There’s two more chapters! Stay tuned! Thanks for your review, I was nervous about the way I described the conversation between patients.
Crime, Thrillers & Mystery / Found Wanting - Chapter 10 (Analysis)
Found Wanting
Chapter 10
“What’s that?” Marc asked as they pulled into the convenience store to get their usual morning cup of coffee.
“Let’s get our coffee,” answered Brian. He had been thinking about the empty vial of Potassium Chloride he had found. He had gotten distracted since his shift with Joyce; dealing with paramedic class, calling in sick, recuperating from a rough week. After a few days he had nearly forgotten about the unusual medication he had found in the sharps box when it accidentally spilled out. He gave it a minute and waited till after obtaining their drinks and were back in the truck.
“Ever heard of Potassium Chloride?” he asked Marc.
“Of course,” Marc replied, somewhat less cheerful. “Why?”
“What’s it used for?” Brian inquired.
“For patients with hypokalemia. Low blood potassium can result in arrhythmias. It usually looks like a tall T-wave on the EKG. If your potassium’s really low, it can kill you. Studying pharmacology this week, I see,” he answered, laughing but without humor.
“I was looking up drugs on the internet. Potassium can be quite deadly, apparently,” Brian said. “Did you know it’s also the stuff they use on Death Row for executions by lethal injection?” Brian continued.
“Yes. Too much potassium will kill you the same as not enough.” Marc fidgeted in his seat. “Why do you ask?”
“Do we carry it on the truck?”
“No. It has to be given on a pump and it’s only given in the hospital,” Marc answered flatly, looking straight out the front of the windshield. He paused a second and asked Brian “Did you bring your lunch today or are we buying lunch today?”
“I’ll have to stop and get something. Or try to, at least,” Brian answered. Just as he opened his mouth to change the subject back, dispatch called on the radio, “Stand by to copy,” said Mandy.
Mandy dispatched Marc and Brian to a motor vehicle accident on the West Bank. Behrman and Tullis, almost at the Jefferson Parish line. “One of the vehicles is supposedly on fire, I’m sending rescue and fire with you,” she said.
Brian wrote down the information and rolled his eyes. “You ever notice how the more hysterical dispatch sounds about calls, the less serious the calls are?” he noted.
Marc laughed more genuinely as he drove to the scene. “Yep. Guarantee you this’ll be nothing but a bunch of bullshit,” he commented.
They pulled up to the scene. Both medics quickly surveyed the scene and were astonished that it really did appear to be a serious accident. One car was near the side of the road, upright but it had obviously rolled over several times. The only undamaged portion of it was one of the tires that wasn’t flat. The other car was across the street lying on its side, its front end still wrapped around the stump of the telephone pole it had broken. Flames licked out from under the hood. Bystanders had gathered around the car and appeared to be pulling the car’s occupant from out of the open sunroof.
Marc looked at the upright car on his left and noted two occupants inside, not moving, apparently dead. “I’ll look at this car, they’re gonna be fatalities. You take the other one.
Brian ran over to the burning car and enlisted the bystanders to help move the female farther away from the burning vehicle. She appeared dead, with burns over much of her body and several fractures apparent.
Marc peered into the upright car and saw the two women inside, not breathing. Their bodies were pushed up into the center of the car and the mass of wreckage around them made it impossible for him to reach them. “Keep rescue coming, but this is gonna be a recovery; I have at least two fatalities here.” He glanced over at Brian across the street and saw a dangerous situation; Marc couldn’t waste any time by walking over to the other car. “Brian, get those bystanders out from under that power line!” he called to his partner over his radio. “The pole is broken and the car is setting fire to it!”
Brian glanced up, saw the power lines hanging awkwardly and evacuated the bystanders from the area. Marc had arrived with the EKG monitor. He told Brian to help him move her farther from the burning car. As he attached the monitor, he saw the display confirm the burned woman was dead. The flames from the nearby car began to spread from under the hood to the rest of the car. “Get out from under these power lines,” he ordered Brian. He contacted medical control quickly to get the woman pronounced. Halfway through his report, the flaming car exploded; Marc felt the heat and the blast but was distant enough that he was uninjured. The broken pole had caught fire; Marc decided it was time to get away and headed back to the first car. As he left, another explosion emanated from the burning car, knocking the pole and breaking the power lines, which sparked and crackled on the ground in the exact spot that Marc, Brian and the bystanders had been. Marc completed his report and obtained a time of death, switched back to the dispatch channel and asked for the power company to come out to disable the electricity. “We don’t need any electrocutions on top of all this mess,” he informed.
