Stepping out of the vehicle, my breath immediately fogs. The first thing I notice is the noise, there are goats bleating loudly from a pen off to my right. Several goats from the sound of it. From the backyard, I hear multiple dogs barking, almost enough for a musher’s yard (which means double digits).
My boots crunch in the frozen snow as I trudge up to the porch, past the ambulance that’s already here. Cataloging the clamor, I think, Have the lambs stopped screaming Clarice? “Obviously not,” I answer the movie reference under my breath as I climb the porch steps and push through the screen door.
Just inside the doorway a large woman lays in a wide leather recliner in front of a muted television. She is unresponsive and snoring, with her distraught husband a few paces away and the crew making their way through an assessment. The intern takes the initiative to lean the chair back a little and do a jaw thrust, laying claim to what promises to be a challenging airway. Jen is coming in with equipment and goes to check the blood glucose and Dustin is reading a quickly obtained ECG. A long haired cat perched on a nearby cat tree bats playfully at the wires and the paper strip in Dustin’s hand. Other cats snake around the furniture, eyes staring at us from random vantage points in the room.
It is apparent the woman is having a cerebral event. Just as we are making our plans for treatment and egress, she reinforces our differential for us by decerebrate posturing and projectile vomiting (pizza, with mushrooms and olives if anyone was curious). We get her onto her side and manage the tide as best as we can.
The dogs from the yard take an opportunity to get through the screen door out back and start galloping into the house. The basset hound trips over its own ears as it slides around the corner, an Irish wolfhound gallops like a horse across the kitchen tile, and I can’t even discern how many others there are. The husband dashes toward them and gets them corralled into the kitchen before the sea of frantic furry guardians can reach us. When he comes back, I take a minute to update him on what our plan is and to get any additional information that I can.
While we are talking, I run my eyes over the room.
We walk into all kinds of homes, and let’s face it – if you’ve called 911 you probably won’t have time to tidy up before we get there, although some people do try. Clutter comes in a variety of types and each says a little something about the household. There is the “toddler” variety, which is toys and clothing strewn in whatever manner will directly impede your walking through an area. “Teenager” and “College” overlap a bit, involving piles of laundry in degrees of filth that can only be measured by smell (determining an item’s re-wearable status) and half-empty food containers. Accumulations of true refuse indicate the more serious kind of clutter indicates neglect, or lack of self-care – when a person is simply unable to maintain their living environment.
The best kind of clutter however, is the “life on display” variety – where the house resembles something akin to a roadside souvenir stand in the Mojave Desert. The beloved bric-a-brac and sundries from a life fully lived. Collections that make little sense to the viewer but give the owners satisfaction and reminders of better times, milestones and adventures that they may never get to fully share with anyone else.
The glass gaze of the bear’s head above the bookshelf stares balefully down at me. Family
photos taken over decades fill the spaces on shelves and walls, and by “family” I include animals. Shelves crammed full of books fill an entire wall, and there are practical and homemade objects everywhere. In the corner on the floor stands a huge Victorian-style
wrought iron cage. Another memento perhaps, a taxidermy model of epic proportions with glossy black feathers. From its backside, it looks like a vulture, which would be a local anomaly here. I take a spare second to creep around and look, and a huge turkey turns and looks back at me.
Silent, blinking, we stare at one another as I try to process all the reasons one might keep the enormous bird in their living room. There is no time really and we have to get going.
Neighbors arrive to help take care of the husband, we can spare no more time with him right now. This is a challenging carry.
As we are navigating the living room I call out to the folks at the feet, “Turn left at the turkey.” We make our way out into the night.
The woman did not have a good prognosis, we all realized that. Still we ran that case with everything we could use. She received excellent comprehensive prehospital care and when we turned her over in the ER we looked like hell, but she was clean and had whatever dignity we could give her.
After the call, with the smell of recycled pizza in the air and the intern stripped of her vomit-covered uniform, we debriefed about the call – we went over the logistical and clinical challenges and discussed what went well and what decisions we might have made differently.
And we laughed.
We laughed about the goats, and the cat messing with the 12 lead. We laughed about the basset hound tripping over its own ears, and the never-ending flow of olive-studded vomit. As we scrubbed the equipment and the floors we laughed about using the recliner as a controlled slide, and the turkey in the ornate cage. Was it a pet? Was it being prepped for an upcoming holiday dinner? This is Alaska, it could go either way. (Turns out it was a pet.)
We did not laugh because we were mocking the unfortunate woman, or make light of what was likely to be a terminal event for her and her family.
We laughed to relieve the pressure, and off-set the stress of managing a critically ill patient. We laughed because we were celebrating. The call presented us with one unique physical and mental challenge after another, and as a team of professionals we met each one. Together we were able to think on our feet and do the best we could with what we had. We laughed because these things were unique, and funny.
It is OK to laugh because something is funny. The professional is the one who knows when it’s OK to do it openly.
This is a true story. I could write this same tale for you, and by using different words, break your heart. I could tell you about a marriage of over thirty years, of a husband watching his best friend and partner die just days before Christmas, of a basset hound mournfully baying at the gate and the unopened presents for the children under the tree – but I won’t.
I choose to celebrate the work that we did here. I choose to see this call as just one incident, albeit tragic, in a life well-lived and fully realized. These guys did an outstanding job in adverse conditions, giving this woman the best possible outcome she could have in this single scenario.
That is not a tragedy, that is a job well done.
Choose your story, every time you go out there. Make each ending one you can live with, that’s how you isolate the bad from the good. You learn to see the good first, because that’s the ending you can live with. It’s OK to laugh, learning when to do it is just part of the art that is medicine.
Remember, turn left at the turkey and it’s not a good shift unless your intern’s going home in scrubs.