"We only have one ambulance in eight towns in the middle of the night."
by KATELIN MOODY
I’d met Mike Wilds a few weeks ago. He sat across from me in the empty training room and told me he’s a “shit magnet.” Shit always seems to happen when he’s on duty. Although, at the time, he was seven hours into a forty-eight-hour shift, and call-free.
Mike has a face that’s grim when still, but jolly in motion: rounded cheeks, cropped white beard, freckled forehead interrupted by deep creases, thick, expressive eyebrows. He has a gravelly voice that grumbles when it starts then warms into something fuller and richer. An EMT for twelve years, and firefighter for two decades before that, Mike’s an encyclopedia of emergency response stories: the repeat offenders, the favorite patients, the spouses with perfect punchlines.
He told me about Jeff, a retired soldier who drunkenly doused himself and his house in gasoline. Twice. The second time, Mike called in the Bradford Fire Department for a HAZMAT scene, directing the firefighters to scrub Jeff with Dawn dish soap. Mike cut off Jeff’s clothes, leaving him standing “naked as a jaybird” on his lawn before he was hosed off, wrapped in blankets, and then delivered to the police. Mike chuckled. There was a third call for Jeff. When he arrived at the scene, Mike had asked Jeff if he dumped gasoline on himself again. “Oh hell no,” Jeff had replied. Instead, he’d shot himself in the stomach with a .22—because he thought shooting himself in the head might be too painful. But Jeff survived, and then he moved to Oklahoma. Mike doesn’t worry about him anymore.
Once Mike received a call for an unresponsive man in Corinth. He found the man slumped in a recliner, not breathing, blood pooled into one arm. Mike imitated the soberness with which he turned to the man’s wife, informing her that her husband had passed. “Well no shit,” she’d said. “I knew that.”
“There’s a lot of humor in EMS,” Mike said. “For an outsider looking in, they might think we’re sick. Demented. But we do care. This is how we have to deal with it.” He crossed his arms, leaned back in his chair, flicked his nose.
“There is stuff that tears you apart. Stuff that aggravates yah.” He thinks back to a man he rescued last winter who was freezing to death in a trailer.
Mike’s care is evident in the tenderness with which he talks about Charlie, a 90-year-old with heart disease who demanded that he be allowed to finish his pancakes and sausage before accompanying Mike to the hospital. Sometimes, when patients die, a few ambulance employees attend the funeral. Mike will check in on their spouse.
Some patients are even more obstinate than Charlie. Mike chalks it up to Vermont toughness, a reticence to accept help. He remembers a call for another old man, who had descended from the tractor he was driving to lie down in the middle of a field, announcing to his daughter that he felt like he was dying. “He was pissed to see EMS when he woke up. He says, ‘I’m just tired. I was taking a nap.’ ‘You were taking the almighty eternal nap!’” Mike had boomed. The old man hadn’t seen a doctor since he was thirteen years old. That day he needed an internal defibrillator.
A fuzzy radio voice swam across the hall from an office. Mike cocked his head to listen. Brush fire in Bradford. The Fairlee Fire Department, which shares the building with the Upper Valley Ambulance, was being called in to cover Bradford while their department dealt with the fire. Mutual aid agreements exist in forty-two towns in the Upper Valley, which promise help during emergencies free of charge. The revving of engines carried from the garage.
Upper Valley employs seven full-time members and seven ‘per-diems.” The office manager and director also respond to calls. It’s still not enough. “There’s a shortage in the field right now.” Mike’s voice was low and gruff. “The pay sucks, and with what you deal with—some people aren’t cut out for it.” Mike is usually working two to three jobs. Currently, he also works one day a week at Clear Choice MD in Lebanon, a walk-in care center, and mows lawns for the Director of Woodsville Ambulance. He’s also starting paramedic school. “I told the woman at the desk, ‘I haven’t cracked a book since high school chemistry.’” But he hopes to continue EMS work for another twenty years, and as a paramedic he can provide more advanced care: IVs, airway management.
