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"Possible overdose," the dispatcher said. "Thirty-four-year-old female."
The location of the call was near my house. Otherwise, I might not have gone. Kirk and Bobby and Pia were on duty and easily could have handled it.
I pulled my uniform from the closet and slipped it on over my shorts, grabbed my portable radio, and headed for the car. "Possible overdose" doesn't tell us much. It doesn't tell us what was taken, or the level of consciousness, or the respiratory status. Deputies often accompany us to overdose calls for adults because of the likelihood of a volatile situation. With children, the overdose is almost always accidental; with adults, it's intentional.
Our security force was already on the scene. Clay met me at the driveway.
"I don't think she's taken anything, Pat," he said, shaking his head. "Her neighbor called us and then called for rescue. He said she was acting funny, but this isn't the first time."
"What's she doing?" I asked him.
"Reading from the Bible. Saying she's got to get rid of the devil. She needs some help, Pat, but I don't think she's taken any pills. We've been here before, just to ask her to quiet down."
"What's her name?"
I heard the siren in the distance and reached for my radio. "EMS 29 to Medic 292."
"Go ahead, EMS 29," Bobby responded.
"Come in easy," I told him.
On the front porch, a small boy played quietly with plastic toy dinosaurs.
"Hi," I said, kneeling beside him. "My name is Pat. An ambulance will be here in a minute just to make sure your Mommy's okay."
He nodded slowly and held a dinosaur up for me to see. "I'm Tyler and this is a Tyrannosaurus rex," he said.
"The king of all the dinosaurs," I replied.
He smiled then, but only with his mouth. There was no sparkle in his eyes. There was no luster in his pale, slender face.
His mother was standing in the kitchen reading aloud from her Bible. Her back was to me, and I approached her quietly. "Lisa," I said, but she seemed unaware of my presence until I reached out and touched her arm. She wore a sleeveless shirt, and her skin was cool to the touch. She turned and looked at me, her dark eyes dazed and vacant.
"And the children of Israel again did evil in the sight of the Lord." Her finger moved slowly, deliberately across the lines. "Listen!" she said, and she read it to me again.
"Lisa," I began, "we want to know that you are all right." My words sounded hollow, even to me, for it was quite clear she was not. "We would like to take you to see the doctor."
"I am not sick," she said. "I am evil."
"I don't think you are evil," I responded. "Sometimes things get very confusing for us. Sometimes life is very difficult —"
"I am evil and I want to speak to a minister," she interrupted me. "This book says I'm evil. The Bible says I'm evil. I don't need you. I want to speak to a minister."
"All right," I told her.
We summoned the local minister. Bobby and Kirk stayed on the porch with Tyler and played dinosaur games. Lisa was eager to sign the refusal form, which stated that she did not want us to treat or transport her. We were not so eager to leave. Kirk and Bobby lifted Tyler to the ambulance. He listened to his own heartbeat with the stethoscope and put a Snoopy Band-Aid on an imaginary cut. Kirk gave him a small stuffed dragon to go with his dinosaur collection.
Pia and I stayed close to Lisa while we waited for the minister to arrive. She would not leave the kitchen, and continued to read to us from the Bible. We pulled chairs in from the dining room and sat in a circle next to the sink, where dishes were piled high. Lisa showed us a scar on her arm where she'd once had a tattoo, then had it burned away. "It was Satan," she said.
When the minister arrived, Clay was the first to leave, having determined that the scene was secure. Lisa and the minister sat together, still in the kitchen. I placed my hand on her shoulder before Pia and I left, but she was again unaware of my presence. Her head was lowered over the Bible, her dark, unkempt hair obscuring her face.
"Please call if you need us," I said softly to the minister. He nodded.
Kirk flashed the lights of the ambulance for Tyler as they drove away. The small boy watched them from the porch, his hand half raised in farewell. I drove the short distance back to my house.
It was not quite nine o'clock on that beautiful May morning in 1992. My older son, David, would be home from Austin the next day. His year in VISTA was over, and he was coming home for three months before leaving for Ecuador and two years of service in the Peace Corps. Matt, finishing his first year at the University of Arkansas in Fayetteville, would be home by the weekend. There was much to do.
I thought of Lisa and Tyler many times throughout the morning. I hadn't learned much about her from Clay. I did know she was a single parent, trying to raise her child by herself. She'd recently lost her job and was growing more and more isolated.
My children and I had made it through separation and divorce. It had not been easy, and it had surely taken its toll, but we had survived. Why is it, I wondered, that some of us survive and others don't? And when is it that we lose the ability to cope; when do misfortune and heartbreak take on the shape, the silhouette of demons, and at what point do hallucinations become real and fill not only the corners of our minds, but also, finally, the corners of our rooms?
