Tomorrow We Die

by Shawn Grady

  He nodded. “Sounds good.” He turned his head toward his shoulder mic and spoke something into it.

  The ladder truck roared into high idle. Firefighters went to work, prying and cutting.

  Heavy helicopter blades whipped overhead from the AprisEvac MD 900. A flight medic stood with the door open and one foot on a landing skid, torso bent to get a clear view of the cylindrical tail boom. The pilot made his descent. Pebbles scattered and shot through the air.

  I shielded my eyes and caught up with Bones in the dirt median. He knelt by the driver’s window, talking to a man trapped upside down in the rolled-over vehicle. Firefighters with struts and wood cribbing worked to stabilize it.

  “What you got?”

  “One male patient. Stable. E-T-O-H.”

  The abbreviation for ethyl alcohol. It was a useful way to say that a patient was drunk without the patient realizing it.

  “Got ya. Injuries?”

  “Minor, actually.”

  “Need anything?”

  He shook his head. “No. Once they get this thing stabilized, we’ll get a bunch of hands to lower him onto a backboard. I’ve got enough guys here to do it. What do you got?”

  “One code fifty. One trapped. Critical, though conscious.”

  “All right.”

  I walked back to the truck captain and shouted to be heard. “The rollover patient is stable but intoxicated.”

  He pointed at the black sedan. “So this patient on the bird first?”

  I nodded. “Yeah, I think we can take the rollover patient by ground.”

  Back at the black sedan I noticed Jeff’s color had deteriorated from pale to ashen. The firefighters worked to pry the driver’s door open.

  I really didn’t want a second death on this accident. First one wasn’t my fault. This one . . .

  We needed to get moving.

  At the passenger side I pulled out a bag of normal saline and spiked it with IV tubing.

  The flight medic and flight nurse hopped out of the helicopter. Wearing white helmets, they carried bags and hunched beneath the rotors. It wasn’t until the nurse drew closer and pulled off her helmet that I recognized her.

  Naomi Foster.

  The AprisEvac engines idled down, and the fire captain gave Naomi a quick rundown on the patients. Naomi caught my eye and turned to her partner.

  I leaned in the passenger window and wrapped a tourniquet around Jeff’s right arm. He looked to be in decent shape. He’d normally sport ropes for veins. But with his blood pressure tanking, nothing was visible. His body was trying to protect his core organs by shutting down peripheral circulation. I felt around for a vein in the antecubital space at the crook of his elbow. My fingertip found a faint rounded shape.

  A familiar female voice spoke behind me. “Can you get a fourteen in that?”

  I craned my neck, seeing only Naomi’s torso through the window, her flight suit following her curves, name and title stitched into the fabric. She bent down and smiled, sandy chin-length hair dangling, eyes still the same striking blue.

  I kept my finger on the vein. “I’ve got it by feel only. Better give me an eighteen gauge.”

  She raised and lowered her eyebrows, went to the roof, and returned with the smaller needle. She handed it inside with a wry curve to her lips.

  She was going to shame me into a larger-bore catheter. The bigger the IV needle, the faster we could flow fluid into Jeff’s body and improve his blood pressure. But also the more difficult of a stick.

  “All right,” I said. “Fine. Give me a sixteen.”

  A smile tugged at the corner of her mouth. She opened her other hand to reveal the larger sixteen-gauge.

  I prepped the IV site on Jeff’s arm with an alcohol swab, pulled his skin taut with my thumb, and inserted the needle. A flash of blood confirmed my placement. I popped off the tourniquet and held pressure above the catheter.

  “Sharp out.”

  Naomi held a red needle container for me.

  “Thanks.”

  I hooked up the IV line.

  Naomi lifted the saline bag and spun the white wheel on the tubing. “Good flow. Running wide open.”

  The car rocked with a loud metallic pop. The driver’s door creaked open. Another firefighter moved in to cut the hinges.

  The truck captain walked up. “We’re going to take the roof.”

  “Got it.” I took the IV bag from Naomi and squeezed it under the passenger-side headrest. “Hang in there, Jeff. This fluid’ll get your blood pressure up. They’re going to cut off the roof and get that dash off your legs. All right?”

