ON WRITING 1: Just Tell The eFfin' Story

It's funny because it was blogging bout the ambulance messes that re-opened up the writing part of me. Spittin out these weird little vignettes that I'd throw together from memory in 20 min btwn calls reminded me of a simple rule of writing: just tell the fucking story.

Seems so obvious but I see how not remembering that caused some real blockage in my creative output over the years. Get so damn caught up in angles and analysis and voice---nothing happens. My big overeducated head a dang boulder on the path.

So it makes sense that I'd start throwing in some thoughts on the craft of writing among these twisted true life tidbits. The ambulance work feeds me, literally and literarily, because what better fodder for a writer than night after night of humanity's tiny disasters? Even the boring shit's a nice little packaged short story (repeating again and again...) and rather than falling in 2 the cliched role of passive observer that we writers are prone to, the medic is unavoidably, irrefutably and literally arm deep in the shit.

So these notes on writing won't b as gory or ridiculous as the ambulance ones but they will b curse-laden and spiritually engaging. Yes, spiritually.  And they'll be clearly marked so u gorehounds can disregard @ will...

So Today’s Topic: Just Tell the eFfin' Story. Much as I believe in the other timeless wrtier's rule: Ass In Chair, I’ve logged many a-blank stared hour in this chair and wound up with blank pages. Or the inverse: pushed hard and cranked out pages and pages of utter uselessness. I believe in freewrites something fierce- it’s the best way 2 dislodge that thought-fraught brain and clear writer’s block. But for me, thrusting forward towards a word or page goal isn’t the way 2 go.  (For other writers, wordcounts are the beesknees: http://thewordsofawriter.blogspot.com/2009/10/i-love-goals-for-writing.html )

I am though, a big fan of the Outline.  Right behind me, winding across my wall in a serpent of post-it notes, is the outline of the novel I’m deep into. (A sample: http://tidepoolfiction.wordpress.com/2009/10/01/flatbush-spirit-dance/)  Actually, there’s two intertwined strands, one a completed work and the other a completely different strand of that forking off at page 30. It’s a roadmap- guarantees that each time I sit down to write, I’ll know where I’m going, where I am and where I been. That way, the work on the story itself happens all the time, on the train, in the ambulance, in the shower, while I’m treating a patient- whatever, and gets scratched into my handy blackberry, spat onto my wall and then the writing time allows me to throw away all other concerns and Just Tell the Fucking Story.

Which is what writing is all about.

TOO LITTLE TOO LATE

It’s amazing how many calls we get for old men that wanna complain about the “tiny little guys” running around their apartments. There must be an infestation of freaky leprechauns in the city. I know it’s gonna turn up in 1 of my short stories soon…

But anyway, that’s not today’s topic. Today’s we’re here to discuss the little dude that makes sandwhiches at one of the delis of 125^th St in Harlem. He called because he was having pain all up and down his left side (came over as a CARDIAC job, because they included the chest in “all over”…smh). So he’s 32 years old, no medical problems, no medications and he’s basically rocking back and forth and going “OOOh it feels so WEIRD! It feels SO Weird!”

what’s weird?

My whole left side of my body!

Does it hurt?

No! I can’t feel it! Or it’s like pins and needles! Aiiiii!

How long it’s been going on?

Since the day before yesterday…

Anything else wrong?

Yeah, when I poop: blood comes out…

Oh boy…how long THAT been going on??

Since about…well, matterafact since the day before yesterday!

What the hell happened the day before yesterday?

I fell down the stairs.

How many stairs you fell down?

Shit…all of ‘em.

…And you’ve been shitting blood ever since?

Yep.

And you can’t feel half your body?

Uh huh. You think Imma be alright?

NO I DON’T THINK YER GONNA BE ALRIGHT! …jeeeeeze…(aside: do you really need me to tell you that?)

So you think I should go to the hospital?

No, I think you should’ve gone to the hospital 2 days ago when you ruptured your internal organs and severed your damn spinal cord but now u HAVE to go to the hospital…

Sigh….okay let’s go…

That is all.

