“You have to stand six feet away.”
It was the first time I had ever said that to a patient, and I didn’t enjoy it. My partner for the shift, Talia, and I were standing in a parking lot beside the ambulance. We had responded to this patient’s 911 call in order to provide him with care. Telling him to stand back seemed contrary to that mission, but distance was part of our new working conditions.
“The thermometer goes under your tongue—”
“—Make sure it’s all the way in the back of your mouth—”
“—Tell him to put it under his tongue.”
English was not a language the patient spoke, so his teenage son was translating. The adolescent was thin and dark-haired, doing his best to help. Two men, friends of the patient, were hanging back by the entryway to the apartment building, remote witnesses to the proceedings. I couldn’t tell if they were frightened, overwhelmed, or just trying to stay out of the way.
The 911 operator had told the patient to meet us outside. Our new field guidance instructed us, whenever possible—that is, if the patient could walk—to assess the patient outdoors.
But it was cold that night, and the patient was shivering. Whether he was shivering because of fever or the weather, I couldn’t tell. I needed to see the reading on the disposable thermometer in his mouth.
A fire engine had been the first responder on scene. The crew had already taken the patient’s vital signs and prepared the patient to be transported in our ambulance. In the County, ambulances are dispatched from fire stations, often together with fire trucks. Most firefighters are also EMT’s.
Kind cadences were the only palliative care I could offer: I had no treatment to give.We had parked our ambulance behind the larger vehicle and began the process of accepting hand-off of the patient’s care from the fire engine crew. They gave us report and their notes.
The patient was short, heavy-set, and coughing. Although he stood in a recess of dark in an area strobed by emergency vehicle lighting, the distress on his face was clear. Six feet away, to his right, was his son. On his left, six feet away, was Talia, the ambulance’s driver. I stood six feet in front of the patient.
Following the new protocol, Talia and I were suited up in N95 masks, eye goggles, gowns over our uniforms, and gloves.
I didn’t know if we were recognizable as humans, much less as volunteers, people who cared. I didn’t know what the patient could read on my face. I was sensitive to the possibility that the situation might seem menacing. As if trying to establish some normalcy to the interaction unfolding, the patient attempted to close the distance between us, walking forward to show me the thermometer, then hurrying back apologetically in response to our admonishments.
“What does it say?”
The disposable thermometer was a flimsy device, like a bowling-pin shaped band-aid with a temperature-sensing end. I scrutinized it. “Nothing.”
“It needs a full minute.”
“Let’s try again.”
Per the new rules, we had covered the patient’s nose and mouth with a surgical mask. He again inserted the thermometer into his mouth under his mask—we couldn’t gauge if he was placing the thermometer correctly.
While we waited the full minute, the patient’s son said that his father wanted one of his friends to accompany him in the ambulance.
We asked if his friends could translate.
We emphasized that they would not be allowed in the Emergency Department.
Notwithstanding the need to for a translator in order to get an adequate medical history, Talia recommended that we not transport anyone but the patient. The field guidance discouraged passengers. Everything we were doing was designed to reduce exposures, and passengers in the back of the ambulance defeated our efforts.
We couldn’t get a temperature.
The patient said (and his son translated) that he wanted to go to the Emergency Department alone. He had his phone.
His pronouncement had an air of nobility. He wanted to spare others.
Talia went to the ambulance cab, and I helped the patient into the back. He was around my age, and he had suffered acute onset coughing and shortness of breath in the past hour. The episode was still ongoing. He felt like he couldn’t breathe.
His facial expression reflected a resigned preparedness for ill tidings. He cooperated with all my ministrations en route: I took his blood pressure and measured the oxygen saturation of his blood. Thankfully both were normal. I could be less concerned about the risk of the patient going into a life-threatening respiratory arrest during transit.
Love isn’t discussed in our firehouse family, but—without the word being articulated—everyone functions as anyone would in a social fabric knit with love.But the language barrier hampered the establishment of rapport. I couldn’t understand him when he pronounced his name. (I guess the fire engine crew had had the same problem: their notes had the wrong name for the patient.) And I couldn’t get a medical history. When I had transported non-English speaking patients in the past, a family member had always accompanied them to facilitate communication of this critical information. Now that work-around was not available. Telephonic medical translation services exist, but the county EMS system did not appear to have subscribed to one.
