For protection of privacy, all names of people involved in this story have been changed.

"We're so laid-back, it's not even funny," Lauren said as she gave me a brief but thorough tour of the ambulance. It was 10:15 in the morning, and she and Jamie were preparing for a normal ten-and-a-half-hour shift of work. I, notebook in hand, was preparing for ten and a half hours of excitement and adventure.

Lauren is a paramedic. Jamie is an EMT. They both work for MAST, Kansas City's emergency medical services (EMS) provider. I was writing a paper for an honors seminar on EMS, and job shadowing was part of the project.

Not many people have the opportunity to observe these people at their work without calling 911; the general public isn't allowed to ride on ambulances. Students working on health care-related assignments, however, are an exception.

"We've been getting a lot of good calls lately," said Jamie. I asked what that meant, and he clarified, "Real calls, not people with a chipped tooth or a ring that's stuck on their finger." I was astounded that people would actually call 911 for a stuck ring. Jamie and Lauren laughed and assured me that not everyone uses the EMS system for its intended purpose. Later in the day, I would see firsthand that this was true.

I settled into a seat just behind the driver's seat, facing the shelves of equipment and the ominously empty stretcher. The inside of the vehicle was deceptively small, hiding a vast amount of drugs, needles, gadgets, and tools. The seats were red leather, and the lights were on even in the middle of a sunny day.

Jamie drove, and Lauren sat in the passenger seat. Before we left the MAST parking lot, they stopped for a cigarette. I wondered why health care professionals would be smokers, but I didn't bring it up yet. Lauren and Jamie seemed nice, but I didn't want to risk alienating them during the first five minutes of the shift.

After a few minutes of driving, we pulled into an empty area by a gas station. This, I was told, was where we would stay until they got a call. Jamie and Lauren passed the time by reading and dozing. I passed the time by pestering them with questions.

How much training did they need? It takes a one-semester course to become an EMT, and two years to be a paramedic. How far did they drive during each shift? About two hundred miles. How long had they been doing this? About a year, and they'd been partners for about six months. How did they decide when to turn on the lights and siren? Code 1 and 2 calls used the lights and siren, with code 1 being more urgent than code 2, and code 3 calls didn't require the alarms. When you get to an accident and more than one person is hurt, how do you decide which to help first? A process called triage, through which they rank the patients based on need for care. If a patient is badly hurt but wants to go to their own hospital, and theirs is farther away than the closest one, what do you do? They try to convince the patient to go to the nearer hospital, but they'll take them to theirs if they insist. Who pays for the ambulance? Patients have to pay, but sometimes insurance will help.

After about half an hour, we got a call. Jamie turned on the lights and sirens (it was a code 1) and careened out of the gas station while Lauren grabbed a pair of gloves and draped a stethoscope around her neck. A line of cars stopped for us, which Jamie later told me is unusual: most people don't bother to move out of the way.

We reached the apartment building the call came from and searched for the address. A girl standing in a doorway flagged us down. A fire truck arrived. Everyone trooped into the apartment, where a woman was sitting on a bed, gasping for breath. I tucked myself into a bathroom with a view of the room, staying out of the way.

Lauren asked a few questions about the situation. Then they fetched the stretcher and, with the help of the firemen, got the woman out to the ambulance. I was impressed but not surprised by the level of calmness they showed, but I hadn't been expecting the woman's family members to show the same calmness. The other adult in the household was ironing clothes as we left.

Jamie drove as Lauren started an IV line in the woman's wrist and took her blood pressure. I gathered that the woman had severe asthma and had been recently diagnosed with bronchitis. She wasn't at a lot of risk just then, so the lights and siren were off. When we got to the hospital, Jamie and Lauren described the situation and the emergency nurses took over.

The hospital provided a sort of break room for EMS personnel, with coffee and a TV. Not all of the hospitals we visited during the day had a whole room for EMTs, but every one had some kind of perks - padded chairs, soda, snacks, cold water bottles.

Jamie and Lauren each had another cigarette, and Jamie asked me if I had any questions about the call. I asked him to clarify a few things about the procedures for my paper, grateful that he had offered. This wasn't the first time this patient had been to the emergency room, which explained why her family had been so unperturbed.

I told Jamie that I had read that coconut milk could be used for IV fluid in an emergency, because it's sterile and has the right amount of sugar. He laughed and said that he'd never heard that, but he believed it.

At 12:30, they got another call. On the way, Jamie's assertion that cars don't usually move was supported by a dipwad in a truck who puttered along in front of us for four blocks at fifty miles an hour without even trying to pull over, despite the loud noises Jamie caused to emanate from our vehicle.

When we eventually got to the call, Jamie and Lauren told me that they'd been here before. The call had said that the patient was throwing up blood, but the woman we found curled up on the couch, clutching her stomach, showed no signs of having done so. We left her kids with a neighbor and took her to a hospital.

