Priority One

You are on call, you head to your assignment not knowing what to expect. what you find horrifies you. But you can not let others see that. People need you. People are relying on not the things you head, listened to or seen, people are relying on you and what you know you know. So what are you going to do? How are you going to do it? How will your actions affect others?

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5. A quiet Night

I was working. A somewhat quiet night. That in itself was unusual. My partner Sam and I were at the station on the outskirts of Melbourne. Sitting around. Sam drinking tea, me reading the same outdated magazine I had read last week. Time was passing apparently very slowly. I found I had no idea how long Sam and I hadn’t been on a call.

“Wow it’s nearly ten at night and its only you and I who are currently not working.” Sam said.

“Yeah... that is odd. My last shift was busy as hell.” I said turning the page of the magazine carefully not looking at the emaciated celebrity bodies being publicised and looking up. Sam had the news on the television. The room was bare, with a worn lounge at one end, a dining table at one corner, a bookshelf next to the TV in front of the sofer and in a room off to the right of the door was a small kitchen. A bathroom through a door off the lounge and in an office through another door just near the front door was the coms centre.

I pushed the magazine away, picked up the cold mug of coffee I’d made almost an hour earlier took a swig and left it on the coaster. I got up, stretched and walked into the bathroom. I looked at my face in the mirror, I looked like hell. It has been months since I had slept for more than three hours at a time. The dark circles around my eyes made me look like a ghost. But somehow I had begun to get used to an impossible schedule. I lived alone, my boyfriend had warned against taking on so many hours and recently he had slipped away. The calls lately had been legit, minimal suicides, minimal psych calls minimal ODs. Things were ok. Not one month ago I was in counselling for suspected PTSD. I had a self harm problem, which was inexplicable since I know full well the damage it can do to a person having been on a fair few S.I. calls. Recently I had stopped therapy, being a medic I had come to realise meant too much to me to give it up. Occasionally you have a really good day, or night where you actually save a life or nobody dies at least. In the months before stopping therapy, the calls were bad; we had one cardiac arrest at the onset of PTSD which didn’t go well. Sam and I threw everything we had at his stagnant heart. But it was in vein. He died at the scene. After that things spiralled downward. I began to drink, dabble in a medication stash hat even I know was dangerous. I was taking antidepressants. I was sick. But things had since looked up a little bit. My sleep meanwhile continued to elude me.

I took out my compact and began to apply a fresh layer of congealer on the dark circles. I felt tiered but my heart was beating rather fast for relaxation. I was on duty and the night was when things usually got busy. Tonight however was weird. When I was satisfied my dark circles were covered up I closed the compact slipped it back in my pocket and walked towards the door. I hadn’t taken one step when the alarm from the coms room went off.

I positively jumped out of my skin. I ran out the door and across to the coms room where Sam was already on the phone to operations, witting things down as he listened. I went out taking my hat and jacket as I did so off the hook, out the door and into the passenger seat of the van I went. Sam followed at a run. He jumped in, strapped himself in and started the engine. It rumbled and we reversed out into the dark street. Headlights on high and sirens blaring we set off. Sam handed me the slip of paper. On it were the words “SI and OD unconscious. History of mental illness. 125 Swanston Street level three apartment b.” My heart sank. It had been months since I had treated anyone who had ODed, self harmed or had a psych history let alone thaught about it. I had a strong feeling I wasn’t going to be able to keep my cool but for some reason I hadn’t let slip any of this to Sam. My heart rate had gone from about ninety to well over on hundred as we were speeding down Swanston street.

“There in the right!” I said having just spotted the apartment block we were after. I looked up at the second floor before getting out and saw the light was on in three of the windows. I got out and opened the side door, got out the resus, oxygen, trauma kit and drug kit. Sam had got out the stretcher.  I shut the side door and helped load the equipment onto the stretcher. Together we wheeled it across the path and in the double doors. We got into the elevator and were taken up to level three. The building was set out so that each property was an entire floor. The door of the lift opened into a short hall at the end of which was a red door with the letter B on it. I stepped out and knocked hard on it, a strong feeling of dread welling inside me.

“Ambulance!”I half shouted. About ten seconds latter it was opened by a woman. Red faced, tear streaked and wearing a dressing gown, hair, up in a messy knot. She stepped aside without a word. As we passed her we left the stretcher in the hall. I took the resus and trauma kits and Sam took the drug bag and the oxygen.

“Where is the patient?” he asked her as he passed. She pointed through the door to the left and then walked through it. It appeared to b a bedroom. A queen-sized bed was in the middle. The window looked out onto the street. You could see our ambulance down blow. The bed covers were thrown back and blood stained. Our patient was lying in their midst, white faced. Sam set his equipment down beside her on the bed and walked round to her other side.

