SYMPATHY FOR SQUID

'Clark County Dispatch to Freeside EMS… We've got a priority 1 ALS call on Fremont Street, coming from the call button by the Kings School of Impersonation. Cot is required. Patient is an adult male calling in for difficulty breathing, chest pain. Patient was having a hard time speaking. You'll want to bring a monitor. Bring the airway kit too. He sounded bad.'

That's how the call came in. The first sentence that Doc Alvarez had said after the call signs was that this was an advanced life support call. Everything about it screamed "This patient needs an EKG!" and "This patient needs IV drugs!" And yet, despite all of that, she found herself reaching for the mic. Depressing the button.

She was RIGHT there! Just across the street!

"Foxtrot-Street-69, I'm enroute! I'll grab the stretcher. Don't ask how. Have people meet me on the way to the Fort, whoever can."

Before anyone could respond to her, she'd already thrown her jump bag out her bedroom window, and climbed out after it. She soon followed suit, grabbed it, and ducked into the alley between her house and her neighbors. She shimmied behind the dumpster. Batted the nasty little flies out of her face.

It wasn't a nice stretcher. It was rusty, it didn't go up or down, and one of the wheels was stuck in position. It only had one working strap and it was really long and constantly snagged in the wheels. But it got the job done and no one had noticed when she nabbed it. She checked over her shoulder to make sure no one was looking, and wheeled the abominable device out of the alley. It was hard to maneuver on her own, especially with how short she was, but she pushed hard and fast and she made it work. It whined and creaked all the way.

Even through the fog, it didn't take long to find the patient. He was slouched up against the wall of the Kings School of Impersonation, clutching his chest all dramatically. He looked like he'd just got finished running for his life. Squid could see the neon lights reflected in the sweat on his chest and forehead. He'd taken off his shirt and his fat old belly was hanging out for the world to see. His checkered boxers were riding up above his raggedy old jeans. He didn't have any shoes.

"What's good in the hood!? My name is Squid! I'm a medic, I'm here to sort your shit out!"

"Oh thank sweet baby Jesus…" the man let out a nasty cough. For a second he seemed like he might stop, but then he just kept coughing. Squid grabbed him under his slippery wet armpits.

"I'm gonna need you to sit on the stretcher for me. Then I'm gonna take your vitals. Can you stand up- like if I help you can you stand up?" Squid got him to sort of half slouch up, but when she tried to guide him down on the stretcher, it rolled a little bit and he immediately collapsed onto the ground and fell into a heap. Squid rolled her eyes. "Okay, we're gonna try that again! Just get up and get on the stretcher bro. On three. One. Two…"

"Fuck you!" The man kept coughing. His face was red, twisted with anger and exertion. Spread eagle on the ground, completely useless. "Where's the- agh, where's the doctor!? Damned stupid kid!"

"Hey shut the fuck up! I'm trying to help you!" Squid squared up the situation and decided that the whole stretcher thing wasn't worth it. She briefly abandoned the patient and strode over to the EMS call station, the one that the patient- the John Doe- had summoned her with. She hit the big red button. "Hey, Alvarez! This is Squid! I can't get this asshole on the stretcher. Just send everyone to the scene. Stretcher is still here. Don't know anything about him but he's heavy and weak. He's doing bad."

Squid looked at the man on the ground. He was coughing up pink bubbles now, and breathing very, very fast. "What the hell is even wrong with you?" she muttered to herself, as she crouched down on one knee beside him. She rummaged around in her jump bag for inspiration, for some item that would bring order to the situation, but she found nothing. There was a bag valve mask, which she was probably going to need soon, there was a bunch of gauze and shit, some airway supplies…

Fuck fuck fuck!

Squid was starting to sweat. Stable patients didn't cough up pink bubbles or act like this guy was acting, and she was totally brahmin-fucking this call. Since she didn't see herself fixing what was wrong, she decided to at least grab a set of vitals. She fumbled with the blood pressure cuff.

"Hold your arm still for a second." She jammed her stethoscope in the crook of his elbow and angled her neck so the cheap earpieces sat right in her ears. Eyes on the dial, she began to inflate the cuff. After a few squeezes she realized that she'd forgotten to close the valve and was just blowing air. "Come on man…"

She fixed it. She inflated the cuff properly this time. She blew it up all the way up to 240, and almost as soon as she started releasing it, she heard a thumping noise through her stethoscope. The hand on the dial jumped with each beat.

