Tag Archives: gang

Strike Out 2/2

We’re driving in the middle of the city after having just stopped at Starbucks to grab some caffeinated motivation for the day ahead of us. It was a long night yesterday as I was on the SWAT standby for an hour past my regular off-duty time. After the anti-climactic end to the situation I was able to go home and almost got enough sleep to make it through the next day. The hot coffee in my hand is helping to fortify my resolve as the morning commuters are exiting the freeway and the busy urban downtown area starts to come to life.

My coffee-inspired day dreams are interrupted by the computer on the console as it gets toned out and a call location drops almost on top of the icon representing our ambulance. The dispatcher comes up and tells us we have a patient with a laceration at the city police department on the second floor in the interrogation rooms. I’m actually looking right at the city police department building as the disembodied voice of the dispatcher is giving me the call information.

We pull up to the front doors as I load the gurney with all of my equipment and bid farewell to my warm coffee. I know we’ll be up on the second floor and the interrogation rooms are quite a ways on the other side of the building. Coming back to the rig for a Band-Aid could take a long time so it’s best to just take everything with us on the first trip.

A detective is waiting for us and proves to be a decent escort through the maze of the police intake and booking area as we make our way back to the interrogation rooms. The detectives aren’t really saying much but I can read their body language enough to know that something bad happened.

The detective opens the door to the little room and I’m faced with a complete blood bath. The tiny room looks like a set piece for the TV show Dexter with blood spatter covering the walls, desk, and floor. There’s a man sitting at the table with his hands cuffed to a metal ring on the desktop. Under his hands there is a fresh pool of blood.

I turn to the detective. “What the hell happened?” This is obviously the kind of high profile situation where Internal Affairs will get involved because someone messed up really badly. That explains why the officers were being so quiet and not telling me anything. The less I know about the facts the better it is for everyone when the investigation finally gets going.

The detective has a quiet voice as he fills me in. “So, did you hear about the hostage situation last night? Well, this is the perp from that scene. We had him in the room all night waiting for the morning shift detectives to come on duty. He asked for a soda. Someone gave him a can of Coke. He drank it, tore it in half, and cut his wrists with the sharp edges. We found him like this an hour later.”

“Wow!” That’s all I can say. I mean really, this is such a jacked up situation on so many levels I just don’t know where to start. The officers know how bad this is and they really don’t need the Paramedic to point out the sequence of stupidity that led to this bloody outcome. Whatever, I’m not here to judge, I’m just here to clean up the mess, as usual. But seriously, paper cups might be a good idea.

The man at the table hasn’t moved since I entered the bloody room but I can tell it’s the same man I talked to last night through the bars of the police cruiser. “Hey, are you okay?” Fine, it’s a stupid question but I have to start somewhere.

“Fuck you!” Seriously, are we going to play this game again?

Last night I could walk away from this guy based on the fact that he wasn’t visibly injured and refused all assessment. Today I can’t do it. I’ve got to check his wounds, bandage up what I find, and get him over to the hospital for medical clearance. He will eventually return here and be put on suicide watch.

I’m in the interrogation room and my partner, Anna, is handing me supplies to clean him up a little so I can see how bad the cuts are. As it turns out he missed the artery and all of the blood is just slow trickle stuff from the veins. He’s going to need some sutures and he’ll have some very impressive scars in a month or so when it all heals. Regardless of his medical outcome he just accomplished his third strike last night. He’ll be seeing the inside of a prison for the rest of his life, whether or not he manages to end his life a little early.

Three Strikes Laws are statutes enacted by state governments in the United States which mandates state courts to impose life sentences on persons convicted of three or more serious criminal offenses. In most jurisdictions, only crimes at the felony level qualify as serious offenses and typically the defendant is given the possibility of parole with their life sentence. These statutes became very popular in the 1990s. Twenty-four states have some form of habitual offender laws.

The name comes from baseball, where a batter is permitted two strikes before striking out on the third.

The three strikes law significantly increases the prison sentences of persons convicted of a felony who have been previously convicted of two or more violent crimes or serious felonies, and limits the ability of these offenders to receive a punishment other than a life sentence. Violent and serious felonies are specifically listed in state laws. Violent offenses include murder, robbery of a residence in which a deadly or dangerous weapon is used, rape and other sex offenses; serious offenses include the same offenses defined as violent offenses, but also include other crimes such as burglary of a residence and assault with intent to commit a robbery or murder.


