Chapter 3. Your Friends and Neighbors (excerpt)
The streets are full of insane and dull people… (C. Bukowski)
I have worked at my current station four consecutive years, and five of the past eight, and at stations within a mile for another nine: #southsidepride, as the kids say. I am familiar with the area and the people we respond to. I know the streets, the buildings, the trouble spots, the regulars. We see people and are seen, while we train, shop, do inspections, respond on calls; we attend block parties, church cookouts, cultural events. And when people are struggling or scared or angry, having a familiar face can help de-escalate the dynamic. At the heart of it is a human connection.
(This was certainly true in the aftermath of George Floyd’s killing. That was, and remains, our area. We were there, and we have returned to the Memorial — as community members, residents, visitors, and in official capacity on emergency calls. We try not to see, or to be, the they in an equation. This is us, imperfectly.)
There’s something else, too, about our job. We see you. We enter your world when no one is prepared, and, while we’re there for a purpose, in moments while we are working, or in the long stretches waiting for the medics to decide whatever happens next, or tromping through the wreckage, we SEE your life, exposed (those of us who remain awake to it). Even if you were expecting company and tidied up, you weren’t expecting us. We take in the furniture, the clutter, the meals half-cooked, -eaten, or never-to-be-completed, the kids, the mess, the order, the underwear, sex toys, drugs (SO many drugs and sex toys), empty bottles, medications, homework, bills, trinkets, figurines, all the usual flotsam and jetsam of domesticity and human foibles.
And the photos. I love seeing people’s pictures. Chronological history, literally. Generations assembled on the walls, captured in and out of time. Sometimes it’s a kick in the heart to be working an old person — someone withered, fragile, dying — and look up to see this person’s earlier incarnations captured in photos on the walls. Seeing a life’s span arrayed like that, without context or footnotes, can be jarring and sad. I see the patient’s lost youth looking down on us as we wrestle Death for them. In other homes, we witness good people trying to make good lives, making do with little. We see not-so-good people who might have the same basic photos on their walls as the good ones. Everybody loves their babies — just some folks don’t know how to love…
We go to work in lots of very sparse apartments, filled with nothing but bad air and the residue of despair, sorrow, fury. Damaged walls, broken furniture, no furniture, meager possessions looking more meager in the barrenness of the rooms, clothing not even unpacked from the garbage bags used to haul their lives from one shitty place to the next whenever the landlord’s evict them.
It’s an intimate glance at the human condition, and often far more than a glance.
*
We joke about ‘job security’ that comes from our citizens’ myriad and ongoing bad decisions, but, too, the range of WHY people call 911 is astounding. Most people encounter piddly nuisances on the daily, and most of us handle them without calling for the city’s emergency resources. I try to explain the types of calls we catch, and friends are aghast and incredulous. They would never call 911 for something so obvious or preposterous. Likely so. Many other folks, however, do call for things that, from an inch outside the moment, are ridiculous. If not ridiculous, clearly not emergencies. Hangnails, buzzing fluorescent lights, a single bump on the skin, a swath of bumps, a cough, a runny nose, a vague sensation that something might be wrong.
One early favorite, still top-tier audacity: a man called 911 because he’d incurred a thumb cramp during a marathon session on his children’s Playstation. He said maybe it was a stroke. Dispatch sent us for one having a stroke, possibly a heart attack. For a grown man with a thumb cramp from monopolizing his kids’ video game.
It’s emblematic of a culture that has somehow ceded autonomy AND a culture that demands others solve all problems. I generally hint to people by saying, ‘Well, if it were my (house), (cat), (child), (bloody nose), I’d let it be.’ (I don’t say, ‘I certainly wouldn’t call 911 for this nonsense.’) Because, at the root of it, people want to be reassured.
We get called to check a phantom ‘gas’ odor. It is nothing. Perhaps something on the breeze, or a burp from the sewer, or burned food, but no hazard and nothing dangerous. We use our monitor to check for the range of bad things we can check for, we use our noses, we look at their pilot lights. ‘All clear,’ we say, politely. They will insist that they still want the gas company to come — just in case.
A kid is playing with her friend and one of them trips on the sidewalk. She has a bruised knee and a scraped elbow. There is no loss of consciousness, no open fractures, no blood from ears. The child speaks coherently and is crying appropriately. But the parents will ask (demand) that we treat and transport the child — just in case. And, the thing about exploratory investigations — like going to therapy too much — is that if you keep digging, you will find (or create) something that might be a problem…
The cornerstone and the bedrock of American public healthcare and emergency response is quite simple: the Good Samaritan principle — and fear of litigation. We take everyone at their word and presume that every 911 call is indeed a matter of Life or Death. The majority of our calls are not truly critical. Many are emergent but not critical. Which means, then, that the vast number of 911 calls are falsely — inaccurately — entered. But the call takers who must follow a flowchart of scripted questions, the folks in Dispatch who relay what the call takers enter into their computers, and all of us firefighters and paramedics (police, too): we have no discretion but to go, and go hard, because the system is predicated on the assumption that someone might be dying. We respond excessively, redundantly, for many (most) calls, but that’s because we will need this much and more on those actual critical cases.
