Al Steiner: Doing It All Over

I was feeling stressed that day. That was why I said what I did to the old man. In retrospect it was perhaps the wisest thing I've ever said in my life.

I picked him up at a convalescent home in suburban Spokane; a withered, emaciated ninety year old. His race was indeterminable, he was so withered by time but his name on the bank of paperwork the con home staff had given me identified him as So Li, which, I was reasonably sure, made him Chinese. He was suffering from cancer, not just to one particular body part but throughout his entire body. I took one look at him and knew he wasn't long for this world. His breathing was ragged and irregular, his skin pale and feverish. His body probably weighed about seventy-five pounds if he was lucky. There was absolutely no muscle in evidence upon his bones and his flesh hung loosely from every extremity. Despite all of this he was mentally quite aware of his surroundings, something else I recognized almost immediately.

"How are you doing Mr. Li?" I asked him, bending over his form on the hospital bed.

"Can't…" He puffed softly. "Breathe." He finished.

I nodded, taking the stethoscope out of the leg pocket of my jumpsuit and putting it in my ears. I listened to his lungs, hearing nothing but bad news. He was barely moving any air at all. I'd been a paramedic for eight years but even a newbie could have seen that Mr. Li's survival on the trip to the hospital was in question. He needed a breathing tube placed in his lungs to help him.

The nurse (and I use that term loosely) was the epitome of white trash. Bleach blonde, sixty or so pounds overweight, and chewing a large wad of bubble gum as she peered at us. She'd placed a facemask on him but had only turned the flow to two liters per minute. The effect of this was to give him LESS oxygen than was available in the atmosphere, since the mask was a closed system. Business as usual in the con home. My partner, without being asked, switched the supply tubing to our portable tank and cranked it up to fifteen liters per minute. This helped Mr. Li a little, but not much.

"He needs to be intubated." I said to no one in particular, referring to the placement of a breathing tube.

"No, no, no!" The nurse yelled, startling me. "He's a DNR! You can't put a tube in!"

Mr. Li gave her a contemptuous glance and I grabbed her arm and pulled her out into the hall. DNR stood for 'Do not resuscitate', a physician order, commonly given to people like Mr. Li, ordering paramedics and hospital personnel NOT to use advanced life support measures to save their life. After all, what would be the point of bringing Mr. Li back from the dead only so he could continue to die of cancer? But she could have found a more tactful way of informing me of this fact.

"Do you have a copy of the DNR?" I asked her pointedly.

She dug through the file she had for a moment and then produced the form. I looked at it, making sure it was legal. Patient's name, the words DNR or NO CODE, and the Doctor's signature were all present. "Okay." I said, handing it back. "You might consider working on your tact a little in the future." I advised the nurse. "Mr. Li can hear everything you say."

She scoffed at this, giving me a condescending look. "He's a gork." She told me, using medical slang for an unresponsive person, or vegetable. "And a gook on top of that. What's the big deal?"

I turned away from her in disgust. As hardened as I've become doing this job, it never fails to amaze me how crass, incompetent, and tactless con home nurses can be. It was one of those situations where you had to figure that if they were any good at what they did, they wouldn't be working THERE.

I returned to my patient and looked at him. His breathing, temporarily relieved by the oxygen increase was now worsening once again. "Mr. Li?" I asked him, speaking loudly in case he was hard of hearing. "I have a doctor's order not to assist your breathing mechanically. Do you understand?"

Looking in my eyes, he nodded his understanding.

"Is that your wish Sir?" I asked him. "For me NOT to do anything?"

He smiled slightly. "Yes." He panted. "It's… " A pause to breathe. "My time."

"As you wish." I told him

We loaded him onto our gurney and wheeled him out to the ambulance. Once in the back I hooked him up to my EKG machine in order to allow me to watch his heart rate. I put my pulse oximeter on his finger, looking at the display for a reading. The pulse ox registered the amount of oxygen saturation in a person's blood. A normal reading for a person breathing room air was around 99%. Mr. Li was breathing one hundred percent oxygen and his reading was 74%. Yes, he was dying fast.

"Mr. Li?" I addressed him. His eyes creaked open to look at me.

"I'm gonna start an IV on you." I told him. "Maybe they can give you something at the hospital to, you know, help you with the pain and the discomfort."

He smiled, nodding at me.

I went to work, setting up a bag of saline and hanging it from a hook on the ceiling of the ambulance. His veins were so fragile that I was forced to use the smallest needle that we carried, the kind that is meant to be used on infants, in order to establish the line. I threaded it in slowly, cognizant of the fact that advancing it at this rate was probably painful for him.

"I'm sorry Mr. Li." I told him when I finally secured the line. "I don't like to do it that slow but your veins are not in the best shape. It's better to do it that way than to miss it and have to try again."

"Thank… " A pause. "You."

"No problem." I told him.

While I adjusted the drip rate I noticed him staring at me, a queer smile on his face. He took a few deep breaths, as if he was storing up oxygen, and then started to speak.

"You're a… good boy." He said, panting. "You treat me… with… respect… where… others don't."

"I'm just doing my job." I told him, returning his smile.

He shook his head. "Been taken… before… " He said. "Not all… like you. Not at… all".

"Well." I shrugged. "I try."

"What… " He asked. "Is your… greatest… wish?"

"My greatest wish?" I asked, raising my eyebrows. He nodded.

I laughed, thinking of my life. I was a thirty-two year old private paramedic that had been doing the job too long. I wasn't a dirtbag by any means but I wasn't at the pinnacle of success either. My job was constantly in jeopardy of being taken away by the Spokane Fire Department, who were just itching to get into the ambulance business. Like many fire departments around the country, they had initiated so many fire codes and regulations over the years that they no longer had any fires to put out. They knew that it wouldn't be long before the tax-payers started wondering just what they were paying these guys for anyway and, as such, their mission for the next century it seemed, was a take-over of the medical aid business. Private ambulance companies, who didn't have the political clout or the hero reputation to exploit, had already fallen to them in cities and counties all around the United States. It was a nationwide trend. Spokane FD had already tried twice, getting voted down by the city council once and then, having the same body approve them later, they were stopped by a superior court judge. At my age, I was too old to get picked up by them when they were eventually successful and I didn't know how to do anything else. I had an ex-wife and an ex-kid to pay money to each month. In short, I was in a rut that I saw no way out of and had been dwelling on that, as I'm prone to doing, that shift. For that reason I answered Mr. Li the way I did.