Chapter Text
It’s wild how fast a call can go to shit. One minute you’re just a little nervous about the vitals, forming a plan about how you’re gonna go forward. Then the next, the patient goes down the drain and all your plans go out the window - the call becomes a reckoning, for you and the patient. Garbage isn’t going in the can anymore, equipment has made its way onto the floor. You’re moving your hands faster than you can think and sticking used needles in the bench seat even though your boss told you not to. The sirens and horns are just static in your mind.
I’m telling you, something about the ambulance makes it a cursed place. People are always fixing to die there. I don’t know why; it’s a horrible place to die. They usually only spend twenty minutes there with me, thirty minutes maximum, but it still happens. It makes you wonder how differently it would’ve gone if we’d gotten there just ten or twenty minutes earlier, you know? Maybe they’d do all this at the hospital instead of back here with me.
I tell you all this because someone was trying to die in my ambulance today. I don’t remember what her name was, and if I did, I wouldn’t be allowed to tell you. I’ll just call her Wendy. But I do remember that she was a 70 year old obese asthmatic smoker, and she looked (and sounded) like hell at this point. We’d given her a nebulizer, she’d been doing fine. Not getting better or worse. And then suddenly, she started to get tired…
“Squid, how far out are we from the hospital!?” I shouted to my EMT partner and driver, hoping she’d hear me. I wasn’t able to turn to face the cab and look - I was busy holding the rubber mask to my patient's face, and silently coaching her to breathe alongside the breaths I delivered for her. I’d never used the BVM like this, squeezing the bag along with the patient's breaths while she was awake, looking me in the eye. But when I’d take it off her face and put an nebulizer mask on, and let the breathing treatment blow passively through her lungs, she’d gasp like a guppy for air and my pulse oximeter probe would start screaming at me as her oxygen level plummeted.
“Shit, I don’t know! How bad is she doing!?” Asked Squid, from up front.
I looked at the patient. “Very poorly!” I shouted back. “She’s begging for a tube!”
“Then I can make it in 5 minutes!” I felt the ambulance speed up. Squid layed on the horn, and yelled at someone over the PA. ‘MOVE OVER TO THE RIGHT! MOVE. TO. THE RIGHT!’
A tube, in this world, meant intubation. A tube down your windpipe, protecting your airway from vomit and making it easy to breathe for you. I didn’t want to intubate this poor asthmatic woman, since all the doctors in my life had told me asthmatics didn’t do well when intubated. But was she going to stay conscious for five more minutes? And things were going to get much worse at that point. I looked at her with doubt. Her sweaty brown skin glistened in the harsh dome lighting. Her lips and fingernails were pale and she was breathing hard and fast. I could hear her wheeze even without a stethoscope, air struggling to pass through her constricted lungs.
“Breathe with me. Count, okay? Purse them lips, once every five seconds. One, two…” I squeezed her shoulder gently and then got back to holding the mask on her face. She was dozing off at this point.
Even if she survived this ride, I might be the last face she ever saw.
“Jesus H. Christ,” I murmured. I balled up my fist and rubbed my knuckles viciously along her sternum. “Hey Wendy!! You still awake? You in there Wendy?” She made some vague noises and rolled her head around, but she didn’t even give me any eye contact at this point. I looked around in desperation. Her heart rate was 140. Her oxygen saturation was 94%, which was good, but it was about to get worse. I hadn’t taken a blood pressure in who knows how long. And I hadn’t prepared my intubation supplies. I didn’t even have an IV established, just two failed sticks that ended up stuck in the bench seat. This had all happened so fast.
“Isaac! Have you called the Hospital?” asked Squid.
I couldn’t help but laugh. “F -No! No, I have not!” I let go of the ventilation bag for a moment and stooped down to grab the hospital communication radio off the floor. It was wedged underneath the stretcher, I’d seen it go there after we hit a sharp turn. I tossed it up to the front cab. “You call it! Tell them I’m trying to intubate an asthmatic 70 year old, who ain’t responding to albuterol treatments!”
