I’ve been inspired to return to writing since my trip to Newark. My time on deployment exploded so many new sections of my brain that writing, at other brain-bending times, has always helped in narrating. Writing my thoughts as I discover them is a way to reflect and process, to put words to places in myself that I’m surprised to be meeting for the first time. This blog has become a way to both heal from what I’ve seen in Newark (and in life), and take folks on the adventure of both the rough ride and and the emotional debrief with me. It’s nice for me…the reminder that I’m not alone is a balm.

I’m learning that work life in the field of emergency services requires ongoing emotional maintenance. It’s not like I didn’t wonder before I started as an EMT a year ago…I knew it would be hard. And I don’t just mean finding self care in a good meal, a solid chat with a friend, or a relaxing bath. I mean every single one of us in this work probably needs a hard cry once a week, at least. It’s an essential part of the job that is in most places entirely under-supported with little to no training, infrastructure, or accommodation. Folks in this profession are exposed to a jaw-dropping array of horrifying situations. From the devastating physical impacts of poverty and addiction, to the under-attended bodies and hearts of elders in packed nursing facilities, to the psychotic episodes wreaking havoc on what once were calm and tender minds; treating the physical trauma of an accident while easing the emotional stress of witnesses- first responders see it all. We see it multiple times a day, day after day, month after month, and try to sleep and build full lives in between.

But it took leaving on deployment and coming back transformed by the dramatic impact of Covid19 to really understand how easily folks in this field get isolated, with or without a pandemic. It is absolutely essential for mental health and emotional stress injuries to be an ongoing part of conversation in the field of EMS. I am a member of the Peer Support Team at my local office to support fellow EMTs process work-based trauma. I have been humbled at needing to rely on the services I usually offer at work. Because as happy as I am to be back in Seattle, to sink into my own bed and grasp on to what small sense of normalcy remains in my house in the midst of this pandemic, I feel ongoing waves of loneliness.

It turns out there is loneliness even in coming home. It was a relief, to say the least, to literally fly from the grip of the virus working hard to squeeze the life out of New York and New Jersey. But in leaving that experience, I was also ‘leaving behind’ almost all of the people who knew anything about what it was like to be there. All the solidarity shared amid dark and coping humor, the understanding that lay in the stretched out quiet spaces between sentences over lunch among strangers. I was known for things on deployment that no-one knew me for back home…being a sound and sprawled out sleeper in the break room, being ‘from Seattle,’ being somebody that helped to save a baby. Who was this new woman I was becoming? Nobody back home knew yet, and in coming home it felt hard to reconcile being both versions; I noticed loneliness in losing that newborn 8-day old bit of myself with no-one here to recognize it. I can’t tell if this sounds dramatic, it’s just what feels right trying to describe it.

My local office provided a deployment “debrief” this week: those of us deployed and who wanted to participate got together with trained peers and a professional mental health counselor to share space around our feelings from working on Covid19 FEMA front lines. I had mixed feelings when I initially heard about the debrief. I felt doubt- what does it matter how FEMA deployment felt, it’s over now, next question. I also felt anxious, because what if I was the only one with feelings? After all, I have been back a few weeks now, worked a full pay period of my normal shift already, and am sleeping well in between. My friends and family have been checking on me, I’m eating well, and talking about my time in Newark. I have told my closest ones all the ways it was sad and hard for me to touch dead bodies, to get goosebumps all over every time I retell the baby call story. I’m fine, okay?

But in this debrief I sat in a wide circle, six feet between us all, and made eye contact for the first time since coming home from deployment with the very same faces I traveled with and worked alongside in Newark. And as soon as I sat down in the circle, I felt at home. That 8-day old bit of myself was still here after all! I was instantaneously, magnetically drawn back towards the feelings that I didn’t realize had been slowly floating away; pushed by the ever-moving present, and pulled by my own stubborn internal urges to “get over it.” I was surprised to find myself in tears only a few sentences in to my share. I felt embarrassed, grateful to be wearing a mask. I had to convince my own brain every few seconds that it was not just okay to cry about this, but that it was in fact a sign of healthy and strong growth. How odd that I don’t feel entitled to my own grief, even when it is so clear that not only can I have it and show it, but I can share it and let it go.

