26 May 1992 - Avocado Street, Springfield, Massachusetts
Well, I’m back in uniform, Jeff thought as he stepped out of his truck for his first day of orientation. He was starting at Connecticut River Valley Ambulance today. He’d spent part of last night pressing his uniform and shining his boots in advance of his first day. It was a little strange to be wearing a white shirt and navy blue trousers rather than Army green but he’d get over it.
“Get your ass in gear, New Guy!” called a voice from across the parking lot.
“‘Who said that?’” Jeff quoted as he stomped across the lot towards the speaker. “‘Who SAID that? Who’s the slimy little communist shit twinkletoes down here who just signed his own death warrant?’”
Gene Choamsky laughed while he shook hands with Jeff. “Hey, that was pretty good for an Army guy.”
“Do you know how often I wanted to channel my inner Gunnery Sergeant Hartmann with some new privates in my unit?”
“Probably as often as I wanted to. First day?”
“Yeah, riding third today from six to two.”
“About time you got started; I’ve already got five months of service on you, Airborne!”
“Yeah, but I’ve got a state championship title and a district finals appearance on you, Jarhead!”
“Yeah, yeah. Did you bring lunch today, or were you going to try and buy it?”
“Buy, at least until I know how much room there will be in the ambulance for a cooler or something. Plus I want to get a handle on the routine.”
“The only ‘routine’ I’ve seen in this job is when you punch in. After that, every day’s a little different.”
“Speaking of punching in, I should get inside and find the crew I’m working with.”
“Come on, I’ll show you where you need to go.” Gene led Jeff into the ambulance station. He pointed out the office’s layout to Jeff while they made their way to the crew room. “Hey! Bubblehead!” Gene called when they entered. “Your fresh meat is here!” A short, stocky man made his way over to Gene and Jeff. “Stu, this is Jeff Knox; we went to SRVCC’s EMT class together. Jeff, this is Stu Masterson. Don’t let him feed you a line of shit about how the Navy is the best armed service.”
“Don’t worry, Gene. I know the Army’s the best.”
“He’s been here all of five seconds and he’s talkin’ shit already?” Stu asked Gene. “At least this Jarhead was in the Navy Department,” he said to Jeff.
“Yeah, the men’s department of the Navy!” Gene shot back.
“Isn’t it time for you to go home?” Stu asked; Gene was coming off the night shift. Gene waved over his shoulder as he walked away, laughing. “Damn Marines,” Stu muttered. “Where you from, Jeff?”
“Enfield. You?”
“Davenport, Iowa, if you can believe that?”
“Iowa? How’d you wind up in the Birthplace of Basketball?”
“A long and convoluted story, Jeff; I’ll tell you later. You were in the Army then?”
“Yeah, I did a hitch with the 82nd Airborne after high school. I got out last year and started my EMT class in the fall. I did a little assistant coaching for my high school and worked at a hardware store until I got hired here. Did I hear Gene call you ‘bubblehead?’ Submariner?”
“Exactly. I did a tour on an Ohio-class boomer and a tour on the beach at the sub school in Groton.”
“Are there a lot of vets in this job?”
“There are three of us prior-service folks here at CRVA, and you’re number three.” As Stu said that a large man came through the door. “Hey, Neil, come meet the new guy who’ll be riding with us today.” The man made his way over. “Neil Fournier, meet Jeff Knox. Jeff, Neil Fournier.”
“Good to meet you, Neil.”
Neil grunted. “Stu show you where we keep the fallopian tubes in the truck yet?”
“‘Fallopian tubes?’ No.”
“Go find a box with fallopian tubes in the back of the truck.”
Jeff looked at Stu and gave him a quick wink. “Sure.” Jeff walked out of the crew room and out to the garage. Instead of looking through an ambulance for a box of fallopian tubes, he found one with a female EMT checking her vehicle’s equipment.
“Excuse me?”
“Yes?”
