Once the students were gone, Meghan sank gratefully back into the chair she had vacated. Fred came over to her and leaned on the desk. “Okay, you made it through class. But how are you planning to make it back home? I don’t want you passing out at the wheel.”

“That’s a good question, one I’m not sure how to answer.” Meghan sighed, placing her head in her hands.

“Do I need to take you to the ER?” Fred asked, serious. “Or call for a unit to haul you in?”

Meghan brought her head up sharply at that. “No!” The room spun on her, and she went rather pale. Fred stepped in to steady her. “Whoa, there!”

“I’m okay,” she protested. “Just moved too fast.” She braced herself against the desk and waited for stuff to calm back down. “I don’t want to go to the ER if I can help it. Let me call Mitch and see what he says.”

Fred wasn’t happy, it was apparent, but he nudged her phone closer to her. “Well, call your brother-in-law and see what he says. I’m going to take your blood pressure again. If it’s lower, I’m calling for transport,” he warned.

Meghan nodded, dialing the phone and jamming it between her right ear and shoulder while Fred wrapped the blood pressure cuff around her left arm. He had started pumping up the cuff by the time Mitch picked up the phone.

Branston residence, Mitch speaking.

“Hey Mitch, it’s Meghan. I need your advice.” She could feel the cuff deflating on her arm.

Sure thing, but why ask over the phone? You were planning to come over, weren’t you?

“Well, that’s the thing. I’m not sure if I can make it over there.” Fred wrote down the BP on a slip of paper and held it up: 78/34. Meghan groaned.

What’s going on, Meghan? Are you okay? The tone in Mitch’s voice sharpened.

“Well, my BP is dropping again, and the lightheadedness is here with a vengeance. Fred’s threatening to call an ambulance,” Meghan said weakly.

What’s your blood pressure now, do you know?

“Fred just took it: 78/34. It was low 80s systolic about an hour ago. Could you just come pick me up? I really don’t want to go to the ER.” Meghan was almost pleading on the phone.

Meghan, you need to go to the ER. Even if I thought the delay was not going to hurt anything, I’d be driving you to the ER. I can’t treat you here at the house. Go ahead and call the ambulance, and I’ll meet you at the hospital, okay?

Meghan sighed. “Okay.”

Pass the phone to Fred, Meghan, for just a moment, okay?

“Okay,” Meghan responded, then held the phone up. “Doc wants to talk to you.”

Fred took the phone from Meghan. “Bellarmine speaking.”

Fred, it’s Dr. Branston. Go ahead and get an ambulance to transport her to the ER. Start an IV, push the fluids, and try to get some labs drawn if y’all can. I’ll meet you at the ER.

“Sure thing, doc. I’ll call for a unit now. Bye.” Fred hung up and handed the phone to Meghan. “Stay here – I need to make a call.” He waited for Meghan’s nod before heading to the office and picking up the phone. He dialed 911, speaking to the operator and getting an ambulance dispatched. Hanging up the phone, he headed back to Meghan’s side. He slipped the pulse ox back onto her finger. “They’ll be here in just a few minutes, kiddo. How are you feeling, really?”

“Lightheaded and nauseous. Feels like I could just slide into the fog without much help. And embarrassed,” she added, as they started hearing the sirens approach the school.

Soon, firefighters carrying medical equipment entered the classroom and headed for the two instructors. “We heard there was a medical call. Where is the patient?”

Fred gestured to Meghan. “Right here. Her blood pressure is really low. Let’s get her on some oxygen,” he directed. Heads nodded, and hands dug into the medical kit to pull out a nasal cannula and get it hooked up to the oxygen tank. One of the firefighters, Tony, was taking the lead. “Here, Meghan, let’s get you on some oxygen. What’s going on tonight?” He gestured to another firefighter to get a new set of vital signs.

“I’m lightheaded and nauseous, and my blood pressure is tanking. Talked to Dr. Branston. He wants me to go to the ER.” Tony noticed the slowing of her normal speech and how pale she was. Considering they’d worked together for several years, he was able to pick up on the changes between her normal state and the way she was presenting now.

One of the other firefighters handed Tony a slip of paper with her vital signs written down. “Well, your vitals aren’t great at the moment: pulse 112, respirations 16, and your blood pressure is rather low.”

“What is it?” she asked.

“76/32. Someone get me an ETA on that ambulance,” Tony directed, and he heard a radio squawk in response.

“Would you feel better if we lay you down?” he asked.

“Yes, but I’m afraid I’m going to pass out if I move,” Meghan confessed.

“I’ll catch you,” Tony promised. He gestured to a couple of the other guys, and they took hold of Meghan’s arms and torso, carefully easing her out of the chair and onto the floor. Fred, seeing what they were planning to do, quickly grabbed the first thing he could find to toss over her for warmth: her turnout coat. He made his way back to the group just as they got her safely onto the floor, shoving over a chair to prop her legs up with and tossed the coat over her torso.

Tony looked up, grinned and winked, before returning his focus to Meghan. “Ambulance is almost here, Meghan. Are you still with me?”

It took a moment for Meghan to respond. “What’s going on? Oh.” She had indeed passed out momentarily as they transitioned her to the floor.

“Ambulance is almost here,” Tony repeated. He noticed the tears forming at the edge of Meghan’s eyes. “Are you in any pain?”

“No,” she replied, “just embarrassed.”

“No need to be embarrassed,” Tony said, holding her wrist to check her pulse. “Sometimes we just need to help each other out. Any changes to the lightheadedness now that you’re lying down?”

