El Sol no brillaba

It is pouring rain, hard cold, wind-driven, diagonal rain that hits you in your face and makes you walk on a slant. You get drenched before you can even put up the hood on your rain coat.


First call is at the Spanish Market for a man unconscious. It turns out he was just sleeping. While we are there, I go visit my favorite Spanish carryout stand and get boiled green bananas and root vegetables.

**

I practice some Spanish. I take it from the Cat in the Hat, El Gato Desombrerado.

El Sol no brillaba.
Hay demasiado mojado.
Es un dia para sientar adentro de la case.
Un frio, frio, dia mojado.

The sun did not shine. It was too wet. A day to sit inside the house. A cold, cold, wet day.

***

Next call is a nursing home transfer. As a paramedic you face many obstacles. Each situation is unique. How do you treat the person passed out behind the toilet? How do you get the man out of the back seat of the smashed car? How do you get the guy out of the ditch?

What is a smaller, but more everyday occurrence is -- how do you get the person out of their bed in the nursing home? Nursing home rooms are small, tight enough for stretchers without throwing in furniture in the rooms. Dressers, TVs on big stands, bedside tray. The man tells us to turn off the TV, and be careful wheeling the desk it sits on. He says yesterday, the leg broke on the stand and the TV fell. I move it very carefully. Then I move the bed stand that has a pitcher of water on it, the telephone, a half eaten breakfast, some pens, paper and glasses. I try to lower the bed rail, but it will not budge. It seems every bed in every nursing home and hospital has a different mechanism to raise and lower the side rails. I understand this mechanism, but it is broken. The rail will simply not go down any further, leaving it jutting up about three inches above bed level. We unlock the bed and pull it from the wall, place our stretcher next to it, then place a pillow on the bed rail, hoping if we lift the patient up the extra three inches, it won’t hurt when we move him across. I take the patient side. I will have to lift high and maintain it all the way across the bed. We lift on the draw sheet. The man is moderately heavy and as we pull/push him across, I lose my balance, and fly forward. My foot comes up and kicks his roommate’s bed stand, knocking over his pitcher of water and sending his false teeth dish chattering across the floor. I apologize profusely. They don’t appear broken. We take the patient on his way to dialysis – another situation handled.

***

We do a wait and return at the wound care center. The company doesn’t like us staying more then twenty minutes, so we always ask how log the patient will be. If they say more than twenty minutes, we clear and give them our number to call when the patient is ready. Most places are wise to us – they say twenty minutes, and when twenty minutes passes, they say just a little longer. Over and over. Today, the doctor says fifteen minutes and sure enough, she is done in fifteen minutes.

***

We get sent for the pedestrian stuck at the intersection of two downtown streets. We think it can’t be too bad because the traffic is so congested down there, no vehicle ever gets up much speed. We can see two fire trucks out ahead of us. There have been no updates on the radio demanding our ETA, telling us to hurry because the patient needs paramedics now. We pull up to the scene. I can see a crowd gathered under umbrellas around someone sitting up on the curb. I tell my partner it looks like nothing.

I get out and approach. I see a girl maybe eighteen talking to a policeman. She has a small hematoma on her forehead and a slight abrasion about it. I ask what happened. Everyone starts talking. “She got hit by a bus.” “She done fly through the air.” “That bus driver he should look out. He got to look when he turn.” The officer says she was hit. No LOC. “They say she flew through the air,” he says, raising an eyebrow.

I introduce myself to the girl. She tells me her name and tells me she has a headache. I ask her what happened and she starts telling me a long story about how she was just walking across the street and … All I am really interested in is that she is alert and completely appropriate in her answers and actions. I ask her if she has any pain in her neck or back and she just says she hurts all over.

We c-spine her, and get her in the back of the ambulance out of the rain. I tell my partner to head to the kid’s hospital on a low priority. En route I take vitals and finish my full body survey. I call the kid’s hospital to let them know we are coming. Normally I might not even call, but lately there has been a bit of controversy about kids and trauma, due mainly to one major call where a child died in the kid’s ER after the ambulance tried to take him to the local trauma center but was diverted. The kid’s hospital is operating under different protocols. I patch in, trying to stress that the kid is stable, unhurt except for the headache. They want to know full vitals. 110/70, 88, 18. They want to know how fast the bus was going. Slow, I say. They tell me to hold on. Finally they come back on and tell me to go to the trauma center. Okay, whatever.

We make our way there. Without even looking at the patient, they call a pedi-trauma alert. They are just going by protocol. The girl who is the size of a normal adult is 15 so she gets the full workup, wheeled down to the critical hallway and met in the big trauma room by several staff done up in gowns. I give my report. Struck while the bus was turning the corner. No amnesia. No LOC. Good vitals. No deformities, just the hematoma. Completely appropriate. They smile and nodd. When I bring my run form back, she is getting full body X-rays.

The nurse is apologetic. I had to call pediatric trauma, she says. Pediatric hit by bus. I don’t want to go to court and have to answer why I didn’t call a trauma. But, members of the jury, parents and grandparents, the child – the poor child -- was struck by a bus.

Last year a kid was in a bad motor vehicle accident -- the crew wanted to take him to the trauma center, but they diverted him to the kid's hospital over the medic's objections. The kid died four hours later in the ED because they were too concerned with his broken leg to pick up on the fact his aorta was about to rupture. The upshot was medics can overrule a diversion request if they think someone needs the trauma center, and the kid's hospital has become very skittish about any pedi trauma.

***

We do a woman who cut her hand with a knife while making soup. The floor sink and kitchen are splattered with blood. She looks like Julia Child as played by John Belusi on Saturday Night where she bleeds to death, while talking to the audience and trying to control her bleeding. She finally tries to call 911, but the phone on the wall is just a prop. Very funny. The dressing on this lady’s hand is soaked through. I take it off and hold pressure hard for ten minutes. Finally it stops. She refuses to go with us, and says she’ll have a friend take her to the walk-in clinic.

***

Still rainy. Its dark. We’re sitting here listening to the rumble of the diesel engine, Three hours to go.

***

Last call is for an old man with Parkinson's who falls and has shoulder and hip pain. We get out late.