X-ray Chapter 7, part 12

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Back on the platform, Andy dragged Jeremy up the stairs to the daylight with an iron grip. Marcus sent One-nine Adam and Lieutenant Squadron, who had an inclination to vanish once extrication was complete, with Jeremy and Andy, then hopped in himself with Three-five Carlie and Ian. In the ride to the hospital Ian had Maria pull the ambulance to the side and he decompressed the patient's right chest: clean the site quickly by pouring iodine over it, find the second intercostal space midaxilary, sneak over the third rib with the IV catheter until a rush of air, remove the needle, recheck lung sounds and compliance, and attach a flutter valve.

At the hospital, they dropped their patient off and reconnoitered with Three-three Zebra, while Lieutenant Squadron caught a lift back to his car with Three-five Charlie, the Williamsburg Rocket. The other basic bus was immediately dispatched out for a twisted ankle. The four paramedics sat on the hoods of their ambulances and watched the rain fall together; there was nothing better to do.

[END CHAPTER]

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X-ray Chapter 7, part 11

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Twelve feet away Andy's patient was giving up on his side of the Mets-Yankees debate. Andy squeezed his patient's hand - Marc, it had turned out his name was. This was not the time Andy was interested in winning this debate. "Marc," he called, "Marc."

Halfway between the two patients Rescue Three had completed their cribbing and placed their air bags. You guys wanna pull out?" the fire lieutenant asked.

"Oh," Marcus indicated their patients, "we'll go when they go."

"I'm not leaving without my date." Andy said.

"It's cold." Marc replied.

The whoosh of air and the creak and groan as the car stirred, shifted, and rose. Rescue Three braced and cribbed the car at its new height, then Lieutenant Squadron, the two medic units, and the newly arrived Three-five Charlie and One-Nine Adam pulled both now-unresponsive patients free from the train.

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X-ray Chapter 7, part 10

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Two minutes behind Louis came improved lighting and coffee, courtesy of the MTA engineers. Jeremy reappeared with another cylinder of oxygen and an umbilical cord of IV lies and extension sets that stretched 25 feet over and up to a Liter bag he had tied to a straphanger's pole. In the glare of the halogen light his face shone ashen and drawn. His breath came fast and hard and he fumbled with clumsy fingers. He was hyperventilating.

"Jeremy, you're hyperventilating," Marcus said.

"I'll, I'll be okay."

"Slow your breathing down, Jeremy. Deep breaths."

"I'll, be okay"

"Jeremy- sing, Jeremy," Marcus counseled.

"What?"

"Sing. You can't hyperventilate if you sing."

All Jeremy could come up with was to chant The Four Questions. He started in a low mumble.

"Sing, Jeremy," Marcus admonished him. "Let Andy hear you."

Drew and his patient heard the singing and broke off their baseball debate.

Up on the platform, Lieutenant Squadron looked up from his clipboard.

The MTA engineers crossed the platform and gazed down beneath the train. The train's two conductors followed them.

Jeremy's clear tenor interrupted Rescue Three in their cribbing construction.

The rookie policeman broke off his report to dispatch, then joined in for the last line. In the half silence that followed, Ian though he could make out the hiss of Andy's jazz cassette. Then Andy and his patient reiterated their arguments, Lieutenant Squadron bent over his clipboard, the engineers and conductors returned to their contemplation of lunch, Rescue Three redoubled their building speed, the cop recontacted his dispatcher.

"Rats," Ian said as Jeremy retreated.

"Ian," Marcus scolded.

"No, rats. Rodents. On the Lifepack."

No joke. Ian was closer to the monitor, but his hands were full with ventilating the patient; Marcus couldn't reach the bag valve. But Marcus could reach the prefilled syringes. Streams of lidocaine, then epinephrine shot at the interlopers. They retreated.

The monitor, which was waterproof, started showing PVC's again.

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X-ray Chapter 7, part 9

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Ian and Marcus had their hands full, too. PVC's had started to show up on the monitor. And although Ian had a line, it wasn't going to run because he couldn't raise the bag. Red blood had already started to streak back up the tubing. "Jeremy," he called.

Jeremy stuck his pale head down between the cars like an inverted jack-in-the-box, took in the situation with a quick glance, nodded, and disappeared again.

"Can you reach the lido?" Ian asked. "I think it's time."

"One hundred of lidocaine," Marcus pushed the prefilled syringe.

Ian squeezed the bag to flush the line. He reached for a pulse and wondered what he would do if he couldn't find one. "One hundred," he announced. "PVCs perfusing." Things could be worse.

Ian looked up when he heard the music. He had heard the exchange between Andy and the cop, but had already forgotten it. Louis Armstrong was drifting heartily beneath the train. "Thank you!" Andy shouted up to the unseen police officer. "I don't see why we can't be civilized just because we're under a subway train."

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X-ray Chapter 7, part 8

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Ian, another twelve feet further under the train with the second patient, grinned quietly as he struggled with the laryngoscope. "I'm in," he told Marcus, inflating the balloon and attatching the bag valve.

Marcus listened to the patient's lungs with his stethoscope. "Equal," he said a moment later.

Ian secured his tube, noted the lip line at 22, and slipped an OPA in beside it. Marcus tapped an ETCO2 detector across the patient's chest, but Ian shook his head. "I don't think I can fit it without kinking the tube. What's the oxygen at?"

Marcus glanced at the regulator. "About 900."

Ian glanced at the monitor, still sinus, then his watch. Ten minutes they'd been here already.

Andy was also facing problems with his patient, though of a different nature. He was alone with his patient because he had learned almost too late that Jeremy was claustrophobic. "Your knuckles are white, Jer," he told him, "Jer, you're crushing, Jer - Jer!"

"I'm fine. Fine, I'm fine."

"You're claustrophobic."

"No I'm not."

"What do you mean you aren't. Go away, away!" he pulled a liter of saline from his ALS bag and threw it at Jeremy, who retreated a few feet but sat there, looking uncertain.

"Go." Andy said. "Go." He chased Jeremy from under the train, "Go. And don't come back. Sorry about that," he said to his patient, "What were we talking about?"

The jaywalking laws. Which led to traffic, busses, back to the subway. Oops.

"I don't want to die." Andy's patient said. This was definitely a problem.

"I won't let you die," Andy said. "I will not let you die."

"I'm cold."

"We're lying on wet cement beneath a subway. It's normal to be cold. You think I'm not cold?" he smiled.

His patient smiled, too, then shivered once. Andy reached out to the one hand he could see and took it.

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X-ray Chapter 7, part 7

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* * *

The two days off passed in a blur. Ian returned to work with the feeling that if Sam hadn't been in there would have been open battle. He leaned his forehead against the glass of the driver's door and closed his eyes to block out his headache. Then he opened the door and climbed in.

Marcus had the paper spread open on the dashboard. Almost all of the dashboard - certainly more than just his half of it. Ian pulled his door shut and started the ambulance.

On the way down to coffee Ian opened his window for fresh air. Marcus would soon be after him to close it or shut of the A/C; Marcus would have to deal. Ian turned the stereo on, flipped through the presets, turned it off. He pulled back the wiper-washer lever and cleaned the windshield. He pushed in the cigarette lighter and power locked the doors. The clock on the dashboard was a minute slow; Ian reset it.

Traffic was at a near standstill due to utility work at the intersection. Ian fought off the urge to lean on the horn, and turned on the stereo instead, tuning in to a weather report. He drummed his hands on the steering wheel.

It would have taken a far less observant man than Marcus to not have picked up on Ian's mood. Marcus quietly reassembled and folded his newspaper, holding it in both hands and looking complacently out of the windshield.

Ian breathed in and out deeply a few times then shook his head as if clearing cobwebs. "Supposed to be nice all week," he commented on the weather broadcast.

"That's what they say," Marcus replied. Traffic inched forward. What Ian wouldn't give for a Diff Breather now. Anything to turn on the lights and siren and hop onto the sidewalk. The radio and MDT, however, remained stubbornly silent.

