A/N: I am finally finishing this story, but in going back through it I found that a mistake had been made. I researched two different dialects of the Ojibwe language and the wrong one got placed into this chapter so I am changing it to the dialect that is more suitable to the area I have designated as the reservation Johnny grew up on in Montana. Later today (January 1st 2014) I will be posting the next chapter and that will give the answer as to what Johnny was saying when he was delirious.
Checks and Balances
Chapter 10
It was 2:30 in the morning when Roy backed the squad into the apparatus bay. Dwyer went straight to his bunk while Roy headed out to the kitchen having seen a light on; knowing that Captain Stanley would be waiting to hear about Johnny. As he anticipated, Cap was sitting at the kitchen table with the log book entering calls for the engine and looked up when Roy went to the refridg to get a glass of milk.
"How's John doing?" Cap got straight to the point.
Roy took a seat feeling more tired than he had in a very long time even though he seriously doubted he would get any sleep once he hit his bunk. "He's off the respirator and breathing on his own, but he's in a coma."
Cap looked carefully at Roy before closing the log book and pushing it to the side. "What aren't you saying? I know a coma is bad, but there's more isn't there?"
'Am I that transparent?' Roy just shook his head, this was Cap; he could read each of his men like a book. "He went without adequate oxygen for a long time, Cap."
"It couldn't have been that long, Roy. We got to him as soon as the in-house alarm went off."
"That's true, but all evening long he wasn't getting enough oxygen. He had the pneumothorax for hours before he collapsed." Dismay colored the senior paramedic's voice as guilt once again assaulted his heart and mind.
Confusion rippled over Cap's face as he shook his head. "Now hang on, didn't John have an x-ray this afternoon? I'm no expert, but shouldn't a collapsed lung show on an x-ray?"
Roy stood up to take the glass he had been drinking out of over to the sink to wash out. "Yeah, it did, only Dr. Brackett didn't look at Johnny's x-rays when he cleared him for duty. Somehow Johnny's films got mixed up with another patient and were labeled wrong. Dr. Brackett found out about the mixup just before we found Johnny. He said he called the station, but by that time we were already contacting the base station at Rampart after he had collapsed."
Roy understood the shocked expression on his captain's face. He imagined he had a very similar expression when Dr. Brackett told him about the miss-marked films. "That isn't all."
Cap rubbed his hand down his face bracing for what could be coming next. "There's more?"
"Yeah, you should probably know that the hospital is conducting an investigation, actually a couple of investigations. The fire department brass will probably be getting a call tomorrow. Dr. Brackett seems to think they are looking for someone to blame and the fact that I preformed a thoracostomy was mentioned."
Cap no longer looked shocked. Stunned was a more accurate description, until that morphed into something that more closely resembled anger. "You were acting under Dr. Brackett's direct orders! You saved John's life with what you did. How in blazes can they dump this on you? It isn't your fault that the hospital mixed up the x-rays."
Cap's voice never rose in volume, but it became steadily harder and more infused with righteous indignation with each word.
"Dr. Brackett told me not to worry. He made sure everyone knew that he is taking full responsibility, but with an official investigation I'm sure everyone here will have to give statements."
Roy walked back over to the table and sank down into his chair. "Honestly I still feel responsible. Dr. Brackett thinks that it is ultimately his fault for not realizing that the x-ray he was looking at wasn't Johnny's, but I was with him all day. I was the one who should have seen the signs. I'm a paramedic, the most senior paramedic in the county since Stoney moved on to become a captain. Hell, I'm the only guy in the entire department who actually went through the training program twice when we brought the second class through. I knew something was seriously wrong! I knew it, Cap, but I let it go because I trusted Dr. Brackett, and because Johnny..."
Anger at himself flared up in Roy's gut and he slapped his hand down on the table, ignoring the stinging pain that came along with the action. "Damn it! He told me that he felt lousy. He asked me to take him back to Rampart, but he wanted to wait until morning because they were still so jammed up. I don't know, Cap. We both trusted that Dr. Brackett made a good call when Johnny was cleared for duty. I know it isn't right or even fair, but there's a part of me that wants to blame Dr. Brackett."
