EMS Front Lines

Dispatch led around 1730 on a tuesday. It was dark, rainy and cold. Sometime in early spring of last year. I was sitting at our main station shooting the shit with the BLS crews. 

Cardiac emergency. No notes or further info on the tablet, which is weird. “Great. I’m so Pumped for this bullshit.” I mumble to myself. Ah Dispatchers am I right? 

I am in a chase car. I arrive to a scene packed with cops and some sort of tac team. There are detectives and PD white shirts. 

This was a raid. 

Definitely not dispatch’s fault on lack of CAD notes. 

No one is running around which means the job is done. Dozens of cops are outside shooting the shit with hands in their vests. A cop friend of mine calls this a “piggy bank”. 

As I walk towards the house a cop approaches and whispers in my ear, “Doc- He’s in the back. He has been making kiddie porn. He is complaining of chest pain”

Right on cue, like out of a movie, multiple children with obvious physical and mental disabilities are being escorted from the house.

“Jesus Christ” flashes across my brain as I wait for kids be assisted down the stairs so I can enter the house. 

I brace for impact. 

The cops stare at me and reluctantly part as I walk inside. They know I have the ability to stall all their efforts of this entire evening. This man’s medical needs, despite what he has done, come first. 

What the cops don’t know is that I don’t want this power. What they don’t know is that I am already mentally gearing up to try and treat this man like a person and not a sick piece of shit. I want off this ride entirely. Give me mee maw clenching a tissue all day over this shit.

I am no one’s friend here, not even my own. I cant stand up for the kids I saw outside. I can’t smash this guy upside the head with my lifepak 15. I have to do my job: treat the patient and do so in a respectful manner. 

The living room is covered with trash and bags of clothing. It is dark. It is normal for these houses to only have one or two lights. Or no lights. There are illuminated stairs to my right. I keep walking back towards the light in the kitchen. It is a long old townhome built in another time. These homes always seem to go on forever. The bright kitchen light in the back of the house cuts through the corridor making sharp angles on the walls.

I am almost there. Dreading this encounter with every ounce of my being. I step on different from my previous steps- something squishy. I look down.

I lift up my duty boot and see a pair of bright pink dora the explorer little girls underwear. 

Fuck. This. 

The kitchen is blindingly bright and tall compared to the hallway. A few cops are back there with a detective. They are unfazed. 

There is a man handcuffed while seated in the kitchen. He is white, in his 50s and has crucifix earrings. He is claiming innocence. He is screaming at the cops. He doesn’t even look at me until one of them states I am here for his chest pain. 

He turns to me and stops yelling but still looks agitated. He is ready to take me on too. 

I explain I am medical and not part of the investigation. 

He tells me he has chest pain and it started when “these fucking cops” showed up and they “kicked me down the stairs”. 

He tells me he needs his nitro and is having a heart attack. He states the cops are refusing to give him his medication and are tearing his house apart. He has nitro upstairs but they wont get it for him. His rage explodes and He starts yelling at the cops again. He has trouble staying focused on my questions. 

This is normal for people under arrest. Right now, I hate this fucking job. 

I get vitals. Do my assessment. Grab a 12. A BLS crew with an ambulance shows up. They watch. Offer to carry my bags. 

The pt is trying to verbally initiate a fight with the cops. The cops don’t take his bait. He is sinus tach no ST changes. I ask him he wants to go to the hospital. 

He tells me again the cops kicked him down the stairs. He yells he just wants his nitro from the dresser. 

I tell him I was not there. I ask him with as much neutrality in my voice as possible if he wants to go to the hospital. 

He peers up at me and stops yelling. 

I say I can take him to the hospital for evaluation. I seriously thought he was going to say yes. 

Nope. He suddenly turns away from me and says he doesnt want to go. He goes back to yelling at the cops. Damn does he have great EJs. 

I leave the house. 

I call medical command for a refusal. A young resident answers. 

I explain the vitals and that the pt is in custody. 

The resident tells me he really wants the pt to go. He wants me to put pressure on him.

“Doc. With all due respect, I have asked multiple times. He doesn’t want to go. This man is being charged with manufacturing and distributing child pornography.“

The resident without missing a beat: “Refusal granted”

I think he heard the irritation in my voice. I just wanted off this ride. 

I go back inside and ask the man one more time if he wants to go, to be safe. Cover my bases. He is done with me. He knows I can’t help him take on police. I am useless to him. I recite the risks to him as he continues to yell at police and claim innocence. I tell him to alert someone if he wants to call us back. I will gladly return and take him to the hospital for evaluation. Police sign for him as he rattles his chair and tries to intimidate everyone around him. 

I load up and leave.

I go back to the main station to chart. I didn’t tell anyone what the call was and no one asked. Usually if it is any good, people will share it. 

The fact is, this call wasn’t any good. It was terrible. Ive treated dozens of prisoners and people in custody. They always suck. 

I don’t want to know the criminal history of my patients. It isn’t my place and makes it hard to focus on patient care. However, this is unavoidable especially on a hot scene. 

As I was driving home I called one of the EMTs who was also working tonight. 

I told him the gist of the call. 

He said something along the lines of Jesus christ, why didn’t you say anything?!

I was irritated and snapped at him “Because I was not done my shift. Now I am done. Here I am saying something.”

I linger in thoughts about how fucked up those kids will be. How one person’s actions, which were likely a result of another person’s actions, will just keep going. There isn’t any amount of therapy or time that can undo what was done. Therapy gives you a safe space to learn to cope. Time doesn’t heal anything. It just puts more distance between you and the event. And In that space, on that timeline, we pray to god, no similar traumatic events have room to manifest and restart this whole screenplay.

