Time Enough for Love
By Philip Eggerding aka Cirrel - former EMT
With apologies to Robert H. Heinlein for using his book title.
The accident happened during one of those wild winter storms that claim a few victims before quickly blowing themselves into a cold memory. We get a few of them every winter. I've been a paramedic for over 11 years now, and I've seen worse, but I will never forget what happened that night, and how hard my patient fought to see her family.
One last time.
Grove City Paramedic Station: 4:16pm
"Fergus, you lazy excuse for a live body, get your flatulent carcass out here! With the weather the way it is, we'll probably get another call before I can play this excellent hand I have."
A silver wolf wobbled out of the station's ready-room toilet, still tugging up his white pants. "Hold your cojones, Carlo."
"I would, if my hoofed fingers were big enough," I called back.
"You know, for a horse, you sure act like an ass sometimes," quipped the wolf, zipping up both the tail hole and the front of his pants in one fluid motion. "I suppose you're not going to believe me if I tell you my cards are better than yours."
"No. I can always tell when you're bluffing because your tail twitches to the left."
I noted with a smile that his tail twitched obligingly to the left.
Actually, I could have told him it twitched to the right when he lied and his tail would have gone that way instead. That's because Fergus is real good at following directions. Give him a mapped-out medical protocol and he'll follow it to the letter, come hell, high water, blizzards, or screaming bystanders. I'm the one who can think 'outside the box' when the situation calls for it. Together, we made a damn good paramedic team.
Fergus sat down and picked up his cards. He glanced at them briefly before looking over at me. "So, are you gonna play the first card of your incredible hand, or are we gonna sit here till hell freezes over - which is a distinct possibility given how cold it is out there."
"In a minute," I murmured, concentrating on my strategy.
If I did this right, I could sweep him. My fingers went for the ace in the trump suit, but I never got the chance to play it because at that moment the call bell sounded.
"Damn!" I yelled, tossing my cards on the table. "That's the best hand I've had all shift!"
"Oh, good," replied Fergus. "I had crap."
"I know," I said, running to the call screen. "I can still smell it." I quickly read the report. "Looks like an accident on Highway 58 east of McCoytown. An 18-wheeler and a compact."
"Mange and Fleas! That's not good," yelled Fergus as he grabbed our cold weather gear, which was still wet from our last run. He tossed me mine, and I put it on as I jumped into the double axel all-wheel drive ambulance. Roads were too bad now for the lighter vehicles. In no time, we were zooming down snow covered Center Street, lights flashing and siren blaring. Fergus kept on the radio while I drove. We were patched directly into the state squad handling the scene, and Fergus began to pass me updates as soon as we turned east onto Main.
"How far east of McCoytown?" I asked.
"Close to the county line," answered Fergus. "About an eighth mile west of Township Highway 376."
As we headed out of Grove City on Highway 58, I wondered what the traffic would be like. Accidents attract onlookers, and some of them don't have enough sense to keep moving. I hate rubber-necking gawkers.
"Looks like we may have to do some cross-line driving," commented my wolf partner as we approached McCoytown. "The eastbound lane of 58 is clogged for about a mile east of the scene." I nodded as I sped through the dot on the map that was McCoytown. It was only a few moments before I could see the stalled traffic ahead and switched to 6wd. Then I slowed down and switched to the oncoming lane. The east-bound traffic was in no position to pull over, though some tried and would probably get stuck in the snow on the shoulder.
Fortunately we didn't have to contend with any oncoming traffic. Flashing lights through the falling snow told us we were approaching the scene on the right shoulder. As we drew closer I looked for the vehicles involved, but all I could see was the 18 wheeler.
Where was the compact?
Highway 58 Accident scene: 4:34pm
I pulled up next to a state police squad, set the brakes, and jumped out to assess the situation while my partner broke out the jump kits.
"What have we got?" I yelled to a coyote with a state cop uniform.
"The big rig slid into the back of the compact whose driver must have slowed down due to poor visibility."
"So where's the compact?"
The officer pointed to the 18 wheeler and that's when I saw it. Crushed beneath the front bumper of the tractor, almost out of sight, was a mass of metal.
"Scene's as safe as it can be," said the officer. "There's some leaking fuel, but..."
I didn't hear the rest. I'd just caught the jump kit Fergus tossed me and was off at a run. Fergus and I skidded to a stop in front of the rig's tractor just as an officer pulled himself from the front of the tractor's right front wheel well.
"One victim. She's alive, but you can only get to her through the passenger window and it's a squeeze. Roof's been flattened. We can't back the tractor off because the rear of the trailer is jammed against the guardrail, but we can't pull the car forward either. Looks like the rig's steering arms got caught on the car's rear roof supports when it rode over the top."
Fergus looked to me for orders. Like I said, he can follow medical protocol to perfection, but on-scene problem solving was not his strong suit. I went around to the right side of the tractor and poked my head in the wheel well. It definitely was a squeeze. I pulled my head out.
"Fergus, get the Jaws of Life and the big hydraulic jacks."
He nodded and was off. I poked my head back into the mass of metal and plastic. There was about an eight-inch space between the car's collapsed roof and the passenger window sill - just enough room for me to poke in my head and one arm. I grabbed the LED flashlight from my jump kit and pushed myself in as far as I could. Then I steeled myself and flipped on the flash.
