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Primary Complaint
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  Page Two

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"He's ok.. He's ok. Uh,... A short period of asystole, now bradycardic."
Roy said, gripping the old man's carotid pulse. "Palpable."

Both medics eyeballed the EKG monitor as Osterloh's respirations
went from deep and fast ones to weak and slow ones and then into
a pause of nonbreathing for a long moment. Then Osterloh gasped
through his faint, which started the cycle all over again.

Gage looked up. "Chet, get on his head. Make sure he keeps color."

"I got him." said Kelly.

Roy looked at Cap. "Fire up the defib, Cap. We might be needing it."

Hank bent over the bed to turn on the Datascope's power button.
"Want it charged?"

"Not yet. Save it." DeSoto grunted as he studied the old man's pupils.
"They're fixed Johnny. And he's flushing again.." he said, pointing to
Osterloh's flaccid face.

"Incontinent." said Gage, looking down. Then he reached for a nearby
wrist. "Got a pulse down to here."

Stripping off their patient's slippers, Gage pulled out his clothes shears
from his hip holster and ran their snubbed ends up the bottoms of both
of Osterloh's feet firmly, one at a time. The toes curled downwards
at the tickling. "Bilateral Babinski's sign with a resumption of effective
heartbeats." reported Johnny to Roy.

"Stokes-Adam's attack?" DeSoto asked him.

"That'd be my guess.." answered Gage.
Johnny got on the phone again. "Rampart, our victim's just
suffered what seems to have been syncope triggered by
a heart arrythmia."

##I saw that small change, 51. Make sure he's perfusing and
breathing adequately. Has he regained consciousness yet?##

Roy looked back up at Chet, who nodded as the old man began to stir
in his hands. "That's affirmative, Johnny." Kelly announced, making sure
the oxygen mask stayed firmly over the man's nose and mouth.

"That's odd." said Johnny out loud.

It was overheard by Glenda. "What's odd? That? That was just one of his
usual spells whenever he gets stressed out. They never amount to much."

"Ma'am, I beg to differ, but Stokes-Adams is a serious symptom." said
DeSoto sharply. He immediately checked himself and got to work on
getting another blood pressure reading.

Johnny tried to ignore the tension that was growing in the room.
"Rampart, our patient's showing extreme diaphoresis now and he's
beginning to moan incoherently."

"It's up again.." said Roy, reading the air dial on the blood pressure cuff.
"160 palp."

"He's proving positive for labile hypertension, doc. Dyspnea's growing more
pronounced despite an effectively returning consciousness level." said
Gage quickly when Ted began to utter some words in anger.


"Dix, sounds like his sinus node and the AV node are degenerating."
Kel said.

"And no one noticed that over there?!" Dixie asked, getting mad. "Just
what kind of nurses are they hiring at the state level?"

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Gage confirmed Kel Brackett's new fear.
"New degeneration is progressing through the whole conduction system, doc,
advancing from the SA node downwards towards the ventricle. I'm seeing ST
elevation in the inferior leads II, III and aVF.  Also he's got some diffuse ST
elevation with reciprocal ST depression in the anterior leads, especially in
the right V leads."

##51, sounds like he's getting a right ventricle infarction. Let me see a new strip
a.s.a.p. Also, carefully re-auscultate the chest and inspect again for peripheral
edema as an indicator of right ventricular failure. There may be other
acute changes going on that we're not yet aware of. Be thorough, guys.
This is important.##

Roy bent over Mr. Osterloh with a stethoscope and motioned the nurses and
newly arrived ambulance attendants into silence. He listened a few seconds
in every field on the sick man's chest. "Johnny, he's got a transient abnormal
point of maximal impulse. It's laterally displaced to the anterior axillary line,
over the fifth intercostal space.  And it's enlarged. I'm also hearing an S4. It's
manifesting as a short, soft basal diastolic murmur. Is he in pulsus alternans?"

"Yes. It's prominent most at the radials to carotids." said Johnny, checking
the man's heartbeat equality at his wrists, foot tops and neck.

The nursing assistant Kathy watched on with growing puzzlement and stress.
::Oh, what now?:: she thought with great worry.

Gage snatched the biophone receiver from his shoulder. "Rampart, new findings
past that new acute inferior MI. We've got a pulse deficit and a growing atrial gallop."


Brackett looked up at Dixie with a sharp frown. "Severe regurgitation?" he thumbed
the talk button. "51, is your patient exhibiting a widening pulse pressure?"

Roy check the man's BP again. This time, with a stethoscope, anticipating trouble.

Gage leaned over to see what Roy had written down.
##10-4, Rampart. He's 152 over 80 on the left.##


Dixie's eyes widened. "An aortic insufficiency murmur? I wonder how long he's
had that going on?" she hissed with growing fury.

