Thursday, April 3, 2014

Blood, Sweat, and Tears (Part 2 of 2)

… I approached the car from the front, as I was always taught to do.  The intent is to get the patients attention without causing them any surprise that would cause them to jump or turn their head.  Things were already not going like the book says it should; all I could see from the front of the car was a wall of torn metal.  The bumper was about waist high, and the remains of the hood were pushed back over the windshield opening.  Even on my tiptoes, I could not get a glimpse of my patient, so I made my way around to the driver’s-side window.  The intrusion had deformed the car tremendously, but I could see that he was still sitting straight forward, with the steering wheel against his face.  I noticed no signs of life, but realized that the opposite side of the car had not caved in as far and my best access would be from the passenger’s side door.  I tried the handle, but knew by looking at the creases behind the hinge that this door would not be opening any time soon.  My visual assessment through the window was not pretty, but I did see that his eyes were open and moving around in bewilderment, like a newborn examining the world for the first time.  I found a place to perch my supplies and managed to wiggle my ass through the window opening.   Yes, I was a bit more svelte and agile in my younger years.  I introduced myself, and began methodically running through my trauma assessment checklist.  
This poor guy was in bad shape.  The impact of the collision left his frail body entombed in plastic and metal.  The four-inch gash on his forehead was spilling blood down his face, and the only extremity he had free was his right arm. Other than a few cuts on his hand, his arm seemed fine.  He alternated between wiping his eyes of the crimson river that kept blinding him, and trying to push the dash and steering wheel from in front of him.  I threw a trauma dressing and “kling” snugly on his head to plug that leak, and helped him wipe his eyes and face.  I was honestly thinking about making him as comfortable as possible…there was little else I could do at the moment.  I engaged him in some small talk to distract him, as well as assess his mental state.  He clearly had no idea where he was, who I was, or what had happened.  I tried my best to explain the answers he sought, while I assessed his situation.  I was looking at the dash, floorboards, steering column and door that had him pinned in to see what we would need to free him, and he was looking at the same things trying to understand what they were.  I remember being able to touch the radiator cap, it was that close to me.  No doubt that directly behind the flooring was the hot engine block pressing tightly against his legs. In the steamy atmosphere, I could smell the coppery taste of his blood, the sweetness of the antifreeze, the stench of burned motor oil.  The five or ten minutes I spent with George in our demolished little “world” seemed like a life-time.  I learned that he was 70 years old, worked on the railroad his entire life, and was only a few weeks from retirement.  

As I was clearing debris to create some wiggle room, he spotted a lunch kettle of the floor and asked me if that was his!  I remember it was a well-worn, dark gray plastic hinged-top Thermos brand lunch pail.  I remember because he asked me to look inside of it.  Not sure what he was after, I obliged his request and gave him a verbal inventory of what was inside.  This is also when I discovered his name was George; it was in red Dymo label on the front of his lunch pail.  Once we determined he had already eaten, he immediately made the connection that he must have been on his way home from work.  “My wife will be worried”, he sadly whispered to me, as a wilting frown fell from his face.  “I have never been late coming home from work in 48 years.”  He didn’t say much more after that, and I was at a loss for words myself.  I kept talking, but I may never know if he kept listening.

I watched as his color drained, and his eyelids grew heavier.  His breathing became shallow and more labored, despite the oxygen I was pumping through the non-rebreather mask.  I heard determined voices surrounding the car, and the familiar clunking of wood cribbing as the rescue squad started stabilizing the car.  Before long, I felt the door behind me shifting from the strength of the Hurst spreaders.  “Hang in there, George; we will have you out of here in no time!”  There was no response…  “George?”  Still nothing ...  Even his right hand that was gripping me a few short minutes ago was limp and listless.  

I remember a simultaneous sense of frustration and relief, as I gave up my position for a medic that had arrived to take over patient care.  By now there were responders everywhere, so I grabbed the opportunity to catch a breath and take in the scene from a wider perspective.  I immediately began my self-critique and mental debriefing.  The adrenaline kept me from crying, at least until I got home later that afternoon.  As I left the car, I told George I would see him later, but I knew that was a lie.  I hope he forgives me…