Love On Call

“Roger.” Glenn leaned toward Mari and lowered her voice. “How are you feeling?”

“Fine,” Mari said. “I’m good.”

She was. Her heart galloped with the adrenaline rush, but she wasn’t nervous and she wasn’t afraid. She also wasn’t alone, and she knew it. If she got something she couldn’t handle, she’d have backup. Glenn was here, looking solid and sure, as if she’d seen and done this kind of thing a hundred times before—because she had. Dr. Remy too. But most of all, Mari trusted her training.

“Good,” Glenn said. “You’ll take anyone who isn’t actively hemorrhaging or in full arrest. Use room one.”

“Okay—you better tell me about grain silos. What can I expect?”

Glenn’s gray-blue eyes darkened to nearly black. “Don’t see much of that in LA?”

“Try never.”

“Depends on what was in the silo, but usually corn or wheat, which generates heat, toxic gases, and a hell of a lot of dust. When the structure collapses or the contents avalanche inside, whoever’s buried will suffocate in seconds or be crushed, but they can also get sucked into the augers and mixers—meaning broken or severed limbs.” She spread her hands. “If it takes more than a minute to extract the ones who are completely submerged, their lungs will be full of dust and even if we intubate, it’s not going to be enough.”

“So blood gases on everyone,” Mari said, trying to formulate a treatment plan on the fly. This was nothing like a multi-vehicle pileup on the interstate, but the principles were always the same. “What else? Injury-wise?”

“Compression syndromes, fractured ribs, open and closed extremity type injuries. The fractures can all wait unless there’s vascular compromise.”

“Right. Airway will be the thing.”

Glenn nodded. “If you need an assist, holler. I’ll be right across the hall.”

Bruce appeared around the corner. “The first bus is here.”

Abby strode confidently into the center of the waiting staff. “All right, everyone, you know what to do. Let’s go to work.”

Mari took a deep breath and hurried into her room, quickly scanning the instruments set out beside the exam table. She pulled on gloves just as a stream of first responders burst into the ER pushing stretchers toward the rooms where Bruce had directed them. Two EMTs angled a stretcher into Mari’s cubicle with a small form nearly dwarfed by oxygen tanks, an EKG monitor, and IV bags. All Mari could make out beneath the tape and O2 bag was a blue-tinged face and a shock of yellow hair.

A heavyset redhead at the front of the stretcher croaked hoarsely, “Juvenile, maybe ten years old, buried in three feet of dust—” He lost his voice for a second, then continued, voice steadier although agony misted his eyes. “The family had already dug him out, and the dad was doing mouth-to-mouth. We intubated in the field.”

“Pulse ox?”

“60.”

Mari’s stomach plummeted. 60 was barely compatible with life and not enough to sustain brain function. She quickly listened to the boy’s small chest and could hear no air moving in the lower two-thirds of his lungs. Thankfully she detected a rapid heartbeat, but that wouldn’t last long if they couldn’t ventilate him. “On a hundred percent O2?”

“That’s what’s running, but it doesn’t seem to be doing much good.”

Mari glanced at Beverly, a middle-aged brunette nurse who’d arrived to help. Her mouth set into a tight line, and Mari didn’t have to ask why. If they did nothing, this child was dead. But no matter what she did, it probably wouldn’t make a difference. Still, her job was to fight, as long as reasonable, and fight she would.

“All right,” Mari said, hoping she sounded confident, since she hadn’t actually heard of what she planned to do being used for anything like this. Although she hadn’t heard of this until ten minutes ago. “Let’s set up a saline lavage, get another pedi tube ready.” She looked up at the two EMTs. “What size do you have in there?”

“Six,” replied the second EMT, a thin young blonde with a silver hoop through the corner of her left eyebrow.

“Who intubated him?”

“I did,” the blonde said.

“Did you see debris in his trachea?”

“I didn’t see anything. It was a blind intubation.”

“All right then, let’s see what we can see.” She ought to clear this treatment with someone before she went much further. “Beverly, can you get Dr. Remy or Glenn for me?”

“Not for a few minutes,” Beverly said. “I saw them both at a resuscitation on my way in here.”

“We don’t have a few minutes,” Mari muttered.

“Let’s not waste any time, then,” Beverly said briskly, as if telling her to do what she needed to do. She stood by with suction and a small-bore catheter connected to a saline bag under pressure.