  He kept his eyes closed. “Okay.”

  I picked up the first-out bag and backed out of the way. Firefighters went to work on the roof posts.

  Naomi zipped up her medical bag on the roof and slung it over her shoulder. She took her helmet in hand and stood back beside me. “It’s been a while, Trestle.”

  How long had it been? I didn’t think we’d spoken for more than five minutes at a time over the past four years. “Where have you been flying out of these days?”

  “Mostly Truckee.”

  “Ah.” I glanced over at Bones. It looked as if he and the firemen almost had their patient out. “You like it up there?”

  “It’s pretty. But slow. I’m actually back here at County now.” She tucked strands of hair behind her ears. No ring on her finger. “I like it. The days fly by. Literally. How about you?”

  “You know, still working the streets. Four twelves. Did have a strange code the other day.”

  “What was it?”

  “An older guy in full arrest on the sidewalk. We got him back. He said some bizarre things. I went to drop something off for him in CCU and found out he’d left the hospital already. I followed up and found him dead outside his motel room.”

  “Wow. That is weird.”

  “Yeah. Name was Simon Letell. Ever run on him downtown?”

  “Sounds vaguely familiar.”

  I watched the firefighters lift the roof off the black sedan and carry it out of the way. “How’re your parents?”

  “My mother . . . She’s had some health issues. But they’re getting through it.”

  A hydraulic ram pushed against the dash. Plastic creaked and cracked.

  The captain pointed. “Now get a new purchase point here.”

  In the median Bones and the other fire crew strapped their patient to a backboard.

  I wanted to tell Naomi about the scholarship. I wanted to know if she was still living in Truckee and what was really going on with her parents, to hear about her life since we – since our friendship had reached its limit. But all I ended up saying was, “You must like flying.”

  To a disinterested nod.

  The waning momentum reminded me of the other “conversations” we’d had in the past years. I didn’t want it to end. “You been doing much on your days off?”

  She eyed me. “Reading.”

  I scratched my jaw. “That’s it? You just stay at home and read?”

  Naomi folded her arms and creased her eyebrows. A strand of hair came loose from her ear and fluttered in front of her face. “Who said I just stay at home? I happen to get out quite a bit.”

  Dagger to the spleen. Why did I even ask?

  The firemen reclined the driver’s seat and slid a backboard behind Jeff.

  Her statement shouldn’t have bothered me. Of course she’d get out and be social, be seeing other people. . . . Other guys.

  I cleared my throat. “So you get out quite a bit?”

  “Yep.”

  “And like what, have a book club at the coffeehouse?”

  Naomi pushed her lips together. “Jane Austen is a fine companion. Tea at three and a good read is all a girl needs.” She flashed a quick look at me.

  “That’s all a girl needs, huh?”

  She drew a breath – “Absolutely” – and pulled on her helmet. “You said your patient’s name was Letell?”

  “Yeah.�
��

  She kept her eyes on the car. “Deux Gros Nez happens to be a great café to read in.”

  I laughed and then did a double take. She’d just dropped where she hung out.

  Her cheeks reddened. Maybe not noticeable to anyone else. But I could tell. My chest swelled.

  Victory.

  What did she know about Letell? I swung the first-out bag on like a backpack. “It’s been a while since I’ve been to the Deux. Maybe I’ll check it out again.”

  The AprisEvac engines throttled up.

  Naomi smiled. “Maybe you should, Trestle.”

  Firefighters lifted Jeff out on the backboard and set him on the pavement. We walked to the board and helped secure him to it with Velcro Spider-Straps. I knelt low by his head so he could hear me. “Jeff, this is Flight Nurse Naomi from AprisEvac. She’ll take good care of you on the ride to County. All right?”

  He grabbed my elbow. “Thank you.”

  We lifted the backboard and walked to the bird. Naomi climbed in, and we loaded Jeff onto the helicopter cot. She slid the door closed and positioned the helmet mic by her mouth.

  I backed away, watching her as the helicopter lifted, staring as she grew tinier against the blue backdrop, my heart pounding like the pulse of spinning rotor blades.

