Pronouncing Ferdinand

On April Fools Day I was awoken by the be-bop going off, and a dispatcher's voice over the loudspeaker sending us out on a resuscitation call. I automatically pulled on my pants and boots, and looked at my cell phone as I headed for the pole. It was 6:38, and I remembered I'd set the alarm for 6:46, to have just enough time to go up to the roof of the firehouse to see the sun rise at 6:54. Over the course of the 48 hour shift that was drawing to a close, I'd attempted to pray with tobacco, as do the Peruvian shamans I'd been doing ceremonies with over the previous few months. But like an alcoholic falling off the wagon by guzzling the communion wine, I'd quickly slipped from blowing the smoke out to summon the spirits, to inhaling it deeply for my own sensual gratification, as I used to do before quitting smoking five weeks before. That's the white man's way of smoking, I was told. Smoke like that, they say, and you'll learn to pray alright, praying for your life. I'd thrown away the pack of cigarettes the night before, but felt that I should do some kind of purification ceremony, to be able to forgive myself and start with a clean slate. Now I had to deal with someone else's crisis instead, I thought as I turned off the alarm so it wouldn't go off while we were on scene with a patient, and slid down the pole.

Once on the engine, the four of us rode out the door and down the hill in the morning twilight, towards the one commercial zone in our first-in district. No siren necessary at that hour, our red lights flashed across the sleeping house fronts. I was pulling on rubber gloves when the dispatcher informed us that CPR was in progress, and a paramedic captain was being sent along with ourselves and the ambulance. This was going to be a real call. I've been doing this work for twenty-three years, nineteen of them as a paramedic, so I've run my share of early morning calls on patients whose days of waking up in the morning are over. We pulled up to the block where there's a taqueria named after the musical instrument I played in high school, where we get lunch when morning drills or calls don't leave enough time to cook at the firehouse. The engine's dispatch computer screen specified to enter through the back from the parking lot around the corner, and the reporting party's phone was registered to a "Ferdinand". I thought of the children's book by that name about the gentle bull who would rather smell the flowers than fight, that I read to my son. I had never noticed the second floor apartments before on that block, above the shops. I thought about running into Jonathan Richman once when I came out of the corner store where I used to buy cigarettes, like a scene from 

Something About Mary

, except he was carrying bags of take-out food instead of a guitar. I'd had the presence of mind to thank him for producing Vic Chesnutt's last album, 

Skitter on Takeoff,

  before Vic took his own life the previous Christmas, and we shared a moment of sadness and loss, searching for redemption in his story of making the album in San Francisco. "That voice," he'd said, "we built the album around his voice." I told the EMT to grab the suction along with the O2 bag as I put the medical bag on my shoulder, pulled the heart monitor off the engine, and crunched across the gravel lot, up wooden stairs. There was an older lady in her bathrobe standing in the doorway with a pained expression on her face. "I can't roll him over," she said.

He was face down in the small bathroom, a skinny old man in his underwear. I grabbed his ankles and pulled him into the bedroom, rolling him over and checking his fingers and jaw for rigor, but they were still supple. His neck was still slightly warm as I checked for a carotid pulse, and I asked the woman if this was her husband. "I'm his ex-wife", she said, "but I come by to check on him, to make sure he's eating. We went out to see Hutch play at Westlake Joe's last night, and I spent the night." I asked if she'd heard him fall, and she said, "No, I just found him there, but he always gets up to fix coffee at 5:30 to 6 o'clock, and he started the coffee maker already." The EMT was hooking the ambu-bag up to the oxygen tank as I put the electrodes of the heart monitor on his chest, skipping the defibrillation pads as I saw where this was going. I had turned on the monitor and saw the expected flat line of asystole as the engine driver led the paramedic captain into the room. "What's the down time?" he asked. "At least half an hour, possibly an hour," I said as I shined a pen light into his eyes, finding his pupils fixed and dilated. The engine officer had taken the woman into the kitchen to find his medication bottles. "We don't have to work this," the paramedic captain said, and I agreed, "No, I don't believe we're going to change anything here." He looked at his watch, and said, "We'll call the pronouncement time 6:43." I ran a six second strip in each of the three leads, shaking the cables to produce some artifact, and turned off the monitor. I reached up and closed the old man's eyes.

