My Ambulance Education. Joseph F. Clark

Visions of a Garfield cartoon scene kept popping into my mind. When we got to the point of trying to identify the burglar we found he had no ID on him. I immediately suggested calling him Garfield Doe and the cops and ambulance personnel unanimously agreed.

      Tom and I seemed to have bad luck on calls, with more than our share of unidentifiable bodies. It’s bad enough when a body (and any paper ID in the wallet or purse) has been burned beyond recognition and dental records must be used. The real problem, however, comes when the severely burned victim is still alive.

      Burn victims were always difficult calls. Severe burns— third-degree burns over more than 50 percent of the body—are often lethal and it is difficult to handle the patient without removing skin or tissue. The severely burned patient needs fluids, but the skin covering the veins that we normally would use to provide those fluids has been turned to bacon and gristle. Thus the ambulance crew will usually douse the person with sterile water and get him or her to the hospital, where the patient can be given IV fluids through lines into major vessels.

      On one of our worst calls, a Ford Pinto was hit from behind by a delivery truck and both burst into flames. The truck driver was able to get out, but the Pinto driver was trapped. We arrived with the fire department, which quickly put out the flames, but there was little hope of finding anyone alive in the burned-out wreck. Nonetheless, Tom went in to check. Inside was a person with third degree burns over what looked to be his entire body. Since he was still in the seat, we couldn’t assess the burns on our patient’s back, but his front was as black as a hamburger lost in the coals of a backyard grill. I was waiting for Tom to confirm that John Doe was DOA (making him a “DoDo”) so we could leave, when he called me over to the car. I grabbed the trauma box and ran to him. Pale and sweating from the heat of the burned car and cooked victim, Tom exclaimed that the victim was still breathing. This galvanized everyone at the scene into action. Our victim was making loud rasping breaths that seemed to crackle like a freshly poured cola. The unusual breathing noise was caused by the trachea, or windpipe, being burned and swollen, narrowing of the air passage. The crackling noises were likely a result of the tissue in his chest being cooked, and thus unable to move with his breaths.

      The heat of the fire was cooking his flesh, so our patient needed to be cooled immediately. The fire department gently hosed him down to cool his body while being careful not to spray water in his face. (Water in the face could be inhaled into the lungs.) Next, we needed to get him out of the car as quickly as possible. But knowing the fragile state his skin would be in after such burns, we would need help in moving him gently.

      I called over a couple of firefighters and they quickly got the door off the car. We then tried to slide the crispy critter out of the car and onto the stretcher. Tom and I were pulling him towards us and guiding him onto the stretcher when all of a sudden there was a loud ripping noise and a pop. John Doe’s arm came off into Tom’s hands. All four emergency services personnel froze in stunned silence. My stomach was knotted with the horror of what we had just done. As we stared at him holding the left arm of this still-breathing burn victim, he turned to me and gesturing with the charred arm said, “Wanna bite?”

      The laughter that followed was forced. Tom was a true believer in the idea that jokes are one of the best defenses against the stresses of this job. None of us really thought his joke was funny, but it jolted us back into action. When we got John Doe on the stretcher, we had to have him sitting up, because all his muscles were cooked into the sitting position. Even his remaining arm was thrust forward as if he was still gripping the steering wheel. As Tom drove us to the hospital and I checked again for breathing sounds coming from our unfortunate passenger. There were none. There was no place on his body where I could easily check for a pulse and because of the position he was stuck in, I couldn’t even consider CPR.

      We drove to the hospital with lights and sirens as I sat in back looking at the burnt shell of a man that continued to radiate the heat he had absorbed during the fire. I stared blankly and helplessly at the hole where our patient’s left arm had been. It oozed a thick, viscous blood that dripped down onto the stretcher and pooled on the floor. I tried not to think about the barbecue smell that dominated the ambulance. When we arrived at the hospital I could see in Tom’s red, puffy eyes that he was feeling the anguish of what we had been through.

      Later, after we got the greasy feel of burnt human flesh washed off our hands, I asked Tom, “Do you want me to write up this John Doe?”

      Tom knew I was really asking him if he was OK, and he came back with the only reply that would tell me that he was. He said, “His name is Barbecue Doe, and I want to write it.” He wrote the call up with surgical precision and detail and dealt with the rest of the day’s calls with his typical gallows humor, but we avoided talking about Barbecue Doe.

      Police, medical personnel and clergy are all profes sionals who deal with death regularly. Death is part of the business. Many people ask me about the worst or most disgusting call I ever had, and some even ask about the worst dead body I ever had to deal with during my years on the job. For me, the dead body that was the hardest to deal with was one of the first I ever encountered. A person is a person, and when life ends the body is a bag of cells, proteins, salts and water. However, that bag of cells was once someone’s son, daughter, husband, wife or loved one. The John and Jane Does emergency personnel often have to deal with were loved by someone, somewhere.

      Just before sunrise on a clear spring morning, we were called to assist a police officer. The location was not an address, but a lonely stretch of road. Roger, the cop, had observed a car traveling erratically and pulled over the lone female driver. The woman in her late 40s was dressed in a pink nightgown that made her seem almost ethereal. She stopped and immediately jumped from the car and started to run along the grass verge. Roger ordered her to stop and she appeared to trip and fall face first into the grass. When Roger came up to her she was not moving and apparently unconscious. When he placed his hand on the middle of her back to prevent her from rolling over and turning on him, his hand was pierced by a knife. She hadn’t stabbed him—a large knife had been stabbed into her chest so far that the point was sticking out of her back.

      When we arrived Tom bandaged the cop’s cut hand and I went to see the woman. We were not sure if this was a suicide, accident or homicide, so I had to work carefully to preserve the scene. It was easy to see the knife protruding from the middle of her back, just to the right of her spine. Blood was oozing out around the point of the knife and flowing down her right side; the handle was out of sight underneath her. I couldn’t reach her wrists to take a pulse because they were beneath her body as well. Her head was turned to the side, and as I moved the long black hair from her face to try to take a carotid pulse, I got a close look at her. Much to my horror I was looking at the body of Mrs. Collins, the mother of a very close friend of mine from high school.

      I had known her son Ryan for many years and been to their house often. I shared dinners there, too. While this changed things for me emotionally, I still needed to work the scene in a professional way. I knew the medical examiner had already been called and that our job was to determine whether the person in front of me, poor Mrs. Collins, was in need of medical care or if she was dead. I quickly and sadly determined that there was no pulse, no respirations or other signs of life from her. The life had been drained from her by the large flow of blood that had gathered below her body in the dirt. The bright red blood was clotting in a smooth, glistening bed below wild violets just starting to bloom.

      I turned to Roger, a patient who could still be helped. But Roger refused to be taken to the hospital. He seemed to be behaving as if the scene was his and he was going to work it. Fortunately, a police supervisor arrived and ordered Roger to be taken to the ED. So Tom drove and I sat in the back with the injured cop.

      The medical examiner pronounced Mrs. Collins dead and the crime scene forensic people took over. As we headed for the hospital I mentally began plans to attend Mrs. Collins’ funeral. I never told Ryan or anyone else in the Collins family that I was at the scene of her death, nor did I tell the people at the scene that I knew Mrs. Collins. Eventually, the family and the forensic guys were able to piece together that Mrs. Collins had committed