  CHAPTER 07

  Trent Matley squinted into the sun, pulling a cigarette from his lips, blowing smoke with purpose. His lanky arms dangled at his sides, short black hair spiked with a firm gel hold. He shook his head and cursed to himself for no apparent reason.

  I sat on the bench outside the ER doors, the wood rough but warm, usually a pleasant place to finish up a chart. Trent’s EMT partner redressed the gurney behind their ambulance parked next to ours.

  Trent nodded. “ ’Sup, dude.”

  “Hey. Busy day, huh?”

  “Tell me about it. All bull too.”

  I pulled out a pen for the chart’s narrative section.

  Medic Two arrived on scene to find a forty-year-old male awake, alert, and oriented, three-point restrained and suspended in the driver’s seat of . . .

  A horn blared. Light traffic halted by a crosswalk on Mill Street. I glanced at Trent. “So what’d you guys bring in?”

  He stared across the street. “Seizure.”

  “And you don’t consider that a bona fide call?”

  He turned to me with a condescending look. “Dude. Really? How many seizures do we go on every day? It’s not even an emergency.” He took a pointed drag and shook his head.

  Even from the far side of the bench his ego was edging me out. But I expected that attitude from him. I shrugged it off and quipped, “That’s why they pay us the big bucks.”

  The glass doors slid open and Bones walked through, Styrofoam coffee cup in hand. I still had half of my charting left.

  Rolled-over sedan with moderate damage to the roof and passenger side.

  The acrid stench of cigarette smoke wafted past the bench.

  Trent watched his partner clean the back of their rig. “And they wonder why they can’t keep medics around here. Pay them scrap to do what? Haul around drunks that aren’t going to pay for the ride anyway.”

  I’d given up on coherent reasoning with Trent. A breeze flipped my chart. I flattened it out.

  Positive ETOH, complaining of minor cervical and thoracic spinal pain.

  The radio beeped. “Medic Two or Medic Nine, can you clear County for a call downtown?”

  Nine had arrived a solid ten minutes before us. I waited for Trent to answer. He blew smoke and cracked his neck.

  “Medic Two or Medic Nine, Aprisa.”

  I shook my head. Forget it. We’ll take it. I tossed the chart in the metal clipboard and stood.

  Trent flicked the cigarette on the concrete and depressed the transmit button. “Aprisa, Medic Nine’s available.” He ran his tongue under his lip. “See you, Jonathan.” He pounded the side of the ambulance and shouted at his partner, “Dude, come on. Let’s go.”

  The Washoe County Morgue was not one of Bones’s favorite establishments.

  But several rigs came available after Medic Nine took the downtown call, so I managed to talk dispatch into allowing us an extended stay on the hospital grounds to follow up on Simon Letell and visit an old friend.

  The morgue was its own separate but small building, set out on a far corner of the hospital’s parking area. We greeted the receptionist in the lobby and descended the stairs into the basement. A glass wall, interspersed with steel support members, separated a small vestibule from the large exam room. Through the glass at the far end of the room I saw Dr. Eliezer Petrov’s stocky frame operating the crematory oven.

  His curly white hair stuck out from under the surgical cap he wore. He noticed us standing there, waved, and walked over. Pulling off a pair of latex gloves, he opened the door.

  “Jonathan, great to see you again.”

  I shook his hand and patted his shoulder. “It’s good to see you too, Doc.”

  Fog bordered his spectacles. He turned to Bones. “Hello, Thaddeus.”

  Bones couldn’t stand that Eli used his proper Christian name. “Hello there, Dr. Petrov.”

  Eli wiped beads of sweat from the sides of his nose. “Takes a bit to fire that thing up, but once it gets going . . . You know we’re one of the last morgues to still operate a crematory?” He leaned on the door and exhaled. “What brings you two down to the dungeon?”

  My radio squawked. I turned down the volume. “There’s a couple things, actually.”

  “Do tell.”

  “Well, for one, I’ve been awarded that full-ride scholarship to UNR Med School.”

  His face lightened with pride. “Jonathan, that is wonderful news. I am so happy for you.” He pulled me in for a hug.

