When the paramedics are about to save the “bum”, the minimum plan is simple: shut down the murder

Working in an ambulance service is neither easy nor pleasant. On the contrary, especially when you have to make a trip to a drunk man several times during one shift. «When diagnosing such a person, it is easy to obtain medical malpractice. When little yellow creatures jump from his clothes to my hands, it is really hard to remember that the anthem of the Medical University of Warsaw, which I graduated from, has the title “Medicine is Art”, writes Jakub Sieczko in his book “Pogo”.

1. Jakub Sieczko is a doctor. Currently, he works in one of the hospitals in Warsaw, but has also served in the emergency room in Warsaw
2. He talked about the specifics of working in an ambulance without censorship in his debut book “Pogo”, which has just been published by the publishing house Dowody na Existienie.
3. We publish an excerpt from Pogo below
4. More current information can be found on the Onet homepage.

“Reason for call: it lies”. And so several times during one shift

They talk about the following: bastard, lump, lump, luj, bey, dive, squire, lumberjack, deck chair, dyke maker, żul, żulian, mister pretty. I don’t think there are so many terms for any social group. We could probably go on and on for a long time, but these nicknames have long since stopped amusing us. We are Andrzej and Henryk – although there are also women – very tired. Each on call several times. Reason for call: lies. On the sidewalk, bus stop, staircase, in front of the church, at the gate and in the park, in front of the kindergarten. “But the children are looking at it, sir.”

Come on, Marcin, it’s time to leave. What we have? He is lying. If Marcin is in a good mood, he does not comment on the content of the call. If he’s in the wrong, he has his opinion expressed aloud about it, f *** him. During the battlefield medicine course, for which he himself paid, Marcin practiced haemorrhage control with the use of tactical tourniquets and hemostatic dressings. He knows the basics of pre-hospital ultrasound. He knows what fluid bolus to administer in a 5-year-old hypovolemic shock and that in a st-segment elevation myocardial infarction, the drug of choice – apart from acetylsalicylic acid and unfractionated heparin – is now ticagrelor, not clopidogrel. 180 mg of this ticagrelor – a modern trend in cardiology.

Marcin, packed with this knowledge like kabanos, goes to collect another tramp from Grochowska street, I fuck, which one is it today? Fourth? Sixth, Marcinek, already sixth. Usually such a patient is not a patient at all, but has fallen asleep. He is lying – it would be enough to touch him and wake him up. We turn on signals along the way, because sometimes it is dangerous, for example when his heart has stopped working. He would be entitled to CPR by anyone who is there, but first aid before ambulance arrives rather clean people. For Mr. Kloszard, the chain of saving human life usually begins with an ambulance service. Before that, there is nothing more than a careful observation from a safe distance and a phone call to 999. Anyone who has worked in the alert for at least three months is fed up with this. We do not like to touch them, pick them up from the ground, undress them, examine them. We don’t like smell, gibberish, urine, feces, saliva, vomit, blood, unpredictability, i.e. wild aggression interspersed with baby’s meekness.

Once, Tom did not manage. He vomited on the lawn

We already recognize many of those from Grochów, and they will recognize us. And although we don’t like a lot of things about them, we even like some of them. To these we say: “Lord!” – but with sympathy. There is no point in being harassed, life has harassed them enough. There is nothing to feel sorry for, because they don’t need pity for anything. You have to try not to forget that they are people. It is not difficult to do everything you can when resuscitating a two-month-old child or a young woman pulled under tram wheels. The trick is not to hiss “f ** k mać”, resuscitating a dirty and smelly 50-year-old, that is – let us specify – for half an hour touching his chest, face and hands and leaning over him so low that the face of the rescuer is several dozen cm from a fetid flesh. This fragrance is permeated for hours. It is not easy to keep cool professionalism: the poop flowing from the leg of the rescued person, several layers of dirty sweaters, sticky skin and small bugs – of course in the hair, but also on the lower legs, in socks glued to the foot, on the abdomen, armpits, nose and epiglottis ( it is the cartilage that closes the entrance to the larynx, where worms can walk, I saw for myself).

