Asphalt Surfing

“Hey AD, got a second?” the stuporvisor asks me as I’m leaving the staff meeting. He seems almost apologetic.

“Sure Stupe, what’s up?” I ask agreeably.

“Not here,” he replies indirectly, “let’s step into the office.”

Uh oh. This is going to be one of those talks.

I follow Stupe into his office and shut the door behind me. It’s hard not to think of him as a kid, even though I’m only five years older. But I remember when he was a rookie EMT, a volunteer victim at the National Registry exams. He was green, and impressionable, and impossibly eager to please; a frisky puppy of an EMT. We examiners made sure to give him some extra practice for his paramedic skills exam between candidates, and were rewarded by seeing him ace his exams when the time came, even though none of us were allowed to actually test him – to assure impartiality, you see. We knew he’d turn out to be a good medic, and he grew into a pretty good supervisor, too. He’s fair, and looks after his crews.

Which is why his discomfiture is particularly amusing. I can’t have done much of anything serious and I haven’t been here long enough to piss off that many people.

“Your partner has some concerns about your driving,” Stupe begins hesitantly, and holds his hands up as if to ward off a blow when my eyebrows shoot up. “Just hear me out, dude,” he pleads. “I know how she is, but I promised her I’d address it with you.”

“What concerns, exactly?” I ask darkly.

Methinks it is time to spank the partner. Hard.

“She says she doesn’t feel safe riding in the back with you driving the long-distance transfers. She thinks you fall asleep and veer off the road.”

“Okay, let me get this straight. She doesn’t feel safe when I’m driving?” I chuckle and Stupe nods ruefully. “I gotta tell you, Stupe…that’s about as rich as three feet up a bull’s ass. She’s the last person who needs to complain about someone else’s driving.”

Not to mention, she obviously didn’t take my “If We Have A Problem With Our Partner, We Take It Up With Our Partner First” speech to heart. She will regret not paying attention to that.

“Do you fall asleep on long trips, AD?” he asks pointedly.

“I’m not gonna bullshit you, Stupe. I used to be bad about it. Twelve years ago, that is. I’m sleep apneic, and as long as I wear my CPAP, I’m good to go. And if I get drowsy on a trip, trust me, I’ll be the first one to pull over and switch seats.”

“So you’re telling me you haven’t fallen asleep at the wheel on any trips you’ve made with her?” he asks in his “This Is On The Record” voice.

“Not one fucking time,” I confirm vehemently. “I focus on smooth driving. Occasionally if I catch a groove in the pavement or get blown to one side and my outside wheels catch the ‘Wake Up’ strip outside the yellow line, I’ll ease it back over. Smoothly. If she had bothered to ask me about it first, she’d damned well know that. And if I don’t have a ten-foot-wide breakdown lane as a cushion, I hold it tight.”

“Okay, that’s all I need to know,” Stupe says decisively. “I told her I’d check into it, and I have.”

“And?”

“And nothing,” he assures me. “Case closed. How y’all getting along, by the way?”

“Pretty good I thought, up until now. She’s gonna need some remedial education in Working And Playing Well With Others. That will start tomorrow night,” I vow.

“Now don’t go retaliating just because I told you she came to me with a concern,” Stupe warns.

“She’s chickenshit, Stupe,” I sigh. “You warned me before I ever got cleared, and so did everyone else. But relax, I’m not going to break any rules. She is going to adjust her attitude, though, or working as my partner is going to turn into an experiment in just how much humiliation a Basic EMT can endure before she straightens up or quits.”

“You know,” Stupe guffaws, “several of us said that very thing when we assigned you as her partner. Try not to leave any marks, AD.”

That I can’t guarantee, Stupe. She refuses to learn the easy lessons. I think it’s time to show my fangs.

**********

“I fucking hate just sitting here,” Bitchy Partner fumes. “It’s so pointless.”

We’re parked outside a Super Wal Mart at 0145, sitting in an idling ambulance, praying the air conditioner keeps up. Actually, with diesel prices so outrageous these days, we’re supposed to shut down the engine, fire up the gasoline generator that runs the module power and air conditioning, and sit in the back of the rig. We’re over the company fuel budget by 100%, and have been so since the beginning of the year. I just heard our unit in the next town mark out at the hospital, though. We’ll be moving again soon. It doesn’t keep BP from living up to her name, though, and frankly right now I’m too weary to have the “let’s shut it down and get in the back of the rig” argument only to have to get up and move in twenty minutes.

