Conflict Resolution

con·flict

1 : a state of open, often prolonged fighting; a battle or war
2 : a psychic struggle; often unconscious, resulting from the opposition or simultaneous functioning of mutually exclusive impulses, desires, or tendencies

res·o·lu·tion

1 : the firm decision to do or not do something
2 : the quality of being determined or resolute
3 : the action of solving a problem or contentious matter
4 : music; the passing of a discord into a concord while changing harmony

I tell the fire crew that I’ve got this if they want to cut out. They are always in a hurry in this city and when it’s a stat call that’s a great thing, but when it’s a geriatric patient who’s looking for his reading glasses on a non-emergent call, they tend to get impatient and that’s not so good. I’d rather let my patient take his time and feel comfortable than hurry him out the door. He finally spots his reading glasses on the music stand surrounded by three trumpets he’d been practicing a short time earlier.

We were called here because his wife noticed that he got dizzy when he stood up from the couch and was slow to answer questions after sitting back down. I do my assessment and find him negative for stroke signs, STEMI (S-T elevation myocardial infarction, meaning heart attack), diabetic problems, and everything else I could think to ask about that may cause a near syncopal (fainting) episode.

It’s likely that the beta blockers he takes for hypertension kept his heart rate low enough that his blood pressure couldn’t keep up with the sudden demand of standing up and he got a little light headed. His wife cares about him and wants him to get checked out anyway. Both he and I can see that arguing with her is a losing proposition so he’s going to humor her and go to the ED with me. That’s okay with me, honestly I would rather take a man in his mid-eighties to the ED than spend an hour documenting why I didn’t take him.

I complete my entire assessment in his living room and he’s symptom-free so I’ve got very little to do as we drive to other side of the city to his preferred hospital. Being a non-emergent call (some might call it a BS call), I don’t have to rush him to the closest facility or take him to a specialty hospital — he can choose where to go. If it makes him feel better to go across town that’s fine with me.

As I’m sitting on the bench in the back of the ambulance, filling in his demographics on the laptop for my paperwork, I do a quick lookup on him to see if we’ve transported him before. We have, so his information comes up. His insurance information indicates VA (Veterans Administration) coverage.

His name is of Japanese decent and he’s in his mid-eighties. I always like to thank the older Vets for their service and sometimes hear some stories when I get a chance, so I ask if he fought in the war. Men in their eighties only recognize one war; everything since was just a conflict.

“Oh yeah, I fought in the war, got drafted in ’44 as soon as they let me out of the internment camp.” He has a slow meticulous cadence almost as if he is planning where to stop and take a breath and adjusts his words to facilitate regular breathing.

“Are you serious, you were locked up and then you went to fight for the country that did that to you?”

“Yeah, my mother told me to. She said, ‘You were born here, this is your country. If they want you to fight for it then it’s your duty.’ So I did.”

I remember hearing about the 442nd Combat Infantry Group that fought in Europe. It was comprised almost exclusively of Japanese-Americans. They became the most highly decorated regiment in the history of the US Armed Forces with 21 Medal of Honor recipients. Yeah, okay I’m a geek, I’ve been known to put off cleaning the kitchen because there’s something compelling on the history channel, much to me wife’s chagrin.

“Well, I was sixteen when they put me in the camp. When I turned eighteen they said I had to sign up for the draft and as soon as I did they drafted me. I was supposed to go to the 442nd and was in the States training for it because they were losing those guys all the time — almost half of them died. But part way in they changed their mind.

“See, I was bilingual with no accent so they wanted me to help out in the Pacific. They sent me to language school for seven months, it was supposed to be nine months but they were in a hurry. Once I was done I got attached to the War Crimes Investigators and did translation for the interrogation of prisoners as we took back Manila.”

I think of the integrity and maturity that was displayed by this eighteen year old boy. After being imprisoned in a camp for two years at such a formative time in his life, he’s able to come to terms with some of the most difficult issues faced by humanity; prejudice, loyalty, inequality, duty.

“So you’re eighteen and doing the translation as they interrogate people?”

“Yeah, they were worried about me being so young at first too. They asked me, ‘Are you sure you can do this?’ I said, ‘I don’t know, let’s give it a try!’ So I guess my language skills were pretty good because it was easy for me. They were really impressed and kept me busy for the rest of my tour as we moved across the Pacific and into Japan. Being bilingual probably saved my life – as a translator I wasn’t really in danger of being killed.

“When my tour was over I got a job as a contractor in McArthur’s Tokyo doing intelligence work translating military documents. It was a good job, I did that for another five years.”

