Hard Roll: A Paramedic's Perspective of Life and Death in New Orleans

By Jon McCarthy

Experience the rush as an emergency medic details some of the most formative calls of his career in the Big Easy in this action-packed memoir.

Known as one of America’s most dangerous cities, New Orleans plays host to incidents ranging from the tragic and disturbing to the completely bizarre—and during his career as an emergency medic, Jon McCarthy saw it all. He chronicles some of the most formative calls of his career in this autobiography that reads like crime fiction. McCarthy demonstrates with detail and clarity that the difficult choice is often the right choice. While not for the faint of heart, each entry in this collection provides poignant insight into the bonds between medics and the people and city they serve.

Praise for Hard Roll

“One of the things Jon McCarthy does so well in this book is capture that combination of adrenaline, dark humor, and old-fashioned heroism that makes up the daily life of a first responder.” —Susan Larson, NPR’s The Reading Life

“Masterfully describes the exhilaration of touching a patient at their most vulnerable moment and the emotional toll it takes when the outcome is not favorable and the sheer joy when medical experience meets the opportunity to make a difference . . . A must-read as one tries to grasp the social inequities, fragility of the war on crime, and paucity of basic healthcare that plagues our urban communities.” —Juliette M. Saussy, FACEP, former director and medical director of the New Orleans EMS, former paramedic, City of New Orleans

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Apr 13, 2017
• ISBN: 9781455623228

Book preview

Chapter 1

Misguided Judgment

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You likely have made decisions, both personal and professional, that have placed you on a different road than the one I have taken. You do what you do; I do what I do. Who we are as a person is a direct result of whom we have met, what we have experienced, when we experienced it, where we experienced it, and why we made certain choices. These are known as the "Five Ws," and journalists use them in order to report the full story.

Most people’s exposure to life’s horrors is limited to news reports, the Internet, movies, and the occasional documentary. When a normal person’s path intersects with that of someone who has seen bad things, they are naturally curious. This curiosity often leads them to ask certain inevitable questions: You must have seen some crazy stuff, huh? What is the weirdest thing you’ve ever seen? What’s the worst thing you’ve ever seen? Everyone who works as a first responder comes to expect these questions.

Most of us will indulge you with a tale or two that will make your mouth hang open and your eyes go wide. This is usually followed by: I don’t know how you guys do that. There’s no way I could do that stuff. You know what? That is totally OK. You will likely never have to do it, because we have chosen to do it. Just as we will likely never have to encounter the difficult things you face in your selected field.

When you learn how we deal with the darkness and the horrors that make your mouth hang open and your eyes go wide, it is important that you realize there is a price to be paid for prolonged exposure to the bleak side of the world and the unsavory aspects of humanity. We are not insensitive. We are not insane. We, like you, are totally OK. We just deal with things a little differently than you might expect or understand.

I suspect that black humor has been around since the origin of human tragedy. At the very least, I think its other name, gallows humor, adequately shows how long it has existed. It is a defense mechanism for the individual who is repeatedly exposed to the psychological trauma of witnessing horrible things. All of the best medics, nurses, doctors, cops, firefighters, and soldiers either use it or lie about not using it. I would speculate that gallows humor is as common as profanity in these fields. Like profanity, it is not politically correct and we all know it. That’s why we do our best to keep it between us. We understand that the public views us as heroes, and it is not a heroic characteristic to laugh at tragedy, find humor in horror, or say, I hate humanity, when getting a late call. What those who don’t work this type of job may not realize is that if we couldn’t laugh, we would cry. Our gallows humor and profanity work like a relief valve that vents pressure. Without these unheroic things, we couldn’t continue to fight the good fight because the obstacles we face every day would drive us insane. We are human and therefore subject to the limitations of the human psyche’s tolerance threshold.

Many years ago, way before Sean and I met, I was precepting, or training, a new medic in the New Orleans Health Department. He, like me, was not from New Orleans and came for the experience of working in this city as a paramedic. He took his profession seriously and was good at it, even then as a new guy. He would go on to serve our nation as a combat veteran and is now a registered nurse.

