Corpsman Chronicles XXXIII: Super RBOC, I think I love you (part ii)

What's the difference between a fairy tale and a sea-story? A fairy tale begins, "Once upon a time..." A sea story begins, "This is no shit!"

I try to be careful to change names, but to the best of my recollection the events and locations are substantially correct. Of course I can only describe events from my perspective, so there's that. Readers who were present will doubtless have different recollections of any particular event. This is what it was like to serve in my tiny slice of the U.S. Navy between the late 1970's and early 1990's. It really was an adventure.

This is part two of the Super RBOC saga, but it actually takes place a couple of years before part one unfolded. I'd like to tell you that I did this on purpose for some grand strategic and mystic writer's reason, but it's just the way it happened. Also, there's simply too much story for a single blog post, so I'll have to serialize it.

Anyway, 

This is no shit!

##########

It is the way of things in the naval service that men go down to the sea in ships. In the fullness of time, most of them eventually return to the shore. They are always different men when they return, and they always return to a different shore. There is good and bad, wonder and storm, in each of these things.

##########

When I returned from deployment in mid-spring, early 1980's, I had just wrapped up one hell of an adventure. Over the course of eight months I'd pushed myself very hard and greatly expanded my horizons. I'd worked nights on the flight deck for the entire deployment. I also took up the slogging work of seeing morning sick call each day, and once I'd established myself as a serious student of clinical medicine, H-Division's physicians put me through some very rigorous training. Along the way I bagged a lot of plane guard and ASW hours with the helo squadron and flew some fascinating and complex medevacs. My personal highlight reel included sticking a couple of chest tubes and doing a couple of appendectomies (under the ship's surgeon's direct supervision of course), preventing a Grape from backing into an E-2C prop, nearly getting killed twice in a single day...

(Here's what was shootin' at me)



...and a few weeks later finding myself upside down at night in a rapidly sinking Sea King. It would be fair to say I made my bones on this deployment. When USS Boat tied up at Pier 12 at Naval Operating Base, Norfolk, Virginia (NOB NORVA) at the conclusion of deployment, I was generally held in high regard by my squadron, by the airwing, by the boat, and by the boat's medical department. But now it was time to transfer my TAD status from USS Boat's H-Division to Branch Medical Clinic Oceana, at Naval Air Station Oceana in Virginia Beach. I'd made this transition thrice before, and it was always tricky.

##########

A little stage setting.

As a squadron corpsman I was always permanently TAD. The acronym stands for Temporary Assigned Duty, or at least that's what it stood for back in my day (sonny!). For most sailors, TAD meant being assigned temporary duties away from your usual job in your usual shop for a defined period of time. You might also be sent TAD on a multi-week detachment with part of the squadron for training. Weapons Det to Yuma or Strike-U Det to Fallon. Or TAD to a particular school. There were all kinds of TAD variations. The squadron corpsman, who was always the only corpsman assigned to the squadron, was different. He was ever and always TAD, assigned either to the air station clinic when the squadron was ashore or the ship's medical department when deployed. He belonged to the squadron, but he always went to work at medical.

This permanent TAD thing was a challenging path to navigate. In most cases squadron corpsmen were very junior, yet they were the senior medical department representative for their squadron. They were responsible to their squadron, and the squadron was the entity that took care of their chow, quarters, pay, and everything else. Yet they were always TAD to medical, and fell under the direct day-to-day control of the medical chain of command. In this way they were strongly pulled in two directions, with each foot planted in a different tribe. Consequently, the squadron corpsman never completely belonged to either tribe and was always a bit of an outsider, a bit exposed and vulnerable. There were advantages and disadvantages attending this simple reality. It was always a challenge to strike a safe, useful, and appropriate balance.

