Peter Canning

Arthur Gasparrini, my old partner from over twenty years ago, passed away this week at the age of 80. I'd lost touch with many years ago, only occasionally hearing updates. About ten years ago, I'd heard he'd had a stroke and was living in Florida. The obituary said he was living in Indiana. He was a good partner and good man. I hope the final years of his life were good ones.

 

In 2000, Ballantine published my second book, Rescue 471: A Paramedic's Stories. Arthur was my partner then, and he pretty much the stole the show. All anyone who read my book wanted to know was how Arthur was doing and if I had any more stories about him. And of course, I did.

Below is an excerpt from the book, from an early chapter titled appropriately enough, Arthur.

 

***********

 

Arthur is a nudist. "Show them your tan line," I say. He takes off his watch and reveals the white underneath that stands out against his deeply browned skin.

 

   "I wouldn't kid you," I say. "There's the living proof. That's his only line. Tell them about it, Arthur."

 

   Nurses don't know what to think, and they listen with interest and mild disbelief as Arthur talks about the campground where he and his wife go every weekend. He plays naked tennis and naked volleyball and drinks iced tea naked in the Bare Bottoms Bar. He says it is like skinny-dipping all the time. They have all ages, shapes, and sizes there. It is a wholesome family environment. Once when he and his wife invited me over for dinner, I saw on his refrigerator a Christmas card sent by a family he knows from the campground. The father, mother, and five children sit on a bench in descending order, bare backsides to the camera, heads turned, waving.

 

 Before I worked with Arthur, I thought he was a nice, laid-back, type B personality, a friendly guy with a smile and warm words for everyone. He used to be Shawn Kinkade's partner, but he switched to me because I work a better schedule. Shawn works Monday through Wednesday six A.M. to six P.M. I work Tuesday through Thursday seven A.M. to seven P.M., which are the same days of the week Arthur's wife works as a hairdresser. By working with me, they get an extra day a week at the campground and he gets to sleep an hour later in the morning. When he became my partner, I joked with Shawn, handing him a Snickers bar in return for Arthur.

 

    "He's a good partner," Shawn said as we shook on the deal. "A nice guy. Good luck." He smiled.

 

    "Good luck?" I got a sudden queasy feeling.

 

   I am glad to be working with Arthur. He is strong, knows the city, has a good work ethic, and likes to drive. It is the driving, however, that people have warned me about.

 

   "He's a maniac," one says.

 

   "After Glenn," I say, referring to my last partner, a young man who drove like a cowboy on a mustang chasing Indians, "he can't be too bad."

 

   No response.

 

   "Can he?"

 

   A smile.

 

 In the city, cars don't respect ambulances. They don't pull over. They either keep going or stop suddenly in the middle of the road. If they do pull over, they pull to the left, not the right, and usually the pullover is a sudden swerve in front of you. They don't know the traffic laws, play music too loud, talk on cellular phones, are more interested in people walking along the sidewalk than cars on the street, are zombies, think they own the road, or just don't care. And they get away with it. I have never seen a car pulled over and a driver lectured—much less ticketed—for failing to yield to an emergency vehicle. At worst, drivers get a frustrated EMT slamming the air horn at them and shaking a fist. Not only does bad driving delay our emergency response, it is a real safety threat.

   Arthur, I learn on the very first day, can't stand for cars to disrespect our ambulance when we are running lights and sirens. He races up on traffic, blasting the air horn above the modulating double sirens. If the car ahead of us won't pull over, he swears and jams his finger down on the air horn button as if the sound itself will explode them off the road. When the car finally pulls over, he often slows, glares, and gestures at the driver. You idiot. Moron.

 

   We're racing down Main Street. Arthur is right on the tail of a black sedan with tinted windows that won't pull over. He slams the horn.

 

   "Arthur," I say.

 

   The car doesn't yield.

 

   "Arthur," I say.

 

   He hits the air horn again, still close on the car's bumper.

 

   "Arthur, our turn was back there."

 

  I adopt the same policy I had with Glenn. I strap on my seat belt and pray we will make it to the scene alive. I say nothing about his driving. My bargain with the devil is I let my partners do most of the to-scene driving. Because I am six-eight, my legs are cramped in the driver's seat. I prefer the passenger side while we wait for a call. I fold my legs up and set them on the dashboard while I read. The passenger seat is also nice for arriving on an accident or other scene. I can jump right out and not have to worry about where to park. Also, the less I drive, the less likely I am to have an accident, which would threaten the $150 year-end bonus they give to those of us with perfect driving records, but I don't tell this to Arthur, nor will I give him a cut of my bonus. What I do tell him when we are en route to the hospital is to go on a three, no lights, no sirens. It is rare that I will ask for a two, lights and sirens, and extremely so that I ask for a one, lights and sirens in a serious hurry. I need to work in the back of the ambulance and I cannot work when I am being thrown all over and subjected to sudden stops and violent air horns. Unless the patient is gunshot or needs a surgeon immediately or has an injury or sickness I simply can't handle, the nonemergency mode works fine. It makes no sense to me to race lights and sirens to the ER, then wait in triage ten minutes or more for a room assignment, and then have the patient wait even longer in the room to be seen first by a nurse, then a doctor. Time to hospital does not equal time to treatment. If I can provide the treatment, I do it in my ambulance. The emergency is then usually over. No need to risk our lives rushing through traffic.

 

   "Go on a three," I say.

 

Spending forty hours a week in an ambulance with the same person, month after month, year after year, is a lot like being married. Sometimes you get along great, other times you can't stand each other. You are fiercely loyal in the big picture, but you can often be a petty complainer about the small stuff to anyone who will listen.

 

    There are some days I come home and I think I just can't deal with Arthur anymore. "He's a psychopath, a complete maniac," I'll say.

 

   And I am sure he feels the same about me. I picture him at home, saying, "What an asshole my partner is. He doesn't respect me. Always yelling at me. He doesn't know how good he's got it."

 

   It is true I yell at him when we do a hairy call, constantly telling him to do three things at once. "Get him on the monitor. I need that bag spiked. No, no, give me that thing. I need the thing. Now!"

 

   "What thing?"

 

   "The thing, the thing, you know."

 

  "Help me out."

 

  "The thing you use to, you know, squeeze air, the … the …"

 

   "The ambu-bag."

 

   "Yeah, yeah, give it to me!"

 

  Sometimes, probably not often enough, I go up to him afterward and say, "Arthur, I'm sorry. Like I told you when we started working together, if I am yelling at you, I am really yelling at myself, so don't take it personally. You did a great job on that call. You are a good partner."

 

   "Thank you," he says, with a hint of understated righteousness.

 

   I do work him hard and don't compliment him nearly as often as I should. I don't know why that is. Maybe it is because he is older, and I want to believe that I can still work at his age, that I will not complain about being tired, that I will be every bit as fit as the twenty-five-year-olds who make up the bulk of our company, that I will always be strong, a good worker. If I compliment him too much he may slow up, take it easier. I want us both to be supermen.

 

I know there are many things I do that irritate Arthur, particularly when I am tired from working overtime shifts. I know I should thank him more, but I find it difficult to do. What he hates most about me, I think, is when I am grumpy or don't talk to him. There are some mornings I just want to get on the road and be left alone. I don't want to hear about his weekend at the campground, whether or not he won his naked tennis match, or about the naked yard work he did on his trailer lot at the camp. Nothing against him—sometimes I just don't want to talk to anyone, I don't want to be there. The misanthrope that is close to my center becomes a big hairy ape that sits in the shotgun seat, swatting down all attempts at conversation and good humor.

  I always come in early and check out my gear and the rig, so when he arrives on the dot of seven, we are ready to go. "Let me just check the oil," he says.

  "But Arthur," I say, "they serviced the car last night. Let's get on the road."

 

   "You can never be sure," he says.

 

   If we're down a quart, I have to wait for him to go over to the garage, where he spends fifteen minutes talking about cars with the mechanics. Meanwhile, I'm impatient to get out on the road, worried I am going to miss saving a life or delivering a baby. Later when the company sends out a memo about crews being subject to suspension or firing if the oil runs out, as it has in two other rigs, I say nothing to Arthur, though I know if there were two of me in the crew we'd never check the oil, and probably end up blowing up the engine and getting fired.

   I buy a paper every morning. He insists on paying for half of it, handing me a quarter. It takes me five minutes to read the paper. I just skim the headlines and the few articles that look interesting. It takes him all day to read the paper. And he is always reading the paper aloud to me when I am trying to read a book, and worse, he will read the paper in the form of a question that demands an answer. "So what, did they discover life on Mars they're saying here?"

 

   "Yup," I'll say.

 

   "Huh?"

 

   "Yes, they did."

 

   "What was it, some kind of microscopic bacteria?"

 

   "I don't know."

 

  "It was. Microscopic bacteria. I'll be damned. Who would have thunk it?"

 

On Albany Avenue, as we race to an unknown, people hold their hands over their ears as we pass. Ahead, three large young men in baggy clothing saunter in front of the ambulance. Arthur slams the brakes and shouts "Get out of the road!" He shakes his fist.

 

  They glare and make hand gestures at us, which I fear are gang signs for I'm going to put a cap in your ass.

 

  "Arthur," I say, "you are going to get shot one of these days."

 

  "They were on your side," he says.

 

  "Oh, thanks," I say.

 

Arthur listens to the oldies station on the radio. I love all this music, but when you hear "Green-Eyed Lady," "Brandy," "Brown Sugar," and "In the Still of the Night," every day, twelve hours a day, three days a week, every month of every year, it all becomes elevator music. I complain, then he'll switch to a classic rock station, and then I get tired of "Layla" and "Sweet Home Alabama." Every now and then while he's inside writing his run form, I'll switch to rap or modern rock head-banging music, just to mess with him. Later he'll surreptitiously turn the volume down or change the channel. Sometimes when he gets out of the car, I'll do the same, turning the oldies music off or just putting the volume all the way down. An hour later he'll turn the radio on and inch the volume up, never saying anything about it having been turned off, turned down, or the station switched.

 

Every night at six-thirty, he calls up dispatch and asks if we can come in off the road. "My honey's cooking dinner tonight," he'll say. Every night his wife is cooking him something special for dinner. I want to do extra calls, I want the extra pay. But no. Six-thirty comes along, he calls up dispatch and asks if we can come in for the crew change because his honey is cooking him something special for dinner. And because he is nice, they most always let us come in, while they keep other "honeyless" crews out long past their crew change.

 

   "You are robbing my retirement savings," I say as we head in. "When I am old and destitute, I will curse you. No six-packs of Ensure in my mini refrigerator. I'll have to recycle my Depends."

 

   "Tough luck. My honey's got dinner on the stove."

 

   Sometimes I don't mind going in. After a long day I'm beat and I can use the beer waiting for me at home. If I'm in a good mood I'll turn the volume up on the radio when we're heading in, and we'll sing along to the oldies. "Chantilly Lace." And a pretty face. Hot day. "Summer in the City."

 

For all his idiosyncrasies, Arthur is a very good partner. He is solid, reliable, strong. He never complains when I decide we need to carry a patient down a flight of stairs instead of making them walk. He does what I ask, even when I am shouting at him to do three things at once. And even though he is six-two, he always lets me take the back of the stretcher so I don't have to be bent over like Quasimodo, pulling the front. And for all our spats and silent feuding, we have a good time together.

 

I hate going into nursing homes, but with Arthur it can be fun. "Let's get the old folks stirred up," he says as we enter the front door. The old people are always lining the corridors in their wheelchairs. As we roll down the hall, Arthur has something to say to each of them.

 

   "Hello, young lady!" he says to an old woman in a wheelchair, her head down.

 

   She looks up, surprised, and breaks into a big smile. "Well, hello."

 

   "What a lovely sweater you're wearing! I'd like to find one like that for my honey."

 

   "Thank you."

 

   To a man wearing an army veteran's hat: "General!" He salutes. "Top of the morning to you. Everything shipshape?"

 

   The man returns the salute. "That's right."

 

   He continues this way down the hall. "What pretty white heads," he says to the assembled ladies in their wheelchairs. "It must be beauty parlor day." The smiles break out like falling dominoes as we pass

 

   Ahead an old man in a wheelchair barrels out of a room, causing us to stop suddenly to avoid him. "Out of my way, out of my way," he grumbles at us as he motors past.

 

  "That's going to be you in twenty years," I say.

 

  "Maybe," Arthur says, "except I'll be naked."

 

  Our patient is an old lady who fractured her hand in a fall. She is very anxious. "Don't worry, we won't drop you," he says, "not like that last lady."

 

  "What!"

 

  "We never drop anyone on Wednesday."

 

  "It's Thursday

 

  "Whoops. I mean, we shouldn't be saying whoops, that's what we said the last time. A bad word in this business."

 

  "You dropped someone?"

 

  "Right on her head. I mean we're not supposed to be talking about it, advice of lawyers. But she's not feeling any pain, at least not anymore, poor dear."

  By the time we leave, he has her laughing and comfortable, her mind at ease. As we head back down the corridor, the troops have their eyes raised, ready to converse as we wheel back past. Arthur smiles, laughs, and jokes with all of them.

 

  Later in the day, we take a patient from Saint Francis Hospital back to a nursing home after a ten-day stay for congestive heart failure. He goes through the same routine with the residents in the hallway, making their day.

 

  "A little encouragement means the world to these people," a nurse says to Arthur as we leave. "You can see it."

 

  When we get back outside, he says, "If I ever end up in one of these places, put a bullet in my brain."

 

********

 

And here's a post called Old Partners I wrote in 2005 about working a shift with Arthur shortly before he left the Hartford Division, and Farewell Tour, about our last shirt together on his last day at work..

 

Rest in Peace, Arthur. Or better yet, if you have made it through the pearly gates, sign yourself up to be God's limo driver. I have heard Heaven is a very spacious place, and God sometimes needs helping getting around. He deserves the honor of riding next to you.

When I was a new paramedic, I wanted to be the greatest paramedic ever. I took pride in never missing work.  When I was at work, if I got a late call, I didn't care.  I welcomed it in fact.  Cardiac arrest five minutes before my out time, send me!  I took as many overtime shifts as I could.  I wanted the experience because only with experience could I truly reach the heights to which I aspired.  When I wasn't working I read medical textbooks and journals.  We didn't have instructional YouTube or podcasts then, if we had I would have watched them all.

I loved being a paramedic.  For someone who'd worked a coat and tie job in an office, I couldn't believe the freedom and adventure being a paramedic bestowed on me, and I was getting paid for it.  Of course I didn't have kids then, and I was single. 

 

When we were younger many of us in EMS were six feet tall and bulletproof, as the country song at the time went.  I fancied myself an EMS Joe Magarac.  Magarac was a fabled steel worker and a Paul Bunyon type folk hero.  He was the best worker in the mill.  He could mold steel rails with his bare hands.  He did the work of ten men.  When the mill was threatened with closing down due to cheap foreign steel, he climbed in the cauldron and melted himself down into the finest steel with which they built a new plant and restored their glory as the greatest steel town.  I thought that was pretty cool.  In one of my novels (Mortal Men), I had a paramedic character who lost his life.  He was cremated and his ashes spread on the streets where he worked so he could keep on looking out for his coworkers and the people of the city he'd loved.

 

After being a paramedic for about fifteen years a doctor asked me to address a conference talking about how I kept up my passion for the paramedic work.  I thought about talking about all the things I loved about the job — the red lights and sirens, the thrilling calls, the chance to be a hero, the pretty nurses, the great food in the city, the fun partners, the down time between calls when I could shoot baskets, climb park jungle gyms to stay in shape, or just read good books when I wasn't cracking jokes with my partners.  I ended up turning the doctor down because it wasn't all true.  While I loved the job, I had my periods of burnout when I didn't. I had times when it was a struggle to care, and I had calls that I had to keep at a distant place, locked away to prevent them from being a part of me.  I learned to dissociate.

 

I've been at this for thirty years now, and many of those who rode with me as partners are buried in the ground.  Dead of suicide, cancer, drugs and alcohol, and heart and lung disease.  Some died with broken hearts after the work had turned against them.  All of them dead too young.

 

I've been lucky so far. I married a nurse and had a family.  I stopped trying to die nobly for a cause, as the old quote from J.D. Salinger's The Catcher in the Rye, goes, and started living humbly for one.  I never became the greatest paramedic – not close. Hubris doesn't last in this line of work.   I try to do well by my patients, but I understand my limitations. Nowadays I want to get out of work on time. I want to live to a gentle old age and die during a peaceful sleep.

On March 22, 2023, the Connecticut Public Health Committee held a hearing on a series of bills it was debating.  One of the bills was to create pilot overdose prevention sites in Connecticut.  Two hundred and seventeen people signed up to speak that day on a variety of issues, but a good many of them were on this important issue. Testimony began at 11:00 AM.  By the time it was my turn to speak, it was past midnight.  You had the option of speaking via Zoom or coming down and testifying in person.  I monitored the hearing on Zoom during the day, and then drove down to the Legislative Office Building when it was getting close to my turn.

 

This was not the first time I had testified before the legislature.  Every time I have done it, I am filled with a sense of wonder.  You sit at single person table and address the committee who sit in a horseshoe in front of you.  You push a button to activate your microphone. You are given three minutes to speak and then they comment of what you said or ask you questions.  Anyone who wants to speak will be heard.  You just have to sign up and then show up.  Democracy in Action!  It is my understanding the committee stayed there until 3 in the morning until the last speaker had spoken.

