Dripping With the Milk of Human Compassion

“Where do you want to park?”

“Doesn’t matter. As long as it has some shade.”

“We could park outside of McAlister’s…”

“Fine with me.”

“Or we could pull around behind the medical mall. Would that be okay?”

“Sounds good.”

“Do you need a Coke or something first? Want me to run by the Jiffy Stop?”

“Nah, I’m good.”

“Well, we could park on the back side of the Jiffy Stop, and that way you could just run inside if you wanted a Coke or a snack or something…”

“Fine.”

“…but I’ll park wherever you want me to.”

“WILL YOU SHUT THE FUCK UP AND PARK, ALREADY?
For Pete’s sake, what is it with you and all the questions? Do you find it that difficult to make a decision?”

“I’m sorry. You just…intimidate…me. I don’t want to fuck up.”

Intimidate? Moi? I am Mister Warm and Fuzzy. I am nice to old ladies. Children love me.

“Have I ever, even once, jumped your ass for anything?” I ask tiredly. “What has you so afraid of me?”

“Nothing you’ve done, AD,” she concedes. “You just have this… reputation.”

Reputation? REPUTATION? Jeez, don’t tell me this whole Doctor Ambulance Driver thing is going around again…

“People call you Doctor AD,” she explains. “They say you know more than most of the doctors around here. I just want you to think I’m a good paramedic.”

I roll my eyes knowingly. “They say I’m better than the doctors, or do they say I think I’m better than the doctors?”

“Well, some of them say you think you’re better than the doctors,” she clarifies, “but most of them actually say you are better than the doctors. And frankly, that intimidates the shit out of me when I work with you.”

“Allison, I can’t control what people say or think about me,” I sigh tiredly. “I have my head up my ass just as often as anyone else. I screw up. I make mistakes. And contrary to popular belief, I am not an egomaniac who thinks he is more qualified than any of the ER docs around here. I’m a college dropout. Even the worst of them has three times the education I have.”

She says nothing, just raises an eyebrow.

“Okay, maybe I’m more qualified than Dr. Kirk, but he doesn’t count. Even the other doctors think he’s an incompetent ass.”

“I’m really not like this all the time,” Allison explains earnestly. “I only get this performance anxiety when I work with you.”

“What does that have to do with finding a fucking place to park the ambulance?” I whimper plaintively. “It’s a hundred degrees out there, the air conditioner ain’t working worth a damn, and all I want is to find a shady spot and go to sleep until Satan calls our unit on the radio. You don’t have to kiss my ass or cater to my every whim. You’re my partner. I’m not going to bite your head off, Allison. “

Do you think I’m a good medic, AD?” she asks, almost tearfully. I groan and lean forward, banging my head repeatedly against the dash.

Yes – bang, bang – I think you’re a good medic – bang, bang – you’re the best darned medic I’ve ever worked with – bang, bang – plus you’re smokin’ hot and every guy that works here envies me for working with you – bang, bang – and I’ll pledge my undying love and respect if you will just find a shady place to park this fucking diesel-powered sauna – bang, bang so I can do my fucking Sunday crossword and catch a nap – bang, bang – PLEASE. I’m begging you.”

Allison sighs and pulls the rig around to the back side of the medical mall, parking under the awning in the shade. The radio stays mercifully quiet as I finish my crossword, and I roll my rain gear up to serve as a pillow, prop my head against the window and try to find a comfortable position. It isn’t easy. The air conditioning has barely begun to cool the rig, and the temperature outside is already approaching ninety – at 9:30 am.

I am six-feet-two and, shall we say, big boned. A less charitable definition might define me as fat and hopelessly out of shape. Even our biggest units lack the legroom for me to be comfortable, and I can’t go lie down on the stretcher to catch a nap. I can’t rely on Allison to hear the radio if we should both doze off, not to mention the fact that she is incapable of navigating the parish without my help, so I stay up front and try to wedge my bulk into a semi-comfortable position.

The air conditioner blows gently on my face as I slowly drift off to sleep…

“Control to 307,” says a disembodied voice, then repeats it again, with an edge. “Control to three.Oh. Seven.”

I awaken with a start and look over at Allison, head back and snoring with a cardiology book propped on the steering wheel.

“307,” I respond. “Did you have traffic?”

