I sat in the back with her, the whole way. It was an almost 2 hour ride. It was bumpy, uncomfortable, and at times too hot and other times too cold. But I put up with it all, we both did, because I was there to watch over her and she was there to be watched over. All the while I was listening to her almost incomprehensible speech; her personal mix of Spanish and English. I listened to her speak like a tired old woman. She spoke of things that were terribly confusing to me but I’m sure they made perfect sense to her…but then again, did they?

I’m an emergency medical technician and I’m in an ambulance and Ellen? Ellen is my patient.

She’s not my typical patient mind you. I don’t have her on oxygen. I don’t have her on the blood pressure cuff or the pulse oximeter. I don’t have to check her vitals. I don’t have to do anything as far as my typical interventions are concerned. I just have to be here. I have to watch over Ellen on our nearly 2 hour drive.

Ellen’s family specified that they do not want her resuscitated if anything should go wrong; “wrong” being if Ellen should start to die in the back of my ambulance. But today nothing will go wrong. If Ellen is supposed to pass away, then she will not be doing it the “wrong” way. Everyone has their time to go, and whether we’re the most skilled in our field, not one of us is ever God and don’t ever presume to be, nor can we save the un-savable. I’m not to resuscitate her. If Ellen should begin to show signs that she is passing away, I must let her go. But how am I to be I my profession, my line of work, and not try to save this woman’s life? I didn’t take a Hippocratic Oath as would a doctor that says I will “do no harm” to my patients, but I did take the course at the college to become who I am today, an EMT, a person who’s sole purpose is to save lives. So how can I not save this woman if I should see her start to fade away? What kind of person would I be if I allowed her to pass away? I don’t care about what the family says, I have to, but I don’t. Perhaps I’ll do what I can in the back of the ambulance to save her. I hope I don’t have to make this dreadful decision anytime soon.

I look up and Ellen is staring up at the ceiling; her mouth is slightly open, her eyes are a little more than a slit. I can see her mouth twitching, probably a muscle-control-type-thing that her body runs through on a daily basis, but twitching none-the-less; it makes me think she is talking to someone. I look down her body; as I’m trained to do as an assessment. I check for any eye movement, check the chest; does it rise and fall appropriately? Check for hand or arm movement, legs, feet, toes. Ellen is all right. Ellen is still with me.

Ellen’s mouth is no longer twitching; she is now talking to me in her broken language. I can’t understand or even hear anything that she is telling me at this time, but it is clear to me thatShe is silent now she’s said all she has thought to tell me, all she’s thought about saying. I’m almost quite sure Ellen doesn’t remember that I’m sitting here, right next to her, mere inches from her right arm.

I choose to sit in this little seat, not the bench seat, not the pilot seat, but this little cubby seat nestled between two counters its dreadfully uncomfortable. The seat cushion doesn’t seem padded enough however the back cushion is padded so much that I’m forced to sit awkwardly forward. I hope the seatbelt works properly, otherwise, I’m in for a treat. I may actually end up on Ellen’s gurney with her!

Ellen is in my ambulance, her body, as old as it is and as worn out and weathered, lies in a position of comfort. A position of comfort for her, that is. This means she doesn’t complain, although I know she would if she could speak better to me. She would tell me if she didn’t like how she is lying on the gurney, she would tell me in a heartbeat; hers OR mine. Her body is here, lying before me, but I can see by her eyes that her mind is far, far away. She has drifted off into a land that keeps her at peace for this long ride. Wherever that place is, she’s very focused on it, and I know she’s tried to tell me about it, but I just don’t understand and that truly frustrates me. I wonder if it frustrates her as well? Would I see signs on her tiny, wrinkled face? I wonder.

