My Paramedic Final Exam

The final exam I took to become a paramedic, or more accurately to remain a paramedic, did not take place in a classroom. The day of my final exam was a cool, autumn day in October. I was on duty in Fauquier County as a paramedic driving a Ford Explorer as a response vehicle. My job was to respond with any of the five fire and rescue departments in the southern region of Fauquier County and fill-in the gaps. Mostly, this meant operating as a paramedic on medical emergencies, but my job also required me to be a firefighter, drive fire trucks, and generally help out the volunteer agencies as needed on each individual emergency incident. My exam took place at 4:09 PM on October sixth. The events of the day leading up to my exam are not clear in my mind, but every minute between 4:09 PM and 4:32 PM is permanently etched into my soul.

There were three of us; we were professional firefighter/paramedics employed by the county of Fauquier. Fauquier County has been described as the bridge between northern and rural Virginia. For emergency response purposes, the county was divided into three areas: north, central, and south. Each area encompassed approximately two-hundred twenty square miles of beautiful Virginia countryside. We worked from 6:00 AM until 4:00 PM, Monday through Friday. This was the time paramedics were most needed because the volunteer paramedics had normal nine to five jobs. Although our official day ended at 4:00 PM, I often procrastinated and marked off duty usually no earlier than 4:15. It just didn’t feel right leaving sharply at 4:00 PM when I knew there would be no volunteer paramedics around until at least 5:00 PM, or in the worst case scenario, until I marked on duty the following morning.

I was sitting in the ready room at Company Two, the Remington Volunteer Fire Department. I was passing time and contemplating the ten minute drive back to company thirteen. The Lois Volunteer Fire Department was where I marked off duty and left the title of ALS-2 behind each day and returned home. I had nothing planned for the evening, and paramedics were a scarce commodity that time of day. I had just listened to my two peers, ALS1 in the central area and ALS-3 up in the northern area mark off duty. I was now the only career personnel on duty and, therefore, would be dispatched on any call in the county.

I’ll wait until fifteen after, then drive back, fill out the logbook detailing my calls and actions for the day, and mark off duty at 4:30. That’s about all the time I can justify without actually being dispatched on a call.

As I completed this thought, the radio came to life with a piercing tone signifying a medical emergency, “Companies six and one, 4780 Red Spruce Lane, for a cardiac arrest.” Time immediately screeched to a halt. This was the address where I had spent the majority of my life, my parents’ home. Thoughts of my father were thrust to the forefront of my mind. He was sixty-seven years old and had several heart blockages he had been ignoring for years. He had been afraid to undergo the essential cardiac bypass surgery that would save his life. He still smoked cigarettes and had been doing so for the past fifty years.

Dispatch did not send me on this call because they know it is my parents’ house. They are supposed to dispatch me on any call in the county. No matter, I will certainly be responding to this emergency.

“Craig…Craig…are you okay?” asked Zoey, a young volunteer who had just completed her initial emergency medical training.

I had stopped talking mid-sentence, and all the color drained from my face when the address echoed throughout the room. I stood up, quickly walked to the phone, and dialed the phone number to my childhood home.

“Hello!” my father answered in an exasperated tone. His breathing was harsh and fast. He was panting, and his voice was clearly faltering as he struggled to utter a simple hello.

I was taken back. My father was the sick one. My mother had high blood pressure, and she smoked as well, but otherwise, she was healthy. What could be going on here? I had prepared myself for my father’s death, and now I was speaking to him on the phone!

“What’s wrong dad?” I asked in a determined voice.

“Your mother is dead! I came home from the store and she’s dead.”

My father was never one to mix words, but when he said this so abruptly, a switch flipped inside of me. I became very tactical and calculating. The world slowed even more around me. I would not let my mother die. I can fix this. I am a paramedic for God’s sake. I’ve done this before. I can do it again. This is my mother. I have to do this. I needed a few simple bits of information, and then I would be on my way. My vehicle was idling out front.

“Is she cold and dead, or warm and dead?”

“She’s not that cold,” he answered.

“I’ll be right there!”

Click…I dropped the phone back on the receiver. That was all the information I needed. I began quickly walking with a purpose out of the building to my awaiting vehicle. To run would

be to lose control. I was not going to lose control. I was going to be completely in control of this situation. This is what I did for a living. I took chaotic situations and brought them back to order. I did this several times a day for other peoples’ families. Now I was going to do the same for my own.

“Do you need any help?” I heard Zoey say in the background as I headed out the door.

“If you can keep up!” was my response, and I meant it! Nothing was going to stand in my way. Zoey scrambled across the room and out the front door, barely shutting the passenger door before we peeled away.

I grabbed the microphone, “ALS-2 responding.”

“ALS-2 responding 16:10,” answered the dispatcher.

