The Worst Thing I've Ever Seen

"What's the worst thing you've ever seen?"

This undoubtedly tops the list of FAQ's to all paramedics, EMTs, and probably everyone in public safety.  Needless to say, all of us have our go-to story that isn't quite the worst thing we've ever seen, but will nevertheless satiate the inquirer's insatiable appetite for drama.  Although everyone enjoys the graphic, traumatic tale that many of us could relay to our listeners, I think the most profound response that I've ever heard to that question was from a paramedic who used to work at my service, Ramon Henderson.

When I asked him this question, I was a rookie; still very, very green.  I had no clue what was in store for me.  All I wanted was to hear the war stories.  I wanted the sultry details of every bad call.  But his response left me speechless and dumbfounded, and admittedly, at that time I didn't quite understand how to digest what he had just said.

His go-to story was simple.  In fact, it wasn't a story at all.  It painted a picture for any person seeking a word thrill, without the gory, blood-and-guts-type details that most want.  Instead, it painted a different style of a grim story.  It conveyed a message to all those searching for excitement through others' tragedy and despair that the exciting moments, the desirable moments of our job, aren't those represented by the collateral damage of a human life.  Those certainly aren't the moments we want to remember in a positive light, not to mention share.

His answer with some of my own extrapolation: The sheer poverty that exists in our city.  The poverty that prevents those who need to care for themselves and their family from truly being able to care for themselves and their family.  The child abuse and child neglect.  Children unable to reach their innate potential due to extenuating environmental circumstance.  Children unable to meet their potential due to lack of parental guidance, concern or attention.  Children unable to achieve their potential because their parents lack the resources - financial, social, and otherwise - to provide for them.  Or children incapable seeing their potential and of surmounting the preconceived set of rules that govern their life and abilities to develop and then conquer their goals.  Hungry children.  Fearful children.  Children who don't know where their next meal will come from, when it will come, or if it will come.  The blatant maltreatment of and disregard for human life.  The human trafficking.  The drug abuse and dependence.  The elder abuse.  The sexual abuse.  Abuse of disabled.  Abuse of Veterans.  Lack of education, both in school and at home.  The substandard, overcrowded, often lacking water and power housing arrangements.  Or no housing arrangements; homelessness.

Worse, however, is our interpretation of those issues.  Our frequent or occasional denial in the face of reality.  Our society's refusal to acknowledge the existence of these conditions and those that cause these conditions.  Our desire to maintain a photo shopped world sans the violence and death that occur in their reality, but only in our local news, the TV shows we watch, and while we're on the clock.  The us versus them mentality.  The approach from an often (more) privileged and myopic perspective.  And the stance we take from afar with a certain blindness to the inequalities that exist in this world, natural or environmental.

We all have our stories that will forever scar our hearts and leave long-lasting images in our eyes and brains; the stories that create audible tension in our minds and palpable tension in every room we enter (or maybe that's also in our minds as a result of our experiences). But sometimes, despite overwhelming negativity in our daily work lives, some positive light can shine through.  And, in fact, as a general optimist, I try to see or create the positive in the face of all the negativity.

For example, recently I experienced two fairly juxtaposed situations that have definitely left a mark on me.  The first is probably, to date, one of the saddest, yet touching moments of my career.

I was posted at a gas station across from a skating rink.  My partner and I walked into the gas station to buy a few snacks and some drinks.  As we exited, we were met by an 11 year old child who appeared to be upset, but we didn't really think anything of it.  We continued walking toward our ambulance and the child called out "Excuse me, do you have a phone I can borrow?"  My gut instinct is always to say no.  In fact, I even considered using my standard line "we're not allowed to give money or let people use our phones because we're on camera".  I guess after working in EMS for some time I am always suspicious when someone asks to use my phone (especially after someone tried making an international call at one of our northern posts).  But something about this situation felt different, so I turned around and asked the child who he needed to call.  He said his mother.

So naturally, I asked the kid for his mother's phone number, put my phone on speaker and made the call for him.  He told his mother that he needed her to pick him up because the "guys" wouldn't pay for him and he has no way home.  His mother, screaming at him through the phone, asked him where he was, who's phone he was using, why he wasn't skating, etc.  She told him she was out and couldn't pick him up and he'd have to find another way home.  I interjected and explained that I was a paramedic and would see to it that her child would get home safely.  The kid looked devastated and embarrassed.