As he put the stretcher back in the ambulance, Jamie told me that the patient hadn't been as sick as she had claimed to be. She hadn't been throwing up blood, and he thought she had been exaggerating the stomachache, too. I asked if the patients were always as quiet as the two we'd seen so far, and he nodded and said, "Usually."

I got some 7-Up from the perk refrigerator, and we kept moving. I mentioned that we were close to my house, and Jamie swung by to let me wow my family with my sleek ride. Sadly, no one was home except my older brother, who was unimpressed.

Still without a call, we headed to a local coffeehouse. I ran into an ex-boyfriend, so at least I got to impress someone. While Lauren was inside, I asked Jamie why he became an EMT. "Because I got sick of being a counselor," he told me.

We're called to do a patient transfer from a hospital to a nursing home. At the hospital, Jamie and Lauren discuss a recent case of epilepsy in a stripper, who had a seizure at work. They wished theirs had been the ambulance on that call. I wholeheartedly agreed.

We drove around for a while longer, and then stopped to eat, and then drove around some more. I drifted off a little, soothed by the rumbling of driving. I was awakened by another call in the late afternoon. We were very close to it, and pulled up to the house a few minutes later. We knocked on the door, and a dog started barking.

The door opened and an elderly woman peered out. "Oh, you're here already! That was quick," she said. The dog, a tiny, shaggy little thing, kept barking. "Oh, hush, Smoky," she scolded, and said to us, "Don't mind her, just tell her what a darling she is. Here, come in."

I raised an eyebrow as we entered a living room, stocked with the clutter of decades. Another elderly woman was sitting on the couch, and introduced herself as Valerie. Marie, the one who had opened the door, pulled a thick pink sock off Valerie's foot. "Look at that," she said. Valerie's ankle and foot were very swollen. Marie pulled off Valerie's other sock. "See her other foot?" she asked, pointing. "This one is twice the size it ought to be."

Marie adds tactfully, "Now, Valerie has two problems. The foot, that's the one we called about, but there's another problem too. She needs Depends. You know, for a bladder problem. Make sure to tell the people at the hospital about that." Lauren assures her that it will be taken care of.

We got Valerie out to the ambulance and strapped her into the stretcher. "I got a taste in my mouth would make a cat spit," she says, causing Jamie to shake with laughter as he drove.

Lauren asked Valerie her age. "Ninety-two," Valerie said. "Marie is younger than me. She's just eighty-eight, I think." Lauren continued filling out the form. When asked to explain her medical history, Valerie mentioned her "male nurse," prompting another giggling fit from the front seat.

We arrived at the hospital. As Lauren got out, she instructed Valerie, "Stay right there."

"I kinda have to, don't I?" asked Valerie, gesturing to the straps holding her to the stretcher. "You made sure of that. She's kind of a smartaleck, isn't she?"

The next call was less entertaining. Someone had dialed 911 from a pay phone at a bus stop. She climbed into the ambulance of her own accord, apparently perfectly healthy. Jamie quietly told me that he wanted me to sit in the passenger seat instead of the one in the back. Slightly confused, I did so.

We took her to the hospital where she wanted to go, and Jamie explained that she was probably homeless and probably on drugs, and had nowhere else to go. Some hospitals will let people like that stay for a night, he said.

I asked Jamie whether driving an ambulance had affected his regular driving. "Oh, yeah," he said. "Sometimes I'll be driving my car, and I'll cruise right through a red light, and then I'm like, ‘What am I doing?'"

The last call of the day was from a nursing home. As we swerved through intersections and dodged cars, Jamie hollered, "Look out, bitches!"

The call was an old woman whose oxygen level was apparently 33%. I carried bags, held doors, and did what I could to help get her to the ambulance quickly without touching the stretcher (it had been made very clear to me when I was scheduling this observation that I was not to touch the patients in any way). I heard the phrase "false 30" being tossed around, and sure enough, the woman's oxygen level was nowhere near that low. If it had been, "she would be blue," said Jamie.

After we delivered her to the hospital, I followed Jamie out to the ambulance to help him put the stretcher back. I wasn't much help, but Jamie was patient about showing me how it worked. As he did, I idly mentioned that I probably should have gone on a night shift if I'd wanted to see anything really intense.

"Actually, we're the busiest shift," Jamie says. Aren't there more shootings at night? "Not necessarily. There are a lot of shootings during the day."

Somewhere around the homeless drug addict, I gathered the courage to ask about the smoking. "We're gonna quit soon," Jamie said. "It's pretty much the stupidest thing I've ever done." When I thought about it, though, I realized that it makes sense. They see a lot in their work. They switch between periods of high tension and stretches of boredom, and I can see how smoking during the downtime might become a habit. It helps to relax, and EMS professionals might need some help with that.

Lauren's comment about being laid-back was truer than I'd expected. Both Lauren and Jamie were much more easygoing than I'd expected from people in such an intense job. But that makes sense, too. People need to be immediately willing to trust them with their lives, and they have to be able to understand each other perfectly.

After all, in most fields, bad communication can mean losing a client. In this one, it can mean losing a life.

Copyright 2007 Metropolitan Community College