Tuesday, August 16, 2011

OG and some unusual math

It was a soggy, rainy day on the east side of Oakland in the killing fields; a square that is bordered by Seminary to the north, 106th Ave. to the south, MacArthur Blvd. to the east and 880 to the west. Most of the shooting, stabbing and other various gang activities that Oakland is famous for take place in this neatly packaged little slice of hell.

I was picking up an overtime weekend shift to try and compensate for some lost time I had due to an injury in my rotator cuff and my lower back. Minor setbacks like that can really cripple you financially. I was working with a new guy. We had been talking about how he had never had anything really bad yet like a shooting or stabbing, which is not a great idea. In general, I’m not superstitious, but everybody knows not to talk about something unless you want it to happen. One of the first rules. You never mention that it is “slow” or “quiet” either, unless you are looking to get run. Of course, on this day, we were stupid enough to talk about my partner’s lack of “good” calls.

We heard a number of calls drop in succession on a hot corner notorious for gang activity. There were a total of four all within a block of each other. We were assigned as first unit in on a GSW (gun shot wound) with a non-secure scene. My partner hit the lights, the siren and the gas and we cut through the town.

As we were approaching the scene, we were trying to be cognizant of the fact that there were no fewer than four calls all on the same block. All kinds of fire trucks, police cars and ambulances were all triangulating in on this one block at a high rate of speed. That can be very dangerous to all the responders, so we took it on alert. The pouring rain cut down on visibility further complicating the response.

Two of the calls on this block were for GSWs, most likely related to each other being that close in proximity. One was for a MVA (motor vehicle accident). The fourth seemed to be a medical that was unrelated. Certainly possible given the level of poverty and lack of even basic health care this area is famous for. Some people will go a lifetime without any preventative care with astronomical hypertension and untreated cardiac conditions. Walking, ticking, time bombs just waiting for their fifties to creep up on them. A few blocks out we heard a second unit attached to our call and dispatched to our location. So now we had five ambulances, four fire engines, countless cops and who knows what other resources coming. Add to that a couple dozen looky-lous and you have a recipe for disaster.

Since we were first to arrive (besides the police of course) the bystanders were easily as confused as we were as to where we were supposed to be at. We saw a BLS rig from another transporting agency a block from us with several police cars. It looked like they were on the ground working someone up. As we passed the first scene the bystanders were obviously very agitated we were not stopping for their patient. The jumped up and down and yelled waving their hands over their head. Some of them held up their iPhones to film us. A cop jumped out into the street pointing back to the first clump of people on the sidewalk indicating that was going to be our call. Apparently he and the BLS crew had his corner of the block handled and we were needed back a couple houses.

I called in again to dispatch asking if the scene was secure. The answer came in an OPD officer shining a flashlight at us and directing us through the crowd to a small run down house with way too many people in front if it pointing down their driveway.

“I guess the scene is secure and this is our guy.” I said to my partner.

“Five fifty-nine we are on scene, waved in by PD.” My partner said into the radio.

“Well, ask and you shall receive, here’s your shooting you were looking for.” I said to my partner.

I was putting my gloves on waiting for the ambulance to come to a stop. I wanted to be ready to jump out and get to work immediately. These kinds of scenes can be very sketchy and the quicker you get the victim packaged up and out of there the better. There were police and firefighters swarming all over the place with about fifty concerned citizens mucking up the progress. Everyone wanted to tell somebody their version of what they saw or more likely didn’t see.

Once the rig stopped I said to my partner, “I’ll get the board and C-spine, you get the gurney ready and get it as close as you can.”

I ran around to the back of the ambulance and the fire engine was just pulling up. The Lieutenant stepped out talking into his mike on his shoulder and the medic approached me.

“Know anything yet?” he asked me.

“The cops said he’s out back.” I said handing him some of the gear.

I particularly liked this fire medic. He has always been competent, supportive and an all-around nice guy on previous calls. I was happy it was him.

We walked down the crowded driveway into the back yard. There was a pit bull on a chain that could almost, but no quite reach us. He was testing the strength of the chain and barking like he would certainly eat us given the chance. I didn’t want to find out.

