Fire Station, Kern County, 1:39 am. The fluorescent light above my single bed flashes on, accompanied by an audible alarm that has obviously been finely-calibrated to wake the sleeping without producing a minor heart attack; a Goldilocks of sirens. The headboard speaker streams the dispatcher’s voice, relaying the relevant station number. I quickly sit up in bed. Tom[*], my shift captain, has assured me that I will hear people running if the call is for a fire, shuffling if it is for something else. I hear nothing. I slip on pants, shoes and a shirt, grab my notebook, and unwisely make a stop in the bathroom on the way to the apparatus bay (the garage). I climb into my designated spot in the cab of the engine to find everyone – fireman, engineer, and captain – waiting for me. There is no shame like letting down a team, doubly so when you are the new guy and trebly when you are allowed to even be there in the first place purely out of their generosity. As I place my headset over my ears, Tom hangs his back up and, smiling, runs his hand across his throat to signal the universal sign for “canceled.” I have dodged my punishment of buying ice cream – penance for missing a call – but the message is received. On just the second call of my shift, my goal of staying out of the way has crystallized: Do not be a liability.
I am on a two-day ride-along with the Kern County Fire Department in the Bakersfield metro area, California’s ninth biggest city and perhaps its most maligned: the city has been labeled the most polluted, one of the worst places to live, and the least literate city in America (which means no one is going to read this blog). It is hot, dusty, far-flung and suffers from both high rates of poverty and crime, so Kern County is as good a place as any to spend thirty-six hours with one of America’s most respected and, in retrospect, inaccurately named professionals: firefighters.
The station fronts a wide street in the Bakersfield suburbs and is one of the county’s newest, a modest and comfortable building that sleeps ten firefighters and a battalion chief. There is a workout room, a large dining room table, and a kitchen big enough to cook meals for everyone. The station operates in three shifts – A, B, and C – with each shift working three rotations of forty-eight hours on and forty-eight hours off, followed by eight days of recovery. Each shift has two crews of three men: a fireman, an engineer, and a shift captain, with corresponding rank and responsibilities indicated, as one firefighter tells me, by the fact that “the captain is always furthest from the poop”. One crew operates the “engine,” a Pierce Quantum pumper, and the other operates the “truck,” a Pierce Dash 100’ aerial platform, the actualization of your first-grade what do you want to be when you grow up homework assignment. Except this one costs a million dollars.
The truck crew responds to fires and car crashes, the engine crew to those and everything else as well. Each bedroom has a toggle switch on the wall that alerts the relevant crew when an emergency call comes in, and there is an alarm and a loud speaker in the main area of the station as well. When the crews aren’t in bed asleep, studying, or doing maintenance, they are together watching television or cooking, playing games for dish-duty, or generally acting how I imagine brothers act if they have to be around each other for forty-eight hours. I quickly gather that the single most important quality required to be a successful firefighter is an ability to get along well with others.
8:20 p.m., possible structure fire. Both shifts – the engine and the truck crews – are fully engrossed in the Dodger game, but at the sound of the alarm everyone is up and moving. Tom goes first to a fax machine and then to a map on the wall where the station’s section of metro-Bakersfield is divided by number and quadrant, with street names visible and a little red dot for every fire hydrant in the area. Tom and his engineer (the driver), a man with an infectious smile, a mop of curly, flaming red hair, and ironically surnamed “Hernandez,” match the address on the report to the closest cross streets on the map, and they head for the trucks. Though Tom suspects this call is just an air conditioning unit on the blink, potential fires require all hands, and both truck and engine are out the giant bay doors, lights flashing and sirens blaring, in less than two minutes. We reach the house minutes later to find a pajamaed family gathered on the driveway. Tom gets information from the matriarch, and one crew checks the outside of the house while the other checks the inside, but it’s all anti-climactic. Nelson, a hulk of a man but also the fireman – thusly closest to the poop – is selected to squeeze himself into a tiny crawl space about the size of a pizza box and up into the attic where he sees no evidence of fire. The A/C unit motor is indeed burned out (which is surely a legitimate emergency in Bakersfield), so they cut the power to the unit and return to the station, the entire process, from alarm back to the Dodger game, lasting less than fifteen minutes.
