For the sake of private health information, no real names have been used in this article.
The first time I met Dorothy I had only been working as a paramedic in my new service area for a few weeks. She, like a large chunk of America’s geriatric population, is a resident at a local nursing home. The day I first met her I was there to transport a different resident to the hospital, but I got to know her all the same. Whenever my ambulance crew would come through the front doors, Dorothy was usually waiting there with some sort of hand-drawn picture for each member of the crew. When she had enough time, she would bring a cookie or some orange juice. Dorothy’s eyes would light up, and she would be as friendly as if we were stopping by her house for a quick chat.
I still see Dorothy when I visit her nursing home, but the light in her eyes long faded away. She’s no longer allowed to bring us pictures, cookies, or orange juice. She’s not allowed out of her room, under any circumstances. She, like every resident at her nursing home, is confined to her room 24 hours a day, seven days a week. When I pass by her room sometimes she rolls over just in time for me to see the loss on her face. Instead of light, there’s an emptiness in her eyes. Dorothy has dementia and doesn’t understand why any of this has happened to her. The vibrant woman I once knew has been replaced by someone who can’t even muster the will to get out of bed.
The last time I transported Hugh I ended up in an altercation with his nurse. Hugh had been diagnosed with COVID-19 and was in the COVID wing of his nursing home. He was isolated and neglected. Instead of being around people and staff that would check on him regularly, he was holed up in his room. He still had staff looking in on him, but they didn’t want to get too close or do too much because he had COVID-19.
All it took was one quick glance to figure out what was wrong with Hugh. It was not, as his nurse had said, a pulse rate that couldn’t be controlled. It looked like the staff had kept emptying Hugh’s Foley bag, which contained all the urine that drained through his catheter, even as its contents grew more and more putrid. By the time I was at his bedside the contents of his bag were dark brown, and it wasn’t because of a bleed. In addition to COVID-19, Hugh had developed a UTI, which through neglect had turned into a septic infection. Hugh’s nurse couldn’t hear the questions I was asking because of my full-face respirator. I started shouting, she started shouting back. This continued for a minute or so until I finally showed her the note in his transfer papers that said his Foley had first become cloudy a week ago. She shrugged and walked away. Me and my partner left, did our due diligence, the hospital did theirs, and we filed an elder abuse report. None of that prevented Hugh from dying because of the infection.
Gerald can’t manage his diabetes well and it should be a good thing that he is in a nursing home, because he needs around the clock attention. His meals and his doses of insulin have to be regulated so that his glucose levels stay within a normal range. Gerald already had COVID-19 and the long-term effects of the disease seem to have made his diabetes even worse. He could die from it, but he likely won’t. Instead, he’s now in for what could be a lifelong weekly routine.
Once every week someone at my station gets called out to see Gerald. Every time this happens, the staff says he’s been acting abnormal and they aren’t sure why. As soon as you enter Gerald’s room, the foul stench of the urine he’s been sitting in gives away the problem. Take your pick as to the neglect Gerald has endured, the end result is the same either way: He drank more because he was hyperglycemic, and he urinated more as a result. Maybe the morning staff didn’t want to deal with cleaning him up, so they left it for the night staff, and by the time they checked on Gerald he had peed himself three or four times and was altered mentally.
I didn’t become a paramedic because I wanted to help people. I did it because I knew I would be good at the job. In paramedicine I found something that made me feel like I finally knew what I was doing in my life. Even when I had just started out as an EMT, I connected with emergency medicine in a deep way, and being on the ambulance felt like home to me.
Every one of us tends to have a similar story coming out of paramedic school. “They didn’t really prepare us for all of [gestures broadly at everything].” You see, paramedic school focuses mainly on life-and-death scenarios because that’s what we need to be trained to handle. What it doesn’t focus on enough, or hardly at all in some cases, is the fact that the great majority of your calls aren’t life and death. Being a paramedic isn’t about saving lives or wearing T-shirts with kitschy slogans. More often than not, being a paramedic is about letting someone know that there is at least one person in this world who cares about them and what is happening to them.
No one, at any level of my training, ever prepared me for how hard it would be to maintain the human side of the job if a pandemic were to occur. In the early stages, it wasn’t that hard because none of us really knew what was going on. We were getting almost zero guidance from any form of government and had to figure out most of it on our own. Eventually we did, and that’s when we started donning gowns, eye protection, and some sort of respirator on just about every call. It protects us, it is essential that we protect ourselves, but it also stops us from connecting with people as we did before.
As paramedics, we are trained to deal with death, but that still doesn’t mean we handle it all that well. Most of us use some combination of gallows humor and compartmentalization. In doing so we can move on from the death we were just a part of and onto the next call. It makes sense, at least that’s what I tell myself as I bury my emotions and feelings so as to not seem weak back at the station.
When COVID-19 hit, I ran into a problem: People were dying at a rate that I couldn’t even begin to cope with. No amount of dark humor can save your mental state from call after call where people are extremely sick or dying and no one seems to care. No one has any answers, no one can tell them why they are having trouble breathing or why they’ve had chest pain and a pounding migraine for four days. Paramedics are bombarded by patients and family members who want to know why. They want to know why they aren’t getting better, or why it seems like I didn’t do everything I could to save their loved ones. Those questions are normal, but as they piled up my ability to deal with the stress of the job slowly withered away.
Even worse than death is the constant trips to nursing homes where patients are dying in actuality and spirit at an alarming rate. The state of care found nursing homes have always been an issue that paramedics have been forced to confront. COVID-19 has just made it more glaringly obvious that nursing homes function as a place to house senior citizens so they can die without burdening us too much. According to The COVID Tracking Project, 37 percent of COVID-19 deaths have occurred in long-term care facilities, despite the fact only one percent of Americans live in such facilities.
Senior citizens and young people with varying disabilities are tucked away neatly into these homes so that their families and the government don’t have to worry about taking care of them. They routinely suffer neglect and abuse from the staff, yet local governments keep enacting laws to protect the nursing homes themselves from being held liable for their neglect and abuse.
The fact that Dorothy, Hugh, and Gerald are no longer the exception but the norm makes me question my job in ways I never have before. There are days when I’m not sure I have the mental strength to drop off a Gerald and head out to get another Hugh. The nursing homes continue to be flooded with patients they can’t handle. There are some nursing homes we go to now that we refer to as death camps. We know that one by one every resident is coming down with COVID-19, and that a few will die. Every time I walk into a nursing home I feel as if I am walking into some new nightmare that will haunt me every time I close my eyes. Then I open them and head out for the next call.
I’m good at my job, I was meant to be a paramedic. That’s what I tell myself as I take another nursing home resident with COVID-19 to a hospital where there’s a good shot they’ll be on a ventilator in a couple of weeks. I’m not a hero, I don’t ever want to be called one and I hate when people label us as such. I’m just a paramedic trying to do his job and provide the best possible care I can for vulnerable people. The government doesn’t care about these people, the corporations that back these nursing homes don’t care about these people. That’s why I keep going back out every two days and reliving the same nightmare over and over again. I don’t have the power to make the nightmare stop. I only have the power to help these people when I can and that’s how I’m going to keep living during this pandemic.