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Life, Death and Everything In Between

“Suction,” I say calmly. “Press harder, too. More to the left. No, your left. His right.”

Obligingly, my partner applies more pressure to the teenager’s thyroid cartilage with one hand while wielding the suction catheter with the other. The vocal cords wink into view, still partially veiled by saliva and blood.

The steady hum of the suction unit, punctuated by obscene slurping sounds, gradually draws back the veil, the frothy effluvium marching inexorably through the clear tubing like a strawberry daiquiri through a crazy straw, only to disappear somewhere into a canister sheathed in Cordura and Velcro, sitting on the pavement by my left elbow. The cords wink again, and I deftly slide the tube home.

“Breath sounds,” I order again, ducking my head as my partner snags the stethoscope draped over my shoulders. I attach the bag-mask and squeeze in a few breaths as my partner listens carefully, eyes screwed shut as he strains to hear over the crowd noise and traffic.

Why do people close their eyes when they’re straining to listen? Same reason we turn down the radio volume when we’re looking for an address, I suppose.

“Equal on both sides,” he confirms as I painfully rise to my knees and contemplate the gravel imbedded in my elbows and forearms.

“Do me a favor,” I sigh, still grasping the tube delicately between my right index finger and thumb, the rest of my fingers curling around the victim’s cheek. “Slap on a tube restraint and hook up the capnograph adaptor for me, would you?” I rock back onto my heels and my back threatens to spasm.

“Don’ know, man…” our victim’s buddy is saying behind us, one hand pressing his Motorola Razor to his ear, “…dude fucked up…just fell out, having a fit…the ambulance drivers be wit’ him right now…”

Ambulance drivers.

My partner and I share a baleful look as our concerned spectator narrates the unfolding events to his friend on the phone. He lowers the stretcher as I eavesdrop on the conversation with one ear, hoping to hear some useful details. He hasn’t exactly been forthcoming with information. All we know is that was kickin’ it with his homeboy, and Dude just fell out. Being a true friend, he immediately called 911, but not before kicking Dude out the passenger door of his ride, lest he spew bloody vomit all over the velour seats.

He doesn’t know Dude’s medical history. He doesn’t know how much Dude has had to drink. He doesn’t recall if Dude had injured himself somehow before he had the seizure. And he sure as hell isn’t going to tell us if Dude has been taking any drugs.

Not that it matters anyway. Two milligrams of Narcan haven’t restored Dude’s breathing, and his heart rate is still dangerously low. Whatever illicit substances he may have coursing through his veins, there are more than just opiates present.

Or hell, there may not even be any drugs at all. For that matter, his name may not even be Dude. We’ve been working feverishly on this man for six minutes, and we know nothing more about him than when we climbed out of the rig.

We do know that his homeboy, the spectator, is obviously qualified to be an EMS supervisor. He’s even well versed in scene times and Unit Hour Utilization.

“Yo cuz,” he glares at me belligerently. “Fuck you waitin’ for? Git yo ass movin’! Load him up an’ take his ass to da hospital! Thass my boy, cuz!” To emphasize his point, he prods me rudely with a toe and clenches his fists menacingly.

Yep, definitely supervisor material.

Resignedly, I look to my partner. He has already hung the cardiac monitor on the stretcher rail, and the IV bag on its telescoping pole. He’s holding the kid’s heels, waiting patiently for me. I detach the bag-mask from the tube and struggle to my feet, ignoring the protests of my aching knees. I squat and snake my arms under Dude’s shoulders, and nod to my partner that I’m ready to lift.

“Remind me,” I groan as we struggle to move his two hundred pounds of dead weight safely onto the stretcher, “why the hell do we do this, again?”

**********

Calls like that are a dime a dozen when you work on an ambulance. I’ve run so many of them that the details have tangled themselves into a morass of vague memories; sweat pouring into my eyes, the fetid stench of alcohol-laden breath, faces of bystanders, patients and partners, my aching knees, vomit and blood on my forearms, disembodied voices in white lab coats, the judgment heavy in their tone, wondering, “why didn’t the EMTs…”

Even in the days when I worked in an ER, in a nicer environment and for better pay, I missed the rig. The crews would come in wrestling with a combative drunk, or desperately pumping the chest of an old man in cardiac arrest, or struggling to keep the guy with the head injury safely restrained on the spine board, and everyone there clucked sympathetically at their disheveled appearances, the sweat rings on their collars and armpits, the grit on their elbows and knees, and the mud caking their boots. They’d say, “Man, I’m glad I don’t have your job.”

Me, I’d be taking their report and starting my assessment, all the while thinking, “Damn, I wish I’d been there.”

At some point in our careers, every EMT has asked himself the same question. It’s all too obvious that EMS does not love us nearly as much as we love it. Even now, as I type this sitting in an air-conditioned room, ensconced in a comfortable chair, my 41-year-old body still recuperating from sitting in a cramped ambulance cab all night with only the crackle of the radio to break the monotony, I still can’t say that I’d rather be doing something else. The hours are long, the pay is low, and the pressures are enormous. So why do we continue to do it?

