I find it difficult to imagine a time in the future where this comfort that I have with my city, my coworkers, my patients, my fellow responders is old. Where it makes for a burnt out Angela, and not a confident, happy medic.

There is a road in my city, it spans from the beautiful suburbs to the east all the way down town to the worst that this area has to offer. Its more than one road really, but its straight, and it’s the first road you learn to travel when working in this system. It literally takes you everywhere. This morning I happened to come up to this road, patient loaded, at one of its main intersections just as the sun was clearing the trees. A historic building, long since converted to apartments, which have long since been considered a desirable place to live, was lit up with the most perfect streak of sun. It was beautiful, it was a moment that made me remember that there is a side of this city, a side of this job that some people choose to overlook.

I’ve said it before, but it needs to be restated, it is an honor and a privilege to do this job. This is an important classification of coworkers for me; people that treat what we do as a stepping stone, as a means to an end and people that love this. People that are here for the same reason as I am, and people that are not. I prefer to work with the people that are here for my reasons, but I can tolerate the people that are not; the folks who grace us with their presence on their 5 off from fire, just to pay for a new bike, or an addition to the family home in the suburbs, that call this job ‘slumming it.’ I detest their idea about this kind of work, but there are valuable lessons to be learned from them, and they can learn from me as well. But the people that I love to spend my work hours with are the people that feel this work the same way I do. The people that don’t just come here to get a little thrill working in the big city and then retreat back to their comfy day rooms for 3 squares and a bunk at night, happily forgetting that they started here before they grabbed that golden fire ring.

My people are the folks that are happy to be bleary and battered, happy to do that last call before end, happy to be posted downtown at 2 am on a Saturday night, happy to pick up the regular who calls for the same exact thing, three times a day. We’re a dying breed however, so when I find these people, I hang tight. What makes us a dying breed? In my area, the ’big city’ is covered by private services. I am often curious about what fire or third service employees would say about their job satisfaction in other city settings. What are those employees moving on to? And if the answer is nothing, what is it that brings the fire mentality, the fire happiness to the private service call volume? Is it the pension? Do they really make that much more? Is it the lack of mobile posting? Does a station matter when you never get back to it? Or is it something about working for a city and not a conglomerate? I’m hard pressed to believe that those people that just like to complain poison municipal EMS as much as they do here in the private service. Maybe its something else still. Maybe it’s the smaller number of part time transient workers. The people that call my job ‘slumming’ don’t work at those publicly funded EMS organizations. That strength report is filled with full timers.

The real point about all this is the simple fact that publicly funded anything is becoming a thing of the past; everything is going private. There’s a reason for that; our infrastructures are crumbling. Schools are falling down, roads are coming apart, public health care is bankrupt. Your child is just as likely to graduate from JFK High as he is The Pepsi-Cola High School for Future Diabetics. The private sector will pump a lot of money into a system where they can reap rewards, and they have that money to spend. I’m not making a judgment about what we gain or lose when the public sector loses control in favor of increased ad space by these companies. What I am saying is that no one has ever talked about me being laid off. I have a job as long as I have a pulse and medical control. I don’t have a pension, my retirement plan is my own making, but I’ll never have to worry about how many people are below me on the seniority list. I have job security in a sector that will never-in my lifetime-become obsolete. I’m not worried about becoming a call employee, I’m not concerned about 7 people working opposite me being laid off because my job has been funding their positions for a decade. I’m really not worried about my working conditions changing at all. We get new trucks that look like space ships, we go through trials and tribulations finding cost effective EPCR equipment, we’re last in line for the newest cardiac monitors, and we answer to a different hierarchy, but the private sector is the wave of the future. Why is it that we are less selective in hiring? Why do the bottom of the barrel employees still pull us all down on a daily basis?

I’ll admit, I sound anti-fire. And I suppose that’s not inaccurate. To be more accurate, one would say that I am anti-fire based EMS-and of course we all know I‘m anti-the risk that goes along with fire suppression. More importantly than that, I am anti-working with assholes that hate this job and think that full time employees of private companies are second class citizens, especially when they themselves are full time employees working in private EMS. I can only surmise that these misers, these Debbie Downers have long ago reached their personal call volume and never found a way to jump ship, never had a back up plan. I think about that possibility often. Will I hate my job when I’ve been doing it for 15 years? What career options will be available to me then? What back up plan do I have? Well, none. But I think there’s an intrinsic difference between my humble beginnings as a medic in the big city and those that are senior to me and begrudgingly putting one foot in front of the other every time they pull the cot behind them. That difference may have something to do with being able to see the beauty in the sun rise over the projects.

