A
Paramedic's
Journey
By
E.
W. Crook Jr.
EMT-P
The
First Step
1966
was a time of war, it was a time of space exploration and it was a
time when I was eight years old and a patient in a children's
hospital. The walls were a pale white and there age showed through.
The hospital beds were made of heavy steel that was cold especially
at night. When the bed's rails were raised the bed looked like a
cage and to that eight year old boy it had the feel of one. I saw
children die in those cages and I remember how lonely it was and I
was afraid that I might die. Children were warehoused in cages
all lined up in a row. You could reach out to other kids and make
friends, but there was a price to pay. You would see their pain,
their deformities or whatever it was that made them not a normal kid,
and sometimes you watched them die. Some kids were there because they
were abused; some burned, but most like me had a handicap or
deformity from birth. This hospital was not the exception; in
the 1960's it was the rule. Medical Miracles were seen there and a
lot of good people worked there, but not all. Some staff did not have
the compassion for children in pain. Maybe they had seen too much and
built up a wall for their own self-preservation. Cries of pain, and
fear were tolerated only so far. Accepted methods of discipline
included losing wheelchair privileges or your weekly soda pop, and
sometimes even straight jackets were used. This was a time when
healthcare workers including nurses were seriously underpaid and
there were no screenings done to check for criminal history or
records of abuse. Children received bruises, from pinches or where an
arm was held to tight. Bruises were sometime left by the straight
jacket when some staff made them too tight or left them on longer
than the rules allowed them to. You never resisted when one was put
on, you knew it would make things worse. At times the fear was
overwhelming. I remember a night when I wet my bed rather than
calling out, because I knew which nurse was on duty and I was afraid
of her. Each shift change was a scary event not knowing who was
coming on duty.
The worst
time for me was about a week after my surgery. The pain was so
consuming that all I could do was cry. It was the kind of crying that
no matter how hard you try to stop it, you can't. Many of the staff
had lost patience with me because I had gone past the time that they
had expected the severe pain to end. To make it worse they had cut
out most of the pain medicines. It finally reached a point where they
would not tolerate what was considered my bad behavior any more. So
much of the time when my parents were not around I was left to cry
while wearing a straight jacket. Mom and Dad were allowed to come to
see me anytime for three days after the surgery but then it went back
to the regular visiting hours. So all they could do was trust that
the staff knew what was going on. The 9th day after my surgery fell
on a Sunday. As soon as visitors were allowed in Mom and Dad were at
my bedside. It took only two minutes of seeing me for them to start
asking why I had been left to endure so much pain. The explanation of
bad behavior did not go over very well with mom. In less than an hour
I was in a procedure room having my cast cut off so that my legs
could be checked by the orthopedic surgeon. Cutting a cast should be
a painless procedure. Not in this case. The degree of pain was seared
into my memory from that point on. They were surprised when blood
started seeping from the first cut into the cast. They were able to
correct the problem but I don't remember much after that because
they kept me sedated with pain meds for several days. Then there
were the angles, the ones who I still believe to this day were sent
to us by God, to help us through the endless days, and the even
longer nights. Their bright faces and their beautiful smiles gave us
the hope to keep going. They fought for us against the ones who
didn't care, the ones who caged us, they took the reprimands for
spending too much time with each child, they would hold us, and wipe
away the tears. They loved us, and they stayed with us. I have
forgotten most of their names but I still remember their faces
because in my mind's eye those were the faces of God's Angels. I
had a strength that some kids did not have a Mom, and Dad that loved
me. They were there every Wednesday and Sunday during visiting hours.
Visits were only allowed then, or at other times, like birthdays, or
if you were having surgery. The hours went by much too quickly. Mom
and Dad would bring me coloring books or car models to help me pass
the time until they could come again. I remember once during those
long months when a High School Band came and played for us. They took
those of us that could go, outside where the band was. The greatest
part of it was that it was on visiting day, and since it was outside
my sisters could come with Mom and Dad for the visit. It was the only
time I got to see them the whole time I was there, except for an
occasional look out the window, when a sitter could not be found and
they were outside on the hospital grounds playing, waiting for Mom
and Dad. We also would occasional have visitors like the local
host of the Saturday morning cartoon show. Or when some entertainers
did shows in nearby larger cities they would come by and do a show
for us. I got my first look of one of the early Rock Groups, and was
in wonder when I saw the reactions of some of the teenage girls from
another hospital ward. I guess the one I remember most is when Emit
Kelly Jr. came to the hospital. He came around to every child that he
was allowed to visit. I had my picture taken with him. I never saw it
or got a copy of it. I hope that guy had film in the camera!! I guess
you can get some great memories from some of the worst places, as
long as you have someone who loves you.
