keeps his patient calm in an atmosphere akin to a demolition scene. The work of the rescuer outside must be coordinated with the needs of the patient inside. The agitation the firemen often experience while working a tough extrication must be calmly transformed by the medic into productive energy. The patient’s pain must be absorbed by the medic or the patient may panic, and that panic will be transferred to those working outside. “One, two, three” . . . tap. The volunteers continued their exercise in futility. “Oh, Jesus Christ, give me that damned thing!” the sinner grabbed the firemen’s play toy. He took out his pent up frustrations with the axe head and beat a crease across the roof so it could be bent. They would roll it back and expose the horror that it hid. Up to that point in his career, he had only seen pictures of scenes. That day, he had been momentarily stunned by what he saw in the car. Later, he would see heads in back seats, laps filled with intestines, different combinations of severed limbs or ones that were grotesquely mangled, and impaled body parts. He had learned to prepare himself for the worst. When the roof was rolled out of the way and the car’s interior was flooded by the morning sun, the boy’s broken body would be boldly exposed to the virgin eyes of the firefighters. He hoped then they would understand the reasons for his actions. With a heave, the roof rolled back and his fears were realized; but he hadn’t anticipated seeing what he saw in the lap of the boy . . . his Jehovah Witness manual. The saint then realized that the boy had not only been driving nearly 100 mph and trying to pass while blinded by the rising sun but he had also been reading a manual on how to better serve his heavenly Father — the heavenly Father that had better be looking over His children, or shortly this one of them would join Him. The medic had to work diligently to keep the boy’s airway open while he called for equipment. The young driver’s blue-jean-clad legs lay limp, crumpled, and showed no sign of human form except for the stylish running shoes which had been awkwardly repositioned by the car’s brake pedal. The obviously deformed legs were evidence of the impact. It had not only shattered the bodies of both vehicles but it also buckled their undercarriage and rutted the newlypoured asphalt. The sudden, violent stop had sent ratchet sockets rocketing through locked metal toolboxes and the camper shell. The saint had read about kinetic energy, and after seeing the damage that could be worked by weight

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The Street Saint times speed squared, he gained a new respect for speed and for what he had read. He thought about relaying the clinical information to the firemen, but decided against it. He just said, “We need to move, guys!” and then asked, “Any word on the chopper, yet?” Gayle, the young female paramedic, appeared at his side and asked, “Do you need any help?” “Is the Pope catholic?” he barked. “What?” Gayle hadn’t caught on. “Yeah, I need help!” His attempt at being a “tough guy” had failed, so he stopped mincing words. “Let’s get this kid out of here and ready for the chopper! He needs to be tubed, two lines, but right now he needs to get out of this car!” “Backboard” is one word everyone connected with rescue understands. It is the big piece of equipment that everyone can find and grab a hold of, to do something worthwhile. The backboard was brought by a couple of the firemen and placed with the wider head end under the boy’s behind. The foot end was supported by another firefighter. The saint again dropped to his knees and tried to think of a way to move the boy’s shattered legs without sharp bone ends causing further damage. In his inexperience, he decided that all the possible damage had already been done; they had to make up for lost time and there would be no way to tell if any more damage had been done in the move. The saint didn’t like the rationalization, but couldn’t argue with it either, so he grabbed both pants legs and pinched them together just above the knees. He then pivoted the boy onto the board. Gayle stabilized the boy’s head the best she could. “Gayle, when you lay him down, keep an eye on his airway. I’ve sucked about 500 ccs out of his throat and it’s going to run back in when we lie him down.” “Gotchya,” Gayle muttered through clinched teeth that her strain had caused. “Let’s get the board on the ground because I can’t do anything now.” The boy was poured, rather than slid, onto the board. All his long bones had been shattered, giving him an amoeba-like appearance. “I’m going to need some MAST pants!” he hollered, while he pulled his trauma sheers and started to cut and remove the patient’s clothes. A well-meaning volunteer firefighter handed him the shock trousers, unfolded. Working with unfolded MAST trousers is like putting on wet panty hose. MAST pants, like many other pieces of medical equipment, were invented to help treat soldiers in Vietnam. They auto transfuse blood from the lower

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Chapter 13. If his Dad were there extremities, stabilize fractures in the pelvis and legs, and externally apply pressure on internal hemorrhage. No one knows how they work; the saint only knew they were a blessing. Those who work hospital say they don’t work and many services have pulled them from their trucks. In this man’s work, they proved their value time after time. “My God, what am I supposed to do with these? Find someone who knows what they’re doing and get them folded, and do it now!” he screamed, close to tears. One of the well-meaning but un-knowing firefighters had opened the pants and they hung in front of the saint’s face like a ripped-up pair of coveralls. It would take five minutes of concentrated effort in a calm atmosphere to put them back in shape; time the saint didn’t have. “You want to use mine?” a calm voice from behind him asked. The saint turned to see a chubby Latino-American male flight nurse. He stood and offered the MAST pants that he had taken from his larger, and more efficiently packed, jump kit. The nurse and a paramedic had been sent from the University Hospital about 50 miles away. The jet-powered bird had sat down on the road not more than 30 yards from the scene, but its landing had gone unnoticed. The engine-driven equipment, idling diesel engines, and the hectic atmosphere of the scene covered the noise of the landing. “Thanks.” The medic knew the best thing he could do for everyone was to remain calm. He tried only to speak in short phrases and only when he knew someone was listening, both physically and emotionally. “Now, do what I do,” he ordered the flustered volunteer firefighter. The saint had him apply manual traction to the patient’s fractured legs while the flight medic helped with the pants. They were quickly applied and inflated. The patient’s head was where it should have been but his feet extended about nine inches beyond the six-foot board. He thought, “My God, we’ve stretched the kid!” The injuries and the strength of the adrenaline-pumped firefighters must have added about a foot to the crumpled body. “Does anyone know this kid?” “Yeah, I do,” said a blue-shirted highway patrolman who had been watching the cluster. “How tall is he?” The saint tried to cross his fingers as he hoped for the right answer. “Oh, he’s really tall, and a runner. I’d say he’s about six nine.” So they had not redesigned the anatomy. What a relief.

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The Street Saint He thought his work might be about done. Like the tired plow horse that smelled the barn, he looked around and hoped to see that the boy was intubated and could be moved. He had delegated simple airway maintenance to his counterpart; with the delays he had encountered, the youngster should have been intubated and at least one IV established. The other medic had done nothing. She had just watched the agonized respirations under the mask the saint had placed. “Oh, come on, suction the kid! And at least bag him if you’re not going to tube him! Are you going to sit there and watch him die?” He was yelling again. His patience was gone. He looked to the right of the patient’s head and saw another flight member and assumed he was the pilot. He was kneeling, and was handing Gayle the laryngoscope. He removed the oxygen mask and then whispered something to her that the saint couldn’t hear. The “pilot” looked at the saint and with a kind, understanding smile, said, “It’s OK, Bud, remember, you’ve done everything you could; that’s all that can be expected. I’m proud of you.” The saint didn’t think anything of a pilot saying he was proud of him, yet the words made him feel good. With that vote of confidence, the saint felt a weight lifted from his shoulders. It was as if the pilot’s words had made the MAST pants work their magic, because the patient began a mournful groaning that told the rescuers his level of consciousness had improved. “We’ve got a long way to go and a short time to get there . . . get him in the bird and we’ll work on him on the way.” The flight nurse started her part of the rescue. She took the baton of responsibility without the saint passing it to her. With her words, hands grabbed and spaced themselves equally around the board and lifted the young man to the chopper. It carried him to the University, where a trauma team had universal blood waiting and a surgeon who would begin the rapid but careful process of repairing bleeding organs and arteries not revealed by palpation. A few hours later, anguished by the unbelievable stupidity of the young man’s family, the trauma surgeon screamed into the phone and told the saint that the boy had just died. The operation had been a success; he should have survived. But friends of the family had stopped the “heathen process” of giving “demon blood” to a Jehovah Witness. For all practical purposes, even after careful extrication and advanced trauma life support on the scene and in the air, the young man had bled to death while blood hung idly by his side.

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Chapter 13. If his Dad were there The saint had to control the sinner, then, but the saint would not realize until the next day how much control it took. The saint would have to be satisfied with wondering how an adult (the patient was nineteen the day he died) could have not been treated. How could the words of “friends” have killed him? Implied consent should have dictated the surgeon’s reasoning, but the family’s lawyers would have argued that, if the young man had been awake, he would have followed the teachings of his religion and refused the blood. Years of intensive education had saved the boy; a simpleminded religious view killed him. Fear of lawsuit had cost a young life; the saint should have just left him in the car. The conversation with the surgeon was a once-in-a-lifetime experience; he would never again hear a trauma surgeon scream his disgust at such a waste of life. The saint would eventually learn that one patient wasn’t worth the pain. One day, he would wonder if the surgeon had been upset over the loss of a life or over having his medical divineness superseded by another. The sinner knew that giving medically-acceptable treatment to an unconscious patient could never be viewed as doing harm. He knew a judge would never hear such a case; and if there were such an idiot on a bench, a jury would acquit him. Wouldn’t they? If not, he didn’t have any assets worth suing for, anyway. He would apologize for saving that person’s life and promise to never do it again. He later talked with several flight crews and no one knew, or had ever seen, that pilot with white wavy hair. The pilot’s hair and his eyes were the two distinguishing features that the saint had remembered. Years later, shortly before his own accident, he looked at a wedding picture of his mother and father. The light coming through his mother’s living room window hit the glass in the frame in such a way that his father’s naturally brown hair glowed white. He saw the love in the man’s eyes and the sheepish grin that his father had often worn. The smile brought a tear to the corner of the aging saint’s eye. Seeing his father’s unforgettable smile, he understood that the words spoken by the pilot, “Remember, you’ve done all you can . . . I’m proud of you,” were his father’s words. The smile and the bright blue eyes were his. His father had died a few years before the accident and never knew that his only son had made the decision to care for his fellow man. At least, the saint thought his Dad never knew. But after realizing what he had seen, he could never be dissuaded that his Dad had been on that scene too. He knew his help was needed. Even though the saint had spent his life doing the best he could for

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The Street Saint others, he had dismissed most religions. But he was happy to know that his Dad had been with the young man when he took his last trip home. CHAPTER 14. WHAT’S IN A NAME? Everyone in the county recognized him, by the radio that seemed to be permanently affixed to his side. The radio, his badge of honor, carried with it responsibility; it could never be set aside. He never knew when he would be needed. His people rarely called upon him, but to miss a call could have been fatal for someone. Children often asked, “Are you a doctor?” And when told he was a paramedic, they seemed happy to meet a “hero” and not some stuffy old doctor. The sinner always added, for the parent’s pleasure, that paramedics work for a living. In his later years, he would say, with a broad grin, that people could tell the difference between doctors and medics in the emergency room — the medics have gray hair. Money was a constant worry, especially in the last days before the next payday. Sometimes he spent days at the base so he wouldn’t waste gasoline going home. He told bill collectors that he was sorry for falling behind and that he was looking for a better-paying job, which was a lie. He never over-spent, and the joke among EMS workers was “What credit card?” He never looked for a more lucrative job, because he couldn’t turn his back on the families in the 900square mile area he served or give up the adrenaline rush or the ego boost that his radio afforded him. There was a difference between the saint of the church and the one that worked on the street. The street saint carried a sinner that sometimes got him into trouble, but the saint forgave him and supplied excuses. Without those infractions, the saint could not have done his job. With the sinner’s help, the saint learned not to feel guilty. They had similarities. They both worked Sundays and there was no such thing as a holiday when others needed help. They both had to be good listeners and have patience. Both are often present when people die. The ordained knew a door to a better world was opened; the sinner nailed it shut while he cussed, bit, and scratched to keep people alive longer. Men in black explained that God had called a loved one home. The saint sometimes said something similar to comfort the family, but only after he had explained why nothing else could be done. The saint’s wife was upset once when she learned that he had done nothing for a man who had died shortly before the saint arrived. She went into a rage and

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Chapter 14. What’s in a name? screamed at him, “Who do you think you are, God? You have no right to decide who lives and dies!” Her statements bothered him. It still crossed his mind, every time he conceded to the dark angel, had to call a coroner, and had to tell a family that a loved one was with God. He may concede to the dark one but he also cusses him for sneaking around, his presence only known to the soul he had stolen. There was no honor in prolonging the life of those who had rightfully been called. He had learned to accept death with honor and dignity and often shared those thoughts with others. Men of the cloth and the saint are thanked; and both embrace people showing overwhelming sorrow. But for those who show their sorrow through psychotic outbursts, the reverend prays while the sinner has to restrain. The reverend passes the plate and spreads guilt if the public doesn’t contribute. Citizens don’t understand the financial needs of EMS. Many think ambulances are overpriced and assume that the personnel are well paid. The public got used to being let off the hook when it came to paying the bills; only about 10% of their bills were paid. Government reimbursements equaled about 20% of what was needed to operate the ambulance. You could say that the public treated the street saints the same way they treated the saints at church; they tithed 10%. There are differences. The priest was trained to console, to counsel the troubled souls of alcoholics and the mentally distraught. The saint, who was called to the scene on a moment’s notice, had next to no training for treating those maladies. His guidelines were not dictated by Rome but by legislatures, and he faced accusations from lawyers who sat in a perfectly calm world and decided his fate. Forgiveness was given by the priest, without question. The saint never understood the scenes he had to face, and little was forgiven. By opening day of deer season, the saint had cut their hunting allowance to one box of shells and a couple of old boards nailed across a tree’s limbs and a few more boards for steps. That morning, the saint sat in his car and watched as his pride in blaze orange climbed the tree to wait for the big buck. They both wanted the other to succeed; but they each also wanted to take the trophy. Dad had propped his rifle in front of the passenger seat while his portable radio lay silent on the dashboard. He sat there; ready to respond to the action of a deer in the woods or to the radio that could summon him in seconds. He could have responded from the woods, but he didn’t have the resources to build another stand. He had worked so many hours that time had slipped by, and even if the funds had been available there was no time to build another one. The

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The Street Saint sinner would feel good if he could take out his frustrations on something, but the saint had decided that nothing would die at his hand. The morning went well, for all but the boy. The sinner’s ego had been stroked at the hardware store when he answered questions about the accident. The saint was pleased that the shopkeeper used the ambulance service’s tax number and saved the saint four bits. Dad shared in the joy of the young man who kept one eye on Dad and another on the woods. The town’s priest was asleep on that brisk Saturday morning and the sinner was happy complaining about everything including the sleepless night that the saint had inflicted upon him because of yesterday’s scene. Goob finally had enough of the boredom and left his perch in the tree. He walked to the car and said, “Maybe we’ll catch them before dark. We’ll come back this afternoon. OK, Dad?” “Sure, kiddo.” He was glad to have his son back with him, even though it meant the end of their morning hunt. “Come on in and warm up a little. I’ll run you around to the house. Mom said she was cooking a big breakfast and I’ll bet it’s about ready.” Goob got into the car and Dad said, “I’d say a nap is in order, and then we’ll come out and kill that big one you found, OK, Bud?” He moved the rifle to the back seat so his boy could sit and then secured the radio between the bucket seats. Goob rattled on about the things he thought he had heard in the woods and the “glimpses” he thought he had seen. They arrived at the house and by the time they had shed their hunting gear, Mom had breakfast on the table. The meal was shared with the conversation usual for that time of year — mainly, how big the deer were and how many they would hang in the barn. His wife busied herself clearing the table while she gave confidence to her son and teased her husband. She said that when she wanted venison, she had friends at work that would give her some. After breakfast, Goob sprawled on the floor with his video game on the T.V. Dad hit the couch and, before Mario had saved the first little princess, the tired deer hunter/medic who had been up all night had fallen fast asleep. A knock on the front door woke him up. The Goob had joined him in nevernever land and “Days of Our Lives” entertained the only person left awake in the house. “Is this where the paramedic lives?” a young woman’s voice asked.

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Chapter 14. What’s in a name? A call for help? He rolled off the couch and went to the door in his socks and long johns. “He’s here, but he’s asleep. Can I help you?” his wife asked, even though she knew he was coming. She had tried to shield him from the interruption of a much-deserved day off, or maybe she was trying to hide his attire from the two pretty country girls who were standing on the front porch. “It’s OK. I’m awake,” he said. “What can I do for you, girls? Do you need help?” They looked like sisters. One was a young adult, the other, about four years younger, still had the baby cheeks of her youth. A tall, neat, clean-cut young man stood behind the older of the two and said, “Sorry to disturb you, Sir, but their brother was killed in a car wreck yesterday morning and no one seems to know anything. The secretary at the ambulance office told us where you lived, and thought you would be the best one to talk to.” “Well, come on in and let’s talk,” the saint said, “but didn’t your Mom and Dad tell you? I understand they went to the hospital?” The saint didn’t understand why they wanted to see him. The trio walked into the living room and the older of the girls took the “power seat” of the armchair. Her husband half sat on the arm and half stood on a stiffened leg behind her for strength, but out of the way. The younger of the two, even though concerned with the matters at hand, sat on the couch and looked at the television: a source of relief for her generation. “Didn’t your Dad tell you what happened?” He questioned cautiously, because he had been warned about patient confidentiality. With medical legal issues, what appeared to be right and fair was not always the best way to proceed. The younger girl explained the reason for their visit. “My father didn’t tell us anything except that our brother’s dead . . . to forget him!” She started to cry, and she turned her head back to the soap opera. “He just told us that he was killed.” The older one picked up. “They’re going to cremate him at the hospital and I’m just supposed to forget him!” Her flood of tears then joined her sister’s. “You see, sir,” the husband took over, “We’re Jehovah Witnesses, and their father makes the rules for the family. It’s not my place to say what a man does with his family, but I agree with them. They’re talking about their brother and they should know what happened. They don’t even know where the car is.”

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The Street Saint The saint felt his heart tugged, but the sinner threw up red flags. This was dangerous ground. The firemen were surely talking, and details would come out in the newspaper — so much for patient confidentiality. But how accurate would the stories be? Didn’t the girls have a right to know? Did the saint have a right to tell them? What were they looking for, anyway, and who would be held liable for what? “What was it that you want to know? I can only tell you about the scene and only my opinion. I wasn’t really with him very long.” “Was he dead when you got there?” the oldest asked with her eyes full of tears. That was a safe question. “No, he was still alive.” Both girls broke down in tears. “Did he tell you what happened?” The other asked. Harmless question, but could be looking for who to blame. But the answer, luckily, was easy. “No, he was unconscious and the most we got out of him was a groan after we increased his blood pressure.” The saint had measured his words to ward off any chance of a lawsuit. “Did he suffer much?” The sinner be damned, the saint would answer that question. It had nothing to do with the dead. It was for the living and how they perceived the death of their brother. “Hon, the impact was so severe I think he was out the minute they hit. I don’t think unconscious people feel anything.” There was nothing wrong with saying that; it was something he believed. “Do you know what they did at the hospital?” “Watch out, Bud here comes the negligence suit!” the sinner quickly warned. “No, I don’t have anything to do with the hospital. The last thing I knew about your brother was when I helped put him on the helicopter. I do know the operation was a success and the surgeon was very upset that he couldn’t give your brother the blood that may have saved his life.” He had defended the actions of a professional and attacked the guilty. It they wanted to blame someone the saint wanted to make sure that they blamed what had ruined his, and all the others, good works. The sinner always liked calling a spade a spade but the deliberate provocation the saint had thrown at the family made the sinner hop around and raise a fuss. “They wanted his eyes!” She blurted out in a wail and then broke down again.

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Chapter 14. What’s in a name? “What?” the internal racket the sinner was causing and unexpected outburst had confused him. The girl explained, “They called about fifteen minutes after they had told my dad that my brother was dead and wanted to know if they could dig out his eyes. His beautiful blue eyes! I loved those eyes, and they wanted to dig them out of his head!” She was near hysterics, flailed her arms, shrieked, and almost hyperventilated when she spoke. The saint’s wife left the room. She couldn’t take the emotional stress. She had done her part when she had tried to keep the girls on the porch. Like most people, she believed the best way to handle a problem was to keep it as far away as possible. The Goob looked at the woman and frowned. He looked much older than his years and seemed to understand their distress. His face showed his shock and confusion. He turned to his Dad with a look that asked, “What weirdo would dig out some dead guy’s eyes?” The saint had to look away. At first it was because the Goob’s look had struck the sinner as funny, but his son also sat where the 12-year-old girl’s chair had been and he had again felt her presence. The saint shared a youthful passion with his son and understood his concern. Maybe that’s why they were so close. He was glad to see that someone in pain had touched him. Their horror over the eyes was understandable; but it was caused by ignorance and the boy had shared that also. That’s what had struck the sinner as funny. The saint explained, “They were asking you to donate his eyes to a living person who needs them.” He chose his words carefully. “That’s organ donation, and it’s very much needed.” While the memory of the 12-year-old girl played again in his mind the other young lady continued to cry but asked, “But, couldn’t they have waited for a couple of days, or something? That’s cruel to tell someone ‘Your brother’s dead and by the way, can we dig his eyes out?’” “Honey, they didn’t ask if they could dig out your brother’s eyes, did they? That’s not what your Dad said, was it?” “I guess not . . . but they could’ve waited!” She retracted her accusation but was still upset. “You know,” the saint continued, “I do a job that a lot of people say they couldn’t do. I understand that.” He led her away from the topic of digging out eyes. “But the people who work with organ donation have to act quickly. I respect them, because I don’t think I could do their job. Would you like to have to ask someone in your condition that question?” Maybe if she could sympathize, it would help her understand.

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The Street Saint “I wouldn’t do it!” She said. “People should be buried with everything they were born with so their families know they’re going to be alright in heaven.” The saint didn’t know if she had spoken from immaturity or from the same religious beliefs that had contributed to her brother’s death. But he understood what she was trying to say. He thought about how he had pictured himself in heaven, in one piece, healthy and reunited with loved ones. He knew that they would be healthy, smiling, and happy to continue their relationship. Maybe she had a point. The sinner had believed in Darwinism since he had been introduced to it. The science he had studied, and then later the medicine he had learned, had proved it. But there were times when he still saw things that he couldn’t explain. But he had seen the rot of a dead body and had seen how it had started to return to the soil from which it evolved. The Bible says, “dust to dust”; the scientist talks about “the cycle of life.” Both agreed, without necessarily admitting it. Discussing his beliefs with the women weeping in his living room would do nothing to resolve the situation, so he kept them to himself. He had never denied the presence of a “spirit.” For that very reason, he believed organ donation and transplantation was a good use for body parts. He also believed that “harvest” was better used to describe crops and shouldn’t describe the organs of loved ones. As a standard policy, family members should be told how much good the organ they donated had done. The positive reactions from those two minor changes might abort the feelings and the attitudes that he had just encountered. It was not time to argue religious beliefs or scientific hypothesis. This time was for the two young women to grieve. It was going to be harder for them, because they weren’t going to be able to close the lid and let it go. So, to understand what had contributed to their brother’s death, they must, on their own, question the wisdom of ancient beliefs and compare them to life today. “There is a tremendous need for transplants.” He began his explanation by appealing to their emotions. “Wouldn’t you like to see a young boy or girl who had been living in darkness finally be able to see because of your brother’s gift? To know they could see flowers, the sky, and their Mom and Dad for the first time, because your brother had been gracious enough to let them use his eyes?” It took several minutes for the two girls to regain their composure. The brother-in-law turned his head away and wiped his eyes. The saint started to wipe away his tears too, but decided to leave them where they were. He was not

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Chapter 14. What’s in a name? unfeeling. It was his heart that had served their brother, even though it had been his scientific training that had kept their brother alive. “What about his legs?” The older of the two girls changed the subject. “He loved to run.” “Yeah, someone told me . . .” The saint wanted to know just how blunt he should be. “Do you really want to know?” “Yes, we want to know everything.” When the saint saw that he had a green light, he didn’t hesitate. Better to drop the news like a bomb, and hopefully head off their step-by-step questioning. “They were crushed, like rags. I doubt if he would have walked without assistance ever again.” “Oh God, he loved to run so much! Don’t tell me any more!” She placed her face in her hands and sobbed loudly. Her husband consoled her and rubbed between her shoulder blades. She raised her head and looked at the half-dressed saint and asked, “Would he have lived, if he had been given the blood?” Handle this one and you got her, Bud, his sinner whispered. There was a light at the end of the logistical nightmare that his passion had gotten them into. Maybe he could come out a hero, with no one getting hurt. “The surgeon said that everything was good, he was even hoping that he would pull through without the transfusion but, in my opinion, he would have not lived the way that you remember him. That brother died yesterday when those two cars collided.” He said it softly but directly. He then wondered if she was selfish enough to still want her brother alive, even though he may have been crumpled and crippled, useless to everyone save maybe to talk. Did she love her brother the way she said she did, and would she let him go, and accept her loss? “Then I’m glad he’s dead,” she said emphatically when she lifted her face from her hands. “My Dad’s wrong about this, and we’re moving to another city, but I’m glad my brother is dead. I wish I could hug him one more time and tell him good-bye, but I’m glad he’s dead if that’s the way he would have lived.” The bravest speech he had ever heard. “He would never have wanted to live like that; I’m happy he’s not going to suffer.” With the two sisters in agreement, they rose and thanked the saint. They each apologized to his wife for upsetting her family, said their good-byes and left. When the door closed behind them the Goob solemnly asked, “You don’t feel like going hunting, do you, Dad?”

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The Street Saint “No, we’ll go. I promised.” Dad knew he hadn’t done a good job of lying. “Dad, I think we’ll just stay home today. I don’t feel like killin’ nothin’.” The Goob picked up his Nintendo controller and turned the television back to channel three where Mario would save both the little princess and Goob’s emotions. The saint knew his son was upset and wished he hadn’t had to listen to all that, but maybe it was a good thing that he had. Maybe he would remember how people can work through their depression and what a car wreck can do to a family. He knew that some of the things his son would experience by just being close to him would bother him, but that day, he wished they didn’t always have to share. The medic walked into the kitchen, picked up a cigarette and lit it. He blew the smoke out faster than he had drawn it in and said to his wife, “I don’t want to ever have to do that again.” The hunters sitting in deer stands overlooking the fields that surrounded the saint’s house cussed the person who had made the racket. But there had been enough thought of death that day. If only his family knew what lay in store for them in the years to come. He walked out the back door carrying his gun and their box of shells. He walked onto the back deck, loaded his 3030 and emptied it into a gallon jug that had been placed for target practice about 100 yards away. He reloaded the rifle and shot until the box was empty. Goob didn’t join him. His wife didn’t say anything when he returned. CHAPTER 15. IF YOU CAN’T BEAT ’EM . . . MOVE ON The saint got tired of working with fellow employees whom he was supposed to train but who didn’t have a desire to learn. They wanted only enough to get a license and they learned to hide their inadequacies. They ousted those who showed a better way of doing things. Their attitude would cost lives, and there was nothing he could do about it. He moved on. He only did what his books had prepared him to do; the doctors appreciated it and his partners burned from the attention he received. “Duty” to him had become “work,” because others had used “policy” to best fit their understanding. They objected to working with him, but they didn’t realize how hard it was for him to work with them, in their obstinate ignorance.

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Chapter 15. If you can’t beat ’em . . . Move on He had to get used to working with bosses who were not paramedics — people who had to follow his orders on scenes but who made decisions in the office that would affect the way he worked. Members of the ambulance boards could not understand why he wanted things done a certain way; they wanted everything to look “nice,” and understood little more than that the ambulance gave “rides to the hospital.” The saint’s only concern was the treatment his patients received. He was needed on the scenes of true emergencies, but the rest of the time he was helpless. He was only in control when others didn’t want to be responsible, and he was helpless when others wanted to flex their political muscle. The politics of EMS was not the only reality he had to face. He moved from citizen to professional when he learned that he saved most lives by improving respiratory efforts, raising or lowering blood pressures, or regulating beating hearts. A paramedic only treated bad trauma about 2% of the time and even then could do very little. Many who had entered the field ignored the medical calls where they could have been the most help; they liked the trauma for “the rush” and because the treatment modalities were easier to learn. Nurses didn’t appreciate the paramedic’s freedom with treatments, because they had to wait for written orders and couldn’t do the majority of lifesaving skills that a paramedic could. On the other hand, many didn’t understand the reasons for his interventions and they belittled him for it. Those who understood wanted the rush he had enjoyed and secretly wished that the patient had arrived unstable so they could “play.” But everyone appreciated him when he did things that saved them work. If he could have done the work while they got the rush, everyone would have been happy. He administered aspirin to lessen the severity of strokes and heart attacks. Moms gave it for fever and headaches. A nurse could do it only with an order, and a paramedic couldn’t do that at all; those conditions aren’t emergencies. People did not understand that an advanced life support ambulance does not carry Band-Aids. At the same time, nurses would complain about his rapidlyapplied pressure dressings or bloodied equipment that was still attached to a mutilated body. He stabilized critical patients and sometimes brought people back from the dead. He wasn’t needed when time allowed for definitive care or for what “Mom” should have done at home. The system wasn’t designed for that kind of response — and even though they comprised 90% of his current work, no changes were made to the system, to accommodate that fact.

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The Street Saint “OK, so the pay is about the same and we would be living at a resort, but what about the fire departments?” he asked the owner of the ambulance service he was considering moving to. She had asked the state for someone who was sharp, who hadn’t been tarnished by the inner city. He wondered if he was being too outspoken for a potential employee. “I wouldn’t worry about that,” the lady said. “We train the firemen here, and if I say so myself, they’re one of the best in the state. They’ve got a huge tax base and they don’t run short of equipment.” Then she made him an offer. “I’ll give you a $100 more a month than you make now, and a two-bedroom trailer that I own. I will remodel it for you and have it ready by the time your family gets here.” It was too good of an offer to pass up. He would make $1050 a month and only work 120 hours a week. He accepted the offer and moved to the “promised land,” where a free home awaited the family he dearly loved, but felt he never properly provided for. Not only had they been deprived of his physical presence but also the positive comments he so often thought of — while he sat, alone, on duty. He often only had time to offer the guidance he knew was needed from a responsible Dad. He often just wanted to tell them he loved them. He gave thirty days notice to fulfill his obligation to Terry. He arrived on his new job to find a trailer full of warehoused supplies, and rats — so much for another EMS promise! His job started the first day he was in town, but still, he thought he would have time to get the trailer ready for his family. As it happened, the boss had been looking for a paramedic to whom she could relinquish field responsibilities, and she put him right to work. It didn’t take him long to learn that “the promised land” had pitfalls, like any other area. “Medic 44,” the dispatcher called. “Need you to respond to Dorothy’s house,” the boss said, “her son has upset her again and she’s got chest pain.” Even the boss, who was happy with the money a call generated, was disgusted with Dorothy, who called every Sunday. He knew she always called between 11:00 and noon. She didn’t like her daughter-in-law, and Dorothy’s call for help made sure her son spent every Sunday at the emergency room with her. To get her there, a $400,000 dollar rescue truck with a paid fire fighter and ten volunteers who traveled with lights and sirens in their personal vehicles also responded. “Oh boy, there go the experts.” His new partner, Carl, said when he heard a family of four responding. They were imports from the big city — the brother of the fire chief, his wife who was an EMT and senior medical officer, a daughter

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Chapter 15. If you can’t beat ’em . . . Move on who had gotten a job dispatching for the county, and a son who would soon be a paid fire fighter. The saint wanted to turn off his siren. He felt like a high school kid who had gotten his girl to snuggle closer by checking out a noise that had been made by the wind. The pseudo 911 call would prove to the public that the volunteers could handle everything and that the ambulance only “gave rides.” The fire department would log another “save” and Medicare would pay the boss. The saint didn’t need the ego boost like the others did. Dorothy was a nuisance. It took an average of nineteen minutes for a paramedic to get on the scene, but the volunteer department could be there in eight. The fire department had capitalized on the financial explosion of the county and did a good job when they performed CPR, and often times had trauma patients packaged before the medic arrived. The saint wanted someone with his level of education there first, to institute even better care when it was needed, and to limit a response when that was appropriate. That meant the “family of four” would lose their positions. It looked impressive: neighbor helping neighbor. But the work, by “professional” standards, was what counted. The saint needed the well-meaning volunteers for the equipment and the manpower their organization provided; but the trauma those inexperienced citizens endured was never calculated. The maiden voyage of one of their trucks was to rescue a dog. It got great press but the ambulance refused to transport the animal to the veterinarian to be “checked out” — not enough money, the firemen had said. He thought about a few of those things before he got to Dorothy’s house. Office workers can dodge phone calls, salespeople can dump difficult customers, and doctors become unavailable to people they don’t want to see. The paramedic doesn’t have that leeway. He enjoyed center stage, but generally was given it when he wanted it least. “She says she has chest pain and her nitroglycerin didn’t work,” the first responder said, while he rose from his kneeling position and then gave the pills to the medic. “Hi Dorothy, isn’t this the same bottle I told you last week you had to replace?” She didn’t answer. “Remember?” He asked as if he were interviewing a child. He asked loudly so the rescuers would slow down. Dorothy tried to defend herself, “My son said he was going to get them but his wife wouldn’t let him.” Because of her foolish obsession, half-a-milliondollars worth of equipment sat outside her door

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The Street Saint “Well, Dorothy,” the saint had no choice but to follow protocols. “Let’s go over the list,” and he began the medical questioning. She answered most questions before he finished asking and he found it comforting to know that a patient was so well versed in emergency medicine. One day her “crying wolf” would kill her. He contacted the hospital while en route and the nurse who answered the radio recognized the age of the patient and the time; she asked if it was Dorothy. Dorothy wasn’t the only patient who abused the system. He saw patients who were concerned over bowel habits. Doctors knew the ambulance was a 24hour-a-day operation and used it to transport their patients when they didn’t want to be bothered. The saint was first exposed to the habit in the rural area, but in the inner city he would meet the masters. “Abuse calls” are rarer in rural areas, but are almost nonexistent where the patient has to pay his bills. It’s true that, nuisance or not, that type of call did provide a stress-free environment and afforded an opportunity to keep skills sharp. If he was called for nothing but guts and blood cases, it would have driven him crazy, and the time between true emergencies would have dulled his skills. On a busy day he ran maybe five or six calls; on the average, three. In the ’hood, he would run that many an hour. The big city calls could sometimes be attributed to the lack of available care; in the country, it was usually the professional who offered the medic’s services in place of his own, when the “professional” didn’t want to be bothered. Visiting nurses called an ambulance on Fridays if they thought it would keep their patients from bothering them on the weekend. (Why are nurses not held accountable when they abandon their patients after dialing 911?) The doctor who didn’t want to be bothered would order the patient admitted to the hospital, so he could discharge them after seeing them on Monday. Naturally, the doctor’s “customers” felt “special” when the doctor ordered them taken home in the ambulance. The saint knew which nurse was on call and what doctors had plans for the weekend by five o’clock every Friday afternoon. Hospitals countered the surge in patients by pushing doctors to discharge on Friday. That left the saint ferrying some patients to the nursing home and others back to the hospital, because the nursing home had staffs that were likewise sparse on the weekends. The sinner suggested they just switch the names on the charts and let the people stay where they were. People were shipped so much he began to call it UPS: Unwanted People Shuffling.

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Chapter 15. If you can’t beat ’em . . . Move on Carl became not only his partner, but the best friend he had ever had. Carl came from the big city. He had seen his friends destroyed by drugs and his city turned to a cesspool of disgust. He was a small man but his heart was big. He took his duties seriously and liked the possibilities of better care that the saint had talked about. He often soothed egos when the sinner left disgruntled “dogooders” in his path. His loyalty knew no bounds. He understood the saint’s frustrations when he ranted. Carl stood fast when others deserted him. He even hugged him, when the saint’s marriage ended. The saint never saw the end of his marriage coming. He had entered a deep depression; he was tearing himself apart inside. He never realized that for two years he had talked about nothing but EMS. His obsession had chased away his pleasant personality, and he no longer smiled. When he hit bottom, he asked Carl, “Why don’t you leave me, too?” Carl looked him in the eye and said, “I’m your friend; that’s why.” “Yeah, some friend I am!” He hadn’t noticed that Carl held him tightly by the upper arms and wouldn’t let him leave. Carl had seen the depression coming and had taken precautions to protect the saint, without his knowledge. Carl needed strong words to reach his friend, so he yelled, “Yeah, you fat slob, and do you know why I know you’re my friend?” “That’s what I just said, I have no idea.” He was taken aback, and getting frustrated. “Because you’d die for me! That’s why!” Carl said coldly, firmly, and with a voice that the saint had never heard him use before. The saint had never thought of dying for someone else, even though he could have died on any rescue. He hadn’t thought of himself as a hero; he just did a job. The saint finally got the meaning behind Carl’s words. He then understood what he meant to the many who hadn’t taken the time to tell him. They hugged again, in a burst of passionate compassion that few men get to share without any concern for homophobia. The saint took strength from the small but powerful man, and cried for himself for the first time since childhood. He was afraid to release too much, because he thought he might not be able to regain control. He felt again the passion of the political arguments; the scorn of those he had intimidated; and calls that hadn’t gone well. He saw again the disappointment in the eyes of those left behind, who had hoped for more; and felt the anguish of not being the father that he had hoped to be. He had even started to doubt if he was a good medic.

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The Street Saint Carl not only gave the saint a chance to release but he had also proven that there was one person who believed in him and understood his inner self. The saint grew and learned to accept that inner self and his profession for what they were. When he thought about what his life might have been if he had not divorced, he had to think about what his family life would have been if it hadn’t been for his career. Those thoughts led him to the people that he had touched and the times that he had been there when a stranger needed him. Those memories finally brought him back to Carl. Carl had shown him what saints meant to everyone. He didn’t know what he had done to deserve such a gift, but that was the beauty of it. Carl had given to the saint as the saint had always given to others . . . without expecting something in return. Carl decided there was not enough money in EMS and it left no time for him to enjoy his life. Maybe the end of the saint’s marriage had something to do with it; Carl left EMS, but remained the saint’s friend. He later told the saint that many of those who had battled with the saint later headed committees that instituted the same changes the saint had once suggested. Carl didn’t mince words when he reminded them who had given them the ideas. Before the saint left the area, the head of the emergency room shook his hand and said, “If I ever need an ambulance, I hope to see you standing there.” That vote of confidence from one whom he had respected made the saint’s personal sacrifices worth what he had given. It gave him the spark to try once more to find the team that he had always dreamed of. CHAPTER 16. AGE AND WISDOM There are books, protocols, legal precedents, and well-trained insurance people who handle the aftermath of car wrecks. Insurance companies pay for medical treatment, reimburse for lost wages, and pain and suffering. A profit will not be made. Many people believe being “checked out” by a doctor is standard care following an accident. Physicians evaluate symptoms and observe signs; they can’t find problems that don’t exist. Paramedics “check out” people and it would be wise to consider why they ask if someone wants to go to the hospital after an assessment. The medic knows that any profit from a car wreck belongs to the lawyers.

