The Beast in the Bone

by Blair Lindsay

  That had been six months ago. She wondered what Wong thought of her now. Would she feel worse if he were disappointed or unsurprised?

  Those thoughts fled as Grainger walked into the admin area, a bit of a saunter in his step. He gestured for her to precede him into his office and pointedly left the door ajar. He was almost but not quite suppressing a self-satisfied smile.

  “Well, well… Killer Keller. Good to see you.”

  Keller had imagined she might wear that kind of nickname, but she doubted Grainger was smart enough to think of it by himself so… it was on the street too.

  “Good to be back.”

  Grainger’s face darkened a little. He was asshole enough to expect a “Good to see you too” even after an insult. Keller imagined her expression showed how broken up she was about his injured feelings.

  He scratched at his chin. “Wouldn’t have wanted you back myself, I gotta tell you.”

  “You do, huh? Gotta tell me?”

  “Yeah, I do.” He spread his hands and smiled. “But these days, we get all sorts of fuck-ups back on the job. Alkies… druggies… ‘PTSD.’” His hands came up to form mock quote marks when he said PTSD and Keller felt her antipathy for the man grow by an order of magnitude. Not just on her own behalf, but for a dozen friends who’d developed some of the same symptoms she had after years of seeing misery and pain on the street.

  Grainger, leap frogging after a scant few months on the car up to management, had either had his psyche spared or was inured enough against human emotion that such things didn’t affect him anyway.

  Keller looked him straight in the eye. “When you’re right, you’re right. All sorts of fuck-ups on the job. All sorts of unfeeling bastards too. Good thing some of them are in management. Not taking care of patients that way, at least.”

  Grainger absorbed that with a chuckle. “You know why you’re back in Calgary Metro, right? Killer Keller?”

  In fact, Keller did not. She had been based out of Drumheller when the fentanyl hit the fan.

  “Do tell?”

  He leaned forward over the desk. “So I can keep an eye on you.” Again, Keller sensed he was lying, that he had nothing to do with her new job in Metro, but she saw no point in debating the subject. “And you’ll do reorientation. Two tours. You’ll be riding with an ACP and PCP.”

  Advanced Care Paramedic, like she was. And a Primary Care Paramedic, like poor Jonas. She’d be third on the car, being babysat.

  “Well, I feel all protected.”

  “You’ll be piss tested too,” Grainger said. “Every shift for the next two years, at least.”

  Keller simmered, eyeing the coffee cup sitting on Grainger’s desk. A grinning dolphin was emblazoned on one side with Mazatlan – Mexico inscribed beneath. The dolphin was holding a beer in one flipper and winking.

  “Gave some to the nurse on my way in, but I think I could manage again if you want some more.”

  Grainger followed her gaze to his cup, his expression hardening. “Don’t you think for a second I won’t be watching you.”

  “Hey, that sounds a little creepy, Drew.” Lang was leaning in through the door, grinning at Keller. “Hey, girl. Good to see you wearing blues again. You ready to ride?”

  She was riding with Lang? Someone must have pulled strings. Wong?

  Grainger turned baleful eyes on Lang. “This is a private meeting.”

  Lang held the stare without letting her smile slip even a millimetre. “Sorry, but you left the door open.” She tapped at her watch. “We want to be on time for shift, right?” She pointed at him, with two fingers instead of one like a pistol, but Grainger didn’t seem to notice. “I know how much you hate late turnovers, boss. Overtime, right?”

  “Well…” Grainger looked indecisive.

  “Let’s go, Ash,” Lang jerked a thumb over her shoulder. “We’re hitting the road in ten.”

  Keller rose, waiting for Grainger to object, but he seemed to sense the moment had passed him by. Lang laid a hand on her arm and dragged her out into the corridor and off toward the ambulance bays.

  “You’re stationed in High River,” Keller said when they were well away from Grainger’s office. “What the hell are you doing here?”

  “Was in High River.” Lang shook her head. “Think I’m going to let you party in the big city without me?”