Strike Out 1/2

strike

1 –  to try to hit or attack something

2 – Baseball; a pitched ball judged good but missed or not swung at, three of which cause a batter to be out

3 – Collective refusal by employees to work under the conditions set by the employer, a work stoppage

4 – to be unsuccessful in trying to do something

 

out

1 – to a finish or conclusion; the game played out

2 – a means of escape; The window was my only out

3 – used in two-way radio communication to indicate that a transmission is complete and no reply is expected

As the car passes the officer he recognizes the driver as a known felon. They’ve been briefed on this guy – armed and dangerous, two strikes down in a three strike state, gang affiliations with narcotic distribution. The plates on the car come back as stolen and the officer calls for backup before attempting a felony traffic stop. The man in the car knows that he’s been made so he speeds up, trying to outrun the officers. Every officer in this part of the city starts to converge on his location. When he finds himself boxed in he exits the car and starts shooting at the officers in their cars as he runs down the quiet neighborhood street. Seeing another officer blocking his escape route, he realizes that he’s trapped. He makes an abrupt turn and runs up to the nearest house. One kick to the front door and he makes entry into someone’s home. The officers hear screams as he takes a few hostages and yells threats through an open window. The officers surround the house but pull back as they initiate a SWAT call-out for a hostage situation.

The Bear Cat rolls past me and slowly drives up the street to park in front of the house where the suspect has barricaded himself. The six SWAT officers in the armored truck are positioned to report on any changes in the house and they will be used as a rapid reaction force if the suspect does something stupid like killing a hostage. Their job is to hold the scene at a forward position and react as needed to buy the rest of the team some time to formulate a plan.

From my vantage point in the incident command center I can see the SWAT commander setting up his game plan: floor plan of the house on a white board, arrows showing expected direction of attack, frequent radio communication and the occasional cell phone call. The SWAT snipers, dressed in woodland camouflage, begin the long and solitary walk to disappear into the neighborhood, with Remington-700 Police Sniper Rifles slung on their backs and a M4 duty weapons slung in the front. They quickly vanish from sight, undoubtedly taking up overwatch positions from rooftops a few streets away.

The SWAT Medic that is embedded with the team comes up to my rig and we make a game plan on various extrication scenarios and transport options. We’ll work under force protection protocols and enter the warm zone if necessary to initiate prompt treatment and extrication of wounded. If the suspect decides to force the officers into shooting him I’ll go in afterwards and make a field pronouncement. If he’s really stupid and starts shooting the hostages I’ll handle the initial triage and treatment while my partner calls for the appropriate number of units for transport. I’ll utilize the SWAT members to help extricate victims to the curb for the responding units to transport to the hospital.

The police helicopter finally shows up and starts doing lazy orbits of the house from 800 feet in the air. The pilot has the FLIR (forward looking infrared) turned on the house so he can see any movement. It’s sharp enough to pick up a hand on a window and discern our uniforms with the patches on the shoulders or the characteristic lack of heat signature where the ballistic vest insulates the torso. Unfortunately it’s not sharp enough to pinpoint heat signatures in the house. By now the snipers are in their overwatch position and I hear their quiet radio transmissions as they report on activities in the house as seen in their magnified scopes atop the rifles.

The rest of the SWAT officers start showing up to the command center that was hastily carved out of this quiet street in the middle of the hood. Their duffle bags of gear have been laid out like dominoes on the sidewalk. Officers who drove their personal vehicles into the hood stroll up to the duffle bags and begin their transformation from average citizen to door kicking SWAT officers. Black uniforms, heavy ballistic body armor, communication ear buds placed under headphones, and finally weapons loaded and made ready. The SWAT commander walks around to the troops showing a picture of the suspect as they prepare for the final showdown.

Whoomp! Whoomp! Whoomp! The continued noise of the forty-millimeter grenade launcher has been rhythmically pounding the house with tear gas for the last ten minutes. They systematically hit the house room by room – filling the interior with gas – until they have the suspect and hostages pushed to a back bedroom where there is no escape. I count 35 gas grenades before it finally goes silent.

The SWAT officers – who have collectively just heard a dispatch on the radio – turn in unison to walk down the street towards the house for the final assault. The K9 officer falls in with them and someone grabs a Halligan tool for door breaching. I’m going over scenarios in my head for possible outcomes in the next few minutes. I may end up with more patients than I can handle, with trauma that I can’t fix here on the streets. I could end up with wounded SWAT officers or a dead suspect or a random bystander shot in the mix. Maybe an officer twists his ankle on entry or gets a dog bite while going through back yards or a sniper falls off of a roof. Hell, anything could happen, I’ll just have to wait here and deal with the consequences as they come.

The tear gas grenades have been quiet for fifteen minutes now and the bulk of the SWAT officers turned the corner towards the house ten minutes ago – it’s been quiet since then. Out of the darkness from the direction of the house comes a lone patrol car backing slowly towards my rig. The officer steps out and walks up to my window. “Hey, we’ve got the suspect here, can you check him out real quick before we take him downtown?” Really, just like that and it’s over?

I walk around the back of the police cruiser to the back window which is rolled down. I can see a man in his mid-30s, hands cuffed behind his back, calmly siting in the back seat. I can talk to him through the bars on the back window. “Hey, are you hurt?”

“Fuck you!” Not exactly the response I was looking for but okay I guess it’s something.

“Did you get taken down hard or is the tear gas hurting your eyes?” It’s not the first medical assessment I’ve done through the bars of the back of a police cruiser.

“I said FUCK YOU!” Maybe I’m just asking the wrong questions.

