The Worst Thing I've Ever Seen

August 13, 2008 It was hot, but not so hot that you had to have the windows up with AC blasting. You could still keep the windows down and enjoy it a bit. System status, and we were posted on the north side, hidden from the public behind a Home Depot. My partner and I had been working together for quite awhile, and worked well together. He was studying the inside of his eyelids in the driver’s seat, and I was chatting on the phone with a friend, my feet up on the dashboard.

We were hailed on the radio and Scott grabbed the mic. I continued to chat on the phone. We were off, windows up, lights and sirens on. Scott knew the city like the back of his hand, so didn’t need any directions from me. I was well tenured, so let him do his thing, finishing up my phone call and clearing intersections for him as we went. I never did hear the dispatch information, so had no idea what we were going to.We pulled up to a gated apartment block. The engine had just driven through and the gate was closing behind them. We watched from outside the gate as they parked, while we waited for on-site security to open the gate back up for us.

As we started to drive through, I noticed the fire crew had their bags in hand and were running toward an apartment. They never run. “What’s the call?” I asked Scott. “Pedi respiratory distress or something.” he said. Seeing the fire crew run concerned me. I asked Scott to park while I got out to see what was going on. The fire dept. medics had their bags, and Scott was a competent guy. He’d get the ambulance parked and then come join us. As I walked up to the apartment, the fire crew was standing outside the door, staring down at the sidewalk in front of the apartment. They were just standing there. Frozen.

I looked down to see what they were looking at and found a nightmare. A bloody, rag-doll of a boy. Head different colors of white and gray and blue. Blood streaming out of his nose, mouth and ears. And they were just staring. “What happened?” I asked. “A TV fell onto his head” came the reply. It looked like his chest was moving. Barely. I felt for a brachial pulse. He had one. I bent down and carefully scooped him up. And then I ran. It was the only thing I could think to do. I ran to the ambulance with a medic from the engine running behind me. I never ran. I screamed to Scott “SCOTT! WE’VE GOTTA GO!!!” and practically leaped into the back of the ambulance. Scott had set everything up in the back for me, just as he always did.

The hospital was maybe 2 miles in a straight line from where we were. It wasn’t a trauma center. We didn’t have a trauma center. But it was the closest place we could go. I laid him down on the gurney. He had agonal respirations and needed his airway cleared. I told the fire medic to start compressions and I went to work on the airway. It was awful. Full of blood, and worse – brain matter. I’d never seen that before. Brains in the airway. He was dead. His body didn’t know it yet, but he was dead. Compressions and a tube. That’s all we had time to do.

We arrived at the hospital in what felt like an hour, but in reality it was more like 2 minutes. We transferred patient care to the ER doc who terminated resuscitation immediately. I walked down the hall like a zombie. I went out to the rig to start the cleanup and paperwork. When I walked back inside I heard it. A sound that can’t be forgotten. The soul-tearing wail of a mother who has lost her child.I shut down the rig and we both went home. There was no way I could handle another call that day. My mind was numb. Here’s the thing… this little boy was born just one day before my son.

I went home to my sweet little infant son and sent the babysitter home. Another parent went home to emptiness.I have sleep issues. Always have. I used to have to medicate to sleep sometimes. My wife came home. She is also a paramedic, and was working on the other side of town when I got the call. She knew what it was. She knew I was grieving. We put the baby to bed and then climbed into our own. I had a drink and some Ambien and drifted off to a very restless sleep. I was off the next day. My wife wasn’t. She brought the baby into bed with me when she left for work.

This was a normal routine. He would curl up and sleep soundly against me or snuggle up on my chest. But on this morning, the routine changed. I had finally fallen into a deep sleep in the wee hours of the night. My son woke up before me and started to explore. He crawled his way to the foot of the bed. I woke with a start at the scream from my son. He was lying on the hardwood floor at the foot of the bed, up against my dresser – with a tube TV perched on top. All I could see was that little boy. Not my little boy, but someone else’s. Blood coming out of his ears, mouth and nose.

I picked him up quickly and screamed as the most primal fear I could ever imagine came racing to the surface. I forgot that I was a paramedic. All I could see was that little boy. As I hugged my son close and checked him for injuries I could see that he was fine. He calmed down and stopped crying. I cried like I had never cried before. I put him back in his crib, and still in my pajamas, removed every TV from the house and put them on the sidewalk. I worked for another 2 years on the ambulance, then 3 more on a helicopter, then I left EMS.

