Tomorrow We Die (2 page)
Authors: Shawn Grady
The defib alarmed.
Color drained from his face.
I squeezed his shoulders. “Wait. What? Who’s Martin?”
Bones picked up the laryngoscope. “He’s bradying down.”
The man slumped to the sidewalk. On instinct I rolled him away from me. It wasn’t five seconds later that he spewed yellow chunks all over the park ranger’s shoes.
Bones cleared the man’s mouth with the portable suction catheter.
A vigorous sternal rub didn’t wake him.
Bones reset his intubation equipment and talked to himself. “GCS less than eight. Intubate.”
A fire engine siren blared a couple blocks out.
Things moved too fast to process.
Slow down . . . stick with ABCs.
Airway.
His respirations were shallow and slow. His skin felt cool and sweaty. I held his wrist but couldn’t find a radial pulse anymore, only a thready carotid on the neck at thirty beats per minute. Bones placed his stethoscope in his ears one-handed, the other hand holding an inserted tube at the man’s lips. He listened to lung sounds to make sure his tube was good.
Airway secured. Progress. The rumble of a fire engine exhaust brake sounded behind me, followed by the squeak and hiss of an air brake.
We needed to get our patient’s heart rate up before it stopped beating again. “Bones, I’m gonna try to pace him.”
I set the defib to deliver sequential minishocks of electricity to our patient’s heart. The pectoral muscles in his chest twitched. Heartbeats flicked faster on the display. “Okay, we’ve got electrical capture.”
Bones nodded. “And I’ve got radials with that.”
A firefighter walked up. “Where you guys at?”
“Let’s grab a quick blood pressure and then load and go.”
The fire captain clipped a radio mic to his shirt. “Saint Mary’s?”
“Yeah, that’ll be closest. Mind if we take two of your guys?”
“Not at all.”
One firefighter moved to the man’s head to squeeze the bag now attached to the breathing tube. The other pumped the handle of a blood-pressure cuff with a stethoscope in his ears.
He bled off the air. “Eighty-two over fifty.”
“Okay.” I blew out a quick breath. “Let’s roll him on the flat and get him loaded onto the gurney.”
We buckled the patient on the bed. My eyes met the park ranger’s. “Thank you.”
He gave a nod.
I climbed into the back of the ambulance.
Bones looked back through the doghouse, the small opening between the cab and the patient area. “All set?”
“Let’s roll.”
He flicked on the siren and set off for the ER. I found myself wishing I had gathered more history on scene. Had our patient been complaining of anything before he passed out? Did he simply go into spontaneous cardiac arrest? Had the Narcan helped at all?
I turned my focus to a vial of amiodarone and inserted a needled syringe to draw it up. The medication would deter his heart from going back into a lethal rhythm. I flicked the bubbles to the top of the syringe and injected the contents into a second IV bag I’d hung from the gurney pole.
The siren shut off and the ambulance jostled into the parking lot. It turned, the back-up alarm sounded, and through the back windows the emergency room doors drew closer. The firefighter across from me reported another blood pressure similar to the first.
Questions about the patient abounded in my mind.
What happened to you?
What were you trying to tell me?
I took a last listen to lung sounds to ensure the breathing tube was still in place, then stood up and organized the myriad wires and IV tubing aboard the gurney.
“All right. Monitor, O
2
bottle, tube’s secure, IV bags and tubing . . . we’re all set.”
The ambulance shut off. Bones came around back and swung open the doors. He raised his arms, grinning with televangelist grandeur. “Thou, unknown man down. Come forth.”
We got off work an hour late after cleaning and restocking the ambulance and finishing paperwork. The Sierras stood dark and majestic, silhouetted by the day’s crimson farewell. What was it they said in the navy?
Red at night, sailors delight. Red in the morn’, sailors mourn.
Norah Jones escorted me home, her sultry, smoky voice enticing “Come Away With Me” through the car speakers. The black leather of my VW Passat presented a comfortable contrast to the gritty chaos of the workday. I longed to shed my uniform, to be free of the sublime stench of the ambulance.
A paper crinkled in the side pocket of my pants. And I heard my patient’s raspy voice. . . .
“Arepo the Sower holds the wheels at work.”
I pulled out the note and unfolded it atop the steering wheel. A series of markings littered both sides of the sheet – straight and curved lines, dashes and slashes.
Chicken scratches.
I tossed it onto the passenger-side floor.
Streetlights glowed along the sidewalks. The lengthening day disappeared in the west. Blue and red lights illumined my dash.
That look in his eyes . . .
“Give this to Martin.”