Here it is, the first week of my new life, and here I sit, bored, unsure of myself with restless hands and blaring music. Here, where my son isn’t, where my husband doesn’t exist, in a cozy little world that I have made. People say, “Write. Put it out there.” and I mean to, but I can’t somehow. I don’t have it in me. I look at an empty page and I see flashes of light, places where good, meaningful things aren’t.

Am I reparable?

I’ve been spending a lot of time with Ramona lately. In fact, we just signed on to be full time partners. it’s a good move for me; the possibility of working with some people on the road makes me cringe, and I’m avoiding confronting other people, so full time with my bestie works, its ideal in fact.

Ramona is a natural at EMS. Its amazing to be in the presence of a natural, I’ve been in EMS for five times as long as she has, and I am in awe of her every day. I base my medicine almost exclusively on my ability to see an emergency from the doorway, and also my knack for putting people at ease. I have never conquered the book smart side of anything. I’m quick witted and a bit of a firecracker, but, as I’ve said before, I carry the protocol book around for a reason. I’ve also encountered very few people that get both sides of this amazing job. Most folks are people wise or bookish. Some people have years of experience that leads them to expertise, but few are truly answering a calling, and not just answering dispatch.

We learn from these naturals. I have watched Ramona hear important things, absorb them, and use them appropriately. One morning as she was teching an 80 yo f that we talked out of thinking she was having a stroke-and rightly so, because she wasn’t-I heard her ask the patient, “how do you feel now compared to when I walked in the door?’ I was blown away by her ability to boil the situation down to the root of the problem and find a way to verbally assess her patient in clear, easy to respond to fashion. Its not always about recognizing a rhythm from a 6 second strip, it about seeing what’s in front of you, about responding to your patients’ needs. I’ve learned how to recognize ability and skill in fellow providers from Ramona. I’ve learned that not all new basics are created equal, and I’ve appreciate the way influencing her encourages me to take advantage of teaching moments that I have typically let pass with my little brothers and sisters in EMS.

But that’s not all this kid has given me. I’m now a ‘Beth’ to someone, I’m someone’s big sister in EMS, its an awesome responsibility and it makes me consciously think every day how I can be better at my job, how I can be better for my patients, and how I can make my workplace somewhere that I can imagine myself retiring from.

And she keeps me grounded…about these personal things (read: failures) that have been going on in my life. I say X (where X=stupid statement about above stated personal situations) and she immediately comes back with Y (where Y= ‘stop talking like that you moron.”). This Ramona and me work thing, this night time thing, it’s the one reason I’ve been able to keep going throughout all of this. Missing my son, wondering if I’m making the right choices, being in the grip of crippling heartbreak, it’s all held together by the fact that I am proud of the difficulties that I’m enduring to do what I think is right for myself-and ultimately right for my little guy. Its so easy sometimes to make decisions in an emergency, its so easy to find the lowest common denominator of things that make sense and can be handled, just airway, or just circulation, and if you never get past the ABCs, you’re still alright because that’s the heart of it. In life though, there is no lowest common denominator, or if there is, its vague and without clear cut rules that govern it. Be Happy. There’s the goal, make it happen, you have a lifetime. But really, a lifetime isn’t that long. The controlled, but frantic rush of a sick patient passes in an instant, and so does the time we have on this planet to be happy, to love each other, to leave a legacy. I have trouble being told to wait, to be patient, but no guarantees applied. I get anxious thinking about waiting to be happy, when the wait is assured and the happiness hasn’t been tried on for size. I feel that controlled, but frantic rush with life. I’m paddling my ass off under the surface, I’m trying to get there, to be happy, but its all relaxed duck above the water. The waiting game. It certainly wasn’t made for this humble blogger. I’m in a rush, in a rush to find out what my life is going to be, in a rush to put the past behind me, in a rush to get to the next call and let Ramona amaze me, in a rush to see my son, in a rush to have a guarantee. That’s just the thing though isn’t it? There are no guarantees. If there were guarantees, nothing would ever take my breath away…

