Saturday started out as one of the happiest days of my life. My younger son, Steve, and the love of his life, Jess, flew down from Seattle to San Diego to surprise my wife and I with the news that they’re expecting a baby.
What great news on the heels of being blessed with our first grandchild six months ago by my oldest son, Joe, and his beautiful wife, Kristen. Steve couldn’t wait to tell Joe and Kristen the great news, so we drove to their house on Saturday morning to tell them and, of course, see our precious little grandchild, Hinley.
We left their house at noon and on the drive home my cell phone rang. It was Bobby Brunio, a longtime friend and EMT I hadn’t heard from in a while. I knew in my gut that the call had to be bad news. More specifically, I felt the call was going to be about one of my greatest fears, the loss of one of my dearest friends, paramedic Billy Guth, a 36-year veteran paramedic and paramedic supervisor from Bethlehem, Penn.
I was correct and totally crushed by the news. Billy, a long-term diabetic, had experienced dyspnea while shoveling snow at home and stopped to tell his wife, Mary, that he wasn’t feeling well. She checked his blood sugar and found it to be in normal limits, so she knew something else was wrong. Rapidly, he progressed into cardiac arrest. The City of Bethlehem police and paramedics responded to find one of their own in complete arrest. To make matters worse, Billy’s long-time partner was one of the medics on the call. They made valiant attempts to save their colleague’s life but couldn’t resuscitate him.
The crew transported him to St. Luke’s Hospital, the same medical center where Billy had taken thousands of patients during his 36 years of service. The emergency physician on duty, John “J.P.” Patterson, MD, had served for many years as the EMS medical director for the City of Bethlehem paramedic service, as well as for Bethlehem Township Volunteer Fire Department, where Billy and I spent much of our careers. J.P. had spent close to 30 years in close contact with Billy. He and the entire ED team at St. Luke’s, all of whom knew Billy intimately, worked an extended code to try and save his life. But they were unsuccessful.
Billy Guth started out his career as a part-time EMT for the City of Bethlehem and advanced to the paramedic level with me in 1976. Over the next 30 years, he spent much of his career as one of the most active paramedics in the Eastern Pennsylvania EMS region I had once directed as the regional EMS director. The last seven years of his career, he served as a paramedic supervisor in the system he loved.
As an accomplished professional, Billy practiced incident command long before it was fashionable. He didn’t serve as an incident commander as much as he did “command” every scene he was on as a paramedic and a paramedic supervisor.
I write this note to you because Billy, like you and many of the EMTs and paramedics that you know, fit the same mold. He was always a consummate professional, always arrived at work early and left late, was dedicated to his city and loved it with an indescribable passion.
Bethlehem is known as the “Christmas City” and is famous for the Christmas Star that adorns most city decals and landmarks. Billy helped organize the popular Christmas City tree lighting ceremony and served as its chairman, logistics coordinator and, of course, emcee of the annual ceremony. There was rarely an event in the city that Billy either didn’t cover as a paramedic or attend as a proud citizen of his community.
He was also a very accomplished photographer, taking countless photos of beautiful scenes around his treasured city. He was honored for his efforts by the City of Bethlehem with a special showing of his work in City Hall. It was one of his proudest moments. I also tapped him to shoot photos for JEMS and our communications magazine. Simply tell Billy what you wanted and he had them to you the next day.
He also authored articles for JEMS. Shortly after one of his articles (The Bare Necessities of EMS: What you need in your ambulance) appeared in JEMS, a box arrived at the office addressed to Allie Daugherty, editor of JEMS. Inside was a beautiful, carefully packaged glass Moravian Star, a symbol most people equate with the City of Bethlehem. (See photo in gallery above.) It’s a coveted piece that you can only get at the city’s famous Moravian Book Store. Having just a plastic one at my home in California, I called my friend Billy right away: “Hey you SOB, I’ve known you for 40 years and you never sent me a glass Moravian Star!”
His immediate response: “Well, you never edited my stuff and made me sound as good as Allie did!” Two minutes of belly laughs followed.
Billy was always on duty. I mean that in many ways. The City of Bethlehem is rather unique in its paramedic system design because each paramedic is assigned a portable radio. That radio rarely left Billy’s belt and was turned on pretty much 24 hours a day. If he heard a bad call anywhere in his immediate vicinity, he responded from his home like most of the city’s paramedics, leaving family dinners and holiday meals to assist his colleagues. It also wasn’t uncommon to hear Billy reporting a speeding motorist to his police buddies over the police channels. He felt it was his duty to help them with their law enforcement efforts as much as they helped him on EMS calls.
You see to Billy, like most of you, EMS wasn’t just a passion. It was an addiction. It’s a good addiction in the fact that we care for anyone, be they an adult in severe distress or a little child simply suffering from a splinter in their finger.
