I heard a formal announcement that included my name and the large wooden doors swung open.  A judge, several court employees, some attorneys, a full jury, and about a dozen onlookers were all watching my entrance very carefully.  At this point in my life I had quite a lot of experience with public speaking through teaching.  So I was no stranger to walking into a crowded room and having to perform.  But this was different.  A lot of tax money had been spent, and a lot of people who are far above my pay grade were all waiting for me to say the right things.  I was attacked by a sudden sense of insignificance.  However, I sensed that the court was getting tired of me standing in the doorway looking sheepish, so I willed myself to walk towards the witness stand.

Just like on TV there was a lot of wood in this courtroom.  There was an aging bailiff, and a moody looking judge.  As I walked down the aisle I tried to catch a glimpse of the patient, but to be honest I could not pick her out.  The front tables and rows of seats were filled with women in business suits.  She must have been one of them.  The call had occurred three years previously so I had no recollection of what she looked like.  Someone in a suit ushered me up some steps to a witness stand that felt like a high perched crow’s nest once I was seated inside.

A couple of people asked me if I was comfortable, and then someone came by to swear me in.  There was no bible to put my hand on like you see in the movies.  I was just told to raise my right hand and swear to tell the truth.  I went through the ritual and had a seat.  The attorney I had talked to previously started out with a couple of pleasantries and then asked the usual set of baseline questions to establish my identity to the jury.  Then the real questions began.

“Could you tell us about the events that occurred when you responded to the motor vehicle collision involving the plaintiff?”

***

This wreck happened on one of the most dangerous stretches of road in Louisville.  Ask most EMS professionals about “the curve” on _________ road and they will have three or four stories to tell.  I must have run about a dozen wrecks on this very spot, but this one was the worst I can remember.

A tiny little sedan had been crushed head-on by a semi that slipped out of it’s lane in the rain.  The woman trapped inside was barely identifiable.  She was covered in blood.  We were out looking for lunch when the call came in.  We were only about a mile away, and we got there fast.  When I walked up to her car door she was breathing agonally.  She was unconscious.

“Crap!” I shouted behind me to my partner, “This is bad.  We are actually going to have to work.  Put together a BVM would you?”  The doors to the car wouldn’t open.  It was crushed on all sides.  However, all of the windows had been broken out so while I was fastening the chin strap to my helmet I broke what was left of the glass out of the window frame of the door behind the driver’s seat.  I grabbed my intubation kit and squeezed through the window.

A fireman’s head appeared through her window.

“Oh cool, grab some c-spine and hold her head still would you?”  I didn’t recognize him, but I figured he knew what to do and I was busy.  A quick glance told me he was doing all right so I began putting my tube together.  I took a quick look around for dangers or blood pouring out of an open wound.  Her leg was obviously broken but the bleeding didn’t look that bad.  So I just decided to secure the airway and proceed from there.  My partner had arrived with a BVM and was now attempting to squeeze a few breaths in, maneuvering around the other fireman holding her neck.

I was having trouble trying to find a place to put my feet.  I was twisted up in the back seat on my knees and starting to regret it.  Broken glass was making its presence known under the pressure of my knees on the seat.  I tried to ignore this as I lubed up the tube.

“Alright man, pull back and let me get her.”

My partner pulled the bag away while the other fireman remained, holding her head in place.  I stretched around the head rest to look at her face.  I saw her take a short sharp breath.  I placed the tube in her nose, twisted past the turbinates, and waited.

“What are you waiting for?”  The fireman holding her head must not have seen many nasal intubations.

She took another breath.

“For that,” I said as I used her intake of air to seat the tube in her trachea.  There was that instant cough-in-a-tin-can sound that let me know I was in the right place.

“Hey,” my partner exclaimed, “that was pretty fast for a cranky old man.  What do you know!”  He reapplied the BVM to the new tube while I tied it off.

“Hey!” I shouted at my partner to get his attention and make him look at me.  Then I silently mouthed the words, “Cause I’m a bad mother fucker!”

He laughed and the other fireman rolled his eyes.

By this time I could hear the unmistakable sound of the cutting tool compressor firing up.  Those little engines always make a funny sound like someone is trying to ring a bell in a muffled box.  A collar was being placed around her neck while someone asked me if I wanted to get out.

