She disappears and comes back fifteen minutes later. I am still trying to hold him down so he does not injure himself.
“I got through to his wife: divorced. She doesn’t want any part of him,” she says flatly to an aide. “Says she has been through enough and that we should call his work if we need to talk to anybody. She seems to think he has no friends left who care about him.”
The IV medicine has finally stopped his thrashing. He is relatively still. I speak his name, trying out my newly minted skill as miracle worker. He does not respond.
“Wheel him up to Intensive Care,” says the nurse to an orderly.
“Do you think he will live?” I ask the Chinese intern.
“Doubtful,” he says.
I watch the man being wheeled away to Intensive Care. I imagine the final call to his wife who doesn’t care. To his boss. Will anyone come to his funeral? One of the strange things about emergency medicine, at least for EMTs, is we seldom know what happens to the patient after they leave our care. Our relationship with our patients is short and intense, there is no aftercare or follow-up by us. Sometimes the way we find out what happened is to read the obituary in the local paper.
The man with the DTs has taken an emotional and physical toll on me. I would like to sit down for a while but I can’t. As soon as I spy a chair I am summoned by a nurse. “We need help in the isolation unit,” she says. I am pointed in the direction of the holding tank for violent and mentally deranged patients, where a huge black man sits on the edge of a chair behind a glass screen.
The guard fills me in. “He is a professional karate teacher, he is schizo . . . tried to strangle his mother this morning.”
“Oh,” I say, at a loss for words. I watch him rock back and forth, talking to somebody in his head. The cops who brought him in have taken the handcuffs off and are now leaving.
“He needs to be taken up to the psych ward,” the nurse tells me. I find a wheelchair and roll it up to the locked glass door. The guard opens his holding pen for me.
“Hi, I’m Jane,” I say.
There is no response. He is too deeply engaged in talking to the voices in his head.
“I am going to take you for a ride upstairs to another department,” I tell him as I roll the chair into the holding room. He stands up and sits down in my wheelchair. He is at least six feet four. He is wearing shorts and a tank top. His biceps are huge. I see he is drooling and working hard to keep up his side of the conversation with his inner demons. I roll him out of the locked room. I realize I have no idea where the psych ward is.
I roll the man through the ER. I ask the guard at the door where the psych ward is. “Four,” he says.
I don’t know where the elevators are. I find them. I don’t know if I should use the elevators that are for the public. As they are the only elevators I see, I push the button and when the doors open, I roll him in. There are four other people in the elevator. Two hold bouquets of flowers; they are visiting sick people. One has a balloon that says IT’S A GIRL. My homicidal schizophrenic karate expert has taken this moment to play with his genitals. He rams a hand into his shorts and starts to masturbate. I smile at everyone in the elevator as if I am the perfume spritzer in a department store. “Four, please,” I say to the man with the balloon.
All three people in the elevator jump out on two as soon as the doors open. I am now alone in the elevator with this crazy person. He has tired of his penis and now seems to be aware of my presence. I smile. I am terrified. “So you’re into karate,” I say. “That must be fun.”
We get to four. I roll him out on the chair and push as fast as I can to the locked psych ward door. I knock. A nurse buzzes me in.
“Who is he?” she asks.
“He tried to kill his mother this morning,” I answer. I have forgotten to take the pad with me with his name and stats on it. “He is psychotic,” I pronounce.
The nurse gives me a withering look. “What is his name?” she asks.
“I don’t know,” I say.
“Well, go downstairs and get the paperwork, and why wasn’t there a guard with you?” she asks.
“I don’t know,” I say.
She shakes her head. “It’s your ass,” she says as if to tell me that only a total idiot would get in an elevator with a crazed would-be murderer with no guards or restraints.
By the time I have gone back down to the ER, given the admission sheet to the psych nurse, and returned, all hell has broken out. A teenage boy and girl have been brought in by the paramedics. One of them is in very bad shape.