I drove into Fredericksburg that afternoon to do some last minute shopping. Ingredients for lasagna and banana nut bread were high on my list. Jennifer and I would fix her brothers' favorites. She was fifteen then — sometimes we giggled together over silly things and hugged each other tightly; other times, we both struggled with her quest for independence.
It was three-thirty when I turned into Lake of the Woods, my home now for sixteen years. On my right was our Volunteer Rescue Squad and Fire Department. I stopped briefly to get my mail and to look over the call sheets to see if there had been any emergencies while I was in town. Nothing since the call for Lisa.
Jennifer's bus went by as I left the building. I picked her up at the next stop. "Hi," she said to me. "Why did you pick me up here?"
"Just so I'd get to spend more time with you," I told her.
"Can I switch the radio station?" Her hand was on the dial before I answered, and Garth Brooks was suddenly transformed to the Red Hot Chili Peppers.
Just as we turned onto Yorktown, our street, the tones went off. "Attention Lake of the Woods Rescue Squad, unresponsive child on Lakeview Drive. Expedite."
I knew it was Tyler.
"... because Erica said she was going to the dance with Robert and Robert said he didn't know what she was talking about —"
"Jennifer," I interrupted her.
"I hate it when you say my name that way," she sighed. "I always think I'm in trouble."
"Rescue 292 is en route to the scene." It was Kirk. "Additional personnel respond to the scene." His voice, usually strong and self-assured was shaky. He, too, knew it was Tyler.
"No," I assured her. "You're not in trouble. Get your things together. I'm going to drop you off at the house. I've got to go on this call."
Lisa had thanked the minister for taking the time to talk with her. Yes, she assured him, she was fine. Talking was all she had needed. She walked him to the door and out onto the porch. She reached down and mussed Tyler's hair, a loving gesture, waved good-bye to the minister, and retreated into the house.
When Tyler got hungry for lunch he left the porch and went into the kitchen. He moved the chair to the counter and climbed on it to reach the peanut butter. He moved quietly, sidestepping his mother, who stood in the kitchen holding the open Bible, reading softly to herself. He ate his sandwich on the front porch, then carried the dinosaurs and stuffed dragon into the front yard. The Tyrannosaurus rex and Brontosaurus peeked out above the fresh May grass. Tyler hummed a happy tune from Sesame Street.
She told him they were going for a swim. He stood up and reached for her hand and they walked the short distance to the lake, to the water's edge. He carried the small green stuffed dragon in his free hand; in hers, she carried her leatherbound Bible.
On the lakeside road, a front seat passenger was the first to notice the woman and boy in the water. She commented to her husband, "It's awfully cool for swimming, don't you think?" He readily agreed, but neither of them noticed that the woman and the boy were fully clothed.
The driver of the second car to pass thought the two were playing in the water. He slowed down for a closer look, then sped away to report what he'd seen; but by the time he reached the security office, two other people had called to report a woman in the lake attempting to drown a child.
Tyler broke free. He was almost home when he tripped and fell. A neighbor had heard his screams and rushed to him, arriving just as he lost consciousness: terrified and winded from the struggle and the long run home, he had fainted.
When I arrived at the house, I found Tyler bundled in a blanket, awake and responsive, in the neighbor's arms. "I lost my dragon," he said. His voice cracked as he spoke. "He drowned in the water," he told me, and he began to cry. The neighbor held him tightly.
"I'll get you another one, Tyler, just as soon as the ambulance gets here. You can have your pick," I said, reaching for his small, pale hand.
When security reached the site of the reported drowning, Lisa was standing waist-deep in the water.
"Satan is here," she screamed at them. "Let me baptize you before Satan lays his hands on you."
They got in the water with her. She didn't resist them when they picked her up and carried her to the car. They brought her to us, her Bible clutched tightly in her hand, and we lifted her onto the ambulance. She shivered as Pia and I removed her clothes and covered her with blankets.
"Read to me," she said, finally relinquishing the Bible and handing it to me.
"In a moment, Lisa," I responded. "I will in just a moment."
While we took her pulse and blood pressure, Kirk carried a teddy bear and a stuffed brown rabbit with floppy ears to Tyler. Joe was there with him. He, too, had driven to the scene, and was helping Al and his wife with Tyler. Although Tyler seemed fine except for a scraped knee, they had talked to the doctor and were planning to take him for a checkup. Joe told him we were taking his mother to see the doctor, too.
"Will she be all right?" he asked. "Will Mommy come back home?"
When we answer such a question, we hope that our response will not be a lie, that there will be some truth in it, especially when the question comes from a child. "Yes, she'll be all right," Joe answered. "And she'll come home as soon as she can."
When we pulled away, Tyler waved.
"Don't use the siren until we get out on Route 3," I told Kirk. "And only when it's necessary," I added. I was concerned that it would only alarm Tyler. Lisa might also be startled by the sudden wail.
