Editor’s Note: We’re pleased to publish an exclusive excerpt from a new book by veteran paramedic Bob Holdsworth, “Wading Into Chaos – Inside the Life of a Paramedic.” In the book, Bob shares the emotions, the frustration, the sadness and the dark humor that accompanies responding to fatal car crashes, 14-year-old suicides, inner city gang violence, train accidents, medevac helicopter landings, and the forgotten elderly who just need someone to talk to. In this excerpt, Bob recalls a trauma run he experienced as a new paramedic. It’s available at Amazon and Barnes & Noble.
Willie
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As good as I was feeling about what I was doing, I realized I was working way too much. I’d always loved going to Vermont, so I bought myself a timeshare up in Stowe. For the next couple of years I took time off around my birthday to unplug. I only managed to get a full week once. My personal life was still stuck at next to nil. I’d been seeing the same woman for nearly six years, and we’d finally realized we were completely different people and had agreed to move on. I ended up moving out, getting an apartment, and starting over.
Professionally, the severity of the calls we were getting — shootings, stabbings — was escalating. Collectively everyone involved in EMS in Hartford realized that we needed to step up our level of patient care. The emergency room directors of Hartford’s three hospitals got together and agreed to offer a paramedic training course, which they cooperatively put together.
About fifty people applied from within the ranks of the greater Hartford EMS community. Twenty-four of us originally started the program. We began what was an eight-month course of study, all of us still working full-time and rearranging schedules so we could get to the classes.
At the same time, Hartford Hospital decided that it wanted to go into the air ambulance business. They were training the first group of flight nurses for the Lifestar program. Quite often our classes would come together, so the first group of flight nurses and the first group of paramedics trained together.
The best thing about the program was that, because it was a first time, cooperative program, the heads of departments came in to lecture. The heads of the neurology, respiratory, anesthesiology, obstetrics, emergency medicine, and psychology departments all came in to teach us. The chief trauma surgeons from each hospital were actively involved. We had the best Hartford had to offer and a phenomenal educational experience.
From my perspective, the education was like starting from the ground up. The level of anatomy and physiology we were expected to learn was very complex, literally thousands of pages. I’d look at the other people from my company who’d entered the program with me and wonder just how big a bite we’d taken, working full time and going to school four days a week.
When it began, I was still working with the remnants of my injury from the Corrections Department, so I took notes with an injured wrist. I couldn’t work road shifts either, so I began dispatching at night. I tried to give my classmates a break, putting them on the last truck out so they could study, sleep, or whatever they needed to do. We worked all night and had to be back to class at nine in the morning.
For the first five months, we took practical lab courses, practicing intubation (putting breathing tubes into a patient’s throat), working on the mannequin until we could do it in fifteen seconds or less. We had to be able to start IVs. We had to be able to do medication calculations, know which medications were appropriate and which ones were contraindicated because they’d cause the patient harm.
After the first five months of classroom training and skills sessions four or five days a week, we went into the hospitals to spend time in the emergency room, in the operating room, in the OB/GYN suite, the psychiatric suite, and the intensive care unit. We were evaluated every step of the way by the clinical coordinators to make sure we were not only learning the stuff, but that we could actually apply it. That’s when we started to lose a few people. We started with twenty-four; twenty graduated.
After the clinical training in the hospital, we had to take our knowledge to the streets. We had to use our skills under the watchful eyes of senior paramedics. On every call we had to tell them what we wanted to do, and why we wanted to do it. They would quiz us mercilessly:
If it’s this heart rhythm on the monitor, but the patient looks like this and they’re taking these medications, what can’t you give them?”
“Hang on.”
“Don’t give me ‘hang on.’ You’re in the back of the ambulance. You’ve only got thirty seconds to figure this out.”
I was assigned to one paramedic preceptor who walked in on the very first day and said, “I’ve been a paramedic for seven years and you don’t know anything, but you will when you leave.” I had been in EMS at this point for about the same amount of time but wasn’t about to say so.
“Yes, sir. I understand.”
He then went to the paramedic unit that we were going to ride with for the day, pulled out the spare drug box, opened it up, turned it upside down, and dumped absolutely everything out on the floor. Boxes with prefilled syringes, IV tubing, IV solutions, bandages, IV catheters and thirty-seven different medications in different vials and ampules were now on the floor in a big pile of glass and plastic.
He took the now-empty drug box, handed it to me, and said, “Start putting that back together again. I’m going to go get a cup of coffee.”
As I reassembled the drug box, he would come in and sit with his arms crossed, his cup of coffee on the table, feet up, rocking back and forth in the conference room chair. “What have you got in your hand?” I’d read it to him.
He’d say, “Tell me what it’s used for; tell me what its contraindications are; and tell me how it’s administered.”
I did. If I were right, he’d say, “Move on.” If I were wrong, he’d say, “Go get your book and study it.” He did this to me twice in my week with him. I learned everything in that box upside down, inside out. I knew it by sight; I knew it by shape, so that when I was working in the ambulance and I had a partner who might not have been as experienced, I could say, “Hand me the Lidocaine.
It’s in the third compartment in the top tray.” In hindsight it was great training, and as I became a paramedic preceptor later on in my career, I had to thank him for that knowledge, even though, as I lived through it, my future gratitude wasn’t first on my mind.
I didn’t dump the boxes out on my students, but I did make them go through the drug box every single shift. I made sure that they went through and checked the expiration dates on the medications. I would make them pull something out of a particular tray.
“Tell me the indications, the contraindications. What can’t you use?” Once we were done with that five months of education, about two months of clinical rotations through all of the different departments of the hospital, and then another month or so riding on the medic units with preceptors, we were deemed worthy to graduate and take to the streets as medics in the City of Hartford.
