Three Envelopes by Carrie Mac

This guy has had his paramedic license less than a month, yet he swaggers around the station like he’s about to retire; curating a forced, casual confidence that directs a high-beam light on the fact that I’ve already forgotten his name and none of the full-timers have even said good morning to him. We’re both filling in on this shift. We met five minutes ago.

“Can I drive?” he says as we check the ambulance. The night crew only had medical calls so I replace the emesis bags and blankets and IV lines while he sanitizes the cot and door handles. “I know Surrey like the back of my hand. It’s all up here.” He taps his head and grins.

***

Our first call is a pedestrian-versus-car, but we don’t expect it will be that bad because the address is deep in a traffic-calmed residential area of matching near-mansions with manicured lawns and smooth sidewalks. We’re sent routine at first, but then get bumped up to Code 3.

“What’s your name again?” I ask as he flicks on the lights and sirens.

“Dale.” He leans on the horn at an intersection plugged with cars. “Move over, motherfuckers.”

“Shut it down until they have somewhere to go,” I say, but he whop-whops the siren, bullying the cars out of the way and inching through, leaving a mess as the lights change behind us.

We pull up to find our patient lying on the concrete where the sidewalk meets the street at the edge of a driveway belonging to a home with fat, garish pillars that make it look like a small-town courthouse. I grab the kit from my side of the ambulance and go to meet Dale at the back, where he should’ve already pulled out the backboard and the stretcher. He hasn’t though. I don’t see him at all, actually.

***

White orthopedic shoes, brown polyester pants, a pink cardigan with little red hearts marching around the cuffs. An arm outstretched and resting in the pool of blood seeping from her head, a curly plastic bracelet with one key, a fistful of mail. Her head is the wrong shape. A dirt tire-track crosses her face. Her jaw lists to one side. Her temple is a shallow bowl, her nose smashed flat.

An SUV is parked in the middle of the road. The driver’s side door is open, and the engine purrs. Talk radio leaks out: —Coming up, traffic and weather on the ones.

She’s still breathing, but not enough. She has a pulse, but only at the carotid. I glance to my right, where the cot should be waiting, but all I see are Dale’s gleaming boots.

The woman slurps air through a mouthful of blood. Another woman is screaming, but I can’t figure out where she is.

“What do we do?” Dale hooks his thumb on his belt, which is crowded with all the things the rest of us don’t bother with after a while: little pouches for gloves and phones and radios and scissors, clips for keys and flashlights. “Fuck,” he says. “Fuck!”

“This is a scoop and go, partner,” I say. “Get the stretcher and backboard. Bring the suction.”

“Yeah.” His shadow falls across the woman. “Scoop and go.”

On the way here, Dale told me about the marinara sauce he made for dinner the night before. This is something an experienced paramedic can do; unzip a city morning rush hour while talking over the sirens about how great scissors work for cutting herbs, and how his girlfriend asked for seconds, which she never does. But now we’re here, and he’s spooked. There is no getting away from the fact that the blood and vomit pooled to one side look a lot like marinara sauce.

***

The woman’s face is sticky with short, bloodied white hair. She gums a set of broken false teeth, askew and undulating against her tongue. I pull out the dentures and set them aside. Her glasses are caked with bits of bone and viscera from her left eye, which is a thick soup in the socket—a piece of grass, several small pebbles, her pupil dilated, staring. A cop pulls up and jogs over. I follow the crease of his pants up to see a man with a turban and a tidy beard.

“How is she still alive?” He pulls off his sunglasses. “What the hell is with your partner? Is he okay? Have you got back-up coming? What do you need? Oh, no way man. That’s brains.”

“Don’t worry.” I spot Dale. He’s got both hands on the stretcher—still parked in the ambulance—head bowed, like he’s praying. “It’s just her breakfast.”

A firetruck parks across the street, the wheeze of the brakes cutting between the traffic report on the car stereo and the screams of the woman I still can’t see.

“That’s the driver.” The cop gestures to the house. “She’s inside.”

I lift the woman’s jaw to put in an airway, but she’s still chewing—on her tongue, her cheek, a mouthful of blood. I twist the airway in anyway, but it sticks out too far, not doing much good.

“This is the driver’s house,” the cop says as the fire crew approaches with all the equipment I didn’t have to ask them to get. “She was going to pick up her kid from preschool and she backed out of the driveway and ran over this lady here.”

This lady here.

This lady here, who sticks her tongue out at me as she bucks the airway and her chest lurches with sucking, agonal breaths.

“What’s that?” The cop squats to inspect a bit of pulp on the concrete, near the hand gripping the mail so tight that her fingertips are as white as the envelopes. “Is that brain matter? Tell me it’s not brain.”

