Crime, Thrillers & Mystery / Found Wanting - Chapter 9 (Analysis)
Found Wanting
Chapter 9
Brian and Joyce managed to avoid any more calls for the rest of the shift. The West Bank had entered its quiescent phase. Despite the quiet, the last hour of the shift was always the most anxiety-driven. Waiting there for the end of the shift and to go home, but anticipating the possibility of receiving a late call made it impossible for Brian and Joyce to rest or study. You can’t do anything productive while you’re waiting for something.
Brian was scheduled to work on Wednesday, but Marc had called out sick. He ended up working an uneventful shift with Bryan, the paramedic whose name caused gossip around the station to be incorrectly attributed to Brian. To clarify which name the other employees were talking about, Brian was referred to as “Straight Brian” and Bryan was called “Gay Bryan.” Their patient load consisted of mostly elderly people feeling weak during the day, and drunk tourists at night, along with one of their frequent fliers uptown. The most interesting aspect of their shift was the vaguely entertaining times that ER staff would say “Hey, Bryan,” and both medics would answer.
Brian had to call out sick on Friday; he wasn’t really sick, but paramedic class had taken a lot out of him and needed to rest. He had class every day he was off, and the night shift with Joyce had wrecked his internal body clock. With Brian out sick, Marc would work with Gay Bryan that day. Gay Bryan worked the other swing shift on a similar schedule as Marc and Straight Brian, ten a.m. to midnight, three days a week.
“Nice to work on a double-paramedic truck for a change,” Marc said after a few calls. “I like Brian a lot, he’s a good partner, but having to tech every call gets old after a while.”
“I know what you mean,” Bryan answered in his slow southern drawl. “My partner’s a Basic too,” he said, referring to Mandy, his usual cohort. “She’s been moved to dispatch.”
“Oh yeah, I was wondering who that was on the radio. When is she due?” asked Marc.
“Not for six months. But her doctor said she had be on light duty, so no lifting or CPR or anything. I’ve been working with mystery meat since she got moved. I worked with your partner on Wednesday. He said paramedic class is killing him. I said ‘boy, you’re preachin’ to the choir here.’ He’ll make a good paramedic one day.”
Both paramedics laughed at Brian’s complaint about how difficult paramedic class was. Marc had been a paramedic for fifteen years and an EMT-Basic and an EMT-Intermediate for four years before that. Bryan had been a paramedic for five years and a Basic for two years. Yet both could recall their own difficulties with paramedic school as if it had been just last week.
They picked up a patient with continuous seizures, a kid with asthma, an elderly man who had fallen and broken his hip, and a heroine overdose during the first half of the shift. All their patients had required interventions: IV’s and oxygen on all of them, Valium for the seizure, Albuterol and Atrovent for the asthma, Morphine for the broken hip and Narcan for the overdose. “Man, we are some drug-pushing bitches today!” Bryan observed.
“No shit!” Marc responded. “I don’t mind picking up patients that actually need the ambulance; it’s those chronic motherfuckers that step on my last nerve with both feet.”
“Oh, I know,” Bryan answered. “I had Jimmy Givens the other day with your partner. Tried to tell me he hadn’t been to the hospital in months when I knew full well that I had picked him up two weeks before that.”
“You mean that guy who always tries to claim he was a Navy Seal?”
“That’s the one. If he was a Navy Seal, then so was my grandmother. Fucking crackhead. And the worst part about him is he really does have medical problems, so you can’t get him to refuse transport or tell him to get up the street,” Bryan went on. “And he cops an attitude when you try to call him out on his bullshit.”
“Yeah, I know him,” Marc affirmed, pondering the possibilities of Givens being his next recipient of his unique form of therapy.
After nightfall, the French Quarter calls began coming out as usual. Since it was Friday night, it was particularly busy. Mandy called Bryan and Marc to send them to a “man down” at 800 Bourbon Street, at the Oz.
“This is your neck of the woods!” Marc joked with Bryan as they drove to the scene.