  Keller winced inwardly. Two years earlier, Lang had transferred to High River in search of a quieter life. Small towns weren’t immune to traumatic events, of course, but they tended toward the stability of families and long-time residents. They felt safer. It was sometimes an illusion, but a comforting one. Lang had now sacrificed it to partner with Keller again.

  “Bullshit. You don’t—”

  “I called in a favour,” Lang said. “No big deal. You know that Grainger would’ve put you with the worst burnout he could find.”

  “Worse than you?”

  Lang grinned. “You little asshole. You’re buying coffee for that.”

  She felt nervous, suddenly. As if it were her first day on the job all over again. If you can’t handle things with Kate as a partner you’ve got no excuse, do you?

  She would’ve sworn Lang saw all of it, knew exactly what she was thinking, because she slung an arm around Keller’s shoulder and drew her close. “Let’s go fuck up Grainger’s expectations, huh?”

  Thirty-Three

  Keller drove.

  By all rights, she was third on the unit, being on reorientation. Third on the car was usually a student. That meant you sat in the airway seat in the rear patient-care compartment while the two veterans rode up front. But their PCP, a twenty-four-year-old kid named Tyler Atchison, whose blond hair and perfect teeth put Keller in mind of a Cali surfer boy, had brought a backpack full of textbooks—med school on his horizon—and was happy to sit in the back and study.

  So Keller drove. Driving usually meant an easier day. Sure, you’d help out with patient care on scene and do most of the unit cleanup at hospital, but the attending medic was at the pointy end most of the day, making all the final patient-care decisions and juggling half a dozen medications and procedures en route to hospital, if it was a busy call.

  Except Keller was on reorientation.

  That meant she would do double-duty, triple-duty whenever on offer. Drive to calls, perform assessments and patient care while Lang or Atchison drove to hospital or clinic, document it all at the end, and help restock the unit afterward. A busy day, but Keller knew without even asking it was what Lang had in mind: not to test Keller, but to show her Lang knew she could handle it.

  Before all that, though, Keller led them through checklists. Start of Shift Requirements. A checkout of the computers, the vehicle, and supplies and equipment including all medications—heart drugs, anti-emetics, paralytics… a dozen others. And narcotics.

  If there were little things to be proud of in Keller’s post-train-wreck world, one might have been that she’d never thieved any narcotics from EMS.

  Yeah, you took the high road and got a dealer.

  Narcan, though… that had been different. Your average dealer, even a full-service We have a lovely selection of coke, weed, or meth kind of dealer usually didn’t stock Narcan.

  She had taken it from the automated Pyxis dispensaries in the hospitals, high-dose stuff to inject if something went wrong while she was trying out a new batch of fentanyl. She rationalized it—and couldn’t you just about rationalize anything when you were an addict?—by telling herself she wouldn’t have needed the fentanyl in the first place if not for what she’d seen on the job.

  Narcan was maybe the one drug AHS would never have noticed going missing from its dispensaries because they were in the middle of an epidemic, the “opioid crisis.”

  It wasn’t just the classic “addict” dying anymore—the guy in the alley with the needle in his arm. What laypeople thought of as “normal” people were dying, too, and lots of them. Your neighbour’s mom, your daughter’s elementary school tea
cher, your cousin’s hockey coach. Turned out that an awful lot of those “normal” people had opioid dependencies.

  Before the crisis, these nice normal addicts found doctors who’d write them scripts or else bought Oxycontin—still a manufactured drug and safer by far than street stuff—from their dealers. But a few years earlier, governments had started monitoring narcotic-prescribing practices more closely, and the company that made Oxycontin—Purdue—became the target of government investigations and lawsuits. Suddenly good old-fashioned Oxy was a lot harder to get.

  No problem, not with fentanyl available. The Mexican cartels, Sinaloa particularly, were overjoyed at the government “crackdown.”

  Except the fentanyl that the Sinaloans were smuggling in was potent almost beyond measure, and the cartel was unfortunately not possessed of the Walter White Breaking Bad professionalism that would’ve ensured end-point manufacture of non-lethal doses of the drug. When portions of fentanyl as small as a few grains of salt could mean the difference between life and death, a lot of people started to die.

