| Note: While
'Code Blue' can stand alone as a story, it is written
within the contex of Matt McCullar's "You Don't
Believe" Fornax novel . For a more complete reading
experience, please read "You Don't Believe"
first. (Available from Fauxpaw
©2002 By Philip .J. Eggerding - Fornax Characters ©1999-2002 Matt J. McCullar
I looked at my watch and wondered again if Belesun, my 'newbie' partner for the evening, was going to be late again. Even if that tiger had a lot on his plate right now, schedule juggling shouldn't put patient transfer duty on the tail end of things. Granted, these routine transfers to other medical facilities might not be as glamorous as a real medical emergency, but if he couldn't keep to the schedule for the easy stuff, how was he going to perform during a true medical emergency?
Well, he still has five minutes. I might as well go over his paramedic residency file one more time.
After initial training, all Sarawak's paramedics go through a 'residency' program that partners them with an experienced paramedic. It's to see how they perform under real conditions. Belesun had been in the program only two weeks, so he was still restricted to the humdrum patient transfers.
As I looked through Belesun's file, I noticed that the song playing on the ambulance ready-room's speaker was one of my favorites. 'A Friend in Need'. I smiled and started humming along with it.
"Gods, Anson!" said Relenor, a fellow buffalo and paramedic. "You're not gonna start singing again, are you?"
"Hey! Can I help it if I have the voice for it?"
"You call that snorting you do singing? You ain't no Fornax sister, that's for sure."
I chuckled and continued humming. Relenor was just jealous because I had tickets to the Fornax concert this week and he didn't.
Suddenly, the clanging call bell crashed through the music, and I nearly jumped out of my seat. No matter how often I hear that sound, I'll never get used to it. Two of my fellow paramedics, dashed to the vid-screen.
"What's up," I called out, as they turned and headed for the door.
"Aircar accident, south side!" yelled the bear over his shoulder - and they were gone.
Well, this shift is starting out with a bang, I thought, and then smiled at my own dark humor. Paramedics are like that sometimes. Occasionally, you have to make light of the situation or it will drive you crazy - and crazy is something you can't afford to be if you're one of us. Despite the blood and horror you walk into every day, you need to keep your cool and know instantly what to do. That isn't easy. It also isn't easy to test for. There are many cases of paramedic candidates passing the academic and practical side of training only to blow their cookies on the clinical trials.
Except for being late, Belesun had done okay so far. But then, he hadn't been on a real run yet.
Again, the call bell sounded, and just as before, I jumped. This time, however, four furs answered the call and started heading for the ambulances.
"Hey, what gives!" I yelled.
"That last call - it was really a multi! Seven vehicles and a tanker! Rachet building!" And then they were gone, too.
Oh Gods! The blind air corridor behind the Rachet building.
Would they ever fix that dangerous situation? I'd already been there several times responding to accidents.
Suddenly, a double clang sounded. Damn! An all-units call! Rushing to the vid-screen, I saw that the tanker at the multi-scene had blown and everyone else in the ready-room was out the door except me. I couldn't go because I was doing training duty, and in an all-units situation, the training pair stayed behind to provide coverage for any other calls.
Too bad my damned 'partner' isn't here yet!
I sat back down, but before I could calm down, a familiar voice called out from behind me.
"So Anson, how's my favorite buffalo this evening, and what's all the commotion about?"
I looked at the clock before turning and giving the tiger a cold stare.
"You're one minute late, Belesun," I grunted.
"Only a minute? That's not so..."
"There are a thousand ways to die in less than a minute, tiger!" I shouted, huffing a belch of steam from my nostrils to let him know just how mad I was. "In case you hadn't noticed because you were late, our ready-room is now empty! The next real call is ours! I wouldn't want to be in your fur if it had come in before you got here."
He just stood there, jaw open, and then he dropped his tail. I could tell he was profoundly embarrassed and that was good. He should be embarrassed, but I wasn't going to let him off that easily.
