|Ducks and the Dead|
Photo Credit: Audrey
There is a wholly different feel to the morning when you come upon it from the other end. Waking up to the sun shining in a bedroom window, a person is completely clueless about the things that have happened overnight. The truth is, watching the sun come up at the tail-end of a shift is akin to watching a golden bath wash a city clean of the deviance, the debauchery, and the death that commonly hide in the dark hours of early morning. I know this now. I have been the reaper's witness on occasion, heard the crying of the family and smelled the awkwardly comforting hominess of the houses where the bodies lie. Over time I have come to conclusions about life and death and how to deal with it as a paramedic, but I haven't always had these ideas; every healthcare worker must go through a period of uncertainty and growth during which they form an attitude towards the end.
When I was nineteen years old I secured a job in the transportation department at Tucson Medical Center. I had just completed my training as an EMT-basic and was eager to get out there and start helping people. This being my first experience in a hospital, I was nervous and anxious and all the things that go along with being nineteen in your first position of any responsibility. Training went easily and I soon discovered all the hiding places to take a break. There was a small courtyard with a pond and a few tables that I took a particular liking to. It was situated directly across the hall from the hospital cafeteria, making it a natural choice for a post-lunch spot.
On one of my first days working, I noticed a small sign in the window of the courtyard which read: "Please don't feed the ducks." I thought it was an odd sign to have posted in a place where there were no ducks. I came back later that day, thinking that I might find the ducks were only there in the afternoon. They were never there. Day after day I would walk past that courtyard and never once did I see a duck. Not one. I asked various coworkers about it and the best answer I was ever able to get was a disinterested shrug. It seemed that there had never been any ducks; even Jerry, who had been there for seventeen years didn't remember ever seeing ducks, and had no explanation for the sign. Still, it sat there, posting warning to all those who ventured out into the courtyard to eat their lunch in the Arizona sun, or to chain-smoke cigarettes on one of their short breaks—hospital administration had a clear policy on the subject of ducks and the feeding of them.
One of my many duties as an EMT transporter at the hospital was to move patients from one place to another. Often these destinations were testing areas, or rehabilitation centers within the hospital. Other patients would need to be transported off hospital grounds to receive either treatment that was not offered at TMC, or to be taken back to the nursing home they originally came from. Also, I had the responsibility of taking people to the morgue. When a patient expired, I was responsible for taking the body there.
The morgue was locked with a combination and a key. Inside this door was a small room with cabinets lining the walls, and to the far left was a thick metal door, just like the doors I'd seen leading to a walk-in cooler in the back of a restaurant. This door was again locked with a padlock, and within, there were four metal carts. These carts generally held one body apiece, though when the morgue was particularly full and the local funeral homes were overworked, it was possible to double up, keeping as many as eight bodies at once in the small walk-in. On the right side of the cooler there was a shelf at about the height of an average person's head where dead babies and miscarried fetuses were stored. There was also a red plastic trashcan lined with a red biohazard trash bag. This was for the purpose of dumping amputated limbs. Although all bodies were kept in body bags and weren't directly visible as human, it would have been immediately evident to anyone who stumbled across it that this was not just any walk-in freezer, and that if you were looking for food, you had made a serious miscalculation.
On the door of the cooler there were two signs. One was meant to remind those who might forget that these people had families and that one should treat them with respect. The other sign read as follows: "You must put all bodies back in the cooler. If you cannot do so, you must find someone who can." I always wondered if this was a problem. Had someone walked into the front room of the morgue to find some poor old bastard lying on the floor? Was there an incident of an employee who thought it would be amusing to pose the bodies, perhaps sitting at a card table, playing gin? I always imagined them wearing party hats—I don't know why.
I was sitting in the duck-free courtyard one afternoon after only a few weeks of working at TMC when my pager went off. There was a patient who needed moving, and I needed to call the hospital's automated phone system to find out the specifics. It turned out that a man who had been a patient in the ICU had died, and it was now my job to take his body to the walk-in cooler. When I arrived in the unit I found that I would need some extra help. The man, only thirty-four years old, had weighed somewhere in the neighborhood of four-hundred-and-fifty pounds and it would be quite impossible for me to move him on my own. The nurse who had been caring for him while he was alive said that she would help me, but it was obvious that we would need more than two people.
