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Wednesday, October 14, 2009

Without the Kiss

Yesterday morning, my wife and I were in a doctor's waiting room, watching "Good Morning, America." Dr. Sanjay Gupta, America's favorite Model-Minority Physician, was discussing the virtues of "compression-only CPR," and how it was carefully developed and greatly increases the chance of saving lives.

"Bullshit," I murmered in my wife's ear. "It increases the chances that people will actually perform CPR on some dirty hobo who collapses in front of them on the street, if they don't have to actually put their mouths on the stinking bastard."

That afternoon, after my wife went to work, I got a text message from her. It's very long, because we just got an unlimited texting plan, and she just got a brand-new phone with a QWERTY keyboard:

"You're right about comp. only CPR: they
developed it to increase the likelihood
someone will actually do it. Dr. Sanjay
Gupta admitted it on NPR. Love you!"

See? Sometimes there is even truth in my cold, cruel, cynical view on the world. Welcome to The Kiss of Life, without the Kiss.

Of course, I don't mind that they've developed a handy-dandy new way to do CPR, namely, with your handies, that's fine-- but I do have a problem with their couching it as a "better" or "more efficient" or "more lifesaving" way to do CPR. It isn't. One of the first things they taught us back in EMT school was that CPR has a less-than-2% success rate. 20 compressions to 2 breaths, 50 compressions to 2 breaths, 100 compressions to 2 breaths. 10 to 1. 12 to 2. Whatever-- it doesn't matter-- the guy's dead by the time you've started, and chances are he's going to stay dead.

And all you'll get is very fucking tired.

My CPR certification expires in two months. My EMT certification expires on October 1st, 2011. I suppose, soon, I'll have to start making decisions about whether or not I want to renew both, or just the CPR, or neither. I haven't tended to a patient in an ambulance or driven one since February of 2007. Yet, when my EMT certification was due to expire in 2008, I renewed it for three more years, taking a bunch of ridiculous online courses and practice quizzes. I know that, if I decide to renew my CPR certification, that they will have changed the procedures. They change them every two years which, coincidentally, is how often you're required to get re-certified in cardiopulmonary resuscitation.

Funny, that.

I have no doubt that, with the American Heart Association and the American Red Cross's PR blitz about compression-only CPR, they'll be pushing that hard during the 2009-2010 re-certs. And that's fine. I can remember getting certified in CPR for the first time in 2004 or 2005, I forget which. The instructor, a 6'3" red-faced, big-nosed, no-nonsense paramedic, said,

"Look, if you come up on some disgusting scumbag with a stoma spewing yellow shit all over the place, you're not going to put your fucking mouth on that, right? You're gonna do compression-only, because you'd be outta yer goddamn mind to kiss that foaming neck-pussy."

In my seventeen month career on the streets of Philadelphia, I never kissed any foaming neck-pussies, and I never performed CPR on anybody. Neither had my partner, who was a paramedic with many more years on the street than me. I found that out one day, when it was quiet in the ambulance, I turned to him and asked him if he ever had.

"No," he said, before very a-typically launching into a monologue, "but there was one time where I was real close. I had this patient, typical cardiac old lady, in the back of the truck and she was going to the hospital for chest pain, but she was talking to me, nothing weird going on on the moniter, and then she just looked at me, and I knew something was going to go wrong. Then, all of a sudden, she went stiff as a board on the stretcher and the cardiac monitor flat-lined, and I was like, oh, fuck, you know? Here we go. So I checked her pulse, nothing, then I straddled her, you know, I was down on my knees with one leg over top of her, I rolled up my fuckin' sleeves and, I swear to God, I was about to push down on her when her eyes popped open and she was fuckin' staring at me, on top of her with my sleeves up. And she goes, 'Is everything okay?' And I stared at her for a minute and I was like, 'Uh.. I think so. Is it?'"

