Medic 465

Most people, if they truly knew about the intricacies of the profession, would not give it a second thought. Beyond television made glory  we are left with many professions that are run by people who are naïve, adrenaline junkies or, as many would consider, just plain crazy. The pay is barely enough to cover even the most basic expenses, the people we interact with are often times rude, pushy or just plain jerks (although Jerk is not the word we most often use to describe such people). The hours are long, the work is dirty, the opportunity to contract numerous infectious diseases is constantly present and quite often eleven out of twelve hours of your day are spent doing work that is the product of a gross social misconception but in many cases just down right abuse.  I wish that I was talking about the life of a garbage man but I already mentioned that the pay was negligible which eliminates that possibility. For the next few moments I invite you to ride along with Medic 465, on the streets of every major American city.

         I must have considered these facts a thousand times since I started this job four years ago. Today I am sitting in my truck contemplating the mysteries of EMS while watching the sun set over the high peaks of the Anonymous Mountains, still waiting for my partner to arrive.

         Some EMT’s  and Paramedics think that they develop a knack for sensing when its going to be a busy or slow shift. Most of the time they are only interpreting the tall tell signs that any one who has been working here more than a week can interpret. Its been raining all day and the moon is going to be full tonight, I figure that we are pretty much screwed already.

         My partner arrives at his usual time, late. I just had my finger on the speed dial number for dispatch when he comes strolling out the front doors of the station. Its no wonder why he is late; I would probably be late if I was weighted down with a 40 pound bag full of college books, with Starbucks and a cheese Danish in either hand. I want to tell him that he needs start making punctuality a virtue but I decide to try and let the problem work it self out with management. I am probably being naïve but I cant tolerate a confrontation this early in our shift.
         
         “Sorry that I’m late, traffic was terrible with this rain today,” Ryan tries to be apologetic and sincere but he’s not fooling any one.
         “So they are serving Starbucks on the interstate now?” I don’t try to be sarcastic but Ryan doesn’t seem to notice so I let the issue go with out another word about it all shift.
         “Does dispatch have anything holding for us?” Ryan asks while still situating his hefty book bag behind his seat.
         “I don’t know. To tell you the truth I was sort of afraid to ask but I have not gotten a page yet so there still may be hope for us.”

         Now is the moment that I have personally come to dread the most, going 10-8 (available for service) for the day. Its not uncommon to have as many as 12 calls or more backed up at the beginning of your shift. Most of these calls will be inter-facility calls, a transfer of a patient from one hospital or medical facility to another.  All of the 911 calls will get dispatched out first and what non-emergent calls are left over will stack up on a list based on their severity and then in the order in which the call was taken. Just a few calls can be cleared in a couple of hours between all the ambulances in the system. Now add the weather, the full moon, the time and day of the week, alignment of the stars and divide that number by the number of Paramedics out on the streets and you will come up a number close to what you can expect out of your work load tonight.

         “Dispatch, four sixty five, ten eight for the day with radio four three five, in truck one twenty two,” I hold my breath and wait.
         “Four Sixty Five nothing holding post twelve.”
         I cant wrap my mind around it but who cares, the more I think about the greater the odds will shift.

Anonymous City has been my home for the past nine years. I moved here when I was starting my first year of junior high school. I thought that I knew the community that I lived in after being here for that long. I have come to find out that a person never really knows their own town until they get into the very cracks and crevices that most of us would care to avoid. I suppose that we could make a list of the people who understand best but those who I will interact with the most will be the Fire Department, Police, Nurses and Doctors.
         I have come to learn some rather fascinating, strange and even dark secrets about Anonymous City. The next corner we turn is where I picked up the Alcoholic who blew his entire VA check on booze. A block down from that is an area notorious for drug and gang activity that even the Police are wary to enter. If we turn left then well head down Samantha St. where you can still see the burn marks from a 2004 Chevy along the sides of the wall and by this time we have already passed Herbert St. where I some times still catch a glimpse of old Mr. Kramer’s ghost. Street by street, house by house, the city continues to reveal it self to me.

         “Four Sixty Five I need you take a code three at Washington and Myrtle Beach for a roll over MVA,” The crackling squawk box calls out my partner and I.
         “Four Sixty Five.”
         “You know there’s no better way to start a shift than with a good trauma!” Ryan shouts.
         “There’s no better way to start a shift than an hour sleeping at post twelve.”
         
