Emergency Medicine: Ghosts

Emergency Medicine: Ghosts
You never forget your first one.
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While I cannot recall a specific year, or a specific date, or even the specific patients I treated, I can often remember their ghosts. A kind of whisper of who they were in the few moments I was with them, the impression they left upon me.

Back in the beginning, when I was young and new to this pre-hospital paramedicine world occupied by the men, by the daring, the caring and the broken, I was in awe. Each time the radio would produce its mechanical set of tones I'd imagine the worst, which to those on the job were "the best" as far as calls went. I was in school to be a paramedic, or I was about to start the portion of training that took place on an ambulance, the point being that I had yet to do much more than assist the elderly, the bedridden or those going to and from a physician or other medical appointment.

On this day, I'd gone to visit a crew; Bob, a paramedic, and his partner. They'd wanted a quick lunch and invited me along, so I jumped into the back of the ambulance for the few minutes ride down the street to the closest fast food restaurant. The day had been quiet, which was a word I would learn that you never say while on duty. There were very few calls for service and there was no reason to think our ten or so minute jaunt would be any different. Of course, it was.

Before getting to lunch, the tones blared from the bulky radios the men wore on their hips. The call: a MVA (motor vehicle accident), code 3 (lights and sirens). The location: a highway that could be treacherous when dark, wet or foggy. It wound back and forth over the hill with drops to one side into rock and brush while the opposite side mirrored its landscape. This highway had few passing lanes or turnouts, making any attempt at passing or turning around difficult if not impossible. On warm summer days the two-lane road would be packed with beachgoers and families heading toward the Pacific Ocean. That day, from the back of the ambulance, I remember the sun shining and the many cars on the road heading toward the coast.

Bob, someone I called a friend, was in the front passenger seat; he would be the lead for whatever would be found when we arrived at the accident scene. His job on the way to the call was to mentally work through all the possible scenarios: what additional equipment he might need, what hospitals were diverting patients because they were too full to accept anyone else, what time frame was acceptable for a critical patient to be taken by ambulance versus landing a helicopter to fly them out. My job was to observe. While we worked for the same company I wasn't on duty, I wasn't in uniform and I wasn't trained to the extent that Bob and his partner were. No matter though, as most of the time these calls ended up being minor. Someone with slight back pain who wanted to go to the hospital 'just in case', or maybe someone who may have strained their neck and hoped that whomever caused the accident had enough insurance to cover the ambulance bill. Those were often the issues paramedics would find at many accident scenes.

On the way up the highway we lost the radio signal; at times, it would come through momentarily like the desperately needed breeze on a hot summer day, but then it would fade out again just as quickly. While the dispatchers on the other end of the radio likely had more information, we were unable to get any updates as to what to expect. Bob and his partner casually talked about the possibilities, where we were geographically related to possible landing zones for a helicopter or places to turn the ambulance around.

It took what seemed like an eternity to get to our destination. I watched through the opening between the front of the ambulance and the back, where I was sitting. We weaved through cars on the roadway using the few wider areas with their slender dirt shoulders as our own lane, until finally rounding a corner where a vehicle had been laid on its side blocking both lanes of traffic. I don't recall the last thing that Bob or his partner said, but I do recall the sudden silence from the front of the ambulance and my heart starting to race. The ambulance stopped and the silence was suddenly broken by the distinctive deep metallic ratcheting sound of the emergency break being applied. I remember feeling nervous and quickly putting on my "work persona", the face that shows no emotion, the voice that will not waver.

Before I knew it the rear doors of the ambulance had been thrown open. Bob's partner grabbed the trauma bag and signaled me to come out. Once I jumped from the rear of the ambulance I came to see why they had moved so quickly. I'd seen the car on its side while looking through the opening to the front of the ambulance, but I didn't see the people standing in the roadway pointing. There was shouting and somewhere the sound of crying. 

Bob’s partner went around the ambulance, heading for the driver's side of the vehicle which was laid on the roadway. I stuck with Bob. We went around the other side, where the undercarriage of the car faced up the hill. Bob, I recall, looked me in the eyes. I knew what he wanted. He was trying to see if I was 'there', able to function and follow his instructions. The look was brief, but it was clear, concise. I merely nodded and he started giving me instructions.

It didn't strike me just how odd the scene was as Bob and I quickly knelt on one side of the body in front of us. A body, face down on the black pavement, lying still in the shade of the vehicle. No face visible, just the denim jeans with a bit of tummy rounding out at the side near the hip, a t-shirt, not ripped or torn. No sign of blood or deformity registered in my brain. 

Bob and I took our positions ready to roll the body towards us, ensuring that when we did it would be one smooth movement, making sure that the spine was kept in line with the rest of the body and we were working together. When Bob gave the word, we would roll the body so that he could assess it. It was on his count, on three. One. Two. Three. We rolled the body, I at the hip and shoulder, he is stabilizing the head and neck. We rolled the body only slightly, just until I heard his voice, somewhat breathy, urgent, say stop. I froze. He leaned his head over towards the face. I too leaned just slightly forward to try to see what he was looking for, or at. It was then I saw the dark pool of liquid forming under the chest, the fluid that had start to coagulate just under the head, and as Bob maneuvered to better his view, I had a clearer view.

The body was female; her neck had a thick choke chain, the type with big sliver links that you'd see on a dog. Her t-shirt a dark color with perhaps a rock band name or emblem on the from. I remember those details because I had to look away from her face. Bob stopped us rolling her because of her face, it was caught between the pavement and the drive side front tire.

I recall only images after that. Bob checking her carotid pulse, instructing me to lie her back down in the position we'd found her. It was then I knew she was dead. Bob sent me back to the ambulance to get what we called a CHP blanket, the bright yellow blanket that are seen at accidents over bodies or used to cover a patient when it was raining hard. I don't recall what happened with the other patient, though I don't recall transporting anyone in the ambulance from that accident.

Once we returned to the station I sat and decompressed with Bob and his partner. Bob finished has paperwork and his partner worked on restocking and cleaning the equipment used on the call. The PCR (patient care report) needed to accompany the body, it detailed the scene, where the vehicle was, where the body was, what Bob and his partner had done and the time that Bob determined death.

Over the years, I'd continue to see the girl from the accident in my head. The way her face was set upon the front of her head like an ill-fitting mask, still attached by pieces of skin on one side, but the rest was scraped, battered and seemingly not where it should be. Her blond hair that lay perfectly upon her back, then when turning her over the front matted and tagged with coagulated blood. These are the images I remember, the first real death images of someone my age, a contemporary. 

Years later, I'd run my share of calls on an ambulance as the medic and the teacher. I'd see my share of death, both old and young, from medical and traumatic causes. But, one day while at work I received a call. Bob, my friend, my teacher, my mentor, was brain dead and on life support awaiting an organ harvesting team. The paramedics that responded to him, to the call for a 'man down', likely thought of him as just another patient, just another set of tones on the radio or a PCR to fill out, not knowing they had followed in his footsteps.

For me, the news of this death brought back the freshness of death, it brought back the image of that girl on the asphalt with her face hidden, seemingly just laid out to rest in the shade of the overturned vehicle. Death was new again because it was the death of a contemporary, a fellow medic, a friend. Bob, was the first person to formally introduce me to death as a paramedic. He is now one of my many ghosts, a memory, a whisper that lingers.


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