***

The firefighters know the choreography. We collar her and roll her carefully onto the backboard. Our pace is solemn, slid towards the bottom end of a scale every paramedic has. A child, choking or in status seizures or covered in burns, an imminent complicated birth, a teenaged boy whose heart stops on the hockey rink, a grandpa having a stroke in his recliner, a gardener who forgot his epi pen, the drunk who takes a swing at me? I move fast for those. But this woman is actively dying. Moving her is as much a cruelty as doing nothing, but I can’t just sit there on the concrete and hold her hand until she dies, and I cannot help her along.

The woman in the house keeps screaming. Another police car comes.

Someone kills the engine of the SUV mid-weather report.

***

In the back of the ambulance, I reach for saline and a line. I grab an IV catheter and instruct one of the firefighters to cut her clothes off. I park another firefighter at her head, where he bags her every few seconds.

Dale leans in. “Need anything before we go?”

He asks it like no time has passed from when he walked away. Casually, like maybe I want a cup of coffee, or a sandwich.

“Where the hell did you go, Dale?” The tourniquet is tight on her plump arm, but I can’t find a vein. “Why are the bucketheads doing your job? Where is ALS, Dale?” This is an Advanced Life Support call. We should not be in charge of this call. I should not be in charge of this call.

He shrugs.

“You have them coming, right?”

“Yeah.” But when he steps away, I hear him asking for ALS on the radio. Dispatch says the closest car is a good ten minutes away. These ten minutes will not be good.

***

I take a firefighter along to help me. When we lose her pulse about halfway to the hospital, he bags her, while I do compressions.

“Why can’t you just call it?” he says.

“ALS can call it.” I lock my elbows and pump on her chest. “Not me.”

Could I call it? I’m not sure. If she was decapitated, or decayed, I could call it. But her head is mashed in and she’s still not quite dead and she should be, but she isn’t, and the truth is that I’m not sure if we should stop CPR or not. I know she’s dying. I know that she’s mostly dead. But still.

“This is almost a joke,” he says. Squeeze. Squeeze.

“This is a joke.” There’s a crunch as her sternum cracks. We should stop. Should we stop? “Know what?”

“What?”

“I wore a push-up bra today, and now my tits are falling out.”

“Well, I can’t see them down your shirt,” he says.

“That’s good.” There’s an uncanny give with each compression now. The last colour slips out of her skin. Her chest doesn’t rebound, and the firefighter isn’t getting any air into her. There’s too much blood and bone. Her jaw slips under his grip.

“Actually, I can see them,” he admits. “I just didn’t think I should say so.”

Push and push and push and push.

“Where’s ALS?” I shout to Dale.

“It’s better I said it, though, right?” The firefighter squeezes the bag. “Now I’m not sure. If that’s harassment, I take it back.”

“Don’t worry about it.” Up front, my partner stomps the brakes and I fall back, landing on the bench. The firefighter drops the mask.

The woman’s jaw slumps to one side. We’re moving again, through oncoming traffic.

“Jesus,” the firefighter says. “Where’d you learn to drive, asshole?”

“What?” He’s got earplugs in. He lifts one away. “What?”

“Where is ALS?” I shout.

“They’re going to try to meet us.” He tucks the earplug back in. “I don’t know.”

He grips the steering wheel, both elbows shaking.

Just a moment later, I hear another siren. ALS, at last. Dale jerks us to a stop at the side of the road.

“I’m going to punch him in the face,” the firefighter says.

“At least he has a face,” I say.

And then we’re laughing. Dale looks back at us. He’s pale, eyes wide. He’s horrified, and I suppose most of the world would think we should be, too. But I’ve laughed at worse. Maybe Dale is one month into a job he should quit.

***

After ALS pronounces her dead, we take the woman to the morgue, but the secretary sends us to Emergency to try to get an identification first. I hand the triage nurse the three envelopes I collected from the floor of the ambulance, where the woman dropped them when her grip went slack. There is not a single drop of blood on any of them. She lines them up. They’re all for the same person, with an address near to where we picked her up.

“Melnyk, Melnyk.” She types in the name. “Here she is. Stephanie Anne Melnyk. Fifty-six years old.”

“That’s too young.” I tell her about the granny underwear and compression socks, her sagging breasts and papery, wrinkled neck. The orthopedic shoes. “Come have a look?”

***

The woman’s milk-white belly wobbles as the nurse and I climb into the ambulance.

I put on a pair of gloves and take out the airway. I fish the grass and the pebbles from her eye socket.

“See?” I lift the woman’s hand, her wrist with the key dangling.

“That’s an old woman’s hand,” she says. “What does your partner think?”

“He doesn’t.”

“Think she’s older? I want his opinion.”