Black, white, and red.
Colors are the first thing I see when I look at a victim. I don't know why. That's just what I do. Then the other details fill in. She was a skunk, perhaps in her mid 30s. A mist of frozen breath was coming from her nose and mouth so she was indeed alive. A pair of broken glasses lay on the passenger side floor. Her head was twisted toward me and pinned between the collapsed roof and the dashboard behind the bent steering wheel. The air-bag hadn't gone off - not surprising in a rear-end collision. Her right arm was bent around the automatic transmission lever - fractured no doubt from the angle of it. Blood matted her white hair, and blood leaked slowly from her ear. Incredibly, she was conscious and had an eye on me, following my movements.
"Ma'am, I'm a paramedic. I'm here to help you."
Her right eye blinked slowly in acknowledgement, but her left eye didn't move. I strained my head down farther to get a better look and let my flash play across her face. The left edge of her mouth drooped slightly.
Bleeding from the right ear. Semi-paralysis on the left side of the face. Pupil of the immobile left eye fixed and dilated.
She has a right-side basal skull fracture.
It must have happened when the roof collapsed and hit the back of her head. This was bad enough, but it looked like she had other injuries. Frothy, pink blood was bubbling from her mouth and nose. Reaching back and blindly fumbling in my jump kit, I located the stethoscope. First thing I needed to do was check her vital signs. I clipped the stethoscope leads into my ears and, taking the diaphragm, I stretched my arm as far as I could and placed the instrument on her bloody chest. As I listened, I heard two things - the crunch of fractured ribs as she struggled to breathe, and the swift, muffled beat of a heart slowly having the life squeezed out of it. For a moment, my own heart seemed to stop. A cold much deeper than the winter wind on my backside had taken a hold of me.
An injury to the heart itself could be bleeding into the tough sack encasing the heart, in which case the accumulating blood was slowly squeezing the beating organ into a smaller and smaller space. It must have happened when her chest rammed the steering column.
Taken separately, the skull fracture and the pericardial tamponade were survivable - if the victim got to the hospital quickly. Taken together, her chances of survival were not good at all.
Then I caught the look in her eye - the one that still worked. She already knew what I had just realized. She was hurt really bad. Most victims would have gladly passed out to avoid such a grim conclusion.
"Fergus!" I roared behind me, trying to suppress my growing fears in a flurry of activity. "Haven't you got those jacks placed yet?"
"Almost!" came the muffled answer.
Blood frothed from her mouth as the skunk began to speak. I squeezed in closer.
"Please, don't let them put me under... I want to see my family..."
A single, racking cough convulsed her, and pain twisted the right side of her face into an ugly grimace. That sort of pain can render a victim unconscious, but not her. I could only marvel at her determination to stay awake and hope it wasn't in vain.
"Don't try to talk, ma'am. We're working as fast as we can to free you."
She simply mouthed the words 'Stay with me, please?'
I nodded and gently grasped her shoulder. She winced, but the look in her eye was one of gratitude.
"Carlo!" came my partners shout from the other side of the tractor. "The jacks just squish down into the dirt when I pump them up. What do I do?"
I jerked my head up, only to bang it on the car roof. "Dammit, Fergus!" I yelled, shaking my bruised head as my vision sparkled. "For once in your life, use your own imagination! Get something to put under the jacks! And don't forget to put the blocks under the tractor frame after it's jacked up!" I looked back at the skunk. "My partner needs written directions and a map to take a dump."
I immediately cringed at my thoughtless comment. Flippant humor isn't normally a good thing to use in a serious accident situation, but amazingly, I saw her roll her good eye and try to grin. In the face of her pain and dire circumstances, she wanted the small bit of normalcy some humor could bring.
I could sympathize with her. Things here were far from normal.
Highway 58 Accident scene: 4:45pm
It may have only been five or ten minutes, but in an emergency everything feels like it takes forever. Finally, I felt the tractor move slightly.
"It's working now, Carlo," called my partner. "We're going to start jacking up the tractor."
"Okay," I answered and turned to my patient. "We're going to lift the tractor off your car, Ma'am. That way, we can pull the car away from it. There may be some shifting and loud noises, but we'll try to be careful." I backed out of the window, but kept her in view in my flashlight beam.
She blinked and croaked a few words. "Whatever happens, I must stay awake. I must see my family. I…"
But the rest was drowned out in a groan of metal. I saw the truck begin to rise. I also saw the back of the car still caught on the steering arm, lift with it. It rose about eight inches before the steering arm broke free.
It wasn't much of a jolt, but when the car hit the ground my patient screamed. It wasn't loud (she had no room to take a deep breath) but, I've never heard so much pain contained in a single sound. It physically hurt to hear it. Tears rolled down her muzzle, and her scream had sprayed blood all over the dashboard. Incredibly, there was no anger or blame in the look she gave me - just the bright light of total awareness. It seemed she would endure anything to see her family.
"We're gonna start towing the car forward, Carlo," yelled Fergus.
"One moment," I yelled back and turned to my patient. "I'll be here right next to the car, and I'll have my eye on you all the time."
