The following events are not fictional, but they may have happened at different times, with different patients, at different places. Each one of the authors has had patients just like these, in situations just like those described. If you want to know what it’s like to live a day in the life of an ambulance driver, or a small town cop or a small town ER nurse, join us for the story.
It’s the same story. On the same day. With the same people.
This is what we do, and working with nurses and cops like these is part of the reason we do it.
**********
“So he’s got a scrape line following this little ridge,” Bodie is saying, “and I tell ya’, there’s some scrapes there as big as the hood of my truck.” He spreads his arms to demonstrate, and the fork in his right hand makes a musical ‘ting’ against the diner window.
“Buck that big, be hard to catch in the daylight,” opines Vernell Owens, owner and chief cook of the Bugscuffle Ptomaine Palace. He slides a plate full of runny eggs and greasy hash browns in front of me and refills Bodie’s coffee cup before he pulls up a chair and settles heavily into it.
I sit silently and listen to Bodie wax enthusiastic about the monster he’s currently chasing. With Bodie, the deer are always huge, and the scrapes are always as big as a truck hood. I’m beginning to think it’s his universal frame of reference. Vern holds the coffee pot poised over my cup, one eyebrow raised. I shake my head and hold my hand over the cup. Seven years Bodie and I have occupied the corner booth for breakfast at Vern’s place, and seven years Vern has failed to register that I don’t drink coffee. Ever.
“Anyhow, like I was sayin’,” he grunts, “buck don’t get that big without being smart. All the hunters in the woods this time of year, buck that big’ll go nocturnal. He’ll check his scrapes at night.”
“Not this weekend,” Bodie insists, sawing into his breakfast steak. Vern’s breakfast steaks tend to be rather…chewy. “The woods narrow down into a little bottleneck between the Farm-to-Market road and Buck’s pasture, and I’ve got my stand hung in a big sweet gum tree about fifty yards off the trail. We got a cold snap forecast for this weekend, and it’ll be overcast at night. I’ll get him,” he concludes confidently.
“Buck’s oldest boy bagged hisself a big ‘un in that little scope of woods ‘bout ten years back,” Vern informs us. “There’s some good bucks in there, all right.”
“Probably nothing more than a 100-pound spike, and your fevered imagination,” I tease, winking at Vern. “Just like last year.”
Before Bodie can retort, the radio crackles. I don’t catch all the traffic, but I do manage to hear the address.
“212 Muir Road?” Bodie grins around a mouthful of runny eggs. “Mrs. Schenk must be feeling lonely again. Remember last month when we – “
I shush him with a raised hand and turn up the radio just in time to hear Car 12 mark en-route to the call, the deputy’s voice a muddy, Scottish-tinged prairie twang. LawDog.
Damn. I was hoping that’d be us.
Helen Schenk was widowed a couple years before I started working in Bugscuffle. Rumor has it that she has kids, but I’ve only met one. Her youngest boy is an Army major stationed in Kansas, if memory serves.
Or is he a lieutenant colonel by now? It’s been almost five years since we met.
“Must be a pain in the ass to go out there all the time,” Vern observes. “She’s callin’ 911 what, two, maybe three times a month?”
“Not that much,” I grunt, “maybe once a month. But I’ll take ten calls to the Schenk place over one like we did this morning.” We had taken an overdose patient from Bugscuffle Community Hospital to Big City Memorial Medical Center. It was not our first time dealing with that particular worthy, but it may have been our last. This time he was on a vent and barely able to hold a blood pressure. He had been the reason we were eating our breakfast at ten o’clock instead of eight.
“So how is little Bobby Perkins doing anyway?” Vern asks knowingly. “Meth get the better of him this time?”
“You know we cain’t talk about our patients, Vern,” Bodie admonishes. I say nothing and just sip my sweet tea.
Not as good as Helen Schenk’s. Your tea’s getting a little bitter there, Vern.
“…not like everybody don’t already know anyway,” Vern is saying. “His stepdaddy was in here this mornin’, talkin’ about it. Said he smoked too much of that stuff and his heart liked to burst. That boy has given his Momma hell since he was -“
“Car 12, County,” the radio crackles. “I’ll be 10-6 at 212 Muir.”
