Corpsman Chronicles XXI: "That ain't funny, Doc!"

Yes it is.

Navy Corpsmen have been accused of having a sick sense of humor. Well, back in the day they were frequently accused of that. I've no idea how it all plays out today. Nevertheless, I wouldn't have argued with my naval peers bitd. I wouldn't have called our sense of humor sick, exactly, but I could certainly see how it might be viewed that way from a non-corpsman/non-medical perspective.

Here's the thing, from my perspective. I have closely attended the death and life-changing injury of young sailors. My main purpose for being, at that time, was to stave off death and mitigate injury. There were more times than I like to remember when I failed in this mission, and when that happened, it was a double kick directly in the balls of the soul. My personal failure was the lighter of the two blows. The searing knowledge that a shipmate was gone forever or that his life was now unalterably changed for the worse and forever, well, it's a crushing thing to live through.

Those blows are hard to take. We took them, because that was part of our job, and because our shipmates (and many of us) routinely operated millimeters and moments from catastrophe, and the call could come at any time. None of us could afford to wallow in regret when our skills and best effort were liable to be needed at any moment. We had to grow tough skins, as it were, and part of that tough shell was reflexive humor. It was almost always dark and stark, and could seriously shock the non-corpsmen. Sometimes it looked as if we were laughing at the misfortune of others. And we were. But a large component of our mirth attended the fact that we were laughing at (relatively speaking) mild misfortune. At survivable misfortune. The pain and fright of injury is real, and it will leave a scar. We knew that. But having seen much worse, and having attended soul-smashing tragedy, our laughter at mild(ish) misfortune was in part safety relief valve, and in larger part a celebration of certain survival. The fellow in question was having a bad day, and it sucked to be him at the moment, but he was gonna be okay. Compared to the alternative, it was a lovely thing indeed. And probably called for some of that dark and stark corpsman humor.

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I've written about tree farming before, specifically about the navy retirement tree program in the Tidewater area of Virginia. I have no idea if it's still a thing. Back in the olden days, it was very much a thing. At the tag end of that post I noted that it was one of many amusing emergency room happenings I've experienced over the years. Here are a couple more.

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I think it was a weekend, but it might not have been. I'm quite sure it was daytime. As I recall, the Emergency Room at the medical clinic at Naval Air Station Oceana was hopping.

I liked to stand at the L-shaped counter of the ER check in desk to write up my medical notes on the patients I saw. This location gave me a good bit of situational awareness. I could see the waiting room and the entrance doors as well as observe and listen as the staff checked people in and out and discussed cases. At this particular time and place I didn't have a formal need to maintain situational awareness. I was just one of the duty corpsmen and didn't have to worry about the big picture. I'd learned over time, however, that paying attention and being prepared could give you a vital head start if an emergency developed, and a head start could not only make a significant difference for an ailing or injured patient, but could also help you avoid looking like a flailing dickhead. Which was important.

So there I was, writing in a chart, when the entrance door slid open. I must have been trying to spell a two syllable word or something because I didn't actually look at what was walking in.

I sure smelled it though.

A stench of raw and combusted gasoline with strong component of burned hair and clothing rolled over me. That got my attention and drew my eyes. The apparition standing in the doorway was -- and remains -- nearly impossible to describe.

He was of average height. He was wearing only tatters of clothing; a shirt collar and one sleeve and jeans shredded (and largely missing) from the belt-line down. Taking in the state of the tattered denim, I imagined that the leather belt was the only thing keeping the sooty, grimy cloth in place. His, uh, "stuff" was swinging in the breeze, but rather diminished. His skin, and I could see most of it, appeared to be angry red with a heavy charcoal overlay. There wasn't a hair on his head or face, though a collapsed layer of gray ash looked as if it might have been a beard. There were fewer but similar traces atop his now hairless pate.

I peered at him for a long, suspended moment as he stood there. His eyes swiveled about, looking at us looking at him. It seemed as if he hadn't planned what to do once he got here, and he was having a hard time deciding how best to proceed. As his eyes darted around small tendrils of smoke rose from the tattered remains of his clothing.

