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Page Two

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From: "patti keiper" <>
Date: Wed Feb 21, 2007 4:04 pm
Subject: Here's to White Coat Medical Know- How...

Roy DeSoto was ever glad when he finally saw velvet ropes
swing open the automatic doors of Rampart's emergency
department in response to his ambulance backing up.

Johnny Gage, was even faster, snatching open the rear
doors of the Mayfair. "Roy, how is he?"

"He's showing brady now, at 50, with some coving of
of his ST-T waves." Roy replied, keeping a hand on Vince's
carotid pulse while the EMTs began wheeling him inside
the hospital. "His LOC's dropping again. He's at a ten."

Gage took hold of Vince's EKG monitor, and he paced
with it so he could study its tracing. "His T waves are a lot
wider than they were before."

"Yeah." DeSoto replied. "Came on suddenly, too. Pressure's
still elevated. 162 palpated. Breathing okay."

"D*mn, I can't figure out what his underlying problem is. And I thought
about it a lot on the way in." Johnny said, keeping a hold on Vince's
chin so he wouldn't tongue obstruct at the bumps and jolts the gurney
was suffering while it moved.

"That's why we're getting him to the big guns." Roy told him.

"He took that nasopharyngeal okay?" Gage said, checking the liter
flow remainder on their resuscitator tank lying in between Police Officer
Howard's knees.

Roy nodded. "Didn't even fuss. I put that in because that nausea's
growing even with his decreasing consciousness level. I got a sample right
here." he said, casting a head at the sealed emesis bag in a catch container
under Vince's head nestled inside the stretcher's frame.

"Any blood in it?" Johnny asked.

"Nope, none." DeSoto said in worry.

"Good." said Johnny.  He looked up to see Dixie rushing towards them.
Her hair was in a freshly damp ponytail around her pinned on nurse's cap.

"Treatment Three." she said no nonsense, already knowing who to expect as
a patient. "Joe said he's got Dr. Brackett waiting for you." she said.  
Uncharacteristically, she reached under Vince's shoulder and pulled out
his I.V. bag. She helped carry it, hanging over the bed.

Johnny noticed. "Why aren't you as surprised as we are about seeing Vince
today?" he asked in curiosity as they maneuvered a turn around the corner
hallway x-ray machine.

"His station's captain called us, fishing for details. I was the one who answered
the phone." McCall said, opening the door to the treatment room. "Believe me,
I may look calm as cookies on the outside, but inside....." Then she leaned
down to Vince's ear and whispered to him. "Vince, you've arrived. I promise
we'll take really good care of you. I got a hold of only the best." And
smirking, she added. "Don't worry about that perp you left with us in Treatment
Five. L.A. City took him downtown in a pair of double handcuffs two hours ago.
And he wasn't looking too happy about it." she joked.

The paramedics thought they saw a few lines around Vince's closed
eyes relax out of stress at the end of one of his shallow respirations.


In the "stabe" room, they found Kel on the phone and two orderlies were
present. The no nonsense doctor looked up. "Get him stripped down and
warmed up." he told them. Then he finished his phone call. "Betty, I want
an endocrinologist, a nephrologist and an oncologist down here for an
emergency consultation, stat." Then he hung up the receiver. "Boys...?" he
asked Roy and Johnny, as he joined them to place a hand on Vince's
clammy forehead. Kel began an eye exam while Dixie switched out
Vince's oxygen supply.

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DeSoto started talking while Johnny helped the orderlies take off the rest of
Vince's uniform. "He's a little worse, doc. The arrythmias are more pronounced."

"Okay.. Stan, get another strip run out for me." he said to one of the men. "Dixie,
would you read this history and tell me if he's got anything pertinent?" he
said, passing the file folder off to her when he recognized the police records
markings on it.

"Right away, doctor." Dixie replied.

Kel straightened up from his eye exam. "Roy, did you notice this? Take
a look at his right eye."

Roy pulled out his pen light and looked. "What in the world is that?"

Kel smiled, briefly. "That's called band keratopathy, Johnny, I want you to
examine this, too, and you'll see some calcium precipitation lying in a
horizontal band across the cornea in the palpebral aperture. This is
a sure sign of hypercalcemia."

Dixie spoke up. "Kel, he's got nothing remarkable in here. At all."
she said holding up Vince's police employee file.

