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************************************************** From: "patti keiper" <pattik1@hotmail.com> 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 Dixie." "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 baseline." ::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 checking. 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 complied. 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" <pattik1@hotmail.com> 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, ...like 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 bushed." 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 himself. "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" <rguthei1@twcny.rr.com> ##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 asked. "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 apparatuses. |
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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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