"If you're late one more time, Belesun, I'm taking you off the clinical trials, and only Dr. Hakim himself can reinstate you. Do I make myself clear?"
He nodded and sat down, totally deflated, his ears flat against his skull and his head bent low. I let him stew in it for a while and let my own anger cool off before speaking again.
"Belesun," I finally said, tapping his residency file. "You've got a good academic record here - one of the better ones I've seen - but all the head knowledge in the world won't help if you're not at the scene in time to use it! Remember the 'Golden Hour' rule. If severe injury or illness doesn't kill a victim in the first five minutes, chances are, he has about an hour before irreversible shock sets in. One hour. That's all. If you can't pull it together by then, you might as well call the coroner. Time is everything!"
I paused to let that sink in.
"The other thing you must remember," I continued, "is that getting to the scene of a medical emergency can chew up a lot of that Golden hour. That's why we have to be here on time, and ready! That's also why ambulances have the right of way. And thank the Gods for the medi-copters."
Amen to that. Copters could simply hop over the traffic. However, they weren't always the ideal means of patient transport. Having been there before, I knew that the area behind the Rachet building made using the 'copter impossible, so it had been left behind. The 'copter and one other ambulance were now the only emergency vehicles on hospital grounds--and Belesun and I were the only paramedic team left.
"I'm sorry, Anson," mumbled the tiger. "I didn't think I would be needed for anything important this evening."
"But that's just it," I snapped. "That's the nature of this business. Boring, boring, boring - interspersed with sharp bursts of barely organized chaos. You gotta be ready all the..."
I wasn't able to finish, because the call bell went off again, and I saw all the color drain from Belesun's muzzle.
This was a real call - and it was ours.
Racing to the ready-room vid-screen, I saw the call information scroll across the screen and felt my jaw drop as I looked over at my green-as-grass partner. Oh Gods! He was going to get his first clinical trial by fire, and it didn't get much hotter than this. We took off running and headed for the copter pad on the roof.
In five minutes, our ride landed us on the hotel roof, and we jumped out to unload the trauma sled from the back. We'd just slipped it out of its mooring bay when I spotted them. Ratels. Big ones. Heading right for us. I could see Belesun turn and begin to freeze up, so I gave him a punch in to ribs that meant 'Move it, tiger! They're not the problem.'
Initial scene assessment - it'll save your life someday. You've got to take in the whole scene when you get to an emergency site. It's probably as important as treating the victim. See what's there. Figure out who and what the real problems are. After all, you don't want the problem to get you. Becoming victim number two makes you damned useless as rescuer number one.
So, in one quick look, I had sized up these formidable honey badgers. Their uniforms told me instantly that they were security personnel, so they probably weren't part of the problem. They were here to clear the way for us.
"Lead on! We can handle the sled." I yelled as the first guard reached us. Turning around, the ratel barked an order to the others, and they formed an escort around us. Good. At least we wouldn't be fighting through any curious onlookers on our way to the scene. All we'd need to contend with were friends and family - which could be a real pain in the ass sometimes.
Friends and family always want to help, but since they can't really help, they run around, cry a lot, ask stupid questions like "Will they be all right?" (as if I would know), and generally get under paw. But I wouldn't have it any other way.
It means they care.
Still, I wasn't prepared for the sheer number of friends/family that we ran into when we reached the hotel room. Furs of all types were standing around crying or looking shocked.
'They're here!" someone shouted.
"She's in there," screamed another, and we pushed our way through to the hygiene.
Now, I know the dispatch info for this run stated 'Blue Fornax' as the patient, but somehow you just can't believe a famous fur like her can be hurt until it smacks you right in the muzzle, and the scene that greeted us in the hygiene was a one, two punch. First, there was all the blood. Second, the four ratels frantically ministering to their sister were the Fornax sisters. We bulldozed our way in and dropped to the floor.
