Fresh Air
At first it was the simple things I savored. Standing on a highway in rush hour, pulling some poor guy from his car that was heaped up against the overpass support. Sometimes a semi would go by and it would suck the wind from my lungs. I loved working in the middle of roads, walking across them where cars usually travelled. It gave me a surge of adrenaline to be so near my own death while trying to prevent someone else's. I liked the smell of diesel as we worked on someone in the back of a truck with the doors open. I liked being in the back of a portable ER and having the world just a step away. My favorite part was the lights. Not during the day but at night, in the pitch dark, as we screamed down the road. I loved the flashing blue and red, shining off the ditches, throwing garish flashes across fields and dark roads. When we were out in the boonies and there were no cars around, we would kill the wailing siren and fly. The cabin of the truck sealed, the hulking thing became graceful and silent at 90 miles per hour as just our flashing lights heralded us, the ones who could save your life.
It was those simple things that mattered at first, why I loved being a medic. But as I worked my way through school, I discovered that I had a natural talent when it came to being a paramedic. Early in my internship, the period when you act as a paramedic in every capacity while an instructor watches over your shoulder, my save rates went up. I had a knack for every part of being a paramedic, and my confidence grew.
During this time I received my first serious call. The dispatcher came across the radio with a "conscious choking person". A person choking means that there is no air getting into their body. No air in the body means no oxygen in the blood or the organs. No air equals death. We were lucky that the guy was only a mile away at a Sirloin Stockade. The dispatcher told us when we were en route that the manger had tried, unsuccessfully, to use the Heimlich on the patient. I looked at Dave, my preceptor, and he looked at me and gave a half smile. "This is it, your first real call" he said. My hands started to sweat a little, and I felt my heart start to thump.
One of the first things you learn about being a paramedic is to be calm. You learn that when you walk on to a scene that everyone looks to you for direction. If there is panic, you have to calm it. So no matter how bad something is, no matter how bad you want to crap your pants, you have to act like you really do this every day. That is what I kept telling myself as we walked into the restaurant. Inside, the fire department had already arrived on scene. The restaurant had become quiet, as people stopped eating their steak to watch and see if a man's life might end. It was a little strange, like I was an actor in a dinner theatre, struggling to save life while people watched, their forks poised over plates.
The fire guys had an old man, maybe eighty, laid out on the floor by a table. Dressed in a dark navy suit, the old man's skin had turned gray, and he looked like he had come to the Sirloin prepared for his funeral. His wife, frail and bent over from age, stood a few feet away. She was quiet, perhaps prepared for what she knew was coming, but never like this. I lay on the floor by the old man's head and opened his mouth, tilting his head back. Putting my ear over his mouth I listened, hoping to hear or feel air. Nothing. Looking at Dave, I only gave a nod and he yanked the guy's shirt open, and put two patches on his chest, whose wires led to the heart monitor. Taking a laryngoscope, I held the flashlight like handle and switched on the light that ran down the tongue depressor like blade. I inserted the blade into the man's mouth, sliding it along his tongue to the back of his throat. Then pressing up against his tongue, I lifted and straightened his trachea so I could peer into his throat. I could see into his mouth, down his trachea, then past his vocal chords. The food was deep. "It's past his Chords", I told Dave. "Do you want me to do it?" he asked. I shook my head and looked at the EKG. The tracing jumbled across the monitor and then began to go flat. I watched his heart stop. I turned to the man's throat, and picked up a pair of long forceps whose end curved out to one side. Sliding the forceps' end down through the chords, I knew that if I brushed the sides, then they could slam shut, trapping the food beyond reach. The tips of the forceps nudged something soft, but solid. I opened the ends and then closed on a piece of steak. Carefully pulling back, I eased the food out of his throat and his mouth. The man's lungs filled and I felt a rush of air as he breathed again.
I knew then that this is what I was meant to do. My hands, my mind, my heart had been made by God to be a medic. This revelation brought instant purpose to my life, made me feel that I had meaning. As my confidence grew, so did my abilities to take care of diabetics and cardiacs and drunks. I felt propelled to earn the title of paramedic. My training was almost over.
The first day of the last week of my training began as many of the other days of my internship had begun. I arrived at the station at seven that morning and started the day by washing the ambulance I would be working out of for the next 24 hours. The water was cold as it splashed along the side of the truck. It was just a few days before Christmas and the last snow was loitering on the ground in shadows untouched by the sun. Once the truck was washed, the tedious task of inventorying the ambulance began. Every medication had to be accounted for, all splints checked, bandages restocked, and IV supplies replenished. Once that was done, the sirens and lights were tested and any maintenance on the engine was completed.