We have a tough job. It has often been said that EMS is more of a calling than a career; where many of us work for absurdly low pay – those of us who don’t already donate their time as volunteers – with little prospect of retirement. The average career expectancy for an EMT is five years.

Five years.

Those that don’t move on to nursing or PA school will leave EMS with a career-ending back injury, or leave EMS healthy but not whole; jaded and cynical, their idealism burned away in the furnace-like reality of our profession, their faith in the innate goodness of man gone like so much ash and smoke up the chimney.

Those that stay, soldier on in a profession where the Bureau of Labor Statistics notes that, among all professions, the only ones paid lower than EMT-Basics are dishwashers, meat packers and preschool teachers. A profession whose divorce, suicide, and substance abuse rates soar far higher than the average population. A profession where line-of-duty death statistics are comparable to firemen and police officers – and more than twice the national average for all workers.

We do it despite the system abuse by patients who don’t know any better  and condescension by nurses and doctors who should, sacrificed by administrators on the altar of System Status Management; our training and skills reduced to an expendable commodity, an afterthought to the worship of Unit Hour Utilization.

We sift through broken glass and twisted metal, wade through piss and shit and vomit, weather heaping torrents of verbal abuse from the people we’re trying to help, all for the prospect of a few dollars on payday, and perhaps…just perhaps…a show of gratitude now and again.

Where’s our invitation to the damned birthday party? Where are our party hats and hugs from the grateful families? Haven’t these people ever watched an episode of Rescue 911? I mean, Captain Kirk himself promised us grateful patients who would shower us with praise and confetti!

After more than seventeen years in EMS, I’m still waiting.

And you know, that was the promise. For most of us, that was the expectation when we got into EMS; that we would be saving lives, and that people would be grateful for the effort. I got into EMS for much the same reason as anyone else. I wanted to help people, and the work seemed exciting, Honestly, who among us wasn’t a sparky little adrenaline junkie when they first hit the streets?

What’s that? You mean there’s a job that lets me ignore the speed limit, run through red lights, go the wrong way down one-way streets, and other motorists are required to get out of my way? I get half-price discounts at all the local burger joints, I get to save a life at least once a shift, and I actually get paid to do it? COOL! Where do I sign up?

When you’re young and idealistic, the romance and thrill of EMS is powerful. Plus, there’s a decent chance it might even get you laid. What’s not to like?

Our instructors gave us the knowledge, drilled us ceaselessly on the skills, hounded us mercilessly until we could do them in our sleep, and the carrot they always dangled before our noses was, “Pay attention. This may save someone’s life one day.”

Well, that and the prospect of getting laid.

I believe that there are two basic types of EMT school graduates. There are the kind that are scared of their own shadow and pray that they don’t get a bad call…and then there are the other ones; the ones that are itching to save lives and stamp out disease and pestilence, if only someone would have the freakin’ common courtesy to drop dead in their response district.

I was the second type.

I was dashing. I was heroic. I was a lifesaver. Most importantly, I looked hawt in a mock turtleneck and a Topps EMS jumpsuit.

I just wasn’t running those lifesaving calls like I was promised. Instead, I ran dialysis transfers. Toothaches at 3:00 am. Colds and runny noses. Even the car wrecks were more about insurance settlement checks than actual injuries.

And it also seemed like the only hot chicks who really dug seeing me were the febrile little old ladies at the nursing home. It had become painfully clear that my dream job in EMS was not going to be the constant stream of adventure and excitement that I had been promised. Indeed, it began to look rather dreary.

I considered my talents wasted on nursing home transfers. To squander skills as sublime as mine on something as mundane as a routine dialysis trip was on a par with painting a mustache on the Mona Lisa. I felt like Secretariat being asked to pull a plow.

And then I met Frankie.

I’ve come to believe that every EMT carries his own personal cemetery with him, and the stones there are engraved with the names and faces of the people you failed. Perhaps it’s my own particular curse that all the patients I’ve helped over the years have faded into a vague tapestry of diagnoses and names half-remembered. Most of the calls where everything went right, well…those just don’t tend to stand out.

But you never forget the first patient you killed.

Frankie was that guy for me. I remember his name and his face. I even remember his birthday. You see, it was on his birthday when our paths crossed. Since that day, he pays me a visit now and then, just to remind me that I’m fallible. I make mistakes.

I was called to transfer him from our community hospital ER to the big regional medical center, after he’d caught a stray bullet in the belly during a drive-by shooting. Or maybe the bullet wasn’t stray at all. Perhaps someone was aiming specifically at Frankie; you never learn the whys and wherefores of such things.

I knew who he was, of course. Everyone did. I had played against him in high school football. He was a hulking beast of a linebacker on the field, and a pussycat everywhere else. He was not the kind of kid you’d imagine having many enemies.

