One thing that always used to really bother me when I was a working paramedic was the people that would approach me in the coffee shop, with their eyes bright and their cheeks flushed, and want me to tell them what was the worst thing I had ever seen.
My answer was, I've seen people die. Does it get worse than that?
I remember a wreck, some few years back, where we had a lot of patients and could not spend time on trying to bring dead folk back to life. Sometimes we have to make that choice. It's called "triage." I covered two of them, laying in the median, with a sheet.
Later in the call, when I was climbing out of an ambulance with blood from head to toe, I looked up to see two by-standers holding up the corner of that sheet and staring at the bodies. When I started walking towards them, they walked away. When they looked back and saw that I was still coming, they ran to their car and left. It was a wise choice.
I have walked down railroad tracks, picking up a kidney here, a brain there, and putting them in plastic bags. One of my early calls was to a lovely old lady whose entire face had been ripped loose and was hanging down on her chest.
You want the worst? I'll give you two that wake me up at night and break my heart again as soon as I think they're gone.
Now, this is a small community. A lot of people know me. A lot of people have followed my adventures over the radio for years. And everybody seems to follow all the gossip.
Just a word to those local folk. When I write about the EMS, you may think you know the call of which I'm speaking. You are wrong. In every case, I find a way to camouflage it in such a way that I can always show the judge how you are mistaken. You would be surprised how often calls are almost identical. I may, therefore combine calls. I may start out with a wreck where a mother, rather than have her child in a seat, holds him in her lap and crushes the life out of him when there is a wreck that left the back seat and the car seat safe as houses - and then start treating a child who got the same way in a whole entirely different incident. I'm giving you the cold unvarnished truth, but my mama didn't raise no ordinary fool.
There was a woman who had a small child, just barely a toddler. She drove all over and, as a matter of some kind of sick principle, refused to use a car seat. I believe she may have taken a little nip to kind of ward off the cold sometimes. Or maybe it was a big one. I don't know.
One day, with the baby in the front seat, she decided to run head-on into another vehicle.
When I got there, the infant became mine. I've always wished that it had not.
We got the child into the ambulance. There was clearly little chance this child could survive. Any one of several injuries had every right to be fatal but you do what you can do and pray for the best.
The way you do this is to forget that it's a child, forget that it's a person, catalog the injuries and sort them into their proper order. Than you take one and fix it. Then you go to the next one. They're not a patient, they are a series of injuries for you to fix.
You prioritize the problems.
Airway, breathing, circulation.
Your immediate goal is to get oxygen to the brain. If the airway is closed, there will be no breathing, if there is no breathing, there will be no oxygen in the blood, if the heart can't get oxygenated blood to the brain, the patient will die.
Get the airway open. Get them breathing, or breathe for them. Get the heart pumping blood to the brain or pump it yourself. If the blood is running out of them, stop the leak.
The first problem was the airway. The child wasn't breathing and clearly could not breathe because the airway was severely damaged. Looking into the mouth, all you could see was torn meat and tiny little baby teeth down at the opening of the trachea.
I grabbed a laryngoscope, close to the smallest blade we had, and a similar sized endotracheal tube. I turned the tiny light on and started. First I positioned the child in as neutral a position as possible with my partner holding the tiny head so that we would not damage the little spine. Then, holding the tiny jaw open, I tried to sort out the torn tissue to find my way to the epiglottis and the trachea it protects. Hard to see because of all the blood but suctioning the blood didn't help that much – it came back as fast as we suctioned it away. Just keep trying.
I knew where it should be but it was such a mess, and everything so tiny, it was very, very hard. Finally I found the epiglottis and got my blade under it, lifting gently so I could see the trachea – and I saw it. Squashed closed. Okay, got to do something. I tried a lot of stuff and nothing worked.
Maybe, if I could just get the tiny tip of that tiny tube just barely into the opening, I could use the tube itself to do the job.
I tried and tried. I kept losing the whole thing and having to go back and start over. I needed to open that thing so I could look in and pass the tube between the vocal chords.
Finally I gave up on seeing anything and just tried to do it by feel, but that didn't work either. I could get it in a little ways and then it would hang.
This isn't working. I cradled the baby in my arms and made sure that, if somehow something could get through, it would be pure oxygen. My partner drove like a crazy person as hard as that truck would go, which was, back before they governed them down, well over a hundred.
One of us talked to the ER by radio and they were waiting. They snatched the ambulance door open and we all took off for the first treatment room.
I laid the baby on the cot and they took over. I told the doc what we had done and what all I had seen: the torn tissue, the teeny tiny bitty teeth. Then he, and an anesthesiologist he had called in to help, went to work.
I went outside, sat on the ground and cried. I had seen paramedics do that in that spot. And the docs too. It was not uncommon. There was this little corner there, kind of out of the way.
It wasn't very long before the doc came out. He put his hand on my shoulder. He told me that there was nothing I could have done. Those little teeth weren't teeth – they were bitty little vertebrae. The spine had been ripped from the brain, and the reason I couldn't push the tube in blindly was that the trachea had been ripped in two.
The mother? Nothing much. And what did they do to her? Nothing. "She's suffered enough poor thing."
I'm sorry. I don't think so.
I will say no further on the subject except to say that I found a lady psychiatrist who patched me up enough that I could pretend to be okay. Except maybe during the nights. And whenever the sun was up.
Now, as to the other one: It should go much faster.
We were called to a mobile home out in the woods for something. I don't remember what. The trailer was full of younguns and the patient was in the back bedroom. The place reeked of poverty.
We went into the bedroom, examined the patient and determined that the problem was not life threatening. The mother elected not to have us take the child to the ER. My partner went outside and started writing up a report for the mother to sign. I gathered up our stuff and started out.
A little girl, maybe six, maybe even seven, had been beside me the whole time from the first step inside. She was still there. She was wearing a little dress, not very clean lookin. She had pretty brown hair. She kept looking up at me with big soft clear beautiful eyes. Just before we made it to the door, she wrapped her little under-fed arms around my thigh, looked up at me and asked, "Would you please be my daddy?"
Okay. You tell me. Which one of these two calls was the worst? If you had to take one of them yourself, which would it be? The psychiatrist lady? She couldn't make a choice. Give it a try.
Sleep well tonight. You needn't worry yourself over these matters. Don't worry, I'll take care of that. Me, and a lot more like me in ambulances all around the country and the world.
God help us all.
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