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Ron Riekki

Airway

 

Cox says, “Don’t worry, relax, everything’s gonna be cool.”

You never say that to a patient.

Never.

As a matter of fact, if you ever hear that from a medic, it means you’re not going to be all right.

And this guy’s in that category.

First of all, he’s a motorcyclist.

Bad start already.

Second, he has no helmet.

Getting worse.

Third, he went airborne.

Even if he landed in a bed of flowers, he’s instantly classified as trauma.

And he didn’t land in flowers.

He went through the window of a food truck.  Hit wall.

You can’t make this kind of stuff up.

Hit wall.  Then landed on their grill.

The Grim Reaper, when He wants you, He wants you.

        The guy rolls over, lands on the floor.  Takes out his phone in his pocket, and calls 911.  Mostly because nobody else is.  Everyone else is panicking.  And when someone panics, they basically do nothing.

        I’ve had so many patients, so so many patients, where if a passerby would’ve grabbed an AED off the wall just feet from the patient, just inches, that person would have been saved.

Simple CPR.  And grandpa would be alive.

        I mean, moronic CPR.  Not even doing it right.  Just give the guy some chest compressions.  Hell, break a rib in the process.  But keep that heart going.

But people just stand there.  “What should we do?”

Anything.  Other than stand there.

How about dialing 911?  That’s a start.

And everybody has a cell phone nowadays.  Some even have two.

So our motorcyclist dials and we arrive.

It’s all ABCs now.  Airway, breathing, circulation.

        Except this is Sault Ste. Marie.  It’s November.  It’s 41 degrees.  Which means even airway is secondary to something more important … Hypothermia.

        The biggest worry with burn victims—and this guy has superficial, partial-, and full-thickness burns—the biggest worry is hypothermia.

        You have loss of skin.  Clothing burned off.  The body in hemorrhagic shock.  Did I mention the femoral bleed?  His blood has cooked on the grill.  The smell is like, is like … well, your olfactory senses memorize smells like that, ineffable smells.

Cox says, “Hey, relax, everything’s gonna be cool.”

Then adds, “Everything’s gonna be all right.”

I shoot him a look.

        This is all while we’re making sure he has an airway, stopping the bleeding, doing initial assessment, closing the front partition to limit wind, getting blankets to warm this guy.

        But we’re doing this all with pretty much no words.  Nothing other than Cox’s Tony Robbins motivational B.S. that’s going to get us sued.

        Whenever you talk to a patient, you want to be clinical, medical.  Don’t start gabbing.  Don’t relax, let out an f-word.  Do that and Livingston, Livingston, & Livingston or whatever multiple-generation family of lawyers in town is ready to pounce.

We do this all silent.

        Any TV show you watch, if medics jabber away with “get me an epi” and “I need six kilos of pain killers,” all that fake vague language, that just shows the producers don’t know the pre-hospital world.  You know what you’re doing, you don’t talk.  You just do.  Maybe nod.  Maybe point.  But that’s it.

And we get this guy in.  Quick.

What do medics do?

We transport.

Do we save patients?

No.

Doctors save patients.

We transport.

We hurry up.  And then wait.

Tons of paperwork.

That’s what we do.

Or what Cox will do.

This is Cox’s call.  His PCR.

We get motorcyclist in.  The nurses take over.  And it’s filling out forms.

Getting a nurse signature in a time like this is next to impossible.  No, is impossible.

We lean against white wall.

A signature and we’re gone.

Times like this, I read.

I’ve read a hundred books like this.

        Read Dr. Atul Gawande’s Better: A Surgeon’s Notebook.  Whatever it’s called.  Read 1984.  That book was crazy.  Read this one graphic novel about a mouse in Hitler’s Germany.  Seriously.  Mice and Nazis.  And it was good too.  Really good.

        But I forgot this James Patterson book back in the ambulance.  I can’t remember the title.  It’s forgettable.  Something about dying.  I forget.  Death on Death Street.  Something stupid.  The book’s not bad actually.  I just hated the title.  Which got me interested in reading it.