“Hi, I’m Jeff Knox; I’m starting today. I was wondering if you could help me out?”
“Hi, Jeff. I’m Connie Willis. What do you need?” Jeff explained what he’d been asked to find and what he wanted to do. “Oh, I’m in!” she answered with a laugh. Connie followed Jeff back to the crew room.
“Here you go, Neil.”
“Where’s what I asked you to find?”
“It’s right here,” Jeff replied, indicating Connie. “A box with fallopian tubes I found in the back of a truck.” Stu sprayed a mouthful of coffee across the floor; he was lucky he didn’t hit anyone. The other EMTs in the room laughed while Neil looked like he’d bitten into a lemon.
Stu mopped up his coffee, then grabbed Jeff by the elbow. “Come on, New Guy, time to check the truck.” Stu led him back out to the garage and showed him which ambulance they were assigned to that day. Co-workers came by to congratulate him on his handling of the hazing ritual. “I’m guessing the old left-handed O2 wrench gag isn’t going to work on you either?”
“It looks like every job has their FNG rituals, huh? Would that wrench be in the same place where the sonar return or something like that is in the Navy?”
“Yeah,” Stu laughed, “right next to the screen door for the submarine.” Stu showed Jeff how the storage in the back of the ambulance was laid out. He told Jeff he was lucky that CRVA standardized ambulance storage layouts a few years ago. “Try remembering where things were in ten or fifteen different ambulances, all with different layouts. Luckily, they buy the ambulances from the same manufacturer as much as possible.”
Five minutes later Neil emerged from the crew room. “Hey! New Guy! Come here!” he called from the back of the truck. Jeff stepped out of the back and onto the garage floor; he knew he was about to get it. Neil stared at him for a minute before smiling. “That was pretty good. Nice job, kid. Come on, time to show you what the job is really like.”
Paul Ezekiel jogged to Bilzarian’s loading dock the following afternoon. He was running late for his after-school shift. He was approaching his one-year review date, and hadn’t been late for a shift in that time; he didn’t want to break his streak. He punched in, noting he made it by one minute. He straightened his name tag and stepped out onto the sales floor.
“I thought you were actually going to be late, Paul.”
“Hey! I wasn’t sure you’d still be working here now that you’ve got that job in Springfield!”
“I dropped down to about twenty or so hours a week for now. I can’t pick up any overtime at the ambulance service until I’m off training. It’s not like I have a tough commute to get here, so Steve’s keeping me on the schedule.”
“When did you start?”
“Yesterday. I ‘rode third’ from six a.m. to two p.m. I was the third member of a crew, when the normal staff on an ambulance is two. I observed a lot yesterday; my shift tomorrow will be more hands-on.”
“Anything you weren’t expecting?”
“Sure. Lots.”
“Like what?”
“Like, how much cleaning you have to do. The ambulances are diesel, not gas, powered so that generates a lot of black dust you constantly have to clean out of the ambulance. We weren’t all that busy yesterday, so I learned how to clean the inside of an ambulance.”
“Sounds very different than what you learned in EMT class.”
“Not too much different than when I finished up my training in the Army then reported to Bragg. They teach you the basics in Basic, pun intended, then you do on-the-job training to learn all the little things about the every day routine.”
“When’s your next shift? Tomorrow?”
“There? Tomorrow, six to two with one of the guys I worked with yesterday. Here? Tomorrow night, five to close. But enough about me, how’s your young lady?” Paul blushed. Jeff punched him in the shoulder. “Wear your raincoat.”
The next day Jeff was once again working with Stu Masterson. Connie Willis was their partner. Jeff held his coffee while he walked through the door and punched in.
“Good thing you’ve already got your coffee, Jeff,” Connie said when she passed him with a box of supplies for the ambulance. “The calls are coming fast and furious already today.”
“Did you already check the truck?” He’d arrived fifteen minutes before his shift was supposed to start, but that didn’t appear to have been early enough.