It has only been half an hour and I know there is so much more time between now and her home. That’s where she is going…she is going home. For the reason, I’m sure of, but never asked, so Ellen can die in her own bed. Her family doesn’t want her to die in a nursing home or extended care. And I don’t blame them. This woman is not dead, she may be close to dying, but she’s still very active, very alive in her own way. Her eyes may not see very well any longer, but they say she can hear and speak just as well as I can. She doesn’t need to be locked up in a hospital room in an uncomfortable bed surrounded by people that she doesn’t know very well. People that all they seem to want from her is to check her diaper or barely listen to a word she has to say and push her around in a wheelchair all day. This wonderful woman needs to be surrounded by people that know her the best, people that love her; her family. They need to be her caregivers, not some stranger who is only by her side because their insurance is paying for it.

I stare out the window on the side door and watch the dull landscape go by. The brown dirt; laden with only a few patches of tufts of green here and there; the seemingly infinite blue sky and the white fluffy clouds that don’t seem to be moving as fast. Occasionally, just so you know, I’ll catch the glimpse of a misty blue mountain creep in from the left. It is boring scenery. I am not thrilled to be watching the same landscape pass me by for the next 15 minutes. I had to watch it for 30 minutes now and the only thing breaking up my boredom is a town, a very small town. I know the scenery will change when we get to Ellen’s town, it’s in a much higher altitude and there are better chances for greener pastures, so to speak.

Ellen looks tired. I’m afraid she more than likely looks like that all the time now. I’m sure her life, as long as it has been, has been full. She’s a tiny woman, her skin barely covers her skeleton. The only other definition to her body is her large blue veins. I think about how Ellen has beautiful big blue veins. Any medic would salivate over them, they’d enjoy giving her an I.V., if they weren’t afraid of accidently tearing her skin in the process, that is.

As I look out the window and watch the landscape go by, I wonder about Ellen’s life and did she watch her landscape go by? What was her world? Did life go by her like a fast moving train or did she take every day one at a time and enjoy what she had, when she had it. Based on her age, she didn’t have a lot when she was young and I can only assume that she had very little in her life. What kind of woman was she? I look at her face, she is little more than a skull with flesh and liver spots, she is tiny and frail, but there is peace on her face. Her eyes are between light brown and hazel and her hair is still a shade of brown with some grey sprinkled in. I have to laugh at myself because I am wondering if her head of hair is natural or if a woman of her age still uses hair products to change the color? I can’t see the lines that are left behind from a constant troubled or furrowed brow she doesn’t look to me like a woman who lived her life with a scowl. She doesn’t even seem to be upset at anything at this time either. Even though she is out of her element, there is no worry on Ellen’s brow. But what made Ellen happy?

Was she a wonderful mother who doted on her children and possible grandchildren? Is she old enough to have great-grandchildren? Did she have a loving husband if and when she was married? Did she have a job at all? Was she the type of woman that believed in fully staying at home and raising the children and doing the housework while her husband did the outside work? Was she the type of woman that considered herself independent, even though married, and believed that she needed to provide for the family as well? I can ask Ellen all these questions, but her answers would make no sense to me. This make me feel sad because I wish I could have the answers to this mystery woman on my gurney.

They say the biggest part of an EMT’s job, whether we are at the basic level or the paramedic, is counseling. We are all counselors. But what exactly am I to Ellen today? I know I will be nothing to her tomorrow, but what am I today? I can not talk back to her when I do not understand a word that escapes from her pale lips. I can not ask her to elaborate on what it is she is talking about so I can further understand the situation. I can not help her and answer any of her questions. I am only sitting by her side, watching over her as she continues to stare upward, not moving anything but her mouth. I am not caregiver, I am not counselor, what am I? I believe that today, I am merely, here.

