Perspectives.

The following events are not fictional, but they may have happened at different times, with different people, at different places. Each one of the authors has had patients just like these, in situations just like those described. If you want to know what it's like to live a day in the life of an ambulance driver, or a small town cop, or a small town ER nurse, join us for the story.

It's the same story. On the same night. With the same people.

This is part of what we do, and working with EMT/Paramedics and nurses like these is part of the reason we do it.
_ _ _ _ _ _ _


God, but I'm tired. Even though I've gotten what I thought of as "enough sleep" during the day, it has neither been enough nor of the quality that can keep a man's eyes from wanting to droop at... well, the dash clock of the Crown Vic cruiser says "03:02 am." Still four hours left on shift in this old country town. Surprisingly, I haven't found anything of interest all night, though it's a warm weekend night. What the hell kinda kids they rearing these days? To quote my old FTO: "Sheeeit. If I couldn't make it go no faster'n' that, I'd park it."

But you know-- it is about lunch time, and I think I've earned myself an omelette at one of the all-night places in town. The Golden Hour for drunks has just about passed, and nothing much is gonna stir until about 05:00. I'll just wander on into town, drop by Dispatch, pick up any returns and signed PC affidavits, and run by Denny's... no, IHOP... no, Denny's... (or maybe Taco Cabana?) for a little sumpin' sumpin'. Supper with the family was a long, lonnnnng time ago. Let's see: I really could dig some good coffee, and IHOP grinds their beans fresh and puts the whole coffee pot on the table, so that's probably the way I'll go. . .

The radio burbles on about stuff in other towns throughout the county that doesn't matter to me. I wish they'd get another channel or two and dispatch by region. I don't care what's going on 20 miles out of my town. But this is the system they've used for decades, and will probably continue to use for another one. I mutter to myself. (I've been doing that a lot, lately. Hmmm.) Then:
"Attention all units: Attempt to locate reckless driver, westbound FM 123 west of Sleepytown. Caller reports a red Toyota SUV, license plate unavailable, almost ran complainant off the road. Caller reports that the vehicle is alternating high and low speeds, currently traveling 45 mph, running from ditch to ditch. Caller is still behind the actor vehicle in a white Ford SUV. County clear, 0304 hours."

Well, crap. That's just a little west of here. If he's as bad as all that, there's a chance he'll pull over to pee or throw up or run into something, and I can catch 'em. I start rolling west. It's not my call. That SUV is out of my city and getting further away. But it bothers me. With the exception of one of the few houses down that way, he almost certainly came through my town, and I missed him. I think back to the few vehicles that I've seen over the last few minutes. Then again, I was thinking damned hard about what I was going to put in my omelet for the last twenty, wasn't I? I put my foot down.

We've got our own deputy assigned to our side of the county, but he's on another call, according to my MDT. At this hour, there are no constables out, and the troopers who haven't gotten a DWI for the night on the interstate are beginning to head on home. I am without a doubt the closest unit to that reckless driver. And If he doesn't hit something first, I can catch him. If it's a cut-and-dried DWI, I'll be walking out of the jail in two hours. If he's just sleepy, I'll wake his happy butt up, and go get lunch. I grab the radio mic:

"588."

"588, go ahead."

"I'll be en route from just west of my city to try to locate that reckless driver in the red SUV that you just made the broadcast over. Any updates?" My MDT makes a tone, and I know that I've just been assigned to the call.

"588 stand by. 111, go ahead with your traffic."

So unit 111 gets his traffic stop logged. See what I mean? Even when it's dead, a man can't get done what he needs doing.

"588, your caller reports that the actor vehicle is now traveling 60 mph, keeping it on the road, just passing Neal Rd." Well, maybe he was just sleepy. Good...

Then: "588, update: caller reports that the red SUV just went into the ditch briefly. Can you continue en route?"

Sigh. "10-4. I'm about a mile back of 'em. I'm entering the S-curves now." The S-curves slow me down, and I lose a little time. As I'm halfway through them, Dispatch gives me some bad news:

"588, information: Caller reports that the actor vehicle has turned off southbound onto 234, and the caller is continuing on to Bugscuffle. Your location?"

"Still in the S-curves about a mile behind them. I probably won't be able to catch them. Go ahead and notify Bugscuffle County."

"10-4, should I take you off the call?"

"Negative, not just yet, County." Hell, haven't they heard of throwing good money after bad? I'm so dadgummed far out already, I might as well check the area before heading back. I seem to recall that CR 234 has some pretty scary curves in it as it drops down into the creek bottoms, too. I might well overtake that SUV. Ah. Here's the junction now. I crank it to port, turn and burn.

"588, 10-60." In the area. We'll just see what we've got. I accelerate out of the first tight switchback, and brake going into the next one.

I see the steam and the dust cloud first.

