A good EMS call is an adrenaline rush no pharmacological recipe could come close to replicating. After years of training and experience all of us medics were never out of earshot from our portable pagers. They recharged batteries on the bed stand. They hung on our hips as we made our way throughout the day. Pity the poor fool who lost their pager, or worse, were unwitting accomplices to their destruction. 

Driving a pumper on a Thursday training evolution, I parked the water heavy iron monster, set the emergency brake, and bent over to chalk the wheels. Little did I know, my pager slipped off my belt, slid to the ground, and landed right in front of the rear wheels. After training, hanging up my gear, I felt for my pager. It was one of those “Oh, crap!” agonizing moments of frantic searching, all for naught. I lived with a spare replacement and the shame of losing face in front of the other members of my EMS crew and line firefighters. 

The next spring, at the annual banquet, I did the requisite chaplain duty of saying grace and introducing the M.C. for the evening, a well-known local radio personality. Introductions were made of the incoming team of officers. Thanks were extended to the outgoing group. The awards came after steak and deserts. Many in attendance were six or more drinks into the festivities. The chief called me forward.

“Oh, great. Now what did I do?”

He held a wrapped gift and began to make his presentation, pulling slowly on his prepared speech to wring out the maximum drama. He told the story of my lost pager and frantic, unsuccessful attempt to locate it. A lot of cat calls, hooting, and laughter was hitting me like a fire hose. My cheeks burned red with embarrassment. I smiled, forced a thank you, and accepted his gift. 

“Go ahead,” he said. “Unwrap it right now in front of everyone.”

One hundred fifty firefighter, spouses, and distinguished guests shifted forward in their chairs and looked intently at my unenviable position. Gift paper shredded to reveal a homemade plaque, on which was glued thousands of destroyed pieces of my former pager. The chief saw it on the ground after I pulled the chalks and drove off, crushing it beneath the real wheels of my fire truck. He saw the opportunity and seized the day. Good on him. 

It was the only pager I had to replace. 

___

“Man down” was an EMS call we all lived for. The response was always balls to the walls, drop everything, and hit the gas. Calls were generally categorized by type: either medical or traumatic, and, severity: Critical, Unstable, Potentially unstable, and Stable. Training gave us the acronym we used by memory: “Fit to CUPS”. Our department ran “Ya’ll come” calls, as opposed to shift work, like paid and other agencies. The tones dropped, tripping everyone’s pager, and you responded. On EMS calls, some responded to the barn to drive the rig, others of us carried equipment in our personal vehicles and drove directly to the scene. You’d see medics who made a bare minimum of calls per month show up at “man down” calls and try to take over. Talk to the hand, dude. 

Some were funny, despite the fact that a life was dangling by a thread.

“Man down. Not breathing,” the 911 dispatcher told us after dropping our pager tones. As per protocol, an Advanced Life Support paramedic team was dispatched from 20 miles away. The call was a good six miles from our station into our neighboring fire district. I was the Intermediate Life Support medic, so I’d be the first on scene and be able to initiate immediate care. If the paramedic made it there before we left, great; join the party. If not, we were told not to delay transport and head for the hospital. Maybe we could meet enroute, but today, it was unlikely.

The call was to a large farmhouse at the end of a long country lane. “AM-24 on scene,” Vern, my driver, informed dispatch. On the gurney I loaded the medic bag, Oxygen tank, defibrillator, portable radio. The kitchen door opened to my banging. “You call for the ambulance?” I asked the woman who answered the door. She was barely dressed with a toddler on her hip. Another near naked woman with a baby on her hip was cooking bacon on the stove. “He’s in there,” she pointed over her shoulder with her thumb. 

Vern and I pushed in to the bedroom. We found a middle aged buck naked male laying face up on the bed. Full Monty. Was there a smile on his face? I don’t know. He wasn’t talking. Or breathing. I called on the radio for more help and pulled him off the bed to the floor and began CPR. Memory fades, but I probably attempted to jump start his heart into a survivable rhythm. In time, more of my crew arrive. They took over the thump and pump while I sunk an E.T. tube, taking control of his respirations. The IV could wait until the back of the ambulance. ALS was still fifteen minutes out. Time to hit the gas and haul ass. 

Stretcher and patient, equipment, and crew pushed out the bedroom, through the kitchen and out to the idling ambulance. Barely pausing to notice, the two mommas and babies continued to go about their business in the kitchen, as if it was another ordinary morning. I paused for a moment, “What is his name?” I asked, the Patient Care Record (PCR) and clip board in hand. One looked at the other; they both look back at me, in unison shrugged their shoulders and said, “I don’t know.” 

—

Most were not. 

Two a.m. Nothing good happens at 2:00 a.m. “Man down.” The address was well known to me, elderly members of my parish, the parents of one of our village cops. In a flurry, I dressed, called in route, and met the wife at the back door. “Bill is in the bathroom,” she cried.

