The Perfect Ten

"Sixty-six year old female, chest pain."

The roads are rimed with ice, thick in places, bumpy, dangerous. Cable chains, coupled with tremendous weight, give our aid car traction and mobility. It's two in the morning, and we are hurrying on the treacherous streets, closing distance with the medics. The address is at a mobile home park, "The Estates", a manicured ersatz village brimming with retirees, trailers lined up in tidy, landscaped, aluminum rows. We go there often.

At the station, Rich had stared sleepily at the map on the wall, pulling on his bunker pants. "I don't know where we're going."

"It's by the freeway." It had sounded so helpful in my head, before I said it. I try to coax my groggy mind into showing off with turn-by-turn directions. "Follow the medics. They know where they're going."

We lose sight of their flashing red and white lights. A dispatch to "chest pain" is urgent in itself, but a slow start and an icy night make me anxious. The medics have made the only possible turn, and when we come around the corner, we can see them again, two blocks ahead. I'm in the officer's seat, pulling on nitrile gloves, Rich is focused on navigating the slippery route - slow on the corners, faster on the straights. He closes the gap between the two vehicles, and I relax a little.

We arrive seconds behind Medic forty-six, parking behind them, and uphill on the glazed asphalt lane. A narrow set of stairs leads up to the door under the carport. I wait at the bottom, until the medics are inside. Last week, I was bringing a gurney into a similar mobile home, and my foot went through a rotten plywood step. I bounce experimentally on the treads, assessing their strength, should we need to carry a patient out this door - no cracking or creaking under my weight.

I enter the home, and a woman is flitting about at the front door. "I was hoping they'd send some handsome firefighters!"

"Nope," I deadpan, "They sent us, instead."

I expect her to usher us to our patient, but one of the medics, Eric, asks her to take a seat and launches into interview mode. I've got a report and clipboard in my hand, and it's my role to record patient demographics (name, age, address), medical history and chief complaint. I'm still groggy, and I strain to make sense of the conversation, recording pertinent facts. No one asks her name, so I scan the counter for medications. I pluck a bottle, empty of oxycodone, from the window sill. I squint at the label.

"Are you Peggy?"

She is and she has a host of medical issues, none of them cardiac related. But because she uttered the magic words to dispatch, the medics are chasing down the chest pain path. They hook up the cardiac monitor, sticky little blue patches connected to wires at her shoulders and hips, under her robe. Nothing remarkable.

"The pain is right here." She thumps her belly with a closed fist, below her ribcage. "It goes to my stomach, and chest. And my back."

Roger leans her forward and palpates her back in several places. She jumps a little when he presses her flank, in the middle of her back.

"Oooh, right there."

"Well, Ma'am, I don't think this has anything to do with your heart. But, these boys will be happy to take you up to the hospital... -if you want." Boys. Rich and I are both over forty. But it sounds down-homey. I let it slide.

She wants. Happily, she can walk just fine, and no one is too concerned if she does, but we would be for a patient in cardiac distress. Rich and I each take an arm, and steer her toward the door of the aid car, mincing our steps on the packed ice. She has some difficulty climbing in, due to her bum knee, but I don't want to lift her on the gurney, on this icy hill, if I don't have to. We take our time and soon she's belted into our bed in the back of the aid car. The heater barely maintains 68 degrees F, against the bitter cold outside, but I shake off the chill, and call the nurse, while Rich starts us in the general direction of the two hospitals.

I flesh out the report in the back of the rig, while we bounce along. The document constitutes a legal and medical record of the event, and different types of calls require specific information. She was never asked her to rate her pain during the interview.

"Ma'am? On a scale of one to ten, how would you rate your pain? With one being no pain, and ten being..."

"Ten."

"...being the worst possible pain imaginable?" Like losing a leg in a meat grinder, like getting impaled on a fencepost, like giving birth to quintuplets - simultaneously?

"Oh, it's a ten." She smiles at me, nodding. Her hands are folded across her generous lap.

"Okey-doke. Ten out of ten. Got it. Thanks." I bend to the paperwork, making a note of her statement, but I frame it in quotation marks, in the subjective section of the report.

I reckon I've experienced 7/10 pain, and it made me sob. But I've seen 10/10 pain. I've heard the wailing, the moaning, the pleading for it to stop. The desperate writhing. The gnashed teeth, enamel squeaking, the clenched knuckles, squeezed bloodless, white. Ten out of ten? Balderdash. Hooey. Confabulation. Steaming bullshit.

There's no traffic, and despite the ice, we arrive at the hospital shortly. After a short wait, we are sent to a room at the emergency department. Peggy wriggles from our gurney to the hospital bed, after we raise the latter to the same level. There hangs a new flat screen monitor on the wall which monitors and displays vital signs. I like technology, and I comment on the addition to the room.

"Oh. I thought that was a TV. Isn't there a TV in here? I am so thirsty." She is sitting up, gazing about the room. "I thought there'd be TV..."

The admitting nurse has followed us into the room. "Nope. Sorry." She doesn't sound very apologetic.

I give her my short report, epigastric pain, radiating to the chest, abdomen, and back. I high-light the ten out of ten rating with animated fingers.

"Right." She looks blankly at me. "Worried about TV and a drink?" She smiles sweetly, and shrugs a little. "A ten? I don't think so."

"I know..." I tear off the pink copy of my report and hand it to her.

"Thanks. You have a good morning."

"You too." I call over my shoulder, "Bye Peggy! Hope you feel better." Rich is waiting in the idling rig, the cab heater blasting.

"Let's go home, Cowboy. I'm sleepy - A ten out of ten."

Out Of Phase

Like the brains of dogs, and certainly cats, the human brain is a fragile organ, susceptible to damage and pernicious meddling. Conditioned to respond to a recurrent situation, the brain re-wires its behavior to handle the repeated and expected situation. Consider the adopted pet, having changed households, now displaying inexplicable and irksome behavior towards its new owners. Ring a bell, Puddles salivates. Stimulus, response.

It seems that a small part of my own brain has been perverted from its previous programming in new ways both inconvenient and devious. Like an "abductee", wandering around Terra Firma after the rumored anal probe, I scratch my head and wonder aloud, "How did I get here?" Or more accurately, "What day is it?"

Give me your hand, walk with me.

The pre-Colombian Mayans didn't use the wheel, but they measured the length of the solar year to a far higher precision than the Europeans who formulated the Gregorian calendar. Curiously, the über-precise Mayans preferred a whole number, 365, to the precise value they measured, and built their elaborate calendars around that figure, eschewing leap days. Even with that small error, and given a (long) life time, by the time you were eighty years old, spring would arrive just a few weeks earlier (by the calendar), than it had when you were a Mayan child, playing in the mud.

The word month is a cognate to the word Moon, meaning they have a common, or related origin. In a climate without appreciable seasons, or if the Moon figured more prominently in your mythology than did the sun, it might seem reasonable to mark the passage of time by the phases of our satellite. The observant and diligent shaman, however, might eventually eventually discover four other ways to define the Moon's orbit: the sidereal month, relative to the stars; the tropical month, relative to the vernal equinox; the anomalistic month, relative to the Moon's position nearest to (or farthest from) the Earth; and the draconic month, relative to the ecliptic plane. The lengths of these five periods vary by as much as two days.

Every great thinker wrestles with the issues of incorporating new information into the body of "knowledge" he already possesses. Aristotle, later Ptolemy, played with a mental model of spheres, each moving a particular celestial object relative to the other objects, with the Earth in the center. The periodicity of the Moon has no direct numerical relation to the annual revolution of the Sun, and it must have made the great thinkers, trying to correlate the two, crazy.

I can easily imagine a Lunar Interpretive Committee arguing the merits of the different months around a campfire, weighing common sense against spiritual belief, much like certain discussions around the firehouse dinner table. In the end, apparently, some wise figurehead threw out the whole notion of a month's duration being, in any way, tied to the Moon. Subsequently, we inherited a year of twelve months, of varying duration, correlated to the signs of the Zodiac. Call it executive prerogative.
The seven day week, depending upon whom you ask, came from the average weight of a baby camel, the number of fingers on the hand of a convicted pirate, or the alcoholic content of early beers. Actually, seven is a hallowed number, derived, by most accounts, from the number of naked-eye, visible stellar objects in the night sky: Moon - Monday; Mars - Tuesday; Mercury - Wednesday; Jupiter - Thursday; Venus - Friday; Saturn - Saturday; Sun - Sunday. The length of the week in the western world has been solidly established for at least two millenia, perhaps much longer.

