Listen to author read the story:
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In a town this small, saying “that address is familiar” feels stupid. We’ve only got 70 miles of roads and a few hundred year-round residents. Paved road, steepish drive on the north side, opening to a small clearing that contains a beige double-wide home. Three steps up to the door centered on the building. I don’t know why, but the lady of the house fusses at me each time I show up. She’ll need a name because this story is about her, or it is about me, you’ll figure it out, I suppose, and tell me. We’ll call her Terri, a nice benign name. At squad meetings and when on the phone with Harry, I have explored my frustrations about Terri in the past.
Which means that when the tones drop telling us, the squad, we have a medical emergency, I can envision the driveway, the house lot, the home, and her, Terri, arms folded tight against her body at the door.
At my own door, I jump into my uniform, leaving linen skirt and shirt on the mudroom floor.
“Dispatch 14RC5 en route.”
In a minute, I hear “5, 2 on 2.” I flip my handheld to the dispatch frequency and tune my more powerful radio to the ground/tactical frequency number 2.
“5 on 2, 2?” Calling out to Harry, RC2, our assistant chief.
“B, I’m on my way. 20?”
“Just hit dirt. You?”
“Haley’s field.”
“Yeah, I thought you were hayin’”
“Call came when I was reloading twine.”
What we’re not saying over the rather public radio frequency is that by calling out landmarks we shall match arrival times without anyone noting that one of us might have slowed a touch. That’s the old rule we’re all taught: “Two in. Two out.” For Sam, my wife, it speaks more of Army battle buddies.
Two red trucks meet at the bottom of the drive, one from the east and one from the west. Harry’s truck carries echoes of Harvard Crimson. Mine is more whore’s lip red.
Hearing a call follows a cognitive process. First you catch the address and hopefully the nature of the call. I sometimes repeat it as the dispatcher provides the rest. Skills I learned before we had text- and app-based messaging to help. Skills I still need in a rural, hilly terrain where mobile phones often fail to find a tower. You hear the address, then you envision the address. Maybe it is a silent marker on the road near by: a neighbor’s house, the scene of an accident, a stone improbably balancing on its tip. If the house and family are known, then I do a run-through of the folks living there and who is the sickest and most probable patient. By now, I normally have pulled my EMS trousers up to the knees. Past treatments, past crises, medical histories, and social histories bubble forward.
The dread hits as I climb in the truck, starting it and waiting for the electronics to stabilize.
The dread.
Why I am walking out of my office? Why am I giving up hours of well-paid billable work to go get yelled at by some Terri? Why am I giving up income to volunteer, to deliberately walk, run, drive towards someone else’s shit?
Then they yell at you. Then they honk at you. Then they drive around barriers you erect.
Hearing Harry call for me on Tac 2 turned my mind from dread to joy.
I am here because he is here. He ran off of a hay field because I am en route to a call at 2 o’clock on a June Tuesday. Who is in Trowbridge, Vermont at 2 o’clock on a June Tuesday? Old folks, kids at the local school, their teachers and staff. The road crew and town clerk. Preschoolers and their guardians. Maybe someone sleeping off a night shift. At 2 o’clock on a Tuesday, I am often the only EMT in town.
Often, if I don’t go, no one else will. Game over.
Had Harry been on his tractor cutting or teddering or bailing, he would not have heard or felt the call. He’d be tucked in, Bluetooth headset on, listing to NPR stories while his fire/EMS pager buzzes invisibly against the vibrations caused by the blue Ford tractor.
One from a hilltop hayfield and one from a Scandinavian-inspired office overlooking a Vermont valley, two EMTs find each other at the bottom of a driveway at the same time. Each of us driving a red truck. Each of us with red-and-white emergency lights. Each of us with a long, whippy antenna, each of us with a nylon bag that carries our few tools.
Calm waves down my body the moment Harry says: “5, 2 on 2.” He says in the plainest possible language, Brighid, I love you and I am here for you, let’s do this together. Hands open on my steering wheel as I pace my landmarks against his. I drove up and right from the southwest. He approached from the northeast.
“Dispatch, 14RC2 on scene with 14RC5 establishing Trowbridge Command. Any word on an ambulance.”
“Trowbridge on scene, establishing command. No word from an ambulance.”
“Understood.” Yup, we all understand.
What’s-her-name meets us standing sentinel to her home, a few feet in front of the three steps that lead to the house. We each park for a quick exit, and to leave ample room for an ambulance to drive up, turn around, and also prepare for departure. Yeah, Terri, Right. That’s what I’m calling her this time. Terri.
I envisioned her arm position wrong. She stood akimbo, as a sentinel to her home.
