Authors: Shawn Grady
Evening blanketed the valley. The ambulance bay felt deserted as I sat behind the wheel of Medic Seven, waiting for Bones to return with the drug keys and radios. The first shift of our night rotations. The door across the bay swung open. I started up the engine.
Bones hopped into the passenger seat. “Priority one, downtown.”
“What?” We’d be at least seven minutes out from that.
“We’ve got a call.”
“I haven’t even put us in service yet.” I picked up the mic. “Aprisa, Medic Seven in service. Trestle and McCoy, twenty-one hundred to oh-nine hundred.”
The sultry voice came back. “Copy, Medic Seven. Stand by for traffic.”
I looked at Bones. “You told her we’d take a call right out of the gate, didn’t you? To get on her good side.”
“I did no such thing. System’s just busy, I guess.”
“Right.”
The radio toned. Dispatch gave an address for O’Farrell’s Hotel-Casino, seventeenth floor – man down, unknown problem.
I clicked the red master emergency light switch and pulled out into the street, gunning down the road for O’Farrell’s.
From the moment we started, we were late. I could just picture Spitzer calling me into his office, questioning why we couldn’t make it downtown in a Friday-night-traffic-impossibility of five minutes fifty-nine seconds. “According to our studies,” he’d say, “you should be able to make that in five minutes forty-four seconds.” Yeah, sure. As the cursor flies on Google Earth.
I took oncoming traffic on Mill and wailed under the freeway overpass, blaring the air horn. We passed County Hospital and weaved across lanes into downtown, passing under
The Biggest Little City
arch and parking outside of O’Farrell’s Casino in the neon glitz.
Seven minutes thirty seconds into our response.
A female security guard, who looked to be about eighty years old and four-and-a-half feet tall, met us on the sidewalk. Bones pulled the front of our yellow Stryker gurney with one hand. I pushed the opposite end. Our airway bag, monitor, and first-out bag were all seat-belted on top of it. The guard led us through the labyrinth of slot machines, over heinously designed carpet, and under gaudy ceiling tiles to the guest elevators in back, using her elevator key to recall the car.
“I don’t think our gurney will fit in these elevators,” Bones said to her. “We usually take the freight elevator.”
She shook her head. “Out of service.”
We unlocked the seat belts. I grabbed the first-out with both hands, and Bones lifted the airway bag and monitor.
The elevator car arrived, and the ubiquitous Barry Manilow accompanied us to the seventeenth floor. I wondered what kind of difference, if any, an extra two-and-a-half minutes would make in this case.
We exited into a long, narrow hallway, Bones whistling “–Copacabana.” A different security officer, this one sweaty and potbellied, waved and pointed to us from the end of the hall.
“Yes, hello.” Bones nodded back. “We see you. Yesss, we see you.”
“You think he wants us to hurry?”
“What was the nature of the call again?”
“Another unknown man down.”
“That’s right. Excellent memory, Jonny-boy.”
“You save lives. I save you.”
The guard kept waving at us.
“I think he wants you to run, Jonathan.”
“How about no, Bones?”
A fire captain appeared in the doorway. “GSW to the left temple. Looks self-inflicted.”
Gunshot wound to the head.
Time to drop it in gear.
“He’s agonal,” the captain continued. “We’re setting up to bag him right now and I’m having my engine operator bring up a board and c-spine stuff.”
A mammoth revolver lay on the bathroom counter. A police officer questioned a sobbing woman sitting on the toilet. A few steps more and a queen bed came into view with a middle-aged man lying supine with snoring respirations, the right side of his head shaped like a volcano cone. One firefighter in turnout bottoms and boots squatted on the bed, suspenders strapped over a blue T-shirt. He wore clear trauma glasses and held a purple bag-valve mask with latex-gloved hands. Oxygen tubing trailed from the back of it to another fireman who was in the process of pulling out a green and silver oxygen bottle. He opened the valve, and pressurized oxygen shot out with a hissing sound that muffled when he connected the tubing. I went to the patient’s head.
The firefighter looked up, eyes wide, hands full. “We found him like this on the bed.”
The glow of streetlights disseminated through the room’s thin white curtain. The television flickered a
Jeopardy
answer in white letters –
Robert Young is best known for the patriarchal role in this ’50s TV program.
“Will he take an oral airway?” I said.
“He looks pretty clenched down.”
Bones unzipped the airway bag behind me. “They need an OPA?”
“No, he’s trismussed.” I turned back to the fireman bagging. “How’s that compliance?”
“It’s not.” He wasn’t getting any air into the lungs.
“Let’s drop an NPA, Bones.”
He flipped the green trumpet-shaped tube through the air. “Need some K-Y?”
“No, I’m good.” I wiped the nasal tube through pooled blood on the man’s upper lip and slid it flush with the opening of his nostril. Placing my stethoscope in my ears, I listened to breath sounds beneath his armpits.
