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Health care’s exhausted pain reliever

Life as a paramedic—you call, we come—in the overburdened medical system.

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DANIEL SUNDAHL, DANSUN PHOTO ART
  • Daniel Sundahl, DanSun Photo Art

Editor's note: In order to protect patient privacy, names and ages have been changed in the scenes Andrew Bethune witnessed while on the job, and times, places and other details have also been obscured. Names, quotes and details from news stories have not been changed.

Three in the morning. The glare from the late-night pizza shop can be seen from a distance, a landbound lighthouse in the night. Inside, the buzzing of the usual late-night drunk crowd. Drunk people milling around, in their own drunk world. A long line of people waiting for a slice. Everyone talking louder than they think they are.

In the middle of it all is a young man sitting at a table, a young woman standing behind him. She holds a bunched-up paper towel to his left cheek. From beneath the paper towel, down his face, neck and t-shirt is a dried waterfall of blood.

We squeeze through the line and catch sight of our patient. We ask what happened. The woman unfolds her hand from his face to reveal a gash. His cheek has been slashed from the corner of his mouth up to his ear. Raw flesh bursting out of the flayed cheek. It has a wet, bright red trough of blood in the middle. I quickly press the woman's hand and paper towel back over the injury, and ask my mentor to take a look.

Around us it's like nothing happened. Loud talking fills the room. The line moves forward, people fumbling to find the right debit card, rocking on their feet. An off-balance drunk stumbles into me from behind. Another comes to the table.

"Can I sit here?" he asks.

"No," I say, pointing at our patient, "we need the space." He gives the injured man a glassy look and shuffles away.

We stuff the gash with gauze and bandage his head. He looks like a man in an old movie who has a toothache.

"How are you feeling?" I ask the patient in the ambulance.

"Shitty," he says. "This really sucks."

He is remarkably calm. He is military. Military patients are excellent at keeping calm. They are my favourite patients.

He says some guy called his girlfriend a bitch. He challenged the stranger to a fight. The stranger swiped at his face. It felt like a slap. The stranger looked terrified, and ran off.

Our patient didn't realize he had been knifed in the face. If the swipe were six inches lower, his throat would have been cut.

We give him the standard treatment and keep an eye on his gauze dressing. A dark shadow of blood is growing in it when we get to the hospital.

He seems destined to look like the Joker.

Later, walking back to the ambulance, my mentor says, "I hope he gets a good plastic surgeon." He shakes his head.

Driving away, we are hit with another call.

If this city were Gotham, the Bat-Signal would never go dark.

The apartment door swings open and a middle-aged woman lets us in, turning to walk away. "He's in here," she says over her shoulder. On the couch in the den is a man with a black crew-cut wearing plaid pyjamas and an old t-shirt, lounging. He doesn't seem to notice us. We set our gear on the floor and go to work. "What's your name, sir?" I ask. "David," he says, looking at me blankly.

"What's going on with him?" I ask the woman.

"Oh, there's nothin' much wrong with him," she says, "he's just stupider than usual." We all chuckle. David smiles weakly.

A car accident a decade ago ravaged his back muscles. Ever since, he has taken opiates to ease the pain. His dosage was increased recently because his body had gotten used to the drugs and the pain was breaking through.

David is nodding off in the middle of sentences. Too high to stay awake. We pack him up on our stretcher and take him to the hospital. He'd been prescribed an overdose—he had too much medicine.

An unlucky man gathers up his garbage into two black bags by the door. He puts out food for his two cats, then stretches across his bare mattress. He lays his head on his hand, and dies.

A few days later, a neighbour thinks it has been some time since the man was seen or heard from. Nobody answers when the neighbour knocks. The door is locked.

First responders arrive. The apartment air is wet with the aura of putrefaction. In the hot apartment the garbage has turned to slime in the bags. Sunlight beaming through the windows has baked pools of cat piss into sticky pungent puddles. The dead man's insides have begun turning to slime, too. His face is twisted into a weak, silent howl. The side of his body lying on the mattress, from his ankle to his face, is a giant purple-black bruise. When you die, gravity makes blood seep through your blood vessels and collect in your skin at the lowest point.

Some rooms have such a cloudy aura that when you leave it feels like a repulsive mist has stuck to you. The first thing I did getting home was shower.

If you're curious to know what it's like to work with dead people, poke your head into your compost bin on a hot summer day. Then try to think straight.