 

Here is my testimony taken from the official transcript:

 

REP. MCCARTHY VAHEY (133RD):

And we have Peter Canning. Welcome.

 

PETER CANNING: Hello. Hi. Thanks for having me, and thanks for this wonderful setting. I mean, this is just democracy and action here to have listened to all the things that have gone on today and to all your thoughtful questions to people.

 

My name is Peter Canning, I've been a paramedic in Hartford for almost 30 years. When I started, I thought people who used drugs had a character flaw. I'd tell them, you better stop using or you're going to end up dead or in jail.

 

Only when I began listening to their stories did I learn that addiction is a disease and that many people who use drugs began their perilous journeys because of doctor's prescriptions following an
injury or illness.

 

I heard the same phrase over and over from my patients, "I used to be a normal person once," and they had been, they were loved people, all who were sent on journeys that they could not have
anticipated, and which for many proved impossible to extricate themselves from.

 

I have found people dead behind dumpsters, down alleyways, under bridges, alone in parked cars, in basements without light, and behind locked doors in public restrooms and family homes. Stigma in law drive people into the shadows where there is no one to help them if they overdose.

 

According to the CDC, 91% of those who died of fatal overdoses died using alone. A few years ago, I was called to an overdose in a wooded area of an abandoned lot right next to the community health center on Grand Street. The medical staff there up on the fourth floor had looked out into the abandoned lot, and they saw someone who'd been using drugs, and they saw he was motionless, so they called 911.

 

We got there and were able to revive him with naloxone. The next day, I responded to a medical emergency in the community health center up on that same floor, and I talked to the staff about it, and I thanked them for calling and said they'd saved the person's life. And then I had a suggestion, I thought, wouldn't it be a great idea if instead of hiding in a wooded area of an abandoned lot, that man could have come into the health center, to a special area where he could have used under the watch of a caring health professional who could have treated him if he overdosed, provided ointment for his abscesses, and talked with him about his life and his problems, and helped guide him toward treatment. A little-known part of the Hippocratic Oath says, "Into whose ever house I enter, I will enter to help the sick." Wouldn't it be nice if the sick could enter our medical houses and be treated like everyone else with dignity, with care and love? 

 

I support the creation of overdose prevention sites in Connecticut. They won't save everyone, but they will save those who walk through their doors.

 

Thank you again for this wonderful hearing that you put on and for your consideration of this issue.

I'm happy to answer any questions if you have one.

 

REP. MCCARTHY VAHEY (133RD): Mr. Canning, this Committee in this session has heard a lot of very powerful and very emotional testimony, and I've made it through all of it, but somehow your description of how alone people are is just hitting me in a very different place. Maybe it's because it's after midnight, but to say that 91% of the people who died, died alone, and if there's nothing we do, that's more important in this Committee, is to make sure people know that they are not alone and that they have help. And I want to thank you for your testimony here today.

 

I went home injured a couple weeks ago.  This wasn't the first time I was injured on the job, but the first time I couldn't finish a shift.  How it happened is embarrassing.  I coughed and didn't splint myself properly.  I pulled a muscle in my lower back on the left side.  I couldn't bend over.  I made it though one more call, then had to pack it in.  Not that i didn't want to finish out the shift. I realized I would be putting my patients in jeopardy because I might be able to move in the manner that paramedics sometimes have to do to care for the sick and injured.  I didn't fill out an injury report because I knew in a few days I'd be better.  I went home and put a bag of frozen peas on my back and took ibuprofen.

 

A few years ago, I got thrown in the back of the ambulance and was hurting pretty bad by the end of my shift.  My back hurt and had some numbness in my legs.  I went out for two weeks.  I went to oc health and when they looked at my back x-ray, they asked what I was still doing carrying people up and down stairs.  The words the PA used was my back was "past its expiration date."  They gave me two weeks of rehab, some stretching and I was back to work.  I'm still working and I still have the numbness.

 

I'll be sixty-five this summer.  With my other job at the hospital, I am down to only working one day a week on the road.  I want to keep going.  I try to work out, try to stay in shape.  I jump rope every day and lift weights every two or three days.  I do one set of seven machine exercises and then a couple of dumbbell routines.  I rest in between exercises.  I remember using really heavy dumbbells when I was younger, like forty pound dumbbells.  Now I use twenties when I am feeling strong and fifteens when I am just trying to get through the workout.  I used to do two or three sets, but one wears me out.  I have to lift in the afternoon because if I lift in the morning or at lunch, I'll fall asleep at my desk.  Each year it gets harder.  I need to be more careful when I cough which is all the time it seems.  I don't know if I am tired or if I'm just…

 

old.

 

I was talking to another paramedic this week.  He is a service chief now and hasn't practiced in years.  In his day, he was one of the best paramedics I knew.  He said he always worried about staying in the field too long.  He wanted to go out on the top of his game.  I think about that some time when I watch sports stars retire and then come back for the love of the game, but they just don't measure up to what they once were.  I think of Willie Mays playing for the New York Mets and young pitchers firing fastballs by him at will as he no longer had the bat speed to get around on the pitch.

 

I don't want to be the paramedic who can't get down on his belly to intubate, I already have to put on glasses to see the vocal chords clear enough to put a tube through them.  I don't want to get winded running up four flights of stairs following a family member frantic for me to help her ailing family member. They tell a younger medic about an older respected paramedic, "He's forgotten more than you know."  I don't want to be the older paramedic who has forgotten so much he knows less than the younger medic knows.  And most of all I don't want to sit in the EMS room after a difficult call, with my head bowed, knowing I have lost my powers. 

 

My hearing isn't as good as it was when I first strapped on an ambulance shoulder belt.  What?  What did you just say?  Say again, please. But for all how bad my hearing is, sitting here writing this now, I can still hear the ambulances going by in the distance.  I still hear the sirens call.

In 1988, from my second story apartment over a liquor store on Springfield's Main Street, I watched a paramedic and his partner attend to the chaos at the accident scene below as the red strobes of their ambulance lights illuminated the street.  Then for just a moment, the paramedic, a tall roughened man in his late forties, looked up at me, standing there in the window.  Seconds passed, and then his partner handed him a Philly Collar, which he then carefully placed on the driver's neck, and then they extricated the patient onto a long wooden board, and onto the stretcher, and then wheeled him over to the ambulance.  They picked the stretcher up with a two man dead-lift, and into the back.  The medic got in the compartment with the patient.  His partner closed the doors, and then got into the driver's seat, and the ambulance drove off, siren wailing in the night.

 

I went to EMT school that winter ( I was out of work at the time), and three months later, I was hired by a small ambulance company (5 ambulances, only three on the road at a time).  I did a mutual aid call into Springfield one afternoon for a multi-patient motor vehicle accident and that same paramedic was there.  He stopped me while I was putting my patient on a board and took the old man's coat off before laying him down.  He never said a word, but he nodded to me with a hint of a smile like he understood I was new to the work.

I don't know whatever became of him.  My company went out of business and I ended up moving down to Hartford and working there.  Every so often I'd do a call that would take me up to Springfield (now Baystate Hospital).  I saw him there outside his ambulance a few times, but that was decades ago.  I hope he had a good life.  EMS is not always kind in the end to those who have worked its streets for so long. 

 

I think about him every time I take someone's coat off before laying them down on the stretcher. And I do wonder what he thought that night long ago of the stranger standing up in the window, looking down on the street scene.  He probably was just lost in a momentary dream of his own, and never actually saw me at all.  But I like to think that he did truly see me and that in his mind he said to me, "Come out on and join the fun.  It's not the worst life.  Maybe you'll like it."

 

Thirty-five years later, I'm still out here answering the siren song.  At times I have paused myself and met the eyes of a curious onlooker.  "It's not the worst," I say to them in my mind.  Come on out.  Maybe you'll like it."

 

I surely have.

In EMS, we can't take pictures of the dead. We can write about them, but we have to change the details so the person cannot be identified. I have done this on many occasions. In my head I have a photo gallery of the fallen in this opioid poisoning crisis. The photos are not blurred, the details, all of them, remembered.

 

Each week, I add more to the collection.

 

An emaciated man sits on a decrepit couch in the basement darkness, his right leg is folded up on his left knee as he probes his ankle for a vein. There is blood drawn back in the barrel. The small basement area is dirty, nearly a dozen used syringes lay on the table, along with torn heroin bags. In the corner, in a broken laundry basket is a dust-encrusted bird head — the top half of a sport mascot outfit worn long ago.

 

The woman who lives upstairs, heard him come in last night, and then found him unresponsive this morning. She administered two vials of naloxone, which lay now on the cement floor, and called us. The man is cold to the touch and riggored into position, the needle still in his ankle, his hand still holding the syringe.

 

One of 100,000 dead in a year alone. Still no end in sight.

A number of winters ago, I responded for the "welfare check" in a local apartment building.  Carrying my gear I trudged through the snow to the door where the super met us and we walked through the bare lobby. He told us "his hands and feet are all blue." By the way he said it, I knew he was talking about a body and not a person who needed help.  We walked up two stairwells to the third floor, where the super led us down a dim hallway and then opened the door of a one room apartment, and gestured for us to enter.  On the floor, there was a collapsed clothesless body, head faced into the wall.  The legs and arms were blue as the man said, and the rest of the body, a wazy white. There was vomit on the ground outside the open bathroom door. A small TV was turned on to the Andy Griffin show in black and white. The place smelled of cigarettes. There was uneaten food on the stove and the trash overflowed the bin.  In the corner of the room there was an open rabbit cage. I knew it was a rabbit cage because I saw the rabbit staring out from under the bed. There was rabbit poop on the floor along with scattered carrots and lettuce near the cage. I ran my six second strip of asystole, and marked the time.  After disconnecting the monitor wires, rolling them up and putting them in the side pouch, I did a quick survey of the room.  No drugs or alcohol.  I walked over to the dresser where there was open mail, bills, etc.  I was looking for the patient's name.  That's when I saw it.  Fuck.

 

Roger Smith (not real name).  I looked at the face turned to the wall.  It was blue and misshapen, but It was Roger.  While we were never regular partners, I worked many shifts with him an easy decade ago.  I liked working with him because he was strong and didn't bitch about doing the job.  We talked about working out and girls and sports.  He was a Yankee fan.  I liked the Red Sox, but we didn't hold it against each other.  I turned him onto Jamaican food and he got me onto these megavitamins I had to buy on the internet.  Bull kidneys, horse spleens, and lizard gizzards and a lot of other crazy ingredients.  I was never stronger than when I was taking them.

 

Roger developed mental illness, or if he had it all along, it became noticeable.   There were never any incidents at work that I was aware of, but it was serious enough in his life that he stopped working for us.  I heard he worked for a couple other services for awhile, but didn't last. He was homeless for a while.  Sometimes I'd see him outside the hospital in a magnificently long winter coat.  He looked almost regal in it. A friend of mine said he let him in the hospital EMS room one day and security had to come and kick him out because he ate nearly all the sandwiches in the refrigerator.  It had been years since I'd seen him.

 

I stood over his body. "Good bye, Roger.  You were a good partner."

 

I checked the papers for days afterwards to see if any obituary appeared.  None did.  I don't think he had any family left.  Maybe an ex-girlfriend, but not one who maintained any contact.

 

When you die alone and without family, what becomes of you?  Are you buried in a potter's field or are you cremated and your ashes stored in a paper bag in case some long lost relative ever shows up to claim you.  What happened to the rabbit? Donated to some animal shelter probably. And what about that long overcoat he wore in winter?  Was it burned or was it donated to a homeless shelter? Maybe that coat provide warmth against the cold and elements to some other poor soul who might be wearing it even now?

 

A couple months later in the spring when the snow was gone and the flowers were just starting to come up, I saw a nurse on one of the hospital floors who had also worked with Roger when she was an EMT and who I had told about his death, and we had wondered together if he still had family.  She handed me a copy of Roger's obituary she had cut out of a small local paper that she had been keeping to show me.  It turned out Roger did still have family–an older sister,  two nieces, one of whom had young children who evidently adored him.  The article described Roger as a loving, caring man and mentioned how much he loved being an EMT.  There was a picture of him, looking just like he did when I worked with him. A good looking man with a confident smile.

 

Twenty years as an EMT.  He mattered in this world.

 

 

When my book Killing Season came out, Amazon chose it as one of the best nonfiction books of April 2021.  The book was also profiled on CSPAN books and I was interviewed by major networks including the BBC and ABC.  I was hoping for a review in the New York Times Book Review, but no luck there.

 

Writing a book and getting a book published can be an emotional rollercoaster.  The highs come when someone agrees to publish it, and then when the first copies arrive at your house and you get to hold it in your hands.  The lows, at least for me, are after the book has been out a couple months and the buzz starts to fade.  You check the Amazon sales rank and the number keeps falling.  You feel like your work is already being forgotten and no one is reading it.  It makes you question why you write and is it worth it to spend all that time and effort.  You may work on another project, but it is just not coming together and you question yourself.  The book will never amount to anything. Why even bother to write any more?

 

Last week, I was sitting in my paramedic intercept vehicle under the highway when my friend Kelly came to meet me as she does every week.  I have known her for many years now and enjoy chatting with her.  Sometimes my daughter bakes her brownies.  I may give her fruit and power bars and a can of soda and I always give her some money.  I told her long ago the money was not charity, but was for her stories and for her answers to my questions about the drug scene in Hartford.  Kelly is a drug user, often homeless, and along with her husband Tom, they have helped inform my views and provided me with a perspective I might not have otherwise had.  I don't think I could have written my book had I not met Kelly.

 

When I first met her I was walking in the park looking for heroin bags.  I was fascinated by the different brands.  She approached me and asked what I was doing.  When I told her she gave me a big smile and said she would be happy to answer any questions I had since she herself used heroin regularly.  I was a bit shocked because at that time she didn't look like my vision of a heroin addict.  She was in her early twenties with a punk hairdo and a bright disposition.  In the years since, I have often seen her look worse than she did that day, usually depending on her current living situation — under a bridge, living in a tent, or having an actual room.

 

Kelly is very animated this morning, as she often is, but this time is especially so.  "Guess what?" she says.  "You're not going to believe this!  So we are staying in this shack down behind the projects.  We found this book there and I started reading it, and oh my goodness, that's me.  It was your book!  You wrote about me!  I remember all of it.  I remember you saying you were going to write a book and you did, and I'm in it.  And it's permanent, you know.  It's like something that will always be there.  It will help people understand what's going on.  I'm going to send a copy to my father and say that's me and if he doesn't believe it, I'm going to give him your phone number and you can tell him that that's me there."

 

I had debated telling her about the book, but she and Tom disappeared before I finished it, and they only reappeared after the book came out.  I thought about telling her, but I guess I was worried she might not like it.  I changed details to protect her confidentiality but she could recognize herself in the pages.  Hearing how happy she was that I had documented her story along with others made me happy.

 

The New York Times might not have been interested in reviewing it, but here my book had been found in an abandoned shack frequented by homeless users who were reading about the crisis and about how the stories many of them had told to me had reshaped my views and how I was trying to bring their voices to the halls of power where people who could make a difference– legislators, government officials and public opinion makers and just general readers– could hear them and maybe reconsider what that they had previously thought.  And Kelly liked it and thought it was important for her father to read it, too.

I told her I would bring her some copies and would even write a note to her father. 

 

I'm still having trouble coming up with a new book, but I am proud that Killing Season, while not making it to the top of the New York Times best seller list, still made its way to that abandoned shack where Kelley found it.  And I am most thankful for Kelly and her big heart and wish her and Tom and all the other good souls out there a better world coming.

There are three loaves of bread sticking out of a paper bag in the passenger seat of the car. I recognized them from the bakery on Park Street where people pick up fresh long loaves of the crusty pan de agua (water) bread hot out of the ovens when the shop opens at six. It is now eleven on this brisk November day and the bread is cold. We pulled the young man who bought them out of the parked car and laid him down on the pavement in the apartment building's isolated rear lot. Now a woman screams when she recognizes the man. People come out of the back door of the building. The older onlookers try to shield the children's view. We work the man for thirty minutes and then five more on the short trip to the hospital, but the straight line on the monitor never changes.

"You're covering the city," dispatch says to us, when we clear Saint Francis after an early morning cardiac arrest. 

 

We park on Albany Avenue. The sun isn't up yet, but the black birds are stirring.  We're on for another ten hours.  By midday, we'll have twenty ambulances on, but right now it is only us.  The others are calls-an asthma on Martin Street, a diabetic on South Whitney, and two early dialysis runs.  Another ambulance is at the base doing a crew change.  The rest sit parked in neat rows in the cavernous garage, waiting for their crews, still asleep, to rise and slowly make their way back in.

 

The avenue is quiet.  A cop sits across the way waiting like us.   From Park Street where the coffee at Cubanitos is being put on to brew and the days bread just starting to come out of the oven north to the Bloomfield line, where early workers are trodding to the bus stop along Blue Hills Avenue; from Prospect Ave where the governor sleeps in mansion East to Interstate 91 that runs along the river, where traffic is still free flowing, that's the territory we are covering.  From restless newborn baby to dreaming old man, from those with newspapers filling their shoes to the ones who wear silken slippers, from homeless shelter to crowded apartment complexes to nursing facilities to single family homes to those under the bridges, anyone at all who is sick or hurt and dials 911 in this area of ours, we are the ones who will respond.