I used the automated phone system to have several of my coworkers paged and sent to my location. We then proceeded into the room to help the nurses place the patient into a body bag.
Something about body bags that most people don't know is that they come in different sizes. They range from small to extra-large—we were all out of extra-large.
Problem solvers that we were, we decided to place a sheet under him, and another on top of him, tying the two sheets together at the corners, above both of his shoulders. When my backup arrived, we placed the man on the cart designated for this kind of thing. It was a struggle to move his massive weight, but there were enough people there to help and we moved him without enormous difficulty. Once transferred and covered by the green canopy which prevented the general public from being exposed to the pale grayness of death, we walked the body down the halls to the double-locked door. There were six of us and we flanked the stretcher three on each side, walking with it like Secret Service men walking alongside the President's limousine. It occurred to me that this was probably the most important this man would ever appear.
Once in the morgue, we were faced with a problem. The body bag serves not only to retain the dignity of the dead, but as a functional tool, something for us to grab onto while sliding the body from one cart to another. Without a body bag, and with our numbers fewer than they had been in the ICU (two nurses helped with the move), we were forced to grab arms and legs, and one unfortunate person had to slide her hands under the man's shoulders.
We were poorly coordinated, and there was an attempt to move him before everyone was ready. The jostling of the body caused his left arm to fall, landing the hand squarely in my groin. His limp, cold hand gently cupped my scrotum through my green scrubs. Had I not been so mortified at that very moment, I would have described the nature of the touch as caring, even loving.
I leaped back, screaming much like a twelve-year-old girl.
Though I was told many times that my reaction to the incident was hilarious, I had a hard time finding the humor in it. I claimed that we should not laugh about the dead, that there should be more respect.
"Listen, this guy is dead and he was only like thirty-four years old. We should have more respect." I said to them, trying to break in between fits of their laughter.
"Oh come on! You should have seen the look on your face, man!"
I was surprised then, and still am by my reaction to the situation. I was still a kid. I had graduated high school and done some traveling, but the real world was still new to me. I wasn't completely comfortable making any kind of moral stand, especially in a new job where I didn't know many people well. Looking back on it, my reaction was more out of embarrassment than personal beliefs—to be honest, it must have been pretty funny to see.
Life in the hospital is cyclic. One week there would be nothing but morgue run after morgue run, and then the next week we would have nothing but pregnant women to take to testing centers. Throughout every cycle, though, the movement of the place itself continues uninterrupted, as if this ebb and flow of life and death meant absolutely nothing to the great community that was Tucson Medical Center. Every day I would go to work, and everything was always the same. The cafeteria served the same food, the nurses had fixed shifts so there would always be familiar faces in every unit, employees had meaningless and banal conversations, people continued getting sick, and relatives continued to visit them.
There were only a handful of places that people could go to relax during our long shifts. Naturally, the cafeteria was one, and there were scattered break rooms in the different units, but the place I made my own was the courtyard. I spent many of my breaks there, usually excluding myself from the social groups and sitting alone in the shade, smoking cigarettes and thinking about the things that happened at this strange place. Whenever I was present for the end of a life, or witnessed something particularly bloody in the emergency room, I would retreat to the courtyard and reflect on how I was affected. It was also the place where I was beginning to form my own opinions on life and death, and the healthcare field. Everyone in medicine eventually comes to conclusions about the mortality of others. It's a necessity, really. We see it so often, we would be lost or burned out or worse within a few years if we didn't come up with defense mechanisms.
On the occasion that I didn't feel like excluding myself and desired social contact, I would sit with coworkers in the cafeteria or one of the other small patios at the hospital and tell stories about the "gross" things we saw. We would joke about the patients, talk about smells and sounds that people on the outside of medicine never encounter. The infamous "code-brown"—what we called it when a patient defecated in their bed or their pants—was a typical subject, along with other body fluids and the stains they had a tendency to leave.
"We had this one guy, like, six months ago. It was so fucking gross…" Rikkie, one of the other transporters who always had some story to tell, began one of her personal favorites.