Brackett grinned. "Easy, hon. That nursing staff's not to blame. A possible aortic
aneurysm looks just like a heart attack in a lot of cases and sometimes, they
even form without any symptoms whatsoever." he said. "They were good
enough to see the new MI as soon as it was happening. And that, very
possibly, is going to save his life today. If he hadn't of had one, most likely,
that aneurysm would've killed him by nightfall before anyone realized
that something was even slightly wrong."


Roy held onto Mr. Osteroh's arms to keep him flat when he began to speak as he
reawakened. His voice was now raspy and weakened. "What's going.. uh, I
can't.. seem to.." he broke off, struggling to breathe. "Somebody.. help me." he
croaked. "..please. I still can't ...swallow the medication.. in my mouth.."

DeSoto gestured at Johnny, drawing out a suction wand as he swept a couple
of fingers across his own throat in significant meaning. He began to use it
to clear out Osterloh's airway. The sputum he got out was red tinged.
Osterloh started to cough and couldn't stop as Roy aided him. DeSoto spoke
quietly, trying to calm the tired old man. "I got this. Just relax. Let me
do all the work. Just try to keep breathin' calm and slow. Keep this
oxygen on now, ok? Don't try to fight it here." he said, pulling Osterloh's hand
away when the man tried to pull off his mask. "All this spasming'll go
away just as soon as I'm done. There.. I'm through. That wasn't so bad
after all, now was it?"

Mr. Osterloh sighed, trying to suppress all of his misery and painful hacking.

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Gage nodded, adding that coughing clue to his notes. Then he picked
up the phone again, but before he could speak, Kel beat him to it.

##51, is the patient exhibiting hemoptysis with all of that coughing?##
Kel asked, cocking his head at the noise he was hearing over the frequency.

"That's affirmative, Rampart." Johnny replied.  

##Place two large bore intravenous lines in around the saline lock
and begin Nitroprusside, 0.5-3 mcg/kg/min IV. Use in conjunction with
Esmolol to counteract the physiologic response of reflex tachycardia that might
occur if the nitroprusside's used too early. I want to drop all of that
blood pressure flowing against his weakened aortic wall now.## Kel told Gage.

Across the room, the home's nurses didn't hear the second diagnosis.

Glenda leaned over and whispered into Kathy's listening ear. "Nitroprusside
causes peripheral vasodilation by direct action on venous and arteriolar smooth
muscle, reducing artery peripheral resistance. This is commonly used IV because
of its rapid onset and short duration of action. It's the most easily titratable to
reach the desired effect we need right now. Mr. Osterloh's pressure's unstable now."

"Is he going to be ok, ma'am?" trembled Kathy.

"He's got a good chance if the surgeons react quickly. Now more about
Nitroprusside.. It's light sensitive. Both the I.V. bag and the tubing should be
wrapped in aluminum foil.  Ah,...see? That paramedic remembered. He's
given one of his firefighter friends that chore to do."

Kathy nodded, handing Marco a roll of soft tape from the blood drawing
tray that had been near the bed out of his reach.

Glenda smiled. "Now about Esmolol... It's an ultra short-acting beta 1 blocker
that's particularly useful in patients with labile arterial pressure because it can
be abruptly discontinued if necessary.  Especially for patients with his kind of
hypertension history who's at uncertain risk of bronchospasm from beta blockade.
Now that drug's elimination half-life is nine minutes. You'll soon see the paramedics
trying to bring his pulse down to a target heart rate of 55-65 bpm."

Dr. Brackett's voice continued issuing critical orders.
##51, for the beta blocker.. This is your loading dose infusion rate:
Use 250-500 mcg/kg IV over 1 min, followed by a 4-min maintenance infusion
of 50 mcg/kg/min. If his heart rate's not down yet after a minute, your
repeat loading doses will be as follows:
Cycle 1: Load 250-500 mcg/kg IV over 1 min, 50 mcg/kg/min IV over 4 min
Cycle 2: Load 250-500 mcg/kg IV over 1 min, 100 mcg/kg/min IV over 4 min
Cycle 3: Load 250-500 mcg/kg IV over 1 min, 150 mcg/kg/min IV over 4 min
Cycle 4: Load 250-500 mcg/kg IV over 1 min, 200 mcg/kg/min IV over 4 min...

When he drops to 100 systolic on his BP,  increase the interval between
your titration steps from five to ten minutes to maintain him above shock

Kathy almost whispered to Roy. "What's happening, sir?"
"He's getting into new respiratory distress. All that wheezing, dyspnea,
and that new cough suggests that he's getting a bit of fresh blood into
his lung tissues."

"He's been injured?" asked Kathy. "How? We've hardly moved him.."

