The Paramedic's Brother-In-Law

Chapter Forty

Meghan quickly turned back towards the stairs, shoving gloves onto her hands. “Mitch! Mitch, can you hear me?” Mitch was unresponsive.

Jerry, still at the top of the porch, waved wildly at the firefighters who had made it back to their rig but not left yet. The captain opened his door. “Hey! The Doc is down. Bring us the backboard and stuff!” The firefighters clambered out of the rig and headed for the ambulance, pulling out equipment and bringing it over.

“What happened?” the captain asked as he passed a c-collar to Meghan.

“The steps are slippery with this mist. I almost slipped, and Mitch apparently did. I saw him hit his head when he went down.” She applied a c-collar around his neck while Jerry held Mitch’s head still. They carefully rolled Mitch onto his side. Meghan could see a large knot forming on the back of Mitch’s head. Wedging the backboard behind him, they rolled Mitch back onto the board and secured it. They carried the board towards the ambulance while Jerry ran to pull out the cot. The board was placed on the cot, secured, and Mitch was placed into the ambulance. Two firefighters jumped into the ambulance before Meghan clambered up.

Jerry had already started cutting clothes to make sure there weren’t any hidden injuries while one firefighter was obtaining vital signs, the other hooking up a nonrebreather mask to oxygen and settling it over Mitch’s mouth and nose. Meghan grabbed IV supplies and spiked a bag with blood tubing, just in case. She pulled over Mitch’s left arm, found a large vein, and inserted the IV. The pain of the stick was enough to get Mitch to groan and weakly try to pull away from her.

“Hey, Mitch! Open your eyes for me.” Meghan finished securing the IV and pulled out her penlight. The first firefighter, Ryan, looked over at her. “Vitals, Meghan: resps 16, pulse 104, blood pressure 158/96.” Meghan nodded her understanding. She used her penlight to check Mitch’s pupils. She wasn’t sure, but Mitch’s pupils looked a little uneven in size to her.

“Jerry, check his pupils. Anything in the physical exam?” She moved so Jerry could squeeze by her and handed him her penlight.

“No deformities and abdomen is soft. He’s got some swelling around that left ankle, though. Could be a sprain.” Jerry checked Mitch’s pupils. “Right one looks to be a little bigger, but it’s not blown. Any signs of CNS fluid?”

“No. Okay, guys, let’s get out of here and get to County Med.” Jerry handed her the penlight and headed out of the vehicle towards the driver’s seat.

“Need a rider?” The firefighters offered.

“Sure, wouldn’t hurt.” Ryan opted to stay, and the other firefighter hopped out, shutting the ambulance doors.

They felt the ambulance moving forward and heard sirens start as they got back onto the road. “Ryan, could you grab another IV setup for me? I’ll put a hep-lock in the other arm, just in case.” Meghan leaned over Mitch and tried to get him to respond to her. “Mitch, I need you to open your eyes for me. Wake up, Mitch.” She did a sternal rub, which got a small response of a facial grimace, but that was all. Ryan tapped her shoulder.

She carefully made her way to the small space on the right side of the cot and quickly had the second IV in. She did a blood draw of the rainbow tubes and connected the small section of tubing to the IV catheter, flushing it with a saline flush before taping it down.

“Seven minutes out,” Jerry hollered.

Meghan maneuvered out of the tight spot and headed for the radio. “County Med, County Med, this is EMS 18. How do you read me, over?”

EMS 18, this is County Med. Read you loud and clear, over.

“County Med, this is EMS 18. Incoming patient report, Trauma Alert.”

Go ahead with patient report, Trauma Alert, EMS 18.

“I have a 43-year-old male, slipped and fell down 5 stairs. Patient hit his head on the stairs on the way down and was unresponsive on scene. Current GCS of 6: withdraws from pain and grimaces. Patient has a large knot to the back of his head. Right pupil appears a little larger than the left. Also noted swelling to right ankle without deformity. Patient currently in full spinal precautions. Vitals are: resps 16, pulse 105, blood pressure 154/98. Patient on O2 at 12 liters per minute. Two large-bore IVs established, Normal Saline. Cardiac monitor shows sinus tach at 106. ETA approximately 4 minutes.”

We copy, EMS 18. Come to Trauma One on arrival.

Meghan replaced the radio and went back to Mitch’s head. “Mitch, we’ll be at the ER in a couple of minutes. Open your eyes for me. C’mon, you need to wake up.” She felt the vehicle slow in preparation for turning into the ambulance bay. She moved the Lifepack to hang on the back of the cot and switched the oxygen tubing to the tank on the cot. Jerry parked and came around back, opening up the double doors.

He pulled the cot out, the wheels dropping and locking into position. Ryan and Meghan hopped out, and they wheeled Mitch into the ER and into Trauma One. Cot straps were unhooked, and several hands reached out to move the backboard over to the ER gurney.

