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Chapter Twenty Four

YUSUMBICH MYSPOR TAKFF! CHEMEE TAKFF! When Colt woke up early Thursday morning, he heard Roy down on the street shouting. Another voice screamed back. Roy was having one of his arguments with Max, the bearded beggar who often stood on the far side of Chautauqua and panhandled for small change when drivers stopped at the light. They had their own language and Colt couldn’t understand a single word they were bellowing. The argument went on for another ten minutes before both vagrants ran out of steam and fell silent. Colt cursed them for starting up so early, rolled over, pulled his pillow over his head and tried to go back to sleep. It was too late, he was wide-awake.

Three hours later, Colt drove south on the 405 Freeway, going to his performance review at PTI—the Paramedic Training Institute of Southern California. He turned off the freeway and drove through Carson, a low-income community with gang problems and a sky-high homicide rate.

Southern California Hospital had closed two years before Colt began his paramedic training, leaving the area without a major health care facility. He passed the deserted hospital and turned down a narrow driveway that led to the paramedic training center, a one-story building that once housed the human resources department. Colt looked at his watch and realized he was early—something of a miracle in a city where the average speed on the freeways was less than 20 miles per hour. He parked among the motorcycles, cars and pickup trucks with firefighter license plates and red and yellow stickers from the California State Firefighter’s Association. The lot was almost full. Classes met four days a week. On the other days, they studied and practiced skills and techniques. Colt thought the nine-month course was the hardest thing he had ever done and wondered how the men with wives and children found time for their families.

Colt had fifteen minutes to kill. He walked across the parking lot and slipped between a gap in the temporary fence that ran around the hospital. The deserted facility was depressing. The buildings, none more than four stories high, were spread over two city blocks. Once colored pink and rust, neglect and oxidation had changed the outside walls to shades of dirty brown. Colt wandered around the perimeter, looking in at the deserted rooms, treatment centers and hallways. He saw bulletin boards still covered with outdated announcements posted on colored sheets of paper, but there was no sign of life. The hospital was empty, stripped of equipment, furniture and anything else that could be salvaged. In a few places, a lonely chair or a stray box of files remained unclaimed. Colt found it unnerving to look through the windows of the buildings and see the street on the far side. The grass was faded to the color of straw and the shrubbery had withered. Only the largest trees were green, somehow surviving in the dry Southern California climate. Even in the bright, hot sunshine of mid morning, Colt thought the facility screamed decay and death.

He turned and walked back through the breach in the fence to the training center. Outside the entrance to the school Colt saw the familiar blue cases containing the life-sized upper body dummies used for airway management training. Although they were identical, each dummy had a crazy name written across its forehead. Every class changed the names, creating a little humor and diversion to relieve the stress of the hours spent learning endotracheal intubation—insertion of a breathing tube into a patient’s windpipe. It was a difficult and critical procedure and Colt had wondered at the time if he would ever be able to do it when someone’s life hung in the balance. The instructors assured everyone that paramedics intubate hundreds of patients during their careers and that it would become second nature.

After hours of training on the dummies, Colt’s class had gone to San Diego to practice on a real cadaver before a group of medical students dissected it. When the paramedics entered the OR, they saw a body on the table covered from the waist down. From across the room Colt recognized the round yellow disk secured to the corpse’s right ear. He moved closer and confirmed that it was the same identification tag used on cattle. It carried a serial number and as Colt knew from experience, it was almost impossible to remove without tearing off the ear.

Under the bright lights, the man’s skin had a gray-brown pallor. His chest looked emaciated. The shoulders and arms were skeletal, the underside of his body a dark red-purple color where the blood had pooled. His head was bald, his eyelids closed. The mouth, with withered, cracked lips, was slightly open, revealing the tip of the tongue. It was clearly an older person and the body appeared diminutive—Colt guessed it was no taller than five-one. He wondered about the high points of this man’s life. Had he loved someone? Did he have a family? Was he a war hero, a great scientist, a famous criminal? What were his last thoughts?

Someone in yellow scrubs joined them in the OR. “Let’s get started,” he said. “I’m Dr. Davis and I teach gross anatomy to first year medical students. This is called the ‘Gross Lab.’” He paused to see if anyone appreciated the joke. He got no reaction and proceeded to hand out a black and white diagram of a cross section of a throat. “Study this. By the time you’re training is over, you’ll need to know the terms for the anatomy of the larynx.”

“Where did the body come from?” one of Colt’s classmates asked.

“That’s always the first question,” Dr. Davis said. “We never know anything about the cadaver except that before death it was donated to medical research.”

“So the person knows what’s gonna happen?” another paramedic asked.

The doctor nodded. “Full disclosure and a half-dozen legal forms.” He bent down, touched a button and the operating table rose. “Step closer please.”

