First Response

By Adam Michael Nicks

You look out the front seat of the ambulance window at the city pulled to the edge of the road and think about your comatose sister in the hospital just a few miles away. The blue Camry that you’re speeding towards is an accordion; shattered glass peppers its sides like a ring. There’s a pole splitting it in two that remains unharmed and victorious, standing firm and inconvenienced by the four-wheeled hunk of metal that lost the joust. Dispatch fights to be heard over the static and siren blasting overhead. Bruce swerves in and out of traffic with the lights swirling. You hop onto the radio: “Rescue 1 is en route to Dean’s Way.”

Things always happen this fast in this line of work, you always have to be ready. The 911 call came from a frantic witness saying that the Camry just lost control. Sometimes these things happen. Tracy is in the back preparing the bags and the stretcher for what you might find.

Bruce pulls up and throws the vehicle into park. Tracy jumps out and wheels the bed alongside you. Just like you’ve all been trained, you take in the scene and begin to work. The body lays twenty feet away, motionless. You check the car as you pass to see if there’s anyone else inside. Empty. One of the three most important rules of your training is spinal precaution, but in a situation like this it doesn’t make much of a difference. The damage is too severe. Tracy helps you turn over the body: a girl. You think she might be just a few years younger than your own sister, who is in desperate need of a heart transplant.

“If she were wearing her seatbelt this wouldn’t have happened,” Tracy mutters. “Probably texting, too.” Her four children are in for another lecture on the subject when she gets off. Bruce tries to stay calm, ignoring what he calls his “Italian Temper” while he shoos away the gawkers. Car accidents are gruesome free sideshows and everyone has a ticket.

The fire truck pulls up to extinguish the nonexistent flames and attracts more gaping mouths and macabre thoughts. Firefighters block off the street and direct traffic, there’s not much else for them to do. From the outside, they look like the glamorous heroes of disaster.

Tracy scribbles down the victim’s vitals on the clipboard while you reach into the bag and pull out the transparent mask. You strap it over the girl’s mouth and begin to pump, struggling to get airflow. Her ribs are cracked and shattered, tearing through her chest and exposing her insides. Behind shredded tissue, sharp bone, and puddles of blood, you can see her weak, but still present, heart churning. You watch the organ throb from underneath the holes in the lung – it’s just begging to escape. It would be so easy to reach in and take it, and you would if it could save your sister. She’s nearly at the top of the donor waiting list.

Bruce says: “You see those tire marks? She was going way over the speed limit.”

Distracted, you look back at the black burnt rubber on the pavement leading up to impact. Your hands go through the motions of saving her; it’s second nature at this point, but when everything happens at this speed it’s easy to get left behind, so you refocus. Saving lives is your job.

The left side of the girl’s face is only halfway there, almost as charred as her arm, which sports a new unnatural angle thanks to an unsheathed bone. When she was thrown from her seat she must’ve turned slightly for her fatal surf along the cement. This isn’t anyone’s first call; you’re all veterans who have seen every horror imaginable before. Knowing when people will live or die comes with the territory. This girl will die. She will not live long enough to see the hospital. Your sister though, she might be able to live if she could take that thumping fist-sized pump.

The girl starts choking on her own blood. She gurgles sound and vomits incoherent guttural death rattles. Her teeth are broken and mangled and there are more pieces of glass embedded into her flesh than there are stars in the sky. If you squint, you can almost see your sick sister’s face in the grotesque trail of the girl’s remains from her slide. It’s morbid, but unsurprising – she’s all you ever seem to think about, and you’ve been seeing your sister everywhere you look.

You’re the older sibling and you have to watch out for her, especially now that your parents are both gone. She’s your responsibility now; you promised your mother that on her deathbed. Somehow you got lucky and avoided the hereditary heart problems that plague your bloodline. First dad, then mom, now your sister, but she’s the only one with a fighting chance.

