Silent Siren, page 22
Double Duty
Dick and I are directing a big Presbyterian funeral at a Bainbridge Island church. The funeral is for a well-known member of the community, and over one hundred people are in attendance.
We get there at least an hour early to position the casket for viewing, arrange the flowers, or “floral tributes” as they are called, and set up our lectern at the front with the guest book and prayer cards. For most of the service, my job is to stand there in my dark suit, look attentive and helpful, hand out prayer cards, and direct guests to sign the register at the front.
As the service commences, Dick and I move the casket from the viewing area to the front of the church, positioning it perpendicular to the altar. At the close of the service, we come back to the front, reverence the altar, and slowly move the casket out of the church to the waiting hearse for burial, the family following closely behind. It’s a simple job but requires reverence and some degree of silent communication, as well as choreography. As Dick has said more than once, “You only get one chance to get this right.”
As the service concludes, visitors and family stream into the parish hall for the reception. I gather flowers, place them into our service car, and drive to the cemetery to prepare the grave for the burial. Removing flowers from the altar can often be a challenge, as it involves weaving through throngs of mourners, caught up in their own conversations, oblivious to the guy in the suit struggling with two giant vases full of flowers.
I’m halfway to the cemetery when Dick calls my cell phone. “Can you come back to the church?” he asks. “There’s a man here who doesn’t look very good.”
I flip a U-turn and head back to the church. Probably an old guy who got a little faint in the heat. No big deal. A little pillow fluffing and he’s back to his coffee and cookies.
As I pull the old white Plymouth service van into the church parking lot, I hear the sirens of approaching emergency vehicles.
Hmmm. This must be more serious than I had thought.
The medic unit screeches to a halt ahead of me before I have a chance to exit my vehicle. A paramedic and two EMTs exit and run into the building with all their ALS equipment. As medics, we never run unless the call involves a cardiac arrest or a child in distress. I know this call doesn’t involve a child in distress so it can only mean one thing.
On the cold hard floor of the parish hall, a thin elderly man lies on the floor, inert beside an overturned walker. Funeral attendees continue to chatter in their small groups, drink coffee and eat cookies as firefighters perform CPR.
I make my way through the crowd and make my transition from Matthew Sias, funeral director, to Matthew Sias, paramedic. I feel like Superman without the cape. Though my suit is dark and funereal and my name tag reads “Matthew Sias, Funeral Assistant, I jump into the fray and ply my trade as a paramedic.
I assign myself to med box duty and inject cardiac drugs at the direction of Jeremiah, the paramedic running the resuscitation.
Dick stands at a respectful distance and watches the drama unfold, probably wondering if he is about to acquire a new client.
The resuscitation is not going well. The man has a few paroxysmal heartbeats but is not regaining a pulse or consciousness. I update Dick on the developments, but he seems already to realize the futility of our efforts.
Our service car is now full of flowers and if I we cease resuscitation here, I will need to drop the flowers off somewhere, make my way back to the mortuary, and load up the gurney in order to make the removal.
I go back to the resuscitation where Jeremiah is doing some last-ditch effort to generate a pulse in the elderly man. He wants to know some medical history on the patient, so I offer to call his daughter, inform her of the situation, and gain information on the patient’s history. Obviously, when I call, I identify myself as Matt, a paramedic with Bainbridge Island Fire Department rather than Matt, Funeral director with Catalano and Sons. That would be awfully presumptuous of me.
I get the necessary information and relay it to Jeremiah, who has now realized very little is left to do. So as to avoid declaring the man dead in the middle of the parish hall among people mourning another death, we decide to transport him outside to the medic unit, with ongoing CPR. It is only a charade, but one that makes things a little more comfortable for everybody.
Once in the medic unit, the resuscitation ceases. A sheet is pulled up to the dead man’s chest, and the doors are closed.
Lieutenant Denise Giuntoli from Bainbridge Police is on scene now and makes the obligatory call to Kitsap County Coroner to determine disposition of the body.