Fuck this city
Fuck the street with the dark crematorium parking lot where I bled
good decisions.
Fuck having a finger on this impoverished pulse
Put your finger on the delicate dip in my wrist and feel my pulse.
I’m real.
This is artificial, this is the hype of round holes and square pegs
Fuck making something out of nothing but adrenaline
and time away from playing happy family.
Fuck leaving this in the dust,
bewildered and
awestruck,
jealous and
superstitious; waiting.
A beat doesn’t wait, a pulse will throb
a lifetime
unnoticed
until its absence resonates.
Its the silence that speaks to me. Its always the silence
Stop giving me your soundtrack,
I’ve got my own playlist
Fuck pretending, who would bother pretend, and why, when this pain is so exquisite?

How do you connect? Lately, I’ve been wondering if the very reasons we’re good at our jobs are the reasons so many of us have problems at home. We come to work completely steeled against the potential tragedy of our EMS day. We have compassion in a limited and guarded way. We walk into that corner of our brain where the switch for emotional availability lies and we flick that switch off before signing on with dispatch. Its hard to see back into those dark corners to flip up the switch when we’re bleary and beaten at the time clock at the end of the day. For those people that have regular partners, this unavailability is shared….its a bond forged in un-bondable conditions. Its strong. We have a ‘you and me against the world’ feeling with some of our partners at work. Are we able to translate that to our home life? I think largely the answer is no. In a non-EMS family, there is one absolute bond: the bond between family members that would lay down their lives for each other. When you respond to 911s, you’re looking at your partner and saying, ‘I will never let anything bad happen to you.’ If you’re like me, part time and thus routinely subject to partner du jour, I say that, I make that silent promise to people I barely know. Its a fierce loyalty that I give to someone who is sometimes nothing to me other than a body seat-belted in beside me. What do I have at the end of a shift that is just for the person to whom I’m committing my life? What special bond, unique bond can I give to a man that trumps my ability to look at a stranger and feel protective of them, and put their emotional and physical well-being at the forefront of my mind for 12 hours?
I’ll be honest. I’m not in a position to wax poetic about the joys of marriage and making a life with someone right now. But I can look at this situation without the rosy adrenaline fueled glasses. The feeling that I get, on an ambulance, responding to the worst that humanity has to offer with my partner at my side is valuable to me. It defines me. I need it in a way that is occasionally directly inverse to the ways that I need to be with my family. Sometimes I find myself picking up hours, a shift here or there just because I’m looking for that thrill. The feeling that comes from knowing that I have no idea what’s going to happen next. The loss of predictability. Its reckless….and yet it isn’t. When I’m at work, I walk into chaos and create order. Its a feeling of ability that I’ve never had at home. I can’t create order in these four walls, I can’t even create happiness. But when I get in my truck at the beginning of a shift, I know that sometimes order comes solely because I demand it. That’s not being interested in the loss of predictability though is it? Its a desire and actualized form of being in control. I’m not reckless, I’m the opposite of reckless. I’m desperate to be in charge of a situation, any situation in my life, and I think that’s something that I share with my EMS peers. We want to control our scene, we aren’t playing a game, we aren’t just driving fast and shooting from the hip. We’re looking for a way to ensure that everyone goes home. For me at least, I’m offering my fellow responders care and protection that I haven’t been able to extend to my loved ones in any tangible way. I’ve failed at home, but at home is not where lives come in to play. I’m making a mess, leaving figurative bodies in my wake in my personal life, but at work, everything is copasetic. I’m in charge of the path I make at work. I’m in charge of the whole show. Why wouldn’t I want to work 70 hours a week? That’s 70 hours a week when its ok for me to be commanding, and when my commands create good. Declarative statements never work at home, that’s not how we relate to our loved ones, not how we make bridges between one emotional being and another. But at work, my emotions don’t have anything to do with my task. I’m an automaton. Doing exactly what needs to be done because I know what’s best. Can a person do both? Can I walk into work with the confidence and authority required to successfully do my job and look out for my partner and on the same day throw off my gloves and be vulnerable at home? I’m not rotten, I’m not a mean person, but I have a hard time letting go of that need to know that everything is ok. For everyone. I’m not a control freak, but I take it personally if people around me are unhappy, or uncomfortable. How do I learn to be part of a relationship that isn’t based on one person being in charge of happiness and security? I’m half of a team at work. I want to be able to do that at home. But we need more than a safe scene at home. I take care of my partners at work. Can I be someone that takes care of my partner at home? I think I can. Maybe more central to the issue-for me at least-can I be someone that allows her home partner to take care of her?

