After the sirens, p.16
After the Sirens, page 16
They drove for hours. The city stayed dead.
Cate was disappointed, but she should’ve known not to get her hopes up. A double medic car, in the superstitious world of EMS, meant they had zero chance of getting any calls requiring even one medic. And so it went.
Until sunrise. When all hell broke loose.
Around 0600 they got hit out for a very pregnant woman vomiting blood. The first patient Cate had seen go from sort of okay when they got there to not at all okay by the time they hit the ER. The fight just left her. You could see it happen.
After it was over, and Cate was putting the truck back together—which was taking forever—she tried to evaluate how it had gone. The baby was a big concern, but not one they could do anything about other than try to stabilize the mother and drive like hell. Wocka and Rodriguez were still running around the ER, but Cate thought they were pleased. In the sense that everything that could have been done, was. And reasonably well. Like all their calls, they’d never know how it all turned out. Whether what they’d done had been enough.
Cate relied on the reactions of the medics and EMTs who had seen more. Because there was still never a moment on the ambulance Cate didn’t doubt what she was doing. Whether she should be doing more. Or less. Whether she was missing something. Or overreacting to something. It wasn’t that the experienced medics didn’t make mistakes or wish they’d done things differently, but they knew. They knew when it had gone badly. She hadn’t seen it on her truck yet, she was grateful for that, but she’d seen crews at the hospitals cleaning up their trucks in silence. Crouched down against the walls, smoking one cigarette after another. She’d seen medics spend hours writing reports on calls where something, or everything, had gone wrong. Partially because they knew they might have to answer for what happened, but also, Cate thought, because it was their last chance to do something well. Fix the only thing they could.
She could see Wocka through the glass doors, leaning on the nurses’ station, waiting for a face sheet. She felt protective of Wocka.
She crawled around the floor of the ambulance for a third time, scrubbing at the last streaks of blood, then sat on the bench seat and went at the tread of her boots one more time. She was assembling questions in her head to ask Wocka. By now she knew enough to get most of what was going on most of the time, but the why still felt miles off.
She’d just thrown the last of the trash away when the radio set off its “heads up” information tone. A single piercing tone that didn’t precede calls but preceded something else the dispatchers wanted everyone to hear.8 Usually it was information for the system—unexpected closures of roads or hospitals, very serious weather alerts, or, most commonly, a Level Zero. Code for they were out of medic units and please do something about that by hurrying the hell up.
Just kidding. Dispatchers never said please.
In this case, the message was for Cate’s unit to clear as soon as possible. Right away she heard Wocka clear them from inside the ER. The tones dropped the second he released his radio mic. Unconscious person, reported CPR in progress. Cate loaded the stretcher quickly as her thoughts went everywhere. Tony, Roof, and Sara had all run at least one code. No one had had a save yet, but they’d all at least seen it. Had a chance to try, to do CPR for real. This was Cate’s chance to do something big. She checked again to make sure everything was back where it should be, then climbed in the back. Wocka finished off the radio traffic and got in the driver’s seat since he was the first one out. Rodriguez walked quickly out of the ER, keys swishing on her belt clip, and swung into the passenger’s seat, opening the laptop for notes. Cate, unconcerned with being cool at that particular moment, stuck her head up between them to hear.
Rodriguez swiped through a long list of dispatch notes, longer than any Cate had ever seen. “Eighty-six-year-old female. Hospice.” Scrolling. “Just stopped breathing. Family . . . they put ‘DNR’ with a question mark.” Wocka’s eyes narrowed as he flipped on the sirens and pulled onto the street. “Family on scene arguing. Hospice not present. CPR instructions being given.” Wocka’s eyes narrowed further. Rodriguez scrolled further down and gave out a bark of laughter. “Screaming in the background. Caller hung up. PD en route.” Rodriguez beamed and punched Wocka in the shoulder. “This is going to be cra-zy.”