He took me out to the garage. We walked past the sedan used for community paramedicine visits, past one of Fairlee’s remaining firetrucks, and hopped in the back of an ambulance. Most of the floor space was occupied by a stretcher, with a seat at the stretcher’s head and bench along its side for the EMTs. The left wall was entirely covered by clear, plastic compartments bursting with gloves, syringes, the tools of the medical trade. Mike proudly tapped a heavy, wired box resting on the bench: their new monitor, which measures CO2 levels in addition to oxygen and heart rate. He looked comfortable, feet planted wide and arm resting against a seat back. I wondered how many hours he’d spent here, checking heart rates, shouting through the small sliding window to the driver, knees bumping against the cot on the way to Dartmouth-Hitchcock or Cottage Hospital in Woodsville. He was proud. “I tell my wife, if something happens to me, drag me to the Bradford-Newbury town line so I’ll get picked up by Upper Valley.”
* * *
I pulled into the parking lot of Upper Valley Ambulance a little after five on a Monday evening, as the searing afternoon sun was just starting to soften. The sound of whining cars travelled from Interstate 91, a short turn out of the driveway. Gravel crunched underfoot as I made my way to the glass door marked with the EMS Star of Life: a blue six pointed star bisected by a snake twisting around a staff.
The hallway inside was cool, dim, and smelled faintly antiseptic. A voice delivered instructions in the room on the right. I poked my head into the office on the left.
“Hi, is Mike around?” I asked the man sitting at the computer. He swiveled, leaving the cursor blinking in the Google search bar.
“Mike’s out on a call. He should be back pretty soon though.”
A young woman walked over from the training room—Caroline, a fellow Dartmouth student. She was wearing the same uniform as the guy in the office: a black polo shirt tucked into cargo pants. “The thing that is so common,” she told me when we first met, “and this I think is so common in rural EMS everywhere, is for people who don’t have insurance, don’t have a primary care provider, the ambulance is their doctor, or emergency room.” Caroline calls them “frequent flyers.” They rely on the Upper Valley ambulance as their first line of care. She described an entire day spent checking in on a woman with low blood sugar at a Medicaid funded nursing home.
“Medicaid won’t pay for test strips until you’ve seen an endocrinologist, probably. And so they couldn’t test her blood sugar,” Caroline speculated. “But you know, she had clearly pretty progressed diabetes. There’s such an intentional distribution of resources, and we only have one ambulance in eight towns in the middle of the night.”
The stories that stick with her are either medically fascinating or extremely sad: the elderly without insurance who call again and again, the suicidal teenagers. Seeing the Upper Valley in its raw form can be shocking.
“The area around here is beautiful,” she reflected, “but people leave Dartmouth and they travel so far away to see health disparities and people who are disadvantaged, and all you have to do is drive twenty minutes north to be in Fairlee to see that.”
We slid past the training room—Monday night CPR class, Caroline explained—and headed into the garage. She led me past an empty bay to the second ambulance. The right half of the bumper was missing, cleaved clean.
“Mike hit a deer last week.” She chuckled.
* * *
I was sitting in the backroom of the station, talking to a paramedic named Chris, when Mike swung open the door, a tall EMT named Mark in tow. The men walked with heavy steps to the armchairs, and sank into them without a word. Mike took out his cellphone.
“I’m telling her war stories,” Chris explained to Mark. I sized up the soldiers, now in a semicircle around me: all three men dressed in EMT polos and shiny black boots, all leaning back in their chairs with arms folded over sizable bellies, all with moustaches.
The call was for Charlie, Mike’s favorite 90-year-old.
“It’s getting bad,” Mike grumbled. “He’s at the point where he knows.”
“He’s at the point where he doesn’t buy bananas that aren’t ripe,” Chris said.
Chris told me that he has one more story to share before he goes. He reminisced about responding to a “possible gun injury,” a twenty-year-old combat vet whose flintlock musket blew up in his face, spilling brain matter onto his forehead. The flint stone travelled through his head without impacting the brain stem. The man’s vitals were nearly perfect. Chris lifted his hand to his chin. The man lived for two weeks after the call.
“That was one of my top calls ever.”
