Читать книгу My Ambulance Education - Joseph F. Clark - Страница 6

When the holidays are approaching, death always seems to take on an added poignancy. During my first year on the ambulance, fall came and went all too fast and the winter was here. High school kids were learning the skills they would need for life, and one of these skills is driving. Teenagers kill themselves all too often in car accidents caused by speed and reckless driving, but a car can kill in many ways besides the shocking wreck wrapped around a tree.

Tom was a great partner who was my age and quite experienced. He was working on the ambulance full-time to pay for school—as he put it, he was on the eight-year plan, because it was going to take him that long to finish college. Tom wanted to be an engineer and make prosthetic devices for people who lost limbs. He had a slight build and looked frail, but this appearance masked a dynamic and energetic person who could be a powerful one-man army if necessary. It was rumored that he was a third-degree black belt in karate and knew a half dozen ways to kill a person with his bare hands. Tom was not a person to mess with, but I liked him a lot and enjoyed spending time with him both at work and away from it.

One very cold winter morning we were called to the scene of a “person not moving in a car” in the park. I first imagined a drunk who fell asleep and might be hypothermic. We arrived with the cops to find a car and something in the back seat that looked like a person not moving. The doors were locked, so after a bit of pounding on the car to see if someone would wake up, we smashed the windows and let ourselves in. Only then did I realize that the car was running. The inside was warm, with a ripe smell of exhaust and dead person. Two persons to be exact: a teenage boy and girl, both dead from carbon monoxide poisoning. Their arms, legs, lips and lower extremities were locked together in a lasting and terminal embrace.

Apparently they had headed out to the park for a latenight rendezvous to celebrate the victory of the local high school football team. They parked the car, got in the back seat, took off their clothes and got under some blankets. The driver had left the engine and heater on. The problem was that he had backed up into a snow bank. The snow blocked the exhaust, so the car filled with odorless but deadly fumes. They enjoyed a night of passion and fell asleep with their lips joined in a deep kiss. I had to pull their heads apart to check for signs of life and saw that each bore the impression of the other’s puckered lips after I separated them.

There was nothing we could do for them, but we nonetheless decided to take them to the hospital by ambulance. Though not completely standard operating procedure (SOP), we occasionally did this to provide the gentlest possible environment for the families—so they could identify the bodies in the ED rather than the morgue. Tom and I started to untangle the arms and legs of these two completely naked lovers, a John and Jane Doe. (Using the terms John and Jane Doe for unknown persons, even in written reports, is common practice in medicine—not just in North America, but around the world.) John was on top, but when we started to lift him off of Jane something prevented us. They were joined at the waist. They had been making love when they died and he was still inside her. I ended their coital encounter that morning and John Doe was shipped off to the hospital with all his anatomy present and accounted for. There is no delicate way to describe the process of retrieving his male organ—this is not a technique they teach ambulance personnel—but it did remind me of an old joke. What did the leper say to the prostitute? Keep the tip.

The story of Jane and John Doe made the papers. Previously, when I participated in calls that made the news, I was generally shocked at how poorly the papers presented the facts of the call. This time, however, I was grateful for how little detail they included about John and Jane’s last hours. Tom said the paper should have made it clear that they went out with a bang. Blunt as he was, Tom’s defense was humor and this was his way of dealing with the tragic loss of two high school students.

The weather got even colder during the next few days. One of these mornings Tom and I were called to an exclusive neighborhood known for its large singlefamily houses. The call came in simply as “police request an ambulance,” so we had no idea what we would see when we got there. When Tom and I arrived at the address, there were already two police cruisers and an unmarked car in front of the house. The unmarked car was a bad sign, because that meant a police supervisor was needed at the call. We were soon speaking with the detective supervising the scene, who was underdressed for the weather. With his hands firmly in the pockets of his flimsy jacket, he brusquely said, “We have a murder scene. Confirm the corpse is a corpse, don’t touch anything, and get out.”