“Look out, ghosts,” I chuckle.
“Whaddaya figger?” Bodie muses, “Hamlet or King Lear?”
“Who knows?” I wink. “Whatever mood strikes him, I guess. One thing’s for sure; there ain’t no other ghosts in hill country that get a command performance of LawDog’s Shakespeare Dinner Theatre once a month.”
“What in the hell are ya’ll talking about?” demands Vern. “Shakespeare?”
“When Mrs. Schenk gets a bit lonely rattling around that big old house by herself,” I explain, “her ghosts get a little rambunctious. So she calls the Sheriff’s Office to come sort ‘em out.”
“So what does that have to do with Shakespeare?” Vern asks, confused.
“Most time, the cops will go over there, stomp around upstairs for a bit, make some noise or whatever,” Bodie grins, “and then they’ll come down and tell Mrs. Schenk they’ve rousted all her ghosts. LawDog, though…well, he likes to get a bit more…theatrical.”
“That boy ain’t right,” Vern chuckles, shaking his head. “You know, I always knew that old biddy was crazy as hell, but I never figured – “
“No, not crazy,” I correct him, the warning clear in my tone. “Maybe a little eccentric, that’s all. She lives in that great big house all by herself, no husband, kids all moved away. She gets a little spooked, that’s all. Who wouldn’t?”
And too damned proud to sell it and move into town. Too proud to venture into town and overhear people whispering behind her back about the crazy old widow who lives out on Muir Road.
“Mr. Schenk used to come in here every morning for breakfast before he opened his store,” Vern grunted. “Nice fella, but kinda stiff until you got to know him.”
“What was he like?” Bodie asks curiously.
“Proper, I suppose you’d say,” Vern mused. “Breakfast crowd’s a rowdy bunch here, y’all know that. He’d never join in the arguments, just sit in his booth and read the paper. Never failed to wish you a good mornin’ or shake your hand, though. Ordered black coffee and huevos rancheros with salsa, home fries on the side.” In Vernell Owens’ universe, people literally were what they ate.
So why is it that you can remember the breakfast order of a man dead ten years, but can’t remember that I don’t drink coffee? Alzheimer’s settin’ in, Vern?
“Ever meet Miss Helen?” Bodie asks.
“In town, frequently, but never in here,” Vern sneers. “I reckon we’re a little too rough here at the Ptomaine Palace. Too much coarse language and cigarette smoke.”
“Not any more,” I grin, winking at Bodie. “Not since the ban. Now, if people want to risk their health, they’ll have to do it by eating the food.”
Five, four, three, two, one…
“Goddamned government,” Vern explodes, right on cue. “Damned health Nazis tellin’ me what I can and can’t allow in my own damned place! I tell ya, the time is comin’ when we all just…”
I turn my attention from Vern’s rant to the Mustang pulling into the parking lot. The blonde driving it parks next to our rig, gets out and walks in. The bell rings as she opens the door, announcing the arrival of another customer, but Vern scarcely notices. He’s on a roll now, delivering a profanity-laced tirade about gubberment intrusion into private bidness and high taxes and how we all oughta just start an armed insurrection and throw the bastards out…
“Good morning,” Babs greets me with a quick peck on the cheek as she slides into the booth next to me. “Late breakfast? Or are ya’ll doing brunch now?”
“Yeah, it’s fruit and Brie with white wine spritzers every day at ten o’clock here at the Bugscuffle Ptomaine Palace,” Bodie guffaws, “ain’t that right, Vern?”
“Mornin’, Miss Barbara,” Vern blushes. “I didn’t hear you come in. Can I fix you something?” Vernell Owens may be a crude slob with an apron that classifies as a Class III biohazard, but his Momma did not raise him to cuss in front of ladies.
“Large diet Dr. Pepper and sausage biscuit to go, Vern,” she smiles. “My shift starts in fifteen minutes.”
“Had an early morning transfer,” I tell her. “One of our upstanding citizens OD’ed on meth and PCP this morning. I thought you were off today.”
