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  The Long Hours
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Page Two

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From :  patti keiper <>
Sent :  Thursday, July 5, 2007 8:22 AM
Subject :  Like Well Oiled Machinery..

Station 51 was a half-mile away from the scene, when they spotted the smoke plume.

"That's big enough to be a fully involved house." muttered Cap, as they drew nearer.

"You're probably right, Cap."   said Kelly. "That's the new housing development at the edge
of town."

Mike Stoker drove the Ward LaFrance swiftly down the boulevard towards their destination.
Engine 51's sirens ground down to a halt as they pulled up in front of the yard. It looked like
an explosion had just occurred. A woman wearing a skirt was lying on her back near a running
garden hose. She lay amid blown debris, and she was bleeding from a cut on her forehead.

"Check her first." ordered Cap, as he opened the door of the engine and got out. Then
he thumbed the mic on the radio.  "L.A., Station 51 is on scene. We have a fully involved
two-story wooden structure. Notify the gas company and electrical utilities to shut down
service at the corner of 17th and Maple. L.A., respond a second alarm to our location."

##10-4, Engine 51.##  New SCU tones began to fill the air as additional assistance was
summoned. ##Truck 127, Engine 18. Respond with Station 51....##

Johnny Gage and Roy DeSoto pulled on their turnout coats rapidly. Marco Lopez
snatched their medical gear out of the squad as the two of them knelt on the grass
next to the fallen woman. They kicked the running garden hose water stream, away
from her face.

Roy reached for her carotid.  "She's alive." Leaning over, he peeled back one of her
eyelids. "Looks like a head injury only.  She doesn't have any obvious burns anywhere."

Nearby, Cap began to issue orders. "Marco, Kelly! Get out two inch and a halves
and start tackling the north and east exposures from upwind."

"Right, Cap." they replied.

"How is she breathing?"  asked Johnny, opening up the biophone.

"Fair."  replied Roy as he opened her airway a little wider with a modified jaw thrust.

"I'll get the 02." said Stoker.

Weak coughing got Roy's attention. The young woman in his hands was waking up.
"Easy.  Easy. I got you. Don't try to move around too much, you've been in a fire."

"Oh, *gasp* I-I tried to-... but I- *cough* They- *choke*" blinked the woman groggily.

Johnny scrambled over to her side with the resuscitator mask. "Here, breathe some
of this in. It'll help you wake up a little faster. How's your head?"

The woman didn't reply, and she started shivering. Mike Stoker began to cover her
up with a shock sheet. Her limbs began to twitch, and she groaned, lapsing half
unconscious again.

Roy gripped the sides of her face, making sure to keep her neck still, in the same
position he had found her in. "Hey, can you hear me? Open your eyes!" he shouted

The woman only choked weakily. Johnny began to ventilate her when she didn't
breathe in adequately to his liking when she fell still again.

"I got a bad feeling about all this." said Johnny as he inserted a short oral into her mouth.
"How much do you want to bet that somebody's still inside the house? You can let
go. I got her." he said, repositioning the demand valve over her nose and mouth firmly.

Roy looked up from where they were working.  "Hey, Cap! We think she's not alone!"
shouted DeSoto as he pulled out a stethoscope from the I.V. box.

From the street, Hank looked back and nodded. "Chet, drop your line and get into scba.
Truck 127 can take over on that side as soon as they get set up!" he said as he heard
sirens approaching. "Search the house!"

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Chet Kelly ran for the engine and the storage compartment. He also grabbed out a
safety line. He got into his air bottle and tied the end of the rope over his waist belt.
Captain Stanley left the street and ran with him to the open door of the hot, rapidly
burning house.

"Make it fast."  Stanley told him. "I don't know how much longer that roof will hold."

Kelly smiled through his mask.  "Time for another race? I'm up for it today."

"I got your back. Go ahead. And keep your HT on at all times." Captain Stanley
patted Chet on the shoulder and told him he was set to enter. Cap picked up
Kelly's line and wrapped it around his gloved wrist.

"Whatever you do, don't let go, Cap. Keep feeling for my tug." Chet said as
he disappeared into the smoke.


Inside the house, flames and burning wood crackled all around him. Chet
was reduced to feeling his way around on top of the steaming, incinerating
carpeting crawling on his hands and knees.  He began shouting.  "Hey, can
anybody hear me?!"