Overhead a pigeon circled, landing on the sidewalk beside the ambulance. Ian considered the bird, losing himself in the complexities of its shading, the way its feathers flashed pink and green in the sunlight, the fact that it absolutely had to bob its head to walk. How had they figured that out, he wondered, picturing a scientist squatting over a pigeon, holding its body and neck in rigid formation. No, that wouldn't work, he reasoned, the pigeon would peck at him. Perhaps a neck and body cast? Perhaps a Stiff-neck C-collar? He smiled.

Traffic had pulled up a car length or two, so Ian released the brake and let the bus roll forward. "Anything in the paper?" he asked Marcus.

"Oh, the usual. Now the mayor's cracking down on jaywalkers."

"Really? This is New Gotham. Who does he think he is?"

"He thinks he's the mayor."

Finally, the corner. Ian twisted the steering around until it hissed, slipping the bus onto the cross street and bumping one of the rear wheels over the curb. Somewhere he had read that some off road vehicles had artificial horizons on their dashboards. He wondered what it would cost to install one in the bus.

They took their time climbing out of the ambulance, but eventually made it into the deli. "Mister Marcus, your coffee," Abraham called as they walked in. "Fresh and hot, not milk."

"You look good, Abraham," Marcus replied.

"Not my time yet it was, not yet, but one of these days. Come to it we all do," he handed the coffee across the counter, "Every one, yes."

"I don't think it's your time yet, Abraham. And consider Elijah."

"A chariot of fire, yes, but only he proves the rule. With milk?" he asked Ian.

"Please," Ian answered, not wanting to be rude and still being in too much of a mood to be able to politely decline.

"Here, for you," Abraham handed the cup across.

They paid, they insisted, and Ian bought a newspaper off the rack, then they turned to go. "The Lord bless you and keep you," Marcus called from the door.

"The same may he do for you," Abraham called back. "The same may he do for you."

Outside, the earlier half mist had grown into a thin, drifting rain, the type Erin had called an Irish rain. "He looks good," Ian called across the bus's hood as they unlocked their doors.

Inside Marcus set his coffee on the console to buckle his seatbelt. "He does. The doctors told him very little damage. They t-PA'd him within five minutes of our arrival."

"Wow."

Ian found jazz comforting, as a general rule, and once they were parked again, he dialed up the jazz station on the stereo, flipped through the paper to the crossword, and leaned back into his seat. Andy found jazz comforting, too, and held to the philosophy that if he was going to be stuck somewhere he might as well have it to accompany him. "What do you mean, you can't get jazz down here?" he asked the pale-faced police officer who had climbed down below the R train to reach him and deliver his message. "Get me jazz."

The officer, a rookie, didn't know how to reply. "Get me a CD player, a tape player, I don't care. Jazz. Not blues," he cautioned as the officer crawled backwards from under the subway car, "jazz." He turned back to his patient in mock exasperation, "Some people."

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X-ray Chapter 7, part 6

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Ian slept. He dreamed. He awoke. It was still raining. The radio was crackling: "Woman Acting Strange."

A note stuck to the steering wheel said that Erin had gone ahead with the Williamsburg Rocket, Three-five Charlie. Ian climbed over the console, catching his stethoscope on the radio mic., and slid into the driver's seat, fumbling for the ignition keys as he did so. The engine wouldn't start. He cranked, and cranked, and cranked until it caught, hesitated, and settled into a stumbling rumble. Ian shifted into gear and turned the wheel, shocked at the resistance he met. The power steering was on vacation. Once he had wrenched the wheel sufficiently around, he tried to pull out.

But the bus was stuck in the mud. Deep mud, Ian learned, promptly sinking to his ankles as he climbed down from the driver's seat. The rear wheels were buried to the rims, on both sides, it turned out. He threw his weight against the back of the bus and pushed.

All of the bags were still in the bus because Erin hadn't taken them. All she had was Three-five Charlie's oxygen and their HeartStart. "Ian," she called on the radio, "Ian, Ian."

Ian jumped as he felt a hand on his shoulder, and he opened his eyes. "Ian, the shift is over," Erin told him, "It's time to go home."

Ian had slept through the ride back to the station. Sara was waiting for him, leaning against the cab of her navy blue truck; Ian's car was in for an oil change and she had dropped him off to work. Ian pulled his bags from the bus and handed off his narcotics in the station office. In the locker room he changed quickly, then met Sara in the parking lot, tossed his bags in the back seat of her Yukon and climbed in shotgun. He reclined the seat, breathed in and out a few times, and settled down for the ride to the airport, where they were picking up Sam. "Never take it home," he told himself, shrinking from Sara's touch as she placed her hand over his.

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X-ray Chapter 7, part 5

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Ian drove while Erin sat in the back and completed her SAMPLE history. At the hospital she gave the report, then, "She has a full bottle of Prednisone filled two weeks ago next to a half full one filled a month and a half ago. Toast was buring in the toaster when we arrived, the smoke detector didn't go off, and it took her close to five minutes to find the coat closet when we went to leave. Lives alone, apparently a son drops by to deliver meds, including an OTC epi inhaler. I've had her three or four times since New Year's."

"I'll tell the social worker," Anne signed the run report

"That's all in the report. Thanks," she said as Anne handed back the report. Erin left behind the pink hospital copy and joined Ian in the Truck.

"I didn't offend you giving the report?"

"No. You knew her."

"Laura always flips if I get involved with patient care when its her day to tech. Ready for lunch?"

"Yeah." Ian punched up their numbers from the MDT and filled in the rest of the ACR, but his thoughts drifted back to the essence of the call. Erin had done a good job of trying to lay it all out in the report. A nursing home would just add to her confusion, but clearly she was no longer able to take care of herself. "You haven't seen any live in care around here, have you?" he asked Erin.

Erin paused to squeeze past a double parked 18-wheeler before answering. "Live in care? No. Not unless its a family member. Mrs Leonardowitz . . ." she trailed off. "They're closed."

Closed for good. The Top Hill Diner sat cold and empty with two new signs posted next to the advertised specials. "Death in Family," one read, "Closing our Doors." "For Rent," read the other, with a local phone number.

"Not even a thank you for years of customer support," Ian was suddenly very angry. He hadn't realised how much he had wanted his number two special until it was denied him. They crisped their bacon without shrivelling it. Done right every time. "Why can't one thing go right today? Why can't we just get a decent two egg special with toast, home fries, and bacon? For Chris' sake, it's not that complicated," he tossed the clipboard onto the dash. "Let's see what else is open," he said tiredly. Then he closed his eyes and fell asleep.

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X-Ray vignette

The tall, pillared nave of the stone cathedral was filled with the moving sound of Bach’s “Saint Mathew Passion.” The singers, 20 or so of the congregations oldest members, plus two younger members, understood the true nature of the piece, having practiced all year, and most of their audience sat in rapt admiration of the beauty of their singing.

In the middle aisle, however, rather closer to the front of the nave than to its back, a small group of people was not paying attention. One of them was a young woman, very beautiful but clinically dead. Two were EMTs, vigorously performing CPR to revive the young woman, and two more were paramedics, who struggled feverishly to provide the young woman with an airway by fitting a tube into her trachea.

X-ray vignette 4 - Blowfish

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Down at the Gantry the ambulance bay was full, so Frank parked by
the station's diesel pump. He and Ian draped a blanket over Mrs.
Leonardowitz and hurried her through the downpour to the
hospital.

Inside, patients were backed up into the hallway. Ian
watched a full code unfold in one of the Trauma rooms, and a
housekeeping worker clean the last of a pool of vomit from below
a stretcher in the hallway. Maintenance personal struggled with
the innards of a pneumatic tube station. Nurses, techs, doctors
circulated in a chaotic ballet, while patients and family
wandered like lost sheep. The portable X-ray machine drifted
through, a blind, lumbering beast.

The worst, however, was the patient in curtain twelve.
"Doctor!" he called, "Doctor," he paused, "Doctor!" again and
again, over and over. "Doctor! Doctor! Doctor!"

