Tag Archives: bicycle

Ghost Rider

ghost

1 : any faint shadowy semblance; an unsubstantial image; a phantom; a glimmering; as, not a ghost of a chance; the ghost of an idea

2 : the disembodied soul; the soul or spirit of a deceased person; a spirit appearing after death; an apparition; a specter

3 : to die; to expire

rid·er

1 : someone who rides on an animal such as a horse, or on a vehicle such as a bicycle or motorcycle

2 : a supplementary clause or amendment added to a legislative bill, insurance policy, or legal document

As a rule, the more bizarre a thing is the less mysterious it proves to be. It is your commonplace, featureless crimes which are really puzzling, just as a commonplace face is the most difficult to identify.

Sir Arthur Conan Doyle – Sherlock Holmes – “The Red Headed League”

I walk into the small eight-by-eight foot room with a single empty desk pushed up against the wall. Two men with guns strapped to their waists follow me in and sit down in the Spartan chairs to either side of the desk. Obviously the chair left for me is the “hot seat.” I don’t see a spotlight shining on the chair but there’s no mistaking the fact that this is an interrogation room and the men with the guns and badges have some questions for me today.

“Let the record show that Detective Jones and Detective Brown are present with Paramedic KC. Today is one, one, eleven at 1500. Paramedic KC, do you recognize this man?” He slides a picture across the table to me – actually it’s a mug shot with lines showing height behind a perturbed looking man facing the camera.

“Yes sir. He was my patient three weeks ago.” I’m starting to wonder if this is the time when I should ask for a lawyer. At least they didn’t read me my Mirada rights. I wonder if that’s a good thing or a bad thing. Either way it’s obvious that the conversation is being recorded by the way that they are verbally describing the occupants of this very uncomfortable room.

“Can you sign here please? This acknowledges that you recognize the person in the photograph and that he was your patient on the date written below.” OH CRAP! This is starting to sound serious…

“So, the man in that picture passed away three days ago and we’re looking into the cause as a possible homicide. Can you describe the circumstances in which you met this man and what transpired during the time you were with him?”

— 

Medic-40, copy Code-3 for the man who fell of his bicycle three days ago.” The radio crackles to life interrupting the enjoyment of my afternoon quad-espresso over ice.

“Medic-40 copy, we’re en-route.” Kevin flicks the lights on and chirps the siren to enter traffic headed in the direction of the call. Seriously? Code-3 for a three day old bike accident?

As we pull up to the Church’s Chicken I see a man sitting on a bench by the door with three firefighters standing around him. The guy has to be 450 pounds and from the rig I can see that he’s interacting so he’s probably okay. “Let’s leave the gurney in the rig and see if this guy can walk.”

“Exactly what I was just thinking.” Kevin and I are on the same page. Lifting a man that size on a gurney is a group effort and anything to avoid injuring ourselves is a good thing. Classic, a fat man sitting in front of Church’s, who would have thought…?

As I’m getting out of the rig the man stands up with the firefighters and starts to lumber towards us. Awesome, he walks!

Once he’s situated on the gurney, in the back of the rig with me, I start asking questions as Kevin starts entering information into the computer. It’s not exactly a stat call so we have time to sit here and do an assessment prior to rolling to the ED.

“Okay, so I understand you fell off of your bicycle three days ago. Why are you calling us today?” I’m taking a blood pressure and getting him hooked up to the monitor while I ask questions.

“Cuz it just kep gettin’ worser so I has to get checked out.” He’s pleasant enough and almost seems apologetic for having to call us. It’s a normal occurrence for us; people with no insurance put off going to the clinic as long as they can and then call 911 to get treated in the Emergency Department.

“What got worse?”

“All this swelling in my face. This ain’t normal for me.” I wiggle past him to the foot of the gurney so I can see his face straight on. Sure enough – now that I look at him straight on I see that his face isn’t symmetrical – his jaw and cheek are swollen on the right side.