Lots of cardiac arrests take place on the commode. We were taught in training that the same nerves that are used to strain are also the ones that control normal heart rhythms. Push too hard or too long, and that predisposed vessel or electrical pathway just might blow. Poop is often involved. It isn’t pretty and I’ve been at that retching call far too many times.

Problem was, this evening, Bill was wedged unconscious against the bathroom door, preventing it from opening more than a sliver. “Bill!” I shouted. No response. “You awake?” Pushing hard, I could see there wasn’t any movement. Eyes closed, head down, chin buried in his chest. Grace, his wife, sobbed in the background. Still by myself, I got on the radio and called for more help. Shit. I couldn’t get in to get him out. I needed beefy firemen with wrecking tools. Fast. 

Yet, never one to give up easily …

I pushed and pulled with all my might. Leaned my shoulder into everything I had to give. “Sorry, Grace. The door has to go,” I apologized. Seeing this unsolvable puzzle blocking any hope for a successful outcome, she mumbled, “Do what you gotta do, Pastor Todd.” 

BAM! I hit the bathroom door, breaking it off its hinges, knocking Bill completely off the commode. I struggled through the debris and dragged him by his nightshirt, pajama bottoms down around his ankles, into the kitchen. “CPR in progress. Hit our tones again for more help,” I called into my radio. I thumped and pumped all by myself. Five compressions, one breath. Wash. Rinse. Repeat. 

Exhausting. Sweat in the eyes. Where was my crew? Sirens wailed throughout the village. If Bill had any chance, it was with me. His pastor. His medic. From experience, the outlook didn’t look good. Crews began to call on scene. Between compressions, I caught a glimpse of highly polished shoes and a police officer’s cuffs. “Give me a hand, buddy,” I called to the cop talking on his portable. 

He froze. “Come on, dude. I need a hand.” He didn’t move. I continued CPR until I rolled off completely whipped by my arriving crew. “What in the actual …” I was about to cuss just as I caught sight of the frozen police officer. Recognition was immediate. It was Bill’s son. “I can’t,” he cried. “I couldn’t.” 

At the end of the day, it wouldn’t have mattered. Bill had been down and not breathing long enough on the commode nothing could have been done to change the outcome, even though we tried. Minutes matter when brain cells go without oxygen, and they only get oxygen from the blood cells pumped by the heart. The pump stops, the brain dies. That’s all she wrote.

The family recognized our effort and memorial donations came into our Fire Department and the church. I sat in the same kitchen with a cup of coffee with Grace and her son a few months later. “How would you like the memorial money used?” I asked. 

“Bill loved stained glass windows at church. What do you think? Is there any way this could be possible?”

Above the East entrance to the Palmyra (formerly) United Methodist Church there is a stained glass window in memory of Bill. May it long stir fond memories and witness to the benefits of a depth of faith.

—

The lap pool called my name twice this past week, instead of the usual Monday, Wednesday, Friday two-step. The transition weather we are experiencing between winter and spring tends to give wild fluctuations off the beam of emotional stability. Nothing quite like a forecaster’s prediction of snow after a week of mild calm. In a lame excuse to myself, a vigorous walk on the indoor track would have to do.

Laps are reflective, meditative; uninterrupted silence where thoughts tend to invite and invoke critical moments in life. Man down calls invoke memories of my father’s sudden cardiac death over forty years ago, September 30, 1985. He had recently completed a cardiac stress test and received a clean bill of health. He jogged multiple times a week, keeping his weight under control and his inner demons at bay. Newly appointed to a church in Central New York, one morning he fell weak, tired, lost consciousness and died.

On the ambulance, we called it DRT. Dead. Right. There.

Mom had just gotten him in the car to drive to the doctor’s office when his mortal fire was extinguished. The medic on the ambulance who responded? Yeah. Unbeknownst to me, she would become one of my instructors when I went through training and recertifications. It’s a small world, filled with divine agents of God’s amazing grace.

As my arms and shoulders tired, I thought about the anxiety carried forward attributed to my father’s death. He died at age 59, three months, nine days. Translated to my own life, that year was one where I watched the calendar closely. Would I survive the old man? There are thousands of reasons for a heart to stop, which gives pause to downing that greasy hamburger and fries. Was I fated by poor genetic sequencing?  I inquired of my siblings, each expressing relief when they aged one day older than dad.

Last year, visiting my brother, a retired physician, we were talking about dad’s unexpected sudden cardiac arrest. We both outlived our fated genetics, I observed. “What do you mean?” Bryan responded. “It wasn’t genetics that killed dad. It was a virus.”

I blinked once. Twice. Three times. Did I hear what I thought I heard?

Yep. My brother gave me the detailed account of how he insisted on having an autopsy performed after Dad’s unexpected death. The finding? His heart was inflamed by a viral infection and had swelled to over three times it’s normal size. Swelled heart inside a fixed container resulted in a heart that grew progressively inefficient and eventual death. “Moral of the story?” my brother paused for effect. “Always get your vaccines.”

And for all those years of worry? Thankfully, they are all behind me, like the final stroke on my last lap before the showers.

