I am having a problem my shrink tells me is often experienced by first-year medical students. I have every symptom of every disease Frank mentions in the classroom. I am no longer clinically depressed but instead am dying of everything simultaneously.
Now I have fancy words for what is wrong with me. I am no longer sweaty. I am diaphoretic. My hand wanders constantly to my neck to check my carotid artery to see if my pulse is thready or bounding. I am no longer breathing rapidly but I am suffering from tachypnea. I have all the symptoms of a heart attack, a stroke, an aneurysm. I feel impending doom, my heart races, my hands tingle, I can’t feel the right side of my face. When I am not enmeshed in my imminent death from medical problems, I am obsessing about all the impending scenarios of trauma waiting out in the world.
A car is not fun to drive anymore. It is a metal cage waiting to kill me in a dozen ways I have never thought about. I can get trapped inside underwater. The rescue personnel will not be able to free me thanks to Ralph Nader, a man I once admired but who now, as all EMTs know, is clearly Satan, having been responsible for cars whose doors do not fly open in a crash and come with safety glass that can’t be shattered easily to free the victim. When Nader’s name is mentioned the paramedics and firemen sneer and make the same spitting noise my Jewish grandmother made at the mention of the Nazis.
Terrible things can happen in cars. The seat belt can crush my intestines, my head can hit the dashboard and send my brain bouncing around inside my skull like a Pac-Man figure under siege. It isn’t just cars. After about ten classes everything in the world has become an accident waiting to happen. Dogs have teeth that cause severe puncture wounds, the propane gas tank on our outdoor grill can explode and level the whole block. Have a cocktail and you can get sloppy about chewing and choke to death on a hunk of steak. Bees can sting you and anaphylaxis can set in, causing you to suffocate. UPS trucks can carry up to seventy-five pounds of unnamed volatile chemicals. Babies and children are walking disasters, their big heads and delicate bodies designed for toppling, their large tongues for choking.
Frank stands before the class and tells us, “One out of twenty of you has a main artery that is congenitally faulty and will at some time hemorrhage. If you are lucky and it is caught in time, you will not die.” He looks at me while he talks. I am now cyanotic, diaphoretic, and my pulse is bounding. “Stern, take your hand off your carotid artery,” he says. “Pressure there can stop blood supply to the brain.”
So what?
I think.
I am almost dead anyway.
By the twelfth class I see my notebook is filled with marginalia written from me to Dot and back. It bears the name of various physicians in the area. She wants to know who I use, who’s good, who returns phone calls. Clearly she is dying like me.
The next class has me writing my shrink’s name over and over in the notebook margin as a totem that everything will be okay. It says “TOM KNOX” down the page, as if those seven letters can stop fears the way Superman’s cape does a speeding bullet. I have also written the word
bleech
in large wiggly letters—a word I haven’t used since I was a kid and found the word while reading Don Martin cartoons in
Mad
magazine.
Bleech
(pronounced
blek
) is a great all-purpose word of disgust. It comes in handy for class. We are learning about internal bleeding and feces, and how we have to see if someone’s shit looks like coffee grounds, is dark and tarry, or gushing bright red. I think not.
I am at this point determined to specialize in shitless EMT events. I am also placing vomit on the no-can-do list. Frank tells us that a great many 911 calls will have us finding the patient in the bathroom, having taken a swan dive from the toilet. Sorry. But I will not do toilets. I begin to wonder if Georgetown will let me have a specialty involving only coming to calls where people are fully dressed and dry of ass. I am still thinking about blood as an option, but I have already decided that shit and vomit will not work for me.
Chad Howard has rescued us from Frank’s odious world of “bleech.” He is giving a class on the most innocuous practical subject: physical fitness. How not to strain our knees and backs while lifting people.
Chad is a young physical therapist. He is also a major hottie, blond and rippling with muscles and dressed in an endearingly dissolute preppy manner. Dot and I have pulled our desks closer together to better assess this situation. The margins of our notebooks are filled with lascivious scribbles. “He is WAY too cute,” she writes to me. I feel like we are preteen fans of ’N Sync.
I ask her how old she is.
“40,” she writes back. “You?”
I write “53
.”
I am more than twice Chad’s age. Dot and I don’t listen to a word he says. We don’t really need to pay attention to what he says; it is all written down in the instruction sheets we will get at the end of class. Instead we watch him squatting and lifting the Rescue Randy, and we see his corded tan forearms flex and the muscles in his thighs under his chinos expand as he shows us how to flex at the knees to save our backs. His cute butt is in the air, his shirt rides up to show six inches of smooth hairless back.
Frank is hanging out in the back of the room and looks like he desperately needs a smoke. He calls a break, and Dot and I swoon like schoolgirls, or maybe like vile old leering men at a topless bar.
