BACK TO THE CHALKBOARD

I see the crystal raindrops fall,

And the beauty of it all

Is when the sun comes shining through,

To make those rainbows in my mind…

"Squid!"

She didn't appear to notice. The headphones were firmly affixed to her ears. Her head was bumping up and down to the mellow beat, which was just loud enough to be audible to Bayen and Nurse Marwan, who were seated in their rusty folding lawn-chairs on either side of her. Her eyes were half shut.

We look for love, no time for tears

Wasted water's all that is!

And it don't make no flowers grow

Good things might come to those who wait-

"SQUID! Take your damn earphones off, I'm trying to give a presentation here!"

Finally, Squid looked up at Doctor Isaac, though she didn't remove her headphones. She fiddled with the dials on the radio she had sitting between her legs, and gradually, Bill Wither's rhythm and blues faded from the room. Isaac gave a weary little smile. "Thank you!"

"Not very disco of you, Doctor Isaac," said Squid. Her disapproving energy filled the room.

Though he was deeply wounded, Isaac simply dismissed her comment. It was all he could do. He tried not to let these sorts of bad faith criticisms, these insinuations that he was somehow a "sellout," or "another one of the g-men," bite too deep. He cleared his throat. "...So, moving on! Thank y'all for showing up, truly. I know you're all busy folks with busy schedules. And I know this meeting was uh, sort of short notice-"

"Yes. We are very busy. So please cut to the chase, Doctor Saller."

Eddie Vasquez, MD. Isaac clenched his jaw so hard that it began to hurt within a matter of seconds. Paying no heed to the content of his speech, that skinny little son of a bitch's droning, adenoidal fucking monotone was enough to set off his sympathetic nervous system whenever he spoke. Isaac could practically feel his blood pressure creeping up as the skin of his face flushed red.

"Well Eddie, I was just gonna get right into it- but I think I'm gonna call a little lunch-break now. Make sure we're all well fed before we start!" There were a few pity chuckles throughout the room. Doctor Vasquez did not look amused. "Uh, Anyways! How many folks have we got in attendance today? I see eight, nine medical personnel. Oh and Savanna, don't think I didn't see you coming in back there!"

"Hi baby!" A few people turned their heads to look at the well-dressed, one legged woman who had been lingering around the doorway since she entered. She tucked one of her crutches against her elbow to blow Isaac a kiss. He tried to maintain a professional air as he smiled and blew one back, but now that she'd caught his attention, he couldn't help but be a little distracted. He glanced slyly in the other direction.

"Soooo, some of you might've heard about the call we had last week, where two of our first responders, an EMT and a cadet, responded to a third-party caller, who hit one of those nifty new alert buttons we've been putting up around Vegas. Today we're lucky enough to have the woman who's managing that program, miss- or uh, Doctor, Doctor Alvarez, to tell us a little about how that system works, before we get into discussing the meat of that call. Doctor Alvarez, why don't you… stand up?"

There was an awkward silence. She was already standing up. Doctor Alvarez, a small, mousy woman with neat blonde hair took up a position next to Isaac, and motioned for him to move out of the way of the chalkboard. Standing next to Alvarez, he felt a bit ashamed realizing that he was in fact shorter than her.

"Thank you, Doctor Saller. Mind if I draw us a quick visual aid?"

"Oh, Doctor Saller was my father's name. Just call me Isaac!" There was another awkward silence. In the audience, Isaac heard Eddie Vasquez coughing his stupid pointy-cough. "Ah. No. Not at all. Draw away."

Once she'd picked out a good, robust piece of chalk, Doctor Alvarez began scrawling a rough diagram of the Emergency Radio Transmitter, with various boxes representing each major component. It got so quiet for a while that Isaac could hear Squid's music again, but he didn't say anything. He'd lost enough credibility already. He just hummed to himself, and tried not to smile as Savanna made faces at him from across the room.

Once Doctor Alvarez was done, she bent down and picked up the yardstick off the floor. She gave the green chalkboard a few good raps. A cloud of chalk rose into the air, and compounded with the ever-present cigarette smoke in the cramped conference room. A few people in the front row coughed.