 

People ask why I like being a paramedic. It is quiet moments like these, watching over the city whose streets I have worked for over a quarter century.

 

Peace to all.  Stay safe.

For many of us in EMS, our origin story began with watching the TV show Emergency. The decent paramedics Johnny and Roy, the wise Drs. Brackett and Early, and the beautiful unflappable nurse, Dixie McCall. Together they stood for all that was good in the world. They were role models for us in showing us a path to lead our lives as rescuers.

 

When we entered the workforce, or at later times, contemplated the other work we were doing, and wondered if there was something more meaningful, the example of Emergency was always there for us

.

I came to EMS later than most. I was in my early thirties. I had been working in government/politics for a United States Senator, and with his defeat in 1988, I was at a crossroads. I liked the man I worked for - US Senator Lowell Weicker. He was a liberal Republican who was not afraid to buck his own party if he thought his actions would benefit the people of his state and country. He was a member of a group of moderate Republicans like Charles Mathias of Maryland, Jacob Javits of New York, and Ed Brooke of Massachusetts who crafted compromises both parties could live with. Sadly today, as William Butler Yeats warned in his poem "The Second Coming," the middle did not hold.

 

"Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,"

 

Politics today is no longer about making good policy, it is about making political points in a battle for personal power. Everyone is partisan. Weicker was defeated by Joseph Lieberman, a Democrat who ran attack ads that distorted Weicker's record, while Weicker preferred positive ads believing the people understood he was their champion. We didn't know it then, but the world was changing. There was no FOX cable news channel then. No MSNBC. No internet. No Facebook or Twitter, but the seeds of the future were already being sown.

 

I never really cared for the political life. I could have stayed in Washington and became an aide to another Senator or joined an interest group or lobbying firm. Instead, I (full of beer and passion) announced at a going away party for the Weicker staff that I was going to become an EMT, and then having said it aloud, I had to follow up on it. And so began my EMS odyssey. Even when Weicker ran for and was elected governor and I worked on his campaign and served as a speechwriter and executive assistant at the state health department for his four year term, I continued to work as an EMT at night, while thinking about going to paramedic school.

 

The other day I came across a collection of quotes I had put together at that time (1992). The quotes represented what I thought about life at the time. They contained song lyrics, passages from books, poetry and culture, along with illustrations. I saw one quote I had forgotten about, one that I remembered finding in a book by the great oral historian Studs Terkel.

 

"The fuckin' world's so fucked up, the country's fucked up. But the fireman, you actually see them produce. You see them put out a fire. You see them come out with babies in their hands. You see them give mouth to mouth when a guy's dying. You can't get around that shit. That's real. To me that's what I want to be."

 

I worked in a bank. You know, it's just paper. It's not real. Nine to five and its shit. You're looking at numbers. But I can look back and say, "I helped put out a fire. I helped save someone.' It shows something I did on this earth."

-Tom Patrick, Brooklyn firefighter quoted in Studs Terkel's Working.

 

I believe that quotation, as much as all the episodes of Emergency, set me on my ultimate life's path as an emergency medical responder. When Weicker left office in January of 1995, the next day I was on the streets of Hartford with a paramedic patch on one shoulder and an American flag on the other.

 

Now at sixty-three, in a world that seems to be threatening to fall apart, from the hateful politics of the our times, to the roof of my house, to my battered 200,000 mile plus sedan, to my own health no longer that of a young man, here I stand, still putting on my uniform and going in to work to answer the call.

 

I did seventeen 911 responses in a ten hour shift last Friday, and when I came home I just sat in front of the TV with my wife and daughter and ate a late dinner before going to bed to sleep the sleep of the weary.

 

I wish all jobs were like ours, where the oath is to do no harm, to help others, to make the world a better place.

 

 By all accounts, the opioid overdose epidemic is getting worse.  A recent study published in JAMA which analyzed emergency department visits (ED) found overdoses were up 29% from March to October of 2020 versus the same period for the previous year.

  

Opioid overdoses 29% higher in 2020 than before the pandemic: Study

 

Fatal Unintentional Drug Overdose Report Key Findings of Drug Overdose Decedents, 2019 – January 2021

 

Connecticut has released its final numbers for 2020.  Overdose deaths reached a new high -1374, up 14.6% from the previous year.

 

Connecticut Accidental Drug Intoxication Deaths Office of the Chief Medical Examiner

 

If we want to decrease opioid overdose deaths, we have to understand why people die from these deaths, and then take bold steps to address those causes.

 

As a paramedic who has responded to opioid overdoses with increasing frequency over the last twenty-five years there are two mains reasons why people die.

 

They use alone.

They use a tainted product.

Naloxone has been credited with saving countless lives, but if there is no one around to witness an overdose and then administer the naloxone, no amount of naloxone will save the victim.  A review of fatal overdoses based on the EMS reporting to the Connecticut poison control center found that while 59% percent of overdoses occurred in residences, 82% percent of fatal overdoses occurred in residences.  In 95% of these cases, the person overdosed alone.

 

People overdose because the product they consume is stronger than they anticipated.  This can happen due to lowered tolerance.  The patient just got our or rehab or jail or is using after a sustained period of abstinence.  The other reason is an unexpectedly strong product.  This is the true danger of fentanyl.  On much of the east coast, heroin comes in powdered form.  Dealers have found that is cheaper to either lace their heroin with fentanyl or replace it entirely with fentanyl.  Fentanyl which is 50 to 100 stronger than heroin is thus 50 to a hundred times smaller in size thus easier to smuggle.   $4 bag of fentanyl is not 50 to a 100 times stronger than a bag of heroin.  It just has less active ingredient.  With less active ingredient, there is more cut, which makes it harder for dealers to get an even mix.  Additionally fentanyl has been noted to clump, creating a chocolate chip cookie effect.  A user make get 1% fentanyl in their bag or a clump of 10% fentanyl, which could be fatal even to an experienced user.  In the past, users needed to be warned of bad batches on the street—unexpectedly high strength drugs.  With fentanyl, any bag has the potential for being lethal, even if the overall strength of the larger batch is low.

So what bold action do we need to take to solve these issues.

 

Why do people use alone?  Because law and stigma drive them into the shadows.  When we treat addiction as a crime instead of a disease, and when we shame users instead of treating them as members of our community deserving of the same love and compassion as anyone else who is vulnerable, they are are going to hide their use, and they will continue to die alone behind locked doors, in dark alleys.  I have long advocated safe injection sites.  Keep people from dying alone.  If any of my three daughters became addicted to heroin, I would insist they shoot us at the kitchen table rather than hidden in their bedrooms.   I have been on too many scenes where parents have found their children dead behind locked doors, and others where children, cast out by their families died alone alone under bridges.

 

What do we do about the product strength issue.  Legalize, regulate and tax drugs so people have access to medicinal quality opioids.

 

These are bold initiatives that few politicians dare speak of for fear of the political climate.  But if we want real solutions to prevent death, this is how.  End the War on Drugs.  Bring the drug use out of the shadows.  Bring our loved ones back into our community.  Embrace all with love and caring.

I was a new paramedic.  The senior medc briefed me.  They took two guys out of a basement apartment with high carbon monoxide levels.  Ones already on the way to the hospital for evaluation. Your patient is the guy over by the building door arguing with the police officer.  He wants to go back in his apartment to get some items, and the officer won't let him.  Just then the man punched the officer in the jaw.  The officer threw the man against a car and put him in a headlock, and then handcuffed him.  Instead of bringing him over to us to be evaluated, the officer put him into a squad car.  "Asshole!" he shouted at the man.

"Do you think he's an asshole or do you think maybe carbon monoxide is making him act like an asshole?" I said to the other medic.  "Shouldn't we go over there and talk to him?"

The medic shrugged, and said, "You can't argue with a man with a gun."

The cop took him to the police station for booking and we cleared the scene "Patient item A (arrested).,"

Hours later we both happened to be in the hospital EMS room when a supervisor came in and told us the man had become increasingly altered at the police station and was rushed to the hospital where they found critically high carbon monoxide levels in his blood.  "I'm glad it wasn't my patient," the senior medic said, without looking at me..  

I spent the week worrying that I was going to get a phone call telling me my medical control had been taken away and I was finished as a paramedic.  Fortunately, that call never came.

That was over twenty-five years ago and I was still learning my way..  The episode taught me two lessons.  Don't rely on someone else to make the good decisions for you, and if you are there as a medic, you need to speak up on behalf of your patient, prisoner or not, asshole or not..

I am not saying that from that point on I always stood tall, but I was at least headed in the right direction.

Over my twenty-five plus years as a paramedic, I have had clashes with police officers regarding patient care, less so as the years have gone by and police departments have become progressive, and possibly I have learned a calm, assertive manner.

When I worked in a contract town, I was always getting called to evaluate prisoners for "jailitis."  There was pressure for me to tell the prisoners they were fine and did not need to go to the hospital.  Sign here.  If I insisted on them going to the hospital, the police department (PD) would have to send an officer along and the officer would have to wait as long as the prisoner was there, or until an officer from the next shift arrived to relieve him.

The PD wanted to cover their liability by calling me so they could say they offered the prisoner medical help when asked, but they wanted me to shoulder the responsibility for the refusal of transport.  I played it straight forward.  If I thought the person was sick, I advised them to go to the hospital. If I thought they weren't sick, I'd tell them what I believed, but always made clear if the patient requested to go to the hospital after my evaluation, I would fight for their right to be evaluated there.  It would be up to the PD to refuse.

I noticed sometimes the PD would wait till my shift was done and another (more pliant) medic was on to call for the prisoner evaluation.

I have also responded to scenes where the police were sitting on patients, and I have always done my best to make certain that the person being sat on could breathe and that if they were going to be restrained, it would be in the safest manner possible.  I prefer 10 mg of Versed to four point restraints and a spit shield.  I have said clearly, "This man needs to be evaluated at the hospital."

The line the medic used that day-- "You can't argue with a man with a gun"--I have heard many times over the years --medics explaining why they did not immediately treat a patient who needed care, or why an MVA victim was transported to jail instead of the hospital, only to later need an ambulance, or even a shooting victim was left to die because one of the officers wanted to tape the crime scene off to preserve evidence.

A lesser known line from the Hippocratic Oath goes like this:

"Into whatsoever houses I enter, I will enter to help the sick."

Remember when you are on a scene, you are not just John Paramedic, you descend from Hippocrates and all who have held his faith.  We are advocates for our patients.  We stand up for them, bad or good, rich or poor, white or black, asshole or not.

You will have confrontations in this work. Stand tall.  It's okay to argue with the people with guns.  They will respect you if you are professional and firm.

 There is a bill in the Connecticut legislature to allow the police to take into custody anyone who overdoses and is resuscitated with narcan, who then refuses to go to the hospital.  The proponents of the bill speak of a 72 hour hold in a clinical setting to keep the person from going back out to the street and overdosing and dying. 

 

The proposal is known as Brian Cody's law after a young man who died of an opioid overdose at a young age.

I provided written testimony against the bill.  While I understand its intention, I felt that it might have the negative effect of inhibiting people from calling 911 if one of their friends overdosed knowing it would lead to being taken into custody.

Here's what I wrote:

 

WRITTEN TESTIMONY for PUBLIC SAFETY AND SECURITY COMMITTEE

Of Peter Canning, Paramedic, Emergency Medical Services (EMS) Coordinator UConn John Dempsey Hospital

In Opposition to Raised HB 5583: AN ACT CONCERNING EMERGENCY INTERVENTION BY A POLICE OFFICER WHEN A PERSON SUFFERS AN OVERDOSE

 

Public Hearing: March 2, 2021

 

Good morning, Senator Bradley, Representative Horn and distinguished members of the Public Safety and Security Committee.  I am Peter Canning.  I have been a paramedic in Hartford for over twenty-five years.  I am also the EMS Coordinator at UConn John Dempsey Hospital and have been actively involved in the EMS Statewide Opioid Report Directive (SWORD) tracking and collecting data on opioid overdoses.  I am testifying today to oppose H.B. 5583 AN ACT CONCERNING EMERGENCY INTERVENTION BY A POLICE OFFICER WHEN A PERSON SUFFERS AN OVERDOSE.

 

According to SWORD data 95% of all nonfatal opioid overdose victims that receive an emergency medical response are currently transported to the hospital (1).  Only five percent of overdoses victims refuse transportation.  If a person is alert and oriented with stable oxygen saturation, after we give them a talk about the risk of not going to the hospitals for further medical evaluation, they can legally sign a refusal of transport.  Those who are not alert and oriented or who are unstable, are always transported.

 

Most people who have been revived from an opioid overdose that are transported to the hospital are evaluated and discharged from the Emergency department within a couple of hours.  We studied this in the Hartford Opioid Project, the predecessor to SWORD, and found 86% of those patients transported by ambulance to the ED were discharged from the ED (2).  This included those who leave against medical advice.  It is important to understand that not all patients who seek rehabilitation once they are in the ED are able to be immediately be placed in a rehabilitation facility.  Many are sent home with a list of rehabilitation facilities and phone numbers to call in hopes that a bed may open up for them if they still desire to enter rehab.

Fortunately repeat overdoses are not common. We studied this for the first seven months of the SWORD project, and found only 11% of all patients in our data base suffered 2 or more overdoses in the seven month period (3).  Our conclusion was the assumption that opioid users overdose repeatedly appears false.  Clarifying this stigmatizing inaccuracy is important in understanding opioid overdose and directing resources towards addressing it.

 

Most opioid overdoses are accidents not willful events.  Overdoses occur for two primary reasons.  One, the person who overdoses has a lowered tolerance due to recent abstinence caused by time in rehabilitation, prison or by abstinence of their own choice.  With lowered tolerance, many people cannot handle the amount they were previously used to using, and thus overdose.  The second reason for overdose is the potency of the drug used.  This is where fentanyl comes into play.  Because fentanyl is 50 to 100 times stronger than heroin, far less active ingredient is used when mixed with cut or fillers.  If batches are not properly mixed, which happens with fentanyl due to its tendency to clump, a $4 bag can easily contain a lethal dose even for an experienced user.

 

Harm reduction workers, which include many of us in EMS, warn people not use to alone.   We also urge people who use opioids to carry naloxone and to immediately call 911 if someone they are using with begins to show signs of overdose.  I worry that if this bill passes, knowing that their partners will be taken into custody, people may fail to immediately call 911 when someone is overdosing.  They may hope that their naloxone alone will reverse the  overdose, or if they lack naloxone, they may first try home methods of drug reversal such as throwing ice in the person's pants or putting them in the shower or bathtub.  If their efforts fail and they then decide to call 911 as a last resort, precious time will have been lost before EMS is able to arrive to try to resuscitate them.  We may be too late.  I believe, however well-intentioned this bill is, more people may die if this bill passes than be helped by it.  I urge you to vote against it.

 

1. Connecticut Statewide Reporting Directive data. June 1, 2019-February 28, 2021. Nonfatal transports.
2. Canning, P. McKay, C, et al.  "Coordinated Surveillance of Opioid Overdoses in Hartford, Connecticut: A Pilot Project." Connecticut Medicine, Vol 83, No. 6, 293-299.
3. Canning, P, Doyon, S, Hart, K. Kamin, R., Kosciusko, M, Frequency of Multiple Opioid Overdoses per Individual in Connecticut During Seven Month Period, Abstract - New England Regional Meeting of the Society for Academic Emergency Medicine (SAEM) 2020

You can read the testimony of others here:

 

Proposed H.B. No. 5583 Session Year 2021  Public Hearing Testimony

 

I was asked to write the testimony on short notice.  I thought about writing about how on many scenes police already force people to go to the hospital with the hospital or jail choice.  Those people often leave AMA the moment we take them out of the ambulance at the hospital.  Other testified that the science shows people don't do well in forced rehab.  And as I mentioned there aren't enough beds as it is for people who want help.

Support Harm Reduction.  Battle Stigma.  Increase funding for services.  Treat Addiction as a disease.

As I approach the house with my medic pack over my shoulder and my monitor and isolation bag in my hands, two boys, maybe fifteen or sixteen, stand on the sidewalk out front of the building, and look at me expectantly.  "He's not alive?  Is he?  Is he still alive?" the shorter one asks.

 

I keep walking, up the stairs and through the front door, headed for the third floor.  The fire department is there waiting for me.  They let me through.  The apartment, empty of furniture, looks under haphazard renovation.

 

The man, maybe in his sixties, dressed in a blue winter jacket and a red knit hat, is on the floor.  He has rigor mortis with lividity.  His limbs are stiff and his blood has pooled to the dependent parts.  With the freezing temperatures outside and no heat in the apartment it is hard to tell how long he has been dead. The boys outside apparently found him while they were doing whatever it is kids do when they trespass. The building owner says the man is homeless.  He last saw him a week ago down on the corner by the ranch house restaurant. He was sick.   How did he die in this cruel winter? I don't know. Opioids?  COVID? Hypothermia?  No matter the way, he died alone.  I run my six second strip of asystole, and write down the time.  I hand the arriving police officer the presumption of death information, and exit.

 

The two boys are still outside.  "Did he have a pulse?"  the shorter one asks again.

 

I shake my head as I walk past.

 

 

On December 18, 2020, I participated in a panel hosted by United States Senator Richard Blumenthal and Connecticut Attorney General William Tong to discuss the opioid epidemic. 