          No need to try and map out this call because it’s a busy intersection just a few miles from here. Its perhaps the most dangerous part of working in EMS, traveling to the scene with your lights flashing and sirens blaring. Just last week a partner and good friend was involved in a head on collision while en-route to a call going “Code 3.” Although his seatbelt saved his life, it is questionable if he will ever be able to return to work here again after sustaining a back injury. I am fortunate that, despite his short comings, Ryan is an excellent driver so I feel a lot more confident during every run, especially when I am in the back treating a patient.

         As some what of a “community service broadcast” I will try and explain a concept to you that may seem simple and straightforward but non the less eludes about half of the American driving population. The standard driving protocol for avoiding an emergency vehicle is to: Pull over as far right as possible and slowly come to a complete stop until the emergency vehicle has completely passed you. You should then check your rear view mirror for other emergency vehicles because in many communities they often travel in pairs, e.g. Fire Truck with an Ambulance a few hundred meters behind. The most common response  that I have seen from people is to: Slam on the breaks, look in the rear view mirror, put down the cell phone, slow down to a complete halt, wait for five seconds. By the time we have blown the air horn about 20 times we decide to move around the driver to the right ( a practice that we try very hard to avoid) and by the time that we have just about cleared the car in front of us the driver suddenly gets it into his head to finally get out of our way by, quickly and with out any warning, swerving to the right. This results in us narrowly missing both the car that has now swerved towards us and  car to our immediate right that we almost side swiped in order to get out of the way.

         You never know what to expect when rolling up to a call. In my mind I always picture the worst and am then relieved to find the situation much less dramatic. I always assume the worst to prepare my self mentally, to begin to anticipate what I will need to do and how I will conduct the call before I even set foot out side of my Ambulance.
         
         As we rolled up on the blue suburban I knew that worst assumptions had probably been correct. The front part of the suburban had been completely destroyed with half of the engine hanging out of the vehicles frame. The passenger compartment of the suburban had sustained considerable damage and broken glass was strewn across the road in all directions. Something, however, gives me the sickening feeling that this is not the vehicle that has rolled over.
         
         We were directed by the police around the suburban and I could see Firefighters extricating the driver from the cab. At first glance he did not look to be in very serious condition. He was awake and talking to the technicians who were still freeing him from his vehicle.
         The police officer stopped us a few hundred feet away from the suburban and at first I wondered why. As I searched around the area it became obvious to me. Hidden from direct view was the car that had rolled over six times and came to rest under a palm tree. The silver sedan (it was too mangled now to be identified) had been cut into two pieces when it side impacted the palm tree at over 60mph. The drivers door had already been pulled off revealing be helpless body inside of the car.

         “She looks bad,” Ryan muttered as we pulled our gurney stretcher out of the back. I pulled out our trauma bag from the bench seat and headed towards the scene.

         The Firefighter who is in charge of the scene gives me a brief report on the status of the two occupants of the sedan. The young lady in drivers seat was restrained by her seat belt when they were broad sided by the green suburban. She is semi conscious and keeps going in and out, talking to the Fire department and then passing out again. She is breathing although it is labored, and her pulse is strong and rapid.
         I walk up to the mangled wreck of metal and glass. Pools of water flicker, reflect the flashing lights of the Ambulance. Blood is everywhere inside of the car and all around the ground where Fire is still working to free her. The scene is loud, wet, cold and bloody but it is not chaotic. Everything seems to be orchestrated perfectly. The team comes together and works to accomplish the same goal with complete selflessness. Now I remember why I got into this profession.

         It will be a few more minutes  until the young girl has been freed from the wreckage, so I walk around to the other side of the car to get a better look at what is left of it. A little ways away from the car, in the slippery grass I find a heap of flesh and bone that has been covered with a white blood soaked sheet.  The police did not even bother to tell me about her because she was dead from the moment that she was ejected from the car.

