A Thankless Job

By Becca

            The screams emanating from Treatment Room 2 of Rampart Hospital’s E.R. were ear-piercing.  They were reminiscent of the terrified, guttural cries that emit from a wild animal whose leg is caught in a steel-jaw trap. 

            Inside the treatment room, firefighter/paramedics John Gage and Roy DeSoto were helping the Rampart staff apply leather arm and leg restraints to the bloodied young female patient.  She thrashed and kicked wildly, screaming unintelligibly.  One of the nurses had attempted to hold the field IV in place but was unsuccessful; now, as blood flowed from the venipuncture site, the same nurse was trying to apply pressure with a wad of 4x4 gauze.  Another nurse was trying in vain to reason with the hysterical woman, hoping to gain at least the smallest bit of cooperation before starting to push a large plastic nasogastric tube up the patient’s nose and down her throat in order to perform a gastric lavage, commonly called “pumping the stomach”.  Although the caregivers continued to urge the patient to relax, she fought on with an enormous strength that belied her petite size.

            “Are you sure about what she took?” Dr. Brackett yelled to Gage and DeSoto, who were now fastening the buckles on the heavy restraints around the patient’s ankles.  Next, they would loop the restraints’ straps through the metal railing on the stretcher, effectively tying her to it.

            “Pretty sure, “ Roy called back.  “The other people at the party said it had to be PCP.  They knew someone was planning to bring it.  She’s had a lot to drink, too.”

            “Damn,” Brackett muttered.  “All right.  Carol, let’s get that IV restarted.  Sally, gastric lavage till clear, and follow it with 30 cc activated charcoal.  I also want a bottle of mag citrate down the NG tube. Let’s monitor her LOC carefully.  Roy, can you let Dixie know that we need an ICU bed stat?”

            “Sure thing,” Roy replied.  The restraints were now in place and the nurses were efficiently administering the ordered treatments.  Roy headed out the door.

            Johnny watched the scene uncomfortably for a moment longer.  “Do you need me for anything else, Doc?” he asked.

            “No, thanks, Johnny,” Dr. Brackett replied without looking up from his exam.

            Johnny left the room, the young woman’s screams still ringing in his ears.  Roy was at the nurse’s station, gathering the replacement supplies they needed.  “Thanks,” nurse Dixie McCall said as she hung up the phone.  Turning to an orderly standing nearby, she instructed, “Tell Dr. Brackett in Treatment 2 that the ICU bed will be ready in 30 minutes.”

            “Yes, Miss McCall.”

“If she’s still alive by then,” Johnny thought to himself.

“You guys are a mess,” Dixie teased, surveying the disheveled appearance and blood-stained shirts of the Squad 51 crew.

            “Well,” Roy replied, “let’s just say she won’t be winning any awards for cooperation.  Right, Johnny?”  Johnny was leaning against the counter staring at the closed treatment room door, his back to Roy and Dixie, oblivious to the question directed at him.

            Roy looked at Dixie and shrugged.  “Let’s go,” he said, handing the supplies he had gathered to Johnny.  “See ya’ later, Dix.”

            “Okay,” Dixie replied, “but let’s not make it too soon,” she added with a smile.   

            Outside, Johnny placed the supplies in the appropriate equipment compartments and climbed into the squad.  “Squad 51 available,” he apprised dispatch tonelessly.

“Squad 51,” came the reply.

Roy pulled the vehicle away from Rampart.  He was running over the call in his mind, as was his habit, making sure they had followed the appropriate protocols and hadn’t missed anything in the patient’s symptoms or treatment.  He really hadn’t noticed his partner’s rather somber mood.

After a few moments, Johnny broke the silence.  “Do you ever wonder …?” he started, then shook his head and sighed.  “Never mind.”

“Wonder what?” Roy prodded.

“What makes someone do that to themselves?  I mean, getting that drunk and stoned that they’re out of their minds?”

“Yeah,” Roy replied.  “I do wonder.  But I don’t come up with any good answers.”

“Me either.” 

“You know, when you were getting into the ambulance, her roommate said she might have been trying to kill herself.  Seems she’s been really upset over breaking up with her boyfriend.”

“Man,”  Johnny replied, “that’s awful.”

A few moments of silence passed, broken occasionally by the drone of radio traffic.  The road was under construction and down to one lane in each direction; vehicles moved at a crawl and the squad was still only a few blocks from the hospital. It was a chilly day for Southern California and a light drizzle had begun to fall.

“You ever thought about it?” Johnny asked quietly.

“About what?”

“About killing yourself.”

Roy paused before responding.  He was somewhat taken aback by the question.  “No,” he answered.  He didn’t really know what else to say.  Then, quietly, “Have you?”

“Nope,” Johnny replied.  “Guess that’s why I can’t figure it out.”

“I don’t know,” Roy speculated.  “Maybe some people just aren’t as capable of handling their problems as others.”

“Maybe.”

The traffic had started to pick up speed and they were nearly at the station. Johnny looked out the window and continued to brood.  He didn’t know what it was about her that had gotten under his skin.  Maybe she reminded him of a girl he used to know.  Maybe it was seeing her child-like peaches and cream complexion splattered with her own blood, or hearing her animalistic screams still echoing in his ears.  The thought of it made him shudder.  Roy glanced over at him with concern.

“She’ll be okay,” he said reassuringly.  “Then they can get her some help.”