You remember something random – a time when you two were much younger and she somehow convinced you to let her put mom’s make up on you while the babysitter was asleep on the couch. She wanted to make you all fancy for the two of you to play house. She took her tiny hand and patted your face with foundation, creating mushroom clouds of powder on your cheek. Then she drew a smile on your face with lipstick that was large and uneven, somehow managing to get around your lips but in between the cracks of your teeth and on your gums. By the time she went in with the mascara brush, your parents had come home to find the mess. Your baby sister pleaded with them not to be mad, she just wanted to make you pretty.

Bruce yells out your name and Tracy has to call it again before you snap back to the scene and see that nothing is pretty here. They’ve already run away and climbed into the ambulance leaving you frozen on the ground like a statue. Time for the transfer of care – a formality really in this case, you might as well take her straight to the morgue. When you get back in, you use the radio to inform the hospital you’re on the way and you help Tracy try to stabilize the victim.

“I’m en route with what appears to be a twenty-five year old female with severe lacerations, internal bleeding, heavy blood loss, several cracked and protruding ribs, a punctured lung, a shattered arm, likely spinal and skull fractures…” the list goes on and on. You stop after each ailment hoping that Tracy will tell you that the girl is too far-gone and you should stop. She’s not worth saving.

Doctors will have four to six hours to put this heart into your sister. This girl could be her donor. This might be the heart that could save her. Didn’t she deserve it? Hadn’t she been through enough? Hadn’t you?

You gaze at your watch to find you only started this shift eight hours ago. When you last left your sister’s bedside, the nurse told you that she wasn’t looking good. She might not have long. You prayed for something like this to happen: that a girl like this one might make the biggest mistake of her life and in turn, give someone else a chance to not be so careless with theirs.

One day, your sister will find someone she loves and get married, have kids, and you’ll both look back on all of this and laugh. Your sister’s been chained to that bed, those wires and machines, for so long now that it’s hard for you to remember what she used to be like before the thick scar ran between her breasts. Now it’s all part of her.

“Any I.D.?” you ask Tracy. But she gives you a look of confusion and disbelief as her gloved hands attempt to hold in oozing organs. You stare at the gooey pieces of the girl popping up between Tracy’s frantic fingers. Other people can use those things, she really should be more careful.

Bruce shouts that you’re almost there and Tracy prepares for the girl’s exit. Doctors and nurses are waiting outside to receive her and they throw open the doors to get her out fast. You help lower the stretcher while the girl’s eyes roll up to look at you one last time – to look at anything one last time. The medical staff disappears through the automatic doors, but one stays behind to talk to Tracy. Since you have a few minutes, you check in on your sister on the fifth floor and leave Bruce to clean up. He understands.

There’s a heavyset nurse who tells you that your sister might not make it much longer. You don’t believe it though, they’ve said this before and she always bounced back. The infallible machines do all of the heavy lifting now; they control the life in her. The color of her face, the same face that you see when you look in the mirror, has long since changed to a ghostly hue and her body is withered and jagged. Her hair used to be thick, like yours, but now it’s stringy and thin.

In the right lighting or angle, it’s easy for you to mistake her for your late mother lying in the bed instead. If you stare too long, you can even picture your sister whimpering at her side, holding you close after they pronounced mom dead. Your sister’s solemn expression matching your memory of the one she wore at the funeral of your father.

You don’t stay in her room for long; you notice a tiny bit of blood somehow leftover under your fingernail from the girl. Going into the bathroom, you clean your hands of the situation.

Tracy does the paperwork on the way back to the station and Bruce whistles loud in your ear. They both know what happened back there, you spacing out, but they won’t say anything about it. That accident could’ve happened in the hallway of the hospital and there still wouldn’t have been anything more that could’ve been done for the victim, but it’s obvious you’re not all there. Maybe you didn’t try as hard as you could have; maybe this is just a one-time thing. You’ll do better next call, they’re probably trying to convince themselves, but your head is with your sister and this isn’t the first time something like this has happened.

There’s always a debriefing after an assignment, mandatory within stations across the nation after the rate of suicide and alcoholism skyrocketed amongst EMS and firefighters. The higher-ups are worried about PTSD, bad P.R., but there really does need to be a certain level of desensitization, you think, otherwise how could you all live with yourselves having seen what you’ve seen? Having done what you’ve done? When a job deals this closely with mortality it becomes a routine because it has to be. There needs to be a disconnect with death.

