A Day in the Life: Notes From a San Francisco Paramedic

I had been out last night for a drink or two and was trying to take a cat nap in the back of the ambu­lance; it was around 0900. That’s how you survive the long shifts with little sleep — cat naps. Just to close your eyes for a half hour is a relief, but you never really sleep, one ear is always on the radio, you wait, behind a curtain of semi-consciousness, for the unknown, to be hurled into the breech. That’s a lot of what we do, we wait, passing the time talking about everything — our lives, the lives of others.

I had just drifted off to sleep when the radio toned, my pager began to vibrate and the voice of a female dispatcher broke the silence of a dreary grey morning. “Medic 1442 stand by for code 3 dispatch. Units due Medic 1442, Engine 30, your location 45 Hemlock for major trauma, PD is also en route.” I got out of the back and climbed into the passenger seat; I took my stethoscope and hung it around my neck, put on my gloves and started to mentally prepare. Many times the nature of the call as it’s dispatched is very different than what was actually called into 911, and often we are sent on calls that sound quite serious but end up being absurd, and visa versa. So when I say I mentally prepare, I do so successfully only if what info we’ve been given is correct — major trauma, to me, means someone got ran over by a garbage truck after falling off a rooftop, not a fucking hurt toe, under­stand?

We were very close to the location of the call and took under one minute to get there. We turned the corner just in time to see the Engine crew walking to the house. We pulled up behind the Engine, shut off the siren, but left the engine running and the lights on, we got out and pulled the gurney out with all our bags already on it and headed toward the house. We entered the property by a driveway that separated two houses. As we got halfway up the driveway I could see the Fire crew with the patient; I saw a young man in his twenties sitting upright outside on a bench with an Asian female firefighter holding a bandage on his right hand as she elevated it above his head. Oh, this is bull­shit, I thought. He cut his hand?” We got to the patient and took the bags off the gurney. I looked at the bloody bandage around his hand and began to grasp what had happened. Just then a firefighter approahed me quickly, I turned to him, his arms extended hold­ing something out to me, I looked down and saw a bloody human hand still inside a glove.

I took the hand from him and pulled a plastic bag from my jump bag. “Ice packs, ice packs!” I called to my partner. He grabbed two out of the bag and squeezed them till they made a popping noise. He shook them and put them into the plastic bag con­taining the hand. Keeping an amputated body part on ice is important as it can preserve tissue until it can be reattached later. Don’t forget that the next time you sever a limb.

We were now working as fast as we could. “We gotta move quick here, guys, let's get him on the gur­ney!” the fire medic shouted. I was surprised that the patient was able to stand up, step to the gurney and sit down on his own. The strange thing was he wasn’t talking at all, just staring at us. I elevated his legs and put an O2 mask on him; we headed back down the driveway still not knowing how this all happened. On the way down we ran into two uniformed officers — “He cut his hand off, we don’t know how, we gotta go,” I said with some excitement. “Where are you transporting to?” one of them asked hurriedly. I shouted back which hospital as we rolled by them without stopping. This whole time the firefighter who was holding pressure on the stump had not left his side, she couldn’t — once pressure is applied to a wound it shouldn’t be released until you’re at the ED, (bleeding control). We loaded into the ambulance, I and the firefighter in back. My partner jumped into the driver's seat and got on the radio to dispatch as I started to reassess the patient. I had noticed a lot of blood on the ground at the scene and was starting to put together a ringdown (a radio report directly to the ED from the field prior to arrival) in my head as I got some vital signs. “OK, bro, let's go!” I shouted through the small opening between the back and front of the ambulance. We began to move.

I only had approximately five to six minutes to take vitals, start IV’s and do the radio report. The patient's vitals were surprisingly decent, his blood pressure, which I expected to be low, was almost normal, breathing was increased and so was his heart rate. “What’s your name? What happened? Can you talk to me?” I spoke loudly over the wail of the sirens. “He has a psychiatric history,” said the firefighter. I nodded.

Suddenly the man began to talk; he told me his name, where he was, he couldn’t tell me what hap­pened, he denied having pain. I write on my glove when I’m in a real hurry like this — name, age, what time event occurred — the paperwork would have to wait. I had only a few minutes left to start an IV and do the ringdown. Starting an IV in the back of a moving ambulance is like trying to sew a small button on a shirt in a rowboat in rough seas — you bounce, heave and sway with a needle in your hand, bracing yourself against the wall or the bench. I couldn’t get in; his skin was leathery, I ran out of time. I grabbed the radio and dialed in the hospital, keyed the mic and waited.

“This is General Hospital, go ahead,” a voice said.

“Hello General, this is medic 1442, we have Code 3 traffic for you, ETA five minutes; on board we have a 24-year-old male with chief compliant of a completely severed right hand proximal to the wrist with approximate blood loss at 500 to 800cc.” (I read the vitals and some other info; a good medic can give a quick and to-the-point report in less than a minute). “…and if no questions we’ll see you in just a few.”

Once my report is given a flurry of activity begins in the ER — doctors, interns, nurses, students, volun­teers, trauma surgeons and their teams all set into motion to prepare for our arrival, planning their immediate treatment in the ER and prep the OR for reattachment of the hand. Time is tissue…

We pulled into the ambulance bay and quickly unloaded — this is one of my favorite parts, the grand finale, the doors swing open, the gurney comes out, we rush through the sliding glass doors past other EMT’s and medics, security guards and horrified visi­tors. Rounding a corner we enter the trauma room, there are at least 15 people in this room, all wearing gloves, gowns, masks and eye protection, and all waiting for us. Usually the attending MD will quiet everyone down, “OK, everyone, I want to hear one voice right now and one voice only,” he will say sternly and then I’m on, everyone in that room, and outside the room as well, is looking at and listening to me. It is like a performance, I have to speak out loud and clear so that everyone can hear me, I give a report that’s basically a larger version of my radio report, with more details. I also have to field direct questions from doctors and nurses about the scene, the patient's history if known, while actually moving the patient to his gurney with tubing, wires and torn clothing dan­gling.

Once care is transferred the team encircles the table and begin to work on him. I look on with con­cern for a moment, then exit to find a stool or a chair to sit and do the paperwork. It’s the intensity, the urgency that I love, but more than that it's the tre­mendous impact of knowing I may have had on some­one's life, someone I don’t even know and who may not remember me at all — that’s all right, I’ll remem­ber him. He may even play the piano again someday. I hope so.

Later we learned from the police that the wounds were self-inflicted.

Most of the calls we had the rest of the day were mundane and my thoughts kept returning back to that first call — more stimulating than a cup of coffee, and stays with you much longer. Later, chatting with other medics, swapping stories, we had to make some rather bad jokes, which are sometimes necessary. “Did you high five him?” “Did you bend down all the fin­gers on the hand except for the middle one?”

It's not that we don’t care or lack compassion. Quite the contrary. We fight Death every day, and we can't let Him know we’re afraid of Him, or He’ll kick our asses.