If you’ve ever been to a Crossfit box you’ll know they can be family friendly and some even have child care services. I go to a pretty run of the mill box. I keep to myself, do the WODs (workout of the day) and get on out. Weekends are kid heavy. I am in an affluent white area. The exact opposite of the communities I serve. Most days the contrast of my home life doesn’t bother me. I live on a farm. I spend my time off in the woods, alone or with friends, being at peace in nature. Recharging for the never ending chaos of my job. 

It’s sunday morning. I worked yesterday. It was busy. I am down on charts but I am here to do something for me. 

Today, however, although waking up in a great mood, I start to get irritated in the warm up. I notice I am deeply and irrationally bothered by the kids and their parents. This turns to anger. I am doing my warm up just livid at these kids nearby who have zero interaction with my personal space. I then realize I am mad at the parents. I inhale deeply and take a mental step back. 

I almost snowed an 8yoM yesterday. 

“Snowed” (verb): EMS and ED slang term to describe heavily sedating a patient who is combative. Snowing drugs are usually benzos or ketamine. Ex: “Bill snowed that guy on PCP after he broke restraints and tried to jump out of the ambulance on 95”. 

I was desperately trying to get caught up on charts when I hear the BLS crew call for a medic. They were on a psych. 

This was a very good crew. If they were asking for me, something was deeply wrong. They likely had a combative patient and needed sedation. I scrambled off EMS charts, got to my car and  blasted off to the scene. 

I arrive and one of EMTs met me outside. He grabs one of my bags.

“Sorry we wouldn’t call you unless we needed you-“

I cut him off: “Don’t apologize. I know you wouldn’t call me unless you needed me.”

EMT nods. 

“8yoM. He is combative and agitated. Threatening to hurt himself- we can’t get him to calm down. He has been sedated before.”

Me: “You think he needs to be sedated?”

EMT: “yeah I think so”

Me: “okay I got the narcs. Let’s go”

This apartment was wild. 

The patient had been contained to a closet where he was actively screaming and kicking the door off the hinges. 

His mother states “This is where I put him to calm down!”

There are two cops and a crisis social worker on scene. 

Ive called for mobile crisis in the past and never had anyone available or they say the scene isn’t safe so they refuse to come. I stopped calling them since it was always a waste of time. I was actually excited to see what they did. 

Spoiler alert: Apparently they just take notes. What do they do with those notes? Maybe Ill remember to ask someone one day. 

One of the EMTs pulls me into another room to talk with the mother. Two other young boys are tearing the apartment to shreds screaming at the top of their lungs. 

His mother is afraid of him. She is equally scared and exhausted. She says he tried to jump out the window 2x. He is violent. He kicks and fights and tries to hurt himself. 

This kid didn’t end up needing to be sedated, thanks to the phenomenal EMT’s kid skills, but I rode it in because that’s what we should do. I talked to the kid in transport. He’s just an average eight year-old boy who wants to kick and scream and do what boys do. He had mental health struggles and that is 100% OK 100% treatable. Before we left for transport, his mother showed me one of his drawings. This kid was drawing beyond his age. I smiled and thought to myself “a fellow creative”.

In transport, the kid told me he didn’t know what happened, but he remembers being very mad and thrashing about. He told me how his dad won’t let him play soccer and how he wants to play football. I asked him what position he wanted to play and he didn’t know. I asked him if he wanted to be on defense or offense he said offense. I asked him if he wanted to throw the ball or catch the ball and he said catch and I said so you wanna score the touchdowns and he said yes I want to score the touchdowns and smiled. 

We transferred him to the PED facility and he was so cute with the nurses zipping around on his wheelie shoes showing us tricks. He was polite. He was kind. He is an eight-year-old boy.

Around the 2 year mark, I noticed I sometimes reacted differently to thoughts or normal activities. Nothing was interfering with my functioning but I was occasionally just “off” with things in my day-to-day life.

It started as I would get emotional or start tearing up at stuff that was not important. It wasn’t necessarily bad stuff either. Just random shit like a mother horse nickering at it’s newborn on youtube. Sometimes things were going really well and I would cry because it was going so well. I’ve never done that before in my 3+ decades on the planet. I did not recognize this new behavior.

The less common thing which came to my attention was that I occasionally felt wronged by people who didn’t deserve it. People who were unrelated to anything that had to do with my line of work or where I had been or who I had treated. People who had no idea I even existed or what the hell was going on inside my brain.

I was mad at them.

Spreading the chaos and trauma to people who didn’t deserve it in the least. 

I didn’t deserve it either. And neither did my patients or partners or supervisors or bystanders.

 So here I am at CrossFit. Furious that these parents have no clue how good they have it. That they bitch and moan and complain about stupid shit like the Eagles and the Super Bowl and schedules and taking their kids to sports games.

I’m so mad at these parents. They have no lack of resources. Their kids play sports and go on vacations. They have their own rooms and TVs and computers. 

I’m probably also embarrassed of my own upbringing. Mad at myself. Born into a home with beyond ample resources. Fully paid private school and a college degree were written in my future before I was even conceived. I was given a car when I turned 16. We vacationed in europe in the summer and the virgin islands in the winter. I lived in Italy 2x working on my masters. My parents have been married for over 40 years. I was born lucky. I never longed to want.

The contrast makes me nauseous. I feel guilty and ashamed. Am I allowed to feel?

My patient is a human. He is a little boy who deserves to be running around a CrossFit gym just like all these other kids. 

But it’s not their fault and it’s not this little boy‘s fault. And it’s not all the kids faults and it’s not Crossfit‘s fault and it’s not my fault either. And then I started to tear up. Moments like these are empty as a void yet heavy at the same time. Where you feel so helpless, even though you did all the right things. 

You treated a little boy with kindness and avoided sedation. This is a huge win. No one wants to be sedated. No one wants to snow a child. No one wants to be apart of that last resort effort which can be so violating even though necessary. The little boy doesn’t want to be pinned down and darted with Versed. No family wants to see that. No provider wants to do that. It does not get easier. Sometimes you have to recognize the situation is just fucked. 

