The average adult has eight pounds—twenty-two square feet—of skin. Healthy adults can lose a liter of blood before going into shock, and vital signs help monitor the onset and stages. Unlike adults, children can lose nearly half their blood volume and still have a blood pressure holding steady. With shock, “adult vital signs go up the mountain and then drop off,” our EMT instructor Nancy says. “Children’s are like, ‘I’m okay, I’m okay—DEAD.’”
Tourniquets. Nancy tells a story of a father who strapped a belt around his son’s neck to stop forehead bleeding. We spend three hours looking at photographs of gruesome vehicle collisions, crime scenes, electrical burns, head injuries. I know now that it’s epinephrine that accompanies my stomach turn, the slight increase in heart rate with each new slide. Nancy repeats and repeats and repeats. She has a point. I passed out the first time I watched open-heart surgery. But then I watched dozens more. So Nancy is going to tell us one more story about the amputated legs of a motorcycle passenger, and then about that time the guy was stabbed in the eye, and just once again about the man so severely burned in a house fire that…
The Middle East, India, North Africa, Afghanistan; this is the longest period I’ve spent in the States in almost ten years. Since I returned from Afghanistan I’ve run a marathon, had dozens of searching conversations, interviewed hundreds of people about PTSD. Recently, I’ve been struggling.
EMT class gets out after 10 PM on a weeknight and then we stand in the parking lot talking about the army and Afghanistan and anything. Just small talk in a parking lot, but I drive home from class every night feeling a little more able to heal, a little more healed. Emergency response is the opposite of storytelling. It’s about searching for and containing the damage of the story that happened and is over now—or maybe not over yet.
Julia drives the fire engine and the crew gives each other a hard time over sirens and heavy horn. It’s any Friday night: unconscious patient in a walk-in freezer, apartment gas leak, potential stroke at a nursing home. Then we pull into the station and nothing happens for hours. “It’s dead, nobody’s dying.” We sit in the bay watching emergencies flash on the screen, dispatched to one of the other twenty stations in the county. Not us, not ours. “It’s a little morbid to sit here hoping for an emergency,” I say. The paramedics’ tones drop and they stumble out of the bunk room blinking hard; the ambulance pulls out.
I don’t bring up trauma; they do. The man with his neck sticking out the back of his head, breaking a dead patient’s ribs during CPR, a child crushed under a minivan, charred bodies from an electrical fire, any five-month-old patient, ever. “Sometimes it’s hard,” Nate says as we sit in the bay—steel table, concrete floor, fluorescent lighting. “We come back here and we talk about it, we laugh about it. Everybody here has kind of a dark sense of humor.”
“You have to have a couple screws loose to be here,” says Julia, who earlier that night while opening a hydrant had rolled her hips and eyes sarcastically and said, “It’s a man’s world, I just live in it.”
Tyler’s a former Marine who works with the Pentagon and volunteers fire. The Marines were the best times for him: Yemen, Iraq, Turkey, Afghanistan twice, Pakistan, “Africa.” He bleeds a hydrant and the engine lights flicker over his face like a movie. It’s pouring. “I was going 100 miles per hour for seven years, then I got discharged. They said that I couldn’t do it anymore,” Tyler says. “That was it.” A romance ended, badly. “It’s just real hard, I’ll tell you it’s real hard to adjust. That’s why I got into this mostly, the fire.” The engine carries 1,000 gallons of water wherever it goes. It’s real. “Seven years and then that was it.” Tyler closes the hydrant and stares into the engine’s flashing lights, which reflect in his eyes. “When these lights go on, it’s a reminder of that life.”
“Fire is very primal,” says my EMT classmate Tyson, who started as an EMT in St. Louis, was an Army combat medic in Afghanistan, then served almost five years in the Secret Service. “It’s like a living thing. Fire has no malice. It just does what it does. That’s an interesting thing, when your enemy is like that. Why does it go up here and across the ceiling there? Because it wants to. Feeling that heat and that pressure is a really good feeling. It’s powerful. Fire is powerful and when you put it out, you feel powerful.”
An EMT class is like drinking water from a fire hose. Twelve weeks can only skim emergency response. Effectiveness comes with experience: months, years, decades. Four of our EMT instructors collectively have more than a century of emergency-response experience. We hear stories and stories and stories; someday we’ll have our own. “The pregnant woman who got hit by an airplane was amusing and entertaining”; “There was the jackass in the road. They radioed it in. I told them to get his name and license number and they seemed confused.” It was a real donkey.
“We teach to the worst-case scenario,” says Steve, who has taught EMT since 1983 and spent decades working trauma centers and medical evacuation helicopters. “Which makes us disappointed when we get to the scene and Grandma has her bags packed waiting for you to take her to the hospital. Annoying, right? But it’s the patients like that, that piss us off, that save us. If every one of your patients was a goddamn train wreck, you’d be burned-out in six months. Disaster after disaster. You start to lose your perception of reality. You think everybody is a train wreck. You start to believe you are next.”
“Sonder is the emotion that every human being you see has a life that is just as complicated and interesting as your own,” Amanda, an ambulance driver, says during one of our late-night parking-lot conversations after EMT class. “Most people look at things like, ‘I’m the only one who matters.’ But when you look at things like, ‘He’s going back to his wife,’ or ‘Her daughter’s struggling with school’…I think a lot about people I see, where they’re going.”
