One Day In The Life of a Paramedic
Henry Lansing Woodward
Copyright 2022 by Henry Lansing Woodward
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a Paramedic, I chose to work for private ambulance companies. My
company was subcontracted to provide 911 emergency responses to the
general population, so we performed the same duties as the
Firefighter Paramedics. We, however, had a whole different pay
scale. There were no overtime, medical, or 401K retirement benefits,
and we were paid about eight dollars an hour. We were very underpaid
for the responsibilities of our job.
did this because I had already spent my time in a military
organization. I had been a Navy combat medical corpsman in Vietnam,
“boots on the ground,” as they say, and that was enough. I did not want
the morning musters standing in line in uniform and
saluting the officer in charge.
mentality was not for me. The whole genre brought back too many bad
memories. Because there were only these two options for working as a
Paramedic, I chose the private ambulance sector despite the poor pay.
working for a private company or a governmental agency, all
Paramedics and EMTs do the same job. We try to deliver the best
medical care possible in any particular emergency each time we choose
to step into an ambulance and answer the call.
peers and I would
regularly encounter a life-or-death situation, and we were required
to do the right things correctly within the first thirty seconds the
first time we tried. Meanwhile, a whole lot of family or other
people were watching. That was all. No pressure there, right? And
this happened time after time after time.
did this for
years, working twenty-four-hour shifts for about eight dollars an
hour. After completing my duties, I would turn the patient over to
the ER staff or cover him at the scene with a white sheet from the
ambulance, whichever was appropriate for the particular situation.
Then, I left as if it had just been another thing to do and tried to
prepare for the next. As I look back today, I realize I would not do
it again for that pay. Actually, I realize I would not do it again
at all, whatever the pay.
twenty-four-hour shifts would pass with four to ten dispatches. They
usually consisted of a tragedy or two and a few assorted horrors. It
was all quite routine. Then there were those shifts that were far
more than that, so much more. This is the story about one of those
shifts. Just one shift, just one day in my life. I leave it to you
to decide whether or not I’m just a complainer about the pay. This is
how it went.
never had a chance.
every shift change the EMT of the on-coming crew washes the
ambulance, and the Paramedic inventories its contents and checks
every piece of equipment. This routine happens for every shift
change, every time. My partner had just brought the long-handled
washing brush, a bucket of soapy water, and the hose when our
dispatch alarm sounded. I hadn’t even touched the ambulance.
call came in as
a “Man Down.” That was all the information we received. We had no idea
what we were to find. We arrived after responding
CODE THREE, lights, and
sirens at a
popular Reno downtown cafe. It was packed with the regular morning
dinners, many tourists, and it was really busy. There was even a
line waiting for those cheap Reno breakfasts and complimentary
man was standing
in front of that line, frantically waving his arms above his head. We
parked the ambulance at the curb near the police cars and the fire
engine, and after getting out approached the man, and he said,
“Follow me. The others are inside.” While the
firefighter first responders brought our gurney, Oxygen, and the
heart monitor from the ambulance, we followed the man with our
First-Out box of medical supplies in hand. He was leading us to the
restroom. As we entered, the smell of fresh, raw vomit and feces was
so strong I had to hold my breath to keep from adding my vomit to
that already there. The smell was debilitating.
assault of that smell, and as soon as I could refocus my eyes, I saw
a huge man, a really huge man wedged into one of the two stalls with
the door still open inward into the stall. At the very least, he had
to weigh five hundred pounds. Five hundred pounds of human flesh
covered with vomit. I was amazed he had been able to get into the
stall, let alone sit on the toilet. The door was open because once
he had managed to sit on the toilet, there was no room for him to
swing the door closed.
was sitting on
the toilet, slumped forward toward the open stall door with his head
tilted down at his thick neck with his chin on his chest. Then there
was the vomit, a whole lot of vomit. As we stood before him, it was
still coming out, going down his chin, over his chest and huge
abdomen, down the front of his huge legs (he didn’t have a
lap), where it covered his feet and where it had gathered into a pool
from the open
stall door, the wall was covered with a coating of vomit. The man
must have initially experienced “Explosive or Projectile
Vomiting,” with at least the first or second event. Of course,
the floor between that wall and the stall also had a thick covering.
All of it, all that ugly odiferous raw vomit, was a mixture of
freshly eaten, undigested breakfast food and the “Breakfast
Marys” included with the cheap Reno breakfasts. His face was
as blue as I had ever seen a face in death, and he was not breathing.
The vomit continued to ooze from his mouth.
the Firefighter first responders had been trying to dislodge this
huge man from the stall. Because of the vomit on the floor there
wasn’t any footing, and they had not been successful. Also,
there wasn’t any space in the stall to get a good hold. Finally, the
stall wall was sawed away with one of those saws with
the big, round blade the firefighters carry on their engines, and the
door came away with it. In the meantime, my partner had brought
several white sheets from our ambulance and placed them on the floor
to provide the needed footing. They were very helpful.
the side wall
and door of the stall gone, the man was pulled out and onto the
vomit-covered restroom floor. His head was in front of the toilet
where the stall door used to be, and he vomited again.
was like a
fountain. The vomit stream went about a foot or two straight up into
the air above his face and sprayed those of us who were closest to
him with fluid and chunks of his breakfast. It was an ugly thing,
and the smell was suffocating.
that vomit fell
back down onto his face and splashed vomit on all of us again and
went back into his mouth. We tried to roll him onto his side to keep
it from going into his lungs, but it was a futile effort. Even with
the white sheets in place, it was like trying to roll a water
man had been
“down” for over twenty minutes without Oxygen or CPR. The Fire Chief
kept track of those important things. I tried to
attach the gel electrode pads for the cardiac monitor to his chest,
but, again, because of the vomit and sweat they would not stick.
Finally, I used the defibrillator paddles against his skin, not to
defibrillate but only to visualize his cardiac activity. There was
none. Flatline. I ran a paper strip showing that flat line to add
to our report.
man had probably
died immediately from a fat embolism. Fat emboli are pieces of fat
(cholesterol) plack collected on the inside wall of a vessel. It
can break free anytime. When that happens, they float in the
bloodstream to a place where the blood vessel becomes too small to
float any farther. There they obstruct the blood flow so everything
downstream from that spot dies because of lack of blood, or rather,
Oxygen. It had probably blocked a vessel in one of his lungs, heart,
this had not
taken his life, the time involved for us to reach him and for the
Firefighter first responders to cut away the stall wall and door and
pull him out could also have done the job. As a result, too much
time had passed without Oxygen or CPR. There was nothing to do for
this man. He had eaten his last cheap breakfast in Reno.
equipment and placed it onto the gurney. The Firefighter first
responders pushed it and our gear out of The Vomit Room, and we all
walked with it back through the dining room to the ambulance and fire
engine. It was still packed with people eating their cheap Reno
breakfasts, and there wasn’t an empty chair at any of the
tables. That is except for the one our patient had been sitting in.
That one was empty.
stopped and spoke
with some of the people at that table. They were still eating as if
nothing had happened. They said he was eating as usual and was on
his third breakfast and drinking his fourth Bloody Mary. He hadn’t
complained about a thing when he suddenly let out a loud moan which
everyone heard. Then he stood up, said he had to use the restroom,
and rushed away from the table. A friend checked on him when he
didn’t return. That was it.
I radioed the
ER, the doctor told us to do no more and clear the scene. It was
already a busy morning, and he wanted our ambulance back in service
as soon as possible. This time we needed two white sheets from the
ambulance. The others already in the restroom could not be used. The
radio spoke again when we were about ten minutes from our
station. There hadn’t even been enough time for the smell of
the vomit to fade from my clothes.
The call came in as a single car MVA (motor vehicle accident) located
beneath the North McCarran Blvd overpass on HWY 395 as it leaves
Reno. It was about nine to ten minutes away while driving CODE
THREE, with lights and sirens, and I would still be
of vomit when we arrived. My partner, too.
395 is the “business” route northwest of Reno, so we
thought there might still be a lot of late morning rush hour traffic.
My partner, who was driving, looked at me and said, “why only
one? In that place, there should be more than one.” We were
soon to find that one was enough.
the overpass, the highway consisted of four lanes separated only by
double yellow lines. The Police had all four lanes closed well
before and well after the location of the lone jeep involved. “Why
are the other lanes closed?” my partner asked. “They
only close the other lanes when there is a death. Where are the
other cars?” It didn’t take long for him or me to have
an answer to his questions.
we pulled into the scene, we passed the Firefighters and the Police
who were the first responders to this call, and none of them seemed
to be in much of a hurry. They were just standing around, away from
the jeep, not doing much. They only did that when they were waiting
for someone to arrive to pronounce death. They couldn’t clear
the scene until that happened.
were no other
vehicles involved, or they had driven off. There were no other
people involved, or they had run away.
was an open-air jeep with a roll bar behind the two front seats, and
all the windows except the windshield were rolled down. It was
sitting in the right-hand lane as if it had been parked there
purposefully, and it showed no marks or scratches of any kind. There
was no evidence of an accident, and there were no other vehicles
involved, or they had driven off. There were no other people
involved, or they had run away. Sitting behind the steering wheel
was a young guy slumped downward and forward with his forehead
resting on the steering wheel, and he wasn’t moving. Things
didn’t look good at all.
parked and I got
out and walked to the jeep to examine the driver. I went
empty-handed because I thought I wouldn’t need the first-out
medical box, and I was right. As I approached I was amazed at what I
saw. This was a first.
top part of the
skull had come off, and I could see directly into the empty bottom
part of the skull where the brain should have been. The “Brain
Pan,” as it is called, was empty. I mean absolutely empty. Not a speck
of tissue, not a spot of blood. The inside was shiny and
glistening like the inside of an oyster shell where it is covered by
Mother of Pearl.
was unmarked, and except for the obvious problem of no top to his
head and no brain in that head, the rest of his twenty-some-year-old
body was visually undamaged. It was the most surreal accident scene
I had ever attended or would ever attend. Nothing else ever came
first responders were always nearby. I could always depend on them
to be ready to help. Always. That was just the way they were. I
did not ever thank them for that. I should have.
taking it all
in, I turned to the Firefighter who had walked up next to me and
asked, “Where are the top of his head and brain?” He
turned a little to his left and pointed down the road toward the two
oncoming lanes on the other side of the double yellow lines. “The
brain is down there,” he answered. “And, what’s
that smell?” he asked incredulously.
was a tough one,” I responded. “The morning is busy, and
I haven’t had time to change my clothes.”
soon,” he remarked. “Me too,” I responded. “Could
you show me where the brain is, please?” I said, trying to
change the subject.
he said. “Come over here.”
