Rescue 471

by Peter Canning

  “Six-eighteen,” the doctor says, calling him.

  I get our times from the office. We arrived on scene at 6:00. He was declared dead at the hospital eighteen minutes later. Unbelievable time coming from where we were.

  I am all fired up. I don’t know if it’s getting the tube, bagging the double EJs or the wild ride, or just that it’s the end of the week for me. I feel sorry for the guy, but the call went great, couldn’t have gone much better. While Arthur is resupplying, I put the stretcher back together. I lift it up to put it in the back of the ambulance, but I can’t get it to lock. I keep slamming it against the lock, but it won’t catch.

  Eric Salisbury, a longtime EMT, is standing there watching me with a bemused look on his face. “Typical paramedic,” he says. “Doesn’t even know how to put the stretcher in. You’re putting it in backward, buddy.”

  I look at the stretcher. Son of a gun. “Hey, I’m tired,” I say. “End of the week.”

  I take it out, turn it around, and finally get it to lock.

  When we clear the hospital, Arthur says, “Nineteen years old. A permanent solution to a temporary problem.” He shakes his head. “What a shame.”

  The Red Sox game is on the radio. First inning. Mike Stanley drives one deep. It’s off the center field fence. A double. Two runs scored.

  “Yes! Yes!” I shout, pounding the roof of the ambulance. “Sox! Sox!”

  “You all right?” he asks.

  “Yeah, no, actually, I have an incredible headache.”

  “Yeah?”

  “It’s killing me. Long fucking week, huh?”

  “We were busy.”

  I feel really spacey. The spaciness you get when you are real tired and can’t concentrate.

  At the base, we shake hands. “Good job on the code,” Art says.

  “You, too. We did great. Have a good weekend.”

  “Drive safely,” he says.

  To get home I take I-84 east, then get on the flyover to I-91. I’ve got the game on, but I’m not paying attention to it. I’m just driving through the night, watching the red taillights, the highway signs. I live in Enfield. I normally take exit 48. I know something is wrong when I look to the right and see the lights of Springfield ahead. I’ve gone five miles past my exit, clear into Massachusetts. I used to live in Springfield so I guess I just tuned out for a bit. I get off the exit and get back on southbound, getting off at exit 49, Route 5. I head south. I see the light up ahead is red. I go right through it. I wasn’t supposed to do that. I go through the next light. Cars are honking at me. Another red light is ahead. I’m not certain what to do. I think about pulling to the side of the road, but instead I go through the light. Three red lights, man, that’s not right. Fortunately, my right turn is up ahead. I take it, and go straight down Alden street, which runs right into my parking lot. I get myself parked and get out. Safe.

  The hallway down to my apartment seems awfully long. I get into my apartment and get a beer and turn on the stereo. I hit random play on the one hundred CD changer and up comes Jimi Hendrix, “All Along the Watchtower.” I sit on the couch, and pick up an old newspaper, but my eyes can’t focus. Too much confusion. The words scroll across the page. Guitar. I sense something wrong. I fear I am poisoned, mother. The giant cords. The Karl Wallenda veins. The pounding in my brain. The red lights that couldn’t contain me. I am weary. No relief. I see a series of fast black-and-white flashing photos of my life. Faces of friends. Faces of patients. A skeleton in a black hood laughing. I want to lie down, but I float upward. The disorder, beer bottles, dirt, and grime ground into the carpet. Flashing lights. My world. I bounce against the ceiling like a balloon.

  I Don’t Want to Die

  The eighty-year-old man is passed out on the hardwood floor just outside the bathroom from which he exited. He is cool and clammy. We are unable to get a pulse or blood pressure. I put him on a nonrebreather. On the monitor he is going at 24. En route to the hospital I start an IV and give him a milligram of atropine and run the bag of saline wide open. His rate comes up to 52, but still no pressure. I am thinking I may have to tube him, though his family told me he wants no extreme measures.

  “I don’t want to die,” he mumbles now, surprising me. “I don’t want to die. I’m not ready.” He is crying.