Billy was one of those unique paramedics that never complained about system abusers or non-emergency calls. In fact, he somewhat relished in their management. He would joke with the homeless, buy them a meal or make sure they were taken to a shelter. He never left a patient behind without making sure their welfare was taken care of.
He always attended continuing education without complaint and, like many of you, shared any knowledge and assessment tips with anybody that would listen to him.
He had a tremendous rapport with the medical community and was very vocal when he had a concern. I remember standing next to J.P. many times when Billy would “go off” in a controlled tirade about a system problem or medical issues that needed to be addressed. J.P. would always wait smiling for Billy, red-faced and going through his signature gyrations and orations, to finish–listening to his every word. He would acknowledge Billy’s concerns and act on them, not just because he respected Billy’s devotion and strong love of EMS, but because over the decades they knew each other. He couldn’t help but love him like a son.
Like many people you may know in EMS, Billy was loved by everybody. His biggest attribute was probably his humor. You have to have humor in EMS or you’ll go crazy. Billy had a million stories that he told with his gravely, thick-tongued voice and a laugh that made your sides hurt. And there was always a lesson in the funny stories and accounts Billy told.
He was like a brother to me; the brother that I never had. I called him often and can’t remember a time (day or night) when he didn’t answer his cell phone. When he would answer the phone, he always answered with the same familiar, upbeat greeting, saying “HELL-O!”
I had the privilege of working with Billy, having him as a close friend and having his respect when, in a supervisory role, I asked him to change or correct his behavior or respond to a call at the end of a shift. I also had the privilege of responding on mutual aid calls from my township into his city. He always greeted me with a smile and pat on the back to thank me and my crew for our response whenever he was on the scene.
You see. Billy “owned” the City of Bethlehem. City officials didn’t fully appreciate it, but, the patients that he served would tell you that Billy was more popular than any mayor or city council member.
He was a “community paramedic” long before that term and concept became trendy. He addressed concerns for patients well outside the medical domain. It wasn’t uncommon for him to return to a home where he had cared for a patient just to check on, not just the patient, but their family.
I watched him go into the waiting room at receiving hospitals on many occasions and either sit or kneel down next to the family of the patient that he brought in. He’d give them what little information he could about their loved one’s condition, comfort them and, more importantly, let them know he truly cared.
As an example of who Billy really was, I’ll share a story with you that one of Billy’s former partners, John “Duke” Lindsay reminded me of today.
A woman called the Bethlehem City police desk to ask for an ambulance, indicating that her daughter had an earache. Billy and Duke responded to the residence without delay. At the time, it was cold, miserable and raining heavily outside as well.
They arrived at the home and went inside to find the child in her bed with moderate discomfort in her right ear. The little girl was clearly scared and presented with a low, irregular cry; the type of cry that goes straight to your soul.
Billy took a blanket, tenderly wrapped up the child and carried her down from the second floor to the ambulance.
He replaced the wet blanket that had been soaked by the cold rain with two warm blankets and softly spoke to her, promising her that everything was going to be all right.
Billy carefully examined her ear and obtained her vital signs to be sure nothing else was going on with the child. The mother rode up front with Duke, listening to Billy in the back comforting her daughter all the way to St. Luke’s hospital. At the hospital, Billy made sure the emergency room staff knew the mother and daughter had no ride home.
After the little girl was seen and treated, her and her mother were placed in a taxi and sent back home–paid for by St Luke’s. In hand were medications and those warm blankets.
Most folks would see the earache as a non-emergency for which an ambulance shouldn’t be requested. But Billy said this was an emergency to that little girl; and it was an emergency to her mother as well. They had no car and no way to get help. He profoundly commented that any level of pain was an emergency for a child.
The next day, the child’s mother called the Bethlehem communications center again; only this time it was to ask the dispatcher to contact Billy to come to her house to pick up a special dinner of beans and rice she made for him and his family.
This is just one small example of who Billy Guth really was and what he meant to the City of Bethlehem. Billy’s care and compassion was second to none and, while it probably can’t be duplicated, it can certainly be emulated by you and me.
Billy’s passion was contagious along with his majestic atmosphere of calm. The situations he was confronted with over the years weren’t what any average person could ever deal with. I sat down and calculated the impact he had on patients throughout his 36 years, not just during his Bethlehem City shifts but with the volunteer Fountain Hill Emergency Squad and part-time involvement in my Bethlehem Township Fire Department and Medic One mutual response and quick response paramedic unit.
I used an average of 48 hours a week for his service in EMS, with six calls per eight-hour shift (36 patients a week) times 52 weeks, to come up with an average of 1,872 “patient contacts” he had in a year. Multiply this number to total up all the patient contacts he had throughout his 36 year EMS career and you have an amazing total of 67,392 patient contacts.
If you add in an average of three family members to the equation, you find that he actually “impacted” the lives of at least four people on those 67,392 calls, for a total of 269,568 people impacted by his care and compassion.