When the wife came back into the room, we were putting a blanket over him. I said, "I'm sorry, ma'am, but there's nothing we can do to bring him back," and she put her hand over her open mouth. "When a person goes into cardiac arrest," I explained, "and their breathing and circulation stop, the body can survive about 3 or 4 minutes without oxygen. After that, the brain and heart cells begin to die, and it's irreversible at that point. He wouldn't have suffered, but I'm very sorry for your loss." She said, "He smoked 3 packs of cigarettes a day, and didn't take very good care of himself. It was bound to catch up to him sooner or later." I asked how old he was, and she said, "seventy-seven". I said, "That's pretty good, actually," thinking about a doctor I worked with once who said that a couple years of smoking probably wouldn't have any long term effect, but beyond that, it's going to shorten your life. Fifteen minutes per cigarette, I read somewhere.  "We just went out to hear music last night, with a friend of his from high school he hadn't seen in years. They played together in the jazz band and the stage band-- how am I gonna tell him?" she asked. "There'll be time for that," I said, emphasizing, "it's really good that you went and heard live music last night. I'm a musician, too, and that sounds like a really good last night to me." She repeated, "We saw Hutch play piano at Westlake Joe's-- he used to be Hutch's bass player when he had a band." I asked, "Was that his instrument, the bass?" and she replied, "Yes, the standup bass-- but he's been so weak lately that he hasn't been able to lift it up anymore."

The paramedic captain had cancelled the ambulance as they pulled up, and told us we could go back in service too, that he would stick around to write the patient care report and wait for the medical examiner. After putting the equipment back on the engine, I found him sitting at the kitchen table with the wife, explaining the process of the medical examiner coming to the scene, and being able to release the body to a funeral home if his doctor would be willing to sign a death certificate. "He hasn't seen a doctor in years," she said. "They may need to take Ferdinand to the county morgue then, initially," he said, "and further arrangements can be made from there." She said, "He went by Fred."  The EMT asked if there was anyone she needed to call, and she said, "Yes, I need to call our children." She brought the phone over to her, and was helping her to dial their oldest son, a minister up in Aberdeen, when I noticed her hands were shaking. "Do you have any medical problems?" I asked, and she admitted to diabetes, and not having eaten anything yet today. The EMT put the phone receiver back in its cradle and went over to the refrigerator to get her a glass of orange juice as I went back down to the engine for the glucometer, remembering when I saw the driver sitting behind the wheel that it was April Fools Day. There was a story in the paper a few weeks earlier about a man who called 911 up in Sonoma County when he found his wife unresponsive one morning, and began doing CPR on her. When the paramedics arrived, they found him dead on top of her, having had a heart attack himself. I flung open the passenger door and shouted, "Looks like we're gonna be doing CPR after all-- the wife just went down," but when he turned around wide-eyed, I couldn't keep a straight face.

Walking back into the house, I noticed the organ in the back hallway, under the jazz posters and pictures of Fred as a young man, playing bass in an Army uniform. It wasn't a B3, but it was a Hammond, the kind of organ I'd love to have at home, to play myself and for my three year old son to fool around with. When I got back in the kitchen she was on the phone, saying, "You've got to call your sister, because she's gonna say, 'You've got to do this and you've got to do that, and there's nothing that can be done!' " I pricked her finger to get a drop of blood to test her sugar level, and as the glucometer counted down I looked up at the pictures of the kids on the wall, the drawings and cards addressed, "To Grandpa, With Love". After making sure there was nothing else we could do to help, no more questions we could try to answer, I left her sitting there at the kitchen table with the paramedic captain who was writing on his clipboard. I said, "You know, this is a very unique event in the lives of you and your family here today, but we actually see this situation quite a bit. People die in the city every day, and it's saddest when they die alone, no family to even contact. You obviously loved Fred, and he had the love of your children and grandchildren, too, and his friends. That's what it's all about, really. Nobody gets out of this world alive, but being loved is the best we can hope for. And you went out last night to hear good music, besides." Going down the back stairs with the EMT, I mentioned the organ, and asked her if she thought it would be okay to ask the wife if she thought Fred would want a chance to be an organ donor after all. "That's just wrong," was all she said, but she was smiling.

