Notes From A San Francisco Paramedic

by Sebastian Gonzales, February 11, 2011

December — It had been raining all day. I was working with a new medic, which always requires a little more energy. We were on our way to a non-emergent call that sounded like bullshit when we heard another call go out much closer to us. We radioed our location and were redirected. It was a street resuscitation at a downtown intersection; an engine had been dispatched as well and was already on scene when we arrived. We jumped out and unloaded the gurney and gear. I glanced over at the doorway — it was a shitty looking hotel that people die in all the time; I guess it’s an inevitable terminus for some, they had lost their jobs, the house, then their families — the last stop before the end.

We pulled the gurney into the miniscule, stale smelling lobby and took the bags up on foot (remember, I don’t like small elevators). The room was on the fourth floor. I hadn’t been working out very much lately because of school and I could feel it going up the stairs; still I always prefer stairs to elevators.

At the fourth floor landing were two women; both looked to be in their 30’s. One was crying as I passed by — family, the sister — I thought. As we got closer to the room, the smell hit me. I slowed down. At the entrance the smell was really strong. Several firefighters emerged, one gave a quick shake with his head and handed my partner a strip (an EKG strip to verify death) “He’s dead, there’s rigor, pooling, looks natural.” We thanked them and entered.

“Oh, yeah, he’s good and dead,” I said quietly to my partner. It was a tiny, fetid room with a bed in the corner which looked surprisingly new, but there was crap all over it — empty bottles of cheap vodka, newspapers, crushed cigarette packs, and black pebbles which we both agreed were rat shit; there weren’t any sheets. In the other corner was a vomit-filled sink, which added to the smell of dead tissue. The faded carpet was stained. The dresser was covered with more empty bottles and what looked like cocaine.

On the floor between the bed and dresser in a fetal position was a white male who looked about 50, his pale, bluish face had some kind of rash; his mouth was gaping open as if he had died in a scream. His rigid arms were drawn up close to his bare chest; he was wearing only a dirty pair of pants. He was quite thin and malnourished looking, He was facing away from us so we had to lean over him to see all this, and at that angle the smell was much worse.

My partner was new and had never done a DOA before and I could tell he was trying to keep his composure, making note of things he was seeing, or not seeing. He now had to call the medical examiner, identify himself and give a brief report — he is then given an ME’s ETA to us. I helped my partner with all of this. By now SFPD arrived — one officer with short grey hair and blue eyes. We filled him in; after that I started to bring all our bags back down to the rig. I passed the sister again at the top of the stairs; I introduced myself briefly and told her I’d be right back to talk with her. She nodded, still crying.

Returning from the rig I climbed stairs yet again and was now with the sister to get some info. Her crying subsided a bit as we spoke. When I talk to people in these situations, I try hard to show respect and honesty without being patronizing. I told her first of all that I was very sorry for her loss. This is hard for us too, because often we come off sounding insincere — how could a total stranger be sorry for the death of my sibling? Well, we can. I was sorry, that’s not to say that I’m always sorry on a personal level — sometimes dying is the most merciful thing that could happen to a person. When a beloved dog has aged and become sick with cancer, and we know that he will never get better, and that all that is in front of him is pain and suffering, what is it that comes to mind in our society of decent thinking people? It is the decision to do the most humane thing — to put the dog out of his misery — and everyone would agree with that.

But what of humans? Why is it we can’t apply that same rationale and ethics to ourselves? Some of the most grotesque and horrible deaths I’ve seen could have been avoided if we could only rise above this inflated sense of morality, which deludes our judgment, narrows our thinking, and prevents us from doing the right thing. I guess we don’t have the rights of a dog — no offense to animals, but they seem to be better off in this respect. Maybe it’s the belief that human life is more valuable than an animal’s and we can’t just go around putting people to sleep — that just wouldn’t do — so we’ve made it illegal to kill yourself, because everyone’s life is precious.

Yes, all life is precious. I’m hard at work to preserve it everyday I’m out there, but this dilemma isn’t so black and white. There are those whose lives have deteriorated to primitive levels of existence, who are no longer living, but merely existing, waiting to die and some, I’m sure, wanting to die.

Maybe life is precious to a point, but when someone is living in hellish physical conditions, in his own excrement, addicted to drugs, whose mind, body and spirit has become numb with pain and suffering with no end in sight — wouldn’t this be the time to consider doing the humane thing? Of course this should be considered only after doing everything possible to help these individuals improve their lives, to change all that. I have witnessed some people are simply beyond help — once you’ve given up on yourself, then the walls of the world are not far to fall in on you. This is what we must concede — save those who are salvageable — but then who is to decide who is salvageable?

From where I sit, which is in an ambulance, it isn’t that hard to see the answer to that. Am I saying that we must eventually give up on people? Yes, I am. We can’t save everyone. I wish I could tell you that we could, but we can’t. When I say save I’m not talking about the heart we just shocked back to life, I’m talking about the person who, for years, has abused himself, refused care, and now calls 911 everyday because he’s dying, slowly and painfully, by his own hand.

I learned from the sister that her brother was only 33. Jesus, he really did look 50; he had a history of bipolar disorder, alcoholism, and some surgeries that may have contributed to his death. I got some information for our report, tried to console the woman and then went back into the room to get my partner.

We went back down to the rig; it was raining even harder now. Sitting there while my partner wrote his report, I could taste the dead guy; it’s such a potent stench that it permeates your mucus membranes and you can smell and taste it for an hour or so afterwards. I got quiet, just thinking — maybe they remember us, we are the last people with them before they go, or immediately after, maybe they’d thank us if they could — for trying — I’d like to think so. Maybe they follow us around on our days off as we’re getting coffee or reading a book...

Often, after a call like this one, what comes to mind is the eternal question: what is the meaning of life? To ask this question can imply there is one single answer — that some higher power has predetermined why we’re here, and I just can’t buy that.

We simply exist, and life has what meaning we give to it; each day, each moment, whether good or bad, in bliss or despair, there is the potential for it all to mean something. Life’s what you make it — that’s what we should be thinking about each day, and if you can mold it into something special — that meaningful existence — then you’ve answered the question.

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