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Bob Gibson, A Stranger No More

June 16, 2010 1 comment

Omaha‘s produced many black sports legends, and I’ve had the privilege of meeting, interviewing, and profiling most of them.  Arguably, the biggest name of this group is Bob Gibson, the Major League Baseball Hall of Fame pitcher.  The following story for The Reader (www.thereader.com) introduced me to Gibson, who had agreed to an hour or so interview and thereupon shocked and delighted me when he ended up giving me almost five hours. The occasion for the interview and story was a charitable golf tournament he was starting up.  He had no idea who I was and by rights I had no business getting that much of his time, but I believe he indulged me because, one, he was motivated to get the word out about his new event, and two, I had done my homework, which I assume he respected.  Also, not long before the interview his second autobiography had come out, and so he was probably also interested in promoting that.  He also had me and a photographer over his home for another couple hours.  Whatever the reasons, I’m glad he did share himself with me so generously, as it led to this quite extensive piece and a few others. Look for more Gibson posts. There is a second Gibson story already on the site, entitled “My Brother’s Keeper,” which details the story of how his older brother Josh schooled him to become the great competitor he became. Another, titled “Master of the Mound,” goes into the dominance Bob Gibson displayed out on the field.

 

 

 

 

Bob Gibson, A Stranger No More

(NOTE: for similar stories, click on the Omaha Black Sports Legends and/or Out to Win categories)

©by Leo Adam BIga

Originally published in The Reader (www.thereader.com)

 

Homegrown baseball icon Bob Gibson normally shuns the media spotlight. Even during a Hall of Fame pitching career with the St. Louis Cardinals (1959-1975), this sober, wary, intensely private man barely tolerated reporters’ intrusions.

But the Omaha native is letting his guard down now to promote the Bob Gibson All-Star Classic, a June 14 charitable golf tournament at the Quarry Oaks course near Mahoney State Park. The event will benefit two groups he’s long been involved with – the American Lung Association of Nebraska and the Baseball Assistance Team, an organization helping indigent ex-baseball personnel. He serves on BAT’s board of directors.

He will host an impressive array of sports figures and celebrities at Quarry Oaks, including fellow baseball Hall of Famers Willie Mays, Lou Brock, Sandy Koufax and Stan Musial, basketball Hall of Famer Oscar Robertson, actor Bill Murray and former NBC sportscaster and Today Show host Bryant Gumbel. He’ll also welcome some high-profile Omaha natives, including former NBA players Bob Boozer and Ron Boone, football Hall of Famer Gale Sayers and world-class investor Warren Buffett.

Gibson’s return to the public arena is apropos given this is the 50th anniversary of the late Jackie Robinson’s breaking of major league baseball’s color barrier.  Growing up in Omaha’s Logan Fontenelle Housing Projects, Gibson idolized Robinson. “Oh man, he was a hero,” he told The Reader. “When Jackie broke in, I was just a kid. He means even more nowthan he did then, because I understand more about what he did” and endured.  When Gibson was at the peak of his career, he met Robinson at a Washington, D.C. fund-raiser, and recalls feeling a deep sense of “respect.”

A baseball-basketball standout at Tech High and Creighton University, Gibson became, in 1957, a two sport pro athlete – playing hardball with the Cardinals’ Triple AAA club in Omaha and hoops with the famed Harlem Globetrotters. After making the St. Louis roster in ’59, he concentrated solely on baseball and within a few years became a premier pitcher.

Gibson was in the forefront of black athletes who, following Robinon’s lead, helped secure African-Americans’ foothold in professional sports.  Like Robinson, he’s distinguished himself as a fiercely proud, highly principled man with, as author David Halberstam put it, a “samurai” sense of honor and duty.

“He has certain beliefs and he sticks with those. He doesn’t waver one way or another in his decision-making. I admired him as a young man and teammate, and I admire him as an individual to this day,” said Jerry Parks, a teammate of Gibson’s at Tech, who today is Omaha’s Parks, Recreation and Public Property Director.

“Not only as a baseball player, but as a man, he’s got a lot of dignity,” said Preston Love, Sr., an Omaha musician who’s known Gibson for years. “He’s really an exquisite man. An elegant man. A class act.  is private life, during and after his years in baseball, has been just exemplary.”

Friends appreciate the fact that Gibson has never left the area or abandoned his roots. He and his wife, Wendy, and their 12-year-old son, Christopher, live in a spacious home in Bellevue’s Fontenelle Hills.

“He didn’t get big-headed and go away and hide somewhere,” said Parks. “He continues to stay in communication with all of his teammates.”

“What I admire about him most is that he’s very loyal to people he likes, and that’s priceless for me,” said Rodney Wead, a close friend. Wead, who grew up with Gibson and became a noted social services director, is president and CEO of Grace Hill Neighborhood Services in St. Louis.

In a recent interview at a mid-town Omaha eatery, Gibson spoke about Robinson’s legacy, about racism in and out of baseball and about his own pitching prowess.  A trim, handsome man of 61, he arrived promptly, sans entourage, dressed in a sweater and slacks. At times he displayed the same no-nonsense, I don’t suffer fools gladly, bluntness of his 1994 autobiography, “Stranger to the Game,” and at other times revealed an engaging, shy congeniality that suits him well.

To Gibson’s dismay, media coverage of the Robinson anniversary has focused on the paucity of blacks filling managerial roles in baseball and not on the larger issue –- that 50 years later blacks continue facing widespread discrimination. He feels it’s hypocritical to make baseball a scapegoat for what’s a systemic problem.

“This is a perfect opportunity for anybody to cleanse their soul through baseball,” he said. “But the problem with racial prejudice goes far beyond baseball. And as soon as this Jackie Robinson thing wears off, everybody’s going right back to where they were before. That’s why when people talk about the lack of black managers and coaches, I just laugh, because we’re talking about a sport where we’re supposedly accepted. But you get into the business world, and we’re not accepted. We’re only able to go so high and then we’re limited to making some lateral movements.”

 

 

Gibson’s playing career coincided with the nation’s civil rights struggle, when change in baseball, as everywhere else, came slowly. When he joined the Cardinals the franchise adhered to custom at its spring training complex in St. Petersburg, Fla. by having black and white players stay in separate quarters. By the time Gibson firmly established himself in the early ‘60s, he and his black teammates had begun confronting even the hint of racism head-on, fostering a progressive, tolerant attitude throughout the organization that led the Cardinals to flaunt existing Jim Crow laws.

In his book Gibson describes the camaraderie on the club as “practically revolutionary in the way it cut across racial lines.” Perhaps the best testament to it is his friendship with former Cardinal catcher and present FOX network sportscaster Tim McCarver, a Southern-born and bred white, who credits Gibson with helping him move beyond his bigotry.

Gibson said the brotherhood the Cardinals forged then could be a model for America today, if we only let it: “Just like it happens in sports, it can happen in other aspects of our lives, but people won’t allow it to. They just won’t allow it. A couple of my best friends just happen to be white. Now, I don’t know if I hadn’t been playing baseball if that would be possible. It could be…I don’t know.” He adds the special feeling between him, McCarver and their old teammates “will always be there.”

His St. Louis experience wasn’t always blissful, however. He and his first wife, Charline (with whom he has two grown daughters), were discouraged from moving into predominately white areas during the ‘60s. They met similar resistance in Omaha.

He confronted blatant racism during a brief ‘57 stay with the Cardinal farm team in Columbus, Ga. “I was there for three weeks, but that was a lifetime,” he said. “I’ve tried to erase that, but I remember it like it was yesterday. It opened my eyes a little bit, yeah. You can see movies, you can hear things, but there’s nothing like experiencing it yourself.”

He acknowledges the progress made in and out of baseball, but sees room for improvement: “Some of the problems we faced when Jackie Robinson broke in and when I broke in 10 years later don’t exist, but then a lot of them still do. I think people are a little bit more sophisticated now in their bigotry, but they’re still bigots.”

He cautiously welcomes the recent pledge by acting baseball commissioner Bud Selig to hire more blacks in administrative roles. “I’m always encouraged by some statements like that, yeah. I’d just like to wait and see what happens. Saying it and doing is two different things.”

He’s encouraged too by golfer Tiger Woods’ recent Masters’ triumph. “What’s really great about him being black,” he said, “is that it seems to me white America is always looking for something that black Americans can’t do, and that’s one other thing they can scratch off their list.” Gibson’s All-Star Classic will be breaking down barriers too by bringing a racially mixed field into the exclusive circle of power and influence golf represents.

When the very private Gibson announced he was holding the very public event, it took many people aback. Gibson himself said at a press conference:  “I have never done anything like this before.” “I was as surprised as anyone,” said Wead, “but so pleased.  He has so much to offer.” Why then is he returning to the limelight?  “The golf tournament is not to get back in the public eye,” Gibson elaborated for The Reader. “That’s not what it’s for.” The purpose is “to raise money” for two causes very close to him and do it via an event “unlike any Omaha’s ever seen before.” Efforts to treat and cure lung disease have personal meaning for Gibson, who’s a lifelong asthma sufferer. A past Lung Association board member, he often speaks before groups of young asthma patients.

“I’ve been going around talking to kids with asthma and trying to convince them that you can participate in sports even though you have asthma, as long as you have a doctor who’s on top of everything. The kids listen. They ask questions.  They’re interested. A lot of them are frightened when they’re out running around and they get a little short of breath and don’t quite understand what it’s all about…when, a lot of times, all they need is a little TLC. I think it’s helpful to have somebody there that went through the same thing, and being an ex-baseball player, you get their attention.”

His involvement with BAT dates to its 1986 inception. The organization assists former big league and minor league players, mangers, front office professionals, and even umpires, who are in financial distress.  “Unfortunately, most people think all ex-players are multimillionaires,” Gibson said. “Most are not. Through BAT we try to do what we can to help people of the baseball family.”

