by Caleb Cleek
As he knelt, I recounted to him what I had observed.
“This looks bad,” he muttered. As he felt for her pulse, he shook his head back and forth. “This is not good, she’s burning up.” Finally his fingers settled on a place at the junction of where her neck and jaw met. He looked at the scarred face of his digital watch and silently counted her pulse. After thirty seconds, he removed his fingers from her neck and reached into his black nylon med bag and brought out a stethoscope and blood pressure cuff.
He placed the cuff around her right bicep and fastened the Velcro at each end to maintain its circumference around her arm. His finger and thumb gave a quick twist to the pressure relief valve, closing it off so the cuff would retain all the air he was about to pump into its rubber bladder. Several quick squeezes of the rubber bulb inflated the cuff to the point it crushed her brachial artery, preventing blood from passing through. He gave another twist to the pressure relief knob, this time opening it just enough to allow a slow stream of air to exit the bladder. His eyes tilted up to the right as he carefully listened through the stethoscope for the sound of blood beginning to pass through the artery again. His eyes shifted slightly, which I took to mean he had detected the systolic blood pressure. A couple seconds later, he took the cuff off and moved the earpieces of his stethoscope from inside his ears to around the back of his neck.
“Forty-six over twenty-eight,” he said. “She’s in serious trouble. I need to get her on oxygen and get her to the hospital. I don’t think she is going to make it.”
As he was reaching into his bag for the second time, the woman on the floor tensed up. Her body went rigid for a second and then completely relaxed and her head canted slightly to the right. While Lawrence was setting the oxygen flow on the regulator, I watched the woman’s pupils slowly dilate. Lawrence placed the clear mask over her nose and mouth. I noted the absence of fog adhering to the inside of the mask. The fog, normally present, resulted when warm, moist air being exhaled contacted the cool rubber mask, causing a vapor to condense on the inside.
Lawrence noticed the signs, too. He felt for a pulse again. His fingers moved around her neck, obviously not finding what he was searching for.
He quickly reached into his supply bag again and withdrew an Ambu bag which was attached to a face mask. He placed the face mask over her nose and mouth.
“You start the chest compressions and I’ll breath for her,” he said frantically.
The county couldn’t afford a second person on the ambulance. Normally ambulances have two people who work together to stabilize a patient. One person would then drive to the hospital while the other attended the patient in the back during the trip.
Since our ambulance was a one man team, I was accustomed to helping stabilize patients prior to transport. When Lawrence and I performed CPR, I always started out on compressions.
I interlaced my fingers and put the palm of my right hand over the back of my left hand. I leaned over the woman and placed the palm of my left hand over her sternum. I allowed the weight of my body to come down on her chest, causing it to collapse. Then I took my weight off my palms, allowing her chest cavity to rebound to its normal volume. The idea was to mechanically contract the chambers of her heart, causing it to move blood through her body.
By the time I had performed thirty repetitions, Lawrence had connected a line from the oxygen tank to an inlet in the Ambu bag. Our artificial respiration wasn’t nearly as efficient as her own breathing would have been. The increased oxygen levels in the Ambu bag would help offset our inefficiency. I tilted her head back to open her airway as Lawrence pressed on the face mask to make a good seal and squeezed the Ambu bag two times. With two breaths delivered, I continued chest compressions.
After four compression breath repetitions, Lawrence advised me to check for a pulse. I felt her neck for a nonexistent heart rhythm. “Nothing,” I said.
Lawrence grunted from the strain of standing and stated, “I’m going to get the defibrillator from the ambulance.”
“Use that one,” I said, pointing to the green box hanging on the wall below a white sign that read “A.E.D” in red letters.
Lawrence pulled the box from the wall while I continued chest compressions. He opened the box, revealing a device that had an LCD display above a keypad. It also had a foil packet that was connected to the device with a white, plastic-coated cord. He pushed the power button and we were greeted by an electronic voice, “Unit OK.” The voice paused for two seconds, and then continued, “Adult pads,” another pause, “Stay calm…Check responsiveness…Call for help…Attach defib pads to bare chest.”
