ADELAIDE Independent Monthly Literary Magazine / Revista Literária Independente Mensal, New York / Lisboa, Online Edition  






by Jay Hookham



I work too much. I keep telling myself it’s because I need to if I want to stay in school, the couple of small scholarships I have cover tuition and little else. They certainly aren’t enough for me to live off. But as always, there’s more to it. I also work to forget about my many, self-inflicted problems. I deny this and try to convince myself it’s because I am a full-time student and need to support myself. I can’t work a normal job with nice daytime hours designed with humans in mind because I go to school during the day and so night shift is all I can do. Although that may have been true a couple of months ago, it’s not the only reason anymore.

I work for a local ambulance agency, not the highest paying job but it is what I know how to do. At sixteen a volunteered as a junior firefighter for a local fire district, had my EMT license by eighteen, and got a job at the ambulance agency a couple months later. Now after three years, I was ready to move on, hence the college thing. However, college wasn’t going so well at the moment and if I didn’t get my grades up, even the little scholarships I had would be gone.

Its 1:28 a.m. Monday and I am just getting back to bed from the last call. Ever since the 12-hour shift started at 6:00 p.m., my partner Jessie and I had, gotten back to back calls and finally it looked like we were going to get some sleep. That was the one perk of night shift, if you don’t get calls, you can sleep through your shift. This was my third night shift in a row, needless to say, I haven’t slept much lately. I mumble good night to Jessie and we both go upstairs to the little bedrooms in the station. The rooms are really just glorified closets, a tiny, squeaky bed, small TV, a lamp, and of course the speaker in the upper corner whose only job is to wake me up in the night to tell me someone needed my help right that second. Too tired to get undressed, I pull off my zipper boots and collapse face down on the bed ignoring its mouse like protests.

“811 primary ambulance respond to Highway 25 south mile post 157 for a two vehicle traffic accident, one vehicle upside down, possible entrapment. 02:12” I hear as I am rudely pulled from sleep only to have the reality of the call to sink in. I hate traffic accidents in the winter; they’re cold, which makes everything more difficult, the workspace around the incident is small due to piles of snow, and they take forever. I push my way back into my boots and slam through my door harder than I meant to, still waking up and stumble down the stairs. Jessie meets me at the ambulance. “Yours,” she says telling me what I already know that it is my turn to take the call. I get into the passenger side of my ambulance and fumble for the radio as we pull out of the shed into the night.

“811 to fire control you can show us en route to the accident on 25,” I blurt into the radio, my voice a little slurred from lack of sleep.
“811 you are responding for a two-vehicle traffic accident one vehicle on its top the other in the ditch, fully blocking traffic, possible numerous injuries.” How on earth can the dispatcher sound so cheerful at this ungodly hour for a call like this?. Well, maybe “cheerful” is too strong a word, apathetic maybe? I take a moment to catch my breath, mostly awake now. “Lights,” I tell Jessie to have her turn on the emergency lights as we speed through the night.

If only I had emergency lights a month ago, maybe things would have turned out different, I start to think before I tell myself I’m being stupid.

I look up and see stars in the cold night sky, no snow is falling. Good, that means I can probably get a helicopter in if I have a serious patient. Medflight air ambulances are the best way to get patients to the high-level trauma centers quickly instead of the lower level facilities nearby. I sit back in my seat, my lack of sleep beginning to show again. It is the short, quiet times like these I can’t keep the image of my sister away. After a long self-loathing minute, I shake off the painful memories and look out the window.

 “How much farther?” Jessie asks after a few minutes.
“Couple miles” I respond looking up from the map on my phone.

 We round the last corner, skidding a bit on some black ice, and see a white hatchback of a now unidentifiable make on its roof in our lane, the other car, an SUV half in the left ditch blocking the other lane. Other than a couple of cars pulled over with their hazards blinking dimly, no other vehicles are present. That’s odd, I think to myself, fire units and law enforcement almost always beat us to incidents out here. It took us almost twenty minutes to get to the scene, fire units are stationed much closer. “811 fire control we are on scene.” I radio in as we stop about a hundred feet away from the smashed hatchback.