"Hmmm." Kel sighed. "Figures. Guess we'll have to do things the
hard way and start from scratch."

Roy was thoughtful, thinking where he stood. "Stones, bones, abdominal
moans and psychic groans." he mumbled, indicating to Kel where he had
found the guarding around the apparent mass in Vince's groin area.

"Huh?" Gage asked him.

Kel chuckled. "Oh, very good. Johnny, he's describing the mnemonic for
the constellation of symptoms and signs of hypercalcemia. Don't tell me,
you learned that while serving in Viet Nam."

"Yeah.. From a very good doctor. Hawkeye Pierce." DeSoto said quietly.

"My predecessor." Brackett's eyes twinkled. "Roy, you called this one right
on the money. Cardiac effects include syncope from arrhythmias. Hypercalcemia
affects nearly every organ system in the body, but it particularly affects the CNS
and kidneys. With very high levels, somnolence, coma, and death may ensue.
The CNS effects are due to the direct depressant effect of free calcium in the
bloodstream. You were right to rush Vince into the hospital. Any sudden change
or rise in calcium levels should've triggered consideration for a more serious condition.
You saw this spot on."

Roy accepted the compliment with difficulty, because he was worried.

"Is this high calcium causing his hypertension?" Johnny asked.

Doctor Brackett answered while he did percussion thumps and a
careful hands on exploration of Vince's damp abdomen. "Yes,.. most likely.
Based on what Roy and I are feeling here, presumably from renal dysfunction
caused by urinary retention and direct Ca+ ion effected vasoconstriction." Dr.
Brackett told him. "Now all we have to do is find out whether or not this abdominal
mass is really the cause of this problem, or not."

Gage frowned. "I don't like the way that last part sounded, doc."

Kel agreed. "Neither do I, gentlemen. The two most common causes for Vince's
condition are hyperparathyroidism, easily corrected by a surgical neck exploration
and removal of one or more parathyroid glands if it's warranted.." he met both of his
paramedics' eyes. "...or neoplasmic activity."

"Malignancy?" Dixie mouthed in dismay.
"Cancer?" said Gage at the same time.

Johnny sucked in a breath.

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"I'm afraid so." said Brackett. "I have three very good specialists on the
way down here to help determine exactly what, if that second condition
pans out in his initial labwork, is going on."   He turned to Dixie. "First
thing's first. Dixie, I want him set for full volume expansion with constant
saline diuresis. I want a second LRS I.V. begun. We'll use this first one
that Roy and Johnny started for fluid loading to increase calcium excretion.
We've got to get his levels down a.s.a.p. But the second line, I want set
aside for an infusion with a concomitant loop diuretic. Uh,...make it
standard furosemide."

"What else do you want, Kel?" McCall asked.

"Another med, Pamidronate, 90 mg I.V. over twenty four hours. I want to
attack his imbalance from multi-angles. We'll try and use a different
bisphosphonate orally later on to inhibit further bone reabsorption
after Vince's more awake and feeling a little better." Dr. Brackett said.

McCall wrote down fast notes in Vince's new chart. "Aredia, 90 for one
day. And Lasix. 1.0 mg/kg slow I.V. push over 1-2 minutes. Let me know
if you want that repeated." she told him.

"I will. With any luck, that diuretic will nip his hypertensive crisis in the butt
at the same time." Brackett affirmed. He turned to the orderlies. "Insert a
nasogastric tube and aspirate all of Vince's gastric contents. Least we can
do is spare him some repeated vomiting. Also, cath him. Let's see if
we can relieve that bladder to expose his groin mass a little more. When you're
through, one of you remain behind to regularly assess his consciousness level.
If he goes down any deeper, we'll manage his cerebral edema with intubation
and hyperventilation. Dixie, if he does need support again, call Dr. Rivers
to perform an arterial cannulation as a monitoring aid during mechanical ventilation
if it's needed. We can use it to keep tabs on his Po2 levels or for further
intensive care for his developing coma condition and acidosis." ordered Kel.

Dixie bit her pencil. "Do you want a Mannitol drip on standby to stop brain
swelling in case of coma?"

"Yeah,..If it happens. 0.2-0.5 g/kg over 15-20 min (1-2.5 mL/kg of 20% solution);
after that, repeat after an hour. But we'll only go ahead with that when we
have all-inclusive signs that Vince isn't suffering from progressive renal damage.
When you infuse it, should it become necessary, carefully evaluate his
cardiovascular status first, I don't want a sudden dose of mannitol resulting
in any fulminating CHF. Vince's ill enough as it is."