“Jeanell called in sick,” she explains. “I get off at eleven. Since you’re working a 72, I figured I could use the overtime.”
“Take all you can get,” I advise. “You need it to support me in the manner to which I have become accustomed.” Her reply is to smile sweetly and steal a French fry off my plate, middle finger covertly extended.
“So, about Mrs. Schenk,” Vern interrupts as he settles back into his chair and sets Babs’ order in front of her. “What do y’all do when she calls y’all out there? Paramedics exorcise ghosts, too?”
“She has dizzy spells every now and then,” Bodie winks. “Usually when the Sheriff’s Office is busy. Wouldn’t be surprised if she had a scanner.”
“Still, gotta be a pain in the ass to go out there every time she gets lonesome,” Vern observes.
“Oh, I wouldn’t call it an inconvenience,” Bodie answers mildly, no doubt thinking of warm cinnamon rolls and sweet tea. “It has its fringe benefits.”
“Put that on my tab, Vern,” I order, nodding at Babs’ breakfast order.
“Already did,” he answers smugly. “When you actually gonna pay your tab?”
“So what’s wrong with Helen Schenk this morning?” Babs interrupts before I can frame a reply.
“Ghosts,” I answer. “Right about now, I figure LawDog’s givin’ ‘em the St. Crispin’s Day speech. They’re very discerning ghosts.” At that, Bodie and Vern break out into outright guffaws.
“Y’all hush,” Babs admonishes. “She’s a very sweet lady.”
“You see her at the hospital?” Bodie asks, surprised. “Reason I ask, is we never transport her. Other than the occasional ghost sighting or dizzy spell, she seems as healthy as a horse.”
“Never as a patient,” Babs corrects. “She volunteered with the Hospital Auxiliary until her husband died. Visited people and brought flowers, that sort of thing. Every Wednesday, she used to bring the best warm cinnamon rolls to the ER.”
“Better than mine?” Vern asks haughtily, one eyebrow raised.
“Vern, nobody can beat your buns,” she winks coyly.
Vern blushes like a tomato and chokes on his coffee. The radio crackles again, “Car 12, County.”
“Go ahead, Car 12.”
“Would you send a paramedic to my location, please?”
Shit.
“Say again, Car 12?” I can see the little cartoon balloon over the dispatcher’s head as she asks the question: “What the hell? What’s wrong with Mrs. Schenk?”
“Send a paramedic unit to my location,” LawDog repeats evenly, but you can hear the steel in his tone. “Tell the
m Code I, please.”
No lights and siren. Whatever’s wrong, he doesn’t want to upset her.
“That’s us, honey,” I say, sliding out of the booth as the pager tones go off. “Gotta go.” I stoop and give her a quick kiss goodbye before turning to leave.
“Be careful!” she calls after us as we trot for the door. “Say hello to Miss Helen for me!”
**********
“So, what you figger?” Bodie muses as we roll out of the parking lot, reflexively engaging the lights and siren as we turn onto Main Street.
“More to it than the usual,” I point out as I turn off the warning systems. “LawDog called us, not Mrs. Schenk. Whatever’s going on, he thinks it needs a paramedic.”
“Got a point there,” Bodie concedes. “I ain’t wild about letting a cop decide what is and what ain’t emergent, though. If he thinks it needs a medic, it oughta get an emergency response.”
Heh. I love you Partner, but you are positively ate up with the Siren Syndrome. Been in EMS for twelve years, and still craving the adrenaline rush.
“He’s an EMT too, Bodie. Been one for years.”
Bodie says nothing, just grunts noncommittally. We’ve been burned before, mostly by cops who slept through their First Responder course at the police academy twenty years before. Work with someone long enough though, and you learn whose judgment you can trust. Not everyone is qualified to make those kinds of distinctions.
Now Helen Schenk, hers is an interesting story. She stands five-foot-nothing, weighs maybe a hundred pounds. Graying hair, gentle manner, and laughing eyes that still resembled the shy girl in the wedding photo in her foyer. Don’t let the grandmotherly manner fool you, though. There is steel in Helen Schenk. When the Schenk boys occasionally ran afoul of the law for the misdemeanor infractions that are the province of teenage boys in small towns everywhere, it was their Momma’s wrath they feared, not their Daddy’s or the cop’s.