It is not uncommon for the PD to request a confirmation of death at the scene, so we were there to make sure the person in question was deceased and let the ME take the case. The odd part of this scene was that the corpse was under the porch of an affluent person’s house. The homeowner had found the body and the cops didn’t want it moved until they had a chance to see if there was any evidence. I had experience with this sort of thing, so I grabbed a stethoscope as well as a flashlight and headed under the porch. There I found a middle-aged white man with Mediterranean features. He was dressed only in his underwear and his hands were tied behind his back with duct tape. He was sitting up with his legs apart, propped up by his hands behind his back. His head was leaning forward and there was a bloody icicle hanging down the right side of his face coming from the single bullet hole in his right temple. I placed the stethoscope on his bare back and it made a clinking noise. This gentleman was frozen solid. With my bare finger, I tapped his back and it felt like a frozen chicken right out of the freezer. He was definitely very dead.

I crawled out of the porch and turned the scene over to the police. Tom and I stayed to write up the call and observe the spectacle. There was an impending logistical problem and I wanted to see how the police dealt with it. The entrance to the crawlspace beneath the porch was very low and narrow. The corpse was frozen solid and spread out in such a way that it would be impossible for it to pass through the opening. I wanted to watch as they went through the process of advising the homeowner that they would have to disassemble part of his porch before the body could be removed. We also stayed to see if we could get a name to use in the paperwork. Tom suggested just writing it up as a John Doe, but I said that since we’d already done a John Doe that week we ought to use another name. I suggested Papa Doe, because the victim looked like the stereotypical Italian mafia boss. Tom, however, suggested a better name: Popsicle Doe. Though the facts behind this call may never be fully known, it appeared that Popsicle Doe was killed as part of a mob hit and the body placed at that address as a message to the residents. (I diligently scanned the obituaries and watched for news stories on this victim, but I don’t know if Popsicle Doe was ever identified.) The homeowner denied knowing who Popsicle Doe was, so we filed the report with that name. Before we left though, Tom and I said the paramedic blessing for Popsicle Doe: “He’s dead meat. Let’s beat feet.”

Very late that night, Tom and I entertained ourselves by listening to the police chase a burglar across the rooftops of a block of buildings. The chase ended suddenly and a call went up for the ambulance. We knew it was for the burglar and not the police because the call came in as “police request the ambulance at the scene.” If a police officer was injured, they would say “officer down.” Those words would mobilize the emergency services, but that was not what we were heading to now. It turned out that two officers were chasing the suspected thief when he tried to jump across an alley to the neighboring building. I’m sure he had seen a bad guy on TV get away by doing this, but this time the bad guy missed the roof he was aiming for. He hit the wall of the brick building and slid down it to the alley below. The fall was seven floors, so he was not likely to survive. When the younger of the two officers saw the guy fall, he turned to run down to the alley. His partner grabbed him and said, “Do you think he is going to get up and run away?” So the two of them walked down the stairs while calling the ambulance. When we arrived, Tom went to check our patient while I brought the equipment. The burglar was dead, so we needed to determine what the police wanted us to do. This type of scene would require an investigation to ensure that the rights of the burglar had not been not violated. We would probably have to wait for the medical examiner to turn up and release the body to the ME’s office. But the cops seemed to be preoccupied with shining their flashlights on the wall of the building and looking intently at it. What was so interesting for them were the obvious bloody streaks: the burglar had left skid marks down the side of the building as he fell. When we looked closer at the body in front of us, we saw that the man’s hands and fingers were severely scraped and scratched, with fingernails missing. Our fleeing burglar had clawed the wall like a cat as he fell, eventually losing his battle with gravity. Visions of a Garfield cartoon scene kept popping into my mind. When we got to the point of trying to identify the burglar we found he had no ID on him. I immediately suggested calling him Garfield Doe and the cops and ambulance personnel unanimously agreed.

