People ask me if I still work the road, and many are surprised when I say I still do, qualifying it with “just one day a week.” They shake their heads and smile and say, “good for you!”
While I do generally work one day a week, I didn’t work at all in July due to a combination of family emergencies, sports trips with my daughter, and a nagging knee issue that forced me to see a doctor who told me at my age 66, she saw no need for surgery. I likely had tears in my knee at my age. Most people do, she said. And of course I had some arthritis. Her best advice to me was “yoga should be my new best friend.” The visit reminded me of the words of the occupational health doctor who told me my back was past its expiration date. That was five or six years ago, after I was thrown hard in the back of the ambulance ( I was sitting over the back wheel when my partner hit a vicious bump and I was thrown up and then hard down in a rig that seemed to have no shock absorbers. I envisioned the chassis not connected to the wheels. For the first and only time in my thirty plus eme year career, I was out on comp — a horribly boring experience that thankfully lasted only two weeks.
My long stated goal is to work until I am 72 when my daughter will graduate from college, but I am not certain I will make it. A couple weeks ago, I pulled a muscle in my back stupidly trying to lift a couch from a bad angle. I was able to work, but only because of my firm belief in the never strand your partner code. The day I worked, I had to slowly straighten up each time I got out of the ambulance. Thank goodness for the heated seats that I kept warming my back even though it was a hottish day. Both my back and knee were feeling better this last Friday when we got a call for a sick person at an apartment building. As we drove up my partner suggested we drive behind the building where there was stretcher access to the elevator. I told her I had never been to the back entrance but it seemed everytime I had been to this particular apartment building, the elevator was out of order. I told her a long ago story of being called for a patient with neck and back pain post MVA. The call was on the 5th floor. The patient had walked up the stairs to his apartment after the accident and gotten into bed. Now, he couldn’t move. We carried the man on a backboard down all five floors, and in this high ceilinged building, there were two flights of stairs for each floor. That had also been on a hot summer day. Sure enough, when we brought the stretcher in on the basement floor, the elevator was broken. Walking up all those flights of stairs, carrying my equipment, I went at a slow but steady pace with my hand on the rail for support, glad that the call hadn’t been for a cardiac arrest or a baby choking. Turns out the call was a refusal for a person having an anxiety attack. I ended up having to walk all the way back down to the ambulance to get the laptop computer so we could take the refusal, and then walk all the way back up to get the signature, and then all the way back down again. My partner volunteered to be the one to get the computer, but I wanted to prove to myself I could still hold my own. No special favors for me. Walking that many stairs provided time for reflection. How much longer am I going to do this? How much longer can I do this? When will I know my time has come? Do I quit while I still can or do I work until I know I can no longer do it? Till I embarrass myself?
Later that day we were called for a fall in the bathroom. The house was a split level. Split levels are also almost always stair chair-carry downs due to the layout. We walked up the stairs and down the hall to the bathroom to find a man wedged between the toilet and the bathtub. He was naked and on the large size. Like almost 300 pounds large. I said hello and started assessing him, but in my head I’m thinking, how am I going to get the guy up? In my younger days, when I was not only younger but lifting heavy weights regularly, it was never a concern. Brute strength took much of the thinking out of it. I tried to get behind the man and said I was going to put my arms under each of his shoulders, and while holding his forearms tight to his body, drive my legs up and get him to his feet. My partner shook her head. You’ll hurt yourself. She was right, of course. I let her direct the lift, incorporating the police officer on scene to help us safely lift the patient up, with one of us under each arm and the cop holding the stair chair and using his feet to keep the patient from slipping forward. I think the copy had probably been an EMT once as he was very helpful.
My partner and I had a conversation later. I reflected that I was glad neither of the calls I mentioned were critical. Only working once a week, I worry that my skills are getting rusty and I wonder how I will perform when not only is the scene difficult but the patient is critical. I am fortunate that my full time job as an EMS coordinator keeps me up to date with protocols and constant contact with scenarios. Still I sometimes find myself consulting my protocol cheat sheet on calls to make certain I am following them correctly. Protocol dictates I consult my protocols, I say if I sense my patient is wondering if I know what I am doing as I consult my phone on the scene. One of my coworkers told a new paramedic that I had forgotten more than he knew about ems. I worry I have forgotten too much. Sometimes, particularly when protocols have changed so much over the years, I struggle to recall what the latest changes are. For a rapid afib, the drug is cardizem. The first dose used to be 0.25 mg per kilogram. Now it is simply 10 mg. I thought so. I just wanted to check. “You’ve still got it,” my partner says after the call. The patient we responded to with a heart rate of 177 with chest pain and a weak pulse, arrives at the hospital with a pulse of 80 and feeling fine. Fixed him. I like calls like that. I will miss them when I stop this work. I will miss the life. Being a paramedic.
I know several medics who have quit in recent years. Two expressed to me that the longer they stayed on the job the more worried they were worried they would make a mistake. Seasoned medics had lost their confidence. Good medics. I can understand that. Years of calls can after time erode the six feet tall and bulletproof bravado of more youthful providers. You start to have more in common with your patients than your partners. Some people announce their retirement months in advance, some get sick and never come back, some just quit, leaving their uniform shirt on the supervisor’s desk, the thought of doing another call unbearable; their body or mind or both — broken.
I know medics who have quietly quit out of the blue, the shit they have seen finally taking them down. You can put all those bad memories in a little box and put that box on a shelf, but sometimes that box gets opened and the ghosts all come out and for some there is no putting them back. The medic sits alone in his apartment, or if he is lucky on a back porch where the birds can watch him, drinking coffee, smoking cigarettes, no longer able to sleep without pills or alcohol. For some a lifetime of work with not much tangible to show (divorced, kids grown, house where you use to cut the grass long gone. Now just an apartment with bad light. 30 years with no retirement, couldn’t afford the 401K or just didn’t know better to contribute. Social security not much when you retire at 62. No longer a paramedic patch on one shoulder and an American flag on the other. No band of brothers to shoot the shit with. Only creaky joints, a chronic cough, and not even energy to keep the house clean anymore till one of us finds them dead on the floor. Stress, cancer, organ failure, mental illness. “He was a medic. He worked for us before you started here,” a new partner is told. Not much conversation in the ambulance for a while after that.