Extreme Medical Services: Medical Care On The Fringes Of Humanity Page 12

  The location was only a couple of blocks away and they saw the lights of the other ambulance as they approached the scene. They pulled up behind the other unit, parked, got out and started to push their way through the crowd to an alley between two buildings. On the right was a bar with a sign that read Wicked Moon. On the left was a 24-hour drug store. As Dean was moving to the edge of the crowd he glanced to the side and saw James Lee, Brynne’s boyfriend. The vampire met Dean’s eyes and smirked, mouthing the words, “too late.”

  “Hey, Brynne, did you see …” Dean started to say to his partner.

  “Yeah, I saw him,” Brynne said. “Keep your eyes open. Something is going on here that might require us to do something strange. Be ready to distract the other crew if I tell you to.”

  “Right.” Dean said.

  They approached the edge of the alley where two paramedics were in the process of performing CPR on the young woman. She had that pale look that a patient gets when their heart stops beating and pushing blood around the body, or when you’re a vampire, Dean thought. Brynne came up and addressed the senior medic on the code who was managing respirations with a bag valve mask while his partner pumped away on the chest compressions, counting out loud. “What do you have, Ray?”

  “Hi Brynne,” the other paramedic said as they approached. “She was found collapsed here in the alley. Bystander CPR was started when they realized she was in cardiac arrest. She’s in PEA on the monitor with a sinus bradycardia showing but we haven’t had a chance to do anything else but continue CPR and get her hooked up to the monitor.”

  “Okay,” Brynne said. “Dean, take over compressions and give him a break. I’ll take over respirations while you guys get IV access and get some epinephrine on board.” Dean waited until the paramedic doing compressions finished a round of thirty compressions and then jumped down and started pumping on the chest. He focused on his technique as he’d been taught.

  Brynne knelt down at the girl’s head and began using the bag valve mask to breathe for her, sealing the mask to the girl’s mouth and nose with one hand, maintaining an open airway and squeezing the bag with the other while watching for chest rise. “Dean, let’s go to continuous compressions and asynchronous respirations.” Dean stopped counting and switched to doing continuous compressions at a rate of one hundred per minute. Brynne started her smartphone CPR metronome app to help Dean with the pacing and delivered a breath every thirteen compressions with the bag valve mask. While she was doing that she examined the young woman carefully from her perspective at the head and Dean saw a change in her expression.

  “Dean.” She said quietly and turned the girl’s head to reveal her neck to her partner. He glanced down and saw two neat puncture marks on the side of her neck near the junction with the shoulder. Alarmed, he looked up and met her eyes. He realized he was slowing down his compressions so he refocused his attention to listening to the smartphone metronome beeps while his mind raced. The girl was in a pulseless electrical activity rhythm which indicated that there was something that was inhibiting the effective pumping of blood outside of the heart muscle itself.

  Brynne had just narrowed the cause down to two choices, trauma or hypovolemia, a loss of blood. Both could be related to a suspected vampire attack. They couldn’t do anything until the other medics got an IV line in place. This girl needed a fluid bolus to raise her blood pressure, assuming she had any blood left. They didn’t carry blood products on their units, which is what she really needed, but a bolus of IV saline might help give her enough volume to revive her long enough to get her to the hospital. Dean was finishing up his first hundred compressions, already feeling the fatiguing effects.

  The other paramedic team was working quickly. Ray, the team leader, had the intraosseous gun out which would drill a needle directly into the fibrous center of the bone in the patient’s ankle allowing them to quickly get fluids and medications into her. She was wearing a short skirt so getting access was easy. Ray’s partner was preparing the IV fluid bag and tubing to attach to the IO needle catheter when it was ready. Ray took the end of the IV tubing from his partner and attached that to the intraosseous access point. His partner had wrapped a manual blood pressure cuff around the fluid bag and pumped it up until he saw the drops start to fall in the drip chamber on the tubing. The paramedic holding the bag of fluid handed it to a police officer standing nearby while he got out the med bag.

