I just have to write this story down. It’s a bit… well, I don’t know how it is… but if The Happy Medic can use his blog as an online therapy journal, I guess that I can as well.

I just can’t shake an incident that happened to me. I can’t get it out of my head. It happened years ago while I was off-duty and was hanging out with a friend who I haven’t had much contact with in recent years. However, a recent conversation with that friend brought a lot of memories flooding back into my consciousness and I figure that if I write it down it might help me shake it.

I’ve written a lot about sadness in the past, especially the sadness that we as EMS providers are exposed to on a daily basis in our careers. It surrounds us. Most people shy away from the death, destruction, and sheer madness that abound in the Human Condition but EMS people are special. We cannot shield ourselves from the external pain that death, injury, and illness bring. Thankfully this pain is most often being experienced by strangers and our role is to bear witness to it and attempt to intervene as best as any human can when faced by the insurmountable fact that we are indeed fragile mortal beings. While I have worked upon family members, I’ve been blessed in that I’ve been mostly left untouched by trauma and death inflicted on my loved-ones. Not to say that I haven’t experienced the loss of those close to me, just that I can understand that everyone dies and sometimes it’s at the worst possible time. We don’t control that. Sometimes we can prolong the inevitable but a lot of the time circumstances are simply beyond the power of any mortal being.

This case was one of those times.

It was the Fourth of July in the Midwest. The chill of winter had long since been buried in the recesses of our memories and the hot times of summer were upon us. Like good, God-fearing, Red-Blooded, Midwestern Americans we were set upon celebrating our country’s independence in the way we are best accustomed, by getting together and partying our butts off. Midwestern parties, especially the ones frequented by the age bracket I was a member of at the time, involve alcohol, loud music, and strangers popping in and out of the door set upon sampling the festivities. It was common to make new friends and acquaintances and uncommon, at least in the crowd I ran with, to have any trouble. That was fine with me. I was a functioning career paramedic and had been so for a few years. I get my excitement on the streets and am quite content to relax and have a good time when I’m off duty. I still don’t get too loud or too wild and still enjoy observing the antics of more animated people when they have a bit too much to drink. Staying sober has always made things more enjoyable for me when at these kinds of events. This party was no different. A coworker of my best friend had invited us all to his hip apartment in the city which featured the entire rooftop of the building as a patio. My girlfriend at the time, her friend, and I were sitting on a parapet wall of the roof watching the college kids from the school in town have their fun. The party was one story from the ground and was full of people. I only knew probably a good ten percent of the people there, but I’ve always been comfortable making new friends. We were having a blast. Good Music, Good Friends, and Cheap Keg Beer. Good times.

Then reality hit.

I got a knot that set quickly in the pit of my stomach when I heard a sickening crack and saw a crowd of people run towards a sky light that happened to be in the middle of the roof. Walking towards it I could get a sense of what happened. Through the panicked crowd of onlookers I made my way to the side of what was now an open hole. Some kid had been attempting to step over the skylight when he lost his footing and fell. The thin, translucent plastic had given way immediately allowing his body to plummet the twenty or so feet to the unforgiving concrete floor below. I looked down and saw him lying motionless on the floor… It was dark and the visibility was very poor, but I could see the expanding circle of dark blood flowing out from this poor kid’s head.

Snapping into my official mode I grabbed the host of the party by both shoulders. “How do I get down there”. His blank stare of horror met me back as he stammered “I… I… I don’t know”. An anonymous person in the crowd shouted “Someone get a rope and lower me down there” and I knew that the crowd would not be helpful in this situation. I told the host to call 911 and handed him his cell phone that was clipped to his belt. I then left the roof, ran down through the apartment and out onto the street. It was oddly quiet as I surveyed the surroundings. None of the shrieks of the crowd above had seemed to make it to street level. As I looked at the building I found a garage door that seemed to have light shining through its windows that could have come through the skylight. I looked, and sure enough, there lay the kid on the concrete floor of the garage.