I imagine what it must have been like for him as a young man of Japanese descent – working within the American military machine after the national outrage following the bombing of Pearl Harbor. Then to go to the country of his parents’ birth immediately after atomic bombs were dropped on civilian targets. The conflicted emotions must have been overwhelming.

“So what did you do when you finally came back to the States?”

“Oh, I worked as a CPA for twenty something years. I mean, I still do some work for them in tax season but mostly I’m too busy to work any more.”

“Too busy? So you’ve got a lot to do these days?”

“Oh yeah, I’m real busy. I play the trumpet in two bands, seems like I got a gig a couple times a week and I’m practicing all the time. I even go to a brass workshop for two weeks every year. I love to play the trumpet, it keeps me young.”

His face lights up, he sits up a little straighter, and gestures with his hands while talking about music. This obviously means a lot to him – it seems it’s a big part of his life.

“When did you start playing?”

“Oh, when I was a kid in high school, then when we were in the camp it was pretty much the only entertainment we had. A few of us in the camp could play an instrument. We’d get together and play concerts to keep people’s spirits up. Then when I went into the Army I played the bugle to wake people up in the morning.

“When I got out and started working I didn’t have a lot of time, but twenty years ago I retired, well mostly retired, so I had a lot more time to play again. Been doing it ever since!”

As we’re backing into the ED I realize I haven’t done any paperwork. I’ve been listening to this fascinating man throughout the trip. He’s a man of honor and duty who led an amazing life and is now enjoying his golden years as a musician. The whole time I’ve been talking to him he was smiling with an alert sparkle in his eyes as if recalling fond memories. He has made peace with the past and expresses his strength of character and love of humanity through his music. I am a better person for having met him.

 

 

Quiet Giant

qui·et

1 : making little or no noise; quiet neighbors

2 : the quality or state of being quiet; tranquility
2 : free from turmoil or agitation; untroubled

gi·ant

1 : A person or thing of great size
2 : A person or thing of extraordinary power, significance, or importance
3 : Greek Mythology; one of a race of humanlike beings of enormous strength and stature who were destroyed in battle with the Olympians

He’s old, really damn old! I’m not really sure why he called me here or what he expects me to do for him. Honestly I’m not really sure he’s a he but I decide that works for now.

His friends and family stand around quietly whispering amongst themselves; even his children are old. I reach up and touch his lower extremity which was burned some time ago. It’s an old injury with minor discoloration and scarring being the only evidence. I doubt it bothers him anymore although the fire that raged through his neighborhood must have been frightening.

He has a serenity to him that makes me feel relaxed and peaceful. I wonder what world events he has witnessed in his lifetime: the men that landed on the moon; the two times that men of the world took up arms against each other; the men who came to these shores in boats and eradicated a peaceful nation; the men who traveled across another continent to wage war in the name of a prophet; even the birth of that prophet. I suspect he’s stood silently throughout all of these events without judgment.

I don’t think he called me here to help him. More likely that he called me here to be helped by him. I have to admit, I feel better after spending some time with him but it’s starting to get dark now and I should get back.

Walking the trails back to the car I feel the sporadic drips on my head. It’s not rain, just the evening marine layer coming in off the coast and condensing on the boughs of the enormous redwood trees overhead; then falling to earth like tears.

Burning Questions 5/5

It’s after 0300 and we’re driving in the city on the way to our post. The streets are completely deserted except for the strong police presence. All of the rioters have either been arrested or have gone home. The only evidence of the chaos is all of the broken windows, burned out dumpsters, and torn down security gates. Police SUVs roam the streets; every seat occupied, all eyes on constant scan of the abandoned urban landscape.

I’m on a three man unit; another paramedic and an EMT. We’ve all been up 20 hours so we trade off sleeping between calls on the gurney in the back. We’ll be up for another 10 hours before getting cleared to go home. Our regular posts have been abandoned; it’s too dangerous to spread us out so thin in the city without protection, so we post at the hospitals in secured parking lots.

Today it’s the classic big city EMS calls; abdominal pain for the pancreatitis patient who spent the last night drinking, the ALOC for the woman who just wants a sandwich and a place to sleep. A dialysis patient who seems to have had a stroke at sometime during the night; we call it a cold stroke, unknown time of onset.

Around noon we get the call for the MVA (motor vehicle accident) with a few patients that just want to get checked out at the ED, just for law suite purposes. Darren is on the engine that responds to the call as well as our over staffed ambulance. The other medic on the ambulance is in rotation to take this call so I’m kind of a bystander; helping out with bags and vitals and such.

We end up transporting two patients from the accident, really nothing wrong with them but they feel they need a doctor to tell them that they are okay. The other medic and EMT on my rig are dealing with the patients so I get a moment to talk to Darren. We exchange greetings and thanks that we are alright after the chaos of the last 24 hours. I remind him that my wife and I will be there for the block party and that I signed up to work the grill and bring the hamburgers. We’ll catch up later when we have more time.