- - - -

The SUV is initially not even in view, but through the dust, steam, and darkness I see a glow out in the pasture. The ditch was pretty pitched here, and the old barbed-wire fence on cedar posts was pretty tired, but together they and some trash trees along the fenceline have convinced a Toyota 4-Runner that it really probably shouldn't be attempting what it had done, which was to straighten out a sharp turn, crash through the ditch, knock down a tree, break through the heavily-repaired, rusty old wire fence, and roll. It looked like, given the width of the skidmarks through the gravel at the road's edge, the SUV had been sliding sideways when it hit the ditch. Dropping the outside tires into that ditch was all it would take to make the body roll. The undercarriage had caught some of the fence, and rolled the fence up in it as well, so that when the 4-Runner came to rest on its tires, it looked like it was just parked over a fence. Out in a field.

I get every light in my car turned on. Overheads to keep from getting hit from behind. Arrow stick to get confused traffic to divert around me to my car's left. I turn on the takedown lights to get more light on the situation. I get the spotlight onto the SUV. I even turn on my hazard lights. I get on the radio as I park, and hold the button down for a two-count before speaking. When it's important, I don't want to have to mess with "short-keying," where the first part of the radio transmission is cut off by the repeater not catching up. Also, that pause gets some people's attention, which I need right now.

"588, County: Major accident." We're now supposed to call them "crashes." The idea is that an accident doesn't adequately describe that these things happen for a reason, and that we can prevent them by enforcing the laws, and can determine the cause by correctly interpreting the site. While I agree with the philosophy, my old habits die hard when I'm busy.

I give my location, tell them to get EMS rolling, and ask for a trooper to assist. Hell, it's his accident --excuse me-- "crash" to work, anyway. I grab my big rechargeable flashlight and head over to the SUV, and take a look.

Aw, crap. I am not going to be eating omelets tonight.

I call for a helicopter to be launched.

+ + +

Cops can do that. They'd probably better not do it very often, but if the first-responder sees the immediate need, he can call for a chopper. It's quite a powerful tool that they're giving to a guy who doesn't even have EMT training, and doesn't have any idea about triage. I went to a show-and-tell talk by our friendly neighborhood CareFlight 'copter crew one night, and they said that a round trip transport gets the patient charged $26,000. Heck, that was some years ago; it may be more, now. I'm damned careful about launching birds on my own. I'll put 'em on standby at the drop of a hat, but calling to have them in the air on my own is a very rare occurrence on my part. We've got this crazy-assed ambulance driver who hauls butt to the scenes, and seems to have a pretty good feel for when to hold 'em, and when to launch 'em.

I've got a little bit of first aid training, but I can't claim that I'm trained, in any sense of the word. I was a Boy Scout, and my dad was a cop who had worked his way through high school and college first as an ambulance tech (they didn't have EMTs back then) and then as a hospital tech. Mom had been a medical writer for a major paper, and had volunteered to work in a hospital E.R., many years ago. On more than one vacation trip, we pulled over for my parents to attend to people in major accidents. I've grown up knowing basics like splinting, airways, CPR, and direct pressure. The "ABC" of first responder care priority made sense the first time I was officially exposed to it-- but then, who wouldn't know that? Or so I had thought. Over the years I've learned that a surprisingly high percentage of people don't have enough of a grasp of the basics to save a person's life when they're dying in front of them. I've been told "yeah, but you've got that cop first-aid training." Yeah. Right. People have no idea how basic that stuff was, and it was almost all lecture, except for the CPR. No practical demonstrations beyond breaking Simulator Sarah's ribs over and over again, while blowing coffee breath into her plastic lungs. I know enough to know that I don't know much, and that can sometimes help when I'm trying to decide how loudly to sound the call-out.

I know that a dead-- truly dead-- person can't be brought back. There are times when it frankly makes sense just to call an ME, and keep the medical staff from messing up a scene. In such times, I try to get the best, most level-headed and pragmatic paramedic available to make the initial evaluation. When you're trying to piece together what caused an accident, or even determine whether a death was an intentional act of suicide, homicide, or mishap, you really don't want the single most important piece of evidence (the body) moved before the scene has been properly documented. At any rate, I can accept a fatality. I've seen 'em, and except for the kids, I have never shed a tear. (And I kept right on working through the tears, redirecting traffic while troopers drove pavement nails and measured distances, took pictures, and finally called for wreckers.)

But I've met some decent people whose lives were saved by extraordinary measures taken quickly and decisively. I've also met some decent people whose lives were saved by extraordinary measures taken to preserve the body of an organ donor. I've met two organ recipients from my best friend's little sister. Her heart beats strong 10 years after her body was CareFlighted to a trauma center. Her liver is flourishing in the abdomen of a man she'd never met before a train struck her little car. Good work by small town firefighters and a flight nurse and paramedic gave her family a chance to say goodbye, and to make the decision to honor her wish to give parts of herself to 10 people. So even if you can't save this patient, you can perhaps save another patient by working hard, and working fast.

