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Kevin Andrews

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.

Home

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.

Not Right

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.

 

Battle Royale

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.

Nursing Homes

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

Tiger

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.

15 Minutes

 

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

 

 

A Ravine in Winter

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

25 Years

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

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.