Lawrence pulled a pair of scissors from a pocket on the thigh of his pants and quickly cut through the green, silky fabric of her shirt. The machine repeated, “Attach defib pads to bare chest.”
After he had cut the shirt from top to bottom, he pulled the severed fabric to either side, revealing the skin that covered her slight frame.
“Attach defib pads to bare chest.”
“What do you think I’m trying to do?” Lawrence yelled to the machine in frustration as he fumbled to open a foil package. His fat thumbs and fingers struggled to separate the foil halves containing the pads. Finally, he was able to pull the halves of the package apart and reveal the defibrillator pads. The pads consisted of a twelve inch long blue rectangle with a square pad coming off the top left and another square pad coming off the bottom right. Lawrence laid the top pad on her chest above her right breast. The blue rectangle ran down her sternum. He positioned the bottom pad across the left side of her abdomen. Her bra interfered with the pads laying down flush on her skin.
Lawrence retrieved the scissors from his pocket a second time and placed one blade above and the other below the connecting strap between the two cups of her bra. All the while, the voice urged him to, “Attach defib pads to bare chest.” He brought his fingers together, causing the blades to slice effortlessly between the satiny white material. The tension from the shoulder straps and the elastic strap around her back snapped the two cups to either side.
I instinctively averted my eyes, feeling like I had violated the woman by seeing her in her unconscious, helpless state. Reason took over. Lawrence needed my help and so did she. I pushed the guilt out of my mind as I turned back to assist Lawrence. He removed the plastic backing on the pads to reveal the sticky backside. With the sticky side exposed, he pushed the top pad down and it adhered to her skin. He repeated the process with the pad over her lower left side.
The electronic voice broke the silence, “Analyzing, don’t touch patient.” A moment later, it announced, “Push flashing button to deliver shock.” Lawrence pushed the button and the woman’s body jumped on the floor. The voice instructed, “Begin CPR.”
We switched positions and Lawrence began chest compressions and I held the mask and Ambu Bag, ready to deliver breaths to her. We continued the cycle of compressions and breaths until the voice interrupted our work. “Analyzing, don’t touch patient.”
At the machine’s request, Lawrence pressed the shock button again, causing the woman’s torso to rigidly lurch on the floor and then relax. Rather than immediately begin CPR as instructed by the voice, Lawrence checked for a pulse. After ten seconds he looked up at me. Shaking his head back and forth, he peeled the pads from her skin and set them on the floor.
He reached over and turned off the oxygen tank regulator. He placed his right hand over her open eyes and slowly moved it down toward her mouth, gently brushing over her eyelids. When his hand had moved low enough, her eyes became visible again, but this time they were covered by her closed eyelids. He had performed the last trick in his repertoire.
The man who had been seated beside the deceased woman, prior to her collapse, had been silently peering over my shoulder as we worked. I looked back and I could see his eyes begin to glisten. The moisture continued to build until it was pooled around his bottom eyelids. Gravity suddenly overcame the surface tension that had been holding the liqu
id in place and a tear rolled down the side of his left cheek, rapidly at first and then it slowed, leaving a wet trail in its wake. “One hour past, she say ‘have pain in head.’ She say, ‘feel bad, very hot,’” he offered in explanation as he pulled the severed halves of her shirt together to cover her naked chest.
He obviously didn’t want to leave her side. He couldn’t believe she was gone. Three and a half hours ago, they had been embarking on a journey together. Now he was embarking upon another journey, a journey of solitude.