+ + +

There's a boy in the back, and he's screaming. I holler out to him as I approach, and he goes nuts. I lean in through the broken-out window and see that he's pinned in the back seat behind the passenger side front seat. He's a fat boy of about 20 years, with red hair and a sparse beard. His broad face is pinched with pain, and tears are streaming down his face, but he stops yelling when he sees me. First things first: "How many of you were in the car?" I ask.

He moans. I think at first that he didn't understand me and I begin to ask him again, when he says, "James. Bobby. Arnie.... Arnold. My legs. I think both my legs are broken. I can't get them out and it hurts to move them." They must hurt a lot-- he's not mentioned the obvious compound fracture in his right forearm, or the cuts to his face and head.

"Stop moving. Four? There were four of you?" I demand. I can smell alcohol in the air, and I see someone sitting on the ground on the other side of the 4-runner. At least he's sitting up. That's two. Where are the other two? He groans and nods with his eyes squeezing out tears from the pain that he's in.

The kid is trying, but I've got to push him-- I suspect that he's going to pass out soon, and for all I know, he has two femoral fractures. Sharp bits of shattered bone floating around next to a pressurized artery the size of your thumb can make a dumb drunk kid into a death notification very quickly. He begins to moan and reach toward the door again. "Listen to me: Don't. Move. I need you to sit very still," I order him. His moaning rises into a quiet closed-mouth squeal, as if my very words have made it worse for him. "Do you hear me? Do you understand me?" I demand in my best cop voice. He opens his eyes and nods.

"Where are the rest of them?" I ask, thinking quickly that I've already wasted too much time. I've been on scene for almost a minute, now.

"588, can you give me a size-up?" the dispatcher reasonably wants to know over the radio.

"Rollover accident, One white male trapped, conscious and breathing, with probable femoral fractures and other unknown injuries. Stand by for further."

"Jimmy was driving," he says. "Arnie was sitting in front with him. Bob was in back with me..." He says, and stops to gasp.

I jot down in my pocket notebook "Jimmy-- (FL); Arnie-- (FR), Bob (RR)."

"What's your name, kid?" I ask.

"Tony... Anthony Willis." I want more, but I've got to find the other boys.

"How old are you, Tony?" ("Tony-- (RL)," I scrawl in my notebook)

"19," he manages to say.

Jeez. I've been calling him 'Kid,' just out of hand-- with that beard and his size, I figured that he was well into his 20s. But 19-- he's a teenager! I look at his face again. There are glistening tracks running from his eyes through the dust on his cheeks. I'm only 35, but I guess that I'm feeling a little old, all of a sudden, which perhaps explains the unexpected paternal feelings that spring up.

"I'll be back, son," I promise.

"I think Arnie went out the window-- help Arnie!" he says. I'm already walking away.

I'm looking. Searching. I'd seen that the windshield was gone, and now pray that it doesn't mean an ejection. Tony's most recent statement is kind of cryptic-- did Arnie "go out the window" by crawling? Or flying? I check in front of the FourRunner, and find the busted windshield, still attached to the frame by a long strip of black rubbery crap, lying in the tall grass immediately in front of the SUV. Great. That tells me nothing. It could have been kicked out by the front seat passenger, or thrown out by the impact. I trot over to the bare-chested kid on the ground.
He's sitting on the ground, legs splayed open, staring at the big puddle of vomit in his lap. A long stream of what I'll charitably call "drool" connects his chewed-up lip to the puddle in his lap. The enormous amount of alcohol that he's consumed, stirred up, warmed up, and re-introduced to the outside air makes his vomit surprisingly strong-smelling. And... it looks like he's had something with peas and carrots recently. He's still looking vacantly at the ground in front of him. "Hey kid!" I say to him abruptly. I really don't have time to move at Drunk Speed. I crouch in front of him quickly and put my light in his face.

He doesn't move. He doesn't say a word. He barely blinks. But I can tell he hears me. I can tell that he's thinking as fast as his addled brain will allow him to. He's heard how he has the right to remain silent. Sitting drunk on the ground just outside the driver's side door of a vehicle that's just wrecked, and he's thinking, if he opens his mouth, he might get in trouble. To say that I have a doubt in my mind that he's the driver would be like saying that I have a doubt in my mind that the sun will rise this morning. I glance at my notebook. "Jimmy. JIMMY!" I yell at his face. He stirs a little, then looks back at his lap. Most of the puke has slid into the dirt, now. I put a hand on his shoulder, and shake him a little.

"Jimmy, I need you to tell me where your friends are. Where are Arnie and Bob?" I ask him.
He doesn't say anything. Maybe he does have a little light-running shock going on. But he's not even trying to help his buddies, and I hate him for that. I get up.