“No, he doesn’t think. Also, I haven’t seen him since we pulled in.”

“Well, I agree with you,” she says. “Maybe the woman on the envelopes lives with her mother. Let’s go check next of kin for the name we do have, and call them.”

***

I don’t mind calling people with hard news. It’s a script we’re used to, leaning on language like critically injured, doing all that we can, despite our best efforts, dead and avoiding niceties. No God, no promises.

“I’m calling from BC Ambulance,” I say when a woman answers. “I’m calling about a patient I picked up near your address. Do you live with an elderly woman?”

“Yes. My mother.” I hear a jangling of keys. She’s already heading out the door of wherever she is. “What’s happened? Is she okay?”

“A woman was hit by a car,” I say. “We think it might be your mother.”

“Oh. My God.” A pause, and then, “Is she okay? Where is she? Where was she? Are you at the hospital? I have to call my husband. I have to call my brother. I have to call my boys! How does something like that happen? Wait, wait. You think?”

“We’re at Surrey Memorial,” I say. “We need to confirm our patient’s identification. What’s your mother’s name?”

“Belinda Marie Garner.” I write it down and slide the paper to the nurse. “Just a moment, please.” I cover the receiver with my hand. The nurse enters the name. A record pops up.

“Look at that.” She highlights the date of birth. “Your girl is eighty-seven. “That makes more sense.”

“The name and birthdate fit,” I tell the woman on the phone. “We’re nearly certain that our patient is your mother.”

“Nearly certain?”

“She was carrying a few envelopes—”

“She always walks to get the mail in the morning!” she says. “I can show you pictures! I’m coming there right now. Is she in surgery? Did she break her hip? She fell last spring and broke her left hip. Did she tell you that?”

“I’m very sorry,” I say. “Despite all life-saving efforts, our patient died.”

There’s a pause, and then— “Where’s the mail?”

“The mail?”

“You said you had mail,” she says. “I’ll come get it. Don’t throw it away.”

She starts to cry. I let her sob for a moment, and then just when I’m about to interrupt to tell her to meet us at the morgue, she hangs up.

***

I haven’t found Dale, so we’re still parked in the ambulance bay when Stephanie arrives fifteen minutes later with her husband, her brother, her two grown sons, one of their wives, a baby, and a toddler. The social worker was paged, but she isn’t here yet.

“Did she say anything?” Stephanie reaches for me. “Before she died?”

“No,” I say. “No, she didn’t.”

“What happened?” the husband says. “Who runs over a little old lady?”

“She was legally blind,” the brother says. “Maybe she didn’t see the car?”

“Who hit her?” Stephanie’s husband won’t sit. He paces, cheeks red, fists at his side. “It has to be a neighbour, right?”

“Dad,” one of the sons says. “Dad, don’t get mad.”

“I want to see her.” Stephanie grabs my arm. “I want to see my mother right now.”

“When the morgue is ready for you.” I can feel everything slipping away from how it’s supposed to go. “They’ll clean her up and then you can see her. They have a room where—”

“I want to see her now.” Her grip is tight. “Right now.”

“Is she in your ambulance?” Stephanie’s husband wags a finger in my face. “Is she still in the ambulance?”

“Yes, but I—”

And then he’s pushing past me and marching out of the room, down the hall, and out the automatic doors. We all trail after him, like a parade. Stephanie, her brother, her sons and the daughter-in-law with the babe in arms, the toddler with his thumb in his mouth, and me.

***

There are three ambulances, but only ours has all the doors shut. The others are open, the paramedics making up the cots and tidying up the back.

“This one?” Stephanie’s husband bangs a tinted window with his fist.

The family collects at his side, all eyes on the ambulance, except for the baby, who’s watching a pair of pigeons flirting in the rafters above.

“It’s locked.”

I want to take back that moment when I laughed with the firefighter. It’s a true part of the story, but I do not want to admit it. It was funny that I had to arrange my breasts back into my bra as we pulled up to the hospital, not that the woman was dying. I want to tell the daughter that her mother was the centre of everything, from the moment I saw her white shoes to this very second. I would like to tell her daughter that I held her mother’s hand and said a prayer as she died. But I didn’t do that.

“Open it,” the man says.

“Your mother-in-law suffered fatal injuries.” There is blood all over the floor. Soiled gloves tossed on her naked chest. Her arm hanging off the side of the cot, fingertips grazing the floor, the bracelet with the one key. Her face, rearranged. “You don’t want to remember her as she looks right now.”

“Unlock the fucking ambulance.”

The other paramedics start to gather. “Is there a problem?” one says.

Two security guards come out. “Everything okay out here?”

“No!” Stephanie points at me. “She has my mother locked up in that ambulance like some kind of prisoner.”