We run 5000 calls a month, we can’t do it all. We are working with limited resources on empty. We have our own personal lives with personal problems we cannot bring to work. We cannot bring work home either. We are under paid. We are sent back into the street even after serious trauma and injury because there is no one else available. Most days, we go to work sick, tired and hungry in a monster energy and nicotine haze. All roads led us here, to this career, to this place, to these patients. We stay because in our heart of hearts, we want to be a part of the good side of humanity. 

“Original Sin” by Sofi Tukker

92yoF left hip and low back pain. She is in visible distress, seated in her apartment kitchen chair with her adult daughter nervously scurrying around.

Dispatched as cardiac emergency with chest pain.

My crew is a VERY seasoned EMT with his trainee.

Our pt is restless. She cannot sit still and is clenching to the side of her chair to try and relieve the pain from the left hip.

EMTs start with vitals and history. I listen as the new EMT gets some experience.

Pain started yesterday and has increasingly become worse. She has a Long history of lumbar herniated discs. Her daughter recounts her mother having intermittent back pain when she was growing up.

The pt is crying. She has short, shallow respirations. She winces in pain.

Her vitals are within normal limits. She said she was having chest and left arm pain. Although I believe this is positional and from clenching the chair, I do a 12, both because of her age and her long list of cardiac meds. The 12 is normal sinus in the 80s, no ST changes.

My seasoned EMT starts to package and I ask for my IV kit. He looks a little startled, but nods with a softness in his eyes. More on that later.

She is a hard stick and scared of needles. She is willing to temporarily dismiss her fears for my word. I have pain management. The trainee and daughter come over to hold her up and comfort her.

24g Left hand. Talk shit all you want, I proudly reach for a 24g instead of throwing the whole plan away.

85mcg of fentanyl on board. We lift the pt and move her to the stretcher and out of the apartment building in 10 degrees of icy winter winds. Her pain drops from a 10 to a 7 in transport. She stops crying. She can now speak in short sentences. Did I fix her? No. Did I magically make all the pain go away? No. However, I did enough that she can endure the transport. Enough to have her stop clenching the side bars. That is the best I can do.

The rest is the same. Transfer to nurse. Clean. Restock. Crew goes available.

So why the startled expression from my EMT when I asked for my IV kit?

Some of you already know. You are probably an EMT. An EMT who has been forced to move a patient in obvious pain and distress because the medic didn’t want to do their job. A medic saw stable vitals and kicked that all the way back to BLS.

Pain is a clinical finding. We can treat pain. We need to treat pain. We, as medics, need to do better.

This patient could have been dumped on my EMT. He knows this. I know this. His trainee doesn’t know this, yet.

After the call I tell his trainee, “Pain is a treatable clinical finding. That patient was in pain. If you think a patient is really in pain, you call for a medic. Some medics here are nasty and will fight you on it but you stick to your guns, don’t let a medic try to convince you a patient is not in pain.”

Medics, maybe believe your EMTs for a minute. At least listen, take vitals and do an assessment. Think about what happens next. Would you comfortably move this patient? Oh you have 20 charts back at the station? Get in the game. We can only do one call at a time, after all, so how about this one?

A few times over the past year I have been called by EMTs for patients in pain. One of the recent ones (girl broke a tib/fib falling off a bike) the EMT said “Oh thank god its you- I know you won’t write us off”

My heart sunk when the EMT said that outside the ambulance. It just solidifies how many medics are not taking pain seriously. It killed me.

This girl had obvious deformities and signs of pain. This means medics are writing off obvious traumatic injury patients like her…it makes me disgusted. It makes me even more disgusted when I hear that BLS rather transport a patient such as this one with no pain management than risk staying on scene longer for a medic to gaslight the crew (and pt) before ultimately kicking it back to them.

Pain management is good clinical care.

As providers, we want a bigger drug box. We bitch about the state and how medics aren’t taken seriously. Well, narcotics are pretty serious if you ask me… or the DEA. If we do not prove we are competent and compassionate providers in something that has the potential for immediate relief, why should the state or your medical director or anyone give you more tools in your tool box? Or why should they let us keep the ones we have if we are just going to BLS release it anyway…

You know what pain feels like. Treat it.

Before entering EMS, I was a personal trainer and ran a gym with another trainer in a very affluent area. My co head trainer specialized in what we call the “toyota camrys”.

Toyota Camry: If you don’t make it go fast or jump it, they will last forever.

He had a booming cliental of consistent middle aged professionals.

I specialized in (adolescent) athletes…which we joked was the equivalent of building a race car. It required a team of which I was only one component. Race cars need pit crews. At the peak of my business, I worked alongside two massage therapists, a Phd candidate At Korey Stringer, a Registered Dietician, and a PhD physical therapist. Race cars break and need constant adjustments. It was a 24/7/365 job. I was lucky to have an award winning trainer mentor me as my success continued. To him, you know who you are, I know you had no reason to help me but am forever grateful you chose to. Thank you, big brother.

I would receive calls at all hours about injuries or concerns from over bearing parents or kids who screwed up but did not want to call their parents…just yet. I was watching games and learning sports. I was juggling contracts with individuals and teams. Annually reevaluating my insurance coverage and consulting lawyers to revise releases. I was adjunct faculty at a college for two years. I was on a national board to help restructure the boxing program for a major brand for over a year. I had the opportunity to meet athletes and trainers from all over the country. I had an absolute blast as a trainer but it was also the hardest job I have had in terms of work-life balance. The job is personal.

You take it all home. That is your job. The dreams of your athletes become your dreams. Their injuries break your heart but you have to be strong for them. You prescribe the plan, then “we” execute it. However, as my mentor said time and time again at my frustration at athletes pissing away their talent, “you can never want it more than they do.”

