Seeking Words of Balm

Summer, 2000

The man’s face is waxy and pale. His cheeks and eyes are sunken, the lips drawn in a wrinkled circle outlining his gums. His dentures sit in a glass on the night stand. I take my time attaching monitor electrodes while Pardner attaches a bag-mask device to the oxygen cylinder. If I thought there was any hope at all, I’d have started off with the hands-free defibrillation electrodes. Pardner would have been doing CPR.
I knew he was dead when I walked in the room. Attaching the monitor and watching the flat line march across the screen merely confirmed it. I check his hands and his back. The fingers and wrists are stiff, and his back is mottled with lividity. Pardner and I trade a look.

I straighten and turn to the woman standing behind me in the doorway, supporting herself on a walker with tennis balls on the legs.

“Is there anything that can be done?” the woman asks, her voice every bit as frail as the rest of her.

“I’m afraid not,” I tell her gently. “Nothing we’d try would work. He died sometime during the night, in his sleep.”

She nods silently as she looks at the body in the bed, her husband of fifty years. Behind her stands the staffer of the assisted living home who called us. She looks more emotional than the old woman.

The old woman lets out a ragged sigh and turns back to the living room, pausing to give the aide a gentle, sympathetic pat on the arm as she goes. She putters around the small kitchenette, arranging mail, placing her breakfast dishes in the sink, emptying coffee grounds and her husband’s uneaten breakfast into the trash.

I watch her as she moves about the kitchen as if no one else is there, as if her husband weren’t lying dead in the next room. She pours a cup of coffee, turns around and offers it to me.

“I suppose I need to call the funeral home,” she muses, speaking to no one in particular. I take the cup from her and pass it to Pardner, and steer the woman to the couch.

“I need to tidy this place up before the funeral home boys get here,” she mutters. “So much to do…”

“Ma’am.” I lay my hand gently on her arm. “Why don’t you let us do that for you? You shouldn’t have to worry with all this,” I tell her softly, gesturing to the nearly immaculate apartment behind me.

“If not me, then who?” she asks hollowly, looking me in the eyes. Pardner clears his throat.

“Ain’t there somebody we can call, hon?” he asks. “Family, maybe? A preacher?”

“No, there was nobody but us. He was all I had left.”

And then the tears come.

We sit there with her and wait for the coroner to arrive, me next to her on the couch and Pardner sitting in a chair, for the better part of an hour.

Not a word is spoken. But we stay anyway.

Late Spring, 2005

Her face is misshapen, the blonde hair plastered to her skull, still wet with blood. Her tongue is bloated, her face purplish. She had run straight through the stop sign, striking a pine tree head-on. She lay slumped over the steering wheel, pinned between it and the seat, her blood pooling on the deflated air bag. Her shoulder restraint is still in place.

I play my flashlight around the wreckage of the car while Part-Time Partner rants and bangs on the roof of the car behind me. There is a formal dress still in its cellophane wrapper lying in the floorboard behind the front seats, and a garter hanging on the rear view mirror mount, still stuck to the shattered windshield.This is how PTP deals with the senselessness of it all – he gets angry. He has daughters this age, and I know what he is thinking. There is no one here but me and the deputy to see him vent his fear and frustration. PTP keeps it in and seethes silently when we have an audience.

Goddamned prom parties!” he shouts, gesturing to the pinkening sky behind us. “Why the fuck else would she be out at this time of the morning?”

I say nothing, walking around the wreckage, playing my flashlight over the ground.

“Probably drunk off her ass,” he continues, veins bulging in his neck, “seventeen Goddamn years old and now her life is over before it even started!”

“No alcohol evident in the vehicle,” the deputy points out quietly. “You smell anything?”

“No,” I answer.

Did you know you can smell the alcohol in someone’s blood? You can.

“No skid marks, either,” the deputy sighs, pointing his flashlight back up the road. “She never even hit the brakes. Besides, she was a responsible kid. I’m thinking she fell asleep at the wheel.”

“You knew her? I asked.

“Yeah,” he says sadly, his shoulders sagging. “My daughter’s the same age. We go to church with her family.” He clicks off his flashlight and places it back in the holder on his duty belt, looks absently back up the road. “Wrecker oughta be here in a few minutes, then I’m gonna have to go tell her Daddy. Damn.”