The trauma started out as the most routine of events. The pair were driving along a wooded road in a neighboring town. A deer jumped out, they braked hard, swerved, and their car came to a halt against a small stone wall. The impact forced the driver against the steering wheel. He was not wearing a seat belt. When the police arrived after a passing motorist called 911, the boy was standing by the side of the road, assessing the damage to the car. He was furious that his car was smashed in, but told the police that physically he felt fine. An ambulance had been dispatched and when it arrived the boy started to sign a refusal. He did not want to go to the hospital. In a few minutes he began to feel odd. It was hard for him to breathe. He thought he was having an attack of nerves. The paramedic put a stethoscope to his chest and listened. The boy was placed on a stretcher and hauled into the back of the rig along with his girlfriend, and with lights and sirens furiously blaring, they headed to the hospital.
The boy is suffering a bilateral hemopneumothorax, a fancy medical term that translates to the simple fact that his lungs have slowly collapsed after the impact of the accident and now he cannot breathe.
It is interesting to see how fast an ER is transformed into one big lifesaving machine when a life hangs in the balance. Suddenly the slow methodical triage of cases is turned upside-down with doctors and nurses shouting and calling out orders. The trauma surgeon is paged, and as we wait for him to arrive, the boy is placed on a bed in the trauma unit of the ER. The paramedics are working on him.
The boy looks like Axl Rose, lead singer of the rock band Guns N’ Roses: a handsome, lithe teenager with long satiny hair flowing down his back.
He has been separated from his girlfriend, who is strapped to a spine board and wearing a cervical collar, awaiting treatment in another room. “Where’s Sammy?” the boarded girl keeps asking. “Is he okay?”
Sammy is not okay. He is dying fast. His lungs have stopped functioning; he is trying to suck in air and it isn’t working. Yet he is still able to scream in pain and thrash about wildly on the table. He is drowning in reverse. The nurses and paramedics rush in to hold him down, and the trauma surgeon appears. He takes his scalpel and holds it to the side of the boy’s chest. The kid is trying to get up off the table. “Hold his legs down,” someone yells at me. I look up and see Ralph, the paramedic who always brought the worst slides to our class.
I grab the kid’s legs. The nurses have taken off his clothing. I noticed he has a smooth, lovely chest. It had been a while since I had seen a young man naked. He is beautiful and he is dying. How do you put those things together? I stand dumbly and hold his kicking feet. A few inches from my face the trauma surgeon slices the boy’s side open and inserts a tube that will help inflate his lungs.
The head nurse is holding his head. She is talking to him as he screams for help, for the pain to stop, for breath. “You’re going to be fine, honey, just hold on,” she says. Her face is deeply furrowed with compassion. “You’re going to be fine.”
When his lungs start to work he stops kicking. “We don’t need you now,” I am told brusquely by the surgeon’s assistant. I stagger back a few paces. I take in the scene, the knife, the blood, the tubes. I feel I should faint. I walk into the hallway to an area that will give me room if I do pass out. As I wait to faint, I don’t. I am amazed. How can I watch what I just watched and still be standing? Maybe there is something in me that makes me able to do this. I go to the bathroom and throw water on my face. The crisis is over; the boy is being wheeled up to another part of the hospital. I can hear his girlfriend calling his name. I walk into the curtained cubicle.
“Where’s Sammy?” she asks. She is clutching a CD case filled with discs. “I have to go to the bathroom,” she whimpers. “I’m scared.”
I place my hand on her forehead. “Your friend is going to be fine,” I say. “I’ll get you a bedpan.”
“I’m scared,” she says again. “Are my parents coming?” I look at this girl. She has a tattoo of thorns around her upper bicep and wears a heavy-metal T-shirt. Her face looks like that of a frightened eight-year-old.
“I’ll ask the nurse,” I say as she holds on tight to her boyfriend’s CDs.
By 8 P.M. my day in the ER is finally over. I go up to the head nurse but she is too busy to hear my good-bye. I wave at a few people in the beds waiting to see doctors. One nice lady has come in because she is burping a lot, another man is nervous that his heart is racing too fast. Like a candy striper in an old Gidget movie I fluff their pillows and make small talk, and then I leave.
I see Ralph Miro at the front door to the ER. “Hi,” I say. He looks at me blankly. “I’m in Frank’s EMT class,” I say. Obviously he does not know me. “That was some hemopneumothorax,” I say, trying again to bond with him.