Johnny nodded but said nothing.

As the squad pulled into the station, Roy wondered why Johnny was taking this particular run so hard.  The pair had been on plenty of overdoses and suicide attempts in their five years as partners.  Though never pleasant, they did come with the territory.  Johnny had usually dealt with them just as professionally as Roy did. 

            The two left the vehicle and Roy followed Johnny into the kitchen.  The engine crew was just putting away the last remnants of lunch.  “Hey, guys!” Marco called.  “Too bad you missed lunch.  It was great!”

            “Yeah,” Mike chimed in, “best lunch in a long time!”

            “Well thanks for not rubbing it in,” Roy said with a smile.  “What’d we miss, anyway?  It smells great.”

            “Marco’s Aunt Elena dropped off home-made tamales,” Chet answered, wiping off the table with a kitchen towel.  “Too bad, Gage - I mean, they are your favorite, if memory serves.”

            Johnny sank down in the recliner, not in the mood to join in the banter.

            “Aw, come on, Johnny.  Don’t pout.  You can have tamales next time.”

            “Lay off, Chet,” Johnny replied flatly.

            “Hey,” Marco offered, intentionally trying to lighten things up.  “These tamales are still warm.  Why don’t you guys finish them up?  I’ve had Tia’s tamales for breakfast a few times and they’re even good cold ”

            “Sure thing,” Roy said, “I’m not proud... just starving.  Come on, Johnny, let’s eat.”

            “Okay,” Johnny replied.  He didn’t really feel like eating, but knew they had a long shift still ahead of them.  Besides, he didn’t want to hurt Marco’s feelings.

            While the paramedics ate, Captain Stanley busied the others with their afternoon chores, and when Gage and DeSoto were finished, he handed them a tall stack of run reports that needed to be alphabetized and filed.  Johnny had cheered up a little, but he clearly wasn’t himself.  Roy tried to figure out what the trouble was but couldn’t put his finger on it.  For that matter, neither could Johnny; he couldn’t shake this bad mood he was in.  “Maybe I’m just tired,” he told himself.  “We’ve had a rough couple of days.”  

            As the two sat at the kitchen table silently sorting papers, Roy started replaying the past few shifts in his mind.  They seemed to be having more than their share of trying patients lately.  Sometimes they would go for days with nothing but the routine calls …minor MVA’s, elderly fall victims, industrial injuries and so on.  Then there were those shifts that were packed with back-to-back difficult calls - suicides, ODs, pediatric traumas.  That’s how the last few days had been.  One of the great mysteries of emergency medicine was why these cycles occurred … was it the stars, the planets, the moon?  It was as if a light switch had been turned off, then on again.

Still sorting papers, Roy tried to pinpoint the whatever-it-was that was eating at his friend.  No doubt Johnny tended to be the moodier of the two... if Roy was a tugboat captain steadily chugging his way through life, Johnny was a wind surfer bobbing up and down on every wave and dip.  Sometimes Roy envied Johnny’s enthusiasm and his ability to throw himself into everything he did with his entire spirit.  But it was a double-edge sword.  Johnny may have been capable of higher highs than Roy, but he was also susceptible to lower lows.  

            Roy flashed back to the last call of their prior shift on Saturday night.  It was about 2:30 in the morning when the tones went off, jarring him from a sound sleep.  The station had fought a house fire earlier in the evening.  Fortunately there were no injuries, but it had been a particularly stubborn blaze, with hot spots flaring for over two hours.  By the time it was finally knocked down, the crew was exhausted.  He knew Johnny was as tired as he was and they had both dared to wish privately for a quiet night … it was an unwritten rule, however, never to state such a thing out loud, as that would surely jinx it.  “I’m getting too old for this,” Johnny had commented as he climbed sleepily into the squad.  “Yeah, I know how you feel,” Roy commiserated.  “Remember, no matter how old you are, I’m always gonna be older... and wiser,” he chided good-naturedly.

            The Saturday night call had taken them to a motor vehicle accident.  Fortunately, only  one car was involved: a Ford Maverick that had taken a curve way too fast.  The driver lost control and crossed the center line, barreling head-on into a power pole.  When they first saw the crumpled mass of metal, now barely recognizable as a car, Johnny and Roy exchanged a knowing glance, both sharing the same thought … we’ll be damn lucky if there’s anyone alive in there to treat.                             

            The two grabbed their equipment and ran to the car.  The engine crew was close behind, ready to offer whatever assistance was needed for extrication or fuel clean-up.  Roy had gone to the driver’s side but was unable to open the door.  Johnny had better luck with the passenger’s door and quickly climbed inside the mangled car, pushing the passenger’s seat forward as much as possible so he could get in behind the driver’s seat.  The first thing he noticed was the strong odor of alcohol mixed with the unmistakably pungent smell of stale blood.  Although wearing his turnouts, Johnny could feel the bits of shattered safety glass that blanketed the back seat poking through as he crawled on his knees toward the driver’s side.  It was a dark stretch of road under any circumstance, but now that the street light the driver had struck was no longer functioning, it was nearly pitch black.  Johnny reached for his penlight and steadied it between his teeth as he positioned himself behind the driver, leaving his hands free to examine and treat the injured man.  He reached over the driver’s seat, one hand on each side of the headrest, and checked the ABC’s.  He quickly determined that the man was alive but unconscious, his stridorous, gurgling respirations indicating a life-threatening upper airway obstruction.

