Joe Amaral

Back of the Bus

When the ambulance doors shut, a fertile silence is wrought as patient and paramedic situate into the tight, mobile quarters. The patient, strapped backwards on the gurney like a carnival ride, stares upward at bright lights and cabinetry chock-full of colorful medication boxes. As the ambulance takes off toward the hospital, the paramedic begins an ataxic dance, hopping and twisting over blood pressure cords, pulse oximetry, heart monitor leads and IV tubing.

Patients may not be as forthcoming around large numbers of family, bystanders or medical personnel, but the atmosphere in the back of the ambulance is made for intimacy and truthful candor. I make sure they’re comfortable as can be, and then I continue the interview. Chief complaint, SAMPLE history, secondary issues, reassessing everything. Once it’s just the two of us on what can best be described as an awkward first date, we both open book and overshare.

Some joke or express their deepest pain and fears. Anxiety, stresses, regrets. The alcohol and pills they imbibed. The nagging injuries, traumas and diseases. I stay nonjudgmental.

COVID patients speak about the shame and small mistakes they made to contract it. One man on high-flow oxygen being transferred to the ICU …

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Differential Diagnoses

When their ambulance is dispatched to a 9-1-1 call, paramedics attempt to cherry-pick a diagnosis based on the age and the one-sentence description they get of the patient’s complaint. We occasionally nail it, most times not, with humor, sarcasm, gloom or fatal cheer. There are often curveballs; it’s hard to streamline individual patients and their array of needs with our quick-and-dirty prehospital tools.

Being Human

I work as an ambulance paramedic. Nowadays, on every call that meets the criteria for COVID-19, my colleagues and I wear masks, gloves, eye shields and gowns. We stand six feet away from our patients as we interrogate them about the presence of fever, cough, body aches, or breathing problems. 

Our overall 9-1-1 volume is down, as people stay home instead of driving drunk, as they decide to stay away from hospitals, as most of them (minus the over-advertised outliers) shelter in place. But I notice more secondary symptoms: domestic abuse, assault, anxiety, mental illness, loss of sobriety.

Protea caffra

Beverly called the ambulance because she couldn’t walk anymore. Her feet were edematous after ten days of radiation treatment for metastatic lung cancer, and her heart was slowly overfilling with fluid, backlogging into her body. She was stoically resigned to her pain and newfound infirmity, but she kept a wry sense of humor, cracking jokes about being waited upon and the “magic carpet ride” sling we lifted her onto.

During transport to the hospital, Beverly told me she grew protea: pale red, pink and cream-colored flowers native to South Africa. Her family sells them at local farmer’s markets in bouquets. When I inquired further, Beverly perked up and gave me the rundown:

A Perceived Snub

I ambled with squirrels and rabbits on an urban trail overflowing with chaparral and mossy oak. Early morning bird chatter, drone of bugs in rays of sun, and the crackle of underbrush beneath my feet kept me company. My thoughts wandered brisk as the sound of river water on rock.

A man wearing a holey T-shirt and sweatpants approached me, accompanied by a large German Shepherd. The dog was off leash but seemed friendly. The man had a vacant stare, and as I passed him I gave a perfunctory smile and “Good morning.”

He didn’t even note my existence nor change his faraway gaze, and I immediately snickered at his lack of basic human decency. Shaking my head, I glanced back at him. He had stopped, looking up at the cloud-threshed sky, and suddenly emitted an unearthly wail.

Pre-Surgical

The old woman bends forward, rubbing life into her putrid socks to ease the black pain emanating from her gangrenous toes. All the while, she coughs, calling it “the other person inside of me.”

Comfort Care

The hospital-style bed lurks emptily alive in the pale living room. Rust flecks along its silver rails pock my distorted reflection. Cold sheets triangulate like sagging tepees, housing the smell of long-term illness. These are the ghostly remains of hospice care.

Denial

It was a dark and rainy night, the man was wearing a black t-shirt, and he wasn’t in the crosswalk when the bus hit him. There were no sodium streetlamps, only narrow headlight beams. The bus driver didn’t see the man, only a shadow in the beam. Then came a disembodied thump that sucker-punched the poor man to the pavement.

Assistance

I used to always walk in the woods

      before I became crippled.

            — from a dying woman 

I respond to a ranch house at twilight. An old woman is dying from metastatic lung cancer, vomiting blood. In between episodes of dry heaving and spitting dark clots, she reaches her hand out, sometimes grabbing my arm, other times involuntarily seeking the sky. We both know what her family refuses to see: she will be dead in a few hours. 

Work/Life

“We lock the door and shut the curtains, and, when its all clear, we line up in a special order and listen to what our teachers tell us.” –My kindergarten daughter, Zelia

They say work to live not live to work but how do you come home crushed by a forty-eight-hour shift on sixty minutes of broken sleep and kiss your babies and tell them it’s all going to be okay when their school is on lockdown due to a nearby shooting and the suspected gunman is still on the loose as you tend to a patient with suspicious wounds while the world keeps debating nuclear stories around you, and you think this small town ain’t so bad: the knife and gun club has low enrollment compared to the gang-ridden inner city you grew up in where shots fired were barely flinched at (because they weren’t en masse), and hella felons ran through your property with cops and helicopters giving chase.

Fray

Driving the ambulance in crushing fatigue, my weighted eyelids slit to make sodium glows of street lamps into arcing orange, bobbing like stars that penetrate unfired darkness. Saintly portals to dawn.

Transfer of Care

 

We take a man home on hospice from the hospital: end stage cancer, metastatic. His Power of Attorney requested one last pain shot of Dilaudid. We cinch belongings into bags, gather discharge papers and old flowers in vases. He groans being moved from cot to gurney, and again over the bumpy roads. It’s his final ride; we are his transporters.

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