Chapter 26.

Three weeks later

"I'm tellin' ya, Chet—this time it's gonna be different!" Johnny waved his fork towards Chet as he made his proclamation. "Tomorrow night—Friday—it's gonna be our third date, and—"

"Great, Gage—already two more than usual! That's a sure sign she's gonna be the one, huh? You buy the ring yet?" Chet jibed, as he passed the salad to Marco.

"Oh, ha ha. I just don't have the vibe that, you know, I'm gonna get dumped, is all. You'll see," Johnny said confidently. "Whaddaya think, Roy? Am I right? Or am I right?"

Roy shook his head. "I'm not gonna touch this one with a ten foot pole."

"We've got a couple twelve-foot pike poles on the engine," said Mike, uncharacteristically adding to the conversation. "Would that work?"

"That might be all right," said Roy. "Nice and sharp on the end, too."

"I dunno," said Chet, "the pointy part might puncture someone's fragile ego, and—"

BWAAAAAAAAM BWOOOP BWEEEEEEEEP!

"Station 51, car over embankment, unknown injuries, Old Canyon Road one quarter mile south of intersection with Fire Tower Road; Old Canyon Road, one quarter mile south of intersection with Fire Tower Road; time out: 1821."

Instantly, every man put on his game face, and headed to the apparatus bay. Mike started up the engine, pulling out of the bay as soon as everyone was aboard, and Roy and Johnny followed in the squad.

It was a longer drive than usual to their incident, which was all the way at the edge of their district. Everyone hoped to high heaven that there wouldn't be any fire involved; the brush in that area was likely crisp and dry, and to start with, they would only have the water that the engine carried in its tank.

Roy flexed and extended his fingers a few times as he drove. It was his third shift back on duty. His hand was feeling as good as new, but, for the first time since he'd returned to duty, they had a call that seemed like it might turn out to be something really big. On his first shift back, he'd had to do CPR, but only for about six minutes total, trading off with Johnny every two minutes as was their habit. He'd been plenty sore later, but everything had worked the way it should have. On his second shift back, they'd had to perform a trench rescue that had involved a tight squeeze—Johnny's specialty—so there was no question about who was going to do the hard work on that one.

But this incident had Roy's pulse elevated. The accident was in a remote location, and whoever called it in to dispatch obviously hadn't had a lot of information, and had probably had to travel some distance to get to a phone. By the time they would arrive at the scene, it was likely that half an hour or more could have passed since the accident happened—a long time, even if there were only minor to moderate injuries, and a potentially fatal length of time if any of the injuries were severe.

"Okay, Fire Tower Road should be coming up," said Johnny. Half a minute later, the engine pulled over ahead of them. Roy cut the engine on the squad, and he and Johnny got out.

Cap had partially sized the scene up even before he exited the engine. "We've got two cars, one up against the hillside here, and one down the embankment. Looks like we have injured people in both cars. Roy, John, I'll need one of you up here, and one down the embankment. Mike, you and Chet are on the car down the hill; Marco, you're with me on this one."

Roy and Johnny peered over the embankment to see what they could from the road. The first thing that was apparent was that the vehicle at the bottom of the hill was a station wagon. It must have flipped at least once, because the roof was caved in, but luckily, the car had come to rest in an upright position. Roy paled at the thought that a station wagon usually meant a family. The second thing that was apparent was that one of the doors was open, and that one of the occupants was sitting cross-legged a few yards from the car.

The third thing that was apparent was the pigtails on the seated victim.

Roy looked Johnny straight in the eye. "I need to take this one."

Johnny stared back, searching Roy's face for hesitancy. He found none. "All right. I'll handle things up here." He rushed over to where Cap and Marco were busy stabilizing the car that had plowed into the hillside on the other side of the road.

Chet and Mike had already set up ropes to belay Roy down to the scene below. Roy listed the equipment he'd be likely to need, holstered the Handi-Talkie, hitched the line onto the carabiner on his safety belt, and rappelled down to see what he'd find.

On his way down, Roy thought about the moment where he wasn't sure that Johnny was going to let him take the lead on this rescue. It was important that Johnny had said what he had—that Roy could take the rescue, and Johnny would back him up. But to Roy, what was more important was what Johnny hadn't said. "Are you sure?" "Is your hand going to be up to this?" "But what if—" or any of those other possible questions or statements that could throw a monkey wrench into their newly revived and still somewhat fragile trust.