about fifty feet from the front of the jeep into the two oncoming
lanes. In the inside lane lay a perfectly intact human brain. It
was slumped over like so much Jello out of its mold and shining rose
pink in the sun.
driver had not
been wearing a seat belt, and from the skid marks he had needed to
stop fast. The steering wheel was broken from the impact on his
chest, and he had crushed his ribs. I applied pressure to his
sternum with my fingers, and it sounded like I was popping bubble
wrap. I remember thinking he probably didn’t have an intact
rib in his chest. If that were the case, he probably also had
crushed his heart and torn his Aorta. This guy must have hit that
steering wheel hard, followed by his head hitting the top edge of the
instantly. The top of his head had traveled about thirty feet
farther than the brain before coming to rest on the side of the road
about a foot or two off the shoulder. It was one round piece of
bare, clean bone just about the size of a Yamaka . All the hair,
scalp, and other tissues under the scalp were gone. I never heard,
but I suppose they found all that somewhere.
was it for us. We covered him and the front seat part of the jeep with
sheet. We also placed a white towel over the brain and one over the
skull cap and left everything undisturbed for the Coroner. Then I
radioed dispatch and asked permission to go home for a uniform
change, and they said, “yes.”
our ambulance back in service and headed for my apartment. We
planned to drive to my partner’s house after that. Hopefully,
we would do all this before the next call. At some point, we also
wanted to squeeze in breakfast.
came forward. The cause of the accident remained a mystery for the
rest of my days in Reno. Sometimes there just aren't any answers.
took a warm bath.
had been driving
for about five minutes when the next one came in. We still hadn’t
been able to change our uniforms. It was a dispatch to a possible
suicide at a private house in an upscale neighborhood about fifteen
minutes from our present location. The husband had been the one to
THREE, lights and sirens response, we arrived at a grand
house, if you could call it that. It was more like an estate. There
was a long, horseshoe gated drive leading to the front door, where
there was a portico under which we came to a stop. Standing outside
the house patiently waiting was a man wearing a good-looking business
suit with a blue french cuff dress shirt and a gold silk tie. These
people had money.
we pulled to a
stop, he calmly approached the passenger side of the ambulance, and
we rolled down the window. “She’s inside, upstairs in
the master bath. She had threatened to do this many times over the
years, and after rushing home to find her drunk and completely out of
it, I finally stopped believing her. But, today, something in her
voice was different. Something told me I should probably come home
this time to check on her.” With that, we grabbed our
“first-out” gear while the Firefighter first responders
grabbed the gurney from the ambulance, and we all began to run
no hurry,” he continued as he slowly followed, “I’m
sure she’s gone.” He pointed us to the bedroom and the
master bath, where we found a naked lady lying in a bathtub filled to
the rim with red water. I remembered what he had just said and
agreed. She was probably “gone.”
were two long
and horizontal, linear lacerations on the inside surface of each
wrist. Actually, they were more like incisions a surgeon would make.
Each one extended approximately three inches from one side of the
wrist to the other. They were deep, wide open, and efficiently done.
Most people, when they cut their wrists, don’t cut them deeply
enough. They also do not extend their cut side to side, so they cut
the arteries on both sides of the wrist. Rarely does anyone do it
correctly. It appeared this lady knew what she was doing.
are two main
arteries in the wrist, and they are parallel to one another. One is
on the thumb side, and the other is on the little finger side. They
travel in straight lines coming from the arm into the hand. That
means they are as wide apart as the wrist is wide.
suicide by cutting their wrists from the middle to one side. Along
with that, they usually don’t cut deeply enough. Mostly they
only cut veins, and veins bleed out very slowly. That’s why we
usually arrive in time for a suicide attempt by wrist cutting. The
few who succeed with these inefficient cuts have a long, drawn-out
dying process. They only succeed because they don’t call
anyone to tell them what they are doing. No one came over in the
nick of time. Instead, they are found hours later when someone comes
home. This lady did things correctly. She cut from one side of her
wrists to the other and made very deep cuts. Because of this, she
successfully cut both arteries in both wrists.
think of it, she
had to do one wrist at a time. After cutting the first, she had to
change the razor blade to the hand of the just cut wrist with the two
arteries squirting blood. Then, she had to do the same to the other
wrist. Can you imagine the grit and determination that must have
I believe she
knew what she was doing because she was in a warm bath. I didn’t
think she just wanted to soak in a warm bath with a drink and smoke
while doing her thing. She knew how to cut her wrists properly, so I
believed she knew that hot water would cause her to bleed out faster. I
believed she knew that heat would dilate her arteries and veins,
thus allowing the blood more room within her vessels to flow faster. I
believed she had thought of everything.
we walked into
the bathroom, I touched the water in the tub. It was still warm. Also,
on the inside flat edge of the tub, where the side wall meets
the rear wall and forms the corner, there was an ashtray with the
butts of two filtered cigarette butts. She had smoked them until
there wasn’t anything left to smoke. Nothing but the filters
were left, and they had been crushed out forcefully. They were
still bent over in half and squashed flat. She made sure they were
out. Her lighter and pack of cigarettes were next to it, and they
both had blood on them. She must have smoked her second cigarette
after cutting at least one of her wrists.
the outside flat
edge of the tub was a chimney glass. It still had ice and a few
drops of a yellow liquid at the bottom. There was also orange juice
pulp clinging to the inside. Perhaps she had finished a screwdriver
cocktail and smoked her cigarettes while making the cuts. The
outside of the glass also had blood on it.
there she was,
her feet toward the faucet and drain and her head resting on the back
rim of the tub and the wall. The ashtray, cigarettes, and lighter
were on the right side of her head and the empty glass on the other.
She had just laid there in her warm bath and fallen asleep into
I did was touch
the water and feel for a pulse in her neck. There wasn’t one,
and she wasn’t breathing. The warm water was so red that it
was doubtful any blood was left in her. One of the Firefighter first
responders who happened to be Jewish remarked, “well, at least
she had a kosher death.”
lot of us who do this kind of work are members of an affected group.
Not all, but a high percentage is. I certainly was. Sometimes
things are so horrible, so gruesome, so ugly we need to find a way of
dealing with them at that moment. If we let it affect us, we
probably wouldn’t be much good for the patient.
of the ways we
do this is to use humor. But it’s not “funny, Ha Ha”
humor. What the Firefighter used was Sardonic humor. It is humor
that is dry,
understated, and sort of mocking and is known for clever remarks that
sting because they are so accurate.
Firefighter did not mean to mock this patient or her suffering. We
all knew that. Rather, he was trying to be humorous to deflect the
full impact of what he was experiencing. In our ways, we all were. My
partner brought a white sheet from the
covered her in the tub.
equipment while the Firefighter first responders helped return the
gurney to the ambulance. As we began to pull away, I radioed
dispatch that we were back in service and available. Before we had
driven the length of the other leg of that long horseshoe driveway
and out the other gate, dispatch contacted us again.
story about pain.
was a brush fire far outside Reno in an area near Pyramid Lake on the
Paiute Indian Reservation. The Silver Sage was burning hot on a hot,
dry day. A strong wind was driving it along at about twenty to
thirty miles per hour enlarging it and keeping it out of control.
and my partner and I were working the Sparks One Paramedic ambulance.
We were far from the emergency location but were the closest unit,
so the call was ours. One of the firefighters had been burned when
the fire circled back and trapped him within its flames. It was
unknown just how badly he was burned.
responding CODE THREE,
sirens, it would take a long time to arrive. If the patient had any
significant burns to his body, he would continue to suffer all the
time we were on the way. And, as it turned out, this man was in a
lot of pain.
fifteen minutes to arrive. A long time. As we pulled up and
stopped, I could hear screams. They were animal-like, high-pitched
screams and were as loud and disturbing as I had ever heard. He had
probably been doing it the whole time we were on our way. His pain
must have been beyond imagination.
we approached, a
small bunch of firefighters was gathered around him, and all of them
were waving frantically with their arms straight up over their heads.
As they waved, the arms crossed over each other to form an “X”
as they moved from side to side.
had been with
this man and his screams of pain during the whole time we were
responding. I’m sure the anxiety and psychological trauma to
these firefighter partners must have been similarly intense. The
only option they had for helping was to keep him wet with their fire
hoses, which had done nothing to stop the screaming.
hear his screams, we knew our patient was still alive, awake, and
breathing. That was a good thing. However, we also knew he was
severely injured and in severe pain, which was not.
jumped out, ran
to the back of the ambulance, and grabbed the gurney. We didn’t
bring any other equipment with us. Only the gurney. We knew this
would be a “scoop and run” case with all our treatments
done in the ambulance. By doing this, The Firefighter would receive
the hospital definitive care he required much sooner.
he was in
critical or extremely critical condition with his life in danger, I
was required to ride with him in the patient compartment while my EMT
partner drove. One other firefighter came with us to ride with his
friend and partner.
continued while we drove and were amplified in the small space of the
patient compartment. It was very disturbing. Along with those
screams, the smell of burned flesh, hair, and his heavy firefighter
outfit and boots assaulted my senses and were so oppressive it was
difficult to breathe. We had exhaust fans, and they were set on
high, but they made no difference. My partner opened the front
windows, but it didn’t help.
Firefighter on high flow Oxygen and began a liter size, 1000cc, IV
infusion of Normal Saline, medical water. Then I handed it to the
ride-along friend and told him to squeeze it until it was empty. While
he was doing that, I started another one and handed it to him,
telling him to sit on it and squeeze it too as best he could. During
transport, his firefighter buddy ride-along squeezed three and a half
liters of medical water into our patient before we reached the
emergency room. Those fluids probably kept him alive, let alone
burned, human or otherwise, the cells are cooked. Others burst, and
in both processes, their inside fluid escapes and seeps out of the
body. Depending on the extent of the burns and their severity, the
body can quickly become dehydrated to a significant degree. This
man’s burns covered about half his body and were mostly
is a sunburn, and second-degree burns have big, water-filled
blisters. For a burn to be third degree, the tissue is cooked. A
fourth-degree burn is when the tissue becomes charred down to the
bone. Besides the third-degree burns on our patient’s skin, I
had to consider that the fire had also burned his lungs when he
inhaled the hot air. He had to be losing a lot of fluid. This man
was in big trouble.
the Oxygen and
the two IVs were running, I contacted the emergency room to give a
report. The EMT or Paramedic must do this to validate the treatments
already administered and receive orders for any further treatments
the doctor might want to add. In this case, however, I didn’t
wait for the doctor. Instead, I asked permission to immediately give
our patient Morphine for his pain.
doctor deals with the EMTs and Paramedics in the field according to
their style. This doctor was well known to have a “Doctor-God”
attitude where-in only he could correctly treat the patient. Usually,
he did not give orders for advanced treatments in the field,
and Morphine was an advanced treatment. He was the doctor and would
initiate the advanced treatments in the emergency room.
would not allow
me to give this man anything for his pain, and I knew this was a bad
decision. This patient needed Morphine now. So, I did something I’d
never done before. While he was still talking, I keyed the
microphone and cut into whatever he was saying. Then for a full
fifteen to twenty seconds, I held that microphone about two inches
away from the patient’s mouth while he was screaming his
animal-like scream. I just held it there, and held it there, and
held it there until I was fairly sure the doctor thoroughly
understood the severity of the situation.
after I closed the microphone, the doctor began talking again.