But none of that was in my mind when we met over that ER bed at 3:00 am. What was in my mind was sleep. I wanted to be back in bed, and instead I was up at oh-dawn-hundred running another damned transfer after a day full of them, out of my damned response district, while the damned crew that should have been handling the transfer was sleeping soundly in their damned beds. Damn it.

And so it was with barely-concealed disinterest that I took the nurse’s report as I transferred Frankie to my stretcher:

Blah, blah…BP 100/52…blah, blah…two IVs, good for you…blah, blah, blah…oxygen at two liters, yeah you people think oxygen is a poisonous gas…blah, blah…combative, huh? Well, can’t blame him. I wouldn’t be happy about being in this fucking Band-Aid station either…blah, blah, blah…restrained on a long board…blah, blah…yeah, you too. Thank you for calling the big white taxi.

It wasn’t long into the trip before Frankie crashed. He vomited blood in such amounts that the suction unit couldn’t keep up with it. He was too heavy for me to turn onto his side – not and keep suctioning – and his blood pressure bottomed out. The IV lines started in the hospital were far too small for someone with his injuries, and the fluids couldn’t keep pace with the blood he was losing. I needed more hands, more equipment, more experience…more everything. I was left sitting at the head of the stretcher watching helplessly as Frankie drowned on his own blood and vomit…

…and there wasn’t a damned thing I could do about it.

Oh, I could have. If only I had paid attention to the nurse’s report, I might have noticed the IV lines and asked that she insert something better. If only I had read the part of the ER chart that said he was spitting up blood, I’d have had the suction unit ready and waiting. If only I had questioned whether he still needed to be on a spine board, he might have been easier to position. If only I had noticed his declining vital signs, I might have asked for additional help on the transfer.

If only I had been less cocky and more competent, Frankie Maryland might be still be alive.

To make matters even worse, his aunt witnessed the whole ugly scene from the front passenger seat. She heard the fear in my voice as I shouted for my partner to drive faster. She heard my anger and frustration as I shouted obscenities at her nephew, God, or whoever might be listening, urging him to fight, to keep breathing, to do anything but die in the back of my rig.  She saw the blood smeared on my uniform shirt, my forearms, my forehead…

…and yet, when I walked back to my rig after the ER staff had stopped trying, she put one hand on my arm, and pulled my head close, and whispered her thanks for trying so hard to save her nephew.

We drove back to the station, and I stripped bare and sat down in the shower, and cried myself to sleep. The blood washed away, but the shame lingers still.

A powerful motivator, shame. It can either haunt you with the faces of the people you’ve failed, or it can spur you to be the best you can be. In my case, it taught me the price of mistakes in EMS. In the years since, I’ve made friends with Frankie Maryland’s ghost. Along the way, I’ve strived to make my skills and knowledge the equal of my ego.

Not that it’ll ever happen, though. Those who know me will tell you my ego is huge.

But ultimately, stories like Frankie’s are just war stories, one of a thousand such tales I’ve told and heard. And their primary distinction from fairy tales is that fairy tales begin with ‘once upon a time, in a land far away’, while the EMS war story begins with ‘no shit, we had this guy the other night…’

That is, unless you choose to learn from them.

What I learned from the death of Frankie Maryland made me a better paramedic, of that I have no doubt. I’d like to say that the lessons I learned have saved other lives, but that would be an overstatement. The fact is, even in EMS, there are precious few calls where you know your actions saved someone’s life.

That flies in the face of the propaganda that we feed to the general public, even to the impressionable rookies that enter EMS to do just that – save lives. Hell, it’s part of our professional ethos. The theme of EMS Week 2008 was EMS: Your life is our mission.

Your life may be our mission, but the opportunity to actually save it comes all too rarely, and when it does present itself, the outcome depends more upon luck and timing than our skills. In fifteen years, I’ve had my share of code saves. Some of them even made it out of the hospital alive. Others hung on just long enough for their families to tell them goodbye. I’ve made the critical diagnosis, gotten the tough airway, turned around the crashing asthmatic, and stabilized the shocky gangbanger with multiple unnatural holes in his person. I’ve needled chests, paced, defibrillated, and cardioverted, and given countless drugs.

But, other than a handful of exceptions, I can’t state with any certainty that my actions were the difference between life and death. In that handful of exceptions, all but one or two were saved simply by applying the techniques that any John Q. Citizen with a basic first aid course could have done.

That isn’t to say, of course, that I haven’t made a difference. I have, just not in the ways I expected. Once, I gave voice to my disillusionment and frustration to a friend over beer and wings at an EMS conference. My buddy Jeff commiserated. He’d been there, too. “You know, Kelly,” he belched gently, “I have it figured out, dude. We’re the Special Teams. It’s not our job to score touchdowns.”

As I am wont to do when confused – or drunk – I cocked my head and adopted a quizzical expression, much like a dog watching cartoons.

“You know, like Special Teams in football,” he elaborated. “It’s our job to field punts and kickoffs, and advance the ball up the field as far as possible, so that the offense is in the best position to score. Scoring isn’t our job, but if we don’t get good field position for the offense, it’s a lot harder for the offense to score.”