So instead, I crack one eye open and ask mildly, “You’ve never worked in a SSM system, have you?”

“What’s SSM?”

“I guess that answers my question,” I yawn. “SSM means System Status Management. Imagine getting in your truck at the beginning of the shift, and not getting out again until the shift is over.”

“What’s the fucking difference?” she says dismissively. “We never see our station as it is!”

“Not true,” I point out. “If we’re not at ours, we’re at one of the other stations, except for the rare occasion like this. In a SSM system, they don’t even have stations. You have no idea how good you have it here.”

The distinction is lost on Bitchy Partner, however. Right now, she’s busy texting someone. I suppose I should be thankful that we’re sitting still while she’s doing it.

“Assigned to Post 102,” chirps the mobile data terminal. Our station. I grin triumphantly at Bitchy Partner.

“Not like it fucking matters,” she says sullenly as she slams the truck into gear. “They’ll only move us again thirty minutes after we go to sleep. Our dispatchers are so stupid. Honestly, I am so tired of The Borg. This place is so chickenshit.”

Pot, meet Kettle. Look how tanned you both are!

“So quit,” I taunt. “Go follow your ex-partner. I hear they have openings.”

“I should,” she threatens. “Believe me, I’ve considered it.”

“You want some free advice, BP?” I sigh. “That is, if you’re willing to stop pissing and moaning long enough to listen to it?”

“Sure,” she says, looking at me in surprise.

“I’m gonna sound like an old man when I say this, and that’s guaranteed to make you roll your eyes and tune out everything I say…”

“No it won’t!” she protests.

“Yes it will,” I grunt. “You haven’t listened to anything I’ve said in two months, but I’m gonna say it anyway. There is a certain degree of chickenshit at every company you work for. They’re just chickenshit in different ways. There are stupid dispatchers at every company, just like every company has its share of EMTs who are impossible to please.” I pause to see if she’s listening, or even registered the implied rebuke. She hasn’t. Right now, she’s texting someone. While driving.

“Put down your fucking phone and listen to me,” I bark.

She jumps guiltily, then puts her phone away, looking ashamed. It won’t last.

“You can quit and go somewhere else,” I tell her gently, “but it ain’t gonna make anything better. You run into these same things everywhere you go. This is EMS, kid. This is the profession you got into. You can either find what satisfaction you can in it, or get out of EMS entirely. This is as good as it gets,
BP.”

“I’m a good EMT! I don’t want to get out of EMS,” she protests plaintively. “I just want to get out of here.”

“Yes, you are a good EMT,” I agree. “You just suck as a partner. And I’m telling you, the things you’re looking for, you’re not going to find in another company. Doesn’t matter where you go, BP. People are pretty much the same wherever you go. You bitch about bullshit calls, stupid patients, clueless dispatchers, mindless bureaucracy, and system abuse. Those kinds of things are found in every EMS system, BP. The problem isn’t EMS at The Borg. The problem is your perception of what EMS is. The problem is you.”

“You know something?” she flares. “Fuck you, AD.“

You hurt her feelings, smartass, my little voice tells me. Still, she needed to hear it.

**********

We pull into the station, and BP throws the truck into park even before the rig comes to a complete stop. She climbs out of the rig and stomps into the station without a word, hostility radiating off her in palpable waves.

You can get glad in the same panties you got mad in, Sister. I’m through coddling your ass. If being hit over the head is the only way you grasp something, then I’ll swing the Clue Bat.

Sighing in frustration, I gather my clipboard and Coke Zero, and trudge into the station behind her. She’s already ensconced in her bedroom, the door shut behind her. I’d hope that a little sleep will improve her mood, but it rarely does. I settle in a chair in the office, sign onto the computer intranet, and state blearily at the screen. I’ve got four run tickets to close out, and a couple more to revise because the armchair quarterback QA medic didn’t care for the way I dotted a particular i or crossed the odd t.

Thirty minutes later, I’m refreshing the final page of my last run ticket for the umpteenth time, hoping that the information will at last be transmitted before the connection times out. Here in Crack Central, fast in an Internet connection is a relative thing. You’d think that at 2:30 am, there’d be far less people downloading porn and clogging up the Intarwebz, but that evidently is not the case.

