Sunset

Another beautiful afternoon. The first inklings of spring have begun to push their way through the clouds and rain of winter. Today is sunny, if cold, and the dog happily sniffs her way along the blocks near my house.

Last night we walked down these same streets, heads down, pelted by ice-cold windblown rain, soaking through clothes and fur alike. Today is much nicer. We can agree on that.

But she doesn't agree on what has to come next; getting shut up in the house, watching me get in the car and drive away. She'll sit on the couch and look out the window. For all I know she'll sit there for thirteen full hours, until my car pulls up again, in the dawn light.

I think that I run the risk of conditioning a Pavlovian response in the dog; risk making her sad every day when it gets dark, because she knows it's probably time for me to go. Most days, anyway. Today, certainly.

The sun is setting, everyone is coming home, and it is time for me to go to work. In my locker is a blue uniform and scuffed boots. In the crew room there is a rack of radios, and another of keys. In the bay is a gleaming white ambulance. In houses and cars, on sidewalks and streets, in backyards and bars and businesses, are men and women and children, not yet sick or hurt enough to pick up the phone and dial those three magic numbers.

All of them waiting, waiting for me, just as sure as the dog waits at the window.

Truths

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.