In these sessions, everyone has to talk about their feelings and be supportive of one another and discuss what happened and how. Are you okay? What can we do to help? What could we have done better? None of that helps you. They can’t help you unless they’re able to give your sister a heart. Tracy and Bruce know your situation, you’ve all been working together for years, but you don’t buy a second of their phony sympathy. All that you care about is whether or not the girl in the wreck was an organ donor, and though you try to phrase it as casually as you can, you fail.

Tracy says that she wasn’t. All of that hard work for nothing.

And it’s another two hours before dispatch tells you that you’re needed again. For this call, you’re driving. Bruce goes into the back to prep and Tracy sits next to you up front. When the radio tells you the address, everyone knows and groans – this is the infamous Mrs. Williams, the seventy-five year old diabetic. She’s what you guys like to call a “frequent flyer.”

“Looks like you got the short end of the stick,” Bruce laughs with his booming voice. Mrs. Williams calls 911 at least once every two weeks and everyone in EMS has helped her a minimum of three times. No one can figure out how she affords it all or why she hasn’t learned her lesson. Her blood sugar drops to dangerously low levels, and as a result her mind will go. She never realizes that paramedics are there to save her life so she bites, scratches, spits, and kicks like a belligerent child throwing a temper tantrum. Her daughter lives with her and takes care of her; she’s a few decades older than your sister.

Mrs. Williams, you know for a fact, is an organ donor.

You back into her driveway, you could do it with your eyes closed by now, and follow Tracy and Bruce at a somewhat slower than usual pace. One of the three most important rules of your training is quality patient care – no matter who or what. Still, an audible sigh occurs when you all reach the door.

Mrs. Willaims’ daughter left it unlocked, so you walk in. On the shag rug of the living room is Mrs. Williams, motionless near the stiff leather reclining chair she spends most of her time in. Her daughter’s crying and hovering over her, poorly administering CPR as the operator directs her to over the phone. She doesn’t even notice that you’ve come in. Bruce runs up and pushes her to the side while Tracy starts to work. You follow behind with the clipboard and write down what you see.

But what’s the point?

She’s dead.

You help zip up the black bag and load her onto the cart. The police bully their way in to conduct their investigation before you can step out. Wheeling Mrs. Williams through the front door, you can hear the sobbing heaving of her daughter, now an orphan. You know the feeling. She swears she was asleep for just an hour and when she came into the living room to check on her mom, she found her like that. Oh god, oh god. No foul play suspected.

Behind the wheel, you drive Bruce, Tracy, and what’s left of Mrs. Williams to the morgue. None of you are sad. “Well, I guess now we don’t have to worry about getting a call from her anymore,” Tracy laughs. Doctors can’t put a heart in that’s been gone this long into another body. Even in her death, Mrs. Williams finds a way to annoy you.

And just like that, you’ve only got a few minutes left before your standard 24-hour shift is over. This time you’re in the back of the ambulance alone. Bruce rides shotgun and Tracy’s driving. All you can think about is your sister. You had refused to say goodbye when you last saw her a few hours ago at the hospital because you promised yourself it wouldn’t be the last time you’d see her. That’s a promise you intend to uphold.

When she was in high school, your sister threw a party while your parents were away. It was a huge turnout, and when one of her friends spilled a bright red, poorly mixed margarita on the off-white couch, your sister knew she was caught and would likely be killed by your dad. You promised you’d help her clean it in the morning, after everyone left and the party died down. Everything was going to be fine, you promised.

She threw a towel over the spot and tried to have a good time, which she did, but you stayed up all night scrubbing and washing the cushion to get it back to normal. The next day when she took the towel off, she was shocked to find that it was as if it never happened at all. You told her she imagined it and had worried for nothing. She was so relieved. You didn’t want her to feel guilty about everything you went through.

