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 Dawn Ebersole, a new EMT at CRVA, a week later. 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 forms of lifting required on this job.” Randy was a weighted training mannequin most often used by fire departments. If he was 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, either.

“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 own weight on this job, no pun intended; he’d have no patience for someone who couldn’t and neither would any of the people he trained with. Dawn’s eyes widened as she swallowed and nodded.

He and Connie reviewed proper body mechanics before the test. Dawn needed a few pointers during the two stair chair repetitions, and a few more with the stretcher. Jeff warned her about the pins when lowering the stretcher; neither he nor Connie said anything about the graphite grease to Dawn. 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 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’ is Springfield Technical Community College.

“Any feedback from them about her?”

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

“Is she training with you? Is that why I’m being foisted off on Gene after today?” he asked.

“Yeah, she is.”

“You’re super thrilled, aren’t you?”

“Good partners can be 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 together 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 just violated a major 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 out both hands towards the radio as if to say “you see?” Gene laughed, picking up the microphone.

“Fifteen.”

“Fifteen, Western General Medical Center, fourth floor, patient Hamelin 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 gonna 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 an extra liter 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 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. Tonight would be a good night not to move Trudy more than you have to.”

“Okay, thanks. Frau Noke, I’m going to go 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 which was closing and lobbied the hospital to purchase it.

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

“Yeah. They took extra 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. They weighed her, then Jeff returned to her nurse and reported the after-treatment weight. Mrs. Noke asked to have the head of the stretcher lowered most of the way after they loaded her into the ambulance. Jeff backed into the Noke’s driveway twenty minutes later. The lights for the 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, then wheeled her up the ramp behind the house.

“Glad I convinced Paul this ramp was a good idea,” Mr. Noke commented as Jeff and Gene wheeled his wife to the slider off the deck. Paul was the Nokes’ oldest son, a builder. He’d brought a crew to his parents’ house during Mrs. Noke’s stay at the nursing home; they’d built the ramp in a week, having it ready well in advance of 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’d 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.

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. You boys have a good night.” Jeff and Gene wheeled the stretcher back out to the ambulance.

“Man, they’re like grandparents to all of us at CRVA.”

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

“Hey, Jeff! How was the night?” Connie Willis asked Jeff as 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 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 next week you can get back to what EMS really stands for: 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’d been working there, but she wasn’t going to win Employee of the Year, either. It was five minutes before their shift was scheduled to start. 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 she thinks you’re ‘yummy?’”

“Connie, I’m so tired I’m gonna throw up already. 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 more interested,” she crooned, batting her eyelashes.

“Or more turned off by her, 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 her, you know?”

“I’m telling you, Gene, I feel like I’m being watched while I’m at the apartment lately.”

“You’re just paranoid.”

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

“The one where they hit the personnel office?”

“Yep. Don’t repeat this Gene, but Bill Harris told me whoever broke into the office only opened the file drawer with the employee files in it; they didn’t touch anything else in the office but that filing cabinet. The folder with my file was the only one removed 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 the pair arrived at Riverside Hospital to pick up Mrs. Noke. The sixty-six year-old woman 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 to 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 three hours 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, as were most of the house lights, when Jeff backed into the driveway. Nr. Noke always turned them on before they returned his wife after dark. Jeff was getting a bad feeling.

“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. The Captain 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, sweaty, and his breathing was labored.

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

“Edgar!” Mrs. Noke said in a voice full of fear. “Mein geliebter Edgar!” Tears were already streaming down her face as she stood near her husband.

Edgar Noke’s pulse was rapid, irregular, thready. Jeff heard wetness in his breathing and felt the swelling in his ankles. Gene rushed back in with the two items Jeff requested. Without needing to be 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 asked. “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 the medication names and prescribed dosages for both 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.”

As 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 you 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. Let’s get moving.”

They lifted Mr. Noke onto the stretcher. Mrs. Noke clung to his hand. Jeff asked her to wait inside as they moved through the front door; they wouldn’t fit if she was still next to Mr. Noke. He placed her hand back in Mr. Noke’s to give her something to hold onto once they were outside.

Gene helped Frau 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 as 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.

He 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.

It was less than five minutes. 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. He was still having chest pain, but his color had improved with the oxygen. Mrs. Noke clung to her husband’s hand again as they all walked into the ER. They were directed to a room. A nurse neither Jeff nor Gene recognized entered to take their report, pulling the privacy curtain over the doorway. She looked bored.

Jeff began to give her a report as she pulled the oxygen mask off Mr. Noke. She seemed to ignore everyone in the room as she roughly pulled their patient’s shirt off. Jeff grew more annoyed with each passing second; he could tell Gene felt the same way. Mrs. Noke was also growing upset with how her husband of forty-six years was being treated.

“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.”

“Damn lazy ambulance drivers,” the woman muttered.

Storm clouds gathered over the heads of both Gene and Jeff; they both hated that term. 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-axe 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 also called my partner and I ‘lazy ambulance drivers’ because we didn’t start an IV or give nitro. As basic EMTs, we aren’t allowed to start IVs or give medications.”

“She didn’t say that, did she?” Sally asked in a pained voice as 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, pulling open the curtain. Mr. Noke was as pale as when they walked into his house; the man was keeping himself upright, holding onto the bed rails as 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 wedged a pillow behind Mr. Noke. The oxygen went back on next.