Glenda, still standing near Kathy, gently took her by the shoulders as
she stood behind the shorter woman.  "Kathy, Ted may have an
aneurysmal complication newly developing."

"His aorta?" the girl gasped.

Roy nodded. "Most likely, it's a TAA in his ascending arch. Did
you notice how hoarse his voice sounded when he said he couldn't
swallow the aspirin very well? Bulges in the aorta at that point
can causes pressure on the vagus and peripheral nerves controlling
his larynx, causing sudden onset vocal raspiness."

Kathy nodded.

A reply back from Brackett nearly made her jump in her skin.
##Assess pain intensity, location, and duration once again, 51.
Give me any new symptoms a.s.a.p..##

"Why did he order that?" asked the CNA of her teaching RN.

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The older RN nodded her head gently. "The most consistently occurring
features of any possible thoracic aortic dissection relates closely to the quality
of the pain. The pain from a TAD is clearly distinct from the type of pain
associated with an AMI. A careful history focused on the quality of a
patient's pain is the most useful tactic for distinguishing an aneurysm
from a heart attack. It's critical that the right priority problem be found as
soon as possible. For Mr. Osterloh, that means open chest surgery
immediately while he gets treated for that inferior infarct. For time lost is
heart muscle lost on one, and a definite life threatening delay on the other."

"This is a dissection then?"

"Yes, for if Ted's aorta had ruptured medially anywhere instead of
just leaking out in between arterial layers like it seems to be doing,
he would've long since been dead."

Johnny looked up after speaking with his patient. He lifted up the
phone receiver. "Rampart, he's got a new hoarseness in his voice,
difficulty swallowing, wheezing in all fields, swelling in his neck and arms
and positive Horner's syndrome.."

The RN beckoned Kathy forward. "Go ahead and take a look at what
he found on those signs. I'll watch you."

Kathy soon located the noisy, wet sounds in Mr. Osterloh's chest under
her stethoscope and the constricted pupil, drooping eyelid and dry skin
on one side of his flushed face. ::So that's Horner's.:: she realized.
::I've only read about that definite sign of a TAA.::

She stepped back after making sure she wasn't stepping on any tubes
or wires behind her.

Brackett's voice acknowledged Johnny's focused reassessment.
##51, D5W is contraindicated now as it'll increase vasoconstriction, and
double the heart's afterload. Keep using intravenous normal saline. That
solution will increase the heart's volume and stretch the right ventricle
and decrease his damaged aorta's load. Disregard the MS orders and
discontinue the NTG. Use 80 mg's I.V. Demerol instead, one time,
for that right ventricle pain. The last thing I want to do is pool blood to the
right side of his heart as his pressure falls.##

"10-4, Rampart."

##As soon as you get that done, I want a new strip. Then you know
the drill, 51. Give me a vitals set every five minutes and transport as
soon as possible. Be sure to inform me of any further negative changes.##

From: "Derrick" <>
Date: Tue Sep 5, 2006 9:10 pm
Subject: A Short Reunion

"Our ambulance has arrived, Rampart. Our ETA is about
seven minutes." Johnny promised.

##See you soon, fellas.##

"County 51, out." Gage said, as he ended the call.

Harold and Malcolm pulled up the gurney soon after Roy had
administered the blood pressure medication and started the drip.

Meanwhile, the rest of the nurses, exept for Glenda, the charge nurse,
went back into their normal routine of taking care of the residents.

Marco, Chet , and Mike, helped place Mr. Osterloh gently
onto the gurney as EMTs Harold and Malcolm made him comfortable and
put a blanket on him. Then the boys made their way down the narrow
hallway, into the spacious lobby, and out to the ambulance. There they
decided that it was Roy's turn to ride with the patient into Rampart.

As Mr. Osterloh was being loaded in, an old man in a wheelchair
came beside Captain Stanley.

"Poor Ted. He's never been the same since his wife, daughter and
beautiful grandaughter all passed away in that terrible fire up in
'Frisco. Part of him went when they did you know."

A chill of memory swept down Hank's spine.
"Sir, are you telling me about the Latham's Department Store fire
a couple of years ago?"

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"Yes, captain. My son worked it along with dozens of other
firemen that day. Three of his buddies died there besides my own
boy, Ted's family, and four other civilians."

"Well, I'm sorry to hear that." Hank said.

"If you see Ted again, you tell him that Sweet Louie hopes
he gets better, you hear?" said the wrinkled man.

::Sweet Louie? I've heard that name before, hmmm..:: thought
Captain Stanley. Then he remembered, with a physical start of shock.
"Ah, sir...uh,.." said Captain Stanley. "Are you "Sweet Louie"
Jessups, who used to work with my dad at old Station 17 a
few years ago?"