“Are you saying that you don’t want any help from the Paramedics and you just want me to go away?” I think they call that a leading question.

“No, I don’t want anything from you. FUCK YOU!” Okay then. Somewhat of a limited vocabulary but he’s made his wishes quite clear.

I stand up from the window and address the officer who has been standing by waiting for me to complete my medical assessment. “He’s all yours.”

 

 

Impact 4/4

Driving home I see the text message from my wife telling me that she couldn’t stay awake any longer and is going to bed. I got held over by three hours tonight and it’s well past midnight before I make it home.

I give my wife a kiss and pet the dogs who are asleep in their monogrammed dog beds on my wife’s side of our bed.  Sleepy eyes look up from the pillow, “How was your day?”

“Busy, I’ll tell you about it tomorrow love, go back to sleep. I love you.”

I spend an hour in the hot tub – cool wind in the trees and stars overhead – tying to let the adrenaline dissipate from my system and introspectively looking for answers while listening to the lonely call of an owl sitting in a nearby tree.

Don goes to the middle east, putting his life on the line for his country, while getting shot at by the Iraqi version of bangers in their very real killing fields. In an effort to help his fellow serviceman even more he starts medical training and gets shot at by local bangers – the very people whose freedoms he swore to protect – in the domestic version of the killing fields.

Of all people to shoot at, why shoot at EMS? We are the best chance a banger has when they get shot. We are their ONLY advocate and our single purpose is to make sure they don’t die – a job that we have become quite proficient at over the years. In the summer months of this year 204 people were shot in the urban city that comprises most of my county. Of those 204 people only 11 people died. That’s a survival rate of 95%.

In the world of modern medicine we are able to keep the elderly alive long past their bodies’ ability to function – giving their families just a little more time with grandma and grandpa. That same modern medicine seems to also be keeping the violent offenders alive through multiple life threatening altercations and solidifying their personal self image of indestructibility – thereby prolonging and intensifying the violent behavior. In the dark ages a ruffian would have died from infection following a minor cut in a knife fight. Yet today I have many patients with multiple laceration and GSW scars that tell the tale of escalating violence – and by extrapolation an escalation of PTSD, dissociative violent behavior, depression, and many other mental afflictions. It’s possible that the ability of the physical body to cope with trauma has out-paced the mind’s ability to cope with the effects of the same trauma.

As I lay in bed – wife and dogs sleeping peacefully near me – I wonder if my mind has the same limitations to cope with the trauma that I bear witness to – and occasionally participate in – on a daily basis.

One week later Jim tells me that the victim in the GSW that we worked was a friend of his neighbor. He was attending a Quinceañera party – the celebration of a Latina’s fifteenth birthday where she transitions from childhood to being considered an adult. He had a perforated right lung and ruptured pancreas as the bullet had a straight trajectory in a downward angle from right mid-axially, bouncing off of the left iliac arch. He spent three days in the ICU under sedation. Upon waking up he told the nurses that he wants to meet with Jim and I to thank us for saving his life. That should be interesting.

His shooter was arrested one day later and is expected to be charged with assault with a firearm and attempted murder. The motive for the shooting was a gang initiation test to shoot a random person.

The suspect that shot up our ambulance is still unknown…

Impact 3/4

Thwack…..Thwack..Thwack.

“Drive!” I tell Jim to get us out of here now after hearing the metallic impact noises to the back of the rig. The dark streets of the killing fields become a blur as Jim accelerates away from the shooter and adrenaline floods my system while narrowing my field of view to a small tunnel with a blurry periphery – it’s the definition of “fight or flight” response.

I’ve slumped down in my seat a bit, unconsciously lowering my profile in the rig and putting more metal between me and the outside world.

“Anyone hit?” Communication is truncated to just specifics as Jim chirps the siren through a few stop signs and gets us out of the area. “I’m good,” comes the answer from Don behind me – the closest one of us to the shooter. Jim is the definition of concentration as he deftly maneuvers the rig through the hood, “Good.”

I pick up the radio, “Medic-40, priority traffic.” I really hope I’m keeping my voice calm.

“Medic-40, go.” The stoic dispatcher comes back quickly.

“Medic-40, we’ve taken shots to the rig. Relocating now, Code-4, non-injury. Shots fired at our previous staging area with four suspects heading east.”

“Medic-40, copy that, sending PD now, go with suspect descriptions.”

“Medic-40, four suspects, African-American, ages 15-18, one in a white hoodie, three in black hoodies. One black hoodie has white skeleton bones on the front and back.” I think I just described half the population of my mostly urban county.

I help Jim navigate to the well lit commuter train parking lot, hoping it’s a little safer than our last location. I heard our supervisor requesting our location from dispatch who has been watching us on the GPS and gives him our new location.

As we get out of the rig to check the damage, police cars start to show up. City PD, county sheriff officers, and the commuter train officers followed by our supervisor. Descriptions of the suspects are given again and the officers race off to canvas the area. I doubt they’ll find the shooter as all of the suspects were wearing the uniform of the hood: sagging jeans, black hoodie pulled over the head. You can never pin a crime on one person when everyone dresses the same.