“Oh, you heard about it?” he says. He obviously didn’t see me, a foot away, holding the boy’s feet down. “That was textbook,” he says.
I float invisibly out the door and into my car. I am too edgy to go home. What will happen to all the people I met that day? What will happen to the coma lady, the lawyer, the karate guy, the teenager? I wonder if the nurses or doctors will notice I have left, signed out, shift over.
I already know the answer to that one. I am just a spare pair of hands that day. I have no name, no authority. I want to go home to a place where people aren’t sick. I also want to turn the car around and go back to the ER. I am hooked.
7
I arrive at the national boards for my first day of testing with the joie de vivre of someone going to the electric chair. I am terrified. I have heard horror stories. Someone tells me that if you even turn your head to look at another student, you automatically fail. I am told not to bring a purse, not to bring my stethoscope or BP cuff, to bring photo ID to prove I am me, and to figure out a way to spend time between “practical stations” without talking to anyone or reading a book (no books allowed, as they may be cheat sheets).
It takes me two hours by car to get to the vocational school in Middletown where the test is held. I feel wildly out of place the minute I park the car. I see lines of young men, boys really, waiting to take the test. They have buzz cuts like the young public safety servants they aim to be. These soon-to-be-cops and firemen look trim and humorless. They also look worried as hell. I can’t believe they have studied as hard as I have, but they all look like they could carry Sven down a flight of stairs without difficulty. To ease my mind I think that, unlike my psychiatrist Tom Knox and me, they do not look like doctors.
People say the practicals are the easy part of the test. Not for me. I am fine with a written exam, which you can take only after you have passed the practicals. I know about words, they don’t throw me, but hands-on action with machinery is another thing. It is not my strong suit and today I will have six hurdles to overcome. Fail one and I cannot move on to the written exam.
It is now time to transform myself into the Dorothy Hamill girl in the EMT-B videotape, to regurgitate all my knowledge back to the instructor in perfect sequence. And so, for a whole day I go from classroom to classroom, where, with the aid of volunteers offering their bodies for me to splint, examine, bandage, and stop imaginary bleeding, I try to figure out why they were holding their stomachs, pretending not to be breathing, or pretending to turn blue.
I wear a white shirt and uniform pants to look “professional.” It is a version of what I wore in the ER at the hospital. Unlike the girl in the video, my ass looks huge.
Weeks pass and I find out by mail that I have passed. Two weeks later, I am back in Middletown to take the written exam. This time I drive up to the same vocational school with Dot and Liz Jennings, another woman from the class. We plan to review all the way up. Dot has the study aid cards and reads the question, then gives the answer before we do. She keeps doing this. When she gets nervous she gets manic; when Liz gets nervous she becomes silent and tight-lipped.
Liz is a licensed helicopter instructor who wants eventually to pilot the Life Star helicopters that bring the seriously wounded to the hospital. The more Dot yells out the answers to the cards the more Liz shuts down, not talking as she hunches up in the backseat. I am trying to cram for the test and play social hostess at the same time. It is my car, and so I feel it is my job to make things pleasant. I tell Dot to stop giving us the answers to the questions right away before we have time to answer, but she keeps doing it.
We stop at Denny’s for something to eat before the test. We have arrived an hour ahead of schedule. The booths are all taken so we sit at the counter, our nerves strung so tight that we can’t figure out how to do this. We are like the Three Stooges: “You sit here. No, you sit here. No, you sit here.” We keep getting up and exchanging stools with each other. The food comes and is borderline inedible. For some insane reason I order chili with beans, a bad choice before a three-hour test where if you go out of the room to use the bathroom you are not allowed back in. I take one bite; it tastes like dog food, so I eat the saltines that come with it and drink a Coke.
We pile back in the car and drive to the center. A group of our classmates have come early. They are the well-heeled contingent from New Canaan. They have actually prepared a tailgate picnic that they are serving from the back of the SUVs. They wave us over. We look like three nervous Third World immigrants. Dot with her purple spiked hairdo and wretched-looking parka, Liz wearing old blue jeans and a sweatshirt. I am wearing a long skirt, a cowboy shirt, and jangly earrings.