“What’s her name?” Sam asked the friend.

“Jess.” She said sounding chocked up. She was standing by the door one hand over her mouth, hiccupping.

“Jess! Can you hear me? My names Sam this hears my partner Rose. Can you squeeze my hand for me” he pressed his gloved hand into hers and waited a few seconds. I remembered my gloves and quickly put them on. Sam had one finger on her radial pulse. I was turning over her arms. Checking her pupils, equal and reactive, normal. Her breathing was slow. Her resp rate was about 14. Her skin was pale, clammy, lips were dry and there was evidence of cyanosis...

“Pulse is 58 but very faint. Pass me the sphyg.” He said.

“Pupils fine.” I handed him it had h took her blood pressure. I threw back the covers and checked her legs. I was absolutely shocked. Nothing could have prepared me for the scene of utter horror being played out on her upper thighs. Linear parallel and criss-crossed deep incisions, fresh and seeping blood into the depression in the bed where her pelvis was. It was making her look like she had miscarried in her sleep. It was unmistakable, but still no more obvious how someone apart from me could do this to themselves. I was appalled and more than anything I wanted to leave the house as soon as I could. I was the last person to offer any kind of assistance with a problem like this. She deserved someone else. She didn’t deserve to be helped by someone who very well could just go home and do the exact same thing to herself.

I had to pull myself together. I had to realise that I was fine and that it wasn’t me who was bleeding freely. It was my patient and of she bled any more she would die.

While Sam was listening to her lungs I dressed the wounds on her legs which were bleeding in spurts. I pressed dressings to them and tied pressure bandages round her legs, twisting them over the cut and stretching then as far as they would reach. I didn’t know for sure but I was fairly sure she hadn’t cut the femoral artery. If she had she might very well have been a DOA. My hands weren’t shaking. Surprisingly, I was working more efficiently than I had expected. I had started dressing the other leg when Sam stated that her lungs sounded clear but her breathing was very shallow.

“Dextrose 5?” I said looking up.

“Yeah, could you... oh no I’ll do it.” he said noticing as he looked up that my hands were working on her wounds.

“she has two linear deep incisions on her upper thighs, no evidence of femoral arterial bleeding but it needs stitches and she’s lost allot of blood. Better also get a Hudson mask on her too, there’s cyanosis.”

“Dextrose 5 it is then.” Sam said.

I opened a bag of normal fluids. I untangled the tube. Sam was at her arm tying the elastic round it and watching her blue contrasting veins. He was aiming with the catheter for the biggest vein in her inner elbow; he stuck her with it, piercing the vein from the side. The blood flash back was slower than usual. I handed him the tube and he attached it to the canulla. I adjusted the drip rate, and into the extending chamber I injected a prefilled syringe of dextrose. A BGL enhancing drug commonly used to treat shock. He taped the catheter down and then looped the tube. I had connected the oxygen while he was working on her drip.

“Hey what’s your name hun?” I asked the friend.

“Emily.” She said sounding slightly calmer.

“ok Emily, could you help us out” come here and hold this up high for us.” I said to Emily who walked tentatively over and took the IV bag from Sam who was writing the vital signs down on his gloved hand. This was extremely handy, as you could take the glove off latter and have the notes there with you still when the paperwork needs doing.

“Do you want to ride with us? We have to take her to hospital.” I asked Emily. She nodded taking out her phone. Sam left the room to bring in the stretcher. Emily holding the IV bag Sam and I lifted her onto the stretcher. I strapped her in and then raised her legs.

“Wait a minute!” I said remembering.

I turned ion the oxygen to 8 litres per minute and placed the mask over her face and put the bottle between her legs.

“Ok then let’s go.” I helped push the stretcher out into the elevator. While we were going down I was taking her pulse again. It had come up and was now about 60, it was stronger. Her colour was slowly returning and her wounds didn’t look like they were seeping anymore. She hadn’t opened her eyes yet. Emily was standing behind me holding the IV bag. When we reached the ground floor we hurried out to the ambulance. I opened the back door and helped Sam load her in.

“Emily, I may need you in the back with me, is that alright?” I asked helping her up into the van.

“Yeah that’s alright.” She looked resolute. Averting her eyes from her friend she sat down in the seat at her head. I hung the bag on the IV post and sat down. I heard Sam start the engine and turn the sirens on.

The hospital was at least half an hour away.

“So Emily, my names Rose, can you tell me if Jess has any allergies?”

