Saturday, January 30, 2010

I Wasn't Born a Crusty Ambulance Driver...My First Run...

I wasn't born a Crusty Ambulance Driver. At one time I was a sympathetic trainee, in the back of the box. I was scared, conscientious, enthusiastic, and compassionate. I even remember getting pysching myself up, thinking, 'I'm going to learn my job so well that nobody will ever die in my care.' I thought I would be a life-saving, EMT superhero. This was long before the box beat my ass, over and over again, and transformed me into the ugly, cantankerous, crusty, shell of an EMT I am today. I look in the mirror today, and I hardly recognize the mean old bastard I've become.

I don't know if it was my first day or first run, but this is the first day I remember being on the box...

I was in EMT school, doing my ambulance rotations. I remember actually being excited for my first several runs. Back then, I even got butterflies in my stomach when a run came in. I carried my EMT textbook with me so I could look up things I didn't remember, in order to more thoroughly care for my patients.

Who knows what this particular call was dispatched as...probably an "intoxicsted person." Back then, I was naive enough to think every call was an extremely life-threatening emergency...every call was a "cardiac arrest" to me. When we arrived at the location, which was an old, do-it-yourself carwash, we found a man lying in the prone position, on the ground, and he was surrounded by a bunch of hobos, who were apparently his "roommates." The temperature was very cold; it must have been 30-something degrees.

My trainer walked up to the patient, walked a half-circle around his head, and within 5 seconds, callously declared, "yep, he's dead."  I thought to myself, 'What?!!! How do you know he's dead?!!...You didn't even check for a pulse, and we learned in EMT school that a person's not dead until he's WARM and dead.'

Trying to suppress my surprise & disgust, and trying not reveal that I doubted him, I humbly asked my preceptor, "Not that I doubt you...I'm just trying to learn...but, how can you tell he's dead?"  My trainer curtly responded, "Just look at him!"

I looked at him and saw that his face was purple, but I figured it was just because he was cold.  I asked, "Should someone check his pulse?"  He flippantly said, "Go ahead, but he's dead."

Finally becoming frustrated, my trainer grabbed the hobo's shoulder and rolled him over.  Pointing to his face, he asked, "See the lividity?" The hobo's face was flattened by the ground, and it didn't bounce back when he was rolled over (I had never dreamed of seeing something like that!). The front of his face was purple, and there was a clear line where the purple ended and white skin began. However, not really knowing what lividity looked like back then, I lied and responded, "Oh yeah, I see the lividity."

I was slightly intrigued and simultaneously horrified to see his face. Up to that point, I don't think I had really seen a dead guy in person, and it seemed weird to be looking at a real dead guy. I pretended like it didn't affect me. I also felt a little weird about saying he was "dead," right in front of the dead guy. I thought it might make him feel bad or something (...make him feel self-conscious about his dead-ness).

My trainer further pointed out the rigormortis, and then he guided me through checking for a carotid pulse, which he did not have. Even though I had already been pretending to realize that he was dead for a long time, at that moment, I finally realized, for myself, that he was probably dead.

We interviewed his friends and asked about his medical conditions. One of the hobo's friends explained that he had breathing problems, and he used an inhaler. My trainer asked if he knew where the inhaler was. The dead hobo's friend said, "Yeah, I actually have it," and then he explained that the dead hobo kindly loaned him the inhaler the night before, because the dead hobo's friend was feeling like he was starting to have breathing problems of his own.

My trainer then told the dead hobo's friend that the dead hobo probably had an asthma attack during the night, and since he didn't have his inhaler, he passed out, and then died from the cold.

The dead hobo's friend immediately started crying while looking at the inhaler in his hand, as if it was a gun that he had just used to murder his best friend. Tearfully, the dead hobo's friend explained what a great hobo his dead friend was and how much he will be missed by the rest of his hobo-tourage.

I got a big lump in my throat, my eyes got glassy, and I had to fight to hold back the tears (I couldn't let my trainer know I was getting all emotional over a hobo). I wanted to give the filthy friend of the dead hobo a big hug and bring him home with me. I remember wondering how I could personally help this hobo so that HE didn't end up freezing to death, face down in an old, do-it-yourself carwash. Of course I did nothing beyond thinking I should help him.

That may have been the first and last time I ever felt sympathy for a dead hobo and his surviving hobo friends.

Even though I believe I give an honest effort to do everything I can to help save ANY patient's life; I don't believe I'm capable of feeling the same compassion I felt for that hobo on that day. I don't know if it's a good thing or bad thing, but everyday I lose a little bit more of that compassion I was once capable of feeling.

This post was written for "The Handover, Blog Carnival."  This month's theme was, "The First Emergency."  All the submissions for this month's edition, from various bloggers, can be found at:


Eric cartman said...

Oh, oh, Jesus. I was laughing so hard–the milk came out of my nose.

Anonymous said...

Crusty - as an Australian ED nurse - I have to say I love your blog.

And I thought I got my fair share of losers and idiots passing through the door of the ED.

Please post more often.

medicblog999 said...

Crusty -
I dont know if this is just co-incidence, but this blog fits perfectly with the theme for this months 'The Handover' blog carnival. Would you mind if I add your post to the other submissions?

If you have any objections, you can email me at



Jason said...

This is a very interesting blog that you have here. It's important that their are blogs out there who hold a very strong opinion towards certain issues.

I have a site myself where anyone can freely express their opinion towards controversial issues. I'm telling you this because I believe that you can provide others with some valuable insight towards some issues.

Keep up the good work, and maybe we can do a link exchange.


Scott said...

I love the HIPPA disclaimer! Don't feel like your alone after 18 years of EMS crap Iv'e become a little crusty as well.

Dawn said...

Dude, at least you didn't run over a person lying on the interstate while driving your ambulance....

Educated and Unemployed said...

You are a sick individual. Maybe you should consider a mental evaluation. With high hopes that your blatant disregard for humanity leaves you unemployed, the voice of the underdogs.

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