  Now that they had IO access, they could start administering drugs for the cardiac arrest. Brynne and Dean switched positions as they pushed the Epinephrine in. He checked for a carotid pulse while looking at the monitor. No pulse detected. Dean thought of a way to get them to infuse fluids without revealing what he and Brynne had discovered. Usually hypovolemia was due to massive trauma but since there was no sign of bleeding, they had to come up with another reason to explain it.

  He continued compressing the bag of the bag valve mask, focusing on breathing regularly as the other paramedic did her turn of continuous compressions. Brynne said. “She must have been in that night club and may be overdosing on ecstasy. She might be severely dehydrated or hyperthermic. Try a volume infusion.”

  Ray looked up from where he knelt at the foot of the patient. “That’s a good thought, Brynne.” He looked at the patient again. “She’s probably about one hundred twenty pounds so we’ll say fifty kilograms. Do it Brynne,” he said to Dean’s partner. Brynne pumped up the pressure on the cuff around the bag of fluid the officer was holding until the saline in the drip chamber started flowing continuously.

  The team kept going on compressions for another minute then the other paramedic, Dave, asked Dean to swap out again. Still no pulse and no sign of a change in rhythm. She asked Ray to bag the patient while she got the airway kit out of the other medics’ bags and got set up to intubate. She got out the video laryngoscope, then got set up to drop a tube into the girl’s airway. After passing the tube, she used a small syringe to inflate the balloon securing the end of the airway in place. Ray attached the end tidal capnography sensor to the end of the tube. He bagged the patient a couple of times watching the ET CO2 numbers on the heart monitor. Using one hand, Brynne placed her stethoscope in her ears and listened bilaterally in the lung fields. “I hear lung sounds and nothing over the epigastrium. Tube placement is confirmed by capnography and auscultation,” she said then took over bagging for Ray.

  Dean swapped out compressions with Dave, the second paramedic from 792. Man CPR was hard work, he thought. He looked up at Brynne. “What’s next boss?” he asked. “Are we due for another round of Epi?” She nodded and a glance at Ray confirmed it so he pulled out another pre-filled syringe of epinephrine and assembled it. Brynne gave the BP cuff another couple of pumps to increase the pressure on the bag as it emptied its contents into the girl. Dean attached the syringe to the port in the IV tubing and pushed the drug into the patient.

  A minute or so later, as they continued to work, Ray spoke up. “Hey, I’ve got a spike in the capnography reading. Check a pulse.”

  Dave stopped compressions and checked a carotid pulse. “I think I’ve got one,” he said. His brow furrowed as he concentrated on feeling the girl’s neck. “Yep, I’m sure. It’s faint and thready but it’s definitely there.”

  “Okay,” Ray said. “Let’s get the stretcher and move her to the ambulance.”

  “Dean and I will go get your stretcher. Come on Dean,” Brynne said taking her partner by the arm. The two of them started towards the other unit to get the stretcher. “Okay, we’ll let them take her into the ER. We need to get a dose of garlic extract on board when they’re not looking, though, to counteract the vampire bite. We’ll write up our version of the report when we get back to our station. The hospital needs to know she has a suspected vampire bite in case she doesn’t survive. They’ll have to take further steps to keep her from turning.”

  Another voice sounded from behind them as they approached the back of the other crew’s ambulance. “You should have let her
be. She wanted this.” Dean and Brynne spun around and saw James standing behind them.

  “Did you have something to do with this, James?” Brynne asked quietly as she turned and kept walking. The crowd was watching them so she didn’t dare say anything too loud. “You told me you were finished feeding on people.” Brynne said in a low voice.

  “It has nothing to do with you, little one,” he said in a condescending tone. “This was an arrangement with a friend to whom I owed a favor.”

  “What friend? Her?” Brynne said referring to the patient.

  “No one, and I said it is not your concern. I will not have you cross me on this, Brynne. It’s an obligation I had from many years ago.” James said.

  “You can’t just go around biting women and killing them. We’ll have to report this to our superiors,” Dean said, defiantly. He wasn’t sure what they could do about it but he was sure this was not the first time it had happened.

  “Ah, the baby bear has some fangs after all,” James sneered. “Do not dabble in things you do not understand, Dean, my boy. This is not merely some Siren you’re tangling with.”