Bryan smiled. “Nah, I never go there. Bunch of posers at the Oz. I like the Bourbon Pub across the street. Good videos.”
“Videos, huh? Riiiight,” he continued. He and Bryan both laughed at the irony of the joke. Bryan was a very good-looking, muscular man from backwoods Mississippi, the hunting/fishing/football type of guy. Even his name at work was a joke; Gay Bryan was one of the last people anyone would expect to be gay, even though he was “out” and it was no secret.
“They do have good videos,” Bryan said, still laughing. Many of the EMT’s, both gay and straight at the service, visited the Pub for drinks. Tolerance for “alternate lifestyles” in EMS was a non-issue. The unspoken camaraderie that existed between the EMT’s drawn from the pressure of dealing with life, death and suffering day in and day out transcended any prejudice over being straight, gay, black, white or any other dividing line that others might recognize.
At the scene, there was a swirling crowd of people at the corner of Bourbon and St. Ann. Since it was near New Year’s, the state had sent in extra state troopers to assist NOPD with law enforcement. Blue lights flashed all around, making the street a more flamboyant disco floor than the mirrored ball and lasers did inside the gay bar. Bryan pulled the stretcher out of the truck as Marc headed into the crowd to try to find their patient. Marc’s search was unnecessary, as four state troopers pushed out of the mass of people toward the ambulance carrying a man by his arms and legs. Even before Bryan could lower the stretcher to ground level, the state police swung the unconscious man up and flopped him onto the stretcher.
“Wow. Thanks!” said Bryan, appreciative of the troopers’ saving him and Marc the trouble of going through the crowd.
As he and Marc got the stretcher and the man back into the truck, two other men began to climb into the back of the truck, both wearing only tight jeans and leather harnesses over their bare chests despite the cold December night, the same outfit as the man on the stretcher. “We’re physicians!” they both shouted. “He’s in cardiac arrest!”
“Whoa, whoa! Y’all can’t come up in here!” Marc shouted at them over the noise of the crowd and music pouring out of the nearby bars.
“We’re both emergency room doctors! We work at Keesler Air Force base in Biloxi!” He’s in cardiac arrest!”
Bryan had been assessing the patient and attaching the EKG monitor. “They’re right, he is in cardiac arrest,” he said noting the ventricular fibrillation on the monitor. Bryan began chest compressions. “You two can come, but you have to assume full responsibility for the patient and you have to ride with us to the hospital,” Bryan informed the two of the service’s policy for on-scene physicians who wanted to bark orders at the EMS crews.
The two guys looked at each other and hesitated a moment. Usually informing a doctor of the policy was enough to scare the doctor away when faced with the inconvenience and liability of assuming care of whatever random patient they happened to find themselves near on 911 scenes.
“Okay, we’ll go with you!” one said as they climbed into the truck.
“Oh, Jesus!” Bryan muttered under his breath to Marc.
“He needs to be defibrillated!” one of the doctors shouted, with a gay lisp that made both Marc and Bryan chuckle.
“I know,” said Marc as he attached the defibrillator pads to the man’s bare chest. “Well, that harness at least makes it easy to get to his chest,” he commented nonchalantly.
“You can defibrillate?” the doctor said.
“Um, yeah. Clear,” he said making sure no one was touching the man or the stretcher. He charged the monitor and hit the shock button.
“He needs to be intubated!” the other doctor shouted.
“I know,” said Bryan. “I’m on it,” he said as he pulled out a laryngoscope and endotracheal tube. He pushed the blade of the scope down the man’s throat, followed by the tube.
“You can intubate?” the lispy doctor asked.
“Obviously. Check his breath sounds,” he said to the physician, tossing him his stethoscope.
“You’re in!” shouted the doctor, listening to the man’s chest as Bryan squeezed the Ambu bag to ventilate the patient.
Marc had started an IV on the man while Bryan intubated. “He needs Epi!” the doctor lisped.
“Yes he does,” Marc said calmly. “Got it right here.” Marc pulled an Epi syringe from the bag.