“Ten-four, 307!” comes the snippy reply. “Traumatic injury, 2354 Johnson Ferry Road. Parish Fire is responding.”

What kind of traumatic injury, Control?”

Penis caught in a zipper? Chainsaw massacre? Thermonuclear detonation? Another ostrich attack? Would it trouble you to provide a little more information, Satan?

“Unknown at this time, 307,” comes the unhelpful reply. “Bad cellular phone connection, and we’re not sure on the location.”

“307 en route,” I yawn as Allison puts the rig in gear and engages the lights and siren.

“I hate that bitch,” she mutters as we pull into traffic. A green Chevy Lumina panic stops in front of us, forcing Allison to swerve to the right.

“Hate is such a strong word,” I tease. “Besides, she can’t help the way she is. The head injury left her with nothing but a sour attitude and the ability to tie her shoelaces. And dispatch, of course. We should be happy she can still control her bowels.”

“She hates my guts,” Allison says adamantly. “She always gives me the shit details.”

“I’ve noticed that. Since I’m your partner, I tend to get splattered with it, too. She hates you because you’re young and attractive, while she looks like six pounds of soft shit in a four pound sack. Plus, she hasn’t been laid since the Reagan administration. She’s entitled to be a little cranky.”

“She is evil, and she must be destroyed,” Allison intones solemnly, then brakes hard at the Interstate on-ramp. “Which way?”

“Westbound,” I say, pointing. “I’ll agree she is an agent of Satan, but her duties are large
ly ceremonial.”

Allison floors the accelerator as we merge onto the Interstate, and the old rig lumbers up past eighty-five and tops out there. Eighty-five doesn’t sound fast, unless you’re in a vehicle with a braking distance and turn radius slightly smaller than the average ocean liner. I whimper silently and suck a little bit of velour up my ass as Allison crowds a slow-moving Ford pickup. She curses and honks the air horn repeatedly.

Our Father, who art in Heaven…I wish she wouldn’t pick emergency driving as the avenue to demonstrate her assertiveness and confidence. She drives like a fucking NASCAR driv – JESUS CHRIST! She’s going to kill us both.

Allison becomes aware of my feet stomping the imaginary brake pedal as she weaves back into the other lane, with scant feet between our rear bumper and the car behind us.

“Idiots!” she says disgustedly, but with an insanely happy grin on her face. I reply with a sickly grimace of my own.

“Remember the First Axiom of Emergency Driving,” I say through gritted teeth as I grip the Jesus Handle on the windshield pillar. “Anyone driving slower than you is an idiot. Anyone driving faster than you is…a maniac.”

“Are you okay?” she asks with a concerned glance.

“Just fine!” I lie. “You know, it does us no good to get exactly halfway to the scene really, really fast.”

“Sorry,” she blushes, easing her foot off the accelerator.

“Take Exit 37 North,” I direct, “about three miles up. Johnson Ferry Road is way the hell up Highway 22. It runs back toward the river.”

“Gotcha,” she nods. As we exit off the Interstate onto less congested parish roads, I lay my head back on the seat and try to think Happy Thoughts.

“Just go north until you get to the fork in the road,” I yawn sleepily. “Johnson Ferry goes to the left. Wake me up when we get there.”

Ten minutes later, I feel the truck brake hard and yaw to the left. I open my eyes just in time to see the Johnson Ferry Road sign flash by my window.

“Have a nice nap?” Allison inquires sarcastically. “Thanks so much for all the help navigating.”

“Don’t mention it,” I say graciously. “Take it as proof of my utter confidence in your stellar paramedical skills.”

“So where are we going?” she asks, scanning the side roads.

Damifino. And neither does dispatch.

“Slow down and look for a water trail,” I advise, only to get a blank look in reply. I smile tolerantly. “Metropolitan Parish Fire Department has a station not five miles from here. If I were a betting man, I’d say one of their small tankers is already on scene.”

As if on cue, the radio crackles, “Parish Fire to Corporate Greed EMS Unit responding to the incident on Johnson Ferry Road.”

“CGEMS 307, go ahead.”

“ETA, 307?”

“No idea, Parish Fire. Where are y’all?”

“Come all the way to the dead end. The patient is in the woods about three hundred yards down a logging road. Man had a tree fall on him.”

I’ll bet that smarted.