Dr. Shultz was again on duty and took charge of the case. “What happened, Meghan?” The trauma team worked around them, hooking Mitch up to oxygen, to telemetry, and other wires and tubes. Meghan moved closer to Dr. Shultz and focused on her report.

“Mitch has been riding along with us today. We had an AMA at a trailer home with a wooden deck and stairs. As we were leaving, it had started misting, and the stairs were really slippery. Mitch slipped on the 3rd stair down and fell, hitting his head on the stairs as he came down. I think he fell down about 6 steps.

“He was unconscious on scene. I saw and felt a large gooseknot on the back of his head. Right pupil is a little larger than the left. Abdomen was soft, and the only other injury we saw was a swollen right ankle.”

Dr. Shultz nodded and headed to Mitch’s side. “Someone call for CT of the head. I need labs, put in a foley. Xray: head and neck, right ankle. Bring that ultrasound over here.” Meghan watched her brother-in-law’s form as they worked on him.

The lab tech came over to Meghan. “Did you draw any blood?” Meghan nodded and handed her the bag of blood tubes. “Thanks.”

Someone threw a couple of blankets over Mitch’s still form. People started clearing the room when the radiology tech moved forward to get the requested films. A nurse breezed in and moved to chat with Dr. Shultz.

A hand tapped Meghan’s shoulder and she jumped. Jerry gave her a sideways glance. “C’mon, Squirt. No sense taking up floor space.” She allowed him to lead her towards the nurses’ station. Brandi was standing there, waiting for her.

“You okay?” Brandi asked, concerned. Meghan shook her head. “Jerry called me on the way in and told me what had happened. I drove your car over. I’ll finish your shift, and you take care of your brother-in-law and sister. Jerry, go get her stuff from the rig, okay?”

“I need to call Kelsey,” Meghan said, haltingly. Ryan gave her a look and took her hands just as she started to pass out. He was able to lower her to the floor, sitting her down and moving to place her head between her legs. Meghan quickly came back around.

Brandi had Meghan’s wrist in her hand, checking her pulse. “Welcome back.”

“What happened?” Meghan asked, disoriented.

“You took a swan dive into Ryan’s arms. Feeling a bit better?” Brandi asked. Meghan groaned.

Jerry came back in with a coffee cup, Mitch’s jacket, and both Mitch’s and Meghan’s backpacks. He quickly took in the minor scene taking place by the nurse’s station and sighed. “Squirt, what am I to do with you?” Meghan just sighed, closed her eyes, and let her head rest back against the side of the desk.

Dr. Shultz exited the trauma room as Mitch’s gurney was rolled out of the room and down the hall. He saw the cluster of people crouching around someone and went to see what was going on. He saw Meghan sitting on the ground. “What happened?” he asked, concerned.

“She passed out,” Brandi said, matter-of-factly. Meghan sighed and opened her eyes.

“I’m okay. I’ll be fine.”

Dr. Shultz gave a disapproving look. “What’s her pulse?”

“It’s 124 and a little thready,” Brandi reported.

“Let’s get her checked out. I think there’s a curtain room available.” He started to look at the board.

“I’ll be okay, I promise. I don’t need to be checked out,” Meghan protested but was silenced by a look.

“Let’s do some vital signs and be sure. Go into curtain 3 and I’ll be there in a minute. Go ahead and start an IV, Normal Saline.” Brandi nodded. Jerry brought over a wheelchair, and they helped Meghan into it.

Wheeling her into Curtain 3, Jerry, locked the wheelchair and went to help Meghan up when she passed out again. Gentle hands caught her and settled her onto the hospital gurney. Brandi started hooking Meghan up to the telemetry while Jerry started looking for an IV site.

It took a few minutes for Meghan to come around again, and by that time she was on the monitor, the IV was in and running, and Dr. Shultz was standing over her, calling her name. “Come on, Meghan, wake up. That’s a girl.”

Meghan blinked lazily for a moment, gaining her bearings, before she realized where she was. “Oh, crap.” She sighed in disgust.

Jerry was still in the room and chuckled. “No kidding, Squirt. Hey, Brandi is covering for you, and someone’s already notified Kelsey and is going to pick her up. Your stuff is in the room here, as is Dr. Branston’s. Get to feeling better, and let us know how things turn out.” He winked. “I’ll see you later.”

Dr. Shultz raised an eyebrow as Jerry left and turned his attention back to his patient. “Meghan, a blood pressure as low as yours is will garner medical attention anytime.”

She struggled to see the monitor but gave up – it made her lightheaded to try to look at it. “What is my BP?” she asked.

“You’re sitting at 78/30. Let’s see if we can get some fluids into you and raise that up, okay? I’ll send a nurse in to draw some labs and bring you some warm blankets.” He turned to leave, but Meghan stopped him.

“Any word on Mitch?”

