July 7, 2021 - Bill Rothschild
Since the 2020 Muddy Angels National EMS Memorial Bike ride was canceled due to the covid epidemic, I organized a loose group of EMS folks to do informal bike rides. Sometimes there were as many as 6 of us, sometimes as few as just two. We would meet up and ride on a local bike trail, and we would ride between 20 and 50 miles. When we finished a ride and were back at our cars, we would have a little tail-gate scene, where we would eat and drink back any calories we had lost on the ride. I can't really say how it happened, but these after-ride events began with a bag of chips, a jar of salsa dip and a 6 pack, but evolved into coolers, chairs, music and sandwiches.
We usually rode on Sundays. That's because our earliest rides took place on the Bronx River Parkway bike Sundays, an event where they close a 7 mile section of the BRP for 4 hours for bikes and runners. We quickly outgrew that little 14 miles round trip, especially because we would ride it round trip two times on any given Sunday.
As the weekend that would become “That Day,” approached, we had made a plan to meet at the main Empress base in Yonkers, then caravan down into Manhattan. Our thought was to ride the pathway between the George Washington Bridge and the Staten Island Ferry terminal.
As the weekend approached, though, the weather became iffy. By Saturday night the forecast was for drizzle and rain the next day. We all agreed that we would chat text in the morning to see how things looked.
I woke up at about 0630 and the ground was wet, the sky was clouded over and water dripped from the leaves. Well, I thought, no ride today, I can actually sleep late in my own bed for a welcome change. Nope. At about 7AM, Matt called to see if we were riding. “I dunno,” I said, “seems kinda wet.” Matt was not accepting. Matt lived in Pennsylvania, and he made the long commute to Westchester once a week to work a cluster of shifts at two jobs. Sunday was a break in that cluster and he wanted to use it.
Matt suggested that we ride a local trail in Westchester. Oh, great idea I thought. Westchester rain is a lot drier than Manhattan rain. I consented to meet him in Yorktown in two hours. I texted the new plan to the bike riding group our Union had set up for us. To my surprise, I got one positive RSVP, from Ron Pugh, my regular partner on the Yorktown medic truck.
I need to take a minute to adequately describe Ron. He is about 6'3'' and 160 lbs. Before his mid-life change to EMS, he did masonry construction. On work sites, it was easy for him to slip between the vertical studs on open walls. Ron was married, with two great teen-aged kids. We have all gone sailing together, and Ron and I spend 12 hours a week pretty much living together as the two medics working on Wednesdays on 34 Medic 1, the fly car that provided ALS coverage to the Town of Yorktown, under contract with Empress.
Ron is a very pleasant, friendly and generous guy. He was unabashedly enthusiastic about everything. I know it's a cliche, but he would give you the shirt off his back. He is also a certified mechanic and is willing to assist in any issue he could help with. But more than anything else, Ron was a giver of words. A LOT of words. I have described him as a Niagara Falls of verbiage. I may also have said that Ron could come back from using the bathroom, and spend the rest of the shift talking about replacing the empty toilet paper roll. Unlike many medics, his stories did not involve him being the hero at a scene. They were just stories about calls. Every call. From beginning to end. I know he won't be insulted to read this. Ron knows he talks a bit.
So it was that we met at Railroad Park in Yorktown, so named because it had been a large rail yard before the railroad shut down in the 70's. Now it was a park on a rail-trail. It was just the three of us under the dry but threatening sky. We unloaded our bikes, got our road gear ready and changed from street shoes to bike shoes, the kind that clip to the pedals. The loose goal was to ride to Brewster, in Putnam County. It was about 17 miles away.
Rail trails make for pretty flat terrain, since they are on former railways and trains cannot climb real hills, unless they are the inclined, cog trains. The pedal to Brewster was uneventful. The rain held off, and the riding conditions were good. When you ride with a group, even if it's just three, there are certain dynamics occurring. Some guys are better at hills, while other guys keep a faster pace on flat ground. Still others seem to coast faster than others on the down-hills, sailing past even when no one is pedaling. So you find yourself either leading, or trailing, or clustered together based on terrain and other factors. I always knew when Ron was close behind me because I could hear him. I might be huffing and puffing on a hill, but Ron always had enough spare lung capacity to converse freely.