The phone rings, startling me. A second, then a third ring before I can pick it up. Bitchy Partner is already on the phone.

“…MVC on Highway 84 North at Kleinfelder Road…” I hear the dispatcher say, and from the other room, the sound of the phone being slammed down. I can hear her snarled curses through even the closed door. Silently, I meet her at the front door, holding it open as she storms through, trailing a stream of profanity behind her. For me, the word fuck is an agile, utility infielder of a word, good for many uses, but nonetheless a small part of my vocabulary. For Bitchy Partner, if you removed fuck from her lexicon, she’d be reduced to communicating through pointing and grunting.

In the truck, she is still bitching. “What the fuck are people doing on the road at 3 am?” she asks rhetorically. I say nothing, because she already knows the answer.

This is EMS’s witching hour. All the bars are closed, and the drunks are driving home. Right about now, the graveyard shift nurses at the nursing homes are just making their rounds after the 11 pm med pass, and noticing that Mrs. So and So hasn’t moved since she got her applesauce and pills puree four hours ago. All the little old ladies are sitting on their toilets, constipated and grunting until their hearts slide slowly downward in a spiral of vagally-induced cardiac arrest. We call it Doing the Elvis, and this is the time it usually happens.

“When do they fucking expect us to fucking sleep?” BP snarls as she slams the truck into gear and stomps the gas. “This is so fucking stupid…“

“They don’t expect you to sleep,” I say bluntly. “That’s why you work a twelve hour shift. If you can’t manage your second and third jobs, childcare and your busy social calendar without expecting to sleep through an entire shift at your primary job, perhaps you should seek employment elsewhere.”

She says nothing, just grips the steering wheel and fumes, accelerating to 70 on a residential street meant for 35. The Tattletale Box squeals a 50% force count as she stomps the brakes at the next stop sign, only to stomp the accelerator again as soon as she has cleared the intersection, in a vain attempt to reach 70 again before she reaches the next stop sign.

“BP…” I say quietly, in my Warning Tone, “…you can bitch to me as long and as loudly as you want, because I’m your partner. But you better stop channeling your rage through your driving, and when you get out at that scene, you Goddamned well better be 100% sweetness and light and calm professionalism. You show your ass in public once more, and I’ll have a new partner by the next shift. And I’m the only medic who will work with you as it is, BP.”

She stares at me appraisingly for a few moments, and then, slowly eases off the accelerator. We run the rest of the response in silence, me working the siren while she navigates the nearly-empty streets. When she tries, she can actually do smooth and fast at the same time. That’s what so infuriating. It’s not that she can’t do the job the right way. It’s that she won’t.

We spot the scene a minute later, the blue LED lights of Sheriff’s Department cruisers acting as a beacon to show us the way. We pass a Saturn Vue SUV stopped sideways in one lane, the passenger door caved in perhaps a foot, and my mind starts to report “that’s not so bad…” when I see the overturned Harley Sportster in the center turn lane, and a knot of deputies and bystanders crowded around a prostrate body nearby.

Shit, I breathe. The bike made that dent.

I treat my partner as a partner, and not a pack mule, so usually when we get out of the rig, my first steps are to the equipment compartments to help fetch gear. Unfortunately, BP doesn’t share the same philosophy. By the time I reach the patient with the spine board and first-in ALS bag, she’s already there, asking questions.

And I hate obtaining history second-hand, or asking the patients to repeat themselves because BP runs patient history through her own filters before relaying it to me. Things get lost in translation, primarily because her attitude colors her perceptions of almost everything she hears. She assumes a lot.

I cut her off by stepping in between her and the patient, and wordlessly handing her the spine board, standing it erect like a wall directly in front of her face. She peeks around it with a look of pure hatred, and I respond with a look of my own. My look doesn’t communicate vitriol quite as effectively as hers, especially if you don’t know me. In fact, my look is designed to hide my anger, while at the same time communicating quite clearly what I want.

And what I want is for her to shut the fuck up, help assess and package the patient, and do it with a smile on her face. Without questions. We’ve only worked together for three months, but she knows that look.

“Howdy Ma’am,” I say gently, kneeling next to my patient. “Can you tell me what happened?” Simultaneously, I sweep her and the bike visually, and the story starts to unfold.

