Wednesday, April 30, 2008

From a Streetcorner, 3am

And once again, here we are. Sitting. Waiting. Burning diesel, subsonic rumble the constant backdrop to my work-night. Orange skyglow, dark trees. Soft teal instrument panel lights. Muted computerglow. Streetcorner. Low levels. The usual.

For seventy-five miles around, we are it, for transporting ambulances. I am it, sitting rightseat, next up. Such is rural EMS. I like it.

Driving down the mountain earlier, we pass through a long, dark chute, trees wrapping high and close around the long downsloping two lane road. The forest is still deep and cold and merciless in the uncaring way of nature. We are it for that too, the sum total of backcountry-capable ALS resources on-duty in two counties.

The woods are vast and thick and trackless and above all dark. I have a headlamp. A backpack. Boots. A few more toys. Seems very little, against the immense, endless, towering evergreen-filled snow-covered hills.

In the end, I suppose, if it comes to it, it'll be enough.

Wednesday, April 23, 2008


She is old, body withered with osteoporosis and arthritis, mind withered with Alzheimer's and dementia. A bloodstain spreads out across the carpet from where she fell. She has a cut and goose-egg, swelling over one eye. She has neck pain, when I gently palpate it.

She is not happy.

We put her on the backboard, reluctantly, but recognizing it as the right move.

She does not agree.

"Put me back! You don't know what you're doing! Put me back, you little sh*ts!"

We trade glances with each other, with the staff. One of them shrugs, half-apologetically. She's always like this, they say. We nod, and load her up. My partner smirks, first from the rear door, and then from the rear-view mirror as we drive in, and I am bombarded with confused, frustrated, furious insults.

"You're a bunch of brainless farts! You don't know what you're doing! Brainless farts!"

"Ma'am, you fell, we're taking you to the hospital, you need to see the doct--"

"Shut up!"

"Ma'am, we're taking care of you, th--"

"Shut UP!"

"Ma'am, I--"

"Shut up shutupshutupSHUTUP!"

* * * *

He sits on a bar stool, holding his belly. We carefully help him step to the stretcher. Flickering LED lights from the eight or ten police cruisers outside illuminate the club in sporadic bursts of light. He doesn't seem to be bleeding too much.

Quickly we load him up. My partner grabs a set of vitals while I put him in the trauma system. We're less than fifteen blocks from the Level I; a ten minute walk, let alone a drive. My partner reads off the pressure and heart rate and then bails out for the driver's seat. I wipe the man's belly off with some gauze, and see that there's only a single stab wound. Doesn't even look that bad. His blood pressure and, more importantly, heart rate are fine.

As we pull out from the club, I quickly pull down supplies to put an IV in. This close, I can't do the two I prefer, but I can at least get one.

We've been driving for thirty seconds when I realize I can still hear the strobes clicking. I shout to my partner.

"Code one, code one, shut it down! We're fine going code one."

"Right," he says, and I hear the lights go off.

"Ain't got no damn time anyways," I mutter to myself, taping the IV down ninety seconds later as we turn into the hospital driveway.

Ten minutes after that -- and maybe half an hour after the call came in -- he's on the operating room table. Despite my earlier frustration, I smile to myself. That, I think, is good trauma care, right there.

* * * *

She is younger, and the confusion comes from the case of tallboy beers, not dementia, but just the same she too does not want the backboard, or our help. A giant scalp laceration, easily a foot long, winks at me as we tape her head down.

In the ambulance, she calms down. I explain what's happening, repeatedly, kindly, and gently coax the facts of what happened out of her. As we drive in to the hospital, she goes from argumentative to cheerful, albeit confused.

"'zis'sh an airplane?"

"Uh, no, ma'am, it's an ambulance."

"... sounds like we're in'na air."

"We're on the freeway, ma'am."

She chuckles. "No! You're full of it. Stop messin' wi' me."

I smile, myself. "I would never mess with you." I stand up, so I can meet her backboarded gaze.

"Whoa! How'dsh you do that? 'm I standing on m'head?"

"Uh ... no, ma'am, you're flat, and I'm standing next to you."

She can't seem to figure out how the stretcher and ambulance configuration works, and chortles the whole rest of the way that I'm messing with her, and it must be some kind of a trick. But she's jovial enough. I explain three more times that she needs stitches, and to make sure her neck isn't hurt.

"Whatever," she says, patting my knee. "I'm fine, I know it."

When we get to the hospital, on the way in, she holds up a hand. "Thanks," she says. "You've been really nice to me."

I shake her hand. "You're very welcome, ma'am. I just hope you get well."

She twists under the tape and collar, trying to look at me. "You do good work, sonny." The hospital doors open smoothly, and she looks up at the bright flourescent lights and white walls.

"Oh hell, whatsh this?"

* * * *

He is old, but not that old.

He is naked, lying on the living room floor.

He is dead, most assuredly, even though my partner is still doing CPR, a fireman is still bagging, and another fireman is watching the monitor and pushing drugs.

We've been here for half an hour, through a few rhythm changes, none responding especially well to treatment. Vasopressin kicked the asystole to fib, but shocks kicked the fib to PEA, and there it's stayed, complexes widening and bradying, despite epi, fluid, atropine, and good CPR. His head and neck have begun to purple and mottle.

Finally the firemedic running the code nods to himself, and starts reviewing the drugs we've given. "We're at 35 minutes. Our end-tidal is--" he glances at the Phillips monitor and winces, "--8. Anyone have any other ideas?"

A roomful of silence. "Okay. Four-twenty-two, then."

I stand, walk outside, take a breath of cold night air. Walk down to the idling ambulance. Grab a white hospital blanket and a couple of red plastic biohazard bags. I pass the bio bags to my partner and spread the blanket over the dead man.

Five minutes later we're outside again, my partner with a copy of the paperwork. The firemen agreed to wait for the M.E. and cops -- only fair, as they arrived first.

I reach up, key the mic riding my shoulder. "Medic 38 in service."