When Mr. Melvin took ill, she nursed him through cancer and ran the store and her household by herself. Three years of hospital stays, trips to MD Anderson way down in Houston, chemo, radiation, fear and dashed hopes, and none of that broke her. She didn’t sell the store until that last year when Melvin was confined to his bed. For the first five years after his death, we’d still see her around town fairly often. The last five years, not so much. That was about when the ghost sightings and dizzy spells started.
If anyone’s entitled to an occasional ghost sighting or dizzy spell when the house feels a little too empty, it’s Helen Schenk.
Bodie makes the turn off FM 124 onto Muir Road, and the Schenk place becomes visible over the first rise. Set way back from the road in a grove of pecan trees, it’s a stately old plantation house surrounded by open pastureland. It has two stories, massive white columns, and the memories of four generations of Schenks residing therein, with Miss Helen now the sole custodian of it all. If there are ghosts, they’re most likely familiar and loving ones.
Just up the road, maybe a hundred yards from the main house, sits a tidy little cottage that in less politically correct times was known as the servant’s quarters. Two of her children had started their families in that house, but Miss Helen had sold it when the youngest had moved away. Donated all the furniture in it to the town, too. Three or four days a week, I get to sleep on an antique four-poster bed. I wish I could swap it for the Sealy Torturepedic I have at home.
The woman who lives in that house now teaches math at Bugscuffle High School. Certified calculus teachers are hard to lure to rural towns, but Helen Schenk is a persuasive woman, and rarely takes no for an answer. A nice house offered at a very attractive price was only one of the enticements she was willing to offer.
Bodie pulls into the drive at 212 Muir Road, eases up alongside the Bugscuffle County cruiser and bloops the siren once. By the time we lug our first-in bag and oxygen up onto the front porch, LawDog has stepped outside to meet us.
“Morning,” I wink. “Are we doing a second act this morning? Just so you know, I want a speaking part this - ”
“I wish it were that simple,” he answers quietly. “You’ll need your cardiac monitor and stretcher this time, gentlemen.” Without another word, he opens the door and walks back inside.
Bodie gives me The Look, thrusts the oxygen cylinder into my hands and sprints back to the truck, and I follow LawDog into the house.
**********
Helen Schenk is gray, and not the gray of hair that confers age and wisdom. I’m talking gray, that unhealthy pallor unique to very sick people, and her skin has a sheen of perspiration that belies the coolness of the house. True to form, she puts on a brave face.
“Honestly young man, it’s nothing more than a toothache,” she smiles, but the assurance stops at her eyes. She’s worried.
“On both sides of her mouth,” LawDog clarifies. “With heartburn, too.”
“When did all this start, Miss Helen?” I ask, handing a nasal cannula to LawDog, who quickly loops it over her ears and attaches it to our portable oxygen cylinder, cranking the flow meter to four liters. He’s sure-handed and smooth, which in itself is rare. Usually, when you hand a nasal cannula to a cop or volunteer first responder, well…let’s just say that the term oxymoron has it’s own meaning in the EMS lexicon.
“Well, the young officer was upstairs, giving my ghosts what-for,” she explains, and LawDog, standing behind her, nods solemnly…and winks. “I was pouring both of us a glass of tea, when I felt a touch of heartburn. We were sitting down enjoying a pleasant conversation when my toothache began, and I…”
“…and she began to feel rather…peaked,” LawDog finishes, stepping to one side as Bodie enters the kitchen. “BP was 100/64, pulse 56 and thready, respirations 24.” At my raised eyebrow, he explains, “I still keep a small bag in my cruiser.”
“You feel this pain anywhere else, Miss Helen?” I ask. “I mean, besides your jaw and chest? Any problems breathing, or nausea?” She shakes her head no to all three.
“Howdy Miss Helen,” Bodie smiles warmly as he scoots the tea glasses and saucers to one side, setting our cardiac monitor on the table. “How you feelin’ this mornin’, hon?”
