Extreme Medical Services: Medical Care On The Fringes Of Humanity (2 page)

   
She shrugged. “I’ve never known anyone to have a negative reaction and I have seen what can happen to someone who gets exposed without them. All in all, you are better off with them.” She turned the wheel as she pulled up in front of the bay doors at their station. “Hop out and back me in.”

   
Dean popped his seatbelt off and jumped out, walking around to stand in the ambulance bay doorway as the garage door started to go up. She pulled the ambulance up, lining up the back end so she had a straight shot to back in. Dean saw her looking for him in her driver’s side mirror. He checked behind himself and then slowly walked backward, directing her into the bay.

   
Brynne shut the unit down, jumped out and plugged the ambulance in to the shore line power plug hanging from the ceiling. Dean waited, then asked. “What next, boss?”

   
“We need to replace the glucagon we used, then write up our run report,” she answered. “Let me show you how we get our drugs out of the provisioning machine in the back. It’s kind of like a giant snack machine but instead of food, it dispenses medications.”
 

   
She led him up to a big metal box with windows and doors in it. “Any medication we use is kept stocked in here. If it needs refrigeration or climate control, it’s on this side.” She gestured to the left side of the box with small, separate, windowed doors. “If it’s stable at room temperature, it’s on this side.” She pointed to the right side of the machine. Dean saw familiar meds: epinephrine, atropine, bicarb.

   
Brynne pulled her photo ID badge off her uniform and swiped it in the machine, then entered a four digit code. “When we get you in the system, and you have your ID badge, you’ll be able to do this, too. It automatically keys the med dispensed to your ID in the computer. When you start a patient care report you can pull up meds used and replenished.”
 

   
She selected a letter-number combination and after a few seconds, a thump was heard at the bottom of the box. She reached down into an open bin in the bottom of the dispenser and pulled out a new dose of pre-constituted glucagon. “Go put this back in the med bag where you got the original dose then meet me back in the squad room. I’ll get started on the report.”

   
Dean climbed into the back of the parked ambulance and looked around. It sure looked like a regular ambulance, he thought. He pulled the med bag out of its cabinet and replaced the boxed dose of glucagon. Turning off the interior light, he climbed out of the back of the rig and shut the doors.

   
“What have I gotten myself into,” he muttered to himself.

   
Dean thought back to the ceremonies for his paramedic class just a few days before. The Elk City EMS Academy class of new paramedics stood at the front of the room. They all looked out at their families and friends who watched as each of them was recognized for their achievements over the last two years. The program was an Associates Degree program that culminated in the students testing for the National Registry Paramedic (NRP) certification. That certification, coupled with the passing of the Maryland State EMS protocols test, made them a licensed paramedic.

   
The group of forty-five had once been a group of seventy-eight. The rigorous testing and course load winnowed that down pretty quickly. They had completed hundreds of hours of clinical time including airway management and intubation practice on both cadavers at the state university medical school and time in the operating room assisting anesthesiologists with their patients.
 

   
They’d ridden on the road alongside experienced paramedics, learning the art and craft of caring for injured and ill people in unusual situations. It was often said that anyone could manage a difficult airway in a well-lit operating room or start an IV line in a vein with a patient stationary on a cot in the ER. It took a true artist to do that kind of work upside down in a ditch on the side of the highway at night. That was the life of the paramedic.

   
Dean Flynn had worked hard alongside his classmates with that one goal in mind. He stood a little apart from the others in the group. He had always wanted to be the best, not just good, but the best paramedic in the academy. That drive had put some distance between himself and his classmates as he expected the same drive to be the best from them, too. Most of them considered him aloof at best.

   
Dean had always wanted to be a paramedic. Ever since his own tumultuous ride in the back of an ambulance following a car accident at sixteen, he’d known this was what he wanted to do. He’d watched from the ambulance’s front passenger seat as his girlfriend’s life was saved. That quick thinking, fast acting paramedic, working his magic in the back of an ambulance speeding to the trauma center. Now all the hard work, the long hours studying, the working alongside real paramedics with street smarts was about to pay off.
 

   
Dean had heard that the top of each class got to pick their first assignment in the city. He’d thought long and hard about where he wanted to be. There was Station 1, located in the center of downtown. He’d get his share of high energy calls, with shootings, stabbings and other exciting trauma calls to keep him busy between the boring medical runs for the diabetics and asthma patients. He’d given some thought some about picking one of the two stations near I-95 where it went through town. They got some pretty terrific car accidents there which would test his skills and problem-solving abilities as he tried to extricate the victims from the twisted wreckage.

   
He was sure of one thing. He didn’t want one of the outlying stations in suburban areas, where they were working on implementing some community paramedic and integrated health programs. These paramedics made house calls and didn’t even get to transport most of their patients to the hospital. He’d done his rotations there and learned the importance of helping patients with chronic disease and minor problems stay out of the hospital. He knew that these stations were part of the new health care reform that was shifting high health care costs to the savings of prevention, but where was the fun in that? There was no glory in helping a diabetic patient keep his blood sugar even from day to day, was there?

   
Dean looked out at the crowd from the stage in the auditorium where he and all his classmates were lined up. They wore their light blue uniform shirts and navy cargo pants with the pockets for all the gear they would carry. He was average height at 5’ 11” with short cut brown hair. He was thin and thought he looked good in his new uniform. He prided himself on being pretty fit, though not as muscle-bound as his classmate Jeff Jones. He looked as if he could lift a car off a trapped patient all by himself. Dean had achieved his goal of being first in his class, getting top marks not only in his National Registry test but also on his grade point average and his clinical rotation scores. Even in the boring parts, like the community paramedic stations, he’d paid attention and tried to learn something from the medics he figured had washed up there at the end of their careers.

