A nugget of Big Medicine every day. #64 Look for the clues
A long time ago, I worked with a paramedic named Mike ‘Elwood’ Crowley. I loved that I was The Jake* of the team.
While we called ourselves The Blues Brothers, we were known to the cops as The Yid & The Kid – and many of our elderly Jewish clients called Mike the ‘Semi-Kosher Shagutz’ because he was able to converse with them in fairly fluent Yiddush despite the fact he came from good Irish Catholic stock.
Once you got past the nomenclature, we were seriously good paramedics. We were both atop our respectives games and we were fiercely dedicated to providing the best possible care for each of our patients. We frequently ran afoul of the official rules but not because we were clinical cowboys. We always worked our patients up in the same manner and we never left a clue unfollowed. According to the rules available at the time, Mike and I were constantly under scrutiny for doing more than was officially required of us: load and go. Nothing more. No worries if less came with faster transit times to the ER.
The worst you could be accused of back then was ‘stay and play’ as if by paying careful attention to the patient, packaging he/she carefully, and listening attentively en route to the hospital you might compromise the great game of resurrection medicine that awaited once you crossed the automatic-door-opening threshold and arrived in the Emergency Room.
Mike and I were convinced that by taking it down a notch and gathering a full history complete with context and background information we could provide the receiving med or trauma teams with essential information that would help guide their efforts.
We were among the very first ambulance crews who carried a Polaroid camera [yes, we’re old] and shot pictures of the mechanism of injury so that nurses and docs would understand why the patient was fully immobilized even if he didn’t lose consciousness after being rocketed out of the front seat, through the front windshield, and out about 10 metres in front of his car.
The picture, however grainy and out of focus, usually was good for a few hundred words of explanation.
“No shit. Wow. That’s a helluva long way from the car. And you’re sure he didn’t lose consciousness? Wow.”
We rolled on some fairly wild calls back then.
There were the bank robbers who totaled their car in the Atwater Tunnel after the dye pack in the money bag exploded. I was the one who had to climb into the backseat and deal with Carl – the newly red and thoroughly traumatized trigger guy who was fixated on trying to gather the very marked bills with his open frac’d arm. That boy was seriously in deep shock mixed with equal parts denial and bravado. He giggled as we extricated him from the car – ten- and twenty-dollar bills plastered to his face with blood, sweat and grease. I don’t think we took a picture at that scene. No need, the patient’s presentation was self-explanatory.
We had a call for a road traffic crash where the driver of a car plowed into the back of a parked car at a high rate of speed. Both cars were ready for the scrapyard. Our patient was conscious but unclear on how the crash had occurred. One moment he was cruising down the street in his brand-new Mercedes and the next he was coughing as the air inside the car was filled with impact detritus. He was complaining of a burning pain in his throat. The airbags had deployed properly and there were no steering wheel tattoos on our patient’s chest. Upon getting up close and personal there was a faint odour of cigar smoke on the patient’s breath. ‘Were you smoking?’ ‘I don’t think so.’
The patient was adamant about refusing care and transport.
Mike was certain there was more to the story. He was looking for clues.
As it turned out, Mike’s brother-in-law was the service manager at Mercedes-Benz. They confirmed that the small burnmark we had found in the airbag was an exact match for the size of a cigar. As it turned out the driver had been distractedly trying to light up when he drove right into a parked car. The airbag punched the cigar right down our patient’s throat. Talk about a burning sensation. I suspect he probably gave up smoking cigars while driving.
Be well. Practice big medicine.
*Jake is a complimentary slang term for a firefighter.