##########

When I rolled back in to the Oceana Clinic to take up my shore-based or "on the beach" medical duties it was fashionably late, something like 0845. I'd just come from the squadron personnel office where I'd picked up my TAD orders to the clinic. Even though I'd done this very thing in this very clinic a couple of times before, and even though I was intimately familiar with the joint and most of the folks working therein, it's important to do the reporting in thing right and to make a good first impression. I was squared away in razor-creased working whites; a two-chevroned crow on my left sleeve, Fighter Squadron name tag over my right shirt pocket, four rows of colorful BTDT Chiclets over my left shirt pocket, topped with gleaming golden wings, gig line correct, belt buckle shined, and a mirror polish on my "working-not-flying" flight boots. The flight boots weren't regulation. Nor was the name tag which read Mikey Evertson rather than simply EVERTSON. My 1980's porn star/naval aviation mustache exceeded permissible limits in all four dimensions -- length, height, width, and attitude. The lack of a maroon good conduct ribbon on my shirt salad meant that I'd bounced hard off the permissible lines a time or two, and along the way I'd learned how to wear the uniform right, but also how to wear it wrong correctly. It's a skill.

I walked into admin and handed my orders to Zuki, who was not yet an E-5 but was already Zuki. Her face split into a grin, as did mine. I did a quick round of handshakes and high fives around the office. These people were all my friends, and it felt a lot like coming home.

Zuki took me across the passageway to present me to the Senior Chief. "Be ca-ful," she said, "he gotta bug up his ass like u-sal."

The Senior Chief gave me a baleful glare before perusing my orders. "I'm gonna put you in sick call," he said, "report to HM1 Black." I caught him eyeballing me out of his peripheral vision, looking for a reaction.

"Roger that, Senior," I said.

"Ah, Seen-yah," said Zuki, "C'mandah Chin wan' him in ER. You 'membah."

"Oh, for fuckssake," said the Senior Chief. "Okay, I guess I'm putting you in the ER, he said, shifting his glare to Zuki, "if that's okay with you, HM3."

"'Kay, Seen-yah. T'anks."

##########

Back in the Emergency Room, or ER (which had been re-branded "Acute Care Clinic" by the new self-appointed "nursing supervisor," Lieutenant (Junior Grade) Mary Agnes Rottencr Alias), it was once again old home week. In addition to Cookie, the HM1 LPO, my good friends and fellow  E-5 ER Corpsmen included HM2 Schnozz, HM2 Mare, HM2 Boards, and HM2 Wobs. Schnozz and Boards were male-type corpsmen, Mare and Wobs were female-type corpsmen. There were also a pair of E-4's and a handful of E-3's. I knew HM3 Bob and HN Daryl, who were each afflicted with the Y chromosome disease. I did not know the new girl, an HM3, who was away on an ambulance run. I had a briefing from Cookie and then another from Lieutenant Commander (LCDR) Chin, the physician in charge of the ER. He was a trauma specialist and a good guy to work for. My job was essentially unchanged, as were my duties and responsibilities. The hands on patient care I would do in the ER was under the direction of Chin, and we had a good working relationship. He had a fair handle on my abilities and we had already developed a good bit of mutual trust. Chin informed me that based on certain deployment reports he'd received, (Navy Physician's Mafia) he expected me to pick up my game. Fair enough. At 0930 on a lovely spring day, I got stuck in.

It was a busy morning, and before I had a chance to fill my coffee mug a bloody sailor in dungarees wobbled through the door, squadron duty driver helpfully holding pressure with a greasy shop rag to a laceration on the lad's noggin. The fellow had managed to catch the leading edge of an Intruder station one pylon in the forehead, and he'd done himself a mischief.

Station five. One is mirrored on the port wing. Perhaps you can see the potential for trouble with the pointy bit.

I quickly had him checked in and assessed and was soon in the process of suturing a rather complex laceration.

I'd finished with the subcutaneous closure and was carefully closing the tricky scalp layer when illumination from the overhead surgical light was abruptly occluded.

"Petty Officer Evertson, you are not qualified to be suturing!" opined Lieutenant (Junior Grade) Rottencr Alias, as she leaned aggressively into my surgical space. Sigh.

If you've never done this medical stuff you might easily miss the wrongness of invading a surgical space like that. What Mary Agnes did was no more than lean over the sterile eye-sheet drape I had placed over the sailor's head. But in medicine a sterile field is sacrosanct, and you only ever invade that space if you yourself are surgically scrubbed and wearing appropriate sterile surgical garb. The following clip (1:06)  from M*A*S*H makes the point perfectly and with perfect military medical humor. "Somebody get that dirty old man out of this operating theater..."



