A Memoir
While I cannot recall a specific year, or a specific date, or even the specific patients I treated, I can remember their ghosts and mine as well. My memory, now at a disadvantage from both age and illness, is not what it used to be.
Back at the beginning, when I was young or new to this ambulance based pre-hospital world occupied by men, by the daring, the caring and by the broken I was in awe. Each time the Plectron would produce its’ mechanical set of multiple tones, I’d imagine the worst, which to those on the job were “the best” as far as calls went. I was in school to be a paramedic, or I was about to start my internship, the point being that I had yet to do much more than assist the elderly, run people to their dialysis appointments or transfer a bedridden patient from one place to another.
On this slightly overcast but warm day. I’d gone to visit a paramedic, Tom and his partner. I in my civilian attire and they in their uniforms, ready to head out to a call at a moments notice. They’d wanted a quick lunch and invited me along, so I jumped into the back of the ambulance for the few minute ride down the street to pick up some food. It wasn’t a holiday, there were no special events going on and the day had been quiet (which was a word I learned that you never say while on duty or with those on duty). There were very few calls for service and there was no reason to think our ten or so minute jaunt to pick up and bring lunch back to the station would be any different. Of course, it was.
Before getting to our fast food lunch, the tones blared from the bulky and burdensome old radios the men wore on their hips. The call was an MVA (motor vehicle accident). Code 3 (lights, sirens, with all haste). The location was Highway 92, halfway up the hill that separates the Pacific Coast and Half Moon Bay from the inland of San Mateo County.
Highway 92 was known for being treacherous when dark, wet or foggy. It wound back and forth with drops to the side into ravines that were filled with rocks and brush, and the other side steep rock and brush covered hills. While there were trees at the base of the road that to another freeway, the trees were few by the halfway point up Highway 92, and even fewer turnouts and passing lanes. The two lane road would be packed during the summer and weekends; beachgoers, families, campers and vans. I’d been on that road in the dark and in the fog, it was a discomforting drive as a young person. When I was tired, the windows would be rolled down and the radio on high just to stay awake and remain alert. That day though, from the back of the ambulance, I remember the sun shining in the mid afternoon and no major events were going on “over the hill”, as it was called.
Tom, who I called a friend, was in the front passenger seat. He would be the “technician”, or lead, for whatever would be found once we got to our destination. His job on the way to the call was to get radio updates, work through in his head all the possible scenarios; what additional equipment he’d need, what hospitals were on divert because the ER’s were full, what time frame was acceptable for a critical patient to be taken by ambulance versus landing a helicopter to fly them out. These were just a few of the things he had to consider before we got to where we were going. My job was to observe. While we worked for the same company, I wasn’t on duty. I wasn’t in uniform and I wasn’t trained to the extent that Tom and his partner were. No matter though, as most of these calls ended up being quite minor; someone with slight back pain who wanted to go to the hospital “just in case,” someone who may have lightly strained their neck and hoping that whomever caused the accident had enough insurance to cover the ambulance bill. Those were the typical results of this type of call.
On the way up the highway we lost the radio signal. At times it would come through momentarily like the desperately needed breeze on a hot summer day, but then it would fade out just as quickly. It took what seemed like an eternity to get to our destination, weaving through cars on the roadway, using the few wider areas with their slender dirt shoulders as our own lane, and finally as we rounded a corner seeing a vehicle on its side blocking both lanes. I don’t recall what Tom or his partner said but I do recall my heart starting to race, putting on my “work persona”, the face that shows no emotion, the voice that will not waiver, the reassuring hand that may lead someone to or away from something.
The ambulance stopped; the distinctive deep metallic ratcheting sound of the emergency brake being applied was a sound I could almost taste. Before I knew it one of the crew had thrown open the back doors of the ambulance, grabbed a jump bag (with trauma supplies) and signaled me to come out to assist. Once I exited the back of the ambulance, I came to see why they moved so quickly. I’d seen the car on its side while looking through the small transition area from the back of the ambulance to the front, but what I didn’t see were the people, standing in the roadways, their vehicle doors open. There was pointing and some shouting and I recall the sound of crying somewhere behind me.
Toms partner went around the car to the driver’s side, against the roadway. I stuck with Tom; we went to the other side, where the undercarriage of the car faced up the hill. Tom looked me in the eyes, I knew what he wanted; he was trying to see if I was “there,” able to function and follow his instructions. The look lasted a fraction of a second, but it was clear and concise, and within the same breath he started yelling instructions. It occurred to me that I was on my first really big accident scene and that I was actually going to be putting my training into use.
It didn’t strike me just how odd the scene was as Tom and I quickly knelt on one side of the body in front of us. A body, face down on the black pavement, lying still in the shade of the vehicle. No face visible, just the denim jeans with a bit of tummy rounding out at the top, a t-shirt, not ripped or torn. No sign of blood or deformity registered in my brain. Tom and I took our positions ready to roll the body over, ensuring that it would be in one smooth movement, the spine kept inline with the lower body, the head and neck aligned with the spine. When Tom gave the word we would roll the person so that he could assess the severity of the injuries. It was on his count. One, two, three. We rolled the body, me at the hip and legs and he with the head and upper body, we rolled very little until his voice, somewhat high pitched and just loud enough for me to hear, said stop. I froze. He took his right hand from the shoulder of the body, placed it on the pavement near the stomach and leaned over towards the face. It was then I saw the dark pool that was under the chest, the fluid that had started to coagulate just under the head, and as Tom leaned back it struck me. The body was a female, her neck had a thick choke chain, the type with big silver links that you’d see on a dog. Her t-shirt was a darker color with a rock band name or emblem on the front. I remember because I had to look away from her face. Tom stopped us rolling her because of her face, caught between the pavement and the drivers side front tire.
I don’t recall much after that, just images. Tom had checked her carotid pulse, and then he instructed me to gently lie her back down in the position we’d found her. He sent me to the ambulance to get a “CHP Blanket” and it was then that I knew she was dead. I don’t recall what happened with the other patient, though I know we didn’t transport anyone in the ambulance that day.
I ended up “decompressing” at the station. I don’t recall what we talked about, just that the three of us talked and Tom did paperwork. Later in the afternoon we would go drop off the “run report”. The report detailed the scene, where the vehicle was, where the bodies were, what Tom and his partner did and the time or which Tom “pronounced” death.
Tom, as young as he was, barely twenty, was always a teacher. He asked if I wanted to see the body as it was on the exam table. I indicated I’d be willing. We went in and this was the first time I’d gotten a good look at her. She was around seventeen, just a few years younger than me. With reddish brown hair, the front matted and tangled with coagulated blood. Her face was set upon the front of her head, like an ill fitting mask. It was still attached by pieces of skin on one side, but the rest was scraped, battered and seemingly not where it should be. This is the image that I have always remembered, the first real image of “death” in someone that was my age, a contemporary.
Years later, I’d run my share of calls on an ambulance as the ‘teacher’ and the medic. I’d seen my share of death, both old and young, from medical and traumatic causes. But, one day at work as a paramedic I received a call: Tom, my friend, teacher, contemporary, had apparently overdosed on his Insulin at his home. He was brain dead and on life support, awaiting an organ harvesting team.
To those who came to help him he was just another “call,” another set of tones and a code 3 response. For me, the news brought back the freshness of death, it brought back the image of that girl on the asphalt with her face hidden, seemingly just laid out to rest in the shade of the overturned vehicle. Death was new again, because it was the death of a contemporary, a fellow medic, a friend. Tom is now one of my many ghosts, a memory, whisper.
