Wednesday, February 17, 2010

Turkey and Pumpkin Pie

It was an unseasonably warm late afternoon for the time of year. Being just past Thanksgiving, you would expect the air to have more of a nip to it. Instead the still air had a comfortably warm heaviness to it, like an old comforter. Though it was only four o’clock, the shadows were stretched long across the Starbuck’s parking lot the way they do in early December. Perry and I were not complaining. We were having a nice slow shift that almost felt like a day off. Almost. The conversation turned to how it had been a long time since either of us had a “real call” meaning the kind of “stat” stuff you see on TV or the movies.

“Man, over the summer I was the grim reaper, but the past month has been nothing but bogus calls.” I joked.

“I know bro, you have a reputation for that. Everyone has a ‘Kup story’ about a crazy call they ran with you this year.”

The way the call deck gets shuffled is beyond approach. I stopped trying to figure it out a long time ago. Some nights you will get murdered. Critical call after critical call in a steady stream like a chain-smoker lighting one off the last. Then for the next two weeks you wont have anything above a sprained ankle or headache. There is no rhyme or reason to it. I’ve tried tracking the day, time of day, the lunar cycles, the times of year, you just can’t put a finger on it. The only thing you can count on in Oakland is that the dragon will eventually find you. It lurks and waits in the belly of the city until your guard is down and strikes with extreme prejudice.

“You know, I could go for a code.” I said, meaning working up someone who has just died. I didn’t mean at all that I wanted someone to die, just that if someone’s time was up, (and in a big city, somewhere, somehow, somebody’s number is up right now, it’s just statistics) I wanted to be there to help and to sharpen my skills as they were getting soft in this current slump.

“Dude, I totally feel you. I haven’t had a code in months.” Perry replied.

This form of small talk has a lot more behind it than seems on the surface. A couple of things are going on here. First off, we were trying to gauge our respective critical call volume as compared to the other guy’s. We always futilely try and make sense of it all, if not just for sport. Secondly, you are trying to see if your partner is “due”. This is silly superstition. Nobody is ever due, just like a blackjack table is never “hot”, but often enough it seems like it, so you still ask the questions. When you are due, you know it and walk around with the specter of death just a few steps behind you. You know it’s coming, just not when and are relieved when it comes.

The third part of this silly little verbal dance, and this is important, is we need to talk about what we do. We need to hear about each other’s calls and relay our information to them about what happened, how we responded, and lessons learned. This is part learning and part therapy. To recount a crazy and stressful situation is to revisit it using the front seat of the ambulance as a psychiatrist’s couch. When this is done to sympathetic ear that really understands the job, you get to chip away at a little piece of the burden we carry around in memories and bad dreams. That is the therapeutic component. The learning side is also important given that most patients do not fit into the neat little boxes in our protocol book or in our training session in school. You may go your whole career and only get one opportunity to see one odd presentation or unusual set of circumstances. If your partner has already hit the jackpot, you want to know about it and store it away in that little dark corner of the mind that paramedics hide all these heinous stories for retrieval later. Then when you get your chance to shine, you access that dark place and dig it out. Turn a negative into a positive.

This unseasonably warm evening in that Starbuck’s parking lot my door was opened and my feet were propped up in a position that shouldn’t have been comfortable, but somehow was. I was in deep relaxation. Shooting the breeze with one of my buddies and sipping on an iced coffee. It had been over an hour since there had been any traffic at all on the radio. It was quiet out there, but the dragon was lurking.

“Can you believe we get paid to do this?” I asked Perry.

“For real” Perry is kind of a hippie/surfer type from Santa Cruz and has the lingo and longish locks of black hair to prove it. Well, long for the public service sector anyway. His boyish looks cause many to mistake him for a student, which is the source of much razzing. All in good fun.

“So tell me about what would be your worst call right now if we got one.” I asked with my eyes lazily closed behind my sunglasses, basking in the sun like a lizard on a rock. I love to chew the fat about the job.

“I hate the kid calls” he said.