Marc tried to get Do Not Resuscitate orders on the other two women in the first car. “I have two patients in this car, both females approximately in their mid-twenties, unresponsive and apneic. The vehicle is too damaged for me to climb in and get an EKG on them or do any kind of interventions, but their injuries are apparently incompatible with life, and it’s gonna be a very extended extrication process to get them out. Calling for DNR.”
Dr. Hunter on the other end of the radio said “So can you give me an idea of what kind of injuries they have? Are you sure they’re pulseless?”
Marc repeated “As I said, I can’t really physically get to them, so I can’t give you a full assessment of their injuries. But I can tell you that both are unresponsive and not breathing, crushed under several feet of car, so whatever their specific injuries are was enough to cause death. Calling for DNR on both.”
“Well, I’m not going to be able to pronounce them until I have a better assessment. Is there any way you can get closer to assess them?” Dr. Hunter asked.
Marc glanced at Ricky, the rescue paramedic who had arrived on the scene in the extrication truck. “Is he giving you shit trying to get a DNR?” Ricky asked, confounded that Marc was getting such a hard time from medical control.
“Yeah! Wants me to to get a better assessment! I can’t get anywhere close to those women unless you cut the whole car apart! What the hell?” Marc said to Ricky, almost exasperated.
Brian shouted to Marc from a hundred yards away, “Marc! We have another patient! She’s alive!”
“Shit!” Marc said. He keyed up his radio but released the button, not knowing what else to say to Dr. Hunter. He was obviously not going to grant a DNR on the other two dead patients, and now Marc had someone who had survived the accident to deal with. Marc knew the new patient’s injuries would be severe, judging from the impact that was enough to kill three other people.
Ricky noted Marc’s quandary. “Dude, you go deal with the new patient; I’ll handle this and get your DNR from med control. You have bigger fish to fry,” Ricky said, switching over to the medical control channel to talk to Dr. Hunter.
“Thanks, man. I owe you one,” Marc said, taking him up on his offer. Marc grabbed a spineboard and cervical collar from the truck and headed over to Brian’s location.
The woman was unconscious; bystanders had gotten her out of the burning vehicle first, and told Brian about her while Marc was dealing with medical control. She had a head injury and red marks on her chest. The two medics quickly got her onto the board and collar and into the truck. “Blood pressure is eighty-six over forty, heart rate one-thirty, pulseox is 75%” Brian informed.
Marc attached the EKG leads and spiked a bag of IV fluid. “Check her breath sounds,” he said to Brian.
Brian listened to her chest through his stethoscope. “I dunno, I think they’re okay. She’s not really taking deep breaths.”
“All right, you get this IV, I’ll check,” he said.
After observing and listening to her chest, Marc fished the airway supplies out of the bag. “She’s got a tension pneumo; have you ever decompressed a chest before?”
“No,” Brian answered, nervousness in his voice. “You mean like a chest tube? We have those?”
“No,” answered Marc. “We just have to make do.” He located a fourteen gauge IV needle from the bag and attached a syringe to the end of it. Brian watched as Marc swabbed the left side of the girl’s chest with alcohol, then pushed the needle deep into it, near her left shoulder. Brian winced as he watched Marc stab her. He pushed the IV needle in, pulled the plunger back on the syringe, withdrawing air and a little frothy blood, then took the needle out, leaving the IV catheter protruding from the chest, which hissed as the needle came out.
“Dude, you got that IV started?” he asked Brian, who had gotten distracted from the task while watching Marc perform the chest decompression.
“Oh, sorry!” he answered. He turned back to the arm he was trying to start the IV on.
Marc pulled out the laryngoscope and an endotracheal tube. The cervical collar made it difficult to open the girl’s mouth enough to see, and she gagged as the steel blade pressed deep in her throat.