The patient is most often a recidivist and we have already seen him a few seizures, several times we took him to the hospital to suture a broken head or gave him to city guards, so that in the Warsaw Center for the Intoxicated People (SODON for short – associations with Sodom not accidental) at Kolska he had until now receipt of a bill for PLN 350. Code y.91 – intoxication – probably the most common of my diagnoses. This probably proves that six years of studying medicine is a gross exaggeration. The plan of the maximum, straight from candy series about medical rescue, would be such that each of them should be talked about «a man addicted to alcohol, hygienically neglected, in a crisis of homelessness or at risk of this crisis, which requires optimal diagnostic and treatment procedures and support from the aid institution social ». This is what you should write in your medical records.

For those who are overburdened and tired, that is for us, there is a minimum plan, not at all easy to implement, although it sounds very simple: shut your mouth. Recognize that his or her story is none of our business. Do your thing. Do not preach, do not shout, do not try to change the course of life, remember that we are from medicine – nothing more, but also nothing less. Not to pretend enthusiasm, warmth that doesn’t exist, or empathy that has long run out. Shut up. Examine, pre-treat, bandage, take to hospital or hand over to the municipal police when there is no need to go to hospital. Then go to the ambulance disinfection. Such a job. In order to implement this demanding minimum plan, you need to keep your nerves in check and maintain professional professionalism.

Once, Tom did not manage. He interrupted the examination of the patient, ran out of the ambulance standing at the busy South Prague intersection and vomited onto the lawn. Passers-by waiting for the green light were a bit confused by this situation. It is not easy when a patient breathes rotten alcohol in the face, abuses his clothes or urinates on the ambulance stretcher in the third hour of the hot July shift, during which the ambulance will have to be used for 21 more hours. I was losing my nerves then and I saw those who were losing it. In emergency departments I heard young, angelically gentle, tiny nurses, from whose mouths a bundle of the most hideous curses. These good girls chose this job because they wanted to save human life, and they cut fifth smelly pants on duty. Then they lose their shape and balance, and most of all, lose faith in the fact that the chosen career path is the right one.

Bedsores rot. They sleep in puddles of urine. They have scabies and they scratch themselves everywhere

Popular culture often sees the fate of the tramps quite cheerful. Movies with them in the leading roles break popularity records on YouTube. The phrases they utter enter the language. Happy is the life of a tramp! Apparently, he is sometimes the owner of hidden, deep wisdom in life and a reliable supplier of coupons, dictatorships, and Facebook anecdotes. It may seem that three such gentlemen are almost always three Himilsbachs commenting on reality more accurately than columnists of the most widely read weeklies. Socrates, Plato and Aristotle on a bench in Skaryszewski Park. The history of philosophy in the Grochian style. However, when they do not become internet stars or utter golden thoughts, their faces swell and pus oozes from open wounds on the head. They get p ***** for what and it is not known from whom. Bedsores rot. They sleep in puddles of urine. They have scabies and they scratch themselves everywhere. They freeze during the winter night on Wał Miedzeszyński. You don’t get likes in social media for such stories.

It is drunk in den, and Warsaw is located in den. There is always a mountain in the hiding place. It has an eclectic structure – it consists of, for example, bitten corn cobs, bottles, dogs, syringes, the tabloid number from last year, a Sanyo TV remote control (in the absence of a TV), scattered matches, 76 grams, a poster with a naked woman, wax stuck to the carpet, a rotten green sweater, a sticky black something, a fingernail, a mesh jockey cap commemorating the 1996 Atlanta Olympics, second layer of bottles, Hellena orangeade, beer opener with the logo of the Democratic Left Alliance, torn off with a curtain rod dark navy blue, slightly burnt curtain, glass fragments, fluff, rancid butter vegetable, dog hair (and the dog is a Gypsy or a Negro), dust, dirt, epilepsy pills (loose), a map of Beskid Niski, moldy bread, a can of tourist tinned a few days ago, a woman, a comb with broken teeth, ear buds all in an atmosphere of stuffy and sticky deep sleep. It is either very loud or (more often) very quiet here. It takes a short time to warm up, sleeps for a long time – most often on couches with burnt-out pipe holes. It happens that the couches catch fire from these pipes. The mountains are also on fire, and sometimes the hair and faces are affected. In the den, it smells like a forensic medicine – death, but here still alive.