 

I want to thank both of these fine public leaders for their consistent and longstanding involvement in the fight against opioid deaths.  We were joined by several other leaders in the state, including my friends, Mark Jenkins of the Greater Hartford Harm reduction Coalition and Bobby Lawler, of the New England HIDTA (High Intensity Drug Trafficking Area).  I also want to thank Brandon Bartell, the operations manager at American Medical Response Hartford, who let me adjust my paramedic shift at the last moment so I could participate.

 

It was a great discussion that can be viewed in its entirety at this link.  

 

Forum with Attorney General Tong and U.S. Sen. Blumenthal on the Opioid Crisis During the COVID-19 Pandemic

 

I start speaking at the 42 minute mark.  I was told I could speak for five minutes, and I managed to keep within my time.

 

The Hartford Courant wrote a nice article summarizing the meeting.

 

Connecticut projected to exceed last year's number of fatal overdoses, as COVID-19 results in isolation and fentanyl drives deaths; over 1,300 fatalities expected in 2020

 

When thinking about what I was going to say, I focused on the question of why people die from opioid overdoses.  Most people involved know the larger causes of the opioid epidemic: over prescription, corporate greed, poor public policy, etc., but I wanted to focus on the causes, from my experiences as a paramedic, that are actually leading to people's deaths.

The two main reasons people overdose are low tolerance and excess potency.

 

Low tolerance occurs when someone who has just gotten out of prison or rehab, or someone who relapses from a period of abstinence, uses the same amount they used to use, and consequently they overdose because they have lost their former tolerance.

  

Excess potency comes from buying a product that is stronger than you anticipated.  The best example of this would be (a few years back) buying a bag of heroin that is unexpectedly laced with fentanyl (hardly unexpected these days) or a bag of fentanyl that has a larger than normal percent of active ingredient compared to cut.  This can happen easily with fentanyl because the active amount of fentanyl is small and widely variable (you could easily have 0-10% or more in different $4 bags from the same batch).  Because fentanyl tends to clump, you don't get dilution like when you put food coloring in water and stir, instead you get the chocolate chip cookie effect, and your bag may have a deadly fentanyl chip of death in it.  

The way I see it, the major thing you can do about tolerance is education.  Warn people to be careful if they haven't used for awhile.  Just do a little at a time.

 

Excess potency can be addressed through quality control. The problem with street drugs is there is no quality control.  In addition to not knowing the strength, the drugs often contain other potent chemicals.  Xylazine is a horse tranquilizer increasingly implicated in opioid deaths in Connecticut.  We've seen PCP and other drugs added to the mix.  No one really knows what they are putting in their veins.  It's Russian Roulette.  How about we try some medicinal fentanyl or heroin pilot projects where a trial group of users are allowed to receive medical quality heroin or fentanyl in a clinical setting under a physician's care?  They do this in England and other countries.  It may be considered outrageous by many, but it would reduce the problem of people dying from "hot spots" in batches mixed by street dealers.

 

New heroin-assisted treatment: Recent evidence and current practices of supervised injectable heroin treatment in Europe and beyond

 

Another method would be helping harm reduction clinics purchase lab equipment so users can tests what's in the latest bags on the street.

 

Drug checking as a potential strategic overdose response in the fentanyl era

 

While addressing low tolerance and excess potency will help limit deaths, the number one reason people die is because they use alone.  If they use alone and their tolerance is down or they have a batch with excess potency, and they overdose, if no one discovers them in time, no amount of naloxone will bring them back.

 

Why do people use alone?  They use out of sight because stigma and law drive them into the shadows.  I have found people dead behind dumpsters, in porta-potties, down wooded ravines, in cars in secluded back parking lots, and behind locked bathroom and bedroom doors, as well as in solitary hotel rooms. Had any one of these people used with someone else or used in a public location where they could have been spotted, they would have survived to live among their loved ones another day.

(Think of all the parents who find their children cold and dead behind their locked bedroom doors.  What if it was normalized for them to dose in the kitchen (as part of their care plan or a simple stay alive pact) under their parent's eyes with an injector of narcan on the table?  Think of the tragedies avoided.)

 

People hide their drug use because addiction is thought of as a character flaw, not a disease.  People hide because they don't want others to see their struggle.  They hide because they have to break the laws of our country to get what they need to fight off the sickness of withdrawal.  We recognize them as victims of a larger societal, medical and governmental failure to keep its citizens safe, yet we treat those with addiction as outcasts.

 

How do we stop our loved ones, our neighbors, and our nation's citizens from using alone?  End the stigma with education campaigns.  Decriminalize drug use and possession of drug paraphernalia.  Reverse the justice department's position on the federal crack house statutes and their opposition to overdose prevention sites. Fund harm reduction including money to establish these same overdose prevention sites where they can dose themselves under the eyes of trained professionals who can not only administer naloxone, but who are there to talk with them and perhaps help guide them to treatment if they are ready.

 

Hear the drums beat.  Twelve hundred (1200) dead in Connecticut in 2019 with 1300 or more expected in 2021.  It's time to do what's necessary to save lives.  If we don't want people to die we have to find ways to help them use under supervision.  Let's end the stigma, and bring our people in from the cold.  Let's welcome them back to our communities.  Let's welcome them home.

 

 

 

The American Hospital Association, the American Medical Association, and the American Nurses Association issued a joint release today urging health care professionals "to get the COVID-19 vaccine and share your experience with others."

 

They wrote:

 

"While the arrival of vaccines is good news in the fight to defeat COVID-19, it does not signal an immediate end to our nation's suffering. Just as we have been pushing for adoption of the precautions we all know work – masking, hand hygiene and physical distancing – we must also push for high rates of vaccination within the U.S. population if we hope to overcome this virus.  This will require trust in the COVID vaccination process, from the development, distribution and administration of a safe and effective vaccine as well as a willing public to get vaccinated….As frontline caregivers, our essential role in protecting the health and wellbeing of our communities goes beyond the care we provide. As a valued and trusted voice, our example is perhaps the strongest health resource we have."

 

Here is my story.

 

I was extremely fortunate to be among the first group of providers at our hospital to get vaccinated on Wednesday.  (The top dogs got the vaccine on Tuesday!}  I had no qualms about getting it.  I read about it, talked to experts and was sold.  A few key points:

 

You can't get COVID from the shot. It contains no dead virus or attenuated (weakened virus.)  Corona virus consists of 25 proteins; the vaccine tells the body to make one protein.

The mRNA cannot mess with your DNA. It enters the cell, but not the nucleus.  MRNA viruses have been given safely to cancer patients for years without major issues.

While vaccines typically take much longer to approve, thanks to advances in technology, including the mapping of the human genome, great strides were possible. Red tape was removed, funding was plentiful, the best minds worked on it, and most importantly, no shortcuts were taken in the final clinical portion of the trial.  Over 70,000 doses of the vaccines were given to people before approval and independent safety boards found no major concerns.

The vaccine is 95% efficacious.

My man Dr. Fauci says it's good enough for him, so it's good enough for me.

 

I received the shot at noon on Wednesdays and as I write now over thirty hours later, I have had no fever, no aches and no fatigue.  I didn't feel the needle go in and I did not bleed.  Once in the night when I lay on my left shoulder, I could feel I had a shot there.  Once, I had a five second shiver, but that was  due to an unpleasant thought.  I was going to take it easy today, but we had a Nor'easter last night that dumped more than a foot of snow on us, and with the wind drifts, almost buried my car in the driveway.  For my 25th work anniversary gift (we get to pick it from a catalog), I chose my first ever snow blower, which I assembled last night.  Unfortunately, The storm was too much for it.  It wasn't very powerful, and crapped out before my driveway was a third done.  I grabbed the manual shovel and like John Henry, I showed the machine who was the man.

 

 

Still feeling good, I'm ready to hit the streets tomorrow.  COVID is still out there, and I don't think the vaccine kicks in fully for a week or so (I will have to get a booster in 21 days) but I will be armed with my mask and PPE and be ready to do my job.

 

I hope everyone gets a chance to get the vaccine soon and that they will act on it.  Protect yourself.  Protect your family and protect your community.  That's what we do in EMS.  It's our job.

 

Peace to all and a middle finger to COVID.

 

Also, many grateful props to the scientists who developed the vaccine and all who helped make it a reality.  Thank you.

Twenty-seven years ago, in a retaliatory shooting, a man in Hartford's north end opened fire with an automatic weapon, killing his target.  He was sentenced to fifty years in prison.  He left at home a baby daughter.

 

***

 

I get called for the unconscious.  I arrive first and climb windy wooden stairs to the third floor apartment, where a terrified young woman, holding a toddler, kneels in the hallway by the open bathroom door.   "He collapsed and he won't wake up!"

 

An older man with a grey beard lays on his back, eyes rolled into his head, gurgling.  His arms are stiff.  His carotid pounds.

 

"What kind of medical history does he have?" I ask.

 

"I don't know,'' she says.  "He...he takes pills."

 

"Is he diabetic?  Has he ever had a stroke?  Or seizures?"

 

"I don't know!"

 

I have an ambu bag out and with the help of the arriving fire department we pull the man out into the middle of the living room floor, where we start breathing for him.

 

"Does he do drugs or drink?"

 

"No, no."

 

"What's your relation to him?"

 

"He's my father."

 

"Does he live here?"

 

 "Is he going to be alright?"

 

His pressure is 170/100.  I can't get a good look at his pupils.  I am leaning stroke, but his respirations are slow (6-8 a minute) so I gave him two of narcan in the nose just in case.

 

With bagging, his oxygen saturation is 100% and his end tidal is 59.  The ambulance crew arrives and I tell them I am not certain what is going on.

  

The other medic asks if I want to give him more narcan, but I say hold off.  He is breathing well enough that we don't need to bag him.  If it's an OD we'll know soon enough.  As they get the stair chair ready,  his respiratory drive picks up.

 

The man opens his eyes.

 

"Well, that answers that," I say.  "What did you take?" I ask him.

 

"Huh?" He says.  He has that uh-o surprised look to the left look to the right look that so many overdose patients have when they suddenly wake up and find the room filled with people in uniforms standing over them.

 

"Nothing," he says.  "I'm fine."

 

"Fine?  You weren't breathing, you were unresponsive."

 

"I got high blood pressure," he says.

 

"No, you used heroin," one of the firefighters says.

 

"He used drugs?" the daughter says.

 

She turns on him.  "You're gone twenty-seven years and you come back now and you're going to leave me again like that, after you promised to never leave me again.  Are you going to bring this into our house?  With me and my son?"

 

The man says nothing.  I feel bad for him.  And for his daughter and grandchild. 

 

"He just got out of jail," she says to me.  "One week he's been here.  One week and he goes and does this."

 

Twenty-seven years ago, I imagine a man could sniff a bag of heroin and it was nothing but a nice peaceful easy feeling.  Not today.

 

I tell the daughter about fentanyl, which she knows about. She lives and is raising her son in this neighborhood where drug trafficking and use as well as violence are daily facts of life. I tell her to be patient with her father, that he no doubt loves her, but this transition must be hard for him and he is going to need her.  He is going to need both of them.  She wipes tears from her eyes and hugs her son.  I tell her how she should have narcan in the house and where she can get it.  Even if he promises to never use again, opioids are a powerful force, and if he does slip up again, she can help keep him alive, until more help comes as it did today.  I give her a wrist band with the harm reduction center number on it. You're not in this alone.

 

The daughter, holding her toddler and I follow her father and the crew down the stairs.  Outside, they load him into the back of the ambulance.  Daughter and father eye each other, saying nothing as the door closes.

 

"He should be back in a couple hours," I say. "Don't be too hard on him."

 

She watches the ambulance drive slowly down the street, its red lights no longer swirling, and then she and her boy go back into the house.

 

I get into my response vehicle where I write my patient care form.  Then I Google the man and learn what happened twenty-seven years before, not five blocks from the apartment where he, his daughter and his grandchild will try to become a family, and live the simplest of all our dreams.

 

***

 

A study in the New England Journal of Medicine found that prisoners in Washington State were twelve times more likely to die in their first two weeks after release than were members of the general population (matched for age, sex, and race), and tellingly the ex-cons were 129 times more likely to die of an overdose.

 

Ingrid A. Binswanger, Marc F. Stern, Richard A. Deyo, Patrick J. Heagerty, Allen Cheadle, Joann G. Elmore, and Thomas D. Koepsell, "Release from Prison—a High Risk of Death for Former Inmates," New England Journal of Medicine 356, no. 2 (2007): 157–65.

Welfare check.  The superintendent lets us in.  The apartment is a poor man's hoarderville, open boxes and dirty clothes stacked as high as the unwashed dishes in the sink.  The man is sitting at a table with his head in his hands; a chess board in front of him.  For a moment, I fear he is not breathing, but when I nudge him he moves.  He turns slowly and stares blankly at me.  I ask if he is okay, but he doesn't answer.  I nudge him again but he is out of it.  I try to get him to squeeze my hands, but he doesn't follow any commands. Still, he has a decent pulse and his breathing while a bit slow is even.

 

His medications are on the table alongside the chessboard.  I read the labels.  Metoprolol and HCTZ for hypertension, furosemide for congestive heart failure, simvastatin for high cholesterol, coumadin for atrial fibrillation and blood clots, allopurinol for gout, metformin for diabetes, oxycodone for pain, colace to soften his stool. As I reach for each bottle, I can't help but admire the antique chessboard; the pieces are large and carved from wood.  No idle purchase.

 

I always wonder about my patients' lives.  On the wall there is a picture of a strong man in military uniform and another with the same man with a large family around him.  There are many pictures of younger children.  The pictures are old and faded.  

We pick him up, me with my hands under his arms, and a firefighter grabbing his legs.  It is then I see the torn heroin bag on the floor below the chair. I check his eyes once we have him strapped in on the stretcher.  His pupils are pinpoint, but he is breathing well enough that I don't need to give him any naloxone.  This is a dose, not an overdose.  All he needs is a little shake  to keep his breathing up when he nods off.

  

I wonder how many years has he been using and where did he get the heroin from?  By the door there is a walker, the kind with tennis balls on the ends to make for smoother rolling.  Did he push his walker all the way down to Park Street to get his $4 bag or does his dealer knock on the door with a regular delivery?

 

Was he once one of those who played chess in the park for a dollar a game? When was the last time he played a fellow human, relegated now to playing against himself in this dim apartment?  I wonder if he replays lost games from his past, like many chess masters do, studying them to see where he went wrong.  Maybe the heroin helps him play better, relaxing him and letting his mind see patterns that reveal to him the proper move.

  

I pick up my gear as we prepare to head down to the ambulance.  I take a last look at the chessboard.  I am new to the game, but it looks like if he is playing black, he is in a losing position.  White's pawns are advancing on his king and his two rooks are about to be forked by the opposing knight.  Soon his pieces will join those already taken, standing helpless now on the sidelines, among his battalion of prescription pill bottles.  The battle will come to an end.  As it will one day for us all.

 

On the Sunday morning sidewalk
Wishing, Lord, that I was stoned
'Cause there's something in a Sunday
Makes a body feel alone.
"Sunday Morning Coming Down" - Kris Kristofferson

 

Twenty-six people in Connecticut died of overdoses on the four Sundays of this past April. Twenty-one males.  Five females.  One was aged 15-24, eight were 25-34, six 35-44, four 45-54, five 55-64, one 65-74.  I don't know their names, what kind of lives they lived, or who they loved.   Twenty-six deaths was the most fatal overdoses on any day of the week in a month so far this year.*  

 

I don't believe people overdose deliberately.  But I believe some overdose deaths are unintentional suicides of despair.  The person using the drugs knows that the amount of drug they are doing at the time may lead to their death, but they are so sick and forlorn and tired, and often so deeply alone, that they throw an extra bag or two in the cooker in hopes the pain will go away and that they will escape into a bliss they have not known for a long time.

 

On March 21, 2020, Connecticut shut down the state due to COVID.  That move undoubtedly saved countless lives as Connecticut was able to eventually get some semblance of control (at least in the first wave) of the rapidly escalating pandemic.  Unfortunately, some of these twenty-six may have been collateral damage.

 

In a blog post, Fatal Overdoses, written last April, I discussed the possible reasons we might see increased overdose deaths.

 

Established drug supply lines experience disruptions that force users to buy from unfamiliar sources, increasing their chances of overdosing.

 

Training and substance outreach programs are either closed or have limited hours.  Some have moved on-line, which is okay if you have a home and a computer. Not so much if you are displaced.

 

People may not have access to the help they need as well as reduced access to naloxone and clean needles.

 

Isolating people with existing mental health issues may lead former users (with now lowered tolerance) to return to substance use.

 

The increased release of prisoners with a history of drug use puts them at risk for overdose due to their lack of tolerance.

 

Patients with undiagnosed COVID-19 may be less resilient if they do overdose due to reduced respiratory capacity.

 

And people without work, with increased economic and social pressures, may seek escape.

 

I wrote about talking with Mark Jenkins, the head of the Greater Hartford Harm Reduction Coalition, about a homeless woman who I found dead on a mattress in a vacant apartment that she had found a way into.  She had been a regular at his drop-in center, and they were all mourning her passing.  Mark told me that day how worried he was. Now in this time of COVID we are telling people to isolate, he said, to distance themselves, which is opposed to everything we have told the substance use community in the past. Come together, look out for each other, there is safety in groups.

