The jittery lady lasted one class. She fidgeted through the lecture and I saw her handing her textbook back to Frank at the end. I tried to make eye contact with her as she left the room but she held her head down.
The human body as I first learned about it as an EMT is a stick figure. That is what I drew in my notebook during the lecture. This stick man had lines going through him. Sideways he was cut into anterior and posterior segments, through the chest he was midclavicular, his twiglike fingers were distal to his medial section, his single line of a chest was proximal to his heart. The stick man’s spine was divided into four sections. His cervical spinal process, his thoracic region, his lumbar region, and his sacral region. A big black ink splotch on his anterior thorax showed the xiphoid process, “landmark for all CPR compressions,” we were told.
I loved the words of the body’s geometry. They were poetry to me.
Scapula, maxilla, ischium, meniscus, calcaneus, acetabulum:
I moved them around in my mouth like smooth lapidary pebbles. I loved the word
cyanotic,
meaning blue from lack of oxygen. We saw slides. Dead was a gray blue like the churning waters off Gloucester, Massachusetts.
I was immediately good in class, but it was only because I knew the bones of the body from my years as an art student. Art was what I had majored in as an undergraduate as well as a grad student for seven academic years (about as long as it takes to become a medical doctor). I sketched and painted the human body. I came to know it draped and disrobed, fat and thin, young and old. I especially loved anatomy, loved tracing my hand across the ivory bones of the class skeleton, loved the books that showed the body dissected to reveal flaps of muscle and cartilage. Like architects building a house, as artists we had to learn what held this thing called the human body together. We had to know how it moved, and what lay under the skin.
I was strong coming out of the starting gate as an EMT. I had a leg up, I knew my tibia from my fibula. I hugged my white plastic loose-leaf to my chest as I left the class at the end of the night. I could do this. I knew things.
My jump start didn’t last long. Was it possible that when I was younger and went to school five days a week that my brain could absorb as much information as I was getting now? Now I felt overwhelmed with facts. It was different than when I was a child. I remember classes and I remember homework, but this was unique. Maybe I cared more now, maybe my brain, like the rest of me, had slowed down. I wondered if the antidepressants were causing brain lock. I looked around the class and wondered if anyone else felt as overwhelmed and flooded as I did.
I think that I cared too much. I was the one who sat taking notes like mad. I was the one who always had my hand in the air. What Frank said to the class seemed like the wisdom on the tablets God gave to Moses.
Frank explains to us the correct placement of a plastic airway into the patient’s throat. I can see myself ham-handed in the back of an ambulance, inserting the airway the wrong way. I cringe, and turn around to see the slack faces of my fellow classmates. They do not share my intensity, my horror of missing any of the minutiae. I see one of the two identical-looking Spanish sisters who have joined the class pushing her cuticles back. She is not listening. I am thinking, What if she was the EMT in an ambulance when I stopped breathing? What if someone handed her the plastic airway and she had not remembered that Frank had said something about putting it in one way and then flipping it around the opposite way during insertion? It ceases to matter, because after two more classes both sisters dropped out. I ran into them on the streets of the town two weeks later and asked them what happened. “Too gross,” they say in unison. They didn’t like the slides of people with their brains spilling out.
I am amazed I have stuck it out this far.
Frank is our main teacher but he is joined by five different paramedics from time to time who come in to lecture us. They seem to me to be a good ol’ boys club. I think they regard us students as insignificant fleas skirling about on the surface of emergency medicine. During the breaks they ignore us and laugh and talk with each other.
Even though they hang together they all have different personalities. There is Ralph Miro, a trim, neatly dressed man who comes to lecture us wearing a well-cut suit and tie instead of the coplike uniform that Frank and the others must wear on the job. Despite his sartorial style he is the one who brings the most horrific slides to show us, and clearly delights in raising the squirm factor. He wants to scare away those who can’t take it, or who think EMT is holding the hand of an attractive person with a hangnail and offering comfort and a bandage.