“Not me, for me it’s breathing calls. I can’t stand the anxiety and panic the patient goes through when they can’t breath. It’s as if some of their anxiety gets transferred to me”. I wasn’t kidding, I hate those calls, but I am learning to embrace them since they are a bread and butter call for us.

“I feel ya bro.”

Just then a call came in for a familiar SNF. A SNF is short for a Skilled Nursing Facility or as we call them SNIFFs. Perry was very familiar with this particular SNF and had run several calls recently on the same guy who says he is “short of breath” but really isn’t. To make matters worse, this guy weighs in at a portly three hundred plus pounds and doesn’t really help you out much so you have to carry his dead weight. Ahhh people.

As we pulled up Perry was telling me about the guy we were about to run on and I was mentally preparing how I was going to deal with it. The whole day had been a day at the beach and neither of us were going to break that vibe. We sauntered up the front door and were let in by a very anxious Filipino nurse. She was like a rabbit running around, talking too fast for us to understand and pointing us down the hall. She was standing next to an oversized and gaudily decorated Christmas Tree with various presents under. Empty cardboard boxes with festive wrap and bows on them, no doubt. It’s always weird running calls in the presence of all these icons of happy days and good spirits. That spell was broken by the familiar stench of the SNF, which is a combination of urine, feces, vomit, and rotting decubitus ulcers. How people work an eight-hour shift in these places I will never understand.

“She down there. She can’t breath. She have asthma.” The Nervous-Nelly nurse shot-gunned at us in a constant loop until we responded. Already our gears were turning. Asthma was an easy one. We deal with it all the time and can often times fix it in the field. She was awfully high-strung for an asthma call.

As we walked down the corridor decorated with cheap dollar-store Santa cut-outs, gold and red garland, and generic greetings for a joyous season, we could see some of the fire departments medical gear boxes and bags sticking out of the doorway of a room down the hall. Perry looked at me with a puzzled look.

“Dude, that’s not his room” he stated with just a hint of surprise. I just shrugged. A call is a call, I could certainly go another day without meeting our frequent caller. Besides, this was an asthma call. Easy as pie.

I was at the front of the gurney and was the first to pop my head in the room.

“Crap Perry, they’re intubating her!”

I snapped the cool breeze vibe we had been riding. It was too good to be true anyway. The reality was that firefighter was not actually intubating her, he was looking down her throat with the laryngoscope. The patient was a fifty year-old grey haired lady lying face up on the tile floor. She was pale, unconscious and struggling to breathe. The captain was busy writing down the patient’s medications and trying to get some information out of another nervous nurse The engineer was preparing an IV bag of saline.

We left the gurney in the hall and quickly entered the room, it was time to get our heads in the game.

“What do you need?” asked Perry. It was his call after all. Since we trade off every other call, I was functioning as the EMT on this dual medic bus, an assistant of sorts.

“Get me a line, she’s really tight. Not moving any air at all. I’m trying to see if I can see any blockages.” the firefighter responded. He quickly turned to setting up the BVM with an albuterol nebulizer in-line. He was going to try and force some albuterol into her lungs, maybe it would free her up a little.

Perry went straight to the patient’s head. I stayed at the feet. It was obvious the engineer was not going to get an IV. He had already tried three times with no success. I went straight for the bone drill. This patient was going to be critical, possibly a code blue. I didn’t want to waste any more time with IV needles.

“So what’s the deal?” Perry asked in an even, laid back tone. What does it take to fire this guy up? I was happy he was here.

“She’s sat-ing really low” reported the firefighter referring to her oxygen saturation in her blood. “and when I try and bag her, I don’t hear any lung sounds. It’s really weird” the firefighter was understating the gravity of the situation, which we sometimes do to cut the tension. Without oxygenation to the lungs this patient had minutes or even seconds to live depending on how long she had been down.