"I'm too old for that kind of work anymore, Hank. Tell me, was your
dad still ornery as hell right to the bitter end?" laughed the old man
as the rest of the Engine 51 crew gathered around. There was nothing
but affection in his voice and it softened the harsh sounding remark.

Stanley flushed at that proper peg of his dead father's personality.
"Then it IS you?! How are you, Louie, you old devil?" he grinned

"So you remember me, Hank Stanley. How nice it is too see you again.
You were just a little boy when I first met you. You used to go see your
pappy all the time at work when you were.. still just a tiny little thing.
So, now you've..... finally got your own station." Louie said with a bit of
sadness. "You're dad would've been very proud of you to see that..."
he whispered fondly. "And your own good men, eh?"

"Yes. This is my engineer Mike Stoker, and my hosemen Marco Lopez
and Chet Kelly." The firemen extended their hands to the retired and
crippled department colleague with a show of appreciation and respect.
"My paramedics are Roy DeSoto and Johnny Gage. They are on the way
into Rampart Emergency with Ted right now. Don't worry. He's in
very good hands."

"I'm not worried. I see a lot of these new fangled paramedics around these
parts nowadays. For obvious reasons.." he chuckled.

The gang laughed along with him.

"Do you fellas know that ol' Ted Osterloh was a tillerman and hoseman
up in 'Frisco for a whole crop of years?" he told them. "He worked the
earthquake there in '57, the hotel fire back in '63 and he was on firewatch
for many days back in '68 when they tried to burn the city down after Dr.
King was killed. He just retired in '72. It's a shame today had to happen
like the way it did for him."

Unexpectedly, Cap felt overwhelmed at seeing a figment from his
happier childhood days sitting so wasted and time diminished
in front of him. He fought down a choke of emotions. "Well Louie, it was nice
seeing you again but ..we've.. got to get back to the station. We still have
a lot of work to do." Hank said. "So far, it's been a real busy day."

"You boys be careful and don't let it bite ya in the butt."
Louie said as Hank and the guys left his wheelchair's side
sitting on the lawn.

What he meant needed no translation.

"We won't."  Chet replied as they all waved goodbye.

As they walked back to the Ward engine, tears were welling up in
Captain Stanley's eyes.

He and the rest of the crew got in, one by one. Hank nearly slammed his
door shut forcifully before he stopped himself. Disturbed, Hank rested
his head in his hands with his elbows perched on the dashboard and
stayed uncharacteristically quiet as he took his helmet off to rub his
eyes dry.

"What's wrong, Cap?" Stoker inquired. "Are you ok?" he asked.

"I'm fine, Mike." Hank sighed. "I just wished Dad could have been here to see
how Jessups remembered their old firefighting days. You know it's my fault
that I don't remember dad as well as Louie does. I should've spent
more time with him. Jessup warned me about the way these d*mn*d cigarettes
mess with your memory and all." Hank said as he tossed a full pack of
them out the window.

Realizing that nothing needed to be said, Stoker remained quiet as
he fired up the Ward's ignition.

Hank picked up the radio and said. "L.A . Engine 51."

##Engine 51..##

##L.A., we're 10-8 and returning to quarters.##

##Engine 51. 10-4." replied Sam the dispatcher.

Instead of pulling into the street after the transmission,
Stoker just idled there, thinking. Then he spoke.
"No, captain, it's not all your fault. I know for a fact that your
dad tried to give you the best life that he could. I know.. that
he wanted you to love the life you live and live the life you love
being a part of the fire department...just like he did. He had to
make a sacrifice every day to live that kind of life and we have
to make one too, just slightly different. That includes spending time
with our families now... For every moment that we spend with them,
means that we cherish those family members we used to have, still.
You should cherish everything your dad was, Cap. Nobody had
to make up his mind for him to smoke two packs a day. He chose
to do it and yeah, he thought that nothing was going to happen to him
until he got emphysema and finally learned that it was slowly killing
him. You're still young, Cap. Your kids don't have to see you go
the way he did. It's still your choice."

Hank turned to Mike and said in sarcasm. "Hey, do you know, for once,
that you're right?" Hank agreed, letting his eyes glisten in remembered
grief. And relief.

Stoker nodded. He looked out the driver's window at the old
man named Louie Jessups who was slowly making his way back
up the ramp for the nursing home's graceful entrance. ::Peace on
you, Louie. From all of us still in the business.::

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From: Patti or Jeff or Cassidy <>
Date: Wed Sep 6, 2006 2:20 pm
Subject: Blow Out

It was later that day and four runs later.

"So what did he have, doc?" Roy asked, leaning in over
the nurse's counter in the ER at the hospital.

Kel looked up from the mug he was pouring coffee into
from the glass pot by the base station. "Huh? Oh, you must
mean that state home invalid you brought in this morning." he

"That's the one." Johnny agreed.

