Today marks the official end of Kilted to Kick Cancer 2011. My kilts go back on their hangers, relegated now to occasional wear when the mood strikes me, and not as an obligation. I've enjoyed every step of the way, and look forward to doing this again, bigger and better, next year.

But while the awareness campaign has drawn to an end until next September, I'd like to remind you that the fundraising challenge does not end until midnight on Monday, October 3rd. I extended that deadline to give one of our participants the chance to have his employer match employee contributions to Kilted to Kick Cancer. I'll announce the winners and the fundraising tally on Tuesday.

Until then, I'd like to beg of you one last time to donate. I have six books left that I'm willing to sign and ship to anyone who donates $40 or more to Prostate Cancer Foundation or LiveStrong. Click either of those links, make your donation, and then forward me your donation confirmation, and I'll send you an autographed book – but I only have six left. Time is running out.

I realize that there are some of you who haven't read my book, and so I offer a brief excerpt here, as a teaser of what you'll be getting with your $40 donation.

And for my regular readers who often ask me, yes, there is a sequel in the works. I have enough stories compiled from the blog alone to make a second book, and I'm currently working on fleshing out twenty or so more stories that will appear nowhere but the book. So for you readers who anticipate the next book, I will offer this:

Donate $100 to Prostate Cancer Foundation or LiveStrong, and I will include you (or the loved one on behalf of whom you donate) in the dedication to that book, and I will use your name as a pseudonym for one of the real life characters in the book. 

And I promise, it won't be the system abusing, drug addicted skell or similar loathsome character. I'll make you one of the good guys!

Just. Donate.

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Little White Crosses

It’s 3:17 am.

This is our witching hour, when the weekend drunks have left the bars and headed home. Everyone else’s Circadian rhythms are at their lowest ebb, including mine. Around here, the cops catch the drunkest ones in town, as soon as they weave out of the parking lots. The ones we see are those who’ve slipped the net, or those driving home from Big City, 30 minutes away.

The strobes are hurting my eyes. I reach over and turn off the siren, earning a quizzical look from my partner. I snap at him, “Why do you have to run that fucking thing in the middle of nowhere on an empty road?” He says nothing, and I immediately feel like an ass. He’s just following company policy, and green enough to still worry about breaking the rules – even the ones that make no sense. But, he fears my disapproval even more, so he shuts his mouth and keeps driving.

Junior Partner is a good kid, just 25 going on 17. He still acts like a carefree high school senior, despite the fact that he’s got two kids. He’s been a First Responder for about eight months, just long enough to be excited rather than petrified about calls like this.

We’ve been slammed running transfers all day, and only got to bed just two hours ago. My eyes are sticky, and I’ve got a serious case of bed-head under my cap. My mouth feels like a cat shit in it. JP, on the other hand, looks fresh.

Fucking kid.

We’re heading to a “Signal 20-I,” which is cop-speak for a motor vehicle accident with injuries. They usually turn out to be total bullshit, or at the other end of the spectrum, road pizza. Not many fall in between.

At 3:17 am on the s-curves of Highway 35 South, they’re always bad news. There are enough little white crosses on that stretch of road to fill a small cemetery. JP is not yet experienced enough to dread calls like these. I know better. I’ve cared for my share of the names on those little crosses. JP slows down as he passes the Hooterville Volunteer Fire Department. The bay doors are open, a good sign. We don’t have direct radio contact with some of the volunteer First Responders, but I’m hoping the folks from Hooterville will be at the scene. Extra help never hurts.

As if reading my mind, the radio crackles, “Unit One, Dispatch. Be advised Hooterville First Responders are 10-97.” Good. JP slows even more as we round a curve, easing over the center line. A doe and two yearlings are standing in the ditch on my side.

“You see ‘em?”

“Yep. Big buck standing just in the trees behind them.”

“Well, be careful.”

The moon is full, and the deer will be night feeding along the road shoulders and in the pastures. At least once a year, a doe zigs where she should have zagged, and wipes out the front end of a rig. JP snaps the wheel to the right, just a little jerk to get my attention. It startles me a bit and I glare at him. He’s grinning at me. At least he’s not mad at me for snapping at him earlier.

“What, you got something against eating road kill?”

“No smartass, I just don’t like wiping out at eighty miles an hour.”

He snorts, unable to envision a situation where his reflexes would not be equal to the task.

See what I mean about 25 going on 17?