“My car’s in the shop,” she explained as they walked out to the garage. “Again. My neighbor dropped me off, but she had to be at work at six also. I’ve been here since about 5:30.”
“What’s wrong with your car?”
“Wish I knew. It’s been in and out of the shop over the last month, stalling, no pep, running rough. I’m beginning to think the garage is jerking me around.”
“Are you anywhere near Enfield?”
“About a half an hour away, why?”
“If you can’t find a place closer to bring your car to, you could try Valley Automotive on 21 in Enfield, just over the line from Belchertown.”
“Heck, I’d drive fifty miles to have my car running right. Thanks for the tip. Have you been going there for a while?”
“Years.”
Stu joined them a minute later. They rolled out of the garage and were given a call right away. The call itself wasn’t very involved, but there was another one right behind it. Jeff was learning that “we have one coming out when you’re done with that” was not what you wanted to hear when arriving somewhere. He was glad he’d brought his lunch today.
They’d finished their third call of the morning and were heading to get another coffee when the fourth rolled in.
“Ambulance Fifteen?”
Stu’s head dropped to the steering wheel and he motioned for Connie to answer the radio. Connie sighed as she picked up the microphone. “Fifteen.”
“Fifteen, the River House Nursing Home for the code. Paramedics en route from the station.”
Stu dropped the pretend dramatics and hit the lights while Connie answered. “Fifteen has the River House.” She put the microphone down and turned to Jeff, who was riding in the back. “A cardiac arrest, a ‘code, ‘ at a contracted nursing home. Put the oxygen bag and a jump kit on the stretcher so we can unload as soon as we get there; grab the short board too so we can use it for CPR, to put under the patient. Once we get inside, just worry about doing CPR; we’ll handle everything else. We’re about five minutes away, the medics are fifteen and the closest hospital is the one we just left so that’s ten minutes back there.”
Jeff nodded and did as Connie directed. He moved carefully while the ambulance wove through traffic. One hand for the ship, one hand for yourself, he reminded himself. Pulling on his gloves he waited for the end of the response. Jeff opened the back doors and hopped out of the ambulance when they arrived. Stu helped him unload the stretcher.
“Follow me once we find out where the patient is, Jeff. Connie will get the paperwork and meet us wherever we wind up,” Stu told him.
They stepped through the ambulance entrance into the nursing home. The entrance felt like an afterthought as they had to weave around boxes stacked in the small entry. Once inside the nursing home proper, Jeff noticed an odor he knew he’d become very familiar with if he stayed in the ambulance business: stale urine, feces and disinfectant.
“Breathe through your mouth,” Stu recommended, noticing the look on his face. “It’ll help. It’s not perfect, but it’ll help.”
Someone stuck their head out of a room further down the hall. “In here!” the woman called. The three crew members walked to the room in question; Connie didn’t bother to stop at the nurses’ station since no one was there.
They stepped into the room to see a half-dozen people around a bed. One person was doing CPR on an elderly woman; another was using a device called a pocket mask to perform a type of mouth-to-mouth. Jeff questioned how effective the CPR was since the woman’s torso sank into the bed’s mattress with each down-stroke. The four other people in the room didn’t appear to be doing much of anything.
“Who’s got her paperwork?” Connie asked. She had to repeat herself in a louder voice to get someone’s attention. She and one of the on-lookers left the room.
Jeff looked over at Stu. “On our stretcher?”
“Yep. Set up on the side of the bed opposite from her,” Stu said, indicating the woman doing CPR. Jeff got the stretcher ready. They moved the patient using the bed’s sheet. Once the patient was on the stretcher Jeff cut the nightgown she was wearing to expose her chest. He checked his landmarks. He placed one hand on top of the other, locked his elbows and pressed down.
He felt several of the patient’s ribs break with his first compression.
“What was that?” one of the nursing home’s staff asked.
“Her ribs,” Stu answered while he secured the stretcher’s straps around their patient.
