Just Here Trying to Save a Few Lives

by Pamela Grim

  “Bullshit, that's total bullshit. There is no reason why you have to ask me a bunch of stupid questions.”

  The surgery resident persisted. “When was the last time you ate?” (Anesthesia always wants to know.)

  The patient exploded. “What the fuck difference does it make about the last time I ate? You're here to fix me, not ask me a bunch of stupid questions. So fix me, goddamn it, and don't fuck around.”

  “Listen,” I said into his ear. “We're trying to save your goddamn life.”

  “You just do your job and fix me. That's all you have to do.”

  “Hey, guy,” one of the security guards said. He had been standing watching all this from the doorway. “Take it easy.”

  The patient looked him over. “Oh, so you are the tough guy. You are the big man. You think you can take me on, big boy. You can just kiss my ass.”

  That's when Sheldon, one of the beat cops, came in. He walked over to where the patient lay and looked down on him. “What happened?” he asked the patient.

  The patient looked at him. “What the fuck does it look like happened?” He stretched out his arms. “I've fucking been shot.”

  Sheldon scanned the room. He must have figured out the scene pretty quickly: an asshole patient surrounded by a bunch of stony-faced, seething health care professionals.

  “Well,” Sheldon said, patting his shoulder. “It looks like it couldn't have happened to a nicer guy.”

  The next night we took care of another solid citizen. This time Sheldon had brought him in, an eighteen-year-old kid picked up for selling cocaine. Sometime during the thrash of an arrest, he had eaten the evidence. Sheldon had brought him in for us to lavage the guy out and work the rest of our ER magic.

  “You need the stomach contents for evidence?” I asked him.

  “No,” Sheldon said. “We're not doing anything with this.” He looked at me, genuinely concerned. “I just want to make sure the kid's okay.”

  I looked at him quizzically.

  “I know him,” Sheldon said. “He's a good kid, basically. Just really stupid.”

  Sheldon was one of the nicest cops I had ever met. He was a tall, immaculately bald black man, broad-shouldered, narrow-hipped. He had a big man's presence and ease. Sheldon never had to menace; he could take control of a situation just by walking into the room. He never lost his temper; never succumbed to provocation like the rest of us.

  Sheldon's usual partner was Dino Dupuchio, short and excitable. He played small, yappy terrier to Sheldon's Saint Bernard. A gentleman, though. When he was on night shift rotation, every night about three A.M. he would bring us donuts from DonutLand and then sit around with us showing us pictures of his kids.

  That night their suspect, in addition to swallowing crack, had also smoked some “wet”—a combination of PCP and marijuana. (“Nice mix of drugs,” Donna said, “the marijuana sort of takes the edge off the psychosis.”) He lay limp and “unresponsive” on the cart, eyelids fluttering, playing possum, while we got everything started to hose him down.

  “We got to get that cocaine out of you, dear,” I told him. “We're going to have to put a big tube down your throat.”

  He lay inert, eyelids still fluttering.

  Donna opened up the lavage kit, got out the Ewald tube—a tube with a diameter a little smaller than a garden hose—and said to Sheldon, “What's his name?”

  “Benny.”

  “Benny. You are going to feel something sliding down your nose.”

  Donna got the tube about three inches into his nostril when Benny woke up a madman. He reached up and pulled the tube out of his nose and then swung at Donna, sending her back against the wall. He took off toward the end of the bed at top speed, but his right wrist stayed tethered by handcuffs to the frame of the bed. Sheldon was on him in a second. He swung him back up on the bed while the rest of us grabbed at various body parts trying to hold the kid down. Even with Sheldon there it took five of us.

  “Come on, Benny,” Sheldon kept saying. “Now let's be reasonable here.”

  Bill put Benny's head in an “ER headlock.” An elbow is placed on the patient's carotid, the forearm across the mandible, the other hand levered down on the first arm's wrist, providing extra torque. If the patient continues to misbehave, then a little more pressure is applied with the elbow.

  Under Bill's arm, Benny was screaming something, maybe the same thing, over and over.

  “What's he saying?” I asked Bill.

  Bill lifted his arm up and we all stopped to listen.