By the end, the pressure sat at 220/130. The highest she'd ever seen.

"This is it…" John-Doe looked almost gray now. He was puckering his lips like a fish with each painful breath he took. The skin on his belly and his arms was all red and blotchy. He reached out as if to grab her but he was too weak and his arm flopped back down on the ground. Squid looked around helplessly. "I can't breathe. Can't breathe. Fuckin, help me."

"I'm trying my best asshole!" Squid wiped the sweat off her brow. She took the bag valve mask out of her jump bag and placed the cracked rubber mask against his face. She squeezed in time with his breaths. "More guys are coming to help. Just… hold on a second."

It was hard to get a seal on his face. Hard to keep a seal. She could feel air rushing out from the sides of the old rubber mask with each squeeze. Still, it seemed to help somehow. John-Doe seemed relieved. He didn't resist the bag.

It was still early in the morning. The sun was still rising over the North Gate; the morning dew hadn't even dried yet. Squid felt something strange in her heart as she saw the first golden rays break through the fog in the air. Like the Battle of Helm's Deep but without the cavalry.

Were they even coming?

Squid wondered if anyone had heard her message. Maybe they were still working under the idea that they were going to meet her on the way. Who knows how long it would be until someone came to help her?

Just as she began to come up with some sort of insane plan to drag the 250 pound slab of dead weight onto the stretcher, or to give in to her pride and go running to the Kings for help, two figures laden with supplies emerged through the fog- a tiny little guy with a coat and a defibrillator, and a bigger guy with a tacklebox and a bag. It didn't take her long to figure out who they were.

"Marwan! Doctor Isaac!" She wanted to throw her hands up in victory but since she was doing stuff with them, she just nodded her head really hard.

"Squid! What's ailin' him?" Despite carrying way more stuff than Marwan and being way shorter, Isaac hauled ass to the scene a lot faster. It didn't take him almost any time to drop down beside Squid and dump his assorted crap all over the ground.

"I don't really know doc! He started coughing up pink bubbles and fell over and his skin got all blotchy, and now his blood pressure is really high which doesn't make sense to me. It was like 220 systolic! Anyways now I'm bagging him cause he seemed like he was gonna stop breathing soon."

Isaac nodded. He'd already slipped an IV into the man's jugular vein. He propped the guy up into a half-sitting position using his jump bag. "You remember what that bottom number was?" He asked. Squid stared down at the discarded pressure cuff.

"120. I think."

Doctor Isaac took a big, deep breath. He peered over his glasses at Squid. He looked sort of nervous. "I've got an idea what's goin on. Hook your bag up to oxygen, I've got a can in my jump bag. I'll ventilate for you." Squid did as she was told. She opened up the regulator on Isaac's green O2 can to 15 liters per minute, plugged in the tubing, and stuck it on the adapter. Wordlessly, she took back over ventilating. She noticed that there was a new valve on her BVM that she'd never seen before. "Good. I'm gonna throw the pads on and get a 12 lead right quick, alright? Then we're gonna move him outta here."

By this time, Marwan had arrived. He opened up the tackle box full of drugs, and selected a saline flush with "EPI" written in big red letters on the side. He presented it to Doctor Isaac for confirmation. Doctor Isaac shook his head.

"I think this is a SCAPE type of deal. Spike me a 250 bag and get 1 milligram of IV Nitro in there. Just run it wide open."

"I understand." Marwan removed a tall brown vial that Squid had never seen before and drew up the whole thing. He injected it into a little bag of saline and got to work setting up tubing. Before long, he was nudging squid's hand aside to plug it into the patient's jugular IV.

The patient was still awake through all of this. He probably wished he wasn't. He'd submitted to the bag valve mask, and was breathing in time with Squid now, waiting, watching for her to squeeze. Isaac gave him a little rub on the shoulder. "Hang in there, partner! Even if you feel like you can breathe alright, just keep lettin' her do her thing. We're gonna get you to Old Fort Mormon, alright?"

Isaac and Marwan were working together to wipe the sweat off the patient's chest and apply the electrodes now. He also had a lot of hair on his chest that was really getting in the way. Suddenly, a couple of neurons collided in Squid's skull and produced an intelligent idea.