When you step out of the back of the ambulance with the stretcher, the view of the pile up is overwhelming. Seven cars are connected in a line by dents and damage ranging in severity and the worst are the ones in the center. This is way more than the three of you can handle, and Tracy calls for more help over the radio. Bruce runs with you to each car to assess the conditions of the victims. The people in the back two are fine; they’re already out of their cars and walking around. The next three are in bad shape, and Tracy’s already checked the front two and tells you they’re not a priority.

One of the three cars demanding attention has a mother dead at the steering wheel of her powder blue minivan; her two young children are in the back with erratic breathing. The second car is a smoking silver Oldsmobile with an elderly woman bleeding from her head and convulsing. The final car holds a teenage girl, about ten years younger than your sister, crushed by her own red Hummer at the waist. “This is bad,” Bruce yells.

“We’ve got to split off until the other guys arrive,” Tracy orders, because in a situation like this, you triage. You take the girl in the red Hummer. She’s conscious and functioning, fine aside from the flattened abdomen. Her brown hair is glued to her face with her own blood and her hooded sweatshirt is bunched up and tattered where the car divides her. A thin stream of crimson runs down from her lips and bubbles when she calls out for help. She keeps screaming, oblivious of her shock.

“Can you hear me?” you ask her. She tells you that she can. “Are you in any pain, ma’am?” She tells you that she isn’t. Her hands are outstretched like she’s reaching for something invisible beyond where the windshield once was. Behind the stain on her chest, you can make out the logo of the local high school’s mascot, a stallion, bucking on its hind legs. Her lower half is confined in a scrap metal cocoon, pinned by her door, draped with her airbag. There’s a look of terror and serenity in her gaze and even though she’s looking right at you, it’s like she doesn’t even know you’re there.

She won’t make it.

Bruce and Tracy are busy with their people; you can already hear sirens approaching in the distance. The living dead girl shouts for her mom and dad.

Everything is under control, but the only way you could save this girl is if you went back in time to stop the crash from ever happening. They don’t teach you how to do that in your training. You try to stop the blood; you try to keep her calm. You think you should say something that might help settle her so that she doesn’t twist or move and pull herself in two, but you’ve only got one thing on your mind. “Are you an organ donor?” She says that she is.

One of the three most important rules of your training is looking out for your own safety and well-being.

“Give me your hand,” you say, and she does. It’s already going cold, but her grip is so strong it surprises you. All it would take to end her suffering is a little tug, and you imagine it would be kind of like pulling apart gum or melted cheese – stringy and difficult to sever, but you’d be wrong.

Just one clean jerk and you can end her hell. You can make it quick for her and she’d be quiet for you when you finish the job that the red Hummer started. If you got the upper half of the corpse to the hospital fast enough, they might be able to do something to help your sister. Lights start flashing behind you: the cavalry has arrived. You’d better make your decision fast. We need an answer.

What was the happiest day of your life?

That’s easy. It was when you took your sister by the arm and helped her walk out of the hospital without some wheelchair or crutches or anything. She shed her tubes, wires, and monitors, but kept the scar between her breasts as a reminder. You joked with her that it added a certain level of cool mystery to her otherwise dorky exterior. Now she had an edge, she might even be dangerous. People see something like that and wonder how you get a scar that big. You suggested she create an elaborate story involving a knife fight origin, or a shark attack, or something.

You loved to see her laugh again. Her color returned, her energy was back to normal, and she thanked you for always being by her side to help.

“You have no idea what it was like,” you told her. “To see you in that bed for so long. The things it did to me.” And you thought about all of the things you’d done and had to do to see her like that again, and you thought it was worth it.

She smiled and told you that you must be used to that kind of thing, working in an ambulance and seeing it all. Even off the clock you were saving lives, you saved hers. She gave you a hug and walked to your car in the parking lot and you helped her lower into the seat. In the spot next to you was a red Hummer. Far away you could have sworn you could hear someone calling out for their mom and dad. Someone else somewhere else was screaming for help. It was all loud and clear but your sister didn’t seem to notice. You looked around. No one was there.


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