  Narcan began flying off the shelves of dispensaries in hospitals as if it were a Black Friday special. Before long Keller didn’t even have to steal it. The epidemic was so bad that pharmacies began giving it away in kits to anyone who asked for one.

  Here’s a five-minute cure for your addiction. Sorry we can’t get you into the long-term care that would actually get you off the drug, but hey—good luck.

  Hashing this over made her remember Philby’s question. If she was truly ambivalent about living, here was more evidence. She’d had easy access to medical-grade, non-lethal narcotics and never used it.

  “You ready to go?” Lang said, nudging Keller on the shoulder.

  Keller realized she’d been staring at the open med kit. “Yeah, I’m good.”

  They finished crosschecking the rest of the unit and got on the road. Keller punched a button that showed them as available to both dispatch and the Proxima software system, and they were immediately directed westward on Country Hills Boulevard. There were no immediate calls on deck but the northwest was emptier than it ought to be, so that was where Proxima shot them.

  Atchison pointed out a Starbucks three blocks away. “Let’s hit that.”

  After they all had coffee in their hands, Keller nodded at Atchison’s pile of books. “You’re going to med school?”

  “That’s right.” His voice echoed in the patient compartment. “You think I want to spend my life in this engine of destruction?”

  “Keep telling you you’re too literary for med school, Ty,” Lang said.

  He peeked into the cab via the pass-through. “They want today’s doctors to be well-rounded, hadn’t you heard? I’ve read all the classics, studied music, and now I’m spending a few years on the mean streets.”

  “‘Mean streets,’” Lang mocked, eyeing Keller. “Every minute he’s not on a call, he gets paid to study.”

  “And I can pull some shifts while I’m in school too,” Atchison said. “To mitigate those student loans.”

  “Hard going, med school.” Keller sipped at her venti, making conversation mostly to tamp down her nervousness. The last time she’d driven an ambulance had not ended well, after all.

  “Harder here, though, right?” Atchison said. “Crazy busy, crazy stress. System’s bursting at the seams. PTSD skyrocketing. All that.”

  Keller eyed Lang.

  “He knows who you are.” Lang’s smile was a little sad. “Knows who I am too.”

  “Glad to be working with you.” The earlier lightness was gone from Atchison’s voice.

  “Is that right?” Keller said.

  “PTSD is skyrocketing, or more likely it’s just being reported more. I heard a little bit about… what happened to you. Kate says you’re good people.”

  “He’s just trying to keep you calm,” Lang said. “I told him you’re a nutcase, could snap at any time. That’s the real reason he wanted to sit in the back.”

  “It’s all true,” Atchison said.

  The radio came to life. “One Alpha Thirty-Six, One Alpha Thirty-Six, we have a call for you.” Their dashboard CAD computer chimed and details flowed across the screen in typically disjointed factoids. 10-Delta at 445 45th Avenue Northwest. Patient is conscious, short of breath and sweaty. No signs of shock. Sixty-three-year-old male complaining of chest pain, history of high blood pressure. No previous EMS responses. Delta response, fire is en route.

  Lang punched the En Route button on the computer while Keller looked ahead. Traffic was congesting around the next red light, but only in their lane.

  She flicked on the lights and siren, easing the steering wheel left and swinging the ambulance into oncoming traffic, feeling the familiar thrill. The sole car coming toward them, a Honda Civic piloted by a bearded man whose head was down as he texted, lurched suddenly sideways as the driver registered the siren and their looming presence.

  Keller played with the wheel, danced the ambulance around the Civic, and heard thumps behind her as Atchison’s books flew across the patient compartment. She eased them to a brief halt at the red light, crowding the wrong lane with siren blaring, as if the ambulance were a barroom brawler, challenging the other vehicles. When she was certain it was safe, she thrust her foot against the accelerator and surged ahead, weaving the unit back into the right lane.

  Behind her, she heard more books flying.

  “Damn it!” Atchison scrambled to retrieve his schoolwork.

  Lang laughed and looked over at Keller. “Welcome back to the jungle.”

  Thirty-Four

  The chest pain call turned out to be what a lot of chest pains calls were.

  The condo was nice, decorated in a southwestern motif. Hardwood floors.