As to the reprogramming of my neural equipment, I'd lived forty years, happily measuring my days with the accepted and understood year, month and week, negotiated oh so long ago. When I was hired by my Department, the damage began. We use an eight day rotation of shifts, working two twenty-four hour shifts (plus the occasional overtime) in that time. Our days off comprise a "two-off" and a "four-off", meaning a two and a four-day period between shifts.

We ask a bread-and-butter question of some of our patients, to assess their level of orientation: "What day is it?" It's a mediocre question, often irrelevant to the changeless world of an extended care facility, where one day blends into the next. I often must perform some mental calculations of my own, before I can process the answer. Curiously, I have no problem remembering how many days until I work next, but I seldom know what day of the week it is.

The biggest effect arises as the real world moves out of phase with my eight-day week. Take for instance, weekends. The odds of a real-world weekend completely lining up with my time off are 50%. If I include Friday or Monday as part of the weekend, the probability drops to 25%. I'm not complaining; I have abundant unstructured time off from work, but it can be difficult to coordinate weekend activities with friends and loved ones.

Particularly troubling is the complication created by my kids living out of state. Initially, I was overjoyed with the schedule when I was hired, and the prospect of all the time it would allow me to spend with them during the week. After they moved to California, repeatedly negotiating which weekend the kids are coming up each month became a huge pain in the ass. Three quarters of the year's three-day weekends necessitate a trade or a day off to maximize visitation. I have a very limited pool of possible trade partners, and I try to reserve those trades for the months without an open weekend.

Conversely, it's nice to go do something during the week, without the weekend crowds. Movies, museums, trails are much less crowded on a Tuesday. I have a lot of flexibility in my week for dentist or doctor appointments. I have to go to bed on time just eight days a months, but every work day is both a Monday and a Friday.

What day is it today?

Give Thanks

“The end of the human race will be that it will eventually die of civilization.”
- Ralph Waldo Emerson

We live in a time of abundance. Food, Metabolic energy, is cheap and plentiful. Indeed, many of the patients I see suffer from the side effects of abundance. Obesity, diabetes, alcoholism are all symptoms of too much, too good. It's easy to meet your caloric needs, and not much harder to exceed them, and just as easy to indulge in some recreational chemistry.

Life used to be much harder, and humans earned every calorie they consumed, whether it came from food grown from seed, or meat brought to the hearth after days of following the herd. Killing a mammoth, bringing in the harvest, warranted a feast, and the revelers would gorge on the bounty that they had wrought. I've heard that there is a "feast or famine" gene still lurking in our chromosomes. Refrigeration is a relatively new process, and it's been suggested that over-eating, over-spending, and over-indulging are related genetically-programmed behaviors, left over from the not-so-distant past, when meat would spoil if not consumed quickly.

Consider the peanut butter and jelly sandwich. Assuming you aren't eating them daily out of economic necessity, it's a pretty good snack or lunch item. At worst, the PB&J is a sweet and gummy collection of tasteless and humble staples, but, when prepared with high-quality ingredients, it can achieve gourmet magnificence .

One of my favorite lunches, dating from my middle school, 4-H Club days, is a double-decker PB&J (three slices bread, the peanut butter and jam separated by the third slice of bread) and a can of V-8 juice. The sandwich is transformed by the extra bread and the segregation of ingredients. The V-8 juice forms a backdrop, a canvas, against which the elemental notes of peanut, strawberry, and wheat bread are rendered in a gustatory still life. Approaching fine French pastry, it has the supreme balance of taste, texture, that satisfies some fundamental, psycho-emotional need for sugar, fat, and salt.

Made with whole wheat bread, costing only pennies, half of a peanut butter and jelly sandwich compares almost identically with a Clif bar, at $1.49. Maybe it's a little messier, and won't suffer weeks, or months, in your backpack, but a PB&J is definitely cheaper, easier, and handy. Properly assembled, it contains that balance of carbohydrates, fats, protein, and fiber for which people, athletes, spend a fortune, every year, on energy bars, hoping to find that perfectly-formulated, pre-made, pre-packaged product that will sustain them in the course of their daily adventures.

I offer the humble peanut butter and jelly sandwich as a metaphor for the modern diet. I fully believe that the PB&J, two thousand years ago, might have spawned bloody wars of conquest, bent on acquiring the fabled sandwich. Today, it is a tried and true lunch box staple, but way back then it would have been an unheard-of delicacy, in an age without refined sugar, leavened bread, and the necessary mechanization to mill peanut butter.

This Thanksgiving, please take a moment to acknowledge the unknown, the unsung, the unappreciated men and women who came before you. The person who invented the buffalo fall, the person that first added spices to roasting meat, the one who built a boat capable of carrying passengers to a new life in a new world. The inventor of peanut butter, Dr. Salk, Thomas Edison, Robert Ranson (inventor of the cast iron plowshare) also deserve our gratitude. And don't forget the people who, today, this day, make your life possible: the garbage man, long haul truckers, oil field wild-catters, police and fire.

And when the turkey's all gone, make a peanut butter and jelly sandwich and wallow in the gifts of civilization.

“There is something even more valuable to civilization than wisdom, and that is character”
-Henry Louis Mencken

“A nation or civilization that continues to produce soft-minded men purchases its own spiritual death on an installment plan.”
-Martin Luther King, Jr

“To be able to fill leisure intelligently is the last product of civilization, and at present very few people have reached this level.”
-Bertrand Russell

A Fire Service Pantheon

"Kinda quiet today..."

"Whuuups! What did you say?."

"Whuh?"

"You angered the Gods. We're going to get our asses kicked now."

------------------------------------------------------------------

High above, drifting on the ever-present layer of stratus, floats a row of thrones, constructed from broken bones, the mangled wreckage of cars and motorcycles, glucometers, fire alarms, and a thousand failed human hearts. Tonus, the God of Dispatch, rears back and lets loose a deep and mighty belly laugh. Leaning on his elbow, he had been combing the surface of the earth for a foolish and prideful firefighter to torment. He motions Meteoro, the God of Natural Disaster, to his side.

'Your bidding, Oh Great One?" Meteoro clasps Tonus' forearm with his damp and cold hand.

"Create a deluge, in this City, on that busy highway." Tonus points to our freeway, "At that curve," stroking his beard, chuckling, "I want to see the horseless wagons spinning."

'It shall be done!"

A piercing wolf whistle summons Gravita, the Goddess of Falls from her perch, mincing in her too-long gown. "Find the infirm, the lame, and play havoc with their walkers. I want broken hips. In the bathroom!"

"Of course, my Lord." She claps her hands above her head, sinking through the carpet of clouds, plummeting toward the planet below, with the falling rain.

Tonus yells down after her: "And look for humans on ladders, cleaning their gutters!" Craning to see around his celestial lair, his long white hair flying, he bellows, "Bubba!"

Bubba, the lesser God of Bad Judgement, rolls in on a unicycle, juggling bottles of high-gravity beer, catching the spraying drops of brew in his mouth. His eyes are red, and his bare feet work the wheel back and forth, idling before the God of Dispatch.

"Bubba, find some, ah, vulnerable, humans. Goad them into dangerous activity. You know, the usual."

"You betcha, boss!" Bubba downs a beer, springs off of the unicycle, and cartwheels out of sight.

The mighty and fearsome God, Tonus, leans forward eagerly, rubbing his huge palms together, watching the mayhem unsue.

------------------------------------------------------------------

And so it goes... The Gods are easily offended. Unspoken, yet understood, rules govern our behavior in the station and on duty. Never boast about a quiet shift. Never laugh at another rig's number or type of calls. Before sitting down to a meal, it's good form to acknowledge the probability of the tones going off, if only silently. Go to bed, but don't expect to sleep.

