In Case of Emergency (14 page)

30.

“Stop CPR,” says the lead medic.

Finally bending my blood-filled arms, I lean my weight back on my heels. It feels weird to be touched by Ruth. Her gesture had been businesslike but tender. I feel the sweat at the roots of my hair and wonder
how damp and flushed my face had felt on the thin skin of her forearm. “Thanks,” I whisper. Her gaze fixed on the monitor screen, she doesn’t appear to hear.

The dramatic spikes my compressions created plunge into a subdued quiver above and below where the man’s asystole line would be. “V fib,” a paramedic calls out to the captain. “Setting up a shock.”

Squeezed shoulder to shoulder in the tiny office space, the large men work steadily around the patient’s body, most crouching or on one knee. Three firefighters prepare IV lines and drugs, two unpack the intubation kit, and another, halfway in the act of cutting off the man’s jeans with trauma shears, rocks to his feet and takes a step back. Carl, his fingers gripped around the man’s jaw for leverage to open his throat, squeezes one more breath into the man’s lungs with a bag valve mask.

Defibrillation is something I’ve never seen, and I feel another small thrill. In EMT class I learned what shocking actually does, and realized I’d been lied to by TV shows and movies my whole life. Sending 250 joules of electricity through a person’s chest stops his heart completely. It’s counterintuitive to think that to save a man’s life you would first kill him, but two rhythms—ventricular fibrillation and ventricular tachycardia—create irregular electrical activity that doesn’t actually pump blood, and are worth silencing. After defibrillation, a small chance exists that the barely quivering heart might suddenly restart itself and throw an organized rhythm, which would create pulses again. Unlike in the movies, no one would ever shock a person in flatline. Why stop a dead heart?

“Everyone
clear
?” the lead medic asks. He looks at the monitor and not at us; his finger hovers over a blinking button. A shock of 250 joules also stops the heart of anyone touching the patient, and there are horror stories of responders dying in the field because they weren’t paying attention. Ruth narrows her eyes at me, and I hold my hands up and scoot my knees back in an exaggerated show of reliability.

“Shocking,” he says, and presses the button.

The man’s body jerks upward, forward, almost airborne, but his give-or-take 160 pounds is too much weight for flight. Our patient’s arms land at different angles than before, and his face swings toward mine. Mouth open and covered in spittle, eyes fixed and dilated, he looks less like a dead person and more like someone who just received terrible news.

“Sinus brady!” yells the lead medic. The news ripples through all of us, pulling us together for a breathless, hovering instant. My eyes snap back to the monitor screen, and sure enough, there’s sinus bradycardia, a too-slow but nevertheless functional rhythm. The number in the right-hand corner blinks at 48, then 50, then 47 beats a minute. The man has pulses again. We are lifesavers.

The moment over, I rest on my heels, dumbfounded and elated, amid the overlapping voices and resumed flurry of activity. Meanwhile, one firefighter finds a vein and plunges in an IV catheter as Carl hands him the line; the lead medic has cranked the man’s jaw open with a laryngoscope blade and inserts the breathing tube; another firefighter removes the rest of the man’s clothing. I’ve lost Ruth—apparently the excitement of getting pulses back caused her to forget about her role as field training officer. Of everyone’s hands, hers move the fastest.

“Good flow on the line, keeping it TKO.”

“Where’s that epi?”

“No signs of trauma, no spontaneous breathing.”

“Skin signs are warm and diaphoretic.”

“Okay, tape it up. Can someone get me a D-stick and a blood pressure?”

“D-stick is 110, working on a BP now.”

“Does he have any medical problems?”

“No! Wait, hypertension. Is he… that’s good, right?”

In the midst of all this, I hear his wife speak and realize she’s been standing behind me, looking on and talking to the captain in a trembling voice.
I had forgotten she was there. I lift my head a little, goose bumps erupting, wanting to turn and look at her, wanting to jump into the flurry and be useful, thinking,
I helped save a life
, and catch sight of something in my peripheral vision. The computer screen flashes the Eiffel Tower. We haven’t even been here long enough for the computer to switch from its screen saver to sleep.