   
The Elk City deputy fire chief who was chief of EMS was now standing up addressing the group of paramedics. He was talking about their call to serve the community, congratulating the family members and guests of the class for their support during their studies. Dean didn’t have anyone out there in the crowd, so he didn’t care about what the chief had to say about support. He’d done this on his own, and he was proud of it. His mother had wished him luck but was disappointed in him not going to regular college to find what she thought of as a real job. His father, well he was never around enough to say anything worthwhile or supportive anyway. So Dean was standing there waiting for the chief to finish so the reception could begin, and they could all find out where their assignments would be. He’d ended up requesting Station 1 downtown because that was where he’d get the best calls and all the good trauma patients.

    
Deputy Chief Decker wound down the speech. He turned to look at the row of newly minted paramedics standing behind him and asked the crowd to give them a round of applause for their choice to be servants to their community. The applause was enthusiastic since this was the end of the ceremony. A few of the folks out in the audience even whistled and cheered. Then Dean was walking off the stage in a line with his classmates and into the reception outside in the cafeteria and student lounge. He chatted with a few of his classmates. Jill Manning told him she was hoping to get assigned to one of the community paramedic shifts and he wasn’t surprised. Everyone knew that she eventually wanted to continue her education in healthcare and become a nurse practitioner some day. It suited her. She’d never really bought into the adrenaline rush that most of them wanted in this business of emergency medical services (EMS).

   
Dean wandered around, making small talk with the few people who would talk with him. He filled up his cup with some more punch from the refreshment table. His primary instructor, Mike Farver moved around the room with a collection of big manilla envelopes, talking to each of the students in turn and handing them one. Dean knew that in each envelope was their final scores and the badge they had earned to pin to their uniforms. That was the badge that said paramedic on it. The envelope also contained their new uniform patches and, most importantly, their new assignments and the name of their preceptor at the new stations. It was a formality in his case since everyone knew he’d picked Station 1 by now, and the top of the class always got their pick of assignment.

   
Mike was taking his time getting to Dean, though. He’d passed by and said hi when he first started handing out the envelopes but since then, the older paramedic instructor had not come over in Dean’s direction. People and their families were starting to leave as the assignments were handed out, shaking hands or hugging each other before they left, wishing each other luck on their first days on the job next week.
 

   
At this point, Dean had pretty much figured he was going to the be the last one who found out where he got assigned, and he was ok with that. Everyone else had people here to congratulate them and most were going out with family to congratulatory dinners and such. While he considered himself friendly with his classmates, he’d never gotten close with any of them and he didn’t have anyone here to celebrate with anyway. The reception had pretty much wound down by the time Mike came over to Dean with the final manilla envelope. The deputy chief had left long ago, along with all of the other invited dignitaries. The catering crew was starting to clean up the tables and mess.

   
“Took you long enough.” Dean said with a smile as Mike made his way over to him with his assignment. “I would have thought that I would get to go first.”

   
Mike stepped over and shook his hand. “‘The last shall be first, and the first shall be last,’ my friend,” he said smiling. “I wanted to have a few words with you in relative privacy before you got your assignment. You’ve been the brightest of my students in a long time, Dean. You’ve studied the hardest. You have a good handle on skills, and you're one of the best intuitive problem solvers I’ve ever seen. I want you to know that it’s been a pleasure teaching and watching you grow into a fine paramedic these past few years.”

   
He handed Dean the envelope. Dean could feel the extra bulk as he took it. The badge and patch were pushing the envelope out in places. Mike continued, “I just wanted you to know as you head off to this first assignment, you got picked for it because you're one of the best to come through the academy in a while.” Mike put his hand on Dean’s shoulder. “This is not what you expected, Dean, but it suits your unique skills and talents. Remember to keep an open mind and stay safe out there. You’ve got the skills to do this job the way it needs to be done.” And then he shook Dean’s hand again and walked away, grabbing his uniform coat and heading out the door to the parking lot.

   
Well, that was weird, Dean thought as he flipped the metal tabs on the manilla envelope and lifted up the flap to look inside. He reached in and slid out a stack of papers along with his patch and badge balanced on top. He sat down at one of the tables as the caterers continued to clean up around him, looking briefly at the silver badge that said paramedic on it. The patch looked a little different than expected which was weird. He thought all the Elk City paramedic patches were the same. It said EMS-U at the top, had a star of life in the middle and Paramedic at the bottom. There was a certificate of completion. His diploma for an associates degree in applied science as a paramedic was in there along with another white sealed envelope with the Elk City letterhead on it. He quickly opened this one, tearing open the sealed flap with his finger, careful to avoid a paper cut, and pulled out the paper inside. He unfolded it and read the letter.
 

   
“Dean Flynn, congratulations on your achievement and graduation from the city college paramedic program. This is your letter of acceptance to employment as a paramedic for Elk City and pending the receipt of your state paramedic license, will act as your proof of licensure. Please report on Monday morning June 2 to Station U …”

   
“Station U?” Dean muttered under his breath, his shoulders sagging a bit with disappointment. “Where the hell is station U?”