Paramedic: On the Front Lines of Medicine
Published in hardcover by Fawcett Crest/Ballantine Books in 1997, and later in paperback, Paramedic was a Literary Guild Selection and chosen by the New York Public Library as one of the best books of 1997.
"The author writes compassionately of people in crisis -- abused children, alcoholics, the sick elderly, the homeless -- and of his struggle to become a professional in the field....The book should generate respect for the dedicated professionals who are on the front lines of emergency medicine."
--The Washington Times
"An excellently written account of the lifesaving roles played by paramedics in an increasingly dangerous world...His book deserves the broadest possible audience."
--James Alan McPherson, Pulitzer Prize winner
"This thrilling true story made me feel like quitting my job and becoming an EMT."
--Roger Cooper, Editorial Director
The Literary Guild
"Well written and reflective."
"Canning goes beyond war stories and delves into many of the complex issues confronting today's EMS providers that aren't taught in the classroom or written about in textbooks. Everything from scene dynamics, partner relationships, watching your partner's back and street justice to low pay and family pressures of "when are you going to get a real job....an insightful account of one medic's journey into the world of EMS."
-- Journal of Emergency Medical Services
"Canning is more than just a storyteller...he thinks deeply about the basis for these stories. More than most people, he understands how the decisions of public health policymakers translate into conditions on the street and in hospitals...you will find food for your brain and ideas to test your complacency. This book of stories may change your thinking.
--Journal of Emergency Nursing
Canning's "book is both a personal story and a vivid portrait of his profession, one that despite its importance is often taken for granted. . . . PARAMEDIC deepened my appreciation for the work paramedics do."
--The Washington Post
"FAST-PACED . . . VIVID . . . EYE-OPENING."
--The Hartford Courant
"A vivid account of emergency medicine that should go a long way toward generating respect for paramedics.
1997 Book Tour Interview
Interview with Peter Canning, author of
PARAMEDIC: On the Front Lines of Medicine
Interviewer: Tell us about your book?
Canning: Paramedic is about my first year as a paramedic on the streets of Hartford, about how I left my job as an aide to the governor to prove myself on the streets. Its about the calls I did, my struggle to succeed and how I felt about the job. It is a book that shows EMS as it is, its moments of great success and its moments of despair. It's also about the people of the city, their struggle to live and survive in a tough environment.
Interviewer: Tell us how you got involved in EMS in the first place?
Canning: In 1988 I was working for Senator Lowell Weicker when he was unexpectedly
defeated in his re-election bid. I had worked for him on and off since I was seventeen, and the defeat was quite a blow to me, particularly because I'd been with him on the campaign trail. I lay around on the couch in my apartment for a few days reading the paper, trying to avoid the help wanted ads. I read an article about paramedics, the excitement of their lives, their victories and defeats. There was also an ad for an EMT course taught at the local college. At night I could hear ambulances racing past on the street below. The sounds seemed to call to me. Here's a new life, a new adventure. You've written about drugs and infant health from your desk in Washington, here's your chance to see it up close and get splashed by its grit. We had a farewell party for Weicker in Washington one night and I went out with some old friends and had a few beers, and we got to talking about what we were all going to do now. Some spoke of hooking on with another legislator or a lobby firm, going to law school or trying their hand in business. I swallowed hard and announced I had decided to become an EMT. If I can no longer help people with my head, I told them, this is my chance to at least do it with my hands. In the morning they had probably forgotten my vow, but I had said it aloud, so I had to make it true. I took an EMT course and five months later was working on an ambulance in Springfield.
Interviewer: Now, is there a difference between an EMT and a paramedic?
Canning: Yes. The paramedic is the highest level of EMT. When I first started in EMS I
was a basic EMT, which meant I could treat someone in an ambulance, patch their wounds and give them oxygen. I did that for a year, then Weicker called me and said he was going to run for Governor, and would I come back on board. I did. He won, and I was appointed to the state health department. All the time I continued to work one night a week on the ambulance. While there were nights I did no calls, there were some days where I found myself closing my office door and laying my head down on my desk for a short nap after a night of doing CPR on the highway side or more likely driving an old woman to the hospital who was vomiting and a fever. Despite the demands of my job, I couldn't get the EMS out of my blood. I decided to go to paramedic school at night to improve my knowledge and because during the day at work I was becoming involved in reshaping the state's EMS system, and thought it would enhance my knowledge. A paramedic is capable of starting intravenous lines in the field, cardiac monitoring, including defibrillating an unstable heart, intubation, passing a plastic tube into the trachea of a not breathing or poorly breathing patient, and administering over thirty emergency medications, including epinephrine and morphine. The course, which involved classroom time, hospital clinical time and field time riding on ambulances was fascinating. I got to intubate patients in operating rooms, observe babies being born, and do IVs and give drugs in the field, under the eye of a paramedic. I loved it.