"So, how many of you have seen one of these things yet? Show of hands?" Both cadets and Bayen raised their hands. Nurse Marwan did as well, and Isaac, Savanna, and one of the other doctors, Hazel Bolton, with the marble-eye and the tattoos. Not really a surprise… "And, because I know that there's a lot of third party calls where you never end up meeting the caller, how many of you have responded to, let's say… more than five calls involving one, even if you didn't see the radio transmitter?" The same people raised their hands, minus Savanna, and plus poor doctor Sunset Scotty with his peeling skin. Alvarez nodded. "Alright. So, Isaac is going to talk about the specifics of those results later, and I'm planning to do a more scientific assessment at some point. But I think already some of you can see that city calls, regardless of the actual complaint, are overwhelmingly seen by BLS providers, and a few dedicated "city-bird" doctors and nurses."

"Sorry, Doctor Alvarez?" Both Isaac and Alvarez turned their heads to acknowledge Nurse Marwan. His hand was raised at half-mast. "Excuse my bluntness, but what is your point with this? The division of labor is a conscious choice by Julie Farkas, and by the responding clinicians."

Alvarez opened her mouth, started to stammer out a response, but Isaac quickly raised his hand to stop her. He gave Marwan a look that he hoped was stern.

"We're getting around to that, Nurse Marwan. So let's keep the questions and comments to ourselves until the end of the presentation. Alright?"

"Very well."

And Doctor Alvarez's presentation continued on, uninterrupted. Good. Isaac was able to maintain a silent and professional veneer, but he and Savanna shared a quick look- a tiny little smile, an invisible wink- because inside, they both knew that Isaac was elated. It was usually Marwan chewing him out, not the other way around!

"Thank you, Doctor Isaac. So, the problem with these emergency radios, on a very basic level, is that they only work one way. It's a radio transmitter, so when they hit this button, right here, it sets off an alarm at our outpost up by the 188 trading post, and opens up a communication channel with whatever operator is present. But it's a one way channel, so the operator can't ask any questions. We rely on the caller to tell us information based on the informational plaques we have installed below the speaker, but in my experience, they almost never do."

By now, the point was becoming slightly more clear. A few folks were still scratching their heads, but everyone who was even remotely involved with the city aspect of the first-response program had figured out where this was going by now. Doctor Alvarez looked to Isaac for approval, and he nodded to her to keep going. She cleared her throat. "So, how does that relate to you field operators, and to the incident Isaac mentioned earlier? Well, it's all about appropriate resource allocation. Which is to say, it can be hard to tell based on the sorts of calls we get what the definitive care for a patient is going to be. Sometimes we get enough information to be fairly sure we can send two BLS- that is, Basic Life Support responders to the scene to treat the patient and send them on their way or walk them back to the fort, but a lot of the time, it's more complicated than that. We send the first responders as scouts, but there's a chance it might end up being a case they can't handle alone, and the patient might not be able to walk. We might need to bring the Advanced Life Support care to them, which means dispatching two nurses or doctors and carrying a bag of valuable drugs through Freeside."

"And how do you suggest we solve all this?" Isaac tried to glare at Marwan again, but he glared right back. This was a real question. The grumpy old nurse wanted answers this time, and Alvarez was out of steam. She lowered her yardstick.

"That's a good question, Nurse Marwan. This seems like a good opportunity to pass things over to Doctor Isaac."

She handed the stick to Isaac and scurried down the packed-dirt aisle back to her lawn-chair, leaving Isaac alone at the ceremonial chalkboard with a diagram he didn't even draw. He felt the room lurch in front of him. And not in a way that adjusting his oversized glasses would fix; he was starting to feel sick to his stomach. Nonetheless, he gave the small audience a nice stroke-victim smile, an awkward little wave, and tried to get off on the right foot.

"Howdy again! So, now that you all understand the problem, let's talk about how we can- yes, Squid?"

"I think you should give EMTs more protocols."

Isaac sighed. He knew she was going to say that. A few people laughed though, so he couldn't just completely ignore the comment and move on. He just shook his head.

"Squid… I'm not giving you any insulin, alright? So get off my back about it. It's not a first-responder type drug. I'll consider adding more drugs to the BLS protocol if we're able to effectively train you folks how and when to use them, but that'll take time and I'll need to bother Aunt Julie about it. And if I have to go and do that, I'm gonna tell her it was your idea. Do you want that kind of heat?"

