Apparently, this cat was talking on his cell phone and then, for no clear reason, ate pavement. According to the witness, he just dropped. When we found him, his mouth was around someone front step and there was a pool of blood and some teeth nearby. Securing his spine, we rolled him over, back boarded him, got him on the bus, took a better look. He’d somehow managed to slice his chin almost off — it looked like the butt of a french roll of bread but it was still attached slightly so when we put the c-collar on the chin got flipped upwards and was resting on his mouth.
He was still completely knocked out when PD asked if we needed them and we said no thank you and pulled off and THEN homeboy decided to wake up. I was driving, but apparently his eyes popped open and he went right for the collar around his neck, Frankenstein style. Then, and this I heard along with probably half of the East Village, he said “WHAT THE FUCK!?!”
I pulled over the ambulance. The dude I was working with is solid enough but we had a student that day, more or less the intern from 30 Rock, and the patient was easily 300 lbs and pissed. He had already unstrapped his upper body and was sitting up straight, swiping at the student and yelling “REALLY? YOU GONNA DO ME LIKE THAT? THIS IS HOW YOU GONNA DO ME? REALLY?” While the student just made little cooing noises and said “no, no, that’s not how we did you sir! We didn’t do you like that!”
The cops had been following us and when they saw me pull over they jumped out and we all rushed the back compartment. The guy had a big broken tooth grin on and he was looking back and forth at us with wide, uncomprehending eyes and giggling and repeating one of the above phrases like a damn Elmo doll on crack.
“Just lie down, buddy,” one of the cops said.
“REALLY THOUGH? WHAT THE-”
You can’t reason with folks when they’re off the deep end like that. His chin was still flapping back and forth on his face and he was covered in blood and still grinning like an asshole.
Fuck it, my partner said, unimpressed. Just roll carefully.
And he was right. You’re not gonna win coming at the dude, he wont’ be talked into normalcy, and it’d take more than the two cops and three of us to wrastle him into any kind of submission. I rolled carefully and when we got to the ER and reeled him out he was still on that same shit, except now he was reaching into his mouth and trying to pull out shards of his own teeth. Which he then ate.
With some struggle, we got him into the ER and thru to the trauma room, where the assembled doctors asked us: What happened to this dude?
I let him answer that question himself.
It was daybreak and the daytour was giving me a ride home. We were just pulling off from the ER bay when a dude came running up to the ambulance. Now…when people come running up to ambulances about 90% of the time it’s to either ask directions or tell us about how their friend’s like sooo totally drunk could you just like take her blood pressure or whatever. So, excuse us if we don’t get really excited when folks come tapping on the window. Anyway, it was still dark out and we couldnt quite tell which of the 2 this guy was until he said “Yo, some old dude just got fucked up over there!” Still…this could mean sooo many things, but we rush on over and sure enough, there’s a car sticking out of a building and an old dude crumpled on the curb next to it. And yeah, he was pretty bad, because as we were approaching I first thought he was just a pile of random debris, so still was that old dude. Usually when you mistake people for inanimate objects it’s because they’re dead, but this guy actually took a breath just as we started going to work on him. So he wasn’t dead, but he was an absolute complete damn mess. The bystander’s description actually turned out to be pretty accurate. I’d thought he had been in the car and either been ejected or stumbled out when it crashed. Usually when people are ejected though they’re like, across the street or in a tree somewhere, not right right there. What actually happened was the guy’d been on the far adjacent corner, minding his, when a carload of drunken patygirls barreled on through, clipped him and sent him in a massive acrobatic airborn spin across the street and onto the curb. To hear the witness tell it, the guy’d done like three pirouettes and a butterfly kick on the way (“Yo, his legs went up like this and they kinda did one a these and then he rolled up and over” like it was all in slowmo…). Anyway, then the car had swerved and smashed into the wall, the gaggle of hoochie mammas all hopped out at once, clucking away apparently, took one look at the patient and screamed, simultaneously “YOU KILLED HIM!” and clackity-clacked off towards Flatbush in a perfume flavored huff. The driver, a really irritated looking dude, was standing there talking to 911 on his cellphone when we rolled up, trying to make it sound as little his fault as possible (“No, the guy musta been drunk! Walked right into my car!”)