I shrugged it off, watching the road zip beneath me. Norah finished. The Byrds came on. “
To everything . . . turn, turn, turn.”
I laughed and shook my head. The man had been obviously low on oxygen and perhaps delusional. A paper full of scribbles meant nothing. I was going home. I was going to relax and get away from work and have my own life for at least the next ten hours.
The notepaper sat on the floor.
I couldn’t see throwing it away in good conscience. That left me one option . . .
I hit the blinker at the next intersection. I’d turn around, take a half hour to go back to Saint Mary’s, and give the piece of paper to the man – or at least to his nurse – and be done with it. The sooner I found him, the sooner I could drop it off and be home in a hot shower.
Night had fallen by the time I pulled into the hospital parking lot. The fatigue in my muscles made it feel later than it was. The evening air bit sharp with the reminder that winter had yet to fully loosen its grip.
At the ER doors I punched in the key code to enter. By now they probably would have moved our patient to the cardiac intensive care unit, but I decided to stop and ask to be sure. A multitasking middle-aged nurse with long, frizzy brown hair gave me three seconds, time enough for her to say, “CIC, ’bout an hour ago,” before trading the clipboard chart she was holding with a new one from a shelf. I don’t think she even heard me thank her as she set off for the next patient room.
I made my way down the long corridor that led to the elevators. The entire hospital buzzed in a constant state of movement, someone always going somewhere and doing something. The extent of my interaction was limited to a polite smile as I shifted with the sea of changing faces.
In the elevator I ran my fingers over the folds on the paper. I placed it in my jacket pocket, and at the fifth floor exited and walked toward a tall reception counter in the cardiac intensive care unit. Behind it sat a young nurse with straight black hair just long enough to be pulled into a ponytail. She reclined in a cheap office chair, staring blank-faced at the surrounding rows of flat-panel monitors coursing with electrical heart rhythms. I recognized her from the ER.
She grinned with straight white teeth. “Uh-oh. Here comes trouble.”
I smiled and scoured the back of my mind for her name.
Sherri . . . Brandi . . . no, something more androgynous . . .
“Bobbi,” I said in stride. “Hey.”
“How have you been, Jonathan?” She almost succeeded in concealing a glance at the name sewn on my work jacket.
“I’m all right. Tired. It’s been a busy week. We ran three cardiac arrests in a row today.”
“So you’re the one who’s been sending us so much business.”
“I wish I could say that. Only one made it to the hospital.”
“Oh yeah? What’s the name?” She leaned forward and pulled a scrunchy out of her hair.
“I actually don’t know it. We found him on the street, and he didn’t have any ID.”
“Hmm.” She sifted through a stack of charts on the desk. “We did get a John Doe from the ER about an hour ago. This says he was a field save, came in intubated. Male, in his sixties.”
“That sounds like him.”
“Wow.” She stared at the chart. “You’re not going to believe this.”
“What?” I leaned forward on the counter.
“According to this he just AMA’d outta here.”
Against Medical Advice.
“He just up and walked out?”
Bobbi twirled her scrunchy and looked aside. “So that’s what all the commotion was about . . .”
“What commotion?”
“You know, being stuck out here I am so out of the loop. I swear, I feel like all I do is stare at ectopy and hit Silence buttons.”
“Bobbi, what commotion?”
“What? Oh. Well, a tall, disheveled-looking man stormed past the front here. And I thought I heard a couple of the other nurses saying that he was lucky he didn’t yank his vocal cords out.”
“He pulled his tube.”
“Yeah.” She glanced at the chart. “And his IVs too.”
“That must’ve been him.” I nodded at a small brass key with a plastic ring tag clipped to the top of the chart. “What’s that?”
She picked it up off of the clipboard and read a small sticky note beneath it. “ ‘Patient belonging left behind.’ ” She twirled the key between her fingers and thumb.
“What does it say on the tag there?”
She held it close to her nose. “River Crown Motel.” Then flipped it over.
I huffed. “The River Crown. No doubt.”
“You know it?”
“Too well. East Fourth Street.” I scratched the back of my neck. “I just can’t believe that he left already.”
“Maybe you should check on him.”
“This day is never going to end.”
“What’s that?”
I’ve come this far. . . .
“You know, you’re probably right. He could be really sick somewhere.”
“Yeah.” She made a face of joking concern. “Or at the very least locked out.” Bobbi looked around and then took my hand in both of hers on the countertop. A cool metal shape dropped in my palm. “You really are so sweet to go the extra mile. Poor guy, he might not even be able to get into his room.” She ran her fingers along my knuckles.
