Читать книгу My Ambulance Education - Joseph F. Clark - Страница 9

I don’t know what is going through a person’s mind when they are preparing to commit suicide. Frequently, I think the answer must be nothing, because they sometimes do the strangest things.

In big cities, people often jump out of tall buildings to commit suicide. I have been unfortunate enough to actually observe a couple of jumpers hit the pave ment and it is a shocking experience. The body makes a sickening noise that is somewhere between a splash and a thud—I always called that unique noise a splud. When a jumper goes splud, the body actually bounces. Not quite like a rubber ball, but the body definitely rebounds. It’s the bounce that gets the biggest response from witnesses, because it can look like the person is trying to get back up off the ground. The crowd has a big influence on what a jumper does. I have witnessed a small group of people chanting “jump, jump, jump” when a person is perched on a ledge, contemplating the drop in front of him. These chanters actually got other people to join them and their prompting eventually did convince the jumper to step off the ledge. When he jumped, a cheer went up from the crowd that lasted until the splud and the bounce. At that moment, the once boisterous crowd went dead silent. I doubt any of them were ready for what they saw. They suddenly realized what they were doing, what they had participated in and dispersed quickly. People who encourage and witness a jump tend to leave or deny seeing it, while new rubberneckers come to look at the body.

Steve Estes and I were called to a jumper who, after being taunted and beckoned by the crowd, jumped and made a pretty substantial splud. Steve was a former ARP, a Puerto Rican gang member, who got out of the gang and became one of the city’s best paramedics. He lived in the neighborhood he was raised in and was considered a local hero, simply because he was a survivor and now a medical man. He loved the neighborhood and hated the gangs and drug dealers that were killing his people. For him, the degradation of the neighborhood was a very personal loss.

Steve and I went through the usual routine with this jumper, who was still alive when we arrived. Normally when treating a jumper we were watched by a crowd. The onlookers in this case, however, did not want to acknowledge what they had witnessed or contributed to, and they had left. We were there alone with the bloody mess on the pavement. I wondered how those chanters felt when they heard their first splud. The head and neck of the jumper were severely damaged, and it was hard to get air in and out of his lungs. A mixture of blood and phlegm came bubbling and foaming out when we tried to use the respirator to pump oxygen into his lungs. He had multiple broken ribs and our chest compressions were producing a lot of grinding of bones and probably doing little to benefit his circulation. Although the odds were against us, we pressed on with our efforts to save him. We worked well together and did everything right, but he died anyway.

As Steve and I worked our way through the rest of that picture-perfect summer evening, we resolved to head to the beach the next morning. One of the perks of working nights in an East Coast city is that there are beautiful sunrises over the Atlantic Ocean. That particular summer I worked almost exclusively nights. During the day, I would often head to the beach and sleep there all day long. I therefore had the world’s best tan—or at least the best tan I had ever had. This system of working nights and sleeping on the beach worked very well for the most part. One day, however, I woke up to find the beach completely empty. The reason for this was painfully obvious—it was raining. I was so tired that I hadn’t noticed the light, cold rain that was coming down on me and the lifeguards had all sought sanctuary in their little huts as the bathers left the beach. As I gathered up my stuff and headed home, I felt the eyes of the lifeguards on me and could imagine the conclusions they must have jumped to when they saw me sleep through the rain. Maybe they thought I was dead. I wondered if any of them had bothered to check for a pulse.

I was looking forward to a day at the beach now, but still had to focus on the shift and calls at hand. Steve and I were dispatched to a call of “woman choking.” We got there to find a woman of about 45 in obvious respiratory distress. She wasn’t choking, but she was vigorously coughing, wheezing and sputtering. There was also a distinct chemical smell in the apartment. We got vitals on a Ms. Reichert and gave her some oxygen, while she explained what had happened. She had chronic asthma and used a prescription inhaler whenever she had an asthma attack. Well, this particular attack was severe and she fumbled around in her purse to find her inhaler. She found it and quickly took a big hit from it, inhaling the spray deeply into her lungs. Unfortunately, she had accidentally grabbed her can of pepper spray. This chemical can be lethal when inhaled by an asthma patient.

Ms. Reichert had immediately called 911 and also took her asthma medication. When we got there, her apartment was filled with enough pharmaceuticals and paraphernalia to suggest a person plagued by medical problems. She was in great distress as we took her to the hospital. I drove and Steve took care of Ms. Reichert. He kept her talking to try to prevent her from getting too excited and to keep her mind off of her problem. After we arrived, Steve told me that Ms. Reichert had recounted her sad life story in the back of the ambulance as the effects of the Mace wore off. Apparently she had not only medical but family problems. She had recently lost her parents, had a sister in California that she never saw and felt all alone. Steve advised the ED staff at the hospital that this woman might be depressed. The ED was very good at treating the immediate physical injuries, but Steve was concerned that they might miss the psychological ones.

The next evening we got a call that came in as “California woman requests ambulance for her sister.” The address was the same fifth-floor apartment of Ms. Reichert. When we got to the apartment, the door was locked and there was no answer when we pounded on the door. Steve and I employed an old ambulance trick to get in—we made enough noise in the halls for the neighbors to complain. We told the neighbors to call the building superintendent to bring the keys to let us into the apartment. While waiting, I had a bit of a brainstorm and knocked on the door immediately adjacent to Ms. Reichert’s. An older woman opened the door a crack and I asked, “Excuse me, ma’am, but does your balcony happen to be connected to Ms. Reichert’s balcony?”

The neighbor said, “Yes, it does. Why?”