“Well, it’s hardly morning any more, young man,” she corrects him with a pained chuckle, “but I’ve felt better.”
“Well, let’s see if we cain’t do somethin’ about that,” he reassures her. “I got some aspirin here I need you to chew up and swaller,” which Mrs. Schenk obligingly does, “and you can wash it down with a sip of your tea here…”
Bodie and I have a system. He knows what I want, and he does it without prompting. Generally he does the assessments and interventions. He takes the vital signs; I decide what they mean. He gets the EKG; I interpret it. He does all the BLS interventions; I take the history and do the paramedic stuff.
Only in this case, I already know her history. Helen Wilcox Schenk is 72 years old, has high blood pressure and high cholesterol, takes Lipitor and Metoprolol, is allergic to sulfonamide antibiotics, had a total hysterectomy in ’77 and a left knee replacement a couple of years ago. She doesn’t smoke or drink, and she keeps two tea pitchers in the fridge, one made with Splenda for herself, and one made with real, honest-to-God sugar for her guests. If pressed, I could probably remember her birth date and social security number.
Oh, and she occasionally hears ghosts and has dizzy spells.
LawDog motions me into the other room, and I follow close behind.
“She’s sick,” he says quietly, his face grave, “but she’s not going to admit it. I found a big bottle of Tums in her medicine cabinet, half full. There’s an empty one in the wastebasket. Probably been gobbling antacids for weeks.”
“Well, we’ll know what’s going on in another couple of minutes,” I decide, “and then we’ll speed her on to Big City.”
“Why so far?” he wants to know. I know he’s thinking of Bugscuffle Memorial just ten minutes away.
“If it’s a heart attack, she’s better off going straight to the cath lab. It’s another thirty minutes on the road, but well spent.”
“Fair enough. Anything else you need?”
“Let’s get the stretcher in here as close as we can,” I answer. “I don’t fancy making her walk.”
“I don’t fancy trying to convince her she’s going to the hospital, period,” he retorts. “She’s a stubborn woman.”
“We’ll tag team her. Between the three of us, we can – “
“Hey, AD!” comes Bodie’s urgent voice from the next room. Alarmed, I bull my way back into the kitchen, LawDog fast on my heels. Bodie has his hands full trying to ease a limp and barely conscious Mrs. Schenk to the floor.
Oh, shit.
“What happened?” we demand in unison, each of us taking an arm and easing her into a sitting position on the floor. LawDog gives the chair a gentle prod with his boot, and it scoots backward a couple of feet and catches the rug, toppling over with a clatter. Together, we lay Miss Helen supine and I tilt her head back to open her airway. Her blouse is pushed up around her neck, and I can see where Bodie has managed to attach all six of the chest electrodes without having to remove or even reposition her bra. Neat trick, that.
“I gave her one nitro, and was just about to acquire the 12-lead, when she just slumped over on me,” he answers, his voice clipped. I can read his thoughts by the expression on his face.
Not Miss Helen. Not now.
Funny how that always works. You sit at the ambulance station all day, wishing for something good and bloody, or someone really sick – I mean ambulance sick – to make up for all those patients who weren’t. You never count on it being people like Helen Schenk.
“Start bagging,” I order tersely as I feel for a pulse. I find my answer as Miss Helen weakly bats at Bodie’s hands, trying to push the mask away as he starts ventilating.
Still with us. Thank God.
I rip her blouse open, buttons popping off and clattering along the hardwood floor, but I am stymied by the bra. It is not a delicate lace and silk contraption one would find at Victoria’s Secret. No, this is a sturdy Old Lady Bra, Country Edition™, suitable to keep the twins in check through a hard day of breaking colts or tossing hay bales onto a trailer. It will not be ripped easily by human hands.
Witnessing my frustration, LawDog sighs mightily and produces a black anodized knife from somewhere on his person. A flick of his thumb opens it with an authoritative snick, and with a studied nonchalance, he cuts Mrs. Schenk’s bra in half with a flick of his wrist. Somehow, I don’t think the manufacturer of his tactical cutlery ever envisioned it being used for such a purpose.