 

In total, April in Connecticut saw 133 overdose deaths, 56% more than the previous April, and as many as would die later in July 2020, a month that is historically one of the highest (unlike April) for overdose deaths. 

 

Connecticut is on pace in 2020 for 1400 people to die of overdoses-- an increase of 200 deaths (17%) over 2019. 

 

I hope that as the chaos clears from the election as it seems to be with an emerging Biden presidency and a continuing Republican Senate, that Democrat and Republican can come together and put vitriol and power struggles aside and start working for the people again, start looking out for our most vulnerable.

 

Address this crisis.  Recognize Addiction is a Disease and Treat it Medically.  End the Stigma.  Embrace Harm Reduction.

 

Bring our brothers and sisters in from the cold.  No one should be alone in this great country of ours.  We take care of our own.  We are our brother's keepers.

 

 

***

 

*Not counting July, a month  known for higher overdose deaths, when there were 27 deaths over five Fridays.

 

Data from Connecticut Department of Public Health

 

Drug Overdose Deaths in Connecticut 2015-2020

(Accessed November 5, 2020)

 

Drug Overdoses Monthly Report, January 2019-September 2020

There is a cartoon hero named Narcania created by the same guy who wrote Lil'Dope Fiend Overdose Prevention Guide."  In the mini comix, Narcania rescues people who have overdosed and gives them new life.  As one character who has been resuscitated remarks, "I don't know if there is anything worth living for, but at least now, I'll get to find out!"

 

In San Francisco there is a Narcania mural, Narcania vs. Death proudly painted in an alley.

 

In 2017 I wrote about Narcan Man, the mysterious person or force who seemed to always arrive and be gone before us, leaving only an empty vial of narcan and sometimes a confused, or vomiting person at the spot where we were dispatched for the overdose.  I imagined a man with bandoliers of Narcan and a gold tooth who roamed the metropolis, keeping people safe, and then disappearing into the mist.  Who was that man?!

 

I believe I have finally met the real life Narcania, the female Narcan Man.

 

Her name is Carrie.  She is a smallish woman in her late twenties, whose face shows both the promise of her youth and years of hard living.  Her voice is gravelly from cigarettes, and her eyes are hardened blue grey.  I've seen her walking Park Street and I've seen her helping out at the work harm reduction van.  And most recently I've seen her at a number of overdose scenes, where she stands to the side and disappears once we arrive.  I know her well enough now to call her by name and to chat a little.  One of these days I want to talk with her at length and learn her true story rather than one I might imagine.

 

This time  she was walking through the park ravine when she came across a man half hidden by a pile of logs.  He was unresponsive and cyanotic with agonal breathing.   She hit him with 2 mg of Narcan in the leg with her autoinjector and gave him some good hard shakes until he came around.  When she saw it was me getting out of the paramedic vehicle, after I'd driven down a dirt road and across a field to get to the OD site, she stayed.  The man didn't want to go to the hospital, but she was able to convince him to go.  I let her do the talking because I knew he'd be more apt to listen to her than me.  While I walked him to the arriving ambulance, she gathered the belongings he had left and brought them to him.

 

Once he was loaded in the back of the ambulance, I turned around to say goodbye to Carrie, but she was already walking across the field.

 

"If she hadn't found him, he would have been dead," I said aloud.

 

I waved to her, and she gave me a little salute in return as if she were a cowboy and was tipping her hat to the townspeople as she rode off into the sunset.

 

"Who's that girl?" One of the firemen asked me.

 

"That," I said.  "That there little woman is Narcania!"

 

"Huh," he said.

 

"I read about her in the comix!"

The Hartford Courant this week noticed what most everyone else around here has-- panhandlers are on nearly every corner of big intersections these days. Many carry the standard signs drawn on ripped cardboard "Homeless and Hungry." Some wear masks, others don't. Some make eye contact, others look down at their feet. They almost universally say "God Bless," when you roll down your window and give them a dollar. I suspect that is more panhandler etiquette than religious belief.

 

How many of them have lost their jobs, and their homes due to COVID and the economic downturn? And how many of them are substance users? What are they doing with the money? Buying bread to feed their families or buying liquor or drugs and/or alcohol to fight off withdrawal sickness?

 

The article reports that several towns are asking people not to give panhandlers money for fear it will encourage them and increase the problem. Instead, they advocate donating money to local homeless shelters and other charities that service the homeless population.

 

I am one of those who gives panhandlers money. I donate to a local harm reduction charity too, but I know how much a smile, a look in the eye and a dollar or two goes for someone down on their luck or even someone in need of four dollars to get their next fix to hold the sickness at bay. A couple of dollars means nothing to me. Even though I have a daughter in college and another headed there, I work two jobs and make enough money that I can sleep at night. Between the floor of my car, the ashtray and the center console, I always have a few bills and a ton of change that I am not doing anything with. And if I have a single wrapped protein bar or an unopened bottle of water, I may hand them one of these, too.

 

I do have certain rules about which panhandlers I donate too. I admit I freely donate to people I know to be heroin users. These people I either know by sight as people I have seen on Park Street or who I judge by their gauntness. You give them a buck or two and they are gone, headed to Park Street to get their medicine. The ones I tend to avoid are the ones who are there everyday, who stay in one post and never seem to leave. You give them food and they say thank you and then they put the food into their backpack or shopping bag. I have given apples to heroin users and they have cored them before the light has changed. For heroin users with no teeth, I give them oranges and they have peeled and munched down on them before they have even remembered to say God bless. The ones who put the food in the shopping bag and don't eat it right away I am skeptical of.

 

There is an old man with a white beard and a can who is a frequent panhandler at one of the major intersections. I stopped giving money once I realized I never saw him on the rainy days, that he kept regular hours and that he never seemed to eat the food people gave him. I began to suspect he was a professor conducting research on panhandling. I'm probably wrong about that and he may in fact have a chilling life story. Another woman I stopped giving to, is on the same corner from morning to night, and every time I drive by she is putting the food someone has given her into a shopping bag. I don't know if she is putting the food away to save for her family or to hide from people's view who may be less inclined to give if they see her haul. Maybe she has kids at home, but I don't think so. I wish I did know her story, and writing about her now makes me feel like a bad person for judging her. If I had to make up a story for her, I would say she has an abusive boyfriend/pimp who puts her on the street not for sex, but to collect change which she has to give to him at night in place of a mattress to sleep on. No easy life that. When I do give to her, I don't see relief or happiness on her face, just pain. One day I ought to get out and give her ten dollars in return for hearing her story of how she came to be on that corner every day.

 

Sometimes I give heroin users five dollars and ask them to tell me about their lives. I consider it fair value as what I learn is more than I might learn from renting a movie. I think I favor giving my change to heroin users because I know how happy or relieved the money makes them feel, knowing that they can stop worrying if even for a few moments about how they are going to get their next fix. They remind me of the myth of Sisyphus, where Sisyphus is condemned to forever push a rock up a hill and when he gets to the top, it rolls back down and he has to roll it back up the hill. I feel if I give them a dollar or two, it's like I am offering them a chair to sit in and a glass of lemonade to sip for a moment before they resume their relentless struggle.

 

I know some say I am enabling them. I don't think that my dollar is the difference between their decision to quit using or continue. Addiction doesn't work like that. I think my human interaction is more important. I'd like to think that it tells them that the world is not all against them, people do not look down on them, but view them as fellow journeyers on this planet, and that kindness still exists in a world that has treated them roughly.

 

Some of my fellow EMS workers will give to panhandlers, but only food. Food is appreciated, surely. But I bought a large pizza once for a group of users once and bought turkey dinner another time to others. While the gestures were appreciated, the food did not fare well for their stomachs that were not conditioned to that type of greasy food in such quantities.

I always remember the time I asked one user who was standing in front of the Spanish Market if she wanted two dollars or for me to buy her anything she wanted for lunch. "Two dollars," she said without hesitation. I gave her the two dollars, then went inside and in addition to my order of roast pork, yucca, rice and tostones, I asked for an alcapurria  (a fritter made of plantain) and a champagne cola for my friend.

 

Two dollars has more value in a homeless heroin user's world than food. The two dollars ends the body aching, the nausea, the stomach upset. It brings peace, forgetting, even if only temporary of their painful trail and current place.

 

And I have to tell you. If I can bring them a little bit of happiness, it makes me feel good too. So there is some selfishness there. I feel like Bill Gates. Let's give some money away. I drive around the city and in twenty minutes I am ten dollars lighter, but I have made five people happy and I feel good myself. Everyone may have their vices. Giving spare change to others is better than me spending it at the bar myself. I go home at night to my warm house, kiss my kids, fill my belly with food and sleep soundly next to my wife.

 

Here's what the Pope has to say about giving money to panhandlers:

 

Interviewer: Many people wonder if it is right to give alms to people who ask for help on the street; what would you reply?

 

Pope Francis: "There are many arguments to justify oneself when you do not give alms. 'But what, I give money and then he spends it on a glass of wine?' If a glass of wine is the only happiness he has in life, that is fine. …Help is always right. Certainly, it is not a good thing just to throw a few coins at the poor. The gesture is important, helping those who ask, looking them in the eyes and touching their hands."

 

Help is always right.

 

And it turns out it is good for me too.

 

Proverbs 11:24-25 "A generous person will prosper; whoever refreshes others will be refreshed."

 

The Psalms (112.5), "Good will come to those who are generous and lend freely, who conduct their affairs with justice." 

 

I feel the same about politics and government. I may be one of the few, but I am always willing to pay higher taxes if the money is going to help others. I don't like it when government cuts taxes for the right and the programs for the poor are slashed, jobs cut and average American thrown out on the street, while the rich get richer.  I feel happier when I sense the world has less suffering in it.

 

The term panhandling comes from people holding out tin pans asking for money.  Alternatively, they are asking for money to buy bread, which is also known as pan. Breaking bread with someone else is a Christian term, meaning to have a meal together, to share common humanity.

 

Help is always right.

 

God Bless.

Years ago, I did all of my writing at a desk in a lonely room. I would write on yellow legal pads and then when I had something, I would type it out on my portable smith corona. When my daughter was little, I showed her my old typewriter and she was fascinated with it. She had never seen anything like it. I told her about white out, which for those of you who don't know was like white paint you put over your mistakes so you could retype over the error without having to retype the whole page. I hitchhiked across the country carrying a backpack, a sleeping bag and my portable typewriter. I went everywhere with it, but when I used it, I only used it at a desk.

 

Over forty years later, I do most of my writing on a $125 Google chromebook that sits on my lap -- whether I am in the front seat of an ambulance or now, sitting in a gym (mask on) watching my daughter's AAU basketball tryouts. Her coach called the other night and was talking with me about her playing up another level with older girls, and we discussed the pros and cons -- whether she plays with her own age girls where she can be the star or with other girls where she may struggle. I talked with my daughter about it on the ride over here tonight and she said, Dad, it doesn't matter which team I play for, I get to play basketball!

 

With COVID numbers creeping steadily up, we don't know if there will even be a basketball season, but it sure would be great to be able to keep watching her and other girls out on the court running and shooting The ball swishing through the net. Seeing them all smiling. It's basketball!

 

The town opened the pool up so I have been swimming four times a week. I am not in the shape I was pre-COVID, but I am slowly getting back in shape. Today I did several 50 yard freestyle sprints. I got plenty of rest in between efforts drinking Gatorade while I caught my breath. It felt great to push myself again, head down, arms reaching fast and long, kicking tight and strong, driving for the wall. Swimming! Racing!

 

When I work the ambulance, the shift is long, but I try to clear the hospital quickly when it is busy. I am in the rapid response fly car. When the fire radio goes off, I hit my lights and sirens on and notify dispatch where I'm headed. (In our system Fire gets the call first, then they notify the ambulance.) The fire radio gives me a jump on the calls, and I often am the first to arrive on scene. Up the stairs, through the door, down the hall into the bedroom, where a person lies unconscious on the floor, everyone else in the room now looking at me. When I punch out at the end of ten hours, I am tired but fulfilled. I earned my pay and felt my work was valued.

 

My days are full between work at the hospital and on the ambulance, with taking my daughter to her sports, doing chores around the house (not enough chores as my house is always in a state of disrepair), trying to keep up with the events of the world and trying to make sense of it all with the words I write.

 

Sitting here pounding away at the keyboard, I feel that life is good. I am making use of time. Every night when I go to bed, I am sad that I have to go to sleep and say goodbye to another day on earth.

 

I don't sleep as well as I wish I did. Too much on my mind. COVID-19, Race Relations, Opioid overdoses, the presidential campaign, division and violence in the world. And on a more personal level: Am I being a good father to my daughters? A good husband to my wife? Was I a good person to others? When will I see my father who lives in Florida again? How is my health? (My shoulder hurts, I have a nodule on my thyroid, I cough chronically, I am due for a colonoscopy, but don't want to go). What repairs do I need to do to my house? (One gutter is falling down. I will soon be in need of a new roof, the back steps are starting to rot, all the rooms need repainting). Have I saved enough to retire when my body can no longer carry me through my working day?

 

I am still tired when I get up in the darkness of morning as my world spins farther from the sun on its annual trek. But I don't linger in bed. I don't tarry. So much to do. So much life to live. I may slip up, and I have no white-out to fix my mistakes, but I keep on typing. Keep on keeping on.

 

Now I look up and see the ball swish through the net. Joy on my daughter's face, and then determination and she hustles to get back on defense. No rest on the court. Playing basketball!

 

Stay safe all. Keep on keeping on!

 

Tap Tap Tap.

My old boss, former United States Senator and later Governor of Connecticut, Lowell Weicker used to say, the mark of a great country is not how it treats its richest citizens, but how it treats its most vulnerable.  Yesterday, we witnessed President Donald Trump emerge from Walter Reed Hospital, chopper on Marine One back to the White House, stride across the lawn, mount some stairs, stand on a balcony like an emperor and then rip off his face mask and smile (smirk depending on your view).  The same man earlier tweeted "Don't Be afraid of COVID.  Don't let it dominate your life."  He later declared that COVID was less of a threat to people than the simple flu. (COVID has already killed more Americans than the last five flu seasons combined.)

 

In a matter of days, he had gone from a man with a high fever, needing oxygen to again assume the throne of the most powerful man in the world.  While in the hospital, he had received world class care, including two drugs typically reserved for the sickest COVID patents and an experimental monoclonal antibody "cocktail" not yet approved by the FDA and unavailable to nearly everyone else.

   

Some have speculated he never had COVID and this was a political stunt.  I don't believe that, given the ridicule he has faced oer being infected as well as the high number of people who were apparently infected at the rose garden "superspreader event."  Others are not so sure he is recovered.  We know  from experience that it is in the later stages 7-14 days post infection often after the person has started to feel better that COVID sinks its teeth in and hauls down its prey.

 

Let's hope that's not the case here.

 

I write this because a nation is not its leader, it is its people.  Hear the drumming.  210,000 dead and counting.  Nationwide we mourn those we have lost.  Millions more still sick with long roads ahead and for some no recovery from permanent damage.  But don't let it dominate your life.  Today Anthony Faucci warns we could lose another 200,000 this winter if we are not careful.

 

As we in EMS have learned over the years to look through the eyes of our patients, so should we as a nation look through the eyes of our citizens.

  

Empathy, Compassion, Kindness, these are the traits of which we, as a nation, should strive for and be most proud.

 

Stay safe out there.

For over twenty-five years I was a full time street medic.  I have been part-time now for only a few months.  I have tried to work at least 20 hours a week, but there have been a couple of weeks when I have only worked once, and one week where I did not work at all.

 

I sit at my desk at the hospital and watch the crews come in and listen to their stories, and i feel like a desk-jockey fan boy wishing i was still out there.  Tell me again about that call…

 

When I was full time I always worked at least three twelve hour shifts in a row so my weeks balanced between being a paramedic and then living a regular life.

 

Now that the regular life is a much larger portion of my time, I am finding two things.  I don't look forward to going to work as much as i did and when I do, I am nervous.

 

This isn't to say that I still don't enjoy the work, and don't for most part, still feel comfortable in the position.  It is just that I feel unbalanced.

 

Not having to get up at 4;30 in the morning is great.  Being always free to take my daughter to her sports practices and games is very special.  Getting more time to exercise is life-saving.

 

But when I am back on the street, I feel like a second string guard being put in to play for a few minutes while the starters get a rest, then I am back on the bench, never having really gotten into the flow.  Maybe I scored a bucket or two or had an assist, but I am not the starter.  I think back to when ten years ago, I worked six days a week, and working as a paramedic was as smooth for me as breathing. It was my world.

 

Now sometimes after a long busy shift, I start to feel back in the groove but then I am punching out, and several days later when I punch back in, I feel like a newbie again.

  

I do good calls and I want to work more.  Schedulers who are always trying to grab people for extra shifts (The COVID slowdown has ended) would do well to post themselves in hospital EMS rooms after big trauma calls or STEMIs.  You want to work an extra shift?  Hell yeah!  Sign me up!

 

Sometimes, even after the end of the busy shift when I have done calls that I felt mattered, I will take a look at the open shifts.  I'm a paramedic.  This is where I belong.  This is what I do.

 

I look at my schedule now and say, yes, I'll take that, no, wait a minute, I have a meeting at the hospital that day or yes, I can, no, wait, my daughter has basketball practice, sorry, not available.

 

I do feel more rounded in my life and healthier, but I don't think I'll ever be fully comfortable as a part-time medic.

