The alarm pierces through the good time you and Scarlett Johansson are having in your dream, telling you it’s time to get up and shower. Your alarm is the house-tones from a popular TV show from the 70’s and 80’s about paramedics and firefighters. You mock other people that have that as a ringtone while secretly loving the nerdiness of it. You hit the snooze once trying to convince your soul and brain that it is a good idea to go through the next 24 hours of what you have to do. You silence the alarm again and make your way down the steps to the bathroom, motivated by something, but you are not sure what.
You stand in the shower as the drops of water hit you, each telling you that the day is real; the day has started and that it’s time to drag your heart, your mind, and your soul through the mire of emotions that you know you will have today. Like dragging a brand new coat through a mud puddle, just so you can take the coat back home to wash it and make it clean again. You look forward to getting in this shower when you get back home. It makes you feel like, if you have the water hot enough, you can wash the day off; the negative emotions off of your heart and the bad things out of your brain.
Before you know it, the shower is over. You shave so your SCBA mask will fit tight on your face. You know you probably won’t need it since you are on the medic today, but you do it anyway. You brush your teeth so that when you kiss your sleepy significant other goodbye, you leave them with the memory of your fresh breath and your clean body and cologne to get them through the 24 hours without you. “I love you, and you smell great,” they whimper through sleepy eyes. That’s all you need to light a fire in your soul that burns until you get back home the next day.
You get your stuff together and get to the car. You get in it and sit for a minute trying to remember which place you are working at today since you work a couple of different departments to make a living. You tell yourself you do it to make your work experience “well-rounded, ” but you know deep down that it’s because your inner EMS nerd can’t get enough of the work. You check the schedule to see who you are partnered with on the medic today and decide whether that person will make it a long, frustrating day or a fun-filled one. It’s someone that you work well with, so you have that going for you. It should be fun, but it will still be long.
You get to the firehouse at your usual time. You make your way in and survey the rig line-up to see what rig you are riding in today. It’s the big piece of shit medic. Your department just got some new medics, but the one from this station is out for repair already. Not a big surprise, since the dwindling tax revenue over the last decade has crippled the infrastructure of the city. The roads are shit; the water mains are shit; the city is decaying around you. It beats up the rigs as they traverse the streets, so things need to be repaired often.
You take in the smell of the apparatus bay. Yep, they had a fire. You can smell the burnt plastic and wood. You see the wet hose hanging up to dry. You can tell the engine ran a lot because it’s dirty. You know the crew washed it before supper last night, they always do. But it’s dirty again, so it went out at some point during the night. The medic is dirty too, so you know what kind of night they had.
You make your way to the kitchen and get the coffee going. You turn on the TV to catch up on the events on the news and see if anything newsworthy happened in the city last night. Yep, there’s the fire. A garage fire. It looked pretty simple. You scan for last names on coats so you can rib the guy that wasn’t able to hide from the cameras. It’s the new guy of course. The rest of us are like ninjas. We hide behind trucks and chiefs to keep from being seen. We’ve bought enough ice cream over the years. The new guy can have his turn. His mom will be proud of him anyway, so that washes out the ribbing he will get from us.
The rest of your crew makes it in. You sit and discuss the problems of the world and have them all hammered out by the second pot of coffee. Yesterday’s crew stumbles out of their bunks to go home. You sit with them and review the last 24 hours. You hear what got done and what didn’t. You get an apology for the fire truck being dirty. We all know why it was so it’s no big deal. It happens to all of us. The previous crew heads home, and you go out to check the rigs.
Nothing big is missing from your medic. You straighten up the supplies and cabinets. Have a quick review with your partner about what you need, so you can dig through the supplies at the station or get it from the hospital. Everything checks out except there is no shoreline power to the back of the medic. You have seen this 100 times before, and you quickly resolve the issue. You put it on your mental list of things to watch throughout the day.
The first call is banged out. Off to the nursing home for something easy. The staff at the ECF didn’t want to wait for the ambulance service to transport the patient to the Emergency Department for the abdominal pain they have had for three days, so they called you. You load the sweet old lady onto the cot and get the vague info from the staff. You have a mental check list. It looks kind of like a bingo card. You put a dot on the square that matches what the ECF “nurse” tells you in the report. “I just got here,” one dot! “This is not my patient,” another dot! “She was fine the last time we checked on her,” three dots! If I use the gingivitis “free” space, you only need one more to win. You covertly ask a few more questions to get the last space. And then she lays it on you……”her pulse was 50/20, so the doctor wants her to go to the ER” BOOOOM!!! You win with the vital signs that make absolutely no sense!!! The prize looks a lot like me not hating you for being incompetent. She doesn’t look like she feels the winning. It must be your smile and polite comments that are throwing her off. You have become a master at passive aggressive, sarcastic customer service by now, so you keep your opinions to yourself and share them with the ER staff when you get to the hospital. Everyone chuckles, but you know the loser in this scenario is the little old lady who is in the care of those nursing home idiots most of her day.
