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A White Trash Christmas Carole

 Awake. Violently awake. The pager evaporates a rare dreamless sleep on my last nightshift. 06:01, the shift ends at 7. Fuck. Almost made it. 

The initial information is sketchy. Something about a hurt baby. The update moments later clarify that there has been an out of hospital birth with no further information. My mood does not improve. 

Wiping the last of the sleep out of my eyes, it occurs to me that perhaps we will need two trucks depending on what we find. I have them notified. Ruining their sleep as well. 

The address is in a small town 15 km away. With a contrasting population of elderly, devout Baptists, and dodgy, unemployable hillbillies, there is little doubt what demographic we will be dealing with. 

My partner refreshes our memories on post delivery and neonatal care while on route. My policy has always been to assume the worst before you get to a call, so worst case scenario is you're never surprised, best case scenario it turns out better than you expected. 

In accordance with this policy, I envision myself fishing around elbow deep in a bloody toilet bowl searching for a blue, translucent fetus that never had a chance in hell with its half formed body developing in a soup of methamphetamine and fentanyl since the day of its unfortunate conception while the mother tries her best to bleed to death. 

With this bit of pessimism in my head, we arrive on scene and back into the driveway. A trailer. Of course its a trailer. 

Everything comes into the house: Jump bag, oxygen bag, defibrillator, baby bundle, extra linen, and an infant bag valve mask which weirdly isn't in the baby bundle. 

We walk past the puddles of blood in the snow in front of the trailer, up the steps and into the porch. More bloody puddles. Once in the porch the smell of cat piss insults our nostrils. "Sure hope its cats and not meth" I grumble mostly to myself. 

We're met at the door by a tall, skinny, sketchy looking dude holding what looks to be a year old toddler. "She's in the bathroom" he says while blowing a lungful of cigarette smoke onto the kid's head. 

It takes us a minute to get through the kitchen and down the hallway because of the immense amount of shit piled everywhere. "Sorry about the mess, we just moved in" the skinny guy says. I've heard that old excuse from every hoarder I've ever encountered. 

I take a deep breath of cat piss, brace myself, and enter the bathroom. The mother is standing in the bathtub, blood running down her legs. On the toilet is sitting another woman with what looks to be a living baby wrapped up in a dirty sweatshirt. 

I make the clearly selfish decision to go with the baby. My partner has never had a baby, and furthermore, she and the patient share a reproductive system making her in my mind eminently more qualified to evaluate and treat the mother than I. I take the infant to the kitchen table, and tell my partner to holler if she runs into any trouble. 

The female infant appears to be full term, clear airway, good respiratory effort, actively moving, warm, pink, no peripheral cyanosis, occasionally crying. A full ten on the APGAR. I'm beginning to relax. Listen to the chest. Clear lungs, strong fast heart rate. Examine the umbilical stump. It looks torn rather than cut. No bleeding. Good. Lots of room still to clamp. She opens her dark grey/blue eyes that all newborns have, and solemnly regards her filthy surroundings. She pees all over her blanket and begins to cry. 

The second crew has arrived by now. I'm happy to see the newbie and another old time medic. I send them to check on my partner with the mother. I am talking to the woman that I found holding the baby. It takes me a little time to sort out who is who in this situation. The tired, chubby looking woman I am talking to tells me that the sketchy dude is her boyfriend with which she has the toddler I saw earlier. The woman who has just given birth is a friend or roommate with which the sketchy dude had a baby last year. "I'm going to have a chat with him when you guys leave" she says. "I forgave him last time it happened, but if it turns out this baby is his too, I'm taking our child and leaving for good." She seems eerily calm. Like that moment before a tornado takes your home. I ask if she knows any history of the pregnancy that i can use in my call report. "All I know is she either didn't know she was pregnant, or just hid it. She just told everyone she was getting fat." Remembering all the blood outside, I asked where the baby had actually been born. "Oh she had it in the porch. Says she didn't want to wake anyone up." 

I ask my partner if she was all good. "Yup, we'll be on our way shortly, take the newbie to drive, and we'll follow you in a few minutes."

"Man, I was shitting myself all the way here" says the newbie as we get to the truck. I tell him thats normal. "Until I had a baby of my own, I shit myself through every call I ever had that involved an infant. It should be a prerequisite for all paramedics to have a child I think. It takes away a lot of the fear." 

I update the hospital about what we're bringing in. They sound as unimpressed as I felt at the beginning of the call. We have no car seat, so I sit in the back holding this unnamed infant and we look at each other. She's probably hungry, instinctively casting about with her mouth for a nipple. I have nothing to feed her, and she starts to cry again.

I used to sing The Green Fields of France to my own daughter when she cried with a great deal of success. Not the lullaby of choice for most people, a sad song about a dead nineteen year old soldier in World War 1, but it does the trick again. I hope the newbie can't hear me. 

We arrive at the hospital, I give my report to a doctor and three happily smiling nurses. Everyone loves a baby I guess. 

Thats it. My tour is over, and I'm on days off. 

I always effortlessly leave work at work, but I find myself still thinking about it. 

It will be Christmas in less than a week. A dirty porch in a trailer park smelling of cat piss is maybe more similar to a manger in a stable than many of us care to think about. There are no angels singing, and no wise men from the east. All she got was three tired, cranky medics and a starry eyed newbie. There was no virgin birth, and definitely no certain future for this baby with no name; but you can't look at the newly born without a certain amount of hope for things to come. Maybe it will turn out alright in the end after all. 

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