The Fall of a Fire-Medic

November, 1981

The Greyhound bus pulled into the station in downtown Minneapolis. I needed to stretch my legs so I grabbed my bag and waited for the bus to come to a stop. I took my place in line behind an elderly man and waited for the door to open. The old man stepped down. As his feet hit the blacktop, he lost his balance and veered into a concrete pillar, striking his head. I instinctively grabbed him by the jacket and lowered him to the ground. The laceration on his forehead began to ooze a little blood.

I asked if he had neck or back pain. He didn’t. It was a minor impact, so I didn’t need to worry about immobilizing him. I asked if he was hurt anywhere else. He said he felt fine, except for the wound to his head.  I helped him stand up and walked him into the terminal. We looked for an empty seat. A security guard spotted us. A few minutes later the paramedics arrived.

They dropped their gear and began assessing the old man. I was just a few weeks away from becoming an EMT, so I watched intently. They urged him to go with them to the hospital, but he didn’t feel like going. He was on his way to Fargo, North Dakota to meet his grandkids. The medics insisted that he go. He insisted he would be fine. They argued back and forth and it turned ugly. The medics used every kind of coercion they could think of to get him to go, but he refused.

I was shocked that they seemed so indifferent to his situation. They didn’t care about the fact that he was in a strange town with no friends or family. It seemed like the only thing they cared about was their own liability. What would happen if, in a few hours, something happened to him?  They might be liable. Their fears about liability were more important than the man’s right to do what he wanted.

I told them I was an EMT and offered to sit next to him for the remainder of the trip. If anything happened, I’d let the bus driver know and he could radio for help. Reluctantly, the medics let him sign the release form. They hopped in their ambulance and departed.

“What arrogant bastards”, I thought. I swore to myself that night that I would never become a proud, arrogant fire – medic.

April, 2000

I was working as a paramedic for the fire department of the city where I lived. I tested the highest out of all the applicants. I had already done my stint as a flight paramedic. I was in the prime of my career. I’d finally made it to the top.

A big part of the job of a medic is critical decision-making. In the system I worked in, we didn’t transport all the patients we saw. We triaged them and transported the most serious. The less serious ones went with a private ambulance staffed by EMT’s or they went by car. Some patients were left at home if the condition didn’t warrant treatment. The question we dealt with on every call was – do they require a paramedic intervention in the next 30 minutes or not? If the answer was ‘no’, we usually sent them by private ambulance or by car.

I’d been having problems with my partner for a couple of years. Sometimes we disagreed about who should go with us. He thought I was making bad decisions. I thought my decisions were fine. Well, actually – deep down inside, I knew he was right. I was making some bad decisions. But I’d become so proud and arrogant that I couldn’t admit I was wrong.  I’d become the arrogant fire-medic that I swore I’d never become.

It was pride and arrogance and a deep sense of worthlessness that brought me to despise what I had become a year earlier. It was brokenness that led me to embrace Jesus as my savior on May 25th, 2000.  In the year since my conversion, I’d begun seeing things differently, though I still struggled with pride at times.

My partner Jim took on the role of preceptor for paramedic students. One day we responded on a call with a student, who was doing his first ride. We saw a man in his fifties who had been having chest pain for two hours. Jim and the medic student interviewed the patient. I talked with his wife and got his list of medications. After a few minutes, we met and discussed the plan.

Our patient had been seen in the Emergency Department five hours earlier for the exact same symptoms. Same length of time. Same everything. They did the usual tests and found nothing suggesting a cardiac event. They gave him a GI cocktail and his symptoms resolved. They wrote it off as indigestion and sent him home.

When Jim called the hospital, he spoke with the doctor who saw our patient five hours earlier. He remembered the case. He had the man’s EKG and labs in front of him. Jim thought he was stable enough to go by car to his private doctor. The doctor agreed. I was shocked that they didn’t want us to transport him. I understood their reasoning, but with a paramedic student onboard, I thought we were setting a bad example and my gut told me this was a bad decision. I argued that we should transport him. Jim argued back. I gave him all the seasons I could think of for transporting him. Jim said, “Look buddy. I already called base station and the doc agreed. We’re not transporting him.”

We had the man sign a release form and we left the scene. I couldn’t shake the feeling that something bad was about to happen. We went to the bagel shop for breakfast. Before we could order we got a call for a cardiac arrest in the parking lot at a doctor’s office.  My heart sank. Somehow, I knew it was him.

The engine company was already on scene when we arrived. The parking lot was a mess. The staff from the clinic had dragged out all their junk into the parking lot and had it strewn all over the place. We dropped our gear and went to work. Jim let the student call the shots. He was nervous as hell. He recognized the man we were doing CPR on. We’d just seen him 20 minutes earlier.

My role in the resuscitation was to hand drugs to Jim and chart the times they were given. Each time I handed him an amp of epinephrine or atropine I said, “Jim – it’s him”, trying to let him know it was the guy we’d just seen. But somehow, Jim never recognized him.

The story we got from the engine company was that his wife was driving him to the clinic when he became unresponsive. In a panic, she drove the rest of the way and alerted the clinic when she got there.

I noticed his wife pacing back and forth on the sidewalk. I walked near where she was and made eye contact trying to convey with a look, my sadness. We intubated, pushed the usual drugs, and did CPR, but never got a pulse back. After 20 minutes, we called the hospital and got permission to stop the resuscitation. The engine company gathered their gear and split. The nurses from the clinic moved their stuff inside. We called the medical examiner and gave them the info and began cleaning up our mess.

It was times like this when I thought about quitting medicine. My thoughts took on more sobriety than they had in years.

“We killed our patient. If he’d been in our unit when he had his cardiac arrest, we could have shocked him and he’d probably still be alive. Our own stupidity caused his death. And we did it with a friggin’ paramedic student onboard. Great. Some heroes we are.”

I felt absolutely worthless.

In the back of the rig, I talked with Jim. Once again I simply said, “It’s him”.
Jim had heard enough. He raised his voice and snapped back, “Hey buddy…What the hell are you talking about?”

I replied, “Do you remember the guy with chest pain that we left at home this morning? That dead guy in the parking lot is him.”

He was speechless. The gravity of the situation began to grow heavier. He looked out the back window. I quietly said, “You see that lady crying next to the body….that’s his wife.”

We got our gear put away and returned to the station. Jim stormed around the medic office the rest of the day, being pissed off at himself. I suffered the rest of the shift in silent regret. The paramedic student would go through a de-briefing with the Captain.

Pride goes before a fall. And sometimes the impact proves fatal.