Let’s just say when I was accepted into paramedic school, I thought my background as a trainer would help me a lot more on the medical end.

I could not have been more incorrect.

When people ask me about the transition I say, “I went from training the top 1% of the population to treating the bottom 1%”.

What I took with me from the trainer side was nothing from the physiologic department. It was from the “people” category.

I remember I was leaving the YMCA after a christmas eve run and swim many years ago. I received a call from a parent of one of my athletes. My athlete had gone to her dads house and taken a bunch of pills in an attempt to kill herself. Her dad came home early, found her on the floor and called 911. She was in the ICU.

I remember the mother crying on the phone as I stood with wet hair in the parking lot looking at my warm breath diffuse the sky. I asked if I could go see her but they were not accepting visitors. I said all the things you are supposed to in those situations, and I meant them. I told her to call me anytime and I am here for anything they need.

I had taken this athlete on as a favor. My books at the time were slammed but I tried really hard to never turn down work. People go on summer vacation, get injured or graduate. I knew it would even out eventually, maybe. Her mother had pleaded with me to give her a shot.

She had been bullied a lot at school. She had no training but wanted to try out for her school’s softball team in the spring. She worked hard for me. She worked hard for herself.

Although she did make it out of the hospital, she never returned to school or training. She went into a psych based boarding facility. She sent me a lovely hand written card once, which I have hanging in my art studio.

This would not be the last time I had an athlete try to take their own life.

I took this with me into EMS. The feeling of being on the other end of that call. The side where you cannot do anything but wait. I hope the EMS providers treated her with kindness, although I am skeptical after working in the field.

I carry this athlete with me.

———————————————————————————————————-

My Toyota Camry partner approached me and said he had a client who he wanted me to assess. Although this trainer did not focus on athletes, he had been drafted and had extensive experience within sports. I always assumed he chose his Camry focus as it provided job security and less drama. Athletes can be a bad reality tv show. He was an excellent trainer and I could not have asked for a better business partner.

This athlete was in his senior year of high school. He had blown BOTH his ACLs. It was the fall and he had surgery. He had received an athletic scholarship to play football and run track for Howard. The kid was an animal.

We had 8-9 months to rehab these surgeries. Camry trainer and I would split the account. I was to work bilateral balance, mobility and fine motor skill. Camry would handle the conditioning. The athlete was also in physical therapy multiple days a week and receiving proper rehab between sessions. Rehabbing alone was a full time job. I remember taking this on with the mentality “hope for the best, plan for the worst”. So much was on the line.

But hell, this damn kid had the best attitude of anyone I have ever trained. He never missed a session. He never showed any doubt in himself or the plan. He laughed when he failed and then tried again.

You know what? He did it. He made a full recovery, kept his scholarship and played all through college.

I carry this athlete with me.

———————————————————————————————————-

I took on a girl from a local college. She used to compete but works for a friend of mine on a farm. She is 21 and had a hip replacement 7 months ago. It was degenerative. She did PT for a few weeks before they cut her loose. She has not been able to walk right since the surgery.

She came to me scared. The leg and hip were so weak she walked with a limp. She was not able to lift her knee to 90 degrees. She told me she was “afraid it would fail” on her.

She had lived years with a bad hip and shortened leg. She had this ailment since she was a young child. Due to the constant changes of pediatrics combined with the insurance calling the treatment shots in the US, this pt had to wait over a decade for surgery approval. She had grown comfortable with the pain and handicap. She said sometimes she couldn’t stand up after class and would have to sit in an empty classroom until her leg would activate.

She had grown accustomed to the devil she knew over the course of her life. Surgery gave her a new body, an unfamiliar one at that. Slap on a lack of PT and you have a girl who is alone, away from home, afraid and unprepared for her new baseline.

I told her we would build her up together. Start with showing the muscles their length, then we would add on strength. Not my first rodeo. Slow is smooth, smooth is fast.

Our second session, we were working on spider mans. Hold Plank and then step your same side foot to the outside of that hand. She was unable to do it on the surgery side. She said it didn’t hurt but she was scared. I told her to use her hands and guide the leg up. Her hip will hold- she had a great surgeon. Stop if it hurts.

She got her foot up and paused. She made a face.

I asked, “are you okay? What is that face?”

She looked up at me and said “I didn’t know my leg could do that”

That face was astonishment. It was relief. It was her breakthrough. Her reaction was unexpected to me. It was uniquely human and brilliant. The moments like these are why I continue.

That was the moment she started trusting me but more importantly started trusting herself, trusting the leg.

That one choked me up when I finished the session. This young woman had been through the ringer her whole life with this injury. Here I am bearing witness to a moment she (nor I) will never forget. The simplest movement leading to the exhale of a complicated and painful past.

I carry this athlete with me.

———————————————————————————————————-

I started teaching a sequence of college credit courses I had developed on martial arts at a military college a few years ago. I was there as adjunct faculty for 2 years. I had the absolute pleasure of instructing some truly spectacular young men and women.

One of the cadets I had my second semester approached me right off the bat.

“I want to fight in golden gloves this year”

It was the end of January. Golden Gloves starts late February/ early march.

I asked if he had a camp. He said no but he has been training for a while.

I said he needed to wait until next year as he had missed the wave for this year.

He told me “but I have heart- I can do it. Whatever you say I will do, Coach”

I saw the “it” factor in him. I knew he was telling the truth. I also knew if he waited a year, he would be conditioned to be a champion physically and technically.

“I’m sorry. I will coach you for next year but it is too late for this year.”

His hope turned to anger.

“They told me they had boxing and you aren’t who they said you were!”

I let him get it all out. He was already in my class. He stayed enrolled, which surprised me.

Every day he asked about Golden Gloves, as if I was going to change my mind or be worn down. I didn’t budge.

“Cadet, you are not ready. I will train you for next year.”