I became a paramedic so I could sail. I grew up sailing little boats. Now I wanted to be a deckhand on a seafaring vessel. Skip a Canadian winter for once. See all the beaches and glittering waters, breathe the salty sun-warmed wind.

An internet search showed sailboat jobs for a medic. Another website had the sentence, "above all, a medic should want to help people." I had found the job for me. Sailing was a recreation I wanted to do more often; helping others is a desire that runs deep in my soul. As soon as I read that sentence, I committed to the profession.

More searches led to the paramedic college. Six months later, I sat in my first class. I took great pride in building knowledge. The classroom taught me a lot. The streets taught me more.

Becoming a paramedic was exciting. I looked up to them. These are the grunts of health care, the first-line foot soldiers, the steel-toed scouts, I thought. They were strong, quick-thinking and rugged. I was thrilled to join their ranks. The uniform, the ambulance—I couldn't wait to do the adventurous life-saving things paramedics do. Walk into a swirl of chaos and bring the situation under control. Speed through streets, traffic parting like the Red Sea, red and white lights flashing, the siren announcing help is here.

My education was eye-opening. I got to explore almost every department in the hospital: a neonatal intensive care unit to monitor a heart murmur in a newborn and 20 minutes later, the bedside of a 100-year-old man, to observe the same thing in his heart. I was fascinated that someone six hours old would have the same expression as a 100-year-old. I saw the same things in their faces: oblivion, apathy and exhaustion. It was probably for different reasons, but still: What a curious coincidence for these two very different souls to be in the same place, wearing the same expression, being treated for the same condition. Disease is the great equalizer.

I started working. I'll never forget the first time I cured a person's pain. A man felt a sudden onset of chest pressure; paramedics were called. We came. We started an IV, stuck electrodes on his chest for an EKG to measure the electrical activity in his heart and gave him aspirin. I gave him nitroglycerin, a drug that relaxes blood vessels and reduces the workload of the heart. Driving to the hospital, he said the chest pain had gone. When we arrived, I gave a report to the charge nurse. "Great, you fixed him!" she said. I looked at the man on my stretcher. He looked tired— relieved. The hall was quiet. Sunshine from the window cast a yellow square on the floor next to him. It was one of the best moments of my life.

I loved to wake up diabetics who had low blood sugar. It's similar to drunkenness: the person will slur their words, stumble and eventually pass out. Without sugar they will die. We would walk in and see a man on the floor, barely conscious. His family would tell us they found him slumped on a chair. We would take vital signs, start an IV and inject a special sugar solution. The patient would awaken. In minutes, he would return to normal. He was cured. He would thank us. His family would thank us. All smiles as we left the house. Another life saved.

Nothing is better than taking away somebody's pain. It was the best part of the job. I knew I was only treating symptoms, not curing their underlying disease. Still, it made me feel like a hero.

On the worst days, there was nothing I could do. It made me feel helpless. To be a paramedic is to kill pain, if you can. Every shift was different.

Paramedicine attracts motivated, smart and brave young people. There are three levels: primary, advanced and critical care. Some ERs employ paramedics at night. Some industries, like oilfields, employ worksite paramedics. Some cruise ships employ paramedics.

I was an ambulance paramedic for seven years. It was the most exciting, depressing, touching, rewarding and punishing job I've ever had.

A firefighter emerges from the orange glow inside a burning house. Another walks directly in. Others come around from behind the house. Police are at the edges of the scene, holding back the crowd.

Two medics crouch over a figure lying in the driveway. One is kneeling, doing CPR. The other is kneeling at the patient's swollen, sooty head.

Despite the fire, the air is dead cold. No heat is coming from the house. The roof can't be seen. Black clouds billowing from the building look like great bales of dead seaweed rolling into the sky. The icy air is flooded with noise: The idling diesel engines of the firetrucks, chirping alarms from firefighters' empty oxygen tanks and radios on each responder blaring distorted voices.

Someone asks, "Is this the only patient?"

Someone else says, "There's a six-year-old girl."

Giant, spinning black clouds roil up from the house. She may have hidden somewhere and be miraculously lucky. The fire hasn't been burning that long. Maybe 30 minutes.

We'd lost the patient on the driveway. I phone the on-call doctor for permission to stop CPR. I pronounce our patient dead. About one hundred Canadians die every year in house fires.

Somehow the clouds from the fire aren't as dark as the night. They look like huge bunches of black fur. Time runs on. Forty, 50, 60 minutes. Nothing inside could survive. Everyone waiting. The scene is draped with a heavy blanket of dread.