"He's alive and currently undergoing a hypothermic, circulatory
arrest, open-anastomosis." Kel smiled as he rattled off the
procedure's official name.

"Excuse me, .." coughed Johnny, on a donut. " *Sputter* A what?"

Roy elaborated. "A cold patient bypass operation.."

"Yeah, I got that part. I got that part. Geesh. What I meant was,
what for?"

Kel angled another eyebrow at Gage. "Mr. Osterloh had an acute
fusiform thoracic aortic arch aneurysm dissection in progress. We're
successfully repairing it." he grinned.

"Wow, is he a lucky guy." said Johnny.

"He sure is." said Dixie McCall from where she relaxed on a metal
stool in front of a small stack of charts. "He only had a false passage
for blood opening up between the layers of his aorta. Something called
a fistula began leaking into his lungs through the pulmonary vein's
overstressed capillaries during the fifteen minutes you had him."

Kel demurred. "And that inferior MI was his only, easily resolvable,
resultant complication."

Gage whistled low in his throat. "So when did his aorta begin to tear?"

"Probably at the moment you two noticed his onset of Stokes-Adams."

"Doubly lucky!" Gage exclaimed, spraying out pastry crumbs all over
the desk.  "I've heard a TAA dissection usually begins with a tear in the intima,
the vessel's innermost lining." he contributed. "And kills people slowly in
their sleep."

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"It can and does." Kel laughed in amusement.

With feigned disgust, Dixie brushed away the donut pieces raining down on
her paperwork. "All true.." she agreed. "Doctor? What exactly
are the stats on that?" she teased sarcastically, getting into the conversation.

Kel, obliviously in his element, took her quite literally. "Stanford class A
TADs will give ST segment elevations suggesting AMI in up to 8% of cases.
Some ST segment changes (elevation, depression, or nonspecific) are seen
in up to 42% cases of class A-TAD. One of his chest x-rays showed
characteristic cardiac enlargement with a dilated calcified aorta."

Right then the phone rang, and Dixie picked it up. "Rampart Emergency. This
is Nurse Dixie McCall..." She fell into listening. "Joe, thanks for the news.
Would you page Dr. Cederstrom and tell her about him, too? She was
worried about Mr. Osterloh."
Brackett eyed Gage happily. "Wanna see it?"

"What?" said Johnny, still trying to figure out what Dixie was talking about
on the phone with Dr. Early.

"His chest x-ray... I'm rather proud of it." Brackett said conspiratorially.

"Sure.." said Johnny eagerly, breaking out of his reverie.

Kel showed him the telltale film.

"Wow. And he's gonna make a full recovery?!  I mean, for sure?"
Johnny gaped.

"No doubt." said Dixie. "From both the aneurysm and his heart attack."
McCall said, hanging up the phone. "That was Dr. Early calling from Cardiology.
Joe said Mr. Osterloh's catheterization contrasts are coming back
with a zero percent thrombolytic occlusion rating in his right coronary
artery, post surgical. And the Dacon graft sewn in place of his removed
aorta's not leaking out even one tiny bit into his drains."

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"That lucky b*st*rd!" Dr. Brackett shouted.

Gage sniggered, mumbling. "You took the words right outta my mouth, doc."

Kel went on, still excited. "Do you know how hard it is to avoid Prinzmetal's
unstable angina after that kind of heart attack and TAA dissection?"

"No.." said all three of them.

"Oh.... Well.... Never mind. I guess you'd have to be a doctor in order to appreciate
that one." said Brackett as he set down his empty coffee cup and walked

"I guess so..." chuckled Roy softly, watching him leave. "See you later, Dix.
Johnny and I'd better be getting back to the station. It's almost dinner time."

"See ya, fellas. Have fun on your next rescue call."

Gage lifted his HT. "Squad 51 to L.A. We're available. Returning to quarters."

##Squad 51....*Spap.* ##

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Please click the sparkles for a music change.

From: E!lf <>
Date: Thu Sep 7, 2006 9:52 am
Subject:  It Never Rains

The sun was rising over Carson, California, as station 51's A-shift
reported for their next tour. At least it was probably rising, though today
that was more a matter of blind faith than anything else. Heavy black clouds
curtained the sky, prolonging the night. Lightning flashed and thunder rolled.

John Gage stood in the open bay door, inches from the downpour, and
warbled off-key. "..They say it never rains in southern California.  
Seems I've often heard that kind of talk before . . . ."

"Jeez! Is someone strangling a hyena out here?" Chet Kelly said
as he wandered out into the bay. "Oh, Gage is singing. I should have
guessed. Hey, DeSoto! Make him stop singing before you have to
treat us all for ruptured ear drums."