I quickly explained our urgent need to get into her neighbor’s apartment. She let me in and I rushed to her balcony. It was connected to the neighboring balcony, but there was a thick cinder block wall between the two. I climbed carefully across the small ledge at the edge of the wall onto Ms. Reichert’s balcony. Fortunately, the balcony door was open on this pleasant summer evening, and I rushed past a bleeding Ms. Reichert to open the door for Steve.

Steve brought our equipment over to Ms. Reichert, who was sitting at her kitchen table with a pool of blood spreading out in front of her and spilling onto the floor. On the table were some of her medications, which I recognized from the night before, a straight razor, an empty bottle of cheap wine and a bottle of rubbing alcohol. Ms. Reichert had cut her wrist with the razor, and she was confused and lethargic. Her vital signs were consistent with someone who had lost a lot of blood.

“Did you drink this?” Steve asked, holding up the wine bottle.

“Yes,” murmured Ms. Reichert.

“Did you drink this?” I asked and I held up the rubbing alcohol. I was afraid that she had. Rubbing alcohol is isopropyl alcohol, which is very poisonous. This would bring the call to a true life-and-death emergency. I imagined the damage the rubbing alcohol would be doing to her intestines and liver. Ms. Reichert didn’t answer me—she just kind of shook her head. This response was not very reassuring. “What is this for?” I demanded, still holding the bottle of rubbing alcohol.

“I used it to sterilize the razor,” she said.

In preparing to commit suicide, Ms. Reichert had sterilized the razor she was planning to use. Sterilizing a surgical instrument such as a scalpel is normally done to prevent infection. Ms. Reichert obviously didn’t want to get an infection from her slashed wrists. This also meant that she didn’t want to die from her suicide attempt. We took her to the ED and she survived. This time however, the ED physician did request a psych consult for Ms Reichert.

According to the psychiatrists, Ms. Reichert’s attempted suicide was a cry for help. Her intention was not to die, but to bring attention to herself. This was evident not only in her sterilization of the razor, but also in the fact that she had called her sister to tell her of her intention. This is why the call came in from California.

Fortunately, Ms. Reichert had no lasting physical impairments. Other survivors are not so fortunate—an attempted suicide can result in permanent disability. A non-lethal drug overdose, for instance, can permanently damage a person’s brain, kidneys or liver. The result is often referred to as being “Quinlaned,” after the tragic story of Karen Ann Quinlan, who was in a coma as a result of a drug and alcohol overdose in 1975 until her death 10 years later. In a case like this, a suicide victim is relegated to a life of dependence upon medical personnel, with no chance of a normal life. Therefore, if you ask an ambulance veteran the surest way to commit suicide, you will be inundated with a barrage of suggestions, including standing in front of a train, gassing yourself with carbon monoxide, jumping from a building (above the seventh floor), jumping from a height of greater than eight feet with a rope tied around your neck, or putting a .38-caliber bullet in your mouth. One that usually comes at the top of the list is to use a shotgun to blow your brains out. A shotgun can do an enormous amount of damage too, and if it is pointed anywhere near the head it almost sure to produce lethal injuries. But nothing, not even a shotgun suicide, has a guarantee.

Steve and I got another suicide call that came in as a GSW—a frantic neighbor had heard a shot. We arrived at a single-family house just after the police, who smashed the window in the door and let us in. In the bedroom was a bloody mess. There was a shotgun blood-splatter pattern on the wall above our victim’s head and a tear-stained note on the nightstand. But there was no shotgun anywhere in sight. This made me wonder if it could be a murder.

The patient’s face had been taken off by the blast—he had no visible chin, tongue or nose. One eye was completely gone and there was something that looked like a strand of spaghetti connected to a liquid-filled marble hanging on the other cheek. There was no place on the neck to get a pulse and I was trying the wrist when a gurgling sound came from the neck. My eyes met Steve’s just as I felt a strong and rapid pulse in the shotgun victim’s right wrist. This guy was alive—with no face. The gurgling noise was this poor man, a Mr. Ramone, trying to breathe. Steve and I both picked at the remnants of Mr. Ramone’s neck, trying to find the opening to the trachea. We found it and Steve slid the airway into it and ventilated directly into his lungs. Next we started two IVs and packed his face in large trauma dressings. One of the rookie police officers was a bit shell-shocked by this scene and he wouldn’t get out of our way. So I gave him the two IV bags to hold and asked him to keep them elevated and watch the drip port to make sure there was two drops a second. This made the rookie feel useful and actually helped us a little. Cops, family and bystanders make good IV poles.

We were just getting ready to transfer Mr. Ramone to the stretcher when one of the cops found the shotgun. The force of the blast had sent it all the way across the room and under a dresser. Mr. Ramone must not have had a tight hold on the gun when he pulled the trigger. He also must have clutched the gun too close to his body, so it was not pointing at his brain. He had absolutely no injury to the brain. When Steve and I opened Mr. Ramone’s airway and gave him oxygen, we had saved his life. But we had also consigned him to a life of being blind, mute, and permanently disfigured.

Steve gave the report to the ED physician, Dr. Frank. When he finished, Dr. Frank said, “Mr. Ramone must be the world’s worst shot to miss from zero feet.” Mr. Ramone had gone to great lengths in his preparations to leave the world that day. He had left a thoughtful and detailed note saying goodbye. He also used the usually infallible shotgun technique to end it all, but he was thwarted by his unfortunate aim, and then by Steve and me. All he wanted to do was die and we wouldn’t let him. I hope he understood that we wanted to help him, even though that was against his wishes.

Mr. Ramone, wherever you are, I am sorry to have changed your plans that day.