Roy half expected Cap to admonish him for knowing better like he had that afternoon, but his commanding officer's voice was calm and reasonable. He took on a tone that was meant to diffuse Roy's tension rather than to accuse him.
"Roy this isn't Dr. Brackett's fault. He was given information that was incorrect and came to a conclusion based on that erroneous information. This isn't your fault either. You may be the most senior paramedic in the county, but Johnny is also a paramedic, and a damned good one; second only to you. He was the one experiencing these symptoms, these signs that you think you should have seen, yet didn't recognize them either. If he didn't pick up on it, why should you? Look, Roy, the fire department as well as the hospital have systems of checks and balances in place to prevent mishaps like this, but those systems aren't completely fool proof, and unfortunately Johnny fell through the cracks."
Roy knew that Cap was right. He didn't blame Dr. Brackett, and in his heart he didn't really blame himself. He just desperately wanted to take the whole day back to do over again. Dropping his head down he spoke quietly.
"I'm worried; what if he never wakes up? Or worse, what if he does and he isn't the same. Prolonged periods of hypoxia and even a short period of anoxia can cause permanent brain damage. We may have already lost him."
Roy started when Captain Stanley sat up straight pushing the chair he was sitting in back; the legs scraping the floor.
"Thinking the worst will accomplish precisely nothing, Roy. I have read that people in comas can hear those around them, and when they wake up they can recall whole conversations while they were unconscious. If you don't believe that John will recover, it'll show in your voice and he then won't believe it either. John trusts you more than anyone he knows; that's a plain and simple fact. You have to stay positive for his sake as well as your own.
Look, Roy, I'm no doctor and I don't know anything about hypoxia or anoxia, but what I do know is that John Gage is strong. He has managed to beat the odds many times. He beat that monkey virus, and getting bitten by a rattle snake. He has broken his leg more than once, was hit by a car and lost his spleen, and still he made it through all of that. He has the entire department behind him and we will remain positive."
Cap stood up and grabbed the log book. "Come on, Pally, it's ridiculously late, and you're exhausted. You've been going all day; you need to get some rest. Go get some rack time, and you can consider that an order."
Cap's words bolstered Roy's spirit. He was right, Johnny had beaten the odds so many times before, there was no reason to doubt he wouldn't again. "Thanks, Cap. I guess I just needed to hear it from someone else."
Roy did fall asleep despite his concern that he wouldn't, but the morning tones came too soon. Coffee helped to get him moving a bit, but his fatigue still showed even after his third cup. Naturally all of his shift mates wanted to know how Johnny was doing and remembering Cap's words he reported that Johnny was off the respirator and breathing on his own. He didn't mention his fears about possible brain damage because as Cap pointed out it wouldn't accomplish anything to do so. Before the next shift began to filter in Cap called Roy into his office.
"I just got off the phone with the Battalion Chief. They were contacted by some suit over at Rampart about John's injury yesterday. I told him what happened including the mistake with the x-rays and that Dr. Brackett was going to back you 100%. He doesn't think it will amount to much and that this is just posturing on the part of the hospital, but you were right about them insisting on a formal investigation. An investigator is being sent over to interview you, but the brass won't allow that to happen unless you have the department's lawyer present so he is also on his way in."
Roy sat down feeling slightly light headed. Somehow it seemed more real now than it did yesterday, especially with headquarters sending over the departmental lawyer. The thought of losing his certification made his heart race. Cap must have seen the doubts fly across Roy's face.
"Now, Roy, I don't want you to worry about this. You did nothing wrong and all of us will back you up on that. The chief assured me that the interview is more of a formality to cover the department. You have nothing to worry about."
Roy still felt uneasy despite Cap's assurances and he knew he wouldn't rest easy until it was over. "Yeah, sure, Cap. When will they be here?"
"From what I understand, within the next hour. This investigator may want to interview all of us so I am going to let the guys know what's going on. Why don't you give Joanne a call and let her know that you might be a little late getting home this morning? I assumed you would be stopping by Rampart after you leave here anyway."