John, one of the guys I went to paramedic school with, took a night shift with me. We weren’t too far into the shift when the police dispatcher announced, “Unit 463, respond priority one. A possible shooting.” It was in a notorious housing project, long since torn down, but then a hotbed of drugs, gang wars, and murder.
It was raining, and the reflections of the red and white lights danced off the buildings as we raced down the wet streets. Sirens screamed a warning to the very few people who dared to walk the street at night. We made a final turn and the scene came into view. There was a lone police car, its light bar extinguished so as not to call attention to itself. We followed suit and shut our lights and siren off as we approached.
In the center of the rain-soaked street, a crowd had gathered. A woman was screaming, held up by friends or family. A man lay crumpled in the middle of the road next to his wheelchair. The cop looked nervous as we rolled to a stop and stepped out of the ambulance. “He’s been shot—a lot,” he shouted from about ten feet away.
The decibel level immediately increased from the crowd of distraught onlookers. We knew we would have to work quickly to save the patient and get away from the scene for our own safety. We grabbed the heart monitor, oxygen, trauma bag, and stretcher for the fourth time on this shift, and once again we waded into chaos.
I remember being surprised that there was only one cop on the scene, because this typically was a show-of-force area. The problem with this kind of situation is the bigger the show of force, the more the crowd gathers. Sometimes going in quietly is the safest way to get in and out of these situations without getting into trouble.
As we got closer, we recognized the victim on the ground: Wheelchair Willie. We knew him very well. We treated him for something a couple of times a month. He was a local resident, a drug dealer. He got his chair about five years earlier because of a gunfight with another drug dealer over turf.
We began to assess our patient and things were not good. Willie was definitely going to die and there was nothing we could do about it except make it look as if he had a chance. People in the project didn’t trust authority figures. They didn’t trust the police, they didn’t trust firefighters, and they didn’t even trust the “street doctors,” as paramedics were called, especially white ones.
All of the responders on this call fell into that category. We had to hurry. Any perception by the crowd that we white folks were not doing our job right would lead to violence against us. Fresh in our memories was an incident involving one of our coworkers who had been assaulted a week earlier, just down the street. She was punched in the face and shoved down a flight of stairs by a relative who was unhappy with the speed of care being rendered to his mother. I looked up and noticed the cop looking more nervous with each passing second. His eyes were darting over the crowd, looking for any sign that the shooter was watching, waiting to see if Willie needed to be shot a few more times to finish the job.
As we worked on him, bent over in the rain, I heard a shrill voice through the bedlam. “Doctor, you going to save his ass or what?” I knew the voice without even looking up. It was Willie’s lady, Darlene. They made quite a team. She was a ninety-pound, sickly-looking addict who lived with Willie. She got drugs, and Willie got help to and from his chair and the money from Darlene’s side business as a hooker.
“Darlene, we’re going to do our best.” I lied. “He’s hurt really bad this time.”
Now the screaming ratcheted up a notch from the crowd, most of whom were members of Willie’s customer base. John and I made eye contact and our look said it all, Put on the show for the crowd, get Willie in the ambulance, and get out of here before he dies.
There were three bullet holes in his chest, two in his abdomen, and two more in his useless legs. Willie was so badly injured that he’d stopped bleeding, which is always a bad sign. We put the oxygen mask in place and applied the cardiac monitor leads, which showed a completely lethal heart rhythm. Willie’s body was secured to a backboard with two straps, and we headed for the ambulance. The cop provided a very false sense of security for us, and the crowd surrounded us and followed us like a premature funeral procession.
We loaded the stretcher. John hopped in and began to listen to the fading sound of Willie’s heartbeats. He hung a 1,000cc bag of IV solution as the crowd watched the show. I closed the door, got in the driver’s seat, shook my head at the cop, indicating the outcome, and completed the final act of our street play by flipping on the lights and siren, leaving the project as fast as I could get us out of there.
I looked in the mirror to see the cop following me, adding to the show with his lights on as well. The noisy parade was all part of an illusion created to allow us to say that we had done all we could. It would allow us to face these same people on the same street tomorrow and not get hurt for not saving Willie.
We arrived at the hospital three very short minutes later. The IV was running and Willie’s veins were so depleted of blood that there wasn’t going to be any catching up. John was sweaty from doing three minutes of CPR. The trauma team stood at the door of the ambulance. We pulled the stretcher from the rig and gave a report. The doctor looked at Willie’s wounds, listened to his heart, and pronounced Willie dead with a simple statement: “Time of death 23:13.” We never even made it into the ER. We were still on the ambulance ramp.
The doctor looked at us and said, “Nice job, guys. How’d you even get a line on him?”
John wiped his face and said, “I dug.”
The head nurse, Greg, looked at me and said, “Sorry, guys. We’re swamped. You’ve got to take him to the morgue for us. I’ll get the key and a toe tag and take you down there.”
Just like that, Wheelchair Willie and his business enterprise ceased to exist, all in twenty minutes from the first report of the shooting to the presumption of death.
Four other things also happened in that same twenty minutes: Someone took over Willie’s business territory; someone was planning retaliation for the shooting; Darlene would be working for somebody else by midnight; and a shooter was still loose in the north end of Hartford.
We cleaned up the truck after the morgue visit and John said, “I’m starving. How about a slice from that place down by the train station?”
“Sounds good to me.”
I took a left out of the ER parking lot, heading downtown. So far, it was a normal Saturday night, and we were only four hours into the twelve-hour shift.
You can buy the book at Amazon or Barnes and Noble