By Robin Kilmer
New York really excels at glorifying some of its heroes–namely firefighters and baseball players. And if you are a hero with superpowers Hollywood will make a movie about you. But the fact remains that many heroes remain unsung.
But not Axel Ander. Today is his day–the day he will be a sung hero. He works as an EMS here in New York City, so there is much to sing about. It is a song with many versus–each far more meaningful than any lyrics that could be devoted to A-Rod. If Axel weren’t so humble, the tone of the song is much like Beethoven’s Fifth Symphony–dark at times, but overall triumphant.
Verse 1: Uses for Baseball Bats in Brooklyn
A nice way to describe the neighborhoods in Brooklyn where Axel and his EMS crew work is that they have been hardly affected by gentrification. He spends most of his working hours in neighborhoods like Brownsville, Coney Island and East New York–neighborhoods which I have heard being described with adjectives like ‘sketchy’, ‘bad’ and ‘mad ghetto’.
However, I was surprised when Axel explained to me that many of his calls are related to minor medical problems. “Someone will call 911 and we’ll ask ‘Hi, what’s your problem?’ And they’ll say ‘I have a headache.’” This does not mean that Axel does not have his fair share of more serious calls. “We get a lot of pedestrians hit by cars and a lot of violent crime–shootings, stabbings…people beating each other with baseball bats…”
Verse 2: Why Cincinnati Might be Important to You
A good portion of calls is related to drug overdoses and strokes. To identify a stroke, EMS uses the Cincinnati stroke scale, which is threefold process. “Many people suffering from a stroke will have facial droop on one side of their face. To see if someone is having a stroke, you ask him or her to smile. If they are having a stroke, only one side of their face will be able to smile. Another indicator is slurred speech, so you have a patient try to repeat something back to you.” If the patient is unintelligible when they try to repeat you, they most likely are suffering from a stroke. “The phrase they teach you in EMS training is ‘You can’t teach an old dog new tricks’.” Apparently someone in Cincinnati has a really sick sense of humor. However, slurred speech in itself is not indicative of a stroke, as many times a patient might overdose on medication or drugs, which will also lead to slurred speech. The third component of the Cincinnati stroke scale checks for arm drift. “You have the patient hold their arms straight in front of them like Superman as their eyes are closed,” explains Axel. If they cannot raise one of their arms, it is usually indicative of a stroke. If someone around you is having a stroke, Axel recommends that you prevent them from doing any physical activity that would necessitate excess oxygen use. Many stroke patients are asphyxiated by their own tongues because they have lost control of their muscles, so do not let someone who is having a stroke eat or drink anything.
Verse 3: Vomit and Denial
It is far more unsavory to deal with a patient who is overdosing on drugs than it is to treat a patient who is having a stroke. Reviving someone from an overdose is much more complicated than Pulp Fiction would have it seem. “First you have to identify that the person has overdosed on an opiate such as Heroin or Morphine. They usually will have an irregular breathing pattern, and are usually unconscious. They will have constricted pupils. As you provide life support you administer NARCAN–an antidote for a heroin overdoes, which you inject into their veins. That brings them out of their overdose almost immediately. Then you have to be careful because they have a tendency to projectile vomit.”
Then you might think that the person who was just rescued from the brink of death might thank Axel and his team profusely. But Axel set me straight. “They can be violent because you stole their high.” I asked Axel what a common post-overdose reaction is. “It varies. My personal favorite is when we wake them up and then they ask what we are doing. We tell them that they overdosed and then they say ‘Well, I don’t do drugs–while they have a syringe still in their arm. Other times they don’t say much, they just try to hit you.”
If someone you know is overdosing, obviously the best thing to do is the call 911. Axel explained that a common cause of death when someone is overdosing is that people choke on their own vomit. While you are waiting for EMS to arrive it is recommended that you lay the person on their side so their vomit can exit out.