As I’m driving to the ED, two patients in back with my two partners, I’m thinking of the police officers that will be laid off in the next few days. We really could not have done this without them. We got lucky this time; the self proclaimed “anarchists” from out of town who intended to instigate a full blown riot failed. They just didn’t have enough time to get to the city to start trouble before PD shut the others down. PD, FD, EMS functioned in lockstep formation to ensure the safety of the community and prevent widespread escalation of civil unrest.

It’s mid afternoon and I’m tired, my two partners are tired as well, we’ve all had a 30 hour day. We clear the hospital and get some food. Our snacks, stashed in jump bags, have been depleted for hours. The city is back to its normal vibe with the regular population doing the normal every day tasks. We sit at our post and wonder what will happen when the judge brings down the final sentencing. Will we get activated again or will the city continue as it always has? Either way, we are here, doing the job that we signed up to do. Bring on the craziness, bring on the mundane, that’s what we do day in and day out…

Burning Questions 4/5

Darren and I stand in the shade of a tree watching the children play soccer in the coned off street; children of all colors and ages laughing and running together. The final game of the world cup just finished so all the kids are excited about soccer. Watching them enjoy themselves we talk about the contrasts of where we work and where we live.

There are many differences of course but we see it from a unique perspective. We walk into people’s houses and apartments, sometimes on the worst or even the last day of their life; we see how they live, what their prized possessions are, and what’s missing in their life. Most notably we see the lack of books and computers along with the lack of fathers. The children of the hood are growing up with a myopic view of the world without the benefits of a strong family unit. The socioeconomic inequity of their situation is propagated from generation to generation; teenage mothers becoming thirty year old grandmothers. Their education comes from the street which becomes the extent of their world view. Of course they are angry; they have a right to be angry. They’ve been marginalized by society and government with ever shrinking budgets and reduced social programs to benefit the people in need. The violence is a manifestation of their inability to adequately communicate their needs and create effective change in their communities. In many cases violent outrage is the only voice they have left.

The people in this community drive past these neighborhoods every day without ever getting off the freeway. They are equally myopic in that they choose to limit their world view to only see the things that appeal to them. It’s easy to avoid the hood; you just don’t go there. You look at your cell phone while sitting at a red light instead of the homeless man standing there with a sign asking for help. It isn’t race that separates us, its socioeconomic status and the inability to empathies with people and situations we know nothing about. Neither Darren or I have any good answers to fixing the situation. Possibly just the fact that we are able to frame the question is a good first step.

The soccer game is winding down and kids are starting to get tired. We start to put lids on the food and clean up as people are thinking about going home. The sun was strong today with a high UV index. With my fair skin I had to reapply sun block to prevent a burn. Darren’s black skin protected him yet his wife is as fair as I am so she wore a fashionable sun hat. My wife plays with his daughter’s beautiful naturally curly hair.

Burning Questions 3/5

As we clear from EPS we are sent further from the big city and the chaos that has already started to get ugly. Our first deployment of tac-medic units are already at the staging area near downtown. They are getting pared up with their counterparts in PD and FD to create mobile task forces for civil unrest response.

I’m scheduled for the second deployment which should be in maybe ten hours, only two hours after finishing this shift. This could be a very long day.

As we drive away from the city we are monitoring four radio frequencies: our regular EMS station, EMS tac-channel, PD tac-channel, and local news reports on an AM station.

The crowds have grown to over 500 with smaller groups smashing store fronts, looting businesses, and setting garbage dumpsters on fire. PD is maneuvering skirmish lines of police in riot gear to contain the worst of them. On the PD tac-channel we hear the yelling from the crowd, the bottles smashing as they are throne at the officers, the M-1000s exploding near the skirmish line (very large firecrackers throne by the rioters.) Three armed men are maneuvering in the crowd; they have paper masks with the depiction of the face of the man killed by an officer just 18 months ago. The officers give the order to don gas masks, they ignite smoke grenades at their position to cover a strategic redeployment (retreat).

The dispatcher comes up giving us a call. We’re in the city furthest from the chaos so it will be unrelated to the craziness going on thirty miles away. With all of the radio traffic going on at once we couldn’t hear the nature of our call. I turn down the extra frequencies and ask our dispatcher to repeat our call information.

“You’re responding to a male patient, victim of a shooting, your scene is not secure, please stage out.” Seriously? In this city, what the hell!

