It’s been over five years since I did my last shift in the ER so I’m fresh out of fresh ER stories. This, however, is sort of an ER story from the eighties. The patient needed a level one trauma center and a social worker and all he got was me. Shortly after this incident I went to UCLA and attended Emergency Medical Technician school. When you are the only medical professional in your little village, people come to depend on your judgement. I had a friend about half an hour away with a clinic and he would see anyone I brought to him free of charge so I guess I was a triage person. If I was going to have that responsibility, and it didn’t look like there was any way out of it, I’d need to buff out my skill set.
Bob Lanz LCSW EMT
DEATH ON THE HIGHWAY
I’m not the first guy to have trouble with his moral compass while traveling. Hell, that’s why a lot of guys do travel, to work out the kinks in their moral compass far from home. But this isn’t a story about drugs or sex or smuggling or any of that other stuff that is so much fun while on the road. This has to do with my real moral compass. What was the right thing to do? And how much was I willing to pay to be morally right?
The evening started out nice enough. I was staying at a little fishing village catching a few waves and hanging out, chilling in the balmy tropical air. I had made arrangements to go to a friend’s house for dinner about 30 minutes away and this was long enough ago that no one had phones so meeting someone for some reason was always up for confusion and revisions.
I pulled off the dirt road onto the paved highway that headed through the mountains over to Banderas Bay. The night was warm and the air was thick with the smells of wet jungle and all the bugs you could ever want. I had picked up an older couple at the crossroads, as any reasonable person would do, and in the direction I was headed I could get them pretty close to where they were probably headed too. I make it a practice to go reasonably slow while jungle driving in the third world, especially in a vehicle like the Jeep-no top and no seat belts. A lot of things can go wrong in the jungle, on the highway, in the dark-well, you can see where this is going.
We crested the highest part of the hill between the ocean and the bay and were dropping down nicely, with the wind in my hair and too much noise to have much of a conversation. My linguistic skills constantly suffer from what I can only think must be brain damage of some sort and it causes me no end of embarrassment. Sometimes, during rambling conversations I have lost control of, I realize it is better to not even get started with anything more complex than Buenas Noches. So when we first saw the motorcycle lying on the side of the road, no one spoke. When I noticed that there was a guy laying in the ditch about fifty feet from the bike no one spoke and my first thought was maybe they didn’t see what I saw. Kind of naive for me to think that and here’s where the needle on my moral compass was about to get a workout. Here’s where it would become painfully obvious that they had a different moral compass than I did. A south of the border compass or maybe they didn’t need a compass of any kind to know where they were going. They sure as hell didn’t need a compass to know what could go wrong here.
Having worked in an emergency room for several years, I was a lot more confident of my medical skills than my conversational ones right then so I came to a stop and jumped out to assess the situation. There was a young Mexican guy on his side curled up like he was sleeping. Now I had traveled in Mexico enough to think this was a possibility. Some intoxicated guy decided this is where he needed to sleep so he just laid the bike down and assumed a fetal position beside the road. Once in Arizona I saw the same thing on one of the reservations and all the locals laughed and thought it was funny when I stopped to help the local drunk that apparently made a practice of passing out on or near the roadway. But not this time. I noticed that the guy had blood coming from a scalp wound and he was making gurgling sounds. The blood had already coagulated which meant that no one else was willing to stop and help him. That was an important clue.
A couple of other cars stopped when they saw me stop first and I tried to get one of them to go to town and call an ambulance. It would be a futile gesture as I could pretty much see that this guy had a major head injury and would probably die no matter what level of care he got. The nearest ambulance was at the state line about twenty minutes away-and they were on the other side of the line and might not even come to where we were. There was an increasing number of gawkers stopping but no one was doing anything to help the guy so it was pretty much my show. There isn’t a lot to do first aid wise for a major head injury and the cut had already stopped bleeding. What this guy needed was a helicopter ride to a level one trauma center. What he got was a helpless gringo who wanted to do something but couldn’t.
The couple riding with me were trying to get me to just jump in the Jeep and leave the guy there and have him be someone else’s problem. Another valuable clue. Let’s see if I can get this right. They were afraid of getting in trouble with someone and didn’t want to stick around. I was driving and I was a gringo and I could easily be blamed for the accident and I could go to jail or have to pay a big bribe or both. On the other hand, no one was going to help this guy but me and I was a medical professional and had certain beliefs and ideas about taking care of people who needed help. I couldn’t just leave him there alone but if I stayed maybe no one else would send for help and if help did arrive I could be blamed. No easy way out of this one. And the couple kept telling me that we ought to leave.
This might not have turned into a real moral quandary for another person with a different compass. That wouldn’t be me and I knew what I had to do but I would have to be in stealth mode. So when the couple was momentarily distracted by a passing bus I jumped in the Jeep and took off, yelling back to them that I was going for help. Like it or not, it was their problem now as they were stuck in the jungle in a low traffic zone. I drove as fast as I could to my friend’s house and he took me over to the police station telling me on the way not to mention to the cops that I had stopped. Everyone seemed to have a much better handle on this situation than I did, in terms of the danger factor.
The police in this little town were state police. That meant they were cowboys. They wore cowboy boots and Levis and cowboy shirts and cowboy hats and had big cowboy belts with big cowboy buckles. They carried cowboy carbine rifles and half of them carried their pistols just stuck into their waistband and aimed at their dicks. Very macho cowboy cops. They jumped into their cowboy pickup and followed me back to the crash site where things hadn’t changed much since my departure. The couple I had temporarily abandoned did some significant scowling but I had a Mexican of my own with me and the cops with us too so there wasn’t much more than scowling they could do. With all the clues indicating a discrete exit would be the prudent thing to do, and my friends dropping some serious hints too, my compass was still overriding my judgement. I know what needed to be done. That dying guy could easily have a broken neck and he should have his spinal column stabilized before being transported. I figured the cops would call an ambulance and the ambulance guys would know something as basic as spinal stabilization. I guess I was still in some sort of lame denial zone.
The cops picked the guy up and laid him down in the bed of the pickup with no attempt to stabilize his neck so if it was broken he would now be facing paralysis, if he lived. Just when I thought it couldn’t get any worse, they threw the guys motorcycle in the back of the truck with him. When they turned on their lights and sirens and took off, the motorcycle fell over and landed on the guy’s head. The couple was no where to be seen when we left, watching the flashing lights and truck disappear into the night. I never saw them again and that was all right with me. Later I figured out that they were a lot smarter than I was.
A few days after that I found out the guy was taken to the little hospital in the next village up from where I started the evening. I’m sure there was no trauma team waiting and I’m sure there was no neurosurgeon to read his CT scan and I’m sure there wasn’t a CT scan machine anyway. While he was waiting to die the school buses from the neighboring villages brought the kids by the hospital on their way to class, marching them all past the soon to be dead guy’s bed until one of them took a closer look and said “Hey. That’s my uncle Jose.”
A least when Jose died, they knew who he was and he didn’t have to die alone.
That was best I could hope for I guess…