He reached the bottom of the embankment, and unhooked himself from his line. He watched his step as he carefully made his way through the brush to the little girl, who was holding a doll in her arms.

"We've been waiting for you for a long time, haven't we, Dolly?" The little girl was speaking to her doll more than she seemed to be addressing Roy.

Roy checked the girl over quickly before he got closer to the car. "Are you okay, sweetie?"

"Oh, I think I have a boo-boo on my elbow. But my mommy was crying—I think she might be all better now, because she stopped. But she's stuck, and my daddy's stuck too." She looked up at him with serious blue eyes. "Our car fell right off the road, and now it's broken. I was wearing my seat belt. It held on to me really tight when our car fell down."

"Is there anyone else in the car besides your mommy and your daddy?" Roy asked.

"Nope. Just me and Dolly, and we crawled out already."

"Okay—now listen carefully, honey. I want you and Dolly to sit right over there under that big tree, away from the car, while I help your mommy and daddy get out, okay?"

"Okay, Mister Fireman." The girl wandered over to the tree and sat down.

Roy steeled himself to go look into the station wagon. It had come to rest with the hood crumpled into a large tree. Luckily, all four wheels were solidly on level ground, and the car looked and felt stable.

He approached the driver's side first. The driver was a man of about thirty—no, Roy corrected himself, as he felt for a carotid and found none—had been a man of about thirty. He was tightly pinned between the steering wheel and the seat. Roy could see that his chest was caved in around the steering wheel. Blood was crusted on one corner of his mouth. Splintered ribs had torn through the side of his shirt, and copious blood from that wound had pooled on the bench seat.

"Please …" came a voice from the passenger's side of the car. "My little girl … "

Roy's head jerked up—the woman on the other side was still alive.

"Try not to move—I'm coming over to your side," Roy said.

Roy quickly went around to the passenger's side, and quickly assessed the woman's positioning and injuries.

"Ma'am, your little girl is just fine. Try not to move—can you tell me where you're hurt?"

"My arm," she said faintly.

Roy looked at her torso. Her right arm crossed her body, and obscured his vision of her left arm. There was blood all over the dashboard, all over the windshield—everywhere.

"Don't move, but just tell me what happened to your arm. I can't see it," Roy said.

"There's a bone sticking out, near my wrist, and blood was spraying everywhere. I grabbed it as hard as I could, and now it's just dripping. Oh, it hurts, it hurts!"

"All right, miss—don't let go. I promise, I'll take your arm in just a minute, but I need to look at the rest of you first. Are you hurt anywhere else? Neck, back, legs?"

"My left leg—I can't tell but I think it's broken, but not like my arm. Please, help me!"

"All right," Roy said. "I'm going to reach across and hold your arm now, all right? I'm going to push your seat back, and get in with you, and take your arm."

"Please … hurry … can't feel my hands …" the woman's voice was getting slurred and weak.

Roy whipped out the Handi-Talkie to call up the hill. "Engine 51, I've got one patient, with a compound fracture and arterial spurting. I need the trauma box, drug box, backboard, Stokes, O2, Biophone, and at least one more set of hands. We've also got a child, unharmed, but who needs attention."

"Copy, Roy," said Cap's voice. "Johnny's got two walking wounded he's tending to; I'll send Chet and Marco down with your equipment, and Mike will come down next to take the child up."

"10-4." Roy placed the Handi-Talkie on the roof of the car.

"Ma'am, I'm going to move your seat back now, all right? Don' t try to help—just let me do all the work, and then I'll take care of your arm."

The woman nodded. Roy could see her skin and her lips were pale—she must have already lost a lot of blood. He reached under the seat to find the bar to move the seat back, lifted it up, and slid the seat back, all at once.

As soon as the seat moved, the woman screamed, and let go of her arm, which was now clearly in Roy's line of vision. Blood pumped feebly from around the area where both her radius and her ulna protruded through her wrist. Now that the seat was back, Roy could see the tremendous amount of blood in the passenger compartment. He couldn't tell whose it was, but if even half of it was from the woman, she was in serious trouble. He reached across her, and clamped his right hand around the middle of her forearm. The woman screamed again, and then keeled forwards onto him.

The blood that was pumping out of the wound slowed to a dribble, with Roy's hand now acting as a tourniquet around her forearm. Roy held on tightly, and used his free hand to feel the woman's legs for damage.

She was right—her left leg was also broken, but luckily, Roy couldn't feel any bones protruding through the skin.