  “Let me go,” Benny shouted. “You're messing up my hair.”

  Sheldon put his head down close to Benny's ear and said, “Come on, Benny, you made us do this. If you had behaved responsibly, we wouldn't be in this position.”

  Benny stopped fighting and now stared out beyond us, lost to us. Just another addled addict.

  Sheldon leaned over him and began singing,

  Night and day

  You are the one…

  here in the old familiar…

  Sheldon looked up at us. “Cole Porter,” he said. “Always settles them down.”

  “Keep singing,” Donna said.

  It took a minute, but finally Benny put his head back down on the bed and appeared to be sleeping comfortably.

  Donna picked up the Ewald tube and waved it at Sheldon. “Care to accompany me while I put this tube down?”

  “Of course,” Sheldon said, getting a good grip on Benny's face. Donna looked at Sheldon standing there, a man's face torqued between his two bear-like palms. “Keep this up and I'm never letting you come to my party again.”

  II.

  I once rode in the zone car around District Five, our hospital district. It was a Friday night.

  “Let's have no end-of-shift arrests tonight,” one of the two officers said. “I was doing paperwork until ten A.M. this morning.”

  “Deal.”

  The scenery we drove through was aging urban: run-down gas stations, ratty quick-stop stores guarded by iron grillwork, shuttered quondam factories, empty lots, Dollar Dave's Easy Auto—no credit, no problem—DonutLand donut shop, a strip joint, a twenty-four-hour Laundromat, Uneeda Car Repair. I recognized the homeless guy pushing a grocery cart up the hill: Anthony Gouchette. I had seen him a hundred times.

  It was a quiet evening.

  If I had waited a week, I would have been there this particular night. I can imagine myself sitting in the backseat, invisible, seeing it all. Two officers, experienced guys, were roaming the streets. They had just stopped at McDonald's and now were coming up Berwin Avenue. It had been a rare summer day, now deeply shadowed, nearly night. Saturday evening traffic ran the long way up the hill, cars braking once they saw the shadow of the dark cherry top of the police car behind them. The officer behind the wheel eased the car out into the middle lane, behind a white Toyota Corolla. The Toyota slowed.

  “Left brake light out,” the officer driving said.

  “I, personally, can live with that,” his partner countered.

  “I, on the other hand, want do some fishing.”

  “Then you call base.”

  “No, you call. I called last time.”

  The officer behind the wheel turned the light on. The Toyota throbbed red, blue, red, blue.

  They went through a green light at Maxwell; the car pulled over just beyond it, stopping in front of Dave's Easy Auto. The first officer took his flashlight, undid his seat belt and adjusted his holster. He opened the door to step out.

  His partner took a bite out of his drive-in burger, than tapped his shoulder pack experimentally with his other hand as he watched his partner slam the door.

  The first officer began the cop walk, saunter speed, up to the Toyota, flashlight held overhand at shoulder level. As he did, the driver opened the door—instant problem—and stepped out of the car. For the second officer it was hard to see because of the glare of the oncoming cars, but the driver appeared to be a white male, thirtyish, in a Tecate
beer T-shirt. The driver took a step forward, and that was when the second officer saw the gun—a rifle—no, an assault rifle with a scope. The man with the Tecate T-shirt pointed the gun forward at the first officer. It was at waist level when he fired the first and then a second shot. The first officer took a step forward and reached for his gun as the man from the Toyota went down on one knee and fired an unknown number of additional shots. As the second officer came out of the car, gun cocked, the shooter stood up, aiming at the second officer. The second officer then fired three shots, all aimed at the man's chest. The man fell to the ground.

  The first officer had fallen as well. The second officer shouted, “Officer down!” into his shoulder pack. He ran around to the side of the car, where he found his partner lying in a pool of blood—one hand to his neck.

  The first officer reached his other hand out. “No,” was all he said.

  The “red phone” rang. It was a dedicated line connected to City Emergency Services. We almost always used the radio connection, so that when this phone rang it was usually a wrong number.

  “You've reached Ambulance Med Command,” I said into the receiver. I was the closest to the phone.

  “We've got an officer down, coming to you by squad car.”

  “Who is this?”