With the truck ready it was time for breakfast. I talked excitedly with Jenny, my fellow student, about who would get the first call of the day over eggs and toast and black coffee while our preceptors grumbled with half smiles about our over enthusiasm for the sick and injured. "Hey", I told them, "someone is going to eventually find themselves a big wreck to get into and it might as well be today". Of course, this brought the reply that it would be fine with them if all the wrecks would happen tomorrow.
We had just settled down into the bunkroom when the first call of the day came out. An older woman had fallen out of bed in the middle of the night and had been found by her daughter just a short time earlier. Jenny acknowledged the page before I could even touch my radio. She and her partner were gone in a flurry of speed and sound, and then quiet came again. Forty minutes passed with perhaps only a murmur or two from the crew on the radio as they coaxed the old woman to go to the hospital and loaded her into their truck. I began to drift to sleep, lulled by the quiet of the bunkroom and the monotony of the routine.
The page came out from the radio. I snapped awake and rushed to the door as my mind picked up valuable information from the dispatcher. A motor vehicle collision had occurred just north of Hutchinson. A passerby had called it in and it was unknown how many were injured. Jumping into the ambulance, the lights flashing the sirens blaring, we began the ten mile run to the scene. Halfway there, a sheriff officer reported that he was on scene and there were multiple victims. His voice wavered. He was scared.
As we came over a hill we saw the intersection where the accident had occurred, just a block from us now. A Jeep Cherokee sat along the side of the road in a small field. Forty feet from it, fifty feet from the road, an old pickup truck was resting on a steel cattle fence by the front end. Every piece of metal had been blown off of the frame of the truck. As we pulled up and got out of the unit, David and his partner quickly looked over the scene. Perhaps 70 feet north of the Jeep a passerby had stopped and a woman and her son leaned against the car. Over by the truck, two men were lying on the ground. We could hear one of them dying. He was struggling for breath but was only making a gurgling sound as he drowned in his own blood. David looked at me and said "check the woman and kid," and then began to move towards the pickup with his partner.
Passing by the Jeep I looked at the windows and, seeing no one, was assured that it was empty. For the first time, I saw the front end. It had disintegrated. The woman appeared to be uninjured as I walked to her. She was pale, and a look of awful grief was marring her face. Her young son, perhaps only two, sat quietly on the ground. I asked her if she was alright. "What about my daughter" she blurted. "Is she alright? Is she dead?" I looked at her, panic abruptly striking me, my heart pounding. "She is still in the Jeep," she said to me. I called a fireman to me and asked him to stay with the woman and her boy. I began to walk back towards the Jeep. Each step my nerves in my body seemed to jump, fear at what I would see. The passenger door was facing me and it was slightly open.
Stopping at the door, I watched my hand reach out and pull the latch. The girl sat in the seat, slumped over her own lap. Her head, facing away from me and laying beside the middle console, was mercifully covered by someone's bright yellow jacket. A ponytail of blond hair hung down the side of her cheek, streaked with the only blood I could see in the vehicle. On the dashboard rested perhaps half of her coral pink colored brain. I noticed that her small slender arm reached down by her shoe as if she wanted to tie it. I was suddenly aware that the air smelled pure in the Jeep. It was cleaner than clean, as clean as mountain air. It was as if all that was clean, all that was innocent had spilled out of her onto the seat and dash. She was dead.
I shut the door, and looked back at the girl's mother. She stood up from the ground, looking at me with anxious eyes. As I began to walk toward her, my steps became heavier. The clean pure smell became stronger and my heart suddenly weighed more than what I thought I could bear in my chest. I found myself standing in front of this mother. I felt the terrible words clog inside of me and I so badly did not want to say them. Then I realized that they were passing from my lips and into the air between us. The words left me and with them, I killed the fading hope for the life of this woman's daughter.
What was left of the call is almost forgotten now. One man in the truck was killed the moment the woman struck them. The other man, the one that was drowning, bled more blood than I have ever seen bled. But with our best efforts he survived and is currently in a vegetative state in a nursing home.
For the rest of the day, I put the morning out of my mind, refusing to let what had happened interfere with the other patients that I came into contact with. There were seven others that day, none of them were emergencies. As the day wore on, I found myself becoming irritated with the patients, angry that they would call us for the mundane and behave like it was critical, feeling that a simple fall or flu warranted using my time. But none of them could have known what a real emergency was; none of them had seen the girl. David said nothing to me, perhaps forcing his own anguish to the side. The calls quieted in the evening, ceasing by seven that night. After writing my final report, I called my girlfriend, Elaine. Living out by Dodge City, she was driving to my house for the weekend. I tried to sound upbeat but instead found pain and fear rising up in me again. "What is wrong?" she asked. I told her that it was nothing that it had just been a long day. She knew I was lying, but said nothing. She told me she was close and wanted to come by the station, but I lied again and told her I had too much paperwork to do. Instead, she drove to my house and said she would wait for me. Bed. I knew what was coming, knew that in the quiet I would remember. I lay down fully clothed and prayed silently for a busy night. Dave came into the bunkroom, and stood for just a second, studying me in the dark. But he said nothing, offered no sage advice. Instead, he undressed, crawled into his bunk, and was soon snoring softly. Suddenly, I hated David. Not because he had offered no comfort, but that he had taught me anything at all. David had taught me how to start IVs and to intubate, how to snatch someone from death. David had taught me to be a paramedic. If he had refused to teach me, then I would not have seen that girl. I realized then, that I did not, could not be a paramedic. Tears began to well up, this time for a different reason. I forced them back, and tried to sleep.
