SERVUS SERVORUM
- Seven snap-top ampules of EPINEPHRINE, 1:1000 concentration. Seven milligrams total.
- Four snap-top vials of ATROPINE SULFATE, 1mg/ml concentration. Two more vials of ATROPINE SULFATE 0.5mg/ml concentration. Five milligrams total.
- 1 Small tank worth of concentrated O2, flowed at Ten LPM through a soiled AMBU-BAG attached to a cuffed SIZE 7.5 ET TUBE.
- One Eighteen-gauge IV catheter, 500 ML NORMAL SALINE 0.9%, and an IV administration set. PLEASE SUPPLY J-LOOPS AND LUER LOCKS!
Arcade let out a long, tired sigh as he looked over the emergency supply request from the Freeside Pediatric Clinic. The list of supplies wasted. Arcade wasn't a practicing clinician, but it didn't take one to know that the woman they'd worked up in the clinic wasn't ever going to walk out of there without a miraculously timely chest x-ray, and immediate surgical intervention from Doctor Vasquez. The poor girl had thrown a PE so disastrous that it had killed her before she'd even started complaining about symptoms.
'And what was I supposed to do? Just stand and watch her die?'
Arcade could already imagine the response. In Doctor Hazel's voice, too- he had gotten pretty good at that. He leaned against the heavy, padlocked door of the supply room and let the whole imaginary debate play out in the forum of his brain.
'Treat it like a traumatic arrest, or a terminal extubation. This was, in a very literal way, Mortuum Flagellas- you were thrashing a corpse when you should have been providing comfort care.'
'I called for Doctor Vasquez on the radio! If that bastard would've shown up, we might have gotten her back…'
"Brought her back with brain damage, maybe! We all know how that story ends- do you really want to make poor Doc Usanagi "wean" any more people than necessary? If they aren't going to be viable, let it sort itself out right there.'
After yet another rhetorical victory against the people living in his head, Arcade finally worked up the power of will to open up the supply room. There were only a few keys on his keyring, and this one had its head painted the same dull red color as the corresponding padlock. He popped the lock off the latch and slipped it in his coat pocket. The door made an unpleasant noise as he pulled it open.
Inside the supply room, it was completely dark. There were no windows. Arcade clicked on the flashlight on his coat, and the amount of dust particles revealed by the weak yellow beam immediately motivated him to close his mouth. He could almost taste the atmosphere on the back of his tongue.
The room itself was underwhelming as ever. It would be pretty hard to believe that it held all of the Medical Supplies for the followers, if they weren't constantly having shortages. Most of the space was taken up by four rows of corroded aluminum racks, with just enough space in between for Arcade to slip in between. He'd organized it himself, so it didn't take him long to find what he was looking for.
In the Airway section, Arcade started by grabbing a new Ambu-Bag and putting it in the supply sack. "New," being a relative word, of course; like many of the supplies on the racks, it was crusty and slightly yellow. There were only two left in supply, but according to Alvarez, a new shipment of airway supplies was coming soon. She said she'd negotiated a deal through Crimson Caravan trading company, and that the same supplier was apparently interested in selling IV catheters and tubing as well.
While he was in the airway section, he grabbed a new cuffed 7.5 ET tube as well. Not a lot of intubations happened outside of scheduled surgeries, so they had a steady supply of the sizes that actually mattered. There was a little mold growing inside this one, but that was nothing that couldn't be cleaned out by Hazel at the clinic.
Arcade purposely skipped the Phlebotomy section after snatching up a single 18g catheter off the shelf, because as of right now, they were completely out of J-Loops and Luer locks, (they couldn't afford them anymore,) and it would be almost spiteful to send more IV administration sets. Everyone, everywhere, had more 15 and 60 gtts drip sets than they knew what to do with, since a massive stash had been discovered a few years back; bags of saline to be used with these sets, however, were no longer manufactured anywhere, and weren't commonly circulated for obvious reasons. Each clinic cleaned, refilled, and mixed their bags on site. Thus, no one wanted to spike a perfectly good bag and prime a full set of IV tubing every time they got an IV. Not every patient warranted that.