The coroner declines jurisdiction. In the back of Medic 21, firefighter Kristin Braun is on the phone with the daughter of the deceased, who is now in the position of choosing a funeral home for her father.
“She says she wants to go with Catalano and Sons,” says Kristin.
Kristin hands the phone to me. I am now in the very odd position of introducing myself to her as “Matt Sias, Funeral Director,” the same person who had twenty minutes ago introduced himself as “Matt Sias, paramedic.”
I am reminded of a Podunk town in the Wild West, in which the undertaker is also the mayor and proprietor of the general store. I can’t help but wonder if she sees a conflict of interest. Had we failed to resuscitate her father because I was trying to drum up business for the funeral home? Nothing could be further from the truth, but still…I wonder.
As we wait in the parking lot of the church for some of the medical equipment to be put back in service, a para-transit bus pulls up and lowers its wheelchair ramp. I recognize it as the same one that had delivered our now-deceased funeral attendee to the church only an hour or so before.
“Are you here for Ralph?” I ask the driver.
“Yes,” he says, the lilt of a question in his reply.
“I’m afraid he died,” I say.
The driver pulls the ramp back up and drives away.
I drive the empty van back to the funeral home to await Jeremiah’s arrival with the body in the medic unit. When he arrives, we transfer the man to one of our mortuary gurneys. I press the code on the keypad to the preparation room. I wheel him into the darkness and shut the door.
Every Sparrow’s Fall
Fog swirls around the headlights of my car as I make my way down the narrow gravel driveway away from my house and towards my parents’ house. I switch on the brights as I turn left to Lovgreen Road, a rutted dirt path that leads past a towering water reservoir to the paved road ahead. The 6:20 p.m. ferry boat from Seattle has just let out its passengers and traffic is moderately heavy. My headlights catch a bounding ball of fur—a neighbor’s cat—running from my car towards the busy street. I’d seen him around for months but never knew which among the scattered houses in the neighborhood he called home.
He runs headlong into the street just as a pickup truck whizzes past at forty miles per hour. There is no skid, just the sound of tires on a rainy street. Struck, the cat skitters on his side a few feet and comes to rest in the median. His tail thrashes violently for a few seconds and then stops. The truck disappears up the road, taillights fading in the distance.
My heart drops in my chest. I stop my car at the end of the driveway and, on instinct, rush to the limp body. Maybe it’s the paramedic in me. Gently I lift him off the road. A few drops of blood drip from his open mouth. His body is still warm from the blood that had ceased coursing through his vessels only moments ago. I feel his skull—soft, yielding. My fingers palpate the fur around his neck for an ID collar. I find none.
Now what? I can’t just leave him here. I have to find his family.
I place the mortally wounded animal in the back of my SUV, turn around, and drive towards my neighbor’s house. His is the only other house on my street and it’s the only area I’ve seen the cat spend any time.
He opens the door and I swallow before I ask, “Do you have an orange cat?”
“No,” he says.
“He’s dead. He got hit by a car. Do you know who his owner is?”
“No. I’ve seen an orange cat around here from time to time but I don’t know who he belongs to,” the man says.
I thank him, walk back to my car, and wonder what to do with the body in the back of my vehicle. Though I wasn’t the one whose vehicle struck him, I still feel responsibility for his death, since he had fled from my vehicle into the path of the truck that killed him.
I remove his body, now rapidly cooling, from my vehicle, and gently place it on the ground next to a cluster of mailboxes. At least this way, when the sun comes up, his owners will be able to find him. If I were to bury him, his family would never know what had happened to him.
I stand by my idling car, arms folded against the November cold, gazing at the still form, saying a silent prayer for his soul. The smell of ozone hangs in the air. Still, something isn’t right. I drive off to Fairmont Lane, to Mom’s garden.
A few minutes later, I arrive back at the cat’s side, my cold hands clutching fall-blooming flowers in purples and whites. I place the small bouquet on the cat’s chest and step back, a lump forming in my throat.