2 CRAZY GERIS

TWO CRAZY GERIS

One of the crappiest parts about this job is the fact that no matter how fucked up your night was, no matter how tired you are, how many chests you pumped on or IVs you started or whining buttheads you dragged 2 the hospital, you can still get hit with an assignment right up until the minute you get off. So at 6:59 am, after a 12 hour tour, we can end up driving all the way up town for some nonsense. And the rule seems to be that those late jobs are always one form of clusterfuck or another- like, somehow, something always goes wrong.

Okay, not always. Sometimes we do a grab n go:

:::ambulance screeches up to Slightly Intoxicated Mexican dude with no shirt on:::

Me: Get in!

SIM: My neck feels funny…

Me: Get in the bus. We talk inside.

::::he gets in::::

Me: What hurts?

SIM: My neck, it doesn’t hurt but it feels funny.

Me: for how long?

SIM: Like, 2 weeks, guey.

Me (to my partner): Go go go!

:::ambulance screeches off::::

And then, sometimes we actually get home on time.

Last month, we got the job for the UNCONCIOUS at 6:30, which could’ve been a quickie but it was a old lady up in a apartment, so you know it’s gonna be slow. Most of the time, theyre really not unconscious, they’re either napping or felt a little woozy, unless they’re in a nursing home and then they’re usually dead.

This lady wasn’t in a nursing home and she wasn’t unconscious, in fact, she wouldn’t shut up. We heard her yelling from down the hall and us comin inside only made it worse.

“Me not going to the hospital! Just wanna drink me tea! Leave me ‘lone I tell you!”

It was one of these get gramma out the house for whatever reason things, probably cuz she’s won’t stop yelling, so call 911 and have us deal with her. We get that a lot towards the weekends…

Anyway, she also kinda had to go anyway, cuz she had like fourteen billion medical problems, was borderline insane and her toes were rotting off.

But she wasn’t having it. Her poor husband was actually dying of cancer in the other room, but I think he really just needed a good nights sleep. Then the daughter showed up and started cursing out the old lady “Just go with the goddamn ambulance people, ma, you always do this, ma, seriously, we go through this every FucKING WEEK!” and then to us: “I’m so sorry, boys, really…”

But without her tea it was a no go.

We sent someone to put the kettle on, but really it was a battle of wills. You could tell she was starting to cave when she got pouty and stopped yelling and carrying on- the non-logic of tea over amputated feet had been barreled over by the sheer strength of her daughter’s curseout.

“But I can get up me own self,” she insisted after finally relenting. “If I can make it to bathroom on me self and make it to kitchen to make me tea, why you think me can’t go to ambulance me self?”

Far be it for me to tell someone that I don’t have to carry their ass- I’m usually the first to agree. Unfortunately for everyone though, grammy’s feet were wrapped in leaking, yellow stained bandages that hadn’t been changed in…weeks at least. Damn near had to wrestle her onto the chair and she actually took a swipe at me as we carted her out, but all in all, granma made it to hosp and everyone else breathed a sigh of relief.

Then last week- we came for the DIFFBREATHER on top of one of those pjs along marcus garvey. The man was ancient! Skin like crinkled up paper, long boney legs bent into an antique wheelchair.

“did you ask for the police to come to?” he wanted to know when we came in. I put a message over the radio for them.

-what’s wrong today sir? You feel okay?

…yes. Yes feel alright.

The apartment was dusty and mostly empty.

-Do you wanna go to the hospital?

-Yes…Yes I think I do.

Ok…Any pain anywhere? Any trouble breathing?

No. None at all.

That’s nice. Why did you, ah…call…911…today…sir?

Lemme get back to talkin’ to my daughter for as sec, he says, indicating an empty corner behind him.

I was about to be able to explain the whole weird episode away as a oh he’s bonkers but then i saw the phone sitting there off the hook. I passed him the receiver.

No- he says- no, dear, it’s just something i have to do. I can’t stand him being here anymore. No, he’s out now. No…I know…It’s just the way it’s gotta be. Okay…alright.