The point of all sterile fields and sterile technique is to keep germs out and prevent infection. In invading the surgical space by shoving her non-scrubbed and inappropriately garbed head over the surgical field, Mary Agnes was sending a clear message that she couldn't give a flying firetruck whether the lad developed an infection or not. The confrontation she wanted to force was far more important than any consequence suffered by a lowly blueshirt.

Of course I was qualified to suture. At that time I had properly and successfully sewed well over a thousand lacerations. What the hag self-appointed ER nursing supervisor (which wasn't even an actual position) actually meant was that I had not taken her personal instruction or passed her personal exam to be formally locally certified. This local certification scheme was a sham cooked up by the Gang of Three, and they'd managed to get the backing of CDR Spicy-Dijon, the clinic OIC. Local certification was an unnecessary layer of bureaucratic paperwork and was wholly invalid, given that not a single one of the Gang of Three were themselves qualified to suture or had ever sutured. Not about to let a fact like that stand in the way, they simply self-certified and had the OIC sign off on both their self-certification and their beautiful new local certification regime.

Mary Agnes was a handsome woman who took pains to look nice. She had honey blonde hair which she wore just an inch or two longer in back than uniform regulations allowed. She got points in my book for that, because I strongly believe in knowing how to wear the uniform wrong correctly. Of course those points were massively outweighed by pretty much everything else she did. But that's just my book, and if you knew her your mileage may well have varied.

In addition to being a handsome woman with honey blonde hair, she was remarkably skilled with makeup. You knew it was there, but you couldn't see it. Ever. And for a trog like me to notice skillfully applied makeup, you know it had to be world class. I had to give her points for that as well.

Unfortunately for Mary Agnes, I was a member in good standing in the U.S. Naval Aviation Community and I belonged to a Fighter Squadron. The challenge she had thrown down caused my fangs to come out, and and I was not inexperienced or unskilled in this kind of combat.

Of course there was the Officer-Enlisted divide. I couldn't just tell her "fuck-off, you're wrong, now get the fuck out of my surgical field" the way I could an enlisted peer or even a Chief. But there are ways.

I looked up at Mary Agnes. "You just flaked foundation all over my sterile field, Lieutenant." I looked around and spied HN Daryl. "Hey Fish," I said, can you grab me another suture kit and some betadine?"

Mary Agnes was shocked. She'd run herself right into the middle of a complex ambush. Her eyes bugged and she turned beet red. In horror, she clutched her face and fled the field for the nearest illuminated mirror.

In truth she'd dribbled no makeup. That wasn't the point. She had invaded an aseptic space and therefore had contaminated a surgical field. It was unpardonable medical malpractice and she knew it. She'd also badly underestimated an unwashed enlisted swine, and how such a thing was even possible was a thorny problem she would be unable to figure out for as long as I knew her. Not that she would ever be any less a menace.

I finished sewing the lacerated sailor up and soon sent him on his way with a light duty chit and orders to return to sick call in the morning for a wound and dressing check.

As I wrote up the chart and discussed the case with Chin, I mentioned the Lieutenant's contribution.

"She'll call you in to her office and explain the new certification process," he said. "Tell her I said you were to bring your entire package to me." Apparently this wasn't his first rodeo with the new regime. I suspected he had a solution.

"Yessir."

##########

When you walked into the ER through the fully automatical sliding doors of the Emergency/Ambulance entrance (northeast or "back" side of the building) you entered a broad passageway that terminated in a set of double doors about 60 feet straight ahead. To the left was the doorway to the treatment area, and a bit further along on the left another passageway branched off. There were a pair of doors on the right side of that passageway which opened respectively onto the cardiac room and CSR (Central Supply Room, neither central nor supply, but rather the place where instruments are cleaned, packaged into trays, and sterilized. It's a medical jargon thing.). The left branching passageway also terminated in a set of double doors, and these opened onto a broad waiting area which ran from the front of the building to the back. Back where we started, just inside the ER entrance, the L-shaped check in desk was immediately to your front right. Opposite the check in desk was the physician's office, and beyond that the waiting area. The check in desk was typical for a medical check in counter; about four feet high on the patient side with a built in desk on the other side. There were two chairs back there and the desk featured a rudimentary CRT monitor and keyboard for a mostly non-functional computer system, telephones, and all kinds of paperwork stuff. Behind the counter/desk area was the Chief of the Day (COD) office and an adjacent and similarly sized room which was at various times an office, storage, and/or a sleeping space. Man, I wish I had some pictures. This describing stuff is hard!