"Got it." and the silvery blond nurse busied herself with preparations.

Johnny Gage ambled over and got on the lab phone. He picked it up.
"Doc, what do you want for Vince's tests and labwork? I'll call it in for

"Thanks, Johnny. Write this down and dictate it to them. Blood glucose,
every hour. Arterial blood gases, blood pH, potassium, sodium,
Blood urea and creatinine, a full blood count, PCV and uroketones. Also
tell them I want a blood culture and an amylase study, serum
phosphorus, serum alkaline,  phosphatase urine, calcium urine phosphate
and a PTH.  Unrelated, call oncology and tell them I want a PSA level

::Prostate enzyme?:: Roy thought at that last test. ::That mass might
be an enlarged prostate gland. That would explain that retained urine, too.::
he figured. ::Smart to cover that possibility.::  DeSoto realized.

He lifted his head after getting another pressure once Dixie had given Vince
his first diuretic injection. "Doc, 134/88."

"That's better." Dr. Brackett said as he watched improving changes on
Vince's heart monitor. "Roy, can you call Radiology and get some
chest radiographs. I want to rule out sarcoidosis."

"What's that, doc?" Gage asked. "Is that a lymphoma?"

Kel smiled at Johnny's curiosity. "Sarcoidosis is not a form of cancer. It involves
inflammation that produces tiny lumps of cells in various organs in your body.
The lumps are called granulomas because they look like grains of sugar or sand.
They are very small and can be seen only with a microscope or on x-ray films
once they clump up into larger groups. If many granulomas form in an organ,
they can affect how the organ works."

"Ah, so you're hunting for signs of acute renal failure in him due to
secondary causes that are manifesting away from that area of his body."
Johnny guessed.

"Yes, I am." replied Brackett. "Sarcoidosis can occur in almost any part of your body,
although it usually affects some organs more than others. It usually starts in one
of two places: in the lungs and in the lymph nodes, especially the lymph nodes
in your chest cavity. Roy also get some plain plates and films of his pelvis and
upper legs, lateral and frontal. I want to know if he has any demineralization,
pathologic fractures, bone cysts, or any bony metastases spreading."

"Ok, doc."

"Also call Dialysis. Tell them I want a hemodialysis against a lower calcium
concentration dialysate solution for Howard, stat. Maybe that'll be the faster
way to lower his soaring plasma calcium levels."

Roy nodded and got talking.

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Dixie flew out of the room with her blood samples. "I'm taking these to the lab
myself, Kel. I'll stay down there until I have his initial results."

"All right, Dix. Call me in five minutes." said Brackett.

Kel leaned forward and began a detailed neuro exam on Vince with
the two paramedics helping him assess Howard's reflexes. They found
hypotonia in all of Vince's muscles and moderate lower leg paresis.
Brackett sighed and stepped back once they were through. "He's entering
early coma." he frowned.

Johnny looked up from a probing sweep against Vince's tongue. "He doesn't
have a gag reflex, doc. Do you want us to intubate him?"

"Go ahead. Use an EOA. If he's depressed, put him on assisted P.E.E.P.."
Brackett said, listening to Howard's cardiac and lung sounds using
his stethoscope. "Looks like we're gonna need that CT scan after all."

Roy helped lubricate an airway for Johnny after taking one the proper size
out of the crash cart parked near Vince's head. "D- Doc? Uh, if this is
renal failure, what are his options for that particular diagnosis?" he said,
handing it over to his partner. He positioned the limp officer's head
back over the edge of the gurney after pulling Vince up on the bed
by the shoulders. He was careful not to disturb his many catheters and
tubes. When he was through, he aimed his penlight into Vince's mouth
while Johnny got to work threading the airway down.

"First of all, I want to rule out all possibilities of malignancy because
hypercalcemia caused by a neoplasm tends to be much more serious.
Often, the hypercalcemia is the immediate cause of death in patients with
what we call ectopic PTHrP production, a chemical imbalance caused by
a tumor eating into the bone tissue that surrounds it."

"That sounds bad. Real bad." Roy said.

"It is." Brackett told him quite honestly."Those patients rarely survive more
than a few weeks or months. Now other conditions such as some of the
micro lymphomas are less catastrophic on the body's systems.  
These patients may live longer but still have a poor prognosis, especially
if their serum calcium levels are very high."