  “This is police dispatch.”

  “What did you say?”

  “Shooting. An officer is down. No other details available.”

  “Are the paramedics going to radio—“

  “That's a negative, Med Command. Transport in squad car.”

  I dropped the phone, fumbled for it and hung up. “Mary,” I said to the unit clerk, “page Surgery.” And don't get all worked up, I told myself. The last “police shooting” we'd had, I had activated the entire hospital trauma system for an officer who had sustained an abrasion on his palm.

  “This is a trauma alert,” I said over the intercom. “We need a nurse to the trauma room and a gurney in the ambulance bay. Repeat—that's a nurse in trauma and a gurney in the ambulance bay.”

  Mary, the unit clerk, looked up from filing her nails. It had been a mysteriously slow evening for a Saturday.

  “What's up?” she asked.

  “Officer shot, coming in by squad car.”

  “Uh-oh,” she said. “I better page public relations.”

  “And page the surgeon overhead. Where is everybody?”

  “Mental health break,” Mary said.

  That meant everyone was out in the ambulance bay already. Smoking.

  “And what lucky surgeon do we have on tonight?”

  It was Don “the Doberman” Doberstine, AKA Dr. Love. Good surgeon, though.

  Bill had already started pulling the gurney out of the trauma room. He rolled it behind me as I walked through the ambulance bay doors. Outside in the warm summer evening Tracy and Donna stood smoking and complaining.

  “Hey,” Tracy said to me. “It's actually nice out here.”

  “Not anymore.”

  “What?” Donna asked flatly.

  “Policeman reported down. Shot. That's all I know.”

  “Who's bringing him in?”

  I shrugged. “I think he's coming in the squad car. City Emergency didn't know anything. They just said he was down.”

  As I said that, there was the wail of a police siren off in the distance.

  I looked at my watch. It was 8:12 P.M. The police car turned down the drive. In a moment I could even see the frightened face of the officer behind the wheel. I felt nauseated first—it took a moment more before I consciously registered that it was Dino behind the wheel.

  “Oh my God,” Tracy said, sotto voce.

  Dino pulled to a hasty stop and leaped out. “It was a routine traffic stop…” he shouted. He had blood on his uniform, blood on his hands.

  We all ran to the passenger side. There an officer sat, head lolling back, covered in blood.

  It was Sheldon.

  Inside the car there seemed to be blood everywhere—on the ceiling, on the windshield, an inch or more on the floor, where a fast-food burger, still half wrapped in paper, sat soaked with blood.

  Everyone pulled, trying to get Sheldon out of the car and onto the gurney. Dino pushed from the inside. Sheldon was completely limp, not helping us at all. He had a wound of some kind in his neck and his uniform was soaked in blood.

  “What happened?” I shouted to Dino.

  “The guy had a fucking bazooka. I think he got him once in the neck and then twice in the belly.”

  “Come on,” I yelled at Bill, who was in the process of yelling something at me.

  This is where TV gets it right. The simultaneousness of a thrash. Everyone started yelling orders at everyone else; we all pushed and pulled Sheldon onto the gurney and ran, tripped and stumbled toward the door. I only managed to grope momentarily for a pulse and got nothing more than my hand covered with blood. There was a bullet hole in the neck.

  “CPR,” I shouted. “We need CPR. I can't get a pulse. Mary, Mary, tell the Doberman to get his ass down here now. Tell him this time it's real.”

  The respiratory therapist met us in the trauma room, took one look at Sheldon and panicked. “Oh, Jesus, it's a cop.” She grabbed for the Ambu bag and the mask. She dropped the mask, retrieved it from the floor, fumbled trying to connect it to the Ambu bag and then dropped it again.

  “Bill,” I said, “there's no pulse here. Start CPR.”

  I needed to intubate. We had almost everything laid out, but I hadn't hooked up the suction yet. I cursed myself. I should have been in here setting things up before the squad car arrived. I grabbed up my supplies: the laryngoscope and its blade, the endotracheal tube, a stylet to put down the tube to stiffen it while I intubated. How many times had I done this? I had no idea—but how many times had I done it on someone I knew?—never. I balked for a moment as I stood there looking down. This was Sheldon's face. I can't be intubating Sheldon. I can't do this. Then with my left hand I adjusted his jaw in order to get the laryngoscope in. His face stayed slack, even as I got my thumb in to open the jaw. I wanted to slap him. “Sheldon, wake up. Wake up, Sheldon.”