JP isn’t a bad driver, just still sure of his own invincibility. I keep my mouth shut. I’ve bitched at him enough, and wrecking a rig might be one of the dues he has yet to pay. He slows down anyway and starts scanning the ditches. I suppress a grin and pretend not to notice. I realize that in the past ten minutes, we haven’t met a single car coming from the opposite direction – not a good sign. My grin fades.

The scene comes as a surprise as we top a hill just south of Robichard’s Grocery. The wreck was reported as several miles further south.

“Fuck me…” JP whispers.

My sentiments exactly.

On either shoulder, cars and pickup trucks are parked for a couple of hundred yards. Quite a few of the pickups have their emergency flashers on, red gumball lights on their dashes marking them as the firefighters’ personal vehicles. The last few motorists start to ease over when I hit the siren in brief bursts, and the sea parts.

There are remains of a compact car sitting crossways in the middle of the road, a mass of mangled metal, like ugly origami folded in the hands of a clumsy giant. It’s impossible to determine the make or model now. The front end is gone, the windshield a cloudy spider web of cracks.

A cluster of volunteer firefighters notices our arrival and beckon frantically. At least two more ignore us, leaning into the shattered windows on the driver’s side. I look at JP.

“Spine board and trauma bag. Let’s go.” He nods, throws the rig into park and bails out.

I am halfway to the wreck when more volunteer firefighters and good Samaritans get my attention. A Ford pickup is in the ditch on the opposite side of the road. A girl is sitting on the ground nearby, hugging her knees and sobbing, rocking back and forth.

All the commotion centers on a spot about ten feet past the truck. I stop, and JP nearly runs me over with the stretcher. I look back at him, hesitating. In the past, I’ve triaged the patients and decided which ones needed the most urgent care. JP has never had to manage a critical patient on his own. Looks like tonight there will be plenty for both of us, and the backup unit is just coming back into the parish, at least 25 minutes away.

Shit.

I grab him by the arm and shout over the snarling of the generator and Hurst tool the extrication crew has just fired up. “Look, holler for Unit Two, and have them start easing Unit Three this way. You take the pickup; I’ll take the car. If you get anything you can’t handle, come get me. Otherwise, just put the volunteers to work.” He bobs his head nervously and heads toward the pickup.

“Wait!” I call after him. I take the spine board and trauma bag off the stretcher. “Send somebody back to the rig for any equipment you need. I’ll take these.” He nods dumbly, and starts to turn away again. He looks scared.

“JP.” I say it softly, in my ‘Calm Voice’. His eyes shift back to me from the wreckage of the truck, and eventually lock with my own. “There’s nothing I can do for ‘em that you can’t. Just assess and package ‘em on boards, and I’ll do all the paramedic stuff on the way to the hospital. You’ve got plenty of help. You can do this.”

I turn away before he can reply. He’ll have to manage on his own for the next few minutes, scared shitless or not.

The two firefighters leaning into the car are Frick and Frack, identical twins and EMTs from Hooterville. Where you see one, you will invariably see the other. In turnout gear, I can never tell them apart. One is reaching through the driver’s back window, maintaining spinal alignment while his brother is standing beside him, reaching through the front window applying a cervical collar.

The driver’s face is a wreck, blood and tangled blonde hair masking her features. I poke my head in between them, and Frick or Frack looks at me from behind the girl’s head, a grim smile on his face. “Wassup, AD?”

“You tell me, guys.”

Frick or Frack backs out of the car and gestures at the interior. I take his place and look in. In addition to the front-end damage, the passenger side of the car is caved in all the way to the center console, and looks to be folded over the girl’s right arm. I glance down at her legs, and they appear to have about four more joints than they should. About two inches of her right femur is protruding from her jeans. Her right ankle is folded under the accelerator pedal.

Her breathing is ragged and gurgling. Amazingly, the rear-view mirror is still attached to the shattered windshield. There is a graduation tassel hanging from it. Everywhere there is a fine white dust from the airbags.

“We gotta get her out now, guys. Let’s see if we can pop this door first, and someone needs to get working on the passenger side to free her arm.”

I back away as the crew moves in with the Hurst tool. I get my laryngoscope and a tube from the airway kit. I hear the groan of tortured metal behind me as the spreaders pop the door open. I don’t really relish doing a seated intubation on this girl, but if we don’t get her out right this minute, that’s what is going to happen.

