Ambulance

ECNALUBMA

                                                A Short Story, somewhat fictional

     The siren wailed in prolonged cry, hurting his eardrums, the winter oaks and maple trees flashing by, reflecting the intermittent white and red “bubblegum” lights from across the top of the roof above him.   It was a moonless night and the emergency lights were visible, Jeffrey imagined, as rays of light streaking out for miles in every direction.  Condos, townhomes and tract houses popped up in square blocks of what used to be forest and hiking trails.  The town’s emergency response system was straining to keep up with the expanding population.

    Stratford’s town ambulance, before the rise in calls for service out in the country, could usually make a roundtrip call in town within fifteen minutes.  These trips to the boondocks up beyond the reservoir would take 20 minutes out and 20 minutes back.  For heart attacks or severe trauma, the minimum time to reach advanced care was, at the least, 40 minutes and, at the most, time didn’t matter because the patient was already brain dead. 

     “How many miles to the turn?” The Chief yelled over the incessant blare.

     “Uh, a little over two.” Jeff used his fingers to guesstimate the distance on the map.

     A dispatch chirp was barely audible under the siren.

     “Mmm… Base to Baker-2.” The town council always hired women with sultry voices for the dispatch crew, tonight’s radio control always began her calls with a tasty hum.  It was distracting, but not so unpleasant that the crews didn’t mind listening to her hum all night long.  The Chief switched off the siren and yelled at Jeff.

     “What are you waiting for, Junior?  Baker-2 won’t answer herself!”

      Jeff picked up the handset and hit the transmit button.

     “This is Baker-2.”  His voice didn’t sound like his own as Jeff felt pumped up on adrenalin and fear.  Beyond the headlights, the road disappeared around corners into darkness.  At 70 miles an hour in an overweighted body box, turns and obstacles would appear too late to do anything, except maybe say the “Oh,”  preceding the “Oh, shit!” which then would precede a terrible crunch.

     “Mmm… What’s your E.T.A.?” The smooth voice asked over the channeled static.

     Jeff looked to his driver, whose eyes were straining to see past the headlights.

     “What’s our E.T.A.?” Jeff asked. The driver had travelled these roads well enough to judge time and distances without a second thought.  Jeff’s driver, trainer and boss was a ten year veteran of the Stratford Ambulance Service; Jeff had graduated from Emergency Medical Training only two months before.  The Chief called him Junior from the moment they met and ever since.  Jeff, knowing he had a wicked passive-aggressive streak, decided to always call him Chief.

     “Dammit, Junior, you just told me we were two miles away.  Figure it out!”

     “Uh, Baker-2 to Base.” Jeff took a deep breath.  “E.T.A. two to five minutes.”

     “Mmm…Ten-four.”

     The Chief switched the siren back to full power.

     “They can hear us coming, they’re just impatient bastards!  Here’s the turn!”

     The ambulance rode heavy on its right tires as it made the turn.  The lights of the condominium complex appeared a short distance away.

     “Baker-2 to Base.”  The Chief drove handling the radio in one hand and the steering wheel in the other.  “We are 10-8 at the Greenwoods Condo.  Confirming building 4, room 208.”

     “Mmm… Base to Baker-2.  Call cancelled.  Caller has refused assistance.” Jeff noted the resonant contralto tones to her immmplied apology.

     “Ten-four.  Baker-2 available, returning to station.”

      The Chief looked at Jeff as he turned off the red lights.  Jeff was sweating and breathing like he had just ran the last two miles to the call.  Sweat had already created a wet ring on the underside of his EMT baseball cap.

     “Take your pulse, Junior.”

     “Take my pulse?”  Jeff asked as he tried to juggle a clipboard with its leashed pen bouncing up and down on its tether.

     “What do you think I said?”

     Jeff reached up to his neck, putting two fingers on his carotid artery while counting against the ticking of his watch.  Before he could finish, The Chief nodded.

     “If you’re above 140, you got a problem.  I give you a month.   If your little heart’s beating above 100 by the time we get to a call, this isn’t the job for you, Junior.”

      Jeff took his fingers off his throat and looked up to the darkness of the road.  The moon was just rising over the Housatonic River to the east making its snaked path glow white in the distance.  It was 8 p.m., his first two hours and his first call.  The E.T.A. to Base was twenty minutes away, unless another call came in to start the drama all over again.

     Jeff really didn’t like The Chief constantly calling him “Junior.”  It didn’t matter that Jeff was wearing a name tag or that his name was on the roster board next to his as crew to his crew-chief or even that he’d been introduced by name by the Chief of Police himself.   If his driver didn’t want to bother to learn his name, Jeff felt that such disrespect could be mutual.

