For some years now, people say to me "Oh you've been a paramedic for 23 years? You should write a book". Well, I must admit that the idea has its benefits, but I am a lousy critic of my own writing. I hereby ask that you appraise the following, do you think it worthy being published? I have others written, mostly more 911-ish. This story is not dramatic or blood and guts, but it meant something to me.

What do you think??
Thanks

Windsor


Pre-hospital medicine is a strange and dynamic arena, far stranger than most of us would believe even after a few years working on the street and dealing with the fluid and ever changing situations that create our working environment. Most of us start out in this field with the belief that the chain of medical care we provide is a simple, straight line; a relationship between patient and caregiver that is initiated by a phone call and terminated at the Emergency Room doors.

This is the world-view that we walk into this job with, that we train with and that we couch our expectations with. We are called, and we come. We treat and we bring. Some live and some die.

This is the way it is for paramedics; simple, quick and hopefully effective patient care. We prefer a straight line of cause and effect. We take comfort in that, since we don’t know what will happen or when. Our comfort level does not always appreciate how the line of patient care can be blurred sometimes and the outcome far beyond our powers of perception or anticipation.

The call came in the late afternoon, when the springtime sun was still low in the sky and its light broke through the budding branches of scattered trees. The dispatcher gave us little information; just the terse, generic term of “sick person” to describe our awaiting patient and the address where he could be found. Aside from the address, this was of little help to us. Collective experience had shown that a “sick person” nature could mean anything from a patient with minor cold symptoms to a person near death.

With only that vague description, we turned on the lights and responded to the call; to whatever was awaiting us.

We turned onto the street and saw that the house was an old Victorian style, with steep gabled roofs and oblong windows. One could see what a beauty it had once been, but it had suffered disrepair and some obvious neglect over the years. The direct sunlight that shown on it was neither complimentary nor forgiving. The house was one of several that had been built in a cluster on the streets close to the river. Once it had been a vibrant neighborhood, but now its neighbors were gone, torn down for a public works project. This house was the only one left on the block, surrounded by cyclone fencing and weeds. Empty lots with forlorn front walks, cement steps that suggested the houses that they had once led to. All gone.

The bare yards next to it, scattered with trash, were not an unusual sight in this area. Economic depression was a word often associated with this city. Vacant houses were nothing new to this area, nor were the sight of old houses long past their prime. What was unusual, however were the fire trucks and police cars lining the street in front of the house to which we had been called. I wondered aloud about their presence to my partner as we got out. As I walked up the front walk of the home an officer coming towards me gestured over his shoulder and said with a wry expression “Good Luck”. Clearly, the ambiguous dispatch of “sick person” was about to prove its worthlessness again. The officer stopped and turned to us.

”The guy in there is real sick, and refuses to go to the hospital. His entire family has tried everything to get him to go, including calling all their friends in the police force and the fire department to come out and talk to the guy; but he continues to refuse to leave. His home is in the path of the public project that tore down his neighbors and he has been fighting with the city to prevent them from evicting him and tearing his home down too. Apparently, he is afraid that if he leaves today, he will come home and find himself locked out. His family is inside with him.”

Offering our thanks for his insight, we walked into the house.

The home’s interior was unlit except for the light coming in dirty windows. Motes swam in the shafts of light striking old carpet. Dusty furniture crowded the rooms. A large assembled crowd of children and adults was now using each piece of furniture available that had a flat surface. It made the stuffiness of the house more so. All of them had the same expression of worry on their faces, and each had their attention focused on a man sitting on the edge of a bed, which sagged forlornly in the front room. It appeared as though he had just finished speaking as we walked in. All eyes were upon us as we set down our gear. He appeared to be as ill as the police officer had indicated. His undershirt was sweaty, and perspiration beaded his forehead. He coughed violently, and the rattle that came from his chest suggested not just an infection, but fluid from heart failure. He looked at us with resignation, as though defying us to pry him from his room.

A woman approached us and told us what we already knew. “He is very ill, but won’t go anywhere. He is very stubborn. We have been talking to him for hours, but he still refuses to leave. ”

I approached the man and asked his name, which he gave without hesitation or rancor.

I asked how he felt.

”Lousy, but I am not leaving.” He replied. That seemed to be the end of it. His gaze was steady, and my presence seemed only to strengthen his resolve. He pushed down on his knees with his hands, and straightened his back. Before he could speak again, a coughing fit racked his body and sapped the rigidity from his frame.

I asked if I could at least examine him and take his vital signs, which he agreed to permit.

