A Day at the Races part 2

I’ve come to grips with the fact that in the proper setting, other people’s discomforts provided me with enjoyment. Don’t get me wrong. I don’t like seeing someone in pain, but without another‘s injury, I cannot do my job. The worse a person is injured, (up to a point), the more creative and exciting my work environment becomes. l have used the following statement to avoid being labeled a sadist. “I don’t wish anyone any harm, but if it happens, I want to be there”. This seems to get the point across fairly clearly.

Back to Jerry and the opportunity. A collapsed lung is a potentially life threatening injury and one which can present very quickly in an otherwise mildly injured patient. There are signs which, when recognized in time, can lead to a very exciting series of actions.

“Jerry, I need to put these ‘soft safety restraints’ around your wrists, you appear to have punctured your lung. I can help you but it won’t be very comfortable.”

I took a long strand of gauze bandage and doubled it over looping it around Jerry’s wrist and tying the end to the rail on the cot. I explained to Jerry what I was planning to do in between his increasing complaints of ‘I can’t breath’.

“I’m going to attempt to re-inflate your lung by releasing the air that has gotten trapped in your chest.” I informed him.

Jerry seemed to be listening; his half-closed eyes opened a little wider. I finished securing his other wrist to the cot and was checking the belts that held his body to the backboard and cot as I delivered the punch line.

“I’m going to have to put a needle between your ribs and into your chest. It’s going to hurt, but you will be able to breath easier when it’s done.”

Jerry had stopped telling me how hard it was to breath and was now just blowing the Sweet smelling air from his lungs in rapid shallow breaths, watching me.

held his body to the backboard and cot as I delivered the punch line. “I’m going to have to put a needle between your ribs and into your chest. It’s going to hurt, but you will be able to breath easier when it’s done.” Jerry had stopped telling me how hard it was to breath and was now just blowing the sweet smelling air from his lungs in rapid shallow breaths, watching me.

I was nervous as this was my first time performing this procedure. I tried to act calm and confident. I also kept the needle out of his sight, which was easy considering he was immobilized to a backboard with his head taped down tight and a stiff collar around his neck. I too began to sweat.

I cleaned the side of his chest with alcohol swabs and then with betadine antiseptic, staining the skin yellow brown. I removed the needle from its pack, two and a half inches long, a ten gauge, as big as a ten penny nail.

“You’re going to feel a sharp poke.” An understatement to be sure.

I could feel the sweat on my forehead. Jerry started screaming as I pierced the skin with the bright steel, remembering the words of all those who had attempted to prepare me for this day. Steady pressure. and as quickly as you can to lessen the discomfort.

Jerry yelled, “You’re killing me!! You’re killing me! !” Over and over he said this.

I pushed, marveling at how much pressure was actually required to push a round steel shank through a relatively thin area of tissue. As I pushed, Jerry continued yelled ‘you’re killing me! You’re killing me!’ over and over, as if I didn’t have enough going on, this guy has to yell at me!?. I stopped for a moment, the needle through the skin but not yet quite where it needed to be. I brought my face directly in front of his. The sweat on his brow mimicking my own.

“No sir,” I said with a calm I didn’t really feel, “I’m saving your life.” There are just some set-ups that are just too good to pass up.

Jerry stopped his screaming and concentrated on breathing, I returned to my tool protruding from between Jerry’s ribs, the 4th and 5th, axially, and pushed once again. A sudden decrease in pressure and a small bit of escaping air, not the high-pressure whoosh I had imagined. Jerry gave a grunt and then continued his breathing, which seemed to come easier over time. I secured the catheter to his chest with tape and gauze and fixed a one way valve to the end of it, allowing air to only escape and not enter, and allowing Jerry’s lung to re-inflate itself.  No more yelling, no more complaints.  We rode in relative silence as I monitored my patient for any changes.