While the airway was of course his first priority, Johnny also wanted to try to protect the man’s c-spine.  The patient’s forehead rested on the steering wheel and his head was slumped over so that his chin was on his chest.  The young paramedic skillfully placed one hand under each side of the patient’s lower jaw line, lifting ever so delicately to raise his head, improving the alignment of the cervical spine.  He pushed the lower jaw gently forward, opening the airway so the patient could breathe better.  The stridor decreased and the respirations became deeper and fuller.

“What’dya got, Johnny?” Roy called in.  He had been trying unsuccessfully to pry the driver’s door open with the claw tool. 

“Unconscious.  I’m gonna need a c-collar and backboard.  That’s all I know so far.”                   

“Cap, we’re gonna need a c-collar and backboard!” Roy relayed.  Captain Stanley directed Chet and Marco to bring the equipment.  “Also better get the jaws,” Roy added, referring to the more powerful extrication tool.  “Johnny,” Roy called in to the car, “we’re gonna try and get this door open so we can get him out of there.”

“Okay” Johnny called back, “I’m not gonna be able to let go here right now.  I’ll check him out as good as I can till you get in.  He had a partial airway obstruction but it’s better now.”

Engineer Mike Stoker hurried over to the mangled car with the extrication tool.  Donning his safety goggles, he expertly set about prying open the door.  Captain Stanley stood behind him, shining a Kel light on the spot where the door met the frame.  Johnny was still maintaining the patient’s airway and c-spine, using his fingers to count the pulse and respiratory rate.  Roy had come around to the passenger’s side and was setting up the biophone as Johnny called out the vitals over the noise of the jaws, “Pulse is 120, respirations 30.  He’s got a laceration on the right forehead.”

“Okay,” Roy replied, jotting the numbers on a note pad illuminated with his penlight.  He plugged in the antenna and picked up the phone to establish base station contact.

Just then, the noise from the jaws and the screeching of metal began to rouse the man from his unresponsive state.  “Arrrrrrrgh,” he moaned, trying to sit upright.

“You’re okay, you’re okay,” Johnny said reassuringly into his right ear.  “Just sit still.  Sit still!  You’re okay.  Don’t move your head.”

“Get away from me!” the man grunted, his speech notably slurred.  His breath reeked of alcohol.  He raised his arms to push Johnny away.  He was a large man, about 28-years old, with a muscular build and a strength fueled by the always-tough combination of confusion and inebriation. 

“Roy, I need some help in here!” Johnny called urgently.  “Sir, please, you’ve got to hold still!  Just try and relax.  I’m here to help you,” Johnny coaxed.  Roy dropped the biophone and jumped in the car, just as Stoker had obtained release of the jammed driver’s door. 

“You son of a bitch!” the man shouted as Roy tried to help Johnny hold him still.  In an instant, the patient managed to turn his head to the right just far enough to bite Johnny - hard - on the right index finger and hand.  “Let go of me, you bastard!” the man yelled, continuing to struggle.

“Owww!” Johnny cried, wanting to pull his hand away from the man’s neck but refusing to do so.  Chet Kelly saw what was going on and yelled back to Captain Stanley, “Cap, we need Vince over here - now!”  Stanley cupped his hands and shouted to the police officer who was examining the skid marks on the road.  “Hey, Vince, we need help over here, quick!” he called, waving a come-on motion with his arm.  Both Officer Howard and his partner rushed to the car.

In a matter of seconds, every rescuer who could descend on the man did so, pinning him hard to the seat of the car.  “Now, look!” Johnny stated evenly but emphatically.  “You knock this crap off right now.  We’re here to help you.  You’ve been in an accident.  Stop fighting me and let me help you.”

The man’s struggling had begun to ease as he developed an awareness on some level of the sheer manpower facing him.  Slowly he began to release the tension in his muscles.  The rescue workers did the same, ever so slightly, but still held him firmly in place. 

Roy let up on the man’s right arm and backed out the door, then entered the rear seat on the  passenger’s side.  He slid next to Johnny and started taking hold of the man’s head and neck, placing his hands next to his partner’s.  Johnny held firm, not sure what Roy was doing.  “I want you to go irrigate that and put a dressing on it,” Roy said, nodding toward Gage’s injured hand.  “I’ll have Chet and Marco help me package him up and we can check him out better in the back of the ambulance where we’ll have some light.”  Johnny hesitated, thinking that a few more minutes wouldn’t really make a difference at this point.  But the wound really was getting sore and it wouldn’t be right to argue with Roy in front of everyone anyway.  “Okay,” he said, slowly transferring the weight of the man’s head into Roy’s capable hands.  “You got him?”

“Yeah,” Roy replied.  “We’ll be fine.  Go take care of that bite.”

Johnny climbed out past Roy, stretching his lanky arms and legs, which had gotten stiff after several minutes in the cramped vehicle.  Captain Stanley spotted him heading toward the squad and called after him, “John, what do you need, pal?”

“Nothing, Cap, just gotta wash my hand off.”

“Did you get cut?”

“Sort of.  He bit me.”

“What?” Stanley asked with concern as he caught up with Gage.

“Yeah.  But the guy’s wasted.  He didn’t know what he was doing.”