“Nope!” I shouted, “I still have stuff to do.  Can you get me a tarp or a blanket to cover us up?”

A blanket appeared in the window next to me and before long the patient and I were under our own personal little tent.  My partner had arranged it so that the bag was on the outside of the blanket so he could breathe for her.  He had also taken over c-spine by using his free hand to pin her collar and head against the head rest.  But under the blanket I was all alone with the unconscious girl.  I could hear the popping metal and glass all around me as they cut through the car, but I tried to focus on doing an assessment without grinding my knees into broken glass.

A second look at her legs revealed that her left one was completely shattered in several places.  Her ankle was folded inward and I could see what I thought was the bottom of her heel even though I was look down at it from above.  The other leg actually had more blood on it but seemed to be intact.  I couldn’t detect any broken ribs or paradoxical movement in her chest.  There was no way I was going to be able to hear breath sounds with all that racket but it was obvious that she was ventilating well.  My partner had already tried to help by shoving a pulse ox under the blanket.  She was riding high at 100% so I decided to stop worrying about the airway for the time being.  She had a radial pulse so I was assuming that she had a systolic of at least 80.

Without being able to access much of anything else I decided to spend some of the time I had under the blanket with her to get an IV.  I grabbed a setup from my kit and leaned farther over the front seat.  I had a really good view, but everything was upside down.  I craned my wrist back towards me and made do.  Before long I had a sixteen gauge taped off in her right AC. 

Then I heard the characteristic cracks and pops of the roof coming off the car.  I felt a few drops of rain fall on my back.  I wiggled out from under the blanket to find myself outside and standing up straight through where the roof used to be..

“Tada!” said my partner with a flourish.  Then he went back to looking board while he gave the patient a breath every five seconds.

A board appeared and we started maneuvering her for the extrication.  Even though we had access now, it was still going to be difficult.  We couldn’t lay the seat back to get the board behind her.  The seat was smashed in the upright position.  After taking a few seconds to consider options we decided that there was no good way to do it.  We were just going to use as many people as possible to lift her straight up and out onto the board that would be laid over the back of the car behind her.

On the count of three we all pulled and most of her came up intact.  Most of her that is.  The shattered leg dangled and spun in ways that made most of us cringe. The patient was so deeply unconscious that she didn’t budge.

“Yaaaaaa!  That’s gotta smart a little!”  My partner pursued the dangling leg and tried to get it to land right side up on the board.

We paused on what used to be the trunk of the car to strap her down and package her some more.  Everyone repositioned and then carried her to the truck.

“Who feels like a trip to the hospital?” I asked.  One fireman who I was very familiar with hopped aboard instantly.  He knew exactly what to do and made his way to the head to take over the bag.

“Hey Buck, you want an easy three or warp factor 10 to U of L?” asked my partner.

Just as he said this the patient’s limbs started to contort inwards under the straps.

“That’s a new one,” said the fireman at the head.

“Uh, oh.  Hey man, as always, make it an easy three.  I don’t want to end up in another wreck in this rain.  And this right here tells me that this is not going to have a good outcome.  It’s too bad too.  It’s not often you get there so quick and get an airway like that.  Just get us there in one piece.”  I told my partner.

“You got it,” he shut the doors and before long we were lumbering down the road.

“What’s she doing?” asked my new rider.  He was a member of the neighboring district’s fire department and he had taken to the medical side of his job easier than most.  Many firemen in this area could care less about being an EMT, but this one was always willing to help and I was glad for it.

“Unfortunately she’s dying.  You see this posturing here?  The intracranial pressure squeezing her brain is making her limbs contort.  Here in a minute they will splay out.  It’s not long after that before there is no coming back.”

“Oh, that’s too bad.  I thought we were doing good.”

“Oh, we are my man.  We are.  But you can’t do everything.  If it gets bad enough the pressure will squirt her brain out the little hole in the base of her skull called the foramen magnum and she’ll be toast.  We are going to do absolutely everything we can do, but this just doesn’t have a good outcome.”

I rushed around the cab examining things and performing various procedures and bandaging.  It wasn’t long before her limbs turned out from her body as predicted.  It almost looked like she was conscious and trying to fight the straps on the board but her face was flaccid.

“Creepy,” he said.

