Monday, January 1, 2007

Where will we live?


The names have been changed to protect my ass...
I'm pretty sure I was ridiculously naive. Upon entrance into the medical field. Even in E.M.T. school I had such ridiculous expectations about what working in as an E.M.T. actually entailed. I didn't think my job would be running around doing dramatic heroic things, I didn't think everyday I would pull people out of cars or something cheesy like that. I don't have a hero complex. I just thought I would be more useful than I actually ended up being. Performing a really valuable service. I didn't expect to being turned into a cog for such a dysfunctional health care machine so quickly. The ambulance company that I worked for didn't have a 911 contract so we only provided transports to and from different facilities, such as convalescent homes, mental health facilities, and halfway houses.
From day one: I encountered a human condition that I couldn’t believe was imaginable in compassionate America: My job was to transport filthy, covered in unbelievable bed sores, low BP, catatonic, elderly or unstable patients to either dialysis or a doctor's appointment. During the doctor's visit we would travel at light speed with lights and sirens blaring (code 3, totally illegal to do unless someone is truly unstable in the back but the dispatch manager was always bellowing at us it was our butt's if we didn't) to grab another patient from another facility and get them to their appointment and then dash over to pick up the first patient hopefully before their visit was over. Constant mad dash, load and go, load and go. No lunch. Ever. 12 hours and more of this every shift. My first trick of the trade: Learning that most ambulance crews are under he same stress. Any time you see a non-fire ambulance crew running with lights and siren and two uniformed employees sitting up front, they are breaking the law. You can go code 3 after you get the patient, but before you pick the patient up all you can do is get there as fast as you can. When an ambulance has a patient the only uniformed employee to sit up front is the driver. The one in attendant role is in the back.
The ambulance company was run (and still is I hear) by an ex-crip and a questionable Russian lawyer. The E.M.T's I worked with were, in general, somehow oddly suited for the job they held, maybe because the all seemed resilient to life's beat downs or perhaps were just enduring them. Being an E.M.T is meant to be a stepping stone for other career aspirations, at least in Los Angeles. The crew was comprised of people who sat down on the stepping stone. Wanna be firefighters, strip club addicts, drug addicts, Ultimate Fighting Championship half-assess and all around scandalous people.
A shining example of someone who seemed to be missing out on life was Paul, the only other white guy working the day shift was a hardcore burnout who got kicked out of the L.A.P.D. police academy for reasons unknown. (Well unknown until you spoke to him) In his mind, he was actually a cop, a super cop, and claim he had a mysterious ability to read the intentions of everybody we passed on the street from his "intense police training". Ridiculously scary statements like, "once you get that training it never leaves you. See that old lady there waiting for the bus? I've identified her as a drug mule." To bad that training didn't get him a decent job. Paul was 40 when I met him and still living with his mother. She'd call him at least 15 times a day and every time he acted like he was getting a call from the goddamn president. Transports would wait for these epic conversations, mostly about where random objects had been stored in their pack rat ancient apartment. Thank god I never had to go for a visit to Mummy but I had heard stories. One of my partners, Geena, told me "It's like, still 1985 in there. I can't explain it."
Geena was a morbidly obese dyke who was actually pretty good at her job. She could talk to patients and put them at ease and did a pretty good job of disregarding the bullshit that came from "base" which was The questionable Russian lawyer’s office and the ex-crips place of residence (Dudley). His office was his bedroom at night, but during the day his bed, a lovely white futon made his office look spacious and comfortable. As if he had clients that could casually comein and relax on his ikea futon couch. But at night:Dudley would bring out what he called "My passion." A red sating sheet would drape the corners of his bed. And the dude had chicks. Every night a different girl, every morning a bleary eyed regretful young woman would leave his office/chamber of earthly sin.
