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 for probable intubation asked me straight up, “Do you think I’m gonna make it?” I had no good answer but weak platitudes of hope and affirmation.

An elderly woman, with no surviving family left, said she worked at a nursery growing poinsettias. She said it was the only life she ever knew how to cultivate well.

Another elderly woman on hospice saw a deer cross the road out the back window and proclaimed it her spirit animal, smiling in bliss and closing her eyes for the last time.

A man dying of cancer told me there was a lunch pail with thousands of dollars in it buried under an old oak tree on his property. I dreamed of sneaking there off duty with a shovel despite seeing he had ten acres worth of oak trees.

The urgency, the uncertainty, and the confessional booth nature of the time I am with patients gives me a quick drink from the deep well of personal malady. I try to honor these stories to get to some diagnostic root, or simply listen if there is nothing else to do but shepherd them to the next step of their journey.

Joe Amaral
Grover Beach, California

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