The conversation revived Mike and Mark, as it steered from lawn mower races—“my wife T-boned a chick once”—to projectile vomit, to “the slumlord of Bradford.”
“Hey Mike!” Chris scratched his ear. “When you become a paramedic, are you gonna be as much of a paragod as me?”
Mark jumped on Chris. “Let me sprinkle some water where you walk.”
“I’m telling you, it’s gotta be an interesting enough call or I won’t go.” They were both laughing.
A teenage girl opened the door and plopped onto the couch. Her pink crocs matched her fingernails.
Mike said, “This is Emily. She does ride-alongs with me on Mondays.”
It was now well past five, and Chris finally grabbed a plastic bag from the fridge and sauntered toward to the door.
“Don’t call me for lift assistance.”
They started to talk about dinner. Emily said she wasn’t hungry, then fished a pint of ice cream from the freezer. An alarm blasted through the room, a high-pitched screech that wailed three times. Mark and Emily were already moving. Mike looked at me. “You wanna go for a ride?”
* * *
I sat in the back of the ambulance, on the low padded bench adjacent to the stretcher. Emily sat at the head of the stretcher, under the sliding window that opened to the front so she could talk to Mike. The flat pavement of the interstate ribboned behind us. The sun began to sink behind the mountains, capping their curved peaks in purple.
As Emily positioned a bulky, red duffel between her feet, she told me she’ll run through the case in her head during the drives, prepare herself for whatever scenario could be waiting. She flicked at a control on the switchboard, adjusting the temperature. I asked if the sirens only go on for life-threatening calls. We were moving quickly, but discretely. Without the fanfare I’d assumed accompanies all emergency response. Emily nodded, pointing out how empty the roads were. Downtown Hanover at five is a better use for the sirens.
We broke off the highway, rumbling down a residential street in Bradford, Vermont. The street was quiet, still, frozen in time in a pleasant, spring evening. Mike and Mark cracked jokes about a guy named Dutton. Every time Dutton leaves the station, Mark explained, there’s a Bradford call within twenty minutes. We lurched into a gravel driveway and came to a stop behind a Bradford ambulance, the first responder already on scene. The speed that carried us to the house was finally tempered by a careful deliberateness. Mike and Mark marched toward the house. Emily hauled the duffel, pulling plastic gloves from a box over the door on the way out. I followed suit, stretching the elastic plastic over my fingertips with a little trepidation.
It was a neat yellow house with a winding ramp leading to the front door. The walls in the entryway were bare save patches of white primer, either in the midst of renovation or never quite finished. I lingered on the threshold between the entryway and main house, crossing my arms behind my back and trying to appear unobtrusive.
Before me was a kitchen, and half of a living room not blocked by a wall. Wheel of Fortune was playing on the TV. There was a man lying on the kitchen floor, legs branching in a V to upturned moccasins, his arms flopped to each side. His hair was scraggly and his mouth drooped. Mike kneeled in front of him, asking questions in a firm voice: What happened? Where does it hurt? The man slurred his responses. His fingers curled and unfurled, joints bending at seemingly impossible angles. A mewling voice called from the living room, out of sight. Jack, answer them. He’s worried because he’s been drinking. I took the voice to belong to Jack’s wife, an eerie disembodied presence, a Greek chorus. Jack, answer them. Jack tried, spit dribbling from his mouth.
“It’s all right, buddy,” Mark tried to calm him. “If I weren’t here I would have had a few drinks too.”
Mark was standing at Jack’s side, next to the responder from Bradford. Emily was a few feet in front of me, shifting her weight from foot to foot.
“Let’s get his vitals,” Mike directed.
Emily and Mark moved forward, unzipping the duffel. Mark explained to Jack that he was taking his blood pressure as he wrapped a cuff around Jack’s forearm. “It’s gonna squeeze.”
The voice from the living room added a stream of commentary. He had a stroke. He’s not normally like this. On screen, Vanna White tapped a green square into a letter.
Mark was trying to gauge what was wrong with Jack’s wrist, how much it was hurting. Jack clutched his leg and whimpered. He couldn’t form coherent sentences.
