Award 2018 Nominee
Hard to save someone when life is flooding the landing and dripping from 5th floor to the 4th
‘Code 1’ signifies the highest priority at the ambulance service, siren on. The whizzing engine of a tired Mercedes is giving its all, rushing to an 11-year-old boy. He has been reported to the 112 hotline with low blood pressure. Control room has passed all the info, the team is already on board. First left into Sosnkowskiego, siren full blast, then left into Pużaka, cars giving way. The team have been two minutes on the road, maybe three since leaving Warsaw’s Ursus depot, when the radio controller calls out their number and gives out a piercing yell:
“He’s stalled on you! Got it?! He’s stalled!!”
Inside the cab: Daniel, the rookie, barely into his twenties, only in his third month in the team. By comparison, the other paramedic, Mirek, is a dinosaur: a phenomenally experienced pro whose hands have returned people to life hundreds of times. And the doc. At 80, she would knock out every professor with her knowledge, but should she be out there, saving people?
An old tenement with peeling rendering, set amid narrow streets made even narrower by the ranks of parked cars. The ambulance’s desperate howling alerts neighbours to a drama playing out behind one of the walls. Onlookers are like vultures: always peeping out the windows, stopping with a trolley full of veggies to check out which entrance they have come to. With luck, perhaps, to see who’s coming out on the stretcher.
It is the fourth floor, no lift. A small flat awaits them, and in it the parents’ wailing. Get the kid down, from the bed onto the floor. Normally Mirek avoids it, but this time he applies mouth-to-mouth for the first five inhalations. To no effect. The attached monitor signals asystole (arrest of cardiac electrical impulse), like in the movies: a straight line, anticipating the worst possible outcome. Young Daniel dashes out to the ambulance for the rest of the gear. Running down the stairs, he passes the doc, working her way up on her last legs. When he is back, the boy has the tube fixed already and a central venous catheter in the neck. Mirek was not idle.
“Michał, the boy was called Michał,”- says Daniel.
“Remember anything else?”
“His icy hands. And empty eyes, open during resuscitation.”
Michał’s room is desperately small. The child is lying on the floor, between the bed and the table, resuscitation plays out in the middle of a rug. All around his toys in a mess: teddies, blocks, cars, a model railway on the table. An hour ago, Michał would have been dispatching trains there, or perhaps played ball, while mum would admonish from the kitchen to quit kicking indoors. For the last 40 minutes Daniel and Mirek have been alternating in this struggle, but to no effect, the boy needs adrenalin. The flat is hot as hell, sweat drips from their brows on the carpet. Mirek can already wring his T-shirt, Daniel will soon reach the same state.
“Water, gentlemen?” – asks the mother suddenly, looking at the paramedics, as they attempt to snatch her son back from death. Since the moment the child got into their hands, the parents have been silent, emanating calm. Only later, Daniel will understand the full dimension of this utterance, coming from the mortified mother as she watched the tragedy. But there is no time for water: press the chest, oxygen, one, two, three, four, five… Blow, blow.
“Will someone shut up the fucking dog!” (It is yapping in the other room). This bloody train on the table… No effect. Decision time: off to the hospital.
Patterns on milk froth
“What one word would best sum up working for emergency in Poland?”
Daniel has graduated with honours from Warsaw Medical University, School of Emergency Medical Care. With his diploma in hand (pharmacology, toxicology, intensive care, and more – knows it all by heart) he had to look for a job in a popular chain café. Got a contract right away at 18 zlotys per hour before tax. A year later, he found a job in his profession. But he had to sign a contract as a self-employed.
As a paramedic, his hourly rate in Warsaw amounts to 18 zlotys per hour (14 zlotys after tax). He becomes a businessman. His invoices will show: date of SERVICE (circulatory & pulmonary resuscitation of a mother of three, children watching), name of SERVICE (defibrillation of a child, venous catheter, intubation), all of it neatly coded in the Polish Register of Business Activities as 86.90.B, Medical Emergency Work.
