Illegal Mom (Whoever Said EMS Had to Make Sense?)

"EMS Reruns" is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don't have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. We don't know everything, but we do know a lot of smart people. If we need to, we'll contact just the right expert and share their advice with you. Send ideas c/o emseditor@aol.com.

You've been up five times already. Dang, you're supposed to teach ACLS at 0900. It's 0430, and the alarm is going off again, for something like childbirth at H and 805. Childbirths are not your favorite kinds of calls. They're messy, and in your Southern California town they usually mean a newly naturalized citizen has just qualified another illegal immigrant family for the state's welfare benefits. And you don't like babies, anyway. You are cran-ky.

Your feet thump loudly on the station's wooden floor as your legs fall out of bed. Your bones feel heavy, your mouth feels like it's full of fuzz, your vision is bleary, your nose is stuffed up, your fingers don't work right, and the sounds of your partner, Linda, getting up seem dull and distant in your ears. That's just for starters. Worst of all, it's her turn to drive-so you're the patient man. You know that with a total of two hours' sleep you've seen the last of your bed, and this whole day is going to be trouble. Good thing you don't need to read the map.

Q. Isn't there some way to ease this constant beating, shift after shift?

A. If you handle this many wake-ups every night, sooner or later you're going to do something you and your boss will both regret. Either your agency needs to add some cover at night, or you need to get away from those 24-hour shifts. There's not one thing about working 24 hours in a row that's medically good for the public. There's not one thing about it that's good for the safety of the crews. The only thing good about it is that we get lots of days off every month. So, let's see. We adhere to the shift structure for the sake of our days off, at the expense of medicine and safety. How does that make sense?

Short of that, you could stop scheduling stuff that's important at the end of your shifts. That's karmacide, and it's just asking for stress.

You roll down your window, hoping the cold morning air will help you wake up, but Linda soon asks you to close it. You call her a lightweight, and she flips you off. You turn away from her and watch the changing reflection of your unit as it passes the big windows of a bank, a real estate office, a clinic. You're thinking, that looks like some other ambulance gliding quietly through your town. You're supposed to be using your siren, but in the real world people just use their own judgment. Whoever came up with that law never worked nights. There are people in every town whose attention you'd just as soon avoid, and the rest are much happier if you don't wake them up six times a night.

Q. Is it really necessary to use your siren at night, when there's nobody on the road?

A. You're right, it's goofy. And if you don't, it's a lot safer with an Opticom system to control your intersectional signals. But goofy or not, if you have a local law that says you have to use the siren, you're giving up lots of legal protection if you don't use it and you get hit. Maybe you and your friends should write some letters to your legislators, after you've had some sleep. You may not get any results, but you can bet nothing will change if nobody does anything at all.

You sort of resent the people huddled around the car in the parking lot of the little mall. They know there's a hospital less than a mile away, but they also know there's less red tape if you deliver this child. You'll document the birth, you won't postpone the delivery, and you'll get the child and its mother right into the ED. The resulting monthly welfare payments will amount to more money than this family has ever seen. Your unit alone delivers at least one baby a month in parking lots just like this one.

Q. You try to live your life with respect for others. But are you a bigot, after all?

A. Not just on the basis of what's presented here. But maybe you do need to sort some things out. For one, these kinds of issues are bigger than you are, because legislators tend to deliberately overlook them. And you're not alone. EMS crews all over the world are trying to compensate people for international quirks that make life difficult for them. EMSers function not just as emergency caregivers, but as ambassadors and as unschooled, de facto social workers. You do those kinds of things when you help people for a living-especially people who are so poor they simply have no one else to turn to. Think about that, because it makes serving them so much easier.

None of us thinks our best thoughts without sleep. But remember, EMS is not about you. It's about those other people. You're their caregiver, and nothing in your training has prepared you or qualified you to judge them-especially without the benefit of facts. Stay in EMS long enough, and you will see more royalty in the poorest grape picker and more dignity in the humblest grandmother than you would ever expect to find in a king or a queen. Try hard to serve them well, and let that experience enrich your life over and over again.

Anyway, what's an illegal immigrant? Most Americans are descended from people who came from faraway places, stole a whole bunch of real estate, and then declared everybody else an alien. Now, that's illegal.