Mary and I delivered Jerry to the emergency room and collected the pats and encouraging words we’d earned for doing that rarely performed and fearful procedure. Jerry was moved to another bed off our pram and we were given our leave of him after gathering all the necessary signatures and handing on the required reporting paperwork.

I still enjoy a good horse race from the stands. Though sometimes I feel like I’m missing something.

A Day at the Races part 1

Today I determined to pack up and take a trip back down memory lane to my days as a Denver medic nearly 20 years ago..

 

A Day at the Races

Standby at the horse races was a unique duty. If you liked horses and racing, you might enjoy it. However, if you didn’t care for either, you didn’t stand a chance.

The horse racing industry had developed a standard for emergency response that placed the ambulance as close to the potential victims as possible. The infield of a horse racing track tended to be very well kept, decorated with fountains and brand new cars, (obviously placed there for a fee, by a dealer hoping the days winners would want to buy one of their cars). This area was off limits to an ambulance, their heavy load being much too destructive to the manicured lawn. A steel pipe fence surrounded the inside and outside of the track in an effort to keep the high-strung race animals contained.  This left only the race track itself as a possible staging area for a crew and their vehicle. Someone in the ‘planning-for-the-worst’ department determined the best possible place to stage, would be directly behind the horses… always.

“There’s the bell!! And they’re off! ”

The gates flew open and the jockeys raised up slightly, legs tense, leaning hard over the necks of the straining horses beneath. The animals began to work together, horse and rider. The horses had been raised to run. Programmed to bolt at the opening of the gate, the bell adding a sense of urgency to their launch. A shock of a riding crop and the small weight on there backs being an annoyance that would only encourage their all out thrust to an even greater limit.

Faster, always faster!

The horses exited the gate simultaneously,  while slightly behind and to the right, as if the gate and bell and sting of the crop weren’t enough they could hear a rumble building to a growl and right behind them. (did they even notice us?) As the hyped animals entered the first turn of the track the growl from behind could be heard to drop a bit farther back, but still it was close. Close enough to hear despite the thunder of the animals all around, despite the sting and the coarse words of encouragement.

“Careful around this turn.” my partner said.

The four wheel drive van, higher than most and carefully altered in the most inexpensive way, entered the banked curve. The track was made of soft dirt, turned between every race to provide a fair racing surface to all participants, at the same time creating a very low traction environment for anything with wheels, including our ambulance. Each race was similar, the fastest horse would win, and the ambulance would come in dead last. The idea being that if a rider were to fall the ambulance would be right there, not even requiring the time to drive the quarter mile around the track, a time period questionably worth the fuel and effort involved. I never saw a rider fall, but I ran many a horse race, round after round, as many as 14 races in a day. All four wheels grabbing for traction, the ambulance sliding slightly sideways through the curves, the engine roaring, always and dutifully finishing last. Easily the best part of a horse race in my opinion.

This was not a race day however. My partner Mary and I were driving through southwestern Aurora wishing something bad would happen so we would have something to do.

“204”

“204, Iliff and Quebec”

“Copy 204. Code three, Arapahoe race track, on a man down”

“Copy, code three, Arapahoe race track”

“That’s correct, security will be on scene to guide you in, appears to be a head injury in the horse stall.”

“Copy that”

I turned to Mary, “Cool! A long hot run.”

It was fun driving lights and sirens, and the only thing that would have made this better would have been more traffic. Traffic provided obstacles which was a more interactive and adrenaline inducing exercise. I reached over and flipped on the lights. Light bar- click, flashers- click, strobes and headlights- click, click. Then turned the knob on the siren to wail.

This ambulance had a nice siren, by placing the knob in between settings a high pitched squeal could be created which may or may not have been more effective at notifying other drivers we were coming, but this sound was different from the usual and therefore, fun to do. Pushing down on the accelerator I pulled into the oncoming lane of traffic and through the intersection we had been waiting to cross, enjoying the privilege of getting to go while others had to wait. We found a Straight route out of town and headed onto the country roads that would take us the 20 miles to the track, pushing the ambulance towards its limit of 70- mph downhill, 55 up. We arrived at the track to find security waiting to guide us in through the main gate and through the maze of a parking lots to the rows of horse barns nearby. We pulled off the paved lot and onto the graveled road that led in between the long steel buildings that provided services for the jockeys and stable workers, some restrooms, a cafeteria and a business office for the horse and track owners and officials.