An inspection of the back of the rig shows three impact points to the metal. They are small circular impacts that chipped the paint and dented the metal but didn’t go through. Given the distance of the shooter we’re assuming it was a small caliber pistol. Fortunately bangers are notorious for shooting with the gangsta-sidewise grip and usually can’t hit anything. In this case they did hit us and that’s really messing with my head. There was a time when everyone in the hood had an unwritten rule: no kids and no ambulances. It seems that rule is no longer in place – we saw that memorial to the kid today and we just got shot at.

I’ve had my body armor on since the last GSW we went to so I guess I was somewhat protected but it’s really just random happenstance that I was wearing it at the time when I got shot at. Yes, I have good instincts, and take every precaution. But honestly this could have happened anytime of the day or night. The rule of thumb for staging is to be 6-10 blocks away without a clean line of sight to the scene – and that’s exactly what we did. But it’s hard when we’re in the middle of the killing fields and there’s twenty blocks of unsafe hood in every direction. I doubt the shooter had any connection to the assault we were staging for. I suspect it was just a random, spur-of-the-moment crime of opportunity. Like so many things in EMS I I’ll probably never know the reason for this act or even the final outcome. As usual I just showed up for the exciting middle part – however unwilling that participation may have been.

The end result of all this excitement is an hour spent filling out paperwork and making police reports.


Impact 2/4

After missing out on an interesting call we’re still posting near the killing fields when we get a call for a GSW about twenty blocks from the one that went out only fifteen minutes ago. Finally, something interesting!

It’s dark now and Jim is navigating through the hood with our strobes illuminating graffiti covered fences as I map out the call location on my iPad. Given the close proximity and time-frame to the last GSW it’s reasonable to suspect that this may be an extension of that scene or possibly a retaliation by affiliates of the victim. Either way it means the vibe in the hood has changed and this is a very dangerous time to be traveling the streets. I pull my ballistic vest out of my bag and strap in the velcro attachments as I’m giving directions to Jim. It’s not something I wear all the time but it seems appropriate right now.

When we’re maybe fifteen blocks from the scene the dispatcher tells us that we’re clear to enter and police have secured the scene. Making the last turn to the street we see the fire engine and six police cars that were parked in a hurry. I tell Jim and Don to get the gurney as I want to get to the patient quickly – this is going to be a stat call and I want to be able to visualize any wounds before the patient gets bandaged up or put on a back board.

Walking up to the scene an officer meets me and accompanies me to the victim. We have to push past a crowd of people who look as though they were having an outdoor barbecue with party tents and folding tables and chairs. I can see the firefighters kneeling in the grass with officers holding back the onlookers. Secure scene my ass! There are way too many random people standing around just feet from my victim – and me.

I’m happy to see Darren, my neighbor, who’s the lieutenant on the fire engine that beat us to the scene by thirty seconds. “Hey KC, good to see ya. We’ve got a twenty year old male, single GSW under the right armpit, no exit wound. We’re working on getting him boarded now.” I thank him as I head over to check out the patient.

Darren’s crew is as dialed in as they come for this kind of call. They have the patient stripped to his boxers, the oxygen mask has already been applied, and they are about to slide the back board under him as I kneel down at his head. A quick greeting to the patient tells me that he’s alert for now and that his airway is good. I give a quick listen to lung sounds to confirm that he’s moving air and feel for a radial pulse which tells me he still has a decent blood pressure. All good so far.

I inspect the wound, which is just where Darren said it would be, and I start looking for additional wounds or an exit wound. As I run my hands down the ribs on the opposite side from the GSW I feel a lump under the skin that moves around when I push it. Fuck me! That’s the bullet! It entered under the right armpit, mid-axillary, and is now resting right next to the left floating rib. That’s directly through the kill zone!

There are basically three possibilities: straight trajectory through the torso; ricochet trajectory bouncing off of bones to end up on the other side; or the luge option where the bullet entered at such an angle that it skated to the other side following the ribs in a circumferential trajectory and bypassed the internal organs. I really hope it’s the last option.

We have him loaded in the ambulance and start transporting in an incredible four minutes and thirty seconds. I brought Darren’s fire-medic with me and I have Don in the back with me. Treatment is fast and methodical from two medics that have done this many times: bilateral sixteen gauge IVs, Asherman chest seal over the wound to reduce the chance of a sucking chest wound producing a collapsed lung, keep re-assessing and go find a trauma surgeon.

After all of the basics are covered I turn it into a teaching case for Don. In an ambulance, traveling with lights and sirens, bumping down the road, I’m walking Don through everything we did and having him re-assess. I have him take a blood pressure in the most challenging of environments using all of the tricks I’ve shown him today. I quiz him on the anatomy that is in danger given the different possibilities of bullet trajectory. I have him feel the abdomen that is now filling with blood and appreciate the rigid distention that only comes from internal bleeding. He then feels the bullet under the skin as I guide his hands and I watch Don’s eyes get big and round. And finally I point to the trends that we’ve been watching over the last six minutes; skin signs going shocky, heart rate increasing by fifteen percent, blood pressure dropping by ten percent, respiration increasing, oxygen saturation dropping. I’m explaining shock and compensation as I roll into the trauma bay filled with this year’s new crop of doc-lings and the rest of the trauma team.

