”Faces of Death.”

Today, I was (almost) asked “the question”.

The question that runs through every person’s mind when they’re face to face with a Paramedic whose resume harbors nearly two decades of field experience.

The question that flashes with realization first in their eyes, then spreads across their face and, occasionally, presents itself in the words spoken from their ignorant mouths.

It starts with:

“Wow. You must have seen so much!”

The question that often follows:

“What’s the worst thing you’ve ever seen?”

This is the question that every seasoned Paramedic dreads. The question whose answer, once spoken, can never be unheard. The answers are things our minds can never unsee – emblazoned in our memories and seared into our hearts. Flashbacks filled with unprocessed emotions as painful as each of the moments in which these things occurred.

The saddest part is, there is no single answer to this particular question – as a million memories of calls gone by flash through my mind in rapid succession. The answer I might choose to give may actually even surprise you.

It is not always the most gory scene – a plane crash or train derailment. Vehicle crashes complete with mangled bodies, twisted metal, tales of heavy entrapment and intricate extrication. It’s not always the gunshots or stab wounds, or bar room brawls that spilled out onto the street in the darkest of nights. It’s not the blackened face or elongated neck of the man who hung himself from the ceiling in his garage – or the disturbing fact that he all he had to do was stand up on his own two feet in order to save his own life.

The worst is found when you focus your attention upon the details, themselves. The heartbreak of a man left to face “the golden years” of life alone – so broken down in his sadness and heartache that he gives away all of his earthly belongings and writes a note so sound with his decision, certain in his belief that he’d be with her, once again. The way he warned his cleaning lady, rather than surprising her, by posting a sign on the door of his home to be seen before she entered:

“Body in garage. Call Police.”

The way he meticulously laid down that plastic tarp for easy clean up, penning an apology to all of us responding, for any mess he may leave behind, as he placed the barrel of that gun in his mouth and pulled the trigger.

Why would you want to know of such things?

Like the man so distraught over a financial crisis and loss of his business that he swallowed a handful of pills, washed it down with a bottle of bleach and ran rampant through the streets, screaming, as his internal organs began to shut down and he died a very slow and painful death.

Or the limp and lifeless body of the child who suffocated inside a hope chest, following a game of hide and seek gone terribly wrong. Or the two unsupervised toddlers, who climbed up on an unsecured dresser, being subsequently crushed to death beneath its fallen weight.

Why would want me to paint this picture or have these images parading inside your mind?

The distressed mother who attempted to “accidentally” drown her child in a bath tub.

The fractured face of young, up and coming model whose jealous boyfriend inflicted irreparable damage with his fists and the help of a Louisville slugger.

Picking up the pieces, strewn across a quarter mile, of a person who stepped in front of a train.

Or the elderly woman, suffering from a “simple nosebleed” who, over the course of the next hour, continued to bleed out into the bathroom sink at the assisted care facility where she lives, proudly boasting the title of “Mayor of the West Wing”, where she had won the facility’s “Dance Off” competition the night before. At 99 years of age, she is sharp as a tack, fiesty and independent, full of detailed stories about her world travels and exciting escapades experienced in the days of her youth. She holds stable throughout the rapid transport to the hospital, despite your inability to control her bleeding. But, as your partner backs into the ambulance bay and prepares to help you unload her, she looks up at the sky and lets out the biggest sigh:

“Oh, Honey! Is this what it’s like? This is nice!”

And, just like that, she is gone… leaving you stunned and speechless, with nothing more than the emesis basin holding every drop of blood her tiny body had contained.

Why do these details fascinate you?

The popping of a person’s ribs and the snapping of their sternum, palpable beneath your hands as you compress into it, performing CPR, knowing that the breaking of their bones is a small price to pay for the opportunity to save their life. Eventually, however, you remove your hands from that person’s chest, look into their dead eyes, as their family and friends surround you, anxiously watching every move you make and you just know… there’s nothing more that you can do.

Don’t you realize that it broke my heart when I delivered that infant, born at just 22 weeks gestation, and I heard him cry? How I held him in the palm of hand and worked to resuscitate him for nearly 45 minutes straight, only to find out that no help is coming because “protocol states, it’s not a viable pregnancy until 24 weeks”. How I was forced to let him go – just stand there and watch as his tiny heart beat so hard against the wall of his skeletal chest… until it didn’t anymore.

Or how I was ridiculed for stalling in the Cath Lab hallway, giving verbal report to the receiving cardiac team, while providing my patient and her husband the opportunity for what would later be remembered as their one last kiss.

Or that hot and hazy 4th of July when, upon calling back into the county and being assigned a post, we came upon an 8 year old in distress, waving us down in the middle of the street. His hair was red and wet, matted down with sweat. He was covered in dirt, wearing only a pair of red and blue shorts – no shirt and no shoes.

“Lady, can you help? It’s my mom – she can’t swim!”

It took nearly an hour to locate the scene along the riverbank from which this child had run, in search of help. It took another hour to assemble river rescue and execute their search, locating her body beneath the murky water. I will never forget the striking resemblance between this woman and her son – same fiery red hair, same pale green eyes. It will take my entire lifetime to forget the look of betrayal on that young child’s face as we carried her lifeless body up out of the river, through the woods, and placed her in my Ambulance for transport to the morgue – my words of reassurance to him echoing in my mind as I had held his little hand along that riverbank, praying to a God I’m not even sure I believe in, begging for some miraculously better outcome than the one I, inevitably, knew would follow.