The blood pressure cuff on her arm hissed as her pressure was taken again. “No, but at least I know that I can’t fall. Any change?” she asked, looking at the firefighter who had taken the blood pressure. He shook his head and she sighed.

Tony kept up a line of questions for his paperwork and soon they heard sirens approaching. One of the firefighters left the room to direct the ambulance crew in.

Meghan heard Jerry before he entered the room. “Hey, Fred. Do you have a student for me, or is it Meghan?” She cringed.

“Squirt, what am I going to do with you?” Jerry asked, making his way through the firefighters to crouch down near her head.

“Take pity on me and take me to the hospital?” she replied weakly.

Jerry nodded, gave her a smile, and focused on the information that Tony was relaying. His features sharpened as he heard her last blood pressure. “Bill, get that cot over here. We need to get going.”

The cot was brought close, straps undone and one side rail lowered.

“Okay, Meghan, we’re going to lift you onto the cot. Fold your arms across your chest for me, now. Just relax and let us do all the work. On my count: one, two, three!” Strong arms lifted Meghan off the floor and placed her on the cot. Straps were buckled and tightened, the side rail was raised into position, and then the whole cot was raised into the upright position and started heading down the corridor of the school.

Fred walked beside Jerry as the cot was wheeled towards the ambulance. “Meghan called Dr. Branston, and he’s meeting her there. He ordered that we push the IV fluids and draw labs if you can.” Fred looked down at Meghan. “Gal, I’m going to get stuff locked up here, and then I’ll meet you at the ER.”

“Thanks for everything, Fred,” she said weakly, lifting a hand.

“You’re welcome. I want you back to work soon and in one piece!” He smiled at her before breaking away to head back to their classroom.

Meghan was soon loaded into the back of the ambulance and it was organized chaos for a few minutes. The nasal cannula was switched from the firefighter’s oxygen tank to the big one on board the ambulance. Another firefighter started hooking Meghan up to the cardiac monitor, while another was busy spiking IV bags and setting out stuff to start the IVs. Jerry looked at Tony and gestured to Meghan’s right side. “Doc at the ER has already been contacted and wants fluids. See if you can get a line going over there while I try for one here.”

Meghan soon had IVs established in both arms, a blanket over her body, and her feet propped up on the cot with the large trauma duffel bag. Tony offered to ride in, and Jerry agreed. “Okay, everyone out! We need to go.” People quickly exited the vehicle, doors were shut, and Bill pulled out, heading for the hospital, lights and sirens blaring.

Jerry and Tony kept up a running dialogue with Meghan, trying to keep her awake. Jerry tested her blood glucose. “Blood sugar is on the low end of normal.” He charted the test. “What’s her latest blood pressure, Tony?”

“Still sitting around 76/30,” he replied. “Fluids aren’t bringing it up. Do we need to consider meds?”

Jerry glanced out the windshield and shook his head. “Better leave it for the ER.” He reached over and grabbed the radio mike, tuning the radio for the ER. He called in report, adding that their ETA was 5 minutes out. He replaced the mike.

“How are you doing, Squirt? We’re about 5 minutes out.”

“Cold. Nauseous. I just wanna sleep.”

“You need to stay awake for me, Meghan. We’re almost there. Has Doc said anything about what he thinks might be causing this?” Jerry glanced up at Tony.

“Not yet. We’re trying to figure it out. Did a lot of labwork earlier this week. Supposed to have more done in the morning.” Meghan closed her eyes.

“Open your eyes, Meghan. You need to stay with us. Good girl,” Tony coached from his position in the captain’s chair.

Bill shut off the sirens as they entered the ambulance bay at County General. He pulled up, then backed the ambulance into position at the loading bay. Tony and Jerry had gotten everything unhooked and switched over to the cot, so they were ready when Bill came around to open the doors.

“Meghan, we’re at the ER. Let’s get you inside and feeling better.” The cot latch was released, and Bill pulled out the cot, the legs of the cot dropping and locking into place. Meghan was wheeled into the ER and immediately was directed into Trauma Two.

Nurses and techs swarmed around the cot, releasing side rails and buckles and sliding Meghan over from the cot to the ER gurney. Her clothes were removed and she was put into a gown. Meghan, whose tenuous hold to consciousness let go, went unconscious.

Mitch was right there beside her as his team worked to get her transferred over and stabilized. “Meghan? Meghan, wake up for me. C’mon Meghan, open your eyes.” He tried a sternal rub and this roused her some, but not enough to wake her up. “What’s her vitals?”

“BP is 76 systolic,” a nurse replied. “Pulse 114 and thready, resps 16 on 2 LPM.”

“Get her on a nonrebreather at 12 LPM,” he directed. “I need labwork drawn.”

Jerry held up a biohazard bag with filled test tubes. “We drew these, doc.” The lab tech snatched them out of his hand and headed for the lab, having gotten orders for labs before they arrived.

Meghan’s eyes finally fluttered and opened. “Welcome back,” Mitch said, leaning over her. “Are you having any pain or nausea?”

“Nausea,” she replied softly. Mitch gave orders for Zofran and for a Foley catheter to be inserted. A nurse shooed out nonessential personnel to provide a modicum of privacy as Meghan had it inserted. Thus, Jerry and Tony were shooed out of the room and found themselves wandering up to the nurse’s station.

Jerry sat his ToughBook laptop on the counter and started typing away, finishing his report. Tony wandered back towards the EMS entrance, heading towards the ambulance to help Bill clean up. Bill met him at the entrance with a freshly-made cot and a pile of clean linen.

They headed out to the ambulance and started cleaning up leftover wrappers, sticky backings, and other unidentifiable stuff on the floor. As they cleaned, they chatted about work… and Meghan.