“Man, how are you gonna intubate her? She’s still breathing and...”
Marc waited a second for her to inhale and as she did, he pushed the tube into her trachea and inflated the cuff to hold it in place before Brian could finish his sentence.
He attached the Ambu bag and listened to the chest with his stethoscope to make sure the tube was in the right place. “You were saying?” he asked Brian, smiling. “Breath sounds are better; what’s her pulseox?”
“Up to ninety-three percent!” Brian said, obviously impressed with Marc’s skills. He had been on many trauma calls with Marc and knew he was a skilled paramedic, but watching him in action on such a stressful call impressed Brian even more deeply. “Ready to hit the road?” Brian asked.
“Yep,” he said.
On the way to the hospital, Brian reviewed the scene in his head. He had been overwhelmed at the accident, unsure what to do besides help pull the body from the burning car. The danger of the burning power lines had escaped his notice, but not Marc’s; he had saved Brian and the bystanders from electrocution. There were three fatalities to deal with, and Marc had done so efficiently and emotionlessly, even while the medical control doctor was making an already difficult scene even worse. Marc worked quickly and skillfully on the injured girl, recognized the life-threatening injury that Brian had missed and managed to complete interventions that Brian doubted he could have done himself. Despite the fatalities, Marc had saved lives today, and not just the patient on the stretcher.
After delivering the girl to the hospital, Brian asked about her. “How could you tell she had a tension pneumothorax? I checked her breath sounds and they sounded fine.”
“You may have heard the crepitus, the noise from her fractured ribs moving, but she had no breath sounds on the left. And her trachea was deviated, and there was some JVD too. Classic signs of a tension pneumo.”
Brian felt sheepish. He knew he was a good EMT and had some the best grades in his paramedic class. But he felt embarrassed that he had been unable to properly assess the girl. Marc had assessed her, decompressed her chest and gotten her intubated in two or three minutes. Brian was still flailing around trying to get one IV while Marc did all that. “Good job,” he told Marc, feeling somewhat deflated.
“Thanks,” Marc answered, putting his arm across Brian’s shoulder as they walked back to the ambulance. “You’ll get the hang of it with experience. You did well too. You were about to ask me something before this call. What were we talking about?”
“Oh. Yeah. Um... I was asking you about potassium.”
Marc quit smiling, abruptly knocked down from his adrenaline high. “Oh. Okay,” he said with a completely different tone in his voice.
Brian was not even sure he wanted to bring up the subject again, especially after seeing how proficiently Marc had acted on the scene of the accident. ‘Surely there can’t be anything amiss. I must have been crazy to think that anything unusual was going on with Marc,’ Brian thought. But Marc’s sudden change in demeanor set off the strange alert in his head again. ‘Do you think your partner did something that caused them to die?’ he recalled Tammy’s words from months before.
A flood of suspicion entered Brian’s mind at that point. The unusual deaths, the potassium he found, Tammy’s ideas of foul play, Marc’s sudden change in mood at the mention of the potassium - all coalesced into a picture that formed in Brian’s head. Another awkward silence filled the truck as these thoughts overwhelmed Brian. Finally, one more image entered his mind. He pictured Marc kneeling on the floor of the church they responded to last week, uttering the words of the preacher, ‘you have been weighed in the balance and you have been found wanting.’ All the strange deaths had been people that they had discussed as being not worthy of existence, a burden on society. ‘Is Marc killing the people that he thinks aren’t worthy of existence?’
“You said it’s used for patients with hypokalemia?” Brian finally said.
“Yes.”
“And what do you use it for?” Brian asked, not quite able to make eye contact with Marc.
He turned slowly to Brian. ‘What the fuck?’ Marc thought to himself. ‘How does he know? Every time it’s been perfect, with no evidence. How do I answer this?’
“What makes you think I use potassium?” he said after a long pause.
“Marc, I found an empty vial of potassium in the truck. We’re the only ones that have used this truck in weeks. You had to have put it there. I didn’t. What was it doing there?” he asked as calmly as he could. Brian kept thinking as he spoke ‘He didn’t deny using potassium. Please give me a legitimate reason for it’s being there.’
