Emergency

Fourth Street, a Wednesday afternoon. A sleepy, single-story motel. A cramped motel room, smelling vaguely musty.

We’re waiting for a call.

I’m hanging out with Paramedic Bruce Toy and EMT II Sean Holbrook in the tiny room furnished with two love seats, a coffee table and a TV. We’re at one of two official EMT post stations, a place to hang and regroup while waiting for a call. EMT radios sit ominously on the coffee table, crackling with dispatch information. Toy, 31, and Holbrook, 20, members of the Regional Emergency Medical Services Authority—REMSA—Unit 23, have settled into a temporary downtime. It could last for minutes—just enough time to shovel lunch into their hungry bellies—or hours.

This feels like an FBI stakeout: the waiting, the seedy motel, the two lithe, calm men dressed in blue.

Then the call comes, and we’re off.

“At least we got to eat,” Toy tells me. “It makes for a long day when you can’t eat.”

The dispatcher informs us of the patient’s problem—a breathing difficulty—and tells us that the call is a Priority One, the highest level of priority. Units are required to respond to Priority One calls within eight minutes, 29 seconds. We’re headed to another motel on West Fourth Street.

RrrraaaaaahhhH! We sail down Fourth Street, sirens singing. From inside the ambulance, the sirens sound muffled—not that high-pitched whine that makes your head ache and dogs howl. Holbrook expertly maneuvers the vehicle through crowded intersections.

“Now, we’re not going to do anything that would put you in harm’s way,” Toy leans back to say. “But we don’t know what this situation will be like.”

He instructs me to be careful when we get in there, not to step anywhere without looking at the floor first.

“OK,” I say, hesitantly. I don’t ask why.

When we arrive at the inn—a three-story deal near downtown—the fire department is already there. Toy and Holbrook grab medical supplies and wheel the stretcher into a first-level room. We find four firefighters inside, leaning over a bed, talking to an elderly gentleman. They’re asking him questions to find out what’s wrong.

Patient-medic communication can be a tricky thing. An unconscious patient can’t put a finger on his aches and pains, and so paramedics have to rely on stats, like blood pressure and heart rate, for assessment. With conscious patients, depending on their emotional state, coaxing out information can be even more frustrating.

In this case, the man is having a hard time communicating his needs to the medics. Toy and Holbrook convince him to come back with them to the ambulance for further assessment. He climbs onto the gurney, and they cart him back to the vehicle, where Toy resumes his questioning, writing notes on his latex glove in neat black lettering.

There seems to be no breathing problem here, only some less-than-specific gastrointestinal and urinary complaints.

“I’m really confused, and I just want you to answer to the best of your ability … do you have problems peeing: yes or no?” Toy asks.

“No.”

Toy tries to persuade the man to provide some medical history, with little success.

“I’m weak and I don’t feel good. That’s all I can tell you.”

Toy asks a few more questions in a calm but increasingly firm tone. He repeats questions slowly and deliberately. Finally, the medics learn that the 77-year-old man has a history not only of abdominal problems, but also of glaucoma, cancer, heart attack and stroke. He also has a pacemaker.

“That’s right,” he says. “I forgot to tell you.”

Toy shoots me a look.

Toy and Holbrook hook the patient up to a heart monitor. The man says he wants to go to the VA Medical Center.

“Call the VA,” Toys says to Holbrook quietly.

The VA, however, sometimes diverts patients transported by REMSA to larger, more extensively staffed hospitals. Toy gives the VA the patient’s stats, and it tells the unit to divert to another hospital.

“I’d rather die,” the man says when he hears he’s being diverted. He rethinks the situation, though, and chooses another hospital.

"[Patient is] being diverted from VA and is very upset about that,” Toy says into the phone.

“Why won’t the Veterans take me?” the man asks. “I want to go to Veterans!”

Toy hangs up. “OK, we’re gonna take you to [the other hospital], and they’re gonna take care of you,” Toy says.

“But I can hardly walk.”

“We’re not gonna ask you to walk.”

The holidays: a time of laughter, gifts, joy and giving. For the folks over at REMSA, giving means spending 12 hours a day driving through the cold and winter gloom to help car accident victims, elderly smokers, flu sufferers and, at times, the lonely and the underprivileged who need, more than anything, a caring hand.

Neither Toy nor Holbrook has poignant, heart-rending stories about his entrance into the medical world. Both men speak in simple terms about their sometimes crazy lives as medics.