We call for backup, put the patient in the back and take a look at what we got. The left tibia is pretty much shattered, his left arm is pretzeled and there’s an open wound where the bone broke, and he’s got more than a few ribs that are in many many pieces. Also, he’s got a buncha little cuts and bruises and whoknowswhats going on with his head. We have him boarded and collared and nothing seems to be actively bleeding anywhere, although there’s blood EVERYWHERE. He’s coming around, which is wretched for him in the short term but ultimately is a pretty good sign. What’s not good is that as we’re getting ready to go the genius that hit him decides he has neck and back pain and needs to go to the hospital too. I’ve been in this situation before, and it sucks. Since there was no other ambulance on scene, it means we can’t leave without technically abandoning a patient and opening ourselves up to colossal lawsuits, getting fired, all kindsa stupidness. We come up on the air, tryna express the urgency of the situation without cursing, and then get back to caring for the patient while we wait for another unit to show up. At this point i remember I’m off duty. Not only off duty, I’m wearing some a spiffy all white suit (for a change) that miraculously has remained bloodstain free up to this point. I’ve always said if some mess goes down while I’m not on the bus you probably won’t be seeing me leaping across the street to stick my fingers in the muck. It’s not that I don’t care about my fellow humans- I wouldn’t be doing the job if that were the case- it’s just that without any equipment there’s really not much I can do for you. CPR…that’s about it. Anyway, here I was in my civies, off the clock, and yet I had a bus full of medic goodies to play with. What struck me though, as I was reaching over the crumpled up old guy to put an IV in, was how different it felt, being out of uniform and dealing with all this mess…It seems like a small thing, or it did, but the mental space that wearing those techpants and button shirt and having that heavy belt on put you in is thoroughly somewhere else from the I’m-just-walking-down-the-street-in-my-nice-white-suit mental space. Like, a whole other planet. The physical act of gearing up, clocking in, checking out the ambulance, carrying around that chattery little radio…it all serves to ground us into that realm of service- a singlemindedness that I’ve spoken of before that can be so cleansing when it climaxes in the thick of a brutal job. Without all that, i felt naked. The other unit finally skidds up and we speed off. The dude’s talking and conscious by the time we roll into Belleview. The sun rises. I help the daycrew clean out the back of the bus. scrubbing away blood, picking up shredded clothing and bandage wrappers. I wonder, as we made our way back to Brooklyn along the East River, what life will be like when I’m done with this job for good and no longer spending half my week intimately wrapped in the ridiculous and tragic beating heart of the city around me. I think I’ll miss it.
I was gonna write about death again- but I do that (…reading back over old posts..) A LOT o_O so instead I’ll talk about um…oh crap this ones about death too but whatever…THE MOST SKEEVED OUT I’VE EVER BEEN.
it wasn’t on the evisceration, or the lady who’s leg was hanging off or any of the crazy shootings stabbings rectal bleeds or other bloody disasters I’ve been on. This might even come as kind of a let down, cuz people at parties are always asking me: What’s like the CRAZIEST ISHT You’ve EVER seeeen? And this definitely was not it. But it skeeved me to the bone none the less. We were riding with this Hasidic kid that night, a student, and some of his boys were on the Hatzolah truck that works nearby- Haztolah is the all Hasidic ambulance group- and somehow they’d gotten a call for a jumper down- it was one of their guys and I guess he’d gone from the roof of one of the all Jewish projects on the Williamsburg/BedStuy border (yes there are Jewish projects). We were nearby and the kid wanted to meet them at the hospital and lend a hand, whatever, see what they’d done, learn something i suppose, so I rode over to let him take a peek. Hatzolah is famous for rolling deep. They call it the clown car cuz the bus rolls up and nojoke like eight little bearded EMTs will pop out, all muttering at each other in Yiddish and usually dressed in tshirts and sneakers. But for some reason, that night, there was no one there, they all musta hopped out and scattered, or maybe they all decided to go in and notify the hospital together, the way girls flock to the bathroom. Either way, it was just this one little sad yarmulka’d fellow left to bring in the patient. Even my student was nowhere to be found.
