Silent Siren, page 2
Once, as a naïve and rather spindly sixteen-year-old, I attempted to open the nozzle of a three-inch attack line at the scene of a dumpster fire by myself. For my efforts to prove my worth as a member of the team, I was thrown backwards by the torrent of water erupting from the nozzle and into a Seattle Fire Department paramedic working an extra shift on Bainbridge Island. He laughed and admonished me, replacing me on the nozzle and extinguishing the stinking heap of baby diapers and discarded Chinese take-out.
The fire service required a wide array of knowledge, from the basics of building construction, to the treatment of a fibrillating heart. I learned the fundamentals of hazardous materials response, water rescue, the pleasure (or terror) of breathing compressed air through an SCBA (Self-contained Breathing Apparatus), and the treatment of any number of medical maladies, from broken femurs to broken hearts. Yet it was emergency medical services that really captured my interest. I found the idea of ferreting out the causes of a patient’s distress and arriving at a suitable treatment to be intriguing. I loved the language of medicine as well, the ability to look at a new word and know what it meant by dissecting it into its component parts.
Medical Terminology
It was not only the Latin suffixes and prefixes of medicine with which I was fascinated; I saw a subtle humor in the way medical folks, with a practiced air of sophistication, described the patients they treated. During long transports to the hospitals on basic life support runs, I would read the doctor’s dictations on the patient I was transporting. A woman with multiple dreadful medical problems was described as “highly unfortunate”—quite possibly the understatement of the year. A benign abdominal exam might be described thusly: “I was unimpressed with the patient’s abdomen.” It made one wonder if the poor quality of the patient’s abdomen was some sort of professional affront to the physician.
The infirmities of old age were described in odd terms as well. Instead of being old, one was “senescent” and in “the seventh or eighth decade.” One of the stranger diagnoses was the prevalent and non-specific “geriatric failure to thrive.” This was actually listed on my grandmother’s death certificate as her proximate cause of death. It was as though there was a deep personal failure on her part to live up to expectations. It brought to mind images of a potted plant—“Well, we watered her and fertilized her like you said, Doctor, but damned if she didn’t just wilt.” I thought it could more accurately be described as “dwindling syndrome”—a gradual and peaceful slipping away from life by degrees—sleeping more, refusing to eat, and making up one’s mind that the end was near.
The effects of morbid obesity were another interesting phenomenon to describe. The apron-like flap of fat and loose skin that hangs over one’s belt-line could be described medically as a “massive overhanging panniculus.” Somehow this sounded both ponderous and frightening at the same time. These panniculi were actually graded on a scale of I to V. A grade II panniculus might just make a person question whether he or she still possessed genitalia, while the almost imponderable grade V paniculus extended past the thighs to cover the knees, obviating the need for any undergarments.
Explorer Firefighter
By sixteen years old, I had fulfilled the requirements necessary to accompany the fire and EMS crews on responses. I knew every piece of equipment in every compartment on every vehicle, though not necessarily how to use all of them. I had just enough knowledge to be slightly dangerous. Since the world was less liability-conscious in those days, as high school kids we were able to perform nearly every task required on scene with the exception of driving vehicles and participating in interior firefighting. On emergency medical calls we learned as we went, starting out just observing, and, with added confidence, moving up to administering oxygen, obtaining vital signs, carrying the stretcher, and whatever we were called upon to do by the lead paramedic.
At the time, all of the paid firefighters in the department had moved their way up from the ranks of the volunteers. They were old islanders, invested in the community. This is where their parents lived and where they had spent all their formative years. When the siren howled from the Station 22 tower, volunteers would leave their tractors in the field, their classrooms where they taught science, and their homes to respond to the needs of their neighbors. In time, the siren would be replaced by chirping belt-mounted pagers that would announce disaster at the most inopportune times—church, Little League games, piano recitals. Sometimes two or three generations of family members had been volunteers. The Callahams and Hannons, among others, were institutions at Bainbridge Fire. Their roots were deep. Their images stared down at us from sepia-toned photographs on the station walls.