As if to add an exclamation mark to her passing, there was a crash to my left. I looked and saw a man laying on his back, five paces away. To the man's right, I saw a woman standing with glassed over eyes and a thin crimson streak from her right nostril that nearly reached her upper lip. Before my watching eyes, she teetered forward. At the point where the attraction of the earth’s mass was about to take over, she caught herself and leaned backwards to counteract the forward motion. She went too far and toppled over. Her head hit the table behind her, cracking like a bat striking a ball. Her head snapped forward causing her chin to briefly touch her chest before her head began another backwards trek, proving Newton’s third law: For every action there is an equal and opposite reaction. As her back hit the ground, her head achieved its maximum rearward velocity and smashed into the tile floor. From the way she landed and the hollow crack of her head smashing into the tile, I judged there was no way she survived the fall.
Chapter 2
I performed a survey of the room. Fifty percent of the people were still seated, the other half were now on their feet, straining to see what was happening. A quick scan revealed something that I had failed to observe previously. With the exception of one man and a woman, they were all sweating profusely. The diner was on the cool side of comfortable at sixty-nine degrees. Mary claimed it was the perfect temperature for a restaurant. If the temperature was too hot, people wouldn’t have an appetite, too cold and you would run them out before they ordered pie. Sixty nine was apparently the magic number. It was low enough that the body felt like it needed more fuel to stoke the metabolic fires which would warm it, but not so cold that it was uncomfortable. It was too cool for people to have sweat dripping from their faces.
Another woman, who was sitting at the left outside edge of her table, appeared to lose consciousness and slumped forward toward the table. At first it was in slow motion. The further she went, the more speed she picked up. The table stopped her forward momentum, but at the cost of redirecting her lean to the left. Her redirected lean was slow at first, but again began to pick up speed. The man sitting across from her made a feeble effort to grab at her shirt. She was leaning too far and the leverage of her falling body was more than he could hold. The silky fabric of her shirt slipped through his fingers like water through the holes in a sieve. There was practically no resistance. She hit the floor with a sickening kerwump.
Two people were dead for sure. Two others were following a pattern established by the first woman. If the pattern continued, they too would be dead shortly. All eyes were on Lawrence and me. The badge on my chest and the EMT patch on the chest of his jumpsuit signified that we were public servants. There was an unspoken expectation that we do something to fix the problem. There was no question that we would do all that we could. Take away my badge or Lawrence’s patches and we would still help.
The need to help those in trouble was irreversibly woven into the double strands of nucleic acids that made up our DNA. How else can you explain an off duty cop running toward the sound of gunfire or an off duty fireman running into a raging inferno? Powerful as we seem to people, we have limits. Bucking against the hand of God is far beyond the limit of my ability and this was beginning to look like an outpouring of His wrath.
Looking around the diner, it was apparent that I was not the only one who perceived the seriousness of the situation at hand. I looked up at Bertha, who was now standing behind the cash register. Both of her hands were over her mouth, sort of like she was praying except that her palms were touching her face rather than held together. She was staring at the small puddle of blood on the floor next to the dead woman, watching as it diffused into the puddles of spilled beverages.
Mary, the owner, was beside Bertha, her face screwed up into a contorted look of bewilderment and disbelief at what was occurring within the walls of her establishment.
Lawrence looked from the bodies on the floor to me. “I can put two in the ambulance and then come back for the others.”
I paused. “No Lawrence, I don’t think we’re going to put anyone in the ambulance. We have four down and several more that look like they are about to go down. I don’t think taking anyone away from here is wise at this point. We need to lock this diner down and try to stop this from spreading while we still can.”
Once again, I clicked the transmit button on the microphone clipped to my shirt, “Dispatch, this is Unit two…” I explained the situation as quickly as possible. I requested that Doc Baker and a nurse come to the diner and treat the patients here rather than moving them away and risk spreading the sickness.
“Lawrence, I’m going to try to help the male,” I said, pointing to the man on the ground. “See which of the females you think would benefit most from your attention and do what you can for them.”
He nodded, placed a hand on the chair next to him and, with a grunt, thrust himself back onto his feet and shuffled to the table where the woman had sloughed out of her seat and onto the ground. It was at the far diagonal corner of the diner from where I had been eating my lunch. I hurried one table ahead and to my right, where the man lay on the ground.