“You have Epi?” asked the doctor as Marc injected it into the IV.
It was Bryan’s turn to handle the patient, and he was already getting tired of the screechy doctors in the back of truck with him. But he tried to remain professional while dealing with the physicians. “Okay, y’all, what are your names?”
“I’m Steve, this is Max,” lisped Steve.
“Steve, Max, I appreciate your help, but let’s try to keep the shouting down. Steve, you ventilate the patient. Max, you do chest compressions,” Bryan gently ordered them.
Once the two doctors had something to do and keep them occupied, the code went much better. It left Marc and Bryan to perform their duties without shouting and hysteria in the back of the unit. The monitor still showed a crazy, uncoordinated line on the screen - ventricular fibrillation. Bryan charged the monitor and shocked the patient again. After a minute of two, he told Max to stop his compressions so a pulse could be checked. The monitor beeped with a coherent pattern now. Max and Bryan both felt for a pulse.
“He’s got a pulse!” Max said, apparently surprised that an ambulance crew might possibly accomplish such a feat.
Bryan checked a blood pressure. “Seventy over thirty. Let’s start some Dopamine.”
Marc pulled out the Dopamine from the bag and hooked it into the IV line, setting the rate after a quick calculation in his head. “Time to go?” he asked Bryan.
Bryan nodded and keyed up his radio “Carry me to Tulane,” he said, informing dispatch.
Marc exited the truck, casting a quick glance at the two leather-clad men, then at Bryan, offering a sympathetic smile as he closed the door. ‘Poor guy. Having to deal with not one but two doctors! God help him,’ he thought.
Bryan cut off the man’s jeans and fished around for identification in the pockets to help get information for the run report. Bryan noticed Max and Steve checking out the patient’s naked crotch. “So do y’all know this guy?”
“No we had just met him. We were dancing with him and he collapsed,” Max informed.
“Probably ecstasy or GHB or something,” Bryan proffered. He noted the two physicians giving each other worried looks at the mention of illegal recreational drugs. ‘Yeah, that’s what I thought. Whatever; who cares?’ Bryan thought to himself.
The patient maintained a pulse on the way to the hospital and the Dopamine increased his blood pressure to normal levels. By the time they arrived, the man had begun moving a little bit on his own, a sign of a successful resuscitation. Bryan and Marc rolled the patient into the ER trailed by Max and Steve in their tight jeans, construction boots and leather harnesses strapped across their bare chests. Both paramedics had a hard time controlling their laughter at the looks the ER staff was giving the two leather-daddy doctors.
After giving his report to the staff, Steve told Marc and Bryan “You two were great. I wish codes would go that well in the hospital!”
“Thanks. Y’all can come ride with us whenever you like,” Bryan responded, subtly eyeing Steve and Max up and down.
Marc caught the almost imperceptible motion of Bryan’s eyes and could hold onto his laughter no longer. He began laughing so hard he fell onto the ground outside on the ER ramp. All three gay guys knew exactly what Marc found so funny and they too began their own bouts of uncontrolled laughing, having been caught cruising each other while trying to maintain some semblance of professionalism while wearing their ridiculous outfits.
“Dude, that was hilarious!” Marc told Bryan later in the truck. Both medics would have a case of the giggles for a while to come, spontaneously bursting out chuckling when thinking about the insane circumstances surrounding their patient. It was situations like that that made for a “good call.”
They had a short break until their next call. It was for a man with “chest pains.” Marc wrote down the address as Bryan drove. “I’ll bet this is our friend,” Marc informed.
“I thought that address sounded familiar. Good ol’ Jimmy again. Wonder how long we’ll be on scene before he says something about being a Navy Seal,” Bryan commented.
Bryan didn’t have to wonder long. As they pulled up on scene, Jimmy Givens met them at the street, wearing a baseball cap, tee shirt and jacket, all three garments emblazoned with “Navy Seal” on them. The baseball cap still had the price tag from the thrift store Jimmy had purchased (or stolen) the clothes.
Marc rolled down the window as Jimmy walked up to the truck. “What’s up Jimmy?”