They edged nearer to the body.

“To provide a realistic dissection,” the doctor said, “the body remains in its natural state. It’s been refrigerated, but not embalmed. When you finish your intubation practice, my first year medical students will cut out each organ and study it. When that’s over, the body and all its parts will be cremated and given a respectful burial.” He paused for a moment and put his hand on the forehead of the corpse. “First year med students sometimes get spooked about lingering spirits and souls from their cadavers. The funeral gives them closure too.” He looked at the paramedics standing around him. “Don’t you guys get any crazy ideas.” He looked at Colt.

Doctor Davis slipped his hand under the head of the cadaver. Long past rigor mortis, the body was limp. He lifted the head and rested it on a Styrofoam support. “For a successful intubation, the head should be in what we call the ‘sniff position,’ tilted back with the chin up.” He looked around. “Who’s first?” He held up a handful of plastic breathing tubes in front of the assembled group. “Help yourselves.”

Each paramedic had a few minutes, assisted by a partner, to use the laryngoscope—a flat blade with a tiny light at the tip—to push the tongue aside, open the larynx and vocal cords and insert the flexible breathing tube into the windpipe. Even after all the practice on the dummies, the first effort on a real body, even a dead one, was difficult.

Doctor Davis hovered nearby, looking over their shoulders and giving instructions. “Take your time,” he said, “and learn to do it right. Just don’t let your patient run out of oxygen.”

When Colt stepped forward and bent over the head, he smelled a faint unpleasant odor through his mask. When he opened the mouth, he saw that most of the teeth were missing. On the first try, Colt couldn’t get the tube into the windpipe. It kept sliding sideways and getting caught in the folds of the vocal chords. Finally, he withdrew it, smeared it with more Vaseline and tilted the head farther back to get a better look into the throat. On the second attempt, the tube slid into the trachea without a problem.

Afterward, as they prepared to leave and the medical students arrived for the dissection, Dr. Davis pulled aside the sheet covering the lower half of the cadaver. Colt was surprised to see it was a woman. Her toenails were ragged and untrimmed, but still showed traces of gold polish.

Colt lingered for a few minutes to watch the beginning of the dissection. The medical students stood in a tight group around the operating table and watched Dr. Davis run a small saw around the skull, remove the top half and take out the brain. Next, he cut away the ribcage with a tool that looked like a big garden clipper. Colt watched as her heart was removed, dissected and passed around for examination.

Colt departed, imagining the end of the session when all the woman’s organs, sliced and diced, were piled on a table, leaving her body a hollow shell of bone and skin. He wondered why anyone would donate their body to be cut up and passed around, piece by piece, by a group of medical students. When Colt applied for his California drivers’ license, the DMV asked whether he wanted to sign up to be an organ donor. The thought had troubled him at the time. His own death was somewhere far into the future and he wasn’t ready to think about his organs being “harvested.” He couldn’t imagine his heart pumping someone else’s blood. He told the clerk he might consider it some other time. Colt had no immediate plans to die.

While he stood by the entrance to the paramedic training center, still daydreaming about the cadaver dissection in San Diego, the door swung open and someone Colt’s age, wearing a suit, white shirt and dark tie, nodded and headed to the parking lot. As he walked past, Colt saw the standard-issue firefighter boots and knew the man had just finished an admissions interview. Colt walked into the reception area and the first person he saw was Nick, the receptionist.

“Hey, Colt,” Nick said. “Welcome back. How’s it going?”

“Can’t complain,” Colt said. He had only been gone a few weeks, but felt strange coming back. It already seemed like another lifetime.

Nick checked his computer screen. “You’re here to see Sandy?” He glanced at the closed door with the SANDY HAYES nameplate. “Take a seat. You’re early and she’s running late.”

“Thanks,” Colt said. The reception area was furnished with ergonomic stenographer’s chairs commandeered from the hospital after it closed. They were uncomfortable and he knew from experience that the back supports were loose. He sat down gingerly and leaned forward. Colt gazed at the pictures of graduating classes hanging on the walls. Three classes a year passed through the paramedic school. Colt graduated in Class 25 and saw himself in the class picture hanging at the end of the hall.

Sandy’s voice boomed out from behind her closed office door. “So when you’re called to a convalescent home, Earl, what do you find?”

Colt heard a low, indistinguishable answer. He looked away from the door. Sandy sounded angry and he didn’t want to listen while she slammed a fellow paramedic intern.

“What you’re gonna find is some poor patient who’s 85 or 90, has six things wrong and is taking two dozen different meds. The medical history file could be an inch thick and your patient could have dementia, or may just be confused. Okay? You can’t just take the vitals and start a treatment. What look like terrible vital signs may be normal for someone in a convalescent home. So what do you do, Earl?”