I really don’t like to get involved in other people’s jobs. It’s wrong for so many reasons but you can’t roll into the hospital with a traumatic cardiac arrest and no one’s doing CPR, no one’s giving ventilations… It’s not because the guy might make it- that was definitely not going to happen- it’s just a really bad look. it’s like showing up to play baseball wearing a tutu. You dont do it. So like a idiot I gloved up and positioned myself on the stretcher to start pumping the guy’s chest. Considering that he’d come down from a PJ, i was surprised that the dude wasn’t splattered. He was white- literally white not just racial construct white- pale as a piece of paper, probably his internal organs had exploded and the blood was scattered inside somewhere, and his feet were pointing in all the wrong directions, surely from having been landed on. They said he’d just gotten out of woodhull’s psych ward and that Jews who suicided weren’t allowed to be buried in Jewish cemeteries but since no one had seen him jump, he might’ve been pushed or it might’ve been a freak accident and he’d get the benefit of the doubt.
Anyway, on my third or so compression, one of the man’s chest hairs caught me right where the glove stops and my wrist begins- that tendon right there? YO. It was like the long finger of Father Death tickling my soul and NOT in a good way. I can’t tell you what it was that eeeked me so much about that all i know is within 2.7 seconds I was off that stretcher and halfway across the street yelling “OH HELL NO!!” and making all kindsa faces. By that time, some other Hasids had materialized and took over but I couldt’ve cared less to be honest with you, I was DONE.
I guess if I’d been shot twice in the face there’d be some people I’d like to call too, but if the paramedic told me to lay down and stop moving that’s what I’d do. Not this dude. This dude is too busy cursing someone out on the other line and swatting off the EMTs while they try and fit a c-collar on him. I hop on the bus and put on my I’m-not-kidding voice: “Sir, you have 3 bullet holes in your face. That means 2 went in and only 1 came out, so there’s a bullet rattling around somewhere and if you move too much it very well might dislodge and end up in your brain.” “But…” “And then you’ll be dead.” He relents and lays onto the board, lookng irritated at me . (I’m not the one that shot him…whatever…) the emts collar him up and strap him down and I yell to the driver to take a not-2-crazy ride to King’s County. If you don’t say that you end up hitting a bump at mach 7 and all kindsa mess can ensue. Especially because when the ambulance roars off me and my partner grab the biggest needles we can find and start poking the patient with ’em. To get the IV of course- not cuz he’s being difficult.
The first bullet entered the ridge of his cheek bone just below the eye, transversed his face somewhere between his eyes and nose and exited through the opposite cheek. The second bullet entered slightly lower than the first and is who-knows-where. Miraculously, the dude’s vital signs are all stable, he’s mentating perfectly well and the only bleeding is a little clottiness around his nose. Still…trauma patients and kids (see next post) can look perfectly fine one second and die the next, so we keep a steady eye on him. Before we get to County he swears he doesn’t know who shot him, gives a false name and fields two more curse-laden phone calls.
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.”
“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…”
“You have no idea.”
“Nah. I was just…you know.”
You just want somewhere to take a nap.
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.
It’s amazing how many calls we get for old men that wanna complain about the “tiny little guys” running around their apartments. There must be an infestation of freaky leprechauns in the city. I know it’s gonna turn up in 1 of my short stories soon…
But anyway, that’s not today’s topic. Today’s we’re here to discuss the little dude that makes sandwhiches at one of the delis of 125th St in Harlem. He called because he was having pain all up and down his left side (came over as a CARDIAC job, because they included the chest in “all over”…smh). So he’s 32 years old, no medical problems, no medications and he’s basically rocking back and forth and going “OOOh it feels so WEIRD! It feels SO Weird!”
My whole left side of my body!
Does it hurt?
No! I can’t feel it! Or it’s like pins and needles! Aiiiii!
How long it’s been going on?
Since the day before yesterday…
Anything else wrong?
Yeah, when I poop: blood comes out…
Oh boy…how long THAT been going on??
Since about…well, matterafact since the day before yesterday!
What the hell happened the day before yesterday?
I fell down the stairs.
How many stairs you fell down?
Shit…all of ‘em.
…And you’ve been shitting blood ever since?
And you can’t feel half your body?
Uh huh. You think Imma be alright?
NO I DON’T THINK YER GONNA BE ALRIGHT! …jeeeeeze…(aside: do you really need me to tell you that?)
So you think I should go to the hospital?
