Friday, July 02, 2010


It's a huge apartment complex. We find the building we want, and park nearby. We shoulder the airway kit and Lifepak and medbox. We walk up the path around to to the front of the building, and then up two flights of stairs.

A young woman, visibly upset, opens the apartment door when we are halfway up the last flight of stairs. Here, she says, in here, leading us to the living room.

He sits on the perfectly normal couch in the perfectly normal apartment, and there is no blood or gore, no gunshot wounds or impaled objects. And yet his eyes are full of fear. His right hand is white-knuckled around his own throat, and he doesn't say a word.

He is barely two months younger than me, and if he lets go of his throat, he cannot breathe.

* * * *

His girlfriend, or wife, tells us the story as she knows it. How he crawled into their room and woke her up. How between a few words he gasped out and his pantomimed gestures she gathered that he tripped over the cat, and struck his throat on the edge of the table. How she called 911 while he sat, trying to stay calm, stenting his own airway open.

He's able to answer questions by nodding. He's healthy. He didn't pass out. Nothing else hurts. We try to look at his throat, but as soon as he lets go his sats drop and he moves no air. We quickly abandon our exam and let him resume his careful hold on his trachea.

Can you walk? we ask. Nod, nod. Good. Let's get some shoes. And we pop a nonrebreather on and walk him down to the ambulance, simple as that, supporting him and taking a break when we need to.

At the car, my partner throws a quick line in while I call the trauma center on the radio. The fire engine has showed up, and I load a couple of friends for the quick trip up to the Level I center. The fire guys sit on the bench seat, doing vitals and reassuring him.

I sit in the airway seat, behind him, out of sight, the cric kit out and open, prepping an ET tube, RSI drugs handy, hoping fervently I won't have to use any of it.

I don't.

* * * *

At the trauma center, at least twenty people have gathered. Trauma surgeons, emergency docs, anesthesia, respiratory ... they crowd the room. Trach trays are opened, sterile gloves donned. Game faces on.

He finally gets really, really worried when he sees everyone gathered for him, and I can see tears well up in his eyes. I'm standing at the foot of the bed -- I have no intention of leaving before I see how this ends. The social worker makes sure she has his girlfriend's information, and steps out of the room to call her.

They prep to attempt a tube with a Glidescope, ready to go into his neck if that doesn't work; anesthesiologists at his head, surgeons at his side. An anesthesiologist has taken over holding his throat. The room is full of quiet, professional chatter; let's go with a six-oh tube and etomidate and sux is fine and are you all ready? A nurse steps up with the syringes full of medicine.

I meet his gaze, and realize that in all the bustle and confusion, there's very little attention being paid to him as a person. And it strikes me how much more frightening that would be.

And so I reach out my hand, and he grabs it, tightly, and I hold his hand until the drugs take hold.