Backwoods E.R.

In these parts, you meet your neighbors one crisis at a time.

By Mike Perry

Published November 11, 1999 5:00PM (EST)

A while back in these parts, a man was accused of molesting a child. One day after he had been charged, he was sitting in his truck when he was approached by the child's mother. She asked him to extend his hand. He did, and she quoted him some scripture: "If thy hand offend thee, cut it off," she said. Then she reached into her purse, drew out a pistol and
blew a slug through his palm.

Several years later, I was at the wheel of the local ambulance, racing to a
hospital some 14 miles away. The man in back was having seizures, maybe a
heart attack. His wife was in the passenger seat beside me, clutching her
purse and a hefty, well-worn Bible. I was trying to focus on the road, and
she kept cursing and praying and pestering me to join in.

Back at the
house, she'd been hysterical, screaming and grabbing at her husband. One of
the emergency medical technicians had pulled her aside. If you can't contain yourself, you can't ride
with us, he'd said. It sounds cold, but it is dangerous and irresponsible to
let a frantic family member loose in a speeding ambulance. Now she
was getting agitated again. "Ma'am," I said sternly, over the siren, "you
promised. You have got to let me drive."

She composed herself, hugging her purse, knuckles white over her Bible. We
delivered her husband to the hospital and settled her in the waiting room.
On the way home, the assistant chief looked at me. "You know who that was,
don't you?" "No," I replied. "That's the vigilante woman, the one who shot
the guy in the hand. You know she never goes anywhere without her pistol in that purse."

I recalled the tone I had taken with her, and gave a little shudder.

Earlier this year, I was at my desk writing when the fire chief knocked at
my door: "You busy?" I asked what he needed. "Remember that guy you took care of last night?" I did. We had been called to an outlying tavern in the wee hours. A man had been making trouble in the bar, and when the police finally arrested him, he began complaining of chest pains. When I tried to take his vital signs and give him oxygen, he was cranky and recalcitrant, so I adopted my stern voice and lectured him into compliance.

The chief told me the man was holed up in a trailer with a shotgun
and a pistol, shooting at people. "The county SWAT team has got him
surrounded," said the chief. "They're gonna try to take him in about half
an hour. They want us to come stand by with the ambulance."

I recalled the tone I had taken with the man the night before, and reprised
the little shudder.

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From so-called "reality programming" to shows like "ER" and "Third Watch" and movies like "Bringing Out the Dead," big-city rescue services get most of the attention, and they earn it. Their call volume is far higher, their drama more sustained. But when it comes to surreal rescue, it's tough to beat rural service. For example, last winter a fisherman collapsed and died on the ice. He must have been catching fish pretty regular because when the ambulance crew arrived, another fisherman was standing over the body with his line down the hole previously manned by the deceased. Strange things happen in the city, but out here, deep in the trees or on a plain of white ice, the strangeness presents itself in tableau.

There is no ambulance in our town. Depending on the location of the telephone pole you clip with your pickup, or where you're standing when the big one hits, an ambulance will be dispatched from a town nine miles to the north or nine miles to the south of our little village. Some of us on the volunteer fire department are basic EMTs and first responders; we'll set out with a pack of rudimentary medical supplies and do our best to stabilize the situation until the ambulance or medical chopper arrives. Sometimes that means crawling into a tangled car in an attempt to keep an unconscious victim breathing. Sometimes it means simply holding the hand of a sickly grandmother or a suicidal farmer.

The business of "rescue" is often rough and impersonal -- you cannot put a tube down someone's throat and deliver a shock to his heart without engaging in a certain level of assault -- but out here, we often get to reassure someone we know, take time to tell them we'll call their brother, or aunt, or grandson.

- - - - - - - - - - - - - - - - - - - -

I became an EMT 12 years ago. I had just finished nursing school, and
thought working on the ambulance would be an exciting diversion. I took a
110-hour class through the technical school, passed the National Registry
exam and started pulling 48-hour weekend shifts for a private ambulance
service in a mid-sized city. We had a high call volume, and I got lots of
valuable experience. But when I moved back to my hometown in 1995, the
experiences became more personal. I found myself being reacquainted with
faces I hadn't seen for 12 years. When you serve as a rural EMT, you meet
your neighbors one crisis at a time.

It's a rare privilege, really, a way to thread yourself into the fabric of
a place. A few winters back, we were called out for a heart attack. When
my partner and I arrived, we found an old man, his body sunk in the snow.
He had been dead some time. There was nothing to do but wait for the
coroner, and so we stood there, scuffing our feet in the melting drifts,
recalling the man we now recognized from our childhood. "He used to feed me cranberry juice in the summer," said my partner. For my part, I remember him standing tall behind the wooden counter of the old general store, beside a large candy jar. He lay dead at our feet, but from the perspective of memory, he smiled above us.

