Squid Soup

"Man down 2514 Empire st between pickup and blue car reporting party on scene."

Engine 43 covers an area comprised of an industrial waterfront, unaffordable homes on the bluff, and a portion of downtown, a colorful mix of decaying hundred year-old brick structures and newer construction. Historical buildings, vestiges of the lumber boom, some dating to the 1800's, house enterprises hawking cell phones, video games, and incensed New Age supplies. Cross the street, go next door; if you need auto parts, a sandwich, or a valve for a boiler system, you will find that too. Sleek banks rub shoulders with apartments, bump elbows with churches. The courthouse and the jail dominate their landscaped blocks with authoritative institutional concrete architecture. Sprinkled around the City, like candles on a cake, are the various huts promising drive-through convenience and Cafe Latte of dubious pedigree.

Taverns and hipster watering holes are abundantly represented in the business district, as are their patrons, some of which constitute a steady stream of repeat business for the fire department. We find them in doorways, alleys, parking lots, the waypoints of the ambitious alcoholic's business travel. It's hard work, poisoning your body, and a short nap might be required, demanded even, on the stumbled path to elsewhere. Rare is the shift that we aren't dispatched to a man down, often called in by an anonymous do-gooder on a cell phone, from a passing car.

The call to the Empire Street address was unusual, not for the time of day (2300 being a drunk's witching hour), but because we don't usually see this issue in the nicer neighborhoods, peripheral as they are to the commerce of intoxication. Brian, my captain, was suspicious that this was, once again, "Lieutenant Dan", a recently-arrived career inebriate. Lt. Dan, named after the character in Forrest Gump, lacks both legs, but, in his wheelchair, enjoys a vexing mobility. En route to 2514 Empire, our dispatcher verified, via a call back to the reporting party, that this patient was indeed possessing of both legs.

As we approached the address, someone stepped into the street, waving a flashlight, continuing even as we rolled to stop next to the aforementioned pickup. Brian trained the spotlight on the young man sitting cross-legged in front of the truck, and I stepped out, grabbing the kits from behind my seat.

Nicely dressed, this kid wasn't the bum I had expected, but flecks of vomit stained his shirt, clung to his cropped hair. "What's going on?" I asked, snapping the aid kit open. Gregg, our driver, joined me, adjusting the stocking cap on his shaved head.

"Where's my buddies?"

"I'd say they left you." I clipped the Oh-Two meter to a clean finger, "What's your name?"

"Jake."

"Been drinking?" (I have to ask.)

"Oh, yeah."

"What city are you in?" It's a standard question, intended to assess a patient's orientation to location, and I'll give the really drunk ones partial credit if they're in the right county.

"Uh... San Diego?"

Our captain was listening to the exchange, writing his report in the warmth of the engine's cab, "Ha! Try a place that's a little colder."

It was a surprising answer, but after the 22 year-old haltingly explained that he lived and worked on an aircraft carrier, hailed from a small town in Wisconsin, and remembered precisely where his parents and siblings lived, I gave him the benefit of my doubt. Gregg and I quickly worked together, collecting vital signs, which I relayed to my captain, standing below his open window.

I turned at the sound of retching, to see "Jake" vomiting copiously on the asphalt. The street gently sloped toward the gutter, and a tide of puke was flooding toward his pleated jeans. Ah... shit. Grabbing an elbow and his belt, I hoisted him to higher ground, preserving his remaining cleanliness and dignity.

"What did you have for dinner? Spaghetti-O's?" I am such a card.

"No. Nothing."

"Looks like you enjoyed a few appetizers..." The humor in the situation suddenly evaporated as the smell slammed into my brain. A hearty dinner of meatloaf and mashed potatoes, tenderly prepared by the medics, bubbled heavily in my stomach, boiled up, into the foreground of my awareness. I fought to contain the rising gorge and stepped into the cold breeze, inhaling deeply through my nose.

I stood upwind, at a distance, keeping an eye on my patient, waiting with my crew for the requested ambulance. The aid kit - my aid kit - lay open on the grass strip beside the curb, yawning up to the night sky, but I could collect it, and the airway kit, from the hot zone later.

Jake began to heave again, and, concerned that he might inhale vomitus, aspirate, Gregg and I moved in to steady him, holding his shoulders. Another fountain of pungent spew splattered on the pavement, and we clutched at his clothing, lifting him away from the viscous mess. Distracted by the task at hand, I gave no thought to my previous nausea. And suddenly, standing there without focus, awash in that foul air, I was visited anew by the angry ghost of meatloaf past.

Gregg fetched a towel to clean up Jake, dabbing at his face and shirt. I removed myself for another dose of fresh air. The ambulance arrived, and our captain described the situation to the EMT's.

"What exactly is his medical complaint?" It was an asshole question. Granted, I wouldn't want him in the back of my AMB either, but this patient clearly deserved transport, and, I thought, a little respect.

Gregg spoke up, "He's at risk for acute alcohol poisoning."

One more time, we entered the ralph zone to scoop Jake up and onto the stretcher, positioning him on his side lest he vomit again. The AMB guys wrapped him in a blanket, and buckled the straps, while Gregg retrieved the kits.

We climbed up into the warm cab. The ambulance pulled around us and then pulled over, presumably to take their own vitals and call the hospital. Gregg reached up and flipped the switch for the emergency lights. A few minutes later, Engine 43 was back in the barn. I wandered toward the kitchen, hoping to satisfy a mysterious craving for noodles in tomato sauce.