There is a parallel world in Warsaw, shamefully underground, hidden from those who did not leave the tracks of life. Sometimes this buzzing world spits someone out. A mother wearing a pressed dress, while walking with a child in the park, will be concerned about the fate of a man lying under a tree and will call an ambulance. The city services of Warsaw have a procedure that has been developed over the course of decades. In order not to offend the sense of aesthetics of the next strollers, they quickly send Mr. Bumble to the world where he belongs. It is a universe whose Greenwich meridian is the aforementioned SODON (such a scary, depressive and smelly place – the last circle of hell – I have never seen). The real, social, living and petty criminal role of these parts of the city is known only to the employees of the ambulance service, city guards and the police. It is a world of cellars, garbage arbors, sheds on plots, cardboard and plywood parades. As long as it is not windy, and if there is also a heating pipe in the area, to which you can cuddle on a February evening, you really do not need much more.

We find them there, because it is a world of random, easy deaths. Sometimes they freeze up when vodka has generated apparent heat and with this heat it lulled him into perpetual sleep, because it is impossible to survive for days at -10 degrees Celsius. It happens that we find them most likely murdered, but when we ask witnesses, how they want health, they have no idea what happened or why a blood stain is drying up next to the corpse, and my friend has a hole where he should have an eye socket and a piece of brain. He took it and died. What was his name? Has he had any complaints recently? Who is he anyway? Silence. Lives run like films from which a malicious censor suddenly cuts out a few random scenes. You will not find out what kind of emotional and social relationships govern this world. I then give the policemen a medical rescue card with the diagnosis: “Death – cause unknown”. Eventually, the prosecutor will accuse someone of the death. They will probably condemn this person to a dozen or so years of sleeping in a warm one.

Working in an emergency, like no other, teaches that people drink in Poland

It is a world – and it is a mystery above all secrets – in which to drink. There will always be a few zlotys for denatured alcohol, the cheapest beer, XNUMX-liter vodka, fruit wine or moonshine. And working in an emergency, like no other, teaches that people drink in Poland. He drinks heavily, unsightly, suicidal, despairingly, to episodes. In fenced estates, plots of land, presbyteries, one-story houses, parks, basements, offices, clubs, railway stations. Non-drinkers, and especially non-drinkers, are drawn into the orbit of this world. Whole tracts could be written about good wives, praying mothers, believing in the transformation of concubines and despising (but still taking off their pissed shoes and lying on their father’s phone calls) daughters. This is the saddest world I know: full of violence, contempt, dirt, coldness, moving from affect to affect, helplessness, stupid choices, wading into alcohol-starvation, and above all – without exception – a world of self-destruction. The last circle of hell for Polish drunkenness.

I had never heard any brilliant retort from a bumblebee’s mouth. Instead, I have heard hundreds of incoherent sentences born in their brains, which ethanol and its derivatives have consumed completely and irreversibly. Stories about drunken old interpreters of Enlightenment philosophers would sound more spectacular, but more often than reciting original passages from Kant, I heard Budka Suflera’s hit song sung in a surprisingly clear voice. It also happened that someone said: “Gentlemen, in the ambulance the pivot pin is working”. They were somebody before, they were doing something. This is the world of sick people – not only with alcoholism, but also with heart, lungs, epilepsy, liver, strokes and diabetes. The temptation not to examine the patient, not to touch the patient at all, but to pack them in an ambulance and take them to the nearest emergency department (let them worry) or hand them over to the municipal police (let them tow to SODON) is not weak. It is easy to make a medical malpractice when diagnosing such a person. When little yellow creatures jump from his clothes to my hands, it is really very difficult to remember that the hymn of the Medical University of Warsaw, which I graduated from, is entitled “Medicine is Art”. Come on, Marcin, mom’s departure. Relax, it’s not. He’s probably sitting. Pelagia, 87. Hypertension. Ground floor, no need to climb stairs. Cool, yeah?

The fragment comes from the book “Pogo” by Jakub Sieczko (Publication of Evidence for Existence).

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