At the time, the volunteers were still the backbone of the organization, often responding directly to the scene in their own vehicles. Some of the volunteers had turned their POVs (privately owned vehicles) effectively into emergency response units with revolving, flashing, or oscillating green lights and aid kits. There were volunteers we could always count on to respond in their home areas. No matter the hour, if the call came in on the south end, Jim Dow would faithfully arise to the sound of his pager and be first on scene. Scott Taylor worked as an engineer in the downtown area. He was lucky enough to have a supervisor who understood his commitment to the fire department. During the day, downtown Bainbridge (Winslow) was his response area.
The fire chief’s command car could be identified from miles away. He had spent part of his career abroad and used the European-style hi-lo siren exclusively. Unfortunately, his grasp of island geography was only slightly superior to my own, and he was just as likely to be hi-lo-ing away from the scene as he was towards it. Frequently during his first few months of employment with the department, we passed him in his command unit, zooming very confidently in the opposite direction of the emergency.
Trial by Fire
My first call is a fully-involved duplex fire on New Brooklyn Road early in the morning. As explorers, we are not provided with portable radios or pagers, so we rely on a phone tree, just as in the old days when the fire chief’s wife, Mrs. Sinnett, called all the volunteers at home to respond to fires. Garrett calls and tells me to respond to the station. Actually, I believe the verbiage was more like, “Get your ass to the station!”
Having no driver’s license, I have to rely on my mother to drive me there. The good mother that she is, still half-asleep and in her bathrobe, Mom drives me to the fire station where I wait for somebody to take me to the scene. I sit bolt-upright in my seat all the way there, shivering with adrenaline and cold, urging Mom to please drive faster! I have Important Duties to perform!
“I’m not going faster than the speed limit,” she says.
By the time our PRV (Parental Response Vehicle) pulls slowly into the station, most of the fire apparatus have already departed, actively involved in firefighting efforts. A resident firefighter eventually shows up, looking very sleepy himself, his curly hair unkempt, with a day’s growth of beard on his chin. We pile into the fire chief’s car and head to the scene, again, much too slowly for my satisfaction.
The black smoke column is visible from at least a mile away—very exciting. My chest tightens with a mixture of anticipation and apprehension. When we arrive, the fire has been contained but not fully extinguished. Rehab has already been set up and two other Explorers are already working. Fred has rescued a cat and is immensely pleased with himself. The resident firefighter, Paul, and I spend the majority of the time ferrying empty air bottles back to Station 21 where we refill them in the Cascade System and ferry them back to the fire.
Another explorer and I set heavy tarps on the ground and placed fresh air bottles and breathing apparatuses on it. As firefighters emerged from the fire building, covered with burning sheet rock and soot, we changed out their air packs and provided them with fresh bottles. Firefighter Jones informs me that I am to wait until after he has removed his mask to shut off his air bottle. We rehydrated the firefighters with fresh water and Kool-Aid as they waited to be sent back in again.
The fir trees have caught fire. His red helmet atilt, his sweat-soaked forehead, Captain Hannon barks commands: “Grab the handline! Protect the exposures!”
A hose line snakes across a patch of weeds that passes for a lawn. I grab the nozzle and hunker into an attack stance. “Protecting the exposures” involved creating a water curtain between what was on fire and what wasn’t, in an effort to prevent fire spread. Steam sears my skin through my cheap hand-me-down yellow bunker gear as I open the bail of the combination nozzle and convert 100 gallons of water a minute to a haze of superheated vapor.
Since I have more enthusiasm than sense, I spend the majority of my scene time wearing my helmet backwards, much to the amusement of the volunteer firefighters. Even though I play a minor role on this scene, it is etched in my memory, the first time it was “the real thing.”
My first aid call is nowhere near as memorable. I’m spending the night at the fire station and awake to the jarring shriek of the alert tones. The lights in the room flick on automatically. The combination of adrenaline and the cold of a winter night make me shiver uncontrollably all the way to the call.