Gibson hopes the All-Star Classic raises half-a-million dollars. The event will feature, arguably, the greatest gathering of sports idols in Nebraska, something Gibson takes obvious pride in, but characteristically doesn’t dwell on. An indication of his standing in the sports world is that no one he contacted to participate turned him down, although some have since bowed out due to scheduling conflicts. It promises to be an event befitting a living legend like Gibson, even if he winces at being called one.

But living legend he is. His career marks support it: 251 wins, including 56 shutouts; 3,117 strikeouts; and a lifetime 2.91 ERA. The two-time Cy Young Award winner and perennial All-Star was also a superb fielding and hitting pitcher. His record-setting feats in three World Series earned the admiration, even the awe, of hard-bitten fans, sportswriters and players. He was named Series MVP in ‘64 and ‘67, each time leading the Cardinals to the title.

 

 

 

 

Then there’s Gibson’s legend-making 1968 season, when he won the Cy Young and MVP awards, threw 13 shutouts and posted the lowest ERA (1.12) in modern baseball history. Many observers consider it the greatest season ever by a pitcher and rank his performance alongside Joe DiMaggio’s 56-game hitting streak and Roger Maris’ swatting of 61 homers as an all-time standard. In that Year of the Pitcher, no one was more dominant than Gibson, and baseball’s rulesmakers responded by lowering the mound and shrinking the strike zone to level the playing field.

But statistics alone can’t capture his brilliance. What set him apart, beyond great stuff and superb control, was a fearsome burning intensity.  He exuded a commanding presence on the field unlike anyone else’s. He simply gave no quarter.  His competitiveness was reflected in an inscrutable game-face whose icy glare bore in on batters as ruthlessly as his searing fastballs. He pitched with an attitude. He messed with opponents’ minds.

His book is full of testimonials about the daunting figure he cut on the mound, including this one by Richie Ashburn, the Tilden, Neb.- native and former Philadelphia Phillies great: “…Gibson dominated…with a vengeance that savaged the batters….His fastball was equal to Koufax’s and Ryan’s, and his slider had no equal. And more’s the pity, Gibson was mean on the mound. He had a menacing, glowering intensity that more than occasionally deepened into a sneer. His intimidating demeanor, his lack of concern for the welfare of the hitter, combined with his almost-unhittable pitches, put Gibson in a class by himself.”

Gibson swears his bad-ass persona was not a facade he developed. “No, I didn’t cultivate that. That’s the way people perceived me. It was strictly business with me, and that’s the way it was. They (opponents) saw it some other way, which was fine, and I didn’t do anything to try and defuse it, but just leave it be. If I had known they felt that way, I would have been a lot worse than that. I would have really played the part,” he said, smiling.

His equally sharp, direct manner off the mound, especially with the press, got him saddled with a reputation for being “difficult.” Looking back, he feels he was “respected” by the press, “but not liked,” adding, “I wasn’t concerned whether they liked me or didn’t like me.”

He resents the public’s and media’s expectation that he explain or expose more of himself. It’s why he’s never been interested in managing.

“Well, I don’t think I need to be understood, and that’s the whole thing. Yes, they misunderstood what they saw, not that I was concerned about it. When you’re in the public eye people want to know all about you,…and I’m not so sure it’s their business. But that’s the only time they want to understand you. If you’re not in the public eye, they could care less.”

Wead said Gibson’s occasional aloofness and curtness stems, in part, from an innate reserve: “He’s shy. And therefore he protects himself by being sometimes abrupt…but’s it’s only that he’s always so focused.”
Gibson suspects he’s paid a price for being a black man who’s dared to speak his mind and go his own way. It’s why he chose “Stranger to the Game” as his book’s title. “I’ve found out that people don’t want you to be truthful about most things.  People don’t like honesty. It hurts their feelings. But I don’t know any other way.  I’ve been basically like that all my life – blunt. Definitely.”

It’s an apt description of the way he pitched too. He epitomized the hard-nosed style of his era, a style dictating whenever a batter cheated –- by leaning too far out over the plate – the pitcher felt obligated to throw inside. In classic brushback tradition, Gibson hummed a 95-plus mile per hour dart toward the batter’s ribs, sending the guy bailing out for cover. The idea then or now wasn’t to hit somebody, although a wild pitch occasionally did, but instead make him feel insecure up there. To plant a seed of doubt for the next swing, the next at-bat, the next game. To gain “an edge” in the confrontation with the batter.

“What you want him to think about is the ball inside,” Gibson said. “He can’t look for a ball inside and away at the same time. That’s why you throw in there…to make him think about it. You can actually see guys thinking. They give it away with their body language and everything.”

 

 

 

 

Gibson, who admits to having strong opinions “about everything,” dislikes the “kinder-gentler” version of baseball played today, when the brushback is frowned on.  e said rulesmakers have essentially taken the purpose pitch away from today’s hurlers. To the point that when pitches sail too far inside, fights often ensue and umpires eject offending pitchers and their managers. He said the reason pitchers get lit up for more runs these days isn’t due to lack of talent, but to changes which penalize pitchers and favor hitters (the near ban on brushbacks, the lowered mound, the reduced strike zone, more tightly wound balls, the Designated Hitter, smaller parks).

“They’ve screwed with the game enough where it’s taken away a lot of the effectiveness of pitchers,” he said.

If it was up to him, he’d raise the mound and do away with the DH. Despite its changes, he still savors the game. He even dreams baseball: “Oh, I dream all the time about it,” he said. “It drives me crazy.  I guess I’m going to do that the rest of my life.” After a certain restlessness, he said, he’s grown more “mellow” in retirement –- devoting his energy to hobbies and home improvement projects. He enjoys working with his hands.

Although he’s kept a hand in the game, he’s never found a permanent niche within the baseball establishment. In the ‘80s he served as pitching coach for the New York Mets and Atlanta Braves (each time under current Yankee skipper Joe Torre, a close friend and former teammate) and as an expert commentator for ABC and ESPN. He was a full-time coach with the Cardinals in ‘95, and the past two spring training camps has worked as a special instructor with the club’s pitching staff.  During the season he performs PR duties at special club functions –- “schmoozing” with officials and VIP guests at Busch Stadium.

He also conducts baseball clinics, including one last fall at the Strike Zone, an indoor baseball academy in Omaha. Strike Zone general manager Joe Siwa said Gibson was a hit with participants: “He did a fabulous job working with the pitchers. The kids really enjoyed being around a Hall of Famer. He did a big autograph session afterwards.”

Whether working with Little Leaguers or professionals, Gibson stresses fundamentals. What made him such a successful pitcher? His velocity? Control? Intensity?  “All of those things,” he said. “Ability doesn’t hurt. But I think it’s concentration, as much as anything.  eing able to focus and block out everything else going on around you. I think you’re probably born with it. There’s a lot of guys with great ability –- with more ability than I had –- but they don’t master it because they can’t focus.“

 

 

 

 

It’s a quality others have noted in him off the field. Countryside Village owner Larry Myers, a partner of Gibson’s in a now closed bar-restaurant, said he often marveled at his “ability to focus on the task at hand and devote all his energy to that task.  Mentally, he’s so disciplined.”

Parks recalls even as a youth Gibson demonstrated the qualities he later displayed as a pro. “Bob was very dedicated and conscientious. As far as that drive, he always did have that,” he said. “I know his brother Josh worked him real hard too.”

Gibson credits his late brother Josh, who was 15 years his senior, with instilling in him an indomitable will to win and a strong work ethic. Josh, a beloved YMCA coach in North Omaha, was father figure to his younger brother (their father died months before Bob was born). Josh coached and Bob starred on the Y Monarchs, a youth baseball squad that traveled to all-white Iowa burgs for games. Gibson recalls how whenever Josh felt the team was getting homered, his big brother would “walk out to the middle of the field and challenge to fight everybody there. He was very competitive. And we’d all be sittin’ there thinkin’ we’re going to get killed…You see enough of that, and that gets in back of your mind. You think, ‘Is this the way it’s supposed to be? Maybe you’re supposed to fight like that.’ Well, I had no problem fighting.”

Gibson’s fought “the racist thing” during his remarkable life‘s journey -– from the projects’ poverty to college privilege to minor league limbo to major league stardom. He’s never backed down, never given up. His tenaciousness has seen him through tough times, like his divorce from Charline, and the loss of his mother Victoria, brother Josh and close friend and former Cardinal teammate Curt Flood.   It’s helped him endure various slights, like being denied a promised Anheuser-Busch beer distributorship by former Cardinals’ owner, the late August Busch. Or waiting 20 years before being brought back as a coach. Or finding employment-investment opportunities closed to him in his hometown and then seeing various business interests go sour. His book’s dedication sums it up: “To my son… May your life be as rewarding as mine, and, I hope, a little easier.”

If Gibson is sometimes standoffish, Wead said, it’s understandable: “He’s been hurt so many times, man. We’ve had some real, almost teary moments together when he’s reflected on some of the stuff he wished could of happened in Omaha and St. Louis.”

Publicly, Gibson’s borne the snubs and disappointments with characteristic stoicism.  Through it all, he’s remained faithful to his hometown. “He’s helped a lot of charitable causes very quietly and without a lot of fanfare,” said Myers. “He likes helping people. He’s certainly given back to Omaha over the years. He’s very sincere.”

Some question Omaha’s commitment to him. The city threw a parade and day in his honor years ago, but there’s no lasting monument. “Omaha has never recognized him the way it should,” said Wead. “For instance, there’s no question the North Expressway should be the Bob Gibson Expressway.“ Efforts by Wead and others to name a park, street or facility after him have come up empty. If it happened, Gibson would undoubtedly be annoyed by all the fuss, but probably secretly cherish the sentiment.

Until then, the June 14 golf classic is Omaha’s chance to embrace one of its best and brightest. To let him know he’s a stranger no more.