“We see your truck, Parish Fire. Control, you can mark our unit on scene.”

Allison pulls the rig to the logging road and pauses there hesitantly. “Whaddaya think?” she asks.

I roll down the window and look at the rough trail. It looks firm enough. God knows, there is no mud. Everything is parched, covered with six inches of powdery dust.

“Should be okay,” I judge. “Plus, I’m not all that jazzed about walking three hundred yards through this shit. Let’s see how close we can get to this guy.”

She eases the rig down the logging trail, and my judgement is soon proven correct. The trail is indeed firm enough to hold the rig.

Unfortunately, it’s also only slightly less rough than an oxcart ride across the Himalayas, with the oxen going at full gallop. Not that it matters, though. This is going to turn out to be a body recovery.

Perhaps a couple of hundred yards down the logging road, we find a clearing with a small Caterpillar dozer parked in it. Beyond it is a cluster of people kneeling behind a log, several of them wearing the blue tee shirts of the Metropolitan Parish Fire Department.

“Well look who it is,” grins one of the fire department EMTs, “Beauty and the Beast!”

“Don’t call my partner a beast,” I admonish. “She’s sensitive. What have we got?”

“Guy was cutting out some dead falls, and he cut the wrong one,” he straightens up, gesturing at the man laying on the ground. “The one he cut was holding another one up, and it fell on him.”

Oh shit, that guy ain’t good. In clinical terms, he is Circling the Drain.

“I told him to leave that damned snag alone,” another logger says, anguished. “There was a bunch of vines between the two trees, and when the tree he was cutting fell, it jerked the rotten snag down on him.”

“How ya doing, partner?” I say gently, kneeling next to the man. He’s lying on his right side, and his skin is an unhealthy gray. I place my hand on his shoulder and am struck by how cool he feels.

“Can’t breathe,” he gasps painfully. “And my back hurts, too.”

No shit. You’ve got a knot the size of both my fists right at the base of your thoracic spine, and from the looks of things, a crushed chest as well. Plus, you’re probably paralyzed.

“My partner’s gonna put some oxygen on you to help with that breathing, partner,” I reassure him, “so just take it slow and easy, and we’ll get you outta here pretty soon. What’s your name, anyway?”

“Larry,” he gasps, sucking in shallow breaths of 100% oxygen. Around his neck is a No Neck cervical collar, pitifully small for a man of his height. Larry is tall and rangy, with a farmer’s tan – brown neck, arms and hands, fish belly white torso under the filthy tee shirt the firemen had cut away

Well, now we know that the No Neck Fits Everyone Society still has plenty of members. At least they had started assessing him, though.

I slowly run my hands down Larry’s torso, noting the coolness of his skin and the Rice Krispies sensation of subcutaneous air under his armpits. Broken ribs on both sides of his chest click as I palpate, accompanied by an agonized groan from Larry. I gingerly probe the massive swelling on his back, expecting to feel pulp. I am not disappointed.

“Larry, can you feel me touching your hands?” I ask, thankful for the affirmative answer. “Okay, now how about your feet? Wiggle your feet for me, please.” Larry complies, moving both feet.

Okay, I am officially fucking amazed.

I look up to see Allison hovering nearby, holding the portable oxygen tank.

Okay, so we’re back to you acting like the subordinate and letting me run the calls, is that it? At some point, you’re gonna have to fly on your own.

“Want an IV?” she asks.

“Nope,” I shake my head. “We’ll get that in the rig. We gotta go now, and we’ve done all we can do here. I want a rapid diesel bolus to West Big City Regional as soon as we can get him loaded, so bring me the spine board.”

“Already got the board right here,” calls one fireman, attaching straps to the board as he talks. “Want me to get the stretcher?”

I look around at the minefield of stumps, small saplings and sawdust, and the powdery fine dust that permeates everything in the area.

“No, I think we’re better off just carrying him to the rig on the spine board. But I will need just about every sheet and towel you can find.” He nods, hands the spine board to his partner, and sprints for the ambulance. I motion Allison and the other two firefighters into place beside Larry.

“Hey, Larry?” I warn. “We have to put you on a board in just a few moments for the trip out of here. It’s probably gonna hurt, man.”

“Can’t you give me something for the p-p-pain?” he gasps.