"Yeah, that's a good idea. She doesn't know anything about this yet."
Roy used the phone in the office while Cap went to the kitchen to fill in the rest of the crew on the situation. Roy didn't get into any details with Joanne, only telling her that Johnny was injured yesterday afternoon and that he needed to stay to complete an incident report before going to the hospital to check on him. He wanted to wait to give her all the details after the interviews were done and he had some idea if his job was in jeopardy.
As he walked out to the kitchen he heard Chet exclaim loudly, "That's a load of crap!"
"I agree with you, Chet, but getting hot under the collar isn't going to help, and it could be detrimental. I want everyone to be courteous to this investigator and give him your statements in a clear and professional manner, is that clear?"
The men stopped speaking as Roy come in and sat down. After a moment of awkward silence each of them voiced their support and conviction that he was in no way responsible for what had happened to Johnny, and that he had, in fact, done a superior job and saved their fellow crewman's life. What Roy had not expected was to have Dixie show up just before the investigator with a cassette tape in hand.
"Hey, guys. Kel would have been here, but he needs to be at the hospital taking care of Johnny right now so I'm here as an expert witness to this farce and I have the tape of the call right here." She said holding up the small cassette tape.
As Dixie spoke the Battalion Chief and the department's lawyer walked in through the back door of the kitchen. Only a few minutes after that, the hospital's investigator arrived and Roy, Cap, the Chief and the lawyer moved off into Cap's office while the next shift filtered in asking questions about what was going on.
The tape that Dixie provided was the first thing to be played and as Roy listened to it he felt a lot more secure. He truly hadn't done anything wrong and there was no way the hospital could find fault with his actions. Both the Battalion Chief and the lawyer nodded in satisfaction after hearing the tape. In their eyes the interviews were unnecessary, but the investigator stubbornly insisted on them. It didn't take long. The wind had been knocked out of his sails effectively when the tape had been played, but he still had to show that the interviews had been conducted when he returned to the hospital administration with his findings.
Within thirty minutes all of the men from the crew had given their statements and the investigator left with very little to say to anyone. The men of A shift stood around talking about how ridiculous the investigation of Roy was, still not knowing about the x-ray mix-up. Chet, never known for subtlety blurted out the question that was on everyone's mind.
"Why are they picking on Roy anyway? The hospital has never questioned what the paramedics do before. It almost seemed like they were looking for some kind of patsy."
Roy, Dixie and Cap all exchanged looks but said nothing. The departmental lawyer stepped forward and cleared his throat. "Mr. ... Kelly, is it?" Chet nodded. "That is not something that I want any of you men to discuss. There are aspects of this incident that you are unaware of and outside discussion of it is inappropriate until such time as the department closes the case."
Chet stood mutely as he was chastised, but said nothing else while the brass left the building along with Dixie. Roy ducked out of the kitchen and headed to the locker room. He needed to get changed and head over to the hospital, but was followed by the rest of his shift mates. Chet being Chet completely ignored what the department's lawyer said about not discussing the situation with Johnny.
"So here's what I think. Someone over at Rampart totally screwed up and that is why they are coming after Roy."
Before Chet could continue Marco interrupted him. "Chet, you heard the lawyer. We aren't supposed to discuss this."
Chet turned to his friend and fellow linesman. "I don't care!" He looked Mike in the eye and turned to make sure that Roy was also listening. "This is Johnny! He's one of us, he's our boy! I'm not gonna be told who I can talk about and who I can't!"
Roy watched as both Marco and Mike nodded in agreement with Chet. All of them turned to look at Roy as he buttoned up his shirt.
"Well, how about it, Roy. What really happened. You must know something since your interview was private and we were all talked to out in the day room." Mike asked.
Roy closed his locker and sat on the bench. "Yeah, something happened all right. Somehow Johnny's x-rays got mixed up with another patient. He was walking around yesterday with a collapsed lung."
The men just stood with stunned expressions on their faces, but it was Mike who spoke what they were all thinking. "How is that possible, Roy? Wouldn't he have been in pain or have some serious difficulty breathing or something?"