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Chapter 16. Age and wisdom “Medic 44.” Again the boss interrupted a pleasant conversation. “Go ahead,” Carl answered. The saint usually ran the radio, but he had started to share some of the truck’s responsibilities; at least, those that Carl would accept. “Need you to respond up here to the end of the lake road.” Carl instinctively switched on their lights while the saint pulled on his seat belt and then held Carl’s so he could snap it in place. The boss continued, “There’s a minor 10-50. PD says there’s a bunch of kids.” “Clear, show us en route,” Carl said. The saint finished bringing the electrical system to life while Carl stomped on the gas pedal. Years later, the saint would respond without lights and sirens to calls where people wanted to be “checked out.” Carl and he had just gotten up to speed when they came upon the vehicle and had to shut down. While Carl placed them “23,” the saint looked inside the undamaged van and saw twelve uninjured children. “They’re my nieces and nephews,” a fashionably-dressed woman explained. “I want a doctor to check them out.” “Ma’am, are they hurt?” he asked, while thinking it would take every ambulance in the county and more beds than the ER had to handle them all. “I don’t know if they’re hurt, and you’re not a doctor!” she yelled — he shouldn’t have asked about injuries, he was just an ambulance driver! She hadn’t considered the risk she was going to place the county in or the $6,000 in ambulance bills alone she was about to obligate herself to pay. When the bills hit, she would ignore them because she would say that they were unnecessary. If asked, she would then blame the licensed paramedic who had said he couldn’t find any injuries. He had been an idiot that “wasn’t a doctor.” She would forget his common sense approach that said that injuries had to be present to be found. Maybe one day she would find a psychiatrist who would find the horrors that she harbored in her mind. He had made the boss’s day when he called for five more ambulances because in the resort area car wrecks meant insurance, and that meant good pay. The fire fighters were bewildered, because the only thing worse than having something to do that couldn’t be done was having nothing to do and finding a reason to do it. In the big city, the kiddos would have walked to one ambulance and been transported as if it were a bus. In fact, once the city teens learned that money

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The Street Saint could (supposedly) be made on an accident, the saint would be forced to transport entire school buses full of “patients” to the emergency room. His common sense finally convinced him to commandeer the bus and ride to the hospital with the patients. The children would be placed in the waiting room until their parents tired of the wait, and went home. In the country, the children would all be packaged and the doctor would run hundreds of dollars worth of tests to prove what the paramedic already knew. Many would say the lack packaging of inner city kids was based on prejudice, but it was in fact just a victory of good sense over the ridiculous. The saint knew what was going to happen when the children were tied to the boards. Their screams and squalls weren’t underestimated. As one little girl was being placed on a board the woman said, “Oh, that’s my daughter; she’s not hurt.” The saint looked at her in disbelief. If she could see her child wasn’t injured, then why not the others? The packaging had been completed and when the other trucks left, the wail the saint heard was not that of sirens but of their occupants, who thought they were being tortured. The trucks were all BLS units, trucks that were manned only by EMTs who provided only “basic” life support. It was an accomplishment for the young EMTs just to get their patients on the boards and keep them there. As incident commander of the “mass casualty,” he was left with one small child to transport. Most people who aren’t injured but request transport are looking to sue, or avoid criminal charges. “The Gold Card” of Medicaid pays for the inner city transports; and since the trip to the emergency room didn’t eat up too much of the patient’s day, so the possibility of settlement was worth the invested time. Many times, those patients denied having Medicaid benefits, because if a settlement was granted, the Medicaid recipient would have to turn it over to the state. He kept her calm by talking; his “Dad” experience managed that. He asked if she watched “911,” and she asked if her picture was going to be taken. Carl had a camera and the saint still had the picture in his scrapbook two decades later. He had busied himself with the paperwork needed to generate a bill. He was a hero in the boss’s eyes. They were about ten minutes into the ride when the neighboring fire department was toned for an overturned vehicle with the driver still pinned underneath. The dispatcher said the reporting party said the man wasn’t breathing. Carl and the saint were only a couple of miles from where the dead man lay, and Carl instinctively stepped on the gas and switched on the lights. The saint put away his paperwork, getting ready to respond. Taxpayers saved

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Chapter 16. Age and wisdom money on homeowner’s insurance by voting for an additional fire department. The ambulance service ran from one base; no one saw the wisdom of spending the area’s public resources on saving lives. Besides, the public believed EMTs were the same as paramedics and the fire department had volunteer EMTs. And the ambulance charged for their rides. The saint’s instructions to Carl were simple. “There’s a dead driver about a mile from here and we’re about two miles from the hospital; get me there fast.” The saint had already reported to the hospital, but he grabbed the trauma radio again. The hospital was already busy with eleven small screaming patients. “Go ahead 44, what you got now?” the nurse asked, wondering what had changed in his uninjured patient. His unit’s sirens blared over the ER’s speakers. “We’re going to have to unload quickly,” he told her as calmly as he could. “We have a trauma code and our other trucks are there, but we’re the only ALS unit. Meet me outside but scramble the chopper crew.” He gave orders for the next call. The man under the car desperately needed help, and an act of stupidity had dispersed the help just when it was needed. “We hear you,” the nurse said, and called him by name. By personalizing her observation, it made the catastrophe smaller than it was. She would be seeing the man shortly after the paramedic pulled him from the wreck. Some nurses said they would shriek if they saw what he saw on scenes, and were thankful that his reports had prepared them. Then the nurse told him something he didn’t know. “Your adjoining district is responding its ALS rig.” She knew about the war that raged between the districts. He said what had become the word of the day, and then told Carl, “We’ve got to get to that call! You know the boss won’t let them have it!” He turned his attentions back to the radio and switched frequencies to his dispatcher. She had just gotten off the phone with the other district’s dispatcher and wanted to know if they should mutual aid. He could refuse it and be blamed for delaying care, or accept it and face the boss. He uttered the word of the day again and then considered the ramifications his decision would cause. The popular answer was to say “no,” but the patient needed help. He protected himself and made the most of it. “Request that they respond.” That alleviated one problem, but before anyone took an attitude, he showed that he had the company in mind. “We have upgraded to code 3, and the ER is meeting me outside so we can dump and run.”

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The Street Saint “Carl, we have to unload before that other truck passes us!” Carl was well aware of the money and the war. He also knew the anxiety that was building up in the responders. They were readying themselves for a trauma code, on a headon path, without benefit of interdepartmental communication. Someone must have seen the accident, and that meant the patient had a chance. Carl was determined that his newfound hero and he were going to give it to him. This was the type of call they had trained for, sans the political rivalry, but they didn’t come often. The saint had never yet seen someone come back to life because he had revived him. He knew this time he had better equipped and better trained help than the “competitors,” and he was a lot closer to the hospital; the helicopter would almost be waiting for him. If he were good, he could succeed. He had to know if he was! Carl had never seen anyone brought back either, and wanted to be there when the miraculous happened just so he would know it was possible. He wanted something to look forward to, the next time the black angel stood in his path. The saint had told him what was possible and differentiated it from fantasy. Carl looked forward to the day when people got the help they needed. If the saint was right, maybe that day was here. The truck’s tires squealed when they turned into the hospital drive. The saint saw two nurses smoking cigarettes, but no gurney. He was being punished for transporting a horde of uninjured patients. The nurses had to work. That’s why they stood outside smoking. It was how they protested. Carl brought the truck to a hard stop while the medic blew open the back doors, pulled, jumped, and talked in one smooth move, “Here! There’s nothing wrong! I gotta go.” He made a diagnosis, but later would be asked why he transported them at all. He disappeared again into the back of his truck after shoving the mummylike child into the unsuspecting arms of the cigarette-smoking nurses. He called to Carl, who still had his foot on the brake and the truck in gear. “Don’t worry about me; just get in front of that ambulance!” He talked while he made sure his equipment was ready. “Give me three minutes and you’re there,” Carl said calmly, but the saint still heard the excitement in his voice. Carl would control the Adrenaline; he was a good partner. “You’ve got two, and I’ll love you!” the saint hollered, over the roar of the engine, the sing of the tires, and the scream of their siren.

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Chapter 16. Age and wisdom “Not me, Bud, you’re too big and hairy for a country boy like me.” Carl laughed, and the laughter relieved their stress. The big box truck squatted with the acceleration. The saint liked the feeling, knowing that accelerating was all they could do. He wasn’t expecting miracles. He knew that within the hour he would be writing cold facts when he documented the death of the person under the car. He would document how he responded as fast as he could with another patient on board. He would cite the dispatch evidence and how the man had been reported dead when he was found and there was no one available because of the pseudo mass casualty. He would make sure he reported his request for mutual aid. His writing would not say how he had sent two nurses waddling into the emergency room because they didn’t know how to carry a patient. He wouldn’t write how Carl jumped a curb and pulled dangerously close to the other district’s unit. He wouldn’t say how Carl kept the gas pedal mashed while they flew down the road. No one would read from his hand that their main goal was to be first, their ego having replaced compassion. Carl tried to find a place to park, but a pumper occupied the road and responders’ vehicles were scattered about as if this were a town barbecue. Ego had clogged well-meaning minds, just as it did when the city’s budget was written and ignored EMS. The needed rescue truck rested with doors open and equipment scattered. Those who had sworn to get help safely to the scene had unknowingly withheld it. The wild ride was for naught. The two ambulances had flown, but had no place to perch. If the scene had ever had any positive momentum, it was lost by the time they arrived. Everyone stood and looked at the overturned motor vehicle perched precariously on its roof. They had come to see the dead man, and that’s just what they did. The firemen stood to the side in what the sinner called the “Oh boy, this is bad!” position. It allowed access up the middle to anyone who wanted the responsibility. Their subconscious posturing had kept them away from it. A backboard lay on the ground. Its coffin shape pointed like a big red arrow at the dead man. The saint crawled onto the board like a surfer practicing on the beach and put his head through the driver’s window. It dawned on him that it was the inexperienced who were standing around; those properly trained and experienced had positioned airbags to lift the car. An off-duty nurse knelt on the roof of the car and cradled the lifeless face of the man in her hands. The other district’s medic let her play paramedic so she would get a medic’s rush, and he only had to give rides.

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The Street Saint The saint didn’t have to feel for a pulse to know the man was dead. “We need to get a C-collar on him.” Her actions were book perfect. He tried to read her eyes for the unspoken. She had played the part of a paramedic perfectly and the saint would not err if he had followed her lead, but then, he would have ignored the efforts that the man needed. The book could be covered later; bringing dead patients back was better. “Do you have a pulse?” Maybe the man wasn’t dead; his prognosis would be better. “No!” she said smashing his last hope. She tried to hurry the saint by saying, “Let’s get the C-collar on him!” The saint heard the near panic in her voice; the sinner recognized her need to command. He knew she had surrendered, and functioned for documentation. Her thought was right . . . if she had thought. The sinner thought it ridiculous to kneel on a car that was crushing the life out of your patient in the name of resuscitation. Maybe if she had been a petite nurse, the kind that medics fantasized about seeing out of their scrubs, he would have tolerated her presence. But she was close to 250 pounds and was wearing bunker gear. The paramedic’s logic had set a timer, but it was the sinner that pressed the detonator. If the man was dead, he needed rapid extrication. His training didn’t jive with the “education” of a college-educated nurse. The sinner bit while he grabbed her by the wrist and “helped” her from the car. “Why don’t you get your knees off his chest?” He didn’t know if he was more aggravated with her position or the one that he had inherited. This call was going to be an uphill battle, and undoing her mistakes wasted time and might just prove to be the killer he couldn’t document. He knew the nurse would punish him later, when she returned to her position of authority in the ER. The saint would learn to be concerned with the future, before he spoke, but the sinner’s mouth often caused the saint hard times. While pulling the rotund nurse to her feet, he ordered the air bags inflated. “We’re gonna need MAST pants!” he yelled over his shoulder. Two firemen disappeared to get the 5-pound item. He wasn’t concerned with losing two helpers. There were more than enough and two stood a better chance of finding what he had sent them for. He did the same thing with his kids when he sent them for a tool. When the firemen returned, they removed the trousers, opened them properly, and placed them on the board the way they had been trained. Much better than the last time. The car slowly rose from the man’s body.

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Chapter 16. Age and wisdom The saint had a few seconds to formulate a plan. “Is there anyone else in the car?” he asked loudly, over the compressors that forced air into the newlyinvented reinforced rubber and canvas bags. “No, sir,” the old farmer said, in a delayed tempo. The saint had almost forgotten what he had asked. “He came a barrellin’ around that thar corner and went off in that thar ditch. The missis and I were in the garden there,” (the saint looked to where the old man pointed, so he could repeat the mechanism to the flight crew; the garden wasn’t important) “and it jist kept a flippin’. I seen that thar boy under there come out through the roof hole and then he was gone. I thought he was thrown clear but I come runnin’ over here and damn there be his face looking up at me.” The saint saw subtle signs of terror, but generations of handed-down calm had served the farmer. “Did he look like he was breathing, when you saw him?” He wanted to know how long the man’s brain had been without oxygen. “No, that thar boy be dead, sir. God bless his soul, but he’s dead. You boys do your job, you’re saints for trying, but I’m tellin’ ya, that thar boy’s dead!” The voice of country experience had spoken. The body was accessible by the time his story ended. The saint had wasted enough time investigating; the pressure of a trauma code excused some answers. The sinner would protect him if anyone accused him of being lax. “Let’s get him into the MAST pants. Carl! Get me a tube and an adult stylet. Clyde, get his pants off and those MAST pants on. Somebody get me those IVs from the back of my truck!” He continually issued orders that the experienced understood and others could follow. The saint grabbed ankles and pulled the 150-pound man from under the car and onto the backboard. The helicopter crew would most likely call the code as soon as they arrived and there was no need to risk the efforts of the crew, raise the ambulance bill, and the hopes of a family that had yet to be informed of the tragedy. There was no sense bringing a healthy heart back to its full potential to profuse an already dead brain. The next few seconds would tell all, but he had to decide without hesitation. While he quickly cut down the front of the young man’s summer weight Tshirt, he reminded others to cut off the pants. Clyde stood, straddle-legged, over the outstretched legs of the patient. Experienced firemen pulled their trauma sheers and started cutting away the trousers. The man’s shirt disappeared and his jeans. The saint looked at the MAST pants that still lay in a heap at the foot of the board.

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The Street Saint Clyde stood with his hands still on his hips like an over-weight Jolly Green Giant. He had countermanded many of the saint’s orders. Equipment had been moved. Traffic control had been established. It was clear to the saint that the attentions of the firemen had turned to orders given by the medic that represented their district. It was suddenly clear to the saint that Clyde’s main concern was to get the chopper on the scene. “Hey, Clyde! Let’s get those pants on!” The saint called to his counterpart. “We’ll need all the pressure we can get!” He thought professionally reminding Clyde of their responsibilities would also remind Clyde who was in charge. “You can’t use them in the chopper,” Clyde gave a good reason, but still it was an excuse for dumping the patient. It also proved that people like Clyde used EMS for ego and to play with big toys. He also let everyone know his true feelings about the abilities of a paramedic when he said, “We’re getting him to a doctor!” Clyde gave the stock answer of why things shouldn’t be done in the field. Now the saint knew why the nurses thought paramedics were idiots. Clyde wanted to send the patient to the hospital, where the doctor would say, “He’s dead, and there’s nothing we can do.” He saw in the doctor’s expression, “What am I supposed to do, when the man’s been dead for a half hour?” Doctors never asked why someone didn’t do something; they didn’t want to embarrass an ignorant “ambulance driver.” Clyde would talk about the “bad call” they handled and demand the respect due to a tough paramedic. “It isn’t any good to transport a dead guy to the hospital!” The young saint hoped his simple statement would win the argument. “The MAST pants might give too much pressure in the air, but right now we don’t have any pressure!” “That’s not my problem.” Clyde answered. “My job is to get him to the hospital,” Clyde watched the helicopter circle overhead. Make it look good! It was obvious what Clyde intended. For documentation purposes, the best treatment was to give the young man a rapid transport to the morgue. “Clyde!” the sinner barked, “Quit being so anal or get off my scene!” Just like in Vietnam . . . “Make the body count look good!” The saint put his hand on the whale belly that was where Clyde’s fortitude should have been and pushed, cleared his 6-foot-5 frame from the end of the board and screamed, “Get the off my scene and get me somebody in here who’ll help!” “Carl!” The sinner called to someone who would never let him down. “Get this idiot out of here!” The roar of the helicopter covered the sinner’s cursing but Carl understood. It was not his position to order a paramedic off the scene, but

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Chapter 16. Age and wisdom following orders given by his medic allowed him to put Clyde in his place. Again the saint had proved himself a hero in Carl’s eyes. Putting on anti-shock trousers may look easy; and it can be, if one practices. The firemen where the saint had once worked didn’t know how to take them out of the box; the firemen he worked with now had obviously practiced. Their expertise gave the saint time to assess the progress of the scene he had assumed. It was going well. He then turned his attentions to where he should have been before Clyde’s ignorance had interrupted him. The exposed chest of the boy was unceremoniously covered with the gloved hands of a fireman who had started chest compressions. Another fireman had started to breathe for the patient with an Ambu bag that the saint’s boss would bill for and didn’t have to buy. The boss would be pleased. “OK, let me see what I’ve got.” The saint said while he applied gel to the paddles of his defibrillator. He placed the paddles and hoped to see something that would prove the old man’s prophecy wrong. The sinner knew he had been right and would get excited when he saw something worth his effort. “We’ve got fib!” the saint called out, as soon as he saw it. “Everyone clear!” Clyde watched from a distance. He should have been able to repeat the saint’s skills in his sleep, but he couldn’t. The saint, who was then ready to deliver a charge that could throw a 5-pound lead ball 300 feet, would soon learn that. Clyde didn’t know the first thing about resuscitating a viable heart. He had somehow made it through school and state testing, but when he was on duty had to use a cheat sheet if he was forced to treat. And even after his ignorance had been made public, the ambulance board still made him a supervisor. He was the only paramedic still employed there. He didn’t believe in continuing education, but he was tough; he had been a Marine. Those still on the scene were about to see a real paramedic at work. Inexperienced, yes, but he had lived through this moment a thousand times, in his head. He was not going to be guided by his seniors on the scene but by his training and his desire to succeed. He was not a genius. But, those who had designed paramedic programs had devised a way for 19-year-old person with a high school education and a year and a half of “training” to save lives. Fresh in his mind, still, was the young girl he had resuscitated three times but who now lay cold, buried with grandparents and an elderly great aunt. He had reviewed his failures and given himself credit for his accomplishments.

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The Street Saint CHAPTER 17. THE GOOD, THE BAD, AND THE UGLY TRUTH “We have to go!” the flight nurse said, without sounding overly excited. “Clear!” was the only word he needed to tell others he had begun his efforts to raise the young man from the dead. He worked with the flight crew and instituted experimental procedures until they got a pulse. He fought the battle and thought he had won. Then he saw something he had not anticipated. “Look at his belly!” Like a flesh-covered Jiffy Pop pan ready to spew popcorn, the man’s belly was expanding up and over the top of the anti-shock trousers. The experimental high-dose Epinephrine had done its job and then some. The artificially high blood pressure had pumped copious amounts of blood through the abdominal injuries that had attributed to the man’s clinical death. “Yeah, but you aren’t going to make it to the university, not with that hot belly!” the saint said. Was he afraid of a dead man dying? “We’re going to the closest,” she said. “It’s not a trauma center; but they have a doctor!” He didn’t like the idea, but he agreed that the man would be dead in minutes if his belly weren’t fixed. He acted on his only option. “Let’s hope they’ve got a doc who knows how to use a clamp!” He pulled trash away from the patient and ordered equipment moved. The chopper was close and the pilot was ready for a rapid departure. He already had the big blades slowly turning. The saint ran from the LZ as the bird lifted and the wash from the blades blew him forward. He felt awkward and helpless, now that he had nothing to do but to watch the chopper fly away. He didn’t feel like the hero that he had gone to school to become; he had just done the job he had come to do. He had handled the scene correctly. His boss almost squealed when she heard Carl’s good news. “He did it!! I knew he could!” Unfortunately, the young man lived only for about another hour and then died on the operating table. Twenty liters of blood were pumped into the man and then ran out again, filling suction canisters and gauze trays. The saint later learned that the man had died two years before in a similar accident. A paramedic had saved him then, also, and a non-trauma related facility had performed a successful operation. Christians believe that God calls people when they die. Would trying to intervene, then, be blasphemous? If so, it’s the sinner the public wants in time of peril. Saints tuck in blankets and give teddy bears to children who need

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Chapter 17. The good, the bad, and the ugly truth comforting and noninvasive procedures. People expect the actions of the sinner, but the warmth of the saint. He had aged and burned out before he figured out that his saintly actions were not the reasons why he was called. The saint was expected when a family was transporting their matriarch to a nursing home, or when those who abused the system were demanding their free ride. By the time he came to that conclusion, the sinner was controlling most of his actions because the saint had exhausted himself trying to be kind to people who didn’t appreciate him. He knew that some got religion when they faced death. It was those people who demanded the least of him, and he refused to disturb their peace. Those who called and demanded service had not accepted death. After his attempts failed, however, they consoled themselves with the thought of joining loved ones in heaven. Then, in their minds, he was saintly. He had kicked in doors, thrown over furniture, crammed tubes into bodies, shocked them, and poured chemicals into them; that was not saintly. It was the sinner that had fought to keep their souls earthbound. On his infrequent trips to church, with his then wheelchair-bound mother, he would sit and watch heaven-sent rainbow-like colors bathe the congregation. He would look over the sea of blue-haired women and balding men while the preacher promised an eternal peace that made earthly wonders trivial. The sea of blue and bald heads grew in proportion to his years of service. Maybe he, or someone like him, could take credit for helping people live longer. Some of the heads belonged to people he had grown up with, and whom he had thought would always be there when he needed them. He was no longer the spry, muscle-bound savior of mankind; he would soon be respected for his senior citizenry. Then, he wondered if his battles for life had been proper. Maybe the true saints were those who had prayed outside an ambulance while he tried to keep a young girl with her family. Maybe the real heroes were those who prayed when they transported critical patients. Maybe he had just waged war against his creator; the giver and taker of life. His number of attempts at resuscitation waned and he found himself only treating those he had to. He no longer felt remorse when a patient died. He told family members that God had called them home, bringing his thoughts full circle — but not for the same reasons as those of the Christians he had rebuked. When he was younger, he had fought the fight willingly, with the sinner leading the “blasphemous” charge for the adrenaline rush it gave him.

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The Street Saint The saint wondered if he should have moved towards the hospital rather than bringing the patient back to life then and there. The doctors said, “Don’t worry about it.” But he did. The sinner commented, “Don’t kill yourself with a medic around, but if you insist, try again.” The sinner joked, but the saint hurt for a long time. He couldn’t accept death as a part of life; a part he would later look forward to for some but still put off for others when it was appropriate. The saint’s next trauma arrest went better. He brought the patient back, and transported him by ground to a hospital that flew him on to the university. The saint was proud, until the boss chastised him. “Well, you didn’t do that well. We didn’t get the transfer. You used supplies he can’t pay for and the hospital would have guaranteed the transfer. I’m out about 600 bucks . . . Thanks for nothing!” The saint learned a valuable lesson about EMS that day. CHAPTER 18. IT AIN’T ALL BAD, IT JUST LOOKS THAT WAY “Do you have any idea what kind of trouble you started in the county last night?” the boss asked. It was 7:00 AM, and the saint was just about to start his third consecutive 24-hour shift. Only two more to go and he would be off to enjoy his midweek weekend, while his wife was at work and his kids were at school. He had only slept six hours in two days. “What do you mean? I needed help, and called rescue.” “Now everybody in the county knows about that threesome, and it’s your fault. You played around and made us the laughing stock of the county.” The boss was hot. “I don’t know what you’re talking about. The guy was unconscious and weighed about 250 pounds, lying under a waterbed. I followed protocols, and with all that equipment, his weight, and the geek you sent with me, I couldn’t carry him.” He recounted his efforts and knew he had followed protocol perfectly. “You could’ve called Ray. He came over anyway to see what was going on.” She was referring to her husband, an EMT who rarely ran with the ambulance any longer. “I didn’t see him.” “He sat in his car and watched.” Chris went back to typing the bills she had been working on when the saint entered — her way of showing her disappointment in him.

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Chapter 18. It ain’t all bad, it just looks that way “Chris, all I did was call for the help I needed. I don’t know what the big deal is.” He went over the call again in his mind. He remembered jumping out of a deep sleep and rolling off the couch to a “man down” call. His new EMT partner came from the other room in his underwear and a much too big T-shirt and asked what to do. “Well, Mike, you could start by getting dressed,” the saint answered. He was not being facetious; this was a lad who needed a lot of “guidance.” “We’ve got a man down.” The saint went on to give the book-smart EMT instructions: “You drive me over there and see if he wants to go to the hospital.” The saint was at his wits’ end with this EMT. The kid had shown promise, but he had never seemed able to apply what he had learned. Littlejohn turned and tripped over a reclining chair that wasn’t in his path. “Never mind, I’ll drive.” The saint shook his head. He had already dressed, pulled the truck from the garage and had his crew en route by the time Mike got there. As Littlejohn climbed in, the saint said, “OK, Little One, watch your side of the road for recliners, I don’t want to hit one.” Littlejohn blushed in the dark and said, “OK.” The saint stopped in front of the house where the man was “down.” He told Littlejohn to grab the oxygen tank. He grabbed his jump kit and monitor, and led the fledgling EMT into the house. A stout young woman met them at the top of steep porch steps that led to an old frame house. “He’s in the bedroom,” she said as she opened the door. The medic, with Littlejohn following closely, was met by a slimmer and much more attractive blond, no more than 30. She wore a short satin gown that showed a lot of leg and the beginning of a firm, shapely bottom. It was late at night, summertime in a resort area, and the saint didn’t see anything strange about her attire or about two families living in the same house. The blonde said, “I think we wore him out,” and then giggled before adding, “He was up in the attic all day putting in insulation. He’s got asthma; I hope that’s not it.” As she finished talking, the saint knelt at the foot of the bed to check the man. “Did he seize?” The saint asked. “No. He just went unconscious,” the blonde answered. The man breathed deep regular respirations and his lungs were clear. There was no problem with his asthma. “Littlejohn,” The saint turned just his head and said, “get him on high flow O2, and if you remember how, put on the monitor.” He then turned his attention

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The Street Saint towards the pretty blonde to ask more questions, “Ma’am, does he have any problems like diabetes or anything else I should know about?” “No,” she laughed, “Like I said, I think we wore him out.” “Yeah, with the heat in the attic, it’s possible.” He still wasn’t sure what she meant. In those days, he still tried to keep people in the best light. He instructed Littlejohn, while thinking about other causes of coma. He had to teach Mike, because EMTs are not taught in school to assist paramedics, yet once they are licensed, they can work on an advanced life support truck. The protocol the saint ordered would eliminate low blood sugar, alcohol, and opiate overdoses as potential causes. He had already noted the patient’s size and knew his partner couldn’t handle the weight. As usual, the saint had to plan for the worst. “Medic 44, Dispatch.” These were still the days when the paramedic carried the radio, because it was presumed that what he had to say was important. His driver drove and did what he was told. “Go ahead, 44.” The boss answered. “I’ve got a big man down; tone rescue.” His request was simple. “10-4; have them en route.” There wasn’t any apprehension in his boss’s voice. He sent his partner for packaging equipment, while he pushed meds. The saint knew he had a good chance of having the man awake by the time the Little One got back. Firemen arrived within minutes. The blonde greeted each of them by name, and they seemed happy to see her. He didn’t mind their stopping to chat, because they wouldn’t be needed until he was ready to move the patient. Then the blonde said, “Hey, what can I say? I think we wore him down, before he rolled off the bed!” She extended her arms wide when she talked, which raised her gown further. “We were having a great time. We kept telling him to take it easy, but he wouldn’t listen.” The saint didn’t know which made his jaw drop further; the blonde’s gestures or the story she openly told. “I was with him and out he went, right off the end of the bed. I guess he bounced under there!” She giggled. The saint reminded himself that what people did in the privacy of their own home was their own business. He continued doing his job. He pictured himself at the nurses’ station, telling the doctor what he had just heard. The brunette was introduced to the firemen while Littlejohn wrestled with the backboard. He tried to enter the room with its 6-foot length extended horizontally. “Turn the board sideways, Mike.” The saint didn’t even have to look up; he heard the banging. The saint had accidentally banged enough boards on his

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Chapter 18. It ain’t all bad, it just looks that way own, and had worked with Mike enough to anticipate his ignorance. Mike was the sweetest man in the world, but he should have never been given an EMT license. Psychological and physical exams to determine job capability would exclude many people from EMT classes. The patient did not come to, after the medications or the initial bolus of fluids, but his pressure came up a little. And now, the pleasant evening talking with two partially-dressed women ended for the firemen, who dragged the man from under the bed. The man was covered up and carried down the steps to the cot that firemen had had the foresight to put at the bottom of the stairs. He slept the rest of the way to the hospital and awoke when being lifted over to the bed. Diagnosis from the ER doctor was exhaustion and dehydration. The blonde was right. In thinking it all over, the saint knew he had done nothing wrong and protested. “But Chris, I didn’t say anything wrong. How was I supposed to know what they were doing, and what difference does it make? It doesn’t make us look bad.” He didn’t understand how his actions, or the threesome for that matter, affected the reputation of the service. “You don’t get, it do you?” Chris asked while standing, “Come on; I need coffee.” He followed her into the next room where she poured her umpteenth coffee for the day, and started her explanation. “The fire chief — you know who that is, don’t you?” No. “Well, he used to be married to the blonde. You’ve heard she used to dispatch here, for the county, didn’t you?” Chris assumed a calm instructor-type melancholy. “No, I didn’t know anything about her until last night. It seemed like the firemen knew her, though.” The naive saint said. Chris laughed, “Oh, she knew them! In fact, they’ve probably had sex with her on several occasions. She used to dispatch for the sheriff’s department, until she got fired for making love to a deputy on the counter while a cop needed help. She was seeing the sheriff we had, then, romantically . . . no, you weren’t here when he was here.” She finally remembered that it happened several years before the saint had arrived. “I thought the previous sheriff was an old guy, I remember him and the election that was held just about the time that I got here.” The medic interrupted. “It seems that she was seeing the sheriff, even after losing her job. The fire chief, her husband, got suspicious because every time he responded on a call the

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The Street Saint sheriff was nowhere to be found. If the sheriff went out of town for the day, the fire chief’s wife disappeared mysteriously also. Well, the chief decided to try to catch them, so he put a voice-activated tape recorder on his phone line at home. Boy, did he get a recording!” Chris laughed while shaking her head. “They were planning to kill him!” Chris looked straight in his eyes. “Oh, come on! I don’t believe that!” “Believe what you want,” Chris said with a hand raised to stop further denial, “but the county was in a mess. If the chief had been from around here, he would’ve walked into the sheriff’s office and blew the son-of-a-bitch away. But, the chief did it by the book. He took the tape to the prosecuting attorney’s office and the prosecutor took it to the sheriff’s office, played it for him, and told him to pack his and her stuff and hit the bricks. Go where they wanted, do what they wanted, but get out of the county by morning. They were gone when we got up.” Chris went back to her office, sat behind her desk, and continued the sordid story. “The sheriff stayed gone; don’t even know where he went. I understand the two of them were together for a while but it didn’t last. She came back a few weeks ago like nothing ever happened. She’s supposed to be dispatching for the neighboring county. I don’t believe it, but she was a good dispatcher.” The county needed services that only a few people could supply. “It didn’t take but about a week for her to hook up with that kinky couple you met last night. People had suspicions, but when you called for rescue and the firemen saw what they saw, it’s no longer a secret. We look stupid, and it’s your fault.” She went back to typing statements. He pulled a chair from a neighboring desk, sat down, and then said, “I don’t see how calling for rescue can make us look bad.” “Everyone in the county has a scanner. You should’ve heard the traffic. All the deputies were double-checking the address and naming her by name. The firemen cracked jokes all the way.” It looked like he had called “the boys” to a party. Now, retaliation by the supervisors of the other departments would be hampered because of their volunteer status (even though they expected to be called professionals); but they blamed the ambulance. “Well, I’m sorry.” “You should be.” Chris said. “Don’t let it happen again. Remember everything you say goes over the scanner. We know everyone, and everything you say or do comes back to us. I know what you’re thinking before you think it.”

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Chapter 19. It’s so sad, it has to be funny Chris was a good boss and taught him the ropes. While lack of funding prevented her from updating things much, she had unselfishly run the business for 24 years and had taken only one vacation; she delivered her first-born while dispatching her husband on a call. Many county residents forgot that she also provided a service without the benefit of tax monies; if you added up all the hours she worked, she was paid at a rate of about $4 an hour. CHAPTER 19. IT’S SO SAD, IT HAS TO BE FUNNY The saint left the quietness of the country behind. He left the glitz of the resort and the “beautiful” people, and hoped to find what he sought in the inner city. It took a bright sunny day to make the city shine. It was usually dark, cold, and forbidding most of the time; and at night, the bustle of business was replaced by ominous figures obscured in hoods. The violence men held for one another disappointed him, but not as much as the greed he saw in rich and poor. The rain turned from snow to sleet and then back again. It wasn’t windy but the cold humidity bit at his cheeks and made it hard to breathe. “Well, Ricky,” the aging saint said to his partner. “It looks like flu season.” He had joined his big city partner for the day at 0800 and knew they would be responding to belly aches, “Vomikin’,” and fever calls all day. “The flu’s not going to be bad this year. I read about it on the net.” Ricky was a 24-year-old EMT with about two years experience. “Oh, I don’t know,” the saint said, trying to keep the conversation going. “The weather’s perfect for it.” He knew that viruses cause the flu, not the weather — but bad weather helps. “The weather doesn’t have anything to do with whether people get sick.” “Hey, hit the filling station,” the saint changed the subject. “I want to get a soda; it’s on sale here.” “We’ll go somewhere on the other side of the city. We’re not going to get stuck down here in the hot zone.” Ricky didn’t even look as he drove by. “Well, I’m thirsty.” The saint knew that they were short of manpower and trucks; they were going to get “tripped” before they made it to the base. Ricky only refused to stop because he had asked him to. “You can wait,” Ricky said. EMTs who drive for private services often get cocky because the company is mostly concerned with the truck’s operation and the money it generates; the paramedic is a cost factor. The public thinks the paramedics are important, but the public doesn’t pay for the truck. The para-

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The Street Saint medic is a necessary evil to maintain the “advanced life support” rating, but they’re not cost effective in the eyes of administrators. The medic always wants new and better equipment and doesn’t consider the cost when treating a patient. Emergency rooms used to close, at night, if they didn’t have an appropriately trained staff. Today, money would be lost if they closed at night. And since only a small minority of patients actually needs emergency care, the administration is safe in its unconcern over quality and experience. “Normal,” to this new breed, includes having cardiac arrest patients pronounced dead before the crew could get them on the hospital bed. It includes watching a patient die because someone didn’t have the time to go to the blood bank or X-ray was too busy to shoot a film that would have told the doctor to insert a chest tube. The saint had seen a different world, and his presence intimidated them. Ricky belonged to the “clique” at the big city service where the saint then worked. He liked to talk the talk, but the saint had never seen him walk the walk. He spent off duty hours either drinking or running with a volunteer fire department whose personnel never would have passed the test for a paid department. He was a member of the new breed, trained to a lower standard and holding lower expectations of himself. He had passed the reduced requirements that were instituted to fill the slots created by the ever increasing “service on demand.” Something is terribly wrong with the system. Critical patients are kept waiting for hours while nurses register patients complaining of flu-like symptoms, menstrual cramps, and sunburns. Nurses and doctors are strained to their limits while bigger ERs are built without considering where the staff will come from. Doctors’ offices send patients to the emergency room rather than staying open longer hours. And patients who need real emergency care are squeezed out of the way. This is compounded by the trend among newer EMTs to see their job as giving fast rides and abiding by better “business” practices. Many good medics have become prejudiced as a result of the onslaught of patients that they were forced to transport. Ambulance personnel used to look for dead bodies, because they were more profitable; today, the administrators generate a strong bottom line by focusing on the patient who needs no more than a ride, and other ways to generate income without assuming liability. Many of the most committed have left the profession, through frustration or burnout. Today EMS sports an average population of “professionals” under the age of 30 and with less than five years experience. Treatments are being scaled down to match the less critical patient load; and those who really need help often become part of an “acceptable” percentage of patients who were too ill

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Chapter 19. It’s so sad, it has to be funny to survive. Sometimes, a good medic can still stabilize them, but nowadays that is interpreted as a sign that the patient was not in such bad shape, after all. A paramedic is no longer considered capable of accomplishing such things. The truth is that the best medics, like the best doctors, can afford to deviate from prescribed protocols. They do it all the time, despite what a doctor may write in patient records. After reading one of the saint’s reports, one younger medic said, “Old man, you can fall into fertilizer and smell like a rose. I heard that call and thought you might be in trouble. Then I heard your radio report, and I knew you were in trouble. I thought you might lose your license. Then I read your report and you wrote yourself out of every corner. Got to hand it to you; you’re really good.” The saint explained how he could do that. “It’s that experience that you say you’ll get ‘later’ that saved me. Remember, if you don’t document it, you didn’t do it; and you know there are reasons to eliminate treatments on a lot of calls that you run. Patients can be unruly, refuse treatment, or prevent the medic from doing his job; and like you kids always say, I was too close to the hospital to do anything, anyway.” “Yeah, but I heard you!” Mike exclaimed. “Everyone in the emergency room knew you punched the guy!” Then he recanted somewhat: “I’m not saying it was wrong; and you documented the injury in your report. It melded perfectly with any story anyone would tell, except for the patient, and no one will believe him. It was beautiful!” This was the first compliment the saint had received from someone younger than him in a long time, and it was because he got away with punching someone in the mouth. The saint didn’t like the young guys who hadn’t yet proved their intentions complimenting their elders for unethical conduct. He knew that if he had performed above and beyond, he never would have acknowledged his good work. The patient under discussion had been in police custody when the saint was dispatched. The desk sergeant said the man was trying to kill himself. The police believed he swallowed a Brillo pad because he had allegedly swallowed a large quantity of crack cocaine. Either the man had not swallowed the cocaine as alleged, or it was still in its plastic bags —because that much cocaine would have exploded his heart. Didn’t the police know that? They also believed that the man could hold his breath till he died. But, they didn’t have to know that that would only make him lose consciousness, and breathe again; they had paramedics for such problems.

