Checks and Balances
Chapter 4
By the time Roy got out to the squad, Johnny was sitting in the passenger seat, his head laid back with his eyes closed. Roy hesitated before opening the door to the cab and getting in.
He reached for the key in the ignition to turn on the engine but stopped for a moment. "Look, Johnny, I'm sorry. I didn't know where you went, so I called the dispatcher to..."
"You called the dispatcher? Man, Roy. I just missed the turn is all." Johnny sat forward, panting slightly and coughed a short dry cough.
"I just asked what your status was. I didn't say anything, I just wanted to know where you were. What are you getting so sore about?"
Johnny leaned forward and grabbed the microphone. "LA, squad 51 available." He sat back and winced when his shoulders came in contact with the seat. "I don't want to talk about it."
Roy gave up trying to talk to Johnny. Dixie was right, he needed to give his partner time to cool off. By the time they got back to the station, however, Roy was feeling a bit put out by Johnny's attitude. He was the senior paramedic and had a right to question what happened in the field. He turned to face his partner to tell him exactly that, but Johnny had already opened the door and was stepping out of the cab.
Roy wasn't going to be deterred. He had been working on a slow burn all the way back to the station and was determined to set things straight with Johnny. He came around the back of the squad and stood in the way so that Johnny couldn't pass, a hard look on his face. Johnny looked up at Roy when he found his way blocked and came up short. Roy could tell that Johnny looked a little uncertain when he saw the expression on his face, but before either of them could say anything, a loud holler from the kitchen drew their attention.
Roy and John moved quickly, their argument forgotten, as Marco stood in front of the sink with water pouring over his hand; a stream of Spanish curses flowing freely from his mouth.
"What happened?" Roy asked, shoving his way through the gathered crew as he moved forward.
"Hot oil, Argh!" Marco shouted.
Johnny and Roy exchanged a quick look before Johnny turned and headed back out to the apparatus bay to get the drug box from the squad, nearly running into Captain Stanley.
Roy stepped up to Marco, who had calmed down as the cold water relieved the pain from the oil burn. It was a little hard to see the hand as water poured over it, but he didn't see any blisters which was a good sign. In a moment Johnny came into the kitchen out of breath and holding the drug box which he placed up on the counter next to the sink.
"Okay, Marco, let's take a look at that," Roy said, turning off the water.
Johnny had already opened up a large gauze pad and handed it to Roy for him to pat the injured hand dry. The back of Marco's hand from the middle finger to the pinky finger was bright red, but it didn't look too serious.
"You got it under water quickly, which was good. It looks like only a first degree burn. Painful, but not more than that."
Johnny coughed a couple of times as Roy turned Marco's hand over to inspect the palm. By the third dry sounding cough Roy turned his head to peer at his partner.
Johnny was busy opening up a Silvadine pack when he coughed yet again then said, "Chet! Oil's burning."
"I got it." Chet moved quickly to the stove and turned off the flame under the pot that Marco had been making popcorn in. Johnny handed the opened pack of Silvadine cream and grabbed a pack of two by two gauzes. Roy applied the cream which immediately gave the man some relief and took the gauze pads to cover up the burned area of Marco's hand. Roy reached his hand back to his partner who handed him a roll of gauze to wrap the hand in while Johnny pulled out a roll of tape to secure the gauze.
By the time Roy had finished with the bandage Marco was shaking his head. "Man, that was just stupid on my part. Thanks guys. It should be fine now."
Roy looked at his crew mate. "Do you want to go have this checked out at Rampart?"
Marco scoffed at the idea. "Heck, no, Roy. I've burned myself far worse cooking at home. Nah, it'll be fine."
"Does it still hurt?" Johnny asked, not really believing him.
"Yeah, a bit, but nothing I haven't had before. Seriously, guys, it's okay. Maybe I'll put a little ice on it."
Roy started picking up the discarded wrappers. "That's a good idea. Listen, Marco, don't be a tough guy. If this thing starts to hurt more than it does now, you need to tell us so we can get it looked at, but I think you're right, it's not a serious burn."
Cap didn't look so sure. "Are you sure, Marco? Roy?" Cap said directing his gaze to his senior paramedic.
"I promise!" Marco said as he held up his other hand. "Seriously, Cap, that cream made it feel a lot better. Say Roy, can I get some of that cream for home? I tend to burn myself at least once every few weeks."
Roy reached over to the drug box that Johnny was packing up and pulled out two of the blister packs of Silvadine and tossed them over.
Marco caught them easily enough with his good hand. "Well, the first batch of popcorn's done anyhow," he said, with a grin.
As Johnny closed up the drug box Roy threw out the used packages. "What's the movie tonight?" Roy asked.
Chet chimed in "CBS is showing The Night of the Living Dead."
Johnny shook his head as he picked up the drug box.