Before we get to the neighborhood our dispatcher comes up again. “You’re scene is now secure, PD is on scene, you’re clear to enter.” Fabulous…

As shootings go this was about as basic as they come; a man in his twenties, wearing the wrong color shirt in the wrong neighborhood, shot by three men in a moving car that sped away. It’s your classic drive by shooting. Strange how I take comfort in the familiar at times like this. It’s a small caliber GSW (gun shot wound), apparently through and through, to the calf. It may or may not have grazed the bone but everything distal to the wound is moving and perfusing. Bleeding is controlled with just a few pieces of gauze and a wrap of kurlex. I would give him some morphine for the pain but he came pre-medicated with alcohol and weed. I just need to monitor him for changes while transporting him to the ED.

I load him up and take him code-2 to the nearest hospital. Perspective is an amazing thing. This county has so many GSWs (3 in the last two hours) that we don’t even trauma activate the patient if the wound is below the elbow or knee. These patients get a slow ride to any basic ED. Once I arrive and give a quick report to the charge nurse she orders a lock down of the ED. All visitors are told to leave; more security guards are positioned at the closed entrances which are secured. They are protecting the victim, and staff, from any potential follow-up violence.

It’s happened before; gang-bangers returning to the scene of a shooting when they realize they didn’t quite kill the guy, or walking into the ED to finish the job. Another paramedic in county was holding c-spine (hands on either side of the patient’s head to prevent spinal injury) when a shooter returned and shot his patient point blank in the head, the bullet passing within inches of both of the paramedic’s hands.

Sitting at the EMS desk in the ER I’m working on my paperwork for this call while listening to the PD tac-channel on my portable radio. The riots are getting worse; more arrests, more fires, more looting. The tension in the officers voice is high as I’m listening to them redeploy platoons to box in the most violent of the rioters. Nurses and doctors walk over to stand close enough to listen to the traffic on my portable radio exchanging worried looks between themselves and texting love ones to let them know they are okay.

Clearing the hospital we are told to report to our main deployment on the edge of the big city. It’s near the end of this shift and they are switching me to another unit to head into the city. Katie is relieved as she’ll be going home soon. I’m not sure what I’m feeling as I prepare my equipment on the drive back towards the chaos.

Burning Questions 2/5

My neighbor’s college age son and his friend take over the grill. The first round of food is done so it’s a little slower. I sit in a chair next to Darren who’s holding his infant son in his arms as he sleeps.

We talk in quiet voices about the chaos of the last few days. We share a bond from all of the calls that we’ve handled together. We take comfort in having a sympathetic comrade living just three doors away. The rest of our neighbors on our street are completely ignorant of the street life that we frequent in our working hours. They watched the news and saw the watered down version of what happened. Darren and I know the real story yet we keep it to ourselves as most people are uncomfortable with reality.

This suburban neighborhood is sheltered from the poverty and desperation of the inner city. With our manicured lawns, home owners association, community pool, and golf course weaving throughout the neighborhood we are a microcosm of self imposed delusion.

Darren and I are interlopers in both worlds; chameleons that quietly navigate between two realities. Blue collar workers living in a white collar neighborhood; our names stenciled on our uniforms, on a first name basis with the homeless, addicts, gang-bangers, and prostitutes of the city. Yet also the friendly neighbor who offers to take the garbage cans in from the curb, picks up the newspaper, and dog sit when others are on vacation.

Darren quietly voices concern for his children; wondering how he will impart the realities of life to them while protecting them from the very same realities. I don’t have a good answer for him, it’s a dichotomy that parents first struggled with shortly after the first city was settled and supported by the produce of the surrounding farms. Sitting in the shade watching the smoke from the BBQ, happy children playing, friendly neighbors talking, infant son asleep on Darren’s chest, we share a comfortable silence and a beer.

Burning Questions 1/5

burn·ing

1 :  marked by flames or intense heat: a burning fire

2 :  characterized by intense emotion; passionate: a burning desire for justice

3 :  of fundamental importance : urgent <one of the burning issues of our time>

 

ques·tion

1 : an interrogative expression often used to test knowledge.

2 : to express uncertainty about: doubt

3 : to dispute; a challenge

—————-

The wind changes direction, smoke and flames blow towards my outstretched arm. I pull it back just in time to save what little arm hair I have. I don my flame resistant glove, pick up my flat metal tool and dive back into flames from an upwind direction. One minute later my perilous task is complete; all of the hamburgers have been flipped and repositioned to avoid the sudden flair up. Didn’t even spill my beer, nice!
Darren comes over, attracted by flames as most firefighters are, and helps to offload some of the finished burgers. Darren’s wife organized the block party and my wife is helping by setting up the tables and taking food orders on her iPhone.

Most of the families on our street are here in the cul-de-sac on a Sunday with perfect weather. Cones block the street from traffic; kids are playing soccer and drawing on the street with giant pieces of chalk.

