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Monday, August 31, 2009

Hitting Close To Home

By Steven P. Velasquez
August 31, 2009

There are many ways that our jobs in emergency services hit "close to home." Most often, a patient may look, sound, or somehow remind us of someone close to us. Children are a big source of identification too. Most of us have a soft spot for the young, usually because of their innocence and the belief that they are, or should be, somehow excused from life's tragedies. Fatherhood has been the single greatest catalyst for change in my personal views on the world and the field I love so much. This time however, I would like to discuss something else that hits close to home -- our hobbies, passions and pass times -- the objects or activities we devote ourselves to when not out "saving the world."

A year ago I turned 40, and with the fast approaching pages of my mid-life about to be authored (crises yet to be determined) came the decision to purchase a Harley Davidson motorcycle.

A passion of mine since I was a teen, tearing up the Meadowlands of New Jersey on my dirt-bikes, I always dreamed of someday owning a cruiser. For years, life circumstances and finances obstructed the realization of this dream, but last year I finally brought her home and have loved and adored her ever since. Together, we've traveled over ten thousand miles, have joined a club, embraced a sunrise, parked on high peaks, hugged the shoreline and inhaled the salty ocean air together. We've coasted through historic towns and smelled the fragrances of the changing seasons. We've been stuck in the rain, battled the cold and raised money for charities together. We've even encountered a distracted driver or two and shamelessly interrupted their phone calls!

One thing I noticed with the purchase of a motorcycle is the sudden interest everyone has in telling me of any motorcycle tragedy within the continental U.S. I've never received so many pictures, videos and web links! People approach me to admire my bike's beauty, the shiny chrome, the glistening pipes, and are awed by the thundering exhaust -- then quickly switch gears and tell me about the beloved uncle they lost, the unfortunate friend who's a quad, or the great video they recently saw where the cops chased a land-rocket that got smashed by a tractor trailer on some reality show! Enough! I know it happens but have no desire to know about every single time it happens anywhere in the country. They seem to forget that I'm a paramedic for a living. I get it! I see it.

And that's where this story gains meaning for me; the part about seeing it. I've been in emergency services for more than half my life. I've seen a good bit of motorcycle trauma, not too much, but I know what it looks like. Recently at one of my jobs, other units responded to a motorcycle MVA that was dispatched as a possible DOA. The dispatcher added that the patient was eviscerated with his abdominal contents in the roadway. The BLS and ALS unit assigned to the job handled it, and the patient became pulseless enroute to the trauma center. When they arrived, I assisted getting him out of the ambulance. The ambulance looked like a twister had gone through it. I saw the patients' blood-soaked helmet laying on the floor and believing it may have some forensic value, I picked it up to take it inside. That's when a switch in my head had flipped. The helmet was the exact make, model and color as the one I use. One of my co-workers just purchased her first motorcycle a few weeks ago and she too, has that exact helmet. This job was now officially "close to home" as I no longer had the objective view of this patient but now saw him, strangely, as my possible future outcome. I felt like Scrooge with a front-row seat to one of his possible futures.

I went inside the trauma bays and watched the team work feverishly to resuscitate the patient. Like a hive of provident bees, they swarmed around their work and performed at a yeoman's pace. He was more fractured than he was intact. They hung fluids and blood, gave catecholamines and other life-saving medications. Finally, he had regained pulses. The physicians consulted about his horribly fractured leg. One said that as soon as the patient begins perfusing, he's going to bleed out from that site; and suggested they amputate the limb. I thought they meant upstairs, when the patient reached the surgical suite! No sooner did the words escape the Dr.'s mouth than another doctor whipped out a scalpel and began cutting along the circumference of the limb. Within seconds, they sliced, then gently applied pressure and pulled the patient's leg away from his body; no bone saw, nothing intricate. They cut with the same grace and ease as the guy at your local supermarket deli; and in a few seconds it was done. The patient's leg lay still on the floor, still wearing the sock and sneaker that he began this tragic night with. The patient was mortally wounded and hanging on by a thread, but "miracles do happen" I thought!

My thoughts followed a strange path to what kind of future this patient would expect to have if he did somehow live. Morbidity, mortality, length of stay, cost of treatment, rehabilitation, pain and suffering, medications, support from family/friends, future income and a long list of other thoughts began to race through my tired mind; thoughts alien to the newer "get the tube, get the line, let the surgeons figure out the rest" paramedics. Thoughts that probably appeared because it was now me laying on that table and not some random, unfortunate person.

After this patient was whisked off to the surgical suite, my motorcycle riding partner and I went back in service. An unnatural quiet joined us. Ironically, both of us rode our motorcycles (together) into work this evening. We even had a long discussion about serious motorcycle trauma with our Chief at shift change. Our now eerie silence began to unnerve me. I knew she too had been affected by what we had just witnessed. I also thought she'll talk to me if and when she's ready to. The night had given way to the day. Our shift had come to an end. The patient had also given way to his injuries and had passed on. I knew that in a few short days, somewhere in the city a sidewalk memorial with candles, flowers, balloons and a youthful, smiling picture would occupy some street corner briefly reminding passersby that someone was very loved, and had passed away there.

My partner and I rode home together after the shift. The unnatural silence came for the ride too. She and I rode off into the sunrise -- silent, without expression. We took it easy, rode the slow lane and let the hurried others pass. Both of us probably digesting how "close to home" this job just hit.

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