Christmas

Christmas morning. I'm in at work. I enjoyed my three days off. It was nice to have a semblance of a life outside of work. I went Christmas shopping, got to the gymn twice, did some cleaning, paid bills, and played some on-line poker.

It was particuarly good to be in the gymn -- not that I worked out too hard, but I did work out hard for someone who hasn't been in the gymn as much as I should. I really am going to try to make an effort to get in there four times a week in the New Year, even if it is just for a short workout.

Last night I watched Scrooged, the Bill Murray version of a Christmas Carrol, where Murray is the bah humbug head of a big TV network. Bill Murray is a very funny actor, and Scrooged always chokes me up at the end, when the little mute kid speaks for the first time and says "God Bless us Everyone." Then they all start "Singing Put a Little Love in Your Heart" with Murray singing like his old Saturday Night Live lounge singer characater.

But sometimes I feel like I am a Scrooge. I am always working on Christmas. My brother invited me to go to New Jersey and have Christmas with him and his family this year. Of course I couldn't go -- I had to work.

What kind of a bah humbug am I? Working on Christmas all the time. But working in EMS on Christmas is different than working a regular job on Christmas. I have always been proud that when my name is written in the book, I can be counted on to be there. It is not like we can just close up shop on Christmas.

I read an interesting article -- "Will Words Fail Her?" -- about a young Chinese fiction writer, Yiyun Li, who wrote a great collection of short stories called A Thousand Years of Good Prayers. One of her teachers, James Alan McPherson, who was also a teacher of mine many years ago, was quoted in the article as saying in American fiction, we have lost the community voice. It is all about the self, but that community voice still exists in writers in Japan and China, writers like Li.

In this job over time you can lose yourself. You become a part of the community, the blanket of watchfulless over the cities and towns that you cover, and that becomes more important than who you are as an individual. People say it is bad to lose yourself in your job, and I don't disagree -- you need balance in your own life. But at the same time, I don't think it is neccessarily all bad.

In Scrooged, Murray's ex-boss, who comes back as the dead Jacob Marley, says his work, his life should have been that of mankind, not TV ratings. I think you can make the arguement that our work in EMS is the work of mankind. There is a certain privledge in looking out over the community, in being its protector, particularly on Christmas Day.

There is a fine line here, but if you find redemption in your work, that is no small thing.



***

In other thoughts, I rarely follow up with my patients. If they are in the ED when I come back with a new patient, I will stop in and see how thay are doing. Or I might ask a nurse or a doctor what was the deal with a certain recent patient from earlier in the day or maybe even the day before, but I am not one of these guys who is always going up to the floors to reintroduce myself to the patient as the paramedic who brought them in. Not that there is anything wrong with it. I did it a few times when I first started. Haven't for years.

A few weeks ago, we did a code save. It was my third code save this year. By "save" I am using the iffy terminology of a cardiac arrest patient brought to the ED with a blood pressure and still alive when we left the ED.

When it comes to cardiac arrests, unless they are talking to me when I leave the ER, I guess I just assume they die eventually. I was surprised once. I got called for a stroke. I found a man sitting on a neighbor's garbadge can, where he had been talking to them after driving up in his car, when he suddenly slumped over. We went lights and sirens to the hospital following the stoke protocol. I dug his ID out of his wallet and was shocked by the name. It was the same name as a man I had done in a cardiac arrest a year before. I'd gotten a pressure back, but never thought anything more of it. I just assumed he had died or was a vegetable in some nursing home. To make it an even better story, his massive stroke turned out to be a TIA and he was talking to me before we even reached the hospital. He was in fact the same guy. At the hospital I met his family and they said they had tried to get in contact with me, and had gone to the fire station to leave a message for me, but hadn't heard anything back. Niether had I.

With that story in mind, and because on this code, as I have written before, my two partners were a young man going through the EMT class and a 25 year plus EMT, both of whom it was their first code save, I thought it would be nice to find out how the lady was doing. She was after all breathing on her own on the way in. I had found out that a week later she was still alive in the ICU although I had no report on her condition.

I began to imagine her alive. I imagined us visiting her back in her home with her family and all her granchildren and great grandchildren around her. I thought how happy my partners would feel. For one it would be the crowning achievement of his career, for the other, an indelible moment that would guide him toward a long and rewarding lifetime in EMS.