Roy continued to hold the wrist firmly, and got an initial pulse and respiration rate. As he finished those measurements, he heard voices and crackling in the brush up the hill from the car.

"Chet? Marco? Over here," Roy said, "in the car. One of you set up the biophone, and the other one help me get her out of the car."

Roy could hear Marco setting up the biophone and calling in to Rampart, as Chet appeared with the backboard.

"Tell Rampart we have a female, approximately thirty, with greater than 1500 milliliters of blood loss due to a severed artery from a compound fracture of the left radius and ulna. She's been unconscious for about a minute. Pulse is 130, respirations 28, hold for BP," Roy told Marco.

"Chet, we've gotta get her out of here fast. Grab a tourniquet from the trauma box—yeah, that's perfect. Okay—pass it around her forearm, just above where my hand is—perfect—now pull it, more, okay, stop." Roy let go with his hand, and flexed his fingers a few times.

"All right—let's get her out. No time for a backboard. On three, you take her upper body and I'll take her legs: one, two, three!"

Roy slid the woman's lower body free of the foot well, taking care with the fractured left leg, as Chet pulled and slid her upper body out of the car. Roy slipped in the blood covering the vinyl seat. "Hold it!" he said, as he regained traction. "All right—let's get her out and onto the ground. Marco, get the O2 on her."

Chet held the woman with his elbows under her armpits and his hands locked over her chest, and lifted her out of the car, as Roy lifted her legs out of the car. They set her down on the backboard that was next to the car.

Roy grabbed his stethoscope and the BP cuff and took a reading. "95 over 65," he said to Marco, who relayed the information to Rampart.

Without waiting to hear what the physician was going to say, Roy started prepping two IVs.

Marco confirmed the orders Roy was expecting. "Roy? Rampart says two IVs of Ringer's, keep the bleeding down, and transport."

"Got it," Roy said. "Marco, why don't you head back up topside to help pull her up."

Roy's hands moved like lightning as he quickly started the first IV in the uninjured arm. He looked at the injured arm, immediately abandoned the idea of starting an IV there, and started looking at the woman's uninjured leg. It wasn't ideal, but there was no way he could use that arm, and he didn't want to have to go for a jugular stick unless he absolutely had to. He thanked his lucky stars that the woman was slim and had good veins as he started the second IV in a vein in her foot.

He took a second to breathe, and to wipe some of the blood off his hands before he grabbed the biophone.

"Rampart, IVs established. Bleeding is controlled with a tourniquet. Patient remains unconscious. I'll apply splints to the arm and the leg before moving her up the hill."

"Copy, 51," said the voice on the biophone, which Roy immediately recognized as belonging to Dr. Brackett. "Get us a new set of vitals after you have her up the hill."

"10-4," said Roy. He left the connection to Rampart open, as he quickly but carefully splinted first the arm with the open fracture, and then the leg. The woman drifted in and out of consciousness, but, fortunately, did not seem to be particularly aware of the procedures, which would have been excruciating had she been conscious and alert.

"Roy?" Mike Stoker appeared at Chet's side. "I'd like to get the little girl up top, but I don't want to get in your way."

"Yeah," said Roy, "you'll have to bring her up after we've got the Stokes up. Is she doing okay?"

Mike hesitated. "She asked about her parents. I told her we're taking care of them."

"The dad's dead, Mike, and the mom's not in good shape. So yeah, that's pretty much all we can tell a kid that age at this point," Roy said, as he and Chet secured the patient into the Stokes with ropes and strapping.

"All right," said Mike. "I'm going to take her away from where she could see her mom going up the hill in the Stokes. Give me a yell when you're done, and I'll come up with her." He had a second, smaller safety belt strapped to his own.

"All right—this is gonna be tricky," said Roy, looking up the hill. "There's no way we're gonna be able to keep her flat, but we can't afford the time it would take to call a ladder truck so she could go up horizontally. I think we ought to take her up vertical—I'll put the IVs up by her head, so they'll keep going while we're pulling her up."

Chet and Roy made quick work of tying the lines off on the Stokes. Roy radioed up to Cap that they were ready to send the patient up, and that it needed to be quick.

"10-4, Roy—Marco and John and I will have her up in a jiffy."

Chet manned the tag line, helping to control the angle and swing of the Stokes, as Roy packed up the equipment and got ready to return to the road above.

"Chet, send the equipment up as soon as you can, all right?"

"Got it, Roy," said Chet, not taking his eyes off the Stokes he was guiding.