PTP looks at him for a moment, hands still clenching and unclenching, veins still bulging in his neck. Then he marches purposefully to the ambulance, opens the rear doors and climbs in. A moment later, he emerges carrying a folded sheet and carries it over to the wrecked Honda Accord. He unfolds the sheet and carefully, gently covers her body with it.”Sun’s coming up,” he grunts in explanation and I nod my understanding. “I don’t want people driving by and gawking at her.”

As if on cue, a pair of headlights appears over the crest of a hill and grows steadily closer. The deputy removes the flashlight from his belt and signals the truck to go around us. As the pickup pulls abreast of the scene, passing just feet from the deputy, he freezes. The truck continues on for a few feet, and then skids to a stop with a screech of brakes.

A man and a woman bail out of the truck and run back toward the wreck. The deputy intercepts the man, and PTP and I are left to deal with the woman. I step in front of her and catch her before she reaches the car.

“That’s my baby!”
she screams frantically as I try, and fail, to wrap my arms around hers. “Let me GO! Let me see my baby!” she screams as she flails at me impotently. There is nothing I can say to her, so I lower my head and let the blows rain down. None of them do any damage anyway. She’s not trying to hurt anyone. PTP moves behind her and tries to grab her hands.

I look over her shoulder and see the deputy with his hands on the father’s shoulders, forehead to forehead, saying something I can’t hear.

PTP and I manage to walk the mother over to the front of our rig, and she collapses in a heap, still crying and screaming “my baby!” hysterically. PTP’s eyes are moist and his jaw muscles bunch as he kneels next to her, one hand laid gently on her shoulder as she wraps her arms around her chest, trembling violently.

I walk to the side door of my rig, open it and pull the drug box across the floor to me. I withdraw a 5 cc syringe, fish the Valium out of the narcotics pouch on my belt, and draw up a full ten milligrams.

By the time I walk back around to the front of the rig, the father was there, sitting with his back against the front bumper of my rig, cradling his sobbing wife in his arms. His eyes run with tears as he holds his wife’s head to his shoulder, but he says nothing. The deputy and PTP stand there, watching mutely as I kneel next to her, lift the hem of her khaki shorts, and plunge the needle in her thigh. She doesn’t even flinch.

The husband meets my eyes as I stand up. I say nothing to him. I don’t have to. I just stand there quietly until the woman’s sobs start to wane. It takes longer than I thought it would.

The sun is shining and the wrecker has arrived by the time I can help the husband to his feet. His wife just sits limply against the bumper of my rig, eyes vacant and moaning tonelessly. We try to help her to her feet, but her legs are too unsteady. Her husband picks her up and cradles her to his chest and walks to the back of the rig. He doesn’t even wait for us to unload the stretcher, just climbs into the rig and gently deposits her on the cot.

I wipe the tears and snot from her face and brush back the wet hair plastered to her cheek, and spread a blanket over her as her husband sits on the bench seat and holds her hand, staring blankly at his reflection in the plexiglass cabinet doors.

“Where will you take her?” he asks, breaking the silence, his voice low, harsh and strained.

“She’ll go to Bossier for an autopsy,” I say softly. “It’s required by law. After that, whatever funeral home you specify.”

“I meant my wife.”

I blush in shame and mentally kick myself.

“I’m sorry, Sir. We’ll take her to Podunk, if that’s all right with you. They’ll keep her overnight, keep her sedated. I’ll get you some contact info for some grief counselors, if you’d like.”

He doesn’t answer right away, just stares down at his wife. After an uncomfortable silence, he speaks again, still processing information from five minutes ago.

“An autopsy? Why do…I mean she’s still in her…how do they get her…”

“We’ll take you and your wife to the hospital, and another crew will get your daughter out of the car. The fire department will come, and they’ll extricate her. Afterwards, one of our ambulances will take her to Bossier.”

He nods silently, and I watch as his lips start to quiver. He squeezes his eyes shut, and huge tears roll down his cheeks in single file, and drop onto his knees one by one.

“I don’t want strangers seeing her,” he says pleadingly. “Will you ask Danny to stay with her?”

So that was the deputy’s name. I can never remember.

“She won’t be gawked at,” I promise him. “The men that will get her out all have families, daughters of their own. They’ll be gentle, I promise. And I’m sure Danny will supervise things.”