He passed me the phone to hangup.

Popo couldn’t get much more outta him than we could.

Basically, the cop says, you just wanna go to the hospital but nothings wrong?

That was the gist of it. When I went to help him up from his wheel chair and into ours, he reached one long arm into the pillow behind his back, retrieved a 10” butcher knife and handed it nonchalantly to my partner with a curt: hold this for me.

“Uh…ok…” she gingerly placed on the dust covered kitchen table and we wheeled him the fuck out the door.

BLEED IN BLEED OUT

When the word INBLEED pops up on our screens as a call type it inevitably means the next hour of life is gonna be either messy and stupid or boring and stupid. This is because INBLEED is the kind of call you become when you tell 911 you’re bleeding out yer butt, so the range is from “I have hemorrhoids” to lying dead in a lake of blood. That was actually a job I had a couple years ago- start as a INBLEED, turned into an UNCONSCIOUS while we were on the way and then a CARDIACARREST when we rolled up. Sure enough, the landlord met us at the door with the delightful words: “He has HIV and Hepatitis and he just vomited up all the blood in his body and died.” Sure enough, the damn room was painted, floor to ceiling with bright red blood (bright red means it’s recent, dark coffeeground blood means it’s old. For what it’s worth) and there was a dead guy lying in the middle of it all.

Anyway, you basically treat a true internally bleeding patient as if they were a trauma: they need a big IV with lots of fluid going through it and they need to get to a surgeon ASAP, no time to play. But that’s really the very rare exception that shit turns out so dramatic. Most, like 90% of em turn out as

“yeah I found a streak of blood in my stool, wanna see?”

nope.

or “I just vomited and there’s some red in it.”

What were you eating?

“Cherry ice cream with beets and ketchup.”

Hmmmm.

BUT anyway, by whatever odd logic of the EMS gods was at work last Monday, we ended with 3 inbleeds in a row, spanning the whole range of madness. The first was a chick from a shelter who’d just had a little dab a blood here and there whenever she did a number 2 for the past three weeks. Ok, doo dee doo, let’s go. Second was basically the same thing but the guy tried to fake a seizure on the way out cuz he didn’t think we were paying him enough attention. Then the last guy- he made like he was alright, even convinced himself he was I think. He’d had a near syncopal episode (almost fainted) coming back from the bathroom and while he didn’t have any active bleeding, he’d been diagnosed with a bleeding tumor and a stomach ulcer. But the dude wasn’t showing any signs of crashing or even being shocky at all, no dizziness, wasn’t pale, wasn’t weak, his blood pressure was fine, heart wasn’t racing. Did you know when your bloodpressure drops your body realizes it and makes you thirsty so you can compensate the fluid loss? That’s why so many trauma patients’ last words are “can I have some water?” and then they die.

Anyway, this dude had none of that, and he wanted to walk, so we said alright, but kept a sharp eye on him as he stood. Halfway to the door, right in the narrowest part of the hallway, he went gray, flung his arms out to either side, rolled his eyes back and collapsed. Man…

The boyfriend starts yelling about how he always does this (!?) and why he have to be so macho, then their cat starts hollering and carrying on too, and meanwhile my partner’s passing me the IV line and needles while I’m making sure dude isn’t in arrest. It’s tight in here, mind you, like one person at a time tight, and the patient’s large and in charge, but fortunately, not dead. He still needs an iv though, so I wrap the rubber cord round his big ol’ arm and start feeling round for a plump vein, but there’s NOTHING, not a damn thing. He’s waking up now, talking bout –oh I feel better now I can walk? and his man’s like –oh HELL no, boo! And I’m like, dude- where’s your veins? But like I said, he’s fat and probably bleeding out somewhere deep inside, which depresses already hiding vessels. Grrr. Then to top it off, it turns out when I do take a stab at something, his skin is alligator thick. Like, you have 2 put shoulder into it to get the needle through, which sucks for everyone. So he’s screaming and yelling, the bf’s like “man up” in a startling about face from his earlier position, and my partner’s peering over my shoulder tryingto see if my IV any good or not. I push hard, break skin but get no flashback, no love whatsoever from those escondido mothafuckas. We try twice more but with no luck.