A few days ago Darren and I were watching flames throughout the big city where we both work. Darren’s a lieutenant on a fire engine with quarters next to the elevated commuter train station where this whole mess started. As a paramedic on an ambulance in the 911 system I run into Darren a few times a month when we get called to the same job. A few days ago I was posted at the same commuter train station when the page came out to the whole county. The jury is expected to read their verdict in one hour. Darren got the same page while enjoying a day off by playing with his young daughter and newborn son. He grabbed his jump bag and made the 40 minute drive into the city.

I’m looking at the train station through the windshield; all of the windows covered with plywood to protect against the potential for civil unrest. As this is expected to be ground zero; my partner and I decide we need to be somewhere else. Anywhere but here!

Just then the dispatcher comes up on the radio and we get a call; a car backed into a young woman, pinning her to another car in a parking lot. The car took off; hit and run. The young woman has minor injuries and PD was called but I don’t expect to see them any time today. I know they’re currently mobilizing to full deployment. She’ll have to file a report at the hospital.

On scene we exchange apprehensive comments with the fire fighters about what the next few hours will bring. Once at the hospital the same conversations are shared with the ED staff. Out in the parking lot to the ED they are manning their MCI (mass casualty incident) tents with decontamination showers used for pepper spray and tear gas exposure.

Katie, a part time EMT, picked up my unit today as my regular partner took the day off for a class. Katie wants nothing to do with the big city today. I volunteered for the tac-medic units which are sent into the ‘warm zone’ with PD escorts. But if Katie wants out I’ll do everything I can to make it happen. I call our dispatch center on my cell to make the request. They made contingencies for this; almost half of our staff volunteered to work the riots so there’s no reason to send someone there who is uncomfortable with the impending chaos. We get cleared to head towards the quieter cities on the other side of the county.

Before leaving the ED I open my jump bag with my riot gear and don my ballistic body armor. Although it makes me feel a little better it just makes Katie more nervous. I need to get her out of here ASAP!

On the way to our post on the “safe” side of the county we get a call assigned to us based on our GPS location. We didn’t make it out fast enough; the freeways were parking-lots because most of the businesses in the city closed early to allow people to get out before the chaos.

Katie is getting pretty worked up as we drive to the urban sprawl gang infested neighborhood just outside the city. We pass the apartment building where 3 officers were killed last year and the street where two more were gunned down on a traffic stop. But this isn’t that kind of job; this is a basic call for a woman on a psych-hold by PD. Nothing medical going on here so I assign a BLS (basic life support – EMTs) unit to transport the patient to the county EPS (emergency psychiatric services), thinking that maybe we can clear the scene and continue our escape.

Dispatch has other plans; they immediately send us to another call closer to the city. This call could be a carbon copy of the last one with the only difference being that I have no BLS units available for transport. I’ll have to take this guy to EPS myself.

As I’m walking the patient to the ambulance with two officers I hear a shooting go out on the police radio. Katie’s eyes get big and round. The location of the shooting is only 4 blocks from our last call. We were driving past that street just a few minutes ago. The officers’ jump in their cars and take off; lights on and siren wailing.

I transport immediately; the city is becoming increasingly chaotic, Katie is getting worked up, and EPS is further in the right direction to get us out of the city.

Simple Restraint

 

 

 

sim·ple

1 : of humble origin or modest position <a simple farmer>

2 : lacking in knowledge or expertise

3 : mentally retarded, not socially or culturally sophisticated

re·straint

1 : a restraining force or influence

2 : something that is fastened to limit somebody’s freedom of movement

3 : restraint is calm, unemotional, behavior that does not provoke

As we round the corner there are three police cruisers pulled over with officers standing around. There’s a man cuffed in the back of one car with an officer doing some paperwork using the trunk as a desk.

It’s evening in the big city of my mostly urban county. The city police are on full deployment; everyone in the department is doing 12 on 12 off shifts. With PD layoffs on the horizon due to a city budget deficit and impending civil unrest due to a trial of a former police officer, the tension in the city is palpable. The police are backing each other up on every call with a show of numbers on the street.

They called EMS for an individual on a 5150. This refers to article 5150 of the state health and welfare code that states an officer may detain someone for 72 hours for psychiatric evaluation if they are deemed to be a danger to self or others. 5150s are theoretically used when a person threatens suicide or has some sort of behavioral crisis of a psychiatric nature. In practice, it tends to be used when PD can’t find grounds to arrest someone but wants them off the street.

