The Firefighter

The Firefighter sits in a sterile-looking exam room, dressed in “turnout gear”, smelling of barbecue. He wears a fire-resistant coat, unfastened. It is dirty, wet, and heavily scorched. Long legs in wader boots reach almost to the floor from his perch on the exam table. His face is sooty and his anger is palpable.

This man became my patient when his boss, Fire Lieutenant Bradley of Fire and Rescue 12, called me on the field phone to tell me, “This guy Carmichael has become a big problem.” The Lieutenant initiated an emergency medical evaluation for the man at the Easton Fire and Police Public Safety Infirmary, where I am the attending doc.

“I’m sending Carmichael in right now for a ‘Fitness for Duty’ exam. He’s insubordinate, and he’s losing it.”

The terse telephone call from the Lieutenant on his field phone lacks any detail. He brushes off my questions.

“Listen doc, can’t talk, we have another three-alarmer. I gotta go.”

I can hear sirens wailing in the background. The call ends.

The referring Lieutenant doesn’t have time to talk but by the time Carmichael gets to the clinic 20 minutes later I have overheard a third-hand version of events being whispered throughout the office from patients to staff. According to firehouse gossip, which spreads faster than brushfire in California, there was “an incident” after the first emergency call of today’s shift. Hearsay has it that the Lieutenant and Firefighter Carmichael had a toe-to-toe row on the fireground. First responders and citizens alike gaped as the two men shouted into each other’s red faces, neck veins bulging, over the deployment of a hose.

After 15 minutes of explaining near the top of his lungs that the Lieutenant is a “jerk” and always has been and that he, Carmichael, doesn’t need to be in any doctor’s office, Carmichael falls quiet. He wipes his face with his blackened hands, shakes his head, chuckles humorlessly. I have known this man through minor burns, knee strains, shoulder surgery. We have a decent rapport.

“So,” I say, “‘The Lieutenant’s a jerk.’ I get it. So, what? He’s ‘always been a jerk’. What’s different about today that winds you up here?”

He begins to talk, halts.

“Nothin’.”

I sit down and make myself comfortable in a chair in front of the exam table. I cross my legs. I look at him and say nothing. Not a dummy, he gets the message. No one’s going anywhere ‘till I know more.

After about 5 minutes, during which his face twists in embarrassment, fear, and finally pain, he begins to talk. He spills his story with reluctance—first a trickle of words, then a stream of broken sentences. His voice is clotted with emotion. He pauses several times during his choppy recitation and I can see his jaw muscles bunch as he musters the control to continue.

“I’m Fire and Rescue Squad- 12 years now, we get all the worst calls…no old ladies with sprained ankles to the hospital. This emergency call, a factory, the guy, he fell into the machinery—it was so weird… all I could think of was how it was like me, you know, he was tired, working overtime, and he fell. Five hours it took… it stunk, working in his biohazardous wastes…When we got in, he was still alive. The priest, he was giving last rites.”

He pauses, tense and taut.

“You know, I set the body on fire—me, a fireman…”

He looks at me with a humorless grin that is more a grimace.

“… Not funny, I didn’t mean to, all the tools… we were trying to get him out… he was fuckin’ split in two…”

He looks down at the floor, then up at the ceiling, anywhere but at me.

“I keep on seein’ his face.”

He sighs.

“I had this big fight with my wife—said some really mean things, and my Lieutenant… I couldn’t shut my mouth. I can’t sleep, I can’t eat. I see it in my head all the time—something’s wrong.”

The horror story Carmichael relates occurred 3 weeks ago and this man is ailing.

The barriers to his recovery are several-fold and include the ingrained aura of Iron-Man toughness which firefighters feel it is incumbent upon them to exude like the smell of the fire ground. This man, like his firehouse colleagues, most of his friends, and much of the brass, embraces the “John Wayne” theory of psychology: “Suck it up, drink it off, get over it.”

Psychiatric evaluation, much less treatment, is highly stigmatized, and the moment I pull this man off the fireground and therapy begins, his enemies, his comrades, and his own heart will begin to whisper: “Pussy.”

As soon as he is isolated from his daily rounds with his current best support group: the guffawing, knee slapping, life-risking members of his Engine House family, by his diagnosis, PTSD (Post Traumatic Stress Disorder), lawyers and lawyer’s doctors will circle him like the cawing flapping crows they are. They will assure this man that he is “owed” and that money extracted from the City will fix everything—as if cash could assuage his pain, shore up his self-esteem, or replace the role of meaningful work in his world. They will, if he lets them, subtly sap his will to get well.

This man is at high risk of becoming a “victim” for the rest of his life.

He has, fortunately, a few things on his side—his youth, a caring wife, a young stepson who looks to him as a father, good pre-morbid adjustment.

