When
I was
discharged from the US Navy, I decided to remain in Hawaii rather
than return to my hometown on the mainland. After becoming an EMT, I
was accepted into the ten-month Hawaii State Paramedic Program. This
program was divided into two separate phases. The first four months
were in the classroom. The second six-month phase was called
“Internship,” during which we rode on the Paramedic units
of the City of Honolulu. We were required to take charge of an
emergency under the watchful eye of the certified Paramedic and put
into practice what we had just been taught. Simple enough, right?
Fairly straightforward, right? Well, that is what I first thought. What
follows is the reality of, “the rest of the story.”
Certain
criteria had to be fulfilled during the internship to graduate. I’ve
included a copy of those criteria so you might see what was required.
Please look at it carefully. The reality of it is disturbing.
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 a certain number of times under
supervision before I could graduate. To say that was an oversight of
enormous proportions would also be oversight of enormous proportions.
And
to make things
even more macamba, whether or not I would be able to make everything
better for the patients by doing these tasks was not the point. I
just 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 only required to accumulate the 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 relate the
exact time and event of when and how this happened in “Crushed
by His Jeep.” That story is also contained in this book.
This
story is about
the “laissez-faire” approach I maintained throughout my
six-month internship and a very sad event. Somehow, daily, I could
remove myself from what was happening and just think about gaining
enough criteria to graduate. My patients weren’t people; they
were criteria.
It
was my third day
of Internship. I was riding along on one of the Paramedic units in
Honolulu. The dispatch came in as a “possible hanging.” Because this
call was one of my first during my internship, I had yet
to collect any of the criteria on the list. There were two of us
interns in the ambulance, but this was my call. My hanging. Perhaps, I
thought, I would gain some criteria during this call.
We
arrived CODE
THREE - lights and sirens, on a beautiful Hawaiian day as
it
always is in “paradise.” When the call came in, we were
nearby. That enabled a shorter response time to a small, one-floor,
WWII-era house with a small front yard. It was located in a part of
Honolulu known as the Hawaiian Homestead lands. We felt hopeful this
shorter response time would provide success for this call. It wasn’t
to be.
Only
those people
with twenty-five percent or more Hawaiian blood could live on these
lands and own them. The land is known as the “Ohana” in
the Hawaiian language and is the true wealth of their islands.
Throughout their history, the Hawaiians had their lands stolen from
them by commercial whalers and missionaries. To restore the land to
the Hawaiians, the State of Hawaii reserved portions of each island
only for Hawaiians. The family had probably owned this land and
house for decades, maybe longer, long before WWII.
The
small yard had
coconut palms with full-size coconuts ready to fall. Caressing the
palm branches of the palms was the ever present Trade Winds causing
them to sing their song of paradise. One could hear it on all the
islands.
On
the side of the
house to the right of the front door, there were banana trees with
bananas ready to harvest. Each tree only produces one bunch of
bananas during its lifetime. The bunch consists of many smaller
bunches called “hands,” which you see in the markets. They’re called
hands because the individual bananas within the
“hand” look so much like fingers. The entire tree is cut
down when it is time to harvest.
Also
in the front
yard were two giant Plumeria trees, one on each side of the walkway
leading to the front door. They towered over the house and must have
been planted when it was built. One had yellow flowers, and the
other had pink. Along the front of the house were Ti (pronounced
tee) plants. It is said in Hawaii no house should be without this
plant. Before anyone moves into a new house, it is blessed by the
Kahuna, and this plant is used in the ritual. The plant is sacred,
and by using it, the new owners are “married” to the
house and the land and are obligated to care for it forever.
There
were also
Hibiscus plants in the front yard. As the state flower of Hawaii,
the large blooms only last a single day, fading during the night and
then replaced with new blossoms the next morning. Mixed in with the
Hibiscus were Tuberose plants smelling like double-strength
Gardenias. These and the Plumeria perfumed the air so magnificently,
it was like walking through an olfactory rainbow. And this was just
one yard and one house in paradise.