“Great,” Wocka answered, mostly to himself.
The bleakest “great” Cate had ever heard.
Rodriguez turned back toward Cate. “A couple summers ago we worked a code in the middle of a prison riot. Lockdown, horns blaring, guards behind those plastic shields, beating people with batons, the whole thing. It was stupid!” She was practically bouncing off the seat.
Cate nodded. Or thought about nodding. There was a lot of information flying around.
They weren’t going far, but morning traffic was well underway. Wocka laid on the air horn. They had to pick their way through cars pulled over every which way and force others, who thought they were special, out of their path.
Because it was Wocka, he started preparing her before they even got on scene. Cate had ridden with a fair amount of medics at this point and one thing stood out: the more they knew, the more generous they were with sharing it. Which had Cate rethinking many of the supposedly smart people she’d known in her life.
Wocka gave his best guess as to what they were likely walking into. She knew what a DNR was. A do-not-resuscitate order. A legal directive, signed by a doctor, that, for EMS purposes, usually boiled down to the patient not wanting CPR. In other words, if they died, they didn’t want anyone trying to bring them back. Usually the patients who had these orders had terminal medical conditions and didn’t want to drag out the end or make it any more painful. They didn’t want to be “hooked up to machines.” These were people who weren’t going to get, by any definition of the word, better. Medics were all big fans of the DNR. No one wanted to torture people. Cate hadn’t seen it for real yet, but she knew enough to know CPR wasn’t like doing it on a dummy or what you saw on TV. It was violent and messy and went on and on and on, and she couldn’t imagine being a family member watching that happen. If it was a healthy person who could maybe walk out of the hospital someday, then absolutely, you did it all. But if it was a cancer patient who had already gone through hell and that hell was finally over? Wocka said only people who had never seen everything wanted everything done. In that instance.
Hospice was an added layer. They’d covered that in class too. People who had less than six months to live could go either home or to special hospice centers and be taken care of by hospice nurses whose whole job was to help people die. As peacefully and painlessly as possible. Everyone at St. D’s had profound respect for hospice nurses. Usually they handled everything themselves and EMS wasn’t involved at all, but if there was no one from hospice at the house when the patient died, the medics would sometimes go out and do the pronouncement. It was normally very straightforward because hospice nurses worked with the families as much as they worked with the patients. They made sure everyone knew what was going to happen and that they’d made their peace with it. It was always easier for the patients than the families, but last wishes are powerful things, and knowing exactly what the patient wanted and why was almost always enough for the family to come to terms with it.
Almost always.
Because there was a small asterisk to DNRs—the family, the next of kin, could overturn them. In the moment. Which was questionable as far as “final wishes” went. It very rarely happened. But, like all family events, death was not immune from outbreaks of irrational behavior, old grudges, and unresolved issues.
A suicidal or overinsured Mini Cooper cut them off and Wocka laid on the air horn for a good ten seconds.
It was a normal house on a normal street. Two police cars were parked out front. Before they’d even gotten out of the truck, a middle-aged man burst out the door and screamed at them to hurry. A male cop followed him out, charging across the lawn, ordering him to calm down. Next out the door were two middle-aged women. Both shrieking at the man, who, it sounded like, was their brother. That he couldn’t do this. A female cop was trying to corral them on the porch. Neither cop was winning the war. Cate jumped down out of the back and Wocka said, “Just the monitor and the jump bag.” In other words, he wasn’t planning to take anyone out of the house on a stretcher.
The raucous voices of the three siblings and the two cops battered them as they walked across the lawn then quickly up the stairs into the house. Inside was a large living room where one corner, near the bay windows, had been turned into a temporary hospital room. On a rented hospital bed lay an impossibly frail woman in a nightgown and cardigan. Her skin was yellowish gray and pulled tight over her face. Her sunken eyes looked cloudy and dry. Her mouth was open. A young woman, a girl, barely older than Cate, was kneeling on the bed trying to do chest compressions, but she was struggling on the thick mattress. She was also crying. Sobbing. She looked like someone had a gun to her head. The cops had been trying to keep the other family members on the porch but suddenly the room was full of screaming, threats, wailing, pleas . . .