We rolled pretty much in the African-American parts of Los Angeles. Inglewood (which is actually a pretty cool little city with some great history), Hawthorne, Compton, Carson. All the cities surrounding South central. We weren't ever supposed to go into Los Angeles City proper because we didn't have the mysterious and difficult sticker that would grant us city privileges. We went anyway, quickly, the driver usually repeating the mantra "I don't want to lose my license. I don't want a $1000 fine" over and over. Maybe the fine was a threat, but everybody I worked with had expired E.M.T. licenses anyway.
The ambulances themselves were death traps. The rigs were from a dealer in Louisianna that Dudley knew. They had outlived their service in that quality healthcare state so they made their way to Los Angeles, to our sweet company. The only medical device inside was a stethoscope, a bp cuff, and an O2 tank that were all almost always out of gas. The tires on the rigs were always blowing out, they were made to handle the weight of a family van, not an ambulance. I myself blew out two tires by carelessly driving over the edge of curbs. Mechanically speaking, as far as I know, the ambulances were maintained by a team of mystical ambulance engine trolls who would "make adjustments" as the questionable Russian lawyer would say, right when no one was around to see the work being done. At least once a week one of the company’s 3 ambulances would break down on the 405 or the 105, usually with a patient inside of it. I found the possibility of breaking down with a patient inside it nerve racking. But I got lucky, I only got stranded because of blown tires. My coworkers took it as a minor annoyance. Break time I guess. I remember when I quit the company I called the Highway Patrol to report the company, typical dramatic behavior for a pissed off E.M.T. who wants revenge, for the crappy pay, the shame of transporting sick people in ambulances that were unfit for usage, the doctor's who would passingly look at a patient with decubitus ulcers to the bone and write orders that he knew would and could never be met. The cop in charge of ambulance safety at the CHP said, "Look, they just assigned me here, I don't really know what's going on. I'm sorry I don't know what to tell you." He didn't want to take the complaint. He didn't care. Another bummer lesson: I WAS THE LAST PERSON TO FIND OUT HOW COMPLETELY FUCKED UP OUR HEALTHCARE SYSTEM IS.
How could I ever forget the stupefying realizations that one could ascertain about what happens to some poor old people in American culture. The frustration of having to pick up a nearly dead patient from a con home, 7 CNA's sitting down having lunch, talking about anything but what is going on in front of them. Meanwhile the patient we were there to transport to her clinic appointment had a non-rebreather mask on at 2 liters when at minimum they function at 8. She looked sleepy and would only respond with mumbles. The shock of having to get report from the nurse in this con home, the only nurse in this con-home who, coincidentally spoke ABSOLUTELY NO ENGLISH AT ALL kept my jaw to the floor the entire time I was there. The poor nurse presented as an extremely upset Korean woman who kept pointing at the CNA's in horror but was never able to say anything. My partner Mark, didn't want to take the patient. 75/30. 50 pulse. Rapid respiration's.
"We shouldn't be taking this patient. She's about to code." Mark, a very dignified and compassionate African-American, whose goal was to be a screen writer, looked at the patient, looked at me, pushed the nurse aside and said, "Fuck it. Load and go. Let's go now." We didn't have O2 on our gurney, whatever she wasn't getting any anyway. No report, just a pile of papers. Mark loaded her up into the rig with one hand. As I was closing the loading doors one of the CNA's came running out of the con home. Some useful information? Hell no. "Ya'll have any gloves? There aren't any gloves in this whole place!" I tried to say something in disbelief but all that cam out was "whaaa?" in a hushed whisper. I thought about telling her to go to hell but Mark grabbed one of our two boxes and tossed it to her. Then we took off. I was too inexperienced to see how sick the patient was. After a while of working around sick people you can sort of look at a person, scan their vitals and figure out how stable they are, a reasonably accurate guestimate. Mark had developed this ability and took his guestimate, I just followed. My skills were too new, too inadequate to get a good BP while we were cruising at breakneck speed to what I thought was her Doctor's appointment.