A Force of Nature Named Evie: Still a Maverick Social Justice Advocate at 100


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Spend even a little while with Evie Zysman, as I did, and she will leave an impression on you with her intelligence and passion and commitment.  I wrote this story for the New Horizons, a publication of the Eastern Nebraska Office on Aging. We profile dynamic seniors in its pages, and if there’s ever been anyone to overturn outmoded ideas of older individuals being out of touch or all used up, Evie is the one. She is more vital than most people half or a third her age.  I believe you will be as struck by her and her story as I was, and as I continue to be.

A Force of Nature Named Evie: Still a Maverick Social Justice Advocate at 100

©by Leo Adam Biga

Originally published in the New Horizons

When 100-year-old maverick social activist, children’s advocate and force of nature Evelyn “Evie” Adler Zysman recalls her early years as a social worker back East, she remembers, “as if it were yesterday,” coming upon a foster care nightmare.

It was the 1930s, and the former Evie Adler was pursuing her graduate degree from Columbia University’s New York School of Social Work. As part of her training, Zysman, a Jew, handled Jewish family cases.

“I went to a very nice little home in Queens,” she said from her art-filled Dundee neighborhood residence. “A woman came to the door with a 6-year-old boy. She said, ‘Would you like to see his room?’ and I said, ‘I’d love to.’ We go in, and it’s a nice little room with no bed. Then the woman excuses herself for a minute, and the kid says to me, ‘Would you like to see where I sleep?’ I said, ‘Sure, honey.’ He took me to the head of the basement stairs. There was no light. We walked down in the dark and over in a corner was an old cot. He said, ‘This is where I sleep.’ Then he held out his hand and says, ‘A bee could sting me, and I wouldn’t cry.’

“I knew right then no child should be born into a living hell. We got him out of that house very fast and got her off the list of foster mothers. That was one of the experiences that said to me: Kids are important, their lives are important, they need our help.”

Evie Zysman

Imbued with an undying zeal to make a difference in people’s lives, especially children’s lives, Evie threw herself into her work. Even now, at an age when most of her contemporaries are dead or retired, she remains committed to doing good works and supporting good causes.

Consistent with her belief that children need protection, she spent much of her first 50 years as a licensed social worker, making the rounds among welfare, foster care and single-parent families. True to her conviction that all laborers deserve a decent wage and safe work spaces, she fought for workers’ rights as an organized union leader. Acting on her belief in early childhood education, she helped start a project that opened day care centers in low income areas long before Head Start got off the ground; and she co-founded, with her late husband, Jack Zysman, Playtime Equipment Co., which sold quality early childhood education supplies.

Evie developed her keen social consciousness during one of the greatest eras of need in this country — the Great Depression. The youngest of eight children born to Jacob and Lizzie Adler, she grew up in a caring family that encouraged her to heed her own mind and go her own way but to always have an open heart.

“Mama raised seven daughters as different as night and day and as close as you could possibly get,” she said. “Mama said to us, ‘Each of you is pretty good, but together you are much better. Remember girls: Shoulder to shoulder.’ That was our slogan. And then, to each one of us she would say, ‘Don’t look to your sister — be yourself.’ It was taken for granted each one of us would be ourselves and do something. We loved each other and accepted the fact each one of us had our own lives to live. That was great.”

Even though her European immigrant parents had limited formal education, they encouraged their offspring to appreciate the finer things, including music and reading.

“Papa was a scholar in the Talmud and the Torah. People would come and consult him. My mother couldn’t read or write English but she had a profound respect for education. She would put us girls on the streetcar to go to the library. How can you live without books? Our home was filled with music, too. My sister Bessie played the piano and played it very well. My sister Marie played the violin, something she did professionally at the Loyal Hotel. My sister Mamie sang. We would always be having these concerts in our house and my father would run around opening the windows so the neighbors could also enjoy.”

Then there was the example set by her parents. Jacob brought home crates filled with produce from the wholesale fruit and vegetable stand he ran in the Old Market and often shared the bounty with neighbors. One wintry day Lizzie was about to fetch Evie’s older siblings from school, lest they be lost in a mounting snowstorm, when, according to Evie, the family’s black maid intervened, saying, “You’re not going — you’re staying right here. I’ll bring the children.’ Mama said, ‘You can go, but my coat around you,’ and draped her coat over her. You see, we cared about things. We grew up in a home in which it was taken for granted you had a responsibility for the world around you. There was no question about it.”

Along with the avowed obligation she felt to make the world a better place, came a profound sense of citizenship. She proudly recalls the first time she was old enough to exercise her voting right.

“I will always remember walking into that booth and writing on the ballot and feeling like I am making a difference. If only kids today could have that feeling when it comes to voting,” said Evie, a lifelong Democrat who was an ardent supporter of FDR and his New Deal. When it comes to politics, she’s more than a bystander — she actively campaigns for candidates. She’ll be happy with either Obama or Clinton in the White House.

When it came time to choose a career path, young Evie simply assumed it would be in an arena helping people.

“I was supposed to, somehow,” is how she sums it up all these years later. “I believed, and I still believe, that to take responsibility as a citizen, you must give. You must be active.”

For her, it was inconceivable one would not be socially or politically active in an era filled with defining human events — from millions losing their savings and jobs in the wake of the stock market crash to World War I veterans marching in the streets for relief to unions agitating for workers’ rights to a resurgence of Ku Klux Klan terror to America’s growing isolationism to the stirrings of Fascism at home and abroad. All of this, she said, “got me interested in politics and in keeping my eyes open to what was going on around me. It was a very telling time.”

Unless you were there, it’s difficult to grasp just how devastating the Depression was to countless people’s pocketbooks and psyches.

“It’s so hard for you younger generations to understand” she told a young visitor to her house. “You have never lived in a time of need in this country.” Unfortunately, she added, the disparity “between rich and poor” in America only seems to widen as the years go by.

With her feisty I-want-to-change-the-world spirit, Evie, an Omaha Central High School graduate, would not be deterred from furthering her formal education and, despite meager finances, became the first member of her family to attend college. Because her family could not afford to send her there, she found other means of support via scholarships from the League of Women Voters and the University of Nebraska-Lincoln, where the Phi Betta Kappa earned her bachelor’s degree.

“I knew that for me to go to college, I had to find a way to go. I had to find work, I had to find scholarships. Nothing came easy economically.”

To help pay her own way, she held a job in the stocking department at Gold’s Department store in downtown Lincoln. An incident she overhead there brought into sharp relief for her the classism that divides America. “

One day, a woman with a little poodle under her arm came over to a water fountain in the back of the store and let her dog drink from it. Well, the floorwalker came running over and said, ‘Madam, that fountain is for people,’ and the woman said, ‘I’m so sorry, I thought it was for the employees.’ That’s an absolutely true story and it tells you where my politics come from and why I care about the world around me and I want to do something about it.”

Her undergraduate studies focused on economics. “I was concerned I should understand how to make a living,” she said. “That was important.” Her understanding of hard times was not just of the at-arms-length, ivory-tower variety. She got a taste of what it was like to struggle when, while still an undergrad, she was befriended by the Lincoln YWCA’s then-director who arranged for Evie to participate in internships that offered a glimpse into how “the other half lived.” Evie worked in blue collar jobs marked by hot, dark, close work spaces.

“She thought it was important for me to have these kind of experiences and so she got me to go do these projects. One, when I was a sophomore, took me in the summer to Chicago, where I worked as a folder in a laundry and lived in a working girls’ rooming house. There was no air conditioning in that factory. And then, between my junior and senior years, I went to New York City, where I worked in a garment factory. I was supposed to be the ‘do-it’ girl — get somebody coffee if they wanted it or give them thread if they needed it, and so forth.

“The workers in our factory were making some rich woman a beautiful dress. They asked me to get a certain thread. And being already socially conscious, I thought, ‘I’ll fix her,’ and I gave them the wrong thread,” a laughing Evie recalled, still delighted at the thought of tweaking the nose of that unknown social maven.

Upon graduating with honors from UNL she set her sights on a master’s degree. First, however, she confronted misogyny and bigotry in the figure of the economics department chairman.

“He said to me, ‘Well, Evelyn, you’re entitled to a graduate fellowship at Berkeley but, you know, you’re a woman and you are a Jew, so what would you possibly do with your graduate degree when you complete it?’ Well, today, you’d sue him if he ever dared say that.”

Instead of letting discrimination stop her, the indomitable Evie carried-on and searched for a fellowship from another source. She found it, too, from the Jewish School of Social Work in New York.

“It was a lot of money, so I took it,” she said. “I had my ethic courses with the Jewish School and my technical courses with Columbia,” where she completed her master’s in 1932.

As her thesis subject she chose the International Ladies Garment Workers Union, one of whose New York factories she worked in. There was a strike on at the time and she interviewed scores of unemployed union members who told her just how difficult it was feeding a family on the dole and how agonizing it was waking-up each morning only to wonder — How are we going to get by? and When am I ever going to work again?

As a social worker she saw many disturbing things — from bad working conditions to child endangerment cases to families struggling to survive on scarce resources. She witnessed enough misery, she said, “that I became free choice long before there was such a phrase.”

Her passion for the job was great but as she became “deeply involved” in the United Social Service Employees Union, she put her first career aside to assume the presidency of the New York chapter.

“I could do even more for people, like getting them decent wages, than I could in social work.” Among the union’s accomplishments during her tenure as president, she said, was helping “guarantee social workers were qualified and paid fairly. You had to pay enough in order to get qualified people. We felt if you, as social workers, were going to make decisions impacting people’s lives, you better be qualified to do it.”

Feeling she’d done all she could as union head, she returned to the social work field. While working for a Jewish Federation agency in New York, she was given the task of interviewing Jewish refugees who had escaped growing Nazi persecution in Germany and neighboring countries. Her job was to place new arrivals with the appropriate state social service departments that could best meet their needs. Her conversations with emigres revealed a sense of relief for having escaped but an even greater worry for their loved ones back home.