“Sounds like he’s aspirated a lot of blood.” I whipped the stethoscope back over my neck.
The fire engine operator came through the door with a blue backboard, a pair of rectangular foam head blocks, and a set of Velcro Spider-Straps. He slid the board onto the bed. The fireman who was bagging stopped and placed his hands on the patient’s head to stabilize the neck.
“On your count.”
“One, two, three.”
We logrolled the man onto his side, checked his back for any hidden trauma, and then laid him back on the board. I strapped a cervical collar on his neck. Bones and the others secured him to the board with the Velcro straps. We taped his head down last and picked him up.
Bones shuffled backward while carrying the board. “We’ll have to tilt him diagonal to fit in the elevator.”
We strode down the hall, a firefighter at the head still bagging. I wanted to intubate him, but with all the moving we were doing, the risk of dislodging a good tube was too high. Not to mention that, with his teeth clenched down, it’d be a blind intubation through his nose. The security lady stood next to two elevator doors, holding them open with an override key.
We lifted the board upright and angled the patient inside the first elevator, leaving only enough room for Bones and one fireman, one to support the patient and one to bag.
The doors closed, and Bones lilted, “ ‘His name was Rico. He wore a diamond.’ ”
I stepped into the second elevator with the rest of the fire crew. The car descended. No more Manilow. Kenny G. this time. Could a saxophone be more grating? I curled a breathing tube around my fingers to form the best angle for a nasal intubation.
The car jerked, and the doors opened to the middle of the casino floor. Slot machines bleeped and dinged, shelling out change in resonant bins
.
People ambled about with quarter-filled plastic cups and beer bottles, some zoning out by slots with cigarettes smoldering in opaque ashtrays. The digital readout for the elevator next to us showed it descending from the third floor.
We’d beat them down.
I knelt in front of the doors and strapped on a surgical face mask with a clear eye shield. I had the tube in hand, lubed and ready to go.
The green number one glowed against the black background of the elevator readout. Two women stepped in front of me.
“Excuse me, ladies. You’ll have to take the next one.”
They stopped and frowned at me and my face mask, endotracheal tube in gloved hand, stethoscope dangling from my shoulders.
What an inconvenience for them.
The elevator doors opened.
Their eyes grew wide at the sight of an unconscious man strapped to a board, blood oozing from the side of his deformed head.
Bones and the fireman laid him on the casino floor. The ladies arced around to the other elevator, striking back looks of disgust. A man persisted in playing a slot machine behind me.
I pulled out the nasal trumpet and eased in the breathing tube.
Bones knelt beside me. “Careful now, Jon-boy. No room to miss.”
I exhaled, steaming up the visor edges. Visions filled my mind of the famous X ray they show in paramedic school of a nasogastric tube curled up inside a patient’s cranium. This man’s gunshot may have created a pathway for a misplaced tube to end up right in his skull.
Okay, Jonathan, tube the lungs, not the brain.
I advanced with care, timing my movements with his underlying respiratory rate. Condensation filled the tube as I drew closer to the larynx.
“Almost there . . .”
I felt it nudge past the vocal cords and used a syringe to feed air down into a small balloon cuff that would secure the tube in his windpipe. I pulled the stethoscope from around my neck and placed it above his stomach and then his lungs.
“Tube’s good. Let’s go.”
We lifted him on the gurney and wove through the casino floor, out into the city with its lights and activity and Friday night buzz. We loaded him in the box and took off code three, lights and sirens to County Hospital.
This guy didn’t need a medic. If anything, if he even still had a chance, he needed a surgeon and more time.
Take away those and the wages of trauma were death.
The bustling cyclone of nurses and techs silenced once Dr. Thomas Wheatland lifted his hands above the gunshot patient on the trauma table.
He reminded me of an Old Testament prophet.
“I believe Paramedic Trestle was still giving his report.” He eased his dark-skinned hands into a pair of blue nitrile gloves. “Go ahead, Jonathan.”
Eyes shifted to me.
Well, all right, then.
“High-caliber handgun, looked like a three-fifty-seven, self-inflicted to the temple. Agonal and trismussed on our arrival. Nasally intubated with a size seven-and-a-half tube, good confirmation on lung sounds bilat and end-tidal capnometry. Head-to-toe otherwise atraumatic. He’s got a fourteen gauge in the left AC.”
Dr. Wheatland nodded. “Thank you, Jonathan.”
Activity resumed.
I’d had many counter chats with Wheatland over the years – he called them curbsides – following up on patients, gaining his insight on treatment modalities. Ever since I’d caught a case of Wolff-Parkinson-White Syndrome in the ER that changed the way he treated a cardiac patient, he had given high regard to my “mere paramedic” assessments.