Choosing the firehouse over the career opportunities at Home Depot when he graduated from high school, Firefighter Carmichael has learned some discipline, a trade, and “how to learn”. He has been studying for the Lieutenant’s exam which comes in June. Most importantly, he has realized over 12 years that he is not stupid. These assets are of supreme value, and despite his “injuries in the line of duty” Carmichael seems to realize that the “Department” has been good to him in this way.

On the other hand, he has a family pedigree of alcoholism- Dad dead of drink, brother in and out of detox. Plus, his Lieutenant really is a jerk—a petty, bitter, minor potentate who will stoke the firehouse machine of gossip and disdain once Firefighter Carmichael returns to the Engine Company with his “off duty” slip.

Reluctantly, he agrees to see “the shrink”.

Carmichael’s world, as seen by me in office visit snapshots over the next 12 months, became a rocky and difficult place. He responded with his native toughness and managed to skirt the worst pitfalls. He hooked up with a decent psychiatrist, responded well to appropriate meds, and managed to keep away from the bottle.

His wife had a miscarriage. Afterwards, their relationship teetered, then appeared to stabilize with counseling. Perhaps as a talisman of his commitment to his wife and stepson through this bad time, Carmichael arranged to adopt the boy.

He appeared, briefly, to be succumbing to the seductive vision of a “disability retirement” as a panacea for his ills, then seemed to recover from that particularly destructive illusion. Carmichael put in for a regular retirement. Reluctant to give up his career, he talked about “still having time to pull my papers” and return to work “if my head clears”.

As the months went by he developed a bitter attitude towards “the Department” and became estranged from his former comrades.

This last appeared to cut him most deeply.

“We’ve pulled out kids together- live and dead, quick and scorched, and now they won’t even face me, talk to me. When I cleared out my locker, no one would look me in the eye.”

Carmichael’s physical appearance mirrored his transition from gritty fire grunt to civilian. His bulky muscles melted at first, while he was most ill, then morphed into more of a lean runner’s build. He no longer pumps iron, as he used to at the station.

“I just don’t like to push it to the max, not anymore. When I run, I can coast. I can think. It helps.”

He and his stepson Bobby have run together in some of the charity participation races. I remember Bobby as an appealing 10-year old redhead who occasionally accompanied his dad to my office.

At first, Carmichael appeared each visit in uniform, then in flannel shirt and jeans. During the summer, he came in shorts and an “I Ran the Burn Center Benefit 10K” tee shirt. His manner became less overtly macho. He talked about his family, his plans, and his legal case with enthusiasm for most of our visits. His habit was to squeeze in a few hard-wrung phrases about his feelings at the tail end of our time together and leave hurriedly.

I was pleased by his progress. By this time he and I both knew he would never return to the fireground.

The following spring he appeared at my office for his last visit. He wore a gray suit. He had a job interview. His retirement had just come through. His new glasses were smallish, round, and gave him an almost bookish appearance. I wished him well, and he hugged me briefly, patting me too hard on the back. That was two years ago.

Last week during a windstorm, a pine tree fell, crushing our back porch and sideswiping the garage. My husband told me he would call a couple of contractors for estimates on the repairs.

Today, I pull up into my neighborhood, tired and footsore after a long day at the clinic. There is an outsized construction-type truck, Ford F-250, in our drive. I see two children I don’t recognize playing on the lawn with my own. This is one of the first warm evenings in April, and the children appear to be enjoying the ability to be outside without coats. I see an almost-teenaged redheaded boy, and a sandy-haired toddler in pink. My younger daughter is cooing at the baby, who is trying to pluck blades of grass from the lawn. My older girl is eyeing the carrot-top boy with a rapt expression only too easy to interpret.

As I carry my bag and some last-minute groceries into the front hallway, I hear a familiar voice speaking in authoritative and professionally-confident tones to my husband. I hear the rustle of paper and the scrape of chairs. The two men must be back in the kitchen. My ears prick up at the distinctive Baltimore accent.

“Now, Mr. Corby, there are two ways we can go in terms of a solid repair—and still stay in the price range we talked about.”

I stop and lay my burdens on the hall table. Turning back to the still-open front door, I look more carefully at the truck parked in our drive. There is a car seat on the rear bench of the cab and a toy NASCAR racer upside down on the passenger side of the dash.

I peer at the moniker on the truck’s side:

“Carmichael Contracting—Fire Restoration, Storm Damage Repairs—Licensed, Bonded and Insured.”

The painted cartoon logo shows smiling carpenters restoring a scorched home while a hand-holding family of three looks on.

My heart unexpectedly swells, and I no longer feel quite so tired. The children’s voices, chattering and laughing in the front yard, are soothing, and the spring breeze smells sweet. I know who we will ask to repair our home. I feel grateful to the powers that be that Carmichael has managed to salvage his own.

Paula Lyons, MD

Story Editor: Karen Corby Marhefka