Extreme Medical Services: Medical Care On The Fringes Of Humanity

by Jamie Davis

  “Doc Spirelli’s cell phone is programmed into the dispatch system and I have it in my cell phone, too. The Unusuals respect and trust him. Generally, if he tells them they have to go in, they listen, but not always. Ultimately, it’s their decision just like anyone else.”

  Dean nodded. It was the same answer his preceptors gave him when he asked about how to convince a reluctant patient to go to the hospital. Any patient ultimately had the right to make their own health decisions – Unusual or not. It was up to the paramedic to make sure they were fully informed about the possible consequences to their decision.

  Dean went back to the chart he was working on, pulled up the i-Stat blood work that was automatically uploaded to the unit in the ambulance and added it to the patient’s chart. He had to admit that the technology was pretty cool here. The tech was even better here than the standard units in the city. Brynne said it was because of the grant funding for the “Unusual unit”. Everything was automated to make patient charting easier. There was an iPad tablet in the back of the ambulance to keep the patient chart on when on the scene. The heart monitor and other electronic gear all reported and connected to the system as well. Ironic that a station on the fringes stuck in the back of an industrial park was the best funded in the city. He put the finishing touches on the narrative, “painting a picture of the call” as Mike had told him in the academy.

  He was just getting ready to turn it over to Brynne to read over when the tones dropped. He listened as radio’s speaker alerted automatically and the dispatcher’s voice was clearly heard. “Medical box U-843. Allergic Reaction. 634 Bridge Road.” Simultaneously, the printer next to the desk printed out a sheet of paper with the call information, address and box number.

  The box number related to the old system when they had fire department call boxes around the city that would call into the local fire station when pulled. The fire department would respond to that particular box and then would follow the person there to the emergency or, in some cases, follow the smoke to the fire. Now the boxes were a reference to the specific geographic area of the city. Once you got to know the numbers, you could get a general idea of where you were headed while your partner programmed the GPS to get a more specific location.

  Dean closed the screen and hopped up, heading to the door to the ambulance bay, which Brynne was holding open for him. She jumped in the driver’s seat as he walked around to the passenger side. The garage door of the bay was already on its way up as he climbed in. He glanced at his watch - 5:30 AM. Damn, they were almost done with the shift and he was tired, but duty called. As Brynne pulled the ambulance out into the parking lot, he picked up the radio’s microphone and keyed the mic saying, “U-191 responding.”

  “U-191 responding” the dispatcher parroted. “Switch to med channel 1 for additional.”

  Dean switched the radio frequency to the correct channel. While the initial dispatch was on an open channel, all calls were then routed to a secure, trunked radio channel for the rest of the call. He keyed the mic after double-checking the correct frequency. “U-191 on med channel 1.”

  The dispatcher came up immediately. “U-191, respond for a male subject in the parking lot of the Jiffy Mart complaining of a severe allergic reaction, unknown cause. The patient will be seated in a gold minivan.”

  “U-191 copies,” Dean responded and hung up the mic on the dash. “Any idea on what this one is, Boss?”

  “Nope.” she said. “I guess we’ll see when we get there.”

  For 8 minutes, Dean watched the lights reflect off the windows of businesses and noticed the wailing sound of the siren at night had a mournful quality. He also noticed Brynne was a good driver, stopping at each red light or stop sign and acknowledging “due regard” for the safety of others before driving on through.

  As they pulled in to the Jiffy Mart parking lot on Bridge Street, Dean scanned the area. Scene safety was the first responsibility, and while it was moderately busy with people coming in to get their morning coffee on the way to work, there was nothing out of the ordinary. He pointed to a gold minivan parked along the side of the building. The windows were tinted dark and in the early dawn light there was no way he could see if anyone was inside.

  Brynne pulled the ambulance up beside the minivan as Dean keyed the mic and said, “U-191 on location.”

  Brynne put the unit in park and climbed out. Dean did the same. As his feet hit the ground, a short, plump, middle-aged and shirtless white guy jumped out of the driver’s door of the minivan and shrieked “Thank God you’re here.” He dashed to the side of the ambulance, opened the side door of the ambulance box and jumped in, shutting it behind him. Dean was too stunned to move. Brynne went to the back of the unit.