In spite of himself, Colt strained to hear a response. Nick glanced at Colt and gave a tiny nod of his head, acknowledging that he too was listening and commiserating with the guy inside. Colt realized that Nick had probably been sitting at his desk listening to these closed-door conversations for years.

“You get one of the nurses, Earl. The first thing you do is you get one of the nurses and you ask her why you were called. Understand? The nurses in those homes will disappear the minute the paramedics arrive. You have to round them up and ask questions. Got it? You don’t have time to read through a big file.”

Colt shifted around on the stenographer’s chair. Earl, whoever he was, was catching hell.

Sandy went on. “If the patient’s failing, Earl, what do you do next? What you do is, you ask them if there’s a DNR. If the patient is about to take his last breath and he’s left a DNR, it means you don’t try to do anything heroic. You don’t just jump in and start a full workup until you find out.”

Down the hall, Colt heard other voices. It was the mid-morning break and the interns were coming out of the classrooms and practice areas for a breather. They congregated in the hall and dining area or stepped outside for a smoke. A ping-pong game began immediately—the quickest way to relieve the stress. Above the commotion in the hall, Colt still heard Sandy.

“Your preceptor says you know your stuff, Earl, and I agree.” Sandy’s voice grew calmer. “I’m gonna add eight more shifts to your internship. Next time, I want a good report. Okay? You just have to pay attention to the details and be more assertive out in the field. Got it?”

There was silence for a few seconds and the door to Sandy’s office opened. A red-faced paramedic, wearing a patch from the Vernon Fire Department, walked past Colt, head down, not making eye contact.

Sandy stood up behind her desk. “You’re next Colt,” she said and waved him in. “How are ya?” She greeted him with a strong, firm handshake.

Colt sat down and felt the body heat left on the seat.

“Gimme a minute,” Sandy said, and glanced through the pages of Colt’s file.

Colt watched her face, looking for some indication of her response to Brian’s report. She gave nothing away until she finished. Finally, she closed the file, dropped it on her desk and smiled at Colt. “Sounds like you and Brian are doing well together.”

“Brian’s a good guy,” Colt said, relaxing. “I’m learning a lot from him.”

“He’s one of the best preceptors we have.” Sandy leaned forward and put her hands on her desk. “You know the biggest problem I have with new paramedics?”

“No, but you’re about to tell me, right?”

“Right.” She smiled again. “I spend most of my time telling gruff firefighters and military men with combat experience to be gentle and show compassion to their patients. I keep saying, ‘Your patient doesn’t care how much you know, but wants to know how much you care.’ It’s a struggle to get the new guys to slow down and make personal contact with the patient. I have to tell them a dozen times to treat each one like a family member until they hand them off to someone else.”

“Brian said that’s my problem?”

“No, just the opposite. Brian’s concerned you’re gettingemotionally involved.”

“You’re telling everyone else to show more compassion, and you’re telling me to be indifferent?”

“Not indifferent,” Sandy said. “But you’re already way up on the sensitivity scale. In your case, you have to learn to keep some emotional distance. It’s just a matter of time. You’ll learn not to let things get to you.”

“I hope so.”

“Learn or burn. I say you’ll learn.”

“Thanks for the vote of confidence. I’m looking forward to becoming a regular hardass.”

“So you had an incident last week and a girl’s foot was severed and she bled out?”

“Sunday. Someone walked off with the foot.”

“Brian says you’re looking for it?”

Colt looked at Sandy but said nothing.

“Colt,” she said, looking him straight in the eye.

“Some moron hit a light pole. It came down and took off her foot. There’s a dozen Sheriff’s deputies, a dozen firefighters and medics and somehow somebody steals her foot. She was all alone and we were responsible for her. It’s not right. It’s just not right.” Colt paused. Sandy was still looking at him. He realized Nick was probably listening to every word he said.

“Look Colt, stuff like this will eat you up if you let it. You don’t really want to get involved in other people’s lives. That’s what families are for, and you’re not family.”

“She was all alone. You know, my mother...”

“Your mother what?”

Colt sat back in his chair. “Never mind.”

Sandy shifted around in her chair. “OK, enough of that. Another thing you have to learn, along with everyone else, is to manage the stress. The tones go off ten times a day, five times a night and each time you get an adrenaline dump. You have to stay fit, exercise and relax on your days off. Try to keep things in balance. Have some fun. Are you doing that? Have you got a girlfriend?”

“Just broke up.”

“Well, a girlfriend helps smooth out the highs and lows. I’m sure you won’t be alone for long.” Sandy stood up “You’re doing fine, but you’re such a serious guy. Loosen up a little.” She gave Colt another strong handshake. “I’ll see you once more next month, and that should be it. Stay safe and think about what I just told you.”

When he walked out of Sandy’s office, Nick gave him the thumb’s up sign. He had heard every word.

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