The Pitt is a masterful rendition of a fast moving Emergency Department. Like its predecessor, ER, the pace, emotions, and procedures reflect my own experiences in ERs around the region. With my wife, with over 40 years of Labor and Delivery experience, and my experience running EMS and Psychiatric Assessments, we love to watch each episode, call out bull shit when we see it, fill in blank spots in our knowledge. To a large extent, Hollywood gets it right. 

Shout out to ED staffs of doctors, nurses, respiratory therapists, and techs. I loved them all. Some became more than professional acquaintances; friends even. There would be middle of the night calls, when everything was settling down and paperwork was complete, when one would pull up a chair and we’d begin to talk about theology, family, politics, cases. 

It was always a huge relief to transfer care to ER staff, professionals with a higher level of care than my meager Intermediate Life Support Emergency Medical Technician certification allowed. Responsibility for life and limb weighs heavy on every medic. Training only goes so far; it kept me focused in the center of the hurricane, yet, each and every one of us responding to the cry for help from a neighbor remained deeply human. I felt, and cared, deeply for the human hurt and pain I heard and experienced.

—

The man sitting on the gurney opposite from me in the small psychiatric ER room was dressed in uniform. He had just completed his work day, jumped into his pickup truck and drove straight to the ER. He knew he was in trouble, just as serious as if he had crushing chest pains and difficulty breathing. 

Except, he didn’t. 

This soft spoken member of the law enforcement community had been hearing voices recently telling him to kill his wife. He knew they were not real, for he could not locate any source of the voices outside of himself. His experience, he reported to me, was more real than mere fleeting thoughts that could be brushed away by refocusing on a different tasks. He reported to me that he heard these voices plain as day. They began when he woke, continued through the day and into the night. 

He loved his wife, and children. From his world view there was no reason to want to bring harm or violence to his wife or family. Unnerving. Frightening. Terrifying, even. With no history of mental illness, this gentleman came to me desperate for help.

“The voices tell me to shoot her,” he reported. “They are breaking me down, and I’m afraid the only way to make them stop is to do it, even though I don’t want to.” My heart broke for this man, all the while, my brain is franticly searching for cause, treatment, and a path leading to a healthy outcome. He checked the homicidal box, had the means, and desire to carry through on his plan. 

Doing nothing wasn’t an option. He was also armed. 

People who experience homicidal ideation can be very dangerous, not only towards their target, but also to anyone else on the sidelines. Experience and crisis intervention training taught me to establish a non-anxious presence, de-escalate and maintain calm, and compassionately remove the threat. My affect was laid back and empathetic, words were soft and eyes expressed kindness. My brain was praying for God’s mercy to work in and through me. 

My legal pad was full of notes taken, a life spilled into my lap, emotionally flailing in an attempt to find a way out. Even during our interview I could see him wince, blink hard, when he heard his command hallucinations. Maybe he was attempting to block that which was assaulting him. 

“Give me one moment,” I said as I stood and stepped towards the door. “I’ll be right back.” And I left him, sitting in silence, on a hospital gurney, in a small ER room, armed with a gun. 

I went straight to the attending ER doctor, pulled him aside and gave him the brief run down. “And he’s armed,” I told him, driving home the life held by a thread, serious nature of the patient. Fear wasn’t on my radar. Training and experience kept me laser focused. Yes, there was mortal danger, but thinking about that could be postponed to later. Then I could collapse in the staff lounge with a case of the he-be geebies. 

No. He-be geebies cannot be found in the clinical manual of psychiatric disorders. That doesn’t mean they aren’t real. “I’m on it,” doctor Mark told me. “Go back in and keep him calm.” 

So I re-entered the exam room, pen and legal pad in hand. Memory fails regarding what we spoke about, but it must have been effective because he remained calm and quiet. Time passed, as if I could hear every tick of a sweep second hand on the clock. Our conversation was almost casual. There was a knock at the door. 

Turning to stand and open the door, it exploded open and in rushed the A-team. Cops, hospital security, lots of big burley men. I slipped out, unseen. It was over before the patient knew what was happening. He was restrained and disarmed, not of just one handgun, but two. Later, his pickup truck in the parking lot also sported a cache of firearms and ammunition, now secure. Whew!