He has to pay his own National Insurance contributions (two years at a preferential rate of ca. 500 zlotys, then a full rate of 1200), plus transfer tax to the Revenue Office. He’s left with 1,500 in hand. As a barista, the only risk he is taking is to spoil a heart design on milk froth. A mistake in an ambulance can kill a patient. He earns more on little coffee hearts than the real ones, so he is forced to keep both jobs. After a 24-hour ambulance shift, he goes to the Gdański Railway Station to spend another 8 hours asking:
“Can I offer you a cookie with the espresso?”
He cannot afford to buy a car. He lives close to Wola town hall, so he gets up at 5 am in order to get in in time for his shift (7 till 7 shift pattern). First a bus ride to the city centre, still mightily sleepy, then changing to route 517, direction Ursus-Niedźwiadek. Earpieces in, always some energizing music. This is one of his passions. No, he does not play any instrument, but collects discs. He blows all the savings on gigs; heard Toni Braxton in Moscow, and Mary J. Blige in Frankfurt.
“I remember listening to Pulse after resuscitating a child. I still get goose-pimples when I hear that track,” he says with a glow in his eye.
He was born in Orzechówka, a Carpathian village. Are they proud of him in Orzechówka?
“Why do you do this?”
“Brewing coffee? For money. Saving lives? Out of passion.”
A few absent-minded hugs
Getting out of the flat involves near-acrobatics. Daniel is carrying Michał, but he needs to get in the bathroom first in order to leave the room. Mirek is in the hallway with the gear. And all is done with caution, ever so gently, not to disturb the ventilation tube.
“He’s been without pressure too long,” says Mirek, and he knows. They run down the stairs, one floor, two floors, three. The ambulance is waiting, trolley at the ready. Gently, Daniel lowers the child down and reapplies the pressure. Michał is cold, just about hanging on the last thread. They cannot leave because some total idiot has parked blocking them, despite the flashing signal. At last, they are on their way, the siren on. Cars climb kerbs in a jam in Pużaka. And inside the ambulance the desperate struggle is continuing. As if in a trance, Daniel cannot feel his arms any longer, but the battle rages on auto-pilot: three, four… blow… The respirator tube has detached from the intubation, but the rookie cannot stop pressing the chest.
“Please, help me, madam. Put the tube back in!” he shouts at the mother.
“What tube? What do you mean?!” The mother is unhinged, but how can she keep composure when her only child is drifting away in front of her?
Daniel reconnects the respirator himself. At the A&E, a new team already awaits. Another 20 minutes. In the waiting room, the parents are going to pieces, asking again and again what is happening to their son. Daniel and Mirek have also stayed behind, although they do not normally do this. They are drenched and tired. A doctor comes out, throws the door wide open and says:
“Please, listen, that’s his heartbeat.”
He made it.
A few absent-minded hugs and Daniel and Mirek return to base. Replenishing supplies in the ambulance, two more minutes and another call-out. There will be ten more on that day.
A really neat loop
Control room info is hazy. Some suicide attempt, a teenager, here is the address. But is he alive? was it an overdose? a blade? That is not clear. At least the family managed to shout the address into the phone. The prospect is bleak: control room cannot spare an “S” team (this is a specialist ambulance, a team of three, including MD, despatched to the toughest cases), so they will send a basic team (two paramedics, no doctor), Marlena and Grzegorz.
Affluent houses of well-to-do owners, richly ornamented gardens, tall hedges, well-equipped cars on tidy, even drives. Everything suggests that residents of this neighbourhood have made it. But the siren’s wail echoes from the roofs exactly the same as from old tenements. And neighbours in shirt sleeves, behind net curtains, plus a guy on horseback, straight from a polo match, look out not unlike men from courtyards in the Right Bank, mates stripped to their wastes, flexing six-packs in the summer sun. Someone is out there, on the drive, waving, running up, stopping the ambulance, sobbing, shouting, even though she cannot be heard through the siren. OK, this is it.
Marcel must have taken a good while to accomplish such a neat loop on the line. Then he had to haul down the punching bag and store it under the window, move the stool right under the hook in the ceiling. Next, to thread the line through the hook. As he was wobbling the stool and then promptly saying goodbye to life and the basement gym (a gift from dad), the family were returning from the shops, taking the last turn towards the house. Reactions. Father: the knife, initial struggle, mouth-to-mouth, press the chest. Sister: the phone, emergency and shouting over the siren in the driveway, in pieces. Mother: in pieces.