Just as I was about to launch into action Boards came sauntering out of the treatment room, scribbling on a chart. As he passed the apparition, and without taking his eyes from the chart, he delivered a stern admonition.

"No smoking in medical!"

From that point on the hardest part of helping the poor fellow was keeping laughter at bay.

Cutting to the chase, the fellow was another naval tree farmer. His wood lot was a bare 300 yards from the Clinic's emergency room entrance.

The wood lot is still there, bottom right next to the "Oceana NAS Pass/ID" shack. Which wasn't there in 1982. At the time even the clinic was outside the main gate. 9/11 changed all that.

He'd been clearing debris, and surprise-surprise, drinking a good bit. He'd shoved a pile of tree limbs, leaves, and other detritus into a low spot, doused it liberally with gasoline, and then started throwing matches. His fire triangle was lopsided though, and he needed to apply more heat than was available in your standard cigarette-lighting match. He eventually pulled out a propane torch, and that did the trick.

Of course he touched off a fuel-air explosive, which deflagrated rather more energetically than a standard campfire.

At the end of the day the recently retired and nearly exploded sailor was fine. His worst injuries were small second degree burns around his ankles where his cheap Navy Exchange plastic sneakers had melted. Other than that he had some first-degree burns and he'd destroyed a good third of his wardrobe, but all in all he'd come off remarkably well.

The Lord takes care of drunks and sailors. Ask me how I know.

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Five or six years later a somewhat similar odor invaded the treatment room on the boat. The fuel stench was subdued, old and stale kerosene rather than petrol, and with a strong admixture of hydraulic fluid, lithium grease, canopy cleaner, box lunch horse cock, and body odor. The scent of the Plane Captain. Far more powerful was the reek of burned hair. This fellow paused just inside the treatment room too. The left side of his face was red and grimy and sported the ashen remains of eyebrow, eyelashes, and mustache. The right side of his face was normal. If you can call a half-mustache normal. As he stood there, tendrils of smoke arose from the left sleeve of his flight deck jersey and from the left side of his float coat.

I gave him a mock-severe glare and the now famous (in my mind anyway) admonishment.

"No smoking in medical!"

My fellow corpsmen roared with laughter and had great difficulties as they tried to succor the singed plane captain while maintaining proper emergency medical decorum.

I was secretly disappointed with my performance though. I wasn't Boards, and I simply  lacked the thing that made him a legend. In a way I felt kind of dirty. I was pretending and it just didn't feel right.

As it turned out, the plane captain had been pulling external power from a Bug and for some reason the circuit had remained energized. Someone had failed to secure power or a switch crapped out. I forget which. When he pulled the plug a substantial wave of freed electrons washed over his left side at the speed of light, giving him a light toasting. Aside from the 'stache singeing, he wasn't even mildly injured, but the Bug's Bugtronics got fried and so there was a mishap investigation. It was a close call for the plane captain and could have been much, much worse. In the end it only cost several hundred thousand dollars to reanimate the dead Bug, so no harm, no foul.

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The following bit is long and tedious. It's not exactly about grim and dark navy corpsman humor, but it has a component of that. It's more about the friction of competing ideas and the fact that sometimes, even in a very good system, stuff falls through the cracks. The fact that these things happen is one of the main reasons you can't have mindless plug-n-play enlisted automatons. Not without courting disaster anyway.

It was a Saturday afternoon in Virginia Beach and in the Emergency Room at Oceana we were getting hammered. It didn't happen often, but sometimes the medical gods arranged things so that everyone and their pet monkey wanted to come to the circus.

This time I was Chief of the Day, and having just returned from a deployment found that I was not well pleased with one of the recent changes.

When I'd left on deployment some eight months previously, there had been a nice, glassed-in waiting room just to the west of the ER check in desk. Patients could sit in there and watch television or read magazines and wait their turn for care. They were comfortable, out of the way, and close. The big windows allowed us to keep eyeballs on, just in case someone developed a serious problem or needed assistance.

