Flight of Fancy

flight

1 – a swift passage or movement

2 – the motion of an object in or through a medium

3 – the action or process of flying through the air; a bullet in flight

 

fan·cy

1 – not plain; ornamented or complicated

2 – requiring skill to perform; intricate

3 – the power to conceive and represent decorative and novel imagery

 

flight of fancy

1 – an idea which shows a lot of imagination but which is not practical

The back doors to the helicopter swing open to expose a passenger compartment where a flight RN sits in a jump seat and kicks a metal sled, loaded with medical bags, towards me. The sled slides free of the helicopter and we ease it onto our gurney and strap it down with seat belts. Pushing the gurney across the mostly empty tarmac of the airport my partner and I load it into the ambulance as the two flight RNs jump in the back. I take a seat in the front to help my partner navigate to the trauma center.

The morning rush hour traffic has the freeways reduced to parking lot status and the side roads are only marginally better yet it’s our best bet so it takes both of our attention on a constant vigil – on the lookout for the motorists who forget what to do when sirens come up behind them.

We pull into the Big City trauma hospital and I jump out to back my partner into the closest parking spot next to the door. As I stand behind a backing rig, annoying beeping sound assaulting my ears, the ER attending doc approaches me. We have had a cordial familiarity over the years.

“Why’d they send you guys? The patient is on a vent and five drips!” He knows I can’t transport a patient like this as we don’t have a drip machine or vents and I’m not authorized to transport someone who is likely on medications that are outside of my scope of practice.

“It’s okay,” I smile, “I brought a flight crew of RNs with me.” He looks a little surprised as two crimson jump-suited RNs fling open the back doors to my rig and jump out.

The flight crew is getting a history on the patient who’s laying in the trauma bay as my partner and I hang back – we’re pretty much sherpas on this call – we’ll leave all of the patient care to them. While they get up to speed on the patient my partner and I talk to a few of the trauma RNs and police officers that we know.

“So what’s a clean-cut white boy like this this doing in the hood at four in the morning?” It’s somewhat of a rhetorical question and I can’t even ask the question with a straight face. The most obvious answer is that it was a drug deal gone bad. At least that’s what everyone involved is thinking until proven otherwise.

The officer looks tired; I’m thinking he got held over to stay with the victim in case he wakes up and has anything to say. The kid has two chest tubes in him, he’s on a vent with a breathing tube, he’s got milky white paralytics slowly dripping into his veins; he’s not going to wake up for a long time – if he ever does. “We’re not sure what was going on. We just found him in the driver’s seat of a car that had a slow speed crash into a line of parked cars. When we checked on him we saw the GSW to the chest and called you guys.”

I’m in the back with the flight crew as we traverse the urban streets back to the airport. My partner is in the front alone and the siren and air horn are singing a duet in an effort to clear the way.

The kid’s blood pressure just bottomed out to 70/46 and his end tidal carbon dioxide level just spiked to 76. The flight crew are scrambling to reduce the paralytics and increase the vaso-constriction – yet not so much that he bleeds out faster. The bullet created a perforation to the esophagus and a tear in the aorta that’s creating a slow leak of blood into the thoracic cavity. The blood from this leak is constantly being suctioned by the two chest tubes attached to active suction. Drugs are pushed into IV tubing, IV pumps are re-set with new values – it’s a delicate balance between sustainable vitals and faster bleed out. The only thing that will fix this kid is the specialized thoracic microvascular surgery found at the university hospital. Even the attending trauma surgeons at our world class trauma center decided to pass on the surgery. This kid is well beyond critical.

When the paralytics were decreased his level of mentation starts to increase along with his blood pressure. He starts to choke on the tube – we call it bucking the tube. His eyes look as though they’re coming into focus. One of the flight crew pulls a preload of sedative out of his jumpsuit, makes a quick calculation in his head, wastes some of the sedative so that it’s proportioned to the patient’s weight, and injects it into an IV port. Ten seconds later the patient is back in his comatose state and his blood pressure is at a good level for the next phase of transport. Another unit of whole blood is pulled from the biohazard cooler and added to the many lines of tubing that are keeping this kid alive.

Driving across the tarmac we pass the parked airplanes and helicopters. It’s still early in the morning and there’s not a lot of action on this lazy midweek day in the quiet corner of the airport. We see the crimson helicopter with the pilot doing a pre-flight walk around as he opens the back doors to accept our patient.

After loading the patient into the helicopter one of the RNs is thanking us for the ride. “Hey, do me a favor, stick around until we get in the air. You know, just in case he codes… Thanks.”

BIG CITY, USA — It’s been an especially violent week in Big City. Police are investigating a string of shootings in different parts of the city, believed to be unrelated.

Unfortunately, gun violence is nothing new in Big City, but there has been an increase over the last couple of days and officers are doing everything they can to keep up. Big City police are stretched thin as they investigate five separate shootings in just 12 hours.

“It’s been a busy week. I think we had at least three homicides last week and then one… I know at least one working today,” said Big City Officer Jason Smith.

One shooting happened Thursday morning at First and Union streets as a high school student was riding his bike to school. He was shot by someone who was also on a bike. Crime technicians were delayed two hours getting to the scene.

“There were two other callouts this morning so that’s where we’re at,” said Smith.

One of those earlier calls took police to Lake Street near 23rd, just a few miles away. That’s where a man with a gunshot wound was found inside a crashed car.

“It has been busy. We’re doing the best we can with what we got and we handle each case. And ultimately our goal is to solve every case we get,” said Smith.

Three shootings happened on Thursday and two happened Wednesday night. It’s violence that doesn’t go unnoticed.

“It’s been a little intense here in Big City for the past couple nights,” said Jose Martinez.

Martinez works with youth at the Sojourner Center for Human Rights.

“We work directly with those young people who are involved to try to figure out what’s happening here and how we can create lasting peace,” said Martinez.

He says it will be the community coming together to create lasting change.

“What’s happening here doesn’t have to be and there’s a better way to solve our problems,” said Martinez.

He also says a bullet never solved any problem.

 

 

Leave a Reply