Roy looked away, feeling and looking troubled. He didn't met Johnny's
eyes when Gage was through getting Vince set on the respirator.

Kel comforted the pair of men whose team he considered one of the best.
"There's every chance Vince still has a whole lot going for him. If his
calcium levels have been mildly elevated for months or years, then malignancy
is an extremely unlikely cause.  It could swing the other way quite
easily with hyperparathyroidism. If that's the case, then a fairly minor
subtotal parathyroidectomy can be performed, or a complete parathyroidectomy
can be done with reimplantation of a small amount of that tissue in a forearm."

"Doesn't sound minor. Sounds like it's pretty major..." Johnny frowned.

Kel waved a hand of dismissal. "When a biochemical diagnosis of primary
hyperparathyroidism is made, CT scan, ultrasound, MRI, and radionuclide
imaging of the parathyroid gland helps greatly with a surgeon's
preoperative localization. When he goes in, he knows exactly where he's
headed down to the milimeter. So the incision made is only about
two inches long across the neck. Right here." said Kel, demonstrating.

"Wow.. I didn't know that things had changed so much. Seems like all
this CT and MRI machinery's just sprung up overnight."

"It has, we've got the first set of test machines and the only ones in
active practice right now in the entire nation." Brackett said.

DeSoto was a realist. "But how about that ARF? Vince still might be
facing that kidney failure as well, regardless of what's really causing
his calcium level fluctuations." Roy said, studying his hands, where
he stood by Vince's bed.

"That's always possible." admitted Brackett. "Acute renal failure is always
better than any chronic cases, for ARF is reversible as long as a patient
is highly polyuric. And we can offset Vince's developing ARF condition if
we continue to avoid having him fall into hypovolemia. That's the reason for
the massive I.V. fluid loading we're doing right now." he said, throwing a
hand at the new I.V. Dixie had set running wide open.

Brackett frowned and uncharacteristically, took Vince's moist hand to
offer his patient encouragement. "I'm hoping for some kind of chemical insult,
drugs or toxins as being the culprit for causing Vince's ischemic injury to his
kidneys, for that would mean that his overall circulatory system still remains
normal in every respect with an excellent chance on making a full recovery.
All we have to do, is find that chemical and counteract it."

"Besides all those blood tests we ran, what can we do to pinpoint
something like that?" Roy asked softly. His head shot up when Vince's
monitor bleeped out a warning pulse.

An orderly shifted on his stool. "Sorry, that was me. I knocked an EKG
lead off, while I was sitting down. He's fine."

Kel, too grabbed a stool, the one by the white lab phone. Roy followed him
but found that he couldn't sit or even stand still.

Dr. Brackett told Roy the truth. "Ok, this is probably going to be Vince's
clinical course. Remember that pain you found and told Joe about?"

Roy nodded. "Yeah."

"Well, I found his kidneys are normal to large. Enlarged kidneys may be
painful when palpated as pain receptors in the capsule of the kidney are
getting stretched as the kidney enlarges."

"Was that due to urine retention?"

"Maybe. Maybe not." said Brackett. "I'll be honest with you when I say
that I'm unwilling to do any contrast studies of Vince's kidneys by IVP to
pinpoint more details."

"Why not?" asked Gage.

"Ironically, the contrast agent can be a nephrotoxin." Kel told them.

Gage sighed in disappointment and rubbed his face in frustration.

Kel was eager to share other options.
"That IVP renal study isn't necessary to make a diagnosis
of ARF . The cause of it can be found from renal biopsy."

"More surgery?" Johnny asked.

"No." Brackett promised. "Renal biopsy can be performed "blindly"
through the skin or a micro-incision using ultrasound guidance, via a
laparotomy or via laparoscopy. There are some risks associated with this,
include bleeding as uremic patients have abnormal platelet function because
their elevated calcium levels have a tendency to make their platelet proteins
less sticky or aggregable."

"So there's hemorrhaging risk." Roy whispered.

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Brackett held up his hand to calm DeSoto.
"A fine needle aspirate performed in an awake unanesthetized patient
can sometimes yield prognostic information without the need to perform
a biopsy." Kel told him. "And that's gonna be my recommendation to Joe."

Roy and Johnny were not happy, bordering on fearfulness.

