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      Captain's
   Prerogative
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The Story Unfolds...

Season Five, Episode Thirty Five..

  Captain's Perogative  

Debut Launch: July 1st, 2006.

*************************************************
From: "rwein5" <rwein5eve@charter.net>
Date: Mon Jul 3, 2006 7:08 am
Subject: Eye Opener..

He couldn't see the face behind the light.

All he felt was the piercing pain down his left side and the
chorus of bees that seemed to have settled in his head. The
light shifted and he groaned, knowing that the cracked vocal
strains came directly from him.

Cap tried to shut his eyes against the forced brightness, but didn't
have the strength. Finally, the light shut off and a voice filtered
through the buzzing.

"Okay, Hank, good job. Just hang in there," the deep voice
commanded.

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He wasn't sure if he understood the command, but it didn't matter.
There was only so much he was capable of doing right now. Images
began dancing in his mind as he tried to shut out the annoying real
world. Between the pain, the prodding, and the obvious demands for
him to comply, he let himself drift to the earlier part of his day.

That part wasn't filled with pain and anguish. That memory was
pleasant and filled with satisfaction.

Then the whirlwind of images picked up speed and he tried to make
sense of them. His addled brain set into overdrive and he felt the
spiraling descent into the worst part of his day; the part that
landed him here on an examining table with nothing but pain..
Yet the physical pain seemed to competing for his mental anguish.

He desperately wanted to open his eyes and see the faces of his men.
However, that reality was no longer around. All he knew was the
despair of loss and the anguish of defeat; all because of his
decisions and his leadership.

He succumbed to the depths of his own reality where the crew was safe
and all was as it should be.

A veil of darkness slipped around him carrying him away to a
world of sleep. He groaned again.

Remembering . . .

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*************************************************
From: "sniffles_76102" <sniffles_76102@yahoo.com>
Date: Mon Jul 3, 2006 10:15 pm
Subject: Reverse..

It had been a dark cloudy day.

All the men had gotten to the station on time.

Even Gage.

They all had been on time for three shifts in a row. Cap
remembered that he made a bet with all of his men, stating...
"I bet you twits couldn't get here on time, all of you, for three
shifts..."

Smiling, Hank looked around as Johnny came skidding into the
kitchen mumbling, "Sorry Cap, about being late."

Chet looked up and said, "Cap what would happen if we got here
on time, all of us,"..he mused,  while glancing at Johnny, " for three
shifts?"

Hank knowing how at least one of them would always be late, smiled
and said , "I'll hang the hose for you twits without any of you
helping me."

Well that time had come.

::How could I have known that "C" shift had a lot of calls during the night
and didn't have time to hang hose?:: Cap thought miserably while he was
getting the hose hung off the tower and thinking about his men.
::How DID all of my men get Johnny in here on time?::

He was still mumbling to himself, when he looked down...
He immediately made another face.

All of his men were watching him from below the tower.

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"Johnny, how come you can get here on time when I make a bet, but all
the other times you're late?" scowled Hank from where he was.

"Well, Cap. I couldn't let down the men... How was I to know that "C"
Shift left you these nice, soggy presents?" Johnny smiled up at Hank.

"Yeah, Cap. We HAVE wondered how the experts do it." said Chet with
laughter in his voice as he gestured at the long spaghetti trails
of hose slowly moved upwards, one by one.

Stoker really never thought this kind of outcome would happen either.
Mike just laughed and didn't say a word.

Marco was smiling, when he looked around at the clouds. "Hey Cap,
you might want to hurry a little. It looks like there is a storm coming
in." he shouted up.

"Do you twits have nothing else to do, except watch me?!" Cap said a little
testily. He hadn't hung hose in a long time and he was remembering
quite easily why he didn't miss it.

The men turned to go back into the station.

They had just made it inside, when it happened.

Lightning struck the tower and outside, the captain started yelling and
screaming. They saw that he was being electrocuted as the tower
came down through the window.

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The firemen felt like the world had come to an end. They were still
reeling at how the loud the crack of lightning and the boom of thunder
had rocked them.

They raced back outside and began circling the crumpled hose
tower where their captain lay entangled.

Mike turned around and immediately called out on the alcove radio to
headquarters. But he got no reply back. ::The lightning must have
zapped the radio transceiver.:: he thought.