The heat was intense. Instinctively, Chet chose the first hallway to the
right. Kelly shouldered his way through the next door, using the weight
of his bottle as a battering ram. Immediately, he heard the cry of an infant.
And the groan of an older male, to his left, inside the bedroom.

"Get us out!  Help us! Please. *cough* *cough*" croaked a grandfather.
In his arms was a wet blanket wrapped around a tiny baby boy. "He's
hardly moving anymore."  

Kelly reached for him. "Can you follow me out?" he said as he set his mask
over the baby's face.

"I-I think so." he replied blinking sharply in the smoke.

"Who else is home?!" Chet demanded, gripping his arm.

But the older man didn't answer him, deafened as he was by the
din of the flames.

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"Okay, stick close behind me. We're going out the front door!" he promised
him.  "If you get lost, just follow the rope until I come back for ya." Breathing
heavily, Chet brought his HT up to his face. "HT 51 to Engine 51. I found
two victims. We're on our way out the front door now!"

##Any others?## asked Cap.

"I'm not absolutely positive. An adult male senior's too shaken up to answer
much." replied Chet as he curled protectively around the baby.

##Make tracks then. I've got Mike waiting outside with plenty of oxygen.
Hurry it up a little. ##

Chet barely made the front door when a sudden collapse nearly pinned him on
the porch. Captain Stanley had to literally pull him clear by the arms.

"Next time, hurry when I tell ya to hurry." Hank grumbled at him.

"Thought I was hurrying. Maybe it's just a faster fire." he quipped.

Hank had to grin as he helped his man back onto his feet.

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DeSoto looked up after he had fastened the last strap on the young woman's
C-collar. She was awake now, and crying. He saw a commotion at the front door
as Chet and Stoker met each other and traded off a baby and an old man to
other firefighters. "Johnny, it looks like we're getting an infant, too."

Gage's head snapped up from where he was starting an I.V on the girl. "Wha- Uh,
okay. This is done. Brackett wants her head elevated if she's not feeling any
pain past that forehead."

Roy nodded, quickly finishing his notes. "I'll relay their vitals sets to Rampart
as soon as we get them. Cap, could you watch her for a minute?" he asked
127's head fireman.

"Sure." he replied, and he moved to squat near the blanketed girl as he
supervised his men under a watchful eye.

Johnny rose to his feet and intercepted the soot covered grandfather. He
was walking well, but smoke had made him hoarse and unable to talk. Gage
sat him down, and got him into an oxygen mask. "You okay?" he asked him.
The silver haired man nodded gratefully, leaning up against a tree.
"All right. If you get dizzy, just let that fireman right there know, and he'll
help you lie down onto the ground before you faint." he said, pointing
to Marco, who knelt behind the old man to monitor his condition.

The grandfather was fidgety, his eyes alarmed, and the firm grip that he
had on his crying grandson's blanket, tightened a bit when he saw
the woman lying on the ground.

Roy smiled, seeing a family resemblance. "Hey, don't worry about your
daughter, she's doing fine now. It sure looks like she did everything she
could to get the two of you out of the house until we got here." he told him.

The old man started weeping when a neighbor rushed up and held him
close in comfort. DeSoto gave her a gauze pad to tend to his minor scrapes
and spark burns.

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"Relax, sir. You can keep holding the little guy if you'd like." DeSoto told the
grandfather. "Here, take this, and hold it over his face while I check him
out.  Mister? Really, he's okay. His color and reactions are sittin' real good."
DeSoto said as he showed the older man how to hold the tiny pediatric
oxygen mask in his gnarled fingers for the fussy baby to use.

"M-Marsh-a..?" the old man rasped, coughing.

"Is that your daughter's name?" Roy clarified, pointing to the younger

The grandfather nodded, trying not to jostle the baby as Roy gently
pulled off the infant's clothes to look for hidden injuries. He found a word
embroidered on his pajamas. "Is this Joshua?"

Again, the nod.

"He's big for his age." DeSoto said. "What is he, about three months?"

Panting, the grandfather held up two fingers, closing his eyes in relief
as the oxygen he was on started working to alleviate his shortness
of breath.

"Okay, I'm going to take his blood pressure. Then I'll get yours
right afterwards. Keep resting a bit. Are you feeling any chest pain
at all? Any other discomfort?" Roy probed.

The tired man shook his head lightly as he accepted the grip Marco gave
one of his hands when Lopez started taking his pulse.