Ralph’s photos are straight from the hospital and autopsy room. They are a gallery of freakish events. A man who fell on an iron fence railing that pierced his chest, a woman having an allergic reaction whose tongue has swollen to the size of a shoe. A man who was hit in the face straight on with a shotgun and whose nicely cut hairdo now frames what looks like a dish of eggplant parmesan. I am fascinated by what is left intact on these unfortunate people. We are supposed to be looking at a bloody stump of a wrist and I am seeing the grace of the hand that is left behind, the attractive nails and elegant ring on the good hand, the silky skin or the curve of a hip, the svelte fleece of pubic hair that glistens despite being a neighbor to disaster a few inches away.
I think I am weird to notice this, but I am looking for comfort in the midst of chaos. Maybe I am trying to remember these are people and not body parts. By the fourth class things have gotten so intense that I have taken to writing the name of my shrink in the well of my notebook over and over, in an attempt to keep from running out of the room.
I plead my case to the gods of medicine. “Let me get through this,” I say. I think it can’t be worse than sitting in the plane. I am listening to Prozac, but it hasn’t told me everything will be all right.
The class is like a living and changing entity. Cliques form. There are now popular people and pariahs. During the breaks the same people talk with each other. The cops still give us dirty looks and yell at us about parking in their spots. The paramedics hang together, daring us to come near them, and I have made an uneasy alliance with a girl named Dot. At least a decade my junior, Dot wears her hair cut short, dyed purply red and spiked with gel.
Each of us takes our same seat each class. I hold on to the one near the window ledge with the force of a pioneer homesteader. I love this seat because the cracks of the window caulking leak just enough air to make me feel I will not pass out when the lecture gets too visceral. Dot has taken up residence in the seat next to mine. We are both front-row types—intense, educated, verbal. The difference between us is that she fails to understand that this is boot camp and the best way to survive is to be invisible. You don’t want to piss off the paramedics. They clearly hate us just for being new and dumb and are looking for any excuse to make our class time more hellish. Somehow Dot doesn’t get this, or if she does, she doesn’t care, as she raises her hand every five minutes. She questions them, she argues with them, she corrects their grammar. I am wishing she was far away from me; I worry they will think I am in cahoots with her. “Shut up, shut up, shut up,” I whisper under my breath. But she doesn’t.
We are starting to get up from our desks and do what are called practicals. This involves Frank dividing the class into groups of six and practicing things like CPR or trauma assessments with each other instead of just sitting at our desks learning things theoretically. Dot is in a different group than I am. Frank has broken up the groups by last names rather than seat assignments.
I am having a wonderful time because I like the hands-on part. I now get to touch living people, my fellow students. Maybe it is my age or my training as an artist, but I am not at all shy about placing my hands on a stranger’s body.
With the help of the paramedics we learn how to apply traction splints and cervical neck collars and how to cut off someone’s clothing fast and look them over for bullet wounds that have entered and exited. We use each other and we use rubber mannequins to practice on. I am given a rubber baby doll and told to save it from choking. I do the pediatric Heimlich maneuver so hard the baby’s head flies off and lands ten feet away in the corner of the room. This is not good.
I move on to the big adult-sized rubber mannequins. The female mannequin has blond plastic hair that looks like a 1950s swimming cap. All the mannequins’ mouths gape open like sex dolls’. Many of them are just heads and torsos without arms or legs. These are for working on with chest compressions and mouth resuscitations. One mannequin, Rescue Randy, is dressed in real clothing and looks the most human. He is filled with sand and weighs 160 pounds, and is designed to duplicate an unconscious adult male. I tug at his legs to move him. He doesn’t budge.
With the help of a classmate I haul Randy around the classroom, hitting his head on the desks and wooden baseboards. “You killed him!” Frank yells jubilantly at me. “He had a heart attack and now he has a fatal head trauma.”