If you wish to make an impact for one year, plant corn; if you wish to make an impact for a generation, plant a tree; if you wish to make an impact for eternity, educate a child.

Anonymous

Impact 1/4

im·pact

1 : the striking of one body against another

2 : the violent interaction of individuals or groups entering into combat

3 : to have an effect upon; a positive impact upon the community

Words can never adequately convey the incredible impact of our attitudes towards life. The longer I live the more convinced I become that life is ten percent what happens to us and ninety percent how we respond to it. 

Charles R. Swindoll, 1934

We’ve been staging for the assault in progress for almost a half hour and all three of us are starting to get a little tired of just sitting in one place as we wait for PD to secure the scene so that we can safely enter. Normally we would be parked behind the fire engine, as they stage with us, yet this call came in as a Code-2 so we’re running it solo. The police are stretched pretty thin right now as they’re working on the aftermath of two shooting scenes within twenty blocks of us.

My military EMT ride-along is in the back and I have a float EMT partner as Kevin and I got split up today by scheduling. After the excruciatingly slow pace of the day we finally got an interesting call an hour ago – for a GSW that occurred about 20 blocks from our current scene. We rocked that call to perfection and I’m going over the specifics with my ride-along as we sit waiting for a secure scene.

Four young men in the hooded sweatshirt/baggy pants uniform of the hood walk past the rig and down the dark street behind us. One of the black hooded sweatshirts has the white bones of a skeleton on the front – the harbinger of death. My partner is keeping an eye on them in the side mirror when one of them raises his hand pointing at us from fifty feet away.

Thwack…..Thwack..Thwack – three metallic impact noises come from the back of the rig. Don, my ride-along, yells over to us, “Oh shit! They’re shooting at us!!!”

While checking out my narcotics, computer, and miscellaneous equipment from the deployment coordinator I’m told that I have a military ride-along today and head off to the lounge to pick him up for his training day in the hood. He’s an energetic man in his late twenties named Don. I spend a few minutes getting him familiar with the rig and explaining expectations for the day as Jim, my EMT parter for today, shows up.

As usual we seem to have a heavy dose of “third man syndrome” today as it’s very slow and I’m only getting the absolute mundane calls – a fall from a ladder with minor injuries, the febrile seizure, the sixteen year old girl with a tummy ache consistent with menstrual cramping, and an old man who had a seizure in a skilled nursing facility. I do my best to involve Don in everything but there’s really not that much to do on these calls and we have over an hour of posting between each one so we get a chance to talk all day.

Don tells me he’s been in the Army for six years with a tour in Iraq and one in Afghanistan. He switched from infantry to a medical focus and is getting his EMT certification so he can feel like he’s helping his fellow servicemen on future deployments.

Jim and I tell him about calls that we’ve been on and talk about treatments and patient presentations. We pass the time by quizzing Don on how he would do assessments and treat fictitious patients.

We’re finishing up a call and hear another unit get dispatched to a GSW (gun shot wound) with possibly two patients on scene. It’s too far away for us to jump the call from the other unit but the dispatcher sends us to a post that’s near the scene. If there happen to be two patients then I’m sure we’ll be sent in for the second patient so maybe our luck is turning for the day.

I explain to Don how we call this area the killing fields as it’s a flat, 60 by 40 block area of the county where a lot of assaults and gang violence take place. I point out a street memorial – stacks of stuffed animals surrounded by candles and flowers – for the three year old child that was the unintended victim of a recent drive-by shooting. Then we pass by the street where the four officers were killed a few years ago by a banger with an assault rifle. Don’s having a difficult time believing this is happening right here in America. He’s a combat veteran who is no stranger to violence but he didn’t know it existed to this degree in the forgotten urban wasteland of my mostly urban county.

He tells us of his experiences in Iraq where his convoy was often shot at while driving from one base the the next and how IEDs (improvised explosive devices) were a constant source of annoyance and often death.

I hear the unit that responded to the GSW start transporting Code-3 to the trauma center without having called for an additional unit. It appears that there was only one patient and our “third man syndrome” is still in full effect.


Gangsta Rap 3/3

The police officer sees us on the security camera and pushes the button that activates the large sliding metal gate. We drive in to see the parking lot full of police cars and head towards the sally port – a secure transfer spot for taking prisoners in and out of the city jail.

Five officers are waiting for us as Kevin and I step out of the rig to see why they called us to the back of the jail today.

The officer with the stripes on his sleeve approaches me and gives me the story. “Hey guys, so we picked this guy up on being drunk in public. While we’re getting him booked he starts talking about being suicidal and wanting to kill himself. So instead of booking him we put him on a green sheet to get checked out at EPS.”