The night passed quietly, and I left the station as soon as I was allowed. Arriving home, I tried to quietly open the door. I did not want to wake Elaine; not because I wanted her to rest, but because I did not know what to say. She would be the first person I would see that had not been on the call. I sat on the couch to take my boots off and realized how much I had changed in twenty-four hours. I had seen tragedy, seen grief. I had been around it before, but now I had been part of the grief. My heart grew tight, and again I forced my emotion down. I finished undressing and crept upstairs to my room. Elaine lay sleeping in bed; her blond hair lay across her shoulder. I reached out, carefully, stroking it, then let my hand trail down her arm and held her hand. She moved slightly, and then opened her blue eyes. At first startled, her eyes smiled at recognition of me, then softened, as she saw pain ripple across my face. Silently, she opened the sheet up, and I crawled in with her. She held me against her breasts for a time, stroking my hair. Feeling her warmth, her safety, I let the tears come. She held me as I wept, silent.
I had thought that with time I would heal, but I didn't. Instead, I became angry. The pain that I felt from the call caused me to recoil from anyone who wanted to help me heal. Elaine, who loved me and my kids so deeply, tried to comfort me, but I pushed her far enough away until she disappeared, her own heart broken. I closed my self off from my family, never telling them that I had even been on the scene of the accident. I became angry at God for making me be a paramedic. I even became angry at the girl and her family. If her mom had been watching the road, the wreck never would have happened. In the end, I took my anger, and used it to fuel my career. Refusing the idea of giving up what I had worked so hard for, I threw myself into EMS with disdain and contempt, daring God to try and stop me. I shut off the memory of the call and finished school.
But the girl would not leave my life. For ten years I carried her with me, never forgetting the way she looked in that Jeep. I had clipped her obituary picture from the paper. I would stare at the picture, trying desperately to replace the memory of her death by burning the image of her living eyes into my brain. She was often with me on calls, sitting in a corner of my mind. At times, she would help, pointing out things that I had missed, suggesting more oxygen. Other times, she was just there, her head half empty of its contents, asking me for help. With time, my anger quenched any satisfaction I had from my work and I was left only with the anger and the girl. Eventually, the anger even quieted into monotony and it rested, its flame low, waiting for the occasional flare up.
I remarried and my wife reminded me of love and she held me close on nights that evolved from days that brought sick or hurt children, never fully understanding why my tears were hot as I would weep against her. A year and a half into our marriage Angela gave me Annie. Our little girl has the bluest eyes and curly hair and laughs and hops and loves her daddy. One Saturday I sat on the couch to read a letter my mother had sent me. In the envelope with the letter were several clippings from a newspaper that she thought I would find interesting. I scanned the articles, until I came to a picture of the little girl. My heart began to pound, and I felt the pain, the hurt. Suddenly, I could smell that clean smell and I saw her in the Jeep. Annie, almost two, wobbled into the living room and, seeing me, tottered towards my legs, falling against me and the couch. Looking at her, her sweet smile and big blue eyes, I thought of the girl and how she had been with me for so long so often commanding my mind. Annie climbed into my lap and threw her small arms around me and kissed a soft, slobbery kiss on my cheek. Setting Annie in my lap, I showed her the picture of the little girl, and read the article to her. It was about her parents, how they had managed to overcome their daughter's death and how the momentary brokenness of their lives and marriage had healed into a strong and healthy relationship. They talked about how they had used the girl's life and death as a catalyst to form support groups for other grieving parents. They had taken tragedy and guided it into hope.
I looked at Annie and then the girl's picture. I suddenly wondered how much of Annie's life had been stolen from me by my pain, obsession, and long hours in an ambulance. I opened my wallet and dug out an old torn and faded picture of the girl that I had kept hidden for so long behind my driver's license. Taking it and the article, I walked to the trash can. Pausing for a moment, I said to the girl, "I am going to let you rest now. You do the same for me." I knew that she would. I took Annie's hand and we walked outside into the crisp cold day, enjoying the clear blue sky and the freshest air you could ever hope to breathe.