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The Street Saint “Hey, Sarge, what’s up?” the big saint asked, when he entered the room. Ricky hated the way the saint could talk. Ricky often stuttered when he was excited and talked loudly. It showed his unsteady nerves. “Dat man over dare tryin’ to kill hisself, I wants him outta here! No mudder fugger goinna kill hisself in my jail!” The hefty black female desk sergeant yelled from behind her desk. “Well, of course not . . . too much paperwork, right, Sarge?” the sinner retorted. He enjoyed seeing her worked up. She was intelligent, and normally well spoken, but when she got wound up, her Ebonics overwhelmed her and she flailed her arms and made exaggerated statements. “Dat idiot be holdin’ his breath. Said he be killin’ himself and stood right there where me and the wholes world could see ’im and just puffed his cheeks out and quits breathin’!” “Standing up, right?” The saint wondered how long he could control the sinner who was dying to come out to play. “He held his breath to kill himself, right?” “Are yous deff, boy?” (The saint, who was about ten years her senior, would never have gotten away with calling anybody “boy.”) “I’s tellin’ you, dat mudder fugger was goins to do it. I throws water in his face to make him breave.” She pointed to the policemen who stood quietly by while their supervisor explained their predicament; they had helped with the rescue. “Everytimes they throws the water, he takes a big gasp . . . dat water ouda da cooler be some cold stuff! Den da mudder fugger be holdin’ his bress again so we be just throwin’ more water on him!” The saint, with a hidden smile, turned to Ricky and said, “He was going to hold his breath till he died.” Ricky said, “So? It could be possible, if he had enough drugs in him or something.” Ricky would’ve laughed if he was with a younger partner, but then, a younger partner would have allowed Ricky to look important. “Dat ain’t de wurs part of it.” She brought the saint’s attention back to her. “When I lef to be callin’ you, I goes back in dare and da mudder fugger says he ates a mudder fuggin’ Brillo pad. I asks him, what be wrong with you, fool? And he be saying that he wants to die and he knows the Brillo pad will tears his guts right out of him. I told him, ‘mudder fugger, you be going to the hospital. You can just go over dare and die.’ I ain’t goin’ to have dat in my mudder fuggin’ jail.” The saint was worried about her blood pressure. She was a very stout woman. He leaned across the counter and said, “Hey Sweets, you know you can’t

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Chapter 19. It’s so sad, it has to be funny hold your breath until you die? You know that, don’t you?” The saint didn’t want to embarrass her, but could think of no other way of breaking the news to her. The sinner wanted to tell her she was stupid and “gets” it over with. “But de mudder fuggin nigger ate dat mudder fuggin’ Brillo pad. I wants him out of my mudder fuggin’ jail. Fuggin’ dum nigger crack head. He be sellin’ his truck for crack and den when he gits caught he comes here to kills himself. If his guts be fallin’ out, I wants him at dat hospital when dey do!” She was emphatic. There was no point trying to rationalize with her. Besides, his boss knew about the call and would be paid handsomely for the two-block ride. The police rarely called for an ambulance when the prisoner was not transported; that decision had been made before EMS was called. The saint would be accused of playing doctor, because paramedics aren’t allowed to decide whether someone can hold his breath until he dies. “Hey, no problem, Sarge,” the saint said, holding up his hands in an exaggerated gesture to match hers, “let’s get him to the hospital. You got somebody going along? You know, if he walks, the staff isn’t going to stop him, and if he jumps out of my truck, I’ll wave bye-bye while he runs. It ain’t my job to run anyone down and the hospital doesn’t want them.” The saint agreed to transport, and controlled the sinner enough to make him respect her — while he did her job. “Yeah, I knows. You boys gits him out a’ dare and I be sendin’ an officer to follows you.” She came around the desk and opened the holding cell. The prisoner was a tall, slim, black man. His eyes were red, probably from smoking crack for several days. Under the days of grime his binge had collected, his clothes looked well made. “OK, Bud, what’s up?” The saint, in his postured street stance asked. “I’s gonna kills myselves.” “Need help?” the sinner asked. The saint had decided to let the sinner handle the patient. The stupidity and deceit the prisoner had used, combined with the ignorance of the police who had fallen for his bluff, made it impossible for the saint to function in a logical medical capacity. “Do you want to go to the hospital?” The sinner’s personality could handle the prisoner but the saint was going to see to it that the patient’s treatment followed medical protocol. “You know, the hospital you’re going to has a pretty good reputation for people making one way trips?” The sinner was having fun. He hoped the prisoner would get upset; he was in the mood to fight.

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The Street Saint “Yeah, I’m goins to kills myselves and I need to be in CMU.” The patient demonstrated he knew the ways of the hospital. The saint knew he was dealing with someone, like many others, who did stupid things but who also knew how to play the system so they wouldn’t be held responsible for their actions. “Do you have a psych history?” the saint asked. He knew he had to fill out the paperwork after his ambucab delivered the prisoner, who naturally preferred the hospital, paid for by the state, rather than a jail cell without a big screen TV. “Yeah, Dr. Denton is my doctor. He be tellin’ me that I could kills myselves. I want to go over dare so dat don’t happen. They be puttin’ me backs on my medicines.” The prisoner had the system down pat. Psych patients have a free run when it comes to admissions, and almost as free with discharges. They can sign themselves in with a few magical words that are easy for them to remember. If it’s a voluntary commitment, then they can sign themselves back out when they get bored, the weather changes, or the charges against them are dropped. The saint also suspected the man was broke and when he was discharged mental health would give him “some tens and twenties.” The saint was always amazed at these psychotic patients’ ability, once they were off the scene, to answer questions appropriately. Once again in the presence of mental health and medical staff, they would talk to themselves, hear voices, and talk about killing themselves. They weren’t concerned with what the ambulance drivers witnessed because they were just overpaid white truck drivers who had the easy job of giving people like them rides to the hospital. “Well, let’s get this over with; the ambucab awaits.” The sinner turned on his heel and left. Ricky asked, “Aren’t you going to take him with you?” “He knows the way and if he wants to go to the hospital, he’ll get there before we leave.” The sinner was apathetic. Problem was the prisoner, who hurried behind him, appropriately interpreted his apathy; the desk sergeant respected the saint for his toughness, and thanked him for relieving her of such a heavy burden. Ricky didn’t understand. “Ricky, be careful. If you take the corners too fast or hit the brakes too hard, our patient is going to have a hard time keeping his seat.” That comment, Ricky understood. Ricky didn’t follow the saint’s orders very often, but that one was a pleasure. They arrived at the hospital in about two minutes and the prisoner jumped out the back doors, ran into the ER, found the psych room, and was in bed before the registration girl knew they had arrived. The prisoner was overjoyed because, besides getting out of jail, he had gotten away from the crazy

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Chapter 19. It’s so sad, it has to be funny ambulance drivers. The policeman assigned to prevent escape arrived later with a Styrofoam container full of fried chicken. “Hi, everybody. Sir, what is your name?” Theresa, the young white graduate nurse greeted them. She erred in acted like a nice white lady who was in the ghetto. It was a dead give away to the prisoner that he could mess with her and get away with it. He was not just a prisoner seeking medical treatment; he was a psych patient who knew he could not be held responsible for his actions. If all else failed, he could rely on being black in the custody of a brother who would make an excellent witness as to the way he was treated. The white professionals had to let words roll off their back. The policeman was so concerned with the prisoner’s condition that he ate his lunch beside the bed. He was the same one that had refused to write the drunk driver Steve and the saint had struck. “You, Bitch!” the patient responded to her friendliness. “Sir, I just want your name,” Theresa said again, sweetly. He over-enunciated the obscenity that followed. The sinner stood quiet. The prisoner was going out of his way to prove he needed the psych floor, to avoid prosecution. “Sir, if I don’t know your name, we can’t treat you.” Theresa was trying her best. His attitude would have turned a nurse with more experience against him. The man could speak perfect English when he wanted to, and used vulgar language when it suited his purpose. The saint didn’t like it, and restrained the sinner until he could be relieved from his professional constraints. The saint sweetly but strongly suggested, “Theresa, why don’t you step outside and let me take care of this?” He used bad language too, but the prisoner’s had embarrassed him. Theresa objected, and insisted that she was going to do her job even if it meant being abused. A burned out nurse would have walked out already. The cop didn’t miss a bite. Apparently, whatever the saint did would be all that was going to be done. His calm, “Dirty Harry” manner should have been a warning to the prisoner, but some street smart patients are so busy playing their own games that they fail to realize that there may be someone else around who is willing to play along long enough to win. The saint told her plainly to leave, and to not hear what she might think she heard coming from the room. Now, maybe the man would realize he was in a lose/lose situation, and shape up; even an idiot would have understood the implication. Theresa objected again, “But I need to do my job.”

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The Street Saint “You need to get out and let me finish mine.” He was going to surrender his professional ethics to see to it that his personal moral code was upheld. “And then, I assure you, yours will be a lot easier.” Theresa left the room and the saint turned to set his clipboard on the counter. His plan called for him to dramatically turn and then grab the patient by the shirt. He would then instruct the ingrate in the ways of being a gentleman. But the saint had barely turned his back when the prisoner said, “Yeah, and you, Honky.” The sinner didn’t hesitate, and for once the saint didn’t object. He spun and struck the prisoner in the mouth. The punch blew the man off the cot onto the floor, where he landed at the feet of the cop. Ricky froze in the corner and could only slowly drawl out the only word that matched his wonderment, surprised as he was to see so much force from an “old fogey.” The sinner reached across the bed and used one arm to grab the prisoner by the front of his shirt, jerked him from the floor, and slammed him back on the bed. “Now, you listen to me!” The sinner was in control. “If you don’t treat that lady with respect, I’m going to make her leave again, and we’re going to continue this talk!” The saint was surprised the sinner warned. It wasn’t like him to stop mid-attack. “Yes, sir.” The patient proved that the saint was right. The man was oriented, aware of his surroundings, and no longer interested in being harmed. Blood poured from his mouth and ran down his shirtfront, still wet from the cold water the cops had used to “save his life.” Even though Theresa knew that any man pushed beyond his limits would resort to violence, the saint didn’t want anyone to know that he had limits or that he was “just” a man. He calmed himself in the five steps that it took to reach the door. He opened it and Theresa reentered the room. She held onto the sides of the saint’s shirt and she walked behind him. She was protected like a child behind a mighty oak. Her head poked out from under his arm and asked, “Sir, can I have your name now?” The prisoner said, “Yes, ma’am,” and more blood accompanied his words. The saint wanted everyone to understand the lesson he had taught, “Hon, you’re a nurse, and don’t have to take that from anyone. People are here for medical treatment. If he doesn’t want it, the good officer there can take him back to jail where he belongs. If you ever need us, just leave the room and call us. Understand?” His speech let the patient know that if he cared about his brethren, he should spread the word. Saints help people but they are also

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Chapter 19. It’s so sad, it has to be funny capable of demonstrating what “bad” really is. The officer understood the warning as well. Theresa’s pretty smile, and slight flush on her face, told the saint that she appreciated his protection. He saved those needing saving wherever, and whenever, they needed it. The trauma doctor interrupted the classroom and asked, in broken English, “Wat’s goeen on here?” “Doc, this is a 31-year-old man who is in police custody.” The saint began his report. When he told the doctor about the police throwing ice water in the man’s face to make him breathe, the doctor said, “That always works,” and hid his smile. The saint admired his ability. The doctor continued his exam while the seasoned paramedic finished his report. “Oh, he swallowed a Brillo pad, did he? Is that where the blood came from?” The doctor finally brought up the evidence. “Yeah, I guess so,” the medic said. Ricky walked out of the room, disappointed that the saint had gotten away with something. The cop closed the lid to his chicken dinner and looked innocently at the doctor, while Theresa turned away so he wouldn’t see her smile. The medic picked up his clipboard and headed to the EMS office they shared with security. He sat, laid his paperwork in front of him, pulled the rubber gloves off his hands, and began to write the report Mike had said was beautiful. The doctor joined him and said, “Now, tell me again how the man injured his mouth.” “Well, Doc, I don’t know exactly.” Only information pertinent to documentation was needed. “His teeth are poked through his lips!” The doctor’s voice rose ever so slightly. “Well, Doc, you know, on the way over here, he started flopping around in the back of the truck. He might have bit his lip, because he struck his face on the wall before I could stop him.” The saint had assigned a mechanism to the injury. “Oh, he bit his lip while acting a fool? OK!” The doc slapped the saint’s leg and told him to meet him outside for a smoke. The saint finished writing his report before he joined the doctor. “Well, at least you didn’t tell me he fell down the stairs.” The doctor laughed. “What, you haven’t seen the stairs inside the ambulance?” Ricky stood with his mouth open. “You should be more careful with your patients; hold onto them.”

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The Street Saint “Yeah, that’s why he walked into the emergency room, huh?” The doctor asked, but still smiled.“Doc, he was strapped onto the cot. I didn’t think the stairs could get him.” “The patient refused transport by cot; insisted on walking.” The saint lit a cigarette. “You got it all covered, don’t you?” The doctor asked. “Give me a light.” The doctor joined the medic with the prescribed cigarette. The saint looked in the doctor’s eyes and said, “I’ve got to Doc, I’ve got to.” CHAPTER 20. SO, YOU THOUGHT THAT WAS FUNNY? The saint’s radio called from his hip, “50!” The dispatcher seemed to know when the saint had a minute to enjoy himself. He enjoyed talking with the doctor; he enjoyed the cigarette and he had enjoyed seeing Ricky eat his heart out for not knowing how to join in their conversation. “50, go ahead, Dispatch.” The saint said and looked at the doc with a, “what now?” expression. “50, need you at 222 Gompers, two year can’t sleep.” Her voice said it wasn’t serious. “We may be back, Doc; got a two-year-old insomniac that needs an advanced life support ambulance.” “Insomnia reported from someone who can’t spell it, huh?” He tried to make Ricky laugh. Ricky, as usual, ignored any conversation with the saint, if he couldn’t argue. They didn’t run lights and sirens; in their “prejudice” they “assumed” that the call wasn’t life threatening. They only had two blocks to go anyway. “Hey, what’s happenin’?” The saint used a ghetto greeting with the young mother who lived in a government-subsidized apartment. The government’s new regulations about who lived there and under what conditions had brought about some drastic changes. Trash suddenly was being placed in dumpsters, food no longer ran down walls where roaches consumed the aftermath of meals; and he hadn’t run a “bug in the ear” call or “a child bitten by a rat” in years. Obviously, the residents were capable of taking care of themselves if it was explained that it would be to their benefit to comply. “Ma’am, I’m the paramedic and this is Ricky, my EMT. What seems to be the problem today?” He wouldn’t have normally introduced a subordinate that way, but Ricky deserved it.

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Chapter 20. So, you thought that was funny? “My baby won’t stop crying,” the mother said, while she led them to an upstairs bedroom. A strong smell of ammonia hit his nostrils. “How long has she been crying?” He asked, understanding already that the lack of a diaper change had caused the crying. “All night, and I cants sleep,” the mother said from the doorway. She wouldn’t enter the room. Psychologically and physically, she had distanced herself. Her body language, standing with her arms folded across her chest, told him that. The saint began a list of possible causes for the child’s irritation; leaving what his nose had told him for last. He questioned the mother while he patted the head of a three year old and watched a diapered two-year-old streak down the hallway. He noted another crib in the room and asked, “Where’s the other baby?” “She be sleeping in my bed.” “How old is this one?” He referred to the child that had prompted the 911 call. “Three months.” “Mind me asking how old you are?” “Nineteen,” she answered proudly. She obviously saw no problem being nineteen and having four children, three of them in diapers. Some of her “sisters” who had become nurses had told her that it was good that she had had her children young. He went back to his list of medical questions and her answers ruled out any possibility of any sickness requiring an ambulance. He knew what was wrong, but he asked the questions, hoping the mother would see that her baby wasn’t sick and that the problem lay elsewhere. By today’s standards, the questioning was a waste of time. If she wanted to be transported, the saint would have to oblige. “When was the last time the baby urinated or had a bowel movement?” the saint asked. He hoped his hint might tip the young mother to the fact that she hadn’t changed the diaper in a while. “Last night, I guess, she’s been crying all night and day.” Her answer was expected, but it still angered him. “Would you take her diaper off?” He couldn’t diagnose diaper rash, but he was a father of five and a grandfather of five more. If he couldn’t help from a paramedic’s standpoint, he could be a “dad” and do something worthwhile, since he was already there. Ricky shuffled uneasily behind the mother. Giving rides was his job; he wanted to get going.

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The Street Saint The mother removed the diaper and the strong urine odor grew even stronger. The saint expected to see signs of an ammonia burn but instead he saw yet another diaper. Instead of changing the diaper, the mother had put a dry one over a wet one. He asked her to remove the second one. When it was finally bare, he saw that the baby’s groin was red and angry looking. “I think your baby has diaper rash, but I’m not a doctor, so if you would like to go to the hospital I’ll give you a ride.” Ricky agreed and headed for the truck. He didn’t want to be around naked babies and definitely not ones that needed their diapers changed. His plan to expedite his scene time changed, though, when the saint said, “The nurses will question how the baby got that way.” He stopped for a minute, as if he were really trying to figure out a solution, and then said, “If it were my baby, I’d wash her well and use something that will help that heal.” He had over stepped his boundaries, but he believed and was supported legally, that his patient had to be informed of the treatment options. He had also prefaced his statement with, “ . . . and if it were my baby.” That statement was not a medical prescription, but an opinion. As a human being, he was entitled to an opinion. His information brought the young mother into the room as if he had given her a secret. This revelation had given her hope. The saint knew Ricky would disagree and Ricky proved it when he spun around at the head of the stairs. He stood there long enough to make sure the saint had seen his glare and then spun around again and ran down the steps. The “patient” didn’t need an emergency room and she didn’t need to go see a doctor; the baby needed to be cared for by Mom. It was true that the nurse could report the mother to family services. The mother immediately understood that. There was a time when he would have talked the mother into going to the ER. That was when he didn’t have anything better to do. But this was a maddening time for EMS and his service ran 200 calls a day. The call had nothing to do with medicine. The young mother was nice and was willing to accept a sensible solution to her problem. It made him feel good to help someone the way they needed to be helped and even better to stop one unnecessary trip to the hospital. “So, do you want us to give you a ride to the hospital, or would you rather stay here and take care of your baby?” The saint measured his words. The baby had already settled down and the irritation in its groin was drying. “Well, I’s gots some Vaseline here,” the mother started to explain her decision. Obviously, someone had taught her how to care for the child. It wasn’t unusual for a young mother to want a break from the responsibility of mother-

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Chapter 20. So, you thought that was funny? hood and maybe that’s all the call had been. She continued, “And momma lives across the projects. I coulds takes hers over dares and lets momma duz it.” The saint assumed the mother meant she would not be requesting transport. “Good, then we’ll be out of your hair.” The saint headed for his truck. He would tell Ricky what was going on only if he asked. “50, Dispatch.” Ricky could hear what was being said when the saint told the dispatcher; not before. Ricky had proved he had no intentions of functioning as a partner. “Go ahead, 50.” “Show us 10-8; public service.” (A “public service” call required no paperwork.) He started to hang up the microphone when the dispatcher interrupted his motion. “50!” He put the microphone back near his mouth and said, “Go ahead.” “Did you get a refusal?” The dispatcher’s squawk reminded him that his service could be paid for some refusals. The program was developed to assist services that were repeatedly called to assist people off of toilets or lift them out of the bathtub. In truth, the payment was instituted to stop unnecessary transportation of patients to the hospitals, just so the ambulance could be paid. It seemed the government had already made allowances for people to be serviced if they were honest and had asked for the help. It was those who listed medical complaints like, “my baby won’t stop crying,” that the paramedic could do nothing about. “Negative.” He hung up the mike and said out loud, “This is bull!” He should have wasted even more time taking a formal refusal per protocols, so he returned to the apartment to do the necessary paperwork. He had just barely recorded the child’s name when the phone rang. He didn’t think anything of it because ghetto people often called their whole family before calling the ambulance and they would call back while he was trying to load the patient. Often the family arrived before the ambulance and a caravan of cars would follow them to the emergency room. The mother answered the phone, listened for a few minutes, and then handed it to him. “It’s somebody aksins sumtin ’bout the ambliance.” She frowned from confusion; the saint understood. In a deep voice he said, “Haywo.” “This is the director of the ambulance service; why didn’t you take your baby to the hospital?” the boss asked, as if the parent had done something wrong. The saint knew what his boss was trying to do. No wonder the mother was confused.

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The Street Saint The sinner said, “Don’ need to go. My ol’ lady not be doin’ her stuff right. Ma baby done gots the diapers raff. I told dem pairmedkicks ma baby dun needs to be gwoin down to de hospital. My ol’ lady be cleaning her up now, da baby be fine.” He tried to imitate a young black male who thumped his chest and acted like the head of a family he had no intention of supporting. The girl laughed. His boss asked, “Did the paramedic tell you that you didn’t need to go?” The saint answered as naturally as if he had been asked what day it was. “No, man, he be real nice, but dat man ain’t go no sents, he be tryins to talk mize lady into goin’. I be tellin’ him no fuggin’ way, dawg. We be taken de baby to my granny’s.” “Oh,” the boss said. “Did you want to go to the hospital?” The sinner thought, doesn’t he ever give up? He continued with his charade. “Not no mo’, man. De baby she got de diaper rash and I told dat dare paramedic a yos dat de baby need ma granny, not yo mudder fuggin’ ambliance. You people be chargin’ too much to gits a ride.” The sinner was enjoying himself. He knew the boss couldn’t respond to his comment. Ricky was not present to hear the conversation, but the sinner suspected Ricky knew it was going to happen. The young mother laughed each time the saint spoke “Ebonics” and he rolled his eyes at her every time he did. “Did the paramedic tell you that you didn’t have to go?” The saint heard the boss’s pager sound in the background. “Never mind. Thank you, sir.” The phone went dead. “Sorry about that. But, the boss thinks we’re just truck drivers. You see, hon, that’s an $80,000 advanced life support ambulance out there. I’m not a doctor, and I’m not a taxi driver, but your baby has diaper rash. She doesn’t need the ambulance and she doesn’t need the hospital. You can buy something at the grocery store that will treat it.” The saint was perturbed by the conversation with the boss and knew the page had something to do with it. He knew that he would be talking to the boss soon and would have to cover the sinner’s performance. “But, I ain’t gots no money and dat dare stuffs aint on mize card.” The mother protested the saint’s suggestion, and he understood what she was saying. The saint wanted to give her a hand; but he knew that the money would be spent elsewhere and the mother would later take the child to the hospital for the free medicine anyway. The system forced mothers to the ER in an advance life support ambulance because they couldn’t afford Tylenol or children’s cough syrup; if only the medical card covered over-the-counter medications, the ordinary medicine that treated millions of children a year could have been used.

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Chapter 20. So, you thought that was funny? “You might want to wash her up real good and leave the diaper off and see if she’s better tomorrow.” He knew she’d call again tomorrow, but that would be another day and he wouldn’t be there. He completed the paperwork and went to the truck. “50, Dispatch.” He said into the microphone. “Go ahead 50.” “Show us 10-8, refusal signed.” He was ready for another call. The dispatcher acknowledged him and said that the boss wanted the saint to call him on his cellular. He wanted to cuss, but Ricky would have interpreted that as concern. Ricky sat in the truck and didn’t look his way, didn’t say anything. The saint knew his partner had double-crossed him. The saint dialed the number and the boss answered immediately. “Yeah, why didn’t you take that baby to the hospital?” The boss didn’t beat around the bush. “Her boyfriend said he’d take the kid.” “Did you tell them they didn’t need to go?” The boss was playing detective again. The saint hated it when he did that. If he had had the brains to be a detective, he would’ve made more money. There was no way for the boss to prove him wrong, so he said, “No, sir.” “You didn’t?” The boss was trying to set a trap. His jurist line of questioning was beginning to alert the sinner. It was the boss that was going to get snared. “No, sir.” The boss sprung what he thought was the trap, “They called me and said you said you were a doctor and they didn’t need to go. They’re talking lawsuit and I’m tired of you playing doctor. You’re a paramedic!” “That’s right, sir, I’m a paramedic.” Then he fired, but kept ammo in reserve. The saint knew his boss recorded all phone conversations, as most services did. So, if push came to shove, the saint could always demand to hear his accuser use the words the boss had just quoted. “They didn’t call you, sir. You called them. And, may I remind you that even though you are my boss, you’re still just an EMT?” “I did not call them,” the boss lied. “They called me. In fact, the baby’s father told me you’re an idiot!” “No, he didn’t,” the saint said casually.

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The Street Saint “How do you know?” the boss screamed. The boss had heard him return to service but didn’t know he had gone back to the apartment. “Who do you think you were talking to?” The sinner exploded back into the phone. Out of the corner of his eye he saw a frown appear on Ricky’s face. Ricky was the one who had set off the pager. “I know who I’m talking to! Don’t you give me any trouble, or you can go home!” The boss had made another threat he couldn’t fulfill. There weren’t enough medics to cover the calls as it was, and the other crews would go home if they had to do more work. The sinner was tired of the game, and took control of the conversation. “I be talkin’ like a fuggin’ dude in de ’hood anytime I’s pleze.” The boss knew he had been duped. Then he spoke as clearly and forcefully as he could. “I’m tired of people thinking that paramedics are nothing more than truck drivers. I transported 90% of your patients today that didn’t need to go. Yeah, I told those people that the baby had diaper rash and made it clear to them that it was from neglect. They know nurses aren’t stupid and if I had questioned the cause of that rash to the nurse, the nurse would have had them arrested. That’s when they decided they didn’t want to go. I should still report them for neglect.” “You’re job is to take them to the hospital.” Lowering his voice had worked. The boss had started to use his “meeting” voice in hopes of bringing the conversation back to a point where he felt secure. The sinner was not going to let an idiot control the conversation. He knew that if the boss’s anger escalated any more, he would put his foot in his mouth. “You know, I thought you paid me the big bucks to be a top-notch paramedic?” The medic was flabbergasted when the boss said, “No, I pay you to give people rides to the hospital.” He had basically admitted that the service was a fraud. Advanced life support was used only to enable them to charge more for some calls. “Fine, no problem,” the saint surrendered, “I’ll go back in the house and tell the mother she has to go to the hospital. That way, she can tell the nurse that she had called just to have her baby checked out but the paramedic insisted that she go to the hospital because the state was paying for it. I’m sure I can document that some way on the state form so that the state will know what we’re really in the business of doing. And, by the way, tell the next stoolie you put with me that I don’t admire a sneak.” He looked at Ricky to make sure that he had heard him. “I gotta go; I’m on the clock.” He hung up. He had said what he had to say and

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Chapter 21. Are we having fun yet? knew that his threat of reporting the obviously unethical practices of emergency medicine would stave off any more trouble from the boss. “50, Dispatch.” He switched communication devices while he pressed the “end” button on the cellular phone. “Go ahead, 50.” “Would you send my times on the refusal that I didn’t have to get from the 911 abuser?” He knew the boss was listening. If their battle were going to continue, it would be on the air and recorded. “You said it was a public service.” Her voice questioned the change in definitions. She too knew the boss was listening. “That’s right, I did. And then I went back into the apartment and got it, so the boss could get his ten bucks. Send me the times.” The sinner took the opportunity to explain how he could have been in the apartment when the boss had called on the telephone. The dispatcher interrupted him again. “50.” She called him back to duty. “Go ahead. I’m three reports down.” He hoped one of the other crews would show mercy and jump the call, but he knew they wouldn’t. “Need you to go to Adams Park PD, battery victim,” she said — and didn’t try to hide the exasperation in her voice, which told the saint that he was responding to something as ridiculous as the last three calls he had just completed. “10-4, show us en route.” The saint surrendered to the stupidity he had once called a profession. He didn’t say anything to Ricky. He would transport anything that claimed to be a patient from the P.D. CHAPTER 21. ARE WE HAVING FUN YET? One of the advances that EMS had fought for and won was to help make sure the police didn’t incarcerate people who were not unmindful of the law but who suffered medical problems instead. True, in today’s world, most people who acted weirdly were under the influence of something illegal, but “back in the day,” a diabetic easily could have been hauled off to jail by unsuspecting police officers who thought the diabetic was intoxicated. Trying to sleep off a bout of low blood sugar could result in a dead prisoner. Lawsuits, not the pleadings of saints, had forced police administrations to let medical professionals evaluate prisoners who either displayed bizarre behavior or said that they needed medical care.

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The Street Saint The owners of the private services saw another way to “buddy up” to officials and often that service was granted in hopes of gaining favor when other business was available. In some areas, the arresting department was held responsible for the prisoner’s bill. Those who enacted the policy hadn’t realized the potential for abuse — the criminal who claimed illness to stay out of jail. The policy granted prisoners the right to medical assessment, as it should. However, because the potential for abuse was not foreseen, the field practitioner could not offer resolutions that didn’t include transport. Repeat offenders learned quickly to complain so they would be transported to an emergency room. That tied up more police officers, who had to stay with the prisoner at the ER, and an ambulance that did the transport. It also was not ordered that prisoners be held responsible for their bills and that the bills be settled before court proceedings were closed. Therefore, the ambulance and the hospital were forced to accept the burden of treating an incarcerated individual with no possibility of recouping the expense. Some cities tried to handle the problem by hiring social workers and placed them in their booking areas, because most of the prisoners were afflicted with mental illness. But, when an emergency occurred, the social worker called the paramedics to handle it. Naturally, prisoners with psych histories cannot be housed in the city jail, so EMS had to transport them too. The resolution to the problem just created more problems, and created another position that made more money for doing next to nothing — other than calling the paramedic to do the job. The repeat offender learned to control the system. Again, the paramedic assumed more work. To stay out of jail, the prisoner only needed a diagnosis from a doctor who worked for government money. The prisoner waited for bail or slept off his pleasures in the emergency room, naturally after a standard of care had been followed. He would rather watch color TV in the hospital room. “We all must work together,” a supervisor once told the saint, after he had complained about the problem. The “we must all work together” meant the saint had to give rides and listen to the ER personnel complain at the receiving end. The professional who was ethically bound to save lives was again at the mercy of anyone who demanded special treatment. “Dispatch, show us out at Adams Park P.D.” Ricky had suddenly lost all interest in talking on the radio. It was as if he knew that the boss was listening. The way the dispatcher responded told the saint that she had been watching television and had forgotten about the call.

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Chapter 21. Are we having fun yet? Ricky quickly left the truck so he would be the first on the scene. He wanted the cops to think that he was in charge. Ricky knew that if the person had been seriously hurt, the ambulance would have been called to the scene. It was a chance to show the cops what a real paramedic was without worrying about having to be one. Ricky thought he was going to get to play medic and, much to Ricky’s surprise, the saint let him. “Hi, guys,” the saint said as he entered the room. “Hey, old man, they keeping you busy?” the cop asked. He was obviously more concerned with completing his report than the condition of the alleged patient. “Not bad, this is just the fourth one so far,” the saint answered, while he looked around for a patient. “Hey, that ain’t bad. What is it . . . nine o’clock?” “Yeah, not bad since we came on at eight. Haven’t checked my truck yet, but, what the hell? That’s for paramedics to do, right? We just drive the ambucab,” he said, straight-faced. Everyone understood. Any attempt, then, by Ricky to act as if he was actually on a call had ended. “Well, what have we got?” the saint changed the conversation. “Oh, we’ve got a domestic back here.” The sergeant said, after he rose to his feet. “She says she wants to go to the hospital, so you’d better — check her out.” The saint didn’t know why people said to check someone out, especially when they were in jail. Just open the cell so they can walk to the ambulance and he can give them a ride. The police knew the game, but playing the game also meant that they could delay the work that was associated with the arrest. They knew the emergency room would delay evaluation so long that the officers would be off duty before the prisoner returned. The sergeant grabbed the cell keys and the crewmembers followed him to the holding cell. The saint had already decided he wasn’t going to have any more discussions with the boss, but the sinner saw an opportunity to have a little fun. “Well, here she is. We went over to their house earlier and told her and her old man to settle down or they’d go to jail. They kept it up, found out County had a warrant for him, so he’s up there. We get her down here and then she says she needs stitches.” “Hi, I’m a paramedic; this is Ricky. He’s a real EMT and he’s going to check you out.” “What’s going on today?” Ricky asked. He sounded awkward.

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The Street Saint “I’s needs stichis. That mudder fugger sliced my face and these mudder fuggers says I gots to goes to jail. I know my mudder fuggin rights and I’s needs stichis!” The saint looked for a wound, from where he was standing, and couldn’t see one. The policeman had followed policy, and the saint had looked. That was all that was required. “Well, hon. Where do you need stitches?” The saint was sincere, but Ricky blinded the woman with the beam from his twelve-inch long flashlight. “What? You mudder fuggin blind too, honky? Don’t you see dat rights here?” She pointed to her left eyebrow. “Where?” The saint took out his flashlight, too. He ignored the insults. He was accustomed to people like her talking to him in that manner. One more outbreak, however, and the saint would tell the cop that she didn’t need a doctor. The boss couldn’t object if the police told the paramedic to leave, and most cops would listen to a paramedic they trusted. The cop would document that the prisoner was verbally abusive and refused treatment. He knew how to play the game, too. “Here!” She pointed. Finally, after the saint looked with his bifocals, he found a scratch that could have been made by a fingernail. He pointed it out to Ricky, who then said, “I saw it!” He knew once the injury had been acknowledged, she wouldn’t let him leave. All she needed was a bar of soap — easy money for the EMS service. The types of calls a medic is trained to handle don’t pay well. Dead men can’t pay bills. The easy call was the state-funded call and the saint couldn’t begrudge them the money. Money should have meant better supplies, and better pay, which would bring back good workers; if the money ever filtered down to them. Small emergency rooms cannot react within seconds like the major trauma centers, but they offer the personal touch because they aren’t slammed with patients 24 hours a day. In the trauma center, the impossible can sometimes be done by brilliant medical professionals, but the constant influx of non-emergent patients slows their pace to tedious, exhausting mediocrity. By now, the brilliant professionals have been forced to classify patients into two different categories: those who are dead and those who are bull. If the patients are dead, they stay dead, and if they are alive . . . they’re bull. Meanwhile, everyone complained about the long waits at emergency rooms, but failed to see that they themselves were part of the problem. If the injury is serious there is not an EMT, paramedic, nurse, or doctor that would not react accordingly. The public should know that they put everyone at risk by

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Chapter 21. Are we having fun yet? clogging up emergency services with cases that are not true emergencies. The staff is too busy writing prescriptions for over the counter medications to be concerned with a dead body. Sore throat, bellyaches, menstrual cramps, nervous conditions, scrapes, bruises, and fender bender liability claims have to be dealt with. A nurse with the credentials to work in a trauma center is “not qualified” to give out Tylenol. Yet when an HMO controls the purse strings, nurses can manage care over the phone. The saint used to save a life almost every time he responded on a call. Now, he filed a bill to be paid by the government for taking someone to the hospital who didn’t need to go. No legislature would propose changing the system, or even report the excess, because it would cost them votes: the elderly vote, and the minorities who make up so much of the urban community vote. The least hint at reducing services would be political suicide. Doctors once accepted chickens and produce as payment, and the EMS system put treatment first. Big business and a concern for the bottom line changed all that. Many doctors now brave medical school only for the financial rewards; if they went back to accepting payment in chickens, there would be a tremendous shortage of doctors and the fast food outlets would run out of “chicken fingers”. While the vast majority of ambulance and ER users do not, in fact, need professional intervention, the corporations that get paid for providing the unnecessary services are in very good health. And those corporations create the media story and convince the public that they are essential. On television, hospitals are well staffed and paramedics make grand, dramatic life-saving maneuvers all the time — and the public believes that service is available to them. The public doesn’t realize that by overburdening the system, they endanger their own lives. There was a time when a medic’s training taught him to suspect the unexpected when transporting a patient. Every headache could be a stroke, every chest pain — a heart attack, every woman’s belly pain — an ectopic pregnancy or a dissecting abdominal aortic aneurysm, every trauma — a potential spinal injury. But all those possibilities only lurked when patients called for an ambulance as a last resort. In the “old days,” symptoms often had to be ferreted out from the patients, because people didn’t want to be ill. Today they make up complaints to get more and faster attention; and many want to be “disabled” so they can receive an additional income from exaggerated claims.

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The Street Saint It took a metamorphic blow at the dawn of a new millennium to make the saint see the light. He wondered where the big stick would come from that would finally awaken a sleeping public. CHAPTER 22. HAPPY NEW YEAR He reported for duty just before midnight of the last day of the 20th century. He took nothing with him into the new millennium except the love of a woman he had met after his divorce and the love of his son, The Goob. The Goob never expected him to be around and his lover had learned he couldn’t be there on demand. He wouldn’t exactly be alone when the new millennium rang itself in, he would be with people who had exhibited bad behavior and with ER staffs that were only working to fill a contractual obligation and/or to earn extra pay by working on a holiday. He wore a back brace a workman’s comp doctor had prescribed for him. It made him move and look as though he was in constant pain. And he was. The doctor had reported to the insurance company that the saint’s back problem was congenital — the insurance company had paid for his non-biased opinion. The insurance company invested big money to not pay a settlement the saint had never asked for. The doctor said the medic needed no further treatment unless he wanted to have surgery to relieve the pain — pain that the doctor implied hadn’t existed. That must be why one orthopedist who specialized in honesty told the saint that there were almost a hundred thousand unnecessary spinal surgeries done each year and most of them had questionable results. His brace looked like a turtle’s shell. He had worn it long enough to elicit comments from his peers. Fellow workers called the brace his “sled” and said they were looking forward to the first snow so they could ride him down a hill. Then there was Geraldine, the boss’s sister and one of the dispatchers. The saint called her rude and the sinner had a glossary that he could use to describe her. “Rude” was the way she had been taught to show toughness. To her, tough meant professional. She used a voice that the sinner said could have scared small animals to death. “Can’t you wear that under your clothes?” she squawked, as soon as he came through the door. “No, I can’t.” The saint answered simply. “Why not?” She asked. “It looks stupid.” A conversation with Geraldine only ended after she had had the last word. “If you’re that hurt, go home!”