"What happened?" I asked, pulling a pack of cigarettes out of my pocket and leaning forward to hear her better. I was sitting outside with Rikkie and Jesse. I had known them both since my first day at the hospital. Jesse was my trainer during my first week, and she and Rikkie were close friends. Often, when I spent time with anyone, it included at least one of these two.
"Wait just a fucking minute and I'll tell you." Rikkie said to me, cigarette in her mouth. She paused the story to light her second Marlboro 100 in a row. She was young, only a couple of years older than me, but already had two children. She had reddish-brown hair that was usually unkempt, and she was skinny. She talked like a sailor, using profanity to accent most of her sentences and was obsessed with sex.
"Right. Sorry." I said, looking down. I was always a little intimidated by Rikkie.
"So this fucking guy, he was some homeless dude, and he came in to the ER. I think he was here for an infection on his balls or something. Anyway, when they looked at it, the sore was so bad that they had to lop off the whole package. There were even maggots living there, right there at the base of his cock. Stupid fucker didn't even know they were there. He kept asking if the nurse was tickling him." She talked as if the man had intentionally lost his penis, and that it was a great personal hardship for her to have been involved with this patient.
"Are you serious?" I asked, realizing how na´ve I must have sounded.
"No shit. Honest to fucking God." Rikkie said, crushing her cigarette out on the ground and checking her pager. "Fuck, I've gotta get back inside. See you later."
I wouldn't say that Rikkie was being cruel, and she wasn't the only person who told this kind of story. I think that it was just our way of dealing with stress and pushing out of our minds the ugly things we saw every day. I had mixed feelings about these talks, though. I felt that we should have respect for these people, that we should remember that they were here to feel better and not for our entertainment. I wasn't above it though, joining in frequently and never voicing my concerns about the subject matter. It was easy to forget that we were taking care of human beings. It was easy to forget that these were people.
There was a man named Mr. Davis who came to affect me quite personally and taught me my first lesson in compassion. I met him when I was moving his wife from her room in the hospital to the radiology department. He was an old man, but still seemed spry and full of life. He wore flannel shirts tucked into jeans and a baseball cap which advertised some truck stop in California. Though he acted young, his glasses, wrinkled skin and old-man odor gave him away. We chatted as we walked down the long tiled halls; the conversation wasn't terribly deep and I had probably had the same one with six people already that day.
"Gettin' hot! Pretty soon I'll be up on the roof getting the swamp cooler ready. Have you lived here long?" Mr. Davis started the conversation after a minute or two of silence.
"Oh, yeah. I grew up here." I replied. "I don't mind the heat too much. Just stay inside during the day."
"Yep, it's the only way. So I bet you like workin' at this place, nice people and all these pretty nurses!" he said, winking at me. Had we known each other better, he probably would have been digging a knuckle in my ribs.
His wife, Mrs. Davis, would chime in every now and then with a typical elderly lady phrase: "Oh, Roy, leave the poor boy alone! You're embarrassing him!" The conversation continued like this until we got to the MRI machine, and I took my leave of them.
I never found out what Mrs. Davis was there for that first time; to be honest, I probably wouldn't remember now even if I had found out. She was just one of the many people that had the misfortune of getting sick and requiring tests as an in-patient at TMC. There were so many of them that I would never be able to count, nor would I ever really care to. This man and his wife, though, left a mark on me not because of the first time I met them, but because of the subsequent times I saw them.
The next time we met was around a month later. I was slacking off in the emergency department, and after two or three cigarettes in the ambulance bay, I decided I should make myself useful and see if there was anything lying around the ER that needed to be taken to the lab. I asked Renee, the tall, blonde, mannish nurse who had taken me under her wing and referred to me as her "nicer, more Jewish son." She told me that there were some specimens at the west nurses' station to go to the lab, and I not-so-hurriedly made my way over. When I got there I found two large bottles of yellowish fluid marked for the lab. I grabbed them, one in each hand, and turned to start on my way. I was stopped by a voice from behind me "Be careful with those, that's precious cargo you've got there!" I turned to give a polite laugh, but when I looked at the owner of the voice I realized that it was Mr. Davis.