Brackett did his best to reassure them. "We'll do everything in our power
to make Vince more comfortable while he weathers this crisis. Monitoring
may include getting central venous pressures, a PCV/TP, and
very close urine volume checks."

Johnny shifted on his chair, growing uncomfortable. "So he's gonna be
sick for a while, huh?"

Brackett was gentle while he smiled. "Depending upon the degree of renal
damage, his kidneys may repair themselves. The goal of treatment is to sustain
life while the pathologic process in the kidneys heals itself."

They all jumped when the lab phone rang.

Brackett picked it up swiftly. He listened for a few seconds, but then his
face turned red. "But that's not right, Dixie! I'm looking at all his symptoms
and his EKG strip right now. He's definitely acutely hypercalcemic. I don't
care what you tell them just tell them I want them to run it again! There is
no way in H*ll Vince's serum level is 9 mg/dL. They must have missed something
and missed it big time!"

Roy and Johnny rose in concern before they reconsidered and made their
way back to Vince's bed to fuss with his blankets and unnecessary vitals signs

Brackett's voice suddenly broke off when he started thinking. "Wait a minute.
Only 1-2% of total body calcium is in the exchangeable form in circulation,
and the rest forms part of the skeleton. And of that percentage,  the ionized
form calcium binds to urine albumin and only the unbound calcium is
biologically active. Dixie,. my G*d. That's it. The serum level must be adjusted
for his abnormal albumin levels. Let me call Joe fast and I'll call you right
back.." he said eagerly.

Kel hung up the phone and immediately dialed the main ER. "Put me through
to Dr. Early. Stat." he snapped into the receiver. That student nurse hastily

Roy and Johnny heard Kel's next words easily despite the quiet room
and the hiss of the ventilator."Joe refresh my memory. Serum calcium to
correct for albumin levels, what's the conversion factor?  Uh, huh.. uh huh.
Joe, thanks. You probably just saved Vince's life with that recollection..
How's he doing? He's doing fine. ......Now." he said. "Gotta go." and Dr.
Brackett was soon on the phone with Dixie in the lab again. "Dixie.
Tell them they don't have to send someone up for more bloodwork. Tell
them this word for word, verbatim. For every 1-g/dL drop in serum albumin
below 4 g/dL, measured serum calcium decreases by 0.8 mg/dL. Therefore,
to correct for an albumin level of less than 4 g/dL, one should add 0.8 to the
measured value of calcium for each 1-g/dL decrease in albumin. Tell those
lame brains down there that without this correction, an abnormally high serum
calcium level may appear to be normal... Uh, huh. You got it. Tell them to
spread that protocol department wide and I want it done today! So what's his
level sitting at? Doesn't matter if it's the old results, I'll figure it out. Ok...
Got it." But then Brackett cocked his head as he listened to something else
she told him and soon, he began to smile. "You bet. Thanks, Dix. Yes, I'll tell
them. Right away."

"What, doc?" Gage finally asked as they rejoined him.

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"Vince's Ca does show that he's in a life threatening hypercalcemic crisis."

"What are his levels at?" Roy asked.

"15 mg/dL or  3.5-4 mmol/L." Kel reported.

Gage made a face of dismay but Brackett quickly reassured after snapping
out an order to the orderlies. "Boys, start massaging his arms and legs. Get
his blood moving. His current pathophysiology is indicating that his
immobilization will aggravate his hypercalcemia." Then he turned back to
Roy and Johnny. "Guys, it's all good news. His serum alkaline phosphatase
is coming back low. That means he has a vitamin D excess in his blood."

"What?" Johnny exclaimed. "Then no cancer?"

"Absolutely not." Brackett beamed. "It's either a nephrotoxin ingested or it's
sarcoidosis which can be treated effectively for life with mild doses of
prednisone to keep plasma calcium levels down by reducing intestinal
Ca absorption.  All he has to do in that case, is watch his dairy intake
and how much time he spends in the sun to restrict Vitamin D."

"And if it's not sarcoidosis?" DeSoto asked, beginning to grin.

"Then it's strictly chemical and there isn't a forensics investigator born in
my department who couldn't find a poison on one of my patients. I'll give
Shears a call right now to come get external scrapings and hair samples
to take with her, a.s.a.p."

"Well, how much danger is Vince in until that mystery substance's found?"
Gage asked.