Can’t you see that a piece of my soul died along with them? That no amount of time will ever make any of these things “alright”?

The placing of a needle through the submental portion of your patient’s neck, administering Narcan through the vasculature beneath their tongue, because their jaw is clenched down, containing a mouthful of vomit, and they have no adequate veins left in their arms, hands, legs, feet or neck in which to place an IV. It’s the moment when they wake up, insisting that they did nothing, and then sign out of the hospital AMA only to repeat this cycle again a week later and die.

It’s performing conscious BVM ventilations on a patient who is struggling to breathe – and that awkward moment when they lock their eyes on yours in an uncomfortable mixture of silent, somber communication and gratitude.

It’s strategically placing a large bore needle through the chest wall of a woman who looks like your grandmother, decompressing her fragile, collapsed lung, temporarily restoring her ability to breathe.

Or the moment when those bullets, fists, and blades are turned upon you – and suddenly you are no longer racing to the scene to save someone else, but rather, in a race for your own personal safety and the safety of your partner.

It’s the terrified cardiac patient who attempts to strangle you with your own stethoscope because he believes you’re not doing enough to help him or save his life.

Or the irrational psych patient who breaks through their restraints, kicks you in the chest and again in the throat, as you struggle to breathe and get away safely while they continue to advance, threatening to kill you.

The retired veteran suffering from PTSD, after being held captive as a POW, who wakes up startled, in a fight for his life, sees you as the enemy and squares off in preparation for battle. It’s that terrifying look in his eyes that causes you to jump out the side door of a moving ambulance and lock him inside the box until police can arrive and assist you with backup.

“What’s a nice girl like me, doing in a place like this?” (2019)

Delivering a baby, in the backseat of car, through the leg hole of an oversized pair of shorts, to a 15 year old who refuses to even look at, let alone hold, her newborn daughter the entire way to the hospital. It’s walking out of that ER, speaking with the patient’s grandma (her legal guardian) who never even knew the girl was pregnant and realizing that, had that bystander not been walking by, had they not noticed this teenager giving birth, and had they not called 911… this infant quite possibly would have ended up inside the dumpster in that alleyway across the street.

It’s arguing with the patient about to be transported to a level one trauma center, who regains consciousness and wishes to refuse, just as the medical helicopter is landing. It’s the look on her face when you tell her that she was unconscious for nearly 15 minutes straight, as you worked to extricate her from the wreckage… and the heartbreak that follows as reality sets in with the news of her friend, pronounced dead, in the passenger seat beside her.

It’s locking eyes with your patient or their family, their faces so close to yours, and absorbing all of their unspoken emotions – the fear, the pain, the terror, the heartbreak. It’s taking all of that fear and pain and terror and heartbreak and transforming it into a reassuring smile or randomly awkward joke that lets them know that it’s all going to be alright – even when you have no way of knowing if it will, in fact, ever be alright again.

Like the time a young woman locked herself in the tiny bathroom of a local bar, injected heroin into her veins, and collapsed on the floor, completely blocking your ability to break in and save her. It’s listening to the ticking of the old clock on the wall, as you wait for the fire department to arrive with an ax to break down the doorframe, knowing that each minute that passes by equates to more and more death of this patient’s brain tissue, thereby decreasing her chances for survival. It’s breaking down that door’s barrier, gaining access to her pulseless, apneic body and working swiftly to resuscitate her, as her family arrives at the scene, enmeshing their own energy into this dire scenario. It’s being successful with your skill set and in your endeavors to reignite the automaticity of her heart… only to find out, a few weeks later, that although her heart is beating and she is independently breathing, the damage to her brain was severe and irreparable. She is completely incoherent – unable to eat, speak, sit, stand, walk or follow any commands. She will live out the rest of her life, practically lifeless, confined to a bed – her days filled with nothing more than diaper changes, tube feedings, and body rotations by staff, helping to minimize the severity of her bed sores and lessen her chances of severe and chronic infections.

The next time you find yourself face to face with a current or former Paramedic and hear yourself say: “Wow, you must have seen a lot.”, please – just leave it at that. Do not allow yourself to follow it up with “What’s the worst you’ve ever seen?” … because the only Paramedic willing and eager to answer this question is the one whose hands are still so fresh and relatively clean – before the dirt of these experiences have marred their hearts and the blood their patients have shed throughout the years permeates their soul. Once it does, it forever changes who they are.

Asking a Paramedic:
“What’s the worst thing you’ve ever seen?”, is like saying “Relive, for me, your worst nightmares – the images you can’t get out of your head, the things that completely changed the kind of person you are.”

“Yeah…” I replied, earlier today, as their eyes were fixed upon mine. I offered up a forced smile, before continuing, “…but that was then, and this is now.” But, even as I said it, the weight of these things (and about a million more) pressed down heavily upon me. I offered no further details with my response.

Their faces flickered with the disappointment of unrealized expectation, but I held my ground in silence, and they chose not question me further – because eyes that have seen too much will always give you away.


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