October 2007


CIMG9834_CROP

Weathersfield, Vermont.  Click for larger size.

It had been a slow Sunday. Much of the day had been spent hanging around the station; chores done, nothing to do. Around lunch time, I called in our shift’s order to the local pizza place. After waiting for twenty minutes, Becks and I took the ambulance to go pick up our order; we take the ambulance when we run errands so we can respond immediately if something happens.

Just as we pulled out into the street from the barn, the radio spoke.

“Ambulance, stand by for tones”.

I pulled over. There was a 50/50 chance we were heading the right way.

We waited. After about fifteen seconds, the tones played. After the tones, the dispatcher came back on.

“Ambulance, please respond to 244 Cricket Lane for a five-month old child that has fallen on its head. Repeat, ambulance, please respond to 244 Cricket Lane for a five month old who has fallen on its head.”

Neither one of us was familiar with Cricket Lane; Becks pulled out the maps. I got on the radio and reported that we were responding.

Becks told me that Cricket Lane is off of Locust. I knew where Locust was; behind us.

I flipped on the lights and siren, looked about, then pulled a u-turn to head back up the street. We passed the station and continued up, took a left, and headed out of town.

Dispatch came on with more information. The infant had fallen from a bed onto a hardwood floor, cried briefly, gone to sleep, and could not be roused. The kid’s condition sounded bad; the circumstances sounded weird from a number of aspects. This was not going to be an easy call.

Our tension level increased. As I drove towards Locust, I focused on calm for myself and my crew. Kid calls are the worst for maintaining composure. Becks and I were already amped from the dispatch information; we needed to keep it together.

I radioed the hospital; they had been listening to our dispatch channel and were aware of what was going on; they would be standing by for an update.

We pulled onto Locust and then to Cricket. Between the two of us and the stress, we misremembered the address. We both thought it was 224. We pulled up in front of 224, called on-scene, and jumped out. Becks grabbed the first-in bag and we ran to the house. There were a number of people in yards watching us as we climbed the steps to the porch and knocked on the door.

No one answered. I tried the door; it was locked. We went around back; still no way in. I started to get suspicious that we were in the wrong place; I radioed dispatch from my portable to verify the address.

Dispatch corrected us. We ran back to the ambulance and jumped in, roared up the street. A man was waiting on the street for us; we couldn’t see him before because of a slight hill.

We signed off on location for the second time. We got out and followed the man into an apartment building and up the stairs.

On the way, the man said that the kid, a boy, was his stepson. His daughter had been watching the baby on a bed; the girl had got up to change a DVD and the kidlet had rolled over and off the bed. The baby had gone to sleep very quickly and they couldn’t wake the kid up.

We got upstairs and into the room with the baby. The ten-year-old daughter sat on the bed, looking nervous. The kid was in a swing-seat. As I approached the baby, I could see that he appeared asleep. I could see the big red mark on the left temporal area where the kid hit the floor. The kid was in a onesie; he appeared clean and cared for. There were no other visible marks on the kid. Between the environment, the kid’s physical appearance, and dad’s earnest and open demeanor, I was immediately less concerned about this being an abuse case.

Still; the kid didn’t look good. He was pale and not moving.

Before I touched the kid, I clarified with dad that the mark was where the kid had hit the floor. It was. I asked for the kid’s name; Fred.

I tried speaking to the kid first.

“Fred, yo, Fred! Yo, wake up!”

Nothing.

Using two fingers, I rubbed on Freddie’s sternum.

“Yo! Freddie! Wake up!”

Still nothing.

I warned the dad and daughter that I was going to try to elicit a painful response. They nodded.

I pinched Fred’s big toe, then the sole of his foot while I yelled his name at his face from eight inches away.

Nothing.

This was looking bad.

I took Freddie’s tiny fragile head in my giant clumsy paws and felt his skull. I could feel the fontanel; it did not seem to be depressed. The bony parts appeared to be intact. This was all good but still nothing to rule out a closed head injury.

Freddie didn’t resist my pawing at his head.

I asked Becks to see if she could take vitals while I went to call the hospital. She got to work while I stepped into the next room, away from the family members. The hospital ED is on my speed dial; in moments I had the PA on duty on the phone.

I explained my findings and stated that we had not yet quantified vitals. The PA asked me about breathing and airway; I reiterated that we had not yet gotten numbers but that the child did not appear to be in respiratory distress.

