Population 485 (10 page)

This stuff just doesn’t work for me. I can never get the initials to cohere. In my head, the letters Ping-Pong off one another, triggering a parade of words and associations.
P—was that for
P
revious, or
P
otential, or
P
ills, or
P
rimary complaint? M—
M
edications? Or
M
eals
? The letters skitter and simply won’t stand still. In high school, we were required to memorize the twelve pairs of cranial nerves: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, spinal accessory, hypoglossal. Our science teacher, who favored “auditory” over “vestibulocochlear,” recommended we associate them with the phrase, “
O
n
O
ld
O
lympic
T
owering
T
ops
A F
inn
A
nd
G
erman
V
iewed
S
ome
H
ops
.” This phrase has worked fine for generations of students, and I encounter emergency-room physicians and physical therapists who employ it daily, but I could never summon it completely. I would try, and what I would get was the image of a guy with a big belly and knobby knees, wearing lederhosen and peering downhill at a field of barley. The Finn never made the scene. Furthermore, some instructors favor
accessory nerve over spinal accessory nerve
. Their Finn and German view not
S
ome
hops, but
A
hop. Another source disposes with the Finn altogether: “
O
n
O
ld
O
lympus
T
owering
T
ops
A F
amous
V
ocal
G
erman
V
iewed
S
ome
H
ops
.” I see Helmut Kohl yodeling over wheat fields. And what if I
could remember one of these phrases? How to sort those first three Os? And the Ts—is it trochlear, trigeminal or trigeminal, trochlear
? Kenneth Saladin, author of
Anatomy and Physiology: The Unity of Form and Function
, proposes “
OL
d
OP
ie
OC
casionally
TR
ies
TRIG
onometry
A
nd
F
eels
VE
ry
GLO
omy
VAGU
e
A
nd
HYPO
active.” As in,
OL-
factory,
OP
tic,
OC
ulomotor,
TR
ochlear,
TRIG
eminal,
A
bducens,
F
acial,
VE
stibulocochlear,
GLO
ssopharyngeal,
VAGU
s,
A
ccessory,
HYPO
glossal.

I do believe the alphabet soup that fills my head just went bad.

The trouble is, this is one of those areas, like religion or spinach, where the folks who think you need it keep piling it on. That mnemonic didn’t work? Here are sixteen more! I beg them to stop. I am, I want to say, “A Free-Associating Ruminator. Terribly Scatter-Brained. Usually, Mnemonics Bring Little Enduring Relief.” A FARTS BUMBLER. Try to remember that, you mnemonics pushers.

Not all of the terminology and mnemonics I learned in those early days were officially sanctioned. A patient whose condition was deteriorating was often said to be “circling the drain.” An unresponsive patient whose EKG was as flat as a certain western state was said to be exhibiting “the Nebraska sign.” Sometimes you walked into a scene and declared the patient “DRT”—dead right there. DRT patients often presented with “the Q sign.” You’ll get the idea if you draw a smiley face, replacing the smiley mouth with a capital Q.

There was a bluffness to those early years. We were, for the most part, young men in uniform, learning to operate coolly at the nexus of dramatic events. I quickly grew to love the art of cutting through the chaos, to thrive on the idea of applying my knowledge in the field, often without the benefit of bright lights or flat surfaces. I loved stepping out of the front of the ambulance into the teeth of the wind, plunging into the deep snow on the median, the scene lights pushing my shadow ahead of me down to the upended pickup with the guy trapped inside, knowing Jacques was right behind me, and that somehow we would find a way to get to the guy, to package and remove him, to get him safely into a place with sterile sheets and delicate lifesaving tools. Our work environment ranged from dangerous to goofy—one call you are trying to figure out how to safely move a woman impaled on a fence post, the next you are jumping up on the toilet every time your partner charges the defibrillator and yells, “Clear!”

What you are given is a series of opportunities to prove your ingenuity and gumption. Rescue work is like jazz. Improvisation based on fundamentals. Protection of the cervical spine is a number-one priority, so we learn to take and maintain immediate manual stabilization, put on c-collars, and immobilize patients as completely as possible before moving them. In class, back in the high-school library, we practiced placing each other in a KED (Kendrick Extrication Device), a sort of wraparound splint designed to immobilize patients from the base of the spine to the top of the head. The protocol is very specific regarding positioning of the device, and the seven different straps are to be applied in a set order. We rehearsed over and over for the national test, in which we applied the KED to a person sitting calmly on a wooden chair in the middle of an open room. Then you’re upside down in a king cab, your patient is hanging from his seat belt, his head cranked over at an impossible angle, and suddenly your usual tools are worthless. And so, using your head, your hands, and maybe some towel rolls, you find a way to pluck the guy while still adhering to the primary principles of protecting the patient from further injury. You are riffing on a basic chord structure. I was explaining this to a friend once, how the presentation of our patients often requires us to improvise in the field. I brought up the jazz allusion, and he did me one better, putting it in terms of golf. “What you’re saying,” he said, “is you gotta play it where it lies.”

Jacques, of course, was never afraid to improvise. We went to an inservice one day in which an instructor showed us a rapid-extrication technique called a horse-collar. You take a blanket, twist it into a long roll, drape it across the back of the victim’s neck, bring the ends around, and cross them in front of the neck beneath the chin, and then pass the blanket ends back under the victim’s armpits, so they stick out like wings. You grab the ends like handles. The roll is supposed to cradle the patient’s neck as you lug him to safety. The instructor repeatedly stressed that this was strictly a last-resort technique, to be used only when the patient was in imminent danger.