Then he went to the engine, grabbed his HT, and tried once again
to radio out to L.A. for help.

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**************************************************
From: "rwein5" <rwein5eve@charter.net>
Date:  Sat Jul 15, 2006 2:41 pm
Subject: Flashback

Being the best paramedic team in the county had had its drawbacks.

One of the biggest drawbacks had to have been handling an
emergency situation in their own backyard.

Once the lightning had struck, both Roy and Johnny slipped quickly
into their paramedic mode and had administered CPR. Chet and Marco
frantically pulled away the heavy canvas hoses and cleared the
area for the team.

Mike was already at their side with the biophone and oxygen. Despite
the intimidating wind and threat of a downpour, the crew of Station 51
had stayed professional and persistent. A heartbeat soon began
again, and by the time the ambulance arrived, Hank was reading
as stable and was ready for transport.

Image of stokerstokescpr.jpg royjohnnytreatcap

A day of rest and monitoring... and Cap's visit at Rampart was
promised to remain short.

He had survived that one.

---------------------------------------------------------------------------------------------

The scene played out in broken details as Hank continued to
struggle to consciousness once again.

Why he was remembering an incident from several years ago with
such clarity, eluded him and further agitated his pain-riddled senses.
He had survived then. :: But what about today? Will I survive the
consequences of my last decision?:: he thought.

"Hank?"

The tunnel of voices spun away again. He tried hard to listen, but
only shook his aching head in frustration." . . .aghh . . my . .men?"
he whispered.

"Hank? Can you stay with me? Hank . . ?" prompted the question
again.

Stanley felt a softness against his forehead as the gentle voice
made its way to his confused mind.

"Hank? You need to let me know where it hurts? Can you hear me?"
it asked.

Cap decided that he couldn't open his eyes nor find the strength to
reply back.

Dixie looked up at Joe Early as he continued to assess his newest
patient.

Early sighed, putting away his stethoscope.
"I don't know, Dix. We need to see those X-rays before I can do
much else."  he told her, indicating the backboard that Cap had
been strapped to.

"I know. I just wish he was more coherent." she said.

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Hank restlessly moved his arms and legs, attempting to find control
in the physical world and not succeeding. " . . Roy?"

Dixie tried to soothe the injured fireman.
"Shh, Hank. Everything is okay. You're at Rampart and we're
working hard to make you more comfortable."

Hank heard some of the words, but felt no relief. The depth of his
anguish and pain radiated from his groans and the vision of his
latest dream still taunted him. "..jus' lightning . . But thank G*d
they all ...stayed okay while getting to me.. " he swallowed dryly.

Dixie frowned at Cap's mismatched facts as Hank mumbled
through his current pain. "What is he talking about?" she wondered.

Then Early pointed to a detail on his chart. "Two years ago, Dix.
That was the last time he was hurt like this."

Dixie hung her head and once again tracked the fast flow of I.V. fluid
out of the drip chamber that was delivering badly needed electrolytes.

She knew the next few days would be tough as the fireman discovered
the outcome of this latest rescue. Details were still scarce as the rescue
effort continued. Despite her need to attend to Hank's injuries, McCall
also wished she could be at the base station to hear the latest from the
command center.

" . . jus' search  for. . my . .men.." Hank tried to roll to his side as
another wave of pain rolled through his back. "..My decision . . "
he grunted when the immobilization measures he was under, stopped
him.

Dixie took another blood pressure reading and noted the tears
slipping from Hank's clenched eyelids.

"Hang on, Hank . . You have to hang on." she whispered
"Absolutely everything possible is being done to try and find them."

The door to the treatment room opened and Carol peeked in.

Joe and Dixie looked up briefly to acknowledge her presence
and both of them flinched at the look on her face.

"They've found Roy and Chet. Life Flight is bringing them in now."
said Evans.
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From: "Champagne Scott" <chameleonkate@hotmail.com>
Date: Mon Jul 17, 2006 7:46 pm
Subject: The Staining..

Out in reception, Gage was impatiently waiting for
a police car to take him back to the site of the collapse.

A voice startled him from a nearby chair, breaking into
his whirlwind nightmare.

"Please tell me the truth, Johnny. How bad is it out there?"

Gage turned, struck numb with recognition when he saw
Joanne DeSoto, rising to her feet with a kleenix clutched
tight and mangled in her hands.