Immediately he gave orders for the Morphine I had requested. I gave
it to the patient through one of his IVs, and in about thirty
seconds, the screaming reduced in volume and intensity, and then in a
few more seconds, he stopped screaming altogether. The moaning
continued, and he was still in critical condition and shock, but it
stopped his screams. However, it did nothing for the smells.
take away the pain so much as it allows a person to not care about
it. At the same time, it reduces anxiety and, to a point, acts as a
tranquilizer. It is classified as a hypnotic class drug and works
well to alter the level of consciousness and anesthetize the patient
allowing him to calm down and perhaps sleep. When given directly
into the blood flow via the IV, as I had done, it works very fast,
and this guy needed it to work very fast.
enough to last until we arrived at the emergency room and turned our
patient over to the doctor and the staff. I reported to the nurse
and ignored the doctor. All I needed from him was a signature on the
ambulance medical report signifying he had authorized the Morphine. I
presented it to him, and he signed it and walked away without
saying a word. Again, this doctor was known by everyone in the
emergency room to do this sort of thing regularly with the Paramedics
and the nursing staff.
I was leaving
with our gurney, one of the emergency room nurses came up to me and
smiled. She then moved close to my ear and softly said, “nice
touch with the microphone.” As I continued to push the gurney,
I looked directly at her, returned her smile, nodded my head, and
said, “thanks, I was hoping it would work.”
“what’s that smell?”
are having a busy morning. We had a bad call earlier, and I haven’t
had time to change.”
hope you can before you return. That’s a terrible smell.”
I replied. “I know,” and continued toward the door and
the fresh outside air. That doctor never refused to give me what I
asked for ever again, and The Firefighter received the medicine he
needed when he needed it.
emergency room, the firefighter ride-along was waiting for his
buddies to arrive to give him a ride back to his station. As I
pushed the gurney into the ambulance, he walked up to me and stuck
out his hand so we could shake hands. As we did, he firmly squeezed
my hand in a friendly way and, at the same time, in a very nice
voice, said, “Thanks, doc. Thank you for what you did. I will
never forget it.”
was a good
man who didn’t want the ambulance.
leaving the ER, I radioed dispatch and asked permission to drive to
our respective houses to change our uniforms and have some lunch. The
time for breakfast had long passed. They said, “yes,”
but in less than five minutes, we were once again alerted. It was
for another “man down.” This nebulous term is used a lot
by dispatch services. Some others similar to it are “fall
case,” “domestic,” “MVA,” “Difficulty
breathing,” “Possible choking,” and none of them
tell us what we need to know.
throwback to the fifties or sixties when ambulances were little more
than taxis with red lights and sirens. Then the attendants were
“ambulance drivers,” not trained medical caregivers, and
especially not RNs or Advanced Life Support Technicians - Paramedics.
The dispatchers were the same, no medical training, so instead of an
Intracranial Bleed, it was just a “fall case,” and so it
remains today. Change comes hard. Change scares people.
case was at the
Nugget Casino in the City of Sparks, Nevada, “across the street
from Reno,” as the town is known. We were informed the man was
on the floor just inside the north parking lot entrance. After
responding CODE THREE,
lights and sirens
we found a casino official with a man and his wife standing in the
middle of the carpeted hallway inside the casino doors. The man had
just told the official he didn’t need the ambulance and was
trying to leave. He had gotten as far as the door where the official
and the man’s wife were trying to talk him out of it. We had
arrived just in time.
my partner and I
entered the hallway, the man approached us. Before anyone could say
a word, he passed out cold turkey and hit the floor. This was not a
good thing for a man who looked to be in his sixties or so.
and Sparks are
at an elevation of more than four thousand feet above sea level.
Because of this, the air is thinner with less Oxygen, which can be a
problem for many visitors. It happens to so many visitors, it even
has a name. We called it The Reno Syndrome. Maybe they still do.
people who come
to Reno do so by airplane. Thus they must walk more than they ever
did at home. All that extra walking, eating, and drinking at over
four thousand feet can take a toll, especially if a person is an
older male, carrying a little extra weight, and has underlying health
unconscious on the floor, I immediately felt for a pulse. I found he
had a good one, strong and regular. At the same time, I was thinking
about this syndrome and how he didn’t fit the picture. This
man was thin and looked healthy. As we put him on Oxygen and applied
the heart monitor, his wife was telling us he didn’t smoke or
drink, and he ran marathons back home. Something was very wrong with
I could apply
the monitor and put on the Oxygen, he awoke. “I’m fine,”
he said as he pulled himself into a sitting position. “I don’t
need all this stuff, and I don’t need the ambulance or the
hospital. All I need is a little rest.”
matter what I said, he just wasn’t going to go with us. He was
adamant. I checked his pulse again, which was regular and of normal
speed, so there wasn’t much I could say. I did tell him there
might be a problem happening that was not yet visible, but he would
not listen. Then he stood right in front of me and said, “I
don’t need…” and passed out again and hit the
floor. I again checked for a pulse, and this time could not find
one. Not at the wrist or in his neck. There was no pulse. His
heart was not beating, and I didn’t think he was breathing.
as my partner was about to start CPR and I was about to put a tube
into his windpipe so I could breathe for him, he awoke once again. I
felt his pulse, and it was regular but a little too fast. He had
been out longer, and his heart and breathing had stopped. This time,
he was confused, probably due to the lack of Oxygen in his brain.
Still, he would not go with us.
knew this man needed to be in a controlled medical environment, so I
would not give up. “You must see a doctor,” I told him. “Something is
going on with you, and if you were my brother or
father or uncle, I would insist you go now. You must come with us. If
not for yourself, do it for your wife.” Finally, with his
wife insisting, he agreed.
put him on the gurney and got him into the ambulance. My partner
started driving as I inserted an IV and put him on Oxygen. I also
attached the heart monitor so I could see his heart activity. His
wife was in the patient compartment riding with her husband, and my
partner was driving along with normal traffic when he passed out
again. This was very bad.
looked at the
monitor, and there was nothing, no heart activity at all. I yelled
to my partner, “Mitch, let’s go! No heartbeat!” I
heard the sirens kick on and felt the ambulance lurch forward as we
changed our driving to CODE THREE.
I hit him right in the middle of his chest on the breastbone with the
side of my closed fist, and he awoke immediately. His heart began
beating fast with a smooth, regular rhythm. What I had done is called
a “Precordial Thump.” It generates a low electrical
shock within the heart tissue to stimulate it so it begins beating
again. This was the first time I had ever done it, and it worked. I
was so surprised I yelled to my partner, “Mitch, the thump
worked! His heart is beating again.”
the same time I said that, his heart stopped again and he passed out. I
thumped his chest one more time and immediately, he awoke. I
continued applying soft thumps to his chest with the frequency of a
beating heart in a technique called “fist pacing.” As
long as I continued, he remained awake but was disoriented. I
thought that if he was talking, even though his words were
nonsensical, he was breathing on his own, and this was a good thing. I
was still thumping when we pulled into the ER.
we pulled in, I
jumped out of the back doors and began sliding the gurney out of the
ambulance. I had told my partner to keep the sirens on as we pulled
into the ER parking lot. This just wasn’t done. All sirens
were supposed to be turned off before arrival. We hadn’t had
time to use the radio to notify the hospital of what we were doing. I
was hoping this would get their attention. I was right. A nurse
stuck her head out the ER door, and I yelled, “Pacemaker!” That was all
I had to say. Immediately she turned and disappeared
back into the ER.
the gurney with our patient on it from the ambulance. As he then
pushed the gurney toward the ER doors, I rode on a lower railing near
the ground that runs along the side, front to back, and continued to
fist pace. The external pacemaker was ready and waiting by the time
we had our patient on the ER bed.
pacemaker is a device attached to the skin in the area over the heart
and does the same job as fist pacing. It uses a low voltage
electrical charge to stimulate the heart to beat and does it in a
controlled manner. It is adjustable in voltage intensity and
frequency of discharge.
was supporting the patient, the doctor was inserting a catheter
pacemaker through the big vein in the patient’s neck into the
ventricle of the heart. When he had completed the procedure, and it
was working, the nurse removed the external pacemaker. Finally, the
patient’s heartbeat was managed and he had a good chance to go
on to survive. Then the doctor turned to me and asked, “What’s
explained the situation. The doctor offered to lend us some ER green
“scrubs” worn by the staff in the OR and the ER. We
accepted his offer. At last, after about four hours, we were out of
our smelly clothing.
man may or may
not have been a victim of the Reno Syndrome, but it did turn out he
had a full-blown heart attack in the part of his heart that regulated
its beating. Perhaps the reduced Oxygen content in the air at four
thousand feet was the trigger. Perhaps it was just his time. Whatever
was the cause, the precordial thump and the fist pacing
saved this reluctant man’s life that day in Reno.
few days later, my
partner and I visited our patient in the Intensive Care Unit. He
didn’t remember talking with me in the ambulance on the way to
the ER or about the entire experience. He didn’t even remember
the carpeted hallway inside the casino’s door. His wife did,
though, and was very gracious in her thanks.
a copy of my diary entry about the case. It was written three days
after the call happened so it fairly abbreviated.
one was a true
“save,” and the patient lived to go home, where he
probably didn’t run too many more marathons. We were still
cleaning the ambulance when dispatch alerted us again. We hadn’t
had anything to eat all day.
wanted more beer.
patient. Possible head injury,” came the message from dispatch,
and it was in a location a long way from where we were. It would be
a long twenty to twenty-five-minutes CODE
THREE, lights and sirens response to a community outside
known as Sun Valley. That is too long for any serious head injury. And
this one was. Serious, that is. Actually, it was terminal.
responses usually followed by tough cases. Because of the time
required to arrive, if these calls were real emergencies, any chance
of a favorable outcome was mostly lost. This case was over before we
even received the dispatch, but no one knew that until we arrived. This
is what happened.