"Okay." DeSoto replied, beginning his secondary survey on Joshua.
The baby's eyes tracked his easily and he made a disgusted face when
Roy wiped away a ball of mucous from his nose with a gauze pad. He
let DeSoto know about how angry he was with a loud squawl. "I'm sorry..
Wow, a great pair of lungs. I promise I won't do that again." he teased
the grandfather.

Nearby, Marsha was slowly seated upright with Johnny's help. "H- How's my
son doing? And Pa?.. T-They were both in there a long time." she gasped.

"They're better. Now, how much do YOU remember happening? We
found you unconscious, lying in the front yard." Johnny told her.

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The woman flinched when Gage started wrapping the gaping wound on
her head. "Everything. Uh, that is, until right up to when the explosion happened.
Oh, Pa, I'm so sorry. I knew I should have had that furnace fixed the minute it
started having trouble lighting up. Dan's gonna kill me." she said, trying
to see around the collar she was wearing.

Gage smiled at the interchange and the mention of an irate husband.
"Was it just the three of you at home?" he asked, getting Cap's glancing
hint to double check that fact at once. "Nobody else is still inside that fire,

"Yeah... yeah. No one else. My husband's at work." Marsha said, then she
watched as the roof of the house caved in slowly, getting eaten by tall
flames. "Oh, no. And we just built that house two years ago." she winced,
more at the collar than at the headache that was just beginning. "This, is
gonna cost us... a fortune.." she puffed in dismay, tearing up again. "Oh, my
eyes. I can't see very well."

"Is your vision being effected?" Gage asked her.

"No, I...It's I just got soot in them, that's all."

Roy smiled."We'll take care of that and rinse them out for you. Won't
take long."

"All right." Marsha said. "But I'm still not happy." she frowned.

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"Insurance is great nowadays. I wouldn't worry about it." Kelly said,
taking off his scba gear. He jogged off to grab a hose behind a team from
127 to help them out with their frontal attack.

Stanley turned away, satisfied. He lifted his radio. "L.A., This is Engine 51.
All units out one hour. Respond an ambulance to this address, Code 3.
And please send a second for our fire as a stand by."

##Engine 51.*Spap*##

DeSoto got on the biophone. "Rampart, this is Rescue 5-1. How do you

##Reading you loud and clear, 51. Has your female patient's status

"That's affirmative, Rampart. Conscious, alert and oriented time three. We
also have two new victims, rescued from a burning house. Victim Two, an
infant male aged two months, suffering from mild to moderate smoke inhalation.
Pulse is 140, respirations are 30, emotionally distressed. No burns are evident.
BP is 92 over 50. Victim Three is a male, in his mid to upper sixties, conscious but
mildly dyspneic, with signs of vocal hoarseness from exposure to wood smoke.
He has numerous minor cuts and abrasions about the face and neck. Vital signs
are: BP is 152/110, respirations are 20, pulse is 122. Both victims are on 15 liters
of O2." reported DeSoto.

##10-4. On Victim Two, if he's showing signs of dehydration, go ahead and inject
a normal saline bolus of 20cc I.V., monitor him closely for signs of increasing
breathing difficulty. On Victim Three, I want an EKG strip, Lead 2, that's strictly
precautionary given his apparent age and current condition. Start the adult male
on an I.V. D5W, TKO and continue to monitor his vital signs in transit. Get a
full medical history on all three. What's your update on Victim Number One?##

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Johnny took the phone from Roy. "Rampart, she's talking coherently and not
complaining of any neck or back pain from her fall to the ground after getting
knocked out by that flying debris. Shall we keep her in the collar?"

##That's affirmative, 51. We need to x-ray her first to rule out any possible cervical
spinal injury that might be associated with her recent concussion symptoms.
If she refuses a spine board when the time comes, that's her choice. Document
everything she decides from here on out concerning any further medical care, in
detail.## said Kel.

"10-4. Documentation, Victim One. 20 cc bolus N.S. for Victim Two on signs of
dehydration, Victim Three, send a strip and an I.V. D5W, TKO. This is Lead 2,
Rampart.." said Gage, adjusting a dial on the biophone after Roy completed
setting up the connections. "Reading.. mild sinus tachycardia with minor ST
segment elevation." he reported.

##I concur, 51. No gross ectopi in evidence. That's what I was looking for. Okay,
go ahead and transport, Code 3, for all.  What's your approximate time of arrival?##

"Six to eight minutes, Rampart." Johnny told him. "Once they're loaded up."

