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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1. Priority One

The call comes in on the radio sitting on the dash board of the van.

Reported stabbing at fed square post five respond on priority one.

You pick it up before considering making an excuse. You resolve to say into it,

“Ten four, responding on a priority one.”

You look up for the first time since your partner left to deal with an OD, over an hour ago... and your stomach sinks a little bit as you see where your patient is, a small convergence in the middle of the crowded square. There is a party in full swing in Melbourne tonight, for the New Years Eve count down. You’re the only medic at post five, because you stupidly agreed to let your partner go out on a run knowing full well that if you had to leave the post would be unattended and you would be in trouble with the board.

You set the radio down and get out of the van, looking out over the sea of heads. It looks like a disturbance is brewing somewhere near the center, like a whorl pool. You go round to the passenger side and open the sliding door. You pick up the trauma kit, the recus and the AED. It’s not like you’ll need it but it’s always good to have more than enough than not enough right? You slam the sliding door shit, lock the ambulance and set off. Towards the threatening torrent of people.

You should have taken the stretcher....

You push your way through the crowd. Shouting over the music, growing louder as you get slowly closer to the stage. Its taking too long for a priority one, you yell “OI! Let me through! Louder than everyone so those nearest you turn, startled and step aside. The crowd parts and you move more swiftly to your patient.

He is lying on the ground, apparently dead, he is cyanotic, diaphoretic, and his grey shirt is ripped at the side flank, blood standing the torn frays of cotton and seeping out in bursts onto the ground. The colour is draining from his skin. Your partner is there at his bleeding side dressing the wound, his gloved hands covered in blood apparently seeping too fast to be stopped. He looks up as you enter the scene. You have half a mind to yell at him. But your attention snaps back to your patient. Another medic has come on the case, a rookie who turns white himself when he sees the blood, contrasting now alarmingly with the snowy white of his skin. You benign asking bystanders. “Anyone see who did it? What happened? Anyone?” one young woman in a skimpy black dress too short for her to bend down without offending everyone behind her, black fake hair and filled lips says shrilly, “a guy stabbed him in the side and then buggered off. He went that way” she points over your shoulder. You realize then that you probably would have seen him running off if only you’d been concentrating.

You look down at his side and see the knife you hadn’t noticed before. You leave it where it is, you are discouraged from pulling out objects patients have been stabbed. But he clearly pulled it out himself before collapsing, poor guy. You kneel in the pool of blood at the patient’s right side.

“Can you hear me mate! ... Can you open your eyes! ... Hey mate, squeeze my hand for me! ...” Nothing but the smallest, weakest of gurgles. You shove your face into his and feel and listen for breath sounds, your figure on his radial. You feel his radial beat at an almost impossibly slow rate. It would have to be about fifty at best. His breathing alarms you further being gurgle and shallow, his skin as well being the colour and feel of wet glossy paper, blue soft tinges around his dry lips, eyes and nose. Even as your figure detects the slow tapping of his radial pulse it slows down further. You reach your kit, your recus. You pull out the Hudson mask, turn on the oxygen, and amp it up. It pours out. It looks like steam. You fix it to the guys face. You look at your partner. You notice the rookie still standing over his shoulder.

Now much time has passed since he has come? You are unsure. You motion to him.

“hey mate, go and get a stretcher  will you? Run” you say, He turns and sprints off, leaving bloody foot prints. You shuffle up to his head. You find tour way back into action, the game face you apparently temporarily lost. You listen to his chest.  There are nasty sounds, like bubbling water down near the wound. You feel crepitus around it. You suspect the knife had cracked a few ribs, just scraped the left lung and ripped the spleen, the way he is bleeding so much. Your partner has the bleeding stopped. Having wrapped him tightly in three dressing and about three meters of pressure bandage, he had left the bottom left corner flapping open, you can see he has taken my nonverbal advice and allowed lung fluid to drain why providing a one way air valve.

The rookie returns and you jump up and onto of the stretcher you place the pillow scrunched up in the middle right, the other at the head. The rookie appearing to have come out of shock propped up the head rest. Together the three of you, the rookie taking up the oxygen tank, the bottom of which was blood soaked, lift him and the tank, onto the stretcher. Your partner propping his head back, reopening his airway, you push his left side up. You do this to allow lung fluid to drain out of the wound. You strap him roughly in. The two of you wheel him back to your unit running. Him, at the front, you at the head.

