College Girl

She'd be cute, attractive even, if she wasn't sitting in a pool of her own urine. Her mouth is crusted with blood and we can see that a few of her teeth have snapped off at the gums.
"This is Kelly," A JWU cop tells my partner and I.
I squat down to get at eye level in the dark little hallway of an aging residence hall,Ryan (my partner for the evening) starts to get our bag opened and I wave him off. This girl is clearly in rough shape and I dont want to be playing around in the hallway. "Kelly, we're going to get you on the stretcher. Can you stand?" She makes some kind of a noise and I gesture to Ryan to get her other arm and we bodily lift her and unceremoniously plop her back down onto the sled.
"Her friends say she drank vodka and took a bunch of percosets." Another JWU cop tells us. I ask if he has the bottles and he says. "No, you need em?"
"It'd be nice."
He gets on his radio and sends two other officers to make entry into her apartment and grab all the pill bottles, hers or her roommates that they find.
We take a rickety elevator down to the first floor where our bus is parked and hustle her inside. I get a set of baseline vitals. BP 100/Palp, pulse 100 and thready, pupils like saucers , resperations erratic anywhere from 12 to 26 over the course of several minutes. On the monitor shes in a weird sinus arrhtymia, occasional PVCs but the pulse matches the monitor rate. Ryan's going for a 20guage in her right hand, for some reason he's shaking. As a Cardiac Rescue Tech, he's technically higher than me, even though I am waiting for my paper work that says I am officially a medic.
He goes in and gets flash with ease but then he starts to withdraw the needle before he's got the cath seated, the small teflon tube on the end of the hub starts kinking and her hand starts to swell up.
"The fuck you doin?" I whisper.
"I'll get it," he sounds upset.
"Dude, pull it out, heres some gauze." He pops the line out and I tell him to move over. Right next to his little hari kari of her hand I find a vein big enough to support a 16 and drop one in. We start running in some fluid which seems to perk her up a bit. We debate Narcan but with all the facial trauma, the inside of her lip was slashed by her teeth and the possibility of one or more teeth being loose and becoming an airway obstruction requiring intubation we decide to forgo it. Too much narcan on board would make it difficult to knock her down and kepp her that way should the need arise.
Before I head up front to drive I ask her. "What'd you take?"
Shes a bit more coherent now and manages to spit out the words. "Bottle and a half of Vodka and a handfull of perks."
I ask the standard question. "Were you trying to hurt yourself?"
She becomes indignant and glares at me while slurring. "NO! I was trying to get fucked up!"
I nod. "It worked."