Pulling up to a stall midway down the third row, a frenzied group of bystanders let us know we were in the right place. One man came running up to my partner’s door as she stepped out.

“He’s waking up!” The bystander hollered, providing us with a clue that at one time he was possibly unconscious.

“Good.” We both replied, smiling.

On many scenes I’ve found that a bystander or responder will have had a contact with the patient and by doing so will have laid a sort of ‘claim’ on them. Along the lines of counting coup, a practice by the Plains Indians in which an unarmed warrior or juvenile would ride or run through the battlefield rapping victims with a coup stick in order to gather strength and power from the fallen enemy and to show their own bravery. These ‘claimants’ of the victim can sometimes be a valuable source of information, maybe having seen the incident, thus immediately bestowing a manner of status on themselves, eg. “I saw it happen” said proudly, head up and back straight. Other times this person can be a hindrance, failing to ‘bow out’ at the proper cue or demanding recognition for their actions, “I helped them! I pulled them out! I helped!!” “Yes, yes you did. Thank you…”

In this case the bystander was of the more helpful and informed kind.

“I think he got kicked in the head. He drinks a lot. The boss told him to stop but he still drinks. ”

“Do you know if he has any medical problems?” As I approached I saw a man in his early 50’s seated in the dirt of a horse stall, the horse had been removed. The man was awake and his color was good. His breathing was short and shallow, but he did not look ‘sick’.

“Not that I know of.” Replied the helpful bystander.

Although I was close enough to the patient for him to have answered my question himself, he seemed content with the answer provided and did not offer more. I leaned down in front of the man who told me his name was Jerry. I felt his pulse, strong, not too fast. As he said the word I caught the sweet smell of alcohol on his breath. ‘Yes, he‘s had a few’, I thought. I turned to Mary and told her of the current plan. Backboard, 02, IV. EKG. On further exam it was discovered Jerry had chest pain and no memory of what had happened to him.

“Jerry, what happened to you?”

A slightly slurred response, “I don’t know.”

A further investigation of his discomforts combined with the visual clues helped develop a theory. Jerry had been cleaning a stall standing behind a typically high strung steed when the horse, lamenting its poor choice of career, had lashed out a hoof, catching Jerry either in his head or his chest and throwing him into the post at the rear of the stall where Jerry struck his chest or his head, and then had crumpled to the ground, possibly unconscious.

Jerry’s chest pain appeared centered around a reddish area on the right side of his chest over the 7“’ and 8“’ ribs. I made the determination to transport non-emergent to Swedish Medical Center, the closest hospital and still 30 minutes away. We loaded up quickly and headed out of the race park.

About ten minutes out Jerry began complaining he was having trouble catching his breath. His breath sounds were difficult to hear as he was only taking short, shallow breaths. He had begun to sweat slightly and I thought his breath sounds were a little less audible on the right side than they should have been.  This could indicate that when the hoof had struck Jerry, or Jerry the post, he possibly fractured a rib and punctured a lung. Bad for Jerry but providing me with a golden opportunity.

I leaned forward into the cab. “Better step it up to code three. ”

 

 

Atlantis!

atlantis on nassau
Atlantis on the Island of Nassau, Bahamas

 

Atlantis is the single greatest resort I have ever experienced. It is extravagantly amazing to put it mildly. At this point Carrie and I were still aboard the 115’ Broward. We arrived on Paradise Island, Nassau, Bahamas shortly after Atlantis had been completed and was newly opened. It was simply amazing. Atlantis is truly a wonderland for the wealthy. It was our good fortune that the casino was still spotted with nickel slot machines. There were others ranging up to five dollar slots, but it was the nickel slots that I truly appreciated, they being affordable to Carrie and I as at the time we restricted ourselves to a weekly entertainment budget of $40.