The emergency department had been rearranged to limit exposures between EMT’s and hospital staff. We navigated our patient’s wheelchair through the new layout to the triage nurse, a small, tense woman. Like us, she was gowned, gloved, and masked, sporting eye protection and a cap on her hair. I expected her to have a translator phone, or even a medical interpreter, but she didn’t. I told her what I knew about the patient.
Despite standing beside the patient in his wheelchair, she scoffed at his symptoms. “Cough and shortness of breath for an hour? We’re not even going to test him,” she pronounced.
The patient, observing her dismissiveness, spoke into his phone. The automated voice of Google Translate interjected, “I also have dry mouth.”
“That doesn’t matter,” the nurse retorted. “Put him in the negative pressure waiting room.”
I knew that the triage nurse was working long hours in a risky job. Test kits were additionally in limited supply, and the patient’s vital signs did not indicate a respiratory emergency. But I also knew that patients can deteriorate quickly, in a matter of hours. I had heard of other patients who had succumbed to sudden bouts of coughing and shortness of breath, stayed home to wait it out, and been rushed to an ICU days later, where they died alone.
What if our patient was presenting with the early part of that scenario? Our patient’s inability to breathe had frightened him enough that he had called 911. He knew what normal breathing felt like for him—were we doing the right thing by saying we knew better? And why, “we”? I hadn’t made the decision to put him in the negative pressure waiting room. But I was part of the health system that produced this result.
As I steered our patient to the waiting area, I felt deflated. If the patient and I had spoken the same language, perhaps the outcome would have been different.
Walking beside me, Talia whispered, “If they’re not going to test him, why are they putting him in a negative pressure room?”
Fear.
I didn’t say it.
The negative pressure waiting room was a portion of the emergency room reception area that had been walled off with plexiglass. After wishing him well, I left the patient alone, in a wheelchair, under harsh LED light.
He held his phone. He began to push numbers on his screen.
He was the first patient I transported who was suspected of having Covid-19.
*
The next day, I was reviewing the ambulance equipment with one of the EMS lieutenants. He was soft-spoken and had encyclopedic knowledge about the ambulance and EMS protocols—predictably, he was nicknamed, “Professor.”
I was glad for his assistance. More than two years had elapsed since I had last staffed the ambulance regularly. I had maintained my membership in the volunteer fire company, tended my friendships with other members, and undertaken the continuing education necessary to keep all my certifications current; but I had gone to medical school, and I didn’t have time to ride the ambulance.
Among the many up-endings rendered by Covid-19 was the abrupt suspension of my third-year hospital rotations. Third year of medical school would resume in June. Until then, we were to do electives for (fourth-year) credit. Volunteering to support the Covid-19 response was an option for elective credit, so I returned to my fire company, where volunteers to staff the ambulance were needed.
It was a homecoming, and I was elated. Love isn’t discussed in our firehouse family, but—without the word being articulated—everyone functions as anyone would in a social fabric knit with love. Since social distancing measures have been put in place, Argonaut does the grocery shopping for the non-kosher food (even though he’s an observant Jew), and Menachem shops for the kosher food. Three times a day, Argonaut, Noah (the youngest member of our regular crew), Wesley (the second youngest), Talia, Lily, and anyone else they can rope in, are mopping floors, taking out trash, cleaning bathrooms, and disinfecting door handles. Talia, and Menachem and Shosh (a married couple; one of a few at the fire station) have live-in rooms upstairs. Argonaut, Prof, Lily, and anyone who wants to, sleep in bunk rooms and staff the trucks on any calls that come in overnight.
“Cough and shortness of breath for an hour? We’re not even going to test him,” she pronounced.Plenty of the love affairs (riding emergency response equipment can make people feel sexy) end in break ups—thankfully the individual members of the most-recently ruptured couple are friendly with each other around the station. Firefighters are also notoriously long-winded storytellers, and when Gil (or any number of our company’s members) gets going, the monologue spills into enactments, and diagrams on whiteboards, and seemingly nothing can stop the outpouring but a fire alarm, and dispatch sending crews running for the trucks.