On the nightshift one evening, we were called to the scene of a multiple shooting as a backup ambulance. We later learned what had occurred. A husband had discovered that his wife was cheating on him. Along with another family member—a cousin, I think—he decided to hide outside the house and wait for this suitor to show up. Naturally, both men were armed, with the intention of ambushing the cheating couple once they were caught.

On this evening, the suitor showed up, no doubt assuming that the husband was away. Perhaps he was not even aware that his companion was married. Either way, he would learn soon enough.

At this point I should mention that this home is what is known in this area as a shotgun house. There’s an irony to that that will make sense in a few minutes. A shotgun house is basically a single-story home with a series of rooms in a straight line from the front door to the back door. In this particular residence, the inhabitants had chosen to make the front room their master bedroom. I have been inside scores of shotgun homes in this city and the front room is usually used as a living room, while the master bedroom is typically located in the rear. Had this couple chosen to follow that floorplan, a couple of deaths could have possibly been avoided. It’s strange how such a simple decision, like choosing a bedroom, can have such an impact on whether or not one might wind up murdered.

From their hiding spot, the assailants watched the suitor enter the home. They allowed enough time to pass for the cheating couple to become fully involved before kicking open the front door. When the two men burst in, they had a front-row seat to the action. The cousin was armed with a handgun—a forty-five-caliber, if memory serves—and he fired first.

The suitor took a few rounds in the back. None of his wounds were immediately fatal but were more than enough to get his attention. He was able to dismount, in what I would guess was record speed, and scrambled into a bathroom, which was the closest room to the bedroom. This bathroom was also where the couple’s two young children had taken refuge when the violence erupted. Yes, this naked, bloody stranger locked himself inside a bathroom with the children of the woman he was just having sex with and the man who was now trying to kill him.

Back in the bedroom, the husband took aim at his wife from the front door and fired his twelve-gauge shotgun. She was lying on her back, naked on the bed that the two of them had shared for who knows how long. He proceeded to walk towards her, firing the shotgun into her body as he closed in. The last shot was point blank to her head. I know all of this because when we entered the house less than ten minutes later, the shell casings of the shotgun were lying on the floor, with each closer than the one before and the last one resting on the mattress itself. I remember there being three or four total. Regardless of the shell count, the last one did the job. I’d be willing to bet that the sight of what he had just done to this woman was enough to quench the fire of hate that was burning in his gut. That probably saved the life of the suitor and possibly the two children, because the shooters fled the house soon after that final shotgun blast.

The suitor, who was now critically wounded, exited the bathroom with the children in tow. Naked and bloody, he led them past the mangled remains of their mother, out the front door, and across the street to a firehouse for help. The firefighters initiated care and called the rest of us to the scene. As I look back on this call, the thing that I think bothers me the most is the thought of those two kids seeing their mother in the condition that we found her in. I never saw the children during our time on scene, but I really hope they didn’t have to see that.

The first ambulance that arrived was told there were at least two people shot, so they immediately called for backup. One of the two medics began working on the suitor with the help of the firefighters, while the other went into the house to check on the second patient. It only took one glance to determine that she had what are known as injuries incompatible with life. That medic made a quick radio call to medical control to alert them to the condition of the suitor and to confirm the DNR (do not resuscitate) orders on the wife. Just as they were preparing to transport the suitor, my unit arrived on scene.

We got a quick briefing and were asked to handle the thirty report on the wife. A thirty is the shortened version of Signal Thirty, which in New Orleans civil-service language means a homicide. Basically, our role was to write the report on the murdered wife so that the other unit could depart and save the suitor’s life, which they did.

At this point in my career I had been a paramedic for a couple of years, the majority of which were in New Orleans, so I was already well seasoned. The new guy, on the other hand, well, he was still green as grass and not yet used to seeing that sort of thing. I remember there being only one cop inside the house at the time because the detectives had not shown up yet. Walking into a scene like that is always shocking, but for some reason, the more people that are on the scene, the less ominous it feels. I’m sure it has something to do with the extra noise serving as a distraction, or maybe the shock gets more diluted as it is shared between people. Either way, I have been on a lot of bad scenes like this one and the initial gut punch is always stronger when there are fewer people in the room.