“Yeah.  This is just a damn shame, man.  That was some of my best work.  Did you see that tube?  We were breathing for her inside the first 60 seconds of making scene.  That’s some damn sexy shit!  I tell you what man, sometimes this just gets depressing.”

We started pulling into the hospital bay and the doors opened to a crowd of waiting people whose curiosity had been obviously peaked by my report.  Soon she was in the hands of some of the best surgeons in Kentucky.

***

The attorneys and the jury were very attentive while I told my story.  Mind you, what I told them was a little different.  For instance I thought it would be best to leave out the part about me declaring myself to be a bad mother fucker.  But I left the essential details intact.

I had noticed that a young woman had begun to cry while I was telling my story.  I assumed this was the patient.  It may sound cold, but I tried to avoid eye contact with her.  Displays of emotion have never been my thing.  I was nervous enough testifying in front of a jury for the first time, and I didn’t want her to derail my thoughts.

Her lawyer started to question me about her posturing on the way to the hospital and what that meant.  He had told me he was going to do this in the meeting we had before the trial.  There was no reason to embellish.  The truth was the truth.

“To be honest, for the last three years I thought she was dead.  In all my years on the street I have never seen a patient posture like that and live.  To make matters worse, my partner was reading the paper during the next shift and thought he saw her obituary.  That curve produces so many accidents that believe it or not, someone else died very near there on the same stretch of road on the very same day.  It was just coincidence, but because I was expecting it I just assumed the obituary was hers.”

“You must respond to hundreds of calls each year.  Why was this particular call so memorable for you?”

“Well to be honest, it is not uncommon to see someone die.  I have had stretches that lasted a few weeks where I have seen at least one dead person per shift.  But being so close to this call when it came out was such a stroke of luck.  And being able to get that airway so quickly was really making me hopeful.  You see, it only takes 4 to 6 minutes for someone to have permanent brain damage from not being able to breathe.  In 6 to 8 minutes the patient will die completely.  When someone has a wreck like this, it may take bystanders a minute or two to call 911.  It will take a minute or two for the dispatcher to take that information and dispatch the truck.  It will take a minute or two for us to get to our truck and start driving.  To be perfectly honest a patient who is not breathing is often brain dead before we even leave the station house.  And it might take us ten more minutes to drive there.  Usually there is simply no hope for someone with the kinds of injuries that she suffered simply due to the factors of time and distance.  To have someone call right away, and to be dispatched to a call that was right around the corner…something like that only happens every year or two.  And to watch her posture like that after everything else had gone so well.  It was heart breaking.”

As I told my story the woman who I thought must be the patient started to weep uncontrollably.  I was trying to stay focused and had not yet made eye contact with her.  The lawyer then started a long series of boring questions about the bending of metals and vehicle placement.  Something I did not expect was for my run sheet to appear on a monitor just to the right of the witness stand.  They started asking me specific questions about things I had written.  I am ashamed to say that I couldn’t read my own handwriting.

“Could you zoom in on the narrative a bit?  My eye sight is failing me.”

The area instantly enlarged for me.  And I still couldn’t read it.

“Uh, could you zoom in a bit further?”

“Sir, that is a touch screen.  You can use your finger to make a box around the area you want magnified.”

“Oh…okay.”  I drew a box with my finger and instantly it was served up on the screen.  I know its lame, but my handwriting was that bad.  I still couldn’t see anything.  I peaked up over my glasses at the attorney in frustration.  “Well, this is embarrassing.  I don’t seem to be able to read my own handwriting.”  This elicited a few good natured snickers from the court and I was provided a hard copy that was blown up to an absurd magnification.

“I give up.  You could provide me with a microscope and I still wouldn’t be able to read that.  I apologize.”

I felt awful for wasting the court’s time.  Sweat started to seep through the back of my shirt and my neck felt hot.  But everyone was very kind about it and the opposing attorney even offered up that it must have been a bad scan.  The opposing attorney even liked me.  My speech must have made enough points to allow me to coast through this.  (A word to those in the business though: take the time to write your charts legibly.  I felt about one inch tall during that entire exchange.)

