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His hands lay still by his sides, palms up, his small fingers curled slightly. I knelt beside him and placed my hand gently on his chest and felt his struggle for each breath. His eyes were half closed, his lids fixed, his pupils sluggish. Cerebrospinal fluid, watery and clear, drained from his nose and right ear. I didn't know his name then and so when I leaned closer to him, so close I could feel his sweet breath on my face, I simply called him, "Baby." But there was no response.
I glanced at the overturned and shattered car, then turned my attention back to him. There was no blood to wipe away. There were no lacerations to bandage, no broken bones to splint, but when I moved my fingers through his blonde hair I felt the deep depression in his skull.
Lonnie had intended to go to the store before her children awoke. Paula was five now and Jesse was three, and she felt she could occasionally leave them alone while they slept since it was only a fifteen minute trip to the store and back.
She enjoyed taking them with her when there was a little extra money, when she could buy them Starbursts or a fudge bar or one of the toys which hung by the register—checkout temptations, she called them—Silly Putty or ball and jacks. But today her husband had left her only enough for the milk. She knew Jesse would probably make a scene and she'd have to spank him and then they'd both be angry for the better part of the morning. That's why she wanted to go alone.
She changed from her gown into jeans and sweatshirt and was running a comb through her dark curly hair when she heard them laughing. She dropped her comb on her dresser and crossed the narrow hallway to their room. When she opened the door their laughter abruptly stopped, and she saw the movement under the covers.
"Do you have that puppy in bed with you?" she asked them. Her velvety Virginia accent padded her words and stretched them out so each word nudged the next.
The children exchanged a sober glance. "Yes, ma'am," Paula answered.
"Get him out," Lonnie said. "And go back to sleep."
"I don't want to go back to sleep," Jesse objected, dropping the beagle pup on the floor. "I'm hungry." The puppy darted under the bed.
"I'm hungry too," said Paula.
"Well," Lonnie sighed, "we've got to go get some milk first."
Jesse slid off the bed onto the floor and the puppy was there to meet him. "Can I get something?" he asked, scooping the beagle up into his arms.
"Not today, honey," she told him. "Put the dog down so you can get dressed."
"I can't get anything?" he whined.
She pulled his pajama top over his head, then smoothed his tousled hair. "Jesse, there's only enough for the milk."
"Then can I take Rascal with me?"
"Can we, Mama?" Paula asked.
She looked at their upturned faces.
"All right," she said. "We'll all go to the store."
It was 8:00 when they took their places in the car. Jesse sat next to the window with the puppy on his lap, Paula in the middle beside their mother. The car was old. There were no seatbelts.
"Keep Rascal over there, Jesse," Lonnie said as she backed out of the driveway. "Don't let go of him."
Jean Lodge, Joe Broderick, and I were on rescue squad duty that day. By 8:00 we'd been on for 2 hours of our twelve-hour shift. So far, it had been a quiet morning. No calls. I took my pager from its charger and clipped it onto my belt, then finished the last of the breakfast dishes.
I opened the freezer door and studied my selection, trying to decide what to have for dinner. Both Dave and Matt had football practice after school and wouldn't be home until late. Jennifer would get off the bus at her friend's house and I'd pick her up at six when my duty ended. David would be home by 6:30. We often ate in shifts, especially during football season. I decided on meat loaf and took out two pounds of hamburger.
At her home, Jean switched on her TV, waiting for 9:00 and "Donahue," then took out her stationery to write a quick note to her grandson in Florida.
Joe had been at his hardware store since seven, gathering information from the store's computer for the upcoming inventory.
I closed the freezer door. Jean uncapped her pen. Joe jotted down the stock numbers of storm doors.
The tones went off.
"Attention Lake of the Woods Rescue Squad members," our dispatcher announced. "We have a report of a 10-50 PI on Route 624. Three victims, two children, one unconscious."
A 10-50 is a wreck. PI indicates personal injury. Our dispatcher repeated the message, but by then I was already in my car hurrying toward the fire and rescue building. Joe was closest. He had the ambulance out of the bay when Jean and I arrived.
We were on the road in three minutes.
"Medic 29 to LOW," I spoke into the radio. "We're en route to the scene. Tone out for a second unit."
I replaced the radio and turned to Joe. "If our information is correct, we'll need both units."
Joe drove the ambulance skillfully, carefully accelerating over the narrow winding road. Trees stood like sentries on either side. Above us, their limbs touched, forming a golden archway. Pavement gave way to gravel as we moved deeper into the country. Gravel surrendered to dirt when we turned onto Route 624.
Our information was correct.
Jean went to the little girl sitting in the grass next to the roadway. She was softly whimpering and appeared dazed and disoriented. Jean held her for a few moments before she began bandaging the large laceration on the back of her head.
