All manner of bodily fluid has found its way onto the thin barrier my paramedic uniform provides me. Rather than ‘just’ urine or ‘just’ vomit, it’s often a cocktail of biological liquids that attempts to test the absorbability of my poly-cotton blend work attire. The mix sometimes includes blood that is my own.
I’ve been physically assaulted on my job more often than I can remember. Patients, their families, or bystanders have punched, kicked, bitten, and used all kinds of weapons of opportunity. People have been verbally abusive as well, aggressively screaming every mean name you can think of, including a few obscure ones I’ve repurposed for my own use.
Every part of my anatomy has been injured at least once. I’ve been stuck with dirty needles patients kept hidden in their clothing and, once, with one of our own needles that had been used on someone with hepatitis and AIDS. Thanks to the unconventional hours I work, I tend to live in a state of perpetual sleep deprivation.
The city government that employs me has referred to my agency in condescending terms, failed to provide me with basic protection equipment at the height of the pandemic, and continues to deny our workforce the equal pay it gives to other first responders and garbage collectors. *(In NYC, sanitation is considered a uniformed civil service, EMS is not.)
I put up with everything I’ve described for a paltry salary that has needed to be supplemented with secondary employment.
Despite all this, I am finding it difficult to leave.
I've been eligible to retire for a while now. Mentally, I'm ready (mostly). Something still holds me back.
I remember the idealistic 'do-gooder' I was when I first became an Emergency Medical Technician. The ink on my EMT certificate was barely dry, yet only a few months of experience separated me from the ‘senior partner’ in the other seat of the $265,000 vehicle we had in our possession. With the most minimal supervision, we were unleashed onto residents of Manhattan. The city was ours. We were off to “save lives”.
Driving a big vehicle that isn’t mine, while breaking all the rules? Sign me up. Racing through streets known for gridlock traffic is exhilarating. I’ll admit I became hooked on the adrenaline rush very quickly.
Just the excitement of a call that sounds interesting leads to a surge of the fight-or-flight hormone. Once at the actual location, you often find that what has been hyped up to dramatic proportions is not nearly as dire as it was described and your dopamine readjusts the cycle until it begins again.
Alternately, the situation on scene can be even more critical than the information given and you need to rush to stabilize someone or get them to the hospital as soon as possible. Strokes can be mitigated if they’re treated within a limited time frame. There’s a ‘Golden Hour’ for trauma and a ‘Time is Muscle’ mantra for cardiac emergencies. There is a small window of opportunity to get back someone whose heart has stopped as well.
I couldn’t wait to do my first cardiac arrest, which in EMT school, is billed as the be-all, end-all of lifesaving opportunity. CPR [cardio-pulmonary resuscitation] was going to make us heroes, we were told. It’s given equal dramatization in movies and television where all it takes is a few rounds of chest compressions, a determined will, and the utterance of “Damn it, not on my watch!” for a successful outcome. The fictional patient wakes up coughing and looking bewildered but is otherwise fine. In real life, it’s never been that simple.
My first cardiac arrest stands out in my memory as clear as if it happened yesterday. It was in a crowded apartment in Chinatown. The residents living there barely knew each other. Our patient was an older woman who was the sole guardian for her grandson, who immigrated with her only a few weeks earlier.
Despite our determination and best efforts, the woman didn’t survive. I knew when I started in my chosen field, that I was expected to deal with death. I understood it to be a natural part of the life cycle. What I wasn’t prepared for was what to do about the overwhelming empathy I felt for the grandson.
That kid had no one else and we had just covered the only contact he had in this strange country with a sheet. I wanted to cry right there with him. I was helpless to do anything that might benefit him. My heart went out to that young child in a way that fills me with tears and sadness to this day, three decades later. I have no idea what happened to him.
Most of our calls leave us with outcomes for which we will never have the answers. Will the surgeons be able to repair the damage from the bullet or knife in time? Will those victims of violence, the ones we greet on almost every shift, receive justice? How will the rape victim cope in the coming months? Will the woman who escaped death by overdose enter rehab? Will the heart attack guy stop smoking? What will become of the foster children when we take their legal guardian to the hospital if she will probably not return?
