As an EMT on a Seattle ambulance, I was deployed to and recently returned from Newark, NJ to assist with EMS relief response amid the peak of Covid19.

Sitting in the ambulance in Newark is a funny thing for so many reasons. First, I’m so new to town I hardly know how to pronounce the name of the place. It’s sounds like “Nork,” by the way. And coming from Seattle by way of North Carolina and southern Ohio, understanding how to hear correctly through the thick Jersey accents of both our dispatchers and our patients presented me with my first steep learning curve. Secondly, the person sitting next to me in the ambulance is a total stranger. As far as I know, the only thing we have in common is that we both signed up for this deployment. His name is Mark, he’s a father of two from Syracuse, and he’s a paramedic. But as emergency medical professionals, we’re used to sitting in close quarters with strangers for work, and within minutes our small talk has turned into true conversation. And again, like true first responders, we exchange with candor while keeping one ear open for the radio.

Working on an ambulance, you never know how long you might be sitting with your partner- it passes the time to get to know each other, and as an extrovert, I find meaningful conversation more fun than silence usually. Lucky for me, Mark is similar. No matter who is sitting where, or whatever silence or music or small talk fills the front cab of the rig in downtime, it’s a special bond that builds quickly around the agreement that as soon as the radio crackles your rig number over the waves and delivers an emergency with your name on it, the most important sounds to follow are the clicks of seatbelts and sirens wails, turn-by-turn directions to get wherever it is we’re going next together.

I’ve been an EMT for a year. My one year anniversary came halfway through my deployment in NJ. The ambulance I work on in Seattle is “BLS” which stands for Basic Life Support, and is full of two EMTs at all times. We don’t ride with paramedics- we call them when we need them. We’re also rarely first on scene to an emergency, because the fire department arrives and is the first to triage patients before calling us or calling medics. While I’ve seen harrowing things in my work, even as a newbie, I don’t witness a whole lot of trauma (gunshot wounds, stabbings, severe car accidents, etc.). I see a lot of overdoses, folks feeling like they want to end their lives, abdominal pain, stroke symptoms, and chest pain, but even there, encountering death is not a norm. Not that I haven’t tried to mentally prepare- part of me trying to be the best at my job means trying to be ready for the worst. But it just hasn’t come up.

Things are different in Newark. Even on a normal day without the virus, Newark 911 calls are full of gunshot wounds, stabbings, assaults, and other violent trauma. Add the exponentially increasing covid related calls, and the system is quickly overloaded. Many of us in the medical field have been reading the first hand accounts coming out of NYC from nurses, paramedics, dispatchers all saying the same thing: it’s a damn mess, and people are dying. Newark is second only to New York City in Covid19 related deaths. You’re living under a rock if you haven’t seen the terrifying photos of the mass graves created to bury the unidentified Covid19 victims coming out of New York City, so I knew it was going to be a very different life in the ambulance than what I’ve been used to.

The reality I found for myself is that there are two common types of calls dispatched over the radio in northeastern New Jersey right now: one is cardiac arrest, and the other is breathing problems. Mark and I, mid-chat in the ambulance, pause briefly as the radio clicks to life, waiting to hear if it’s us who get dispatched. When we don’t hear our rig number, but before we take the seamless dive back into conversation, we wait to catch the call details…short, sweet, and to the point, dispatchers always deliver.

Call details can vary wildly from call to call: “abdominal pain,” “altered mental status,” “birth in progress,” “unconscious patient,” “overdose,” or “chest pain.” With each phrase we paint pictures in our own minds of what the scene might present. I thought about how differently each one of those calls would look for me now, riding alongside a paramedic with years more training and skills than I have. One thing every EMT or paramedic knows for sure: there’s nothing for sure about what you’re going to walk into when answering a 911 call. But with just the sliver of detail you get over the radio, it is nothing short of exciting to try and guess before you get there. Part of comparing notes after every call is measuring up how close or far your estimates were from the reality.

It’s a special and adapted skill in cultivating conversation that can relax and flow around the needs of driving lights and sirens to a call, or remembering a topic to be picked back up after the patient has been delivered to the hospital. Trust between partners shows its stripes in the quiet seconds when care has been transferred: the patient is in the hospital, the ambulance has been cleaned, and both of us are sitting in the front seat reflecting, readying for the next one. It’s in these quiet moments that all of the feelings about the last call or the next one lurk, floating, available for dissection or disassociation. It depends completely on the partner dynamic which direction it goes.

Mark and I had a level of comfortable, intentional, and kind rapport within a few hours of working together. Because I don’t have much experience in a working relationship with paramedics, I spent the first chunk of our shift picking his brain, trying to get a feel of how to anticipate being the most efficient on scene using our skills together, and to get a picture of what his patients have looked like here so far. Mark was part of the Task Force One deployment- the first wave of FEMA first responders to arrive in the northeast, and the group of professionals who bore the brunt of facing the true horrors of the overloaded 911 systems alongside their local community first responders who were struggling for weeks prior to our arrival. Hours-long wait times for patients calling 911, running call after call with almost no time to rest in between, and the familiar and repetitive call detail of “breathing problems” or “cardiac arrest” echoing from every radio.

Mark was tired. He had been in Newark for an entire week prior to my deployment. He had been working back to back 24 hour shifts with only 12 hours off in between until my deployment arrived. Me joining him on the ambulance meant that all the folks working day and night shift on our rig could, as a group, move to 12 hour shifts. A relief, to say the very least. Mark and I got paired up on day shift- our night half met us at shift change to swap radios and a few stories. And every day, for the next 6 days, I sat with Mark for 12 hours at a time in a travelling box, answering call after call together.