The mother was on the ground near the girl. Joe knelt beside her. She was having difficulty breathing. Her ribs were fractured, one lung punctured. Joe suctioned blood from her mouth, then placed the oxygen mask on her face.
I went to the boy.
Later, in the hospital, Lonnie would remember clearly all that preceded that trip to the store, but her recollections of the accident were blurred. It was Paula who told about Rascal jumping onto the floor and crawling under her mother's feet, and when her mother had reached to grab the beagle pup, the car swerved off the road and overturned.
I watched his chest rise and fall rapidly. His breaths were labored. Suddenly, they stopped. I pressed my mouth over his and breathed.
And he breathed on his own—one breath, then another—slowly at first, but gradually accelerating and increasingly labored. Then again he stopped, and again I breathed into him.
I knew it was Cheyne-Stokes respiration: the bizarre breathing pattern that accompanies a severe head injury.
The cycle continued.
Our firemen were now on the scene and I called to them to bring me a short backboard. We carefully eased him onto it and carried him to the ambulance.
Bill Werber and Cliff Wolff arrived with our second unit. They would transport the mother; we would take the children.
Inside the ambulance I placed electrodes on the boy's chest, then connected the leads to the cardiac monitor. I saw the EKG of a healthy three-year-old. His heart was strong. It was the blood and swollen cerebral tissue pressing against his brainstem and irreversibly damaging his respiratory control center that was taking him from us.
I breathed for him.
Joe moved in beside me.
"Stay with him," I said. "Watch his breathing."
I had asked the firemen to help Jean get the girl on a backboard. She should have already been on the ambulance. We were losing time.
I stepped off the ambulance and saw the sock lying in the road.
It must have fallen there when we moved him. Almost subconsciously I picked it up and put it in the pocket of my jacket.
The girl was more alert now and was terrified. She screamed over and over for her mother. Jean had tried to restrain her on the backboard, but it was impossible.
"I'm going to have to just pick her up and carry her," I said to Jean.
Firemen were hosing down the area around the car where gasoline had spilled onto the ground. Jeff, one of our firemen, was holding a beagle puppy.
Cradling the girl securely in my arms, I started to step onto the ambulance when suddenly she cried, "Rascal!" I turned and paused as Jeff approached us. The beagle was barking and squirming in his arms.
"Is this your puppy?" he asked her.
"That's Rascal," she said, rubbing the puppy's ears.
"Will you let me keep him for you until you come home?" he asked. "I'll take good care of him."
She studied Jeff carefully before she nodded. "Yes."
"Okay." Jeff smiled at her.
She had quieted. I carried her into the ambulance and placed her in Jean's lap, then moved next to Joe.
"Let's go," I said to him. As he moved up front into the driver's seat, I told him, "Expedite."
Before we turned onto hard surface, while we still moved over the back country roads, I could hear Jean and the child talking. Their voices were soft. Jean positioned her so that her back was to her brother, so that she couldn't see me breathing into his mouth.
"What's your name?" Jean asked her.
"Paula," she said in almost a whisper.
"Carla?" Jean asked.
"That's a pretty name," Jean said to her. "Even prettier than Carla."
"What's your name?"
"My name is Jean."
"That's a pretty name, too," the child said.
"How old are you, Paula?"
She held up her hand and spread her fingers. "Five."
"What's your brother's name?" Jean asked her.
Paula turned toward him. That was the only time she looked our way. She watched for a brief moment, then turned back to Jean.
"Jesse," she said. "His name is Jesse."
When we left the dirt and gravel roads and moved onto asphalt and into traffic, Joe switched on the siren. The undulating wail filled the space around us. Jean held Paula closer.
As we neared the hospital, Jesse's condition worsened. The cycle shortened. I became his every breath.
In the trauma room at Mary Washington Hospital, two doctors labored over him. They inserted an endotrachial tube into his airway and injected Mannitol into his veins in hope of reducing the swelling in his brain. He remained unresponsive. They called for the helicopter and twenty minutes later he was flown by Medstar to Washington Children's Hospital for emergency surgery.
We called the hospital that night and again the next morning to check on his condition. It remained unchanged.
Thirty-six hours after the accident, Jesse died.
It was later, when I was cleaning out the pockets of my jacket, that I found Jesse's red sock. I looked at it, so small in my hand. It was new.
"For God's sake, Pat," David said to me, "throw it away."
"I can't," I told him.
I couldn't throw the sock away and couldn't return it, so I tucked it away in my dresser drawer. As time passed, it was pushed farther and farther to the back.
Almost two years have gone by since that day and from time to time, during spring cleaning or when I'm searching through that drawer for something else, I find the sock.
And I remember Jesse and pause for a moment.
Then I think of us, the rescue squad.
"He never had a chance," the hospital nurse had told me on our last phone call about Jesse.
"I know," I had said.