Roy had to take a deep breath to keep his emotions under control as his feelings of guilt began to surface. "There were signs, it's just that neither Johnny or I realized it. You all saw how bruised up his back was. Any pain that he felt he associated with that. He kept coughing, just a short dry cough. I noticed it a couple of times, but we were always doing something at the time, like bandaging up your hand, Marco. I thought it was the oil burning that he was standing right next to that was causing him to cough. On that last run we did together, a diabetic patient, he mixed up the IV bags, then he missed a turn off of Fairfax. The hypoxia was causing him to lose concentration, but it had been such a long day that we both chalked it up to being over tired."
"Man, if that doesn't beat it. I feel kind of bad about razing him, you know about falling off the roof. We thought he was okay, ya know." Chet looked miserable with the memory of giving Johnny a hard time at dinner the previous day.
"Don't worry about it, Chet. Listen, guys I'm gonna stop by the hospital and see how he's doing, if they'll let me in to see him."
"Why wouldn't they?" Marco asked.
"As of last night, they weren't giving out any information about Johnny to anyone who wasn't next of kin. Dr. Brackett took me up to ICU himself or they wouldn't have let me in."
Mike was nodding. "Maybe the hospital administration is worried that Johnny will sue the place if he finds out about the mix up with his x-rays."
"He'll find out, Brackett will see to that. Brackett's taking the administration on about this. Why else do you think Dixie showed up this morning with that tape?" Roy reasoned.
"Give us a call when you find out how he's doing okay, and when they will allow him to have visitors." Marco added.
"Okay, I will. Thanks, guys, and I'll call you when I know something." Roy grabbed his bag and headed out of the locker room.
The drive to Rampart wasn't too terribly long. It was still morning, but past the rush hour traffic. When he puled into the visitor's lot he headed straight for Dixie's desk. She was just coming out of the base station booth. "Hey, Dix. I want to thank you for coming down to the station with that tape. It really helped."
"It's not a problem, Roy. I'm glad it helped. Hey I knew you would be coming in this morning and I'm glad you're here. Kel is up with Johnny right now."
Her expression turned serious which set off alarm bells for Roy. "Is he okay?"
"He spiked a fever last night; a pretty high one." She reached out and touched his arm gently. "Roy, he had a febrile seizure this morning. I didn't say anything earlier because you needed to deal with that idiot from administration. Come on I'll take you up there."
Roy felt his heart rate speed up. Febrile seizures in adults were rare, and dangerous. When Johnny had that monkey virus three years ago he never had a seizure and his temperature got as hight as 105.
The ICU was a flurry of activity; most of it centered around Johnny's room. As Dixie approached with Roy she waved off a severe looking charge nurse who appeared at though she was about to challenge Roy's presence. Roy could see Dr. Brackett looking over the chart at the end of Johnny's bed and talking with one of the nurses. As he approached he felt his heart sink when he overheard the conversation.
"Why wasn't I informed the minute there was a change in his status?" Dr. Brackett growled at the nurse. He was clearly livid that after looking at the chart.
"I was going to have you paged, but had to attend to another patient." The nurse informed in slightly miffed at his tone.
"That is not good enough! There is no reason you couldn't have had one of the orderlies or aides page me. I left strict instruction to have me paged the instant there was any change with this patient. The chart said that he spoke, what did he say? How long was he awake?"
"He woke up?" Roy said from the door.
Both the nurse and Dr. Brackett turned at the sound of his voice. "Roy, I'm glad you're here. According to this chart Johnny woke up enough to say something." He turned back to the nurse who had stepped back a pace to put some breathing room between herself and the doctor.
"I'm sorry, Doctor. He never regained consciousness, and still isn't responsive to stimuli, but you were paged as soon as the seizure began. Mr. Gage has been mumbling on and off for the past few hours, but he also isn't making any sense. I'm afraid it may be some form of dysphasia. I found a tape recorder so I could get a recording of it. I thought the speech pathologist might want to hear it."