They’d walked into hell.
Wocka walked up to the girl on the bed, put his hand on her shoulder, and told her to stop. For a moment, everything stopped. Then the girl ran outside, howling and shaking. No one went after her. The storm door slammed shut. The family members started screaming at Wocka, who backed away, deliberately leading them and their anger toward the kitchen and away from the patient.
Rodriguez put the monitor on the bed but barely looked at the patient. She was watching Wocka, the cops, and the family. “You got this?” Cate nodded and Rodriguez was gone. Cate’s hands were shaking as she took the cables out of the side pocket, unwinding the four leads and attaching the electrodes. Down the hall, the anger and hysteria exploded as Rodriguez’s voice entered the fray. The only voice she couldn’t hear was Wocka’s.
Cate tried to block it out. The sun was up. It was hot and Cate began to sweat. In the kitchen, a glass broke. She heard the female cop threaten someone with arrest. There were sounds of a scuffle. Rodriguez’s voice rose above the others. Repeating what the cop said about jail, only louder.
Cate concentrated on putting the right color lead on the right limb.
White. Green.
She leaned over the body.
Red. Black.
She began humming. Quietly. Whatever came into her head. To separate what she was doing from the sounds coming down the hall. The anger. The threats. The hate.
She pushed the power button and the monitor beeped and settled. Reading it was not Cate’s job. But she knew what she was seeing. Two straight green lines shooting across the screen. No movement. No life.
There was a scuffle in the kitchen and the two sisters’ voices hit new levels. Rodriguez was yelling at someone to back up. Then sounds of a physical fight drowned out everything else as bodies crashed into cabinets, the walls, the door. More glass broke. Someone screamed.
Cate put her stethoscope on and unbuttoned the woman’s nightgown. Her chest was a bird skeleton. Deflated breasts slid sideways from her sternum. Her skin was still very warm, clammy almost. She put the bell of the stethoscope over the woman’s heart and listened. Irrationally terrified of missing something, knowing there was nothing to miss. Trying not to hear the sounds from the kitchen, she cupped her hands over the earpieces and listened to her own breathing. She listened for at least fifteen seconds and then covered the woman back up as much as she could, redoing the tiny plastic buttons up to her chin. She straightened her wig, brushing the hair away from her eyes and then closing them. Which she wasn’t sure she was supposed to, but she did anyway.
She was out of things to do.
Cate had never seen a dead body. There was something different but she couldn’t put her finger on what. Stillness. But more than that.
Cate sat with her.
A few seconds later, Wocka came out of the kitchen. As he opened the door, a wave of violent noise poured into the living room. The increasingly strident voices of the cops, the clamoring of bodies, threats.
The brother lunged out the door, screaming after Wocka, “You faggot! I’ll kill you, you faggot! You piece of shit! You’re dead!”
The cops yanked him back into the kitchen.
Wocka’s face was still.
He headed over to Cate and put a hand on her shoulder for a second before reaching for the monitor. “You okay?”
Cate nodded. In the kitchen, Rodriguez was shouting at the brother to shut up. There was more scuffling. The sisters were shouting at Rodriguez now and she was shouting back. The cop yelled, “Don’t!” Then the sound of a body hitting the ground.
Wocka reached over her and pushed print. For several seconds the paper whirred out of its slot underneath the screen. Wocka’s eyes settled on the woman’s face. Then he tore off the pink paper with its two straight lines. Incontrovertible proof of death. He walked back to the kitchen. Cate followed.
The brother was in handcuffs. The male officer had him by the bicep. Still, he lunged at Wocka with his face as they approached the doorway, his eyes wild. He’d get them fired. He’d sue. He’d have them arrested. He was gesturing with his face to paperwork on the counter, saying something about power of attorney, how it was his right to decide. How his lawyer would murder them if they let her die.
