My high school put a high value on community service. We had a half day of classes on Wednesday; in the morning, the majority of students volunteered in the community. We had class on Saturday morning to make up for the lost school time.

There were a lot of volunteer organizations that one could be involved with; schools, parks, animal shelters, many, many choices. Somehow I always tended to pick healthcare slots.

For two years, I volunteered in the storeroom of the hospital in Torrington, Connecticut. I would fill a cart with various ordered supplies and then deliver them to different departments in the hospital. This was my kind of gig; behind the scenes, autonomous for the most part, lots of movement and interaction with widely different people.

The storeroom was located down a long hallway in the bowels of the hospital, past the maintenance department. Some buildings don’t really have bowels; hospitals do. The only thing farther from the civilized areas of the hospital than the storeroom was the morgue; a set of featureless wood double doors a bit further along. The doors to the morgue were always closed.

One particular Wednesday, a powerful odor struck me on my way from the elevator, even before I reached maintenance. It was a strong antiseptic scent with a hint of something else. It grew stronger as I approached the storeroom.

I asked my supervisor what the smell was. He told me that they were doing an autopsy and that if I were interested I should go in and check it out.

I really wasn’t into the idea. I picked up my first load of supplies and took them around, thinking madly the whole time. I was utterly repulsed by the idea of seeing a dead person, but I realized that I was unlikely to have such a chance again in the future. I should avail myself of the opportunity, I finally decided.

When I got back to the storeroom, I asked my supervisor if he was serious about my going in and seeing the autopsy. He said that he was, and to just go and knock on the door.

So I did.

A few moments after I knocked, the door was opened by a man in scrubs. I told him my story and he invited me in. He introduced himself as a pathologist and introduced me to the other living person in the room, another pathologist. On a stainless-steel gurney in the middle of the room was the body of an elderly woman, split open from crotch to neck. Since she had died within two weeks of surgery, the pathologists explained, the state required an autopsy to be performed.

It was really fascinating. I hung out for an hour or so, watching what they did. They told me about what they were doing as they did it, and I was right there to see it, me, two pathologists, and a corpse, no farther from me than I am to this table. They did some pretty unspeakable things; they split her ribs and palpated her lungs and heart, finding a pacemaker. Her internal organs were amazingly plastic-looking. They cut open her skull with a circular saw, peeled the scalp back over her face, pulled the sawed-off bowl off, and checked out her brain. They removed her intestines and squeezed stuff out onto a tray for analysis. I was pretty unsettled the whole time, but I watched and asked questions.

Looking at the edges of the various incisions, I was really struck by the way subcutaneous fat beads when cut or torn. Of course, I didn’t think about it in those terms, and I repressed the image for over twenty years, until earlier today.

After lunch this afternoon, I left to go over to a client site. I was making a turn when I noticed some activity up the road in the opposite direction than I was intending to go. There was a car off the road and several other cars around. This was not in my area of coverage, so I wasn’t surprised that I hadn’t heard a tone for an accident. Then I realized that none of the cars had flashing lights, so I turned up that way to see what was going on.

As I came closer, it became clear that an accident had just occurred. An SUV was in the middle of the road with front-end damage, and a sedan was up on an embankment. There was someone lying on the ground more-or-less under the sedan with another person standing over them.

I pulled over and grabbed my bags out of the back. I asked a bystander if 911 had been called; it had.

There was only the one obvious injured, so I went over to the sedan, dropped my bags, and gloved up. The victim was an elderly female. Her son, first on the scene but not in an accident vehicle, was holding a pillow over her head to block the sun. The victim was speaking to her son, so I knew that she had a patent airway and was breathing. I introduced myself and felt for a radial pulse. There was one, although weak and fast. There was some blood; I checked quickly for life-threatening bleeding but didn’t see any, although I did note a curious bubbling of the skin on the bit of her other forearm that I could see protruding from her sweatshirt sleeve.

Her son said she was having difficulty breathing and that he had just helped her with an inhaler. Her breathing seemed unlabored but I started her on oxygen both for the reported difficulty breathing as well as to counteract the effects of shock. I then checked the stability of her femurs and palpated her head and spine. All good.

That was the primary survey, to find and treat immediate threats to life. If you have none of those or have stabilized primary threats, you perform the secondary survey, which is finding, examining, and treating other injuries.

The car was on the bank above us. It smelled of gas and was still running. Before starting the secondary survey, I got up and went over to the car and switched it off.

When I first saw the funky bubbled skin on the patient’s forearm during the primary, I thought that I was going to have the opportunity to see an open fracture when I got to the secondary. Of course, I was thinking that in a detached, clinical way. I haven’t seen an open fracture, so it’s only a matter of time, right?

My limited EMS experience has taught me that skin hangs kind of oddly when it is not tensioned correctly. You can sort of glance at something and know that there is a serious injury nearby just by the way the skin bunches up. I’ve seen this several times at accidents… If someone looks like they’ve pasted chicken skin on, they’ve got some major laceration nearby.

I started the secondary on the opposite side, working down the right side and up the left. She had some superficial cuts to one shin; a little blood, but already clotted for the most part. After leaving the only obvious injury for last, I turned my attention to the patient’s forearm.

I started working her sweatshirt sleeve up and was shocked to see a gaping hole in her arm. I got my trauma shears out and cut her sweatshirt sleeve up to her shoulder, finding that her entire forearm had been ripped open from wrist to elbow. There were big chunks of flesh missing or displaced and I could clearly see her bone, her bone, through the gaps in several places. It didn’t look broken, exactly, but it wasn’t right.

While I worked, several police officers arrived and asked me for updates for the responding ambulance.

Her shirt had soaked into the wound in places and I had to pick it out as I cut. Globules of subcutaneous fat were stuck to the edges of the dramatic tear in the patient’s arm and into the nap of the fabric of the sweatshirt. I immediately thought of the autopsy.

I got out a big trauma pad and put it over the injury, then started to wrap the whole mess in a roll of gauze. I thought the woman was amazingly quiet given the shredded condition of her arm.

Around this time, the ambulance, part of the paid fire department in the large town where the accident occurred, came on the scene. One of the EMTs came over and started working my patient while the other talked to the noninjured driver of the other vehicle.

The EMT checked my work, then applied a pneumatic splint over the dressing. We collared and boarded the patient and moved her to the ambulance with the help of the other fire department EMT, the fire chief, and the woman’s son.

The EMTs were extremely professional and friendly to me through the entire scene. They proactively offered to replace my consumables, traded my oxygen cylinder, and gave me several extra trauma dressings as well. I guess they were happy with the quality of care I had been providing.

I was really pleased with the way the scene went, for the most part.

I went from thinking about work to thinking about medicine in no time; usually from tone to scene I have several minutes to mentally prepare.

I was happy with my attitude and stability, especially considering how rattled and discombobulated I felt at my last call, the near-choking ten days ago. I felt completely behind the curve on that call; thank goodness the patient was mostly okay by the time I arrrived.

I dealt really well with the injury. Obviously, it wasn’t my injury, so my issues are puny compared to those of the patient. Still, I had to look at it and treat it. It was the nastiest thing I’ve ever seen in real life. It makes me cringe to think about it now. Yuck. At the time, I was just like, ‘Wow, that’s not right’, seeing, but not internalizing, I guess. Very dispassionate. There’s a part of me that screams, but it’s quite muted.

One thing I did wrong; I should have stopped and put on my turnout gear before I went up to the car. Scene safety is the first priority. At least I had the presence of mind to turn off the car when I realized it was running.

I was late to the client’s. I had muddy knees.

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