##Sounds good. We'll be waiting with a pediatrician and a respiratory specialist
for the baby.##

"10-4, doc. Squad 51, out." said Gage, hanging up the phone. "Okay, let's go."
he told the others surrounding him.

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A piercing whistling got everybody's attention. It was Cap, grinning from ear to ear.
"Hey, look! At least somebody's having fun here today!" he shouted, pointing.

Roy, Johnny and their patients spied a straying neighbor dog, who was dead set on
conquering the fallen garden hose's water stream, completely obvious to anything else.

Kelly crowed. "Good boy, good dog.. Bite the water. Come on, go get it!" he encouraged
the ferociously playing canine. "Man, Cap, we oughta recruit him. He's quite the fire
dog already." Chet quipped, giggling like a banshee. "Look at him go!"

His mood, was infectious and the rest of the afternoon's cleanup, seemed like nothing
at all, afterwards.

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From: "patti keiper" <>
Date: Thu Jul 5, 2007 6:31 pm
Subject: Water Versus Salt..

It was early evening.

Joe Early silently met with Kel Brackett at Dixie's desk and
together, they mutually nodded at each other without speaking
to meet inside Kel's office on a consultation. A very special one.

Kel wasted no time in grabbing the patient files that Joe
handed to him that he himself had just retrieved from the
heliopad paramedics who had been returning Mike Morton
from his concluded surgical procedures at Mercy General back to
Rampart's own ICU unit.

Kel was impatient. "What did they find on his arrival?"

Joe read an entry on the top file.
"He was doing fine then, Kel. His saturation while on
supplemental oxygen and continuous positive airway
pressure was 98%. Eyes normal.  Pupils equal and
reactive.  Neck supple.  Heart regular.  His lungs had
spontaneous respirations with the same bilateral wheezing
and rales that we had noted earlier. A good air exchange.  
His abdomen still presented as benign. And all of his extremities,
even with that humerus fracture, had good pulses and perfusion.
He came through the surgical repairs with flying colors."

Brackett's face was iron. "Well, then, what the h@ll happened?" he

Joe's face was as tortured as Kel's. "Kel, your guess is as good
as mine. According to these records, Mike's cardiac and pulse oximetry
monitors were placed. A Foley catheter and nasogastric tube were placed.  
200cc of fluid was evacuated from Mike's stomach.  His initial
arterial blood gasses were:  pH 7.11, pCO2 27, pO2 140, bicarb 9.  
Electrolytes were: Na 125, K 4.0, Cl 92, bicarb 11. His glucose
wasn't grossly abnormal at 245, considering the stress he was under.
His white blood cell count was 29,500 with 5% segs, 1% bands, 92%
lymphs. Again, a directly related outcome brought on by the stress of the
rescue. But most conclusively, he wasn't bleeding out like we all thought.
His Hgb was rock solid at 12.3, Hct 35.8, and his platelets were a healthy

"Joe! Somebody went wrong somewhere on spotting this and I want to
find out exactly who was responsible and how this clearly developing
adverse condition was missed!" Brackett roared.

A knocking at the door interrupted them.

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Startled, Joe quietly shut Dr. Morton's files and placed an opened newspaper
over the top of the stack so the name wasn't visible.

It was Dixie. She smiled falsely, knowing that she had barged in on
something else very serious. "It's Roy and Johnny, fresh off another fire.
They're asking about Dr. Morton. So,..will you tell them? Or shall I?" Her
eyes flashed additional warning.

That sobered Joe and Kel right away. Brackett's face twitched. "We'll
both see them, ourselves. They played a very active part, Dix." he said softly,
leaving McCall alone with the files. "I don't want them to have to learn about Mike's
current status on their own. It wouldn't be right. Somebody would tell them
eventually, and they'd do it in the worst way possible. It's better if Joe and I break
the news first."

"Want me to come?" asked McCall gently, fingering the edge of the hidden files.

"It's your call." Brackett said, lightly rubbing her arm to comfort her out of tears.
"I won't force you to do anything that you don't want to do."

Dixie said nothing directly, but she went out with the two doctors, leaving the
office door to swing soundly shut.


"Hiya, docs.. Dixie..." beamed Johnny. "Man, did we kill two birds
with one stone. A family saved in the afternoon, and a whole
apartment complex this evening. We're batting a thousand!"

Roy's smile was equally joyful. "Yeah, and in the end, nobody got

The two paramedics laughed openly and long, until they saw the
fallen expression on Dixie's face and the glimmer of unshed tears.

