Dissolution

dis·so·lu·tion

1: annulment or termination of a formal or legal bond, tie, or contract

2: decomposition into fragments or parts; disintegration

3: formal dismissal of an assembly or legislature

4: extinction of life; death

It’s a Code-2 response – no lights and no siren – and I’m in a morose mood as I make my way to the middle of the county. I’m responding solo and driving myself for once. The passenger seat next to me is empty. Scottie is responding from the other side of the county and I’ll meet him there. As I start to get closer I see others on their way to the same place. Uniforms in cars and ambulances, driving slowly in the same direction. I pass a fire engine with its cab full of new hires who are in the academy. I ponder the lesson that the brass is teaching them by having them take the day off from the hard work of the academy and attending a funeral: death is real.

As I make the turn into the cemetery I see the ambulance parked across the street. The cemetery happens to be at a normal posting location. Ambulances are sent to this intersection as it has easy access to a few different cities, as well as the necessities of a mobile crew: a bathroom, some shade, and nearby food options. Many of the cars parked along the wide streets running past the headstones bear county EMS stickers in their back windows.

Walking up to the small chapel I pass ten ambulances, four fire engines, and even a ladder truck. Our brothers and sisters from the fire service have made a good showing – every city in our county is represented, and we all appreciate their presence.

Walking over the small grassy hill to the chapel I see the sea of uniforms – I’ve never seen so many of us in one place before, and it’s overwhelming. Paramedics, EMTs, dispatchers, firefighters, police officers, and of course the honor guard with class-A uniforms complete with swords. There’s even a mounted EMT from the equestrian unit – I never even knew we had an equestrian unit.

All are here to pay their last respects.

At any given time at least a third of us are working the streets and responding to calls in the county. But the 24×7 nature of our work and the size of our county makes it difficult to get so many of us together at one time and in one place. Today is the exception – they put out the call to neighboring counties for mutual aid. Other counties’ EMTs and medics came into our county, checked out our rigs, and opened up the map books to respond to our calls, allowing us to gather for this final goodbye.

There have to be over 300 uniforms standing around the chapel, yet Scottie is able to pick me out of the crowd and he makes his way through it to stand next to me. We have a comfortable silence between us. We’ve only been partners for about a month but spending twelve hours together on a daily basis can bring people together fast. I notice that many other partners have found each other and taken comfort from being together during this emotional time. There is one person who is unable to stand with their partner and that stands out that much more for his solitude.

I find myself in a line which is slowly making its way into the chapel; the honor guard stands at attention as we enter the doors. As I enter the chapel I realize that all the seats are taken and this is actually a line to view the casket – it’s an open casket funeral. I wasn’t quite prepared for this and that’s a strange thing to say. Unlike most people in the world, we get up in the morning and put on a uniform knowing that we have the possibility of seeing a dead body or even watching someone die. Somehow I forgot about that this morning and I wasn’t prepared to see a friend in a casket. I place the rose petals on his chest and file out the back of the chapel before I lose it.

Eulogies are given and a life that ended too soon is remembered. I look over at the crew that worked him in his last minutes and feel an unbelievable sadness. They were camping and hiking that day and too far away from any urban areas when they saw the skin signs. We all know the skin signs – pale, cool, diaphoretic – and the cardiac etiology that they speak to. They did CPR on a friend without their paramedic equipment and waited the 45 minutes for the ambulance to respond.

I can imagine the time feeling like hours as everyone does the sad math in their head. Only about 15% of cardiac arrest patients actually survive. Once in cardiac arrest the chance of survival diminishes by 10% for every minute of down time. I can imagine the absolute anguish of seeing the ambulance finally arrive only to find out it’s an EMT ambulance with no advanced life support equipment on board. The county where they were hiking isn’t as well funded as our county. The three medics and two EMTs that were with him could only use the most basic of skills in an attempt to save his life. The EMS gods were in a very bad mood that day.

The color guard snaps to attention and the bugler begins the sad song of Taps. The flag is ceremoniously removed from the casket and meticulously folded to be handed to the family. The casket is slowly taken from the small chapel to its final resting place. The procession slowly walks past a double flank of hundreds of uniforms standing at attention with salute in place. One of our own has been taken.

