Book excerpt: ‘Ambulance man’

Police sergeant and EMS educator Brian Casey shares memories of the atmosphere of crisis he experienced as a young EMT


The police story has been widely written and portrayed, the firefighter unceasingly praised, yet it is the EMT or paramedic who suddenly appears at the side of the sick and injured, yet remains a mystery to most. Brian Casey’s “Ambulance Man,” is the sometimes funny, sometimes frightening, but always heartfelt story of a young man’s entry into 1980’s EMS. This excerpt is reprinted with permission.

The minister is acting strangely

The night Reverend Lindstrom collapsed the caller only stated, "The minister is acting strangely." Witnessing a sudden cessation of speech, bewildered expression, cluthing of the chest, and falling face-first to the floor, was in fact strange behavior. He may have had a hypoxic seizure while turning an ashen color. It would become increasingly clear that one should hold loosely the stated nature of a call.

I had reported for duty in the diffuse light of late afternoon. Emerging from the ambulance quarters, I was disappointed to find that it was now dark out. I had a thought that warm sunlight would keep me from shivering; I felt weak and cold, although not from the cold.

I was still working as an extra person and rode to calls seated in the patient compartment of the ambulance. As the rig exited the garage, a familiar shudder started at my upper arms and spasmodically drew my elbows into my sides. The wave of trepidation traveled down through my gut and into my legs. My inner thigh muscles would contract and cause my knees to knock together. My clenched teeth caused my jaw muscles to ache.

I endured this same flush of anxiety during each ride to an emergency call, but I knew that once out of the ambulance and moving, I would be able to function. I didn’t understand at the time that the adverse reaction was neurologic, or chemical and not character, my adrenal glands hijacking my body for fight or flight. Instead, I assumed it was a mental defect, another deficit to hide and endure. At the time, I did not imagine a future-self free of this discomfort, but I did understand that my future-self was being formed, formed by a fire of sorts, a fire that hardened steel, hoping for nerves of steel.

We arrived at Ascension Lutheran Church and entered the building. People moved about as if lost in the very church where they had been baptized or married. Some clawed their way to the exit, and others staggered about as if the minister himself had exploded and they had been struck by human debris. We moved against the stream.

The reverend was lying on the floor of the chapel. Having moved too quickly, I arrived at his side before the rest of the crew. Before me was not only a dead man awaiting resuscitation, but someone I recognized. I had met him months earlier at my high school graduation. He was the father of a classmate. Standing near his head, I became enveloped in a void-like silence as I fell into a sudden trance. I was without a filter to protect myself from taking in the full reality, and I lacked the experience to see it from other than a civilian or pedestrian perspective. A circular haze surrounded the small scene as if I was looking down a tunnel. I could see only his deep, blue-gray head surrounded by shoes. I even recognized my own uniform boots.

Cropp barked out an order, and suddenly I was an ambulance attendant again, in charge of mechanical ventilation with the oxygen-powered resuscitator. I became completely absorbed in the task of ventilating him once every five seconds. My concentration was absolute, like a deep form of meditation. I was engaged in a supreme focus on rhythmic breathing, except I was doing the breathing for another. The force of this single-mindedness was so great that we arrived at the without my recognition of the trip.

In the hyper-illuminated emergency room, his treatment turned into a medical exercise of electric shocks and drug administration. It felt good to be out of the reach of the congregation. The doctor had instructed me to take over chest compressions. I applied the same intense focus to the compressions as I had to ventilations. I reasoned that a single lapse in rate or depth would throw away a handful of the man’s brain cells. To precisely time the sequence, I attempted to use a clock on the wall before me. But the clock’s hands, as if personified and waiting for me to look, suddenly spun cartoonishly clockwise then counterclockwise. I was quieted by a nurse’s quizzical look when I regrettably commented on it. Fortunately, my crazy talk was lost amongst the mix of chatter and organized chaos.

A final electric shock returned a heartbeat, and soon after he was reanimated. He began to thrash about on the narrow gurney and vomited more than I knew possible. Each time he did so, the vomitus came out with a gigantic roar. It was as if white-smocked villagers had captured a wild beast and were trying to hold it on a table; despite its large size, fierce sound, and spewing of vomit, they were able to keep the creature from escaping. He became manageable again only with the loss of his pulse. Cropp tapped me on the shoulder and said simply, “Let’s go.” I walked out knowing that I now had a cardiac arrest, the crown jewel of ambulance work, in my small but precious cache.

The rush of adrenaline that had made me nearly convulse, the altered time perception, the crazy spinning clock hands, were all part of the wild ride my body had taken me on. The clock had acted like a clock; I had been the one with internal spinning parts. I kept the experience of the ring of shoes around the minister’s blue face and the cartoon clock a secret, a touch of shame and a touch of miracle. I had decided years earlier to keep my collection of these things to myself.

The call had taught me numerous things, and for the next cardiac arrest, I would be more adept with the essential tools of the trade. Though the lingering smells, sights, and sounds were close at hand, what was most present in my mind was not the victim himself, but the memory of the atmosphere of crisis and death and other people’s reaction to it.

Most importantly my knees had knocked, but I had not fallen down, I had tunnel vision but saw my way through it. There were gaps and crooked lines in my memory, and things had happened that I could not explain, but no one had seen me falter. No one knew what was going on inside me. With no thought of an alternative, I would continue as I always had.

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Excerpted with permission from, “Ambulance Man,” by Brian Casey
Published by Alley Light Press (January 15, 2022)

About the author

Brian Casey is a sergeant at the Saint Paul Police Department and director of their Employee Assistance Program. He has a degree in Health Education from the University of Minnesota and over 35 years’ experience working as a paramedic, EMS educator and police officer. His personal experience with critical incidents and his work as a health educator have given him special insight into the health and wellbeing of public safety personnel. Casey is also the author of “Good Cop, Good Cop: A Get Healthy, Stay Healthy Guide for Law Enforcement.”

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