I/III
Rianna Starheim
I.
A friend asked a question that surprised me: have I seen anyone die? The answer seemed obvious—it’s emergency medicine. But he asked nervously, like he maybe didn't truly want to know. So I guarded my answer, said yes, I've seen a couple people die.
When I started paramedic school, people told me that the patients would blur. I thought: never—every patient is a human. Then the patients began to blur, into a long line of fuzzy red-and-white ambulance lights, soundtrack of a siren, interrupted occasionally by clear memory: the drowned toddler curled in a tiny ball on the cot; the CPR with two small children; the unresponsive rape victim covered in feces, found on the side of the road. That first corpse I put in a body bag, who that morning had no idea the day would be his end. Which is why he had a new pack of rubber bands in his pocket.
During one sixteen-hour emergency room shift, around 4 AM during a lull, my preceptor Noel stood in Room 12 with a urine sample in his hand, telling me that I shouldn't become a paramedic. Burnout is incredible, he said, he was a medic and it gave him forever PTSD. Now he’s in debt, kids, bills—don’t do it, Noel said. I was so tired that I just stood there nodding, leaning as much as I could on the hospital bed half wishing I was in it, feeling many layers between what Noel was saying and the urine sample he was twisting in his hands and myself and the rest of the world.
Do any of the dead patients haunt me, my friend wanted to know. Haunt? Of course they don't haunt me. It's like asking if numbers haunt accountants, or students teachers, or for fisherman, the sea. Bodies the coroner. I left my apartment at 4:30 one morning for a shift, returned after 9 PM then doubled over in the kitchen, grasping the fridge handle then sitting on the kitchen floor, too exhausted to cry. It was difficult to eat dinner because there was not enough air to breathe. It's certainly not patients—they save me—but I like that story more than my own demons. So yes, as it would be for any accountant who loved her numbers, teacher her pupils, fisherman the sea. Haunt? Rarely. Now and then. Yes, yes they do. Sure. Like teachers scare their pupils. Like fisherman haunt the sea.
III.
The charge nurse had a nosebleed. We were just finishing a Code Neuro patient for air transport when the fire department medics called in a Code STEMI, a heart attack. Then Code Rapid Response came over the intercom, which means the Emergency Room becomes the hospital's internal first responders. "NOT IT!" everyone shouted.
The charge nurse—nose bleeding down her face—locked eyes with me and said "You. Us. Now." We grabbed a stretcher and LifePak and sprinted to the outpatient unit, gasping for air, to a patient who didn't understand what all the fuss was about—couldn't we see he was fine? He was calm but his heart wasn't, at almost 250 beats per minute with a systolic blood pressure in the 50s. The charge nurse's nose kept bleeding as we sprinted him back to the ER, hooked up defibrillation/cardioversion pads, rapid-pushed 6 mg adenosine—a chemical defibrillator—which stopped his heart. Five seconds, 10, 11, 12—now my heart was stopped, too—15 seconds asystole, 25. Then it started again, at 103 beats per minute. Good. I burst into the room of a woman with vaginal bleeding to do her IV, all energy and smiles before catching myself—I HAVE to stop being so cheerful in the ER.
But she smiled. "Your joy is infectious," she said. "I was having the worst day but just looking at you it's okay." I grinned at her. "Me too," I said. Code Surge—too many patients for the hospital, dozens not even yet triaged, patients lining the halls. A drunk nurse was sent home. With a boy who makes minimum wage to transport bodies, dead and alive, I took a ten-week gestation fetus to the morgue. It looked strange there, little fetus in a urine cup in a red-striped biohazard bag. Bright and small against the row of white body bags. A teenage fentanyl overdose patient was also airlifted. After his hollow-eyed parents left, I took a deep breath moment to take in the opioid crisis’ most granular scale: his empty code room by dawn. Off to another heart attack, grab vitals on a suicide attempt patient who looks like me. The charge nurse's nose kept bleeding—infection everywhere—infectious energy—drunk nurse and patients sent home—patient/provider—us/them.
I gulped some coffee. I love this. It's all just a we.
Rianna Starheim writes about human rights and wrongs, fire, war, PTSD, and resilience. She is a paramedic in Virginia.