four and a
half months in the county juvenile facility for minor offenders,
mom’s sixteen-year-old son was released, and she had picked him
up. He had been a county guest because he had a nasty habit of
beating up kids around the neighborhood. It didn’t matter how
old or young they were or how big or little, or whether they were a
boy or a girl, he didn’t do it to win. It was his anger. For
him, physical pain and injury from fighting were all about who and
what he was. That had been his life, physical and emotional abuse,
all accounts, he
was a troubled youth. His stepfather and stepbrother were abusing
him, and he didn’t care who he hurt in return. The neighbors
said the two would team up and beat him and sexually shame him in
public any time they wanted. And they did it a lot.
police had been called, but by the time they arrived, no one would go
on record with an official statement. The stepfather and stepbrother
were truly feared by all who knew them. Mom might have been the only
friend he had left, and she was usually drunk, as she was today.
the way home, the
son had talked his mom into stopping for some beer and food so they
could celebrate his homecoming. He had told the police she agreed
and bought two six-packs and some snacks. He had said he wanted more
beer, but mom didn’t have any more money with her. He said she
told him they could get more money later at home, so he had settled
for the two six-packs.
for an afternoon of celebration without the stepfather or
stepbrother. They were away for a week of hunting. Mom and son
could enjoy being home with each other and some of the neighbors
without any problems. Or so they thought.
neighbors said it all started when the beer ran out. The son wanted
more, and mom said she didn’t have any money for beer if they
wanted food for the rest of the month. The neighbors said the son
went “ballistic,” yelling at his mom, “you
promised, you promised!” They said he would not stop.
he ran out of the trailer, grabbed a horseshoe off the front yard
gate, and ran back into the trailer. It was then his anger turned to
rage. Threatening mom with the horseshoe, he yelled again, “you
promised. You said we could get more money at the house.” He
was crying, they said, and angrier than they had ever seen him.
feared him and
had left the party immediately, with only two persons remaining when
he first struck her. They later reported to the police he had
continued to hit her with the horseshoe while crying and yelling,
“you promised, you promised.”
the time we
arrived, mom was dead. Long dead. Her forehead was gashed open and
missing. Brain matter was spilling over the area where the forehead
used to be and down over what was left of her face to the chin.
Everything above her nose was smashed into mush, and she was lying on
the floor with a large pool of brain fluid and blood around her head.
son was handcuffed and sitting in the back of the police cruiser. He
was still crying and saying over and over to no one in particular,
“she said we could have more beer. She said we could have more
beer. She said we could have more beer…” He was on his
way back to the county facility, and now, there would be no more mom
to pick him up if he ever became eligible to leave.
more for us, so we gathered our equipment and returned it all to the
ambulance. At the same time, I grabbed another white sheet and
covered mom, still lying on the floor of the trailer. We were a long
way out of our response zone, and it would take a long time to get
back. On the way, my partner and I looked at each other, and my
partner said, “what a shift. What’s happening today?” “I don’t know,” I
replied. “But, we’ve
already used too many sheets.”
our drive, we
had time for a bathroom break and to buy some fast food which we ate
as we drove. Before returning to our station, we had to stop at the
hospital to replenish our supply of sheets. As we left the hospital,
I grabbed the mic and called dispatch. When they answered, I asked,
“what’s happening with the other ambulances? Are they as
busy as we are?
she responded. “You two are the lucky ones today.”
Ice Pick Story.
ugliness of domestic violence
something called the “Pericardial Sac,” and it houses or
wraps around the heart. One of those reasons it’s there is to
contain the heart as it beats. Another is to reduce friction as it
rubs against the surrounding tissues.
heart hangs like
a pendulum from the arch of the Aortic Artery between the lungs on
the left and right sides. The spinal column is behind it and the
sternum in front. The top part of the sternum is called the
Manubrium, and the lower part is the breast bone. If it were not for
this sac, the heart would flop around all over the place in this open
space. It is because of this sac, and some other reasons which do
not pertain to this discussion, that we do not feel the heart rub
against or hit our insides when it moves with each beat.
this sac and
above the surface of the heart, there is a “potential space.” That is
because the sac rides upon the heart, it is not attached to
it. If it were attached, it would constrict the heart’s
expansion as it fills with blood for the next beat.
can also be
constricted if a fluid of some kind were to collect within that
potential space. When this happens, it is a true emergency and can
cause death within minutes. Literally minutes. This was what was
happening to the patient in this story. This is how it came to be.
to a “domestic” CODE THREE,
lights and sirens to a place about two miles from where we were at
the time. Our patient survived only because of this reason. Our
care at the scene and on the way to the hospital was vital, of
course, but if we had not arrived quickly, there would have been no
need for our treatments.
defined as any kind of violence between partners who are sharing a
living place, a common domicile. In this case, the violence was
physical, verbal, and emotional, and involved a deadly weapon.
we pulled up
after our CODE THREE,
lights and sirens
response, the police were already there. So was a large crowd
standing on the sidewalk and in the street in front of a one-floor
apartment building that extended the entire block length, from right
to left. It was not one of Reno’s finest apartment buildings.
front doors of
the individual apartments faced the sidewalk and curb, and there were
short pathways about ten feet long from the sidewalk and curb to the
front doors. The tenets parked their cars along the curb as close to
the front of their particular apartment as possible, as we all would
do. At this time, the space along the curb was filled with parked
cars, bumper to bumper. Not one space was left.
crowd seemed to
be standing around one car in particular. It was a VW “Bug”
of an early vintage which today would probably sell for thousands of
dollars. As we pulled up, we had to stop in the middle of the street
because the crowd was so deep.
jumped from the
ambulance before it stopped and hurried to the center of the crowd,
on the side of the VW against the curb. Everyone was looking down at
the curb or street, so that is where I went.
I got there, I
found a woman lying in the gutter on her back with her head to my
right as I faced her. She wasn’t moving, and she didn’t
look like she was breathing. Also, there was a tiny hole in the
upper part of the chest bone, the manubrium, I mentioned earlier. It
was the size of a pinhole, just below and to the left of the “V”
in the neck under the “Adam’s Apple.” She and her
partner had been having a heated argument, and her blouse was torn.
People in the crowd were saying he was beating on her. That’s
why she had run out of the apartment and onto the sidewalk.
the meantime, her
assailant had grabbed an icepick (Why would anyone have an ice pick
in their home in Reno?) and followed her. As they continued to
argue, the man again grabbed her blouse with his left hand. Then,
with his right, he plunged the ice pick into her chest. By the time
we arrived, police had the man handcuffed and secured in the back
seat of the cruiser.
lady in the
gutter was in critical condition, more like extremely critical. More
like just about to die, extremely critical. She was “circling
the drain,” as we say when a patient is about to die. It
refers to the water draining from a tub or sink. We’ve all
seen it. As it drains, it forms a vortex “circling the drain”
just before it falls in, never to return. It’s part of that
Paramedic and EMT sardonic humor to which I have already referred in
the story about “The Razor Blade Lady.”
soon as I looked,
I knew this was a bad situation. To see if she would respond, I
touched her eyelash with just the tip of my index finger. Nothing
happened. She didn’t blink or move her eyelid at all. Not at
all. She was deeply unconscious, and this was really a bad sign. There
was no time to waste. I spun around and dashed back to the
ambulance. As I did, I looked back at the crowd and yelled loudly,
“Move that car!” Then I turned back and continued running
to the ambulance.
ran back to the
ambulance to get the ”Scoop Stretcher.” The Firefighter
first responders had already brought the gurney to the patient. On
the way, a Police Officer came up to me and, while running with me,
asked, “Is she critical?” Without stopping, I answered,
“worse. Much worse.”
is an aluminum device about six feet long that opens and separates
down the center lengthwise into two separate long pieces. Once
separated, one of the two pieces is placed along each side of the
patient, slid under their body, and clicked back together. Then the
patient is “scooped” up and placed on the gurney with the
scoop still in place. It provides a rapid and efficient method to
lift and extricate a patient.
I returned to the
patient with the scoop, the crowd had moved the VW. They had banded
together and lifted it completely off the ground, and moved it into
the middle of the street. By organizing this action on their own,
they became a part of the chain of events that saved this lady’s
life. As we were rolling her to the ambulance on the gurney, I
turned back toward them and said loudly, “You folks helped
save this lady. You are all heroes.”
loaded the gurney
into the ambulance with the lady still on the scoop stretcher. They
would need it at the ER. As I jumped in, the same Police Officer who
had asked about the patient's condition followed. Whenever there is
an impending death by a deadly weapon, police must ride with the
patient in case they make a deathbed statement. I was glad he was
there. I would do all her treatments in the ambulance on the way to
the hospital to save time rather than doing them in the street. I
knew I would need his help.
we drove CODE
THREE, lights and sirens to the emergency room, the first
thing I did was to administer Oxygen with a face mask over her nose
and mouth. Then I started an IV with the largest bore needle we
carried. I didn’t use an arm vein because it would take too
long. Instead, I inserted it into her Jugular vein on the left side
of her neck. As I did, she moaned in pain. I turned to the officer
and said, “that’s a good sign. She’s still feeling
pain.” Then I attached a 1000cc soft plastic bag of medical
water to it, handed it to the officer, and told him to “squeeze
it until it is empty.” Not only would we use this IV in the
ambulance, but later in the ER, they would use it to administer any
medications the patient might need.
medications are administered through an IV except for Nitroglycerin
which is given in pill form and dissolved under the tongue. We do
this because when a patient is in shock from any given emergency, the
body clamps down all arteries in an automatic response. The result
is that most of the blood is diverted from the less important areas
of the body, like the muscles, fingers, and toes. As a result, the
blood is rerouted to vital organs such as the brain, heart, lungs,
kidneys, and liver.
these organs are also affected by this clamping down, but because
they are so large, the effect is minimal. In this way, the body
attempts to prolong its life by prolonging the functions of those
effects of this action. "For every action, there is an equal
and opposite reaction.” This means that when the body shuts
down the arterial system to protect some of its organs, the tissues
losing their blood supply begin to develop new problems in addition
to the initial problems of the actual emergency. The cells cannot
eliminate their waste products because the arterial blood flow to
them is reduced. As a result, this causes Ph changes in the tissues
and Carbon Dioxide to collect in the cells. Should this condition
last too long, the entire body will become toxic, even the protected
vital organs. There’s always a side effect to everything.
clampdown, if we were to inject our medications into the muscle, they
would just sit there in the area where they had been injected. There
would be minimal arterial blood supply to pick them up and circulate
them through the body. The patient would not immediately receive the
therapeutic effect they needed.