A tragedy was averted that evening. A story was written that never made the evening news. A tortured mind was made safe, and I can only hope and pray, he was able to find the cause of his hallucinations, to be effectively treated, and to return to a life filled with love and family. 

Why? I wondered. There are many possible causes for such a condition. Medical, chemical, disease, abuse, hereditary, you name it. UTI? Brain tumor? Late onset Schizophrenia? Sometimes it is nearly impossible to nail down a cause, let alone treatment. There but by the grace of God goes any of us. It was by that same grace that I was effective and safe that hot summer evening so long ago in the ER. 

Thank you, Lord. 

—

Every lap in the pool this morning was shared with a fellow traveler on this journey called life. He was kind is offering to share a lane, faster than me – aren’t they all? – completing three laps to my every two. 

Each time we passed I squeezed tight to the lane markers, compensating for the violence of water, splash, and wave. It was as if his displacement pushed against me. It wasn’t intentional, just physics. 

Water has to go somewhere. I reflect on the wet spring we are experiencing, breaking records I hear from the evening weather report. Streams, running chocolate brown, fill their banks full to overflowing. Low dams that used to support mills long since gone have been swept clean of debris, water swift, flowing so fast over the crest it registers as hardly a bump. Low lands, fields, and lawns flood, basements fill, and rain continues to fall. 

Pool water refreshes. River water cleanses. Filtered water nourishes. Baptismal water stakes a claim. 

—

All the classroom training cannot prepare an EMS medic for the full reality of traumatic injury and death. Experience is the only calming effect I know of. Debriefing helps reduce the debilitating effects of post-traumatic stress. But that comes after the fact. This is where having experienced leadership is essential to the effective deployment of an emergency medical services agency. 

We were blessed with Vince and Jean. Retired, but not inactive, a husband and wife duo who had been in on the ground level of emergency medical services in the 1940’s and 50’s, when local undertakers gladly passed responsibility to someone else, anyone else, usually to volunteer fire departments! The ubiquitous black hearse with a gumball light would be replaced with municipally funded, hand crafted ambulances, complete with trained medics and drivers, lights and sirens. Trauma medicine had advanced by leaps and bounds during WWII, Korea, and Vietnam. It was making the leap into every neighborhood and community in the country. 

Vince and Jean, lifelong members of the Reformed church, had seen it and done it all. Some new bucks rebelled against their authority, but quickly were told to toe the line or get out. That’s what the other ambulance service in town was for; our rejects, and it showed, or so we believed. 

Her name escapes me. She was alive when I got to her. Her elderly body trapped by steel and plastic, covered with cubes of broken safety glass, violence now ended, leaving her with exposed bone, blood, and brains. But, she was breathing and had a heartbeat. “Launch Mercy Flight,” I requested in my radio. Standing back, ever the leader and safety officer, Vince agreed and relayed my request to dispatch. 

Our rescue crew fired up the Jaws of Life, its small engine powering a hydraulic set of pincers, coughed and came to life. All I could get at was covering her nose, or what was left of it, with a non-rebreather mask and 16 liters of pure oxygen. A fireman threw a blanked over the two of us, shielding us from shards of glass and flying plastic parts. Her vehicle had been obliterated, engine separated from frame, axels departed, steel twisted, steam hissing, electrical connections severed, one wheel 150 feet down the road resting in a ditch. 

Pulling into the path of a car doing 55 will do that to a vehicle. I know, from personal experience, both as a medic, and, later in life, as a patient. 

Firefighters set up a landing zone a few hundred yards away on a driveway well clear of overhead obstructions. Mercy Flight landed with sound and fury, just as my patient was freed from entrapment. C-collar. Back board. The non-rebreather reservoir inflating and deflating with every breath, until it didn’t. 

Shit. Respiratory arrest, I called out. The Bag-Valve-Mask (BVM) came out and we took over breathing for our unconscious patient. Unbelievable, but she had a pulse. 