The color guard does a sharp left face and marches off. A final salute is given and the assembled uniforms are dismissed.

One week later Scottie is driving us to the post across the street from the cemetery. He angles the rig so we don’t have to look at the rows of headstones with flowers laid beside them.

“I don’t like this post any more.”

“Yeah, neither do I…”

 


Necromancy

nec·ro·man·cy

1 : the practice of communicating with and learning from the dead to predict the future

2 : see also necromancer; one who practices divination by conjuring up the dead

The elevator is cramped with all of equipment and people squeezing close together. My partner, Scottie, stands next to me with all of our equipment stacked on the gurney and the strange addition of two SWAT officers with body armor, helmets, and assault weapons. I can smell the cordite from the recently fired weapons. We passed the shooter on the way to the elevator still warm with spent shell casings laying in the hallway; at least a dozen hits to center mass – no need for medical attention. We’re not here for him; we’re here for the unknown amount of victims that he shot before SWAT took him out.

The silence is broken when one of the SWAT officers keys his mic to alert the rest of his team that he’s coming up in the elevator with paramedics. Adrenaline is pushing through everyone’s veins and has been for the last twenty minutes. Sympathetic nervous systems are stimulated; pupils dilate, pulse and respirations increase, we have to fight not to tunnel vision on what we are about to see.

The doors slide open to reveal two more SWAT officers securing elevator access to this floor of the building. I hear the cries for help as we exit the elevator and see the blood splatter on the wall. Following the blood streaks to the ground I see a wounded officer and tunnel vision gets the best of me. I put a hand over the arterial spray coming out of his thigh as I’m applying the tourniquet with the other hand. Scott pulls the quick release on the officers body armor to check for additional wounds. As the bleeding has stopped I stand up and see the elevator doors open again; it’s my second EMS team with their SWAT escorts.

“Okay, he’s got a GSW to the thigh, arterial spray, tourniquet in place; he’s first out. I’m going to walk the floor and get the criticals ready for extraction.”

Turning from the injured officer to the rest of the room I take in the sites and sounds. It’s a typical legal office with cubicles in the center surrounded by offices. Cries for help are coming from all over the office space. SWAT officers are holding perimeter positions where they can secure the whole room so we can extricate the victims. It’s called force protection; once they eliminate the threat they then secure the scene so we can treat and transport the victims while under protection.

I had a plan before the elevator doors opened but I’ve already deviated from it by front loading the wounded officer for extraction. It’s a natural reaction to take care of the uniforms first; they are here to protect me and I want to protect them first in my treatment; it builds trust between agencies. But the reality is that there are probably other victims that are hurt worse. I need to get a handle on this before the scene gets away from me. I need to get back to my plan.

Standing by the reception desk at the front of the office I yell across the room as loud as I can. “If you can hear my voice and can walk I need you to start walking towards the stairs. Start walking now if you can!” Bloody office workers start to emerge from the cubicles; some limping, starring at blood on hands in disbelief as the SWAT officers herd them to the stairs.

Looking down at the receptionist I see what looks like a shotgun wound to the head. Checking a pulse and finding nothing I move on. A hysterical mother is cradling her twelve year old son who had a GSW to the neck; he can talk but can’t move any appendages, traumatic paralysis.

“Scottie, c-spine this kid, he’s next out.” I see Scottie headed in my direction and the third EMS crew is coming out of the elevator with their SWAT escorts. I need to pick up the pace and sort this chaos out quickly.

I’m making my way around the office with my SWAT shadow. A man in the office clutching his chest, no injuries, probable heart attack; he can wait, I move on. A woman with bilateral GSWs to the knees, arterial spray; two tourniquets and I move on. Another woman with a through and through GSW to the chest; two occlusive dressings to stop the sucking chest wound and I move on. A DOA; I move on. A woman with venus bleeding from a GSW to the leg; pack the wound with gauze imbedded with clotting agents, tell her to hold pressure on it and I move on. An old lady hiding under the desk who was too afraid to move when I called out but has no injuries; I pull her out and have a SWAT officer walk her towards the stairs as I move on. Finally I’ve made it around the room of offices and cubicles and back to the DOA receptionist.

