I'm taking a few days off. In the meantime I am posting chapters 4-6 of my novel Mortal Men, which I am close to finishing. The first three chapters are posted at:
Chapters 1-3
As I mentioned before I probably won't post the entire novel, but will post at least half in the next month or so.
(Disclaimer -- This is a work of fiction. Any resemblence to real people is purely coincidental).
Chapter 4
“456, Chest pain 85 Vine, on a one. 454, Rollover Whitehead Highway. Person ejected.”
Troy and I were on the second floor of Saint Francis Hospital waiting in the hallway while a nursing home patient we’d brought in from Mediplex of Greater Hartford had an x-ray on his hip. Troy’s first day back at work from his hunting trip and here he was working with me again, and all they’d given us were basic transfers.
“We should be out there,” Troy said.
“Why don’t you turn the radio off?”
“I’ve humped more basic transfers today than I’ve humped in the last three years. The least they could do is give us time to get a meal. Fucking Seurat brothers, the both of them. They’re probably sitting back in the office cackling every time dispatch calls our number. Thinking about how good they’re boning me. ‘482, CB-6, going to Glastonbury Health Care.’ ‘482, Pickup up Steady at Saint Fran Dialysis, then grab Edith next.’ ‘482, Alexandria Manor going to the Cancer Center, wait and return.’ I can’t take it.”
I’d worked enough to know when a dispatcher had it in for you, or when they were told to stick to you, and clearly that was the order of the day for us. “The more you complain, the more you let them see they’re getting to you, the more they are going to mess with you.”
“There’re messing with me plenty. Don’s already asked Linda and her kids out on his boat. I saw that coming a mile away.”
“Is there a problem with that?”
“Linda is free to do what she wants. Her kids love his boat.”
“You two were never a couple?”
“We were just partners. We had fun. We understood each other.”
Sanchez had told me when Troy and Linda worked together, they often drove down behind the college at night and parked in the empty lot by the river. People knew enough to leave them alone.
“471, shooting to the head, Park and Zion. On a one.”
Troy swore. I noticed his hands were shaking. He looked pale.
“You all right?”
“Give me fifty cents,” he said.
I dug into my pocket and gave it to him.
He came back with a Baby Ruth bar.
“It’s not right,” he said. “Paramedics doing basic transfers.”
“I’ll do anything they tell me to do,” I said, “as long as they sign my paycheck at the end of the week.”
“If it was about money, I wouldn’t be here.” He unwrapped his candy bar and took a big bite. “All I ask is a chance to use my skills.”
“Careful what you wish for.”
“I wish no harm on anyone,” he said. “But if harm shows up, call my number. I am the cavalry.”
Chapter Five
As much as I didn’t care for Troy, I had never seen a medic with more confidence, more presence, when he walked on a scene. When he arrived, you had the sense the emergency was over, that the calvary had indeed arrived.
We’d cleared a transfer at Britainy Farms and were headed on New Britain Avenue toward Avery Heights for a dialysis run when dispatch called. “482, disregard that transfer. I need you to back up 463 on Overbrook. Their radio’s breaking up, but it sounds like they need help.”
“Overlook,” I repeated. “What’s the nature?”
“Came in as a child with abdominal pain.”
Overbrook was in the Charter Oak public housing complex just a few blocks away from our location. Two story brick buildings built during World War II were laid out around several oval roads. The buildings looked in disrepair, the grass was burned. Shirtless children shouted and waved at us as we approached. Ahead we saw a parked police car and 463, its lights on and back door open.
The stretcher was outside the building in low position with the straps undone and the sheet spread out.
“They upstairs,” a young boy said. “Davey’s sister sick. She got the shakes.”
I followed Troy up the narrow staircase to the second floor. He took the steps three at a time, easy as walking.
We entered the apartment that smelled of rancid hamburger.
“Let them do their jobs!” I heard someone bark.
A man and woman were yelling at a police officer in the room at the end of the hall.
“Just take her to the hospital!” the man shouted.
“Calm down or I’m going to have to arrest you,” the officer said.
“That’s my daughter!” the man said.
“She’s sick! Lord, she’s sick!” the woman cried.
We pushed into the room. “Coming through,” Troy said.
A young woman lay on the bed convulsing, arms and legs jerking together. She had an oxygen mask on her face. She had to be two hundred twenty pounds. On the wall was a shelf of teddy bears and a poster from Disney’s Beauty and the Beast.
Andrew Melnick, a short, skinny paramedic, just twenty years old, was trying to tape an IV down on the woman’s jerking arm. Blood backed up in the IV line. Melnick’s hands shook.
“What do you have?” Troy asked.
“Lord help my baby!” The woman, now by the foot of the bed, cried.