"Well, I think that's a bullshit response, Doctor Isaac, but alright."

Before Isaac could think to respond further, Squid had cranked up the volume on her headphones so loud that she may as well just have been listening without them. Bill Withers' mellow voice washed over the audience once more.

I hear the crystal raindrops fall,

On the window down the hall.

And it becomes the morning dew!

And darling when the morning comes,

And I see the morning sun

I wanna be the one with you!

Has she got that song on repeat? Isaac wondered. Either that song was like, 10 minutes long, or it'd been on a loop. He tried to shake the thought from his head and think productive thoughts, think problem solving thoughts. He gave the chalkboard a righteous Thwack.

"Anyways! Let's talk about how we can solve the problem of field resource allocation. Now, the obvious answer is, we can't, not completely. We don't have enough doctors to send one on every call that might be something serious, and even if we did, that's just ain't a very smart use of anyone's time. But, we do have lots of strong young ladies and gentlemen who I am certain would be willing to carry an extra few pounds of metal to the call, so that if need be, they could carry the patient back!"

And, there it was. A collective groan of protest rose up among all of the first responders. Squid took off her headphones and looked around in confusion. "The fuck did he just say?"

"He said he's gonna make us carry stretchers now!" cried Rylan of Dakota, the oldest (and tallest, the child was a damn giant) of the cadets. Squid threw her headphones on the ground and lurched up out of her chair and towards Isaac. Bayen caught her by the shoulder, but he didn't look much happier himself. And Doctor Vasquez was already doing his stupid little throat clear.

"Really, Doctor Saller? Stretchers? That's your brilliant solution to all of this?"

Isaac turned his gaze to meet Dr. Vasquez's cold, beady eyes. He stared him down. "Well Doctor Vasquez, it's a solution. If it's a complete disaster, we'll try something else. But being able to bring unconscious patients back to the Fort or meet the docs halfway would be a hell of a lot better than what we've got right now. That call we were discussing earlier, we were lucky that backup was so readily available, and that we were able to locate the patient so quickly thanks to Bayen's use of a two-way radio to communicate with dispatch." Isaac tapped the drawing on the blackboard. "Most of our calls for backup involve these one way transmitters right here, which obviously ain't ideal for communicating your position with."

"Hey Doctor Isaac, I have a question." said Squid. Isaac clenched his fists.

"Yes, Squid?"

"What if I can't carry the stretcher?"

Isaac sighed. "That ain't a question." He was met with silence. "Okay. Well, it's a valid thing to worry about. If y'all are having trouble lifting the stretchers, there's a version with drop-down wheels that's available. Those ones are a little heavier, and we're still working out some kinks in the design, but it rolls pretty good, and there's almost nowhere in freeside or the strip that it won't go. Just make sure to talk to Sunset Scotty about how to work the mechanism." Isaac looked around in the "crowd." There were still lots of grumpy faces, but no hands were raised. Savanna gave him an encouraging thumbs-up from the back of the room.

"Alright, well, that about does it for today's meeting. Thanks again for coming, y'all. Next week, we're gonna bring all of you ALS providers in to talk about drug and protocol changes on account of the… shortages. Alright."

Before he'd even finished his first sentence, everyone had already stood up, and they'd all started filing out the door long before he'd concluded his message. Squid rushed out so fast she forgot her headphones, which continued playing their tunes faintly from the dirt floor. Soon, the only person left was Savanna, tucked away in her little corner of the room, shrouded in cigarette smoke. Always a mystery, that woman. Isaac walked down the aisle, picking up a couple of lawn chairs as he went.

"Why don't you sit down, Sweetpea? The leg must be killing you," he said, as a cloud of dirt from the newly planted lawn-chairs rose into the air around them. It mingled pleasantly with Savanna's cigarette-smoke.

"Mm."

They sat down together, facing the chalkboard. Isaac put out two fingers like a sideways peace sign. "Could I bum a smoke while we talk?"

"If you want- but I brought you something even better."

