Blogging Away the Ghosts

Welcome to 911Premed! I’m really excited to finally start a blog. It’s something I’ve been deliberating over for a while now, but I feel that all of us (no matter the profession) should have places to talk, vent, and share our experiences. 

Medicine is no exception, in fact, I’d argue it’s more important. As for me, I stay on the emergency side of things — either as an EMT-B on an ALS truck in Ann Arbor, MI or an ED technician at a level one trauma center in Detroit, MI. 

The call

For the emergency adrenaline junkies out there, there is a secret code, an unspoken understanding between care providers. This dead air that hangs between experiences and our ability to process them is a glaring red flag that plagues too many of us in the field. After repeated secondhand (and sometimes firsthand) trauma the mind separates it from reality. Each call runs more like a movie than real life. They sit in the passenger seat of their own body to protect themselves. We all crack jokes, but these people take it to another level where suffering becomes comedy.

I had a call about a year ago that brought me to this conclusion. I worked Saturday nights so I could do school during the week, and was working my normal 4p - 6a shift on the ambulance when we got a call for a car accident. The radio had been exploding just prior to us receiving the call for the same accident and we would be the fourth unit on scene. It’s unclear exactly what happened or whose fault it was but on one of those two lane backcountry roads someone had drifted over the median causing a head on collision with both cars going about 50 miles per hour. 

For a quick physics lesson, both cars felt the force of hitting a wall going 100 miles per hour while their bodies continued moving forward until they were stopped by a seatbelt (or if no seatbelt then through the windshield and then it's just friction from the ground that brings people to a stop.)

What that quick and dirty lesson doesn't tell you is how the force is distributed differently if those cars were a pickup truck, and the other was a family sedan. 

The sedan was obliterated. The entire left side of the car was just gone. The pickup truck had flipped (as they often do) and was upside down in a ditch not too far away. Officers counted 3 patients on scene. A woman, late 20’s, was in the driver's seat of the sedan. Her arm was mostly amputated at the shoulder. Her husband was sitting next to her in the passenger seat - seemingly unharmed. In the pickup truck, was a man in his 50’s who had questionable injuries, initially presenting walking and talking, but later becoming confused which is indicative of some sort of neurological injury or brain bleed. As it turns out, our bodies are not evolved to go anywhere close to 50 miles an hour. 

It's at this point, that if you were paying attention, and passed first grade math, you might say “Remy, wait. You counted three patients, and then told me that you were the fourth unit to the scene. Why would they send four units for three people?” And you’d be right. They wouldn’t. The problem was that officers miscounted the number of patients. They didn't see the three month old in the back of the sedan. All they told us was that the baby was bleeding from her ears and mouth.

Pause for triage explanation

The first unit to a scene which we call a mass casualty incident becomes a system command. They do a base triage of all patients, usually with the help of police or fire and radio back to dispatch to send however many more units are needed. They perform basic and quick life saving interventions if needed (tourniquets, etc), leave people who are deceased and direct people who can walk and talk to a designated area. Then they will assign priorities to these patients, red, yellow, or green and call back to dispatch to send the needed units.

On our drive to the scene we were discussing the possible things that we needed to be ready for, and quietly preparing ourselves for what we might see. We roll up to the scene, and the husband hands us a crying baby which both of us were relieved to see. A crying baby is an alive baby. I looked in her ears and didn't see any blood, but inside her mouth I saw that during the impact her brand new bottom two teeth hit her top gums and they were bleeding a bit. I was relieved again, but only for an instant, just until my gaze landed on the sedan. There was more blood on the ground there than I had ever seen before in my life. I remember just thinking over and over again that there was no way she could have survived that much blood loss. 

We loaded both the baby and her dad into the ambulance and all the dad could do was repeat himself the entire way to the hospital. “Is she okay?” “I told her to drive carefully.” “I should've been driving.”

Both of them were physically completely healthy, but as I imagined, the wife had lost too much blood and they called her time of death soon before we got there. After making sure that the two other passengers were being taken care of, I went into the room that they were keeping mom in to help prepare her body for her parents to come see her. This was the first time I had seen a dead body. 

You know when we say amputation there's an image that comes to mind of a partial limb, healed and covered by skin. Not the mangled mess I was presented with as I lifted her sheet. Her partial amputation was only held together by a few struggling tendons and sinew. 

I never really understood the concept of paying respects until I was standing over her lifeless body, but in that moment I felt compelled to force myself to think about her, not just as a patient, but as a person. A person with a newborn and a husband in the next room. A person with parents getting the worst call of their lives. However, I was fighting desperately with myself. My survival instincts told me to bury those images as quickly as possible. 

The ghost of EMS future 

Those feelings scared me. It's so easy to say that you'll be different until you are in the same situation. Mike Tyson said “Everyone has a plan until they get punched in the face.” And I got punched in the face. I saw that future – that future where I would be so emotionally blunted that I would have a hard time feeling for anything. The good gets buried with the bad and I couldn't live that way.

How do we get rid of ghosts?

This blog is part of my process to decompress and think about the things that impact me. I can organize my thoughts here without the concern for the emotional toll that it may take on others. In a way, I feel it’s not fair to the people in our lives who are not in healthcare to burden them with some of the terrible things that may make up a normal tuesday.

Ok, Scrooge.. 

That’s not to say I’m all thunderstorms and rainclouds here, I’m also going to write about good learning and fun times. After all, I love the ambulance, and I love the ED more. I'm just hoping that I learn something about myself, and I hope that if you are reading this that you might learn something too.