Walking up to the police car I see a man in his twenties cuffed in the back seat. One of the officers sees me and gives a quick report. He says that this man’s mother and aunt called because he was emotionally disturbed about the situation in the city. He kept going on about wanting to kill some cops and shoot up the nearby police sub-station and he’s off his psych meds. Given what’s going on right now I can see the logic in getting this guy off the street for a while before he does something really stupid and gets himself killed in the process.

I open the door to the cruiser to get a read on the guy. The smell of alcohol flows out as the door opens. Great! Drunk cop killer in the making and off his meds. He’s taller than me and has great muscle tone – maybe prison ripped (prisoners have nothing better to do than work out, so when they’re released they’re amazingly well-built). He also has good veins. Not a junky; could be a fighter.

“Hey Lawrence, how ya feeling today?” This 20 second introduction is my chance to get an idea of how I’m going to be treating him over the next half hour. Do we have a nice conversation on the way to the hospital, do I have 5 cops hold him down while I sedate him for my safety, or something in-between?

“Yo! Why they do me like dis? I ain’t done nutt’n man…”

“Hold up, hold up, I gotta axe you sum questins man.” I match his street vernacular. I’ve got to cut him off quickly before he spirals out on me. Some may see that as insulting but it honestly speeds communication and builds rapport in the hood as long as you can do it well and with sincerity. All of the medics in county can speak street. My wife thinks it’s a riot and tries to get me to do it for friends. Something about an Irish/Scottish guy speaking street is a bizarre juxtaposition.

“Yo! Lawrence how much you drink today?”

“Man, I dun know, jus a couple, shit man why they do dis to me, man I din do nutt’n…”

I cut him off again, louder: “Lawrence! Chill man, chill. Couple a what? When you get your drink on man, what you drink?”

“Pints, jus a couple pints man. Vodka man das what I always drink.” Well, at least we’re communicating now and not yelling at cops. I’ve seen what I need to see. “Aw-rite, Lawrence, yo sit tight man, I’ll be back min’it.” Like he’s going to sit any other way in cuffs.

I close the door and tell my partner that we’ll need restraints for the gurney and tell the officer that we’ll be going to the hospital for medical evaluation prior to getting him transferred to the county emergency psych services. They’ll need to draw some blood to get a blood alcohol level and tox-screen on him. His speech is a little slurred, he ramps up pretty quick, and he had twitchy eye movements. Maybe he’s just a scared guy in a bad situation or maybe he’s a bipolar/schizophrenic who will cycle faster than I can keep up. Either way I want him strapped to the gurney for my protection.

My partner comes back with a big round-eyed look. Oh shit! “Dude, someone snagged our restraints, I checked the rig, we don’t have any stashed.” CRAP! We have the same rig every day, we used the leather restraints yesterday. Unfortunately it happens often that another crew will take equipment from a rig while it’s parked at deployment. Then it becomes a domino effect and you have to see what was removed every morning. It’s my fault – the restraints are in a fairly hidden place so I didn’t think to check to make sure they were still there this morning.

There’s no way I’m transporting this guy without restraints. Fine, we go old school. I go back to the rig and pull two triangle bandages, which are usually used to make a sling for a broken arm. Today they get used for restraints. My preceptor back in the rural county where I interned showed me how to use triangle bandages to make back-up restraints by tying interlacing lark’s head knots. This technique doesn’t cut off circulation but if the patient struggles it cinches down – the more they pull, the tighter it gets. In that county we had a state penitentiary and sometimes had to transfer prisoners more than 30 minutes to the nearest hospital. Being in such close quarters with a guy that’s doing 25 to life for murder, redundancy of restraints becomes a priority.

I have the officers help us to put Lawrence on the gurney, take off the cuffs, and tie his wrists to the rails using my modified restraints. All the while Lawrence is complaining about the injustice how his rights are being violated.

Now that he’s out of the police cruiser I see just how big he is. If I have to overpower this guy it’s going to be hard to do without hurting him. I don’t want to use drugs to knock him out; he’s been drinking and  may have other drugs on board which could interact with my sedative. It’s embarrassing to bring a patient into the ED while bagging them because you knocked out their respiratory drive. I better play this soft, I don’t want him ramping up on me.

I get him loaded into the rig and jump in on the bench seat next to the gurney and tell my partner to just drive. I want this over fast. I take a set of vitals. He’s within normal limits on everything. Well, at least that’s good; no crack or meth.

As I’m talking to him I start to realize his slurred speech isn’t the normal alcoholic slur and his mental associations aren’t the angry disenfranchised minority gang banger rhetoric. He’s actually inquisitive and asks questions about things with genuine simplistic curiosity.

“You got kids man?” Laying on the gurney with wrists tied down. I have the strangest conversations in EMS.

“Nah, no kids man, I got dogs. Dogs are betta.”

“What kine a dogs you got? You got any pit bous man? I love them pit bous!”