  “Thanks, Doc. I couldn’t wait to tell you. They want me to start with summer school in a month.”

  “A month?”

  “Yeah.”

  “Will you still . . .” He motioned toward my uniform.

  “I don’t know. It’s such a commitment. I don’t think I could keep even per diem hours.”

  Dr. Eli folded his arms and took a deep breath. “Indeed. Well done.”

  “You’ve taught me so much down here.”

  “It might’ve helped on those MCATs, huh? What were you?

  Ninety-fifth percentile?”

  “Ninety-eighth.”

  “Outstanding.”

  “It’ll be a big challenge.” I pocketed my hands. “But, hey, the other reason we’re here is to check up on a patient.”

  “Oh, of course. Here.” He motioned with his hand. “Please, come in.”

  The air smelled of bleach, not quite masking the permeating odor of decay. Bones’s pale complexion turned a shade lighter. As many times as I’d been down there, I still felt blood drain from my head and had to focus on steadying myself. But once we dove into the science, the light-headedness mostly passed.

  “One moment.” Dr. Eli walked back to the crematory oven and shut down the burners. “So, this patient you had . . . ?”

  “His name is Simon Letell.”

  “Ah yes. You’re just in time. He’s next up on the list for autopsies I’d ordered.” Dr. Eli walked to a wall lined with oversized refrigeration drawers. He traced his finger down and tapped on a label. “Here we are.” He opened the drawer and unzipped the black body bag that lay in it. “This look like your guy?”

  Letell had the same vacant stare he’d had when I’d seen him lying outside his motel room. His skin was waxen and pale, with a clear line demarking pooled lividity.

  “Yeah. That’s him. I’m curious about cause of death.”

  “Well, all right.” He clapped his hands together. “This will be fun.” He walked to a small office cubicle, squared off by additional glass walls, and picked up a phone receiver. “Tech assistance for autopsy.”

  The tech transferred Letell’s body onto a flat exam table. Bones and I donned surgical masks and stood off to the s
ide. Dr. Eli stood at the head of the table, spectacles on and secured under his surgical hat, gloved hands in the air like a surgeon. A microphone hung from the ceiling, and periodically he would use a foot pedal to activate it, verbally recording the exam process.

  The tech took a large scalpel and, starting near Letell’s clavicles and extending to his navel, incised a large Y-shaped cut through the layers of skin and adipose tissue. He exposed the sternum, brought out a small circular saw, and wound the cutting blade into high RPMs.

  The tech brought it down on Letell’s breastbone with a high-pitched grinding whine and a cloud of bone dust.

  Dr. Eli made his own incision over the back of the man’s scalp and peeled the skin forward over Letell’s face, revealing the skull beneath. It was still a strange sight – to see a faceless man with a bare skull. The tech moved to the cranium to begin his next cuts.

  Beside me, Bones was as white as a sterile four-by-four dressing.

  Eli studied him. “Thaddeus, are you feeling all right?”

  Bones stared at Letell, the hint of a gyrating wobble to his stance.

  “Remember, son, the body is but a tent.”

  Bones pointed at the stairway and managed, “I’m going to – ”

  “Sure.” I nodded and smiled.

  He took off through the door. Nothing with living people fazed him. But there was something about the dissection of a human body that got to him. Go figure.

  It was times like that when I realized I shared a special bond with Eli. And not just with him, but with Vesalius and Da Vinci and Hippocrates. It was in my makeup to be a physician.

  Eli pulled off the top of Letell’s skull, set it aside on a stainless steel tray, and waved me over. Sliding his hands into the cranium, he made a few careful cuts with a scalpel and then cradled Letell’s brain up into the light to examine it.

  He depressed the foot pedal. “Cerebral surface tissue appears intact and undamaged.”

  He set the curled gray mass on a tray and used a blade to cut it into one-centimeter-thick slices. He stopped every minute or so to record an observation.

  The areas of the brain echoed in my head as I watched every transection and incision. MCAT flash cards flipping through my mind – coronal, midsagittal . . . Colored-pencil images from my anatomy drawing book.