  Patrick Reynolds sat in an easy chair in the living room, TV on and tuned to CNN. He looked pale and had a hand on his chest, massaging the area around his sternum.

  Though Keller hadn’t worked with Atchison before and Lang in a long time, they quickly fell into a natural, instinctual rhythm. Atchison took Mrs. Reynolds into the kitchen with the computer, used for what—in an earlier age—would have been paperwork, such as recording Alberta Health Care info, insurance, medications, allergies, past history… all the rest. If any EMS unit had attended the Reynolds house in the last few years, Atchison could’ve called up such info from the previous record, but Patrick Reynolds was a brand-new customer.

  Mrs. Reynolds was crying despite Atchison’s best efforts to calm her. And who wouldn’t? Strangers in your house, connecting wires and devices to the man you’ve lived with for forty years, raised children with, fought and loved and grown old with. For many people, an ambulance arriving at your door was the first piece of concrete evidence that life was finite.

  Physicians didn’t see this. When you went to a doctor, you were in their office, at their work. Paramedics went into people’s houses, saw them full of disease and trauma and fear, stripped of dignity and clutching at hope… in their homes, which were just enough like Keller’s home that she realized again and again, on every call, that no one is really ever truly safe.

  A bleep of siren as a fire pump pulled up outside. Standard fire response for certain calls, chest pains among them. Keller saw men and women coming down from the truck, consulting with their lieutenant, who sent two of them up the walk.

  Keller knelt beside Reynolds, made eye contact, and introduced herself, then wrapped her fingers around his wrist and found his radial pulse pounding a slightly erratic dance against her finger. Like Morse code. An SOS.

  Lang slipped a probe on his finger and found his room-air saturation—the oxygen in his blood bound by hemoglobin—was 89 percent. Not catastrophic but low enough to explain his shortness of breath.

  Keller whispered reassurances and slipped the twin horns of nasal prongs into his nose as Lang tied an orange rubber tourniquet around his upper arm and frowned critically at the thin spider-web veins, only slightly engorged by the tight band. Finding a
nice fat vein, not too crooked, that she could thread a needle through was like drilling for oil at this point.

  “You allergic to anything?” Keller asked. “Aspirin? Ever taken it before?”

  “You kidding?” Reynolds said. “I take it once a day, just like my doc says. Seven years now.”

  “We’re going to give you some more.” She shook two pills out of the bottle in their med kit and handed them to him. “Chew them up really well and swallow.”

  “But I took mine already today.”

  “This is one of those ‘some is good, more is better’ things. Minimal dose, but it works like a son of a bitch. Best thing for you right now.”

  He grinned and took the ASA tabs from her, chewing and swallowing as she took in the room. Pictures covered nearly every wall surface. She saw Reynolds on a tractor, surrounded by children and grandchildren in a field of canola. Reynolds and his wife might be condo dwellers now but they had clearly grown into old age on a farm.

  The firefighters entered, nodding at the ambulance crew, asking what they could do.

  “Maybe the stretcher?” Keller said, and the two excused themselves and darted back out, heading for the ambulance.

  “So… I am having a heart attack?” Reynolds looked from Lang to Keller. His wife was hovering over them, teary-eyed.

  Reynolds was indeed having a myocardial infarction, a coronary, a STEMI. Lots of ways of saying “heart attack,” though Reynolds’s 12-lead ECG said it to Keller and Lang in far more analytical terms.

  A normal heart rhythm had five individual elements, repeated endlessly as traced on an ECG. The P wave was first, the minor hillock wave of the atria—the dorsal compartments of the heart—contracting to prime the big guns, the real pumps, the large chambered ventricles in the lower heart.

  After the P wave came a subsequent QRS—a peaked mountain on the cardiac monitor. The QRS signalled ventricles depolarizing and squeezing blood up into the lungs and aorta and all around the body.

  The T wave came as an epilogue. The heart repolarizing, recharging. But as with most epilogues, that was where the truth of the tale unfolded. Radical changes in Reynolds’s ST segment bespoke a heart attack in progress. Reynolds had ST segment elevation from leads V3 through V6. Lead 1 as well, for the closer.