“We’re going to the hospital,” Mike decided.
Jack started to howl, “Nooo.”
The voice interpreted: he doesn’t want to go to the hospital because he’s afraid you won’t bring him back home. Mark bargained with Jack, down on one knee in front of the squirming, moaning man.
“We can only help you if we bring you to the hospital. I promise you’ll come back here after.”
But Jack didn’t want to go.
A woman emerged from the living room, a corporeal host for the voice. She was short and wore leopard print pajamas that brushed the floor. Her eyes were as wild as Jack’s. She told the EMTs to call her children—Jack has ceded legal guardianship to them. At the mention of a woman named Sheila, Emily piqued up.
“Sheila --? I work with her! I’m Emily.”
The woman smiled at her. She called the son and admonished an answering machine to pick up the phone. Mike and the Bradford responder slipped past me into the hallway.
“This is Dutton.” Dutton nodded, then ducked outside to send an update to Dispatch. Mike shuffled next to me, surveying the scene: Emily and the woman trying to reach Jack’s son, Mark calming Jack, speaking in a friendly tone, rechecking his vitals. I thought back to Mark at the station, harassing Chris, joking about lawnmower races.
Mike was glad this was Mark’s call.
“We don’t want to get accused of kidnaping patients again,” Mike sighed, launching into a tale about a minor who was accidentally transported to a hospital across state borders without the knowledge of his father.
A car pulled into the driveway. A man in basketball shorts, maybe in his thirties, and a woman who might be Sheila entered the house. What followed was a tangled exposé of family dynamics: the man was angry at Jack, and the woman with the leopard print pajamas was angry at the man, but eventually she kissed him on the cheek and Emily and Mike were running outside to get the stretcher.
It was determined the stretcher couldn’t make the sharp turns of the ramp; instead, Mark and Mike lowered Jack down the front steps. Mark turned a crank, raising the stretcher so it was flush with the bed of the ambulance, and pulled Jack gently into the back. Jack’s son signed a consent form. Sheila hugged Emily. Relieved of his duties as the first responder, Dutton retreated to the Bradford ambulance. We were in motion again.
“You can ride in the front with me,” Mike said, but Emily stopped me as I opened the passenger door.
“Don’t you want to see what it’s like in the back?”
I did. The ambulance rumbled to life. Mark scribbled on a clipboard.
“She’s just here to watch me,” Mark explained my presence to Jack, who was lying stiller than he’d been all night. “Can you tell me your name?” Mark asked.
“Can you tell you me your birthday?”
He couldn’t, his voice losing itself in mumbles.
Mark took another set of vitals, explaining to Jack that he was repeating what he did in the house.
“Can you hand me the thermometer? It’s in the top pocket of that bag, should be gray.”
I unzipped the red duffel, rummaged through a slew of plastic packaging. I remembered Mike talking about his nephew, another EMT, during our first meeting when he showed me the ambulance. I’ll turn to Derrick to ask for something and he’s already got it ready. I finally found the thermometer. Mark asked Jack about the pain, and Jack let out a small wail.
“I know, buddy,” said Mark. “It’s just the cards you’re dealt.”
He tried twice to stick the thermometer in Jack’s ear, bumps in the road precluding his efforts.
The night had turned dark while we were in the house; the blackness was now punctuated by headlights that looked red through the window of the ambulance. Mark switched seats with me so he could radio the hospital.
“We’ve got a patient who had a stroke five years ago. Possible fractured wrist.”
I made eye contact with Jack. His lipped twitch, then his eyes drifted away.
“Room one ready and waiting.”
His hair was wiry, twisting wildly onto the white pillow. The black t-shirt he wore stretched tautly over his rounded stomach, not quite meeting the waistband of his shorts. The expression on his face was slack, almost amused. He could have been daydreaming.
Mark switched back with me. He started to rehash the call, whispering across the stretcher: sometimes people don’t want to come. They could have left Jack, but then his hand might have succumbed to septic shock and they’d be called back anyway to a much worse scenario.