“They expressed deep, deep concern and deep, deep sadness and fear about what was going on over there,” she said, “and anxiety about what would happen to their family members that remained over there. They worried too about themselves — about how they would make it here in this country.”

A desire to help others was not the only passion stoked in Evie during those ”wonderful” New York years. She met her future husband there while still a grad student. Dashing Jack Zysman, an athletic New York native, had recently completed his master’s in American history from New York University. One day, Evie went to some office to retrieve data she needed on the International Ladies Garment Workers Union, when she met Jack, who was doing research in the very same office. Sharing similar interests and backgrounds, the two struck up a dialogue and before long they were chums.

The only hitch was that Evie was engaged to “a nice Jewish boy in Omaha.” During a break from her studies, she returned home to sort things out. One day, she was playing tennis at Miller Park when she looked across the green and there stood Jack. “He drove from New York to tell me I was definitely coming back and that I was not to marry anybody but him.” Swept off her feet, she broke off her engagement and promised Jack she would be his.

After their marriage, the couple worked and resided in New York, where she pursued union and social work activities and he taught and coached at a high school. Their only child, John, today a political science professor at Cal-Berkeley, was born in New York. Evie has two grandchildren by John and his wife.

Along the way, Evie became a New Yorker at heart. “I loved that city,” she said. Her small family “lived all over the place,” including the Village, Chelsea and Harlem. As painful as it was to leave, the Zysmans decided Omaha was better suited for raising John and, so, the family moved here shortly after World War II.

Soon the couple began Playtime Equipment, their early childhood education supply company. The genesis for Playtime grew out of Evie’s own curiosity and concern about the educational value of play materials she found at the day care John attended. When the day care’s staff asked her to “help us know what to do,” she rolled up her sleeves and went to work.

She called on experts in New York, including children’s authors, day care managers and educators. When she sought a play equipment manufacturer’s advice, she got a surprise when the rep said, “Why don’t you start a company and supply kids with the right stuff?” It was not what she planned, but she and Jack ran with the idea, forming and operating Playtime right from their home. The company distributed everything from books, games and puzzles to blocks and tinker toys to arts and crafts to playground apparatus to teaching aids. The Zysmans’ main customers were schools and day cares, but parents also sought them out.

“I helped raise half the kids in Omaha,” Evie said.

The Zysman residence became a magnet for state and public education officials, who came to rely on Evie as an early childhood education proponent and catalyst. She began forming coalitions among social service, education and legislative leaders to address the early childhood education gap. A major initiative in that effort was Project AID, a program she helped organize that set-up preschools at black churches in Omaha to boost impoverished children’s development. She said the success of the project helped convince state legislators to make kindergarten a legal requirement and played a role in Nebraska being selected as one of the first states to receive the federal government’s Head Start program.

Gay McTate, an Omaha social worker and close friend of Zysman’s, said, “Evie’s genius lay in her willingness to do something about problems and her capacity to bring together and inspire people who could make a difference.”

Evie immersed herself in many more efforts to improve the lives of children, including helping form the Council for Children’s Services and the Coordinated Childcare Project, clearinghouses geared to meeting at-risk children’s needs.

The welfare of children remains such a passion of hers that she still gets mad when she thinks about the “miserable salaries” early childhood educators make and how state budget cuts adversely impact kids’ programs.

“Everybody agrees today the future of our country depends on educating our children. So, what do we do about it? We cut the budgets. Don’t get me started…” she said, visibly upset at the idea.

Besides children, she has worked with such organizations as the United Way, the Urban League, the League of Women Voters, the Jewish Council of Women, Hadassah and the local social action group Omaha Together One Community.

In her nearly century of living, she’s seen America make “lots of progress” in the area of social justice, but feels “we have a long way to go. I worry about the future of this country.”

Calling herself “a good secular Jew,” she eschews attending services and instead trusts her conscience to “tell me what’s right and wrong. I don’t see how you can call yourself a good Jew and not be a social activist.” Even today, she continues working for a better community by participating in Benchmark, a National Council of Jewish Women initiative to raise awareness and discussion about court appointments and by organizing a Temple Israel Synagogue Mitzvah (Hebrew, for good deed) that staffs library summer reading programs with volunteers.

Her good deeds have won her numerous awards, most recently the D.J.’s Hero Award from the Salvation Army and Temple Israel’s Tikkun Olam (Hebrew, for repairing the world) Social Justice Award.

She’s outlived Jack and her siblings, yet her days remain rich in love and life. “I play bridge. I get my New York Times every day. I have my books (she is a regular at the Sorenson Library branch). I’ve got friends. I have my son and daughter-in-law. I have my grandchild. What else do you need? It’s been a very full life.”

As she nears a century of living Evie knows the fight for social justice is a never-ending struggle she can still shine a light on.

“How would I define social justice?” she said at an Omaha event honoring her. “You know, it’s silly to try to put a name to realizing that everybody should have the same rights as you. There is no name for it. It’s just being human…it’s being Jewish. There’s no name for it. Give a name to my mother who couldn’t read or write but thought that you should do for each other.”

ER, An Emergency Room Journal

June 16, 2010 1 comment

picture disc.
 The camera rolls as emergency room trauma team goes into action.

To be honest, I was hoping for something dramatic to happen in the ER that agreed to accommodate for a few nights my hanging around, asking medical staff and paramedics and patients questions and taking voluminous notes. Nothing much did.  That is to say, a stream of patients came through presenting all manner of problems, but nothing over the top sensational occurred.  I think I still managed a good story out of the assignment. You be the judge.  The article appeared in The Reader (www.thereader.com) as a kind of companion piece to another story I did based on ride alongs with paramedics.  You can find the paramedics story on this blog as well. It’s titled “Merciful Armies of the Night.”

ER, An Emergency Room Journal

©by Leo Adam Biga

Originally published in The Reader (www.thereader.com)

 

Hours of Boredom and Minutes of Terror

Hollywood portrayals of hospital emergency rooms depict white hot action zones where medical drama and staff intrigue continue nonstop. What’s a real ER like? Recent visits to the NHS University Hospital ER found a medical treatment center, social laboratory, educational classroom and last refuge all in one. An intersection where the gallery of humanity meets and various trends surface. A mission, a haven, a hell. Or, as one ER nurse put it, “We deal with the heart of Omaha here.”

Like many staff, nurse Susie Needham feels the ER is THE place to be on the frontlines of medical care due to its fluid nature, one she summed up as “hours of boredom and minutes of terror.” Unlike television’s ER, long tedious stretches can grind by before a single trauma arrives. Then again, a run of critical or extreme cases can suddenly pile-up, kicking a slow shift into high gear. As Needham put it, “From moment to moment, it can change.

Most people that work here are attracted to the fast changing pace and the variety of different patients we see. It’s never the same. You have to know a lot about a lot of different things, and that’s what keeps you on your toes. It makes it interesting.” On a Friday night in April Needham, a pretty freckled blonde with an impish smile, tended a diverse mix, including a bronchial pediatric patient with difficulty breathing, an adult drug abuser suffering withdrawal pangs and a drunk woman ostensibly there for stomach pain but whose battered body and frayed psyche told a more sinister story.

For the most part, ERs treat a procession of fevers, coughs, sprains, aches, cuts, bruises, breaks. Purely routine stuff. Unless it’s happening to you, of course. Since one person’s trivial complaint may be another’s dire crisis, everyone is treated the same. No condition is refused. Nothing is taken for granted. Trained to assess and treat serious problems, medical staff try first ruling out any life-threatening cause before looking at non-critical or non-medical issuses. Most ER medical staff possess extensive critical care backgrounds, but it seems all ERs (the step-child of acute medical care) are not equal.

“Unfortunately, emergency medicine is still the only speciality where you just need a license to practice, so it’s kind of a buyer-beware situation,” said NHS Chief of Emergency Medicine Dr. Robert Muelleman. “At University, we require physicians be board certified in emergency medicine (spending a minimum three years residency in emergency medicine and passing written and oral exams). It helps ensure a certain standard of care or level of competency. Nationwide, probably only between 50 and 60 percent of practicing emergency physicians are board certified, but I think there are more, better trained board certified physicians today than there were 10 or 15 years ago.”

 

Dr. Robert Muelleman

 

 

 

On busy nights (Sundays are worst) patients stack up and long waits ensue. Triage nurses sort cases on an as-needed basis, with the severest seen promptly and the mildest set aside for a kind of walk-up window service, Fast Track. But again, unlike TV, where patients sweep through the ER unchecked, the real world entails staff documentation-communication for all patient admissions, treatments, releases. In terms of volume, University Hospital recorded 27,018 ER visits last year, a slight rise from 1998. Traumas typically account for about 3.25 percent of all cases.

Not long past dusk on St. Patrick’s Day things were unwinding surprisingly slowly in the ER considering this was a designated trauma night (meaning area rescue services were to feed trauma patients there) on a Friday holiday known for alcohol-related injuries. Earlier in the day, staff treated a 43-year-old Omaha man knocked unconscious in a bar fight. Michael Kimball was brought in comatose. Massive swelling in his brain forced doctors to remove his skull to relieve the pressure. (Editor’s Note: Kimball never regained consciousness and, two weeks later, was pronounced dead. Police cited insufficient evidence to file charges in the case.).