  Dean stopped in the street next to the other ambulance and looked at Brynne. “You told HIM about it?”

  “No, I didn’t, but he asked because word gets around in the Unusual community,” Brynne said. “Rudolf probably told him when he got back from his trip. Look, we’ve got to get the stretcher and get her to the hospital.” She turned to James. “This discussion is not over, James. This is not fifteenth century France. You cannot go around biting anyone you feel like, whether there was some arrangement or not.”

  “We’ll see, little one,” James said. “We’ll see.” He turned and walked into the crowd, disappearing from view.

  Dean opened the doors to the rear of the ambulance and reached in to unlock the stretcher undercarriage from its position in the back of the unit. Brynne watched the crowd where James had disappeared a moment more then turned and helped Dean lower the wheels to the ground. Dean looked at her across the stretcher. “He’s dangerous, Brynne,” Dean said. “I don’t know what you see in him. Does he have some sort of control over you?”

  “Drop it Dean,” she snapped. “Focus on the job at hand. I’m a big girl and I can handle James. You get the stretcher out. I’m going over to draw up some garlic extract from our emergency kit. We’re going to have to find a time to get that dose into her without Ray and Dave suspecting anything or seeing what we’re doing.”

  Dean closed his mouth but knew he wasn’t going to drop the topic. There was something going on here he didn’t understand and his partner was deep in the middle of it. He unloaded the stretcher and was turning it around as Brynne returned. She was holding a capped syringe, which she carefully put in the cargo pocket of her duty pants. Dean pondered what he could do about James as the two of them rolled the stretcher back to the girl and the other two paramedics. The girl still had a pulse when they returned but Ray was still bagging her so she still needed assistance breathing. Dave was attaching another bag of saline to the IV tubing. The first bag was empty. He pumped the blood pressure cuff up again to continue infusing more fluid. Dean and Brynne lowered the stretcher and moved it up to the girl’s side.

  “Here, Dave,” Brynne said. “Let me get that. You help Ray and Dean get her ready to be moved to the stretcher.” The other medic handed her the IV bag and turned to start prepping the patient. Dean stepped between he and Brynne to block the view as she pulled the loaded syringe from her cargo pocket. She uncapped it, screwed the syringe hub onto a port in the IV tubing and quickly pushed the dose of garlic extract into the patient. The crowd wouldn’t think anything unusual was going on. They would just see a paramedic giving a drug to a patient.

  Once that was done, they carefully lifted the girl onto the stretcher along with the heart monitor, oxygen tank and IV bag. They then cleared the way through the crowd as Dave and Ray rolled her back to their ambulance. Dean opened the rear doors of ambulance 792 and then helped Dave load the stretcher after Ray climbed inside ahead of it, still operating the bag valve mask.

  “Do you want one of us to ride along in case she goes into arrest again?” Brynne offered.

  Dave shook his head. “We’re only two blocks from ECMC here. Why don’t you just follow us there.” He shut the rear doors as Ray was getting himself situated in the back of the unit. “I’ll signal you to pull over and help if we need you to.” He turned and climbed into the cab’s driver’s seat.

  Dean and Brynne watched them leave the scene. The crowd dispersed now that there was nothing else to see. Dean climbed into the passenger side of their unit, stripping off his gloves while Brynne climbed up behind the wheel. She pulled out and started to follow the other unit to the hospital. They rode in silence. Dean started to speak but she stopped him with a held up hand.

  “Put us back in service,” she said curtly. “We’ll talk about this back at the station. Let’s help them get into the hospital and situated first.”

  Dean contacted dispatch and notified them that they were clearing the scene and heading back to Elk City Medical Center.

  The drive back to the station was quiet. Brynne looked like she was ready to kill someone and Dean wanted to make sure that he didn’t get in the way when she blew up. James had all but admitted to biting and nearly killing that woman and then he acted like it was no big deal. He was taken back to his conversation with Freddy, the zombie chef, about James and wondered if he needed to follow-up on his instincts and contact Mike about this. He thought that Brynne was in over her head and that James was bad news. The events that occurred tonight just backed up that assumption.