I had the ears near me so I put them on and listened as he tried to bag her. He was right, you couldn’t hear any of the air movement you were accustomed to hearing and I found this creepy, like nails on a chalkboard. Was she tight from her asthma or was it something more sinister? The patient was struggling to breath. Her inter-costal muscles around her ribs and collarbone were contracting around the bones outlining her rib cage. Her heaving abdomen was jerking and working overtime to try and draw in even a squeak of air. She was getting tired. She would give up soon. For now she was compensating and maintaining a pulse and cardiac rhythm, so at least we had that for the time being. We just needed a bit of time to figure this out. Just a few more seconds.

“Hang on lady, we’ll get you fixed up” I thought to myself.

Meanwhile, I got back on task and drilled her leg for IV access. It went in easily and smoothly. I could overhear Perry and the firefighter talking at the head.

“Let me take a look” he said grabbing the laryngoscope. “Hmmmmm, pass me the Magill’s” he was referring to the Magill’s forceps. An unusual set of forceps that have an angle to them that allows them to be placed deeply down a patient’s throat.

Perry retracted the forceps quickly and they were empty. Like when you play that game with the big glass enclosure and the claw that tries to pick up stuffed animals; the one nobody ever wins.

“Dammit, I almost had it”. Now we were all intrigued. We were still performing our tasks, but looking up to Perry to see what “it” was that he almost had. This was getting interesting.

“Perry, you’ve gotta hustle bro, she is brady-ing down” I said with more than a little stress in my voice.

The patient was brady-ing down, which means that her heart rate was slowly decreasing at a steady pace. It was at thirty and on it’s way down. She would be dead in moments. Her oxygenation level was also dropping and now had hit the lowest the meter will read, <50%. She was turning that color they turn just before they die. Not good.

“She’s going to code, get ready for CPR!” It was time to rally the troops. This call was about to change radically for the worse.

“I just need a sec….hold on……there!” he said and with one smooth move pulled “it” out.

We were all stunned.

“It” was an unbelievably large piece of turkey the size of a cell phone. Nobody in the room could believe it. It was coated in an orangey-brown substance that instantly grossed everyone out. Well, almost everyone. You could smell the aroma of the puree on the chunk of meat and it was decidedly pumpkin pie. They say that smell is the most potent memory recall device of all the senses. This was a festive smell that one associates with the best times of the year and childhood memories of Grandma’s house not this horrible situation we were in. Why were these two now juxtaposed images being thrust together? Better yet, why was I getting hungry in the face of this crazy call?

I broke my little mental trip to see Perry at the head holding up the piece of turkey. He was pretty damned happy with himself and experiencing a bit of disbelief in the face of this surreal situation. How did this giant piece of meat end up in this woman’s trachea? Nobody would ever eat a piece that big. What exactly was going on here?

Anyway, it was time to get back to business. As soon as that piece of turkey cleared her windpipe, the wonders of homeostasis took effect. She took a big deep breath, and then about fifty more. Her heart rate jumped back up over one hundred and her oxygen saturation crept up by twos until it was over 90%. Was this really happening? Was my little surfer buddy truly saving a life just like they do on ER?

Back to reality, there was still much work to be done. Now that she was breathing she would need a secure airway and to be transported urgently code 3 to the nearest hospital. She was not out of the woods yet. Her air had been cut off for quite a few minutes and that means her brain was not being oxygenated. Brain damage to some level was certainly possible and recovery was not guaranteed. The firefighter rode with us to support Perry and I drove as fast as possible.

Once we had turned over the patient at the hospital we popped outside and started talking about the call. We all had to metabolize what had just happened. Perry was beaming.

“Dude, that was a career call!” He kept saying over and over. “Some guys go their whole career and don’t get to do that!”

Perry was right, it was a career call and one to be proud of. One that will certainly go into heavy rotation on the story wheel when we sit around and talk about our craziest calls. I couldn’t help but start to get a little private eye on this one. There were a few odd circumstances.