"Not much." grinned Brackett. "We've already begun aggressive treatment.
And I hear dialysis coming down the hall right now to hook him up. The only
real risk I'm finding now is that Howard's uremia is interfering with the function
of his white blood cells which are low. That may predispose Vince into
getting.... a cold."

"A cold?  That's it?" Johnny said, gape mouthed with relief.

"That's all." Kel replied.  "The evidence now pointing towards that prognosis,
is overwhelming." bowed Brackett genteelly. "So get out of here
and go get some rest. You deserve it, you two. Nice work. I'm sure Vince'll
be more than grateful to the both of you for getting to him so fast."

"I'm sure he will be." Roy laughed, gathering up their medical gear from
the spot on the floor he had kicked it towards. "Gee, thanks doc, for letting
us stick around."

"No problem. That's what friends are for. See you two later on when we figure out
what that chemical was."

"Bye." said the two as they left the treatment room and the orderly watching Vince.

They got into the squad, and sat heavily, mulling over what could have been.

Then Johnny said....

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From: "Patti" <>
Date: Thu Feb 22, 2007 7:32 pm
Subject: Security Blankets..

"Is it just me? Or are you counting Vince's lucky stars,too?"
Gage said, putting on his seat belt thoughtfully.

"I'm definitely acknowledging every spark up there. Howard
was d*mn*d lucky that we got there when we did. He wasn't
that far away from cardiac arrest a couple of minutes ago. Not
with that kind of junctional rhythm." Roy said, still sitting there,
not really seeing the steering wheel he had twisted to pointing
straight ahead under his palms. He started up the squad's
ignition. "Are you gonna call the police station? Or do you
want me to do it?"

"How about we wait. Vince's barely out of the woods and I for
one wanna be able to tell them what it is that's making him sick.
Don't you?"

"Yeah." DeSoto said. "I guess Dixie'll be fine for fielding that first
phone call. We can always use the excuse that we were ...busy
on another run or something... and got tied up."

Gage didn't say anything, still very cowed by what he had learned
from both his partner and medical director. "You know, I was way
off on what I was guessing to be Vince's problem." he finally said
as Roy pulled them away from the wall and turned right under
Rampart's skyway, heading for the boulevard.

DeSoto looked at him, paying attention closely. "Just what were
you thinking it was?"

"Hypoglycemia from previously undiagnosed diabetes.." Johnny
answered, pulling some dead skin off of his calloused hands.

DeSoto just smiled.
"Believe it or not, that was my first guess, too. I wasn't clued in
on what was bothering him with any great certainty either until I
found that abdominal guarding and moderate pain on palpation.
His reactions were....well, a little off, someone with a palsy."

"L.A., Squad 51. We're available...."
Gage nodded, still holding the Converta-Com's receiver mic in
his hands. "That was the calcium effecting his mental state."

##Squad 51. *spap* ## replied L.A.

"And his muscles." DeSoto said thoughtfully. "And I thought I had seen
everything that could possibly go wrong with a man Vince's age."

Johnny looked up, surprised by the admission. "But you finally guessed
it right, Roy, despite not knowing for sure. If I had been in your shoes,
I would have still missed it entirely. Even with Vince lying right there
directly in front of me." he insisted.

"Yeah, well that hardly makes me feel any better, because one day,
maybe because of fatigue or complacency, we're both gonna guess
wrong about a patient and they might even die for it."

Gage frowned in shock when he realized that real danger, but then
he got righteously angry. "Oh, yeah? So let's fight it then. I'm already
dead set on fixing that very problem with my new invention idea."

"How's it coming?" DeSoto said, finally relaxing as he rounded the final
curve that led to the straight away before their station's drive.

"I've only got to decide where to park it in everybody's house. You know,
they've got to put it where paramedics and law enforcement and other
rescue personnel will find it."

"Find what?"

Gage looked at him in irritation. "I can't tell ya, not yet. It's gotta stay
a surprise. I'll tell ya everything once it's in the chief's beefy little hands, or
somebody just might run away with my idea themselves."

DeSoto chuckled. "What's the matter? Don't you trust me?"

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Gage looked at him. "I trust ya. I trust ya. It's just that....well...I- I."

"Never mind, you don't have to explain yourself to me, Johnny. I
understand completely. You just don't have a very trusting nature, that's all.
And all of us guys, know it." he said, grinning broadly. He waggled his
bronze eyebrows for effect after he finished speaking.