Somebody's radio crackles. A voice announces the girl is with her aunt and uncle. Relief ripples through everyone assembled. Smiles. Someone thanks god. It's like throwing off a leaden cape. None of us wanted to see a dead child tonight.

A thin breeze blows across the six-year-old girl's father, lying less than 10 metres away.

First responders have a special culture. Their scale of good and bad has heavy weights on either side. They see dirt-floor homes with happy families. They see fancy chalets with suicidal millionaires. They see good people at their worst and bad people at their best. Some they can help, others they can't. The left eye sees Death; the right, Survival.

Paramedics, firefighters and police are masters of small talk. It's one way to make things feel normal after an abnormal experience. Who else talks about the weather in the afternoon, after a morning of pronouncing death? Who else compliments good pizza after watching a family home burn to the ground? Who else flips through a magazine after dodging the wild fists of a drug-addled teenager? The ability to control the emotions of trauma is a job skill.

You have to prove yourself to earn other first responders' trust. You have to survive a very serious call. Something with violence, screaming and speed. You have to show you can think among people who can't. You have to know what to do. You have to do it, no hesitation: grab a woman's broken arm and pull her out of a crumpled car while she screams; stick a needle into a child's arm to save his blood pressure while he cries and his parents watch; tell a wide-eyed man it's time to start praying for his wife. It has to be done. It scalds the soul.

Pain runs through these moments like an invisible bully who can't be stopped. The people who do what must be done often feel hurt too. Pain hurts everyone.

You have to speak bad news. I hated being the face that told someone "I'm sorry, your father's dead." They didn't want to hear it. I didn't want to say it. It never got easy. I felt like I was punching the family in the face. Sometimes I thought I could hear their hearts snap.

Prove you can do the harder work, and you're attached to other responders with an unspoken tether. First responders who trust each other can work without discussion. All their meaningful communication is silent. Spending so much time together puts them on the same psychic channel.

They eat together, drive together, laugh together, care together and suffer together. They are more than coworkers; they are partners. Paramedics share a deep trust.

A man sits on the side of a bed in a tiny bedroom. His daughter stands in the doorway. "You have to go with them, dad," she says. He stares at the floor. The room smells of unwashed work clothes. His eyes are hidden below the brim of a baseball hat.

"I don't need to go," he says in a way that suggests he knows he should go but doesn't want to. He stopped taking his heart medicine weeks ago and is now unsteady.

My partner takes a step toward our patient. "C'mon, Albert," he says, "we'll help you." We each take an arm over our shoulders and help the man stand. He takes a few loose, uneasy steps like he is just learning to walk. "That's good, Albert, just a few more steps," my partner says. Suddenly, Albert stops walking. He doesn't put another foot forward. His head hangs from his shoulders. He has gone unconscious.

We carefully, awkwardly, ease Albert down to the floor. As we lay him on his side, we hear "pbthththththththththththththththththththththt." It was the longest fart I've ever heard. The sound of stubbornness.

To be a paramedic is to be overtired. It's impossible to describe the perpetual fatigue of shift work. I wore bruises of exhaustion under my eyes. One morning I awoke behind the wheel of my car, parked outside the gym. Taking a deep breath before I opened the door became a deep sleep. I didn't work out often. According to the World Health Organization, shift work is "probably carcinogenic." Exhaustion is its own disease.

Shift work encroaches on your personal life. Like other jobs in health care, paramedics find themselves working most of their waking hours. Some see their work partner more often than their life partner. Night, weekend and holiday shifts are a given. Emergencies don't take days off. Neither do first responders.

Some days there aren't many calls, and paramedics can take the ambulance to get a coffee or visit somebody in their coverage area. One Christmas morning my work partner wanted to drive to her home nearby to watch her son open his big gift. "I just want to see the look on his face," she said. But we were hit with a call: an elderly woman was feeling nauseous. When we finally made it to the house, it was late morning. When she walked in, ragged strips of paper were all over the floor. The gifts were all unwrapped. Too late.

The employer was notorious for denying vacation requests; union leaders have gone on the record to say overtime, missed meals and lack of vacation are combining to drive paramedics out of the profession. Refused time off was such an issue that policy changed to allow paramedics to cover each other's shifts. They figure out the logistics on Facebook groups.

Social isolation is a real problem. When I did make it to a social gathering, there was little to talk about besides my schedule or a hairy call. I usually stayed quiet. Somebody always asked, "What's the craziest thing you've seen?"

