Everyone else called him Larry, as it was his given name. When I first met him, I assumed Larry was short for Lawrence and started calling him Lawrence. By the time I found out Larry wasn’t short for anything, it was too late. He had already been branded as Lawrence in my mind.
Lawrence made up for his lack of knowledge with an unequaled work ethic. That being said, he never did anything fast. It wasn’t that he didn’t want too. Gravity prevented it. He must have tipped the scales at close to four hundred pounds.
His personal car was a 1998 Saturn with blistering blue paint and a severe case of what I called perma-lean. Lawrence lived about twenty miles away in a small gathering of houses that was referred to as a “town” by the people who lived there. With a population of only twenty-three, it didn’t really meet the qualifications. The daily forty minute drive to and from work, with his massive hulk sitting in the driver seat, had crushed the suspension elements around the front left wheel of the Saturn.
The first time I saw him get out of the car, I assumed it would spring back to level once he stood up. It didn’t. The left front corner appeared to have resigned itself to the fact that it would, forever, live in bowed subservience to the other three wheels on the car.
You could search the globe and never find a nicer, more compassionate guy than Lawrence. He would literally give you the shirt off his back if you needed it. I had seen him do it before. A year ago, we arrived at the scene of a rape at the same time. The victim was sitting naked in the grass in the middle of the park. Her knees were pulled tight to her chest, attempting to cover herself as she rocked back and forth, whimpering. Lawrence walked up to her and took off his shirt. He gently wrapped it around her quivering body as he quietly told her that nobody was going to hurt her anymore. The shirt was enormous on her, but it served its purpose. It restored a small fraction of the dignity that had been ripped from her. That was Lawrence.
I watched as he shuffled to the front door. He stopped at the entrance and reached for the handle, which was a six inch vertical piece of metal bent ninety degrees so the part you grabbed was parallel to the door. It was probably chrome plated at its inception. Forty years of use had worn the shine away: it no longer had a luxurious silver luster. After the plating wore off, the handle showed its true identity to be nothing more spectacular than aluminum. Granted, it was a hardened alloy, but it was aluminum never the less. Lawrence grasped the handle and pulled the door toward himself, ringing the bell as it opened.
The motion was counter intuitive. Psychologically speaking, entering a business should be as uncomplicated as possible. A person’s forward motion should be enough to push the door inward, making entrance effortless while subliminally making the customer feel welcome. The architect who designed the café had not paid attention in freshman psychology.
As Lawrence’s bulk filled the doorway, I could see that the five day stubble he normally sported had grabbed onto part of his early lunch as it had began a downward plummet from his mouth to the ground. He approached the table where I was knelt down and his face changed. It was only a slight widening of his eyes, but I caught it. My life depended on catching minor changes in people. Minor changes often give away secret intentions. If a person planned to fight, he tended to tense up, fingers would curl and uncurl, his head may roll slightly as he subconsciously loosened his muscles for the ensuing struggle. A person breaking eye contact while recounting an event denoted he was about to tell a lie. Lawrence’s change in visage denoted disbelief. He didn’t realize the gravity of the situation prior to walking through the door.
Lawrence slowly knelt down next to me. It was a feat I had seen a hundred times as he prepared to treat a patient. Each time, I wondered what kept his knees from blowing out. The force on them was tremendous, but they never failed him. He began the minute and a half of tricks he had at his disposal. Once they were completed, he would go back out, roll the gurney in, load up the patient, and be off to the hospital.
As he knelt, I recounted to him what I had observed.
“This looks bad,” he muttered. As he felt for her pulse, he shook his head back and forth. “This is not good, she’s burning up.” Finally his fingers settled on a place at the junction of where her neck and jaw met. He looked at the scarred face of his digital watch and silently counted her pulse. After thirty seconds, he removed his fingers from her neck and reached into his black nylon med bag and brought out a stethoscope and blood pressure cuff.