Interviewer: Why did you leave government?
Canning: Weicker was going to be leaving office so that was going to end my speech writing, and while I could have stayed at the health department, I was very frustrated with government. You couldn't just wave a magic wand and say "make it be so." Any thing you did involved countless meetings, disagreements. Particularly in EMS, where there were such deep divisions between hospitals, commercial ambulance services, volunteer services, police, fire, trauma surgeons, emergency physicians, nurses, paramedics, EMTs. Once you got EMS to agree, then you had to argue the needs of EMS versus the needs of all the other health organizations. We succeeded in elevating the status of EMS within the health department, and we were able to enact a statewide trauma network. I felt I'd made my mark and it was time to move on. Too often I found myself standing by my window, watching ambulances go by, when I should have been sitting down at my desk, digging through my mountainous In box. I wanted to be out there doing it. I wanted the excitement, the tests, and I wanted the stories to tell.
Interviewer: Tell us one.
Canning: Election night. We've doing a stand-by at the mayor's victory party when we get pulled away for a report of a man choking in a nearby housing project. We walk through the dark graffiti strewn corridors and enter the apartment where we find a twenty-six year old male, who has tried to kill himself by drinking dishwashing liquid that caused him to vomit. He doesn't want to go to the hospital. The only way we can take him is if we can prove he is not oriented. We ask him three questions. What day is it? Tuesday. Where is he right now? At his friend's house. What's going on in the city today that everybody is taking part in? He thinks for a minute, then says, "People get their city checks." His answer stunned us. It wasn't the answer we were looking for, but it wasn't wrong either. It was a tale of two cities.
Interviewer: Once you got out on the street and were working regularly, how did it make you feel about the work you had done in government?
Canning: It is eye opening to go from working in the capitol building where governor and legislator boast of accomplishments, and just blocks away, I'm dealing with people dying of AIDS, malnourished kids, heroin overdoses, violence, TB. The hardest part is seeing how kids are living in the city. I think of all the years I worked for Weicker, in Washington and in Connecticut, how we fought for kids, for prenatal and expanded health care, the school lunch program, Head Start, and other programs that were going to change their world, then you walk through the poverty that these kids live with everyday, the cold dark, dirty apartments, the drug abuse and broken dreams of their parents, if you have at all ever been in a position of power, you can't help but feel failure. I know that may be naive and that maybe things would be far worse if nothing at all had been done, but still its nothing to rest your laurels on.
Interviewer: Did you like working for Weicker?
Canning: I did. I felt while he could be difficult, he was a great man. He fought for many
constituencies that didn't have a voice in the process. That's how he saw himself -- as a voice for the powerless. He taught me that winning and losing wasn't everything, sometimes you had to raise your voice. He was quite a spokesman for children. He used to say the problem was kids don't vote. In my own way, I hope some of what I write about the life these kids have in the city , can help make a difference. It just breaks your heart to see these kids, bright and full of smiles and love at age four and five, then see young mothers at fifteen and sixteen with cold sneers and hardened eyes. You wonder when does it happen, when does childish smile get beaten into the bitterness? There was a story in the paper about a young mother gunned down in cold blood while walking back from the candy store with her two small children. Then the real story came out. The mother, walking back from the candy store, saw two rival drug dealers cruising by in a car. In front of her children, she pulled out a knife and confronted the rivals for being on her turf. They pulled out nine millimeters and blew her away. The paper said she made it home to collapse on the kitchen floor of her own mother's house, her dying words, “Help me, mommy.” Things are bad.
Interviewer: Some might say your leaving a position of power is giving up?
Canning: Not at all. While I have left government, I don't think I have left trying to make a difference in the world. I do it person by person in my job, and hopefully with the writing, I can touch more people. I appreciate that work that people in government do --it is a hard job. There are people who are in for the wrong reasons, and others who want to make a real difference in people's lives. I hope that my writing will not only increase the understanding of the need for paramedics, but in the view of people in the city, and particularly the kids, may have some impact on people's thinking.
Interviewer: Is that why you wrote the book?
Canning: I wrote it for a number of reasons. You write to say what you feel about life.