He cocked his head. Savanna nestled the cigarette between her immovable, prosthetic fingers and reached into her blazer. She drew out a big green army canteen with a crusty leather strap. She popped off the lid, and the sweet smell of whiskey sent an uncontrollable, beautiful, colorful feeling through every single one of Isaac's Happy-Synapses. His tired expression melted into a puppy-dog smile.

"Ohhh, Savanna… God, I love you so much." He graciously accepted the canteen. He took a healthy shot to start, and liquid fire filled his chest. A little bit dripped down his beard, and he found himself unconsciously licking it up.

"Feel better?"

Isaac nodded. "Lots better. I was about to complain for probably, I don't know, a good ten minutes before I remembered to ask you how your day was. But now I'm doing swell." He raised his flask. "How about you? How's things been in the life of my favorite woman?"

Savanna leaned over onto his lap. She took care not to blow cigarette smoke into his face. "Oh, I don't know. I'm tired. I'm always tired. I taught history lessons at Usanagi's Clinic today, so that's always fun. And I know you're coming home today, but I figured since I was nearby, I'd come see you a little early. I've missed you a lot lately…" Isaac put a hand on her chest, and traced it over her stomach. He started to move down to her thigh, but he noticed something hard and heavy concealed in her blazer there. Something metal. Something dangerous. They both looked at each other.

"And how's… business going?" he asked. Savanna rubbed her prosthetic arm. There was a piece of duct tape covering one of the flowers painted onto her ceramic shoulder, under the blazer. She thought he wouldn't notice it, but he did. Whenever she moved, now, something metal clattered around inside of that arm. "Nothing too dangerous, right?"

"Yeah. Just, uh. Just the usual stuff." The two sat in silence for a while. Isaac took another drink. And another.

Savanna glanced nervously at her watch. She wasn't smoking anymore. Wasn't lying on Isaac's lap anymore either, just sitting rigid and slightly hunched up like the world's most uncomfortable gargoyle. He could feel the tension in her body language, stretching, stretching, stretching…

Until finally, it snapped. Admirable that she lasted as long as she did, really. She threw her hands up dramatically. "Look, I- Isaac, baobie, you know I'm working on the accountant shit! I haven't given up on that. It's just taking a lot longer than I thought, I've explained this to you!"

Isaac didn't look at her. "I know, I know! I get it. It's just, after… the incident, I thought maybe you'd be more careful is all. What, with you losing half your fucking limbs. You'd think that'd have more of an effect on you."

Savanna's face turned red, like it did when she drank. He could see her tongue catching on her words as they struggled to make their way out of her throat.

"I…! You…!" She took a deep breath in. A deep breath out. Her eyes were starting to shimmer with tears. "Isaac, I'm really trying my best here, okay? I know you are too, but the fact is, we're poor as all get-out, and one of us has to pay the bills! So unless you want to get a real job, please don't bitch at me about how I support us, okay?"

Now Isaac was crying too. Crying and shaking his head.

"Shit, I'm sorry. I'm sorry, I didn't mean to say it like that! It just, it just came out!"

Savanna covered her face. The tears were picking up now. "I know! But you still said it!"

Isaac kept shaking his head. "Well, I know, but I'm still awful sorry!"

"But did you mean what you said to me? Do you really feel like that?"

Isaac was quiet for a moment. And when he did speak, his voice was quiet, subdued. Like a man driving a car down a steep hill, his foot hovered the brakes of his tongue. "I'm… I'm not really sure exactly what I feel. But I'm scared, Savanna. I'm really scared about what's gonna happen if you keep doing this. That's all." He put his hands on top of hers- the warm, brown one and the cold, white, ceramic one- and gently moved them from in front of her tear-streaked face. He looked deep into her eyes. "You're the brightest part of my life, Sweetpea. I just ain't ready to lose you again."

Immediately, Savanna's eyes clamped shut. She drew her hands back up in front of her face again. "Oh, you son of a bitch, that's cheating! You can't say things like that while we're, we're arguing! Fuck!" Her voice trembled with a mixture of laughter and tears. She rubbed her eyes with her palms, and for just a moment, Isaac saw a hint of a smile before it disappeared beneath her hands again. "But we aren't done here! This is a cop out! It's cheating!"