“Time me.” Mari took a deep breath and slid out the breathing tube, removing the only thing keeping the boy breathing—and alive. She didn’t have long, but then, neither did he. She slid in her laryngoscope and lifted his chin, giving herself a narrow tunnel down which to evaluate his airway. The thin light at the end of the instrument illuminated the back of his throat and the upper part of his trachea. Where she should have seen glistening pink mucosa she saw only thick clumps of dark debris. It looked as if someone had poured concrete into his windpipe. No wonder he couldn’t breathe.

“Let me have the lavage catheter.”

Beverly slid the thin tube into Mari’s hand and she threaded it down into the debris and hopefully into his trachea. “Go ahead, open up the bag and get the suction ready.” Fluid shot into his trachea, completely blocking what remained of his airway. If this didn’t work, he’d drown. The saline mixed with the dust from the grain silo, threatening to glue shut any possible avenues for airflow, and Mari frantically suctioned before the mixture turned into paste.

“Time?”

“Thirty seconds,” Beverly said.

“Another fifteen seconds,” Mari said, the muscles in her shoulders starting to ache.

The curtain twitched back and Abby Remy looked in. “What’s the story?”

“Foreign material in the airway. Some kind of thick, particulate matter—dust, I guess,” Mari said without looking up. “He was tubed on arrival, but not oxygenating. We’re lavaging to clear the trachea and mainstem.”

Abby threaded her way between the EMTs, who hadn’t budged, to the head of the table and looked over Mari’s shoulder. “Lift the laryngoscope a little bit more so I can get a better view.”

Mari took a deep breath and lifted. Now her arm was beginning to shake. Keeping the jaw open and the airway exposed was strenuous, and she hadn’t intubated anyone in almost a year.

“How long on the lavage?” Abby asked.

“Forty-five seconds.”

“O2 sat?” Abby called out.

“58,” the male EMT reported.

Mari’s stomach plummeted. She was going to lose this boy.

“Keep going. You’ve almost got it,” Abby said quietly, her sure, certain tone injecting much-needed strength into Mari’s aching arm. “You want me to take over?”

“No,” Mari said just a bit breathlessly. “He’s almost clear.”

“There you go,” Abby said with a note of victory. “The suction fluid is coming back clear.”

Mari finally breathed. “Turn off the saline and let me have the new ET tube.”

“Here you go. A pedi six,” Beverly said and slipped the curved plastic endotracheal tube into Mari’s outstretched hand.

Never moving her gaze from the small dime-sized opening that led down into the boy’s trachea, Mari slid the tube between his vocal cords and toward his lungs. “Hook us up?”

The ventilator began to hiss, and Mari slid out the laryngoscope and stepped back.

Abby listened to his chest with her stethoscope, nodding as she quickly moved the diaphragm over his chest. “Breath sounds are good. Pulse ox?”

“65,” Beverly said.

“Increase the rate to twenty and decrease the volume. Let’s rapid pulse him.”

The pulmonary tech adjusted the ventilator, and the machine cycled quickly in short, sharp bursts as if it was panting.

“Suction him down the tube, Mari,” Abby murmured.

Quickly, Mari complied, barely able to take her eyes off the pulse oximeter, hardly breathing herself as the numbers began to edge up. 68, 72, 75, 80, 85, 90.

“Holy Jesus,” the big burly EMT muttered. “You got him back.”

“Let’s get a chest X-ray,” Mari said, tempering her elation. A million things could go wrong, and if he’d been without cerebral perfusion for too long, she might not have saved him after all. Now only time would tell if he would recover. She had to be sure he didn’t have other injuries that could complicate his recovery, and then they would wait.

Abby said, “Draw a full panel of bloods and get him up to the intensive care unit.” Abby squeezed Mari’s shoulder. “Very nice, Ms. Mateo.”

“Thank you.”

As quickly as it had begun, it was over. Beverly drew bloods from the IV line and the two EMTs, who appeared to have no intention of leaving their charge, pushed the stretcher out into the hall. Another stretcher materialized in her cubicle, this one with a young man whose right arm was misshapen and bloodied.

“Hi, I’m Mari Mateo, a PA,” she said, and got back to work.