“Pretty much like everybody else, I just fell into it,” Holbrook says. “I like to help people, and EMS [emergency medical services] seemed like something that was really interesting. I started out washing and stocking ambulances. As I … started seeing all this other stuff that went on, it really intrigued me.”

Ask Toy or Holbrook to paint a picture of his life as everyday hero, and you’ll get a quiet, unpresumptuous response. The two men are not wordy types. But hear Toy communicate with a patient who can barely breath or watch Holbrook gently take the blood pressure of a frail elderly woman, and you realize that they are, in their own ways, eloquent spokesmen for their profession.

The job is not always glamorous or exhilarating. On a routine 12-hour shift, there probably won’t be all that much blood and guts, nor will there be that many white-knuckle medical crises. Toy and Holbrook say that you go into every Priority One call expecting a life-or-death situation. But you may find, as with the man on Fourth Street, that things are less than dire.

“His reaction was a little bit excessive,” Toy admits. “I always try to treat them seriously, but if they’re not giving the answers … He was real emotional.”

Toy says that around this time of year in particular, a little loneliness, a little self-neglect and a lot of bad diet can add up to a somewhat panicked call for help at a not-so-urgent time.

“There was a little psychosis going on,” Toy says.

Holbrook has long wanted to be a firefighter. And, in fact, the day I rode along with Unit 23 was one of his last days on the job before going over to the Sparks Fire Department. A Galena High School graduate, Holbrook began his medic training when he was still in high school and working as a volunteer firefighter. He continued his EMT education at Truckee Meadows Community College and has been working on his current REMSA unit since February.

“When I originally took my EMT class, I just kinda wanted to do it so I could be a volunteer firefighter, and I just kind of grew to like it,” he says. “There’s always something new. Every patient you take in, you learn something from.”

He grins teasingly. “It gives you that warm fuzzy feeling.”

The two men actually aren’t regular partners. Holbrook is filling in on Toy’s Unit 23 because Toy’s partner is pregnant and home ill, and Holbrook’s partner hurt her back. Every unit, they explain, has both an EMT II and a paramedic, a more highly trained type of medic. Since Toy is the paramedic of this duo, it’s Holbrook who teams up with Toy.

While Holbrook isn’t exactly chatty about his road into medicine, Toy is even less talkative. A Chinese American with chiseled features and quiet but knowing eyes, Toy isn’t the kind of guy you can get to know in a few minutes. He comes off as self-assured and capable, but discreetly so. He spent three years in the Navy, where he was a rescue swimmer. Then he worked as a Careflight EMT for two years before becoming a paramedic, a level above EMT II.

“Careflight was awesome,” Toy says. “You go to the ski resorts—that’s always real fun—[and help] the people who crash into trees. The scenery from the helicopter is incredible.”

It’s about 9 a.m. The roads are snowy and the skies bleak. White stuff frosts the ambulance’s back window as Reno’s downtown gets smaller and smaller behind us. We’re headed up to Northern Nevada Medical Center in Sparks. Sarah McLachlan’s “Angel” plays softly on the ambulance’s back speakers.

And there are dying flowers everywhere.

I’m squeezing two vases between my legs, and a gift mug sits at my feet. The drying petals shake off as the ambulance rattles along, leaving my lap decorated in foliage. Another slightly fresher bouquet is strapped in by a seat belt across from me.

We are transporting another 77-year-old patient, this time from Saint Mary’s to Tahoe Pacific, a rehabilitation center at Northern Nevada Medical Center. The patient was living independently until she fell and fractured her pelvis. She’s looking a little frail now, although still feisty. She’d been moving around a lot, something she was too delicate for, so the staff at Saint Mary’s restrained her by the wrists. She was not too happy about it, either.

“She just doesn’t like to be tied down,” a hospital staff member explained when we picked her up at Saint Mary’s. The medics, gathering up the patient, bed-dressings and all, formed a sort of hammock around her as they lifted her from bed to gurney. They commented on how light the bundle felt. Hearing that she weighed in at a mere 70 pounds, I realized that she’s shorter on pounds than on years.

“It’s a little cold out there,” Toy says to the patient. “We’re gonna bundle you up.”

We surveyed the nice floral collection adorning her hospital room—too much for Toy and Holbrook to carry alone, so I pitched in, carrying the bouquets to the ambulance and balancing vases on the way. An ambulance has no compartment for flowers.

