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.