Six Months as a Paramedic
A Story about Death and an Epiphany
Henry Lansing Woodward
©
Copyright 2022 by Henry Lansing Woodward
|
Part of
the author's diary about the case. |
I
had been in Hawaii
for about one-and-a-half years, and I was six months into my new life
as a Paramedic and could do no wrong. After graduating fifth out of
a class of twelve, I was ready, if not eager, to save lives. The
program consisted of three months in the classroom and a six-month
internship during which we rode along with fully certified
paramedics. This experience introduced us to the unbelievable
emergencies that occur on any given day. The internship was the time
to practice what we had just learned in the classroom. To do this,
we were required to handle the emergencies while the certified
Paramedic observed.
For
graduation,
certain criteria had to be fulfilled during the internship phase. I’ve
included a copy of those criteria. Please, look at it
carefully. Making up this list is what a Paramedic, any Paramedic,
encounters most frequently during the normal course of doing the job.
They wouldn’t be on it if they were not. But, as clear as it
is, somehow I failed to register its macamba nature. At the time, I
naively thought these were only some things I needed to experience
several times under supervision before I could graduate. To say that
was an oversight of enormous proportions would also be oversight of
enormous proportions.
Whether
or not I
would be able to make everything better for patients by doing these
tasks was not the point. I had to jump in and become involved as the
decision maker. It wasn’t required that my efforts were
successful or that the patient survived. I was required to
accumulate quotas for each category. Here is the list.
Somehow,
it didn’t
occur to me that these categories were about people. Living,
breathing, suffering, and dying people not just categories on a sheet
of paper. People. It took Six Months as a Paramedic after my
internship for the realities of this list to hit home.
I
was single,
thirty, and making good money in Paradise. So much money I could buy
a new convertible VW “bug” during their first year of
production. Mine was sky blue, “Blue Hawaii blue,” with
a white interior and a white convertible top. It was an eye-candy
car and perfect for cruising in Paradise. I spent many beautiful
hours driving around the island of Oahu with the top down, and it was
indeed excellent, simply perfect.
I
worked for a
private ambulance company under contract with the Hawaii Department
of Health to respond to 911 emergencies. I did not work as a
Firefighter Paramedic because I didn’t want the military-type
environment that went with it. The trade-off was I had no benefits
at all. I worked my entire career without health insurance, overtime,
vacation, sick days, retirement, or a 401K.
Because
of the
availability of many overtime shifts, my income was quite good. But,
in those days of a low minimum wage, I was underpaid for what I did. I
saved lives for about $7.00 an hour.
Along
with working
on the ground ambulance, I was also the Air Ambulance Paramedic for
Hawaii. Here is the company schedule for EMTs and Paramedics. Lots
of time off. Perfect for Hawaii.
- 24hrs. On
- 24hrs. Off
- 24 hrs. On
- 24 hrs. Off
- 24 hrs. On
- Four days off
- Repeat
That
was it. I had lots of time to wander around Paradise, and I had the
car and the money to do it. I could enjoy all seven islands at my
leisure, and I did. Most of my income and time off went into trying
to blot out what I had recently experienced as a combat medical
corpsman in Vietnam. It worked in the beginning, but not for long.
All
this was the beginning of my new life. During my first six months, I
had responded to the typical assortment of medical emergencies,
traumas, suicides, and auto accidents and was dealing with them
reasonably well. Then in one single experience, all that changed. I
was on duty with my EMT partner when we were dispatched CODE
THREE, lights and sirens, to a single-car accident on the
then-new Nimitz Highway. The location was in front of the main gate
leading into Pearl Harbor.
As
we arrived, dozens, if not hundreds of people were standing around
“waiting for the Paramedics.” Again, it was the main
gate into Pearl Harbor, the largest naval base for America, and there
were so many it was somewhat intimidating. As soon as we started to
work, many, if not all, of them would be watching what my partner and
I were doing. In reality, though, they would be watching my hands.
We
slowed and pulled through the crowd via a corridor the police had
created. In front of us, I could see a young male with a
military-type haircut similar to the ones marines are known to wear. He
was sitting on the ground with his back against a concrete traffic
divider, the kind used for defining a new traffic flow pattern in
active construction zones. The new double-decker H-1 freeway was
under construction, and our emergency was under the unfinished upper
deck.