The two grins on DeSoto and Gage's faces wiped off suddenly,
sharply, and the change almost injured the two doctors standing on
either side of Dixie.

Finally, Johnny spoke into the silence, "What..?
Uh, is this about Dr. Morton? Dixie, why are you so upset?"

Roy broke in, nervously. "I mean, he is all right, isn't he? The surgery
at Mercy was successful?"

Quickly, the doctors nodded their heads in the positive. "The surgery
went fine. Uh, just fine." said Brackett.

Roy was firm, even though his face was blank. "Well then, why the
long faces? If there's anything that you gotta say, why don't you just
come out and say it? We're both big boys nowadays playing around
with fire trucks and all." he tried to joke. "If it's serious, we won't--"

"It IS Mike." said Dixie. "I'm afraid he's the one in seven, Roy."

Gage voice was muted, almost flat. "W-What exactly do you mean
by that statistic. It could mean just about anything." he flared, getting

Dixie sat down on her desk stool. And Brackett and Joe leaned over
the counter top. "Keep your voice down, and I'll tell you. Everything."
Kel said, defending her.

Roy pushed away the coffee cup that suddenly didn't taste good to him
any more. Johnny did the same, whirling, until his back was to Kel and
Joe as he listened. He cocked the actively chattering HT onto a
shoulder for some moral support and he bowed his head when Dr.
Brackett began speaking.

"When he was driven to Mercy, Mike was treated with sodium bicarbonate
for his metabolic acidosis, aerosolized albuterol for that wheezing you
two found, and... furosemide for newly developing pulmonary edema."

"Secondary drowning?" Johnny quailed, turning back around. He set
both hands on the countertop to steady himself.

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Joe hung his head and played with the silver rings on his fingers. "The
latest CXR shows small patchy basilar pulmonary infiltrates and he's
deteriorating rapidly as his PE and small airway dysfunction, worsens.
If we can't halt the atelectasis and loss of surfactant in his lung tissues,
there may be an even worse pulmonary inflammatory response 24-48
hours after the initial insult." Early said sadly.

Gage's mouth flopped open. "But we-- we got to him fast, doc. Very fast.
H- He never quit breathing on us." he insisted.

Roy thought hard on the prospects. "Sometimes, it only takes a
mouthful, Johnny." he said, his eyes stinging. His eyes fell on Dixie, who
stood ram rock still. She was trembling. "What else aren't you telling us?"
he asked in a whisper.

Brackett finally got mad, a silent, raging, barely reined in fury at the facts.  
"Hypernatremia may occur if enough salt water has been swallowed."

Roy angled his chin. "What's that? I-I've never even heard of that before.
Is it something we might see on the str--?"

"No, Roy. Never on the street. Only later in near-drownings that have
had the luck of reaching the hospital in time, though a fat lot of luck that'll
prove to be." Brackett growled. "This condition can cause cerebral
edema, renal failure, infection, disturbance of electrolytes, acid/base
imbalance and decreasing lung function. Treatment is mainly aimed
at preventing cardiac arrest."

Gage was calm now, listening close. "What do you mean...cardiac arrest?
Morton's EKG was fine!"

Brackett crumbled and couldn't talk, instead, he busied himself with
straightening up patient slates that didn't need to be straightened.

Joe did the talking. "In salt-water drowning, aspirated water is saltier
than body fluids. So water leaves the blood and enters the lungs to
help dilute the salt."

"We know that part, doc. That's why we bring em in so fast, right?" Roy

Early nodded. "But sometimes, the air in the lungs mixes with the fluids
and forms a frothy foam, which acts as a barrier to oxygen exchange,
this rare side effect can occur within four hours of near drowning and
can turn into full blown ARDS soon after."

Gage closed his eyes in horror and sadness. "Acute respiratory
distress syndrome? Is that what he's got going on right now?"

Kel finally looked up and met him in the eyes. "I'm afraid so. Things
aren't looking so good."

"How so, doc? I mean, if it's just a matter of outwaiting the fluid
build-up in the lungs..." Roy began.

"It's more than that, Roy, much more." said Dixie.

Joe elaborated. "A patient will often require intubation with
mechanical ventilation. And Mike was already on assisted P.E.E.P.
because of going through his back and upper arm procedures. His
ARDS has progressed to the point that inflammatory membranes
are forming around all of his aveoli sacs. Right now, he simply
can't breathe through his lungs normally and get enough air. He's
requiring very high amounts of oxygen and pressure to get that
oxygen into his tissues which in itself can further damage the lungs

Roy sighed, a painful sound. "...barotrauma and oxygen toxicosis."