The SUV turned left in front of her, and she tried to lay it down. The bike flipped back upright, and she went over the high side and got pinned between the bike and the car. Looks like the gear shift lever mangled her foot as she went over, too.

She’s wearing the de-rigueur rebel biking uniform, summer weight edition, right down to the leather Harley halter top with no bra, bandanna, and jeans. No jacket, no helmet.

“She… gave… me… no… time,” the woman pants through gritted teeth. “Leg… hurts… gotta… do… something… with my leg… “

“Your leg is broken, Ma’am,” I tell her, “but we’re gonna stabilize it and getcha to a hospital right quick, okay? Maybe even get you some pain medication along the way. How’d that be?”

“Sounds… good… “ she whimpers, “… just… do it… quick.”

“Holy Christ,” BP breathes behind me. “Look at her foot, AD.”

It occurs to me that this is the first truly bad call we’ve run together. It will be the first time with her that I’ve felt bad enough about a patient’s condition, or my ability to deal with it, that I’ll ask BP to run the lights and siren to the ER.

“I see it,” I tell her curtly. “Bleeding control on that foot, spinal packaging, and rapid transport. Let’s go, BP.” To her credit, she doesn’t ask about traction splinting for the left leg. It’s so mangled that traction is a moot point anyway. She feverishly digs through the ALS bag for trauma dressings and roller gauze while I question the patient and bystanders.

“What’s your name, Ma’am?” I ask the lady, as I run my hands down her body, feeling her ribs, sweeping her arms, bolstering her pelvis, palpating her lower legs and feet. My trauma shears follow the path of my hands and eyes, and I cut away as much clothing as I need to see. Not enough to expose her body to all and sundry, mind you, but enough to flip the remnants back to examine all the bare flesh I need to see. And thankfully, it’s reasonably intact bare flesh. Aside from a left leg and foot that has at least four more joints than it should have, she doesn’t have a mark on her.

“Miranda…” she answers weakly. “Please give me something for my leg…”

“Can’t do that, Miranda,” I apologize, “Not right now, hon.” I wrap my hands around her chest, just under her breasts, as she talks, and I am rewarded with the telltale vibration of tactile fremitus –equal on both sides of her chest, thankfully. I call it my High Ambient Noise Stethoscope, and only half-jokingly. It’s useful information.

“Where’s your helmet, Miranda?” I ask conversationally as I apply a cervical collar. “Were you wearing one?”

“I took it off,” the bystander holding her left leg apologizes. “I needed to assess her airway.” He’s wearing navy blue scrubs and New Balance running shoes, and a pair of nitrile gloves on his hands, which would normally would mark him as an ER nurse at Big City Memorial.

Except, I don’t recognize this guy, and I thought I knew all the Big City ER nurses by sight. Which just as surely marks him as an aide or housekeeper at Decubitus Manor Nursing Home, in my mind. When it comes to bystanders, they’re all incompetent until proven otherwise.

“Fair enough,” I allow cautiously. “Any damage to the helmet?”

“None,” he shakes his head. “I drove up right after it happened, and –”

“Did you take her boot off, too?” I ask warningly, glancing significantly at the lump of mangled tissue that used to be her left foot and ankle. The skin is pale, almost white, and there is an unhealthily large puddle of blood spreading across the asphalt under her sock.

“No, it was off when I got to her,” he confirms grimly. “She musta lost it in the crash.”

A crash bad enough that it ripped off a leather riding boot with built-in ankle support, and only barely missed ripping off the foot with it.

“Well, we appreciate your help,” I reply. “If you would, just hold that leg while my partner gets her foot bandaged, and when we move her onto the board, I want you to hold traction on that leg, okay?”

He nods his understanding as BP feverishly works on Miranda’s foot. She gingerly peels the sock away, revealing what is left. Miranda’s foot has effectively been avulsed at the ankle. The skin has rolled back, sagging in a formless heap off on the lateral side of her foot. The bones of her ankle gleam wetly through the gore. BP stifles a grimace of distaste, and looks up at me with worried eyes. Automatically, she feels for a pulse as she cradles Miranda’s wrecked foot in her hands.

“I can feel a pulse!” she says with a look of relief.

