The first stop for the ambulance that morning was Starbucks.
Its the only thing I have in order, paramedic James F. Deavers said. The rest of the world is chaos.
Standing in line at the coffee shop, their ambulance engine running in the parking lot, Mr. Deavers and his partner for the day, Christian P. Hickey, were preparing for a 12-hour shift on the streets of Watertown on a Thursday morning in late November.
The two are paramedics with Guilfoyle Ambulance Services, the largest private emergency medical service provider in the north country. With 13 ambulances, the company handles about 8,000 calls a year, said Guilfoyle president and CEO Bruce G. Wright.
Seventy-six agencies provide emergency medical care in the north country, according to the state Department of Health. Guilfoyle is an Advanced Life Support agency, meaning it comprises emergency medical technicians and paramedics who can administer intravenous therapy and advanced pharmaceutical interventions.
In other words, the folks there can save your life, and they do whatever is necessary.
There are lights and sirens. There is driving on the wrong side of the road and adrenaline. There also are bizarre situations, strange people and stress.
There is life, death, blood and bodily fluids.
According to Mr. Deavers and Mr. Wright, emergency medical services are being called upon more than ever before.
Were an access point to health care for a lot of people who dont have any other access, Mr. Wright said. We dont say no, and we dont ask right away whos your insurance provider. You call, we come.
Mr. Deavers said EMS providers are seeing sicker and sicker patients these days, people who find it easier and quicker to call an ambulance than to see a doctor; many patients seen by EMS do not have health insurance and use EMS as a way to get treatment.
Only about 5 percent of the calls that emergency medical technicians or paramedics respond to are considered life-threatening, according to Mr. Deavers. But that perception can change depending upon where you fall on the care continuum.
To them its life threatening, Mr. Deavers said. To us, because we have the ability to take care of it, its just a routine call.
44 YEARS IN THE FIELD
Mr. Deavers is a bit of an anomaly in the world of emergency medical services.
At age 61, he moves with the mischievous bounce of a gangly teenager. He worked for 30 years as the director of Lewis County Search and Rescue and for 10 years before that as a paramedic in Richmond, Va. After retirement he went back to work for Guilfoyle on a part-time basis before going full-time about a year ago. He has been working in emergency medical services for 44 years.
I enjoy what I do. It excites me, it motivates me. I cant believe my age sometimes, Mr. Deavers said.
He lived in an orphanage in Richmond, Va., from the time he was 4 until he was 17. He was involved in a Boy Scout troop sponsored by a rescue squad and got involved in EMS when two squad members taught him first aid and CPR.
After that, he was hooked.
On a recent shift, a haircut that left his graying head a mess of cowlicks was concealed by a knit cap, giving him the appearance of an anatomical feature that brought laughter from the nurses in the emergency room. He silenced the laughter with the ready supply of Werthers Original caramel candies he keeps in a shoulder bag with his stethoscope.
Gestures such as that have earned him the nickname Papa.
On a typical day, Mr. Deavers said he and his partner get 10 to 15 calls.
On the Thursday in November, Mr. Deavers and Mr. Hickey performed their pre-duty checks. They ensured that the ambulance was stocked with potentially life-saving pharmaceuticals such as atropine, which is used to treat low heart rate; epinephrine, for cardiac arrest and anaphylactic shock; and narcan, to reverse overdoses from opioid-based drugs.
They also made sure there were enough batteries for the electrocardiography monitor/defibrillator, which is used to detect irregularities in a patients heart rhythm and shock it back into sync if necessary. Then they stationed their ambulance in the J.B. Wise parking lot a central location that allows them to respond to calls quickly anywhere in the city.
On this day, there were only four calls, but they were all important. Theyre always important.
The first request for help came shortly after 10 a.m.
A 92-year-old woman had fallen in her room at the Samaritan Keep Home the day before she was to be discharged. Her family was all there in her room when Mr. Deavers and Mr. Hickey entered.
Members of her family, visibly concerned about the woman, were unsure whether they should wait in the hall or stay in the room while the paramedics worked on her. One at a time, they poked their head in, checking up on the care she was receiving. She had a laceration above her right eye and was complaining of hip pain.
After checking her blood sugar and stabilizing her, the paramedics transferred her to a cot and brought her downstairs to the ambulance. Mr. Deavers talked the family through what would happen next before they went to the emergency room waiting area.
It gives them an idea what to anticipate, Mr. Deavers said. It helps the call go better when youre treating the family like youre treating the patient. You never know that might be the last time they see her. Its good to explain why youre poking an IV in their 90-year-old mother.
While driving to the emergency room, Mr. Deavers mentioned that he once had an English teacher by the same name as his new patient.
It wasnt long before the next call came in, this time from an apartment on Williams Street. A 34-year-old man with a history of heart problems was complaining of a racing pulse and chest pain.
A team of firefighters already was in the apartment. Mr. Deavers and Mr. Hickey went to work, hooking the man up to the electrocardiography monitor/defibrillator. His heart, going at nearly 160 beats per minute, was racing out of control. The man passed out and a woman in the apartment gently shook him awake; he came up swinging before she could calm him.
Upon awakening, his heart rate had slowed to a more manageable level 120 to 130 beats per minute, according to Mr. Hickey.
The paramedics gave the man aspirin to improve blood flow, along with nitroglycerine for his chest pain, and moved him out of the apartment on a stair chair, a special implement stashed in the back of an ambulance that resembles a combination handcart/wheelchair.