I stopped and talked with him for a few minutes. It was out of character for me at that time; I was accustomed to making very brief acquaintances and then moving on, but for some reason I felt like I needed to stay there and talk with this guy. To this day I have no idea what possessed me to become more involved in his problems. His appearance hadn't changed, though he looked tired. He was still friendly and joking, but when he spoke about his wife his voice became monotone and he looked mostly at some spot behind and to the left of me. Evidently, the fluid I was taking to the lab had been "pulled off her lungs" and needed to be tested to see if there was infection present. Mr. Davis proceeded to tell me about his wife's failing health, and how she had been in and out of doctor's offices and clinics ever since I had seen them last. He was hopeful though, this place had "saved her once before," he said, "and by God those smart doctors and nice young fellas like you are going to make sure she'll be ok this time too."
I pondered this meeting on my way down the hall.
That must suck. Poor guy, having to be here so much. I wonder what she's here for this time… I wonder if she's going to be admitted or let go from the ER. I actually feel bad for the guy. Huh.
I passed the morgue and thought about the finality of the place. I had been there so many times, but had never stopped to think about the spouses left behind to sit alone in quiet living rooms. After I dropped off the specimens I walked over to the courtyard and sat down in the shade. It was hot but humid that July, and the monsoon clouds were starting to roll in just like they do every afternoon during the season in Tucson. I thought a little about whether or not it might rain, or just threaten like it does, and then I caught myself thinking about Mr. Davis again. I had a clear picture of him in my mind from the first time I met him, and I realized that he was probably in his seventies at least. It was strange; I normally didn't think about patients unless they were bleeding or particularly funny, but this time I was absorbed in the sound of the old man's voice, and the look in his eye as he painfully tried to explain what was happening to the love of his life.
I wonder how long they've been married. Wow, I hope I never have to be here with a family member. I wonder if they have friends, of if they just spend all their time together…
I began to wonder if I would ever know what it felt like to rely so completely on just one other person.
Two days later I ran into Mr. Davis again. This time I was already headed for the duckless courtyard. He had fallen apart. His wife had apparently had several strokes over the past forty-eight hours and she was being treated in the ICU. I knew what that meant, even though I still had a somewhat limited knowledge of medicine at the time. It didn't look good for her. The man stood there, silent for a minute, looking at me as if he had asked a question and was waiting for an answer.
He looked smaller than he had before, and it made me uncomfortable. He was wearing the same clothes as the other day, but they looked worn out and tired. He slumped when he walked, and when I went to shake his hand in awkward greeting, he gripped my right hand and looked into my eyes. "She's… she's all I've got, kid…" he said, his voice breaking and his eyes becoming glassy.
I was trapped in a situation that I was completely unprepared for. This man wanted me to say something to him that would make him feel better; he wanted reassurance that his wife would pull through or that he would be strong enough to deal with it if she didn't. In the space of just a few seconds, my mind jumped back to EMT school, and the video we watched about consoling family.
"I'm very sorry, ma'am, we've done everything we can, and there has been no response to our efforts. I'm sorry, but your baby has passed away." The movie went on to describe some of the things you shouldn't say, for example: "He's in a better place now" or "We should not question the will of God." The training was not much help in this particular situation. My brain was working overtime.
I wish that this was the part where I could tell you how well I handled the situation. I didn't. I looked at him with my most sincere sympathetic face.
"Well," I said, "this is life."
I exploded inside. My face became hot and I started to sweat, realizing what I had just said to the poor man. You stupid fucker. I cannot believe that you just said that to this man. He wanted reassurance, and you give him what? "This is life?!" I screamed at myself in my head. I felt sick.
Mr. Davis, in either a profound act of kindness and understanding or simply the haze of a man about to lose the one thing in life he thought would be a constant didn't respond to me. He gave me an out that I probably didn't deserve; he just looked down at the floor, released my hand and shuffled aimlessly into the cafeteria. I don't think he was hungry.
