"What do you do for a living?" my neighbor asked me. I told him my usual reply, "I'm a Paramedic. I work on an ambulance." Without fail, the reaction is always the same: "I could NEVER do that!" I think anyone in EMS has had this exact same conversation a thousand times.
What I find interesting though is the variety of answers you get when you ask "why". Some mention they don't like people enough to help them, others mention the hours and sitting in an ambulance all day without a station, but most people have a big hang-up with the gore.
The other day I had one of the goriest calls of recent memory and I found myself puzzled at the prospect that the blood and the smell and the guts didn't bother me, but the "gore" itself did. This may sound strange as most people look at those two things as one in the same, but to me they are distinctly different.
It was a busy Friday night and my partner and I were laughing about how bad my driving was this particular night. Over the past couple of weeks I had a lot on my mind and I wasn't myself on shift. When I am patient man, I usually snap myself right into work mode, however when I drive it doesn't hold the same interest for me and I tend to get scatterbrained now and then. We heard the firefighters radio channel dispatch out a man with a gun threatening suicide and we happened to be in the area. Not long after we were sent to the same call and we were advised to stage for the police.
Staging is quite possibly one of the greatest benefits of being on the ambulance. The police go in first, make sure everything is safe, then tell us to come in. It adds an element of safety to our job that so many people take for granted. Tonight was one night I'm glad we staged. We parked behind the fire truck around the corner awaiting word from the police to come in and handle the psych evaluation. I had my feet crossed as I slouched in the seat getting comfortable anticipating a long standoff and my partner chatted with his girlfriend on the cellular phone. We had been there about 10 minutes when we heard "bang". Chaos ensued.
About 30 seconds after the shot, we were frantically being waved in by the police officers and lead to the man laying on the ground in a pool of blood. One of the officers ran along side of us saying "He shot himself in the left temple with an exit on the right side of his skull." We rushed to his side with the fire department and we could hear a rescue (paramedics) getting dispatched to our call.
As we approached the scene the police on scene yelled to stop. ahead of us was the weapon about 1 foot in front of our stretcher that we almost ran over. My partner and I looked at each other and let out a sigh of relief that some one noticed us before we contaminated the crime scene.
The fire guys were already next to the patient who much to our surprise was still talking or at least trying to talk. He was mumbling as blood filled his mouth from the bullet's puncturing the sinuses. Everyone seemed stunned watching this man die as no one was doing any definitive care. I yelled at one of the firefighters to suction his airway while another grabbed an airway adjunct. I laid the backboard down next to the patient and instructed my partner to get a bag valve mask ready. I told them to load him quick and I'll go set up some I.V.s.
I ran to the ambulance and set up two I.V.s and the firefighters came screaming around the corner with the patient. They loaded him in still frantic from the nature of the call. I instructed one to check for a pulse, he said there is none and was going to get the defibrillator. I told him to forget the defibrillator and start CPR. My partner was starting an IV as the rescue arrived. After a brief report we were off to the hospital.
As I pulled away I looked back and saw several officers trying to console this man's wife. He was 65 years old and he shot himself in front of her, ending a 5 year battle with depression. I remembered realizing that with his depression coming to such a violent end, she will now carry on his pain with a violent beginning to her own depression.
Despite the lousy night I had with driving I had my focus back for this drive. It seemed as though I could see every bump miles before we reached them, and made a safe quick trip to the trauma center.
15 minutes after arrival, at 4:03AM, our patient was pronounced dead by the trauma doctor. We all left the room a bit quietly after looking at the devastation a single bullet caused to this man's head. The right side was completely open and his skull was shattered. Much of his brain and fallen out the side and there were many small shreds of gray matter on the floor. We knew that the mess in the back of the ambulance would have to be handled at the main ambulance hub so we threw the unclean stretcher back in and made way for home.
As we arrived I opened the back doors and had a look at the big mess. There was blood everywhere and small pieces of brain matter. Giant pools of clotted blood making long stretches of half solid/half liquid blood near the corners and the stretcher catch. I grabbed a rag mumbling about the mess when as I started to throw pieces away it dawned on me. This wasn't a mess I was cleaning up, this was a person I was cleaning up. These little pieces of his brain once held hopes, dreams, aspirations, and his memories. It was somewhat saddening to think of it this way, but once I had begun, I couldn't think of it otherwise.
It took over an hour and a half to get the back cleaned up. Blood was everywhere. We estimate he lost about 2/3 of his blood in the back of our truck. I had cleaned up blood, guts, vomit, and even stool one time from the back of the truck. This time though there was a definite sadness to things. It didn't gross me out to pick up his remains, but rather it saddened me to hold a piece of his 65 years of life, a memory that no money could buy, or a dream that was never realized, gone with a gentle squeeze of a handgun.