“I can see a pulse,” I reply grimly. I can literally see her dorsalis pedis artery pulsating slowly. It’s obviously intact. Unfortunately, her posterior tibial artery seems to be leaking like a sieve. “Just wrap it, BP,” I order. “We gotta roll.”

She swallows and focuses on wrapping Miranda’s foot tightly, and presently she positions a spine board alongside her. “Miranda, here comes the tough part,” I warn. “We gotta get you on this board, and to do that we gotta move your leg. It’ll hurt, hon.”

With a nod, I signal for BP and our nurse bystander to roll Miranda onto her side, and we quickly wedge the spine board beneath her. When we roll back and the bystander straps her left leg down to the board, she screams in a high pitched, keening wail. Tears form in her eyes and march down the sides of her pale face to mix with the droplets of sweat there. The bystander looks remorseful, but I wave it off.

“It ain’t pretty,” I shake my head, “but it had to be done. Don’t worry yourself about it.”

**********

Inside the truck, Miranda is wild. The pain has broken through whatever threshold she has, and she has given up on braving her way through it. She is thrashing about, trying to move as best she can despite the spine board straps. Really, all she can manage is to work her right leg from under the strap, and she keeps bending her right knee, planting her foot on the spine board. She makes a few abortive attempts to flex her left leg as well, each attempt ending with a piercing screech as the jagged ends of her femur rub together.

The hastily applied pressure dressing on her left foot is coming off, and what little there is of it is totally saturated with blood. I grab a few absorbent dressings and an Ace bandage from the cabinet and toss them to BP, nodding again toward the mangled foot. While I am cranking open the oxygen tank and applying a non-rebreather mask to Miranda’s face, I watch bemusedly as BP gingerly tries to apply a pressure dressing. Miranda keeps pulling that right leg out from under the strap, planting her booted right foot on the spine board, much to BP’s chagrin.

“I gotta move my leg,” Miranda pleads. “Please just let me move my leg…”

“Stop. Moving. Your. Leg.” BP warns repeatedly, effectively abandoning bleeding control on Miranda’s left foot in order to deal with her other leg. The uninjured one.

This is what inexperienced EMTs do, I sigh inwardly. Problem is, she thinks she’s salty. A weak EMT would have frozen, and she didn’t. But she’s afraid she’s losing control of the call, so she’s trying to assert her dominance. And winds up fucking arguing over the trivial.

I step to the back of the compartment and take the dressings from BP’s hands. “Pull traction on the leg,” I order. “Hold it still.” I hold eye contact with BP and call out to Miranda. “Honey, which leg do you need to move?”

She pauses a moment to consider, the synapses firing slowly in the face of mounting shock. “The right one,” she decides.

“Okay, here’s the deal,” I tell her firmly. “I’ll let you move your right leg to wherever it’s most comfortable. In return, you don’t move another body part unless I tell you, okay?”

“Okay,” Miranda agrees weakly.

“Pick your battles,” I smile to BP. “If you’re gonna engage in a pissing contest with your patient, make sure it’s over something that matters. Now wrap that foot – tightly – and don’t pussyfoot around with it.” BP nods in understanding and finishes her task, ignoring Miranda’s pitiful screeching as we get the bleedi
ng under control and strap her leg back to the spine board.

“Want me to set up an IV?” she asks, and I shake my head.

“Just get us there fast, but safe,” I order. “I’ll do whatever else I need on the way.” BP nods her understanding and starts to open the rear doors of the truck, but before she can twist the handle, the door is ripped open from the outside. A slight man wearing riding gear bulls his way into the back of the rig.

“What the fuck?” BP explodes angrily. “Get the fuck out of my rig!” The guy ignores her and tries to push past, knocking BP off balance. “Somebody get the fucking deputy over here!” she screams out the back of the rig, holding onto the overhead rail to keep from falling out entirely. I rise from my seat on the squad bench and plant a hand firmly in the man’s chest.

“That’s my fucking wife!” he screams, chest bowed out and fists balled menacingly. “Get the fuck outta my way!” It doesn’t make a very convincing threat display. I’m twice his size, and he has one foot still on the bumper of our rig.

“She’s alive, but in bad shape,” I inform him. “And she’s only going to get worse while I sit here and argue with you. You’re interfering with her care.”

