X-ray vignette 2 - coffee should be fresh

[raw and unedited, more so than usual. Let Truck = bus]

GLOSSARY

"Barber's Adagio for Strings" he remembered Marcus saying
the last time he had played it, on a similarly wet morning as
they waited to relieve Tour I's crew. "Barber's Adagio for
Strings}" Marcus said, "he wrote that for medics. Why else would
he have written something so mournful?"

"There weren't any medics when he wrote that," said
Lieutenant Correia from the doorway, "What was that, seventeen or
eighteen-"

"There were medics in the time of the bible. Elijah was
one. 'And it came to pass that the son fell sick, and there was
no breath left in him, and Elijah took him and cried unto The
Lord, and stretched three times upon the boy,' that's rescue
breathing, they didn't have the BVM then, 'and The Lord did hear
Elijah's plea, and the soul of the child recame unto him, and so
he revived."

"Okay." Lieutenant Correia ducked back out to his office and
left Ian alone with Marcus.

"One Kings seventeen, Marcus continued. " And Barber only
died in '81, though he wrote his Adagio in, oh, 1936 or 37."

Ian refused to look up, refused to take the bait. He was
three quarters through his crossword puzzle and he knew that if
he didn't engage Marcus in conversation he would begin to play
again. Few things stimulated Ian's thinking more than-

"Mozart," Marcus gave in. He bent his head to his violin
again and the lounge filled with music. Happy music. Thought
provoking music. Ian continued with his puzzle.\par
}{\plain \par
He had four clues left when Three-five X-ray, their unit, pulled
in.

"Thirty-five minute extrication in the pouring rain," Smiley
said, and that said it all. Ian and Marcus took their keys and
narcotics from the soaked members of Tour I and set about their
Truck check: Lifepack present, with two charged batteries and a
spare, heartstart adapter, EKG electrodes and combination pacer-defib pads. O2 bag, portable oxygen at 1350psi: nebulizer, meds,
adult and pedi masks, nasal canula, O2 wrench present. Main, or
Truck oxygen at 1200. Big ALS bag with sealed drug bag, trauma
tubing, two bags of blood tubes, Moody tubes with IV kits and
solutions, stopcocks and extention sets. Intubation kit; all
bulbs bright white and tight, good supply of tubes and blades,
stylets, End Tidal CO2 detector, 10mL syringe, NG tuges, tape,
laryngoscope handle with spare batteries. In the bus was the
trauma bag, extra bandages, the telemetry unit - not that it ever
worked, the suction, the latex gloves, the OB kits (2), isolation
kits, extra oxygen masks. Packed into the outside compartments
were longboards and shordboards with their straps and collars,
and headblocks. Their personal SCBA gear rode in the compartment
behind the shotgun seat. Light extrication tools lived over the
right rear wheel (Rescue units handled the heavy extrication.)
Lights, siren, two-way radio and Mobile Data Terminal and
finally, fuel: front tank almost full, rear tank three-quarters
empty. It was time for coffee.

Coffee was available in just about every bakery, diner and
deli in the district, but Marcus was even more particular about
his coffee that Lieutenant Grey, the thin, tall, taciturn
lieutenant with steely hair and a steely gaze, was about his.
"If it's not fresh it might as well be yesterday's grounds and
bilge water," Marcus had told Ian their first day together with a
strength of stated opinion so unusual that Ian was struck dumb.
As he got to know Marcus better, he found the strength of his
opinion in this matter even more confouding, because Marcus, that
6'2" teddybear of a man, never expressed much of an opinion about
anything. "I don't know if he has opinions on anything besides
coffee," Frank had later told Ian, "I've been working with him
four and a half years and I've never seen one."

"Yesterday's grounds and bilge water." Marcus repeated. "The
Lord created coffee on the seventh day, and as He brewed and
drank it fresh, on His day of rest, so too should we, in
following His example. The sun riseth and the sun falleth, the
seventh day."

Marcus's opinion that coffee had to be fresh was so strong
that he asked for a fresh pot to be brewed whenever he ordered.
Actually, it was more of a confirmation because all of the delis
and shops in the area knew to put a fresh pot on as soon as they
saw Truck 006 glide to a halt outside their door.

"This isn't fresh," Marcus said in measured tones as he slid
the offending cup back over the counter.

"Yes it is," the astonished counter boy replied, "I brewed
it myself."

"Around ten o'clock? It's now almost eleven."

"Marcus, Marcus, Marcus my friend," the owner came running
up, "I brew a frew pot imidiately. Joseph, you brew a fresh pot
when Mr. Marcus come in, eh? Always a fresh pot for Mr. Marcus."

Joseph skulked off to brew a fresh pot for Mr. Marcus and
his boss, David, sat down to catch his breath. When he had done
so, he keeled over, catching Marcus and Ian unawares as they
browsed the magazine rack.

"Ian," said Marcus as he knelt down beside David, "Why don't
you get the bags while I look after David here. Three-five X-ray," he spoke to his radio as he checked for breathing and a
pulse, "10-36 at 131 Flushing for a syncopal."

"Three-five X-ray 10-36, 131 Flushing for a syncopal."

Ian tossed the bags on the stretcher and returned to the
deli. O2IVMonitor to reveal Mobitz 2 with a ventricular rate of
about 30.

"That just won't do, Ian," he said as he took the pacer pads
and pulled David's shirt back to place them on his chest.
Capture took place at 50 Joules and they ran David at 80 beats
per minute, with a return of consciousness.

"Ow," David cried 80 times per minute. Ian ran in the
Vailum as Marcus applied the 12-lead electrodes. Looking at the
ST-elevations in v1 and v2, he ran a right-sided set as Ian
listented in on David's lungs.