Beyond the battered screen door of the single-wide mobile home, lies an immensely fat man reclining on a plastic sofa. He describes his abdominal pain as, “Dreadful.” His mother, easily one third his size, hovers nearby protectively. He seems to think he is constipated. The paramedic also suspects he is full of shit. Though she seems mightily unimpressed, she sends the man to the hospital in a private ambulance after a thorough medical evaluation. I was just pleased I got the oxygen to work.
During the first few months of responding to 911 calls, I had zero confidence. Being asked by a senior member to put the patient on oxygen would evoke in me a deer-in-the-headlights response. Taking a blood pressure was a monumental task and I’m sure if I was to have undergone a brain scan at the time, multiple unnecessary areas of my brain would have lit up.
Ancient Mammaries
Medic 21 roars down Highway 305, its revolving red lights reflecting off scattered raindrops on a late November evening. Dispatch has sent us to a report of an old woman with chest pain and difficulty breathing on Manitou Beach drive, a three-minute response from Station 21. At the wheel, duty officer Lundin toggles the siren between wail and yelp, finally arriving at the happy medium “whelp,” a yipping sound that clears traffic ahead of us like Moses parting the Red Sea.
We arrive to a dingy double-wide trailer, a wheelchair ramp jutting from a tiny screen door like the tongue of a serpent. Inside a cramped and dimly lit living room is a casually dressed, disheveled woman with a cloud of tangled white hair, her ample posterior sunk deeply into an overstuffed brown recliner. A large and misshapen box of tissues resides in her lap. Sorrowfully, she blows her nose and flings the sodden pink cloth on the floor. Though a trash can is visible just inside the kitchen, soggy tissue dots the shag carpet like a mine field.
How is it possible for so much snot to come out of one old lady?
The paramedic, all three hundred pounds of street-burnished wisdom and too many plates of spaghetti, places his knee strategically between wads of Kleenex, kneels down, and places a reassuring paw on the elderly woman’s fragile hand.
“What seems to be the trouble, hon?” he asks.
I stare down at my gloved hands, perspiration creating patterns of translucence in the palm, and hope I’m not called upon to perform any challenging task.
“Put ’er on the monitor,” commands Lt. Crowthers, and scoots the Lifepak 5 heart monitor towards me.
Still a teenager and rather shy about exposing any woman’s chest, I try to do the task as quickly and with as little exposure as possible. The woman wears a faded college sweatshirt with no bra underneath. Gravity has, shall we say, taken a toll. Her breasts, like two sacks of half-empty flour, hang to just above her hips. On go the electrodes under her right and left collarbones and then one on her left ribcage—or so I think. I flip down her sweatshirt and hope nobody notices the improper electrode placement. The woman seems oblivious. Guess I’m in the clear.
Lt. Crowthers looks at the gauge on the green portable oxygen bottle. It reads low. “Matt,” he says, “go out to the rig and get another bottle of O2.”
Now here’s a task I can do.
I return with a fresh bottle. Lt. Crowthers takes it and smirks. “We’ll talk later,” he says.
The paramedic arises, grunts, rubs his knees, and slings his stethoscope around his neck. “BLS ambulance,” he pronounces, deeming the woman’s condition to be non-life threatening. A private ambulance is dispatched to the scene to transport her to the hospital.
As Lt. Crowthers rides back to the station with me in the back of the darkened medic unit, he clears his throat, runs a thick paw through a pate of thinning black hair and says, “Mr. Sias…when that woman arrives at the hospital, they will find four electrodes on her chest instead of just three. That, Mr. Sias, is known as a mammary gland.” Embarrassed, I look down sheepishly at my shoes and realize that a sizeable wad of Kleenex is affixed to the bottom of one.