Is it wasteful? Yes. Is there another way? Possibly, but the fear of low-balling someone who then dies — exposing all involved agencies to litigious liability — beats common sense, practicality, pragmatism, and financial wisdom. So, we treat each call as if it is as dire as its generic category states: Possible Heart Attack; Respiratory Distress; Difficulty Breathing; One Unresponsive.
I don’t blame the people who are scared or uncertain or confused, who call 911 and answer the call-taker’s questions literally. They don’t know what to do, nor what they’re being asked. Semantically, they and the call takers are speaking two entirely different languages. ‘Chest pain’ translates as ‘Possible heart attack’ even if the caller is just saying his ribs hurt. They don’t know that their call for help, or guidance, is triggering a massive response machinery.
The fire department does not charge people for our services. We show up for everything, gratis. We’re a huge drain on the city budget, and everyone (but the city payroll people) loves us, and we do what we do for free — in terms of citizens’ payments. The ambulances and hospital charge the hell out of them, but we don’t.
The Emergency Room, or Emergency Department (ER/ED), is intended to rapidly treat people experiencing urgent, life-threatening conditions. However, most of its clientele are there because their regular clinics are closed. The ED staff will cover the bases and do its best to ensure you are not dying of some imminent cause. Beyond that? They’ll recommend you make an appointment to see your regular doc in your regular clinic.
Our frequent flyers are a different ilk from the panicked regular citizens. They’re people who call and call and call, get transported again and again and again, and return home ‘uncured.’ What’s ailing them is often the accretion of bad life choices and bad genetics, or impatience. A social worker would solve more of their problems — and vastly reduce their cost to the public health deficit — but that requires forward thinking. To dedicate the money to preemptively help someone challenges the business model of the health systems that can ignore statistics and continue to be surprised that the same person continues to call 911 for the same complaint monthly, weeks, even daily. It has not happened tomorrow, so they can pretend it might not happen (and save money from budget line item). Of course, it does and will happen again, and we will waste more resources yet again.
We respond, repeatedly, to obese people who need help getting into or out of bed. We blow out our backs, shoulders, and knees hefting immense people who cannot move themselves.
We respond to smokers whose lungs are failing but who keep smoking and experience respiratory issues due to smoking.
We get called to people who drink and fall down, repeatedly, and who are found sprawled in public or on their own floors.
We rush to help drug users whose roulette wheels tilts toward Death.
We roll out code-three (lights and sirens) to unhealthy people noncompliant with their prescribed medications who complain of symptoms their meds would address. To asthmatics who smoke. And, we catch a lot of people with objectively minor injuries who demand priority treatment, those who still believe an ambulance will put them at the head of the ER line.
All of them say a variation of ‘I can’t breathe,’ and Dispatch records it as a Respiratory Emergency and sends Fire and ambulance charging to the rescue.
Day and night, night and day, we run these calls. There is nothing we can really do for the patients, not when they won’t do the basics to help themselves. This explains the high burnout rate of paramedics, as well as the jaded disposition many of us develop. We are powerless within a broken system. We have to treat their complaints as if they were real, and the medics have to transport them. All the while, any other call in our vicinity — including a genuine emergency — will be picked up by another company, with delay for the added travel distance.
If a person does not understand that not everything is ‘cured’ instantly, or by a pill, then we’re looking at a losing battle to explain patience and enduring short-term (or acute) discomfort. And it’s their ‘right’ — as customers? citizens? potential litigants? — to call 911 for a ride back to the hospital, where they’ll take up space in the waiting room, exhaust staff patience, and commandeer a bed or triage room to be told exactly what they could already know: they’ll feel better in a day or two.
These routine trivial calls eat time, energy, and resources. The truly emergent calls continue to occur: car wrecks, heart attacks, bad falls, violence — these require rapid emergency response. That is who we are and what our mission is. Yet too often these get swamped in the miasma of non-emergent calls. We are firefighters who seldom see fire. We are medical personnel who respond to nonsense calls: redundancy and futility lacerate our desire to do good. Systems, history, money: we are little players in a big, mean game. But most responders don’t consider that: instead they grouse, ‘People are stupid.’