Ian peeked in the curtain. Patient Twelve stared straight
out into space, "Doctor! Doctor! Doctor!" He was dressed in a
hospital gown, and a thin plastic IV line snaked down from a half
empty bag, curling around and into his left A/C. "Doctor!
Doctor! Doctor!"

Ian considered for a moment. The man's face was entirely
neutral, and he took no notice of Ian's entrance. His skin was
normal, and he was in no distress, but "Doctor! Doctor!
Doctor!" at somewhere between a drone and a yell.

"Blowfish!" Ian suddenly said to the patient, and waited to
see if he had any effect.

"Blowfish!" Patient Twelve said, "Blowfish! Blowfish!
Blowfish!"

Ian stepped back from behind the curtain and traded a covert
glance with Frank. "I guess that's an improvement," Frank said.

Four patients were still in front of them at the triage
desk, and two more had been brought in by EMS while Ian was in
with Patient Twelve. Another patient had walked in alone. Nurse
Dunbar caught Ian's eye as she whisked by with an IV kit. "Have
you been playing with my patient on Table Twelve?" she asked.

"No, Ma'am," said Frank. Ian just smiled blankly.
"Blowfish! Blowfish! Blowfish!" said Patient Twelve. Nurse
Dunbar disappeared into curtain ten.

"You're busy for a Sunday morning," Ian said to Kathy when
she finally had two seconds to take his report.

"Is it Sunday?" Kathy asked.

"Blowfish! Blowfish! Blowfish!"

"Mrs. Leonardowitz is an eighty-seven-"

"I know Mrs. Leonardowitz," Kathy looked up. "Gloria, what
happened? Did you forget your medications again?" Mrs.
Leonardowitz blushed and Kathy continued, "You gave her a neb?"

"Two," Ian confirmed, "Plus Solu-Medrol."

"Mag?"

"There was some reason we didn't give it last time," Frank
broke in, "I don't remember what, but we decided to hold off.
She's doing better without it."

"Blowfish! Blowfish! Blowfish!"

Kathy nodded and leaned over the desk to sign their report.
"Put her in the bed over by the sink," she said.\par
\tab "No room at the inn." Frank remarked dryly as they slid Mrs.
Leonardowitz over and stripped their cot. "That guy doesn't shut
up. Kathy, what's with the patient on table twelve?"

Kathy rolled her eyes but said nothing as she took a quick
set of vitals on Mrs. Leonardowitz. Ian tore off the hospital
portion of their report and left it on the desk. "Blowfish!
Blowfish! Blowfish!"

Frank sprayed down the stretcher while Ian found new sheets,
once the cot was made they rolled out toward the ambulance bay.
"Ihh," Frank shivered, "that guy's driving me crazy.

Ian stopped just outside the curtain for a moment. "I'm
headin' out to the bus," Frank told him, continuing with the
stretcher out toward the bay. Ian nodded and stepped back behind
Patient Twelve's curtain.

"Blowfish! Blowfish! Blowfish!" said Patient Twelve, as
oblivious to Ian's enterance as before. "Blowfish! Blowfish!
Blowfish!"

Ian stepped over to the patient's right ear and softly spoke
into it. "Sssschhhhwwwuff," he said, pausing to hear the result.
Good, but not perfect, he decided. He had to make a few minor
modifications to Patient Twelve's new soundtrack before he was
satisfied with the result.

He caught Amy in the middle of a smirk when he walked out
from the curtain. "Having fun?" she asked.

When he and Frank returned to the Gantry a few hours later
the pace had slowed, but Patient Twelve was still there, and no
one had yet improved on Ian's handiwork. "Sssschhhhwwwwfff,"
Patient Twelve said, "Sssschhhhwwwwfff. Sssschhhhwwwwfff." Mrs.
Leonardowitz, on the other hand, was no longer parked near the
sink. Checking the dry erase board, Ian saw that she was no
longer listed in the department.

"What happened to Mrs. Leonardowitz?" he asked Amy after he
gave his report.

"Gloria? Was she here? Kathy M. must have had her, she's
at lunch."

Anne and a medic Ian didn't know walked in with a patient
and rolled up to the desk. "What, your noise machine is still
here?" she nodded toward curtain twelve.

"Yeah," Amy said, "psyche's running slow today. Somebody
set him on ocean waves, though, so it's kind of relaxing."

Ian nodded a greeting to Anne and remade his stretcher.
"You stopping in at Flanagan's today?" he asked.

Anne nodded at Ian as she gave her report, and Ian rolled
his stretcher out to the bus.

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X-ray vignette 3 - the delivery truck

[again, raw and unedited. Truck = bus]

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"Five bucks on Difficulty Breathing.

"Ten on Pedestrian Struck."

Ian looked at Marcus quizically, then in shock as the
dispatch flashed up on the screen. Back up Three-one Boy for a
Pedestrian Struck.

Traffic was backed up for a block and a half approaching the
scene, so Marcus grabbed the ALS bag and the monitor and
proceeded on foot, leaving Ian to bring the Truck through as best
he could. Ian watched his bobbing form thread through the
stopped cars for a moment, then returned to the gridlock before
him. Solid cars up this block and an 18 wheeler stopped at the
intersection. It was impossible to tell what lay beyond it. On
the left, an unbroken row of parked cars; half a space up on the
right there was an open parking place, but a delivery van was
pareked on the right sidewalk near the corner. Traffic behind
the Truck was already three cars deep.

Marcus would have to take Three-one Boy's Truck. If he
needed Ian, he could sentd one of the Basics back to look after
X-ray's Truck and Ian could run up to the accident on foot.
"Three-five X-ray tech," he called on the radio.

"Go ahead," came Marcus's voice.

"You'll have to take Three-one Boy's Truck. We're blocked
in."

"Two patients. Need that Truck."

Ian acknowledged and checked his mirrors again. Five cars
now sat behind him. Clearly, the delivery van would have to go.

Ian laid on his horn and a low "waaap!" escaped the Truck.
Traffic nudged forward uneasily, herded by repeated blasts of the
horn. When Ian reached the open parking place, he squeezed
through and onto the curb.

The delivery van took less in the way of horn, more in hte
way of just-do-it. When 15 seconds of air horn produced no
driver or movement Ian jumped from his Truck and ran to the
driver's door of the idling van. With an absurd feeling of pride
he snapped off the radio antenna and used it to smash the window,
then opened the door and climbed in.

Only the Fire Department ever gets to break windows, he
thought, maybe I should change careers. He deposited the van in
a Bus stop half way up the block and retreived his Truck, pulling
up to Marcus a few minutes later.

Clearly, this accident was a cluster. Two State Troopers,
State Troopers, stood over Marcus and half of Three-one Boy, one
holding an oversized umbrella, the other two Maglites. Another
Trooper was helping two firefighters roll a rumpled squad car
away from the victim. Engine 157 stood by with a stretcher and
held IV bags. New Gotham Police interviewed witnesses and
maintained crown control.

"Three-three Zebra took the other patient," Marcus
explained. He nodded to the crumpled body on the pavement,
"Bicyclist struck, thrown ten feet into this parked van,
depressed skull frac, pelvic frac, intubated, clear and equal,
pulse 120, 96 over 72 up to 116 over 84 with one liter of saline,
unilaterally blown pupil. Three-one Boy is blocked in. Is
anybody not ready?" he asked the collection of people preparing
to log roll the patient onto a spineboard, "One, two, three."

Marcus, half of Three-one Boy, and FDNG loaded the patient
onto Three-One Boy's stretcher while Ian pulled X-ray's stretcher
out and abandoned it on the pavement. As he helped load the
patient into the Truck he suddenly burst out laughing. Marcus
shot him a look but Ian shook his head, "Later."

Oxygen. Hyper ventillation. N.S. wide open. Mannitol.
Call ahead to the hospitl, and lights and sirens to New Gotham
Trauma Center, with State Police close behind. Doctor Koffi met
them at he door, read their eyes. "OR 3," he drawled, following
them into the elevator. He got hte history on the way up and
disappeared with the patient and his staff when the elevator
doors opened onto the operating ward. Marcus, Ian, and the half
of Three-one Boy watched them recede down the hallway with their
former patient, the sound of the stretcher wheels ringing loudly
in their ears.

