other people's emergencies: random thoughts of an urban paramedic

For more than twenty years I've worked as a paramedic for the city of Boston, Massachusetts. The opinions expressed in this diary are mine alone, and do not represent the views of Boston EMS. Names, dates, locations, and physical characteristics have been changed to ensure patient confidentiality.

Saturday, April 25, 2009

A Little Variety, Please

I want a shooting.

That sounds pretty bizarre, I know. It's not that I want anyone in particular to get shot. Or even that I want a shooting to occur. But if one Bostonian does decide to shoot another one, I'd like to respond to it.

EMTs and paramedics know what I mean by this. EMS personnel are occasionally quoted in the media as saying, "I don't want bad things to happen to people. I just want to be there when they do."

Serious emergencies are the focal point of this business. These are the things that attract people to EMS in the first place. We thrive on trauma and on critical medical conditions like myocardial infarction and cardiac arrest. Nobody becomes an EMT or paramedic to treat headaches or upset stomachs. We want to handle serious problems. Like shootings.

When you first become an EMT, every call is fascinating. Suddenly you're racing through the streets with sirens yelping and strobe lights blazing. Everyone watches as you speed past, wondering what kind of emergency you're going to. It makes no difference that your patient turns out to be an old lady who's had a toothache for the past six months. You're not a bystander anymore. You're the one who takes care of the problems.

But after a while, that's not enough. Racing through traffic becomes more stressful than exciting. You get sick of hearing the sirens. And when you get called to the same apartment for the third time in a single week, where the same old woman once again tells you she has indigestion, you begin to wish for something a little more challenging.

You begin to wish that just for once, someone would get shot.

A long time ago, before I became a paramedic for the City of Boston, I took a part-time job as a paramedic with a commercial ambulance company. Working with an equally-inexperienced partner, I would respond to 911 calls in the City of Cambridge, Massachusetts, each Saturday night.

I couldn't wait for that first call. I wanted it to be a collision. Or a stabbing. Something messy, complicated, and challenging. I couldn't wait to start my first IV and perform my first intubation. I couldn't wait to save lives.

But the hours ticked by, and nobody called 911. There were no collisions, no stabbings, no emergencies of any any kind. Nothing happened.

The following Saturday, it happened again. Eight hours--no calls. It happened again the Saturday after that, and the Saturday after that. For twelve weeks in a row, we spent eight hours driving aimlessly around the city without so much as applying a Band-Aid.

Finally, on the thirteenth Saturday, we were dispatched to a car accident. The vehicles were barely damaged, but one of the drivers wanted to be evaluated in an emergency department for shoulder pain. We stuck an IV into her during the ride--not so much because she needed any fluid, but because we needed the practice.

I'd never do that today, of course. I've started so many IVs that I'll be happy never to start another one. Thirteen weeks in a row without a call sounds pretty good right about now. But that's the difference between a rookie paramedic and an experienced one. The rookie can't wait for calls to come in. The experienced paramedic hopes for a quiet shift.

I spent my first twenty years as a City of Boston paramedic entirely on the overnight shift. Then, roughly a year ago, I switched to the evening shift. I was tired of living on such a bizarre schedule. I thought I would benefit from being awake in the daytime and sleeping in the dark, the way normal people do.

At first, I enjoyed this new routine. For the first time, I encountered patients who weren't drunk. On the night shift, everyone you treat seems to be drunk, or high, or both.

But soon I detected a pattern. Every call fell into one of three categories. We responded to cardiac calls, difficulty breathing calls, and heroin overdoses. Over and over again. Nothing else.

I realize now that I made a mistake in changing shifts. Though I'd never really thought about it before, one of the things I like best about this job is the variety of the calls we handle. You never know what you'll see next. That's what makes a paramedic's job interesting. That's what keeps it challenging.

Nowhere is that variety greater than on the overnight shift. That's when the strangest things happen. People get drunk at night, with with that drunkenness comes some bizarre behavior and bizarre situations. The night shift is by far the most interesting shift of all.