I wish I could, brother. Even though I don’t have a blood pressure on you, but I’d bet money it’s pretty damned low.

“I’m sorry I can’t, Larry,” I apologize. “Maybe once we get you to the truck, I can d
o something about that.”

After I’ve done all sorts of other painful things to you, of course.

The firefighter I sent to get blankets is back, waiting expectantly.

“Lay them out on the board,” I direct. “Pad as much as you can all along the board, but leave a hole for his back.”

The firefighter nods his understanding, hurriedly taping blankets to the board. He kneels next to the patient and wedges the board behind him, and with a lot of grunting and some semi-coordinated pushing and pulling, we get Larry secured to the board. He’s even still able to move his legs afterward. No small victory, that.

Larry’s color has me worried. I’m pretty sure he has bilateral pneumos, and no doubt some intra-abdominal bleeding. His radial pulses are rapid, weak and thready and his breathing is shallow. I’d like to listen to his breath sounds, but I left my stethoscope in the rig.

Improvising, I place my hands on either side of Larry’s chest, mentally wincing at the rib crepitus I feel there. “Larry, I need you to do me a favor,” I tell him. “Repeat a phrase for me. I want you to say the words ‘ninety-nine’, okay?”

“Ninety-nine,” he heaves. “Dude, I’m thirsty.”

Add that to the growing list of Bad Fucking Signs. At least you have tactile fremitus on both sides of your chest, so your lungs haven’t totally collapsed. We need to get you to the truck without paralyzing you, though.

I catch Allison looking at me worriedly. “That ride back to the blacktop is going to be rough,” she says quietly. “Do you think he can take it?”

She’s reading my mind. No, he can’t take it. We drove in at a crawl, and still I was banging my head off the bulkheads. It’ll be ten times worse in the patient compartment, and rolling the stretcher down this pig trail ain’t an option either.

“It would probably be a good idea to turn the rig around and drive back to the road,” I answer. “The firefighters and I will carry him out to the road. We’ll meet you there.”

Allison nods and sprints to the rig as we each grab a corner of the spine board and heft Larry off the ground as gently as we can. None of them seems particularly enthused at the prospect of toting his 180-odd pounds the three hundred yards back to the asphalt. We draft the other logger into Sherpa duty, carrying the rescue bags and oxygen cylinder.

“Okay guys,” I sigh. “Let’s do it, as smoothly as we can.”

At my direction, we start carrying Larry out of the woods. We haven’t made it the fifty yards through the clearing before I can hear my body talking to me:

Brainstem: “Uh oh. I sense some physical exertion here. The Fat Boy ain’t exerted himself this much since the stampede at the All You Can Eat Crawfish Buffet. Okay, let’s get moving folks! Sympathetic nervous system, we need some adrenaline! Lungs, deeper and faster! Heart, you know what to do!”

Adrenal glands: “One huge dose of epinephrine and norepinephrine, coming up!”

Heart: “Holy shit! Who stomped on the gas?”

Lungs: “Faster and deeper, check! Stretch receptors, kwitcher bitchin!”

Muscles: “We need a nap. Y’all keep the noise down up there!”

Brainstem: (sending a jolt of nerve impulses and increased blood flow to my skeletal muscles) “Wake up, you sluggards! Get with the program here!”

Muscles:
(whining) But we don’t wanna! It’s too haaaaaard!”

Forebrain: “This ain’t so bad. I can do this. Maybe I’m not in such bad shape after all…”

Brainstem: “Uh oh, the sensors are detecting False Sense of Security and elevated levels of Self Delusion in the anterior cingulate gyrus. Release the Harsh Dose of Reality neurotransmitters!”

Heart:
“I canna go much faster, Cap’n. I can maybe squeeze another thairty beats or so a minute, if you give me a wee bit o’ time…”

Lungs:
“Okay, activate the Wheeze Mechanism!”

Muscles: “Okay, evidently Brainstem didn’t believe us when we said we’re sitting this one out. Send the bossy fucker a Cramp Message.”

Firefighter: “AD, you okay? You look a little…winded.”

Forebrain: “Did he just say what I thought he said? Pride, tell him to fuck off!”

Brainstem: “Okay, I’m detecting dangerous Hostility levels toward young, physically fit firefighters. Activate the Good Teamwork Internal Censor. Battle Stations, everybody! Heart, dammit man I need more power!!”