As I've noted in previous posts, I really liked to stand at the short leg of the L-shaped check in desk to write my charts. It was very comfortable for standing (leaning) and writing, and from that location the entrance was to my right, the treatment room over my right shoulder, cardiac room over my left shoulder, and windows into the waiting area to my front. It was a place where I was fully tuned in to the goings on in the ER, and it allowed me to have pretty solid SA, or situational awareness. Looking back through the mists of time, I'm quite certain I never consciously planned to stand there writing my charts to maximize my SA. I don't think I actually did a lot of logical processing back then. I think that more than anything it just felt right. So that's where I was and what I was doing.

But before we get to the eleven-hundred go, let's flash back several months in time. I was sitting in the Flight Deck Battle Dressing Station (FDBDS) on the boat, eating my box lunch. Horrible things, box lunches. Nutritional though, and you need nutrition when you are a growing boy and spend much of your waking hours galloping about on a raging flight deck. So rather than starve, I ate the damme box lunches. In addition to other horrible things this particular box lunch contained a hideous North African orange. Such oranges were the size of grapefruits, with a tough rind about half an inch thick. You really had to work to open one of those suckers. And when you opened it the flesh was almost colorless and tasteless and was chock full of enormous seeds. The juice of the thing had the bouquet and flavor of diesel fuel. However, hunger + limited eating opportunity = consumption of North African Diesel Oranges (NADOS).

So I'm sitting there eating with my fellow FDBDS corpsman Weed, who hails from LA (Lower Alabama) and is funny as hell once you learn his language. He says something hysterical just as I'm trying to swallow a section of NADOS. I tried to swallow and laugh at the same time and spewed NADOS detritus out of my nose. I also somehow managed to inhale one of the huge orange seeds.

It's nearly impossible to describe what it feels like to have a foreign object lodged in your airway. The body takes over because keeping the airway open is its number one priority. The hacking coughs that follow are an attempt to blow the object back out, and they are more akin to a terrible spasm than a cough. Only little gulps of air go in between the uncontrollable fits of coughing, so in a remarkably short time your vision begins to fade as your brain runs low on oxygen. This increases the panic you feel, which leads to the realization that you might actually be on the verge of death. Which you are.

Mercifully for me, a particularly powerful hack finally dislodged the seed, which shot across the FDBDS at high velocity and ricocheted around a bit before coming to rest in the scrub sink. It was a frightening experience.

Now that we've waded through that diversion, on with the show.

I'm standing there at the counter writing a chart. In my peripheral vision I notice a car screeching to a halt just outside the entrance doors. I turn and watch as a woman leaps out dragging a small child. Behind her the car continues forward and out of sight. The woman rushes into the ER and I immediately flash back to my recent NADOS seed experience. The little girl is weakly hacking away and the panic on her face looks exactly how I felt with an orange seed lodged in my trachea. She's choking.

Time slowed down as it often does in such situations. As I strode toward the woman and the choking girl I was already troubleshooting and formulating a plan. As I reached for the little girl I found a spare instant to worry about the woman's runaway car. 

HN Daryl happened to be coming out of the treatment area, and he was clearly alert and watching what was going on. Good lad.

"Fish," I said with an emphatic head nod toward the door, "car!" He dashed toward the door and instantly disappeared from my world.

As I grabbed the little girl my mind was racing down assessment and decision trees. I knew she needed to have her airway cleared of whatever she was choking on. Something similar to a Heimlich Maneuver was called for, and right now. But she was of an age where it's tricky. She was too big for an infant Heimlich but too small for an adult or child Heimlich. There was such a thing as a toddler Heimlich, but I'd only read about it. My training had been limited to infants and adults. I'd also never performed a Heimlich in a real choking situation. The little girl was rapidly losing consciousness, and for a few nanoseconds I bumped up against the edge of panic. This living little girl could die right here, right now. In the long milliseconds between recognizing the problem and acting decisively my brain spun furiously. She was so little -- no more than three years old -- that the abdominal thrust of a Heimlich could injure her if done too vigorously. The professional part of me intervened and pushed panic away. The little girl was still moving air. We needed to clear the obstruction now. Forget the abdominal thrust for the moment, it's the second step anyway. Don't put the cart before the horse. Back blows first. When done correctly, external percussion can transfer a surprising amount of energy into the chest cavity, which sets up a very strong pressure wave, pushing air out of the lungs, through the trachea, and out of the mouth, hopefully carrying the obstruction along with it.