It is widely believed that one can curry favor with the Gods by taking calls for other crews, but methinks it folly to endeavor to please such capricious beings. Regardless of personal spirituality, this magical thinking pervades the station, and no one is immune. At any moment, horrible disaster could occur; It's a way of preparing your self.

Smoothie

Right now, if I run my hand across my cropped scalp, my fingers come away with an honest, earthy sort of aroma. Faintly familiar, yet muted by repeated washings, first with anti-bacterial soap, later by several shampooings. Lisa bent to kiss me this morning and was repelled by the odor. She said it reminded her of getting carsick, as a child, in her family's red Mustang. My new Airlift Northwest baseball cap may very well retain a permanent olfactory reminder of this morning. You learn some lessons the hard way.

Almost three years on the job, I claim the dubious distinction of being the lowest-ranking person on "B" shift. I have about a dozen guys below me, but none of our probies have been assigned to my shift. As befits such a dubiously distinguished fellow, completely lacking in any measure of seniority, I am the person who lays down, in the dirt, for the drill. I am the one with the dead-last vacation pick. And when there's a hole in the schedule, I pack up my box of bedding, my bunker gear, and I move it all somewhere new. I find myself scheduled to work on an aid car fairly regularly, but owing to my transient position, I seldom do. I can't claim more than a couple of continuous months on any one rig, at any one station. I ache for a permanent assignment; Constantly moving is a subtle extension of probation.

I have become versatile - I work on engines, aid cars, and, sometimes, the ladder truck. I have a broad knowledge of the City, whereas Seth, hired same day as me, has worked his entire, short tenure in the north end. I have worked with every captain, and more than 90 per cent of the suppression staff, in the same station, if not the same company (vehicle crew). This nomadism is a great way to meet people, but sometimes makes it difficult to find your groove, to cultivate that mix of partnership and smoothness that a seasoned crew possesses.

Smooth is good. A probational rite of passage, measured annually, is donning your airpack for time. The goal is to be packed-up, masked-up, in less than a minute. It's a standard in the fire service. It's a fairly simple process, anyone can do it, but it takes practised finesse to beat the thirty second mark. As a new recruit, your continued employment hangs on your being facile with your equipment, and you're tested regularly on this task. The stress of being timed, coupled with the importance of your perfomance, make it harder than really it is. A minor bungle can cost you valuable seconds that you might not have. The best and wisest advice I received was: "Slow is smooth; Smooth is fast." This scales to everything we do, especially when learning a new skill.

There's a dozen ways to tackle many of the calls to which we respond, but the smooth crew will effortlessly handle the situation. It takes a few shifts, and many calls, to polish the nuances of working together as a team, negotiating roles and responsibilities. You grow into each other, strengths complimenting weaknesses, flexibility accommodating rigidity. It takes time, time I seldom spend in a given assignment.

With six stations and a dozen assorted rigs, the details of my job change weekly. Even though the Department has standardized our engines, there are minor differences in equipment and storage, and every fire station is unique. Knowing which compartment contains the chain saw is smooth. Knowing where the toilet paper or batteries are stored is smooth. Knowing how to get to an address, through traffic and around obstacles, is smooth.

We get exhaustive training on the particulars of the BIG parts of our job: firefighting, CPR and EMT skills, deploying ladders and power equipment. Little things, details, are frequently taught by your peers, and often left as an exercise for the new recruit. When you move around a lot, it's easy to feel a little lost, to feel like the new guy. It can seem like navigating a pitch-black warehouse - you cautiously move in a straight line until you trip over something, walk into a wall, or bump your head.

I worked at station 42 yesterday, a comparatively rare duty on the aid car. I've spent enough time there for it to feel like home, but driving the aid car is a rusty skill. I turned south on the way to an address in the north, headed to the wrong hospital, made the bonehead mistakes everyone makes. My partner was a little rigid in his expectation of smooth. Every time I work with this guy, I come away from my shift feeling like a clueless newbie. It used to bother me greatly, until I realized it wasn't personal - he's critical of every partner. But I'd rather laugh over a minor misstep than defend it.

As driver, my responsibilities include maintaining the aid car, checking the fluids, aid kits, oxygen tanks, sundry supplies. This morning, we rolled on a call for difficulty breathing, just before 0700, which the medics transported to the hospital, on frosty streets. When we returned to the station, I backed the rig up to the fuel pump to top off the tank for the next shift. The hose wouldn't quite reach and I pulled about twelve feet of hose from the reel. After filling up, intending to save the next guy some effort, I made to leave the hose on the ground, rather than retracting it into the drum. To get the extra hose out of the way, I whipped the nozzle in my hand, neatly laying the hose along the station wall. In my mind, a slick and sensible technique - smooth.
The thimble-full of diesel remaining in the nozzle launched into the cold air, flying in a precise arc, splattering on my hair. Suuuunn of uuuuh... I hastily scrubbed my head in the bathroom sink, later laughing about my goof, over coffee, in the kitchen. And so now my hair stinks, and I continue to learn some lessons the hard way.

"Slow is smooth; Smooth is fast."

Rituals

I have, apparently, a psychic rooster - a faithful, imaginary bird. He's not keyed to the sunrise, like the roosters I remember. Usually, he wakes me up just before the alarm clock goes off, irrespective of its setting. I'll lay in bed, pondering the time, when the clock sounds. I wonder if there's some change in the sound the clock makes, as it approaches the designated moment, but I set the alarm, all the same, every night.

And so my eyes came open in the dark and quiet ward, ears strained to detect the tell-tale breathing of my brothers. The face of my watch glowed faintly, too faintly to read in the gloom, when I bent my wrist close. I was too awake to roll over and go back to sleep; the rooster had crowed. I wriggled out from under my sleeping bag and stood up, swaying, leaning against the bed, using it as a landmark. My clogs waited where I had kicked them off in the night, when we had gotten back from the low blood sugar call. A thin blue light, the other colors wrung from it, filtered around the curtains, and I shuffled to the door, pushing it open.

Squinting from the fluorescent glare, I scuffed into the tiled bathroom. I never flush the urinal if anyone's sleeping, and I washed my hands in a pencil stream of hot water. I could make out the squeal of an opening bay door above the splashing, and I felt, more than heard, the cough of the fire engine starting up.

On the stairs, I could taste the burnt coffee in the bottom of a pot, stewing on a burner. Instead of simply pouring myself a cup, I'd have to find coffee somewhere and brew a fresh batch. Guys are gonna want some coffee... I pulled aside the sliding door to the kitchen / TV room, reached for the light switches, noting a sleeping body in a recliner, under a blanket - one of the medics - I dropped my hand. I quietly slid the door closed again, and blinked my eyes until I could see better in the dark.

The Bunn's switches both glowed red in the gloom, and I crept to the fridge, opening the door half-way for some light. Back at the coffee machine, the foul dregs of a pot sat on the top burner, but fresh coffee was tinkling in the pot under the basket. I flipped off the top burner and washed out the carafe in the sink. I grabbed a pair of cups from the cupboard, returned the clean pot to the still-sizzling burner. I was a Ninja in the dark, deftly pullng the pot and replacing it with a cup. As the cup slowly filled, I topped off the other with the pot. Another Ninja move, and the pot was back under the basket, two cups held in one hand, and the fridge nudged closed with a toe. I only lost a drop or two as I opened, then closed, the sliding door.

Out in the app bay, I ducked into the hose tower to grab a long-handled brush. I stepped into the drizzle where Geoff was already hosing the grime from the previous day's work off the engine. A bucket of suds, a brush tipping out, sat at the tailboard. I dropped my brush into it, and handed a cup of coffee to Geoff. Inside the station, the morning tones went off, rousing the sleeping crew, lights coming on automatically.

"Thanks, Schlem!"

"My pleasure."

I gulped a hot mouthful, balanced the mug on top of one of the concrete-filled steel bollards that guard the garage wall, and grabbed a brush. I scrubbed the fire engine in the rain, Geoff rinsed.

Siren Song

The lights flash red on the backs of street signs, shop windows, the wet asphalt, a hundred shiny surfaces. Trees, poles, fences are frozen in a moment, the strobing suspends our relative motion as we pass in the dark. The siren screams high, then drops low. My hand reaches down, turns the switch to "wail", as we roll up to an intersection.