He still wants to walk, which is generous to our backs but unfortunately, not even remotely possible. Just sittin up he gets dizzy again, so we call for a backup truck, pull out the scoop and ease him onto it. Takes some serious heave ho’ing but eventually we get him hoisted up, down the skinny ass hallway and into the ambulance and then carted safely and happily off to the hospital.

STAND UP SIT DOWN LIE DOWN DIE

The next night, after lots of ridiculous little jobs (“my elbow hurts” and “I can’t find my psych meds!”) I was workin with newguy and we walk into a fancy Spanish Harlem apartment to find a little old guy, surrounded by gawking firemen, about to die. Dude was pale as shit, gasping for air, flailing his arms around like he was drowning and couldn’t get more than a word or two out. He definitely had fluid in his lungs, you could hear that raspy gurgling from across the street- the real question was his blood pressure. If you have fluid in your lungs and your pressure’s skyhigh, which is usually the case, it’s very bad- your veins are clenched up tight, you’re heart failing miserably and you’ll eventually drown in yourself. But if you’re ful of fluid and your pressure’s low: you’re fucked. Unless someone puts some dopamine in you quick it’s all over. It’s called cardiogenic shock. That was this guy. To top it off, there was no way for us to give him the dopamine, which tightens up your vessels enough to keep your heart pumping and your pressure up, because the guy had no veins at allll. Nada. I took one look and knew it wasn’t even worth trying.

Here’s the quandary with this situation: no blood pressure means you can’t sit up- any fluid you got needs to be pooled at your upper body, vital organs, so if you sit up it’ll drop to your lower extremities and you’ll die. That’s why people in that situation, including trauma patients who’ve bled out and internal bleeders, all get transported with their feet up, lying flat on their back. On the other hand, people with fluid backing up in their lungs can’t breath, and the last thing you want to do if you can’t breath is lay back- the fluid floods right up your airway and drowns you. That’s why asthma attacks and pulmonary edema patients lean forward in what’s called tripod position.

So here we have a dude with both: no blood pressure- it was like 80 over 50, and can’t breath, and he’s anxious, freaking out, won’t tolerate even the oxygen mask that he so badly needs. So we have the scoop to lay him down in and the chair to wheel him out in but it’s a no win situation either way. He was in a sitting slouch when we got there, so I watch him sit up some and ease onto the chair. He doesn’t look much worse for it and I can tell that laying back further is increasing his agitation, and him getting more upset means his poor failing heart has to work even harder and will sooner collapse. I decide to chair it but have the fireguys walk along side with the scoop just in case he codes and we have to start doing cpr.

He’s spiraling down in the elevator, arms flailing madly like he might take off at any second, water rising higher and higher up in his lungs and everything seems to be going in slow mo, but not in the badass matrix way, only in the whytheFUCKthistakingsolong kinda way. Finally we outside, I toss partner my keys so he can set up the stretcher while I cart homeboy out. Firefighters are scurrying all around me in a frantic escort as I heave ho thru two sets of project doorways and out into the street. We do a quick 1,2,3 evaluation: dude’s still fucked, and then I jump into drivers seat and come up on the air to give the notification: 12xray (that’s our unit number) with a note to Saint Lukes.

I’m throwing into drive, restraining a hot seething curseout as the firetruck that’s blocking us in takes a few milliseconds longer than I want it to to get the f out my f’ing way.

-Go head with your notification, 12xray.

-we have a sixty three year old male, eminent cardiac arrest second to cardiogenic shock, blood pressure 80/50 heart rate 120 respirations 28 be there in 2 minutes.

In my rearview, I see my partner flittering around like a desperate little toothfairy in the back. He’s brandnew and truthbetold, I don’t think the patients gonna make it through the night, but I know the best I can do is get him to the hospital fast as humanly possible so he doesn’t have to get worked up by brandnew dude all by himself.

