Death & Disquiet

The nights hadn’t been plagued as much of late by the dreams, always these pervasive dreams, that seemed to drown out all reason, all warmth. Dreams where a darkened stairway leads down through large automatic doors into a large room, one hundred feet wide and twice as long. Long metal tables with dull gleams stretch out, evenly spaced across the smooth cement floor and old, industrial lamps dangle with their sulfuric yellow lights barely penetrating the surrounding dark. Each light illuminates a body on each table. At first they all seem to be the same, but eventually it becomes clear that each body is a different young woman with different hair and different closed eyes and different silent shapes and tones. In a corner, some people who resembles nurses and doctors surround a body, applying shock pads, administering IVs, worrying, chewing their nails and looking at their white shoes, looking at eachother’s stained white coats, their mouths moving behind masks with words that fall silent shortly after being formed, their eyes hidden in the shadows. A small aisle separates the room in half, and it is inevitable to study the bodies alongside it as the dream carries on, bodies prepared for autopsy, their waxing skin shrunk dismally in death. Some women have breasts which sag to the sides of their nonbreathing chests, some have legs with skin curling above their knees in small frowns, some have long tan lines that coarsely clothe their still shapes. All wear a non-expression that seems as if they were about to utter one last word, one last challenge to the world before their death, words to be etched on their headstones, to be placed in their friends’ or families’ memories.
In these dreams, there is an indescribable loneliness, an isolation, as if I’m the only living thing visiting death’s strange habitation, as if the rocks could be crushed to salt, frail and unwhole due to their sadness. But these dreams had not come for a few nights, for which I was grateful.

I was sitting at a small, cheap table in a small, cheap chair, probably both bought by virtue of their cheapness, in a small side room which served as the break room for the more than one hundred EMT’s that worked with me in Indianapolis. Two of us were needed to return a patient to his home, close to two hours away by ambulance. My partner: a man in his mid-forties with stories of motorcycle accidents whose victims are turned over and spurt blood from unseen wounds in their thighs Or stories of bodies so severely decomposed that they are removed with shovels or with large plastic bags and duct tape Or stories of his youth, tending a remote cabin where he rose each day to a frozen floor, covered with dozens of cheap candles, which he lit, then returned to bed, to thaw the floor for his bare feet, candles he said would save your life, candles he said always to have in the back of the ambulance in case you get caught in the snow. His name was probably Calway or Tipton or Morland. He drove like a teenager who had not yet become accustomed to high speeds or winds on the highway, but who was addicted to the machismo of handling a diesel rig. He spoke on the radio like someone who invented shortwave communications.
We took the ambulance to IU Hospital and navigated the winding and empty corridors to our patient’s room. There were three nurses outside his door, somberly looking at us, ready at any moment to bow their heads and succumb to their weighty sadnesses. A man, a tall woman, and a dark-haired woman whose eyes looked into mine, then past mine, then past the long sterile hallway behind me to somewhere else.

The patient sat or laid in his bed, his hair was reddish and curly and dry, and showed the early graying of late thirties, he wore a short beard of the same color and thickness. His arms and shoulders showed a width of an earlier strength, the coarse hair on his thick forearms matched the hair on his head and in his beard. He wore a hospital gown, and had a tube taped in his nose which supplied him with air and a tube taped to the corner of his mouth, suctioning the clover-green fluid from his lungs that threatened to drown him. I imagine now, that it could have been his dissolved lungs, or a dissolved solid cancer, or a liquid cancer that was carried through the clear hoses away from his body, out of his body. His name was probably Steve Mason or Gary Steele or Mark Amblin. His eyes fluttered, neither open nor closed, and his mouth moved silently, speaking to us from a deep morphine dream.

“We are not going to make it to Lafayette with him,” my partner said to me, leading me out to the hallway and away from his family who sat quietly, anxiously, anonymously in the corner sofa of the patient’s room. “We aren’t going to make it down the hallway without him dying. The nurses just want to get him out of here.”

I nodded, looking solemnly at my feet then at the family. “Do you want to report that he is unfit for transport?” I asked or I just nodded, studying the hunched posture of the patient’s wife from the doorway. She was nervous and tired, looking at the faces of her daughters and her son. She took a pill out of an orange pill bottle and swallowed it without water after delicately holding it in her mouth for a few seconds, perhaps savoring its bitterness as it began to dissolve. Perhaps distracted by a distant thought. The nurses began pulling the lengthy, filled hoses from his nose and mouth, and she watched with glassy eyes.