“Trust me,” I say. “You don’t want to see her like this.”

But then every single one of us hears the unmistakable clunk as all the doors are remotely unlocked. Dale strides across the parking lot, key fob in hand.

***

A look of recognition flashes across Stephanie’s husband’s tear-stained face. He lunges forward and yanks open the back door before the mistake can be corrected. He helps his wife step up onto the bumper. She disappears inside while the husband blocks me from going in after her, to explain why she’s naked, if nothing else.

Absolutely everything falls silent for one moment. Just one moment, and then Stephanie screams so loud that pigeons take off, and the baby starts crying.

The husband climbs in after her, then the brother, the two sons, and all the wretched noises of grief and shock and disgust topple over each other.

Only the young wife hangs back. The toddler leans against her leg while the baby points at the sky, crying at the pigeons who are two tiny specks flying away.

***

After we transfer Belinda Marie Garner—aged eighty-seven—to the morgue, we go back to Emergency to clean up the ambulance. I scrub at the blood on the stretcher, while Dale gathers Belinda’s ruined polyester pants and pink cardigan.

“You’re mad at me,” he says as he shoves them into a plastic bag with her shoes.

“The call is over,” I say. “There’s no way that you can go back and do all the things you were supposed to do. We have nine more hours to spend together, so let’s just get through it.”

“It’s just that I—”

“It’s just that you got up this morning and put on your cool uniform and all that shit on your belt and figured that would magically make you do a better job.”

“I’m sorry.”

“Maybe you’re in the wrong profession, Dale.”

“Maybe.” He takes down the half-used bag of saline and sits on the bench with it in his lap. “On the first day of training, I asked if there was a badge.”

“A badge?”

“Like cops get,” he says. “You know, a badge.”

“You wanted a badge.”

“I did. I wanted a badge.”

Just as badly as I want to take back the moments when the firefighter and I laughed earlier, I would like to go back to the very start of the shift and make sure everyone said good morning to Dale when he bounced in with the energy and enthusiasm that the other paramedics tasted as obnoxious overconfidence and a dangerous lack of experience. I wish he’d showed up with a silver, plastic sheriff badge, which we could’ve all joked about. One of the guys who is about to retire would’ve christened him Sheriff, and it would’ve stuck for his entire career.

“Do you smoke?” The next time we work together, I’m going to pin a damn dollar store toy badge on him. I’m going to appoint him Sheriff myself. “Is that where you went when we got here?”

“I don’t smoke.” He points to a row of garbage bins. “I went over there.”

“To throw up?”

“No.” He shakes his head. “I just went over there to smell the garbage. I wanted to smell something other than blood and puke.”

“Did it work?”

“Sure,” he says. “For a minute.”

***

When the ambulance is clean and restocked, we sit in the front, not talking. He scrolls on his phone, and I eat my lunch, until Dispatch calls us. They want us to go back to the address, this time for the driver, who is short of breath and drifting in and out of consciousness.

“We can’t do it,” Dale replies. “We’re still on our cleaning ticket.” He sets the mike on the hook and sits back. He stares out the window. “No way in hell am I going back there.”

“She’s just having a panic attack. Imagine, killing your neighbour like that. I wonder if someone thought to call the preschool.”

“Preschool?”

“She was going to pick up her kid.” I’m about to say that the woman will never be the same, that this morning breaks her life in half. The before, and now the after. This is the wrong thing to say because Dale is broken in half now too, in the very same way. Instead, I offer him a bird’s nest cookie. “I’ll admit that the jam looks pretty violent. I promise that wasn’t my intention when I made them. It’s my mom’s raspberry jam.”

“No thanks.”

“Have a cookie,” I say. “After all of this, Dale. Come on. Have a cookie.”

He takes one, but he doesn’t eat it. He folds it into a paper towel and tucks it into his lunch bag, beside the container of leftover spaghetti with marinara sauce, labeled in black marker on a piece of washi tape illustrated with a convoy of cute little cartoon ambulances.

There’s Stephanie and her family leaving the hospital; her husband holding her arm, the brother, the two sons, the daughter-in-law with children. They cluster between a minivan and a shiny, yellow sports car. The husband sees me watching.

“Fuck you,” he hollers across the parking lot. “Fuck you!”

“Dad,” the one son says. “Come on.”

Stephanie glares at me. She clutches the envelopes in her hand. The other son steers her into the passenger seat of the sports car and buckles her in. As he pulls out of the parking spot, Stephanie twists her head and keeps glaring at me until she can’t, and then she faces forward and crooks her elbow out the open window, like she’s just a woman and her son sitting in his nice new car, out for a drive one sunny morning.

Image Source: Mihail Maletin / Flickr Creative Commons