He was sick; and sicker than his family likely appreciated. His lung sounds were terrible. Between his fits of coughing I could hear the fine crackles of fluid seeping in from the capillaries that lined the smaller lung spaces responsible for exchanging oxygen. This was indicative of heart failure, and I knew it would only get worse. He was not acutely ill at this point, but he would be soon. If his illness were left untreated, the fluid in his lungs would increase until he began to literally drown. If that happened, even aggressive care might not save him.

His ankles similarly showed that he was retaining fluid, as the skin was tightly swollen over the anklebones and the top surface of his bare feet. My finger left slight indentations when I pushed. His blood pressure was high. All in all, I knew that he needed to be seen in an ER as quickly as possible, and if he would permit me, I could start some elements of care in his home. But he would not permit it, and he was not going to be budged.

I reasoned. I cajoled. I tried every platitude and phrase that came to mind. I looked at his family and saw in their faces that I was treading over ground that they had already marched. It seemed that nothing would change his mind. I could not even take him from his home by force, as his mental acuity was sharp and his decision-making was one of stubbornness, not his desire to specifically harm himself. The family had even tried to have the family doctor speak with him, and he had refused. I told him that his family would wait in his home and that nobody could lock him out of it. His struggles with the county over the status of his home would not be decided in that fashion, but in court. It was all to no avail.


I knelt on the floor, next to his bed and hung my head down, searching for inspiration. I did not want to abandon this man, knowing full well that I would come back and find him near death in a couple of hours. Taking him by force was not an option. No legal avenue existed and it might precipitate worse problems with his heart.

Nothing made sense; nothing seemed to impact his façade of stone. I was supremely frustrated and felt like I should just join the family sitting on dusty couches and resign myself to losing this battle.

I closed my eyes for a minute and a flash of intuition struck me. It was something my dad had told me years ago. My father had practiced family medicine before becoming a surgeon, and he often talked of his experiences. Now, his voice resonated in my head; an echo from a decade-old conversation with a man whom I had lost to cancer several years ago.

He had said to me; “Some people, especially older people, are simply afraid to go into a hospital for care. They have a morbid fear of hospitals because they think that once they go in, they will lose control of their situation and won’t be allowed to leave.”

There it was: an echo, a fragment, a sliver of wisdom earned in the trial of patient care that had gone on in the time before my birth. Now it was coming through to me in my hour of need.

He was not protecting his home from destruction, as we all thought. He was afraid of losing his independence and becoming a prisoner in a hospital. He might even have assumed he was going to die, and had decided that if death were to find him, he wanted to be home.

I looked at him again, and said “Sir, you realize that if you go to the hospital, you are free to leave at any time?” He looked at me again, full in the face. What I saw now in his eyes was the glimmer of fear that I had originally taken as stubbornness; but now I saw hope too. I continued. “ You are an adult. Nobody can take that from you or take away your rights. You have complete control over every aspect of your care. You can walk right out the door if you don’t like something. Nobody can or will stop you.”

Now, I had his full attention. His resistance seemed to waver. His family leaned in closer, and the shift in his demeanor was palpable. Now we were making progress.

I finished. “ You are concerned about your independence, but what I see before me is a man who has lost his freedom already. You can’t walk across the room because you get short of breath. You worry about being stuck in a hospital, but you are imprisoned right now. What’s more, your prison is your body. Your body is failing, and you are worried about dying and you are afraid to see a doctor and get bad news. I am telling you that the bad news is HERE and NOW. You see the hospital as a loss of freedom, and I am here to tell you that if you go to the hospital and get a physician involved with your care, you could have your life BACK. I see a car out in the driveway; do you want to drive it again? Your doctor will likely give you a couple pills that will strengthen your heart and dry up your lungs. Your breathing will improve. You could be active again. You could have your life back, if you take advantage of going to the hospital and getting under a doctor’s care! ”

The inspiration had been correct. My father’s voice had crossed time, space and an immeasurable abyss to recall a conversation that I had all but forgotten. Now I looked at this man and saw tears streaking his face.

”OK” he said, “I’ll go to the hospital when my son gets here in about 20 minutes”. I told him that I would prefer to start treatment now, but he was adamant about that. “No, but I promise I will go.” I looked to the family now “Are you all going to keep him to his word?” They assured me that they would call back if need be.

Outside, the police cars and the fire trucks pulled away from the curb. The family began to bustle in the house; the tension that had been in the home when I arrived finally began to ebb.