Station 13 shared a parking lot with the hospital. The
three angels trooped over for a replacement stretcher and marked
their old stretcher at the hospital OR. Already Ian could feel
the tentacles of the post-call blues.

The State Plice followed Three-Five X-ray to New Gotham Trauma
because their car had hit the bicyclist while going lights and
sirens. Witnesses described in confused but vivid detail how the
police car had sped down the steet at 20, 50, 40 miles per hour,
almost missing the bicyclist, hitting him squaely on the front
wheel, the rear wheel, the side, as he tried to turn away, as he
tried to lay the bike down. The bicyclist was run over, was
thrown into a moving, a parked van, a lamp post. He screamed, he
was silent, you couldn't mistake it, he uttered the Lord's
Prayer. they all agreed that the bicyclist had run a ed light,
except for thosewho knew it was green. "I remember it
distictly," one woman told the police, "the signal wasn;t working
at all." The trooped couldn't recall clearly but thought he had
the right of way. He did have his lights and siren on, or at
least he did when his car came to a rest over the victim.

In the end it turned out that the bicyclist had a helmet cam
on, transmitted live to the web. Hundreds of viewers watched,
enthralled, as they ran the red ligth, caught a flash of grille,
and cartwheeled, landing heavily on hte pavement with an audible
'crack'. The transmission was so clear that they could read the
badge number of the horrified trooper as he knelt over the dying
bicyclist and called for an ambulance. At sony, phones rang off
the hook with orders for that model of camera, which had been
diuscontinued last spring for poor sales.

Back in the Truck, Ian watched life pass him by as he and
Marcus idledat their corner. Trucks, busses, an occaisional
gypsy cab drifted by, hissing on the wet pavement. Overhead the
el rumbled and squeaked. A police car drove by, weaving and
struggling past the mid morning traffic, squaking its siren
relentlessly, fruitlessly. The wipers swished across Ian's
vision and fell silent again.

In the shotgun seat Marcus had already fallen asleep, his
head back, his mouth open. Jazz played softly on the stereo. In
the Operating room, Ian knew, a struggle against death was
unfolding for his patient. A fruitless struggle. Ian folded his
newspaper ans composed himself for sleep. Just before it came, a
small smile appeared on his lips. In retrospect, the door to the
delivery van had been unlocked.

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X-ray vignette 2 - coffee should be fresh

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

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"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

X-ray vignette

GLOSSARY

SPOILER ALERT: depressing material follows

006 was old. It was a pre-merger bus that had seen an
incredible seven births and more deaths than anyone could
renmember. Iw was on its fourth transmission. Through its
fourth transmission. Motor Pool wasn't interested in discussions
of a fifth.

006 sat forlornly at Station 57's diesel island, marrooned,
as it were, with a full tank and no motivation. Frank and Ian
pulled their bags from its cabinets, crossing the wet pavement to
bus 439 and tossing the bags in there. Then they stood quietly
before 006, Frank gave a tire one last respectful kick, and they
climbed into 439. When they returned three hours later to bring
a patient to the Gantry, 006 was gone.

Motor Pool had a parking lot buried in far Queens for
retired busses. On the official city register the lot was
designated "Lot M," but Motor Pool called it the Decommision
Yard, a field of rumpled blacktop with a growning fleet of worn
out ambulances that leaned against each other for support, huddled
close for warmth. Together they watched the sunrises in the
east, unless they faced the other way, in which case they waited
for the sunsets in the west.

Row after rown of empty widshields gazed at the leaden sky,
waiting to donate doors, alternators, wheels to their brethren
still in service before they quietly rusted away. 006 was
dropped off unceremoniously by a flatbed wrecker beside the
crumpled wreck of 216, victim of a city transit bus. The wrecker clanked
off and the seagulls returned.

When Ian wanted to be depressed, this was where he went.
There was a gaurd shack near the locked gate, but Ian had never
seen itused, so he ignored it. He ducked through the fence at
the usual cut in the chain link, stepping into the ambulance
graveyard.

Ian had tried to count the busses at one time, but had given
up. He wandered through the rows, pausing from time to time,
running his eyes over the faded fenders, trying to imagine what
each of the busses had seen in their lives, trying to guess what
illness or injury had finally claimed them.

Stains littered the pavement: coolant, brake fluid, oil. A
pink puddle grew slowly grew beneath 006. Three busses over a
fresh graphiti tag gleamed on another bus's box. Ian considered it,
trying to decide what he felt about it as he walked over and
stood before it. Black spray had run down from the tag, dripping
over the stripes, into the HHC legend. Ian crossed his arms over
his chest.

When he looked up again the filtered light had started to
redden. He turned from the desecrated ambulance and started to walk
away, bending over suddenly to vomit, staggering over to a 006
to kneel before it and rest his head on its bumper. The cool
metal was comforting.

Breathe, he decided. In, out. In. And out. The heavy
twisting in his stomach slowly receded.

* * *Ian woke up with a stiff neck and stiff knees. He sat silently
for a few minutes before painfully rising and tracking back
through the lot to the cut in the fence. He slipped through,
found his car, and drove away.

GLOSSARY

X-ray Chapter 7, part 3.5

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GLOSSARY

NOTE: this fits between Ch 7 parts three and four.

"I thought we were really in the barrel over that one," Jill said as they walked into Flanagan's. "Do you think he bought it?"

Jim shrugged. "He let us go, right?"

"But what if he looks at the PCR?"

"So what?" said Frank, steering toward the table where Andy was already sitting with two half-empty bottles. "The code happened, right?"

"You guys had a code?" Andy asked as everyone sat down.

"Yeah," Ian said. "Some guy collapsed in his pot garden."

"Lieutenant XXXX was pissed." Jill said. "I don't know, I think he'll figure it out. He could fire us. I don't know how I'll make my car payments. Or my rent."

"You had the giggles earlier, didn't you," Andy asked Jill. "You're high."

"Yeah," JIll said suspiciously.

"And now you're paranoid." Andy said. "Always the same. You'll get over it; you always do. Here's the waitress."

They placed there orders, and after further discussion on the merits and demerits of marijuana, their drinks arrived, breaking the flow of the discussion. "Did I tell you what Lonnie did yesterday?" Jeremy asked as the waitress departed.

"I don't wanna know," Frank said.

"Thirty six year old female calls, chest pain. AOS she has a box of tissues in one hand and a bottle of Excedrin in the other, wincing in pain, breathing rapid and shallow. Four days of cough, runny nose and headache, green phlegm. She says she was coughing and felt a pop, now her right side hurts whenever she breaths or moves. Lonnie listens to her lungs. He starts an IV, a line, puts her on the monitor and walks her down the stairs. She's crying in pain. We get her to the Truck, I go around to drive.

"We get to the hospital, Lonnie's giving the report, 'she was tachycardic so I gave her six of Adenosine-'"

"Adenosine!" Frank cried, knocking over his bottle as he did so. "Fuck. Can I get another? he called over to their waitress.

"Party foul!" said Jill.

"You seem to have recovered," Andy said to her as he passed Frank a napkin.

"'Adenosine,'" Jeremy continued, "'then twelve with no relief. I was gonna give her Cardizem but we pulled up.'"

"OhmiGod," Andy put down his bottle.

"Adenosine," Jeremy repeated. "And my name is on that report."

"Did you say anything?" Andy asked.

"'Hey, I don't tell you what to do with your patient.' You've worked with Lonnie."

"Yeah, but your name's on that report," Andy said.

"I know."

"One of these days that schmuck is gonna kill someone," Frank offered as he continued to dab at his uniform with a napkin. "Hopefully it'll be himself."

"Yeah, well," Jeremy replied.

"You don't like him any more than I do." Frank resigned himself to a wet uniform and tossed his wet napkin on the table. "Anyone want something to eat?"

"Oh, yeah," said Jill, "Buffalo wings. They have wings, right?"

Frank collected orders from everyone else, then stood up to intercept their waitress. "She says five minutes on the food," he reported on his return

Jeremy glanced at his watch. "Five bucks it takes longer."