For one, why was the patient fed such a large piece of meat? In reading over the patient’s file at the hospital she needed to be fed. Secondly, why were the nurses trying to sell us on asthma? Someone had to have been feeding her at the time it happened. It’s not like she swallowed a six-ounce piece of meat and coughed it up and aspirated it again. I made sure that my concerns were heard at the ER. This is always a sticky situation when you suspect a fellow health-care worker of foul play or more likely incompetence. The way I usually handle it is to present the facts in an order that allows people to see the inference without making it for them. If they feel it is worth pursuing, they will. The ER is really good about that.

So Perry and I did what most people do after a big call. We went delayed and ate a big old dinner. Food always helps. Sharing a meal with someone else is a great way to de-stress and get your energy level back to normal. Sharing it with a hero I call partner is even better.

Copyright 2010 Jon Kuppinger

Tuesday, February 9, 2010

Crispy Critter

It was five in the morning and we were awoken from our first fifteen minutes of sleep all night. It came fast, hard, and dreamless. Our ambulance was parked high up in the hills overlooking the twinkling lights of Oakland now covered in a thick, fresh blanket of fog. From up here above the clouds, the city seemed serene and less troubled than we knew it to be. A welcome illusion at this hour.

The radio crackled again, startling me as my ears perked like a sleeping dog to listen for my identifier. My eyes remained shut. If it wasn’t ours I would be back to sleep in seconds. Or at least what passes as sleep. I never really sleep on the ambulance.

“Five-five-four, five-five-four, copy code three” Crap. That was us.

“This is five-five-four” I managed in a gravely, dry voice after fumbling with the mic.

“Five-five-four, copy code three at the corner of “this and that” streets, West End, unknown medical, map grid six forty-nine, charlie three. Structure fire in area. How do you copy?”

“Ten-eight” I replied, my even professional radio voice betraying the disappointment I was feeling.

A structure fire standby is usually as non-urgent as it gets and fun to watch. It can burn up a large portion of your shift and rarely produces much work. Maybe you wrap up a small burn on a firefighter’s wrist or take a B/P on an overzealous rookie that overexerted himself. This was a code three call though, so perhaps there was something to this one. It came in as “unknown medical”. Could we get a bit more specific?

I wasn’t driving, my partner Angela was. She was a five-foot three bundle of energy who walked confidently and held her own doing the demanding physical work of an EMT drawing comments and compliments from the firefighters on most calls. She was and EMT that has been working in Oakland for ten plus years, so I was happy to have her driving. She always got us there quickly and safely. I wasn’t worried, even as we rocketed down the hill blinded by the fog, sirens wailing.

I, the paramedic, have the job of navigating on the way to the call. I opened the laminated, dog-eared map book to page six hundred forty nine and through bleary eyes followed our progress as we crossed town. There was no traffic to speak of, it was five AM so we made good time.

As we entered the neighborhood, I noted that the narrow, pothole riddled streets were a virtual corridor framed with rows of tiny bungalow houses, the likes of which you see all around the older parts of Oakland. Most are two bedroom and one bath. Few are larger than eight-hundred square feet. These houses were generally built around the nineteen twenties or so and are now in serious disrepair from years of neglect, weather, and earthquakes. The wrought-iron fences interlinked the front yards, penning in snarling pit bulls, rottweilers, and old cars.

As we approached the street, I threw the map book up onto the dashboard. I no longer needed it, it was obvious where we were going. The house on the south-east corner was fully engulfed in fire and lit up so brightly I was surprised we didn’t see it from the hill. The sky above the house was a brilliant orange as the fog and belching smoke reflected the fire.

The street was completely blocked with emergency apparatus. Fire engines, ladder trucks, police cars, utility vehicles. People were running in all directions, carrying out their tasks in the mad symphony that is an emergency scene. In the intensely thick fog, the red, white, and blue strobes were making the scene confusing and surreal. I felt like I was in a makeshift outdoor disco. Movement, captured by your eye in the strobes, makes everything choppy like the firefighters were doing “the Robot” dance or were ball players from silent movies. We cautiously approached.

“Stop here, Angie, I’m going to jump out and see what we’ve got” I didn’t want to get the ambulance too close and potentially get blocked in.