The *%#*&&#?!! Firetruck has pulled off now and I’m airborne through the windy upper west side streets, winding round the park, hauling ass along 110^th and screeching around onto Amsterdam. My sirens are having a temper tantrum, my lights playing rude games in red and white along the Chinese restaurants, coffee shops and saint johns cathedral and then we’re there, breathless, weary, but the dude’s still alive, if only barely.

He didn’t make it through the night tho.

KER-SPLAT

I was laughing cuz my partner was moody and not in the mood for trauma, but we had a student, and it was Sunday night in Harlem, so even without riding all over town trying to pick it up, the shit was flying our way. We’d already done a pretty low key shooting, no kinda clusterfuck just a straight forward once in the leg, dude was pretty much chilling in the doorway waiting for us and then we were sitting in Garvey Park, enjoying the firefly show when they sent us solo for a cardiac arrest on 110 and Lenox. Text said, MAN FELL OFFA BLDNG NOT BRTHNG NOT MOVING.

Now, lemme say that even when a cardiac arrest is just your regular everyday 200 year old in the nursing home type of thing, you still automatically get EMTs backing you up AND a slew of firemen and a conditions boss. This is because arrests take a lotta grunt work to deal with. It’s like any job but someone has to be doing CPR the whole damn time, and real CPR takes two people minimum to do. Then add into equation that the patients probably gonna be humongous and humongoloids as a rule only live on the top floor of buildings with no or broken elevators- it’s a production.

But even with this patient being skinny and obviously not on the top floor, another seta hands woulda really helped.

When we rolled up the fire dudes were there running around with the general melee of the building, which had emptied out for the spectacle. People were pointing and yelling- He on the awning, yo!, so we walked in the building, up a flight of stairs, down a windy hallway, through someone’s bedroom and out a window to the cement awning where we found our guy.

He had landed Wiley Coyote-style, face first, arms and legs sprawled out at impossible angles all around him. He was also about 60, skinny and frail and, most surprisingly of all, alive. Not only was he alive, he was talking, or groaning anyway. Mostly all he said was “ow” the whole time, but for an older dude who’d just eaten pavement from five stories up that’s not bad. Most guys like that we just put a sheet over.

Anyway, the bucketheads had brought their backboard up but we had a problem: the guy was facedown and had to be rolled to be placed supine on the board, but both his arms were shattered, loose like spaghetti, one of em with an open fracture, bone and everything out for all the world to see. To roll him like we usually do would’ve rolled his arm over and over underneath him like dough. Fortunately, he was slender and light, so we adjusted the arm, grabbed him all along his mangled body, supported his head and lifted him over his own arm and onto the board.

“ow.”

Then I climbed back through the window and we passed the board and dude through the window and out into the hallway. With firemen helping my partner get the guy out, i rushed ahead to the ambulance and set up our equipment. He was a trauma, so he’d need big IV lines and big bags of fluid. Because of the mechanism of injury he was likely to check out at any dang moment, so I opened up the tube kit and laid out on the little shelf next to where the patients head would be.

The door swung open and they loaded our guy in, sill moaning. He turned out to have a decent blood pressure- 130/70, and a heartrate of 70- that’s ridiculous. No one falls off a building and has perfectly normal vital signs, but who am I to complain? Either way he was still broken everywhere, and crush injuries like that can maintain and look normal right up util they don’t, and then the guy will just die.

So we lurch into motion towards Saint Lukes and find two surprisingly bulgy veins to put two bigass needles in and lots and lots of fluid and our man rolls into the hospital in the same vaguely shocked and irritated, broke ass way we found him.

THE MISSING BULLET

But first:

ME: What’s the trouble today young lady?

PT: I’m bleeding…from my vagina.

ME: Um…this has happened before ever?

PT: Yes! A month ago actually!

…

True story.


