A HUGE DUDE LOSES HIS CHIN AND HIS SHIT

Apparently, this cat was talking on his cell phone and then, for no clear reason, ate pavement. According to the witness, he just dropped. When we found him, his mouth was around someone front step and there was a pool of blood and some teeth nearby. Securing his spine, we rolled him over, back boarded him, got him on the bus, took a better look. He'd somehow managed to slice his chin almost off -- it looked like the butt of a french roll of bread but it was still attached slightly so when we put the c-collar on the chin got flipped upwards and was resting on his mouth.
He was still completely knocked out when PD asked if we needed them and we said no thank you and pulled off and THEN homeboy decided to wake up. I was driving, but apparently his eyes popped open and he went right for the collar around his neck, Frankenstein style. Then, and this I heard along with probably half of the East Village, he said "WHAT THE FUCK!?!"
I pulled over the ambulance.
The dude I was working with is solid enough but we had a student that day, more or less the intern from 30 Rock, and the patient was easily 300 lbs and pissed. He had already unstrapped his upper body and was sitting up straight, swiping at the student and yelling "REALLY? YOU GONNA DO ME LIKE THAT? THIS IS HOW YOU GONNA DO ME? REALLY?" While the student just made little cooing noises and said "no, no, that's not how we did you sir! We didn't do you like that!"
The cops had been following us and when they saw me pull over they jumped out and we all rushed the back compartment. The guy had a big broken tooth grin on and he was looking back and forth at us with wide, uncomprehending eyes and giggling and repeating one of the above phrases like a damn Elmo doll on crack.
"Just lie down, buddy," one of the cops said.
"REALLY THOUGH? WHAT THE-"
'Lie down!"
You can't reason with folks when they're off the deep end like that. His chin was still flapping back and forth on his face and he was covered in blood and still grinning like an asshole.
Fuck it, my partner said, unimpressed. Just roll carefully.
And he was right. You're not gonna win coming at the dude, he wont' be talked into normalcy, and it'd take more than the two cops and three of us to wrastle him into any kind of submission. I rolled carefully and when we got to the ER and reeled him out he was still on that same shit, except now he was reaching into his mouth and trying to pull out shards of his own teeth.
With some struggle, we got him into the ER and thru to the trauma room, where the assembled doctors asked us: What happened to this dude?
I let him answer that question himself.

ON BALANCE & COMPASSION

We were held up in the ER for a while the other day, crossed the sacred 40 minute threshold that sends little alarms up and down the system computers, pissing off captains who send angry messages to lieutenants who in turn send angry and/or passive aggressive messages to us. But since we're in the ER, we don't get the messages, which come in on our onboard computer, so then heated lieutenants continue to get messages and fly over in their SUVs, full of wrath and indignation. This particular lieutenant came up on me all a-foaming and frothing as I was walking back to the unit to give an update.
WHY, he demanded, HAVE YOU BEEN IN THE ER FOR SO LONG!?
clearly he didn't want an answer, because no one who asks a question in all caps really expects anything but a blank stare. I presume. Because if you really wanted to know something, surely you'd ask it in a mature-type way, using your inside voice and whatnot. Surely.
WHAT EXACTLY IS SO IMPORTANT THAT YOU HAVE TO BE IN THE ER FOR FORTY MINUTES?!
As it happened, we'd found the patient unconscious and ODing with no blood pressure in an apartment full of men that claimed to know her but didn't have any information on her and told multiple glaring lies about how she ended up that way before disappearing completely and then locking us out as soon as we removed her to the ambulance, so we ended up spending a good chunk of time trying to explain the situation to some skeptical young doctors that didn't seem interested in such complications, and my partner was only now wrapping up the paperwork.
But that wasn't an answer that would get me very far, because what does any of that matter in comparison to the almighty power of numbers? The brass in EMS, in a sickly trickle down sort of way described above, is obsessed with numbers. Numbers make the EMS wheel turn. Period. You find occasional lieutenants here and there that still hang on to some interest in what's going on with the patient or whether or not one of us is traumatized or burnt out, but when someone with a light blue shirt is getting worked up, it's usually got something to do with blipping alerts on computer screens downtown and the corresponding tirade of messages from superiors.

ARE YOU GOING TO ANSWER MY QUESTION?! OR SHOULD I JUST GO AHEAD AND WRITE YOU UP RIGHT NOW!?
and honestly I was so surprised by how upset he was I really had nothing to say for a second. But then I just told him No, I didn't like his attitude or how he was addressing me and so I wouldn't be answering his questions. As he got all red and puffy another lieutenant swept in, one of the ones that seems to give a damn about a thing or two, and dismissed the first one sayin "I got this" and then the whole situation pretty much fizzled out: my partner finished his paperwork, I put us back in the system, life went on.

I said it on twitter and it stands true still, on a job with so many reasons to get worked up, I have no interest in giving time or energy to a person that can't control his temper over numbers. None at all. We who deal with actual people have to work every day to land in that delicate balance between caring too much and not caring at all. We all slide back and forth along that spectrum throughout our lives and careers and the best medics I know aren't the ones that cry for every patient (they burn out quick) or the ones that smirk and roll their eyes at every patient (they're already burnt). They're the ones that know how to measure out their compassion evenly, quietly, justly, sometimes with crass humor or a kind word, and without going overboard so they can do what they have to do and walk away at the end of each shift leaving the job and all its pettiness, hilarity and tragedy behind them when they go.