The Stubborn Bastard

The Stubborn Bastard

The man’s face was blue, and he was not breathing.

I turned and ran to the emergency room doors,

pushed one of them open and yelled,

“Cardiac arrest in the parking lot!”

We were working our regular twenty-four-hour shift for the 911 emergency ambulance service in Reno, Nevada and had just discharged our last patient.  He was a man with a self-inflicted shotgun wound to his leg, and we were still parked in the ambulance parking area in front of the double doors leading into the emergency room.  After each transport (not all dispatches result in a patient or a transport of a patient), there is always some cleaning and restocking to be done.  

Besides re-stocking, the four things always needing to be done were to wipe down the gurney, change the linens, wipe all surfaces and mop the floor.  Always.

On most calls, it was usually as minimal as that.  On others, it could be a major cleaning involving the walls, floors, gurney, equipment, ceiling, cabinet doors, and passenger bench.   In other words, everything.  After the call we had just completed, the floor needed special attention, specifically, the corners where the floor meets the walls.

Our patient had injured himself critically by shooting himself with his shotgun.  Despite two tourniquets, pressure dressings, and tight wrappings, a lot of venous and arterial blood was still escaping.  There was also leakage of intracellular fluids from all the individual cells which had been blown apart or open.  This wound was too large to stop all the bleeding.  It involved the loss of the entire front or top part of the left leg, from the groin to the knee.

The man no longer had the top front part of his left upper leg.  Most of it was still back in his house on the floor.  That is, of course, except for the tissue fragments and the liquids, which were now on our patient compartment floor.

The patient's condition required a lights and sirens transport from the incident scene to the emergency room.  There was no time to spare.  This man needed many infusions of whole blood.

Because of our emergency transport to the ER, the rocking and tilting of the ambulance spread the tissue fragments and liquids all over the floor.   This caused the small pieces of tissue and bone within it to collect in the wall/floor corner junctions.

These areas were difficult to clean correctly, but there was no other option.  It had to be done to sterilize the junction area. The removal of the solid materials prevented any bacteria from growing, thus preventing the unwanted smells of rotting human tissue.

I was applying the “toothbrush method” with alcohol to clean the corners when a car pulled up right behind the open double rear doors of the patient compartment.  The gurney was still outside and was now between those doors and the car.  We hadn’t yet slid it back into the patient compartment because I was still cleaning the corners.

A woman was driving the car, and an older man was slumped forward in the front passenger seat.  Slumping is not a good sign, especially for an older man.  But we’ll get back to that.

After the dispatch had come in for this GSW, we responded with lights and sirens to a small, older house.  When we pulled up, the front door was closed, and no one was in sight.  No one at all.  Paramedics know it is not good to be the first to arrive at a call that involves a gun.  The police must first secure the scene and then allow us to enter.  That is the standard operating procedure, and there were no police.

We contacted dispatch and were told they would arrive in about five minutes.  We were also told they were talking with the caller and that entering was safe.  The emergency was an accidentally self-inflicted wound, and the gun was empty.  The guy was alone in the house, and the front door, although closed, was unlocked. 

It’s not that I didn’t trust the dispatchers in the Emergency Call Center.  They could only act on the information they received.  However, there were many times when there was a big difference between their information and what we found upon arriving at any emergency.

Anyway, the Police rolled up as my partner and I were discussing whether or not we should enter the house.  With their hands on their weapons, they slowly opened the front door, looked in, stepped in, then looked back out at us and waved toward us to enter.  

The small older house was built many years ago and still had the original linoleum on the floor.  The living room was furnished as any small living room probably would have been, with one exception.  A folding card table was in the middle of the room, and it was covered with gun-cleaning supplies.  One folding metal chair was tipped backward and resting in a large pool of blood.  A huge pool of blood.

As I entered the front room, I saw a broad streak of smeared blood on that original linoleum floor.  It was a straight line trailing away from the huge pool of blood.  It almost looked like someone had done a long, narrow, red finger painting.  Mixed into that finger painting-like smeared blood were small pieces of fabric and chunks of human tissue.

The tissue chunks included red muscle pieces, white skin, yellow fat, and ivory-white bone.  Not big pieces, all of them were shavings and small chips.  At the same time came the smell of gunpowder hanging in the air.

The finger painting-like smear of blood stretched to and through a door on the far side of the room about ten feet from the table.  It went directly into the kitchen another eight to ten feet and ended at a guy sitting on the floor and talking on the phone.  He had somehow managed to drag himself almost twenty feet to the nearest phone.

There was so much blood on the linoleum between the pool and the streak he should not have been alive, let alone conscious and talking intelligently.  He was sitting upright on the floor with his back against some drawers to the left of the sink, and he had a faded yellow phone receiver in his hand.

It was part of one of those old-style wall phones designed so the receiver could rest in the cradle over the dialing wheel when it wasn't in use.  The cord was one of those long curly cords, also a faded yellow, almost touching the floor when the handpiece was in the cradle.  It was mounted on the kitchen wall about five feet above the linoleum floor to the left of the sink.  How this guy reached it is a mystery I’ll carry forever.