ANYWAY:

PD started getting excited on their radios cuz a car accident came over and it was right at their favorite bar. Then a shooting came over at the same location. Then it turned out to be one in the same and you could hear all hell breaking loose. “It’s an MVA! It’s a shot! It’s both! Blaaah!” I was around the corner in Garvey Park so I just kinda started easing over that direction nice an’ chill like. When you’re medics, you don’t wanna get on a trauma before everyone else. Better to let the EMTs get there first, deal with all the annoying putting the dude on the backboard/getting him out of the car etc. and then you get to do the fun stuff- starting the IV, intubation, whathaveyou. So I sat on 121 and Park and listened to sirens come screaming towards me from all around the city. Emergency Services flew past- those are like the NYPD’s swat guys. Then some EMTs zipped by and we fell into place behind ‘em, bee-lining towards the sea of flashing lights.

They were pulling the dude out of his escalade. He was 60, 300 lbs and dead. There was a gunshot wound in the back of his head and no other visible injuries. His escalade was mashed into the brick wall of the cop bar. A kind of controlled chaos was hanging in the air as everyone swarmed about our business. Eerily, the guy’s cellphone won’t stop ringing.

A word about being dead: as Billy Crystal said in The Princess Bride, there’s dead and then there’s MOSTLY dead. According to our rules- you’re only truly dead if you fit certain criteria: rigor mortis- which is you know when you’re all stiff, dependent lividity- which means you’re so dead all the fluids are pooling at the lowest point in your body (yes, it’s gross), decomposition- which is self explanatory, you’re rotting and then the wonderful catchall: Obvious Death. That includes everything from beheading to burnt-to-a-crisp. Usually if brain matter is involved, it’s Obvious Death (unless the person’s still squirming). If you fit into any of those categories or have a DNR, we put a sheet over you and call it a night. Otherwise, it’s the whole rigamaroll.

This dude wasn’t quite obviously dead enough to be Obviously Dead, plus they’d already gone to work on him when we got there and it’s a whole other rigamaroll to stop a workup in progress. So we did our thing: got him on the EMT’s ambulance, I set up a fatbag o’ fluid and prepared my iv, my partner took out the laryngescope- a metal scythe shaped tool with a flashlight on the end that we use to look all the way into people’s throats so we can stick a tube down there. Meanwhile, I tossed my keys to the other EMT so he could drive our bus and yelled to the driver to start rolling.

The best way to find a good vein to poke isn’t by looking, it’s by feeling. Sometimes you’re better off not looking- you just roll your finger gently along the area where you know the juicy ones hide until you feel that bouncy vessel poking up. Then you trace it, see which direction it leads, and sink your needle just below it. When the needle finds its mark, blood pours into a little filling chamber. You push the plastic catheter forward while pulling the needle out and then attach the iv line to the hub left behind. All this happens while the EMT is frantically barreling down the street and around corners because he’s new and never been on a shooting before, let alone a crazyass car crash head shot traumatic arrest. Just as we're ripping off scene though, the ambulance stops short.
What’s the problem? I yell from the back.
There’s a Captain onscene, the EMT reports.
So what? I ask. They’ve been getting real uptight about certain things and apparently this one wants to check on us. But really- now is not the time.
He’s blocking the bus, the EMT says.
Drive around him, I holler. Both my hands are busy trying to keep the IV bag from swinging into my partner’s face while he sticks the tube in.
We drive around the captain.

The line is in and so is the tube when we swing into the ER bay a few blocks away. Since we made patient contact, eight minutes have gone by. The energy is coursing through my body- it’s more than adrenaline- it’s the glow of total focus and purposefulness of action and it feels amazing.

At the hospital, they pronounce the dude pretty quickly, but when they x-ray his head there’s no bullet there. Now we have a riddle: there’s only one hole, so where’s the damn bullet? I ask my partner what he saw when he went to intubate. –Just a lot of blood, he says, couldn’t see much. The doctor in charge gets his suction and a light and after some cluttering around in the dead man’s mouth announces he has found the other hole. The entrance wound. Turns out our guy was a suicide. A general murmur flutters around the detectives. Apparently he was talking on the phone with his girlfriend, had been depressed for a few days, crashed the escalade and did the deed, gf still on the line. That’s why she kept calling back.
The doctor puts a sheet over him and I head outside to clean off the equipment.