 

The firefighters are always asking when am I going to retire.  I tell them I will when my daughter graduates college.  Looking at 2030,  I'll be 71.  I hope I can make it that long.  Not sure I'll be able to.

 

I worry that as hard as going part-time has been, retiring completely will likely be even worse.  I'll sit in my rocking chair and when I hear the sirens in the distance, I will have to turn my hearing aide down to keep the pangs of loss from being too great.  If I am ever in a nursing home (please put a bullet in my head), how will I feel watching the crews wheel past my open door?  Will I wheel myself out into the hall and race after them?  Or will I take a pillow and try to suffocate myself to spare myself any further torture of the sad knowledge that life that has passed me by?  When the paramedics come through the door for me, I hope I am long gone.

 

Followers of the legendary guitarist Jimi Hendrix and Duane Allman leave joints and guitar picks on their graves.  Anyone looking to track my final resting place down, please don't put a toy ambulance on my site.  The joint will probably be okay, because I imagine that later in life after my children have grown and moved away, I will have a medical marijuana card by then to ease my  chronic pain and depression.  Wait!  Actually I do not wish to be buried in the cold cold ground.  Cremate me instead.  Spread my ashes in the places I have loved.  Fenway Park, the Atlantic Ocean, and yes, the city streets of Hartford.

Interesting article on NBC news about the use of ketamine for sedating patients in police custody. 

 

Elijah McClain was injected with ketamine while handcuffed.  Some medical experts worry about its use during police calls.

 

The reporter centers the story around the tragic case of Elijah McClain, who was apparently walking down the street, wearing a face mask and listening to headphones when a 911 caller said he was acting strangely.  The police stopped him and ended up taking him down with a chokehold.  He said he couldn't breathe and he vomited.  EMS came.  The officers told them he was on something and was exhibiting inhuman strength.  The medics gave Elijah a large dose of ketamine, and shortly after he was in cardiac arrest.  He was resuscitated, but suffered a brain injury and was unplugged.

 

In light of today's awareness of cases of brutality, this case has aroused considerable attention and controversy.

 

The article seems to take the positions that 1) people should not be injected with a sedative during a police action and 2)  they should not be injected against their will.

 

The reporter talks to two college neuroscientists, a pharmacy professor and two lawyers including  someone from the American Civil Liberties Union.  He doesn't talk to an emergency physician or a paramedic.  An ED doctor or a paramedic would have likely provided insight into the real world conditions where these cases play out.

 

Here is my take on it.  First, I just want to say, this was a tragic case that should never have happened.  Just because someone is acting strangely or may be mentally ill (unless they are bothering someone or are observed committing a crime), they probably shouldn't be physically restrained.  Where I work in Hartford there are a lot of people who act strangely, but once you know them, you learn they are not acting strangely for themselves.  There are just a lot of strange people out there, and not everyone should be held to the normal person standard. 

 

In this blog post, I only want to address why a paramedic would give someone ketamine or a sedative like Versed or ativan (benzodiazepines) against their will.  (Note: I do it quite frequently.)  We don't carry ketamine in my section of Hartford, but as an EMS clinical coordinator that oversees several EMS services, we approve ketamine for use in certain circumstances, including to sedate violent patients. 

 

Our statewide paramedic protocols call for a number of measures to calm someone down and deescalate scenes.  It is not uncommon for us to respond to a violent EDP (emotionally disturbed person).  In many cases, the patient may be on drugs such as PCP and are resisting efforts. They may be naked in the middle of winter walking down the street.  (PCP makes people hot and it is quite common to have them disrobing in public). They may be smashing windows or merely threatening others.  I have had such people jump out of open windows.  They may also be schizophrenic, off their meds and talking about killing themselves or others.  If they are just plain crazy, standing on a street corner talking to themselves, as long as they know where they are, and have no intention of hurting themselves or others, we leave them alone.

 

Patients may only be restrained under the following indications:

 

Any patient who exhibits an altered mental status and may harm himself, herself, or others or interfere with their own care may be restrained to prevent injury to the patient or crew. Restraining must be performed in a humane manner and used only as a last resort.

 

We are authorized to do both physical and chemical restraint.  if someone fights against the physical restraints, I will chemically restrain them.

 

Continued patient struggling against restraints may lead to hyperkalemia, rhabdomyolysis, and/or cardiac arrest, chemical restraint may be necessary to prevent continued forceful struggling by the patient.

 

When I arrive on scene, I try to talk to the person, who the police may be holding down, sometimes in handcuffs, sometimes not.  If the person is alert and oriented and can carry on a normal conversation, I will ask the officers to let them up and take off their handcuffs.  If they are still resisting and are out of their minds, I will sedate them per out protocols.  The sedation works wonders.  It takes a few minutes to work, and I will urge everyone on scene to resist agitating them further, and let the medicine take hold.  I get them on the stretcher, we take the cuffs off and they are often sleeping like babies by the time we arrive at the hospital.

 

Paramedics do not medicate at the request of police.  Paramedics medicate based on their own medical guidelines to protect the patient and others from injury.  If a paramedic medicates a person, they are not transported to the jail, but to the hospital where they receive full emergency evaluation and care.

 

I try to put myself in the situation of responding to this particular case.  If I show up and if police are fighting with a man and they tell me he is on something and is showing extra human strength I am inclined to believe them (provided their description seems to match what is occurring in front of my eyes) and I would be inclined to sedate the patient if it appeared what the police were saying was true.  

 

As far as the excessive dose Elijah McClain received, I will say it is not always easy to properly estimate a patient's weight or age in a chaotic setting.  We can't have them step up on a scale as they might in a doctor's office.  The fact that they estimated his weight at 220 pounds is curious because 220 pounds is 100 kilograms, which makes estimating the dose of ketamine much easier than if a patient weighed less.  At 5 mg per kg, the dose would be 500 mg.  Easy math to do in the head.  If the patient weighs 140 pounds, you would have to do the math  140 divided by 2.2 equals 63.6 kilograms.  Then 5 X 63.6 gives you a dose of 318 milligrams, about 2/3s of what he actually received.  A bit more complicated math, harder to do in your head than with the 220 pound/100 kilogram patient.

 

Maybe EMS should be more cautious of the story they receive when they arrive, but I can say based on experience, when the police say that the patient is violent and has superhuman strength, that is usually the case.  I have seen small women on PCP throw large officers off themselves.  I have seen police officers have the s kicked out of them, all the while employing only defensive tactics against people to avoid hurting them.  I have also seen officers respond back with what I might consider excessive counterattack.  The point is there are many mentally ill patients who are violent and there are a lot of drugged out patients who are also violent.  Sedating them is better than wrestling them or having someone, patient or medical worker, get hurt. 

 

As far as dosing, EMS needs to improve its weight estimating abilities, and should probably err on underestimating, particularly with a drug such as ketamine.

 

 

In 1999, I wrote a letter to the editor of the Hartford Courant about a police shooting in the city.   The newspaper reported that an unarmed 14-year old black boy had been shot in the back by a white police officer.  They put the story on the front page under the headline Family, Police Want Answers: No Weapon Yet Found At Scene Where City Officer Fatally Shot 14-Year Old   

 

The New York Times also ran a story on the shooting:  Unarmed Boy Is Fatally Shot By the Police In Hartford

 

What motivated me to write the letter to the Courant was the photo of the victim the Courant put on the front page.  Here's what is looked like a little larger.

 

They used a picture of a ten-year-old boy.  I knew the EMS responders on the call that night and they thought the shooting victim was a man in his early twenties.

 

I knew the officer who had shot the boy.  He was far from one of my favorites.  He was one of those cops who was a cop and let you know it.  Still I felt he was getting a bum deal.  The photo of the child was incredibly biasing against him, and I scolded the paper for it.  It apparently made little impression on them as it was never published.

 

Clearly my mindset back then was different than it is today.  (I had completely forgotten about this incident until the other day when it flashed into my mind). Not that I still don't think it was shoddy journalism to put a picture of the victim as a ten-year-old, but I did truly believe then that the victim was a criminal, a thug and up to no good and that he likely deserved what he got.  I don't know whether the fact that he was black or not figured much into it.  In the north end of Hartford, 95% of the population is black.    If I worked in a city that was 95% white and a cop gunned down a 14-year-old I might have felt the same, but maybe not.  Maybe if he had been white, the cop would have let him keep running or not believed the boy might be reaching for a gun and it would never have been a story.

 

There was much community unrest over the shooting.  An all-star panel investigated the incident and exonerated the police officer.

 

The Hartford police chief during the incident had taken a leave of absence, and was replaced by a respected black officer, Deborah Barrows.  Her standing  in the community is credited with preventing riots when the report was released.

 

 

The report stated the boy was one of four youths who "rented" a white Cadillac from a drug addict for $15 so the addict could buy crack.  While joyriding in the drug addict's ride, they brandished "guns," tried to mug a 41-year old woman, who Salmon hit over the head with his "gun"and then on being chased by police, fled the vehicle.  When the lone officer chasing them through a dark back yard commanded the boy stop, the officer allegedly heard a gunshot, he thought he saw the victim reach into his belt and turn.  That was when he shot him — a shot more through the side than in the back (consistent with turning) it was later determined.  No gun was recovered, but a cigarette lighter that looked just like a gun was found at the scene, and another one was recovered in the car.  The youths had apparently bought several of these gun-lighters earlier in the evening. These were the "guns" they had been brandishing on their joy ride.

 

That incident occurred at 2:30 in the morning on a school night, and the fourteen-year-old victim had a home confinement bracelet around his ankle.  Despite the bracelet he had apparently not been home for two weeks.

 

I wonder now if the same event occurred today, how we (I) would be reacting.  Maybe there would be video footage that would tell a different tale.  Maybe it would show a boy running and an officer taking aim, and the boy turning with hands up to surrender, and the officer still firing.  Maybe it would show exactly what the report concluded.

 

Maybe Hartford would be on fire.

 

Reading the papers from back then makes me incredibly sad about the lack of progress in our country today.

 

Barrows said she hopes Aquan's death has awakened the city to issues it can no longer ignore — namely homeless teenagers in trouble with the law, who have trouble succeeding in an ordinary school setting…."It's time to stop talking. What are we going to do? Aquan Salmon's death should have awakened everyone . . . If the Aquans of this city aren't safe, my kids aren't safe," she said.

-Chief Deborah Barrows

 

I still feel that the picture of the 10-year-old Aquan Salmon was biased against the police officer as it made people think he had gunned down an innocent child rather than a troubled manchild with a model gun that looked real who was indeed up to no good in the late hours of the night.

 

Maybe better training or more experience would have kept the officer from pulling the trigger, but that is just speculation.  Who am I to judge someone who had to make a split second determination that means the difference between life and death between yourself and a stranger, between going home to your family at night or them laying a wreath on your grave?

 

But I have changed my mind about one thing.  The ten-year-old boy in that photo is a victim.  He was a victim, not of a rogue police officer, but of a system and a society that failed him and many others like him. He grew up in a poor, dysfunctional family, many who were in or spent time in jail.  He had no role models, no one to steer him in the right path.  The schools in Hartford are far from the schools of its suburbs.  Here in Connecticut, the quality of your education is determined by the zip code you live in and the wealth or poverty of your neighbors, not a child's needs.

 

The Connecticut I grew up in was far different than the Connecticut Aquan Salmon knew.  The Connecticut many minority children are growing up in is different than the Connecticut many poor children in Hartford grow up in.  We can talk about black versus white, but it is really opportunity versus none.  It is about the disenfranchisement of our inner cities.  Some people say get what is yours and pass it on to your own.  Others say use your time on the earth to make the world a better place for all.

 

It is easy to put a Black Lives Matter sign on your freshly cut suburban lawn, to applaud the end of the Confederate flag or confederate statues being torn down, but what will matter in the end, is our country's support for a deep and committed redistribution of educational opportunity so that each kid growing up in our country has the same chances, the same preparation to make the most of their individual lives and not get lost at so young an age.  If you live in a rich suburb and don't want to give up the quality education your child receives, then don't fight against taxes on the more advantaged to provide the same opportunity for the children of the inner-city or poor rural areas.

 

Aquan Salmon would have been 35 years old this year.  Maybe he might have found the path.  Statistically, he would have been more likely to end up in prison, certainly on the path he was headed.  Maybe he would have gotten out of prison and become a community leader, helping others avoid the mistakes he made, or maybe he would have been arrested for buying cigarettes with a counterfeit $20 bill.  Maybe he would have ended up on the pavement in some city with a policeman's knee on his neck.

 

I hope that 20 years from now when we look back on 2020, that it won't be the same old story.  I hope we will look back with pride on the actions and commitments we made to right the world.

 

I hope that we make a safe, nurturing place for all children to grow up in.

 

I hope this movement in the country is real and lasting.

 

Peace and justice for all.

 

Power to the People.

With all that is going on these days, I thought of Kevin Andrews, one of my first partners in EMS.

 

In EMS, we cannot help but be shaped by our earliest partners. They are the ones who show us the way. I was lucky in that regard.

 

Kevin Andrews was one of my first partners. This was back in 1989. I was a spanking new EMT — so fresh I didn't even have my certification yet. Due to an EMT shortage I was working on a waiver that let EMT class graduates work pending the outcome of their state exams. I even wore a "whop kit" – one of those pouches that attach to your belt and hold your tools of the trade. Mine was small and conservative by some standards. I had a penlight, trauma shears, bandage scissors, and a window-punch.

 

We worked for Eastern Ambulance, a mom and pop ambulance company in Springfield Mass that had the 911 contracts for three suburban towns in addition to backing up calls in the city and doing transfers. On a good day we only had five ambulances on the road. On most we had three. Some of the ambulances had brown bondo on the sides and in one, you could see the road through a hole in the floorboards. On Fridays, we use to all race down to the bank to try to cash our checks. The last to get there often found theirs would bounce. We didn't have paramedics, just basics and intermediates. We didn't even have defibrillators then. But we were a close-knit group, and there was more to the job than money.

Kevin was an EMT, but he was respected as any of the intermediates. He'd tried to take the EMT-I exam a couple times, but kept just missing it. He was very street smart, but had trouble overthinking the tests. I, on the other hand was book-smart, but had no clue about the street. With the wrong partner, my life at work could have been made miserable. I was always glad to find myself working with Kevin.

 

We were both thirty then, but our backgrounds couldn't have been more different. He grew up in a large family in Springfield in a neighborhood where the drug trade flourished. I was from an upper middle class suburban family and my most recent job was working for a United States Senator until his loss had send me on this personal quest to learn how to help people in person rather than from behind a policy desk.

 

Kevin was a big strong man with a shaved head who a instructor and black belt in karate. Still he was gentle and soft-spoken, with a ready smile. I never saw him raise his voice or become excited on a scene. He had that calm about him that for all the occupations I have worked in, I have only ever really seen in certain EMS responders — an unperturbed always in control manner that seemed to deescalate any panic around him from patients, bystanders or partner. He always knew what to do, and if he didn't, he never let that on.

 

Sometimes we used to stop at his mother's house where she always made sandwiches for us and we would visit with his youngest brothers and sisters before heading back on the road. He was their clear pride. Out on the street, Kevin would point out to me the drug houses and dealers. What I might have thought was an innocent boy of twelve on a bike, was instead a drug-dealer's lookout. It was a new world for me.

 

My clearest recollection of a call with Kevin was on a cold sleety morning in winter when we responded for a woman who had slipped on the ice on the top steps of a church. I could tell right away her arm was broken. I palpated it through her coat and it felt almost as if it were in two separate pieces. I had my trauma shears out in a jiffy, but before I could make my first cut, Kevin had a soft but strong grip on my arm. "This might be the only coat she owns," he said quietly. "Let's see if we can ease her arm out of it." Which is what he did, taking his time not to cause any pain. The woman's winter coat was preserved and her arm was carefully splinted and he talked to her in a reassuring way that caused me to feel only awe at what I was witnessing. It made me see that EMS wasn't really about blood and guts and bad car wrecks and doing CPR. It was about taking care of people.

 

The company went bankrupt a couple years later. By that time I was only working one overnight shift a week. I was back behind the policy desk as the ex-Senator after a year in exile had run for Governor and won. Despite the full-time government job I was not only hooked on EMS and had to get my weekly fix, but I felt like I was a part of a family at Eastern Ambulance and I didn't want to lose that connection. I hated to see Eastern close. Kevin and most of the others we worked with went to work for another ambulance company in Springfield while I joined a volunteer service in Connecticut.

 

I saw Kevin periodically over the years. We had a few Eastern get-togethers. Another time he and his girlfriend brought their kids down for a picnic at the condo in Connecticut I shared with my own girlfriend at the time. I visited him in the hospital when he got a bad infection and had to get IV antibiotics. We'd talk on the phone sometimes and get caught up on how all the people we worked with at Eastern were doing. He told me he was honored when I mentioned him in my first book. I was honored to be able to write about him. Whenever he'd call, even if we hadn't talked to each other for a couple years I'd say "Kevin" recognizing him at the first sound of his voice.

 

The last time I talked to him was three years ago right around the birth of my daughter. He'd mentioned there was going to be a new get together of some of the old people we knew. I wrote his number down, but in the confusion of the time, misplaced it. I have always been somewhat of a recluse. I work all the time and I'm not the best about keeping in touch.