The J-Loop, a 6 inch section of IV tubing with a Luer lock valve on the business end, was the pre-war solution to this problem, an elegant weapon for a more civilized age. They were almost as plentiful as IV administration sets, but once the suppliers realized how much emergency docs loved the J-Loops, the price "mysteriously" shot up. Arcade and Alvarez had an emergency meeting over the radio, and decided that the J-Loops would have to be cut as an unnecessary expenditure until they could get a better price. One of many decisions he'd had to make in the name of summum bonum- "the greatest good," recently.
Arcade had never considered himself a willing servant of the greatest good. The very words made him uncomfortable, conjured up scenes in his mind of unspeakable atrocities throughout history. How many people had been taken off to camps, or placed up against the wall and shot in the name of the greatest good? How many lives had been deemed "unnecessary" when the going got rough? When you whittled human problems down to what was basically accounting, Arcade reasoned, it was easy to lose track of the really important things.
"Sorry Hazel," Arcade said to himself, as he drew his marking pen from his pocket and crossed out her desperate plea for IV supplies. The red ink stood out like blood against Hazel's stricken text. He marked a neat "AG" beside it, and continued to the drugs.
The atropine waste was annoying, but not a huge problem. If there was one drug that the Followers had in abundance, it was atropine. Atropine was essentially goth plant juice. He and Sunset Scotty made new batches in house by extracting it from nightshade plants. He'd given Scotty a page on his home radio frequency earlier that night to let him know they'd need to make a new batch soon, but no one had picked up. Curious.
The real problem here, and the one that Arcade had been encountering frequently when filling supply requests after codes, was the Epi usage. SEVEN FULL AMPULES. The scale of that waste was hard to understand if you weren't intimately involved in supplying and manufacturing the epinephrine. The process was ultimately too complicated to be done reliably in house- Arcade had tried, relentlessly, but converting L Tyrosine into Adrenaline, at the necessary level of purity, required tools and conditions that the followers just didn't have. This was a drug that needed to be bought from The Hub, and it didn't come cheap. Arcade felt a pain, a weight growing against his chest as he placed the little glass ampules of epinephrine 1:1000 in his coat pocket. By the time he'd gotten to seven, he realized he'd be taking more than half the current supply of epinephrine. The weight was considerable.
As Arcade shut the door behind him, he decided to make one last note at the bottom of the supply list that he'd be giving back to Doctor Hazel. He flattened the paper against the door and went in hard with his pen. The red letters were practically stenciled into the page:
BASIC LIFE SUPPORT ONLY ON ALL ARRESTS.
He leaned back to admire his handiwork. Doctors would violate it as they saw fit, but if he could get Farkas to put the order out to everyone, it would at least make them think twice about whether they really needed to waste all that Epi. There wasn't any proof that the drugs worked for arrests, anyways, so as far as he was concerned, it was really just a more expensive way of flushing an IV line. The only reason anyone did it was because it was the standard of care before the war.
Arcade removed the red padlock from his pocket, and slid it through the latch. But something stopped him from locking it- he was feeling that weight against his chest again, where the epinephrine was. Those seven vials were feeling heavier than ever. They did represent more than half the supply, after all…
Slowly, Arcade lifted the padlock up through the latch. If he brought those vials to Hazel, he was delivering them to someone who had just demonstrated that she was willing to let her emotions drive her care to a massive degree. Arcade hadn't been there, but according to the radio timestamps at the end of the code, she'd worked it for almost an hour. Could she really be trusted with 65% of their epinephrine, when they hadn't even secured another batch for the upcoming month?
"Supply side economics 2. Hazel 0." Arcade shook his head and opened up the door once more. He held his head down in shame as he removed all but one of the vials from his coat pocket, and deposited them back in the dusty cardboard box labeled "EPI 1:1000". The weight against his chest melted away, and was replaced with a sickness in his stomach. He made a little red note beside the drug requests, and hurried back out of the room:
EPI SHORTAGE. SORRY HAZEL.
Arcade had always hated the idea of the noble villain. "Good intentions and thirty bucks will buy you a Nuka Cola," his mother had told him growing up, and he'd taken it to heart. He despised people like Caesar, and like Thomas Hildern, who hid behind noble ideas while doing nothing to avoid unnecessary suffering. But the more good Arcade tried to do, the more he tried to brute force his way to a moral solution, the more he found himself resembling the people he hated most.
Arcade was not strictly an adherent to the idea of the greatest good. But he was a loyal servant to Freeside, and to the Followers of the Apocalypse. And when serving the servants, "the greatest good" becomes less a hypothetical and more an essential, daily question.