Hours later, during a protracted lull, staff lingered about “the hub,” the ER nerve center,  bantering in the irreverent MASH humor used for stress relief. Attending physician Dr. Paul Tran made a colleague, Dr. Rick Walker, envious by describing his sound sleep the night before, a rarity after the rush of a nine-hour trauma shift. When not hanging at the hub or crashing in the staff lounge, docs, nurses, techs and residents use computers and charts to monitor the condition of patients in surrounding non-critical care rooms and trauma bays (a total of 16 beds), to track the progress of lab workups, x-rays or other procedures and to file paperwork. A large grease board hanging high on the wall is smudged with running patient status reports. This checks and balances system aims to avoid patient-bed-meds. mixups

The staff perked up that night at the static-filled emergency band radio (always droning on in the background) report of a CODE 3 (critical medical) case en route, with an ETA of five minutes. Staff are uncanny at hearing the calls headed their way and ignoring the others. The paramedic’s sketchy details described an elderly man who fell and hit his head outside a Bag ‘N’ Save. The man, whom paramedics found minus vital signs, had been shocked back to life. With the clock ticking, Dr. Tran, a slight Vietnamese native with a gentle bedside manner, conferred with colleagues on whether to summon the trauma team, a kind of in-house medical SWAT squad on call to treat the most severe critical care cases, or to handle things themselves.

 

 

 

 

It Never Gets Better
Dr. Walker, a beefy man whose pockets are invariably overstuffed with paperback novels and stethoscopes, has spent his entire medical career in emergency medicine. He said part of the appeal for him and others is the extreme nature of the work. “I think it’s very challenging, and that’s a large aspect of it. It’s also a big adrenalin rush, and as I’ve assessed my life and career I’ve come to the conclusion I’m an adrenalin junkie, and I think that’s probably what did it for me.”

He said being exposed to the tragedy that accompanies trauma extracts a certain toll:

“You see bad stuff happening here, and it’s stuff that, you know, can make you cry, like kids dying. It’s tough and it can really get to you emotionally, and so what you have to do is build up a wall because otherwise you’d be breaking down every time you saw something like that and you could not function. That wall tends to stay up most of the time and the last few years it’s become an issue in my personal life.” Nurse Jackie Engdahl said it takes a special breed to work there, “Oh, definitely, Type A personalities make good ER nurses. You have to be very aggressive…very assertive because of what you deal with. You deal with not only ill and injured people, but intoxicated people and drug-induced and psychotic people. You gotta love a good challenge and you gotta be strong enough to whip into shape when the going gets tough.”

For trauma nurse coordinator Kathy Warren, it’s a matter of staying focused no matter how horrendous the reality before her. “Some of these cases are just horrible looking when they come in. You just have to totally ignore that and focus in on the task, so whether you’re starting the IV or helping the docs with procedures, you detach yourself and just click into gear. You can’t get nervous. You have a job to do,” she said. Warren, whose job entails her dealing with family members, said staying composed is hard when working with parents who’ve just lost a child. “Sometimes I have to step back for a few minutes and take a deep breath. When I get home after a case like that, everybody knows its been a bad day as soon as I walk in.”

Added Susie Needham, “People think you get callous or something, but you don’t. Some of the things we see are heart-wrenching and no matter how many times you’ve seen them it still really bothers you. It never gets better.”

Things finally began heating up again on St. Patty’s Day once the Code 3 patient was wheeled in on a gurney by paramedics and lifted onto a bed in the T2 trauma bay. The heavy-set man of about 65 lay there in a coma, a breathing tube inserted in his throat and an IV snaked into one arm, his big hairy belly billowing up and down as a bevy of ER medical staff hovered over him to keep him alive. “I need, STAT, six units of platelets…” a nurse called out. “Tell respiratory to bring a vent, please,” called another.

Then, when someone barked, “I need another set of hands up here,” a tangle of arms belonging to eight nurses, techs and docs converged to perform, seemingly at once, multiple tasks, from hooking up a ventilator to running a blood pressure line to starting a new IV to drawing blood to attaching EKG electrodes. “Sir, there’s going to be a tube going down the back of your throat,” one of them said more out of habit than out of any expectation of a response. Lying there, totally exposed and vulnerable, his life completely in the hands of these angels of mercy, the man, referred to then only as John Doe due to a lack of ID, was an anonymous soul brought back from the very brink.

Time is of the Essence
Time is critical in trauma or near trauma scenarios like these. That night’s charge nurse, Scott Miller, said it involves quick, precise coordination and communication. “Everybody swarms in to get the job done as fast as possible. In a case like this you have Dr. Tran coordinating and everybody trying to feed information to him as to what they’re finding at the same time as they carry out his orders.”

When the whole trauma team is activated, a whole slew of specialists — from surgeons to anesthesiologists to radiologists to lab techs — converge on the spot, making teamwork even more essential. According to Kathy Warren, “You have a lot of people and everyone has a different role and, hopefully, they know their role so they’re not getting in your way and you’re not having to tell them everything. It usually works pretty well, and it’s amazing the amount of things that can be done for a patient in a short amount of time when you absolutely have to. But that’s what a trauma center is supposed to be able to do.”

 

 

 

 

Emergency care often starts with the rapid response of rescue squads on the scene. Paramedic Tom Quinlan was among those responding to the 911 call that found Doe lying unconscious. “He was not breathing. He didn’t have a pulse. So we started our CODE 99 (for clinically dead cases) protocol, which is intubate him, start an IV and do CPR. We ended up shocking him a couple of times. We finally got a pulse back and he continued to breathe for us on the way to the hospital,” he said.

Added Dr. Tran, “Time is of the essence here. After so many minutes, it doesn’t do any good, so it’s all speed and skill. The man probably experienced sudden death when his heart went into fibrillation, meaning it didn’t pump any blood and, so, the brain promptly became unconscious and he fell down and hit his head and only by actions of the paramedics did he come back. He was extremely lucky to have had everything done in that time, otherwise he would be dead by now.”

Dr. Tran said the fall resulted in “about a five-centimeter hematoma on the back of the head.” Since Doe was found unresponsive and bore a scar on his chest indicating a history of heart surgery, the question on Dr. Tran’s mind was whether the patient’s vegetative state was due to the fall or to some new cardiac event. Not wanting to overlook a potential cerebral cause, he called in part of the trauma team after all. As Scott Miller, explained, “We’re assuming now he had some sort of heart event that caused him to fall and hit his head. We will be doing a CAT Scan to make sure there’s not something else going on, like a big bleed in his head. We don’t think that’s the case, but you can’t always tell for sure.”  Later, it was confirmed a cardiac event did trigger the trauma.

As for the long-term prognosis, Dr. Tran said, “I’m not sure of the condition of his brain function later on.” By then, Doe was identified and his family contacted by nursing resource coordinator Regina Christensen, who met with family members. Part of hers dutie entails fielding inquiries from news hounds looking for material. She noted with incredulity some sound disappointed when a case is upgraded from critical to stable condition.

When treating a trauma, there is no room for bruised feelings. The required care  must be delivered NOW. Hashing out differences can come later. One of the reasons nurse Jackie Engdahl likes working in the ER is the maturity of the people working there. “When I worked in other hospital areas there were very clashing personalities and people always bickering back and forth. But here, it’s not that way. You say whatever you want to say to someone and then it’s over and done with. There’s never hard feelings.” And, she said, where some physicians resent or reject nurse input this ER’s docs welcome it. “The doctors here work really well with the nurses. The doctors trust our judgment and they really listen to us. They allow us to do a lot of things, which is nice.” What about departmental romances? “There used to be between the nurses and paramedics,” nurse Janie Vipond said. “It just depends on the group you have at any given time. But, yeah, it happens.”

I Felt I Was in Good Hands
Amid the controlled chaos of an unfolding ER trauma, staff attend to myriad details, not to mention other patients. For the trauma patient whose life hangs in the balance, it can be a surreal experience of wailing sirens, flashing lights, antiseptic smells, probing instruments, strange faces and endless questions. There is fear, confusion, agony. There is even a strange sense of peace. Beverly Harter, a 62 year-old wife, mother and grandmother, has been there. How she got there is a story in itself.

On May 16, 1999 the Logan, Iowa resident was attending a graduation party at the nearby trailer home of a daughter. Various family members and friends were present. The weather was threatening that afternoon. When the sky turned ominous and a tornado warning sounded, the 12 partiers fled the trailer for their cars in an effort to outrun the storm. But it was too late. With a twister bearing down, they left their vehicles to take refuge in a roadside ditch. Huddled on the ground, exposed to the savage winds, the group was deluged by parts of farm machinery ripped asunder in the cyclone and propelled like shrapnel. The metal shards rained down on them, tearing skin, cracking bone, crushing organs.

When it was over, Beverly’s daughter was dead and two grandkids, both injured, left motherless. Her son endured a broken clavicle. A family friend died. As for Beverly, she suffered a punctured diaphragm, a perforated bowel and two crushed vertebra. Her house was leveled. Ironically, the trailer escaped unscathed. Transported by a local rescue unit to Missouri Valley, Beverly was then taken by ambulance to the nearest trauma center, the University Hospital ER.

Beverly, who remained conscious during much of her ordeal, did not have to be told she was badly hurt. “I knew I’d suffered spinal cord damage because my legs were on fire, and they stayed on fire.” she said. She also knew her daughter “was gone” and other loved ones injured. As for her Omaha ER odyssey, she recalls “bright lights,” a sense of “time standing still” and “a lot of people doing a lot of things and asking a lot of questions. I was really hurting and kind of fading in and out from the sedation, but I was able to answer a lot of questions. They explained to me what they were doing at all times, and that was reassuring.”

Indeed, despite her pain and grief, she recalls feeling calm. “You just have a sense that everybody’s taking care of you and that they’re all working together doing their jobs. I felt I was in good hands.” She also felt the staff’s compassion. “They were extremely sensitive and caring and protective about what happened to me and my family. They knew the devastation and loss we had. I was just overcome by their concern for our well-being,” said Harter, who today is confined to a wheelchair.

Kathy Warren said she used to doubt whether the time she spent with families who suffered a loss made a difference until her own father died in the hospital and she found comfort in the support her colleagues gave her. “I realized how important it is to have somebody treat you with kindness and to let you grieve however you want to and to explain things to you. Ever since then I’ve really pushed staff here to sit down with families and to talk to them. It’s not an easy thing to do as a medical person. Some people are better than others. But people don’t expect us to be super men and women. To save everybody. They just need us to be there.”