“Save him, save him!”
“Down in the basement, he’s just 17!”
Marlena and Grzegorz take the challenge. Press, blow, press. Between the first series and the next they call out for support.
“Send us an S- team!”
And on with the struggle, press, mother’s lament, press, sister yelling. After 20 minutes, the S-team arrives. 40 minutes, and still fighting. 74 minutes, Marcel, 17, lies stretched under the window, next to the punching bag (he put it there himself), denying hope.
“Defibrillator, try the defibrillator!” – that’s the father. Sister in pieces. Mother in pieces.
Granny calls me doctor
A city dweller cannot easily understand a girl who would do anything to escape from classy, seaside Sopot to Warsaw. Dreaming throughout her middle school and high school of escaping for good. It’s difficult to understand a boy who ignores lovely mountain view from his family home and wants to be in the capital.
Marlena wanted to, and did escape:
“My family don’t get it. They keep telling me: ‘You are from such a beautiful place, what do you want with Warsaw’s concrete?’ But for me, my home town was grey, and cloudy, and without prospects. I did everything to run away and I’ve succeeded.”
In Warsaw, she studied English at uni. But she could not find a decent job, so after graduation she worked in a fast food bar downtown. Sandwiches, an ocean of crunchy batter, a sea of coke on tap, rivers of people in the queues. One Thursday morning, people drop by for their chips and coffee, as always. Someone places an order, Marlena turns to get it and hears something awful happening behind her back. Another turn and she sees a colleague convulsing in an epileptic fit. Each client volunteers a tip, and each one different: “Put something in his hand! Something in his teeth! Hold him!” But the girl is at a loss what to do, beyond calling out to the kitchen. A week later she is training as a paramedic.
“My family are proud of me. And granny calls me ‘doctor’. I know about medicines, what to do, how to behave, but it’s way from being a doc.”
You fought for this boy the full 74 minutes. But Marcel, 17, lies stretched by the punching bag (he got it down himself). Get up, tuck in the sweaty blouse, pull off surgical gloves, look the father in the eyes (knife, mouth-to-mouth, defibrillator), the sister (phone, driveway, in pieces), the mother (in pieces), and say:
– The doctor confirmed death at 17 hours 23 minutes.
It’s time, over and out.
How not to get soppy
Sometimes, what you see is frightening, events devastate your psyche, and you can only rely on yourself to save your sanity. It is a Summer holiday season, Friday night, Daniel is praying for a quiet shift, because it is his friends’ wedding party this Saturday. His prayers may reach the Deity, but not the Control Room Operator: “An accident: a tram and a BMW.”
Left, left, right, siren on. The girls are all broken up, caught up in what used to be a sports car, but alive. The man (or so he seems to be) is not. An impossibility, after the impact pressed him into glass and metal, the steering wheel and the dashboard. The girls are off to the hospital, the man begins his last journey. Daniel jumps into a suit, shiny shoes, and rushes to the wedding.
“Fortunately, I quickly dump such images. I am not scared on the way to emergencies. We work like automatons,” he says.
Marlena looks like someone who just won’t be moved.
“I’ve got nothing stuck in my memory that would pain or bother me. I don’t get thrown, and I don’t take work back home with me,” she declares. “You can’t carry on in this job without a shell. Without it, paramedics would all be alcoholics or suicides. We don’t have access to counselling like our colleagues in the West.”
Still, in the depth of her memory, Marlena does carry a story, which keeps coming back. A call-out to a woman with cancer. It was the end, and everyone present in the flat knew it, but it did hit Marlena hard when she departed, holding her by the hand.
“Because the moment of passing is the hardest.”
Thoughts rushing through your head
– No shit!
Guess how often Daniel has heard it in reply to his assertion that paramedics put their lives on line to save others. Often enough.
He has already done his 24 hours and should go home. He has covered 14 trips, resuscitated, calmed down, injected, chosen treatments, has not slept a second. He is sitting there, at the depot, thinking of bed and asking himself: “Where the hell is my replacement?” But he is not there by 7, nor 27 past, he is running late. A call-out: Code 1, just his luck, he has to do his 15th emergency.