You clear the hospital and catch a few more calls. Nothing major. You and your partner trade call-for-call to even out the patient load. Shortness of breath, a fall, abdominal pain, back pain, shortness of breath again. Nothing gets you that adrenaline rush you used to have. You are good at what you do, so nothing scares you. You see the new guys with all of their enthusiasm and yearn for your younger days.
Your front row seat to the decay of society keeps you busy all day. You grab food when you can. The hours pass by. You get a full arrest around supper time. That gets you going a little bit, but they seem easy now. You and your partner along with the engine crew have worked together for a while, so the run flows well with not a lot of talking. Just working…IV, intubation, meds, shock, shock, shock. You call Medical Control to get the OK to terminate efforts, and they say “Yes.” Then you get a faint pulse back. You know it’s a waste of time and fuel, but you scoop the patient up and head to the ED. You call the ED and let them know things have changed. The nurse on the other end of the phone is super psyched that you are coming (sarcasm). You look forward to surfing the cot while doing CPR (it’s the little things) and you deliver the patient to the ED. You know you bought the family just enough time to say goodbye. The patient will die in the ED. You knew that before you left the scene.
You catch an overdose call as you leave the hospital. Those have been moved to the same category as the abdominal pain and shortness of breath. You do so many of them now that it is just another “thing” you do. The scenario plays out just like you knew it would. “What did he take?” “We don’t know,” the people watching TV in the other room say. You know what it is because you revived the guy in the recliner last week. You carry a MAD (Mucosal Atomization Device) in your pocket now because you do these so often. Oh look, he’s breathing four times a minute. Oh look, the Narcan brought him around after a few moments. I’m a life saver! Before he wakes all the way up, you pick out what lie he will tell you when he comes to. You have a short list; let’s see what he goes with. Wait for it….”I didn’t take heroin,” he says. Ahhh, come on! That’s the most boring one there is! You wish they would be more creative. “I was riding a pterodactyl into the Superdome, and the talking meerkats told me to heat up the magic brown sugary powder in a spoon and shoot it into my body.” At least that would be funny to everyone in the room and would give me a story to tell. “I didn’t take heroin….” Work on something better and have it ready for me when I wake your dumb ass up the next time. There will be a next time.
You finally get supper and a few minutes to relax at the station with the rest of the crew. They left the food out for you. You shovel it in case you have to bounce out again. They do stuff around the station and tell you to finish eating, but it makes you uncomfortable. You should be helping, but the food is good, even though you had to microwave it. Before you know it, they have washed your rig. You start the dishwasher. There, I contributed. I don’t feel as awkward.
Another overdose and a few more easy calls come in. You and your partner continue to volley them to each other. You are getting tired now. You want a nap. You remember a time, ten years ago when you could pull the “all-nighters,” but you were younger then. You had more energy. You weren’t overweight with high blood pressure then. Your mind wasn’t tired, your knees didn’t hurt, and your back could still take the jarring from the crappy streets. You were in better shape mentally. You didn’t see as much darkness in your work as you do now. You didn’t realize yet that you were just hauling freight, essentially. You didn’t understand that people need the hospital more than they need you. That, even though you do great things in the field, the end game is to get them to definitive care. You know why it’s called prehospital care now. You are collecting these people for the hospital since they don’t do it themselves. You know now that you are working for an EMS department that fights fire, on occasion. You were a dragon slayer once, at least you thought you were. You see skills being taken away from you because they don’t do anything in the field. You see what the future of this job is because you have the past to look back on. You see what people have done to each other. You have seen behind the curtain. You know that nothing happens when you die. You have watched countless people stop being people and become objects that need to be dealt with. You have watched people die. There is no quiet last breath in the company of family for most of them. There is me or someone like me hovering over them, poking, prodding, intubating, breaking ribs, managing puke and smelling the shit. You know what dying is. You have made friends with it. You feel like a recruiter for the grim reaper. Somewhere in the dark corner of your brain, you want their death to be horrible for them because you feel horrible dealing with their death. You want them to feel what you feel, but you get robbed every time. They are just an object. You might as well talk to the ground.
You make it back and crawl in bed for an hour or so. The ceiling witch wakes you up for an “unknown problem” at a location you know well. It’s either a shooting or a maternity if it’s up there, you tell yourself. You stage for the police and ding ding ding; it’s a shooting. You enter to find blood everywhere. You chuckle a little because it looks staged or like a movie set. You find your patient sitting on the couch holding his arm. Yep, they got him. A half a dozen times from what you can see. He is weirdly calm for being shot that many times but you dismiss it. He’s as used to people being shot as you are probably. You load him quick and jet out of there. He needs a surgeon; not you. You do your usual stuff. Trauma is easy for you. You work like a robot and roll up at the trauma center. You unload and meet the blue gown mafia in the trauma room. You shout out your findings and your treatments. You ask the trauma doc if she needs anything else from you and you hand off the patient to her with a “Good luck!”
