We went to a doctor's office for an unknown. The secretary led us to an exam room where a man in his sixties sat in a wheelchair, his chin on his chest,eyes closed, looking very tired. He had a huge distended abdomen and a hint of a yellow tinge to his skin. His wife was with him. She was a few years younger, and very well dressed. It looked like she had used just a touch too much of her tasteful dark red lipstick in the way that once beautiful older women sometimes do.
I asked her what was going on. She seemed taken aback by my question. She looked at me in such a way I almost felt like I was intruding.
"My husband's going to the hospital," she said, and then she gave us the name of the facility as if it were the only facility that one would consider going to.
"Okay, but why were we called?"
"He needs to go to the ER. They're going to admit him."
I've been in this situation before. She wasn't being unkind. She was just looking at us and we were the local people who drive the ambulance, and the doctor had arranged for her husband to go by ambulance down to the hospital where another doctor would see him. She was used to dealing with doctors.
"And what's the medical reason?" I asked.
"Oh, I have all his information. They know about him at the hospital"
I didn't get into it with her. Not that I don't still do it on occasion, but I have found that beating my breast and declaring I am a paramedic fatigues me more than it impresses someone else. While my partner set up the stretcher, I looked around for a doctor or nurse to get a report from. Just then the doctor came out of his office and came over and gave me a detailed and rather excellent report right in front of the wife. The key finding -- the man had cirrhosis and was growing increasingly weak. He had fallen recently and may have broken his hand. The doctor said his wife did a heroic job just getting her husband up to the office but he really needed an ambulance to go to the hospital. I didn't disagree. The husband looked like dead weight. Standing and pivoting him into the wheelchair -- that must have taken determination.
After hearing the doctor give us the report, I noticed the wife was a little friendlier to us. We received a little more recognition. Maybe she saw us now as part of the medical team -- that's good, she must have thought, good to know her husband will be watched over by trained people.
This was just a small moment in the day -- no big deal -- but it made me think about class in America. This man probably at one time was a well-paid executive of a large company. He probably didn't run the company, but he was a boss of a division no doubt with a big office and an attractive competent secretary, a nice salary and expense account, maybe stock options as well.
He was of the cocktail generation. I imagined him everyday having quite a number of cocktails, cocktails at business lunches, cocktails on coming home, cocktails at the country club, cocktails at cocktail parties. Tom Collins, Gin and Tonic, scotch on the rocks, rum and Coke, Whiskey Sours, martinis. Cocktails were a part of the social life of his generation and class, and, for many of those people, social life and business went hand in hand. Over the years he probably had his share and more of cocktails. Not rot gut either. No Mad Dog 20-20 or Yankee Spirit Special, but good grades of bourbon, vodka or gin. Maker's Mark. Grey Goose. Johnny Walker... I don't know, I'm a beer man myself.
It made me think of my parents and of growing up belonging to a country club. My father was the son of a man who worked all his life for the phone company. My mother was the daughter of a mild mannered inventor dreamer mid-level management worker who was always getting scammed out of his money. She lived in a ritzy town where all her friends were wealthy, while she, a scholarship student, had to pretend she came from money. Often there were phone calls from creditors. Both she and my father went to private schools. In my father's case, two childless aunts paid his way, while my mother got scholarships because of her academics and athletics. They went to good colleges. When my father graduated from Harvard, he eloped with my mother, a year younger, who hadn't finished her senior year at Smith. My father joined the Navy, and then, on getting out during the peacetime reductions, worked for Pan Am, as head of a grounds crew, responsible for cleaning the planes between trips, vacuumingthe carpets, cleaning the toilets. We lived in England where I was born, and later in Turkey -- Istanbul. Wanting more for his family, he left to become a trainee for a stock brokerage firm, where he worked for many years. As a boy I remember helping him stuff, lick and stamp envelopes with letters introducing himself to cold clients. He also went door to door seeking business. In time, he rose from managing individual accounts to managing accounts for institutions, and providing his family a good living. His firm paid for our membership at the country club, which the firm's bosses thought would be good for business.
This man and his wife in the doctor's office reminded me of some of my parent's friends. Class-conscious without seeing anything wrong with it, belonging to the country club set, having many doctor friends, always going to the best hospital, and of course, familiar with cocktails. I watched people like them at the country club, some slowly slurring their speech as the night went on, their breath smelling of liquor. Over the years, I saw ballooning bellies in the husbands and increasing makeup on the wives, the world changing around all of us.
