Crash Cont'd

............let me take a step back and put things in perspective on just who I am/was and what led me to be at this crash site at this moment in time. I've always received those 'looks' of "yeah right - this didn't happen to you.." or "how can all of this have happened to one person..." The quick story reads like this, my now famous friend Doug and I loved chasing fires. We would chase them on our bikes as young teenagers, then when the license came along, we'd chase them in our cars. We sported CB radio's, in-car mounted scanners, portable scanners, camera's, etc. We'd go around and find excitement in this stuff. I guess we were kind of wierd but no more so than other people we came in contact with. Then girls started, and we lost a bit of our enthusiasm in the chase. With women who would actually hold our hands and god forbid, kiss us, how could a hormone driven teenager think of anything else? We were coming back from my families boat one afternoon, the girls were in the car (Doug's MaryAnn H and my Megan B) and were driving past this VAC headquarters. Doug turns to me as we pass and says "wanna do it?" Now, we'd never, EVER, discussed joining a VAC. We'd briefly discussed joining the VFD, but we lived in 2 different fire districts and as such would need to be seperated until one of us moved out of our house and into the others or into an apartment. We were 17 years old, and I still wasn't shaving.I turned to Doug and said, "sure, why not." And that my friends was the entire decision making process that brought me to my calling in life, the most beloved talent, whatever you want to name it. There wasn't even time to think about it. For years now, we were joined at the hip and this was another thing that just immediately clicked and made sense. I rolled the steering wheel over, tossing everyone in the car into each other (and causing a slight traffic conflict), and we pulled into a dirt parking lot of an old converted gas station. The building was painted in a flaking white, the 'bay' windows needed cleaning, the front door was a shambles, the inside of the garage was painted this ugly dusty blue. (What in god's name were we doing HERE?) The people inside looked like they were stuck in the 60's psychedlic age (and some from the 40's). They were though, wearing blue shirts and gleeming badges. (My mind immediately shot back to 8th grade and being given my first AV members card.) That was 1981. Within 3 months of joining I had my CPR cerification by two competing entities (American Heart Association and the Red Cross - believe it or not, they had legal battles between them on how CPR should be taught and performed. That was a loooooonnnnngggg time ago.) I also had completed my AFA - Advanced First Aide course and was certified in that so I could start riding the ambulance. 6 months later I'm finishing my initial EMT class, working per diem with NYC EMS while going to college. 3 months later I have 2 more certs BTLS (Basic Trauma Life Support) and ACLS (Advanced Cardiac Life Support). Next 2 months I had my Pediatric Trauma Life Support and Advanced Trauma Life Support classes under my belt. I was fast tracking for all my advanced degrees with Paramedic being the ultimate goal (at the time). I have a thirst for knowledge. I love learning and experiencing new and exciting things. Unfortunately, my grandmother was diagnosed with cancer when I had just finished my EMT. The cancer had metastasized and spread everywhere and was directly affecting her bowels and stomach. She went through a few weeks of severe pain and discomfort and was finally admitted to the hospital because of her unstable condition. While she was in the hospital on a morphine drip, I was visiting daily. The nurses had come by to give her a bath and were hooking her up to a hoya lift. The expression of pain on her face was unmistakable. The morphine wasn't touching it anymore (the Ca had spread to her brain's pain receptor site and was pounding away at it - no amount of medication would have touched it.) While yelping in pain she slowly turned her head turned to me, looked me square in the eyes, almost through me, tears running down her red face, and began pleading with me to make her better. "You're trained in medicine, make the pain go away. Stop them from hurting me." I tried to reason with this now shell of a person balled up in front of me in the hospital bed. Due to her condition she was a person who was consumed with anguish and medication. "Grams, they're doing everything they can for you. If you relax a bit the bath might help." Her response drilled through me, taking every liter of air out of the room, and brought me to my knees crying in front of the nurses, "You don't love me then. If you loved me you'd take the pain away. If you loved me, you'd put me out of this misery."How could I respond to that? I certainly had enough knowledge and training to understand the physiology of the ailment and her bodies reactions to it. I understood the medications impact on her brains reasoning centers. At the time though I didn't have the one thing that might have allowed me to redirect that emotional blow, field experience. With a short-fall of experience my brain didn't know enough to shut down emotionally or deflect such onslaughts until it could put things into perspective. I couldn't yet 'hide' from this emotional pounding. (That would take a couple more years and a few thousand more emergency calls for me to realize.)That very night I resolved to learn about the