I signaled to Fergus to begin. It was an agonizingly slow process. The smashed car didn't move easily or smoothly, but in a series of jerks - each one punctuated by a soft scream from inside the wreckage. I wanted to tear my eyes away from her agony, but I didn't. I'd promised not to.
Finally, the car was free of the 18-wheeler's tractor and I put my head back in the window. Steam rose from the fresh blood she'd sprayed on the dashboard. I also saw my patient's breaths coming in short ragged gasps. This didn't look good. "Fergus! Hurry with the Jaws! We need her out of this sardine can as quickly as possible!" I put my hand back on her shoulder. "Just a bit more bumping and grinding, and then we've got a nice, soft gurney for you to lie on."
I looked to Fergus. As I've said he's a wash when it comes to most problem-solving, but there is one exception. Maybe it's his carnivorous heritage, but he's a genius with the Jaws. He seems to instinctively know where the weak points are, and how a piece of mangled wreckage will react when it's cut free.
"I need someone to sit on the back of the roof there." He pointed. "Otherwise this top's gonna pop when I cut the front supports."
One of the state officers, a big equine like me, scrambled onto the car roof. Then Fergus got to work. First, he sliced the driver's side roof support nearest the victim. She couldn't see what was happening so noisily right next to her head, so I kept up a loud, running commentary on the progress to keep her calm. Then Fergus switched to the passenger side and I hurried to the driver's side and got ready.
Many things can happen when you release the pressure on a trapped victim - severe bleeding - unanticipated movement - and other things. With my patient, I was concerned about her breathing. Ironically, a chest injury with multiple rib fractures feels better when it's confined and supported. Once we released that confinement, her breathing was going to get a whole lot more painful.
"I'm through," yelled Fergus. "Let's peel this can." He and I put our combined weight on the front edges of the roof and Fergus signaled to the officer to slowly get off. Sure enough, as the officer moved I felt the roof straining to rise beneath my arms. Slowly, we let it up until it stopped about 8 inches higher than it was before. The whimpering from inside told me I was right about my patient's breathing. Now we had to hurry.
Fergus and I grabbed the roof and pushed up - hard. With a groan, it bent up and back. We now had what looked like a mangled convertible with its top halfway up. Fergus and I switched sides again, and he went to work on the driver's side door as I climbed into the passenger seat with my jump kit.
"Don't try to move," I told the whimpering skunk. "Let us do all the work."
I checked for any severe external bleeding, but saw only minor stuff I'd seen before. Most of her injuries were internal. Then I checked her wrist pulse on the right side. It was non-existent, but then I hadn't expected to find one. Besides the pericardial tamponade weakening the pulse, the fractured lower arm might have compromised circulation.
"No detectible right radial pulse," I murmured into the small device clipped to my jacket lapel. Thank God for these tiny video/sound recorders we had now. They recorded everything during a run, and that made writing the report later on, so much easier.
I checked the brachial pulse on the upper arm, since I couldn't yet reach the neck unless we moved her.
"Pulse 60, weak, irregular."
"Door's free," yelled my partner, and I tossed him the blood pressure monitor. It would be better applied to her left arm since I'd seen no evidence of a fracture there when I'd been on that side.
"B/P 145 over 125," he reported and started trying to move the driver's seat back.
These weren't the classic signs of shock which usually has low blood pressure and a fast pulse, but that was because head injuries do the opposite - high B/P, low pulse. The space of only 20 points between the systolic and diastolic blood pressures - the narrowed pulse pressure - was a classic sign of pericardial tamponade. Unfortunately, the two injuries were working against each other. Head injuries put more of a demand on the heart, which in her case, was in no shape to take on added responsibilities. Additionally, the injured brain needed more oxygen, something a chest with multiple rib fractures couldn't provide. Lastly, the elevated blood pressure caused by the head injury was increasing the rate of bleeding into the pericardium, worsening the pericardial tamponade - which made it even harder for the body to cope with the head injury.
I quickly checked her eyes again and saw to my horror that her right eye was becoming glazed. "Forget the seat for now, Fergus! She needs oxygen" I yelled, tossing him the cervical collar. "Let's do the neck. Then I've got to intubate her, quickly!"
I gently lifted the skunk's head and straightened it while applying traction. Fergus slipped on and locked the cervical collar. My patient's lack of reaction to this manipulation worried me, but I was going to use it to my advantage while I could. In her present state, she wouldn't much notice what I had to do next.
Grabbing the laryngoscope and a respirator tube from my jump kit, I hopped up on the hood of the car and lay down facing my patient. Fergus held her head by the cervical collar. Quick as I could, I popped the scope in her mouth, pushed the tube in as soon as I saw her vocal chords, and inflated the retaining collar. To my relief, my patient coughed only once.
"In and inflated," I said, and pulled the scope out. My partner attached the tube to the portable respirator machine in his jump kit and switched it on. The soft hiss and whoosh of the respirator started, and I saw my patient's chest begin to expand and contract. With pure oxygen flooding her lungs, it was only moments before her eye became clearer. Then she gagged a bit, and winced in pain. I hopped back in the passenger seat.
"Sorry about the respirator tube," I said, as she regarded me, fully conscious again. "It's a bother, I know, but it should be making your breathing a lot easier. You're feeling better now, aren't you, Kitten?"