Back at the fire station, I went straight up to the roof. I'm fortunate to work at the firehouse with the best view in San Francisco-- possibly the whole world. It was a crystal clear morning, the tall buildings of downtown and the Bay Bridge encircled by the bay with anchored freighters from the other side of the planet silhouetted against the shining water, the east bay hills and Mount Diablo on the horizon. I walked around the castle-like parapet, looking off to the hills of Twin Peaks and the Sutro Tower to the North, the Pacific Ocean to the west, and rows of condos to the south over the crest of our particular hill. The sun was now above them, and I raised my closed eyes to it, feeling its warmth. I lit some sage and blew out blessings to Father Sky, Mother Earth, all the creatures, all my beloved brothers, all my beloved sisters, the Ongwehonwe: those who live true to reality, all the parts of myself, and Great Spirit, the Creator, alive and well within each and every one of us. "As above, so below, as within, so without," I said. And then I spoke to Grandfather Fred for awhile, hoping I'd done right by him, and wishing him well.

I took my time getting home that day, more than usual. Stopping in Half Moon Bay, I had breakfast at at a cafe on Main Street. It was the first time I'd been there that the old man behind the grill didn't start singing, or go put a quarter in his own juke box As I was leaving, I looked at the songs in it for the first time, and found many favorites: good jazz, blues, soul, and early rock and roll. I decided to poke around in some shops, and when I went into an African import shop was hit with the incredible smell of the wood there, masks and furniture made from recycled railroad ties, hundred year old hardwood that's had many souls pass over it, over many seasons. I went into a bookshop to ask about a book on mountain lions I saw in the window, and the older female shopkeeper seemed to be in a bad mood. Or maybe that was just her personality, I thought, detecting a New York accent. She was preoccupied with her computer and scarcely looked up when she handed it to me. She seemed insulted when I'd asked if they were all used books, qualifying them as rare, out of print and signed first editions, books that she said nobody cares about anymore, preferring to read things on their computer or order books online. She then said she was sorry, but that she didn't have time to talk, that she was too busy trying to answer emails, and I walked back into the stacks.

I began to find book after book that I'd either been looking for, or would have been if I'd known it existed, or used to own and lost. I felt like I was in my grandparents' house, now long gone, looking at the collection of once familiar spines, and tears streamed down my face. I had accumulated quite a stack when I took a couple up to the counter, and joined in with a pretty cynical conversation the shopkeeper was having with another customer, about how messed up the world is. Before I knew it, the conversation had completely turned her mood around, and we both tried to coax the middle aged man out of his mind and into his heart. But romantic love was as far as his vision of love went, it seemed. He was the son of hippies, rebelling still against his parents' philosophy for personal reasons. But deep down he knew it was aligned with reality more than most-- it was his parents who hadn't been that well aligned with it. I finally said, "What's your bliss, your purpose here, what do you do?" And he said that he makes documentary films, and was currently making one about hospice work. He said he'd been able to interview Terence McKenna's partner, who was with him when he died, and described how she'd talked about how it was for her to have her lover dying, and all these people from all over the world who loved him too were coming to see him and say goodbye. 

When I brought the full stack of books up to the counter, the last vestiges of bitterness seemed to leave the shopkeeper, her faith in humanity renewed. She said she still needed to find a buyer for the store, though, because she needed to retire when she turned sixty-five, which was in just a few months. "Why retire?" I asked, and she said it was because her true calling was doing hospice work herself, and that's what she wanted to do with the time she had left. When I went out in search of an ATM to be able to pay in cash, I got sidetracked first by a sushi restaurant with incredible teak root burl chairs and benches, like one I had just bought a few days prior, and I began to suspect that I was having a transcendental experience. Seeing everything in a new light, noticing things that may have been there before, but weren't visible to me. In the courtyard where the illusive ATM was supposed to be, there was a man playing guitar, and it stopped me in my tracks again. I sat down as he sang Leonard Cohen's "Hallelujah", a song that's always moved me deeply-- especially Jeff Buckley's version, both he and his father having died so tragically, much too soon for the rest of our sakes. When the song ended and he said he was taking a break, I went up to talk with him. I told him how I had pronounced a bass player dead that morning, and how good it was to hear that particular song. It turned out that he used to be a psych nurse at Saint Lukes Hospital, and I'd undoubtedly brought more than one patient to him over the years. He'd quit that gig, and now did hospice work. He said that he'd been doing that work since his own son died, that he'd taken care of him as he died, and that he'd slipped away in the bed right beneath him. Suddenly I remembered what one of the shamans had told me, that if I didn't live my purpose-- which seemed to include quitting smoking, among other things-- that my own son would die. I can't let that happen, I thought to myself. Just like you'll eventually either crash or get caught if you drive too fast for too long, I prayed that my brief fall off the smoking wagon wouldn't have irreversible consequences.