Was it a Thursday? It was summertime, that’s for sure, baking sun despite the early hour. The door slid shut, the siren on, the team ready, off they go. Andrzej, also a medic, behind the steering wheel. Beside him Natalia, a very young rescuer, new but ambitious. How much do we know? A man, uncommunicative, profuse bleeding, possibly a junkie. A huge apartment block, a beehive already abuzz, people getting ready for work, quite a lot of traffic on the stairs. They sprint a few floors up. A semicircle of neighbours, an open door, a man on the floor. It is 7:40. This is it.
Assertively: “Ladies and Gentlemen, make room, please step aside!”
He is naked, perhaps 30, not older. They lie in the hallway side by side: he and a syringe. Minutes ago, he was searching for pleasure with the needle. Pierced arms directed him down to the groin. But the artery refused to co-operate. There is so much blood that wellies would not go amiss.
Assertively: “It’s too tight here, rookie, get him out on the landing!”
Andrzej is dragging the young man, Daniel is helping, Natalia is watching maroon smudges left by the limp legs on the stone floor. S-team are on their way to assist.
Andrzej keeps pressing the chest, Natalia installs the tube, Daniel inserts a needle for intraosseous injection. A neighbour from across the landing comes out, perhaps to get rolls, pork loin and strawberry jam, but one glance at the action and she withdraws. Must have lost appetite for breakfast. Everything around is maroon. Daniel exchanges gloves, but that does not help, another minute and they are all bloody again. He grabs a vial of adrenaline – quick, quick, faster – ah, it breaks in his fingers. No matter, he grabs another, passes it on. They carry on battling. A doctor arrives with the second ambulance. It is 8:20. This is the time he will enter in the death certificate. The team have done all they could, but it is hard to save someone when life is flooding the landing and dripping from 5th floor to 4th.
Daniel pulls off the gloves, takes a look and connects the pieces of a puzzle. The vial… “Fuck…” he cannot say anything else. A deep cut on his thumb, piercing the skin.
Guess what thoughts keep racing in his head.
Straight from the scene, he goes to take tests in the hospital. For the next 30 hours, he cannot get this image out of his mind: the syringe in a pool of blood. Before results are in, he will have read so much online on HIV and AIDS that he could write his own book on the subject. But he draws the line on photographs. The day after, the tests declare him clean, but he needs to begin a course of antiviral HIV therapy as soon as possible.
“The drugs are very potent, you will certainly feel them,” says the doctor.
“No worries, I’ve done worse…” he replies with self-assurance.
But the drugs are very potent, and Daniel does feel them. They literally knock him out flat. He gets such runs that, ideally, he ought to move to the loo permanently. But that is not an option, he needs to go on another shift. Fast forward three days, and he is comfortable again, just nauseous plus a headache. He finishes the course. Final verdict: while ending his stormy encounter with life, the junkie did not leave Daniel a surprise gift, after all.
Breakfast for lunch, lunch for dinner
There is no such thing as regular work schedules, coffee breaks, lunch hour, soup of the day. Daniel hops off the 517 at the Sosnkowskiego stop at 6:32, goes back 150 metres, turns left and visits the Galeria Wypieków patisserie. Two Danish, three smiles and off to the depot. If he is lucky, he will have the pastries for breakfast.
But he is not lucky today: ambulance check-up, topping-up drugs and supplies, and immediately off on the first job. Then the second, third, fourth. He has the pastries for lunch and the lunch for dinner, between call-outs nine and ten. His favourite Chinese takeaway from a tub. Fried rice with chicken, mild sauce, plastic cutlery (just a fork, knife is unnecessary), he eats sitting on a hospital stretcher.
“I know it’s unhygienic, but if I don’t eat it like that I won’t eat at all.” And another call-out, when he is half-way through the tub. He will finish it at night, if he is lucky.
“Well, yes, there are nights with fewer call-outs, so one can sleep a little, rest a little, sit down, but it is a rarity. Some shifts, you have 19-20 emergencies.” Actually, this is Daniel’s record: “Physically, it was terribly demanding. The last calls were, like, ‘Are you coming with us? If yes, then jump in the ambulance, please. If not, then see you’.”
He works about 200 hours a month at the ambulance station, sometimes on 36-hour shifts. And the part-time barista job, too. On a trot, from one work to the other. If he has a day off, he just sleeps. He knows people who spend several days in a row at the depot. A friend of his has worked the equivalent of 15 years in just 6. Credit, mortgage, what can you do?