Marc stammered on his words. “It... I... I have no idea how it got in the sharps box. Someone else must have put it there.”
Brian was horrified. His eyes grew wide and his breaths came fast. “Marc, I never said it was in the sharps box.”
Both medics sat silently, their heads against the seat, staring at the ceiling. Both quietly confronted their worst fears. Marc had been discovered killing patients. Brian was accusing his partner of murder and had found out he was right. Neither knew what to say.
“Stand by to copy,” said Mandy over the radio. No matter how serious or stupid this call was, both EMT’s felt relief at the distraction this call would offer. They drove to the scene to handle the call. Both medics knew that handling the 911 calls came first and this issue would have to be dealt with in the midst of emergency response. Their discussion continued throughout the day and night, broken up by responses to calls. They spoke about it on scenes, in the back of the truck and over patients they were treating.
“Why do you do it? Does it have something to do with that ‘weighed in the balance’ thing I heard you quote at the church last week?” Brian asked as Marc pushed Narcan into the IV of an overdose patient.
Marc pondered a moment, trying to phrase his words correctly. “I think you already know why. You, yourself, said ‘why are we keeping him alive?’ when we picked up Ivan one day. Tell me, why did you say that?
Brian saw where Marc’s line of reasoning was going.“Because he was a useless oxygen thief. He burdened EMS every day with his drunkenness.” Brian admitted. As the overdose patient woke up, the conversation was suspended till the next opportune moment.
“Right. Not only did Ivan burden us, but every hospital in the city. And who pays for all those ER visits?” Marc asked while tying four-point restraints to a combative, postictal seizure patient.
Brian thought for a minute while keeping the patient’s arms restrained from punching him again. “We do.”
“And what did Ivan contribute to society?” Marc asked. “What did we... I mean, the world, gain from his being alive?”
Brian didn’t know what to say. He just stared as Marc squirted Versed into the patient’s nostril to calm him down. ‘I’d like some Versed too. I wish I’d never brought it up,’ he thought.
“But you can’t just go around killing people!” Brian almost shouted. “It’s illegal!”
“No, you can’t kill people!” said the ninety year-old on the stretcher in a brief moment of clarity from his Alzheimer’s delirium.
“Just because allowing the parasites of society to live is legal, doesn’t mean it’s right.” Marc said sincerely.
Brian was confused. “What?”
“Abortion is legal; does that mean it’s right? Stem cell research is illegal; does that mean it’s wrong? When a rapist or child molester gets off scot-free on a legal technicality, is that right?”
“But we’re here to save lives, not kill people,” Brian protested. “How can that be right?”
Marc secured the cervical collar as Brian strapped the mentally retarded Down’s Syndrome patient to the spineboard. It was difficult to avoid getting spattered with blood from the patient’s lacerated head as he shrieked and thrashed in fright. “Take a look at the rest of the world,” Marc said. “Do wild animals tolerate other animals who contribute nothing to the pack? A tiger that refuses to hunt dies. A squirrel that doesn’t store food for the winter starves. Whole ecosystems have evolved to eliminate parasites - cleaner fish and cowbirds - they exist by removing parasites and the other animals line up to receive their services.”
Marc motioned to the Down’s Syndrome man screaming on the spineboard. “Do you think that this poor soul would have lived to adulthood in any other society? He would have been eaten by the wolves long ago. But at least having Down’s isn’t his fault, he can’t help it.”
“So why not do one of your mercy killings to him, seeing as he’s so useless?” Brian asked sullenly.
“He’s not useless, that’s the thing. We picked him up from his job. He works at that broom factory making brooms. Sure it’s not much, but he contributes something to the world. Just because you’re handicapped doesn’t mean you’re useless. Ever heard of Steven Hawking? Can’t move a muscle, he’s paralyzed in a wheelchair from Lou Gehrig’s Disease. He’s also one of the greatest physicists in the world.” Marc explained. “I don’t care if you’re handicapped or perfectly healthy, I just need to know if you even want to be a productive human being. Think of Ivan, did he even try to do anything with his life anymore?”