“Take her to the hospital!” the man shouted. His breath reeked of alcohol. The police officer pushed him back. “Calm down or you’re out of the room.”
“Everyone quiet!” Troy said.
“She said she had belly pain,” Andrew said. “Then all of a sudden she started seizing. I just got a line and gave her five of Valium, but it’s not working.”
“Did you get a pressure before she started?”
“230/130.”
“Is she pregnant?”
“Pregnant? My daughter not pregnant,” the man said.
“She’s a good girl!” the mother shouted. “A church girl!”
“Take her to the hospital before she dies!”
“That’s it, you’re out of here.” The officer grabbed the man by the arm.
The IV line came loose. Blood squirted in the air.
“Lee hold her shoulder,” Troy said. “Get some tape on that. Andrew get me an 18.”
He knelt on the woman’s forearm to hold it steady and took the IV catheter Andrew handed him. “She’s got to be eclamptic.”
“But she said there was no chance.”
“Look at her pants. That’s not pee, she broke her water.”
Her sweat pants were soaked at the crotch. The smell wasn’t urine.
Troy had the IV in. “Give me some mag.”
Andrew fumbled with the one cc syringe as he tried to stick the needle into the small vial of magnesium I had handed him from the med kit. He pulled the plunger back. The drug drained into the chamber.
“Easy, my friend,” Troy said. “Get it in there and push it slow.”
Andrew again had trouble as he tried to stick the needle through the rubber port on the IV line.
“Easy,” Troy said. “That’s it. Now push slow.”
I felt a tension easing in the girl’s arms. The seizure stopped.
“Get your airway kit out,” Troy said.
The woman lay still. Her chest wasn’t moving. She wasn’t breathing.
“Bag her,” Troy said. He tossed me the ambu-bag as Andrew unzipped his airway kit and fumbled to get out the laryngoscope.
I applied the mask over her face, holding a tight seal around her mouth and bending her head back to keep her airway open as I squeezed the bag.
“How my daughter doing in there?” the man shouted.
The cop barred the doorway.
“Just fine,” Troy said to the man. “I’m shutting the door.” To us, “She still has a good pulse. Tube her.”
Andrew nudged me to the side and stuck the scope in her mouth and swept her tongue to the side, peering in looking for her vocal chords.
“She’s bradying down,” Troy said, “Get that tube in.”
“I can’t see the chords.”
Troy reached up and pressed on the front of the woman’s neck.
“I think I’m in,” Andrew said.
“You’re not,” Troy said. “I didn’t feel it pass.”
“Heart rate’s thirty,” I said.
“No, I’m in.”
“Pull it out,” Troy said.
Andrew attached the ambu bag to the end of the tube. Gave one squeeze. The bag didn’t reopen. I saw the belly rise. He pulled the bag off. Vomit surged out of the tube.
“Listen to me next time,” Troy said. “No, leave the tube there. Go in above it. Don’t go in so deep this time. She’s anterior.”
Troy handed him another tube. He went back in. More puke came out of the other tube.
Andrew’s partner turned his head. I could hear him vomit.
“Rate’s fifteen.”
Troy pressed his fingers against the neck again, just below the Adam’s apple. “That’s it. I felt it pass.”
Andrew attached the bag. This time you could see vapor in the tube. Good chest rise. Troy listened with his stethoscope while Andrew bagged. “Nothing in the belly. Good on the left. Nothing on the right. Pull back a little. That’s good. Solid placement. Tie it off. Yank the other tube.”
“Rate’s coming up,” I said.
But Troy wasn’t looking at the monitor. “We’ve got company.”
“What?”
Troy had pulled the woman’s sweat pants down. There between her legs was a bloody motionless baby.
“Throw me a blanket.”
I handed him a towel that was by the bedside.
Troy lifted the child and rubbed it with the towel. He brought the baby up to his mouth and gave it two breaths. He moved his fingers up and down on its chest. In between breaths, he told Andrew how to set up a magnesium drip, while Andrew’s partner bagged the woman through the tube.
“Drip set,” Troy said, “Hang it from the wall hanger. Lee get her on the board and strapped tight.” He gave the baby two more breaths. “Andrew get the infant ambu out, then get the OB kit and let’s get the chord cut.”
It was hot in that room, and I was sweating too, lifting and turning the woman to get the board under her and the straps around her fat. I was so busy I didn’t have time to stop and admire Troy, the calm he displayed. He kept us focused. At his direction I unhooked the woman from the monitor, and applied patches to the baby, who they laid on the short board on the dresser. Its color wasn’t quite as mottled. Troy had a tube in the baby’s mouth, and coached Andrew inserting a small catheter into the umbilical vein.
