First and Last Aid
Emergency Care

As I've noted before, it seems that the most interesting experiences in medicine come about in emergency care.

Over the years, it has been of interesting to watch emergency medicine move from something which everyone did while doing something else, to a full-blown, bona-fide medical specialty.

Many don't realize that war and pestilence have more than a literary nexus.

The members of the genus Homo have been fighting among themselves since banished from "The Garden" whether you choose to look at that event as revealed in The Bible, figured out be Charles Darwin, or some of both.

Measured in eons or eras, as long as the conjoint mayhem we know as war has gone on, it was only about 80 years ago that we had a war in which more men were killed or fatally injured on the battlefield than died of the pestilence that accompanies war.

As medicine got war-provoked disease under control it then turned more of its attention to trauma, which was supposed to be the business of the battlefield right along.

Considering this, it should come as no surprise that during the Vietnamese War the safest place to be hurt was on the battlefield, the next safest in a major city, and the least safe out in the countryside.

This was the situation when I started practicing in High Point in the early 1960's and in regard to emergency care we fell somewhere between the city and the countryside.

The so-called "Emergency Room" in High Point Memorial Hospital in those days consisted of two small treatment rooms, one on each side of the side corridor leading in from the ambulance entrance.

It was manned -- or should I say it was "womaned" this being before the day of political correctness  -- regularly only by a nurse.

Physicians were summoned, as needed either by who was on call for a practice -- if there was a private patient -- or by who was on call for a service -- if the patient didn't request their own doctor.

We dealt there mostly with people who had sustained minor injuries and who were hurt after hours since during the day the bulk of the patients could get themselves to a private office.

In our practice we dealt only with children.

There was no place for their families to wait while we worked in the treatment rooms except in the halls or outside, weather permitting.

So it was one summer night when I was looking after a small child with a simple laceration on her arm.

She had been brought in by her mother and her young adult brother, the latter about "two sheets to the wind".

As I was finishing my suturing much shouting drifted in from the ambulance courtyard outside, and as soon as I could I went out to investigate the clamor.

Along one side of the ambulance parking space was a row of light wells extending down to the basement windows.

These light wells were guarded by pipe railings, and it was over one of these that my patient's inebriated brother had toppled, and he was now lying 15-20 feet below, not moving.

His mother was frantic and crying out:  "My baby is dead!"

I couldn't climb into the light well and it was too deep to jump down into.

An orderly and myself ran to the basement, hoping for access through a window, but found they were covered by heavy steel wire security grills attached from the outside.

We called the Fire Department.

They arrived and a ladder was lowered down into the light well and a large, very bright spot light was shined down the rungs.

I climbed down to the unconscious fellow fully expecting him to be dead or badly hurt, but was surprised when he sat up as soon as I started examining him.

He squinted up at me and then up the ladder into the glare of the spot light.

He rubbed his head and asked:  "Is I in heaven?"

It wasn't 'til we climbed up the ladder and his mother hugged him that the fellow seemed to realize he wasn't dealing with St. Peter.

His mother was relieved but he seemed a bit let down.

He could well have thought he had been in the hands of Providence, knowing how God is said to feel about drunks and fools.

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April 17, 1996

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