  “Well, get the gear out probie!” she said. “Don’t just stand there with your mouth open.”

  He gestured at the ambulance door. “No need to move the gear, the patient just loaded himself.”

  “What?” She crossed over to the ambulance’s side door. Peering in the window on tip toe, she let out an exasperated sigh. “I didn’t recognize the car, but I should’ve guessed.” She peered at Dean. “Well climb on in. Let me introduce you to Gibbie. His name is Gibson Proctor. He may look middle aged, but he’s a vampire who’s been around more than six centuries.” Dean grasped the door handle, quirked an eyebrow at Brynne, opened it and climbed in with his preceptor close behind. As Dean sat down in the captain’s chair at the head of the cot, Brynne climbed in and sat in the bench facing the patient.

  The patient had stripped off most of his clothes and appeared to be covered in some kind of glitter which was flying everywhere. The glitter decorated noticeable hives popping up all over his torso. Gibbie, as Brynne had called him, ripped open a ten pack of four by four gauze and began to wipe frantically at his skin. He looked up at Brynne and Dean. “Thank, God! Thank, God! Thank, God! Brynne, you’ve got to get this stuff off me. It’s itching like crazy. It’s killing me.”

  “I don’t know about that,” said Brynne looking him over. “Gibbie, calm down. Getting yourself all worked up is only going to make the reaction worse.” She looked at Dean. “Get a bottle of sterile water out of the cabinet behind you. I’ll get some more gauze. There should also be a few folded white towels in with the sheets and pillowcases for the cot. Get them, too.” She turned back to their frantic patient. “Good Lord, Gibbie what is this stuff?” Brynne said as she, too began to wipe the glittery cream off him as best she could.

  “It’s sunscreen, okay. I was trying to impress my new girlfriend. She’s all into those old Twilight books, and I thought I could impress her by showing that I can sparkle in the sunshine, too.” He started blubbering as he looked around. “Oh my God! We have to get out of here. She works night shift here at the Jiffy Mart and gets off at 6. I was going to surprise her by standing by her car as the sun came up. Sparkling the way she wants me to. Now it’s all ruined!” He started sobbing and whimpering as he continued to swab at the glitter cream on his chest.

  “Gibbie we can’t do anything or go anywhere until we get this stuff off of you,” Brynne said. She took the bottle of sterile water from Dean after he wet a white hand towel with it. She poured some into the plastic gauze packaging, grabbed a few with her gloved hand and began wiping Gibbie’s chest off. The hives were getting worse which was making Gibbie start to scratch at his chest and arms.

  “Okay, Probie, what’s next?” She asked Dean as she continued to wipe down the patient. There was glitter everywhere. The ambulance was going to be a righteous bitch to clean later.

  “Right,” Dean said aloud. “Allergic reaction. Moderate to severe. 0.01 milligrams per kilogram of epinephrine, up to 0.5 milligrams max single dose. He’s over 50 kilos so he gets the max single dose. Give 0.5 mg Epinephrine 1:1,000, intramuscularly?” His voice going up at the end of the statement as he looked at his preceptor quizzically.

  “Yep,” she responded. “Do it. And make sure you double check the dose.” She continued to wipe
at the frantically scratching vampire, trying to get as much of the allergen off his skin as possible.

  Dean got the med bag out and unzipped the top. He swabbed the top of the medication vial with an alcohol prep, inserted the needle, and pulled the medication out of the vial. He then turned to the shirtless patient and swabbed his shoulder with another alcohol prep, glanced at the syringe barrel one more time then slowly injected the medication. Gibbie yelped a little. Dean drew out the syringe, snapped the safety cover across the needle and dropped the syringe in the sharps box next to him. Gibbie was already rubbing the injection spot so Dean didn’t need to do that to help hasten absorption into the muscle.

  Brynne’s voice broke in to his concentration. “What’s next?” she asked him. “Epi’s on board but what else can you do or should you look for.”

  “Okay, right. Uh, sir,” Dean turned to his patient. “Are you having trouble breathing? I mean, do you breath? I’m not familiar with your background.”