Time to do the search right. I start my sweep with a quick zig-zag in front of the SUV, extending out in a widening cone, the point of which is at the point of departure from the road. Objects in motion tend to stay in motion, so regardless of the orientation of the vehicle now, bodies thrown will be basically in line with the direction that the vehicle was traveling when it lost control. The SUV rolled at least once. If my victims were thrown clear at the shortest and fastest part of the lever arm of a rolling vehicle, they can be a long, long way out. The tall grass, which is uniformly knee-high coastal hay grass and buffalo grass that's flourished in the spring rains, is both a blessing and a curse. It probably helps reduce injury, but it hides the victims. I pull the Stinger flashlight off of my belt, and hold it and my big SL20XP duty light high above my head in each hand, light twin headlights, pointing down from their 8 foot vantage point to the grass about 20 yards ahead of me, swiveling back and forth. The headlights and spotlight from my car about 50 yards back help some, too. I look at my notebook again. Why can't I remember simple first names?

"Bob? Arnie? Robert! Arnold!" I call. I get no response. "Yell out to me, so that I can come help you!" I mean to sound firm, but I'm afraid that I detect a note of pleading in my voice. The Man In Charge does not plead. He gives clear commands. To some this sounds cocky, but experience has shown me without a doubt that it has nothing to do with ego, and everything to do with getting done what needs doing. (Which may well be saving a life or two.)

I must have passed him by about 15 feet. You'd think a man-sized boy would stick up a little better than that. I find him on my way back from my first quick sweep. I look back to the SUV. Not too far-- about 50 feet. Where's the other one? This guy's on his side, with his arms pulled up in front of him, wrists crossed in front of his chest. His legs are (I hate this word, but damned if it isn't descriptive) akimbo. I'm on my knees, checking for breathing -- ragged-- and reaction to stimulus. His eyes are open, and he's not doing well. He doesn't answer me. His eyes don't move in response to my light. The breathing sounds wet, and reflexive. Crap. Agonal breathing? I don't know. I'm out of my depth.

I pull my mic off my shoulder, key the mic for a second, and call in: "588, E.T.A. on medics?"

An unexpected voice with sirens comes over the air: "Medic One to 588, ninety second ETA." It's Ambulance Driver. I reckoned that he would be out tonight, and I'm glad to have him responding first. "What have we got?"

Well that's a damned good question. What DO we have, in twenty words or less? Something I learned a while back is that it's better to take your time and say it once correctly, than to broadcast it quickly and incorrectly. Huh. For all I know, the fourth guy's fine and has gotten help. Or he's dead. Or he's dying here in the grass, somewhere. Or he's under the FourRunner. (Oh yeah-- I already thought of the death possibility.) Well, let's give him the bare basics. "Rollover with an ejection. Two critical, one moderate, one unaccounted for. County, please advise our Fire Department that we will need extrication for one of the critical patients." Normally I would go into the age, sex, race, and whether they're conscious and breathing, but I hear a distant siren. Just get here.

"County is clear direct, 588, and be advised that 1176 and 451 are en route to you location, as well," responds County Dispatch. That would be a trooper and a Sheriff's deputy sergeant. Since we're well out in the county, this accident will be theirs to work. Aw, who am I kidding? It's the trooper's accident to work. A good deputy is a joy to behold and a wonderful man to have on your side, but he ain't gonna work a major accident when a dedicated state accident investigator is on the scene. Oh, he might help measure, and photograph, and document, and move wreckers and block traffic, and all the other stuff that may well actually require more physical work than the actual accident investigation. But the signature at the bottom of the CR-3 form is the signature of the man who's going to get called into criminal and civil court when this is all through. That's what the state boys in dove grey and the spray-painted hats are paid to do.
My kid (Arnie or Bob?) is having serious trouble breathing, now. He's aspirated a lot of fluid, and while I hope it’s vomitus, it's probably blood. When you're unconscious, either one will kill you. At least he's on his side, and his airway is clear, from what I see. I reach behind me to the little leather pouch on my duty belt, in which I keep a pair of rubber gloves. It's supposed to carry two pair, but I wear extra large (XXL when I can find 'em), and I can only get two gloves in and get it to reliably stay closed. The other guys at my P.D. think I'm a little silly for carrying the pouch, but I've never found that I can plan on when I'll need them. I glove up, thinking that I might do a quick mouth sweep of the kid, and then think back to my old training. Nope. Why give the medics yet another patient? (Teeth!) I use my light and confirm that his mouth is relatively clear. And I see the blood. Dammit. Maybe his just bit his tongue. But even with my minimal training, I know that this kid's probably not going to make it.

We'll do what we can.
_ _ _ _

By the time Ambulance Driver's done a once-over at the scene, it's clear that he's decided that this boy --Robert or Arnold-- is not worth working on for the time being. That's actually being unfair to A.D.. I understand triage. It's the process of deciding how best to allocate your resources. Triage saves many, many lives every hour of every day. It's not about emotion, it's about fact. It requires a person with medical training to use protocols to determine where next to apply his efforts, which sometimes means cutting your losses. I get that. But I also think back to my best friend's little sister, and the lives that were saved because they got her to the hospital in time. I think back to how incredibly important it was to my best friend's family to get to say goodbye before they harvested her organs. Before you accuse me of being too emotional over what was essentially keeping a corpse alive, consider that. Consider his parents. Consider the lives that deserve to be prolonged, and can, by this young man's family's gift. And yes, dammit, consider the chance that he might pull through.