“I’m fucking riding to the hospital with her!” he yells belligerently. BP’s eyes bug out a little bit at that, and wisps of steam start to rise from her ears. She isn’t cowed, not one little bit.

“You better back your ass outta my rig, or I’m gonna –” she starts to yell, bits of spittle flecking his face.

“Shut up!” I bark sharply. I face BP and remind softly, “Remember what I said about pointless pissing contests?”

Before she can reply, I turn to face the guy standing on the bumper of my rig, getting ass-deep into what we refer to in interpersonal communications class as His Personal Space. “These are your choices, Hoss. You can shut up, and ride back here with your wife, or you can continue to threaten, and I’ll make sure you go to jail. And the whole time you’re showing your ass while the deputy bodily pulls you outta my rig, your wife is just gonna get sicker. So what’s it gonna be?”

He glares at me for a few moments, and starts to yell something else, and I cut him off with a warning. “Yell at me or my partner once more, and you go to jail. And that applies all the way to the point we pull up to the hospital. We clear?”

I meet his gaze levelly, and he’s the first to blink. Nodding in acquiescence, he says, almost pleadingly, “O-okay. I…I just don’t wanna leave her.”

“Fine. Walk around the rig to the side door, get in and strap yourself into that jump seat. Let’s roll, BP.”

She glares at the husband as he meekly climbs out of the rig, throws me a dubious glance, and heaves a mighty sigh as she climbs out behind him and slams the rear doors. Fifteen seconds later, we’re headed back south down Highway 84, siren screaming. BP is still angry. I can tell by her driving.

I wrap the NIBP cuff around Miranda’s left arm and press the button as I rummage through the IV cabinet with the other hand. Normally, I don’t like to trust a machine to get my blood pressures for me, especially when we’re moving, but this time I split the difference. I palpate her radial artery as the numbers on the screen count downward, feeling for the pulse to return again. Swaying with the motion of the rig, I toss the IV bag, tubing and tape onto the bench seat behind me, my left hand still gently wrapped around Miranda’s wrist. At 68 on the machine, I feel the pulse come back, thready and weak. It doesn’t improve as the cuff deflates fully and the machine chirps its readout: 76/38.

Damn. Not good.

I’m not much for haphazardly pouring fluids into someone in an attempt to meet some arbitrary blood pressure numbers, but this lady needs a line, even if I don’t use it for anything before we get to the hospital. She’ll need blood, and IV fluids, and pain meds would be nice if I can find a way to give them. I wrap a tourniquet around her upper arm, swab just inside her elbow, and stab her with a 14-gauge catheter without warning. Miranda doesn’t even flinch. I thread the catheter, hook up the line and start the fluids running, then tape the whole shebang in place.

I stand back up, unclip the cellular phone from its cradle and thumb the speed dial button for Big City Memorial as I shine a penlight into Miranda’s eyes. Her pupils are equal, both of them constricting briskly to the stimulus. She blinks slowly a couple of times, focuses on my face and pleads softly, “Leg hurts…can’t you give me something?”

I shake my head gently as I hear someone pick up the ringing phone. “Memorial ER,” a familiar voice says disinterestedly.

“Kevin, it’s AD on CCT 206, five minute ETA with a Status One patient,” I begin.

“Whatcha got, AD?” Kevin asks, all boredom magically gone from his voice.

“Car versus motorcycle MVC,” I answer tersely. “Helmeted female, mid-forties, no reported loss of consciousness. Multiple fractures of the left femur, tib/fib and ankle, avulsion of the soft tissues of the left foot with profuse bleeding. BP is only 68 palp, heart rate is, well…lower than you’d think it would be. Only 60 per minute. We’re gonna need the trauma room, dude.”

“Interventions?”

“High flow oxygen, 14 gauge IV with fluids running, and the bleeding is under control. See you in five minutes,” I remind him.

“Trauma One on arrival, AD,” Kevin confirms. I thumb the END button on the phone and toss it onto the bench seat. I check the dressing on Miranda’s foot, examine her left leg more thoroughly, and peek out the window to get my bearings.

One open fracture of the distal tib/fib, two breaks in the femur as best as I can tell. Can’t check circulation in the foot through the bandage, but it looks like the bleeding has slowed down. Nothing’s soaking through, at least. Four more minutes before we hit the ER. So what’s left to do?