“I like it,” I mused. “The offense does most of the scoring, and they get most of the glory. And occasionally, if we’re very good or very lucky…”

“…we get to run one in for a score all by ourselves,” he finished. “And it’s a great feeling when we get to do that, but it’s not the norm. And if you spend your career expecting to score every time you touch the ball, you’re not going to play the game for long.”

And thus began my slow retreat from career burnout. I began to better understand my role on the team, and stopped trying for a touchdown on every play. Instead, my new goal became to be an all-pro Special Teams player – one the team realized they couldn’t often win without.

You’d be amazed at how much easier and more satisfying the job is when you view it that way. Little victories start to matter more, and you begin to appreciate how they all add up. I became less of a prima donna and more of student of my craft. I gained a better appreciation for my teammates. I took pride in the team’s record instead of my individual stats.

When you’re not trying to be a hero on every call, you can spend less time being resentful of those non-emergent patients, and more time getting to know them. And if you listen, sometimes they’ll tell you of all the ways you’ve scored big without even realizing it.

I suppose the biggest epiphany came not long after my daughter was born. That’s not unusual in and of itself – many perspectives change with the birth of your first child, but what is unusual is how it came about.

My daughter was born prematurely, taken early when the doctors had decided that her best chance at surviving lie in an NICU incubator and not my wife’s womb. Three days of fear and worry culminated in the doctor drawing my daughter from a surgical incision, a full three months earlier than expected. She was blue and limp, and impossibly small.

And yet for me, the fear had reached its crescendo two hours earlier, when I had locked myself in the hospital chapel and lay myself bare before God. I wept, sobbing out my fear on the communion rail, offering any bargain I might make that would spare my child.

But God doesn’t strike bargains. Blessings aren’t bestowed on the barter system. They are given, or they are not. And sometimes, they aren’t immediately recognized as blessings by the recipient. But peace was an asked-for blessing that night, and God granted it.

After that hour in the chapel, I walked into that operating suite knowing that everything would be all right. I was strong enough for myself and my wife, because I knew that my daughter would be okay.

I just knew.

Not that my faith wasn’t tested, mind you. There were setbacks along the way. For every little milestone we passed, there was another mountain looming in the distance. CT scans and ultrasounds and MRIs told the tale. KatyBeth had suffered a devastating intracranial hemorrhage in the womb, destroying much of her brain tissue in the process. Well-meaning nurses and doctors encouraged us to keep hoping for the best, but subtly stopped using words like might and possibly when discussing cerebral palsy and mental retardation. Worry ebbed and flowed.

I spent two hours a visit, three visits a day, for an entire month looking at KatyBeth through a sheet of plexiglass. It was sheer torture.

Even when I was there visiting my daughter, I couldn’t turn off being a medic. Monitor alarms would go off on the babies to my left or right, and my head would snap up, scanning the screens for what might be wrong. I’d open a hatch and reach in to stimulate the Johnson baby in the next bed, gently rubbing her back until the apnea had resolved, or softly call out “motion artifact” to the nurse at the monitoring station before she had a chance to rise from her chair. The nurses would halfheartedly chide me, “Let us do that, Kelly. You’re here to visit your baby.”

Those same nurses would look the other way a month later when, long after visiting hours, I’d slip into the NICU and hold my daughter for a few precious moments to wash away the burdens of a particularly hard shift. I was making up for lost time.

And in the months that followed, KatyBeth rallied, and began to flourish. Her cerebral palsy was never far from our minds, and my wife and I had already begun to adopt the mental and emotional coping mechanisms common to all parents of special needs children. We’d learned to treasure a different set of developmental milestones, to celebrate the tiny victories that occur without fanfare in the lives of other children, because we knew how hard our child had worked for them. Every skill that other babies developed naturally, ours had to be painstakingly taught.

And so when the case worker dropped in to see how we were coping, we were already well acquainted with the routine of raising a child with physical limitations. She didn’t tell us anything medically that we didn’t already know.

But she left us with a treasured piece of wisdom that has since shaped the way I view my role as a father, and my career as a paramedic. It was a short essay by Emily Perl Kingsley entitled Welcome to Holland:

I am often asked to describe the experience of raising a child with a disability – to try to help people who have not shared that unique experience, to imagine how it would feel. It’s like this…

When you’re going to have a baby, it’s like planning a fabulous vacation trip – to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may even learn some handy phrases in Italian. It’s all very exciting.

After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, “welcome to Holland.”

“Holland?!?” you say. “What do you mean, Holland?? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.”

But there’s been a change in the flight plan. They’ve landed in Holland and there you must stay.

The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It’s just a different place.

So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.

It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around…and you begin to notice that Holland has windmills…and Holland has tulips. Holland even has Rembrandts.

But everyone you know is busy coming and going from Italy…and they’re all bragging about what a wonderful time they had there. And for the rest f your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.”

And the pain of that loss will never, ever, ever go away…because the loss of that dream is a very, very significant loss.