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Chapter 22. Happy New Year “I don’t take off work.” The saint said, hoping she and others would think of all the overtime hours he had worked because one of them wanted off; they didn’t react. “Geraldine,” he calmly began, “let me explain to you what was wrong with my spine.” He was interrupted again. “I don’t care what’s wrong with you. If you want to walk around looking stupid, go ahead!”“Well, Geraldine, you are the sad ignorant soul that is going to hear what is wrong with me.” “Are you calling me ignorant?” she laughed. The scene deteriorated, but none of his crewmembers paid any attention. One more spat between coworkers. Geraldine prepared to head out as the evening wore on, and the new dispatcher slipped into place. “Well, happy New Year, everyone!” Donnie said. “Now, if I understand right, we’re only responding on ‘life-threatening’ until after midnight, right?” Donnie knew better than anyone what the policy was; he just wanted to create a diversion and stop the squabbling. Harry, the saint’s partner for the night, walked in. Harry had a good-paying full-time job but worked almost a full time schedule on the ambulance. He was a decorated army veteran with a rough exterior that hid a compassionate soul. Harry’s sinner led his saint; Harry was more popular because of that approach. He was more entertaining. Bob, a new medic who didn’t need the income either, entered the room and gave the saint an unexpected three-man crew. Bob was one of the few new ones who had really wanted to learn. He said he did, anyway, but he had become daunted and frustrated in the face of all there was to learn, and the crushing responsibility. If you treat, and fail, the patient dies. He was beginning to follow in the wake of the meat haulers who scooped and ran for the hospital. It was much easier to follow than to follow the strict treatment modalities; it also helped him get along with the others better. They saw nothing wrong with the patient dying, unless their delay on a scene trying to “play doctor” could be blamed for it. Bob wanted to be good, but his conscientiousness had scared him to the point where he couldn’t function effectively. The saint was glad to see that a tough trustworthy medic and a new, strong, younger medic were going to share with him the first few hours of the new millennium, and the horrors that it would bring. Harry tried to break the tension with a joke, but the saint cut him off. “I don’t know, Harry, I’ve had a bad

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The Street Saint feeling all week. I think it’s going to be a bad night.” Then he turned to the third crewmember and said, “Bob, I didn’t know you were working tonight?” “I’m not; I came in for the ride; thought maybe I might learn something.” Bob’s dedication reminded him of how he had once been. They all had misgivings. The saint felt silly about it, but he prepared a roll of nickels with tape so he could use them as brass knuckles; Harry brought along the big flashlight that doubled as a billy-club. And Bob would leave the oxygen adjuncts behind, because oxygen was never brought to the scene in the hood. Havoc would rule in every corner of the city. Alcohol and drugs would trigger guns; the bullets would bury into bodies deserving and not. Drivers would speed the wrong way down highways, colliding with others who were equally influenced by the celebration of the night. The next rotation would see everything back to normal; tomorrow wouldn’t be New Year’s, and definitely not the overtouted new millennium. The phone rang and Donnie grabbed it. “Ambulance! Do you have an emergency?” This should be the last run card of the century. “What’s the problem?” He asked and then wrote again. The room was quiet for a change, while crew members let the dispatcher do his job. “How old was she?” Donnie had been on the phone too long for it to be a trauma call. They knew it was “just another ambulance run.” The adrenaline already began to subside, but if someone called just before New Year’s it had to be serious. Donnie finished taking the call and said, “OK. What are we going to do?” The saint was dumbfounded. “You know, it’s just about midnight, and there’s going to be shooting?” Donnie asked, but didn’t look at anyone in particular. The saint was aware of the threat of misguided bullets, but the battle with the boss’s sister had put him in a combative mood. “Oh, Jesus Christ! Where’s the call? Are we going to sit around here for half an hour wondering if someone is going to shoot a bullet in the air?” He pulled on his coat and ordered the crew into action before they had time to protest. “Bob, grab the back seat. You can do a check off en route. Harry let’s go! Donnie, where’s the call? If it was a shooting you and everyone here would have broken his neck to get to a truck.” “A church in the 8900 block of Church Drive,” Donnie told them. “There’s a 62-year-old female almost unconsciousness. I told her we’d get there as soon as we could.” Donnie had given him an excuse to respond slowly if he chose to. “That’s on the other side of town . . . where’s our north side unit?” They had a fifteen-minute estimated time to arrival; the other truck would have been there in about three.

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Chapter 22. Happy New Year “Everyone’s here. The boss didn’t want anyone on the street.” Donnie explained. That night, of all nights, they acted differently, dodging their responsibilities — when they ignored gunfire any other night of the year. Donnie added, “Besides, we’re just practicing for white people, right?” That kind of prejudice was based on facts. The proof lay in the dispatcher’s logbook. Call after call came from the same kind of people who added chest pain to the complaint of a boil or who waited three days with nothing more than a chest cold and then called at four o’clock in the morning for help. People added complaint of shortness of breath so they would be carried to the ambulance. They cried wolf, and the inevitable result occurred in those who were paid to respond; it was only natural. Frivolous calls slowed down the EMTs who had repeatedly been chastised for driving too fast; now they took their time, with cigarettes hanging from their mouths and music blaring on the radio. Now the rude and simple-minded called an ambulance to receive preferred treatment, including prompt attention in the ER because they had arrived by ambulance. Their actions made emergency room workers callous. These workers were considered “prejudiced,” also. He rarely saw patients leave the hospital with ice packs or even a wrap for an injured limb. A pillow was impossible to find and a blanket was a hoarded commodity. The pillow was once considered a thing of comfort and was used to attract customers. ER workers no longer cared about attracting more business and if the patient wanted to be comfortable, he could go home and crawl back into the recliner. State law required two pillows on an ambulance and the saint saw to it that requirement was met. He used them for splints, and said that if a patient really needed the ambulance, a pillow hampered treatment and could even compromise an airway. If the patient was so concerned with “special” treatment, ambulance transport was not needed. It wasn’t the color of skin that professionals reacted to; it was the selfishness of a group of people who demanded special treatment. In the inner city, the majority of patients were black; but the saint told similar stories about white patients from when he had worked in the country. For their repeated inappropriate actions, they were eventually treated in an inappropriate manner. Service cannot be refused, but a doctor didn’t have to order an ice pack; it was his prerogative. He can medically substantiate his decision and the hospitals say they can’t afford to give ice bags to everyone with an ache. The government did not reimburse for them; to give it to some and not others would be prejudice. If a

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The Street Saint pillow could not benefit a patient and may even hamper his condition, then what lawsuit could be filed because a blanket was not given — when a blanket interfered with diagnostic equipment required to evaluate a chest pain complaint? Bob followed the saint’s orders and got in the jump seat. Harry, even though a competent paramedic and in better physical condition than the saint, chose to drive. That left the saint to assume the responsibilities of the job that everyone sought but no one really wanted; the practicing paramedic. He lit a cigarette, as usual, and started his routine. He didn’t rush; he knew he had time. It was going to be a long ride.The saint understood Donnie’s comment. He had heard tapes of dispatchers who screamed at people who had called for help. The dispatchers had begun to make assumptions because the overwhelming majority of the calls they answered all reflected a selfish intention to take advantage of the service. The dispatchers’ attitude eventually caused unintentional errors and omissions. “What have we got?” Bob asked. “CFO,” the sinner answered, matter-of-factly. He knew Bob didn’t know what that meant and would have to ask. He wanted the make the crew laugh and loosen up a little. But he wanted them to have confidence in him, since he had thrown them into a situation that they had not wanted. One . . . . two . . . . three . . . he counted to himself while anticipating Bob’s question. “What’s a CFO?” Bob could be so predictable. “Church fall out.” The saint knew that Bob hadn’t learned the nicknames for people and events yet. “Gomer” . . . Get Out Of My Emergency Room. “Rolling raisins” referred to elderly, wrinkled, people transported for no emergent reason. “Gorked out” . . . people who no longer had any cognitive reasoning and stared at ceilings. A “vegetable” needed sunshine and watering and patients who “went snorkeling” were those who lived only by ventilator. The crew chuckled nervously when the saint explained what a CFO was. He knew that he had broken the tension and began the task of bringing the three paramedics together as a unit. “We’ve got a 62-year-old female going in and out of consciousness, in a church.” “Church, at midnight on New Year’s Eve?” Bob interjected. “Sure,” the saint deviated from relaying the call so he could bring the youngster up to par. Harry drove and nodded his head. “The older people have always brought the New Year in with God. Now, in this neighborhood, the thick brick walls, limited windows, and thick pews make a pretty good bunker.

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Chapter 22. Happy New Year They’re safe when the shooting starts. But they get pretty wound up in church, and poof, out they go — faint dead away; you know, ‘be fallin’ out.’” He finished up the explanation while he finished up adjusting his gloves. They were getting close. “You think that’s what we got, then?” Bob asked. He sounded a little disappointed. He thought he was responding on “something good.” “Yeah, it could be an attention getter; but she’s old enough. It could be diabetes, hypertension, heart, who knows?” The saint was reminding Bob that he should always be ready for anything and ought to consider all possibilities before he arrived. Harry maneuvered their truck through the cars full of people who were trying to get somewhere before midnight. He didn’t say much; that was unusual for him. Harry was concerned about the “celebration” that was about to begin. “51 Dispatch.” “Pull into the driveway, Harry,” the saint said before the dispatcher could answer, “they’re doing ambulance aerobics.” This was a reference to the people who jump around and wave their arms in front of the patient’s house, to attract the ambulance. The action wasn’t needed but it burned off some adrenaline for the person who was doing the jumping. Paramedics’ adrenaline would rise the first few times they saw someone doing that; it looked like something serious. But after a while they learned that it was usually just someone who wanted to get a family member to the hospital for the night so they could have the house to themselves. “Go ahead, 51,” Donnie answered. “We’re 23. That address is a church; we’ll be inside.” Always better to let ’em know where you are in case you need help. A church member met Bob as they hopped out of the truck, and the saint caught just the end of their exchange. “They’re with her now. She doesn’t look good.” That sounded ominous. The trio followed the man into the church. “OK. What did he say, Bob?” “I don’t know. I think it’s cardiac.” That jaw-dropped his senior team member. Bob, as a paramedic, had just received a report from the reporting party. The saint had followed him with no equipment, because Bob’s walking empty-handed into the church could only mean that he had concluded there was nothing seriously wrong. “The man said she’s been passing in and out, and looks pale.” The army of three was going into a battle of unknown intensity armed only with a pair of rubber gloves.

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The Street Saint “Any chest pain or palpitations?” “I don’t know, he just said she keeps passing out.” At the back of the church, a gathering of women stood and waited for them. CHAPTER 23. NEW YEAR, NEW MILLENNIUM. WHAT HAPPENED? They found the woman, pale and diaphoretic, in a wheel chair. He felt her wrist and estimated her pulse rate. It was quick, but not too fast, and regular. Her blood pressure felt fine. Medical professionals say that a blood pressure cannot be judged by feeling a pulse, but the saint often proved that wrong. “Is she a diabetic?” he asked. The largest percentage of medically unconscious patients have low blood sugar. The second largest group has high blood alcohol — which seemed doubtful in this case, but couldn’t be ruled out. The third most frequent cause was overdose from opiates, which again would remain a question in the back of his mind until he had alleviated other possibilities. A lady close to them said, “Yes.” “Are you related?” “She’s my Grandma.” She looked awfully old to be a granddaughter of a woman in her early sixties, but in that neighborhood a generation can be born every fifteen years. The patient probably had great-great grandchildren somewhere. The saint asked, “Does she take insulin?” While he waited for the answer he asked the patient, “Hon, can you hear me?” “Yes, she does,” the granddaughter said — and the patient nodded. Her head rolled from side to side when she nodded. “Did she eat supper?” he asked, while he turned the wheelchair and started for the door. Outside, gunfire could be heard. The new millennium had begun. The excitement of the night had done more than set off guns: no, the woman hadn’t eaten supper and she was heading for unconsciousness. She weighed about 250 pounds and they hadn’t brought the cot. All three paramedics knew better, but running too many calls where “patients” walked to the “ambucab” had caused them to omit the basics. They weren’t prepared to treat. Bob, who had said he thought it might be a cardiac situation, had brought nothing to treat the condition he had suspected. The saint had gone along with them because if he had stopped to gather equipment,

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Chapter 23. New year, new millennium. What happened? he would have lost his guide, and that really would have made him look stupid. They exited the door and the sound of automatic weapon fire filled the air. “Jesus,” Harry said. “I didn’t hear this much weapon fire in ’Nam.” He hurried ahead to get the cot out of the truck. Bob and the saint lifted the woman to the cot and then into the truck. “51 Dispatch,” Harry said, after climbing behind the wheel. The truck lunged forward. The saint hadn’t gotten vitals; the sirens blared. “Go ahead, 51.” “We’ve got gunfire in the area so we’re responding to the hospital, code 3.” Harry spun the ambulance around the corner. The centrifugal action threw the saint against the wall while Bob fell into the jump seat. “Harry, what the do you think you’re doing?” “Getting out of here!” “Bob, you asked about the EKG? Didn’t you suspect it to be cardiac? Wouldn’t you say that called for a monitor?” Bob would remember better next time if he was shown his error while still in the situation. “I’m going to get a line, if Harry’s driving will let me, and I want a blood sugar.” The saint tried to overcome the force of the accelerating ambulance that was already a mile or more away from the gunshots. The oxygen had done nothing to improve the woman’s pallor. “Diabetic and fat; this is going to be fun.” He let Bob know it wasn’t going to be an easy stick, and that was why he was going to do it. The only way to gain experience is by doing; but preferably not at the risk of letting a patient’s condition decline when experience can be gotten elsewhere. At the speed that Harry was driving, they’d be at the hospital in a flash and once there, her treatment would be delayed while the policies of registration were upheld. Also, even though the patient was in a serious condition, the new unofficial triage attitudes in the emergency room would determine that if she wasn’t dead yet, she wasn’t that serious. The personnel would be busy talking about how bad the night was going to be. So, he went ahead and found a small straight vein in the back of the woman’s hand and made the stick. He then fought the pounding from the potholed ghetto streets and threaded the 20-gauge catheter in to the vein. He withdrew the needle and handed it butt first to Bob. “Get me a D-stick with that and get the hospital on the line,” he said, while he taped the catheter in place. He pulled the D-50 from the cabinet. Bob handed him the radio. They were about three miles from the hospital. They had traveled eight miles in six minutes.

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The Street Saint The saint requested the appropriate intervention from the hospital and it was granted. He had to assemble the medical sugar, so he threw the mike at Bob so Bob could confirm the order. Harry turned the truck into the street one block before the emergency room entrance. The saint started to inject the medication, and listened to hear Bob parrot the order. Bob said, “Medical control disregard; we don’t have to do anything because we’re at the hospital!” “What?” The saint looked up in disbelief. “Clear 4 Charles 14,” the nurse said, with a question in her voice that embarrassed the saint. “If you think that’s best, disregard the order.” The nurse was gone. “We’re at the hospital; we don’t have to do anything!” Bob said with a truly innocent look on his face. Harry pulled open the back doors. “Let’s get her in there,” Harry said. The sound of fireworks that exploded over the city filled their ears. The flash of the millennium celebration back lighted Harry’s form against the night sky. “Will you slow down?” the saint asked. “You’re driving like a mad man. Do you think they followed us?” He then turned to Bob. “Who told you to disregard my order? We’ve got a patient that’s now unconscious . . . who’s going to treat her?” “The hospital,” Bob answered “Yeah, Doc, we don’t need to play anymore. Let’s get her in there,” Harry told the saint while he unlatched the cot and pulled the patient out from under the needle that was prepared to treat her. “All hell’s going to break loose and we’re going to be needed on a shooting.” Bad luck, lady. Now she would have to wait to be transferred to a hospital bed; that is, after they found a nurse who would take the time to find one for them. The woman would be registered and the registration clerk would be upset that the saint had wasted time doing something as silly as implementing advanced life support rather than searching the woman for identification; the nurse would eventually arrive and take the saint’s report. The nurse would have to make an assessment, which would include finding the ER’s glucometer, before she called the doctor who would assess the patient again before ordering the same medicine the saint had in his hands. The medicine would have to be retrieved from the Pixit cabinet while the patient’s blood sugar level would continue to fall, taking a number of brain cells with it. All the work that the saint had done in the ambulance was wasted except for the IV. The medication that had been in the saint’s hands had to be thrown away, because the hospital couldn’t accept the liability of its use. The boss

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Chapter 23. New year, new millennium. What happened? wasn’t going to be able to bill for it. The saint’s diagnosis was correct, but the hospital would have to go through its own routine to make sure. The patient had needed that treatment in the ambulance but Bob, new on the job, was afraid of “having” to do something and had disregarded his experienced colleague’s order. The saint dropped the medication into the “sharps” container and followed the other two medics into the hospital. The staff thought the medication had already been administered and were caught flat-footed. They didn’t say anything. How could they? A paramedic had deferred treatment to get the patient to a doctor faster. His delay, however, had cost the patient about 20 minutes; the exact reason medics had been created forty years before. He explained the situation to the nurse outside the patient’s room. She said it wasn’t a problem, but he insisted that it was. She was an “old fogey” too and understood his predicament; but with her years of service, she had learned to not make waves. With 500 times more patients admitted daily to the emergency room than she had handled 20 years before, there was no logical reason to increase her workload. “4 Charles 15, Medical Control.” The other ALS unit on duty was bringing in their first patient for the New Year. “4 Charles 15, go ahead.” “Code blue, we’re inbound with an approximate 50-year-old male. Patient’s family says he collapsed in their home and appeared to not be breathing. We have ACLS implemented and we have an ETA of about four minutes. Do you have any questions?” “No, 4 Charles 15, we’ll see you when you get here.” A simple report that told of the end of a man’s life. What wasn’t revealed was the flurry of treatment that had been instituted by “an ambulance driver” in the back of the truck. If he did his job, he would complete it, alone, in minutes. Most hospital would use five people and a lot more time to do the same thing. “Well, it looks like they’re starting out the New Year on a good note,” the saint said to Goldie, the middle-aged nurse he had been talking with. “Yeah, I heard once that the way you start the New Year was what you’re going to do all year.” The saint nodded and remembered how superstitious EMS people were. “Does that mean I’m going to spend a year with green medics overriding my orders?” he asked, trying to keep a sense of humor about what had upset him just moments before.

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The Street Saint “Oh, I don’t think you’ll let that happen,” she chuckled. Then she picked up the house phone and said, “Code blue ER. Code blue ER,” and hung up. The saint pulled out another pair of gloves and went out the door while he stretched them over his fingers. His paperwork was not completed, but he needed a cigarette and the incoming crew could use his help with the man they were trying to raise from the dead. CHAPTER 24. FOOL ME ONCE, SHAME ON YOU; FOOL ME TWICE, SHAME ON ME EMS was born to provide early intervention, and it has proved that prompt intervention can recover desperate cases. Only ignorance says dead is dead. In the days when emergency rooms were for emergencies, the sole purpose of EMS was saving lives. Practitioners were trained to stabilize the patient, not just run to the hospital. The saint had always reacted in seconds, and got his patient to the hospital in minutes. While he was required to explain why he had spent longer than ten minutes on a scene, hospitals often made his patient wait — and now the patient was often dead within the hour. Why expedite transport when there is nothing at the other end? Documentation has never been better. Most practitioners no longer look for subtle symptoms and are intimidated when others do. Those whose job it is to see to it that monies are collected appreciate the government-supported lowmaintenance customers: their bills aren’t reviewed and no insurance carrier questions them. Some of those people receive government support because of disabilities they can’t even identify. Corporations bilk the government and hide behind the notion that they are doing good. The pencil pusher keeps his job and no harm is done. Batteries of tests accompany a standard of care for the complaint that the patient said bothered them. To omit the testing allegedly could cost someone his life and even though the complaint was used to only expedite care no practitioner would assume the liability; administrators reminded them of the liabilities every chance they got. Is it really a surprise that experienced employees become frustrated when they were forced to repeatedly work on problems that don’t exist? Taking blood pressure and filing paperwork is easy work and highly paid, but it creates a conflict in the heart and mind of a medical professional. Patients that could be treated at home fill hospital beds needed by others; many hospitals seek out the repeat rehab customer. This over crowding forces paramedics to divert critical patients to more distant hospitals; and the media

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Chapter 24. Fool me once, shame on you; Fool me twice, shame on me blames the “ambulance driver.” News reports blare, “Victim Dies while Paramedic Drives Past Several Hospitals.” By playing along with this game, the saint occasionally found the opportunity to be a paramedic. He hid on the inner city streets when he could. He still “scanner jumped” good calls, not because they were “good for business” these days, but to avoid nuisance calls and to get a rush. Now, when a real call comes in, trauma and cardiac patients are met by ER physicians who were never trained for that role. How much difference that makes is hard to document, because reports of inept emergency care must come from a doctor. Even hospitals rated to provide the highest level of care are forced to have one nurse monitor a multitude of equipment. And that nurse is not necessarily the best. Visiting hours have been revised so that family members can provide some of the care and report changes in the patient’s condition. On the saint’s last trip to a level-one facility, the team at the triage desk delayed the admittance of a class-one trauma patient in order to complete some computer work, and they didn’t know how to take the patient’s blood pressure. The patient’s paperwork was lost and the medic was blamed. Another patient was waiting for a bed, but none was available because the staff would not change sheets. Situations like this are rarely rectified out of concern to provide proper care; the magic words, these days, include “customer service,” at best, and at worst, “her husband is a lawyer.” Many ER workers pride themselves on being able to flush out bogus complaints and most of the time they are right — even if their knowledge base is poor and their reasoning is wrong. The talent is out there, but it has been spread so thin that it has become ineffective. The present means of responding to the overload gives treatment to those who scream the loudest, while others go without. And professionals suffer, or leave the field. The solution is to triage patients in the field, as was done for decades, and transport them only if necessary. To do that, we would first have to release practitioners of undue liability and free them to use common sense to implement treatment protocols. This would ease the burden on the emergency rooms, and government budgets; and everyone would receive an appropriate level of care. Prejudice was going to have to be acknowledged and explained, so that its cause can be eliminated. The rules of the game have to change. Rides are not offered for doctors’ appointments, yet high-priced ambulances provide a 24hour-a-day service, on demand. Abuse of this system should not bring uniformed

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The Street Saint men who will take you anywhere you want to go; it should bring uniformed men to take you to jail. People should be expected to take care of themselves, to some minimal degree. Medicaid recipients should face the same restrictions as those who pay for insurance coverage. Today, Medicaid recipients often choose a doctor far away, so they can gain access to that area’s hospital. Obliging them to find a doctor closer to home would put more money into the local hospital; it would also free the ambulance quicker and keep it in its own district more often. Such regulations, however, might lose somebody an election. Who pays for all this excessive, yet no longer adequate, service? People who have insurance, for the most part working people, pay for their own medical coverage and they pay taxes to provide police, fire, and sometimes ambulance services for the community at large, as well; and they still have to pay whatever part of the bill their insurance does not cover. They are refused care on demand and often can’t choose their doctor — while those who don’t work, who live off the rest of society, are offered those privileges. In areas without a sufficient tax base, ambulance service is left to a private provider who has to try to stay solvent. If those who are guilty of making spurious calls for an ambulance were charged even a nominal fee, most of the inappropriate calls would be avoided. Sometimes, people with no insurance have bad luck with their doctors: they get pieces of paper rather than pills, and it’s a pain in the neck to have to go someplace else and pick up the free medicine. The ambulance can take you to a different hospital, where the doctor may not be so inconsiderate. The ambulance won’t give a ride to the doctor’s office, but in many cases offices and pharmacies are right next to the hospital so you can still get a free ride. Conversely, medics are frequently called from pay phones in ERs because a patient got tired of waiting for the free care. Doctors are quick to say that their patients are too sick to work and have to be seen every week, even though no medication is prescribed. Patients are told to seek treatment any time they don’t feel right — which generates a constant income for the doctor. No wonder the ambulance is called at the drop of a hat, and emergency treatment is requested. And follow up always accompanies discharge; follow ups can be done in the emergency room without an appointment. Many programs that used to assure necessary treatment for the indigent now kowtow to their every whim. Instead of creating a higher level of satisfaction, this has created a situation that leads patients to complain that people are

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Chapter 24. Fool me once, shame on you; Fool me twice, shame on me treated differently, and that medical people are prejudiced; and they’re right. Some patients need immediate help, and some don’t; the professional has grown tired of those who demand it unnecessarily. Still, doctors and nurses don’t mind seeing an abuser in the waiting room; they help ensure job security. The doors of the ambulance blew open and revealed the cardiac arrest. The medic breathed for the patient without benefit of an ET tube. Vomit ran down the sides of the patient’s face and pooled disgustingly on the cot. The man’s grotesquely large abdomen was an obvious sign that the endotracheal tube had been placed into the man’s stomach. It meant sure death. “Couldn’t get him tubed?” the saint asked. He didn’t want the ER to be the first to see. “I had it, but he threw it up with the chunks,” the young medic said, while he exited the truck with his patient. He had missed the obvious: the tube couldn’t have been expelled if it had been properly placed. The other medic’s partner, a supervisor named Ryan, assisted with the unloading. Neither of the senior medics said anything. Their silence permitted the young medic to believe that he had acted in an appropriate manner, but pointing out omissions or errors would have angered him. It was too late for the patient, so why bother? The saint would have intervened on scene, or even now if the patient had still had a chance, but it was already too late. The younger medic’s ghetto experience had already gotten him a job in a higher paid community and the saint wouldn’t have to tolerate his actions much longer. A trauma surgeon was grabbing a cigarette and acknowledged with a nod what the saint had seen. No one else saw the silent communication; they didn’t understand why the doctors stopped resuscitative efforts. Bob joined the saint while he walked to his truck and said, “You know, I think I’m going to ride with the other crew. You jump in too fast. Besides, I think we should get patients to a doctor. They already had one code and I want to learn from them.” Bob had missed the point. He could have helped stabilize a patient; the man the other crew had worked on was dead, but the code gave the rush Bob wanted. Reviving people from the dead is exciting but it happens far more often on television shows. In reality, it only happens about 20 per cent of the time. Most of those saves are cardiac arrests that are witnessed and dealt with immediately, and the resuscitation almost never happens if there is no bystander who can perform CPR. The American Heart Association says that if CPR is not started within two

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The Street Saint minutes and advanced life support is not implemented within four minutes, the patient stands less than a one per cent chance of walking out of the hospital. In the inner city, medical personnel usually are called in only after the person who found the patient has made numerous phone calls to friends and family members, and CPR is never done. Furthermore, bad habits, obesity, drugs and alcohol abuse adversely affect a person’s chance of surviving a cardiac arrest. For those reasons, the experienced paramedic only attempts resuscitation when he cannot sufficiently document that his efforts would be useless. In Bob’s case, the code would have served the practitioner, because of the rush, and the experience gained, more than it would have served the patient. A couple of weeks later, Bob worked his first arrest without the aid of another paramedic and he too erred in the placement of the tube. His patient had collapsed at a high school basketball game. The staff present knew CPR, but no one had performed it. There were two teams of players who could have carried the man and he had police for crowd control. Bob’s abilities could have been showcased and a man’s life could have been saved. Instead, Bob imitated many of his peers and opted for rushing to the truck instead of initiating treatment. He said he spared the students the trauma of seeing a code; maybe he thought watching a man die was better for them. Bob lacked confidence. He found it by imitating others who never realized the courage it took to wear the patch of a paramedic. The penetrating eyes of the crowd petrified Bob and he felt more comfortable taking the advice of his 30-year veteran EMT who was, of course, a perfect truck driver. They hadn’t taken advantage of potential help and had taken ten minutes to load. Ten minutes after the man’s brain had died, they made a break neck run for the hospital. The doctor pronounced the man from behind the desk. Bob was shattered when the staff told him he had belly-tubed the patient. Bob’s EMT couldn’t verify whether the tube was placed properly because he was alone in the back of the truck. The saint couldn’t support him because he was with a pregnant woman who had felt her unborn child kicking her bladder and called for advanced life support transport. By the time he was free, Bob had already started his dash to the hospital. The staff at the hospital liked Bob; he didn’t intimidate them. They documented his error for their own sake. His license should have been pulled for contributing to a death, but the mistake was blamed on inexperience . . . “Just a paramedic.” The family wasn’t told. Bob would soon run into something that would shake what little confidence he had.

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Chapter 24. Fool me once, shame on you; Fool me twice, shame on me The saint went on finishing the paperwork on the CFO woman that Bob had stopped him from treating. The staff had awakened her with the same medication he had been preparing to use, but it took them fifteen minutes longer. If the saint complained, they would say that he thought he was smarter than a doctor. Peers would say that it was the patient’s fault anyway, for not eating. Bottom line: the patient didn’t have grounds to sue, and the bill would be paid. That’s all that was important. Apparently, paramedics don’t have to treat, nowadays. Does that mean that the years of training and service are wasted? If paramedics had to explain why they hadn’t treated prior to ER arrival, “expediting” would not be an accepted excuse. But, if ER personnel acknowledged that they depended on the treatment instituted by the medic to assure patient survival, then they would have to admit that someone without a degree can do many of the things the hospital billed for and kept sacred. The paperwork was done, so Harry and the saint made their way through a crowd of people outside the waiting room who talked on cell phones, smoked cigarettes, and discussed the fireworks display. The crew recognized a young woman whom they knew had anxiety attacks and called regularly for help. The saint always told her that she was alright, and gave her a hug when she asked for one. The young medics who had transported her this time didn’t know her, and didn’t understand her reason for calling. They felt secure that they had done their best by giving her a ride. She lived about two blocks from their base and was waiting for a ride that probably wouldn’t come. She wanted to go home, since the triage nurse had told her that she didn’t need to be seen. Is it possible for a nurse to rule out a medical condition? Must be, it’s done all the time. He couldn’t fault the younger medics for transporting her; she had called and said she was short of breath. They did their job. Transporting patients with complaints that don’t really exist brings in money and avoids liability. Common sense would have indicated that the woman didn’t need an ambulance, but that was hardly the point. Harry asked the girl, “Hon, do you need a ride home?” The young woman thanked him and followed him to their truck. Harry climbed behind the wheel and then looked at the saint and asked, “You don’t mind, do you?” Kind of late to ask, he thought. “No, I don’t mind. But what about the boss?” “The boss!” Harry barked. “If we can give rides to the hospital when they don’t need it then we can give them rides home when they do.” He drove away.

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The Street Saint The smoke from fireworks and guns that had celebrated the New Year still hung in the air. The saint hated the idea of being a taxicab, but the woman was cute and gave good hugs. Besides, she respected him. After all, he thought, what could happen? They made pleasantries while they rode up the street where Steve and the saint had had their accident over a year before. That location always made him nervous; but it was a new year and time to bury the old. Besides, Harry was an older, more patient driver. Harry turned to cut across town on a little-traveled access ramp that took them quickly toward their remote base. Suddenly, they heard a police cruiser dispatched and the officer went on scene immediately. “He must’ve been in the parking lot.” Harry said. The saint had been watching the intersection as they approached. He turned and started to say, “Maybe he caused . . .” “!” Harry yelled and slammed on the breaks. The saint snapped his head back towards the once empty intersection and saw only a car’s rear window before he felt the impact. He slammed into the side of the truck, felt a sharp pain and heard a loud pop in his neck. His arms went limp and then, darkness. His first conscious thought was Harry. “Harry,” he called. “Harry?” He called louder. He started to panic and hollered as loud as he could, “HARRY!” No answer. His street instincts took over and he looked to the windshield in front of where Harry sat to see if he had been ejected. He tried to move, but felt excruciating pain when he did. His hands barely moved; he felt numb. He said aloud, to the empty vehicle: “I think I broke my neck!” He looked sideways, expecting to see Harry lying there, badly injured, but the seat was empty. Then he heard the girl moan. The pain kept him from moving. He watched the driver of the other car, a black male dressed entirely in black, crawl out the driver’s window. Now he saw Harry, standing in the middle of the dark ghetto street; his white shirt and skin glowed in the darkness. Harry was not alone, and should have known that his complexion endangered him. The saint wanted to go to him but he couldn’t move. He thought again of the warning signs he had ignored in the last accident. The desire to serve and the fear of being ridiculed had won that argument and outweighed his own responsibility to himself. This time, the sinner won out. The saint considered the woman who had trusted him; the woman whose panic attacks had always been eased by his kindness. She sounded hurt, and she

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Chapter 25. “I see,” said the blind man called again for his help. He, for the first time, thought of himself. He was not paralyzed, but his symptoms were obvious. Being a hero was not worth being in a wheelchair. Moving was too great a risk. Maybe he had changed after he realized he had been a fool for dedicating his life to those who didn’t really need him. Maybe he was ashamed for being used, while others raped his country’s finances. It took a smack in the head to get his attention; just like his father always said. Just now, it became clear that the EMS suddenly screamed louder to him than the woman in the truck who had called for his help. The future opened to him like a book that could be written without thought or fantasy. CHAPTER 25. “I SEE,” SAID THE BLIND MAN “Hey, are you with us?” Harry asked, from the driver’s side of the truck. “I thought you were thrown through the windshield,” the saint said, drunkenly. At least, he thought it was Harry; it looked like him. “I was running that mother down!” Harry looked again towards the man he had referred to. “I saw him crawling out of the window. They’re all drunk!” Harry pointed to the people who stood by the car that was welded to the front of their ambulance. The saint saw them through foggy eyes. He remembered the driver but he had no way of knowing who had been in the car. They shouted at the whiteys who were alone on the ghetto street. “Hey, come on man!” Harry responded to their taunts. “You want a piece of me?” Someone in the crowd had offended him. “Harry, stay in the truck; I can’t help.” The saint didn’t want trouble; the police were too busy to help them. “I don’t need your help,” Harry kept his eyes on the crowd. “I’ll kick these mother’s asses!” He said it loud enough for them to hear. “Harry, I can’t move my arms . . . my hands are numb. I think I broke my neck!” He hoped to awaken the medic in him so he would forget the fight, but Harry would rather fight. “I’m hurt!” The sound of the girl’s voice coming from the back of the truck tugged at the saint’s heart. How many times he had ruined good clothes and interrupted the all too rare family outings to help out in an emergency; this time, he had to be selfish. It was a new experience, though, and he felt guilty. “!$@! I forgot all about her!” Harry said. He opened the side doors; they sounded strange to the saint. He was usually the one who opened them.

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The Street Saint “Are you OK?” He heard the girl cry out, but he couldn’t make out what she said. “Let’s get you out here, on the ground.” Harry said. “We’ve got another ambulance coming and they’ll take you to the hospital.” She had taken a good jolt and the saint disagreed about moving her. Harry however, was preparing for reprisals and lawsuits. Without warning, the saint slipped into unconsciousness again and awoke to see another crew go to the people who stood around the car. He heard a lot of yelling and saw a lot of finger pointing. He saw veins protrude from necks and mouths contort. He saw a backboard on the cot and a medic point to it; someone lay down and then a C-collar was placed. The cot was wheeled away and brought back empty. The patient had been lifted to the squad bench and then abandoned — the usual treatment in the ghetto, where no help was available. Most patients aren’t really injured, so they don’t need monitoring. It was wrong, but unavoidable. “Did you see those mothers hiding booze behind those trees?” Harry was back at his side. “No, but I saw the driver climb out of the window. Then I saw you down the street. I guess I passed out again.” The saint’s pride and remnants of dedication prevented him from asking why he hadn’t been treated first. “Yeah man, the sons of bitches piled out of that car!” Harry didn’t even hear the rest of what he’d said. “The idiot over there tried to get away.” Harry was upset. “I chased him down the street . . . told him to stop. He said I was too old to catch him. I agreed — but told him I’d shoot his legs out from under him if he didn’t stop. He tried telling the cops some bull and the cop over there said, ‘Yeah right, you’re going to jail!’ You should’ve seen ’em! They dumped drugs down the storm drain!” Harry was all wound up. It suddenly occurred to the saint that Harry was not there to treat the sick and injured at all; he was there only for the rush and the confrontations. He relished his surroundings and was hoping for more combat. “I didn’t see any of that.” How could all of that happen in such a short period of time? “How long have we been here?” “Oh, I guess it’s been about twenty minutes now,” Harry said, looking at his watch. “The other crew has everyone packaged. All of them claim to have been in the car. Back pain!” “52 Dispatch.” They heard another one of their units check in. “Go ahead 52,” the dispatcher answered.

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Chapter 25. “I see,” said the blind man “We’re at 1100 Broadway. Show us 10-8; there’s no one here. Should we respond to the 10-50 involving our unit?” Steve was driving and wanted to help. On board was the service’s only female paramedic. By her credentials, it looked as if the saint was going to be in good, caring hands. “Negative 52. Go to 562 North 13th. We have an assault victim there. PD on scene requests that we expedite.” Policemen want medics to hurry when there’s blood or they want to get someone off the scene. It rarely was an honest appraisal of a patient’s condition. “What about the 10-50?” Steve asked. The tone of his voice asked ‘what about one of our own?’ He hinted at mutual aiding the other call but Steve’s common sense wasn’t shared with the supervisors. “The supervisor says our crew isn’t hurt and is just requesting transport.” Where did they get that from? Harry hadn’t said anything to them. Either the other crew had said something, or he used the title to rid his desk of the hanging call. He decided to have the call that would draw the most heat handled first. Others on the scene yelled and ranted to get attention. The saint lay quietly injured. Considering his options, and the cute female paramedic who would be coming, he opted to wait. Medically, the saint rationalized; spinal injuries are low on the triage scale. His loss of consciousness, however, should have made him a priority. Obviously, no one had considered that; but how could they, since no one had assessed him? “How’s the girl?” the saint asked. Apparently, she wasn’t going to be treated either. “She’s OK.” Harry said. “I told her to say she was walking down the street and the ambulance hit her when it spun.” The saint thought their unit had broadsided the other car, but the other car had actually barreled into the intersection and struck them on the passenger front. The impact had spun their ambulance 90 degrees and had thrown the saint against the truck’s side. If one of the service’s younger, more aggressive drivers had been driving, they would have entered the intersection faster and the ’98 Cadillac would have hit them square in the saint’s door. “You know,” Harry brought the saint back. He talked to him between outbursts on the scene. “If the boss finds out she was in the truck, we’re going to be in deep doo doo! How are you doing?” Harry asked — but didn’t wait for an answer. “The other truck should be here in a minute.” Harry was just making conversation. “I don’t know, Bud,” the saint said. “I don’t feel my hands.”

