05 June 1995 - Boston, Massachusetts
Jeff was excited. Today was his first day of clinical rotations and he was starting with a bang. He’d be training alongside other paramedic students, as well as with nursing students, physician’s assistant students and resident physicians at one of the nation’s best teaching hospitals - Massachusetts General Hospital; it was one of the best hospitals in the nation, period, as well as one of six Level One trauma centers in Boston. He could be very busy today.
Jeff was sure the ER staff at Mass General would think he was crazy if they could see his face. He wore a grin a mile wide under his mask and face shield; he wore the mask because he was currently in the “Soiled Utility” room, rinsing “waste” out of disposable bed pans prior to putting them in the biohazard collection box. The other paramedic students put their noses in the air and scoffed when they saw him carrying the pans. Jeff’s philosophy was to do the little things to get to do the big things.
“Hey, Christi, those bed pans are taken care of. Do you have anything else you need done?”
Christi Newsome, the nurse he was assigned to for today, smiled. She couldn’t ever remember a medic student volunteering for the shitty jobs before being told to do them. “Would you mind taking a couple apple juices into Room Three? She doesn’t need to be NPO any longer; the doc said it’s okay for her to have something.”
“Sure. The fridge they’re kept in is back there?”
“Right. Thanks, Jeff.”
Jeff brought the requested drinks to the woman in Three; he made sure she was as comfortable as possible before exiting the room and finding Christi again. He did the little tasks that would have kept her from focusing on the medical side of her patients’ needs. In the end, though, Jeff knew that nursing included those little touches, too.
He’d been there for three hours before something “serious” arrived in the ER. The regional air ambulance service called over the radio to report they were ten minutes away with a boating accident victim. From the report, two boats collided on a lake near the Massachusetts / New Hampshire state line; their patient had been a passenger on one of them and was badly injured.
Christi took Jeff over to Trauma One, the trauma bay where the patient would be evaluated. She explained what their jobs would be once the patient was placed on the exam table by the helicopter crew; she also made sure he knew where to find the equipment they’d need. He put a thin plastic gown over his clothes and donned a second set of gloves and another face mask while the trauma team gathered.
A blue-suited flight crew entered the trauma bay; the familiar routine of the crew’s report was interesting to see from the receiving end. As soon as the patient was placed on the table, Jeff stepped over to draw the blood samples. The flight crew had already placed two IVs in the patient’s arms, so no more were needed. Jeff saw the Emergency Medicine resident place a chest tube in the patient while he finished drawing the samples; he winced when one of the nurses placed a urinary catheter, called a “Foley,” in the patient’s penis. Those were two things Jeff hoped he’d never have to receive while he was awake.
The patient was taken to the CT scanner after the initial evaluation. Jeff pulled off his mask, gown and his outer pair of gloves before collecting the trash generated by the team. Housekeeping would clean the room once the patient went to the floor but others could trip over the trash, or slip trying to avoid it, so he picked it up anyway.
“Excuse me?”
Jeff turned to see one of the flight crew standing next to him. “Yes?”
“Is there any more of this cleaning solution? This one’s empty.”
“Sure. Let me grab it for you.” Jeff took the empty bottle from the man; he retrieved the new bottle of cleaning solution and brought it to where the flight crew was cleaning their equipment.
“You’re a medic student? I’m sorry, I didn’t notice that before.”
“No worries. You guys need to get back in service, right? Can’t do that if your equipment is dirty.”
“Thanks.” The man looked at Jeff closer. “Did you ever work out in Springfield?”
“Yeah. I used to work for Connecticut River Valley Ambulance until they got bought out. You look familiar, too.”
“That’s where I know you from! I’m Aaron Sandoval, I used to be a medic for Western General.”
“Jeff Knox. Good to see you again. Small world, isn’t it?”
“I’ll say. How’d you wind up out here?”
“Long story. I’ve been at Brophy in Malden for about two years now. Just started my clinical rotations for medic school today.”