"Okay," Andy took him up. "Five bucks it takes less," he put his watch on the table.

The food came in exactly five minutes, cancelling the bet. "Did I bring the wrong food?" the waitress asked, "What's wrong?"

"Nothin'," Frank answered. "Poppers go here. And can you take some of these bottles away?"

On the TV the Yanks battled it out with the Red Sox. "Son of a bitch," Andy cried as he watched the ball fly over the outfield wall. "I got twenty bucks on this game."

"So do I," Jeremy said, "Let the ball go."

Conversation moved to last night's rain delay, the weather, flooding on Jeremy's street, an anecdote of a white water rafting trip Andy had been on where his raft had become separated from the group.

"Did you ever find them again?" Frank asked.

"Yeah, they waited for us at the take-out. We all hopped into the bus and they were all dry. We were still soaked."

"Sounds like a day at work." Jeremy said.

"We weren't in full uniform. We could peel layers off. The windows on the bus did fog a bit, though."

"You know I tried that anti-fog stuff for the windows," Frank said. "The stuff costs eighteen dollars a bottle, and you have to redo it every week."

"Which one did you use?" Jeremy asked.

"They're all the same."

"We tried a few of them." Andy indicated himself and Jeremy.

"Some of them worked better than others but none of them were great," Jeremy agreed. "None of them got rid of the sauna feel."

Frank grumbled an incoherent reply. Ian looked up from his beer, "Nothing's better for what ails you than sitting around in a sauna in full uniform." he said.

The evening ended with Andy twenty bucks poorer, Jeremy twenty bucks richer, and the usual wreckage of plates and bottles on the table. Two ashtrays sat full of cigarette butts. Ian tossed his cash into the communal pile and walked out alone, opening his window in spite of the rain to unsuccessfully try to clear some of the encroaching fog.

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GLOSSARY

X-ray Chapter 7, part 4

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GLOSSARY

35 X-Ray's post was down the block from the charred hulk of the old Naragansett Brewery. Within reasonable reach were the bodega, which opened at 6, a pawn shop, a newspaper stand, a trash can, the fire hydrant, and a host of empty store-fronts. Within questionable distance were a market and a check-cashing place. Police precinct 20's station house was available for a water fountain and burnt coffee if you expanded the idea of a corner to include a three block radius. 35 X-Ray often did, especially on Tour One, when everything else was closed. Further, the street in front of Precinct 20 was lit, so you could see people before they knocked on your window.

"Do you know where the subway is?" a young woman yelled through the window glass.

"Just down the block." Erin yelled back, pointing toward the monstrous steel structure that stretched over the street. "How'd you get mandated for Tour One, " she asked Ian, "Don't you usually work Tour Two?"

"I swapped with Frain for Tour Three last night. Then I got mandated."

"Are you on today?"

"No. Two days off," he crossed off another clue on his crossword puzzle. "Five letter word for sharp?"

"Quick?" Erin said after a moment's thought.

Ian pencilled the word in. Sara's brother is in town, we're going to see a movie."

"Why are you doing that? You can see a movie anywhere."

"He wants to see that ambulance movie, Taking Care of the Dead, or something like that, so he's taking us out."

"That's nice of him."

"He says he wants to see it with a 'real-life ambulance driver.'"

"Ick."

"Yeah, well.... Five letter word for bouyant?"

"Float?"

"Third letter is a p."

Happy, it turned out. As Ian slowly worked his way through the puzzle, the conversation turned to family, anniversaries, When Harry Met Sally, the staggering price of movie tickets (Ten dollars!), and, just as the MDT beeped for a diff breather, back to Sara's brother.

"Sara's worried about him, I guess he isn't doing to well so she invited him up. You're clear on the right after this green car. Means no sex for me, though."

"Sara won't when he's around?"

"As if he doesn't know. He's an eighteen year old boy, of course he knows."

"She's his sister."

"She's my girlfriend." Ian knew he had no enforceable rights per se, but if he was going to lose in practice he was damned if he was going to lose in theory, too. Besides, he knew he was right. If only he could convince Erin.

"Why are you trying to convince me?" Erin asked as she switched off the siren and brought the ambulance to a halt. Outside of the ambulance, as they grabbed their bags, she said, "I think I know this lady. She's very nice but she's got Alzheimer's or something. She keeps forgetting her meds."

That wasn't all she'd forgotten. The smell of burned metal greeted them as a bent old woman in a nightgown answered the door. Its source was a burning kettle, boiled dry and now starting to warp, Ian discovered when he tracked the smell to the kitchen. He turned off the stove and moved the kettle to another burner.

"Oh, I must have, forgotten that," the woman said. "Silly old me." She broke into a paroxysm of coughing.

"Mrs Leonardowitz, how are you doing today?" Erin asked.

"I, have this cough. The boy down the hall, called you for me, I couldn't, he, I couldn't find my glasses, for the phone."

After a quick history and a physical exam, remarkable for wheezy lungs and the usual signs of mild respiratory distress, they assembled a nebulizer and filled it with albuterol. Once they hooked it up to oxygen, medicated vapor started to drift from its tubelike reservoir. "You remember the peace pipe, right, Mrs Leonardowitz?" Erin asked.

"Oh, yes," said the patient, accepting the nebulizer from Ian and placing it in her mouth

"Good. Breathe it in. Have you been taking your prednisone? Your breathing medication?"

"Prednisone? I don't have any prednisone."

But in the bathroom, Ian found a full bottle of 30 prednisone tablets, dated two weeks ago. A half-empty bottle stood beside it. He also found an over-the-counter epinephrine inhaler, which was empty.

"Mrs Leonardowitz, you shouldn't use that inhaler. It's bad for your heart. You have a prescription inhaler, remember?" Erin said. "Your lungs sound better, but I think you should come to the hospital with us. Do you have a coat and hat?"

She did. Finding them took several minutes as she stepped into first one room, then another in search of it. Ian glanced at Erin and saw sadness, or perhaps just weariness etched into her face for a moment before she caught his gaze and weakly smiled.

Mrs Leonardowitz found her coat. They sat her on the stair chair and buckled her in to carry her down stairs to the ambulance. "Where are you taking me?" she asked. Where, indeed.

First Post|Previous|Next
GLOSSARY

Glossary

This is a work in progress. If something's missing, leave me a comment - B

AGLET: the plastic or metal tip of a shoelace.

AC: AnteCubital fossa - the inside corner of the elbow, where several veins are close to the surface and, hence, a common place to take blood or insert an IV line.

BAR: (Nautical) a shallow area across part or all of the mouth of a harbor, estuary, etc.

BINNACLE: a stand for a ship’s or other vessel’s compass, located on the quarterdeck, and often provided with a light.

BLUE FLAG: (Railroad): A blue flag attached to a locomotive, rail car, or similar, indicating that the locomotive, etc, is not to be moved or coupled to. Blue flags are typically applied to equipment that is being serviced, where moving or coupling to the equipment could result in injury or death to a worker, or damage to the equipment. For safety reasons, once a blue flag is applied, it may only be removed by the person who applied it. To blue flag a piece of equipment is to apply such a flag.

BLUE PETER: (Nautical): a square blue flag with a white square at its center, indicating the letter p. Used alone, the blue peter is the symbol of imminent departure, used to recall members of the crew prior to sailing.

BOARDING AXE: a flat-topped axe with a spike (or pick) protruding from the back of its head.

BOLT ROPE (also, boltrope): a rope that is sewn into the edge of a sail, to provide strength to the sail. (added 7 April 2015)

BREECH
* the buttocks. (added 6 Feb 2010)
* the closed end of a gun, opposite the muzzle. (added 6 Feb 2010)

BUS: an unofficial term for an ambulance, only considered acceptable in some regions, such as the New York City and New Gotham areas.

CARRONADE: essentially a cannon with a shorter barrel. The short barrel meant that the carronade was lighter than a cannon firing the same size shot, and could therefore be handled by fewer sailors. Alternately, larger caliber carronades could be used. On the downside, the shorter barrel meant that the carronade was less accurate (and less precise) than a cannon. The short barrel also meant that fire leaving the carronade's muzzle was close to the hull, creating a potential fire hazard.