And then, there is this contract: no annual leave, no paid sick-leave. Sometimes, he goes to work with a 39-degree fever. On 30th December he worked 24 hours at the depot, and on New Year’s Eve, straight to the café, followed by another 24-hour shift on 1st January. Who cares if he’s down with a virus? Have you found a replacement? No? so hop in the ambulance and stop moaning. On his first call-out, he threw up on the entrance door of an apartment block. Then vomited into a carrier bag in an ambulance carrying the second patient.
“I am 24, but mentally I feel 40,” he says.
It is not like this tiredness never reflects on the patient. Daniel tries to be professional, but he can become irritable, cursing everyone and everything mentally.
One hot day, on a call-out to an elderly, obese lady (so obese that she is too bulky to be carried down to the ambulance), the team insist that she should walk down on her own. There is tension, nervousness, half-way through a very demanding shift. In the end she walks down. She can barely fit in the ambulance, Daniel loses it:
“Sit down here, please, what is it you don’t understand?!”
She sits down, the ambulance starts, a while later the woman collapses on the floor.
- Oh, shit, stop, she’s stalled!
Action stations, resuscitation, signal on, the ambulance rushes her to the hospital. The woman dies in A&E.
“The last words she heard in her life were mine: ‘What is it you don’t understand?!'”
Marlena knows people who work 300 or 400 hours a month. They are permanently tired, irritable, harsh. But what if they have to do it? if they need the money? Marlena has no family; she works once every four days, 192 hours per month, earning around 3 thousand zlotys, before tax. As per usual, she is self-employed, so subtract National Insurance, tax, it’s not difficult to work out how much she is left with.
England will welcome you all
Daniel, now 26, is no longer in Poland. He lives in Oxford. He is just in the middle of a training course. It will still take a while before he can start as a fully-fledged paramedic in an English ambulance, but to have just one job will be a real luxury. At an induction course, he is talking to a local female paramedic:
“In Warsaw, we worked a 24-hour shift pattern. There were some who worked 400 hours a month.”
Her eyes widen. Two days later, this is all her colleagues can talk about, they have not heard anything like it for ages.
Daniel has a simple plan, which he could not realise in Poland: to have one job, enough time to relax, to travel, to go to gigs. He dreams of another trip to his beloved Moscow and on the Trans-Siberian Railway.
“Well, and I’ve bought the car.”
Marlena is also leaving Poland. An ambulance service job is already waiting for her in the UK, she only needs a professional class driving licence. Everybody is leaving: doctors, nurses, paramedics.
“Polish paramedics are the best qualified in Europe, but the money we are paid is disproportionate to all we need to learn and all the work we undertake. Every paramedic in Poland is authorised to dispense 49 drugs. It used to be 27, but our responsibilities are constantly extended. But we get no more money for that, no pay rises. 18 zlotys per hour, equivalent of 14 net of tax and NI, is a joke… A team leader at McDonald’s earns more. Last year three of my acquaintances left already. When I told my manager I’d go, too, she asked: ‘How can you do this to me?’ Well, I can.”
You don’t have to be good, you’ve got to be cheap
“We put up stickers on the ambulances, wore T-shirts. But I suspect the public were more impressed by the taxi drivers’ strike than ours,” says Marlena.
In case you have not heard, paramedics have been fighting for quite some time to improve working conditions, to get a pay rise on a par with nurses (1,600 zlotys per month), plus subsidised training and training leave, also to secure regular jobs in place of self-employment. These are but some of their demands submitted to the Ministry of Health.
“Our strike won’t change a thing. We cannot just leave the patients, we carry too much responsibility. And we always hear the same argument: ‘We don’t have the money to spend on you.’ We would all have to quit to force changes,” says Marlena and adds: “The truth about the Polish emergency service is very sad. In order to get to work there, you don’t have to be super-educated, to stun them with knowledge. It’s enough if you are cheap.”
A call-out, info from the control room: “Sorry, have to dash.”
First left, then straight on, the siren blasting, cars scattering to find the hard shoulder. Code 1, Marlena to the rescue. But who will rescue Marlena?