I volunteer to give a hand 'til more medical help arrives. Ambulance Driver suctions the boy's mouth and hands me some device that I've seen at scenes and on television, but never used-- this one looks like a mask with a latex football attached to it. He has me breath for the kid by compressing the bulb and letting it self-inflate, and runs to help the other boys. I see the drunk, bare-chested kid --Jimmy?-- is still sitting near the wrecked FourRunner. Good. Other cop cars are arriving.

Trooper 1175 and deputy 451 arrive and begin working the scene. Even better. They each put their cars at the distal ends of the curve, the apex of which we're beyond. Frankly, I'd rather they put them even further out, to have their gumball machines warning other drivers of the crash site. Secondary crashes are not uncommon, and often are far worse than the initial crash. And with our closest first responders already tied up, a secondary wreck could be catastrophic. I'm kinda liberal with flares at an accident scene, and if I'm on the road (which I'm not, tonight), I put on my orange reflective traffic vest. If I had a magic feather, I'd stick it in my hat, too. If I wore a hat.

The trooper looks in the vehicle, and then begins to talk to the bare-chested boy. I look down to the kid I'm helping-- has that mask slipped? Pay attention to what you're doing, Matt. The trooper knows his job. I peek up again. The trooper has the boy standing, and the boy is talking, now. Oh, good. I hope the trooper is running video and audio.

I try to check the kid's pulse at the neck. None! No, wait. I reposition, remembering not to use my thumb lest I feel my own pulse. There. It's weak, but rapid. I can't operate the breathing bulb and feel his pulse and look at my watch all at once, but I know it's fast. Vague memories of descriptions of the symptoms of shock fill my mind. I touch the kid's hands. Like ice. It's 68, 70 degrees out. I should have a blanket on this kid.

"Shock kills," said my old Boy Scout scoutmaster almost a quarter century ago. "Keep 'em breathing, keep 'em warm, don't let 'em bleed out, and don't screw anything else up, and you'll be doing your part," he'd said, around a wad of Red Man. "But don't let me catch y'all usin' none of those warmup techniques in the Manual involving stripping the victim down nekkid and using your body heat to warm 'em up. This is NOT that kind of troop!" by this time he had been grinning, and us boys had been howling. Even now, I start to break into a grin, and realize that I'm again not paying enough attention to the victim I'm attending, in the here-and-now. Focus now, A.D.D. Boy, and we'll get you a nice Ritalin lolly, later.

I consider my mood. I'm not upset. I'm not particularly excited, actually. I'm now in a rhythm, of a task I only started for the first time a few minutes ago, and I'm actually a little distracted. I know that I'm probably only helping with organ preservation, and that's fine. But then again, I've seen some pretty miraculous changes in human beings when the right "switch" is thrown. I've seen an ER doc give a shot of sumpin'or'other to an incoherent dopehead, who instantly lost his buzz. I've seen a medic shove some sugar paste into the mouth of a near-comatose diabetic patient, who 30 seconds later became as aware as Sleeping Beauty having newly been kissed. I watched my first daughter enter this world after a 23 hour labor, with the cord wrapped so tightly around her neck that it disappeared in the folds of her skin, and her body was uniformly ashen-blue with periwinkle highlights, so dead-looking that the APGAR score of "2" that they gave her was a gift-- only to pink up like a Valentine's Day heart after they gave her some O2 and suctioned out her airway (and then go on to be in the Gifted & Talented program at school). I've seen multiple-fatality accident scenes have the number of fatalities revised downward (twice, on one occasion). So turn-arounds do occur, whether you want to classify them as "saves" or routine. So we'll plod along on this one, and see if we can't give someone who knows what he's about a chance to push a turn-around.

But this ain't my job, I think. I'm an over-educated jack-of-all trades. I know how to do a lot of things in law enforcement, and some of 'em I do pretty well. One of them is scene size-up, and calling for the necessary help. (Harder than it looks, at first.) Another is on-scene interrogations and interviews, in a manner that gets me some information to do the job right away, but which also can later be used in court. With some cops, it's either-or. I like to make it both. In short, I'd like to be over there, talking to that pukey boy that wouldn't talk to me when I first rolled up. Jimmy. I want to get it nailed down who was the driver, because I know that the driver's going to be charged with Intoxication Assault, and I strongly suspect that it's going to end up being Intoxication Manslaughter. As such, this is a crime scene, and I want to make sure that we have good evidence and statements that we can use in court.

Finally, a couple of volunteer fire-fighters come on over. I'll never understand why they have to wear all that bunker gear when there's no fire, but I feel a certain kinship with them for that-- after all, nobody's shooting at me, but I've got this damned Level II vest on. There's not really much to pass on to them, other than that I found him unconscious and breathing with some difficulty, and that his pulse was hard to find. I also ask them if they can get some of the other responding firefighters to sweep the area in a grid search to check for my last crash victim. "His name is either Robert or Arnold," I tell them. The one not now squeezing the bulb gets on his radio, and calls some of the other fireman over. Looking at them, I don't think that they've got much more experience with that bulb-thingy than I did. But that's part of their job. I've got mine to get to. I head back to the Four-Runner.

