"Mabel"

Aid 42 was dispatched to a tidy brick Tudor, in the north end of the City, for a Lifeline alert, 85 year old female, assist up. We are searching, in the dark, for a hidden set of house keys. On arriving, we had received supplemental information, via the data terminal in the aid car, instructing us to retrieve the keys from under a loose brick in the "fire pit". A survey of the brick fireplace, positioned at the corner of a slimy cedar deck, revealed nothing but secure, well-mortared masonry. A chain-link fence crowds the brick structure on two sides, and I wedge my bulk into the gap, fingering the few broken bricks on the ground, finding nothing but spiders underneath.

A call for an Assist Up is not an emergency, but if we can't find the keys, we will have to force our way inside the house. Prying a door open with the Halligan bar causes certain damage to the framing, costs the homeowner money, and, most importantly, if the keys are here, makes me look foolish. This is taking too long.

I stand up, "Here, take the flashlight. Try looking inside the fireplace." A pair of door mats are draped over the front of the outdoor fireplace, and Eric flips them out of the way.

"Got 'em." I'm still wriggling out from behind the brickwork, but I hear them jingle in the quiet night.

The backdoor unlocks easily enough, but the entry to the kitchen is barred by another locked door. The keys are corroded and all three, tried in turn, resist sliding into the keyhole.

"Dang it. Let's try the front."

Eric fumbles with the keys again, and, when he runs through the whole set a fourth time, I am tempted to snatch them out of his hands in frustration. The door, however, finally swings open with a creak. Secretly, I suspect that we could have gone through the back door.


There are some interesting, parenthetical aspects of this career. Aside from meeting people, (occasionally lucid) in various states of undress, or finding yourself, unknowingly, in a conversation with the deranged, we are invited to enter people's homes, suddenly, and without advance warning. When Grandpa has the crushing chest pain, Grandma probably isn't going to take time to tidy up. We might find a terrified mother, holding her post-ictal child, surrounded by diapers, toys, and laundry, the whirlwind chaos of her family's life. It's tempting to judge people by their housekeeping, but there are days when I know I could not suffer such scrutiny gracefully.

Hygiene, however, is fair game. I've been in homes (plural), where wheeling a sick person out the door on the gurney required a forward spotter, directing your steps around the numerous piles of dog shit on the carpet. Then there's the recent legend concerning a mad woman, living on her own, in a ramshackle house. Someone called 911 on her behalf, and the responding fire engine crew discovered a complete dog's skeleton on the floor, behind the couch. Decomposed, over time, in situ. Yurph.

Another frequent facet of this job is repeated visits to the same address. Often, this is the hallmark of a system abuser, exploiting the fire department's mission, in a quest for pain killers, "free" rides to the hospital, or maybe, simply, some attention. The Department continues to refine its policies for dealing with this problem, but one abuser is eventually replaced by another. Sometimes, though, a repeat visit is the eventual product of probability, or just plain, dumb, bad luck.

A few weeks ago, working on Engine 41, we were dispatched to a fall: possible leg, hip fracture. We found our patient, flat on her back, on an icy deck behind the house, shivering beneath a heavy overcoat and assorted blankets. When she told us her name, the same as someone else I know, I remembered seeing her a year ago when she broke her ankle. This time she had slipped, and, evidently, broken her femur in the fall. Normally, the femur is a tremendously strong bone, and typically breaks during incidents involving a tremendous transfer of energy, like an MVC, a motor vehicle collision. This lady, however, possessed both tremendous bulk and an unfortunate osteoporosis. Given the realities of pulling traction on her leg, on a frictionless surface, and hefting her, first onto a gurney, and then into the back of a medic unit, I can't say it was great to see her again. Both falls occurred outside her house, on the same deck, and the quality of her domestic management remains a mystery.

Now, with Eric, I find myself standing in another home to which I have been previously dispatched. I vaguely remember a warm conversation between my captain of that day, Uncle Ronnie, and a woman, his classmate from high school. I can't recall the reason we had gone there, but the house had been tidy, comfortable. We step into a scene entirely different from that hazy memory.

To our right, in a commandeered dining room, is a double bed. The furniture elsewhere seems to have spawned a crazy, peripheral clutter, in an effort to colonize the open space in middle of the room. On the floor, between a walker and a wheelchair, lies an elderly woman, like a placid turtle, on her back. We bend over her, like vultures over carrion. She is surrounded by scattered envelopes and papers. I speak slowly, loudly, "Are? You? Alright?" She nods happily. "What's your name?"
Her name is Mabel, and in a heartbeat, she is in our hands and hoisted to her feet. Her Lifeline pendant, a sleek medallion, dangles around her neck. Touching the button alerts a dispatch center which responds by calling back to the home through a (loud) speakerphone. Lifeline undoubtedly handles most of their false alerts, but when they can't determine the problem or contact the subscriber, they call us. and we half-expect to find nothing seriously wrong when we arrive. This is looking to be just another Assist Up, but when she reaches, teetering, for the walker's handles, arthritic hands shaking, clawing, my concern increases.