When the class resumes Frank and Chad call on a volunteer to play an unconscious patient. My hand shoots in the air. Maybe I think Chad will lie on top of me and we can make out. I don’t know what I am thinking, until I am lying on the linoleum floor with my eyes closed and I hear Frank tell the class that he and Chad will now hoist me in the air and place me in the stair chair (a piece of rescue apparatus used when a stretcher is too big to fit the surroundings).
I have for the first time in my life forgotten that I weigh a lot. I mean, I really weigh a lot. I never tell anyone my weight, I would never volunteer to have anyone gauge how heavy I am. The last time I even approached the situation of being airborne was twenty-five years ago when I weighed a lot less and a male friend and I were doing a jitterbug. He tried to lift me and swing me over his knee and after getting me six inches off the ground, he gave out with a huge grunt and collapsed on the floor.
Now for some unknown reason I have offered up my bulk to this young blond god, and Frank-who-I-think-hates-me. What is worse is that there are almost forty people as an audience to watch them try and hoist me in the air. I say the name of my shrink over and over under my breath like a Hail Mary.
It is easy for them to get me upright in a sitting position. I feel Frank’s short muscle-bound arms wrap themselves under my bosom. He locks himself in, Chad grabs my legs. I am self-conscious about my legs, they are thick and heavy. All of me feels ungainly. I feel them give me a little tug to assess how hard they will have to lift. I feel my body’s resistance as they pull me against gravity. I keep my eyes closed. I pretend I am dead or unconscious. The class thinks this is method acting but I am simply trying to disappear. Trying to will myself to be as light as helium. To my amazement I am suddenly airborne. It is a revelation. I honestly thought I was un-liftable. I can feel them strain, but I am four feet in the air and then gently plopped into the stair chair. I peek out of one half-opened eye. No one is laughing.
I don’t think I will become an EMT legend in the annals of the unbelievably fat. Already I have heard the stories about the 600-pound people who needed twelve firemen to lift them off the bed. I am ecstatic. I am again a seven-pound baby in her mother’s arms. I am in love with Frank and Chad. I dream of them carrying me everywhere.
4
It seems that much of what we are lectured about in class is what not to do. “EMTs do not diagnose,” we are told repeatedly. “Do not tell the patients they are okay, they may not be. . . . If a patient tells you he is about to die, do not argue with him; he probably will die.”
I am already arguing this point in my head. When I feel sick, I get scared and I often think I am going to die. I was sure I was going to die on the stalled plane. If somebody told me I was probably right, I would likely now be dead from fright. How can I not diagnose, at least to myself? Someone has crushing chest pains radiating up their jaw and down their arm, they are sweaty, have a sense of impending doom, are nauseous, and have a pocketful of nitroglycerin pills. Is it a dislocated kneecap? Doubtful. If someone is telling me the Martians are talking to him through his tooth fillings, do I think he has appendicitis? Nope.
Chad the physical therapist comes back for the next class. This time he is not lifting any of us but helping Frank lecture us about splinting broken bones. We are told that our firehouse will supply us with scissors for cutting people’s pants off to see their injuries. Chad shows us a slide of a broken femur, the big leg bone in the thigh. In the picture it has not only broken but has pushed through the person’s skin. It resembles the main mast of a sailing ship, stark and white, standing upright. The patient’s pants flutter around it like a deflated sail.
Again I find myself noticing the ephemera of the scene. The man is wearing attractive gray flannel pants. I can’t see his face or even upper body but imagine that he is a wealthy stockbroker who got in a car wreck driving his Lexus to the train station to commute into the city. Chad tells us that a broken femur can cause serious blood loss, enough to send the person into deathly shock. What we have to learn to do is to put the bone back in place.
The way we do this is with an apparatus called a Hare Traction Splint. The top end of it is wrapped with black Velcro bands around the top of the thigh, the foot is secured at the other end, and then with a crank like that of a medieval torture rack we pull the victim’s leg apart until the broken leg bone is realigned. “You can expect the patient to complain,” we are told. This I suspect is a serious understatement.
I am not taking notes; instead I draw pictures of a handbag I saw at Neiman Marcus, I draw crucifixes with jewels on them, I make a shopping list of food I need to buy for tomorrow’s dinner. I am looking for comfort, for anything not to have to think about stretching a stockbroker’s leg until his bones snap back into place.
Sometimes I think I am too stupid for this class. I cannot remember how many liters of oxygen is in an M-sized O
2
tank. Other times I think the class is too stupid for me. We are lectured on the following things:
Do not try to replace someone’s organs if they are hanging from their body.
Do not give CPR to a severed head.
Do not try to revive someone who is in a state of advanced decomposition.
If you have a patient whose leg or arm is partially amputated, do not pull it off to make things “neat.”
I wonder who would do these things:
I think the pancreas goes here; this looks like a gallbladder, let’s shove it
in here.