The impeccably coifed flight paramedic approached from behind and snarled at me, “what did you call us for? She’s in arrest. We can’t transport a patient in respiratory arrest.” 

“Well, she wasn’t when I called you,” I responded, anger rising. Now he was on the scene, as a paramedic, he was a higher level of care than me, so the ball was in his court. His call. What was he going to do?

First things first. A is for airway. We loaded her temporarily in our ambulance so he could sink an Endo-Tracheal tube. That meant starting an IV and the paramedic pushing drugs that sedated and paralyzed her. We worked like demons with the house on fire. Success meant a possibility, however slim, for life. Failure, and, well. We might just as well call the undertaker and go home. 

Oh. Yeah. There was blood, bone, and brain all over the place. But she still had a heartbeat. 

“We fly,” he decided, as he looked at me and said, “and you’re bagging her all the way to the hospital.” 

My heart jumped. The prospect of flying in a helicopter, a new experience. “Sure,” I smiled, wiping away the sweat dripping into my eyes.

Bagging was made easier because the BVM was connected to the ET tube. We extracted from the ground ambulance, and with the assistance of big, burley firefighters, rolled the gurney to the idling helicopter, helmeted pilot still in his seat. We ducked beneath the blades, and steered clear of the tail rotor, just as instructed in training, ball caps removed and secured under the belt. The backboard slid between the clamshell doors. I entered the starboard side door, of a very small, cramped compartment. As the patient slid into place, I resumed respirations, knees sandwiching her ears, hunched over, head above her belly. The paramedic behind me monitored the EKG, drugs, and IV lines.

I couldn’t move, shift my weight, or adjust my position. Other than my hands squeezing the breath of life into our critical patient, I became one big cramp. If only I could have looked up or out a window.

The flight to Strong Memorial Hospital was all business. We landed with a thump. Only when the patient was slid from beneath me was I able to move, barely. Fortunately, plenty of hospital personnel took over and I was freed to work my aching muscles.

The broken woman delivered to trauma care remains nameless to this day. I don’t know if she lived or died. If she lived, God help her, for her broken body and bones, and lacerated brains, would need something more than the balm of Gilead.

The turn around was fast; much faster than I was used to on a ground ambulance. The roof top helicopter pad needed to be opened as soon as possible. “Let’s go,” the aeromedical paramedic said to me. Up and out we went.

He helped me strap in and dawn a flight helmet, complete with intercom. “Welcome to my bird,” the pilot said to me. “Time to go home.”

“Can you take me back to Palmyra?”

“No can do, buddy. Rules say I have to take the chopper back to base in Canandaigua. Don’t worry, we’ll get you home.”

“Okay, then,” I said, thinking to myself that my little joy ride just made a three hour ambulance call into a six.

“No worry,” the pilot replied. “Rules don’t say I can’t give you a guided tour back home.”

And so we went, flew up and straight south-east, out of the Rochester airspace. Over Mendon, not quite half way, the pilot began to dive and swoop, banking left and right, giving me a joy ride unlike the best rollercoaster anywhere. It was glorious! I laughed until I cried. The views were fantastic.

The pilot straightened up approaching the Canandaigua airport, set the skids down on a wagon slightly bigger than a Radio Flyer, shut down, and a John Deere lawn tractor towed us into the hanger. I wondered how that was done. Now, I knew!

The owner of Mercy Flight, Paul H., met me as I got out of the aircraft. He shook my hand and thanked me for the help. Hey, I was free labor; why wouldn’t he have a smile on his face? Paul was nice and offered me a ride home to Palmyra. “Sure,” I smiled. “Thank you.” We talked EMS and Mercy Flight all the way back.

I was dropped off at the fire station and everyone crowed around, welcoming me home. “How was it?” “Enjoy the ride?” “Did she make it?”

All the while Vince and Jean stood back, arms folded across the chest, waiting, quietly smiling. When the crowd thinned, then dispersed, Vince came over and said to me, “Good job, Todd. You did real good.”

That was all I needed to hear.

Thank you Lord, for great training and the support of a professional team, all volunteers. Thank you, for higher levels of care. Thank you, for Vince and Jean.