The
saddest faces I ever saw were the kids who would sit there on
visiting day not daring to even hope, for fear of being disappointed.
Month after month they waited but no one ever came. I saw small
children reach out to other kid's parents in hopes of getting a hug
or just a touch. The human touch and to be loved is the greatest need
that a child has. Some memories don't fade as fast as others. I can
see the faces of those kids even after more than forty years. An
eight-year-old can sometimes think that he is the one who has to take
care of his mom and dad, I never told them about some of the deep
dark places and things at that hospital. It would have broken their
hearts. I knew that it was as hard for them to leave me there. The
doctor had told them that if this surgery were not done, within six
months I would never be able to walk again. Mom tried to hide her
tears and comfort her child, and that she did very well, but as I
found out years later she cried on most of the trips home, and she
cried many nights comforted in my dad's arms. Learning to walk
again came slowly and painfully. Mom came to the hospital as much as
she was allowed and helped me. She held my hand and helped me walk
again. She gave me the courage to get through the pain, and when she
wasn't there and none of the hospital staff would help I walked
what I could, and then slid on the floor or did an almost straight
leg type of crawl. The ordeal ended suddenly and unexpectedly.
My dad worked delivering bread, cakes and other types of assorted
goodies. On Wednesdays he would get an early start on his route, then
take a break and come to see me. On this Wednesday I found out I was
going to be released from the hospital about an hour before dad got
there. The hospital did not call home and tell them that I was being
released because they knew my dad would be there that day. That big
red truck with the diamond shaped emblem looked so wonderful to that
little boy who was at the window watching it pull into the parking
lot that day. I half watched the clock and half watched the window
and waited for visiting hours to start so dad would come in find out
I could go and take me home. To my surprise one of those few angels
came up, carrying a bag with all my belongings, and took me by the
hand. She looked into the face of that little boy and told him that
his daddy didn't have to wait out there anymore that we would
surprise him. As we walked out that door we did not go very far
before dad saw us, which was a good thing because my legs were
starting to give out. He came up and picked me up and put me up on
his shoulders. It seemed that he was as tall as a mountain that day,
and I felt like I could see the world. It was one of the few times in
my life that I had the feeling that Dad accepted me for the person
that I was. He deserved to have a son that was the star of the
football team, a son who was stronger than I was, a son that he could
brag about, I never was that for him. I was never tough enough; I did
not know how to be what he wanted me to be. In later teenage years we
came close to totally losing each other. Home was a small
two-bedroom mobile home. Mom and Dad had one bedroom, my three
sisters shared the other, and my room was the couch in the living
room. It looked wonderful to me. It was there that my two-year-old
sister helped me learn how to walk again. Whenever I tried to sit
down she would grab my hand and take me to see something that she had
just discovered in her toddling. By the time school started again
that fall I could get around OK, and was able to go back to school,
but I never did fit in again. I was too slow in sports, overweight
from inactivity, and had missed a lot of lessons in interacting with
childhood peers.
