Chapter 28: Agents of Change

15 September 1992 – Avocado Street, Springfield, Massachusetts

“So this is a simple lifting test with the stair chair,” Connie explained to a new EMT a week later.

Dawn Ebersole was new to CRVA. Jeff wasn’t quite sure what to make of her yet; he only met her five minutes ago.

“We’ll run through this twice: once with Jeff as your partner, once with me. Rescue Randy here weighs one hundred fifty pounds. We’ll use him again when we evaluate your mechanics while lifting the stretcher and doing other forms of lifting required on this job.”

Randy was a weighted training mannequin most commonly used by fire departments. If dropped, he wouldn’t complain much.

“Jeff looks like he could lift Randy all by himself,” the new girl said while giving him an appraising look.

Jeff wasn’t sure he liked the look she gave him. “Maybe so, but this is a team sport,” he reminded her in a stern voice. “You could seriously injure your partner or your patient if you don’t, or can’t, do this right. I want to be able to pick up my kids later in life and maybe sit down for longer than five minutes, too.”

Everyone else he worked with proved to him long ago that they could pull their weight on this job, no pun intended. He’d have no patience for someone who couldn’t, and neither would any of the people who trained him. Dawn’s eyes widened before she swallowed and nodded.

Jeff and Connie reviewed proper body mechanics before the test. Dawn needed a few pointers during the two stair chair repetitions, and she needed more help with the stretcher. Neither he nor Connie said anything about the graphite grease on parts of the stretcher to Dawn. It was something for rookies to learn on their own. After testing her on fore-and-aft lifts, which she needed more work on, they sent Dawn off to the office to finish her new hire paperwork.

“I don’t know about this one,” Connie said to Jeff in a low voice once they were alone.

“Yeah, I’m not sure about the vibe I get from her, either. Where’d she take her EMT class?”

“The vibe, or the fact that she looked at you like a starving woman staring at a medium-rare steak? Anyway, she took her class at Stick during the spring semester.” ‘Stick’ was Springfield Technical Community College.

“Any feedback from them about her?”

“The usual,” which meant they’d heard nothing. Dawn owned an EMT card and a pulse, end of story.

“Is she training with you? Is that why you’re foisting me off on Gene after today?” he asked.

“Yeah, she is.”

“You’re super thrilled, aren’t you?”

“Good partners are hard to come by, Jeff. I trust you’ll have my back when we go somewhere. Regardless of the call, your situational awareness is outstanding, and your skills are top-notch. She’ll have to prove all of that to me, and quickly.”

“I don’t know what they were thinking when they let us work together.”

“I can’t imagine why they would concentrate all of this awesomeness in one truck, either, Gene,” Jeff replied.

“What’s the worst that could happen?”

“Dude, are you high? Why don’t you just say the ’Q’ word? Damn, I thought we were friends?”

Gene had just violated a primary EMS rule: don’t poke the bear. His asking, “what’s the worst that could happen” did just that. Jeff’s reply highlighted another EMS superstition: unimaginable horrors would befall any EMS provider who dared utter the dreaded “Q” word – quiet.

“Ambulance Fifteen?” crackled the radio.

Jeff looked at Gene, holding both hands towards the radio to say, “you see?”

Gene laughed and picked up the microphone. “Fifteen.”

“Fifteen, Western General Medical Center, fourth floor, patient Hamelin is returning to the River House. Requesting a 1330 pickup. Bring in your oxygen.”

“Fifteen received.”

“The River House? The River House? See what you did? You know I hate that place, Gene. It’s going to take me a week to get that smell out of my nose.”

“Oh, suck it up, would you?”

“Guten Abend, Frau Noke.”

“Hi, Jeff.” Trudy Noke responded in a weary voice. She also answered in English, which was unusual.

“Are you okay, Ma’am?”

“We took extra off her tonight,” explained the dialysis nurse.

Jeff nodded. Dialysis was hard on a person. Taking more water weight off of Mrs. Noke than normal always seemed to increase her post-treatment fatigue.

“Is the new scale ready, or do you need us to use the regular scale?”

“Facilities finished the new scale today. So tonight would be a good night not to move Trudy more than you have to.”