I came home to Seattle 3 weeks ago from deployment. Sitting in the circle with a few folks who knew where we’d come from helped me return home to myself again and again, deeper with every story they heard and offered. I didn’t realize how many parts of me were floating in between Newark and Seattle, trying to find their place in this mess. So many snippets of jokes, furrowed brows, desperate calls and scenes, sleepy faces, and deep breaths were waiting to be remembered. So much sadness still waiting to move through.

Grief is endless in this line of work, because it is endless in this world. Suffering is constant, pain is ongoing. I don’t think it is pessimistic to acknowledge this as a reality, and I’m not denying the benign beauty that exists alongside it. Peace and pain aren’t mutually exclusive, and I have hope we can change the systems that continue to traumatize people, that continue to create emergencies. But as I think a lot about how my job fits into that level of work, I continue to return to the reality that has become so clear since coming home: there is solace in community. Connection is a balm. Being seen, being recognized, being honored for just being alive, is the most precious gift we can give one another. Honoring our own human pace is an important place to start, and I am committed to respecting my mental health as part of this journey.

Coming home from Newark has reminded me that there is so much room for our mental and emotional health in this field, as long as we demand it. But it is hard to ask for something if you don’t know what it looks like. I have had to trust myself in so many new ways since starting this job…trust that if something feels wrong on scene, it’s because something is probably wrong. If something feels sad, sticky, confused, dark, old, spiky, smelly inside my heart or mind, it’s probably because there’s something like that hanging out in there. If I’m not sure, it’s become a proven great idea to find someone I trust and try to air it out. That process in and of itself requires an immense amount of trust in myself, and a significant amount of vulnerability in exposing my feelings. Gah! But most times, when I do lean in and ask for someone to listen to my for a minute, I hear myself halfway through retelling a truly horrible scene before I realize “Oh wow, no wonder you feel like garbage, Jourdi, you just worked an awful call.”

Coming home from Newark has allowed a new coming home to myself. I have made some inseparable new friendships as a result. I am grateful to the folks in Newark who held my hand while I wept and cussed. I am grateful to the long conversations in the ambulance with my medic partner, trying to reconcile the world with our feelings. I am grateful for the folks here at home so dedicated to centering mental and emotional health at work. I am grateful to myself, growing more ready to share the messy bits even when it makes me feel dumb.

I’ve been talking to a Critical Incident Stress Management (CISM) team member, and am using all the tools I’ve assembled in my young adulthood with peer counseling to get weekly chances to share my feelings and be heard. I’m sleeping well, using sleep meditation apps and binaural atmospheric sounds to help fall (and stay) asleep. I’m eating regularly thanks to big meals with my home-mates. I’m consciously and intentionally drinking less alcohol to try to clarify my feelings and not numb them.

I’m also eating Oreos. And chips. Sometimes I feel guilty for “wasting” a whole day off because I’m sitting on my couch, too unmotivatied to move, scrolling Instagram and staring off. I make a to-do list and only get one item down before giving up on it. I’m short-tempered, easily irritated by my gentle, tender, amazing partner. I fight waves of seemingly senseless rage? I wake up exhausted, feel sluggish all day at work, and am forgetful. This is all because I’m still a human being, and my feelings from the past month are lingering and moving around and evolving. This is how I’ve come to deeply understand that the emotional labor of EMS is an ongoing commitment- the trauma from one call only builds on top of the trauma from the last one. Unless we are constantly cleaning house (and even then), we will get buried.

