“I know how you’re gonna die.”
“Don’t say that, dude. I hate when people say creepy stuff like that.”
“Well, I do,” he says, turns right on Dixie.
My partner’s driving. We’re on the way to a bar for an unknown medical call, which, when it comes to bars, tends to mean a couple of patients with epistaxis. Epistaxis means bloody nose. We make the patient pinch his or her nose and lean forward. You’re not supposed to lean back, because the worry is aspirating. Aspirating means choking on your own blood.
We walk in. The floor is loud. Every step, it feels like crepitus. You can even hear it over the jukebox that’s a combination of emesis and Taylor Swift.
The floor’s covered with peanuts. I mean, thousands. Of shells. Thrown over the shoulders.
We ask them to turn down Ms. Swift and they don’t.
There’s a certain focus from everyone in the room that the guy in the center barstool is the one we want to be treating. We walk up and it’s the strangest thing I’ve ever seen—actually, I have to be careful with that; as a medic, I’ve seen a lot of crazy shit. I’ve seen a man decapitated by a moose. (There was nothing we could do.) I’ve seen a kid who jumped from the fifth floor of a building successfully into an outdoor motel pool only to have his foot get caught when it broke through a vent at the bottom. (Drowned. Nothing we could do.) I’ve seen a lady who—I could keep going. I’ll stop there. But a lot of crazy shit. Wait. No, I’ll tell you the lady story. It’s quick. She sneezed so hard one of her eyeballs popped out. That’s globe luxation. The only one I ever saw. We just covered her eyes with taped-on Dixie cups and told her to keep looking straight ahead.
But this guy’s got a ping pong ball in his mouth, blocking his airway.
We introduce ourselves to the patient and then ask his girlfriend if he can spit the ping pong ball out.
He shakes his head while she tells us she’s not his girlfriend.
I ask how many ping pong balls he has in his mouth.
Twice, I’ve been called to competitive eating contests that have gone bad. Once it was for hot dogs and once for cheese steaks. The cheese steak guy wanted to win a $100 grand prize and got CPR instead.
Our ping pong patient is starting to struggle, so my partner puts on one of his PPE gloves and goes to take the ball out of the man’s mouth. The man, though, is shaking his head no, to leave it in. But we tell him it has to come out.
My partner touches it and says it’s not a ping pong ball.
I ask what it is and he doesn’t know. He says it felt like a heart.
A human heart?
He says yeah.
Then something about the color makes me think it might be his tongue. I ask the patient if it is and he starts nodding like crazy.
And then he nods himself right off the barstool, passing out. He goes down. I’m looking for cyanosis. I’m ready for cardiac arrest and every bad thing you can imagine.
This is when my medic head starts spinning. Everything has to be fast. In medic school, sadly, the reality is you can get 80% on your tests and pass, which means that one in five of the things I’m supposed to know, I don’t. That’s pretty much across the board for all medics. We’ll get four out of five things right when we really need to be correct on everything.
But tongue inflammation as far as I remember is one of two things. One, snakebite.
I ask his wife if he’s been bitten by a snake.
No. And she’s not his wife.
Or two, food allergy. Does he have any food allergies?
She doesn’t know. She just happened to be in a barstool by him. We ask if anyone knows the guy. The crowd has gotten bigger. Medical scenes attract audiences. The problem is we want the opposite. The best thing for a patient is plenty of room, fresh air, a calm environment. Crowds are always bad. People smoke nearby, which isn’t helpful for someone having breathing trouble.
Then it sounds like fireworks are being lit off in one of the bathrooms, which makes about as much sense as trying to have a parade in a restroom.
I look at the patient lying in peanut shells and have a two-word revelation: peanut allergy. Index of suspicion. We prep the Epipen.
The woman asks if the needle is a needle.
We ignore her.
She starts saying she doesn’t want to see a needle go into—
But before she can finish, my partner jabs the black tip at a ninety-degree angle into the patient’s outer thigh, right through the clothing. He counts out loud to ten when a guy in a cowboy hat says to us with a thick London accent that there’s a guy shot in the loo.
No, I tell him, he’s not shot.
He says that, no, a guy is shot in the toilets.
I yell over the music that he’s not shot. At all.
And he starts talking to my partner, but my partner hates being interrupted when we have a patient, so the English cowboy comes back to me and says there’s someone else shot in the toilet. But his accent is so thick I’m not sure I’m hearing him right, especially with the Hank Williams Jr. drowning out thought.
I shout to the bartender to turn down Mr. Williams Jr. and he doesn’t.