Later in the afternoon, as dusk was descending, EMT Matthew Thomas relieved Mr. Hickey for a few hours. Shift supervisor Jeffrey Lieberman had asked Mr. Hickey to transport a patient to St. Josephs Hospital Health Center in Syracuse for heart catheterization treatment a procedure that is used to diagnose and treat some heart conditions.
Shortly after Mr. Hickey left, Mr. Deavers and Mr. Thomas received the third call of the day, from a house on Washington Street. There they used an implement called a Reeves Sleeve to strap an 81-year-old woman to a backboard so she could be transported down a complex flight of stairs in the familys ornate home.
The woman, who is a paraplegic, later was found to have a fractured femur, a fractured tibia and a non-displaced pelvic fracture.
She was in good humor at the time she was removed from her bedroom, however.
Hey, look, its a mummy! her daughter said as her mother was carried out on a backboard.
Very, very funny, the woman said.
My wife is frisky, her husband said, laughing.
During the last call of the night, a 64-year-old man had fallen on the way to the bathroom. He had a history of heart problems and diabetes, which bumped up the priority of the call, Mr. Deavers said.
With tender care and good humor, Mr. Deavers and Mr. Thomas helped the man get to the bathroom and then headed back to the ambulance. Their work was done. No hospital visit required.
It humbles me a lot, Mr. Deavers said. I probably didnt think much about it when I was younger. But now I think, One day I could be in that position, and I hope somebody is kind to me.
Before that day comes, however, he likely will churn out a few people in his image.
Mr. Deavers is a teacher. Hes an EMS course instructor in Lewis County, and he used to help teach classes at Jefferson Community College, which offers programs where students can earn either a paramedic certificate or an associates degree.
Jeannine T. Gomiela, director of the program, said the course is rigorous and time intensive and includes several hours in the classroom, laboratory, clinic and ambulance.
The course work is ... heavy in the sciences anatomy and physiology and theres a lot of practical application and critical thinking, Ms. Gomiela said.
To become a paramedic takes two years eight hours a week in the classroom and another eight to 16 hours a week in the field.
Adaptability is a key to success in the profession, Mr. Deavers and Mr. Hickey said.
The way they tell you it should happen, it never happens that way, Mr. Deavers said.
You get people ... (who) can definitely be book smart; then they get out on the street and they cant do a thing, Mr. Hickey said.
The paramedic program tries to prepare students for that eventuality by putting them on the street with working paramedics and EMTs as much as possible.
Students will learn a skill, practice it in the lab and complete a test on it. A couple of weeks later, theyll practice it in the field, Ms. Gomiela said.
Often, the job means sitting and waiting for something to happen. Some days are one call after another; other days are quiet.
In that respect, the morning coffee routine is more significant than just providing time to add much-needed caffeine to the system. Its a ritual, and like many people with demanding and unpredictable jobs in which performance is paramount, rituals take on a higher meaning.
Mr. Deavers said he isnt superstitious, but his coffee time is important.
It is one peculiarity among many, all designed to give order and relieve pressure the lattes, the Werthers candies, the gallows humor, the chats in the hallways of emergency rooms and homes, the mention of a former high school English teacher. All these things make the job a little more human, a little easier to bear when difficult situations arise.
One executive in the business, Jefferson County EMS Director Charles F. Brenon III, said one of the hardest parts of being an EMS employee is to avoid the callousness that can come from responding to repeated emergencies.
You have to have a lot of empathy to be a good EMS provider, you have to be a good problem solver, you have to be able to read people, Mr. Brenon said. You cant feel everybodys pain, but you have to be able to relate to it.
It is clear that Mr. Deavers has plenty of empathy, along with an ample amount of the other skills required to be a good paramedic. And it is clear that he enjoys his work, although there is one thing he doesnt like to do: drive the ambulance.
I avoid driving at all costs, Mr. Deavers said. Id rather take care of the worst patient in the world than drive to an emergency call. I had some friends when I was younger, in Richmond, that were killed while driving an ambulance. Hickey knows the city better, and hes a good driver.
Emergency medical services have changed quite a bit since Mr. Deavers became a paramedic. And the history of the profession is relatively young modern EMS goes only as far back as the late 1700s, when Napoleons chief physician organized a system to treat wounded soldiers.
Nowadays, EMS is in a transition phase, emerging from primarily a volunteer force into a highly skilled professional trade. Compensation levels, however, pale in comparison to other health-care occupations.
According to the New York State Department of Labor, EMTs and paramedics make less, on average, than most other health-care providers in the north country.
They earn $32,000 a year, compared with $68,000 for physical therapists, $62,000 for registered nurses, $51,000 for respiratory therapists and $36,000 for licensed practical nurses and licensed vocational nurses.
EMTs and paramedics also earn far less than police officers and firefighters in the state, who average $69,000 and $71,000 a year, respectively.
Everybody who gets into EMS gets into it because of a desire to help people, Mr. Brenon said. They arent in it for the money.
The sky was dark and had been for some time. Under the artificial light of Guilfoyles immense garage, where phalanxes of ambulances sat silent, Mr. Deavers, a loquacious man, said something that seemed to touch on a deeper and infinitely human reason to work in EMS to work closely with people during their worst moments.
You are afforded sacred opportunities in EMS, he said. Holding a hand, comforting them. Thats held to a high esteem in a lot of countries.
Then his thoughts turned to death an inevitability in EMS and in life. A profound paradox revealed itself.
An oft-repeated maxim among paramedics and EMTs is: If death doesnt bother you, its time to get out of EMS. But getting away from EMS is not going to take you away from people dying, Mr. Deavers said. If I walk away, Im not going to get away from death.
Better to face it head on, when theres still something to be done about it.