Twas the night before Christmas
And all through the house
Not a creature was stirring
Not even a mouse
But up in the city
Where life carried on
To their own siren song ...
It was late afternoon, cloudy, starting to get pretty chilly. “Medic 16, 2763 East Washington, Mental/Emotional, police on scene.” We pulled up in front of the cruiser and shut down the lights. Two young officers were standing by a woman who was sitting on a ledge outside of the library. The female officer told us the woman had called because she was living in a shelter down the street, but when she came back after taking a walk, the Sisters who ran the shelter told her she was acting strangely and they thought they smelled alcohol on her breath, so, being a dry shelter, wouldn’t let her back in.
“Do you guys have a PBT?” I asked. “No, we’d have to call another car. She says she wants to go to the hospital to get tested because she denies drinking and has nowhere else to go. We didn’t know what to do for her so we called you.”
“Hi, I’m Guy, I’m a paramedic. What’s your name?”
“So what’s going on Cindy?”
Cindy repeated what the officer had already told me. She has been homeless for a long time and has various mental health issues for which she is taking medication. Her doctor changed her medication a few days ago. She said she was feeling a little better today so she decided to go outside and take a walk for the first time in a long time. She explained she felt happier today than she had been for a while, and she even smiled a little. She denied having had any alcohol, and thought maybe the Sisters attributed her elevated mood to booze. I performed a gaze nystagmus test, smelled no alcohol, and detected no intoxication. “So do you think if we go back to the shelter and I tell the Sisters I don’t find any evidence of alcohol they will let you back in?” Everyone agreed it was worth a shot.
So this unlikely procession of two cops, two medics and Cindy trooped down the street, chatting, until we reached the shelter. I rang the doorbell and a Sister in blue-and-white Mother Theresa-styled robes greeted us. I told her that I had completed a field assessment and found no evidence of alcohol or intoxication, explained the possible effects of the new medications, and asked the Sister if she would let Cindy come in from the cold. She was happy to do so, explaining that they had to maintain a very strict no intoxication policy for the safety of all the women at the shelter. Hands were shaken, holiday greetings given, I got a hug from Cindy, and we went our separate ways.
Toward evening we were dispatched to one of the downtown missions. The Squad was already there assessing Sam, who had gotten dizzy a couple of times during the day and lost his balance. Sam didn’t look so good: jaundiced, poor skin turgor, out of it. His blood sugar was 98 but his blood pressure was 76/68. He hadn’t felt well for a few days. He was also short of breath and wheezing. Sam apologized several times for disturbing us on Christmas Eve. We assured him there was nothing to apologize for.
Five-hundred mls of normal saline and a breathing treatment later Sam looked and sounded much better. By the time we rolled to Bed 2 and the hospital team came in, I was was happy to explain that Sam looked a lot better now than he did when we picked him up. Sam smiled and thanked us again. We told him we were sorry he had to spend Christmas Eve at the hospital, but I was thinking to myself that were it me, I would rather be in the hospital than sleeping on the floor at the mission. We shook hands, wished each other good tidings, I got another thank you from Sam, and we went our separate ways.
We finally got back to the firehouse. The engine crew was watching It’s a Wonderful Life. We joined them but it wasn’t long before the tones dropped for an injury. On scene we were flagged down by a woman who explained to us that her baby daddy had gotten drunk and slipped and fell on the ice. We went inside to find a 20-something-year old guy on the couch moaning, telling us his leg was broken. Well, it was more like, “My leg is broken, I know it. Is my leg broken? I know it is. Is it?”
After a far-too-drawn-out discussion regarding the fact that in order to help him we had to actually get his pants off and look at his leg, we finally got Ben’s pants off and guess what—he was right. I could feel the disturbing grinding of crepitus with minimal movement of the leg. A SAM Splint and a good deal of interfamilial drama later, we finally got Ben into the ambulance. An IV and some fentanyl went a long way to improving interpersonal relations, and on the way to the hospital, to distract him from his injury (and because I find people interesting) I coaxed out his story.
Ben had been released from prison about a month earlier. He is 27, has a 14-year-old girl and an 8-year-old boy, and a bunch of felonies that have kept him in the poky much of his young life. He is now working at the first regular job he has ever had, and he loves it—loves to be able to start providing for his family. But tonight, Christmas Eve, he and his girlfriend were arguing about his drinking and the fact they had nothing for the kids for Christmas. Yes, he acknowledged it would be more responsible of him to buy presents than booze, but he said it was hard not to drink because not being able to provide for his family made him feel less of a man. He started to tear up. Crap, I said to myself, did it have to be It’s a Wonderful Life on the tube just before we caught this run?
I told him when we got to the hospital I would ask around to see if there was anything left from one of the hospital’s holiday toy drives. After transferring care to the hospital staff, I talked to the nurses and a social worker about his plight, but there were no toys left at the hospital. So I talked to my partner and we came up with a plan. We called our lieutenant and asked to remain out of service for a little while after the call to accomplish a “detail.” There was a CVS open down the block from the hospital. We drove over and started walking up and down the aisles, quickly finding a basketball, Nerf gun and bag of plastic soldiers for the boy, and a large squishy stuffed dog, shaggy pink slippers and a fingernail applique set for the girl. Yes, I know, we were gender stereotyping; but time was short, and we figured the parents could distribute them in as egalitarian a manner as they wished. We enjoyed the bemusement and good nature of the cashier as we paid for our purchases and loaded them in the truck. We split the bill.
We drove back to the hospital and slipped the toys and a roll of wrapping paper into Ben’s room. Beaming, he thanked us and asked whom he should say the presents were from. “Santa of course,” we replied. The nurses said they would help with the wrapping. We shook hands, exchanged Yuletide greetings, and went our separate ways. But at least there would be two fewer kids in the city that wouldn’t go without on Christmas morning.
I can’t remember if we had any runs that Christmas Eve that required very much of our medical knowledge or ability. In the street it’s essential to have that knowledge, skill and judgment to be able to treat effectively any injury or illness that greets us when we arrive “on scene.” But, eventually, we begin to understand that this knowledge and skill make up the basics; they are the curriculum of EMS 101.
When we were young, we would brag to each other about the upside-down digital intubation or the chest decompression with the lawn dart or the rescue with the skyhook. Students and rookies measure their worth in the number and girth of the plastic tubes they can shove in the right place; assess value in the quantity of shootings and stabbings and dramatic wrecks and MCIs they attend. Eventually, though, enough tubes have been inserted that their value diminishes; enough dramatic calls responded to that they blur together and fade.
But with this passage of time and hopefully mellowing of character, it’s things of a very different nature that stand out in greater contrast from the background noise of EMS. Gradually the tale of the 14-gauge angiocath inserted in the external jugular through the car’s sunroof while dangling off the overpass is replaced by the story of the sad woman helped back to shelter on a cold Christmas eve; the tale of the fellow offered genuine concern when he got sick at the mission; the anecdote of the father given a hand to feel a little more worthy in the eyes of his children, and his children given a few toys to feel a little more valued on Christmas morning. Such acts can assuage the sadness born of our daily portion of poverty and sickness and violence, can be a balm to the existential sadness that comes from trying to hold back the flood of pain and suffering and anger, call after call, and shift after shift.
So be of good cheer. Our vocation may not offer us much in the way of material reward—this is certainly true. But it does offer us great opportunity to make our world a better place in many small ways—even for the least among us. Amen.