 

A month ago I talked to a woman who'd also worked ambulance up in Springfield, starting shortly after I had left the area. When I mentioned I had worked for Eastern, Kevin's name came up. She said she knew him and that he was helping teach basic EMTs at the college where she also taught. I said to say hello. Later in a New Year's Day phone call, she told me she had talked to him and that he had been excited to hear she had spoken with me. He told her about the good times we'd had as partners. She'd given him my cell phone number and he'd said he was going to call me. She wanted to know if he had ever gotten a hold of me. He hadn't. And now he won't be. The reason for the call was to tell me he had passed away suddenly. She didn't know the details. The rest of the conversation was a fog. I kept thinking. What do you mean? He passed away?

I have always found it hard to believe people I have known are gone. I have to see the obituary in the paper. I found it and there is was in print. Kevin Andrews, 52.

 

I am not one who believes in heaven or an afterlife. I believe when you are dead, you are dead. There is no place where you go to sit with others or wander among the clouds. Your conciousness is no more.

 

But what I do believe in is memory. I can close my eyes and see Kevin sitting right next to me in the ambulance, telling me a story. I can see him standing there in his mother's house smiling watching his brothers and sisters play, and then years later, sitting on the back deck watching his own children play in my yard. I can see the true friendship in his eyes and feel his warm handshake when he says "Keep in touch."

 

And I can still see him taking care of that old woman on the church steps as clear as if I were still there. I watch his hands and I want my hands to be able to soothe someone as his do.

 

***

Kevin shaped me as a caregiver and as a person. He helped make me the paramedic I am today. If I am gentle toward a patient, than Kevin's spirit is in me, Kevin's touch is in my hands. If watching the way those of us who were influenced by Kevin treat their patients, others are now gentler with the sick and injured, then Kevin's hands and heart are also in them. His breadth widens. This is what becomes of him. This is how Kevin is passed on, from one caregiver to the next. Let this be how he is remembered.

 

The great church doors open to the icy weather. Outside on the cold steps, an EMT caring for a patient.

A beautiful spring day.  The sky is robin's egg blue.  The air smells like fresh cut grass.  We cut our sirens on approach, and are driving now through the residential neighborhood.  Kids are out on their bikes.  There are joggers aplenty.  Nearly every house has someone out beautifying their yard.  Neighbors talk and laugh with one another.  Optimism abounds.  In just a matter of days, the state will begin phase one of the opening, but in this neighborhood you can already see a future that looks just like the past.  A return to glorious normalcy.

 

People pause and watch us drive slowly past before returning to their conversations.

 

Several blocks away in this residential neighborhood a man and his wife sit holding hands on the front steps of the home they have lived in for thirty-five years.  Red and yellow tulips line the driveway.  There is a basketball hoop above the garage door and an old swing set in the backyard.  The man, his eyes wet, looks at the woman with concern.  Her hands shake.   A man in a bright yellow hazmat suit wearing a gas mask stands over them, checking the woman's pulse saturation.  It is 84.  The couple tested positive for COVID three days ago, and have been on self-quarantine, but her fever grew worse and she became short of breath so he walked slowly to the phone in the kitchen and dialed 911.

 

"I made a mistake," she will tell me on the way to the hospital, her hands and voice trembling.  They went to a party two weeks before where no one wore their masks.

 

Now as we leave the scene she looks out the ambulance's back window at the house where she has raised her family.  She may be wondering if she will ever see her husband, her family, her home, her neighborhood again.

A large man stands handcuffed, surrounded by six police officers by the side of the road.  Nearby two citizens have their iPhones out recording.  The man does not mince his words.  "I'm going to kill all of you.  I hate cops.  I'm going to eat you.  You're gonna be in my belly."

 

It is clear that this man is having a manic episode.  He will not shut up.  On and on, he goes about the horrible things he's going to do to.  "Give me back my guns!  I already took my drugs!  Now let me go!"

 

The guns it seems are two plastic toys with flashlights taped to them with masking tape.  "I'm going to kill every motherfucking last one of you."

 

I walk up to an officer to get the story.  "Have you dealt with him before?" she asks.  "This is not unusual for him."

 

I don't recognize him, but he is not unfamiliar at the same time.

 

I nod and then approach him.

 

"Look at what they doing to me," he says.  "I'm going to kill them and eat them!"

 

"You like drugs?" I say.  "How about  Ativan?  I'm going to give you some benzos.  They'll make you feel a whole better."

 

"I already had my drugs!"

 

"More the merrier," I say.  "I give you a shot in the leg, tiny needle, no pain.  You'll feel better and we can get you out of these cuffs."

 

"Take me to the hospital," he says.  "But my guns are coming to."

 

"We'll put them in your bag."

 

He takes the shot – I give him 10 of Versed in his thigh.  He takes it like a champ.  It takes a little while, with pushing and prodding, to get him on the stretcher, and he keeps jabbering away.  We get his two bags and put them on the back of the stretcher.

 

I ask the cop to take his cuffs off.  "He's agreed to behave, isn't that right?"

 

The cop looks dubious, but I don't want this guy lying on his wrists.  I am counting on the Versed and my own powers of persuasion to keep him distracted, and keep him from wrecking any havoc on me.

 

The cuffs come off and he doesn't take a swing, though he keeps up the verbal barrage about how he hates cops and will come back and kill them all for his dinner.

 

He doesn't stop talking in the ambulance, but at least he is not aggressive towards me.

 

"You know who I am," he says, as he reaches into his bag and pulls out a long wig of purple hair, which he sets on his head.

"You're Rick James!" I say, referencing the 70's funk star, who he has become the spitting image of.  "Super Freak, Super Freak," I sing.

 

"No, man I am death.  D-E-A-T-H.  You know who lives in my wrist?"  He points to a large scar.

 

"Tell me."

 

"Jesus Christ.  He lives in my wrist.  He comes and smokes weed with me in the mirror at night."

 

"Interesting," I say.

 

"You look stressed."

 

"Well, all this COVID stuff has me a bit drained."

 

"You know where COVID came from?"

 

"Wuhan, China?'

 

"No, it came from my right eye ball.  I set it loose on the world cause I'm death.  D-E-A-T-H."

 

"Are you planning to summon it back to your eyeball?"

 

"No, I got a girl staying there right now.  My soul sister.  I'm getting mine." He punches his fist against his hand several time rapidly.  "You follow?"

 

"I think so."

 

"We all got soul sisters in our eyes.  You, too!  Don't tell your wife about her."  He makes that motion with his fist and hand again.  "Get yours."

 

"Maybe you could make some room in the other eyeball and get that corona back in there somehow."

 

"You look stressed," he says, again.  "You should quit this job.  Go buy yourself some weed, smoke it in the mirror and talk to Jesus Christ.  Then go get yourself a good job.  Go work at Stop and Shop.  Take the load off, you're old.

 

He ends up four pointed in the psychiatric wing.

 

When I punch out, my partner says if it works out for me at Stop and Shop, maybe I can get him a job, too.

 

***

 

I am feeling old.  The COVID quarantine with the swimming pool and gyms closed, my workout routines have gone to seed.  I find myself sitting in front of the TV most nights, and when I watch TV I need to be eating.  I have gone from raw vegetables and berries to bags of potato chips and Oreos.  My pants are starting to feel tight.  I do exercise with my daughter.  We film part of a one on one game we play.  I realize she is getting by me not just because as a twelve year old, she is quicker me than me, she is getting by me because I am slow.

 

I am an old man with a bent back and a shuffle to his step it seems.  A friend at the hospital tells me with my lack of a haircut, my thinning hair on top, and my corona mustache, I look like David Crosby.  I don't think he means this in a good way.

 

***

 

I waiver back and forth from I already had COVID-19 (either I had it in the end of January/early February when I was so sick or I got it on the job and didn't have any symptoms other than the general symptoms of being 61 or I had it and was completely asymptomatic—how could I not get it doing the calls I am doing with the PPE I am wearing if this thing is infectious at all) to it is only something people in nursing homes, prisons and group homes with major medical problems need to worry about to being concerned the ache in my bones, the slight sore throat, the cough a little worse than normal, are the beginning of the end for me.  Maybe I will be one of the ones the germ sinks its spikes into as it climbs down into my lungs and makes waste of me.

 

I'm not sleeping so well.  I am trying to eat better and work out more, but like tonight when I came home, I was tired and outside it was cold and windy and damp.  I ended up just taking the trash out.  I had several trips with it because tomorrow the garbage truck comes.  That was my work-out for the day.

 

***

 

I am watching TV now and trying to make sense of what I'm seeing.  Today the President ordered meatpacking plants ridden with the virus to re-open.  The Vice-President visited a hospital and wouldn't wear a mask.  The Dow Jones was up another 532 points.  You would think this thing was over, that it was all going to be sucked back up into D-E-A-T-H's eye.

 

Something doesn't seem right.

 

He is naked in the nursing home hallway, rolling over and over.  We manage to get a sheet under him and lift him up onto our stretcher.  His room air pulse saturation is 74–severely hypoxic.  The nurse, who told us he was COVID positive, said he walks around the wing and can hold a normal conversation.  He is all gibberish this morning, talking in tongues that don't sound human.  I put a nonrebreather mask on him and then place a surgical mask over it.  He tries to grab the mask, but I am able to keep his hands away.  In the back of the ambulance, he tries again to take the mask and oxygen off.  I keep telling him to cut it out and to stop, but he is too far gone to understand me. I take his arms and put both them at his sides, underneath the middle seat belt.  When I move toward the radio to call the hospital, his arms get loose and  he knocks his mask off again.  When I try to  replace it on his face, he grabs my wrist and starts pulling me towards him.  He is strong.  He has a death grip on my wrist.  He grabs my gown and shirt with his other hand and suddenly we are wrestling.  His mask is off and respiratory droplets are shooting out of his mouth right at me.  Even though I have an N95 mask on and a fogged up face shield over that, I am stressed by this turn of events.  COVID -19 has transformed him into Hellboy and he is spitting respiratory droplets at me like a spitfire plane strafing a beach.  I manage to put my knee on his side and and swing my right arm loose.  He still has me by the wrist.  My yellow gown is torn and pulled off my shoulder.  I am finally able to unpry his fingers off my wrist and then I sit back on the seat out of his reach.  The mask is off his face.  He mutters gibberish in his own world.  In the ER he will be sedated, intubated and shipped to the ICU. 

 

Normally after a call, I try to clear the hospital as quickly as I can, but not after this one.  I wash my hands multiple times, and then sit in an armchair in the empty  EMS room.  I write my run form, but instead of getting right up, I sit there a few minutes more.  And then I put my mask back on and head out to the ambulance.

 

I am finding these constant COVID calls draining.

COVID-19 will change many things about America. One may be the care our older Americans get at nursing homes of skilled nursing facilities as they are largely known nowadays.

 

Much of the war against COVID is being waged in these homes. Here in Connecticut, 40% of all deaths have been nursing home patients. Many of the patients coming into our hospital are coming from the same nursing facilities where others have tested positive. The radio patch comes over: "89-year-old female, short of breath, room air sat is 88%, fever of 103.1. Not tested yet, but many in her facility are COVID positive. Respiratory isolation precautions in effect."

 

There is one nursing home in our service area where I work as a paramedic that has a very poor reputation, made worse by their COVID response. We in EMS judge a nursing home on several things, smells, appearance, readiness of the staff to give us a report when we arrive, but most of all on the condition that the patient is found in when we arrive.

 

Some nursing homes the 911 calls are never very interesting. High blood pressure, altered mental status, abnormal lab values; others are always bad-respiratory distress, sepsis, cardiac arrests.  The first group sends their patients out at the first sign of trouble; the latter group sends them when they are in common parlance, "shitting the bed."

The best way to rate nursing homes, if you could do it this way, would be to count what percentage of the time the ambulance leaves for the hospital lights and sirens after picking up the patient versus going with speed of traffic which is how the majority of EMS 911 trips to the hospital go.

 

When you show up at a nursing home and you can't find a staff member and the patient is severely hypotensive or in major respiratory distress and they can't tell you when they were last seen normal, that is an issue. The other response we often get is, "I don't know, I'm just an agency nurse. I've never seen her before."

 

This happens frequently. The worse the nursing home the more it happens. If a home can't keep its staff, you end up temps and agency nurses. That is not good for patient care.

 

Today we pick up a woman found on the floor with a severe gash on her forehead. No one knows how she fell. She can't tell us. The nurse looks at her medical records and tells us the woman has dementia. "How does this compare to her normal?' we ask. "I don't know. I've never seen her before." Any other medical history you can tell us about?" She hands us a mimeographed sheet of paper from several weeks ago that is barely readable both due to penmanship and the number of times it has been copied.

 

Because of the reputation of this facility, as a COVID hot spot, we came in fully gowned with face masks on. The woman's pulse saturation is fine, she is not feverish, but she is talking gibberish and the lac on her head is deep. We take her to the hospital. On the way I read through the stack paperwork the nurse handed me in a red envelope.

 

I can barely make out the words COVID. I have to put my glasses on underneath my goggles to make it out but there it is COVID +.

 

There was no sign on her door, The nurse said nothing about it. I'm glad we had our PPE on.

 

I know many people labor in these facilities for low pay and they are horribly understaffed, so I am not blaming the workers. I blame the system. We all saw how COVID devastated the first nursing home in Kirkland, Washington when the epidemic was first beginning.

 

We had to know it was coming. COVID is burning like gasoline in their homes, and even if we turn the corner on this wave of the epidemic, if we have flattened the curve and the numbers drop, does anyone thing we are prepared for the next wave or the next epidemic.

 

Let's have an economic come in and look at where the money is going in these homes. The nurse's aren't rolling in dough. Many ride the bus to work and have two and three jobs. They leave at first chance for better work. No wonder there are so many pool or agencies nurses in these places or nurse's who say, today is my first day. The money has to be going somewhere. How much do the administrators make? Who are their bosses? Are these homes run by for profit corporations. Or maybe the problem is the state. Maybe these places are truly underfunded for what they do in our society. Maybe we need a different model. This can't happen again.

 

 

COVID targets nursing homes and prisons. Think about that.

 

I remember what my old partner Arthur used to say when we came out into the sun after leaving another patient at a nursing home.

 

"Just put a bullet in my head," he'd say

It's 12:59 A.M. I have given up on sleep. Fortunately tomorrow is my one day off (I will still go into the office to make my COVID EMS notifications) but I will go in at whatever time I feel like and will only stay for a couple hours. It's not like I have to get up at 4:30 to dress in the darkness for a 12-hour shift on the ambulance.

 

I am up not because I can't sleep, but because my sleep is restless and tormented, and because of the tiger.

 

When I last reported on my nightmares. I was being terrorized by the corona germ that looked like Spongebob. He and I faced off on a basketball court without hoops and I was considerably larger than him and I had a blanket that I tried to smother him with, and even though he escaped, and continued to come at me, making a strange high pitched shrieking sound, I could easily kick him off before he caused me damage. He had no teeth or nails. He was after all only made of sponge,

Now it is a Corona tiger that comes at me. I am no longer on a hoopless court, but in a small two story house. At first the tiger came in the open front door from the yard. But now he comes out of a large square hole in the floor from his basement lair.  I have a host of weapons against him. Giant pillows I can throw at him. Furniture I can pile high that he will have to jump over and doors that I can escape behind. We have a game. He tries to get me and I try to get away, occasionally whacking him with a pillow or a wood board with nails on it. But each time we play, he gets bigger, and my weapons of defense get flimsier. I start on the second floor now and throw stuff on him from the balcony, and he comes up the stairs after me, and I leap over the furniture I have piled high against him, and I escape into the closet with the flimsy wooden door that does not lock. The last time I felt the heat of his breath as he roared outside the door, and I was saved only because he grew bored and wandered elsewhere in the house, and I awoke, but I don't want to play again. He is full size now. When he stands on his hind legs, he can reach the second floor with his sharp clawed paws. I know the next time he will leave deep scratches on me that will not heal.

 

I don't want to play anymore. But he will not leave my house. I can hear him pacing downstairs.

 

Confusion and Unease. That's what I would say is going on now out here in EMS land.

 

Listen up:

 

First the government told us we had to wear N95 masks when faced with a potential COVID patient. Then we were told a simple face mask was fine. The CDC then issued more revised guidelines that defined risk, saying as long as you did not have "prolonged contact" with a patient without wearing a mask, you were okay. 

 

Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)

 

Now a hospital in our area has defined prolonged contact as 15 minutes. They are saying, if you are without a mask for the first fifteen minutes, it doesn't count as an exposure.

 

Read this for yourself:

 

Once on the scene, and as soon as possible, a patient with suspected infection as per the most current CDC recommendations and guidelines should be provided with an isolation (surgical) type mask to wear. Responders should likewise don an isolation mask. If an isolation mask is worn by EMS providers within 15 minutes of initial contact, they will not be considered as having been exposed even with contact to a patient who has tested positive.

 

Where does that 15 minutes come from? What science is that based on? Are they saying it takes 15 minutes of exposure for someone to get COVID? We can get coughed on and respiratory dropletted upon for up to 15 minutes and we will be okay?  Come on.

 

We have also heard that at several services, even if you are exposed, you should keep working until you are symptomatic, even though it is known you can spread the disease on to others before you yourself show symptoms.

 

Many people are angry about this relaxing of restrictions because the relaxing seems more linked to the supplies and the need to keep a sufficient health force working than true safety.

