In Arlington Cemetery

This summer we held a memorial for my grandfather in Arlington Cemetery. His name will be on one of the niches in the columbarium. He was in the Navy and served in the Korean War. The service was short and concise. I think its precision and simplicity was well suited to my grandfather who was a high school and college math professor and liked things to be just right but not conspicuous. The chaplain was empathetic and caring and the soldiers who performed the flag ceremony were on point. As we said our formal goodbyes a trumpet’s song floated in the air above us.

My grandmother used to comment how they enjoyed when I visited because I’d sit all day and laugh as my grandfather told stories. He was a particularly gift storyteller with the dry wit that ignites my science-loving and logic-focused brain. He told stories of the Navy (usually when he and his comrades were causing trouble), his struggles as a student (he went for a doctorate in math but didn’t finish his thesis because of a disagreement with faculty), or his adventures as a teacher (he had many years of teaching from which to draw).

In EMT lingo, my grandfather had an “extensive cardiac history.” When I called my grandmother after hearing of my grandfather’s passing she told me, “The EMTs who responded to my call were wonderful. You do good work.” She said that even though they couldn’t get him back. His heart had stopped and he had no cat-lives left. When my grandfather died, I’d been volunteering as an EMT for several months.

I’m still and EMT and I also work in an emergency department. An interesting thing about providing emergency medical care is that your mission is to lessen pain and ward off death, but you end up seeing a lot of both. You end up being there when medicine meets it limits and the time of death is pronounced. I sometimes wonder what the EMTs at my grandfather’s death thought. I wonder how they ran their emergency call. What did they do to make my grandmother feel like they’d done the right thing? I hope the families of my patients have the same impression when we determine it’s time to stop CPR.

I used to visit Arlington National Cemetery periodically when I lived in DC. I like cemeteries because I enjoy walking the tombs and imagining the histories of the people they memorialize. Now when I visit Arlington, I won’t have to invent my grandfather’s story because I know it. I’m a product of it. I think of him often, partly because I wish he’d send me some of his math-genius as I continue my medical studies. Mostly, I think of him because he is one of the few people I know who successfully and completely built a life he loved. His only unfinished business is the family he left, especially his wife, but we’ll join him again one day if afterlife exists. Until then, we’ll keep making stories worth telling just as he always encouraged us to do.

Photo Credit: Mary Lou (family friend)

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Night Shift

A few months ago, I started working the night shift in an emergency department (ED). Those who have known me awhile were surprised that I decided to work owl hours. When no other forces are at play, I happily get up at 5 a.m., even 4:30. Until I took the ED job, I got up early to study or run before going to work. In college, I worked the opening shift at Starbucks. In high school, I got up to work out or study before my sibling hooligans stirred. I love the stillness of dawn before most people rise. Growing up, I saw deer, foxes, and herons in the gray hours of misty summer mornings. I like the dampness of dew on the grass before it’s evaporated by the sun. I enjoy watching the sun creep over the horizon as I listen to the bird songs crescendo.

I wasn’t particularly surprised I started working the night shift. I’d suspected it’d come to that a few years ago, when I was still in Paraguay. I remember thinking about my return to the US, and my terrible tendency to lay my paper planner out in front of me and plot how to fill the blank spaces. I remember thinking, “Going into healthcare is very dangerous for someone like you. It’s a 24-hour business. Make sure you block out time to sleep or you just might not get enough rest.”

The night shift was the most practical choice when I started my ED job. The wage is higher and it leaves the day for studying or errands. Flipping my sleeping schedule was no light matter, however, especially because I started going to bed an hour before I used to get up. It’s also been a challenge finding a new eating schedule that works for me–I now eat meals at completely different times than before I worked nights.

There’s a strange stillness in the ED when the early hours of the morning approach – 1 a.m., 2 a.m., 3 a.m.. Even when a very sick person arrives who requires many hands to care for them, the ED is strangely quiet in the morning. Many patients are sleeping or too sleepy to chat with their family members anymore. The patients staying with us until a bed opens in a facility that can help them heal their mental health challenges are usually sleeping or partaking in quiet activities. Sometimes a drunk patient arrives and disrupts the silence, but often they too fall quiet as the morning creeps onward.

Now instead of waking to stillness, I head to bed in its midst. As I drive home from the hospital, the birds are just starting to sing, but the sun’s rays aren’t yet seeping into the sky. The roads are empty save for a few souls coming home from a party or, perhaps, going to work. I arrive at a silent house, those there are sleeping. Not even the dog, when he’s visiting from my parent’s home, greets me when I open the door.

When I first started working nights, I was always tired. But, now that I’m used to it, I’m no more tired than I would be after any long day at work. There’s something about the night shift that keeps you coming back. Perhaps it’s because I like quiet, or perhaps it’s because I like the self-efficiency that’s required when you’re providing quality health care without all the resources of regular business hours that excites me. More likely, it’s that the people who work the dark hours are different than those who work when the majority of society is awake. Many of us won’t work nights forever, but we have some reason to do so now. It’s the fact that we have a reason to be nocturnal, I think, that creates a sense of comradery that’s different from any dayshift vibe I’ve known.

The Do-Good High

Did I tell you I’m an EMT? I’ve been running for about 5 months. Long enough to have learned a thing, maybe two. Let me tell you about the do-good high.

There’s a certain kind of person who becomes an EMT and sticks with it. Hint: It has nothing to do with your age, background, or future.

It boils down to what I call the “do-good high.”

There are EMTs who want patient experience so they can then become nurses and doctors. There are others who like sirens and driving large vehicles with lights. Many EMTs want to give back to the community. Others like the satisfaction of saving lives. Whatever the reason, the thing that makes all EMTs the same is that they get a thrill from doing good.

Whether it’s helping a little old lady after she’s fallen or bringing a person back from the dead through CPR, the folks who stay in emergency medicine are there because they’ve caught the do-good bug. When the alarms go off at 3 a.m., waking you from a dead sleep, and the dispatcher comes over the speaker: “56-year-old male, vomiting and diarrhea…”† I think a normal person would choose to go back to sleep. Not an EMT.

The EMT answers the call. Why? Partly it’s our duty to put on our uniform and leave the station as fast as we can, but there’s also something beyond obligation that makes us go. Even in the grossest of circumstances, like when we pick up that vomiting and pooping man and sit with him during the 30-minute ride to the hospital, we helped turn a bad night for him into a slightly better night.

The feeling you have sitting in the back of an ambulance as the sirens holler and you hustle to your patient is something like that of standing on the start line of a giant race. Your heart goes just a tad bit faster and your mind zips through the possible scenarios that could unfold once you arrive at the scene. Then you reach your patient and a calm descends upon you. There’s a human in distress and what’s ailing them is your puzzle to solve. You might be the one who saves their life. But even if you aren’t called upon to be a hero, you can ease their distress by helping them breathe or reassuring them as you go to the hospital. Seeing your patient’s face relax or their color return after you help elicits an adrenaline rush that starts in your center and spreads out to every corner of your body. It’s a high like that from scoring the winning goal or beating a chess genius at their own game, but it’s better because it lingers. This rush and joy that rapidly overtake you after helping a patient is the “do-good high.” All EMTs get it. It’s what keeps us coming back.

 

†Fictional dispatch that captures the essence of a typical call. HIPAA and other privacy measure prohibit sharing patient information.