I send another EMS team towards the sucking chest wound lady as the kid with the neck wound is getting pushed towards the elevator on a gurney. Then the two women with leg injuries are pushed out on gurneys. And finally the man with a probable heart attack is wheeled past me while sitting in his office chair. The SWAT officers protected the EMS crews throughout the whole process; they held the perimeter and escorted us too and from the scene.

I’m making a final lap around the office space to make sure I didn’t miss anyone when a man in a reflective yellow jacket steps out from a cubicle wall. “END EX, END EX!”

The SWAT officers repeat the order to End Exercise over their radios. The DOA receptionist gives me a big smile as she stands up and stretches; sore from not moving for the last ten minutes. Her hollywood quality head wound is still glistening with fake blood.

The basic premise of this scenario is that there is an active shooter situation with multiple victims who have been shot and are in various states of severity. The on scene Unified Command-ers propose using a SWAT team to eliminate the threat and once that is accomplished, to escort the EMS team into the scene and be given close quarter force protection while providing the needed medical care (triage, emergent treatment) and then egress the area under cover and protection.

This was obviously a very elaborate exercise in which 29 SWAT teams from various local and international agencies participated. Currently we do not go into the “warm zone” so fast on the heals of SWAT and under force protection protocols. Yet that concept is being challenged on many levels as the necessity of early medical intervention has growing acceptance.

After the exercise I had an interesting conversation with the head of the Israeli EMS training division. He related a situation where a suicide bomber created an MCI with 150 injured people in which EVERYONE was treated and transported within 29 minutes. We are no where near that proficient yet. But with the new reality of global terrorism and increasing frequency of natural disasters we must continue to train for the worst case scenario.

After running the scenario as the EMS team lead I ran it again as EMS support with a different SWAT team and then observed from the sidelines as another group ran through. It was an extremely enlightening experience. Not only in my own shortcomings  but in the tactics and priorities of other agencies. We can’t predict the future or know what we will face but we can train and push our skills in the hopes that we are prepared. EMS does not conjure the dead yet we do quarry the dead; we learn form them so that we can help others in the future.



Twisted 3/3

“Did she just say ‘car vs train’?” I’m asking Louis as the radio was a little scratchy while the dispatcher gave us the call information.

“Sounded like it. I’ve got my money on the train.” Louis pulls his gloves on and flicks on  the lights and siren to get through the traffic, and heads in the direction of our call.

It’s dark and the strobes illuminate the fields and scrub brush of the landscape in this rural corner of my mostly urban county. We’re heading down a well-traveled arterial yet we’ve taken it to the point that it’s turned into a dirt road. I’ve actually never been this far down this road so I check my iPad to make sure the railroad crossing is still in front of us.

Eventually we see the flashing red lights of the fire engine and the heavy rescue rig. They send out the heavy rescue crew when there is a possibility of extrication. It’s like a giant drivable toy box. Every external cabinet holds all kinds of great toys for guys that never grew up: jaws of life, pneumatic spreaders, inflatable bags, etc. Both rigs are parked next to the railroad crossing where a huge train blocks the road. The lights are on in the train and I can see it’s a passenger train by the many heads that are silhouetted in the windows. It’s not one of our light rail commuter trains. This is a heavy rail interstate train with maybe thirty cars.

We park next the the other rigs and start walking down the tracks towards the flashlights that are visible one hundred yards in the distance. As we’re walking I’m using my flashlight to illuminate the uneven gravel that is littered with car parts and huge gouges in the direction of travel.

Once we get to the front of the train we finally see the car – or what’s left of the car. It looks like a hungry train decided to eat the car for dinner and got interrupted half way through. The car appears to have been “T-boned” by the train and it’s looking like a tin can that was stepped on so the middle is flat and the ends are just twisted heaps of metal that were dragged for the last hundred yards until the train stopped.

I catch the eye of the LT as I recognize him from other calls that we’ve been to in the past. “Please tell me no one is in there.”

“As far as we can tell it’s empty but they’re getting the thermal imager to confirm.”

We have city PD Officers and County Sheriff Officers on scene now and I see that the conductor has made it down from the driver’s seat to see the damage. I confirm with the conductor that there are no injuries to the passengers in the train. They had people walk the length of the train in the passenger space and basically no one even knew what happened. The inertia of the train was such that a little car didn’t even interrupt people’s dinner or spill their drinks. That’s great because I had a brief moment of panic thinking that I was going to have to take 100 sets of vitals and have everyone on the train sign out with a release form.