He kept coming to class and training. Golden Gloves came and went. I took the class down to train with my old team in Delaware.

He didn’t last 4 rounds without being 100% winded. On the ride home he said, “you were right coach, I was not ready”.

I told him that it’s okay.

At the end of the semester he came to me and said he had been accepted into a higher ranked military school. This school had more resources and an active boxing team.

He said he would be “staying here”.

I asked him why and he said “because you’re going to take me to Golden Gloves, Coach. I want to stay here with you.”

“No-

You’re going to transfer, Cadet. This is an amazing opportunity. You need to go. I want you to go. You have earned it”

He begged me to let him stay, even one more semester for training. I told him absolutely not. I would always be here for him.

“Do you trust me?” I inquired.

“Yes, Coach”

He knew where this was going and sighed.

“Then you need to go. You’re going to love it. I promise. Go spread your wings.”

“Yes, Coach.”

By the end of his first semester he was sending me links to watch him fight. He was shining as much as I knew he could. He had been elected as a class leader. I couldn’t be more proud.

Would I have loved to coach him to the moon and back? Absolutely. ABSOLUTELY. However, for him, I looked 2, 5 and 15 years down the road. This was the combo to set up the knock out. I would have driven him up there myself if it came to that.

I carry them all with me. Dozens of athletes who have made me smile, face palm and want to rip my hair out. I carry their successes and failures. I carry their stories, their hopes and dreams. I carry their fears and secrets. I feel lucky to have been given the opportunity to be a part of their lives. They have taught me patience and communication.

Most importantly, they have shown me how much heart plays a role in one’s success, even against all odds. Humans can accomplish some truly amazing feats if their heart is activated, no matter the industry or task.

To all the athletes I’ve coached, thank you for sharing your heart with me.

A little over a year ago I started working as a 911 paramedic in Camden, NJ. As a PA medic, I ventured into “the dark side” with an open mind and ready to see what it was all about. Camden has a reputation.

It is a place we hear rumors about but none can be confirmed. No one outside of Camden really knows anything about what happens on this side of the bridge. Camden looks across the river at Society Hill in Philadelphia. The ultra wealthy and poorer than dirt staring at each other on either sides of the Delaware.

What I found was bittersweet: a silent but exceptionally hard working EMS department, a city packed to the brim with addicts, some truly spectacular local food spots, a dying older generation who carried the city on their backs, excellent pay, the best paramedic partner anyone could ask for, a city without safety, a city caught in between political gains…where no one does checks and balances because, it is indeed, Camden and no one in power of value genuinely cares about this place. It is lawless.

My first call of my last day summed up my experience working in Camden.

37yoF at a bus station going through withdrawal. About 0800.

There were days this summer where all I took were overdoses. 9 dispatches in 12 hours all overdoses. Some go to the hospital. Some tell us to fuck ourselves and walk off. Some don’t wake up.

Pt walks to the truck and sits on the bench seat. It is a cool and dry, sunny morning. My partner and I wait for BLS and plan to kick it to them when they arrive. Pt is diaphoretic, pale, shaking. In disarray but alert and oriented. She has a trash bag of her things with her. All of this is normal for Camden, and for withdrawal. She wants medication for her withdrawal. She states she has a history of endocarditis and has chest pain. She last used around 7p, benzos and heroin.

My partner says “I got it”. We cancel BLS.

We ask for ID and go to start a 12 lead. She says she was drugged, robbed and raped last night.

I tell my partner “I got it” and switch spots with him.

Vitals are what we expect for withdrawal. Radials are strong/ equal/ fast/ regular. Pupils dilated (benzos). No adventitious breath sounds. RR shallow. She is tachy, 120-130. 12 lead is sinus tach. Blood pressure is 140/90 range. Sugar 131. Statting in 90s on room air Lungs clear all fields. Abdomen soft and non tender. Her extremities are covered in sores and bruises- also normal for Camden.

Pt says she has an infection in her genitals from shooting up she would like to have treated.

“At the ED, they will help you with that.”

EMS does not do genitalia unless you’re actively pushing out a baby. We will scream with you in that scenario.

She is cold. Withdrawal is a bitch. We cover her with blankets and strap her in to the stretcher.

We go in route to the hospital. She has no address but is from philly. I ask how she got here and she said:

“Some guys picked me up in a car last night. I didn’t know where they were taking me. Then they drugged, robbed and raped me.”

I looked away. She kept looking at me. She was gauging my reaction. I looked back at her.

She asked “Can I get a room at the hospital?”

I responded “I don’t control that but I will try. Is there a particular reason you want a room?”

She said “if they find me, I’m afraid they will kill me”

I looked away again. Im trying to figure out what to say next.

“I will help you get a room. Do you want to file a report? Do a rape kit? I can have the hospital help you with that.”

She said “No. they will kill me”

She is right. The justice system has failed her. Failed this city. Addiction is married to corruption here. The cops have hands off policies in Camden. They stand by as my co workers get assaulted, that is, if they even show up on scene. They are glorified sheep dogs. Herding the homeless out of camden’s waterfront to make it look safe. This is policy. The politicians policy. Not policing policy. She is right. They couldn’t and wouldn’t protect her. They probably wouldn’t even find the guys. She is another statistic lost in the system that has not yet figured out how to enforce laws in this new landscape of addiction while eliminating the Camden old ways of police brutality from decades prior of painful history. As my partner said “she would be another dead white girl in the river”.

Camden says the crime rate has been dropping.

It does that when citizens don’t report crime because it is safer to stay quiet.

“Do they know where you are now?”

She looked away “no, I don’t think so”

“If you change your mind, let someone know. I am sorry this happened to you”.

We arrive to the ED. I talk to the charge.

Side note- charge nurses are ice cold. They have been dealt every hand. They are the ring master for the circus. They never show emotion. They can put you in your place with a look or a few words. They know their people. They know their medics. Medics, we learn to use our cards wisely. Always respect The Charge.

