Sunday, March 16, 2008

I am going to die aren't I?

It was just after noon on one of those scorching hot Florida summer days. I was on Rescue 1 with Mike Mahoney. He had been traveled in to ride with me. My normal partner was on vacation. We got a call for a shooting. A child was involved.

I worked Rescue 1 through traffic to a small ramshackle wood frame house. All the doors and windows were wide open. It had no air conditioning. We found a young boy about twelve lying on the couch. He had a hole the size of my fist just below his clavicle. He was staring up at us with frightened eyes. Silent. He did not cry or ask for help he just laid there.

It seems he and his brother or cousin, I never got he story straight, were playing with a 30-06 rifle. Somehow it went off. The rounded entered his back just below the shoulder. When it exited, it blew a hole large enough to put your fist in just below the clavicle. A huge artery runs just under your clavicle, if the bullet had lacerated that artery there would not be much we could do for him, but there was almost no blood from the wound. He was pale, cool and diaphoretic.

He was conscious and alert as Mike and I began to work on him. We bandaged his wound as best we could. With a wound as large as his was it was difficult. The best way to bandage a wound is to wrap it and get some pressure on it as you tighten the wrapping. We could not wrap it. It was too big, and in the wrong place to get a good purchase with the Kling.

By now the house was filling up with responders. Engine 2’s crew was there to help us. The normal noise of the organized chaos found at a shooting scene soon filled the house, as firefighters and police officers work side by side on completely different planes. Fire and police radios were blaring. The Engine Company and the ambulance crew were working around everybody and getting things organized enough for transport. The cops asking questions and looking for weapons while firefighters moved equipment and furniture around as we worked on the boy.

We started two IV’s to try and replace the blood he had lost until they could get some whole blood in him at the hospital. He remained conscious through out the treatment, watching us with big frightened eyes that seemed to realize just how badly he was hurt. So I started to talk to him as we worked on him.

“Look partner we are going to get you bandaged up and ready to go to the hospital.”

“ I am going to start an IV now. There is going to be a pinch, so get ready.”

“You need another IV in the other arm get ready again.”

He just watched everything with those big frightened eyes.

With no air conditioning in the small house and the dead of a Florida summer, we were all soon dripping sweat. I called the hospital on the telemetry and gave a report.

“He’s missing a finger.” Mike said.


“Yeah, the bullet must have taken it off as it exited.”

Mike doing a good secondary examination of the boy found something that had been missed in the initial exam. It was something I was not really worried about given; he was not going to die because of that finger. But if we could find the finger, it could be re-attached.

“If somebody can find it. That would be great.” I said loud enough for the firefighters and cops to hear. There was suddenly change in the clamor and they began to look for the missing finger. Mike and I continued to package the boy up so we could transport him to the hospital. We had him on oxygen, his wound had been bandaged as best we could, we had two IV’s and he was stabilized on a backboard. We needed to get moving.

“Anybody find the finger?” I said.

A number of no’s and negatives came back from the firefighter and cops.

“We got to go. If you find it send it to ORMC.”

Mike and I loaded the boy into the back of the ambulance with the ambulance crew. I jumped into the back of the ambulance to ride in case any other treatment was necessary. I remember it as an initially a silent ride. He just watched the ambulance paramedic and I as we double checked his blood pressure and monitored his IV’s.

“How ya doing?” I asked

He just looked up at me. I made the sure the IV’s were still in place and the fluids were running wide open into his veins.

“We’re going to be at the hospital in just a minute. So hold on.”

He looked up at me with those big frightened eyes, IV’s running into each arm and a huge bandage on his shoulder and said.

“I’m going to die aren’t I?”

What the hell was I supposed to say to a 12-year-old kid with a bloody great hole big enough to put your fist into his shoulder? I did not know if he was going to die. But I said.

“Look your badly hurt, but your not going to die.”

He had caught my moment of hesitation. He knew I was either lying or I did not know.

“I am going to die aren’t I. Damn it.” He said. He was mad I was trying to lie to him.

Suddenly I was mad too. I was mad at whoever it was that left a 30-06 with some kid who did not know what he was doing, so he could blow a bloody great hole in his shoulder. I was mad at the kid for asking me if he was going to die. How in the world did I know? I was just a new paramedic trying to do my best to keep him alive. I’m not god. I’m not a doctor. I was mad because he caught me in my hesitation. He had seen through me. By catching me he had opened me up. He knew I was as scared for him as he was for himself.

“Listen goddamn it. You are not going to die.” I said. “You stay mad. Do you understand? If you stay mad and fight you won’t die.”

I believed it. I had seen it work enough to believe it. I only hoped the kid would believe me. We rolled him into the Trauma room. He was soon lost in a crowd of doctors, nurses and technicians. I pulled the doctor aside after he had examined the boy and ordered the procedures and tests necessary.

“Doc is he going to live?”

“Probably but that shoulder. That round made a mess of that shoulder. Most of the muscle has been destroyed, I don’t know what kind of use he will have of it.”

I said thanks and left him to the doctors and nurses. Mike and I restocked the truck and replaced the IV’s and administration sets we had used. We got back on the truck and went off to finish our shift. But that boy has stayed with me all of these years.

I never found out what happened to him. They shipped him up to surgery and he disappeared. I called a week or so later but the hospital was unwilling to give out information out patient information to paramedics. So he disappeared like the vast majority of my patients. The only one’s whose outcomes we knew for sure were the one’s who died when we were there.

But he had taught me something. Something that I would use for the rest of my career, that was to never to exaggerate or lie to a patient, if they were going to survive they would going to have join the fight. Tell them as much of the truth as you know it. I had seen enough to know that patients died who I had thought would live, and patients lived who I thought would die. So I decided it was not my call to tell them but if asked I would tell them the same thing I had told the boy. We were there trying to help, we were going to deliver them to the hospital who will continue that fight so join us in that fight.

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