This is amazing when you consider that the City of Bethlehem only has a population of 75,000 people. That means that, during his career, Billy impacted some residents or their family members on more than one occasion.
Just like you, EMS wasn’t just a job or volunteer opportunity for Billy; it was a “calling” just as strong as for those who go into the military or physicians who go to Ebola-infected countries.
If Billy had a fault, it was simply the same fault that you and I (and most EMS professionals have); he took good care of everyone but himself. He carefully watched his sugar because he knew that it could be his downfall. But he didn’t manage his weight as I and many in EMS fail to do.
He was always a jolly soul, resembling an EMS Santa Claus whenever he was on duty. He filled out his uniform shirt like many of us do in EMS, to its fullest. That doesn’t mean that it’s right, it just means that it was a reality.
I told a reporter that called me this week that if Disney had ever casted a cartoon paramedic character, it could’ve been Billy’s voice and sense of humor inside a body similar to the genie in the animated film Aladdin. He was the size of Chris Farley and perhaps funnier!
He loved to eat and chat with his colleagues and he loved to socialize with everyone. When he left the physically straining job of a paramedic and continued his career in the stressful job of EMS supervision, his weight gain accelerated.
The last time I saw him he was greatly overweight. In earlier visits, particularly after I had undergone gastric bypass surgery, I called Billy and told him how much better I felt losing excessive weight and begged him to undergo the surgery.
He responded with the words that I have said, that many of you have said and most EMS people that are more dedicated to their patients than themselves often say: “I KNOW”.
I write this note to you not just to tell you about what a wonderful, dedicated, loving person Billy Guth was to me and everyone that he touched, but also to plead with you to make a concerted effort to take care of yourself as much as you take care of your patients. There are far too many of us in EMS that neglect our health because of the EMS lifestyle and steady demands of our jobs.
Unlike the fire service that has a regimented exercise period every day to maintain firefighters in top physical condition, and law enforcement personnel who spend time at the gym to make sure that their strength is greater than those that they have to apprehend, EMS doesn’t.
EMS, by its very design and demands, leaves crews with little or no energy at the end of the day to go to the gym. In high call volume EMS systems, EMS personnel are assigned to units and expected to run call after call after call without proper rest, proper facilities to unwind and proper time for the preparation and consumption of appropriate foods.
And, at the end of the day, after seeing the worst cases and conditions in humanity, and absorbing the unrelenting stress that it brings, many EMS personnel simply want to go home and eat and eat and eat.
Just as EMS is an addiction that most of us will confess to, we also must confess that one unhealthy way we reduce stress is by overeating. It feels good to fill your belly after seeing some of the horrific things and witnessing families torn apart by illness and injury.
But the result is that we gain weight and go past the point of no return for a daily exercise regimen. I’ve talked to many responders who feel like it’s hopeless to go to a gym and work out when they can hardly breathe walking up the steps at a patient’s home, let alone the steps into a gym, because they’re lugging around so much extra body weight.
Firefighters carry 75—100 pounds of extra weight when they don there turnout gear, helmet and SCBA and charge into a structure with a hose line or tools to lay a beating on a fire.
In EMS, many providers charge into every home carrying the same weight, but it happens to be their own excess body weight.
If you add to that the stress and strain of carrying 250 pound patients, a monitor, stretcher, med kit and airway bag down three flights of winding stairs with little or no assistance other than a partner, your body will eventually tell you that you have to stop.
More specifically, your heart will begin to warn you through chest pain, dyspnea and high blood pressure that it can’t continue to produce the extra pressure it takes to pump an adequate blood supply through the miles of extra vessels you create by adding excess fat to your torso. If we don’t heed these warnings, eventually the heart says it’s had enough and either stops, goes into failure or throws a clot. It’s painful, but it’s true.
If there’s any message in the loss of a paramedic like Billy Guth, it’s that we owe it to our families, our colleagues and the community that we serve to take care of ourselves and survive not just for our own sake, but for them.
In the evening after his passing, Billy’s body was carefully packaged by his colleagues and placed in a city ambulance. That ambulance, along with two other city ambulances, was escorted by several police vehicles and a command car to the funeral home.
It was the fitting tribute by his fellow paramedics and also police officers who responded with him on every call. He knew every police officer, dispatcher and firefighter by first name. He was always there for them and it was fitting that they were there for him at the time of his death.
On Saturday, a long procession of ambulances, fire apparatus, police vehicles and medical helicopters will escort Billy to his final resting place in his beloved city. It won’t be the same for his many friends accustomed to seeing his smiling face beaming from the cab as he meandered through the city streets. But I know he would have loved the outpouring of love and support for this final escort in his honor.
I commit to you that throughout the rest of my life I’ll include a little pearl from “Billy” into everything that I write to you because he meant everything to me, to his family and to our profession. He left me, and now you, with countless teaching points, patient care tips and compassionate mannerisms that must be shared and passed along.