Heart: “I’m givin’ her all I’ve got Cap’n, and she’s barely holdin’ tageth’r!”

(Yes, my heart sounds just like James Doohan from Star Trek. Yours doesn’t?)

Hypothalamus: “Hey, I’m getting elevated temperature readings on all sensors! Activate Emergency Cooling Measures! Surface blood vessels, dilate! Sweat glands, activate!”

Sweat Glands: “Gimme a fucking break! He’s a fat guy! We’re ALWAYS running at 110% rated capacity!”

Firefighter:
AD, you okay? You need us to stop and rest? Hey guys, I think AD is gonna pass out.”

Forebrain: “Fuck you, you disgustingly fit little simpleton. Take your young ass back to the station and polish your fire truck or something. Go lift a weight or something. Okay Legs, you can do this. Right. Left. Right. Left. Deep breaths. Can’t help Larry if you die from a heart attack first.”

Heart: “Dinna tempt me, ya’ fat bastarrd. Twas you got me inna such poor condition inna fairst place.”

Brainstem: “Uh oh, was that a Pep Talk? Okay everybody, you know what to do. REVOLT!”

Muscles: “Way ahead of you, Brainstem. Okay, Cramp Actuator wide open…NOW.”

Lungs:
“Cough. Wheeze. Hack. Choke.”

Anal Sphincter: “Someone call my name?”

Stomach: “Send up a belch. Stand by for full reverse on the Peristalsis!”

We stagger the the back of the truck with my body in full revolt. What muscles that aren’t rubbery are cramping painfully. I’ve sweat so much that my uniform is entirely soaked, as if I had put it on directly from the washer. The powdery dust has adhered to my wet uniform, making me look like a big, fat, wheezing sugar cookie. My heart is hammering, my ears are roaring, and I can’t summon the breath to even speak. Luckily, Allison doesn’t need verbal directions to position the stretcher behind the truck with the rear doors open.

We strap Larry to the stretcher and load him into the rig, and I clamber in behind him. Allison already has two bags of fluid hanging.

Thank God. I think I’m going to need one of them for myself.

“IV access,” I croak to Allison as I stagger to the front of the truck, ripping my shirt open and standing directly in front of the air conditioner vents. I grab a blanket for Larry and toss it to one of the firefighters, motioning for him to drape it across my patient.

There’s no room to move – too many people in the truck. Firefighters are cutting the rest of Larry’s clothing off, Allison is starting an IV, and the fire captain is standing at the foot of the stretcher.

Fucker looks almost as bad as I feel. At least I’m not the only one here who is outta shape.

“So thirsty,” Larry whispers. “Can’t breathe.”

I motion for one of the firefighters to open a cabinet. “Water,” I gasp. One-word sentences are about all I can manage right now. I can see the incredulous looks on everyone’s faces even as I say it.

He’s not actually going to let this guy drink water, is he?

I motion impatiently for the water, but the firefighter finds nothing in the cabinet but bottles of sterile saline for irrigation. Suppressing the urge to whimper, I dig frantically through the oxygen cabinet and find two sealed humidifier chambers. I cut the tops off with my trauma shears and chug them down, right in front of Larry and the incredulous firefighters.

“Dude, what about me?” begs Larry plaintively. “You’re fucking cruel.

I scoot Allison off to one side as I collapse on the bench seat. She finishes taping down her IV and looks at me expectantly. “Go,” I gasp, making a whirling motion in the air with my finger, praying that she interprets it correctly to mean lights and sirens.

She cocks one eyebrow as if to say, “You got this?” I nod reassuringly and give her a sickly smile. Allison scoots out the side door, slams the doors, and presently we are heading back the way we came, lights flashing and siren wailing.

I can’t hear Larry’s lung sounds in the back of the rig, but there is more subcutaneous emphysema in his axillae and the pulse oximeter won’t get a reading. I open
the IV wide open, wrap the automatic BP cuff around his arm, and fetch two long 14 gauge catheters from the IV cabinet.

Larry looks at me accusingly as I drain the last drop of water from the humidifier chamber with one hand while I swab his chest with the other. “So thirsty, and you’re drinking water right in front of me,” he says faintly. “Cruel bastard.”

You have no idea, Larry. The difference is, if you puke, you choke on it. If I puke, I just get the floor messy.