“Nice job,” he said to Andrew. “A little epi, a little atropine, and maybe things will be all right. You know the dose?”
“I have a field guide.” He reached for his side pocket.
“.01 per kilogram for the epi. .02 for the atropine,” Troy said. “Let’s make it .35 ccs for the epi and 1 cc for the atropine.”
The baby’s rate came up to 140. Troy stopped the compressions. Its color was close to pink now. “Attention all,” Troy announced. “In case you haven’t noticed. It’s a boy.”
When we got to the ED, they had a team from labor and delivery down there with an incubator. The baby weighed five pounds, but the doctor said he appeared to have good reflexes. The mother was stable too. Her pressure was down close to normal. She was breathing well enough on her own that they were able take the tube out of her windpipe.
“Excellent work,” Doctor Eckstein said to Troy. “You guys did a hell of job. Strong work. Strong work.”
She seemed to lighten up around Troy.
“Andrew was the man,” Troy said. “This was your first delivery, isn’t it?”
“Well, yeah. If you could call that a delivery.”
“I foresee a great future for you.”
“I don’t know,” Andrew said. “I was sort of losing it there.”
Troy slapped him on the back. “You hung in there. You were a stud. They should name the kid Andrew in your honor.”
Watching Troy walk down the hall, seeing the way the others looked at him -- two nurses in the station, Melnick, Dr. Eckstein who’d come out of the room behind him, even the cleaning lady looked up from her mop as he passed -- I couldn’t help but feel his aura. He commanded his stage.
Chapter 6
David Nestor was one of the city’s original paramedics. Now at forty-eight, he weighed over three hundred pounds. He’d been taken off the road due to his arthritic hips and cardiac problems, not helped by his three pack a day cigarette habit. Others said the hospital had quietly yanked his medical control to practice because he had been unable to adapt to changing protocols and techniques. His job now was to read through the previous day’s run forms, sort them by number, and make certain all the signatures and insurance numbers were in place before the forms were sent on to the billing department. He often came to work unshaven. His uniform no longer fit. His prodigious gut hung over his belt. He looked like a broken tusked walrus. Instead of sitting at the desk in the back office, he sat on two chairs at a table in the crew room where he liked to hold court.
“Melnick, how can you wear that medic patch on your sleeve?” Nestor said. “I’m looking at this form. You write this guy had rales and you didn’t give him lasix? Didn’t they teach you anything in school?”
“I thought he might have pneumonia.”
“You can’t tell the difference? Didn’t they teach you assessment?”
“Yeah, but you need an x-ray.”
“An X-ray? Bullshit. All a medic needs is a good head on his shoulders and a twenty-dollar stethoscope. A medic doesn’t need an x-ray to see the patient’s in failure. Just reading the form, it’s clear he’s in failure. He’s got JVD, no fever, pedal edema, rales, Bp’s up, he’s tachycardic, Sat’s in the low 90’s despite your non-rebreather.”
“He’s got a pneumonia history. He wasn’t that bad, I didn’t want to take a chance and dehydrate him.”
“Are you a paramedic? You gave him nitro, go ahead and give the lasix. He’s on 60 a day, give him 120 and hand him a urinal. Case closed.”
He turned to see what everyone else in the room was looking at.
Troy stood in the doorway with that demon gleam in his eye. “Nestor, you worthless slug,” he said.
Nestor narrowed his eyes suspiciously like he wasn’t sure whether Troy was serious or just toying with him.
“Nestor, I wouldn’t let you get within ten feet of me with a placebo.”
One moment the EMTs in the crew room had been checking their equipment and strapping on their bulletproof vests. The next they were silent, watching, waiting.
Nestor looked confused and irritated.
“You old paramedics don’t know half what the newest medic coming out of school today knows,” Troy continued. “There’s a new breed on the street. Fifty dollars says Melnick knows all his pediatric doses off the top of his head, and that you would only know them by pulling out your field guide unsticking its pages and putting on your bifocals.”
“Listen to you,” Nestor said. “Go take your medication.”
“That’s right. It would do you some good to take some lessons from a real paramedic, not some washed up old dinosaur that’s killed more people than Son of Sam.”
“You wouldn’t know a medic if you saw one,” Nestor said. “When I first worked the city medics were special -- they were giants of the street. You had to earn the patch. Now days all you need is a pulse and you get hired. Medics are a dime a dozen, but they’re not worth the paper their card is printed on. Shake and Bake medics. Chia Pet medics. No wonder no one respects us anymore.”
“You make a good case for the giant part. The size certainly attests that they were exceedingly large, but like the stegosaurus they had tiny brains and made large shits wherever they went. When’s the last time you took a bath?”