“Insurance cards.”

“Excuse me?”

“My insurance cards are in my wife’s purse in the truck. You’ll need those, right?”

“No, Sir.”

You will never see a scrap of paper from our ambulance service to remind you of this day. I’ll lose the run report entirely, if it comes to that. But it won’t. The Boss understands things like this.

“Who is going to take my little girl to…Bossier, you said? Do you know who it will be?”

“If you’d like, I’ll take her there once we get your wife settled in at the hospital,” I offer. “I’ll do it myself.”

“Yeah,” he sighs, wiping his eyes with his forearm, “I’d appreciate that.”
And so I did, even though my shift had officially ended an hour before.

Thanksgiving Day, 2001

“Can you think of anything else?” I look around at each face surrounding the man’s body. Everyone shakes their head.

“Four epi, three atropine, fluid bolus, tube placement is good even though end-tidal CO2 never got better than 10,” Paramedic Student Partner summarizes as she does compressions. “Blood sugar is okay, bicarb did nothing, and she’s got a purple face and shoulders. I’m thinking pulmonary embolus.”

PSP is showing promise, and she’s starting to put it all together.

“And still asystolic after twenty minutes of working it,” I finish. “Okay, I’m making the call.”

I flip open my personal cell phone and call Dispatch for a patch to Podunk ER. We always do things like this over a recorded line. I walk to the far side of the living room and turn my back to the family.

“Hey Doc, this is AD on Medic Four. We’re on scene with an asystolic arrest, been working it twenty minutes now. Down time prior to our arrival was over ten minutes, with no CPR. Got a tube, got two good lines, four epinephrine, three atropine, and one bicarb on board. Rhythm never changed from asystole. I’m thinking she threw a clot. Requesting permission to terminate efforts.”

“What’s her history?” Doc wants to know.

“Non-insulin dependent diabetic, hypertensive, smoker, age fifty-four. Not much else, according to the family.”

“Helluva a way to celebrate Thanksgiving,” Doc grunts. “All right, call it. Family taking it okay?”

“We’ll see,” I answer. “We may be calling you back.”

“Just put me on the phone if you have any problems,” Doc offers, then Dispatch breaks in on the conversation.

“Coroner’s been notified, Medic Four,” she offers helpfully. “They’re en-route to your location.”

“Thanks, Dispatch.” Not all dispatchers are like Satan.

I tuck my phone into my pocket and walk over to the woman’s daughter, standing there in the doorway between the dining room and the den, the food still on the table in the room behind her. She has stood there and watched the entire scene without changing her expression; eyes red-rimmed and tearful, hands clasped over her mouth, she has leaned against the door frame and watched in mute horror as we tried to resuscitate her mother. Her son-in-law had taken the woman’s hysterical granddaughter to another room shortly after we arrived.

I place my hand on the daughter’s arm and can feel her trembling. She tears her eyes away from the EMTs and firefighters doing CPR and looks at me questioningly.

“I’m sorry, Ma’am,” I tell her gently, “but there’s nothing else we can do. Anything else we could try would be fruitless.”

She looks from me to her mother’s body, and back. “That…that’s it?”

“Her heart had stopped beating before we got here,” I explain. “By the time we started CPR, there was no electrical activity in your mother’s heart. If there had been, maybe we could have revived her. Maybe not. But when there is no electrical activity, there’s not much medicine can do to fix that. We’ve tried all the drugs we can, the same ones used in the hospital. Nothing has worked. At this point, we’re just abusing her body.”

“No…no chance at all?”

“No Ma’am,” I say softly, and then I say The Words. “I’m afraid she’s dead.”

At that, she walks back into the dining room and collapses into a chair, folding her arms on the table and burying her head. Her shoulders shake with sobs. I motion for PSP and the firefighters to stop what they’re doing, and walk down the hallway in the direction taken by the son-in-law. I find him in a room at the end of the hall, sitting on a brass daybed, stroking his daughter’s hair. She is almost asleep, her cries slowed to the occasional snubbing of a heartbroken child.

“I’m sorry,” I whisper, answering the question in the man’s eyes. He nods sadly, looking tenderly at his daughter. He sighs and gingerly gets off the bed, successfully avoiding waking his daughter. It’s a little girl’s room, but not this little girl’s. From the looks of the photos, stuffed animals and 80’s vintage posters on the walls, this was once her mother’s bedroom.