         I see Fire reaching for the back board so I know that they must be close to getting the young girl out. I walk over to the other side and my partner and I get ready with our gurney to accept the patient from Fire. They strap her onto the long orange plastic board and lift her onto our stretcher. We buckle her in and I quickly check to see if she is still breathing and if I can get a response from her. She is breathing but I get no response. Her face has been distorted and cut to pieces by the shattered glass from the windshield. Underneath the mess I can picture a beautiful young girl with bright green eyes and long black hair. We rush her to the back of our truck and get moving to the nearest trauma center that is about 10 minutes away.
         
         “Can you hear me?” I shout to her. I did not expect a response from her but to my surprise she opened her eyes for me and looked straight up at me.
         “What happened, where’s Ashley?” Her voice is shaky, confused and filled with fear.
         “You were in an accident just a moment ago,” I tell her “, Your in the back of an ambulance and we are going to take good care of you.’

         I ask her the typical questions while I can still get a good answer. She tells me that she is not in much pain except for her left leg that I can see is obviously broken. I do everything that I can for her, watching the whole time for any sudden change in her condition. She tells me that her name is Kate Lyn and that she is a senior in high school. She asks me a few questions about the accident, how it all happened and if I can call her parents. I try to give as many details as I can and reassure her that her parents have been notified by the police already.

         “Where is my friend Ashley?” She calls out.
This is where the call begins to get rough. Medicine, especially pre-hospital trauma, is really not that difficult in theory and in practice. I was once told that “A one legged monkey could work a trauma.” Most often it’s the emotional baggage that you can carry around with you that makes a serious trauma a difficult aspect of working in EMS.

         What am I supposed to tell some one in this situation? I have the obligation to tell her the truth but at the same time I have the obligation to do what is in the best interests of her health. If I tell her that her best friend was ejected from the car and didn’t survive will that adversely effect her condition?

         “What happened to Ashley?” She cries out to me “, Please sir, tell me what happened to her!”
I cant lie to her. I try and think about what it must be like to be in her situation. I would want to know what happened to my family and I wont deprive her of that. What difference does it make when she finds out? It will be no less devastating to her in the back of my truck than it will be in the morning.

         They tell you in the text books in school not to be euphemistic or speak in  half truths.
         “Kate Lyn, Ashley died  in the accident,” I try as hard as I can but I still sense that my voice is cold and stale.
         Tears start to swell up in her eyes and pool around the dried blood on her face. I take a piece of gauze and try to clean around her eyes the best I can. For the rest of the trip Kate Lyn does not say another word.

         At the trauma center we are met by a team of the most experienced and knowledgeable professionals in medicine. There is a specific and important job for each of the team members who crowd trauma room 2. It’s a cold, bright and sterile place. A large bright light on a flexible mount hangs over the bed, at least a half dozen life support machines surround the patient on either side and there are dozens of plastic covered wires, tubes and trays. To any person being wheeled in to the trauma room it must look terrifying.

         I give my report to the nurse and doctor in charge while I move Kate Lyn over to a larger gurney and promptly step away to let the trauma team assume care. For the next twenty minutes or so she will go through one of the most fast paced and frightening  experiences that any one can go through. Up eight people moving all around you, performing test, sticking you with needles, poking and prodding, x-raying, and asking you a long list of questions.

         I finish up my report and hand a pink carbon printed copy to the charge nurse. We have just a few more minutes before our dispatcher sends us a page to get back into service. I prop my self against the charge nurse station and stair at my clip board while I try and make some sense in my mind of what really just happened. Its hard to imagine that in just a few brief seconds dozens of lives, perhaps even more, were torn to pieces.  I sometimes dare to ask why but  I often remind my self that it does not really matter.

         I look over at the sound of the automatic double doors to the entrance of the trauma room opening. A crying, desperate looking couple stagger through the doors and walk down the hall towards trauma room 2. This is the last thing that I need. I gather together my paperwork and clipboard and leave.

         The night breeze brings a rush of cool air. As I stand out side of the ER waiting for my partner I sit on the metal back ramp of the ambulance. The wind has blown away the rain clouds revealing the few stars that are bright enough to compete with the lights of Anonymous City.

         A million lights are spread out in front of me. The night life in Anonymous City is just starting to get into full swing. Right now there is no time to think about the last call. The clock only reads 8:30 and there are still ten and a half more hours to go. If I want to even stand a chance at making it through the rest of the shift I will have to stop in the cafeteria to get some coffee.