I had to weave my way around the miles of fire hose that was coiled and wrapped around like gigantic snakes. Some of them even moved like snakes as they were pressurized and depressurized with nozzle manipulation at the business end of the hose. Some of the hoses were spraying out from the couplings and minor leaks like some kind of yard sprinkler toy you would buy for the kids and let them to run through.

I glanced over at the house as I walked around it. I had a few seconds to assess the safety of the scene and take in what was happening. The flames licked up from the eaves and lapped the edges of the roof like thousands of little orange hyperactive hands massaging the roofline. There were several firefighters ventilating the roof with a chainsaw. Smoke and heat were blasting out of their new hole. The dragon was here. Looking through the smashed out windows, I could see the pinpoints of light dancing around in the pitch black of the scorched living space from the flashlights hanging off the turnout coats of the firefighters battling the blaze form the inside. They looked like miniature little search lights, but these lights were not lazily scanning the skies for enemy bombers, they were twitching around wildly in the smoke like a mass lightsaber duel.

Outside, where I was, firefighters in full gear were hustling equipment to and from the house. A guy ran into me carrying a large gas powered fan. Another tripped over a hose dropping a length of hose he had been carrying on his shoulder. These guys were working hard. Some were resting on the grass out front bathed in sweat and water. They relished these few moments of rest before suiting back up and charging into the house.

I quickly found the chief. He was easy to find. White helmet and the only guy not carrying anything.

“Over there,” he growled over the deafening chorus of diesel engines pumping at high idle. He pointed around to the west side of the house. He was older than the rest and this was obviously not his first fire. His cracked face and oversized grey mustache told me that much. He could have been the poster boy for fire chiefs.

I made my way around the northwest corner of the house, careful to not walk under any ladders, and saw what I was looking for, the familiar open orange medications box indicating I had found my patient. Several firefighters were kneeling, others were watching with disgusted looks on their face. I tried not to get tunnel vision as I approached. This was a working fire and a very dangerous scene and I was not wearing any protective gear.

The subject of all the curiosity was a man that was burned to the point you could not tell what race or age he was. He was lying face up, his back arched in an involuntary spasm of pain. He was still smoldering. He had charred skin peeling off of what I quickly estimated to be over eighty percent of his body. I checked in with the medic and ran back around the house to where I had left Angie and the ambulance.

“Angie, bring the rig around!” I shouted with the international home run signal.

“Why, what do we have?” She asked, she was awake now. We both were.

“Crispy critter. Just one. He’s all burned up.” I replied. I could feel the adrenaline now starting to flow. I fought it. I needed a clear head.

Crispy Critter is just one of the colorful euphemisms we use to describe our patients. People who work with the dead and dying everyday need to find ways to dehumanize the horrors they witness without losing touch with the fact that this is a person with a family, friends, dreams, and hopes. One very common way is to use come up with playful or abbreviated ways of describing horrendous situations. If you are shot, you are a GSW (Gun Shot Wound). If you drop dead in front of the paramedics, you DFO’d (Done Fell Out). Sometimes we use number codes to make it easier to say. It’s also easier on the ears of the public who do not speak our coded language. 162s are rapes. 187s are murders. 242s are assaults. 10-55s are dead bodies. It just makes it easier to deal with. Angie knew what a Crispy Critter is so I didn’t have to elaborate more. This wasn’t her first rodeo.

She carefully, but swiftly brought the ambulance around to the other side and found a safe place to park with a good escape route. I ran back to the patient to see what had been done and what I could do. It was obvious they had just pulled him out of the fire. He was completely naked. You could tell the clothes had been burned off. The burns were slightly less severe in the areas where the clothing would have been thicker and in some spots scraps of cloth and who knows what else were still clinging to his now plasticized skin. He was conscious and still breathing. I have no idea how someone could survive such an ordeal. He would open his eyes if you yelled at him. The firefighters had already laid down a sterile burn sheet and were done with cooling him. Now that he was no longer on fire, hypothermia would soon follow. He needed to be protected and covered. Now.