I pulled my card on this charge. I told her I needed a room, please, a safety concern. The charge stops typing but doesn’t look up from her computer. I have 10 seconds to give report before she decides to make my life a living hell. The charge upon hearing half my report stands up from her throne and walks over to the pt.

“Honey, what hurts? Where did they hurt you?”

The patient looks at me, then back at the charge.

“My bottom”

Charge nurse walks back to her desk without looking at me: “Room 30”.

That in this part of the world, is a W.

She is transferred. Left in a bed. She isn’t my first and won’t be my last.

That wall you as the reader now feel, the “that’s it?” Feeling…

Yes. That is it. Welcome to the job. It is fragments of the full story.

Sit with that.

———————————————————————————————————-

Not long after we clear, a dispatch goes out for a retired police officer who shot himself in the head at his old station. He would go every morning and feed the stray cats.

The responding crew said it was a DOA.

“Went in and out.”

They shrugged and headed out to another call as I ate a stale day old bagel left out on the communal table.

I am closing on my second year of being a 911 paramedic in a busy urban/ low socio economic system. Chase cars. MICUs. Dual ALS. Critical Care Fly alongs. A 14 day Critical Care course. Con ed. More Con ed. 16 hour shifts with 9 ALS transports and 11 dispatches. Late calls and late relief. Early calls on frigid mornings. Hundreds of FairLife protein shakes. Missed IVs. Code after code after code. Bed bugs and cockroaches and maggots. Unknown bodies decomposing in forgotten buildings. Shifts I only treated overdoses. Unsafe scenes. Blurred memories of dates and numbers. Lost friendships. A schedule that makes no sense to anyone. SWAT callouts on 2 hours of sleep in 24 hours. Learning how to compartmentalize. Patient care while I battle internal demons. Sleeping sitting up in folding chairs in a ballistic vest. Mastering Google translate. Telling the difference between a Bearcat and MCAT. Where to get the best breakfast sandwich in every local. Fire standbys in July in 100+ degrees. Patients calling me names when I am trying to help. What seems like 10,000 charts. QA Flags. Witnessing my partners skip 0700 coffee and go right to Monster pounders. Trying to avoid overtime. Dismissing sexual advances from patients and coworkers. Watching my boots fall apart but not have enough uniform allowance to replace them. Calls I did all the right things and the patient still dies. No longer having adrenaline when tones drop.

The differences between year 0 and year 1 are drastic. They were noticeable to my peers. I was receiving pats on the back for all my growth. I remember riding in 3 critical patients, a hat trick, to finish my first year. A pt who went UNR (unresponsive) and coded in the resuss bay, a pt in unstable SVT, and a fatal gang shooting.

I recall boldly walking into the ED with my 12 foot ECG tail on the second patient. When I came out, my supervisor and former FTO stood at the back of my truck. My FTO said she was proud of me. My supervisor gave me a smirk and a “good job, Kid”.

My EMT over heard their praise as he was busy restocking the truck. He loudly started cursing my name as “a shit show” and he was never picking up with me again. You can imagine how mad he was on the next call when blood soaked his pants via a shooting victim.

This is how we show affection. He hadn’t had a second to eat his empanadas which he picked up 2 hours ago and were rotting in the un airconditioned truck.

Not going to lie, I felt pretty cool after year 1. I was excited for more growth, for more pats on the back and more snarky remarks from the EMTs. This was awesome.

However, the end of my first year was the last big recognition I ever received. I was in the trenches after that. We do not get pats on the back for doing our jobs unless we give it to ourselves.

The end of year 2 is much more subtle and personal. I find myself looking for loop holes in the protocols, reading pub med and being more curious about what happens AFTER I transfer the patient to the ED nurse. I find that my colleagues now ask my opinion on cases or why I did something a certain way on a call. I have started to develop a “style” or a “practice” as they say in medicine.

I now spend most of my time in a chase car. I noticed the patients I end up treating are much sicker than when I was paired with an EMT on a MICU. I often arrive on scene and do not know the crews. We have 30 seconds to figure each other out and then get on with it. I spend more time at the ceiling of my scope in the cars. I am calmer. I am not surprised much anymore.

Closing on year 2, I have come to the conclusion that my job is much deeper than medical. I have softened to the human condition. I feel myself having more compassion the more I treat. I see that sometimes we are the only ones left to call. We are the last resort.

———————————————————————————————————-

Dispatch for change in mental to a multilevel apartment. I am on a MICU and have another BLS truck with 2 EMTs on scene.

31yoM PMH Traumatic Brain Injury (TBI). Bed ridden in a basement. Mother and home nurse on scene.

Pt is laying supine. Bilateral radial pulses strong, regular, equal. Skin warm, dry and true to skin tone. No adventitious breath sounds. Bilateral chest rise and fall. PEERL. Unresponsive to verbal or painful stimuli. Bed sheets are clean.

Patient (Pt) was struck by a car in February down south and was transported to a Level 1 trauma center in that region. Pt’s mother spent 8k (her life savings) to have him moved up here in May.

I ask my EMTs to get vitals as I talk to the family.

It is now the end of June.

She is crying. The home nurse is quiet but responds to questions. He started last week with this patient.

First, I am a detective.

“Ma’am, I understand this is a lot but please stay focused on my questions. I need to figure out the story and game plan.”

She nods as tears continue to vacate out of her eyes.

Pt has been having more recent periods of lethargy and going unresponsive. His eyes are always open. He just “checks out”. This recent episode started on Sunday. Today is Wednesday.

“Is he taking all his medication?”

Mother responds with “yes, he has a feeding tube. I do everything for him. I promise he gets his medication.”

She says it defensively. I let it go. It is okay. It is normal for people to be on the defense with us, especially in the beginning as we gain rapport on scene. As previously covered, people can be at their wits end when they call 911.

