A GREAT ARTICLE

[Bill]

From JEMS.com July 2, 2007

The Night Is Always Darkest Just Before the Dawn

· Bryan E. Bledsoe, DO, FACEP
· July 2, 2007

It is 4:30 a.m. on a warm Sunday morning in the ambulance parking area outside the county trauma center. Paramedic Jeff Crosby sits on the back of the ambulance staring at the unmade cot. His mind is active—running through the events of the last hour or so.

He and his EMT partner, Barry Willingham, had just completed transporting the victim of a drive-by shooting. Such carnage was not uncommon in the poorer parts of town. But this call was different. The victim, a beautiful four-year-old girl, was sleeping in her bed when gunfire erupted outside her house. While she slept, a .32 caliber bullet fired by a 17-year-old gang member penetrated the wall near her bed and tore into her small skull.
Jeff knew immediately that the wound was mortal. In just the blink of an eye, four years of childhood memories and four years of innocent life were effectively lost as the bullet tore through the young girl’s brain. For the mother, the hopes and dreams she had for her young daughter were gone. All that she had to look forward to now was a lifetime of grief and guilt.

Jeff closes his eyes and plays back the call. The first thing he saw was a Disney “Little Princesses” nightgown covered with bright red blood. The entrance wound was just in front of the little girl’s left ear. She had irregular respirations. Her pupils were fixed and dilated.

Jeff and Barry did everything they had been taught to do. Hours and hours of education, pages and pages of textbooks, more hospital clinical rotations than one could count—all apparently to no avail. Jeff was literally sick.

Suddenly, the still of the night is broken by the pager. Jeff and Barry are being dispatched to a “sick call” back in their regular territory. Barry comes running out of the trauma center and helps Jeff finish the cot and place it into the ambulance. Neither say a word as they drive away from the hospital. Finally, they turn onto a tree-lined street of old but stately homes. The porch light in front of one is lit, and an elderly woman, possibly a housekeeper, waves at the crew. Jeff and Barry park the ambulance. They grab the necessary equipment and cot and proceed into the house.
They enter the elegant living room. Seated on a formal sofa is an elderly woman in no apparent distress and with a look of indignation. The first thing she says is, “It is about time. I have waited over 10 minutes. Dr. Marshall is supposed to meet me at Memorial Hospital.”

Jeff looks down and quietly says, “Sorry. It has been a long and difficult night.” The patient replies, “I don’t care. I’m sick, and Dr. Marshall is going to admit me to the hospital.” The EMS crew attempts to assess the patient only to hear her demand, “Let’s go.”

Finally, they recognize that discretion is the better part of valor. They carefully place her on the cot and move her to the ambulance. Barry runs back to the house and grabs the two Samsonite suitcases brought out by the housekeeper. They depart for Memorial Hospital.

Jeff asks if the elderly patient is comfortable. She ignores what he said and begins, “I pay taxes here. In fact, I pay a lot of taxes. When I call an ambulance, I expect it immediately.” Jeff, halfheartedly, apologizes and stares at the opposite wall of the ambulance. The patient, finally sensing that something is wrong, looks at Jeff and asks, “What’s the matter?” Jeff thinks for a moment, and finally answers, “We just had a bad call. A little four-year-old girl was shot in the head.”
The elderly patient immediately puts her hand to her mouth, gasps, and says, “Oh my. Is she going to be OK?” Jeff looks her in the eye and says, “No, I don’t think so. When we left they were talking about the possibility of organ donation.” The elderly patient, Mrs. Edwin Donahue, again gasps, quickly makes the sign of the cross, and says, “Oh dear. That is terrible, absolutely terrible.” Jeff nods his head and quietly says, “Yes ma’am.”
Jeff is on the verge of tears—but keeps his composure. Mrs. Donohue says, “I’m so sorry. I didn’t know. Dr. Marshall thought I should go by ambulance. I could have gone in a car. I’m so sorry.” Jeff, realizing the remorse of the elderly woman, looks at her and says, “That’s OK. I want you to know that you are just as important to me as any patient. I’m sorry to have troubled you with the details of this evening. I shouldn’t have done that.” Mrs. Donohue, now crying, says, “No, I am the one who troubled you.”

The next few minutes are quiet. Mrs. Donohue breaks the silence and says, “You must get paid well to do this work.” Jeff kind of laughs and says, “Actually, no. I make $15.00 an hour. I’ve got bills I can’t pay. My wife is a school teacher and makes extra money driving the school bus. If it weren’t for garage sales and my mother’s help, my kids would look like orphans.”
Mrs. Donohue thinks for a minute and says, “That’s terrible. Why do you do this work?” Jeff thinks pensively about the events of the evening and finally says, “I don’t know. I really don’t know. When I got out of the Navy I wanted to do something to help society. I was a corpsman in the Navy and becoming a paramedic seemed like a natural transition. I used to have this idea that people are basically good. I thought I could make things better by helping people in their time of need. I really thought I could make a difference.” His voice trails off and, the image of the blood-stained “Little Princesses” nightgown comes to him again. The tears begin to flow. He says, “I guess I was wrong.”

A few minutes pass and Memorial Hospital is getting closer and closer. The elderly woman and the burly paramedic both shed tears and then both are quiet. In the east, Jeff can see the light from the rising sun. He looks at his watch. It’s already 6:30 a.m. The sun signals the beginning of a new day—a sort of clean slate. Then Jeff remembers why he became a paramedic. He looks at Mrs. Donohue and says, “I’m sorry for ruining your trip to the hospital and for the things I said.” She quickly answers, “Why? You have nothing to apologize for. I’m the one who needs to apologize and I do.”

Jeff meets Mrs. Donohue’s eyes and says, “This is the best job I have ever had. Sure, I’ve seen some horrible things. Sure, I’m underpaid. But the good part of this job always outweighs the bad. Although the cliché is old, good really does conquer evil. I truly believe that. There’s nothing more rewarding than seeing a father of three open his eyes after you’ve brought him back from death with a defibrillator shock. There’s nothing more rewarding than clearing the airway of a choking baby and handing the breathing child back to a crying and appreciative mom. There’s nothing more rewarding than helping the ill and infirm in their time of need. I may be naïve, but I believe that chivalry is not dead—at least not yet. But, in the overall scheme of things, I’m just one person trying to make an honest living and trying to leave the world in a little better condition than I found it. I know I make a difference and I am damn proud of what I do.” Mrs. Donohue smiles and nods. The tears still glisten on her aged face.

Barry opens the back doors of the ambulance and they carefully unload Mrs. Donohue and take her to her room. As the EMS crew prepares to leave, Mrs. Donohue looks at Jeff and says, “Thank you so much. This will be a night I will forever remember. And, you are right. People are inherently good—like you.” Jeff smiles and says, “Thank you.”
Walking down the hall Barry looks at Jeff and says, “What was all that about?”
Jeff says, “Oh, nothing. Just idle chatter, I guess.”
They open the hospital doors and are met by the rising sun. Barry says, “Look. It is going to be a beautiful day. Are you up for some breakfast?” Jeff takes a long look at the sky, smiles, and says, “Absolutely. You’re buying, right?”

· Bryan E. Bledsoe

Dr. Bledsoe is an emergency physician in Texas. He can be contacted at [e-mail]. Bledsoe also leads the Street Medicine Society, a group of physicians who got their start as EMS professionals. If you're a physician (MD, DO or equivalent) and have been involved in prehospital care, consider joining the SMS.

With thanks to Doug Bitner, EMT-PII