BUSY WEEK ON THE BUS

MOOD: slightly tipsy, it’s true
MUSIC: Erykah Badu
She was pregnant and lying in a pool of blood. There were 2 others, deeper in the deli, but a quick glance letme know they weren’t nearly as bad. The project across the street was already emptying out, folks screaming and yelling, breaking towards us at a run as PD scrambled to control the scene. Bright lights bouncing across the brick buildings. Utter chaos.
While my partner and an EMT strapped the patient to the long board, I set up an IV and liter bag of saline fluid so everything would be ready when they loaded her in.
The thing about most shootings: they’re a) usually not THAT bad- a in and out tib/fib shot or a hand, and b) the patients are rarely surprised to have been shot. Always wanna act like they saw it coming, like it’s just some of run of the mill shit, bla dee bla. Or like the guy two months ago who wanted us to take a picture of him for the cover of his album (Sweartogod). But this lady was both very near death and very afraid. She had no blood pressure, because she barely had any blood- what she hadn’t left on the corner store floor was quickly soaking through the bandages, and she kept teetering in and out of consciousness.
My partner put one IV in and I yelled to the driver to go, but not go crazy – cuz mofo’s will drive like hotholy hell on jobs like these and make things much worse- and we speed off. There’s no trauma center in North Brooklyn. If we’re any further up than we were we usually haul ass over the Williamsburg Bridge to Belleview but were slightly closer to Kings County, so off we went, slipping along through the rainy night towards Atlantic Ave, then Eastern Parkway. She had a juicy vein along her forearm, so we dropped the second IV there, bouncing along with the Brooklyn potholes and stubborn, non-clearing stopngo early evening traffic.
She wakes up some with the fluids flowing through and wants to know if she’s going to die, if her baby will make it.  The truth is, it’s looking good for her but there’s no certainties with jobs like this. I tell her as much, but with a more positive spin, and give as clear and update as I can while I try to staunch the bleeding and not fly across the ambulance. We screech around a corner, the cop in the back with us looks like he might lose his lunch at any moment, and then we roll up the hill into the County ER bay.
The other two victims roll in soon after us, one in handcuffs from a previous warrant—dang imagine gettin’ shot and arrested in 5 minutes for separate shit… And the hospital staff jump into their frantic dance.  When we leave, I’m happy to say, our patient is stable and the baby is out of danger.
Later that night, we’re in the train station, looking at an elfish Puerto Rican pothead who’s pretending to have chest pain. When we get him away from the cops I raise an eyebrow at him: Really, dude?
He sighs. “No, I just smoked A LOT of herb.”
How much?
“No, bro, I can’t even. No. Too mothafuckn much.”
I won’t write it down on the paperwork, I swear.
“Well,” he laughs hysterically for a few minutes and we wait for him to collect himself. “Three grams. Plus I tripled up on my antipsych meds. Hehehe…”
Damn.
“Yeah, son.”
Hungry?
“You have no idea.”
Chest pain?
“Nah. I was just…you know.”
You just want somewhere to take a nap.
“Basically.”
No problem.
Then, two nights later, we’re chilling in Marcus Garvey Park, whiling away the night, when the cardiac arrest comes over. Everything happens fast and efficiently: we’re there in two minutes along w/ the BLS, the dude is 41 with no medical problems lying dead on his bedroom floor. Wife and 3 kids looking stunned, staring in at us from the doorway as we setup our shit. I pass my partner and the student the tube kit and they get to work putting an airway in him. The EMTs start chest compressions and pull out the oxygen. I throw the EKG pads on and take a look.
Quick cardiology lesson for those that don’t know: when you’re heart stops beating, it doesn’t necessarily mean all the electrical activity stopped. When that happens, you get the flatline. But sometimes there’s still a ridiculous little floppy line of current running through- it’s called ventricular fibrillation. It’s rare and usually fleeting but if you catch it you can sometimes shock it back into a nice normal working rhythm.
When they stop compressions so I can get a look, I see our guy’s in a rare form of v-fib called Torsades de Pointes. It’s pretty, a windy, spiraling squiggle. “Clear away from the patient,” I say, charging up the monitor. Everyone takes a few steps back, I hit the button and the patient flops up in the air, his inanimate limbs jolting around eerily. When he lands, we do another round of compressions and check again. A  few gimpy complexes float past on the monitor before it settles into a nice steady regular rhythm. We check a pulse and voila- miracle of miracles the man has a beating heart. The tube is in, we drop an IV and begin setting up for transport. We’re exchanging glances but trying not to get all excited cuz the shit could fall apart at any given second and usually does.  Even in the rare case that folks DO come back, they almost never come back to be anything beyond total vegetable.  But there’s always a chance.
Our guy stays quite stable throughout transport.
He coded and was revived twice more in the hospital (where a tox screen revealed large amounts of cocaine in his bloodstream) and at last check was still comatose but expected to pull through.