Not all exchanges are so pleasant. Patient complaints over long waits get expressed along the sarcastic lines of, “I’m sure glad I wasn’t dying.” Before things get nasty, staff try defusing the matter. “The basic strategy is to make them see you as being on their side,” said Dr. Bob Muelleman. “On the other hand, you want to be very much in control of the situation. If it’s just a matter of them yelling and cussing at you, well, that pretty much comes with the territory. Once in a while there’s kind of a thrashing or flailing out. If you think there’s the potential of them really getting violent you can call in security or police, but normally you can handle it on your own.”

When care complaints cannot be appeased, they are passed-on, in writing, or addressed on-site by managers like Regina Christensen. “It can be anything from somebody upset that their mother’s IV is out to something as complicated as a gang-related situation where the patient himself or his family is threatening staff. It’s just an array of things,” she said.

The Truth is Stranger Than Fiction
Meanwhile, back on St. Patrick’s, a drunk middle-aged woman involved in a domestic dispute came in with an aching gut. However, the night’s triage nurse, Susie Needham, recognized bruises and marks as signs of physical violence and sexual assault. After questioning the woman, a horrific tale of prolonged torture and bondage emerged that prompted ER staff to follow procedure and report their suspicions to police. Acting on the medical staff’s input two officers, who earlier arrested the woman’s boyfriend on misdemeanor assault charges, returned to open a rape investigation.

According to Needham, “If people come in here with traumatic injuries that don’t really fit their stories, we call the police.” Often, she said, such patients prove to be victims or perpetrators of a crime. Surrounded by staff and police in a room concealed by drawn curtains, the woman cried out, “I can’t take it anymore. I don’t want to take it anymore.”

After examining the woman a visibly shaken Dr. Tran said, “It’s one of the most remarkable cases of domestic violence I’ve ever seen. She has multiple problems. Number one is domestic violence and sexual assault. Number two is chronic alcoholism. Number three is a low platelet count. Number four is what appears to be an upper GI bleed.” As part of hospital policy in such cases, staff called in a domestic violence-sexual assault counselor to apprise the woman of her rights and refer her to appropriate community resources. But, as ER staffers say they’ve seen far too many other victims do, the woman rejected police-medical entreaties to undergo a forensic exam, something required for a criminal inquiry, and declined pressing rape charges. She was admitted and treated for medical problems.

“What do you do?” a frustrated Needham asked. “That’s tough,” Dr. Tran said, “because once enough time passes, the evidence is lost. We can’t do anything. You have to respect the patient’s wishes. Patient autonomy is everything. Why did she refuse? Oh, fear, love rejection, sensitivity. Who knows? Unfortunately, it’s common.”

Bizarre, believe-it-or-not episodes are also common in the ER. Take the time an obnoxious drunk showed up with a fierce but inexplicable pain in his belly. After sleeping it off, he staggered up from his cot and only then did the ER doc notice a speck of blood, on the sheets, which upon closer inspection turned out to be from a tiny hole, splayed by burn marks, in the man’s back. Apparently, he had been shot but was too drunk to recall it. Sure enough, an x-ray revealed a bullet lodged in the abdomen.

Or, take the time a stabbing victim arrived cut entirely from stem to stern, his entire rib cage exposed, yet conscious enough to describe the whole bloody fillet job some whore performed on him. Or, the time a man fell at home on a fireplace iron and walked in the ER with a small wound on his neck which, upon further exam, proved to be a deep puncture penetrating his cervical spine. For Dr. Muelleman, who treated all these cases while working in a Kansas City, Mo. ER, such incidents fall under the heading of “the truth is stranger than fiction.”

 

 

 

 

Perhaps the most frustrating cases are those involving entirely preventable injuries, especially those incurred while victims engaged in some high-risk, reckless behavior, like a young man Dr. Muelleman treated in Omaha who crashed his car while out joy riding and ended up paralyzed from the neck down. “I don’t call them accidents anymore,” he said, “because an accident suggests an act of God. I call them injuries because when people put themselves in these circumstances something is going to happen that didn’t have to happen.”

Anybody-Anytime-Anything
As ERs are traditionally the 24-7 stop-gap or catch-all of American medical care, the entire spectrum of need shows up there. In most public hospitals, no one is turned away, regardless of insurance status or ability to pay. “The emergency department is the safety net for many people seeking care who really have no other place to go, said Dr. Paul Tran. “Admittedly, there’s going to be abuse of the resources because this is reserved for emergency cases, but who’s definition of emergency is it? A toothache at 2 a.m. may be an emergency to you, but it may not be to someone else. We are here to take care of people from all walks of life and with conditions as minor as a toothache or as serious as a heart attack. And from that standpoint, it is very satisfying to provide people the last resort they need and to get the instantaneous gratification of turning them around.”

Given its open door policy, “the ER is where you really see the cross-section of humanity and so, if there are social ills, you seem them in the ER,” Dr. Muelleman said. “Some of the ills we deal with are domestic violence, drug and alcohol issues, child abuse, lack of immunization and lack of access to health insurance. Another segment the ER picks up on are the acute psychiatric and homeless populations.” He said in an era of managed care, ERs play an increasingly large social service and public health role. “

So, if we’re dealing with intoxicated people we try to get them in a shelter or detox center. If it’s an abuse case we bring in social workers, police and protective agency professionals. If we’re dealing with domestic violence, we make sure patients understand the resources available to them.” Nurse Scott Miller is “troubled” by how many kids he treats who “are not well cared for” at home and “very frustrated by the large number of people with legitimate psychiatric problems who can’t get seen” due to a lack of psychiatric beds locally. He said, “I’ve spent many hours fighting on the phone, calling medical staff at home, to get people admitted in the hospital when they don’t really have a medical problem. But when no psychiatric place will take them, we can’t just send them home.”

Dr. Muelleman said where ERs have always tried educating patients about prevention safeguards and optional resources, “Some have gone to the extent of smoking cessation and substance abuse counseling. I’m just reviewing a grant for a hospital to screen Type II Diabetes, which is not something you’d traditionally think of as an ER doing. There is a real move toward ERs getting involved with public health, even things like bike helmet giveaways. Some have even gone as far as to give pneumonia and flu shots. Even here, during seat belt awareness week, we do educational stuff to let people know about the importance of seat belts.”

As a survey of ER web sites will attest, there is debate in the medical community over the all-encompassing role of the ER. On this subject, Dr. Muelleman takes a pragmatic position. “You can’t select why people use the ER. Once they’re here, you can’t ask, Why are you here again?, although you may be tempted to. I mean, I support the notion public health policy in America should be changed to help take care of people’s health needs in a more comprehensive fashion than just having them go to the emergency room, but given that’s not the case, the mantra in the ER continues to be — anybody, anytime, anything. That’s exactly what it is. Should we change medicine so that doesn’t happen? Well, yes, we should, but in the meantime we’ve got to do what we can to help people.”

Merciful Armies of the Night, A Ride-Along with Paramedics

June 16, 2010 1 comment

To date, the only ride along I’ve done as a journalist was for this story following paramedics.  I enjoyed the challenge of reporting and scene description the assignment presented.  It’s the type of project I do from time to time in order to push myself out of the comfort zone I sometimes get stuck in.  The story, which originally appeared in The Reader (www.thereader.com), was meant to mimic and ultimately transcend the television and film depictions of first responders. Perhaps I’ll do a ride along with police officers or detectives sometime.  A companion piece of sorts to this one is also posted on the site — a report I filed based on a few nights observing things at an ER.

 

 

 

Merciful Armies of the Night, A Ride-Along with Paramedics

©by Leo Adam Biga

Originally published in The Reader (www.thereader.com)

The Paramedics Corps
Cutting through the humid summer night, Medic 21 is a rattling five-ton metal box of thunder-on-wheels. The Omaha Fire Department (OFD) rescue squad rushes to another emergency on the near north side. Flashing red, yellow and blue lights pulsate with the same urgency as the wailing siren’s cry that help is on the way.

Two licensed paramedics are assigned Medic 21 on the C shift: Capt. John Keyser, 38, a fair-haired, well-chiseled 12-year veteran of the OFD and Kathy Bossman, 28, a pretty brunette in her third year on the force after a short stint with the Lincoln Fire Department. Partners since last October, the pair work out of a firehouse at 3454 Ames Avenue, one of nine stations in the city housing rescue squads alongside fire engine companies. Anymore, every Omaha firefighter is trained in at least basic Emergency Medical Technician (EMT) skills. Some own intermediate or EMTI ratings. Others, like Keyser and Bossman, are full-fledged paramedics with the most rigorous Advanced Life Support (ALS) training on the force. Paramedics are usually attached to rescue squads, although some serve on fire rigs.

The OFD paramedics corps numbers 147, nearly triple the total from five years ago. Omaha Fire Department Emergency Medical Services (EMS) Battalion Chief Jim Love said this planned jump in personnel came in response to an increasing workload caused by an ever-expanding city: “Last year our medic units responded to 23,558 calls for medical assistance and transported 16,400 of those people. The year before, we responded to 21,272 calls. Our calls are growing at a rate of 4 to 6 percent a year. The population is not only getting larger but it’s getting older, so we’re seeing an increase in the elderly and their associated medical problems.”

Paramedic training is intensive, entailing some 1,000 hours of classroom and field experience, including interning in clinic (hospital) settings and on ride-alongs. A more rigorous curriculum is being implemented in 2001. Omaha EMS Chief Medical Director Dr. Joseph Stothert, head trauma surgeon at NHS University Hospital, said today’s paramedics are more skilled than in the past: “They have better education and better quality assurance in place and I think generally the care in the streets is much better than it was 10-20 years ago. Not only are they able to do more, but they are able to understand more and sort out what’s going on with the patient and to begin treatment before they reach the hospital.” He said things have progressed to the point that medics follow protocols or standing orders to guide their assessment and care in the field where before they called hospitals and awaited orders via radio phone. “Through the years I think the level of confidence has increased in the paramedics because of their training,” he added.

