Mark Smith for Reader's Digest “Mark my words; there is going to be that one call. That one call is going to change your life. It’s going to change how you see the world, if you can even walk away from it to begin with. Consider it your rite of passage.” —My EMT/paramedic instructor, September 2013
“I’m scared,” she said. Scared was an understatement. The woman looked downright terrified.
“I’m scared too.” The words were out of my mouth before I could stop them.
I cursed myself. We weren’t supposed to let them see our emotions. That was rule number one of working on the ambulance rig. It didn’t matter if you were angry or terrified; you had to keep it together for your patients. My hands were trembling as I tightened the tourniquet around her left leg. Her dialysis port was squirting thick, dark arterial blood from her thigh.
“I don’t want to die,” the woman said faintly, dropping her gaze to her leg. “Please don’t let me die.”
I waited for her to look into my eyes again, partly because I didn’t want her to see that I, my partner, and the entire floor of the bus were now covered in her blood.
A few minutes earlier, she had left a dialysis center and stepped onto a city bus. Her dialysis port caught on one of the seats and ripped out of her leg, cutting into her femoral artery and spraying blood everywhere.
The driver had spotted my partner and me—we work as EMTs at the hospital where the dialysis center is located and happened to be nearby—and we followed him back to the bus, armed with nothing but a few gauze pads. We didn’t have the code to open the door to the dialysis center. As EMTs, we had only the code for the ER on the other side of the building, which might as well have been ten miles away. If we couldn’t get her there, she was going to die.
“Hey,” I said. “Hey, look at me,” I said. “You must be terrified,” I said. “But I will not let you die. Not here, not now.”
She slowly nodded her head, tears streaming down her face.
The blood dripped down the steps of the bus and onto the street, melting the snow where it fell. You could almost taste the iron in the air. My boots and uniform were covered in blood.
As the woman slowly faded into unconsciousness, my partner intubated her. My hands were now covered in blood. They felt slippery, and my upper arms were beginning to get sticky as it started to freeze. The bleeding hadn’t stopped. I tightened the tourniquet.
Seven Months Earlier
“Now twist … There you go, Rodocker. You’ve got it.”
I was the last person in line to use the commercial tourniquet. We were halfway through an EMT class that ran from 9 a.m. to 9 p.m., a 12-hour shift designed to simulate being on the job. That’s one thing that I valued about my college’s EMT program: They kept things realistic. The first day of class, our instructor had shown us gruesome videos of car accidents. He showed us videos of people assaulting EMTs and paramedics. He told us exactly how much we would be making: minimum wage for the average EMT, $12 an hour for paramedics, if they were lucky. We lost eight students that day.
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“Now, I’m going to tell you this,” he said about the tourniquet. “The first time you have to use one of these will haunt you for the rest of your life. If someone is bleeding that much, their odds are not that good.”
“We have to get her to the ER,” said my partner. “Now.”
“We need backup,” I said.
“I think it’s time to call X.”
“Call X … Are you sure?”
Calling X over the radio meant things were heading south fast. The last time X had been called was when an ambulance crew had gotten into a car accident and both EMTs were in critical condition. The time before that, a crew was being held at gunpoint. Calling X would broadcast our location to every available police, firefighting, and EMS agency in the area. Help would arrive within seconds. At least that’s what we hoped. There weren’t that many cops or firefighters around.
I reached for my mic.
“Bravo 011,” I said. “X.”
“Bravo 011, please repeat. Did you just say X?” said the dispatcher, audibly distraught.
“Bravo 011 to center, repeat X.”
“Bravo 011, I have your location via your rig; is that accurate?”
“Copy, center. Hurry.”
My skin was crawling. Chills were running down my spine.
The call went out immediately.
“All emergency personnel able to respond, please respond. Bravo 011 is in need of assistance.”
“She’s not breathing,” I shouted, moving my hands from the tourniquet to her chest to start compressions.