Then Cox goes, “So, how’s Kate.”

Kate is in Iowa.

She’s not coming back from Iowa.

I tell him this.

Why Iowa?

        Because that’s where her parents live.  Her millionaire doctor parents.  Her gastroenterological/ophthalmological parents.  In a mansion bigger than most small town hospitals.

She met me and thought I was going to be an E.R. doctor.

Five years of this and she’s realizing I’m not moving up the food chain.

Because I’m not exactly friendly.

        I stumbled on a nine-year-old in August.  A huffer.  What a kid’s doing being taught to sniff paint for a high at that age, I have no idea.

But I found him.

Nothing I could do.  I just stood there.

He was dead long before I found him.

        A circle of pink around his nose.  He looked like he was at the very beginning stages of putting on clown makeup.  Ridiculous way to die.

I wasn’t even on the job.  Just out for a walk.

        This job, it starts to give you an internal divining rod.  For blood.  For leukocytes, erythrocytes, plasma, and platelets.

I told Kate that.  And she left.

No one wants to be around a death magnet.

I don’t tell Cox any of this.

I just say Kate left.  For Iowa.  Nothing else to be said.

He goes, “Don’t worry, it’ll all work out.”

His version of “Don’t worry, relax, everything’s gonna be cool” for me.

The nurse goes by.  He tries to get a signature, but she says hold on.

We stand there.

I go to wash my hands.  Again.

        I go in the bathroom and the window’s propped open.  It smells like hospital hell, but with that window open, it’s like fresh air is battling.  It’s like the hot stench and the clean freezing cold air are at war.

I stand in the middle and breathe.

        Cox comes in, pisses, no hands, fists on his sides like Superman.  Humans don’t piss like that.  I want a partner who can urinate at least halfway normally.

I go into a stall, to blow my nose, to avoid Cox.

With a pen someone has written CLIT on the back of the stall door.

With black marker another person has turned it into I ♥ HERACLITUS.

Shaking, Cox says, “We got another call.”

And we do.

        They say the Upper Peninsula of Michigan is one of the most beautiful places in the world.  It is.  If you ignore the poverty.  And there’s a lot of it.  If you think Detroit is doing bad, check out one of these old mining towns.

        They all look like they have adenocarcinoma lung cancer.  Towns that resemble ninety-eight-year-old pack-an-hour cigarette smokers.  Calumet, Chatham, Sault Ste. Marie, their buildings need chemotherapy.

I think this as we drive.

Slow.

The ice.

No need for us to end up in a hospital.

We’re driving to a Chinese restaurant.

I’m starving.

We go by the locks.

The Homeland Security fencing making you feel like you’re in prison.  A very scenic prison.

A tourist ice cream shop across from a sign saying that all guns will be confiscated.

I stare at the water.  Every time we’re on West Portage, I memorize that water.

Something about it.  It makes me feel like no one could ever drown in it.

And we’ve never had a drowning call yet.

I guess there’s too much people can do to each other on land.

The restaurant is in an alley.

Location, location, location.

The police are on scene.

Police being singular.

The cop comes over, says it’s clear for us to go inside.

Inside, the restaurant is empty.

        The restaurant, i.e. the area where people eat, is the size of most people’s bathrooms.  Two tables jammed together.  Chairs probably salvaged from dumpsters.

We go in back.  The kitchen isn’t much larger.

I step on the red carpet.

It squishes.

It’s not carpet.

        Any time something like this happens, I’ve been taught to stop, take in the scene, make sure it’s actually safe.  Not cop safe, but civilian safe.

Two kids lie in the blood.

Except they look old.

Like they have progeria.

That aging disease.

        I can hear the cop’s voice behind me but don’t turn around.  “Witness says these two guys got in an argument, they had knives in hand, started swinging at each other, and kept swinging until they both collapsed from blood loss.”

        “What were they arguing about?” Cox says.  Probably the least important question he could have asked at this point.