“I’m going to need two of your guys.” I told the captain.

“You and you, drop your gear and go” He barked at two medics.

“Yes sir!” They dropped their helmets, air bottles, masks, and coats and stood in front of me, looking for direction. They were soaked and their chests were still heaving from exertion of being in the fire.

“I need one of you in the airway seat, the other with me in the back” I said using my most calm and authoritative voice I could muster up. I really wanted to turn around and run. To be anywhere but here. But my morbid curiosity was starting to gain control over my fear and I wanted to get to assessing my guy.

By the time I finished that sentence I turned around and four very large men were holding the board the patient was on. The patient was packaged and it was time to go. Seconds count in this game from now on.

Before we closed the doors I quickly asked the captain “What do we know about this guy? Name, age, birth date, anything?”

“Nope, just pulled him out, feet facing the fire, that’s why his head is not as burned” He said and closed the back.

“Angie! Go!” And go she went. The ambulance was now flying down the worn out, pot hole infested streets of West Oakland. We were bouncing around in the back like popcorn kernels in a hot air popper.

I took a few seconds, probably milliseconds, to collect my thoughts. I was now in the back of a van with two profusely sweating firefighters and a patient who produced a smell you can only know if you have smelled it. I pulled back the burn sheet to see what we were dealing with. I had to look, it was my job, but every bone in my body resisted, like when you are watching a horror movie and want to filter the scene through your fingers. Again my curiosity won. I looked.

He was burned.

No, that is an understatement. His skin was peeled off and black at the edges of the peeled sections. The open sections were pink and smooth like raw chicken. You could easily trace the musculature of his body now that it was on the outside. There was an unsuspected shortage of blood for all the skin that was missing. I guess it all evaporated away and the veins were cauterized.

His lower legs must have been closer to the fire. His skin had sloughed off and now looked like he was wearing a pair of ill-fitting grey leg warmers from the eighties. The man was loudly whispering “water” in a sandpaper voice usually reserved for the guy who has been walking in the desert for days in cheap B movies. He did not have his teeth in and the inside of his mouth and nose were coal black from taking in copious amounts of noxious smoke. But again, he was alive and breathing and could talk.

I glanced up and noticed the firefighters who were with me. One was maybe twenty years old, a light skinned black man with a tightly cropped haircut. He was clearly amped and enjoying himself. He kept letting out interjections of “Wooo!” and “Damn this is some crazy shit!” The other was in his forties and clearly enjoying being there for the younger one’s first experience. He had a very smooth way of talking and encouraged the younger firefighter. After a few more comments I gathered the younger one, I’ll call him Junior, was the one who actually dragged our patient out of the fire.

“OK, priorities Jon, priorities. Airway” I thought to myself.

“Can you intubate him?” I asked Junior.

“No way man, dude be like fighting it” Responded Junior. This guy was young.

“OK stick with bagging him, I’ll get the IV”

I went to work looking for IV access. I had no delusions that I would succeed, but I had to check. He desperately needed morphine, and lots of it. As it turned out, one of his arms must have been bent when he was in the fire. There was a small circular spot on the inside of his elbow about an inch and a half in diameter that was actual skin. It was sooty, but it was skin. I could see the anticubital vein.

“No way” I said to myself in surprise. “Spike me a bag”

The older firefighter handed me an IV bag and a flooded line. I got what was possibly the only surface vein this guy had on his body left and began to flow fluids into hip wide open. As I was securing the line, someone stopped their car right in front of the ambulance. Angie had to take major evasive measures to not flatten the sedan with the nine thousand pound ambulance. Unfortunately, this included steering into a pothole that could have doubled for a tiger trap.

“Hold on!” she yelled.

“To what?!” I thought as I fell down partially onto the patient’s chest, propped up by my hand that was not holding the IV. This made the patient jerk and the line popped out. Only vein on his body, and the line got knocked out. Working in an ambulance tearing through Oakland is like trying to sew in a jumpy house. Not safe and not easy.