Dr. Brackett's eyebrow rose in surprise. "What did it sound like?"
"Nothing. Just syllables that don't make any sense strung together. It's the oddest case of dysphagia I have ever come across." She reached over to the rolling table and picked up a small tape recorder, hitting the play button. "He keeps saying the same set of syllables over and over or some variation of them. Like I said it's strange."
'Ningotaaj... wiiji `ishin Nindedem... wiijayaaw Nindedem... gi-zaagi` ina Nindedem wiijayaaw' *
The voice was breathy and weak, but it was clearly John Gage's voice. Dr. Brackett stopped the tape and thought for a moment, then rewound the tape and listened again. After hearing it for a second time he looked up at Roy. "Johnny grew up on a reservation didn't he?"
"Uh, yeah, out in Montana." Roy replied, as he moved closer.
"He would have grown up hearing whatever the native language of his tribe is. That isn't dysphagia, it's a language." Once again Dr. Brackett looked to Roy for answers. "Did you know he could speak a native tongue?"
"No, I had no idea. He's never spoken anything but English to the best of my knowledge. He doesn't talk much about his childhood on the reservation, just bits and pieces. All I know is that they were pretty poor on the reservation and that he isn't too crazy about anthropologists."
Roy looked over at Johnny and could see cooling measures in place. His face and neck were flushed and he was dripping with sweat. "He had a seizure? Is he going to be all right?"
Dr. Brackett set the recorder down on the table and stepped over to Roy turning him away from the room and guiding him to the hallway to give the staff room to do their jobs. Dixie patted Roy's arm. "Roy, I have to get back down to the ER. Come see me if you need anything, okay?"
Roy just nodded and mumbled his thanks to her before turning back to Dr. Brackett. "What's got his temperature up?"
"He has a severe infection of the plural lining. Without a spleen he is more susceptible to infection, and it isn't so uncommon with what he had been through. He spiked the fever in the overnight hours even though he was on a broad spectrum antibiotic. I've changed the antibiotic to something stronger and it does seem to be working. His fever got up to 104.5 and caused him to have a convulsion around 8 this morning. I ordered phenobarbital and that got the seizing under control. His temperature has begun to come down, but is hovering around 103, so we are going in the right direction."
"So what about the coma? What about possible brain damage. I mean if he's speaking, even if we can't understand what he's saying, isn't that a good sign?" Roy clung desperately to the hope that Johnny was going to beat the odds yet again.
"It's still too early to say that. I'm sorry, Roy. He is still unresponsive to stimuli, but I think the fever brought on a state of delirium and that is what prompted him to speak in a language that he probably hasn't heard since he was a child. I am hoping that when we knock the fever down he will begin to show signs of waking up."
As they spoke quietly outside Johnny's room the nursing staff and lab technicians who had been working began to filter out.
"How did it go this morning? I'm sorry I couldn't be there, but I had to be here for obvious reasons." Dr. Brackett asked bring Roy out of his thoughts.
The relief that Johnny might wake up once they controlled his temperature took a huge weight off Roy's heart. The interview that took place only an hour ago seemed like a distant memory. "I wanted to thank you for sending Dixie over with that tape. It really made all the difference in more ways than one."
Confusion clouded the doctor's features. "Oh, how's that?"
"Hearing it on the tape like that made me realize that I didn't really do anything wrong. I was... concerned." Roy didn't really want to say that he was still feeling unsure about the thoracostomy he did yesterday. It had saved Johnny's life, but when he found out about the investigation he once again began to have doubts as to whether or not he should have attempted something like that without the proper training.
"Well, I'm glad it helped. The person behind all of this clandestine posturing is one of the hospital's two vice presidents. He is also in charge of public relations." The sour look that crossed Dr. Brackett's face was almost comical. "The CEO is out of town at the moment, but I have contacted his administrative assistant and should be hearing from him later today. I don't want you to worry about any of this, Roy. Johnny is in good hands and I'll make sure that the ICU staff knows that you are to be allowed to visit him. He responds to you better than anyone else and I believe that your presence is medically necessary. Now, please don't take that to mean that you have to sit here all day holding his hand. You got what 3 or 4 hours of sleep?"