The PA recommended that we take the child directly to the regional trauma center. I was not pleased; the trauma center is 22.5 miles away while the local hospital is two miles away. I could not disagree with the PA’s reasoning, though; the hospital could do a cat scan but would have to send the child to the trauma center for treatment in any event; taking the kid to the local hospital would delay definitive care. The trauma center has a pediatric trauma team on call in the hospital; they would be able to start dealing with the issues right away. The kid had to go to the trauma center and for the best outcome, Becks and I would have to take him direct.

It was a recommendation, though; the PA did not tell me what to do. We could bring the kid in to the local ED if we wanted to.

On many calls a long transport is okay; there are quite a few things that the prehospital practitioner can do to directly aid the patient or to prepare the patient for the waiting trauma team. Little tiny kids are very specialized, though; there’s not much a basic or intermediate crew can do but drive faster.

I went back to the other room. Becks had numbers for heart rate and respiration; they were fine. I squeezed the little guy’s fingers to assess cap refill; that looked good, too. So we had no excuse not to drive him all the way to Regional. I told Becks and the family that we were going to the regional trauma center.

Dad was on the phone with mom. I told him we were leaving immediately; he told mom that we were going to Regional and rung off. Mom was working near Regional and would meet us there. He went outside and asked a neighbor to look after his daughter.

My plan was to scoop and run; I’d carry the kid to the rig, we’d go. Becks gathered up the first-in gear while I poked more at Freddie; then I picked up the kid, put him against my chest and over my shoulder and made for the door.

As soon as the kid hit my shoulder, he woke up. He cried for about three seconds and then was quiet. I looked over and saw him looking at me, sleepily, quizzically.

Becks and I looked at each other. All of a sudden, this was a different call. Maybe the kid was just a heavy sleeper. Certainly, the fact that the kid was now awake and making noise made this much less serious.

We got in back and changed the airway seat over to a kid seat. I strapped Freddie in; he was alert and watching me and the environment. We asked dad to get in back with me, Becks got in front and we took off. I sat on the head of the cot, facing Freddie from about two feet away.

Freddie had a grand ride; he looked around and checked everything out. Now that he was awake, he was very interested in everything. He was very compliant with my poking and assessing; he was even patient with the blood pressure cuff even though it seemed to be uncomfortable for him.

I thought about giving Freddie a stuffed animal from our supply but decided against it; I figured he was too young to appreciate it. I did wipe down a stethoscope with alcohol and gave it to him to play with; he hung onto it and waved it around.

Freddie frequently smiled and laughed; the bumpy suspension seemed to give him great pleasure. Freddie, dad, and I enjoyed the ride.

I patched to the regional center and told them that we were enroute, gave them the current situation. After a while, we arrived at the hospital. I waited until dad got out of the rig then handed Freddie down to dad to carry; as much as I was enjoying the little guy, I felt that he would be more comfortable with dad and that dad would be more comfortable with Freddie.

We left the cot in the rig and walked in. Mom was already at the ED; she was visibly relieved to see an alert Freddie on dad’s shoulder. We were given a room assignment, went in, and transferred care. We said goodbye to mom and dad and waved to Freddie.

Everyone was happy; an excellent outcome.

We drove back to town and picked up lunch at the pizza place on the way back to the barn; the food had been ready for an hour and a half. Lunch was soggy but delicious.

It was my turn to crawl.

The school store was in the basement of the administration building. In addition to containing much of the administration, the building also housed the library and a male dormitory. It was my dorm, in fact; my room made for a convenient staging place.

The store had very limited hours; it was open forty-five minutes or so after dinner several nights a week. The store sold various things; text books, toiletries, candy, batteries, typewriter ribbons. Overall, it offered a meager selection.

The store was run on a volunteer basis by students with a faculty advisor overseeing things. It was cashless; one’s parents sent a check to the school and the balance was applied to the account on a scheduled basis.

A warren of corridors and stair cases separated my second-floor room from the basement store. Part of the route went through dorm spaces; part went through common areas of the school.

In a foyer between the administration offices, the dorm stairwell, and a building entrance door was a solid wood door. This door lead down a flight of stairs to the basement. This door was always kept locked except when the store was open.

When the store was open, the door would be unlocked. I’d go through the door and down the stairs, following the curve to the left. The staircase opened into the basement. The basement had been a recreation hall and a fallout shelter at some point in the distant past; now, much of the large open basement was sealed off with solid plywood walls. The space remaining was a twelve-foot-wide room running to the left and the right for the length of the building. To the left was another door, leading to the store. The store was located in a chamber with cinderblock walls; the deepest part of the fallout shelter, apparently. This door was separately locked when the store was closed.

