1 : undisturbed by strife, turmoil, or disagreement; tranquil
2 : of or characteristic of a condition of peace
1 : one who is engaged aggressively or energetically in an activity, cause or conflict
2 : a man engaged or experienced in war, or in the military life; a soldier; a champion
In thy childhood you were ignorant and blind. And in your youth, you were lured away by sin. In the third stage, you gather riches and when you get old, regretfully you leave them all off.
Ramkali – Sikh Guru
“Sikh temple, seriously?” I didn’t even know we had a Sikh temple in the county and I’ve been working the streets for years. This is one of the things that I love about working here; the cultural diversity is never ending and continuously developing. This call is pretty far from our current post so I have time to check the notes on the call. The notes in the mobile data terminal (MDT) tell us that we’re responding to a man who burned his hand in a kitchen deep fryer.
I’ve been called to a few deep fryer mishaps and it’s never pretty. In this case I’m hopping it’s the left hand because Sikhs wear a steel or iron bracelet on their right wrist. Given that we have a long response time I expect the fire department would clip it off with the bolt cutters before we arrive. The secondary burn from the steel and constriction while the hand swells could be problematic.
Strobes are illuminating the darkness and Scottie is navigating us deftly as we speed through the suburban sprawl. I decide to see how big this temple actually is and pull up the google street view on my iPad.
“Uh, Scottie, this is a huge temple and the notes say there’s a festival going on right now. We might have some crowd control issues. If we can I’ll want to move him to the rig quick so I can work him up without an emotional crowd scene.”
I’ve run a number of calls in the Sikh homes in this part of the county and I feel they are largely misunderstood by most Americans. In the post 9/11 outrage many Sikhs were mistakenly thought of as being Muslim – one man was even killed in an ignorant act of violence. In fact, quite the opposite is true. Sikhism is an offshoot of Hinduism that came about in the 16th century. In only 500 years it has grown to the worlds fifth largest religion – and this from a religion that does not actively recruit. With its roots in the Punjab region of India, which borders on Pakistan in the northwest part of the country, the Sikhs found themselves on the front lines of conflict and protecting India from Muslim expansion. Many people in this country fail to see past the beard and turban to fully appreciate their rich history and culture.
As we round the corner to the temple I can see that my crowd concerns were well founded. Pulling into the circular driveway I see at least five hundred people in the courtyard of the temple. Parked cars have been lining the residential streets for the last several blocks and their large parking lot is full. A bearded man wearing a turban and traditional garb – covered by a reflective vest – is waving us past using a flashlight with an illuminated orange cone. Its a paradox of old world and new that somehow reminds me of a Jedi master. We pull up behind the big red truck to the side of the temple.
Half a dozen young men in turbans and traditional dress encircle us as we exit the rig with the gurney. They usher us towards the side entrance to the kitchen while providing a crowd break. They are yelling excitedly at the crowd in Punjabi; presumably telling them to get out of the way. They’re doing a great job of clearing a path as the crowd parts allowing us to pass.
There are men, women, and children of all ages. The strobes from our rigs illuminate the intricate metal lace interwoven in the women’s head scarves and the traditional curved knives worn at the men’s waists. Many people have plates of food in their hands and the delicious smell only serves to remind me that we never got a lunch break today – a feeling which is juxtaposed with the fact that the man who may have prepared some of this food is now in excruciating pain.
Finally we turn the corner to the kitchen to find my new patient. He’s a man in his forties wearing a white traditional shirt and matching turban. His right hand and forearm are wrapped in a trauma dressing. His face is silently contorted in pain yet he doesn’t make a sound. Damn! It is the right hand.
As the fire medic unwraps the dressing so I can have a look I catch a minty smell. The arm appears to have circumferential partial thickness burns to approximately four percent of overall body surface. Yet it’s difficult to visualize the surface because of a white ointment that appears to be slathered over the arm.
I know the firefighters wouldn’t have put anything on it so it doesn’t really make sense to me. “What’s all the white stuff?”
The fire medic looks up at me with a totally straight face and deadpan delivery, “Toothpaste.” Seriously? Toothpaste?? what the hell?!?
Okay, I’ve seen people put some strange stuff on burns but this is a first. In the last few years I’ve seen: mayonnaise, butter, and yellow mustard. It seems people are always treating burns like a hot dog, although I’m still waiting for sweet relish. But toothpaste is a new one.
I listen to the description of how it happened as I cut his shirt off and move him to the gurney. I’ll leave the turban on for heat retention as he’ll get cold and start shivering here in a few minutes; covering the head helps to hold in heat. I see the bracelet that was cut off of his wrist sitting on the counter, pick it up, and put it in my patient’s good hand. He’s still stoic yet seems to appreciate having it back. He inspects the perfect circle that is now broken and frowns as he puts it in his pocket.
The bracelet is called a kara and is worn by both male and female initiated Sikhs. It is one of the five external articles of faith that identify a Sikh as dedicated to their religious order. The Sikhs wear the kara as a reminder to have a calm spirit and life – it’s an expression of eternity. In India, warrior Sikhs are still seen wearing several karas of large sizes, designed to be used as a weapon in hand to hand combat. It’s an integral item in the martial training that was developed by the warrior Sikhs. I wonder if he assigns significance to the fact that bolt cutters have severed the perfect circle and thereby thrown mind, body, and spirit into a state that is less than harmonious.
Once he’s on the gurney I stick to my original plan and start moving quickly to the rig to treat him further. As I head out of the kitchen my six escorts jump into action and make a path through the crowd. I wish I could take these guys to every call with me as they are doing a great job of expediting my egress from the temple.
After loading into the rig I tell Scottie we can start driving. All of my treatment can be done en route to the hospital because hot oil burns have a way of getting worse with time. I’ve watched blisters form in front of my eyes while transporting similar hot oil burns. Treatment at this point is fairly straightforward: irrigate with sterile water to minimize the heat of the oil and get rid of the toothpaste, get rid of the trauma dressing and apply a sterile burn sheet, load him up with as much morphine as I can, and treat for any signs of hypothermia.
The body’s reaction to a moderate burn is to shift fluids to the tissues to replace fluid loss from the burn. It’s called third spacing as the fluids are taken out of the circulatory system and shunted to the peripheral tissues.This can reduce the blood pressure and cool the core, thereby inducing hypothermia and dropping the blood pressure.
It’s a long ride to the burn center – I have to go out of county as he meets burn patient criteria. Having a circumferential burn to the fingers and wrist could result in swelling, yet the skin is no longer elastic so it could restrict circulation or burst like a grape. A burn center is better equipped to deal with this than a basic ED.
My treatment is basic at this point and he has been stoic throughout. I can still administer a few more rounds of morphine yet as I go to administer he holds up his good hand and refuses additional pain meds.
Laying on my gurney In the back of the ambulance, arm elevated to reduce swelling and so he can feel the cool air if the air conditioning, this brave man refuses pain medication. His face softens from its original squinty-eyed grimace and he relaxes his back to lie more comfortably. With turban in place and a peaceful look to his face I see a tear trickle from the corner of his eye and travel down his face to get absorbed in his beard.
Acceptance is the bridge. Accept the pain, accept the wounds, accept yourself as you are. Don’t try to pretend to be somebody else, don’t try to show that you are not this. Don’t be egoistic, and don’t go on pre-tending and laughing while your heart is crying. Don’t smile if your eyes are full of tears. Don’t be inauthentic, because by being inauthentic you are simply protecting your wounds from being healed. Your whole being will become rotten.
Osho; ABC Of Enlightenment