“Well, I’m sure we’ll cross paths again.”
“ ... this parcel extends just past the crest of the hill in that direction,” their realtor, Kari Koivu, was saying, “maybe fifty yards past the tree line at the edge of this clearing in that direction and all the way back to the road. This trail here pretty much marks the property line on this side of the parcel.”
“How come there hasn’t been much development on this road until now?” Jeff asked the man.
“The gas company’s finally pushing a main up this road. Up until now you’ve had to have those propane tanks on the back of your house if you lived up here; not terribly inconvenient but not something that a lot of people wanted to deal with, apparently. Once they put that gas main in they’ll finally pave the road, too.”
Jeff looked at Keiko; she nodded at him. “Kari, grab this lot before it disappears. Grab the one that you said runs behind the place, too; we won’t try to combine the lots or anything, but I don’t want someone building a house behind ours, either.” A flight of four helicopters went thumping by overhead. “Blackhawks,” Jeff commented, recognizing the silhouetted UH-60s. “Are they from Fort Devens?”
“Yes. They occasionally fly over this side of Lancaster, but not too often since the South Post training areas are over by Route 70. They’re probably on some sort of practice mission with the 10th Special Forces guys; those guys train a lot.”
“Don’t I know it. I was in the 82nd; I remember how much the guys in 3rd Group trained. I think half the ammo dump at Fort Bragg was theirs.”
“Hey, Beth. How are you today?”
“Better than you guys if I’m seeing you after six in the morning, Jeff. Rough night?”
“You and your intended have the same capacity for understatement, Miss Hargraves.”
“Speaking of my intended, where’d he disappear to?”
“Sean ran down to the cafeteria to get us some coffee before we head back to the station.”
She shook her head. “I don’t understand how you guys can drink coffee and not have it affect you right before you head home to sleep.”
“It’s a skill, one we’ve perfected through much practice.”
“Hey, good lookin’. You come here often?” asked a third voice.
“Yeah, but your fiancée is standing right here and she looks like the jealous type,” answered Jeff before Beth could.
“Sean McNeil Brophy, you best learn some better jokes before we start having kids; I don’t want them learning your current supply from you.” She turned on Jeff. “And you! Don’t you encourage him!”
“Yes, Dear,” Sean answered. “You need to start learning that phrase, Jeff.”
“My fiancée is a black belt, Sean. I say that already.”
Jeff’s first shift at Mass General’s ER had been a seven a.m. to three p.m. shift; it’d started off slow before picking up a little more than halfway through. His second shift was a three to eleven afternoon shift; it was like trying to step on a treadmill which was already moving.
“Jeff? I’m Chris. Drop your stuff and let’s head into Room Five,” his assigned nurse Chris Gadbois said to him as soon as he stepped into the treatment area. “We’ve got a chest pain patient coming back here from triage and we’ll need an IV and blood draw. I talked to Christi Newsome earlier and she told me you know what you’re doing and you work hard; I’m trusting her judgment here, so don’t let me down. Start the IV first; try to get at least an eighteen gauge into the person; smaller catheters will cause the red blood cells to hemolyse, to rupture, making the sample unusable. Before you take off the tourniquet and flush the line, draw the samples through the catheter then connect the IV.”
“Got it, Chris.”
One of the triage nurses wheeled an older gentleman into the treatment area; Jeff and another medic student lifted the man out of the wheelchair onto the stretcher. Jeff tied the constricting band around the man’s arm after his shirt was taken off. Before the other staff finished placing the EKG electrodes on the patient, Jeff was done.
“All set, Chris.”
“Already?” Chris looked over, expecting to see a blood bath, but there was no blood visible anywhere. “The doc just ordered some nitro for the patient; why don’t you give them to him and explain the side effects.” Chris was impressed and the kid’s shift wasn’t even ten minutes old. “Do you need me to sign off on that line and nitro for you?”