But…if you spend your life mourning the fact that you didn’t get to Italy, you may never be free to enjoy the very special, the very lovely things…about Holland.

When you think about it, she describes perfectly the disparity between the public perception of EMS and the reality that we experience, day in and day out. We enter the profession dreaming of Italy and saving lives, and we’re shocked to land in Holland, land of the dialysis transfer and 2:00 am hemorrhoid call. And if all we focus on are those things, and our disenchantment, we miss all the other things that make EMS an honorable profession, one worth pursuing. We miss all the Rembrandts that EMS has to offer.

And so I learned to appreciate all the little victories in EMS.

I fought back the boredom of routine cancer treatment transfers long enough to listen to my terminal patient, a decorated war hero, whisper in my ear how I was his hero…just because I found a way to make his wife smile and laugh every time we picked him up.

I figured out a way to laugh when a frequent flier malingerer called with testicular pain at 10:00 pm. And yes, I palpated his balls, because I knew him well enough to know that as sure as I didn’t, he’d turn out to have an incarcerated inguinal hernia, or a testicular torsion, or maybe even the partially absorbed skeleton of his unborn twin down there, and I’d look like a chump for not having assessed him. And I could see the bright side of it…

…because honestly, in what other profession can you say, in all seriousness, “So Gary, what’s wrong with your balls?” That’s tell-your-grandchildren material right there, folks.

Instead of being resentful of being asked to transfer our bedbound frequent flier to the wound care clinic for the umpteenth time rather than a life-threatening emergency worthy of my prodigious skills, I shut the hell up and talked to her. And I gained some insight into cerebral palsy that will prove useful in helping KatyBeth. I found out how painful spasticity can be. I also found out that her favorite singer was Alan Jackson, and her favorite song was his cover of Song For The Life. I told her I liked the John Denver version better. And as it turns out, we both sing a pretty good a cappella duet of it.

I learned an appreciation of the absurd in EMS. Everyone, at one time or another, has experienced déjà vu. Well, only in EMS is it possible to regularly experience its polar opposite, vujà dé – that feeling that what we’re experiencing has never happened before. It’s what keeps this job interesting.

I tell an entertaining war story of an ostrich attack that killed two people. What makes it entertaining isn’t the blood and gore, it’s the reaction of the doctor when we brought the second patient in to the ER, barely clinging to life. He peered over his glasses at her wounds, and clucked, “I dunno…this doesn’t look like any ostrich attack I’ve ever seen…”

Stay away from south-central Arkansas, folks. Apparently they’ve got packs of killer ostriches roaming the countryside. On the bright side, the ER staff is well-versed in treating ostrich attacks.

When one guy called at 3:00 am for urinary retention, I walked right past all three functioning automobiles in his driveway, talked to his able-bodied boyfriend to get his history because the patient was overcome with an acute attack of drama-itis…and discovered that he really didn’t need to go to the hospital. All he really wanted was a kind, caring prehospital professional to milk his prostate so he could pee.

I didn’t even flinch. I calmly informed him that internal prostate massage was a skill beyond my scope of practice, one that fell into the realm of physician-only interventions. I suggested that he request that the ER doctor milk his prostate thoroughly and discharge him home.

And I giggled like a demented fiend when he told the ER doctor what I had suggested.

Of course, appreciating the absurdity of EMS and making an effort to get to know your patients beyond their diagnosis and stretcher necessity isn’t going to stave off burnout all by itself, nor will it magically increase your pay and job satisfaction. You need a support system as well, and healthy pursuits outside of EMS.

There’s a reason why divorce rates among public safety providers are roughly double the national average. It’s easier said than done to leave your job at work when you clock out at the end of the shift, easier said than done to separate work from your family life.

But when you come home and your spouse starts in about how the water heater is busted and the plumber charged $200 a hour to fix it, and Sears called about the overdue credit card payment, and the car is making a funny noise, and the kids have been absolute little monsters all day and you need to go in there and have a talk with your son

…they may not know that your last call of the day involved scooping up a ruined little six-year-old body from the spot where he came to rest after the car struck his bike, and desperately doing CPR on him all the way to the hospital, knowing against all hope that your efforts were futile, and that the only thing that kept going through your mind was he’s just about the same age as my son…and the last thing you want to do is discipline your son when you get home. You want to pick him up and hug him instead, no matter how badly he behaved today. They may not know why you’re upset…

…but they need to.

They may not need or want the details of your day, or of the call that has you so upset. After all, they married you, not your job.

But they need to understand that for a great many cops, firefighters and EMTs, our job is who we are. It’s how we define ourselves. It’s a part of our identity.

So if you aren’t comfortable sharing that with your family, at least make sure that they know the importance of your stress outlet, and that they allow you one. Doesn’t matter what it is – mountain biking, shooting, working out, vegging out in front of the television with a beer and a bag of Doritos, or naked hang gliding – they have to give you that time, and understand why it’s necessary.