"Clear right." Any cars approaching on the passenger side are stopped. My partner returns to the map book in his lap, searching for the right apartment complex.

"Clear right," I repeat. "Thank you." Still, I double-check with a quick glance to the right. Pedal down, and we take off through our green light.

The aid car is heavy, and ponderous on corners. My eyes are narrowed, I focus into the distance for vehicles, pedestrians, any hazards on the road. Hyper-alert, I enjoy the challenges of driving priority through traffic. It's not speed that will get us to our destination quickly, but rather the dialogue of lights, sirens and the response by other drivers on the road.

A car is trapped between the median and a barrier, unable to pull out of the way. The driver panics, maybe freaks out, stopping in the road, right in front of us. Their turn signal is flashing left, but there is no left turn for them. Good Schlem is on my left shoulder, wipes off his milk mustache, whispers in my ear, Patience... I am slamming on my brakes, but I resist the urge to hit the air horn. My partner, Matt, is bracing against the dashboard. But Bad Schlem is on the right shoulder, swilling his martini, roaring, Dumbass! Move it! I agree, "Dumbass." The driver, apparently, solves this small problem, and accelerates past the barrier and pulls to the right. Bad Schlem coaxes me to hit the air horn, just a bit, as we pass the car. Let that be a lesson to ye!

Driving code, with flashing lights and blaring siren, is not a license to speed or break traffic laws. These visible and audible warning devices are our voice in the night, in the street, around the corner, begging your permission to take the necessary exceptions to the normal rules of the road, in this emergency situation. If you don't, can't or won't yield, I can't take those exceptions:
-Proceed past a red or stop signal or stop sign, but only after slowing down as may be necessary for safe operation;
-Exceed the maximum speed limits so long as I do not endanger life or property;
-Disregard regulations governing direction of movement or turning in specified directions.

It should be obvious that there's a lot of leeway for some chaos in those exceptions. Given, that all traffic has stopped, meaning: granted us the necessary permission, I can do whatever I need to do to get through or around traffic, provided, I drive with due regard for the safety of all persons. If I should cause an accident, there is no legal protection from the consequences of my reckless disregard for the safety of others. And that's the fine print in the Revised Code of Washington (RCW 46.61.035), the yin to the yang in the state law. An accident would comprise absolute proof that the safety of others was recklessly disregarded, and expect a lawsuit - against the City, the Department, and me. A fire engine weighs about twenty-two tons, an aid or medic unit seven and half tons- imagine a passenger car under that mass in a collision. When I check the speedometer, I am rarely exceeding the speed limit.

In addition to the two-dozen flashing lights and the 140 decibel siren, we have a secret weapon called an Opticom. Centered in the light bar, the Opticom strobes at a special frequency and traffic lights magically turn green for us when they detect it. This is what gets us through intersections and the associated traffic. The latest generation of Opticom utilizes infra-red pulses of light, coded to provide information about agency and emergency vehicle, but our system is old-school, just a strobing light. Urban legend has it that you can flash your high-beams quickly and trigger a detector at an intersection, but my experiments leave me thinking this is possible, but unpredictable. Suffice it to say, stopping oncoming and cross-traffic is a great tool for rapidly getting from point A to point B when shit happens.

About one hundred American firefighters are killed on the job each year. Sometimes more, sometimes less, but (barring unique tragedies like 9-11, which killed 343) the number oscillates around the one hundred mark. Of those deaths, roughly two-thirds are volunteers, the balance being paid, career staff. Firefighting is dangerous, but few firefighters are actually killed by fire. Most fatalities are directly related to cardiac issues, followed by vehicle or roadway accidents.

Arguably, the most dangerous thing we do is driving to the scene of an emergency, followed by working in the street or freeway. My kids, family, and friends worry about my safety whenever they see or hear about a firefighter getting injured in a movie, or on the news. They tell me, "Please be careful..." But they don't really understand the reality of the risks we face.

I think my department has a strong culture of traffic safety - we have the reflective vests and seat belt alarms to prove it. Every time someone gets behind the wheel and drives code, that culture is tested. Every time we operate on a busy freeway, assisting a driver, maybe cutting him out of his mangled car, mopping up the spilled life-blood of a vehicle, we put our lives on that very real line. We do it daily, and far more frequently than running into a burning building. We've been lucky, or careful, or strategic, so far. I try to keep it front and center in my brain, and both Good Schlem and Bad Schlem sit on their respective shoulders and kibitz.

Please, please, please, yield to lights and sirens. Your life, my life, my brother's lives, could depend on it.

NY State FF LODD Study: http://www.dos.state.ny.us/fire/LODDStats/LODDStats.pdf

Spittin' Image

I was born there, and I still lay claim to her as my original home. Plucked, up and away, to Bellingham, from Billings, when I was just four; the subsequent biannual drives, there and back, are etched deeply onto my memory. Montana is vast, and driving for hours, between points just inches apart on a map, lends a scale to the Earth that still inspires both awe and a little terror. Sawtooth mountains reach above the weather, ever on the horizon, as you slowly creep across the valley floors. There is no dust, no water in the air, and when you crane your neck, peering straight up, your gaze penetrates the stratosphere, to the edge of space.

A promotional pamphlet, published in 1895, touted Montana as The Treasure State, a reference to her abundant gold, silver, and especially copper, production. This name stuck until 1961, when, life imitating art, a representative of the state advertising department asked A. B. Guthrie, the author of The Big Sky, at his remote ranch, permission to use the title as a catchphrase to promote tourism. He reportedly agreed on the spot. The Big Sky sounds more like an ancient, reverent name for a holy place than a best seller about the fur trade, and for years I assumed it was. That Guthrie's editor suggested the title shouldn't prejudice your appreciation for the poetry in the words.

But the sky. The blue, blue sky. So deep, so rich, so full of promise, serenity, happiness, optimism, and over-arching love. I have various snapshots: bucking hay, driving the Beartooth, Christmas '76 - the sky is exactly the same, a perfect indigo that grabs me by the glands and whispers, "Welcome home." The landscape in Montana is writ with the American mythologies of Cowboys, Indians, of liquor and tobacco. The road to my Grandma's house is writ with irony, plastered onto a billboard.

This is my confession: I am a tobacco user. Not cigarettes, not anymore, not for a long time- I flirted with those in college, and gave them up easily enough when a certain young lady expressed interest, although I flirted with them for a while during the divorce - a sort of a relational bookend. I'm talking smokeless tobacco... the rough sawn, hard luck, boom town cult of chewin' tobacco. Chaw. Snoose. Yuck, yeah, right. Gross.

The fire service is thick with chew enthusiasts. More than you might expect. For every firefighter you see with a Cope ring on the back pocket of his jeans, there's several that have a habit they maintain covertly. The rationalization goes like so: "At least I can run the stairs." And they can. It doesn't affect their pulmonary function; they're not inhaling tar and all the lung-clogging crap associated with burning tobacco. But it will probably eventually affect their health.

Some guys always have a dip in, but it might be so small as to not require the signature spitting. Others just suck it up and swallow the poison. Might be the spouse, might be a private shame, but people, in general, frown on the whole spitting thing. Which I don't quite understand. Smoking exposes other people to your smoke when you exhale, but spitting in a coffee cup, or even on the asphalt, can be pretty benign when gracefully executed. The first time you empty a garbage can full of someone's tobacco spit, however, is a memory to savor and share.

At the state fire academy, I took a righteous stance against my fellow recruits' use of chew, and composed an anti-dippin' cadence. When they sang it I convinced myself that I was helping them, but no one quit dipping.

tell me when you've had enough /
eatin without teeth is rough /
why don't you have a nuther snuff?

the scariest thing I ever saw/
was the cancer that killed my grandpa/
why don't you have a nuther chaw?

I can't tell you what to do /
but I don't think you'll be able to sue /
why not have a nuther chew?

'fore you go I got a tip /
I don't think you need your lips /
why not have a nuther dip?

