From the Back Cover
TRUE LIFE-AND-DEATH DRAMAIn taut, thrilling prose, Peter Canning has written a book that captures the rarely seen real world of emergency medicine. A seasoned paramedic who fights under enormous pressure to save lives, Canning trains new paramedics for the rigors of a nonstop, action-packed battle. From a four-month-old baby who has stopped breathing to a sixty-seven-year-old woman with a strange abdominal mass that threatens to explode -- these are gripping true stories from the "ER on the streets". In this exciting, often moving account, Canning tells a powerful story of camaraderie, selflessness, and courage as paramedics try to stand tall and human through both defeat and victory.
About the Author
Peter Canning is a full-time paramedic in Hartford, Connecticut. A former speechwriter to Governor Lowell Weicker of Connecticut and top health aide whose duties included overseeing the emergency medical services system, Canning left his desk job in 1991 to become a paramedic on the city streets, a story chronicled in his first book--Paramedic: On the Front Lines of Medicine. He is a graduate of the Iowa Writers Workshop.
Excerpt. © Reprinted by permission. All rights reserved.
Introduction
My name is Peter Canning. In Paramedic: On the Front Lines of Medicine I told how I left my job as an aide to the governor of Connecticut to become a paramedic on the city’s streets and how I struggled in my first year to prove myself worthy of the job. This book Rescue 471: A Paramedic’s Stories continues my story over the next three years as I battle with life and death, and mature into a seasoned medic, confident of my skills and abilities but smart enough to know there is always more to learn and overcome. I have just turned forty; my partner for much of the time period of the book, Arthur Gasparrini, is in his early fifties. While there are other medics of my age—and a few of Arthur’s—working in the city today, emergency medical services (EMS) is largely a young person’s field. The physical demands of the job aside, burnout is a common occupational hazard for paramedics, particuarly those in an urban setting, cutting short many promising careers. High call volume, continual exposure to death and serious injury, and the incredible abuse of the 911 system gradually wear at your sanity. These stresses and pressures of the job eventually caused me to come perilously close to losing my way. I almost forgot the most important of lessons: that the focus of your work is on your patient, the person that you are helping, and that you can’t let anything—stress, frustration, fatigue—come between you, your patient, and the very best care you can give, medical and emotional. This book tells how I battled burnout and found renewal in this work I love. Here are the sights, sounds, and emotions of the job: the flurry of action in critical moments and the hard loyalty of tested partners. While there is plenty of lights-and-sirens action, the job encompasses so much more. Here also is a view of children in peril, the aged facing death, troubled minds trying to cope with a difficult world, and the heroism of those who keep dreaming and loving in spite of the harshness of their world. These are my stories and theirs. They are all true. A few of the stories have been resequenced. Some names and details have been altered to protect confidentiality.
ARTHUR
Spending forty hours a week in an ambulance with the same person, month after month, year after year, is a lot like being married. Sometimes you get along great; other times you can’t stand each other. You are fiercely loyal in the big picture.
Kools
Our ambulance 471 is dispatched for a man not breathing. My partner, Arthur Gasparrini, races us through Hartford’s downtown business district. He brakes hard at Main and Church, as cars oblivious to our whirling lights and sirens continue through the intersection. Arthur slams the air horn, then hurtles us on north up Main Street, past decaying public housing, abandoned apartment buildings, and businesses with bars on their windows.
Ahead, by a Spanish supermarket, a man with wild matted hair runs out into the street and flags us down. “Four-seven-one arrival,” I tell the dispatcher.
When I step out I can smell the brakes smoking. I grab my equipment from the ambulance’s side door.
“Come quick,” the man says. “My buddy fell out.”
We follow him a short way down the street, then up a muddy embankment and around the side of a boarded-up apartment building.
A man is lying facedown in the weeds. We quickly roll him over. There is a vomit on his chin and the front of his shirt. His body is cool. I put my hand on his chest. A shudder, then no movement. I put my fingers on his neck. “He’s still got a pulse.” I look at his pupils.
“Pinpoint?” Arthur says.
I nod. Pinpoint. A likely heroin overdose.
Arthur gets out the ambu-bag and applies the plastic face mask to the man’s face. He squeezes the bag, forcing air through the mask into the man’s mouth and down into his lungs, breathing for him.