Even better, get them involved. Take your kid camping. Teach your wife to shoot. Introduce your teenage son to the unparalleled freedom of naked hang gliding. Take your mother-in-law hunting. I even have a nifty hat with deer antlers you can let her wear.

Even if your family isn’t your support system, even if you can leave work at work, it’s still important that you don’t shut them out. EMS providers are notorious for giving everything of themselves to their patients and their jobs, and leaving nothing in the tank for their family. I’m guilty of it myself.

My wife was an ER nurse. I trained her as an EMT and a paramedic. If anyone knew the pressures I faced on the job, it was her. She was the person I turned to for guidance, the one who had my back when I quarreled with co-workers or supervisors, the one I vented to when I was sick and tired of the patients that seemed to abuse the system day after day, the one who held me and whispered reassurance on those nights when Frankie Maryland’s ghost would visit. She was my rock.

The problem is, I wasn’t hers. Oh, I tried to be. All the worry and fear attendant to KatyBeth’s birth and her cerebral palsy, the astronomical medical bills, the thrice-weekly trips to therapy, and the constant burden of jobs and finances, all that I kept to myself. I didn’t want to pile what I considered my stress onto hers. I figured that was being strong.

When you stop talking to your spouse, no matter the reason or whether you even realize you’re doing it, the distance eventually becomes unbearable. It certainly was for my wife. When two people who used to lean on each other, a team who once was greater than the sum of its respective parts, became two individuals again, she’d had enough. She took my silence for indifference, and she wouldn’t live with a stranger. One day when I came home from a teaching trip, she was gone, leaving nothing by way of explanation but a note.

And there I found myself, a victim of AIDS – Ambulance Induced Divorce Syndrome.

Don’t let it happen to you, folks.

There was a point not long after my separation that I asked a physician friend a hypothetical question. I said, “Jalal, if a patient told you that he worked long, difficult hours, came home and slept until it was time to work again, and felt so drained that he slept nineteen hours a day on his days off just to recuperate, and had no interests outside of work, would you tell that guy to switch careers?”

“Nope,” he replied. “I’d tell that guy that he’s clinically depressed, and he needs help. His problems are a lot bigger than his career choice.”

“Shit,” I sighed. “I had a feeling that’s what you were going to say.”

And with that conversation, a big swallow of pride, and a prescription for Effexor, I started to climb out of the pit. Ultimately, I abandoned the medication route – not that it doesn’t work for many people – because it didn’t do as much to alter my mood as did the conscious decision to focus on what was good about my life. Then again, maybe it was the Effexor that cleared the fog of depression enough for me to learn that happiness was a choice. It just takes an act of will.

And thankfully, God blessed (or cursed?) me with a very strong will.

**********

Believe it or not, I once thought my biggest talents lay in technical writing. Until a few years ago, I never considered myself particularly creative. I didn’t think my words were of any substance. My brother was the poet, not I.

I was the analytical type, good at breaking down a technical subject into easily understood concepts. What I didn’t realize was that it takes a good deal of creativity to do that.

When it came to the all-important task of wooing my wife back to me, I didn’t even trust my own words. I figured Pablo Neruda could say it better than I ever could.

God, what an idiot I was.

But it was during an internet search for the ultimate love poem that would magically heal my marriage that I came across another, far different, poem that had a much more profound effect on me and my depression; Invictus, by William Ernest Henley:

Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find, me unafraid.

It matters not how strait the gate,
How charged with punishments the scroll.
I am the master of my fate:
I am the captain of my soul.

It’s hard to describe the effect that it had on me, other than to simply say that it spurred my act of will.

I chose to remember that I still had the greatest blessing that God could ever bestow: my daughter.

I chose to do again the things that once brought me joy. I started hunting again. I remembered that I was once a pretty fair shooter, and how much fun it was trying to become a better one. I discovered, once again, that a pale sunrise and a warm dog can heal all manner of ills. And I reveled in teaching those lessons to KatyBeth, as well.

I chose to dwell on the things in my career that brought me satisfaction, and I chose to ignore all else.

My writing started that way, as a mental exercise to stave off despair. The first story I wrote was Little White Crosses. It did not have a happy ending. But to balance it out, I thought of a happier call, and wrote about that one.

And that’s how it went – sad story, uplifting story. Tragic call, funny call. Lose some, win some.

Pretty soon, I had fifty pages, and an outline with enough material for a hundred other stories. One night, and my partner asked, “What the hell have you been doing over there for the past couple of weeks? You’ve hardly taken your eyes off your laptop between calls!”

So I let her read a few stories, and at her urging, I sent what I had written off to another friend, one who I could count on to give me an unvarnished opinion. Unbeknownst to me, she forwarded what I had written to yet another mutual friend, one who had started a fledgling publishing company.

Two weeks later, I had a book contract. The book became a blog, and, well… you know the rest.

But the most powerful lesson that writing taught me, is that it is impossible to write with any emotional depth if you’re not willing to plumb the darker depths of the well. To shield yourself against despair also means that you deny yourself the capacity for joy. To climb a peak, you have to be willing to cross a valley. That’s a lesson that applied equally to my EMS career.