Verse 4: So Many Obstacles
Other than violent reactions from druggies, other problems that can arise for EMS personnel is that people are uncooperative and they don’t understand their condition. “If you are dealing with a kid, sometimes their parents will get in the way. If there was an incident on the street, like a shooting or a stabbing, crowd control can be a problem.” The conditions that people live in can be an obstacle. “Sometimes someone will live in a basement full of clutter and cockroaches and it is difficult to bring the patient out.”
Many of the more dangerous cases involve EDP–Emotionally Disturbed People. “They are generally the scariest because they’re unpredictable. Usually it is someone who has not taken their meds.” Axel explains that sometimes it’s the medications themselves that can attribute to the problem. “A lot of times when people get on meds they become worse. The meds don’t do anything to help their mind–many of them just function as tranquilizers. Many people take Haldol. It makes them feel dizzy, which they don’t like so they stop taking it.” Luckily for Axel, the EMS teams work in conjunction with the police, who are obviously also supposed to arrive on the scene in the event of an emergency.
In a city where 170 different languages are spoken, there is often a language barrier between Axel and the people he is trying to help. To minimize this obstacle, EMS personnel carry around picture cards displaying images pertaining to various medical situations. One picture shows a man grasping an aching head, another shows a drug deal. As one can imagine, the cards’ usefulness is limited, and sometimes Axel has to play medical charades. “One time, a woman was found wondering in a park. She had a giant welt on her forehead but we didn’t know what language she was speaking. We showed the cards to her, but she indicated that she didn’t have her glasses.” She was taken to the nearest hospital where a Chinese translator recognized the language she was speaking as Toisanese. A dialect of Cantonese, Toisanese has no official status anywhere but was the lingua franca of overseas Chinese…in the 1800s.
Verse 4: Resurrection by Way of Freezing
Despite the New York City specific difficulties that Axel faces on the job, he says that it is the best place to work as an EMS. One of the reasons for this is that New York is usually a pioneer in medical technology. One such new technology would be induced freezing. Yes indeed ladies and gentlemen, science fiction is arriving on the scene to help save lives!
It seemed contradictory to me. Freezing to save lives? People can only freeze to death, right? Noting my skepticism, Axel began a carefully worded explanation. Someone whose heart has stopped beating–someone who is clinically dead–can still technically be revived by EMS by means of shock treatment and CPR. However, by the time they have been “revived” most of their brain and organs have been damaged by lack of oxygen, and will therefore die within twenty-four hours anyway. However, a new method will be tried on the technically dead. “We are going to be trying a new treatment in which we run ice cold fluid into their veins, so they can drop their body temperature to increase their chances of a successful recovery,” Axel explained. The science behind this is that one’s organ functions will slow down and decrease the consumption of oxygen, allowing more of it to go to the brain. I was still slightly incredulous until Axel explained to me that there are many incidents in which people who drown in cold water have been resuscitated after forty-five minutes with minimal brain damage while normally, someone can only survive without breathing for only a few minutes. Though the method has only had limited use in hospitals, Axel is keen to get started. “I’m pretty excited. Let’s see if it actually works.”
Verse 6: Death
And if it doesn’t, Axel will try not to let it get to him. When asked if it is difficult to deal with death regularly, Axel replied, “It is disturbing how not difficult its been to cope with death. We do a really good job of distancing ourselves.” To illustrate this point, Axel gave me an anecdote. “On St. Patty’s day, when I worked from 7 am to 11 pm, I started my day out with a breakfast sandwich–I was halfway through when we get a call for an unconscious elderly woman who had passed in the night. All her Irish family was there for the holiday–sons, daughters, grandchildren…we had to explain to them that this lady had passed away. We had to sit there in their kitchen for thirty minutes waiting for the police to take over. When they came I left and proceeded to finish the rest of my sandwich. I went on with my day without thinking twice about it.
Verse 7: I’m No Superman
I should have asked Axel if it would be the same if he had gotten an opportunity to rescue this woman. Would he have returned to consuming his half-eaten sandwich without thinking twice about it? Would Superman think twice about having saved someone’s life? Would he give himself a pat on the back? I don’t know if Axel would. I asked him if he thought of himself as a hero. “No, absolutely not,” he said stoically–probably as stoically has Superman would have said it.