Not only does the thermal imager show that there is no trapped warm body it the car it shows that the engine was cold when the train hit it, so it was parked on the tracks! We have to do our due diligence to make sure we didn’t miss a patient that may have been thrown from the wreckage. Using flashlights and the thermal imager we cover a hundred yards in either direction of the point of impact with no visible hot spots.

As we’re getting ready to clear the scene I ask one of the County Sheriffs why a car would be parked on the tracks at this time of night.

“Yeah, well, it happens a few times a year. Gang bangers from the city will steal or car-jack a car, joy ride all day, then park it here to destroy any evidence and maybe just watch from a distance to see if it explodes. We didn’t find the license plate so we’ll have to run the VIN to confirm – if we can find it.”

Taking the long walk back to the flashing rigs I’m thinking about the utter disregard for human life that someone would have to park a car on a train track. I don’t know what the chances of derailing a heavy train are but had it happened we would have had a serious MCI (Multi-Casualty Incident) on our hands. Even still, the conductor spent a few minutes wondering if he just took a life while driving his train. As a matter of procedure he’ll end up peeing in a cup and handing over his cell phone to make sure he wasn’t at fault for the incident.

I often joke with my wife that I’m in the business of thwarting Darwinism. We save the stupid and negligent people of the world so that they can go on to propagate their genetics and make Mini-Me’s just like them. A thousand years ago they would have been run over by a water buffalo while crossing the trail. Today we patch them up and send them on their way to make more kids. One of these kids has just endangered over a hundred people with a senseless act. I wonder if the genetic pool of humanity is forever degraded as our modern medicine does its magic.

I guess that’s a question for future sociologists to ponder. Meanwhile, we in EMS continue to do our job and hope that in some small way we have the chance to make a difference for the better.

Twisted 2/3

“I guess it actually is a car fire, there’s the smoke.”

Louis and I are out on the fringe of the county in the rural affluent suburbs. We’re responding to a car fire that came in as single car fully engulfed. To be honest, most car fires that I go to are smashed radiators with steam escaping from under the hood. Cars don’t usually just burst into flames as Hollywood would like us to believe. But as we’re driving through the quiet neighborhoods we can see the smoke cloud coming up next to the road. Looks like it’s a real car fire.

Everyone on scene seems pretty calm as we pull up – County Sheriff officers are standing around while the fire department gives the car a thorough dousing, and neighbors are watching the commotion from down the road. It seems as though the car hit a rock that’s about the size of a small dumpster, and the rock went straight into the engine compartment.

The rock is at the side of the road where the road just plain ends. As housing developments push into the rural areas they are built in different phases. They provide the infrastructure, in the form of access roads like this one, for future phases of development. But until they start the next phase this road stops abruptly at the end of the neighborhood.

By the looks of it, the driver didn’t know the road would stop so abruptly and veered off to the side, hitting the rock which is now sitting where the engine should be. The lack of skid marks speak to the level of damage that was transferred to the car.

I don’t see the fire department doing anything medical, just pulling hose and squirting water, so that means one of two possibilities: the driver is either uninjured, or crispy beyond recovery. Walking up to a Sheriff Officer I ask if there are any patients. He points to a boy standing on the other side of the road with another officer – the boy looks to be maybe sixteen. I’m surprised – he looks completely fine from where I’m standing.

Louis and I walk up as the officer is finishing his initial questioning. “Hey, were you the driver?” He nods his head up and down. He’s a bit flustered after watching his car burn up – that’s understandable. “Are you hurt?” He says no. “Okay, so tell me what happened.”

“I was driving about thirty-five miles an hour, talking to my friend, when I guess I was distracted, I missed my turn and didn’t see the road end until it was too late to stop.”

“Okay, so where’s your friend, is he hurt?” He’s thinking a little too hard right now. He’s carefully fabricating a story on the fly and he’s not really bright enough to pull it off with any credibility.

“Uh, I guess he ran off.” Seriously? He ran off? That’s lame.

“You sure you weren’t talking to him on your cell phone?”