There have been a lot more valleys than peaks for me lately. I’m aware of that, and now it comes time to turn my eyes toward the light and start climbing. That’s why I’ve dusted this post off after two years, and finally finished it.

When I started writing it, I envisioned it ending very differently. And when I couldn’t craft the ending I wanted, I shelved it.

Unfulfilling, that. Better to share it with my tribe, full as it is with abandoned non-sequiturs, hackneyed clichés, and unexplored ideas. It’s raw and unfinished, but then again, so is my life. And not telling it is the same mistake that led to the demise of my marriage. The purpose of writing a story is to share it with someone, and to let it languish there in my drafts folder is to choose to dwell in the valleys.

That’s a mistake I’ll not make again.

Comments - Add Yours

  • Jasper

    Thank you for sharing these valuable lessons. It all is very recognisable, well not the part about holland since I already live there ;-), but the rest is.

  • http://twitter.com/rescue_monkey Rescue Monkey

    Great thread AD. It is very hard to remember the small victories, and I love the 'Special Teams” concept. Stay strong, resistance is not futile.

  • http://transportjockey.blogspot.com/ Transport Jockey

    Awesome thread AD. Something that all fledgling and veteran EMTs and Medics should read.
    And the reasons you gave for getting divorced are a lot of the same reasons I wound up not getting married to my ex.

  • frymaster

    Thank you

  • 9_ECHO_1

    WOW! That's just, well, amazing.

  • http://profiles.yahoo.com/u/6ZBPXB4IVJYOQUQLRT5R523ZUE David

    Long time reader, but first time commenting. All I can say is thanks. I'm sitting here on my laptop, 8 hrs into my 3rd shift as an EMT-B and a week away from becoming a “real medic.” This article has really shed some light on alot of the feeling I've had over the last few weeks, and will definatly help in guiding how I respond to them. I can't wait to get home and let my wife read this. Knowing these things and being able to recognize them in early in my carrier will save us alot of heartache I'm sure. Consider this a small victory in the life of another EMT you've never met. Thanks again.

  • TexasDad

    Dear AD,

    You sure know how to thread those words together. The post is long, but so well crafted. What in the hands of someone else would have been a messy pile of multicolored threads was in this case woven into a beautiful tapestry.

    This is really first rate writing. I can only imagine the work of beauty your technical writing must be.

    Thank you for taking the time to be so brave and honest in your post. Your words bring guidance, comfort, and solace to those who are working at being better in their careers, their relationships with friends and loved ones, and as parents.

    Having read your posts for some time know I happen to think that you are posting a Heisman like average in the fatherhood arena.

    Thank you for taking the time to share this.

  • http://crazedpw.blogspot.com Jeffro

    Your comments don't just apply to EMS types – they mean something to anyone who takes their job seriously and gets perhaps “too involved.” Your ending may have ended differently than you originally imagined – experience and learning to cope had a lot to do with that. That's some valuable advice you laid out, and I thank you.

  • http://www.lucrativepain.blogspot.com Christina LMT

    Thank you, AD.

  • samuelefurd

    Been reading you for a long time. If I am not mistaken I first ran across “Holland” from you. I placed it in a prominent place on the forum I was running for a newspaper at the time, Sadly we parted ways, and they trashed it. Anywho, I just want to say that the world is a much better place with people like you in it, Kelly. You have a GIFT for expressing your ideas and feelings. No matter if it is “Little White Crosses” or “Clear” I am uplifted to know that there are people out there that still care in the manner that you do. Thank you for being willing to bare your soul, and thank you for caring like you do.

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  • Maureen

    Beautiful.

    I enjoyed the parts and pieces of the stories that made up this post in their entirety when I read both “Life…” and “En Route”. Nice to see all of them threaded together into the story of a wonderful life.

    Thank you!

  • Linda

    Totally awesome AD!

  • jfusco

    Wow. Thems some powerful words. It makes me realize that I need to think differently about my life. (I've been walking deeper and deeper into the valley lately) By the way, I have also written things that wrapped up much much differently than I intended them to when I started.

  • http://profiles.yahoo.com/u/RSUI4FNO5UHGMBZKW5XHYJSBRI Thomas

    Kelly, I hope you have some idea of the power of your words. Your writing is a gift to all of us. Thank you.

  • http://davidkonig.com Dave Konig

    This post is huge… and no I am not referring to the word count. It's huge to me because I see a lot of similarities, but as to be expected there are also differences.

    On one hand, it is a clear statement of the poor job EMS does in caring for its own… and yet it is comforting to know that there are others out there with similar, if not the same, issues that we deal with both professionally and personally. It's like the Yin and the Yang. The North Pole and the South Pole. Dr. Jeckyll and Mr. Hyde… because in each of us there truly are two natures at war… the good and the evil… the provider and the patient… the choice is ultimately ours… and the one we want most to be, we are.

    Huge.