As I prepared to ventilate her again, my pulse oximeter started beeping at me again. In the brief time I’d stopped breathing for her she’d dropped down to 62%. She sounded like death. Quickly, I shoved the mask on her face and got back to ventilating. But it wouldn’t come all the way back up; it plateaued at 86%, then steadily declined.
“Argh! Screw it!” I dropped the BVM on the backwards facing “Airway seat,” (where folks commonly hid from patients because it was situated behind the stretcher,) threw the nebulizer mask hastily onto her face, cranked up the O2, and grabbed my drug kit. As quickly as I could, I snapped the top off an epinephrine vial -
“Big Bump!” shouted Squid, a little too late. I spilled the ampule all over my hands, then dropped it as I tried to keep from falling.
“Oh come on!” The patient was gasping for air. I sat down on the bench, grabbed another ampule, snapped the top, prepared a 1ml syringe and drew it all up. My hands were shaking. I threw the empty vial away. I don’t remember exactly how it went but I threw aside the blanket and stabbed the patient in the thigh with the needle. I gave 0.3 of epinephrine, to help open up her badly constricted airways. We hit another bump, I lurched back towards her head and grabbed the BVM - where was it? On the backwards-facing “airway-seat,” behind the cot, right where I’d left it. I grabbed the bag, pulled her slack jaw up towards the mask, shoved the nebulizer aside and started breathing for her again. I didn’t want to look at the vitals. They couldn’t be good.
“Have you gotten the tube yet? The hospital wants to know!” Shouted Squid.
I groaned. “I don’t think the tube is happening, hoss!” I glanced at my watch again. It had already been more than 5 minutes. But I wasn’t gonna berate Squid about it. That wasn’t her fault. She was trying her best. And if I yelled at her to go any faster, she might crash and get us killed.
After a minute or so of breathing for the patient, I checked the vitals. An electrode must’ve fallen off because there was nothing on the monitor. But the pulse oximeter now said “70%” and continued to beep at me in a bad way. I moved my fingers down briefly to check her pulse. It felt weak. Like a little bug buzzing under her skin.
I squinted out the back window. I was nearsighted in the extreme, and could not discern details well from inside this compartment, but it looked like we were getting close to the Good-Samaritan Freeside hospital. I recognized the shrubbery. If nothing else went wrong, it would probably be another 2 minutes before we pulled in.
“I got you. Don’t worry ma’am. I got you.” I stroked the patient’s arm and delivered another breath. She was still breathing on her own, albeit not very well. She didn’t seem to be hearing me anymore.
With my last resort, the epinephrine, already administered, and no hope of getting a tube in safely, I suddenly felt hopeless and alone. I was shaking, and I was sweating almost as much as Wendy. I sort of wanted to vomit. But I only had to keep it together for a couple more minutes. I just needed to stay in the moment.
As sirens cut out, and the ambulance lurched to a stop in the ER bay, I did not feel the relief I should have felt. The doors opened up, the warm spring night spilled in. I thought about how I’d present this to the doc as I gave my report. I began to second guess what I’d done. Had I missed anything? What could I have done better? I didn’t want to disappoint.
“Unplug the oxygen! And are you taking her off the monitor or what?” Asked Squid. I blinked. Squid was a greasy, wiry young woman with short black hair and a backwards cap, 18 years old and fresh out of EMT school. She always looked and sounded angry. Right now she was silhouetted by the bright lights of the ambulance and the ER bay, and I couldn’t rightly tell if she was angry with me or if she was just being herself.
“Half the damned stickers already fell off. Help me out here,” I replied. Together we pulled the remaining sticky electrodes off her limbs and switched the oxygen tubing to the cot oxygen bottle. I cranked it up as far as it would go. The pulse oximeter device read 86%. It wasn’t beeping anymore. I urged Squid to leave it in place.
Pushing the cot and breathing for the patient would have sucked but thankfully some folks came out to greet us: Nurse Marwan, and a security guard for some reason. The security guard just looked sort of bewildered, probably thinking ‘What do you want me to do?’ but Marwan immediately began pushing the cot for me and motioned for the security guard to hold open the automatic doors for us.