My friend, Dave, has probably been dipping for thirty or more years. He's my age, but only I started chewing tobacco less than a year ago, spurred by the boredom and privacy of working on my rental home. Ennui and a convenient 7-Eleven conspired to deliver a tin of Kodiak to my mucous membranes. I've known dozens of smokeless tobacco, chew, users, but I never understood the compulsion to pack the dip in the lower lip until I tried it.

There is a learning curve, and I advise the curious to avoid dipping while driving, during the early stages of skill acquisition. Retching in a cup, at sixty MPH, eyes streaming, is probably slightly more dangerous than talking on a cell phone while driving - with your eyes closed. -with no hands. -from the passenger seat.

Remember the blue, blue, blue, Big Sky of the Treasure State? That's the color of nicotine. That's the promise, the optimism, the warmth, friendship, and love that the drug vowed to me. For a while. Then I started to dip more, and it never again lived up to the initial promise of happiness. The tin of chew virtually buzzed in my pocket, reminded me of the lost euphoria, like fading Kodachrome vacation slides. The indigo existed outside my daily experience, and to even conceptualize the indigo required nicotine. Indigo became unobtainable. The world started to render in shades of brown, tans, washed-out slate tones.

I missed the indigo, and so I haven't had a dip in almost two weeks. The physical pain of nicotine withdrawal is really just a few days discomfort: headache, tension, grouchiness. Ibuprofen and beer help. So does exercise. It helps that dipping is a private endeavor; there's no second-hand smoke to taunt you when others indulge around you. I found it easy to refuse the offers of a shared dip. When asked if I was "packing", I explained how I was on the wagon, and had none to share. Don't come round here, no more.

I have my motives for staying off tobacco, but, foremost, stuffing carcinogens into my mouth seems ill-advised, given my family's history of cancers. I don't want my kids to take up tobacco, in the way kids inherit their parents' behaviors and values. And I don't like that I respond so easily, so willingly, to a nagging, whining addiction voluntarily carried in my pocket, with my change.

Lost and Found

Why not Velcro? The thought occurs to me once again, in this urgent moment. I'm fumbling with the zippers on top of the red oh-two kit, knowing the woman on the carpet needs to be ventilated. Right now. I've pulled the oxygen cylinder from the compartment in the kit, spun the valve on the regulator open. I'm ripping open the plastic bag containing the bag-valve mask, but the tubing is secured with a "quick release" tie that does neither. Randy has started compressions, but my world is reduced to this act of wrestling with the equipment in my hand.

The paramedics arrive right behind us, kits in hand. "Get oh-two and a BVM going!"

The BVM is finally assembled, and I'm trying to get air into our patient's lungs. Her head is between my knees on the stained carpet, and I am holding her head back and up, to straighten her throat, forcing the mask against her face with my fingers. Her cheeks are puffing out with each squeeze of the bag, but I see no chest rise under Randy's hands.

The same medic wants to know if she's getting air. "Randy, hold off for a sec, I want to see if this is working." He rears back from her chest, I squeeze the bag, her mouth inflates, nothing's getting in. Crap. "I need an OPA!" The oropharyngeal airway is the quickest way to get the air past her tongue, to her trachea, before one of the medics gets to the task of tubing her. Randy is pumping her chest again.

Off to my right, I see Brian, our newest medic, the man running this code, twist and pluck something from his kit. Engine 43 is on scene for manpower, and he hands Mike the OPA kit. After ripping the zipper open (another zipper), Mikes's comparing the length of an OPA against her jawline, ensuring we use the best size for her anatomy.

I open her mouth to find toothless gums. Ah, shit. Dentures? I scoop my gloved finger into her mouth, but her false teeth are not there. I imagine them bobbing in a glass of water beside the bed where we found her. I'm holding her mouth open like a trophy trout, and Mike is twisting the OPA into place, past the back of her tongue. The tabs are supposed to rest against her incisors, keeping the device from sliding deeper into her throat, but without teeth, it will just float in place. Good enough.
Randy's watching us, and pauses his chest compressions long enough to verify the tell-tale rise of her chest when I squeeze the bag again. I can literally watch the pure oxygen inflating her starving lungs. "Good air!" I announce to everyone.

I look around, timing the delivery of life-saving breaths to Randy's rhythm from the corner of my vision. Brian is almost done with the IV, and Eric, the other medic, has already slapped the patches on her chest, is taking a 12-lead, a recording of the this woman's heart's electrical activity.

Two minutes

Eric analyzes the patient's cardiac rhythm. We all cease what we're doing and move back from our patient, isolating ourselves from her. The monitor indicates that a shock is warranted. "Shocking." Her body barely twitches when he pushes the button. "Resume CPR." We start our second round.

Brian finishes hooking up the IV, and moves to the head, Eric pushing a syringe of drugs into the port on the plastic tubing. "Stop bagging, I'm getting the tube." He has the laryngoscope in one hand and an endotracheal tube and stylet in the other. He rips open the stylet package, inserts the flexible wire into the tube, and lays at her head, on the living room floor, on his stomach. He quickly shapes the tube into a graceful curve, the inserted wire holding the shape. Brian cranks her mouth open, the blades of the scope slips past her tongue.

He's looking through a fiber-optic eyepiece. "Cords!" I've never heard this announced by a medic inserting a tube, but I assume he sees her vocal cords, a critical factor in the successful placement of an ETT. It's in and Brian is trying to pull the stylet out of the tube, but his fingers are slipping on the plastic, threatening to pull the whole thing back out. I grab the loop of the stylet, as he holds the tube with both hands, and the wire comes out easily. A syringe inflates the cuff at the tip, and it's in.

Before the BVM is connected to the tube, Brian slips a short collar over the end. This collar is connected by a long, spaghetti-like hose to the monitor, screwed into the capnography port. The monitor generates a wave form, either on the screen or a printed chart, allowing the medics to observe their interventions' effects on the respiratory efficiency of the patient. The bag-valve assembly slips onto the collar, and I commence squeezing. Brian borrows my stethoscope, verifies that the tube is properly place.

"That's two minutes." My captain is timing this code with my watch's second hand, the clasp of which I had struggled to release through my glove. It's on a doily-draped table, and he's been glancing at it, between notations on the patient report.

Four minutes

Brian calls to stop CPR. "Check for a pulse."

Several arms reach for the woman's neck, competing for the task of palpating her carotid artery. Randy wins, "I've got a pulse..." His fingers rest a moment on her throat. "Sixty-four."

Eric turns to address the husband, perched on the couch across the room. He was in the kitchen, hyperventilating, when we arrived, and I don't know how or when he moved past us, to his current vantage point. "Sir, we have a pulse!"

"Is that good?"

"Yes, my friend. That's very good."

"I See Drunk People..."

"Hey Buddy." I shake his shoulder, firmly. "HEY BUDDY!" He's slumped in the stall, pants down, on the shitter. A small gash seeps on his forehead, probably from hitting his head on the toilet paper holder. A laptop case lies at his feet. Outside, behind me, several police officers and my crew chat in the train station restroom. My right hand seeks a radial pulse... ah, there it is. Not dead. My left hand cracks the ampule of ammonia inhalant, soaking the wrapper with pink foulness. I hold the sachet under my patient's nose for a long moment. He gently bats at it, the vapors plumb the depths of his addled mind. We call them Silver Bullets, the only tool for the job of rousing the poisoned, intoxicated, unresponsive zombie. At last, the odor finds purchase on his brain and pries the stupor out of the way, like a heavy door.

"Cut that shit out, man!" He swats again, this time his hand is pushing the ammonia away. I pull it away for a second and then firmly press it under his nostrils.

"Wake up. What's your name? Talk to me."

"Whatdaya want?" His eyes are open, unfocused, he grabs my hand. I withdraw, replaced by a police officer. A rambling conversation ensues. "Oh, a few beers," he allows. Humorless chuckles from the crowd. The station is closed. He is drunk, broke, homeless. A plan is formulated. I'm gloved up, closest, least senior; it falls to me to hoist his drawers, get him moving to a bench outside the men's toilet. This is, in fact, more difficult in practice than theory might predict.