Down the basement to the right were a soda machine and two doors. One door lead to the outside; the other lead to a windowless utility room. The utility room was kept locked and housed cases of sodas for the machine.

On the other side of the plywood partitions blocking the basement could be found an old pool table, lots of boxes of ancient school records, and some really old yearbooks. Dust was everywhere; the room beyond the partition hadn’t been opened in years. In fact, the administration had no key to the sturdy partition door. This partitioned room contained the only windows in the basement; two twenty-four by twelve inch glass panels set about six feet up the basement wall that opened just at ground level on the back of the building.

Frankie had the only key to this room. When Frankie was a freshman, he’d become friends with a bunch of seniors. When they graduated, they’d given Frankie an incredibly valuable artifact; an item so exclusive that it wasn’t even hinted at in school tradition even though it had been handed down for decades. I mean, even freshmen knew of the existence of the senior fort; a sophomore might know the general area. But no one knew about the Answers.

The Answers were a set of keys to the school. The set was incomplete; most buildings were represented although there were no keys to new locks. The set was apparently a full set of keys to the school at the time it was originally swiped. There were some oddball extras; a key to the town hall, for example. The details of how and when the Answers came into student hands were lost to time.

The Answers were so sensitive that we would not consider referring to them as ‘keys’. Only by name; the Answers. Only three people knew about the Answers during my three years there; only Frankie and myself for the first two years.

One of the Answers fit the door to the basement partition; this was apparently the only existing key. Frankie and I had explored the room beyond the partition during several of our nocturnal excursions. We relished the fact that only we had access and the school staff did not.

We did not have the Answer for the door to the school store in the basement. We did have Answers for the door at the top of the stairs and for the door to the utility room.

A full set of keys was kept in the dean of student’s office. If we really needed a particular key, we’d let ourselves into the dean’s office and get the key, returning it later. We tried to avoid this, though; getting into the dean’s office was a risky proposition given that it was located in a high-traffic area and that the dean had a propensity for being out and about at all hours of the day and night. We avoided this on all but the most desperate of occasions.

We had the Answer for the utility room, though. This was valuable to us in and of itself; we had access to the stores of soda. The room’s true importance was found in the back of the windowless room; a two-foot plywood square affixed to the concrete wall. Pulling back the plywood revealed a hole in the concrete wall leading to a utility tunnel. This small tunnel was filled with conduit, water and steam pipes, decades of trash, and darkness. The tunnel lead about thirty feet to another opening, this one uncovered and behind a bookshelf in the school store.

During the day, one of us would wait outside the door at the top of the stairs as a lookout; the other would crawl. We’d use the Answer inside the door to lock the lookout out of the basement in the hallway. At night, the lookout would come into the basement; one could not be seen after curfew. Depending on the time of day, one or both of us would go down to the basement; the crawler would go into the utility room and go in, locking the door behind him. The crawler would pull back the plywood and go into the hole feet-first to avoid having to turn around in the tunnel. Then he’d crawl.

Crawling was the worst part. Even with a flashlight, the confined space was scary. The crawler would try not to think about rats.

At the end of the tunnel, he’d have to negotiate the bookshelf. This meant slipping between shelves, between stacks of supplies, and out onto the floor without making a huge mess.

The door to the store had a latch on the inside so the crawler would unlock the door if it were nighttime. At night, the lookout would be waiting outside the door in the basement; together we’d secure the booty; two Snickers bars. The crawler would then lock the lookout out of the store and the process would be reversed; back into the hole, this time head-first, out into the utility room and into the basement, then up the stairs. We’d listen closely at the door; it opened into a heavily used corridor between the offices and the outside.

If it was daytime, the crawler would directly grab the goods and reverse the process, going back through the hole and up to the top of the stairs by himself. This was a lonely business; from the time the lookout was locked out at the top of the stairs until the crawler’s safe return to the hallway, the crawler was alone. The crawler would insert the Answer and signal the lookout; the lookout would then wait until the coast was clear, then knock. The crawler would unlock the door from the inside, step out, relock the door from the outside, then pocket the Answers. During the day, we were safe. At night, we’d have to silently return to my room through the building, avoiding any faculty members that might be patrolling or strolling.

Of course, if we’d been caught at our game, we’d likely have been expelled. A lot of unexplainable nonsense went on courtesy of the Answers. Many things would become clear if the existence of the Answers became known to the faculty. The student or students caught with the Answers would have a lot to answer for.