“Here, let me do that,” Stanley said as Johnny struggled to get the lid off the saline bottle he had retrieved from the squad.  The wound was really starting to throb and opening and closing his hand was especially painful.  Captain Stanley let the whole bottle of saline pour out slowly over the bite, the run-off dripping to the ground.  He covered the wound with sterile gauze held in place with a roll of Kling.

“Thanks, Cap,” Johnny said sincerely.  “I’m gonna go help Roy out.”

“Are you sure you’re all right?” Stanley asked.

“Yeah,” Johnny answered.  “No big deal.”

“Well, you be sure to get one of the docs at Rampart to check that out as soon as you get there.”

“Sure thing, Cap.”

By the time Johnny got back to the car, the driver had been removed and was being loaded into the back of the ambulance.  He had a c-collar in place with sandbags straddling his neck, and a roll of gauze was wrapped across his forehead and completely around the backboard several times, stabilizing his upper body. His arms and legs had been strapped to the board in like fashion, providing not only the immobilization his spine needed, but keeping him restrained in case he decided to wig out again in the ambulance.

Unfortunately, being strapped so securely had done nothing to improve his attitude.  He continued to yell and swear as the gurney was lifted into the ambulance and locked in place.  Johnny let the ambulance attendant climb in first and sit in the jump seat, then he entered, taking a seat on the bench near the man’s head; DeSoto followed, in good position to complete the secondary survey and start the IV.  Vince Howard stood by just outside the door. 

“Get away from me, you mother fuckers!” the patient yelled, struggling against the straps.

Johnny sighed wearily.  His voice was quiet, reflecting both fatigue and resolve.  His hand throbbed as he pushed the antenna onto the biophone.  “C’mon, man, be civil,” he implored.  “We just want to help you.” 

“Fuck you, asshole,” the man replied, turning his head as far to the left as the restraints allowed.  Suddenly gathering a hunk of spit in his mouth, he hurled it forcefully at Johnny.  He intended it for Johnny’s face, but thankfully missed due to the straps and sandbags.  It did, however, make it to Johnny’s right arm.

Johnny grabbed a towel from an ambulance cupboard and flung it angrily over the man’s face, using a second one to wipe the nasty glob off his arm.  Roy looked on wordlessly, knowing it was all Johnny could do to keep from losing his composure.  Roy had tried to reason with the man, too, but like Johnny was unsuccessful in breaking through the alcohol stupor.  Gage turned his back on the patient and completed the call to Rampart, relaying the vital signs and physical findings.  Roy tugged on the bottom of the towel, slipping it off the patient’s nose, but leaving it on his mouth.  The man swore right through it, now mumbling to himself more than yelling out loud.  DeSoto heard the hospital’s orders and got the IV set up.  “I think we’ve got it from here,” he told Johnny.  “Why don’t you get the equipment loaded up so we can roll.”  Johnny nodded his concurrence and headed out the side door of ambulance, leaving the biophone in case Roy needed it en route.      

At the hospital, the paramedics were thoroughly relieved to finally turn the patient over to the Rampart staff.  Dr. Brackett headed into the exam room just as the two were coming out.  “Good luck, Doc,” Roy said with a smirk as they passed.  The doctor arched his eyebrow quizzically.  “He’s a real peach,” Johnny added.  Brackett nodded his head understandingly and continued through the door. 

At the nurse’s station, Dr. Early had just finished taking a radio call from Squad 36.  He looked at the two tired, dirty medics approaching and quickly noted the bandage on Johnny’s hand.  “What happened, Johnny?” he asked in his usual kindly tone.

Johnny looked down at his hand and shrugged.  “Oh, nothing,” he said absently.  Dr. Early looked at Roy skeptically. 

“Our patient must’ve skipped dinner,” Roy explained, “’cause he decided to take a bite out of my partner instead.”

“Really?” Dr. Early asked with a look of concern.  “Did it break the skin?”

“Yeah,” Johnny admitted reluctantly, knowing what was coming next.

“Why don’t you come with me and I’ll have a look at it.” 

“Okay, thanks, Doc,” Johnny answered, passing the handi-talkie to Roy. 

“I’ll stay here and get supplies,” Roy offered.

In the exam room, Johnny hopped up gingerly on the gurney as Dr. Early turned on a surgical light and directed the beam at Johnny’s hand.  He gently unwrapped the Kling and removed the gauze, which had adhered slightly to the wound.  “Boy,” he said, turning Johnny’s hand over and back again, noting the purple, swollen finger and obvious teeth marks.  “He got you good.  What did happen, Johnny?”  

“Drunk guy from an MVA.  He’s in Treatment One.  I was holding c-spine on him and he managed to turn his head just enough to bite me.  He was a real jerk, but he was so drunk he didn’t know what he was doing.”

“Well, I know I don’t need to tell you that human bites can be serious.”  Dr. Early removed the packaging from a sterile bowl and poured antiseptic solution in it.  Placing it on a tray table, he took Johnny’s hand and inverted it in the bowl.  “Let’s soak it for 15 minutes, then I want to get an x-ray just to be safe.  We’ll have to start you on some antibiotics.  Your tetanus is current, isn’t it Johnny?”

“Yeah, Doc, it is.”

“Well, just relax and I’ll get your x-ray ordered.  Do you need something for pain?”

“Nah, it doesn’t hurt that bad,” Johnny said.  ”Can I still work?”