My assessment and decision process lasted only the time it took to grab the girl and begin turning her over. Far less than a second.

I flipped her over and laid her face down on the inside of my extended left arm. I cradled the left side of her head and face in my left hand, with the inside of my wrist supporting her at the level of the collarbones. Her hips were up near my shoulder and her legs hung down on either side of my bicep. She was nearly as limp as a rag doll. My mind was still doing lightning fast calculations. I should use my cupped right hand to apply percussion, but I needed to do it in the correct location on her back, not too high and not too low and right on the centerline. I ran my fingers down her spine to properly orient myself to the girl's anatomy. At the same time I also concentrated closely on what the girl's Mom was saying; that her daughter had been eating a chewable vitamin when she began to choke.

The drill was to apply three solid back blows, and if that didn't work you would do three abdominal thrusts. Then rinse, lather, and repeat as needed. My fingers found the right location and I delivered a single solid (but not too solid!) blow, right on centerline and just below the level of the bottom of her shoulder blades. Something solid popped out of her mouth, ticked off the counter, and then off my leg. The awful sound of weak hacking was instantly replaced by the full throated crying of a frightened little girl. Hallelujah!

Time returned to normal. I turned the little girl upright and handed her back to Mom. I pulled out my stethoscope and listened to the wonderful sound of air flowing in and out of the girl's lungs as she cried. All fields clear and moving lots and lots of wonderful air! She squirmed around and looked down at the floor, where lurking just under the edge of the counter was a purple Fred Flintstone, of Flintstone vitamin fame. I picked it up and showed it to Mother and daughter. The little girl stopped crying and glared at Fred.

"Bad bye-min!"

Outside, Fish caught up with Mom's car. It jumped the curb but came gently to rest against the chain link fence surrounding the clinic's backup generator. No damage to car or fence.

Inside, Dr. Chin had reacted just as fast -- if not faster -- than I. He was 15 steps distant though. By the time he crossed that incredible gulf the excitement was already over. He caught my eye with an unreadable expression on his face, then turned to Mom and daughter. "I'm Dr. Chin," he said. "That was scary, but I think we're okay now." He pulled out his stethoscope and listened to the little girls breath sounds. As he did so he favored me with another unreadable expression, then turned back to Mom.

"Let's go ahead and get you checked in. We'll get a chest X-Ray, and I want to call the pulmonary people over at Portsmouth. They'll probably want to take a look at her to make sure everything is okay."

Mom started to reach into her purse for her ID card, but suddenly realized she had no purse. She also suddenly realized that she may not have properly parked her car. Her eyes opened wide and she turned toward the entrance doors just as Fish walked in with her keys.

"I just need to grab my purse," she said. An HM3 previously unknown to me stepped up.

"I'll take her," she says.

I checked the HM3's name tag. Yep, she was the new (to me) ER corpsman I hadn't yet met. And although first impressions can sometimes be deceiving, there just didn't appear to be anything at all wrong with the lass.

The little girl doesn't agree. As Mom starts to hand her over she takes one look at the strange lady, squirms away from her, and lunges at me. In the blink of an eye I've got a three year old clinging to me, arms wrapped around my neck. She holds on tight for a moment, then relaxes, leans back, and looks at me with big blue serious eyes. Mom and the HM3 share a surprised look.

"My name's Mikey," I said to the girl. "What's your name?"

"April."

"That's a pretty name, April. How old are you?"

"Free."

"Do you feel better now?"

"I was coughin'!" she exclaimed.

"Yes you were!"

"You hitted me an' th' bye-min camed out!"

"Yes it did. Did I hurt you?"

She shook her head vigorously, then rested the side of her face against my chest and sighed the sigh of a three year old who's getting too old for this kind of shit.