The exhausted fireman paramedic cast away his glance
with a curious, pained reluctance as he took her palms
in his own.

Firmly, Roy's frantic wife reached out for his fire jacketed
arm. "Please. I know you're under orders. But... I want.." she corrected
herself. "I have to know what to say to the kids..They need hope."
she moaned, fighting crippling fear.

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Gage renewed the tight grip he held, holding Joanne's sweaty,
chilled palms in both of his own while he fought the stinging tears
in his eyes. He looked up, lost for words. ::How can you
relate a horrific disaster like this? :: he thought. "I can't. Not yet.
I.. I-it's not over yet." he whispered.

"Oh, Johnny. He can't even fight back. There's no fire."
Joanne sobbed in the tiniest of voices.

The shreds of Gage's remaining courage, built back up during the
hour it took for him and working crews to free Captain Stanley from
the building, fled like burst fruit and he found himself clinging
to the wife of his friend like a needy child. "It's so hard. I.. It's
hard." he choked. "But he's not..." Johnny broke off. "They're
not...gone. Not yet. I know I'd feel it if they were." he sighed.

Joanne separated softly and wiped the traces of weeping from
Gage's plaster dusted face. "I trust you, Johnny. And the
others, just as deeply." she half smiled through barely veiled
underlying panic.  

A stab of anger coursed through Johnny when he remembered
the last order Captain Stanley had given him, that he had given
ALL of them. . ::He was dead wrong. Why didn't he see that?!:: he
raged inwardly. On the outside, he held his face in professionalism.

Gage nodded, firming up his mouth. "It's only a matter of time
before they're found. Every available county fire station's been
mobilized. And most of the city's." he said of Los Angeles.
"They're moving fast, Joanne. And they're sifting very carefully with
their best dogs. I saw them beginning already when I had to leave..."
he broke off.. " ..leave with Cap. That's the hard part about being a
paramedic. You're tied to your current patient, whereever he goes.
You have no choice about it even if you want so badly to go back
to help in a search.." he choked.

Mrs. DeSoto immediately took him into another desperate embrace.

"Shh," Joanne soothed. "It's ok. One thing at a time. We mustn't
fall apart. Not now. Roy needs us to be strong. Chet, Marco, and Mike
are counting on that, too. Oh, Johnny.. Close your eyes if you have to
from moment to moment, but just trust yourself to do your job....
...I do.." she pleaded.

Gage swallowed hard and blinked. "You're right. You're absolutely
right. I..."

"Fireman Gage.." came a nurse's voice from the desk.

"Yeah?" Johnny said, moving quickly to her side as he returned his
heavily scratched and stained helmet to his head.

"They're bringing in your partner and another named Kelly from your
engine crew." she said, pointing to the scanner and the backs of two
doctors, leaning over the base station inside the glass receiving room.
"Dr. Brackett left standing orders. He thought you two should know."
she told him. "They're both alive but their reported conditions are
rated as serious."

"How are they coming in? By rig or by chopper?"

"By air. On the same flight.They're on approach right now with Station
8's paramedics." she said.

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"Thank you.." Gage said, grabbing Joanne's hand eagerly. Mrs. DeSoto
needed no encouragement to follow him out the ambulance entrance
doors to the helicopter landing pad. "Now Joanne. Stand where I tell
you to stand and don't even think about moving closer once we
get there." he told her firmly. "The rotors have a nasty reach."

"I understand.." she sobbed, longing to see her husband.

Blinking in the fierce daylight, Johnny took Joanne to the edge
of the parking lot and put her slightly behind him to shield her
from all the flying landing debris. He could just make out Craig
Brice's bent form working a suction tube on someone through the
cabin window.

He got on his HT to their call channel. "HT 8. This is HT 51. I'm
outside to help you transfer to your rendevous point."

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Joanne saw Craig's head snap up in recognition at Johnny's broadcast
and the real private reason that he was actually there. Brice offered
the two figures below an encouraging visual thumbs up through the
glass panes as the large red and white helicopter touched down
cautiously into place.

Roy's wife practically melted against a bordering palm tree. "Oh,
thank G*d." she sighed over the roar of the spinning props.

Gage gave her hand one final squeeze and then he ran out in front
of the pilot to await his flashing hand signal that it was safe enough
to approach the side door.