“Okay, thanks. Frau Noke, I will weigh the stretcher instead of this wheelchair, and I’ll be back. Gene will be over in a moment.”

Mrs. Noke nodded with her eyes closed. Jeff put the wheelchair away, then maneuvered his empty stretcher over to the industrial-sized scale the dialysis unit installed to accommodate stretcher patients. The manager had found it at a local shipping business that was closing and lobbied for the hospital to purchase it.

“They’ve got it working?” asked Gene from behind Jeff.

“Yeah. The staff took some extra weight off Mrs. Noke today, so weighing her while on the stretcher will be a big help.”

Jeff and Gene moved Mrs. Noke onto the stretcher with the utmost care. First, they weighed her, and then Jeff returned to her nurse and reported the after-treatment weight. Mrs. Noke asked to have the stretcher’s head lowered most of the way after Gene and Jeff loaded her into the ambulance. Jeff backed into the Noke’s driveway twenty minutes later. The lights for their back deck snapped on at the sound of the backup alarm.

“She slept the whole way here,” Gene reported when he stepped out of the ambulance. The two EMTs unloaded their patient from the truck without jostling her. They then wheeled her up the ramp behind her house.

“Glad I convinced Paul this ramp was a good idea,” Mr. Noke commented when Jeff and Gene wheeled his wife to the slider off the deck.

Paul was the Nokes’ oldest son, a builder, and brought a crew to his parents’ house during Mrs. Noke’s stay at the nursing home. They built the ramp in a week, having it ready well before Mrs. Noke’s return.

“Liebchen, are you okay?” Mr. Noke asked, stroking her hair.

“Ja, Edgar. I’m just tired. Boys, would you put me in my chair in the living room?” They did as she asked.

“Is that okay, Ma’am?” Gene asked once she was in her favorite chair. She nodded. “Jeff and I will see you Saturday night. You take care.”

“Thank you, Eugen,” Mrs. Noke replied.

Mrs. Noke pronounced ‘Eugen,’ ‘OY-ghen.’ Mr. Noke walked them out to the deck.

“Thanks for taking care of my Trudy tonight, boys.”

“Of course, Sir. Will she be alright?”

“Don’t worry too much, Jeff. She’ll bounce back after an hour or two.”

“We’re glad to hear that, Sir. She’s just about everyone’s favorite patient at CRVA.”

“We know, Jeff,” Mr. Noke smiled. “We’re lucky to have people like you two, and the rest at your company, taking such good care of her. So you boys have a good night.”

Jeff and Gene wheeled the stretcher back out to the ambulance. “Man, they’ve become like grandparents to everyone at CRVA.”

“That they have, Gene. Let’s hope they’ll be around a long time.”

“Hey, Jeff! How was the night?” Connie Willis asked Jeff when he emerged from the bunk room at CRVA.

Jeff cast her a dark look. “It sucked, thanks.”

He and Neil were coming off an overnight shift. They’d worked the only ambulance staffed at the basic life support level at CRVA overnight.

“Every time we laid down, the radio seemed to go off. Dastardly Dave had a horrible night, too.”

Dave Amorosino was the overnight dispatcher at CRVA. If they’d been busy, he’d been more so.

“That good, huh?”

“We went to the River House three times, Connie.” Jeff saw a faint smile on Connie’s face. She knew how much he hated that place.

“Well, hopefully, you can get back to what EMS actually stands for next week: Earn Money Sleeping.”

Jeff grunted his agreement. “Where’s your partner? Checking the truck?”

“She’d have to be here, first.”

Connie’s voice conveyed her annoyance with Dawn Ebersole. The woman managed not to get fired in the two months she worked there, but Dawn wasn’t going to win Employee of the Year, either. It was five minutes before the scheduled start of their shift. Even though you couldn’t punch in until your start time, the company custom was to be on-site fifteen minutes early.

“By the way, have I told you Dawn thinks you’re ‘yummy?’”

“Connie, I’m already so tired I’m going to throw up. Don’t help.” Connie teased Jeff about her partner’s infatuation with him every chance she got. She knew Jeff didn’t feel the same way.