There’s a little lull after returning from Tahoe Pacific. After leaving the hospital, Toy and Holbrook are told to post on the south side of town. Although there are two post stations, most of the time “posting” means sitting in a parking lot and waiting.

We head toward the South McCarran/South Virginia Street area, and Toy asks me if there’s anywhere I need to go. I’m feeling a bit uncaffeinated, so I suggest Starbucks. We drive to the Starbucks/Applebees parking lot, right off Kietzke Lane, and I head in. By the time I negotiate the sizable line of smartly dressed and edgily cheerful Christmas shoppers, we’ve been told to relocate again, this time to the corner of Lakeside and Moana. As soon as we pull up, however, we’re dispatched to the Health Access Washoe County Clinic, a free clinic on Wells Avenue.

RrrraaaaaahhhH! Curious to see other drivers’ response to having a screaming vehicle on their tails, I peer out the window and rubberneck. I’m amazed at how few cars pull over to let us pass and the slow response time of the ones who do. One driver, turning onto Kietzke Lane right in front of us, simply stops, like a deer frozen by headlights. I wonder wordlessly if I am this bad.

“It’s amazing how oblivious people are,” Holbrook says. “You just wanna give them the bird. But you can’t.”

They do give one “oblivious” motorist the horn, however—one quick and pointed beep.

We get to the HAWC Clinic and find that a 10-year-old girl is having an asthma attack. The wide-eyed patient, dressed in overalls and a Tweety T-shirt, breathes with a respirator’s help.

“What’s that?” she asks as the medics pull out the cylindrical silver tank.

“That’s our oxygen tank,” Toy replies.

The medics hook her up to the oxygen tank. She seems to be doing OK. Toy picks her up with a playful growl, sets her on the gurney and rolls her out to the ambulance. Her mom, a slim woman with long brown hair, follows. We get in. Mom rides up front with Holbrook. I ride in the back with Toy and the young patient on her way to Washoe Medical Center.

“You don’t like shots?” Toy asks after the girl voices her aversion to needles.

“I like little shots.”

“I don’t like shots, either,” Toy says. He’s getting her stats, doing the usual back-of-the-ambulance stuff. “How old are you?”

“Ten.”

“What grade are you in?”

“Fifth.”

“You like it?”

“Yeah, it’s hard.”

“When you came in [to the clinic], were you having a tough time breathing?” Toy asks, changing the subject.

“Yeah.”

“How ’bout now, does your breathing feel pretty normal?”

“No.”

“Not yet, huh?”

He hooks her up to the heart monitor.

“Well, you’re getting plenty of oxygen, which is a really good thing,” Toy says.

“How long will I stay at the hospital?” the patient asks.

“Well, I don’t know. That depends.”

“I think I might have to spend the night there.”

Toy tells the patient that she’s doing “perfect” and “wonderful.” He calls the hospital on the ambulance phone to let them know of our impending arrival. The second he gets on the phone his voice shifts from its genial, teasing tone and becomes low and brusque.

“So what’s your favorite subject?” Toy asks after he hangs up, returning to his more playful voice.

“Math.”

“Math? I like math, too.”

“I don’t like reading.”

“Yeah, reading’s overrated.” He pauses. “But you’ll need it later. Have you had that cough long?”

“Yeah.”

“How long have you had that cough?”

“Since September.”

We arrive at Washoe Med and navigate our way to a room. The girl’s scared eyes are gone. She seems excited at the prospect of spending a night at the hospital.

“Boy, this is better than any hospital I’ve ever been in,” her mom notes. “You’re stylin'.”

The girl’s room seems comfy, with hardwood floors and a panoramic view of the parking lot. A nurse brings in balloons.

“You could even call room service,” Toy suggests to the girl.

“I don’t know how.”

“You’ll learn.”

Many calls that come in are for respiratory difficulties, the medics tell me.

“Asthma attacks are really, really scary,” Toy says. “If they’re having a severe attack, it can take someone down pretty quick.”

At her worst, this young patient dropped down to 88 percent oxygen content in her red blood cells. She was at about 94 percent upon arriving at Washoe. A person should be around 97 percent, Toy says.

“I don’t think she ever got really, really bad,” Toy says. “Eighty-eight percent isn’t really, really, bad, but with kids you always worry … because kids can’t compensate as well.”

After dropping the asthma patient off at the hospital, Toy and Holbrook grab lunch. We stop at Arby’s on North McCarran Boulevard, where Holbrook runs in for some grub to go. He comes out shaking his head.

