LITMIR.BIZ

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a crack and I asked, “Excuse me, ma’am, but does your balcony happen to be connected to Ms. Reichert’s balcony?”

      The neighbor said, “Yes, it does. Why?”

      I quickly explained our urgent need to get into her neighbor’s apartment. She let me in and I rushed to her balcony. It was connected to the neighboring balcony, but there was a thick cinder block wall between the two. I climbed carefully across the small ledge at the edge of the wall onto Ms. Reichert’s balcony. Fortunately, the balcony door was open on this pleasant summer evening, and I rushed past a bleeding Ms. Reichert to open the door for Steve.

      Steve brought our equipment over to Ms. Reichert, who was sitting at her kitchen table with a pool of blood spreading out in front of her and spilling onto the floor. On the table were some of her medications, which I recognized from the night before, a straight razor, an empty bottle of cheap wine and a bottle of rubbing alcohol. Ms. Reichert had cut her wrist with the razor, and she was confused and lethargic. Her vital signs were consistent with someone who had lost a lot of blood.

      “Did you drink this?” Steve asked, holding up the wine bottle.

      “Yes,” murmured Ms. Reichert.

      “Did you drink this?” I asked and I held up the rubbing alcohol. I was afraid that she had. Rubbing alcohol is isopropyl alcohol, which is very poisonous. This would bring the call to a true life-and-death emergency. I imagined the damage the rubbing alcohol would be doing to her intestines and liver. Ms. Reichert didn’t answer me—she just kind of shook her head. This response was not very reassuring. “What is this for?” I demanded, still holding the bottle of rubbing alcohol.

      “I used it to sterilize the razor,” she said.

      In preparing to commit suicide, Ms. Reichert had sterilized the razor she was planning to use. Sterilizing a surgical instrument such as a scalpel is normally done to prevent infection. Ms. Reichert obviously didn’t want to get an infection from her slashed wrists. This also meant that she didn’t want to die from her suicide attempt. We took her to the ED and she survived. This time however, the ED physician did request a psych consult for Ms Reichert.

      According to the psychiatrists, Ms. Reichert’s attempted suicide was a cry for help. Her intention was not to die, but to bring attention to herself. This was evident not only in her sterilization of the razor, but also in the fact that she had called her sister to tell her of her intention. This is why the call came in from California.

      Fortunately, Ms. Reichert had no lasting physical impairments. Other survivors are not so fortunate—an attempted suicide can result in permanent disability. A non-lethal drug overdose, for instance, can permanently damage a person’s brain, kidneys or liver. The result is often referred to as being “Quinlaned,” after the tragic story of Karen Ann Quinlan, who was in a coma as a result of a drug and alcohol overdose in 1975 until her death 10 years later. In a case like this, a suicide victim is relegated to a life of dependence upon medical personnel, with no chance of a normal life. Therefore, if you ask an ambulance veteran the surest way to commit suicide, you will be inundated with a barrage of suggestions, including standing in front of a train, gassing yourself with carbon monoxide, jumping from a building (above the seventh floor), jumping from a height of greater than eight feet with a rope tied around your neck, or putting a .38-caliber bullet in your mouth. One that usually comes at the top of the list is to use a shotgun to blow your brains out. A shotgun can do an enormous amount of damage too, and if it is pointed anywhere near the head it almost sure to produce lethal injuries. But nothing, not even a shotgun suicide, has a guarantee.

      Steve and I got another suicide call that came in as a GSW—a frantic neighbor had heard a shot. We arrived at a single-family house just after the police, who smashed the window in the door and let us in. In the bedroom was a bloody mess. There was a shotgun blood-splatter pattern on the wall above our victim’s head and a tear-stained note on the nightstand. But there was no shotgun anywhere in sight. This made me wonder if it could be a murder.

      The patient’s face had been taken off by the blast—he had no visible chin, tongue or nose. One eye was completely gone and there was something that looked like a strand of spaghetti connected to a liquid-filled marble hanging on the other cheek. There was no place on the neck to get a pulse and I was trying the wrist when a gurgling sound came from the neck. My eyes met Steve’s just as I felt a strong and rapid pulse in the shotgun victim’s right wrist. This guy was alive—with no face. The gurgling noise was this poor man, a Mr. Ramone, trying to breathe. Steve and I both picked at the remnants of Mr. Ramone’s neck, trying to find the opening to the trachea. We found it and Steve slid the airway into it and ventilated directly into his lungs. Next we started two IVs and packed his face in large trauma dressings. One of the rookie police officers was a bit shell-shocked by this scene and he wouldn’t get out of our way. So I gave him the two IV bags to hold and asked him to keep them elevated and watch the drip port to make sure there was two drops a second. This made the rookie feel useful and actually helped us a little. Cops, family and bystanders make good IV poles.

      We were just getting ready to transfer Mr. Ramone to the stretcher when one of the cops found the shotgun. The force of the blast had sent it all the way across the room and under a dresser. Mr. Ramone must not have had a tight hold on the gun when he pulled the trigger. He also must have clutched the gun too close to his body, so it was not pointing at his brain. He had absolutely no injury to the brain. When Steve and I opened Mr. Ramone’s airway and gave him oxygen, we had saved his life. But we had also consigned him to a life of being blind, mute, and permanently disfigured.

      Steve gave the report to the ED physician, Dr. Frank. When he finished, Dr. Frank said, “Mr. Ramone must be the world’s worst shot to miss from zero feet.” Mr. Ramone had gone to great lengths in his preparations to leave the world that day. He had left a thoughtful and detailed note saying goodbye. He also used the usually infallible shotgun technique to end it all, but he was thwarted by his unfortunate aim, and then by Steve and me. All he wanted to do was die and we wouldn’t let him. I hope he understood that we wanted to help him, even though that was against his wishes.

      Mr. Ramone, wherever you are, I am sorry to have changed your plans that day.

      I never liked working the day shift. There were too many supervisors, too many people watching. Night shifts, however, were full of mavericks. No one wanted to work with them—or perhaps I should say no one wanted to work with us. Night shift workers seemed to fall into one of two categories. There were unbridled heroes who did great good for humankind, and there were losers with whom no one wanted to work. Both groups were similar, however, in that they both wanted to get away with something. The first group wanted to do more than they were normally allowed to do. They were frustrated physician or cop wannabes who wanted to be someone they were not. People in the second group were often incredibly incompetent or lazy. They wanted to do the absolute least they could while still keeping their job. They were hiding from the administration. Sometimes, however, people were sent to the night shift because they were being hidden by the administration. The powers that be seemed to think that a person on permanent nights would do the least amount of harm and cause the fewest hassles—out of sight, out of mind. This is totally incorrect, but the overachievers were more than willing to take up the slack. So a kind of symbiosis would develop between a competent overachiever and an incompetent partner. (This benefit would be lost, however, when the administration scheduled two incompetents together.)

      I, on the other hand, had other reasons for opting to work nights. At one point I had enrolled in a paramedic class while at the same time working on the ambulance and taking some college classes. I got to the point where I had to decide: college, paramedic school or the ambulance. I chose to drop out of the paramedic class and continue as a full-time college student working on a bachelor’s in chemistry, while working on the ambulance at night to pay for tuition. (Lots of people dropped out of college to become paramedics, but I was known in ambulance circles as the only person to drop out of the paramedic class to go to college.) Plenty of people got sick and had car accidents on weekends and nights, so I always had

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