I can reach most of her now with the door out of the way, and as I maneuver in front of her, my arm brushes a trim piece folded over her arm. It moves easily and I tug at it. It comes away in my hand, and I notice that her arm is not entrapped at all. The metal is just crumpled over it, but there is nothing pinning her. Her ankle is broken, the foot folded back under and pinned beneath the accelerator. I move her lower leg and foot gently to the left and cringe as I feel the crepitus in her ankle. But her foot pops free, and I worm my way back out of the car and shout for the board. I lay my laryngoscope and tube on the remains of the hood, just forward of the windshield, and my scope promptly rolls down into a crevice somewhere in the engine compartment.

Lovely. Just fucking lovely.

One of the twins is wedging the end of the board against the seat while his brother holds spinal alignment. I grab the girl by her hips and torso and rotate her onto the board. It’s not pretty and we really need more people for the move, but there is simply no room. We manage to extricate her and strap her to the board.

I feel a hand on my shoulder and look up. It is JP. He has his patient packaged and on the stretcher. He looks a lot calmer now, sure of himself.

“Driver of the truck’s dead,” he says. “This one was ejected through the windshield. He’s unconscious, but he’s breathing. I’ll load him and send someone back with the stretcher.”

I grin at him and give him a thumbs-up as he moves away. Frick or Frack is digging around under the car, and comes up triumphantly with my laryngoscope. “Lose something, AD?” He grins at me and his brother joins in. “Boy, send a guy to Paramedic school, give him cool toys to play with, and we still have to go around picking up after him…”

I roll my eyes. “If you guys were actually any good, you would have found my tube as well. I’m not impressed.” They laugh some more as we load the patient onto the stretcher.

Our girl is not doing well. She has agonal breathing, and we hustle her toward the truck. I get another blade from the airway kit to replace the oil-smeared one I have, and intubate her lying right there on the stretcher at the back of the rig. There is more room and light there.

JP is behind me in the rig, setting up IVs and cutting the clothes from his patient. The tube goes in easily, with good breath sounds all around. Before I can place the tube holder, she bites down on the tube and curls her arms up to her chest in decorticate posturing.

Not good. I have to pry her mouth open to place the bite block between her teeth. As I secure the tube, I can hear a siren approaching, and Unit Two pulls up right behind us. I load our patient as Ernie Keebler walks up to the back of our rig.

“Need some help?”

“As usual, your timing is impeccable. You got here just in time to transport, but you managed to avoid all the hard work.” I love to give Ernie a hard time.

“Yeah, we timed it just right,” he grins, then turns serious. “How many patients do we have?”

“One DOA, two critical. If you’ll take the one JP has, I’ll take this one. We’re going to Big City.”

Over my left shoulder, and twelve minutes away, is Podunk General Hospital. It’s a good hospital, as small hospitals go, but they just don’t have the resources of Big City Regional Medical Center, twenty minutes away.

JP and I hand his patient out to Ernie. His wife, The Troll, has parked Unit Two’s stretcher at the back of our rig, and they slide the spine board onto their stretcher. As I hand the head of the board to Ernie, I notice that JP has written vital signs on the tape securing the patient’s head. The patient is moaning behind the non-rebreather mask. There are several deep lacerations on his forehead, and his upper lip is split all the way to his nose. His teeth are showing through the gap. I can smell the alcohol in his blood.

JP tosses Ernie a spiked bag of saline. “Here. Don’t say I never gave you anything.” One of the twins climbs into the back of the rig as JP slips out the side door.

“Found her purse in the car,” Frick or Frack says.

“Didn’t figure it was yours,” I grin. “It doesn’t match your belt or your shoes.” Frick or Frack replies with a grin and a one-finger salute.

“Need somebody to ride in with you?”

“I never turn down free help, man. Shut the doors and let’s go.” Frick or Frack takes over bagging while I get an IV. I slip in a 14-gauge and tape the line down as JP pulls away, forced to maneuver far onto the shoulder to get around the wrecked car.

I take her vitals, and don’t like the results. Her heart rate is only 62, and her BP low at 84/40. She stopped breathing on her own several minutes ago. Her chest and abdomen seem free of injuries, but her pelvis and legs feel like broken pottery. Both femurs and tibias are broken, as well as her right ankle, but I’m worried most about her head injury.

Aside from the brief episode of posturing when I inserted the tube, she’s been completely flaccid. Both her pupils are dilated and barely react to light. I’m still at least ten minutes away from the hospital, just passing into the outskirts of Big City, so I slip another large bore IV in her right arm and run in some Ringer’s solution. She’s had around 500 ml of saline, and I get Frick or Frack to get another set of vitals while I contact the ER.

