Free Emergency! by MD Mark Brown

the police arrived. The young stab wound victim was not a Jehovah’s Witness at all. He was a thief. He had stolen the wallet.
    LAWRENCE M. LINETT, M.D.
    Loudonville, New York
    

IN SEARCH OF THE GOLDEN
FALLS COBRA
    I was a paramedic student at the time, doing a rotation in the Emergency Department to pick up some procedural skills. That gave me the chance to observe this case almost in its entirety without the distractions of any real duties.
    It started when I was coming to work. I had parked across from the ambulance entrance to the ER and was walking across the large parking lot when a police car, siren screaming, came full throttle down the street and pulled into the Emergency entrance. The car was traveling so fast as it came up the driveway that all four wheels left the ground and sparks flew as it landed. The officer grabbed something from the trunk and ran in the entrance. His degree of urgency was unusual enough to make me wonder what was happening. When the scene was repeated less than a minute later by another patrol car, I knew something out of the ordinary had occurred. But what? An officer wounded? A hostage situation? A riot? As these possibilities crossed my mind, I hurried in to see what was causing so much action.
    Entering the ER, I found a large group gathering around the officers’cargoes. In a stainless steel basin lay the head and the first twelve to fifteen inches of a large snake. The second policeman had brought the remaining five or six feet of the reptile’s body and tail. Though there were seven bullet holes in the carcass, the severed head would flare and rise threateningly, poised to strike whenever anyone came too close. The snake had bitten its owner, who now lay in one of the trauma rooms.
    As the paramedics were evacuating the patient from the scene, they had asked the police to kill the snake and bring it to the hospital so the ER staff could identify it and determine how to treat the victim. The police shot it in the owner’s kitchen. I’ve often tried to imagine that scene. Were the police frightened, or were they cool and professional? How many rounds did it take to hit a writhing snake seven times? What did the kitchen look like afterward?
    When I looked into the trauma room, the patient appeared pale and frightened but calm. The paramedics had treated him with a rubber tourniquet applied above the bite and a nasal cannula for oxygen. IV solution was dripping into the other arm. Nurses were checking his vital signs while curious residents and medical students were gathered three deep around the bed. I found a spot in the trauma room and remained, reviewing the action throughout his stay. This scene was too good to miss.
    The patient had said the snake was a Golden Falls cobra; the problem was that nobody in this western urban hospital had any idea how to treat a cobra bite victim. The pharmacy didn’t even stock rattlesnake antivenin. Police had been dispatched to at least two suburban hospitals to obtain the antivenin just in case it might be useful. Meanwhile, the emergency docs tried to dig up the information needed to treat this unusual injury. Calls were placed to snakebite treatment centers in India, Africa, and South America. No expert could be found who had ever heard of a Golden Falls cobra.
    While the search went on, the medical students hustled off to the ER’s small library to read about snakebites. Every few minutes one would return and ask the patient if he had some symptom or other. Consistently, the patient would initially deny having the symptomand then moments later develop it. After being asked, he reported developing tingling lips, shortness of breath, and even double vision.
    Despite the symptoms, the patient remained stable. Though his arm was becoming purple and congested, no one was ready to remove the tourniquet. At last there was a breakthrough. The police dispatcher called to let us know that his officers were