None of the tailgaters seems to be worried about the test. They are pouring Perriers and cutting Brie and pâté. They all wear pressed chinos and nice sweaters. They look like a Ralph Lauren ad.
I can’t eat, I also can’t be with Dot another minute, as she is driving me crazy. I go back to the car and open my textbook and spend the next half hour studying by myself. Why is it that nothing seems familiar at all?
The room in which the test is given is a huge auditorium. The proctor sits at a desk in the center and when the several hundred people have all been seated, he goes over the rules. Dot is trying to get my attention from two rows away. In my peripheral vision I see her waving at me. The proctor has just told us if we talk to one another we will be kicked out. I do not move my head an inch. She is calling my name and waving. I do not look. I can feel the Denny’s chili moving around in my gut. I try to remember the names of the parts of the digestive system and draw a blank. The test is handed out. We take out our number 2 pencils and when the proctor says go, we open the test and start. In the huge auditorium we have been seated with empty seats between us, stripped of all purses, books, and study aids when we walked in. We are not even allowed to bring in a cup of coffee. My hands are shaking as I open the test book. We have three hours to complete it. I plan on taking the entire time, going over each question with lapidary precision. I take a deep breath and exhale.
I look at the first question. I have no idea what the answer is. I look at the second question: same thing. My toes curl in my shoes. I look down six more questions, and it is not until number seven that I know an answer. My stomach rumbles so loudly I can hear it. The only thing worse than failing the test would be to fail the test and shit in my pants. I hate Denny’s, why did we eat there?
So I begin by answering the questions that I know, and when they are done, I go to the ones I think I know and answer those. By the third hour I have honed in on the ones I know I don’t know. My memory has come back somewhat once the anxiety has decreased and I remember four of the first seven questions. The brain lock has lifted. By the end there are maybe ten questions to which I am still utterly clueless. I just mark the answer key in a pattern that looks pretty, hoping that graphically I have picked the right answers.
I go back over everything. Then again. I change one or two things. Two hours and 55 minutes into the test there are only six people left in the big room. The other five look really dumb. They are obviously “retreads,” people who have failed the written test before and are back to give it another go. Finally, with a few seconds left on the clock, I get up and leave, handing my paper to one of the proctor’s assistants. I rush to the exit and see Dot waving madly at me. “What took you so long?” she wants to know. I don’t have time to answer. I rush to the ladies’ room. When I reemerge the preppy contingent of the class asks us if we want to go out drinking. To my eternal gratitude Liz and Dot want to go home.
We get in the car. It is 9 P.M. and I am so exhausted I miss the highway entrance. Liz navigates while I drive. She talks in the all-capable voice of a professional pilot. I love her for this. I can hear her at the controls of a commercial jet that has just flipped over in the air. “Folks, looks like we hit a little turbulence,” she would say. I tell her how much I hate flying, and ask her if she ever becomes a commercial jet pilot to promise that if I am on one of her flights she will land the plane and let me out if I have an anxiety attack.
When I finally get on the highway we start to go over the questions from the test. Liz thinks she has answered everything differently than we did. This means one of two things. Either Dot and I have failed and she passed, or the opposite. By the end of the two-hour ride home we hit a freak snow squall. I am crawling down the highway and I can’t see two feet in front of the car. We realize that none of us remembers our answers correctly. We now have to wait six weeks until the National Registry of EMTs gives us (again through the mail) a thumbs-up or -down.
The next six weeks crawl by. I am on the phone almost daily to either Dot or Liz. “Did you get your mail yet?” we ask each other. I find a site on the Internet listing all registered EMTs. I check it every day for my name.
I wait longingly for the mailman. Like waiting for acceptance letters to college, you want to see that big envelope in your mail. The little one with only a letter in it is bad tidings. The big envelope has your EMT certification, your wallet cards, some patches that you sew onto your clothing, and a bunch of pamphlets from various professional organizations that you can now join.
Amazingly, Dot, Liz, and I all get our answers the same day. We have all passed. More than passed—we did exceptionally well. Our scores are broken down into categories, and while I have achieved a generally high score, to my chagrin I have gotten a perfect score, 100 percent, on obstetrics. Ugh. I don’t tell Dot because should the occasion arise I still want her to deliver any and all babies in the back of the ambulance.