 I open the back door and grab the trauma bag from the back. “I’ll get this one you check the SUV.” I tell Jessie while I head towards the hatchback.

 “Hurry Up Damnit!” A by stander yells at me for the fourth time as I walk over, negotiating the ice. “Can you move any slower!?” the guy continues. I ignore him as I always do. EMTs don’t run. If I rush somewhere and slip on the ice and break myself, instead of fixing the problem I came to deal with, I become the problem and I’m already too good at making problems. Reaching the vehicle’s driver side, I bend down to look through the broken drivers window to check inside the car. Only the driver.
“Sir can you hear me? I’m Eric with the ambulance I’m going to get you out of there.”
“Yeah, please hurry.” He says in a shaky voice.

The driver is bleeding from a laceration on his forehead and due to the unnatural angle his left leg is bent, I’m guessing his leg is broken. The air bags had deployed, and he is hanging from his seat belt. We would need help getting him out.
Into the radio. “811 to fire control, ETA for fire?”

“Fire not yet paged; would you like us to page now?” Was the response.

Suppressing all the snide replies that would get me fired if I said them over the radio, I simply said “yes.” Fire should have been sent at the same time we were but occasionally that doesn’t happen.
I look back to my patient. He is in his thirties maybe, has a coat on, which will keep him warm for a little while, but he will need help soon because of the artic like wind blowing across the road.
“Where do you hurt?” I ask my patient.
“Everywhere.” He responds more shakily and softer than before.
“What hurts the most?” No response and his eyes have closed. I shake his shoulder a bit and raise my voice. Still nothing from the driver. Shit. I start by going through the basics in my head checking my patient. Pulse a little fast breathing a little shallow. The car looks stable enough, so I go to the back of the car to the hatchback’s shattered windscreen drop onto my back and crawl into the car behind the driver ignoring the broken glass everywhere. It never ceases to amaze me how quickly patients can crash. Unfortunately, there is no room to try to lower him and since he is unconscious, I’m powerless to try.

 Keying the radio again. “811 to Fire Control, launch Medflight to our location please.”

“Confirming request for Medflight.” Dispatch immediately answers.

 I answer in the affirmative and go to work on my patient. I reach through a broken window to my open trauma bag I left by the window and pull out a c-collar and strap it around the patient’s neck to stabilize it in case he has a neck injury. Again, falling back on my training. I then fumble for some gauze in the confined space and hold it to the patient’s head wound to try to control the bleeding. It works. Sort of. I hate head wounds, they bleed a lot, even if they aren’t too bad, it’s almost like there is something important in there that needs a lot of blood. I think sarcastically.

“Hey sir, in the bag’s left pocket are some heat packs, can you find them and pass them to me please?” I say to a pair of legs I assume belong to the bystander who was yelling at me earlier.
A minute later I reach out my bloody gloved hand for the chemical heat packs that are being held out to me.
“These?” The bystander asks.
“Yep, thanks.”

 I activate the heat packs and start stuffing them in my patient’s clothing in strategic locations where large blood vessels are near the body’s surface. I pause with the last one considering keeping it to warm my already freezing hands then stuff it beneath the guy’s arm.

Jessie comes over and informs me that one of the patients in the other vehicle wanted transport to the hospital, she had no obvious injury but wanted to be on the safe side. The other patient has already signed a medical release. I updated Jessie on my patient and the helicopter before she left to take care of her patient. Even though Jessie’s patient was probably fine, Jessie was stuck with her patient to monitor her and would be unable to help me with mime. So, I was alone on my back in a smashed car with a multisystem trauma to deal with.

Laying on my back on the ceiling of a car, trying crane my way around the driver seat gets uncomfortable after about a millisecond and only gets worse from there. Making things worse is the fact that cars are not supposed to be upside down the cramped space makes it difficult for even simple things. I elected not to splint the fractured leg at the moment, it would be much easier to do when there was more space after the fire crews tore some stuff out of the way. To think that half an hour ago, I was in bed.