  The Chief had thick, black hair, a thick, shaped mustache and a thick, solid abdomen and a Bronx-Italian accent that lightly shaded his words.  That was until he got pissed-off; then every phrase became Napolitano with words like capiche, agita, and troiaio. Jeff’s grandparents had been Irish and the only Italian words he’d ever learned would get him fired if he ever said them out loud.  Jeff imagined calling him “Godfatha” with Baker-2 his “pizza delivery truck.”  Poking fun at an Italian supervisor would be insubordinate enough to lose his job.  Calling Baker-2, their white and orange box ambulance a ‘delivery truck’ out loud would put him in concrete at the bottom of Long Island Sound. 

     “Mmm…Dispatch to Easy-3.”  Easy-3 was the crew that covered the south side of town: the airport, marshes and beach.

     “Easy-3.” An unfamiliar male voice answered the dispatch base radio.

     “Mmm… Easy-3,” the dispatcher started. “Respond to a Ten-One-One-Five-D, 98 Sea Wall Drive.  Wait for P.D. units, enroute.”

     The Chief motioned to Jeff to pull out the map and threw on the overhead bubblegum lights.

     “How do I get there, Junior?”

     Jeff unfolded the map and began tracing routes toward the beach roads. He held his penlight like a lollipop between his lips, to turn the map around to face south.

     “Head sowf awn Atthes Road…”

     “What was the address?”

     Jeff dropped the light into his lap.

     “Ninety-eight?”

     “Why do we wait for the cops?” The Chief forced the accelerator to the floor.  The river road swung around south until the distant Stratford Light marked the end of the river and the beginning of the sound.  The sea wall ran east to west from the river to the Bridgeport harbor.

     “But, it’s not our call.”

     “Yeah, but it could be, Junior.  Capiche?  You gonna walk in on a 10-15-D?  You gonna send me into a ‘D’ call?”

     “No, Chief.” Jeff said. “No first response on domestic disputes.”  Family fights were always tricky, Jeff’s instructors had warned him.  There was usually drinking involved and most homes had knives, at least one hunting rifle, and a kitchen full of ad hoc weaponry.  If an EMT tried to help a woman hit over the head with a bottle, the husband would hit him over the head with a ten iron and then the woman, given a chance to recover, would finish the job with her choice du joir: a clothes iron, a fry pan, or a bottle of bleach. Nobody, but nobody, interferes in family affairs.

       The Chief reached up and turned off the response lights. “We could be called for back-up and you’d better know what we’re stepping into.  There’s at least another 200 hours of training they didn’t have time to teach you in EMT school.  Let me go over a few before you step in it good.”

     “Do I need to write this down?” 

    “Fare una figura di merda, Junior. See if you can remember these three things.”  The Chief showed Jeff the back of his fingers and began counting.  “One; keep Baker-2 clean and never come into work dirty.  Two; you don’t work for the hospital.  Don’t get roped into taking doctors’ orders.  Just because they’re short-handed doesn’t mean they get to abuse you. Three; always back up your partner and your rig.  You blame either one of us for your incompetence…,” The Chief smiled at Jeff, but it wasn’t the kind of smile that made him want to smile back, “well, it won’t mean anything.  Until anyone else in the service finds out and we are a bunch of boccalone bastards. No one can keep a secret.”

     “What is does ‘fah un figa merda’ mean?”

     “What do you think it means?  It means don’t give me any agita, Junior.  Capiche?”

     “Capeeesha.”  Jeff took a long breath.  It was late, he was tired, and he hated lectures.  Boccalone, he thought. Boccalone my blarney stones.  Jeff looked out the window at the house lights and began to think of all of the town’s residents, unmaking their beds, turning on the 10 o’clock news, if not hitting each other in drunken rages.

     “Mmm… Dispatch to Baker-2.” The radio voice called from somewhere in the glow of the dashboard lights.  A small, red transmit light flashed on and off on the radio handset.

     Jeff grabbed it and uncoiled the black cord away from the receiver.

     “Baker-2.”

     “Mmm…Baker-2, 10-45 4299 Sikorsky Road at West Broad Street.  45 year old male, unresponsive.  Code-3.”

     “Baker-2. 4299 Sikorsky Road, enroute, Code-3.”

     “Mmm… Ten-four.”

     The Chief made a U-turn towards the north side of town, toggling on the siren as he cut across the southbound traffic.”

     “What do you think, Junior?”

     “North on Main, 2 miles, West on West Broad for 3 blocks.”  Jeff had been the best medic in his class and didn’t deserve the diminutive moniker.  He also knew he would have to bear it until he cleared probation.  The Chief hadn’t yet said a word about the title Jeff had given him.