Roy nodded. It was actually closer to 2 and a half hours but he didn't want to bring that up. "You look exhausted, Roy. Stay for a little while, but then I want you to go home and get some rest. I promise that we will call you if there is any change in his condition. Right now I have to go make some phone calls and see if I can catch a shower. I'll see you later okay?"
"Yeah, thanks, Doc. I know you are supposed to be off right now, but thanks for staying with him."
"You got it, Pal. I put too much work into training him to let anything happen at this point!"
Roy watched for a moment as Dr. Brackett walked over to the nursing desk and speak to the charge nurse who began to approach him when he first came into the ICU with Dixie. She frowned as the doctor spoke to her and looked over at Roy. She looked to be arguing with the doctor, but Brackett stood firm and crossed his arms over his chest giving her his classic stubborn face. Finally she nodded and said something else that prompted a small smile from the taciturn doctor. He nodded back with a satisfied look on his face before turning to leave. Roy had to hand it to Dr. Brackett. It wasn't often that the man didn't get his way.
Roy stepped back into the room and moved over to the side of the bed. He took Johnny's limp hand in his own noting how warm the skin was. He was numb from lack of sleep and distraught over everything that had happened in the last 12 hours. He had to admit that he did feel better about the emergency throacostomy, but nothing Cap or Dr. Brackett had said could convince him that he wasn't wholly culpable for Johnny's situation.
Roy didn't know how long he had been standing there by the side of the bed as his thoughts wandered. He squeezed Johnny's hand and began to speak softly. "Hey, Pally, I don't know if you can really hear me, but Cap thinks you can so listen up. Dr. Brackett says that you are going to be all right. You gave me a bit of a scare there, my friend, but I know you are going to wake up and start flirting with these nurses pretty soon."
Roy had to stop. His emotions were coming close to overwhelming him. He took a deep breath and blew it out.
"Cap and the rest of the guys want to come and see you, but they have to wait for you to wake up and move to a different room. Look, Johnny, I... I let you down. Cap told me that you trust me more than anyone you know and I think that's probably true. I should have seen what was happening. What's tearing me up is; I knew something was wrong. I knew it, but I didn't do anything. I let it go. I won't blame Dr. Brackett for reading the wrong x-ray, or you for not knowing something was seriously wrong, because I did know. I kew something was wrong and I did nothing about it. I'm you partner, and your best friend and no matter what anyone says, I know I let you down. This is on me, Pal, it's all on me. You have to wake up, Johnny. I don't think I can live with myself if you don't. I know I could never continue as a paramedic, not when I failed so miserably when it mattered the most."
Roy stopped again to squelch the sob in his throat. He remembered what Cap had said about staying positive for Johnny's sake, and how Johnny trusted him. He trusted me and look what came of that trust. Roy gave up trying to stop the tears from falling. It was no use. The fell from his face, dropping on the flaccid hand he held. The sounds of footsteps passing the door startled Roy out of his misery. The last thing he needed or wanted was a witness to his weakness. He wiped his face with his free hand and cleared his throat. "I am going to leave for a while, but I'll be back a little later. I have to go see Joanne. She doesn't even know about any of this yet and she'll kill me if I don't fill her in. You know how women are. I'll see you soon, partner."
Roy didn't know what else to say. He was bone tired and his emotions were raw. He needed to see his wife and get a couple of hours of sleep before he wound up in a bed here at the hospital as well. He gave Johnny's hand a squeeze before laying it gently down on the bed. As he turned to leave he didn't notice the tear that slipped out from under Johnny's closed eyelid and slid silently down the side of his face.
TBC
A/N: The language is Ojibwe and it's meaning will be revealed. Since there is no background information on what tribe Johnny is from, I chose the Chippewa. Ojibwe-otherwise anglicized as Chippewa, Ojibwa or Ojibway and known to its own speakers as Anishinabe or Anishinaabemowin-is an Algonquian language spoken by 50,000 people in the northern United States and southern Canada.