Firefighters have dragged over a portable air compressor and Jaws Of Life and a gasoline-powered grinder wheel, and are about to open the SUV up like a can of sardines. I hear a distant whump-whump-whump of a chopper, and look around. I spot the fire captain and ask if he's the incident commander. He says that he is. I tell him that the chopper's inbound and ask him if he needs any help with the landing zone. I've got some other stuff to do, but it's kind of important to make sure that the chopper has a good, safe, clearly-marked L.Z. to land in. "Naw. I've got 3 guys in that field," he points out into the field I just walked out of, and a hundred yards away are the flashlights of three firefighters radiating away from the strobe that they've just placed on the ground as a marker. I tell him that we're looking for a fourth accident victim, who may have also been ejected into the field, and he nods, thinks for half a second, and says that he'll get his guys looking after the extrication and the chopper lifts. It makes sense, really-- treat what you have. The fourth guy may be dead, or have run off. Either situation is not an emergency. Or, he may be in dire need, but the time and manpower used to find him will cost care to other victims. I nod and let him to his duties, which at that point involve multi-tasking the set-up for extrication and talking to the CareFlight pilot by radio.

I go to the door opposite the side the firefighters are setting up the equipment on, and talk quickly to the fat kid trapped inside. I get my notebook out, and make sure (again) that my body mic is on. I look at my barely-legible scrawl.. find R.L (rear left), and decipher the name next to it. "Uh, Tony? Who was wearing the red-and white striped shirt? Arnie or Bobby?"
"Agh. Bobby, I think. With an alligator on it. Didja find him? Is he okay? What about Arnie? Ooh!"

"Yes, I found Bobby. The medics are with him now," I respond. "We're still looking for Arnie." I quickly get Arnie's and Bobby's last names from him, and their ages: 18 and 19 years old.
"We were camping on Arnie's folks' pasture..." he says.

I take a second to get some more information. "What's your date of birth?" He answers with a date that I calculate makes him 19 this year... okay, 18 years old.

"What's your address?" I ask him. I know that somebody's going to need to contact his folks tonight. He gives it, stopping to pant and moan in the middle of its short recitation. The air compressor fires up, and the chopper is getting closer, and people are yelling to be heard, and my radio is going off in my left ear, and and another VFD firefighter is arriving with his siren going, and someone's calling my name I think, and all these things are trying to distract me, and... Everything focuses on this kid for a second. He's crying. He can barely get the words out, and halts to gasp:

"Officer. We were camping... we all were drinking some, but Jimmy and Arnie-- they were drinking a lot more. We were going to go out mudding in the four-wheeler and then fish, but I didn't want Jimmy to drive. He wouldn't let me drive. I know I shouldn't have been drinking, but I was more sober than them. He drove so fast, and he wouldn't stop, and wouldn't let me out!" It all comes out in a flood. When he stops, he begins moaning. "My legs hurt so bad. . ." his voice is lost to the sound of the gasoline-powered grinder firing up and biting into the SUV frame.

This flood of comment sounds like... what? A confession? No. It sounds more like a dying declaration. I've never heard one before, but so help me, that's what this kid is giving me. He thinks he may die. And, to be honest, he could, if his femoral artery is cut and they can't replace the pressure stopping the flow that the seat crushing him now may be providing.

But he's said it: Jimmy's my driver. Jimmy's my bare-chested mute puker. Jimmy's my suspect. I go to find Jimmy.

Jimmy, it seems, has decided to start talking. "What happened to my car?!?" he demands to the world in general.. "Who did this to my new car?!?" He tries to put some real outrage into his voice, but it's not very convincing to the trooper, the deputy, or the EMT he's talking to.

I walk up to the deputy, and tell him, "Arnold DeLima is missing, and the kid in the wreck tells me that they were camping on the DeLima pasture near here. Doing some fishing and beer-drinking."

The deputy smiles and says, "I'll just bet that we'll find young Mr. DeLima down the road, then." He radios dispatch to have another deputy run by the DeLima house to check on the welfare of Arnold. I hope they find him. I hear dispatch call out the address of the DeLima house to the other deputy, and I write that address in my notebook next to "Arnold, (FR), DeLima, 18 y.o.a."
I turn back to Jimmy. He's protesting alternately that he was a passenger, that he was in the back seat, that he wasn't even in the vehicle, that he was in another vehicle following that left, that he walked up on the accident scene.... all with blood dripping down his forehead from where it hit the door frame and perhaps the window or windshield.

I'm really kind of thinking about how nice it would feel to slap the kid.

