By David Williams*

Abstract: An aged EMT learns that emergency medicine consists of more than controlling hemorrhage, dispensing nitroglycerin, and splinting bones. Occasionally, he finds that leading an active life yields rewards that cannot readily be measured.

A Spartan race, a young woman, an injured ankle, and an aged EMT.

Note the adjective: aged. I am not a young man. I am also an EMT. I got into the field really late. I got my EMT license at a time in life when most people in the field have left it decades ago for something better paid and less rigorous. I started my career at a point when most people are looking forward to retiring to where citrus is grown, certainly warmer climes than New England.

This career move was not without issue. The old man jokes started in EMT school and were relentless in the few ambulance services willing to hire an old man to haul three hundred and sixty-pound patients on a gurney that weighs well north of a hundred pounds. If you do the math, you can see that it can be strenuous work, even for a man half my age.

So, I mostly find myself in alternative ways of practicing my late-life profession. I have worked at a racetrack, children’s athletic camps, and an organization providing basic medical intervention at extreme sports such as Spartan races. In the late summer of 2016, I attended one of the two biggest Spartan events in Eastern US, which was held in a field near Barre, Massachusetts.

You may be familiar with such races. You will know them if you have cable TV and are bored of mainstream programming. Scantily clad men and women covered in mud stagger and lurch along an eleven-mile course. Early in the day, professional Spartan athletes compete for big dollar prizes and large dollar endorsements on the same course. These are called the “elites” – they go out on the course before the non-professionals. They are the ones you see primarily on TV.

Ordinary participants, as many as five thousand per day, do it for less material reasons. Successfully completing the course may mean winning a medal, T-shirt, pint of beer, foul tasting sports drink, and bragging rights for life. Dollar prizes are for the elites only, which make up less than ten percent of the overall participants. During the Spartan Race, only the elites are timed. For everyone else, finishing in one hour or in ten hours does not matter – finishing at any time is the goal.

In my experience with these races, I have seen people in their late seventies succeed, and I have also seen world-class athletes fail. I have also seen a twelve-year-old child complete the full eleven-mile course successfully.

For non-elites, it is considered less of a race and more of a challenge to see if they can complete the course. A full Spartan Race is a grueling event. The full course is generally a little over eleven miles in length and studded with more than twenty demanding obstacles. Participants encounter twelve-foot-deep mud pits, barbed wires, hanging ropes, and numerous strength events. These include carrying large tractor tires, buckets full of gravel, and stacks of cinder blocks. Typically, about twelve percent of participants do not finish the race, mostly due to injuries, although some also drop out. There are substantial fees to enter the Spartan Race and the financial commitment to participate is significant: travel, entry fees, motels, meals, much more. Some spend thousands of dollars for a single afternoon activity.

Due to the lack of financially rewarding paths to utilize my EMS training, I found myself working for a company that provides first aid at Spartan races. Some might think this means being exposed to drama: fractured long bones, blood gushing from torn flesh, and sirens screaming. However, this is far from the case. The company limits us to basic first aid – to clean injuries ice sprained ankles, and hopefully identify serious issues for local paramedics to transport. Even simple tasks, such as taking a pulse, are not permitted.

Mostly the job entails long hours for sub-minimum wage. I spend countless hours on my feet and in motion. My thought process includes palpate ankles, assess the possibility of a break, re-hydrate the dehydrated, and cool the hyperthermic. The simplest of medicine. However, occasionally, there is an opportunity for an aged med-tech to transcend the mundane, and to apply a compress that is composed of more than gauze.

It had been a rainy week followed by a tremendously hot weekend for the race. The medical tent was packed, filled to absolute capacity. Every chair was occupied with individuals holding ice packs to ankles. In one corner there was a young, athletic guy maybe in his early thirties, on his knees, quietly vomiting. In another corner was an older guy in his mid/late fifties on his knees, also vomiting. The older man’s wife stood looking coldly with her arms crossed and her grave demeanor. Her deportment suggested that she had seen similar scenes before, and she was not impressed. I cooled them down and handed them over to a paramedic for IV hydration and some anti-nausea medications. An hour later, they were on their way. Before leaving, the son told me buoyantly that the family is planning another race in two weeks. The mother glared.