No, I think you should’ve gone to the hospital 2 days ago when you ruptured your internal organs and severed your damn spinal cord but now u HAVE to go to the hospital…
I was laughing cuz my partner was moody and not in the mood for trauma, but we had a student, and it was Sunday night in Harlem, so even without riding all over town trying to pick it up, the shit was flying our way. We’d already done a pretty low key shooting, no kinda clusterfuck just a straight forward once in the leg, dude was pretty much chilling in the doorway waiting for us and then we were sitting in Garvey Park, enjoying the firefly show when they sent us solo for a cardiac arrest on 110 and Lenox. Text said, MAN FELL OFFA BLDNG NOT BRTHNG NOT MOVING.
Now, lemme say that even when a cardiac arrest is just your regular everyday 200 year old in the nursing home type of thing, you still automatically get EMTs backing you up AND a slew of firemen and a conditions boss. This is because arrests take a lotta grunt work to deal with. It’s like any job but someone has to be doing CPR the whole damn time, and real CPR takes two people minimum to do. Then add into equation that the patients probably gonna be humongous and humongoloids as a rule only live on the top floor of buildings with no or broken elevators- it’s a production.
But even with this patient being skinny and obviously not on the top floor, another seta hands woulda really helped.
When we rolled up the fire dudes were there running around with the general melee of the building, which had emptied out for the spectacle. People were pointing and yelling- He on the awning, yo!, so we walked in the building, up a flight of stairs, down a windy hallway, through someone’s bedroom and out a window to the cement awning where we found our guy.
He had landed Wiley Coyote-style, face first, arms and legs sprawled out at impossible angles all around him. He was also about 60, skinny and frail and, most surprisingly of all, alive. Not only was he alive, he was talking, or groaning anyway. Mostly all he said was “ow” the whole time, but for an older dude who’d just eaten pavement from five stories up that’s not bad. Most guys like that we just put a sheet over.
Anyway, the bucketheads had brought their backboard up but we had a problem: the guy was facedown and had to be rolled to be placed supine on the board, but both his arms were shattered, loose like spaghetti, one of em with an open fracture, bone and everything out for all the world to see. To roll him like we usually do would’ve rolled his arm over and over underneath him like dough. Fortunately, he was slender and light, so we adjusted the arm, grabbed him all along his mangled body, supported his head and lifted him over his own arm and onto the board.
Then I climbed back through the window and we passed the board and dude through the window and out into the hallway. With firemen helping my partner get the guy out, i rushed ahead to the ambulance and set up our equipment. He was a trauma, so he’d need big IV lines and big bags of fluid. Because of the mechanism of injury he was likely to check out at any dang moment, so I opened up the tube kit and laid out on the little shelf next to where the patients head would be.
The door swung open and they loaded our guy in, sill moaning. He turned out to have a decent blood pressure- 130/70, and a heartrate of 70- that’s ridiculous. No one falls off a building and has perfectly normal vital signs, but who am I to complain? Either way he was still broken everywhere, and crush injuries like that can maintain and look normal right up util they don’t, and then the guy will just die.
So we lurch into motion towards Saint Lukes and find two surprisingly bulgy veins to put two bigass needles in and lots and lots of fluid and our man rolls into the hospital in the same vaguely shocked and irritated, broke ass way we found him.
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.