Here I Come to Save the Day
As the gleaming ambulance barrels through traffic (most of which parts to let it past) to the scene of an emergency the vibe inside the squad is part thrilling and part somber as the laconic medics steel themselves for whatever crisis awaits them. With their hearts racing, they are like soldiers driving into a battlefield. Their reactions must be swift. Their minds sharp. As they run through routes and protocols in their head, they keep an eye out for rogue motorists and cock an ear to the radio for updates. They take seriously their role as rescuers. Theirs is a single-minded mission of mercy — responding to a frantic plea for help. It can be anything. A diabetic reaction. An asthma attack. A cardiac event. A gun-shot wound. A personal injury accident. Poisoning. Heat exhaustion. Childbirth. It can be anybody. A child. An adult. Someone hurt in a car, on the street or in their own house. It can be a cop or fellow firefighter, victim or assailant, average citizen or public figure. You name it — these professionals have seen it in the line of duty.

Medics pull 24 hour shifts and no matter when the 911 call comes in — the middle of the night or the fat of the day — and regardless of what it is — a routine health problem or a genuine medical crisis — they show up ready to lend aid. Even when driving conditions stink or the medics are starving sleep, they respond the same. There is a temptation to view them as heroic Calvary riding-in to save the day. That is not how they see themselves, however. “I certainly don’t feel like any knight in shining armor. We’ve just doing our job,” Keyser said. “I really do enjoy helping people. That’s probably the biggest reason why I chose this profession.” His partner, Bossman, added, “It’s nice to be able to help people and to be able to change their life or improve their life in some way. Every time they call us it’s an emergency to them. They appreciate us being there, and that’s a good feeling.”

The anytime-anything-anybody drama of the job is one of its major draws. Even though most runs are routine, no two are ever quite the same. “One of the most appealing things is the excitement,” Bossman said. “It’s a big adrenalin rush. When you get the blood and guts, it makes it more exciting and interesting. You know you’ve got to step it up. You’ve got to move faster. You’ve got to get more things done. You’ve got to use all your skills and training.” Said Keyser, “One of the reasons I went into this is because it’s very challenging. The sleep deprivation is hard to deal with and the stress level is very high.” That stress — of being on call all hours of the day and night to make emergency medical interventions — has a flip side too. “You can get too wrapped up in this job. If you let the pressure and stress mount, all it does is kill you a little bit at a time. That’s why I’ve always thought one aspect of being a good paramedic is recognizing when you need to get away from it,” Battalion Chief Love said. Field medics like Keyser know the demands can overtake them if not careful. “I’ve got at least another 12 years on the job, but I don’t want to be on the rescue squad that long because I don’t want to get burned-out. After a 5-day rotation, I’m exhausted. I have a wife and three kids I want to enjoy,” he said.

On the Run
Medic 21 is among the two busiest EMS units in Omaha. It annually vies with Medic 40, at 45th and Military Avenue, for the title of most runs. The unit is responsible for a wide swath of Omaha — from Bedford Avenue north and from the Missouri River to 72nd Street west. Given that Medic 21 serves a low income area, some residents rely on the EMS system as a mobile clinic and taxi service. “In our territory we seem to have a lot of patients who don’t have transportation to the hospital, so they call 911 even if they have the flu. You treat them the same even though you’re frustrated because it’s 3 in the morning and you’ve seen this patient before and you know there’s nothing seriously wrong with them,” Bossman said. “We tend to see a lot of really young mothers who don’t know much about caring for their kids. We try to educate them a little.” Then there are the repeat customers. “We’ve got quite a few regulars. Most have legitimate medical conditions, but some don’t necessarily take care of themselves very well. They don’t take their medicines like they should and that can worsen their condition.”

Jim Love was a firefighter-paramedic on the streets before taking a desk job. He worked out of Station 21 and said his field experiences there opened his eyes to some things. “I didn’t realize the abject poverty that exists in certain parts of our city until I actively went there, walked into these places, took care of these people and transported them to the hospital,” he said. “I mean, I’d seen poverty on TV and read about it in the newspaper, but until you actually touch it and work with it, you really can’t imagine. For lots of people, we’re their source of medical care. They don’t go to doctors.”

With 3,113 runs made last year by its three crews, Medic 21 is the reigning champ among Omaha EMS units. Through August Keyser and Bossman are averaging 9 runs per 24-hour shift and are 50 ahead of last year’s pace, but on this day (August 10) they are still awaiting their first more than half-way through their shift. “This is highly unusual,” Bossman said. “That’s the thing about this job. A lot of times you’re waiting for something to happen and other times you leave the station and then don’t get back for six hours,” said Keyser. No sooner do the words leave his mouth than an alarm sounds on the overhead speaker alerting personnel to a rescue call. Keyser and Bossman clamber aboard the squad, fire up its engine, roll out of the garage and tear onto rush hour-choked Ames Avenue. With Keyser manning the wheel and Bossman the radio, a 911 dispatcher relays the nature of the call. “Medic Unit 21, there’s a 90 year-female with difficulty breathing…a neighbor became concerned when she didn’t her from her…called police…the female was found on the floor…apparently fallen…police are on the scene.”

Lady in Distress
Less than 10 minutes elapse from the time the call is received to the medics’ arrival on the scene. It is a red brick apartment house at 52nd and Northwest Street. Police cruisers and a fire engine are already there. Curious neighbors and onlookers gather on the small porch or watch from the street corner as Keyser and Bossman stride into the residence carrying an arsenal of emergency medical supplies, including a portable heart monitor/defibrillator and a case filled with meds, IVs, airway supports, bandages, slings, etc.

Police deny access to a reporter along for the ride, citing the tight quarters. The officer guarding the front door, Juan Fortier, describes the situation while Keyser and Bossman treat the elderly patient inside. “A friend hadn’t heard from the resident since Tuesday night at 8. She came by, hollered for her and got no response. She tried entering, but the inside chain was locked. So she called us. We came, we assessed the situation, notified our supervisors what we had and we decided to go ahead and force the lock open. We got inside and the 90 year-old resident was lying on her back on the floor next to her bed with one leg kind of folded up under her. She was still conscious but somewhat discombobulated. She had obviously been there awhile. We just tried to comfort her with our voice and let her know help was here,” he said. Police and rescue squads respond to several such calls each week. Most turn out fine.

Minutes later, firefighters hustle to fetch a backboard and gurney and soon are carrying the patient out on the stretcher, a bag valve mask applied to her mouth, and secure her in place on the squad. With the patient, Olive, designated a CODE 3 (critical condition) Keyser and Bossman tend to her in back while a firefighter takes the wheel. It turns out Olive lives alone and has no family in state. The only prescribed medication found is for some unknown cardiac condition. In cases like this, when a patient cannot provide answers and there is no family member to consult, medics lack basic information to complete a patient history.

Teamwork
“A big part of our job is information gathering,” Keyser said. “Our first job is to assess the patient and determine if there’s a life threatening situation. Then, the most important thing is to find out the history of what brought this person to require our care. We try to get as much of the history as we can for the doctors.”

 

 

 

 

Firefighters often reach a scene first and provide care up to their level of training. Once medics arrive to take over, firefighters remain to assist — providing extra sets of hands and eyes. This team concept is at the heart of EMS. “Most of us have worked together for a long time and everybody knows what needs to be done,” Keyser said. “Firefighters will get a stretcher or set-up an IV or get oxygen going. If we don’t see it being done, we’ll ask for it.” Bossman added, “The firefighters we work with are real good about helping out. They’ll jump in and do whatever needs to be done.” Love said having EMT-qualified firefighters on-site is essential to the continuum of care that extends from pre-hospital settings to the ER. “The important thing about having EMTs on the fire trucks is that not only do they get there quickly, but they take base-line vitals which give the paramedics something to compare with when they take their vitals. It gives us another indication as to whether the patient is getting better, getting worse or staying the same.”

In critical or trauma scenarios, time is everything. “We’re always racing the clock,” Love said. “Our goal is to get somebody to the patient’s side with at least basic level training within 5 minutes and to get someone there with advanced training within 8 to 11 minutes. We try to reach those goals at least 90 percent of the time.” According to Keyser, “Depending on how critically injured that patient is, their best survivability is if they can be treated in the ER within an hour of their injury. It’s called the Golden Hour. We try to get everything done we can in 10 minutes before the patient is loaded on the squad and we’re on the road to the nearest trauma center. We’ll do everything else en route.”

In Dr. Joseph Stothert’s view, “For about 90 percent of the patients paramedics see, their care is absolutely vital and life-saving, including persons in or near cardiac arrest and persons involved in (serious) motor vehicle accidents. Now that there is a defibrillator on every fire and rescue apparatus, there’s been a steady increase of patients we’ve been able to resuscitate earlier.”

With Olive in tow, Medic 21 speeds to the nearest hospital, Immanuel Medical Center, as Keyser radios her condition: “We’ve got a 90-year-old female who has been down apparently since…” During the bump-and-grind ride Olive is dimly conscious. She cannot speak, responding to questions with only her tired eyes or feeble nods of her head. “Can you point for me where it hurts?” Keyser asks. “Olive? Olive, we’re going to give you some nitro on your tongue. Your lungs are full of water. I want you to lift your tongue up for me. There you go. Good girl. Here it comes. Open wide.” Olive weakly responds. Her mottled face is splayed by vomit and pinched in pain. Her eyes close. She is barefoot. Totally vulnerable. Her vital signs are continually taken and any abrupt changes noted. All the while, Bossman comforts Olive by holding her hand and applying pressure to a bag valve mask over her mouth, timing her squeezes in concert with the patient’s inhalation.

“For the short amount of time you’re with patients you just want to try to do something positive. Sometimes, that’s nothing more than holding their hand and talking to them while you’re riding to the hospital,” Love said.