“God damn it” I was beginning to lose my cool. I needed to punch something.

“Jon man! Jon man! Chill bro, it aint no thing!” reassured the older firefighter, “Let’s just do what we can. Do what we can! That’s all there is. Do what we can.”

He was right. We needed to do what we could. Besides, judging from our rate of travel, we would be at the trauma center in a couple of seconds.

I hit him hard with the maximium dosage of morphine we could give him. Anything to make him more comfortable. He was probably not going to live. At least we can limit his suffering.

The ambulance whipped around and the back doors were opened by the receiving staff at the hospital. There were so many of them. I have never seen so many residents and students in the ER. They must have called all of them down to the ER to “see this”. The gurney was pulled out and wheeled in. I followed with the firefighters, it was showtime and we were being rushed to the stage. I stood up on a step stool to be seen and heard and yelled out my report to the thirty or so people in scrubs and gowns who had now showed up. Nobody moved and everyone was looking at me for those few seconds as if I were a preacher and they were my flock. A freeze frame. I ended with “that’s all I have” and it was like the referee just dropped the ice on the puck. Everyone was in action.

I realized I was stumbling as I exited the ER. My body had just gone from zero to 120 mph and back to zero and my metabolism and equilibrium were all out of whack. I went to the radio and called us delayed for clean-up. Angie was sweeping the extra skin out of the back and scrubbing up the odd yellow fluid that was on the floor. I didn’t even want to know what that was. She was also investigating how to get rid of that smell. It would take days to get rid of the memory smells that sneak up on you days afterwards. Those are the worst.

I walked back into the ER to see what was up. I felt calmer now. The patient was now sedated, intubated, and a catheter was being placed into his bladder. They had found a vein in his groin and neck that now were flowing liters into him as fast as the tubing would allow. He looked so peaceful on that bed. He was getting his water.

In this line of business one wonders what happens to these people. I don’t mean what happens to them physically, we know that. This guy will be transferred to a burn ICU and eventually die of a massive irreversible infection sometime in the next twenty-four to forty-eight hours. That much is certain. What I mean is that this guy lived ninety-six years and ended up dying in a house fire two feet from the door. He didn’t get cancer, he didn’t get emphysema, he didn’t die of a heart attack, he didn’t have a stroke. He beat all of the insurance actuary tables. He was a winner. I pondered on of all the lives he touched. All the events and advancements he experienced in the last century both historic and personal. All the tastes, smells, sounds, and memories all snuffed out in an instant. It makes you wonder.

Copyright 2010 Jon Kuppinger

Wednesday, February 3, 2010


I poured the beer the same way I always did. A forty-five degree tip of the pint glass, so as to not make too much of a head. I watched the golden nectar cascade from the mouth of the bottle and roil around in the bottom of the glass like the rapids in a raging river. The liquid was not sure which way to go, but going all the same with a reckless head of steam. The bubbles danced like fairies in the night sky, calling me closer, dancing their seductive dance. The gases infused into the beverage, now free, cascade upward in a reverse waterfall growing the rich, thick, foamy head to a consistency of the icing on a wedding cake. I, thee wed.

I knew the first taste would be the best. The tickling of the tongue, like a million miniature bolts of lightning shocking me back into a time before worries, before my life as I sit in it now on this wooden stool. I could now smell the hops. It reminded me of a long lost love of whose name I can’t, but should remember. I longed for that forgotten, nameless love as I watched the head finish and the glass settle out. There was clarity in my life now, for the last six weeks, four days, and fifteen hours that mirrored the serene clarity in that pint glass. The drink was still beautiful and enticing, but no longer a raging sea of gas and water smashing against each other in a twisted web until no sense could be made. Seeing that beauty is enough.

I will not drink tonight.

Copyright 2010 Jon Kuppinger

Tuesday, February 2, 2010

The March of the Ants

The ants weren’t concerned. They were just being ants. Probably some scout went out on patrol looking for a Kool-Aid spill or a cookie crumb and realized he had hit the motherlode. He sent word back through their intricate communication system. A system based on neurochemical transmitters and receivers 100 times more advanced than anything we have developed, but the ants seem to have figured it out. Go figure. I guess eventually, the word got back to the base camp that a line should be formed, something had been found, things needed to be done.

