Extreme Medical Services: Medical Care On The Fringes Of Humanity (16 page)

   
“I think you’re right, kid,” Gibbie said. “Do you have any ideas? What do these modern gals like?”

   
“You should have this locked down, dude,” Dean said. “Believe me, you don’t want to take advice from me. I’m a complete idiot around women I like.”

   
“Well I have to think of something,” Gibbie said and then he started blubbering. “I cannot lose her. She’s the best thing that ever happened to me. I’ll just die if she breaks up with me.”

   
Dean continued to listen as they made their way to the hospital, occasionally making reassuring sounds and gestures while Gibbie ranted about his relationship failures. Dean checked on his patient’s pain level one more time, but he reported that it was nearly gone and was more like a dull ache.
 

    
Dean smiled as they made their way across town. The aged vampire was beginning to grow on him. In fact, this job was beginning to grow on him. He’d been disappointed when first assigned to Station U as he was sure it was a punishment. But the jobs were interesting and challenging, and even the patients offered something of a thrill ride with their Unusual quirks and traits. The crew he worked with were all top notch paramedics. They were true health care professionals. Brynne was a great preceptor and despite the challenges of the job and the incident with Lydia, he thought that this was a good fit for him.
 

   
“We’re here,” Brynne called from the front of the ambulance as Dean felt them pull up onto the ambulance ramp outside of Elk City Medical Center. He stopped his daydreaming and unhooked the IV bag from the ceiling hook. He then dialed back the rolling valve to close off the tubing so no more fluid would flow and laid the bag across the top of the pillow behind Gibbie’s head. Then Dean moved to the back of the ambulance as Brynne opened the back doors. He hopped down, and she reached over and unlocked the stretcher’s undercarriage from its position. With Dean at the foot of the stretcher, they wheeled it up and into the emergency room entrance.

   
They pulled the stretcher up to the nurses’ station and waited for the middle-aged nurse there to look up from her work on the computer.

   
“Is this the broken arm?” She asked looking up. “Oh, hello Gibbie. I didn’t know it was you.” She shifted her gaze to Dean. “Take him over to exam three. I’ll be right there to take your report.”

   
Dean and Brynne wheeled Gibbie over to the room the nurse indicated then helped him move over to the hospital bed. Dean hung the IV bag on a stand next to the bed and readjusted the rolling valve to the point there was just a drop in the drip chamber every few seconds.
 

   
The nurse who checked them in came bustling in the room. “So, what do we have today with Mister Proctor,” she asked.

   
Dean looked up, “Suspected fractured arm due to a fall or getting it caught in a window, take your pick. We gave 4 milligrams of morphine and splinted the arm at the point of deformity.”

   
“Carol, it was awful,” Gibbie said to the nurse. “Brenda, my one true love, slammed the window down on me, and I was just hanging there. Even if the arm heals perfectly, I don’t think I’ll ever be the same again.”

   
“I’m sure you’ll be fine, Gibbie,” Carol said. “I’ll have Doc Spirelli come in and take a look. He should be able to set it for you and you’ll be as good as new.” She turned to Brynne and Dean. “We’ve got it from here, guys. Thanks.”

   
The paramedics backed their stretcher out of the exam room and wheeled it over to where the linens were kept. They stripped the sheets off the cot, sprayed it down with disinfectant, made it up with fresh sheets and pushed it out to the ambulance. Another job well done, Dean thought.
 

   
Brynne and Dean were on the way back to the station when the next call came in over the radio. “U-191 respond to assist ambulance 792 with a cardiac arrest. 26 year-old female. CPR in progress. 462 West Front Street.”

   
Dean picked up the mic. “U-191 responding, 462 West Front Street.” He reached over and switched on the lights and keyed the siren as Brynne pulled into the left lane and prepared to make a U-turn back towards downtown. “I guess we’re just the next closest unit?” he said to Brynne. “Is that why they called us to assist?”

   
“Could be that, but it might be something else,” she said. “That location is near a bar that a lot of Unusuals hang out in so keep your eyes open. They might need our Unusual talents.”