After 15 minutes that seemed like an eternity, the fire department arrived and started working around me to extricate the patient. The operation was directed by Jonas, a fire captain and EMT who I trusted with the extrication and had worked with many times before. Remarkably, there is little for me to do as they rip what’s left of the vehicle apart around me with nothing but a thin blanket to protect me and my patient. Well, that’s not entirely true, I was protecting my patient as well, making sure that he wasn’t harmed by anything that was happening around us. Fortunately, the fire guys are carful to make sure that nothing happens that would harm us, but it always makes me feel nervous knowing I am inches from equipment that could literally cut me in half.

My patient came around twice during the 30-minute extrication distracting me from what was going on around me and the horrible thoughts that invaded my every quite moment these days. When the equipment got loud, he would only cry out or say something incomprehensible. I didn’t have a thermometer, but I didn’t need one to know he was losing the hypothermia battle. I asked the fire guys for more blankets and chemical heat packs as a cold breeze hit us again and made me shiver. If I was having a hard time keeping warm, then my patient with multisystem trauma was even worse.

Halfway through I got a blood pressure and found that it was pretty low, unfortunately with me on my back and the patient hanging from the seat belts, I couldn’t start an IV to give him fluids to fix the low blood pressure. I tried three times but couldn’t get a stick. That was always the worst, knowing how to fix something but not being able to for one reason or another. It seemed like my patient’s low vital signs were mocking me and my low grades. A firefighter interrupted my gloom just then to tell me a few minutes more and we would be home free. Yeah right.

My patient stirred again as one of the door hinges popped with a spine-tingling shriek of rent metal. When he opened his mouth, some blood dripped out. There had been no blood before when he spoke to me earlier.

“Jonas, keep quite a second please.” I yell out to the firefighters and struggling with my stethoscope investigating a hunch. It took a minute, but I could hear faint breath sounds on the right side but not on the left. A quick check of his oxygen saturation told me all I needed to know.
“Jonas, we need him out now, he has a collapsed lung and his oxygen stats are dropping.” I yell again.
“We almost got it Eric and the helicopter is only a couple minutes out.” Came the response.

A minute later one of the firefighters passed an oxygen mask through the broken windscreen and I strapped it the to patient’s face. I don’t panic, but I was beginning to question whether this guy was going to make it or not. If he could hang on until the helicopter arrived with it came higher-level providers who could go about fixing things like the collapsed lung. However, if he stopped breathing or I lost his heartbeat before then, there was nothing I could do until we got him out and by then it would be too late. The broken-up car started to feel awful small.

A minute or two later we were ready to remove the patient from the vehicle and we heard the chopper overhead on landing approach. While we were pulling the guy out there was nothing to do about his leg except try to be careful with it. There was no time to follow my plan for splinting it now, getting him out was more important. Stupid mistake, I cursed to myself. We got him out as carefully as we could, and I crawled through the broken glass on the ceiling, following the patient out, I glanced around for an instant before getting back to it.

The scene was unrecognizable from when I had entered the car. Fire engines and their floodlights were illuminating the scene, police cars blocking the early morning commuters, a helicopter in the road behind my ambulance, and enough flashing lights to rival the seizure inducing chaos of a casino floor. Not to mention the smashed little car that was now torn apart complements of the Fire Department. As we finished packaging the patient a medic from the helicopter arrived, I gave her my report and then we lifted the patient to their stretcher and into the helicopter. Through the window I saw the paramedic in the dim, blue light, starting the IV I couldn’t. Another of my failures reminding me of my biggest one and I felt like I got punched in the chest when the thought hit me.

My sister had died from a sudden brain aneurysm the month before. I was supposed to be home that day, but I stayed out with friends longer than I should have. She had been complaining of the worst headache of her life, all morning no one thought it was that serious. If I was there, I would have noticed the signs, in fact I did, but not until I checked on her an hour after I got home late. We had been close, only a year apart but in the end, I couldn’t protect her as I had just done for this random guy I don’t know and never will.