Busy feet, busy hands, busy mouths, busy ants. It was like clockwork for them and no source of worry, all in a day’s work. I wish I could say the same for my trainee.

“Do you think he’s dead?” he asked me.

“What do you think?” I sarcastically quipped. There was no way this guy was still alive. He was frozen in a pose like a praying mantis with his elbows bent and hands curled inward. How long had he been there? My estimation was at least a day. Probably not too much longer as it was warm out and I couldn’t smell him from the door as he laid face up on the pale yellow linoleum kitchen floor. Probably not how he imagined he would go. In his boxer shorts. On a cheap floor. In a run down apartment. Not the stuff dreams are made of.

The ants marched on.

“What do I do?” Jeez this kid was full of questions.

“What does the protocol book say to do?” Two could play the question game.

“I guess I need to check him out and make sure he is dead.” I could see his brow was starting to get that nervous sweat on it. Opening day jitters, performance anxiety, whatever you want to call it, he had it.

“Sounds good to me.” I vacantly replied. Ray Charles could have seen this guy was dead, but if my trainee wanted to get his hands dirty and get in there, who was I to stop him? Besides, I was distracted imagining the deafening din of thousands of microscopic combat boots hitting the pavement in perfect unison like so many jack boots in a parade. “Your left! Your left! Your left, right, left!” the miniature caller would shout, probably not as manly as in the army movies. Maybe more like Alvin and the Chipmunks. Yeah, that worked better.

The trainee got to work checking the dead man for any signs of breathing or circulation. Of course there were none. The sour look on his face told me that at least subconsciously, in close quarters, the smell was there to indicate decomposed tissue. The heart monitor was picking up a bit of artifact from the trainee’s movement that produced ripples in the EKG waveform from the familiar flat-line everyone knows from TV and movies. Artifact has given many green medics false hope that there was some activity in the patient’s heart. Classic mistake. The trainee bit.

“Is he flat line?” I asked feigning interest already knowing what he was thinking. This was a teaching moment I couldn’t let pass.

“I think so, but I might have something. Let me check a few things.”

“Sounds good.” I was fine to let him go as long as he wanted, and long he went through every possible check. I could tell he wasn’t sure about rigormortis and kept checking and rechecking for stiffness like a kid who keeps poking a sleeping dog expecting it to wake and snap at him at any moment. I remembered back to when I was a trainee and how the only way to learn about things of this nature was to jump in and just do it, so I let him go. Besides, a crowd was forming and the cops and coroner were just pulling up so I went over to chat with them and let them know the kinds of things they want to know.

With the police, fire department, ambulance crew and now the coroner, we were beginning to form our own version of the work line to and from the body. Lots of gathering of facts and opinions from witnesses and the unlucky fellow’s personal effects. More opinions than facts were offered.

“Your left, right, left!”

There was a lot of work to be done. Shuffling of paperwork. Trips to the ambulance and back. Radio reports back to base. Busy pens, busy boots, busy mouths, busy humans. It was like clockwork for us and no source of worry, all in a day’s work. I still wished I could say the same for my trainee.

After fifteen minutes or so, I started to develop a conscience and pulled the kid off the corpse. “OK, that’s enough, come on you have paperwork to do.” We did. Besides it was time for everyone to finish up. Very soon both production lines would be shut down.

Meanwhile back at the ant line, production was in high gear. They were moving morsel upon morsel back to the hill. They were completely oblivious to the fact we were there. Even more oblivious to the impending fact that their find would soon be snatched away as quickly as their meal’s life had been. I don’t know how or why this particular gentleman passed on. There was nothing to indicate either way, and it’s really not my job to figure that out. Much like the ants, for me it didn’t really matter, the fact was there was a body on the floor and there was much work to be done.

Copyright 2010 Jon Kuppinger