Too, there are bias issues in the medical system — ingrained as well as embedded in the unconsciousnesses (and consciousnesses) of the workers: staff who cannot see beyond the race or culture or gender of the person, and who ignore or dismiss the patient’s complaints. That occurs outside of our purview, but we are the ones who catch an earful the next time the frustrated, aggravated, anguished person calls 911 for the recurring or incessant pain.
We fight the tedium and simmering resentment when responding to the same patently not-sick person over and over again — it’s empathy exhaustion. Even the most compassionate of us must have a purge valve, a means to off-gas the accumulated tensions and frustrations.
*
There’s another type of call, of patient, and these occupy both the routine trivial AND the urgent emergent: all of our citizens who do not have health insurance, who are poor, who are isolated. For this wide, varying, often hidden (until they’re not) section of society, the 911 system is primary care physician, local clinic, social worker. For people who have no support network, no health care, no home, no options, they get by as best they can, and, when things turn dire, we respond, either due to severe and immediate health crises, or because their inability to care for long-term health issues forces them to need hospitalization.
These folks are survivors, one way or another. They’re generally proud, self-sufficient, if self-defeating (by circumstance or autonomy). We try to find a common ground: respect their independence while exhorting them to take medical assistance to keep them alive and somewhat healthy. People without insurance lowball themselves, which often leads to greater, deeper, more significant health issues.
It’s not a crime to sleep on the streets. We get called for ‘one down’ throughout the year. Winter temperatures make exposure risks dire, and we’re called out constantly, mostly by drivers on cell phones who see someone curled inside a sleeping bag under a tarp. They call it in but will not stop to investigate themselves. We arrive and the person says he doesn’t want to go to a shelter. That he prefers to sleep outside, unhassled by rules and authority. We state the obvious: that’s it’s perilously cold outside. He’ll stare at us, hard eyed. He knows how cold it is. The best we can do is echo the medics’ offer to give him a ride to a shelter, if only until the cold snap ends. Generally, it is to no avail. Sometimes, we’ll offer a spare pair of gloves or one of our backup fire hoods.
People go off their medications weekly. We encounter them in their homes, having adverse reactions to what the meds had been addressing. At home, at least, there might be a context to glean (empty bottles, meds lists, housemates). In public, it can be difficult to read the patient, infer a context for their behaviors. If the patient is homeless, we find them when they’re far sicker, far worse off. These spikes cause damage to their bodies, exacerbating symptoms, compounding conditions. When the issues are mental illnesses, going off their meds causes social as well as medical consequences. These people need help, need many forms of help, and they’re generally struggling on their own, without any support scaffolding.
Responding to the routine problems of our poor, disenfranchised, and struggling citizens, as well as catching the truly emergent calls, our job is good, and hard, and punishing. The intimate proximity to physical, mental, emotional, psychic suffering takes a toll on us. But there’s resonance: we contribute to the public welfare. We help those who need help. The positives often, or generally, outweigh the negatives.
In this regard, we often serve as social workers or counselors, with little official training (but, over time, a good sense of how people are). These calls come in as medical emergencies or public disturbance, which also brings the police. The cuts to the mental health system for years now, the reliance on meds, the dual issue of criminalizing mental issues and enforcing the superficial status quo (‘safety’ concerns triggered by someone who’s just talking to himself, the pigeons, or God): there is no good or easy way to address the range of humans trying to get by.
Many of us are able to maintain a compassionate buffer, but that often comes with a healthy, protective measure of humor — most of it quite twisted and gallows-inflected. We have casual, wildly inappropriate discussions — for normal citizenry, that is. In the privacy of the rig or the station, we vent and laugh and make horrible jokes. That kills stress. But it can also reinforce a cynical narrative, and, too, we get so accustomed to our hermetic world that we forget normal citizens do not think or act as we do. Then we open our mouths on scene or with cameras rolling, and there are problems…
We make mistakes because we stop seeing individual patients but just another in a long line of 911 crybabies or people exploiting the system. We cannot engage interpersonally (literally, are not allowed to tell people they are being stupid; I am a tedious anti-smoking moralist…), and we simmer and become corrosive in our defensive shells. Years of this alters how we see the world, how we engage with others, how we treat our families. These ill-effects are what lead to the high percentages of divorce, addiction, burnout in emergency service workers.
What about Be the CHANGE you WISH to SEE in the WORLD? Yeah, well… Good luck with that. The hospital EDs are just a sliver of the corporate medical behemoth. The insurance companies drive everything. The city leaders don’t even know what we actually do. When we make suggestions, they disappear into the void. The US healthcare system is mucked from the very top down.