The Long
Ride Home
Sarah
was one of our regulars. She was only 64 years old but had been
plagued with chronic heart disease for the past five years. Because
of other medical problems she was not even considered for a
transplant. She lived her life in a nursing home. On her good days
she would go out and sit in the lobby or visit her many friends in
other rooms and if the weather was good she would go out to a small
gazebo that was out behind the home. She loved to sit and watch the
birds playing in the birdbath and at the feeder. She took joy at
watching the squirrels chase each other while she felt the sun on her
face. On her bad days she would stay in her room and watch a game
show or two and read books. She mostly read classics but you would
sometimes catch her reading books about history, different religions,
and cultures. She loved people and enjoyed talking and getting to
know everyone she could. We became friends the first time we
met. She was having one of her good days the first time I met
her. We were to take her to the cardiologist and because it was a
short visit we would wait and bring her back. When we came into her
room she was sitting in her wheelchair waiting for us. She greeted us
with a warm hello and a beautiful smile. From the first minute I knew
she was someone I was going to like. That first trip I learned a lot
about her and she learned a lot about me. In route to the doctor's
office she told me about growing up in the rural mountain community
of Seven Springs, about family, and how the community was when she
was a small girl. With every word she painted a picture. I could
almost see the mountains and the stream as she described the view
from the porch of the house where she grew up. She told me that she
had a sister who still lived there and how she hoped that she would
get well enough to go back there for a visit. Time flew by and it
seemed like only a few minutes had passed when we were turning into
the medical center where her appointment was. During her exam the
staff left her on our stretcher and oxygen. Ambulance stretchers are
unique and in this type of situation the Paramedic usually stays in
the room to assist the doctor when he examines the patient. Most
patients consider this the same as a nurse being in the room, but not
all. So you try to position yourself where you are there to help but
where the patient will not feel embarrassed. The exam only
lasted a few minutes but by what I could tell Sarah was not doing too
well. The doctor told her that there was no improvement in her
condition and from the conversation I learned that Sarah was in a lot
of pain much of the time. You could have never have guessed that from
her smiles and calm disposition. As we started back she looked
at me and said: "Now it's your turn. Tell me about yourself. I
gave her the standard rundown, telling her about my wife and sons and
I told her how and why I became a Paramedic. In no time we were back
where we started from, and I had made a new friend. Over the next
few months I spent a lot of time with Sarah going back and forth
between different medical facilities. She became much more than a
patient she was like a member of the family. I got to know her as a
person we talked about many things; she was one of the smartest
people I have ever known, and one who also had a lot of common sense.
Getting to know her was a blessing, but it was also difficult to
see her grow weaker and in more and more pain. In many ways it was
like seeing Mom in pain again. Even though it was hard to see her
like this I still wanted to be the one to transport her when she had
to be sent to the hospital. I had visited her a few times at the
nursing home when I was off duty and had spent time playing cribbage
with her, so after my shift I went back to the hospital with a deck
of cards and a cribbage board in hand. Her face lit up when she saw
me come in the door. I tried to keep the game short so she would not
get over tired but she still would not let me go until she won two
games. She assured me that she was feeling better but when I left she
was looking so pale. The next shift I had run a few calls when
the shift supervisor called me on the radio and asked me to meet him
at the hospital in the emergency department. When we arrived he was
waiting in the EMS lounge with Sarah's doctor. The day had just
become a day that I would never forget. Sarah was near death. She
knew that this was the day she was going to die and her last wish was
to go home to Seven Springs and she had asked that I be the one to
take her there. Arrangements had been made with her sister and the
local Hospice, but her doctor told me that he did not think she would
make it that far. He felt that her heart was too weak. He reminded me
that she was a no code and he asked me if I was up to this. I knew
that it would be one of the hardest things I had ever done but how
could I do otherwise. As I walked into her room she turned her
eyes toward me and smiled. She looked pale and you could see the pain
in her eyes but you could also see a sense of calm and peace. We
moved her on to the ambulance and I sat down on the crew bench beside
her. I let her know that the doctor had given me orders for morphine
if she needed it, and I asked her if I could do anything else to make
her more comfortable. She took my hand and thanked me for taking
this call. She told me that I had been a good friend and that I was
and always would be special to her. She told me that her sister and I
were her only family and she did not want to die alone. She said that
she knew that this was going to be hard for me and she was sorry for
that. I told her that there was no reason to apologize that I loved
the time I had spent with her and how much knowing her had enriched
my life and that she would be missed. She started talking about
home, Seven Springs, about family, and how the community was when she
was a small girl. With every word she painted a picture. I could
almost see the mountains and the stream as she described the view
from the porch of the house where she grew up. Her breathing
became shallow, and her voice became a whisper and then stopped. Her
grip on my hand loosened and her eyes closed. As we crossed over the
small bridge going into Seven Springs the heart monitor alarmed.
