The Night Game

He went up to block the shot–a great save by all accounts–but his feet met an unforgiving patch of mud when they returned to the ground.  Under the bright lights of the stadium, spectators looked on as he threw his arm behind him to cushion the fall.  The mud gripped his hand and his arm bent as he approached the ground.  In an instant, his elbow gave way with a pop, the bones slipping out of the joint, the result of anatomical vulnerability.  "Dislocated elbow" was the call.  Dislocated–the term doesn't begin to describe the agony of the injury, or the terrible anxiety produced by the fragile, horrible feeling of having two bones rubbing against each other with every move.  He screamed.

We cut through his long-sleeve jersey.  Sure enough, the elbow glares at us, angulated, unstable.  Good movement, sensation, and a strong radial pulse.  The referee peeks over our shoulders with interest from a safe distance, sees the injury, shakes his head and walks away.  I wonder if the scream was enough–if he heard the cry and stopped the game immediately, knowing that this was no show-boating for a yellow card, but a serious injury.   

I wasn't thinking about the spectators at the time, but now I wonder what they thought as we strolled slowly onto the field.  I wonder if they could see from their elevated point of view the purpose with which we worked.  Quickly, because each second the player spent lying on the field was one second that he didn't have the relief of morphine.  Carefully, because each movement of his body caused clenched teeth, stifled screams, or sobs.  

McWhacker grabs padded boards and the stretcher, and I practice a forgotten art; one of the few truly creative skills an EMT can apply to patient care.  I put a splint on either side of the arm, gently snake a cravat through the patient's armpit, and secure the two boards above the elbow.  At the wrist, the stabilizing planks are pressed together by loops of roller gauze.  It wasn't a great splint, but there are a few things they missed in EMT class when they taught us how to do elbows–how do you do a sling and swath when the patient is lying down?  With nothing holding the splint to the body, the elbow wasn't truly immobilized, and the patient didn't have the pain relief from splinting I would have liked.  

The splinting done, it's time to boogie.  I look at the patient and at the stretcher a few feet away.  This is going to suck, I think to myself.  McWhacker seems to be thinking the same thought–how are we going to get him onto the stretcher without lifting in a way that will cause undue discomfort.  I almost see the light-bulb come on over his head: "Hang on a second, scoop stretcher!"  McWhacker for the win.

We slide the cool aluminum frame underneath him, clicking the halves together.  We lift the scoop stretcher in concert, gingerly guiding it onto the waiting stretcher.  Sheet wrapped, belts clicked together, we start to pull the stretcher towards the waiting truck.  

The wheels haven't turned one revolution when the crowd explodes.  Cheers, whistles, applause.  Players from both teams, previously locked in battle, scream the patient's name.  The applause and rallying still haven't stopped when we reach the truck.  I can't help but let a charged feeling creep over me.

McWhacker picks up the phone after C$ gets a blood pressure to get orders for morphine.  I wrap a tourniquet around his good arm and slide in an 18 gauge IV catheter.  It is a good stick, but either the short extension set came out of the package with one of the connections loose, or I bumped the wings where the tubing connects to the needleless port, and blood oozes out onto my pants.  I identify the problem, screw it closed, and secure the line.  McWhacker pushes the first four milligrams of morphine, and I hop up front to drive.

Typically, lights and sirens are used to speed response (whether or not they do is a debate I won't get into).  On this call, I use them to slow our transport.  I glide over the streets, weaving around potholes and manhole covers.  I start slowing down for stop signs and turns a block in advance.  As we get to the Point Street bridge, I figure I'll take advantage of the smooth surface to make up for lost time, and accelerate the truck to about 30 miles per hour.  As we come over the top of the bridge, shrouded in the shadow of the median, a manhole cover escapes my attention, and thumps underneath the rear wheels.  It might as well have been a land mine–screams issue from the back of the truck.  Making the turn onto Eddy Street, I idle the truck over a patch of uneven road.  Finally, we arrive at Rhode Island.  After we move him onto the hospital bed, the patient thanks us earnestly.  I'm grateful; I feel like I caused him more pain than we had to.  After 8 milligrams of morphine, he still grimaces continually, and complains of 5/10 pain.  As McWhacker and C$ finish transferring care, I clean the back of the truck, sweeping out grass, mopping up mud.

Finishing up, I look at C$ and McWhacker.  "What the... How are your uniforms so clean?"  My pants are covered in mud at the knees.  The dark blue hides the droplets of blood, but I know they're there.  "Hey," C$ answers, "You jumped in there to splint and knelt down, we just crouched." She grins.