I remember watching a documentary where a psychiatrist interviewed a serial killer. They discussed a time when the killer shot a man point blank in the face with a shotgun. The psychiatrist said that usually when a human being sees that sort of trauma, they experience some emotional discomfort as well as nausea and other physiologic reactions. The killer paused, thought about it, and then admitted that he felt nothing of the sort. As a matter of fact, he said that a few minutes after murdering the guy he sat down and had a sandwich for lunch. What I gathered from that was that sociopaths, who are incapable of empathy, are not affected when they witness human suffering.

This rookie medic was no sociopath. As we entered the house, I remember the room being very dim. The wife was on the bed, in the same position from the moment her life ended. She was a big woman, not morbidly obese but larger than what is considered healthy. The mattress on which she lay was worn and sagged in the center beneath her weight. She, like the scene around her, was a mess. She had several small holes from the buckshot in her chest. Her arms were torn and broken from when she had raised them in a vain attempt to stop the bullets. The most striking thing was her head, or what was left of it. The final blast had removed everything from the nose upward and sprayed it all over the wall behind the bed. The bottom of the skull remained, resting there like some macabre bowl. There was some hair still attached to a chunk of skull and an eyeball on her shoulder. She lay in a pool of blood, bone, and brains that was at least two inches deep around her body. The indescribable smell of gore and gunpowder filled the warm air inside the closed room. In a nutshell, it was something out of a horror movie.

I believe that all first responders go into this line of work with the primary, altruistic objective of helping others and saving lives. Yet there is a small secret part that exists below the surface of our noble motivations. No one admits to it, but once you put on the uniform, you realize that everyone shares this secret, at least in the beginning of their career. That secret is the desire to see crazy, abnormal stuff like this, those aforementioned things that you tell your friends about to make their mouths hang open and their eyes go wide when they ask you what you’ve seen. At the beginning of my career I was ashamed for feeling excitement on murder scenes, but I later realized it was a natural curiosity that everyone has when they get into this line of work. It’s the same morbid curiosity that makes normal people ask those questions I mentioned and turns everyone into a rubbernecker when driving past an automobile crash. The cruel irony is that later in your career—and this later doesn’t take very long to arrive—you feel guilty for how little it bothers you to see the crazy stuff. The new guy was still fresh enough to be impressed with the severity of the trauma.

He had told me earlier in the shift that his eventual goal was to become a paramedic instructor. He wanted to go on as many real calls as possible to see and do everything that would make him a better teacher later. I had noticed his attention to detail on the calls we had already run together and I admired his ambition. You need that sort of drive to keep you coming back for more of this type of stuff, because not much else will carry you through it.

After a quick tour of the murder scene, I had all of the information I needed to write my run report. As we returned to the ambulance, the new guy asked if he could snap a photo of the head wound for his own Atlas of Injuries.

The Atlas of Injuries was a section in the various EMS textbooks of the time. It was a collection of photographs that showed different types of wounds and correlated with what the student was taught in the preceding sections of the textbook. Remember, this was a time before the prevalence of the Internet and digital photography. Consider this moment in our story to be the proverbial fork in the road for the events that would follow.

It was a common thing for medics, cops, and firefighters to carry those little disposable, point-and-shoot cameras to capture images encountered in the line of duty. Candid shots of coworkers would typically fill the limited exposures on the cameras, though they could easily turn into cameras full of your coworkers’ genitals and extended middle fingers if you happened to leave them unattended. These cameras were also used to take the occasional shot of anything encountered in the line of duty that was deemed visually impressive. It was one of those things that you knew was technically against the rules, but everyone either did it or knew about it and didn’t really care.

Hell, at the time this all went down, there were two or three TV shows being filmed about the police department, Charity Hospital, and even the ambulance service itself. This was when the docudrama was booming on cable television and the reality television of today was being born. They were pointing their television cameras at this same sort of visually impressive imagery, and it brought the viewers back each week, that’s for damn sure.

So, when the new guy asked about snapping a photo before we left, I didn’t think anything about it. I doubt I even looked up from the paperwork I was working on at the time. I told him that I didn’t care but to be sure to ask permission from the cop who was inside before he took the picture, because the officer was in charge of the scene at that time. He was in and out in less than a minute. He said the cop was nice enough to even hold the flashlight for him to get a good shot.