“No, he just ran off.” Okay, have it your way.

I give him a full assessment and he checks out fine. Just a little bit of a rash on his face from the airbag deployment. It seems as though he hit the rock, got out of the car, and was clear before it started burning. He’s a minor so I can’t release him unless he has a parent sign a release form for me. Even still, it’s a good idea to get him checked out at the ED. I’m not buying the whole thirty-five miles an hour thing. His little compact car hit a two ton rock hard enough to push it two feet back in the grass and set his car on fire. He was probably doing fifty miles an hour while talking on the cell phone and went straight into the rock without slowing down.

Louis is taking some vitals for me as I go to the car to see if I can learn anything from it before we take him to the ED. The firefighters are rolling up their hoses and the car has stopped smoking. The engine compartment and passenger space are completely burned up – even the air bags and everything fabric or foam in the car has burned up. Otherwise there’s no passenger space intrusion, the seats are still bolted to the frame, the steering wheel is still in place, and the seat belt is locked in the extended position. So he was restrained, and the crumple zone of the engine compartment did its job of stopping the force of impact from extending to the rest of the car. Basically, he was lucky.

I talk to the Sheriff Officer about the “friend.” He tells me they don’t buy it either so I don’t need to stick around to see if another patient shows up. As I get back in the rig to transport the kid is all agitated.

“I have to go get something out of the car.”

“Dude, your car is toast, there’s nothing in there that didn’t get burned or soaked.”

“I don’t care, I still have to get something.”

“The firefighters aren’t going to let you near it – it’s too dangerous. Just tell me what you want and I’ll have a look.”

He doesn’t want to tell me what it is and I’m not letting him near a dangerous car so we call it an impasse and start driving to the ED. During the transport he clams up and I can see that’s he’s working on his story for his parents and the follow-up with the Sheriff at the ED. He probably wanted to try to recover his cell phone so no one could see that he was talking, or even worse that he was texting, at the time of impact. It’s a lost cause, the Sheriff will check the cell records as is routine in this situation. He’s just lucky he didn’t cause any damage to anyone else or himself. But he’s not smart enough or mature enough to understand that.

Twisted 1/3

twist·ed

1:  to combine, as two or more strands or threads, by winding together; intertwine

2 :  bent so that the original shape is change or destroyed

3 to distort the meaning or form of; pervert: He twisted my comment about to suit his own purpose

4 :  a sudden, unanticipated change of course, as in events or story – a plot twist

We pull up in front of the accident so the rig less likely to get rear-ended. We’re at the corner of Really Bad Street and Even Worse Street which is deep in the hood of the large city in my mostly urban county. I saw the car as we passed – a compact two door that was wrapped around the large light pole in the center divide of a busy inner-city arterial. The car somehow turned perpendicular to the direction of traffic and made contact with the pole on the passenger side. It looks like a fortune cookie wrapped around a straw.

There was some confusion as to the actual location of the accident – probably due to multiple calls from cell phones and people getting their locations wrong. So I want to check with City PD, who are already on scene, to see if there are any other accidents around here. That way I can cancel the other unit and save them a trip if I can handle the patients here. There’s no reason to take up extra resources if I don’t need them.

Checking with the officer on scene I find out that this is the only working accident in this area. Then I check with the fire medic and find that there are only two patients, both with just minor injuries. I can take both so I call to cancel the other rig.

Now that that’s taken care of I take in the damage to the car as Louis helps the fire medic to put a cervical collar on the passenger from the car and get her onto a back board. There are at least 24 inches of passenger space intrusion and the air bags didn’t deploy (or maybe there weren’t any). Fortunately, there are no star shaped patterns on the windshield, which would indicate impact by the occupants’ heads. But because of the extent of the passenger space intrusion I’ll have to trauma activate and go to a trauma center. County protocols require an activation based on the mechanism of injury and I’m obligated to follow protocols when it’s this clear cut – even if the injuries to the patient don’t warrant a full trauma activation.

Louis and the fire medic are almost done with the passenger so I try to find out if anything is wrong with the driver. I’ve been kind of ignoring her since I got on scene – or possibly it’s more that she’s ignoring me. She’s been frantically pacing up and down the scene of the accident hysterically crying into her cell phone and occasionally answering a question from PD when they can get her to focus.