I imagine the sun rising the next day and the owners of the cat discovering his body, now cold, dew glistening on his orange fur. I hoped they would see the flowers as a sign that someone cared enough to acknowledge the passing of a small, some may say insignificant, creature from this earth. I guess it’s the funeral director in me, the persona that believes that ceremony and the rites of mourning are essential to our humanity. The body is not unimportant, not to be dealt with as trash. Though it no longer functioned, his body represented who he was. I had to acknowledge the cat’s death, because, though I didn’t know him, he mattered to somebody. For me to do otherwise would be less than human.
Improvising
The coroner tells us she died of a heart attack. Given her considerable girth, it’s no surprise. At twenty-eight years of age, Ellen weighs well over three hundred pounds. The paramedics found a piece of candy in her throat when they attempted to pass a tube into her trachea. Now she lies, cold, limp, and massive under the fluorescent lights of our prep room, face purple from anoxia, endotracheal tube protruding like a snorkel from between her lips.
On a wheeled cart beside Ellen’s body sits an oversized Domet casket, its hinged lid open, waiting patiently for its cargo. Not exactly the Cadillac of caskets, the Domet is about as basic as you can get. It looks like a cardboard appliance box overlaid with felt. The interior of the container is lined with shredded newspapers covered with a thin crepe paper.
“How are we going to do this?” Dick asks.
Billy stands at the entrance to the prep room. She’s another funeral home tech, brought in from home to assist in this endeavor. “I’m thinking,” she says.
I cross my arms. No mechanical lift, three mortuary personnel of rather modest physical strength, and a woman who’s eaten herself to the size of a baby elephant. Sounds like a recipe for disaster.
“She’s going to sink like a stone,” says Dick. “That’s if we can even get her in there.”
Ellen’s immense weight will cause her to sink to the bottom of the casket, the shredded newspaper enveloping her until little is left to view of her but a portion of her face and two hands atop a morbidly obese belly.
Billy brightens. She points out a plywood tray leaning against the wall in the corner of the prep room. “We could cut the end off that shipping tray, lay it in there, and then put her on top,” she says. Used for shipping bodies by air or rail, the tray is used two or three times a month for our “ship-outs” to out-of-state funeral homes.
“We don’t have a saw,” Dick says.
“No, but the fire department does,” I say.
A half hour later, two firefighters pull up in Rescue 21, bearing a power saw and extension cord.
I wonder what the passersby will think. Two firefighters walk into a funeral home with a power saw. Nothing abnormal there.
Sawdust flies onto the carpet as a firefighter cuts the end off the shipping tray. It fits snugly into the Domet. Much discussion ensues as to the most ergonomic method of casketing our client. Our usual modus operandi was to simply slide the body over from the prep table into the casket. That seems less possible considering the immense weight of the body. Tipping the casket over would spell disaster.
Dick has an idea: “Let’s take the casket off the church truck, put in on the ground, and then put her in,” he says.
The two firefighters could, I am sure, think of a hundred better things to do than heaving an obese body into a casket, but they are cheerful, and I am grateful for the manpower. With the five of us, we are able to lower Ellen, in a somewhat dignified manner, into her casket. Nobody gets hurt and Ellen looks, well…comfortable in her giant shoebox.
Some days later, Ellen has her funeral and all goes well. From there she is placed, casket and all, into the crematory retort at First Cremation Service in Kent. Because of her size and much to the chagrin of her brother, she is returned to the family in two urns instead of one.
“Can’t you just get rid of one of them?” says the brother, dismayed.
“Legally, I can’t do that,” says Dick.
The man turns and walks away with the mortal remains of his sister, occupying an embarrassing amount of space, even in cremated form.
I never did find out what happened to “the rest of Ellen.”
Ditched
It’s a crisp, cold evening, and the tones hit for a cardiac arrest on Spargur Loop Road. If I’m available, I respond to all cardiac arrests on the island. A resuscitation is manpower intensive, and often a second paramedic can be quite helpful to bounce ideas off of, as well as to perform skills like intravenous access and drug administration. I respond in my own vehicle, a 2000 GMC Jimmy. The chief has banned our green flashing lights, so it takes me a while to get there. Damn the speed limit!