Miranda is crying softly, still begging me for pain relief. Her husband looks at me uncertainly, all his belligerence and bravado gone. “Man, can’t you give her something? She’s hurtin’, man.”

“Her blood pressure is too low,” I explain gently. “The main drug I can give her tends to make the BP crap out a bit when you give enough for it to do any good. Right now, I’m trying to save her life. Maybe if I get her pressure up enough, they can get her some pain relief in the ER.”

I’ve got better drugs to give her, I don’t say, and I can almost certainly get permission to give them, but by the time I get the doc on the phone, we’ll be at the ER. Maybe in another couple of months, the ER docs and I will know each other well enough that I can treat first, and beg for forgiveness later. But you don’t need to know all that.

“What’s her pressure supposed to be?” he asks, tears filling his eyes as he leans forward and brushes her hair away from her sweaty forehead. Miranda, for her part, shows she’s still conscious by reaching up and grasping his hand.

“A lot higher than it is right now,” I hedge, “but we’re doing what we need to get it back up. At the hospital, they’ll give her blood and take her to emergency surgery.”

“She’s gonna need surgery to fix her leg?” he asks fearfully.

He doesn’t know what avulsion means, I realize, and he didn’t see her foot before we bandaged it. Yeah buddy, she’ll need surgery. She might even lose part of that leg. Her riding days are over.

“So where were you when the accident happened?” I ask, choosing not to answer directly, and taking care to keep any accusation out of my voice. “Did you see what happened?” I busy myself attaching monitor electrodes and fetching more IV supplies from the cabinet.

He breathes heavily, blinks the tears out of his eyes, and stares at the
floor guiltily. “I was about five minutes behind her. We’d been at the bar since about seven, and we were headed to an afterhours club we know. She left before I did, and…”

“How much has she had to drink?”

“More than she should,” he blurts bitterly. “Both of us have. If I had just – “

“Just what?” I interrupt. “Dude, how much you had to drink is between you and the cops. I see no reason to tell them anything. And from the looks of things, she had no time to avoid the car. If you had left when she did, you’d have either watched it happen, or been laying on a spine board right next to her. Don’t blame yourself. I had one turn in front of me not two weeks ago. She damned near killed me.”

“You ride?” he smiles, blinking through the tears.

“Rode,” I corrected. “I’m still stove up, but as soon as I can get my bike replaced, I’ll be up again. I love it.”

“What kinda bike?” he wants to know.

“Suzuki Intruder 1400,” I grin ruefully, “now a permanent resident of the salvage yard on Highway 103, east of here a ways. It was totaled.” I squeeze past him and settle into the attendant’s seat on Miranda’s right side, wrap a tourniquet around her arm, and look for a likely site to insert a second IV. The NIBP monitor says her pressure is now 88/56, and she’s had roughly 350 ml of fluid. Better, but still not good. I stick a 16-gauge catheter in her left arm and quickly attach a saline lock.

“I ride an Electro Glide, and she has a Sportster,” he grins. He realizes what he said, and the grin vanishes almost as quickly as it appeared. “Had a Sportster,” he corrects himself. “We always wanted matching Harleys.”

“Looked like it was a sweet bike,” I say noncommittally. I avoid any empty reassurances about how they’ll soon be riding together again, because frankly, I don’t see it happening. She’s going to lose that foot, and possibly part of her leg below the knee. Riding a bike again is a long way off, if ever.

“It was,” he agrees. “Used to be mine. She liked riding it so much, I got another one for myself.” Before he can say more, the rig lurches and the backup alarm chirps.

“We’re here,” I announce unnecessarily, detaching the IV bag from its ceiling hook and disconnecting oxygen tubing, NIBP cuff and monitor leads. “What’s your name anyway?”

“Paul,” he says, automatically sticking out a hand. I smile apologetically and look down at my hands, full of IV and oxygen tubing, clipboard and monitor cable. “Yeah, sorry,” he apologizes, thrusting both hands deep into his pockets.

“No need to apologize,” I assure him. “Just follow us inside, and I’ll show you where the registration desk is so you can get her signed in.”

He says nothing as he meekly follows the stretcher inside, and as we turn to roll her into Trauma One, a burly security guard gently places a hand on his shoulder and pulls him back. “Can’t go in there yet, son,” he says firmly yet not unkindly. “They’ll call you when they know something.”