Our little three man group made it to Brewster easily. There is a small area where the path ends for folks to sit and rest, and there is a gas station store to shed some weight, and get drinks and energy bars. Or in my case, a Mr. Goodbar. We sat and rested (Matt and I) and chatted (Ron), until we were ready to head back.
On the return leg, early in the ride, there is a long, significant climb. I don't think the trail followed the original railroad here, because this hill is way too much for a train to climb. You downshift, you suck wind, you make it happen. Getting off the bike and walking is just NOT an option, but it might be a serious thought or even a wish. But we all made it, with a short rest at the top before we continued on, with about 15 more miles to go.
About 10 more miles further South along, we crossed back into Westchester from Putnam county. There's nothing denoting the crossing, you just have to know. Probably 99% of riders don't even care. Being a Westchester boy my whole life, I always felt the warmth of familiarity when I got back into the county from anywhere. On the trail, the first town you come to is Somers, where I live. I am also an active member of their volunteer fire and EMS department.
As you ride across the line heading South towards Yorktown, there is a long gentle downhill. During this descent Ron glided ahead and out of sight. Matt was behind me. At the bottom is a beautiful horse farm, and then about a ½ mile gentle climb to where the trail crosses Mahopac Ave. As I glided along, I passed an elderly couple plodding along on foot with a small dog, then I had to push a bit to make the climb to the Mahopac Ave crossing. That part of the trail is pretty straight, and I could see Ron quite a bit ahead. When I got to the crossing I decided to wait for Matt while Ron disappeared out of sight.
I waited. Then I waited. Then I waited a real long time. The elderly couple I had passed before were now walking past me. Well I thought, if Matt had some issue, surely he would have asked those folks to tell me, or they might have said something about a biker having an issue if they saw me waiting. Nothing. I picked up my bike and turned around. I was about to head back North when I saw Matt climbing the hill, but slowly. There were no cars coming when Matt labored across Mahopac Ave. That's when shit got real.
While his bike was still moving, Matt swung his leg over and hopped off, letting his bike crash to the ground. A moment, dear reader, to say that this is something real bike riders simply do NOT do. Think of hoping out of your car while it is in gear and just letting it roll away. It happens, but it’s not normal. The words that came next out of Matt's mouth would be the first tiny step on a journey that would alter many lives forever.
“I don't feel well”, said Matt. “My chest is tight.” I realized then that he looked a tad... pasty. My mind had been on bike riding, not being a paramedic. I was in the wrong mode for this. I uttered the first thing that popped into my head. “What?!” Matt was bent over with his hands on his knees. He repeated his description of his distress. At 12:29 pm, I called Ron, but of course it went to his voicemail. “Hey Ron, Matt's feeling kind of sick, so when you get this, come back up the trail.” If you stopped to answer every phone call when you ride, you would never get anywhere. Meanwhile, Matt said, “Call Kelsey and have her come here and do a 12-lead on me”.
A 12-lead EKG shows the heart's rhythm and rate and in many cases can show if a heart attack is in progress, is approaching or has occurred. Our machines run about $30,000. The rest of a set of a medic’s gear runs about $5000. I had none of that. I used what I had: my fingers. I took Matt's pulse. It was about 70, regular and strong. Too slow. “Do you take beta blockers, Matt?”
“I don't take anything.” He answered. Something was askew. Matt was in good shape, but we were just riding pretty hard, and his heart should be beating substantially faster. I decided we had to call Kelsey to get an EKG on Matt.
Kelsey, too, needs a bit of an introduction. Kelsey is Matt's partner on Saturdays, when Matt and she work the 34 Medic 1 Yorktown flycar. They have grown very tight over the years. Kelsey is about 5'6” tall with long, often red hair. She is very smart, not only being a great medic, but having also graduated nursing school. She works on the side as a set medic, alongside the beautiful people of Hollywood. Somehow she also drives semi-pro racing cars and could converse mechanically much like Marisa Tomei's character in My Cousin Vinney, about piston travel, cylinder pressure and supercharger intake fans. I am trying to be politically sensitive, but also factual here. If I were to say that Kelsey caught the eyes of a lot of guys, I would be only scratching the surface.