“Nah, I got a hound dog and two small dogs. My wife wans a pit bou though.”

“They took away my pit bous man, I love thos dogs man, how can they jus take a man’s dogs away, I love thos dogs.” He’s getting upset, starting to cycle, I’ve got to steer this in a good direction quick.

“I hear ya. Pit bous are good dogs man. I see ‘em all the time at the shelter. I volunteer to wash them at the shelter, give em a bath, man they so happy when they clean. That way they smell good and get adopted faster.”

“Nah man, you lie’n to me. You no volunteer and shit.”

“Hell yes I volunteer, couple times a month. I just go down an wash dogs all day. You wanna see some dogs you go down an’ do it too. You get to play with dogs an make ‘em happy and clean so they get adopted sooner.”

“Nah man, I jus wanna take ‘em home wit me.”

“Nah man, check it – you take one dog home and you jus gave a home to one dog. You get 100 dogs clean and happy so they get adopted, you jus gave a home to 100 dogs. How you think you gonna feel then?” He thinks about it for a while, a little too long of a while, and then his whole face lights up. He tells me how happy that would make him feel to help 100 dogs.

Laying in front of me is not a violent gang banger who wants to kill cops. He’s a seven year old in twenty-something body. The slightly slurred speech, the simple questions, the delayed comprehension – he’s developmentally challenged.

I pull the trauma shears off the wall and make a show of cutting his modified restraints off. He seems like he’s calm now – no cops around making him jumpy – and we both like “pit bous.” Besides, I don’t want the other crews at the ED seeing my restraint method and giving me shit for not checking out my rig this morning.

As soon as I cut the hands free his arms come up towards me. Damn those are big arms. Fuck, no not that, anything but that! He gives me a hug.

We finish the ride to the hospital with more talk of dogs while I finish off some patient information on the laptop. While pushing the gurney into the ED he’s hanging on my shoulder, worried that I’m going to leave him.

“Nah unkol, you cain’t leave me man! Why you gotta go unkol? Thas what they all do. Who’s gonna take care of me man?”

I can only imagine the life he’s led. Growing up in the hood with a disability must be horrible. No men in his life, raised by Moms and Auntie, with three generations of women living in the same house. He’s an easy target for the predatory behavior of his peers. He quickly tries to mimic them in dress, attitude, language, and drug and alcohol use to attempt to fit in or at least stay out of the cross hairs of the more malicious predators. He’s an innocent mirror; reflecting the attitudes of the people around him. They’re angry at the cops so he’s angry at the cops.

“Nah, Lawrence, check it man. These people can take better care of you than I can. They hep you man, I promise. It’s like the pit bous man. If I take you home I only help one person. If I stay on the street an meet 100 people like you, I help 100 people. You get me man?”

He gets it – he’s not happy about it, but he gets it. I give the report to Katie, his nurse. I’m glad she’s here today, she’s the perfect personality to at least make sure he’s looked after while in the hospital. They call a security guard and he takes up a post outside of a room. Lawrence will have to be within sight of him until he’s transferred out. I get Lawrence moved over to the bed. He’s sad and doesn’t want to talk to me any more. He closes his eyes and pouts. I look at the 5150 form written by the officer and take another look at Lawrence to burn the image into memory making the visual association of name to face.

I’ll see him again, if not on the streets then in the news. Someone will convince him to do something stupid and he’ll do it just to please a male father figure. He’s a big intimidating guy at first glance and but he’s simple-minded. The police will be inclined to tase him or shoot him than fight with him or talk to him.

I walk out of the room and the rest of the nursing staff gives me shit for adopting a gang banger. I’m glad this is the last call of the day. My uniform smells like Lawrence, I’m tired, and I’m running low on triangle bandages.

Post Reflection

post

1 : a pole or stake set up to mark or indicate something: a pole that marks the starting or finishing point of race

2 : the particular place where someone works: where a soldier is told to be for military duty, usually as a guard

3 : to leave an electronic message on a website

4 : After; later: postmodern

 

re·flec·tion

1 : mental concentration; careful consideration: a thought or an opinion resulting from such consideration

2 : a manifestation or result: His achievements are a reflection of his hard work

3 : a symmetrical transformation in which a figure is reversed along an axis so that the new figure produced is a mirror image of the original one

Driving into a cemetery with an ambulance always seems a bit strange to me, since most of the people here are way beyond needing any help a paramedic can provide.