“The line, yes; the nitro doesn’t count since it wasn’t an IV medication. Also once I finish my assessment sheet for him would you mind signing it?”
“I can’t believe you guys don’t get credit for med administration.”
“We do, but only if it’s an IV push or infusion.”
“That’s crap! If Dr. Atherton orders a nitro drip, I’ll make sure you start it so you get the credit.”
The pace of the shift never relented. Jeff needed to write assessments on the chest pain, a respiratory distress, a traumatic back pain, a broken wrist and a fall down the stairs by 8:00 p.m. At 9:30 p.m. a Boston EMS BLS crew brought in a stabbing victim from the bus stop down the street; ALS was many minutes behind them and it made sense to just bring the patient in from where they were. The man was moaning and flailing as the ambulance crew placed him on the table in Trauma Two; it was again Jeff’s job to start the IV.
“We’re going to intubate,” the Emergency Medicine resident running the trauma announced to his Attending, who was standing at the edge of the trauma bay, after the initial assessment. Jeff was finishing up a second IV by that time.
“Dr. Snow, any objections to having Mr. Knox make the attempt?” Jeff heard Dr. Atherton ask. Jeff was shocked.
“I’m here for another year, sir; one tube isn’t a big loss. I’ll coach him if you have no objections?”
“By all means, Doctor. Mr. Knox, the intubation is all yours; Dr. Snow will assist where necessary.”
Jeff’s mouth was as dry as Death Valley and his pulse raced. The second-year resident waved him to the head of the stretcher. “Can we get two hundred milligrams of Succinylcholine, one hundred micrograms of Fentanyl and twenty milligrams of Etomidate, please? Okay, Jeff, right?” Jeff nodded. “I’m Josh. We’re going to sedate and paralyze this guy for you so you can intubate. I’m guessing you’ve never dropped a tube on a real person before?” Jeff shook his head. “Same technique as the mannikins, but a whole lot easier. Okay, let’s get set up while they grab the meds. Got everything? Alright, Tammie, go ahead and give the meds.”
As Jeff watched, the patient’s movements diminished while another of the ER nurses, Tammie, pushed the pain medication Fentanyl and the sedation medication Etomidate. The patient’s body twitched all over a minute later - the fasciculations from the paralytic Succinylcholine - and was then still. Jeff flicked the patient’s eyelash and got no response. He nodded at the respiratory therapist bagging the patient and the man stepped back.
Jeff held a firm grip on the handle of his laryngoscope; he was thankful for the gloves on his hands since they kept his sweaty palms from being an issue. He inserted the blade in the patient’s mouth, being mindful of the man’s teeth, and lifted the jaw up and away from him.
The patient’s vocal cords were a bright white against the pink of the trachea. Jeff held his gaze on them while his right hand introduced the endotracheal tube; he watched while it slid between the cords. Once the balloon at the end of the tube was completely past the cords he removed the blade. Inflating the cuff he asked the RT to bag the patient while Dr. Snow listened to the lung sounds.
“Perfect, Jeff. Clear bilateral breath sounds with no sounds over the epigastrium, Dr. Atherton.”
“Good. Depth, Dr. Snow?”
“Twenty-three at the lips, Doctor. Sandy, secure the tube, please?” The RT secured the tube and connected the ventilator.
“Let’s give him twenty milligrams of Pavulon, please. How is his sedation?”
“Holding for now, Dr. Atherton. It’s been about five minutes since we gave him the Fentanyl and Etomidate.”
“Dr. Bennington?”
“We brought down some Propofol; I believe we should start that before we head up to the OR,” the trauma attending stated.
Atherton nodded. “Okay everyone, nice job. Mr. Knox, that was a well-performed intubation. Let’s auto-transfuse the blood in the Pleurovac before we hand off to Trauma Surgery, please,” Dr. Atherton ordered from the edge of the trauma bay.