Writing this, I feel tired and excited. I have had big funny warm moments in between my grouchy surges. I am laughing a lot. I don’t feel alone. But I know there will be more days when I do, and I am so grateful to have a new set of memories built on top of deployment. In coming home, I can reflect on being seen for the new combination of me: sitting in a circle with familiar faces, nodding together in solidarity from experiences I never imagined ever having. I am new and old at the same time; settling into the round and growing group of folks around me, satisfied with simply being together, alive.

This is a story within a story, an excerpt of experience that happened to occur on deployment in Newark, NJ in the height of the Covid19 pandemic.

“Whats the craziest call you’ve ever had?”

It’s the question. As soon as someone learns what I do for a living, that I work on an ambulance (and in a big city to boot), this question tumbles effortlessly out of almost every eager and curious face in the conversation. And for good reason, I guess: every first responder does indeed have at least one call they’ll remember forever, for better or worse. Even among us as professionals, it’s a type of get-to-know-each-other conversation starter: what’s the wildest call you’ve ever had? It hits different, knowing the person you’re talking to has also had their share of wild calls. When a civilian asks the question, it’s hard to tell what they really want.

Do they want the gore or the disgusting, the emotional depth, or the excitement? Do they want a story about lights and sirens and driving fast, the thrill of moving oncoming traffic out of the way, or do they want raw human connection- the kind that only happens in the heat of an emergency? Are they looking for entertainment, or do they have space to hear about a potentially traumatizing personal experience?

When I learned I was to be deployed for Covid19, one of eight EMTs from our local office heading to Newark, NJ to provide relief to first responders there, I was sure that the deployment itself would be my story. You know, the one I’d never forget- “the deployment” as a blanket and arching experience is what I’d tell people when they asked me about the craziest thing I’d ever seen from the seat of an ambulance. What I didn’t understand then, and that I know quite clearly now, is that the deployment itself would be full of stories. With coronavirus as a terrifying backdrop, I would still be experiencing the variety of the 911 experience in a new place. The “being chosen” of deployment, though excellent, was actually the least exciting part of the whole experience by the end.

Being deployed to Newark in the time of Covid19 reminded me of all that I have and all the more I wish I could have given, in how I wish the bounty of the aliveness in my body and in my family and friends could be shared. I realized on a deep and heartaching level the privilege I have in my safety of coming home, knowing no-one I live with is infected or sick, the security of calling 911 knowing someone would arrive in minutes. Serving on deployment made me so grateful for the ease of leaving. But Newark brought me as much joy as it did grief. I was surrounded by resilience too bright to ignore. The smiles and encouragement pouring endlessly out of my new home base at University Hospital EMS made it hard to leave. They are my family now, so it feels natural that there’s no other place I’d choose as the birthplace of one of the wildest and craziest calls of my budding career. What follows is my take on a tale of humility, anxiety, well trained professionalism and above all those things, an incredible pride of what cooperation and strong teamwork can look like under pressure.

‘The baby call’ took place on my second day, midway through making death pronouncement after death pronouncement. After finishing yet another, I walked back to the ambulance, took off my face shield, and felt the emotional exhaustion welling up. We had just pronounced our third death of the day. I breathed deeply the way I have to in order not to cry and made a long, low grumble as I exhaled to channel some of the rage that apparently comes with saying, out loud for the fifth time in two days, yes this new person I’m meeting for the first time is, indeed, dead. I sat down in the drivers seat of the rig hoping for a break and not really knowing what that could even be. I remember wondering if it was going to be this way for the next 12 days of my life. Wondering how people who’d been here for a whole week before me had made it this far. Wondering how the city of Newark, struggling with this for 6 weeks, had made it this far. Mark and I cleared from the call quietly. We were barely into the length of the day, beleaguered by the weight of the mammoth task at hand and the knowing that it might go on and on and on like this.