Joe nodded. "Once a person gets ARDS, the mortality or death
rate is upwards of 50%. ARDS can be caused by many things besides
drowning such as smoke inhalation, other serious infections like
aspiration pneumonia.."

Kel added more. "This is a pathway that any pair of
damaged lungs might eventually take. Anyone who actually recovers
from ARDS can easily be considered...a- a miracle." he sobbed.

Gage struggled to talk. "Well, can.. can we see him?"

Roy nodded, chewing on a fingernail nervously, whole heartedly
agreeing with Johnny with a like nod.

"Sure. I can't stop you. In fact, I'll waive all visiting hours for the both
of you." Brackett told them. "You can come see him anytime you want.
In fact, I'm personally not leaving his side, until all of this is over."

Dixie came over to Brackett and kissed him on the cheek before
she hurried away to hide her growing fear with the numbing distraction
of work.


The ICU room was full of noise, with the sounds of ventilators, EKG
and blood oxygenation monitors and a bubbling humidifier attached
to the wall.

Johnny and Roy were almost reluctant to enter, but Kel went right
in and started a running strip off the heart monitor. "So far so good.
He's still a little tachy and hypotensive, but we've managed to stave
off any serious arrythmias with a course of bicarb to minimize
his metabolic acidosis." he explained.

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Gage took advantage of the doctor to paramedic talk.
"What else are you doing?" he asked, his expression flat and
calculating as he ran all the facts he was gathering from the
machines through his head.

Kel frowned. "We've started another I.V. slightly less than
maintenance to prevent further pulmonary compromise. And
I'm considering antibiotics for his aspiration of contaminated

Johnny pointed to a lab result sitting on Mike's table tray.
"But what about this? He's up to 34,000 now."

"That leukocytosis is a common stress response and is
not indicative of infection." Brackett told him evenly. "It's too
soon to see signs of that yet."

"Why the bicarb?" Roy asked. "He never arrested."

Kel was frank. "As Mike's oxygenation improves, his acidosis will also
resolve, hopefully. And his heart will become less and less likely to
stop as time goes by. We've placed an NG tube to prevent
aspiration and to keep the stomach decompressed. Excessive
contents could elevate the diaphragm and restrict thoracic volume.
That bicarb was just to hurry the process along a little faster."

"More space means more breathing surface.." Gage reasoned.


Roy circled the bed, not resisting the urge to feel for Mike's thready
pulse at one of his wrists. "Is there anything you can do for that rising
hypernatremia? He swallowed an awful lot of seawater. How will it
effect him if you can't get his blood saline levels back down to normal
right aw--?"

On the bed, Morton's body arched into a seizure, upsetting the
endotracheal tube's connection to the automatic respirator. Johnny and
Roy threw themselves at his head to steady it long enough to connect
an ambu bag to the end to keep manual breaths going into his lungs.
DeSoto hit the crash cart code blue button on the wall with his elbow.

From out in the hall, Kel heard the sound of nurses and the attending
running towards them down the corridor.

##Code Blue. Code Blue.. ICU 4. Code Blue..## came the overhead
announcement from the operator.

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Kel held both of Morton's arms as he lowered the bed to level with
a foot pedal. "Johnny, get 10 mg diazepam! Stat. It's in the crash cart.
Top shelf!"

"I got it.." said Gage, hurrying to bleed the needle of air. "Where? ET
or I.V."

"I.V... Push it. We have to end this seizure now." snapped Brackett.

Intently, Roy and Brackett watched the cardiac monitor as a crush of
premature ventricular contractions began to intercede in between the
normal intervals on the monitor. "No.. Mike.. no.. Settle down.." Kel
muttered under his breath as Gage delivered the powerful sedative.

Emergency staff flooded into the room and jumped at every order Brackett
gave them. A minute later, Morton fell out of his seizure and his chest began
to rise in response to being ventilated actively. "He's set, doc. Where do
you want the P.E.E.P.?" Johnny said urgently, still squeezing the ambu bag
connected to Morton's breathing tube. "His PO2 is 86% on the oximeter."

"Set it at 5-10 cm of positive end expiratory pressure." Kel ordered.

"Got it." said Johnny. "Seven cm, at twelve a minute."

The noise of Morton's racing heartbeat on the audio alarm began to slow..
140, 130,..100.

