In March, New York City’s soundscape dramatically shifted. Someone had dragged the usual levels of sidewalk arguments, street vendor sales pitches, and the buzz of hundreds of rubber tires down to a hum, remastering the track with a looping blare of sirens.

I noticed it for the first time on a walk. I hadn’t been outside for over two weeks when I took the first of many weekly strolls around my neighborhood park. Sun-starved and self-conscious in my makeshift bandana mask, I marveled at the socially-distanced row of children lining up for the ice cream truck at the park’s edge. A tune recognizable across time and space blared from the truck, mixing with the dulcet tones and familiar rhythms of overlapping conversations.

I hadn’t heard these sounds—except through the crackle of a speaker or the muffle of a wall—since the city had started to shut down just days earlier. It already felt like months. Having a condition that put me at high risk for a severe case of COVID-19, I had been strictly self-isolating in my studio apartment since the second week of March.

Without warning, the playful song of the ice cream truck was forced into a dissonant duet by the siren of an uninvited foil stealing its center-stage moment, derailing the cheery ode to childhood summers past, present, and future. The ambulance whizzed by, its cry fading as quickly as it arrived. It was a harsh reminder of my fate if I wasn’t careful, and its warning shepherded me back home.

For a few weeks after, all I heard were sirens. They woke me up when I left my window open overnight, and they interrupted work conference calls. This aural marker of New York’s rising health crisis demanded my attention as I restructured my life to accommodate a new, limited indoor existence. Because I work in health IT, the sirens reinforced the bleak trends I was learning about from my colleagues’ COVID-19 data analysis. Yet, in hearing only the rising numbers of critical patients, I realized I forgot to recognize the sirens also represented their operators, the EMS workers putting themselves in the line of fire.

Soon, shrill wails pierced the air in all directions as ambulances crisscrossed our city, hurtling patients towards critical care settings. To the ear, they bordered on menacing, demanding listeners to cower and yield until they receded. However, I knew—perhaps better than most—that these howls amounted to a protective façade. As bystanders in cars and on sidewalks cleared away from their cries, ambulances could expedite the delivery of precious cargo. The sirens’ sensory assault also represented skilled guides carrying patients to safe harbor—their ferrymen across the River Styx.

I’ve needed my own emergency care ferrymen several times throughout 20 years of living with severe food allergies and asthma. Like other ambulance frequent fliers, I know the assumed border between prosaic daily existence and peril is often a flimsy muslin curtain. I’ve been shuttled to emergency rooms due to encounters with the most mundane offenders—a cupcake, a sandwich, even some exercise blended with tree pollen.

Growing up, I learned to fear others’ reactions to my medical emergencies almost as much as the emergencies themselves. One of my earliest healthcare memories is of a woman in scrubs gingerly guiding my hands over my seven-year-old face, showing me how to correctly apply a nebulizer mask as I sat in a New York City ER. She smiled, and over the machine’s rising drone, she assured me I would feel much better soon. The next time I heard her voice, it came raised from around a corner, scolding my immigrant parents for not fully understanding how to care for their daughter’s new and severe asthma diagnosis, and for not acting soon enough in this case. I was very young, but the words “she could have died,” and the implication of whose fault that was, were seared into my memory.

From that day forward, shocked and disapproving reactions to my health crises only continued to shape my own attitude toward my illness. Through peers’ wide eyes, adults’ panic, and doctors’ chastising, I learned that my emergencies were embarrassing, inconvenient, and shameful. To avoid having to manage others’ responses to my health on top of staying alive, I have locked myself in bathrooms during allergic reactions more times than I can count—including twice on commercial flights. If I couldn’t self-isolate during an allergy or asthma emergency, I would apologize profusely. I would be sorry for taking up too much space, for ruining the school trip, for not having an EpiPen when it was out of stock or too expensive. Two years ago, an encounter with EMS shifted my perception and helped me start breaking down those dangerous conditioned beliefs.

“Okay, call 911, do it now!” I shrieked at my boyfriend as I tore off my jeans in the bathroom.

My world was swollen. My vision thumped along with the drumbeats of blood in my ears. Balanced between the toilet and sink, I keeled over in exhaustion, panic, and excruciating chest pain. I fumbled with the epinephrine autoinjector that would make its way into my thigh in a matter of seconds.

