Pop-pop-pop

This was written a few years ago. Names have been changed, of course.

* * * *

One slow winter night, Emily and I were doing the long, boring loop between downtown and southwest. We'd get sent out southwest. A call would drop downtown, and we'd come back. Someone would clear the hospital, and we'd turn back around. We were chatting about nothing, listening to the radio, and generally being terrifically bored. It had been a while since we'd run a good call.

Another call dropped, and we turned back towards downtown. Barely a minute after she flipped us around, the dispatch radio came to life again.

"Truck 1, Medic 325, stage on a shooting, Southwest Second and Ankeny streets, ..."

I thumped the dash. "Dammit! We're second-out for that! Why do we always miss the good stuff?"

Emily shook her head, a bit exasperated - though I couldn't tell if it was with missing the call or her high-speed, over-eager lead. "I dunno..."

Our tones went off, sudden and jarring as always. We paused, waiting for the computer to come up with the call or the dispatcher to start talking. But the computer remained blank - we were in a dead spot for the wireless data, coming out of the hills. And, strangely, there was no voice dispatch.

This was seriously weird.

The seconds stretched; thirty, forty, and nothing. My pager buzzed, and I looked at it to see the address of the shooting we'd heard dispatched a few minutes before.

Okay, I thought. Second patient?

And finally the dispatcher started talking, and we understood the lapse.

"Medic 327, Medic 324, Medic 326, Medic 322, respond with Truck 1 and Medic 325 already enroute at Two and Ankeny for a multiple shooting, at least five patients ... " Another pause. " ... And Fire Dispatch now calling box 0140, Truck 1 requesting a full first alarm. Assignment is Engine 1, Engine 3, Engine 4, Truck 3, Squad 1, C-2, C-4. Ops channel six."

There was a long moment of silence in the ambulance.

"Holy shit," Emily said.

"Yeah," I told her. "Put your foot down."

We flew down the long boulevard into downtown, and jerkily stopped-and-started our way through traffic lights on mostly deserted streets. Occasionally we'd see cops up ahead, blasting through intersections. I put on a pair of gloves, draped my stethoscope around my neck, and tried not to hassle Emily to go faster. I tried to ignore the icy clench in my gut. The radio traffic wasn't helping.

"... all units responding, police onscene say the scene is secure and you are clear to enter. Correction. Police are asking for medical to expedite ..."

"... Truck 1 assuming command ... and dispatch, we may have as many as seven patients per police. Add two more ambulances ..."

Christ. This might be bad. Might be. Then again, two people could be bad, and five could be shot in the foot or ass or something. I somehow fixated on that idea, and decided we had to get there early, to get a "real" patient. I told Emily to hustle it up, and she shook her head.

As we slammed down 2nd Avenue, I saw the lights of another ambulance approaching across one of the bridges. The offramp would drop them onto 2nd, right in front of us – or behind us. As we closed, it became apparent that we'd get to the stoplight just barely ahead of the other unit.

Suddenly Emily hammered the brakes. The light was red, and the other ambulance was only a hundred yards up the ramp.

"Go, go go!" I yelled.

"But they have the green," she protested.

"Fucking go," I told her, and she buried the gas pedal in the floorboards. I could see the faces of the other crew – good friends of mine both – glaring as we burned past them. I gave them the finger.

Thirty seconds later we were sliding to a stop, among a mess of police cars, fire trucks, and a couple other ambulances. I looked out the window and saw a man laying against the side of a building, shoulders on the ground, chin touching his chest, blood and grey matter painting a cone out from one side of his head.

Whoa.

I was out of the car before it even stopped moving, and walked over to where I saw the first-in ambulance medic, a huge man named Sam, standing on the sidewalk. At least four people were laid out within ten feet, and as I looked over them I realized they were all teenagers.

Oh, Christ, this is that underage juice bar nightclub. Perfect.

I just looked at Sam. Dispassionately, as if we were chatting about a football game in the crew room, he started talking and pointing.

"This one is dead. This one is critical; we're taking her. This one is also critical. That one isn't as bad –"

"Great," I interrupted, tossing my head at the second critical patient. "We've got that one." One patient I can handle. If they're critical I can justify taking them right now. I knew, in theory, how to triage. I knew what criteria I'd need to use to classify patients – critical (red), delayed (yellow), walking wounded (green), or dead (black) – but on the street, in the cold January air, with a bunch of kids bleeding onto the concrete, I desperately didn't want to practice.

Sam nodded and turned away. I glanced behind me. Emily was standing there, holding a backboard, and a single firefighter was with her. No one else, yet. I took a step closer to the patient, and three things jumped out at me:

She had at least four holes in her torso.

She looked at least as confused and scared as I felt.

She was very, very young.

"Okay," I said, taking a deep breath. "Get her boarded and we'll put her in the car and go. We can do everything enroute. I'll grab the gurney, and then -" I'm going to throw up for a few minutes? "- I'll spike some bags and get things ready in the back. You got this?"