  • http://twitter.com/lilminimedic Mini Medic

    AD,

    Here I sit at work, trying not to bawl my eyes out…

    Everything in this post hit home, and hit home HARD.

    I needed this. I really did.

  • http://injennifershead.com Jennifer

    *Applause*
    AD, that was beautiful. Full of excellent reminders for all of us.

  • http://certifiableprincess.blogspot.com/ CP

    Just slap the word “Nurse” in there in place of “EMT” and you have written my story. So many similarities. We have all had our “Frankie” and have lived with that ghost. I got divorced after becoming a nurse as well. My significant other just didn't get my job and how I couldn't just put a briefcase down the way he did and say, “alrighty then, day is over…let's eat”. Our service work comes home with us. My “Frankie” was a little baby boy named Jean Claude who was dying of AIDS related pneumonia, throwing repeated pulmonary emboli til his little heart and lungs finally gave out. I worked on him and worked on him to the point of exhaustion. I had lost my own son, one of my twin boys, a mere five years earlier due to substantial heart and lung defects, so I suppose I had taken Jean Claude's case a little too personally. And, like you, I bargained with God. He had taken my one boy. My other son had had the same heart and lung defects and was fighting for his life in NICU. I begged and pleaded with Him…don't take them both from me.

    This essay is very powerful and has brought up a lot of painful yet joyous memories.

    And, so you know, we nurses DO appreciate the work you guys do in transit. It's not easy maneuvering in the back of a moving rig trying to resuscitate a patient. Every EMT I have come into contact with has always been professional, courteous and willing to listen. I think you guys are unsung heroes who don't get nearly as much credit as you should. Far more than big white taxis, you are the lifeline for our patients until they reach us at the hospital. Your work in the back of those trucks make all the difference in the world.

    Thank you for what you do. I mean that.

  • http://twitter.com/seanhfitz Sean Fitz

    Outstanding!

  • http://twitter.com/JustMyBlog Just Me

    My family lives in Holland and it is indeed a beautiful place. It's just not Italy. Or Canada. Or the US. Thank you, AD, for a beautiful post. This hit home for me – as twisted as it sounds, it's sometimes “nice” to hear that others can have the same problems and battles as you do, and that it's okay. And that in the end it can make you a stronger person. So thank you.

  • http://fishmedic.blogspot.com fishmedic

    Wow, that is some powerful stuff right there. Just beautiful.

    -fm

  • http://sevyrr.blogspot.com/ Sevyrr

    I am speechless. This is powerful beyond words. I can relate to all of it, even through the few differences. I am going to have to read this again.

    My ghost's name is Brittany, she was 18 months old. I'll put the story up on my blog sometime if I get the courage, it's already written.

  • emtdragon

    Very well written and I think almost all of us can relate in one form or another…I just hope each of us can learn and take something from one another and be able to give something back.

  • http://twitter.com/Cap11C Jim Grieco

    Unbelievably powerful. I laughed, I cried, I learned about myself. I'll be sharing this with my family. Thank you.

  • bigsnaketex

    if you trained dogs as well as you write, you'd have one of those labs that open the fridge, get your bud light, open it and bring it to the coffee table and put it on a coaster!

    Outstanding. Simply outstanding!

    The ability to bring your ready into the story through images painted with words is a gift that goes beyond the subject matter.

    You are a blessed man Kelly.

    And thank you for blessing the rest of us……..

  • Ambulance_Driver

    Well, Sprite actually did fetch beers from the fridge for me.

    If only she'd had opposable thumbs, I could have taught her to open them. ;)

  • http://oregonemtstudent.blogspot.com/ Brad

    I'm only a Basic student, but your post is very inspiring

  • http://www.facebook.com/profile.php?id=1001868774 Meriah Powers

    Awesome, powerful story…and just on a day when I needed to hear it.

  • MeSimon

    This is, without a doubt, the most insightful piece of writing I have ever read on the subject of EMS. Very moving, and so easy to identify with from this side of the pond as well.

    I'll be back to trawl the archives soon.

    All the best to you,
    Simon

    (Paramedic, London Ambulance Service, UK)

  • anparadox

    Sprite!! Such a good dog.. and she loved you so much, if she had opposable thumbs she would have been happy to open them for you ;-)

  • anparadox

    Beautiful writing, Kelly. I can wait to read your memoirs.

  • http://nctaffy.blogspot.com/ nctaffy

    Thank you.

  • http://tarboxfamily.net/annie Annie

    Wow. Just, wow. So very glad you found the writer in you.

  • jaymazing

    I just wanted to let you know, I really appreciate this post.
    Very well written, and very much an inspirational read. Consider me a new regular to your blog.

  • jaymazing

    I just wanted to let you know, I really appreciate this post.
    Very well written, and very much an inspirational read. Consider me a new regular to your blog.

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  • http://www.facebook.com/people/Steve-Wilinski/1000634725 Steve Wilinski

    Brilliant work! You can’t be your job 24 hours a day every day. Work to live, don’t live to work.