"Oh Gods! It is her!" Belesun exclaimed.
I shot him a quick 'calm down' look but was just as stunned as he. Funny thing about being shocked - with some folks, it makes 'em freeze up - with others, they go ballistic. For me, everything becomes crystal clear. I just hoped Belesun wasn't the type that froze up.
He wasn't, but he wasn't real calm either. He was almost shaking. "Do it just like you did in practice," I whispered, and he licked his lips before nodding and turning to the trauma sled.
Thank the Gods he hadn't fallen apart completely. I couldn't do everything that needed to be done here myself.
"Start an I.V.," I said, but Belesun was already pulling the intravenous equipment from its drawer on the sled. I grabbed the blood pressure monitor and slapped it on our patient before reaching for the oxygen mask. After strapping it to her muzzle, I checked her out.
No. I wasn't eyeing her up. I was simply looking at the signs - taking them in - letting them tell me what was wrong. In a situation like this, you don't see the beauty. You can't. All you see is the blood. And there was way too much of it all over her body and the hygiene floor. I saw Belesun looking over his shoulder and asking a Dalmatian some quick questions about what happened, but there wasn't much that this broken body wasn't telling me directly.
No signs of external injury - rectal/vaginal bleeding and bleeding from the mouth - but no frothing blood. So, it was internal bleeding in the belly - not the chest. I grabbed a Co-Ag compress and (not to put too fine a point on it) rammed it right up her ass. Another went into the vagina. I'm not being sadistic here. It's just that with internal bleeding, rectal and vaginal openings are outlets that need to be plugged quickly. The next thing was to put pressure on the abdomen. That would slow internal bleeding.
| "Belesun!" I yelled
and he turned away from the Dalmatian. "Cut the
chatter and get the trauma suit!"
He gave me an embarrassed look and pulled the suit from the sled as I eyed the victim again. She was a ratel - black body fur, black skin pigment, and black claws, so a finger or claw-root oxygen/carbon dioxide monitor wouldn't work. Fortunately, her tongue was pink and I quickly clamped on the lingual O2/CO2 unit.
"What are we reading?" I huffed, and Belesun growled a number that was way too high for the CO2. Damn! She was going into carbon dioxide acidosis because of her depressed breathing. If we couldn't get her blood 'ph' back to normal, it could trigger a cardiac arrest. I glanced at the cardiac paddles, but quickly looked away. I hoped I wouldn't need to use them.
"I got the reading here," said Dr. Hakim over my ear-com. "I'm authorizing the sodium bicarb. Full ampoule."
I breathed a sigh of relief. Dr. Abdus Hakim, himself, was monitoring this run, and you couldn't ask for a better ER surgeon. Now that he was older, he normally didn't monitor emergency runs, but the multi-victim scene at the Rachet must have used up all the regular ER doctors. No matter. I'll take experience over enthusiasm any day. I shot the bicarb into the I.V. line that Belesun had started and grabbed the shock-drug kit even as the good doctor gave me the go-ahead to use it.
"O2 is low as well," said Belesun - his voice still edged with panic. I gave him a quick look, but he was arranging the trauma suit under the victim correctly. As long as he had a clear course of action to follow, he seemed to be doing okay. I gave him a reassuring nod.
Just keep your stripes on, tiger. We'll pull her through.
I reached for the FleurOx in anticipation of Dr. Hakim's next orders. FleurOx is a clear fluorocarbon-based blood replacement fluid that can transport oxygen even better than real blood, and sure enough, the Doc wanted it. But keeping the oxygen level up wasn't the only thing we needed to do. We needed to increase the blood volume. That's what keeps the blood pressure up - and you need blood pressure. All the oxygen in the world won't help if there isn't enough pressure in the system to push it to where it needs to go. I glanced at the BP monitor and saw that it read a very low 80/40 with the pulse rate of 170.
Damn! She's going into deep shock.
Our Golden hour was ticking away faster than I thought.