Tom and I seemed to have bad luck on calls, with more than our share of unidentifiable bodies. It’s bad enough when a body (and any paper ID in the wallet or purse) has been burned beyond recognition and dental records must be used. The real problem, however, comes when the severely burned victim is still alive.

Burn victims were always difficult calls. Severe burns— third-degree burns over more than 50 percent of the body—are often lethal and it is difficult to handle the patient without removing skin or tissue. The severely burned patient needs fluids, but the skin covering the veins that we normally would use to provide those fluids has been turned to bacon and gristle. Thus the ambulance crew will usually douse the person with sterile water and get him or her to the hospital, where the patient can be given IV fluids through lines into major vessels.

On one of our worst calls, a Ford Pinto was hit from behind by a delivery truck and both burst into flames. The truck driver was able to get out, but the Pinto driver was trapped. We arrived with the fire department, which quickly put out the flames, but there was little hope of finding anyone alive in the burned-out wreck. Nonetheless, Tom went in to check. Inside was a person with third degree burns over what looked to be his entire body. Since he was still in the seat, we couldn’t assess the burns on our patient’s back, but his front was as black as a hamburger lost in the coals of a backyard grill. I was waiting for Tom to confirm that John Doe was DOA (making him a “DoDo”) so we could leave, when he called me over to the car. I grabbed the trauma box and ran to him. Pale and sweating from the heat of the burned car and cooked victim, Tom exclaimed that the victim was still breathing. This galvanized everyone at the scene into action. Our victim was making loud rasping breaths that seemed to crackle like a freshly poured cola. The unusual breathing noise was caused by the trachea, or windpipe, being burned and swollen, narrowing of the air passage. The crackling noises were likely a result of the tissue in his chest being cooked, and thus unable to move with his breaths.

The heat of the fire was cooking his flesh, so our patient needed to be cooled immediately. The fire department gently hosed him down to cool his body while being careful not to spray water in his face. (Water in the face could be inhaled into the lungs.) Next, we needed to get him out of the car as quickly as possible. But knowing the fragile state his skin would be in after such burns, we would need help in moving him gently.

I called over a couple of firefighters and they quickly got the door off the car. We then tried to slide the crispy critter out of the car and onto the stretcher. Tom and I were pulling him towards us and guiding him onto the stretcher when all of a sudden there was a loud ripping noise and a pop. John Doe’s arm came off into Tom’s hands. All four emergency services personnel froze in stunned silence. My stomach was knotted with the horror of what we had just done. As we stared at him holding the left arm of this still-breathing burn victim, he turned to me and gesturing with the charred arm said, “Wanna bite?”

The laughter that followed was forced. Tom was a true believer in the idea that jokes are one of the best defenses against the stresses of this job. None of us really thought his joke was funny, but it jolted us back into action. When we got John Doe on the stretcher, we had to have him sitting up, because all his muscles were cooked into the sitting position. Even his remaining arm was thrust forward as if he was still gripping the steering wheel. As Tom drove us to the hospital and I checked again for breathing sounds coming from our unfortunate passenger. There were none. There was no place on his body where I could easily check for a pulse and because of the position he was stuck in, I couldn’t even consider CPR.

We drove to the hospital with lights and sirens as I sat in back looking at the burnt shell of a man that continued to radiate the heat he had absorbed during the fire. I stared blankly and helplessly at the hole where our patient’s left arm had been. It oozed a thick, viscous blood that dripped down onto the stretcher and pooled on the floor. I tried not to think about the barbecue smell that dominated the ambulance. When we arrived at the hospital I could see in Tom’s red, puffy eyes that he was feeling the anguish of what we had been through.

Later, after we got the greasy feel of burnt human flesh washed off our hands, I asked Tom, “Do you want me to write up this John Doe?”

Tom knew I was really asking him if he was OK, and he came back with the only reply that would tell me that he was. He said, “His name is Barbecue Doe, and I want to write it.” He wrote the call up with surgical precision and detail and dealt with the rest of the day’s calls with his typical gallows humor, but we avoided talking about Barbecue Doe.