Two medic rigs idle on the street, their emergency lights flickering off the windows of neighboring homes. Volunteers’ cars line the nearby driveways, their hazard lights blinking. The smell of fireplace smoke, an odor I’ve always found comforting, issues from a nearby chimney.
The emergency crew is illuminated in the light from the open door, clustered around a woman lying just inside the entrance, her chest being compressed by a volunteer firefighter in blue jeans and plaid shirt. Clad only in a T-shirt and underwear, her son had found her unresponsive, apparently typing an e-mail at her computer, her head flopped over onto the keyboard, the screen reading “Getting ready for the Holmjnhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh.” He had moved her to the living room to attempt CPR. As the woman weighs nearly three hundred pounds, the effort to drag her limp body from the bedroom to the living room would have been no small feat.
Jeremiah is in charge and has already intubated the patient and started pushing meds. Lieutenant Dow arrives with his girlfriend, a flight nurse from Airlift Northwest. She inserts a nasogastric tube in the patient’s nose to decompress the large volume of air that has gone into her gut from aggressive pre-intubation ventilation.
The EKG tracing displays a slow, agonal rhythm—a flat line with a few electrical impulses that do not generate a pulse, a condition known as Pulseless Electrical Activity, or PEA. CPR continues. The patient’s son watches from the kitchen, walks in circles, and punches phone number after phone number into his cell phone.
After about ten minutes, the large woman on the floor has taken on a much deeper hue of purple than she displayed when I first encountered her. None of the oxygen being blasted into her airways is of any use. A television blares from the living room. An anchor announces tomorrow’s weather to ten people who couldn’t care less, preoccupied with the lifeless woman sprawled on her linoleum.
Jeremiah confers with me to make sure we have done all we can do for the woman. “A liter of fluid, three rounds of epi and atropine, bicarb…” Jeremiah ticks off the treatment for PEA.
Captain Lundin kneels over the woman’s right arm, working on a second IV through which to flow additional fluid. He also knows we are reaching the end of the resuscitation. “Are you on duty for the funeral home tonight?” he asks.
“I’m always on duty,” I reply. This gets a chuckle from the crew.
After a valiant resuscitation attempt, Jeremiah pronounces the woman dead and draws a sheet over her face. As is commonly done in the case of a natural death, we carry the deceased woman back to a bedroom and lay her out in bed, where her son can pay his last respects. In retrospect, this is not such a grand idea. Though I am one of the EMTs trying to go the extra mile for the family, I will also be one of the morticians carrying her down a narrow, cramped hallway, and out the front door.
Kitsap County Coroner’s Office arrives forty-five minutes later. While the deputy does his obligatory death investigation, I take the opportunity to drive to the mortuary and pick up our van.
I arrive back on scene and maneuver the funeral home’s 1993 Plymouth Voyager van up the driveway, backing it up to the front door. As I’m backing, I notice that Dick had recently replaced the solid Landau panels on the back with tinted glass panels, possibly because he didn’t want his van to look like a hearse when he’s running family errands.
The deputy coroner snaps a few pictures and obtains necessary information from the deceased woman’s adult son. He helps us move her on a backboard from the back bedroom to our removal cot in the living room. We load the body into the van and I climb into the driver’s seat for the short trip back to the funeral home.
I turn the key in the ignition and drive slowly down the narrow gravel driveway, the yellowing headlights of the van barely illuminating my path. I flick on my blinker and crank the wheel to the left. Suddenly the van pitches sideways. The left rear wheels sink in soft mud. In a pitiful attempt to counteract inertia, I bail the wheel to the right.
The headlights point at a forty-five-degree angle to the horizontal. The gurney slides from the center to the left and the van sinks further. I’ve traveled no more than ten feet from the scene and I have already put the van into a ditch.