It is easy to glorify firefighters. Their mission and very existence is to end the danger in your life. They rescue stranded cats from trees, smile placidly while your elementary school-aged children wipe their snot-covered hands all over their spotless equipment, help old ladies cross the street. Occasionally, to the shame of prematurely big-bellied men and the delight of their wives, they might pose shirtless for calendars, probably while petting a sickeningly cute puppy. No one calls the firefighters on their neighbors, you never see secret video of them beating up minorities, and their first words to you are never “can I see some identification?” In the battle for the citizenry’s hearts and minds between cops and firefighters, it is not a fair fight.
They have much in common with the military. Aside from the clear responsibility to get along well with others, a firefighter needs to be personally responsible while being subservient to the team. He[†] must both appreciate the importance of a command structure and understand his place within the organization (there is irony in the fact that our democracy’s most respected institutions are decidedly non-democratic). He must maintain his composure under adversity and discomfort. He must always be ready – no long showers or a leisurely perusal of The Atlantic while sitting on the can. There is similarity in the friendly ribbing of one another, commonly used to address deficiencies without creating those awkward confrontational moments of publicly embarrassing a guy by telling him he is completely jacked up (for example, “Vino, are you dressed for a barbeque?,” or “Loudon, nice of you to join us this morning. Did you sleep OK?”). And there are long stretches of the mundane, followed by bursts of activity and trauma, the stress dealt with later in the familiar manner of minimizing reality or making light of the grotesque. As an outsider, it is uncomfortable to hear a soldier talk nonchalantly about shooting someone, or to hear a firefighter talk about seeing a kid injured in a traffic accident (at least one firefighter casually spoke of being called to a scene to find his pregnant wife and three-year old child as the victims). The truth is that a firefighter on duty can have a lot of idle time, but he is always there when you need him. And a lot of people seem to need him.
6:30 a.m., medical assist, elderly woman confused. REM cycles should not be interrupted, and after the 2 a.m. false alarm and subsequent difficulty returning to sleep, this alarm has me confused as well. I almost get clipped by an oncoming school bus as I step out of the engine. Calls at this time of the morning are often dead bodies, found when a spouse wakes up to discover the other spouse has died during the night. Instead, two generations of women are there to meet the crew as they walk through the door of the house. Though it is 6:35 a.m., everyone looks as if they’ve been up and ready for hours. Or all night. An elderly woman, the grandmother and the third generation, is reclined on an armchair, purse on her lap and with an oxygen bottle next to her piping air into her nose. Her daughter, granddaughter and one other woman hover nearby. Every few minutes, the granddaughter cracks open the garage door to ask indecipherable questions into the dark. The fireman, Vino, a big man but steady and soft spoken, takes a knee in front of the grandmother and attaches a pulse oximeter to her finger tip. He asks his standard battery of questions: what year is it, who is the president, how old are you. The elderly woman answers “forty-five.” Her daughter, face funereal and clenched arms folded high on her chest, whispers, “sixty-five.”
This is a common theme throughout the sixteen or so emergency calls over the thirty-six hour period. Multiple generations in a modest home, usually clean and well-kept, though some are nicer than others and a few are downright slovenly. An elderly parent is confused, or silent, or simply displaying abnormal behavior. The adult child scolds the parent for not answering the fireman’s questions, or answers the questions for the fireman before the adult gets a chance to, or simply waits patiently in the background until a fireman asks “what hospital do you want to go to?” An ambulance shows up, an EMT straps the patient down, gives a silent head-nod to the captain assenting to patient transfer, and the firemen leave. But I want answers. I want to know why the family is up and ready to go at 6:30 am; why grandma, fully dressed, has her purse in her lap, clutched with both hands. I want to know what wizard and keeper of family secrets lurks in a pitch-black garage and refuses to show his face, or why martini glasses are scattered on the counter. I want to ask about the nimbussed picture of Jesus Christ on the wall that looks more than passingly like skinny Matthew McConaughey. But the firemen don’t care. Not only is it not their job, it is not their place to care, or to judge. Their job is to administer aid, wait for the ambulance, transfer the patient, go home. Repeat.