Our current duty had us set to be spending a few months at this amazing resort, in the marina no less! Extravagance here was evident everywhere we looked, it was over-the-top, and we enjoyed it very much. Liberal use of marble, colored glass, brass, and other metals of all types created an opulent playground populated by craps tables, roulette wheels, dining areas and lounges in true casino form. Then there were the slot machines. I like slot machines. The game is easy, it’s fun to do together while chatting and drinking, and the payouts are a semi-regular celebration. That is to say, they seem to payout in intervals. Not always large, but these machines were paying out fairly frequently. A month or so into our stay the nickel slots were replaced with quarter slots. We were sorry to see them leave. Not only did it affect the time we could spend playing (the house generally took our $40) but it also spoiled us for the nickel slots. Eventually Atlantis brought back a few nickel slots but after playing quarter machines these no longer delivered the thrill we sought.

A large part of Atlantis was their aquariums, they were all brand spanking new and beautiful and gigantic and full of wonderful tropical scenery. While we were moored in line with a number of other yachts, rumors were rampant on who was attending the resort with us. Michael Jackson rented three floors and the sky bridge between them. Oprah Winfrey was in residence, and held her show at the resort while we were there. While walking through the hallway one day I was astounded at the size, height, and entourage of Stevie Wonder!  Walking past them in the hall was like piloting a dinghy past the Disney cruise ship.

Our days at Atlantis were spent with routine cleaning and maintenance of the yacht, nothing unusual or out of hand. The pay was not as high on this yacht as it had been on some others, but the atmosphere was also a bit more relaxed. Dinners aboard were still an extravagant affair, catered and festive with gold and silver detailed flatware, finely polished silverware and crystal glasses. The levels of opulence were evident, but with it there was an air of relaxed ease to the ship. On this boat Carrie and I shared separate quarters due to crew and their needs. Facilities were scarce on this particular smaller of yachts.
Our time at Atlantis aboard the Broward was enjoyable, but as they were to be heading north to the Great Lakes soon and we did not wish to accompany them desiring instead to look for something a bit more lucrative and tropical to spend our next few months on.

 

atlantis marina 3
Atlantis Yacht Marina. aka Yacht Village

 

As we applied for our next shipboard position aboard a 115’ Hatteras (unbeknownst to us at the time, it was to be our last), we had gotten pretty good at the game and negotiated a very good wage as the ship had just come out of the shipyard for some extensive engine work and the exterior was covered in overspray from nearby paint jobs gone wild.  It would be my initial duty to remove that paint from her once gleaming sides.  In our interview with the captain and admiral (his girlfriend/chef), we indicated our relative lack of experience being just over a year and despite that, we had good references and we presented ourselves well thereby justifying our desire for high pay. They both agreed heartily that they enjoyed training new crew and very much looked forward to employing and training us, further encouraging us to contact past crew members for indications on what work aboard might entail. We did so, locating an old deckhand by the pool at a nearby apartment complex we chatted with him about our intended employment and were advised to “ask for more money, no matter what they are offering, ask for more”. I passed on this concern to the captain with a glint in my eye and he looked quite surprised, “Really?” he asked. I assured him that is what was said, but that we would be alright with them paying “more than they had ever paid anyone before”.
And so our adventure began on this 115′ Hatteras charter yacht.

This yacht was to be a little difficult socially from the standpoint that ‘passive aggressive’ was the rule of the day with the captain and with his admiral.  Work aboard was to be heavy at times, especially being just out of the shipyard. Carrie and I happily shared a cabin aboard and enjoyed a good amount of downtime balanced by a fair amount of seagoing adventure including a charter and a visit from the yachts owners. We lasted 3 months aboard, long enough to achieve our financial goals and once our time aboard was up we would be through with yachting.