I start to wonder if I should try to put an OPA in, see if I can get it by the ping pong tongue, but I see him looking at me, which is good. Unconscious patients tend not to blink. They tend not to sit up. Sometimes it’s having a needle jabbed in your thigh that can wake you up a bit. I’ve seen that with heroin addicts. We had one guy, he was overdosed to the point of drooling death and we hit him with Narcan and he popped up and ran right out of the ambulance with the needle still in his arm. The problem is that we have to keep track of all our needles, so I was chasing him down the street trying to get it back.
But ping pong tongue doesn’t need an OPA, because he’s talking, which is always a good sign with a patient. He says mush-mouthed, “Am I gon’ die?”
I say, “Are you alive right now?”
He says, “Yes,” so I tell him that’s a good sign, except I can tell he’s heading straight for shock. Shock is not vital signs. Shock is something you can see. It’s pale, cool, and diaphoretic and his skin is taking on ghost qualities. The whole concept of what ghosts look like comes from shock. We call it “going down the drain,” but it basically means your patient is going to die on you, which means a hell of a lot of paperwork, so I start to get the oxygen ready to pump as much into him as possible. Blow-by oxygen, nasal cannula, nonrebreather, BVM—hell, I want to have all of them going at once, if that was possible. And right when I’m untangling nonrebreather and fumbling with BVM, I see a guy wearing red pants walk up to us.
Except the red pants aren’t red pants. I can tell because they’re dripping. I look up to see a bariatric with Levis covered in blood.
I think I could use you, he says, and turns to show me the reddest part of his pants, the blood oozing out with each heartbeat.
This, by the way, is common in medicine, to end up with more than one patient.
Accidents create accidents.
You have a car accident and another one is likely to happen shortly. Drivers gawk at what’s going on and end up rear-ending the motorcyclist in front of them.
I tell the woman who isn’t married and isn’t his girlfriend to call 911 and she says, Aren’t you 911?
I tell my partner we’ll call it in once we get in the ambulance and we gurney up the ping pong tongue and start wheeling him out and suddenly it’s like a riot is going to happen. People start yelling that they’re going to kill us if we let the guy bleed to death on the bar floor, so I turn to my partner and he tells me, screw it, we’ll put both guys on the ambulance and call for a unit to meet us en route.
We’re not allowed to push a gurney by ourselves and we’re not allowed to ask anyone to help us—too much liability—so I ask the gunshot victim to walk along with us until we get to the ambulance, but I can see his footsteps of blood leading from the bathroom to where he is now. People are leaving that path wide open, not wanting to step in bloody footprints.
I figure he probably shot the bullet down into his leg, which is common with unintentional shootings. So I’m expecting an entrance wound and an exit wound. Exit wounds tend to be explosively larger than entrance wounds. And the way they’re making bullets nowadays, they tend to ricochet off bones, so the bullet can end up anywhere, not necessarily the straight-line path you might think. Who knows, maybe even hit the other leg as well. I tell him to lie down so I can find where he’s bleeding.
This, in the EMT world, is called Wednesday.
This isn’t abnormal. The normal, in emergency medicine, is the abnormal.
We wheel in our anaphylaxis patient, get him inside on the ambulance gurney and I tell my partner to watch his airway. With a patient like that, there’s only one thought—breathing, breathing, breathing.
I run back into the bar and the gunshot victim is still standing there. He’s doing nothing to try to stop the bleeding. He’s not lying down. He doesn’t even have his pants off so I can count bullet holes. So I take my shears out, which are basically big thick scissors, and a man tells the crowd that I’m going to cut the bullet out of his leg.
While I scissor his left pant leg completely off, a woman dressed all in pink—pants, shirt, hair, fingernails—tells me that I better make sure he doesn’t get an infection. As if I didn’t know this.
I’d love to sit down and have lengthy conversations with all of the passersby who, over the years, have offered me the most horrid of medical advice, to explain to them why what they’re recommending makes no physiological sense. But there’s no time to tell her that gunshots are actually too hot to bring infections. The incredible heat caused from the gunshot actually works as a sterilizer. If you ever want an area of your body to be completely sterile, shoot it with a handgun. We don’t take bullets out, because it’s hot lead, so it’s safe to stay in there, for now. And, only a doctor can do that anyway. You want to get fired really quickly, start doing surgery out in the field as an EMT. You’ll end up in prison as well.
When I have his pant leg in my hand, I look up and he says, Guns don’t kill people, rednecks kill people.
Gunshot victims, I’ve found, tend to have every single emotional reaction you can imagine. I’ve seen anger, humor, apathy, sadness. When you put a bullet in someone, their true personality comes out. This guy’s a natural bad comedian.
How you feeling? I ask him.
Like dancing.
Seriously, I say.
