Night Shift (part two)

San Francisco     Fall 2007

I am not working as a paramedic these days, just moved into a related line of work that will not yield any of the stories or photos usually flung upon these pages.  Ah, well.  Almost went to Haiti for a month of earthquake relief work – that would have been a trove of disaster stories, but the new work schedule prevented that.  Here is a second batch of memorable cases taken from working the night shift in the city.

One night we were assigned to pick up a “5150” patient, code for a person under 72-hour psychiatric hold due to the possibility of harming himself or others. Simply a transfer from the hospital he had walked into, over to a proper psych ward across town. Though he was calm and glassy-eyed with sedation, we strapped his ankles and wrists firmly to the gurney for the ride. I jumped into the back with him and read his file while keeping an eye on him. The ER had stitched up his wrist and abdomen for self-inflicted knife wounds, but there was more to the story. I always question these patients because there is no telling what kind of answers they might have.

He said he had been hearing voices again, which is why he chose to get on a MUNI bus, pull out a “big knife” and decide which riders to kill (I wish I had asked if it was the 22-Fillmore.) The driver hit the brakes hard, jumped up and threw Vlad the Impaler out the door. This must have been a large driver, because the offender was not a small guy. Vlad went home, stabbed his cousin in the shoulder, then cut himself up and walked to the ER.

The SFPD did not know this guy’s whereabouts, but hopefully he is in a cage now.  Probably not though.  Hard to verify this one anyway, partly because he was crazy but also because there was no mention of it in the paper, for what that is worth.  Following up on interesting patients is not easy – always another call, a different hospital, shift changes, discharge, etc.

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An upscale mom was in the kitchen with her six-month-old baby strapped to her chest. She slipped on the wet floor and fell, striking his fat head on the dishwasher. He had a skull fracture, but was calm and feeding when I saw him. He would recover fully and quickly.

The awkward moment for all came when we delivered them to the pediatric unit of the hospital and the newborn across the hall was not responding to resuscitation efforts.  I think it was a heart defect.

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We left at midnight for a three-hour ride far out in the country to pick up a premature baby who would do better with intensive care here in San Francisco. On arrival, the neonatal nurse we brought with us went to work on the unstable critter, switching the hospital’s equipment and incubator to her own portable gear and incubator. The baby was hatched in his 26th week, and resembled a reddish-purple Cornish game hen to me. He had a softball-sized head and I do not know why he arrived so early. I think he was 3 ½ pounds, and would easily fit inside my old lunchbox, with maybe room for some chips.

While I was visualizing him riding shotgun with me and chewing the fat on the long drive home (“So how was it in there, dude?”) a thin young woman in a hospital gown appeared at my side.   Oh good, I thought, the mom is coming with us, but she should dress warmer for the return trip. Then I noticed her handcuffs and leg irons, and saw the large woman in the sheriff’s uniform behind her.  Mom said goodbye, maybe for the last time, and she and the baby went off to the back of their respective vans. I never was able to find out why momma was in the pokey, but maybe it had to do with this area’s fame as methamphetamine lab  hotspot.

Our nurse did shed a little light on it though: This was her seventh pregnancy and fourth child. Mom was 23 years old.

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You might not want to drink too much scotch and then chop a watermelon, because you might lose a whole pinky. Worse, neither of the medics would beat the other out of $10 because they both wagered (correctly) that this call involved a meat cleaver.  Odds were in favor of successfully reattaching the digit, but not for the microsurgery which might restore full function, because he had no insurance.

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Police activity, not directly witnessed or verified:

Good shooting I guess:  While apprehending an armed local street gangster, a cop fired nine bullets and hit the thug eight times.  Somehow the guy was shot only in the arms and legs and will live to drain your tax payments for several more decades.

Not good shooting:  two policemen each fired a whole clip at an armed robber outside a McDonalds.  That is 30 bullets, and each one missed completely except a ricochet which hit a bystander in her collarbone.

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Dog versus two-year-old. This is a nasty baby-trauma story, and I recommend not reading it at all if you have kids.  Then again, there might be a lesson here.

Two of my co-workers were sent one hour south to move a patient from a hospital there up to San Francisco for microsurgery. It was a severely disfigured toddler, one that had been a cute Mexican girl. A few hours earlier, the girl had been playing on the kitchen floor when the family dog turned and attacked her. It was a pit bull.  Amazing, I know.

The beloved pet tore and punctured one lower leg, one forearm, and one shoulder blade before getting a hold on her lower lip, and tearing it completely off, along with all the flesh below it, down past the chin. Nothing left but lower teeth and jawbone to look at. Fortunately El Badass  did not bury her lip in the backyard, he just left it there on the floor, where the responding paramedics recovered it.

They quickly transported the girl and the box of ice with part of her face in it up to the specialty center. The avulsed piece was reattached in surgery, and the largest local artery reconnected. Interestingly, leeches were then applied to the entire border of the wound. The blood-sucking at the edges works to pull fresh oxygenated blood from the central artery across that entire area which would not otherwise be well supplied. I am not sure about the predicted odds of recovery, but reattached parts do not always  successfully re-implant. Often they do not regain actual function, or else they fail completely.

Ten days later, dropping off a different patient at the microsurgery hospital, there was the girl. It could only have been her, and the reattachment was obviously rejected. All of her bottom teeth were visible, and the lower part of her face looked like a burnt marshmallow, or a charcoal briquette. Puffy, oozing, black as tar. She was back here to have it removed, but then what? Probably graft a full piece from her backside, maybe tattoo a lower lip on it, but that will not regrow any of the muscles that control the area.

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Photo above: Nicholas Cage zombies along while his partner thrashes the ambulance in Scorsese’s “Bringing Out the Dead.”

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