They could have just done the CPR. Made him stop.
But even as the thought passed through her brain, Cate knew it was wrong. She’d seen the bones nearly poking through the dead, gray skin. The idea of pushing her entire body weight down on that brittle chest even once was horrible. Whatever else was going on with this family, Cate knew no one could want that.
The women were shouting over their brother. Rodriguez was shouting over them. The cops were using their bodies to keep the sides apart. As the man continued to scream slurs and profanity at him, Wocka led the brother by the elbow out to the living room.
He led him right to the edge of the bed. Over the body of his mother, with the sunlight streaming through the window. Wocka explained what the paperwork said and what the ECG showed, even while the man continued to rail at him, though the nasty language was gone now. The man seemed aware again. But still disoriented. Focusing only on Wocka.
Wocka asked him her name.
It was Evelyn. Just saying it, the man crumpled. And it was over.
Wocka exchanged a look with the cop and he removed the handcuffs. The man sat on the edge of the bed and held his mother’s hand.
The sisters came out screaming at him not to touch her.
Wocka put up his arms and protected the man who had started to cry.
Rodriguez came out of the kitchen and hollered at the sisters to get back in the kitchen. She kept yelling, barking orders at the women even after everyone else was quiet.
Finally, Wocka snapped, “Jo, enough.”
Rodriguez leveled a death glare at him. Then she picked up the unused jump kit and walked out the front door, letting it slam behind her.
Wocka was talking slowly in a low voice, and for the first time, all three siblings were listening. Cate could barely hear what Wocka was saying. She only caught the very last thing. “You weren’t ready. But she was.” The man, the son, finally had the wind knocked out of him. Wocka asked one of the cops to go after the girl outside. His daughter presumably. She came back in and now everyone was crying and hugging. Wocka paced in the hallway, talking quietly into his cell phone to the ER doc for the official time of death. Cate asked the cops if she could pull the curtains closed. They said yes.
Back at the truck, no one said anything. Cate put the equipment away. Rodriguez was waiting in the driver’s seat and cleared them over the radio. The shift captain immediately took them out of service so they could get back to the station to change shifts. It was an hour past their time to get out. Cate was late for school.
Rodriguez ignored both of them. The first time all night she’d been quiet.
She was vibrating with an unspoken fury.
Cate wanted to say something, defend Wocka, but she wasn’t sure from what. Wocka turned around and asked her if she had any questions or if it could wait until the weekend. Cate nodded. She didn’t really feel up to rehashing it. It was too bright. Too hot. Too loud. The day had started before the night had ended and that always felt wrong.
Homeroom had started four minutes ago.
In the back of the ambulance, Cate leaned her head back against the tall seat and closed her eyes. She didn’t usually stay for the entire overnight shift on school nights, but she’d been hopeful adding some overnight, predawn hours would get her better calls. Adrian ran overnights all the time. She was tired of hearing about his adventures while she went home like some kid with a curfew. Before all the good stuff happened.
On school days, though, she usually left at 0530. Which meant she still ended up missing a lot of the best calls since a lot of people’s days went downhill, medically speaking, as soon as they woke up. But she didn’t want to create drama at school or give her mom a reason to start getting parental about it, which, so far, she hadn’t. Cate had been skating by on the very dubious grounds that this was a “school activity.”
She’d tried pushing it till 0600 last night because it was Rodriguez and all night long it had felt like something was about to happen.
Be careful what you wish for.
The thought of going to school was . . . She was tired. Too tired to care.
An hour later she was in the air-conditioned school, changed but not showered, feeling grubby. Feeling unbalanced, injured almost, from the hate and grief in that house. From seeing Wocka abused. She hadn’t even asked if he was okay. She should have said something. Her mind wasn’t settled. It was still in that house. It was hard to describe.