        “I wrote it down.”  The cop laughs, reads from his notepad, “The ‘Senkaku Islands.’”

“What?”

        “They were arguing about an island.  This guy’s Japanese.  That guy’s Chinese.  Apparently it means something to them.”

I crouch, careful not to put my knee down.  I note chest rise.  “He’s breathing.”

“This one too,” Cox says.

I look around.  There’s meat everywhere.

“This a butcher shop?”

“No,” the cop says, “Not ‘til now.”

There’s so much blood, I can’t tell where they’re cut.

I see a hand in a corner, no body near it.

“Which one’s Japanese and which one’s Chinese?” Cox asks.

If Cox asked any medical question at this point, I think I’d faint in ecstasy.

“I thought Japan was in China.  I said that and the witness left,” the cop says, “They gonna die?”

I don’t know.

We never know.

        If we make that call, say we think someone’s going to die and they live, we can get sued.  If we say we think someone’ll live and they die, we can get sued.

Keep your mouth shut.

Kate taught me that.

I pick up a finger, put it in a plastic bag.

        Cox goes to get the gurney.  It’s a two-man job, but we’ve been doing this so long we know how to do it solo.

        I pick up the hand, put it in a plastic bag.

        Each step, I steady myself.  One slip and the amount of blood-borne pathogen exposure for me—I don’t even want to think about it.

        I look at one of the men.  He’s got a venous bleed.  Chest.  Purple.  Oozing.  You can see a wave come out with every heartbeat.  Same on his arm.  Abdomen.  There are so many cuts on these guys that it’s pointless to pick one spot to give direct pressure to.  You’d basically have to hug them all the way to the E.R.

        And there’s nothing arterial.  Nothing spurting.  No streams coming out like a child statue pissing into a fountain pool.

The heart.  The lungs.

It all comes down to those two things.

Kate.

I know she’s minor.

Compared to this.

You have a hangnail, it’s all you can think about.

Our own pain means everything.

Other’s pain, no big deal.

But a breakup, honestly, those can kill people.

        The seventy-year-old who dies two months after her husband dies.  Dead of a broken heart.  It happens.  Because it’s real.  It’s physiological.

I’ve read about it.

That pain you feel in the heart when someone is gone, it’s not imaginary.

That’s an authentic cardiovascular reaction.

That feeling like you’re not getting in enough air.

You’re not.

The vasoconstriction and hyperventilation of loss.

I pick up a hunk of flesh, not knowing what part of the human body it even belongs to.

That motorcyclist, probably going 80 in a 35, that’s not accident.  That’s suicide.  That’s psychological.

That’s someone with a Kate.

That’s me.

Except I’ve seen so many suicides at this point that I could never do it myself.

        We had a note once, scribbled by this divorce lawyer who was getting divorced that said something like I don’t want to be a bother to anyone anymore.  Slits his wrists.  He bleeds so bad, the person in the apartment below calls 911 saying that her “ceiling is bleeding.”

Talk about a burden.

You don’t want to be a burden to anyone, you continue to live like the rest of us.

I don’t want to live the rest of my life with your death.

        I pick up something that could be chicken, could be part of an arm, maybe an animal’s cheek, or a human’s cheek.

        These two guys, when they get to the hospital, they’re going to get sewn back together with pieces of each other.

This Japanese guy that hates the Chinese, 1% of his body (or more) is about to be made in China.

This Chinese guy is about to be turning Japanese.

Their blood has pooled into each other, so the process really has already started.

Additional resources arrive.  We get the two chefs on long boards, do the transfer.

At the hospital, I go straight for the bathroom.

There’s blood in my hair.

I put my head under the sink.  Put cheap bathroom soap in my hair, lathering it up.

I look up.

        It’s a simple thing, wet hair.  Such a small thing, but I don’t even look like the same person.  I try to figure out who I am.

And notice someone has scratched a tiny swastika into the mirror.

Another person has scratched even harder, turned the swastika into the apex of a giant heart.

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