A Day in the Life: Notes From a San Francisco Paramedic

by Sebastian Gonzales, March 17, 2010

I am remembering now a call of a few months ago. Some calls linger in my mind while others fade away gradually. It’s random, but this one I remember well. It was the first call of the day — no time for coffee — it was for shortness of breath, but on the way it turned into a code (heart attack, no pulse, no breath­ing). Dispatch informed us as we made our way to the location that CPR was in progress. It was way up on a hill downtown, a tall old apartment building that houses the old money. No one is exempt from pain, loss, from death; it crosses all lines, boundaries, classes. All patients have a common thread; they are all ill or injured and are in need of help, from the filthy homeless man in the gutter to the wealthiest in the tallest condo, they are all equal to me.

Arriving at the apartment building my adrenaline was pumping; these are the moments when someone’s life may be in your hands, figuratively and physically. We passed a large half-circle driveway in front as we wheeled into the lobby where a black doorman in a green jacket greeted us. “This way please, elevator’s right here,” he said hastily. My fear of small spaces has flared up; in the elevator I had to try to keep cool. It seemed to take a long time to reach the floor — God I hate this affliction; it’s all in the mind isn’t it? But knowing that doesn’t really help, does it?

The doors opened and I exhaled in relief. I don’t talk about it to my co-workers; I don’t want to trou­ble them with it. I just want to do my job like every­one else. We’re out of the elevator and into a long hallway — low red carpets, scent of Pine Sol. We found the apartment. Fire usually leaves the door ajar so we can get in, it was half open, we took all our bags, monitor and O2 and left the gurney in the hall.

It was quiet as we entered. There was a short hall­way that opened up to a large living room with an amazing view of the Bay. I heard muffled sounds from a room off to my left. “Hello,” I called. “In here,” a voice responded sharply. We walked into the bed­room and found the patient on the floor next to the bed with four firefighters — one doing CPR, another at the head, ventilating, a third pulling supplies out of a bag, the fourth was a female fire captain — they respond to all the really bad calls to oversee and help; they’re mostly veteran medics with years in the field.

The first thing that struck me was how quiet it was. I could hear the sounds from the firefighter pushing on the patient’s chest and the soft *whooshing* of air moving through the BVM; no one was talking. I asked how long CPR had been going for and what the rhythm was. The fireman at the head answered both questions. The patient was in her late 60s, early 70s, lying there. She was wearing a white nightgown that matched her long white hair, eyes staring, but not seeing. At the foot of the bed stood her husband, about the same age, wearing white flan­nel pajamas, his hands clenched in fists by his sides, trembling and crying uncontrollably. He called her name and begged her to fight, his voice cracking as he did.

I knelt down on the soft white carpet by the woman’s feet and began to work. We needed an IV, the other medic had already tried and missed in her arm. I tried the foot where I often go when there’s nothing in the arms; there were no good veins there either. I did get some blood for a sugar check, it was low. The captain pulled out her IO kit (intraoseous means into the bone, medicine and fluid can be given this way just like an IV, it’s a small electric drill that accesses the bone, then tubing is connected for meds and fluid) and prepared the drill, she placed it against the woman’s shin bone and began to drill. It was quick, she was in. I handed her the IV bag tubing and she connected it. “Run it,” the captain said to me. It was good.

We began to give medicine, epinephrine, atropine, D50 and others. All this time CPR had not stopped, the firefighters were taking turns as it does get tiring. “She’s not going to make it, is she?” the husband said, sobbing. I rose and stepped over to him, “We’re doing everything we can right now, sir. Why don’t you sit down, ok?” I motioned to a chair on the other side of the bed. I don’t know why I didn’t have him taken out of the room. I knew she was going to die, and I sensed he didn’t want to leave her. It was brutally painful. Normally I remove all family members from the room in a call like this. Having that emotional element pre­sent makes it harder for us to work, in fact, he was the hardest part of this call.

We did all we could, but the outcome was inevita­ble. I thanked the firefighters for their help as they packed up their bags to leave. The captain had gone into the living room with the husband; a policeman had arrived and was also with them. I stood for a moment over the dead woman, her eyes still open, the tube protruding from her mouth, electrodes still stuck to her chest. Death has an ugliness that is universal, and all that we do to save people sometimes adds to that ugliness. I covered her with a sheet. It’s hard sometimes for me not to think, in these moments, that someday it might be my wife lying there. I can still hear that poor man crying to this day, his voice rattles in my head, filled with overwhelming loss.

After we consoled him, the captain asked about their lives together, children, where they had lived. He talked about his wife as if she were away visiting relatives, She was very careful in her choice of words. “It sounds like you had a good life together.” The man agreed, still weeping. Fifty years of marriage, children and grandchildren. We asked about photos on the mantel. “Is this you?” “Is that your wife there? She was beautiful!”

“Yes, she was.”

We encouraged him to take care of himself now, she would want him to. The police officer was very good with him; he spoke in a pleasant and honest tone, reassuring him. I was impressed with his people skills. We (police, medics, MDs) all play the role of social worker, it’s part of the job. I pride myself on this — communicating with others in the worst moments of their lives. It has an importance as great as bandaging a wound.

After the Medical Examiner arrived I said my good-bye to the bereft husband. “Take care of your­self, sir.” I shook his hand. What else could I say? Sometimes there’s nothing to say.

I often feel that I am somehow exempt from experi­encing all the terrible events I see happen to others, that I am not subject to the same sufferings and hardships as those I help. I intervene, I often make better of a bad situation and walk away unscathed, untouchable. Of course this is just an illu­sion, and all this makes me appreciate all that I have every day of my life because I know that someday someone will be placing that hand on my shoulder for some terrible loss of my own that I cannot yet see.

This man has been me, and someday I will be him.

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