"Clear bilat." Ian said.

"Right sided ST-elevations." said Marcus, "How do you feel,
David?"

"Och, a bit like the no breath. What happened?"

"It looks like you may be having a heart attack." Marcus
told him, "Does anything hurt?"

"No. No hurt, no pain."

"Do you have any allergies?"

"To the strawberries."

"Any disconfort?" Ian asked.

"A pressing in my chest. I swallow?" he asked as Marcus
handed him two aspirin.

"First you want to chew them, then you can swallow."

Ian listened to the sound of the crunching aspirin as wraped
the blood pressure cuff around David's arm. Patients, on
discovering the horrid cherry chalk flavour of the aspirin, had a
tendency to swallow them whole regardless of being told
otherwise. "108 over 72," he announced, "now take this tablet
and put it under your tongue."

"Och. Burning."

"Absolutely normal." Marcus told him. "You might also get a
headache."

"Och."

They transfered David to the stretcher and wheeled him out
to the Truck. Ian grunted under the weight of the antiquated
two-man stretcher, but they loaded David in without incident.
Then Marcus went around front to drive while Ian hopped up behind
with the patient. "How are you feeling now?" he asked as the
Truck got underway.

"Still the pressing."

"Has it changed at all?"

"Not so bad as was before."\par
\tab "Good." Ian took another set of vitals, then called the
hospital to let them know they should expect a probable M, and to
consult on further meds. "He's 94 over 68 after one nitro, down
from 108 over 72. I'd like to titrate MSO4 to mental status or
pain relief."

"You've got an IV?" the doctor asked.

Who did this she think he was? "Yes."

"Alright, start with a half miligram and see where it goes."

"How much can I give if I need to?"

"No more than three miligrams, don't take any steps bigger
than a half miligram."

"Up to three miligrams of Morphine Sulfate at no greater
than a half miligram at a time, allowing time for each does to
have effect. Tirate to mental status first, pain management
second."

"Correct. See you in about six minutes. Trauma three."

One half miligram, pinch push flush, wait thirty seconds and
take another set of vitals. "How do you feel?"

"Still the pressing, but less it is."

Another half miligram, pinch push flush and new vitals and
assesment. A third half miligram, a fourth, and Ian felt the
Truck lurch. Looking out the rear windows he sat the faded red
brick of the Gantry and Shipworkers Medical and Mental Health
Center, the battered but respectable hospital that shared a
parking lot with Station 57, the equally battered but respectable
EMS station to which he and Marcus belonged. As the bus swung
around the driveway to pull up to the ED, Ian glimpsed Lieutenant
Squadron screaming out of the garage in his Caddy, lights and
sirens blazing. The city of New Gotham had provided Lieutenant
Squadron with one of its standard issue Battalion vehicles, a
tweaked GMC Suburban with leater upholstery. It was truly a
beautiful vehicle: fast, indestructible, solid handling, plenty
of cargo space for the oxygen, spineboards and other equipment,
and comfortable as all hell. The suburban sat proudly in bay
two, having been cleaned and waxed once a month by Larry, the
station janitor, who had fallen in love with its smooth, undented
lines; Jonny Squadron's suburban was the only Truck assigned to
station 57 without a dent of some sort. In five and a half years
as a lieutenant, Jonny had never driven it. The rumor was that
he was afraid to. He was afraid he might dent it.

Jonny Squad drove at work what he drove at home, a 1959
Cadilac Miller-Meteor he'd found at auction and carefully
updated, beefing up the brakes and transmission, replacing the
worn engine with a stroked and bored V-12 and supplanting the
Federal Sirenlight with front and rear lightbars, a Wheelen
siren, and highway riser lights. Ian watched the Cadilac list
heavily as Jonny took the corner out of the lot at high speed,
and then the car was gone. Two seconds later, the garage door
finished opening.

Ian turned back to his patient as the Truck lurched again
and came to a halt. A few seconds later, Marcus was opening the
rear doors and helping Ian pull out the stretcher, then they
swung the doors closed and rolled David into the hospital. Even
at a little before eight on a Tuesday, the Gantry was packed.
Patients lay on stretchers in the halls as they awaited
treatment. Doctors cruised from curtain to curtain, room to
room, occasionally looking into the hall to see how many patients
were still waiting. Nurses circulated with IV kits, used
bedpans, and medical records. The portable X-ray machine nosed
through the crowds like a sleepy, beeping, lumbering beast.
Overhead the building gurgled as the pneumatic tube system
delivered blood samples to the lab, blood products to the ED,
medical records to and from archives. "Trauma three," Ian told
Marcus, and as they wheeled David into the room Ian started to
give his report to Doctor Davis.

"This is the patient you called about?" she asked.

"Uh-huh, two miligrams of Morphine, then we arrived. Good
mentation, last vitals 92 over 60, 80 with good capture, 16 and
adequate. Chest pressure now three of ten."

"Okay. David, how are you today . . ."

Marcus tapped Ian on the shoulder, then drifted off to
collect clean sheets and restock the Truck. Ian waited with his
patient and filled out his ACR, finally grabing one of the nurses
long enough to obtain a signature and returning to the Truck and
his coffee, now too cold to consider drinking.

A brown puddle beside Truck 006's driver's door indicated
that Marcus had reached the same conclusion about his own coffee.
He silently waited for Ian to climb in shotgun, then pulled out
of the bay, into the street. The next order of business was
coffee again. Always assuming that they didn't get dispatched to
another call.

GLOSSARY