Burning Flight

"What's coming in?" I ask the charge nurse, an older guy named Paul.
"Hrmm? Pediatric burn victim. Face and hands." He's clearly preoccupied as we rush to clear out the trauma room and set up a burn dressing kit.
Confused I ask. "They couldn't get through over C Med?" Paul had just gotten off the phone.
"Not an ambulance, kid's father's bringing him in."
I nod as I prep a laryngoscope and a few pedi tubes. Burns are tough to intubate as is but if it should close up the airway is gone and you have to cut your patient. Cutting is never the preferred option and its especially unpopular when the patient is a burn victim because of all of the scarring and partially charred flesh that could always flake off and occlude an airway.
We break out tubs of sterile water, sterile dressings cool packs and a ton of fluids for IV infusion. Luckily one of the docs, Rifino is a former flight physician for Worcester's UMASS Lifeflight, a sort of flying ambulance staffed by a doc, a nurse and usually an EMT or paramedic in addition to a pilot. He's on his personal cell phone running around the code room talking to the Lifeflight dispatcher, pulling ranking and calling in favors to get us a bird. As it stands the on duty crew is about an hour out, doing a critical care transfer from Metheun Hospital to the Brigham in Boston.
As I spike a bag of Lactated Ringers I listen to him cajole and work his magic. "Look, Charlene its Jimmy. Yeah the doc from the bird way back in the day. Listen, you know me, I don't wanna tie up a bird with bullshit. I need a crew here, we have a pedi burn coming in......I know he's not here yet but I'm not gonna play games and.....No, I want to stabilize him here and fly him to Shriners...........Face and head thats why. Yeah, two hours? Not gonna cut it. I got no problem calling Boston Medflight and I mean, shit, we're nice and close to Hartford. Well put a rush on this. I appreciate it....thanks." And like that we have a bird in bound after it's transfer run.
When the father finally got to the ED it was thankfully, anti climactic. The kid was in a bad way, eight years old and his entire face is covered in blisters but he can breath with no difficulty and his lungs are clear and equal. His scalp is pretty singed and as I am applying sterile dressings I take to kidding with him, telling about Kojack.
For the rest of the night he is known as Kojack. Once we establish that his airway is infact patent, remarkably its devoid of burns, he's allowed to suck on ice chips. Starting an IV on him was a bitch, his arms were all moosh from the flames. We ended up starting an IO, a needle litterally drilled into his tibia.
While I am cutting off his charred close, I catch a wicked whiff of gasoline. "Hey Kojack," I ask while Paul the trauma nurse rolls his eyes and Rifino kicks all non essentials out of the room. "How did all this happen?"
His voice is clear, another good sign as any kind of hoarseness would be indicative of airway burns. "We were having a bonfire. I threw a can of gas on it and it exploded."
"Oh, shit man thats awful." I say and continue. "You're too young but when my father and I burn stuff in the back yard we like to have some beers. Tell ya what," I pop another bag of ringers into the now empty line. "When you're old enough you come by my father's place, we'll all have a few and I'll show you the right way to have a fire." He laughes and I have an unsettling flashback to the pedi code I worked earlier, silently hoping that he stays as stable as he is.
Burn patients, especially pediatrics, can decompensate really fast. The body can lose a lot of fluid through the wounds, they can go hypothermic and thus sour very quickly. While its important to cool the burns, the body temperature can be dropped as well which can lead to very untoward consequences.
The radio in my back pocket, a cheapo little two way that all in house paramedic techs have to wear, starts to come to life. "Be advised we have lights in the sky." Its one of the hospital police officers out in the parking lot referring to the incoming bird.
I snort through my nose and turn to Rifino. "That was quick." He grins and says its nice to have connections.
Kojack starts to get nervous so I ask. "Whats up, bud?"
He says hes never been in a helicopter before and that hes scared. "O don't worry, these guys are pros. They fly all over the place. Hey, doc," I call over to Rifino. "Our little buddy here is nervous, come over and tell him about how you used to fly and all that." Rifino comes over and starts telling the kid all about the chopper and about what to expect while I explain to the father that because of the burns and the potential for badness, we are going to medevac his son to Boston. Numbly, clearly drained, he agrees and asks if he can fly too. "Dunno, gonna have to ask the flight crew." I tell him as my radio chirps out that the bird has landed.
Two guys in flight suits and an incredibly tiny woman end up coming into the trauma room. The flight nurse is a guy with a graying beard and a MiniMaglite with the LED replacement bulb that I had wanted to buy but had been to cheap to. They check the kid out, take report and tell the father that he can fly with them.
The cool night air, tinged with moist fog feels good as we push our little patient out to the helicopter. The pilot who moonlights as a firefighter paramedic shows me how they revamped the back end of the chopper to allow us to go closer to the tail rotor than before. I jokingly hand the father a plastic bag and tell him. "If you feel the urge to purge, there's two very important places not to do it. One is on your son because he is very suseptible to infection." On cue the pilot chimes in "And the second is on me because I will kick your ass out of my bird regardless of height." The father stares dumbly for a minute then laughes and tells us we are a bunch of clowns.
We retreat to a comfortable distance as the bird takes off and I see a Worcester medic truck with lights going screaming down the boulevard. My radio blares, vibrating against my ass. "Available tech on the air?" Rolling my eyes I key the unit and tell them I am available. "Good, get in here and prep for a possible MI."
A myocardial infarction, our goal is to get any MI patients upstairs to the cath lab within thrity minutes. My personal goal is under ten. Soon after a foley, a 12 lead and a couple of nitros, some morphine and an elevator ride Worcester's enormously fat patient who was indeed having an MI is on the table at the cath lab.
"No mas," I tell the charge nurse. "I'm going on break, I need a sandwich."

Coping?