Her eye shot open, and I realized my mistake. "Sorry. That was a slip. I call my wife 'Kitten'. She's a Honey Badger - a relative of you skunks and they do look a lot like you except for their gray stripes. It won't happen again. I'll just look through your things for your real name since you can't tell me directly."
I started for her purse which I could now see on the passenger side floor, but she was weakly moving her whole upper torso from side to side as if to say 'no' and was actually trying to say something around the respirator tube.
"Easy now," I cautioned as I grasped her shoulder to stop her. "With that collar on there's no nodding or shaking your head allowed. If you want to answer yes, give me one long blink. If no, two long blinks. Do you understand?"
One long blink.
"Now, can I look through your purse for your real name?"
She didn't blink, but again tried to mouth words. I looked closer and then pointed to her tentatively.
"You… want me to call you 'Kitten'?"
One long blink, and then a look of desperation flashed across her features. That gave me a clue.
"You like that name because someone who loves you calls you 'Kitten', right?" I said, softly.
Another single blink, and her look of desperation deepened.
"Now, can I look through your purse for your real name?"
She didn't blink, but again tried to mouth words. I looked closer and then pointed to her tentatively.
"You… want me to call you 'Kitten'?"
One long blink, and then a look of desperation flashed across her features. That gave me a clue.
"You like that name because someone who loves you calls you 'Kitten', right?" I said, softly.
Another single blink, and her look of desperation deepened.
"My wife likes it too," I said with as warm a smile as I could muster. "Alright… Kitten. I'll give the state police your things and they can find your real name and information. They'll see to it that your husband gets word from us when we get to the hospital, okay?"
She blinked once, and her look of desperation lessened.
"Ready when you are, Carlo," said my partner, who hadn't been idle. The ambulance gurney was positioned by the car, and Fergus had already slipped the extrication device behind Kitten's back. I strapped her in, being mindful of her arm fracture, angled her sideways, and in one smooth motion, slid her lengthwise onto the gurney.
It was time to get our 'Kitten' to the hospital.
Grove City Hospital Emergency Room: 5:21pm
"Make way! We've got an STC here!" I yelled as we banged our way through the emergency room doors.
I had 'prettied up' Kitten on the way here, and now she sported a fashionable air splint, along with several sleek I.V.s to compliment the respirator tube down her throat. Several monitors built into the gurney blinked brightly, and beeped musically.
In other words, Kitten looked like hell.
But she was breathing (thanks to the respirator), and she was still conscious and alert.
"Number 7 exam!" called out a cheetah nurse I knew, and I headed for it. When I entered, several nurses where already there, ready to assist the ER doctor, who I'd heard was Dr. Krank this evening. I was grateful for that. Doc Krank was an 'old school' doctor who actually treated patients like real furs. He could be stuffy at times with other staff (probably because of all the doctor jokes made using his name), but he was good at what he did with patients. He was a lion and his bearing usually inspired confidence.
"You can go now," indicated an otter nurse, doing shooing motions at me with her thick tail, but when I turned to Kitten I could see her blink twice, and she tightened her grip on my arm.
"Can't go," I said. "Looks like I'm too popular with the lovely lady here."
Developing an attachment to an initial rescuer wasn't unusual with severe trauma patients, and I had my CelComm if Fergus needed me. He was doing the post-run cleanup on the rig while I wiled away my time in here.
Just then I heard the exam door open and the nurse say, "Good evening, Doctor." With my eyes still on Kitten, I started to give a quick verbal synopsis of the case.
"Doc, we've got..."
"You will address me as Doctor."
My guts went cold and I turned around. It was Doctor Honel. He was a stoat - short and squat. He was also the hospital's chief medical officer, an admin type - and one of the most "my-shit-don't-stink" physicians I'd ever met.
"Where's Doctor Krank?" I blurted out.
Immediately, I saw this wasn't what he'd wanted to hear. He simply pointed to me and said "You. Out. Now."
Kitten was blinking furiously and holding my arm even harder. I bent down to her ear and whispered. "He'll be done in a minute. I'll be right outside the door."
I pried Kitten's paw off my arm, and stone-faced, I brushed past Dr. Honel. Outside the exam room, however, my equine muzzle turned into a very good approximation of a carnivorous snarl. Why had that pencil-pushing pig picked this night to fill some of his required medical practice time? I fumed and hoped he was a fast reader. I could have given him the essential information about this case in half the time.
It was actually two minutes before the gurney burst out of the exam room and two nurses pushed it down the corridor to the ER Lab. I caught up with them and Kitten latched onto me once more. I could see the lab orders clipped to the gurney and saw that Dr. Honel had ordered the correct ones - but then any first year intern could order up the standard trauma diagnostics for head and chest injuries. What scared me now was what that stoat was going to do with the results.
Kitten was running out of time, fast.
I stayed with her as long as I could, but this time it wasn't a doctor that threw me out. It was the machines. Staying in the same room with a running MRI/CT was dangerous. There were all sorts of energies running rampant in there, doing their invisible poke and prod on the patient. I opted to stay outside with the lab technician. I wouldn't have been able to fit in the diagnostic torus with Kitten anyway, and I think she knew that, because she let go of my arm more easily this time.
I took up a position behind the technician and was pleasantly surprised when both the radiologist, a beaver, and the internal medicine specialist, a ferret, showed up. Either one could have done an interpretation of the results, but two together would make sure nothing was missed.