I did know and had known from the very beginning. From the moment I saw him there on the road, from the instant I saw his hands and his eyes, before I felt the deep depression in his skull, and before I tried to breathe life into him, I had known.
But we try. Even if it means hoping when there is no hope, wishing on a starless night, we try.CHAPTER 2
"I could never work on a rescue squad."
Even before she spoke, I knew she was watching me. She sat at the Formica-topped table in the ER nurses' lounge, clean and crisp in her white uniform.
I poured coffee into a Styrofoam cup, adding sugar and cream. The mixture was grey and smelled like charcoal.
I muffled a yawn. "Why not?" I asked her.
"I like knowing there's a doctor nearby," she said. "And I have to work in a controlled environment."
I smiled at her. "Then you really wouldn't have liked it out there tonight." I raised the cup to my lips, then lowered it. "What time do you fix a fresh pot?"
"Probably not until about 3:00," she said. "I don't drink it myself."
"Well, don't start drinking it now," I told her.
I walked into the bathroom, switched on the light and poured the coffee into the sink. It left a grey ring at the mouth of the drain. I turned on the faucet to rinse it and glanced in the mirror.
I reached up to the right side of my head and felt the blood and vomitus matter in my blonde hair. I tried picking it out, then cupped my hand under the running water and splashed it on my hair, but that just seemed to stir up the smell.
My blue eyes were bloodshot and swollen and ached with fatigue. My whole body was sore and the sight of my image, looking much older than forty, just made me feel worse. The fluorescent light exposed every line and blemish on my face.
"It's hopeless," I said aloud. I washed my hands and returned to the lounge. The nurse had gone.
I walked into the hall. Joe and Norm Ensrud had finished changing the sheets on the gurney. I took a nasal cannula from the supply shelf to replace the one we had used and walked behind them as they pulled the gurney down the hall toward the loading dock.
"Sounds like a Saturday night," Joe said.
The ER sounds never blend together, but rather are like musical instruments in a homemade band, always a little off-key and disjointed. There is no harmony. Low pitched moans, short yelps, the occasional clanging of a dropped bedpan make it difficult to accurately locate any one particular sound.
Voices are easier to define: the paging of hospital personnel over the intercom, "Respiratory therapy, ICU, STAT," quick snatches of conversations between doctors, "I still think the arrhythmia is a result of the amount of digoxin he's taking" and from the waiting room where the walk-ins converge, "his fever's worse," "I've been sitting here over an hour," "She just broke out in this rash," "I think it's broken."
Unless they are especially shrill or vulgar or interesting or frightening, we move oblivious through the sounds and around the voices like people subconsciously aware of the Musak, but unable to recall what songs were played.
"Smells like a Saturday night, too," Norm said.
"I think that's Pat you smell," Joe told him, looking back at me and grinning.
"Very funny," I said.
We walked past the front desk and the triage nurse.
"Hey, Lake of the Woods," she said. "Please don't bring us any more like that last one."
"There can't be any more like him," I told her.
His car had been airborne for fifty feet before it crashed into the woods, coming to rest at a forty-five degree angle, its left side resting on a tree. Inside the car, our patient had been hurled into the back seat.
Marcus Wallace, one of our squad members, lived near the scene of the accident and had responded direct.
"He keeps blacking out," Marcus told us. "We're going to have to get in there, and the doors on this side are jammed. Pat, can you get in from the other side?"
If a patient is trapped in a vehicle following an accident and if entry can be gained, a squad member gets into the vehicle until the patient can be removed. I have crawled through front, side and rear windows to bandage and splint, to monitor a patient's heart rhythm, to start an IV, to comfort, to make patients feel less frightened, less alone, and to be with them when the harsh, grinding noises of extrication explode around them.
But this night would be different.
Norm and Joe and I walked through the underbrush to the opposite side of the car. "How come no one ever asks you all to do this?" I asked them.
Joe patted my shoulder. "It pays to be tall."
Our crash truck arrived along with the fire truck, and the spotlights were turned on, illuminating the scene.
Joe checked the size of the tree on which the car rested, then pulled hard on the back fender of the car.
"It's secure," he told me.
Because of the angle of the car, its door was at my shoulder level. "You're going to have to help me get in," I said to him.
He cupped his hands. "Put your foot here." He boosted me up and into the car.
Inside, it was hard to keep my balance. I had barely two feet of room and kept sliding to the right, against our patient. Finally, I knelt facing him, but still had to brace myself against his left arm.
He appeared to be in his early twenties. "I'm Pat," I said. "I'm here to help you. What's your name?"
"Larry," he mumbled, and I could smell the alcohol. "Get me out of here," he said, leaning hard against me, pushing me into the corner of the back seat.
"We're going to," I told him, placing my hands against his arm to keep him off me.
Excerpted from EMT by Pat Ivey. Copyright © 1990 Pat Ivey. Excerpted by permission of OPEN ROAD INTEGRATED MEDIA.
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