"There's a knife in my pocket! Right pocket. Grab that shit and shave him." Squid felt pretty shameful about today, but at least she was always prepared with a knife and stuff.

"I will shave the hair. Squid, stay on the airway. Doctor Saller-"

"I gotcha Marwan. I've already got a 3 lead going…" He eyeballed the monitor. Squid did her best not to be distracted by the beeping box, but she couldn't help but take a look. There were a lot of spikes. They were going really fast.

"Poor guy is fighting for his life here. Marwan, do we still carry dobutamine?"

"No. We could reach a similar effect with low dose dopamine, which we do have."

"Well, given its therapeutic range, that feels like a recipe for a clean kill." Isaac snapped his fingers a few times and looked to the sky. He was clearly thinking hard.

"Hey, excuse me boss?" Everyone looked at Squid. "What the hell is SCAPE? What's going on with this guy? Why are you giving him stuff to raise his blood pressure if it's already super high?"

"I don't wanna do that at all. That's exactly why I'm scared of dopamine here! I want his heart to beat stronger so it don't have to beat so fast and it can work against the pressure-"

"We do not owe you an explanation right now. Keep bagging." Isaac seemed surprised by Marwan's directness, but he got on board. He tried to look stern.

"Yeah. Jeezum. We're pretty busy, so let's round this call up before I go on lecturing."

She wasn't even gonna talk shit cause she knew Marwan was right. She honed in and kept on bagging. Or at least, tried to hone in. It was hard to focus with the monitor beeping in the background. The patient was breathing more on his own again, so Squid was trying to conform to his breaths now instead of hoping that he synced up with hers. It took some getting used to.

"Alright, I've got a twelve lead printed out. We should start moving soon, but I feel like we're in a bit of a pickle here…" Isaac waved towards the tackle box. "Have we got any Nicardipine? Clevidipine? Hell, Amlodipine?"

"I'm afraid not."

"Have we got a single goddamn calcium channel blocker in that box!?"

Marwan rummaged around for a few seconds. He drew up a little vial with a red label. "We still have Verapamil."

Isaac waved his hand at Marwan. "Ah, Well, I don't reckon he's gonna turn around without the extra push. It all came on pretty fast, right Squid?"

Squid nodded fervently. "Shit was fucked up man! He wasn't like this when I got here, he was still talking a little, sitting up and stuff. Then he just-" Squid stiffed up and did her best fish-out-of-water impression. "Went all, augghhhh! Know what I mean?"

"Mhm." Doctor Isaac had already drawn up the medication. He didn't bother setting up a separate drip, he just bolused it through Marwan's IV line. "Alright, Marwan, we're gonna have to change that bag out soon. And now that we've got the Nitro and Verapamil on board, I'm willing to take the risk with dopamine. Fill that bag up with, I will say, 50 milligrams, and run it over ten minutes." He double counted on his fingers. One of his hands was all malformed, and he was missing a finger. "Yeah. 50 milligrams. Ten minutes."

"Mmh. Now we see eye to eye." Marwan sounded smug. He started setting up the new drip. "What about the Nitroglycerin? We are due for another dose."

"I'm just gonna bolus it when I'm done pushing this stuff. Honestly, I'm not certain why I decided on a drip for the first one. Force of habit?"

Squid was having a hard time following the conversation so she just blocked it out. She considered herself to be pretty into medical stuff, really into the "nitty gritty" kind of shit, but this was a little too high concept. The adults were basically talking about magic at this point. They could be making up words and she wouldn't know the difference.

She focused on John-Doe-Patient and the monitor instead. His heart rate had started going down a lot. His skin didn't look quite so weird and blotchy. No one had gotten a blood pressure for a while, but overall things seemed to be looking up for the miserable man on the pavement.

He did look pretty miserable though. His face was red, and he was all moaning and crying and shit. He was holding onto the face mask for dear life. Squid gave him a forceful nudge.

"Hey! Doctor Isaac!" Isaac looked startled as he glanced over from his IV stuff. Squid nudged the patient again. "Can we give him some narcs? This is making me sad."