"I know, I know. I'm a terrible awful no good dirty rotten cheater…" He laid his head down on Savanna's shoulder. She made a noise at him and bucked him off, but he put it there again and she didn't fight him that time. Eventually, she uncovered her face, and let her head rest on his. She was still crying.

"I want the whiskey back," said Savanna. Isaac didn't argue with her. There was little doubt that both of their vast, immortal souls needed liquor tonight. As soon as he handed her the flask, she held it tight and started downing it like it was vodka. She coughed and gagged like she'd just been punched in the chest after every shot, and yet, she always went back for more. And more. And more…

Isaac just stared at the chalkboard, watched the rays of golden sunlight creep up the green surface as the sun set outside. He didn't want to think about the Savanna thing right now, or he'd go right back to arguing with her again, but he didn't want to think about his disastrous speech either. He didn't want to think about anything.

So he didn't. He let the faint noise of that funky Bill Withers song that was playing on repeat over Squid's headphones take over his tumultuous mind. Let it seep into the cracks, filling every little space with rhythm and blues.

Just the two of us,

We can make it if we try!

Just the two of us,

Building castles in the sky.

Just the two of us,

You and I…

-fin-

Before we end today's chapter, I noticed I had a comment on the iteration of this story asking a question about the treatment provided in the story, and what the realistic options for the patient might be. In the spirit of encouraging these kinds of questions, I've decided to answer it in a little segment I'm going to be calling our "Medical Minute." Any time I get questions of a medical nature, or write a potentially confusing medical section, I'll be sure to clear things up in our:

Medical Minute!

Chumpatrol2 chapter 1 . Apr 19

Is it possible to treat somebody that has that high of a blood sugar? I don't know much about diabetes but ketoacidosis ( if that is what he has) is sometimes fatal.

Referring to the patient from chapter 1, the issue is correctly identified as DKA: When the body lacks insulin, and begins chewing up its fat reserves for energy, producing acidic byproducts (ketones.)

The options for emergency field treatment of DKA begin with the reading and treatment of the patient's blood sugar. In this case, the blood sugar was too high to be read by the glucometer. The fact that the blood glucose is this high does not affect treatment viability; an absurdly high blood glucose is still very treatable.

There are a few possible reasons for this absurd blood glucose level, but due to the circumstances, the providers made an educated guess that it was probably due to insulin-dependent diabetes, and thus a severe lack of insulin. Real world providers would likely confirm that the patient was diabetic before providing huge amounts of insulin, but in the fallout world, patient files are rudimentary to non-existent, and the patient had no one nearby to give a history.

Besides this indiscretion, the real world treatment would go along much like in the story. Insulin to treat the elevated sugar levels and to help the body switch over to using sugar instead of fat for energy, alongside a heavy fluid bolus to reverse the acidosis, since the patient will be extremely dehydrated from trying to clear the excess sugar through urination. The fluid will also help dilute the sugar in the blood. "The solution to pollution is dilution."

If untreated, DKA is indeed a fatal condition. Know the signs, because type-1 diabetes is not always something a person is born with; it can appear at any age (although it's seen more in kids and teens) and the progression of DKA can appear much like a bad virus.

Extreme Thirst

Excess Urination

Hot, Flushed, Dry Skin

Fruity, Sweet smelling breath, Sweet smelling urine (Yes, really)

Fast, Deep Breathing. This is a late sign, and this indicates a person who's blood is full of acid. They are attempting to blow off acid in the form of CO2 by breathing harder and faster, but this can't work forever.

Confusion, Lethargy, Altered Level of Conscious or Coma (They may appear to just be sleeping. The breathing will give them away.)

When I was 12, I lost my best friend Mickey Sullivan to undiagnosed, late onset type-1 diabetes, resulting in DKA. He grew suddenly, violently ill over several days, which he spent in his room, drinking soda and watching TV, before slipping into a coma and passing away. It was senseless, it was tragic, and most of all, it was utterly avoidable.

Let these sorts of things serve not as a suggestion to be paranoid anytime that someone gets sick with something bizarre. But simply to be mindful, to do your due-diligence checking in on your friends and family, and to always say a warm goodbye. You never know when it will be your last.

-M71