It was the early afternoon. A very hot day and the peak of business for the first aid wing. This was the scene in the first aide tent: The tent was packed. Everyone had been cared for, at least in the basic manner we are allowed to. There were thirty or more chairs. Each chair was filled with a patient covered in mud with ice bags propped on their mud-covered ankles. Some had a bloody gauze clinging to a body part torn by barbed wire or abraded by sliding down a coarse rope. Others lay about on the ground, some retching, some silent.

I was walking up and down the aisles, asking “Someone seeing you? How are you doing? More ice? Gatorade? About ready to go?” Mostly what was returned was sullen silence or terse, grunted responses. No one likes to see the high point of their summer ruined because of a twisted ankle.

There was a young woman whose ankle I paused to check briefly. Lift the bag, palpate the long bones, check the joints. No evidence of a break? Replace the ice pack and move on. She was snuffling and wiping tears off on her arm, disturbing the Jackson Pollock mud-motif. Given the physical and financial investment, tears are frequent in the med tent.

The young woman in question had been brought in by an all-terrain vehicle. She had taken a bad fall on the course, perhaps five miles in, and was badly enough injured to need transit out. I did not see her arrive for her initial intake. When I first saw her, she was already ensconced in a folding chair, leg up, an ice bag in place.

As noted previously, failing to finish the course is often seen by a participant as some kind of personal failure. Men often see it as a failure of manhood, whereas women see it as a failure of, well, something. This woman wasn’t just sniffling but had proceeded into full-fledged sobbing. Her breath came in gasping sobs, and her torso shook. Copious tears were furrowing the mud on her face. Something is not right here. This is not ordinary behavior, I thought to myself as I frowned. I figured I should pay attention.

The other personnel were gathered at the far end of the tent, laughing and telling tales of the work they did. “Yup, took three tourniquets to stop the bleed…har, har har!” All were young and probably not the most warm and fuzzy crew. The EMS profession does not encourage warm and fuzzy behavior. Psychic callouses are generally developed quite early in the game and are essential for any kind of longevity. Dark humor and apparently uncaring demeanor are ubiquitous. So is PTSD and the heavy consumption of alcohol. The attrition rate from stress and alcoholism is significant. The suicide rate among EMS personnel is among the highest of all professions. Many EMTs like to talk about high drama; I am not immune. No matter which gender, ambulance personnel generally want to talk about crises: the shattered femur, the open fracture, the gushing artery, the long run at high speed. I rarely get patients like that. Occasionally however, I am part of something much grander.

I started to turn away from the patient, but I was too slow. She made a grab for my shirt and her words came in a torrent, barely comprehensible. Between the sobs and agonized breathing, she stated: “I (sniffle) tried to catch up (sob) but I slipped, the, the mud (sob, snort, sob). I told him to keep going, I wanted him to finish. I told him…told him…”

I felt appreciative that the young woman saw something that made her pick me. It could have been that I was just handy, but it was not the first time that patients found reassurance and comfort in me.

This will be simple I thought, she’s disappointed because she didn’t finish. Just reassure her, then leave her to recover. Still standing I said, “there will be a thousand more races in your lifetime.” Sure, it was a little condescending maybe. I started to turn away again, but once again, it did not work. She tried to catch my eye and succeeded. Her words came in a rush this time, delivered in a raising crescendo of wails and gasping breaths.: “I, I told him to keep going, I wa…wa…wanted him to finish. I ta….ta…told…him…”

I achieved understanding. This was her first race; and she was with a guy. He is a veteran Spartan and she wanted to share this bizarre sport with him. A Spartan warrior, battling alongside her man at Thermopylae – a half-naked pair of warriors slaying barbarians together at the Hot Gates. Maybe it will be for life if she impressed him.