“Hey puppy!” The medic said, acting as if he were going to approach the dog and then backing off saying “just kidding”.

There was a bald, plain-clothes cop in the alleyway in dark sunglasses with a badge on a chain dangling over his hastily donned bulletproof vest. He was holding an assault rifle at the ready and his attention was darting around ready for any combat that came his way. He had a handgun in a holster attached to his belt on his jeans. He was waving to us to move along and make it snappy. There were at least three iPhones tracking us from the windows and porches as we walked back along the narrow driveway to the one car garage behind the little shack of a house.

Everyone films everything in the hood.

Our patient was around the side of the small, detached garage lying on his side cradling his ribs with his arms and rocking back and forth in pain. There was a rusted and slightly physically compromised chain-link fence on two sides of him defining the property line. He had tight cornrows in his hair, looked to be about forty years old with a number of scars on his face. He was wearing a thick, light brown leather jacket over a nice dress shirt that might have been silk. He wore expensive designer jeans, and classic Air Jordans, laced up so he could run. This is the uniform of the older gangsters in the hood. All the kids now wear long white T-shirt, saggy pants, and unlaced hi-tops that make them walk in a funny waddle. Their pants sag well below their crotch so they wear brightly colored or patterned boxer shorts to contrast the simple colors they wear on the outside. In the summer, lose the shirt. In the winter, add a bulky black bubble jacket that may or may not be hiding a sawed-off shotgun or a strap in their waistband. It is for them to know and you to ponder. They sport long extension braids with an oversized, precariously perched baseball cap that has perversely converted the colors of the local sports team’s logo to fit the colors of their gang, car or otherwise and wear gold or platinum removable “grills” in their mouth. The OGs have their own “classier” uniforms and wear their hair cropped much closer and wear gold, not platinum or silver. The OGs have real gold teeth, not these fake “grills” the posers wear. My guy was an OG.

We stood over him for a second trying to figure out what the problem was. There was no blood. He appeared to have either ran in this backyard and found himself trapped or jumped over the fence from the yard behind him and ran out of steam. Either way, it wasn’t clear exactly what was wrong with him.

“What happened man?” I asked him.

“I got shot” he said through clinched teeth.

“Where?” I asked him.

“In the chest” he gasped.

“OK, we are going to have to take all your clothes off” I started to tug on his jacket and he reacted violently pulling away.

“Man, what you trying to do? That hurts!” he barked at us. He had anger in his eyes.

I could smell the combination of leather and the unique tangy odor of adrenalin driven sweat that cut through the musty smell of garbage cans and wet weeds he was lying in.

“I can either take your jacket off or cut it off. Your choice, but it’s coming off.” I told him with authority.

We were running out of time. A critical trauma like this hast to be packaged up and on the road to the hospital in less than ten minutes from arrival. I usually shoot for six. It’s the patient’s best fighting chance of survival to keep it brief on scene.

He quickly sat up and held his arms out like a kid does when it is time to take a jacket off and they want mom or dad’s help. So much for keeping him immobilized in the position found. We pulled the jacket off and there was the blood. The whole upper left side of his dress shirt and wife-beater T-shirt were soaked in bright red blood. I quickly cut the shirt off with my shears and asked him to hold his arms up so I could see under his arms.

There were a total of five holes in his chest. Two were under the armpit area. One was exactly over where you would point if I asked you where your heart was. He was breathing in short breaths so my concern was up that a lung might be punctured. I couldn’t believe he was alive much less talking to us.

I could hear sirens all around us. This wasn’t over yet.

“OK, I’m gonna need you to lay down on this board.” I told him. He did.

As soon as we got him on the board I took his shoes and pants off to look for more holes. He didn’t have any more.

Then the heavens opened up. The rain came fast and furious in sheets. It was time to hustle and get the patient out of the back yard and into the cover of the ambulance. I was wearing rain slicker pants so my bottom half was OK, but from the waist up was getting soaked. I thought it must be worse for the patient who is now naked and on a board getting pelted with rain.