I imagine myself doing chest compressions on a headless body from a car wreck and then running twenty feet down the highway blowing air into the mouth of a severed head. I scribble a note to Dot, who looks as aghast as I do. She seems to think that they are covering all the bases, I seem to think they wouldn’t mention this if someone hadn’t tried to do it.
I imagine myself as the Martha Stewart of EMTs, pulling off ragged limbs to make the victim look more tidy. Maybe I could sew a calico edge along the wound, or crochet a lace trim on the cusp of an amputated leg, like I did with Soft Baby, my teddy bear.
Frank gives us one of the acronyms we will live by: DCAP-BTLS, which stands for deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling. With the inevitable macabre slide show we see examples of each of the above. For abrasions we see a slide of someone who was wearing a T-shirt when he dumped his motorcycle at seventy miles an hour. Seasoned EMTs call motorcycles donorcycles because so many people die on them and their organs go to the waiting list of needy people. The man in the picture looks like Johnny Depp but he has no skin on his back. “Bad case of road rash,” Frank says flatly.
In my notebook margin I have written a note to myself: “If you have to get up for air, just go.” Underneath, I sign my shrink’s name, imitating the unique loopy signature that I have seen on my prescriptions. And then another quote of his from his days as a medical student at Johns Hopkins. “You get used to it,” he told me. I wonder if I will.
I look over at Dot, who is looking at the slide, her face a knot beneath her spiked hairdo. I look at one of the young firemen. “Gross,” he says, followed by “Cool.” He raises his hand. “Frank, do we get to see any autopsies?” That’s it. I get up and run outside to the fresh air to die alone with dignity.
There are things I love in class and things I hate. I love bones, they are white and clean and make sense in their architectural order. I love mentally altered states; the tragic drunks and psychos appeal to me. I love splinting and taping and wrapping the patient in what is called “a hospital ready package.” I like the cleanliness of white gauze and the four-by-four squares used to make occlusive dressings for sucking puncture wounds.
My hate list includes avulsions—big flaps of skin that hang like slices of corned beef from people’s scalps. The birth of a baby in the back of the rig is supposed to be every EMT’s happiest moment, but the movie we are shown in class of swollen pulsating vaginas disgorging placentas and pools of blood revolts me.
Dot, who has two daughters, digs childbirth. Because she and I will be on the same ambulance service, I write her a note and slip it to her: “I HATE this. . . . If anyone has a baby, YOU have to do everything.”
“It’s a deal,” she writes back.
I am also ill at ease with the machinery involved in prehospital care. I have never been a technological person. When my computer fails or the TV remote malfunctions, I am clueless. I wander into Michael’s adjoining office looking for help. Now I have to learn how to use machinery that will save people’s lives. I can no longer afford to stand dumbly and stare at it like I do when the TV goes on the blink. I have to learn how to use a semiautomatic defibrillator, a machine that analyzes and shocks a person’s heart rhythm back to normal. The machine, which is small and wildly expensive, is not nearly automated enough for my tastes. The
semi
in
semiautomated
means we still have to do things like turn it on and push buttons.
Shocking a person back to life involves shaving the hair off a patient’s chest (hopefully men patients, not women or relatives of Bigfoot) to assure correct contact between the skin and the pads. We have to apply the pads in the correct places, check to make sure there is no pulse, press the button, and let the machine analyze the heartbeat. If it is shockable, we have to yell, “Clear,” make sure no one, including us, is touching the patient, deliver the shock, recheck the pulse, do CPR, reanalyze, and reshock until the person is stable or still dead. It is a long process with great margin for error.
The goofiest thing is that the defibrillator talks to you, tells you what it is doing, and it has a built-in microphone that, when turned on, records every word you or anyone on the scene says. This is like having a spy in the ranks, someone who will rat you out if you make a mistake.
“What is the first thing you are going to say when you arrive at a scene and someone is in cardiac arrest?” Frank asks us. The class mumbles various answers.
“No!”
Frank says with authority. “You will all say, ‘Oh, shit!’” We all laugh, and Frank tells us to think it, not say it, and not to verbalize anything like, “I have no idea what I am doing” or “I am too incompetent to do this job,” because it will be preserved on tape for lawyers to have their way with for the rest of eternity.
Huge excitement. We are finally getting the stethoscopes and blood pressure cuffs that Frank has been promising us for weeks. They have arrived, and Frank, seeing the class’s excitement, has started yelling at us in his loudest voice over the buzz in the room. “Listen up, people,” he says, trying to shut us up as his assistant passes out the boxes that the medical supplies come in. Frank wants us to sit still like soldiers and open the boxes in unison, and let him explain the proper use of the things. But the class is wild with glee at the new official medical supplies. With a stethoscope around our necks we will look like real professionals, we will look like doctors on TV, like we stepped out of
ER
.