Keyser tries getting Olive to respond again (“Olive, we’re going to help breathe for you, okay? Olive, can you open your eyes again?”), but she has fallen unconscious. The medics scramble to intubate her with a breathing tube and suction out excess fluid clogging her airway. Amid the cramped space the medics handle equipment and perform procedures in a kind of choreographed dance. They anticipate each other’s moves well. Few words need to be spoken. They work with calm precision and dispatch, forming what Love likes to call “a fine-tuned patient care machine.”

Later, after delivering Olive to the ER, Bossman recaps the run. “She had fallen out of her bed and was on the floor since Tuesday night. She was already dehydrated. She’d been vomiting and had it in her mouth and in her lungs. That caused her to choke and quit breathing. It could have been real bad. If her neighbor hadn’t checked on her and called the police she could have choked to death. She got a little bit worse en route. She quit responding, although her vital signs stayed pretty good. We intubated her to clear her airway. She’s actually pretty stable now. Her airway’s secure. She’s getting plenty of oxygen. They’re going to x-ray her to make sure she didn’t injure her back when she fell.”

Breathing difficulty is a call medics often respond to and make a life-saving difference in. “Outside of critical emergencies, the assessment and treatment of airway problems is where they tend to help people the most, such as people with asthma or people with chronic airway diseases,” Dr. Stothert said. Medics also routinely help diabetic reactive patients make dramatic turnarounds.

Heeding the Call Again
After its crew restocks supplies and completes paperwork in the ER, Medic 21 no sooner pulls out of Immanuel when a new call presses them back into service. It is a  new mother seized by severe back pain. The squad heads east and in no time at all reaches the wood frame residence near 46th and Bedford, where a fire engine crew is present. The petite patient, Sandy Dace, sits in a kitchen chair doubled-over in a spasm of pain. Her tall bearded husband Dennis stands over her, holding their red and wrinkled 5-day old baby boy in his arms. At the bottom of a staircase a boy of perhaps 8 peers with wide-eyed wonder and fear at the rescuers tramping in and out. It turns out Sandy underwent a prolonged labor marked by acute contractions, before a Caesarean section was performed. It is thought her pain is related to the childbirth.

“I got up to go to the bathroom when I heard Sandy crying. I found her just like that. She couldn’t get up. And with him (the baby) here, I had to call somebody. It was maybe 40 seconds before I heard the sirens. It was great when you showed up. You guys are excellent,” Dennis tells the medics. As he follows his wife to the door, he says, “I’ll be up at St. Joe’s as soon as your mom gets here. Okay, dear?” “Okay,” she replies through clenched teeth.

En route to St. Joseph Hospital Sandy grimaces with each jolt during the shake-rattle-and-roll run. She tightly clutches the handles at the side of the gurney to brace herself. “It’s kind of a bumpy ride, so we’ll take it easy on the way there,” Bossman tells her, but while the ride proceeds at a slower than normal pace it is just as jarring as ever. Dace remains stoic, only uttering a sound when answering Bossman, who tries taking her mind off her discomfort with easy chatter.

Built on an unforgiving truck frame, rescue squads are notoriously noisy clatter-traps that ride like bucking broncos. Many have been in service for a decade or more. It is not unusual for odometers to read 100,000 plus-miles. And those are hard, stop-and-go miles. Units often break down with a wide array of mechanical problems, forcing even older, less reliable reserve units into service. “Our rescue squads are on their last legs,” is how one paramedic put it. With so much wear-and-tear, it is no surprise then that perhaps the number one complaint by customers is that “the ride is terrible,” said Love. Squads are nicknamed “puke boxes.” Three brand new units were purchased recently (for $117,000 each) and their increased size and smoother ride makes medics stuck with older models rather envious.

 

 

 

 

The squad transports Sandy Dace to the ER just before 7 p.m. and by the time Keyser brings the empty gurney back out, a LifeNet helicopter lands to stretcher-in a middle-aged patient critically injured in an industrial accident. As for Dace, she is logged in as a CODE 1, which signifies no real medical emergency and no treatment performed in the field. She simply gets a check-up in the ER.

Stories from the Frontlines
On the way back to the station, the medics make a fuel stop at a City of Omaha depot where broken-down cruisers, squads, rigs and plows are warehoused for repairs and spare parts in what is known as “the boneyards.” Life at “21s” or any firehouse is a communal thing. Except for captains, who rate their own rooms, everyone, men and women, share spartan dormitory-style sleeping quarters. It is a high testosterone environment. We’re talking big men wielding axes and saws and handling mammoth rigs.

As the lone female (one of 20 among 600-plus fire division field personnel) Bossman is still something of a curiosity. While a Clint Eastwood pic plays on a big screen TV in the rec room, she explains how it takes a certain kind of woman to thrive there. “If you’re the type who gets real upset at a crude joke, you’re not going to last very long. You can’t be overly sensitive to those things. You just have to go with the flow.” She said when she started she was subject to a “feeling out” process that closely scrutinized her ability to handle the job and to be, “one of the boys,” in effect. “Once they saw I was okay with their cracks and I could pull my own weight, then there was no problem.”

Down time is variously spent doing paperwork (a detailed record of every run must be logged in a book and on the computer), washing down or cleaning out rigs, rapping with the guys, grabbing a bite to eat, zoning out in front of the TV or catching some Zs. When a visitor asks Keyser, Bossman and Love to share some stories from the frontlines, they gladly oblige. Like other EMS professionals, they say the toughest cases usually involve children.

“I remember the first SIDS (Sudden Infant Death Syndrome) case I ever went on. At the time I was an EMTI with a little baby of my own, so it really kind of hit me hard,” Keyser said. Bossman recalls a CODE 99 (CPR in progress) case. “What was thought to have been a SIDS baby was revived but it never regained consciousness. It later turned out to be a shaken baby. That had an impact on me because in the ER I was comforting the mother and father and, later, when I found out it was (allegedly) the parents that had done this to the baby, it really bothered me,” she said.

Suicide runs are hard to forget. “You go there and, of course, there’s nothing you can do. You call the police and while you’re waiting you see pictures on the wall of family and friends. It hits home that this was a human being that had a life. It gets you thinking, What got them to the point they felt they had to do what they did? Those are the ones that really stick with me.” Love said.

Bossman said a disturbing run she and Keyser made was to the residence of a man with critical pulmonary edema. “It appeared to be treatable when we first got there,” she said. “At his house he was talking to us, but then he went downhill real fast in the squad. And at the hospital, despite everyone’s best efforts, he died. Sometimes, despite a perfect treatment, the patient may still not make it. It can change at any time. That affects you because you see this person getting worse and worse, and you want to help them, but you can’t…Over time, I guess you just learn that regardless of what you do the outcome is sometimes out of your control. It’s kind of hard.”

“Bad runs” of this sort often prompt a Critical Incident Stress Debriefing or CISD, an informal talk therapy session for every EMS staffer at the scene. The fire division’s chaplain, Rev.. Chuck Swanson, leads the sessions. Select cases are also chosen for run reviews, where crews and supervisors analyze what went right and wrong.

Ready for Anything
At 8:50 that August night, the crew’s brief R & R respite is interrupted by another call. A young woman has dislocated a shoulder fending off an assailant near 24th and Camden Avenue. She screams in agony, “Oh my God. It hurts. Oh my God.” The police are there sorting out the incident. “They’re are always a welcome sight to us,” Keyser said. The patient, tears streaking her face, screams all the way to Immanuel. This is the first in a series of four straight runs Keyser and Bossman make that evening. Next, it is a young asthmatic, Reggie, with difficulty breathing. He’s tried his inhaler, but it’s brought no relief.

The medics arrive at his house and find a scared little boy struggling for breath. They administer Albuterol with oxygen. He breathes easier but a trip to the ER is advisable. Aboard the squad an IV is started. The medics calm the boy down, assuring him how brave he is. Calming kids is “half the battle,” say the medics. When Keyser asks “Have you ever ridden in an ambulance before?” Reggie replies, “Yeah,” and reminds them they treated him once before — for bruised ribs. On the way to Immanuel a much-improved Reggie points out the rear squad window, shouting, “There’s my mom,” waving to her following closely behind in the family van. Upon arrival at the ER a relieved Reggie announces, “I can actually talk now.”

The last two runs are routine. A woman complains of a host of problems, including difficulty breathing. She is quickly stabilized with oxygen, yet continues acting distressed. Her husband explains, “She gets like this when she’s upset.” It seems the couple had been arguing. The patient declines a trip to the ER. Later, Keyser attributes her symptoms to anxiety, which he said can mimic many medical conditions. Then it’s off to an assault call only two blocks from the Medic 21 home base. Police surround the victim lying in the middle of Ames Avenue. The intoxicated man has been beaten about the face by two or three assailants and has  suffered cuts and bruises. Keyser and Bossman dress his wounds and take him to University Hospital. He smells of alcohol, sweat and blood.

By the end of the run it is around midnight and the medics are ready for a break. “When you’re super busy or you’re up many times over the course of the night you’re sleep deprived,” Bossman said, “and that just makes your reaction time slower. You have to think longer and harder about decisions that during the day might come real quick. That’s when it’s helpful to have a good partner. You work together and figure things out.” When a call awakens crews from a sound night’s sleep it is not uncommon, Keyser said, for hazy mates to slam into doors or each other amid the darkness and the mad dash that ensues to reach a rig or squad.

The wee hours find medics intersecting a surreal scene of crowds hanging out in parking lots or cruising the jammed streets. “It’s a different world down here at night,” Keyser said. “Once, we saw a family pushing a baby in a stroller at 2:30 in the morning.” Added Bossman, “It’s odd. There’s bumper-to-bumper traffic. We somewhat gauge how busy our night is going to be by how many people are out.” At time like these the intrepid medics are urban explorers in search of their next adventure. “It’s always something different,” she said. “Part of being a professional is being ready for anything.”

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