The hole was the scariest part, day or night.

Frankie and I had returned from skiing one winter afternoon on a Friday. It was snowing; a heavy, wet blanket. We had recreational things to do after dinner; we decided a Snickers would be the right thing to get us started.

Frankie and I were about the same age though he was a junior and I was a sophomore. I was on the five-year plan having flunked my first freshman year at some other school downstate. Frankie and I didn’t always get along but we held similar values in many respects. We’d met early the previous year; my first year at the school, his second. All in all, we spent a lot of time together.

We left my room and headed downstairs. It was my turn to crawl so I locked Frankie out and headed down to the hole. I crawled through, grabbed the candy, and crawled back. I got to the door at the top of the stairs and was just getting ready to insert the Answer into the lock when I heard voices outside. I heard Frankie talking to the student that ran the store and the faculty advisor. In a flash, it became clear that they had decided to go to the store before dinner for some reason.

I was in big trouble. I had already landed myself in some silly disciplinary situation this semester over drinking beer on a public bus from New York to school; I had narrowly avoided suspension. If I got caught in the basement with the Answers, I was gone. Gone.

My parents had handled my flunking out of that other school with a certain stoicism. My parents had dealt with my near-suspension calmly. If I got kicked out, though, my parents would be quite upset with me.

I knew the advisor; it was a small school. Anyway, he had been my dorm master in a small dorm the previous year. If he caught a glance of me, I was done for.

I turned and fled down the stairs. I suppose I was hasty; I made a lot of noise. I heard the faculty advisor shout and the jangling of keys. I got to the bottom of the stairs and took stock. The door leading to the outside from the basement opened into a very public courtyard; there was sure to be people coming and going in the late afternoon. Going that way was not an option.

I ran to the partition door and found the Answer I needed; as it turned in the lock I could hear the key turning at the top of the stairs. I ran inside and closed the door behind me; the lock couldn’t be secured from my side.

I could hear running feet on the stairs. I leapt across the room and threw a dirty overstuffed chair up against the wall under one of the windows. Jumping up on the chair, I opened the window and hurled myself up and out through the opening. In my terror, I managed to wriggle through and out into the snow and darkness in a trifle. Once clear, I rolled to the side away from the window through the snow-covered pachysandra leaving me sprawled on my back in the wet plants and dirt outside the building. I was covered head to toe in snow and mud but I was outside and safe for the moment.

I got up and moved stealthily around the corner of the building and through the dorm’s smoking porch. Surprisingly there was no one outside enjoying the legal vice so I was able to sneak unnoticed up the back stairs and down the hall to my room. I quickly hid the candy and shed my filthy clothes, burying them in my laundry bag. I put the Answers in my most secret place.

I grabbed my towel and soap, ran down to the bathroom, and got in the shower. Once under the spray, I started to relax; I hadn’t seen anyone since leaving the basement so I thought I might be okay.

I got back to my room and Frankie was there. He congratulated me on my escape; he thought I was a goner. Frankie had played helpful student and had gone downstairs with the advisor and the student in charge of the store to ‘help’ them catch me. The advisor hadn’t suspected, of course; we were deep underground in those early years.

The administration now had access to the room beyond the partition but it had taken the advisor crucial moments to discover the unlocked door. It was a fine trade.

I happily returned the Answers to Frankie. We enjoyed our Snickers bars and looked forward to the rest of the evening’s entertainments.

(fiction)

After a quiet day, we were toned to a difficulty breathing call on the outskirts of town.

Becks and I got in the rig and headed out into the driving rain, lights and sirens. We reached the turnoff and headed up a rough dirt road towards the call address. The road was one big washboard and the ambulance bounced from bump to bump up the hill. The road became narrow and finally ended in what looked to be a junkyard. Looking carefully we realized that the road had turned into a driveway leading to a yard cluttered with debris. Ten or fifteen discarded water heaters were identifiable; other piles of metal and scrap were less recognizable. I realized that we would not be able to turn around in the dooryard so I backed down the hill to the previous house, turned around in the driveway, and backed up the hill as far as I dared. I could tell that access was going to be challenging.

Becks grabbed the first-in bag and we headed towards the dilapidated house. It took a minute to figure out where the door was; another minute to pick a path through the maze of scrap metal to the door. The door was at the top of a flight of rickety steps; a thin man with the largest mustache I have ever seen stood at the top of the steps.