Two playful cats dart up and down the basement stairs. They are having the time of their lives with all this activity. All these new people, smells and equipment.

The pt is in a cervical collar. His mother states this collar has never been changed. It was placed by the treating hospital down south months prior immediately after the accident. This pt needs repeat scans of his cervical spine. He has not had any scans since the initial imaging after his accident. He has a C1 break.

I have no other information but am handed a med list along with feeding tube instructions.

I inquire, “What is going on with these scans?”

The mother breaks down further. She shakes when she speaks.

“I….I don’t know why he did not get them down south. I…I am so sorry…I don’t know…I had him moved here…I have not been able to get him out of this basement. He has no doctors and no one will help me move him.” (help move him to get him to the hospital)

The home nurse chimes in: “we have prepping to try and get a home doc in here but it has not been successful. I suggested we call 911 and get him to a hospital.”

The patient is in a well kept, clean basement that doubles as the apartment kitchen. He has his eyes open but he does not respond. He appears to have some voluntary movement of his extremities but limited and not all the time.

“He needs rehab…I think- he needs better care- he needs these scans”

His vitals are text book.

Mother reports that on most days he can speak short sentences, softly, to her. She smiles at me. “He says he loves me”.

He hasn’t spoken to her since Sunday. He now just stares off into nothing.

“Okay Ma’am here is the game plan. We are going to carry your son up these stairs and get him out of here. We are going to the ER. I will talk to the doctors. He will likely be admitted for repeat scans and a thorough work up. They will get a short and long term plan together for you.”

She is nervous but shakes her head yes as she wipes away more tears.

I turn to my EMTs, “however you want to do this is okay with me. I am going outside to call command.”

My BLS crew radios for the fire dept to help with an expedited lift assist. My supervisor is also dispatched.

“Med Command Dr. X”

“Hey Doc. This is PM on truck Y. I have a complicated one for you…TBI in February. Struck by a car. Has not had repeat scans. Originally happened down south. Transferred up here via family. Vitals stable. Pt has been AMS since Sunday. We are getting him out now. It’ll be about 15 min before we are to you.”

“Okay got it. See you then”

Fire arrives. They don’t acknowledge when I say hello and thank them. Love me a grumpy group of wackers. Sorry to interrupt your paid shift of binging youtube fire videos.

Our patient is carried up the stairs to the stretcher via the reeves, secured and loaded into the ambulance. My supervisor flies out of his car. I tell him it’s cool and we don’t need him. He is relieved but hangs out for a few minutes, like most attentive sups.

My EMT asks me if I am riding this in.

“Yeah, I got it”

The mother asks me if she has time to take a shower as she hasn’t showered in over a week. I tell her to take her time and he will be at the hospital when she is ready. The barometric pressure raised a few bars with her sigh of relief.

My EMT goes back to our truck. He will meet us at the ED and pick me up. See, I am the medic in this local but everyone wants their cut. I hop aboard the other ambulance, since this the local for their ambulance. They bill for the transport. My company bills for the medic. One call. One patient. Two trucks. Three EMTS. One Medic. One transporting unit. Welcome to logic. I don’t make the rules.

I grab more vitals and a 12.

I have an EMT in the back with me. I tell her to expose the pt and we are going to to a thorough physical assessment. I turn to the pt and tell him we are going to look at him and to let us know if anything hurts.

An instructor in medic school told me once, “They can always hear you”.

I truly believe that.

He is well taken care of, globally. His skin is clean and soft. He is well groomed. He looks to be a strong young man even after months of being bedridden. He has no bedsores or rashes or bruises or signs of abuse or neglect. His feeding tube is is secured with a clean device and is flushed. He has no signs of infection (such as heat, redness, discharge, swelling) or complication with the tube. He has no bad odors and a clean diaper. We look for pain triggers as we work. I find that universally, pain presents in a patient’s eyes.

As we assess, he starts to make eye contact with us and track our movement.

I tell the EMT I am going to get a line and grab labs to jump start everything for the ED. I take the patient’s hand and tell him “I need to start a line okay?”

He squeezes my hand tight which took me off guard.

I ask the EMT to come sit with me and hold his hand while I grab the IV. I talk to him. I know he can hear us.

He Squeezes his eyes tight as I place the IV.

My EMT and I each hold a hand in transport and talk to him. Women seem to be better at this part of patient care. I think if I asked a male EMT to hold a patient’s hand they would scoff and refuse. I learn my EMT is a mom. She affectionately tells the patient and I about her kids.

Upon arrival at the ED, our patient whispers “Thank you” and it stops me in my tracks.

It does not take medical training and 30k of student debt to see the struggle in someone’s eyes.

Upon entering the ED, I ask to give report to the MD and assigned nurse before handing the pt off. It took me 2 tries but the charge realized I was not messing around.

I told them what I knew. I gave them the packets. I told them I am running this as AMS. Which, I know, one could argue, was overkill.

However, one could also argue that this is the job…

We arrive on scene and assess. This patient deserved scans. He deserved care. His mother deserved to have help. I will advocate for AMS knowing it gets this patient where he needs to be. The system had failed him. Call this person. Get this script. This transfer form. Come up with this amount of money. Try this department. Hold please. We can’t help you. Call this other doctor. Maybe maybe maybe. A whole bunch of mazes that result in dead ends. This was all in my verbal report.

I told them this pt should be admitted in my lowly paramedic opinion. The MD appreciated the report and attention to detail despite me capitalizing their precious time.

This patient needed definitive care. My job is to get patients to definitive care. This corn maze of fuckery ends today.

Was this a sexy call? No. Will my coworkers ask about this case? No. Will this end up on 911 on Fox? Trick question. None of our calls end up on that show. The kids game “Operation” has more medical accuracy than that dumpster fire.