We lift him using a backboard and file down the hallway, but before we make it to the gurney, the lead medic halts the caravan and shocks him again. I get a look at his wife’s face, the way her heart stops every time his does, and feel a tinge of horror.

In the back of the rig, Ruth explains the drugs being administered while I push oxygen into the man’s lungs and feel the kickback of his diaphragm. My slippery latex-covered hands occasionally lose their grip, gloves glued to knuckles with sweat.

Ruth, Carl, and I shut ourselves up in the little break room dubbed the “Paramedic Lounge” in the northwest corner of the ER wing. As we get settled, Carl says, “Piper, you better quit now. You’ve got a perfect record—100 percent lifesaver. It’s only downhill from here.” He kicks his boots off and stretches himself out on the flower-print couch, resting the walkie-talkie on his chest.

Ruth digs through the fridge, grabbing a small carton of cranberry juice from the available stack of pink, red, and orange containers. She finds a plastic-wrapped ham and cheese sandwich amidst the pile of bologna and white bread and tosses an orange juice to Carl. “Want anything?” she asks me.

“No, thanks,” I say. Spreading out a mound of paperwork on the gray plastic table, I stare forlornly at the work ahead of me.

Carl chuckles. “I’m so glad I’m not you right now.”

I labor steadily, documenting over thirty treatments, looking up the corresponding treatment codes, writing a two-page narrative. Nowhere do
I mention what a nightmare it had been to remove our patient from the apartment complex, with its tiny elevator that barely fit the gurney. Four of us had squeezed him in diagonally while everyone else took the stairs. When we struggled to remove him from the elevator, I got a look at his bare feet poking out from the sheet we’d covered him with. I’d guess he hadn’t cut his toenails in at least two months.

When I finally finish, Ruth and I look over at Carl, who is fast asleep. Ruth grabs the crumpled-up carton of cranberry juice and ball of plastic wrap from the table and stands next to the couch, looking down at her partner. With a heavy overhand throw, she pitches her trash into the metal wastebasket on the floor next to him, but the dull clanging sound doesn’t wake him up. Undaunted, she plucks a pen from her front uniform pocket and tickles the inside of his ear. Carl slaps the pen out of her hand even before his eyelids fly open, and the pen clatters to the floor. Picking it up, Ruth marches to the sink to wash it off.

Carl looks at me sleepily, not bothering to cover his yawn. The mirth in his eyes is absent; he looks innocent and so, so young. Half-awake and solemn, he says, “I like mint-n-chip.”

My training is officially over, and this is all the more evident by the fact that Carl kicks me to the captain’s chair in the back of the cab and takes my place in the passenger seat. On the way back from the Baskin-Robbins on Ninetieth Street, he and Ruth talk excitedly about our last call. I listen, my ears perked forward like a puppy, every now and then interrupting to ask questions, already reciting the story in my head, practicing how I will describe it to everyone I know, imagining Ayla’s face as she reacts.

“Did you see the way he landed—”

“The intubation tube? Solid on the first try. Stevens runs the
smoothest
full arrest.”

“That was probably the best one I’ve ever seen, though. If it weren’t for that—”

“Damn thing was puny. Should be against the law. No old people in apartment buildings unless the elevator can fit an elephant.”

I’m jolted when I hear Carl call our patient old. I’m only twenty-eight but still the man had seemed young to me, too young to die of a heart attack. I wonder if Carl will still think fifty is “old” when he’s nearing his thirtieth birthday.

Ruth pulls into the Crossroads lot and parks, and I ask in confusion, “I thought we were going back to station?”

Looking over her shoulder, Ruth coolly raises her eyebrows at me and says nothing. My excitement from the full arrest and the adrenaline still pumping in my veins give rise to quick heat in my cheeks. When will they stop ignoring me? How many tests must I pass not to be treated like a boot?