“Not yet. He is currently up in CT. I didn’t see anything that pointed to any internal injuries in his chest or abdomen, but I’m suspecting a sprain for that ankle. So that just leaves the head injury. If he’s lucky, it’s just a bad concussion. If he’s not…”

“Yeah, I’ve got all those scenarios floating through my brain,” Meghan said softly.

Dr. Shultz patted her hand kindly. “Good thoughts, Meghan. I’m going to go up and check on his CT.” He smiled and exited the curtain.

A few minutes later, Bob entered her curtain area with an armful of supplies. He tsked at her. “Now Meghan, what did I tell you about being a patient here?” He glanced up at the monitor and did a double-take at her blood pressure. “That’s low, even for you! Let’s bump up that IV drip.” He deposited his armful on the counter and increased the flow rate as high as it would go. “I’ve got you some warm blankets because you’ll freeze in here tonight otherwise.” He spread two blankets over her, and she basked in the heat.

“And now I need to play vampire. Doc wants lab work.” Bob sat down on the stool and wrapped a tourniquet around her left arm. He palpated a good vein and inserted an IV catheter, which he hooked up to a vacutainer. He drew several vials of blood, unhooked the vacutainer, and hep-locked the IV site. “Just in case.” He also stuck her finger and drew a drop of blood, using it to fill a test strip, which he inserted into a glucometer. The machine thought for a moment and beeped. “You’re looking at 73. When’s the last time you ate, kiddo?”

Meghan had to think for a minute. “Maybe around 1 pm? We stopped off at McDonald’s somewhere around then.”

Bob nodded. “I’ll let Dr. Shultz know. He might order a tray for you. It won’t necessarily help that blood pressure, but it’ll keep that blood sugar from going too low.” He cleaned up his mess and placed patient labels on each of the test tubes. “I’m gonna go send these to the lab. Page if you need anything.”

Meghan laid her head back to rest for a moment, upset at her body for causing problems again. She had almost drifted off to sleep when Kelsey and Dr. Brant appeared. Kelsey had obviously been crying, and Rick looked grim, but Meghan was glad to see them.

She held out a hand to her sister, and Kelsey leaned over the rails on the gurney to give her sister a hug. Rick patted Meghan’s other hand.

“Any news on Mitch? He isn’t in the Trauma room.”

Meghan shook her head no. “Last that I heard was that he was up in CT. He’s got a large hematoma to the back of his head and Dr. Shultz thinks a badly sprained ankle.”

Rick took in the IV and studied the monitor on the wall. Meghan’s blood pressure was starting to come back up, but it was still lower than normal. “So what has you captive in the ER again?”

Meghan was about to answer, but Dr. Shultz walked back in. “She passed out twice after bringing Mitch to us, and her blood pressure was in the upper 70s systolic. Hi Rick, Kelsey.” He studied Meghan’s telemetry. “Blood pressure’s come up a bit, but not enough yet. I’ll have Bob hang another bag of fluids.”

“Do you know anything new about Mitch?” Rick asked.

Dr. Shultz smiled. “As a matter of fact, I do. His CT looks good, and he just woke up as we were bringing him back to the ER. I’ve paged the Neurologist on-call to take a look, but I think it’s just a bad concussion. He will be staying at Chez County Med for a few days to be sure.” Everyone breathed a sigh of relief at the news.

“When can I see him?” Kelsey asked.

“Give me a few more minutes to get him settled, and I’ll bring you to see him,” Dr. Shultz promised. He turned his attention back to Meghan. “I’m going to have Bob bring you some food and let’s see how that affects your system. I’ve gotten a couple of the labs back, and so far everything is looking good.” He glanced at the IV bag, which had almost emptied. “I’m thinking more fluids, as well.”

Meghan nodded as she glanced at the empty bag of saline. “Do you think this is a dehydration issue? I’ve been trying to drink more water.”

Dr. Shultz frowned. “I’m not sure, to be honest. It could be dehydration or an electrolyte imbalance, or it could have a stress connection. I would recommend discussing it further with your primary doctor.” He clapped his hands together. “Okay. I’m going to go check on Mitch and get Bob to deliver some grub. I’ll be back in a few minutes.” He headed from the room, leaving Meghan with her visitors.

Rick turned to Meghan. “So how are you feeling, really?”

Meghan huffed. “Like an idiot.”

Rick cocked his head. “Why’s that?” he asked, a little taken aback at her answer.

“Let’s just say that I don’t like to be on the receiving end of medical care, especially when I’m receiving it from my coworkers.”

“Ah,” he said, understanding dawning. “It puts a dent in your shining armor. A weakness in the macho veneer.”

Meghan nodded. “Yeah, something like that.”

“Okay, aside from the bruise to your ego, how are you really feeling?” he asked again.

“Tired, like bone-deep tired, and a bit of a headache. Bob’s supposed to be bringing food, but I’m not really sure I want to eat.”

“Are you nauseous?” Rick asked.

“A little,” she admitted. Kelsey smiled at her in sympathy.

“I’ll be right back,” Rick said and strode out of the room.

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