That was the last time I saw the man, but I know that his wife passed away only a few days later. I was called to the ICU to transfer yet another body to the meat-locker. When I arrived, I realized that it was Mrs. Davis. Her husband was nowhere to be found, though I imagine he spent a long time sobbing next to her bed after she passed. The room was quiet, and her body was already in the body bag. It smelled like a new shower curtain; I remember that very clearly. I had never noticed the way body bags smelled until then—they must be made of the same kind of plastic. I looked at the tag on the bag, curious about her first name and her birthday. I don't know why. Her name was Elizabeth and she had been born in nineteen-twenty-six. I stood there wondering for a minute how she and Mr. Davis had met, how long they had been married, and if I too would someday lose someone I loved. I forced the thoughts out of my head and took her down the long blank hall. I imagined that we were having a conversation while I walked, and though I can't be sure, I may have let slip a few words aloud while I was in the cooler with her.
"I was young once, too, you know," she said.
"I'm being too hard on myself, aren't I?" I asked her.
"You'll get better, dear. You're still so young," she said.
She told me—more accurately, I told myself—that Mr. Davis had forgiven me for the poorly-handled condolences and I felt at ease. Once again, I headed straight to the courtyard as soon as I had locked up the morgue.
After working at the hospital somewhere in the neighborhood of a year I saw a flyer in the ER advertising a paramedic training program at the University of Arizona. I was excited; I realized that I could actually do this and that my career might finally move forward. I had begun to feel as though I would be stuck at the same level, in the same job, forever. I thought that maybe I would be just like so many of my other coworkers and make a career out of Tucson Medical Center. The place was my world, my life. I knew my way around better than most, I knew all the nuances and the places to hide when I didn't feel like working. I knew the nurses, the techs, the docs, maintenance and all the volunteers. I wanted more though, so I took down the phone number on the flyer and began the application process.
When I was accepted to medic school I was faced with a decision: I would have to quit my job in order to devote the time needed for the training. I was hesitant for a day or two. I walked the halls of the hospital that gave me so much experience and so many friends. I talked to my girlfriend at the time, who worked at TMC in my department. I knew that if I went to paramedic school at the University I would spend most of my time at University Medical Center, a whole new world for me to learn, all new people whom I had never met. I also realized that as a paramedic, I would transport patients all over the city to every hospital in Tucson. St. Joseph's and St. Mary's sandwiched the city like two bookends—one in the east, one in the west. There was Northwest Hospital near my house, Kino down on the poor south side, and El Dorado that served a small contingent of rich. It occurred to me that in each of these medical institutions thrived a world just like the one at TMC, they all had their morgue and they all had some version of the duckless patio.
After I ate lunch one Thursday, I went across the hall and outside to the courtyard. I noticed that the sign regarding the ducks had been taken down, and when I sat down and lit a cigarette, I saw the impossible. There was a family of ducks: two adults and at least six baby ducks waddling around the courtyard, paying little or no attention to the people watching them. Nurses broke off pieces of bread and fed the ducks. I knew that it was time for me to go. Somehow the place had shifted. I felt like it was telling me that things were changing, that I needed to move on. The seasons at the world that is Tucson Medical Center were shifting and I was not a part of it. Had I stayed, I would no longer have felt at home.
When I finished my cigarette, I went to my supervisor and gave him my two-week notice. I told him that I needed to move on, that paramedic school had been my goal all along and that I couldn't pass up the opportunity. I wanted to thank him for the job and tell him about all that the place had done for me. I wanted to explain the ducks and the morgue and Mr. Davis, but I didn't. I guess I just needed to make a clean break.
Once I finished school and I was working the streets as a paramedic in an ambulance, I ended up at TMC quite frequently. I still knew many of the nurses in the ER, and they all congratulated me on my career advancement. The cafeteria was remodeled and they made the duck patio non-smoking. I still knew my way around the hospital, but there was minor remodeling going on all the time and occasionally I would get lost. It was no longer my place, and I was glad I made the decision. I got comfortable at the other hospitals in town and I learned that any world can be made your own given time. I felt good working the streets.
Sometimes people die in my care. When I speak with the family, I have more memories than the video from my EMT class to fall back on. Most of the time, I remember Mr. and Mrs. Davis, and I feel at ease looking these other people right in the eye. My brain doesn't scream at me as often anymore, and I know that all the patients I see are people.
Andy is 27 years old, grew up in Tucson, Arizona and currently resides in Albuquerque, New Mexico where he works as a paramedic. He lives with his wife, two dogs, two cats and a turtle. Email: andrew.shalek[at]gmail.com