Last Saturday:This dude was 60 and totally out- speaking garbly gook like he might have a head bleed but the also kinda had that o.d. look to him. Or maybe his sugar dropped. The thing is, for a medic, the most useful skill we have is our ability to get the story. The best ones are like medical Sherlock Holmeses- can figure out the whole damn scenario from getting the history. New guys always gush about the skills: can u get an iv, how many tubes have you done, etc etc but bottom line is that if you don’t know what to do with that iv when you got it, it aint worth shit. But then there’s dudes like this, who can’t tell you what’s going on cuz they’re just going: Blarga blarga blarga and the cracked out middle age ladies who were with him were either clueless or withholding info. All they would tell us is: he’s hopped up on p-funk. What’s p-funk? They didn’t know. His pressure wasn’t high enough to really look like a stroke and he didn’t respond when we put an amp of sugar in him, which he would’ve if he was hypoglycemic. He doesn’t look much like a standard narcotic OD either- pupils aren’t pinpoint and he’s not in respiratory depression, but he could have any number of things on board, so we push a judicious little squirt of narcan in him to see how it settles. Full body seizure. Not even a fake one. This’ll happens sometimes with addicts, because the narcan puts them into such immediate withdrawal their body rebels. But this wasn’t enough to do that and it seemed unlikely that he was that far in anyway. He came out of it on his own as we sped off to the hospital, where we found out from google that p-funk is a saucy mix of powdered heroin and crack-cocaine…. Which makes me think the seizure happened when the narcan zapped the heroin out of the equation and left him suddenly full of pure crack. Sometimes all you can do is shake yer head and sigh…
Yesyes, clusterfuck, but first, this: It’s pouring rain in that weird semi-suburban part of East New York where the mafia used to put all their dead. We’re backing up a BLS unit on another nonsense DIFFBREATHER. You can tell it’s gonna be no big thing from the call description on the monitor: FEMALE, 48, UPSET, NO MED HIST, DIFFBRTHR… and the EMTs are already inside so I tell my partner to wait in the bus, I’ll just take a quick looksee. When I open the door to the little ramshackle house I find a lake in the living room. The water is easily knee deep. A little electric pump is at the entrance, frantically scooping water up, but it’s facing the wrong way so all the waters’ splashing back into the house. An old blind guy is sitting on a mattress that’s floating in the middle of the room. He’s propped up on his elbows, looking around curiously. Uh- sir? I say. Eh? Sir? Someone called EMS for trouble breathing? Eh? I gingerly wade thru the domestic tide pool to a back room, where the EMTs are chatting with a crying lady. What’s wrong? She didn’t take her psych meds for three days, the EMT reports She’s not upset about…, I nod my head towards the disaster area behind me. The EMT shrugs and the lady sobs. Any chest pain, ma? She shakes her head. Any medical problems besides the psych stuff? Another shake. I make my “you good?” face at the EMTs and they nod (because EDPs get EMTs). I slosh back out into the living room, past the little floating old guy who says “eh” and out into the rainy Brooklyn night.
Ok now the story, and this people, is 1 of the ones that comes to mind when people go ‘Oh what’s the most fucked up shit you been in on the job?’:
Big T was grumpy that night, which usually meant that any little thing could ignite a rambling curseladen monologue that would eventually lead back to his wife. Always amusing, once you got past the fear that he might stab you up. But still- one of my all time favorite partners. You can tell a shot is gonna be legit when it comes in a whole bunch of times in a whole bunch of different ways. This job came in on three different corners, once or twice as a shooting, once a stab. It’s not because there’s so many patients (usually), but more a hint of the clusterfuck that awaits us: shit is so chaotic and everyone is going batshit so everyone calls 911 with a different batshit story. As we start heading in the job becomes a CARDIAC ARREST, which doesn’t even mean he’s dead, just means more insanity. Now an arrest by its very nature requires two units, an ALS and a BLS, so the EMTs can do CPR while we start the ivs and intubate and shock and all that. But tonight, all the east new york EMTs were busy taking stuffy noses and stubbed toes to the hospital, so they had to send a unit from Crown Heights to back us up.
The night was thick with chaos. Even before we get to the job someone’s trying to flag us down cuz he’s getting his ass kicked over some petty robbery shit. Cops are flying around in all directions like dogs chasing their tails. It’s hot as shit out. We have to park at the top of the block because the whole thing is covered covered covered in people who spilled out of a houseparty whn the shooting went down. Everyone already wants to kick our assses the second we get there, and the only back up we have is a bunch of surly Long Island firefighters, who aren’t world renowned for easing the community’s aggression. They do help us cleave a path through the crowd though, and we finally get to our man.