“What is happening here, Saller?” asked Marwan. Marwan Shehab was a seasoned vet; a medic and a nurse, who worked at the hospital and our EMS agency. He was also pushing 50 at this point and he had a grey, receding hairline, an irritable attitude, and a lotta excess weight to show for it. That sounds unkind, but I would do anything for Marwan. Hell, I would die for Marwan.
“I don’t rightly know. Trouble breathing. Asthma. She’s, 70 I think. Right?”
“She’s 70,” confirmed Squid, giving a thumbs up as she pulled the cot through the ER doors. People turned their heads to stare as we came in. It was calm, at a glance. We were disrupting the peace. Harshing their mellow.
“What did you treat her with?” asked Marwan. He rummaged around on the back of the cot and scooped up the patient’s face sheet, the set of papers with her name, her medical history, her meds, and everything else on it. I hadn’t told him to look for it, but he knew the game. He knew how this kinda thing went.
“If you can just give me those papers, you guys can take the patient to room 16. I’ll tell the doc you’re coming in,” said the triage nurse, directing us down the hall towards a half open sky blue curtain and an empty bed. We were already hustling in that direction before she’d finished her sentence. We passed by a dozen little stories on the way. People watching television in their rooms, sitting with their families. Someone had their whole head covered in bandages and a tube sticking out of their mouth. One of the curtains was completely closed and someone was screaming inside. I tried not to pay any attention and just kept squeezing the bag. I could feel her lungs through it, at the tips of my fingers. They kept getting tighter. The epinephrine might’ve helped, but not much. The bag was getting harder and harder to squeeze.
“Hey, Isaac my guy, he asked about treatment,” said Squid, snapping her fingers in my face.
I flinched. I don’t like surprises. “Sorry. We gave her an albuterol nebulizer but she got worse. I tried to do another but I had to start bagging her, supporting her breaths. She was awake at first, but now she’s like this. I gave 0.3 of IM epinephrine and it seems like that might’ve helped, but she’s getting worse again.”
By now we were inside the room. Someone knocked down the bedside rail, and moved our cot so that we could pull her over. Everyone grabbed two fists full of the sheet underneath her and started coordinating the lift. The patient was big as hell. For my part I just kept my grip on the BVM, and kept delivering breaths. That was my job. No one had asked to take over or told me to stop. The patient made a quiet thumping noise as we pulled her onto the bed.
“Sorry it took me so long, what’s - oh, gee!” Me and Doctor Scotty, (who you wouldn’t know was a doctor if it weren’t for his badge - he was always wearing street clothes), made brief eye contact as he stepped into the room, before his gaze settled upon the stricken patient. He strolled up to her side, up to my side, and checked her pulse. “How long has she been like this?”
“No more than twenty minutes. It happened like, real quick in the back…”
I proceeded to hand off my BVM to a nurse, and give the good doc the story regarding the patient at hand. He didn’t seem impressed with my management or handoff report. I could swear he was glaring at me the whole time. But maybe that was just my insecurity speaking, like Grima Wormtongue in my ear.
In the background, I saw Squid holding my run report, harassing one of the nurses. ”Alright, if I can just get a signature - one for the patient, since she’s all effed up, one for you…”
Once I was done, they started intubating poor Wendy. Doc Scotty drew his laryngoscope, and I quietly moved the stretcher out of the room, pushed it against the wall, and leaned back against it. I was no longer needed.
My body hadn’t stopped shaking. I was still out of breath. I let out a long, heavy sigh. In my excitement, I whispered something to myself. Something really stupid. Looking back on it, I’m pretty sure what I said was, “Jeezle petes!”
“You know, I think it was mostly anxiety,” said Squid. She passed me the bottle of “cancer wipes,” the purple tops. Big bold letters said “Kills 99.99%”.