He can barely stand, his pants are still fastened, belted, and catch on his skinny hips. He sways, I lift and steer him past urinals, sinks, out the door. His bare ass is covered by his coat, but I keep him at arm's length anyway. If he collapses I'll keep his head from hitting the tiles, but I will not get poop on me.

He's on a bench now, and I wonder if the cleaning lady who found him will scrub the oak after he's gone. The police are asking him questions again, while I collect vital signs. Does he have a medical emergency? Where does he want to go?

He wants a place to sleep, and the fire department is not needed. I pack up my kit, snapping the case closed, clack, clack. We stride out the doors, into the autumn night, to our idling fire engine.

Several times a day, miscellaneous fire department vehicles are dispatched to man down calls, usually called in by a well-intentioned driver with a cell phone. These alarms are routed to Fire instead of Police, despite an historical record demonstrating "man down" equals "public intoxication." Aid cars, engines, ladder trucks roll up on the address, searching for the patient, taking clues from the information relayed by the (frequently confused) passerby. Frequently, no patient can be found, or a blast from the air horn rouses them from their nap, and they move on, to seek a more private retreat. But, more often, we find ourselves standing above a drunk, shaking him by the shoulder, reaching for the trusty Silver Bullet.

In addition to blood pressure, pulse, and respiration rate, we assess our patient's level of consciousness, as a matter of course. If he answers questions appropriately, he's alert. As his LOC decreases, a response may require shouting or painful stimuli. Genuine unresponsiveness, an emergency in itself, makes the situation, instantly, more serious. Our assessment becomes more critical, and, in certain circumstances, perhaps a tad cynical.

It's not unheard of, to be called for a Police incident in which the subject suddenly goes limp, feigning injury or illness. In EMT school, we were taught to grind our knuckles vigorously into the sternum to elicit a response from the verbally unresponsive. It's old school, and requires no special skill. The sternal rub might reveal the BS in the BLS (Basic Life Support), but it looks bad when executed properly. "Why would that nice firefighter hurt that poor man like that?" an on-looker might ask. Try doing it to yourself, and see how much effort it takes to provoke a grimace. A better technique is to place your fingers behind the jaw, at the neck, and dig a finger into the hollow on both sides. This is innocuous, appearing to the casual observer as a tender, caring touch. Alternatively, a limp arm can be lifted over the patient's face, dropped, and observed. The arm of a patient faking coma will not hit his face, but falls adjacent to his head.

We go on these calls on the off chance that a real medical emergency has occurred. Last night we were dispatched to see a woman at a bus stop. "Unconscious, breathing, pants around knees." We arrived to find her draped sideways over the bus stop structure, bare butt in the air. Handing off an ammonia sachet, I sprinted to fetch a blanket from the rig, while Randy, our driver and former paramedic, checked her carotid pulse. I returned to find my captain and Randy lowering her onto the sidewalk. I covered her nakedness with the blanket and Randy set up the bag valve mask to assist respirations. He asked for an oral airway, a curved beam of plastic, "H"-shaped in cross-section, that keeps the back of the throat from collapsing, and closing off the air supply. She didn't gag on the device as it was twisted into position. That's a bad sign.

An empty bottle of vodka lay on the grass where her head had rested, and pills were found in her purse. Her clothes and shoes looked reasonably expensive, not the usual man down attire. Medics arrived, an IV was started, Narcan administered. One of the medics expressed doubt that the Narcan, a anti-narcotic, would have, with this patient, its magic effect. Sometimes, it sucks to be right. After they tubed the patient, I drove the medic rig to the ER, the engine following. We don't know what happened, we don't know her outcome. Seldom do we.

But, this I know: There will be man down calls. I make sure the kit is always stocked with barf bags and Silver Bullets.

Conversation

I'm secure enough to admit that I have a bit of a shoe fetish. Shoes rank right up there with beer, manners, and proper hygiene - that is to say, something on which I expend some mental energy. Not in the fussy, dapper way some men contrive their appearance, just so. More like the relationship between a carpenter and his favorite tools. And after seven various minor surgeries for ingrown toenails, I can authoritatively state that good shoes are proper hygiene.

With my big, meaty, wide, "Yaba-Daba-Doo!" triple-E twelves, I have come to value fit over fashion. At one point, I had more than twenty pairs of Birkenstocks in the closet, under the bed, and under foot. You'd trip over them, piled like firewood, upon entering my house. Lest you judge to harshly, too prematurely, I should disclose that I was managing a Birkenstock store in Seattle's University District at the time. I amassed my collection at significant discount. Still, the label of fetishist probably sticks well before twenty.

An annual ritual, Mom would return from J.C. Penny with spanky back-to-school garb (think Beaver Cleaver chic), and a new pair of Chucks. Charles Hollis "Chuck" Taylor joined forces with Converse Shoes in the 1920's, promptly redesigned their basketball shoe, signed it, and dubbed it the Chuck Taylor All-Star. Constructed of rubber and canvas, in low and high-top versions, these "gymboots" have become the best selling shoe in history. I would snatch the shoe box, and bolt out the door to find my friend Matt, a virtuoso in the art of breaking in new sneakers. We'd soak them in water and roll them in dirt, grinding the mud into the fabric, scuffing the white rubber toes and outsoles.

These days, Chucks are made overseas in factories owned by Nike (so I'm told), and no longer constructed with two plies of canvas, but remain essential in their form. I found some on sale last January and bought two pairs, mixing the black and grey, keeping a mismatched pair in reserve. Occasionally, my odd shoes are noticed in the locker room at station 41, with two-dozen firefighters at shift change. The minority opinion consists of agitation, confusion, disapproval. I explain that Converse means opposite or reverse, left vs. right, black vs. not black. This seldom furthers my case for individualism, and usually results in head-shaking and a cautious retreat.

But, they still feel right. I can walk miles in my All-Stars, the flat sole flapping down the sidewalk, the heel squeaking a little as my foot lifts. I like them knotted low, and jam them on like loafers. During the sockless season, they get washed frequently, and emerge from the dryer hot but still damp, stinking of rubber and canvas, evoking memories - shoe stores, gym class, the excitement/dread of a new school year. Olfactory memory resides in a powerful corner of the brain, and the ghosts of these experiences spring forth fully fleshed-out with the emotions of the moment. But now, a new memory, a recent memory, a happy memory, competes for my attention when I get a whiff of All-Stars - fire hose.

Your bread-and-butter fire hose is constructed from a rubber tube and fabric jacket, similar to the Converse Chuck Taylor shoe. I am sure, in both cases, that the particulars of the materials employed have evolved a little over the years, but their essence remains the same. Both are unrelentingly robust and reliable. Both require periodic washing to prolong their service life. And both smell the same when wet.
You will find us rolling a thousand or more feet of hose after a good-sized house fire, stooping to start the coil, straining to carry another dirty length to the tailboard. Back at the station, we replace the missing hoselines on the engine. We unroll the fifty-foot lengths of soiled hose, laying them out in parallel rows on concrete apron, and wash the grime from the fabric. The washed hoses are doubled and hoisted into the hose tower, hung from the bars where they air-dry for days. One of our Saturday station chores is to lower any dry hose, re-roll it, and arrange it on a rack, like so many books on a shelf, until needed after the next fire.

I'm drawn to hose towers. They usually contain tools, supplies, and flotsam from the fire station collects there, in lieu of a proper hook or shelf. Spare bunks, giant squeegees, brooms might hang from a pegs. Washing a fire engine begins and ends with a trip to the hose tower for the bucket, soap, and brush. Some towers double as a drill facility, and the ladder, to the hose rack at the top, intersects steel gratings pretending to be floors in a building. The ladder is, at best, perilous, at worst, outfitted with some abominable safety belt that slides on a cable, and sanitizes the visceral thrill of the climb. My preference is for a window at the peak, from which you can scan the neighborhood for smoke, or shoo pigeons for sport.

As I drive around, tooling along back roads or side streets, I occasionally spot an old fire station, converted into a garage or re-purposed for the city or county. The hose tower, an architectural feature as distinctive as a steeple, always gives it away. I dream of living in an old fire station someday, with a brass pole, and a hose tower stacked with books. An antique fire engine might drip its fluids quietly, slowly greasing the floor, and I will be cautious - Chuck Taylors, Chucks, are positively dangerous on an oily floor.