Many
of those dividers were directing the heavy traffic through this
construction zone. As the work progressed, they would, as a matter
of necessity, have their locations changed to re-route the traffic
around any new area of construction. Because of the almost daily
changes in the traffic flow patterns, it could be a dangerous highway
to drive, especially when still sleepy or hungover.
I
couldn’t figure out how it happened, but there he was. He had
been driving a jeep that looked new, just the type a young guy would
buy. The color was shamrock green, and it didn’t have a top,
sidewalls, or any windows except for the windshield, which was lying
down forward over the hood. There was also an open-air roll bar
behind the driver’s seat. Like my car, it was a toy meant for
Hawaii and didn’t have a mark on it.
I
didn’t think
he would have been driving with the windshield down, so something
must have made it move into that position. Maybe he had to do a
quick stop and knocked it down and forward as he flew out of the
jeep. Then, as the jeep continued forward under its own power, it
hit him full force and pushed him against the concrete divider,
crushing him between it and his jeep.
That’s
where
we found him, sitting upright and facing forward. Some bystanders
had pulled the jeep backward away from him, and he hadn’t moved
since. Amazingly, there was no blood anywhere. No blood at all, and
that was a bizarre thing. Something was very wrong with this
picture. Right here in front of me was one of those emergency calls
I did not experience during my internship.
He
was unconscious
(dead would be more accurate), extremely pale, and his head was
tilted downward at the neck with his chin touching his chest. It was
turned in a way a human head could not normally turn, and the neck
was at a shockingly unnatural angle. These alone were ominous signs.
Also, as it extended straight out in front of his body, his right
leg was the only one to be seen. His left leg wasn’t there. There was
no left leg. Then I looked closer.
There
was something on his left shoulder, and it looked like the sole of a
shoe. The toe of this shoe was pointing downward, and it had
turned, so the laces were touching his chest with the sole up. At
first sight, I couldn’t determine why it was there. “This
is bizarre,” I thought. There was no way for a foot to be on a
person's shoulder. Well, there it was, and I was looking right at
it. Then I saw how it had happened.
The
sailor’s
left leg was bent backward under his hip and flung upward behind his
back, depositing the left foot up-side-down on the left shoulder. Of
course, there was no way for this to happen. It was impossible. The
leg bones are the largest and strongest bones in the human body and
could not be arranged into this position. But there it was. My
partner and I immediately moved him from his sitting position. He
had to be on his back so we could treat him. To be able to move him,
his foot needed to be removed from his shoulder, and at the same
time, we had to untangle his left leg from under and behind him.
While
doing this, we
discovered a tear in the skin of the left leg that extended from the
groin to the ankle. The tear was wide open and so large I could see
all the bones in both the upper and lower leg were missing. Here was
the largest laceration I had ever seen, and it wasn’t bleeding. This
was extremely strange. Also, as I was moving the leg, it
looked, moved, and felt like a big, long piece of spaghetti with a
shoe attached at one end. Again, extremely strange and disturbing.
When
we finally had him on his back, we discovered where all the blood
was. I was at his head, preparing to put a tube into his mouth,
down his air pipe, and into his lungs. I was going to breathe for
him using that tube. Before I could insert it, a flash flood of
bright red, bubbly blood gushed out his mouth and covered my knees as
I knelt at his head.
Because
it was
bright red and bubbly, I knew it had to be freshly oxygenated
arterial blood coming from his squashed chest and lungs. All his
blood had escaped from his circulatory system and lungs and collected
inside his chest cavity. When we laid him on his back, out it came.
Finally, here was his blood. Probably all or most of what used to be
in his entire body. There was an incredible amount of blood, and I
was kneeling in it.
This
was a sign that
this young man was dead. It meant that, probably, his heart, lungs,
and aortic artery had all been lacerated or torn open. This, in
turn, meant no blood was circulating in his body, even with my
partner doing CPR. Because his circulatory system no longer existed,
there was no way to get oxygen, or our medicines, to his brain and
heart. I should have stopped right then. But I didn’t.
By
this time, the crowd had grown bigger. A lot bigger. They were
primarily military personnel coming and going to and from Pearl
Harbor. All of them were watching everything my partner and I were
doing. But it was more than that. What they were watching were my
hands. When I looked for an instant, I noticed their eyes were
focused on my hands. I had not anticipated this as part of the job
of a Paramedic. After this emergency, I noticed it was the same for
every emergency I worked, either in the street or a private home. They
always watched my hands.