I’ve seen horrors. The same horrors that others like me have seen. I live with my ghosts and have learned to manage them. I am on a mission to provide support for first responders. We all need help in Managing the Ghosts. Help is available. Break the stigma that stops us from asking for help. Reach out to a friend when you see them hurting. Be the voice of change. Only we truly understand what it’s like to be us.

-Jared
managingtheghosts.org

Ghosts

A Memoir

 

While I cannot recall a specific year, or a specific date, or even the specific patients I treated, I can remember their ghosts and mine as well. My memory, now at a disadvantage from both age and illness, is not what it used to be.

Back at the beginning, when I was young or new to this  ambulance based pre-hospital world occupied by men, by the daring, the caring and by the broken I was in awe. Each time the Plectron would produce its’ mechanical set of multiple tones, I’d imagine the worst, which to those on the job were “the best” as far as calls went. I was in school to be a paramedic, or I was about to start my internship, the point being that I had yet to do much more than assist the elderly, run people to their dialysis appointments or transfer a bedridden patient from one place to another.

On this slightly overcast but warm day. I’d gone to visit a paramedic, Tom and his partner. I in my civilian attire and they in their uniforms, ready to head out to a call at a moments notice. They’d wanted a quick lunch and invited me along, so I jumped into the back of the ambulance for the few minute ride down the street to pick up some food. It wasn’t a holiday, there were no special events going on and the day had been quiet (which was a word I learned that you never say while on duty or with those on duty). There were very few calls for service and there was no reason to think our ten or so minute jaunt to pick up and bring lunch back to the station would be any different. Of course, it was.

Before getting to our fast food lunch, the tones blared from the bulky and burdensome old radios the men wore on their hips. The call was an MVA (motor vehicle accident). Code 3 (lights, sirens, with all haste). The location was Highway 92, halfway up the hill that separates the Pacific Coast and Half Moon Bay from the inland of San Mateo County.

Highway 92 was known for being treacherous when dark, wet or foggy. It wound back and forth with drops to the side into ravines that were filled with rocks and brush, and the other side steep rock and brush covered hills. While there were trees at the base of the road that to another freeway, the trees were few by the halfway point up Highway 92, and even fewer turnouts and passing lanes. The two lane road would be packed during the summer and weekends; beachgoers, families, campers and vans. I’d been on that road in the dark and in the fog, it was a discomforting drive as a young person. When I was tired, the windows would be rolled down and the radio on high just to stay awake and remain alert. That day though, from the back of the ambulance, I remember the sun shining in the mid afternoon and no major events were going on “over the hill”, as it was called.

Tom, who I called a friend, was in the front passenger seat. He would be the “technician”, or lead, for whatever would be found once we got to our destination. His job on the way to the call was to get radio updates, work through in his head all the possible scenarios; what additional equipment he’d need, what hospitals were on divert because the ER’s were full, what time frame was acceptable for a critical patient to be taken by ambulance versus landing a helicopter to fly them out. These were just a few of the things he had to consider before we got to where we were going. My job was to observe. While we worked for the same company, I wasn’t on duty. I wasn’t in uniform and I wasn’t trained to the extent that Tom and his partner were. No matter though, as most of these calls ended up being quite minor; someone with slight back pain who wanted to go to the hospital “just in case,” someone who may have lightly strained their neck and hoping that whomever caused the accident had enough insurance to cover the ambulance bill. Those were the typical results of this type of call.

On the way up the highway we lost the radio signal. At times it would come through momentarily like the desperately needed breeze on a hot summer day, but then it would fade out just as quickly. It took what seemed like an eternity to get to our destination, weaving through cars on the roadway, using the few wider areas with their slender dirt shoulders as our own lane, and finally as we rounded a corner seeing a vehicle on its side blocking both lanes. I don’t recall what Tom or his partner said but I do recall my heart starting to race, putting on my “work persona”, the face that shows no emotion, the voice that will not waiver, the reassuring hand that may lead someone to or away from something.

The ambulance stopped; the distinctive deep metallic ratcheting sound of the emergency brake being applied was a sound I could almost taste. Before I knew it one of the crew had thrown open the back doors of the ambulance, grabbed a jump bag (with trauma supplies) and signaled me to come out to assist. Once I exited the back of the ambulance, I came to see why they moved so quickly. I’d seen the car on its side while looking through the small transition area from the back of the ambulance to the front, but what I didn’t see were the people, standing in the roadways, their vehicle doors open. There was pointing and some shouting and I recall the sound of crying somewhere behind me.