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The Street Saint “Oh, you’ll be OK!” Harry quickly added. He knew what the symptoms meant. Ether he was keeping the saint calm or didn’t want to consider the ramifications. “I think you just rattled your brains some; maybe knocked some sense into you.” Not much of a joke but a pretty good guess, in fact. The saint was forced to reflect. Had all his actions been the living definition of dedication? Or stupidity? He sat and waited for help, and wondered what his future would be. CHAPTER 26. WHO YOU CALLIN’ A FOOL? “A physician who treats himself has a fool for a patient.” — Socrates What if the patient has a fool for a doctor? Any other weekend, the trauma surgeon who had befriended the saint would have been on duty, but he had elected to work Christmas so he could take off on New Year’s to go skiing with his sons. The doctor who was on duty his stead was one whose ideas on emergency work matched nothing the saint had ever learned, although he was certified by several nationally-recognized organizations. The saint had seen him pronounce people dead who still had a blood pressure and a pulse; the doctor had harangued the saint for instituting prescribed treatments. He had arrived in this country on a special visa to help alleviate the shortage of doctors. Unfortunately, he didn’t know the inflections or slang of the city, and apparently didn’t understand his patients. The nurses could not understand him, and others including the saint never knew if he understood them. If bad handwriting is the cause of the majority of errors connected with medical negligence, how many errors come about from not understanding the spoken word? Perhaps the saint should request transport to another facility, but that would have repercussions. Maybe if the doctor diagnosed a problem, he could request a transfer to a hospital where real doctors worked, on the grounds that it would be a lot closer to home. In the meantime, a paramedic with good credentials would treat him, even though a green EMT could have facilitated his transport. Loading him wouldn’t be difficult. Since the “weaker sex” had started working the ambulance, “one and a half man cots” were brought into use: Steve would lift the foot end while Ann lifted the wheels, sans the saint’s weight. Once inside, Ann would complete her assessment. Steve would enter through the side

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Chapter 26. Who you callin’ a fool? and complete the treatment basics. He trusted Ann’s competence to quickly spot his neurological deficit and loss of consciousness. She would free his left arm, take vital signs, and institute ALS care while Steve drove with lights and sirens. He tried to stay conscious, but he couldn’t keep his eyes open. He tried to focus close up and then far away. He couldn’t. He went on to assess himself with the rational mind of a paramedic. He remembered various people he had found with a fractured vertebra who had gone on to live on without consequence. He decided that the worst thing he could do would be to move, so he tried to sit still. He listened to the siren of the inbound unit that was still blocks away, and began to understand why the people he rescued felt relieved, at first, when they heard him coming but then became aggravated when he didn’t arrive within seconds. The sirens echoed though the hushed city and seemed close at hand; yet the ambulance still didn’t arrive. He had waited so long that his feet had fallen asleep. He didn’t know if the tingling was from not moving them for 28 minutes, or if the condition in his lower spine had worsened. He warned himself, “They’ve been on several bull runs and someone has told them this is bull . . . just let them know.” “I’m not going to treat him!” Ann shrieked from somewhere outside, behind him. “What do you mean, you’re not going to treat him?” someone asked. He didn’t recognize the voice because it was angry. “I’m not! This is bull . . . everything I do is bull! Tell that fat son-of-a-bitch he can walk to the truck. I ain’t treating him!” Her shrill voice faded as she walked away. She had entered the other ambulance, hoping to find a “real” patient. His door opened. It was Steve. “Hey, you old fogey! What are you doing sleeping while the rest of us are busting butt?” “I don’t know, Bud.” The saint was confused. The blow to his head made Ann’s outburst hard to comprehend. Maybe she was talking about one of the drunks in the car. “I think I did it this time.” Really, how could he get them to take this seriously? “Why aren’t you wearing your glasses?” Steve asked. Ah. That would explain, at least partially, why his vision was blurred; of course, not realizing that his glasses had fallen off was a sign of a brain that wasn’t functioning properly.Steve found the glasses and started to hand them to

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The Street Saint the saint. Taking a closer look at his face, Steve’s smile disappeared. “What’s wrong?” He looked worried. “I think I may have broken my neck, Steve. My neck hurts, the back of my head is killing me, and my hands feel like ice. I can’t grip. I was unconscious for I don’t know how long and I keep slipping in and out. That’s why I’m still in here.” Steve knew how much pain the saint could endure; he would not be one to suggest he was faking it. The saint went on to explain that Harry had been trying to start a fight; and abandoned his principles and told Steve Harry’s story of how the girl might have been struck when the ambulance spun. “Hey, no problem.” Steve said. “You just sit still and I’m going to get a Ccollar. Ann’s here and we’ll get you to the hospital.” Steve switched the subject to one less tense. “If you didn’t want to work tonight you could have just said so; you didn’t have to wreck a truck.” Steve placed his hand on the saint’s shoulder. “All I know is, you guys should start getting hit on your side of the truck. This is getting old.” The saint’s humor wasn’t hurt but he closed his eyes and didn’t see Steve’s reaction. Steve’s voice appeared louder than usual, and woke him from his daze. “Here you go . . . let me get this on you.” Nice touch the kid has, the saint thought. He wondered where Ann was; he wanted to list his symptoms before he lost consciousness again. Maybe Ann was letting Steve do the basic work before she intervened; maybe she was tending to the girl. “Ann, he’s ready to come out!” Steve called to her. “Ann, do you want to get the end of the board up here, he’s ready to come out?” Steve called to her again; that time with a bite in his voice. “Well, tell him to get out! I’m not lifting him!” “Whoa!” Thought the saint. Maybe she doesn’t know what I told Steve. “He’s hurt, Ann; he needs your help!” Steve insisted. The tone of his voice wasn’t as nice as the words he had used. “Bull! Tell him to get his fat ass out of the truck if he wants to go to the hospital. All I’ve done all night is run bull! This workman’s comp bull stinks!” “Get off it, Ann! get over here and at least act like a paramedic!” “I’m the paramedic and I give the orders!” Ann screamed. “Well, then tell me to do something!” Steve screamed back. “Don’t stand there like you’re stoned. How many of those pills did you pop, anyway?” Steve asked, while trying to place the board under the saint single-handedly. The saint thought about getting out on his own; he was in a cloud.

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Chapter 26. Who you callin’ a fool? The next thing he knew he was on the backboard. Ann snapped the foot straps. Steve tried to fasten the ones across the saint’s stomach and chest but they lacked connecting by about ten inches. “Bud, you’d better lose some weight,” Steve chuckled. “Those are foot straps.” The saint said. “They aren’t the right ones; you see how often we cot people. Let it go, I won’t fall off.” He could answer questions half asleep so why not half conscious? He hadn’t seen Ann earlier, and he had discounted the rumors that when she was “in one of her moods,” she would “pop pills.” She was high strung; he assumed she was just taking Midol or Tylenol. She was having marital problems and her husband had become abusive; she didn’t trust her male coworkers to support her, and thought they would side with her husband. Now she had snapped. The same doctor who called the saint stupid had prescribed a double dose of anti-psychotics for Ann, and she had had an adverse reaction. When she felt strange, she took another double dose. That produced the schizophrenia that was then alone with the saint in the back of the truck. The bright lights hurt his eyes. “Don’t tell me how to do my job!” Ann was hysterical. “Welcome to EMS, hon.” The saint hoped his cool head would help. “It ain’t like this everywhere!” Ann yelled at him, but not as viciously as she had at Steve. “Where have you worked?” the saint asked. “51, Dispatch.” Steve was outside talking on the portable, but his voice came through on the on-board radio. The dispatcher answered, “Go ahead, 51.” “We’re going to be en route to the hospital in a minute. Call a supervisor and get me another medic. Ann’s crazy.” Not over the radio, Steve! The saint didn’t like people going behind someone’s back, and like it or not, Ann was a paramedic and Steve was an EMT. Then again, Steve had tried to talk to Ann. Ann balanced herself on the saint’s chest with her knee and dove for the microphone. “51, Dispatch.” Good thing she was petite. She shifted her weight back into the middle of his chest. “Go ahead, 51. I have the supervisor on public service.”

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The Street Saint “Disregard that last request!” Ann said. “Get me a new driver! Steve is relieved; he won’t listen to me!” The saint heard tears come into Ann’s voice. “The supervisor wants to know if you can get our guy to the hospital?” Donnie asked. “If Steve can drive, we can.” Ann answered. She suddenly calmed down when she knew that the boss was listening. She added, “Tell the supervisor Steve’s not listening to me and he’s telling me what to do. I’m not going to take it! Everyone thinks I’m stupid because I’m a girl! They should all be fired and I’ll hire people who will listen to me!” This time she had played the sexual prejudice trump card. But people didn’t listen to any experienced paramedic, even big and mean ones. He didn’t blame others ignorance and ego on age. But Steve had shut off the radio as soon as Ann said they’d be leaving for the hospital. Ann was already busying herself for review: no one was going to say she had neglected her duties. Even in a manic phase, a medical professional will eventually get around to documentation. After a cold rush of air and the hiss of oxygen, she got the mask on the saint; but his vital statistics would be made up. He felt his turtleneck move and the cold of electrodes placed on him — wrongly, but placed. That’s all that was needed for an ALS bill. There was no other reason for assessment: she believed it was bull, and was only sixteen blocks from the hospital. Her treatment fit well the modalities of the day. He felt the lights go brighter and heard Bob say, “Well ol’ man, you’re either dead or can work lying down!” “Did you ride in with me?” the saint asked as he was being pulled from the truck. “Who did you think attended? You know, you’re a hard stick?” Bob asked. “Have I got a line” Had he been unconscious again? “Nah, I’m messing with you.” Bob laughed. “Ann brought you in. You’re too big and ugly for me.” The saint thought of Carl, and smiled. He felt warmth on his face again and knew that he had entered the hospital. Steve was by his side. “What’s wrong with him?” a nurse asked. Steve gave the report that Ann should have. The nurse said, through a tight smile, “Is that right? That sounds good to a lawyer, doesn’t it?” She heard neck pain and car wreck. She ignored the observations of a good EMT, the veteran paramedic’s complaints, and the mechanism he had reported. “Yeah,” the saint took over. “I felt it pop.”

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Chapter 26. Who you callin’ a fool? “OK-let’s-get-you-in-a-room-and-registered,” she muttered, concentrating on her priorities: bed and registration. Paramedics concentrate on level of consciousness, airway, breathing and circulation. He was lifted to the gurney, but didn’t remember being pushed to the room. “Here, sign this so we can treat you.” He dropped the pen twice before he managed to sign his name. He then heard a commotion in the emergency room. It was still Friday night and New Year’s Eve. A cardiac arrest had just been worked and family members were arriving. A total of five people had been transported from his wreck and four of them were drunk or high, and had become argumentative. Naturally, they would be seen first. Under the circumstances, the boisterous surroundings were really not that unusual. “Zo vots gorin on hare?” Doctor Goatee asked, when he entered the room. At least he was a doctor who could order X-rays and sign a transfer sheet. He decided to tell his symptoms, so he could then be transferred. The only difficulty the saint foresaw was whether or not the doctor could understand English. He painted a perfect picture of a cervical and a closed-head injury. “Oh, I zee,” the doctor said, while he undid the cervical collar Steve had so carefully placed. Goatee grabbed the top of the saint’s head and rocked it back and forth while he asked, “Duz dis hurt?” He considered grabbing the doctor and giving him as much pain as he was inflicting. “Yeah, that hurts!” he cried, squinting in pain. The doctor pressed on his shoulder muscles at the medial aspect of his left shoulder and said, “Duz dis hurt?” “No Doc, not there, it hurts at the base of my skull, around C3, maybe C2. I’m telling you, I think I broke something. I can hardly squeeze my hands and they feel cold.” His stomach churned with fear, disgust, anger, and nausea from the concussion the doctor had ignored. “Letz have zum X-rays of heez neck,” he told the young male nurse. His voice was almost drowned out by the shouting in the hall. The voices awakened the toddler next door, whose cries joined the malaise. Meanwhile, Ann and Steve were continuing their discussion in the EMS office. “What’s wrong with you?” Steve asked. “You didn’t even give a report to the nurse. He’s in there half out of it trying to describe his injuries. Either you’re going home, or I am!”

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The Street Saint Steve reached for the phone. He was more mature and more intelligent than the usual EMT these days. Ann lost all control and lunged forward, grabbed the phone and ripped it from the wall. She picked up a chair and threw it at Steve, while she screamed something that Steve would later describe as the howl of a wounded animal; maybe a mad woman. Ryan came through the door and the chair barely missed both men before it crashed into the door. Ryan’s sinner, nicknamed “the screamer” by the crews, had a saint also, if one looked deeply. Ryan had his own personal problems, but he also had intelligence. His screaming on scenes actually fit the neighborhood where they worked. “You want to see crazy?” he screamed at Ann, “I’ll show you crazy!” Ryan slipped into the act that he used with unruly psychiatric patients. “Don’t make me crazy! You won’t like me crazy! You can’t hurt me! . . . I’m insane! Now you want to get crazy with me? You only take medicine — I’m certifiable.” It worked with the psych patients, and no one minded — the patients put on an act and got a ride to the hospital where they could get their disability check. The boss got paid. The screamer made redundancy of medicine in the ER less boring. Policies, procedures, regulations, and professionalism weren’t needed; they were for upper class white people in a different world. The young medics loved it; they could understand it. They could do it; obviously all great medics acted that way. But Ann didn’t back down, despite the distraction. “Bitch, you’re crazy. If you were a man I’d go APE and kill you!” His eyes bulged, his hands pumped. Ann was used to being able to attack men, and still depend on honorable ones to not hit back. But Ryan’s words and his reputation had gotten her attention. “Now, what’s going on here?” he screamed. When Ann showed she had calmed a little, he allowed himself to relax somewhat and started to sound almost like a man the boss would have left in command while the regular supervisors celebrated. Meanwhile, the staff readied the saint for X-ray. The young nurse said, “I think your uniform has a lot of metal in it, so why don’t you get off the board and put this on?” The nurse held out the gown. The saint surrendered. He knew that he was not being treated correctly; he felt stupid. Did they really know so much that they could tell nothing was wrong with him? When someone gave the symptoms that he had given, he had always protected the spine, just as Steve had done, until the X-rays had been read.

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Chapter 26. Who you callin’ a fool? “You know what, Bud?” The saint stood and deliberately unsnapped his brace. He had tolerated enough negligence and disrespect. The nurse thought he was going to get a tongue lashing and was surprised when the saint said, “I like the way you work; I’ve watched you. You seem concerned and you don’t care if patients are drunk, shot by cops, or if they just killed a family in a drunken stupor. You care, and you work really hard.” “Thanks.” He was a little flustered. “But, I’m warning you,” the saint switched subjects. “Document how you told the doctor my signs and symptoms. That man,” he said, pointing in the direction of the doctor, “is a complete idiot. If I have a fracture, I’m going to sue him, you, and this hospital.” The nurse’s jaw dropped. “I’ll only release Goatee’s malpractice carrier if they take away his license. I’m tired of it!” The vanquished saint tossed his shirt and then his turtleneck on top of the brace. Incredibly, the nurse said, “You know, I used to think he was an idiot, but I’ve watched him work and, you know, he’s always right? He’s amazing.” “Son,” the saint emphasized his seniority, “how long have you been a nurse, and where have you worked?” It was too late to retract the compliment he had given. “Well, I’ve been a RN for six months and a tech for ten years before that. At a nursing home. And I volunteered some time in a small hospital’s emergency room.” “You know, I used to tech at one of the world’s top ten trauma centers.” “Yeah, I heard that; and they paid you as much as a nurse.” “Sure did. It was my years on the street that got me the money, not a piece of paper.” Not a nurse’s degree. “I still take patients in there from here on transfers, you know?” “Yeah, we sent one with you the last time we worked together.” The nurse tied the gown at the back of the saint’s neck. “Well, they repeatedly ask me when I’m going to do something about this hospital and every time they hear Goatee’s name they say, ‘complete idiot.’ Be careful whom you qualify as ‘good’ until you’ve seen better. Does any of this look right, to you? Were you taught this in school?” The nurse shook his head. “Were you told to move trauma patients, at the nursing home?” The nurse again shook his head “no.” “Did you ever wonder why you never see a patient here go to X-ray with a cervical collar in place? Have you ever gone to the level one with a patient and

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The Street Saint watched the receiving physician maintain manual stabilization while the nurse placed a C-collar?” The nurse said, “No, I’ve never been there.” He went on. “I know you know better, so keep this in mind . . . you’re following a doctor’s orders, but if you go along, you’re liable too.” The nurse replied, “I’m really confused. Nothing is done here the way I think it needs to be, except for the documentation. I don’t know what to do . . . I’m following orders, but I don’t feel comfortable with it.” The saint was relieved to hear that; but his head throbbed and his neck hurt horribly. And he couldn’t shut out the beeping of the alarm that sounded constantly on the other side of the curtain — a change in the condition of a baby that lay in the next alcove. CHAPTER 27. OUT OF THE MOUTHS OF BABES . . . The baby cried. The alarm rang its irritating warning. The parents waited. The saint had been dreaming while waiting for X ray, but the alarm sounded again and awakened him. The damn thing was annoying. The warnings were usually false, so the staff didn’t respond. They knew that if the child had taken a turn for the worse, the parents wouldn’t have waited. He couldn’t get up and shut off the alarm; and the curtain prevented his getting someone’s attention. The mother next door thought something was being done because equipment had been attached to her baby’s body. It even appeared to her to be a lot to go through just for free Tylenol. Paramedics in cash-flush locales had such equipment; the saints that ran a couple calls an hour in the ghetto did things the hard way. There was nothing seriously wrong with the baby; only with the system. He watched for Nike shoes to pass under the curtain, the shoes of nurses and doctors. The alarm had been ignored because acknowledging it might invite questions that the nurse would be loath to answer. “The results aren’t back. It isn’t ordered STAT because the baby was not an emergency.” “The doctor was here, but he’s napping. He’ll see all the patients when all the results are in.” “The best thing to do is to take your kids home and care for them the way a mother should.” And, “No, we’re not going to baby sit your kid so you can have the night off. You should’ve thought of that before getting pregnant at fourteen.” Truthful answers, but not good business answers. Administration would be very upset if

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Chapter 27. Out of the mouths of babes . . . the non-emergent patient were to walk out and never return. The saint had heard such answers given by overly-stressed staff members whose tenure was coming to an end. “Nurse?” The saint called to a pair of tennis shoes. They didn’t stop. His room was next to the break room and close to the emergency room entrance that smokers used. It was safe, because paramedics and security were close by. The shoes he called to may have belonged to anyone. Or, they may have belonged to a nurse not assigned to his care. Now Ryan was on the phone with a supervisor. “She’s nuts, that’s what’s wrong with her!” He had professionally explained Ann’s condition to the best of his ability. “She pulled the phone out of the damn wall and threw a chair at me! I just brought in a full arrest . . . Happy New Year! We’ve got a truck down. One medic’s hurt and the other one wants to make sure the damn driver goes to jail. Steve refuses to work with Ann, and the bitch needs to be off the street! I’m the only truck on the street and it’s not quite 2:00 and the partying is still going heavy! That’s it! I’m going to tell my partner to grab his back and act like he’s hurt while I go nuts! Everyone knows I’m crazy! I’m going home! I ain’t going to try to handle all this by myself!” His eloquent speech had pretty well summed up the situation. Ann was outside with Goldie, a good RN and former field nurse. “They hate me!” Ann screamed. “What makes you think that?” Goldie asked. “They always stop talking when I enter a room. They jump emergency calls. They kid me because I can’t lift and they say I’m going to get hurt. They don’t like me! My husband chokes me when he gets mad and he hasn’t touched me any other way in six weeks. My Dad wants to kill him. Both of them want me to quit nursing school. It’s New Year’s Eve and I’ve run my butt off on stupid battery cases and this alleged wreck. They hate me and I’m tired of them! If they’d just let me, I’d show them that I’m good!” She was so angry she had to scream to push her words through her uncontrolled tears. She let herself go and dumped everything on Goldie. “Yeah, Goldie’s outside talking to her now,” said Ryan, just on the other side of the wall from Goldie and Ann. “Yeah, right!” Ryan the screamer responded when the boss suggested Ann be committed. “Put that little white girl upstairs with the ‘boys’!? There ain’t enough tranquilizers in the world to make that safe. She’d look like a piece of hamburger by morning.”

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The Street Saint Meanwhile, Goldie tried to quiet Ann by making her see that her situation was no different from that of any other employee working there, regardless of gender. “Ann, what types of calls were there tonight?” “Well, there was a code. I could’ve done that, but I was on a battery call. They (the saint’s crew) had something they called for orders for, but the patient didn’t need anything — he’s always playing doctor — Then I had a drunk down on the street; he didn’t go. And then some bitch who was popped upside the head with a bottle that didn’t want to go, and then that damn wreck. I had to bring that big son-of-a-bitch in. I ain’t picking him up, I could’ve been hurt.” “So, if another crew had been up next, they would have had to take that call, right?” Goldie asked. “Yeah, they had a call. It was my turn.” Ann answered, after she thought about the chronological order of things. “While you two were tied up,” Goldie continued, “the crew just coming on got sent to the other side of town and handled the hypoglycemic patient. Right? And by the way, the first thing we did with her was to push the D-50. We didn’t understand why he didn’t do it when he had the order. It was called for, and appropriate, in or out of the hospital.” Goldie approved the saint’s actions and made it clear that the young medic should have kept his mouth shut. Then she continued, “But they were up, and no one else was available, right?” Ann liked being upset better than being reasonable. “I’m not going to take it from them any more! They don’t jump simple calls — they want to be the big stinking heroes, while I run around taking care of sick babies and other stuff that doesn’t need a doctor or an ambulance!” “So,” Goldie tried to clarify, “you’re saying you’ve never worked anything bad?” “When I’m closest, they can’t send another rig, but everyone busts over to help. They think I can’t do it! I’ve heard them say so.” Ann kept herself pumped. “Do they say you don’t know what you’re doing? Is that it? I’ve never heard them say that. I’ve heard them say they helped you because your male partner said the patient was large.” Goldie knew how to handle this petite woman of the ’90s who had been troubled by men with old-fashioned values and had tried to impress a lady they found attractive. She expected men to treat her 115-lb frame as an equal, but at the same time she loved the attention that they gave her. She also expected the guys to sacrifice their adrenaline rush, and she didn’t mention the times she had burst in on their scenes, and treated, without helping with the

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Chapter 28. New century, new attitude lifting or the paperwork. Goldie knew Ann called for lifting assistance, and she understood. Her 220-lb frame had once worked the street too. And, as a woman, she understood Ann’s displeasure. “OK, I’ll find out from Goldie what’s wrong, and you call Ann’s parents.” Ryan finished his conversation with the boss. “Yeah, I heard her old man has been rough with her, but with that mouth of hers, I’m not surprised . . . Yeah, OK.” He hung up the phone. “NURSE!” The saint hollered for the tenth time and when the curtain blew open he had almost forgotten what he wanted. “What do you need?” She actually had a smile on her face. “Will you turn that alarm off?” The alarm stopped a few seconds later. The child said, “Mommy, can I go home where I can sleep? It’s too noisy here.” “No, we’re waiting for the doctor to give you some medicine so you won’t keep me awake all night.” CHAPTER 28. NEW CENTURY, NEW ATTITUDE It was four o’clock in the morning when Ken, the nurse, reappeared. “Doc says there’s nothing broke; guess you’re lucky.” “No, Ken, you’re lucky.” The words made Ken stop and turn towards his patient. “What do you mean?” Ken asked “Think about it for a minute, Ken.” The sparkle was gone from the saint’s eyes. There was no “chuckle” in his voice. His attitude had changed. He had realized more in the last four hours than he had in three decades. The words of the child in the adjacent room, “Mommy, take me home where I can sleep; it’s too noisy here,” had made him face his profession for what it had become. Helping him along on his attitude change were the two police officers who had awakened him for questioning. “We need your statement,” one of them said. “Well, a drunk hit us.” The saint tried to bring their faces out of a cloud while he answered. “What about the girl?” The cop with the notebook asked. The blue-shirt tried to catch the saint off guard. But the saint had played the game for years. “What girl?” he saint asked. He liked the game.

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The Street Saint “The one who’s telling everyone she was in the back of your ambulance when it was hit.” The cop looked up from his writing with a piercing look. Because the cop acted as if he were on a Hollywood set, the sinner said, “Hey, Kojak! Let me explain something to you. I’m an attending paramedic, which means I’m in back when someone is on board. I was extricated from the front seat and still had my seat belt on.” “Yeah, they said you had a seat belt on.” The cop agreed — even though the saint never wore one. “That means I wasn’t attending.” “The other crew says they found her in your truck.” “Of course they did,” the sinner had tired of the game. “My partner got her out of the cold. Talk to my partner.” The sinner had admitted nothing. “He says that she was walking down the street and the truck spun and hit her.” Then the police officer said, “There are a couple of witnesses here that say they saw everything. They say your ambulance was just going down the road and the other car hit you. We’ll ask them if they saw anything.” The cop folded his notebook and left. The saint thought, “Where is Harry? He hasn’t even checked on me and now we’re in the middle of a police investigation. I don’t know what he told them.” “You tell those witnesses for me that it’s perjury to lie,” the sinner said, before the officers got out of earshot. There were no witnesses. Someone may have given a story to the police, but it was for some reason other than to be a good citizen. Harry walked into the room a few minutes after the cops left. He didn’t ask about his condition. He just went on with what had him concerned before. “That stupid bitch is telling everyone that she was in our truck. I don’t know how this one is going to go.” His lack of concern was blunt. “How are you, Harry?” the saint asked. “Oh, I’ll be all right; just stiff.” Harry said. He rubbed his shoulder. “That’s good; did they run a urine drug/alcohol test on you yet?” He asked questions to fill the time, before Harry asked about the saint’s condition. If Harry had reported the saint’s blackouts, he would have been treated differently. Or would he? Maybe not. “Yeah, they sure did. I had to drink about a gallon of water, because I couldn’t go.”

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Chapter 28. New century, new attitude The cops returned after acquiring statements from the “witnesses.” The sinner fussed at himself for not immediately asking Harry what he had told them; it could have helped rid themselves of the liability of their kindness. “We talked to the witnesses.” Harry looked tense, and it should have been a dead give away to the cops, but they couldn’t tell that the ambulance crew had been lying. “Sorry, guys.” The words immediately eased the crew’s tension. “They say the woman was walking down the road. They couldn’t tell if you guys even clipped her. They said she might have even had enough brass to open your side door and climb in. The crack head was trying to hang you guys; we’ll charge her and she won’t bother you again.” He put his hat on and went to arrest her. The saint had saved himself at the expense of another; was the saint dead? “Let her go,” he said. “What?” Harry and the cop asked simultaneously. “Let her go.” He offered his rationale. “Tell her that you have a witness that says she lied. Tell the staff the ambulance isn’t responsible for her alleged injuries, but also tell them to call our dispatcher when she’s ready to go home. Tell them that we should be big enough to give her a ride. If they have any questions, tell them to call me.” He held the cops with his eyes. The saint had done everything except confess that they had lied. Harry stood in disbelief. “Well,” the one cop didn’t look up from the floor. “We could give her a ride home, but she lives out of our jurisdiction.” He understood. There was nothing they could, do so they left. After they were gone Harry said, “I guess we got out of that one!” “Yeah, we sure did, Harry. We gave a ride to a girl that was only taken to the hospital so we could make some money. She trusts everyone that wears your uniform, but she’s almost simple-minded. She lives with a bunch of crack heads and she takes their pawing as love. You gave her a ride because you felt it was right, but then you didn’t have enough of a heart to snap her seat belt. We had an accident on New Year’s Eve while you were thinking about the trauma we’d work later. That’s the only reason you work on New Year’s Eve. That girl didn’t lie to the police, and if the crew that transported her really believed your story, they should have packaged her. They put her in registration while I went to a bed. She’s so simple-minded and starved for affection that she believed our story. She will be grateful when one of us gives her a ride, and the thought of that makes me sick.” The saint signed the picture he had painted but wasn’t proud of his work.

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The Street Saint Then he went on. “By the way, I’m going to be OK. I just got my bell rung. The feeling in my hands is starting to come back — no thanks to you, Ann, or this hospital.” He stared at Harry, who had already looked away. “Now,” the saint changed the subject when he saw that Harry had understood. “I’m going to get dressed and go back to work like I did the last time a drunk hit us. We’ll see how much more money we can make the boss tonight.” He had tried to make Harry smile. “Ann went home.” Harry changed the subject. “Her parents came and took her to their place. They didn’t know about her problems or the medicine.” Ann wasn’t given anything before being sent home. “I guess, because she had already been overdosed. Goldie said that she figured Ann had about four times the drug in her. The boss said he didn’t know what was wrong with her, but she couldn’t work until someone found out.” “They’ve got a replacement for you, too,” Harry said. “I’m supposed to take you to your car.” Ken, the nurse, entered the room but kept quiet; he helped him with his shirt. The saint decided it was time for truths. “You know, Ken,” the saint began. “You always seem nervous and stressed when I see you work, like I said before; you work hard and are really concerned.” “Thanks,” Ken said, and seemed surprised at the change in the saint’s attitude. “You watch yourself around Goatee.” He figured the warning was reward for the service that Ken had shown others. “I was actually lying there hoping that there was a fracture in my neck. Rule one in medicine: Do no harm. Watch yourself! He’s an idiot and he’ll nail you when he goes down!” The saint quickly zipped the front of his shirt for effect. In the early morning hours of the new millennium the tired medic made his way to his girl friend’s house. He knew that he needed to be monitored for the concussion the doctor had ignored, and he didn’t want to be alone. What a wake-up call. He surrendered. His dream had finally been shattered. He was through. Like the husband and wife who once loved and then divorced without fanfare, the saint felt his romance with his career end. He couldn’t change anything, but he was exhausted. He was off New Year’s Day and on another 24-hour shift the day after that. Ann was scheduled to work the next day and his first decision was whether he would volunteer for the extra shift and give up the time he had planned with his girlfriend. He called to volunteer, but not out of dedication. He would be paid

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Chapter 29. Let’s look at this again, without the rose-colored glasses overtime, recoup the hours he had lost from being involved in the accident, and earn holiday pay; at time and a half he was almost being paid what he was worth. “We got you replaced,” was his supervisor’s way of asking how he was. The saint chuckled and said, “What for? I was calling to take Ann’s shift!” “You can’t work before you’re cleared by a doctor.” “When did that start? He put me back to work with a towel covering the blood on my shirt while I was still trying to swallow the Ibuprofen, the last time!” The sinner snapped. The supervisor checked with the boss and the boss said that the medic could work his shift. He crashed on the couch and missed the Rose Bowl Parade they had planned to watch. She watched the football game for him. His profession had created another widow whose husband still breathed. That was going to change. He hadn’t told her about his decision, because he didn’t know what his future held. He wouldn’t find anything that compared to his past. The idea of giving more of himself to learn the challenges of a new profession exhausted him before he could even start. He walked in the next day, not as sore as he’d thought he was going to be, but the walk from his car made his back spasm. The schedule said that Ann was working her next shift. The boss couldn’t have known what was wrong with her, but he didn’t like paying overtime. CHAPTER 29. LET’S LOOK AT THIS AGAIN, WITHOUT THE ROSE-COLORED GLASSES Dave and the saint climbed into their truck to begin another shift. There probably wasn’t going to be anything too hectic and he was with someone of equal age and experience. At times, that arrangement made it boring — but at their age, “boring” was comfortable. The sinner looked at Dave and asked if he felt like having some fun. “I figure we’re going to get everyone that partied on the weekend and now has an ‘emergency’. I’m too stiff and in too bad a mood to be the ghetto taxi!” “Well, the boss is out of town.” Dave began to check if they could get away with some free-lancing. “The other crews don’t care and the dispatcher is young, new, and stupid.” Dave laughed and said, “Yeah, why not? If they ain’t bad, they can take a bus. We can’t tell people they can’t go to the hospital; but we can tell them what’s going to happen when they get there — and that should do it.” “Right. We share our experience with our patients . . . informed consent was what they pay for. Although, not the way the boss tells it. We’re just

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The Street Saint supposed to take a blood pressure and give them a ride.” The sinner cussed under his breath while lining up the straps on his brace. “Who says?” Dave asked “That’s what it said on my last review. ‘Quit trying to be a doctor; take their blood pressure and take them to the hospital.” The saint got one strapped hooked. “You’re kidding. What if they’re bad?” “It said to take a blood pressure and take them to the hospital. It didn’t say fix anything,” the saint repeated. He finished adjusting the prescribed brace, sat and looked down at it and said, “You know, it does look like a sewer pipe!” “I’ll tell you,” Dave said, “If I was in your condition, I would have been out of here a long time ago.” He had been the first to acknowledge the saint’s injuries. For the saint, the term was “burn out.” Medics who didn’t have the fortitude or the knowledge to handle the work experienced it in the first few years on the job. It took almost three decades to get to him. The way to cure burn out was to get another career, or at least take an extended break. Others who were burned out had tortured him; like him, they had no other place to go. He knew he didn’t have many years to play with, he was honest with himself, but it bothered him that he had to leave at all. His burn out hadn’t been caused by too many dead bodies; it was from spending his life doing for people what most of them had refused to do for themselves. People who weren’t qualified to carry his jump bag had looked at him as the guy who gave rides to the hospital. When they accused him of not doing his job, the sinner thought, you sure wouldn’t do as much for yourself. Compared to the acknowledged horror of calls, the stress that was caused by the nuisance patient had never been considered a problem.It was not normal to want to experience the grotesque but the strange little bug that lives inside emergency workers does. Sure he felt his gut wrench when he saw children burned in fires. He had seen automobiles that shouldn’t be called cars with bodies still in them that were equally disarrayed; he handled the call by not thinking of them as human beings. “Dealing with it,” was something they had to do. Crying children, bossy significant others, over protective mothers, confused dogs lived in the real world. How stress affected them was talked about in class and laughed about at the base, but the full impact had never been studied. No one in the field ever admitted to it; it would have diminished their “tough guy” image.

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Chapter 29. Let’s look at this again, without the rose-colored glasses The saint understood, but he had become obsessed with the way that he had been treated when he was injured, not once, but twice. He had always been told how “professional” hospital personnel were; he was just an ambulance driver. He remembered times when just being there he had been what the doctor had ordered and there were times when he had used everything he had, and sometimes he had just been used. Paramedics have to be able to “detach” themselves from their surroundings and the good ones have the ability to look at their own performances and critique themselves and make changes when necessary. Each of them had a way of monitoring their stability and ways of pushing the needle back into the safe zone when it was needed. He often used a letter that was once sent to him when he needed to check on the condition of his paramedic soul. He rode quietly in the ambulance and allowed his subconscious to focus on that decade old letter. “Got a letter about you today.” The supervisor said, as he lifted an envelope off his desk. “Oh, yeah? If it’s from Ed McCann, I want the weekend off.” The saint took the letter, unfolded it, and started to read. “If it was from Ed, I’d collect it for you . . . minus expenses.” The supervisor was in a friendly mood, so the saint delayed reading the note a bit. “What expenses?” He saw that the letter was in a feminine hand and was surprised to see such penmanship from someone he had treated. It was neat and organized. “Everything I owe and everything I’ll ever spend,” the supervisor proved the game was afoot. Only those who knew him well were familiar with his humor. The saint chuckled, “Yeah, I thought it was something like that.” He opened the letter and read. Dear EMS supervisors, I wanted to tell you about the men who came to take care of my husband and how I feel about my husband dying.

Oh great! The saint thought. He’d never been accused of killing anyone yet, but it looked like that streak had ended. Maybe the look of sorrow on his face he could never hide, or his gestures that said he wanted to say something but couldn’t, or maybe his size had saved him; who knew? The letter looked too good to ignore. He feared he’d have to answer the allegations, and considered asking for a lawyer. But the city would suffer the

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The Street Saint greatest loss if a suit was filed, and their lawyers would defend him. Discussion with his supervisor was confidential; the truth would protect him. He read on. My husband was a brittle diabetic. I awoke the morning of the 23rd of October while he was still in bed. I rolled over to kiss him good morning, as was my practice, and his lips felt odd, his chest was cool, and he didn’t respond. I thought maybe his blood sugar was low but then I saw that he wasn’t breathing.

“Oh, please don’t tell me this woman had a cold dead guy in bed with her and she’s blaming me for killing him!” The sinner had been awakened. “Just read!” The supervisor said with a wave of his hand. I did the only thing that I could and called 911. They sent an ambulance and gave me CPR instructions. I always wanted to learn, but then feared that my procrastination had killed my husband. I pulled him to the floor as they told me to do, but I pulled him between the bed and the wall and couldn’t do anything. He was too big for me to move and I was crying too hard. It wasn’t long until your men were here, but it seemed like an eternity.

“She’s doing this wrong, if she’s going to sue. Does she think we’re just gonna to give her a check?” The supervisor didn’t acknowledge the saint’s comment; just waved. I was a mess. I knew he was dead, he was gone and I just wanted someone there with me. He was in God’s hands, I know, but it takes a while to realize that. I’m sorry I don’t remember your men’s names but I remember that the word “paramedic” under their names made me feel better. I expected them to tell me that there was nothing they could do and maybe fuss at me for letting my husband die. I felt stupid for pulling him off the bed where no one could reach him. Instead, they asked me where he was, and even called me ma’am. That felt strange, coming from someone older than me, but it also woke me up. I showed them to the bedroom. Nothing I’ve ever seen on television looked like what they did. In seconds my husband was in the middle of the room. I cried when they cut his pajamas because they were my Christmas present to him and it just seemed like everything was being torn apart. They put some things on his chest and I shrieked when he jerked and then I realized they had shocked him. They worked so well together it looked like they were dancing. I never realized the training that you have; I just assumed you’d be there. They

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Chapter 29. Let’s look at this again, without the rose-colored glasses put tubes in him, a man in a white shirt arrived, the fire department came, and before long we were in the ambulance. I wanted to be with my husband but the driver said there wasn’t enough room and when I looked in the back I realized I would have been in the way. The next thing I knew, one of them said they had a pulse. The driver said not to have too much hope, but my husband was alive. I cried the rest of the way to the hospital. I thought it was over and that we’d be together soon. The doctor at the hospital said that my husband’s heart was beating but that his brain had been damaged. I wanted to write to you because some people say that you didn’t get there quick enough and others said you just ran up a bill, but I wanted you to know that what you did had more to do with living than anything people have told me. The life you saved was mine. You gave ME a chance to be with him. I spent almost two weeks in intensive care and even though he never regained consciousness, I knew he was in the mass of wires and tubes. I sat next to him and told him what he meant to the children and me. When I could, I told him how we were going to miss him. I talked like we were at our kitchen table but I never touched, looked at, or felt his presence more than I did then. I knew he wouldn’t be with me long, so I told him how life without him would not be the same. I had my face in his mattress when he left me. The nurse woke me and told me that he was gone. I no longer heard the whooshes of air or the beeps from machinery. The room was quiet and it looked like he was asleep; he looked so peaceful. I missed him immediately, but when I looked into his face I could not begrudge him the peace that I saw there. I want you to know about the wonderful gift that your men gave me. Don’t let them think they failed. They gave me two of the best weeks of my life and I will always remember them. I don’t know if he heard me; the man at the funeral home said he took care of the living, and God took care of the dead. Your job is to save lives, and you did. You saved mine. Thank you so much. You are all saints, Mrs. X

“Whew!” The saint said after he recovered from the letter’s emotional impact. His previous accusations then made him feel stupid and he was embarrassed because he didn’t remember the woman; but he did remember the call. “That’s . . . hammm . . .” He cleared his throat so he could speak. “Quite a letter.” “Yeah.” The supervisor agreed. It was then that the saint noticed that his boss hadn’t raised his head from his paperwork.