I pulled out a few, and started idly scrubbing the bench seat where I’d stuck all those needles, though my attention was entirely focused on Squid. “What gives you that idea?” I asked. I felt like my eyes might pop out of my skull and shoot right through my glasses. Squid loved to say stuff like that. Inflammatory stuff. Some of it was just to get a rise out of me, but she definitely also bought her own bullcrap. “The whole three minutes you laid eyes on her?”
Squid wrinkled her nose at me. “Okay, Jackass. Dickhead. Just got your paramedic disco patch last week and you already think you’re better than me, huh? Think you’re a doctor now?” She shook her head. “I’m just saying dude. I think she made it worse for herself. If she weren’t freaking out so bad she’d have been fine.”
“Squid, my certification’s got nothing to do with this! They intubated her! You saw them intubate her!”
“I know! I know she was sick. I’m just saying I think anxiety was like a, you know. A contributing factor. Type thing.”
“Christ almighty-” I balled up the chain of wipe’s I’d been using and threw it at her. She giggled and ducked to the side, and grabbed something off of one of the working areas. “-God, Christ in Heaven why does it matter!?”
“It doesn’t - but screw you!” Squid revealed that the thing she’d grabbed was an unused syringe full of saline that I’d been planning to flush my IV with if I hadn’t made such a mess of it.
I turned my head to the side and stuck my hands up in the air. “Oh… Oh come on, now this ain’t right…” Before I could finish pleading for mercy, I caught a full spray of salty, lukewarm water right in my neck. I shrieked and tried to dodge out of the way as she threw the syringe itself at me but it bounced right off my forehead.
“Ohhhh, I GOT you!” she shouted. We both laughed maniacally as she searched around for another one, and I ducked down behind the cot to avoid a second spray. I am a man of short stature, and very compact, so it wasn’t very difficult.
“But- but really-” Squid threw the canister full of wipes at me. I ducked down in time to avoid the projectile, but the top popped off and I got sprayed with some of the cancer juice. I groped around for the lid to try and reunite it with the canister. “-You’re a fool! I don’t wanna speak on this any longer! You think everything is anxiety! You’re not old enough to think that!” I clipped the lid back on the canister, took aim, but decided not to throw just yet. I wanted to punk her out a few times - acting like I was gonna throw, getting her to dodge.
Squid didn’t buy it. “Okay! Well, I’m not sorry! Ah, crap!” Squid tried to kick the can out of my hands, but got her leg snagged in the crack between the cot and the wall instead. I climbed up on top of the cot and bopped her over the head with it. She immediately slapped it out of my hand and it went rolling on the floor, and out the back of the cab. We both glanced out the back, and saw another crew walk by, looking at us with dull amusement.
“I’ll get that,” said Squid, after a moment of silence.
I nodded. “Uh. Thank you.”
We finished cleaning up the ambulance in relative silence, then hopped into the front cab where we’d stashed our EMS break-room snacks and soda-pops. This hospital was our favorite partially because it was close, and partially because of the great EMS room. It was genuinely something special: It had a microwave, a toaster, snacks and soda-pop, and even a coffee maker! Sometimes there were even grounds and filters to go with it. I loved this job with my whole heart, but for some of my coworkers I’m pretty sure looting that room was the only part of the day they enjoyed. Maybe in a few years I’d feel the same way.
“Think we get another call on the way back to station?” asked Squid, as we pulled out of the lot. Before I could respond she quickly picked up the county radio and mumbled, “Medic 71 returning to station.”
I looked out the window - no other ambulances in the ER bay, and I couldn’t hear any approaching. It was coming up on midnight. I was already over halfway done with my 24 hour shift. And we’d already run ten calls that day…
“Could go either way,” I decided. I rolled my window down to enjoy the warm spring air. The crickets were chirping outside. It was a nice feeling. Sort of like listening to the rain on your windshield. I think Squid felt the same way because she started rolling hers down almost the same time. “But… if we do get one, it ain’t gonna be anything good. I just used up my last good call for the shift. It’ll be some stupid crap.”
“I bet it’ll be literal crap,” Said squid. I laughed a little bit.