I obtained a refusal of treatment and left the home. I felt ambivalent, but there was nothing else to be done. I was happy that he would get his treatment that he needed so badly, but I would have considered it a victory to get him to go to the hospital with me.

It was not to be so, and I had learned by this time that you had to sometimes just accept whatever outcomes were presented to you.

But that was not the end of the story.

Months later I watched my partner from the inside of a convenience store. He had gone out to smoke while I purchased a soda. Now I saw that he was talking to a man who was very animated. They gestured back and forth and my partner pointed over his shoulder and laughed. I thought, “Wow, he must know everyone”. I left the store with my drink and the stranger approached me. “Hey man, I have been looking all over for you. Did you ever go on a call on such and such a street about 3 months ago?” I replied that it was possible, but I could not remember exactly.

He beamed at me, “ You don’t remember me do you? You don’t remember a guy who would not go to the hospital, and finally he went with his son after you talked him into it?”

Now it clicked. I studied his face and I grinned. He had lost a couple pounds and was wearing a vibrant-colored sports jacket, but his change was not just one of appearance, it was the energetic manner that he now exuded; It was a far cry from the depressed and listless man that I had seen those months ago. He shouted excitedly, “Hey, you see that car? That is the one I drove up here..just like you said! It’s all just like you said! The doctor got me on some pills and I am able to do things I ain’t done in years. Just like you said!” His car was a sporty model, and the paint gleamed with polish. His recovery seemed to have far-reaching implications. Even his car was apparently better off now. His enthusiasm was contagious. My partner laughed and I could see that he was storing everything and every word that was being said so that he could abuse me about it later. That was to be expected.

I was really enjoying hearing this though. It is not often we get such positive feedback, and even more rarely in such a personal and jovial fashion. I congratulated him on his choices and told him that I was happy that I had had a chance to meet him again.

His manner became serious “Naw, you don’t get it.” He suddenly lunged forward and seized me in a bear hug, practically lifting me off my feet. His change really had been remarkable. He spoke in a clear voice that he did not possess those months ago “You saved my life. Don’t you see? You saved my life” He released me, and I regained the breath that he had squeezed out of me.

I was dumbfounded and slightly embarrassed at the praise I felt was unwarranted. “Well, sir, ” I replied, “ You took charge of your life, it is that simple. I am glad to see you doing so well though.”

I felt that strongly, at the time. I had not treated him. I had not transported him. Our interaction had been outside the comfortable, clear, straight-line dynamic of pre-hospital medicine. I had given him good advice, to be sure, but wasn’t that it? This was an instance were the line of care blurred and my expectations of my job had been unfulfilled, but now I realized that they had exceeded any reasonable expectation. I suppose that things are not always as they appear, and the interactions between us all cannot be minimized or discounted.

He stepped back. “Well, I am glad I finally caught up to you. I been meaning to thank you for some time now.” He smiled broadly.

We exchanged some pleasantries, shook hands again and he took his leave, climbing into his car. I ruminated on the linear thinking that had made up my preconceptions of providing medical care, and how this might change those very thoughts.

We waved to each other, and he pulled out of the parking lot, merged with a line of moving traffic. He then drove out of sight.

My reading preference is more Tom Clancy in style.

That being said, your introduction to the main characters is well written.

Does the saved person have a pivitol roll in the life of the paramedics? Or, Is this a "life on the street" of a paramedic? What is the closing act about?

Put me down for a signed copy of a first print and you got yourself a deal.

No, that is it, just a short chapter. Each chapter would be a different story, some short some long, some dramatic some humourous etc.

I never saw the guy again, but it altered how I felt about the strict parameters of my job.

Windsor, I would be very interested in a book like you describe, and if the stories (chapters) are like this one, then I think you are on to something. Keep us posted!

Great writing style Windsor, it's very easy to read. You may want to consider collaborating with a couple other storytellers, perhaps a veteren police officer and/or firefighter. That would give some more variety to the chapters and open it up to the wider public safety audience. I'd buy it!

I think your writing is exceptionally good!

Thank you all for your kind words.

I have taken them to heart and am a quarter-way through it now.

I figure a nice round number is approximately 60 thousand words, I am up to 15 thousand.

I'll keep you all posted, keep your fingers crossed for me.

It has been a long road, but I am still slogging away. Now I just crossed the 47,000 mark some 5 years later...workign full time sux!

Still looking forward to your finished product! Your posts are interesting. Keep up the process!

I assume you still have the SA Colt 45 and you still can't afford your Barth!

hahaha yes still have the Colt. The Barth is going up for sale soon. it was marital property ya know....