“You broke her ribs?” the woman asked in horror, gaping at Jeff.
“A common outcome with CPR, especially in the elderly,” Stu answered. “Does she have osteoporosis at all?” Stu started to pull the stretcher out of the room. Jeff rechecked his landmarks and continued CPR.
“I don’t know. She’s not my patient.”
“They never are,” Jeff heard Stu mutter under his breath.
Connie saw her partners approaching. She stuffed the paperwork back into the envelope she’d been handed. “She’ll be at Western General,” she said to the nurse at the desk.
“The patient goes to Riverside!”
“Not today. Riverside’s across the river and across town, a twenty-five minute ride from here. Western is ten. A patient in cardiac arrest goes to the closest hospital. We’ve had that discussion before.” Connie walked away with Jeff and Stu before the woman could answer. She took over ventilations; Jeff continued his compressions.
They threaded their way back through the ambulance entrance. Jeff stopped his compressions in the narrow space; they wouldn’t have fit otherwise. Another ambulance was backing in when they emerged into the sunshine. Jeff restarted CPR while Connie and Stu pulled the medics’ stretcher out of their ambulance; they loaded it into Ambulance Fifteen.
“Jeff, jump in the back of Twenty-one here and guide the head of the stretcher. Once it’s locked in, restart CPR.” Jeff did as he was told. Connie got in, hooked up the BVM to oxygen and began ventilating the patient again. One of the paramedics opened the “tube roll” while he sat in the seat at the patient’s head.
“Hold CPR,” the medic said. Jeff stopped. He watched as the medic inserted a flat metal blade with a handle into the patient’s mouth. Jeff saw her jaw lift and the medic inserted a long plastic tube. He put down the metal blade and put his stethoscope on.
“Bag,” he said while he listened. He must have heard what he wanted to hear because he took off his scope and said, “Restart CPR.” Jeff did so.
“Line’s in,” his partner reported, “a twenty in the right AC. Got a thousand bag hanging, running wide. Monitor shows asystole. Epi going in.” She paused, inserted a different syringe into the IV and announced, “Atropine going in.”
The first medic nodded. He looked over at Connie and said, “We’re good. We going to Western?”
“Yep, here’s her paperwork. It says ‘Riverside, ‘ but I told staff we were going to Western. I’ll drive, Stu will follow us. This is Jeff; it’s his second day, his first intercept and first response. Don’t break him, he seems like a good guy.” Connie hopped out of the side of the ambulance and shut the door.
“Jeff? I’m Neal and this is Kristi,” the first medic said, introducing his partner and himself.
“Nice to meet you both,” Jeff replied between compressions.
“Jeff, Connie’s a good driver, but you’re still going to get tossed around a bit because you’re standing,” Kristi said as they heard the truck shift into drive. “If you need to, hold onto that bar along the ceiling with your top hand and do compressions one-handed. It looks like your arms are long enough.”
Jeff nodded while the truck began to move. When it moved forward wasn’t the problem; he could brace himself when they were moving forward. The problem was the turns. Any lateral movement sent him off-balance. He was soon doing as Kristi suggested.
“Told ya,” she smiled. “You know what the technical term for that bar is?” He shook his head. “That’s the ‘Oh, shit’ bar.” Jeff chuckled and shook his head again. “You didn’t know this was going to be your introductory class in EMS black humor did you?”
“No. It does remind me of the humor we had in the Airborne, though.” He paused his compressions and nodded at Neal, who squeezed two breaths into their patient’s lungs. Jeff switched the arm he was doing compressions with.
“You were in the Airborne?” Neal asked.
“Yeah. Got out almost exactly a year ago.”
“But this is your first week in EMS? Why the delay?” Kristi asked. Neal was busy calling the hospital on the radio.
“When I got home last summer, a group of friends and I went by my old high school one rainy day to skate. I ran into my former hockey coach who asked if I wanted to be an assistant coach for him; I couldn’t pass that up. He was also my baseball coach so he asked if I would help him during the baseball season, too. Once we lost in the baseball district finals, I applied here. Gene Choamsky and I were in the same EMT class.”