Brackett ordered more labs. "I want a urine osmolality and sodium levels asap.
And call up a radiologist. I want a full head CT and imaging MRI study done
once the labs are collected."

"What caused that convulsion? He was calm, resting.." said Gage when Morton
was stabilized.

Kel sighed, still sweating from every pore. "Acute hypernatremia often results
in significant brain shrinkage, causing a stretching of bridging veins and arteries
between the two cerebral hemispheres. This can result in subdural hemorrhaging."

"A stroke?" Roy asked incredulously.

Kel simply nodded, keeping an eye on the oxygen percentages reading off of
his friend's central line.

"How high can the salt get before it does permanent damage?" asked Johnny.

"Serum sodium levels of 150-170 mEq/L usually indicate dehydration. That
we can fix. Anything over 180 mEq/L results in permanent CNS impairment."
Brackett told him. Kel drew out a syringe from a special drawer in the crash
cart that they hadn't used.

"What's that?" Roy asked.

Brackett's face was intent and lost in hard thought.
"Possibly the only thing that might save Mike now. I'm giving him Vasopressin.
5-10 Units I.M. SQ three times a day, as needed. Duration of action is
approximately 3-6 hours. This will bring out more water from his body cells to help
carry that excess salt so it can be excreted out of his kidneys more rapidly. A
short half-life lessens the risk of acute water intoxication and this makes it the ideal
treatment for him."

"And if that doesn't work?" Roy asked.

"We'll try a combination of diuretics and a D5W infusion. If that fails, I'll risk dialysis.
On second thought, Johnny, start him on a 250 ml/h drip D5W. Let's not wait for
that piggyback aid."

A half an hour later, Roy, Kel and Johnny were still working over Dr. Morton
at his bedside, when the tones went off.

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Click the a-fib strip for a music soundtrack change.

From :  Cassidy Meyers <>
Sent :  Friday, July 6, 2007 6:34 PM
Subject :  Cause and Effect..  

##Squad 51, with Engine 51. Respond with L.A.P.D. at
the amusement park. Unknown type rescue. 1780 Santa
Monica Boulevard. 1780 Santa Monica Boulevard. Cross
street, Caine. Time out: 20:22.##

"Doc?" Gage asked.

"I'll keep you posted." said Brackett, as he looked up
from where he was listening to Mike's breath sounds with
a stethoscope. "Thanks for all your help."

"I'm glad we were here." said Roy as the two of them
started for the intensive care room's outer door.  

"So am I." said Kel. "Would you send Dixie in? I need her."

"First thing." said Gage, he lifted his handy talkie.
"L.A., Squad 51. Responding from Rampart General Hospital."

##Squad 51.##

The two paramedics departed reluctantly.

As they hurried through the busy halls, weaving in and out of
the crowd of patients and staff for the Emergency entrance, Roy
bit his lip. "Boy, I sure hope Dr. Morton makes it."

Johnny was sharp. "Quit being stupid. What makes you sure he won't?"

DeSoto hit the open button on the receiving door. "Might be a feeling."

"Yeah, well. It's a paranoid one if it's anything. You saw the way
Brackett was going over him with a fine toothed comb. There's no way
he can take a turn for the worse again, without his knowing about it
the very same instant it happens. Kinda like how it happened, just now,
for us."

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DeSoto didn't reply and his look spoke volumes. "I hope my instincts are
very wrong, Johnny. But he felt like he was dying to me."

Gage slammed his door shut as they both got into the squad, and hesitated
in putting his helmet on, even as Roy flicked on their lights and sirens to pull
away. "Don't say that. Not while he's still got a pulse." he murmured softly.

Roy nodded, angry with himself and he pulled them quickly away from the
hospital proper. Rampart staff parted like the Red Sea before the squad,
but DeSoto didn't see any of them in his eyes. All he could see was the
bluish pallor that had been encircling Mike Morton's mouth while they were
resuscitating him.


"Cap?" Roy hollered as they two of them got out of the rescue squad
newly parked next to Engine 51's big bulk.

"Over here. And keep under cover!" Hank warned them.

Immediately, Johnny and Roy hugged the back of the carnival games
booths, as they approached keeping low as they moved towards the
sound of his voice.

"Now what?" Gage snapped in irritation, trying to keep quiet with their
medical boxes as their handles and locks jingled.

Hank heard his paramedic and ran over to join them. "Bomb threat."

Johnny was dismayed. "Oh, terrific.." he said sarcastically. "Are we
here to evacuate?"

