timberlands
By: Ed Musto
Tags: Growing Up, Trauma, Trauma Recovery, Teams And Teamwork, Life

Be prepared for hazards in the wild, for those expected and those unexpected, and for those who you love.

Courtesy of Shutterstock, Photo ID: 1045360546

Columbia University and NYC gave me a chance to escape a suburban existence I was not too enamored of. I loved being the guy on the subway at all hours of the night, moving quickly through century old tunnels with my boots and back pack on, and exiting the subway at the Columbia campus. I loved a school environment where smart people focused on and valued inquiries into all sorts of intellectual pursuits. When I completed my undergrad engineering studies and started employment in a suburban cubicle where most of the guys drifted in and out on the tides of breaks, lunch, and day’s end working on a government project most of us had no interest in and where our bosses counciled us to “take our time” answering a question (we were just burning contract hours for a Department of Energy project which had already been canceled) it felt like I had returned to the meaningless drone type existence I had escaped only a few years earlier. So I quit my new engineering job and took a job as a neonatal paramedic at what was the “The New York Hospital” with an Emergency Medical Technician certification and a BSME from Columbia University’s School of Engineering (my boss called me into his office before I left and told me how jealous he was of what I was doing because he was married with kids and always wanted to be a dentist and now he was another engineering manager in a huge industrial project engineering concern in Oradell, NJ). So it goes.

A few weeks afterward I found myself in a set of white institutional scrubs working on “The Baby Bus” and applying for a student position in the adult paramedic course ran by what was Beekman Hospital’s Emergency Care Institute. The cherry-on-top, all of it was in NYC.

“Ever work on an adult bus?” my bearded, laconic interviewer inquired. I don’t remember my response, but I took a screening test, and, shortly thereafter, found out I had been accepted for their single year, 2000 hour course with about 15 other folks from the 100 odd applicants. Within a few months I was in an adult paramedic course, enrolled for 9 graduate credits in Bioengineering at Columbia, had renovated a small nursing apartment I shared with my soon-to-be wife, and was working back-to-back 16 hour shifts on the Baby Bus at NY Hospital (3:30 PM Friday through 7:30 AM Saturday morning, 16 hours off and then 7:30 AM Sunday through 11:30 PM Sunday night (as long as no late calls came in which would find us on the clock till we got back)) and then back to Columbia Monday morning on my bike. I was deep in the urban woods, gliding along and loving it, and didn’t really understand the actual challenges in my existence until it was much too late. A patient contact I met in my paramedic service, identified a few items of importance I missed before starting my year of ceaseless motion, but I didn’t understand their relevance to me until much later.

The time passed ( as it always does), the early clinical rotations and evening classes were far enough along that I got to ride as a paramedic in training (EMT Level IV operating under NYC Medical Advisory Committee (MAC) protocols) on a advanced life support (ALS) bus. My first (ALS) call, sometime during the fall of 1980:

We come screaming down Sixth Avenue, somewhere in midtown. Some type of traumatic amputation. We’ll be the first on sight. We pull up and it’s bad. Young guy; thready, rapid pulse, with shallow breaths and unconscious. His left leg and foot was separated from his body a few inches below his knee and sat in a vertical position with his left foot still secured in the Timberland boots he had put on that morning (which I noticed matched mine in one of those odd meaningless observations one sometimes makes). His right leg, while still attached, wasn’t in much better shape. Later we found just before the accident his parents had insisted he move the coat he had purchased earlier for his wife to their trunk for safe transport before returning to their home in Connecticut (had to be careful in NYC during that time). He pulled over on Sixth Avenue to accomplish this task and while behind his car was struck by a checker cab whose bumper was only stopped by the bumper of his car. The intermediate portions of both his legs were collateral damage.

Very likely the only thing that saved his life was the crushing injury to his lower legs which probably also partially occluded his major leg arteries. We threw a set of MAST trousers on him, started two large bore IVs, squeezed a bunch of Lactated Ringer’s solution into him, bagged the errant foot in a large zip lock bag with ice and transported him to Bellevue Hospital which had a microsurgery surgical suite. I sat with him in the back of the ambulance where the restoring fluid balance started to bring him back to consciousness.

“My left leg feels really funny. . . my left leg feels really funny”, he mumbled to no one in particular.

I leaned in, and speaking as clearly and softly as I could, explained, “You’ve been in an accident and a part of your left leg has been amputated. We’re transporting you to Bellevue Hospital to their microsurgery unit where hopefully they can repair the damage. We have your leg with us on ice.”

He said nothing further and we arrived shortly thereafter at Bellevue where he was quickly rolled into a waiting surgical suite. We cleaned up our rig and restocked those supplies we had utilized, because that’s what you do no matter what just happened. The decisions in most moments of high stress are usually very limited. On that day, we had to decide what to do with the discarded shoes and what vein was the best vein to insert a large bore catheter in.

I ran into his wife in the ER as we pulled everything back together in our rig for the rest of our shift. She pulled my arm, and as I turned, tearfully asked me, “Are you one of the ambulance guys?”

“Yeah”, I said softly.

She leaned in and in a much stronger voice told me, “You tell him I love him. I don’t care what is missing on him, as long as his brain is there I will always love him. You tell him!”

I explained he was in surgery, but I would try to pass her message along. And in response, fresh tears ran down her streaked mascara.

I probably broke some type of protocol that day, but I hugged her as tears welled in my eyes and told her softly I would get the message to someone who would get it to him and I did.

He lost both legs just below his knees. The crushing injuries left nothing for the surgeons to work with. His life and his wife’s life changed that day, but I’d like to think some of the incorporeal light generated by his wife’s words that day created an enduring protective bubble which held at bay the mundane disposition of materials which comprises way too much of our lifes. At least, with no knowledge of their post-accident life, I’d like to believe that.

I said nothing to R, who by that time was my wife and also a nurse, of that afternoon’s events and many other things we should’ve talked about during that year. In retrospect, it seems to me, light and love always helps to ease our passage through the unexpected and should be expected hazards in the wildernesses we transverse and make tragedy bearable, but at that time I was only concerned about the next shift and getting home that night. Perhaps I should have recognized that all of our stories are ultimatedly stories of losses and good-byes. Assuming such, enjoy sunny days with companions glad to be in your company and strive to be a light, however dim, for those loved ones enduring a rush of darkness.