“But if you spent time with her, Jeff, you’d feel the same way,” she crooned, batting her eyelashes.

“The same way I do now, you mean?” Whenever Jeff was around Dawn, she managed to open her mouth and say something that turned him off just a little more.

“Don’t worry; I’ll protect you. I’m taking one for the team working with Dawn, you know?”

“I’m telling you, Gene, lately I feel like someone’s watching me while I’m at the apartment.”

“You’re just paranoid.”

“That doesn’t mean someone’s not out to get me. You remember the break-in at the office two weeks ago?”

“The one where they hit the personnel office?”

“Yep. Gene, please don’t repeat this, but Bill Harris told me whoever broke into the office only opened the file drawer holding the employee files. They didn’t touch anything else in the office but that filing cabinet. The thieves only removed my file from the drawer. Nothing was missing from the file, but things were out of order.”

“Okay, that’s a little creepy.”

“You think?”

“Keep your head on a swivel, Jeff.”

The concerned conversation ended when they arrived at Riverside Hospital. Mrs. Noke greeted them with a wide smile.

“Guten Abend, boys!”

“Hi, Mrs. Noke,” Gene replied. “You’re looking ready to run the Boston Marathon tonight! Did they not have to take too much off you today?”

“No, not too much today, Eugen.”

Mrs. Noke hopped up and walked over to the scale under her own power. If they could have gotten away with it, Jeff and Gene would have let Mrs. Noke ride in the front seat of the ambulance rather than strapped to the stretcher in the back.

“Now, Mrs. Noke, you let us help you to the door. There could be some ice we don’t see in this darkness,” Gene admonished her when they arrived at her house. It was almost six at night in early December. Sunset was nearly an hour ago. “Don’t you be jackrabbiting on us!”

“I’ll behave, Eugen,” she promised him with a pat on his hand.

The front porch lights were off when Jeff backed into the driveway, as were most house lights. Nr. Noke always turned them on before the ambulance crew returned his wife, if it was after dark. A bad feeling washed over Jeff.

“Frau Noke, was Mr. Noke going anywhere this evening?” Jeff asked when he opened the back doors of the ambulance.

“Nein, Gottfried. Was ist los?”

“Your porch lights are off. Mr. Noke probably just forgot to turn them on. I’ll grab one of our flashlights.” Jeff and Gene wheeled Mrs. Noke to the front door on the stretcher. They helped her to her feet and turned to open the door.

It was locked. Jeff’s feeling of dread grew.

“Do you have your keys, Ma’am?” She handed them to Jeff with a look of concern on her face. Jeff opened the door and turned on the lights to the living room.

Edgar Noke sat in his recliner, bolt upright. He was pale and sweaty, and his breathing was labored.

“Gene! Oxygen and jump kit!” Jeff called while he knelt next to the man. Gene dashed away to retrieve those items.

“Edgar!” Mrs. Noke gasped in a voice full of fear. “Mein geliebter Edgar!” Tears already streamed down her face.

Edgar Noke’s pulse was rapid, irregular, thready. Jeff heard wetness in his breathing. Gene rushed back in with the two items Jeff requested. Without being told, he placed a non-rebreather mask on Mr. Noke, giving him one hundred percent oxygen.

“Captain, are you having any pain?” Mr. Noke nodded, pointing to his chest.

“Mrs. Noke?” Gene called. “Mrs. Noke?” She looked over at him. “Does Edgar take any medications?”

“Medications?” she repeated, dazed.

“Yes, Ma’am.” She nodded. “Could you show me where they are, please?”

She led Gene into the kitchen and opened a cabinet. Inside were pill bottles for both; more importantly, there were pre-typed lists of medication names and prescribed dosages for Edgar and Trudy. On the list for Edgar was the other information Gene needed: NKDA. Edgar had no known drug allergies.

Back in the living room, Jeff raised the portable radio.

“Fifteen to dispatch, any ALS available for this address? A seventy-six-year-old male with chest pain, rales, and pedal edema.”

“Fifteen, Twenty-one is tied up. I’ll check with Western General’s medics.”