Roy, carrying a cup of coffee, strolled over to stand next to his partner, and
gazed out at the rain. He pursed his lips in a tiny smile and joined in the song.
"..It never rains in California. But girl, don't they warn ya? It pours. Man it pours!.."

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Kelly made a face of long suffering. "Great. Just what the world does NOT need.  
Singing paramedics." At that moment the tones sounded. Chet cast his eyes
heavenwards. "Thank you! Saved by the bell!"

##Squad 51. Man trapped at sea. Meet fireboat 110 at the dock. Time out 08:17.##

Chet acknowledged the call while Roy and Johnny jumped into the squad. He
handed the call slip in the window. Roy glanced at it, passed it off to his partner,
and took off through the driving rain.

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Hit refresh to restore original soundtrack

From:  E!lf <>
Date: Sun Sep 10, 2006 1:33 am
Subject: Lost In A Fog

When they drew up to the dock, 110's captain was waiting for them.  

Johnny and Roy pulled everything they were apt to need and he
was grateful when the captain helped them gather it up and carry
it down to the fireboat.

"Cap," Roy acknowledged him.  "You got any idea what we're looking
at here?"

"An old passenger steamer," he told them.  "An environmental group down
the coast was trying to sink it, to form the basis for an artificial reef."

"Today?" Johnny interrupted incredulously.  "In this?"

The captain shrugged.  "I guess today's when they had their licenses and
permits for it."

"So what happened?" Roy persisted as the boat got underway.

"They got caught in a storm surge.  We don't have all the details, but
apparently one of the old funnels collapsed and caught one of the
guys underneath.  They said he's out cold and they can't get the funnel off him.  
Anyway, we'll know the whole story in a few more minutes."

Rain churned the sea surface into a foamy froth and raised a light mist that
thickened into patchy fog as they left the coast behind.  Passing through
stretches of limited visibility, they were forced to slow down.  The fireboat's
foghorn sounded at regular intervals, flat and forlorn, and now and again it
was answered by distant horns or by the far off clanging of the bells from channel

Johnny leaned over close to Roy.  "Don't stand too near the side," he cautioned.

"Yeah," Roy agreed, regarding his partner solemnly through the double curtain
of rain dripping off both their helmets.  "I wouldn't want to get wet."

The pilot slowed the boat as a larger shape loomed suddenly in front of them.  
They passed by the bow, where the name "Irene Elizabeth" was briefly visible
before being hidden by the mists, and pulled up under the steamer's boarding
ladder.  The two boats faced in opposite directions, their starboard sides together.  

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Crewmen on the fireboat tossed bumpers over the side and made the boat fast.

To their port side a Coast Guard cutter emerged from the fog and came up
next to them.  A young officer climbed nimbly from the cutter to the fireboat.

"Chief Petty Officer Adams.  Glad to see you guys!  We've been waiting.  We
can help you get the funnel off him, but we don't have a doctor aboard so we
figured we'd better wait until you arrived before we did anything."

"You did right," Johnny reassured him.  "Can you show us where he is?"

"Yeah, but there's something you need to know first.  There are explosives
aboard that vessel."

"Explosives?" the captain demanded.  "What kind?  How many?  Where are
they and how and when are they supposed to be detonated?"

"I don't know," Adams told him reluctantly.

"Well, who does then?"

"The guy who's pinned under that funnel up there.  He's the demolition expert.  
He was setting the charges when the storm surge hit.  It's anyone's guess
how many he had set by then, or where.  No one else seems to know anything
about it."

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For several seconds the small group of men stood in the rain, regarding
each other in dismay.  Then Roy and Johnny turned simultaneously for the
boarding ladder.

"Sooner started, sooner done." Roy said laconically as he followed his
partner up to the deck of the doomed steamer.

Adams joined them aboard the Irene Elizabeth and led the way aft to where
a tall, broad funnel lay tilted at an awkward angle.  As they approached they
saw, first, a pair of legs sticking out from under the funnel's edge.

The three men circled the funnel and Roy and Johnny were relieved to see that
a capstan had caught the edge of the funnel and was keeping its full weight off
of the man who was trapped.

"This doesn't look too bad." Roy said.  "That leg's gonna be broken and I'd say
he hit his head on the way down."  He knelt by the victim's head and used his
penlight to check the man's eyes.  "Pupils are equal and reactive.  No blood
or spinal fluid in his nose or ears."  He used a C-collar to immobilize the
victim's head and neck.

Johnny was examining the funnel as two more crewmen joined them carrying
a stokes.  "Roy?  I think we can just lift this off him and pull him out.  You
reckon it's safe to grab him and go?  I don't know about you, but I'll feel better
once we're well away from this rat trap."

"I know what you mean.  I think that'll be fine.  We can treat him en route."

