By Crystal Wallin, NREMT-P, CCEMT-P, Tri State Ambulance
He was a year ahead of me in school, a joker and a clown and for awhile we rode the same bus until he got his license. I hadn’t seen him in a few years but here he was now. We didn’t speak. I didn’t know what to say, but I was too busy anyway. It didn’t matter even if I could’ve thought of something to say because he wouldn’t have heard me.
I got there in my private vehicle soon after the others, so I didn’t catch the whole story. I just joined the mostly silent group, stepped in and relieved the responder doing compressions. The patient was slight, a young and pretty slip of a girl. She might’ve been a year or two older or younger than me. It was tough to tell. I tried not to think about the crepitus beneath the heels of my hands as I started in on the age-old rhythm of compressions. Tried not to think about the connection to my younger years as he stood with bowed head and slumped shoulders, weeping.
We got her to the ambulance outside, the yard redolent in the heat with cicadas singing as we carried her to the truck. Got settled and then we headed down the winding country road. The siren seemed vulgar to my ears. I had been a volunteer a little less than two years at that point, I think. I remember I was wearing blue jean shorts and a white tank top with flip flops. I’ll get to why I remember that in a minute. For now, I rotated with the others, giving respirations with the bag valve mask thru the Combitube, then rotating back to compressions. There wasn’t a lot said. I knew him, but the rest of the first responders knew both of them. I hadn’t seen him in a few years, this was his girlfriend. One of the other responders told me he came home, found her. Still warm and apparently it may have been a recent code, or maybe it was the heat? Anyway, they started to work her and here we all are now. Going down a beautifully green leafed back road, winding our way down the rural landscape they must’ve driven together many times, laughing certainly – or maybe listening to the radio. But now she’s so little, and pale, and I see his pickup truck following behind us with the flashers on.
Someone had called for an intercept with the paramedic service about 45 minutes north of the residence, maybe before I arrived on the scene. It seems like so long but eventually I can hear a second siren and we are pulling into the parking lot of a fish hatchery, and parking. Our siren stops; so does the second siren.
The back doors open and a very serious man’s face appears. Brisk and businesslike, he begins asking questions. His hands are busy working on removing supplies and medications. I don’t remember what his partner looked like, or what was said for a bit. I kept rotating between compressions with another responder while both of the paramedics attended to the airway. The first man is younger than me, but the professional appearance of both made me suddenly aware of the shorts and white tank top – and flip flops. Time to transport, and the second paramedic gets back out. The first one, the one with close cropped hair, rapid speech and precise movements – he stays in the truck with us.
As the second paramedic gets out, I see my schoolmate pacing, weeping quietly. We begin to transport again. I’m watching intently as the paramedic in our ambulance takes out a device I’ve never seen. He selects a site, and to my horrified fascination, and with A DRILL places a bizarre needle in the patient’s leg, just distal to her knee. He connects IV tubing, and hangs a bag that is inside a sleeve. He pumps up a bulb attached to the sleeve, much like the pump on a manual blood pressure cuff. He gives medication thru the IV line.
About this time, he notices me for the first time, as a person it seems rather than a fellow body passing objects back and forth – and he meets my gaze. He’s serious but his eyes are kind and he asks me if I’ve ever seen the IO before. I shake my head, look down and say I’m a newer first responder, and this is only the 3rd code I have seen. He asks, “do you want me to tell you about what I’ve done?” and I reply in the enthusiastic affirmative. Horrible as the circumstances might be, it was evident from the moment he stepped foot into our ambulance that help was here, and help knew exactly what to do.
He begins to walk through everything he did – layman’s terms but not insulting, outlining the indications for each and the expected outcome, the hopeful outcome. He explained what he was doing as he rechecked interventions, rechecked rhythms and what the medications he had given were for. I drank in every word, fascinated in my tank top and sweaty hair. I don’t remember if he ever had a visible droplet of sweat, but I do remember to this day how he made me feel drawn to the medicine despite the fact that the small pale form on the cot was not far removed from my little world at home. She looked like my small best friend, and that bothered me too. I focused more on the medicine. I told him I knew of her, went to school with and rode the bus with her boyfriend. He shook his head and said that was too bad, went back to his medications with not much more emotional response.
I’d never heard a radio report like the one he gave; I was impressed by the succinct way he summarized this whole experience. Walking into the city ER, I tried to be as small as possible next to these two uniformed paramedics in their competence and calm. Standing outside shortly after, putting our ambulance back together, they emerged again. I asked how it was going and the paramedic that rode with us said briefly, “they called it.” I remember sagging against the ambulance, somehow just feeling like a balloon with all the air whooshed out. I had hoped that somehow all these people who were so far beyond my knowledge would fix things. I remember them explaining how the disease she had often meant patients didn’t live much past their early 20s. They were kind, explanatory and collected. Then they were gone.
On the way home, I just sat, the details swirling around in my head like an out of order kaleidoscope. I had never seen my schoolmate diminished like that, head bowed, weeping. I kept thinking of their little home, and of him returning to it alone. Thinking of what I didn’t know how to do and if I had known all those interventions, would she have had a different outcome? Looking at my sweaty street clothes with embarrassment. Wishing I had thanked that paramedic with the rapid speech and professional competence. Remembering what he took the time to teach me.
Wishing I could be like that.
Years later, I’m a dispatcher for that same paramedic service in the city and that rapid speech replying back on the radio becomes familiar to me. Later, and I’m a paramedic student; he’s one of my preceptors, teaching me still with that medicine-based professional air and I try to remove the emotion from my approach to patients, to be so matter of fact like he is.
It’s 2018 and I just graduated nursing school and I can tell you there is still so much to learn from this quiet and decisive educator. He watered a seed that was already in me, and his demeanor of efficient movements, ready to teach with equal respect both co-workers, students and those on the periphery of emergency medicine like I used to be.
As I’ve been around emergency medicine now for 14 years, I’ve seen many alpha males and females, many Monday morning quarterbacks. I think we need a lot more of the seed waterers, the educators, those who teach and lead by example.
His name is Nick. I think we need a lot more Nicks. I’m sure glad I met him, glad he ignored the tank top and flip flops and explained intra osseous intravenous access to me with as much deliberation and gravity as if I’d been a young medic. He was just promoted to program manager of clinical education of that paramedic service, very well deserved,
Be a Nick. Light that fire in someone, show them what you do, include them.
“See one, do one, teach one.”