Similar
beauty is
everywhere in this garden paradise, and today, it was all in sharp
contrast to why we were here in its midst. Who would have thought
there would be pain, suffering, and loss in such a place. Such a
Paradise. This is what I was thinking as I carried our medical
equipment into the house.
There
were a lot of
people standing around in that small front. They were standing under
the coconut palms, about as far away from the front door as possible
and still be in the yard. There were so many, some of them spilled
out of the yard and onto the sidewalk. Some were even standing in
the street, and no one, not one single person, was making a sound. It
was as if there was something poisonous in the house or that it
was on fire, and everyone had run outside to escape it. As we walked
past all these people, in a low voice, I heard someone said, “He’s
in his bedroom, down the hall on the right.”
As
we entered, it
was like entering a time warp. All the furniture appeared to be of
the first and only generation of furniture originally purchased for
the house. I felt like I was in a World War II Pearl Harbor movie.
Just
inside the
front door in the main room, there was an old, faded, one-time
yellow, square armchair built low to the floor. It had to be from
the forties or before and was styled with wide armrests, flat on
their top surfaces and both sides. It had a square, thick, wide
cushioned back, also flat on the top, both sides, and the front and
back. The seat cushion between the armrests was also square, thick,
flat and faded in the center where people had sat for many years. It
drew my attention as we rushed past, but I didn’t have the time
to look it over. It just struck me as being very curious, and at
that time, I wasn’t sure why.
We
crossed the main
room, went down the short hallway, and found the bedroom door on the
right. But, it wasn’t a door to a bedroom. Instead, it was a
closet door and the closet had been turned into a bedroom. Inside
the closet bedroom was just enough space right to left for a twin
mattress to fit on the floor with its head touching one wall, the
foot touching the other, and the back edge touching the back wall.
About
four-and-a-half feet above the mattress was a metal bar extending
wall to wall, right to left. It was so packed with clothes on
hangers, it should not have been possible to shove them aside, along
the pipe, to hang even one more item. But, somehow, it had been
possible because, in the middle of that bar, between those crammed-in
clothes on hangers, was a young Hawaiian boy hanging from it by a
belt around his neck.
He
and his sister
were in high school, and she always came home after he did. For some
reason, in my diary entry accompanying this narrative, I wrote he was
twenty. That could not have been possible because the sister was in
high school, and he was younger than she. He was a young schoolboy
who had just hung himself and was now dead.
As
we entered the
closet bedroom, there was a bare wall to the left. Actually, it
wasn’t exactly bare. It was covered with angry writings with
words of all sizes, mostly black, screaming out things like, “There
is no love.” “I hate them all,” and more. The
words “hate” and “screw them” were everywhere
mixed in with drawings of angry faces, lots of knives and guns, and
lots of profanity.
And
there in front
of us was that young Hawaiian boy hanging by his belt. His knees
were bent and his feet were touching the mattress. He could have
easily supported himself. He could have just stood up. But he
hadn’t, and it was obvious he had already been there too long.
It
must have taken
him some time to tie the knot at his neck. He had taken off his belt
and looped it around the hanger pole using the buckle end. Then,
probably because the remaining length of the belt was very short, he
had to stand on the mattress to get as close as possible to the pole.
Only by doing this would he have enough belt length to wrap it
around his neck and tie the knot. The distance between the buckle on
the pole and the knot on his neck was about four inches, so short his
head was touching the pole.
Can
you picture him
struggling with the short belt, his head pressed against the metal
pole next to the buckle, as he was tieing it below his chin where he
could not see what he was doing? I can not. After almost twenty
years what I can do, unfortunately, is still picture all of this. And
every time I do, it makes me shudder thinking about the planned
finality of his actions.
The
two wraps around
his neck were enough to hold it in place. Then he let his knees
buckle so the belt could begin to tighten. No one will ever know if
he had lowered himself slowly while considering whether or not he
should go through with it. Maybe he had accidentally gone too far,
or too long, to recover. Maybe he had done it all at once to get it
over. From what I saw on the wall in the closet bedroom and later,
on that square yellow chair later as we were leaving, I felt sure he
had wanted to do it and had done it in one action.