Almost immediately the first image showed up on the monitors.
It wasn't good.
"According to this," mumbled the beaver, pointing a webbed finger at the head scan, "she's dead already."
"She's not dead!" I cried, surprised by my own vehemence.
The radiologist winced. "Sorry, I keep forgetting these images are from a live fur on the other side of this wall."
"What's wrong with that scan," I asked, not knowing if I really wanted to know.
"Ah. I see the problem now," continued the beaver as the scan switched to a different shot. "The angle of that last shot made it look as though she had a blood clot, directly inside her medulla - the breathing center. This shot shows that it's a sub-dural hematoma on the right side of the medulla. The result of this skull fracture here no doubt." He pointed again. "That will have to be managed quickly, if we want to insure proper breathing."
The ferret was looking at the charts. "Sub-dural hematoma is consistent with the vital signs she's been displaying. Surgery will have to do something...."
He trailed off, and I saw him flipping back and forth through the charts with a look of alarm. "Have we got the chest scans? Can we go to those yet?"
The technician punched a few buttons, and new pictures flashed on the screen.
"Damn!" mumbled the ferret.
"What? What is it?" I had the feeling my worst fears had just been confirmed.
He pointed to what looked like a fifth chamber on the heart.
"Bleeding into the pericardial sack. There's no evidence that a heart chamber's been breeched - she'd have been dead by now were that the case - so maybe it's a damaged coronary artery. Not a fast bleed, but we'll have to do something quickly about it too; otherwise she may go into v-tach. Looks like she's got some bleeding into the pleural space, as well. Damn! I hate these multiple..."
"Look here," said the beaver, interrupting, "on the anterior wall of the left pulmonary artery."
"God!" exclaimed the ferret. "It looks like there's almost nothing there. What could have happened?"
"It could have been partially torn during the blunt trauma to the chest or it might have been an asymptomatic congenital defect that was aggravated by the chest injury. In any case, it looks like it could blow out at any moment. Thoracic surgery will be very risky with that there."
The two doctors continued to chatter back and forth, but I wasn't listening anymore. I was thinking of Kitten and her desperate need to see her family. Did she already somehow know how bad things were for her?
"So what are you going to do?" I finally interrupted.
Everyone stopped and looked at one another. Finally the ferret spoke.
"Surgery is her only hope right now, but with all the problems and complications..." He sighed heavily. "Realistically, I don't think there's anything we can do that won't be as risky as doing nothing at all."
The silence that followed felt as cold as the winter wind outside.
Grove City Hospital Emergency Room: 5:54pm
We were back in the ER in one of the curtained off cubicles.
"How are you doing, Kitten? You feel a little better now that you've got a few pain killers working for you?" It had been a job convincing her that the low dose of pain meds wouldn't knock her out.
She nodded and tried to smile around her respirator tube. She could nod and shake her head again because they'd removed her neck brace for the diagnostics and hadn't replaced it. No need. There was no significant neck injury. Not that it mattered now.
"You need anything?" I asked for about the tenth time. I knew I was babbling, but I hadn't worked up the courage to tell her the results of her lab tests.
I know. Paramedics aren't supposed to brief patients on their injuries, but I doubted… no, I knew… Dr. Honel wouldn't tell her, even though it was his job. Damn! She had the right to know! It was her life!
I felt the lump in my throat grow bigger.
It's also her death.
I looked everywhere but at Kitten. How was I going to tell her? How…
I felt a tug on my arm and I looked back at her. Kitten's good eye was looking at me with an unreadable expression, so I was surprised when she mouthed three words.
'Am I dying?'
I let out a breath I hadn't known I was holding. I should know by now that patients are aware of a lot more things than we medical types give them credit for. She could see I was trying to tell her something bad, and the worst thing that could happen to her was her own death.
At first, all I could do was nod, but then I started telling her as gently as I could about all the things we'd discovered in the lab, and what the specialists' opinions were. I could see her listening, but it was hard to tell if she truly understood. Her expression was so… neutral. I was just about to tell her about the likely fatal outcome of surgery when the curtain flew open and Dr. Honel strode in followed by Nurse Nickols, a fox from the surgical ward.
The Doctor frowned at me, but couldn't throw me out this time since he wasn't here to perform a procedure. That would be Nurse Nickols job, if what I thought she was here for was true.
Dr. Honel came to the bedside and cleared his throat. "Yes, miss..." He seemed at a loss for Kitten's name.
So much for you remembering what's on her chart, Doctor.
He cleared his throat and continued. "Yes... Anyway, Nurse Nickols is here to prepare you for a much needed procedure I just ordered. I'm afraid there are quite a few boo-boos inside of you that need fixing."
Oh, Puh-leeze! I thought.
"Nurse Nickols will be giving you something now that should calm you considerably."
I turned to Kitten and mouthed the word sedative, and she released her grip on me. Then I saw her do something that should have left no doubt in anyone's mind how she felt about this.
She flipped Dr. Honel the bird.
The doctor's snout turned beet-red and he sputtered for a moment.
"Miss!" he finally managed to say. "Surgery is something you need, and the sooner, the better!"