BUT- there’s a chick clinging to him. They’re both covered in blood, who knows whose, and she’s screaming for us to help him but won’t get the f out of the way. We erupt into a chorus of: lady, you gotta get off the dude so we can help him, lady, miss, seriously, now, lady, get off the dude NOW RIGHT NOW YOU’RE NOT HELPING. And she’s screaming: HELP HIM MY GOD PLEASE OH HELP HIM PLEASE… And believe me people, I wanted to physically detach her myself but i already had a large angry crowd looking for a reason to whup my ass and touching the screaming lady was not about to 2 be that reason. Meanwhile, we still have no BLS to back us up and the Fire dudes are looking pretty iffy about the whole thing. Lady: HELP HIM! SAVE HIM! PLEASE! Us: Get…OFF…THE SHOT DUDE…NOW! And the guys barely moving at all. It takes FD, PD and us to convincer her to get the f off him AND THEN: (and i don’t even like using capital letter but if i was telling u this in person I would be raising voice plenty, because although this happened a few years back when i was a new medic, the trauma of the night lingers. In a healthy way) Aaaaanyway: AND THEN: it turns out the lady didn’t even know our guy. Did…not…even…know…the dude….Damn. Just rolled up on the scene and jumped right into the action. Covered herself in his blood, delayed his medical care- which in any other circumstance would land yer ass in central booking, and he a total stranger. Well…sometimes you just have to move on.
EMTs showed up and I swear I’ve never been so happy to see them. Situations like this- you need as many hands as you can get. When we get him on the bus they get a blood pressure and cut off his clothes while i set up an iv and my partner does a full body super fast assessment. He’s got one thru the hand, one in the left chest and one in the gut. The chest one turns out to be a problem because it’s pierced his lung, collapsing it- that’s why he’s not talking. This is the most pressing issue he’s got, will kill him quickest. Second most pressing is the gut shot, because you can easily bleed out and/or later on, toxify your system from that. Those are eerie because you may not even see a drop of blood, but it’s all gathering in the abdomen somewhere and then they’ll suddenly have no blood pressure and crash, just like that.
For his bleeding out gut, we have a big bag of saline, attached through a drip set which is attached to HUGE ASS IV that I stick into his arm. The collapsed lung is more complicated: I pass my partner an equally hugeass needle, which he inserts into the third intercostals space, meaning between the second and third rib. With the needle removed, the open catheter allows the extra air that’s built up in the chest cavity to escape so that the lung can reinflate. It did and the guy started talking and looking a little more alive as we rolled into the er bay.
Unfortunately, that’s when things started getting really ugly. We musta caught em off guard, cuz it was a hosp i’ve seen work miracles in some f’ed up situations. We definitely told the dispatcher to let them know what we were coming in with, but maybe they never got the message. Either way, they weren’t ready for us, which led to chaos: nurses and doctors running around, paging trauma teams, screaming back and forth. You know things aren’t going well when you have to repeat the presentation like five times to different people. In the midst of this, homeboy’s lung recollapsed right in front of me, so I re-decompressed him, using my partner’s needle hole as a marker. Then someone pulled out that fat iv i’d worked so hard to get, and a scramble commenced to get another. Then suddenly everyone disappeared for a haunted few seconds, but not for an x-ray, maybe just to huddle and try a new approach, cuz then they were all back with renewed chaos. I should’ve known just to do my job and back away, but like i said, i was new, and we’d worked so damn hard on this guy, i wanted to see what happened. He could see things weren’t going well, was yelling and screaming for them to help him and then finally, out of breathless and hopeless, just looked at me, dead in the eye actually, and said goodbye. Then he dropped his head back on the stretcher. They tubed him but didn’t have a oxygen ready to push into the tube, and by the time they got it his pressure was bottoming out and they whisked him away to surgery, where he died.
Okay people- I realize as I’m scratching out all these stories that a lot of folks don’t have much idea what the this whole EMS thing is all about. So here’s a primer for those that’re interested.
Q: What the hell is EMS anyway?
A: EMS is the Emergency Medical Services. That’s the whole system. There’s the transport side, which is mostly when nursing homes, dialysis centers, etc have contracts with private companies and call an ambulance to get their clients towed back and forth inbetween, and then there’s 911- which is when you call 911 and someone at 9 Metrotech in downtown Brooklyn directs your call to EMS and a GPS system tells them which 911 ambulance is closer. 911 has private ambulance companies, hospital ambulances and FDNY ambulances in it, all doing the same job and each claiming the other is full of useless skells and lowlifes.
Q: What are you- EMT? Paramedic? What’s the difference?