arterial supply returns, all that medicine would be dumped into the
body at one time. This could be very detrimental to the patient. Thus,
we always use IVs in the ambulance to medicate our patients.
that the patient
was receiving pure Oxygen and the IV was being squeezed in by the
officer, I had the time to radio the doctor and give a report.
told the doctor about the patient's condition, the argument, the
fighting, and the ice pick. I described the location of the stab
wound by saying, “there is a small hole in the upper part of
the manubrium at its left edge.” Because of the patient's
status and the hole's location, he knew this patient not only had a
hole in the pericardial sac, there was another in the upper left
atrium. He knew this patient was collecting blood within that
potential space between the heart and the pericardial sac. This
condition is called Cardiac Tamponade. It develops when the heart
loses blood through a hole each time it beats, and it begins to
collect beneath the pericardial sac.
begins to collect
because the hole in the sac closes. The blood cannot bleed out into
the void of the chest cavity. The hole in the heart doesn’t
close because of the high pressure inside the heart caused by the
contraction of the muscle when it beats. The pressure is needed to
push the blood out of the heart to the lungs or the body.
every time the heart beats, even if the amount of blood being pushed
out through that hole is minimal, a lot of blood begins to fill that
space. In turn, pressure is applied to the heart itself which
restricts its ability to expand enough to accept the normal amount of
blood returning from the body. In turn, again, this causes less
filling of the heart chambers. With less filling, less blood leaves
the heart. When less blood leaves the heart, less Oxygen is
delivered to the body. Because the heart is beating sixty, eighty,
or one hundred times a minute, you can imagine it only takes minutes
or seconds for this process to decompensate or kill the patient.
this happens in
some remote location far from a hospital, we must deal with it. To
do that, we carry a 6” cardiac needle and a large capacity
syringe. These suck out the fluid in the sac. I only had to do
this once during my time “on the road.” This time we
were so close to the ER, the procedure was not indicated for this
patient, but I did have the needle and syringe ready.
first thing they
did for this patient upon her arrival was to do this procedure. They
pulled out about a cup of dark red blood. Immediately, the patient
regained consciousness but was still very disoriented. Once they
stabilized her, she was sent to the operating room for an appointment
with the surgeon. She lived to walk out of the hospital on her own. Her
domestic partner was sent to the Nevada State prison for thirty
patient was a
true “save,” as we say in our profession. Too many
others just like this were not as successful.
didn’t know she was pregnant.
dispatch was another long CODE
lights and siren response back to Sun Valley from Reno, bringing us
to a small trailer house. They told us to expect a “CVA,”
a cerebral vascular accident called a “stroke.” We soon
learned it wasn’t that at all.
neighbors outside the trailer directed us to the bathroom on the
right side of a short hallway leading to the one bedroom in the back
of the trailer. We expected to see “granny” crumpled on
the floor between the toilet and the wall, and we were totally wrong.
Instead, we found a seventeen-year-old girl sitting on the toilet,
looking down at her cupped hands in front of her vagina. As we
entered, she looked up.
was a look of
amazing surprise on her face. It was mixed with confusion and
questioning sadness. I had never before seen such a look. Then she
said, “It’s out. It’s out. I didn’t know I
was pregnant, and it’s out.” I looked down into her
cupped hands and saw it most certainly was.
in her cupped
hands, was a very small fetus. It was probably at three to four
months gestation and very blue. The umbilical cord and the placenta
were still attached. My partner was a married man and had a kid on
the way. Upon seeing the fetus, he released a loud gasp and later
told me he had been totally blown away. He wasn’t the only
one hurt. Both
of us were suddenly and deeply shocked. I could only guess what was
happening to the woman with her baby cupped in her hands. We gently
assisted her as she stood up from the toilet. Then we walked with
her four or five steps to the bedroom, where we helped her lie on the
bed. She was still holding her aborted fetus in her hands.
fused shut, and there was meconium in the lashes and the corners of
both eyes. I could also see it in the nose holes, around the mouth,
and in the ears. There was a respiratory effort present, but it was
happening without drawing any air through the mouth or nose and into
the lungs. As it struggled to breathe and live, the chest tissue
between each tiny rib retracted downward as the chest tried to
expand. The tiny chest would rise, and the rib tissues would sink. No
air was getting in. There was a heartbeat, but it was very slow. This
fetus was dying. I tried bulb suction to clear the nose and
mouth while my partner milked the umbilical cord to force the blood
within it into the tiny body. Then he clamped it and cut it.
this time, the
Firefighter first responders had the gurney placed at the trailer
door. Still holding her aborted fetus in her hands, she walked to it
and laid down on it. Then we loaded mother and gurney into the
ambulance and drove away CODE THREE,
lights and sirens.
where she lay
on the gurney, she was able to watch as I tried to resuscitate her
fetus/baby. I was sitting on the bench seat along the right side of
the patient compartment just next to her holding her fetus in the
palm of my left hand. With mom watching, I began mouth-to-face
rescuing breathing and a soft “tapping” CPR with the tip
of my index finger. We arrived at the ER without any changes in the
conditions of either patient.
the ER, we
continued CPR and rescue breathing until the arrival of the
Pediatrician. Upon seeing it, his first comment was, “we just
don’t have a viable fetus here.” Wayne, my partner and
father-to-be, said he had known it immediately. I think mom knew it
while she was still in the trailer bathroom, and probably I did too.
But, the only thing to do at the time was to try.
ambulance, my partner and I sat on the rear step at the open double
doors of the patient compartment and discussed the whole event. We
were trying to understand what had just happened. Remember, he and
his wife were expecting, and he was still experiencing that initial
shock. Talking about it helped some, maybe, but not a lot. We were
both still deeply stunned by the whole experience.
only thing left
to do was the paperwork and get ready for the next one. It was now
about 5:30 pm. Maybe we could return to our station and get some
rest. About five minutes into our drive, the radio spoke again. They
said it was a self-inflicted “GSW,” a gunshot wound
by a shotgun.
Dutiful Nevada Wife
drove him to death.
discharged our last patient, the man with the shotgun wound, and were
still parked in the ambulance parking area in front of the double
doors leading into the emergency room. After each transport (not all
dispatches result in a patient or a transport of a patient), there is
always some cleaning and restocking. The four things always needing
to be done, besides re-stocking, were to wipe down the gurney, change
the linens, wipe all surfaces and mop the floor. Always.
most calls, it
was usually as minimal as that. On others, it could be a major
cleaning involving the walls, floors, gurney, equipment, ceiling,
cabinet doors, and passenger bench. In other words, everything. After
the call we had just completed, the floor needed some special
attention, or specifically, the corners where the floor met the
injured himself critically by shooting himself with his shotgun.
Despite two tourniquets, pressure dressings, and tight wrappings, a
lot of venous and arterial blood was still escaping. There was also
leakage of intracellular fluids from all the individual cells which
had been blown apart or open. This wound was too large to stop all
the bleeding. It involved the loss of the entire front or top part
of the left leg, from the groin to the knee.
man no longer
had the top front part of his left upper leg. Most of it was still
back in his house on the linoleum. That is, of course, except for
all the fragments and the remaining twenty percent of his liquids
which were now on our patient compartment floor.
condition required a CODE THREE,
and sirens transport from the scene of the incident to the emergency
room. There was no time to spare. This man needed many infusions of
whole blood. Because of our emergency transport, the rocking and
tilting of the ambulance spread all that seepage, and the small
pieces of tissue and bone included within it, all over the floor
where it collected in the wall/floor corner junctions.
difficult to clean correctly, but there was no other option. It had
to be done to sterilize the junction area. The removal of the solid
materials prevented any bacteria from growing, thus preventing the
unwanted smells of rotting human tissue.
was applying the
“toothbrush method” with alcohol to clean the corners
when a car pulled up right behind the open double rear doors of the
patient compartment. The gurney was still outside and was now
between those doors and the car. We hadn’t yet slid it back
into the patient compartment because I was still cleaning the
corners. A woman was driving the car, and an older man was slumped
forward in the front passenger seat. Slumping is not a good sign,
especially for an older man. But we’ll get back to that.
we pulled up to
the house, the front door was closed, and no one was in sight. No
one at all. Paramedics know it is not good to be the first to arrive
at a call that involves a gun. The police must first secure the
scene and then allow us to enter. That is the standard operating
procedure, and there were no police.
dispatch and were told they would arrive in about five minutes. We
were also told the caller was currently talking with them and it was
safe to enter. The emergency was an accidentally self-inflicted
wound, and the gun was empty. The guy was alone in the house, and
the front door, although closed, was unlocked.
I didn’t trust the dispatchers in the Emergency Call Center. They could
only act on the information they received. However, there
were many times when there was a big difference between their
information and what we found upon arrival. Anyway, the Police
rolled up as my partner, and I discussed entering the house. With
their hands on their weapons, they slowly opened the front door,
looked in, stepped in, then looked back out at us and waved toward us
house was a
small older house built many years ago and still had the original
linoleum on the floor. The room was furnished as any small living
room probably would have been, with one exception. In the middle of
the room, covered with gun cleaning supplies, was a card table, the
folding kind. There was also one folding metal chair. It was tipped
over backward and resting in a large pool of blood. A huge pool of
I stepped into
the front room, I saw a broad streak of smeared blood on that
original linoleum floor. It was a straight line trailing away from
the huge pool of blood. It almost looked like someone had done a
long, wide, red finger painting. Mixed into that finger
painting-like smeared blood were small pieces of fabric and chunks of
tissue. The tissue chunks included red muscle pieces, white skin,
yellow fat, and some ivory-white bone. Not big pieces, all of them
were shavings and small chips. At the same time came the smell of
gunpowder hanging in the air.
painting-like smear of blood stretched to and through a door on the
far side of the room about ten feet from the table. It went directly
into the kitchen another eight to ten feet and ended at a guy sitting
on the floor and talking on the phone. He had somehow managed to
drag himself almost twenty feet to the nearest phone.
was so much
blood on the linoleum between the pool and the streak he should not
have been alive, let alone conscious and talking intelligently. He
was sitting upright on the floor with his back against some drawers
to the left of the sink, and he had the phone in his hand.
was one of those
old-style wall phones designed so when it wasn’t in use, the
handpiece could rest in the cradle over the dialing wheel. It had
one of those long curly cords from the handpiece to the phone and was
mounted on the wall about five feet above the linoleum floor. How
this guy reached it is a mystery I’ll carry forever.
must have been
the closest, if not the only, phone in the house, and to say this guy
needed a phone would be one of the greatest understatements of the
year. He had been cleaning his “unloaded” shotgun, and
then “Bang!” He was missing the top part of his upper
left leg. The little pieces of bone in the blood had come from the
top of the Femur. It sustained a lot of damage. He had not
immediately bled to death due primarily to the incredible engineering
of the arterial circulatory system of the human body.