I had missed them, and they had missed me, and I was happy to be home.
And I was ecstatic to be back on my beautiful ambulance. With its sirens, flashing lights, oxygen tanks, stretchers, splints, defibrillators, automatic CPR device, suction, narcotics safe, duffel bags with equipment for traumas, respiratory arrests, and pediatric emergencies, backboards, splints, stairchair, EKG machine, IV kits, and radios, with its mission of mercy, and its capacity to deliver the sick safely through the dangers of transit, the ambulance draws from me both awe and adrenaline. It puts me in mind of the chariot of fire that heralded Elijah’s departure and the vesting in his disciple, Elisha, of the capacity for performing miracles. Like that biblical chariot, the ambulance signals a departure (with, like Elijah’s leaving, a hope of return) and the possibility of wonders. In my years away, my beloved ambulance had evolved—actually, it had been replaced with a newer model, something that probably never happened to Elijah’s chariot—and Prof was helping me reacclimate.
Then the captain called us to an impromptu meeting by the station entrance. Cap is a man who, diplomatically-speaking, evokes strong emotions in others. Bald and built like a bulldog, Cap has scrutinizing eyes and a brow that furrows readily. Many of us love him. He’ll be the first to emphasize how many people hate him; he may take joy in that fact. He has a distinctive voice that is gruff—possibly a side effect of his cigar smoking, but maybe he gruffens it up for effect. He is relentless, high-energy, stubborn, and visionary, and he had summoned us for an immediate training on the latest change to our Covid-19 procedures: decontamination.
In typical Cap fashion, he began, in his rapid machine-gun fire delivery, as if shouting, “If you finish a call. And you feel icky—”
Frankly, decontamination was not a topic of great interest to me. In my training, it had always been introduced in relation to hazardous materials, which as a rule I avoid. Theoretically, I understood that the Covid-19 virus is a hazardous material, and that decontamination is necessary following exposures—but the language of decon put me in mind of Fukushima. The whole arrangement seemed complicated, and if I didn’t exactly tune out, I didn’t strive for anything more than the most basic understanding: the ambulance has to be sanitized following transport of a person suspected of having, or confirmed to have, Covid-19; and the EMT’s have to shower. Great.
Of course, with an attitude like mine, it would happen—as it did—that I was the first EMT to go through the decontamination procedure.
*
The call came around 8 pm in the middle of a fire company meeting. My partner for the shift was Menachem, but Talia generously jumped up to take the call; Menachem was multi-tasking during the meeting, and he was in the middle of eating dinner with his wife, Shosh.
The call was for an 89-year-old woman in a nursing home. She was lethargic. She’d had exposure to a confirmed Covid-19 case.
Talia turned on the ignition. As I was bounding onto the ambulance, Cap appeared and barked, “Did you see the notes from dispatch?”
“I’m putting on a Tyvek,” I replied.
“Outstanding.”
Although the field guidance was to wear a gown, the gowns did not cover the whole body. In addition, they were in short supply. When fire stations ran out of gowns, the county had resupplied them with trash bags.
Cap did not accept the gown as adequate protection for his EMT’s.
Instead, he ordered us to wear turnout gear or Tyvek suits. Turnout gear is a boots-pants-and-jacket ensemble that fits over your uniform and provides insulation and contact protection. Firefighters wear turnout gear on every call. EMT’s usually only wear turnout gear if we have to do something like get into a wrecked vehicle to care for a trapped patient while the firefighters take the car apart. In the county, our EMT turnout gear is blue and universally referred to as the “Smurf suit.”
The Tyveks were a prize. Other fire companies in the county did not have them. Cap’s brother, Luke, who was a lieutenant on the tower truck at our fire company, was able to score the Tyvek suits because part of his business involved asbestos removal. Luke contributed 200 Tyvek suits to the fire station. Worth thousands of dollars, the suits were functionally donated. Reimbursement to the fire company from the county was vanishingly unlikely.
The call was for an 89-year-old woman in a nursing home. She was lethargic. She had had exposure to a confirmed COVID 19 case.
Cap had told us to wear turnout gear if we were caring for a single patient in a private home suspected of having Covid-19, but instead to wear the Tyvek suits if we were going into a nursing home or other facility where multiple cases were likely. We knew of a nearby rehabilitation facility that had around a hundred confirmed cases of Covid-19.