Back at the station, dispatch hailed us on the radio with a new assignment. We waited for the inevitable “cardiac arrest,” or the “breathing problem,” and my heart jumped into my throat when the call detailed a “breech birth in progress.” I clapped my hands together in surprise, and Mark and I both smiled. Though a breech birth (baby coming feet first) is never a comfortable prospect, especially in the field, the idea of new life coming into the world amid such dulling death brought warmth to my sad bones. I was trained as a birth doula years ago, and assisted two incredible women as they brought their babies Earth-side (not as an EMT in the field, but in more controlled birth center or home midwife experiences). So though I’m not a mom, I know firsthand the rush and joy and fantastic gift it is to behold new human life being born. At this point, as an aside, Mark and I had built confidence in each other as a working duo- we were good at anticipating each other on scene, and did our jobs well. Neither of us seemed intimidated at the potential of encountering a complicated birth in the field: humbled, yes, but not quite intimidated. It’s fair to say we were stoked, but more than anything, we were relieved just to have a call that wasn’t either death or explicitly Covid19.

En route, dispatch gave an update that Baby had been born and we arrive on scene a minute later to find our fellow EMT-only BLS partners’ ambulance already there, with the crew presumably inside. Mark and I begin the PPE ballet as quickly as possible. We both hop out of the ambulance to finish tying our gowns when Steve Silva, one of the EMTs of Newark UH EMS, rushes out of the building with a bundle (of Baby) in his arms. Mark looks at me and says “get back in the rig, we’re going right now.” I abandon my gown and mask, jump back into the drivers seat, and watch Steve hand off the baby to Mark. In the next sixty seconds, Mark and Baby load up in the back of the ambulance and the only details I know are what I overheard in the handoff: Baby is minutes-old, has gray/blue coloring, and is not doing well. The supervisor on scene and Jocelyn Wall, the other EMT taking care of mom, advise me on the closest hospital equipped for this high acuity emergency. Joyously, my destination is only a mile and a half away, but my insides wince with the first worry about the next looming challenge: the transport.

Before we get too far into the weeds with the details just yet, let’s take a wide angle perspective for a moment. This is my second day working on deployment. It’s my second day not just working in Newark but also ever being in Newark for anything at all. I don’t know where the hospitals are, I don’t know the best routes to use for anything, and I certainly don’t know where we are on this particular call in relation to anything else. How great that the destination is only a mile and a half away, but my stomach turned realizing I didn’t know anything about how to get there on my own. Looking out at my fellow EMTs, medics, and supervisors, I couldn’t find anyone with a shred of doubt in my ability to get us there, but I’ll be damned if in that moment I wasn’t having trouble finding a whole lot of confidence in myself.

The difference between Mark and I’s jobs on this call become starkly and immediately clear. Mark, as the paramedic, is in the back working on Baby, who it turns out was born very premature at 25 weeks old (healthy gestation for most babies is between 38-40 weeks), was not oxygenating well, and whose heart rate was dangerously low. My job as an EMT in this particular scenario is to drive immediately, and to do it fast, safely, and well. Unfortunately for me, a big part of driving is knowing where you’re going- did I mention it’s my second day in Newark? So before doing anything else, I take a deep breath. Mark didn’t need help in the back. The other EMT crew on scene, Jocelyn Wall (also UH EMS) and Steve Silva, were transporting Mom safely in their ambulance. We would all meet at the hospital- we just had to get there. With another deep breath, I look briefly at the route Google Maps has chosen for me, and deciding it looks good (what the hell do I know, I’ve never been here before), I follow my navigation system.

Commence the mind boggling and fantastically terrifying ways I begin to practice deep and immense trust for the next most important 15 minutes of my life.

Trust step #1: It is clear that my only job on this call is to drive, and everyone on scene trusts that I can do this job, and so I will fucking drive like the best driver I’ve ever been and ever could be so help me Gods n Goddesses.

Trust step #2: It is my training to use the tools available and trust my mind. Trust my training. Talk to dispatch. I radio in to let them know we’re currently en route with a newborn baby, and to alert our destination (keep communication lines open and keep my status updated, check). GPS tells me I am five minutes from the hospital, and I hope that in running lights and sirens, I can turn that five minutes into three.