     “An old man has fallen and he can’t get up.  We get a lot of calls for old people who’ve fallen out of bed.  They could have broken a hip or had a heart attack or stroke, but most times it’s just the family doesn’t want to, or can’t, put them back into bed.”

     “Do we put them back in bed?”

     “Probably.  If it’s a resident who makes a habit of it, we can take ‘em to the E.R. for evaluation.  The town council is going to start charging a nuisance tax for false alarms.”

     “Mmm…Baker-2.”

     “Go ahead, dispatch.”  Jeff answered as he watched the cars pull over to the right side of the road in front of them while cross-traffic sped up to make it through their green light.

     “Mmm… Baker-2. The caller states the patient is not breathing.”

     “Ten-four. E.T.A. Five minutes.”

     “Ten-four.”

     The Chief turned onto Sikorsky Road. There were people standing in the road, neighbors frantically waved at them from beneath a streetlight a half-block away.  The Chief turned off the siren and grabbed the handset from Jeff, pointing toward the small, cape-styled house with white-washed shingles.

     “Go ahead and take a primary survey, Junior.  I’ll be right behind you with the O-2 and board.”

     “Ten-four, Chief.”  Jeff grabbed the trauma kit from the patient compartment of Baker-2 while several hands began to grab and pull him towards the house. He could hear The Chief talking to the dispatcher as he turned toward the front gate.

     “Baker-2, On Scene at Sikorsky Road…”

     The neighbors pulled Jeff up the front steps in the dark.  There was no porch light, but there was also no second story to deal with.  An older woman, presumably the wife of the victim, was crying between her hands. Three young boys, all under the age of ten, pointed to a back bedroom.  Jeff paused to look back to Baker-2 before moving down the hallway.

     The room was decorated in an incredibly garish French boudoir design with red drapes and hand-carved, guilded furniture.  In the middle of the king-sized bed, lying on his back, was the victim.  His first real victim.  The man’s beer belly was pale and bloated upward, stretching the elastic on his worn-out briefs.  His face had the look of someone surprised and then frozen, laying there with his eyes wide, his jaw slack with the gold fillings in his teeth peeking out from his gums.

     A-B-C, Jeff thought, as he began his survey.  Airway, Breathing, Circulation.  Easy as 1-2-3.  Climbing onto the bed next to the man, Jeff placed his hands around the unconscious man’s head, tipping it backwards. Nothing moving.  No breathing. No breathing.  Where’s that Chief?  The smell of partially digested marinara drifted up from the man’s gut, but it was not followed, nor was it preceded by, a breath of fresh air.

    The last thing Jeff thought, as he pinched the man’s nose closed and began rescue breathing, was DAMN!  After four quick breaths across the man’s lips, all the while quenching an overwhelming desire to vomit himself all over the room, Jeff pushed his fingers into the fleshy part of the man’s neck.  The man’s neck was thick and muscular; Jeff pushed his fingers deeper, felt in and around the man’s larynx.  There might have been a pulse there, but it was too weak, too slow, or non-existent.

      Damn! Where’s that arrogant ass of a crew chief? Jeff moved the man’s arm out of the way and placed his hands, left over right, between the nipples of his chest.

     The man’s wife and children stood in the doorway and began screaming when Jeff’s shoulders rocked up in down, giving their father cardiac chest compressions. One-and-two-and-three-and-four-and… Jeff counted to himself with each drive of his hands from sternum to spine.

     The Chief entered the room by the time Jeff had counted to ‘and-ten-and.’

     “Merda.”

     Jeff felt a strong hand grab onto his shoulder from behind, pulling him backwards onto his hip and elbows.

     “Roll ‘imp on his side, get the backboard under him.”  The Chief lifted the wooden board flat onto the bed and pushed it under as much of the dead weight as he could.  He turned to the crying kids and flipped his arm in the air.  “You kids go wait for the police.  Go outside!”

     “Daddy didn’t do nothing!  Daddy didn’t do nothing!” The children cried hysterically.    

     The victim’s wife grabbed her children as their faces flooded and grew from pink to red. “Daddy will be fine.  The Lord will watch after him.  The Lord will watch after us.”  The woman’s voice helped to herd the children down the hallway.

     The Chief began compressing the man’s chest as Jeff fumbled through the trauma kit, grabbed a blue plastic airway and face mask.  Jeff slid the airway into the man’s throat, his fingers touching the slimy tongue.  He put a breathing mask over the man’s face.  The Chief stopped his compressions just long enough for Jeff to blow a couple more breaths into the man’s chest before he checked for a pulse again.  Nothing.