Isaac stared at Marwan for a couple seconds without saying any words, then went back to playing with his IV stuff. Marwan started to say something, then shook his head, shrugged and started drawing something up. They both seemed annoyed with each other now.

"Thanks for bringing that Up, Squid. Marwan was gonna do that, but I guess he was just too busy earlier!"

Marwan looked like he actually wanted to shoot and kill Doctor Isaac. He spiked another bag and pushed the narcs in through the medication port then tossed it up onto the stretcher so gravity could do its work. "I am not going to respond to that right now. Could I have an 18 gauge and a prep pad please?"

Supplies were exchanged. John-Doe-patient grunted and flinched as another needle found its way into his vein. Soon there would be narcotics flowing through his system. Soon life was gonna get easier for him.

It was getting to be the time of morning where people woke up and went places. The fog was gone. The hum of the morning crowd was ramping up. Dogs had started barking, skells on the street were panhandling and shouting at passerbies. A little group of assholes had gathered to point and gawk at the "street doctors," like it was some kind of stage play. A group that was just gonna keep getting bigger if they didn't hurry up…

Squid felt a pit in her stomach. Her heart fluttered. A shiver wracked her nerves as the hairs on the back of her neck stood on end. A month ago this wouldn't have bothered her at all. But some part of her had woken up since then, and the whole world looked different. Looked meaner.

"Hey guys, if we don't leave soon someone is gonna kill us and steal our stuff," said Squid. She pointed her elbow at the stretcher. "I can, like, pull the stretcher if someone else wants to bag this dude. My hand muscles are getting really tired."

Marwan looked around at the crowd and nodded in silent agreement. He slung the monitor over his shoulder and grabbed the drug box. "We can put our belongings on top of the patient. The jump bag goes under his head. Doctor Saller, you are short, so you will push the stretcher while I ventilate. We should head straight to Usanagi's clinic."

Isaac didn't even seem offended. But he was a little bit confused. He pointed at all the half empty bags of fluid on the stretcher.

"That sounds beautiful, but this thing don't have an IV pole! What are we gonna do about that?"

Marwan cracked a smile. He patted Doctor Isaac on the shoulder. "Sure it does. I'm looking right at him."

The sun was bright and hot and high in the sky by the time they'd gotten John-Doe-Patient back to Saint Usanagi's intensive care unit. It was kinda far away from the fort, so they hadn't even gotten to celebrate with the boys after the call. There wasn't any party waiting for them. Just the unforgiving glare of the desert sun as they pushed the empty stretcher back to the Fort.

"Soooooo…" Squid clicked her tongue. She was chewing on some kinda tree resin, and it was all out of juice. Now it was sticking to her teeth. "What was his deal?"

"He was stuck in a sympathetic loop. People usually call it stuff like "Flash pulmonary edema, or "acute heart failure," said Doctor Isaac. Marwan stayed behind to help Doc Usanagi at the hospital so it was just them now, walking back to the fort. Squid stared blankly at the doc. "...What I'm trying to say is, his body noticed that his heart was havin' trouble pumping, so it tried to raise his blood pressure and pump faster to keep up. But that made things worse. And so to try and fix it, his poor old body tried to raise the blood pressure even more, and his heart beat even faster, which only made it worse… and so on."

"Oh. That sucks for him." Squid spit the resin out on the ground and gave it a little push with her shoe, like she was putting out a cigarette. She tried to shift her focus to maneuvering the stretcher through the rocks and sand. Anything to not be in the present. "I mean, it seems like it'd be a shitty way to die. He was really, like, begging me for help. And crying and stuff. You know?"

"They do that sometimes."

They kept walking in silence. Squid's skin was already sweaty. So was Isaac's probably, but Squid's eyes were firmly planted on her nails so she couldn't know for sure. She was gonna have a sunburn on her neck and her face if she didn't cover up with something but her mind was wandering; it was hard thinking about things like that right now.

"Hey Doctor Isaac?" She didn't look up, but she could tell that Isaac was looking at her. She suddenly felt very small. "Do you think that dude's gonna live?"

Doctor Isaac sighed. "I don't know Squid. I hope so."

Neither of them spoke again. Crows cawed and bugs clicked somewhere in the distance. The wheels of the old metal stretcher clattered all the way back to base. It probably wouldn't be empty for long.

Some adventure this was.