“Hey there’s a spill cleaning kit in the top compartment!” You shout to the rookie.

“Follow the instructions and clean the blood up, then pack up! You did alright!” you make yourself say back to him. He did shit. Now you notice, looking at your watch while taking his pulse in the back of your ambulance, that what had appeared to have taken three hours, too long for a patient this badly hurt to live, had actually taken about twenty minutes. A tiny bubble of hope pops in the pit of your stomach. Your patient’s colour is returning slowly as you drive up Elizabeth Street. His eyes flutter. His pulse now banging on your fingers pressed on his radial artery. You look at him.

“You’re going to be fine.” You make yourself say as you detect the fleeting moment of panic in his eyes. They dart around the moving ambulance the come to rest on your face.

“You’ve been in an accident. Don’t worry. You’re in an ambulance. We’re taking you to hospital.”

You remember the concrete ground onto which he fell.

“Can you tell me your name?” you ask.

He raises a hand gingerly to fumble with the mask. You lift it. He stammers, Mark Grayson. His voice is raspy. You check his pupils and relief sweeps over you as you confirm no evidence of concussion, equally reactive and in size. His sees open again. He looks at you. You notice they are swimming in tears. You are not even half way up the street.

You tell him that you are going to patch him into an ECG. He nods.

You connect the patches to the weirs. His line is fastish, bouncy. Sinus rhythm. Unbelievably, there are no PVCs, no ST elevation. Nothing that suggests to a medic there was anything wrong with his heart.

“Things look good with you considering...” you say, trying to inject confidence into your voice. Though really, your heart is racing and you feel close to nervous collapse.

“Your couler is coming back mate that’s really good, we’re nearly there, I need you to tell me the scale of your pain, on a scale of one to ten how bad is it?” you ask him a little too loudly. His mouth open, he holds up seven fingers, five, then two with his right hand, his left holding his wound.

“Ok mate. What I’m gona do is give you morphine, have you had that before?’ you ask. He gives one nod. You nod and from the chamber you draw into a syringe the appropriate estimate all be it just a little b it less than that, of morphine. You wipe his arm with a swab and warn him of the sharp sting before sticking him with the needle. You aim for the biggest, bluest vein on his inner elbow. You push the drugs into it. You take his arm, put a cotton bud in the prick and bend the elbow in. His face relaxes.

“In a minute your pain should subside, you should feel allot better ok... you’re going to be fine.” You say again as you see the tears fall down his still pale face. He turns to you as you sit back down.

He mouths the words “thank you.” And gasps. His breaths shallow, raspy, crying.  He blinks tears out of his eyes and they fall into the mask as you turn the corner into the emergency department entrance and come to a halt. You re-position the mask, get out and help your partner unload; warning him of the couple of bumps he would feel on the way out. The legs of the stretcher fall to the floor and the two of you wheel him into the double doors which open for you. Three nurses, an orderly and a doctor await you as you come in a nurse walks at his side helping push the stretcher, the other holds a clip board. The third runs to catch up. The doctor walks behind with your partner who briefs him on the incident. You always hope you never have to do the handovers.

“Patient, male, approximately twenty five, stabbed in the left lower chest upper abdomen, wound measures approximately three centimeters. He’s been given 8 liters O2 per minute...”

“And about ten minutes ago a minimal dose of a morphine derivative!” you interject turning the corner into the recus bay. The doctor nods and he takes his place at the head. Two nurses help you and your partner move him to the table. You hand over the oxygen tubing. And a nurse connects it to their oxygen tank. Your partner takes the oxygen tank, gives me the paperwork and steers you to the door. You walk out together down the hall. His sleeves and knees are covered in blood. Blood soaks your cuffs and hems of your pants.  You walk together back to your ambulance.  You’re holding the paperwork still incomplete. Your partner starts cleaning up the stretcher. You hadn’t notices he had wheeled it out for you. You sit in the passenger seat and finish the paperwork.

Primary treating officer B...  you sign the box.

List any drugs given intravenously... morphine 6 mLs...

You think about the patient’s few words en route, “thank you.” No patient had ever said those words to you in that state before, he was wounded badly, he had a chest wound and internal bleeding which you know needed surgical repair and yet he was able and found it in him to acknowledge the often thankless task of helping someone in their ultimate time of crisis.

You lighten up inside, for the first time in months.

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