Читать книгу My Ambulance Education - Joseph F. Clark - Страница 7

Police, medical personnel and clergy are all profes sionals who deal with death regularly. Death is part of the business. Many people ask me about the worst or most disgusting call I ever had, and some even ask about the worst dead body I ever had to deal with during my years on the job. For me, the dead body that was the hardest to deal with was one of the first I ever encountered. A person is a person, and when life ends the body is a bag of cells, proteins, salts and water. However, that bag of cells was once someone’s son, daughter, husband, wife or loved one. The John and Jane Does emergency personnel often have to deal with were loved by someone, somewhere.

Just before sunrise on a clear spring morning, we were called to assist a police officer. The location was not an address, but a lonely stretch of road. Roger, the cop, had observed a car traveling erratically and pulled over the lone female driver. The woman in her late 40s was dressed in a pink nightgown that made her seem almost ethereal. She stopped and immediately jumped from the car and started to run along the grass verge. Roger ordered her to stop and she appeared to trip and fall face first into the grass. When Roger came up to her she was not moving and apparently unconscious. When he placed his hand on the middle of her back to prevent her from rolling over and turning on him, his hand was pierced by a knife. She hadn’t stabbed him—a large knife had been stabbed into her chest so far that the point was sticking out of her back.

When we arrived Tom bandaged the cop’s cut hand and I went to see the woman. We were not sure if this was a suicide, accident or homicide, so I had to work carefully to preserve the scene. It was easy to see the knife protruding from the middle of her back, just to the right of her spine. Blood was oozing out around the point of the knife and flowing down her right side; the handle was out of sight underneath her. I couldn’t reach her wrists to take a pulse because they were beneath her body as well. Her head was turned to the side, and as I moved the long black hair from her face to try to take a carotid pulse, I got a close look at her. Much to my horror I was looking at the body of Mrs. Collins, the mother of a very close friend of mine from high school.

I had known her son Ryan for many years and been to their house often. I shared dinners there, too. While this changed things for me emotionally, I still needed to work the scene in a professional way. I knew the medical examiner had already been called and that our job was to determine whether the person in front of me, poor Mrs. Collins, was in need of medical care or if she was dead. I quickly and sadly determined that there was no pulse, no respirations or other signs of life from her. The life had been drained from her by the large flow of blood that had gathered below her body in the dirt. The bright red blood was clotting in a smooth, glistening bed below wild violets just starting to bloom.

I turned to Roger, a patient who could still be helped. But Roger refused to be taken to the hospital. He seemed to be behaving as if the scene was his and he was going to work it. Fortunately, a police supervisor arrived and ordered Roger to be taken to the ED. So Tom drove and I sat in the back with the injured cop.

The medical examiner pronounced Mrs. Collins dead and the crime scene forensic people took over. As we headed for the hospital I mentally began plans to attend Mrs. Collins’ funeral. I never told Ryan or anyone else in the Collins family that I was at the scene of her death, nor did I tell the people at the scene that I knew Mrs. Collins. Eventually, the family and the forensic guys were able to piece together that Mrs. Collins had committed suicide. It was not clear if she stabbed herself or intentionally fell on the knife. But a note left on the chopping block in her kitchen apologized for her departure from this world. The funeral was very hard to take. The secret knowledge of being at the scene of her death was a tremendous burden that I didn’t want to talk about. This made me feel incredibly out of place and I was only able to offer the briefest of condolences to the family because I feared breaking down.

This episode also made me realize the human drama that followed our handling of a body and how many lives are changed by the loss of one life. I had known this in theory, but had always been able to walk away from scenes and calls and forget them. Now I saw firsthand how Ryan and his family changed after Mrs. Collins’ body was bundled onto a stretcher. In the months that followed, I was constantly reminded of the call that changed my friend’s life. Ryan became very withdrawn and macabre. His friendships, including with me, soured. Eventually the family moved out of town, probably to get away from memories in their house and around town. What had been happy memories were now reminders of what had been lost. By that time, it was hard for me to go to Ryan’s house. The pictures of Mrs. Collins on the walls gave me flashbacks to the scene with her face-down in the grass.

One way that emergency personnel deal with a DOA is to see the ironic or humorous side of the scene. But I was completely unprepared for Mrs. Collins’ death and the gallows humor that resulted from Roger the cop being stabbed by a dead woman made me feel less than human. I really wish I could have helped Mrs. Collins.

Mrs. Collins death taught me that I had a great deal to learn, and there would be many ways to get that education. I was both an emergency services worker and a college student, and I wanted and needed to be good at both. Fortunately, there were opportunities where both of these interests could be addressed simultaneously. I was taking an anatomy class with the nursing students during the summer, for instance. It was being offered to professional students and was a chance for me to earn college credit while taking a class that would have been difficult to take during my regular chemistry curriculum. Anatomy is a hard class, because there is a lot of information (and some difficult concepts) to be assimilated and there is a great deal of memorization involved. There are hundreds of muscles in a human body and we had to learn them all, as well as where they connected to the bones, the nerves that controlled them and the actions they performed. These concepts were referred to as, “origin, insertion, action, and innervation.”

The 40 or so people in the class included nursing students, pre-med students, pre-dental students and me. It was an accelerated class and a lot of work, but my job gave me opportunities to see anatomy in action. A kid fell down some concrete steps onto some glass, for instance. There was a cut on his hand by his thumb, and he claimed he couldn’t feel or move it. We had learned in class about the nerves that control the hand and thumb. The recurrent branch of the median nerve is an important nerve to the hand that is in that area very close to the skin and I realized that he may have injured this nerve. While this injury was not life threatening, he did need a surgeon and firsthand observations like these helped me in anatomy class. One week we were learning about the cardiovascular system and perfusion to different organs. Each organ and tissue is continuously perfused by blood (that is, it has blood flowing through it) and that blood flow increases and decreases as demand changes. The skeletal muscles need more blood flow when we are exercising, the brain needs more blood during activity such as fast or complicated speech, the intestines need more blood flow after a meal and so on. We were given an essay assignment: “Choose your favorite organ and discuss its perfusion at rest and stimulated.” We had a week to finish the assignment and had to get our chosen tissues approved in advance. The next day the professor, Dr. Brenda Oaks, asked the class if anyone had decided on their organ yet. One person raised her hand. Dr. Oaks said, “OK, what organ do you want to discuss?”

“The penis,” replied the student. There were a few snickers, but not too many—we were paraprofessionals, and the mention of an organ of reproduction was not a big deal.

“OK,” said Dr. Oaks, “that is an interesting choice. That is actually a complicated discussion because of the multiple perfusion changes that occur when this organ is stimulated.”

“Really?” said the student, “I thought it was the simplest.” That brought a lot of laughter from the students. From the class a male voice called out, “Can I do the penis too? I have a fond attachment to that organ.” Dr. Oaks laughed at that.

I resolved to discuss a skeletal muscle in my essay but I did want to meet the student interested in penises. In the hospital café, I saw her in line for lunch. She looked a little like a young Mrs. Collins. I stepped up behind her and casually asked how her essay was going. “I was so embarrassed,” she said.

We chatted briefly and I learned that her name was Holly and she was a nursing student interested in working in the emergency room. I told her my story of ambulance work and college chemistry. She smiled, nodded and said that the ambulance sounded interesting and fun. I agreed and I knew that I would be seeing her again.