“Yep, that’s swollen all right. So this all happened in the last three days?” He nods his head and it looks like it hurts him just to do that. “Okay, let me feel your jaw.” I put my hands on either side of his mandible and he opens and closes his mouth, wincing in pain as he does it. No clicking that I can feel and the jaw seems solid – probably not broken – but it’s hard to say with all the fat and swelling deforming the normal jaw lines. I pull out my flashlight and look inside his mouth and I’m met with a putrid smell and green/yellow puss on the right side. Yikes!

“Looks like you got a pretty bad infection in there.” The infected teeth and the vitals that I got are starting to add up to a pretty sick guy, quite possibly a lot worse than he looks.

“I got bad teeth, you know, don’t go to the dentist all that much. I think when I got hit they got knocked loose a little. Then I start spitting that yellow stuff today so I called you.” Fair enough, but hold up…

“You got hit? I thought you fell off of your bicycle.” I’m having a very hard time picturing this man on a bicycle. I’ve gone to calls for a lot of bicycle accidents and I can’t remember anyone being over 200 pounds, much less 450.

“Yeah, you know, when I hit the ground.” Okay have it your way. I check out the side of his face with my flashlight and don’t see any road rash or bruising – just inflamed swelling and a bit of redness.

Either way, the damage is done, and all I can do is treat what’s in front of me so I start transporting him to the ED while I look over his fat skin in hopes of finding a vein for an IV. His heart rate is in the 130s and respirations of 32 with an end tidal carbon dioxide of 23. The temporal thermometer comes back with a fever of 101.7. Everything is adding up to sepsis but it’s still a little early so he’s not going into shock yet. At the ED they’ll drop a few liters of fluid on him and start some IV antibiotics. They’ll take x-rays of the jaw to see if the infection has progressed to the bone – if so he’s in for some pretty painful surgery. I can get the process started now and see about taking the edge off of the pain.

I crack open an ice pack and have him hold it to his jaw as I thread a 22 gauge catheter into the only vein I can find – in his knuckle. It’s too small to get very much fluid on board during my short trip to the ED but I leave it wide open just to start the process as I break open the morphine vial.

He’s a big guy so I’m sure he can take as much morphine as I’d be allowed to give him so I’m surprised as we’re pulling up to the ED he tells me that his 10/10 jaw pain is now a 0/10. Awesome! At least I did something for him.

As we push him into the ED a triage nurse that I don’t recognize is taking my report. “Fell off his bike three days ago? You can take him to the lobby.” There’s a nursing strike right now and this woman has a thick southern accent – she probably just flew in to help staff the hospital and isn’t too familiar with how we do things in this county.

“Yeah, can’t do it. I started an IV and gave him fifteen of morphine. If he’s not septic yet he will be in a few hours.” Sorry if I’m inconveniencing you by actually treating patients…

“You did what? Oh fine! Give him Hall-6.”

My last memory of him is sitting in the corner of the ED as he thanked me and waved goodbye.

“So you never saw a bicycle at the Church’s Chicken?” Detective Brown has been taking notes while Detective Jones asks some follow-up questions.

“No, didn’t see any bicycle. He said it happened three days ago so it didn’t surprise me not to see one. I still can’t picture a man his size on a bicycle but that’s what he said.”

“Anyone standing around him when you arrived?”

“Just the firefighters.”

“Okay, KC, I think that’s about all the questions we have for you. We appreciate you coming in.” What, that’s it?

“Can I ask what happened? I mean, why a homicide investigation?”

“Well, we’re still trying to figure out what exactly happened. I can tell you that he was treated at the ED and ultimately transferred to University Hospital for surgery to clean up an infected jaw. He eventually died at that facility from the injury. There were no medical malpractice issues but the cause of the injury is suspect so we’re looking into it.”


Impalpable 2/2

We’ve been driving for twelve minutes with lights and siren and we’re still miles from the call location. Our ambulance travels further into the hills on this foggy morning, in a desperate attempt to find the curvy ridgeline road where a bicyclist has been hit by a car. The update came in a few minutes ago that CPR is in progress and the Parks Department Fire Rescue is on scene.

I’ve been going over CPR ratios with my military EMT student who is anxiously peering into the front compartment. He’s twenty but looks like he’s twelve with a fresh, bootcamp buzz cut and black-rimmed glasses.

