A Paramedic's Journey

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.