I went in to see the hospital's EMS coordinator, and ask him if he could look up the three code saves I had this year, particularly the last one, to see how they made out. He said it would take some leg work, but he would be happy to do it for me.

I thanked him, then went out to the car, and opened up the newspaper and there she was on the obituary page -- our save -- rest in peace. I saw the coordinator later that day and thanked him for his offer, but told him not to bother looking up the others.

***

First call of the day is for severe bleeding. It turns out to be a burst abssess in a teenage male, who had injured his thigh and was going to have surgery to remove the undrained blood. At first I didn't know what it was. His friend was holding pressure on it, and had told me about spurting blood. We removed the pressure and then after a moment's delay this huge hunk of blood began to flow out of the large open wound. I covered it right back up and held pressure. He screamed. When I uncovered it again, I saw it was just pus. It was like pus from a boil, except it was at first, dark red, then pinky. The pus that flowed out was larger than a grapefruit. At the hospital, as I am giving my report to the nurse, who hasn't seen the patient or the wound yet, is chowing down on these little pastries. He hands me a creme-filled one. As soon as I am done with my report, I walk around the corner and drop it in the trash can.

***

We pick up a naked four hundred pound woman in a dirty apartment who fell and can't get up. We slide a board under her, lay her down on it, strap her in, then I take the head, and lift her up straight to her feet while my partners struggle to keep her from slipping down. She is righted. We get a refusal. Happy Holidays and wishes all around.

There aren't any stores open today and I haven't brought much in the way of food. But I admit I don't have much of an appetite right now.

***

At six they send an ambulance out from the city to pick me up and take me in to work another six hours of OT. They were paging out for people to come in for Christmas night and I volunteered yesterday if they couldn’t get anyone else, but they wrote me right into the schedule.

It’s pouring rain, but the temperature is in the high thirties so its just wet out. We do a transfer from the ER going back to a nursing home. Later we do a community an assist, helping a mentally disabled relative make it out to the car where his ride downstate waited. He had just frozen up and wouldn’t take any steps. We just picked him up and put him in the stair chair and carried him out of the house, through the rain and down several sets of stairs to the car waiting at the edge of the icy drive. The family all came out in the rain and thanked us. I saw a man palm a green bill and he started to make a gesture offering it to us, and while he was saying something like at least get yourself some hot coffee, I was saying, no, no, thank you anyway, we are highly compensated. It’s our job. Pleased to be of service. Happy Holidays.

***

It's getting time to head in. Another car is sent for a stabbing. A few minutes later we get sent for a man hit in the head by a gun. We pull up on the dark rain-drenched street to find several cops standing in the road with shotguns looking every which way. I hear a cop ask on his radio for a better location, then out of the fog we see a guy come staggering up to us. He is bleeding from the head. I see that we will have to c-spine him, so I have my partner set up the stretcher, while the cops are asking him questions. We get him into the ambulance. He is alert and trying to give the cops a description of the guys who jumped him. He says he doesn't think he got knocked out. He is wearing several heavy coats. We have him sitting on the board with a collar on while we lift his rain soaked leather jacket off, and then his tan hooded sweatshit. I ask him what else hurts and he says his side, his side. My partner sees it first. There is big hole in his side midaxillary down about the level of the costal margin. The hole is actually protruding out of the body several inches, and blood is coming from the wound. We are on our way to the trauma room just like that. The guy doesn't remember what happened other than two guys jumped him and they were fighting. He says he may have heard a gun shot. It looks more like a knife wound. It doesn't really matter to us. We are out at the hospital and into the trauma room. I only had time to strap him down, get his vitals, name, date of birth, social security number and address, quick medical history, and pop an IV lock in.

I show the wound to the doctor in the trauma room and blood starts spurting out.

I am glad we took his coats off-- all those layers.

I remember a story my teacher told me many years ago when I was in EMT class -- about a guy who had been hit in the head with a gun, and was walked into the ER, and placed in the waiting room. He passed out in his seat, and bled out and nobody noticed till he was dead. He had been stabbed, but nobody knew it.

***

After that call, I get dropped back at my suburban post where I will sleep for six hours, then go back on duty for another 12.

Merry Christmas Everyone!