“He ain’t dead, is he?” The man who called us stands over my shoulder.
“Not yet. Is he your friend?” I ask.
“No, no, he’s just an acquaintance.”
The man has thick track marks on his arms, scarring from years of shooting up. “He did heroin today?” I ask.
“No, I mean maybe, yeah, yeah, he did. Like I said, he’s just an acquaintance.”
I find a small vein in his right arm and insert a catheter. Blood returns into the needle’s chamber. I attach a small rubber IV port to the back of the catheter.
“Is he going to be all right?”
With a syringe I draw two milligrams of Narcan out of a small vial. Narcan is an antiopiate that quickly reverses the effects of heroin. I inject the drug through the IV port. I’m worried we might be a little late with this guy.
“Any sign of breathing yet?” I ask. Thirty seconds have passed.
Arthur stops bagging. Still no movement. He resumes bagging. I’m starting to get a little anxious.
I draw up another two milligrams and give him the extra dose.
When another minute passes and still no effect, I say, “I’m going to tube him.”
“Do you want to wait a little more?”
“He looks pretty out.”
I am in charge on all our calls (as an EMT-Paramedic I am more highly trained than Arthur, who is an EMT-Intermediate), but I usually give weight to his suggestions. He has a good point about giving the Narcan more time to work, but I think this man may be too far gone, and I like to be aggressive when it comes to gaining a better airway for a patient.
I take my intubation kit out of the blue bag and switch places with Arthur so I can be at the head. Holding the laryngoscope in my left hand, I slide the steel blade into the man’s mouth, then I sweep the tongue out of the way and lift up. The small lightbulb on the end of the blade illuminates the throat. I see my target: the narrow opening between the white vocal cords that guard the entrance to the windpipe. If I miss, I end up in the stomach. I pass the tube through the cords. “I’m in.”
Arthur attaches the ambu-bag to the tube. With my stethoscope, I listen under each armpit, hearing lung sounds as Arthur squeezes the bag. Then I listen over the stomach. No sounds. Perfect. “Let’s get him out of here,” I say.
“We have a problem,” Arthur says.
“What?”
The man’s eyes are open.
“Whoa!” Before I can stop him, he grabs the tube.
“No, hold on!”
He yanks it out of his throat, sits bolt upright, and pukes over himself, then turns onto all four and pukes again. “Goddamn,” he moans.
I shake my head at Arthur’s grin.
The man looks around: at me, at Arthur, at the guy standing with us. “Fuck.”
“You okay?” his friend asks.
“No, I’m not okay.”
“I thought you was dead,” he says.
“Dead, bullshit, I ain’t dead. What’d you fucking do to me?” He gets shakily to his feet.
“I was trying to help your sorry ass.”
The man pats his shirt pocket, then pats it again harder and looks down to see it empty.
“Where’s my cigarettes? Who took my cigarettes? Shit. Did you take my cigarettes? Where’s my Kools?”
“Never mind your cigarettes,” I say. “You should come to the hospital with us.”
“I ain’t going nowhere.” He notices the IV plug in his arm.
He rips it out as I weakly say, “Don’t.”
“Fuck this shit.” He pats his pants pockets. “Where’s my money? You took my money? Somebody robbed me!”
“We didn’t take your money,” I say. “You weren’t breathing. You need to come to the hospital. What I gave you may wear off before the heroin leaves your system.”
“Heroin? I didn’t do any heroin. What are you talking about? I’m breathing fine. Did you jump me, motherfucker?”
“No, man, you just done fellout.”
“What’d you call the cops for?”
“We’re not cops.”
“You some kind of friend,” he says. “You some kind of friend calling the law. Fuck you, fuck all of you.” He scowls and walks away.
“You’re welcome,” Arthur says, as the man disappears behind the overgrown hedges.
“How’s that for thanks?” his friend says. “How’s that for thanks?”
We start gathering up our gear, the IV wrappers, intubation equipment.
The man lights a cigarette, still shaking his head.
I note the brand when he puts the pack back in his pocket. “Kools?” I say.
“I prefer Camels,” he says. “But Kools’ll do me.”