I shouted simply because I had no control over my body anymore. My body was pumping so much adrenaline into my veins that I felt like I was on fire.
Nine Months Earlier
On my very first clinical, a call went out over the PA for all students to report to the resuscitation room. This was a hospital in downtown Detroit, where people don’t go into the resuscitation room unless they are dead or very close to it. They brought in an older man, a man who was very much dead. They stopped CPR long enough to register that there was no shockable heart rhythm on the cardiac monitor, and then the students stepped in, each of us getting our chance to practice on the corpse. I was excited and afraid at the same time.
Chest compressions are hard to do. Sure, the mannequins that we all practice CPR on are a nice rubber texture. Nothing cracks; nothing breaks. Real CPR is terrifying. You’re pumping on someone’s chest, and suddenly you break all of his or her ribs and his or her chest doesn’t rise back up after you’ve been pushing on it for so long. There is a blank, empty look in the person’s eyes, and you can see that there is no soul in that body anymore.
When it was my turn, I stepped up to the “patient,” placed my hands, and pushed. It was nothing like pushing on the mannequin. I had to work so hard to press down that I couldn’t get into a rhythm.
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“OK, kid,” said a nurse. “Push hard, push fast, get a good rhythm going. Think of a song that you like, like an upbeat song. Sing it in your head, and your compressions should line up with that.”
From that moment on, I have been complimented many times on how good my chest compressions are.
The first police officer stepped onto the bus. She promptly turned around and vomited.
“Oh my god,” said the first police officer to step onto the bus. She promptly turned around and vomited all over the sidewalk. Another officer got on the bus, his movements causing the blood on the floor to ripple like a wave. He stood frozen for a moment, then sprang into action.
“What needs to be done?” he asked.
“We need our stretcher out of the rig, now!” I was still shouting; there wasn’t anything I could do about it.
“Where do you want it?”
“Put it by the wheelchair ramp,” said my partner, beginning to look green. “We’ll put her on it and lower it to the ground. Then we can move her to the ambulance.”
I kept pumping as they lifted the woman and moved her down the aisle of the bus, out the door, and onto the stretcher. “Let’s move through the building instead,” said the cop. “It will be faster.”
“Do you have the codes?” I said.
“No,” the female cop said. She turned to her partner. “Run into the dialysis facility and find a nurse. They should have the codes.”
The other cop ran off. We strapped the woman to the stretcher, and the smallest medic that I have ever seen jumped onto the cot with the patient, straddled her, and began some excellent chest compressions. She stayed like that throughout the bumpy ride through the building and into the ER. Doctors and nurses rushed to our aid. We went into the trauma room, transferred the patient to a bed, and stepped back.
“She’s in hemodialytic shock,” yelled a doctor. “Start blood transfusions! Get the trauma surgeon in here now!”
There was nothing more that we could do. My partner and I left the room. We walked back to our ambulance, following the trail of our bloody boot prints. I was in shock, hoping that I had imagined all the blood. Our supervisor arrived shortly afterward and told us to go back to HQ, take showers, change into scrubs, return to the hospital for a quick round of antibiotics, just in case, and go home.
for the next month, I woke up screaming. I was terrified of closing my eyes. I didn’t want to see that haunted look that the woman had on her face. I didn’t want to hear her rattling, labored breaths. At work, we had group counseling sessions. We talked about every aspect of the call. We explained our fears. The counselor said we had done everything that we could. We’d reacted to the situation immediately, he said, and we had done very well.
During one of these sessions, he did something I will never forget.
He got up from his chair, opened the door, and wheeled the woman into the room.
She had left the hospital with six broken ribs, a broken sternum, and a new dialysis port. It had been a long time since I had cried, but as she wrapped us in her arms, tears of relief streamed down my face.
It was at that moment that I knew that I could walk away from my one call. My instructor was right—it had changed my life. I have paid my dues to the EMS gods, and they are appeased. I have earned my passage.