"Uh, yeah," she said. "Sure, boss. We'll meet you at the car."

I skittered back to the ambulance, hauled the gurney out, then jumped in the back and proceeded to make a mess. I pulled out everything I thought I could possibly need. Oxygen mask. Two bags of IV fluid. Everything I'd need to put a couple lines in. Monitor leads out and ready. I grabbed the chest decompression kit off the wall, and clenched a little tighter, wondering if she'd dropped a lung.

Okay. Okay. Slow down. I tried to take a few calm breaths, tried to pretend my hands weren't shaking a bit, and then the back doors were open and they were loading the gurney in.

We cut clothes, and I confirmed my earlier estimate of at least four holes in her torso. She was awake, and breathing, but neither of us could feel a pulse at her wrist or hear a blood pressure over all the noise. She couldn't talk much, and when she did it was with a foreign accent I couldn't place. I asked what her name was, but couldn't understand the answer. She told me she was eighteen. Alright, I told her, breathe easy. We've got you.

I listened to her lungs and decided they sounded about equal. No need, yet, for the whaling harpoon of a needle sitting on the bench behind me. Emily helped me get oxygen and the monitor on, and then asked if I wanted help with an IV.

"No," I said, "she's young and healthy. I can drop one on the way. Let's go."

"Alright," she said. "I'm still waiting for a destination from the sup."

Our medic supervisor had showed up a few minutes after us, and was now coordinating ambulances, making sure patients were split evenly between the two trauma centers.

"Well," I snapped, "tell him to hurry the fuck up, we need to leave."

"Copy that," she said, and hopped out. I took the minute's pause to look for a spot for a line. Whoops. Nothing. Great.

The back doors popped open again. "Okay, we're going to Charity."

"Right, let's roll."

She glanced at the patient, then me, and a ghost of a grin appeared on her face. "Code one or code three?" she asked, rhetorically.

"Fuck," I told her, emphatically, already looking at the girl's other arm for some kind of vein, anything.

The car dropped into gear, and the chaos and lights and sound disappeared behind us. The siren yelped occasionally, but otherwise it was abruptly quieter in back. I finally found a spot and slipped an IV in the girl's hand, a twenty-gauge, tiny for this sort of trauma but all I could do. She was trying to ask me something.

I grabbed the monkey bar and leaned over her face. "What did you say?"

"... 'm I gonna die?"

I wanted to tell her no, but my face had to have given away how scared I was for her. Don't lie to your patients. They will know. Thanks, nameless instructors. I put one of my hands over hers.

"I don't think so. We're going to take really good care of you, okay?"

She nodded. I felt awful. Hell of a pep talk, but she seemed a little calmer.

I glanced out the back window, and realized we were only about five minutes out. Still couldn't get a blood pressure. I listened to her lungs again, and now one of them sounded fainter. Way fainter. Shit. I glanced at the chest decompression needle, but decided we were so close, and she needed a chest tube. Hell, she needed to go right into an operating room. Luckily Charity could do direct to OR - but they'd need to know.

I spun the radio to the TRAUMA channel. No dice; I could have sat for half an hour and not gotten through. Screw it, I'll go against procedure and call the hospital direct.

"Charity Hospital, Medic 327, code 3 traffic."

"Charity, go ahead."

"Medic 327, we're, uh, three minutes out, eighteen year old, from the shooting, at least four GSWs to the torso, heart rate of 120, no radial pulse, can't get a BP, all we've got is a small line, and she's maybe got a pneumo."

"... ah ... we're not aware of this patient, 327. I think you were supposed to go to University Med."

Thump-thump. Well. That's the driveway.

"That's nice, Charity. We're on your doorstep. See you in about thirty seconds."

We unloaded quickly, and rushed her through the double doors. I got the fleeting impression of barely controlled chaos before a senior attending trauma surgeon blocked our way. He held out his hands in a placating gesture.

"Whoa, okay, what have you got? We don't know where you're going yet."

Emily told me later that my voice was high and stressed. "Doc, she's eighteen, at least four holes in her chest, I stopped looking after that. Airway is good, she's awake and talking, but I can't feel a blood pressure, we've only got one tiny line, and I think she's dropped a lung."

I raised my finger, pointing at her, and then behind him, to the next set of double doors. "We. Need. An. OR."

He blinked, clearly taken aback. "Uh, okay. Uh. OR 14."

"Thanks," I replied, already in high gear, rolling past him. We slid into the sterile whiteness of the OR, and lifted her from our gurney to the operating table. I stepped back as Emily pulled the gurney away and the nurses and docs crowded around. I'd later learn that it had only been twenty-five minutes since we got to the scene.

"Goddamn," I said to no one in particular, standing in the scrub hallway outside the trauma ORs. "God-damn."

"Well?" Emily asked when I came outside.

"She's gonna die," I sighed. "I mean ... yeah. Yeah. Shit."

* * * *

About six months later, my girlfriend had to ask me why I was sitting at the table, teared up over a picture of a very normal-looking girl at a high school graduation, healthy and happy and very much alive.