Brian thought for a long while. “I don’t know. How can you set yourself up to be judge and executioner of these people? No, I’m not going to kiss you,” he said as the drunken sorority girl on the stretcher continued to ask the medics to make out with her.
“We all judge. Some people judge others based on first impressions. Some people judge others based on their race or nationality or religion or sexual orientation. Stop, you’re getting vomit on me,” he said as he removed the drunk girl’s hand from his crotch. “I’m only taking action against behavior that everyone else complains about, but they do nothing to rectify it. Even you’ve told me that you wondered why we tolerate parasites.”
“Yeah, but I don’t kill them!” he argued.
“Like I said, just because it’s legal, doesn’t mean it’s right, letting the parasites live,” Marc answered. “Instead of taking an example from nature, which by the way, has prospered for billions of years by ‘survival of the fittest,’ people have set up a system that allows individuals to leech off of others their whole lives, sucking up resources but never contributing a thing to the system that supports them.”
“So that’s your criteria? Whether or not someone has a job and pays taxes?” Brian asked as he started an IV on the gunshot victim.
“Not necessarily. You can be a productive human being without a job. For example, someone who’s jobless and on welfare can still raise a decent family. A poor, starving artist who doesn’t pay taxes is still contributing something to the world.”
As a vial of crack cocaine fell out from between the patient’s butt cheeks after Marc had cut off his pants, Brian asked “So what about this guy? He’s a drug dealer, not contributing to society. Why are you bothering to help him?”
“His lifestyle will kill him. Hell, it already has. He’s not going to survive this,” Marc said, pointing at the brain tissue protruding from the hole in his head. “He doesn’t need me to help with that.
Marc applied oxygen to the unconscious priest who was having a stroke. “Everyone needs to have a function in the world. Mine is like the cleaner fish and birds. I help society by getting rid of those who unnecessarily burden and sicken the rest of the population.”
Brian said little through the rest of the shift, thinking about Marc’s arguments. ‘He’s so damned logical about it, but he can’t be right. Killing people cannot be right, no matter how you look at it.’ he thought.
After their shift was over, they stood in the parking lot together. Marc smoked a cigarette; Brian stared at the ground. “Can I ask how many?” Brian said, his eyes fixed on the pavement.
“I have no reason to lie to you. Eleven,” he said. “So now that you know, what are you going to do about it?” Marc asked Brian, depression in his tone.
The cardinal rule of EMS sounded in Brian’s head.‘What happens in the truck, stays in the truck. But I can’t just let this slide! Knowing about it makes me an accomplice!’
“I don’t know, man,” Brian said at last. “I’ll have to think about it. This is a lot to deal with.”
“Making the world a better place is never easy, and seldom welcomed. You do whatever you think you have to do.” Marc got into his pickup and drove away, leaving Brian lost in thought. After a minute, Brian drove away too. In each of their cars, both medics cried.
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KarmaSutra reviewed Version 1 -
Read 100% of the Item
Wow.
Each chapter get’s progressively more in depth and more realistic. I’m a CSI nut and I love the realism in the character development and in the setting.
The pathology reports and the dialogue are as real life as I’ve read and experienced. I particular yearn for more interactive dialogue between character’s like Marc and Brian. These two have a symbiotic link together and their experiences explode when they’re talking.
I enjoy learning when I read. You’ve managed to add classic prose and a learning lesson in this chapter in particular. Well done.
The criminal aspect is readily apparent but surrepticiously hidden under the plot which is a difficult feat indeed. This makes your readers become rabid fans.
My girlfriend is a paramedic and she agrees that this is poignant and realistic.
Keep up the great work and I am anxiously awaiting more of this story (especially more about crack falling out from a guy’s ass crack!).
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Bo reviewed Version 1 -
Read 100% of the Item
A good story and lots of dialogue to keep the story going. An interesting plot using EMS as executioners, or at least Marc. The rushing from patient to patient while the two discussed the morality of Marc’s thinking in regards to society and what benefits is the stuff we here about by some nurses in hosptals.
Grammar and spelling was throughout, maybe a stronger ending with some type of resolution like Marc injecting Brian with a syringe of Potassium Chloride would have added a nice twist at the end. Good going
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