This one kind of spiralled out of control so I've decided to post it in two parts. Part two should hopefully be up by Monday.
This still isn't beta-ed and I'm still not a doctor. Subject matter could be distressing for some so read on at your own risk.
I'm six days in when I lose my first patient. The fact that paramedics face a daily battle with death had been ingrained into me by my college lecturers from the very first day right up until the minute I walked out onto the stage at graduation. I thought I was prepared for it, but in reality it turns out that I was anything but.
We're nearly at the end of our shift when we get the call. There's been a pile-up on the Veterans Memorial Freeway and there are multiple vehicles involved, and that means multiple casualties. Heather's face is grim as she reaches across the dashboard to flip on the lights and siren.
Our bus is lit up like the Las Vegas strip as we barrel along the freeway in convoy with another ambulance but as we get closer to the scene it becomes apparent that our 'blues and twos' are going to be about as useful as a chocolate teapot. The H2 freeway ahead of us is at a standstill. All six lanes of it.
Tapping my index finger against the steering wheel impatiently, I glance over at the hard shoulder but the damn thing has been cordoned off due to work that's being done on an exit ramp a few miles ahead of us. My only option is to push my way through the mass of unmoving cars.
"Move, damnit… Oh, C'mon!" I growl at an Escalade, whose driver has yet to notice that we're behind him. Frustrated, I lean on the horn. It does the trick and he finally pulls over enough for us to squeeze past. "Thank you! Finally…"
It's slow going. It takes us nearly eight minutes to cover a mile and a half but we eventually make it past the road works and I'm able to swing out onto the hard shoulder, and put my foot down. Despite the delay, we're one of the first to arrive at the scene. There's a marked police car parked across the two middles lanes of the freeway, stopping traffic, and several more parked along the median, as well as another ambulance and a first responder car. Two fire trucks pull in behind us as we hurriedly gather equipment from our rig.
"Hard hat," Heather reminds me as she pulls the defibrillator and an oxygen tank from one of the lockers. "I'm gonna go find out what happened and who's in charge."
My hands are shaking as I jam my protective hard hat onto my head. Behind me, the tarmac is littered with debris. Glass from several shattered windscreens glitters ominously under the orange-yellow glow of the streetlamps overhead and I feel it crunch beneath my feet as I pick my way through the wreckage towards my partner and a man I can only assume is the scene commander.
"There were six vehicles involved," Sargent Lukela explains as he directs us to the front of the pile-up where a semi and a car have collided. "According to witnesses, the truck started to swerve and then it jack-knifed before slamming into the central divider and colliding with the car. The driver appears to have suffered a heart attack at the wheel. He's already been pronounced."
"What about the driver of the car?" I ask, glancing at the mangled wreck in front of me. The car is almost unrecognizable, having been crushed by the sheer magnitude of the impact. The front end on the driver's side is sitting pinned beneath the trailer of the over-turned semi.
"Alive, but only just," Lukela says grimly. "I had two of my guys smash the windscreen but her legs are pinned somewhere underneath the dashboard."
As we get closer, I can just about make out a high-pitched keening sound over the wail of sirens and my heart just about jumps up into my mouth.
"Is that a baby?" Heather asks with a frown.
The sergeant nods sadly. "Yeah, there's a kid in there with her, can't be much older than one and a half, two years old. The impact jammed the doors so we can't get to either of them until Fire and Rescue get here."
"They pulled in right behind us," Heather reassures him. "As soon as they jimmy the doors, we'll get in there and get them both stabilized for transport."
"I'll go get the back board," I offer, setting my kit bag down on the ground. "Is there anything else you need me to grab?"
"Just the board." Heather looks back to Lukela and I hear her ask, "How far out is Medevac?" as I turn and start to run.
Between us, Heather and I decide that I'll work on the driver until Medevac arrives and then I'll help Heather with the baby. I'm hyped up on adrenaline, my heart racing, and my hand is clenched tightly around the strap of my kit bag as I wait impatiently for the all clear to go in and start treating my patient. Thankfully, it takes Fire and Rescue less than a minute to force open the doors. As soon as the job is done, the two fire officers and Sargent Lukela look to us for instructions.
"We're going to take the baby out first," my partner tells them. "As soon as the baby is out, we need to get someone in behind the driver to stabilize her head and neck while Chloe gets her prepped."
"I'll get one of my men to help you with that," Lukela offers, reaching for the radio clipped to his belt.
Heather nods. "Alright. Let's go, Chloe."
Ducking my head, I climb into the foot-well beside the driver. The driver is around my age, blond and slim, and it's pretty obvious from the amount of blood running down her face that she's hit her head off the windscreen. The glass is long gone thanks to HPD's rescue efforts but if it were still in place, there would be a starburst of tiny, spidery cracks radiating from a spot right above the steering wheel. The deflated airbag reminds me of a misshapen, baggy old gym sock.
The woman's seatbelt is still fastened but she's slumped over against the door, eyes closed, her head lolling against the shattered glass of the driver's side window. It's almost impossible to tell if she's still breathing and I reach across to check for a pulse, only letting out the breath I wasn't even aware I was holding when I feel the faint heartbeat fluttering beneath my fingertips. Moving closer, I can make out the gentle rise and fall of the woman's chest. A surge of relief floods through my veins.
"She's still alive," I shout, motioning over my shoulder for someone to pass over my kit bag. I grab the pressure cuff and my stethoscope and set both on the passenger seat in front of me before leaning over to give the woman's shoulder a gentle shake.