Ellen told me at the beginning of our journey that she saw a face above her. I remember specifically, because I noticed her staring up there and at the time that we first got her into the ambulance, she was actually speaking very clearly. I looked up and I saw the large light fixtures in the ceiling and told her that it was a light that she saw. She only said; “oh”. But she stares at that same light and she moves her mouth and lips as if she’s talking to someone. To me, there’s nothing there, but what does Ellen see? Does she see a face in that light? Do I believe that when a person is near death that they are visited by someone from the other side to bring them back home? I think I do. I think I do believe that we are sent someone to help us, to bring our souls to where we need to be. I’ve been told, by more than one person, heck, by more than a dozen, all in the medical field, usually nurses, mind you, that when they were with someone on their death bed, that patient suddenly began to talk to someone or something that only they could see. That patient would make some sort of comment about how they see a relative or close friend standing at their doorway or near their bed telling them that everyone is waiting, or that it’s time to go. There have always been incidents of such. Is Ellen experiencing this now?

I’m snapped out of my existential trance, thankfully, by Ellen poking my arm and looking over at me to get my attention. I lean in to the frail woman and ask her what she needs. Ellen begins to tell what is troubling her, only I don’t understand anything she is saying. I do notice that she is tugging at one of the three seatbelts I have secured around her. I can only wonder if that is what she is talking about.

“That’s your seatbelt, Ellen.” I tell her, in a voice louder than my everyday volume, “You need to keep that on so you don’t go flying around.” Ellen just looks at me and says; “yeah” and then continues on with her very quiet, unclear talking. She is very determined to tell me something, but I feel like I am traveling with a foreigner and I am lost.

She talks to me like this for only a few minutes and I get frustrated. Not at or with Ellen, no, but at the fact that she is trying to communicate to me and I have no idea what she is saying. I cannot make out a single word and when I think I understand something, all I can do is repeat what I think I heard;

“Ceiling?” I turn my ear to her mouth to listen better. She doesn’t make sense to me. “Do you still see a face in the ceiling?” I think she says yes again and continues on with her silent whispering. Her talking gets softer and she still plays a little with the seatbelt and then I lose her to the ceiling again. Her eyes are fixed on the same spot they have been on all trip. They only time they move is to look at me. I think that she is just looking at the light, but is she?

Only one hour has passed and I wonder how long has it been for Ellen? Does she understand the passing of time right now? Does she feel the trip is flying by or dragging on? I don’t feel it’s doing either, but I’m aware of both. I know it’s not dragging on because that would be insensitive toward Ellen and my “care”. I also don’t feel it’s flying by because I have no “care” to give, therefore I have nothing to keep me occupied. So I’m torn between both, yet I care for neither. I don’t mind my company on this trip, she is a bit entertaining, whether she means to be or not, and I’m deeply intrigued by this lady.

I glance back over to my patient and she is much more active now, she moves her legs a bit, still tugs at the seatbelt at her waist, and even her mouth is moving more. Although I think she is tired because she keeps rubbing her left eye, she is still wide awake. She continues to stare upward, move her mouth in silent speak and tug away.

Almost as if out of nowhere, she suddenly seems more aware of her surroundings. She places her finger in her mouth as if she has something stuck in there between her cheek and gums; like something is bothering her terribly. She rubs her eye again, the left one, always the left one. She pulled at her pillow as if to try and adjust it, but it does no good, either she doesn’t have the strength to actually pull it, or she just thinks that she did the job she tried to do. I ask her if she is all right, does she need me to get her something. She tells me in what I now consider her language, something. I hate this “something”, because to me, it’s nothing. I hate that she wants to tell me something, anything, everything, but I have no idea what she is saying to me at this point. Or should I say, what she is trying to tell me?

I feel sad. Sad because this woman is lying a mere six inches from me and she can not tell me what she needs. She reaches toward the ceiling as if someone, or something, is there for her to touch. She is fidgety. She seems agitated in some way. The combination of her constant tugging at her seatbelt, her reaching skyward, her mouth moving in silent words, her playing with something in her mouth, her rubbing of her eyes is a constant reminder to me that this woman is very much alive and living and well. She is bothered. Every little thing to her at this point, bothers her. There is nothing I can do to help her. I can’t take the seatbelt off, I can’t fix what is wrong with her mouth, I can not hear the words she speaks, I can not see what she sees above the both of us.