“Man, I need to go the hospital. My chest is killing me,” Jimmy explained.
“Jimmy, I just brought you there two days ago for the same thing,” Bryan said from the driver’s seat.
“What, you tellin’ me I ain’t having no chest pains? Man, I protect and serve you and this country every damn day and you’re saying I ain’t sick? I’m a damn Navy Seal, man!”
“Protect and serve us, huh? How? By calling 911 every day for your non-existent chest pain?” Bryan argued back.
Marc decided to end the bickering. “Come on Jimmy, get in the truck,” he said, getting out and opening the back door for Jimmy. Bryan grumped and hopped into the back too.
On the stretcher, Jimmy continued complaining about the paramedic’s attitude towards him. Both Marc and Bryan knew he complained about EMS crews’ “attitudes” regardless of how polite the crews were, so it made no difference whether they were polite or insulting.
Bryan attached the monitor and ran a twelve-lead EKG while Marc checked a blood pressure. The EKG was a mess, as usual. Givens had a litany of real medical problems, many brought on by his constant crack abuse. Marc listened through his stethoscope to the blood pressure. “Seventy-two over fifty,” he informed Bryan. “I think he really has something going on today.”
“You see? I told you I was sick!” Jimmy told Bryan with venom in his voice.
Marc looked for a vein in Jimmy’s arm to start an IV on while Bryan spiked a bag of IV fluid. “I’m not gonna fish around; you’ve got no veins I can see here. I’m going to have to stick you in your neck, Jimmy.”
“Yeah, you do that. I serve you every day; it’s about time you serve me,” Jimmy ordered.
Marc laid the stretcher down and stuck the needle into the jugular vein on the right side of Jimmy’s neck and attached the IV line. “Just run it wide open,” he told Bryan. “Pull out the Dopamine, I’ll give it en route.”
Bryan opened the bag and located the spare Dopamine. They had used the premixed bag on their cardiac arrest earlier, so Marc would have to mix it the drug. Bryan pulled out the two vials of Dopamine and a smaller IV bag of D5W, 5% Dextrose in water. He placed it on the bench seat and hopped out to get back into the driver’s seat. ‘I’m glad it’s Marc’s turn. I can’t stand that bastard. I’d be tempted to just give him all the Dopamine,' Bryan thought to himself.
Marc drew up the Dopamine into a syringe and stuck a piece of tape on the IV bag, writing “Dopamine 400 mg” on it so it would be clearly labeled. He spiked the bag and piggybacked the line onto the first IV going into Jimmy’s neck.
“That asshole thinks he can talk to me like that. I’ll sue his ass! I’m a Navy Seal and he ain’t shit!” complained Jimmy about Bryan as the ambulance headed off.
Marc picked up the syringe full of undiluted Dopamine. It was used to increase blood pressure. Jimmy’s run report would say his pressure had initially been 72/50. Marc calculated the proper infusion rate for Jimmy. Jimmy should get ten micrograms per kilogram of body weight per minute. His calculation came up with an infusion of a half milliliter of IV solution per minute, eight hundred micrograms of Dopamine per minute to increase his blood pressure with the powerful medication. He injected the syringe directly into the IV line, giving Jimmy over five hundred times that amount in the space of one second.
Marc pictured the cells in Jimmy’s body. Dopamine was a natural chemical found in the body. It functioned as a neurotransmitter and helped regulate blood pressure and brain activity. When given as a medication, extremely tiny amounts were used. Marc envisioned the neural receptors in Jimmy’s heart. Suddenly flooded with pure dopamine, they would contract and not relax. The EKG monitor confirmed Marc’s imagination. It showed a brief interval of ventricular fibrillation, then a flat line a few seconds later as the Dopamine washed over the cardiac muscle cells. Some Dopamine reached Jimmy’s brain and other organs in the final few heartbeats before all activity stopped. Marc imagined his brain cells being overwhelmed with the chemical. The overstimulation would cause a seizure, but being hypersaturated with Dopamine like the heart, the synapses were unable to transmit the chemical messages through the nervous system to the body. As Marc had seen in his mind, Jimmy’s body simply ceased to function.