severed by a blast like the one from this guy’s shotgun or by a
crushing injury, they automatically pucker and constrict to close
themselves. Automatically. It’s an ingenious and
sophisticated method of stopping blood from squirting from the
high-pressure arteries. Only the arteries do it. Blood escaping
from the low-pressure veins flows much slower and is, therefore, less
life-threatening to a point. I have no doubt it was designed by the
Master Medical Engineer.
applying a tourniquet and some pressure dressings, we moved the
patient quickly to the ambulance. He had lost so much blood he was
in critical condition, perhaps extremely critical. Because of this,
we did our additional treatments, including two fluid-replacing IVs,
some more pressure dressings, and applying high flow Oxygen in the
ambulance on the way to the hospital CODE
THREE, lights and sirens. This saved time and this man’s
time was running out, just like his blood. We arrived at the
emergency room in time for him to survive his blood loss.
there we were at
the emergency room doors. I was on my hands and knees using that
toothbrush method to clean the corners of our patient’s tissues
and blood. My partner was inside getting replacements for the
supplies we used to treat our patient when that car pulled up with
the slumping man in the right front passenger seat. I stopped what I
was doing, got out of the ambulance, walked to the car, and looked
was blue, and he was not breathing. I turned and ran to the
emergency room doors, pushed one of them open, and yelled, “Cardiac
arrest in the parking lot!” All the right things began to
happen. In an instant, the Cardiac Team came out with a gurney and
pulled the man out of the car.
they laid him
onto it, two members of the team, one on each side of the gurney,
stood on the bottom rails, so they were riding along with the gurney.
One began CPR. The other began mouth-to-mouth rescue breathing. At
the same time, two other people, one at the head and the other at the
foot began rolling him and the two riders on each side of the gurney
into the emergency room. It was all done very quickly and
remained outside with me. She was telling me what happened, and it
seemed important to tell her story and that I should listen to her. She
even delayed going inside to be with her husband to talk with me. This
seemed very strange. Usually, you can’t pry the family
away from their loved one(s) in an emergency. But, here she was,
talking to me.
admitted he wasn’t feeling well. She said this was a big
admission for this self-reliant-read stubborn-Nevada pioneer. “He
never complained,” she said. “Never. His whole life, he
just did what he felt needed to be done when I could see he should
not be doing it.”
say,” she continued, “It has to get done, Ma. Who else
is going to do it?” “There was no use arguing with him,”
she added. “For over fifty-five years, he would never give in. He would
never let me or any of the kids have our ways. It was
always his way. He surprised me by admitting he wasn’t feeling
well. He didn’t ever do something like that.
calling 911 to send an ambulance, but he would have none of it, and
that was it. He had made his decision. Once again, things were
going to be done his way. “Drive me in the car, Ma,” he
had told her, and that was what she did. They then walked to the
car, got in, and she started driving.
told me to drive him, and all our lives, we always had to do things
his way. I didn’t want to cause him any discomfort, so I drove
really slow. Real slow.” It seemed to me there was a double
meaning in her tone.
about ten minutes from their house. Not too far. I knew this
because she had told me where they lived. On the way, there were
several traffic lights, and it was just about dinner time, so the
traffic was somewhat heavy. She drove slowly and carefully, watching
the traffic and managing to stop at each light along the way. It had
taken her about twenty minutes to make that ten-minute drive to the
hospital. She said, “At the third stoplight, he fell asleep. I knew he
was probably gone.”
a long life of
doing things his way and keeping her vows of loyalty to her husband,
she had once again faithfully completed the last task he had told her
to do. She slowly and dutifully drove “that stubborn bastard”
(her words) to his death.
her, I felt confident she knew what she was doing and what was
happening with her husband. I was also pretty sure she knew I knew
what she was implying. It was as if she wanted me to know. While
she was still talking, a nurse came out and asked her to come in. They
needed her to register her husband.
partner and I
finished cleaning and restocking the ambulance and began our drive
back to the station. I didn’t say anything to him about the
conversation with the wife. I considered it private and was
perfectly content to keep it between us. I felt honored she chose me
to hear her story.
patient with the
shotgun blast to his leg needed a lot of blood and had his leg
amputated just below the hip. The man in the right front seat of the
car could not be saved.
actually made it
back to our station and were able to sleep for about four and a half
hours, but it was not to last. This shift would not end.
story of two brothers at university
was a little past midnight when the alarm went off. The call was at
Juniper Hall on the campus of the University of Nevada in Reno. We
responded CODE THREE
lights and sirens,
and because we were close to the University, we arrived at the scene
about four minutes after receiving the dispatch.
my partner and I
approached the dorm's front door, we could see a large crowd
gathered. It was so large it had spilled off the sidewalk and
continued into the street, and it was silent. Not a sound. Usually,
people wanting to be helpful are volunteering information like, “He’s
in the lobby,” and other such comments. This time on that Reno
night, amid all those people, there was nothing, and it was very
we entered the
building, we encountered a smaller group of people in the dorm
lobby. This time, it was limited only to Firefighters and Police
Officers. They were standing in front of the elevator, and they,
too, were silent. Again, very strange indeed.
door to the
elevator box was open, and it had stopped short of the lobby floor by
about a foot and a half. There was also a liquid dripping from above
the elevator onto the lobby floor, and I looked up to see where it
was dripping from.
I did, at the
upper left corner of the box, I came face to face with some “thing”
staring down at me that did not appear to be human. The liquid was
oozing out of the “thing’s” skin as if it was
sweating and then collecting at the point of what appeared to be a
chin. From there, it dripped onto the floor.
I saw staring down at me was a human head. At first, I only knew
this because the Firefighters and Police Officers had told me. It
was “facing” forward with the “chin”
downward, was perfectly round, and about twice as large as a
neck visible, and really, there wasn’t a chin. Or a face. Or
a nose, or ears, or mouth, or eyebrows, or eye sockets, or
cheekbones, or forehead, or anything else that normally provides
depth and texture to a human face. Everything, every recognizable
facial feature, had been stretched smooth. I guess they were there,
but they appeared to have been drawn or painted onto the surface of
one very large, perfectly round balloon which was inflated way beyond
its normal capacity. It was so swollen it looked like it would
explode any minute. I didn’t know why it already hadn’t. And then there
were the colors.
healthy pink skin of a Caucasian. There was nothing of that, nothing
at all. The colors I saw were mostly black-purple and maroon, so
dark it too looked black. Some pale, yellow areas were spread
through and blended into and under all the dark colors. This
appeared to be fat tissue from beneath the skin that had been forced
onto the surface and had mixed in with the dark colors. Dark red
patches of various thicknesses were also on the surface. These
probably were from the blood that also had been forced through the
skin and was now clotted. It was very difficult to look at, and it
wasn’t only because of those horrible colors.
surface were two flat circles that looked like eyes, except there
were no corners or eye shapes. Between them were two holes that used
to be part of the nose but the nose that should have been between the
eyes, if they were eyes, wasn’t there. The circles and the two
holes between them looked like someone had painted them onto the
flat, round surface.
at least twice the size of a normal eye, and inside each were two
more circles. First, there was one of white, the sclera of the eye.
Inside that, there was one of green, the iris, and inside that was a
huge dark round center. Huge and dark. It was like looking into the
black hole of stark terror. They made me shudder as I looked up at
them, looking down at me.
knew those eye
circles were staring down into space, but it seemed they were staring
directly at me, and the terror I saw in them was not to be believed.
They were frozen in time, screaming in amazed shock, incredible pain,
and stark horror. Even today, over thirty-five years later, I can’t
stop seeing them. I would say they were the worst things I had ever
seen, those eyes and the burned human flesh in the Vietnam war. I
can still see everything as plainly as I saw it on that night in
first, I thought
perhaps it wasn’t a human head. Hopefully, all these people
gathered in the lobby were wrong in their collective assessments.
Perhaps it was one of those mythical creatures called a gargoyle that
was placed on ancient buildings to ward off various evil spirits.
Perhaps some mischievous college student had put it there, at the
corner of the elevator box, as a joke. But this was no joke, and
this dispatch turned out to be the worst ambulance call I had ever
experienced, before or after, in my entire tenure as a Paramedic.
was a game they
played, the student residents of Juniper Hall. Only on this occasion
it had suddenly stopped being a game and turned deadly. There was no
getting around it. There really was a college student up there
jammed between the corner of the elevator box and the wall of the
elevator shaft, and all of us gathered in the lobby, the
Firefighters, the Police Officers, my partner, and I had to deal with
the box corner
began squashing him against the shaft wall, the student must have
suffered from the conscious, terrified, horrified, and painful
disbelief of knowing what was happening until the end slowly arrived.
This is the story of how it came to be.
been playing The Elevator Game. It was easy to do. All they needed
was a chair and an elevator. After placing the chair in the elevator
box just below the ceiling hatch, the older brother used it to climb
up and open the hatch. Then he climbed through it onto the roof and
pulled the chair up after him.
brother at the controls, it must have been a fun ride sitting in that
chair or standing on the box roof while the elevator rose or
descended within the metal framing of its tracking matrix. Up and
down he rode, up and down until, of course, that wasn’t enough. That’s
when they added the “Ride, jump off, jump on and
ride” extra component of the game.
four floors. The Freshman brother was inside the box at the controls
of the elevator. He began The Elevator Game by pressing the
fourth-floor button. Once pressed, the elevator rose from the ground
floor to the fourth floor without stopping. That was how the
elevator was programmed.
began to move up, the older brother readied himself to jump off the
top onto and into the metal matrix in which the box was tracking. He
had to jump quickly and a little upward. Doing this would allow him
enough time to embed himself within the metal matrix. It was
necessary to do this so the box could continue its excursion upward
without hitting him after his jump.
third floor was
the jumping floor. It provided the proper amount of time for a fun
ride back on top of the box down to the ground floor. As The
Elevator Game was happening, both the students were lost in
unthinking enjoyment. So they could hear themselves talk and laugh,
they left the ceiling hatch open.
was a fun Friday
night for two brothers enjoying time away from home at university. The
college years were supposed to be like this. Some of the best
years of our lives. What could happen? After the older brother made
his jump, the box continued rising to the fourth floor and stopped. He
then yelled, “I’m ready. Send it.” Thus began
the tragic events. When the top of the box was in the correct
position at the third floor, the older brother jumped.
the week just
ending, the elevator chains, wheels, and pulleys had been serviced,
leaving behind a small pool of oil. It was right where the older
brother had landed after his jump. Upon contact with the oil, he
continued forward, sliding right off the roof and down into the space
between the wall of the shaft and the corner of the elevator box.
he slid, he must
have been on his back and tried to turn to his left, probably to grab
onto something to stop himself. Because of this, when he slid down
into the shaft, he was still partially turned at the waist with his
back toward the shaft wall and his front toward the corner of the
elevator box. This turn to the left allowed the point of the corner
of the box to push directly into his upper abdomen.
was in the spot
where the ribs come together at the upside-down “V”
formation. The corner point pressed deeper and deeper into him as
the box continued its descent. While this happened, he was screaming
ever louder, “Stop it, stop the elevator! Oh God, stop it,
Inside the elevator,
the freshman brother could hear everything and was in total shock and
fear. He had heard his brother land on the top of the box and slide
across it. Then he heard the screaming and the noise of his
brother’s feet kicking the outside box wall right next to his
ear as he stood at the button panel. He knew what was happening to
cries and kicks became less frequent and softer and softer and softer
until there was silence. He tried, again and again, to stop the
elevator, hitting every button over and over and over, again and
again, in a vain effort to stop it. Every button, that is, except
pressed the first-floor button, there was no way to stop the
elevator's descent. It was designed to continue without stopping
until it completed the initial command. In his total disorientation
caused by the terror and fear of the moment, he had pressed every
button on the control panel except for one.
was the one
button that, had it been pressed, would have immediately stopped the
process. That button was the bright red emergency stop button in
plain sight on the panel next to all the other buttons. But he had
not, and because of that, his brother was slowly squashed to death as
the elevator box descended.