"Push the FleurOx, Belesun!" I yelled, and he clamped his big paw around the bag, squeezing it to make it flow faster. As he did so, I zipped the victim's legs and lower abdomen into the trauma suit and began inflating it. External pressure applied to the legs and belly from the ballooning suit would slow the bleeding and force blood from the lower body into the upper trunk and head, hopefully raising the blood pressure. Sure enough, the BP was starting to inch its way back up - but very slowly.
Gods, please keep her pressure up.
I quickly started a second I.V. line pushing gluco-saline.
"The O2 levels are still too low," commented Dr. Hakim over the com. "How's her breathing?"
I looked at the blood soaked fur on her upper body. Her chest was barely moving.
"Not good," I said.
"Then I think you'll need to intubate her."
Belesun and I stared at each other.
Intubation involved sticking a tube down the throat and into the windpipe. A bulb on the end of the tube was then inflated to seal it in the trachea and a respirator would then take over the breathing. The problem was, neither of us had ever intubated a ratel before, and throat anatomy could be radically different between species. Also, if you didn't do it right, you could damage the vocal chords - vocal chords that, in this case, were a world treasure.
But if we didn't do it, this world treasure might be lost forever.
We both came out of our trance at the same time - Belesun tearing open the intubation kit with his claws, and me grabbing the laryngoscope.
Okay. Take it easy. Do this right. Tilt the head back. Slip in the scope.
As I peered in, I could see blood bubbling up from the esophagus. No wonder she was having trouble breathing. She was aspirating blood clots. Using a gloved finger to scoop the mess out of the way, I cleared the throat and pulled the scope up to expose the larynx. Now all I needed to do was thread the respirator tube past the vocal apparatus - except I'd never seen vocal chords that looked like these before. The tough chords themselves appeared normal, but a stiff bridge of tissue in the middle of the larynx seemed to split it in half from front to back. It was almost as if the right and left chords could use the bridge to operate independently.
Double voiced. So that's how they do it.
However, I wasn't here to admire nature's handiwork, I was here to save a life. Quickly picking the left opening, I carefully slipped the tube into the trachea and inflated the bulb.
"Respirator on," I said, and heard the click and whoosh of the machine starting up. No leaks, in the trachea so the seal was good, and I pulled the scope.
|Whoever had screamed that was in real pain.
And sometimes, that sort of pain was much worse than the physical kind.
Suddenly, four female ratels barreled into the elevator with us. They were Miss Blue's sisters, and they looked like hell - which wasn't surprising, since hell was what they were going through right now. I hated to say what I had to say next.
"Sorry girls, no room in the 'copter. You'll have to make your own way to the hospital. Sarawak Hospital. Downtown."
They stepped back, and as the elevator doors closed all I could see were four sets of pleading eyes full of fear and black tears.
Gods! They were hurting.
The trip back to the roof and the waiting 'copter was all swift efficiency. The ratel security personnel made sure of that. Yet, even in their efficiency, there was a kind of urgent desperation. Yeah. Ratels can be scary, but it seems they can get scared, too - just like the rest of us. I turned to one of them.
"We'll do our best," I yelled over the 'copter noise. All he could do was nod back.
As we locked the trauma sled into place in the copter's cabin, Belesun pointed to the B/P monitor. The blood pressure was starting to fall again. Damn! We were running the I.V.s as fast as we could! The trauma suit was at full inflation. All the drugs used to support blood pressure had been administered. What else could we do?
Belesun had a bleak look on his muzzle as he eyed the cardiac paddles. Gods! It couldn't come to that! In cases involving deep shock, the cardiac paddles were a last resort - and most of the time, they didn't work. As the 'copter lifted and began speeding toward the hospital, I thought again...
What else can we do?
I don't know what possessed me to think of this, but maybe the problem wasn't with Miss Blue's body. Maybe it was her spirit that was broken. Despair can kill as surely as a knife thrust to the heart. I've seen it. Furs with injuries that normally wouldn't be fatal could die simply because they had lost the will to live. And then I thought of the one medicine we hadn't tried yet.