9:12 a.m., medical assist, woman complaining of stomach pain. The engine arrives at the home four minutes after the alarm sounded at the station, and as we approach Tom says “we’ve been here before.” Repeat customers tend to be either old or drug users, and this woman appears to be both. She lives in her garage on a filthy pull-out couch, with old food on makeshift counters and dirty dishes piled up in a sink. Her son is indifferent, and answers most of the questions for his mom, who is in the fetal position on the bed and groaning softly. She is able to tell Tom her birth year, and he glances over at me with raised eyebrows, acknowledgement of the effects of drugs. The woman is 45, the same age as both Tom and me. She looks like she could be 70. There are scars and pockmarks on her arms and back near her armpits, but Tom hesitates when I ask if she is a drug user. She could be suffering from some sort of withdrawal, and the 911 call might be for legitimate pain. But it might also be for a free trip to the hospital, or an attempt to get more drugs.
“There’s no consequence to overdosing or to calling 911,” Tom says. “So why change your behavior?” Easy to judge Tom as callous. He joined to fight fires and to save people, though those types of calls seem to be in the minority. Of sixteen calls, just two are for fires and both are essentially false alarms. Of the remaining fourteen, there are elderly who are confused and disoriented with signs of stroke, but more often than not it appeared that a 911 call was unnecessary – or at least the presence of firefighters was gratuitous. The firefighters are on the scene within seconds and typically leave as soon as the ambulance and paramedics show up and take over. They never stayed longer than fifteen minutes at any site. A trip to the emergency room in an ambulance won’t get the patient in to see a doctor any quicker than driving there themselves, and EMTs who responded were uniformly quick to point out that there was a two-hour wait at the hospitals of choice. The fact is that of 40,000 calls in Kern County in 2012, just 3300 were for fires – that’s less than 8%.
Is this a bad thing? Worthy of discussion? Or simply the normal cost of doing business in a well-functioning and caring public-welfare system, a sign of progress rather than decline. Technology has made life easier in vastly more ways than it has made it more difficult. It is reflexive – and perhaps correct – to say that it has also made us less resourceful and less capable of taking care of ourselves. Why remember directions when my GPS gets me home? Why know calculus when my computer calculates for me? Why read about the Kennedy assassination when I can just watch a movie? Why, for that matter, drive to the hospital when my insurance company tells me to call 911? But there is always an adverse, and that doesn’t change. In one of the last scenes in No Country for Old Men, Sheriff Ed Tom Bell visits Ellis, an elderly friend of his father and a wheelchair-bound sage. Ed Tom is looking for sympathy, someone to tell him that he’s right to be disappointed in his inability to stem the downward spiral of America, but Ellis is having none of it: “What you got ain’t nothin’ new.”
12:14 p.m., medical assist, elderly man fell in the shower. The address is nearby, and we arrive two minutes after the alarm. An on-site nurse meets us at the door with a curt “Bill fell in the shower again.” Bill is seventy-one and has dementia and Alzheimer’s disease, and we find him sitting awkwardly on his tiled bathroom floor, naked and disoriented, one leg folded under him. His face is bloody, with a bump the size of a half-grapefruit on one side of his head and a blood-red week old bruise on the opposite side of his face. Maria, his caregiver, says this is the third time he’s fallen in recent weeks, and points to a hole in the wall near the toilet as evidence. Louden calmly suggests that perhaps the tile is a bit slippery, and a non-slip mat might be a good investment. Nelson – again, closest to the poop, though this time it is for real – asks Maria if she has some towels to clean the blood and feces from Bill’s face and legs. But all the towels are in the wash, and Maria doesn’t appear to be in any hurry to retrieve them, so Louden calmly asks if he might pull them from the washing machine himself. Nelson asks Bill his age (“I AM FORTY-TWO!”), if he might be able to stand on his own (“WHAT?”), and if he wants to go to the hospital (“HELL NO!”). Maria shakes her head and says, “Bill does what Bill wants to do.”