  After eight hundred ccs, I get a pressure of 90. I ease the fluid off. His pulse is still in the fifties, but I can palpate it. The crisis has passed.

  At the hospital, when his family visits, he is alert and they say he is more coherent than he has been all day. They thank me. “You saved him,” his daughter says to me.

  “Just doing my job,” I say.

  Driving home, I hear his voice over and over, the tears in his eyes, the words, “I don’t want to die, I don’t want to die.” The words crowd around me like the night that has fallen. I feel cramped, closed in. I want to drive back into time, whipping around the globe in my car at a hundred times the speed of light, chasing old sunny blue-sky days at the beach, coconut buttered bathing teens and cut muscles I never had, going back to when I was young and didn’t know about any of this—this getting old and dying, this end.

  An Ordinary Head

  I’m working the Sunday overnight with Toniah Abner. It’s been snowing all night, and we’ve done nothing but B.S. accidents, cars skidding into one another, people with neck and back pain, insurance talking. It’s cold and windy out, and I only have one glove, can’t find the other. We finally get a break around four A. M. We sit in the front of the ambulance, the heat on, and doze. I think I hear our number called. “Four-seven-one?”

  I answer. “Four-seven-one.”

  “Four-seven-one. Motor vehicle accident on Maple Avenue. On a two.”

  I nudge Toniah.

  “Another MVA,” I say.

  “Great,” she says. It is a half hour before our crew change.

  Maple is only a few minutes away. The streets are still snow-covered, and we can’t go more than thirty. Ahead we see two cars in the middle of the road. The back of a white car and on the other side, a Jeep. The doors to the white car are open. Two people stand in the road waiting for us.

  “This is going to be B.S.,” I say.

  As we pull up, Toniah looks back at the white car and sees the windshield is smashed. “Well, maybe not,” she says.

  The cars hit head on. The hood of the white car has been bent upward. The Jeep doesn’t have too much damage.

  “Are you okay?” I ask the man who comes limping toward me.

  “Yeah, I’m all right. You should check him out though. I don’t think he’s doing so good.”

  “He’s got a nasty cut on his head,” the woman says.

  I walk over to the car. There is a grapefruit-sized hole in the windshield. The man is sitting in the front seat, his head slumped forward.

  “Hey, buddy, are you all right?” I ask.

  He doesn’t answer.

  I give his shoulder a little shake. His head falls backward, his mouth open. A grim bony smile. I shiver. He has a huge gash across his forehead. He looks like he has been scalped. I look at his chest. I don’t see any movement. He doesn’t look like he is breathing. He is not breathing. I shout, “Toniah!”

  We extricate him quickly from the car.

  “Is he breathing? Is he all right?” the woman on scene asks.

  I say nothing as we wheel him past her to the ambulance and lift him in the back. Toniah gets out the ambu-bag and monitor as I quickly open my airway kit. I go into his throat, lifting the tongue, looking for the cords. A gush of blood comes at me, but Toniah reaches up, and presses down on his throat, dropping the cords down into view, and blocking off the blood. I pass the tube and quickly secure it. He is flatline on the monitor. Toniah starts compressions. A cop opens the back door. “Get in front and drive!” Toniah says to him.

  Two minutes later, we are out at the hospital and charging into the trauma room. The man has a torn aorta. When they insert a chest tube, blood gushes out. They wor
k him five minutes, then call it.

  We go back to the scene to look for my trauma shears, which I find on the icy ground by the car door. We look at the cars. There is more damage than I thought. The Jeep is extensively damaged under the bumper. The white car seems to have veered across the road. The engine is pushed in a foot or more. The steering column is bent. I look at the hole in the windshield. There resting on the glass, half in, half out of the car are a pair of gold wire-rim glasses.

  * * *

  I’m working with Manny Sandoval. We get a call for a motorcycle accident just blocks from the hospital. Thirty seconds later, HPD calls for a second ambulance, saying it’s really bad. It doesn’t take us a minute to get there. I see a bike wiped out on the sidewalk. A woman moaning nearby. I start toward her when a firefighter—the accident is right across the street from the fire station—says, “Go to him, he’s really bad.” She looks at least alert. I turn and approach him. He is sitting up, his back to me. He turns and looks up at me. His face is a bloody Halloween jack-o’-lantern. His eye is on his cheek, hanging out of its socket, bouncing with the thrashing of his head. “How are you?” I say stupidly, then shout, “Manny, C-spine.”