"Are you sure that you're okay?" Her spine is bowed almost horizontal at her neck, and I'm on one knee, at eye level with her. "What happened?"

"Oh, yes. I just fell while I was... I was maneuvering." She smiles a broad smile, and I'm reminded of a jolly Jack-O-Lantern, her missing teeth outnumbering the remaining ones.

I ask her to squeeze my fingers. Her grip is weak, but symmetrical. "Are you normally...", more delicately, "Do you..." Screw it. "Is this normal for you?"

"Yes, but I'm fine." That smile again. I'm concerned about a possible stroke, but every stroke victim I have ever met was terrified by some sudden affectation: a headache, an inability to move or communicate, even voices in their head. She watches me patiently.

"Have you ever had a stroke?" A history of prior stroke increases the likelihood of future strokes, but might also explain some of the deficits we are seeing. The signs and symptoms of stroke are fresh in my head, having just delivered a stroke training module to dozens of my brothers, over the last week.

"Oh, yes. Oh-one, July. Horrible." And yet she's smiling. "My left leg don't work so good now. That's why I moved in with my daughter. She's at work til two." I look over at Eric, but he's already unpacking the tools to measure blood pressure, oxygen saturation, blood sugar. Simple assists up don't normally require the completion of paperwork, but if we take vital signs, I will need to write a report.

Do you want to go to the hospital?" The six hundred dollar question.

Oh, no. I'm fine." I want to believe her, but the circumstances smell a little fishy. A trip to the emergency room can be expensive, a trivial concern in a genuine emergency. However, lying on a hospital bed for hours, unnecessarily, waiting for attention, waiting for a ride home, these things worry me.

"Can we call your daughter?" I can't leave this woman at home if I have any doubts as to her health, and I have a few doubts. I motion to Eric to hold the wheelchair, and we move her to a seated position. Stethoscope in his ears, he inflates the blood pressure cuff with the rubber bulb in his hand.

"Well... Penny works til two. You can't call her at work. Sandra - she lives five blocks away." Her words come slowly, deliberately. (Eric announces her BP and blood sugar: both unremarkable.)

"Sandra? Can we call Sandra? Do you know her phone number?" She rattles off the number before I am ready, stressing the last two digits with a rising inflection: "Two. Niiiiiine." She repeats the number for me, and Eric jots it down on the back of his nitrile glove, smiling when she sings the last two digits again, pitch-perfect. Eric dials and gets an answering machine, but leaves no message.

I explain my concerns, and that we couldn't reach Sandra on the telephone. Mabel admits that her daughter usually goes to bed early. "How well do you know your neighbors?" I envision knocking on someone's door, trying to explain the situation, on the porch, in my uniform, but she reels off another phone number, rapid-fire, before I am ready.

"That's Annette. She lives... right next door." She repeats the number, and it's like listening to a tape recording, again delivered in the same tone and rhythm. Her memory, at least, seems to be intact.

Eric dials and someone answers. "Is this Annette? Hi. This is Eric with the fire department. Do you know Mabel?" He explains the situation carefully, stressing that we don't think this is an emergency, but we need some outside confirmation. A few minutes later, the neighbor is in the room with us, wearing a green wool jacket with brass buttons, like she just got home from church or a dinner party. She's chats with Mabel, leaning down. I watch the conversation closely, looking for signs that Annette is distressed by our patient's condition, but they shoot the breeze casually, if a little slowly, discussing daughters, weather, and the handsome firefighters in Mabel's living room. I'm filling in the blanks on my report, fleshing out the narrative. Eric packs up the kits.

Annette turns to me, "I think she's fine. This is completely normal."

We set to tidying up the mess created in the fall. Mabel has a system for keeping medications, bills, letters close at hand, much of it piled on top of a footstool, overturned when she went down. She is very particular, directing Eric to place her medications, just-so, by the phone. She keeps a glass of water, half-full, by the pills, and another in the basket on her walker.

"Seems a little precarious to me." The footstool is designed to rock and I wobble it experimentally.

"I..." She's scooting the wheelchair with her right foot, "Maneuver."

I explain the required signatures on my report, and Mabel, pen in her gnarled hand, signs with a flawless script, the kind I could never master. Annette thanks us for calling her, and after signing as a witness, offers to help get Mabel ready for bed. We say goodnight, and we're out the door.

Eric takes the kits to the aid car. I return the keys to their hiding place behind the house, in the dark, and Aid 42 is in service.