Sirens

This is how it starts: a patient is found in cardiac arrest, most likely medical, most likely a thrombus, which is to say, some kind of clot. Imagine a piece of plaque, built up over years, caused by physical punishment to the body, eating fatty foods, sugars, smoking forty fags a day. Imagine this piece of plaque breaking off and hurtling through the blood vessels like a piece of space rock rolling towards planet earth, only in this scenario planet earth is the heart, maybe it’s the heart of a fifty-five year old smoking, type 1 diabetic female with an extensive cardiac history.

Maybe this is your first cardiac arrest. Maybe this is your first cardiac arrest and you’re working on your own and you’ve just came out of the training school two weeks ago.

Imagine this is the first time you’ve interlaced you fingers and put one hand over the other and pressed them into the naked chest and snapped the sternum like it was dry kindling.

Picture back up arriving. A double crew sweeping into the scene asking questions: What’s the story? Any shocks? Have you managed to get a line in? Oh, you’re just a Tech. Okay, will you stay on the chest while we get airway and access sorted?

One, two, three, four. Steady rhythm up and down, ribs popping like bubble wrap. One, two, three, four. Forearms burn, shoulders burn, the lower back twisting and knotting.

Rhythm checks.

Adrenaline.

Sweat. The smell of urine and faeces.

Imagine the line on the defibrillator jumping and writhing in time with your chest compressions and when you stop the line goes flat. Imagine after twenty minutes of this the Paramedic says: Let’s call it. Time of death is blah blah blah.

You don’t hear the rest. While this woman’s heart doesn’t even twitch, you can hear your own heart pumping in your ears and maybe the Paramedic manages to tell you to take a minute and maybe you stagger to the kitchen where the lights burn your skin and your eyes.

Here you stand. Here you think: this is nothing like the training school. Maybe you start to unravel just a little bit and you start questioning whether or not you can even do this job.

Maybe there’s a box of medications and maybe one of the medications is diazepam or propanolol or sertraline. Maybe it doesn’t matter and you wash some down with water and maybe this is where it starts.

Maybe what happens is this moment of indiscretion becomes a crutch to lean on and then this crutch becomes a life raft and you’re clinging on with numb fingers trying to keep yourself from going under.

This doesn’t just happen over night.

Maybe in the lull between jobs or the start of your shift when your colleagues are chatting and laughing and talking and drinking tea or coffee or showing photos of their dogs, maybe in these moments you’re sitting in silence thinking about what’s coming next and let’s say you’ve tried not to memorise the incident codes because it makes you feel worse knowing what’s coming but you can’t help it and the codes have been carved into your brain and they’re wedged in there, stuck like a piece of broken Lego and when your radio screams your heart pumps needles of fear through your body and you look, you have to look, and you see the code. Chest pain. Fuck. Breathing difficulty. Fuck. Traumatic injury. Fuck. Stabbing. Fuck. RTC. Fuck. Nosebleed. Fuck. Unable to telephone triage. Fuck. Fuck. Fuck.

Maybe your body has built up a tolerance to the stolen benzodiazepines and the beta blockers, maybe they no longer quell the cold fire scorching your veins, or maybe it’s just a choice. You want it.

Let’s say on a cold Tuesday nightshift while your colleagues get some fabled rest and the rain has made the car park slick with wet and the orange glow of the security lights flare in the murky puddles, lets say you grab a bottle of nitrous oxide, Entonox, and you cradle this bottle like a newborn and take it to your car and while the windows steam up around you, you suck on that mouth piece until the bottle is an ice block in your shaking hands and your mind drifts and your fingertips tingle.

Then one night a Paramedic might trust you enough to discard unused morphine, maybe 5mg, and just before you plunge the liquid into the night you stop yourself and instead splash a couple of drops onto your desperate tongue just to see, just to try, and maybe there’s not a profound effect but you definitely feel something, the prologue to euphoria and you want more.

Soon you start welcoming certain codes and you look forward to attending patients with traumatic injuries because maybe then you can have another hit of discarded morphine, or a patient having a seizure who might require midazolam. Then there’s the palliative patients, patients on end of life care who have a buffet of different medications.

And maybe soon work becomes a haze and each job is just rinse and repeat and your mind is so fogged that not even death can permeate your emotions and between jobs you just sink into yourself and ride whatever high you might be on and still nobody has asked you if you are okay.

Maybe this one night you get a call, one you’ve been waiting on, the white whale, an overdose, a forty-nine year old male, unresponsive, lips turning blue, and normally this would have sent warning fires flaring through your system and adrenaline would’ve made your skin quiver but now you have clouded your senses and all you can think is Valium, heroin, fentanyl, crack cocaine and when you arrive on scene in a scabby part of town and you enter the property you find the male curled into the corner like he was fleeing from some unseen terror and his skin is grey and his lips are blue and his breathing is almost untraceable.

Maybe during the mess of dragging the patient onto his back and shoving an airway adjunct between his parted lips and starting to provide ventilations, maybe there’s a noise from deep within the darkness of this flat and your colleague looks up frowning and says he thinks there’s someone else in here and maybe he gets up to investigate and then you might hear him say fuck me and then he returns to tell you there’s another patient and he’s going to deal with him.

Maybe your colleague leaves you on your own and maybe you abandon trying to help this man and instead you frantically check his pockets looking for…..for…..and there it is.

A bag of something the colour of brown sugar.

You take it.

Later, you shoot it.

Maybe what happens is this stuff hits you like the Polar Express and maybe you sink into the carpet and it engulfs you in a warmth you have never felt before and maybe what you feel is love but what the person who enters next sees is the colour of your skin and your lips and the needle sticking out of your groin and maybe this person is your fourteen year old sister and maybe she’s screaming for help but you can’t hear this because you’re elsewhere, a place beyond reality, beyond imagination, beyond anxiety and fear and loneliness and maybe now there’s a call in place to respond to a thirty-one year old male having an overdose and maybe now this young man has stopped breathing and the fourteen year old sister has to put one hand over the other, interlace her fingers and start chest compressions and maybe the sternum breaks and maybe the light has already faded from the young man’s eyes and maybe this is where it ends.