Mr. Clean, one of our volunteer firefighters who stands an inch taller and 30 lbs heavier than I do and has a shaved head, grabs him by the shoulders and begins telling him angrily while shaking him a bit that he needs to know precisely where Jimmy was sitting, so that he can treat him properly. Mr. Clean is doing this for us, and the questions are worthwhile, but the hands-on approach is a bit heavy, and won't help us in court. The trooper turns away. I put my hand on Clean's shoulder, and he stops.

"Jimmy?" I ask.

"Yeah?" he looks askance at me.

"What's your full name and date of birth?"

"I already gave..." he begins.

"And you'll be giving it again," I smile encouragingly and tell him.

"James Ashley Heaton." He gives me his date of birth. 19 years old.

I pull a card from my ID case, and quickly read him his Miranda warning, asking him after each right if he understands them. He says that he does, with wide eyes.

"Am I under arrest?" he asks.

"No." I tell him. I consider saying "not yet." Sometimes that helps-- they'll talk and talk to forestall arrest. But I decide not to put it that way, just yet.

"So where did you drive from?" I ask Jimmy.

"I wudn't drivin'!" he protests. Then, "Who stole my car?!?"

"Okay. Now, that act isn't going to work," I admonish him. "First, I've got a witness that put you in the car. Second, you're bleeding from fresh scrapes to your head, like, you know, from a car crash, or something. Finally, a minute after the accident had occurred, I found you sitting on the ground in the open door of the car. So, you want to revise your statement about who was driving?"

"Okay, it was Tony! Tony was driving! That fat drunk sumbitch!" he declares.

"Tony was driving. Tony Willis." I mean it as a question, but it comes out flat.

"Yeah. He drives crazy! Wouldn't let us out...."

"So that's your new, revised statement. Why didn't you tell us that in the first place?" I ask reasonably.

"Cuz I was scared! And, uh, 'cuz I'd been in a wreck and was shook up!" he's kind of shrill now.

"What happened to my car?!?" he suddenly demands, for no reason I can see.

"Uh, Jimmy-- you've already admitted now to being in the car. You KNOW what happened to it. Now, where were you sitting? In the car? During the wreck. Which you were in?" I'm speaking with patience. I'm speaking with calm reason. I will not slap this kid. I will be as nice and professional and courteous as I can... while I work up a case to put his ass in prison.

"I was in the, uh, back left seat," he says.

"Back left? With Tony driving?" I clarify.

"Yep." he actually crosses his arms now, with a set jaw and a nod, to let me know that This Is His Final Answer.

"So, let me get this straight. First you lied about not having been in the car during the accident, and now you're telling me that you were sitting in the back seat, and the driver of the vehicle was the kid that those firefighters over there are currently extricating from the seat position which you're telling me that you were sitting in, where he's currently trapped and crushed under the front seats?" I ask him.

I let it sink in for a few seconds. His watery, bloodshot eyes tell me that he doesn't fully get what I'm telling him.

"You're lying again, Jimmy. You couldn't have been sitting there, and he couldn't have been driving." I tell him. "You've got one more chance to redeem your credibility."

"I wudn't driving!" he blurts out.

The trooper has come back, and asks one of the EMTs from the second ambulance if he can take Jimmy inside the box for some privacy. I know why, but our intense fireman Mr. Clean doesn't immediately get it. His eyes light up and he grins as he murmurs "tune up time?" I snort, as I climb up on the back bumper to block the window with my body. Mr. Clean has seen too many movies. We cops don't "tune up" suspects to get confessions. The whole trade-off of getting a worthless confession versus losing our job, getting sued, and going to prison just really isn't that appealing. And those that might consider it worth doing wouldn't ask to take the suspect into a borrowed ambulance box with a dozen witnesses around. Plus, "tune up" is more of a prison term, anyway.

The reason that I'm using my body to block the back windows of the ambulance is because I'm trying to assist the trooper in his investigation into Jimmy's suspected level of intoxication. Or, I should properly say: his intoxication. The test that the trooper is administering to Jimmy in the ambulance is not designed to detect the level of intoxication, but whether the subject is or is not under the influence. The test, Horizontal Gaze Nystagmus, is probably the single best field tool in establishing intoxication. It's a simple test that looks for involuntary twitching of the eye while following a stimulus (usually a pen). But it requires that no flashing lights be visible to the subject, as strobes (which can cause eye twitching) can invalidate the test. With two ambulances on scene, a helicopter, 3 police cars, a brush truck, an engine, and a couple of POVs outfitted with strobes so that volunteer fireman could respond directly to the scene, there's no shortage of flashing lights in the vicinity of the crash site.

I use the time to get the driver license info on the four boys from the dispatcher. After six minutes of standing on the back bumper of the ambulance, I look in through the window and see that the trooper has moved on to interviewing Jimmy, and I step down. I see the deputy's face has a bit of a grin on it as he cocks his head to listen to his radio, tuned to a different channel than my portable. "Well. They found Arnold DeLima," he says.

I know he wouldn't be grinning if it were bad. "Where'd he run off to," I ask.

