Rescate Nuevo Uno Uno
Chapala, Jalisco, Mexico
It was 10 minutes before my shift would be over, when word reached us that the medics were on their way in with 7 patients from a motor vehicle crash up on the Libramiento. To make matters worse, many of the patients were reported to be children. Everyone scattered to prepare, somebody asked me to find a pediatric breathing device, and my heart was heavy as I began the ominous search. The first ambulance arrived, cut the siren, backed in, and a parade of gurneys with bloody patients strapped to backboards began. Not one of them would have been there had they been belted. Not one. Instead, five of them eventually got their heads shaved and sewn up.
True to the report, many of them were children – most only minimally injured. All were silently sobbing. Alone and perched on the edge of one big white gurney was a small girl. Terrified, she sobbed inconsolably. Her beautiful round mocha colored face was dirty, cut, and streaked with blood and tears. She clutched a small fist full of pesos in her left hand. I thought back to the last hour of her life and what it must have been like for her. Someone her size, unbelted, would be tossed around like a rag doll inside an out-of-control rollover vehicle until it finally came to a halt. I stopped what I was doing and put my arm around her. She shyly leaned into my side and I picked her up. I carried her around with me as I prepared equipment for the doctor. The doctora was examining her mother, and looked concerned. The patient was critical; I wondered what I would do with this little girl if her mother died.
The other siren was getting closer now. I went with one of the nurses out to the bay to wait for it and to get the first glimpse of the patients so we could begin mentally triaging them – with trauma patients every single second can count. The medics turned off the siren and with lights and wigwags flashing they swung out into the street preparing to back up to the door. Then they stopped…and sat there. ‘What’s the problem,’ I thought, ‘what are they waiting for?’ I started out to open the door when I heard clip-clop clip-clop. Trauma’s golden hour ground to a halt for a few minutes so a small herd of 7 horses could pass through with a young colt bringing up the rear, picking his way among the cobblestones, concentrating hard to stay on his feet. He annoyingly paused to scratch an itch.
The doctors and nurses and I come from different countries and cultures but have the language of medicine in common. They have welcomed me and my spoiled American medical ways into their emergency clinic so I can learn how emergency medicine is practiced in Mexico and, hopefully, help them in the process. I’m a California trained paramedic, lucky enough to work at the Cruz Roja Mexicana Chapala Delegation ER and I love every minute of it! The doctors and nurses are quick and smart and work together without having to talk. That’s a good medical team. I’m also happy to see that the patients are treated with respect and empathy. We were never allowed much time for that in the US.
Today, Daniel, Carlos, and I laugh and trade gory paramedic stories and I’m amazed to learn that our training and medical protocols are nearly the same. As we discuss cardiac arrest saves and losses, I also notice that we share the same feelings. I look away when Daniel tells me he has just lost a patient on a tennis court and nothing he did made a difference. Some days are just like that. In the ambulance the first thing I recognize is the yellow Ferno 4-wheel drive gurney I used to use. Then I notice the same EKG machine, bags, meds, backboards and C collars, only a bit older. We discuss the pros and cons of the digital Glucometers and I feel like I’m back at work in the San Francisco Bay Area.
I hear shouting out in the street and realize, suddenly, that it’s in English! The staff asks me to respond. I am directed to a second floor apartment across the street. Daniel is behind me, having stopped to grabbed a couple of medical bags, and I wait for him to catch up. We climb a steep tight spiral metal staircase. I think, ‘what hell this will be to get the patient down, if we need to.’ As I get to the top, I see that I’m on the building next door and there is an American looking man sitting on his patio, not responding to my voice. To get to him I must climb over the staircase and onto his building and over the wall to his patio. Daniel and I reach him at the same time noting that he is dead and not workable. His pupils are fixed and dilated and he has dependant lividity as well as the beginnings of rigor in his chin. Dani and another medic search the apartment while I look over the immediate scene as Doctora Lorena arrives, examines, and pronounces him. Cigarettes and tequila are everywhere, no food in the spotless fridge, and large zip lock bags of meds are lying around. An American Vietnam vet from downstairs arrives and says the patient is a Canadian citizen who had just returned home from a military hospital in Guadalajara after a lupus crisis. We find evidence of a GI bleed in several rooms. Soon the scene is crowded with Policia investigating and questioning. The apartment owner is complaining the patient was behind in his rent three months, and an official of the local American Legion chapter is looking for identification to determine if the patient had End of Life papers on file with them. Other expatriates gather below on the street smoking, talking quietly, and feeling sad for their friend.
A battered, once white, unmarked, short-bed pickup bounces up and a middle aged Mexican woman in black and white asks Dani and I to help bag and remove the body for her. She is the forensic investigator and will take the body to Ocotlán for autopsy and safe keeping until the family in Canada can come for it. Daniel grabs the flat and we are given an extra long gray plastic bag. I wonder how much of this tall man will fit in this bag. He does, but only barely, and Dani, a police officer, and myself roll him onto the flat and descend the stairs. We slide him into the back of the pickup headfirst and roll him off the flat. I protest that the back of the truck’s cab will cause trauma to his head and the forensic investigator strategically shoves an empty 2-liter plastic Coke bottle between the head and the cab. The truck rumbles off down the cobblestones and potholes for the two-hour return to Ocotlán.
It’s quiet now and the doctors, nurses and I sit around an empty gurney like a quilting bee with an 8 inch stack of gauze squares in the middle, while we talk and laugh and fold the squares into 2×2 bandages. Jesús takes a couple at a time and carefully folds them into a piece of brown paper then places them in the oven for the prescribed amount of time. They emerge sterile 2x2s. When the stack of gauze is all gone we start folding gloves into brown paper to tape and bake and emerge as sterile gloves. They laugh and ask me if paramedics make bandages in their spare time in the US. Yeah, I think, wouldn’t the unions have a field day with that one. Seems like the US with its spiraling medical costs could learn a lot from its sunny southern brother Mexico. I sure am!