Read Online Population 485 by Michael Perry - Free Book Online Page A

encyclopedia one day, I hit on it. The most popular tourist attraction in Belgium is a sculpture dating back to the fourteenth century. It is a bronze statuette of… a little boy peeing .

    At first, Travis is completely unresponsive. Then he begins reacting to loud verbal stimuli. That is to say, he rouses when we yell his name. It is a diminished response, however, and he is disoriented. On the initial assessment, in which we scan the patient from head to toe, we find two lacerations on his head. After determining that they are superficial, with no underlying crepitus or depression to indicate an obvious cranial fracture, we control the bleeding by applying simple gauze squares. In the meantime, the rest of the assessment reveals no other obvious injuries. We give Travis high-flow oxygen through a non-rebreather mask, which has a little bag attached to concentrate the oxygen. Because of the severity of his injuries and his deteriorated mental status, we have already ordered the chopper. In the time it takes us to cut him free of the car, we take his vital signs three times. When we get his foot free, we take traction on his leg, holding it straight and checking for a pedal pulse to make sure blood is still being circulated throughout the length of the leg. His upper thigh looks swollen in comparison to his uninjured side, and this is a concern, as a femoral fracture can cause tremendous “invisible” bleeding in which the blood infiltrates the spaces between the muscles of the thigh. By the time we get Travis on the board and free of the car, the helicopter has arrived and landed on Pine Street, right in front of the old lumber yard. We give report to the flight nurse, help load Travis into the chopper, and away he goes.
    By this time, Tricky has been handcuffed twice and released twice. He alternates between demanding treatment and refusing it. He asks us to produce a release form, then refuses to sign it. At one point Tricky puts his wrists in my face and demands that I document the red marks from the cuffs. I track down Bill, the quietest patient. He is sitting in the back of a pickup. His knee has several puncture wounds. We splint the knee, put Bill on a back board, and load him in the ambulance. On to Elmo.
    Elmo has a small laceration on his chin, and my mother notices during her assessment that his left eye won’t close and the pupil is non-reactive. “I was in an accident before,” says Elmo. “This whole side of my body has been rebuilt. It’s titanium.” We urge Elmo to get checked out at the hospital, but he refuses. When we hand him a release form, he holds it but will not sign it. We summon a deputy, and with her as witness, urge Elmo several times to accept treatment or sign the release. He refuses to do either. Eventually, after the helicopter is gone and the ground ambulance is leaving with Bill, Elmo says he will sign the release. The release forms are all in the departed ambulance. The deputy chief and I write out a release on a notepad, and Elmo signs it. We begin cleaning up the accident scene and Elmo interferes. When a sheriff’s deputy tells him to leave the scene, Elmo says he now wants medical attention. We radio the ambulance, and they head back to the scene. Before Elmo can change his mind, I place him in a seated position on the ground, put him in a c-collar, wrap him in a rescue blanket, and tell him not to move. I then give him a thorough head-to-toe assessment, hampered greatly by the fact that Elmo is shivering and waving his arms around. The ambulance arrives. “I’m not going to the hospital if my wife isn’t here,” says Elmo. The EMTs and I exchange glances—we are being pushed to the limits of professionalism. We lift Elmo to the cot. “I don’t need this, guys, I don’t need this.” In the end, Elmo allows himself to be transported.
    Later, while writing up the report I try to imagine myself in court two years from now, facing some lawyer armed with the patient