Monday, December 29, 2008

Cluster Fuck

Cluster Fuck

Vietnamese really kill me (not literally). I respect them because they rarely call 911. When they do, the patient is usually pretty sick and the ambulance is needed. However, like so many immigrants, we Americans are the ones who are expected to figure out how to communicate with them. I’ve learned no fewer than four languages, partly specifically so I could communicate in foreign countries. Such consideration is apparently not the norm when you are planning to move permanently to another country that does not speak your language. I learned Spanish quite involuntarily, picking it up from my patients and a couple trips to Cancun, since most Hispanic immigrants have absolutely no desire to pick up even the most basic of English phrases but insist on calling 911 on a regular basis.

But I digress. The Vietnamese. To wit: I was called once to a motor vehicle accident. One of the vehicles was a van with nine Vietnamese occupants. Fun. Of the nine, exactly one person had bothered to learn the slightest bit of pidgin English. He served as my translator for the scene, which meant that not only would I have to assess his injuries, medical history, name, address and so on, but he would have to be the intermediary for eight others for the same tedious questions. As I inquired about the rest of the van’s occupants, he would inform me of who they were. “That is my cousin,” or “that is my sister,” he would say.

“What is your sister’s name?” I would ask, scribbling on my life-saving clipboard.

“Um, I don’t know.”

“You don’t know? She is your SISTER, right?”

“Yes, I don’t know.”

“OK, how about that person?”

“That is my mother.”

“What is her name?”

“I don’t know.”

Dumbfounded, I wondered how the Vietnamese got along. How does one exist in a society where supposedly intimately acquainted relatives do not know the others’ names? Since I speak no Vietnamese, I can only speculate at their naming conventions. Noting that most Vietnamese are named Nguyen, I surmise that Nguyen is roughly translated “Hey you - person who I am somehow related to.” Another common Vietnamese name is Vu. Vu may mean “person living in house with others.” It is marvelously efficient to be able to distill these cumbersome English phrases into a single Vietnamese syllable, but for intangible reasons, it still seems preferable to have an actual name.

One day I was called to another MVA. It was another van. This time the van had tried to occupy the same space at the same time as the small tree was busy with the space. From the outside, very little damage was apparent, only the front end was messed up. A new radiator, a new bumper and the thing would be good as new. I approached the van while regarding the dozen or so silhouettes inside. I grumbled that this would be a time-consuming call, with lots of paperwork, as we would have a dozen patient refusals to write even in the best-case scenario. The driver, who was walking around on scene and had no complaint had already made it clear that he would not be taking responsibility for his passengers. I wondered who his passengers were, that he would be in their decision-making loop. I soon found out.

As I slid open the side door of the van, I was greeted by shrieks and howls of panic. Fourteen sets of dull, teary eyes stared back at me. Behind those eyes were swollen faces attached to oxen bodies. Few of the bodies made sounds which could be interpreted as actual communication. The van that had hit the tree was none other than the Short Bus. For adults. I had on my hands fourteen panicky, extremely strong, very large, very mentally disabled Down’s Syndrome patients. My worst nightmare come true.

For the most part, Down’s Syndrome patients are very sweet, happy, inoffensive people. Until you do something they don’t like. Like craashing their van into a tree. Or putting a cervical collar on them. Or strapping them to a backboard. If you have ever gone eight seconds on the back of a bull at a prison rodeo, I call you a pansy. Try riding one of these broncos. Or more specifically, getting them to ride with you.

As part of the first crew on scene, it was my job to triage all fourteen of them. None were obviously injured, and none were capable of informing me of any symptoms, what with all the bellowing and screaming and crying. All would have to be immobilized with cervical collars and spineboards and transported to hospitals. I called for extra units. Every clear ambulance in the city as well as several private-service units came to pick up their designated patients. As each crew appeared on scene and witnessed me trying to herd the c-collared behemoths, who were literally running around in circles, arms flailing in the air or ripping off the cervical collars I had placed, the medics stared at me as wide-eyed as my panicky patients. I wondered what they were startled with, they only had to deal with two patients each, I had fourteen! Slowly, we began to get each extra chromosome placed on the spineboards. It is significant to note that after dealing with our group of patients, who had no injuries, one of our EMT’s and two EMT’s from the responding private services had to go home with injuries sustained from caring for our little herd.

And to think I was complaining about the possibility of having to write a dozen refusals!

Another MVA involved a school bus. Forty-three third-graders were on a bus that got a ding in the back from a car inching forward in rush-hour traffic. There was NO damage to the bus, and only mild damage to the car. The car’s driver was perfectly fine and didn’t want EMS. There wasn’t a blessed thing wrong with any of the children on the bus. Naturally, the school bus driver nor the principal (who had miraculously bothered to show up) weren’t about to take the responsibility the children’s parents had entrusted them with. Neither would sign for the kids to not be transported by EMS. It was clear to a blind chimpanzee that there wasn’t a thing wrong with any of the kids, so instead of actually demonstrating that they had earned the position of responsibility that they held, both the principal and the driver thought it would be a better idea to deny an entire city of 350,000 people access to emergency medical services, because to transport all forty-three kids it would have taken every single one of our 911 ambulances, plus the vast majority of the private-service ambulances in the city.

I was not about to let these clowns do that to my city, nor make fools of our service. I said “Fine, if you want a paramedic to transport all these kids, this is what we’re gonna do. Driver, you’re going to drive this bus to Charity Hospital. My partner is going to stay on the bus so there will be a paramedic with all these children.” I hopped out of the bus, followed it in my ambulance to Charity, and informed the doctors and nurses what was going on.

