Crawling from the Wreckage

Sunday evening. Ear infections, vaginal bleeding, stomachaches and other routine emergency complaints abound. There is a business-as-usual atmosphere and we actually have time to talk in detail about recent trends in diagnoses and diseases and chit chat about our families and compare the latest things our kids have done to prevent us from getting any sleep. The nurses are leafing through take-out menus trying to decide what to order for dinner. 

The shout comes like a rifle shot through the calm. “There’s an unresponsive patient in the back of a car!” Aaron the security guard holds the door open as we bolt into the waiting room and out into the ambulance bay, the nurses following with a stretcher.

Family members stand helplessly around the car and hospital people come running from all directions. An enormous man is unconscious across the backseat and since his feet are folded up in front of me I can’t tell of he is breathing or not. I climb into the backseat as Jack the tech flings open the other door and reaches in to keep the patient’s head from falling out. We both say at the same time “He’s breathing!” and Jack adds “He’s got a pulse!” so we have time to think, but Jack acts faster than he thinks and pulls the upper half of the patient out of the car. I slide my arm under the patient’s bent knees and lift the lower half of his body until a half-dozen hands reach through the door and pull him by the pants onto the stretcher and we fly like a flock of birds back through the doors into the ER.

Our patient was sick but it didn’t take too long to figure out that he was in liver failure and his coma was a consequence of elevated ammonia levels. As we settled the patient into the ICU and his family expressed their gratitude for our efforts, I was reminded of all the vehicles I’ve climbed into to retrieve a patient since I began working in the ER.

In college, I worked as an emergency medical technician in the ER at SUNY Stony Brook and I can’t count the number of cars I crawled into in order to retrieve an unconscious person. The hairiest scene came in the parking lot of the ER, when a car flipped over and I had a crawl in through the passenger window. The fire department had to shatter the rear window in order to get the drunken, unconscious teenager out of the rear seat and I was picking glass out of my scalp and hair for a week.

As an emergency medicine resident in North Philadelphia, I dove into plenty of police cars to drag out young black men that had been shot to hell. One time, a white van pulled into the ambulance bay and three black boys tumbled out of the back, all victims of “acute lead poisoning” (meaning they had all been on the losing end of the gunfight at the O.K. - Old Kensington - corral). Al, my senior resident, and I both dove into the dark of the back of the van and pulled out two more half-dead kids. As Al and I slid an incredibly fat kid through his own blood onto a stretcher, we were white-blinded by a wall of spotlights that appeared from the top of a television news van that had followed the gunfight into our ambulance bay. I watched myself and the rest of the team on TV the next morning. It was pretty cool.

I love climbing into dark, scary places to rescue people. I think my colleagues in emergency medicine secretly like it too, although most are too cool to admit it.