“Psycho,” Nestor mumbled. He looked down at his run forms.
The EMTs in the room smiled like jackals and grinned at Troy, like they’d just crowned him lion king. I felt nauseous. Nestor was red-faced.
“Atropine .02 milligrams per kilogram,” Melnick said. “Epi...”
“Shut up Melnick,” Troy said.
I went out to the car. Troy might have been a phenomenal paramedic, but he grated me the wrong way. We all traveled our own roads and took our own hard lessons. I guessed his were yet ahead of him.
“482, You available to sign on yet?”
“Just about,” I answered. “Give us a couple minutes. Troy’s in a meeting.”
“Tell me once he’s finished his paperwork, I need you to sign on and cover Newington.”
“Understood,” I said.
I went back into the crew room. “Have you seen Troy?” I asked Nestor.
He shook his head without looking up from his run forms. “I’m not his keeper.”
I looked in the bathroom, but no one was there. I glanced in the supply room. I saw no one. Then I did a quick double take. Troy lay on the floor in the corner of the room, half hidden by several stacked crates of IV fluids. He wasn’t moving. When I approached I saw his eyes were glassy. His skin was gray and beaded with sweat. I shook his shoulder. “Are you all right?”
He was unconscious, his skin cool to the touch.
I turned for help just as a tall broad-shouldered medic came in the door. He was about Troy’s age, blonde and fair-complected, wearing a Boston Red Sox hat. He went right for Troy. “Yo, bro!” He rubbed his knuckles into Troy’s sternum.
Still no response.
“Don’t worry,” he said to me. “He does this all the time. It’s his sugar. Now go close the door.”
I knew Troy was a diabetic. I’d seen him checking his sugar with his pocket glucometer, pricking his finger to produce a drop of blood for the test strip, but certainly I hadn’t expected to see Troy Johnson like this. The medic talked gently to Troy as he put a tourniquet around his arm. “Sometimes he resists, so you have to be careful. He’s being good today.” He took an alcohol wipe and rubbed it over a large vein in the crook of Troy’s arm. He stuck a needle in. I saw the blood flash back. “Get me some D50 from the shelf.”
I handed him the blue box. He took out a large bristo jet and a glass ampule of Dextrose, screwed them together, and then stuck the Bristo jet needle in the rubber port of the IV line. He pushed the ampule deeper into the jet, pushing the sugar water into Troy’s vein.
Troy’s eyes were still closed, but his skin was less diaphoretic.
“Shit,” he said, groggily. He looked up at us. “Gimme a four by four."
“You know you have to eat,” the medic said.
“I got a headache. Don’t push it so fast, you know that.” Troy grabbed the four by four I offered, placed it against the IV site, then ripped the line out of his arm, and bent his elbow. “That hurts.” He got to his feet. “What’d you use? A sixteen?” He walked out of the closet and went into the bathroom across the hall.
“Nothing better than a grateful friend,” the medic said. “I’m Pat Brothers.”
“Lee Jones.” We shook.
“I’ve heard about you. I guess no one gave you the spiel on Troy. I’ve been on vacation or I would have.”
“I’ve got part of it. Not this part.”
“He’s a brittle diabetic, and you’ve got to watch him constantly. As long as his sugar stays above 70, he’s got your back. It dips below; you have to have his. Are you any good at IVs?”
“I’m not IV certified.”
“That’s all right. I’ll teach you.
“This happens frequently?”
“Yes, it does, though it runs in spurts. He can be fine for months, and then it’ll happen every day for a week. The company knows he has a problem, but not to the degree it happens. There isn’t a medic here that hasn’t had to sit on him once or twice or five times to get some sugar in him. If you’re going to work with him, you’re going to have to learn how to do IVs.”
I could have answered that I wasn’t an IV tech, but from looking at the light blue of the EMT rocker on my shoulder he already knew that. I saw how things were, and I’ve done worse deeds than look out for a co-worker.
Pat grabbed two EMTs out of the break room, and despite their protests, had them roll up their sleeves. He gave me a quick course. I stuck each of them twice, and Pat three times, getting veins in the crook of the elbow, the forearm, wrist and hand. “Excellent, you’re a natural,” he said. “You’re all set.”
Troy came out of the bathroom ten minutes later, looking hung over, his hair out of place. He put on his Yankees cap and walked right past Nestor like nothing had happened between them.
“A pity the young are so frail,” Nestor said.
I thought Troy would go home for the day, but he sat in the ambulance, and we went out on the road. He said nothing about the incident.
“You’ll learn to see it coming on,” Pat said to me that day. “He starts doing crazy things. Make him eat. Don’t take anything he says personally. He just needs a little sweetening from time to time.”