“Thanks, Dr. Snow,” Jeff said in a quiet voice as the two prepared to leave the trauma bay. He watched as a nurse hung the collection device for the chest tube from a pole; a drain line was connected to a filter and then to the patient. Another nurse hung the Propofol, a milky-white medication which would keep the patient unconscious.
“What are they doing, Dr. Snow?”
“They’re giving the patient’s blood back to him; you don’t have to type and cross that way. You can call me ‘Josh, ‘ by the way. How old are you?”
“Twenty-five, sir.”
“I’m twenty-eight; no need to call me ‘Doctor’ or ‘sir’ all the time. What do you need me to sign for you?” Jeff handed the resident his skill log. He nodded to the man and stepped over to the ER Attending while Josh signed.
“Thank you, Dr. Atherton.”
“Jeff, I’ve watched you bust your backside here all afternoon and Christi told me about your first shift. You earned this chance, plain and simple. Most of your classmates are still standing around with their thumbs up their butts.”
“The resident gave up a tube?”
“Trust me, Sean, I was as shocked as you are. He reminded me he’ll be a third-year resident when the new class arrives July first; he’s lost track of how many tubes he has. He knows he’ll get more before he graduates, too.”
“Will wonders never cease?”
“I think Dr. Atherton’s beaten some humility into these kids; he’s a pretty cool guy. Anyway, are you sure you’re okay with us just going to a Red Sox game?”
“For my stag party? Yeah. It’ll be just you, me and Dad; I don’t need a crowd of people or the whole strip club thing. It’ll be my first game at Fenway. Plus, you know what Beth looks like! Why do I need to go somewhere to look at another woman, or to look at another woman at all?”
“I thought your Dad would have taken you to a Sox game by now?”
“He did, but that was during a road trip we took to Toronto after we met. Just haven’t found the time to go to Fenway since I moved up here.”
“They’ll reject your application for New England citizenship if they ever find that out! We’ve gotta fix that!“
“So how long does it take to get your paramedic license anyway?” Jenna, a nurse at the Mass General’s Cardiac Care Unit asked.
Jeff was sitting at the nurses’ desk with his class notes, reviewing them during some slack time in the shift. “You don’t get licensed as a paramedic in Massachusetts, Jenna; you get certified.”
Jenna was horrified. “You mean you’re up here practicing on our patients without a license?”
“No, I’m operating under a license.”
“You just said you weren’t!”
“I don’t have a license of my own; all EMTs in Massachusetts operate under the authority of the license of their medical control physician.”
“And who is that?”
“No idea,” Jeff shrugged. The other nurses on the unit watched the byplay with some interest; many of them never knew what they were hearing from Jeff.
“You don’t know?”
“Nope. I have no idea who the paramedic program’s medical director is; I know who my ambulance company’s is, but I’ve never met the man. The state EMS office knows, and both entities are still in operation, so it must be cool with them.”
“Well, you’re not touching any of my patients!”
“That’s okay. Don’s my evaluator today, anyway.”
“Hmmph!” Jenna snorted and stomped away.
“Okay, that’s a ‘no’ for putting Jenna on my Christmas card list,” Jeff muttered to Don Tollefsen.
“I wouldn’t worry too much about that, Jeff. She’ll get over herself soon enough. It’s not like we weren’t in the same position while we were in nursing school! We weren’t licensed, either!”
Jeff shrugged. “Someone somewhere is okay with how we all do our jobs. I’m not all that wound up about it.”
“Jeffrey, what am I going to do about a place to live while our house is being built?” Keiko asked over the phone one night.
“I think we should get an apartment together in Shirley or Ayer, somewhere convenient to Devens Regional, while we’re having the house built. We put any items that we don’t need, that won’t fit in the apartment or we don’t think we’ll keep, in storage.”
“We do not have much time to find such a place. It is already the middle of July.”
“It’ll work out. I’m worried more about finding a builder who is reputable, isn’t booked solid already, and who can finish the exterior in time for the winter. If worse comes to worst, we ask Charlie and Emilie if you can bunk in with me for a month or two until we find a place.”
