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I Wasn't Born a Crusty Ambulance Driver...My First Run...

Posted Aug 19 2009 5:03pm
I wasn't born a Crusty Ambulance Driver. At one time I was a sympathetic trainee, in the back of the box. I was scared, conscientious, enthusiastic, and compassionate. At one point, I even remember getting fired up, thinking, 'I'm going to learn my job so well that nobody will ever die in my care.' This was long before the box beat my ass, over and over again, and transformed me into the ugly, cantankerous, crusty, shell of an EMT I am today. I look in the mirror and I hardly recognize the mean old bastard I've become.

I don't know if it was my first day or first run, but it's the first day I remember being on the box. I was in EMT school, doing my ambulance rotations. I remember actually being excited for my first several runs. I probably even had butterflies. I carried my EMT textbook with me so I could look up things I didn't remember, in order to more thoroughly care for my patients.

Who knows what the call was dispatched as. Back then, I was naive enough to think every call was an extremely life-threatening emergency. When we arrived on location of an old, do-it-yourself carwash, we found a man lying in the prone position, on the ground, and he was surrounded by a bunch of hobos, who were apparently his "roommates." The weather was very cold; the temperature outside must have been in the mid to high 30's.

My preceptor walked up to the patient, walked a half-circle around his head, and within 5 seconds, declared, "yep, he's dead."  I thought, 'What?!!! How do you know he's dead?!!...You didn't even check for a pulse, and we learned in EMT school that a person's not dead until he's WARM and dead.' Trying to suppress my surprise & disgust, and trying not reveal that I doubted him, I humbly asked my preceptor, "Not that I doubt you...I'm just trying to learn...but, how can you tell he's dead?"  My preceptor curtly responded, "Just look at him!"

I looked at him and saw that his face was purple, but I figured it was just because he was cold.  I asked, "Should someone check his pulse?"  He flippantly said, "Go ahead, but he's dead." Finally becoming frustrated, my preceptor grabbed the hobo's shoulder and rolled him over.  Pointing to his face, he asked, "See the lividity?" The hobo's face was flattened by the ground, and it didn't bounce back when he was rolled over (odd!). The front of his face was purple, and there was a clear line where the purple ended and white skin began. However, not really knowing what lividity looked like back then, I lied and responded, "Oh yeah, I see the lividity."

I was slightly intrigued and simultaneously horrified to see his face. Up to that point, I don't think I had really seen a dead guy in person, and it seemed weird to be looking at a real dead guy. I pretended like it didn't affect me. I also felt a little weird about saying he was "dead," right in front of the dead guy. I thought it might make him feel bad or something (...feel self-conscious about his dead-ness).

My preceptor further pointed out the rigormortis and showed me how to check for a pulse. Even though I had already been pretending to realize that he was dead for a long time, at that moment, I finally realized, for myself, that he was probably dead.

We interviewed his friends and asked about his medical conditions. One of the hobos explained that he had breathing problems, and he used an inhaler. My preceptor asked if he knew where the inhaler was. The dead hobo's friend said, "Yeah, I actually have it," and then he explained that the dead hobo kindly loaned him the inhaler the night before, because he was feeling like he was starting to have breathing problems of his own. My preceptor then told the dead hobo's friend that the dead hobo probably had an asthma attack during the night, and since he didn't have his inhaler, he passed out, and then died from the cold.

The dead hobo's friend immediately started crying while looking at the inhaler in his hand, as if it was a gun that he had just used to murder his best friend. Tearfully, the hobo's friend explained what a great hobo the deceased was and how much he will be missed by all of his hobo friends.

I got a big lump in my throat, my eyes got glassy, and I had to fight to hold back the tears (I couldn't let my preceptor know I was getting all emotional over a hobo). I wanted to give the filthy friend of the dead hobo a big hug and bring him home with me. I remember wondering how I could personally help this hobo (and all hobos) so that HE didn't end up freezing to death, face down in an old, do-it-yourself carwash. Of course I did nothing beyond thinking I should help him.

That may have been the first and last time I ever felt sympathy for a dead hobo and his surviving hobo friends. Even though I believe I give an honest effort to do everything I can to help save ANY patient's life; I don't believe I'm capable of feeling the same compassion I felt for that hobo on that day. I don't know if it's a good thing or bad thing, but everyday I lose a little bit more of that compassion I was once capable of feeling.

This post was written for "The Handover, Blog Carnival."  This month's theme was, "The First Emergency."  All the submissions for this month's edition, from various bloggers, can be found at: http://medicblog999.wordpress.com/2009/08/27/the-handover-edition-7/
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