STAND UP SIT DOWN LIE DOWN DIE

The next night, after lots of ridiculous little jobs (“my elbow hurts” and “I can’t find my psych meds!”) I was workin with newguy and we walk into a fancy Spanish Harlem apartment to find a little old guy, surrounded by gawking firemen, about to die. Dude was pale as shit, gasping for air, flailing his arms around like he was drowning and couldn’t get more than a word or two out. He definitely had fluid in his lungs, you could hear that raspy gurgling from across the street- the real question was his blood pressure. If you have fluid in your lungs and your pressure’s skyhigh, which is usually the case, it’s very bad- your veins are clenched up tight, you’re heart failing miserably and you’ll eventually drown in yourself. But if you’re ful of fluid and your pressure’s low: you’re fucked. Unless someone puts some dopamine in you quick it’s all over. It’s called cardiogenic shock. That was this guy. To top it off, there was no way for us to give him the dopamine, which tightens up your vessels enough to keep your heart pumping and your pressure up, because the guy had no veins at allll. Nada. I took one look and knew it wasn’t even worth trying.
Here’s the quandary with this situation: no blood pressure means you can’t sit up- any fluid you got needs to be pooled at your upper body, vital organs, so if you sit up it’ll drop to your lower extremities and you’ll die. That’s why people in that situation, including trauma patients who’ve bled out and internal bleeders, all get transported with their feet up, lying flat on their back. On the other hand, people with fluid backing up in their lungs can’t breath, and the last thing you want to do if you can’t breath is lay back- the fluid floods right up your airway and drowns you. That’s why asthma attacks and pulmonary edema patients lean forward in what’s called tripod position.
So here we have a dude with both: no blood pressure- it was like 80 over 50, and can’t breath, and he’s anxious, freaking out, won’t tolerate even the oxygen mask that he so badly needs. So we have the scoop to lay him down in and the chair to wheel him out in but it’s a no win situation either way. He was in a sitting slouch when we got there, so I watch him sit up some and ease onto the chair. He doesn’t look much worse for it and I can tell that laying back further is increasing his agitation, and him getting more upset means his poor failing heart has to work even harder and will sooner collapse. I decide to chair it but have the fireguys walk along side with the scoop just in case he codes and we have to start doing cpr.
He’s spiraling down in the elevator, arms flailing madly like he might take off at any second, water rising higher and higher up in his lungs and everything seems to be going in slow mo, but not in the badass matrix way, only in the whytheFUCKthistakingsolong kinda way. Finally we outside, I toss partner my keys so he can set up the stretcher while I cart homeboy out. Firefighters are scurrying all around me in a frantic escort as I heave ho thru two sets of project doorways and out into the street. We do a quick 1,2,3 evaluation: dude’s still fucked, and then I jump into drivers seat and come up on the air to give the notification: 12xray (that’s our unit number) with a note to Saint Lukes.
I’m throwing into drive, restraining a hot seething curseout as the firetruck that’s blocking us in takes a few milliseconds longer than I want it to to get the f out my f’ing way.
-Go head with your notification, 12xray.
-we have a sixty three year old male, eminent cardiac arrest second to cardiogenic shock, blood pressure 80/50 heart rate 120 respirations 28 be there in 2 minutes.
In my rearview, I see my partner flittering around like a desperate little toothfairy in the back. He’s brandnew and truthbetold, I don’t think the patients gonna make it through the night, but I know the best I can do is get him to the hospital fast as humanly possible so he doesn’t have to get worked up by brandnew dude all by himself.
The *%#*&&#?!! Firetruck has pulled off now and I’m airborne through the windy upper west side streets, winding round the park, hauling ass along 110th and screeching around onto Amsterdam. My sirens are having a temper tantrum, my lights playing rude games in red and white along the Chinese restaurants, coffee shops and saint johns cathedral and then we’re there, breathless, weary, but the dude’s still alive, if only barely.

He didn’t make it through the night tho.

THE MISSING BULLET

But first:

ME: What’s the trouble today young lady?