Prior to Covid-19, as the EMT in the front passenger seat on the way to a call, my job would have been to navigate for the driver. Now, however, my job was to get into personal protective equipment. Doing this job is not compatible with wearing my seat belt. I always reflexively belted myself in, and then unbelted and prayed that the ambulance didn’t have a collision.
I secured my hair under a hat styled after those worn by anesthesiologists. Cap had supplied them for us. (A local tailor had sewed them.) I slipped my goggles on. Then I donned my N95 mask and confirmed that the nasal bridge sat under the goggles. A face shield went over this entire get up. (Cap had the face shields made for us. A local organization donated its 3D printer to allow us to print them. Cap had so many made that he donated some to local hospitals.)
Next, I unlaced my boots. I needed to take them off to put on the Tyvek suit. The suit zips down the front and is gathered at the wrists and ankles. I put on one pair of gloves and pulled the Tyvek sleeves over the edge of the gloves. I zipped up the Tyvek. Then I put on a second pair of gloves and pulled them over the ends of the Tyvek sleeves. I jammed my feet and the pants legs of the Tyvek into my boots and laced them up again as we arrived at the nursing home.
*
Going into the nursing home, I brought as little equipment as possible. In normal times, I would have mobilized the stretcher, the “blue bag” containing the basic medical supplies for our calls, and possibly the “red bag” for respiratory emergencies. Now I had a two-gallon plastic bag with a pulse oximeter, thermometer, glucometer, blood pressure cuff, and stethoscope in it. I carried a clipboard with a note pad. And I took my radio.
I left Talia outside. Everything we were doing was designed to reduce exposures. Better to lose one EMT than two, if it came to that. Once inside, if I needed anything, I would radio her to bring it to the door.
I am not frightened by this mode of working. I feel protective of Talia. Everything I am wearing imbues me with a sense of safety. I appreciate that I am nonetheless taking a risk, but my calculus is that the benefit outweighs that risk. Indeed, I trained and acquired special skills specifically in order to be able to take this risk.
Because I know that my rational mind is unlikely to have much to do with how I feel about walking into a nursing home to take care of a potential Covid-19 patient, I observe that, at the most primal level, I don’t understand why I am not scared. I could call it a personality trait or use the word, “courage,” but none of that seems fundamentally explanatory. In the realm of those aspects of myself that persist in mystery despite my probing and inquiry, this fearlessness looms large.
Someone from the nursing home met me in the lobby. She was an older woman; I noted her white roots growing in. She was wearing a surgical mask and gloves. Her name was Betty, and she was chatty and informative. She pressed a manila envelope of medical records into my hands. The patient, Eugenia, had dementia, but normally could walk and talk. A week ago, she had had two days of diarrhea, like many other residents at the nursing home. Over the weekend, one of the residents had tested positive for Covid-19. Three days ago, Eugenia stopped talking and eating. She had since stopped drinking and can no longer stand up. Now she has a temperature, and her oxygen saturation is in the low 80s. (Blood saturation with oxygen is supposed to be above 95 per cent.) Betty had pleaded with Eugenia’s family to allow her to call 911 earlier, but the family kept refusing. They didn’t want Eugenia to go to the hospital because of the risk of contracting Covid-19.
“Did you give her oxygen?” I asked.
“We don’t have a tank.”
I radioed Talia for the portable oxygen tank.
I made a plan with Betty: the nursing home staff would get Eugenia out of bed and into a wheelchair. I would put Eugenia on oxygen. Then we would wheel Eugenia outside, where the nursing home staff would help me transfer Eugenia onto the ambulance stretcher that Talia would set up for us.
As we walked to Eugenia’s room, Betty asked me, “Do these masks work?”
“They work.” I replied as I did because it’s true: surgical masks do help prevent the circulation of droplets from the wearer’s mouth. They can limit the infection of others. But I think she meant, “Do these masks work to protect me from Covid-19?” I don’t know how useful the surgical mask is for that purpose. I wouldn’t feel safe doing my job in a surgical mask. I am in a privileged position, relative to Betty, in terms of my access to personal protective equipment. Instinctively, I don’t want to say anything to emphasize my privilege.