This is not the first time something like that has happened. An individual takes up an activity to be with the subject of his or her affection. A passion to be shared. I have some personal experience with such things and maybe you do as well. There is more to this story. She is afraid of losing the guy. She fears he will regard her as weak. She has been training for this sport in order to share it with him. She thinks he is the one, maybe THE ONE. This should be easy, I thought.

I went down into a crouch, good eye contact. Two or three fingers lightly on her arm. “Look at me. No, at me, not the ground, I’m over here.” I pointed to my eyes with two fingers. Her gaze wandered to my face but did not linger. “You have no idea what has happened, not the slightest clue, do you?” No response except for sobs. More severity was called for and that is something I do well. “Are you clueless? He stopped because he wanted to stop. He didn’t want to finish without you. He wanted to help you.” Looking at the ground, she began shaking her head in denial.

Forcefully this time, I said: “What you have achieved this day cannot be bought for gold. For the price of two tickets to this event and a twisted ankle you have achieved what you might not have in decades. Thirty years of shared sorrow and adventure might not give you the bonding experience that you have in one day. If you knew what you have accomplished, you would run through camp screaming with joy.” She was listening now.

I thought lightening up was called for. “OK, maybe you would limp through camp.” She sobbed out a chuckle, with a mud-covered face streaked with tears, a crooked smile, and a wad of snot crawling south from her nose.

“Listen! If he wanted to leave you, he would have. Let him care. He wants to care. Do not deny him this. I know. It took my woman and me twenty years and we did not achieve this kind of bonding…not until an illness ended it. And her.” Her eyebrows raised and she looked at me closely. The blubbering was gone, I had established my bona fides and she was paying attention intently. “Let this young man care for you. Let him know it was not a mistake to care. Tell him you appreciate it, not that you are sorry he cares.” She was listening closely. “If you live to be a hundred with this man, there may be no experience more potent than what you have achieved today. Maybe when you hand him his child for the first time. Even then, that day and all the other days will have their origin today, from this moment.” I knew I had her. “Do not ruin it!”

“You love this guy”. She looked down and to the right. Thank God for body language. She does love him, but is afraid to say it, even to a stranger. She has not said it to him, maybe not even to herself. She cannot meet my eye. Telling, isn’t it? “Does he love you? Don’t equivocate, you know.” There was no response, but there was no sobbing either. Still looking down, she could not meet my gaze. She thought so but he had not said it. The word had not been uttered by either of them.

A final shot was called for. I stood, looming over her, pointed my finger in her face like an angry parent and imperiously demanded, “Remember what I told you! Remember!”

I looked up to see another person entering the back of the tent. A young man, thirty-ish, clean shaven, good looking, with high-end running shoes and clothing. Despite his reek, there was the aroma of prosperity. Like everyone else, he was liberally decorated in mud. His legs were streaked with running blood, probably from a barbed wire obstacle. She had not yet seen him. He heard what I said last and was puzzled, as if thinking, what is she supposed to remember?

 “Are you looking for someone?” I asked, as my patient turned to look over her shoulder and exploded. Tears returned. She found it difficult to reach the guy behind her chair. Her ankle did not help. She was trying to blubber her thanks to the guy.

Withdraw, I thought. Yes, I wanted to know what was being said, but are such things any of my business? No, but when has that stopped me? Nosey old fool. Leave them alone. You wouldn’t want such a conversation overheard if it were you. I moved on to peddle my ice and Gatorade, kept wandering and asking if anyone needed more help.

When I could, I glanced over surreptitiously from a distance. They were talking quietly, mostly the woman while looking into the guy’s face, but I caught Ms. Sprain gesturing in my direction. My God, I thought, what is she saying? He looked over as well.

He was now in front of her and was kneeling in the mud, legs dripping with blood. There was intimate conversation going on, heads close, both of his hands holding hers. Now it was mostly the man talking. Whatever he was saying, it was being well received. She had a smile and maybe a few tears, but the quality was different. She put her arms around his neck. Embarrassed, I turned away.