Roy went to the line Mike had come down on, and started pulling himself up. The hill wasn't a sheer cliff, or he would have waited for someone to pull him up from the top, but the angle was steep enough that it was hard work climbing back up again. He reached the top, unhooked himself from his line and went straight back to his patient.

He took a second set of vitals, borrowing Johnny's stethoscope and BP cuff, and had just finished with that task as the biophone and the other equipment made it back to the road.

"Rampart, I have a second set of vitals on the patient with the blood loss and compound fracture. Pulse is 125, respirations 27, BP 95/75. Patient is in and out of consciousness, and not alert." Roy could hear an approaching siren.

"10-4, 51. What's the ETA on your ambulance?"

"Any second, Rampart. Our ETA to Rampart is fifteen to twenty minutes." Roy could practically hear Brackett's eyebrows knitting at that statement.

"Any idea how long it was between the accident and when you arrived?" Brackett asked.

Roy knew Brackett was concerned about blood supply to the woman's hand, in addition to the fact that with such a huge blood loss, none of her organs would be properly perfused with oxygen. "Over half an hour," he replied, "maybe more."

Brackett sighed over the biophone. "10-4, 51. Bring her in as fast as you can. Sub in a full bag of Ringer's as needed, and apprise us of any changes en route. Also, get us a tube of blood so we can type and cross-match."

"Copy," said Roy.

The ambulance attendants pulled the gurney up next to the Stokes, and everyone helped transfer the woman onto the gurney.

"Just the one going with us, Roy?" one of the attendants asked.

"Yeah," said Roy. "There's a kid, too, but she doesn't have a scratch on her. Seat belt success story, for sure," he said, as they worked together to lift the gurney into the rig. "And Johnny's guys are gonna have to wait for another ambulance. I can only handle this one patient right now." He climbed in the back, and Marco passed the equipment he'd need in, closed the door, and thumped it twice.

"Speaking of seat belts, make sure you guys buckle up in the front there, all right?" Roy added.

"Yeah, yeah," said the driver. "Boss has been on us about that all week. Just got a memo from the state saying it's gonna be law soon that we have to wear the seat belts, so we might's well start now."

Roy brightened a bit at hearing that—there was no way the actual law was going to change soon, but perhaps people were starting to get the message about safety in emergency vehicles.

The trip in to Rampart seemed to take ages. Roy checked the woman's vitals every few minutes, and was relieved to see a slight decrease in pulse and respiration, and a slight increase in blood pressure. He drew a tube of blood, so the lab could type and cross-match for the transfusion the woman so desperately needed. Every so often, the woman came around slightly. Once, she regained enough consciousness to speak briefly.

"Jenny?" she whimpered.

It was a common name, but still, hearing that the little girl's name was the same as his own child's gave Roy the cold chills.

"She's just fine," said Roy. "Just a scrape on her elbow, thanks to your seat-belt rule." Roy didn't say anything about her husband—the fact that she hadn't mentioned him suggested she knew he was no longer alive.

As the trip continued, Roy realized he was feeling something he hadn't felt for a long, long time. He was coming down from a huge adrenaline rush—not the kind you have when your own life is in danger, but the kind you experience when you're involved in a situation so emotionally intense that your body protects your mind by shutting it down a little bit—letting your mind do just what's needed for survival, but not letting it dwell on things that would get in your way. Roy realized it had been a long time since he'd actually had such a reaction—probably because in the months leading up to the Wall Incident, as he and Joanne had started calling it, he was so mired in depression that his mind hadn't needed to be shut down any further.

Finally, the ambulance arrived at the emergency entrance at Rampart. Roy handed Dixie the tube of blood he'd drawn to type and cross-match for a transfusion, and transferred his patient to the care of the physicians.

For a moment, he didn't know what to do with himself. He stood there in the hallway of the emergency department, suddenly realizing how exhausted he was. Coffee, he thought. That'll cure what ails me.

Roy made his way to the staff lounge, and put his hand up to push the door open. He stopped, and realized he'd completely forgotten he was covered in blood. His shirt was spattered, and the knees of his pants were becoming stiff as the pools of blood he'd knelt in in the car started to clot and dry. He sighed, putting off thoughts of coffee, and headed for the staff locker room instead. He stripped off his uniform, placing it into a mesh bag to go through the hospital laundry, and showered quickly. He retrieved his spare uniform from the basket he had in the locker room, and changed into it.