“Oh good,” she answered. “I was worried.”
I was worried for Betty, too. She looked to be in the age range where she might be vulnerable to a tougher course of Covid-19, if she were to contract it. She obviously cared about Eugenia and was doing the best she could in her job. The unfairness of the situation deflated me. It returned me to the helplessness and disempowerment I’d experienced when I’d left my first patient suspected of having Covid-19 in the negative pressure waiting room.
Although the field guidance was to wear a gown, the gowns did not cover the whole body. When fire stations ran out of gowns, the County had resupplied them with trash bags.
Betty then confided that they had another patient in the nursing home, a man, whose oxygen saturation was even lower. They had used their only oxygen tank for him. Did my ambulance ever transport two patients?
I told her no.
Oh well, she reflected, she had to call his family anyway.
Eugenia was brought out of her room in the wheelchair. She looked grandmotherly and preoccupied. I introduced myself, and she made eye contact with me. I told her that I was going to put a nasal cannula on her to give her some oxygen. I showed her the plastic tubing and explained what I was doing as I put it in her nostrils. She let me rig the tubing around her ears and under her chin. I then placed a surgical mask over her nose and mouth, covering the nasal cannula. I connected it to the oxygen tank and turned on the flow. “See? That feels better, right?” If Eugenia reacted, I couldn’t see it.
As we wheeled her out of the nursing home, I spoke continuously to her. I told her we were going onto an ambulance to take her to a hospital where she would get medical care. I noticed that she was walking her feet along the ground as we rolled her out, as if she perceived herself to be in motion and knew that, if she was walking, she should be moving her feet. Maybe she couldn’t understand that she was in a wheelchair. Worried that she might stub part of her foot on the ground, I encouraged her to keep her feet on the foot rest. If my words registered with her, she didn’t comply.
Outside, Talia had gotten the stretcher out of the ambulance. She maintained a distance of six feet from me and the two nursing home aids as we lifted Eugenia onto the stretcher. Then Talia stood by and talked me through the process of using the automatic stretcher loader on the ambulance. This was a new addition, and something Prof and I had not discussed. Once Eugenia was safely on board, I climbed in with her, Talia shut our back door, and we were on our way.
The ride in the back of an ambulance is not smooth; it might rival the ride in a tank. As we EMT’s go about our patient care tasks en route, we have to contend with the lurch and bump of the surface beneath us. Although we had a new, non-disposable thermometer, it was a temporal one, and I had to wait for a stretch of steadiness to place it against the side of her forehead. Once there, however, the thermometer instantly produced Eugenia’s temperature on its screen. It was 101.2º F.
Her pulse oxygenation had improved to 90 percent on the oxygen. We had been warned to avoid oxygen, if possible, out of concerns that oxygen delivery would cause aerosolization of droplets. But Eugenia obviously needed the oxygen. I took her blood pressure and was relieved to find it normal.
En route with Eugenia, I was engrossed. Although the ambulance has windows in the back doors, I was seated so I could not see out of them. The exhaust fan ventilated the back compartment, and I couldn’t hear much beyond the sound of my blood pressure and pulse oximeter machine, and my own voice, comforting Eugenia. My world had telescoped itself into the task of her patient care. I looked through the medical records that Betty had given me. Eugenia had a past medical history of high blood pressure, which was one of the underlying conditions common among people with a difficult course of Covid-19. On Eugenia’s Medical Orders for Life-Sustaining Treatment, I saw that her health care proxy had designated her, “Do Not Intubate.” I radioed the hospital to advise them that we would be arriving shortly with a suspected Covid-19 patient.
Throughout the ride I spoke soothingly to her. I told her we were a team, and we were working together to ensure that we would arrive safely at the hospital. Kind cadences were the only palliative care I could offer: I had no treatment to give. I asked her the questions to assess her mental status. Did she know where she was? Did she know the date? Could she tell me her name? She said nothing. Her facial expression betrayed no awareness of me. I spoke her first and last name, raising the intonation of my voice at the end of her name to indicate that I was asking, “Is this who you are?,” and she nodded solemnly. I felt this affirmation to be a great triumph.