I know she called us. She should be waving her arms at the end of the steep drive, no? Or standing aside briefing us in breathless speech. Or maybe deliberately leaving open the front door for us and greeting us with a yell of: “Hey, I’m back here!”
Terri dialed 911 asking for medical assistance then stood in front of the door like a guardian preventing entrance.
“Why is it that every time I dial 911 I get you two? I tell 911 to send anyone else. And I’ve told Langford Rescue to never come here again. They’ve nearly killed my husband with their bullshit.”
Harry believes himself to be a peacemaker. He’s lovely about it and sometimes misses the mark. I should be a natural peacemaker, but I kinda need to be in a better mindset. I can’t find peacemaker in the tool kit when one, I walked away from my afternoon’s income; two, I anticipated the hostility from my own dooryard; three, I’ve heard her do this before.
“How can we help? Did you call 911?” Let’s go back to basics.
“It is my niece. She’s not feeling well. She broke her leg the other day and had surgery. We just need a simple ride to the hospital. I called Starkville Ambulance directly, they are supposed to be coming.”
“Terri, I think Starkville forward the information to 911. We’re not in Starkville’s service area.”
“I don’t want you guys here. Can’t other people show up?”
Neither of us know how to answer this.
“How about we take some vital signs and help you get an ambulance here? That’s what our radios are for.”
She says neither “yes” nor “no.” She simply turns and walks into the house, leaving the door open. On our open-air stage, Harry and I look at each other, shrug theatrically, and step forward.
That wave of gratitude starts at my feet, crawls my spine, and finishes at my neck. I shake my head, thinking, at least Harry is with me. If I had written “caller prevented access to the scene” on my run report, I’d be just fine, because of the law. Landlord trespasses a visitor, and visitor must leave or be subject to arrest. If she tells me to go, I must go. But she dialed 911 because somebody needs help. Terri and I would have stood at an impasse.
Terri walks the narrow corridor and points to the small bedroom.
We enter and start talking with Niece.
“You’re not feeling well?” Harry asks, dropping his bag in the hallway.
My bag is behind me on the floor. I take Niece’s hand in my hand. Skin feels moist and cool. Skin doesn’t return to pink after I apply pressure. Pulse is too fast and too wimpy to be very effective.
In an instant, Harry and I both acknowledge, with deep dread, that this woman is sick. In the sick/not-sick assessment, the score and resultant needle point far, far into the sick column. We share a glance that lasts milliseconds. We each encode the silent message with the brevity of “5, 2 on 2.” I am low in a squat next to the bed. Harry is high near the door by the niece’s head. I toss a pulse ox on the finger. I scan her lower body. The leg is immobilized and has external fixators. The black fabric cast ends at the knee.
Harry asks about the basics: name, date of birth—he writes it on his glove in pen—allergies to meds, and then stalls out. He stalls because she stalls. She was answering in one-word or two-word phrases. She got her name out clearly. Date of birth took three breaths. Sometimes that is all you get.
Simultaneously, while I brace her up, grabbing knees, Harry grabs shoulders. In a grunt that sounds like “one,” we lift and pivot her to the bed. Harry shakes his head at me. I know this message too. In another grunt of “one,” we slide/lift/drop our patient to the floor. Then in symmetrical movements, we push the bed and all furniture to the wall giving us a small place on the floor to work in.
From his bag, Harry pulls a pony bottle of oxygen. From my hip, I pull my portable radio.
“Dispatch, Trowbridge Command.”
“Trowbridge?”
“Dispatch fire to the scene and please find us an ambulance forthwith.” I could have left the forthwith off. Even with a practiced cadence, and level tone, every dispatcher and listener on the frequency knows I just hit the “oh-shit” button.
They answer: “1434,” a banal reading of the current time.
Terri keeps yelling at us that Niece has a broken leg and is recovering from surgery. Yes, Terri, we know we need to be gentle or the leg won’t heal correctly.
“Jesus, What the fuck are you doing? Can’t you see she’s injured.”
I did just lift the lady from her knees and place her on the floor. Maybe you, Terri, should be looking up, where Harry is attaching oxygen to his BVM or Ambu bag. Terri is still yelling when Harry squeezes a breath down Niece’s trachea. I open a vein, laying in an IV with speed and precision.
“She only has a broken leg. Why are you doing all that?”
“Dispatch, Trowbridge. CPR started.”
“1435”
Harry looks at me. “EKG?”
“Alex, has it.”
Which is when Harry’s bag moves and we’re handed an EKG from the door from a bodiless hand.