Toms partner went around the car to the driver’s side, against the roadway. I stuck with Tom; we went to the other side, where the undercarriage of the car faced up the hill. Tom looked me in the eyes, I knew what he wanted; he was trying to see if I was “there,” able to function and follow his instructions. The look lasted a fraction of a second, but it was clear and concise, and within the same breath he started yelling instructions. It occurred to me that I was on my first really big accident scene and that I was actually going to be putting my training into use.

 It didn’t strike me just how odd the scene was as Tom and I quickly knelt on one side of the body in front of us. A body, face down on the black pavement, lying still in the shade of the vehicle. No face visible, just the denim jeans with a bit of tummy rounding out at the top, a t-shirt, not ripped or torn. No sign of blood or deformity registered in my brain. Tom and I took our positions ready to roll the body over, ensuring that it would be in one smooth movement, the spine kept inline with the lower body, the head and neck aligned with the spine. When Tom gave the word we would roll the person so that he could assess the severity of the injuries. It was on his count. One, two, three. We rolled the body, me at the hip and legs and he with the head and upper body, we rolled very little until his voice, somewhat high pitched and just loud enough for me to hear, said stop. I froze. He took his right hand from the shoulder of the body, placed it on the pavement near the stomach and leaned over towards the face. It was then I saw the dark pool that was under the chest, the fluid that had started to coagulate just under the head, and as Tom leaned back it struck me. The body was a female, her neck had a thick choke chain, the type with big silver links that you’d see on a dog. Her t-shirt was a darker color with a rock band name or emblem on the front. I remember because I had to look away from her face. Tom stopped us rolling her because of her face, caught between the pavement and the drivers side front tire.

I don’t recall much after that, just images. Tom had checked her carotid pulse, and then he instructed me to gently lie her back down in the position we’d found her. He sent me to the ambulance to get a “CHP Blanket” and it was then that I knew she was dead. I don’t recall what happened with the other patient, though I know we didn’t transport anyone in the ambulance that day.

I ended up “decompressing” at the station. I don’t recall what we talked about, just that the three of us talked and Tom did paperwork. Later in the afternoon we would go drop off the “run report”. The report detailed the scene, where the vehicle was, where the bodies were, what Tom and his partner did and the time or which Tom “pronounced” death.

Tom, as young as he was, barely twenty, was always a teacher. He asked if I wanted to see the body as it was on the exam table. I indicated I’d be willing. We went in and this was the first time I’d gotten a good look at her. She was around seventeen, just a few years younger than me. With reddish brown hair, the front matted and tangled with coagulated blood. Her face was set upon the front of her head, like an ill fitting mask. It was still attached by pieces of skin on one side, but the rest was scraped, battered and seemingly not where it should be. This is the image that I have always remembered, the first real image of “death” in someone that was my age, a contemporary.

Years later, I’d run my share of calls on an ambulance as the ‘teacher’ and the medic. I’d seen my share of death, both old and young, from medical and traumatic causes. But, one day at work as a paramedic I received a call: Tom, my friend, teacher, contemporary, had apparently overdosed on his Insulin at his home. He was brain dead and on life support, awaiting an organ harvesting team.

To those who came to help him he was just another “call,” another set of tones and a code 3 response. For me, the news brought back the freshness of death, it brought back the image of that girl on the asphalt with her face hidden, seemingly just laid out to rest in the shade of the overturned vehicle. Death was new again, because it was the death of a contemporary, a fellow medic, a friend. Tom is now one of my many ghosts, a memory, whisper.


Jennifer Schmidt is a former paramedic and police dispatcher who is currently working on a novel as well as a book of short stories. She resides in Monterey County where she works as an emerging web presence contributor and facilitator.

The Silent Battles We Fight

The following was sent to me from a friend who wishes to remain anonymous.

Things were simpler then. The day was planned around washing the ambulance, running calls and catching some sleep. Sleep was not as elusive then. We rested in between snapshots of despair, and harried voices coming out of the radio…respond to a female with chest pain…a 65 year old male not breathing…and limp babies in the middle of living room on the carpet wearing only a diaper. Blue lips and all waiting for someone, anyone to do something. But they just stared at him, his parents, and watched as we scooped him up and tried to resuscitate him. I tried not to shoot accusatory glances, but I couldn’t help it. The siren drowned out the pounding in my head as recipes for life saving cocktails raced through my mind. Pump harder on the chest…I hope I can get this tube…and I did as my hands shook mostly from anger but also from fear? Would I really be the last one to see him alive? 

