Thursday, October 15, 2009

- Exits

"That's a negative, Whiskey-6, fire on scene, saying it's going to be a DOA. Check your call notes, please."

I have just been denied a back up request, and toss the mic down in disgust. I've already read the call notes. Apparently the dispatcher on the phone with the caller asked if the patient was breathing. The response is quoted on our MDT screen:

*Caller states "His face is blown off"*


Ink is my new partner. He's young, and green, but he takes orders well, and we have the same sense of humor. We're on our way to a self inflicted gunshot.

"OK, Ink, I know you're thinking shotgun to the head, that pretty much erases everything right? The thing is, a lot of times, when they go to do the deed, they lean forward a little, and redirects the muzzle blast out instead of up. End up blowing off their face. It looks like they're toast, but every once in awhile, there's something you can save." (Jesus, I think, when did I become such a blow-hard lecture monkey...)

We arrive on scene to find several layers of police tape strung up. We end up having to park about a hundred yards away from the scene, out back of a trailer, adjacent to a bayou. Ink and I grab our gear and walk to the scene. There are still several layers of tape between me and the patient

A cop grabs Ink and points at me. "Just you back there, March. It's still a crime scene."

I look back at Ink. I do not like this one bit.

I walk pass the last layer. I can see a body lying out near a tree with a large pool of blood, uphill from the body. Hmmph. Someone moved it. Blood doesn't run uphill. As I round a picnic table one thing become abundantly clear:

Our suicide is still alive, and his body shudders as he tries to breathe.

The cops look at me expectantly.

"He's still alive, guys. I gotta work him. Get fire back here, now." I turn around and yell for Ink and grab my radio, requesting back up.

"Ink, grab c-spine. Let's get him on his back." We are delayed as fire runs up to grab the rest of the patient. We flip him on the three count. One of the firefighters, an older male, stumbles back and throws up.

Time seems to stop. His face is pretty much unrecognizable . I see, just posterior to the chin, the entrance wound. It is as big as my middle knuckle on my pointer finger. The flesh of the cheeks is displaced by the blast, rippled and stretched in an obscene perversion of a human face. His breath sounds labored, like he's holding a mouth of full of water and is trying to breathe through it.

Blood is pouring from his nose and mouth. It looks like one eye has been pushed into his skull but in reality the cheek and nose have been so displaced it's just an illusion. The other, I cannot see. The forehead is relatively normal, but immediately into the hair line and a little right of middle is a 4 inch diameter exit wound with flapped open skull and brain matter nearly protruding. Incredibly, I see a tooth sticking out from some of the gray. The blast must've carried it through.

I'm not to proud to say that I almost lost it for a second. I gag, but only once, and after I'm reaching for my airway equipment. Firefighters are now crowding in, and I send them back to my unit for the mechanical suction. One little girl, can't be more than 20, is right up in the mix. I open my medic bag and toss Ink a BP cuff and steth. "Get me some vitals, and let's get him spinaled. We're gonna shit and get."

I slip my safety glasses down and quickly prep my intubation equipment. I'm worried about what I'm going to find. I open up his mouth and the piece of the jaw I'm manipulating feels like a bunch of little Legos shoved into a latex sleeve. Opening the mouth, there are teeth fragments everywhere and a large pool of blood pooling at the bottom of the throat. I have already hooked my ETCo2 sensor to the end of my tube in anticipation of having to tube some bubbles and needing rapid confirmation. Luckily blood has only risen halfway up the cords, and they are plainly visible. I manage to pass my tube first try. I inflate and try a breath in. The ETCo2 value immediately jumps to forty and stays there. There is no resistance and I secure the tube.

In short order we finish spinaling and get vitals. Incredibly they're normal, except for a little tachycardia. My back up arrives and we get him loaded up. I wrap two trauma bandages around the mess that is his head. The tooth lodged inside falls down somewhere and hits my unit floor with a click.

Louisiana has recently instituted a trauma network where we phone in our unit number, patient's qualifying criteria, and location, as well as our resorces available. The medic at the phone then checks a board to see where the patient should be transported to. This enable the proper patients to get the proper care, as well as spread major traumas around the area so that one hospital doesn't get too busy. Since all the hospitals are with in 4-9 minutes of each other, the transport delay isn't too terrible. I actually know the medic who answers the phone personally, and give him a report of what we have. He whistles softly and directs to the nearest hospital that has 24 hour neuro surgery.

The medic I have riding in with me and I talk to one another, assessing. I got the tube, and we got off scene pretty quick, but I have kind of a shitty feeling. I look at the massive trauma to his face. I didn't go this guy any favors. I suction several times on the way in.

We hand off when we get to the hospital and I go and clean the blood out of my unit. Ink picks up the tooth from off the module floor and holds it up. I shrug, and he tosses it into the biohazard can.

A deputy would later tell me that the patient was sitting on the picnic table, and they find one of the patient's canines embedded in the door frame, twenty feet away. I restock my truck when we get back. The rest of the day is busy and I fall into a dreamless sleep that night.

* * *
I return to the hospital the next day. Our patient's parents are there. I go to check on him. He is still alive. The Louisiana Organ Procurement Agency has been called in. I confer with the nurse for awhile. Mercifully they have wrapped his head in large beige bandages to hide the trauma beneath. Only his mouth is visible, but they've cleaned the blood off of the sides and he lies under a blanket. The LOPA doc greets me cordially. He asks if I was the one who brought him in, to which I answer yes. He claps me on the back heartily, congratulating me on getting the intubation.

They take him on the vent that afternoon, and he breathes on his own for a short amount of time, but it goes ragged, and they let him fall into asystole. They tell me later that the harvest went incredibly well.

I take some solace in the fact that all though I was not able to save him, I was able to help other people.

But I still think about him a lot.

-MM

8 comments:

Medic999 said...

Wow MM,

Tough job, great tube, and a few families that will always be in your debt if they knew what your decision to actively intubated and treat the patient had on the lives of their children.

I'm sure you still think alot about him and the scene, but you did a great job that day!

JeRRTep said...

MM-
I don't know how you do it, I could never be a 1st responder! I don't have the stable stomach to do it. Some of the medics in my area do a great job of covering the patients before I get them and I totally appreciate it! Thank you for doing what you do! And thank you for being strong enough to do it!
kT

Matt M said...

That was hard to read.

Thank you for writing it. I feel guilty about the relief I feel that he did not live long, and that other benefited from his donated organs.

Loving Annie said...
This comment has been removed by the author.
Loving Annie said...

MM,

I am glad he did not live, and his organs were able to be harvested...

It is at least some small mercy that he did not survive and does not have to live with not only what drove him to committ suicide, but the psychological misery/horror/sense of failure and despair of not being able to complete it, plus the physical disfiguration and pain that would have followed because of his injuries....

You have to wonder how many years, months, weeks and days he lived with his unhappiness before he decided to do something he thought would be final...

I wish there was more joy and less despair in our world.

Kyle said...

Sounds like you saved several lives that day.

I work in a system where a dispatcher would never deny you an assist unit. As a paramedic and dispatcher I can not imagine a system where the dispatcher could second guess the crew. You may have to justify the request later but if you ask for a back-up unit you are going to get it.

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