  Instead I slipped the laryngoscope blade into his mouth, lifted his tongue and mandible up out of the way and slid the tube in place. I inflated the cuff to make an airtight seal. The respiratory therapist attacked the Ambu bag and began squeezing like mad. Good breath sounds.

  My fingers kept slipping out of place, though, because of the blood. As I looked beyond the endotracheal tube, I saw the bullet hole in the neck and thought—No, no, it's too lateral to have caused any serious damage—too lateral to have struck the carotid. If it had hit the carotid we might as well just stop now.

  I looked up. Bill was doing CPR, bearing down on Sheldon's chest. Up, down, up, down. Tracy was hacking at his uniform with a pair of trauma scissors while Carol struggled to get the ECG leads in place. I checked for a pulse again. When Bill gave CPR, I thought it was there, faintly, but when Bill stopped, it stopped.

  I started calling out injuries for the charting nurse to record.

  “We've got a through-and-through neck wound, right side. It looks like it went lateral to the carotid.”

  Bill paused from CPR so we could yank at the Velcro straps and undo Sheldon's bulletproof vest. “No chest wounds,” I went on. “It looks like two gunshot wounds, entrance wounds, to the abdomen. One in the left upper quadrant and one just above the umbilicus.” I motioned for Bill to stop CPR and help me roll Sheldon. “We've got what looks like one exit wound here. Right flank.”

  Two gunshot wounds in the middle of the abdomen; nothing in the chest, no blood pressure. He must be bleeding out into his abdomen, I thought. The bullet must have struck the abdominal aorta. We might be able to stop the bleeding by cross-clamping the aorta within the chest, tying off the artery until the surgeons could repair it. That would mean a thoracotomy.

  I palpated Sheldon's belly. It was distended and dull to the tapping of my finger.


  “Restart CPR,” I told Bill.

  “Someone take these bloods,” Carol said. “I've drawn enough to cross-match for four.”

  Our volunteer, a diminutive, nerdish creature—actually premed at a local college—stood out of the line of fire, one hand raised to his white face and his open mouth—The Scream embodied. I pointed at him. “Tell Mary we need four units of type-specific blood now, now, now.”

  He fled out through the ER doors, passing the Doberman and the second-year surgical resident, who were coming in.

  “What's this?” the Doberman asked, stopping before the bed.

  I leaned over Sheldon, the back of my hand to my forehead. “Thirty-seven-year-old male, shooting.”

  The Doberman looked at the patient, puzzled. He must have been sleeping and was only now waking up. “But this guy is a police officer,” he said.

  “…shot in the gut and the neck. 1 don't think the neck one got the carotid.” I pointed out the neck wound and then I looked up at the Doberman, looking for reassurance. “But I'm sure whoever shot him nailed his abdominal aorta. We gotta open his chest. That's his only chance.”

  “Blood pressure?” he asked.

  “Not here; not now.”

  “Oh, Jesus. How many shots to the abdomen?”

  I raised my fingers. “Two. One exit wound.”

  The Doberman looked down at Sheldon's chest and sighed. “Vitals in the field?”

  “We dunno. His partner brought him in.” I put my hand on Sheldon's chest. “I know him,” I told the Doberman. “We've got to get him back.”

  Even I could hear the pleading in my voice. I looked at him, then at the surgical resident, who was panting with puppy-like eagerness at the thought of cracking a chest.

  The Doberman slid his hands over Sheldon's chest and then along his belly, pausing to press deeply over the bullet holes. He looked up at me, shaking his head.

  “We could try to cross-clamp the aorta,” I went on.

  The Doberman cast a weathered eye up to the monitor and then down the length of the patient. “Well,” he said, “if that's what you want, somebody should hand me the thoracotomy tray.” He turned to the resident. “You start a central line.”

  The resident, pissed because he wasn't doing the thoracotomy, slunk off for the kit.