“Wait, where did you go to school?” she asked as she injected another medication into the IV. “No change in rhythm, Neal; second epi’s going in.” Neal nodded while he finished giving his report.
“Swift River Valley Community College.”
“No, high school. Who did you coach for? Second atropine, Neal.”
“Oh, Thompkins in Enfield.”
“That’s why you look familiar! I was at the state finals! I used to play in high school myself. Jezus, your left wing was phenomenal! What a speed demon!”
“Darrin? Yeah, we call him ‘Streak.’ Would you believe he didn’t make the team at the start of the season?”
“You’re kidding!”
Any further discussion was put on hold when they backed into the ambulance bay at Western General Medical Center’s Emergency Room. Kristi took down the IV bag; she clamped it off before putting it on the patient’s abdomen. The cardiac monitor went on the patient’s legs. Kristi looped a stretcher strap through its handle; Jeff guessed that was to keep it from falling. Kristi asked Jeff to lift his hands while she covered the patient with a sheet, leaving her face visible.
“Always maintain the patient’s dignity, even on calls like this,” Kristi advised him. “You never know when family will be waiting for you when you open the back doors; the last thing you need to do is to pull Grandma out of the ambulance nekkid in front of them. You help steer the stretcher; I’ll do the compressions on the way in.”
“I’m okay,” he said. “I can keep going.”
“I’m sure you can, but I’m lighter than you. It’ll be easier for me to stand on the bottom stretcher rail and do compressions while you push the stretcher. The reverse wouldn’t work so well.” He guessed she weighed one hundred pounds lighter than his own two-fifteen.
As soon as Connie put the truck in park Stu opened the back doors. Kristi told Jeff to hop out and help unload the stretcher. Once Neal said they were all set, Stu and Jeff moved the stretcher into the ER.
“Room Two,” a nurse told them when they entered; Room Two was right off the ambulance bay. Inside, Jeff helped move the patient over to the hospital stretcher once Kristi and Neal made sure everything was ready. Connie took their stretcher outside after telling him to stay and listen. Neal was giving his report when Jeff turned his attention back to the room.
“ ... seventy-eight year old female, found pulseless and apneic in her bed at River House Nursing Home about thirty minutes ago, unknown downtime. CPR in progress upon BLS arrival, though the patient was still on the bed and staff there had nothing under the patient while they did compressions...”
“So, ineffectual compressions?” interrupted the ER doctor.
“I’d have to say so, Doc. BLS started CPR on their stretcher with good support underneath, dropped an OPA and began ventilating the patient; they emerged from the facility as we arrived. She’s got a seven-point-oh tube, twenty-one at the lips, good breath sounds, mist in the tube, no epigastric sounds, I saw the tube go through the cords. She’s got a twenty in her right AC. She’s gotten about three-fifty of fluid and only two epi, two atropine because we were so close. She’s been asystolic the whole time. No allergies, med list’s with your nurse. They wanted us to take her to Riverside, so I doubt she’s in your system.”
“Riverside? At this time of day?”
“We told staff we were coming here; they didn’t seem happy.”
“As your medical director, I would have been unhappy if you’d driven across the city with a cardiac arrest. You guys did the right thing. Good job.”
Neal nodded and waved Jeff out of the room. They walked back out to the ambulance together. Stu, Connie and Kristi were cleaning the back of Paramedic Twenty-one.
“Hey, Jeff, you doing okay?” Connie asked.
Jeff was puzzled. “Yeah. Why?”
“Your first code, first time doing CPR. They’ll pronounce her pretty soon, I would imagine.”
“Connie, I was in Panama and the Gulf War; three members of my squad were killed in an ambush in Panama. I helped out at a highway accident with two deaths in Ohio last June. You might say, ‘this ain’t my first rodeo.’”
