The roads are really slippery. I have to keep turning the wipers on higher because it is muddy. It is getting foggier the higher this old ambulance climbs. The driveway is really long and steep and it gets stuck twice. I get it out the first time, but the second time there is no getting it out. There are State Police there and neighbor’s silhouettes litter all of the front porches on the road. They tell us it is just a few hundred feet to where he is. Each of us grabs as much equipment as we can carry. I have the jump bag, which holds the cervical collar, BP cuff, SPO2 monitor, sanitary gauze and oral glucose…basically anything I may need within the first 5 minutes of a call. I also carry the defibulator. I have this really strange feeling in my gut on the way there. They say in any medical field that you grow a sixth sense about these things. We all develop superstitions.
I glance at my watch. It is 11:58P.M. It is New Years Eve. As I walk up the icy path, it becomes clear that if he is in bad shape, we aren’t going to be able to get him back to the ambulance very quickly. All of our stabilizing work would have to be done on-scene; establish an airway, stop all major external bleeding, and restart the heart if it isn’t beating. We are all nervous. The State Police walk with us lighting the path before us with flashlights. The air is surprisingly warm for that time of year, but still cold to the exposed skin. There isn’t much snow on the dim path, just ice and rocks. It takes us about seven minutes to get to him. The call was dispatched as “snowmobile accident with one unconscious male.” None of us know what to expect
His friends are all around him, about five of them. They all turn and come toward us like a wall. One tall blonde man wearing snow pants and a sweater grabs my arm and starts dragging me to his friend. “Please help him! Please do something! My buddy, he isn’t breathing!”
As I get closer I can see that he is face down in a puddle. Someone had tilted his head to the side. There is another man standing next to him. His overalls are muddy and he has blood on his hands from the man on the ground. He has a big scruffy beard and I have a clear view of his giant muddy boots as I kneel next to the man on the ground. The scruffy man says, “His face was in the puddle and he was gurgling so I turned his head. After that he stopped gurgling.” It hits me like a ton of bricks…this helpful neighbor, with all his good intentions, probably snapped the man’s neck when he turned his head. I get close to the victim’s head, listen for breathing and check for a pulse.
Nothing.
I look up at Kathy and Bill and say, “we’ve got to get him on his back.” They take his grey snow pants and flannel shirt and I stabilize his head. In one swift motion we flip him over. It is very dark, but I can still clearly see his face. I am on my knees next to him, staring at his young smooth face. He has a distinct, memorable profile. Strong cheek bones, long eyelashes, proportionate features, although obviously swollen. There is blood coming out of his nose, mouth and ears. He is my age. I am overcome with the fear of letting him die. He is too young.
I attempt to do a jaw thrust to open his airway, but I can feel the bones slip away from under my hands and know that his jaw is crushed. Bill has his back to me, talking to the people around us, looking for the sequence of events, how long he’d been down, how fast he was driving and if anyone has any of his personal information. “Bill I need suction!” I shout. Almost in slow motion, he turns, looking down on me on the ground, “we don’t have it with us.” Right then I have to restrain my sense of panic. This is a disaster. We can not secure an airway without suction. I can’t see into his mouth because it is too dark. I pull the pocket mask out of my wallet and apply it over his mouth, the smooth vinyl slippery in my wet hands. I know if there was any debris or blood in his airway that attempting artificial respiration would do more harm than good. I also realize that there was good chance that his blood is going to get into my mouth, but I know if we don’t get some air into his lungs, he would suffer brain damage, if he hasn’t already. We still don’t know how long he’s been down.
I muster up all of my courage and attempt to hold his jaw open with one hand and plug his nose with the other. The first breath doesn’t even come close to his lungs. As I suspected, his mouth is full of blood and vomit, and it does get into my mouth. The smell is horrific. No words can describe the smell; something like regurgitated Doritos, Corona, and salsa. It is the most wretched smell I have ever experienced. It takes over my nose, it is in my mouth, on my clothes and the wave of nausea hits me like a bus. I pause to re-center myself. Kathy and I look at each other and know we are in a tough position. His friends are all around us, screaming and crying and begging us to do something. We want to start CPR, but you can’t do that without an airway. Kathy begins chest compressions. I try to scoop some of the liquid out of his mouth. Bill carries over the AED and attaches the pads to the victim’s chest. The screen is flat line. “Continue compressions until I get medical control on the phone” Bill says. (Medical Control is a direct line to a physician at the hospital.)