On the evening shift, we deal with the same problems, call after call, shift after shift. Chest pain, chest pain, chest pain. Asthma, asthma, asthma. Every once in a while, a heroin overdose. That's about as weird as the job gets in the evening.

It's been nearly two years since I've responded to a shooting. On the night shift, we used to see a couple of shootings every week. I'm tired of treating cardiac problems. As the old saying goes, it's not that I want anyone to get shot...

But just once, I'd like to be there when they do.

12 Comments:

Blogger Kathy said...

all the nonsense happens after midnight. :) But it's also starting to get warm, and people will be venturing outside, starting trouble... never fear - it will come..

6:05 PM  
Anonymous scannerbuff1 said...

I know what you mean about not wanting something bad to happen, but wanting to be there if it does. In the Boston suburb I live in, fire dept. does EMS. 90+ % of all FD calls are for medicals (very rare stabbings, no shootings, occasional trauma, but mostly illness). Not exactly the action most of the guys anticipated when they joined.

We have an average of 10 building fires per year. None of the many firemen I know want to see someone's house burn down. And yet, when a fire does occur, the number of off-duty firemen who show up at the scene (without getting overtime) is incredible. No one wants to miss that occasional big event, when the daily work is so much less interesting. But these same guys work many hours each week on fire prevention activity, hoping to reduce the number of these fires.

As for your wanting the trauma/violance calls when the do occur, have you thought about switching trucks? P1 seems like its in a relatively high-end section of the city. Which trucks serve Dot and Roxbury? Wouldn't there be more trauma in those neighborhoods, and certainly more violance?

8:28 PM  
Blogger TS said...

Kathy:

That's very funny, actually. I never thought anyone would console me on my lack of tragedy. Thank you!

10:13 PM  
Blogger TS said...

Scannerbuff1:

Those are both excellent points. I know a fair number of suburban firefighters, too, and you're exactly right--nothing makes them happier than going to a genuine building fire. But for the reasons you mentioned, this doesn't make them bad people.

As for changing trucks, well, you're absolutely right. I could stay on the evening shift but move to the Roxbury or Mattapan truck, and I would certainly see more shootings and stabbings than I see now. But my previous assignment--downtown, at night--had the best of everything--a fair number of shootings and stabbings, but also the really bizarre stuff you don't see elsewhere: people trapped beneath subway cars, collisions in tunnels, drownings, jumpers from the Tobin Bridge, and so on. I made a mistake in giving up that spot. That's all there is to it. And unfortunately for you and other readers of this blog, this means a lot less interesting stories.

Thanks for trying to help, though.

10:21 PM  
Blogger Kathy said...

I worked in a Boston ER for almost 15 years (as a secretary) - I know all too well what you are talking about. :)

10:39 PM  
Anonymous MichiganEMT said...

I know exactly how you feel. For the last five years I have worked as an EMT for a retirement community on the midnight shift. All we do is pick up someone who falls. Once in a while we'll have a good cardiac call. I work part time for a private company, also on midnights. Even as a basic truck we'll average one to two priority one calls per shift. I make a hell of a lot more money at my full time job, but there are times when I am tempted to work full time on the truck just to respond to some real calls. I have eleven years as an EMT and still love the adreneline rush of priority calls. We all do.

11:30 PM  
Blogger Herbie said...

That's one of the best things about working nightshift--the variety.

I miss it to.

Be safe.

8:24 AM  
Blogger TS said...

Thanks, everybody.

9:31 AM  
Blogger brendan said...

This comment has been removed by the author.

11:18 AM  
Blogger TS said...

Brendan:

That's hilarious. Thanks.

1:48 PM  
Anonymous Anonymous said...

Yup, as a nurse in an ER that doesn't get too much action I've often found myself wishing for something to get my teeth into. But as you put it, nothing but chest pain, asthma, OD's and lots of broken hips.
But by now, if they dragged a couple of grisly GSW's in here they'd probably have to resuscitate me. (Sigh...)

5:40 PM  
Blogger TS said...

I feel your pain.

6:04 PM  

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