Johnny's mouth flopped wide open and he launched into the granddaddy
of all scathing self-lectures right into Roy's amused, and listening... ear.


Cap, Stoker, and Marco were all standing around the stove, sipping
late afternoon coffee while they watched Chet handle a call from the
public that wasn't an emergency.  In fact, it was the third call from
the same old lady that day.

"Ma'am.. Can you hear me all right now?" shouted Chet into the phone
receiver from where it hung on the wall. "If your little Trixie's back inside
the house and gets out and climbs the tree again, you can always call
us back. Ok? Here's our number.. It's (310) 830-3170. Got that? Ok,
now repeat it back to me.....Yeah,,   yeah.. uh, no the last two numbers
are seven zero.. Say it again. Uh,,, no that's not it either. Shall I tell you
the number again? No ma'am.. I'm not getting short with you.. I'm just
trying to help you be able contact us again more easily.. Yes, ma'am.
.....Yes, ma'am. I am aware of the fact that your tax paying dollars goes
for part of my salary. Yes, ma'am. Tell you what, if your cat ditches you
again for the wild blue yonder, try calling the operator and she'll get a
hold of us.. Lickety split, I guarantee it." and he hung up quickly.

Roy and Johnny walked into the kitchen just in time to see Chet making
a beeline for the chair farthest away from the phone where he happily
picked up his deck of solitaire cards again.

"What's his problem?" Gage asked.

"Too much public adoration.." Stoker replied.

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Johnny snorted. "Hughh. Don't tell me. Another stuck cat call."

"You got it." Hank replied. "So how did your call go? You two looked

Roy sat down in Cap's recliner and he found he suddenly didn't care
that he hadn't asked Hank's permission to use it in his weariness.
"Guys, we've got some hard news. It was Vince and he was in a bad
way after fainting at work."

"Is he all right?" Cap asked, moving to sit on the arm of Roy's
chair to offer him his glass of not yet touched lemonade.

Roy took it gratefully, gulping it down. Shivering a little, he let
Johnny answer him.

Gage caught Roy's look and he spoke up quietly.
"He's fine, Cap. He had an electrolyte imbalance and just a little
breathing trouble that Brackett cleared up fast." Johnny insisted.

Chet was curious, but worried a bit, as he sat up a little straighter.
"Did Vince overwork today or something to get himself sun sick?
He is outside a lot."

"No, Dr. Brackett said that it was some kind of chemical working on
him that did it." Johnny told him.

"That's strange." said Cap. "I wonder what he got into." he wondered,
thinking about what kinds of chemicals could be around a police
station that might be unknowingly toxic.

Marco spoke up. "Maybe we should call him to see how he's doing."

Gage made a face, and reluctantly held up a hand, looking guilty.
"Ah.. Ya can't. Not yet."

"Why not?" Kelly asked. "I thought you two just got done saying
that he was okay, Gage."

"You can't call just yet.. because he's....still intubated.." said
Johnny reluctantly, hiding behind Henry's bulk for security.

The gang's reaction, was harsh.

"What?! Johnny, that's not what I call fine. That's-that's FAR
from being just fine in my book." said Marco, beginning to grow
sharp from where he leaned against a TV chair.

Kelly matched his ire. "Yeah, why'd you both just lie to all of us? He's
a good friend of ours. And yours, too, so I thought."

"I didn't lie, guys. I-I told you the truth. Listen to me. Listen to us..
He's.. not.. gonna.. die.." Johnny said with careful enunciation.

An interval of silence fell like heavy bricks between them.

Then Roy and Johnny winced at the smack of a large hand on
the table top. "Being intubated IS half dead, Gage. I read THAT in
the paramedic's manual!" glared Cap.

Johnny looked up, cowed. "Oh, really? Heh.." he laughed weakily.
"We..we..uh, didn't know that ya had. Heh.." he frowned lopsidedly.
"Sorry. But we were led to believe that things are gonna be okay.
Eventually.." he said, holding up both hands in surrender.

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Roy rescued his partner. "Cap. Dr. Brackett wasn't worried. Not even in
the slightest. And if we both seem tired it's because Johnny and I
received quite an earful at the hospital while Vince was getting diagnosed.
Doctors seem to like to talk from an entirely different plain of existence.
It gets a little too much to handle sometimes."

