Friday, December 10:
Station 51
Johnny greeted Roy in the locker room. Roy noticed that his friend looked much better rested. Gone were the dark hollows under his eyes and the lines that tension and fatigue had etched around his mouth. He even looked like he may have gained back a pound or two. "Where's the trainee?" Johnny asked as he dressed. Like all paramedics, Roy and Johnny were often assigned to mentor a paramedic trainee for a shift.
"Not here yet. Cap said his name is David Hansen. He's fresh out of the classroom."
"This is his first shift?"
"Yeah."
Half a minute later, Cap brought the trainee into the locker room. He introduced him to Roy and Johnny and asked them to get him settled. "Roll call is in five minutes." Before leaving the locker room, Cap made a quick visual assessment of Johnny, noting the obvious physical signs of improvement since the last time he had seen the paramedic. Although Dr. Wilson had given the go-ahead for returning to work, Cap would continue to keep an eye on him throughout the shift.
Cap made the daily housekeeping assignments. "DeSoto and Hansen, break room. It's a mess. Gage, kitchen. Stoker, engine bay. Lopez, dorm. Kelly, latrine." Then he launched into his 'welcome the new trainee' speech. "These two are one of the best examples of a paramedic team you can hope to find." Cap concluded his little speech.
The set-up was just too tempting for Chet to ignore. "Yeah, Roy is the best example of a good paramedic and Johnny here is the best example of a bad paramedic!"
Four mouths dropped open in astonishment at the incredibly bad timing of a tacky joke that might have worked in a different situation. David glanced back and forth between all the men, unsure of the dynamics.
"Kelly!" Cap growled through clenched teeth.
"Ha, ha, Kelly. Very funny." Johnny said at the same time. Motioning to David, he said, "Come on. We'll show you the squad."
Roy tossed an exasperated glare at Chet before following after them.
Cap gazed at their retreating backs, thoughtfully considering Johnny's reaction. Satisfied by what he saw, he turned to Chet and ground out, "Kelly! Are you bucking for latrine duty for life?"
"No, sir!" Kelly stood rigidly at attention.
"Get outta here!" Cap dismissed him with a wave of his hand and a hint of amusement around his eyes.
"Chet…" Marco began.
"I know! I know! Don't even say it. I'll apologize to him later," Chet moaned as he headed for the cabinet to retrieve the necessary supplies for cleaning the latrine.
The morning passed quietly, in relatively minor runs.
"Is it always like this?" David wanted to know. "Somehow I thought it would be more exciting."
"Yeah. I'd say that about only one run in twenty is life threatening. Most of the time it's bumps and scrapes or really weird stuff," explained Roy.
Bumps and scrapes had constituted the only calls to which they had responded that day. They hadn't had any weird run, yet. "Like what?"
"Like a girl getting her braces caught in the carpet. That happened a couple of shifts ago. It was kind of hard not to laugh. The situations that people get into, especially when they don't get seriously hurt, are often quite funny. To us, anyway." Johnny answered this time.
Roy looked thoughtfully at Johnny before launching into another tale of a weird rescue. "We had a lady stuck in the doggie door not too long ago." He started to laugh at the memory. "You wouldn't believe how often this happens. I don't know why people think they can fit through there. She had accidentally locked herself out of the house and thought she could get back in that way. There she was, with her fanny bulging out around the edges of the doggie door, wearing these purple paisley with yellow polka-dots shorts, …"
The squad had just returned from another easy run. Roy and David had gone into the kitchen for coffee. Johnny was leaning over the hood of the squad, using it like a desk as he jotted something down on a clipboard when Chet sidled up.
"Johnny?"
His eyebrows went up at that. Chet rarely called him by his first name.
The words tumbled out of Chet's mouth. "I'm sorry about that crack earlier. I didn't mean it like that. It came out wrong. I really do think you're a good paramedic…."
Johnny interrupted Chet before he could get too maudlin. "Thanks, Chet. I appreciate that." Noting Chet's continued discomfort, Johnny added with a grin, "See if I rescue you the next time!"
"You'd better, Gage!" A smile spread over Chet's face, relieved that Johnny wasn't offended by the stinker of a joke.
"Squad 51. Possible heart attack. 214 Renton. 2-1-4 Renton. Cross street Cluff. Time out 15:47."
David's heart began to beat a little faster upon hearing the words spoken by the dispatcher. This sounded like it would be his first real emergency rescue. The three men jumped into the squad and fastened their helmets. Cap handed the slip of paper to Roy, which he in turn passed to David. Johnny had out the map. The squad pulled out onto the street, sirens wailing.
"Okay, it's a left at the next intersection. Whoa, watch out for this blue car on the right. Okay, clear." Johnny navigated for Roy.
"What's the number, David?" asked Roy.
"214. Should be on the right side. There it is!" Excitement tinged his voice.
A distraught woman came running up to the squad. "I think he's having a heart attack! Please hurry!" she cried, plucking at Johnny's sleeve.
"Okay, ma'am. We're coming. We need to get our supplies. Could you just stand over here for a minute?"