William Faulkner in his Nobel prize address said he believed man would not merely endure, he would prevail. I agree with that. In EMS you are there on the edge of life --you see people at their best and worst. There is lot of enduring going on out there, but there are also moments were people prevail. Just a few months we were called to a house in a poor section of town --we went in and there was an old woman having difficulty breathing. We put her on oxygen, started an IV, gave her some medication, and we were ready to carry her out on the stairchair when her deacon arrived, and he called for a moment of prayer. They gathered in a circle, the woman, the deacon, and her family and friends, and then the deacon invited us to join in. Neither my partner nor I are church-goers, but we joined in and the deacon said a prayer, thanking the lord for our coming and for the doctors who would soon be helping our sister and thanking him for all the benefits he'd given them in live, and hopefully one day we'd all be joining him in his kingdom where everyday is like Sunday. The other people are adding "amens" and "say it brother's," then his voice boomed, "Where everyday is like Sunday!" It was like being in church, it was very special. Then we carried her out to the ambulance and took her to the hospital. She got better for a little while, but then we read her name in the obituaries a few months later. I know we both --not that either of us believe in heaven –felt that wherever she was it was Sunday and she was at peace. It made me feel better about the world and people's strength.
Interviewer: Why else did you write the book?
Canning: When I first began in EMS, as a reader I looked for books to tell me what I was getting into, but there really weren't any. There were doctor books, nurse books, but few books that really told what EMS was like. So there was a clear need for this type of book. Also, the more I worked with paramedics, the more I came to admire the people I worked with, and I felt that somebody ought to write a book about what they do, about how hard the work can be, and about how special they are. I have met paramedics who are artists of their trade, Michael Jordans and Rembrants of the street, who perform amazing feats of skill, patience, grace under pressure, and compassion. Sometimes they fail, other times they succeed were no one could have imagined they could. I wanted to sing their songs.
Interviewer: Was there one moment when you knew you had to write this book?
Canning: Well, I told you before how I used to stand by my office window at the health
department and look out on the street as ambulances raced past, and I'd wonder where they were going, what was I missing. Later once I had left the department and was working as a paramedic, we were coming back from the hospital. We were near the health department when we heard a thud against the side of the ambulance. A bunch of kids were throwing snowballs at us. We got out and yelling and laughing, started throwing snowballs back. Soon we were overwhelmed and had to retreat back inside the ambulance. My: partner smiled and said, “Ah, winter!” I looked up at my old office, at the window where I used to stand, and saw there was nobody there. I knew then I had a book to write.
Interviewer: Did you ever doubt that you would make it as a paramedic?
Canning: Yes. Frequently. It's one thing to do well on tests, to have book knowledge, it's
another to be able to do it in real life. I knew the 94 I got on the state exam didn't count for squat in the street. Whether its getting an IV on a person trapped in a car on a rainy night while they are screaming at you or treating a man with chest pain, who's fighting you because he can't breathe and the heart monitor shows him in a lethal rhythm that you have to shock right away or he has no hope at all, there are moments were you think you are just not going to get the job done. Few things are textbook. The first section of my book is about my preceptorship, which is my trial period, at the end of which the hospital either gives me medical control to work as a paramedic or else I'm done. Fortunately, I made it through. I had a good preceptor .
Interviewer: What are the toughest parts of the job for you?
Canning: The kid calls are the worst. If I show up on scene and there is seventy year old man who is not breathing, it is much easier to deal with than an eight-year old hit by a car who is seizing. One person has lived a full life, the other just beginning. Also when a person is still alive when you get there, and then they crash, and you can’t get them back, those are the hardest of all. You can't help but doubt your ability sometimes. I had a thirty year old woman recently who had a bad asthma attack and by the time I got there had stopped breathing. I had a hard time getting an airway into her. It took me three attempts to get the tube into her trachea, which had closed off by her laryngospasm. In between attempts, I tried to force air into her lungs with what's called an ambu bag. I finally got the tube in, and got some good air into her, but by then she was in cardiac arrest --her heart had stopped, and we were doing CPR. I got an IV line, and just started slamming epinephrine in. I got a rhythm back on the monitor, but no pulses. I kept working it, and finally I got pulses back, and by the time we got to the hospital she was starting to come around. The bad news was because she was deprived of oxygen she suffered some brain damage. I got her back, but if I'd gotten the tube on my first attempt, maybe I would have gotten her all the way back. I wished I was better at my job.
Interviewer: How do you deal with that?
Canning: You learn from everything. Sometimes the person who didn't make it teaches you something you use to help the next person. I know they do. But I don't want to give the impression that every call is life and death. It's not that way. We do a lot of minor calls, colds and flu, small cuts, drunks, motor vehicle accidents where the patients are faking injuries for law suits. There is a lot of abuse of the 911 system in the city. What is bad is when you're tied up on a call for a person with a tooth ache and down the street someone has been shot and there are no ambulances available.