I stood up. "It's quite obvious to me, Doctor, that she doesn't want to do this now! She wants to see her family first!"
"And it's quite obvious to me," spouted Dr. Honel, "that she's delirious. I'm the doctor here, and I say my judgment is best for her. Nurse, administer the medication!"
Despite the obvious pain it caused, Kitten was shaking her head violently now. There was only one thing left to do. I physically grabbed the nurse's paw that held the syringe.
"Before you do that," I said to her, "I have one more question to ask the good doctor." I turned on him, teeth bared.
"Doctor Honel! Is it possible, even likely, that this sedative will cause her to slip quickly into an unconscious state from which she will never recover?"
Dr. Honel sputtered again. "That is not a proper question to ask in front of the patient!"
"I disagree! It is a most proper question! In fact, it would be grossly negligent not to ask it in her presence! This is her life, NOT yours! Or have you forgotten about that in the thin air at the top of your ivory tower?"
"I will not stand for that kind of talk from someone like you!"
But I wasn't listening. I had turned back to my patient and was giving her the most serious look I could muster. Kitten needed to know everything now. And then she needed to make a decision.
This was the moment of truth.
"This sedative begins your preparation for surgery," I said slowly and clearly. "Surgery is you only chance now. However as I was about to tell you, the chances of surgery being successful are so small as to be nonexistent according to the radiologist and the internal medicine doctor of this hospital. The most likely outcome is that you will die before ever regaining consciousness."
I noted Dr. Honel wasn't disputing me. He couldn't. All of this was a matter of record. I steeled myself. This was what it all came down to.
"Kitten, do you wish to be prepped for what most likely will be deadly surgery before your family arrives?"
Kitten stared at me. I silently cursed my need to be heartlessly blunt, but she had to decide now. There was no time left. The blood pounded in my head as the silence wore on.
"You see?" grunted Dr. Honel from somewhere behind me. "She's incapable of making a decision! You will allow the nurse to administer it!"
"Do you want to take a chance on surgery now," I asked Kitten again, ignoring the doctor.
I was looking her right in the eye - an eye no longer passively neutral. She was finally realizing the true gravity of her situation, and it terrified her. But just when I thought she might give in to her fear, she slowly began to shake her head.
"Move aside! Let the nurse administer…"
"Shut up, you ass!" I shot back at the doctor. "This patient is clearly indicating her preferences. She is shaking her head 'no'. She does not to be prepped for surgery at this time!"
"And I say she's delirious! Immediate surgery is her only chance! She must take it! If you don't allow the nurse to carry out my orders I'll have hospital security remove you!"
Now I was really mad.
"Fine," I said through gritted teeth. "You do what you want, but if you do, I swear to God, I'll take this whole sorry mess to court!" I held up my run report sound/vid recorder that I still had clipped on my shirt pocket. It was clearly turned on. "As you can see, I've got all of this on flash card - sound and visuals. We'll see what a jury with feelings has to say about your opinion, Doctor!"
Dr. Honel said nothing for a long time. Then he snorted, and turned to the nurse. "Page Dr. Krank. As of right now, this is his case. I wash my paws of it!" He turned, whipped aside the cubicle curtain, and stormed out.
Nurse Nickols put away the syringe and pulled out her page-communicator. "Dr. Krank. Please report to the ER for a new patient assignment." She turned to leave, but not before giving me a "You're crazy" look. I stared at her back as she left. Maybe I was crazy. I still had some doubts about the wisdom of this. Immediate surgery would give her a tiny chance, but far greater was the chance that it would keep her from seeing her family again before she died.
And if I knew nothing else, I knew she wanted to see her family.
A small sound behind me made me look back at Kitten, and what I saw shook me to the core. The stark reality of her own imminent death had finally sunk in.
If you've never seen anyone trying to cry their heart out while on a respirator, you don't know what frustrated pain is. She couldn't weep, sob, or make any sound at all. She couldn't even breathe in the gasping, tight-chested way one does when crying. All she could do was cover her face with her good paw, rock back and forth, and let the torrent of tears flow. It was heartbreaking.
But if she didn't stop, her grief and fear would kill her as quickly as a knife to the heart. The monitors were already starting to beep erratically.
Quickly, I knelt down beside the bed. This couldn't wait for family. She needed to know she was loved right now. I pulled her toward me, and her good arm snaked around my neck, pulling me down as she buried her muzzle in my shoulder. I said nothing because there was nothing to say. All I could do was hold her, stroke her hair, and hope it was enough.
Grove City Hospital Emergency Room: 6:47pm
I don't know how long Kitten and I held onto each other, but finally one of the ER nurses came in and tapped me on the shoulder. "You'd better leave now," she said in a hushed voice. "The check-in desk says her family just arrived."
Kitten's feeble grip on my neck relaxed and she opened her eyes to look at the nurse. The pain was still there, but now a kind of joy had replaced the desperation.
"Time to be a family again," I whispered to her as I disentangled myself from the tubes around her. She gripped my arm feebly, pulled me close once more, and slowly mouthed four words around the respirator tube.
'Thank you for everything.'
I tried to say 'You're welcome', but my mouth didn't want to work like that just now. Instead, I took her paw, raised it to my lips and gave it a tender kiss. It was as much to ease my own pain as to tell her that I thought she deserved better. Her half smile told me she understood and that it was all right.