I took my time coming around again, even stopping to hear a young paramedic brag about her medical abilities. Eventually I worked my way back to my patient with the ankle. Her friend had found a chair adjoining and she was clutching at his arm as if it were a life preserver.

Standing, the young man turned to me and asked what I thought of her ankle. I was by far the oldest person in the tent, so maybe he thought I was in charge. Maybe the young woman told him that I was the guy caring for her. I told them that I saw no evidence of a break, but to be sure, they would need an x-ray. I provided sprain care instructions and directions to the local ER. He was going to get food, he thought she needed it.

I waited until he left. “How are you doing?” I asked her.  She shrugged a little and blew her nose. “OK, I guess,” she said with a slight smile.

“Are you really OK?” She nodded. I gave her fresh paper towels to replace the soggy wad in her fist. “I think you could use another ice bag. Where’s your friend?” I asked. “He went out for a bit” she responded nervously.

I moved on, circulated, peddling my wares: “Ice bag? Gatorade?” Eventually I became occupied with a new ankle and a patient care report.

When I had time to look again, the young man was back. The young woman had her face buried in a slice of watermelon, her guy behind the chair rubbing her shoulders. In her lap was a large ice cream cone in a dish. She was tearing off gobbets of food like a wolf, with watermelon juice creating new streaks in the mud. New patterns had developed on her arms and chest, watermelon seeds now dotted the motif. Speaking to them both, I smiled and nodded, “Good choice for electrolytes.”

The man looked at me closely with a strangely intent expression. His eyes bored into me. The look was not far from awe. A new experience for me; unique in fact. He met my gaze quite intently. He said, “you have an awesome bedside manner.” Had she told him what I said? We certainly weren’t discussing watermelon.

I was taken aback, and my mind raced.  I responded with a self-deprecating manner, “My medicine may not be the best, but my bedside manner cannot be faulted.” I moved on, trying not to show what I was feeling. The glow might have shown through my clothing.

With her food gone, the young woman was ready for discharge. They were a quarter mile from the bus pickup that would drive them several more miles to the parking lot. “How are you getting to your car?” Can you walk that far?” I asked. “I don’t know.” She was learning on him. I asked him, “How do we get her to the car?”

The guy did not hesitate: “I’ll carry you.” My face must have lit like a neon sign. I could not believe what I was hearing. Ms. Sprain demurred, “No, no, I’ll walk.” I leaned over and loudly enough for both to hear, “Let him carry you! Let him embrace his inner Neanderthal.”

They left with brief thanks. The woman was leaning on him heavily. His embrace was more intimate than ambulation on a slight barefoot limp would have seemed to require. Just before my view was blocked, I looked up and saw them. As they walked, she looked up at his face. Such a look of adoration and passion on the woman’s face I have never seen elsewhere.

I did not get their names. Nor do I know where they were from. 

*Author Bio: David L. Williams has lived in Williamstown, Massachusetts since 1983. He has a tremendous amount of education, given the modest niche he inhabits in life. He has two undergraduate degrees, one graduate degree, and is ABD for the doctorate degree, all in fields unrelated to medicine. After the death of his life partner of twenty years, later his wife in 2002, he contemplated a change in profession to something which he might regard as a positive contribution to society. He got his license as an Emergency Medical Technician, and less than a year ago, he advanced his license to Advanced EMT. He has, with regret, turned down deployments in Antarctica, the north slope of Alaska, oil rigs in North Dakota, and a small island off the coast of Peru. Given the limitations of age and ageism, he currently works at Covid injection sites, the occasional sports events, and at summer camps when possible. He lives with his second wife and four cats. Inside the front door of his home sits a bust of Mark Twain, an author that he regards with the kind of reverence that Romans of the classic period regarded their ancestors. David plans to continue spending his life practicing and writing.