However, in my experience, these are the calls, that make a difference. As cited by a mentor of mine, “Do the ordinary extraordinarily well”.

Know the system. Know your protocols. Know your patient. Always do what is right for the patient and advocate like hell. That is the job.

Dispatch ALS- Syncopal Episode

Dry, sunny, 40s. Typical row home in this impoverished area. Greeted by the aunt of pt. Pt is seated on couch just inside the front door. There is little to no other furniture. A mattress on the floor. A kid on the stairs, he may have been 7 or 8. A man in the kitchen doing dishes stops and looks at us.

20yoM said he got dizzy came downstairs and his aunt called 911 for him. I grab both radial pulses. They are a bit fast but strong, equal and regular. Pt is AO x4, (alert and oriented), Pt skin is warm, dry and true to skin tone. His arms and legs are shaking a bit, mildly. He is scared. He says he is having a heart attack and his heart is going so fast. He does not smell like alcohol. He does not have tracks or recent injection sites on his arms and hands. His pupils are normal and reactive. He has no shortness of breath (SOB), has bilateral chest rise and fall, no dyspnea, no adventitious breath sounds, speaks in complete sentences with appropriate words and no slurring.

Okay first impression is done, I am not worried. But lets keep moving down the list.

My EMT partner is already putting on the BP cuff and pulse ox as I get the Hx and take a blood sugar (BGL). Sugar is 89 which is within the normal range. Pt states he is on no medications, has no health hx including no cardiac Hx. He said this happened once before in the summer and he was dehydrated. He denies chest pain or any pain. He denies any sensory changes, tingling, numbness or pain anywhere else.

Initial vitals: 137/91, 115HR sinus tach 4 lead, 98% SpO2 RA, 16RR normal, BGL 89

I tell my partner we are going to do a 12 lead.

I lean in so the aunt cannot hear me across the room and ask about drug use. He wont answer. I assure him I am not the police and he is not in trouble. I just need the full picture in able to help him. He sighs and tells me he has done Robutussin, Benadryl and weed in the last 24 hours. He said he was in rehab 2-3 weeks ago. He said he probably wasn’t drinking enough and that he hardly ate today. I thank him for his transparency and move on.

We apply the electeodes for the 12 lead which means lifting up the shirt to access the chest. The patient all of a sudden gets nervous and says “Is this going to hurt?! What happening?” His aunt rushes over to see what we are doing. We stop and say no no it is just taking a picture, it will not hurt at all. You’ll feel nothing. He settles again. The aunt stays with us. 12 lead is Sinus Tach. I had to take 3 because he had trouble sitting still. I coached him on his breathing the 3rd time and we got a pretty clean strip.

I tell him what I know: his vitals are good. His heart rate is a little elevated. I am not a doctor. I want whats best for him. I ask if he wants me to call my med command doctor to talk to him. The patient says yes.

I call command, tell him what I have, what I think. Command sounds like a resident. He is stoked to talk to the patient and glad I called for advice.

The patient immediately panics and tells the doctor he is having a heart attack and said he wants to be transported. The doctor agrees with transporting. I now feel like an idiot. I take the phone back, go outside, thank the doctor for his time and hang up.

Upon re entering the house, the pt is back to being unsure about transport. I take a deep breath. I call to the aunt who had returned to the kitchen. She rushed back over. I asked her to get him a cup of water. I said to the patient: “we are going to pack up our bags and hang out for a few minutes. Drink some water. Your heart rate has already dropped a bit since we have been here. I am not in a rush to leave you. I have time.”

EMT partner takes another set of vitals:

124/71 BP, 108HR sinus tach 4 lead, 98% SpO2 RA, 16RR normal.

My partner starts packing the bags. He could read the room and see I was not rushing. Nice and easy. A sibling comes home and tells his aunt he missed the bus to planet fitness because he was on the wrong side of the road. I make a joke about the disgrace of our public transportation system. Both of them look at me stunned. Then laugh.

My Partner returns. We re approach the pt. Pt states he is feeling “a lot better” and does not want to be transported. I tell him I need to call the doc back and let him know the decision. I step outside. Make the call. State I think it is a mix of dehydration and withdrawal and pt is stable. Doc approves refusal and does not want to speak to pt.

We get the refusal signed etc. Tell the pt and his aunt they can call us back anytime and we will be happy to reassess and/or transport. I make the pt promise me he will eat something and drink more water. The Aunt says she will make sure he does.

We leave.

Dispatch to refusal signed was maybe 30 minutes. We were on scene 20 minutes.

On the way back to the station my EMT, who has been working for high quality services for 20 years, said “you are far more patient than most people.” I brushed it off and responded “first call of the shift, ya know?”

There is a stigma in EMS that we are not allowed to be soft. Or patient. Or kind. That we are to be rough around the edges and unfazed by anything or anyone. We are supposed to have the emotional capacity and expression of a house plant.

Later that night my partner and I are eating dinner. He said:

“You know you really treated that whole family well. Don’t ever lose that. That little brother on the stairs was watching your every move on the call. How you treated his brother. The Aunt, her husband. They were all watching you. You showed them that race doesn’t matter and that there are good providers. So many medics would have loaded him into the truck and dumped him at the hospital but you gave him a thorough and full assessment. You did not rush, you listened to him. You built provider trust between him and his family. I will work with you anytime.”

I quite honestly was stopped in my tracks and told him “you were just as much a part of the call as I was- I cannot take all this credit”. He disagreed and again told me how important it is that a white provider took care of a poor black family without pushing them along to some conclusion that would end the call faster. That extra time on scene saved the triage nurse time. Saved the kid an 8 hour wait. One less patient dumped into an already full hospital system.

Race relations are so deeply engrained in this society whether or not you see it. We do not know what crews have been through there before, how our patients were treated. What family history lies in those walls. I did not think much of this call until my partner said something. I am glad he did. I am glad he was also watching.