The first day was busy. We ran between 8 and 10 calls. Answering a dispatch for our first call that day, detailed to us over the radio as “cardiac arrest,” I saw my first dead body in the field. I learned how to place the electronic sensors (“leads”) on the torso of the body to get an accurate heart rhythm reading so that he could make a death pronouncement. This was our first of the day, but he said he had pronounced over 20 deaths since arriving to Newark just a week ago. We were dispatched to two more “cardiac arrests” that day, and made two more death pronouncements upon arrival. Most of our pronouncements were for people who died alone. One, though, was for an elderly man who died while in the care of his family, who called 911 when he wouldn’t wake up. In full mask, gown, face shield, and gloved attire, I stood in their living room feeling my breath condense, beading along my upper lip while holding the heavy cardiac monitor as it printed out the flat line of his non-existent heart beat. A piece of paper in memoriam, requested by the family. “I’m so sorry for your loss,” I said. “What was his name?” I asked, tensing regretfully; wishing in half an instant that I had waited a little longer to use the past tense. How odd that I knew he was dead before I knew his name. I couldn’t believe my own body, saying and doing these things just one day into deployment. I was in another world.

Sitting in the ambulance afterward, in those precious moments between the past call and the future call, the treasured debrief time, Mark warned me it would be a grim week ahead. He confirmed my worst fear, that most of the calls he responds to look like that one. There’s no way for us to know if Covid19 killed that man, but his daughter said she had tested positive and recovered recently, tried to do her best to protect her father but as she was one of his two only caretakers, the most she could do was wear a mask and continue caring for him. The assumption hearing “cardiac arrest” over the radio now was an impending and almost certain D.O.A.

I became grateful for any call that wasn’t a cardiac arrest, but calls of “breathing problems” took us deeper into homes full of anxious people worried they were sick, or sick people worried they were dying. People feeling like their breath is just out of reach, “can’t quite catch it.” For stable patients, our treatment was to encourage folks to stay home. If their symptoms worsened, we advised them to call 911 and we’d come back. Otherwise we’d explain that, due to their risk of contagion, it’s more dangerous to take them into the hospital and risk infecting others if they could just as safely stay home. I kept my fingers crossed leaving each of those homes, hoping they’d call us before it was too late as it continued to look as though the sweet spot between ‘not sick enough to transport’ and ‘dead’ was getting smaller and smaller.

We’d talk this topic to ragged ends in the ambulance together, Mark and I, wrestling endlessly with the shrugging conclusion that there wasn’t much else to do. Taking someone who’s not urgently sick to the hospital is a strain on resources, puts them at risk, and isn’t medically necessary. But the amount of people dying outside of the hospital from cardiac arrest and breathing problems before we could even get there is an equally hopeless quandary. Shrug, we’d say. It’s fascinating coming to terms with feeling so desperately sad about this momentous and uncontrollable thing, this virus, and to do it all so quickly in front of someone I hardly know.

The second day, and the third, was the same. More death, more of looking into unfamiliar, frozen faces, staring distantly and in calm surprise. There is something so intimate about placing leads on the body of a dead person. As a care provider, I always try to obtain consent before touching my patient, or engaging with them in general. To touch a body without introduction, without permission, felt too uncomfortable. I remember introducing myself to the first dead patient I encountered on deployment. I knew he wouldn’t say anything back, but I introduced myself anyway. I explained everything I was doing before I did it, knowing he couldn’t hear me, knowing there was no opinion. I said my knee-jerk midwestern “‘Ope, ‘scuse me” when I awkwardly fumbled with one of the wires. There’s so much humanity in each of us- alive, dead, in the middle of dying, or coping with the result of it around us, and it ought to be treated with dignity. It felt silly in the moment; I listened to myself talking to this dead man and thought “wow Jourdi you’re really in it now,” but it wasn’t silly. It was my aliveness showing.

“SEVENTEEN FOURTEEN ALPHA” crackled out of the radio, calling us. I brought the radio up to my face, and looked into the holes of the plastic where the updates on life and death comes out. “SEVENTEEN FOURTEEN ALPHA” I responded to dispatch, letting them know Mark and I were listening, ready for our next assignment. The brief description of the incoming call came in over the radio. I pulled the ambulance up to the edge of parking lot, flipped on the flashing lights and whooped the sirens as the address patched through, and Mark and I sighed “breathing problems” in unison as we roll out to answer the call.

It was a practiced dance now, the PPE ballet. Our box of gowns and gloves sit next to each other in between our seats. My 3-day-old reused N95 stays tucked in a paper bag, wedged far in front of the steering wheel between the dashboard and windshield. My face shield is an awkward bendy bundle of plastic that never did fit comfortably anywhere in the ambulance, so I was always searching for it. And pulling up on scene, we do the same choreographed movements, every single time, together. After we announce our arrival on the radio, we begin doing multiple things at once: we look around for 2.5 seconds as we put our N95s and eye protection on, and take in the vibe of the apartment building, house, business, or street corner we’re about to enter. We open the doors of the ambulance and hop out while unwrapping our disposable gowns that billow frustratingly in the breeze, turning to stand into the wind so the gown pulls itself around and is easier to tie behind.

Putting on an increasing amount of personal protective equipment (PPE) has drawn out the time required on scene before making patient contact. As helpful as it is in keep us, as first responders, safe, this is especially uncomfortable when the patient is really close by, maybe an overdose patient on the ground surrounded by people who are watching us. I stand a couple feet away, taking what feels like an eternity tying on a goddamn glorified apron as the patient lies there unresponsive, life in waiting. It’s excruciating, to say the very least. Gloves are the last to apply; we grab the cardiac monitor, airway bag, and meds bag, and with a double beep behind me, I lock the ambulance as we walk on scene together.