In a second, I cut everything off the woman’s chest. Shirt, bra, and some thin necklace. We push our patient closer to the bed, watching as her off-side shoulder and hand go into the dark space. With an EKG, pads, a mechanical airway, and all the cardiac meds we have with us, we try.
Alex says: “1455.” A second clue that Alex silently arrived on scene. He’s called out the time hinting that we’ve done 20 minutes of CPR and thus hit the end of the protocol.
Harry and I make eye contact and stop.
“1455,” I say making the declaration of death official. “Alex, can you call it in?”
I hear him on the landline phone. First, to dispatch, cancelling the ambulance and requesting the police to the scene. Second, to the hospital for medical control where he recites each of our actions and our patient’s responses. Whereby the doctor decides that our patient is dead. A fact known by me and Harry for a goodly while now.
Terri had stopped yelling and recognizes the facts as they are. She attempts to loosen her grip on the facts she wants to believe. Terri steps around the mess in the corridor. Alex attempts to provide comfort to Terri with all the right words from the training. Yes, your niece is dead. Our crew did everything possible. Can we call someone for you?…etc.
Harry and I discretely remove the wire leads from the EKG. We disconnect the one-time use pads we shocked the patient with. We leave the airway open and the BVM attached. Harry turns off the oxygen, leaving the tubing. We drop our gloves on the floor and retreat from the room with our medical kits. Harry bends to retrieve his glove with the name and DOB. I recite both to him quietly. He drops the gloves to the floor.
“Ma’am, it will be thoroughly investigated, I assure you. The state police are on their way.”
Harry and I carry our bags out, securing them in our respective trucks. Harry pulls out a strip of police barrier tape and two pieces of duct tape. Back in the home, formally seals now-closed door identifying it as a crime scene – do not cross.
We three, the chief, the assistant chief, and me, the captain of a tiny rural EMS squad, now must remain at the beige single-wide home. We must sit, stand, wait quietly for hours for the state police to arrive, for detectives to arrive, for a call or visit from the associate medical examiner. We three must continue to communicate as a team while Terri spins through every emotion, including anger towards the EMTs that just killed her niece.
I envision the blood clot, or clots, that let loose from her leg. Eventually one squirted out of the aorta, taking the turn to the coronary branch, and then, with a left and right through the web, it finally came to rest when the left anterior descending artery got too narrow to let it through. Maybe another clot or two followed. A dam was built. The tissue distal to the clot started starving for oxygen. The tissue didn’t like that and started misbehaving. Tissue lives. It needs sugar, oxygen and a bit of this-and-that. Like all things that live, it poops waste. No tissue, no critter can live in a bath of its own waste. Starving and drowning in crap, the tissue dies. As tissue continues to starve for oxygen, the tissue nearby feels the effects. It convulses, stutters, and dies. A zone of death expands, eventually rending the heart non-functional. That happened about five minutes after we arrived. We did not kill her. A blood clot from her leg killed her. No amount of in-the-field advance cardiac life support will unfuck that artery, tissue, muscle, or heart.
I did not kill Terri’s niece. A blood clot did.
Harry did not kill Terri’s niece. A blood clot did.
Alex, as a senior, as chief, as paramedic, did not kill Terri’s niece for his lack of effort, even though he stood in the doorway watching.
Terri knows we killed her niece due to our ignorance, our lack of abilities, our inability to provide the right medications at the right time.
That’s not the point.
The point is that Harry heard the call from dispatch and said, “5, 2 on 2.” The point is that at no point was I alone. With skilled rhythms, intensive training, we moved through the call like a flock of starlings, weaving and swooping with nearly no words. During those thirty minutes, I shared in human magic. Harry and Alex and I mind-melded. We were one. For thirty minutes, I had six arms and three brains. Even dispatch, miles away across the river in another state was in that shared space with us. Every EMT and medic in the region knew that there was a tiny crew of people kneeling on a floor doing everything in the book to reverse the advance of death through a fellow human.
The spell broke when we lifted out medical kits and closed the door.
We wait our hours in post-spell fatigue, we brace for interviews, for the scrutiny over our every action. Some jackass will make sure that every drug, every modality we used was prior to the expiry date. Our credentials will be reviewed by detectives, again. And the louder Terri gets with her accusation that we killed her niece, the more pressure the medical doctor will, in turn, feel. Right or wrong, our next call will undergo intensive reviews. Why did Alex stand still while Harry, certified at a lower level, undertook so many tasks? Terri will tell anyone who will listen that the local rescue squad killed her niece.
Terri never again met emergency crews with akimbo arms.
Oh, right. She never dialed 911 again.
I would go on another call if only to feel that sense of belonging. So, I am a murderer. Whatever. I am loved too. I’m good with that.
Fabulous!!