I activated the lights and siren and began the 15 minute drive to my parents’ house. Not a word was spoken inside the vehicle during the trip, but my mind was racing. The air was ladened with tension. The monotonous siren was a distant white noise blending into the background as I mentally prepared myself to work a cardiac arrest on my mother.

I can do this. What good is all of this training if I can’t perform now when it really counts?

The drive was down country roads. Trees and signs flew by me in the blur of my peripheral vision. Suddenly, one particular sign instantly took shape. It formed out of the haze as we approached the first sharp turn: “Maximum Safe Speed: twenty-five miles per hour.”I glanced down at the speedometer. It read eighty-five miles per hour. I eased onto the brakes.

Slowing down too fast at these speeds could be detrimental. I don’t remember how fast I was going when I entered the turn, but I pushed the Ford Explorer to its limits. As we rounded the turn, I lifted my foot from the brake and slammed back on the accelerator powering out of the turn at maximum speed. I felt the centrifugal force pulling my body out the window as we steered through the turn. The seatbelt did its job holding me firmly in place, the vehicle struggling to keep all four wheels on the pavement. Zoey’s handprint probably still can be found on the passenger door handle, her knuckles turned white as she held on with everything she had. Having successfully navigated the first major obstacle, my thoughts trailed from driving and returned to my mother.

She’s probably going to vomit. I have to be able to put in the breathing tube before she vomits. I can’t let any vomit get into her lungs.

I grew up driving these roads. I knew every turn and every bump in the road. If I had only known I would need to make this trip in record time. If I had only known my mother’s life would depend on how fast I, the only available paramedic in Fauquier County, could get there, I would have practiced it more.

Why did I get a job in this damn county? I shouldn’t be here. No one should have to do this, but I was the only one who could do this. I had to keep it together.

The Explorer was not going fast enough for me. My foot was to the floor, and it felt like we were crawling up this large hill. As we crested the hill, all four tires briefly left the road, my stomach leapt into my throat as we touched down. On the downside of the hill, my speed increased to a more satisfying level. I didn’t feel I was getting there fast enough unless I pushed the vehicle to its breaking point at every moment.

I need to make sure the IV gets placed quickly. Mom has good veins on her hands. It’s better if I can get an IV closer to her heart, but I will start in her hands just to make sure I have access. The sooner I can give her medications, the more likely she will come back.

The last long, straight stretch came up. I hated this part of the trip. The forty-five mile per hour speed limit was onerous on a normal day. I could feel the vehicle steadily gaining speed. I didn’t have the resolve to look down and see how fast I was going. I just concentrated on not making a mistake. Two more turns and I would be at the half mile gravel driveway to the house.

Get there fast, but don’t wreck on the way. That will help absolutely no one. But, I’ve got to get there first. I’m the only paramedic for miles around. If I can’t get to mom in time, she will never make it. How am I possibly going to get through this? Shut up, you freaking wimp. I’ll tell you how you’re going to get through this, one damn step at a time. And you are not going to make one mistake. Mom’s life depends on everything you do. Sometimes every single thing counts, and this is one of those times. Keep it together!

I made the last two turns and began driving up the long gravel driveway. The house was at the very end. Dust surrounded the vehicle as I went as fast as the gravel would allow. The rear end occasionally swerved right or left as my speed caused a loss of traction on the loose gravel. I pulled into the front yard and stopped ten feet from the front door, sliding through the grass and leaving brown ruts in the lawn as the Explorer came to a halt.

“ALS-2 on scene,” I barked into the radio as I swung open the door, leaving it open and bouncing against the hinges from the force of my exit.

“ALS-2 on scene 16:18,” replied the dispatcher. I had made the fifteen minute drive in eight minutes.

Eight minutes. Oh my God, that’s too long. Brain death occurs in four to six minutes. I can still do this. I have to do this. I’m the only one who can do this. God help me!

I grabbed the bags, the cardiac monitor, careened into the house and floated up the stairs. I could hear my father in the master bedroom, so I knew where to go. I rushed to my mother’s side. She was sitting up in her bed, pillows propping her up, with the remote control for the television in her hand. How many times had I seen her sitting in bed like this watching her favorite soap operas? She looked peaceful. The blanket was pulled up to her chest. I could tell dad had not disturbed her. I dropped the bags and placed the monitor by her side.

Rapid defibrillation is the key. I have to deliver shocks as fast as I can to save her life.

When I reached out and touched her for the first time to feel for a pulse, I was startled by how cold she felt…so incredibly cold. There was no pulse. Her jaw was frozen in place, as was her hand around the remote control. I couldn’t open her mouth at all. Her arms were stiff and ridged. Rigor mortis had set in. I grabbed the cardiac monitor and began placing the electrodes on her chest to read her cardiac rhythm. The room began populating with several people, but I remained fixated on my task. They were like flies buzzing around me. The ambulance had arrived. The police had arrived. My boss had arrived, and I was oblivious to them all.