Chronic exhaustion is one thing that leads to burnout. Social isolation and random shift work is another layer. Career stagnation is the next. After months and years, even the exhilarating calls, ones where I could kill pain, started to lose their thrill. The excitement of lights and sirens soon gave way to a soul-deadening boredom with long-distance transfers and parking lot postings. Bad shifts started to outnumber the good ones.

Ironically, time spent with non-emergencies is a major contributor to burnout. It is common for people to become so bothered by months-old pain that at 4am they call 911 for constipation, toe pain or sore hips. Sometimes paramedics feel like a misused cog in the system when they respond to those calls. It's a consequence of unavailable doctors.

I watched problems grow as people without family doctors got sick. The hallway of the hospital was usually filled with these people, attended by paramedics, waiting to be seen for relatively benign problems. I spent lots of time there. Once I sat with a patient for 10 hours straight. In September 2019, Nova Scotia paramedics' union leader Michael Nickerson told Global News that because of burnout and fatigue, morale among paramedics was at an "all time low." Paramedics are quitting because they are sick of 15-hour days, sitting in hallways and missing meal breaks. Most of all, they feel their skills are going to waste.

First responders live by a mantra: You call, we come. It is the basic rule of the paramedic. It was true every day, on every call, no matter what was the matter. You call, we come. It was a fact of the universe. It was as true as rain is wet. It was as certain as death and taxes. Until the laws of physics broke.

In August 2019, a man named David Benedict spent the last hours of his life waiting for an ambulance. His wife, Karla Dehmel, told the story to CBC. Benedict arrived at Soldiers Memorial Hospital, in the small Annapolis Valley town of Middleton, with a severe headache. He had been there the day before for the same complaint, which the attending doctor treated as a migraine. I wasn't there, but I know if a patient is back, and feeling worse, they're either an insatiable hypochondriac or a seriously ill human being.

As CBC reported, on the second visit, when Benedict was disoriented and weak, the doctor ordered some tests—a CT scan and a spinal tap. That required sending Benedict to Valley Regional Hospital, in the much larger town of Kentville, about a 35-minute drive away. An ambulance was called for the patient transfer.

Benedict and Dehmel were told the ambulance would arrive in a few hours, around 11pm, and then that it wouldn't come until 2am. Benedict soon went unresponsive in his hospital bed. Nurses kneaded his sternum with their knuckles to see if he was conscious enough to react to pain. No movement. They shone a light in his pupils. They stayed dilated. Benedict was essentially comatose. The ambulance would never arrive. He died waiting.

Paramedics in general knew in advance something like this might happen. The paramedic union started a Twitter hashtag in 2018, #codecritical, to announce the frequent ambulance shortages in the province that endanger the public. Benedict's death was the ultimate proof of the danger.

Lots of people die before they get to see a doctor, but usually they die at home. Benedict died in a hospital waiting for a transfer. This is a worst-case scenario, an utter failure of the system. If a person needs an ambulance, they deserve to get one. That somebody died waiting hours for an ambulance is an unacceptable outrage.

Paramedics don't belong in hospital hallways. As highly trained clinicians, they could be the spearhead of a forward-thinking health care system. Right now, they are the spackle.

The room is decorated with violence. Blood is sprayed across the four walls of the small bedroom. A body is splayed on the floor over a rifle. The first thing seen coming into the room looks like cherry pie next to what is left of his head. Only the bald back half remains, with thick rolls of pallid skin.

We read the blood-sprayed envelope entitled "To whom it may concern," and the letter apologizing for the mess and arguing for assisted suicide, which would have stopped his suffering and surely would have been cleaner.

The TV is on. "I swear to god I didn't (bleep) him!" a frantic lady shouts at Jerry Springer, swinging her arms behind the blood-speckled screen. What was on when this man shot himself? I stand in the still room, stupidly taking everything in. The man's cell phone starts ringing on a table next to the body. Somebody is calling their friend Don, but Don's not here. Don's mouth is spread across the west-facing wall, and the language part of his brain is on the floor next to my foot like a giant freakish wad of gum. The call is confusing. To the outside world this man is still alive.

That suicide was the first dead body I ever saw.

Thirty minutes later I was on a new call with an elderly woman. She had back pain. I asked this new patient when the pain started and how badly it hurt.