Johnny grabbed the drug box and the heart monitor out of the compartment. Roy grabbed the defibrillator and the bio-phone from the other. David hesitated briefly, unsure what he should get. "Bring the oxygen," Roy directed David. The three took off for the house at a trot.
They found a man in his fifties who looked pale and diaphoretic and was experiencing difficulty breathing. He was extremely agitated. "Hello, sir. We're here to help you. Everything's going to be all right. How long ago did the pain start?" Roy asked. He got the oxygen mask ready.
David closely examined the man with his eyes, still holding onto the oxygen tank. While he had seen survivors of heart attack in hospitals before, this was the first real heart attack victim he had seen outside of training films.
"About twenty minutes ago," the man gasped. "Hurts real bad!"
"Get his vitals," Johnny said to David as he prepared the defibrillator and the cardiac monitor.
David jumped a little. He had been engrossed in observing the man and listening to Roy's questions. He got out the BP cuff and inflated it on the victim's arm.
"Sir, I'm going to open your shirt and put these pads on your chest so we can see what's going on. Just relax. Everything's going to be all right." Johnny spoke soothingly to the man.
David surreptitiously watched Johnny as he took the vitals, wondering what it would be like if the man coded. He began reviewing the ABC's of basic CPR to himself - airway, breathing, circulation - just in case he needed to be ready.
"BP 210 over 160. Pulse 162. Respirations 24." David reported the vitals in what he hoped was a calmer manner than what he was currently feeling.
"Paroxysmal supraventricular tachycardia," Johnny said, reading the monitor. "I'll get the IV set up." Then, addressing David, he added, "They'll probably order 6 mg of Lidocaine rapid IV push. Get ready."
Nodding that he had heard, David reached for the drug while reviewing the sequence of advanced cardiac life support procedures he had learned: defibrillation, intravenous line, airway, assessment.
Roy called Rampart. "We have an approximately 50 year old male. He began experiencing chest pains about 20 minutes ago…" Just then the man began to choke. "Hold on, Rampart."
He surged halfway out of the chair and then collapsed back unconscious. David gasped, eyes wide, somewhat panicked by the dramatic display.
"V-Tach!" Johnny exclaimed, setting the paddles aside. David immediately grabbed the paddles and charged them. Johnny and Roy lowered the man to the floor. Johnny checked for a pulse, found it and was counting, when David yelled, "Clear!" Johnny reflexively jumped back and yelled, "Wait!" at the same time. The paddles discharged. "David!" Johnny hissed as he grabbed the paddles out of David's hands.
David sat back, horrified at what he'd just done. He'd shocked a man who had a pulse! He'd killed him! The room felt like all the air had been sucked out of it as the scene became a blur of sound and motion to him. His universe collapsed to encompass only the two paramedics working seamlessly and rapidly as a team to save the victim.
"V-Fib! No pulse. One. Two. Three-four. Clear! No conversion. Beginning CPR. Clear! No conversion. Rampart, victim is in V-Fib. We have lost the pulse. We have defibrillated times two, inserted an esophageal airway and begun CPR."
He'd killed him! The voices flowed around him, controlled, calm, surfing over the chaos.
"10-4, administering epinephrine. One. Two. Three-four. Clear! No conversion, Rampart... 10-4,administering Lidocaine. One. Two. ! No conversion, Rampart..."
No conversion. No conversion. His first day on the job and he'd killed a man. His mind went blank, the room shrank down to a pinprick of light and the sound of his own blood in his ears was deafening.
"10-4, administering epinephrine. Clear! No conversion, Rampart... 10-4, administering Lidocaine. Clear!"
"51, you have idioventricular rhythm at 40 beats per minute. Smoothing out into sinus rhythm at 58 beats per minute."
"David, get the vitals," he heard a voice say from far away.
"David, get the vitals," the voice said again.
Feeling something nudge him, David looked down at Johnny, who was holding the BP cuff in his hand.
"Is he going to be okay? Did I …" David's voice was the barest whisper.
Johnny shook his head once, pushing the cuff into David's hands. "It's okay. Get the BP." He reached for the victim's wrist to take the pulse.
Roy was back in contact with Rampart, giving the updated vitals and receiving instructions. "Two litres of O2, lidocaine drip and transport immediately. 10-4, Rampart."
They prepared the man for transport. Johnny and Roy's eyes met over the gurney as they helped wheel the man to the ambulance. They came to an unspoken agreement to say that the patient had no pulse when he arrested. "I'll ride in," said Roy.
Johnny and David jumped into the squad and headed for Rampart. They drove in silence for a few moments. Glancing at the stricken trainee out of the corner of his eye as he drove, Johnny cleared his throat and said, "David… he had a pulse. I know you already know this, but you never shock a pulse. You always check for a pulse before defibrillating."
The young man stared out of the window, his expression ashen. "I almost killed him. I almost killed him." David kept whispering the phrase in horror over and over.
Johnny cut the siren on the squad and backed into the area near the emergency entrance. "You didn't kill him. We're here. Right now, you've got to be a paramedic. We'll talk some more about this later."