Dia de los Muertos 3/3

The urban city life is far behind me as I take the off-ramp from the freeway to my quiet neighborhood. I’ve outdistanced the commuter train and the only traffic at this time of night are the workers who got held late in the city and are only just now returning to their bedroom community. I see the late night basket ball game at the well lit community park; black, white, asian, and middle eastern players all having a competitive game in racial harmony. I smell the water in the air as I pass the manmade waterfall that signifies the entrance to my master planned community. A mini-van has pulled over to the side of the road and a woman is taking a night time picture of her children standing in the lights with the waterfall at their backs. I chuckle at the van parked at the side of road as I feel the weight of the night lift and flappy paddles drop the gears down for the turn into my cul-de-sac.

Making the final turn into my house I push the button on the rear-view mirror that activates the garage door. The cleansing light of the garage washes over me while the horizontal shade of the door slides up to the ceiling. The turmoil, dirt, vomit, blood and death of the day are washed away replaced by the anxious squeals of the dogs who await my opening of the door and the multitude of interesting smells on my uniform after a day in the hood.

Having just left Jimmy in the ED – cashing in the last of his frequent flyer miles – I am more than ready to go home. I have some paperwork still left to do but I don’t care at this point; we’ve already been held over by an hour and I just want to clock out so I don’t get another call.

Lester, our favorite dispatcher, clears us to go home and I jump in the driver’s seat and tear out of the ED, through the hood, towards the freeway. If only my ambulance had flappy paddles! Kevin is beside himself with happiness to be done with the day. “Yes! We are finally done!” And everything stops working…

The lights are dead, the engine is off, the power steering is off, the brakes are gone, and we’re doing 45mph down a residential neighborhood deep in the hood.

It always comes in threes…

I put all of my weight into the brakes while torquing the steering wheel for all I’m worth just to coast into an empty spot on the side of the road. There we sit, dead rig, stuck in the hood – parked on the side of the road with tennis shoes adorning the phone lines and random hooded bangers walking the streets. I look at the dash and see that the problem is obvious; the odometer reads 213,356.7 miles. This rig has served it’s time and is ready to cash in it’s own frequent flyer miles for a retirement spot in the corner of the back lot of deployment.

A phone call to the supervisor and to Lester to let them know where we are makes me feel a little better. The supervisor tells us the tow-truck will be about an hour and we should just hang tight until they show up. Another unit, who was posting close by, comes over for moral support and parks next to us – safety in numbers. Twenty minutes later our supervisor shows up. Two ambulances and an SUV are parked in the hood and colleagues get a chance to decompress from a long day. I finish the day getting a chauffeur driven ride back to deployment with a nearly toothless tow-truck driver – at least I’m able to finish my paperwork by the time we arrive.

I open the door from the garage to the house. I’m bathed in the bright light of a happy home and three dogs eagerly vying for my attention. My wife gives me a huge hug with a kiss. “Welcome home love.”

Dia de los Muertos 2/3

Leaving the urban areas behind I accelerate into an increasingly empty freeway as the lights trail off, replaced by trees and scrub brush hills. There is solitude in the darkness, yet the open roof allows judgment from above as I navigate the quiet freeway home. With a crescent moon overhead I see the airliners strung out in their landing pattern like white Christmas lights hanging in the sky. I feel the rush of wind as I pass the big rigs hauling goods to far off destinations. Cold wind is still on my face, and I have a tightness in my chest when I breathe deep, so I allow my breaths to become increasingly shallow – it’s just easier that way. I wonder what he thought just before he took the last breath of his life.

“It’s Jimmy, looks like his asthma is acting up again.” Kevin pulls us up to the bus stop where Jimmy is sitting down and sucking hard on the Albuterol treatment provided by the fire medic.

We’ve seen Jimmy every few weeks over the years. Sometimes it’s drunk in public, sometimes it’s his asthma, or weakness, or hunger, or just a little cold. On occasion we even get the calls from the cell phone heros who think he’s dead yet keep driving so we have to show up and wake him up in the morning. Although he’s usually not in any serious distress he does have every chronic problem in the book: hypertension, CHF, diabetes, asthma, COPD, previous heart attack, etc. He’s an urban outdoorsman (a.k.a homeless), and a frequent flyer. It seems like he’s been in the county forever. The fire medic doesn’t even bother with a hand off because we all know him.

As I load Jimmy into the rig I hear the fire engine accelerate away from us. Jimmy’s having a hard time holding the Albuterol treatment so I convert it to a mask for him as I tell Kevin to start transporting – I’ll do everything en route to the ED because he’s looking pretty serious.

As I lean Jimmy forward to listen to his lungs I can actually hear the fluid level increase – filling up his lungs as I work my stethoscope higher on his back. FUCK ME!!! The asthma exacerbation triggered a flash pulmonary edema episode. Uncontrolled high blood pressure and congestive heart failure are pushing blood into the most porous organ in the body – his lungs. He’s drowning in his own fluids!

Just as I pull out the CPAP (continuous positive airway pressure) and affix a nebulizer to it, I see Jimmy’s head slump to the right. Fuck! Can’t use CPAP on an unconscious patient.

