Pieces of the Puzzle

We spot the police car pulled into a dark gas station.  In the back seat, a man sits halfway into the car, hunched over.  The police officer leans against the open door, looking at his would-be passenger with only mild interest.

"I don't know what's going on," the cop tells us.  "I got him out of his car and he asked for a rescue... now he looks like he's going to throw up."  He's friendly, especially considering we love-tapped his cruiser with the truck last week.

I look at our patient.  He had been living in his car at a gas station, and his clothes show it.  He wears a thick down jacket, a baseball hat with a wool cap pulled over it, and dark aviator sunglasses.  I try to ask him what the problem is, but he mumbles a quick reply I can't understand.  "Okay," I say, "Why don't we go to the truck so we can check you out?"  We make the short walk together, illuminated by the pulsating red glow of the ambulance's lights.

In the truck, I have him sit on the stretcher.  "Can you take off your sunglasses so we can see you?" I ask him.  He offers only a staccato shake of the head and more mumbles.  "What happened tonight?" I probe again.  

"I have drink, I have drink" he answers with a thick accent.  

"Okay, how much did you have to drink?"

"I don't know."

He looks uncomfortable on the stretcher; he fidgets with the railing and squirms in the seat.  I ask Gorilla-EMT to get a set of vitals;  I wouldn't be surprised if our patient was asking for a ride to the hospital to avoid a ride to a jail cell, but something about his restlessness gives me an inescapable feeling that there is something more to the call.  

As he looks down towards the pulse-ox probe clipped to his finger, I catch a glimpse of his left eye over the rim of his aviators–it is dark purple.  "John, I'm going to take your glasses off," I tell him as I slide the glasses off of his face.  A plum-colored hematoma stains the area around his eye, and swells his left eyelid shut.  "John, how did this happen?" I ask

"I have hit, I have hit."

"Tonight?"

"Yes."

"What did they hit you with?"  The police officer's ears perk up from the side door where he stands.

"Hand."

"Okay, we're going to get your jacket off so we can take a better look at you."  I try to help him out of his jacket by lifting his left arm, but he winces, and clutches at his left upper chest.  

"What's the matter?"  I ask

"I have hit," he repeats.

"They hit you in the chest?"

"Yes."

"With what?"

"I don't know, maybe chair, I don't remember."

"Did you fall to the ground?"

"Yes," he nods.

"And did you pass out?"

He nods silently.

"For how long?"

"I don't know," he shakes his head.

I press against his head and neck; his face tells me that it hurts all over.  

A quick, wordless glance at Ugly sends him out of the truck to get a backboard, straps, and a collar. 

In the meantime, Gorilla gets the patient's shirt off so we can look at his chest.  There's no real deformity, but when I try to press against his ribs to make sure they're stable, he shoves my hand away, guarding his injury.  His breath resonates equally in both lungs.  His mental status is hard to assess across the language barrier, but all of his neurological signs are intact.  We board him, and start towards the hospital.  I place an IV-lock, not in the interest of being able to give any medications, but because I anticipate John's destination being a trauma room.  There are just too many unknowns–the timeline, the exact mechanism of injury, the length of loss of consciousness, his baseline mental status, whether his intoxication is masking a more serious injury, or if the head injury had caused a bleed, to name a few.  Showing up with a patient with so many unanswered questions of that nature not on a board and without an IV in place would be poor form.  

During the ride, I try to get more information, but the continual grimace on John's face tells me that he'd rather lie on the board in silence than relive the bar fight.  Not making any headway, I give up and call ahead to the hospital.  Once there, he does wind up in a trauma room as a level 2.  I give the story, holes and all, to the trauma team, finish up my report and leave.

It is hard to capture the pathos of the situation, but it is a little sad to have to bring a man who lives alone in his car to the hospital after he got his ass handed to him in a bar he was probably drinking at alone.  Then again, maybe he's a jerk, and that's how he ended up homeless, alone, and with a shiner on his face. I'd like to think that's not the case, but who knows.