When Gene turned back to the living room in the kitchen, he spotted the Nokes’ small personal phone book.

“Ma’am, we’ll bring this with us so you can call family.” Mrs. Noke nodded.

“We’re ready to put him on the stretcher, Gene,” Jeff reported when they returned. “Twenty-one’s unavailable. Dispatch is checking on Western’s medics.”

Gene snorted. “We can be at Riverside before they even cross the bridge. So let’s get moving.”

They lifted Mr. Noke onto the stretcher. Mrs. Noke clung to his hand. Jeff asked her to wait inside while they passed through the front door; they wouldn’t fit if Mrs. Noke still held Mr. Noke’s hand. Jeff placed her hand back in Mr. Noke’s to give her something to hold onto once outside. Gene helped Mrs. Noke into the front passenger seat when they reached the truck, then helped Jeff load Mr. Noke. Jeff connected his patient to the truck’s oxygen tank once inside. Gene closed the doors behind them. Mr. Noke grabbed Jeff’s hand when they rolled out of the driveway, lights spinning.

“Take care of my Trudy, Jeff,” Mr. Noke gasped.

“You’re going to be around for many more years, Captain,” Jeff assured the man.

Jeff rechecked Mr. Noke’s vital signs before picking up the radio to call the hospital. Jeff gave a short, curt report and hung up the microphone.

“We’ll be at the hospital in about five minutes, Sir.” Mr. Noke nodded.

Three minutes later, Gene backed the ambulance into the ER at Riverside Hospital. He helped Mrs. Noke to the back of the truck, then helped Jeff unload her husband. Mr. Noke still had chest pain, but his color had improved with the oxygen. Mrs. Noke clung to her husband’s hand as they walked into the ER. Staff directed the new arrivals to a room. Neither Jeff nor Gene recognized the nurse who entered to take their report and pulled the privacy curtain over the doorway. She looked bored.

Jeff tried to give her a report while she pulled the oxygen mask off Mr. Noke. She ignored everyone in the room as she roughly pulled Mr. Noke’s shirt off. Jeff grew more annoyed with each passing second. He could tell Gene felt the same way. Mrs. Noke was upset with the treatment of her husband of forty-six years.

“Where’s the IV?” the nurse snapped, interrupting the report she was ignoring. Mr. Noke looked like he was having more distress again.

“We’re a basic life support ambulance,” Jeff informed her. “BLS isn’t allowed to start IVs.”

“Did he get any nitro, then?”

“BLS isn’t allowed to administer medications, either.”

“Damn lazy ambulance drivers,” the woman muttered.

Storm clouds gathered over the heads of both Gene and Jeff; they both hated that term. Finally, Jeff stopped giving his report, stepped out of the room, and looked around. He recognized a few other nurses at the desk and walked over.

“Sally, would you mind coming over to Room Six before Nurse Ratched kills my patient?”

The woman looked up. She didn’t remember the name of the EMT who made the request, but she recognized him. He was a competent provider who’d always given her good reports that matched his patient’s condition.

“Is something wrong?”

“The battle-ax in there just pulled a non-rebreather off a diaphoretic chest pain patient with shortness of breath, audible rales, and pedal edema – without listening to my report or getting any vitals. She then proceeded to manhandle him while trying to undress him. She then called my partner and me ‘damn lazy ambulance drivers’ because we didn’t start an IV or give nitro. But, of course, as basic EMTs, we aren’t allowed to start IVs or give medications.”

“Shit, she didn’t say that, did she?” Sally asked in a pained voice while she rose. The other four nurses rose as well. There were very few things that could piss off an EMT so quick as calling them an ‘ambulance driver.’

“She most certainly did.”

“Great. Come on, ladies.”

“I’ll get Dr. Caswell,” one of her colleagues said as she headed in the other direction.

Jeff, Sally, and the three other nurses hustled back to Room Six and pulled open the curtain. Mr. Noke was as pale as when they walked into his house. He man-handled himself upright, holding onto the bed rails while the rude nurse tried to make him lie down. Sally stepped over and pulled the back of the hospital stretcher as far upright as she could. She then wedged a pillow behind Mr. Noke. The oxygen went back on next.