Before
he passed
out, he had to have felt the belt begin to tighten around his neck. As
it continued more and more to inhibit the blood flow to his brain,
he would have finally passed out, and the weight of his body and
gravity did the rest. Thirty minutes later, his sister found him
when she came home from school. She called 911, but she left him
hanging. No one had told her to get him down.
After
my internship,
in all my years as a Paramedic, people were left hanging when there
was a suicide by hanging. Every one of them. No one person, not
even family members, had cut them down. After calling 911, they just
left them hanging in place. If it hadn’t been too late to save
the person when they were first found, it surely was when the
emergency services arrived. If only they would have immediately done
something to get them down. Perhaps then I would have had fewer dead
people in my life, never to be able to forget.
This
case was over. His head and neck were pulled to his left at a severe
and unnatural
angle, and the skin on the opposite side of his neck was stretched so
tight, it looked like leather and had developed white stretch marks.
The saliva which had flowed from the corner of his mouth down over
his chin was now dry. There was also a wet area in his crotch. When
the bladder muscles relax in death, allowing the bladder to empty, it
is already too late.
I
heard the lead
Paramedic say, “don’t touch the knot,” as he
grabbed the boy around the upper legs and lifted him enough for the
downward pull of gravity to be relieved. As he did this, the left
side of his face was against that wet spot in the boy’s crotch. I was
interning with a good Paramedic.
As
he continued to
support him, I held the defibrillator paddles of the cardiac machine
against the boy’s chest. If there was a heartbeat they would
be able to detect it, even while he was still wearing his shirt. There
wasn’t. All was silent inside the chest of this boy. I
recorded a flat-line paper strip to document the absence of cardiac
activity and my lead Paramedic relaxed his hold.
That
was all there
was to it. We gathered our equipment and we too left him hanging in
his closet bedroom just like his sister. Because he was dead, the
scene had to be left as close to the original condition as possible.
The police and coroner had to do their investigations. That is why
the lead Paramedic had told us not to touch the knot. If we ever
were to cut down a hanging patient, the cut had to be somewhere
between the attachment point on one end and the knot on the other.
Neither end was to be changed or altered.
In
silence we walked
again through the short hallway back to the main room to return to
the ambulance. As we passed that old faded yellow chair, this time I
paused and looked at it closely. I had to know why it had drawn my
attention as we entered the house.
On
the flat surface
of the right armrest lay his wristwatch. He had taken it off and
laid it carefully in an arranged position so the metal wrist bank was
shaped into a perfect oval. Next to it there was an empty glass and
an ashtray, an open pack of cigarettes and his lighter. He had
arranged all the items in such a way they looked as if they had been
placed as offerings upon an altar. I guess he had parted with all
his earthly goods before he did what he had decided to do.
When
he had arrived
home, he had fixed something to drink and retrieved an ashtray. Then,
he sat down in the chair and lit a cigarette. After doing
that, he must have laid down his pack and lighter on the armrest and
drank whatever it was he was drinking. When he had finished, he then
must have snuffed the cigarette in the ashtray. The filtered end of
it and the ashes were still there. Probably the last thing he did
was to take off his watch.
Then
he must have
risen from the chair and walked down the short hall to his closet
bedroom on the right and acted on the final decision he was ever to
make. That chair told a sad story. I think it had wanted to tell me
that story when I first passed it. Maybe that was why it originally
drew my attention.
That
was my first
911 ambulance call. Remember those intern criteria I listed at the
beginning of this story? Well, I hadn’t completed even one of
them. Not one. None of those items were knocked off that list. One
hundred and forty-four more people still had to die or nearly die
before I could be certified as a Paramedic. This angry, lonely and
sad Hawaiian highschool boy and his death didn’t count. From
what I had seen in his closet bedroom, it was probably the same for
him most of his life. He just didn’t count.
This
call had been
on my third shift as an intern. As a Paramedic, so many more exactly
like this one were yet to come. I had no conception of what it was
going to be like in the profession I had chosen. None. What a naive
life I had been living.