“No.”

“And any medication”

“She’s on something called xzanax.” She said. “When she called me I asked her of shed taken that lately and she said no. She sounded bloody awful. I just didn’t know what to say. And then shd dropped the phone and I couldn’t get her back.... so I hung up and called triple zero..... And now her parents are gonna kill me, they knew she was depressed, I knew it, but what did I do about it.... fucking nothing....” she was hiccupping worse than ever. I had jotted down her medications and a brief description of the state we had found her in.

“You know you did everything possible to protect her welfare. If you hadn’t have called us she might just have bled out, you did absolutely the right thing.” I said leaning forward and looking her in the eye.

“Jess? Jess can you open your eyes for us Hun?” I half shouted clasping Jess’s slightly warmer hand. Her eyes fluttered and she gowned. Turning her head towards the sound of my voice. Emily was now sobbing her head in her hands.

“Jess?”

She eyes opened and she looked at me then all around the ambulance.

“Don’t worry; do you know where you are?” I asked her.

“A...A....ambulance..” she said hoarsely.

“Good, it’s alright we are just taking you to the hospital, you’ve had a bit of an accident.”

She groaned and looked away, tears swimming in her eyes. I could tell she was furious that she was found in that state. I would have been too.

On the report I wrote down in extra info, psych history, depression, and apparent self harm episode. I clasped Jess’s hand again and suddenly I felt a rush of adrenalin, of admiration for Emily, her courage in making the call probably against her friend wishes was admirable. I suddenly felt like I wasn’t so sick, like things from my side of suicide were ok. I suddenly felt both more alive than ever, and at the same time like this was the first patient we had had in ages I could genuinely care for, could identify with, and that was awesome. Yes I felt bad about the extent of her wounds as they would affect her muscle power and she would probably have nerve damage but at least she was alive. At least she was available to go through treatment that she hadn’t been successful in ending her suffering because now things for her would get better. I was sure of it.

It felt good to be able to care.

We turned into the royal Melbourne hospital emergency department. Sam got out. I adjusted the Hudson mask and the sheet and helped unload her. Emily followed behind. I held the IV bag up high as I pushed the stretcher from the head. Sam was pulling it from the feet. As we wheeled her past the nurses’ station one nurse said:
“In there.” pointing into treatment room three. We turned into it; two other nurses were waiting there.

“Ok Jess, were going to lift you over to the bed, you just relax, let Sam and I do the work ok?” I said, she didn’t answer but shut her eyes. The two nurses, Sam and I grabbed handfuls of the sheet and lifted her on three onto the bed. I hung the bag up on the post near her had, and Sam disconnected the tube from the tank and handed it to the nurse. I took the carbon copy of the paperwork off and handed it to the nurse behind the desk outside the room. I walked back in. I took Jess’s hand and looked into her frightened eyes.

“You’re going to be fine Jess. You’ve got an amazing friend out there who just saved your life.” I said and just before I left, I thaught I saw the faintest hint of a smile flicker across her tear streaked and still pal face. As I walked out of the hospital to find Sam already cleaning the ambulance, I went to sit in the front; I took the radio and made us available. I filled out the rest of the paperwork.

“Ten thirty five... patient was transported to the royal Melbourne emergency dept. Patient hand over at ten thirty-eight...”

It suddenly occurred to me that I had nothing to do with the patient hand over and since I needed Sam to sign it too I put it in the glove box and went to help him clean.

“You look better.” Sam said after I had finished wiping down the stretcher.

“Really?” I asked.

“Yeah. Brighter.” He said looking at my face.

“Well that was a good call. I feel good about it, I mean not what happened to her, that was awful, but what we did about it, what Emily did about it. That was amazing. It’s good to be able to care. You know?”

“What do you mean be able to care?” He asked quizzically.

The happiness lessened.

“Well... I found that while I was off these last couple of months I thaught I might never be able to come back because I thaught I wouldn’t be able to deal with those calls again. But I did it and it feels great.” I lifted my sleeve to revile aged linear marks similar to those on out last patient. “I wanted to show her that self harm can be overcome, but I didn’t.” I pulled down my sleeve. Sam was pale and looked shocked.

“It’s alright now; things are going to get better. I’m going to work harder and help more people. I know it.” I said the happiness swelling inside me.

You might say it’s sick. You might not be able to say or think anything. We had a patient moments ago who was bleeding out from self inflicted wounds and hear I was feeling faintly happy, for the first time in months. You might say that was because we had literally saved her life. As a person who can tell you exactly why people self harm and who has the scars to prove it I can say that helping someone else in the same boat feels amazing.

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