Sunday, June 22, 2014

That Person

Somewhere, somehow, I became that person.

I didn't realize it, of course, because it doesn't look different from the inside. I only realized it when I saw how others approached me, or deferred to me. I only realized it when I saw my younger self in the people talking to me, and realized who that must make me. 

That person. The experienced one, the leader-without-being-a-leader.

Maybe it came from the mountain, long nights in deep woods with sick patients and not another paramedic in sight. Maybe it came from precepting, from having to stretch and grow and teach, and learn how to teach. Maybe it came from doing enough rock med events. Maybe just from running enough f'd up calls. 

Whatever caused it, I know the effect: The relaxed, almost lazy confidence that I always looked up to. It's not arrogance, or a conscious "I've got this!" thought process. It is knowing that this is something you can handle. 

Because I've seen this movie before. I've seen the alternate endings. I have a very clear idea of the ways in which it can play out. And I know what to do, usually from painful experience. 

* * *

The flowsheets of assessment and treatmeny are mental paths, like a hedgerow maze in a garden. The paths loop in impossible ways, over and back on themselves, crossing and re-crossing. They lead to intersections, and cul-de-sacs, and four-way stops. 

Maybe we can imagine little stone tables at these intersections; on them sit a variety of things that it has come time to use. A heart monitor. A CPAP mask. A small purple cardboard box. A bag of IV fluid and a grey-striped needle. 

Maybe we walk these paths together, you and I, in the early evening, with the birds chirping and a warm breeze coming down off the distant hills and the gravel crunching softly under our feet. And we chat as we walk, and debate which turn to take. 

Maybe it scares you, becase you don't know what lurks down these paths, what beast waits silently and patiently, sharpening horns on stone, softly chuffing hot breath, ears a-twitch. 

And maybe it doesn't scare me, not because I'm not fearful, not because I'm so supremely confident, but simply because I've walked around this labyrinth enough to know most of the twists and turns. 

And because I know that, at the end of the day, there is no cloven-hoofed minotaur waiting for us. Only a few more intersections with their stone tables, everyday and plain. 

On one sits a blue vial and a red vial, and a couple of syringes. 

On another sits a scalpel and a peculiar little tool, a double-ended hook, with a wide, flat U-shape at one end, and a narrow V at the other, tapering to a sharp point. 

At the last intersection there is no table at all; instead a statue of a man kneeling over another. His elbows are locked, his hands clasped one over the other, pressed on the second man's chest. 

On his forehead, a tribute to some long-dead sculptor's supreme skill, sits a single drop of stone sweat. 

Wednesday, January 22, 2014

The Circle

This story seems unbelievable. I assure you, it's quite true. 

* * *

Early 2006 


I was in the clinical phase of paramedic school, doing rotations through the hospitals. Mid-afternoon on my second shift with the pediatric transport team, they – we – were paged to respond to a small community hospital about seventy miles away, to bring a patient back to the children's hospital.

When we arrived she was awake and happy, sitting up, a little blonde girl, maybe seven or eight years old. She was going to Portland for further tests. As stable as she was, we just put a DVD on – it was a pediatric ambulance, after all, with a TV and all – and had a nice quiet ride back. The transport nurse talked to her a bit, I talked with her some, and she happily chattered back. She was curious and happy and totally unfazed by the situation.

She said a dog in the movie was silly; and I told her about how my dog would go to sleep on the foot of my bed and end up next to me on the pillow when I wake up sometimes. On our way into the pediatric ICU we stopped for a second by a window, so she could see the city. She thought that it was pretty neat.

After we dropped her off in the ICU, I went to have lunch and catch up on my paperwork. An hour or so later I walked past the room the little girl was in, and she waved at me. Her dad – who I hadn't even met – said, "Hey, there's your friend!" Apparently she had been talking about me to her parents. Of course I went out and hung out in her room.

She was curious about everything that was going on, so I stayed in her room and explained as the nurses put in a second IV and got her hooked up to a portable monitor. Then I walked with her and her family over to Imaging so they could do a CT scan, to repeat and confirm what they'd seen on her scan at the community hospital.

She wanted to know about the pulse ox – "the light on my finger" – and I told her it was watching how well she was breathing. I was glad that she was old enough to understand an explanation.

She told me about her family, and I showed her a picture of my dog. "That's the dog that sleeps on your pillow, right?" she asked. Exactly, I told her. Smart, cute as a button, and very brave.

Oh, so terribly brave.

* * *

Her parents had taken her into the small community hospital this morning for an outpatient MRI scan. She'd had some headaches over the past few weeks, some episodes of loss of sensation on one side of her body, and over the past day some nausea and vomiting.

The mass in her head was at least 5 centimeters across. 

Her mom started crying as the image slices came up in real-time, because you could see it. Easily. No radiologist needed. It was surreal, because from the outside, she was perfectly neurologically intact, while the scan clearly showed a huge mass putting pressure on her brain. "Midline shift" is the term. It's a dry term for an ugly thing. 