You’re welcome, his smile seems to say.
Without being asked, he rips the defibrillator pads from their foil envelope and hands them across to me, and I pause just long enough to look at the screen before taking them. Almost as an afterthought, I press the RECORD button on the 12-lead EKG.
Second Degree Type II block, rate of thirty. Not good. And shit, an anterior wall infarction. The Widowmaker. Damn. It. All. To. Hell.
I slap the pads in place – thoughtfully labeled by the manufacturer with little pictorial graphics for the illiterate EMTs who can’t understand words like apex and sternum - set the rate at eighty, and turn up the current. The machine passes twenty, then thirty milliamps, and Mrs. Schenk’s breasts start to bounce as her chest muscles contract with each pulse of pacing current. It seems obscene, somehow.
As I increase the pacing current past forty, I am rewarded by seeing her EKG complexes merge with the pacemaker spikes, forming the characteristic wide complexes of pacemaker capture. The monitor beeps at a comfortingly steady eighty beats a minute.
“Strong pulse here,” announces LawDog, his left hand grasping her wrist.
“Breathing better, too!” Bodie chimes in.
Thank you Mr. Zoll, for your wonderful invention.
“Let’s try to keep it that way,” I decide. “Let’s get her ready to roll. LawDog, you think you can manage to get the stretcher in here?”
“Consider it done,” he says confidently and marches back into the foyer. Bodie continues bagging as I reach across Mrs. Schenk’s chest, digging through the ALS bag for IV supplies. I quickly set up a bag of saline and tie a tourniquet just above her right elbow. I turn her hand this way and that, searching fruitlessly for a suitable vein.
“Got a big external jugular up here you can get,” Bodie announces, turning Miss Helen’s head to the side so I can see. With his accent, it comes out as “Gotta big sternal joogler up hyar yew kin git.” The only thing missing is the musical ting of a tobacco stream hitting the spittoon.
“No thanks, partner,” I demur as I stick, and miss, a tiny vein on her right forearm. “I’d rather save that sternal joogler for a last resort.”
Miss Helen flinches and pulls her arm away, and I look up at her face. Her eyes are open, and even better, they’re focused.
Hot damn. Looking better by the minute. I don’t like that rattle in her breathing, though.
“Well hello there, Miss Helen,” I tell her, leaning directly over her and making eye contact. “You had us worried for a minute.” Her eyes search mine questioningly, but she says nothing. “You had an abnormal heart rhythm,” I explain gently, “and it looks like you may be having a heart attack. We’re taking you to the hospital.”
At that, she shakes her head vehemently and tries to push the oxygen mask away from her face. I grasp her hand and squeeze gently, and use my I Will Be Obeyed Voice.
“Mrs. Schenk. Helen. You are seriously ill. You. Will. Go. To. The. Hospital. If you think I’m going to let something bad happen to the lady who makes the best cinnamon rolls in Bugscuffle, think again.”
Her eyes brim with tears, but she nods her head, yes. I grin and wink, and clasp her hand just a bit tighter as Bodie replaces the resuscitator mask with a non-rebreather. The slam of a door, a mechanical clatter followed by a loud crash, and a muttered “sweet shivering Shiva!” herald the return of LawDog with our stretcher. He backs into the kitchen, bent over uncomfortably at the waist and towing our collapsed stretcher behind him.
“Broken glass on the floor in the foyer,” he says apologetically. “Watch your step.”
Together, we gently deposit Miss Helen on the stretcher and pile our gear on board. Oxygen tank goes in the caddy at the stretcher foot, cardiac monitor hangs on the side rail, ALS bag slung over Bodie’s shoulder, and LawDog brings up the rear, carrying all the wrappers and assorted detritus that seems to flower on any ALS call. At the front door, Miss Helen grasps the doorframe as we pass through, halting the stretcher. Lawdog almost bumps into me as we stop suddenly.
“M-m-my hou-house,” she hiccups, her voice muffled by the mask and syncopated by the steady pulse of pacing current, “who’s g-going to w-wa-watch it?”
