My first body came on my first shift. It was a Friday night, dark and cold, the wind whipping across the empty fields. We were at a rollover on a country road. Someone had drifted too far into the snow on the shoulder and gone into a ditch. There had been two occupants, but somehow they were fine, not a scratch on them. On the way back to the ambulance — here in Ottawa, the paramedics call them trucks — we stopped to look inside their car, which was still on its roof. There were two barbells that had banged around in there and settled on the ceiling. We were ducking our ears into our coats and talking about how lucky the people were not to get brained when the radio squawked.
Serving a region with a population of just over one million, the Ottawa Paramedic Service answered more than 103,000 calls last year. The calls come over the radio in bunches. In my first five minutes inside the truck, there were calls for a woman having a seizure in a grocery store, an eight-week-old boy choking, a homeless man found unconscious in an alley, an elderly man with difficulty breathing, a possible heart attack in a chicken restaurant. If you just sat inside that truck listening to the radio, you'd believe the world was falling apart. It's madness. But even in the midst of all that screaming and chaos, there are calls that stand out. A Code 4 is a life-threatening emergency, lights and sirens. A Code 4 VSA — vital signs absent — is lights and sirens and a little bit more. This call was a VSA, a woman stretched out in the darkness to our west. Darryl and I jumped into the truck and bucked it.
Darryl Wilton was my mentor and partner. He's thirty-six, tall with a shaved head. If you could request a particular paramedic when you dialed 911, you would ask for him. He's been in the truck for twelve years, and he has seen a lot of things. As part of my training, he showed me published and unpublished media photographs from some recent calls to make sure I had the stomach for the work. He didn't want to have to treat me, too. ("The barrel-over-the-falls effect," he called the bilious uprush that rookies suffer.) There was the motorcycle wreck in which a husband and wife were launched across an intersection like crash-test dummies. There was the poor bastard who had been pulled into a printing press by his right arm. That's when I was introduced to the term "degloving." The guy had lost every shred of skin from his fingertips to his shoulder. His arm looked like an illustration in an anatomy textbook, a collection of red muscle and white flashes of bone and ligament.
I understood there would be my life before I spent time in the truck and my life after. We raced through the night, and I tried to prepare myself. Darryl prepared, too, but in a different way. He switched his brain into its most methodical gear. It was almost as though he were treating patients in advance of seeing them. "Time is tissue," he said. With every minute that passes before treatment, more body parts that should be pink turn white or blue, and white or blue equals death. As we listened to updates on the radio, he'd ask me what I thought about what was coming, and he would gently guide me toward the likely reality. Code 4's that came in just after snowstorms were often heart attacks — someone goes out to shovel and his heart can't handle the exertion. VSAs early in the morning were often unworkable, because chances were that the victim had died in the night, hours before he was discovered. Then the Code 4 would become a Code 5. "There's clinically dead, which we can work with," Darryl said. "And there's obviously dead, which we can't."
We knew this woman was elderly and laid out in her garage. It was a little after 7:00 p.m., which gave us a few possibilities. It had been snowing pretty hard, so maybe she had a shovel in her hands. (Paramedic calls follow the seasons: Summer sees an increase in trauma; winter brings a spike in medical calls.) Or maybe she fell on a patch of ice and hit her head. Darryl worried that she might have gone down sometime in the afternoon and not been found until someone returned home from work. We both reached into the box between us and pulled out blue nitrile gloves.
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