     “Keep going, Junior.  Watch for vomit.”

     “What’s going on with his stomach?”

     The sound of a police siren approached until the lights streamed in red through the velvet drapes.  There was the sound of more hysterics from the family outside mixed with the radio chatter of the officers to the police dispatcher.

     The floorboards creaked as the police carried in the stretcher into the house.  Their steel-toed boots clunked down the hallway towards them.  The first officer held a black, hand-held respirator bag in one hand.

     “Bless you.” Jeff grabbed the breathing bag and attached it to the mask and then squeezed air into the victim.

     The second police officer called into his radio.  “Notify St.V’s, Baker-2’s bringing in a full arrest.”  The officer looked to The Chief.

     “What’s with the stomach?  Looks like he’s ready to give birth.”

     “I noticed that.”  Jeff said.

      By the time Baker-2 pulled into the emergency entrance of St. Vincent’s Hospital, the man looked like an adult version of the starving African children in the “Adopt A Child” advertisements.  His lower abdomen had extended so far out that Jeff knew his compressions were not going to keep the man alive.  The hospital’s staff of nurses and residents helped to pull the backboard off Baker-2’s stretcher onto a gurney.  A respiratory therapist took the ambu-bag away from the police officer and hooked up a respirator.  Jeff kept pace with compressions as the entire crew walked the gurney into a code-blue room, swarming like bees over a queen.

      The therapist yelled at Jeff.  “Count it out!”

     “One-One Thousand-Two-Two Thousand-Three…” Jeff compressed as the therapist forced an intubation tube down into the man’s trachea.  The on-call resident looked at the cardiac rhythm and ordered epinephrine and blood gasses before he placed his stethoscope on the man’s abdomen.

     “Four-Four Thousand-Five…” Jeff stopped and held his hands up, pausing while the intern listened to different areas on the patient’s chest.

     “Keep going!” The intern yelled and continued to bark orders that sounded like a chemistry test to Jeff’s untrained ears.

     “One-One Thousand, Two-Two Thousand...,” Jeff cringed as he heard a hollow ‘pop’ under his hands.  The ribs began to break under the strain of repetitive compressions.

     “Stop compressions!”  The intern yelled at Jeff.  He looked up at the EKG monitor.  “No rhythm.” The intern looked over his shoulder and pulled off the EKG tracing.  “That’s it.  This man was dead before he got here, this was an exercise in futility.  Someone give me the time.”

     Jeff walked out of the emergency room.  This wasn’t what he expected, not on his first day, not on his first call.  The Chief was at the entrance, washing his hands in a large sink just inside the entrance doors. 

     “What was the second thing I asked you to remember tonight, Junior?”

      Jeff didn’t say anything. He pumped iodine soap into the palm of his hand.

     The Chief didn’t wait more than a second for a response.

     “Do not allow the E.R. staff to take advantage of you!”

     “I can’t walk away when I’m pumping a man’s heart, Chief?  Capes?”

     “Yeah, you can.  They’ll find someone else. Even the housekeeping staff can do C.P.R., Junior.”

     “Right, Chief.  I’ll remember, next time.”

     The Chief slicked back his hair and re-planted his EMS hat on his head.  He picked up the radio from his belt.

     “Baker-2 to Dispatch.”

     “Mmm… Go ahead, Baker-2.”

     “We are back in service, requesting a 10-5 stop.”

     “Mmm… 10-5 to the pumps; mmm… Ten-four, Baker-2.”

     The Chief handed Jeff the clipboard with the carbon paper triplicate forms, most of the information blank, the only line filled in completely was the Chief’s signature, which was illegible.  The Chief patted Jeff on the shoulder.

     “You survived your first call, Junior.” 

     “Yeah.” Jeff said.

     “Too bad your patient didn’t.”

    The Stratford Police station had been built in 1968 next to Longbrook Pond, where kids fished in the spring, summer, and fall and ice-skated in the winter.  The two story building was faced with gray concrete and red brick, but it felt less ‘station’ and more ‘facility.’ The Baker-2 Emergency Medical crew was quartered in the basement and, as box-styled ambulances generally ran about 5 miles per gallon, re-fueling at the station was a regular shift activity. 

     While The Chief was watching the gallon meter rise on the pump outside, Jeff sat in the front seat and tried to get the taste of soured marinara out of his mouth by sucking on some wintergreen candy.