body and mechanisms of disease and injury. To immerse myself in emergency medicine, books, manuals, technology, training, seminars, etc, etc, so I WOULD have the answers and ability later on, or at least be in a position to help when my training lacked. That was my response to curing MY personal pain, which all stemmed from this one night with my grandmother 2 days before she died.In the following years I trained hard. Worked double shifts. Found the most sinister of areas to work in because that's where the emergency calls kept coming without a break and were most serious. I got my name onto the lists of medical 'GO' teams who'd respond to natural disasters around the world. I taught, lectured, traveled, became part of an airborne medical transport crew, on and on. Years later, when I stopped counting and started averaging the calls and transports I'd been involved with, the numbers were staggering. Around 20,000 in just shy of 20 years. 20,000 patients. Everything from critical cardiac transports, helicopter transports (my love), earthquakes, forest fires, crashes, confined space rescue, bandaid placement, splinter taker-outer; I'd been shot, stabbed, threatened, punched out, assualted, hit by cars and been in auto (ambulance) accidents.By 1990, I'd experienced about 60 % of my lifes experiences mentioned above. Sure, I'd been to Mexico City in '85, Puerto Rico for hurricane Hugo and California - Loma Prieta (almost back to back in 1989.) I never thought or planned though that those hits would keep on coming. Coming like a freight train right around the corner in 1990. I guess, in retrospect, there hadn't been enough time in between these disasters for my mind to process and digest what I'd just been through only months (or weeks) before, only to again have my senses assualted with this plane crash. Here I was, being asked to triage (in every sense of the meaning of the term) a plane-load of passengers on a trip to......America. I must warn that the next accounts will be extremely graphic and saddening. The struggles between life and death, and the mostly futile attempts made by mere mortals to short-circuit movement between them, can be terrifying and gruesome.It was nightime. The air penetrating with heavy cold moisture. Here I was in a basic, very orange, wind-breaker (we took off our standard winter coats back at the car and doned our high-vis jackets so we'd be recognized for what we were from a distance. They had absolutely no insulating value.) We weren't wearing gloves - cold weather or latex protective. The smells were strange. Outside the immediate area of the plane was a mostly light scent of kero tossed in to the very heavy smell of fresh earth. Closer to the plane things changed. That's where you'd smell the odors of........people..... in all forms. These passengers had been on a plane for a long long flight from Columbia. (To that point, I'd never heard of Avianca Airlines.) Beside the cabin opening your nose picked up the stench of body odor, of being in a confined and hot tube for a long time with little air-conditioning. First it was stale air, then like a hit from a sledge-hammer, the smell of bowel, then stomach contents, bile, bladder, blood...It was wrenchingly pungent, pervasive, stomach curdling. You'd turn your head to try and find a pocket of fresh air soaked with kero.....and fail. You'd only find another collection of extremely disturbing smells mixed with burnt plastic, ozone, and abused seat cushion foam. A light breeze would blow outside and come rushing up the fuselage to air out those dank, wet, smells which were then replaced with generator exhaust and the smell of vomit from rescuers and the injured lower down.Wires hung everywhere. Overhead storage bins had dislodged and tumbled down onto the people seated below. Most seats were left moderately intact, though certainly damaged and moved about, accordian style. It was dark. Flashlights were about but too few to accomodate the many people needing them inside the cabin. A beam of light would play out across the cabin interior to reveal seat and valance colors, blood stained walls and bodies. Some of the bodies were kilted to the side as you'd imagine in a thriller movie. Others looked, well, alive, and some indeed were. The ones you thought were alive and weren't were the harder ones to deal with. (Harder still were the children.) You'd call out with the need for help to dislodge the passenger you first thought was alive. The firemen would stream down to help and then you'd find that the smirk on the entrapped persons face wasn't a look of life, but a snapshot of terror frozen there as their life had ended. Thankfully, more times than not, the eyes were closed. When the eyes were open, you felt as if you were truly looking down the path to the other side.I was grabbed from behind and told they were removing a child. Having no viable patient in front of me I scrambled up the few feet to the edge of the opening and then jumped out. I'd felt as if I was the only connection these poor people would have to hold them on the living side... preventing them from taking that dreaded pathway down toward death. (I'm using down because the death of my patients to me is a dark time and a dark passge between here and there. Though I always wondered why I didn't see it the other way around for a white upward leading path.) I rushed the few meters to where a backboard was being suspended by four firefighters. There on the glazed wooden plank was a child of seven maybe. The head