Dr. Early thought for a moment.  “If the x-rays are negative, I think it will be okay as long as you keep the dressing clean and dry.  Of course, if there are any signs of infection, you’ll need to get back in here right away.”  Johnny nodded and Dr. Early headed out the exam room door.

Johnny yawned and glanced up at the clock.  3:50 a.m.  He looked down at his hand, soaking in the reddish-brown liquid.  “I love my job,” he said out loud.  He eyed the pillow at the head of the stretcher.  He was so tired and it was so inviting.  “I’ve got a few minutes before x-ray will get here,” he thought to himself, leaning back on the bed and closing his eyes.

A few moments later, Roy, who had stowed all the supplies, went to check on his partner.  “What’d the doc say?” he asked as he pushed open the door.  Johnny jumped at the sound of his voice.  “Sorry,” Roy said.

“That’s okay.  I was just closing my eyes.  He said x-rays, antibiotics … you know the drill.  Guess you better let Cap and dispatch know.”

“Right,” Roy said.  “Hey, I’m gonna grab a cup of coffee.  Do you need anything?”

“Yeah,” Johnny deadpanned, “a two-week vacation.” 

* * * * *

As he reminisced about the run, Roy finished sorting the large stack of run reports into several neat piles on the table. Grabbing some file folders, he began to place each group of papers into its own folder.  Johnny had gotten a little frustrated trying to separate the flimsy forms with the bulky tube-gauze dressing on his injured finger, but eventually they completed the task.  Dr. Early had cleared Johnny to work and started him on a course of antibiotics.  The drunken driver sustained only minor contusions and abrasions, save for the few stitches needed to close the laceration on his forehead.  No broken bones, no internal injuries.  It was another great mystery of emergency medicine that the drunks always seemed to escape serious injury.  At the hospital, Vince asked the man how much alcohol he had consumed. “Two beers,” came the standard reply, belying his 0.31 blood alcohol.  The third great mystery of emergency medicine was why, no matter how plastered someone was, they never admitted to more than two beers.

That vacation comment was still on Roy’s mind as he straightened the stack of folders and headed toward the filing cabinet in Captain Stanley’s office.  “I guess Johnny’s just tired.  I know I am.  All we need is a little good luck to finish out the shift.”

As if intentionally giving him the raspberry, the Klaxon tones sounded.  “Squad 51.  Injured person.  1350 South Garden.  1-3-5-0 South Garden.  Cross street Britton.  Time out, 1625.”  Roy took a second to drop the files on Stanley’s desk, then rushed out to the squad. 

Approaching the scene, they observed a crowd gathered in a circle on the sidewalk.  Roy pulled the vehicle to a halt as Vince Howard strode up to the open window.  “What’s up, Vince?” he asked.

“Hi Roy.  Guy was out jogging.  Says he was daydreaming and didn’t see a tree limb that had fallen on the sidewalk.  He took a pretty hard fall.  I think he might have a dislocated shoulder.”

Roy and Johnny grabbed a few pieces of equipment and made their way through the group of onlookers.  On the ground in the middle of the crowd was a preppy young blonde man wearing a polyester jogging suit.  He was cradling his right arm with his left and holding it tightly to his chest.  “My shoulder,” he cried, “it hurts so much!” 

“Okay, just relax, we’re going to take care of it for you.  Let’s see if we can slip this jacket off,” Roy said soothingly.  Johnny gently supported the man’s right arm as Roy began to slide the sleeve cautiously down on the left.

“Owwww!  Please don’t touch it!  It hurts so bad!” 

“Okay, it’s all right,” Johnny responded.  “We can leave your jacket on.  Let me just try and take a look at your arm.”  Johnny tenderly palpated along the man’s right clavicle to the shoulder joint and down the right humerus.  “It’s dislocated,” he said to Roy.  “What’s your name?” he asked the soft-spoken young man.  

“Curt,” the man whimpered, “Curt White.  Please help me.”

            “Why don’t you give him something for pain?” a female bystander’s voice came from the crowd.  “Can’t you see he’s suffering?  What’s taking you so long?”

            “Yeah!” a few others called out.

            Johnny shot a sharp glance at the crowd, then looked pleadingly at Vince.  “All right, back up everybody,” the officer said, extending his arms outward and urging the crowd back.  “Let’s give the paramedics room to work.”  Roy began taking vitals on the patient while Johnny established radio contact.

“Rampart, this is Squad 51.”

“Go ahead 51,” came the reply from Nurse McCall.

“Rampart, we have a male victim, 21 years of age, who tripped while jogging.  He has an obvious dislocation of the right shoulder and is in considerable pain.  Standby for vitals.”

“Standing by,” Dixie replied, motioning to Dr. Brackett, who was just down the hall.

“Rampart,” Johnny continued, “the BP is 132/82, pulse 100, respirations 24.  Distal pulses are intact and cap refill is normal.  Request permission to administer something for pain.”

“51, are there any other injuries?  Did the patient strike his head?” Brackett asked.

“That’s negative, Rampart.  Apparently he landed with his right arm outstretched to break the fall.”

“10-4, 51.  Start an IV with D₅W and administer 2 mg MS slow IV push, titrated for pain to a total of 8 mg.  Monitor vital signs closely en route.”