We spend less than an hour, in most cases, with the patients we treat and take to the hospital. That hour is more than enough time to make a connection, however futile, and ingrain a memory. They, and our reactions to them, become tethered to our memories and later, to our subconscious. Sometimes they haunt us, sometimes they redeem us.
There was one man who my partner and I saved from certain death. We quickly recognized two connected lethal events that were occurring simultaneously and acted immediately. We provided multiple, efficient interventions and prepared the doctors at one of only three specialty hospitals designated to treat and even reverse his problem. He was lucky we had gotten there when we did. Our efforts unequivocally saved his life.
I know this outcome because his family made a complaint about us.
The man was alive and doing well, according to the people who called 911 for their loved one that day. They noted, in their letter to the department, that a successful intervention should not detract from the fact that my partner and I didn’t take the man to the hospital they demanded at the time.
The hospital they requested that day was in a distant part of the city. They knew someone who worked at that particular facility and it seemed to be the sole motivation for their choice. The patient expressed no opinion in the matter. He seemed scared and preoccupied with what was going on inside his chest.
The small facility his family wanted was not equipped to provide the optimal care the patient needed. We explained the situation and went into detail as to why the specialty center was our only option. They were not swayed. The relatives had a negative opinion of the hospital we went to against their wishes. A person they knew died there once, as people sometimes do when they’re in their 90’s and have terminal cancer.
The complaint against us did not take away from the ultimate satisfaction of that experience. We were rather grateful for the investigation our department took against us because it allowed us to confirm that our efforts were triumphant. It gave us a long-action dose of our favorite drug. It was the same adrenaline rush without the zigzag through traffic.
It’s the kind of euphoria that makes you feel happy for the ungrateful family members who got to spend more time with the person they loved. Knowing they wanted scorched-earth discipline on your behalf gets a pass. It’s truly a powerful feeling.
Knowing that your wonderful achievement came with a demand for punishment is something my coworkers and I can laugh about amicably. We all have similar stories.
My coworkers are adrenaline junkies themselves. We remain hooked on the drug that keeps us coming back to witness mayhem and the strange predicaments people seem to find themselves in. We continue to chase the highs where we might be able to help someone critical, but lower dose experiences work as well. The bizarre and unusual give us enough sustenance to keep looking for more.
We try to one-up those long tales of our most outrageous situations during our support groupings. Everyone has an extensive catalog of stories involving hoarder homes, carrying patients down broken stairs, getting stuck in elevators with claustrophobic people while caring for an ill person. We congratulate each other for the news clips we find ourselves in on television and laugh at our disheveled appearances on the Citizen app.
It is with my fellow addicts that I can share our driving triumphs through the slalom of double-parked cars and shake our heads together when a well-meaning person takes a critically injured person to a non-trauma center in their cars. We snicker that they probably would have waited had the medical complaint been trivial.
My coworkers have the same PTSD issues I have. It’s easier to commiserate with them about the horrors humanity is capable of because they’ve seen it too. They know what it’s like to hose down the back of a vehicle covered in blood and bits of flesh and go back into service almost immediately afterward to do it again; to be left with such little time in between to process and frame things into a way that makes life acceptable again.
My sage mentor, the one with four months of extra experience, once told me that if I stuck it out here, much of my social circle would be made up of other EMS people and he was correct. I married another paramedic. Most of my friends either work as first responders or they once did or they have a connection to someone who does.
I'm lucky to have friends who don’t do this job and have put up with me and my unconventional scheduling issues. It’s nice to spend time with people who haven’t been tainted. I look forward to a future like that.
At the same time, it’s difficult to leave behind this EMS group who I have come to see as my extended family. They understand everything I’ve been through. More holiday meals have been shared with them than with my own relatives. Balanced on the dashboard of whatever vehicle we are assigned, we have all broken bread with the ones who have our back and share our experiences.
I'm going to miss these unusual people who share and encourage my addiction to adrenaline. They are my enablers and I love them.