“I can’t give you any water,” I tell him as I unsheathe the needle. “And this may hurt you, but right now I’m trying to save your life.”

Without further preamble, I pierce Larry’s chest with the needle, right above the third rib in the mid-clavicular line. Air rushes out, and Larry barely has the time to grunt before I repeat the procedure on the other side of his chest. I slump back on the seat and punch the button on the automatic BP monitor.

So far, so good. If I can keep from passing out, we both just might make it. And his blood pressure is…what, 94/60? Not as bad as I thought, but he’s had five hundred of saline. Time for another IV.

As I’m looking for a vein in the other arm, I thumb the speed dial button on the cellular phone, still docked in its cradle.

“West Big City ER, this is Jeremy speaking. Go ahead with your report.”

“Hey Jeremy, it’s AD with Corporate Greed EMS. We’re…” I pause to look through the divider window between the patient module and the cab, and Allison holds up one hand, flashing all five fingers, twice. “…ten minutes out with a severe chest trauma, logger hit by a falling tree. Bilateral pneumos, probable thoracolumbar fractures, too. GCS 15 right now, though, and he’s moving everything. I’ve decompressed his chest, got him packaged, working on a second line. We’re gonna need a Trauma Room.”

“Vitals?” he wants to know.

“94/60, heart rate 136, respirations 30, saturation unobtainable.”

“Good enough,” he replies. “Room One on arrival. We’ll be waiting.”

I brace my forehead against the cabinetry and make the stick on Larry’s right arm, sinking a second 16 gauge catheter just inside the bend of his elbow. He winces and cries out.

“Goddamn!” he curses me. “Dude, I’m hurting here, and I’m sooooo thirsty. Don’t be cruel, man.”

Yeah, but you’re obviously breathing better. And your sat is starting to come up, too.

“Actually Larry,” I tell him, “I am fucking dripping with the milk of human compassion. It’s just that I can’t give you either of those things in your condition.”

Before Larry can reply, the truck slows and yaws right as Allison takes the Interstate exit to West Big City Memorial. We’re less than thirty seconds from the Emergency Department. I spend the little time I have left doing a quick secondary survey, looking for minor injuries. In addition to what I’ve already found, I suspect his left scapula is broken as well. His vitals have improved markedly, though.

“A ten foot section of tree trunk maybe two feet in diameter fell off the top of a dead snag,” I tell the ER doc as we wheel Larry into Room One. “Hit him square between the shoulders. Broken ribs on both sides, probably left scapula, too. Big deformity to his lower thoracic and upper lumbar spine – we padded as best we could. I decompressed both sides of his chest. He’s had a little more than 1500 of saline. Vitals as we were pulling in were BP 104/66, pulse 120, respirations 24. Saturation is up to 91% on high flow oxygen.”

“Neuro deficits and level of consciousness?” Dr. Shepherd asks, stepping back to allow a portable x-ray machine to be maneuvered to the bedside.

“Awake the whole time,” I answer, leaning unsteadily against the wall. “I never asked him if there was a loss of consciousness prior to our arrival. Motor and neuro intact in all extremities.”

“You okay?” Dr. Shepherd asks.

“Actually, I could use a couple of ice packs, a wet towel and a large glass of water,” I tell him.

“I can imagine,” he chuckles. “Hot as hell out there.”

“No Doc, you don’t understand,” I tell him, gripping the door as I try to stem the overwhelming dizziness threatening to engulf me. “Unless I get cooled off, right now, you guys are gonna be picking me up from the floor.”

“Get the stuff,” he says curtly to the unit clerk hovering outside the doorway. Shepherd scoots me down the wall a few feet until I’m out of the way of the resuscitation team, and then eases me to a sitting position on the floor. Presently, the clerk brings me the wet towel, ice packs and water.

“Thanks,” I tell him gratefully, draping the towel over my head and placing the ice packs on my neck and forehead. Dr. Shepherd turns his attention back to managing Larry’s chest trauma. I sit for a few minutes as my head gradually clears.

“I don’t know how you do it, AD,” the clerk says admiringly. “You damned near kill yourself trying to save a stranger’s life. I couldn’t do what you do.”

“Yeah,” I sigh ruefully. “I’m a real giver. Larry and I were just talking about how damned compassionate I am.”

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