Bryan was listening to his radio as he drove. He heard someone key up and announce to dispatch that their patient had just coded. It took a second for him to realize that the voice on the radio was that of his partner. “Givens coded?” he called through the window into the back.
“Yep. Went into asystole,” Marc informed.
“Holy shit! That’s awesome! I’ll drive slow,” Bryan responded, welcoming the unexpected news. ‘I never thought we’d be rid of that bastard.’ he thought.
Marc began his usual steps. They were only a few minutes from the hospital, giving Marc time only to intubate Givens and push one round of Epinephrine and Atropine. He was about to shoot the drugs into the wheel well, but paused and gave them intravenously. The activity of the vasopressors would increase the action of the Dopamine that was inhibiting the function of the cells, ensuring that Givens wouldn’t be resuscitated at the hospital.
The ER staff continued working on him, giving more Epinephrine and Atropine. Marc knew that every injection on top of all that Dopamine was pushing Jimmy farther and farther into the grave as his cells continued to be more and more overwhelmed. Each chest compression circulated the deluge of Dopamine throughout the body, shutting down organ systems one by one. The code drugs would come right behind and reinforce the overstimulation that the Dopamine had caused. After twenty minutes, Dr. Morgan decided to call it. “Time of death, twenty-two thirty-two,” he announced.
Marc thought back to his church call from the previous Sunday. Givens had been weighed in Marc’s balances and had been found wanting. He was a useless, lying, rude, crackheaded thief, who had never served in the military a day in his life despite his claims. He drew welfare, disability and Medicaid for the host of medical problems he had caused to himself. And Marc had no need to hide anything this time. He couldn’t have asked for better circumstances. The Dopamine was clearly indicated to use for Givens low blood pressure, even though Marc had actually measured the pressure at a hundred ninety over ninety-four. What mattered was that is appeared on the run report as dangerously low, as Marc had misinformed Bryan. No one would check whether or not there really was Dopamine in the bag of fluid labeled “Dopamine 400 mg.” And being a natural neurotransmitter, nothing unusual would show up in any autopsy, especially since the chemical would break down by the time an autopsy took place. Even the problem of tissue necrosis was solved. Such a huge dose of Dopamine would normally result in tissue death if it had been injected in an IV in an arm, but since the IV was basically a central line, placed into the jugular vein, nothing would be noticeable. It was perfect.
Marc and Gay Bryan finished out their shift, transporting one more patient to the hospital, a gunshot victim shot to the chest. After work, Bryan asked Marc if he wanted to go for a drink. Marc accepted, asking “Where do you wanna go?”
Bryan answered “Where do you think? Bourbon and St. Ann! Let’s go find those doctors.”
Marc laughed again. “Okay, man. Sure.”
They headed out and found Max and Steve, hung out at the Bourbon Pub till four a.m. exchanged stories and recollected the events from earlier, as EMT’s usually did when away from work. Eventually, Bryan left with the two doctors; Marc headed home.
‘This was a good day,’ he thought to himself as he laid down to sleep.
Sunday rolled around; Marc’s next scheduled day to work. Straight Brian was back. He greeted Marc as he got the truck ready for the day. On the way out of the station, Brian commented “I heard you coded what’s-his-name, that Navy Seal guy who always calls. Bryan was telling me”
“Yeah,” answered Marc. “Died right in the back of the truck on the way to the hospital.”
“Hmm,” he said. “Another one like that?” Brian thought for a few minutes as an odd silence filled the truck. “I have to ask you something.”
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Homosexual might be a better word.
“giving Jimmy over five hundred times…” Wow, his heart will burst right in his chest or at least his veins will explode( what few he has) Good descriptions. I will email. Sandi
I enjoy the mystery of this piece. As usual your characters are well-drawn. The medical terminology is stellar and adds realism to your work. You have away of putting the reader in the back of the ambulance.
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