Nova Scotia's ambulance service isn't public. It's a private company—Emergency Medical Care Inc.—in what it calls a "long-term performance-based contract with the provincial government's Emergency Health Services (EHS)." EMCI's parent company, Medavie Health Services, also owns the ambulance services in other provinces including New Brunswick and PEI. In Nova Scotia it will cost you about $150 to be taken to hospital in an ambulance. Out-of-province patients pay $733. Non-Canadians pay $1,099.

Early in my career, NS paramedics almost went on strike. Contract disputes between the union and the company stood at an impasse. At every posting, in every ambulance, paramedics discussed what could be done. Could we stop driving for non-emergency transfers? Could we choose which calls to respond to? Could we possibly walk off the job?

DANIEL SUNDAHL, DANSUN PHOTO ART
  • Daniel Sundahl, DanSun Photo Art

The pay, considering the job's demands, was unacceptable. I made about $22 an hour. The contract offerings of the company were insulting. One such offer amounted to a raise of 28 cents per hour.

"Another day, another 28 cents," my partner joked. Then we were called to treat a dying man with an internal bowel bleed.

I knew there would be no strike. Paramedics want to help people. It's in our genes. There was no way we would stop working and let somebody suffer. I believe our employer knew it too. In the end, it didn't matter. The government stepped in, forced the employer's contract onto paramedics and removed their right to strike. Atlantic Canadian paramedics are still among the lowest-paid in the country.

One year earlier, Metro Transit bus drivers went on strike for about a month. As reported in The Coast, once resolved every bus driver was given a $4,000 bonus. Their new entry-level hourly wage was more than an entry-level paramedic. New bus drivers are still paid more than new paramedics. That may change; paramedics recently voted on a new contract. There are no reports yet whether it was accepted or rejected. The public won't learn the issues anytime soon. On the day this story was published, Nova Scotia's health minister announced that a government-commissioned review of the ambulance system—already a year overdue—would be kept from the public because it might impact contract negotiations. This time around we know for sure there will be no strike.

"Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret where he must look for an explanation for his failures," said pioneering French vascular surgeon René Leriche.

The nature of health care means anybody working in the field will hold some variation of Leriche's cemetery in their minds. Suffering leaves a mark, even when it's another person's pain. For paramedics the cemetery is spread out, more like a village. A paramedic will stop at an intersection and remember a car wrenched in half as if a giant was trying to wring water from it. She will remember the stop sign, a red octagon buried halfway in the ground by the car when it leapt off the street. She will notice the new sodding where the grass and dirt had been ravaged by the accident. She will remember the young woman's stone-dead body, twisted and tangled like a contortionist, in the driver's seat. Then she will drive through the intersection, on to her destination.

Another will walk through a park full of kids running and shouting. He will remember a boy hanging from a tree branch, the playground empty and still while police and firefighters did the unenviable job of cutting down the body and finding his family.

Another will pass by a house and remember a screaming little girl on the front lawn, her face smeared with blood from a dog bite inflicted by the family pet.

These vignettes are like a thin silk veil sitting on reality, a scene made of vapour. Sometimes the visions don't evaporate. One in four paramedics will develop post-traumatic stress disorder. It's the cost of visiting people on the worst day of their lives. Things that happen once in a lifetime for most people happen every day to a paramedic. It takes a toll. It's hard to tell how long you can keep paying. Most first responders know they are just one call away from the end of their career.

I sit next to a man who is passing out, his head lolling to one side and then the other as our ambulance rushes through the streets. Over the sound of our siren, I try to rouse him. "Ralph," I say, grasping his wrist to take his pulse. I don't feel it. On the monitor I watch his heart rate drop from 68 to 48, to 33, to 21. He's crashing. I reach for the resuscitation equipment.

I feel a cannonball in my chest. Dread. A voice springs into my head. I wallow, hoping this man stays alive: "I don't want to watch this man die. Not again. I don't want to be here. I don't want to do this anymore."

Today I decide to quit. I have reached my limit of witnessing pain, being exhausted and sore and feeling alone. It's not worth it anymore. I have to give up killing pain. I am sick of death.

A paramedic sees the best, the worst and the funniest of people. It was wonderful when we ran into a patient who was good-natured despite their circumstances. I have met breathless lung cancer patients who pant when they stand, but still find their voice to say "thank you." I have met a man paralyzed from the waist down who joked about Viagra. I have met young people who care for wheelchair-bound parents without a hint of resentment, while their friends are out drinking and dancing. Sometimes attitude is the only thing you can control, but not everyone does. I've met people who make no bones about taking advantage of others, ordering health care providers around like butlers and maids, shouting and screaming like spoiled children.

