Musings on the fraility of human existence…and bones.

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As a paramedic I get up close and personal with death and dying in all it’s various forms. And I witness it in it’s natural habitat, so to speak. BEFORE the tubes and wires and beeping machines, the sterile cot and stark white lights. I see it slumped over on the living room couch, drowning from the inside due to a tired heart, or gaze fixed to one side, mouth drooling, flat on the kitchen floor as a vessel in the brain says “Enough crack!” and bleeds into the cranial cavity. The heartbreaking dilated pupils and pale still form of a 6month old boy on a stained sofa surrounded by the toys and clutter of the siblings he won’t ever get to play with, mom and dad hysterical in a cornor.

You get to learn a little about death and loss and grieving when you deal with it on a regular basis. Death has it’s sweet side. The relaxed passing of the 90 year old cancer patient in his sleep, free of pain after a long life. The 86 year old dialysis patient whose spouse has passed before her and she’s ready to join him. Most of the time  the “Do Not Resucitate” form is truly a Golden Ticket.

At this point, you may be wondering where “bones” fit into this little narrative. Well, how about…right here. Trauma is the other side of death that we EMS-ers (including Fire Department First Responders) see quite a bit of. You become amazed at how much the body can withstand in some cases and in others you are reminded uncomfortably of how easy it is to be broken. So, bones. Those concrete pillars of the human frame. The hardened core of our structure, protecting the brain and vital organs, giving us mobility and dexterity. Without bones, we’d be amoebas. Or sharks (if you have enough cartilage). I like bones, the skeletal system was my favorite in anatomy class, I was fascinated by the osteoblasts and osteoclasts and the intricate design of marrow and layers with openings for vessels like a hub in the center of  little bone cell cities. Bones look tough, resiliant, fashioned into weapons in some places. Yay bones!

Thats what I initially thought of bones, but slowly, insiduously, my appreciation of bones turned to one of discomfort and sometimes horror. Thats it?? That thin porceline cap is supposed to protect my brain?! Not only that, it’s breakable enough to dent my brain matter, but too stubborn and unyielding to let my brain swell without injury. They drill holes in peoples skull because what seems a somewhat minor concussion leads to swelling and the stupid, stubborn skull (so easy to break!) won’t budge to give the brain room. Fingers and toes we expect to break, they even look breakable, but how easy to break a wrist! Two bones, snap snap, and a floppy hand. And jaws, a big, angular, tough looking bone. I had a motorcyclist who face planted. His jaw and cheekbones were so shattered the his face slid down into his neck. Talk about a weak chin. He was completely unconscious, but somehow still breathing. Every time we tried to assist ventilations with a bag valve mask and some O2, air would blow out a hole along what was left of his jawline, spraying everyone with blood like a benevolent whale. We were all red freckled by the time we got to the hospital. His face was so mushy, we couldn’t get a good seal on the mask. Bones, pah!

There are two major long bones in the body, the humerous (upper arm) and the femur (thigh). I’ve seen both broken. Another motorcylcist had rearended a different motorcylcist on a major highway and went flying. There were pieces of his bike everywhere and inside the thick, skin glove of his person he had a tib-fib fracture (lower leg bones) and a humerous fracture. His bicep, a fit mans bicep, swelled to twice the size of normal, the skin streched painfully tight as blood and fluid congregated at the site of his humerous fracture. So easy to break!

Motorcyclists, sheesh. I’ve seen one with BOTH his femurs broken. And his pelvis. He was mushy from neck up and waist down, but his torso only had road rash. I’m used to thinking of the femur as a big bone. A tough bone. A really hard to break bone unless you hit it just right. This guy had both broken, and one sticking out like a broom handle, 2-3inches of bone exposed to the world. All I could think was, “Are you sure thats bone? It’s so small!” There it was white on the outside, yellow and red ringed at the break. I could see the marrow. So small!

Bones. Bones are supposed to be the tough part of our body, and all they’re protected by is easily torn muscle and paper thin skin. I think I’m going to invest in body armor. Trauma can be more devestating than illness, it claims the young and dumb in the prime of their drunken lives, as well as the innocents simply in the wrong place at the wrong time. Accidents, assaults, falls, MVCs…trauma is random and indescriminate. And bones, those Brutus’s of the body, so ready to snap when you need them most, tearing up your tender insides instead of shielding them from outside forces. I am wary of my bones.

Here I must end, or I’ll be late for work….

P.S. Instead of making EMS workers more leery of death and truama, we tend to be rather cavelier about it all. Death is inevitable and trauma not always unavoidable, so why worry? Still, it’s hard not to get a funny jolt in your stomach when you scrape someone off the pavement and realize how breakable you are…

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