Were I less tired and less consumed by the growing cloud of mystery surrounding this patient and his absurd statements and the ridiculous piece of paper that I couldn’t seem to throw away, I may have capitalized on that moment and scored a date with a hot young nurse. But instead, half considering myself a fool, I simply patted her hand and smiled. “Thanks, Bobbi.” I turned and made my way to the elevators.
“Don’t be a stranger, Jonathan.”
Back in my car, I hunched over the wheel and exhaled. The steam from my breath climbed over the windshield and retreated. I held up the key in the fluorescent parking lot light.
All right, Jonathan, let’s get this done.
I waited at a red light for no one.
Across the intersection sat my destination, marked by a dilapidated neon sign that read
River Crow Mo el.
With the green light I pulled forward and parked in a lot that over time had become more gravel than intact concrete. The motel was two-story, L-shaped, probably built in the sixties during the heyday of Highway 40. Construction of the interstate years ago dropped a slow poison into the old artery, prompting the appearance of strip clubs, bars, and boarded-up businesses. The River Crown’s rectangular pool now brimmed with pebbles, adorned at the edges by dead junipers in terra-cotta basins. The room doors sported custom numbering by hand with what appeared to be black permanent marker. A dull amber light loomed at the corner office. I found the door unlocked.
The small reception room reeked of smoke and dust and sweat-gland-excreted alcohol. Fifty years of shag-carpet collective odor. The walls, infested with faint yellow orange patches of bacterial growth, were in desperate need of cleaning or painting – or both. Behind the front desk, the light and shadows of a television danced from a dark room at the end of a hallway. Save for the muffled din of the TV set, it was silent.
I sounded the ringer.
A short and stocky man waddled to the front. His scruffy gray beard failed to mask the folds of his double chin. He looked me over. “What do
you
want?”
He obviously did not in any way assume that I was looking for a room. I remembered I was still in uniform.
“I am . . .” I didn’t know how to phrase it. I decided I’d keep it simple. “I’m looking for a man.”
I paused, not knowing quite how else to proceed since I knew so little about my patient. But then I realized what my pause could imply after my curt statement and became immediately embarrassed, knowing that I had to say something quickly, regardless of its pertinence.
I cleared my throat. “That is . . . a specific person I need to find.”
His eyebrows relaxed from the raised position they had been in.
“Right.” I drummed my hands on my thighs. “Perhaps you would recognize him if I described him?”
“You don’t know his name?”
“No, see, I’m a paramedic.”
He gave me an impatient look, as if I was patronizing him.
This was supposed to be easy.
“He’s tall, slim, with sort of thin, wispy, light-colored hair and a beard. He wears a black overcoat – ”
“Yeah, yeah. That’s Simon Letell.” The man ran his finger down a guest list. “He’s in 210. Real quiet guy, a little off his nut, keeps to himself mostly.”
“He’s been here for a while, then?”
“At least a month.”
“Thank you. I appreciate the help.”
He gave a wry half smile and shuffled back to the hole of a room he had come from. I turned and made my way out the door.
The chill fresh air was a relief. I shifted my gaze to the upper floor and wasn’t able to make out room 210, so I walked to the stairwell at the inside corner of the motel. It smelled like urine, and the soles of my shoes stuck to the steps. At the top of the stairs a row of pale lights shone, illuminating a balcony bordered by a four-foot wooden sidewall with chipping blue paint. The first door was numbered 218, with 216 beyond it, so I made my way down toward 210.
My legs locked in place.
Adrenaline welled up in my chest. My lips parted as I squinted my eyes to bring into better focus the dark mass lying on the balcony floor – directly in front of room 210.
Not again.
Simon Letell’s feet pointed toward me, his long dark overcoat enshrouding him as he lay on his side, one hand tucked in toward his chest, and his other arm bent up by his head, quasi-fetal position. His face was ghastly white. The pupils of his wide-open eyes were fixed, dilated, and gelled over. His mouth hung agape, his yellowish teeth apart. The side of his face that lay upon the concrete was livid purple. I placed my fingers upon his wrist and tried to move his arm. Rigor mortis had already set in. He lay frozen in the position in which he had died, his skin waxen cold.
An icy wind swirled through the upper walkway.
I pulled my phone from my pocket and called dispatch. I told them to send a coroner. No need for medics.
I took a few steps back and leaned against the balcony wall. My one save was now beyond saving. The Reaper had the last laugh after all.
I exhaled and, through the wafting steam, read the numbers on Simon Letell’s door –
Two . . . One . . . Zero.