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Patient Care

Stories from the Streets: James

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“Rescue 1, respond to Swann Street, possible shooting.”

“Rescue 1, responding.”

A car was stopped in front of the address at Swann, motor running, all four doors open, windows shattered. Police cruisers dominated the scene, and officers searched frantically for shooters and victims. Moms quickly escorted their children away from the house, while party balloons floated peacefully, tied to a porch railing. Our patient sat on the steps, holding his upper arm.

“Where’s James?” he shouted, frantic, his street cool shattered.

“I don’t know,” I replied honestly. “Stay still, I need to stop this bleeding.”

“I don’t care about that,” he said, shoving my hands away from the wound near his biceps. It looked like the bullet missed anything major, probably just a flesh wound.

“Do that again and I’ll break your fingers,” I replied. There is a way of threatening to do bodily harm that puts patients at ease. What can I say? I guess it’s a gift. It helps being seasoned when dealing with gang members. They don’t feel threatened by somebody old enough to be their dad. If they even had one.

“It hurts.”

“I’ll bet,” I said, and cleaned the wound, applied pressure and wrapped his arm with gauze. “What happened?” I asked as we walked toward the ambulance.

He was reluctant to talk, but once his words began to flow it was hard to stop him.

“We came from the north end for my niece’s birthday party,” he explained. “We was just parked in front of the house, not doin’ nuthin’, when these gangbangers from the southside pull up and start firing. They was chasin’ James last I saw—where is he?”

“I’m listening to the police radio, looks like James got away; the scene is secure.”

“Whassat mean, secure?”

“It means the guns are all gone.”

His sneer returned, and what might have been a handsome face returned to the arrogant contemptuous mask that had formed during his 16 years of life. With his fear alleviated, his friend apparently safe and his wounds not life-threatening, the boy vanished and the thug returned. I wondered when the first transformation began—10, 11 years old, maybe younger. Perhaps the only moments of serenity he ever knew were while in the womb, when his environment truly was secure, and the outside world had yet to invade.

He insisted on walking into the emergency department, GSW and all, and I let him. I’ve learned that sometimes it does far more harm trying to make them conform and put up a fight while we try to get them to lie on the stretcher. A bullet wound, even a “flesh wound,” is serious, and there is no sense making it worse with a struggle. The kid just got shot; he’s had enough to deal with. It also helps being seasoned while dealing with the triage team at the desk. The raised eyebrows diminish as the years progress, and the people on the inside know and appreciate that those of us on the outside have a better understanding of what it takes to get a patient in without doing further harm.

“You’re going to be okay,” I said to my patient, while leading him to one of the gurneys. I like to believe that for the briefest second the boy returned, but sometimes I delude myself.

“You aiight,” he said as I walked away, my portable radio coming to life as the distance between us increased and any connection I had hoped to establish with him was gone.

“Rescue 1; respond back to Swann Street, possible DOA.”

Damn. I keyed the mic as I walked into the bright Sunday afternoon sunshine.

Rescue 1, responding.”

James was in the backyard. One of his sneakers was on one side of a six foot stockade fence, the other still on his foot. They caught him next to the pool. Bullets had pierced the wall, and streams of water  poured out of the holes, soaking the bloody ground where I knelt next to him, feeling for a pulse that I knew was not there.

Michael Morse, EMT-C, is captain of Rescue 5 in Providence, RI, and has served on the city's busiest engine, ladder and rescue squads as a firefighter, rescue technician and lieutenant during his 21-year career. He is the author of the books Rescuing Providence and Responding.

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