Fine.
This is what patients are supposed to say. Patients are put on Earth to lie to medics. Their entire purpose is to tell you they are perfectly healthy so that they can die on you. If you’re a smart medic, every person is inches from death. If you’re a smart medic and you find a person lying down in a park, they’re not sleeping; they fell from a plane. You always imagine the worst. And the worst for me now is finding out how many bullet holes we have. I count one. He’s got a major hole in his leg—medial, inferior. He’s lucky, because I’m not seeing the streams of blood that comes with arterial spurting. I had one guy who was like a fountain with his bicep. The blood shooting in amazing gushes, pausing, gushing, pausing, gushing with his heartbeat.
He’s all capillaries and venous bleeding. A dark red, an oozing.
It’s amazing he’s been able to walk on it. But my partner told me about a guy who had his feet cut off in an eight-car pile-up and was walking around on his tib-fibs, the second most insane thing he’s ever seen.
Our bariatric probably weighs about 400 pounds, so I want to lie him down and ask for some people to help get him to the floor, but no one wants to come near the guy, so I ask him to sit down again and he says he wants to stand.
I just stare at him and he asks what I’m doing, and I tell him I’m waiting for him to pass out so that I can start treating him. And this gets him to go down to the floor, with a lot of wincing, but now I don’t have to worry about him falling on top of me while I’m mid-gauze.
Emergency medicine can sometimes be painfully simple. The number one thing with a gunshot victim is to stop the bleeding. You’d think all gun owners would be well versed in first aid, being that they have this thing around them that’s made solely for destroying flesh. But the reality is none of them seem to have a clue what to do once they get shot.
Treating gunshot victims is a bit like factory work. We have a conveyer belt of these patients. I’m based out of Orlando and the amount of bullets flying around that city makes me wonder how Mickey Mouse’s ears have never taken a bullet. My old EMT school was based right in the heart of the murders for the city. The guy who bought the building got cheap rent. That’s because one day they found a corpse in our parking lot. That’s the funny thing about the U.S. Places like the White House and Disney Land, these great American landmarks, are really surrounded by nonstop murder.
I shout for the bartender if he could perhaps get some people out of the bar and turn the music down. He pours some shots for a group of weightlifters.
I control the bleeding. It’s a bit like trying to control your brother. It tends to do what it wants to do. And the problem here is I don’t know how many brothers I have. I start searching for the entrance wound, because there has to be one.
My partner comes in and tells me that we have a patient alone in the back of our ambulance and he could stop breathing at any time.
I ask if he’s radioed all this in and he nods yes like he hates the question.
He crouches, finds the entrance wound in one second.
Where?
He shows me the tiniest hole known to mankind.
You sure that’s a gunshot wound?
He looks at me like it’s the stupidest question in the world. It is. He’s right. Entrance wounds can be so small that it’s common for EMTs to deliver patients to the E.R. and completely miss them. Especially with all the blood.
We slap on all the sealant.
Pressure points are bullshit. You have a medic doing that, he’s caught up in the 1980s.
We’ve got QuickClot, which is a miracle drug. I’ve never had to do one single tourniquet in my life, although, trust me, I’m pro-tourniquet as all hell, but with natural vasoconstriction, luck, and Celox, bleeding, for me, is something that I’ve never had to worry about with a patient. I mean, the ones who lived.
My partner whisper-shouts, How the hell we getting this guy in the ambulance?
We aren’t. He needs a bariatric ambulance. We actually have ambulances made specifically for fat people. We have to. We can’t get them into regular ambulances. And obesity, from what I’ve seen, is becoming an art in America. Patients every year get fatter and fatter. And, a lot of people don’t know this, but the number one injury for EMT is lifting fat people. I’m not making that up. Research it. You’ll see it’s true. Back pain from lifting fat patients. I was down for a week after I blew out my back lifting a diabetic woman who weighed five hundred pounds and, keep in mind, she didn’t have any legs.
If I’m not sounding like the most tenderest, kindheartedest person when I talk about patients, you have to understand that they actually teach you to hate your patients in medic school. The instructors constantly make it so you see them the same way that cops see criminals. Patients have no problem getting you killed. Patients will give you the common cold and hepatitis and tuberculosis and not lose sleep over doing so. I used to cry about patients until one time my boss took me aside and told me I need to look at elderly people as animals, that I’ll end up committing suicide if I don’t see grandmothers as Siamese cats and grandfathers as miniature poodles. Sometimes we have to put them to sleep. It’s called cancer and heart disease and chronic lower respiratory disease. Stroke happens.
Is anybody coming?
Yeah.
When?
My partner shrugs.
So?