  “Do I breath?” the vampire said, astounded, his voice getting higher and more frantic with each word. “Do I breath? Brynne, honey, what have you gotten me into here? You let this know-nothing cretin treat me?”

  Dean flinched at the man’s reaction but in his mind it was a valid question. Vampires actually are dead, aren’t they?

  “Calm down, Gibbie,” she soothed. “It’s only his second shift. He’s on the right track and we got the important medicine in you. You should be feeling better soon.” Brynne turned back to her partner. “Dean, to deal with the histamine release, causing the hives, what should you do now?”

  “Oh, right,” he said. “I need to get an IV started then administer 25 mg IV diphenhydramine.” He glanced at the patient. “I should also consider albuterol/ipratropium inhaler via nebulizer for breathing difficulty, uh if there is any breathing difficulty.”

  He turned again and began to get out an IV solution bag and tubing. Pulling the tab on the bottom of the 1,000-milliliter bag of saline, he then pushed the hollow plastic spike on the end of the tubing into the exposed tube in the bottom of the bag. He pinched the drip chamber to fill it from the bag as he held it up. Brynne took the bag from him and slipped the hole in the top of the bag’s flap over the metal hook in the ceiling. She stood up and offered him the other seat so he could get better access to start the IV line. Dean shifted to the offered seat, reached over and tied an elastic tourniquet just above Gibbie’s elbow.

  Brynne spoke up, “His veins are flatter than you’re probably used to. Think ‘dehydrated 80-year-old woman’ and you’ll get the right idea. You’ve got this Dean.”

  Dean started looking for a vein on the back of Gibbie’s hand then worked his way up to the forearm using his eyes and gloved fingertips to palpate for a vessel. He thought he found one he could both see and feel as he lightly pressed down, sensing the spongy feeling of the vein. Wiping the area off with another alcohol prep, he reached over and, looking at the IV box, thought to himself, ‘dehydrated 80-year-old woman,’ huh?

  Selecting the thinner 22 gauge IV needle he slid the cover off, hovering the tip briefly over the forearm then, at a slight angle, slid the needle with the IV catheter into the arm. He watched the chamber at the base of the needle watching for the flash of blood that signified success and was surprised to see dark red blood fill the small chamber. He hadn’t been sure if vampires had blood in their veins or not. Now he knew. He pressed down on the arm just above the insertion point to stop blood from flowing out of the tubing as he withdrew the needle leaving the hollow plastic catheter in place inside the vein.

  Brynne handed him the end of the IV tubing she had primed and he attached it to the end of the plastic catheter. He got the clear IV dressing that Brynne handed him and laid it down over the site where the IV catheter entered Gibbie’s arm. Lastly, he assured the IV was running properly into the vein and not into surrounding tissue.

  Satisfied, he looked up at Brynne. “Twenty-five milligrams IV diphenhydramine next, right?”

  “Right, but what else do we need to do?” She asked. “I’ll get the med drawn up for you. What else haven’t we done yet? Think basics.”

  Dean thought for a moment before he came up with the answer, “Consider oxygen, IV’s done, now monitor.” Brynne nodded and he began to gather the electrode leads and sticky patch electrodes, attaching four of them to Gibbie’s upper arms and ankles. Turning on the heart monitor, his own heart rate spiked when he saw the rhythm. Ventricular fibrillation, a lethal heart arrhythmia. Damn, he needed to shock this guy, except he was awake and talking to them. One of his instructor’s famous phrases rolled through his mind. ‘Treat the patient, not the monitor.’ He looked over to see Brynne smiling at him.

  “Vampires don’t have pulses,” she said. “That’s why you see V-fib. Sure, in a normal human, it’s a sign of cardiac arrest and one of two shockable rhythms. In a vampire, it’s completely normal. I’m still not sure how their circulatory system works or how the blood moves around, but you should be able to run the diphenhydramine in and it will get where it needs to go.”

  Brynne finished drawing up twenty-five milligrams of diphenhydramine and handed the syringe to Dean. “That’s twenty-five milligrams of diphenhydramine from a concentration of fifty milligrams per milliliter so you should have …” she paused for him to finish.

