Al Steiner - Doing It All Over

I myself was as guilty of this as everyone else. I'd done my time chanting teasing rhymes at her back then, deriding her, calling her ugly, making fun of her lisp in as cruel ways as fourth grade minds could conceive. Though she'd gone to speech therapy until well into junior high and lisped no more, the damage was done to her. She was an outsider, belonging to no clique, doomed to be by herself until probably college where she would show up the vast majority of her classmates by working her way into a one hundred and thirty thousand dollar a year job.

But even then the mark of her school years would be forever upon her. I would know her as a paramedic, would frequently transport patients to the emergency room where she was employed. She would have a reputation as a cold hearted, vindictive bitch among the paramedics and nurses that she dealt with. She was the kind of doctor that would question a paramedic or RN's every decision, no matter what the outcome of the patient. And she'd always reserved her most scathing comments for me. I'd always known that this was because I'd gone to school with her and had once, in grammar school, been one of her tormentors.

A typical example of her wrath is something that occurred nearly a year before my recycling, on a frigid January day. I'd been dispatched to a call for a child with seizures in a middle class section of the city. Child seizure calls are generally nothing that gets paramedics terribly excited. Usually the child either has a history of seizures or is having them because of a high fever. Seizures are not usually life threatening.

However, when I walked into the house that day with my partner and the crew from a Spokane Fire Department engine company, I took one look at the kid in question and knew that I was dealing with something more than a seizure call. The kid, who looked to be about ten years old, was lying on the carpet near the sofa. His skin was blue; as blue as a police uniform, and he was not breathing. His eyes were vacant, staring into space, bugging out. He was lying still.

There was a brief second of pause while we all clicked into 'this is really an emergency' mode. And then every eye in the room (except for the kid) turned to me, waiting for me to tell them what to do.

"Start bagging him." I barked to one of the firefighters and she rushed into action, opening their bag and pulled out the equipment.

I kneeled down next to the kid and felt for a carotid pulse. It was there, but it was weak and very slow. What the hell was going on? I'd wondered, trying to think. Ten year olds did not just suddenly collapse and die from a seizure. There was something I was missing.

The mother was, understandably enough, absolutely hysterical but, while I opened up my airway bag and began setting up to put in a breathing tube, she was able to tell me that she'd heard a strange noise and had entered the room to find her son seizing on the couch. It had gone on for a considerable time and then he'd simply stopped just before we'd arrived. His breathing hadn't started again. She told me he had no known medical problems. He'd had no fever, had in fact been perfectly fine when she'd talked to him less than ten minutes before she found him seizing.

While I pulled out my breathing tube and a laryngoscope, a lighted instrument used to peer down someone's throat prior to placing the tube, the firefighter began bagging the child, forcing air down his throat and into his lungs. While she did this my partner had hooked the child up to our EKG machine. I took a quick glance at the reading. His heart was only beating thirty times a minute and was slowing further with each passing beat. What the hell?

The firefighter that was bagging seemed to be having trouble. "The air won't go in." She told me. "It just blows out the side."

Armed with that information I took another look around the room. The television was on, tuned to a cartoon show. A half-eaten hot-dog was sitting on a plate on the coffee table. The light bulb suddenly went off above my head.

"Was he eating?" I asked the mother.

"Yes." She sobbed, wringing her hands. "I'd just given him his lunch."

"Shit." I muttered, everything falling into place.

"Stop bagging him and let me in there." I told the firefighter. She stepped aside and I picked up my laryngoscope. Lying on the floor near his head I inserted the blade into his mouth and lifted the tongue out of the way. A lightbulb on the end of the blade illuminated his airway for me. It was blocked solid by a chunk of pink hot dog.

"Matt, give me the Magills." I told my partner.

He slapped a long set of forceps into my hand, an instrument designed specifically for removing foreign objects from airways. I'd never used them before, true choking calls are rare, but they worked just exactly as I'd been promised. I grabbed the chunk of meat and pulled it free, revealing his vocal cords and trachea behind it. I gave him a second to see if he would start breathing on his own. When he didn't, I picked up the breathing tube and slid it through his vocal cords. The firefighter attached her bag to the top of the tube and began forcing pure oxygen down into his lungs.

By the time I got the tube secured his skin had pinked up considerably and his heart rate had increased to more than a hundred. By the time we loaded him into the back of the ambulance his eyes were open and he was gagging violently, no doubt upset to wake up and find a large tube in his throat. By the time we got to the hospital I'd been forced to remove the tube and he was breathing well on his own. He was a little confused and dopey but awake and able to talk. When we brought him in to Nina's emergency room I was positively glowing with the satisfaction of a job well done, convinced that out of all the times I'd been needlessly called, for once I'd actually been NEEDED.

And what did Nina, the good doctor have to say to me after she heard the progression of the call?

"You're supposed to try abdominal thrusts on an unconscious choking victim before you resort to the Magills." She said icily. "Did you miss that part of the class back in ambulance driver school?"

She actually wrote me up for this, making me answer to our county emergency medical services authority. I was given a written reprimand in my file for failing to try a less invasive method of clearing the airway first. The medical director, to give him credit, was at least apologetic as I signed it. He mumbled something about how the ends don't justify the means and then explained that "certain doctors" seemed to have a problem with the whole world.

Though I'd been pissed at her, she'd after all turned one of the high points of my career into a disciplinary procedure, I'd understood even then that I was partially responsible for what had happened. I understood even better looking at her now in the cafeteria, sitting alone and reading a book while she picked at a plate of cafeteria spaghetti. After all, the experience with Richie was fresh on my mind. Had what she'd done been much different than what I'd done? We'd both attacked visible symbols of past torment. We'd both given in to basic human nature.

Was it too late for Nina? I wondered, looking at her. Was the damage to her already done?

I took a deep breath and headed her way.

"Okay if I sit here?" I asked her when I arrived.

She looked up at me with suspicion plain in her eyes, perhaps wondering if I'd come to renew the teasing she'd been so familiar with in grade school. While waiting for an answer I looked at her, marveling over the power of suggestion. Nina had been called ugly since the third grade. It was an accepted fact among everyone that she WAS ugly. But the funny thing is, that she really wasn't. She was skinny and had small breasts; a late bloomer as I've mentioned before. Her face was without any make-up but it was smooth and actually sort of pretty. Her brown hair was unstyled but looked just like everyone else's hair all the same. She was called ugly and probably felt ugly because we'd all agreed back in third grade that she WAS ugly.