“That’ll be me, Ma’am,” LawDog offers gently. “I’ll tidy up and lock up the place for you. Make sure the ghosts behave themselves while you’re gone, too.”
She smiles gratefully and gives his arm a pat as we roll her outside, and he and I share a look. It’s bad, my eyes say, and he nods gravely in understanding. Bodie and I quickly load the stretcher and stow the gear, and LawDog gives Mrs. Helen one last reassuring squeeze of the hand before he backs out of the rig.
“Run hot,” I tell Bodie tersely as I settle in on the bench seat and unsheathe a fresh IV catheter. Two simple words, but Bodie knows what they mean. We rarely transport any of my patients with lights and sirens. In our partner shorthand, “run hot” means this is beyond my capability to stabilize. Get me to someone who can. I don’t say it often, and it always means Bad Things when I do.
Bodie nods curtly, and offers two words in reply. “Hang on.”
True to his word, the ride is rough as he pulls back onto Muir Road. It’s an eight-mile run, back up Muir Road onto FM 124, and then all the way through town to Bugscuffle Memorial Hospital. Driving the way he is, Bodie will make it in eight minutes. It sounds like a much slower drive than it is.
I set my feet against the sway of the rig, grasp Miss Helen’s left arm and extend it, and tuck her hand just under my left elbow. I wedge my feet against the stretcher frame, brace the knuckle of my right index finger and thumb against her forearm, and wrap the remaining fingers around her elbow. I give myself a little pep talk before I stick, the needle poised near the bend of her left elbow.
Not moving at all, AD. Just her arm and the needle, a fixed point in space. Piece of cake.
Blood fills the flash chamber as I advance the needle, proving once again that even a blind squirrel occasionally finds an acorn. Afraid I’ll jinx myself, I try not to grin until I have the line taped down and flowing. I’m still not happy with Mrs. Schenk’s color, although it has improved since we got her heart rate up with the pacing.
“Still hurting, Miss Helen?” I ask as I press the button on the NIBP cuff.
“Yes,” she answers shortly. Just a one-word response, through gritted teeth. I know it’s not the pacemaker, although some do tend to hurt. But in the greater scheme of things, it doesn’t much matter why she’s hurting. Pain is pain, and tends to make the heart work harder than it should.
“I’m going to get you something for that, Ma’am,” I assure her as I slide into the jump seat behind her and reach for the cellular phone. “Just give me a moment and I’ll…”
The cellular phone isn’t in its hanger. Sometimes I’ll forget to seat it properly and it falls out of its base and winds up in the garbage can on the floor, and I’m rummaging through IV fluid wrappers and paper towels when I hear Bodie speaking.
“Chest pain…MI on the 12-lead…shocky…heart block…pacing her now, AD’s working on a line…” he is saying into the handset, still a step ahead of me. Feeling immensely grateful to have a partner who anticipates my needs, I reach instead for the drug kit.
“Hey, AD!” Bodie calls back to me through the sliding window, phone still pressed to his ear. “Vital signs?”
“Uuuhhh, heart rate 80, BP is…hang on…112/56, respirations about 14…and tell ‘em I’m giving 4 of morphine!”
“Heart rate 80, BP 112/56, respirations 14, givin’ some morphine right now,” Bodie dutifully relays. “Yep, one nitro and an aspirin on the scene. See y’all in five.” He flips the phone closed and pitches it into the passenger seat.
I feel the rig slow as we turn off of FM 124 into town. The traffic is never heavy here, but only a fool barrels through a town at seventy miles an hour, siren or no. Even so, I feel the rig surge as Bodie puts his foot to the floor.
What the hell is he doing? He’s not even slowing down!
“Five more minutes,” I smile reassuringly at Miss Helen as I administer morphine for the pain. “And in not much longer than that, you should feel some relief from this pain.”
Her lips move, but I can’t hear her words beneath the mask. I lean closer and clasp her left hand, and move the mask up onto her forehead. “Thank you,” she mouths silently, and then closes her eyes and grips my hand tightly. Tears form in the corners of her eyes and slowly march down her temples into her hair.