"What's with you, Johnny? You said you liked that film."
"Thanks, I'll pass." Johnny said.
"You'll pass? What do ya mean you'll pass? Whatsa' matter, you think you're gonna have nightmares of that new nurse coming for ya?" Chet said as he imitated a zombie shuffling toward him with his arms outstretched.
Johnny just turned his back and walked away.
"Aw, come on, Gage, it's a great movie." Chet called as he began to follow Johnny out to the squad, but he stopped when Roy reached out and put a hand on his forearm.
"Give it a rest, Chet," was all he said as he followed his partner.
"Talk about sensitive! Geeeshh! It's just a movie, is all I'm saying." Chet muttered as he began to move the chairs from the table over in front of the TV.
Roy stepped out into the apparatus bay just as Johnny was closing up the doors to the squad. "Hey, you okay?"
Johnny sighed and turned toward the dorm. "Can I talk to you privately?" he asked, moving past Roy and heading for the dorm.
"Yeah, sure." Roy followed his partner and took a seat on his bunk facing Johnny who had already sat down on his own.
"Look, Roy, I'm sorry I got sore at you earlier. It's just that I feel pretty stupid for mixing up the IV bags and you know Dixie is tight..." Johnny stopped for a moment. "... with Dr. Brackett. I just don't want him to think I can't do my job."
"Dr. Brackett wouldn't think that. Come on, Johnny, I know you better than that. What's really bugging you?"
Johnny got up and started walking toward the locker room unbuttoning his shirt as he went. Once he got there he sat down on the bench looking a little winded. "I feel lousy. If I'm supposed to feel worse tomorrow, I'm not looking forward to it."
Roy sat down on the bench next to Johnny. "Should we go back to Rampart?"
"Nah, they're still jammed up. I'll tell ya, though, if I still feel this lousy tomorrow, I'd even be willing to go see Morton," Johnny said, as he made an attempt to get his shirt off, wincing at the discomfort.
"What do you have against Morton?" Roy asked as he stood up and helped Johnny get the shirt down off his shoulders.
"Oh I don't know," Johnny answered sarcastically. "Maybe it's because the last time he saw me he called me soft."
Roy looked at the bruising across Johnny's back. "Yeah, well I don't think anyone can accuse you of being soft, sporting this bruise."
Johnny turned his head trying to see over his shoulder, then thought better of the idea when the movement caused a sharp pain through his back and chest. "Bad?"
"It's not pretty." Roy admitted as he reached into Johnny's locker and pulled out a T-shirt to hand to him.
"Will you do me a favor?" Johnny asked as he gingerly got the shirt over his head. "Tomorrow, will ya drive me over to Rampart? I can't take those pills Brackett gave me while I'm on duty, but I plan to take a couple as soon as we are off shift."
"Yeah sure, but you know you'll probably have to see Morton."
"I know." Johnny said sourly. "Brackett said I'd be sore, and I am. I do trust him, it's just..."
"You feel lousy. Dr. Brackett would be the first one to tell you to get checked again or to get a second opinion. We'll head over there right after we get off shift."
"Thanks, Roy. Maybe we should get Marco to tag along." Johnny quipped as he slipped off his trousers and put on a pair of long black sweat pants.
Roy hung his partner's shirt and pants, closing up his locker while Johnny brushed his teeth at the sink. Johnny looked so tired when he turned and headed back into the dorm that Roy followed closely behind. He noticed that Johnny was moving more slowly than he thought he should so he sat down on his bunk while John set up his turnouts for the overnight.
"Listen, maybe we should just go in to Rampart now."
"As jammed as they are from all the accidents today, we'd be there forever," Johnny said, as he lay down and threw his left arm over his face in his customary sleeping position. Roy just sat there watching him for a moment.
"You gonna watch me sleep, or go back and watch the movie?"
"Huh?" Roy didn't get up.
A moment or two passed before Johnny peeked out at his partner from behind his arm. "Roy, you're freaking me out a little."
Roy stood up. "Oh, uh sorry."
He wanted to say something else, but he didn't know what, so he just turned and left the dorm switching out the light as he went. Something about all of this was bothering him. Johnny was probably right. Roy trusted Dr. Brackett as much as Johnny did, and he knew that Brackett would never have cleared Johnny for duty if there was something wrong, so why did he have a feeling that something got missed?
Dr. Baktash Bootorabi wasn't expecting a mildly frantic call from one of his radiology residents at nearly 10:00 at night. Nor did he expect that he would have to make a trip down to the ER to have a conference with Kelly Brackett, the head of the ER, but that was where Rampart's chief Radiologist found himself at five minutes to eleven that evening.
"Hey, Kel, we have a problem."
"Boot, what're you still doing here? I thought you went home hours ago."