“Every time I go in there, the girl asks me, ‘So, did anybody die today?’ “

We head to that little Fourth Street motel to post. Toy heats up a beef and rice meal in the microwave there. He calls his wife, Nancy, from the motel phone.

“If he doesn’t call, he gets in trouble,” Holbrook jokes when Toy hangs up the phone.

“I love my wife,” Toy says.

I ask Holbrook if he’s married.

“Not for another 20 years.”

I ask Holbrook about his unique experiences as an EMT, and he tells me about serving on the medic unit out at Burning Man.

“It was … it was … I can’t describe it. I met people just going there and letting loose of all their morals. People walk around naked, ride bicycles naked. The people that are high are going through the bonfires … a lot of people have artwork and they’re climbing around on the artwork and falling.

“Mostly there are burn injuries … and a lot of dehydration and drug overdoses. … We patrolled the whole setup, and people would come up and knock on the [unit] window and say, ‘Hey, we need an ambulance.’ “

I had assumed that medics would have some sort of magical ability to instantly locate a crisis situation. Not always so. While they have intimate knowledge of most city streets, they still have a hard time finding addresses. At times, patients aren’t coherent enough to tell the dispatcher just where they are.

Early in the afternoon, a call comes in. The dispatcher tells us that it’s another breathing problem at another Fourth Street motel. First, the word comes in that it’s on West Fourth. Then the dispatcher amends his directions: East Fourth.

Toy and Holbrook look for the address, craning their necks to see barely visible street address numbers. We turn around on a side street marked by some serious decrepitude and look on the other side of the block. Our best bet looks like a mom ‘n’ pop shop with large glass windows. Toy and Holbrook bring out the gurney and roll it into the store.

“They’re looking at us kinda funny,” Holbrook notes.

Looks like no one ordered an ambulance here. They suggest we try next door, but that’s no better. We load up again and circle around, letting the dispatcher know that we couldn’t find the place. Though police are already on the scene, the police can’t seem to tell us where it is, either.

“Well, that’s kinda scary,” Toy comments.

We search a bit more. Toy finally says to call it quits. The police are there, and they’ll send out another call if needed.

It’s about 4 p.m., and the shift is nearing its end. We do a parking lot post again near Shopko on the south side of town. Toy asks me if there’s anywhere I need to go, but I say I’m good. Toy feels like having a snack and announces that we should find a microwave. Holbrook suggests that he try Shopko, but Toy replies that they’d probably not like it if he sauntered in and popped his food into one of their microwaves.

“I thought you meant to buy,” Holbrook says.

I eavesdrop as the medics banter.

“Are you a member of a gym anywhere?” Holbrook asks Toy.

“No. Haven’t had time. And then I got married, and that blew it,” he jokes.

“What does your wife do?” I ask Toy, who’s recently been wed.

“She’s an accountant,” he replies. “She’s the brain. I’m the brawn.”

After Toy finds and uses a mini-mart microwave, we head north on South Virginia Street. Some classic rock, REO Speedwagon maybe, comes on the radio.

“Is this Britney Spears?” Toy asks Holbrook.

“Nah … Christina Aguilera, I think.”

They never crack a smile.

About 4:30 p.m., Toy and Holbrook get one last call. We’re dispatched to a trailer park near Kietzke Lane and find that a patient who had been diagnosed with emphysema earlier in the day is having difficulty breathing.

The medics take her vitals, set her up with an oxygen tank, hook her up to the heart monitor, and discuss the 72-year-old patient’s condition with her concerned relatives. She seems to be breathing easier by the minute. In the end, against the advice of her family, the patient decides that she doesn’t want to go to the hospital.

Toy has a long chat with both the patient and her relatives; he says she’s most likely out of danger but advises her family to call for an ambulance if any danger signs return. They instruct the patient to fill out a liability release form, a requirement for those who have received medical attention but choose not to go to the hospital.

At 5:25 p.m., we head back to the REMSA building on Edison Way in Sparks. The day seemed pretty routine to the medics. In the Reno area, unlike in larger cities, most calls involve respiratory problems, car accidents or fainting. Toy and Holbrook say they are frequently called to casinos, where they tend to dizzy, disoriented or drunken casino patrons.

“We have a lot of smokers and drinkers,” Toy says.

The medics roll the ambulance into the super-sized REMSA garage. They put their medic bags and equipment in order for the next shift.

“All right then," Holbrook announces. "That’s a wrap."