Sarah was home!
10:07
PM
It
had been a demanding day with everything from a broken leg to a car
accident with four injured. On toward evening it seemed to have
calmed down to the point where my partner and I were able to get
supper at a restaurant that was a step above normal fast food. After
leaving the restaurant we stopped to fuel the ambulance then headed
back to base. Suddenly the radio came to life and the alert tones
sounded. Dispatch gave us an Unknown Medical Call that was about 15
minutes away in the upper corner of the county. Fortunately there was
a local fire department that had trained First Responders nearby and
they were dispatched jointly with us. An Unknown Medical call is
given out for an assortment of reasons ranging a simple
misunderstanding to where a caller is so panicked that dialing 911
and giving directions is literally all they can get out. When the
call came out we were already in our ambulance ready to go whereas
the first responders had to come to their station from home to get
their rig and then respond. We were only about two minutes from our
destination when we heard them call in that they were on the scene.
That close behind them we did not expect to get any report before our
arrival. We could see the reflection of their emergency lights while
still a block away and as we turned onto the street we could clearly
see our destination which was the second house on the right. What my
eyes saw next will forever be etched into my memory. With the
illumination from the street lights and our headlights, the dark gray
night was pushed away to reveal the horror in a mother's face as the
first responder took the lifeless baby from her arms.
My
partner, Sandy was driving on this call so even before the ambulance
stopped I had my seatbelt off and had climbed through the small door
between the cab and the patient compartment so I could start setting
up equipment. When Sandy stopped the ambulance she got out and in
less than a minute the back doors opened and she came in with the
baby in her arms. She confirmed the worst and said: "We've got a
Code." As the medic at the head of the ambulance cot it was my
job to take care of the airway while Sandy connected the heart
monitor, The first responder who had brought the baby to Sandy and
had followed her into the into the ambulance started CPR. While all
of this was going on another First Responder came to the back door
and stood ready to help if needed. I recognized him as Ben Fall and
had gotten to know him well, from the time I had taught his First
Responder class just a few months prior. He did a great job and was a
natural when dealing with people so I knew he would do well when I
told him, "Go take care of the Mother." I had
confirmed that the baby was not breathing and so I placed a small
tube in the baby's airway to keep it open while I used a bag mask to
breath for him. Sandy told the first responder to hold CPR so she
could check for a pulse there was not one, and the monitor showed the
rest, the baby's heart was not beating. The baby's heart was
fibrillating. It was not pumping blood but there was still some
activity and it was a shockable rhythm. Most people think that when a
medic shocks a patient's heart they are trying to start it. That's
not entirely right. The shock is done to stop the heart from
fibrillating in hopes that the hearts own pacemakers will start it
working again. We did the shocks and gave the first line of meds.
--- It didn't work! More help arrived and we had another first
responder drive us in to the hospital. We did CPR, we shocked
again and we gave more meds. We tried everything! Traffic was light
so it only took about 12 minutes to get to the hospital. God it
seemed like hours! In most cases like this the doctor knows from our
report that everything that can be done, has been done. They usually
do one more round of shocks and one more round of meds then the
doctor calls the code and pronounces the time of death. That's in
most cases, but not when it's a baby. They called in all the staff
they thought might be able to help. They did more shocks; they used
more meds, they tried for over an hour. People were physically and
emotionally exhausted. It was 10:07 PM, one hour and forty seven
minutes since I first saw that little lifeless body and the look on
his mother's face. Now the baby was dead! When this type of call
happens, your training takes over. You have to focus on what you need
to do. You follow your protocols and even if you do everything right,
it may not work. The tones sound and you are on the way to another
call. It will be later when your shift is over before you can dare
take the time to think about what has happened. You go over
everything again in your mind. You ask yourself did we do everything
right, could we have done more? You remember the mother and you know
that somewhere tonight, her heart is breaking. You look at your own
child and thank god that they are safe. You don't want to bring this
sadness home to your family so you find a private place to think, and
maybe even cry. You know this is going to take a while to get over
but you know you have to pack it up and keep it under control because
your next shift starts in the morning.
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