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.
“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.
“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