I was getting
this report from the Firefighters and Police Officers, we all were
still standing in the lobby in front of the open doors of the
elevator with those huge, round eye circles staring down at me. The
liquid was still dripping from the chin onto the lobby floor. The
freshman brother was there with us and kept repeatedly saying, "
I killed my brother, “I killed my brother, I killed my brother,
I killed my brother.”
walked up to him
and, placing one of my hands on each shoulder, I looked him straight
in the eyes and said, “No, you did not. An accident killed
your brother, not you.” He stopped saying it, but I doubted he
had accepted what I said.
eyes were empty. No light. No glistening. No blinking. No tears. No
all. If our eyes are the windows to our soul, his windows were
closed, and at that moment, I feared they would never re-open. He
was just gone. On that night in Reno, Nevada, the family of those
two brothers lost two sons. What a horrible night for that family.
had to climb onto
the top of the elevator box to ensure death had occurred. It was
already obvious, but it had to be done to make it official, and
because I was the senior medical person at the scene, the task fell
surreal. On the box top was the chair knocked over onto its side. Next
to it was the pool of oil with a straight-line smear leading
directly to the edge of the box where the older brother was still in
place, squashed between it and the wall. He really was there. It
wasn’t a nightmare, and yet, it was.
the dark elevator
shaft, the smells of that oil, and the ozone smell of the electric
equipment, were hanging thick in the air. There was also the
sick-sweet smell of old blood mixed with alcohol. That odor always
reminded me of pancake syrup. I had smelled it too many times at
countless auto crash scenes.
walked over to
where the student was jammed between the shaft wall and the corner of
the box, being careful not to step in the oil, and looked down at the
top and back of his head and then on down passed it. His upper body
was still turned to the left, toward the corner of the box, toward
me, but his head and face were turned to the right a little, toward
the shaft wall, and were tilted downward.
is why we could
see those horrible eye circles while I was standing in the lobby,
looking up at the corner of the box. After he had slipped on the oil
and was sliding on his back, he must have twisted around to the left
to find a handhold. After not finding it, he must have turned his
head back to the right a little to look down at what was happening to
him. It was in this position that I found him.
had only taken
two or three seconds for him to slide to the edge of the box. Then,
it only took the time needed for the elevator to descend from the
third floor to the lobby for the corner of the box to become embedded
deeply into him. But, that had been enough time for him to turn his
head back to the right and down to see and know what was happening to
him, as it was happening to him. As I was standing over him in the
darkness and smells of that elevator shaft, I could see this boy had
been the victim of a cruel, short but drawn-out death process.
the box corner
squeezed into his body, the pressure it caused inside him increased
and increased. As a result, the contents of his upper abdomen and
the chest cavity were displaced upward, passing through the neck like
it was a tunnel to the floor of the skull. In that skull floor is a
round hole through which the spinal cord passes as it descends from
the brain. This hole is about an inch wide and about two inches
meant all his
organs, including the lungs and heart, the pancreas, the gallbladder,
the liver, the spleen, the kidneys, the aorta, and the other arteries
and veins and other tissues, including a lot of blood, had been
pushed up through the neck tunnel and then through this small hole
into the brain cavity.
probably liquefied all these tissues before passing through that
small hole in the bottom of the skull. There was no other way for
them to enter the brain cavity where there was still a brain. As
they entered, the skull had to expand to about two and a half times
its normal size to allow for all that incoming tissue.
not have been an easy physical process. The pressure needed to
liquefy and squeeze all those tissues through that small hole must
have been incredible, and in the beginning, when still awake, so
must have been the pain.
the top of the elevator box, I approached the freshman brother. As I
did, he turned and walked toward me without saying a word, not one
word. Then, the two of us walked to the ambulance. He was limp and
mute and seemingly in total shutdown. As we walked, I thought he was
going into a catatonic state caused by acute and severe PTSD.
we approached the
right-side double doors of the van ambulance, and in total silence,
without any urging or assistance from me, he stepped into it.
Automatically he laid down on the gurney on his back and just stared
blankly upward toward the ceiling without blinking or moving his
I reached under
him to unbuckle the two gurney safety belts, he didn’t move an
inch. Not one inch. I needed to unfasten them to re-fasten them
over him to secure him to the gurney. Then, I closed the double doors
and sat on the bench seat that ran along the right side of the
patient compartment. I was as near to his head as I could get.
my EMT partner
began to drive us to the hospital, all I did was join him in his
silence. I didn’t even take any vital signs. I didn’t
want to intrude. I let him lie there, staring blankly at the
compartment in this van-type ambulance is contiguous with the
driver's compartment and the two front seats. There is no wall
separating it and the front two bucket seats from the patient
compartment. As I sat near the freshman’s head on the
right-side bench seat, I was directly behind the right front
passenger seat and had an unobstructed view directly out through the
windshield. The two windows of the side double doors were to my
two or three
minutes into the transport, I catch a glimpse through those two
windows of a large, white-panel delivery truck at full speed coming
directly at me and those double doors. There was no way it would not
tee-bone the ambulance. It simply could not miss hitting us.
threw myself over
the patient to cover him on the gurney. As I did, I looked out
through the windshield, and there, in plain sight, was a red traffic
light pointing right at us. We were driving through a red light
without any change of speed. Then, bang! The truck hit us with a
glancing impact. The driver had managed to turn just enough to avoid
hitting us full-on.
I was lying on
top of him, I could feel he didn’t move an inch when the truck
hit us. Not one bit. There was no response at all. No surprise, no
startle reflex, no flinch, no change in expression, and not a sound. He
maintained the same silent demeanor throughout the entire event.
stopped, and the EMT got out and handled everything while I remained
with the freshman. After agreeing to meet the truck driver at the ER
to handle the business of the accident, my EMT partner continued the
transport. As we drove away, I leaned forward and, from behind him,
gently asked, “What happened?” He turned his head to
look right at me. His face was tense and stressed as he said, “All
I could see were those eyes. Just those eyes.” I knew what he
the ER, I gave
the report and released the patient into the care of the ER staff. He
was unchanged from the time we had left Juniper Hall. I realized
my partner had also been injured in this case and took him off duty.
Then I wrote a medical report about what had happened and had him
admitted. I listed a provisional diagnosis of acute PTSD with
hallucinations. Then, I took our ambulance out of service until they
could find a replacement EMT. I now wish someone would have written
one for me. In about an hour, I had a new EMT partner.
should have walked
away that night in Reno, Nevada. I should have admitted myself as a
patient. I should have applied for Social Security Disability for
PTSD myself. I should have parked the ambulance and quit, and walked
away. But like on so many prior occasions, I did none of those.
few years before
coming to Reno, my partner and I in Hawaii had a call that was also
very tragic, as so many were. After it was over, I asked my senior
Paramedic partner, “How are we supposed to handle this stuff?” He was
driving and turned toward me and said, “We just eat our
lunch and get ready for the next one.” I don’t think I
ever got ready for a “next one” like this.
have included a
copy of the story about this tragedy as it was reported in the
“Sagebrush,” the student newspaper for the University of
Nevada at Reno. It was on the front page.
Our dispatch alarm
sounded at about one-thirty in the morning. The dispatcher said it
was an infant in distress, and she didn’t specify what kind of
distress. Once again, it was in Sun Valley. Our response would
require about twenty minutes. That was not good for “an infant
in distress.” Already things were not going well.
When we finally
arrived at the trailer house after our long response time, there was,
of course, a crowd of neighbors gathered just standing around. A
fire truck and two police cars were also on the scene. “Here
we go,” I thought, “they’re all waiting for the
Paramedics. This doesn’t look good.”
The crowds which
gather outside a scene of an emergency tell a lot about what’s
happening inside and this crowd, in their silence, spoke volumes. It
was fair-sized, about twenty people, and was totally silent. They
were standing in two’s and three’s, so it seemed they
knew each other. A few were smoking, but basically, these neighbors
were just there and silent. This, as I had thought, was not only not
good, it was really not good.
Inside the trailer,
my partner and I were directed to a five-drawer chest of drawers. The
drawer second from the top was pulled open and inside that drawer
was a very blue, very cold, and very stiff, long-dead infant lying on
her stomach. She was maybe five months old.