The doctor tells him to stop CPR. Kathy and I are doing compressions and attempting mouth-to-mouth for about ten minutes while he is on the phone. This is already too long for a person to go without the heart pumping blood to the brain. Panic settles deep into my throat like a golf ball. I know that we cannot save him. I know that his neck is broken and we have no chance. I know that his friends are standing all around us crying and begging us to do something and there is nothing else we can do.
I know that his blood is in my mouth and I can not get the taste out and as I wait for further instructions, I am still gagging periodically from the iron bitterness. It’s not just the metallic taste of blood; this is something much more acidic, perhaps bile. It is fetid.
My boss says that the coroner is on his way and that we can pick up our equipment, but we cannot leave until he gets there. My pants are soaked with his blood and vomit, my sweatshirt splattered. I am covered in his lack of life. It creeps into me slowly and I feel increasing anxiety. As I carry my equipment back down the dim icy path, the sound of his girlfriend’s moans and cries turn my stomach. It’s never the scene that haunts you; it’s the smells and sounds. I know already that this taste will never leave my mouth.
Back at the ambulance, Kathy comes up to me with a wet towel and washes my face. She is worried about me and she is visibly shaken as well. She is new. This is the first time we have ridden together. She is older than I am but I am her senior tonight. She is supposed to follow my lead; only, I can’t lead because I am unsure how to be strong. This event, this sequence of events has altered my vision and knocked out my sense of balance. As we reload the rig, the coroner pulls up and we point him in the right direction. His car wont make it either. A bystander uses his tractor to pull the coroners vehicle up the steep slippery path. Bill comes quickly down the hill and says its time to go. We have another call waiting in town and there is no crew to take it. None of us have time to recover from what has just happened. None of us have time to regroup. It is time to go to a new scene with new people and pretend that their problems are just as serious (they never are). It is time to put myself last for another, like I have done countless times before, only this time I don’t feel the same drive that I usually do. I want to go home. I want to wash that poor man’s blood and DNA off of me. I want to separate myself from what I was just witness to. I want to change my clothes into something untainted, something less tragic. I want to change my thoughts and go back to my boring middleclass existence and watch Survivor, but I can’t.
So we go on that call and it is like so many others that seem insignificant. It is like so many others that make us all question why we do this for a living, but we do it and we think we are done for the night. We are not.
At the Emergency Room, they tell us there is a premature baby who needs to be taken to Albany Med. We are still the only crew on duty, and the day crew won’t be on for another two hours, so we agree.
It is a long drive home and I have a lot of time to process the events of the evening. The baby arrives in Albany unscathed. He is treated and released from Albany Med with no complications and some part of me feels vindicated. I have been part of the end of a life and the beginning of another in a single twelve hour shift.
In some ways I feel like medicine is sacrilegious. Maybe people are not supposed to interfere with God’s will or plan. Or maybe this is part of the plan too. So often I feel our only job is to stand witness, to bear the burden of the closing of another’s life, to validate it, to make it real. Maybe their family isn’t there, or maybe they had no family at all. Maybe their family is there, like tonight, but at least we are there to carry a little piece of the weight. You tell yourself it’s for the family, if no one else. We are gatekeepers, looking over the abyss and holding the key to their fates. Each of us takes a turn holding their lives in our hands.
Of course, I don’t know if I even believe in God, so it’s difficult to assess whether I am on some predetermined path or not. I guess it doesn’t matter either way. Perhaps I am there to make the family feel just a little less helpless, or maybe, as I like to think, I am here to witness the passing of a soul from one realm to another. It doesn’t matter. The fact is that I do see it; I am present in that moment. My crew and I, it affects us regardless of whether we belong there or not.
For me, there is a handful like this one. There are those calls that are irreversible, tragic, flawed and raw. Every one of them illustrates how little control we possess. They are the calls that went terribly wrong-- where incapable, hasty hands did not perform their duty. There is indescribable guilt buried close to the surface with each one of them. It is irrelevant whether I did my best, the memory revives as failure.
Overall, the thing that I have taken away from each of them is that sense of mysticism. There is undeniably something greater than humanity, something both controlled and chaotic all at once. One cannot deny the difference between a body with a soul intact and a body devoid of one. It’s impossible to witness that distinction and not have it change you. It is a spiritual experience. Every time.