“Did he actually do anything to hurt himself or is it just talk?” I’m just trying to see if I’ll have any injuries to deal with or is it just verbalizing suicidal ideation.

“No, he didn’t do anything – he actually wants to go to EPS. Go figure.”

“Has he been violent with you guys?” Trying to gauge the need for restraints or not.

“No, he’s been good, but he’s a big guy so we kept him cuffed.”

“Sounds easy enough. Do you want us to come in and get him or do you want to bring him out?”

“You can hang tight here, we’ll bring him out.”

We’re in the mid-county, more affluent cities, so there are more available police officers than in our Big City. In these cities it’s common to have four or five police cars respond to a single incident where as in the Big City they are stretched so thin it’s hard to get just two cops even when we need them.

The officers return from the sally port escorting a man in handcuffs. With one officer on each arm, and three more keeping watch, the man is doing a slow shuffle towards me as I wait next to the rig. He’s got his eyes closed down to slits which gives him a menacing look yet also allows him to surreptitiously observe his environment without others seeing the direction of gaze – prison yard stealth. With his shifting gaze he never looked past my blue uniform, which matches the police officers, to see who I am.

“Yo, Lil’G, what the hell you doin’ down here?!” The officers stop mid-stride as they didn’t expect to hear “street speak” coming out of the clean cut paramedic standing in front of them.

Lil’G’s eyes pop up to full round and he drops the prison yard stealth mode as recognition sets in. He gets a big smile on his face, “Yo, T2, it’s my boy. Ya’ll did me right, you called my boy to come get me.”

“Lil’G, you all right man. You gonna be cool if I get you outta those cuffs?”

“Yeah man, I cool, you my boy.” I can smell the alcohol coming off of his breath and hear the slight slur to his speech.

I turn to the officers holding on to his arms. “I’m good guys, you can un-cuff him. We’re old friends.” They catch the irony in my voice.

Lil’G happily climbs up into the ambulance as I chat with the sergeant for a few minutes.  “I usually see him up in the Big City around the seventies. I’ve never run into him down here.”

“Yeah we haven’t seen him before. I’m happy to send him up to EPS and out of our city.” It’s the classic small town sheriff giving the trouble maker a bus ticket out of the city.

“I hear ya’. We’ll take care of him. See you next time.”

I climb in to sit on the bench next to Lil’G and pull out the fat person blood pressure cuff to fit around his enormous guns.

“Lil’G, you losing some weight? You’re looking skinnier than the last time I saw you.”

“Yeah man, I going through some shit, you know. Not eatin’ much. I lost my daughter two week ago, she dead.” He’s introspective and just a little bit sad. I’d say that’s justified.

“Oh man, I’m sorry to hear that.” I’m curious about the circumstances but I honestly don’t want to talk about it too much with him. Remembering his bipolar diagnosis I know he could cycle on me and you just never know where that’s going to go.

In an attempt to steer the conversation somewhere else. “You got any new raps for me?”

“Yeah man, I got a rap for ya T2, it’s my story.”

I’m a play’a… that’s my number one life style.

I’ve been a play’a… since I was a li’l child.

I grew up… havin’ hard times every day.

I had to choose a road… but didn’t know which way.

 

Started kickin’ it with the fellas… on seven ohh.

Makin’ money… cuz that was the way to go.

Smokin’ dank, full tank… get an even high.

Even had three ho’s… on my side.

 

Two was cool but one… thought she was a gangsta.

But I didn’t know… I was fuckin’ with danger.

She kept on tellin’ me how down she was… you know.

She said she didn’t give a fuck… about five-ohh.

 

Till the day on the ave… we was kickin’ it.

Wasn’t nothin’ else to do… but get lit.

Straight hands to a gangsta… whole nine yards.

Till the sucka tried to pull… my damn playa’s card.

 

I threw a left… and connected to the fool’s jaw.

The punk fell an’ tried to walk… but he had to crawl.

I split the scene… and went to the fuckin’ sto’.

On the way back… I ran into the Po Po.

 

Shit was cool… so I didn’t want to bail.

Fuck the po-lice… I ain’t going to jail.

I cocked my nine… then I fired at the dirty mack.

I started trippin’ and my mind… started to un-fold.

I’m in the middle of a shoot out… damn I’m told.

 

As curiosity was fuckin’… with my damn head.

Bullets kept flyin’, people dyin’… and bodies bled.

I dropped my nine, then I reached… for my four-four.

Empty one clip, then I headed… for my car door.

 

I couldn’t believe my eyes…

It’s my mind’s surprise…

I’m the only black nigga gonna stay alive.

 

Jesus Christ… this mutha fuckin’ gang.

Po Po try an’ jack me… and playin’ wit my fuckin’ brain.

But I ain’t going down… I’m not a sucka.

You want me… you gotta kill me mutha fucka.

 

Bill Gates… and the rest a the klan.

Ya’ll can suck my dick… cuz I’m a crazy ass black man.

But in the mean while… I’m just as versatile.

That’s my life… gangsta life… that’s my life…style.