We are by no means isolated. A major highway runs right past town. But
our coverage area is large, and extends well out into forest and marshland.
Our clients are a mix of townies, farmers, upper-crusters who own lake
property and a wide range of trailered recluses. Other areas are far more
remote, but we have our pockets of darkness, and we're often the first to
discover them.

On a night when it is 20 below and our breath freezes on our beards, I
follow our fire chief into a skeletal, slouching farmhouse. The fire we'd been called for has been extinguished, but the air inside the house is toxic with
the odor of scorched carpet and raw fuel oil. A black dog woofs
thunderously from beside a greasy couch. A young woman is cradling a baby. The baby's lips and nose are soot-stained. A crooked length of copper
tubing snakes over the slanted floor to a small heater the husband has
rigged. He is tattooed and wiry, and has a burn across his forearm. Like
his baby, his face is soot-stained, and he has a hacking cough. The only
light in the room radiates from a garish aquarium and a huge console TV.

We take the family to the rescue van, give the baby and father oxygen and wait for the ambulance. The father worries about what our help is going to
cost. (His concerns are not uncommon. When one of our crews arrived at the cabin of an Illinois tourist recently, his wife met them at the door with a
handful of plastic. "What credit cards do you accept?" she asked. When the
crew told her pre-payment wasn't necessary, she was flabbergasted. "Where
we're from, you have to pay before they'll take you.")

A practical note: When we respond on behalf of our fire department, there is no direct charge to the patient -- the charges are paid by the townships we serve. The ambulance service bills patients directly, but since many of our patients are covered by Medicaid or Medicare, the service receives only partial payments. Most of the remaining costs are subsidized by the townships, but the service "eats" a number of delinquent accounts every year. The bottom line is, if you call the ambulance, it will come, and you will receive care regardless of your ability to pay.

I warm a stethoscope and listen to the baby's lungs. I hear the air go in and out, and I wonder what this little life will come to. Back in the lopsided house, the aquarium is bubbling, and Jay Leno is giggling with a starlet.

I keep using the nominative I, but only because I am telling the story.
The story is not mine. The place is not mine. Our roles -- those of the rescuers and the rescued -- are not clearly defined. Out here, rescue is less about throwing ropes or stanching blood than assuming a role in a quirky narrative that weaves itself without seams, until one day you look back and it has become history.

Every two years my fellow EMTs and I take a 30-hour refresher course and complete an additional 48 hours of continuing education classes on our own. We are trained, and retrained. But we are never completely prepared.

A man is having a heart attack in the middle of nowhere. When we finally
locate the patient, deep within the stygian woods, he is standing staggered
in the snow, leaning against a tractor, surrounded by a leery knot of men
who reek of bacon grease and banjos. One of the men detaches from the
group, puts his rawhide face in mine and, in a boozy, baccy-stained gust,
announces, "He coded three times. I did mouth-to-mouth."

It's a little
strange, out here in the moonless boonies and snot-freezing blackness at the
tail end of some logging trail, to be informed by an alcoholic apparition in
stained coveralls that someone has "coded." Later I will decide that he
picked up the term from TV, and that after a long day of whiskey-stoked ice
fishing, his buddy hadn't coded, but simply passed out. I don't doubt for a
moment, however, that he revived whenever Dr. Deliverance laid on the
lip-lock. The very thought tightens my spine.

We'd been led here from the county road by two guys in a car who signaled our rescue van with their flashers, then we'd careened down a snaky dirt trail paved with nothing but snowpack. We were already 12 miles from town when they led us off the paved road, farther and farther into the forest until the road petered out and we were fishtailing up this twin-track logging trail.
We kept radioing directions to the ambulance -- still several minutes out --
right until the logging trail opened into a clearing and our headlights
illumed the banjo boys.

The patient is big and bearded. I try to give him oxygen, but he isn't
having it. He acts woozy, but his eyes are fierce. When the ambulance
struggles into the clearing, I give a report to the lead EMT, explaining that
the patient had reportedly experienced cardiac arrest, whereupon one of the
coverall contingent, hearing the word "arrest," rushes me and threatens to
knock my teeth in if I take his friend to jail. The other men form a
protective circle around the patient while I commence a rather hurried
review of medical terminology.

Apparently my explanation penetrates the ethanol fog and paranoia and is deemed satisfactory, as the patient is released back into our care, although not until he has whispered into the ear of his chief defender, who then clasps him by the head, looks deep into his eyes and says, rather mysteriously, "I promise, man, I promise."

Once on the cot, the patient commences to thrashing and cursing and tearing
his shirt to reveal slack tattoos of an unprofessional sort. The trip back
to the county road is a trial and a test of our goodwill, although the
patient's determined efforts to wrassle provide us the opportunity to
surreptitiously pat him down for weapons. When we finally emerge from the trees and reach blacktop, we transfer him to a waiting chopper and
gratefully release him to the sky.

Mike Perry

Mike Perry is a registered nurse who has written for Esquire, Newsweek and the New York Times Magazine. He lives in Wisconsin.

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