   
The location was only a couple of blocks away and they saw the lights of the other ambulance as they approached the scene. They pulled up behind the other unit, parked, got out and started to push their way through the crowd to an alley between two buildings. On the right was a bar with a sign that read Wicked Moon. On the left was a 24-hour drug store. As Dean was moving to the edge of the crowd he glanced to the side and saw James Lee, Brynne’s boyfriend. The vampire met Dean’s eyes and smirked, mouthing the words, “too late.”

   
“Hey, Brynne, did you see …” Dean started to say to his partner.

   
“Yeah, I saw him,” Brynne said. “Keep your eyes open. Something is going on here that might require us to do something strange. Be ready to distract the other crew if I tell you to.”

   
“Right.” Dean said.

   
They approached the edge of the alley where two paramedics were in the process of performing CPR on the young woman. She had that pale look that a patient gets when their heart stops beating and pushing blood around the body, or when you’re a vampire, Dean thought. Brynne came up and addressed the senior medic on the code who was managing respirations with a bag valve mask while his partner pumped away on the chest compressions, counting out loud. “What do you have, Ray?”

   
“Hi Brynne,” the other paramedic said as they approached. “She was found collapsed here in the alley. Bystander CPR was started when they realized she was in cardiac arrest. She’s in PEA on the monitor with a sinus bradycardia showing but we haven’t had a chance to do anything else but continue CPR and get her hooked up to the monitor.”

   
“Okay,” Brynne said. “Dean, take over compressions and give him a break. I’ll take over respirations while you guys get IV access and get some epinephrine on board.” Dean waited until the paramedic doing compressions finished a round of thirty compressions and then jumped down and started pumping on the chest. He focused on his technique as he’d been taught.

   
Brynne knelt down at the girl’s head and began using the bag valve mask to breathe for her, sealing the mask to the girl’s mouth and nose with one hand, maintaining an open airway and squeezing the bag with the other while watching for chest rise. “Dean, let’s go to continuous compressions and asynchronous respirations.” Dean stopped counting and switched to doing continuous compressions at a rate of one hundred per minute. Brynne started her smartphone CPR metronome app to help Dean with the pacing and delivered a breath every thirteen compressions with the bag valve mask. While she was doing that she examined the young woman carefully from her perspective at the head and Dean saw a change in her expression.
 

   
“Dean.” She said quietly and turned the girl’s head to reveal her neck to her partner. He glanced down and saw two neat puncture marks on the side of her neck near the junction with the shoulder. Alarmed, he looked up and met her eyes. He realized he was slowing down his compressions so he refocused his attention to listening to the smartphone metronome beeps while his mind raced. The girl was in a pulseless electrical activity rhythm which indicated that there was something that was inhibiting the effective pumping of blood outside of the heart muscle itself.
 

   
Brynne had just narrowed the cause down to two choices, trauma or hypovolemia, a loss of blood. Both could be related to a suspected vampire attack. They couldn’t do anything until the other medics got an IV line in place. This girl needed a fluid bolus to raise her blood pressure, assuming she had any blood left. They didn’t carry blood products on their units, which is what she really needed, but a bolus of IV saline might help give her enough volume to revive her long enough to get her to the hospital. Dean was finishing up his first hundred compressions, already feeling the fatiguing effects.

   
The other paramedic team was working quickly. Ray, the team leader, had the intraosseous gun out which would drill a needle directly into the fibrous center of the bone in the patient’s ankle allowing them to quickly get fluids and medications into her. She was wearing a short skirt so getting access was easy. Ray’s partner was preparing the IV fluid bag and tubing to attach to the IO needle catheter when it was ready. Ray took the end of the IV tubing from his partner and attached that to the intraosseous access point. His partner had wrapped a manual blood pressure cuff around the fluid bag and pumped it up until he saw the drops start to fall in the drip chamber on the tubing. The paramedic holding the bag of fluid handed it to a police officer standing nearby while he got out the med bag.