  “Gloria, Gloria,” the man calls.

  The fireman is telling me he hit the curb and went flying headfirst into the pavement. I try not to look at the eye, as I put the collar on his neck and get him down on the board. We get him in the back of the ambulance in no time flat. As soon as Shirley Lessard and Bruce Lincoln arrive in the second ambulance to take care of the girl, we take off for the hospital. A firefighter drives. When I go to put the nonrebreather on the patient’s face, I have to look right down at the eye and bloody face. I shiver so hard, I heard the sound hrrrurrr escape from my mouth. I look away. I patch to the hospital to get the trauma room ready, then drill an IV in his left arm. Manny suctions blood from his airway and tries to calm him. We’re out and rushing into the trauma room. Response time one minute. Scene time three minutes, transport two.

  “High-speed motorcycle accident, no helmet, flew twenty feet, landed on his face. Massive facial trauma,” I say. I point to his face. “No loss of consciousness. Alert and oriented. Vitals stable. Blood in his airway.” I step back. I watch the faces of the doctors, nurses, and techs as they catch a glimpse of the eye. Their reactions are all similar to mine. They wince. Nasty.

  They knock him out and try to tube him. The tube goes into the stomach and blood gushes out like an oil well. They try again. His whole face is fractured and unstable. The front part of his skull is basically free-floating on his face, top of skull, cheekbones, jaw, all broken off from the cranium. They have to trach him, cutting a hole in his throat to pass a tube into his lungs to protect his breathing. His head seems to swell in front of our eyes. They sit the eye back on his face where the socket once held it. It looks like a lifeless golf ball.

  A couple nights later, I respond to an MVA on the highway. We come around a bend in the road and see it suddenly ahead. “Four-seven-one, holy shit,” I say, into the mike. “We’re out.”

  A tractor trailer is sprawled across the road. It looks like a dinosaur on its back with its neck broken. I see another car in the wreckage. I have to climb a cement embankment to get through the wreckage and to the driver, who the cop has said doesn’t look good. I find the man crashed against the wall, his head caved in, his legs pinned. “What do you need?” my partner, Jack Early, asks.

  “The monitor,” I say.

  I attach the leads. Flatline. I call him right there on the highway. Injury incompatible with life. I run my strip.

  That night I have a dream. I am walking the countryside carrying a head in a black sack. I am trying to sell it, but I am not having much luck. I am on a hilltop among some apple trees when an attractive, well-dressed woman approaches me and says, “I hear you have a head for sale?”

  “I do.”

  “May I see it?”

  I take the head out and show it to her. “It’s not a bad head,” I say. “There is some dried blood and bruising about the nose and face, but it’s still largely intact.”

  She studies it, saying nothing, pondering, wondering whether to invest in this head I have for sale. Finally she says, “Thanks for showing it to me. I’ll get back to you on it.”

  “Okay,” I say. “I’ll be around.”

  I watch her walk off over the next hill. I put the head back in the bag and continue on my journey. I am just an ordinary man carrying some other guy’s head.

  Nicki Joyner

  I hear over the radio a basic crew being assigned a transfer—Nicki Joyner, going from the hospital to a nursing home. Nicki Joyner. A name I won’t forget. I get on the phone and call dispatch. “Can we do this one?” I ask.

  “Sure, if you want. It’s just a basic run. No specials.”

  “We got a transfer,” I say to Arthur, who has just put the stretcher back in the ambulance, after remaking the sheets and resupplying the rig.

  “Oh, no,” he says. “I just put the stretcher away.”

  “Nicki Joyner,” I say. “Going to Mediplex. I requested it.”

  “Nicki Joyner,” he says. He nods and says nothing more.