I was half-dressed and trying desperately to vomit post-injection when I heard the sirens growing louder, my humiliation and panic drowning them out. I blinked, and uniform-clad strangers descended to accompany me into the living room. They tightened a blood pressure cuff around my arm, and the familiar interview began. What had I eaten? When had I eaten it? What allergy and asthma medications had I taken? When had I taken them? I slid into autopilot answers programmed by countless experiences with this line of questioning. I plastered a smile on my face and thanked them for their time. I apologized. I mixed up recalling the dosages for my antihistamine (Benadryl) and my bronchodilator (Albuterol). I apologized again. They led me outside and helped me onto a gurney.

A woman with a grey pixie cut and a welcoming smile joined me in the ambulance. She sterilized my forearm to insert an intravenous line. She jabbed me several times on both arms and the backs of my hands, failing to find an adequate vein. Her needle was not having the same luck as my EpiPen. I apologized for that too.

The ambulance doors closed, cutting me off from the Before, and my journey to the After began. My guide patted me on the arm and told me I didn’t need to apologize, I had done the right thing by calling for help. The vessel lurched forward, and the siren filled the surrounding streets, clearing our path. The sound was notably duller—less distressing and almost comforting—from inside the ambulance.

My guide with the pixie cut told me about her previous jobs, about different kinds of calls her team responds to, about what her kids thought of her work, and as she spoke something improbable happened: I relaxed. I cracked jokes that I was glad she wasn’t still trying to find my veins as we bounced over potholes. Injected adrenaline still coursed through my veins, but I felt my muscles disengage. We laughed.

Halfway through the journey, she told me that she didn’t want to stop the ambulance to try to find a good vein again, but she wanted to give me another dose of Benadryl. I told her I would be happy to swallow the pink pill I had taken many times before. She shook her head.

“I have the injectable Benadryl,” she said. “You can take that by mouth, but it’s going to taste terrible.”

I agreed. “How bad can it be?”

“I’ve been told by patients it’s the worst thing they’ve ever tasted,” she said. “And I don’t have a chaser.”

“Well, it’s a good thing I’m Polish,” I said, with another laugh. “I’ve been prepared to take shots straight.”

She smiled and I thought I heard my boyfriend groan from up front. A needleless syringe filled with clear liquid materialized.

“Aim for the back of your throat and swallow as quickly as you can,” she advised, handing it to me.

I positioned the syringe, aimed, and fired. For a second, I wondered why she had insisted it would be foul until I discovered the rancid taste comes in waves. I gagged after swallowing, then burst out laughing.

“You were right, that was terrible.”

We were nearing the hospital and the taste of unadulterated liquid Benadryl festered in my mouth. My swollen tunnel vision, however, was gone. My blaring panic and guilt had receded to a muffled babble. The ambulance soon came to a stop and the doors opened again to the afternoon sun. We had reached the After.

I entered the hospital still fearful and queasy, but also steady and even amused. While she had failed to place an IV, my EMS guide had disarmed my guilt and panic. She gave me permission to refocus my energy on healing and advocating for myself in the healthcare system.

I wish that I could say that this encounter ended my habit of apologizing for my health conditions. It hasn’t, at least not fully. However, I gained a greater trust for healthcare workers, particularly for those who reach us before we cross the threshold of a formal healthcare setting. I had permitted myself to be cared for when I needed it, and that was progress I could build on.

The alarming crescendo of ambulance sirens heard in March has died down in New York City. As the first wave of the pandemic begins to roll away from the city and we brace for a possible second, I am comforted and awed by the knowledge that EMS workers are still out there every day. Volunteer and paid first responders continue to put their lives on the line to guide sick New Yorkers to the care they need despite staff shortages, low or nonexistent pay, and traumatic work conditions.

EMS workers have guided me physically and emotionally through some of the scariest moments of my life. I rank among legions of patients for whom that sentiment must be true. In this terrifying moment for their profession, I wonder, who will guide the ferrymen?

Kasia Kalinowska is a New Yorker living with several severe food allergies. After graduating from Princeton University with a B.A. in the history of science in 2019, she has worked in health information technology in the Bronx. Kasia writes and podcasts about food allergies, public health, medical history, and humor. She loves telling and reading stories about how the healthcare system works for and against patients. You can find more of her work at kasiakalinowska.com, on Twitter @kasiakalino and on Instagram @thatallergicgirl.

 

Header Image by Patricia Tiffany Morris