You spend the next 45 minutes doing your report. You try to piece together the timeline. The first few minutes are a little fuzzy because you weren’t completely awake yet. You review the report several times so that you can maybe not get raked over the coals by the QA/QI people later at the trauma review. Your partner figured out how to get coffee out of the new coffee machine in the EMS room, so he’s the real hero this morning! You leave out of the ED awake because the adrenaline comes late for you. It floods in after the call is over. You are on autopilot during the call, but afterward, that chemical floods in and wakes you right up! You fool yourself for a minute by saying “I can do this until I’m 65.” You’re an idiot. You will be washed out or dead by then.
You catch a call coming back. You walk into the home of an elderly couple with the blood from the last guy on your boots. You figure out what is wrong. The gentleman has had pain for a while and just can’t bare it anymore. You load him up on the cot and get him in the rig. You come back in and collect his wife of 65 years and help her up into the front seat of the rig. Your partner has this one, so you make the short trip to the ED. The wife is concerned so you make polite conversation to ease her mind. They are on a new adventure this morning, but you are finishing up the long day you have had. For a second you think about that shower. You can feel the water warming your back. You can’t wait. But first, you have to finish the adventure you are on with these total strangers. You unload your cargo, and your partner rolls the cot in by himself. You help the wife out of the rig and walk with her as she shuffles along. You reunite them in the ED room. You accept the 100 “Thank you’s,” that you get from them. It feels good for a minute until you remember something you should have done on the shooting. You go from gracious to grumpy.
You put the rig back together and help your partner stay awake to finish his report. Hey, look, more coffee! You head back to quarters with 30 minutes to go. The new guy from the oncoming shift is always there early, so you know at least one of you will get home on time.
You back in the station and tidy up the rig for the next crew. Nothing else happens until shift change, so you get out of there after another world problem-solving session at the kitchen table.
You load up the car and head home. You pull in at home not knowing how you got there. Your brain was processing the shifts events all the way home because it didn’t have time to do it while the day was unfolding. It sorts through the stuff it wants to keep and the stuff that it will put in a box and shove in the dusty corners of your brain, never to be opened again. There are a lot of boxes filling the corners and one day all the boxes will fall over to spill out all of what’s inside. You don’t think about that very long. It’s the thing that lurks in the minds of all of us in this line of work. Is today going to be that day? Will a 10-second scene in this movie be the thing that knocks over all of those boxes like the school yard bully that doesn’t get his way? Will I be crying, loudly, in this theater? We wonder what will happen on that day. We try to put it off as long as possible. But it is not up to us.
You make your way inside to an empty house. That’s OK with you. You did enough “people-ing” during your shift. You welcome the opportunity not to have to explain something or interact with someone. You shed the blue Superman suit. You are sick of blue. You make it to the shower, the moment you have looked forward to. You wash off the day. You get warm. You relax. You fight the memories of the shift and what you could have done differently. You finish separating out the hours from the last 24 that you want to keep and the ones you box up. You try to decide if you are going to try to take a nap or stay up. Your significant other will be at work all day, so you have the house to yourself. You make some coffee and mull it over. Yes, more coffee.
You go back to the “keep and pack up process” because your brain just can’t get it done today. You look at each hour of the last 24 and decide if this is the moment I choose to quit doing this or is it the moment I decide to stay in it for another few years, months or shifts. It’s a weird decision, and you make it after every shift. You wonder if your lawyer dad or school teacher mom ever sat and thought about their job the same way. I’m not sure their jobs were as intertwined into the very fibers of who they are. This job is. This job violates spaces in your brain you didn’t know existed. It works into the spaces; between the spaces. You wonder and drink coffee.
The nap idea wins. You lay down and go blank. You wake up to a text from your significant other asking how it went and that they love you. You respond that there wasn’t much to talk about. “Just the usual,” you say. They will dig deeper when they get home. By then the sorting process will be complete. You won’t tell them about what you put in the boxes. You will talk about what you kept. The sweet old couple from the end of the shift will play well with your significant other. It’s more palatable. You won’t mention the blood on your boots. That’s for you to deal with. They know there is more, but they won’t push. That’s why you love them as much as you do.
So you had 24 reasons to leave or stay. You are the only one that can decide what you will do. Will you stay? I always do. It’s what I want to do right now.
Someday that won’t be the case. I will be OK with that.