     Jeff heard the pump click and stop, click and stop and, after a few minutes, The Chief returned to the driver’s seat and put Baker-2 into gear. The moon was high overhead when they pulled out onto Barnum Boulevard.  Jeff watched his reflection as Baker-2 rolled pass the big glass windows of the car dealerships at the turn onto Main Street.  They continued on by the fire department, the town hall and, after the Methodist Church, the old police station.  It was two stories tall with a red brick and grey concrete façade like its successor; it had been built by FDR’s Work Projects Administration during the Depression but it had since been turned into a Social Services office after the Longbrook Station opened.  Jeff was nine-years-old at the time and had gone for counseling there.  He remembered that he could still smell the place where the old jail had been. 

     The Chief hadn’t said anything again since the re-fuel, except to call to the matronly voice on the dispatch radio to tell her Baker-2 was, again, available for service.

     “Were you saying I did something wrong?” Jeff said, his breathe visible as steam, waiting for the heater to warm up.

     “C.P.R. 101, Junior.  Do you ever begin compressions with the patient on a bed? 

     “I didn’t feel I could wait, I didn’t feel his pulse, I knew…”

     “Either move him to the floor,” The Chief cut him off, “or wait for the backboard.  Here’s ‘four’ and ‘five’ of the things they don’t teach you in EMT school.  Four; respirations without oxygen is like pissing in the wind and, Five; if you do mouth-to-mouth, expect to get mouth-to-vomit by the fifth breath, e che fare i gattini.” The Chief reached to his belt and pulled out a pocket CPR mask. “Like my father told me, always carry protection. You got lucky, this time, Junior.”

     “Not lucky enough, Chief.”

     The Chief swung Baker-2 into the parking lot of the Dunkin’ Donuts, the only business open all night. He picked up the clipboard and read Jeff’s report.  “Mr. Creosote, Sikorsky Road to Saint Vincent Hospital. Cardiac arrest?”

     “Yeah.”

     “Listen to me, Junior. Mr. Creosote had an aneurysm that popped like a weasel in his belly, probably right after he finished his evening bowl of spaghetti-os.  With every count you pushed,” The Chief put his hands together and pushed them down into the ghost of Mr. Creosote, “another pint squished out of his heart and into his gut.  You learn to figure these things out.  Ready for some coffee?”

     “I don’t drink coffee.”

     The Chief looked at Jeff’s face and shook his head.

     “Not yet, Junior.  This is just your first night.”

    Jeff waited inside Baker-2, enjoying the warmth inside once the heater kicked in, while the Chief went inside to grab a few doughnuts and yak with the cops working on their reports.  Jeff listened to the dispatcher humming calls to Easy-3 on the south side.  Able-1 was off until 7 a.m., that unit’s night shift was cut out of the budget this year.  

     “You know, I used to be a town cop before there was an EMS.” The Chief said in between sips of hot coffee when he returned.  The Chief moved Baker-2 to the parking lot behind the high school, waiting for the next call to come in.

     Jeff put his head back and closed his eyes.  He heard the last Metro North train pass over the viaduct by Stratford Center, headed to New Haven, on time for its one-thirty a.m. arrival. 

     “I worked for five years on the force,” The Chief said, his voice only lightly tinged by the Bronx inflection, “and if there was an emergency, you just wrapped up the guy in a blanket, threw him in back of the station wagon and flew like a bat out of hell to the nearest E.R.  Sometimes we had a doc on call, but by the time he arrived, it was usually to pronounce the guy dead.”  The Chief drank a mouthful of the black coffee, his lips smiled as he pulled the cup away, the warmth steaming up in ghost-like spirals.

     Jeff remembered those old town police cars.  They were green, back in the early 1960’s, when the old police station on Main was the only police station.  He remembered those green wagons with the one revolving red light on their roof.  Its siren sounded like a 50 foot long snorkel truck blasting through the town.  Those station wagons were the only cars on the road, besides the big plows, when it snowed, and it snowed a lot in 1964. 

     There was about a foot of snow on the ground when the green station wagon had pulled up to his house, and the policemen, in their long, black coats and black boots  stepped across the living room, walking over his  Dr. Suess books that had scattered over the floor.  Grey slush had caked in the crevices of those big boots and left a permanent imprint over the faces of the Horton and The Grinch .  The cops carried his father down the steps and slid him into the back of the green station wagon.  His mother was sobbing.  He remembered his own voice as he gasped for breath, how he had cried until he had wailed.

    “And don’t you forget, we don’t ever pronounce anyone dead.” The Chief sipped down some more coffee and continued.  “You don’t even write that he’s D.O.A.  You transport and write on the trip sheet it was to ‘rule-out death.’  Got it, Junior?”

     “Capiche, Chief.” Jeff leaned his head against the cold window and let his muscles relax a little.  He listened to the pulse from his heart.

     “Mmm… Baker-2?” He heard the call.