My partner looked at me for a moment then said, “We should go ahead and get him on the ambulance.” So we did, moving him ungracefully from his bed, dragging him on a flimsy white sheet, his body moving in wide slow jerks to our pulling and pushing. Free of the hoses, free of the dripping machines and monitors, free from his large electronic bed, his face seemed to relax, his eyes began to flutter more slowly. His breathing immediately began to rattle deeply inside his lungs, and his frame sagged to the side.
As the nurses scrambled to find a last piece of paperwork, my partner sat next to the family, and I stayed next to the patient, listening to his breathing, feeling for the pulse in his arm, gripping with my hand over his eerily familiar tattoo, a skull wrapped in a banner that read Death Before Dishonor.

This is what my partner said to the family, addressing mostly the wife amid her silent nodding and her distant mind:

“I’m very sorry to have to discuss this with you, ma’am, but I want to so you know what we will do if something happens where your husband takes a turn for the worse. Now, he is a no-code, is that right, ma’am? What I mean to say is, if his heart stops while we are in the ambulance, we are bound by law to leave him in God’s hands. Now, ma’am, we can do other things that probably will not be able to bring him back, but we can try. We can put a mask on his face and breath for him. Would you like us to do that? Okay, and we can do things like drop a tube down his throat. What I mean is we’ll place a tube down into his lungs so that we can be sure he is getting air in his lungs. Now, ma’am, like I said, this probably won’t be able to help keep your husband alive, and it will cause him a great deal of pain, and, if he does expire, we’ll have to bring him to a hospital so that they can remove the tube, and it will incur you an extra expense. Do you understand, ma’am? Okay, then, you let us know if you change your mind and you want us to put that tube in, and we will, okay, ma’am? Ma’am is this your son? Who will be riding with us to help us find your house in Lafayette, if anyone is? Is your son going to? Now, son, I want you to know that we’re going to do our best to get your dad back home, as it’s his wish to be at home when he dies, but we can’t promise he’s going to make it. Son, I’m going to need you to know that if your dad stops breathing, we can’t do anything else for him, but you can be there for him and talk to him. You can be there for him and talk to him, okay, son? We’ll pull over and you’ll know something is wrong because I’ll be pulled over and the lights will be flashing. Now, ma’am, are you going to be following us in your car? What model and color is your car? Does your son have a cellphone where he can reach you? Okay, ma’am, do you have any questions? Yes, ma’am, we’ll wait for you just around the corner on University, do you know where that is? Yes, ma’am, we’ll wait for you until you are ready and behind us, just flash your lights. Okay, son, come with us.”

We retraced our steps through the still hallways, disquieted, the gurgling sounds of our patient’s breaths filing the hall as he slowly began to drown, as he slowly began to fade, a green stain spreading below his beard on his hospital gown, his arms gripping the rails of the cot and relaxing, his son following a few steps behind us.

We waited for longer than thirty minutes outside the hospital for the family’s car, the son sitting in the front seat while my partner continued his rambling consolation or his calming speech or his distracting lilt from despair, me sitting in the rear of the ambulance, my hands adjusting the pillow under the patient’s head as he turned his head and fidgeted, my hands holding onto his arm as he moved it unconsciously toward his face or across his chest, my hands pressing the hard plastic suction hose into his mouth and around his nostrils, my hands desperately checking his pulse or listening with the stethoscope to the cavernous bubbling inside his chest as his lower lungs filled with fluid. Then, again, we waited near the on ramp for the highway which would bring us north, as the family’s car became confused, lost. Then we were travelling north, travelling much too fast as the wind wagged us and threatened to topple us, travelling slowly through time, sounds of our travels rising and falling as the diesel engine’s belts slipped and stuttered.