I took a quick glance at her as I was checking out the car – no blood or obvious signs of trauma, moving all extremities, able to focus on the officer when he asks her questions. The lack of proper phone etiquette – especially in young people – really astounds me sometimes. I’m constantly asking people to put down their cell phone so I can finish an assessment.

The fire medic and Louis are loading the passenger into the rig. Louis jumps in to get a set of vitals – he’s a great partner and I trust him to do the initial work up and give me good information once I get ready for transport. I’m still trying to get the driver to focus on me as I follow her up and down the street. Finally I get her to hang up the cell phone.

A quick assessment shows that she has no signs of injury, no complaints, and no neurological deficits. I run a State of Maine neuro exam on her just to make sure. It’s a really effective way of finding any deficits that would warrant taking spinal precautions. As I find nothing noteworthy I walk her to the ambulance and have her take a seat in the “captain’s chair” at the head of the gurney.

Louis gives me his findings and I re-check a few things just to make sure everything is okay. Right before we pull out into traffic the officer hands me an incident report number for the driver so she can track her car as it’s getting towed to the city lot.

Now that we’re driving to the hospital and in the controlled environment of the ambulance I can focus on the patients a little better. They are both 17 year old girls, from the more affluent city on the other side of the county, and dressed like they are going out to club or party. Both of them have high heels, perfect lipstick, tight fitting clothing, and hair that’s done up with highlights.

I’ve said it before and I’m sticking to my guns on this one: Paramedics profile their patients – and these two girls don’t match the situation. They’re too dressed up for early afternoon, this is not the right neighborhood for them, and they’ve been acting just a little evasive when I question them. There’s more going on here and I’m having a boring day so I decide I’m going to see if I can figure it out.

I have to tell cell phone girl to hang up again as she’s trying to call people. I ask her to tell me how the accident happened. I need to know so I can give the MD a decent description, but I also need her to focus as she’s on the verge of hyperventilation – very emotional.

“This car came up behind us and was driving all crazy. It cut me off and I swerved into the pole.” She’s breathing fast and waving her hands around for emphasis.

“So there was no impact with the other car and the only damage was your car hitting the pole?” She nods her head. “Okay, then what happened, were you able to get out of the car yourself or did the fire department have to help you get out?”

She’s waving her arms around again. “No, this guy opens the door, and I like think he’s helping us get out when he grabs my purse. I’m pulling on it when he opens it up and takes my cell phone and money. He takes off down the street and I chase him, I fought him for my cell phone but he took off with the money.” Seriously? Robbed by a bystander after an accident?

“Were you hurt when you fought him for your cell phone?” She tells me no. “What were you doing in this neighborhood when you live twenty miles away?” She thinks about it for a while and tells me they were visiting a friend. “Okay, so how much money did he steal, was it like thirty dollars or three hundred dollars?” She says she doesn’t know. “You told the police all this right?” Yes.

Okay, I’m done. It’s obvious they are both hiding something and not answering questions with complete honesty. I have no doubt that she was robbed. But it’s the circumstances that bug me.

First, she’s not being straight with me about being in this neighborhood and “visiting a friend.” They are both dressed wrong for the situation. And if a guy is going to rob them he’s just going to take the purse and run. He’s not going to take the time to open it up while she’s hitting him and rifle through it to find her cash and cell phone.

Think of the audacity the thief would need to have to be fighting with a girl in a car in the middle of a busy street just after the accident. They are actually within sight of the police sub station and he’s got to know that PD/FD/EMS will be there any second. Then the improbable act of chasing him down the street in high heels, actually fighting him for the cell phone and having no marks on her. And finally, every seventeen year old knows exactly how much money is in their purse. It’s just not adding up for me.

I’m reminded of Dr. House from the television show, “Why should I talk to patients? They just lie to me.” That sentiment has rung true for me more often than not. It’s a lot simpler to just treat what I find and move on. In this case I’ve actually got nothing to treat so I do my paperwork on the way to the hospital.