bobbed slightly to the side and I got a glimpse of a tear running down his cheek. "Hustle" I yelled over the din of the generators that had been set up in the area. I stumbled to catch up. These firemen went into immediate overdrive and were double timing to the triage area. All of those historic notions of firefighters and an injured child came flooding through my head in an instant. Heroic, brave, unstoppable, unbowing, fierce. A hurt child and a firefighter meant balls to the wall hustle, which is exactly what this child was getting. I wasn't supposed to leave my sector, but this kid had a bad arterial gash that was foaming about the neck. I had pockets stuffed full of 4x4 bandages and kling wrap. I had caught a brief glimpse of a few firemen's efforts inside the fuselage to extricate a man in his late 30's, but that was going slow. Too much debris needed to be removed yet, but they were making quick headway. I figured I had 2 minutes to try and save a child's life and return. I ripped open the 4x4's and stufffed them against the wound. It was leaking profusely, so I added more bandages. Shit. It wasn't helping. I needed hemostats (clamps) and allot of light to see where this bleeding artery was. I looked up and was startled as we had arrived at triage. Not only were we at triage, but a guy in a lab coat greeted my eyes. As he turned I caught a glimpse of his name tag which said something I couldn't pronounce, but I did see the most valuable of letters at the end of those 22 letters (mostly vowels).... MD and underneath....gynecologist. Hey, an MD was an MD in my book. If it said PhD, I think I'd have fainted right then and there.I yelled toward him and he bounded over. I showed him what we were dealing with. I told him I had to get back. He said if I thought he was going to do this alone, in front of a garage, in the dirt and cold, I was nuts, and firmly held on to me. A fireman with a flashlight hovered near us. With a quick hand motion I caught the fireman's attention and he trained its beam down on us, red blood everywhere. The doc got in and clamped it on his first try. I was elated (for 15 seconds the world stood still and harmony was restored. I came close to screaming in elated joy). Then reality hit me like a speeding Mack truck. "DOC!!!" (It was the first fireman who'd coined that nights name for me.)I spun off my knee and headed back with my 'partner' the flashlight toting fireman. My 'namer' had gotten a hand signal from one of his comrades that was working extrication in my area of medical command. I looked through the hazy mist to see another fireman running with a child in his arms. (Oh god, I can't do this again, back to back? I wanna leave right now and go home. This is too much). The child was covered in mud, wearing shorts, shirt tattered and ripped to shreds, cuts all over her bare skin, what was once I'm sure long and flowing hair was now a clumped and matted mess. She was maybe 10. This child was shoved into my arms. I received her, clung on tightly, spun and started heading to triage again. I was giving her a very fast once over. In my very limited and severely broken spanish (every other word of my horrible spanish ending in 'o') I asked "does it hurt?" No. Then, oh yeah, "where does it hurt?" No. was the reply. "Pain?" No. I prodded her extremities, nothing seemed out of place. All limbs were attached. I got an ouch when my hand passed across a large scrape on her forearm. Her eyes were good, no bleeding from her ears or nose...hmmm. Then she did it. She entered my heart. "Daddy?" Ugh, I didn't know her dad from a hole in the wall. I didn't know her name.. hey, name, that information would help... "What's your name?" Nothing. oh well, it was worth a shot. That was the only time that night I got to recieve or deliver a marginally healthy person to triage. I'd held on to that mental image to get me through the next 8 months.I gave the girl to a nurse who'd appeared at triage and gave my quick account of the last 2 minutes and headed back in. The next person I saw was not so lucky.The firemen had worked tirelessly to free the trapped man from earlier. They did a bangup job too. They were able to move what looked like a ton of debris trapping this man and then slide him up and out of the plane on a backboard. Here came the four firemen.. "we got this guy out doc, what'da ya think?" The man was wearing a blue zipped sweat jacket, was ashen in the face and barrel chested. His arms and legs were flailing off the sides of the backboard in unnatural ways. They were articulating in ways they should not be. I stopped the firemen, reached down and placed the mans arms and legs on his chest and said, "he's dead guys, put him on the expired tarp." One of the older firemen not knowing what to expect had empathized with this guys plight and personalized him. Inside the cabin he'd started talking to a man he thought was dying, but who in fact was already long dead. He didn't want to accept the death I had just announced. He tried to shake the man awake. He tried to yell, then louder still. He tried to pinch the mans cheek. I then saw this very heroic fireman full of conviction and gusto look at me and say "he's....dead?" I shook my head and watched him loose his composure and begin to cry. Another fireman took his corner of the backboard and they continued on toward the expired tarp. When I turned around, the fireman who was larger than life when I met him, was now sobbing uncontrolably and being led away by a police officer...........