Sweet Dreams

We are winning the race, my partner and I. Our jack is not your standard Safeway-issue model, this is a racing pallet jack. Bright yellow, with handles for carrying up the stairs in this epic steeplechase event, but still heavy for two men to lift. On flat terrain, one steers, the other pushes off. We alternate propelling it, but rules dictate that three feet must be on the jack whenever it is being scooted. Our legs strain as we tromp side-by-side up the endless steps, lugging our load in the dark. Sponsors' stickers adorn its vertical surfaces, non-slip tape on the forks. Our thin lead is but seconds, and the next team is hot on our heels. I can hear their panting below us, as they ferry their pallet jack...

Dong-ding-dang-dong

The distant notes descend the scale, reaching down, pulling the curtains across the strange screenplay in my brain. Hunh? 'zatta call? I place my hand over the pocket of my gym shorts. Buzzing. Aw, crap. "Engine forty-one, BLS..." I throw off my unzipped sleeping bag, shuffle into my clogs, and strain to comprehend the words on my pager, glowing teal in the dim ward. My eyes won't quite focus, so I try to recall the dispatch moments ago. Somewhere on Puget Avenue... I'm not driving us there, and that's more than I need to know right now.

My bunker pants wait beside the engine, pushed down around the boots, suspenders splayed out around the feet, ready for disaster. Holding the boot loops, I jam my feet in, wiggling into the heavy trousers, flipping the straps over my shoulder with an exaggerated shrug. As I climb up, I peer around my seat at the computer screen, glowing atop the pedestal to the left of the Captain's seat. Unknown medical. I'm awake now, and mentally preparing myself for the worst: heart attack, stroke, miscarriage...

Our trip is short, less than a block. As we roll on-scene, I hop out and pull the aid kit and O-2 kit from their cubby, behind my seat. Cap'n's saying something from the cab, out his open door, something I can't quite make out, over the idling diesel.

"Schlem! Code Green," he repeats. A young woman is standing in the entrance to the veterinary clinic, holding the door open, her hair backlit in a wild halo.

"Sorry!" She waves.

I don't wonder at how we were called to the vet's office at 0530, but I'm happy to head back to the station. We put the engine away, readying our gear for the next call. Back in my clogs, I scuff up the stairs to the ward. Chief's up, and the smell of his excellent coffee is calling me, in a round, roasty whisper. Up the stairs. I can still get one more hour of sleep. But I don't. For fifteen minutes, I wait for a mantle of relaxation to pull me down. I finally get up and resign myself to a great cup of joe. I kick my clogs back on and hope there's still half-and-half.

Sleep has become a dirty word in the fire service. The realities of protecting life, property, and the environment, twenty-four hours a day, necessitate that firefighters occasionally go without sleep. The City's taxpayers resent paying us a union wage while we sleep. Our administration is skeptical of the endless studies correlating sleep loss with health and safety problems.

Our schedule is the envy of civilians, about eight days a month, not much more than the accepted forty-hour work week. That's at least twenty-two days off, if you aren't blessed with an, increasingly rare, overtime shift. The danger inherent in our work led our union, long ago, to negotiate regulations that protect us from working too many hours in a week. Regulations also prevent us from working more than twenty-four hours in a row, excepting a disaster like fire, earthquake, or UFOs landing at the courthouse. Sleep loss compromises your ability to make decisions, drive fire engines, and, we've since learned, increases the risk of obesity, diabetes, and cardiovascular disease. And a busy, sleepless night will also destroy the following day, a day off, a day of plans, time with family or children.

But, for many firefighters, every night is a busy night. Sleep disorders are a common side-effect of repeated sleep interruption. Years of waking up two, three, -six times a night can shatter the gears of the internal clock governing the normal cycle of day-time waking and night-time sleeping. Once awakened by an alarm, emergency or not, these firefighters do not drop back into the restful slumber they need. Every shift has its night owls, firefighters who spend the night in a recliner, channel surfing, unable to sleep. Others find that the communal noise of the ward keeps them awake. It's no coincidence that difficulty sleeping, sleep apnea, and snoring all share the firehouse dormitory. When the subject of snoring comes up, I guiltily redirect the conversation.

Luckily, we still have a tradition of naps in the afternoon, a secret, not widely advertised. After lunch, time allowing, captains close their office doors, pipemen, drivers flop into the Laz-E-Boys. Blankets are tucked up around shoulders, eyes closed. The possibility of being up all night is a persuasive argument, but I'm seldom sleepy enough to make it happen. Recently, I began trying to nap the day after I work, usually through lunchtime, and it makes the remaining day more enjoyable. Occasionally, I'll crash for four hours or more, a luxury when I can pull it off.

In the station, at bedtime, a switch is flipped from Monitor to Alert, usually by the probie or least-senior man. The ubiquitous background of fire department radio traffic is switched off, unless a rig in your station is dispatched, in which case, tones are audible by everyone in that firehouse. A given rig may not roll on a given night, but when someone else goes out, all are roused.

We are seeing progress in our department, though. Walls have been erected in the largest wards to shield sleepers from their neighbors' noise. There is increasing talk of segregated crew quarters, isolating individual companies from irrelevant tones, and the disturbance of people coming and going from a shared sleeping area. A couple of our stations house only one company, and there the sleep is better, but that duty is generally meted out to senior members. It would be nice to have that kind of experience in the larger stations, with a dynamic collection of characters in the daytime, but peace and quiet at night.

In high school, I learned a trick from my best friend's mom. She spoke of seeing colors, lights, when she went to sleep. I didn't understand what she was talking about at the time, but now I do. The rods and cones, on the retina, fire randomly when your eyes are closed. Easy to ignore, they form random shapes and patterns, swirling, floating, when you allow yourself to see them. If you relax, your mind will impose sense onto the image, like finding pictures in the shifting clouds. You may find you need to clench or rub your eyes to start the show. It's very relaxing, and very distracting from the day's events and concerns. It's my experience that the hind brain soon takes over, segues into unrelated visions, and usually into sleep.

I know I'll sleep well tonight, I'm tired, and I have a race to win.

International Association of Fire Chiefs' report on sleep deprivation

Passing

"Medic forty-six, Aid forty-six, Engine forty-six, ALS, cardiac history, witnessed collapse, CPR instructions being given..."

We might be shopping for groceries, or dinner may already be on the table. We might be snug in our bunks, living beautiful invented lives, in our dreams. When the call goes out, and the tones go off, we scramble to our rigs, abandoning whatever we were doing. There are calls, and there are genuine emergencies. Chest pain is right up there, but a collapse with prior history is a red alert. We move faster, we drive faster, and when we arrive, we run up the stairs. We trot, panting, into the living room or through the kitchen, taking clues from family, finding our patient, assessing him even before we touch him with our gloved hands.

We arrive first, in the aid car, at the address in the mobile home park. A worried, but calm, woman meets us at the door and directs us in. This guy is in the bathroom, a common enough place to have the big one, so frequent, it's become cliche. He's a dark purple-blue and not breathing. I drag him, by his wrists, into the living room, where we will have room to work this patient, surrounded by panelled walls and knick-knacks. We cut off his t-shirt, and this guy is fat. His belly rises above his chest like pregnancy. I start compressions and my partner fumbles for a moment with the AED, the automatic external defibrillator that we carry in our EMS kit.

Our new protocol dictates two minutes of CPR before delivering a shock, via the AED. This is a marked change from how we did things in the past. Our instincts and training have always told us to get a shock on board as fast as possible. Now, we are trained to slow down a bit, to perform good CPR, give the heart time to flush out metabolic toxins, in order to maximize the potential for life-saving conversion to normal sinus rhythm. It seems to work, too. My buddy, Mike, on engine 43 brags about a three for three save rate since the new protocol.

"How 'bout some oxygen?" I suggest this kindly, keeping count in a corner of my mind while I form the words. He hooks up the bag-valve mask to the Oh-two regulator.