"I See Drunk People..."

"Hey Buddy." I shake his shoulder, firmly. "HEY BUDDY!" He's slumped in the stall, pants down, on the shitter. A small gash seeps on his forehead, probably from hitting his head on the toilet paper holder. A laptop case lies at his feet. Outside, behind me, several police officers and my crew chat in the train station restroom. My right hand seeks a radial pulse... ah, there it is. Not dead. My left hand cracks the ampule of ammonia inhalant, soaking the wrapper with pink foulness. I hold the sachet under my patient's nose for a long moment. He gently bats at it, the vapors plumb the depths of his addled mind. We call them Silver Bullets, the only tool for the job of rousing the poisoned, intoxicated, unresponsive zombie. At last, the odor finds purchase on his brain and pries the stupor out of the way, like a heavy door.

"Cut that shit out, man!" He swats again, this time his hand is pushing the ammonia away. I pull it away for a second and then firmly press it under his nostrils.

"Wake up. What's your name? Talk to me."

"Whatdaya want?" His eyes are open, unfocused, he grabs my hand. I withdraw, replaced by a police officer. A rambling conversation ensues. "Oh, a few beers," he allows. Humorless chuckles from the crowd. The station is closed. He is drunk, broke, homeless. A plan is formulated. I'm gloved up, closest, least senior; it falls to me to hoist his drawers, get him moving to a bench outside the men's toilet. This is, in fact, more difficult in practice than theory might predict.

He can barely stand, his pants are still fastened, belted, and catch on his skinny hips. He sways, I lift and steer him past urinals, sinks, out the door. His bare ass is covered by his coat, but I keep him at arm's length anyway. If he collapses I'll keep his head from hitting the tiles, but I will not get poop on me.

He's on a bench now, and I wonder if the cleaning lady who found him will scrub the oak after he's gone. The police are asking him questions again, while I collect vital signs. Does he have a medical emergency? Where does he want to go?

He wants a place to sleep, and the fire department is not needed. I pack up my kit, snapping the case closed, clack, clack. We stride out the doors, into the autumn night, to our idling fire engine.

Several times a day, miscellaneous fire department vehicles are dispatched to man down calls, usually called in by a well-intentioned driver with a cell phone. These alarms are routed to Fire instead of Police, despite an historical record demonstrating "man down" equals "public intoxication." Aid cars, engines, ladder trucks roll up on the address, searching for the patient, taking clues from the information relayed by the (frequently confused) passerby. Frequently, no patient can be found, or a blast from the air horn rouses them from their nap, and they move on, to seek a more private retreat. But, more often, we find ourselves standing above a drunk, shaking him by the shoulder, reaching for the trusty Silver Bullet.

In addition to blood pressure, pulse, and respiration rate, we assess our patient's level of consciousness, as a matter of course. If he answers questions appropriately, he's alert. As his LOC decreases, a response may require shouting or painful stimuli. Genuine unresponsiveness, an emergency in itself, makes the situation, instantly, more serious. Our assessment becomes more critical, and, in certain circumstances, perhaps a tad cynical.

It's not unheard of, to be called for a Police incident in which the subject suddenly goes limp, feigning injury or illness. In EMT school, we were taught to grind our knuckles vigorously into the sternum to elicit a response from the verbally unresponsive. It's old school, and requires no special skill. The sternal rub might reveal the BS in the BLS (Basic Life Support), but it looks bad when executed properly. "Why would that nice firefighter hurt that poor man like that?" an on-looker might ask. Try doing it to yourself, and see how much effort it takes to provoke a grimace. A better technique is to place your fingers behind the jaw, at the neck, and dig a finger into the hollow on both sides. This is innocuous, appearing to the casual observer as a tender, caring touch. Alternatively, a limp arm can be lifted over the patient's face, dropped, and observed. The arm of a patient faking coma will not hit his face, but falls adjacent to his head.

We go on these calls on the off chance that a real medical emergency has occurred. Last night we were dispatched to see a woman at a bus stop. "Unconscious, breathing, pants around knees." We arrived to find her draped sideways over the bus stop structure, bare butt in the air. Handing off an ammonia sachet, I sprinted to fetch a blanket from the rig, while Randy, our driver and former paramedic, checked her carotid pulse. I returned to find my captain and Randy lowering her onto the sidewalk. I covered her nakedness with the blanket and Randy set up the bag valve mask to assist respirations. He asked for an oral airway, a curved beam of plastic, "H"-shaped in cross-section, that keeps the back of the throat from collapsing, and closing off the air supply. She didn't gag on the device as it was twisted into position. That's a bad sign.

An empty bottle of vodka lay on the grass where her head had rested, and pills were found in her purse. Her clothes and shoes looked reasonably expensive, not the usual man down attire. Medics arrived, an IV was started, Narcan administered. One of the medics expressed doubt that the Narcan, a anti-narcotic, would have, with this patient, its magic effect. Sometimes, it sucks to be right. After they tubed the patient, I drove the medic rig to the ER, the engine following. We don't know what happened, we don't know her outcome. Seldom do we.

But, this I know: There will be man down calls. I make sure the kit is always stocked with barf bags and Silver Bullets.