There
was another
thing I realized while I was tending to this young man. I had been
doing it from day one without being aware of it, but for some reason,
it burst into my consciousness for the first time during this
emergency. I felt a lot of eyes watching everything I was doing. While
working an emergency, Paramedics had to diagnose the problem
correctly the first time, then treat it correctly the first time, and
do this perfectly within the first thirty seconds of EVERY EMERGENCY.
The first thirty seconds after arriving at an emergency defined the
job of a Paramedic, and over time, it became a heavy burden to carry.
But to continue.
Because
I hadn’t
stopped when I’d realized this young man was dead, I tried
suctioning the blood from his mouth with our suction machine. It
proved to be a futile effort. There was so much blood I could not
see into his mouth well enough to locate the air tube, and there was
no hope of reviving him without locating the air pipe so I could
insert the air tube. Finally, I had to admit to myself he was gone. He
probably had died immediately, long before we arrived.
So,
in front of that
large crowd, I stopped the suctioning and stopped trying to insert a
tube into his lungs and said out loud to no one in particular,
“forget it.” Then I told my partner to stop the CPR and
discontinue the IVs.
As
a six-month-old
Paramedic, I made two mistakes that day in Paradise. First, I
started resuscitation on a dead person. In my desire to help, I
failed to evaluate the emergency properly. I was too eager to save
this young man. I should have never started. I should have
immediately admitted to myself this young sailor was gone.
I
should have also
admitted to myself there was no indication to treat him. Young as he
was, maybe twenty-two, this man was dead when we arrived, and I
should have stopped right there. He had probably been so badly
injured, there wasn’t even any hope of saving his organs for
donations.
The
second mistake
was stopping the resuscitation in the field. Once started, it had to
continue until an MD stopped it in the emergency room. After I had
stopped, I contacted dispatch and asked them to connect me to a
doctor in the emergency room. I reported the condition of the
patient in graphic terms and the events leading up to the point I had
stopped.
The
doctor responded
by telling me I was not to stop. He directed me to continue with
everything and transport the patient to him in the ER. He said he
was the only one to determine whether or not to discontinue
resuscitation efforts.
At
that point during
the communication, the radio went silent. The next thing I knew, I
was connected to a different doctor in another ER. Dispatch said the
reception on the first communication was breaking up so much, they
were having trouble hearing the first doctor.
As
a result, they
ended that communication effort and re-connected to a new ER doctor
in a new ER. It just so happened the second ER doctor was known to
be much more flexible with Paramedics and routinely accepted whatever
actions they thought necessary.
Because
of their
rapid and insightful actions, the dispatch guys rescued me from a
terrible situation. They handled the whole thing with finesse, if
not entirely on the up and up. They had saved me, and I was very
grateful to them all. This second doctor agreed the patient was dead
and authorized me to stop the resuscitation.
I
waited two days
for someone to contact me about the call. I was bothered by how it
went. I thought I would have to answer for my actions, and I was
waiting for that to happen. On the third day, when it had not, I
could wait no longer. I had to know if I had not killed my patient,
so I contacted the county coroner for a follow-up case review.
He
was dogmatic in
his report. “What did you have to work with?” he
immediately said. “He had a broken neck and a large skull
fracture. His chest was crushed, and both his lungs had popped.”
He
continued, “the
Aortic artery in his abdomen was torn open along with the heart, and
all his blood was in his chest and abdomen. His pelvis was totally
crushed, and the left leg bones were missing. They found them about
thirty feet away and brought them in. This guy was dead
immediately.” With those words, I was freed from the big load
I had been carrying.
On
this emergency,
with that crushed young man in my hands, right in front of the main
entrance to the Pearl Harbor Naval Base of the Pacific, I graduated
as a Paramedic. Finally, I had enough of those internship emergency
criteria. It took an extra six months and the death of this young
man for me to say to myself, “I am finally a Paramedic.” I had been so
naive for so long.
I
knew this because
while working on that young man, I had felt a fundamental change
within me. Then, when I stopped working on him, I felt it again. It
was the reality of uselessness. The awareness of it was the thing
that finally caused me to accept the fact there was nothing I could
do. This guy was dead, and even with my training, the advanced
medical equipment, and our “magic herbs,” I could do
nothing “to put him back together again.”
I
had experienced
many terrible emergencies in my first six months, but this was my
first as a lead Paramedic with an EMT partner. I was the Paramedic,
and I was responsible. That realization made me shudder to think
about what was to come.
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