There is despair, either real or perceived, in every 911 call. People might not always call for genuine emergencies, but neither do they call to make conversation. Emergency calls are made because people panic, because they don’t know what else to do, because there is nothing else they can do. Maybe they call because it is easy. Sometimes this appears to be the most obvious answer, but the firefighters are uniformly kind and respectful. Both crews interact with the elderly and the infirm; with likely drug users; with insensitive parents and children. They never raise their voices, never show frustration or impatience, are never condescending. The most common sentence is we’re going to get you fixed up. Vino politely asks a twenty-eight year old why she took a bottle of pills; Tom asks after an old man who was the catalyst for an earlier 911 call; Nelson literally picks up an old man covered in shit and deposits him in his wheel chair so he can be safely moved into the shower and washed off. Perhaps it was to ensure he showed up at the hospital relatively clean. Perhaps it was to give him some dignity.
5:50 p.m., medical assist, elderly male not responding. As we return from a false alarm at Lowe’s home improvement store, the dispatcher reports a potential stroke victim. The man is eighty-four years old, and though he seems aware of his surroundings, he is completely non-responsive and refuses to answer any questions. He sits in his boxers, tall in a chair, as his daughter speaks to him sternly; clearly there’s a history of him not doing what she wants him to do. The scolding is out of love and frustration. Joe, the old man, has an air of defiance, a man who knows his days are numbered but would prefer to do his best to not give one shit about it. His daughter says he built all the cars in the garage, and there are trophies testifying to his proficiency. The EMTs arrive and take over, asking Joe to smile – a simple test to screen for a cerebrovascular accident – but Joe is stone-faced. The EMT, a black kid and by far the youngest of the techs over the last two days, shows the first impatience I’ve seen from any of the first responders, and he elevates slightly his aggressiveness with each “smile for me Joe. CAN YOU SMILE BIG FOR ME?” Though his youth might explain his impatience, it might also have something to do with the confederate flag draped over a table at the entrance to the house.
Is there a “too old”? There is no denying that medical advances have helped the human condition, both in quantity and quality. In 1900, the life expectancy of an American was forty-seven years; in 2000 it was seventy-seven. Though the increase has as much to do with shrinking infant mortality rates (a decrease from 100 deaths per 1,000 live births to 6.9) as it does with quality care of the elderly, using a length-of-life metric to measure the luminosity of our society’s enlightenment avoids the philosophical question of what life is worth preserving. One-hundred-year-old Don Pellman can run one hundred meters in twenty-seven seconds, long jump six feet and pole vault three, but Socrates (or perhaps a generous Plato) will have you believe that only the examined life is worth living.
Perhaps age should have nothing to do with it. Maybe Joe had a legitimate stroke. Or maybe his rheumatic hands could no longer turn a wrench, and his loving daughter and stacks of trophies are testament enough to his presence here on our earth.
A neighbor shuffles up the driveway and peers into the living room; she is an older woman with thick glasses and a German accent. She wears slippers and a house robe with some sort of medical device in her pocket, and asks Tom if everything is OK. He tells her that she should talk to one of the family members, but that he thinks Joe will be all right.
She slowly looks at Tom, then at Joe, then back at Tom again. “It’s tough,” she says, “being old.”
[*] All names have been changed.
[†] Of 465 firefighters in the Kern County Fire Department, two are female.