My name is Lil’G… and I’m out.

Lil’G is a very real man and the above rhymes are his words. I apologize for the graphic nature and language yet I think it’s important to keep it authentic as an accurate  representation of how his mind works. It would be easy to dismiss this as typical gangsta rap but I think it goes deeper than that. This is a man who has been in and out of institutions – criminal and psychiatric – since he was young. He may have actually picked up some coping mechanisms to deal with the turmoil that haunts his waking moments and it manifests with introspective communication in the only way he knows how. Just as his bipolar mind cycles from emotion to emotion his physical body will cycle from street to institution until both are exhausted. There is no escape for his mind or body from the streets that created his life…style. 

Gangsta Rap 2/3

Kevin and I are dumb-founded. It was actually a good rap, despite the disturbing subject matter, and Lil’G seems to have some talent. I’d much rather listen to him rhyme than watch him tear the place apart.

“Lil’G man, you got some talent, you write that when you’re in prison?” I’m honestly curious.

“Nah man, I gots too much to do when I’m in the joint.” He’s dismissive with a wave of his hand.

“Too much to do? What, you working out all the time? Gotta build up those guns?” Referring to his biceps. Yet a tickling on the back of my neck reminds me that we didn’t exactly search him before he got in the ambulance with chest pain a few minutes ago. I hope Kevin did the “EMS pat down” as he put the monitor leads on him.

“Nah, I don’t work out in the joint. I’m too busy keepin’ an eye on all those niggas. Don’t never know when some fool’s gonna come up and try to stick me. Gotta be ready for a smack down, you know?”

After what seemed like an eternity PD shows up. Fortunately they pulled up to the front of the rig and I’m able to brief them before Lil’G notices they are here. The officers walk around the back of the rig so Lil’G can see them and it’s obvious by his expression that he’s not surprised. He knew this was happening all along. He’s been in this situation before and knows the drill just about as well as we do.

After a quick conversation and some paperwork the green sheet is finished and we can start to transport to the Emergency Psychological Services (EPS). Lil’G will get a psych evaluation and maybe stay a day or two for observation. It all depends on how he answers the questions.

It’s Kevin’s tech so I’m up front driving to EPS while Kevin finishes off the paper work. It turns out that no restraints or sedatives were necessary as Lil’G seems to want to go to the EPS. I can only imagine the life he’s led up to this point and how it may actually be comforting for him to rest in a relatively safe institution for a few days.

Growing up in the hood he presumably had few positive role models. He must have been in harm’s way often and exposed to some traumatic events. Just as a soldier comes back from a war with PTSD, I can imagine that life in the hood can create the same effect. Then at a formative age he’s placed in prison with its strict routine and lack of freedom accompanied by the ever-present danger of prison violence. Past traumatic experiences have created at least as many mental/emotional scars as physical ones.

Yet even with these obstacles this man has made it to his forth decade of life, which is rare for people in his situation. He seems to focus his energy on his rhymes, which he presents in all modalities of communication, with a harmony of visual/kinesthetic/auditory artistry. A man with limited education and vocabulary is able to access his inner emotions and express his feelings, dark and violent as they may be, to others and himself.

Pulling into EPS I hear the disturbing rhymes from the back of the rig.

I chop your head off… let it roll in a buck-et.

I punch your eyes out… so I can skull fuck-it.

 

But I aint trippin’ nigga… I won’t beg.

I drink the blood… from a bull dog’s left leg.

 

I told you once nigga… I ain’t even trippin’.

You get found nigga… by three old men fishin’.

 

We can do some shit… I might bust your brain.

But on the tip of my shoes… I’m leavin’ doo-stains.


Gangsta Rap 1/3

gang·sta

1  :  black slang; a gang member

2  :  a type of rap music featuring aggressive misogynistic lyrics, often with reference to gang violence and urban street life

rap

1  :  to hit sharply and swiftly; strike

2  :  a criminal charge; a prison sentence

3  :  music; to talk using rhythm and rhyme, usually over a strong musical beat

4  :  to have a long informal conversation with friends

Violence is a part of America. I don’t want to single out rap music. Let’s be honest. America’s the most violent country in the history of the world, that’s just the way it is. We’re all affected by it. That’s one of the frailties of the human condition; people fear that which is not familiar.

Spike Lee

“Ya’ see, I didn’t really call you here because I was havin’ chest pain. It nothin’ like that at all. Ya see, I thinkin’ about killin’ myself.” As the fire engine accelerates away from us Kevin and I have a very different call on our hands than the one we thought it was going to be just a few seconds ago.

Getting called to the middle of the hood for chest pain is a common enough thing and we answer these calls on a daily basis. Today we happened to be just a few blocks away when the call information arrived on the Mobile Data Terminal (MDT). I turned the ambulance around and we were on scene in less than two minutes.

Sitting on a chair in front of an urban church outreach center was a man in his early forties. The pastor and church volunteers are comforting him as we walk up to see what’s going on. Holding his chest he tells us of the pain he’s feeling and how he wants to get checked out at the hospital. It’s an easy call and the assessment and treatment are so rote that we fall into auto pilot as we go through the motions.