___

Some “man down” calls just made me angry.

Memorial Day. Kids off from school. Big parade planned in the village. High school bands were marching in hot, wool uniforms. A brief service at the village cemetery planned by the American Legion completed the annual ritual. As fire department chaplain and local church pastor, my roll was to provide the invocation and benediction in my fire department dress uniform. As a N.Y. State certified medic, I’d ride shotgun in the ambulance, tucked nicely behind every truck the chief could get on the road. We had both our rigs in the parade, each loaded with a full crew in dress uniforms. Siren jockeys deafened the crowd. Firefighters riding the trucks dressed in bunker gear tossed hard candy to scampering children in the crowd.

In front of our ambulance marched the American Legion color guard. You’ve seen them; guys dressed in spit polished shoes and starched uniforms, toting flags of state and nation, or, sporting rifles used for a twenty-one gun salute in the cemetery. Most had beer bellies hanging over their belt, or long hair and a beard, a far cry from their active duty days. Lots of gray hair were tucked underneath service hats, adorned with pins and patches.

The route was long through the village under a hot sun. Didn’t bother me; I closed the window and turned up the air conditioning. The parade concluded at the cemetery; a right turn, roll under the arches (while fire trucks returned to base), then snaking our way to the veteran’s memorial, on a hill, center rear. Podium and bleachers under beautiful hardwood branches waited for our arrival. Thousands of patriotic neighbors lined the path and crowded in at our destination.

It was a beautiful day for a parade.

I saw him drop. It was called a witnessed arrest. The moment his heart seized to a stop, the Legionnaire 20 feet in front of our ambulance lost consciousness and slumped like a bag of potatoes to the ground. Vern hit the brakes and got on the radio, calling for help. Within 10 seconds half the medics in our department were on our feet, hauling equipment, and rushing to the unconscious veteran’s side. The marching band stopped playing. People surrounding the entry road to the cemetery bunched into a crowd. Hundreds came together like subway riders at rush hour, each straining to see what often isn’t seen by the general public.

We know CRP and put it to practical use nearly on a weekly basis. Basic Life Support (BLS) medics started the thump and pump. My Advanced Life Support (ALS) partner opened the airway kit and prepared to intubate. Another of our crew used trauma scissors to bare the patient down to his shorts and socks. I worked the semi-auto cardiac defibrillator, placing sticky electrode pads on his hairy chest, ankles and wrists.  

“Everybody! Clear!” I ordered. This gave us a clean strip to read, record, and interpret, as well as, healthy separation of my crew from the massive amounts of joules I was prepared to release from the unit’s high-tech batteries. I switched to manual. I wanted full control of the trigger in the right handed paddle. Conductive jell was spread liberally. “Charging to 120.” The internal capacitors filled with the tell-tale whine. I paused to survey the scene.

A pulseless, breathless patient. Everyone on my crew letting go and stepping back. Time slowed. I saw the crowd and squinted, the hot sun in my eyes, humidity as thick as molasses, sweat rolling into my eyes, perspiration soaking my shirt, soon to make me clammy. Spectators, hushed,  watching the drama unfolding before their very eyes, seeing what shouldn’t be seen. A man’s life account being settled, his existence held at the precipice edge, the raging current pulling at his lifeless body.

And there was an idiot with a camcorder. Red LED blinking not 20 feet away.

“Aug!” my inner voice turned rage inside out, “Stop CPR. Clear.” Everyone obeyed. “Shocking 120!” as I depressed the trigger, the patient shuttering as expected. Normal sinus rhythm was nowhere to be found. The tape printed an exotic cardiac rhythm way beyond my pay grade to make hide or hair of its meaning. All I knew was that it remained a shockable rhythm even though there wasn’t a pulse or breath. “Stop CPR. Clear.” The scene remained safe. “Charging to 200. Shocking 200!”

The neanderthal with the camcorder perched on his shoulder squeezed in closer, tighter. The captain of our ambulance stood back, arms crossed, doing his own survey of the scene, taking it all in. “Clear,” I called out a third time. We only got three chances in the field. Someone trained to a higher level of care might have different rules, but I was three shocks and done. CPR stopped a third time and everyone backed off, yet again. “Charging to 360.” I waited for the alerting tone indicating a full charge. “Shocking 360!”

Nothing, damn it. “Resume CPR.” Jimmy would try his ET and IV sticks inside the rig, away from prying eyes. “Let’s load and go,” I yelled. Swinging onto the rig, I looked back for a moment, right into the lens of the camcorder staring me in the face. The brief pause almost irrupted like a volcano of rage, veins in my temple bulging. Lips tightened, less I say something regrettable, the door slammed shut behind me. For a moment I let the anger dissipate before refocusing on the task at hand. All hands were needed. A job needed to be done.

It didn’t come as a surprise. No, the patient did not survive. Few did. What surprised me most, is that the entire Memorial Day parade “man down” call, fully recorded on videotape, did not end up on the evening news. Thank you, God.