In practice, a vessel could be equipped with cannon, enabling it to accurately fire smaller shot from a distance; carronades, enabling it to fire larger, more powerful shot, but only at short range; or a combination of the two.

CHASER: (Nautical) a cannon or other large gun mounted to fire forward or backward. A stern chaser is mounted in the stern, and fires behind the ship, while a bow chaser is mounted in the bow to fire forward. The curvature of the bow and the presence of the bowsprit forced bow chasers to fire slightly to port or starboard, rather than exactly straight ahead.(added 25 Feb 2010)

COUNTER: the rear face of a ship's or other vessel’s stern.

COURSE a square sail on, or meant to be hoisted on, a lower MAST. Courses were further named based on the mast they belonged to, with the fore course on the fore mast, the main course on the main mast, etc. (added 25 Feb 2010)

CYLINDER-TOP DESK: similar to the roll-top desk (which it predates), the cylinder-top desk features a writing surface backed by a series of pigeon holes or drawers. A curved panel can be rotated down from the top of the desk to conceal the writing surface and pigeon holes/drawers.

DARK LANTERN: (19th Century) a lantern designed to shine in a single direction, with a shutter to regulate the amount of light shed. With the shutter entirely closed, the lantern sheds no light whatsoever.

DEFIBRILLATE/DEFIBRILLATOR: pending - for the moment I'm going to defer to Wikipedia on this one.

DONKEY: short form of DONKEY ENGINE

DONKEY ENGINE: a stationary engine used for lifting or pulling loads, but not for propulsion.

ENDOTRACHEAL TUBE: a tube inserted through the mouth, into the throat, and through the vocal cords to provide an airway for a patient. An inflatable cuff at the far end holds the tube in place and prevents anything from sliding past the tube (e.g. prevents saliva from entering the lungs).

ET TUBE: an ENDOTRACHEAL TUBE.

FIREBOX (also, fire box): (Steam power): the part of the boiler in which the fire burns. (added 26 Feb 2010)

FIRE ENGINE: a piece of fire apparatus equipped to pull water from a hydrant, lake, or other source, and pump it into hoses for use in fire suppression: a pumper. Sometimes shortened to engine. Compare FIRE TRUCK

FIREMAN:
* Naval Artillery, 19th Cent.: a sailor whose job is to put out any fire arising from the guns use, as from errant sparks lighting in the rigging.
* Steam power: someone whose job is to feed fuel to a boiler, and (for wood and coal) to make sure that the fuel is properly distributed in the FIREBOX. Also known as a stoker. (added 26 Feb 2010)

FIRE TRUCK: a piece of fire apparatus equipped to raise fire fighters to an elevated position, such as a ladder truck, TOWER LADDER, or SNORKEL TRUCK. Sometimes shortened to truck. Compare FIRE ENGINE

FISH: (Nautical): (verb) to apply reinforcing splints to a damaged mast. (noun) such as splint. A mast that had been reinforced in this manner was said to be fished, and was unlikely to be as good as new.

FREEBOARD: the distance between a ship's waterline and the deck. Water rising above the freeboard can spill into the ship, unless the deck has been sealed. In any event, water rising above the freeboard will wash over the deck.

GALLERY: (Nautical) a series of windows spanning the stern of a vessel. Also stern gallery.

GLASS
* Steam engineering: a sight glass: a glass tube that shows the water level in a boiler.
* Hydraulics, and Refrigeration: a sight glass enabling one to view the color, condition, etc of a liquid. (added 7 April 2015)
* Nautical: a telescope, sand glass (e.g. hour glass) or barometer.

GUDGEON (typically pl: gudgeons): of the hinge that supports a ship's rudder and allow it to pivot, the part that is attached to the ship's stern. The gudgeon consists of a socket to accept the pintle, which is the part of the hinge connected to the rudder, and a bracket to connect the gudgeon to the ship.

GUNPOWDER (added 16 Jan 2016): Gunpowder in the age of sail was what is now known as black powder, a mix of charcoal, saltpetre, and sulphur. Originally, the components were ground and then mixed, then stored in kegs bound with copper (i.e. non-sparking) hoops. This gunpowder, which came to be known as serpentine powder, had a tendency to separate out into its components if jostled, as it undoubtedly would be in the magazine of a ship at sea. Serpentine powder was also hygroscopic, absorbing water from the environment, and the varying size of its components limited the ability of air to circulate and participate in combustion.

These tendencies were solved by wetting down the mixed powder to hold the components together, and then passing it through a series of screens to divide it by grain size. Smaller-grained powder was used in smaller fire-arms. This powder proved more reliable and more powerful than the serpentine powder it replaced. After the development of cylinder powder (see below), this corned powder came to be marked with blue lettering on its kegs.

Later still, it was discovered that preparing the charcoal in a (cylindrical) oven rather than the traditional kiln made it more uniform, which in turn yielded more powerful gunpowder. This cylinder powder was marked in red.

The final type of gunpowder was recycled, which was less powerful than the cylinder powder (my source offers no direct comparison between recycled and corned powder), and was marked in white.

JOHNSON BAR: on a steam engine, the Johnson bar regulates the valve timing. Varying the timing trades power for speed, and also determines the direction that the engine (and vehicle) runs. This makes running a steam engine different than running an internal combustion engine, since there is no transmission; power output is controled by varying the speed and direction of the engine. A result of this is that a steam-powered locomotive can run just as fast backwards as it can forwards (steam-powered ships cannot, since the shape of the hull allows faster movement when traveling forward).

LARYNGOSCOPE: a tool for looking into the larynx (in the throat), for the purposes of inserting an ENDOTRACHEAL TUBE, or to locate and remove an object that a patient is choking on. (added 5 Apr 2010)

LUNAR WHITE: a bluish-white color, named for its resemblance to the moon. See also WHITE SIGNAL.

MAST: a SPAR, standing vertically. Masts were designed to support YARDS, but also found use supporting elevated crew positions, such as for a lookout, or to allow sharpshooters to fire down on an enemy. Masts further served as attachment points for flags, lights, lightning rods, radio and radar antennas (once developed), and the like.

In larger vessels, masts consisted of several spars. The lowest portion was the lower mast (also sometimes known as the mast, confusingly), and sat on the vessel's keel. Above this came the topmast, and then the topgallant. Naval (military) vessels might carry royal masts above the topgallants, as might merchentmen belonging to the East India Company. Using multiple spars enabled the masts to be shortened in heavy weather, so as to reduce the amount of TOPHAMPER and so reduce the strain on masts and hull.

MOLE:
* Chemistry a unit, similar to the word dozen, but whereas dozen indicates 12 of something, mole indicates 6.02 x 10^23 of something. (added 2 Apr 2010)
* Espionage: an undercover agent, apparently working for one government (or group), but secretly working for another. (added 2 Apr 2010)
* Nautical: a stone, masonry, or earthen pier or breakwater, or connection between two places separated by water. (added 2 Apr 2010)

MONITOR:
* Medicine (20th, 21st century): a heart monitor, or a combination heart monitor and DEFIBRILLATOR. A heart monitor is a device that depicts the heart's electrical activity as a moving line on a screen.
* Nautical: a type of steam powered, ironclad warship, named for the U.S.S. Monitor (1862), having one or two rotating cylindrical turrets, each typically housing a pair of heavy guns. Monitors were typically on the small side and had a low FREEBOARD, the idea being that they would present as small a target to the enemy as possible. Their low freeboard made monitors unfit for ocean travel (the Monitor, indeed, almost sank at sea as she hurried south to meet the Virginia/Merrimack, and later did sink at sea as she traveled between ports) and the ships were generally restricted to rivers and shore patrol. (edited 2 Apr 2010)

