But first:

ME: What’s the trouble today young lady?

PT: I’m bleeding…from my vagina.

ME: Um…this has happened before ever?

PT: Yes! A month ago actually!

True story.

ANYWAY:

PD started getting excited on their radios cuz a car accident came over and it was right at their favorite bar. Then a shooting came over at the same location. Then it turned out to be one in the same and you could hear all hell breaking loose. “It’s an MVA! It’s a shot! It’s both! Blaaah!” I was around the corner in Garvey Park so I just kinda started easing over that direction nice an’ chill like. When you’re medics, you don’t wanna get on a trauma before everyone else. Better to let the EMTs get there first, deal with all the annoying putting the dude on the backboard/getting him out of the car etc. and then you get to do the fun stuff- starting the IV, intubation, whathaveyou. So I sat on 121 and Park and listened to sirens come screaming towards me from all around the city. Emergency Services flew past- those are like the NYPD’s swat guys. Then some EMTs zipped by and we fell into place behind ‘em, bee-lining towards the sea of flashing lights.

They were pulling the dude out of his escalade. He was 60, 300 lbs and dead. There was a gunshot wound in the back of his head and no other visible injuries. His escalade was mashed into the brick wall of the cop bar. A kind of controlled chaos was hanging in the air as everyone swarmed about our business. Eerily, the guy’s cellphone won’t stop ringing.

A word about being dead: as Billy Crystal said in The Princess Bride, there’s dead and then there’s MOSTLY dead. According to our rules- you’re only truly dead if you fit certain criteria: rigor mortis- which is you know when you’re all stiff, dependent lividity- which means you’re so dead all the fluids are pooling at the lowest point in your body (yes, it’s gross), decomposition- which is self explanatory, you’re rotting and then the wonderful catchall: Obvious Death. That includes everything from beheading to burnt-to-a-crisp. Usually if brain matter is involved, it’s Obvious Death (unless the person’s still squirming). If you fit into any of those categories or have a DNR, we put a sheet over you and call it a night. Otherwise, it’s the whole rigamaroll.

This dude wasn’t quite obviously dead enough to be Obviously Dead, plus they’d already gone to work on him when we got there and it’s a whole other rigamaroll to stop a workup in progress. So we did our thing: got him on the EMT’s ambulance, I set up a fatbag o’ fluid and prepared my iv, my partner took out the laryngescope- a metal scythe shaped tool with a flashlight on the end that we use to look all the way into people’s throats so we can stick a tube down there. Meanwhile, I tossed my keys to the other EMT so he could drive our bus and yelled to the driver to start rolling.

The best way to find a good vein to poke isn’t by looking, it’s by feeling. Sometimes you’re better off not looking- you just roll your finger gently along the area where you know the juicy ones hide until you feel that bouncy vessel poking up. Then you trace it, see which direction it leads, and sink your needle just below it. When the needle finds its mark, blood pours into a little filling chamber. You push the plastic catheter forward while pulling the needle out and then attach the iv line to the hub left behind. All this happens while the EMT is frantically barreling down the street and around corners because he’s new and never been on a shooting before, let alone a crazyass car crash head shot traumatic arrest. Just as we’re ripping off scene though, the ambulance stops short.
What’s the problem? I yell from the back.
There’s a Captain onscene, the EMT reports.
So what? I ask. They’ve been getting real uptight about certain things and apparently this one wants to check on us. But really- now is not the time.
He’s blocking the bus, the EMT says.
Drive around him, I holler. Both my hands are busy trying to keep the IV bag from swinging into my partner’s face while he sticks the tube in.
We drive around the captain.

The line is in and so is the tube when we swing into the ER bay a few blocks away. Since we made patient contact, eight minutes have gone by. The energy is coursing through my body- it’s more than adrenaline- it’s the glow of total focus and purposefulness of action and it feels amazing.

At the hospital, they pronounce the dude pretty quickly, but when they x-ray his head there’s no bullet there. Now we have a riddle: there’s only one hole, so where’s the damn bullet? I ask my partner what he saw when he went to intubate. –Just a lot of blood, he says, couldn’t see much. The doctor in charge gets his suction and a light and after some cluttering around in the dead man’s mouth announces he has found the other hole. The entrance wound. Turns out our guy was a suicide. A general murmur flutters around the detectives. Apparently he was talking on the phone with his girlfriend, had been depressed for a few days, crashed the escalade and did the deed, gf still on the line. That’s why she kept calling back.
The doctor puts a sheet over him and I head outside to clean off the equipment.