“Do you think that is a viable option?”
“They like you, so I doubt it will be an issue. We present it as a temporary inconvenience before I move out. They’re thinking about having kids, so they’ll want the room I’ve been using back but there’s no rush.”
“You are still happy with the design we chose?”
“The modified Colonial farmhouse? Absolutely. I think it will give us plenty of room for the kids we’ve talked about and still leave us with a guest room. The views to the southwest will be a great from the entire first floor and the family room downstairs.”
“I believe the same. I will begin searching the apartment listings for the area near the school while you complete your paramedic training.”
“Hey, Devon!” Jeff called to Devon Aguilar when he reported to Wilberforce Ambulance Service for his first ride-along shift in early August.
“You’re the paramedic student who is riding today? I must’uv pissed somebody off!”
“Be nice, Devon, or I’ll ask you to let me practice IV starts on you,” Jeff said with an evil grin.
Devon smiled. “Good to see you, Jeff. How’d clinicals go?”
“I ran out of space in my skills logs by my last few rotations. My first tube was in the ER on my second rotation there.”
“I heard! I don’t think that’s ever happened before!”
“So, what’s the plan for today?”
“I don’t know about you, but my plan is to do as little as possible; I’m already a paramedic, remember? I might have to hammer you on pharmacology and stuff, though. You know, to make sure you’re not getting too big for your britches.”
“Ha! Bring it on, buddy!”
Three weeks later he was back at Wilberforce for another ride-time shift. Pete Noonan and Maura Flaherty were his medics, neither of whom he’d met before but he had seen them around while working. Devon had obviously briefed them on how to torture Jeff during the shift; they kept up a near-constant stream of questions, quizzing him on every topic covered during class.
Little else happened during their twelve-hour shift. The two medics tired of firing questions at him after five hours, so they went to get lunch; recharged from their meal the medics began the questioning again an hour later. At approximately five o’clock in the afternoon they got their first call.
“Medic Five, Operations?”
“Medic Five, quarters,” Maura answered.
“Medic Five, in Wilmington for the cardiac arrest, Thirty-one Boutwell Avenue, three-one Boutwell Ave.”
“Five has three-one Boutwell Avenue in Wilmington.”
“Alright, Jeff,” Pete said from the passenger’s seat while Maura drove. “All you have to worry about when we arrive is to get the tube. After you get the tube, then we’ll worry about you pushing medications or any other skill, okay?”
“Got it,” Jeff responded. He spent the rest of the ride thinking through the steps for intubating in his head.
When they arrived at the house, Wilmington Fire directed them to their patient; she was a ninety year-old woman lying in a hospital-type bed in what was once the house’s living room. The fire department EMTs were administering CPR to the woman and bagging her while Jeff moved to the head of the bed. Pete, Maura and the engine’s lieutenant pulled the bed away from the wall and raised its head once Jeff indicated he was ready.
Jeff’s laryngoscope lit up the back of the patient’s airway, revealing a pool of phlegm in the back of her throat; he could see bubbles rising out of the yellow semi-liquid. Jeff bit back the bile rising in his own throat. Without clear landmarks, Jeff relied on his knowledge of airway anatomy and aimed for the bubbles. He felt the tube pass through the vocal cords.
Jeff listened to the lung sounds while Wilmington Fire bagged the patient. He heard no sounds over the epigastrium, the point where the esophagus enters the stomach. The lung sounds weren’t the clear sounds he would have expected in a normal patient but were heavy with congestion; the patient was reported to have been suffering from pneumonia so they made sense.
Maura secured the IV line and they moved their patient to Wilmington’s ambulance. The three from Wilberforce hopped into the back with a Wilmington firefighter. A member of the engine’s crew prepared to follow the ambulance in the Wilberforce truck.
“Where are we headed?” called the firefighter/EMT from the driver’s seat of the ambulance.
“Lahey,” Pete answered while he watched the cardiac monitor.