He placed the cuff around her right bicep and fastened the Velcro at each end to maintain its circumference around her arm. His finger and thumb gave a quick twist to the pressure relief valve, closing it off so the cuff would retain all the air he was about to pump into its rubber bladder. Several quick squeezes of the rubber bulb inflated the cuff to the point it crushed her brachial artery, preventing blood from passing through. He gave another twist to the pressure relief knob, this time opening it just enough to allow a slow stream of air to exit the bladder. His eyes tilted up to the right as he carefully listened through the stethoscope for the sound of blood beginning to pass through the artery again. His eyes shifted slightly, which I took to mean he had detected the systolic blood pressure. A couple seconds later, he took the cuff off and moved the earpieces of his stethoscope from inside his ears to around the back of his neck.
“Forty-six over twenty-eight,” he said. “She’s in serious trouble. I need to get her on oxygen and get her to the hospital. I don’t think she is going to make it.”
As he was reaching into his bag for the second time, the woman on the floor tensed up. Her body went rigid for a second and then completely relaxed and her head canted slightly to the right. While Lawrence was setting the oxygen flow on the regulator, I watched the woman’s pupils slowly dilate. Lawrence placed the clear mask over her nose and mouth. I noted the absence of fog adhering to the inside of the mask. The fog, normally present, resulted when warm, moist air being exhaled contacted the cool rubber mask, causing a vapor to condense on the inside.
Lawrence noticed the signs, too. He felt for a pulse again. His fingers moved around her neck, obviously not finding what he was searching for.
He quickly reached into his supply bag again and withdrew an Ambu bag which was attached to a face mask. He placed the face mask over her nose and mouth.
“You start the chest compressions and I’ll breath for her,” he said frantically.
The county couldn’t afford a second person on the ambulance. Normally ambulances have two people who work together to stabilize a patient. One person would then drive to the hospital while the other attended the patient in the back during the trip.
Since our ambulance was a one man team, I was accustomed to helping stabilize patients prior to transport. When Lawrence and I performed CPR, I always started out on compressions.
I interlaced my fingers and put the palm of my right hand over the back of my left hand. I leaned over the woman and placed the palm of my left hand over her sternum. I allowed the weight of my body to come down on her chest, causing it to collapse. Then I took my weight off my palms, allowing her chest cavity to rebound to its normal volume. The idea was to mechanically contract the chambers of her heart, causing it to move blood through her body.
By the time I had performed thirty repetitions, Lawrence had connected a line from the oxygen tank to an inlet in the Ambu bag. Our artificial respiration wasn’t nearly as efficient as her own breathing would have been. The increased oxygen levels in the Ambu bag would help offset our inefficiency. I tilted her head back to open her airway as Lawrence pressed on the face mask to make a good seal and squeezed the Ambu bag two times. With two breaths delivered, I continued chest compressions.
After four compression breath repetitions, Lawrence advised me to check for a pulse. I felt her neck for a nonexistent heart rhythm. “Nothing,” I said.
Lawrence grunted from the strain of standing and stated, “I’m going to get the defibrillator from the ambulance.”
“Use that one,” I said, pointing to the green box hanging on the wall below a white sign that read “A.E.D” in red letters.
Lawrence pulled the box from the wall while I continued chest compressions. He opened the box, revealing a device that had an LCD display above a keypad. It also had a foil packet that was connected to the device with a white, plastic-coated cord. He pushed the power button and we were greeted by an electronic voice, “Unit OK.” The voice paused for two seconds, and then continued, “Adult pads,” another pause, “Stay calm…Check responsiveness…Call for help…Attach defib pads to bare chest.”
Lawrence pulled a pair of scissors from a pocket on the thigh of his pants and quickly cut through the green, silky fabric of her shirt. The machine repeated, “Attach defib pads to bare chest.”
After he had cut the shirt from top to bottom, he pulled the severed fabric to either side, revealing the skin that covered her slight frame.
“Attach defib pads to bare chest.”