It's said that the sense of hearing is the last thing to go when slipping into a coma or going under anesthesia. It's your last connection with the world before the dark descends. My wife and kids say my baritone voice has a nice burr to it. It doesn't have much vibrato. It's soft and smoky - the sort of voice that's good for singing lullabies or for pleading. So, I leaned close and began whispering softly in Miss Blue's ear.
"Miss Blue? Please don't go. I saw your sisters just before we left, and they love you so much they were crying."
Nothing. The BP monitor was continuing its slow, inexorable slide into the red. Miss Blue was dying and I could do nothing to stop it.
No! Dammit! It couldn't end like this! Again I leaned close, putting my feeling of desperation into my words.
"Miss Blue? Your sisters don't want you to go. I don't want you to go! The whole world doesn't want you to go! Please... you've got to believe me!"
Was is my imagination, or did the corners of her mouth curl up slightly at those last words? Yes! She was responding! I then remembered something I hadn't thought of since my youngest offspring was only a calf. It had been her favorite lullaby, and it seemed apt for the moment. So, I started softly singing to my patient.
Don't go wandering afar too long.
It's silent here without your song.
If I lost you, I'd cease to sing.
A silent home is a sad, sad thing.
So come back safe and don't you stray.
Please, little one, come home to stay.
Yeah. Silly lullaby, I know, but Miss Blue was definitely smiling now, and more importantly, her blood pressure had stopped falling. She was fighting it - she was trying to come home. Thank the Gods.
A moment later, we landed at Sarawak Hospital, and the ER personnel took over. Our job was done.
And that's when Belesun lost it.
Barging into the nearest hygiene, he slammed the door, and I could hear him tying to cry and puke at the same time. I simply waited him out. Then, when the hygiene door finally opened again, I ignored his embarrassed look and put my arm around his striped shoulders to guide him back to the ready-room.
A short while later we were sitting at a table and he was nursing the cup of cafone I'd brought him.
"Feeling better?" I asked.
Slowly, he nodded, but there was a pain in his eyes that I'd seen before in other paramedics. I'd even felt it myself... once or twice.
It was called self-doubt.
"I don't know, Anson," he finally muttered. "I can see a hundred things now that I should have done differently. What if I'd messed up really bad? She could have died! I... I just don't know if I'm cut out for this sort of thing."
"Why?" I asked. "Because you didn't do everything 100% right the first time? That's to be expected on your first real run. Even seasoned paramedics forget things. That's why we work in pairs. Between the two of you, you get the job done," I clapped him on the back, "And I couldn't have done this one without you. That's a fact."
"But what about me throwing up?" he answered, still depressed. "I've never gotten sick at the sight of blood before. How can I function as a paramedic if that happens again?"
I shook my head. "Being horrified by something that's horrible is actually pretty normal. Just remember to save your retching until after you get back from the run. Blowing chunk on your patient is very bad bedside manners."
Looking up, Belesun stared at me for a moment, and before he could stop it, a rasping, growly laugh poured out of him.
Oh yes. This tiger'll do well.
Then I thought about Miss Blue, who must be headed for surgery by now. Would she do all right? It was too early to tell, but I hoped so. After all, how often are you rescued by a compete novice and a paramedic who sings to you? The Gods wouldn't let something that crazy happen unless they had bigger plans for you. Would they?
I said a quick, silent prayer, anyway.
Just then, the vid-screen beeped and, shaking off my own apprehension, I turned my attention to the message. It was a call for a routine patient transfer.
"Ready for some of the boring stuff, tiger?" I said, looking at my partner.
Belesun nodded, and then gave me a wry grin as we stood up. "You sure I can handle it, buffalo?"
At that, I started laughing, too.
This tiger would do just fine.
© 2002 by Philip J.