“Is that so?”
“It is so! I’m talking feces dude. I bet they’ll be covered in shit.”
“Okay. Don’t bring that kind of bad energy on us. Hell, I was already pushing it.”
Luckily, Squid’s bad energy didn’t manifest into reality. Not yet anyways. Back at the station, most of the other Unit 2 guys were playing Super Mario 64 on the TV. They’d been taking turns on the controller since before we left for our call. Conner Bayen, the hippy redhead, and Captain Curly, (who would also be a redhead if he weren’t completely bald,) were sitting in the armchairs in the dim common room, enchanted by the screen.
It was unusual for Curly to let people sit in the armchairs on a non-weekend day, seeing as how he was a hardass, but I guess he was just that into the Nintendo. Or maybe he made an exception for Conner due to their commonalities. Both redheads, both gulf war vets. Though the similarities ended there. Curly was short and muscular where Conner was tall and lean. Curly was covered in garish, colorful tattoos while Conner had only a peace sign on his upper arm and a lizard on his foot. Conner was a hippy and Curly went hunting on the weekend…
“Howdy folks. Where’s Savanna?” I asked. Neither answered, so I stepped up behind Conner, and leaned over his head. He looked up at me with a bewildered expression. “Bayen. I got to get into the supply closet. Where’s Savanna?”
“You can also ask me, dipshit!” said Captain Curly, not looking away from the screen. I coughed.
“I didn’t wanna ask you. You seem otherwise occupied.”
Curly snickered to himself. “Yeah, I am otherwise occupied. Trying to get the last star on this stupid clock level.” He paused the game, and turned to face me. I am not so good with expressions, but I could still tell he was smiling in a shit eating way. “Plus I don’t even remember the code. Or know where Savanna is. So maybe it’s good you didn’t ask me.” He unpaused, and immediately, Mario said “WWWWAHHHHH” and went falling to his death. Captain Curly threw the controller down in his lap. “Goddamnit dude! Were they on crack when they made this level!?”
“Zhao is in the computer room. She said she’s catching up on reports,” said Conner Bayen, once Curly was done throwing his tantrum.
I nodded. “Thank you Conner.”
In the computer room, Savanna Zhao was not in fact completing reports. Though it was difficult to tell what exactly she was doing. Her screen had all these graphs and numbers on it with red and green, up and down. She acknowledged my entrance with a cute little nod of her head. “Sup, Isaac?” she said. I took a deep breath, like I was about to put my head under icy water, and walked up next to her. Savanna was about my height, a little tubby, with straight black hair and a dusting of freckles. And she had this big, bright smile. I leaned stiffly on the table where she had her computer and peeked over her shoulder. Just like the folks in the day room, Savanna was absolutely honed in. She held her computer mouse like it was an extension of her hand, idly scrolling the cursor across the screen. “Did you need something?”
“Well, me and Squid are restocking, but there’s no BVMs left in the restock bins…”
She nodded her head again. “Mhm?”
I felt myself starting to sweat. “...Uh. We figure there’s probably some locked up in the supply cabinet. And seeing as how you’re in charge of supply, I reckoned you might be able to sort us out.”
Savanna kept nodding. “Yeah. Probably.” She pushed herself away from the computer, and let herself spin around in her rolling chair. Her slippers thumped up against the frame. She was one of those people who chose to wear pajama shorts and non-uniform shoes at night, and keep their Boots and pants by the ambulance. I was not. But I thought it was neat. Savanna was still spinning around in her chair, so I coughed to get her attention again. “Oh, right. Well, I’m not supposed to give out the code, so I’ll just open it up for you and you can grab what you need,” said Savanna. She hopped up from her chair and led me off into the dark recesses of our ancient station, into the forbidden corner where the mildew ridden supply closet lay. Only my bootsteps made any noise.
“So what were you doing there?” I asked as we walked down the hall, just trying to make conversation.