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The Street Saint “Have you got some paper? I want to write her.” The saint hated the emotional roller coaster that he rode on his job but he remembered the pain he had felt when his father died. He would have liked to have had two extra weeks to tell him the things he still held inside. “Yeah.” The supervisor still hadn’t turn around. “Back on the desk behind me.” The saint sat at that desk and when he raised his head to contemplate his words, he watched the supervisor wipe his eyes. Then he did the same. He wasn’t ashamed of being emotional; and he didn’t have to think about what he was going to write. But he was concerned how his letter would affect the woman. He considered telling her that medically nothing could have been done, but she knew that. He thought about asking permission to use her letter to show the importance of early CPR, and then decided against that. The letter he was writing was a letter of warmth; something he rarely got to do. It was closure for her. Dear Mrs. X, Thank you for such a moving letter; it was beautiful. You’re right; when God calls us we all must go. I appreciate the things you said about us and we’ll be there if you need us again. You made me remember that I don’t control anything. The reference I just made to God I must admit was the first time I have used his name without four letter words behind it in a long time. Thank you for helping me be mindful of something other than my job. I wish I could be of more comfort, but I have worked hundreds of cardiac arrests and most don’t turn out even as well as your husband’s. Most are dead, stay dead, and that’s it. But, of everything I have experienced, while witnessing those last few minutes of someone’s life, there’s one thing I do believe . . . your husband heard you!

He hadn’t planned to write those last words; the pen just wrote them. After he reread what he had written, he realized there was nothing more to say. He folded the letter, placed it in a department envelope, and laid it on the supervisor’s desk. “You didn’t write something that’s going to get me in trouble, did you?” the supervisor growled with his usual sarcasm, as the saint neared the door. “Nope, read it . . . I got work to do.” The saint walked out, climbed into his truck, and wished he could have shared his thoughts with his partner.

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Chapter 30. It’s not the load; it’s the straw that breaks the camel’s back “Chewed you out, didn’t he?” the young EMT asked. “You know, he overreacts to everything.” “Yeah, he’s opinionated, alright.” The saint looked out his window. He hid his face as the supervisor had hidden his. “But, I think he overdid it this time.” CHAPTER 30. IT’S NOT THE LOAD; IT’S THE STRAW THAT BREAKS THE CAMEL’S BACK He could still feel the emotion of the letter. He felt like crying. He felt funny the rest of the 8-hour shift with Dave and it lingered still when he picked up his second partner, “Dawg,” on his 24-hour shift. Working with Dawg was refreshing. Dawg was black but he was a different kind of black man than most the saint had encountered in the hood. He had been raised in a small town by his parents, who were still married. He had done well in school, played sports, knew the meaning of discipline, and had learned at an early age the advantage of functioning well in society. Dawg was young enough to be the saint’s son and their discussions often crossed the gap between age and race. The saint was tickled when the Dawg discovered a promising singer by the name of Frank Sinatra and brought him a copy of some of his music. Dawg shared his rap music. He seemed to appreciate the saint’s wisdom and asked what it had been like growing up in the turbulent ’60s; he tried to envision how it had been to function in the fledgling EMS systems of the ’70s. Dawg was efficient. He was thorough. Like many of the medics who worked the hood, he tried to get out of a call anytime he could, but when on a call he handled it professionally. “Dispatch, 50.” The dispatcher’s voice broke the saint’s reverie. He had hoped that the day would be nothing more than Dawg and him comparing notes on living in a different generation and as a different race. “Go ahead.” Dawg tried to sound like the call was important. “Need you at 3340 Jefferson. There’s a 13-year-old girl,” the dispatcher singsang the words and then took a deep sighing breath to show her exasperation, “who says she has a tummy ache.” “That’s clear, Dispatch; show us en route.” He parroted and then asked, “Where’s her parents?” She would need a parent or guardian to sign. “She says she doesn’t know.” The dispatcher had said exactly what neither of them had wanted to hear.

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The Street Saint “Clear.” What he wanted to say was that he could do nothing for the girl, so why go? The crew was silent while Dawg hung up the microphone and the saint slipped his fingers into his gloves. The saint broke the silence. He knew what they both were thinking. The salt and pepper team had been prejudiced by the clientele they served. “I remember a time,” he began, “when a woman of child-bearing years complained of abdominal pain, we took a fast ride to the hospital with IVs hung and running wide.” “Yep, ectopic pregnancy until proven otherwise,” Dawg agreed. Dawg knew his stuff. But Dawg stayed in the flow of the Saturday afternoon inner city traffic. They were working, but the weather was too nice and the mood in the truck had been too amiable for them to force a situation. There was no way out of the inevitable, but that didn’t mean they had to plunge into it. Their good mood was about to be killed. The two had been talking about the past. The saint had a pile of “used to be’s” that he had enjoyed reliving. Dawg had never experienced anything different other than what he worked in every day. Nothing could be changed; the hierarchy had seen to it. The system had been designed to handle emergencies and that mindset opened the door for would-be “do gooders” to use every medical complaint fathomed by man to bill the government. Symptoms that were been made up only to expedite service had calloused those who had to change their careers to taxi driver. Their ignorance could send a patient headlong into a grave and that excuse was used by the hierarchy to stop medics like them from triaging those who needed their services. Knowledge used to be shared in a time when days might pass before the emergency phone rang. Now, their service ran 16,000 calls the first two months of the millennium; they all couldn’t be emergencies, and there was no time to reflect, no time to experiment, and definitely no time to learn. Education ended when the career began and the career was just a blur of one call piled on top of another. The saint often saw Dawg add an extra blanket for an elderly patient, even though it wasn’t needed. He watched him talk to a child and take the few extra minutes that would only delay the inevitable screaming. Dawg never seemed to become aggravated with nurses who insisted a patient be transferred immediately but didn’t have the reports photocopied so that the crew had to wait. The saint began to wonder if his own pain had slowed him and had made him less compassionate than he had once been.

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Chapter 30. It’s not the load; it’s the straw that breaks the camel’s back No more. He would no longer document the need for an ambulance when it didn’t exist. Dawg could help him with that; he was black, and a charge of prejudice wouldn’t stand up. Dawg put them on scene, where a teenage black girl was doing “ambulance aerobics” in the front yard of a mobile home, frantically jumping around and acting as if the ambulance would fly by and miss the address if she hadn’t gotten its attention.. “What’s going on?” Dawg asked, stepping in front of the saint to hide his attitude. The girl pointed to another her age, who sat with her chin in her hands looking terribly bored. She did not appear to be in any distress, unless the dried tears on her cheeks were an indication. The saint wondered if the young man next door that was partying with a couple of older teenage girls had anything to do with her “distress.” “What’s happening today?” She ignored him. The saint stepped up and introduced Dawg and himself by medical licensure and then asked her again what was wrong. No one with stomach pain would sit the way she was sitting. “I need to go to the hospital,” was all she said. The saint needed permission from a parent or guardian, unless the girl’s life was threatened.“Is one of your parents around?” “No.” She answered without taking her eyes off the boy next door. “Can we call them?” “No, I don’t know where they are.” “OK,” he chuckled from frustration. “Have you ever had a baby?” If she had, she was emancipated and could sign her own refusal. “No, I’m on the pill.” “Well, that’s good.” It was unusual to find a young woman thereabouts practicing birth control. He looked at the Dawg and Dawg responded by raising his eyebrows as if to say, “That’s different.” “Are you pregnant?” She looked at her girlfriend as if she might know, and said, “I don’t know.” “When was your last period?” The saint hoped she was late and he could “assume” that she was pregnant, consider her an adult, and accept the refusal from her. But if her period was six weeks late, his attentions would shift to the possibility of an ectopic pregnancy and she would be treated as a patient. “I’m with it now.” Not much need for an ambulance, then.

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The Street Saint “Where does your stomach hurt, baby?” Dawg took over the conversation. The saint stood silent, hoping Dawg could bring the ridiculous to a rational conclusion. “Down low,” the “patient” said. She didn’t lean back or touch herself to better indicate the location of her discomfort. “In the middle?” the saint asked; bladder infections or pelvic inflammatory disease often prompted such calls from teenagers. “Yeah, down low.” “Does it burn when you pee?” Dawg asked. “No.” That pretty much ruled out a bladder infection. “Hon, do you know what menstrual cramps feel like?” the saint asked. “No.” Her immaturity was only matched by her ignorance. “Do you think that this could be menstrual cramps?” Dawg asked. The girl straightened up and looked around as if seeking help. His questioning bored her. She again answered, “I don’t know.” “Have you tried taking anything?” The saint placed a foot up on a chair. He had stood too long and his back had started to hurt. Wasting time on the call was bothering him more. “No.” It was becoming quite obvious that she had tried to use the ambulance to get attention from the young man next door. Her plan had failed, so now the two rescuers were no longer important to her. The boy still held her attention. The crew knew that. That’s why they lingered on the pregnancy questioning. “When are your mom and dad going to be home?” The saint touched her forehead to check for fever. He didn’t find any, but even if he had, he knew the emergency room was only going to babysit her. “I don’t know.” She was annoyed with the situation. “Hon, let me explain something to you. You are not old enough to sign for treatment. I can’t let you go, unless a doctor releases you. Your parents could tell me to leave, but you don’t know where they are. If I take you to the hospital, they won’t treat you. You have menstrual cramps, which is one of the things God uses to remind you you’re the weaker sex and to curse us men.” Dawg laughed and walked away, to wait out the inevitable in the truck. His departure was his way of telling the saint that he had surrendered; just load her up and get it over with. But the sinner was too block-headed to take the easy way out. “Well,” she looked at her girlfriend and said, “I don’t want to go.”

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Chapter 30. It’s not the load; it’s the straw that breaks the camel’s back “OK,” the saint said. “Let me call the doctor and see if I can get a refusal.” But as soon as the emergency room learned that the patient wasn’t coming to their facility, they ordered the saint to transport. “OK, you’re going to the hospital.” The girl was still looking over at the boy next door. She hadn’t comprehended, yet, that she had been used by her young boyfriend for immediate gratification, the same way she had tried to use the 911 service. “The doctor won’t let you stay home. You’re only supposed to call us when it’s an emergency and since you don’t know any better, the law says that you don’t know you’re having menstrual cramps and should take a Tylenol.” The young woman again put her chin in her hands. “I don’t want to go.” “Well, hon. You called for help, and now you’re going to get it. You’re going to sit in the hospital until your parents arrive.” She was mature enough to want a man. She was hurt when a woman with more experience had diverted his attentions. She could activate a multi-million dollar response system; but the saint had to treat her as if she were “just a little girl.” The sinner was thankful someone had the foresight to put her on birth control. It is always disturbing when a young mother sucks her thumb while her baby is being delivered. He bent his frame as far forward as his brace would allow and said, “Sweetheart, you’ve got cramps. You don’t need a hospital or an ambulance — you want attention. You need to be spanked. A doctor has ordered me to transport you and we’re going to do that, one of two ways. You’re going to get up off your little butt and walk to the truck, or I’m going to throw you over my shoulder and then put you over my knee when I get you there. Now, which way are you going?” “I’m staying here!” She looked defiantly into the sinner’s eyes when she said it. “I’ll go.” She sighed, got off her chair and walked to the ambulance. “You see, you’re better already, you’re standing up straight, you’re walking fine, and you’ve learned to listen to authority. You see, 911 does do miracles.” He put her on the bench seat and picked up the trauma radio. “Alpha 50 regional,” he barked into the microphone. “Go ahead Alpha 50; this is regional,” the nurse at the other hospital answered. “We’ve got about a two minute ETA with a thirteen-year-old minor female who has menstrual cramps. You’re going to have to babysit.” He released the button to the mike and only silence came over the speakers. He didn’t have to fantasize about what was being said in the emergency room. “Clear, Alpha 50, put her in the waiting room. Regional, clear.”

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The Street Saint The saint looked at his watch. He was 23 minutes into the second part of his shift. Only 15 hours and 37 minutes to go. Obviously, even deliberately trying to derail the system was not possible. “Respond to a sick baby; been running a fever for three days . . . respond to a 32-year-old male with psych history; Mom wants him out of the house . . . respond to a 61-year-old female; daughter wants her out of the house . . respond to a 10-50, PD on scene; five ambulatory patients want to be checked out . . . respond to the PD; prisoner in a holding cell says he was struck, respond to . . . Twenty-two responses in 24 hours and most of them came in as complaints that warranted a lights and sirens response. Each time, the men’s adrenaline needlessly responded and then it had to be dumped. All of them were conditions that common sense could have handled, but common sense was nowhere to be found. Any one of them could have been a real emergency, and in that case the crew’s prejudice would have held them off the scene for too long. And while they responded to these spurious calls, hundreds of other patients arrived at emergency rooms. Lines stood at registration desks and some facilities had waiting rooms for people even before they registered to wait. By the end of the shift, Dawg and the saint were exhausted. It wasn’t the type of exhaustion that they appreciated and looked forward to; it was the kind of exhaustion that mothers experience after chasing toddlers and ferrying teenagers to after-school activities. On the way to the base Dawg said, “Dude, I don’t know how those people can live like that, generation after generation. I guess they’re still slaves, in their minds.” The saint just looked at him. Was he really going to blame the white race for the way society functioned today? But after giving it a minute’s thought, he appreciated that, in the mind of a young black man, this might be the only logical explanation. “Dawg,” the saint began. “Let me give you a different bone to chew on. Do you realize how much money those people would have to make, if they went to work, in order to match what the government gives them every month?” Dawg had no idea. They spent the next few minutes putting together a budget that covered only what the government paid for; about $45,000 a year. “So, you see, Dawg, those people think they get something for nothing, when in reality they are more enslaved now than they ever have been. They can’t come and go as they wish and they have no way to change the situation. They don’t learn, even though the schools are there for them. Most of them say that they can’t afford to go to college, when every one of those young people could go to

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Chapter 30. It’s not the load; it’s the straw that breaks the camel’s back school for free. Every teenager we saw today knows that if the government is kept intact they will qualify for Medicaid at the age of eighteen and they can get their own apartment once they have a baby. The boys know they just have to make a girl happy, and they have a place to live. No one expects any more of them and they don’t expect any more of themselves. The ‘government’ (the saint made quotation marks with his fingers to emphasize the point) is represented by elected officials who keep the welfare state the way it is to preserve their jobs. If you want to do something for those people, tell them to move out of the government housing and turn their checks back in to the government. Tell them to tell the politicians, who have enslaved them for a vote, to go to hell. Tell them the next time a doctor tells them that they have a disease, without running any tests, to not accept the potential for social security disability the doctor has promised them — and to find another doctor. Tell them to quit looking for what’s free, because you and I both know there is no such thing as a free lunch.” Dawg was quiet. What the saint had said irritated him, because it put people of his race in a position of power rather than one of pity, the pity that they had used as an excuse for generations. The saint had suggested that the people could do something about their condition and the only excuse they had was that they couldn’t be bothered to better themselves. “I’ve heard all my life about how your people were slaves. When I was young, I felt guilty about that. What do you want me to do, Dawg? Have you ever read the whole history of my people?” Again there was no answer. “You know, there are millions of stories that were never recorded, and we don’t have a white history month. Did you know that my Irish ancestors worked for a couple of dollars a month, and all that money went to company stores?” The Dawg just shook his head no. “Did you know that when they could no longer work for ‘the man’ they were thrown out into the streets along with their families? Did you know that my grandmother was forced to sew dresses in a room with one light bulb, and when she worked too fast she put a needle through her hand? The foreman came over and broke off the needle, and fired her . . . Did you know that I worked for the better part of my career without medical insurance and used to haul people with $400 glasses and gold teeth while I was missing some of mine and had to squint to read ampules?” Dawg gave the saint a quick sideways look. “Man, I never thought of that. The problem is that the people who have it all just want more, and guys like us who don’t have anything will never get it.”

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The Street Saint “I think you just did, Dawg,” the saint said, and then looked out the window. The people in those neighborhoods lived the way they had for generations, thinking they were being given something for nothing. They had learned one subject quite thoroughly: which party talked about cutting government spending, and how to play the system to get what they wanted. CHAPTER 31. THE DAWNING At least his advancing age gave him something to talk about with the older physicians. Sharing the battles that had been won and quietly mourning those that had been lost had built an esprit de corps between the street warriors and their generals. They only talked about their common aches and pains when young ears were not present. The saint realized that the truck would not be his for much longer; and he had no retirement plan or pension. Young people often don’t understand why an elderly patient needs an extra blanket. They don’t understand an aged mind that may be slow to answer questions, or a grip that may not be weak from illness. They don’t know that the lack of pain might be a symptom more deleterious than its presence. Maybe he just resented their youth and the life they were able to live, while he wondered if he had wasted his. He was tired of a society that pays those who do the work less than those who control it. Today, the administrative staff at many small hospitals is equal to the number of its patients. Doctors need ten non-medical personnel to administrate their offices. Instead of two nurses, ERs have several registration clerks, unit secretaries, and nurse assistants. The saint was his own tech and unit secretary, and made less money than any of them. This all started to rankle when he decided that he had been used as a fool. “You’re just frustrated that you didn’t go to medical school!” a young nurse barked one night. “No, when I see things like what I just saw, I’m glad I’m not a doctor,” he told her. “I would disappoint those I was sworn to heal. You and I both know that if these people had half a brain and a clean pair of pants they would sue him, and he’d be cutting grass. And, little girl, until you learn what a nurse is and what can be done in an emergency room, stay out of my way and keep your mouth shut!” He would never have lasted as a doctor anyway, because he knew too little was done for those that really needed it and too much was done to appease the majority that brought the most revenue to the hospital.

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Chapter 31. The dawning The saint rarely saw what he considered to be emergency personnel. The real ones respected one another and in their dance lay the true artistry of emergency medicine. Their eccentricities allowed them to take horrors in stride. They could not explain their thought processes, how they felt with their gut, persisted in “hopeless” cases, and adapted time and time again with success. These skills are partly intuitive, and are not endlessly reproducible. It stands to reason that not all personnel are equally talented. With more services offered, good personnel are spread thinner. Because the few with real ability are wasted on the mundane patient, death finds its way to some patients who needed them. Many such deaths went unnoticed; the percentages favored the system. Hospitals have less staff on weekends, just when bad trauma is more prevalent. The pencil pushers see overtime, comp pay, and weekend bonuses as an avoidable expenditure and one that has to be avoided, to balance the budget. The saint balanced his own accounts every time a critical patient survived. He had few entries: airway, breathing, circulation, and how much else he could get done. That was the budget that he understood. He was bound by law to take emergent patients to the closest facility where the law said a competent doctor resided. Non-emergent patients are allowed to choose a hospital when they demand to be transported by ambulance. That meant the “gold card” empowers the ignorant and costs the taxpayers more money, while taking help away from those who may really need it. The paramedic had to identify life-threatening scenarios in seconds but was not allowed to tell a faker that he had to go to the closest hospital. The same doctors who were allowed berate him with their inexperience needed only say “transfer” and the responsibility shifted again to “the stupid paramedic,” who then had to manage the patient en route to a real doctor. Nonpaying patients leave a trail of bills. There are no provisions for refusing care to patients who neglect to take their free medicine or follow up with their free medical care. They call, the emergency services haul; the public pays. In the new reality of emergency medicine, doctors are solicited for in the newspaper and good pay is promised to graduating nurses if they work in a hospital’s emergency department or intensive care ward. At one time, nurses in hospitals knew the same protocols the saint was trained in, and had showed him treatments and assessments. Today, many work for temp agencies and don’t even know where the elevators are. They don’t know how to document and

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The Street Saint don’t know what emergent care is. When the saint was in a hurry, he went directly to the doctor. ERs are doing a prosperous business. Administrators can provide figures to the contrary, but all one has to do is look in an emergency room to see the truth. As a wise old accountant once said, figures don’t lie — but liars figure. A city is a group of buildings that are occupied by people. People are basically the same and one city isn’t much different from than any other. No city could supply all the medical personnel its people can demand. In trying to meet that objective, a degenerative problem has been created and it needs immediate attention. The number of nurses has dwindled and most of them say they wouldn’t take their families to the facilities where they work. Transport means more ambulances and more unnecessary expense. Personnel will only be available if salaries are raised or training is reduced so that even younger and less experienced personnel are trusted with lives. Women have far wider career choices than they had forty years ago, and today, most women place nursing and teaching near the bottom of the list. Hospitals ran short of nurses and instead of using the paramedic’s skills, they created other positions to lessen the demand on nurses. Or did they lessen the number of nurses? The new positions cropped up just as nurses’ salaries went up. The new departments gave the hospital more income without employing degreed individuals. Standard admission protocols include tests that provide a maximum profit and utilize those departments to their fullest. The hospitals that had once owned ambulance services did away with them as a financially losing proposition; but in so doing, they got rid of the only professionals specialized in emergency medicine. The paramedics were absorbed by the private sector, where “call and haul” tactics scrape dollars to survive. The hospitals said that the “degreeless” paramedic was a liability, but in the departments they created they employed others who had even less schooling. The nurses who had convinced the hospital’s administration that a paramedic was a liability weren’t stupid. The paramedic worked for less and had more skills; the nurse’s job security was threatened. The paramedic profession had avoided the politics of medicine and instead had opted to give patients the care that they needed; and they continued to serve while being pushed further and further down the professional totem pole. No one had ever thought of creating a third position in EMS that would have given the elder medic a place to serve when he couldn’t meet the rigors of the truck.

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Chapter 31. The dawning He had attended advanced classes with doctors who were drilled the same way he was. Not everyone passed the classes, and few held advanced certifications. At that time, nurses weren’t even required to know CPR. When certifications became mandatory, requirements were lessened. Today, no one fails. Now, in an advanced class, nurses may not be tested in all the stations because those stations are beyond the nurses’ licensure. Paramedics are rigorously tested, and the nurses are granted the same level of certification. Doctors don’t have to take the advanced training (although many do sit through the classes). So, as the country moves towards a uniform way of treating emergencies, the doctor can stop the advancement. He was talking with his old acquaintances over a cup of coffee. These were men who could effect changes and it looked like the right time for the saint to relay some of his thoughts. One of the doctors asked why ambulances brought patients with lame complaints to the ER. “You know, Doc, I know we bring people in here that shouldn’t be here, but our hands are tied, too.” “What do you mean? You brought somebody in here the other day because he had athlete’s foot! You said so, in your radio report. I know you guys have to make some money, but come on, have a heart! We’re busy! If you want to make a buck, take them somewhere else!” The doctor hadn’t raised his voice, but still placed the cause of his ills on the “overpaid truck driver.” The saint looked at his medical director, who sat at the end of the table. Maybe he would explain to the others why medics couldn’t choose hospitals or refuse transport; but the doctor just sat silently and studied his reflection in the black coffee. The saint was alone when the chips were down. “You know we can’t do that, Doc,” the saint replied. The medical director looked up and smiled as if to say, “Handle that one.” “Sure you can,” the ER doctor said. “Tell them they don’t need to go. You put them in the waiting room, anyway. How can you do that, if you don’t know they don’t need to be here?” The doctor unwittingly had used one of the medic’s own debating points. Nurses and doctors never stopped him from doing something that had made their job easier; it was doing something that their professional organizations had reserved for them that got their dander up. The ER doctor had spoken without consulting the accountant. A doctor’s attention span isn’t very long and is practically nonexistent if he’s not the center of attention. “I wish I could just tell you guys my assessment,

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The Street Saint and then follow your orders,” the saint baited.“You do that already,” the doctor said. “But, I don’t understand why you bring them in when you know there’s nothing we can do for them.” “Doc. It’s simple. If I find someone as stiff as last week’s bread, you don’t argue. He’s DRT (dead right there). If he’s dead but I think he’s viable, I do what I have to do and call you. You don’t have a problem with that. If he’s crashing, I do my job and if he has a serious complaint, I set him up and talk to you about the best way to proceed. But what do I do with things that aren’t in my protocols? You know —deciding to do nothing is a decision also? What do I do?” He raised his hands and waited a moment for an answer. Obviously, the answer lay in the bottom of the doctors’ coffee cups, because that’s where they looked. The answer was obvious. “At one point in time, people only called on us when they were seriously ill or injured. That kind of patient is what our standard of care is based on.” One doctor raised an eyebrow and then his shoulders. The saint assumed again his point had been made, so he continued. “I used to encourage calls, but now I’m trying to figure out how to stop them. What should I do with a complaint of a headache, for example?” He waited for a response that didn’t come. “What if someone calls me for flu symptoms? Should I start an IV and tell him he may be having a heart attack?” One of the doctors finally responded, “Well, it would depend on his or her associated symptoms.” “That’s right, Doc!” the saint had cracked the shell. “I don’t have a protocol for a headache or the flu. My Mom used to take care of that.” He looked at his medical director and still hoped for some helpful intervention. “Headache could be a CVA,” the medical director said, without looking up. “It could be,” the saint agreed. The doctor had proven how easy it was for a doctor and a paramedic to discuss things. Then he countered, “But isn’t there a deleterious finding?” “The blood pressure could be elevated from the pain,” one doctor said. “True. But would the pulse rate reflect the sympathetic response to the pain?” “It could.” “The point I’m trying to make, gentlemen, is that at least 50% of the people I bring in here could be treated over the phone. Then we could handle actual emergencies better. If I eliminated only 40% of what we don’t need to see, you

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Chapter 31. The dawning should agree that that would be a conservative but a fair estimate and a considerable help.” The doctors had mixed responses, ranging from nothing to an affirmative nod, but none had disagreed. He explained that the ambulance service could be paid for the assessment and state laws wouldn’t have to be changed, because the senior medic could respond on his own. “Laws don’t have to be changed because they were written about ‘ambulances.’ We could be ALS-equipped and arrive on bad scenes long before I am now. On serious calls, I’d have a three-man crew instead of me trying to work by myself. On basic transports I could stay in the neighborhood and make the report for the EMTs.” It was a simple plan that only could be mired in paperwork and fear. It would only fail if the profession maintained its cowardly omnipotence. “Doc, the profit is the same.” Maybe he shouldn’t have just blurted it out but someone had to admit that the most important thing in medicine was the bottom line. Those who supported their good works had to be satisfied. He had also said that people like him could do the emergency room’s job as well as them at least 50% of the time, and he had to show how the emergency room was going to benefit from not seeing those patients. Their responses were what he needed to hear; their help was mandatory if his plan were to ever have a chance. “I was reading some federal stats and I’ve talked with other medics on the Internet. Things are pretty much the same everywhere.” “There’s no way you can treat and release emergencies,” the doctor said. “That’s just it!” the saint jumped on the opportunity. “We’ve been approaching it all wrong! It’s time we admit that we don’t see emergencies every minute of every day. We’ve been perpetrating a fraud and calling ourselves heroes and saints for doing it!” He pulled a hunk of newspaper from a pile and placed it on the table. He clicked his pen and continued. “I’ve been looking at this for a while, Doc, and I couldn’t come up with the answer. The hospitals themselves were the main problem with my original plan, because the administrators would never back us. They tell people that every complaint has an underlying life threatening emergency, so they can be the only game in town. When was the last time you scanned a head for just a headache? When was the last time you ordered CPKMBs drawn on someone with a green productive cough? I’ve seen you guys do it . . . you write the scripts before you even see the patient. If you can do that, then why can’t you do it based on my assessment? You order treatments that

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The Street Saint would kill some patients if I was wrong, and you give those orders without hesitation. But hang on a minute before you shoot me down,” the saint raised his hand to ask for understanding. “You’re not going to play doctor; and I don’t care what your figures show!” Just what he thought the doctors might say. “That’s right! You doctors do wonderful things! Now, tell me why I can go to a med-stop clinic and be out in 45 minutes with a strep culture done and a prescription written, or a doctor’s office and get the same prescription based on my signs and symptoms, and it will take five hours here for you to discover that I have strep throat and you give me Tylenol and an order to go see a doctor for the antibiotics? You know what I’m saying is true, so tell me which one of those doctors is the best and which one is playing with a patient and collecting the money for the privilege of seeing the ‘medically divine?’” The doctor glared, but didn’t speak. He had attacked the medic by accusing him of playing doctor; the saint had never asked to “play doctor”; he had offered to assess and report. The doctor had also stated that he didn’t care to look at research findings or try to find a way to improve patient care. By that refusal he admitted that he was not interested in being a doctor. Now, he had no comeback. “Take a look at this.” He swallowed, and wanted a cigarette. His heart raced. He knew he didn’t have long to talk because staff was waiting to talk to them. His own records proved that only a small fraction of their patients needed professional intervention. Government had tried to control spending, and EMS and hospital administrators had countered by enticing more and more patients, which only meant that the government was going to use the larger numbers, dividing them into the same budget and paying less per head. “Yeah, I know,” the medical director said. They all knew. The question was whether they would accept his resolution. “Of course you do!” He said feeling like a vacuum cleaner salesman nailing down an affirmative answer. “If we leave out the majority that don’t need us, we’ll see that 3% of our patients are going to die.” He saw two affirmative nods and a look at a watch. “2% of the patients,” he continued, “need help but can be transported by a car. But, we’re the richest nation in the world and if we can’t relieve a little pain and provide a little comfort, then what are we doing?” He paused to see if their emotions could still be moved, after years of hardening their shells.

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Chapter 31. The dawning The doctor who had sparred with him spoke again, but this time he sounded like someone interested in doing the best for his patients. “They could come by car, but I see your point. We could do the things we do for everyone, but by selectively reducing some of the people that we see, we could do more for the ones who need it.” OK! The saint thought; he adjusted his stance and then said. “That’s 95% of our patients, and all we do for them is to give them a ride, fight off the inevitable, and make someone comfortable. That’s a lot of money and education for nothing.” “That leaves us with 5% of our patients. The sad thing is, we do a good job 95% of the time when we’re not needed, but when it counts, we don’t do very well.” He stopped and waited for a reaction. If the doctors disagreed, they didn’t show it. “So, we do what a cab driver could do; and you have to give EMS an ‘A’ for our 95% proficiency, even if we kill every patient that really needs us.” The saint had not yet succeeded to make his point; the doctors looked at him as if he were committing genocide. He tried again. “Can you count on every paramedic to handle a life-threatening emergency?” He hit them right between the eyes, and hoped he was ready for the comeback. “We can’t depend on doctors sending us patients with that level of care,” the doctor with the scalded mouth said. They had admitted that things weren’t the way they were supposed to be. The saint continued with more confidence. “We need to stop some of what is running us into the ground. We have to do the job we were designed to do. Some EMS dispatchers screen calls, but people who need the ambulance don’t always call. Those who abuse the system learn the tricks and get their ride and obligate you to a standard of care. We need experienced medics to evaluate them and then follow your orders. If EMS doesn’t do it, nurses will, and we’ll be transporting the same numbers. There aren’t enough nurses, and few that know how to work the street. They’re going to get raped, robbed, and ribbed. They’ll quit, and the idea will die.” The medical director leaned back in his chair and put his hands behind his head. The other two stared at the table. “Both sides get paid and we actually create more jobs but control those that are responsible for the care. Let’s take some old fogeys like me and put them in four-wheel-drive vehicles. I’m getting too old to be on the truck, and there’s no place to put my experience. This would give the younger staff a reason to learn more, and a higher level to work towards.

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The Street Saint We’ll handle what doesn’t need to be transported, and be on serious scenes in seconds. You can pay for my experience, because I’m bringing in more profit, and I will control scenes where young medics are getting their feet wet. I answer directly to you; you get paid for talking, see 50% fewer patients, and get a greater profit margin. The bottom line is: an appropriate level of care for everyone, and a higher profit margin. That’s what the hospital wants to hear.” He then showed other advantages to his plan. “The ambulance would have to respond with lights and sirens about 10% of the time, and have no dry runs. Equipment and insurance costs would go way down, and they would actually only need paramedics for transfers that nurses could do. Only a handful of trucks would be on the street and the number of accidents would go down. People would start to pay attention to sirens again because they wouldn’t be bombarded with them. The government and insurance companies could save millions a year, in this city alone. That money could be spent to defray costs of dental, medical, and optical services for people who don’t have insurance. “We’ve got to do something like this, or everyone with a brain is going to leave or lose his or her mind. I’m tired of the stress. I’ve seen medics handle calls that turned my stomach, and then flip out because someone took the last Coke.” The ER radio that was piped into the break room interrupted him. “Medic 5, Medical Control: inbound patient, report with orders, rush traffic!” The medic on Medic 5 was calm, but experienced ears heard the tension in his voice. “Go ahead, Medic 5, this is Medical Control,” the nurse answered. The break room went silent when the words “rush traffic” were uttered. “I’m inbound with an approximate 25-year-old female patient. Suicide attempt. She was found unresponsive and a number of empty pill bottles were found in the trashcan. We have her trauma-packaged.” His report continued, and when he painted a dismal picture for the patient he also proved that he knew how to remedy it. The medical director had already headed for the door when he heard “suicide attempt,” “unresponsive,” and the sirens. The sirens and the cool calm voice of the veteran paramedic meant nothing to the layman. To the doctor, his eyes, hands, and ears had heard a call for help. His voice came over the intercom, “Medic 5, this is Medical Control. Continue your IVs wide. Place the patient in Trumdelemburg unless it interferes with respiratory effort. Go ahead with your coma of unknown origin protocol. You don’t need to ask for ACLS in cardiac arrest and if you think the patient can take a tube . . . sell ’em one.” He

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Chapter 31. The dawning clicked off the radio and a host of nurses that needed signatures surrounded him. The saint watched as the doctor with the burned mouth entered the GYN room to treat a routine belly pain. They all knew that the 15-year-old girl inside only wanted a free pregnancy test and had been taught that one would be provided as an initial step in assessing her complaint. The third doctor joined the interns at the physician’s desk and signed off on EKGs. The saint knew his speech had been well received. But, in the rush of unnecessary traffic he was so desperately trying to bring to an end, his unsolicited words had been filed in something akin to the X-files somewhere in the doctors’ brains. The saint joined the security guards on the ramp where Medic 5 would soon back in. He took the opportunity to grab a few puffs on a cigarette. He had wanted to continue the conversation with the doctors, but knew it was best left with just his presentation. He at least had gone on record. Medic 5’s siren did a death whine as it came around the corner. It sounded exhausted and glad the run was over. The driver deftly turned and backed into the slip. The back-up alarm clanged in the saint’s ears. He realized that he usually didn’t even notice it when he had a critical patient; the mind was selective. He opened the door and the young woman, who was a little overweight but not bad looking, was sitting up on the cot. She looked at him and as their eyes met he thought, “Whew, she’s got some problems in there!” “Hey, you’re looking better!” The other medic printed an ECG strip while the saint spoke to the patient. “Yeah, I think the Narcan worked,” the other medic said. “Her pupils are normal. Her BP was 100/60, her pulse rate was up to about a 100 and we’re showing a sinus tach,” he said in a droning, singsong voice. He didn’t have to tell the other medic but it was habit, and he was proud of his work. His actions that had restored life in the young woman would soon be forgotten. At most, he would get a “Thank you; good job!” from the receiving physician. He would then answer another call and she would start rehab to return to a “normal” life. The saint would go on. It was routine. Those who claimed medics weren’t needed would say, “It was just a drug overdose, or just a diabetic, or just a slow heart rate, or just a low blood pressure.” The saint released the cot latch. It was time to move the patient. The cot began its journey into daylight while the patient remained in the darkness of her mind. Neither medic would know her future, but hoped she would soon bless every waking day. They both knew, however, that they would most likely see her

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The Street Saint again. When they did, if they succeeded again, they would be angered at being repeatedly tested for what they had already mastered. If they failed, they would silently blame themselves and wonder if they could have done more. That’s why they didn’t celebrate their successes. Someone always remembered when they had failed. CHAPTER 32. THE PROOF IS IN THE PUDDING The paramedics, techs, doctors and nurses filed into the level-one room with the young woman who had decided her life wasn’t worth living. Security followed. She didn’t know it, but she would not be going home. She could ask for help and get it, or deny it and be committed. Her attempt hadn’t killed her, but it had sealed her fate. The team would need to lavage the woman and then pump activated charcoal into her stomach to absorb what toxins the flushing of the lavage had missed. He hated to take part in a lavage; of all the blood and guts the saint encountered, in and out of the emergency room, the surest way to ruin a white uniform was to be in the line of activated charcoal when it didn’t stay where it was put. “Let’s get it started. Someone secure her hands.” The doctor stepped back so the team could work. In the real world, a doctor did little, unlike on TV. Sure, there are procedures only doctors can do, but many of the lifesaving procedures are in a paramedic’s licensure. Ramming a large plastic tube down the throat of a tied-down woman and pumping her stomach full of tap water and then sucking it back could save a life, but no doctor was required. The patient was stripped and inspected for signs of abuse, self-inflected or otherwise. Guards secured her wrists to the bed with four-inch-wide leather restraints. A gown was draped loosely over her front but the blankets were removed from the bed. It wouldn’t be long before running fluids chilled her from the inside out. They would gurgle up and gush from her mouth and nose. Often, patients would urinate from the shock and soil themselves as well. Blankets wouldn’t do any good. Besides, they were a hoarded commodity at that time of year. The evacuator tube was lubed with KY jelly; a jaw screw was placed. The new appliance looked more grotesque than sliding the tube up the nose and then down the throat, but it made things easier for everyone. After considerable gagging by the patient, and sometimes by others in the room, the tube’s position

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Chapter 32. The proof is in the pudding was confirmed. Many liters of water would be pumped down it; if any of that got into her lungs, she would drown. The tube was well placed, and the procedure continued. The woman couldn’t vomit, but the retching sound and her screams for help could still be forced over her vocal chords. It was a mournful sound. The staff ignored it; they were “prejudiced.” The large clear bag at the head of the patient’s bed was filled and a pump was attached. The saint listened to the other medic reiterate the call and checked off the incident in his mind. Doing that allowed him to gain another experience and correct mistakes without being there. But, the call had been “routine,” so the retelling only allowed the other medic to purge. No one ever got used to seeing pretty girls lavaged. Their faces turn crimson from the strain. The water lowers their core temperature and makes them shake uncontrollably. The screw holds their jaws open like a trophy bass. Finally, the pills were sucked up and the activated charcoal pushed down. The patient sat limp and the staff cleared the room. He thought of war footage that showed the aftermath of torture, but he couldn’t feel any remorse for her because she had brought it on her self. EMS people are prejudiced against those who attempt suicide. He felt pity for a small child who had swallowed pills that someone had thoughtlessly left behind, but that wasn’t suicide; and even then, his “pity” had to be set aside. He had a job to do. The medic from the ambulance steadied her head while the nurse withdrew the tube. They didn’t want to make her gag and vomit the charcoal. After the tube cleared, the lady’s wet gown was removed and the restraints were loosened; she could do no harm. One nurse, the saint, and the other medic remained. The saint was leaving when the nurse asked, “Hon, why were you trying to kill yourself?” He was glad he left. He had heard all the reasons. His own depression wouldn’t allow him to call them stupid for feeling the way they felt, but he still had no compassion for them. “I was depressed.” The saint only had two more steps to go before he could shake his head in disgust. “What do you mean, you’re depressed?” the other medic screamed. The saint turned and saw him grab the patient and slam her back onto the cot. “Do you want to see depressed? I’ll show you depressed!” And he slapped her. The nurse froze, with the washcloth still in her hand. The saint thought he had missed something that that would have explained the medic’s actions. The patient must have done something; maybe she’d made a move to grab the nurse,