The ambulance jolted to a halt. I jumped out into an empty parking lot and face the squat, brown walls of Cottage Hospital, the community hospital for the Northern Upper Valley. The doors to the ER glowed yellow, casting a halo on the pavement outside. Emily and Mark rolled Jack up the ramp. Seeing me hesitate, Mike grumbled “you’re fine,” then strode to the door to scan the key fob that gave us access. We entered a long hallway lined on the left by three rooms with glass walls. Mark wheeled Jack into the first room, and, with the help of a waiting nurse, bumped Jack from the stretcher to the bed in one fluid motion. Mike made for the reception desk at the end of the hall, the divider between the common space of the hospital and the private space of the emergency ward.
“Shoot I forgot my clipboard.”
I volunteered to retrieve it, and Mark tossed me the keys. The entry doors parted to cool air. The back doors of the ambulance stood ajar. I leapt into the back and grabbed the clipboard, the front page of which was notated with the limited information gleaned from Jack. Back inside, the nurse was flurrying around the room. Jack was making a lot of noise “I have to pee!” The nurse pulled out a plastic bedpan.
“All right, buddy,” said Mark. “We’re gonna do this the redneck way.”
Jack spotted the bedpan and let out a bleating “Fuck you!” The nurse drew the curtain tight against the glass.
I wandered over to Mike, who was back from the desk and stripping the stretcher by the door. When he saw me, his cheeks filled with air and he released a slow breath.
“That was a difficult one. Yup, that was a difficult one.”
I asked how the hospital will handle Jack, if they’ll need to contact his son each time they make a decision. Mike admitted that it will be tricky, tucking in the corner of a fresh sheet. He was hoping a family member would have come for that purpose, but they hadn’t seem too interested in hanging around. This was a sad one. His voice was low; he looked at the ground. A sad situation—giving up your rights to your children. But then he chuckled to himself again, remembering how he signed his rights away to the Marine Corps after high school. Mike pushed the stretcher out the emergency doors.
I balanced on the bumper of the ambulance, pacing a short line along the perforated steel platform. Mike cleaned: securing the stretcher back in place, wiping the seats, tossing gloves into the trash. He talked about the Marines; he talked about Cottage Hospital; he talked about his family. Soon the ambulance was gleaming, ready for the next call.
Laughter announced the arrival of Mark and Emily. Emily planted her hands on her hips.
“Where are we going for dinner: Cumby’s or McDonalds?”
This time I rode in the front with Mike.
“I think I get the humor thing now,” I told him. I was thinking about the glazed look on Jack’s face.
A few minutes from the hospital we arrived at an intersection with a Cumberland Farm’s on the right and McDonald’s on the left. We took the left. Mark and Emily hopped out, pausing at the passenger window to see if we want anything. Mike asked for a Coke, and gave them his card to pay.
“Emily seems a lot older than seventeen.”
“She does,” Mike agreed. “And she’s gone through so much, so much family stuff.” He remembered how when she first started ride-alongs, she needed to be walked through every step. Now, he’ll turn to her with, say, a cardiac patient, and she already knows what he needs. Just like his nephew. “My wife and I have really taken her under our wing. She calls us uncle and auntie.”
When Mike had his large Coke in hand we hit the road. Mike radioed Hanover Dispatch with an update. The voice on the other end was clear and efficient.
Mark and Emily’s muffled voices carried from the back, punctuated by bursts of laughter. We drove south under a half moon, crossing the Connecticut River into Newbury, Vermont. Mike pointed out a white house with a porch, shadowed in the dark.
“That’s the house where I grew up.” He used to play tricks with his friends, standing on opposite sides of the road and pretending to pull a rope tight when cars passed. “You’d see the surprise in their eyes.”
It was peaceful inside the ambulance, warm, winding over empty roads while Mike told his stories. I wondered how he’ll tell this one, how Mark will tell it. What will be the punchline? Or is this a forgettable story, to be relegated to the back of the shelf with the countless other “sad ones” to make room for the swift water rescues and backfiring muskets and suicidal veterans?
As we crossed the town line into Bradford, Mike picked up the radio: “Upper Valley Ambulance, back in range.”