It was all right?
For a moment I simply stared at her. Here was a fur who was perhaps only minutes away from death, and she was trying to make me feel better? I could picture her now when her family showed up. Regardless of her own needs, she'd try to them feel better, too. I blinked away a tear.
God doesn't make them any better than this.
If only she could last long enough, maybe, just maybe, by some miracle, she would make it through surgery. Maybe she wouldn't die. Maybe…
I heard footsteps beyond the curtain, and I turned, but it was only Dr. Krank. I turned back to Kitten and gave her paw a final squeeze. "Gotta go. Need to make room for your visitors." I stood up, and pushed past the doctor, but he held me up for a second.
"I just finished reading her chart, and Fergus told me about the accident." Dr. Krank gave a small smile. "That partner of yours is something else, you know? The first thing he did after you brought your patient in was to get all over the State cops. Wouldn't quit badgering them until they called her husband. The cops wanted to wait for the official word from Dr. Honel, but Fergus would have none of it. He said contacting the patient's family right away was what the patient wanted, and she was promised. Said he'd do it himself if he had to."
"We're talking about 'by-the-book' Fergus, aren't we?" I whispered, amazed.
Dr. Krank shrugged. "All he said was 'A promise is a promise'. He said that's what she wanted most of all, and he and his partner kept their promises." The doctor looked to Kitten, before turning back and tapping the chart. "I don't know how much time she has left - for her family or for any attempted surgery afterward," he whispered, "but I'll put on my 'hopeful' face and make things as pleasant as possible."
I nodded. "Don't be too graphic about the accident," I whispered back. "The family doesn't need to know that right now."
We both looked back at Kitten. She still looked appalling, but the desperate urgency in her face was gone. She almost looked pretty.
I left the cubicle then, trying to ignore my feelings and the voice in my head that was saying I'd never see her alive again. There was still a chance.
There just had to be.
I was making my way toward the double doors at the other end of the ER when the doors flew open and a fox with a small fox-skunk mix kit burst through. I slipped to one side to let them pass. It had to be the family. The doctor and nurse weren't going to be pleased with a kit that young being there, but that was just their 'proper protocol' talking. They'd see the right of it soon enough. I watched Dr. Krank appear at the curtain and talk with the two of them for a while before they all disappeared into cubicle four.
Suddenly I felt a crazy sense of elation.
She'd made it.
They were a family again.
Grove City Hospital Emergency Room: 7:03pm
"Number Four, crash cart!"
The shout over the intercom jerked me out of the semi-doze I'd fallen into after finding a seat by the ER doors. I'd only intended to rest my feet for a moment. Was I that worn out? Suddenly, the doors in front of me banged open and a silver cart loaded with emergency gear barreled past. That's when I became fully alert and glanced at the clock.
It can't be! She hardly had any time with them at all!
But as I looked down the row of cubicles, I saw the cart disappear into cubicle number four. Almost by instinct, my mind went into emergency mode. I could see what they must be doing to her in there. How many times had I done it myself?
Power up the defibrillator. Check the settings. Expose and shave the chest. Start charging the capacitors. Grease the paddles. Place them on the chest.
"Clear!" came the faint shout from cubicle four.
Reflexively, my thumbs punched imaginary buttons on the armrests of my chair.
Come on! Work! There's still a chance!
It hadn't worked.
Boost the settings. Charge the capacitors. Place the paddles again.
My thumbs pressed even harder into the armrests.
God! Please let it work!
Boost the settings to the maximum. Charge the capacitors. Place the paddles one last time.
My thumbs dug painful holes into the armrest.
GOD! Don't - let - her - DIE!
But there was only silence.
Then I heard it - the terrified howl of a young kit. The sound broke my fierce resolve, and the part of me where hope dies suddenly knew that nothing would bring her back.
"God, please let me be wrong about this, please!"
But I wasn't wrong.
In all too short a time, ER personnel began to drift out of cubicle four, and the sad expressions on their muzzles told the whole story.
Kitten was… gone.
I leaned back in my chair, covered my eyes, and heaved a sigh as deep as a sob. Why had this one gotten to me so badly? I could picture her face in the darkness behind my eyelids. It was a different picture of her - one that contained none of the horror of recent reality. It was a pretty face - a gentle face - a loving face - but it was no longer the face of a living fur, and it slowly faded away along with any sense of peace I'd gained from her reunion with her family.
At first I didn't notice the fur who had stopped in front of me.
I dropped my hand, opened my eyes, and looked up at Dr. Krank. He looked tired and probably was. He'd been working emergency all day and this was a lousy way to end a shift. I didn't ask him what happened, I didn't need too, but I suddenly realized there was something I did need to ask. In all the crazed rushing, and in the tense, silent moments between, I'd forgotten to do one thing.
"Doc?" I hesitated a moment, wondering what he would think. "What was her name? Her real name?"
He blinked his surprise, and I ducked my head in embarrassment.
"I'm sorry," I mumbled. "I called her 'Kitten' because she wanted me to, but after all we went through today, you'd think I'd know her real name. I… I need it to complete my run report."
A sarcastic thought flashed through my mind.
The job ain't finished till the paperwork's done.
I gave a disgusted snort. "Ha! Some paramedic I am. I don't even know my own patient's real name!"
