Journal Entry: The Faded Cross

Disclaimer: the Journal Entry series are personal stories that I have written about my own experiences and are taken from my personal diary. They are written as a form of therapy for myself and as a way to bring understanding to my loved ones. This series is meant to provide examples of the reality of life as a first responder. Content may be traumatizing or triggering to some.

My car slows to a stop at the red light. It’s a warm summer day, the windows are down, music is playing – it’s a good day. I’m off work and just headed into town to run some errands. This is a main drag that runs from my town down to the city and I travel it often. As I look around the intersection, impatiently waiting for the green light, my eyes wander to the little wooden cross on the side of the road. It’s been there for some time now, about twenty feet off the side of the road. The white paint is beginning to fade, and any flowers that had been placed along with it are long gone. Unlike the cross, the memory of what happened here is as vivid as the day it occurred, unfaded, in all its blinding glory.

I blink. 

The car is pushed off the road, having been hit squarely on the side by a dump truck just behind the driver’s side door. I can see him slumped to the side in the seat unconscious. Dark red blood is running down his face in stark contrast with his pale ashen skin.

I blink again. 

He doesn’t. His eyes are half open and staring blankly. He makes a feeble attempt at a gasp for breath as I reposition his airway. Warm blood flowing from his ear trickles over my hand as I place it on his neck, feeling for life. The rhythmic pulsing of his carotid artery under my fingertips feels like a ticking time bomb rather than the hope of life – the clock is running out. 

I take a breath. 

I’m squeezing the Ambo bag. It is hooked up to a tube running into the mouth, down the throat, and into his trachea. I put it there just a few minutes ago. As the air is forced into the man’s lungs I can feel the vibrations in the bag and the resistance in his lungs. I can hear the bubbling sound of air being forced into lungs that are already halfway full of blood. I sit back and look at the man. He is an upper middle aged man, unconscious and not breathing, his heart still pounding blood through his body, not wanting to give up. I wasn’t sure it was up to him, and I’m almost positive it wasn’t up to me. 

He hit his head causing a vessel burst, raising the pressure in his cranial vault to the point of gushing from his ears, but his chest and torso took most of the impact, lungs and other vital organs have been turned to mush. When I passed the breathing tube between his vocal cords and into his trachea, a fountain of bright blood forced its way out, spraying my uniform and splattering onto the floor, running into the well by the door.

I suctioned as much as I could and began breathing for him. Just breathing and suctioning, suctioning and breathing. It was all I could do for now as we raced towards the hospital. As much blood as I evacuated from his lungs, more just kept filling him up. He was quite literally drowning and there really wasn’t much I could do about it. Looking at him, I realize if the lack of adequate respiration doesn’t kill him, every other one of his injuries most surely will. It looks hopeless. Nothing I will do for this man will allow him to return to his family alive. 

The bag had become harder to squeeze. Air and blood in the chest cavity were building up pressure and collapsing his lungs. If it isn’t relieved, he will die. I need to perform a thorocostomy – insert large needles into his chest to relieve the pressure. I insert one on each side of the chest. As the first one enters, air rushes out followed by a spray of blood. The second one is like deflating a tire. The breathing is a little easier – at least I can get air into his lungs again.

As we pull up to the hospital, he begins to posture. His legs and arms become completely rigid, and every muscle in his body is strained. This is brain-stem herniation. The pressure in his head has gotten so high, the brain is being compressed down the spinal column. This is usually quickly followed by death as the major features of the brain are rearranged inside the skull. The hospital staff whisk my patient away and hurry him off to surgery. A couple days later, the fresh cross on the side of the road tells me everything I already knew. 

The light turned green. As I pulled away, I reached down and turned the music up just a bit. The drive isn’t over.

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