He got it half a minute later.

Then the chopper door cracked open to reveal...

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**************************************************
From: Jeff Seltun <finiterider@yahoo.com>
Date: Wed Jul 19, 2006 11:28 am
Subject: Transfer of Care..


...the unmistakable shape of Roy's feet and body, lying
under a yellow shock sheet in a stokes. Johnny saw
that he was unconscious and firmly head and neck
immobilized, but he was entirely without an ET. "What's
his Glasgow?" he asked Brice as he grabbed an edge
of the basket stretcher along with several hospital orderlies
to help pull DeSoto out of the chopper.

"Nine. We found ligature around his neck from electrical
wires. He's started not being able to handle secretions
just a minute ago, but we've seen no obvious deformity
of the underlying structures in his neck. Resp rate's twenty
six. Here, take this.." shouted Craig, passing off a suction
tube to Johnny that he had placed openly on Roy's exposed
EKG cabled chest. "His lungs are still sounding clear. If
you need it, the ambu's right there." said Craig, pointing
to the clear green bag valve mask assembled and waiting
off a regulator cracked oxygen tank lying in between Roy's knees.

"Ok."
Gage saw that Roy had dark facial congestion with faint centralized
cyanosis above well demarcated petechial hemorrhages from his
neck on upwards, above the shallow cut the constricting wires had
made. Both of his unseeing half cracked eyes were shot red with
high pressured in blood and his tongue had swelled out around
one side of the oral airway. "Just the strangulation?"

"Yeah.." said Craig. "Quit breathing on us for a few seconds while
we were digging him out but his sats got up again quickly after
a few shots off the ventilator. No rib fractures at all. We guess he
was protected by the main support beam we found lying over him."

Johnny sucked out another surge of bloody saliva from Roy's mouth
as they carried his dusty stokes over to a safety braked, bare
mattressed, and wheeled gurney. "His EKG's holding. Sinus tach.
Bump down the I.V.  His intervals are shortening."

"Thanks. I got it." said Craig, dialing down the Ringer's crammed
under Roy's shoulder. "Babinski's is normal on both, but we
collared him anyway."

"Craig. Joanne's here. We gotta plan out what to tell her."
Johnny gasped while they pushed Roy closer to the
edge of the parking lot.

"John, we'll think of something." Brice said with a half smile.
"How about,.. 'Don't worry. He's nowhere near dying?'"

"That'll work." grinned Gage.

"Sure it will." retorted Craig. "Because it's true."

They were still inside the dangerous hundred foot flight zone
when Roy's stomach began rippling forcefully.
That halted them all.

"Hold it. Hold it!" Gage ordered, anticipating a possible need
for a rapid log roll. "Is he choking? Or vomiting?"

Craig bent over Roy with a penlight, who had been rapidly tipped onto his
side so Brice could look into his mouth and clear it with the suction tube.
"It's just nausea. The general swelling inside's still about the same."

Gage spoke up, having snatched the stethoscope from around Craig's
collar. "Breathing's ok.  And still no thrill or bruit." he said, feeling and
listening lightly over Roy's carotid arteries, one at a time. "Got it all?"
he said, holding Roy's oxygen mask nearer, on continual blow by.

"Yeah.." said Craig, removing the last of the gastric debris leaking
from Roy's mouth. A strong sound of empty air sucking inwards into
the tube announced the task's completion. Brice sighed in relief.
"Ok, guys, let's go.." he told the attendants as Johnny repositioned
the O2 flow back over his partner's nose and mouth firmly.

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"Easy. Easy.." Johnny said as they set DeSoto onto his back once
again and elevated his gurney's head a little higher so the stokes
would angle up along with it. Only then did Gage give a glance
back towards Chet who was beginning to be eased out of the hot
running chopper, attended by Brice's partner, Bellingham.
"How's Kelly doing?"

"Non specific head injury. Reacts to pain but he's got an unexplained
unsteady low BP that isn't reacting to a fluid challenge."

"That's why he was flown? And the reason for the mast suit?"
Johnny asked, pointing back at the attendants now carrying
Kelly's stokes to a second gurney waiting a safe distance
away from the helicopter.

"Yeah." Brice told him.

"What else did you find on him?"