I peeled off my gloves and scrubbed my hands with surgical soap in the washbasin.
My role as paramedic was difficult to characterize – moving from “para-god” powers in the eyes of lesser-trained first responders to the disdainful attitudes of occasional disgruntled RNs. Though higher in the medical food chain, some couldn’t get past the physician-level authority extended to us and not them by big daddy doctor. All that attention in the course of a call. Finish my paperwork, load up the gurney, and do it again.
No sooner had we rolled the cot away from the trauma table than Aprisa squawked from our hips that we had another run.
Bones tossed the gurney sheet in the bio bin. “Are we the only ambulance in this city?” He picked up his radio. “Go ahead with traffic for Medic Seven.”
“Medic Seven, Aprisa. We’re level zero. Can you come available?”
We rolled the gurney through the automatic doors. Bones’s keychain jingled against his hip. “Affirmative, Aprisa. Go ahead.”
“Medic Seven, priority one. Infant choking, Damonte Ranch High School at the baseball field.”
I loaded the gurney in back. Bones slid behind the wheel. I hopped up in the cab. “It’s a mess back there.”
“Among other places.” He flicked on the lights and switched on the siren. We bounced onto Mill Street and shot east.
I figured eleven minutes out on this one – at best – even with Bones driving at warp nine-point-eight. But there was a fire station not too far from there.
I picked up the radio mic. “Aprisa, Medic Seven.”
“Go ahead.”
“Do we have fire responding on this as well?”
“Stand by. Will attempt to contact their dispatch to confirm.”
What if they weren’t available?
We shot down the freeway like a bullet through a barrel, outrunning our siren, fighting time with speed – passing other cars, other people in their houses, shoppers in stores, folks living life and wrapped up in their own concerns. We were just another ambulance. An annoying sound interrupting a show or the first stages of sleep. A requisite part of the city din. And at the forefront of my mind lay an infant turning purple and flaccid and the distressed faces of family wondering where 9-1-1 was.
“Medic Seven, Aprisa.”
I clicked the mic. “Go ahead.”
“Reno Engine Fourteen just arrived on scene.”
I exhaled. “Copy.”
What if they hadn’t been available? What if they’d been out on a fire like the downtown crew when we rolled up on Simon Letell?
Bones pulled us up on scene outside of the baseball field at the high school, towering white lights refracting in the cloud cover. The engine company stood around a teen mother holding a crying infant in her arms – noisy babies were always a welcome sign. Everyone’s body language looked relaxed. One fireman held a small oxygen mask near the baby’s face.
The mother’s cheeks were red and tear streaked. “I just didn’t know . . .”
“That’s okay,” the fire captain said. “That’s why we’re here. Sounds like she swallowed down the wrong pipe for a moment.”
The mother sniffled. “I just didn’t know what to think. I’d never seen her hack and cough like that.”
The captain nodded to me. “Didn’t sound like she wanted to go by ambulance, guys. Baby’s doing good now.”
He relayed the vital signs they’d taken. Bones had the mother sign a refusal of transport form, and we hopped back into the rig. He offered to drive again so I could work on the chart for our gunshot patient. I balanced the clipboard on my thighs and began my incident narrative.
Bones caught the freeway north toward Rock and Victorian post at dispatch’s request. It marked the center of the valley and subsequently was the highest-priority post. Being sent there meant we were still the only ambulance available. Busy Friday nights weren’t atypical, but this had the stench of understaffing.
“Four hundred thousand people, Jonathan. And only one of them has to call 9-1-1.” Bones smirked and clicked on the stereo. “I meant to tell you, I found out a little more about your guy Letell.”
I looked up. “Really?”
He nodded, eyes scanning the traffic lanes. “I called a buddy of mine at NMHI.”
The Nevada Mental Health Institute.
He changed lanes. “He used to be an ER nurse. Now he’s in admitting over there. State retirement. Pretty sweet gig. I asked if he knew about a Simon Letell. He said even if he did he couldn’t tell me.”
“HIPAA violation?”
“Right. I told him that Letell’s dead and didn’t have any relatives – so he was all right with that.”
“What’d he say?”
Bones gave a “Sorry to break this to you, but you’re not getting a bike for your birthday” sort of smile. “Letell was bipolar and suffered paranoid delusions. Big conspiracy theorist. He wasn’t violent. Just off his nut.”
I leaned my elbow on the door and rested my head in hand. “Are you sure?”
“That’s what he said.” He merged onto Interstate 80 East. “Sorry. I know you were aiming to be a super sleuth. Guess you’ll just have to settle for being a plain old doctor.”
I sat back. A jetliner descended toward the airport. I felt my shirt pocket and the stiff crinkle of Letell’s note inside it.
Chicken scratch.
Dispatched toned. “Medic Seven, traffic.”