My point here — throughout this book — is that the system is a mess, and while some smart, visionary people might be trying to reform or fix or obliterate it (and running into corporate objections and lobbyists undermining them at every turn), the citizens continue to get sick, get hurt, fall, give birth, overdose, die. And there we are, up to our elbows in someone else’s innards.
*
(One challenge for this book, in two ways, is the graphic nature of our work. I am trying to explicate the lost connection to the human process (dying and death, among others). Our disconnect (denial) leads to suffering, for our family members AND ourselves. This means I treat as matter-of-fact subjects, content, experiences that can be upsetting. I also share them to express that, for of all of us in emergency services, these ARE our realities, our work.)
We were discussing weird calls as we returned from something abject and pointless late one night (a heroin overdose in a derelict, menacing household; every adult in the place was abusing drugs or alcohol or both, no one appeared sober or functional, small children were neglected. It was a fire-trap, haphazard ‘bedrooms’ (mattresses on the floor with tarps or tapestries as walls) blocking exits, everything filthy and cluttered. Yet there were gestures toward domesticity (a sign: ‘Stop fucking smokin by Eddies room. Hes sick!’; toys and sports stuff, raggedy but present). There was also a long police history for ODs, fights, threatened violence and assaults of neighbors, drug dealing, domestic abuse. The OD was the least-disturbing thing going on in that house. We left feeling shaken and depressed). The topic shifted to suicides as we heard a crew across town catch a reported hanging.
We discussed the range of suicides we’d had, which type sucked worse. It was quiet on the streets as we rumbled along, the rig’s lights throwing brief sharp shadows along the lawns and houses. We discussed calls where someone had slipped down to the basement, or up to the attic, out to the garage, into the bathroom, and stepped off the earth while his (almost all these suicide calls were men) family was unaware.
‘How cruel and lasting that trick,’ someone said. Taunting the survivors forever with the futile regret that if only they’d found him…if only they’d opened the door, if only they’d checked on him sooner, if only, if only, if only. The brutal weight of survivors’ guilt.
We discussed the suicides who snuck away and died in private, who left notes or just ghosted their dear ones. Which was worse, in terms of pain for the survivors? Reeling from the haunted knowledge that he died in another room while you were cooking, or that he was alone and sad and scared as he took his final breath? It is forever in one’s heart and mind, this sorrowful unanswerable searching, and none of it truly matters — one just cannot see that yet, not through the torrents of loss and pain.
Our consensus: it truly doesn’t matter. The lives are obliterated. And, as we backed the rig into the station and I looked out at the quiet, cold street before returning to my bed, I pondered: We just had a ten minute conversation about the nuances of suicide, all the variety of deaths we have encountered, and we objectively discussed these gradations and distinctions.
There is no point in saying, Suicide is bad. Don’t do it! because that’s not how our job goes. People do it. We get called. We enter the room or garage or basement or woods, and find whatever the aftermath may be. Sometimes we simply turn away, sometimes we try to work the body. Sometimes it’s quiet, still, empty. Sometimes there is a spouse or entire family screaming and crying and shouting at us.
This is how our work goes. What we share, what we see, what we can talk about together. It is not a conversation I can have when I collect my kids from a sleepover, starting a casual discussion with the other parents about which form of suicide seems the least- or most-damaging to family members.
I thought of the various notes I’ve found, on both completed acts and foiled or self-aborted attempts: how the note is better than nothing, but the note is nothing of substance. For nothing can explain the truth, which is never even true, just the momentary embrace of despair. Some letters are manic and incoherent, desperate and unhinged. Some are direct and contained. All fail.
But those who leave no notes? They leave the worst mystery, the haunting WHY?! behind to echo for years and through lives. The act is the act. A permanent conclusion to a temporary problem. No words will explain Thanatos sufficiently, but no words at all leave the bereft grasping into the ether.
I didn’t share that with my young crew. One firefighter had had just one suicide; the other had been on two or three; the driver had five or so. Only one body of all of those had they worked, a gunshot to the head that hadn’t (yet) done its job. I wasn’t sure how many I’d seen, how many I’d worked, how many more we’d stood over in death’s finality. Enough that they only bother me occasionally?Enough that I don’t give most of them much thought? Enough that only some have claws? Enough.
I remind our rookies, as I was reminded years ago: The citizen’s emergency is not our emergency. It is our workplace. Do not meet their panic with panic of your own. Handle it with grace, aplomb, and humor. Save the snark until we’re back on the rig. Treat people well, smile, and be kind. Enjoy as much as you can. Make people’s days better, even by your mere presence at their side as they suffer. Take it all in, remain open, remain human.