Three
A.M
. the next morning. Jacques and I are staring at a drunk guy in a Yugo. The wheels are down, but he has rolled the thing once or twice. All the corners are rounded off. We are on an overpass. The wind is cutting straight through, driving sleet into our eyes. It’s a struggle, getting the c-collar and KED on, and the guy is cussing us the whole time. By the time we’re done, my hands are numb with cold. Finally, everything is in place. The KED comes fitted with handles, and Jacques and I each grab one. “One, two, three…go!” We move the guy about six inches and can get him no further. Turns out the Yugo has pancaked just enough so that the KED is too tall to fit out the door frame, and it has become wedged. Now the guy is really cussing us. We are alone. No fire trucks with equipment to cut through the door frame. I’m standing there trying to figure out what to do next when I hear the ambulance door slam. I look back, and here comes Jacques. His arms are outstretched, and he is twirling a blanket, spinning it into a long roll. “Umm, Jacques, do you think…?”

“Get the cot,” he says, leaning into the car.
Pop, pop, pop…
there go the KED straps.

I can’t bear to watch. I get the cot, already rehearsing what I’ll say in the deposition. Behind me, I hear more drunken cussing, and a
thwack!
as the discarded KED hits the concrete. I roll the cot up just as Jacques drags the guy, cussing and gargling, from the car and drapes him over the cot. On the way to the hospital, I quickly check to see if the man can move his arms and feet. Everything checks out. Up front, Jacques is whistling.

There were always the calls, though, that pulled you back. The ones you couldn’t laugh off. On a gray morning just after dawn, Phil and I answered two consecutive pages, the first for a wounded cop, and the second for the man who shot him. From a fundamental standpoint, everything went well. The cop had been shot through the upper chest. I got my IV lines in, and Phil controlled the sucking chest wound. The cop kept telling us how much it hurt, and when he couldn’t talk, he squeezed my hand. We were deeply relieved when we delivered him alive. He was on his way to surgery when we got the page for the shooter. The shooter had tried to blow his brains out, but had succeeded only in lifting away half his skull. The right side of his brain was completely exposed and perfectly intact. His EKG squiggled out and flattened as we pulled into the ambulance garage. The ER doc stuck his head in, took one look, and shook his head. Then he told us the cop had died in surgery. We were dumbfounded. Driving back to headquarters through the morning rush, I remember irrationally wishing to flag down each and every car, to look each driver in the eye, and say, “Do you realize what has happened this morning?” Ten years later, I called Phil, and he says the image he retains is the cop’s gun belt on the bloody ambulance floor, the buckle open, the holster empty. On a sunny afternoon, Jacques and I transported a one-legged, three-hundred-pound man back to his home from the hospital. He was in his seventies. He wore a trim fedora and held his head with dignity, but he was weak and pale, and said he didn’t think he was ready to return home. It was all Jacques and I could do to slide the man from the cot to his bed. His wife hovered in the background. She weighed maybe ninety pounds and was visibly shaken at the prospect of caring for him. Back in the rig, Jacques shook his head, and we talked of what it must be like to exist on such a fragile cusp. Another night, I helped a homeless alcoholic get to his feet from the doorway of the hardware store where he had collapsed. He was dirty and smelly. After I got him settled on the cot, he rummaged around in his pocket, pulled out a little black plastic comb and began combing his hair straight forward with slow, deliberate strokes. I was reminded of the way a toddler pushes a comb, trying to look grown up. It was this sad, noble little effort at tidying up. I watched, and my heart broke.

The Silver Star days were good days. There was life and death, and loose-limbed esprit de corps. I accumulated a deep base of experience. My hands still shook on the way to the worst calls, but I knew the shaking would stop as soon as I got into action. I was toughened but not hardened. The right sort of call could still put me back on my heels, and I was glad for that. But more and more, I wanted to take these things I had learned and apply them in a place where the faces were familiar. I was formulating this idea that if you took care of your neighbors, even to the point of letting them puke on you, one day someone would be there when it was you on the cot. The algorithm pointed toward home.

When the time came to move on, I was ready. The original renegades were gone. The ambulance service was sold to a large chain operation. Phil became a paramedic and took a job in Minneapolis. Leif is a paramedic in Las Vegas. Porter got a nursing degree and headed for Denver. Baz hanged himself. Donnie became a prison guard. I lost track of Todd. Fred I’m not sure about. Last I heard, Jacques was in Indiana. Recovering from surgery for a brain tumor, someone said. We e-mailed once, but lately I can’t raise him.

S
TRUCTURE
F
IRE

T
HIS WAS A DANGEROUS PLACE.
The low-slung cellar joists dripped with runoff from the fire hoses aimed at the outside of the burning house, attacking the fire from the exterior as we attacked from the interior. We were on a mop-up, really, trying to douse a few hot spots, those intransigent little clusters of flame that soldier on in the hidden crannies of a house afire, weakening it from within rather than devouring it from without. We arrived here by feel, knee-walking beneath the collapsed roof of the attached garage, groping through the haze, dragging a two-and-a-half-inch hose, charged and heavy with water. We advance. We’re at the basement steps now. We’re about to go in. I suppose the soundtrack in my head should be thundering something like, “Let’s rock and roll, you smoke-eatin’ sonsabitches!” but it’s not. It’s fretting, Will the house fall in on us? Will the water pressure fizzle right about the time the furnace explodes? Will I get my feet wet? Will I get out of here alive? For all firefighting’s cinematic potential—screaming sirens, snapping flames, roiling slugs of luminous, milky orange smoke colonnading the black night sky—most firefighting deaths have very little marquee value. The firefighter who dies silhouetted in a nimbus of flame while rescuing a child is a reality, but a rarity. More likely he’ll be crushed under a collapsed wall. Get hit in the head by a waterlogged beam. Touch a ladder to a power line. Run out of air in some smoky hallway. Or fall to the most common firefighter killer of all: a plain old-fashioned heart attack. The dangers linger long after you knock down the big flames.