As I knelt beside him, my radio chirped to life again. “Unit two, we have a problem. I just received a call from Joan at the Knick Knack Shack. She said a woman passed out and was bleeding from her eyes and nose. It sounds like the same symptoms as the people in the diner.”
I stood up so I could look out the window and across the intersection to the Knick Knack Shack. I saw Claire Mantell running out the door of the shop, followed by her two kids. Her mouth was opening and closing, but I couldn’t hear what she was saying. I didn’t have to. Her facial expression told me she was in a panic, which is what I would have expected from her. She lived just down the road from me and she was prone to overreacting. In this case, she probably had the right idea; get herself and her kids away from what was happening. The problem was, it might be too late, in which case, she was going to make the problem worse.
When I was a kid I used to love to rake the leaves around the sycamore trees in my grandpa’s yard. It was a big job for an eight year old. Once I had all the leaves in a big pile, Grandpa would bring his pickup out to the yard and help me load the leaves in the back. We would cover the load with his ancient canvas tarp and he would let me sit in his lap and drive to the burn pile in his field. On one occasion, I told him I was ready for the pickup and he said he would be out in five minutes after he finished his lunch. Before he came out, a slight breeze picked up from the north. It sent a few leaves skittering across the lawn. I chased them down and put them back onto the pile. The breeze increased and a few more leaves went sailing around the yard. I continued to bring them back one at a time until the breeze suddenly gusted into a gale. The entire pile was immediately redistributed all across the yard and even across the street into the neighbor’s field. No matter how many leaves I brought back to the pile, I could never get close to staying ahead of the wind.
I was hoping that Claire Mantell was not going to be the beginning of the gale. At this point, hoping was all I could personally do because my hands were full.
“Unit two, Doc Baker will head to Mary’s in twenty minutes. He is taking care of a patient right now.”
“I can’t leave the diner to help at the Knick Knack Shack. Contact Unit three and see if he can take care it.”
“Ten-four. Unit three, respond to the Knick Knack Shack and assist with the medical emergency.”
I turned to the r
ecent widower who was still hovering beside me. “Was there anyone on the bus who didn’t come into the diner with the rest of you?”
“Yes, Miyu say she feel sick and no want to eat. She say she go buy gift for grandson instead. Her husband Takumi go with her.”
Leaves in the wind.
I turned my attention back to the man on the floor in front of me. As I was searching for a pulse, he began to convulse. In police work, patterns are important. If you can establish a good pattern, you can predict what will happen in the future. The pattern that was beginning to develop promised bad things to come.
I looked toward the register where Mary and Bertha had been standing. Steve, the cook, had now joined them. “Mary, can you bring me some ice and some towels?”
She quickly pivoted on her left foot and scurried through the swinging door into the kitchen. Thirty seconds later she reappeared with two buckets of ice and about a dozen dish towels. She brought them to me and quickly retreated to her position behind the register.
I turned to my shadow. “What’s your name?” I asked.
“I Yuto,” he replied with a bow.
“Yuto, I need your help,” I said as I placed a handful of ice in the center of a towel, rolled it up and twisted the ends. “Can you hold this on this man’s head while I try to help the woman over there?”
“I help,” he said, looking relieved to have something to occupy his mind.
I looked at Lawrence who was now tending another man who had fallen to the mystery sickness. Lawrence refused to give up, even though we were obviously fighting a losing battle. I handed him one of the ice buckets and half of the towels as I moved to the next, newly unconscious victim. For the next twenty five minutes we moved from person to person, trying to do anything we could to help.
By the end of twenty five minutes, Mary had refilled our ice buckets twice and brought what she said was the last of the towels. The situation appeared hopeless. At least twelve more people were dead. Out of fifty people from the bus, only six were conscious. Of the six, only Yuto and a woman looked healthy. He was still following me from person to person, doing what he could to help. Four of the remaining five were sweat drenched and two were bleeding from their noses and one from his eyes.