Johnny confirmed the orders as Roy got the IV and medication ready.  After receiving the first dose of morphine, the patient relaxed enough to allow the medics to place a sling on his right arm.  He was loaded into the ambulance and Johnny climbed in beside him.

“It’s really starting to hurt again,” Curt moaned, leaning his head back and wiping tears from his eyes with his left hand.

“Okay, I can give you a little more medication,” Johnny replied sympathetically as he finished rechecking the vitals.  He inserted the morphine syringe in the injection hub and pinched off the tubing, delivering another 2 mg dose intravenously.  “Just relax.  You should be feeling better soon.”

Wheeling the patient into the exam room, Johnny updated Dr. Brackett on the patient’s status.  “His vitals are stable, Doc,” he said, “I’ve given him the whole 8 mg, but he’s still in a lot of pain.”

“Okay, thanks, Johnny,” Brackett replied, turning his attention to the young patient.

Johnny met up with Roy at the nurse’s station and listened in as Dixie spoke.  “I don’t know who thinks up these things, Roy,” Dixie said, shaking her head.  “All I know is that from now on, when any paramedic unit needs to replace a narcotic, you have to go down to the pharmacy to get it.”

“What’s this?” Johnny asked, furrowing his brow.

“It’s the new ‘Pre-Hospital Personnel Narcotic Disbursement Policy’, effective today,” she said, rolling her eyes.  “You guys have to go to the pharmacy now to restock narcotics.”

“Why?” Johnny asked, his eyes narrowing suspiciously.

“Because some bureaucrat upstairs has to keep thinking up new policies to justify his paycheck,” Dixie offered sardonically.

“Yeah, that’s for sure,” Johnny agreed. 

“Either way, we better get down to the pharmacy so we can go back in service,” Roy suggested.  “Thanks, Dix.”

“See you guys later,” Dixie said as the pair headed down the hall.

Based on the blank stares they were met with at the pharmacy window, the paramedics quickly concluded that the staff there had no clue about the new edict.  After several phone calls were exchanged between the head pharmacist, Nurse McCall, and the unnamed hospital administrator, the morphine tubex was finally released to Roy.

Heading back to the E.R., Johnny glanced at his watch.  “Looks like we missed dinner again,” he moaned.  “And I’m starved,” he added, patting his stomach.  “Think the guys saved something for us?”

Before Roy could reply, the two were intercepted by Dixie in the hallway.  “Did you get everything straightened out with the pharmacy?” she asked.

“Eventually,” Johnny replied.  “But you wouldn’t believe what we had to go through to get it!”

“And you guys wouldn’t believe what young Mr. White did,” Dr. Brackett chimed in as he strode down the hall to join the trio.  Roy and Johnny glanced at each other quizzically and then looked at Brackett.  “Did you tell them yet, Dix?”

“Tell us what?” Roy asked curiously.

“Your friend with the dislocated shoulder disappeared from x-ray,” Dixie answered.  “Pulled out his IV, picked up his clothes and left while the x-ray tech was developing the films.”

“What?” Johnny asked, incredulous.  “But what about his shoulder?”

“Well, that’s where the story gets good,” Dixie continued.  “I checked with the other E.R.s in the area.  Seems he’s pulled this on everyone but us … until now.” 

Seeing that the paramedics were still perplexed, Dr. Brackett picked up the story.  “A few years ago, Mr. White dislocated his shoulder water skiing.  He opted not to have surgery.  Now he can pop it in and out of joint at will.  He also happens to be addicted to narcotics.  So he pops his shoulder out, fakes a fall and goes to the E.R. begging for relief.  Once he gets it, he takes off.”

“I don’t believe it,” Johnny mumbled, shaking his head in dismay.

“Don’t feel too bad, fellas,” Brackett offered.  “I’ve seen quite a few drug seekers in my time, but this one fooled me, too.  I even gave him a shot of Demerol before I sent him to x-ray.  He’s very convincing, and those clean-cut looks and polite manners don’t fit the usual picture … not to mention his very convenient injury.”          

“We’ll be sure to pass the word on to the other squads,” Roy chipped in. 

“That would be great,” Brackett replied.  “I gotta run.  I’ll talk to you guys later.”

Johnny and Roy headed out to the squad.  It was obvious that Johnny was doing a slow burn.  He slammed the door as he got in and his voice was gruff as he made them available.

When they arrived back at the station, the engine crew was out on a run.  The two entered the kitchen and started foraging for leftovers.  There was a baking pan on the stove with what was formerly a chicken casserole.  Now it was a dried-up mass with a burnt bottom.  Still, it was food, and being nearly famished, they forced it down with copious gulps of milk.  As they were cleaning up the kitchen, the engine crew returned.  All were tired, and after watching the evening news, turned in for what they hoped would be a restful night.     

            At 2:10 a.m., the station was toned out for a single vehicle rollover.  Johnny was normally quick to spring out of bed at any hour, but Roy noticed that he seemed to be a step behind this night.  Their destination was a remote mountain road, specifically a curve that was known to be deadly.  A few minutes from the scene, the squad was canceled. The police had already arrived and the victim was dead.  The engine continued on to assist with cleanup.

            There was silence in the squad as Roy turned it around and headed back down the winding two-lane road.             After rounding a few tight curves, they were on a more even, though still dark and quiet stretch.  No street lamps, no buildings, no moonlight.  After a few moments, Johnny’s words broke the uncomfortable stillness.  