“I figured she was gone,” he tells me quietly as he shuts the door behind him, “but thank you for trying.”

“I wish the ending could be different,” I offer. “Sometimes it is, but most of the time we can’t get them back.”

We pause at the entrance to the living room, and he watches as PSP and the firefighters gather up the assorted detritus of a resuscitation and rearrange the furniture we moved.

“We have to leave the breathing tube and the IVs in place,” I explain, “until the coroner gets here.”

He nods absently and looks at his wife, still with her head down on the table. “What happens now?” he wants to know.

“The coroner comes and does his investigation, and then he’ll call whatever funeral home you request. We have to stay here until he arrives. We can call a family member or your minister if you’d like.”

“Okay,” he nods.

“We’ll wait outside,” I offer. “Give you some time alone with your family.”

“Thanks,” he sighs, looking at his mother-in-law’s body lying on the living room floor under a sheet, “but I think we’ll wait outside instead.”

August, 1998

“He’s gone, isn’t he?””Yes, Mrs. Dodge. I’m afraid he is.” I knelt next to the frail body on the bed and gently tucked his hand back under the covers. It was a hand I knew well.

Jeremy Dodge was close to my age, just twenty seven. He had suffered a devastating brain injury in a motorcycle accident when he was sixteen. The strain of caring for Jeremy had taken its toll on JoAnne Dodge. It very nearly ruined her financially and broke her marriage. Through it all, JoAnne cared for her son with an unwavering faith.

We first met him when the home health agency had called us to transport him to the hospital.

“What for?” we had asked.

“He needs an IV access,” the nurse had explained, “and I can’t find a vein.”

“He’s going to the ER just to get an IV line? What if we can get one right here? Can he stay home?”

“Well sure, if you think you can get one,” the nurse had said dubiously.

One stick later by my partner, Vascular Access Wizard, and we had made a new friend. Even the home health nurse had been grateful.

We cared for Jeremy Dodge for five years. On duty or off, day or night, one of us would run over to the Dodge house when they called. We only transported him when we had to, and we got to know JoAnne and her other children, Jeremy’s half-sisters.

The official medical opinion was that Jeremy Dodge was profoundly brain-damaged, and only minimally aware of his surroundings.

We knew better. We could tell when he was happy or sad, and all of the pretty nurses had learned never to lean over Jeremy too closely. Even contracted as he was, he could grope a boob with unerring accuracy.

Eventually sepsis took him, as it does so many bedridden patients. JoAnne had called, desperation in her voice.

“He can’t breathe!” she had blurted desperately. The home health nurse had taken the phone from her and told us what was going on. So Pardner had swung by my house and picked me up, and we had beaten the ambulance there by ten minutes. Even then, we weren’t quick enough.

Heather, the home health nurse, had cleaned Jeremy up by the time we arrived, and the look in her eyes told me all I needed to know. JoAnne and her daughters had composed themselves, and Jeremy was no longer breathing. A quick pulse check of my own confirmed what Heather’s eyes had told me, and I tucked the kid’s arm back under the covers.

“I’m sorry, JoAnne,” I said as I knelt next to her rocker and hugged her. “I wish I knew something more to say.”

“Sorry for what?” she asked, a warm smile breaking through her tears. “This is a time to rejoice, not grieve. I’ve grieved for my son for eleven years. Now he’s sixteen again, healthy and whole.”

“I believe that,” I tell her honestly.

“Are you a Christian, AD?” she asks. “All this time, and I’ve never asked.”

“Yes, Ma’am,” I answered. “I am. Not as good a Christian as I should be, but I believe, yes.”

“The doctors all say that Jeremy wasn’t aware of anything. He had never been Baptised before the accident. I didn’t find my faith until after it happened. He was born out of wedlock, you know.”

“Yes Ma’am, you told me.”

“Do you believe people can go to Heaven if they’ve never accepted Jesus as their personal Lord and Savior? My religion says no.”

“I believe in a loving and merciful God,” I tell her, “one who wouldn’t condemn Jeremy as he was. So yes, I believe he’s in Heaven.”

“So do I,” she smiled with utter conviction. “So do I.”