“What do you think I’m trying to do?” Lawrence yelled to the machine in frustration as he fumbled to open a foil package. His fat thumbs and fingers struggled to separate the foil halves containing the pads. Finally, he was able to pull the halves of the package apart and reveal the defibrillator pads. The pads consisted of a twelve inch long blue rectangle with a square pad coming off the top left and another square pad coming off the bottom right. Lawrence laid the top pad on her chest above her right breast. The blue rectangle ran down her sternum. He positioned the bottom pad across the left side of her abdomen. Her bra interfered with the pads laying down flush on her skin.
Lawrence retrieved the scissors from his pocket a second time and placed one blade above and the other below the connecting strap between the two cups of her bra. All the while, the voice urged him to, “Attach defib pads to bare chest.” He brought his fingers together, causing the blades to slice effortlessly between the satiny white material. The tension from the shoulder straps and the elastic strap around her back snapped the two cups to either side.
I instinctively averted my eyes, feeling like I had violated the woman by seeing her in her unconscious, helpless state. Reason took over. Lawrence needed my help and so did she. I pushed the guilt out of my mind as I turned back to assist Lawrence. He removed the plastic backing on the pads to reveal the sticky backside. With the sticky side exposed, he pushed the top pad down and it adhered to her skin. He repeated the process with the pad over her lower left side.
The electronic voice broke the silence, “Analyzing, don’t touch patient.” A moment later, it announced, “Push flashing button to deliver shock.” Lawrence pushed the button and the woman’s body jumped on the floor. The voice instructed, “Begin CPR.”
We switched positions and Lawrence began chest compressions and I held the mask and Ambu Bag, ready to deliver breaths to her. We continued the cycle of compressions and breaths until the voice interrupted our work. “Analyzing, don’t touch patient.”
At the machine’s request, Lawrence pressed the shock button again, causing the woman’s torso to rigidly lurch on the floor and then relax. Rather than immediately begin CPR as instructed by the voice, Lawrence checked for a pulse. After ten seconds he looked up at me. Shaking his head back and forth, he peeled the pads from her skin and set them on the floor.
He reached over and turned off the oxygen tank regulator. He placed his right hand over her open eyes and slowly moved it down toward her mouth, gently brushing over her eyelids. When his hand had moved low enough, her eyes became visible again, but this time they were covered by her closed eyelids. He had performed the last trick in his repertoire.
The man who had been seated beside the deceased woman, prior to her collapse, had been silently peering over my shoulder as we worked. I looked back and I could see his eyes begin to glisten. The moisture continued to build until it was pooled around his bottom eyelids. Gravity suddenly overcame the surface tension that had been holding the liquid in place and a tear rolled down the side of his left cheek, rapidly at first and then it slowed, leaving a wet trail in its wake. “One hour past, she say ‘have pain in head.’ She say, ‘feel bad, very hot,’” he offered in explanation as he pulled the severed halves of her shirt together to cover her naked chest.
He obviously didn’t want to leave her side. He couldn’t believe she was gone. Three and a half hours ago, they had been embarking on a journey together. Now he was embarking upon another journey, a journey of solitude.
As if to add an exclamation mark to her passing, there was a crash to my left. I looked and saw a man laying on his back, five paces away. To the man's right, I saw a woman standing with glassed over eyes and a thin crimson streak from her right nostril that nearly reached her upper lip. Before my watching eyes, she teetered forward. At the point where the attraction of the earth’s mass was about to take over, she caught herself and leaned backwards to counteract the forward motion. She went too far and toppled over. Her head hit the table behind her, cracking like a bat striking a ball. Her head snapped forward causing her chin to briefly touch her chest before her head began another backwards trek, proving Newton’s third law:
For every action there is an equal and opposite reaction
. As her back hit the ground, her head achieved its maximum rearward velocity and smashed into the tile floor. From the way she landed and the hollow crack of her head smashing into the tile, I judged there was no way she survived the fall.