  He was still thinking about it when they arrived back at their station. As they got out and restocked the ambulance, he noticed again that Brynne wore a turtleneck despite the weather. Was she just cold-blooded or was she letting James drink from her? Was that what was making her so angry, or maybe afraid? She didn’t seem the type to scare easily, but after seeing that girl close up maybe she saw herself. Maybe she could see the danger she was in by dating someone like James.

  They went back into the squad room to do their patient reports from the two calls. They sat down at their computer workstations and started to work. Finally, Dean couldn’t take the silence anymore. “Brynne,” he said as he leaned back in the desk chair. “We have to talk about what happened back there with that girl and James. Shouldn’t we call the police or headquarters or something? That girl was almost murdered. She still might die.”

  “We don’t have any evidence of wrongdoing on anyone’s part.” She said after a bit. “James’ statements to us were casual enough to be considered harmless by a court of law. It would be our word against his. He’s been doing this for too long to get caught that way.”

  “But you think he did it?” Dean confirmed. “He bit that girl.”

  “Yes,” she said, gritting her teeth. “I think he did it. He knows how I feel about it and he did it anyway.”

  “Oh, thank God,” Dean said. “I was sure you were letting him bite you, too.” Then he saw her self-consciously put her hand to her collar. “Wait a minute, you are, aren’t you? You’re letting him feed off you?”

  “That’s none of your business, Dean,” Brynne snapped. “What I do in my free time with other people is not a workplace concern. Period.”

  “Don’t give me that,” Dean said, raising his voice. “I saw that girl. She almost died … hell, she could be dead now. That could have been you. You can’t let James put you in that kind of danger. You have to stop and break this off with him. You don’t want to end up that way, do you?”

  Brynne paused and took a breath. Then she turned to look directly at him. “Dean,” she said quietly. “There is more here going on than you know. That girl wanted to be bitten. She wanted to be bitten and then die so that she could have a chance to come back as a vamp. That’s what James was talking about. The arrangement he alluded to had to do with her paying some sort of tribute t
o be turned. The fact that he did it is something he told me he wouldn’t do anymore. He told me he wasn’t that kind of vampire anymore.”

  “Clearly he was lying,” Dean said. “He seemed almost proud of it. In any case, something happened with the plan. She ended up in the alley.”

  “Something must have gone wrong,” Brynne said. “Maybe she changed her mind and tried to get away. I don’t know. I just don’t know.”

  “Brynne,” Dean said softly. “We have to tell someone. Something has to be done.”

  “James knows they screwed up,” Brynne said. “There must be an explanation. Why else would he have stuck around, right? I have to talk to him about it and get his side of the story. Maybe he was forced into it and didn’t want to admit it in front of you. Let me have a couple of days to sort this out and find out what happened. Then, if there is not a better answer, I’ll make the call myself. Okay?”

  “I don’t know, Brynne,” Dean said. “There has to be some sort of report made tonight. We have our charts to turn in. Headquarters dispatched us to that call for a reason. They have to know that there is some connection to our work here at Station U. If we don’t turn in a report, we’ll have some explaining to do. I just got this job. I don’t want to lose it over a missing report or falsified records.”

  “You will not lose your job,” Brynne said. “I’m your preceptor, so it is on me to make sure that the proper paperwork gets filed. Let me deal with this. There has to be some explanation. I’ll get it and report it to headquarters. Okay?”

  “If you say so, Boss,” Dean said. “If you say so.” He really didn’t know what else to say to her. She was in charge, and that was that. She could make the call. The problem was, he wasn’t sure she was making the right call. When he was in school, he was told that there would be occasions that he would not agree with other providers’ calls in the field, but he had always assumed that would be a medical issue. This was something else altogether. This was attempted murder, or maybe an assisted suicide. He was not sure. Either way, he couldn’t be a party to a cover up of something like that. Still, he guessed he owed her something in the way of thanks. She’d bailed him out of that Lydia situation, and she was his supervisor. He decided he would write up his own version of the night’s events and keep it on hand in case he needed to turn something in later on.