We can tell we’re getting closer as passing bicyclists are pointing back up the hill as we go by. We round the bend to find firefighters doing CPR on a man in the middle of the street. I walk up to the scene carrying my monitor and suction with my student in tow.

I set my monitor on the uphill side of the patient because blood is flowing downhill at every compression. I tap the firefighter who’s doing CPR on the shoulder and ask if my student can get some compression time while I start assessing the injuries and looking for a pulse. The firefighter pulls back and I feel at the bloody neck for a pulse while listening with my stethoscope for heart tones and breath sounds.

Nothing.

“Resume CPR.” My student starts compressions on the chest like a machine and I have to remind him to count it out for the others while I’m attaching electrodes. I’ll get an electrical reading of the heart on the next pulse check but I already know what I’ll find.

I suction out the mouth, which is a reservoir of blood that just keeps filling on every compression. The firefighters have been doing this for ten minutes and they know as well as I do that this guy isn’t coming back. As I’m waiting for the next transition of CPR the lieutenant shows me the helmet. The top is actually concave! Usually I see scrape and slide marks on helmets from a bicyclist. The concave nature of the helmet tells me a lot. I kneel down to feel the section of his head that corresponds to the helmet damage. Palpating the bones of the skull I feel them give away to depress into the brain. I look up to the lieutenant, “You can cancel the helicopter, we won’t be transporting.”

He walks away while talking into his radio as I have my student stop CPR so I can document the flat line of asystole – showing that the heart has no electrical activity – with a long printout from my monitor.

I switch my student into the airway position and show him how to use the suction while another firefighter picks up the compressions without losing a beat. Walking across the road to the guardrail I pull out my cell phone and hope for a signal while I stare at the hillside disappearing below me in the fog. After a few rings I hear a voice on the other end.

“Medical control, this is Dr. French.”

“Good morning Dr. French. This is paramedic KC on Medic-40 calling for base orders to discontinue resuscitation efforts on a traumatic arrest.”

“Okay, Medic-40, go with info.”

“I have a 43 year old male involved in a head-on bicycle vs. auto. BLS Fire has been on scene for fifteen minutes. The patient was pulseless and apneic upon their arrival. An AED was applied with no shock advised. They proceeded with CPR until our arrival. My monitor is showing asystole in three leads. I have a compromised airway that refills with blood upon every compression. I have a concave bicycle helmet consistent with impact to the car’s bumper and skull crepitus corresponding to the helmet damage.”

“Yeah, that sounds non-viable. Is that your assessment as well?”

“Yes sir, that is the consensus on-scene.”

“Okay, let’s call it: time of death zero nine forty three. Have a better day.”

“Thank you sir. You too.”

While on the phone I’ve been standing next the the guard rail at the side of the road and the fog lifts to reveal the hillside extending for miles below me with the city by the water and bridges extending across the bay that disappear in the marine layer. The view is breathtaking and I’d love to be able to enjoy it but I have other business to attend to.

Turning back to the task at hand I give a discrete nod to the lieutenant who’s standing over the CPR efforts. He unfolds the yellow rain blanket and covers the dead body laying in the middle of the road. As the rest of the scene comes into focus for me I see five men in matching bicycle spandex uniforms standing at the side of the road. Underneath the yellow blanket lies their missing teammate who was wearing the same uniform. It looks like I still have some work to do and it’s one of my least favorite aspects of the job.

“Hey guys, come on over here and let me explain what’s going on.” They are crying and shaking from the cold of the morning. I send my student back to the rig for blankets as I position myself with my back to the guardrail – this focuses them away from the bloody mess in the road and gives a majestic backdrop to the difficult speech I’m about to give. They huddle close as my student is draping blankets over their shoulders.

“We’ve been working on him for over twenty minutes now and he wasn’t responding to any of our efforts. I had a conversation with a doctor and we both agreed that it was time stop and pronounce death. What I can tell you is that he had very severe damage to the head and extensive internal damage to the organs. It’s very likely that he died upon the initial impact. I wish that there was more that we could do but his injuries were incompatible with life. I’m very sorry for your loss.”