*

Mari had no idea how much time had passed by the time the last patient left her cubicle for an observation room upstairs. It might’ve been ten minutes, it might’ve been ten hours. All she knew was she’d never felt so exhilarated in her life. She’d splinted fractured limbs, inserted a chest tube under local anesthesia, and treated an acute case of asthma with inhalation agents and intravenous medications, avoiding a dangerous intubation. She’d evaluated more complex cases in one day than she had in a month of training, and she’d managed mostly on her own. She’d been dimly aware of the seething activity around her as she’d worked—once she’d heard the high-pitched wail of someone’s heart breaking, and a moment later Glenn’s low-pitched, melodious cadence calling for a cutdown tray. Dr. Remy popped in and out of her room, checking patient status, reviewing a treatment plan, offering suggestions.

As soon as the transport orderly took her patient, a forty-five-year-old fireman with an impending MI, to the medical intensive care unit and no one brought another patient to replace him, she sagged into the hard plastic visitor’s chair against the wall of her treatment room and stared at the litter-strewn floor. An errant glove someone had tossed toward the trash can and missed, an IV tube dangling from a metal stand, the saline slowly dripping into a clear puddle, bandage wrappers, a plastic cap from a syringe. A war zone.

“How’d you do?” Glenn asked from the doorway.

Mari glanced over at her. “Okay, I think. I didn’t lose anyone.”

“That’s a good first day, then.” Glenn grinned and checked her watch. “Of course, you’ve still got another eleven hours to go.”

“You’re kidding.”

“Nope. It’s just a little bit after 0830.”

“Oh my God.” Mari blew a strand of hair from her eyes. “Is it over? Did we win?”

Glenn’s eyes clouded. “Mostly. Two fatalities, both submersion casualties—a twenty-year-old farmhand, first day on the job, and the thirteen-year-old daughter of the farm owner.”

“Damn,” Mari whispered, sadness blunting the thrill of victory she’d experienced just moments before.

“But I hear you saved her brother—smart thinking. A gutsy call.”

Mari shrugged. “Probably more beginner’s luck.”

“I don’t believe in luck—unless it’s bad.”

At the sudden dark tone in Glenn’s voice, Mari took a hard look at her. Her skin was pale beneath her tan, her face drawn and tired. She’d had the critical patients and had probably been involved with the fatalities. “Are you all right?”

“Me? Sure. Fine.” Glenn shrugged and her usual mantle of calm control fell back into place. “Come on, I’ll show you where the locker room is. You can get clean scrubs and shower if you need to.”

Following Glenn’s pointed gaze, Mari looked down at herself and realized that a spray of blood from one of the IVs she’d started had left a crimson crescent across her chest. Another splotch of blood marred her thigh. She couldn’t see patients the rest of the day like this.

“You’re right. I need to get cleaned up.”

“You probably ought to have something to eat. This kind of thing burns off a lot of energy, and you don’t want to crash later.”

“I’m not eating anything until…” Mari made a face and indicated her blood-soaked scrubs.

“I’ll grab something for you while you shower. Cereal is always a good quick fix.”

Mari grimaced. “How about a bagel.”

“I can always dig up a bagel. Cream cheese?”

“Peanut butter. More protein.”

Glenn grinned. “You got it.”

The women’s locker room occupied the opposite end of the ER from Dr. Remy’s office. Glenn tapped a locker with a small metal tag stamped with the number 37. “This is yours. You’ll need to bring a lock from home, but truthfully, no one is going to take anything.”

“I don’t really have much to take. A five-dollar bill is all the money I brought with me.” Mari shook her head. “I should’ve thought to bring a change of scrubs.”

“Don’t worry about that. The hospital provides. Towels are in the shower room.”

“Thanks.”

“Don’t mention it.” Glenn hesitated for a second. “And you’re right, you’re not all that green.”

Mari smiled to herself as Glenn disappeared, leaving her alone. She chose the farthest of the three shower stalls, found the clean stack of white towels, and grabbed two. She left her clothes in a pile on a narrow bench outside the stall and stepped into the hot water. She kept her hair dry as she slowly turned in the strong jet, reveling as the heat soaked into her muscles and eased away the tension and stress. Tilting her head back, she closed her eyes and emptied her mind.

“Hey, you need anything?” Glenn’s voice called from somewhere nearby.

Mari’s eyes snapped open. She thought she might actually have been asleep.

“No. Thanks. I’ll be right out.” She quickly turned off the water and stretched an arm outside, feeling around blindly for the bench where she’d left the towel. Only then did she realize she couldn’t reach it without stepping out. “Um…do you think you could hand me the towel?”

For a long moment, she thought Glenn had left.