The next thing I felt was the wash of air from the helicopter blades spinning above my head as I backed away from the aircraft with the firefighters and it lifted off. “Good jobs,” and “nice works,” were passed around by the fire crew around me. I thanked them and headed back to my ambulance.
A minutes later I saw Jessie for the first time in over an hour in the back of the ambulance. She was taking care of one of the passengers from the SUV, an older lady who didn’t seem to be injured, but wanted to be sure. I couldn’t blame her. Jessie told me she was ready to leave if I was. Since my patient went out in the helicopter and Jessie had hers in the back, I got to drive back to the hospital. Twenty minutes for me to be by myself and sulk. Great. Just what I need. I curbed my self-sarcasm and lingered in the back for a moment before getting into the driver’s seat relishing the first hint of warmth I had felt in over an hour; or maybe a month.

After we got to the hospital and transferred the patient, I cleaned out the back of the ambulance. The trauma kit was missing half its stuff thanks to the veritable train wreck of a patient I had. I looked for the blood pressure cuff I had used on the patient only to remember that I’d left it on the patient. I’d have to restock when we returned to the station. A blood pressure cuff. That is all I would have needed to figure out that something was wrong with my sister. Why hadn’t I checked? It would have been sky high and I would have put it all together and rushed her to the ER. My mind kept trying to tell me that it wasn’t completely true; that symptoms don’t always show up the same way for every patient making an accurate diagnosis difficult, but it didn’t work, and I still felt the guilt of my failure. And now, I would never know if I could have saved her.

I returned to Jessie sitting at a computer finishing her report in the small EMS room in the back of the ER. I hadn’t even started mine yet, but it would have to wait until we got back to the station.
“I forgot to get a signature from her can you get it for me?” Jessie asked, handing me the form, not waiting for an answer.

I took the piece of paper and walked back down the hall of a pleasantly quiet hospital to the room where we dropped off the patient from the SUV. I passed that room, the one where I said goodbye to my sister.

At the right room I tapped gently with one knuckle against the frame of the open door trying not to wake who I assumed was the patient’s daughter sleeping in a chair, no hospital staff were in the room.

“Ma’am?” I said softly sitting down on a wheeled stool next to the bed. “My partner forgot to have you sign this earlier.”
“Do you have a pen?” she asked.
I handed her a pen.
“You look tired.”
“It’s been a long night. . .or two.” I answered.
“I’ll bet, with this weather and all. What’s your name?”
“Thank you, Eric, for all you do.”
“Sure, it’s what I’m here for.” I say, always kind of embarrassed during the rare instances a patient thanks me.
“Do you know how the guy in the other car is doing?”
“No,” I answer breathily, “we flew him out to another hospital. We usually don’t find out at all actually, privacy laws and all.”

A pause.

“Are you sure you’re all right? It seems you’re more than just tired.” She had a concerned look in her eyes, and I realized that she genuinely cared about me.

I don’t know why but I had the sudden urge to tell her all, how I wasn’t there to help my sister until it was too late and how I wasn’t supposed to be late, my grade troubles, feeling like I was failing my patients like the one tonight where there was so much more I should have done but couldn’t, all of it.
And I did.

Ten minutes later I was finished; drained completely, laid bare before this stranger. She didn’t say anything during this time only looked at me with what I could only guess was love. Outside of friends and family, I rarely felt that, if ever. It was kind of weird. Embarrassed again, I apologized and told her to take it easy and turned to go, at the door she said, “Hang in there Eric, you’ll make it through.” And I believed her. I smiled weakly. As I left, there was something in her face, a look I couldn’t quite place.

On my way back to Jessie I again thought of the look the lady’s face had that I couldn’t quite put my finger on. Something intangible. I passed by a door with one-way privacy glass and caught my own reflection for the first time in weeks and found that it mirrored the look I had just seen. It was the look of someone who had experienced loss and pain. That was why she cared, that’s why she understood. Ileft feeling less troubled than I had in weeks, if only a little, with the feeling that maybe, just maybe, everything might turn out okay in the end. That maybe I could heal.



About the Author:

Jay Hookham is a senior student at Central Washington University's Creative and Professional Writing bachelors program. Most of his writing has been academic in nature. Outside of University, he has contributed to online wikis and similar community engagement.











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