Johnny snorted. "And how.. But they do nice work, though. He sure saved
Howard's n-- uh, rear." he said, amending himself. He snatched up Roy's
glass in a toast in Howard's honor. "So here's to Rampart, huh? Another
save in the can..." he said quickly and swallowed the juice down in two gulps.

Grumbling, the rest of the guys finally turned away and got back to what
they were doing.

Roy came over and sat shoulder to shoulder with Johnny for some moral
support. "That went well. Feel any better?" he whispered, helping Gage
out as the young paramedic scrubbed Henry's coat vigorously to distract

"Yeah, once the lions calmed down enough to let us feed them." Gage
admitted, still irked as he patted Henry's side loudly to burn off a little
aggression. Henry just yawned, still entirely happy with the world.

Roy took in a deep breath, and sighed when he felt the eyes of the
others finally turn away. "Aren't you glad we decided we weren't gonna be
the ones to call the police station about Vince?" DeSoto asked, pouring
Johnny another glass of lemonade.

"Yeah..." he replied. "Whole heartedly." Gage replied in relief as he
reached for an apple from the fruit bowl.

The tones went off, making no one else jump but Station 51's two paramedics..

It was an all-call. A big one.

Date: Fri, 23 Feb 2007 14:55:21 -0000
Subject: [EmergencyTheaterLive] Into the Hot Zone
From: "Robert Gutheim" <>

##Station 51, Truck 127, Station 8, Station 36, Squad 110...
Industrial fire at Heating Manufacturers. 510 Winthrop St.
5-1-0 Winthrop St. Cross street Kincaid. Time out : 16:00.##

"Station 51, 10-4, KMG-365." said Hank.

The squad followed the engine out of the garage as they headed
for the large three story plant where household heating furnaces were
assembled. Soon, they were there.

Captain Stanley went up to the plant manager.
"Did you make sure everyone made it out safely?" Cap asked him.

Before the man could answer, another man with a dark skin tone jogged
towards them. "Two of my guys are missing, boss. I think they were over
by the area where we test units to make sure they work.."

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The plant manager spoke up. "Exactly where, Steve?"

"Uh... over there..." he panicked. "..B-Before they are palleted
and crated." the terrified guy reported.

"Oh, you mean inside the quality control area. Is that right?" the manager

"Yeah..." Steve stammered. "I can show you exactly where." he offered,
starting to turn back towards the burning building in a run.

Cap stopped him firmly by gripping his arm. "Ah.. no. We'll find it. Your job
right now, is to keep yourself and the people you got out, safe.  Just point
us to the right building."

Steve did so, and he coughed as a curl of black, acrid smoke blew into
his face.

"Now, get everybody you have moved, upwind, before you all get sick."
Hank told the two workers.

They hastened to do it.

Cap glanced around and saw Gage and DeSoto by the squad.
And he noticed the squad from 110, pulling up. "Roy! John!..."
Cap hollered. When they looked up, he swept a gesture
at the road. Nodding with satisfaction, he watched his two paramedics
run over to Wheeler and Kirk to fill them in on the plant's general layout
as all four of them rejoined Cap for their working orders.

"We've got two victims still in there. Over in a unit test area. Guys, my
men are going to tank up to see if they can find them first." Cap instructed
the two newcomers. "You're gonna be their relief team if they can't do
that in five minutes."

"Okay.." said both firemen from 110's.

When Cap had left to oversee the rest of the firefight, Johnny
made a face. "I hate calls like this." Gage muttered as the two
of them went to put on their turnout coats and scba bottles.

Roy didn't say anything. He didn't have to.

"Gage, DeSoto, we'll get things set up for you." Wheeler offered,
throwing open their squad's medical gear doors. His partner, Kirk
had already reached inside the truck for a couple of resuscitator

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"Go ahead, Tom, Kirk. Thanks." Roy said as he pulled on his gloves.

As they neared the fire, Johnny was introspective. "I'm glad
they didn't send us 16's. I'm not sure I could've handled dealing
with Brice and Bellingham in a life or death situation." Gage muttered.

"Why? Don't you trust them?" DeSoto quipped. "You told me an hour
ago that you didn't trust me. What makes them so different?" he grinned.

"I can live with all your faults. I'm not so sure I can work with theirs."
Johnny said honestly through his mask.

"Everyone's a critic.." DeSoto mumbled as he felt around a door,
looking for a way inside.

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