"Okay then, get set.  We'll lift, you pull.  On the count of three."

Johnny crouched beside the funnel with Adams on one side of him and the
two-fireboat crewmen on the other.  They counted three and lifted together.  

The funnel rose and Roy pulled the victim clear.

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It was the work of but a few seconds to get him into the stokes, covered
with a yellow blanket and strapped down.  The two crewmen picked up
the stokes and the group of men made haste for the boarding ladder and
the safety of the fireboat.

Johnny scrambled down the ladder first, turning to steady the stokes as
it was lowered over the side.  The captain came to help him and they
settled it onto the deck of the fireboat as Adams and the two crewmen

Roy handed down the trauma kit and the drug box and was just reaching
for the ladder when the first three explosions hit in rapid succession and the
Irene Elizabeth heeled over sharply onto her port side.

Only the captain's quick action in cutting the tethering line kept the fireboat
from being capsized as well.  The Irene Elizabeth tipped nearly enough to
show them her keel and for a minute it looked as though she might turn turtle.  

Then two more explosions went off, one fore of the fireboat and one aft.  The
direct force of the blasts missed them, but the percussion created waves that
drove them towards the doomed ship.  The pilot gunned the engine and they
streaked out from beneath the steamer just before she crashed back to an even
keel.  When she leveled out her deck was awash and she sank from sight in less
than a minute.

A circle of ripples spread out from where the steamship had sank, rocking
the fireboat and the cutter, standing ready at a short distance.  As quickly
as it had begun, it was over and the only thing that marked the ship's passing
was that now the rescuers had gained a man . . . and lost a man.

"Roy!" Johnny called, his voice echoing weirdly in the drifting fog.  "Roy, where
are you?  Are you out there?  Can you hear me?  Roy?"

Only the boom of distant thunder and the sound of rain on the sea broke the
silence that answered him.

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Date: Sun, 17 Sep 2006 07:49:53 -0700 (PDT)
From: "Roxy Dee" <>
Subject:  The Silence~~

110's captain sprung into immediate action. He got on his plastic
wrapped hand held. "Boat 110 to Coast Guard Seven. We've a man
overboard! Our location! We need an emergency sweep right now."

##10-4, Boat 110.## replied the petty officer's superior over the
frequency. ##We're heading for your port side. Calling in a secondary
air support chopper from her current monitoring position.##

It took everything Gage had to let the others start looking for Roy
while he completed securing the injured man's stokes to the fire
boat's deck hooks. ::Why didn't I back us out when we still had the
chance?!:: Johnny agonized. ::The scene wasn't safe. Not by a mile.::

Moments after he even thought up his self-chastisement, Gage could
almost hear Captain Stanley's unspoken instant refutement in his head.
'Since when is a scene EVER safe for ANY firefighter?' Hank's inaudible
advice sang out over the din of the storm. 'If we sat around waiting for our
butts to be covered first, a sh*tl*ad of folks would die waiting for us to
rescue THEM. Now tell me, is too high a level of caution a true definition
of a first responder? Our job in hindsight after the fact, can be one h*ll of
a bear in the guilty-what-if department, but I refuse to believe that anyone
here at the station won't rise up to the challenge of facing a little extra
danger when it's all for a greater good.' said the voice of conscience.

Gage sighed in unrelieved stress. He still found that he couldn't tear his eyes
from the water while he worked on the wounded seaman.::Oh, Roy. What
kind of challenge is it when it's twenty tons of exploding ship against just
one guy?:: came the thought, unbidden. A sharp hand movement from an
airborne frogman, who had been scoping the sea intently just seconds
before, caught Gage's eye.  "Cap! They've found him!" he shouted, pointing
to the chopper diver as he made his leap from the helicopter.

110's captain glassed the area with his incident binoculars. "DeSoto's
conscious. His head's bobbing. He must've let the sinking ship pull him
down out of danger to avoid the brunt of the explosions."

Johnny agreed. "He's a Vet. That's what he did. He would know what to do."
Gage said happily. "Let's get over there now, Cap. That diver's gonna need
help in all this heavy surf."

The coast guard diver surfaced after a monster wave and he regrabbed Roy
from behind, where he floundered in the water weakily, as if he was extremely
dizzy. Johnny could see a multitude of small cuts and pock marked burns
dotting Roy's face and scalp where molten metal had melted skin and hair.

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The boat got near and Johnny eagerly reached out with both arms. "Is he
talking? Any broken long bones in his arms or legs?"

The diver spat out his regulator, shouting over the roar of the hovering chopper.
"No, I checked. There's nothing obvious cropping up except the fact that he's
breathing fast from some kind of pain; not like he nearly drowned at all."
said the rescueman.