   
Now that they had IO access, they could start administering drugs for the cardiac arrest. Brynne and Dean switched positions as they pushed the Epinephrine in. He checked for a carotid pulse while looking at the monitor. No pulse detected. Dean thought of a way to get them to infuse fluids without revealing what he and Brynne had discovered. Usually hypovolemia was due to massive trauma but since there was no sign of bleeding, they had to come up with another reason to explain it.

   
He continued compressing the bag of the bag valve mask, focusing on breathing regularly as the other paramedic did her turn of continuous compressions. Brynne said. “She must have been in that night club and may be overdosing on ecstasy. She might be severely dehydrated or hyperthermic. Try a volume infusion.”

   
Ray looked up from where he knelt at the foot of the patient. “That’s a good thought, Brynne.” He looked at the patient again. “She’s probably about one hundred twenty pounds so we’ll say fifty kilograms. Do it Brynne,” he said to Dean’s partner. Brynne pumped up the pressure on the cuff around the bag of fluid the officer was holding until the saline in the drip chamber started flowing continuously.
 

   
The team kept going on compressions for another minute then the other paramedic, Dave, asked Dean to swap out again. Still no pulse and no sign of a change in rhythm. She asked Ray to bag the patient while she got the airway kit out of the other medics’ bags and got set up to intubate.
 
She got out the video laryngoscope, then got set up to drop a tube into the girl’s airway. After passing the tube, she used a small syringe to inflate the balloon securing the end of the airway in place. Ray attached the end tidal capnography sensor to the end of the tube. He bagged the patient a couple of times watching the ET CO2 numbers on the heart monitor. Using one hand, Brynne placed her stethoscope in her ears and listened bilaterally in the lung fields. “I hear lung sounds and nothing over the epigastrium. Tube placement is confirmed by capnography and auscultation,” she said then took over bagging for Ray.
 

   
Dean swapped out compressions with Dave, the second paramedic from 792. Man CPR was hard work, he thought. He looked up at Brynne. “What’s next boss?” he asked. “Are we due for another round of Epi?” She nodded and a glance at Ray confirmed it so he pulled out another pre-filled syringe of epinephrine and assembled it. Brynne gave the BP cuff another couple of pumps to increase the pressure on the bag as it emptied its contents into the girl. Dean attached the syringe to the port in the IV tubing and pushed the drug into the patient.
 

   
A minute or so later, as they continued to work, Ray spoke up. “Hey, I’ve got a spike in the capnography reading. Check a pulse.”
 

   
Dave stopped compressions and checked a carotid pulse. “I think I’ve got one,” he said. His brow furrowed as he concentrated on feeling the girl’s neck. “Yep, I’m sure. It’s faint and thready but it’s definitely there.”

   
“Okay,” Ray said. “Let’s get the stretcher and move her to the ambulance.”
 

   
“Dean and I will go get your stretcher. Come on Dean,” Brynne said taking her partner by the arm. The two of them started towards the other unit to get the stretcher. “Okay, we’ll let them take her into the ER. We need to get a dose of garlic extract on board when they’re not looking, though, to counteract the vampire bite. We’ll write up our version of the report when we get back to our station. The hospital needs to know she has a suspected vampire bite in case she doesn’t survive. They’ll have to take further steps to keep her from turning.”

   
Another voice sounded from behind them as they approached the back of the other crew’s ambulance. “You should have let her be. She wanted this.” Dean and Brynne spun around and saw James standing behind them.
 

   
“Did you have something to do with this, James?” Brynne asked quietly as she turned and kept walking. The crowd was watching them so she didn’t dare say anything too loud. “You told me you were finished feeding on people.” Brynne said in a low voice.

   
“It has nothing to do with you, little one,” he said in a condescending tone. “This was an arrangement with a friend to whom I owed a favor.”

   
“What friend? Her?” Brynne said referring to the patient.

   
“No one, and I said it is not your concern. I will not have you cross me on this, Brynne. It’s an obligation I had from many years ago.” James said.