When the questions were over I was told that I was excused and that the court was going to recess for 10 or 15 minutes.  I made my way out of the witness stand and started to walk towards the wooden gate that led towards the back of the court.  That’s when I knew that a meeting with the patient would be inevitable.  She had trouble standing, but she got up as fast as she could.  The accident and the hypoxia had left her with brain damage that had proved hard to overcome.  She had to learn to walk again, and even three years after the fact still needed a cane.  Pressure had built up in her brain, but I learned that within 10 minutes of our arrival she was being prepped for surgery.  Not long after that the pressure was relieved.  For once the system worked.  It was so rare, but on that day that planets must have been aligned and she lived.

A crowd of people had gotten up to take advantage of the recess, and she was having trouble getting through them.  She was determined though.  I felt bad for her and wanted to motion for her to stay where she was and that I would walk over to her, but she wasn’t looking at me.  She was staring at her legs trying to will them to move before I got away.  When we finally met she threw her arms around me and started sobbing on my shoulder.

This is going to sound wrong.  This is going to sound awful.  But I have always had a problem with displaying emotion and touching strangers.  Nothing is more uncomfortable for me than being in close quarters in a crowd of people.  I am not claustrophobic, I am just private and like to keep to myself.  I think the term that my wife uses is ‘cold hearted bastard.’  She says this in a loving way though.

But there I was, with this complete stranger grasping on to me for dear life chanting “Thank you, thank you, thank you, thank you,” into my shoulder between sobbing.  It should have been touching.  It should have been a wonderful moment.  I should have been moved.

But I wasn’t.

And that’s the most horrific thing about this whole story.  I felt guilty for not feeling anything during this pivotal moment.  Most people whose life you save will do just about anything but thank you.  I have been punched, kicked, and spit on.  I once had a patient pee in a cup and try to throw it on me.  A couple of patients have tried to stab me.  One drunk lady jumped on my back and tried to claw my eyes out while I was doing CPR on her husband.  I had to run through a doorway and smash her into a doorjamb to scrape her off of me.  All of those years of death, and pain, and anger, and fear all culminated into this moment where someone was actually thanking me.  And I simply couldn’t appreciate it.  I’m not proud of that.  It still bothers me to this day.  The painful truth was that I wanted nothing more than for her to stop hugging me.

But I am also human.  So I let it happen.  I thought to myself, “Buckman, that’s it.  You are the coldest bastard that ever lived.  There has to be some karmic retribution for wanting to peel this poor lady off of you.  You better sit here and take this.  Let her have her moment.”  So I gritted my teeth and hugged her.  I even put my chin on top of her head and let it go on for awhile.  People were beginning to collect around us and get into the moment.  And where was I?  I was absent.  Mentally absent.  But what I did must have done the trick, because after a couple of minutes she was satisfied and let me go.  Some on lookers clapped for awhile, I excused myself and made my way out.  I gratefully disappeared into a sea of people in the hall and escaped without any further dangerous emotional display.

I am honored to have done that for her.  I really am.  But I know how rare it is, and that it was just a fluke.  I don’t want to be cussed out or spit on for doing my job, but I also don’t want to be singled out to that degree either.  The fact that she lived was dumb luck.  In a world full of head-on semi vs. sedan wrecks she won the lotto and lived.  And just in case anyone was reading my pervious post and thought they could throw this one in my face and say, “See, we do make a difference,” I have something else to say.  Unfortunately for everyone of her that I have encountered there are dozens that I have rolled up on and have had nothing else to say except, “Yep…they’re fucked.  Anyone have a sheet?” 

But I don’t want to take anything away from this event.  I am glad that she lived, and I am honored to have been part of the team that made it happen.  Sadly, I never found out the outcome of the lawsuit.  She was suing the trucking company for wrecking her life.  The driver was apparently some sort of scumbag with prior drunk driving charges that were inadmissible.  I was there to establish the severities of her injuries.  When I told her lawyers about the posturing and that I had just assumed she was dead all these years, they ate it up with a spoon.  They also wanted me to testify as to the position of the vehicles and clarify what had happened to the car during the extrication.  I never really thought about it, but it is apparently hard to figure out exactly what happened during a wreck after you cut the car into little pieces and leave it in an impound lot to rust for three years.  Who knew?

What’s the take home lesson from all of this?  Handwriting.  Take the time to make your charts legible.  And also be prepared to get a big sloppy hug if you testify in court.

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