            “Roy?” he started quietly.

            “Hmm?”

“Don’t you ever get tired of it?” Johnny sighed, staring out the passenger’s window.

            Roy glanced at him with uncertainty.

“I mean … doesn’t it ever get to you?”

Roy kept driving.  He had a feeling Johnny wasn’t done yet.  He was right.  Sometimes his partner was like a spring that had to get coiled a little too tight before it would finally let loose with all the force of its withheld tension.  

Johnny rubbed his eyes with his fingers.  “I’m tired, Roy.  Not just physically tired.  I’m tired of seeing all the suffering.  Seeing little kids get hurt because their parents are too busy to watch them.  Seeing innocent victims struggling so hard to stay alive, while other people throw their lives away on drugs or alcohol.  Drunks … I hate drunks.  How come they never get hurt?  I’m tired of being yelled at and spit at and cussed at by the very people we’re busting our butts to help,” he paused.  “It just seems kind of pointless sometimes, you know?  Doesn’t it ever get to you?”

Roy thought for a moment.  “It tries to,” he replied quietly.  “But I don’t let it.  I think the only way to do what we do is to stay focused on the positive… those few calls where we really do make a difference, where someone takes the time to say thank you.  I guess that’s what keeps me going.”

“ ’Thank you’,” Johnny repeated glumly.  “You know how long it’s been since I’ve heard that?”

“It’s not that bad,” Roy replied with a gentle smile.  “Look, Johnny, you know you’ve done an awful lot of good out there.  In an emergency, people don’t always have time to say thank you or they forget in the heat of the moment.  That doesn’t mean they don’t feel it inside.”

“I know.  You’re right,” Johnny agreed, starting to feel a little guilty about what he had said.  “But it would still be nice to hear it, maybe once in a blue moon,” he lamented, fiddling absently with the dressing that still protected his right hand.

“You will, Junior,” Roy patted him on the shoulder, “you will.”      

A moment passed before Johnny spoke again.  “Damn,” he muttered, looking down at his hand.

“What?”

“We’ve been so busy that I forgot to take my antibiotic,” he said, shaking his head.

“Did you take it this morning?”

“Yeah, just not at dinner.”

“Well, take it as soon as we get back to the station.  That should be all right.”

Johnny nodded.

When they returned to quarters, Johnny headed for his locker and downed an antibiotic capsule before finally hitting the sack.  Once again he dared to hope for a quiet few hours.  Once again, it wasn’t meant to be.  The unwelcome Klaxon chimes sounded.  “Squad 51, ill man, at the convenience market, Adams and Miller, time out, 4:08.”   

The paramedics dragged themselves out of bed.  It was a short drive to the 24-hour market.  As they pulled into the parking lot, they were flagged down by a disheveled man standing near the pay phone.  His clothes were old and his appearance unkempt, but he did not appear to be in any acute distress.  Roy pulled the truck to a stop and the two approached him.  “Did you call the fire department?” Roy asked.

“Well of course I did,” the man replied sharply.  He looked like he needed a bath; he also smelled like it.      

“What’s the problem?” Johnny asked, reaching out to feel the man’s pulse. The man jerked his arm away.

“I need you to take me to the county hospital,” the man replied impatiently, as though the two should have already known.

“Are you sick?” asked Roy.

“No, I’m not sick!” he answered sarcastically.  Johnny and Roy exchanged exasperated looks.

“All right, then why do you need to go to the hospital?”  Johnny asked reluctantly, like someone waiting for the punch line to a really bad joke.

“Because I need my Dilantin, why do you think!”

“You need your Dilantin,” Roy repeated flatly.

“That’s right, I need my Dilantin,” he replied snidely.  “I ran out three days ago and if I don’t get it, I’ll have a seizure, now won’t I?”

The rescuers looked at each other in dismay.  “Sir, just out of curiosity, why did you wait three days to call us at four in the morning?” Roy asked.

“Who cares why!” the man snapped.  “Look, I pay your salaries you know.  You’re public servants.  I can call you any time I want!  And I want to go to Rampart, now!”

Johnny used the handi-talkie to ask dispatch for an ambulance.  They took the man’s vital signs as he continued to berate them.  “You county workers are all alike.  Paid vacations, paid time off, then someone calls you for help and you act like you can’t be bothered.  I have a good mind to report you to your chief!”

Gage and DeSoto said nothing.  Why bother?  They went about their jobs matter-of-factly, filling out a run report and sending the man off to Rampart in the ambulance.  Getting back in the squad, Roy tried to find what little humor he could in the situation.  “Well, I think I’ve had all the fun I can handle for one shift.  How about you?”

“Yeah, it’s been a real barrel of laughs.”

By the time they got back to the station once again, the medics knew it would be foolish to try sleeping.  Getting a few minutes of sleep often left them feeling worse than not getting any at all.  Both men rested in their bunks until the inevitable wake-up call came. 

Johnny decided to pass on his usual a.m. cup of coffee; he didn’t want the caffeine, or anything else for that matter, coming between him and his pillow once he got home.  The members of B-shift were starting to filter in.  As soon as he gave report to his replacement, he gathered up his belongings and headed out to the parking lot.  He felt a little better after his talk with Roy and had decided to work on improving his attitude; unfortunately, that last call was the last thing he needed.

About halfway to his car, Captain Stanley’s voice broke through Johnny’s thoughts. “Gage,” he called, “wait up, pal!”