I got mom a box of tissues while the nurse hugged her. Dad was in the scan room with a lead apron on, holding her hand. He never saw the pictures on the screen.

They scheduled neurosurgery for the next morning.

* * *

A couple days later, I wrote about her in an email to a friend:  I don't know if I'll follow up next week. I don't know if I want to. She seemed happy to have a friend, and her parents both thanked me, which makes me feel a bit better, for making a kid in a scary situation feel a bit better. 

A PICU nurse told me I shouldn't get attached, that you can't do the job if you get attached, which is maybe true for him working twenty-plus years, but not so much for me with this one rotation. We'll see. I was ready to walk away and leave that distance, until I saw that smile and wave and heard "Oh, there's your new friend..." 

Godammit.

* * *

I did try and follow up, two weeks later.

Tried. She had been discharged, a week after surgery. I quickly found out that being a student meant a brick wall as far as any other information was concerned.

In any case, my pediatrics rotation was over, I had new things on my plate, and, in my heart, I felt like I probably didn't want to know.

I wanted that sweet, bright kid to grow up, to do all the normal things that kids do, to not be sitting in a hospital gown on a too-big bed, full of wires and lines.

I wanted to imagine she lived to summer, to Christmas, and I knew just enough medicine to have a pretty good idea that would not be the case. 

* * *  

Late 2012

Six years later, I had mostly forgotten about the little blonde girl.

I had worked as a medic in the city, ran some ugly calls, helped a few people live, watched more people die. I'd gotten my feet wet, and then transferred out to a rural ambulance, working on the mountain. Long transports, sick patients, to be sure, but also lots of down-time. Lots of time to talk.

One night I was talking with my partner, an EMT who was a few years younger than me, and we got on the topic of pediatric patients. And so I told him the story of the little blonde girl, who was so brave, whose fate I never knew. I meant to tell the story as a way of discussing the value – and risk – of making emotional connections with your patients. There's no clear answer, I was going to say. Sometimes it's for the worse, and sometimes it's for the better. 

I never got to the end of the story.

Halfway through, my partner got a strange look on his face, and started grilling me for details. What happened to her exactly? When exactly was it? What was the little town we took her out of? 

What was her name?

Of course, I had long since forgotten her name. I told him what details I remembered, and his expression just got stranger. He looked spooked. Are you sure? 

Yeah, I told him. I think so. Why? What the hell is up, dude?

He said he had to make a phone call, and stepped out of the ambulance station. About five minutes later, he came back in, and sat down, heavily, in a chair. He looked at me, and looked down, and looked at me again. The silence stretched.

"What?" I finally asked. "What is it?"

"My aunt," he said.

"She knew – I mean – before I told her. I just asked her about when my cousin was sick, when she was little. When she had brain surgery. 

"I asked if she remembered any of the names of the crew that transported her to Portland. 

"And she said oh yes, there was this paramedic, he was so sweet, and she told me your name."

"My – what?"

"She remembered you! Told me the exact same story! That was my cousin, man, my little cousin you took care of."

 I found that I was holding my breath, and let it out, slowly. "I – I never found out what happened to her ..."

"Oh, god! Oh, shit, oh – she was – it was just blood, it was nothing."

"... Nothing?" I said faintly.

"Yeah, man. A little aneurysm or something, they fixed it and cleared that blood and that was it. She's fine. I saw her a few months ago. She'll be starting high school next year."

Saturday, January 04, 2014

It's All Moments

A man cries on my stretcher.

He's rounding on a hundred years old. A carpet took him down tonight, nothing more. He isn't even seriously hurt. Just hit the wall hard enough to rattle his brain a bit. He's not really confused, just can't quite remember the last six weeks or so. 

His wife died a month ago, and so I hold his hand and listen to him cry, as the loss is made new again.

* * *

A man lies on my stretcher, muscles flexed, teeth clenched, arms rotated peculiarly so his palms face outward, to his sides. Blood streams from cuts on his head and face, and he breathes quickly, noisily, snoring. He doesn't respond to anything we do. The air in the ambulance smells of beer and iron. 

I hand two syringes to my partner and look down at the man's face as she gives him the meds, one after the other. I adjust my safety glasses, thumb the laryngoscope open, and wait for his breathing to stop. 

* * *

A toddler sits in the car seat, which in turn is strapped to my stretcher.  He cries, confused, hot, still coming out of the seizure I fervently hope was caused by a virus. His mother holds his hand, trying not to look scared. As my partners work at assessing him, I stand behind the gurney, patting his shoulder with a blue-gloved hand, telling him softly, "It's okay, it's okay, you're okay, sweet boy." 

Neither he nor his mother speak a word of English, and I cannot stop thinking about how much easier this was before I had a child of my own. 

* * *

I have the same conversation a hundred times.

"Whoa, you're a paramedic? I bet you see some crazy stuff. It's got to be a super stressful job!"

Every time I lie. 

"Eh, not really. Most of it is pretty routine. Little old ladies falling down. Nothing like you see on TV."