I wiped away the green fluid from his mouth and from his beard and from his neck with the coarse ambulance towels. A dark green, particulate fluid that I imagined briefly to be ground pesto or pond water found near the shore or wheat grass, imagining it to be anything but his lungs liquefied, his body liquefied by the cancer that spread too rapidly from his pancreas, this odd gland from which our lives are spared or from which cancer is spread. Imagining it to be anything but an untimely herald carrying the putrid smell of impending death. He tried to speak or his mouth moved, and a drowned mumble escaped from his mouth. I leaned closer, ignoring the lurch of my stomach as the smell grew stronger. He fell silent. His eyes looked at me, then away from me, closing and opening, and his mouth moved around the suction hose, biting it then releasing it. He coughed gently, weakly, futilely.
By now I had taken my gloves off, his skin was growing cold and his pulse was growing weaker, too weak to feel through the thin latex gloves, my last remaining line of defense, of separation. I had the feeling that I was watching as his life slipped away, had the feeling that I’d seen his tattoo before in a dream, had seen his thick forearms before. Forearms I pictured working in a Union job heating and shaping steel to the meandering shapes of auto exhaust systems Or turning an iron, four-pronged crank, crushing the water out of wood pulp to make paper Or swinging a long-handled hammer into the concrete ground, crushing pavement into small pieces of debris, shoveling that debris into a wheelbarrow’s basin covered in white dust, forearms covered in white dust crisscrossed with darkening rivulets where sweat had dampened his arm hair, covered by the inexhaustible heat of Indiana’s late summer sun.

But this was winter, is winter. I looked out into the black distance that our ambulance emerged out of and plunged into, watching as the lines of the road escaped us and made their way into an unresisting dark. His life was slipping away. His breathing slowing and his pulse quickening. We were off the highway, quickly making our way through a stretch of tall trees, navigating the darkness as his son gave directions in short bursts of one or two words. I was waiting for something to happen, morbidly aware of the passage of time, aware of the ragged, inhospitable breathing sounds in his chest having crept up to his upper lungs, aware that the space in his lungs that remained unfilled with fluid had shrunken beyond the means to support life. His body, bearing this cruel fate of men to live only to die, waited with me. I looked up to the profile of his son’s back, sitting unaware in the front, waiting to get home.

There was little else to do besides wait. I counted his breaths. Six barely perceptible rises and six falls from the man’s chest in a lengthy minute. I began fitting the mask onto the bag, filling the reservoir with oxygen, the only thing left to do to lengthen his life for another few minutes. Perhaps enough to get him home.

Two blocks from his house, his breathing slipped down to four breaths. I announced to my partner, “I’m bagging him, BVM plus oxygen,” or perhaps I said something more similar to, “We’re losing him,” or even, “Light it up.”

He replied, “We’re almost there.”

“He’s only breathing once every fifteen seconds.”

“Shit.”

“I’m bagging him, pull over and turn on the lights or get us to a hospital.”

“We’re not going to a hospital.” Then, “I’m coming back there, hold on.”
I lowered the cot so that his head lay flat and began to breathe for him, my bare hands pressing his chin up, pressing roughly against his green-stained beard. I squeezed the bag slowly, rhythmically. He stopped breathing. The ambulance was pulled over, and now my partner was next to me, feeling for the patient’s pulse, listening to the hollow sounds of his chest through the stethoscope. He nodded at me, I nodded at him.

“Son, come back here and be with your dad. Tell him to hold on, tell him that you want him to make it,” he said to the kid, the child of barely fourteen or fifteen who was then by my side, familiarly holding onto his father’s forearm with his small, frightened hand. The son’s white baseball cap had come off of his head, and he had left his matching white zip-up hoodie in the front seat. His eyes were wide with shock then reddened then heavy. He sat next to my partner on the bench.

“Hold on, dad. I want you to make it. You can make it,” he said quietly, distantly, impotently. “C’mon, dad,” he said. Then he was silent, resigned.
My partner looked at me again, his hands lifting the stethoscope and placing it in the area above the patient’s heart. He did this slowly, methodically. I matched his look, waiting, looking into his eyes. This time he shook his head, reached up and took the stethoscope out of his ears. I nodded and took the mask off of the face of the body, turned off the oxygen. I looked at my watch. 11:11p.

“I’m sorry, son. It’s gonna be okay, your dad has moved onto a better place. A place where there is no suffering. Now come with me, come be with your mom,” my partner said, already in motion toward the back doors of the ambulance. The son turned to leave, and the body’s vacant eyes stared upwards. In a final, stubborn motion, his lungs pushed out the air that I had pumped into them, carrying with it the final, stubborn mass of green fluids, which pooled out around his head. I put gloves on, and shut his eyes. His wife had pulled in behind us onto the gravel shoulder and was out of her car, and I could see her, through the open back doors, shudder as my partner spoke with her, her knees weakening then straightening. She stepped up into the back of the ambulance, and I tried vainly to clean up the body’s face, tried desperately to clear away this green death, this terrifying smell. I covered the stains on the cot with a towel, covered his stained gown with another towel, put a fresh towel next to his head. The wife sat down on the cot next to the body.