In the process of triaging all forty-three, the New Orleans Public School system education quality became apparent even more. None of the children had names like Kevin or Sandra or Brian. Instead, these kids who were already at a spelling disadvantage because of their educational institution, were further burdened with ridiculous names by their parents, who were also alumni of New Orleans “education” system. There were names like LaKym’ia, Tr’jyn, K’eshi’qUitia’kaY’e’’’’ and some that were probably spelled ‘A’p’o’s’t’r’o’p’h’e’. I wondered when people were going to start incorporating numerals, ampersands, carats, asterisks and parentheses in names. These kids were all doomed to a life of drug dealing, medicaid and litters of welfare babies because their ignorant parents had given them stupid names and their school officials didn’t have the education or smarts that a blind chimpanzee has.

One morning, on my day off, my wife and I were dozing in bed, half asleep. Our house was near the Interstate and it was common for us to hear sirens and traffic, so we had grown pretty inured to the noise. But this particular morning, sirens persistently drove by for a good half-hour or so. We began to wonder what was going on. I decided to turn on my work radio to eavesdrop on the goings-on in the world of EMS. As I went to my radio, the phone rang, which my wife answered. I turned on the radio and heard one of our medics calling our administrator: “ least fourteen dead, a couple dozen more with critical injuries...”

Holy shit! What the hell had happened? By the proximity of the sirens, I surmised that whatever it was must be pretty nearby. My wife hung up the phone. My sister, who was an emergency room nurse at the time had gotten a call from her then-boyfriend, who was one of our paramedics. He was on duty and was the first ambulance on the scene of a bus that had veered off the Interstate and crashed about a mile from my house! My sister had called to let us know she was going to the scene to assist and would we let our mother know she would be late preparing for the Mother’s Day crawfish boil we had planned for that day.

My wife and I stared at each other, wondering what the scene must be like. “Do you want to go?” she asked me. I said no, but she could tell I wasn’t really sincere. “You need to go there,” she said. I did want to go, not because I’m a trauma junky (I’m not, I got over that long ago), but because our EMS service was clearly overwhelmed and needed more hands for this event. Besides, we are expected to be prepared to respond for disasters, which this certainly was. I told her to get dressed and come with me.

We jumped into the car and headed to the interstate. A police car blocked the entrance. I informed the officer that I was off-duty EMS going to help with the scene. He asked me to prove it by showing him my city-issued radio. I did and he let us through. My wife asked what she was expected to do. I told her “anything.”

Upon arriving at the scene, I saw what had been the tour bus that had crashed. A full one third of its length was gone, crushed into a mangled mess at the front end. My administrator and several ambulance crews as well as an off-duty ER physician were tending to patients on the side of the road. My wife and I went to the patients and began helping get them on spineboards, splint fractures, start IV’s and apply oxygen. One woman who we cared for had, quite literally, every bone in her body broken, from the Laforte III facial fracture to the bilateral femur, tib-fib and ankle fractures, but was still awake and talking to us. My wife was not an EMT, but was able to assist greatly anyway. She had gotten first-hand education from the countless EMS stories I and my co-workers had related. We had run out of cardboard splints for fractures, and she began to fashion splints from various debris found lying on the ground. The physician and I were impressed by her ingenuity.

After the majority of the injured had been transported to hospitals, I climbed up into the wreckage to search for trapped survivors. The bus had veered off the road at a place where the interstate went over a concrete drainage canal. It flew over the canal and hit the far concrete wall, then bounced back up onto the side of the road. It collided so hard that most of the passengers had been thrown to the front, but even the ones still in the rear of the bus were dead from the violence of the impact.

The majority of the dead were in the smashed front of the bus. There was a pile of bodies that had spilled out of where the front had been. The passengers were mostly elderly folks who had chartered the bus from their nursing home in Lafayette to go to the casinos on the Gulf Coast. I stared at the pile of bodies and body parts. There was one woman’s dead face looking towards me; her face didn’t look quite right. I touched her head and it was squishy in exactly the way that one’s head shouldn’t be. I lifted up her head only to find that all that was attached to her body was a face and scalp. The skull that should have formed the framework for the flesh was gone, ripped out from its place atop the skeleton, leaving behind a grotesque mask where a proper head should have been.

Nearby I saw a wig - a blue-hair wig that might be expected in a bus of nursing home residents. Beneath the wig a bit of flesh peeked out. I assumed it was a brain, perhaps the brain of the skull-less woman. I moved the wig and gasped when I saw that the flesh was part of a severed arm lying on the ground. I placed the wig back on top of the arm, not knowing what else to do with it. I poked up into the wreckage above me. I noticed a woman’s face in the twisted metal above. I could barely reach her and could see less. I asked for an EKG monitor in case she still had a pulse; she was in such a spot that previous searchers might have easily missed her. As I tried to attach the EKG leads I managed to maneuver myself into a position to get a better view. What I thought was a seat cushion behind her head was in fact her own buttocks against the back of her head. I switched off the monitor. I had seen enough and climbed out of the wrecked bus.

Later that day, we had our crawfish boil as planned. After he got off duty, Frank, my sister’s boyfriend at the time, joined us. We talked about the crash, but tried not to dwell on it. The total was twenty-three dead on scene and twenty-four were transported to hospitals, with several of those transported dying later. We brought the extra crawfish to our headquarters for the other EMT’s to enjoy. Months later, the city awarded all who responded to the scene with a special commendation. The news interviewed me and my sister. I still think about it. It was probably the most trauma I’ve ever seen in one place.

I sometimes think of these experiences, most of the time I don’t. Regardless of whether I think about them or not, I believe I have learned the hard way the definition of “Cluster Fuck.” Pass the lube, please.

1 comment:

lotek said...

holy fuck dude that sounds awful