I put away the clipboard and cleared us from the scene with dispatch. As we were leaving, the ambulance that was transporting the suitor called us on the radio. The suitor had just told them that the headless wife was seven months pregnant, and they asked me to let medical control know of this new development before we departed the scene. From my memory, that conversation went something like this:

NOHD to Charity Med Control, I said into my portable radio.

This is Charity; go ahead, came the reply.

Yeah, Doc. This is Jon. I’m on this Signal Thirty scene with the female, shotgun blast to the head. The other unit is transporting that 34-S to you guys right now. They already got DNR orders on this patient, but their patient is now saying she is seven months pregnant. We just wanted to advise before clearing this scene.

I remember there being a long pause. That gave me the first clue that I was standing on a volcano of feces that was beginning to rumble.

Charity Med Control to that unit, said a new voice.

The original person I had been speaking to was a resident physician. Now, I was talking to one of the attending doctors. This meant that the situation had been deemed to be something beyond resident level, and a big dog’s decision-making skills were now required.

Yeah, go ahead, Doc. The new guy and I were now staring at each other.

What’s the down time? asked the doctor.

He was asking me how long the wife had been dead. I don’t remember my exact answer but I said something like ten minutes. The pause from their end was long. That let me know that eruption of Mount Crapcano was imminent. I am certain my eyes closed slowly during this point and I shook my head from side to side as the reality of what was about to happen blossomed.

OK, NOHD, we want you to go ahead and transport.

Uh, ten-four, Doc. Not sure exactly what you want me to do. You do know that she has no head, right? I asked.

Yes, she’s dead. We’re not worried about her. Just do chest compressions or whatever you can and get her here ASAP. We’ll have a team from L&D [Labor and Delivery] standing by for an emergency C-section. Unless you think you could do that there. I can walk you through it if you have the equipment.

Most certainly my eyebrows rose at the possibility of me being the first medic ever to do a postmortem C-section of a murder victim in the field. I do remember briefly performing a mental checklist on the equipment needed, most of which I had in the ambulance, and my imagination playing the rough cut of that scenario. Sixty-two ten, the unit number of the EMS shift supervisor, nipped that in the bud and reeled me back to reality.

Sixty-two ten to that unit. Negative on doing a C-section; package your patient and transport, the supervisor interjected via the radio.

Ten-four. It’s going to take us a few minutes to get her out of here, so we should be there in ten to twelve, Charity.

The change in plans had not registered with the new guy. He was still looking at me with wide-eyed confusion as I exited the cab of the ambulance.

What’s up? he asked.

Come on, man; we’re transporting. Let’s get this over with, I said as I pulled the stretcher from the rear of the ambulance.

Man, I don’t know if I can do this, he responded with wide-eyed sincerity as we carried the stretcher inside.

I’ll do it. Help me get her loaded up and let’s get out of here.

At this point, a few other cops had arrived and were all inside the bedroom, examining the corpse and probably snapping their own photographs. Upon seeing us enter with the stretcher, they all looked at us as if we were insane.

Apparently she’s pregnant, so now we have to transport her, I said as I placed a spineboard beside her on the bed.

Those boards are made of hard, yellow plastic, and I remember registering that the pool of blood around her body was deep enough to completely cover the surface of the board so that I could no longer see the color of it.

The reasons we needed the board were multiple. The woman was too heavy, too naked, and too covered in blood and the mattress was way too saggy for us to be able to lift her onto the stretcher by hand. We needed to get her onto the board and then lift her onto the stretcher that we had placed beside the bed. The other problem here was that she was in the center of the mattress and this was a king-size bed. That meant the new guy and I had to climb onto the wobbly bed, stand in the pool of gore, roll the headless body onto the backboard, and then lift her off. As soon as we were on the mattress, ankle deep in it, that’s when the new guy realized that this was a person and not just the subject of a photograph. I don’t say that in any negative way; it can happen to all of

Reviews for Hard Roll

[Laura Hewitt · Rating: 5 out of 5 stars]

Thank you for the glimpse into the past, of my Parent's lives working EMS. I heard the funny stories and the heartbreaking stories growing up, and have a deep respect for EMS workers. This book is very well written and I read it all in one day.