Lachrymatory 3/3

We’re standing in the triage room of the county hospital and I’m giving a report to the nurse so she can assign us the proper room. The officer catches up to us and is working on his report as Scottie is taking some vitals on Anika. I catch the officer’s eye and do the head twitch to ask him to come over next to me. Still talking to the nurse I raise my voice just a little so the officer can overhear my report. “She was also treated for similar injuries at this facility two weeks ago; no ambulance that time and no police involvement.” The officer understands the game and scribbles in his notebook. He’ll question her about it later when he’s taking her statement.

Strictly speaking, that’s not a breach of patient confidentiality. If I know of a crime I have to report it yet everyone in the medical community is so touchy on the subject it’s best to use discretion. Above all else I am an advocate for my patients and will do what is necessary to make sure they get the help they need, be it medical, emotional, or involving law enforcement. Right now Anika is a minor who doesn’t have a single advocate.

We get Anika settled into a room and the officer sits next to her doing some paperwork. I give a quick report to the nurse that’s going to take over and start to walk back to the rig.

Turning the corner towards the exit I see Sasha. As she sees me she does a little dance in the hallway and does a fast high heel shuffle to give me a hug. Sasha is a bundle of flirtatious energy in an otherwise drab sea of scrubs. She’s always dressed like she’s headed to the club for drinks and has a smile for everyone. Her job is to handle the HIV screening for the county hospital and as such she has access to all of the records for the ED and offers screening for at risk patients.

“Hey pretty lady, how you doing today?”

“I’m doing fabulous! It’s good to see you. Are being safe out there?” Sasha always worries about us in EMS. She knows the hood and the people who live there by way of her work and always checks to make sure we are being safe.

“You know I’m always safe, I gotta come back to visit you.” We have an ongoing flirtation that’s a fun distraction from the realities of our respective jobs. “Hey, you want to do me a favor and talk some sense into a girl who needs a little help right now?”

“Sure, what you got?”

I explain whats going on with Anika and how she not only needs the HIV screening she needs someone to talk to that she can identify with. Sasha is the perfect person to set her straight on what she needs to do. Sasha says she’ll go talk to Anika and also try to get her screened. As she starts to walk off, she asks me a question that shakes me to the core.

“Is the boyfriend pimp’n her on the streets? That’s what they do. Especially a foster kid – she’s an easy target.” Damn! I actually didn’t put that together. 

Sasha has more street smarts than I do – she deals with this sort of thing all the time. And she’s right – that’s exactly what this was all about. This was a pimp beat down and I missed it. I’m relieved that I bumped into Sasha, knowing that she’ll know what to say to Anika and be able to get her set up with some domestic violence services for women.

I go back outside the ED to the rig and put the final touches on my paperwork before transmitting an electronic copy to the county and receiving hospital. Scottie is still engrossed in the word game on his iPhone. The wipers are still on delay, wiping away the rain every few seconds as if someone is wiping away the tears that are shed in the city on a daily basis. I transmit my patient care report (PCR) on the laptop and pick up the mic.

“Medic-40, we’re available, where would you like us…?”

Lachrymatory 2/3

The grumpy crime scene tech finally arrives and climbs into the ambulance with a camera to document the injuries. He’s a middle-aged bald guy with a goatee and a belly, wearing a jumpsuit and a badge. In big yellow letters on his back it says; crime scene investigator. I see him often and we have a running joke. “Man, CSI Hood, I sure thought you’d be prettier.” He just growls at me. I guess he is in a bad mood.

Once the photos have been taken we start driving to the county hospital. The officer tells me he’s going to meet us there so he can finish taking a statement form Anika.

Now that we’re away from the crime scene and alone in the back of the ambulance the reality of the situation starts to sink into Anika. She’s a minor who’s dealing with some very adult problems. She’s emotionally unprepared for everything that’s happening around her and has no active parents or advocate. The system has let her down and she’s quickly falling through the cracks.

Scottie did most of my paperwork on the computer while we waited for the not so pretty CSI tech, so I spend the ride talking to Anika and trying to calm her down. But it’s not working.

I had initially planned to just do basic treatment and only give her an ice pack for the pain and swelling. Yet with her emotional state I decide to more aggressively treat the pain with some Morphine. It will help with the pain a little but even more important it will calm her down so she can make some rational decisions in the next few hours.

As the Morphine slowly drips into her vein I watch the waveform of her respirations change to reflect a more relaxed state. Now that she’s calm we can have a more productive conversation. I continue where the officer left off in pushing her to press charges. I give examples of things I’ve seen on the streets in the hopes that it leaves an impression. I have a special affinity for kids in the foster system. I know from personal experience what they are going through and how the deck is stacked against them.

The statistics are grim. According to a local foster advocacy organization, youth in foster care are 44% less likely to graduate from high school. Less than half of former foster youth are employed 2.5-4 years after leaving foster care, and only 38% have maintained employment for at least one year. Sixty percent (60%) of women who emancipate from foster care become parents within 2.5-4 years after exiting care. Girls in foster care are six times more likely to give birth before the age of 21 than the general population. Parents with a history of having been in foster care themselves are almost twice as likely as parents with no such history to see their own children placed in foster care or become homeless.

