Hearing Death’s knock

It was a typical paramedic drive day, if that’s possible, on the streets of Birmingham. A call came to us from our station telling us we needed to roll to the scene of a cardiac arrest in an apartment complex; the fire department had just arrived. When we got there, I quickly saw that the apartment was on the second floor—and the surrounding scene was chaotic: firefighters and first responders were frantically communicating with hospital doctors, people were moving purposefully in and out, each dealing with their own small part of the larger whole.

I grabbed my medical supply jump box (which I’d transformed from a large fishing tackle box to hold all my needed medical paraphernalia) and headed up. Seriously concerned faces greeted me at the door. When I crossed the room, I neared the circle of firefighters who were performing CPR, and it wasn’t until I moved around a sofa that I saw, lying on the floor—my instructor, David Markham! There was no time for shock, or remorse, or wonder; I had to put into action much of what he had so graciously and eloquently taught us. Our team continued CPR, intubated him to ensure a complete airway, started an IV, contacted the emergency room by telemetry—new technology at the time!—and received instruction to administer cardiac drugs and perform defibrillation. All these carefully taught and carefully learned actions, unfortunately had no effect. By this time the team had worked on David for close to 40 minutes and his pupils were dilated and unresponsive. Our only option was to transport him as quickly as possible to the ER where, hopefully, more intense procedures could be performed. But we all knew it was too late, and mourned even as we desperately followed procedure, and hoped for a miracle. We found out later that, unbeknownst even to him, David had congenital heart disease, and it took him in his prime. What irony that the teacher who taught us emergency response procedures should die partially under our hands. It haunts me to this day.

Pushing through a door of change

The 4th of July in the South can be a raucous affair. Late one afternoon, my partner, Billy, and I got a call to a celebration party that had gotten out of control. When we got there, we heard gunshot blasts that sounded like (very loud) popcorn, and people screaming. We pulled into what seemed a safe spot, I grabbed my jump box, and, crouching, prepared to enter the melee. I was immediately accosted by a woman who screamed into my face, “You need to help my husband!” Simultaneously, others were crying for help—and the popping gunfire continued over the din. Billy and I joined the on-site police in trying to control the crowd amidst the chaos. Bringing my focus back to the job at hand, I found this woman’s husband lying in a pool of blood, his breath gurgling in his chest. I quickly found that he was suffering from a sucking chest wound caused by a bullet, and was having extreme difficulty breathing; he must have a lung puncture. Sometimes simple solutions are best for complicated injuries: I had learned to carry a roll of plastic wrap as part of my equipment, and now used this to bind his chest and seal the wound, which both allowed his lungs to develop pressure and stopped the bleeding. The scene was massive mayhem, but thankfully many other responders were there to relay injured to the hospital and establish crowd control.

Billy, my ambulance-driving partner, was not a medic: these were still the early days of ambulance care, when all you needed to know was how to drive fast. He was pretty shaken by the afternoon’s events. My medical training was teaching me to shut off emotions, stay calm, and focus. The aftereffects, if any, I could deal with later, but poor Billy was still living right in the moment.

We hit the road, lights and siren blaring. Billy was having a hard time keeping himself together and the ambulance rocked at speed. My efforts at patient stabilization were moving along fine until my patient suddenly became very still. One look at his eyes, pulse, and blood pressure showed me that he was going into cardiac arrest. I began instant CPR, made more complicated by the unstable swerving of the vehicle. Just when I was thinking, “Okay, we’re just about under control here,” it came from out of nowhere—our ambulance was T-boned, hard, as we went through an intersection. I was thrown to the floor, but immediately jumped up and doggedly kept up CPR on my patient through the jumble of tubes, bandages, and other supplies that spilled from their shelves.

Billy had a quick through-the-window confab with the driver of the offending vehicle, and determined that we were not damaged enough to prevent our continued mission. All this time I kept up the constant “Stayin’ alive…” CPR rhythm on my patient (watch a demo here: https://www.youtube.com/watch?v=n5hP4DIBCEE). Our ambulance, despite being a complete shambles of supplies and equipment, was fortunately still functional, and I shouted to Billy, “Just get to the ER ASAP! Erm, but in one piece, please.”

Billy screeched up to the ER, the doors burst open, and the triage team whisked my patient away, no longer my responsibility.

Out of bedlam often comes opportunity, and I began to work more in my spare time in the actual Emergency Room of the University of Alabama (Birmingham) Hospital, luckily for me, an excellent teaching hospital. As everyone in the ER had grown to know me from my frequent visits through ambulance work, I had carte blanche to move at will, which was fun and educational. I expanded my work into the Emergency Department voluntarily, and one night was visited by a hospital administrator, who wanted to know, “Have you ever heard of The Partners of the Americas?” The Partners of the Americas was founded in 1964, under JFK, and was similar to the Peace Corps, in that it was designed with the vision of fostering cooperation and understanding between countries throughout the Americas. This was accomplished by individuals and teams visiting twinned countries and cities, sharing culture and education. My questioner wanted to know if I was interested in flying to Guatemala (that was twinned with Alabama, and the small town of Coban with Birmingham), to work with their La Cruz Roja—the International Red Cross. I jumped at this opportunity to change my stripes again, alter my life in yet another direction, and broaden my always-eager social awareness.