We ask the patient if he’s good to go. If he can sit there until someone comes.
We say another unit’ll be coming shortly and we start to go.
And the bartender now suddenly acknowledges our presence, telling us we can’t leave the guy. He’s got 400 pounds on the floor, a liter of blood poured all over the place. The bar is nothing but blood and peanuts.
As we’re walking out the door, someone says, Just so you know, that guy’s HIV positive.
I turn, but I don’t know who said it.
My partner tells me to hurry, but I start asking the crowd who said that and my partner is about tugging me out the door when I say to hold on, I’m using the bathroom.
He says I must be kidding, but there aren’t any sinks in the back of ambulances. There’s no running water back there. It’s probably the stupidest thing about emergency medicine. If you want to save a ton of medics’ lives, do one simple thing: install a goddamn sink in the back of the ambulance. You puncture yourself with a needle or have a patient vomit in your eyes or put your hand down in a pool of blood, you’re screwed until you get to the hospital.
So I tell him I’m using the damn bathroom.
I crunch across the floor, avoiding the bloodstains, open up the door with the word AMIGO on it and a smiling sombrero that looks like it’s on fire and the first thing I see is the blood. The bathroom looks like a slaughterhouse storeroom. And I see legs on the floor inside one of the bathroom stalls.
I turn and crunch my way straight back to the front door.
I get into the ambulance, crawl up front, and my partner says, That’s abandonment.
I ignore him and tell my partner to radio in a murder.
What murder?
There’s a body in the pisser.
What pisser?
That fat guy shot somebody.
Himself.
And somebody in the goddamn bathroom. I try to keep my voice down. There’s no ping pong ball in the guy’s mouth anymore. He’s sitting up, one-hundred percent flow of O2. He looks ready to pinch hit for the Dodgers.
Did you treat him?
Who? The bathroom guy?
Hell no.
You didn’t do anything?
I got out of there. Scene safety. Drive!
He starts up the ambulance.
I go in back, making up vitals for the time when I was inside. We are firmly in lawsuit territory right now. We’re firmly set for a future in Quality Improvement hell.
The patient is doing fine. He’s 122-ish systolic. A little high, perfectly in range. He’s twenty breaths a minute. A little fast, perfectly in normal range. He’s 100 bpm. Little high, normal range. All those numbers mean nothing. What matters now is change. What matters now is inclining or declining. What matters now is change.
I remember the HIV comment. I have a moment to think. Vital signs for a guy like this are done every fifteen minutes. I tend to do them every five for every patient. I usually take nonstop vitals. Just in case. Except if a patient complains. If a patient says, Don’t touch me, then I don’t touch them.
But I take a minute to get some alcohol swabs. I rub my hands. I check for blood on me. I find a speck on my wrist. I look at it.
I get minimum wage.
I’m a bit fat myself.
I don’t have a girlfriend. Or a boyfriend. Or, in fact, a friend. Not here. In California, where I was born, I have plenty. But here, in Orlando, I don’t hang out with a single person.
I shout up to my partner, saying, So, how am I going to die?
I hear him laugh.
I look out the back of the ambulance. I remember something my EMT instructor told me. He said, Orlando—it’s a good place to die. Good as any.
My partner yells back, Maybe that guy in the bathroom was just drunk.
Passed out.
I feel a sense of relief until I realize he probably fell out of a plane. Being passed out in a bathroom spells death. Part of me wants to go back, but there’s never any going back.
We drive.
Well, I say.
Well what?
How’m I going to die?
He shouts back, It’s simple. However your parents die, that’s how you’re gonna die. It’s all heredity. They’re doing studies, catching cancer before people get it, because their father’s colon cancer warned ‘im it was coming. Medicine is magic, he shouts.
I think of catching my death before it happens.
I see the Jesus amusement park pass by, the constant car sickness I have from this job, watching the cars tailgate us so that they can speed.
The Holy Land Experience passes in a flash. I heard that one of the guys who plays Jesus there gets laid a lot. I heard he’s a big pot-head, that he’s done acid so many times that some doctors would declare him legally insane. I heard that he’s a really nice guy though, mellow. But there’s a lot of bullshit talk in the break room back at the base station. Who knows what’s true?
Funny thing though is the EMT who’s friends with the fake Jesus said that I remind her of him. She said I’d make a good Jesus if I could lose the weight and start smoking pot. She said it’s hard to get hired there though, that you really have to be good at faking like you’re a Christian.
A family that looks scared gawks in through the ambulance’s back window at me. I stare back at them, the sun blinding, perfect for a car accident, and I think of myself delivering the Sermon on the Mount for minimum wage, my robe as clean as all hell.