Sometimes, during a particularly long transport, I would silently pray that my patient wouldn't code on me. I guess, I would have known what to do if it happened, but I was always panicked by the logistics of different things you had to do. Were you supposed to radio dispatch to report the code? Would they notify the ER for you? Were you supposed to call the ER? If you were on a Basic Life Support ambulance, staffed with two EMTs, were you supposed to call for an Advanced Life Support ambulance to meet up with you to provide higher intervention? I was never certain how many liters of oxygen you were supposed to give a patient through the bag-valve mask once compressions were begun. If you're on an Advanced Life Support ambulance, and you, the EMT, are in back with the patient who codes, should the paramedic driving pull over and jump in the back since he has the higher training and the goodie bag full of drugs? I just didn't know. And I had even read the employee handbook, cover-to-cover, confident that I was the only employee of our company ever so to do.

Early on in my career, I had a conversation with an elderly, black EMT nicknamed Strollin' Roland, for the lackadaisical manner in which he lumbered to and from his daily activities-- like a moose through Jell-o. He had a slow, melodic way of talking, and he spoke as if he were constantly on the verge of falling asleep midsentence.

"Have I evah been scared in this bizness? Yes, ah have... Have I evah had patients die on me? Yes, ah have... You get used to all that shit."

I got used to a lot of shit in that job-- incompetent supervisors, manic dispatchers, psychopathic partners, rude nurses, malingering patients-- but I don't know that patients dying under my care is something I could have gotten used to. I guess, of course, we'll never really know. Unless I do decide to renew that cert in 2011 and suit up in blue for one more round.

I'm thankful, though, that I got out of EMS before I ever had to do CPR on a patient, before having a patient die on my watch. I feel lucky, like the cop who retires with 25 years under his belt and never had to fire his gun. Maybe going back would be like tempting fate. Maybe the first call of the new chapter of my EMS career would be an unresponsive male or female or, God forbid, child. That is how God works, isn't it? That would show me I should have just let that cert go the way of an autumn leaf.

Then again, maybe it's just a rite-of-passage that I never got to experience, unlike all the rites I did go through: slamming an ambulance into our station's garage door frame on the first day at our new base, being part of a six-man crew called to lift and transport a 680 lb. patient, getting AIDS blood and pee on my uniform, having a nurse slip me her phone number, almost being killed by my partner with a clipboard, getting stranded in a broken-down truck in the middle of summer, having a 92-year-old nun scream "Heil, Hitler!" at me, complete with gestapo salute. But maybe, just maybe, you have to give CPR to a patient in order to be a lifer.

Me? I just left one cold day in February.

And, when I did, I bade my partner of a year-and-a-half a warm farewell before he unceremoniously patted me on the back, declared, "It's been a lot of fun, man," and walked to his car. I shook my supervisor's hand, and the hand of another paramedic who was in the office, and I walked to my car. And, in the parking lot, I stopped. I turned around, and walked back into the base. My supervisor was still having a conversation with the other paramedic. When they saw me, they stopped talking and they looked at me. I looked at them. Then, I grabbed my uniform shirt and pulled it way, way up, exposing my stomach and my nipples. I jumped up and down and screamed in a high-pitched voice, bugging my eyes out. I showed my supervisor my nipples, and then I turned to the other paramedic and showed him, too and, as they collapsed on the desk in front of them in hysterics, I ran out of the office, slamming the door behind me as I jumped into my car and skeedaddled out of the parking lot.

Well. No one ever said I didn't know how to make an exit.

And who knows? Maybe I'll return, and maybe I won't. One thing's for sure, though: whether I go back on the ambulance or not, I won't be putting my mouth on that foaming neck-pussy.


  1. yay!! omg I love this kind of stuff! Foaming neck pussy, Hitler spewing Nun!
    When I was a kid I got stuck on Emergency. Then it was St Elsewhere,then lastly E.R. So basically I have to wait every 10 yrs to watch medical drama! Boo.
    I think it would be cool to just keep having the certificate but thats just me.
    Thanks for the fix Mr Apron!

  2. I don't have the heart or the stomach for medical work. I don't even know CPR. It keeps me off of the hero list.


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