Once in the ambulance we got to work quickly. I got a baseline set of vital signs which were amazingly normal. He said it was getting hard to breathe and was starting to really complain of pain in the chest. I listened to his lungs. They were equal, with good tidal volume and air movement, but he still winced in every inspiration. The holes in his chest were oozing, but not aggressively bleeding and there was no obvious signs of a sucking chest wound. I covered the wounds with occlusive dressings, and prepared the decompression kit just in case the situation worsened.

On the way, I tried to make conversation with the patient just to keep him conscious. He was not very forthcoming and knew he was potentially in a lot of trouble so the less he says the better. I don’t make a habit of asking about the details of crimes or even wanting to know as it affects my ability to provide unbiased care. I was able to get out of him that he had no pre-existing medical conditions, took no medications and had no allergies to medications that he knew of.

We came into the hospital hot. His vitals were still holding well and his bleeding was well under control, but still, this was a guy who took several rounds to the chest in the area of his heart. If things were good right now, chances are they wouldn’t stay that way too long.

After I turned over to the trauma team and the students and residents swarmed him like yellow jackets on a spilled soda, I asked one of the nurses if the other guy came it yet.

“What other guy?” she asked.

“There was another gunshot patient on scene” I said.

Another crew came in fast and furious. They were performing CPR on the go as they hustled in to the ER leaving a trail of watered down blood behind them as it was still torrentially raining out. They were bagging the patient and someone was holding pressure just below the armpit on what I assumed was a wound.

“Is this the guy from the car?” I asked.

“Yeah. One shot axillary. Witnesses say your guy was the driver”

Through talking with the other crew, I was able to put it all together. Suddenly it all made sense. My guy was driving, the shooter was in a passing car that pulled up to the driver’s side and opened up on them striking my guy four or five times and hitting the passenger once. This caused the car to crash into another car, creating further injuries to the other vehicle’s occupants and rendering the OG’s car inoperable. The OG bailed out of the car and jumped a few fences between backyards until he either ran out of steam or felt he was a safe enough distance to call out for help.

I talked with the ER doctor later and got the rundown on the injuries. The OG would be going home later that day. The other guy would be going to the morgue. The cops said there were no outstanding warrants and my guy was not on parole so given that he is not talking, he will be free to walk.

But the inequality of the equation, and what kind of freaked me out is the following. My guy had several holes in his chest. They were all at the perfect trajectory, speed and caliber that they were able to bounce off of ribs. On first inspection, clearly any could have killed him. The other guy only had a lone hole but it was in just the right exact position to slip between two ribs and hit a major vessel (the aorta most likely but any major vessel would do) an cause him to bleed out internally in seconds. Just dumb luck. But the trauma game is a matter of millimeters and a lot of dumb luck.

On my next run to the hospital I stopped into OG’s room. He was all smiles and had a friend visiting him. A youngster in a long white T-shirt, braids, sideways red hat, baggy jeans and unlaced hi-tops. Associate is probably a better word. There was a large bandage over his whole upper left chest, but other than that he looked to be in very good health.

“Well there’s the luckiest guy in the world” I said as I walked in startling him and his guest.

“Hey!” he said “This is Jon, the paramedic that picked me out there when they shot me” he introduced me to his friend. His friend gave me the nod, no words.

“I hear you are getting out of here soon” I said.

“That’s what the doc says. Nothing major hit, just flesh wounds.”

“Hmmmm, that’s great.” I said. “So here is what you have to do.”

“Yeah?” I had his attention.

“As soon as you get out of here, you need to go straight to the minimart at the bottom of the hill.”

“Why?” he asked.

“Because you need to buy a lottery ticket tonight, you are the luckiest son of a bitch in the world.”

“Awww man, you know it. I think I used up all my luck though. Aint no thing. I’ve been shot before.”

“ I still think you should get yourself a ticket.” I persisted.

“Alright then, I’ll do that.”

“Oh, and buddy, if you win, I get half!”

We both laughed and I headed back out to prepare for the next call.

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