I don’t give Anika these statistics – she’s had a bad enough day as it is. Yet it’s all in the back of my mind as I talk to her on the way to the hospital. She really doesn’t deserve this.

She’s much more relaxed now that the Morphine has taken full effect. I can tell by the way it’s effecting her that she has a clean system. She had no track-marks or signs of drug use. I think she’s just a good kid in a bad situation. She starts to feel comfortable with me and talks about her life. She mentions that she was in the same hospital two weeks ago.

“Why were you there two weeks ago?” I already know the answer…

“I got beat up and thought my nose was broken.” She has a slight slur to her speech from the Morphine. I noticed the minor swelling to her nose but thought it was from today’s beating.

“Did you go in by ambulance?”

“No, my boyfriend took me on the bus.”

“Is he the one who hit you two weeks ago?” She just nods her head.

Lachrymatory 1/3

lach·ry·ma·to·ry

1 : of, pertaining to, or causing the shedding of tears

2 : a small, narrow-necked vase found in ancient Roman tombs, formerly thought to have been used to catch and keep the tears of bereaved friends

We’ve been sitting here in the rig, parked deep in the hood, for the last 25 minutes. Scottie is playing a word game on his iPhone and I’m checking e-mail and reading EMS blogs on my iPad. There’s an assault going on six blocks from us but there are no police officers on scene yet so we have to stage here until they tell us it’s safe to enter. It’s been raining all day and the wipers are on delay; going off every few seconds to wipe the rain from the windshield.

“Anything new in the notes?” Scottie doesn’t even look up from the game.

Glancing over at the mobile data terminal (MDT) in the center console I see that nothing has changed. “No, still no PD on scene.” It’s unbelievable to me that an assault can continue for a half hour and the police are stretched so thin that they don’t have the manpower to respond. I wish the city council members who voted to lay off the officers six months ago could spend the day with us and see what their decision is costing the public.

At the 30 minute mark the MDT finally shows that two officers have arrived on scene and five minutes later we are cleared to enter. We pull up at the same time as the fire engine who was staging on the other side of the incident. We ran a call with this crew earlier in the day and they were a good group. Walking up to the corner I smell the fresh scent of rain. It’s refreshing how it washes down the hood and makes it a little more pleasant but even the rain can’t change the fact that it’s a dangerous neighborhood.

The officer walks up to me and points to a young woman in tears standing by his car. “Just one vic – looks like a domestic, assaulted with closed fists.”

She’s crying and breathing fast but otherwise she looks okay at first glance; no blood and she’s able to walk and move all extremities. I look over at the LT on the engine and tell him I can handle it so they can clear and go on to the next call. As the engine is pulling away I walk my patient to the ambulance and she climbs in to sit on the gurney.

As I’m doing my regular checks of vitals and cataloging wounds the officer pops his head in the back door. “Hey, can you guys hang out here for a few? My crime scene tech is in a really bad mood and doesn’t want to go to the hospital for photos”

I slam the ice pack into my knee to activate it and hand it to my new patient to apply to her facial swelling, along with a few tissues to wipe away the tears. “Yeah, no problem, I’ve still got a little to do here and she’s pretty much stable.”

As I continue my assessment the officer is standing in the back door of the rig and questioning my patient, Anika. I listen in and start to get the story of what happened. She’s a foster kid who ran away from home with her adult boyfriend. She’s been living with him for the last few months. Today he was angry and and he took it out on her by hitting her in the head, stomach, back, and kicking her when she fell to the floor. She’s more emotionally distraught than physically hurt – all of the injuries are pretty minor. As she’s telling the story the other officer walks up with a gun. That is exactly why we were staging until the scene was secure…

“When he was beating you down did you ever see this gun?” With a cracking voice and uncontrolled tears she tells him no. The officer is looking for anything that would increase the charges on the assailant. Possession of a firearm during the commission of a crime would increase the time he spends behind bars.

Anika asks the officer, “How long is he going away for?” She’s scared yet also conflicted.

“We’ve got him on an outstanding warrant and firearm possession but you need to press charges for the assault to stick.” Anika is holding the ice pack to her quickly swelling face and eye while shaking her head. She doesn’t want to press charges. “Look, I’ve seen this before, it just gets worse; the next time he’s really going to hurt you. You didn’t do anything wrong and you don’t deserve this. It’s not okay to treat a woman this way. You need to help put this guy away so he doesn’t hurt you or anyone else. I’m telling you; it’s going to get ugly next time.”

I’m tracking her respirations on the monitor so I can see a wave form for each breath she takes. The wave form is getting smaller and the duration between breaths is getting shorter – she’s starting to hyperventilate. The officer is pushing her a little hard but it’s for her own good. We all know where this kind of thing will lead. We’ve all seen the final outcome and it really is as ugly as the officer said it would be.