POINT:
* Nautical: 1/32nd of a circle, or a little more than eleven degrees, generally used as a direction. The points of the compass are the 32 cardinal directions, i.e. north, north by east, north-northeast, northeast by north, northeast, northeast by east, east-northeast, east by north, east, east by south, east-southeast, southeast by east, southeast, southeast by south, south-southeast, south by east, south, south by west, south-southwest, southwest by south, southwest, southwest by west, west-southwest, west by south, west, west by north, west-northwest, northwest by west, northwest, northwest by north, north-northwest, north by west, north. (Film aficionados may note that there is no "North by Northwest". (added 2 Feb 2010)
* Railroad: one of the two moving rails in a railroad switch. (added 2 Feb 2010)

POST HOC, ERGO PROMPTER HOC: Latin: "it follows this, therefore it was caused by this". The fallacious idea that if one event follows an earlier event, then it must have been prompted by or caused by that earlier event. (added 2 Feb 2010)

POUCH OF REDA: REDA'S POUCH (added 2 Apr 2010)

POWDER: GUNPOWDER (added 16 Jan 2016)

PREMATURE VENTRICULAR CONTRACTION: a type of abnormal electrical activity in the heart, where the VENTRICLEs contract out of sequence (prematurely). PVCs may perfuse (pump blood, and thus produce a pulse) or they may be nonperfusing. PVCs are indicate that the heart is having difficulty, and may slip into a heart rhythm that cannot support life, such as V-TACH (which is essentially a string of uninterrupted PVCs) or V-FIB. (added 6 Apr 2010)

PVC: a PREMATURE VENTRICULAR CONTRACTION. (added 6 Apr 2010)

RAKE: (Nautical) (1) to fire SHOT along the long axis of a ship, etc (i.e. from BOW to STERN or from STERN to BOW) so that the shot travel along the full length of the ship, allowing them to do maximum damage. (2) the angle of a MAST from vertical. Most masts were raked AFT a few degrees, rather than pointing straight up at 90 degrees from the deck. (added 7 April 2015)

REDA'S POUCH: the compartment created by the interface between the uterus and the urinary bladder. Also known as the pouch of Reda. (added 2 Apr 2010)

SAIL: a sailing vessel.

SAMPLE: acronym for Signs and symptoms, Allergies, Medications, (pertinent) Past medical history, Last oral intake (last food or drink), Events leading up to injury or illness. SAMPLE, coupled with a physical exam, comprises the necessary parts of an EMT's or paramedic's evaluation of a patient. (added 2 Apr 2010)

SCHWA: the upside-down e used in phonetic descriptions to indicate some unstressed vowels.

SHIP: (Naval, 19th Century): a three-masted sailing vessel, with each MAST square-rigged and in three parts, i.e. lower mast, topmast, and topgallant. A ship might also carry royal masts above the topgallants.

SHROUD: (Naval) rigging designed to prevent a MAST from falling to the side. The shrouds, along with the ratlines running horizontally between them, also formed a ladder to enable sailors to climb up into the masts and YARDs.

SINUS: (Anatomy) broadly, a pocket, such as one of the empty spaces in the skull facial bones. Also refers to the part of the heart in which the electrical signal for the heartbeat normally originates. A sinus rhythm is one that starts at this location, as opposed to some other place in the heart. (added 5 Apr 2010)

SMOKE BOX: (also, smokebox) the portion of a boiler in which smoke and combustion gasses collect after heating the water. The (smoke) stack emerges from the smoke box. On a steam locomotive, the smokebox is found at the front, and is sometimes painted in a different color than the rest of the locomotive. (added 2 Feb 2010)

SNORKEL TRUCK: a FIRE TRUCK fitted with a large bucket at the end of an articulated boom, for a fire fighter to stand in while working. A fire fighter stands in the bucket and is lifted into the air to allow access to a fire from an elevated position: a cherry picker. Sometimes shortened to snorkel.

SNOW: a sailing vessel equipped with two square-rigged masts, plus a snowmast (also known as a trysail mast) placed very closely behind the mainmast. The snowmast is rigged for fore-and-aft sails. Snows were generally used as merchant vessels, though a few saw military service.

SPAR: a piece of wood (later, similarly-shaped iron or steel) designed to serve as a MAST or a YARD.

SPLINTER NETTING: rope netting spread above the WEATHER DECK to protect the crew from falling debris, as during a battle. (added 1 Sept 2014)

STOKER: (Steam power): a FIREMAN. (added 26 Feb 2010)

SUPERHEATER: in a steam engine, a fire in the FIREBOX generates combustion gasses, which heat water in a boiler, creating steam. This steam can be used directly, or it can be heated further in a superheater, which pipes the steam back though the combustion gasses. Steam that has been through a superheater is said to be superheated, and delivers more power than non-superheated steam. (added 26 Feb 2010)

TOWER LADDER: a ladder truck fitted with a bucket at the end of its ladder, for a fire fighter to stand in while working. A cross between a ladder truck and a SNORKEL TRUCK. Sometimes shortened to tower.

TOP: (Naval): a platform at the top of a lower MAST, designed for spreading the SHROUDs of the topmast. In battle, sharphooters might stand in the top and fire down on the enemy's deck.

TOPHAMPER: The portion of a sailing vessel designed to support the sails, such as the MASTs, rigging, TOPs, etc.

TOUCH HOLE: the hole near the BREECH of a gun by which fire is applied to the gunpowder, firing the weapon. (added 6 Feb 2010)

TRUNNION: one of two horizontal posts on the opposite sides of a cannon, etc, used for attaching the gun to its carriage. (added 6 Feb 2010, edited 7 July 2011)

TUMBLEHOME: an inward slope of a ship's or other vessel's side as it rises from the water.

VENTRICLE: an anatomical chamber. In the heart, the ventricles are the main pumping chambers. (added 6 Apr 2010, edited 7 July 2011)

V-FIB: ventricular fibrillation. An abnormal heart rhythm where the VENTRICLEs beat in a disorganized fashion that cannot produce a pulse. V-fib is one of two heart rhythms that can be DEFIBRILLATED. (added 6 Apr 2010)

V-TACH: ventricular tachycardia. A type of tachycardia (abnormally fast heart rate) where the VENTRICLEs beat without being signaled to do so. V-tach may produce a pulse, or it may be pulseless. Pulseless v-tach is one of two heart rhythms that can be DEFIBRILLATED; v-tach with a pulse requires a more sophisticated type of electrical therapy known as synchronized cardioversion. (added 6 Apr 2010)

WARD M: a slang term for the hospital morgue.

WEATHER DECK:
* Nautical: The deck exposed to the weather, by virtue of having no deck above it, or only a partial deck above it. (added 1 Sept 2014)
* Space: a deck or space from which a spacecraft can be exited; an antechamber to an airlock. (added 1 Sept 2014)

WHITE SIGNAL: (Railroad): early colored-light railroad signals used white light to indicate 'go'. Red signals indicated 'stop,', and yellow indicated 'approach' (proceed to the next signal but be prepared to stop there) or 'stop, then approach." Green later replaced white. SPOILER (highlight text to read): The problem with white was that a lost or broken red (or yellow) lens would reveal a white light, tricking the engineer into proceeding when he should not. In the early twentieth century, some railroads used a lunar white signal for restricting - allowing a train to slowly enter a track on which another train was known to be already present, with the understanding the the engineer would have to be able to quickly bring his train to a halt. Modern signals may be much more complex, using a multitude of colored and/or white lights at the same time.

YARD: (Nautical) a long piece of wood, (later, iron or steel), held up by a MAST and carried horizontally, for the purpose of spreading and supporting a sail. In conjunction with their associated masts, yards also functioned as cranes for lifting cargo, boats, etc. Also, a facility for building or servicing ships, etc. (edited 5 Apr 2010)

Last update: 16 January 2016

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X-ray Chapter 7, part 3

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Lieutenant Squadron glared at Frank, but only said, "well, then?"

"Where was I?"

"Jeopardy?"

"Yeah, Jeopardy. So he's only halfway through Jeopardy, and then he was in. I smoked him again but it didn't do anything."

"Smoked him?"

"Shocked him, Lieutenant," Ian explained.