Two of us arrived in Guatemala for briefing before setting out to our distant village, and we were a great pair. My partner, Daniel, spoke fluent Spanish in contrast to my halting remembrance of Spanish spoken by my mother when I was a young boy. But love, care, and opportunity find a way. We bused from Guatemala City through the mountains up almost 4,500 feet into the mists of coffee plantations left over from German prewar settlements. Daniel and I kept ourselves busy teaching basic Red Cross first aid skills, and receiving in turn a rich dose of cultural orientation. Coban was about 5–7 hours away from the famous Mayan ruins of Tikal—by the by-then well-known scary mountain bus travel. This required interminable stops for the bus to disgorge and pick up an assortment of local indigenous people, most of whom toted a menagerie of animals and implements to sell in the markets of Chichicastenango, Quetzaltenango, and Chimaltenango.

A representative from our small town offered to arrange a jungle trek to the Cahabon River nearby, and we happily took him up on the offer. The Cahabon meanders through deep, turquoise pools, where it then gathers force to be swallowed into a cave’s maw, reemerging far downstream. Accompanying us on this extensive hike were two porters. These squat, muscular descendants of the Maya carried our camping gear, (apparently) quite comfortably strapped across their foreheads, as they trudged up and down the steep mountain trails and along circuitous jungle paths. At one point, the earth jutted up in an unrealistic mound about 20 feet high, and I wondered aloud what would cause that? Later, I was told that these were unexcavated Mayan ruins, though they had probably been looted for treasure to be sold on the black market before archaeologists could perform proper examination.

When we neared the river, I paused to look back toward the sound of howling spider monkeys and toucans and was suddenly engulfed by a strange burning sensation, traveling up my legs and into my torso. Looking down, I realized that I had halted right in the pathway of marauding fire ants! The best way I can describe this sensation is that it’s like being hit by hundreds of high voltage electric charges and getting countless cigarette burns—all at once. “Fire ants” is a lame moniker for a creature who inflicts such indescribable pain! I instantly ran screaming down the heavily vegetated path—like a mad bull, mindless of destination. Slapping at my lower body didn’t help quell the pain, but to my great luck, a river lay just ahead. I wasted no time in my search for relief by jumping into the water—with no care for consequences! Only after the pain subsided did I consider that the water I now happily reposed in could easily be home to crocodiles and boa constrictors who would find my soft flesh easy pickings. That would have not been a good trade, but I was lucky. After days of personal first aid to relieve dozens of pus-filled sores, the adage to look before leaping was burned, so to speak, into my memory.

A month later, an opportunity arose to fly into Tikal, the famous pyramid city rising out the jungle. We left from Guatemala City in a 1930s-era DC3 workhorse, with only bench seating along the fuselage in selected spots near the front of the cockpit. I peered out the window portholes at what seemed like a slow-moving vista of mountains and jungle passing our low-flying plane, not the other way around. The earth flattened, and as far as we could see, nothing but jungle. Suddenly, the stonework of a 12-story, 187-foot temple loomed up out of the forest of green, while other similar structures poked up out of the nearby trees.

We circled these edifices and, to get a better view of the pilots’ skillful landing of this lumbering and vibrating workhorse, I stood in the open cockpit door, with no thought of seatbelts. Nobody said anything, so there I stayed until the beast was safely parked on the jungle floor. It was hot, and there were only about ten of us exploring the site at this time. It was eerie to be there in the silence which the density of jungle creates. I could hear my heart beat hard in the heat and humidity as I climbed up into the welcome shade of the temple top. It was probably here that priests sacrificed the unlucky to the gods for rain, fertility, or strength against enemies. Many years later I learned that shaky wooden scaffolding had been constructed, allowing visitors to climb to the temple top, circumventing the crumbling stone stairs. For me, at that time, it was a step–wheeze, step–wheeze experience. It wasn’t until years later with the advent of LIDAR radar technology that we discovered that the entire region of Tikal was a vast city extending for miles, with sophisticated infrastructure, irrigation, interlaced communities, farming, and civic building. Planes flying in zig-zag patterns over the terrain were able to image through the thick jungle foliage into the earth’s topography, showing previously hidden marks of civilization.

My several months’ term of service in this spectacular region came to a close and I returned “home.” But change was again afoot, this time leading to worldwide aquatic discovery and adventures. And that is another story…