We are half an hour away from our destination, and Ellen seems much more alert to me now. When we speak, I understand her, but she speaks to me as if someone else is talking to her as well and something is definitely bothering her mouth. Ellen begins telling me that a man is telling her things and I start to understand her words better. She tells me that “he told her to have the soup.” I asked her who she was talking to, was it her husband and she said yes. I asked her what his name is and she tells me. She began telling me things about him, what he did, etc. She partly talks about the past and she partly talks as if her husband were right here with us. The information she gives me is broken and not making much sense. I know it’s not her fault that her mind is running around amok in her head. She doesn’t think yesterday was yesterday, to her yesterday could have been years ago.

This all goes back to my beliefs, though, because I can honestly believe that her husband is here with us right now, but at the same time, I can believe that she doesn’t see her husband, but that her mind is making her believe that he is right here. It makes me marvel at the amazement our bodies put us through to compensate and go on with our lives, no matter what situation we are in. Ellen is failing; rather, her body is failing her. Things that she talks about now, things from her past that happened so many years ago, we’ve all lost count, are now being brought back into her daily life as if it or they happened mere days ago. When Ellen was in her right state of mind, when she was still sharp as a tack, I imagine she wouldn’t have remembered much of her past, but now, now that her mind is taking her to a place where she is comforted and feels safe, she remembers it all. Isn’t it funny? I know this has to be true, because I’ll ask my mother to this day something that happened when I was a kid and she’ll just tell me; “Oh Kristin, I don’t remember that anymore.” Did Ellen say this to her children when they wanted to know about something that happened so long ago? Now all her memories are flooding back to her to keep her safe and warm. She’s remembering the past so she doesn’t have to face her present.

Ellen reaches her arms out every now and again and fidgets with her seatbelts. Every time I ask her if she is okay, she tells me the same; “oh yes”. I don’t understand what is happening with her mind this late in her life, but I do see that it jumps around between the here and now and some place in her past. She will tell me about her husband, as if he is still with her, out on a job somewhere. She’ll tell me about her children and talks as though they are still young. I think that her husband has passed away, and I know that her children are maybe even older than me.

Ellen tells me her husband used to work on the trains, that he would sleep on the trains and he had something to do with them if they ever had a crash or wreck. I don’t fully understand it all, but that’s the best I can get from her. She speaks as if that is where he is right now.

When I ask her what she used to do for a living, she tells me that she already told me and goes into what her husband used to do again. She also tells me that she wrote me a little note the other day. I’m not sure who I am to her right now, but I realize I am not her caregiver, or the girl on the ambulance with her watching over her. I now have to wonder who I was to her this whole time. Was I ever an EMT to her, or just someone in her life that she should know, or that should know her? It’s all mind boggling to me. How is it for Ellen, though?

As far as I can get from her, she has four children and only three grandchildren, and they used to live with her. I don’t think she is quite sure of what she is saying, and maybe she’s mincing her memories together. I do know that I met three of her children, and I’m not sure if they’re all her children or one of them might be an in-law. I can’t sit here and pretend to know any of it and can only take her word for the truth. I do know that whatever she is telling me is the truth to her, and quite possibly the truth for me, only, it’s not happening in the way that she believes it is.

All the while Ellen goes from fiddling with her seatbelt to playing with her mouth and occasionally lifting her arms up toward the ceiling of the ambulance. She is silent in that she isn’t talking to me anymore, but her mouth moves just the same and she looks up at something or someone that only she can see. She is happy, content and comfortable, for the most part, and for her sake. I’m willing to bet at an earlier time in her life, she’s hate being here with me right now. I know I would be. It’s a long, long trip for me…maybe even for her as well.

My trip with Ellen is drawing to a close. I can see the town we’re taking her to from here. In front of our ambulance is the white pick up truck that her son or son-in-law is driving so he can show us the way. I really don’t know which he is. It wasn’t my pleasure to find out. I do know that at the home in which we picked her up at, he was very loving to her and caring, he orchestrated the whole thing. I would later find out that he is a co-worker of my boss.