“So what’re you in for?” Amanda had asked straight-faced the day I met her, earlier this year in a trauma center, gesturing at my IV like it was handcuffs. I said something like, “I know this is not your fault I think it’s better if we don’t talk I’m sorry.” Fifteen minutes later, on the transfer ride to the hospital, she shouted jokes back to us from the ambulance cab, and the EMT and I couldn’t stop laughing.
The first day of class, Amanda takes my notebook and writes down the best websites to buy heavy-duty clothing. Halfway through a verbatim reading of “Initial BLS Certification Programs Prerequisites for EMS Training Programs, Criminal History and Standards of Conduct in the State of Virginia,” she grabs my notebook again to write “order pants 1 size up you need lots of room to move around and wear layers underneath!” She passes the notebook back and the lecturer gives us a glare. I blush. Later, at home, I order pants that leave room for layers.
“One of my biggest desires is to pull people’s dreams out of them,” Amanda says one night in the parking lot. “To challenge people to live fully and completely. That’s what I love doing. Don’t give me that excuse! We all have bills. We all have bills. Pursue your dream and have bills or hate your life and have bills.”
A sign in the Academy driveway reads, safety training in progress. please use caution. I accept a Dorito offered by another student, then a Skittle, turn down a Warhead. “You probably don’t remember me, but you’re the reason I’m here,” I tell Amanda. She squints at me, then recognizes. “I told you you’d be okay!” she says, grinning.
Bones bleed. Fracturing a pelvis could cost you three to four pints of blood. Bones are not just structures; they are living tissues. “If they weren’t, they couldn’t heal themselves,” our EMT instructor Steve says.
Steve tells us about the red-hat firewoman who arrived at a highway run-over and fixated on a patient’s feet before checking the airway. The patient was already dead, but her feet were backwards. Her feet were backwards! “Be mechanical,” Steve says. “Your eyes will play tricks on you. They will gravitate towards the grossest part of a trauma patient. No.” Trauma is not methodical. EMTs must be. “Do they have an airway?” Without an airway, every and any patient will die. But remember, even bones can heal.
For a gas to be poisonous, it doesn’t have to actively harm. It just has to steal space. When a benign gas fills our lungs, the lack of oxygen is deadly. “There are many different ways in which patients’ hearts show they are in trouble,” my EMT textbook says on page 493. “There are many different ways in which patients’ hearts show they are in trouble,” I write in my notes and remember, and remember, and remember on an Alexandria ambulance.
Across any language, any country, lives are a product of infrastructure. I feel a rush when I drive by data centers, bridges, electric substations, dams, airports, fire stations, through automated toll lanes on four-, six-, eight-lane highways as I listen to one of fifteen pop-music radio stations. Loudoun County, Virginia, grew by nearly 3,000 students and hired 800 new teachers this year. For less than 50 cents, the United States Postal Service will deliver a letter anywhere in America from anywhere in America.
Our aortic arteries are one inch in diameter. Our body’s lifelines, supported by our bones. “One-inch diameter!” Steve says. “That’s so thick—” Is it? One inch doesn’t seem very thick to me. I struggle. It seems ironic that the languages of medicine are dead. Patience has never been a strength of mine. But I always underestimate my body, my mind. Humans are so resilient. Remember, I remind myself. Even bones can heal.
Breathing in is called “inspiration.” Oxygen is a drug. We’re all on the same team.
The most interesting call for one of my EMT classmates, a firefighter, was a shooting—sixteen gunshot wounds, including one to the jugular. They resuscitated the patient three times before the helicopter arrived. “The first time he died on us…” the fireman says to preface the remarkable thing he wanted to convey.
For years, the questions I have been asking are macro-level. I have forgotten heartbeats. For an EMT or paramedic, the big picture is the whole body, not the whole world. Emergency responders meet people on the worst days of their lives. Scared to death, scared of death. The goal is to prevent that day from being their last. Inspire, expire, inspire, expire—the long-term goal is inspiration.
In EMT class, we look at photographs of close-range gunshot wounds to the head, limbs lying near bodies, knives embedded in necks. “I’m not asking you to diagnose,” our instructor says. “I want you to stop the blood. I want you to save this life.” I ask too often, “What is the meaning of life?” The American Heart Association’s motto is “Life is Why.”
I forget a hair tie, I run late, I can’t remember, I don’t follow up—I’m not myself but I’m the self everyone here knows. “You’re a lifesaver,” I text Amanda, the ambulance driver, who covers for me and covers for me and still hugs me every class. “That’s my job,” she replies.
I use a stethoscope for the first time. Place buds to ears and horn to heart and gasp. My classmates laugh and tell me they felt the same their first time. I would’ve thought my heart skipped if I couldn’t hear it steady. Breathing in is inspiration. We are cruel to ourselves, and each other. But early ambulances were off-duty hearses, operated by funeral homes. How far we’ve come.
I show firefighters something I’ve written. It’s full of self-indulgence, bad writing, but I’m trying to believe my best is good enough. “I like it,” they say. “How can it be better?” I ask. The captain frowns. “This is your story,” he says, as if talking to a child. “It’s not about better. It can’t be better. It’s just your story.”