Sometimes you just get a flash, and in an instant you know. They are going to die. 

The real answer is is that there are no answers. I keep looking. I want there to be that one thing that makes it okay. The one mystical all knowing being that can keep me from always wanting to crawl out of my skin. I just want to stop the itch, the crazy freight train of thoughts driving through my head. 

The homeless man shuffles along the sidewalk, his eyes bore into my soul. He sees right through me. His pant legs drag on the ground, caught under the heel of his worn out shoes. He almost trips. His greasy beard forms a pointy upside down triangle, framing his wrinkled face. His sign says “hungry.” Mine would say empty. 

And just because it’s not an emergency now, doesn’t mean it won’t be soon. The woman who rolled in alive, young, just 38 with belly pain, left in a bag. Zipped up for good. No looking back. And oh did you know she worked here? Yeah, you remember her, right? She was the quiet one that worked nights. But I didn’t. I tried to remember, but I couldn’t. I wanted to place her face there scooping my mashed potatoes, but I didn’t see her. I still can’t look at the fries without seeing the poster on the cash register, when she was alive and happy and there for her kids. It was beyond sad seeing my very capable doctor fight death and lose. She slipped away so fast, and I just watched him, having been in those shoes myself, my heart going out to him. Knowing that he was questioning his orders, his decisions, not that it would have mattered. She was going to go no matter what.

 
The monitor alarms, and there is a vtach streaming across the screen. At the other end is a man who wonders if he is dying. He probably is. I think about what I am going to have for dinner later, because I don’t want to think about him dying. The family is crying, they are hovered over them, their sadness palpable, and I don’t want to be here. I have paid my dues already as a paramedic. I have been with the dead, the newly dead and the almost dead. I do not want to see any more carnage, any more tragedy, and yet I don’t feel at home anywhere else. I need to be near the energy of the chaos, and attempt to reign it in and to actually excel at calming the storm putting out the fires, always having the answer. It validates me, in a way I never was anywhere else. I am the one with the plan. I am the one what will make it stop. I will take away the pain. I will be strong and carry you to the other side of your terrible nightmare. Who will take away my pain? 


I lay there waiting for sleep to come. I fantasize about being a janitor, or some other 9-5 mindless job I used to pray I would never have to do one day. I worked hard in school, I had dreams, about what i was going to do one day. And, man, I was going places. I was not going to be one of THOSE PEOPLE, who droned on about their day, doing the same thing over and over and never had to engage a single ounce of thought. No one relied on those people, and that could not be me. 

I am one of those other people now. I literally have life and death decisions to make every day. I often times don't have very much data to go on while making these decisions. I combine gut instinct, a physical exam, my teachings from school and my experience to decide what to do. I need to act fast, think on my feet and i am always being interrupted mid thought for some other pressing matter. There are alarms, bells and people yelling, talking and retching in the hallway. It is a recipe for disaster. It is a pressure soup, and I am the meat that is cooking in the broth. 

When I leave for the day, I am spent. Physically from bending over sewing a forehead with the tiniest sutures they make. I am drained by the end of every day, from the endless questions i can't answer. I am sorry i don't have an answer why you can't lose weight, what you were allergic to that caused your rash and no i am not sure how long it will take your knee sprain to heal so you can play football again. I patch you up, put a Band-Aid on it, and you go home. So do I at the end of the day. Go home.

But before I do, I walk by the janitor on my way out. She is the sweetest lady, always smiling. Her blue latex gloved hands gesture as she talks about this or that, never anything earth shattering. Her plans for her next day off which is not soon enough. “Honey you have fun, i am so glad YOU have the next two days off, you need it, you deserve it”. And she waves and smiles, and reaches over into the trash bin. Her cute ponytail bounces behind her punctuating her words. 

I am envious of her. Her carefree way, and that no one asks her what to do. No one asks her when they will get better, and what medication to give right now! Not in 1 minute from now, decide now. I miss that life of weekends that are actually weekends, not spent thinking about the guy with the toenail you removed, or the kid with pneumonia hoping they are okay. It’s a curse really, to care this much. But if i just had a trash can to care about, a floor to wax, maybe i could actually sleep at night. 

These are the ghost that haunt us. EMT’s, medics, nurses, doctors and PA’s. These are the silent battles we fight.