The
vomit was still slowly coming out and flowing down his “chin.”
Then
it ran down his chest and huge abdomen and down the front of his huge
legs,
(he
didn’t have a lap), where it covered his feet and gathered into
a pool around them.
At
every shift change, the EMT of the on-coming crew washes the
ambulance, and the Paramedic inventories its contents. This
routine happens every shift change, every time. My partner
had
just started with the long-handled washing brush when our dispatch
alarm sounded. I hadn’t even touched the inside of the
ambulance.
The
call came in as a “Man Down.” That was all the
information we received, so we had no idea what we would
find.
After responding lights and sirens, we arrived at a popular Reno
downtown cafe. It was so popular a line extended outside onto the
sidewalk. Everyone was there for those cheap Reno breakfasts
and complimentary cocktails.
A
man stood before that line, frantically waving his arms above his
head. We parked the ambulance next to the police cars and the
fire engine, and as we were getting out, the man who had been waving
approached us.
Almost
yelling, he said, “Follow me. The others are inside.”
While
the Firefighter first responders brought our gurney, oxygen, and
heart monitor from the ambulance, we followed the man to The
Vomit Room.Immediately,
I was hit by the smell. It was debilitating and
horrendous.
I almost added my vomit to that which was already
there.
As
we entered, the wall on the left that fronted the stalls on the right
was coated with vomit. This man must have experienced
something
called “Explosive or Projectile Vomiting.” That’s
when the vomit shoots out forcefully and travels several feet from
the source. The wall on my left was over three feet from the
open stall door. And the floor was covered with the stuff.
After
the initial assault of the smell and the visuals of that
vomit-covered scene, and as soon as I could refocus my eyes, I saw a
huge man. An exceptionally huge man. Somehow he had
wedged himself into the stall on the right of two green metal
stalls. The door was still open inward because once he had
managed to get in and sit on the toilet, there was no room to swing
it closed. No room at all. He filled the entire
stall.
I was amazed.
Do
you remember when you were a kid and watched cartoons? And do
you remember that sometimes in a cartoon, one of the characters is
stuffed into a square box? And do you also remember that when
the cartoon character got out of the box, he remained the same,
square shape of the box? Will, that was what I was looking
at.
A dead, six-hundred-pound man squashed into a box.
He
was so stuffed into it he was squashed against both green metal sides
with his mountainous shoulders and fat arms forced toward the middle
of his huge body. His arms pointed straight down and pushed
inward with the hands and elbows turned outward.
There
was no way this man would have been able to move, let alone clean
himself after completing his mission. As that thought
occurred
to me, I wondered how he had been cleaning himself in any
bathroom.
It was an ugly thought, and with it, a cold shudder passed through my
entire body.
At
the very least, he had to weigh six hundred pounds. Six
hundred
pounds of human flesh covered with vomit squashed into a box.
How he got into the stall, let alone sit on the toilet, will be a
mystery for the ages. He must have somehow been able to
squeeze
in backward.
He
was slumped forward toward the open stall door. His head was
tilted down at his thick neck with his chin on his chest. But
he didn’t have a neck or a chin, just a face and a chest.
I could only tell there was a neck because his head was tilted.
The
vomit was still slowly coming out and flowing down his
“chin.”
Then it ran down his chest and huge abdomen and down the front of his
huge legs (he didn’t have a lap), where it covered his feet and
gathered into a pool around them. The pool was a red mixture
of
ugly, stinking vomit that consisted of freshly eaten and undigested
breakfast food and the free “Breakfast Marys.” Before
we arrived, the Firefighters had been trying to dislodge this huge
man from the stall. They were having a tough time because
there
was no room to get to him and pull him out. Also, because of
the vomit on the floor, they were slipping all over the place and had
no leverage.
So
now, as we arrived, they were using one of their saws with a big,
round blade to cut away the wall. When they finally had it
cut,
the door came with it. In the meantime, without being asked,
my
partner brought two white sheets from our ambulance and spread them
on the floor to provide some needed footing. I had a good
partner.
With
the side wall and stall door gone, the man was pulled off the toilet
and laid on the vomit-covered floor. I used “pulled”
because five big Firefighters could not lift him. Instead,
they
slid him from the stall using his slippery vomit on the
floor.
When they had him out enough so we could get to him, his head was in
front of the toilet where the stall door used to be. They had
him on his back with his face upward so we could treat him.
Then
he vomited again.
It
was like a fountain. The vomit stream went about a
foot-and-a-half straight up into the air above his face. In
the
process, it sprayed those closest with fluid and chunks from his
breakfast. It was an ugly thing, and the smell was
suffocating.
Then
that vomit fell back onto his face and again splashed us. We
tried to roll him onto his side to keep it from going into his mouth
and then into his lungs, but it was futile. Even with the
white
sheets in place, it was like trying to roll a half-filled water
balloon.
The
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 to visualize his cardiac activity. There
was
none. Flatline.
Per
protocol, I ran a paper strip showing that flat line to add to our
report.
Death
had probably occurred immediately, most likely from a fat
embolism.
Fat emboli originate in the fat that collects inside a blood
vessel.
These collections are called Plaque, and pieces of 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 become stuck and obstruct the blood flow. When that
happens, everything downstream dies because of a lack of blood or,
more precisely, a lack of oxygen. It had probably blocked a
vessel in his lungs, heart, or brain.
If
this had not taken his life, the time involved for us to reach him
certainly could have. 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.
We
gathered our 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.
It
was still packed with people eating cheap Reno breakfasts, and there
wasn’t an empty chair. That is, except for the chair our
patient had been sitting in. That one was empty, with his
breakfast plate still there. I wondered who was going to pay
for his breakfast.
I
stopped to speak with some of the people at that table. They
were all still eating as if nothing had happened. A man told
me
he had been eating as usual and was on his fourth breakfast and fifth
Bloody Mary. Pure Gluttony. But who among them was
counting?
He
continued, “He hadn’t said or complained about anything
the whole time we ate. Then suddenly, he moaned, stood up,
and
said he had to use the restroom.”
When
he didn’t return, a friend checked on him. That was it.
When
I radioed the ER, the doctor told us to put our ambulance back into
service and return to our coverage area. We
needed two more white sheets from the ambulance to cover him
completely. One wasn’t big enough, and the two already
in The
Vomite Roomcould
never again be used. About
ten minutes from our station, the radio spoke a second time.
We
would have to wear our vomit-covered uniforms for a while longer.