All the while, he thought about the run he'd just completed. He'd done well, in a tricky situation, and he knew it. There was nothing he could think of he could've done better or faster. Johnny was faster than he was at a lot of things, but one thing Roy had always excelled at was figuring out where to put IVs when the conventional forearm or hand placement wasn't an option. And, Roy realized, this had been a rescue where his hands were crucial, and his recently injured right hand had held up remarkably. From rappelling, to using his own hand as a tourniquet, to the precision of movement needed to establish an IV in an atypical site—his hand had done everything it had needed to do, without a complaint or a twinge.

Roy exited the locker room, to try again with the coffee. On his way out, he ran into Dr. Brackett.

"How is she?" Roy asked.

"We're transfusing her now," Brackett said, "and the surgeons are looking at her arm and hand."

Roy's heart sank. "Do they think she'll lose the hand?" Roy knew it was a tricky situation—the tourniquet had been necessary to control the potentially fatal bleeding, but her hand had gone about an hour without good blood supply.

"They're not sure yet," Brackett admitted. "One question we all have, though, is why she didn't bleed out in the half-hour it took between when the accident was and when you arrived. That's a bit of a mystery."

Roy shook his head in amazement. "You wouldn't believe it, Doc. She was squeezing her own forearm the whole time. She could tell she was bleeding to death, I think—and I'm pretty sure she knew her husband was dead. I'd be willing to bet the only way she managed that was because she knew her daughter would be an orphan if she didn't stop the bleeding."

Brackett's eyes widened. "Well, she certainly saved her own life, that's for sure. And you did an excellent job as well—the only other place that second IV could've gone was the jugular, which also would've been tricky. I don't know if you saw, but the bruising from her seat belt was pretty severe—the belt hit high on her shoulder, right up near her neck, and she's got a huge hematoma at the junction of her neck and shoulder. So the foot was the absolute best choice—good going."

"Thanks, Doc," said Roy. "Well—keep me posted, if you can. I'd love to know how she does."

"From what you just said, Roy, I'll bet no matter what happens, she'll do fine. That's one heck of a strong lady."

Roy silently agreed, as he made his way to the lounge for a cup of coffee. The lounge was empty, which was a bit unusual for that time of day. He grabbed a mug from the supply of communal cups in the cabinet, and filled it with the burnt-smelling brew from the aluminum urn. He added sugar and creamer to make the stale brew palatable, and sat down to drink it.

From his spot on the ugly Naugahyde couch, Roy had a perfect view of the bulletin board by the door. About two weeks ago, maintenance had finally gotten around to repairing the hole Roy had punched in the sheetrock. Now, the patched area was freshly painted, and there was no sign of the violence he'd perpetrated on the wall.

Roy looked at his hand—there might still be a slight swelling of bone callus near the knuckle of his pinky finger, but nothing a casual observer would ever notice. But he knew that wasn't the important change—bones heal faster than psyches, he knew, and the orthopedist had assured him that the bone would be stronger in the broken place than it had been before. So Roy indulged himself with a bout of introspection, and looked at his psyche as well.

Was it broken? It had been, that was for sure. But, just like the hand bone, it seemed that the place where it was broken was stronger than it had been before. He'd seen death today—the death of a young father—and it hadn't stopped him from doing what he'd needed to do to save the mother. He'd seen a child in distress—a child who was too young to understand the situation, but was still keenly aware that something terrible had happened—and he'd been able to set her aside gently to do what he needed to do, and allow someone else to handle her with care.

So like the hand bone, and like the wall, a casual observer would never know, looking at him today, how broken Roy had been just a few months ago. And for the first time since returning to work a few shifts ago, Roy was sure: he was sure he loved his job, and didn't want to give it up quite yet. He was sure he had what it took to keep going, to flex instead of snapping, when things got tough. And he was pretty sure, that once he needed to move on from being a paramedic, that he had what it would take to be an excellent captain—one who could command incidents, make decisions, and bear the burden of responsibility for his men.

As Roy was staring at the freshly painted wall, the door next to it swung open, and Johnny came through.

"Hey, there you are," he said. "Boy, you sure look a lot better."

Roy knew Johnny meant he looked better with the blood washed away and with a fresh uniform on. But Roy couldn't help thinking about the last time they were in this lounge together.

"Yeah, Junior. I'm better. Good as new. C'mon—let's get back to work." And without a glance at the place where there used to be a hole in the wall, and without a second look at his hand, or into his head, Roy followed his partner back out to the squad.

THE END