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The Street Saint The saint felt weak. There was nothing wrong with the patient; it was the medic’s problem. “I’m tired of you people messing up and trying to kill yourself!” He choked the woman. The nurse tried to pull his hands free, but she couldn’t break his death grip. Whatever had sent the medic into his rage had made him too powerful. The patient lay bug-eyed under the assault of the deranged medic. “Hey!” the saint yelled. He didn’t know what to do. He hoped his verbal intervention would stop the bizarre display. “Come on, man, let her go! What’s wrong with you?” the saint screamed while he pulled at the flipped-out medic’s arm, but his strength was superhuman. The girl’s face was turning blue and was frozen with terror at the betrayal by one that she had trusted, and the horror of not being able to breathe. “Damn it!” The saint didn’t know how to proceed, and the sinner knew only one way to react. He threw his left arm around the medic’s neck so that the bend of his elbow locked across the medic’s windpipe. He slammed his right arm into the back of the psycho saint’s head — a maneuver he was taught in the army. His goal was to remove the hands that had saved so many lives from the throat of someone who had tried to take her own: the same hands that had saved her just moments before. The sinner never hesitated to do what was needed; the saint only regretted that he had to be the one to do it. The patient’s depression had set off an even deeper depression in her rescuer. She had triggered his frustrations over being used. The saint stunned the other medic enough to clear his hands from the woman’s throat; took him to the ground; and heard footsteps in the hall. Their raised voices had alerted security. Not surprisingly, the security guards looked suspiciously at the saint; he had attacked a renowned worker. “He’s gone 96!” the saint barked. “Let’s get him restrained or I’m going to have to hurt him!” The sinner spat a promise. He kept a secure hold on the head that he knew was usually as cool as his own. He felt sad in his victory. He understood how the other medic had felt, and remembered doing similar things to other “patients,” but those battles had taken place by design and in front of the staff so they could document his professionalism before, during, and after the battle. He had grabbed patients by the throat, too, but never unprovoked. The medic under him could have fought better. They had battled with others before, so the saint was familiar with his battle readiness. In fact, he’d had second thoughts as he grabbed for him. He worried that his age, brace, and

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Chapter 33. He’s always been crazy, but that’s what’s kept him sane constant pain, that might have handed him his first defeat. But the man had gone down easily. He was breathing faster than his physical exertion warranted. He had snapped. She had been the straw that broke his emotional back. It would have been different if she had been a man who was whacked out on drugs or had killed a family in a car wreck. His attack could have been silently appreciated, then. “It wasn’t the call!” the saint said loudly, while he dusted off his pants. His back ached a little and his armpits hurt where his brace had pinched him. He had chosen the wrong time to react to conditions. He couldn’t control that reaction, but he immediately returned to himself after being pinned and cuffed. The saint looked through the legs of the officers and heard the medic say that he was alright, but the saint saw something different in his eyes. As the officers led him away, the saint saw the three doctors he had spoken with earlier about his idea. They were part of the group of spectators who had stood in disbelief and shared in the sadness of the spectacle. “It wasn’t the call, I’m telling you . . . it’s the bull!” He wanted to tell the mob of would-be patients what they had caused. He wanted one of them to say something so he could finish the fight that he had just refused to finish. “It’s bull!” He yelled again; no one accepted his challenge. He walked out the automatic doors and climbed into the truck and lit a cigarette. The silence of the crowd was not cowardice, and he knew that. They knew he too was just a couple of steps away from restraints. The others in the ER had enjoyed the show and went back to waiting for their free Tylenol. He sat for a minute and started to regret what he had just done; but then he decided to dump it into the trash bin of his mind where he stored things he didn’t want to remember. He grabbed the mike and said, “Dispatch, show me 1008!” That meant he was in service and ready for a call. CHAPTER 33. HE’S ALWAYS BEEN CRAZY, BUT THAT’S WHAT’S KEPT HIM SANE “What the hell was that all about?” Ricky asked, after he climbed behind the wheel. “Oh, I think he had just had enough,” the saint answered without turning from the window. He concentrated on the drops of blood left on the concrete from an assortment of injuries he could no longer remember. “He just picked the wrong patient to go off on, that’s all. I wish he had choked her to death. Maybe if people thought we’d choke them to death if they bothered us, some of this would

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The Street Saint stop. But, I guess that’s not the answer either.” The saint took a drag from his cigarette and turned his thoughts to the other medic, now patient, inside the facility. “He’ll get some time off now. I just wish I hadn’t had to take him out. I don’t feel good about that,” the saint said while he unwrapped his third pack of cigarettes for the day. “Yeah,” Ricky replied; but he couldn’t resist further intimidating the saint. “Well, you’re lucky you took him from behind. If he had known you were coming, the docs would be working on you.” Ricky still maintained his ignorance. The saint wanted to remind him that he could have killed the other medic with the hold he had used, but he was too tired and disgusted to care any longer. The saint thought about the idea of putting medics alone on the street so they could ward off the unnecessary calls and get to those who needed real help quicker. What if that medic had “gone off” with the woman, alone in her house? No one would have been there to stop him, and she would be dead. But that was a ridiculous thought: the new system the saint had proposed would have avoided the frustrations and tensions that had led to the outburst. Maybe his field physician assistants couldn’t even be started in the field. Maybe they would have to work in triage at the hospitals and then be allowed to suggest alternative treatments before discharging the patient. The ambulance would still have to transport, but the admission would be halted at the door. That also meant that even more people would call the ambulance, in hopes of dodging the triage medic. They already believed that alleging “chest pain” and “difficulty breathing” to the dispatcher got them preferred treatment. He began to picture other ways that his plan could be doomed from the start by those who would see another opportunity to form a clique, inflate an ego, or make more money. His head spun. The bottom of the food chain couldn’t decide what was on the dinner table; they had to leave their existence to the discretion of the predator. His idea could easily become another lesson in futility. The medic who lay sedated in the emergency room would undergo a psychological evaluation. It would be determined that either his father hadn’t loved him, his mother had weaned him too fast, he suspected his wife was having an affair, he suffered from sleep deprivation and too many hours worked, or some sort of family history that would earn the man a vacation; maybe a disability. No one would suspect that he had lost his mind because his job had become too “easy.” He would be medicated when he returned to work and then would quit taking the medications because he couldn’t function on them. The only thing

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Chapter 33. He’s always been crazy, but that’s what’s kept him sane that would be mentioned about his job in his diagnosis would be the “stress” and the hours that he had worked. The stress that had caused the breakdown would be misinterpreted, based on car wrecks, cardiac arrests, bullet-riddled children, and, probably, being under educated for the job. No one would dare say that he, Ann, and many others had lost control because they were repeatedly ordered to handle patients who should have taken a Tylenol and stayed home. The saint was stressed because he knew the solution to the problem, but could do nothing about it. He had to watch millions of dollars a year spent for services that were not needed, while money was not spent on things that could have increased the efficiency of his job. He knew of the big salaries that were paid to those who ran the show, the cost to the government that caring for people who had refused to care for themselves entailed. There was little money left over for guys like him. If he was going to work amongst thieves he should have at least gotten his cut of the bounty. If he was going to work for profit he shouldn’t be asked to do things in the name of dedication. He was respected in the eye of the general public but to most of his patients he was the white guy who had gotten his job because he was white. They expected him to respect them and to be happy that he had the privilege of being paid so well as the driver of the cab with red lights. Part of the medic’s stress came from the fact that when his children had needed medical care, his insurance company told him when and where he could see a doctor. He, even though a paramedic, had to call a nurse who worked for his HMO’s hotline. She may not be good enough to get a job in the hospital but she was good enough to tell him over the phone whether or not his family was sick. He was good enough to accept the responsibility of saving a life, but couldn’t get permission to treat a headache. Should he blow the whistle, or sit tight and make the best of it? He had other options. The medic lying in dreamland in the hospital had taken the best one; he might be able to retire. The saint had lost a lot of pride, but he couldn’t go out that way. He would just quit. Ricky would be glad to see him go. And he could always go see some of the old timers from time to time and appease his need for a rush by talking over old calls. His ego could be falsely boosted, like the young who would be left to serve. People would die, but people were doing that, already. He ignored Ricky’s comments. When the story was repeated, Ricky would see to it that he was the hero or at least the saint had done nothing. It was best just to turn and look out the window. The saint had made up his mind. The best

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way to win the battle was not to fight it. The best thing to do was to retreat. It was no longer a battle concerning life, ethics, or pride, but a battle of survival. His life on the street was coming to an end. He was in triage mode, and he had become the only patient. He could no longer handle the nursing home circuit where people lived far beyond their natural years. He could no longer drag people who should be in long-term facilities out of homes they had stayed in because the family wouldn’t give up the check they got for allegedly providing care. He no longer felt obliged to consider the wellbeing of the many. His ethics had changed; maybe he no longer had any. He tried to pull back some of what he once had by focusing on a call he had often used to see if his emotional level still held its bubble between the lines. He was doing that more and more lately. He thought about sharing the story with Ricky, but he knew better. He relived it for his own benefit and to see if his attitude had changed. The call had taken place years before, while he still worked for a rural service. The intercom had barked and awakened him and his partner just minutes before they were to go off duty. “Need an ALS crew down here at the end of the road . . . shots fired . . . man down. The RP says it’s a gunshot wound to the head. Be careful, the sheriff is en route.” Sleep was still in the boss’s voice. The saint rolled off the couch and his partner came sleepy-eyed from the back room. “Did she say, ‘gunshot wound’?” he asked, while hopping up and down to get his duty boots on. “Yeah, and it ain’t deer season.” They went down the stairs without discussing who went first. His driver clicked the batteries and brought the rig to life. The truck shot gravel from under its tires. A deputy’s car blew the doors off the ambulance and cut off the last part of their directions. His driver yelled at the deputy while he tried to hold the box-styled ambulance on the narrow asphalt road. “Normally, I would agree, Bud,” the saint said. “This time, let him go. There’s a man down from a gunshot wound and we don’t know why. I want to know who has the gun and what they’re planning to do with it.” They turned into a small cluster of homes that bordered the lake, and posted there until the deputy said the scene was safe for them to enter. The saint was the first to reach the man, who was on his back. He wore a robe and a T-shirt but was nude from the waist down. His legs had been wrapped in an Ace wrap. A bullet hole cyclopsed his forehead. The deputy

pointed out a bullet scar on the bark of the oak tree behind the man. Lying next to him were several envelopes that had been sealed carefully in Saran Wrap. They were addressed to men with the same last names and a woman whose last name was different. There was one letter addressed to an attorney. The man was dead, and it looked like all his children lived out of town. The deputy said the coroner was en route and that he had recovered the weapon. He was confident the man had committed suicide. “Why are his legs wrapped like that and why doesn’t he have on pants?” his partner asked. “I’d say congestive heart failure,” the saint said. “Wrapping his legs would keep the swelling down.” The saint looked at the scene and then added, “He planned this well.” The dead man’s neighbor approached from his yard. “I can’t believe he did it!” the neighbor began. “He’s been out of the University Hospital about a week and he told me the other day he’s going to have to go back. He was worried he would have to sell the house to pay the bills.” The saint looked at the man and nodded. He understood. Then he thought of the University. “That’s a state-funded hospital,” the saint stood shocked. “He doesn’t have to pay!” The coroner pulled up, and jumped out. “What do we have here?” he asked. “It’s a suicide,” the deputy answered. The saint caught the questioning look from the doctor, who had often worked feverishly on scenes with him. “He’s gone, Doc.” The saint answered the unspoken question. “The bullet went right through the middle of his head. He planned it well. He even stood in front of the tree so he would know the bullet was stopped.” The saint offered what he had deduced. He wanted to impress the coroner with his investigation and show the man who was also a doctor that the saint had only honored a dead man’s last request. “You know,” the neighbor interjected before the doctor could speak, “he knew I walked my dog every morning at 7:00. I had just walked by, heading that way,” the neighbor pointed down the gravel road. “I heard the gunshot, ran back, and found him like this. I didn’t move anything before I called you guys.” That confirmed the saint’s suspicions. “You had a short ETA and a short down time.” The coroner’s statement demanded an answer. “Take a look, Doc. He took his pants off so he wouldn’t mess them. He timed his neighbor so he’d be found right away. He stood in front of the tree so he wouldn’t hurt anyone. He wrapped the letters to keep them clean. He planned

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The Street Saint to die and took every precaution to make it as easy as he could on everyone. We’re not even going to have any trouble loading him for the morgue. I let him go. That’s where he wants to be. But, I’ll tell you, if I had known that he had done it over a hospital bill, I would’ve gotten a pulse so he could have lived on life support. I thought he did it because he didn’t want to suffer any longer.” There had been a sincere apology in his voice, but also anger for the system. The system had made the man take his life because they charged too much for saving it. “I know what you mean.” The coroner said, while he opened the first letter. After he read, it he cleared his voice so he could speak. “Gentlemen,” the coroner began, “the house we’re standing in front of was purchased forty years ago by this man who worked overtime and his wife took in laundry to give their children a place to vacation. They came here for family reunions and such. I assume this letter was to his son. He says he doesn’t want the family to lose something their mother and he had worked so hard to give them.” He says here, “My greatest gift to you will be to leave now, live in your memories, and build you a better place with your mother . . . yeah, it’s his son. It’s signed, ‘I love you, Dad.’” “Son-of-a-bitch!” the saint said. He walked to the side of his truck. He turned his monitor on where it sat and recorded two leads of Asystole . . . flat line . . . proof that no resuscitation had been warranted. He returned to the coroner. “He’s dead, Doc!” He said while he handed the strips to the coroner, “Here’s the proof! Do you want me to call the hospital for permission to DNR, or do you want to handle it?” the saint asked, using proof he blatantly had acquired thirty feet from the patient. “He’s dead!” The coroner didn’t say anything, for a minute. He just looked at the saint. The coroner was also the doctor who could pull the saint’s license. “He’s dead,” he parroted. “What time do you have?” The saint pointed to the strips and read aloud the time that the computer had printed. “He’s dead,” the coroner repeated, and issued an unneeded warning. “But if you ever come upon some 16-year-old kid who shot himself because his girlfriend dumped him, you’d better be working like crazy when I get there, is that understood?” The doctor had agreed with the saint on that day’s problem, but he had also made it clear that he didn’t think life was expendable. “That’s understood, Doc, and you know you wouldn’t have to worry about that,” the saint said. “Medic 22, Dispatch!” His emotions would only allow him to bark into the microphone. He called from outside the truck as if he had to clear his mind

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Chapter 34. To be or not to be? Ah, that’s too deep! Just do it! before entering. The boss answered, knowing that if the saint had time to talk, the news for the family wasn’t good. “We’re 10-8, 10-24, 10-22 coroner on scene.” He said that he was in service with his unit, his assignment had been completed, and the coroner on the scene had disregarded them. There would be no paperwork to file. He asked without waiting for an answer, “Is my relief in?” She heard his false apathy. The hardest part of that call for the saint was that there was nothing that could have been done. Not much of a story to tell. The gist of it was that he was a paramedic who had found a dead body. He could only tell his wife that the patient was shot in the head and nothing could be done. She had talked with him before about playing God. She only would have been upset if she had heard the details. He reviewed the scenario again in his mind while he rode silently with Ricky, and he asked himself for the hundredth time: Would he feel differently today? His answer told his future. “Yeah, I wouldn’t have waited for the cops, because they would have been somewhere else. I would have chanced going in alone. There was no way the coroner would have been there that fast, and I wouldn’t have gone through the trouble of running the strips. The cop was a deputy coroner and had already pronounced him, so I wouldn’t have to be concerned with it. The investigation of the shooting was not my problem and I only would have tried to solve it for my own benefit. The reason for the suicide wouldn’t have affected my decision.” The saint could still see the man lying in a pool of blood, but for the first time saw him as a fool. Experience had taught him that the man could have sold the house to the kids and then gone on welfare. The hospital only threatened collection so they could write the bill off their taxes because a conservative form of government had allegedly cut spending. He no longer felt any remorse. He could still feel the pain the family must have felt, but they were not his responsibility. He no longer questioned his decision. The only thing that bothered him now was that he had been bothered for so long. With the realization that his attitude had changed, he had more to think about and decisions to make. His life as the saint was over. CHAPTER 34. TO BE OR NOT TO BE? AH, THAT’S TOO DEEP! JUST DO IT! If he had been with another medic, someone who could understand, someone who didn’t fear expressing his feelings, maybe he could have discussed his. Not with Ricky. He then realized he had been soft too long. It was not his

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The Street Saint truck to share; it was his truck, period. There had been too much “buddy time” among crewmembers, too much “let’s make friends and ride around together” and too little old-fashioned discipline. Asking someone to do his job should not mean asking a favor. “Dispatch, 50.” He reached to answer the call and Ricky said, “I can do it.” “You keep both your hands where they belong!” the saint pointed to the steering wheel. “That’s the way you were taught to drive and that’s how you’re going to do it!” The saint’s bark drew a surprised look. “I always run the radio.” Ricky prefaced his retort with an obscenity, as people at loss for words usually do. The sinner answered Ricky in kind, and rejected his reasoning for operating the radio. “I always let you run the radio. This is my truck, and today you’re going to see how we’re supposed to do things, not the way you kids have turned it around.” He turned his attention towards the assignment not yet dispatched and said into the radio, “Go ahead, Dispatch, this is 50.” “Need you to respond to a 10-50 on the bridge. They say there are bodies all over the road and a car is on fire. Must be three or four cars involved.” “That’s clear. Show us en route.” He flipped the lights into action. He looked at Ricky and said, “Just drive. That’s your job and if you don’t do exactly what I say on this run, I will have your job and your license, and will kick your little ass! Now, tell me I’m too old or too stupid to do any of the three.” Ricky responded the only way he knew how. “Well, at least driving with two hands hasn’t limited your vocabulary. “Dispatch, get me everything we’ve got going that way. I may need extrication, so call mutual aid and get the big rescue truck. Contact medical control and advise them I’m en route to a potential mass casualty. Tell them I’m going to need a bed count and what facilities can handle what. You got that?” “What?” Geraldine was the dispatcher on duty. A medic had never given her instructions before. Even if the others had known what to do, they tried to speak with her as little as possible. “Call the resource hospital and tell them it looks like I have a mass casualty on the bridge! I’m on the HEAR radio. Tell them to get ready, and advise me of what to do. You got that?” He thought he had made it simple enough. “OK . . .” The sound of her voice gave him a chill. He knew that instead of following his orders, she would call the boss. The boss didn’t like requesting help; he ran his company, and he would call the shots.

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Chapter 34. To be or not to be? Ah, that’s too deep! Just do it! He felt the tension in the cab as Ricky sauntered down the road at about 40 mph. “Is there something that you’re waiting for?” the saint asked. “I’ve never complained about your driving, even though most of the time it’s too fast, but if you don’t get me to that scene, I’m going to throw you out!” “Call our fire department; we don’t have to mutual aid.” The shift supervisor had spoken. Everyone prejudged the situation, because they received calls every day from people who described horrible accidents and when the crews arrived, they found people who only wanted to file a police report. So today, help would not be expedited, but at least his company’s other units were on the way — he thought. The mutual aid request had been squashed. He knew Geraldine wouldn’t call the resource hospital, so there weren’t any trauma teams setting up for his arrival. His company’s job was to get people to the hospital. After the patient was delivered there, it was the hospital’s job to do the best they could. “You need two people in the ambulance to respond.” Ricky snapped back, but still he drove a little faster. That much of the saint’s plan had worked. “And you think they’re going to fault me for putting a paramedic on the scene alone to save lives while he waited for a driver? By the way, son, the law was written back in the day when we were short and didn’t put up with you punk kids. I can respond by myself if there are no other units in the vicinity, and I can transport by myself with a civilian driving as long as I can document that trucks weren’t available. I’ve done it before. There’ll be EMTs on that bridge dying to do something.” He reached for the trauma radio, already knowing that the dispatcher had not followed his instructions. There was a reason for those instructions. By following such a plan, he had once been the only person to ever put a critical patient in a level-one facility 92 miles away inside the “Golden Hour.” He wanted to do the impossible again, for those who had never seen it done. He wasn’t a saint. He had never seen any godlike qualities in himself. He was human. He wasn’t over educated. He was experienced, but he knew there were others with just as much experience. He had just done his job as well as one could. He believed people smarter than he was had written the books and he believed those writings had been proven correct — although there were times when a little amending and rewriting were necessary. “4 Alpha 19 medical control,” he said into the trauma radio. “MCIC requested.” The words felt strange in his mouth; he had never used them in the city.

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The Street Saint “What are you doing?” Ricky screamed over the top of the sirens. “I’m doing something you and your little buddies have never seen; I’m doing it the way it is supposed to be done.” This would be an event that most EMTs dreamed about. He had spoken with the woman who answered the radio many times before, but suddenly her voice sounded different. Background noises were strangely absent from the emergency room. He had ordered Mass Casualty Incident Command. Alpha 19 would be designated command and all orders would be channeled through it. He told the hospital what he knew and requested they give him a bed count. They granted command instantly and it took only a moment for the woman on the radio to read off the computer screen and tell him what hospitals could accept what level patient. His mind was whirling, but it felt good. He was back in control. He was working by the book, the way he had done for years before the mayhem had started. This call was going to be his piece de resistance. He was not going to tolerate and ignore the actions of those around him. “Ricky, if this is bad, I’m going to start on the first one that’s serious. I’ll need you to triage the rest,” he said as he hung up the microphone. Ricky tried to show his skepticism. “Let’s just see what we’ve got.” Ricky knew he would have the radio on the scene and would be in control. Ricky also liked the adrenaline rush that disorganized scenes brought. “By-the-book scenes” were boring. Unfortunately, the only time the saint had ever seen a scene run by the book was in his days in the rural area where he swooped in, stabilized, and sent his patients flying to a level-one trauma center 100 miles away. Ricky snaked their way through the traffic. At times, the unit seemed to exhale so it could squeeze through narrow pathways. Some of the drivers moved their vehicles to the right and stopped, as they should have done. Some moved to the right and only slowed; that action scared emergency responders because a moving vehicle cannot be trusted. Some moved to the left because it seemed like the thing to do; and some held their position. As usual, the drivers had interpreted the law to best convenience them. The traffic became a parking lot without lines. Ricky reduced his speed. The slow-moving traffic, the urgency of those who lay dying and the ever-present wail of the siren added to the growing anxiety shared between them. The cars that impeded their progress would later be acknowledged in his report when the saint explained why it had taken his

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Chapter 34. To be or not to be? Ah, that’s too deep! Just do it! crew three minutes to drive a mile. The ignorance of the other drivers would be discussed for days in squad and emergency rooms. Could it be that people had seen so many emergency vehicles that the significance of them had been lost? As they neared the accident scene, the traffic ahead coalesced into a dam of metal and windshields, a barrier that could not be gone around because of the bridge’s concrete embankments. After what felt like an eternity, and still a full quarter mile from the accident, the saint said, “There!” He pointed to a billowing cloud of black smoke that bubbled skyward. They hadn’t gotten much closer when he saw the head of the fire. Its mane glowed gold and crimson. Even above the sirens, and rude remarks made by drivers, they could hear its roar. If the people in that car had waited for the saint to save them, they were dead. If they had been thrown clear, they had a chance. The saint hoped they had neglected to fasten their seat belts. He would have felt easier if the car had stood alone while it burned, but no, there were vehicles scattered all across the four-lane highway. They were not positioned as if to stop and help; they were tossed hither and thither as though a child had scattered them. “Do you want to walk?” Ricky asked. The sinner asked in disbelief. “You’re kidding, right?” “I was just thinking that, maybe with a jump bag, you could get up there quicker.” That was the first time Ricky had ever acknowledged that maybe the saint could make a difference. The saint didn’t know if Ricky had said it out of respect or frustration; maybe Ricky just wanted to call on scene so he could show a good response time. However, packing a jump kit through a quarter mile of traffic with limited supplies, alone, and without communication would have been more foolish than heroic. One of the pitfalls of mass casualty, he had learned at the school of hard knocks, was losing contact with others. He had no intention of starting the rescue out of touch; things were going to get worse before they got better. What appeared at first to be correct often was later belied. Good intentions could not be used in a courtroom and were not tolerated under the unforgiving eye of review. “He froze, he panicked, it got to him, he was overwhelmed, and no one could have done any better under the stress” — those were some of the things he had used to defend others. He would never use them for himself. He felt an urgency to prove. He would draw a picture to show others if need be. His canvas lay in front of him. His tools, his colors, were limited and would dry if he delayed. His masterpiece would hang in the gallery of his mind

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The Street Saint and maybe he would be the only one to appreciate its beauty. His patients would benefit and the artist’s reward would be his. If nothing more ever came of his career, he would know that all he had hoped to become had been with him all along. He never got through the traffic. The scene swallowed him like a great monster. From the depth of the belly of the beast was where he worked. He snatched the inflicted and made the beast regurgitate them. He was there for those who needed rescue. “50, Dispatch.” He had already started his scene appraisal. If he had taken Ricky’s suggested hike, he would still not have been on scene and he would not have had any communication. Before he could relay everything he saw, someone was pounding on his window. “Get them out! They’re not dead!” the woman screamed through the glass. “Stand by, Dispatch!” He said, while he rolled down his window. “Who’s not dead?” “My friends are in the convertible; they’re unconscious, but they’re not dead! I was thrown out!” His wish had been granted, for one at least. “My boyfriend’s hurt bad . . . he was thrown out, too.” She pointed to the other side of the car towards the unseen and continued to yell, “On the ground, on the other side . . . you can’t see him from here!” She had managed to contain her hysteria long enough to bring the saint up to speed. He was impressed with her control and decided to rely on any other information she might be able to relay. “Did the people get out of the car that’s burning?” he asked while he opened the door. While she answered, he popped open the side door and pulled his jump kit. “The boy did.” He could tell by her frown that she was rewinding the video that her brain had recorded. “But I think the man’s still in there. There are people down there in that van, too.” She pointed a full 100 yards down the road. “But you have to help my friends first! They’re closest, and you’re right here!” She raised her voice a little and pulled on the saint’s arm; he felt sticky moisture adhere to him and realized the woman’s hands were covered with blood. He started to object to the contamination but rationalized that he would soon be bathing in different blood types anyway. “I’m going to look, but I’m going to see everyone,” he told her, and kept to the promise he had made himself concerning the scene.

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Chapter 34. To be or not to be? Ah, that’s too deep! Just do it! He walked towards the new black Lexus convertible that was the center of her concern. It was the closest, and it was a good place to start. He could see two heads that didn’t move; the front of the car was all but gone, and once the fire department extricated the two people trapped inside, it would be unsalvageable. He read the crushed front end as injury to the occupants; it would have to be reported later to the attending physician. A few steps closer and the saint could see that the driver sat, trapped. He could be dead, unconscious, or in a drunken stupor. Two more steps and he saw the steering wheel crushed against the driver’s chest. No matter what his blood alcohol level, the driver was a lot more than just drunk. The windshield had exploded from its frame. Either the impact had shattered it or, more probably, a passenger had gone through it. That passenger, the saint knew, must be lying on the ground on the other side. He should be dead. There are times when medical workers hope for the worst, for the minority, so more time can be given to those who would better benefit from their skills. This was one of those times. The saint wanted to move faster, but he kept his steps deliberate. Even though there was no time to plan, each of his movements had to have purpose, or be wasted. He absorbed what information he needed as he moved around the front of the car. The woman’s boyfriend lay where she had said. The saint could only tell the sex of the passenger because the woman had said “boyfriend.” He had slid on the asphalt and burned a lot of the flesh from his body. His face was nearly gone, and with it, a good piece of his skull. The windshield may have caused the wound, or he may have encountered the frame, or he may have struck the bridge embankment. Either way, part of the passenger’s head had done combat and lost. The bridge had fought that battle before, and had never tasted defeat. The man’s death was imminent and the medic would let nature take its course. If he had had no other patients, he would have transported; and a doctor would have agreed with him. “Get me ETAs!” the saint yelled in Ricky’s direction. Ricky stood by, looking as if he wanted something to do but didn’t know which way to go. Deep down, the saint wasn’t feeling any differently, but it was his call. Ricky would not be considered in the review, but Ricky would be part of the review process. Ricky would pick the saint’s actions apart, as the young always did, but the saint wouldn’t say anything about how Ricky had stood clutching the radio while he adjusted to the carnage. The saint would have to answer the questions and try to

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The Street Saint sleep later that night, and many nights to come, with the thought of where his split-second decisions had taken his patients. “50, Dispatch,” he heard Ricky say, while he knelt over the man for another second. Then he said, “He’s gone.” The saint moved to the car. “Go ahead, 50,” the dispatcher answered, as if nothing was going on. She would have liked to have kept it that way. “What’s the ETA of our units?” Ricky asked. “We’ve got a bunch of patients up here and my medic wants an ETA!” Experience had taught him to say, “My medic wants . . . ,” so the medic could be blamed when others accused him of talking on the radio and not scooping and running for the hospital. “I don’t know.” “What does she mean; she doesn’t know?” the saint yelled while he suctioned the throat of the driver who was pinned by the steering wheel. The dispatcher explained, before Ricky could ask. “I’ve got a battery patient at the PD and PD is on the scene of another battery, and the supervisor told me to divert our trucks to them. I called in a couple of trucks from the surrounding area.” “What!” the sinner exploded. “Are they out of their minds?” He inserted an oral airway, and moved quickly to a woman in the back seat whose legs were spread around the driver’s bucket seat. She hugged the seat with her whole body; her chest heaved every time she breathed. The screams and crying of other patients were louder than he had noticed on similar scenes. The roar of the adrenaline in his ears equaled the rumble of the flames that fully engulfed the car nearby. His heart drummed as loudly as the pistons in his diesel engine idling a few feet away. Hearing anything as intimate as air entering and leaving lungs was impossible. The saint worked from experience. He would act based on similar injuries that he had handled before. The rules of triage prevented him from doing much: “If they’re dead or dying, move on.” Politics had taken the help that he badly needed, and sent it elsewhere. The burning car was next. The human being who sat melted into the steering wheel, fingers burned off, face devoured in flames, was dead. There was nothing that a paramedic could do. The fire department would bring four men to squirt water so a tow truck could drag the car away. There was a good chance the tow truck would arrive before the next ambulance did. Before leaving the car, he noted the deformity to the driver’s side front fender and saw that the other side had been smashed up against the bridge. He

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Chapter 34. To be or not to be? Ah, that’s too deep! Just do it! wondered how the boy had gotten out and away; that was too much to think about. He had patients he hadn’t seen yet; that man was dead, too. He would remember what he saw and reiterate it later when he documented the reason for leaving him. He was sure he would have no problem remembering the melted face and deformed hands. Triaged patients have to be able to survive on their own. He looked for those patients when he walked up the bridge. It was impossible to tell who would definitely survive, but there were ways to tell who was definitely going to die. They had to be eliminated. It was a perverted way to look at things, but it was part of EMS. It was not hard to call dead what had obviously died, but it was tough to walk away and let someone go. The saint usually gave them an extra second so they wouldn’t fool him, but that extra consideration was only for his peace of mind. He wondered how many more of those final decisions he would have to make while his supervisor deployed resources elsewhere to gain popularity and praise. He wondered if the man knew that, while stroking politicians and the police, he had left one medic to face a nightmare unmatched on any battlefield. If his field physician’s assistant program had been initiated, the scene would have been crawling with senior medics and the drunk with the bump on his head would still be at the police station after being given an aspirin and a cell. Instead, the saint circled the wounded, opened an airway, and moved on. The length of time he would have to maintain that vulture like hovering was not clear. The condition of other patients yet unseen was unknown. He had to ignore the cries, “Do something for them!” so he could continue the assembly line of averted disaster. He stopped to check on a teen, who stood staring into the flames. “Son, move back in case that blows,” the saint offered, but while he said it his experienced eye picked up on something wrong. Others might have interpreted it as horror for the scene that had mesmerized the youth. “My Dad’s in there,” the young man said, calmly. The teen’s left hand moved quickly to his upper left side of his abdomen when he spoke. Another patient, the saint thought. “I know, son,” he said. “We’re doing all we can for him.” It made his actions sound heroic, and he hadn’t lied. He was doing all he could for the father that still burned in the family car. The saint changed the subject to one more relevant to that place and time. “How did you get out of the car?” He never lied to a

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The Street Saint patient, but there was a time and a place for the truth. The boy couldn’t yet accept the truth; but he knew. “I don’t know how I got out.” The saint pressed on the young man’s stomach where he had seen him touch. The teen winced. The saint felt a stomach firmer than he would have suspected. “What’s the last thing you remember? I need you to lie down.” He pulled the boy to the bridge to stabilize his blood pressure. The boy said he saw the Lexus coming at them and his dad swerved, was struck, and their car slammed into the bridge and burst into flames. The saint grabbed a hunk of fender well that had been conveniently thrown nearby and slid it under the boy’s feet. “I got out the window and went for my dad, but it was burning too bad.” The saint looked at the car where the man was being cremated, and noted that the driver’s door had been pushed deeply into the passenger compartment. The father had never felt the heat of the flames; he had been crushed before it burned. The saint could forgive himself, then, for not getting there faster. He made a mental note to pass that on to the family; the man had not suffered. His main concern for the family now was helping the boy. He had resorted to “Boy Scout technology” to treat. He had no time to start the two large-bore IVs that the patient needed. “The truth” had to be ever present in his mind. He knew “the truth” concerning the boy he would try to treat later. The saint would report, “He has a distended, rigid abdomen, with guarding and tenderness.” A doctor would send him to surgery with a diagnosis. It was the saint’s job to package, load, and start IVs en route. That would give the patient more time for the doctor to discover what the saint already knew. The truth was that the boy’s spleen was damaged and only his youthfulness had kept him standing. The truth was, too, that the boy would lie on the bridge deck for who knew how long while the saint’s supervisor made points with local politicians. The truth also was that the police wanted someone to say their prisoner could be taken to jail, or take the prisoner of their hands and transport him to the hospital. The truth was that the paramedic could only transport and could not legally clear the patient for incarceration. The truth was that the prisoner would make the ultimate decision himself, opting to lie in a hospital bed and watch television while his bond money was being gathered. The truth was that those not in need of emergency medical treatment and unable to pay for it, and those who continued to live with people they knew were violent, had demanded

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Chapter 34. To be or not to be? Ah, that’s too deep! Just do it! treatment; and because of that, irreproachable people lay dying. The saint moved on. The saint yelled over the chaos. “Is the bleeding controlled? And get that girl on O2, I’m checking this car and we’re going to go around again . . . I’ve got two critical and one serious. Sounds like you’ve got two serious ones . . . give me the radio, I’ll call it in.” He approached another car and tried to put the burning vehicle out of his mind. The fire department, undermanned and overworked saving deserted structures, had either been busy elsewhere or the crew on duty had not seen any reason to respond any faster than the halted traffic. He passed Ricky, who said, “Got a man over there with a bunch of his leg missing and a girl that is lethargic — I’m going to look for more.” “What do you need it for?” Ricky stood and gripped it tightly. “I’m MCIC; I need to call it in.” Ricky ignored the unfamiliar procedure. He plainly said what he thought about it and then added, “I ain’t calling in reports. We’re taking them to the closest, like we always do!” He had the radio. That was that. The saint could argue with Ricky’s childish stubbornness, or he could work. There was no sense calling for a supervisor or arguing with Ricky. His work had more purpose. There were other areas that could have been brought in, but they hadn’t been called. Where tax money was sufficient, so were personnel. In areas where disease, crime, and rotten surroundings were an everyday occurrence, there were few workers. The public would understand and the media wouldn’t know; he wasn’t allowed to tell them. Winning an argument on the bridge with Ricky would solve nothing. People would remember that the two white men in white shirts, illuminated by a fire, on a scene that was rapidly turning more fatal, argued and did nothing while people died. Ricky’s lack of experience, education, training, and seasoning could be used as excuses. The saint didn’t have that luxury. The saint’s authority again had been plucked from him, this time because of the lack of funds for two radios. Ricky knew that getting the injured to the local hospital would keep others from discovering his shortcomings. The supervisor had spoken. The scene was theirs and theirs alone. Maybe Ricky was right. Not going along with the situation made the one who was trying to function correctly wrong. It was perverted, but it was “the truth.” “Ricky, do what you can for them.” The saint surrendered. “I’m going to check on these . . . ”

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The Street Saint After he had taken a few steps, towards the last car, he turned and yelled, “Check those people along the side of the bridge . . . I think some of them might have been in the cars.” He suddenly heard the sound of a crying child. Hell! He didn’t bother to hide his frustration. He looked in through the driver’s window. A woman, maybe 30, had slumped over onto her right side. The car seat in which she had carefully placed her toddler supported part of her upper body. Her face and blouse were covered with blood. The saint looked at her chest. It moved, slowly, erratically — but she breathed. The child was squashed under her upper body. He had no time to try to put together the mechanism of injury. The child’s seat was turned, still secured . . . maybe not tight enough originally . . . no matter . . . Mom pinned her child. The child was covered in blood . . . mom’s . . . his? Don’t know but a young child isn’t going to tolerate much blood loss. The saint tried the driver’s door. No luck. He ran around the car . . . the child’s crying was becoming weaker and more irregular. The driver’s door would have been his best avenue, but he couldn’t get in either side. His gut was telling him that the child needed to be tended to quickly, or would die. The window was down and the mother lay between the dying and the rescuer. She had, some time earlier that day, carefully secured her son in his seat in case of just such an emergency. There was no way to get to the child rapidly without going over the top of the 115-pound woman. Maybe he could pull her from the car and place her on the ground. Her thick blonde hair lay soaked and clotted with blood. He shined his small pen light into the compartment and saw that the rear view mirror had been broken . . . jagged edged . . . the windshield behind it was starred . . . the steering wheel was bent . . . blood ran down the front of the console and formed a river that led to the ash tray. There in the tray he saw the answer that told him what he had to do: part of the young mother’s brains. He put the light away and forced his large frame through the window far enough for him to reach the top of her head. The moment of truth: was she salvageable? Quality of life passed through his mind. The child, whose cry had been reduced to an insignificant grunt, would be without a mother if he did what his instinct told him to do. The left side of her head felt thick and gooey. He’d felt that sensation before and knew it was blood. He reached under her head and felt a cavernous hole . . . she was dead.