 

Add that to our understandable paranoid belief that EMS worker safety might not be the top concern with higher ups and throw that against the onslaught of news describing the terrors of COVID, "the perfect killing machine," and people are rattled.

 

Here is what I believe:

 

Most Americans (70-80%) are going to get COVID eventually. (This includes many who have or have had it or will get it and not know.)

 

The effort at social distancing and closings are geared to flatten the curve (spread the sickness out over time) and keep the health care system from being overwhelmed, enabling it to save more COVID patients as well as other sick patients who will need ICU level care.

 

These efforts will fall short, but will be better than no effort at all.

 

We will have a true period where the shit hits the fan. Likely beginning in May.

 

The ever changing guidance to EMS reflects the need to find a balance between safety and not exhausting the supply of PPE and the supply of EMS responders. If you insist on the proper level of safety, too many of us will have to be self-isolated and there will not be enough PPE to make it through.

 

We are given a limited supply of PPE and told to only put it on when we encounter someone with a fever and symptoms of respiratory illness and possible contact with a positive patient. Yet we walk into a hospital and everyone is wearing masks, everyone except EMS. You see pictures in the paper of nurses gowned up in space suits to do COVID testing, wearing full body gear that looks nothing like the paper napkin gowns they give us for the most extreme cases, a gown that in my case doesn't even reach my knees. You can see why people feel uneasy.

 

Many like me are resigned to getting it. I hope that my 15 day January/February illness was COVID, but I fear waking up each morning with a raging fever. I'm 61 and am in good health for the most part. I have read enough to understand most of those dying are old and with comorbidities that I do not have.  I want to work.  I love being a paramedic, and have always been and am still willing to be on the front lines.  Like those I work with, I will take the risk.  Just be honest with us about them.

 

For many more posts on the COVID epidemic, go to:

 

Street Watch: Notes of a Paramedic

 

 

There is a picture in the Hartford Courant of Mark Jenkins talking with police officers looking as forlorn as I have ever seen him. They stand next to yellow tape sectioning off an area of woods just off Park Terrace where down a small ravine a man has been found dead. The paper describes the crime scene as a homeless encampment but it is little more than a small clearing with a dirty mattress, a blanket over some branches as a tarpaulin and a hollowed out log. Mark is the leader of the Hartford Harm Reduction Coalition. A former user, who went to rehab himself seventeen times, with the help of friends he found his way, and now has dedicated his life to harm reduction, which he describes as set of principles that recognizes the humanity of users and works to get them help or keep them safe until they are at a place in their lives where they are ready to stop using.

 

A couple months back, I got dispatched to this same place for an overdose. Mark and two members of his organization, Jose and Bryan, were already there. They had been on their way to work on the construction of their new walk-in center when they were flagged down. They found a man cold and not breathing on the broken winter branches and mat of old heroin bags. They gave him naloxone and by my arrival, the man was breathing again. He was just starting to rouse and was combative in his haze. They helped us carry him up to our stretcher. He was lucky someone has seen him and that Mark and his crew were driving by. In the hospital the man's core temperature was 90 degrees.

 

Some days when I am working, I stop by the site. A few weeks ago, after we'd pulled to the side of the road, I looked down the small ravine and saw a solitary man there. From my vantage, I saw he had his arm outstretched and was injecting himself. In the summertime the clearing is completely hidden by greenery, but in winter, it is all grey and naked trees. The man in jeans and a black shirt nevertheless blended in, as if in this same season, he were stripped himself of much of what he once was. I told my partner to drive on.

 

I don't know if the dead man is the same man I took to the hospital or the man I saw injecting himself in the cold grayness or someone else. I do know that he is not the first to die in those woods.

 

123 Americans died of overdoses in Hartford in 2019. 17 have already died in 2020.

 

In Mark's face you can see the burden of this war he is fighting against stigma, against convention and bureaucracy, against death, against time.

 

***

 

Connecticut drug deaths spiked in 2019, reaching record highs. Those on the front lines of the opioid crisis say they aren’t surprised

 

Harm Reduction

I hit my twenty-fifth anniversary at work last month. Twenty-five years full time as a paramedic. I am sixty-one years old now and feeling the wear and tear, particularly in these last two years. I don't sleep well at night. My hearing is shot. I need a stronger prescription for my reading glasses (which I also use for intubating and IVs). Last summer I suffered my first worker's injury to my back that has left me with a lingering weakness in my legs.  Fortunately  it is not bad enough that I can't work, but it is bothersome nonetheless. I still carry all my gear up five flights of stairs. I don't get to the top as quick as I used to and I am sure to use the railing on my way back down. I was sick for over a month this winter. I had the really bad cough that everyone seems to have. I worked through the first three weeks because that's what we do in EMS, coughing up green phlegm and downing decongestants. My energy level just wasn't there. I finally said, enough is enough. I'm not coming back until I am well. I laid in bed for two days, and then when I went back to work after a week out, I had a splitting headache and was getting short of breath toward the end of my shift, and so I took some more time off. Good thing, I had plenty of PTO.

 

On Friday when I came in to work I saw the boss (a young man I precepted) and told him I wanted to change my status to part-time. I managed to get some more hours added to my hospital EMS coordinator job so going part-time at my medic job was going to be necessary anyway eventually, but finally saying it out loud, it felt momentous. I'm not going to work Sundays anymore (unless I want to) and other than a few remaining shifts I am already scheduled for, no more getting up at four in the morning. I will still work twenty hours a week, but will just call in when they have shifts available (they always do) and work the hours I can that don't conflict with my work, family, and trying to get healthy again life-style.

 

The boss said he was glad for me, and then gave me my twenty-five year plaque and pin, which had been sitting in the supervisor's office. I took it and shook his hand. The plaque is in the back seat of my car now. Eventually I will just put it in a box in the garage along with my 10, 15, and 20 year plaques. Not that I don't appreciate it, I just don't display things like that.  I also get to choose a 25-year gift from a special catalog). I got a kitchen knife set for my 10th and 20th anniversaries, which I still have (9 knives for the 10th and 13 for the 20th). For the 15th I got a GPS that my wife lost. I am thinking about whether to get the 17 piece knife set, a digital smoker, or a snowblower. The snowblower would be great for snowy mornings, but if I am no longer getting up at 4, the need isn't as pressing, plus with global warming, I shovel less and less each winter anyway.

 

When I went to punch in Friday, after I'd gotten my plaque and told the boss I was going part-time, I saw a flyer over the clock and a picture of a guy I'd gone to paramedic class with. I was 34 and he was 24 back then. Like me he worked 25 years for the same company but in another division. The paper said he had a medical emergency and passed away unexpectedly. He was just 52. Nice young man with a family. A good paramedic. Since we were in different divisions, I saw him infrequently, always at the hospital pushing a stretcher. We'd say hello by name, and then go on our ways.

 

On Friday I worked with Jerry, an old partner of mine, who's been with the company almost as long as I have. We have a great time together, laughing most of the day. Riding with Jerry, it's like we're not even working, just two friends hanging out. During a downtime between calls, we ran through the list of all the people we'd worked with who had died over the years. It was a long one. Some of the people we struggled to remember their names.

 

I still love being a paramedic. I just know its time to take care of myself and my family first. Today, instead of sitting in the ambulance writing this, I am in the stands watching my twelve year old daughter warm up with her team on the basketball court. I am putting the computer down as the game is about to start.

 

 

1200 Dead.

 

In 2018 Connecticut overdose deaths dropped after six years of steady rises. Was it a plateau? Or just a pause in a grim climb? The first six months of 2019 hinted that the deaths might be be on the upward move again, but none of us were prepared for yesterday's news from the Connecticut Medical Examiner's Office.

 

1200.  An eighteen percent increase over 2018.

 

94% of the deaths involved opioids.

 

The dead ranged from 17 to 74.

 

The culprit:

 

Fentanyl was present in 979 of the deaths (82%), its most ever, continuing its unremitting rise since 2012 when it was detected in only 12 deaths.

 

What's the answer?

 

End the stigma. Treat drug users like we treat victims of heart disease, lung disease, diabetes. With compassion, love and evidenced based medical care.

 

Recognize addiction for what it is — a chronic brain disease, not a character flaw.

 

Make rehab available to those who want it and make medication assisted therapy (MAT) methadone and buprenorphine available to all who want it.

 

For those who aren't ready for rehab or MAT, bring them in from the cold, open drug overdose prevention sites where users can be in the presence of trained providers instead of forcing them to shoot up behind dumpsters, in park thicket and in locked public restrooms where we find them dead.

 

Make naloxone as widely available as possible and drill in the message, never use opioids alone.

 

Sue the pharmaceutical companies for their pivotal role in creating the epidemic (lying about the addictive qualities of their products and for producing massive quantities of painkillers even though they knew they were shipping vast amounts to distributors who were then flooding the black market with their products.

 

Use the money to fund a drug war against addiction.

 

Above all, be kind to those afflicted.

 

She frequented a neighborhood park near the hospital. I'd see her times smoking a cigarette while she sat on the playground swings. Many nights, she slept on cardboard by the fence, sometimes she tied a tarp from the fence down to the grass to provide shelter on rainy nights. She was tall and gawky with red hair and looked a lot older than her thirty odd years because she had lost most of her teeth. Nothing makes a person look older than when their gums recede. I first saw her one morning this summer when the temperature was already up into the 90's and the humidity made it hard to breathe. I asked her if she wanted a bottle of cold water, which she did, smiling in such a way you could see her youth hadn't completely been obliterated from her body from the hard living she had put it through. I also gave her an orange and a couple bucks. She had a tattoo of a blue pony on her neck. It was faded, but the pony looked like a magical kid's pony — the kind that could fly when it wasn't being cuddled by a four-year-old.

 

I never found out too much about her. I knew her name Tammy and knew she was a heroin user. I didn't know her back story of how she came to call the small park her home. She rarely came down toward Pope Park where we post sometimes in the ambulance and where I get to know many of the users walking east up Park Street to buy their drugs. I usually saw her as I drove past in the ambulance headed west.  She walked alone, going in and out of bodegas or standing on the corner lighting cigarettes. Even among the murals and store signs on Park Street, her orange red hair stood out like technicolor in the old movies.

 

Early on a cold fall morning when you could already start to see people's breaths as they stood at the bus stop or hurried down the street to whatever job put subsistence in their pockets, we get called for an overdose on the basketball court in the park. My partner pulls the stretcher and I sling the house bag over my right shoulder, and carry the heart monitor in my other arm. The fire department responders stand in a semi-circle over a body. One of the guys gives the finger across the throat sign to say we won't be needing the stretcher. As I get closer, I see two feet sticking out from under the blanket. I pull the blanket back and stare at the face. When someone dies their soul leaves and their face becomes almost unrecognizable to what they once were. Then I see the tattoo.  I look at her face again. It is white and waxen. She's been dead for hours. Her limbs are cold and stiff. Her mouth is riggored shut. I run my six second strip of asystole.

 

A slow drizzle has started. I pull the blanket back over her face. We head back to the street, past the empty playground. The morning is black, white and grey.

A federal judge ruled yesterday that a nonprofit group in Philadelphia's effort to open a safe injection site where people can use drugs under medical supervision does not violate the federal crackhouse statutes prohibiting the operation of a space "for the purpose of manufacturing, distributing or using controlled substances."

 

U.S. District Judge Gerald McHugh wrote: "The ultimate goal of Safehouse's proposed operation is to reduce drug use, not facilitate it." 

 

The federal government has not only vowed to appeal, they have threatened to shut down anyone who attempts to open such a site.  Deputy Attorney General Jeffrey Rosen said, "Any attempt to open illicit drug injection sites in other jurisdictions while this case is pending will continue to be met with immediate action by the department."

 

Ten years back I would have thought a safe injection site was a foolish idea, but after witnessing the sorrow, devastation and death caused by the opioid epidemic, I have come to see these spaces as essential.  The evidence from safe injection sites operated legally in countries around the world shows that they work in reducing death and the spread of disease as well as increasing the number of people getting into treatment.  They are a common sense solution to a major problem.  Today users in Hartford shoot up in public spaces, leaving drug paraphernalia (open needles) on the ground, and many of them die behind dumpsters, in public bathrooms and in their battered cars because they are found too late to be revived.

 

As Mark Jenkins of the Greater Hartford Harm Reduction Coalition often says, we have plenty of public drug consumption spaces in this city already today.  The restrooms of McDonald's, Subway, Burger King, the public library,  not to mention sidewalks, alleys, and public parks are all commonly used to as public places to inject drugs.  But these sites are far from safe for the user or the public.

 

A safe consumption space provides a clean environment where users not only get sterile supplies, they get counseling and access to social services.  They are treated by people who care about them and recognize them as fellow human beings who are afflicted with a severe chronic disease.  They are not stigmatized as scumbags and degenerates. 

 

We can't forget that nearly all of these people are trapped in a vicious addiction that often began through an injury or illness and a visit to their doctors.  Their doctors prescribed them dangerously addictive medications that the pharmaceutical companies were making billions off of, while hiding their addictive dangers. Even those who began their drug use through experimentation don't deserve the horror that addiction inflicts.   If you take addicted opioid users and put them in an MRI, the imaging will show the damage done to their brains as surely as it will show the damage done to hearts injured by cardiac disease, or lungs by respiratory disease. 

 

Heroin destroys and rewires the brain's reward pathways.  For many, the damage is so severe, recovery is not possible, all that can be hoped for is periods of remission.  The job of harm reduction is to keep people alive and minimize the ill effects of their drug use.  It is about being our brother's keeper.

 

 

Peace to all.

We are called for an unconscious and find the man out cold on his feet near Pope Park.  He is a tall man in his early thirties with a ghost white complexion, standing there on the side of the road, his head nodded forward, arms hanging down swaying.  Another drug user on the nod in Hartford.  I shake him and he opens his eyes and says he is fine, but then he drifts back out.  My partner wheels the stretcher over and we gently push him down onto it.  He wakes enough to again, say he is fine, but he drops back out.  In the ambulance, I check his ETCO2 and his pulse saturation.  The numbers are 66 and 90.  I can stimulate him and the numbers come up a little, but if I leave him alone, he doesn't breathe well enough on his own.  I put in an IV, which he doesn't feel.  I take a 10 cc syringe, squirt out one cc, then add 1 cc of Naloxone to the syringe.  I slowly give him one cc of the mixture, delivered 0.1 mgs of Naloxone, a tiny dose.  When he doesn't respond, I give him another 0.1 mg dose, and soon he is talking to me.  He doesn't even know I have given Naloxone to him.

 

"I don't need to go to the hospital," he says.  "What time is it?   I have to get back to work or I'm going to lose my job.  I'm on my lunch break."

 

It is three-thirty in the afternoon.  I ask him where he works and he says he is a house painter.  He asks where we picked him up, and after I tell him, he tells me he is painting a house a few blocks from there.

 

I tell him the doctors will look at him at the hospital, and after, watching him for an hour, will let him go.

 

"Dude, I can't wait that long," he says, "I'll lose my job."

 

I feel for him, but we had to take him in.

 

His name is Keith and he lives in an upscale suburb of Hartford.  The street is familiar to me.  I did an overdose there maybe a year before. I remember the mother sobbing at the sight of her son on the bathroom floor, even though we were easily able to revive him.  I sensed she was at her breaking point.  He had already been through rehab four times.

 

"You didn't give me Narcan, did you?" Keith asks.

 

"Yes, I did," I say.  "Just a little, enough to keep you breathing without me having to shake you every minute."

 

"Fuck, I'm going to lose my job."

 

"You have to be careful if you are going to use," I say.

 

"I only did a half a bag.  I just haven't used.  I got out of a program last week."

 

"Your tolerance is down.  If you are going to use no matter what have someone there with you.  Have Narcan around.  Do you have it at home?"

 

He nods.

 

"Who do you live with?"

 

"My Dad took me back in."

 

"Does he know how to use it?"

 

"Yeah."

 

"You have to be careful with the fentanyl around."

 

"I know my friend Marty died a month ago."

 

The name rings a bell with me.  "What was his name?"

 

"Marty Harris."

 

"I took care of him before," I say.  "That was a year ago."  Marty was the young man I remembered.  The news of his death, even though I barely knew him shocks and saddens me.  Marty and Keith were the same age

 

 "He got out of jail after nine months and he oded and died."

 

"I'm sorry."

 

"Man, I'm going to lose my job."

 

Once we get to the hospital, he gets even more anxious, and he ends up pulling his IV out.  I try to get a nurse to come over.  I give the heads up that he wants to leave.  The nurse says he'll get a doctor to look at him.  The doctor comes over and the doctor and Keith end up in a shouting match.  The doctor tells Keith he obviously doesn't care about his own life because he is doing drugs that may kill him.  The young man tells the doctor to fuck off and walks out, swearing that he is going to lose his job and he has to walk all the way back to the job site.

 

That night I google his friend Marty's name and add obituary and the name of the town to the search.  And there he is – a picture of the other young man.  There is nothing in the obituary that mentions drugs.  It just says he died too soon and what a kind heart he had.  He was a high school swimmer, an avid soccer fan and an accomplished cook.  He liked to camp with his family in the Adirondacks.  There is a long list of family members he left behind.  I read the comments.  One poster says how he remembered him so fondly as a little boy playing in the neighborhood.  There are even pictures of him when he had to be about five.  One shows him with another young boy, and I wonder if it is the man who I transported today.

Another poster writes:   "He is no longer in pain."