Looking out the window I see that we’re basically on the same block where my last patient checked out on me. I tell Kevin to upgrade to Code-3 and let them know we’re coming in with respiratory arrest. I switch the nebulizer over and attach it to the BVM (bag valve mask) and squeeze the football to try to oxygenate the lungs that have decided they are going to stop working tonight.

One minute later we’re at the ED and I’m watching his heart rate slowly drop; 60, 50, 40. “Start compressions.” The doc states the obvious – Jimmy just coded. Fifteen minutes later they are throwing the “Hail Mary” drugs at him in an attempt to counteract years of abuse to a body plagued by addiction and street life. Twenty minutes later I’m finished with my paperwork and the ED tech, Nick, walks up. “Man, I hope you’re going home now because I’m tired of working codes tonight.”

“Yeah, that was my last call, I’m done. It’s the end of my week – no more patients fixin’ to die on me.” I wave at him as I head out the doors. “Have a good one.”

Dia de los Muertos 1/3

Dí·a de los Muer·tos

1 : the day of the dead

2 : a holiday, particularly celebrated in Mexico, which focuses on gatherings of family and friends to pray for and remember friends and family members who have died

The fabric roof recedes behind my head in silent automation and reveals the stars in the heavens in all their glory. A moment of solitude and infamy which is quickly interrupted by the speeding commuter train on its elevated track, with its onslaught of light and noise, rushing off to unknown destinations. At the end of my shift I sit behind the wheel of my personal vehicle and take a deep breath – finally it’s over – and listen to the engine cycle into a familiar purr to tell me that it’s ready for the drive home.

I recline the driver’s seat to stare straight up at the infinite expanse of the universe and wonder where the three dead souls have gone this night. It wasn’t my fault, I mean seriously, how am I supposed to reverse multiple years of abuse in the fifteen minutes I’m with a patient? Well, the last one was probably my fault, I pushed him a little too hard, but even still – it was his time to die. 

Any why does it always come in threes?

Precision German engineering growls back at me as I depress my foot and accelerate away from the deployment center. Cold wind rushes past my face and street lights streak overhead as the flappy paddles on the steering wheel cycle the gears up in a desperate attempt to distance myself from the memories of a day from hell. Three hundred and thirty-three horses are unbridled at the on ramp to the freeway, with a rapid acceleration, as the increased g-force pushes me into the seat. The cold wind bites at my short sleeves and exposed skin – it’s a little too cold for a convertible ride so late at night – but I did it on purpose knowing full well what to expect. I wonder if that’s what a cutter says as she drags the razor blade in ever increasing depth across her forearm? Does pain and discomfort somehow remind you that your alive and in that revelation then become a celebration of life? Or is it time to check myself into Emergency Psych Services on a 5150 – should I start to worry when the madness actually starts to make sense?

“Medic-40 copy code three for the OD on the transit bus. PD is on scene, Code-4, you’re clear to enter.”

We’re only a few blocks away and Kevin puts us behind the bus and fire engine in just a few minutes. As we walk up to the bus I see a man in his early thirties surrounded by county sheriff officers and firefighters. He’s looking at me in this kind of thousand yard stare as the fire medic shows me the empty bottle of vodka they pulled out of his pocket. It’s the classic “drunk on the bus” and I’ll have to take him to the ED because he can’t even walk by himself. It takes four of us to pick him up and plop him on the gurney and the firefighters take off without even taking vitals or offering to help out.

As I strap the seat belts on my new patient I notice a little bit of plastic between his lips. I reach up and pull out a baggie that’s been chewed down so all that’s left is just a few white grains of powder – obviously an attempt to hide a drug possession from the officers. I hand the baggie to the officer and feel for a pulse; strong in the sixties – good for now. “Kevin, I’m good to go as soon as we load up, this could go downhill fast…”

My new patient isn’t answering questions or even acknowledging that I’m here so my only assessment is what I see on him and the monitor. The most obvious options for the white powder are crack cocaine, crystal meth, or heroin. Crack and meth speed you up; heroin slows you down – I really hope it’s the heroin because that’s the only one I can turn off.

We’re a half mile from the hospital when the vomit and head spinning scene from the Exorcist starts up right there in the back of my ambulance. First thing I notice is the heart rate climbing from 66 beats a minute to an incredible 236 in the course of twenty seconds. As I tell Kevin to upgrade to Code-3 the vomiting starts. Now I’ve got bio-hazard all over the back of the rig (not to mention the stench), and all of my focus is on keeping his airway open to prevent him from aspirating vomit into his lungs. I’d love to throw a line in and hit him with a sedative but I can’t do it at the expense of his airway. Well, I guess it wasn’t heroin.

Two minutes later we have him in the ED. Two minutes after that they are throwing the drug box at him to slow down his heart and attempting a gastric lavage to clean out his stomach. Fifteen minutes after that they are doing CPR – his heart had stopped beating when it gave out from fatigue. Twenty minutes after that the maintenance crew is mopping up the vomit from the floor and trying not to disturb the dead body on the table with the sheet pulled over its head.