“Tell ya’ what I believe,” Pardner broke in laconically. “I figger Jeremy wouldn’t be sittin’ here gettin’ all weepy like this, wonderin’ if he’s with Jesus or not. He’d be up, actin’ up and bein’ a sixteen-year-old kid. Then he’d grab Heather’s boob.”

And we all laughed uproariously and listened to funny stories of Jeremy’s childhood, many of which we had heard before. When the coroner arrived, he thought we were all nuts.

September, 1994

Simple human touch is next to impossible through a PPE kit. You want to touch someone, the gloves, eye shield, gown and face mask thwart you at very turn. Even feeling a pulse is tough through double gloves.More importantly, they can’t feel you.

Not that I wanted to touch her. She was smeared from head to waist with AIDS infected blood. In 1994, during the height of AIDS hysteria, death lurked behind every exposed needle, every splash of blood or bodily fluids. People believed you could get HIV from a toilet seat or an infected mosquito back then. I wasn’t taking chances, not at first.

She had contracted the virus from a boy she met in college. Her parents, highly religious people, had shunned her when they found out she had AIDS. Her first inkling she had the disease was when she got sick for the first time. That cough and the weight loss…well, it wasn’t just HIV, it was full-blown AIDS.

So she sought solace from her family, and her parents cast her out like so much garbage. Not only did their daughter have that homosexual disease, she had fornicated with a man outside the bonds of matrimony. She was dead to them.

And they were probably right, if a few years premature. The cocktail wasn’t widely used back then, or at least I hadn’t heard of it. So she had tried to speed things along in their front yard, by taking a knife to her wrists. For a first-timer, she did a pretty fair job.

I’ll never forget the coldness of her father as he had stood there behind that screen door and watched his daughter lie bleeding on the lawn.

“Get her out of here,” were the only words he had said, a curt directive before closing the door in our faces.

I learned all of these things about her on the thirty minute trip to the Big City, in between her broken sobs and her whispered conviction that she was going to Hell. I don’t remember saying a word. What was I going to do, tell her she was wrong? Her entire religious upbringing told her otherwise.

Her own father had told her she was damned.

So she sobbed and she talked, and she begged me to understand, and I tried to smile comfortingly and answer with my eyes.

Kind of hard to do that behind a mask, though.

Somewhere along the way, she grabbed my hand and held it, and I resisted the urge to pull away. So I put away my forms and my clipboard, and I sat there next to the cot and I held her hand all the way into the ER.

Held her hand all the way through the hand-off report, too. I had to pry her fingers away from mine. I wished the gloves hadn’t been so thick.

The nurse I handed her off to was one of those stern old battle axes who had known Florence Nightingale personally and been working the ER since Hippocrates was an intern. Frankly, she scared me a little.

But when she leaned over that stretcher, there was no judgment in her eyes, and she was as soothing and motherly as the girl’s own mother should have been. An angel, if a stern one. She took her vital signs and cleaned the dried blood off her face and arms and disposed of her bloody clothes and put her in a gown.

I stopped in the EMT lounge before I left and grabbed a couple of Cokes from the ice chest. I ducked into her room, opened one of the Cokes and sat it on the procedure tray next to her bed. I still don’t think I said anything.

But she was able to see my face and eyes, and I clasped her hand again before I left.

Without the gloves.

These little recollections were brought to mind by an e-mail I received from one of my readers, a medical student who seeks the proper words to ease the grief of a loved ones’ passing, or the proper approach to the family of a dying patient. Seeking words of balm, in other words.There are no proper words, Rav. Medical school will teach you how to improve and extend life, how to ease physical pain and suffering, perhaps even how to save a life if the situation presents. Where the training, and advice like mine, always falls short is in what to do when there is nothing left to be done.

You’ll read the words of Elizabeth Kubler Ross, if you haven’t already, and you’ll be taught how to recognize and deal with the five stages of grief. You’ll be taught to use words like “death” and “dead” and to avoid platitudes and euphemisms like “passed on” or “in a better place.”

And all of that will fail if you do not feel compassion. If you do feel compassion, most of that knowledge will be rendered irrelevant. Don’t let the grind of your education beat the compassion out of you.

Compassion is the one thing that traverses all cultural and religious boundaries. It is universally understood, be you atheist, Christian, Muslim, Hindu, Buddhist or Pagan.

And it need not always be expressed in words.

Hope that answers your question.

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