They say that human beings have the capacity for great strength when faced with horrific circumstances. I’m no neurologist, or psychologist, or anyone who studies such things… but I believe that it has to do something with the fact that our nervous system keeps our muscles from achieving their full capacity for strength when we’re not under extreme duress. It’s the phenomenon where grandmothers are able to lift a car up off of their grandchildren and such. When adrenaline is so prevalent in our bodies, we are all capable of things greater than we imagine.

This was one of those times for me. My best friend said that above the din of the horrified crowd, through the building and onto the roof, he heard a guttural yell. It was me. I’d simply decided that the locked garage door was going to open whether it liked it or not. I grabbed it and opened it about a foot against the protestations if its locking mechanisms. To that day and from that day on I’ve never accomplished a feat quite like that and I don’t think that I could again. I’ve never been the most physical person I know and the thought of spending hours in the gym picking up heavy pieces of steel in a repetitive fashion simply bores me to tears. While I am a good Midwestern Farm Boy, I can’t claim to be someone who could rip open a garage door with my bear hands if I was asked to do so in normal circumstances. However, this time I did. Nothing was going to stop me from taking care of that stranger.

When I crawled in to the garage I made my way to the kid in the dark. He lay prone, slightly rotated to his Left side, and he was breathing rapidly and shallowly. The air he was moving made sick gurgling noises in his airway that was full of blood. There was blood pouring from his ears, nose, mouth, and scalp and I could guess that his head had stopped his vertical progress when it met the concrete. I checked for responsiveness and found none. Someone from above me yelled out “Don’t touch him!” as I moved to open his airway with a Jaw Thrust and I heard a murmur run through the crowd above as my friend shouted “He’s a Paramedic”. I positioned his airway as best I could with no tools, alone, in the dark and shouted for someone above to send down my friend who was an EMT and my girlfriend at the time who was an EMT and paramedic-in-training. After a few moments, they made it to the garage and together we positioned the patient in a left lateral-recumbent position to protect his spine and allow for the blood to drain out of his airway. We kept him like that until a paramedic in uniform crawled in with equipment.

The medic, an acquaintance of mine, worked for the local fire department. I was not a member and was off-duty and out of my jurisdiction. His partner followed soon after and I helped them ready their intubation equipment after giving them a report on my assessment. They tubed him before we helped them package him in c-spine precautions. After that, the engine company called for a few guys to help them open the garage door. I did, as did some of the other guys there, and this is strange. Even with six guys attempting to raise the garage door higher, the door wouldn’t budge. The engine crew had to slice through the locking mechanism with a saw. There’s no way I could have opened that door by myself but somehow I did. I don’t know how either.

The more experienced members of the audience already know how this story ended… with a family hoping against hope and with the stranger’s life expiring shortly after he took one slight misstep at a party. He didn’t plan to die that day and his family didn’t plan on experiencing the pain and lost that they undoubtedly did. I did go to the ER to check on his status, but only stayed for a few moments after I spoke with his nurse. I didn’t need to hear the family wail and lament. I didn’t need to know who the kid was. I had played my role to the letter and that was all I intended to do. It’s not that I’m callous… just that I get enough sadness on duty, thank you.

And interestingly, from that day I’ve only talked about that incident about three or four times. I’d almost forgotten about it. Really. It was just another traumatic death to bear witness to for a person who dedicates a career to that kind of stuff, it only shocked those who were uninitiated. At least so I thought until I talked to my friend and I was brought right back there to that skylight, to the Fourth of July, and to blood and death marring the innocence of a crowd of people who didn’t know that kind of stuff could really happen.

If you’ve read this far, thanks for helping with my therapy session. I feel better after getting this out. This isn’t a story about any kind of heroics or any nonsense like that, rather it’s a story about futility and fragility. It’s a teachable moment that helped formulate who I am as a person and as a paramedic.

If you’d like more on my feelings on Sadness in EMS, read this: “Splashed Sadness  – A Look at Negative Emotions in EMS”

Thank you.