"The police have already taken care of that. The Bomb Squad's here,
with their sniffer dogs. They're looking for a device that might be located
somewhere on the pier."

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Roy rubbed his chin around his helmet strap. "What tipped them off?"

"An anonymous pay phone call." Cap said, dripping displeasure. "Placed
about twenty minutes ago."

"And we're the standby in case that thing's real, and goes off?" Johnny asked.

"You got it." said Kelly, looking small as he crouched behind a solid
pier piling. "The dock's been cleared up to where you see them making
their move." he said, tossing his curly head into the specialists direction.

Cap sighed. "Stoker. Go charge up a line, just in case."

A dog, under one man's leash, began to whine, straining as it approached
a large, chained down wire basket full of trash.

"Everybody down!" yelled the detective in charge. "Spike's on point!"

Gage couldn't resist, and he peeked around the corner of the building
from under the edge of his tipped down helmet rim. "They're about
a hundred feet away from us. Out in the open. Right in the middle."

Cap and the others took a caution look, too.

Hank beat him to his next thought.
"Do you think those bullet proof vests and shields are tough enough to
decently protect those men?"

"No." said Chet.

Gage glared at Chet in irritation for jumping in. But he soon sided with Kelly
wholeheartedly. "I have to agree with Chet. They look as thin as tissue paper,
even from over here."

Roy made another observation from where they all pressed against the
building, holding their breaths in silent waiting. "Their legs and arms are
completely exposed. If they get nailed, any bleeding'll be arterial beyond a

"Don't get morbid." said Cap to DeSoto.

"I'm not. I'm just being a paramedic, anticipating the worst, so I'll be better
prepared." Roy said seriously.

"Ignore him, Cap. He was doing the same thing at the hospital after we
visited Dr. Morton."

Cap brightened, in spite of the situation. "Oh? How's he doing? Is his
back okay?"

Johnny cleared his throat nervously as the excited dog was cautiously
backed off and re-crated. "It's too soon to tell. Right now, they're
concentrating on stabilizing his condition first."

"Stabilizing?" asked Marco. "Did something bad happen?"

Roy sighed. "Mike had a convulsion. Brought about because of a metabolic
imbalance due to a large ingestion of seawater. But he's sedated now,

Johnny added more."Guys, they're evaluating him for the possibility of having
suffered a stroke. They're suspecting the seizure was the first symptom of that."

"What?" Stoker whispered. "But Dr. Morton's healthy. I thought he was just
a little banged up this morning; nothing that couldn't be fixed easily."

"So did we." said Gage. "But apparently, those horror stories we always hear
about on the perils of drinking seawater, are true."

Stoker was quiet. "What are his chances?"

Roy shook his head minutely. "I don't know. Dr. Brackett doesn't know either.
And that's got me real scared. He's not leaving Mike's side at all. You should
have seen the look on his face as we left, guys. It was--"

Johnny watched as two of the senior bomb squad members advanced on
the open wire waste basket with a shrapnel shoulder yoke bucket and thick
pairs of gloves and leg guards. "You know, I'm really starting to regret every
bad thought I ever had about Dr. Morton. His gruff bedside mannerisms
aside, he definitely is a good doctor now that I really think about it." he

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The others didn't say anything. They didn't need to, each were lost in their
own thoughts.

And that's when it happened.


"Pipe bomb!" yelled the detective, running out from behind his sheltering wall
as he watched his two bomb defusing men fall. A cloud of nails and a plume
of incinerated propellant coned up around their upper bodies as blast shock
took hideous effect.

Hank yelled. "Safe?! Is it safe?!"

"Yeah! Get 'em in there!" shouted the detective.

Galvanized into horrified action, Roy and Johnny ran for the smoking officers lying
on the boardwalk. Their hands were raised and fingers frozen, both reaching out in a
rictus of pain. Their legs and arms were throughly porcupined with embedded nails
and screws. The garbage basket itself was flower petaled open, all of its fresh
trash and papers burning with other falling cinders, igniting wood planks all around
under a flaming soot fall.

Cap snapped out orders. "Mike, Marco, get that inch and a half and put out
this fire." He hefted up his walkie talkie. "Engine 51, L.A. Our bomb has exploded.
Hazmat danger zero. This was a low-order. Fire containable. Two victims down.
Send an additional squad and a beach helicopter for air-evac. Stand by for our
patient status in five."

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Click the ambulance
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  The Long Hours
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