I knew Kelsey was working on the Yorktown truck this day we were riding, with a different partner, Dick Harvey. “Well Matt,” I started to say, “We're a bit far outside of Yorktown for that.” I knew that Kelsey would doubtless respond immediately if I called her, but that if it was discovered that she had left Yorktown, she could be in serious trouble. We were in Somers, which was covered by another agency and another group of medics. Yorktown contracts with Empress to cover Yorktown, not to go gallivanting around doing curb-side 12-leads in Somers. If Empress found out we did that, there would be hell to pay. Scott Holland and his wife Sherri were both Empress managers and lived nearby, so being discovered was not just a remote possibility. I did not want to be the guy to set that shit storm in motion.
Matt was now standing and doing some stretching, twisting, arching his back. “I feel better”, he said. “I think it was the bananas I ate. Now that I'm not hunched over the handlebars, it's starting to feel better.”
I considered this and offered, “It's about ¼ mile to the Granite Springs Rd crossing. It's down hill. I'll call Kelsey and have her meet us there. It's only about ½ mile from the Yorktown line. Do you think you can make it, nice and slow?” I know it's odd, but we were in farm country. The roads were few and by traveling just a bit further South on the pathway, it would put us a lot closer to Yorktown by road, but technically we would still be in Somers. “How do you feel? Are you up to it?” I asked. Internally my mind was a slot machine with three wheels spinning in a blur, with various symbols flying by: Would the wheels stop with 3 clowns, the EKG showing no problem and Matt's distress being gone in a few minutes? Maybe with 3 beer bottles, reflecting the laughs we would have over this later. Maybe 3 jokers, with the hazing we would take from our fellow medics if this turned out to be nothing? Or, would the wheels stop with 3 Grim Reapers? As the minutes passed, I began to fear the odds. “Yeah, I can do it”, Matt said.
At 12:31pm, I called Kelsey's cell phone, my main worry now was that she was on an EMS call. The Yorktown truck responds to 2,500 calls a year, so this was a real possibility. It went to voicemail. Shit! At 12:32pm, I called the station phone. Someone picked up and I asked if Kelsey was in quarters while I closed my eyes in silent prayers. They were answered by Kelsey. “Hey Kelsey, it's Bill Rothschild. Listen, we are on the County bike path and Matt is having chest pain. It seems to be improving but it's not gone. Can you meet us where Granite Spring Rd crosses the bike path? I know it's outside the district, but it's pretty close”.
“Oh my god, yes”, she said.
“Great! Who are your working with? I asked.
“Dick Harvey” She responded.
“Ok cool” I said, giving more thanks.
Dick was a real team player who would not give us up for this fool's errand. Dick, at well over 70 years old, was the oldest medic we had in the agency. He was about 5' 7 and about 260 lbs, nearly all of it muscle. He had a deep gravelly voice and a very significant handlebar mustache. One of the Yorktown medics joked that Dick looked and sounded like Yosemite Sam from Bugs Bunny. I likened him more to Mr. Krabs from SpongeBob. Dick has had most major joints in his body replaced. I called him once, 48 hours after a hip or a knee was done, to check up on him. “I just did 3 miles on the treadmill and 10 miles on the stationary bike. My doctor said I'm an animal.” Dick's theory of surgical recovery went like this: If I do double the amount of physical therapy, I can come back to work in half the time. Two knees and two hips later, that plan was working for him.
Dick's hurry to return to work was a mystery, because of another title he held at Empress. In a staff of about 500 EMS workers, Dick was rated Empress' #1 Shit Magnet. Some background here: Dick managed a call in Yonkers where 3 firefighters had to jump from an upper floor. One died. Dick transported one of the others, who had broken EVERY rib. On another occasion, working in Yorktown, Dick was on scene with just one other EMT when he had to handle a major MVA with multiple fatalities, including children. A car with a family of four lost control and flipped over the median, landing roof-to-roof on another car traveling the opposite direction. The carnage and debris field were so dense that traffic backed up in both directions, and the responding ambulances were a good 20 minutes behind him. On yet another occasion, having just returned from another surgery, Dick swapped shifts with his son so he could work a “very quiet” ambulance for his first shift back. This quiet ambulance covered only a hospital campus and the county jail, and few calls ever occurred on Sundays. But, on that Sunday, someone smuggled a load of K2 into the jail. Six inmates seized and the facility went into lock down. With Dick on the wrong side. This left Dick with a brand new hip, ½ dozen seriously ill patients, with no back up and no way to get them out. Later in this “quiet Sunday” shift, Dick was called upon to respond to a fatal car crash and pronounce someone dead. For this kind of thing, we blessed him with the nickname “Hurricane Harvey”.