You’re saying you don’t love me anymore?

So I’ve struggled with what I want this blog to be. It has been cathartic for me to write, and good for me to be able to peruse when I’m having a bad day. I’ve always felt that in my heart I’m a writer before everything else, and truly, its the only thing I’ve always done well-well, writing and being modest that is. But I look at these posts and I don’t see all of Angela. I see half of who I am. Perhaps this is because I’ve felt like half a person for so long, just part real, and the other part just a portion of the stuff that goes into a marriage. Truth is, I haven’t been really happy in a long time. I’m not going to say that my marriage is awful, or that I’m miserable. My husband has never done any of those lifetime movie of the week things to make me decide one day to get up and leave. But as I’ve spent more time in the world, as a worker, as a friend, mentor, student, whatever, I’ve realized that I’ve become just a part of a whole. Just a piece of a larger picture, and its not really a picture I buy into. Don’t get me wrong. I want to enjoy being a wife, and although the 2 year old challenges my patience on a moment to moment basis, I do love being a mother. I guess maybe this just isn’t the situation I thought I would be in. I haven’t felt like my husband and I are on the same team in a long time, actually, since before we were married interestingly enough.
So, I decided to leave. And for some reason, it surprised him. I think about that a lot. All the warning signals were there for him to see, I’ve clearly been using work as an escape-and also as a means to repair my broken self esteem-I’ve been distant and I glaze over when we have the same argument for the 5th time in one month. I haven’t even had the passion to fight about anything. I checked out a long time ago. I was just too insecure to leave. But this seems to be something he would have been happy doing forever.
And now I’m leaving. I’m moving in a little over a week, and I’m really excited about it. People come up to me and say that they’ve heard a rumor and I think they expect me to break down crying as if I’m a woman scorned, or perhaps I’ll confide in them-give them all the juicy details of my personal failure, as if no longer being married makes me less of a private person. My standard response is, “Yeah, I think it’ll be good for everyone. Sometimes you just bring out the worst in people.” And more than once I’ve gotten the very judgmental, “Well, you seem happy about it at least.” What does that mean? What’s the response to that? “Yes! I’ve been annoying someone with my happiness for 5 years! I’m gonna let go now before I become someone I hate! Isn’t it great?!” I know I don’t have to answer anyone’s questions but my own, but its a very strange and disarming feeling to know what a small world EMS is and that I’ve been a topic of conversation in this world for a few weeks.

Reckless abandon

So I’m starting a new life. I’ve been asked if I have a “plan”, as in, loose guidelines as to things I want to happen in my new life. I do, I have those things. I know I want to be in EMS forever. I know that I want to magically turn into the kind of mother that other women so effortlessly seem to be. I want to be happy being alone. But the big questions right? Do I want to be married again? Do I want more babies? I think I have to table that. The first time around I was sure. I wanted a baby, I wanted to be his wife. There was no doubts…..perhaps because I refused to listen to them. This time I’m going to listen to doubt. I’m not going to be so cocksure of myself. But I’m not going to hold back either. I’m going to be happy, and look for happiness and beauty everywhere. I’m going to love fiercely. I have a tough time believing that we shouldn’t give our hearts away, that we’re on this planet to guard our emotions, to hold back when something feels right. That we’re on this planet to just at all costs avoid getting hurt. Its an exquisite, breathtaking pain when a loved one hurts you. Its also a moment of clarity. We can learn so much about ourselves from simply putting our hearts in someone’s hands and letting them do what they will with it. I’m not scared of being hurt. I’m scared of never being in the position to be hurt again.

My old partner and I had a code word for patients that take blood thinners. We are both medics, and we both like to just put the patient in the truck and sort our call out without screaming bystanders. Often, we would both be in the back, who ever was teching the call would be doing the patient care stuff, and the other would be looking through scraps of patient info and med bottles finding clues. If a patient happened to be taking a blood thinner, the detective partner would say, ‘Signal 30.’ Which in our service means going back to base to de-con. The other would then prepare the inevitable 4x4s needed to clean up after the iv. I always passed the 4x4s and went right for a towel.
I suck at tamponading.