  He looked up from the monitor and the alarming heart rhythm. “Uh, right, so twenty-five milligrams of the drug is half an mL, right?”

  “That’s right,” she nodded in agreement. “Remember, this is a slow IV push so take it easy.”

  Dean checked that there was half a milliliter in the syringe then screwed the syringe hub on to the port on the IV tubing and began to slowly depress the plunger. It seemed to take forever.

  Brynne finished up wiping what glitter sunscreen she could from Gibbie’s arms and torso. “I have to say, Gibbie, you have outdone yourself this time. This is a first even for you,” she said with a smile. “Where’d you pick up this stuff?”

  Dean perceived that vampires didn’t blush, but Gibbie still looked embarrassed. “I found it in the back of a magazine for Cosplay folks. You know the folks who dress up like cartoon and manga characters?” He shifted as he tried to scratch an area on his shoulder he couldn’t quite reach. “Brenda’s such a fan of Twilight and was so excited that she found a real Vamp to date. I thought I’d treat her to her own sparkly hero boyfriend. I figured I’d be able to take the early sunshine and not get burned with the sunscreen on. Then I could sparkle for her just like Edward.” He shook his head. “This is embarrassing, Brynne. I can’t wait for the Twilight thing to blow over. Every century it’s something new. This Twilight phase is almost as bad as the 40’s and 50's were when everyone was expecting us to have Bela Lugosi’s Romanian accent. I got so tired of the whole ‘I vant to suck your blood’ thing, I thought I was going to scream.”

  “Well you should feel better soon but you're probably going to want to go into the hospital and get some steroids on board just in case that reaction is worse than it looks,” Brynne said.

  “No, I’ll be alright,” Gibbie said. “The itching’s starting to feel better already. You know vampire constitution. I just need to get home and get some rest. I spent all night coming up with the perfect romantic touch and now it’s all ruined. I just want to forget the whole thing.”

  There was a tap on the doors to the back of the ambulance. Dean looked at Brynne and his patient. The younger paramedic got up and opened one of the doors partway. A woman’s voice from outside was heard.

  “Is everything okay?” A woman’s voice asked. “I just got off work and saw you here with your lights on next to my boyfriend’s van.”

  “Brenda,” Gibbie cried. “Don’t come in, I don’t want you to see me like this.”

  “Gibson, is that you?” Brenda stuck her head into the doorway, looking past Dean. “My dearest, what happened?” She pushed the door open and climbed in, rushing over to sit on the cot next to Gibbie. She lo
oked from Dean to Brynne with raised eyebrows. “Is he alright?”

  “It’s nothing my love, just an allergic reaction to something,” the vampire told her as he reached out to hold her hand. “I was being foolish.”

  She looked around at the glitter, coating everything in the back of the ambulance, and what little remained on her boyfriend. “Did you do this for me?”

  Gibbie nodded sheepishly.

  “How romantic,” she said throwing her arms around him and showering him with kisses, oblivious to the awkwardness of the situation and the two onlookers. “You don’t have to dress up to be my man, Gibson Proctor. I love you just the way you are.” She looked at Brynne. “Is he okay now, can I take him home?”

  “I think he’ll survive,” Brynne said. “There’s some paperwork to fill out, but I think he’s on the mend.” She winked at Dean as the two lovebirds embraced.

  ———

  Dean and Brynne watched the minivan drive away followed by Brenda, in her little hatchback. Brynne playfully punched Dean in the arm. “Well, that’s part of your initiation done with at least,” she said with a grin. “You’ve now met Gibbie.”

  “I take it we see him a lot?” Dean asked.

  “Often enough,” she answered turning to climb back in the unit and put things away. “Put us back in service and then come back here and help me get the rig back in order. We’ve got to get this glitter cleaned up.”

  They returned to the station and signed off the shift. Dean headed home to his apartment, musing about his first week on the new job. He was surprised as he thought back about the week, that he was smiling with a sense of accomplishment. The new paramedic was sure he wasn’t going to like the new assignment out of school.

  Dean spent his three days off refreshing his knowledge base. Mike had always impressed on their paramedic class the need to continue learning after they graduated. He sure hadn’t thought he’d need the refresher so quickly, though.