Savanna instantly perked up. “Oh, on the computer?” I nodded. “I’m day trading! Or, night trading I guess. The market closed at 1600 so I’m just reviewing intraday charts right now. I’ve already made some mad profits on this stuff. I might even be able to finance my physician assistant program like this if I keep holding onto BBY and the stock keeps going up!”
“Hell, that sounds smart,” I said. I didn’t really know what she was talking about. But Savanna was generally a really smart person. She was the only person I knew of that actually had any kind of degree at Tri Town EMS, so I wasn’t lying. Everything she said sounded smart to me.
“I’ve put a frightening amount of money into it. But I think it’ll pay off,” said Savanna, with a hint of pride. We approached the closet door. The keypad glowed a faint green in the dark. “Now, avert your eyes buddy. This code is top secret.” I pretended to look away as Savanna typed “#1111” into the keypad, said “open sesame!” and popped the door open. She did a dramatic flourish. “All yours. I’m gonna get back to my computer. Don’t steal any morphine or I’ll slip some succinylcholine into your coffee tomorrow.”
“You reckon the IV stuff would work if it were mixed into coffee?” I asked her, as she shuffled away and I made my way into the closet.
She shrugged. “I’ve never tried it.” A moment passed in awkward silence. “Well, anyways, goodnight. Maybe we’ll find out tomorrow?”
I watched her walk away, then let out a deep breath and fanned out my shirt cause I’d been sweating a little. Ever since we’d met I just could not stop thinking about her - I got all clammed up whenever we spoke in private. I’d only ever told Squid about it, to which she called me, “hopeless,” and, “a queer.” She suggested we should instead be hitting the town and picking up hot college chicks together.
Once I’d gotten the supplies and restocked the ambulance, I sat in peaceful contemplation on the bench seat in that bright lit cabin for a few minutes. I checked my watch. It was 0121. I got off at 0700. Was it still worth it to try and catch some shut eye? I was going to stay up all night thinking about my patient anyways. I just knew it. Already, I was second guessing how I’d treated her. I was wondering if she was going to survive, and if she did, if her life would ever be the same. And I’d probably never find out, unless she had another emergency. My pa, who was an emergency doctor down at the big uni hospital, called this, “Schrodinger’s outcome.” I thought about that term whenever I lost sleep over a patient like this.
Before I could decide about sleeping, a shrill series of beeps echoed through the bay. I winced. Even in the back of the ambulance, with the doors pulled shut, I wasn’t safe from the damn tones. I waited eagerly to see if it was gonna be me or the other crew who was damned:
Medic 71. Engine 96. Injury from a fall. 2187 Birch Street.
And just like that, my chances of sleep blew away in the warm spring wind. I crawled up into the front cab. I could fit quite easily through the hole that connected the two, and I didn’t feel like hopping out. I plopped my butt in the passenger's seat. In the background, I could hear Squid’s footsteps growing closer. I picked up the county radio before she could be herself into it. “Medic 71, copy, Enroute to 2187 Birch Street.”
Squid hopped up into the driver's seat and revved the engine. She looked positively pissed. The engine sputtered a couple times, then leapt to life - the garage door creaked open in front of us as I hit the door clicker.
“Medic 71, as of now this is a lift assist. Patient is not injured. Caller is a family member, requests a silent approach, no lights and sirens,” said a lonely, tired voice over the county radio. She was in purgatory, just like us. “Patient is a male, 81. Naked. Screaming. He says he’s covered in feces.”
Me and Squid glanced at each other from across the cab. She didn’t say nothing. I didn’t say nothing. There was nothing to say. Instead, Squid just turned up the radio, flipped the lights and sirens, and peeled out the bay. The Spice Girls were halfway through “Wannabe” as we hit the streets at dangerous and excessive speeds. Our red lights glinted off the pavement and painted the sides of houses as we blew recklessly through 4 way intersections. The sirens echoed down the streets. Squid changed the tones up every few seconds for maximum effect. Meanwhile, I just took a deep breath, leaned back and nestled into my seat. I should’ve started filling out my run report, but that could wait. For now, I just wanted to clear my head and enjoy the ride.