Interviewer: What calls do you like best?
Canning: The calls where I save somebody's life. Those always get me fired up. I guess you can break saving somebody's life into two categories --the ones were they are dead when you get there, and you bring them back and they live to walk out of the hospital --those are rare, and the more common calls where they are having a heart attack or they are shot or they are in a diabetic coma and you treat them with oxygen, IVs, medications, and make them better or in the case of the shooting get them to the hospital quickly so a surgeon can save their lives. Many of the drugs we carry are fantastic and work right before your eyes. A person in pulmonary edema, where their heart is overworked and backed up so much that their lungs fill with fluid and they can't breathe --its very frightening. You get an IV line, give them a nitro pill under their tongue, then lasix and morphine through the IV line, and the combination eases the load on their heart by dilating their veins and causing their kidneys to get rid of excess fluid. Suddenly they can breathe, and they look at you and say "I thought I was a goner.” Not this time. We give DSO or dextrose into the veins of a diabetic, and in a matter of a minute, they go from unconsciousness, seizures or just out of control combativeness to being fully awake and alert. We did a sixty-five year old little Italian gentleman a few weeks ago whose blood sugar was really low, and he was throwing three of us all about like he was the stunt double for King Kong. We finally all sat on him, while I got an IV line, and got the sugar into his veins and up to his brain. The next minute, he was fine, and apologetic for nearly beating us all up. We give narcan to heroin overdoses, people who are out cold, pupils pinpoint, barely breathing a few breaths a minute. The narcan wipes the opiate out of their systems and they wake up like that. If you push it too fast, they wake up puking, violent and pissed off someone has just stolen their high. I push it slow and give them just enough to get their breathing back and make them manageable. Those are calls where you feel like you are doing something. They help make up for the ones where no matter what you do, the person is going out and you're not going to save them. The medical aspects are only part of the job. I love the view of life, one minute being in an executive suite overlooking the whole city , treating a man having a heart attack, the next carrying a baby with a fever out of a housing project. Sometimes I just want to hold my arms out and embrace the whole city --its so full of life and interesting people and situations.
Interviewer: Tell us another one.
Canning: We get called for a person having difficulty breathing. An old woman answers the door. She has a nasal cannula on hooked with lengthy tubing to a home oxygen supply. “You think you're coming for me, huh?” she says. “Not today. HAH, HAH, HAH. Not today. It's him you're looking for." She points up the stairs. “lt's him. Earl! Earl! They've come for you! Get down here! He's got pneumonia. Get him out of here before he gives it to me. HAH HAH HAH.” A young man comes down the stairs. He has a nasty cough and looks awful. He says he wants to go to Hartford Hospital. As we start out the door, we see asocial worker coming up the walk. The woman sees him and smiles. “Thought they were coming for me, huh?” she says. “HAH, HAH, HAH. Not today. Not today. They ain't taking me today. HAH, HAH, HAH.” I got a kick out of that one, the spirit of that old lady.
Interviewer: What kind of respect do paramedics get?
Canning: We are treated the spectrum from superhero to garbage. I read once in some survey that paramedics along with firefighters are the most respected professions with businessmen and lawyers at the bottom, but most parents would rather have their daughters marry doctors than “ambulance drivers.” A doctor I knew through my work at the health department –an emergency physician --said to me once why on earth would you want to become a paramedic. I muttered something about being tired of working behind a desk, not the answer I really should have given. I've heard of a head of a large commercial ambulance company say if a paramedic owns a house, he's making too much money. Generally, the pay is low, and unless you work for a municipal fire service, there is little or no retirement. The truth is the work is so strenuous, the burn out and injury rate --particularly back injuries is very high. You don't see many fifty year old paramedics on the street. But still you can't beat the job. The view of life, the chance to help people, to test yourself, the comraderie you share with other medics. It's great. What I really like most of all is how at the end of the day when its very busy. We clear the hospital and are the only ambulance available in the city, and the dispatcher says to us, "You are covering the world." I think I may not be a Senator, or the right-fielder for the Red Sox, or a rich man, but here I am covering the world. And no matter who gets sick, whether poor man in the projects or governor in his mansion, when they call for help, I will come through the door. A grandfather feels a tinge in his heart, a young man hits the brakes hard to avoid another car, a toddler climbs out on the window ledge. If anything goes wrong, I am their protector. Hopefully, the tinge passes, the cars do not strike, the toddler crawls back inside and finds the warm arms of his mother, and I can go home, but if I'm needed, I am there doing my best.
Interviewer: How do you feel at the end of the day?
Canning: Like I've done something in this world.