I slipped my goggles on. Then I donned my N95 mask and confirmed that the nasal bridge sat under the goggles. A face shield went over this entire get up.I was gratified when we arrived without incident at the hospital that her family had requested. This hospital had forbidden EMTs to enter the Emergency Department, so I opened the back doors and jumped down into the ambulance parking lot, so that I could off-load the stretcher, with Eugenia on it.
The hospital had an entire operation set up outside. Light flooded the scene. A tent had been erected for triage of patients who were not suspected of having Covid-19. The hospital had provided a port-a-potty for EMT’s. Hospital beds were ready outside, along with staff to transfer the patients from the ambulance stretchers onto the waiting beds.
I gave my report to the triage nurse, making special effort to enunciate through my N95 mask. I could barely see the nurse’s face through the glare of light reflecting off her face shield (was I any more visible to her?), but I could still discern her smile. I concluded my report by saying, “Stay safe.”
The techs rolled a hospital bed alongside the stretcher, and we transferred Eugenia onto it. I wished her well. The techs wheeled her through the bay doors.
Eugenia was now in a place where she could not be visited by family. She would not see anyone she knew or recognized. If she had Covid-19, she might not survive. CCovid-19 is associated with a condition called Acute Respiratory Distress Syndrome, characterized by the inability of the lungs to function. Without intubation (or even, perhaps, with it), Eugenia might experience a sensation akin to suffocation or drowning when she tried to breathe. For how much longer would she be able to affirm her name?
I had shared a significant exchange with her. I valued that moment of rapport, and I also felt the poignancy of being a stranger in possession of an experience that her loved ones would have treasured. I felt the obligation of vicarious valuation: the duty to treasure that moment of connection with Eugenia, differently than I otherwise would have, out of consideration for people who did not have the opportunity to have it themselves.
When I returned to the ambulance, Talia had bleach wipes and a red biohazard bag open. Talia and I had gone to the same college. I had recruited her to our fire company. Now a nursing student, Talia worked shifts in the ICU with suspected and confirmed Covid-19 patients. She had also been elected an EMS lieutenant at our company. She knew what she was doing. I was so proud of her. She talked me through extracting myself from my personal protective equipment.
First, I took off my boots. Talia disinfected them with the bleach wipes.
Next, I unzipped the Tyvek. Talia put her gloved hands inside the Tyvek and peeled it off me inside-out, pulling my outer set of gloves off in the process.
Then, with my underlying, clean pair of gloves, I removed my face shield, eye goggles, and N95 mask. The face shield and the eye goggles could be decontaminated. The N95 mask went in the biohazard bag. I removed my anesthesiologist’s hat and threw it in the back of the ambulance. It could be washed. I pulled off my second pair of gloves and tossed them in the biohazard bag. Finally, I disinfected my hands with sanitizer, rubbing them until the alcohol dried completely.
Everything we were doing was designed to reduce exposures. Better to lose one EMT than two, if it came to that.Roughly 90 minutes after the call had come in, Talia and I drove back to the station to decon me and the ambulance. (Talia did not need to decon—our mode of working had kept her “clean.”) I was so grateful to Talia. Getting out of personal protective equipment is an opportunity for contamination. Her guidance and help had been critical to my sense that I had not exposed myself in the process. “You’re a star,” I told her.
We parked the ambulance on the apron outside the station in the midst of what felt like a festival. Everyone in the station came out to greet us. Sandra, the president of the fire station, and her husband, Gil were there for the occasion. Wesley and Noah ran away in mock horror when I stepped down from the ambulance. Cap, Argonaut, and Prof were in Smurf suits, shower caps, and masks. Cap was wearing a safety device inspired by gear worn by the Italians: a snorkel mask fitted with an N99 ventilator filter. He looked semi-terrifying, but at least the face piece muffled his voice sufficiently that he was almost impossible to hear. Cap and Argonaut were holding spray guns.
My first thought was, are they going to spray me? I really should have paid closer attention during Cap’s decon training. Then I realized that the spray guns were for the ambulance. Every surface in the ambulance and anything that had been touched by either me or Eugenia was being sprayed down with hydrogen peroxide: blood pressure cuff, pulse oximeter, Toughbook (our laptop for filing our electronic health record reports), stretcher, face shield, goggles, boots, belt, hair barrette, and everything in my pockets—lip balm, driver’s license, pen light, pens. Tarps were spread out on the apron next to the ambulance for decontaminating these smaller items.