She had been put to
bed in that drawer the night before by the babysitter. I had seen
this done in other situations on other calls, and it seemed like a
safe thing to do. The baby slept there all the time.
parents did not
have a crib, and the drawer seemed to be a deep, safe place. She
could not roll out, and it was high enough from the floor to be away
from any pets. So, there lay this clean, blue, cold, and stiff
perfect little baby on her tummy in clean bedding and with
still-fresh diapers. In this trailer, the baby was well cared for by
This Good Babysitter.
arms were bent
at the elbows and extended up and above her head on both sides. Her
legs were extended downward, bent at the knees with the feet and toes
pointing outward in a normal, “frog-leg” tummy sleeping
head was turned
to the right, and I could see her little baby face, which was blue. So
very blue, and she wasn’t breathing. Because she was so
very blue and stiff and cold, I knew she hadn’t been breathing
for many hours.
entire body was
covered with blue blotches, and the palms of her tiny hands and the
soles of her tiny feet were solid blue. When I attempted to check
for a pulse, it was like touching an ice cube.
whole body was
as hard as a rock with rigor mortis. It was obvious this beautiful
little infant was dead and had been dead for a long time, at least
for more than four hours. She must have stopped breathing right
after being put into her drawer bed.
was so obvious
she was dead, the Firefighters who were first on the scene had not
even started CPR. There was no need. This beautiful little infant,
again, was obviously dead to everyone. Obviously dead to everyone,
that is, except to the fourteen-year-old babysitter. She had been
the one who found her during the morning check.
had kept her responsibilities perfectly during many previous times
watching this baby. She had known her from birth and had wanted one
just like her and was now in full denial. After all, she was the
babysitter, a neighbor, and a family friend. This infant was “her
baby,” and in her tear-filled eyes, I could see she just was
not accepting the fact that “her baby” was gone.
could also see at
fourteen her innocent days of childhood had just ended. At this very
moment, she was experiencing a traumatic and fundamental life change,
and it wasn’t a good one. Now the Paramedics were here, my
partner and I, and she was pleading, “do something. Please. Do
can still hear
her. She was standing close in front of me with tears streaming down
her tortured face. Using just the tips of her index finger and the
thumb, she had a light hold of my shirt where it came together at
the buttons. It was so sad. So. Very. Sad.
heart dropped to
someplace below the floor of the trailer. There was absolutely
nothing to be done that would bring “her baby” back to
real and only
patient here now was the babysitter. She was in a full-blown
emotional crisis, probably driven by some imagined quilt. She also
kept saying to no one in particular, “I let my baby die. I let
my baby die.” It was absolutely crushing to all of us in that
trailer. A real heavy moment.
to treat the
only patient present, the babysitter, I desecrated a corpse and began
a make-believe resuscitation. A little infant corpse pretend
resuscitation. To do this, I needed to lift the long-dead infant
from the drawer bed. As I touched her, she was cold as ice, stiff as
a board, and blue, so totally blue. It was disturbing, very
disturbing, to hold her rigid, cold body in my hands. Over three
decades later, I can still feel that cold.
head, arms, and
legs did not bend or sag like they normally would have if life were
present. Instead, her arms remained extended above her head, still
bent at the elbows and her legs remained rigidly positioned in that
frog leg formation. “I have to do this,” I thought to
myself. “She needs it.”
laid her on the
coffee table on her back, a little dead infant on the coffee table
with her head still turned to the right. I didn’t ask anyone
to assist. I couldn’t do that to them. I was about to
desecrate a corpse, and I alone had to do it. But, without asking,
my partner joined me. I’m sure he knew what I was doing and
why. I was partnered with a good EMT.
watched in silence, along with the Police and Firefighters, my
partner and I desecrated that little infant corpse. After making a
show of it for a while, I looked over to the babysitter and softly
explained to her we had done all we could do. The baby was gone.
using a sheet
from the ambulance to cover her, we left the infant corpse on the
coffee table for the coroner and transported The Good Babysitter to
the emergency room for psychological support. No one knew the
location of the babysitter’s parents, when they would be home,
or how to find them. She was now the patient, and as a
fourteen-year-old minor, we could not abandon her there. The Police
agreed with our decision and would meet us at the hospital.
diagnosis of “Acute severe psychological trauma” for This
Good Babysitter. I was sure it would probably be life-long. We
searched for and found her best friend, and I asked her and her
parents if she could ride with her best friend. They both said,
“Yes,” and followed in their car.
and the medical care delivered in the field are reviewed by the
County Medical Director. It is required for all Paramedics and EMTs
to be ready and able to support their choices for the medical
treatments we provide before consultation with a physician.
one, not one
single person, ever contacted my partner or me about this call. We
waited for it, but it never came. In the eyes of those who review
our actions in the field, this call and what we did must have been
acceptable. It was a big load off my mind.
never saw or heard
of the babysitter again. The cause of the infant's death was
diagnosed as SIDS, Sudden Infant Death Syndrome. I never heard
anything about the parents, and The Good Babysitter was cleared of
any fault. I would not want the job of trying to convince her of
one asked how my
partner and I were doing.
rest for the weary.
had been in our station long enough to park the ambulance and walk
inside when it happened again. We hadn’t even sat down. This
time it was a “woman in distress,” whatever that meant. We turned
around and hurried back to the ambulance.
it was still
late at night, we didn’t turn on the lights or sirens until we
were out of our local neighborhood. That way, we wouldn’t
bother the neighbors who were still sleeping. On some calls in these
early hours, we didn’t use the sirens at all, just the lights.
were rolling with
the lights only, a silent CODE
dispatch contacted us again. “Sparks One, cancel your
response. Cancel Sparks One.” We looked at each other, and my
partner, who was driving, reached up to the buttons over our heads
and turned off the lights. I responded to dispatch that we had
canceled. In silence, both from the ambulance and us, we began
driving back to the station. I turned to my partner and said, “well,
it’s almost three-thirty. Maybe this means our ‘shift
from hell’ is almost over.” Just then, dispatch spoke
other shifts such as this one. Thankfully they were few and far
between. The Paramedic and EMT teams in large metropolitan areas
like New York, Chicago, Los Angeles, etc., didn’t work
twenty-four-hour shifts for this reason. From when they come on duty
for their eight-hour shifts to when they go off, they never stop
running, just like we were doing. But for us, this type of shift was
unusual. They didn’t happen like this in the smaller venues
where the shifts were twenty-four hours. But today, tonight, it was
happening, and I knew I would only have one day to rest before my
next shift. I had had enough, and I just wanted this shift to end.
Red Beanbag Chair.
needle was still in his arm.
DOA,” she said. DOA stands for dead on arrival. This time I
was driving and turned to my partner and said, “another one? If they
know he’s dead, why call us? Why not just call the
coroner?” It was a rhetorical question, of course, and my
partner remained silent. But I think he remained silent because he
was still too sleepy to answer, not because he knew it was a
are going to need another sheet,” At this, he turned his head
to look at me and said, “at least we won’t need to
transport anyone back to Reno doing CPR.” I looked at him and
responded, “let’s hope not.”
the third time
in one shift, we were again on our way to Sun Valley. That had never
happened before. We rolled another silent CODE
THREE and, in about twenty-five minutes, arrived at the
trailer. The police cruiser and fire engine were there with their
lights still on, so I knew it was the correct trailer. As we pulled
up and slowed to a stop, the fire chief came up to me and said, “I
don’t think he needs you, doc. I don’t think he needs
anybody.” I knew this chief, and his assessments were always
“dead” on (Paramedic humor.) As we walked toward the
trailer, I told my partner to bring another sheet.
we entered, the
first thing I saw was a dead man in a huge, red leather bean bag
chair sitting almost in the center of the room. The television was
still on without any sound. It was one of those bean bag chairs that
were so big, a person had to roll out of it before they could stand. He
was deeply sunken into it and looked very dead. Long time dead. The
second thing I saw was a syringe hanging from his left arm with
the needle still in him and an untied tourniquet still in place
around his upper arm.
companion was standing in the living room next to him in her sleeping
clothes and probably had awakened to find him dead in the bean bag
chair. She told us she had come from the bedroom to ask him when he
was coming to bed. She was the only other person in the trailer, so
she had to have been the one to find him and then call.
I approached to
get a closer look, it appeared he had just pierced the vein and was
trying to release the tourniquet with his teeth. At the same time,
he was probably starting to inject whatever he was injecting. One
end of the handkerchief tourniquet was hanging straight down and
lying on his chest below his chin. This must have been the end he
bit to loosen it. The other end was still under his arm and hanging
down along the outside of it.
tail under his
chin and on his chest looked like it had fallen from his mouth to
where it now lay. His right hand was resting in his lap, palm up. It
must have fallen from the syringe as he was doing his injection. I
thought this because the syringe was not empty, and the plunger was
not in all the way.
had vomited, and
there was a lot of it. It had flowed out of his mouth over his chin
down to where it somewhat covered the tail of the tourniquet on his
chest. No vomit was sprayed out to any other place in the room, so
his vomiting must have been a slow process instead of being forceful.
It appeared it had just slowly oozed out of his mouth.
crotch area of
his pants was wet. Frequently in death, the bladder muscles relax.
Actually, all the muscles relax and allow the contents to escape. I
felt his wrist artery in the non-syringe arm and the jugular vein on
the right side of his neck. There was no pulse, and there were no
spontaneous respirations. He was stiff, cold to the touch, and his
face, arms, and fingertips were very blue. This man was dead and had
been for a long time.
the white sheet over the man and the entire bean bag chair, and the
police said the coroner was on his way. All I had done was to state
he was dead. It had to be said officially.
returned to the
ambulance and began our drive back to Reno. We were again far out of
our response area and needed to return as soon as possible. We still
had three and a half hours left on our shift, and there was plenty of
time for more dispatches. We arrived at our quarters at about five
am and had two-and-a-half hours of uninterrupted sleep. At about
7:45 am, the oncoming crew arrived to take over. Finally, our shift
from hell was over.
twenty-four hours, we had experienced thirteen dispatches consisting
of nine deaths, one “save,” two extremely critical
patients who went on to survive, and one dispatch canceled en route. I
was ready to go home. I had to be back the next morning to do it
it turned out, my
entire day off consisted of eating breakfast, playing with my cat,
and doing laundry. About 10:00 am, I went to bed and slept until
6:30 am the next morning, about twenty and a half hours. I didn’t
even wake up to pee.
ended, but I knew there would be more like this one. I knew there
would be more suffering and horror and death. When I awoke the next
morning, I took my bath and shaved. While shaving, I looked myself
in the eyes and said out loud, “I wonder who will die today.” I was a
Paramedic I was, and it’s a Paramedic I am,
that, nothing can change.
was a way of life, a series of events,
even old age cannot rearrange.
many memories, so many thoughts,
carried night and day.
has never happened,
much longer will they stay?
haunt me always,
matter where I roam.
won't let me be,
found a permanent home.
are days I’m sad and nights I cry,
seems just yesterday I was there.
heart attacks, car wrecks and OD’s,
SIDS babies new and fair.
shut down to avoid involvement,
I entered tragedy and horror ad-lib.
life was in an avoidance mode,
all my feelings I hid.
years and years, this was my way,
thinking of what was to come.
hid my feelings in drugs and alcohol,
a life undone.
decades I “self-medicated,”
make those memories stay away.
Recovery left them untouched,
they're all still here today.
I’m writing them down to get them out, out, out,
late, but I really must try,
I’ll find some peace, peace, peace,
willing before I
of the message
won't know where to send it.)
Henry's story list and biography
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