“Lahey Clinic in Burlington it is!” Jeff felt the transmission shift into drive.
Along the way Jeff administered two rounds of cardiac arrest medications after interpreting the rhythm on the monitor as asystole; the medications and EKG interpretations were all recordable skills as was the ET tube he’d placed while in the house. Pete and Maura had him deliver the report to Lahey’s ER when they arrived there; Jeff ran through the skills he’d performed and the medications the patient received while under their care. The ER staff ran through the asystole algorithm once before the doctor pronounced the patient dead.
“Time of death 1742 hours,” he stated. “Thank you everyone.”
As Jeff left the room he looked back over his shoulder at his patient; she was half-naked with a plastic tube sticking out of her mouth. The nurses were beginning to clean up the area around her.
Jeff wrote his patient assessment sheet while Pete wrote his report as they sat side-by-side. Maura was cleaning their equipment and putting it back in their truck; they would be headed back for shift change once they were done. Jeff walked to the nurses’ station with Pete to deliver their report.
Something drew Jeff back to the room they’d delivered the patient to. The codes he’d done in the past never impacted him much; he’d always been able to compartmentalize well and hold the calls at arm’s length. Not this call, though. He’d realized, while he was writing his assessment, that someone had died so he would have the chance to become a paramedic. Jeff peered around the door frame and into the room.
The patient was mostly covered with a sheet, leaving her head visible. He could tell someone had brushed her hair and cut the ET tube off at her lips so the family wouldn’t be jarred by the sight of what they’d done to her. The doctor who’d pronounced the patient was now wearing his embroidered lab coat while he spoke softly to a couple in their late 50s or early 60s; the wife cried while her husband rubbed her back, trying to console her. Jeff tuned the scene out as his thoughts consumed him.
“Hey, Jeff,” Pete called in a low voice. “You okay?”
Jeff looked over his shoulder to see Pete and another man standing next to him. He shrugged. “Yeah, I guess so, Pete.” The look on his face contrasted with his statement. He turned back to the scene in the treatment room.
“What is it?”
“I was just thinking about the call,” he answered, still looking into the room, “about how I just got all those points for all of those skills. Did she really need to die so I could become a paramedic? It doesn’t seem right. My grandparents are roughly her age; how long before that’s my Dad in a room like this trying to comfort Mom because Grandpa or Grandma are dead?”
“He’ll be a good medic, Pete,” the other man said to his preceptor.
Pete nodded. “Yes, I believe he will. Devon’s been telling us about him for a while; he’s got the clinical knowledge but he also connects with his patients. They’re still people to him, not just something to be moved from place to place.”
“‘Jeff’ was it? I’m Tony DiBennedetto.”
“Nice to meet you, Tony. Sorry if I’m bringing you down with my attitude; this all just hit me.”
“I’m a paramedic with Billerica EMS; I used to work with Devon, Maura and Pete at Wilberforce before I got the job there. I understand, Jeff. I understand more than you know.” Tony paused and looked into the room also. “Your patient is... was ... my grandmother. Mom’s mom as you’ve probably guessed.”
“I’m sorry, Tony.”
“You know it’s coming, but that still doesn’t prepare you for when it does,” Tony said, watching his mother stroke her mother’s hair. He turned back to Jeff. “Don’t lose your compassion, Jeff; it’s what separates the good providers from the ones just going through the motions. Even when the good ones joke about having none, they still do.”
When Jeff returned to the condo that night he spent hours talking to his grandparents on the phone.
“Thank you for your help yesterday, Jeffrey.”
“No problem, Keiko. I learned something today while I was helping you clean, too.”
“And what is that, Jeffrey?”
“That I would rather scrub the 504th‘s latrines for a week before I clean another women’s bathroom. That was frikkin’ disgusting!”
“My roommates seemed to have had less than stellar hygiene habits, yes.”
“I assure you that this roommate of yours likes a clean bathroom.”