"Home. Hell, he just lives over the hill, yonder," he beams. "I sent another deputy over there to check on his welfare. Turns out, he's pretty beat up. Cuts and bruises. Probably needs stitches and a bone set. They're having an ambulance respond mutual aid to take care of him. Our deputy, ah, is accompanying him."

Well that's good to know.

They've finally got Tony out of the SUV, and have splinted the hell out of him, with immobilized neck and back board. I can barely see the kid for all the parameds, EMT's, and firemen crowded around him as they take him to the helo. Gawd, he must be bad, if they're needing all those people... I think, and then realize. No, you moron-- he's about 300 pounds by himself, and that ground's rough over there-- they need the extra people to move that kid to the helicopter.
The other kid --Bobby-- has been put on a backboard and taken into an ambulance by AD and his sidekick. I feel a little better about the kid-- they don't seem to be too frantic. But then, they wouldn't be if they knew that it was all for nought, too. They get fired up and head to the hospital. I consider that they hadn't CareFlighted Bobby, and I hope that his mother gets a chance to say goodbye.

"You got it?" I ask the deputy. The scene's in the County, after all, and the trooper will shortly be taking Jimmy to the hospital for his blood draw. All the deputy has to do is wait for the wrecker and see that the road is clear.

"Oh, sure," he says, as he begins to fill out an impound slip.

"The kid who was CareFlighted-- he lives in our city. I'll make the notification to his family," I tell him.

"You gonna contact the other kid's parents-- the one who went by ambulance?" he asks me.
"They live at the other end of the county. Maybe we can get Piddling Point P.D. to drop by?" I said. "He's probably not going to make it, and will need a personal notification. Who's on over there, tonight?"

"297. Here." He pulls out his cell, and pulls up a phone number that he recites to me. "Call him direct." I look at him questioningly-- most of us don't have each phone number for each of the 100-odd other cops in the county. "Eric and I went to academy together. He can give a good notification."

I get in my car, and mark my times on my patrol sheet, using MDT for reference. I sign myself out "On Follow-Up," and call unit 297, cell phone. I give him the run-down of what's gone on, and ask if he could run by the boy Bobby's address and try to notify his family. I tell him the hospital that they've taken him to, and explain that the boy might not make it.

"Time sensitive, or stable?" is all he asks. I admit that I don't know, but repeat that AD didn't seem to feel he was viable.

"I'll probably end up giving them an escort, then," he says, and hangs up to do what he can.

With that taken care of, I head on back to my own town, and go to the address of Tony, the CareFlighted boy who cried to me. I negotiate with three dogs before gaining the porch of the tired old house. Junk is piled around on all sides. I bang on the door with my knuckles, then the side of my fist, and finally with my flashlight, before I hear someone stirring toward the door. I illuminate myself with my flashlight, and announce myself. Getting myself shot on their front porch would not be helping these citizens. For that matter, it wouldn't do me any good, either. The door flies open, and a very heavyset older woman asks what's wrong. I ask her relation to Tony, and she says that she's his grandmother, who Tony lives with, because he and his mama don't...

I interupt. "Tony's been in a bad car crash. He's hurt, but he's being taken to a very fine trauma center by helicopter." I have to say it kind of quickly, because she's starting to get wild-eyed, and I know that the crying is about to start. When her husband appears in the door buttoning his overalls, I could hug the man.

"What's this about Tony being hurt?" he asks me with hard eyes. He doesn't want any window dressing; just get down to brass tacks.

"He was in a bad car wreck with three other boys. He was conscious and able to talk to me when I arrived. He may have broken his legs, and he's broken an arm. Right now they're concerned about the legs, which is serious. But they got CareFlight to take him to Big City Trauma Center, which is the best emergency care around," I reassure him. "Can y'all drive? Do you know how to get to Big City?"

He assures me that they do, and that he'll be taking his wife. He's concerned, but not hysterical. She is just about 2 clicks shy of hysterical. I have her sit on a bench on the porch, and repeat for her (she had been heaving and crying before) the bit about the good care he was receiving. Then I worry: What if he doesn't make it? Are you setting them up for the worst surprise? But Big City Trauma is 48 miles away, and I can't give them an escort all the way there. I need them to drive calmly. And besides-- I haven't lied or embellished-- I'm telling them what I believe.

While she goes back inside to dress, I check with GramPaw a little more-- the boy is his wife's grandson, he tells me, and he's been in trouble before, but he's a good boy. Light of their life.

I see no reason to mention the loaded marijuana pipe I found in the SUV.

"Tony made an effort to tell us what happened at the scene," I tell him. "He was honest about the fact that they'd been drinking some, and that helps us know what happened." I think about that pain-wrenched confession that he made, and wince.

I get out a card, and think for two beats before putting my work cell phone number on the back of it. You keep giving out that damned cell phone number, and you'll have no one to blame but yourself when they're calling you at all hours. "Please call if you need anything." I tell him, and he shakes my hand.

As I walk back to the car, I key up my portable radio. "588, County: Ten-8." Clear for calls.

It's in somebody else's hands, now, I think.