Gage was beside himself. "All right. Are you absolutely positive? Neck
and back ok?" Johnny asked, triple checking things before he tried to
move Roy an inch out of the ocean. He started to reassure himself of Roy's
stable condition after getting a grip on his carotid from where he leaned
over the waves from the boat's dropped rear launching platform.

"Yes, sir. Not a single scorch on him anywhere past this head singe-ing."

But Johnny was no longer listening. Gage was worried. Roy's eyes were
cracked and seeing, but he seemed distant and staring, around all the blood.

DeSoto moaned. Once. "Ohhh.." he grunted. Then his eyes opened wide in
surprise and he didn't try to speak again.

"Roy.. Where are you hurting?!" Gage asked as he gripped Roy's face
where it stuck out of the water in between the diver's arms. He shouted
the question again as he and the other firefighters with him fought to keep
the diver and DeSoto in contact with the boat as the storm's wild waves rose
and fell. "Come on, try and look at me if you can."

Despite some light guidance, Roy didn't react any differently. That's when
Johnny noticed the bright streams of reddish gore running from both DeSoto's
ears. "Cap. He's got concussive injuries. Get the O2 out on the double."

Seconds after DeSoto was pulled out of the water and hauled carefully
into the boat with his belly down, he began vomiting violently around their
feet. It was a mixture of frothy seawater and regurgitated bile.

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Roy, uncomfortable beyond tolerance and a bit confused, began struggling
to right himself desperately shortly afterwards.

Gage snapped out an order. "Sit him up!" he said when he noticed that Roy's
eyes were spinning and shifting in their orbits rapidly. "It's vertigo causing
this. When it stops, start him on high flow O2 that's been heated. He's gonna
get even shockier on us real soon."

"I'll get a relay set up with Rampart through your HT." said 110's captain.

Gage nodded. "I'll be ready for them in two minutes."

Roy started muttering as he slowly became more aware of his surroundings.
"Get out! Gotta get out. Fire in the hole! Get down!" he coughed. Gasping, he
tried to get as small as he could around his knees and in doing so, he knocked
off his oxygen mask unthinkingly.

Johnny took him by the sides of the face and gently turned his head up.
"Roy? Hey.. Listen to me. Or at least, watch my face. You gotta keep still on
your butt just like we've placed you...."

DeSoto seemed to understand and he stopped writhing. "I.. can't.....hear anything."
DeSoto choked out with a bit of panic in a salt abraded voice. He closed his
eyes tightly as his dizziness finally started receding.

Gage held him by the shoulders. "I know. I know. Easy. You've got some barotrauma
and you're gonna have to hold your head still and elevated to keep ahead of all
your nausea. It's positional vertigo, ok?" Gage beamed hugely as well, false
as it was, to carry his words in other ways so he could communicate with his
seriously stunned partner.

Roy lifted swelling eyes but still, he couldn't focus them."I can't..*cough* I can't
tell up from down, Johnny..." he rasped tiredly.

Gage looked up from where he was taking a blood pressure. "Moore. Steady him
against your chest. And the rest of you guys, handle him as hypothermic, because
that's what he's gonna be in very short order. Cover him up with everything you've got.
Roy, can you hear me at all?" he asked again, waving fingers in front of Roy's nose
to get his attention.

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"Everything's totally...q-quiet, *UghhH* Roy grunted, fighting gut heaves.
"But I...don't ...think I'm hurt much past that. H-head's clear now. Chest is---"

"Hey..You let me be the judge of your current condition." Gage hissed, delivering a
small finger tap to Roy's cheek to get him to focus more on him again. Relief
started soaring even as Johnny gave into the shakes of reaction, ones he did
not want Roy to mirror. He placed a firm hand over Roy's oxygen mask pointedly
as he used his other one to grip the top of DeSoto's head in a light admonishing
squeeze."Just shut up and relax a little. Let me do all the worrying about everything."

Roy finally got the gist of what Johnny meant through his roaring deafness and he
closed his eyes at last. Sighing, he covered both of them with the flat of his
palms in an effort to quell his violently roiling stomach with a little applied pressure.
"..Compazine...*cough*...Diazepam..?" he whispered to no one in particular,
seeking no reply.

But his comment had been overheard.

Gage reassured him of coming relief meds with a brisk flourishing tie-off of a latex
constricting band around Roy's upper arm. "Right after an I.V. start and a neuro
check to rule out any head injuries.." he promised with a grin that was only just
beginning to return to his lips. ::80 over 40. I can live with that number, any day.::
he thought gratefully.

110 leaned over. "How is he?"

"He's gonna live, Cap. Most definitely. But I still think we should fly him out.
He was awfully close to those explosions."

"Gotcha." and the grizzled man began communications to set up for a basket
drop over the boat.

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