Instantly, Paul bristles and his fists clench. His face reddens immediately, and he turns to confront the security guard.

Damn, this guy has a short fuse. But he’s scared, and just a little drunk, and he doesn’t know what the hell to do.

“Paul,” I call out to him, and he turns his head toward me. “Remember what I said, dude. Getting pissed doesn’t speed things up for her. Go where the man tells you, and I’ll come get you in a few minutes.” Kevin shuts the trauma room doors behind us before I can hear his reply.

**********

Twenty minutes later, my paperwork completed, I peek back inside Trauma One. Miranda is still surrounded by nurses, and the ER doc is standing at the bedside, quietly giving orders. A vascular surgeon and the orthopedist poke and prod with professional interest at her mangled left leg, conferring with one another in soft, grim tones. Kevin is hanging blood on the line I started in her right arm, while a nurse is injecting some sort of medication into the line in her left arm. For Miranda’s sake, I hope it’s a big, whopping dose of Fentanyl.

I scan the monitor readouts, get Kevin’s attention, and nod toward the door. He walks over to me. “What’s up?” he asks softly.

“When’s she going upstairs?” I ask. “Her husband is outside, and I promised I’d fill him in on things.”

“She’s going to surgery any minute now,” he answers grimly. “She’s gonna lose that foot.”

“Damn. Too much vascular compromise?”

“She’s got a blood supply,” Kevin allows, sotto voce. “But there’s just too much damage. Vascular and ortho are just arguing over how high to cut it off. Personally, I don’t see why they can’t have that damned conversation over an OR table. We’ve done all we can do down here.” Behind him, the two doctors pore over images of her mangled leg on the radiology viewing screen.

“What can I tell the family?”

“Have the clerk put them in the Family Room, and say the ER doc will be in to talk with them in a little while. You can tell them she’s stabilized, but don’t tell them about the amputation, okay?”

“You got it, Kevin. Thanks, dude.”

“Don’t bring us anything else tonight,” he chuckles. “That’ll be thanks enough.”

I trudge down the hallway to the ER lobby, and look around for Paul, but he is nowhere to be seen. I check outside in the ambulance bay, half expecting to find him there smoking to calm his nerves. Still no Paul, and for that matter, BP is nowhere to be found, either.

I walk back into the ER, and on a hunch, try the door to the Family Room. It opens, and I find Paul and a small knot of family members all sitting huddled in one corner, talking quietly. Hope and fear simultaneously dawn on five faces as I open the door, and I feel almost guilty that I don’t have more news to offer. Before I can say anything, the other door opens and BP backs through it, carrying a tray full of Styrofoam coffee cups. She looks at me in surprise but says nothing, sits the tray on the table and passes out the cups, softly offering words of support. If I didn’t know better, I’d swear that aliens abducted my partner and replaced her with an exact duplicate that had a heart.

BP makes the introductions, and the rest of Miranda’s family thank us profusely for everything we did, a phenomenon that happens all too rarely and never fails to make me uncomfortable when it does. I blush like a tomato, and tell her family that she’s stable, and will be going to surgery in the next few minutes. I keep the news hopeful, but vague. They thank me again, but none of them bombard me with questions like I expected.

“I’ve been sitting with them, kinda keeping them updated,” BP explains softly. “They know what’s going on.”

“Oh,” I say. It’s all I can think of. After an uncomfortable silence, I make a show of checking my watch, and clear my throat.

“Yeah, we should be going,” BP gently tells the family. “Let us know how she does, okay?”

Everyone rises as we turn to leave, and to a person, they all hug Bitchy Partner before she walks out the door. Even Paul. I smile once again reassuringly, and gently shut the door behind me.

Outside, BP is waiting for me in the rig with the engine idling. She says nothing as I strap myself in, but before she puts the truck in gear, she asks nonchalantly, “So, how was my driving? Did it meet your standards?”

“Roughest fucking ambulance ride I’ve ever had,” I yawn, leaning my head back against the seat and closing my eyes. “I think I’ll be requesting a new partner first thing in the morning.”

She stares at me for a long minute, until I open my eyes again and turn to look at her. I hold her stare for as long as I can…and then I wink.

“Fuck you, AD,” she says as she puts the truck into gear, but she’s laughing when she say
s it.