Friday, March 07, 2008


When I went to paramedic school, they taught me many things. Science and medicine, medications and procedures, techniques and tricks to stabilize - and occasionally save - those who are critically ill, slipping away. How to shock a heart, pop a chest, drop a tube. These are the things they need, the quickly dying.

But out here, a year and change later on the streets, I've learned something important. Its not about the quickly dying, not usually, not most nights, no.

We deal with the slowly dying.

The diabetics; the dialysis patients; the breathers, with emphysema and heart failure; the old and the sick. These are the people we deal with, day in and day out. These are the people who slowly get worse and better, who wax and wane like the moon, who we learn to know by name and face and address. Veins destroyed by years of access, for sugar in or dirty blood out. Sleeping in hospital beds crammed awkwardly into rooms into houses gone dirty and shabby from a lack of time, or energy, or motivation. Some try to keep their spirits up; some are sad and angry; some have already checked out.

And, of course, not all of these patients are slowly dying from some externally imposed condition. They're not all cursed by a vengeful God for acts of a past life. Oh no.

Some -- many -- of them are killing themselves slowly, with drugs and alcohol and tobacco. Coughing, lungs a riddled mass of scar tissue and collapsed alveoli, home oxygen cannula in their nose, sucking at a cigarette. Drunk again, stumbling and slurring, liver a rock distending their belly. Barely breathing, pupils tiny pinholes, locking them away from the pain of the real world.

And so we drive around, in endless circles, and take the slowly dying to the hospital, over and over. Maybe we'll do something for them, more than just transport. Probably not.

So occasionally, when we do see the quickly dying, we get excited, and we must ask forgiveness for our enthusiasm. We are not excited that someone is so sick, so hurt. We are excited at the chance to use our tools, our toys, our experience, our training; to be more than just a big white taxi.


Drew Rinella said...

Wonderfully worded.

Anonymous said...

keep writing...I work nights in our ER and your blogs are fun and insightful and right on the money!


RevMedic said...

"we get excited, and we must ask forgiveness for our enthusiasm"

Excellent point! I've always felt a little guilty high-fiving my partner after getting that particularly tough tube, putting out a 'good' house fire, etc.

It's not that we're excited for your loss, we're just happy to have played a part in stopping the damage.


NJ EMS said...

Love this post!

Ellie said...

Well put, glad to see a new post!

RC Huder said...

That is the street. That is the challenge of the street. To find some meaning in all of the routine IV and transport patients. Because the ones that are the most challenging rarely survive. I struggled with the same thoughts for 26 years. I retired in 2000. I think the struggle to find satisfaction gets harder not easier. I found it in the simple act of providing the care and worked hard not letting outcomes be my standard. I was not always successful. But that is the street.

Melissa said...

You summed it up perfectly.

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