"Not much else. All quadrants were soft. We found no ecchymosis
anywhere past his forehead and his right shoulder. Does a broken
pinky count as serious trauma?" he joked.

"Maybe his hypotension's due to inhaled fumes or something." Johnny
replied, grinning.

"It might be that. He's got some rales bilaterally that the oxygen
isn't clearing." Brice shared.

Gage paled uncontrollably when he did the next natural thing.
He asked about his coworkers.

Brice met his eyes fully. "There's still no word. But the dogs
are reacting positively. Someone's still alive under the debris
and they're getting excited right over the spot where your men
were ordered in."
 
Johnny fought his emotions for a long moment. Then he shook himself.
"All right, I'm breaking away to go handle Joanne. Thanks for
their updates." Johnny said, reluctantly releasing the brachial
grip he had on Roy's weak arm pulse.

"No problem." smiled Brice as he loosened his helmet's chin strap.
Then his expression changed. "I'm sorry all of this had to happen,
Johnny."

Gage sighed at the repeat of Brice's rare usage of his first name.
"So am I, Craig. So am I... Our captain waded through the worst
possible situation call imaginable. And unfortunately, he's gonna
have to live with what he did along with the all the rest of us."

"It's a real tough break. Is the chief here yet?"

"No, but he's gonna be and I don't think I wanna be there when
it comes time for Cap to start facing all the music." Johnny said,
eyeing up Roy's EKG monitor one more time. "That flow rate's good,
Craig. Lock it off. His tach's slowing." he said as he ducked down
to leave the hospital workers and station eight's paramedics to
finish conveying Chet and Roy into Rampart.

Seconds later, it would have taken a hydraulic spreader with jaws
on full to break Joanne away from her husband's side. Her tears
gone, inner strength took over solidly in their place. "Roy, I'm
here with you and Chet. Johnny's here, too. So's Hank. Don't
worry about anything you don't have to worry about. Let the doctors
do the hard part for you, love. Can you feel me holding your hand?"
she said loudly as they entered through the ambulance doors.

Dr. Brackett met both firemen and Kel triaged them right there
in the entryway. "Tardieu spots?" he noted as he peeled up
Roy's eyelids with both hands.

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Craig nodded. "And the beginnings of dysphagia although I
can't tell if it's cranial nerve IX involvement or just due to
posterior or lateral pharyngeal wall bruising. We've had
to suction out his airway twice during the last three minutes."

Kel nodded, and turned to a very closely listening Dixie McCall.
"Dix, order the standard trauma blood studies: CBC, electrolytes,
and all warranted blood chemistry levels, blood type and cross-
matching. For his imaging studies, I want plain-film radiography in
a 3-view series of the cervical spine to look for emphysema, fractures,
displacement of the trachea, and the possible presence of a foreign
body.

"Craig,when we get into the presurgical room, I want you to establish
a second intravenous access in that arm opposite the side of this
injury." he said pointing to the soft sign nonexpanding hematoma that
Craig had told him about over the radio at the scene.".. I want that option
working in case disruption of Roy's ipsilateral venous circulation has
occurred." Brackett said.  "Has his breathing been noisy or impaired
at all following that apneic period he suffered during extrication?"

"No, doctor." said Brice. "He didn't complain of tenderness over his
larynx or trachea even one bit before he blacked out. I didn't feel
anything out of the ordinary there either."

Brackett palpated Roy's throat cautiously down to the shoulders.
"I agree with your findings. But let's err to the side of caution. Dixie,
prepare Roy for an emergent intubation. He's starting to show an
increasing inability to suitably handle his secretions here. While
he's being intubated, tell the respiratory specialist I want him to
look for obvious distortions of any neck landmarks, tell him particularly
to watch out for tracheal deviation or the existence of large amounts
of subcutaneous air. I'll join up with him in a minute."

Joanne stepped forward, looking startled. "Wait a minute.
Johnny, Kel..I thought you both said my husband was doing all right.."

"He's doing fine all things considering, Mrs. DeSoto." said Kel, taking her
aside while he waved the orderlies to move Roy on into a nearby treatment
room. "But Roy may develop hard signs of an arterial injury, include a
resumption of expansion in his neck bruising with severe active or
pulsatile bleeding. He may develop shock unresponsive to fluids, or start
showing signs of a cerebral infarct, with or without the presence of a bruit
or thrill and diminished distal limb pulses.