“Now what?” Johnny thought to himself.  Instead, Stanley came up and put an arm around his shoulder, handing him a letter-sized envelope.  “This came for you in yesterday’s mail,“ Stanley explained.  “I guess we were all so busy that I forgot to give it to you.  Sorry.”

“That’s okay,” Johnny replied sincerely.

“Listen, you have a good day off,” Stanley said, patting him on the back, “and stay out of trouble,” he added with a wide grin.

“Thanks, Cap,” Johnny said, fingering the envelope.  It was hand-addressed, made out only to ‘Mr. John Gage, L.A. County Fire Department, Los Angeles, California.’  It looked like a woman’s handwriting, but not one that he recognized.  Patience was not Johnny’s strong suit anyway, and the draw of an unopened letter from a mystery lady was enticing; on the other hand,  its contents could provide new fodder for Chet if he caught Johnny reading it.  He had resolved to open it at home, but only got as far as the front seat of the Land Rover before giving in to his curiosity.  Cracking the window slightly for air, he retrieved the letter from his jacket pocket.  Flipping it over, he carefully tore open the seal, unfolded it and began to read…

            Dear Mr. Gage,

My name is Linda Rivera.  You don’t know me, but a few weeks ago, you took care of my mother, Mrs. Mary Flores.  You may not remember her, but I want you to know that she will never forget you. 

On November 3^rd, Mama woke up in the middle of the night with a very bad stomach ache.  She felt like she needed to go to the bathroom, but when she got out of bed she was very dizzy and thought she was going to faint.  She laid back down and called the fire department, but the stomach cramps were too strong, so she got down on her hands and knees and crawled to the bathroom.  She couldn’t help it that her bowels moved on the way there. 

The doctors told me later that Mama was bleeding internally.  She has had arthritis for years and they said that all the aspirin she has taken caused the bleeding.  So when her bowels moved, she was also passing blood.  She told me in the hospital that the odor in her house was very terrible.

Mr. Gage, Mama has always taken great pride in keeping herself and her house spotless.  Even though she never had the money to afford fancy things, she would spend many hours at the sewing machine when we were young so that we had nice clothes to wear to school.  She even made the beautiful curtains for the windows.  She loved to dress up for church on Sunday and although she came down with arthritis, she worked hard to always look her best.

Mama was terribly ashamed that you and your partner had to see her in the condition she was in that night.  She had soiled not only her house but herself as well.  And here were two handsome young men seeing her like that!  But she told me how you helped change her gown while you were waiting for the ambulance, and how you used a warm washcloth to gently wipe off her legs.  She said that you even cleaned up her rug.  Most importantly, you never made her feel embarrassed by what she had done or the way she looked. 

Both you and your partner were wonderful, but Mama especially remembers you because you were with her in the ambulance.  You held her hand and stroked her hair and asked about her grandchildren - you should have seen the smile on her face when she told me that you said she looked too young to be a grandmother.  You calmed her fears and gave her your strength when she was feeling so alone and frightened.  And of course you also saved her life. 

Mama has a very strong faith, and she is convinced that God sent her an angel that night.  That angel is you, Mr. Gage.  She said she could see the goodness in your eyes.

My family and I will be forever grateful for your kindness and we just wanted to say… thank you.  I know it is not much, but I’m afraid it is all we can offer.

God bless you,

Mrs. Linda Rivera  

            Johnny put the letter down in his lap and was surprised to find his eyes filled with tears.  Embarrassed, although he was alone, he quickly wiped his eyes with his jacket sleeve.  Yes, he remembered Mrs. Flores well.  Of course the smell and the mess had been tough to take, but it had never occurred to him to make her feel badly about it.  After all, what she was going through wasn’t her fault, and he imagined that his discomfort was nothing compared to her own. 

Seemingly out of nowhere, a quote entered Johnny’s head.  He had read it once on a plaque in a doctor’s office shortly after becoming a paramedic.  When asked, the doctor explained that it was a prayer sometimes used at medical school graduations.  Johnny didn’t remember all the words, but one line did stand out.  He hadn’t thought of it in many months.  Perhaps too many.  “May I never see in the patient, anything but a fellow creature in pain.”*

Johnny closed his eyes and tilted his head back, resting it on the headrest.  Tears flowed again.  He was powerless to stop them.

“Hey, you okay?” Roy asked, tapping lightly on the passenger window. 

Johnny sat forward with a start.  He turned away and quickly wiped his eyes.  Turning back, he motioned Roy to come in, reaching over and unlocking the passenger’s front door for him.  Without a word, he handed Roy the letter.  As Roy read, Johnny stared out the window, struggling to get his emotions in check.

Although he would never let on, Roy had noticed his partner’s reddened eyes and his attempt to hide his tears.  When he was done reading, he handed the letter back to Johnny with a smile.  “Thank God for small favors,” Roy thought gratefully.

For the first time in days, Johnny let a crooked smile cross his lips.  “See you next shift,” he said.

 * * * * *

*  From the Prayer of Maimonides.   

Author’s note:  As in my previous story, I incorporated as many real-life incidents as I could from my years in EMS.  The patient with the dislocated shoulder and the one who wanted his prescription refilled at 3 a.m. are actual people.  The others are composites of several different (though still real) patients.  Please let me know how you liked it!

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