I’m keeping my eyes on the road, holding the radio in the same hand that’s also on the steering wheel while my other hand changes the sound of the siren at intersections. Folks in Newark couldn’t care less about an ambulance, sirens or no, so being extra diligent at intersections is absolutely essential. My eyes are on a constant pendulum, sweeping back and forth, left to right to left and occasionally flicking to the rearview mirror to check on Mark, glance at the side mirrors, left to right and back to Mark and back to the road. My phone is sliding around on the passengers seat and I’m trying to keep my mental gymnastics in check. The chatter on the radio seems incessant for a while. I can hear them hailing our rig number, maybe wanting details from me that I couldn’t quite make out, but I abandoned listening because, with a chirp of confusion in the back of my mind, the GPS has brought me to merging on the highway. I didn’t remember seeing a highway in the route overview prior to leaving, but no time for second guesses now. An entrance ramp isn’t the place to pull over for a moment and get my bearings.

I take another deep breath, wondering how long it had been since I last inhaled, and I giggle at how my brain could produce such a singularly unexpected thought so unrelated to my driving. At around this time, Mark announces from the back “CPR in progress, CPR in progress.” It wasn’t a yell, but it also didn’t need to be. I am vibrating with the intensity of every moving moment now- I gather that I’m now in what folks call “flow state.” I pendulum my eyes again and wait for a break in radio conversation to update dispatch, who would then update the emergency department, “Seventeen Fourteen Alpha, CPR in progress on newborn baby, still en route to University Hospital.”

I am on the highway, checking my GPS for the next update, and I watch in horror as it routes me immediately off the highway again, and then navigates me through a U-turn to get back on the highway going the opposite direction. I know I didn’t miss a turn. Something is wrong. The 5 minute arrival prediction changes before my eyes to a 10 minute estimate. A slow panic starts to seep out in an explosion of sweat from my armpits, the hair on my neck stands up, and my fear briefly gets the better of me. I know from experience how loud it is to ride in the back of an ambulance, so I yell “FUCK” to absolutely no-one at all, confident that Mark can’t hear a thing. I realize with the gravity of a deflating balloon as I merge yet again onto the highway that I have a dying newborn baby in the back of my rig and I’m caught in a GPS loop because my phone-satellite connection is completely confused. I admit to myself in quiet terror that I have absolutely no idea where I am or where I’m going.

I take another deep breath (there’s a theme here), and get off the highway with the hope that GPS will catch up and reroute me on side streets to the hospital. A few turns later and I start to recognize where I am. Days seem to have passed since we started this drive, but it appears everyone has waited for us- further up ahead I see our supervisor with his rig pulled out into the middle of the road, motioning me towards the ambulance entrance of the University Hospital Emergency Department. I have no idea how long I’ve been driving, or how they knew I had gotten lost, but I could feel the shame and embarrassment of my disorientation creeping up the back of my throat. At this point I’m convinced of two things: Baby is dead, and if I hadn’t gotten lost, maybe they wouldn’t be. I pull into the ED and try to keep up with Mark, who probably set the new world speed-walking record into the hospital carrying Baby. An entire team of nurses and doctors were waiting for us, and two other ambulance crews watched us transfer care. I let myself out after I saw Baby leave Mark’s arms.

A supervisor, who folks affectionately call ‘Tuna,’ was one of two chiefs who came to the hospital to meet all the responders on this call. He followed me out of the ED to my ambulance. I was pulling off my mask as he watched me move through the feelings, and when the strap of my mask broke, so did my resolve. Tears leaked out of my face and he told me to take a seat in the ambulance. Sobbing ensued, and fellow EMTs materialized. They surrounded me quietly, hands on my shoulder or knee. Between a few of those awkward sob hiccup things, I curse loudly, tears still flowing, and my peers respond only with knowing nods as I let the tension and fear of the past 15 minutes shakily unravel from inside out.