Carl hops out of the rig and uses the walkie-talkie to contact Dispatch: “Sir, 7101 requests permission to do a Code HLP.” The scratchy transmission from the dispatcher reveals he is laughing; I remember that he and Carl are friends, so this must be some kind of inside joke. Carl’s request gets approved, and I search his face—big smirk or little smirk?—for some clue as to what a Code HLP might be. He’s unreadable.

Carl nods at Ruth, clipping the walkie-talkie to his belt. She tells me to bring the ice cream, then locks the doors and turns on her heel. She’s headed toward the entrance to the emergency wing, and Carl follows after her, whistling.

I trudge after them up the ramp. We are doing a Code HLP at CRH after a SOB mutated into a full arrest and was delivered to the ER with pulses and a BP. A new acronym is not what I need right now. I rack my brain for all the jargon and slang I’ve learned recently, for A & O Ambulance’s policies and paperwork codes, and wonder if Carl’s slang has something to do with the hospital itself. If a “code” means there is some kind of action
involved, like a Code Blue is a full arrest, and Code 3 means driving with lights and sirens, then “HLP” could mean… what? Nothing comes to mind, so I start to make things up. Hemorrhagic labor pain? High-level pressure? Heart liposuction?

Ruth pushes through the double doors but instead of walking into the belly of the ER department, she makes a left and goes through another set of double doors I hadn’t noticed before. Close behind Carl, I listen as his whistling mixes with the rolling of carts, beeping of machinery, yelling of patients, chatter of doctors, laughter of nurses. When the second set of double doors swings shut behind us, his whistling stretches to fill the empty hallway, mixing only with the clipped percussion of our boots.

“Where are we going?”

Carl ignores me, as I knew he would. “You’ll see,” says Ruth.

We walk down a series of hallways, pass signs for
RADIOLOGY, SURGICAL UNIT, URGENT CARE
. We arrive at an elevator in another part of the hospital, and once we get inside I notice a small keypad underneath the usual panel of buttons. To choose the ninth floor, Ruth holds one finger on the button and uses her other hand to enter a four-digit code on the keypad.

When the elevator doors open we step out directly onto the roof. The early evening light soothes my pupils after the long trail of fluorescence. A strong wind has cleared away most of the haze, and from up here I can see the glittering downtown skyline to the northeast. I stretch up on my toes to look west, imagining I can see all the way to the Pacific.

Carl’s white teeth flash in his grin. “This hasn’t been used since 1993, but we keep hoping.”

Ruth digs out the ice cream and bright pink spoons, and traps the plastic bag with the gallon container so it can’t blow away. “For bonus points at the end of your training,” she says, standing upright and throwing her shoulders wide, “what do you think HLP stands for?”

Looking around for clues, I notice the rooftop has a bright red circle with a thick gray cross painted on it. My hair whips my face as I smile. “Helicopter landing pad.”

Carl raises his arms over his head and whoops loudly. I laugh, and add my own crowing to his sounds.

Ruth says, “Easy, children,” but she is smiling, too.

We sit near the edge of the roof and carve pink spoons into melting neon green. We don’t face west, toward the wide, tree-lined streets that lead to the ocean, or north, toward the serpentine concrete that converges downtown. We sit facing the south end of South Central, with its tiny houses and their tiny yards, its rundown churches and schools, its lack of freeways or greenery. From up here you can’t tell how rusty the cars are, how filthy the streets, how tattered the sidewalks.

PART TWO

19

The beautiful, delicate object nestled at the end of your auditory canal has a complicated shape. On one end of your inner ear, the snail shell of the cochlea spirals down before rising upward into the concentric loops of the semicircular canals. Those fragile, overlapping archways make careful circles before feeding back into the nubs and nodes of vestibules, which descend into the trunk of the cochlea to start all over again. It’s a self-contained system. You can trace it with your finger like an Escher drawing, unsure where it begins, unsure where it will end. You are moved to think like a sculptor: you would love to have been the first to design this elegant form, or even to re-create it.

The whole system becomes only more elegant when you learn how it works. Every last spiral, from the snail shell to the archways, is hollow and filled with fluid. If you were to slice apart this delicacy and look inside, you would see an even more intricate system held within, an underwater labyrinth of looping chambers.