There's a phenomenon I've noticed that occurs when people die who we know, and love. It's that, for those of us who remain here in this world, there's a period when the veil is thinner, when doors are open, and there's an infusion of grace into our lives. I first noticed it when my own grandfather died, when I'd just become a paramedic. I've pronounced a lot of people dead in my time-- one every shift when I first started out, so that they called me, "El Muerto" back then. But as competent at minding the gate as I try to be, and as kind as I try to be with the survivors if the patient does cross over, my heart usually isn't all that open. One gets callouses, or one can't sustain this work for long. It's really hard maintaining an open heart when the tragedies just keep on coming. But sometimes, when we can somehow identify with someone who's died, it's different. Then synchronicity abounds, confirming that we're connected with the mystery beyond our understanding, with the whole of which we are a part. Separation is an illusion of the mind, after all. The brain with its hemispheres perceives reality in dualistic terms, a struggle of opposites. When we create with the mind, we may get what we want-- but we also get the opposite of what we want. Caught up in the mind, we struggle for understanding that will never come to us. As all the indigenous peoples of the world know, and all the religions in their purest forms teach, the heart is where it's at. The heart perceives the world in unity. In the empathic understanding that I am you and you are me, we can actually feel that there is but one Spirit in this world, moving through all of us and everything. And when we finally figure that out-- not with our minds, but with our hearts-- we grow up into maturity. At that point it's clear, that our most realized way of living is the path of compassion, of loving each other. For we are each other. But sooner or later, it seems, we slip back into not being able to love our self, to forgive our self, and therefore all others. 

So, in spite of a couple more transcendental experiences on the way home that made me feel like an angel, the grace began to fade. Ego began to get in the way. It was so good to make it home to my wife and son, and to have them agree to go hear some live music that night, as we hadn't done in far too long. Dan Bern was playing in town, at the same place where we'd heard him do an acoustic set when our son was just a few months old, falling asleep in his Baby Bjorn after the first few songs. But the band was starting too late for my son's current bedtime, and when I ran into the singer-songwriter whose band was going to be playing as he came out of the bathroom, I think I kind of freaked him out. I told him about pronouncing Fred dead that morning, that years ago I'd pronounced Boz Skagg's son dead of a heroin OD at the Royan Hotel, and when he said he was sorry the set was too late for us, I said, "Well, you're gonna be playing music for a long time to come, right?" He replied, "Well, yeah, I guess so, unless I start doing other things instead," in such a way that he may have thought I was the angel of death or something. I felt ashamed, and wished I hadn't said anything. The over exuberance at life that felt like grace that morning now seemed like only the effects of sleep deprivation.

After another day at home immersed in ordinary reality, I again headed back to the city to work a 24 hour shift. It was when I drove past the fence of the parking lot behind Fred's apartment that I noticed the signs for the first time. "i love you, too", the biggest one proclaimed, and there were white calla lilies in beer bottle vases attached to the chain link. I pulled over and walked across the street to take a closer look. "Good Morning, Sunshine", and, "hello again!" they said. "Love is Louder", and "Tell me what it is you plan to do with your one wild and precious life?" I especially liked the one that read simply, "XOXO".  If they were on the fence the other morning when Fred died, I had looked right past them. Sometimes things remain invisible to us, until the precise moment when they can do the most good. And I needed that affirmation then. Grace had returned, confirming that I'm still connected, that I'm forgiven, that all my efforts at living and loving in this world are not for naught. I'm on the right track. I'm loved back, by the everything!  I noticed the, "Give Love, Get Love" sign, with the web address, "LoveYou2.org", and vowed to look it up. Finally, I read, "did it hurt when you fell from heaven?" Yes, yes it most certainly did. And it's a two way street: it feels so damn good to make it back up again.

MEDIC 833

San Francisco, California