(Originally written a number of years ago, when I was a new medic. I was reading a little too much William Barton.)
4am. The inside of our quarters are dark and we leave them that way, ducking out of the rain, locking the door. My partner flops on the couch, benefit of being a lead. I curl up awkwardly on a recliner, trying to get the damn thing to stay back while I lie on my side. I push a few buttons on the pager; it asks, SET AUDIBLE ALERT? and when I confirm it chirps happily.
Radio just a quiescent brick of plastic, sometimes murmuring softing with the voices of dispatchers and other crews, engine nine medic three twenty a trauma at three nine st and southern ave stage for police map page six nine two four dee delta. I clip the pager to my shirtfront so it won't be muffled by my jacket, and think about snuggling up with the radio held close. Maybe if I keep it happy it will stay quiet.
No. I'm more likely to roll over and key it up, treat the entire county to my snores. Instead, I set it on the table next to the chair. Sooner or later one or the other will go off, the startling, not-quite-synchronized tenor BEEP BEEP BEEP BEEP of the radios alerting for a call, or the high soprano DWEEEE DWEEEE DWEEEE of the pager, telling us to move posts.
On days, when the radios went off, I'd always be listening for the one tuned to the fire dispatch channel. What are we going on, I have to know. Punching the button on mine hastily to make it stop alerting, happy little radio with CALL RECIEVED flashing on the tiny screen, the beeping covering up the voice of the dispatcher, FD1 Dispatch up at the comm center, sitting in front of her five screens, maybe occasionally talking to FD2 FireTac sitting next to her. They sound so serious and professional on the air. Go up to the dispatch floor, through three or four remote-locked doors, and they're all laughing and fun, middle-aged women mostly, in jeans and sweatshirts.
But still the radios beep, and FD1 reads out the call that CT1 or CT7 or CT13 just entered, and FD2 waits patiently for us to switch channels and tell her we're going.
At first all we hear is the type of call. There are the meat and potatoes calls, abdominal pain, sick person, minor trauma, was unconscious but awake now. Assaults, ass kicked in a bar fight. Stage for police. Chest pain and breathing problem, could be something, could be nothing. Random calls we hear less frequently. General OB problem. Tyke on the way. Allergic reaction. Animal bite. Too hot or too cold. The ubiquitous traffic accident, could be minor, could be hellacious. And then there are three types of calls that do get our attention, at least a bit. Major trauma. Shooting or stabbing. And unconscious and not breathing. On days I always listened for the type, tried to figure out what was gonna happen.
And then, when we get in the car, I can look at the computer, nuggets of data hidden among vast strings of computer abbreviations. A call might come up looking something like this:
04/17/2006 1RUN#1100320041 CHPN
FMAP: 6284D TMAP: 656D2 FBLK: 0065
1298 MAIN ST <3000>
( HIGH XST: 12TH PL )
BROWN, JOE, SON
SA/C 503 555 1234
0041 ENTRY: M, 41, CH PAINS
0041 FIRSTSUG E23
0041 NEXTENG 'E9 'E4
0041 DISP E23
0041 $ASNCAS E23 #PF0041672384
0041 EMSSUG M321 M315 ?M329 M334
0041 ASST M321
0041 $ASNCAS M321 #MD0128495672
0041 TALKGP OPS1
0041 R1 --> O1
0042 SUPP (CT13 ): SOB, SWEATY, HEART HX
0042 ENRT M321
... and out of that all that's useful is that it's a diaphoretic guy with chest pain and trouble breathing who's had heart trouble before.
At 4am I could care less. I just have to get up, glasses on, make the radio stop beeping, tell someone we're enroute, get to the car. If I'm driving I may not know what we're walking into until we arrive. It's a call.
Doesn't matter what.
Someone told me nights are all bullshit or ohshit. Much more of the former than the latter. I marvel at the way my partner goes from cussing out the patient, dispatchers, fire department, anyone on the road while we drive to a call, to kind, attentive, and caring when we're in someone's house.
And then, well, all of a sudden you're at someone's bedside and they're guppy-breathing, or have crushing substernal chest pain radiating into the left arm, or are seizing, or have stroked out, and it's all you, baby.
Delegation always buys me a few seconds for thought. Get vital signs, fireman. Get some o's, oxygen, on. Start looking for an IV site, partner. Get the monitor. Get a sugar. Get the gurney. When it's bad -- start bagging. Get suction. Get versed. Draw up the sux and amidate. Get the intubation roll. Get the patches on. Continue CPR. Very demanding, when you're the almighty PIC, Person In Charge.
But you have to be, because while they're doing all that crap, all the skills that we could train a moderately clever rhesus monkey to do -- no offence to firemen OR monkeys -- you've got the tough job, the detective work.
When did it start. What does it feel like. Has it happened before. What happened then. Does it radiate. What makes it worse. Better. How bad is it.
And you're standing there, behind the shield of your professionalism and your questions and your neat blue uniform shirt and colorful PARAMEDIC patch, with the firemen in their turnouts and the big red engine and big white ambulance, strobes stuttering lightning in the predawn dark, low rumbling diesels, heart monitor and oxygen bottle and medkit all arrayed. And they look up at you with scared eyes, breathing fast, clutching their chest, pale, diaphoretic, shaking, puking, swaying, bleeding. And they tend to ask the same two questions -- what's happening? Am I going to be okay?
Maybe you know what's happening. Maybe you have no clue. Tell them a carefully edited version of the truth. It looks like you may be having a heart attack. We're not sure, everything looks good so far. I think you're having an allergic reaction. I think your asthma, your heart failure, your diabetes, your chronical medical condition with a long latin name, that thing, is acting up. We'll have to see. The hospital can run more tests.
But some things we don't say. It looks bad. Your EKG is all wrong. We're behind the eight-ball. You should have called hours ago. You need to be tubed. Your car is destroyed. Your passenger is dead. Ohshitohshit I've never done this -- a surgical airway, decompressing a chest, whatever -- before. I'm as scared as you are.
Which hospital, we say instead. We'll take good care of you. That's a good hospital. Can we lock up your house. Here's your keys.
Do I look worried, sir? No? Then you shouldn't be. A reassuring pat. You can be scared when I looked scared, ok?
I don't explain that I'm a very good actor.
1 month ago