Being a paramedic brought to my life mental, emotional and physical destruction. Fatigue and stress made me moody and irritable. When I laid in bed at night, it wasn't restful. An ambulance would drive past my house and I would awaken drenched in sweat, heart pounding, jaw clenched. My body reacted to the sounds of my work even when unconscious. Seeing the suffering that I couldn't change made me depressed. People abusing the system made me feel abused. I loved being a paramedic and hated being an ambulance driver. Long drives and awkward lifts of bodies made my own body feel beaten and meant I would never make it to retirement. The low pay made me feel worthless. I noticed I wasn't sailing at all anymore. I was missing holidays and time with my family. My excitement for paramedicine had turned to disappointment. Full of sorrow, I resigned from my job. I had to stop wearing the uniform and coming to the rescue. To keep working would be irresponsible.

It's just a line on my resume now, but I'm glad I was a paramedic. Those seven years were wild. First responders are my favourite people. They know a kind of human truth others don't. Languages, homes and clothes may be different, but people are the same. Pain hurts. Problems abound. A breath is a blessing. Love can grant unnatural strength. It's a privilege to sleep at night in your own bed. The future is uncertain. You can say beautiful things with dirty words. Shit comes in storms. Eventually everybody gets sick.

Life is hard to define. Death is not. Death is a vandalism of life. It is stillness, certainty. Life is simply "not death." The life of a human and the life of a dog are quite different. The only difference between a dead dog and a dead person is shape, size, how they're buried and what they leave behind. Their futures are identical: Not life. Above all, I learned that living things are more interesting than dead things.

Life is change. Even when life is bad, it will change as long as you keep living. Life is a rare thing that manages to be both fragile and hard. It is precious.

If times are bad, it's good news that things aren't worse. No matter how hard something is, you still get to live through it.

It was a profound honour to become a part of so many people's lives. They became a part of mine, too. Some memories still make my eyes water.

It's been over a year since my last ambulance shift. I never did get to be a medic on a sailboat. Two weeks after I quit, my wife was pregnant. I don't mind staying on land. I am grateful every evening to be at home with her and my new daughter.

Sometimes an ambulance drives by outside with lights and sirens. I can tell the noise apart from police cars and firetrucks. The siren might be distant and weak to the ear; but it is loud in my head. When I recognize that sound, I no longer sweat or grind my teeth. I silently hope that the patient will survive, that their suffering will cease. I hope there is a hospital bed for them when they arrive at the ER. I hope the paramedic caring for them isn't burnt out.

Then the siren fades into the distance. I enjoy the calm.

"Stay awake, Emily," I say, my hands cradling the child's head. Her eyelashes flit. Her eyes open. Sky blue. Bleary. Emily was run over by a car. When we arrived she was sitting cross-legged in her driveway, clutching her stomach in obvious pain.

As we tried to talk to her, the entire neighbourhood gathered. It looked like a block party. The chorus of voices rose until we couldn't hear her talk. We turned away a dozen neighbours who wanted to know what was going on. We collected her into the ambulance.

My partner does most of the work; I sit behind the stretcher where Emily lies. I hold her head in case she has a broken neck. When she gets drowsy, I keep her awake. I feel guilty. She looks so tired.

"I have to give you a needle, OK Emily?" my partner says.

"I don't like needles," Emily says, unhappily.

"I know," my partner says, sympathetically. "It's just a little pinch, OK?"

"OK," Emily says. Her eyes close.

"Wake up, Emily," I say. She opens her eyes. Sky blue.

Emily had a burst spleen but would be OK. She survived. I was relieved, happy she would grow up. Her parents still had their daughter.

At home before dawn, a sound comes from my baby's bedroom. Gurgling or choking. I get nervous. My paramedic work taught me that death is silent and choking is subtle. You have to look for it to catch it.

The room is too dark to see anything but a small figure in the crib, a little movement. I step in quietly, shoulders hunched up. Leaning over the crib, I pull back the curtain. Dull light pours down onto my baby's eyes smiling up at me. Sky blue. An image of Emily's face wisps away like steam.

I pick up my daughter, smiling back at her. We go to the window and watch the sun rise into the pink and orange sky. Cottony clouds float by. Distant trees sway like cornstalks in the wind. "You're going to have fun today, baby girl," I say softly in her ear. Today we're going sailing.

———

Andrew Bethune is a copy editor at The Coast and a freelance writer. He is working on a book about his years as a paramedic. You can reach him by email at andrewbethunewriting@gmail.com.

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