The medics arrive with the engine company. CPR is hard work, and like any difficult task, we throw manpower at the problem. I'm only into a minute of compressions, and the extra hands ready the monitor, a fancier AED, placing sticky electrodes on shoulders and legs, the large patches on the chest. Tools, medications are readied. One of the medics tries to tube our patient, to put an endotracheal tube into the lungs, a patent airway, a guarantee that we can deliver ventilation. Hands off, I cease compressions to minimize movement. The other medic is trying to find a vein in the elbow, Chad, the pipeman on the engine, assembles the IV tubing and bag of saline.

"It's in!" I place my hand on the big round stomach and feel bubbling as the air is forced down the esophagus, as the BVM is squeezed.

"Feels like it's gastric," I state, wondering if that makes sense. A stethoscope on his chest confirms it, no air is moving in the lungs, the tube is in the wrong hole. It's pulled out and I resume CPR, but we are having difficulty getting air into the lungs without the tube.

"Clear the patient, analyzing," we move back, not touching the body, the monitor recording the absence of electrical activity in the heart. There's nothing to shock, no uncoordinated contractions, no sign that this heart is fighting to survive. "Resume CPR."

Chad takes over compressions, a medic calls the doc at the hospital, laying out the details of the code. He lists the patient's history, medications, interventions, waits a moment, listening, and hangs up. "Stop CPR. What time is it?"

Family is comforted, explanations offered. The body is covered. We pick up the garbage we generated, scattered on the floor. We shuffle our gear outside, leaving the Captain and medics to express our collective regrets.

I've been party to this drama repeatedly, and the tone is usually the same, a hushed reverence when someone ceases living. We habitually distance ourselves from our patients, relating to them as a problem to be solved. We do our best, and, in the end, if it's not enough, we usually shrug it off as that guy's time to go. But deep inside, we know that this man, this woman, had a life before they died, and they leave a hole, however small, after, in this universe. It's a privilege to be present for that pivotal crisis, when a person is facing certain death without our skills. We don't know the past, we can't know the future, but we are there, in that moment, to help.

I attended a memorial this week for my (ex) step-father. It's a complicated relationship to explain, but wasn't in life. He loved me and everyone in his extended, blended family. I went, reluctantly, knowing I'd be facing down a lot of ghosts. My kids were there with their mother and step-father, and my son sat with me. Former in-laws, lost friends, all present in the church where I had been married twenty-two years ago. Family animosities, arguments, and ambivalences were pushed down below the level of the solemnity of the ceremony. We laughed and cried and hugged. I had some cookies and caught up with people I will probably never see again.

Wayman died from a terminal cancer. He didn't pass in a chaotic, heroic minute, it dragged on for weeks, then months. I'm sure he received the best possible care from doctors and nurses during that time, but I wish I could have been there for more than a phone call to Florida. He had a long full and happy life, and we all miss him terribly now.

I'm tired of attending funerals, tired of shaking out my Class-A uniform. I know, as I age, this is only going to get worse.

A Comic Book Model

"I can think of no more stirring symbol of man's humanity to man than a fire engine." -Kurt Vonnegut
Before fire brigades came into being, whole communities could erupt in flame, the conflagration spreading like the wild fires that plague California and western forests. Then someone had a better idea: "Saaaay, what if we picked some guys... Gave them, um, buckets of water! ...and they would extinguish fires before they consumed our town? Whaddya think? Huh? Huh?" Or something like that.

Since that moment, Fire Departments have become entities with a broader mandate of disaster mitigation. Car wrecks, heart attacks, funny odors - who you gonna call? We regularly, daily, roll on the report of a "man down", called in by a helpful Samaritan, universally a malt-beverage-enthusiast napping in the shrubbery. We drill for the predicted, and inevitable earthquake. We have a tractor-trailer stuffed with sensors, equipment, and rubber suits waiting for the tanker car carrying methyl-ethyl-mess-you-up to derail in the switch yard. If you are in a trench, installing pipes or cabling, and you should find yourself suddenly in a cave-in, buried in glacial till, we have a plan. All this official and professional worry is financed by your tax dollars. We are the City's residents' insurance policy.

Our training, equipment, vehicles, and responsibilities necessitate a certain cost to the City to effect our mission. This necessary investment in social services, schools, police and fire departments, roads, water and sewage systems, hospitals, are a hallmark of civilization. We, long ago, signed a compact acknowledging the benefit of taking care of each other. It costs money, real money, money that people grudgingly pay with their mortgages, cars, businesses, and lesser purchases. Someday, somewhere, you will need the safety net that society provides. The fire engine (or police car, clean drinking water, public transport) is the incarnation of an ideal, rooted in the greater good, the assurance that help is at hand.

We are a force of good in a harsh and indifferent universe. One of my favorite captains, thirty plus years-on, we call him Uncle Ronnie, once told me, "When you start hating your patients, you start hating your job, and it's time to go." He's right, there are guys on the job who suffer from this creeping cancer, it poisons every public interaction, and there is only one cure. It's not our job to judge or select our customers, no matter their emergency.

So, can you really blame the family with a feverish child, lacking a trusty pediatrician, and the funds to pay her fees, for dialing 911 at midnight? They (or their better-off neighbors) pay our wages, buy our shiny fire engines and aid cars, and they know we will come. We stomp up the stairwells, knock on the doors, find the patient, collect vital signs, and arrange transport to the hospital, all for the price of a local phone call. There are system abusers and it's a tired cycle. Cynicism creeps into our conversations en route to these calls, friendly wagers are laid on the weight of the patient, the number of floors back down to the ambulance. But we come, we help, and it feels pretty good.

There exists a pernicious notion that fire departments can profit (at least in WA state) by billing insurance companies for the transport of patients. Utter dreck. The private companies that subsist on this commerce have optimized for this business by offering fast-food wages, exploiting high turnover, specializing only in patient transport. This can't scale to an organization whose charter is to "protect the lives of our citizens, their property, and the environment".

We shan't be in the business of padding our budget, it compromises our values and fosters inappropriate decision-making. Consider one example: the aforementioned feverish child. EMTs find no critical medical issue, just worried first-time parents. The clinic is open tomorrow morning, and the parents have transportation. Should we coax them to accept a ride in our aid car to the emergency room, at a cost of $600 or more, with the expectation that the fire department makes a buck? Most guys wouldn't (largely for selfish reasons - time, paperwork), but there is a potential for compromising our values. I reject this idea absolutely. A fire department cannot be a revenue generator, it cannot taint it's mission statement with the footnote of "*and make a few bucks!" There is no nobility in seeking a reward for service, it should strive to operate simply: you call, we come, we help.

All of which leads me to a digression, perking in my brain for years. It is impossible to not be familiar with, what I'll call, the Comic Book Mythos. The media has fully inoculated us with stories of Spiderman, Superman, Batman, and a pantheon of other superheroes, their struggles with Evil, personal conflict. For every Hero, there is a mob of anti-heroes, bent on selfish goals of world domination and financial gain. Just when Batman defeats the Dr. Octopus, the Joker arrives on the scene, spreading his mayhem. A superhero can't get a break, there's always another crisis! To boil it down, the Superhero is focused on the welfare of society, the greater good, the Villain on power and his bank account. Good vs. Evil, Love vs. Hate, altruism vs. self interest.

Further, it's been explored in legend, books, and movies that Good cannot exist in a vacuum. How can you know Good without the manifestation of Bad? Life on this blue planet wavers between two extremes, with happiness and contentment on one side, bankruptcy, death, and extinction across the way. It's called the drunkard's walk, made famous by the paleontologist Stephen J. Gould, and, to paraphrase, the goal of game is to maximize the amount of time you stagger down the sidewalk, before you eventually stumble into the street and are hit by the cosmic bus. Heavy stuff, and I wouldn't bring it up if I didn't believe that we can influence the duration and quality of our sojourn around our sun. We can, by voting for the ideals that further civilization, by electing candidates that will make things better.

This is fully my opinion, and I equate the Democratic ethos with Superman, the Republican's with Lex Luthor. I know it's a broad stroke with which I paint this landscape, and I'm speaking here of collective values, not the exceptional individual who crosses party lines (and maybe that's an argument for the unelectable Independent). Of course, it's not the perfect analogy, but I think it's fairly solid. So please consider carefully this November, when you make your choice.

Be a hero, vote.