PT: I’m bleeding…from my vagina.

ME: Um…this has happened before ever?

PT: Yes! A month ago actually!

True story.

ANYWAY:

PD started getting excited on their radios cuz a car accident came over and it was right at their favorite bar. Then a shooting came over at the same location. Then it turned out to be one in the same and you could hear all hell breaking loose. “It’s an MVA! It’s a shot! It’s both! Blaaah!” I was around the corner in Garvey Park so I just kinda started easing over that direction nice an’ chill like. When you’re medics, you don’t wanna get on a trauma before everyone else. Better to let the EMTs get there first, deal with all the annoying putting the dude on the backboard/getting him out of the car etc. and then you get to do the fun stuff- starting the IV, intubation, whathaveyou. So I sat on 121 and Park and listened to sirens come screaming towards me from all around the city. Emergency Services flew past- those are like the NYPD’s swat guys. Then some EMTs zipped by and we fell into place behind ‘em, bee-lining towards the sea of flashing lights.

They were pulling the dude out of his escalade. He was 60, 300 lbs and dead. There was a gunshot wound in the back of his head and no other visible injuries. His escalade was mashed into the brick wall of the cop bar. A kind of controlled chaos was hanging in the air as everyone swarmed about our business. Eerily, the guy’s cellphone won’t stop ringing.

A word about being dead: as Billy Crystal said in The Princess Bride, there’s dead and then there’s MOSTLY dead. According to our rules- you’re only truly dead if you fit certain criteria: rigor mortis- which is you know when you’re all stiff, dependent lividity- which means you’re so dead all the fluids are pooling at the lowest point in your body (yes, it’s gross), decomposition- which is self explanatory, you’re rotting and then the wonderful catchall: Obvious Death. That includes everything from beheading to burnt-to-a-crisp. Usually if brain matter is involved, it’s Obvious Death (unless the person’s still squirming). If you fit into any of those categories or have a DNR, we put a sheet over you and call it a night. Otherwise, it’s the whole rigamaroll.

This dude wasn’t quite obviously dead enough to be Obviously Dead, plus they’d already gone to work on him when we got there and it’s a whole other rigamaroll to stop a workup in progress. So we did our thing: got him on the EMT’s ambulance, I set up a fatbag o’ fluid and prepared my iv, my partner took out the laryngescope- a metal scythe shaped tool with a flashlight on the end that we use to look all the way into people’s throats so we can stick a tube down there. Meanwhile, I tossed my keys to the other EMT so he could drive our bus and yelled to the driver to start rolling.

The best way to find a good vein to poke isn’t by looking, it’s by feeling. Sometimes you’re better off not looking- you just roll your finger gently along the area where you know the juicy ones hide until you feel that bouncy vessel poking up. Then you trace it, see which direction it leads, and sink your needle just below it. When the needle finds its mark, blood pours into a little filling chamber. You push the plastic catheter forward while pulling the needle out and then attach the iv line to the hub left behind. All this happens while the EMT is frantically barreling down the street and around corners because he’s new and never been on a shooting before, let alone a crazyass car crash head shot traumatic arrest. Just as we’re ripping off scene though, the ambulance stops short.
What’s the problem? I yell from the back.
There’s a Captain onscene, the EMT reports.
So what? I ask. They’ve been getting real uptight about certain things and apparently this one wants to check on us. But really- now is not the time.
He’s blocking the bus, the EMT says.
Drive around him, I holler. Both my hands are busy trying to keep the IV bag from swinging into my partner’s face while he sticks the tube in.
We drive around the captain.

The line is in and so is the tube when we swing into the ER bay a few blocks away. Since we made patient contact, eight minutes have gone by. The energy is coursing through my body- it’s more than adrenaline- it’s the glow of total focus and purposefulness of action and it feels amazing.

At the hospital, they pronounce the dude pretty quickly, but when they x-ray his head there’s no bullet there. Now we have a riddle: there’s only one hole, so where’s the damn bullet? I ask my partner what he saw when he went to intubate. –Just a lot of blood, he says, couldn’t see much. The doctor in charge gets his suction and a light and after some cluttering around in the dead man’s mouth announces he has found the other hole. The entrance wound. Turns out our guy was a suicide. A general murmur flutters around the detectives. Apparently he was talking on the phone with his girlfriend, had been depressed for a few days, crashed the escalade and did the deed, gf still on the line. That’s why she kept calling back.
The doctor puts a sheet over him and I head outside to clean off the equipment.