could you please stop breathing, please?

code 2 calls: no lights, no sirens, obeying all traffic laws. minor injury, minor illness, major drunkenness. not a big deal.

code 3 calls: lights, sirens, go through stops and reds and aging yellows. major injury, major illnesses, major drunkenness. probably not a big deal.

so one friday night around two a.m. or so, my partner and i were dispatched to a call for a code 2 police-requested evaluation for an assault. usually these are non-transports for someone who scuffled with another and now has a busted lip, a black eye, and a bruised ego. often these calls are a gift of an ice-pack, some sympathy, and having them sign a release so that they can go home and put a bag of frozen peas on their injury. this particular call was in a fairly rough area of the city, "the hood." we slowly drove to the call and saw about five police cars and some yellow tape... yellow police tape for the minor injury... weird.

it was my partner's turn to tech this call, so when i pulled up, he got out with nothing more than his patient care report. i saw him walk under the police tape and he took a look at the patient who was lying on the sidewalk about 25 feet from the ambulance. "dude... grab EVERYTHING," he yelled to me as I was walking toward them.

i gathered the jump bag, the monitor, the ecg, a backboard, and a collar. the patient was an asian male, about 25 years old, lying face-up on the sidewalk, with what looked to be about a quart of blood leaving his head. i called for more assistance. this job was bigger what the two of us could handle.

this patient, this victim... he was in a BAD way. he was lying face-up with his head cocked slightly right. his mouth was half open, his eyes... wide open. his forehead... man. his forehead had a hole in it above the left eye, and just to the right of that hole, and i'm not lying here, was brain matter about the size of a soggy crouton. if this wasn't bad enough, the guy was breathing. i couldn't believe this. brain matter outside of its house with signs of life is rare. and not only was he breathing, but he was making a good amount of noise with his groans. we were going to have to transport this guy who was gonna die at any moment. i wanted to just stand there for about twenty seconds or so and let that happen, but we really don't have that option.

the extra resources arrived on the scene and then everything got a little crazy. some people are pretty calm when shit goes down, and others simply are not. there was an engine emt who arrived... a short female about 30 years old or so who just started flipping out. my partner and i were being methodical. it's all an algorithm what we do out here, and it's best to follow that model calmly. you'll get more accomplished faster and more efficiently. but this emt didn't believe this philosophy, or perhaps never heard of it, and she began to flail around like like someone being startled on america's funniest home videos. "oh my god, we've got to get the fuck out of here! he's shot in the head!" yeah... no shit.

we loaded the patient in the ambulance and the engine paramedic, my partner, and this emt all went in the back. we told the emt that she didn't need to go, but she either didn't hear this or didn't care. it's hard to read a crazy person. i think she thought she could save this guy. because of this, i was able to get into the front seat and drive. i was pretty relieved as i really didn't want to deal with patient who i was sure was going to die on the way to the hospital.

and he did. about one minute into the transport i saw the emt starting chest compressions and my partner was attempting an intubation. the other paramedic was busy trying to get an iv, and it just looked frantic. i could hear them getting frustrated with eachother, "don't stop your compressions!," "did you get a tube yet? what's the problem!?," "CLEAR!" i felt lucky to be in the front.

we pulled up to the hospital and i opened the back door. all three of them were sweating, were irritated, and were doing their best to resuscitate someone who had no chance. as we were rolling the patient into the emergency room, we left a trail of blood that was leaking through the many layers of gauze that was on the back of the patient's head. this guy was shot through and through.

because this was my partner's call, he had to do all the charting for this patient, and because i drove, i had to do the clean-up. i definitely got the short end of stick on this round.

the back of the ambulance was the worst i have ever seen, and i've seen a lot of really bad ones. first of all, the equipment was all over the place, and they used a lot of it. the airway kit, suction, the ekg, a bag valve mask, gauze wrappers, it was like we crashed the ambulance and everything flew off the shelves. and not only were they all over the place, but they were bloody and some of the equipment was reusable. and speaking of blood, it was everywhere, on the floor, the bench seat, and worst of all, in the gurney tray. the gurney is loaded up into the ambulance in a metal cradle which is about seven feet long and a couple of feet wide which locks it so it doesn't roll around during transport. the tray has edging around it which is about an inch high. that gurney tray had a small lake of blood from the front to about two feet back, filling it about 1/2 inch high. i've never seen anything like it, and it was fucking gross. blood congeals extremely fast so this was like a crimson half-set jell-o.

like i said, the back of the ambulance was really bad, but the gurney itself was worse.

not only did we leave a trail of blood while we entered the hospital, but even as i rolled the empty gurney back outside to the ambulance, it was still leaving it's mark. i took the bloody sheet off, tossed it in the biohazard can, and then took off the pads so that i could hose them and the gurney down. the gurney was a wreck, from the bed to the wheels. i took a rag and began to wipe down all the obvious bits. i started at the head of the gurney which was the worst. i was wiping the blood off the head of the gurney and saw a small piece of flesh. as i wiped over it there was a scraping sound like fingernails on a chalkboard and it raised the hair on my forearms. the scraping came from a small skull fragment. i threw the rag into the biohazard can and shaking my head i wondered how i ever got into this profession.

i realized that feeling lucky for not having to tech this call was premature... the clean-up of this mess was far worse. on a regular call you can get an ambulance ready to go in about five to ten minutes, 20 if it's pretty messy. this took me a little over an hour to clean and a couple days to clear out of my head.

turns out this was some sort gang-related execution. someone took a pistol, put it right up to this guy's head, and blasted him. how he was breathing and making noise with a piece of brain matter on his forehead and falling skull fragments i'll never know... but i hope i never see that again. it's just too messy.