Around here, all hospital contact is done via cellular phone, so I place the call while Frick or Frack struggles to hear a BP over the siren and engine noise. I recognize the nurse who answers the phone. My report is brief and to the point, nothing like the full patient report I was taught to deliver.

“Hey, Jeremy. This is AD with Podunk Ambulance. En-route to you with a female driver, frontal impact collision. Multiple lower extremity fractures, pelvis as well. Possible head injury. I’ve got her tubed, bilateral IVs and about 500 cc’s of fluid. GCS is 3, BP 80 palp, heart rate 60. We’re seven minutes out.”

I finish cutting her clothes off and assessing her. There’s not much in the way of outward injuries to treat, and splinting her legs at this point would be wasted effort. I feel the truck lurch, and suddenly we’re backing into the ambulance bay at Big City Regional. JP flings open the door and helps us unload. There’s a lot of shit to sort out – cardiac monitor, two IVs, oxygen tubing, and the shreds of her clothes hanging off the cot.

Jeremy meets us just inside the door. Just behind him is Doc Magoo. It’s late and she’s obviously tired. She looks haggard. She says nothing, just points to the trauma room.

As we move her over on the board, I give Doc the bullet: “Unrestrained driver, frontal impact. Airbag deployed, steering wheel deformed, windshield starred. Lots of dash intrusion. She was unconscious at the scene. Got her tubed, lines on the way, 500 cc’s of saline. Pelvis and lower extremities fractured, probably a head injury, too – her pupils are dilated and un-reactive.”

“Any posturing?” she asks, sidestepping to the left as the radiology tech maneuvers a portable x-ray machine into the room.

“She showed some decorticate posturing when I intubated her, but other than that, nothing.” I shrug my shoulders. It’s not an expression of indifference, just helplessness. Doc Magoo smiles tiredly as she turns back to the patient. She doesn’t waste her breath on words like “good job” or anything so trite – she doesn’t have to. I know if I had not done something to suit her, she’d have chewed my ass thoroughly.

I have a lot of respect for Doc Magoo. She’s a strong advocate for EMS, and always treats the crews with respect. On the other hand, she’s also quick to quietly, methodically tear off a strip of hide if you fuck up. She taught me the basics of acid-base balance in medic school – Magoo’s Acid-Base for Idiots.

I collect my paperwork and walk outside. As usual, my rig is a total mess. If trashing a patient compartment were an Olympic sport, I’d be a Gold Medalist. JP is busy cleaning up behind me, but it will be at least half an hour before we’re ready to go. I’ve managed to get blood on the cot, the grab rails on the ceiling, and on the underside of several cabinets – basically everywhere I put my hands. I help him make up the stretcher and carry the biohazard bag back inside for disposal.

Everyone is filing out of the trauma room – Doc Magoo, nurses, respiratory therapist, radiology tech, everybody. Our girl coded right after we got her there, and they’ve been working her for the past twenty minutes while we cleaned our rig. They’ve only just now called it. Just like that, a young girl is gone.

The ER staff never even knew her name. Come to think of it, neither did I. Her purse is still outside in the rig. I go back outside to retrieve it, and I find her wallet and driver’s license inside. She was eighteen years old, her birthday only a couple of weeks ago. Her name was Jennifer.

As I walk back inside with her purse, I pass a woman clutching a cell phone with a bewildered look on her face. I start to tell her that the ER waiting room entrance is around the corner, but she sees the purse in my hands and recognizes it. She looks a lot like her daughter.

She stops me and starts to ask me what, where, how her daughter is, but she can’t find the words. She just chokes back tears and looks at me pleadingly. I tell her that her daughter was badly injured, what I did for her, what the doctor and nurses did for her after we got to the hospital, but I am too much of a coward to tell her the rest. I want to be able to say something to this woman, something that will banish the horror of this night for her, but I can’t find the words either.

She asks anyway. “But, is she going to be okay?” My silence tells her enough, and she slowly collapses in on herself, sobbing but making no sounds.

“The doctor will be out to speak with you soon,” I tell her as I take her hand and lead her to a chair in the waiting room. It’s a lame response, and we both know I’m too much of a coward to tell her the news.

On the way out I tell the ER clerk that the girl’s mother is in the waiting room, and I climb into my rig to leave. JP is already behind the wheel, catnapping as he waits for me. The sun is coming up.

Some day, I’m going to get better at this. Some day I’ll know what to say.