“What’s going on?” I asked the man.

“It’s not me; it’s him. He’s inside,” the man responded.

My partner and I walked up the rotting wood steps. The steps bounced under our weight. I thought about getting a patient out of the house and through the maze. Becks and I had a fighting chance of dealing with this ourselves if the patient was small.

We got to the top and went inside. The interior of the house was a mess with stacks of boxes, rotting garbage, and papers on every surface. We passed numerous rat traps; one was on the kitchen table.

“He’s in there, at the far corner,” the mustachioed man said.

We made our way through the kitchen and around a partition. A large, seemingly naked man sat on a chair. From across the room we could tell that he was having a bad time. The man looked like a grimy Buddha. He had a nasal canula; home oxygen. He was surrounded by papers and trash.

“What’s going on?” I asked. The man did not answer.

“He’s having a hard time breathing.” I looked around; a woman sat nearby. Although I had walked right by the tired-looking woman, I hadn’t noticed her for all of the disarray.

The woman explained that the man was a COPDer and that his difficulty breathing had been coming on over that last two days. I asked how much oxygen the man was on; he grunted that he was on three liters per minute. I asked about other medical problems; they initially denied any other problems.

It was clear that the patient was going to be transported and that Becks and I were not going to do it by ourselves. I asked Becks to start the assessment and stepped outside to call dispatch. I asked dispatch to tone the station for more assistance. I went back inside and gathered history from the woman while Becks continued the assessment.

I didn’t like the way the guy looked. He was tachycardic, hypertensive, sweaty, pale. He was clearly anxious. In addition to the difficulty breathing, he was complaining of chest pain that he described as 7/10. I was starting to get the impression that this was more cardiac than respiratory. I went outside and called the hospital to let them know that we had a serious case that was going to take time to transport; then I went to the rig and grabbed the monitor. The rain had let up though it was still drizzling. As I started back inside, Ambulance Two pulled up.

The guy’s state of undress made it easier to hook him up to the monitor. I realized that the patient was not naked; he was wearing shorts though his body covered most of the fabric. The rhythm looked pretty crappy; tachy and irregular.

Greenie and one of the twins came in; they had arrived in A2. Greenie is much senior to me but apparently felt I had things under control; he went back outside and started to clear a path to the ambulance. The twin went to get the stairchair. I was growing concerned that the guy was going to code before we got him out and I wanted vascular access; I set about installing a saline lock. After I popped the catheter into the guy’s arm, I drew four tubes of blood for analysis at the hospital.

The twin and I got the guy onto the stairchair; luckily the patient was able to stand and pivot for us. Everything was complicated by the extreme clutter. I didn’t want to touch anything.

We got the guy into the chair and started towards the door; the twin pushing, me pulling. We had to stop every few feet so that I could rearrange the clutter to allow passage of the chair. As we neared the door, I noticed an electrical panel for the first time; the household breaker panel was open and multiple extension cords lead into the box, spliced right into the breakers. Lots of exposed copper wires ran back and forth inside the box. The layout of the house was such that we had to squeeze within about three inches of the exposed wiring to get the chair outside.

We got out and onto the steps. Greenie had finished clearing a path and came over to help guide us down the stairs. The stairs were shallow enough that we could not use the handy stair-descending treads on the chair; we had to carry it down. I pointedly ignored the thought of going through the steps with the large man and the stairchair; Becks later said that she saw the step under the twin sagging under the combined weight of the patient and the twin and was concerned that the stairs would collapse. We all breathed a sigh of relief when we got off the steps and into the maze. We got the patient to the driveway without too much difficulty and transferred him to the cot, then into the ambulance. Becks and I got in back; the twin got in front.

We left immediately for the hospital. Along the way, I gave the patient nitro and aspirin; I considered a neb but decided against it due to the tachycardia.

The patient became much less apprehensive as soon as we arrived at the hospital. We gave what history we had to the ED staff; the patient remembered some other pertinent medical history; CHF, diabetes, a laundry list of medications. I helped the staff get the patient started while Becks and the twin dealt with the cot and the rig.

As I went to leave the room, the man stopped me. He had been very terse and withdrawn on scene; he was much more relaxed and friendly now.

“Thank you very much for your help,” the man said. “I really appreciate it.”

“Any time, sir, glad to help.”

“I’m really sorry about the mess.”

“That’s okay, sir, I know you weren’t expecting company.”

The patient seemed happy with that response.

Becks, the twin, and I drove back to the station.