It must have been the closest, if not the only, phone in the house, and to say this guy needed a phone would be one of the greatest understatements of the year.  He had been sitting in that tipped-over, folding metal chair cleaning his “unloaded” shotgun, and then “Bang!”  Because he had been sitting with his legs bent at the knees, all the damage was to the top surface of his leg, and that damage was devastating.  He was missing the top of his upper left leg from the groin to the knee.

Little pieces of bone in the blood that had come from the top of the Femur were mixed in with skin, muscle tissue and a lot of blood.  His leg had sustained incredible damage.  The only reason he was still alive was due primarily to the engineering of the arterial circulatory system of the human body.

When arteries are severed by a blast like the one produced by this guy’s shotgun or by a crushing or tearing injury, they automatically pucker, or constrict, to close themselves.  It’s an ingenious and sophisticated method of stopping blood from squirting from the high-pressure arteries.  Only the arteries do this.

Blood escaping from the low-pressure veins flows much slower and is less life-threatening.  I have no doubt the Master Medical Engineer designed this incredible ability of the arteries.

However, even with his arteries “puckered,” he still had lost so much blood he was in critical condition, perhaps extremely critical.   After rapidly applying a tourniquet and some pressure dressings, we put him on the gurney and rolled him to the ambulance.

We had decided to do the rest of his care on the way to the ER as we drove lights and sirens.  That included starting two fluid-replacing IVs, some more pressure dressings, and applying high-flow oxygen.  A lot of time was saved by doing this, and this man’s time was running out, just like his blood.  We arrived at the emergency room in time for him to survive his blood loss.

So there I was at the emergency room doors. I was on my hands and knees cleaning the floor corners using that toothbrush method.  During the transport, our patient’s blood and pieces of tissue were spread around the floor and gathered in the corners.  My partner was inside getting replacements for the supplies we used.  

Without warning, that car I previously mentioned pulled up to the ambulance's open rear doors, with the older man slumped over in the right front passenger seat.  Again, slumping is not good for an older man.  I stopped what I was doing, got out of the ambulance, walked to the car, and looked in.

The man’s face was blue, and he was not breathing.  I turned and ran to the emergency room doors, pushed one of them open, and yelled, “Cardiac arrest in the parking lot!”

Immediately, all the right things began to happen.  In an instant, the Cardiac Team came out with a gurney and pulled the man out of the car.

As they laid him onto it, two members of the team, one on each side, stood on the bottom rails, so they were riding along with the gurney.  One began CPR, and the other began rescue breathing.  At the same time, two other people, one at the head and the other at the foot, began rolling the gurney with the old man and the two attendants into the ER.  As it moved, the two riders on each side of the gurney continued CPR and rescue breathing.  It was all done very quickly and efficiently.

The man’s wife remained outside with me.  She was telling me what happened, and it seemed important for her to tell me her story and that I should listen to her.  She even delayed going inside to be with her husband to talk with me.  Usually, you can’t pry the family away from their loved one(s) in an emergency.  But here she was, talking to me.  Strange, very strange indeed.

Earlier, her husband had admitted he wasn’t feeling well.  She said this was a big admission for this self-reliant and stubborn Nevada pioneer.

“He never complained,” she said.  “Never.  He did what he felt needed to be done his whole life, even when I could see he shouldn’t be doing it.”

“He would say,” she continued, “It has to get done, Ma.  Who else is going to do it?”

Then she added, “There was no use arguing with him.”

“For the fifty-seven years we were married, he would never give in.  He would never let me or any of the kids have our ways.  It was always his way.  Today I was surprised when he admitted he wasn’t feeling well.  He didn’t ever do something like that.”

I couldn’t help noticing she was referring to her husband and their marriage as in the past and showing no sadness.

She had suggested calling 911 to send an ambulance, but he would have none of it, and that was it.  He had made his decision.  Once again, things were going to be done his way.

“Drive me in the car, Ma.  I’ll be fine.  Just don’t drive too fast like you usually do,” she said he had told her. 

“All our lives,” she continued, “we always had to do things his way.   So, I did.  That way, I would be sure not to cause “That Stubborn Bastard” (her words) any discomfort.  I drove really slow.  Really slow.”

There was a double meaning in her tone.  The hospital was only about ten minutes from their house.  Not too far.  I knew this because she had told me where they lived.  I also knew three traffic lights were between their house and the ER, and it was dinner time rush hour. 

So, she was driving slowly and carefully and watching the traffic.  Somehow she had managed to stop at all three lights, turning a ten-minute drive into twenty.

“At the third stoplight,” she said, “he fell asleep.  I knew he was probably gone.”

During their whole marriage, she had faithfully kept her wedding vows of loyalty and duty to her husband.  On the final day of his life, she had once again completed the task he had told her to do.  Slowly and dutifully, she had driven “That Stubborn Bastard” (her words) to his death.

I felt confident she knew what was happening to her husband for the entire drive.  I was also sure she knew that I knew what she was implying.  It was as if she wanted me to know.

While we were talking, a nurse came out and asked her to come inside with her.  She needed to register her husband.

My partner and I finished cleaning and restocking the ambulance and drove back to the station.  I didn’t say anything to him about the conversation with the wife.  I considered it private and was perfectly content to keep it between her and me.  I felt honored she chose me to hear her story.

The patient with the shotgun blast to his leg needed many blood transfusions, and his leg was amputated just below the hip.

The Stubborn Bastard in the right front seat of the car could not be saved.