Seeing the fire engine approaching from down the street I write the man’s name and birthday on my glove and hold my hand up high so the fire lieutenant can copy it down for his records without having to exit the engine. In seconds they are off to the next call and we are alone with the patient. Of course, that was before I knew the true nature of the call.

After our patient drops the bombshell on us, Kevin and I take a collective deep breath and one look between us confirms the sudden detour this call has taken. In our business suicidal ideation is taken very seriously. A person who is truly suicidal, who has ceased to care about their own life, may not care about other people’s lives. Therefore, we can be in danger when dealing with these people.

Our new patient, Lil’G, is quite a formidable man. He has scars on his face, one of which is consistent with a knife wound. He’s 240 pounds of compact, short, boxer’s build with huge upper body development. He’s seriously built like a smaller Mike Tyson. He jokes with Kevin because he had to pull out the fat person blood pressure cuff just to fit around his huge biceps. He does a muscle man flex and smiles showing me a gold tooth. I’m feeling very uneasy about this. I give Kevin a look that he understands. “I’ll be back in a second.”

“Hey, where you goin’?” He’s quick with predatory instincts, watching every movement – nothing escapes him.

“I just have to get the computer from the front.” It’s a half truth which I hope he doesn’t see through.

Walking up to the front of the rig I turn on the portable radio on my belt. Opening the front door I grab the computer and turn off the rig radio which can be heard from the patient area in the back. I stand in front of the engine compartment so I can keep an eye on Kevin through the windshield as I call in to dispatch on my portable.

“Medic-40 go ahead.” The radio crackles back to me.

“Medic-40, please send PD to our location, code-2, our chest pain call just turned into a 5150 with suicidal ideation. We’re code-4, for now.” The code-4 tells my dispatcher that we are not currently in danger. The ‘for now’ tells her that I don’t know how long that’s going to last.

I’m standing outside of the back doors as Kevin is doing further assessments on Lil’G. Kevin knows the drill: we have to stall as long as possible so PD can get here to write up the green sheet (5150). Without it we have fewer of the options we may well need in this case, like restraints and chemical sedation.

I’m watching Lil’G as Kevin continues with the 12-lead EKG. Lifting up his shirt I see the multiple GSW (gun shot wound) scars.

“Lil’G, how many times you been shot?” Anything to distract him and buy us some time.

“Yo, I been shot four times, stabbed two, and sliced up a couple. It’s hard man, growin’ up in the 70s.” He’s not referring to the decade – to him the 70s are the street numbers in his corner of the hood.

“You ever do time?” I’m thinking prison ripped could explain the boxer physique.

“Yeah, I did six year, fo’ bangin’. You know; sellin’ a little, had sum ho’s, and a little bit a shootn’.” He’s not talking about shooting up with heroin. “Yeah, I got a strike on me.” In this state it’s three strikes for felony convictions and you’re in prison for good.

Kevin’s still trying to stretch out the assessment as I’m typing on the computer. “You got any medical problems?”

“Yeah, I got PTSD, bipolar, paranoid schizophrenia, and depression, but I ain’t takin’ no meds for it.” FUCK ME!!! I’ve got a bipolar psych patient who’s off his meds, built like Tyson, and thinking about killing himself. I really need a raise.

Lil’G could shred both Kevin and I if he put his mind to it. Not to mention tear the ambulance apart. We’re walking a fine line here and we have to keep him on the good side of his bipolar disorder. I’ve watched manic bipolar patients cycle from happy to violent a dozen times in the course of a single transport. If this guy cycles on us we’re fucked.

Despite the lethal potential of Lil’G he’s actually pretty engaging. He has a fast wit and keen observation skills. He decides I look like the silver terminator from Judgment Day, in reference to my hair style and clean cut white boy appearance. Seeing as the terminator impersonated a cop through most of the movie I’m not sure I like the reference.

“Yo man, that’s your new name, I’m gonna call you T2.” He has a full bodied laugh with muscles rippling to the diaphragmatic contractions. Great, I have a street name.

And just like that Lil’G cycles on us. Yet not to a violent nature – quite the contrary. Right there in the back of the ambulance he starts rapping. With perfect tempo and surprisingly colorful depictions he tells us what’s on his mind in the only way he knows how.

I’m on the microphone… gotta do it quick.

But never give a care… I ain’t scared to hit a bitch.

Gotta hit her from the back… nigga back side.

I don’t give a fuck nigga… it’s time for a wild ride.

 

Call me Lil’G… when you see me.

I see niggas on the street… trying to be me.

I got these knuckles man… I make ‘em laugh man.

Never give a care… put ‘em in a bath man.

 

Gotta do it good… cuz you know what’s right.

I never give a care nigga… cuz I’m hell’a tight.

I come from 69ville… nigga eight-five.

Never give a care… boy I don’t duck and hide.

 

I’m born on the east side… I’m going east bound.

You a block head… whose name is Charlie Brown.