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Chapter 34. To be or not to be? Ah, that’s too deep! Just do it! He pulled his knees under him and knelt in the middle of the small woman’s chest. She couldn’t breathe with his weight on top of her, but dead people don’t need to breathe. He pushed her head to the side so he could see the baby’s face. It was covered in his mother’s blood and had turned blue. The baby’s eyes stared at the ceiling of the car and showed no sign of life; he had suffocated in his mother’s blood-soaked hair. The saint could leave him there. It was justifiable. No one would question it. The respirations once heard and felt from the child’s mother were no longer a concern. They had stopped. But the child was not going to die; the rules of triage be damned! This one, he would treat. Others might question that decision, but he didn’t care. It was the only pleasure that he felt any more: knowing that he was right when others had thought he was stupid. He placed his mouth over the mouth and nose of the infant and steadily, softly breathed life into the tiny lungs. The chest rose. He breathed again . . . the chest rose . . . he breathed again . . . “What are you doing now?” Ricky asked through the window. “You’ve got others out here that need help and you haven’t seen the two I told you about!” The saint looked up; the lower portion of his face was covered in the blood, and asked, “Did you call, like I told you too?” “No, I checked on the others and they’re still alive . . . nothing has changed,” Ricky said while the saint gave the baby another breath. “Did you get me an ETA on the other units?” the saint asked just before he breathed for the infant again. “No, there’s no sense calling; they’ll get here when they can,” Ricky said. “Well, then you go do what you think is best.” He breathed again. “I’ll do what I think is best.” He gave another breath. “Unless you want to take over here?” He motioned towards the bloody face he had been breathing into, and missed a needed breath just so Ricky could see. “No,” Ricky said, and searched his inexperienced soul for a reason. “You keep doing that, if you think it’s going to help. I’ll keep an eye on the others and tell you if they’re starting to crash.” Then he asked, “Is the woman dead?” Ricky had seen where the saint was kneeling. “I called her when I got here.” He breathed again. As Ricky walked away, the child coughed once, did nothing for a few seconds, then coughed again. He then used the saint’s breath to whimper and then break into a full-fledged bawl. Ricky heard the baby and came back.

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The Street Saint “Get a pede’s collar and get it on this kid. Leave him in the car seat and bring him out like that. I haven’t done a secondary, but I don’t think you’re going to find anything wrong,” the saint said, while he backed his aging body out the window. He looked at Ricky, knowing his face was still covered with blood. Ricky just stood there and looked at him. “Where’s my jump kit?” the saint asked. “Uh, by that car I guess,” Ricky said. “Good place for it, don’t you think?” The saint started for the bag. The young man still lay with his feet up on the car bumper; his father still burned. The saint saw a flash of red lights in the distance. The fire department was about to make its appearance. The two trapped in the other car were still breathing and unconscious. The saint reached the truck and, out of breath, said into the mike, “50, Dispatch!” “Go ahead, 50.” “Just so you know, and anyone else who gives a damn, I have six critical patients here and two of them are pedes. I got one serious teenager. I have two confirmed 10 – 79s. I’m going to do what I can but when you call the coroner, tell him he’s going to be busy if somebody doesn’t quit messing around with bull, and help us.” He didn’t hear the response because he had thrown the microphone, grabbed his kit, and headed for the two that he hadn’t yet seen. CHAPTER 35. TO MAKE AN OMELET, YOU HAVE TO BREAK A FEW EGGS Thinking that his instructions on the scene had been followed, the saint loaded the driver of the car that had been trapped for so long. The driver was the last patient to leave, and the saint had followed the rules of triage, taking responsibility for the last that would be transported. Before help had arrived, the saint had performed as a one-man trauma center. He had successfully intubated three patients. He had started a total of eight intravenous lines. He had spent 45 minutes feverishly saving lives while he waited. Around him, just beyond the glow of the burning family car and less than eight miles away were two level-one trauma centers; and fifteen advanced life support ambulances idled within another city’s limits. Within five miles, there were 36 more firehouses and the largest and the third-largest rescue squads in the world. They hadn’t been called, and they didn’t know their help was needed.

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Chapter 35. To make an omelet, you have to break a few eggs Three people died on the bridge, and it took some time to get the patients out of there; but, like a child, his boss thought that, “if no one found out, he wouldn’t get a whippin’.” And who would tell on him? If the saint made waves, he would be blamed for the delays. He should have been able to call medical control and request outside help, but the radio had been withheld from him. He could be accused of not being able to maintain control over his crew — he couldn’t get the radio away from Ricky or get him to relay information that was needed to expedite the situation. That would sound like an excuse. Medics from his company transported the patients as soon as they had finished appeasing the local government (which gave them no tax money). None of the crews had been on the scene long. He had based his decisions of where to send the wounded on the information that medical control had given him while he was en route to the scene. He could relax, even though he did not know the outcome of the patient that lay packaged, intubated, and plugged with IVs and a cardiac monitor in front of him. At least he was down to just one patient. He didn’t have to worry about whether the other patients were being treated properly, because he had done the work before the other medics arrived. All they needed was a less than ten-minute ride to the facilities that had been prepped to receive them. As he reached for the microphone to announce his pending arrival at the level-two where he was employed, he rationalized to himself about the absence of help. At least none of the hospitals could say he had dumped on them or didn’t give them enough warning. They could’ve eaten lunch, smoked a cigarette, talked to their lovers on the phone, and gone to the bathroom before the first patient arrived. “Alpha 4 15, inbound patient report.” He loved it when a plan came together and that one, even though it hadn’t gone exactly as planned, was about to be completed. He had scattered patients so there would be no stress on the receiving facilities. All the patients would receive an appropriate level of care. He had proven that the book was right and that he was one of the best. He would be the only one to pat his back — he knew that — but his arms were long enough for the job. He felt good about his work, and that was all that he had really wanted. “Four alpha 15; go ahead with your report. You’re killing us here!” The PA’s voice came over the radio. The PA had been trained to assist doctors in their offices. The level two hired them to shoulder some of the mundane load. The

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The Street Saint doctors, through necessity, had put the PA in charge of patients they hadn’t been trained to handle. The PA was something special, a new position in the medical world, just as a paramedic had one day been. The sinner was not in the mood for the attitude he heard in the PA’s voice. “Sir,” he began in a professional manner, “if your facility cannot handle a trauma at this time, please advise and I will divert to the level one!” “Negative, I wouldn’t think of diverting you.” He knew what kind of trouble that would have brought him from administration. “What do you have?” Policy had defeated the PA; the saint enjoyed the shoe being on the other foot for once. “I’ve got a class one head . . . trapped for better part of an hour. He’s intubated . . . vital signs are stable. I have a large-bore IV established and the patient is packaged. I’ll be there in about three minutes . . . Do you need anything else?” The saint had deliberately given an abbreviated report. The saint had complied with his company’s policy and brought them a bad trauma. According to his orders, they had four or five walking wounded and a couple that needed some suturing. That should be enough money. He had nothing to fear. If comments were made about the patients he had sent to other facilities, he would recite the orders he had received from medical control; and if that didn’t suffice, he had the same two-word phrase that his young colleagues used to answer everything. “Well, Bud, I guess there’s nothing more to do but breathe, huh?” the saint said to the man whose head was between his knees. The medic would just squeeze the little blue bag in his hands and enjoy the rest of the ride. He thought about the scene and wished it had gone better. Looking back objectively, he knew that he had preformed above and beyond what would have been expected of any paramedic. The professional review would be OK. He thought of the woman whose last breaths he had stolen, and dismissed the thought. Medically, he had committed a sin, but medically he was also right for leaving her for dead. He shifted his thoughts to her child, whom he had saved, and who now lay in a trauma center specifically designed for children. The baby would be fine. Better cherish that thought and hope the mother’s ghost wouldn’t bother him on nights when he was overcome with melancholy. He wasn’t looking forward to arriving at the level two. He had intentionally sent only walking wounded there and had deliberately not sent any children to that facility. This last patient was going to die anyway, and that’s why he didn’t mind taking him there. His company would get paid for the transport and the

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Chapter 35. To make an omelet, you have to break a few eggs transfer later to the level I, where he should have been taken to begin with. His boss should be happy with that. The sinner would eventually have time to tell of his heroics and the staff would eventually have time to listen. That would be an ego boost, when the time came. He started to feel a cramp in his hand each time he breathed for the man. He wished his company would buy an oxygen-powered vent, but as his unit swung into the driveway he remembered that his boss would not be concerned with the cramp in his hand. The concern for patients died when balancing the budget had become more important. He finished the things that he did every time he arrived with an advanced life support patient just as the cot started to move. He had relaxed in the glow that his endorphins had afforded him. His report to the hospital would be easy, and since the staff had nothing else serious to handle, they would come to his aid. They must have known about the delay and the stress that he had been under. Most of them, like him, worked in this field just for such moments. At first, he thought he was receiving a hero’s welcome. The five ambulances scattered around the opening to the ER must have come there to hear the story, to help him unload, to help his partner restock his ransacked ambulance. He wasn’t the kind of guy who recognizes trucks by style or manufacture of light bar. He rode in whatever equipment he was given; he wasn’t in it for the toys. Still, when he approached the ER entrance, he recognized some of the people who had helped. Maybe they had already returned from where he had sent them. Then he recognized some of the walking wounded, who stood by the nurse’s station. Nothing unexpected in that. But then he heard the cries of the baby that he had sent to the pediatric trauma center. He looked at the nurse’s station, where the medic responsible for her care was doing his paper work. He didn’t have time to ask the medic why, but as he tried to enter the level one room with his level one patient, a nurse rapidly exited the room and pushed him to the side. Through the open curtain he could see the passenger that had been ejected from the wreckage and he had left for dead. Someone had packaged him, had started chest compressions, and had transported him to the closest facility. He looked at Ricky and asked, “Who brought him in?” and he pushed the cot to the room the hospital used for a second bad patient. “You’re going to have to put him in the hallway!” yelled the nurse who was just leaving that room. She scurried by, her fingers spaced with blood tubes.

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The Street Saint “Why did you send all of them here? I thought you were in charge?” she asked without looking back. He stood dumbfounded. A state trooper approached him and asked, “Where’s the kid that caused this mess? I told you he was under arrest. I just got down here from the bridge and the fire department said that you refused to transport him and he left with his parents. He’s a felon in your care. Where is he now?” The saint had no idea who the trooper was talking about. He thought the driver that was on his cot had caused the accident, but it was a 16-year-old kid who had been racing the driver of the Lexus. His car had struck head on the car that burned; the Lexus had avoided that collision by eating the embankment. He didn’t have time to answer or to find out who the patient was, because his pager vibrated at his hip. He knew it wasn’t times and mileages; he had already received them. He clicked the green button and read, “The supervisor wants to know where you are. The coroner is on the bridge and wants that body moved. Supervisor says get out of that hospital and get that body to the morgue. Call him when you’re through.” He almost exploded. The supervisor had deliberately assigned him that task to show him who was boss. Disgust and aggravation, along with several other emotions, swept over him as the truth revealed itself to him; he had been hoodwinked. Without telling him, the powers that be had set into motion their own plan. The fear of not knowing what to do, and unwillingness to take bad trauma cases to a facility whose staff would report their incompetence, had caused other medics to override his orders. They took the patients to the place where they felt most comfortable. The facility had one “doctor” and had no trauma team available. It had a light nursing staff including perhaps one nurse who could claim proficiency at a level one. Instead of a team of nurses for every critically injured patient, there lay within those walls a team of critically injured patients for every nurse. That had not been his plan; that was not what he had trained for. That was not what he had worked so hard to accomplish that night. He saw reality painted with the blood of the dying people on the ER floor. It hit him hard in the face. The system had proved that there were no patients, only situations. The ostensible love for patients and fellow man had only masked ego and avarice on the part of those who had been trusted with the process.

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Chapter 35. To make an omelet, you have to break a few eggs Situations are real; they come and they go. People had become surreal and unimportant. Situations could later be avoided. Patients die and are forgotten. It was not a person that had punched him in the face; it was “the truth” that he would fight. “Here, bag him, Ricky!” The saint said, while he turned the ambu bag towards his partner. “I’ve got something to do.” “To where?” the sinner asked, set his jaw and walked away. He was ready for battle. Over the years, he had seen things that had upset him. When he was young, he had felt duty bound to report the problems that he had seen. He had been naïve and wanted things to be right. What he learned was that his actions had pegged him as a troublemaker. Ricky squeezed the bag and said, “Hey, we’ve got to move him over.” Over the years he had swallowed more and more. From patients, that had been expected; from green medics, well, they would learn eventually. From EMTs who had thought they knew it all; they sometimes learned and sometimes didn’t, but he knew that their ignorance would eventually hang them. As for nurses who didn’t know, and even worse, those who didn’t care, the system or their own stress would eventually wash them out. Not a problem. He learned which doctors should have never been allowed to work in an emergency room. He would take patients away from them and turn the drunks loose on them. Bad business, and hopefully good lawsuits, would get rid of them. But, the reality of that night had been his last straw. He had always wondered why people took a gun down from the wall and killed people. He wondered why there had been no warning signs. He wondered how disgruntled employees could return to their workplaces and murder supervisors and co-workers. How did someone that mentally ill ever get hired, anyway? He walked into the level-one room where the cardiac arrest was still being worked, and asked, “Doc, if you don’t mind me asking . . . what are you doing coding a guy that I called dead an hour ago?” The saint was already out of line. He felt pressure on the inside of his ears. He could hear the beat of his heart resound off those delicate membranes. He was at the point where he acted on instinct because the pressure on his brain obliterated all rationale thought. “What are you talking about?” the doctor asked; his hands covered with bloodied gloves. “The crew said this guy coded in the truck, only minutes from here.” The doctor held up his right hand and stopped the sweated-browed staff.

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The Street Saint “That guy was the third one I found on the bridge. I called it. He was thrown through a windshield, his skull’s caved in, and if you check under that Ccollar, that I didn’t put on, you might find a broken neck!” the saint talked, but the words hadn’t felt like his when they came out his mouth. “But the other crew said . . .” The sinner exploded. “The other crew!” The sinner yelled at the top of his lungs. “That was my goddamned scene . . . I was stuck up there for 45 goddamned minutes while other people played politics. I called that guy, in lieu of the other patients I had. He’s not supposed to be here. Most of the goddamned people I’ve seen in this godforsaken place aren’t supposed to be here, and I ain’t got the slightest goddamned idea how they got here. The one patient I held for this place, because he’s going to die, is out there on my goddamned cot with a goddamned idiot trying to breathe for him while you guys are running around with your goddamned heads cut off trying to treat patients that aren’t supposed to be here!” “Well, we’ve got to make good with what we have,” the doctor said, as he motioned to the nurse to print the patient’s final EKG strip. He looked at the clock on the wall and announced the time of death. The doctor had responded to the saint much more calmly than could have been expected. He headed for the door; tears filled his eyes and rolled down his cheeks. Partly out of was sorrow for the system that he had just publicly pronounced dead. Mostly it was out of anger for the years he had wasted, trying to bring it back to life. CHAPTER 36. THE END; AND THE BEGINNING The saint returned to the scene on the bridge. Some of the crowd had stayed on to watch him remove the man that had burned: the last of the horrors. He knew they weren’t prepared for the show; after 26 years, he still had to prepare himself. Firemen wore strange faces under their smoked helmets when they were in the presence of a “crispy critter,” and those were the faces that greeted him. He said nothing; just removed a body bag that he needed. He utilized the firemen for their coats and gloves so he wouldn’t smell like burning flesh for the rest of his shift. They touted themselves for their bravery, and he allowed them to prove it. The man’s flesh had to be peeled from the seat that he died in, because his skin had dissolved and melded with the foam seats. Better to take some of the

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Chapter 36. The end; and the beginning seat with him to the morgue than to leave some of him behind. The man’s skin had an eerie, waxed appearance. He was dry and stiff and would have resembled a store manikin if he had had a nose and ears. His fingers were melted stubs, like candles just before dawn. The petrified state of the body made it easy to lift him out, but he had to be repositioned so the bag could be closed. His legs seemed to still operate the pedals and what was left of his hands were still positioned to hold the steering wheel. Placing him in the icebox at the morgue would not be difficult; the opening to the refrigerator was wide and bumping the patient would not be a concern. The night was over. The saint was glad to get home. He thought the story would be on the news, but then he realized that the accident had happened on the ramp that led to the ghetto. Other than the late night traffic jam that it had caused, it had been of no importance. However, if the news crews could have caught the burned body on film, it would have been the lead story. He thought about getting something to eat before he got home, but he had worked 32 out of 40 hours and had run 29 calls, dealt with numerous deaths, and could stand to lose a little weight. He thought maybe a session on the Internet would help him relax and give his mind something else to ponder. He checked his E-mail and was surprised to see how many days it had been since he had last been on line. Again he was reminded of how days slipped away while he served. He felt a cramp near his stomach and thought it was hunger. His mind could say he didn’t want nourishment, but his body had the right to disagree. He found some mail worth reading and some that he wanted to answer. The pain increased. He thought it was a muscle cramp, and stretched to alleviate it. He noticed that he was getting cold and his hands felt tingly. Maybe he’d better eat, after all. He drank some milk. If his pain were caused by acid, that would alleviate the symptoms. However, the pain increased and was becoming intolerable. He chewed some of his girlfriend’s antacid medicine and vomited as soon as it hit his stomach. If it was gas, it should have escaped, but it intensified to a level that he had never experienced before. The man who looked back at him from the mirror was pale, ashen. He pulled his cell phone from his uniform pocket. The pain had doubled him over; he punched the speed dial for his girl’s cell phone. She answered, thinking that he had called to keep her company while she drove to work. He described his symptoms to her and said,

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The Street Saint “You’d better come home and take me to the hospital.” She turned her car around, saying, “I’m coming home right now, but hang up and call 911, you’re having a heart attack.” He thought of his symptoms, and agreed that Socrates had been right: a doctor who treats himself has a fool for a patient. He made it to the couch and elevated his legs, which gave him some relief. He decided he would be all right and could wait for her to come home. Hopefully, the pain would be gone by the time she got there and then they could spend the day together. That thought had made him feel so warm that he briefly wondered if it was just the anxiety from the last few days that had gotten to him. But then the pain swelled again in his chest and it felt as if someone had inflated a balloon the size of his fist around his heart. He picked up the phone, dialed 911, and said, “I’m a paramedic and I think I’m having a heart attack. I have no pertinent medical history. I have left substernal chest pain that has started to radiate into my back. I feel cold. I’ve vomited once. Tell that to your medic.” He gave his address and his call back number, without being asked. The dispatcher was speechless; he’d never had a caller request an ambulance and give all the necessary information in less than ten seconds. He immediately toned the fire department because, even though the saint lived in a highlytaxed area, there were no ambulances in his city. The pain continued, the saint kept himself calm, and the dispatcher kept him on the phone until the first of the rescuers arrived. The first to enter was a volunteer firefighter, about 60 years old, who began the necessary lifesaving run report. A uniformed man entered next, carrying a cardiac monitor. Seeing the monitor made the saint “assume” — always dangerous — that the man was a paramedic. He placed the limb leads while the saint gave his symptoms without being asked. The firefighter gave no signs of recognizing the words’ significance. Either he was ignorant or was at the end of his shift, but he did look good — well dressed in a sharp uniform. The saint saw changes on his EKG that would indicate cardiac ischemia, but he had been told for over a quarter of a century that those leads could not be used to diagnose or eliminate an infarction. Another man entered. The EMT stopped the saint mid-sentence and said, “Here’s the paramedic.” The younger of the two printed the EKG, handed it to the medic and said, “He’s not having a heart attack.” From that point on, the saint’s symptoms were ignored.

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Chapter 36. The end; and the beginning He was placed on oxygen and then on the cot. The monitor was disconnected and carried back to the truck. His girlfriend came through the back door as he went out the front; she said he looked like a ghost. They put him in the truck and stood around outside, talking about how long the trip was going to take in rush hour traffic. They weren’t going to use lights and sirens; they had decided the saint wasn’t serious and the hospital he had requested wasn’t the closest. The closest facility had exposed its incompetence the year before, when his girlfriend had had an anxiety attack complicated by caffeine and OTC antihistamines while the saint was on duty. The hospital had referred her to a doctor who prescribed open-heart surgery because he couldn’t find anything wrong. The nurse couldn’t read the lead II monitoring that every emergency room uses. The patient was admitted to ICU and discharged early the next morning without the standard halter monitoring equipment, because the hospital didn’t have enough of them. It was one of the highest-priced hospitals in the area but it was located near poor white folk; maybe they too had been prejudiced. He hadn’t seen mistakes made in his hospital of choice, probably because he rarely went there. The medic finally joined the saint, and they started their journey. The paramedic took the saint’s vitals and, when asked the reading, picked up his clipboard and said, “84/60.” The saint read a pulse rate of 70 on the monitor; considering his pain and the low blood pressure, the heart rate should have been quicker. The combination of a low blood pressure and a slower than normal heart rate alerted the medic on the cot; the one in charge had just gone on to start his paperwork. The saint said, “You know, with a low blood pressure, chest pain, and some ST changes, an IV might be in order.” The medic sat his clipboard aside and said, “Do you think you need one?” When the medic with thirteen years’ experience couldn’t locate a vein, the saint showed him where to stick him. He told the saint that he had just finished the police academy and was looking forward to changing careers. The saint had checked into emergency services in the area before his girlfriend bought the house, and had been told that they were among the best in the state. He was glad the man was advancing his medical career by becoming a cop. It would better suit his abilities and benefit the citizens the most. The saint likewise asked for medications that would normally be given to a patient with his symptoms. Obviously, the highly-rated service had received their marks for trucks and equipment; they had “nice stuff.”

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The Street Saint The aspirin the saint got was individually wrapped; he was impressed. He used baby aspirin, dispensed from bottle to hand. The monitor was a good one; what a shame there wasn’t anyone who could read it. The truck rode nicely, but the crew treated the saint the way he treated street bums and those who abused his system. He always looked first for any possible serious problems. “Prejudice” had spread to the suburbs. The first nitro relieved the pain, but it came back a few minutes later. The second shot relieved it again, but it returned as bad as it had been when he called the ambulance. His blood pressure was barely 90 when he arrived at the ER — and that’s when he remembered that nitroglycerin should not have been administered to a person exhibiting the signs that he had. He didn’t know what his pressure was after the administrations, because the medic didn’t monitor it as he should have done. The nitro hadn’t burned his tongue or given him a headache; a sure sign that the nitro was no good. The reputation of the emergency room equaled matched its reputation, after all. The doctor was foreign, but the saint had no trouble understanding him. He wondered if that was what had distinguished him from his competitors and earned him a job at the fancier hospital. He was personable; he pulled a chair up and talked with the saint. He listened to his lungs, but otherwise didn’t assess him. The EKG techs were pretty, and he noticed that when he needed a urinal, it was an RN who gave it to him and then emptied it also; he was impressed. His girlfriend arrived and scolded, “That’s enough. A man of your age can’t work that many hours anymore. You’ve had a heart attack; now, what good is the extra money going to do you?” She touched his arm gently to let him know that, even though they hadn’t been anywhere in months, she was not complaining about the service that he provided others. She was concerned about his wellbeing. “Who else is going to do it?” he asked. “And who’s going to take care of you?” Good point. He had a liter of fluid in him and was starting to feel better. His blood pressure was still low, but he no longer felt like he was fading away. The doctor wanted to admit the saint, even though everything looked fine. The saint wondered what he compared it to, but the absence of records was part of the doctor’s reasoning for admission. The saint said, “Doc, I know what you’re saying, but I could just go home and come back tomorrow for the tests.” He was surrounded in seconds. The

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Chapter 36. The end; and the beginning nurse told him that he was staying; his girlfriend jumped up and said, “You need to stay here.” The doctor laid his hand on the saint’s other arm and said, “You know better than that. I’ve got a room ready for you, and if things look good in the morning, you can go home then.” The staff in the hospital where he usually took patients would have run for “Against Medical Advice” forms and the patient would have been discharged in minutes. The saint thought about it for a minute. He needed the rest; he’d wanted to have his cholesterol checked, and he wanted to have a stress test. He no longer believed he had had a heart attack. He had decided that he had been dehydrated; the only pain that was left was in his upper right quadrant and under his left shoulder blade. He had an inflamed gall bladder and was dehydrated from the fever that he had been working with for the last couple of weeks. He remembered the last time that he had signed out AMA after he had passed a kidney stone so he could prevent the surgery that wasn’t needed. His insurance hadn’t paid, because he had refused a doctor’s advice. He decided to stay put. He was taken to the telemetry unit. He joked with the tech who put the third set of electrodes on his hairy chest. He was met by a “hospitalist” who served as doctor for patients who didn’t have their own. It had been a good business move. She was young and couldn’t open her own practice yet; the hospital could make money on her services; she could meet potential patients; and another doctor would be available when she left to start her own practice. In minutes, a young female cardiologist arrived, accompanied by a young man who could barely speak English but who made the saint feel at home. Talk about service. The saint had been there barely over an hour. Things were different in a hospital where the people who were admitted had good insurance and were actually in need of hospital care. He had grown accustomed to people being admitted for frivolous reasons after waving their Medicaid cards. He also knew he would be discharged tomorrow, after the doctors were confident that he hadn’t had a heart attack. The insurance that he paid for would insist on his discharge. Medicaid and Medicare patients would stay for three days and then be given a cardiac catheterization before being discharged. The hospital would make the same money from them as they did from him; it would just take them a few more days and a “standard of care” that he wouldn’t receive. When the World Trade Center was smashed, early announcements cited the “firefighters, police officers, and EMS workers” who were killed; later reports mentioned, “firefighters, policemen and emergency workers,” which included the power and gas guys; and finally the formula was simplified to “firefighters

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The Street Saint and policemen who gave their lives.” EMS workers were ignored, even in death. Those heroes shouldn’t even have been there. They were trained to stay back until a scene was safe; but they had gone in, unprotected, to help evacuate people from the tumbling towers. He was still upset when techs arrived to draw his blood. One was male and one was female. He thought that was quaint. The man approached, and the saint assumed that the girl worked on little old ladies and the man worked on grouchy old men like him. The first words out of the man’s mouth were ones of recognition, “I’m an EMT and I’m going to be a paramedic.” The saint said, “Don’t bother. You work here and they’ll send you to nursing school and work around your schedule. In this state, you can still play ‘Ricky Rescue.’ You can do so as a nurse.” “Yeah, but I want to do something more exciting than being a nurse.” He hadn’t seen the saint’s girl smile. The tech stuck, and missed the vein. “You know, to be a paramedic, you have to do that at 90 mph in the back of a truck.” His girlfriend looked at him with raised eyebrows that said, “Be good.” “Yeah, I’ll get experience doing that. But you’ve got bad veins.” The sinner remembered others who had told him they would get their experience, and didn’t want to accept his advice. He knew he had “ropes” for veins. “I’ve got bad veins? There’s an intern vein you can put the tubing in.” His girl gave him an “I’m warning you” look. “Let me try in this arm,” the girl tech tightened a tourniquet. The saint thought maybe she was the senior of the two, and had let the man try for experience. She touched around on the back of his hand, his wrist, forearm, and finally his AC. “You’re right, he doesn’t have veins.” The man found another spot and stuck the saint again and missed. The young woman stuck him in the other arm, and then again. The man stuck him again in the other arm. The saint looked at his girl and that time her look said, “Do what you want, they don’t have the slightest idea what they’re doing.” The saint was glad to be released, even if it took being stabbed six times to get there. “Look, sweetness,” he said to the young woman. “Put a needle right here at the end of my finger.” The saint pointed to a spot on his right forearm. “Oh, that will be a blind stick and I hate doing those.” She seemed a lot more afraid than the saint should have been. “Man, from now on I’ll call you with tough ones like this,” the male tech said. “Sweetheart, this vein is at least a quarter inch wide and a quarter inch deep. Just put the needle right here at the end of my finger, and push.” The girl

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Chapter 36. The end; and the beginning put the needle where she had been instructed, pushed, and squealed with delight when she got a return of blood that indicated she was in a vein. “I didn’t know what I was doing; he showed me.” That was different. He thought everyone took credit for things they didn’t know or do. The two left the room and the saint turned to his girlfriend. She said, “You don’t have to say anything. You’ve done it a lot longer, and they need the experience.” “Yeah, I know, and I helped, but they still don’t know what it was that I showed them. And look at me!” He held up his arms to show the seven cotton balls they had left taped to his arms. “You know, this is getting ridiculous. So far I’ve had to ask a paramedic for an IV and medications, I had to tell him what the EKG read. Now I’ve had to show two techs how to stick me. I thought it was just bad in the hood.” He realized that there were a lot more ignorant people treating people than he had imagined. The whole medical field was suffering. No wonder people questioned an IV in the back of the ambulance. No wonder other “professionals” considered him a “rogue medic.” His girl knew him better than he realized. “I think it’s time you tell your story. I saw you work a wreck once when you were off duty and compared to the ambulance crew that came on scene you were awesome. You’ve always been right in ‘diagnosing’ my family and me, and I just saw you have the patience to teach someone to draw your blood. I accused you once of being prejudiced and I understand now what you were trying to tell me. You’re a good teacher. It’s time for you to teach.” She kissed him again, told him that she loved him, and left. He sat, lost in thought, until he fell asleep. He was awakened at 4:45 AM when the night nurse decided to weigh his roommate. The day nurse awakened him again at 7:00 to draw more blood. She did so without effort. He liked the day nurse. He had listened all night to the man who lay next to him complain. He heard him talk about the pain in his legs. He heard his wife tell the first nurse that the man wouldn’t get out of bed. The saint knew that the man’s pain was greatly aggravated by his inactivity. When the second nurse returned, he explained his suspicions. The saint was taken to a stress echocardiogram and when he returned, the nurse had the man out of bed sitting in a chair and eating breakfast. The nurse looked at the saint and winked. There were obviously two professionals in the hospital that understood medicine and how to handle people. The saint had also heard the rest of the man’s test results, and knew he was going to die. He had suffered his heart attack long before current

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The Street Saint interventions were discovered. The bypass would do no good and he could not stand the strain of opening the circulation in his legs. He would be in pain until he died, and that wouldn’t be long. The saint had spent 36 hours in bed before he began the stress test. He got on the treadmill as soon as it was cleared by another patient. Two others arrived in the eight and a half minutes he was on the treadmill. The hospital was making a fortune from the testing. As he began to walk, the tech increased the incline and the speed of the machine without warning. He almost fell each time. When his heart rate increased passed 140, he asked how far they were going to go. The doctor said, “Oh, I want you up to 170.” The saint would have treated someone with a rate over 150. He handled the cardiac workout, but the inactivity of the last day and a half, coupled with the electrolyte imbalance from his dehydration, made his lower legs cramp. He stopped the test at eight and a half minutes. The doctor said that the saint’s heart was fine, but he was horribly out of shape. He should have made it to nine minutes. The cardiologist met with him again and explained that his cholesterol was below normal and his heart looked like an 18 year old’s. He should eat heart healthy, lose some weight and reduce his stress. He called his girlfriend and said, “Get me out of here!” After he explained the results, she asked, “Well, what was wrong with you, then?” He grinned and answered, “I’ve been working too many hours and got dehydrated. My diaphragm cramped and I’m not having enough fun.” The added diagnosis had tipped her off to what he had been told. “In other words, they didn’t look at what sent you there to begin with, and you made your own diagnosis?” “That’s right. I said chest pain; they ruled out heart attack, and sent me home. That’s managed care. They’re done.” He looked at her and smiled. “One of the finest hospitals in the area and it’s not any different than where you work in the ghetto!” she exclaimed. “That’s right. What have I been trying to tell you? I think you’re right, I need to write that book, I started it last night.” He reached in his pocket, pulled out a cigarette and lit it. “You know, my cholesterol was way below normal. I think we’ll get some biscuits and gravy.”

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Chapter 37. Hurt me once, shame on you; Hurt me twice, shame on me He went home and his boss called, and said that he knew the saint had been discharged and asked when he was coming back to work. The saint excused himself for the next few days. He drove three hours and went fishing with his son and watched his youngest grandson catch his first fish. Life had gotten better. He hugged everyone good-bye and promised to be back within the next couple of weeks. He had no choice but to be at work the next morning for a 16-hour shift. CHAPTER 37. HURT ME ONCE, SHAME ON YOU; HURT ME TWICE, SHAME ON ME He responded to a psych patient who had a history of beating his mother. It was great to be back on the job. The mother had called and said her son had shown up at her place, had not taken his medicine, and was acting bizarre; she was concerned. She had called mental health instead of the police. She had learned that the traveling nurse was allowed to act quicker than the police could — they were bound by a liberal court system and slowed even further by the number of responses they had to make. The mental health worker immediately dialed 911 and the ambulance was promptly sent. The police had learned that the paramedics would advise if the police were really needed. It would be up to the paramedics to deal with the 30-year-old man with a history of violence that had become a burden on society. The saint entered the house and found the man calmly sitting on a bed. The saint identified himself, but the man asked, “What are you doing here?” “Well,” the saint began. “Your mom thought you might be having some problems.” “What do you mean, ‘problems?’ I don’t need any medicine, and you white mother fugger can get out of my house!” the man exploded. The saint recognized symptoms that placed him in danger, but none of them matched the psychiatrist’s diagnoses of paranoid schizophrenia. The sinner only saw a little boy who had never been spanked. The doctor’s diagnosis was used because it made it easier for the immature adult to draw a complete disability pension from the government. “No problem sir, I’ll be getting out of your hair,” the saint said, after the patient made a racial slur and a physical threat. As he exited the front door, he shook his head to the mental health worker and she then turned immediately to the police, who had just arrived. She told them to anticipate violence.

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The Street Saint One policeman put on his sap gloves and the other reached into his front seat and pulled out an axe handle. The saint heard a noise in the house and realized that the man had barricaded himself in the room. Before he could say anything, he heard a window break. The police ran into the backyard and the saint followed, so he could maintain contact with his patient. The mother was upset, and the saint was concerned because there was a small child in the house. The sinner figured the man had the whippin’ coming from the police and the three of them could handle him. Neighbors started to come over to watch the show; some brought out lawn chairs. By the time the team had gotten to the gate, the man had emptied the room into the back yard and was standing in the window. “Look here, bitches,” he said, while he raised his shirt and then slowly turned, “I’m not carrying.” He jumped into the yard, grabbed a metal ironing board he had thrown there, and then swung it at the police. He cussed, and then looked at the saint and said, “My gang is going to kill your president!” The saint looked at his partner and asked, “Do you think we ought to call the secret service?” His partner chuckled. The game of cat and mouse continued in the backyard, with the man out maneuvering the police. “They’re letting this go too far,” the saint said to his partner. The words were no sooner out of his mouth than the man started to walk towards the gate. The saint had tired of the show and was leaning cross-legged against the fence. His partner stood where the gate should have been. The saint turned to tell him to let the man go, if he wanted to run. The saint had seen the man display nothing but normal cognitive reasoning. There were no signs of mental illness, only the signs of another social misfit that society was afraid to handle. The man understood fully what he was doing. He had just tired of his demonstration of “manliness,” and if the police weren’t going to stop him, the saint wasn’t about to impede his progress. When the saint turned his head to speak to his partner again, the man charged and grabbed the lid to a barbecue pit as he ran. The saint saw his partner flinch and when he turned to see why, the barbecue lid crashed into his face. The sinner reacted. He grabbed the man by the throat, smashed him into the wall and then slammed him into the concrete driveway. Blood poured from the saint’s mouth and nose; somehow, his glasses had been spared. The police grabbed legs and the saint pinned the man’s head with a knee. The neighbors screamed at the saint to let the poor sick man go. He curtailed his actions

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Chapter 37. Hurt me once, shame on you; Hurt me twice, shame on me because he was the minority there, and his intentions didn’t jive with what the system endorsed. The man under him began to laugh. At first, the saint thought it was the laughter of a madman, but then the man said, “I took out the biggest white guy!” The sinner saw red. Attempts at goading a white man into hitting him were going to succeed. His neighbors believed that he wasn’t responsible, because he had not taken his free medicine — although he was responsible for that choice, too. He believed his black brothers at the police department would protect him; he didn’t know that the brotherhood of rescuers was stronger. He should have watched more television. He believed the hospital would treat him kindly; he didn’t know that the saint served and protected the hospital personnel, too. Attacking the saint would not create a favorable reception for the attacker. He knew he would spend a few days at state expense and then get money to return to mainstream society. He would be a hero to his friends — without consequences. But he didn’t know the consequences that the sinner was willing to inflict; after all, the sinner was a little crazy, too. He had had enough of it. He grabbed the man’s head, pinned it to the concrete, and pounded him with his fist until he was out of breath. The doctor was right; he was terribly out of shape. When his anger subsided, a cop said, “OK, we’ve got him — take care of yourself; you’re bleeding.” The saint hadn’t noticed that both of his arms were covered with blood and blood covered the front of his shirt from his broken nose. He then felt the pain that the man had inflicted on him. He got up and went to the ambulance, and after getting a trauma dressing to stop the bleeding, called to his partner. “Get another unit up here!” His partner said there wasn’t another unit available. “Well, get another company then, I’m not transporting that idiot.” The police had the man cuffed by then and had thrown him face first down on the cot. The mental health worker approached the saint. “You’re going to have to put pressure on the state’s attorney, because he won’t press charges. The man needs to go to a prison for the criminally insane.” The sinner wanted to say; “He needs to be whipped on a regular basis until he learns to leave good people alone.” But the saint changed his mind. He had already proven he was more of a man than the ingrate coward had been. He would transport the man for treatment. The police escorted, but within two blocks the man came free of the restraints. The saint pulled the truck to the side of the road, got in the back, and hog-tied the man. One of the officers came in through the rear and told the other

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The Street Saint cops to close the door. He slapped the man and said, “Now, shut up! I’m not going to hear it anymore!” The patient, who allegedly hadn’t known what was going on said, “Yes sir, I’m alright now.” He knew he had been defeated, but the trauma he had caused the saint was his victory. The saint was seen for his nose. The two bruised knuckles, the doctor explained, had happened when the psych patient had fallen repeatedly against his fist. When the neighbors called to file charges against the saint, the police told them that the paperwork was being filed in the “round file.” The alleged “psych” patient knew exactly what he had perpetrated, knew that it was wrong, and should have been punished. The mental health nurse knew the patient had problems and agreed with the saint that the man was a sociopath. The police (with a twenty year veteran on the scene) said that the man had his full mental capacities and was aware of the pain that he had inflicted and used his alleged “illness” to not collect an income from the government and to excuse his criminal behavior. The state’s attorney refused to file. Batteries occur every day in the hood. The courts are tired of ill-prepared presentations and the liberalism of the 1960s still prevails. The courts are as prejudiced as the emergency rooms. Both repeatedly see the same players and long ago tired of the game. Justice had been served at the scene, but the saint could have gone to jail for it. The minority have forced the return of street vengeance that used to plague professional police work. He had been happy most of his life fulfilling the wishes of others. He was going to plan the few years of health that he had left around being of service to himself. He called a respected nursing college, and estimated that he could have his nursing degree by the first of the year. He had wanted to do it for 20 years. He decided to work in an emergency room for a year, PRN, as needed, so he could choose his hours and the places where he worked, and make the most money. By the time deer season started, he would be part time and hunt with his son and grandson instead of worrying about what drunk would vomit on his uniform or what hoodlum would splatter it with blood. The next New Year’s Eve he would hold his sweetheart in his arms, not someone dying from the night’s celebration. He thought about working in emergency rooms and fighting for change from the inside, but it was clear that one person could not do it alone. He pronounced the system DRT, and declined to initiate resuscitation.

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