A: There’s Basic Life Support and Advanced Life Support. EMT means Emergency Medical Technicians; they do BLS, which includes bandaging, immobilizing, bleeding management, delivery of oxygen and a few medications and transportation to the hospital. Paramedics (that’s me) do ALS, which involves more invasive procedures like giving IVs, intubation, needle cricothryoidotomy (putting a HUGE ass needle right below someone’s adam’s apple when they have an airway obstruction) and chest decompression (putting that same hugeass needle inbetween someone’s ribs to let the air out of their chest cavity when their lung collapses.) We also give medications, about 50 of them from Adenosine to Vasopressin, and are equipped to do for an asthma or heart attack what any Emergency Room would do in the first hour of treatment. If you call 911 and say you stubbed your toe they’ll send you EMTs. If you say you stubbed your toe and your chest hurts, you’ll probably get medics. If you tell them you stubbed your toe and now you’re dead, they’ll send both. It’s happened. Sometimes EMTs will get called for the sick and get there and find a heart attack, so they can call for us. You get shot, it’s EMTs unless you get so shot up your unconscious or dead. That’s why sometimes we medics keep an ear to PD radio and take a quick ride over when there’s a shooting. If you “feel weird” you get EMTs unless you’re especially old or diabetic, then you get us. It’s all a little ridiculous but also there’sa weird logic to it. I’ll just say, when the man called the other night to tell 911 that he was unconscious, they made the job an “UNCONSCIOUS” and sent us. If you just had a seizure it’s EMTs but if you’re having one, even if you’re the one saying you’re having one, it’s a “STAT EP” (status epilepticus) and it’s medics. Even the guy that calls every other weekend because he feels like he’s about to have a seizure, but never actually does, even he gets medics, even though he’s actually an EDP and EDPs get EMTs.
Q: What’s an EDP?
A: Emotionally Disturbed Person. Aaah we could go on for hours about the many wondrous events that happen when folks don’t take their psych meds or lose their shit for one reason or another. Any of us could go EDP at any given moment, far as I can tell, cuz they range the range across all borders. Many jobs will start as DIFF BREATHER and end up as EDP when we get there and patient says something like “I haven’t been able to exhale for like three days,” or “I haven’t taken my psyche meds and I want to fucking kill somebody.” Sometimes EDPs hide behind locked doors, which makes them BARRICADED EDPs, or hide weapons places (“that’s just my rock…i keep him in a sock…” which makes them VIOLENT EDPs. They can also stand up on high places, when they become the JUMPERUP, and then fall, when they become JUMPERDOWN.
NYPD is always getting into a hot mess over EDPs and then having to get retrained on how to deal with them. Usually its cuz they get confrontational with em, and the last person you need to argue with is someone who’s completely disengaged from reality (“Sir, you need to go to the hospital.” “I am in the hospital…” “uh…”). It’s like arguing with the last drunk guy at the party. (most recently see: Iman Morales, who was screaming naked on a Bed Stuy fire escape before PD tasered him, causing him to fall to his death.)
Q: Do you really drive the ambulance?
A: We do and yes it’s really cool but blowing lights and parting traffic jams like the red sea is really not nearly as cool as some of the shit that happens in the back of the ambulance. But people are usually more excited about the woop-woop.
Q: What’s like the craziest shit you’ve ever seen?
A: Why do people always ask that like they’re the first person to think of asking it? I dunno, depends on when you ask I guess. I’ll probably blog about it sometime…
Q: Do people really call for stubbed toes?
A: Stubbed toes, runny noses, burning genitalia, crying babies. “I feel: tired, sick, lonely, strange, different, okay, weird…” “I have an appointment at the hospital.” “I just needed to get out of my house for a while.” “I was bored.” “I hate my husband.” “Can you look at this huge cyst I have on my nuts?” “My tooth hurts since like, three weeks ago.” “I don’t want to talk about it.” “I’m bleeding from vagina, same as i was about a month ago.” “i can’t get out of my chair but i don’t want to got to the hospital, just help me…get…unstuck…”
Those are really the vast majority of our calls. About 80% let’s say is freakish dumbshit and then 15% is like mildly important medical situations and the last 5 is really good urgent crazy shit. Depends on the week though.
Finally, I’ll end with this one: We were called for the CARDIAC- 78 year old with chest pain. We arrive to find a dapper little elderly gentleman sitting calmly in his East New York apartment. Whats the trouble today sir? My heart is broken. Excuse me? It’s broken I say. Does it…hurt? It hurts a lot. How…long has it been going on? Oh quite a few years now. You want to…go to the emergency room? Yes please.