Three five Charlie ("That's us," cried Jill. "He knows that." said Jim. Lieutenant Squadron merely glared again.) was on scene in two minutes. They recognized the smoke immediately. "No, it can't be," Jim said as he leaned in through the doorway.

"Oh, yeah it is. You two want to take over CPR? We've done our hard work for today. You have any trouble finding us back here?" Frank asked as Jim and Jill squeezed themselves into the closet.

"This very nice hysterical woman showed us the way in," Jill told him.

"Yeah, we met her, too. Don't step on the drug bag," Frank said as he wiped his brow on his uniform sleeve. "Man, it's warm in here."

"I hate CPR in cramped spaces."

"It could be worse."

"How?"

"I don't know. Ow - watch your elbow."

"He could be decapitated." Jill offered with a giggle.

"That just makes it easier." Ian offered. Jill had taken over the bag valve mask - now hooked up to the ET tube - and Ian opened the IV kit. "The person doing the chest compressions doesn't get in the way of the person doing the airway."

Jill giggled again, then suddenly stopped. "I don't get it."

"I'm over hear doing the compressions," said Jim, "while you're in the other corner doing the airway," Jim explained while Ian contorted himself into a corner to try for an IV.

"You get it, yet, " Frank asked after several moments

"No," Ian said. "Both of his ACs are trashed. Use the tube for now."

Frank frowned, but Jill disconnected the bag valve from the endotracheal tube. Frank injected the epinephrine into the tube and Jill reconnected the bag, giving several quick breaths to send the medication home. Jill suppressed a giggle.

"Charging 360." said Frank. "360 Joules, clear - clear!"

"How?" asked Jill. "Should I climb on top of Jim?"

"Yes. Please." said Jim. "I think we'll have to pull him into the other room."

Together, they dragged the patient out into the greenhouse, accidentally knocking over one of the plant-laden tables and sending its contents to the floor. One plant, unnoticed, fell into Three-five C's airway bag.

"Shocking," said Frank again. He pressed the button, then charged the defibrillator again. "Charging 360," he announced. "Wow," he said. "Even out here the smoke is strong."

Jill sniffed, strangled a laugh into more of a snort, and sniffed again, wiping her nose on the shoulder of her jacket. In the background the hysterical woman continued to run in circles.

"Oh, no, I did six," Jim suddenly said from his position at the patient's chest.

"What?"

"I did six compressions instead of five."

It's okay," Jill told him.

Frank sent a round of lidocaine down the ET tube, then followed it with Narcan, "just for kicks."

"I got it," Ian suddenly exclaimed. "I got it I- oh, damn. The line blew."

"Charging 360," Frank warned.

"Jill, toss me an 18 gauge?"

Jill handed the catheter over to Ian. "Shocking 360. Clear. Is anyone else's mouth dry?"

"Yeah."

"Uh huh."

"Yeah."

"Just wondering."

Out in Three-five Charlie's ambulance Ian sent Jill around to drive. "I can't," she giggled, "I have no peripheral vision!"

Ian vainly tried to suppress his own laughter as he shoved Jill into the back of the ambulance with his foot and yelled at Jim to go up front and drive.

Outside, the woman had followed them to the ambulance and was still crying and carrying on. "How is she still there?" asked Frank. "Aren't we moving yet?"

"I'm stuck," Jim's shuddering voice responded. For reasons known only to him he had not gone around the outside of the ambulance to get from the box to the driver's compartment. He had instead tried to climb through the interior window. His buttocks and legs still protruded through into the box.

"Will you - fix your partner?" Ian asked Jill, then turning to Frank, "You wanna try this IV?"

Frank did and got it on the first try. "Are we on drug or shock?" he asked.

"I don't know. Which do you like?"

"I want to use my IV."

How they made it to the hospital Ian never could remember. His next recollection was finding Jim clinging to the steering wheel post call. "Jim, what are you doing?" he asked.

"If I let go, I'll fall."

"You're sitting in a seat."

"You don't understand. I'll fall into the sky."

"Oh," Ian shut the door. "I'll just, yeah." Then he went off to find Frank and decide where they'd left their bus.

"So really," Frank concluded, "you should be thanking us."

"Thanking you? I could be busting you."

"For what. We found your bus. It wouldn't look very good for you to have to report the absence of a bus to Captain Pullings. I think we've got you over a barrel, Lieutenant. There's four of us and one of you. Watch your step with who you threaten." Frank would have gone on, but Jill burst out laughing. And Lieutenant Squadron still didn't understand what Jeopardy had to do with any of it.

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Edited for location, 10 Feb 2009

X-ray Chapter 7, part 2

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Two days later, Ian was back in the ambulance, once again working with Frank. Late in the day, they were called back to the station. There, in the garage, they met Three-Five Charlie, driving bus 408 and held late specifically to meet them, and a very unhappy Lieutenant Squadron. "Would one of you like to tell me," the Lieutenant began, "why there is pot in bus 408?"

"Oh, yeah," replied Frank. "There's a funny story about that."

Earlier that day he and Ian had been called to a crumbling row house for a woman acting strange. They met the anxious woman on the street. "He fell down," she told them, "He fell down he fell down. He was in the garden and he fell down and I can't wake him up and aren't you going to do something!?"

Ian looked at the building, the sidewalk, the street. Nowhere was there anything he'd call a garden, nor were there any fallen bodies. "Ma'am, ma'am, calm down," he said, "calm down. Where is he?"

"He's in the garden he's in the garden," she gestured into the house, pushing Ian inside and then squeezing past him to drag him through the house and up to a cramped apartmeent on the third floor. Frank gamely brought up the rear, struggling with bags, monitor and stairchair because Ian hadn't had a chance to grab anything before the woman had kidnapped him.

In the apartment, the woman dragged Ian through a small living room into what he could only describe as a greenhouse. Black trash bags covered over all of the windows, but bank after bank of flourescent lights shone down from the ceiling, making the room ofensibly bright. Beneath the lights grew a verdant blanket of potted plants, all of the same type.

Ian had little time for inspection, however, as the woman pulled him through the greenhouse to a small, smokey closet at the far end. Here, an older man in a white t-shirt and boxer shorts lay in a crumpled heap.

"He's not breathing. Boy he's sweaty. Did he fall?" he asked the woman as Frank worked his way past her to get into the room

"No, no fall. His heart, his pills. Do something!"

Ian quickly assembled the bag-valve mask, pulled the patient into a straighter position, and put two quick breaths into him. Then found some tubing and hooked the mask to their oxygen cylinder. Frank shook his head. "It's always the fat ones on the walk-ups," he said before he called for back-up and hooked up the heart monitor/defibrillator. Quicklook on the monitor showed an SVT, so Frank prepared to shock. "100 Joules, clear," Frank called, pressing the 'shock' button. While the monitor recharged he pulled out his IV kit.

"200 Joules, clear," Frank pressed the button again. "Do you smell that?" he sniffed at the smoke.

After a moment Ian recognised it, too. "That smells like- Jesus, can we get him out of here?"

Frank looked over the small closet, and then intot he greenhouse beyond. "No," he said. "Not really."

"V-fib," Ian broke in, his eyes attracted by the chaotic, irregular tracing that now took over the monitor's screen. "Am I tubing or are you?"

"I've got the monitor, you've got the airway." said Frank. "You tube. 300 Joules, clear."

Ian broke out the intubation kit, worked himself into a slightly better position, and thrust the assembled laryngoscope into the patient's throat, searching for the vocal cords.

"360 Joules, clear," said Frank, and when Ian didn't move fast enough, "I said clear!"

"One moment," said Ian, "I'm only half-way through the Jeopardy theme."

"What? Will you clear so I can smoke this guy?"

Ian didn't immediately respond, since he had found the cords and was advancing the tube down the patient's airway. "Jeopardy. You know, the TV show?"

"What the hell does Jeopardy have to do with contraband in Three-five Charlie's bus?" Lieutenant Squadron broke in on Frank's narrative.

"I'm getting to that," Frank said. "Don't get your panties in a bunch."

EDIT 10 Feb 2009: changed location to interior room.

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