"Virtually all patients with newly developing hard signs of an arterial injury
require operative repair. And for that possibility, Roy will have to be fully
airway protected and anesthetized or things might quickly become
problematic in very short order."

"But what if he gets better on his own, Doctor Brackett? Sticking a tube
down his throat sounds a little bit extreme to me." she said worriedly.

Kel bent over Chet, beginning Kelly's quick survey after he glanced
over Bellingham's notes on him. "Mrs. DeSoto, soft signs, such as
stable bruising and absent paresthesias, do not improve the predictive
value of an arterial injury any more than guessing its wound proximity to
a major vessel just by viewing what the area looks like. The fact that we still
have a clear presence of both carotid pulses doesn't exactly exclude
a vascular injury, nor would a sudden absence of a strong pulse
on either side be indicative of vascular damage. We won't necessarily
have to perform surgery on Roy today once he's been secured.
But he needs endoscopy regardless to reassure everybody that his
trachea truly hasn't been structurally compromised. Before inserting
any scope, we will confirm that his airway is patent, intact, and thoroughly
protected before we begin anything. Also, as a side hedge to that ace,
his films will reveal beforehand, all possible cervical spine disruptions.
Afterwards, once he begins to reawaken, we can begin
checking for neurological deficits. ."

"Roy might be paralyzed?!" Joanne quailed.

"It's always possible. We won't know whether or not he
is until he's conscious." Brackett told her frankly.

Joanne sucked in her breath, not willing to face such
a disturbing idea.

Brackett knew that as a fireman's wife, Joanne would always
appreciate brutal medical honesty before anything
else concerning her husband's condition. So he went on.
"Not only was Roy's spinal cord vulnerable how he was
injured, but so were other neural pathways like the phrenic,
recurrent laryngeal, and lower lying cranial nerves, as well
as the brachial plexus bundle.  Additionally, detection of
a neurological deficit may signify damage to the carotid
or vertebral arteries with subsequent CNS ischemia.

"But then again, anything adverse that happens in the future
could occur only temporarily. When pressure is exerted
on the the carotid vessels of the neck, a decreased level of
consciousness occurs, but only sometimes, will contralateral
hemiparesis result because of it, mimicking stroke-like
symptoms." Brackett said.

"What should I be on the look out for later on, doctor?"
Joanne asked, studying Chet's half conscious, wincing
face while Kel palpated his injured shoulder around
the splint.

Image of joannevertical.jpg Image of chetintreatmentroomclose.jpg Image of dixiebrackettfrowntreatstethoscope.jpg

"Any drooping of the corner of the mouth, vocal hoarseness.
An inability to shrug a shoulder while rotating his chin simultaneously
to the opposite shoulder, like someone would do while putting on
a T-shirt over one's head. Any sideways deviation of the tongue
after he sticks it out at you. Tell us immediately if that happens.
Especially if he thinks it's jutting straight out perfectly..."
Kel suggested. "These are all abnormal cranial nerve signs."

"I'll watch for them." she said, moving off to the same chair in
the waiting room that she had been in when she first ran into Johnny
Gage ten minutes earlier.

Dr. Brackett looked to Station Eight's medic as he kept a hand
on Kelly's stomach to monitor his slightly rapid respirations.
"I've found suggestions of Zone I wounds right here. He might have
suffered damage to his thoracic cavity.." he said, showing Bellingham
the faintest marks now just beginning to rise over Chet's collarbones. He  
mandated an order for a chest x-ray. ::I'll circumspectly review the film
for a hemopneumothorax or a widening mediastinum with emphysema.::
he mentally planned out. "The crackling breath sounds you're hearing
could be due, not to gas inhalation, but to possible developing bilateral
pleural hematomas. Nurse. Get another pressure. Stat. " he told the one
assigned to assist him with Chet. Then he asked his paramedic another
question. "How was he when you first uncovered him?"

Bob frowned thoughtfully. "Unresponsive to verbal but he was
self ventilating adequately. Unlike Roy, he never turned a bad
color at any time."

"A point in his favor. Looks like Chet's proved once again that
he's got a head hard enough to survive just about anything. "

"Doctor,.. blood pressure is eighty over forty." said the nurse.

"Ok, let's get him into Three." Brackett grimaced tightly.

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      Captain's
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