I feel heavy hearted at this time. Ellen will be home with her family soon and I will very likely never see her again. She is 89-years-old and very well may not have many more days or months left. I am pretty sure that is why she is going home to her children’s home. If she were my mom, this is what I would want for her. But I have to wonder, why was she in that nursing home in the first place? Why was she put in there? Was she an inconvenience? Was she medically incapable of being left in a home setting? Did she have to have some sort of operation that rendered her unable to be away from hospital care for too long? It makes me wonder what I would do in the same situation. What would I do if my mother could no longer take care of herself? Would I stick her in a home? I know that I would do whatever her wishes are, and being here with Ellen make me decide that even more. I have a pretty good sense of that now. I hope to never leave my mother alone.

She’s quite antsy, this one. I’d swear she’d jump right up off my gurney if I let the seatbelts off of her if I didn’t know any better about her not being able to stand on her own any more or walking without assistance. I read the report that the nursing home gave me right as we were leaving the parking lot. I wanted to see what sort of woman I was dealing with here. It said she could speak and hear almost perfectly but her sight was not so great anymore. It said that she had little to no use of her legs any more. How does that feel to anyone? One day you’re trotting along in your everyday life and the very next you can’t even stand up any longer without someone’s arms around you holding you up. To take away freedom like that must be terrible.

The last stretch of our ride is along a very bumpy road and I can see what looks to me like fear in Ellen’s eyes. I ask her if she is all right and she tells me that she is. “Bumpy isn’t it?” I ask her. “Yeah,” she answers. I take my hand and I caress her shoulder and arm, it’s the only comfort I can give to her at this time other than listen to her when she has something to say. She seems to welcome my touch. I feel like this little gesture might actually mean a lot to her, but I can’t be sure, because she certainly doesn’t look over at me and tell me thank you, but because of the way I feel her arm in my hand, it’s like a cat or dog just letting you caress them. It’s hard to explain even to myself, but I know she’s not willing to reject my touch at this point.

She looks out the back window and asks me, in a very clear-as-day voice; “is it going to rain?” She wants to know if it’s cloudy outside. Again, I remember that she doesn’t see too well. I tell her no, it’s not going to rain. I tell her that there are big white clouds in the blue sky and it looks like a very beautiful day. Very warm and inviting, I tell her. She seems to except my answer and moves back to staring at the ceiling, then she looks at me again. She says something about California and the boys liking it out there and then she drifts back to some day back when. She begins a story with me, but yet again, her clear speech becomes her broken speech and anything that she is saying to me at this point is lost. Again, I’m totally frustrated because now I want more. I want more of this woman’s life. It seems far more delicious than mine, but the older generations always do to me because they made their lives from what they had to make them from whereas we today, use technology and rely on others. I guess I’m thirsty for her life so I can realize what it was like for her in her day.

I wonder when we’ll reach our destination, not because I want to be away from Ellen, but because even though she gives me tiny, miniscule fragments of her past life, I feel what little I am getting from her is shaping our relationship, if only for today. And as I said, I know she’s not going to be in my life again, so I won’t get to fill in the gaps she is leaving behind. I’ll never get to hear about California, or the trains, or what she even did for a job, if she even had one. I’ll have to sort them out myself and make her story what I want it to be. But this woman has grabbed me. She has put her hold on me and I want more. I know that I will not soon be forgetting my trip with Ellen. On the other hand, however, I could just let it all go away like every other patient of mine that I meet.