When I returned, the waiting room was devoid of furniture, dark, and empty. This was the work of the Gang of Three, or the three navy Nurse Corps officers assigned to the clinic. I'll get into their story in more detail in future, but for now let's just say that imo, they were ill-led, underemployed, and prone to do stupid shit because reasons. As with every other thing in the world, the story isn't that simple, but for the purposes of this tale it's a good starting point.

Anyway, patients desiring to utilize emergency medical services after hours and on weekends were now required to check in and wait in a different area of the clinic entirely. Let's see if I can describe the previous and new procedures.

Branch Medical Clinic Oceana. This is the front of the building with a (relatively) south exposure. The main entrances are offset to the east. The left or west doors open into the active duty side while the east doors open into the dependent or family care side. Back in the 80's-90's anyway.

First, the clinic was a big rectangular building. There were two main entrances on the south or front side of the building. The southwest doors led into a big, open area with lots of chairs for waiting. Medical records was on the immediate right, with Pharmacy on the other side of a broad east-west passageway. Along the west side of the big waiting area were the multiple check in counters for active duty sick call. Behind the check in counters and extending all the way to the dental side of the house were three passageways lined with individual exam rooms and offices. This set up was mirrored on the east side, where family care and pediatrics resided.

Back or north side of the clinic. Everything to the right or west side of the right elevated section is dental and therefore doesn't count ;). The elevated sections are mechanical spaces btw. The ER entrance is the dark cutout to the left or east of the portico where ambulances were parked. The covered extension just to the left appears to be a wheelchair elevator and was not there back in the day. It's located at the northwest entrance, which was the "new" ER entrance as conceptualized by the Gang of Three. The two white sheds and the slightly larger roofed structure next to the ambulance/ER driveway weren't there. The entrance behind them with the small overhang is the northeast entrance into family care. The bump-out section of the building is supply. On the day in question there was a long aluminum radio antenna leaned against the building halfway between the "new" ER entrance and the family care entrance.

On the north or back side of the clinic there were also two main entrances which opened on to the same large waiting areas. If you came in via the northwest doors the active duty sick call waiting area was to your immediate front. A passageway to your right led to the Emergency Room. To your left was the lab, and across from lab was x-ray. If you came in through the northeast door you'd be entering the family care side.

Also on the north or back side of the clinic, farther west than the "main" entrance doors, was the Emergency Room, which had its own separate entrance, complete with automatical sliding glass doors.

During the clinic's normal hours of operation -- that is to say, M-F, 0700-1700 (excluding Royal Federal Holidays), you could enter the building through any of the doors, front, back, or emergency. After hours and on weekends/holidays the four main doors, front and back, were locked up. The only after hours entrance was through the Emergency Room.

The way patients gained after hours access to medical care before the Gang of Three worked their magic was by entering the clinic through the Emergency Room doors and presenting themselves to the check in counter which was, like, right in front of them. From there they'd either be immediately whisked into a treatment area or spun out to the waiting room, which from their perspective, was just through a door to the immediate right of the check in counter.

The new and improved Gang of Three method was different. Patients were no longer allowed to use the Emergency Room entrance. They were now required to enter the building via the northwest entrance. There they would find a tiny little stainless steel check in desk, manned by a single tiny little non-ferrous corpsman. The corpsman would begin the process of filling out an emergency care form with patient information and a "chief complaint." He (or she) would then invite the patient to have a seat in the large waiting area (which happened to be the sick call waiting area during normal business hours). At some point, when the tiny little corpsman had finished the paperwork, they would hand carry said paperwork down a passageway through a couple of sets of double doors to the actual check in desk in the actual Emergency Room.

Makes sense, right?

Except for a couple of problems.

For instance, think about this. The clinic is a very large building. After hours the staff is concentrated in the Emergency Room only. Why physically separate patients from the staff? What if a patient has an actual medical emergency out there, away from the ER? Why take that risk?

Along the same line, why separate one of the staff members? Why stick that tiny little non-ferrous corpsman out there with the separated patients and away from immediate assistance and emergency medical equipment?

Why make things harder and more risky than needed? How does that support the mission?