After dropping them off at the ED Louis and I are talking about the call and pointing out all of the inconsistencies. We decide it went down like this: two girls from the affluent neighborhood go to the hood with a lot of money, possibly looking for drugs. The wrong people find out they have money and one of them uses a car to run them off the road into a light pole. He then jumps out and threatens her until she gives him the money. Then he drives off. She then has to make up a story that will explain all of this to her parents who are going to be pissed that she’s in the wrong neighborhood and totaled the car.

Our version of the story is much more credible, but the fact is that I’ll never know the real one. That’s often the case in EMS – we get partial truths, misinformation, and misdirection. It’s an exercise in filtering to weed through the things that really don’t matter and treat what is necessary. It’s the wrong career for people who are dedicated to absolutes. If you’re comfortable playing in the gray area of reality then everything works out pretty well.


Serial Killer

se·ri·al 

1 :  arranged in a series, or forming parts of a series

2 :  responsible for a series of usually criminal acts over a period of time; a serial arsonist

3 :  serial killings and/or attacks are a series of killings/attacks committed by the same person

kill·er

1 :  one that kills

The sun is shining and it’s a warm day as I walk into the barber shop. It’s my day off and  I’m trying out a new shop as I just moved to this area. It’s always hard to find a new place to get my hair cut. You’d think a flat-top would be a simple haircut, yet not too many people can do it well.

Sitting in the chairs, waiting for the next available person, I see an old man get up after getting his haircut. He stands and takes a step then starts to crumple to the floor. The woman who was cutting his hair and I both grab an arm and helped him to sit down in a chair. I instinctively went into paramedic mode – asking all the questions and running a differential before calling the man’s son to come and drive him home.

That’s how I first met Barbara. She’s younger than me with a bubbly personality. She gave me a free haircut after that because I helped the man out. Turns out, she did a good job so I’ve gone back to her about every three weeks for the last three years. We have the cordial familiarity that grows over time with a barber. We talk about work, the dogs, vacations, family, etc.

Three visits ago Barbara told me she found a lump in her breast. She’s comfortable talking with me about medical issues. We discussed the possibilities and possible treatments for a lump in the breast. When I left she said she had a doctor’s appointment the next day.

I often find that people are more comfortable talking with paramedics than with doctors or nurses. We are approachable – we speak plain English, yet we can translate the cryptic medical language. More importantly, we actually make house calls – no one else does that in the US anymore.

Two visits ago she tells me that the doctor confirmed that it is breast cancer. It’s an early catch but it’s also an aggressive presentation. He recommended a double mastectomy and a double round of chemotherapy. She tells me that she just had the first trip to chemotherapy a week ago and it knocked her on her but for five days. She’d scheduled the surgeries for the following week. We talk about what to expect for the next six months as she gets a dose of chemo every other week. The hair falling out, the nausea, the weakness. I’ve had patients tell me it feels like the worst flu they ever had – only worse.

On my last visit I see Barbara finishing up on a customer while I wait my turn. She has a little cap that covers her head. Both of her breasts are gone and her blouse is still a little baggy on the top after having been stretched out and tailored to fit her old shape. I see a little bit of a dressing and tape peek through the v-neck of the blouse. She’s still doing wound care after the surgery. I see the subtly rounded lump on the chest where she has a port-a-cath implanted under the skin. It’s a device that allows access to the veinous system for repeated treatments. Barbara is still her bubbly self yet I see the underlying sadness and uncertainty.

In the course of one month her life has completely changed. The two physical attributes that both men and women identify as the superficial expression of femininity have been taken away from her: her breasts and hair. The healthy woman who went to the doctor for a routine annual checkup has now become a frequent flyer of the medical community. It’s still too early to know if the cancer has been eradicated. Basically it’s a situation where she will be re-examined for years to come to see if the treatment worked.

In time her hair will grow back and the scars will heal. She tells me she’s considering getting implants but it’s a long and painful process where they insert a balloon and slowly inflate it over time. This allows the skin to stretch out to accommodate the implants. Whatever she decides I suspect I’ll see the progress at every visit – in order to check that my flat-top is flat, she always positions my head to where I have no choice but to stare her straight in the chest as she trims my hair with the clippers.

My blog has the word fiction in the title but this is a very true story that happened just one month ago. Breast cancer is something that affects us all and this month is breast cancer awareness month. Please get involved, donate, and spread the word. Maybe together we can make a difference.