By the end of the class I am in my usual trembling sweat. The sheer physical exertion of becoming an EMT is something I never thought about. It seems we are always moving, stepping, squatting, pushing on someone. We have to be careful not to step on their arms or legs, to walk over their chest, to further damage the patient beyond what is already wrong with them.
The big rubber mannequins look so inhuman it is easy to forget they are supposed to be people. I find myself pulling them around by their faces, or reclining against their armless torsos during the breaks as if they were toss pillows.
It is always good to take a break. We are given one midway through the class. All the smokers run outside. I join them although I don’t smoke. Frank smokes. He tells us that one of the big stresses for EMS personnel is bad health habits as he drags on his second cigarette.
I like it outside because the winter air is cold and dry and it wakes me up and dries off the sweat from working in the classroom. People still have not connected. There isn’t the usual stoop chatter one hears among coworkers. People smoke in silence.
At the end of the class I get my coat from the hooks in the back of the room and leave. I am the last to leave because I have helped stack the chairs against the wall, something the cops demand we do. In the quiet parking lot I see someone standing alone by her car. It is Dot. She looks upset. I stop and talk to her. She tells me she thinks people in the class hate her. She seems so beaten down and miserable that I talk to her for what seems like an hour.
My hands and feet are freezing but Dot seems to be unaware of the cold. “No one wants to work with me,” she moans. “When I join a group the guys completely ignore me or give me looks that could kill.”
I don’t know what to say to her, so I am honest. I’m not sure it is the best policy but I am too cold to think of anything better. “Maybe you should not raise your hand so much, just keep your opinions to yourself.” Basically I am telling a bright person to act stupid. This is not going over well.
She starts to argue with me.
“Think of this like boot camp,” I say. “The medics are here to weed out the weak. They want to break us down, so just get tough and don’t take it personally.”
As I am talking, one of the cops pulls out of the driveway in his patrol car. He yells, “Don’t park in our spaces!”
Frank, who has packed up his lecture notes, pulls out in his SUV. “Good-bye, Frank,” I call out and wave. He doesn’t answer.
Dot still looks miserable. I ask her what EMS service she is joining after we graduate.
“Georgetown,” she says.
The class is given its first test. I score an 80. I am devastated by how mediocre I am. I do nothing but study. This is a class filled with young cops and firemen, and I have a graduate degree from Yale. How can I be less than brilliant? I look at Dot’s paper; she has gotten 100. Frank has even scrawled “good job” on the top. I am wild with jealousy.
Because Dot has claimed the seat next to me and she is left-handed, everything she has on her desk is aimed right at my line of sight or resting on my right leg. She is also a sprawler. I am anal about my textbooks, my pristine white notebook, the boundary lines of my desk and beloved windowsill where I park my coffee. She is always fifteen minutes late to class, rolls in unapologetically after Frank has begun the lecture, and throws her backpack down on the floor. She is in many ways my exact opposite. While I smile at everyone, she glowers. Dot looks rumpled, while now that my depression has been replaced by a feverish study of emergency medicine I have standing orders at the Georgetown dry cleaner for my shirts to be laundered with extra starch. Dot always wears jeans, a big ungainly windbreaker, and hiking boots. My cowboy boots are custom-made and my jeans well ironed. Her casualness is one reason why I am in despair that she has gotten 100 on the paper. “You got an 80?” she says.
She has stopped one micron before saying the words
I
thought you were smart
. “It’s not you,” she says. “It is this test. It is a semantic mess.”
As Frank lectures to us she scribbles wildly on her notebook so I can see it, something I haven’t done since the seventh grade. Dot tells me she has a Ph.D. in semantics, and she goes into furious detail about every flaw in the questions. I appreciate her making an excuse for me. To her way of thinking, I am simply too smart to take a dumb test. I don’t have the heart to tell her that the semantics really were not the problem, the problem was that I simply didn’t know the answers to 20 percent of the questions. I imagine standing over a dead body in the back of the ambulance and telling the grieving family that it was not my medical error but merely a matter of semantics that I failed to save their loved one.