As we restarted, Matt started walking his bike, which I had not thought he was going to do. “Ugh” I thought, “This will take a long time.” Maybe he realized it as well, because after a dozen steps, Matt swung back into the saddle and began pedaling. As I had promised, it was downhill, so after a few turns of the pedals, we just did a slow coast. I watched Matt closely, while those blurring slot machine wheels spun in my head. Very soon, the wheels were about to come to a very sudden stop.
It took us all of three minutes to get to Granite Springs Rd. Matt dismounted his bike, and before I could inquire, Matt updated his condition: “It getting a lot worse, Bill. I can feel it moving to my shoulders now.” OK, shit was getting realer by the second here. I took my bike and leaned it on a post, with my flashing white light facing in the direction I knew the fly car would be coming from, in case they weren't familiar with the area. There was a thick timber post in the path that was made to support a heavy gate that had not been installed yet. Matt was now bent forward, leaning hard onto that post. “OK, listen, I'm calling Kelsey to have her start an ambulance out, OK?”.
“OK,” Matt said. It was alarming that he offered no protest, because medics notoriously don’t willingly choose to be patients in our own ambulances. He then began taking his riding jersey off, leaving himself topless. “Here”, he said, “Take my car keys and cell phone”
'Jesus fucking Christ' I thought. 'He knows! He's not saying it , but he FUCKING knows!' Only one reason a guy having chest pain radiating to his neck would strip off his shirt and give his property to someone to hold. The metaphorical wind is picking up. The sky is getting dark. The flashes of lightning are getting brighter and closer together. The distant booms of thunder are getting louder. Those slot machine wheels are a spinning blur.
I left Matt leaning on that post and took a step towards the road, so he wouldn't hear me. I called Kelsey again. “Hey, Kelsey, where are you?”.
“We are on Granite Springs,...passing Curry Street”, she answered.
“OK listen, he's getting a lot worse. Pick it up and start an ambulance out, I don't care where you get it, but start one out. Matt's pain is radiating to his neck”.
Kelsey answered, but I don't recall exactly what she said, because a sound behind me caused me to pull the phone away from my ear and whip around. Matt had only been about 6 feet away. The best way to describe what I heard would be to say it sounded like a large sack of crushed glass hitting the ground. I've never heard that sound. I have no business using it as a metaphor.
Matt had collapsed. He wasn't crumpled, he was stretched out, on his back, his open, unseeing eyes gazing up at the drizzling sky. There was no sign of breathing. Matt Tuttle was dead.
“Kelsey! Kelsey! Matt just collapsed! I'm starting CPR.” I hit the red “end” button. I found out later that Kelsey had been screaming, “Put me on speaker! Put me on Speaker!” I never heard her.
I knelt down on the pavement next to my friend, and began the brutal act of chest compressions. Real, effective CPR is demanding physical work. It is NOT like in the movies. You are trying to transmit enough energy into the victim's body to keep him alive with your expended energy. You are using your body's life force to keep two people alive. It is not pretty for either party. I tell people it's like performing as a tow truck. You don't see any 4 cylinder compact tow trucks, what you do see are large framed 8 cylinder rigs that have enough power to move themselves AND the car they are towing. CPR is like that.
Adult CPR calls for 80-100 compressions per minute, while allowing the chest to fully return to its normal position between each one. You are supposed to compress the chest a good 2-3 inches with each push. Your hands are not supposed to rise off the chest. Compressions must be performed smooth, not jerky, with the rescuers in constant motion, either in an upstroke or down stroke. Picture-perfect CPR moves about 30% of the body's normal blood flow. That may, or may not, stave off brain damage for a while until medicine, a defibrillator or luck gets the heart to begin beating on its own. Even if you get lucky and the heart does begin to beat, it is uncommon to see any other life signs immediately. Sometimes you see some arm or hand movement or some gasping breathing, maybe some eye opening. Most of the time, when a heart is restarted, it begins a cruel waiting game to see if there is going to be a return to anything like normal, or if the patient has an anoxic brain injury and will spend years, or decades in a massive long term care facility, tethered to a ventilator until fate returns to end it, usually via pneumonia.
That is what was flying through my head on that drizzling August afternoon and I slammed down on Matt's chest 100 times a minute, 3 inches deep as my bare knees ground into the pavement of the bike path, waiting for Kelsey and Dick and hopefully the rest of the Calvary to arrive.
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