Bleach
I respond to my first cardiac arrest on a bright, sunny day in August of 1989. The primary medic unit is out on a call and that left us in the backup rig, a decrepit loaner from Olympic Ambulance. Our brand-new medic unit had recently been involved in a collision, in which it had rolled on to its side. It would take nearly a year for it to be repaired. The loaner was cramped with advanced life support gear. The horn didn’t so much honk as it did wheeze like an emphysemic old man. Half the emergency light bar was frozen in place while the other half twirled enthusiastically.
The station speakers blare: “Bainbridge Fire, respond to a full arrest, thirty-two-year-old male…” The adrenaline hits my gut and I sprint for the rig. Thirty-two years old. What could have happened?
Lieutenant Crowthers and Captain Nolta climb in the front, while I dodge various obstacles to make it into the rear of the rig. We take off, the elderly siren mewing like a sick cat, and soon arrive at a house surrounded by gardens that could be featured in Sunset magazine. Like repairmen on a terrible mission, we trundle our heavy gear down the gravel path, past brilliant rose bushes and crystal-clear water features to the front door. I glance down at my shoes as I run—brand new and bright white, contrasting ridiculously with my dark uniform.
The stricken man lies on the carpeted floor of his bedroom, naked with the exception of a diaper that has half fallen off. He reminds me of a mannequin, his skin still pink, half-open eyes gazing dimly upwards. His room smells of sickness—musty and medicinal. A shaded lamp casts a yellow glow onto a bedside table upon which rests at least eight orange bottles of prescription medication.
A volunteer firefighter kneels at the man’s side, thumping his chest. A hospital bed with an air mattress takes up half of the room, sheets are strewn haphazardly from where the man had been rapidly scooped and placed on the floor for resuscitative efforts. Oxygen hisses uselessly from a discarded nasal cannula. The man suffered from full-blown AIDS, we were to find out, and his caregiver had found him unconscious and breathless.
Lieutenant Crowthers claps the bag-valve mask over the man’s slackened mouth and squeezes the bag. Paramedic Howie Cannon applies the defibrillator paddles to the frail chest, glancing at the heart monitor for any signs of life.
A woman of generous proportions bursts in the room, waving a sheet of paper. “He’s a no-code!” she proclaims, shaking her head vigorously for emphasis, jowly cheeks quivering. “I’m his caregiver and”—she pants, face red, hands on her thighs—“he didn’t want heroics.”
Lieutenant Crowthers removes the resuscitation mask and turns off the oxygen, leaving us in silence.
I stare at the bare, bruised chest, expecting it to move. It doesn’t.
My gaze catches a framed photograph above the bed depicting two smiling young men, their arms around each other, clad in ski gear.
At thirty-two years old, the man is dead. I draw a clean white sheet over the man’s head, shuck a pair of sweaty blue latex gloves into a red garbage bag, and begin picking up scattered equipment.
The sunlight greets me again as I pack our gear out to our rig. I trudge past immaculate rows of flowers—the man’s children, his creations, thriving, oblivious to his demise. Life goes on.
We take all precautions to clean our medical equipment and return the rig to service. One of our members, who will remain anonymous, sees fit to pour a strong bucket of bleach and water and to soak the defibrillator paddles in them. I am certain that all traces of HIV were eliminated, though the paddles, to the tune of several hundred dollars, are a complete loss.
We ride back to the station in silence, the man’s body remaining on the floor of his bedroom, awaiting the arrival of Hess Funeral Home. My sweaty palms rest on my lap, white shoes kicked up on the railing of the stretcher, clean and unused, awaiting a viable customer.
Shocked
As an Explorer, my responsibility was primarily to learn, and secondarily to assist firefighters and EMTs. I was a “go-fer,” running back to the rig for additional oxygen and medications. I think I spent more time outside the scene than in it. As one who had not yet acquired the essential skills of an EMT, I was, among other things, a convenient IV pole. A paramedic, his hands full with more important duties, would often hand me the IV bag to hold which offered me a convenient position to observe the various goings-on on scene. On occasion, when not enough volunteers showed up, I would be promoted to de facto EMT and take on more responsibility than I really should have been assigned.