Dot and I decide we will take each other’s blood pressure. I have never done this before, nor has she. “Me first,” I say. She obligingly rolls up her sleeve. I notice how thin her wrists are, how small and white her arm is. Under her lumpy array of sweatshirts and down jackets she is tiny and womanly. I wrap the cuff of the sphygmomanometer around her upper arm, I place the stethoscope in my ears and the bell on the artery point near the crook of her elbow. I start to squeeze the bulb, I keep squeezing, I watch with glee as it rises, 110, 130, 160, 180, 200 . . . I keep squeezing. Dot is suddenly screaming in pain. Her face matches her maroon hair.
“Stop it, you’re killing me!” she wails. I have no idea how high to send the needle before I deflate it. I have no idea how to deflate it, I haven’t found the metal screw that controls the pressure.
Frank is still trying to get control. “People, people, I need you to take your seats and listen to me,” he is saying. Dot’s wails are drowning out his words. I finally find the screw that deflates the cuff, she collapses chestfirst on her desk and rips the Velcro cuff from her arm, which is now bright red. She accuses me of trying to kill her, to squeeze her to death like a python.
It is her turn. She squeezes the cuff in retribution, but I refuse to cry out in pain. “I can’t hear anything,” she says. “You have no pulse.” I tell her she has the ear part of the stethoscope backward, and that she has the bell part turned around backward as well. She adjusts everything. Now she hears my racing pulse. “Your blood pressure is high,” she says ominously. She tells me the number and I am surprised it isn’t higher.
I can hear my own heart slapping against my chest wall. “Please God,” I pray, “don’t let any of my arteries explode until after the national boards.”
The human head weighs between seventeen and twenty-two pounds. We are told this by Harry Downs, another paramedic, who shares the teaching load with Frank. Harry is very tall, talks in a commanding voice, and wears the uniform of a Norwalk Hospital paramedic. He has been doing this EMT job for a very long time, and amuses the class with stories from “the war zone.” He has come to deliver the lecture that he immodestly says is “the single most important thing we will ever learn in the class.” It is about the head and neck. He calls the brain’s nervous system the Big Kahuna. He tells us that without it, the body wouldn’t know to breathe, digest, regulate temperature, have a heart rate, or do anything else to sustain life. He gives us a dozen scenarios of hideous things we EMTs can do to screw up the head and neck. They all result in the same thing: irreversible paralysis, people who will end up unable to move from head to toe. One tiny movement of an injured person’s neck the wrong way and you have made a quadriplegic.
The handwriting in my notebook has become neat again as an homage to the seriousness of this subject. “Spinal cords don’t stretch,” I write in my best penmanship, almost calligraphic. We learn about whiplash (hyperflexion) and what happens when you dive into a swimming pool and hit your head on the bottom, jamming your neck (hyperextension). We learn about hangman’s injuries, the break in C1 and C2, the vertebrae that control the breathing nerves and the diaphragm’s rise. We learn the danger of dangling from playground jungle gyms, from sledding, from football, from wrestling, from skiing. The big seventeen- to twenty-two-pound head that sits atop your neck is just waiting to be smashed like one of Gallagher’s watermelons.
As if things could not be more dramatic we learn that men with spinal injuries develop a penile erection that will not deflate, a truly dire sign. I am obsessing about the permanent erection. Is this the silver lining to the dark cloud?
I am currently married to Xavier’s head. Xavier is a young Mexican-American man who works as a night security guard and wants to be an EMT. He is very big, very sweet, and very shy. I never see him talking to anyone. He looks constantly terrified. The only time I have seen Xavier happy is when he had to lift someone in class. He is immensely strong, and it was effortless.
Harry Downs is showing us how to avoid making someone a quadriplegic. At the accident scene we are to hold the victim’s head manually in a neutral position (that is, straight on) and then have another EMT apply a rigid cervical collar and transfer the person onto the long, rigid spine board. Once the patient is on the board, we secure the head with stiff foam blocks and straps or tape. The main thing is to never, ever, under any circumstances allow the head to move. One tiny shift might be all it takes to paralyze him.
“You are married to that person’s head until you get them in a cervical collar,” Harry barks.
My hands are buried in Xavier’s thick black hair. I smell the lush tropical floral oil he uses on it. “Xavier, I am proud to be married to your head,” I say to him. He blushes. I don’t have the heart to apply the cervical collar as tightly as it should go. I am claustrophobic about such things myself and know this is only a test. I wrap it loosely around Xavier’s bull-like neck. Harry comes over to inspect my handiwork. He sticks two fingers in the space between the collar and Xavier’s tan flesh. He wiggles it, indicating that Xavier has room to move, room to become an instant quadriplegic. “You killed him,” Harry shouts at me. “FAIL!”