“No need to thank me,” I shake my head, grinning. “This is what I do.”
“Th-thank the young off-officer with the r-red hair for me, too,” she whispers. “He’s m-my fav-favorite.”
“You can thank him yourself,” I tell her firmly, looking her squarely in the eyes. “You’re not going anywhere.”
“He’s quite the thes-thespian,” she winks and grins weakly. “S-sometimes I s-stand at the f-foot of the s-stairs and listen t-to him give m-my ghosts a sh-show.”
Heh. Busted, LawDog.
“So what was today’s performance?” I ask, playing dumb.
“Hamlet’s so-soliloquy,” she chuckles. “It w-was really quite…” her voice trails off, and her eyelids flutter. Her left hand clenches mine hard, spasmodically, and then goes limp.
God, not now.
I quickly feel for a pulse, and find none. She’s not breathing, either, even though the monitor still shows a steady pacemaker rhythm.
Come on, Miss Helen. Please don’t do this to me. What the hell happened? Just no pulse all of a sudden, and no change on the monitor? We had good capture with the pacemaker, and it still shows a good…
…the pacemaker. All I’m seeing is the pacemaker.
I quickly switch off the pacemaker to see the ugly scrawl of ventricular fibrillation scrolling across the screen. Charging the defibrillator to 150 joules, I shock her once, and the rhythm changes to asystole, an ominous, unbroken flat line on all three lines of the display.
Damn. It. Do NOT die on me now.
I start CPR compressions with one hand as I feel the truck slow and yaw to the right as Bodie pulls into the ambulance bay at Bugscuffle Memorial. Bodie lurches to a stop, throwing me off balance. I desperately hold on to the ceiling bar with my left hand as I do compressions with my right. If there is ever a time I need to do perfect CPR, it’s now.
The rear doors fly open, and LawDog is standing there, looking surprised to see me doing CPR.
How the hell did he beat us here?
“Get the IV,” I order, in no mood to answer questions. “Let Bodie get the stretcher.” To LawDog’s credit, he asks none. I hand the bag out the door to him, still doing compressions with one hand as Bodie unloads the stretcher, and together we wheel her inside.
“Whoa,” observes Moonlighting Paramedic as we roll past the nurse’s station. “Straight to Room One, AD. We didn’t know this was a code.”
“Wasn’t one until we pulled in,” I grunt as Babs enters the room with the ER doctor in tow. I pause just long enough for us to shift Miss Helen to the ER stretcher, and continue my report. “Same thing Bodie told you over the phone. The Widowmaker on the 12-lead, then she went into Second Degree Type II block, passed out on us. Started pacing, got good capture at 45 milliamps, vitals came back up. Gave four of morphine on the way here for pain. She went into v-fib on the ramp, I shocked her once and she went into asystole. Past history of hypertension, nothing cardiac that I know of.”
“Any epi or atropine?” Babs asks as she sorts out the tangle of monitor leads, oxygen tubing and IV line. Behind her, Moonlighting Paramedic resumes chest compressions.
“There wasn’t time,” I explain. “One second she was holding my hand and talking to me, and the next she was – “
“We’ve got it from here, gentlemen,” the doctor interrupts impatiently, shooing us out the door. “It’s getting crowded in here.” With that, he unceremoniously shuts the door in our faces.
Bodie, Lawdog and I stare mutely at the door for several long moments, each of us lost in our own thoughts. After a long silence, LawDog clears his throat.
“So what were you two talking about?” he ventures softly. “When she arrested, I mean.”
“Her kids,” I lie. “She was worried about her kids.”
His shoulders sag. “Right,” he sighs. “I’ve got calls to make.”
“It’s ‘bout lunchtime,” Bodie observes. “Don’t feel real hungry, though.”
“Me neither,” LawDog and I answer in unison.
Outside, he tips his hat goodbye before he drives away, and Bodie and I put our rig back together in silence. There’s nothing we can say, anyway.
“You know,” Bodie observes, pausing with the key poised just outside the ignition, “it’s never easy when it’s someone you know.”
“No it isn’t,” I sigh, “ especially when you know everyone.”
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