Dr. Krank showed me her chart and pointed to a name. I nodded, but the doctor must have sensed my darkening mood.
"Carlo, you mustn't brood about this. We did what needed to be done - what she wanted."
I looked up at him sharply. "Maybe so, but was it the right thing to do?" My doubts were back, and I couldn't ignore them. "At the end, I could see it in her eyes! She was convinced she was going to die no matter what we did, and deep down so was I! I saw the scans. I saw the lab reports. They convinced me she had no chance. And then I convinced her! But what if there had been a chance? What if surgery had worked?" I couldn't look him in the muzzle anymore. I suddenly felt very ashamed and very angry. Jerking my head around, I glared my self-recrimination at the unfeeling ER. "What sort of sick mind just accepts death without a fight? I'm a paramedic for God's sake! I'm supposed to save lives! Not give up on them!"
I didn't know what I was saying anymore. All I knew was that someone good had just died and I was mad as hell about it.
Dr. Krank grabbed me by my shoulders, dragged me through the ER doors, and into an exam room. Then he gave me a hard shake. "We can't save everyone, Carlo! You know that better than anyone! And don't say we didn't fight death. With our help, she fought death and beat it - for as long as it was necessary! Sure, we could have brought in our fancy equipment and used all our lofty knowledge and skill, but she probably still would have died - and not with nearly as much dignity." Slowly, his expression softened. "Sometimes, it's not our job to save their lives."
We both could still hear the mournful crying coming from the ER, and the doctor looked toward the sound for a moment. When he looked back, I saw the glint of tears in his eyes, and my anger began to fade.
"Carlo, our job tonight was to keep her alive long enough to see her family again. That's what she wanted most - to be with her family. Waiting on the surgery was the only way to guarantee that."
We walked out of the exam room together, and for a long time, we just stood by the ER doors and listened to a family's grief. It hurt to listen, but it told me how much she was loved. Hell, how could anyone not love her? I'd known her for only...
I looked at my watch. It was 7:25pm.
Only two hours and fifty minutes.
In so short a time, I had come to admire, respect, and even love her in some small way. How much more did her own family cherish her? Dr. Krank finally nodded toward the reception desk and the exit beyond.
"Life goes on," he said quietly. "Other duties await."
He squeezed my shoulder a final time before turning and walking back into the ER.
I too, turned and left through the ER entrance to go back to my paramedic station. I needed to clean up, complete my run report, and finish my shift. There was nothing more I could do here.
Grove City Paramedic Station: Just after midnight.
Ironically, there were no other calls that evening. The storm had taken its required toll and obligingly blown itself east. At midnight, I left the paramedic station feeling no better than when I'd left the hospital. I walked to my car in the parking lot, but instead of getting in and driving home, I continued walking to the small park across the street. An icy silver moon in a black velvet sky was bathing the landscape in a stark white light that made the fresh snow glitter. I suppose I should have admired the beauty, but I simply stood there watching my frozen breath drift away one puff at a time. Here was proof that I was alive. One breath followed another - and another - and life went on.
Yet, how easy it is to snuff out.
All of us are only one breath - one heartbeat - away from death. Why then, if death is so close, are we so surprised, so angered, and so heartbroken when it finally takes one of us away?
Because most of us aren't ready for it. Too many things left unsaid and undone.
I brushed off the light dusting of snow that a night breeze had swirled onto my coat and walked back to my car. It was time to go home. As I opened the door and got in, I had a sudden, overwhelming desire to let my wife know, now, in no uncertain terms, just how much I loved her. I quickly pulled out of the parking lot and headed towards the 24 hour mall. There had to be a place I could pick up some flowers this late at night.
Sure enough, the all night grocery had flowers, but all that was left were some carnations and two red roses. With a smile, I cleaned them out and headed back to my car. In no time, I was on my way home with flowers for my 'Kitten' - at midnight no less! It was crazy, but it was what my heart was telling me to do.
What my heart was telling me to do...
As I drove on, I realized that everything I'd done today had come from the heart - and that doing so was as important as doing it the 'right' way. Looking back, I could see that my partner and I had always done things this way, and I knew we would continue to do so, even though that much caring could hurt terribly when we lost a patient.
...from the heart.
Though the night was clear, I found myself pulling over and stopping by the playground a few blocks from my house because I could no longer see. I had to wipe the tears from my eyes.
And there was one more thing I had to do before I could go home.
I had to say goodbye.
Taking a few of the carnations and a single red rose, I got out of my car and walked through the snow to where a birdbath made a glistening, white pedestal in the moonlight. It wasn't much of a memorial, but it was all I had. Carefully, I laid the flowers on the fresh snow atop it and stepped back to gaze up at the stars. I wanted to say something appropriate - something she would hear - but the words weren't there. So I pictured her face instead and concentrated on imagining the pain she must have felt, how much she wanted to be with her loved ones, and how much strength and courage it must have taken to buy those few moments at the end with her family. Lastly, I thought about the simple goodness I'd seen and felt in her, and that's when I knew what I had to say.
Wherever you are now, Sabrina, may you always find time enough for love.
I held her vision a moment longer before letting it fade back into the stars.
It was enough.
I could go home now.
Home to the one I loved.
And I did.