But wait. It gets better!

The after-hours staff of the Emergency Room is the duty section plus a duty physician. Six or eight corpsmen and a flight surgeon. That's not an overly large crew. On days like the day I'm describing, it's enough, but only barely, and only if everyone works very hard and very efficiently. And now we've got to take a sixth or an eighth of our manpower and park them "out there" in the sick call waiting area? Not feelin' it.

A complicating factor is that corpsmen aren't really interchangeable. In most duty sections you'd have two -- possibly three -- who were experienced and certificated in emergency care. They'd be doing the hands-on patient care stuff. They'd be assisted by the less experienced and non-certificated junior members of the duty section, who would be learning and gaining experience while writing and fetching. If you do the math, that leaves one or two on the desk to push paper, answer phones, manage patient check in and check out, etc. If you're still following the math, you might wonder (as I did back in that long ago moment) who exactly is going to be the tiny non-ferrous corpsman sitting at the tiny stainless steel check in desk. Because eight minus three minus three minus two equals zero.

Fortunately, in this case, the beginning number was actually nine. My duty section had a brand new, freshly minted corpsman. This fellow was an E-2, or Hospitalman Apprentice. He'd graduated from Hospital Corps School a couple of weeks before and the Oceana Clinic was his very first duty station. He'd doubtless be a good fit for check in duty. The job wouldn't be too taxing to his freshly learned but never before practiced medical skills, but would also be challenging enough to be interesting and provide a steep(ish) but surmountable learning curve.

A seemingly perfect solution to the problem of who to put out there on check in duty.

Beware perfect solutions.

As it turned out, the new corpsman was, to be charitable, severely challenged. I'm trying to recall what he looked like but I'm drawing a blank. Something makes me think he was tall, skinny, and goofy looking, but I may have him confused with a different E-2. Or many dozens of different E-2's. Not that it matters.

His job was to do the "Can I help you?" thing whenever a prospective patient would enter the building. He'd get their ID card and transcribe their info onto an emergency care form. He'd also ask them the nature of the malady which had prompted their visit to the Emergency Room, and write it as a "chief complaint" up at the top of the notes section of the form, something like this:

CC: Patient states "I poked my eye out with a fork while changing spark plugs on my car."

With the chief complaint recorded and patient information filled out, he would invite them to have a seat in the waiting area, attach the emergency care form to a clipboard, and then carry the clipboard back to the ER check in desk, making sure to hand it directly to the desk corpsman. If the patient was in distress and needed immediate attention he would of course escort them directly to the ER or call for help.

The new guy's job would be relatively simple but also fairly challenging for a fellow who'd only had training under direct instruction so far and had never done ER triage. He'd have to use a little bit of common sense and be able to think on his feet.

Aaannddd... It didn't work out that way.

No one could read the kid's writing. It looked like the penmanship of a writer deep in the throes of a grand mal seizure. He also couldn't figure out the concept of handing off the clipboard directly to the desk corpsman, thereby alerting her to the presence of another patient in the waiting area. He somehow managed to sneak in and stack the clipboarded forms on the end of the counter when no one was looking. Finally, he couldn't do the common sense thing. Thirty minutes into the watch he had three guys sitting in the waiting area trying to staunch bleeding lacerations with paper towels they'd found in the head. 

Which none of us knew. We thought we were finishing up with the half-dozen patients we'd inherited from the off-going duty section, and thought we were rapidly closing in on coke-n-joke time.

The final straw was when the kid showed up at the check in desk mumbling something about "there's a guy laying down on the floor out there..."

"Patient down!," yelled the corpsman at the check in deck. Several of us scrambled out to the new and improved waiting room, where a young fellow in civilian clothes was sitting on the floor near the tiny check in desk, shaking his head and trying to get his bearings. A pair of bleeding sailors were standing by, trying to render assistance. I glanced around and took in a surreal scene. There were far more people in the waiting area than I'd expected. Most of them, I was sure, were waiting for care. There were also blood trails everywhere, deposited by the lacerated sailors as they searched for paper towels. The blood trails reminded me of the aftermath of a claymore initiated ambush.