"Hello," I call, squeezing her arm. "Can you hear me?" There's no response so I check her pupils and then wrap the pressure cuff around her arm.
"I've almost got the baby out," Heather calls back over the increasing whap-whap-whap of the approaching Medevac helicopter. "We're having trouble getting the car seat restraints undone. How's she holding up?"
"She's unresponsive and tach-y. Pressure isn't great, either." I make a face at the reading as the crowd that's gathered around the damaged car suddenly erupts into shouts of joy.
"She's out!"
Thank God, is all I can think as the distraught child is wrapped in a blanket and Heather clutches her close to her chest. My own chest tightens when I catch a glimpse of the 'Frozen' character barrettes in the little girl's blond pigtails. As soon as Fire and Rescue pull the little girl's demolished booster seat out of the car, a uniformed officer slides in behind the driver's seat.
"I need you to hold her head still until I can get the brace on her." I position his hands and then gently tilt the driver's chin to open her airway. "Just there's perfect."
The woman stirs as I'm inserting an intravenous line near the crook of her elbow and she reaches out blindly, disorientated. "Sadie," she mumbles. "Where...?"
"It's okay." I grab hold of her hand and squeeze it tightly. "My name's Chloe, I'm a paramedic. What's your name?" The only response I get is a soft moan and I press my knuckles into the woman's sternum when her eyes slip shut. "Keep your eyes open for me." I press down a little harder until she responds by trying to move away from the pressure. "That's it," I say encouragingly. "Is Sadie your little girl? They've got her out of the car and my partner is checking her over. I can see them both from here. She's doing just fine."
Outside the car, the chief fire officer is examining the mangled wreck and I feel my heart sink when he calls out for the heavy-duty cutting equipment.
"We're going to have to take the roof off the car," he explains. "Once it's off, we can dismantle the front end and see what's trapping her in there."
I pause. "I want to stay with her."
The officer frowns at me, then shrugs. "It's your call. We all set?"
I glance down to where the young woman's hand is still clasped limply in my own and nod tightly. "Yes," I say. "We're all set."
Fire and Rescue have just started to dismantle to dashboard when I notice the young woman's eyes slipping shut once more, her dark eyelashes standing out in stark contrast against the paleness of her skin. That's when everything starts to go to shit. I give her hand another squeeze but there's no response.
"Hey, no sleeping, remember?" I say, shaking her shoulder. Nothing... A bubble of panic builds in my chest as I press the tip of my pen into the delicate skin beneath one of her fingernails. Still nothing... I look over at the two firemen in desperation. "How much longer?"
It takes the fire officers approximately ninety seconds to free the young woman's legs but by then it's already too late. Her blood pressure starts to drop almost as soon as the last piece of the dash is lifted clear. The rapid decline is terrifying.
The piercing wail of an alarm startles me and for a moment, I panic as the woman starts to crash. Thankfully, I come back to my senses but it's almost as if I'm moving through syrup as I scramble over the center console and jam my fist into the crease between my patient's hip and her thigh.
"Someone get in here and take over," I yell. "We need to move her onto the seat and push it back until she's lying flat. On three…"
We work quickly to get her lying flat and a brace is fitted around her neck, an Ambu-bag pressed over her mouth and nose. Her chest rises with every forced push of air.
"Okay, towards me on three."
Four sets of hands pull the driver over onto her side while the backboard is placed beneath her and, finally, we're able to lift her clear of wreckage. I immediately get to work establishing a second line while one of the Medevac technicians, an older guy with kind eyes and a greying mustache, applies a tourniquet to the woman's thigh to try to get a handle on her blood pressure. The second is cutting through the woman's blouse and applying sticky pads to her chest. He hooks her up to the portable heart monitor and frowns at the print out.
"She's in asystole. Get ready to start CPR."
Sweat is beading beneath the waistband of my navy uniform pants and I'm breathing hard from the effort of keeping up a quick pace, my heart pounding against my ribcage. It feels like an eternity before the defibrillator beeps shrilly, signaling the end of the chest compressions. In reality, it's been less than a minute since I started.
"Stand back."
I sit back on my heels as the paddles are placed against the woman's chest.
"Clear."
Unfortunately, it's not like in the movies. The woman's heart doesn't automatically start beating again after the first shock, she doesn't gasp for air or miraculously regain consciousness. Instead, the countdown starts over and I push the heel of my hand into the woman's chest wall again and again until the muscles in my arms begin to cramp. I can feel tears mingling with the sweat on my face.
"Come on." I put my full weight behind the movement and then wince when I feel the woman's chest wall give under the pressure. There's no time to worry about it, though. Maintaining a constant supply of oxygen to the brain is the number one priority. Better a broken rib than oxygen deprivation.
Compressions. Adrenaline. Shock. We repeat the cycle over and over until my triceps are screaming out from lack of oxygen but I don't stop. Across from me, the older medic has one eye on the countdown timer and the other on his watch. I catch the downward pull of his mouth and the subtle shake of his head as sadness pools behind his eyes. Before he opens his mouth, I already know exactly what he's about to say.
"That's almost twenty-five minutes. Are we all in agreement?"
"No." I drop back onto my butt and cover my mouth with my hand to stifle the sob that's welling up in my chest. "There has to be something. Please…"
Both medics look at me with sympathetic eyes.
"She's gone, kid," the older one says, his tone not un-kind. "There's nothing more we can do for her." He gently squeezes my shoulder and glances back down at his watch before continuing softly.
"Time of death, eighteen forty-seven."
To be continued…