To this day, I don’t know why I began to attach the cardiac monitor. There was no need to see what her heart rhythm was if rigor mortis had already set in. Such diffuse rigor mortis meant she had been gone at least three or four hours. It was a complete waste of time, but I wasn’t ready to let go. I didn’t get a chance to save her. I didn’t even get a chance to try!

A voice entered the din of my existence as the ambulance driver piped up, “You don’t need to do that, Craig.”

I glared in his direction. How dare him! I wanted to unleash a fury of anger on him for having the nerve to interrupt me. Before my anger was fully formed and able to lash out, I felt my resolve begin to lapse. When I was finally able to respond, I simply answered in a meek, cracking voice, “I know…but do you know who this is?”

Silence was my only answer. His silence disarmed me even more. A tear began to run down my face as I finished hooking up the cardiac monitor. All hope and determination was siphoned from my body, and numbness took its place. When I was done, I just starred at the flat line as it crawled across the screen. A flat line signified no electrical activity. There was nothing I could do. I was powerless. I was defeated. All of my training meant nothing. I collapsed onto my knees beside the bed and began crying uncontrollably. I don’t remember when I stopped.

The funeral was held several days later. The death certificate stated sudden cardiac arrest as the cause of death. The doctors said it was either a massive heart attack or stroke. My father had gone into town several hours earlier and returned home to find her. She must have died shortly after he left. No autopsy was performed. There was no need because there was no suspicion of foul play. She was elderly with several risk factors for both heart attack and stroke. As I sat in the funeral home listening to different people speak about my mother, I thought back to that horrifying day. I didn’t feel responsible or guilty about her death because she had been down for so long. There was nothing I could do. I felt guilty for risking my and Zoey’s life on that eight minute hell ride only to find my mother beyond all hope. I was angry that I was robbed of the chance to try and save her. If only my father had not gone to town. If only he had come home earlier. These were just a few of my thoughts as I tried to make sense of all this. Throughout those days, I came up with so many what-if situations, but not one of them helped bring my mother back. I did not blame my father. He was just following his routine and taking care of his daily chores. He had no way of knowing the love of his life would be taken from him that day.

When it became my turn to speak, I rose from my seat and approached the front of the room to deliver my mother’s elegy. I reached into my inside coat pocket and pulled out a poem I had written. I don’t think a single person in the room understood a word I read because I was sobbing throughout the entire reading, but this is what it said.

Regarding the Loss of My Mother


In times like these it seems that sorrow is the norm. No matter how much the sun is shining, I can feel the tears swelling up like the coming of a storm.

There are no words to express such a tremendous loss, loss of a mother, loss of a life, not to mention the loss of my father's wife. So I will spend no more times remembering the bad, only the good things that bring me to what I now have.

The memories of a mother that was unsurpassed. A woman who could make a house into a home, that could create a family and make it last. A woman who welcomed children into her home, they were just friends of the family, but she raised them like her own.

For 44 years she took on this task, never thinking of herself, for richer or for poorer, in sickness and in health, till death do they part. That's how it should be and that's how it was done.

If you can hear these words please remember your mother. If there is ever an undying love it exists in no other. If your mother is gone you can feel my pain. If you've forgotten to love her, never do it again.

Yes, in times like these it seems that sorrow is the norm. But we must remember the good things in life as we continue to morn. With each breath of a new baby's life another mother is born. This undying love now exists in another. But still, there are no words to describe the loss of my mother.

I returned to work two weeks later. When I marked on duty, I opened my log book and turned to the date October six. The date was neatly inscribed at the top of the page. A sea of white followed without a single blemish. It remains blank to this day. Somehow it didn’t seem right to record my actions of October six like it was just any other day. It was anything but a typical day. It was my final exam to remain a paramedic, and I passed. When I sat in class learning how to be a paramedic, I memorized human anatomy, cardiology, pharmacology, and treatment algorithms for various medical emergencies. I completed the course with flying colors. It all seemed so easy. I was so proud of the knowledge, skills, and abilities I had learned. I felt very comfortable managing medical emergencies, and I relished the challenges, but nothing I learned in any class or anytime throughout my life had prepared me for that day. It was difficult to return to work even two weeks later, but I did. If I had failed that exam, I wouldn’t have returned to work, and I wouldn’t be a paramedic today. It could have easily stripped away my identity.

Lesser trials have broken better men. That particular October six occurred fifteen years ago, and I still work as a paramedic today. Since my exam, I have been tasked with training many new paramedics. I have dedicated myself to helping prepare paramedics for their individual final exams. I often tell new students that all the initial training and certification does not make you a paramedic. Don’t worry about the test to become certified. That part is easy. Successfully passing the simple classroom trials only gives you permission to learn how to be a paramedic. The real test will happen one day when you are least prepared, and it will occur when you least expect it.