  I feel trepidation going up in the elevator. The last time we saw her she was on our stretcher, not breathing. I had struggled with the tube. She’d coded, but I’d brought her back, though I have heard she has brain damage. I need to see her for myself, need to come to grips with it.

  Outside the room, the nurse hands me the forms and says, she’s been here for months. She runs down a list of complications: infections, impacted bowels, sepsis. She had an anoxic event, she says. Was in a nursing home for a while, then developed a fever that just wouldn’t go away. I say nothing.

  From the room, I can hear an aide talking to her as she changes her diaper. “You be all right now, pretty girl,” the aide says.

  I am hopeful that she can understand this. I walk in the room and see her now. She is in her thirties. Her hair is short and greasy, her face has a hundred or more whiteheads. I look at her eyes—they float in her head, but don’t focus. Her eyes drift back and forth. She has a hole in her throat—a trach, through which she gets oxygen from a mask. Although she is hemodynamically stable—a good blood pressure, pulse, and respirations on her own—she can’t control her airway. If she were to choke on food, she wouldn’t know it and would stop breathing. The trach lets her breathe without worry, but it is an enticement to infection.

  “Does she respond at all?” I ask the nurse.

  “She seem to move to voices sometimes, but no, dear, she’s …”

  Just then a man comes in the room. “What are they doing here?” he says. He is in his thirties; he goes right to her and strokes her head.

  “They are taking her to Mediplex. Your family knows about it.”

  He nods, then whispers to her, “It’s okay, Nicki girl. How are you today?”

  He looks at us. I wonder if he was there, if he remembers us, but there is no look of recognition. “I didn’t think she was going today,” he says. “Can I get a ride with you?”

  “Sure,” Arthur says.

  We move the stretcher up next to the bed and lower all the side rails. We take her foley bag and lay it on her feet, then grabbing the sheets, we prepare to move her.

  “Okay, ma’am,” I say, “We’re just going to move you over to our bed.”

  “They’re just going to move you, Nicki, honey,” the man translates, running his hand over her forehead, then steps back to let us work.

  We slide her over, then get her comfortable, putting another sheet over her foley bag. Her eyes move back and forth, seeing nothing.

  The man comes down with us in the elevator. I want to ask him questions, but I don’t know what to say, and I don’t want to betray that we were the ones who responded, that if I had gotten the tube in time, none of this might have come to pass. I keep quiet.

  He sits in the front, and I am alone in back with her. We go without lights
and sirens because it is just a simple transfer. I take her blood pressure and pulse and count her respirations, which I record. I shine a light into her eyes. No reaction at all. The pupils stay fixed. I look at her head. I think about how I tried to lift her tongue up and peer down into her cords. How they were hard to see, and then when I saw them, they were closed shut, and I couldn’t pass the tube. How even when I tried to bag her, no air got through, and how it was only after her heart had stopped that I was able to finally get the tube in and get air back to her brain. Too late. Right here on this same stretcher, in this same ambulance, we’d fought and lost. If there was one call I could do over, this would be the one. If I’d tubed her and kept her brain alive, she’d have been out of the hospital and right now could be walking by on the street, or sitting on the stoop, drinking a beer with her boyfriend in the front seat, or maybe in the back bedroom with him, sweating and groaning.

  I watch her eyes roll back and forth. I shine the light in them again. Nothing. Nothing.

  I let out my breath and look up at the ceiling. I sit alone with my failure.

  At the convalescent home we take her into her room, where the nurse knows all about her, having gotten a report on the telephone. Her boyfriend leans over the bed, talking to her, “Nicki, you’re going to be okay, girl. You’re going to be all right.”

  I watch him, my throat thickening.

  He glances up. “Thank you,” he says.

  I keep looking at them. Then I walk over and put my hand on his shoulder. “Good luck,” I say. The words seem to catch in my throat. “They’ll take good care of her here.”

  He looks up at me. “Thank you, thanks again.” He seems touched by it, touched that a faceless ambulance attendant would show concern for his plight, which is killing him, dragging his spirit down. “Thanks.” He looks tired.

  We leave the room. I take the front of the stretcher. “Don’t you want the head end?” Art says.