But Ellen isn’t like every other patient of mine. Ellen scares me and intrigues me at the same time. I’m scared because she is talking to her husband in my ambulance and quite possibly seeing him as she reaches out, and this may mean that she might be leaving this place for another sooner than we all think. I’m scared because they handed me a bag of “goodies” that I’m going to have to change her if she uses the bathroom on herself. I’m not looking forward to that! I’m intrigued because she is handing me very small pieces of what is going on in her life right now, or what happened in her life some time ago and I may never get to fill in the pieces. I know I’ll never get to fill in the pieces. Her shattered life as it’s unfolding in front of me today will remain just that, shattered. All I can do is pick up the pieces and form them into my own stained glass window of her life…and be happy with the particles that make up the whole picture for me.

We turn off the main highway and onto what I can only describe as a riverbed that has been turned into a road. The sun is now shining directly into Ellen’s eyes and I get off my uncomfortable seat and stand in the side doorway so that my body can block the sunlight from hitting her delicate eyes. Whenever the sunlight hit her eyes, it was as if someone had shot her, her whole body would jolt and jerk and she’d turn her head away quickly. I would have sworn to anyone that asked me that the light hitting her face gave her physical pain. The more I think about it, the more this might actually be true.

The road we are going down is worse than the one before, it’s a lot more bumpy than it was on the way in here before we hit this dirt “road”. I fear poor Ellen is going to bounce right off the gurney…my other thought is that it’s just going to cause her to lose control of her facilities and use the bathroom on herself and I’ll have to use the bag of “goodies” that I was handed. This thought is sad but true, as I’m not a CNA, I’m an EMT.

After what seems like a longer trip down the “driveway” than the distance from Flagstaff to Snowflake, we finally arrive at our destination. The home we pull up on is so far out of the way and surrounded by absolute nothing, unless you count the endless rows and patches of cedar bushes, (which incidentally smell like cat urine, just so you know), that I ask my partner, who has been driving down this fun-ride-of-a-road, if he’s sure we’re not being set up for some killing spree. If something were to happen to us out here, no one would ever know!

The ambulance is backed up to the front door of the house and we take the gurney out of the back of the ambulance with Ellen on it and wheel her into the house. I look momentarily at the young grandson, his name is Lou and he’s only 17-years-old, he looks mortified that his grandmother is actually here. It seems to me that he’s not happy and now that she’s being wheeled into his home, the reality of what he may consider a burden has hit him. He just doesn’t seem too happy to have the “old woman” here. I feel sorry for Ellen. I know he is young and he may or may not understand the implications of what is happening in his grandmother’s life. I do know that she is more than likely going to be here, in his life longer than he may think, and this might not sit too well with him.

We are instructed to place Ellen on a recliner so she is comfortable and the young grandson is told to go and get her some water. Her son or son-in-law is completely surprised that Ellen hasn’t used the bathroom. I’m relieved. I don’t know if she’s wearing a diaper, I can only assume she is. I never did look in that bag of “goodies” to see if there were any in there. Lou brings his father the bottled water and it is handed to Ellen who is now sitting straight up in the recliner with no assistance from any of us and she is very much alert. It is a different woman sitting in that chair than who was lying on my gurney and I’m completely surprised by what I see.

We are still standing around in the living room of this house as the son or son-in-law stands and talks to my partner. I just look around the house and listen to the stories. I occasionally glance over at Ellen and wonder if she remembers or even thinks about her trip here. I imagine that she is a very sharp woman and maybe the trip was too much for her to handle and for whatever reason, she went inside herself the whole time we were together and I saw a different woman because of it. The Ellen in the chair is not the Ellen in my ambulance. Interesting.

We say our goodbyes to the family, what is there, anyway and load our gurney back into the ambulance and head off back down the riverbed converted road and onto the highway. It has been a long trip, and thankfully, only 30 minutes sit in front of us and home. We turn left on the highway and head off to get something to eat, and as the landscape falls behind us, so does Ellen. She is now just a memory of yet another patient that has sat in our lives. I have to wonder why this one in particular is going to leave such a large imprint. My trip with Ellen, was fruitful, frustrating, entertaining, unique and very pleasant, despite the bumps in our road, both physically and mentally.