"What's her BP?" Mark yelled back to me.
"80/60, I think. I think she's crashing." She wouldn't respond to my calling her name, "Mrs. Mayfield! Can you hear me?" The sleepy eyed look she had at the con home was gone. Her eyes were just closed.
"Look, you need to tell me what it is exactly. If you need me to pull over so you can do this then I'll pull over."
"all right pull over." A gray cloud was coming over me. I knew I wouldn't be able to take this BP. I was too stressed, too new, and I just couldn't seem to slow myself down enough to do what I had been taught.
"Just do it over palp, man!"
I blurted out, "What's that?"
Mark jumped over the driver seat into the back of the rig, ripped my bp cuff out of my hand.
"Inflate, when you feel a pulse over her wrist you have systolic. That's all we need right now. 70. She's holding." Off we went. We rolled into a now closed Gardena E.R. The ambulance bay doors opened, and... jammed up. We were number four on the wall. An absolute gurney traffic jam everyone waiting for rooms to open up. And in a 16 bed ER this was probably going to take a while. Graffiti marked the 80's brownish colors of the peeling wall where we waited, staring at our patient who was becoming what I now recognize as ashen. "22 crew waits you hard!" "Bad timing." "Who's fucked?" engraved into the wall by the same ballpoint pens that would no doubt write the transfer reports detailing a perfect drop off, enabling the voracious ambulance companies to secure their medi-cal payments.
Mark tells me to go find the charge nurse and to tell her that our patients bp is below 80. I find a woman who looks like she is in charge. I tell her exactly what Mark told me to say. I'm too stupid to be freaked. I think because we are in an ER that everything is cool, not our responsibility. The truth is that until the hospital takes custody of the patient, the patient is still yours. The charge is steady, calm, and collected. "3 ahead of you, two are county paramedic runs. It's gonna be awhile." I walk back over to Mark. He's found a portable BP. Holding at 70 over something freakishly low. The sun was coming down, shining through the lookout windows on the top of the bay doors, starting to turn orange. Mark continually runs the bp, 65 systolic.
"Tell the charge nurse her BP has dropped." Mark is calm. So I am calm. I tell the charge nurse. She stares at me for half a second. She walks over to my patient. The charge nurse looks at her and quietly says, "2".
The county firefighters give us hate stares as we walk by. Mark reminded me to switch over the 02 to the house tank, especially since we took our over size tank from the rig and put it on the bottom of our gurney. Too new to realize how totally obvious it was that we were working for a shit company and how ill-prepared we were. I still didn't get the gravity of the situation. Things had happened so fast that it didn't even occur to me that we had just dropped our patient off at an ER, not a clinic. E.M.T.'s do not make code 3 ER runs straight from a con home without a paramedic on board. We got back to the rig, I got on the radio and obliviously reported the run we had just finished. The manger, Tara, a very attractive, very psychotic spaz who couldn't speak to anybody without screaming "You fucking listen to me" first bellowed accordingly, "You fucking listen to me! You were supposed to drop her off at Ce---- Clinic not the C------ E.R.! I'm telling Dudley. I want your asses fired." Somewhat typical speech blaring from our banged up nextel, although this time her screech was a bit more murderous. I sat staring at the nextel. I wondered what other horrible shit would come out of its speaker. Mark calmly took the nextel out of my hand.
"Tara this is Mark." He paused, held down the speak button so she couldn't respond, "She crashed. What should we do, drop a half dead woman off at a clinic for a 45 minute wait?"
"You fucking listen to me! Yes, you should have!" Mark told me to hold down the speak button and not let go. I didn't, not for 15 minutes until we got back to the station. Dudley was there. Waiting. Dudley and Mark had what I later called, "the cool black guys conversation." Mark and I were punching out when Dudley appeared from seemingly out of no where on our left hand side. He was leaning on the closed office door. I didn't even hear it open.