The most dangerous part of EMS to me is getting dirty. Blood, puke and other body fluids are gross to walk around wearing. I have partially disrobed in the trauma room before, and I’ve been greeted with stares from some of the baby doctors. I always choose the clothes under my work clothes with care. Do I want my coworkers to see me in this? No skanky tank tops under the work shirt for me. Sometimes a girl just needs to be able to strip off a layer that is speckled with blood and grey matter.

There are a few moments during a nausea/vomiting call that scare me more than any other unsafe scene you could throw my way. Gun shots ringing around me? The crisis patient grabs a knife? Pulling the dirty needle out of a heroin od’s arm? I feel nothing. Make me be bottom while stairchairing a green, gagging patient and I quiver in fear. I find myself trying to make small talk, with the patient’s family, police, the landscaping while I avoid putting the straps on stretcher. Its a very vulnerable spot to be in, leaning forward in front of the patient, cursing the Gods of EMS for giving you a cot with those pathetic short straps on one side and the needlessly long ones on the other side, just waiting to see your arm covered in some one’s idea of a good midnight snack.

The worst is when the things that are coming out of a patient still hold some resemblance to the things that went in. I can no longer eat Spaghetti-Os for that reason. Ramen Noodles are just going back on my list of okay foods next month, and show me Campbells Chicken Noodle Soup and I will puke all over you.

Just because foods are liquid based doesn’t mean you don’t have to chew them people!

One night we picked up a handcuffed, combative patient. He had an above the elbow amputation on his right arm, and we were talking to pd about the safest way to restrain him for the transport. He had been drinking for hours and told a friend he took the ubiquitous “handful of pills,” so he needed to go. After watching him try to knock some sense into himself against the window in the back of the cop car, I finally just said, ‘Alright, we’ll just 4-point him.” Dear patient, who somehow heard this, started waving his amputated limb and screaming “3 POINT MOTHERFU*@ER!” Once we pulled ourselve together and got him, my partner, and an officer loaded into the back, we took off. My partner dials C-Med, and as she’s giving her report, I hear her say, ‘Are you going to vomit!?’ She hung up the mic, and I saw her, through the rearview, jump up on the bench and take the bag with her. The police officer was not as fast or puke avoidance savvy. It wasn’t my tech.
Which means it was my cleanup.

Some people say they’re going to puke and they make these cute little gagging noises, and spit a bit into a convienence bag. Some people say they’re going to puke and then spew forth vile from the depths of hell with force enough to knock out the back windows. The people that really worry me however, are the ones that say nothing at all. They have a few fingers pressed to their lips, their skin is transparent. Their eyes are half closed and you can see them willing themselves not to let go of their lunch. The stuff that comes out of those patients always makes me want to ask if its just corpses and feces in their diet, or if they also eat other things….

A friend of mine got injured in a fire tonight. Some smoke inhalation, a little heated airway trauma for your Friday night. Its nothing major-in the sense that he’s not tubed in the ICU-but major in that whole, friend injured kind of way. I have the greatest fire friends, I truly do, but this one friend in particular had said something to me about 8 hours before his injury, we were bidding each other the standard pre-shift safe wishes. He said, ‘I won’t get hurt- I promise.’ You’re thinking the same thing I am, I’m sure. And its kind of heartbreaking….to me at least.

I told you I was going to see you tonight…

He’s a new-ish friend. We’ve been coworkers for my entire EMS career, but have only recently started to talk. We’ve worked together a few times now, and on one shift in particular we spent all night running calls and just talking. The calls were simple, we both missed lines-me because my partner made me nervous, him because his patient evidently was part alligator-we teased each other and had easy banter with our patients. It was just one of those shifts that went well. Just a good vibe all around. He started the shift not unlike I start my shift with new basics. With The Rules. Mine are simple and mainly revolve around you-new basic-not killing me-mother of a 2 year old-with your driving. His however were a bit more detailed:
1. No protocols on the overnight. We do what our patients need and we’ll sort the rest out later.
2. We get dispatch a coffee at midnight. This is how things used to be done, it may be brown nosing, but we’re bridging the ever expanding gap between road crews and comms.
3. Lower the bar, you’ll be less disappointed.