Tuna asks if this is my first time handling something like this. I nod. He asks gently if I would like some information. I nod again. He shares that Baby is alive and stable, mom is healthy, and my partner is doing great. I bawl briefly again. I’m surprised to see Mark sitting in the passenger’s seat simply beaming with joy and pride, exclaiming, “that was freaking AWESOME!” when he fist-bumped me. Nurses from the Neonatal Intensive Care Unit (NICU) came down to commend us for an incredible response, and they took our picture. We did it. It’s over.

We took some extra time before clearing for the next call. We got ice cream and sat in the parking lot of an auto parts store near Baskin Robbins eating our rewards, processing the first moments of many to come where people referred to us as ‘heroes’ and meant it.

The weirdest thing about being a first responder is that every day is full of small ‘hero’ moves. Things that are routine for us are someone else’s worst day ever. Moments that, upon reflection with anyone outside of the profession, seem normal but are absolutely panic-inducing for someone else to imagine. It’s humbling, and sometimes I want to ask folks to wait on doling out the hero title for a few years; it makes me laugh out loud when I really think about it. “Dang, y’all! You called 911 and you got ME? Good luck to us all, amirite?” But who really believes even newbies can’t do amazing things?

Experiences like the baby call are what we train for, what our worst case scenarios are built on, and what each one of us worries about actually getting, no matter how long we’ve been in the field. I can’t tell you how many coworkers I’ve talked to who all agree that getting a sick baby is 100% everyone’s worst nightmare. But it’s also the occasion each of us strive to rise to every time we clock in for the job. So it’s incredibly surreal when a call like this drops on you, because it just as easily could’ve landed in the lap of another crew and been handled supremely well. It is simultaneously effortless and exhausting. I was using every inch of my brain for every nanosecond of that call, and yet felt like I was functioning on pure instinct and muscle memory. It is basic and also the most challenging. There’s no way to handle it except the best possible way I can, relaxing and ‘cracking open a can of calm’ (as my EMT school leadership would say). Weighing and measuring every single action with scrupulous analysis is essential, with hawk-like foresight and hyper-critical hindsight, knowing it could truly make or break the outcome and save a life. A contradiction of the most extreme sorts: relax… but by god, don’t fuck it up.

The call couldn’t have moved so well without everyone involved, and sometimes I get a little sad at the acclaim and brief fame that graced Mark and I at the end of this call. The picture at the NICU couldn’t possibly have fit all of us: dispatch, the BLS crew, nurses, supervisors, and Mom/Baby, but they each belong in the spotlight. Dispatch was clear, concise, and responsive. The BLS EMT crew, Jocelyn and Steve, triaged and treated Mom and Baby quickly and effectively on scene prior to our arrival, and they transported Mom safely. The supervisors on scene managed information and and support perfectly. Mom did an incredible job handling a breech birth on her own at home, and Baby fought alongside NICU staff like a champ to stay here.

What an honor to share this experience with so many other people, and to watch life force its way forward anywhere, but especially in an environment so impacted by death and sickness. In the ambulance bay I wept in understanding that Baby was alive- yes because it was a close call, yes because I had a hand in it, but it was also because it was a win we needed. This call was life changing for me not only for the ways it challenged me in my profession, but also for the way it reminded me of the bright wisdom that still persists in desperate situations, in the heaviness of chronic death of Covid19. There is birth, newness, and breath inspiring if we can remember to take it in.

I will never forget the that breathing was most helpful and powerful skill I used repeatedly on this call. Is it hokey? Maybe, but I’ll be hokey all day if it helps things turn out as well as this call. I took a deep breath in every moment that I wasn’t sure about. Each exhalation brought my next step closer to the taking. I love this job because it leaves me grateful for, and humbled by, the world moving around and around. I’m just trying to keep up in turning with it, wielding the mighty power of such a simple tool.

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.