As Mom went to fetch her purse, I stole a glance at the HM3, looking for signs of irritation or hurt. She'd just been rejected by a three year old in favor of some dude. There was none of that though, just a twinkle of good humor in her eyes.

"They told me you were a ladies man," she said with a grin. "I'm Rebecca."

I carefully stuck out a hand. "Mikey." We shook.

##########

Words don't do an adequate job describing how I felt in that moment. Being allowed to witness a child going from near death to normal in only a few moments is a gift beyond any possible corporeal measure. Being allowed to assist -- to be the tool used to apply knowledge and technique developed and passed along by the giants of lifesaving -- was indescribably wonderful. From my professional perspective I always felt and believed that it was simply my job to know what to do and how to do it in such situations. That's what I was cashing my paychecks for. It was a very simple transaction, and because I enjoyed my job and I was reasonably competent I could and almost always did take satisfaction when I performed up to standard. That's all well and good and it's exactly the way the thing is supposed to work.

But this was something else. It was a transcendent moment where I was somehow allowed to step out of myself and catch a glimpse of something enormously bigger and better. I wish I had the words but I do not.

##########

With Mom's ID in the hands of the desk corpsman and the paperwork underway, I reached over the counter and grabbed an X-Ray chit, then Mom and Rebecca and April and I headed over to X-Ray. This would be a bit tricky too. We needed to get two chest X-Rays, an upright PA and an upright Lat. PA stands for posterio-anterior, meaning the X-Rays come in from the back and go out through the front. If you've ever had chest X-Rays, it's the one where you stand upright with your chest to the film holder and your back to the machine. Lat stands for lateral, or a side view. That's the one where you raise your arms over your head and stand with one side against the film holder and the other side toward the machine. It's all very simple (more or less) when the X-Rayee is an adult, but it can be challenging when the X-Rayee is a clingy three year old who has already had her fun meter pegged for the day.

In the X-Ray room I asked April to help me put on my "coat," or lead apron. While she helped me I told her what we were going to do. The Tech shooed Mom and Rebecca out and April was a perfect little X-Rayee. After I slipped off my "coat" I offered her my hand to see if she wanted to walk, but she wanted to be carried, and that's what I wanted too. There was just something magical in those moments about holding that living little girl and feeling her warm breath on my neck.

Outside the X-Ray room while we waited for the films to process I held April and talked to Mom about what we were doing and why. Rebecca seamlessly joined the conversation, tossing in important stuff I'd overlooked. Theoretically we weren't out of the woods yet. There was still a chance that she could develop an airway spasm or could suffer a histamine cascade very like anaphylactic shock. Either of those things could rapidly compromise her airway and require immediate intervention. Which is one of the reasons we stopped by the cardiac room on our way to X-Ray so that I could shove a laryngoscope and a pediatric endotracheal tube in my back pocket. Considering what had happened and how the girl had responded, I felt 99-plus percent sure that she was going to be fine, but you just never know.

As we talked April's Dad arrived, and in a small surprise coincidence, he was a Chief from my Airwing, a jet mech from the A-6 squadron. I'd seen him around plenty of times but had never met him. He looked pale and frightened when he walked up and I was momentarily concerned that he might pass out, but he quickly calmed down.

In another surprise -- perhaps puzzle is a better term -- April was clearly happy to see Daddy and didn't want Mom and Dad to go anywhere without her, but she was completely unwilling to let go of me or have anyone else carry her. I think she had found a perfectly safe and comfortable state of affairs and given the fright she'd endured only minutes before she was loathe to rock the boat.

The films plopped out of the developer and I carried April into the film room while the X-Ray Tech put them up on the light box. Rebecca, Mom, and Dad followed, crowding the tiny space and breaking the tiny regulation about unauthorized people in the film room. I quickly glanced at the lateral film but I was more interested in the PA view. My eyes found the place where April's trachea branched into right and left main-stem bronchi. Where the right main-stem branched again I could clearly see a spot of swelling. I peered more closely and resolved in the midst of the swollen area the outline of Fred Flintstone, clear as day. It was an amazingly perfect image made possible by the experience and skill of an outstanding X-Ray Tech. I pointed the spot out to Rebecca, Mom, and Dad and high-fived the Tech. Then we took the films and headed back to the ER.