After several seconds, the wife said his name out loud. I stood paralyzed. She said his name again, more loudly. Then she sighed, shrugging off the weight of a giant, quick cancer, the constant smell of hospitals and deterioration. She cleared her throat and lifted her chin. Then she said his name again and tears spilled from her eyes in two parallel lines down her cheeks. She sobbed and seemed to hunch forward, but then she was falling, falling toward me, standing dumbly beside her. I had taken off my gloves again. I caught both her shoulders and kneeled next to her, trying to look at her eyes. They were open, looking past me, past the floor of the ambulance, past the ground beneath us toward something else. I held her there for a moment, looking at her face, all her weight resting on my hands, then I slowly pushed her shoulders back until she was sitting upright.
“I’m okay now,” she said, patting my hand on her shoulder. She looked at the body, put her hands on his forearms, and began to cry, her shoulders rising and falling with each troubled, jerking breath. I went out of the back of the ambulance.

I stood on the shadowed side of the truck, my back leaning against the side, thinking about reality and its precarious lack of dominance, lack of permanence. I thought about the sad aspect of being an EMT when someone has decided not to be resuscitated, the absolute powerlessness that a person inherits when very little already exists to help stave off an ever insistent death. The family huddled together now, more brothers and uncles had arrived and the wife was now with them. My partner had given them blankets from the truck, or perhaps I had given them the blankets. I watched my partner smoke and talk to the other paramedics and the policeman who had arrived. I watched my breath come out in transient clouds, felt the cold air in my lungs, imagined it filling one lobe of my lungs at a time like water filling and overflowing a waterclock’s chambers in sequence, imagined my donut-shaped blood cells in veins near the air, changing from blue to a blackened red, then leaving and being pumped through my chest and into my head, my arms, my body.

I covered the body with a clean sheet, and my partner and I started the ambulance toward the Tippecanoe County Coroner’s Office. He told stories about the smell of death and how it sticks to everything. How years from now the smell will be on my pants, on my hands. The short, stocky, probably Irish coroner casually greeted us at the door, and quickly lugged the body onto an unadorned, huge, dully gleaming metal table on wheels. He was exactly as I imagined a county coroner to look and sound. He jammed the table into a crowded coldroom, the body rolling back and forth with each subsequent thrust of the table into the darkness. The table banged against other tables and things that littered the ground. The sheet came off of the body’s face, and for a fleeting second I had the stupid, dull thought that maybe we had made a mistake, maybe he was still alive. His eyes had come slightly open, probably as a result of the banging table. With a sudden finality, the coroner shut the huge metal door, latched it, and locked it. He disappeared through a door in the side of the building where I glimpsed the family sitting. I returned to the ambulance and threw away everything that I could see, everything with the slightest hint of death, then wiped and washed the cot and put on fresh sheet.

On the way back, I fell asleep for a few minutes in the passenger seat, my head against the window. I dreamt that I was walking with a staff or dreamt of just a staff. Two giant serpents climbed up it in spirals. I set it down and looked off, downhill, into the distance, through the dense green trees surrounding me into a clearing where all the memories of my life were in slow motion. All the small memories of my life, all the monumental memories, played out among the trees, on the clover-green grass, all replayed at an agonizingly slow speed.

“You couldn’t have done anything differently. You did everything right,” my partner said to me, waking me out of the dream.

I didn’t answer, I just sat with my eyes closed, listening to the passing winter landscape, feeling the coolness of the window surrounding my face.

“You might not think so, but what you did is the most important thing an EMT can do. To be there when someone dies,” he continued. My eyes still closed, I idly wondered if he was looking at me or at the road. It seemed as if we were driving at an incredible rate.

“Not everyone can be there, be calm for the family, be calm for the patient. You had to do those things. You had to be the one to be there for him, and that takes something. It’s what people like you and me are made up of. You handled it fine.”

Opening my eyes, I saw his hands at the top of the wheel, his head hunched forward in concentration. It had begun to snow in huge white flakes that reflected back the light of our headlights. We were heading south, into oblivion, back to Indianapolis.

“I know,” I said. But I thought of the vainness of being an EMT in the back of an ambulance when a DNR patient’s heart stops beating, of the painful uselessness I had experienced, of the minute power I had to stave off death becoming blunted further by a patient’s wish to die.

I closed my eyes again, feeling the throbbing of the diesel engine as it revved and recovered, feeling the small bumps in the road with my skull.