Dudley: Say Mark, you guys got a minute? What's up? all right. You should have taken the patient to her clinic appointment.
Mark: Yeah man, you right, but see, she got bad in the back , you know what I mean?
Dudley: all right. Don't pick the patient up next time, cool? Take them to their appointments and that's it.
Mark: My bad. Thanks.
Dudley evaporated in front of our eyes, like he walked into the office backwards, turned around and closed the door behind him. I never seen anybody disappear without actually disappearing but Dudley did it. I'd never seen Dudley pissed off, he was quiet and sleazy most of the time. As calm as he was, you could tell this guy could go just as hard the other way, scary.
And that was it. A million rules broken at a million miles an hour and there was no hell to pay. Just doing the job.

One of my favorite guys to work with was an old dude named Ronny Master's. He had been working with the post office for a long time but quit for reasons unknown, not even rumors existed about why he quit, so maybe he just got sick of it. So he was now a 50+ E.M.T. showing me around where he was from. Mostly Inglewood. We'd be driving in between calls and he would suddenly bring the rig to a stop and say, "See that house right there? Earth, Wind, and Fire used to hang out there before they'd do a show at the Forum. That was the lead singers mother's house. The spot."
He also showed me a house that Sammy Davis jr. used to live in, "When he had a black wife. Before the KKK poked out his eye for marrying a white woman." He took to his mother's house in Inglewood, a beautiful home that was large for LA standards, well kept and contradicting every image I had of Inglewood. In fact, every partner that I worked with was local and went out of their way to show me the community that they were from in Los Angeles. Eager to dispel the myths they knew I had in my head about their homes. They all went out of their way to contradict them. As if I was the token white guy they could speak to and hopefully change everybody's perceptions.
One of my partner’s was a meth addict. This is where my naivete came into play. I knew my partner, Julio, was addicted to speed, that much was obvious. Losing weight, getting irrational, terrible skin,I couldn't comprehend how he didn't get fired, how he kept getting the day shift with the important repeat clients, why nobody ever said anything about his drug problem. First realization: Everybody, no matter what their job title says is a human. Lawyer, doctor, judge, firefighter, just people performing duties that have been branded with expectations of performance by the prevalent culture that may not actually represent the reality of the actual jobs. Our collective image of higher profile jobs frequently seen in the media are so wildly grandiose and in no way based on reality. Everybody has a job, no matter how unusual, glamorous, or demanding the job may be. When it comes down to it, if you work it full time and you need to pay your rent or mortgage, it's a job. And that means bullshit from above and reality engulf you like fire from a kiln.
Julio was just doing his job when he OD'd on meth and cocaine and Ronny had to pull the rig over, take the O2 off the patient in the back and put it on Julio. Ronny said the previously comatose patient sat up and said, "Uh Oh. He doesn't look too good." Julio came around, did another line and they finished the shift. I worked with Julio the night after this happened. He hadn't gone to sleep or stopped working for that matter, so while on a run to a county psyche ward with a scary ass spaceman in the back Julio started to make ponderous statements like "Do you see the spiders on my face? I think they're crawling into my eyes. Puta Madre! Do you like maple flavored ice cream? These spiders are all over me. I just gotta keep driving."
These statements were particuarly alarming because up until that moment, eight hours into the shift, all Julio would talk about was his visiting family from Idaho and his concerns that they wouldn't do the dishes after breakfast. Keep in mind this was already 11:30pm, not only had I been listenting to his concerns all shift, I was starting to get really worried about how he would react when he realized they would have to contend with the left over dishes from lunch and dinner as well.
“Damn,”I remember thinking, “I should have sat in the back.”
We finally dropped the patient off and instead of heading back to the station we had to drive around East Los Angeles for another hour looking for some fucking maple ice cream. Which he did eventually find at a 24 hour drug store and kindly bought everyone in the store a scoop.
My perception of noble, divine, honest mobile medical service had been permanently fractured. My eyes were opening up...

4 comments:

Kim said...

What a story - an eye-opener! I couldn't stop reading.....

Matt said...

I really enjoyed that story.

I guess that this makes me a bad person.

Anonymous said...

wow, is all this shit for real ??? I love you take on Nursing...

Angry Male Nurse said...

This shit is for real. And that was two years ago. So much more shit now.