“It will be appreciated. How long will it take us to get to Shirley in this truck?”
“It’s a newer truck, so it shouldn’t take too long. The engine has decent power and the suspension isn’t bouncing us all over the place.”
“I am glad we were able to secure this apartment before you had to ask Charlie and Emilie if I could live with all of you temporarily.”
“Me, too. We’ll get your stuff unloaded at our new place then head back to Malden with the truck for the night. We’ll load up my things tomorrow and get them, and your car, out to Shirley; I’ll bring the truck back tomorrow night and drive back to Shirley in my truck if you want to stay in the apartment and start getting it set up?”
Keiko smiled and held his hand. “‘Our’ place. I believe I like the sound of that, Jeffrey.”
“As do I, Keiko. Are you ready for our trip to Austin next week?”
“Yes. I look forward to meeting your friends in Amarillo also.”
“Dearly Beloved, we are gathered here today...”
Jeff half-listened to the Justice of the Peace as he stood next to Sean Brophy. While part of him waited for his cue to hand over the ring to Sean, he daydreamed about his wedding to Keiko next year; they hadn’t discussed their own wedding much while Jeff was dealing with paramedic school and Keiko dealt with finding their apartment. Their trip to Texas kept their attention off next year’s ceremony as well.
Jeff handed over the ring at the appropriate time. Beth gazed up at her new husband with love in her eyes after the JP pronounced Sean and her man and wife. They walked down the aisle together, but Charlie joined Emilie and Jeff found Keiko for their turn. With only three dozen guests the newlyweds didn’t feel they had to stick to tradition too closely; they’d come up with the idea.
“This is what I want, Jeffrey,” Keiko whispered to him while they walked down the short aisle together.
“Which, Keiko? They wedding, the yard, the good weather?”
“The wedding, Jeffrey. I find that I will not require a large, church wedding. Do you think your parents would allow us to be married in their back yard?”
“We might be able to do that. You do remember how many cousins I have, right?”
“I seem to remember that, yes,” she responded with a smile. “And thank you for helping me set up my classroom last week; I am sure you could have spent the time studying for your paramedic exam instead.”
“I have vast experience in Classroom Design; I was almost born doing it after all. You’re sure you want this style of wedding, Keiko?”
“I am sure, Jeffrey. Allison’s wedding was beautiful, do not misunderstand me, but unless you have your heart set on a church wedding we do not need that. I already have what I want.”
Jeff stopped by the apartment’s mailbox after parking his car. He’d just run out to the house in Lancaster to check on its progress; the exterior was finished before the end of September and the interior was almost complete. They’d let a designer pick finishes, fixtures and flooring for them and the design was perfect. Once the trades were done with their work he and Keiko would do a walk-through with the builder; as soon as they signed off on the property the furniture would be delivered. They’d be in their house by Halloween he guessed.
There was a large, white paper envelope stuffed in their mailbox. Jeff carefully extracted it so the rest of the mail wouldn’t go flying. He stared at the envelope. It bore the return address of the state’s EMS office.
He forced himself to walk slowly up the stairs. Once he was satisfied the rest of the mail didn’t need urgent attention he opened the one he’d wanted to open first. He let its contents slide out onto the kitchen table. The top document was a cover letter addressed to him. When he read “Congratulations” in the letter’s first line he didn’t need to read anything else.
“YES!” he bellowed, pumping his fist. Jeff dug through the rest and found the score report from his paramedic test’s written exam. AAFEMS - the American Association for Emergency Medical Services - reported that he’d scored at least ninety-five in each of the exam’s six sections; seventy-five was passing and a failing grade in any one section would have required Jeff to retake the entire exam.
Jeff kept digging until he found the one thing he’d wanted from the day he started in EMS and first saw it: the AAFEMS paramedic patch embroidered in a mix of red, blue and gold thread. It sparkled in the sunlight coming through the window. He’d proven to the state and AAFEMS that he understood the class material. Now it was time to prove it to his coworkers.