It’s a large cemetery in the foothills of the big city but I think of it as more of an oasis in the midst of chaos. The gang violence and inner city turmoil seems to stop at the gates of the cemetery. No one rolls through here with shiny 24-inch wheels on a crappy Buick, bump’en rap on over modulated speakers and the hookers stay to the more frequented areas off the main streets. Just outside the gates I can see high traffic, an all-in-one check cashing/liquor/nail salon with a security gate that covers the store front, and three women in short shorts with a seemingly disinterested young man standing just across the street, subtly watching everything they do and everyone who approaches them. But here inside the gates, there is peace, serenity, and well-maintained lawns dotted with plaques, tombstones, and mausoleums.

We have been assigned to a post that’s within a mile of here, but it’s safer for us to post in the cemetery than at the actual designated post. Posting locations are fixed places, but as long as we are physically within a mile of that place we’re perfectly OK, and this cemetery is within the allowable radius.

Posting the cemetary is also convenient. It’s a sunny day and starting to get hot in the city but there’s a lot of shade here and easy access to a bathroom in one of the small churches on the grounds. We park in the shade, turn the EMS dispatch radio down and take in the serenity.

It’s a slow day for EMS calls but that’s something my partner and I won’t actually acknowledge until the end of shift. Superstition and Murphy’s Law dictate that immediately upon verbalizing how slow it is we will get back to back calls for the rest of the shift. It’s happened to everyone so often that there’s an unspoken understanding that we just take the down time when it comes, silently thankful.

As we drove here from the last post I had the mental images of previous calls go through my head; forever associated to the street corners, store fronts, and houses where they occurred. The restaurant takeover invasion just two blocks away at the Irish Pub. The 11 year old boy shot in the back in a random drive-by while he attended piano lessons one block away. The chest pain call at the assisted living high-rise five blocks away. The drunk driver who T-boned my ambulance just outside the gates to the cemetery. The young man shot by police on the elevated train terminal just a few miles from here. It’s strange to think that over the last three years I have become a participant in the inner city urban landscape of this county.

A fat woman walks by the ambulance with a fat basset hound whose belly bottoms out on the grass, his ears touching the ground as he sniffs. I pull out my iPhone to check the latest news on the trial. A few hundred miles away a jury of twelve men and women will make a decision in the next few days that will likely turn my city upside down.

As I read the latest news the dispatcher sends another unit towards our post. She’s a good dispatcher (surprisingly not all of them are) and she knows we haven’t had a break today. In theory we get two half hour breaks every day where we are not interrupted for system calls. In practice we’re lucky if we get one a day and even more fortunate if it’s not interrupted. Five minutes later the dispatcher comes up on the radio clearing us for a Code-7: lunch break. The other unit is within zone to cover us while we take some down time. We thank her on the radio and say that we’ll take our C-7 right here. My partner and I always bring our own food as we can never guarantee that we have time to pick anything up.

As I’m browsing the news feeds I think of the recent training we went through to prepare for the expected civil unrest; caring for tear gas and pepper spray exposure, dragging techniques for fast extrication of victims from hot zones, various levels of organization to attempt to cope with an overloaded system. I have already purchased body armor and an external vest with various medical supplies in the pouches and I’ve been issued a gas mask with a riot helmet. All of these new items are in my bag just in case today is the day.

This city is on the verge of full scale riots even on a good day. If the football team wins the locals roll cars over and disrupt traffic. A loss will lead them to set cars on fire and smash store fronts. I can only imagine what the verdict in this trial will incite. It really is the perfect storm in the making; the police are about to lay off 10 percent of the force due to budget cuts, it’s a long holiday weekend, and any verdict the jury presents is likely to touch off the chaos. Much like a similar trial 18 years ago involving racial tension and police use of force that plunged Los Angeles into riots, this could get ugly.

A woman walks by pushing a double stroller typically used for twins. The kids look to be only a few weeks old and she seems to be attempting to work off the postpartum pudge. Many people use this cemetery for exercise – taking the paths all the way to the top of the hill is quite a workout, but with a big payoff. The view up there is spectacular – bridges, water, the city. I went to a car fire at the top last year. Someone stalled at the look-out point and tried to get his faulty carburetor to work by pouring gasoline in it, of course it got on the hot engine and turned into a fully engulfed car fire. I was posting right here when another motorist drove by and told us there was a fire at the top. Upon driving up there and seeing the fire we called our dispatch center and had a fire engine sent to our location. No one was hurt so my partner and I watched the firefighters put out the fire while we finished our lunch. Dinner theater: EMS style.

As I finish up with the news feeds on my iPhone the dispatcher comes up on the radio telling us our C-7 is over and we are needed in another part of the city. As my partner drives to the next post I watch the urban landscape slide past and wonder what the next week will bring. What new associations will be assigned to corners and storefronts that I will respond to in the coming chaos? I am truly a participant in the events that constitute life, death, and everything in-between; and it all makes me feel incredibly alive!