Lisa continued to tremble, and Pia tucked more blankets around her. I reached for the Bible. The pages were wet and difficult to pry apart. Her eyes were fixed on me. I turned to the book of Matthew, and read:
Blessed are the poor in spirit: for theirs is the kingdom of heaven. Blessed are they that mourn: for they shall be comforted. Blessed are the meek: for they shall inherit the earth. Blessed are they which do hunger and thirst after righteousness: for they shall be filled. Blessed are the merciful: for they shall obtain mercy. Blessed are the pure in heart: for they shall see God.
She closed her eyes and was quiet en route to Culpeper Memorial Hospital, but she was not at peace. Her body never relaxed. The shivering never stopped. When we arrived, we moved her gently from the gurney onto the stretcher. "I don't know you," she said, her eyes wide and apprehensive. "But I love you."
"We love you, too, Lisa," I told her.
That evening a sheriff's deputy drove her to Western State Hospital in Staunton, a Virginia facility for patients with psychological problems. Tyler's father came to get his son.
And that night I listened to the rest of the story of Erica and Robert while Jennifer and I made the sauce for the lasagna and baked two loaves of banana nut bread.CHAPTER 2
It was in October 1981 that I began my journey into the world of emergency medicine. My first steps were unsure, and I carried with me uncertainties rooted in fear and ignorance.
Nineteen eighty-one was the year the first test-tube baby was born in the United States. That year, the price of stamps rose to twenty cents, and Sandra Day O'Connor was the first woman appointed to the Supreme Court. In October 1981, Ronald Reagan was in the tenth month of his presidency. That same month, I submitted my application to the Lake of the Woods Rescue Squad.
The world has turned many times since that month, that year. Many seasons have passed. Enhanced 911 has come to Orange County, and many of the dirt and gravel roads we traveled are now paved. We have lost our first patient to gunshot wounds in a drug deal gone sour, a seventeen-year-old boy shot at pointblank range on a dark country road.
Late at night, I hear the cows mooing from a nearby meadow. My house sits in the flight pattern of the Canada geese. My ears are attuned to their honking, and when I hear them in the distance, I move quickly from whatever I am doing so I can run outside to my deck and watch them in their perfect V above me.
We are a rural rescue squad. There are thirty-seven of us, and we are all volunteers. As an EMT/CPR Instructor, I have taught thirty-one of them, and now I am their Captain. I tell them they are like my children to me. They are good and dedicated people, and it is my job to take care of them.
It was a springlike October day. She was helping her husband. Something was wrong with the drive shaft, he'd told her. They lay beneath the truck, inspecting it. Then he eased out from under the truck and climbed into the driver's seat.
"I'll start it," he called to her. It would be easier to see the problem. He turned the key, and the heavy engine bellowed. As he stepped from the truck, it slipped into gear.
We were on duty that day, Joe and Dick and I. We had been dispatched to Orange, twenty-five miles away, for a possible heart attack. Our patient was an eighty-eight-year-old man who'd had eight heart attacks in three years. His chief complaint on that day was weakness and dizziness. In a healthy person those symptoms might not be serious, but with this man's medical history, weakness and dizziness could be the prelude to cardiac arrest. We put him on high-flow oxygen and I started an IV.
We were on our way to Martha Jefferson Hospital in Charlottesville when we heard snatches of conversation on the radio: "... injury ... Spotsylvania County ... 293 ..." The transmission was broken and heavy with static, but we recognized Norm's voice.
"Another call," I remarked to Joe. "Injury."
He acknowledged me, nodding. "Pulse is still 84 and strong," he said.
I leaned forward. "No chest pain or tightness?" I asked our patient. I reached for his hand as he shook his head, no. It was cool but dry, and that was good: diaphoresis, heavy perspiration, is another warning sign. "And no difficulty breathing?" Again, he shook his head. "Good," I said to him, "We'll be there in about ten minutes."
We are lucky; we have regularly scheduled duty crews. This was our day to serve. But we were forty miles away when the tones went off for the second call.
Norm was the first one to arrive, then Mike and Scott, just back from class. Kathy, heading home from work, had reached the building just as they were about to leave, and had asked if she could go.
"It's an injury," Norm had called to her. "Probably nothing serious but come on," he said, waving.
The deputy on the scene called it a terrible tragedy. When the truck had slipped into gear, it had rolled over the woman. She'd screamed once, no more; it was too difficult to draw a breath.
Their neighbor, hearing the scream, called 911. "A woman's hurt," she said. And gave no more information.
Excerpted from EMT Rescue by Pat Ivey. Copyright © 1993 Pat Ivey. Excerpted by permission of OPEN ROAD INTEGRATED MEDIA.
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