In short order Dr. Chin looked at the films, called pulmonary at Portsmouth, and it was time to saddle up and take April for an ambulance ride. The trip to pulmonary would be precautionary and unless the lung docs found something they didn't like she would be going directly home afterwards. It was now closing in on 1300 and it had been an interesting day so far. In a way, it was a very odd grouping there in Dr. Chin's office. I sat on the straight back chair next to his desk, while Mom and Dad sat on the sleeper couch arranged on the other side of the small room. Rebecca leaned against the north wall of the office next to a small window. April sat on my lap, snuggled up tight. She was quiet and getting sleepy following an overly-exciting hour or so, but she was still unwilling to switch mounts. To compound the oddness there was something strange going on between myself and Rebecca. Though I'd only just met her and we'd exchanged only a handful of words, we seemed to have somehow become almost instantly comfortable with each other. It was a bit of a puzzle. Another oddity was the fact that there was no way I was going to let any other paramedic or EMT transport April to the Naval Hospital. This was odd because ambulance transports to Portsmouth sucked mightily. They took forever, were always boring as hell, and were usually more akin to punishment than reward. In this case, however, I was not going to allow anything to upset the little girl, and abandoning her to the care of people she wasn't comfortable with would surely do so. I could have made a solid medical argument for this and likely would have prevailed if someone had presented a "better" idea, but somehow there was an unspoken consensus in the room that I would carry (literally and figuratively)  her through to Portsmouth. The final oddity was another unspoken agreement -- that Rebecca would drive the ambulance. She was EVOC certified and therefore perfectly qualified to drive, yet she was also an EMT-I. A common sense approach would have one of the idle non-EMT EVOC staffers take the wheel, and that would be a more appropriate allocation of human resource capital. Nevertheless, Rebecca would be driving.

Mom asked if she could ride along in the ambulance, a perfectly normal question in such a circumstance. The answer was generally no, for various reasons. Both Oceana and the Naval Hospital prohibited non-patient/non-medical passengers in ambulances. It was a regulation we commonly violated when it seemed appropriate. In this case I'd have been happy to have Mom ride along, but Dr. Chin saw it differently. There was a small but non-zero chance that April might develop an airway problem, and in such a situation having a parent in the vehicle could be less than optimal, for what are probably rather obvious reasons. He also wanted April to be transported sitting up, which was doable but would be easier for everyone if she was sitting in my lap rather than strapped into the gurney with the back elevated. And while she was sitting in my lap I'd be able to feel every breath she took, a big advantage over simply watching her breathing pattern. Finally, if Mom rode along Dad would follow in his car. Dr. Chin sensed that Dad was a lot more upset than he was letting on and thought it might be best for all concerned if Mom drove and Dad rode with her. Dad immediately agreed, and that surprised me a bit, though it shouldn't have. It was a little thing that reminded me that in emergency medicine little details are important.

The trip to Portsmouth was trouble free and remarkably quick. I sat in the attendant's seat in the back with April in my lap and the usually spurned seatbelt carefully adjusted to restrain both of us if needed. April fell into a sound sleep within a few minutes of departure and I spent most of the trip delighting in her smooth and steady breathing.

When we emerged from the ambulance April was ready to be carried by Mom, and we all trooped on up to pulmonary and got them checked in. As Rebecca and I prepared to depart Dad reached out to shake my hand. His face crumpled and he began to silently sob. I'd never seen a Chief cry before. Somehow I understood that this was no time for words. Our handshake turned into a hug while the little girl's Daddy struggled to get his Chief back on. It was another transcendent moment for me, another fleeting glimpse beyond all the smoke and mirrors and game-face bullshit and into the heart of that indefinable thing that makes us more than lizard-apes.

Rebecca and I silently retraced our steps toward our mighty naval ambulance. It had been a long and eventful day, and there was much food for thought. Strangely, we walked more closely together than is the norm for most ambulance crews.

The sailor who had returned from the sea this time was indeed a different man than the one who had left eight months ago. In his absence, the shore he returned to had changed as well.

Be well and enjoy the blessings of liberty.



If you're interested, here is a good overview of the Heimlich Maneuver and CPR. Scroll down and you'll see how it can be a bit tricky when it comes to little ones. The important thing is to clear the airway and do your very best not to cause additional injury.