"I did, but my resident called me back. Some films were mis-labeled late this afternoon. The time stamp on the set of films I have is 17:43, but with a mix up in the ident cards the time could be wrong. I've spoken with Dr. Hargrove in oncology as well as Dr. Stackhouse, today's hospitalist*. The film doesn't match any of the oncology or in-house patients. I have also had the file secretary go through and pull every folder on our out-patient list for the day to try and find the patient matching the films that were mismarked and we have come up empty," he said, holding up a set of chest films.
"Okay, so what's the problem?" Dr. Bracket inquired. Dixie had just finished up some paperwork and stepped over when she overheard that there was a problem. As the head nurse for the ER it was her job to fix or clean up most of the 'problems' that occurred so she knew this was something she should listen to.
"Process of elimination says it must be one of your ER patients. Here let me show you what were up against."
Dr. Bootorabi walked over to a treatment room and threw the films up on the light box. "That's the problem." He pointed to the film which showed a pneumothorax on the right.
"Kel, if the timestamp on the identification flasher is correct, this film was taken over six hours ago, and it could potentially be longer than that. If this has gone untreated then this man is in serious trouble."
Boot pointed to the identification square at the bottom left edge of the film. "This film is marked Roger Clements." Then he pulled another film out of a file folder. "Take a look at Mr. Clement's film from a month ago," he said, as he put another chest film up. The two x-rays clearly showed that the patient from the film taken a month ago was not the same as the patient with the pneumothorax."
Kelly Brackett became very concerned. The collapsed portion of the lung wasn't too big, but in six hours or longer that could have drastically changed. "So how do we figure out who this is?" he asked, pointing to the film taken that day.
Boot shook his head and sighed. "Well, we can pull every folder on every patient you have seen that matches the parameters of the patient, but if this patient has never been seen here before we won't have anything old to go on."
Dr. Bracket frowned. "Boot, we've seen nearly one hundred and fifty patients in the past twenty four hours. That's going to be a lot of charts to go through, to try to narrow this down."
Dixie, who had been standing quietly, stepped forward. "I think I have seen every patient that has come through here today. Maybe I can pull out a few likely candidates before we look at every patient. What else can you tell us about this patient? You said it was a man so that cuts our search in half right there."
Dr. Bootorabi pointed to the film indicating the different things he was talking about. "Going by the bone density of the ribs and anatomical structure, I can tell you that this is a young man, in his twenties or thirties. He is tall and slender. There doesn't appear to be a tear in the lung, but again that is hard to definitively determine. There are no rib fractures. The pneumothorax could be pathologic in nature, although I see no other radiographic evidence of pathology. However, bear in mind that tall slender men are more prone to spontaneous collapse of the lung than other body types. The left lung looks clear, intact and free of disease. My guess is that this could have been a result of a blunt force trauma, even though there is no evidence of rib fracture, but of course that is only a guess."
Both Dixie and Dr. Brackett's minds immediately began to mentally scan through the scores of patients that had been seen in the ER. Dr. Bootorabi pointed to the bottom of the film now.
"Also, see here near the bottom of the film on the left side you can see what looks like the tip or edge of a surgical clip. That could be indicative of stomach or spleen surgery. Other than that I cannot give you anything more concrete."
That mention of a surgical clip near the spleen and the general description of a tall slender man in his twenties or thirties struck a chord with both Dixie and Dr. Brackett. They looked at each other as the same thought occurred to both of them simultaneously.
"Oh, God, Kel." Dixie said.
Dr. Brackett grabbed the films that the Radiologist had put up and plowed through the exam room door nearly running a very tired Dr. Early over.
"Hey, what's up?" He was surprised to see Dr. Bootorabi fly out of the exam room right behind Dr. Brackett and both followed by Dixie. "Boot, what are you doing here at this hour?"
Dr. Early joined in the procession following Dr. Brackett who went directly to the light boxes in his office where a set of chest x-rays hung and flipped on the light. He pulled down the lateral view and quickly put up the frontal view of the old film Boot had brought of Mr. Clements. They were clearly the same patient. Boot looked at the films and pointed to an old calcification protruding from the lateral surface of the right humorous bone at the level of the shoulder joint space.
"See this calcification? This film is the one taken of Mr. Clements this afternoon." Then Boot looked at the name printed on the film. "So who is John Gage?"
"Damn it! How did I not see this earlier? John is a firefighter and one of my best paramedics. He fell fifteen feet from a roof this afternoon rescuing a two year old child."
The radiologist nodded. "That would cause the injury. Do you know where Mr. Gage is now?"
"That's what I'm about to find out," he said, and he reached for the phone on his desk.
TBC
* A hospitalist is the admitting doctor for the hospital. Once a patient leaves the ER they are then transferred to the care of the hospitalist who is responsible for all in-patients until such time as their own physician takes over their care or they are discharged from the hospital.