I asked the kid where he lived and he told me.  I can't really go into the part of the story about how I was able to get permission to "figure out a way" for the child to get home, but what I can write is that at some point during that process, my partner pointed out to me that he thought the kid didn't have money to skate, not to get home as I had thought.  We went back to the gas station and withdrew money from the ATM.  It required no further thought.  It's what needed to be done.  After all, skating only cost five dollars, so what the hell.  We gave him $5 for skating and $5 for food/snacks/drinks and watched him overcome with relief, joyfully walk back to the skating rink where he'd presumably join his friends and have the fun night he planned on having.

Whether anyone else in my situation would have done that or not is irrelevant.  What is relevant, however, is the fact that this child was upset.  The child was nearly in tears when he asked us for a phone to call his mother.  The child felt abandoned by his friends, and now by his mother.  This child still had the innocence in his eyes we often don't see in our line of work.  He still had a kindness and respect that we generally aren't afforded.  He had something different.  He hadn't yet been affected by the gangs that patrol his neighborhood, the violence that he regularly hears in his back yard, the limitations society has placed on him.  He hadn't been scarred by his version of normal.  He was a child.  A child that no one (until now) would know.  A child that, unless something unusual, or spectacular occurs, may succumb to his surroundings and lose his sense of self and his dreams.  Or the potential to form an alternate future for himself, rather than the one he has been taught to believe exists.  A child incapable seeing his potential and of surmounting the preconceived set of rules that govern his life and ability to develop and then conquer his goals.  Maybe that's who this child was, or maybe not.  But at that moment, that was the child I saw and that was the child I felt was different; a child I felt needed someone, anyone, to stand up for him and show him that the world is not always a terrible place.

The second situation is almost the opposite.  My partner and I were called to the home of a young child who recently had a catheterization to repair a hole in the septum between his atria and was now complaining of dizziness and left arm pain.  Of course, on the way to the call, I went over the list of cardiac medications we carry and their pediatric dosages in my head and out loud with my partner, as I think anyone would (or at least should).  When we arrived on the scene, we were greeted by a very worried mother holding her young child.  En route to the hospital, I could see the worry on the mother's face and we started talking.  The child, by the way, was stable and considerably stoic.

The mother explained to me that she noticed her son wasn't as playful as her other kids were when they were his age, but thought nothing of it.  She said the doctors discovered the hole in his heart because she wanted to take her son to get his teeth cleaned, but because of his age, the dentist required a physical.  The pediatrician who performed the physical noticed some abnormal heart tones and referred the child to a cardiologist.  At the cardiologist, multiple tests were conducted and it was determined that the child's lack of energy was likely a result of a congenital atrial septal defect that would need to be repaired.

I spent the majority of the transport monitoring the child while quelling the mother's fears to the best of my ability.  One thing we don't spend enough time on in paramedic school is the interpretation of pediatric 12-leads.  I pulled out my smart phone and started researching after explaining this fact to the mother.  I assured her, that regardless of my ability to interpret the 12-lead, I would be able to care for her child as he needed.  I also transmitted the 12-lead to one of our local adult emergency departments and spoke with the doctor over the phone who confirmed my interpretation as unremarkable.  After discussing the situation further with the mother, I called the pediatric receiving facility to which we were transporting and consulted with the pediatrician over the phone to again confirm that nothing acute was apparent on the 12-lead.

The mother explained to me that she had never had paramedics seem so invested in her child's health or her own well-being as a mother.  She told me that given her limited education and financial resources, there are some times that she is incapable of providing for her children, but that she does everything in her power to do so and to raise them right.  Regardless of her best efforts, her child will forever have a cardiac history.  He will forever have this history.

Both children in the above examples will forever have the situations in which they were brought up, but what they do with those experiences, those limitations, with the blessings and the curses, is what will define them and what will make their lives seem limitless.  They will not be defined by their past social or medical histories.  They will not be forgotten.

When people ask me what the worst thing I've ever seen is, their faces, among the many other children I see on a regular basis will populate in my mind.  What I will think about are the conditions that produce the sick children we see and society's sightless view of them, both their present state and their presumed future.  I will internalize their plight.  I will sympathize with their suffering.  I will convey to whomever will listen that the worst things we see are not the colossal car accidents or the mangled limbs they produce; they are not the people shot or stabbed; they are not the strange anatomy through which we were able to pass an endotracheal tube; they are not the cool and unusual cardiac rhythms; they are not the tragedies of others' stories.  Rather, they are our own tragedies and lack of awareness.

The worst thing I've ever seen is the unfairness in this world that cascades to produce further disparity affecting the lives of children, their social and psychological development into adolescence and adulthood, their futures and ours.