In between calls we talked about the usual stuff that people talk about at 3am. He talked a lot about the psyche of people in our particular line of work. The theme seemed to be that we’re inherently selfless and selfish at the same time.
That’s an interesting way to look at things, selfless and selfish. He said that we have a need to feel what we feel when we’re helping someone else. We crave that pat on the back that comes from a job well done. We can, and do, function without the accolades that the job merits, but he was right. I often look at my looming EMS day as getting on stage. The lights flashing, the family and first responders holding their breath until I walk through the door. Me. For a trauma or medical 911 phone call, I am the star of the show. That’s the feeling I crave, the selfish part of what I do.
This feeling has come to live in me at all times. I perform all of life this way. Like my medic instructor said, ‘You have to be like a duck. Calm above the surface, paddling your ass off under water.’ Try throwing something my way that messes with me. Its a unique perspective to have. Broke? Car trouble? Failing marriage? I’ve held dead babies.
I get why firefighters do their thing. I do. Its personal gratification. Its a bigger, more obvious job well done feeling at the end of the day. But I hate it. I hate it so much. Let shit burn to the ground. Seriously. I really don’t care if your entire life is inside that house. Why not just surround and drown? Ok. Maybe if there are kids, or elderly people inside, do what you can. And by all means, throw up the ladder and let an able-bodied adult climb down. But don’t go in!
I married a firefighter. He wasn’t on a department when we married, but I knew it was his ambition, and sure enough, 7 days after my son was born, he started a fire job. I resented it. I thought-without actually putting it together-that it was selfish and selfless.
If you DIE, in a god damn FIRE, what do I tell your son!? ‘Here’s the better part of half a million kiddo. Daddy died trying to save some kid’s dog. Consequently THAT kid’s dad wouldn’t go in after the dog himself. And he’s fine.’

Fires are rare. Especially in areas with large amounts of new construction.
We are trained to do it safely.
We protect life first, property second.

All shit. All complete shit to me. If my home were burning, and my child was safe-which he would be because I would crawl over hot coals to ensure his safety-I would demand that no one went inside. Let it go. Baby pictures? Family heirlooms? The last letter gramps wrote gram before he was killed on Omaha Beach? Fuck it. What is more important than life? People think, ‘it’ll be ok, the fire department will come, they’ll save our home.’ Fuck your home, those are men and women walking into your ‘unsafe disposal of smoking materials’ fire. That’s someone’s most favorite person in the whole world. Let’s risk their lives so that your mother’s wedding china can live to see another holiday.
Its not just about assigning value to things we choose to protect though. Here is what I was told. Here’s what starts the mending of my heart. It came to me, via text, from another guy who was at that particular fire. He sent it after I met them at the hospital, watched them wheel in my new friend, sucking on an updraft and sounding like a 70 pack year smoker, after I professed my anger.

I know you’re pissed and I get it, that’s a rotten thing to have happen to a friend. We don’t like it either, he is like family to us. Try not to be too hard on him he takes a lot of pride in his job like we all do. Despite how we may talk from time to time we are not all cowboys, and speaking for he and I at least, we don’t think of this as an extreme sport with a paycheck we take the risks seriously, and do what we can to do things safely. Sometimes bad things happen on the job, but that’s true of all public safety jobs

He’s right. Sometime bad things happen on the job. According to the US Fire Administration, in 2010 there were 85 line of duty deaths in the US. Bad things. A small number I suppose, but here’s a large number to think about: 1. One firefighter, your firefighter, killed protecting someone else’s life. Someone else’s property. Bad things.

I’m blocked folks. I see so much every where I look. I’m full of as many emotions as someone like me is capable of right now. And yet nothing. There is nothing in here that is coming out in any cohesive fashion. I’m writing about my writers block for crying out loud. I’m walking around in the world as if I’m new here. All of a sudden, I’ve created a situation where I’m discovering that I’m a person in addition to being a mother, and a medic. I feel every step toward figuring out who I would have become had I not spent my early 20s starting my family is a step away from my little guy. How is that fair? Does my identity have to hinge on being a mother? And if the answer is yes, yes it does, what’s wrong with me that yes is not the obvious answer? Who am I? What the hell am I doing? Its 0220. What the fuck is my problem?