On the back of my ID for the ambulance is a small sticker with the name, date of birth and date of treatment for a three month old girl named Gwen. Worcester EMS brought her in asystolic on the monitor, two Worcester firefighters doing CPR on her tiny body. A tube smaller in diameter than a drinking straw had been gingerally inserted down her trachea and a tiny bag valve unit was being used to pump breaths of air into her lungs.
I had two pairs of gloves on, I always do when I work a code or any "real" emergency for that matter. I remember watching the lights from the Worcester medic truck as it backed up into the ambulance bay, throwing flashes of red and yellow about the code room. Vaguely the voice of Dr. Diaz telling us not to get excited and that this was like any other code comes back to me.
Her eyes were the worst part, tiny pale blue orbs that looked up at me while I used my thumbs to do compressions. Trying to block out the fact that she's a cute little baby (really a beautiful little child) I stare at the wink and wiggle my compressions are making on the monitor. A resident, blond hair and strangely eyes of the same color takes a laryngoscope and opens the young patient's mouth to make sure tube placement was correct.
At the back of the room a WEMS medic says. "We gave her an amp in the truck, we did the whole algo with her....." His voice trails off and I feel wetness on my face. The respitory tech took over bagging from a Worcester fireman, he stands dumbly off to the side, unable to move until a nurse gently guides him a way to the back of the room.
"Can you close her eyes." My voice doesnt sound like my own, coming from somewhere else. I keep pressing my thumbs, hands almost cramping. "Please close her eyes," I ask the respitory lady again.
Her voice is small, shaking. "I tried, they won't stay closed." I feel my head nodding vigorously as my cheeks burn. The monitor still shows that weird unnatural EKG that CPR produces. Biting my lip I keep staring at that monitor, trying not to do what I'm doing.
"Nick," one of the nurses, a normally fun woman with cute little square glasses asks me "are you okay? Need to switch?" I can't talk so I just shake my head. I'm fine, I can take it.
Diaz comes back into the room and asks the Worcester crew to leave. Reluctantly they leave, a firefighter coming over one last time to look down at the little victim of whatever ended her life so early.
"All right guys," Tavi, Diaz's nickname, starts off. "Family's here. Keep doing compressions and make it look like we're doing something. It'll help them cope. Worcester says that shes been down for 25 minutes now." I bite my lip harder, pinch my eyes shut for a minute and then force them open to check the monitor.
When I hear her voice its quiet, tinged with the weight of whats going on. "Nick, you should leave the room."
"Why, what'd I do wrong?"
"No, honey, nothing. You didn't do anything wrong. You're crying." Shes pretty close to crying too and indeed a minute after I leave, she does too. When I strip off my gloves I just barely choke out an apology to the code team, a team that has already dwindled as people had to leave the room from the pain. "Don't be sorry." Tavi calls out, "Don't ever be sorry for your actions here today." Nodding I leave the room, feeling the tears streaming down my face as I scramble through the packed ED, practically running out in to the EMS bays.
The Worcester crew is still there and a medic wordlessly hands me a cigarette as the five of us sit there in silence. Its freezing out, one of those Worcester fall nights where it feels like it could snow but I dont realize how cold it is until another tech comes out and hugs me, tears coming down her face too.
"Em, I'm sorry I left you in there....." Her grip is like a vice, too strong for a girl her size.
"Don't be sorry. It means you have a heart, thats why you do your job. Its why we do this." One of the Worcester guys, I couldn't tell if it was a medic or a fireman is sobbing too, his budy propping him up.
I go off to the other side of the bays, behind the big decon trailer that we keep there and make a few phone calls. I call my girlfriend, a vet tech at a 24 hour emergency center out on the Cape and leave a message asking if I can see her the next day. I call my dad and tell him what happened, leaving out the details about how the baby looked.
The next day my phone rings at nine am. Its the employee services office asking me to come into a voluntary stress debriefing later in the day. Groggily I promise to think about it then promptly turn off the phone and think about how the little bundle seemed so heavy on the walk down to the morgue the night before. I think about the detective who came in, how for some odd reason all I could think upon meeting him was "God I want that fleece." He had a really nice black Northface fleece.
When Mandy comes down, we sit on the back porch as she smokes one of her cigarettes, I tell her about how I couldn't sleep without seeing that little girl's face the night before. I show her the little sticker on the back of my ID that I don't remember putting there. Then we go down to O'Rourke's, a local Irish pub where I have my own seat and the bartender proudly proclaims that her establishment is the "Future owner of Nick's pension and liver." I'm kind of a regular there and when we sit down the digital TVs, brand new additions to the Irish eatery, fizzle out and die.
"This would never happen at Applebees." I tell Cora, the Irish lilting bartender. We laugh and I start in on my steak and cheese, Mandy enjoying her first Sam Adams Winter Lager ever. And for those two hours, a trip to O'Rourke's is never less than two hours, I forget about Gwen and the hell of the night before.
But now, almost a week later, I can't sleep or even close my eyes without seeing her own, tiny and oddly beautiful as they stared up at me. It was like she could see us, her little curious eyes watching everymove we made like a living baby, with that "everything is new" glaze of discovery still hauntingly there. I hope the new place where she is now, where ever it is that she went, is better than where she left.