My mother loved the country club, loved to tell others I went to a private school. She loved the fancy handcrafted lightship basket my father had made for her one summer by a Nantucket craftsman -- a basket many ladies at the country club had -- a sign of status and that meant much to my mother. I wonder now, many years later, what she might have had to endure as the poor girl pretending to be rich, and how later belonging to a country club and sending her children to private schools without scholarships validated her journey in some way. I never saw her be cruel to a person of a lessor class, although she clearly wanted our family to continue its ascent up the social ladder.
Once she said of my father, what impressed her most about him when they started dating, was that he was always nice to the ladies on the other side of the cafeteria food line. I saw that in him too, every person he dealt with -- company boss or waitress, big client or maintenence man, he looked them in the eye, asked how they were, remembered unique things about them such as their children's names.
Not all parents were that way. Many in the country club were quick to put others down, to order employees around or worse to ignore them. These members weren't necessarily bad people, they were just who they were, who their world and influences had created. I remember how angry one man was that his son was spending the summer crewing a yacht for a rich man -- his son was supposed to have people working for him, not being ordered around. I thought it was pretty cool, being able to sail around the world, but for the father, it was a bitter pill to think of his son cleaning the toilet in another man's boat.
From a young age, I tried to be like my father. He spent his college summers hitchhiking across the country working in pea canneries or driving a truck and other odd jobs. When I was younger I worked in factories, unloaded semi-tricks, drove taxi-cabs, sold Bibles on the telephone, and worked on roofs in the hot sun. I loved seeing the world, meeting people, hearing their stories. Much of my young adulthood was spent going between two worlds, working odd jobs all over the country and wearing a suit and tie and working for a US Senator and then Governor. I'd work a few years in government, and then leave to see the world. A few years later, I'd trade my blue jeans and tee-shirts back for the coat and tie world -- much to the relief of my parents, who encouraged me to think of the future.
But as much as I admired the man I worked for -- I wasn't really cut out for the world of politics, the social climbing involved in it, so I'd go back to the other world, telling my parents I was just taking the jobs I did to support myself while I devoted my time to writing the great American novel. EMS was one of those jobs and it became the one that wouldn't let me go.
In Washington D.C., I used to play tennis with the Senator on this beautiful indoor tennis court in the Dirksen Senate Office Building. It was an amazing court -- hidden from public view. To get there you had to enter a door that said "Warning Hard Hat Area Only" and then walk through a web of heating and air conditioning ducts, and then up some narrow stairs and then there was the court. I played with many Senators -- John Kerry, including George Mitchell, J. Bennett Johnston, Dan Quayle and Ted Kennedy. We played with Quayle, who later became Vice-President, the most because he was the one that was always free. The others were always having to stop in the middle of the match to take important calls or to run off to sudden meetings. One evening, just as I was getting up from my desk to go out for a night of drinking beer with my friends, the senator's secretary called and said Senator Kennedy needed a fourth and had asked if I was available. I was flattered, but I thought about it a moment. I had promised my buddies I was going to go out with them to this new bar where they sold "yards" of beer -- beer in a three foot glass. I was only a kid, but for some reason this decision became one of character. What kind of person was I? Was I going to be faithful to my pals? Or was I going to jump at an opportunity to network, to play tennis with a famous man, who might someday hold the key to a new world for me if I played it right? I saw it as a test of friendship and loyalty and not being a "suck."
Today I am a paramedic, and while I think my decision not to play tennis with the Senator was foolish looking back on it -- experiences should rarely be turned down --my choice not to go was who I was and it was one of a small number of decisions that defined and guided who I became. Maybe I was hearing my mother say of my father, he was always nice to the ladies behind the line, that implicit in that lesson was that no man was more important than another.
Today in many ways when I meet patients like this man and his wife, I am on the other side of the line. I am perhaps, to them, the one washing toilets and not the owner of the yacht. Some of these people see and may respect me, but others do not notice me. Of course, I know enough now to know what my father knew, that there is no real line. People are people, good ones and bad ones, all a product of their lives and worlds, and their parents's lives and worlds. They all have their moments of glory, of being bosses of their worlds and they all have times when they are sick and can't stand on their own, when the world has become something they cannot control, something they could not have imagined.
I've done compressions on the chests of vagrants and millionares. EMS teaches you not to judge too harshly. We're all going to end up in the same place, some sooner than others.
We were gentle with the man. I assured his wife we would take good care of him. And in her eyes, her guard down, I saw how much she appreciated that.