Lily showed me to an open door, next to the entrance to the station. The door had a laminated sign on it that featured the Covid-19 virus and the word: DECON. I stepped into the isolation room. I realized that I had paid enough attention. I knew what the drill was.
The isolation room was a no-frills space: four walls and a light bulb. It also contained a shelf, about shoulder-high, on which rested a roll of garbage bags and sealed plastic bags with scrubs in them. I took off all my clothes, my uniform shirt and pants, underwear, bra, and socks, and put them in the garbage bag. I opened one of the sealed plastic bags and donned a pair of scrubs.
The isolation room had two doors. The one I had entered through led to the outside. The other door opened onto the red floor, the area of the fire station where the ambulance, engine, squad, tower, and utility trucks are parked. I stepped onto the red floor.
The garage doors were open, creating a continuous space between the red floor and the apron where the ambulance was being deconned. The area was alive with collective action, a hive’s worth of effort to restore hygiene.
My contribution was to go immediately into another room off the red floor: the decon room.
It had the charm of a basement utility room, but its significance was that it had a shower, soap, shampoo, a plastic basin for our contaminated clothes, sealed plastic bags with towels, and sealed plastic bags with clean clothes, in case we had forgotten our “go bag.”
I hadn’t forgotten my “go bag.” It contained a change of clothes, and—as Cap had instructed—my “go bag” was on the ambulance. Talia, the star, had retrieved it; it was waiting for me in the decon room.
For the second time in five minutes, I stripped naked. I threw my bag with my uniform in the basin, along with my scrubs. I took a shower. I toweled off and dressed in the clothes I’d put in my “go bag.” I opened the decon room door and emerged, damp-haired and clean, ready to rejoin my society.
Everything I had just gone through had been organized and funded by Cap. The county required ambulances to get permission to decontaminate in order to regulate the amount of supplies that were being used. Cap wanted to ensure that our personnel and ambulance were decontaminated whenever, in our judgment, we determined we needed decon. He had even informed the EMS system managers that he was offering the decon services at our station to every other ambulance in the county. He had bought the spray guns, the scrubs, and the cleaning supplies, all without hope or expectation of reimbursement. He did it to keep us, and the patients we serve, safe.
The gravity of the day had exhausted me. It was late. I was hungry. My priority was finishing my report. Each call has an aftermath of electronic record filing, supply restocking, and debriefing. Noah brought me the Toughbook as soon as it had dried from its hydrogen peroxide bath. I tried to work quickly, but everyone wanted to talk.
I gave an account of the transport to Sandra and Gil. I gave feedback on the decon procedures to Cap. I expressed gratitude to Argonaut and Prof, who were—as always—working tirelessly. I broke the proscription on using the word “love” and told Talia I loved her. I finished my report and posted it to the cloud, so the county EMS supervisors could review it and bill accordingly.
Cap told me to wash my uniform in the fire station’s washing machine, and—as it was in use, laundering Smurf suits—Argonaut said he’d do it, so I could go home to sleep. Argonaut and I are the same age, and we both have long, curly brown hair. The running joke is that, from the back, we look like the same person. I call him my brother from another mother, and I’m his sister from another mister. So I felt okay warning him that, in addition to my uniform, my bra and underwear were in the bag I was handing him. He felt okay telling me that he would wear them.
On my way out of the station, I passed Cap, mercifully without his snorkel mask respirator, amidst a crew organizing Smurf suits. “Thank you for saving my life,” I said.
“I didn’t do all that,” he rebuffed.
It felt like the right thing to have said anyway.
___________________________________
Out of consideration for the privacy of the patients we transport, and our company’s members, all efforts have been made to preserve the anonymity of the company. If you want to contribute financially to support our volunteer fire company’s operations during the Covid-19 pandemic, you may do so at our GoFundMe site. We appreciate that financial contribution is not within everyone’s means in this trying time, and we are grateful for any expressions of generosity, be they words of encouragement, good intentions, or your prayers.