The "down" patient was a sailor from my own airwing. I'd seen him around the boat. He had a severe chest cold with a pretty high fever and had fainted while waiting to be checked in. I fumed for a few moments while assessing the situation. This new waiting area concept was a loser, and it clearly put the patients at unnecessary risk by separating them from the ER staff. So firetruck it.

"Okay, listen up," I announced to the crowd of patients. "This (air quotes) 'new waiting area' idea isn't going to work out. I apologize for the inconvenience and confusion. The people who came up with the brilliant idea don't ever work weekends or stand duty so they're obviously not here, but we're gonna go ahead and go back to the old way. Everybody grab a chair and follow me."

When I went to unlock the old/new/reinstated waiting room door I noticed that the Gang of Three had gone so far as to remove the key from the Chief of the Day's key ring. Since they had decided to behave like stupid bitches they had completely failed to understand the concept and utility of the master key. Fully reinstating the waiting room to its past glory was a snap. Open the door, flip a light switch, click on the wall mounted television.

I took personal charge of the sailor who had fainted. I looked at the emergency care form and couldn't read a word of the chicken-scratch recorded by the new guy. It looked kind of like Chinese, 病人说他有阿米妈妈, but it wasn't Chinese. It was chicken scratch, made by drunk chickens. I called for the new guy and asked him to translate. He couldn't read it either. I shit you not.

"What do you think it says?"

"He said he has ammimomma," replied new guy.

"What the fuck is ammimomma?"

"You know, like a really bad cough thing."

"Pneumonia?"

"Maybe."

My mind quickly spun through thousands of leadership events and options. I had to see if this kid was reachable and teachable. For that, I needed...

An attention getter!



Outside a steady rain was falling, attended by the grumbling of thunder. The worst of the storm had passed, but there was still a bit of lightning flashing from time to time. Also outside, leaning against the north side of the clinic, was a radio antenna which had just been replaced by a new and actually functioning antenna.

"Okay," I said, "I've got a job for you. Go grab the radio antenna out there and carry it around to the front of the building. Put it in the exact location it's in now, only out front. Don't walk on the grass, stay on the driveway. And carry it vertically. Okay? Now go."

He went. When he returned he was soaking wet. I told him to stand by and walked through the building to the front doors to see where he'd placed the antenna. He'd done a credible job of it, but of course we couldn't leave it there in front of the building. It was an eyesore.

"That's not gonna work," I told him. "Go put it back. Stay off the grass and on the driveway. Carry it vertically."

We went through this exercise several times with several variations. The lad got very wet and chilled, but he followed instructions quite well.

I spent several hours with new guy, trying to assess his medical skills and potential. Which was hard, because he had none and didn't seem interested in developing any. He'd gone to Hospital Corps school because that's where the recruiter sent him. After expending a lot of time and energy I decided that he wasn't short-bus special or, to put it in politically correct terms for 2019, a retard. He was plenty bright. He was simply completely passive and didn't seem interested in learning or doing. He knew he was an E-2 and would more or less do what he was told to do, but without any real effort or initiative. In the absence of orders or direction he'd simply stand or sit quietly. He was one of the strangest cats I ever met.

My Chief of the Day log entry was long and detailed regarding the "new waiting room" fiasco. I didn't record anything about new guy in the log because that was a personal personnel issue and didn't belong in the log. When I turned the watch over to Sam (actually Dianne, you had to be there) the next morning she happily agreed with me and decided to continue using the old/new/reinstated waiting area.

On Monday morning I reported to the Senior Chief bright and early and explained my actions, logged and unlogged. I rather expected to get a blast for moving the waiting area, but I never heard a peep, and it never got moved back. New guy got moved from medical records to supply and came off the clinic watch bill, though he went on the Air Station three-section watchbill as a supernumerary.

I came clean with the Senior Chief regarding my "attention getter" as well. Again I expected a blast and again I didn't receive one. The Senior Chief seemed to find it amusing and appropriate. I think he understood what I was trying to accomplish, though I'm not sure I understood it entirely myself.