A slow night shift and gorgeous winter weather finds me outside in the ambulance bay taking in the night air when a small pickup truck comes screeching into the ER entrance, urgently beeping its horn. This is quite common. The locals here often will just throw a sick, injured or dead person in the back of the car and drive to the hospital rather than call for an ambulance. There’s always a desperate urgency, even when the chief complaint is dizziness. I arrive at the truck at the same time as the ER staff. They’ve responded to the notification bell we have for just this sort of thing.

Across the back seat of the pickup is a man who’s not breathing and has no detectable pulse. Time to go to work! In the confusion of extracting the patient from the backseat of the small pickup and the family members wailing and interfering, it’s passed that he was stabbed.

That’s odd. I find no blood. I’d expect a stabbing victim to have a bit of blood in his clothes. He’s completely dry and, as we slide him onto the bright yellow backboard, he leaves no telltale streaks of red. He’s also not as “floppy” as I would expect someone who just died. My brain records this and many more things as we do our work but the screaming family (and complete lack of security) are plenty of distraction.

As we roll the stretcher into the better-lit doorway of the ER, I see his face is swollen and covered with a pattern of burst blood vessels. I’m still looking for a wound or some sort of injury. My brain is already thinking asphyxiation but it’s also on the “trauma” mode of thinking and, for the life of me, I can’t find any obvious injury. As I do chest compression, the cartilage of his sternum and ribs does its dutiful crackling and his ribs are in fine shape. It seems he wasn’t crushed.

In the resuscitation room, I have to hip-check a screaming man (the patient’s brother) who’s getting in our way. We cut off the patient’s clothes, looking for a wound, injury, anything.

That’s when I start to notice things:

Head, Eyes, Ears, Nose, Throat (HEENT): Face is swollen with a pattern of bulging eyes and burst capillaries indicative of asphyxiation but no bruising or trauma around his neck. The vertebra of his neck are normal and his larynx is normal-shaped. His jaw is stiff and difficult to open. No blood in the mouth, eyes or ears. A few scratches and bruises on his face and forehead.

Chest/Abdomen: All the bones are intact (except for where my chest compressions separated a few) but he’s got some minor cuts and scrapes on his back and a strange pattern of bruising all over his abdomen: a repeated mark across his belly that looks like a fresh bruise. He’s also got what we call dependent lividity. That’s where the blood has settled to the lower tissues of the body. It looks like a big purple bruise without the swelling and usually occurs a few hours after death.

Extremities: All the bones are intact but his joints are a bit stiff. I notice his wrists. There are dark red rings around his wrists. Like a bruise that stayed dark red. No swelling, no purpling. The ring is single on one side and double on the other side of his wrists.


Around his ankles is a pattern of similar bruising (red, not blue or yellow) but they’re like hash-marks spreading from his ankle to the bottom of his calves.

Then I see it in my mind:

He’s seated in a chair with his ankles tied to the chair legs and his hands cuffed behind his back. They beat his stomach over and over again. It’s painful. It fills his gut with nausea and waves of pain and knocks the breath out of his lungs. He tries to get away but his hands are tightly bound, straining against the metal of the handcuffs, making a deep impression in each of  his wrists.

Then comes the plastic bag. It goes over his head, tied off but not too tight around his neck. He tries to suck in air but the plastic closes off his nose and mouth. As he gets hungry for air, he tries to kick his feet and thrash around. The chair digs into his back. Again he can’t move his wrists but his legs are strong and they thrash against the restraints (probably zip-ties) around his ankles and they chafe and cut against his skin. The strain of trying to breathe bursts the small blood vessels in his face and makes the soft tissues swell. He keeps struggling, using up his remaining oxygen to the expected result.

I’m stunned. My stomach starts to flip. We’ve stopped attempts to resuscitate. Before I can get properly sick, I’m distracted by the frantic family member who worked his way into the resuscitation room. He goes ape-shit and starts attacking the staff.

Where the hell is security?

I spin, block his blows on a nurse and shove him into a corner. He backs off but he’s in obvious grief. He’s very agitated and wants to get close to the patient. I’m in full-on fight mode: strong stance, on the balls of my feet and my guard is up. I’m not going to let him get near anyone in scrubs. At the same time, I’m being ripped apart inside. This guy is in the painful grip of grief and I’m going to have to put hands on him to protect my staff (Where the f**k is security?). What kind of person am I that I would add to his pain? What the hell am I doing? Why the hell am I here, in this place?

Finally a lummox in a uniform arrives, followed by his comical companions to take the burden from me.

I walk out of the resuscitation room and the story comes out of the arriving horde of family. Two days ago, the family gets a call from the victim that he is suddenly going camping in the desert with some friends. Camping in the desert is common this time of year so they don’t seem to think it’s too odd but it does seem abrupt. At two o’clock this morning, their doorbell rings. When they finally open the door, they find a bundle on the front steps that turns out to be their dead father/brother.

It keeps coming back to me, though: handcuffs.

I ask a few of my local colleagues about how easily one can get handcuffs. We can buy them just about anywhere in the USA. Over here, they’re not at all common. Pretty much, the only people who have handcuffs are cops and the government.

They dumped him on the family doorstep. They could have disappeared him into the desert but they dumped him on the family doorstep!

I wade through the crowd of wailing, veiled women and sobbing men in the hallway. As I approach the nurses’s station, I see smirks and eye-rolling on the faces of some of the staff who were not involved in the resuscitation room.

“Jesus! Why does there have to be so much drama?” Asks one of them. There’s a few nods of agreement and a lot more eye rolling.

I’m going to throw up! I have to get the f**k away from these people! What the hell is wrong with people? Is it somehow “cool” to be jaded and dispassionate? I’m thinking to myself that if I woke up to a doorbell at 2 am to find my father tortured, murdered and dumped on my doorstep (probably by my own government), I’d be making a lot more noise than all of the family in the hallway and the parking lot combined! How can these nurses be so glib? When did compassion become a bad thing?


I’m angry. No, I’m furious! I’m out the door and I go to the furthest corner of the parking lot. I have to be away from people. If anyone comes near me, my anger will lash out. I feel like a boiling kettle full of bile, fire and despair. Bring on the SARS, MRSA, drug-resistant TB and global warming! This species doesn’t deserve to live anymore! What the hell is wrong with us?

I’m angry at the people who would do this to another human. I’m angry at the organization that would call for it and find it worthwhile. I’m angry at myself for hurting that poor, grieving man. I’m angry at the medical “caregivers” who would wipe their asses with someone’s grief and then shove it in my face like a joke. I’m angry at the broken, backwards place where I live. I’m angry at my own nation that does the same thing but conveniently exports it outside their own borders. I’m angry. It’s burning in me still.

It’s a lower flame now, though. I have unlimited gratitude for my family and my friends upon whom I can rely. One friend in particular dropped everything and gave up a chunk of time to help me turn my head around.

Thank you. Forever thank you.

I’m still going to be messed up by this for a while but I will get better. I know this. I’ve been beat down like this before and I know what to do, I know how to apply “first aid” to this pain. Another thing I’m thankful for is the ICISF. Saved my life more than once.

I’m also going to keep writing here. I need this.


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  • Student Paramed

    The only words I can come up with are profanities.

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