The left side of his heart, the left ventricle more properly, was in distress from lack of oxygen. Somewhere in the thick muscle wall an artery was narrowed, maybe even closing.
“I’m afraid you are having a heart attack, sir. So—”
“Shit.”
He paled further and Keller placed a hand over his. “You did all the right things—calling us, taking your own ASA—and there’s a lot we can do and the hospital can do to fix this or at least make it not so bad.”
Reynolds glanced toward his wife. “All right, I guess.”
Lang eyed the 12-lead printout as Keller applied the pads to Reynold’s chest. “Transmitting now.” A simple button press and within seconds the man’s ECG would be arriving at Foothills hospital. “Nothing posterior. Nothing on the right side.”
“That good?” Reynolds asked.
Keller squeezed his hand. “‘Good’ would be you and I having breakfast at Ricky’s Grill down the block. This is ‘not bad.’ We’re going to give you some nitroglycerin—a spray under the tongue. Really helps. You haven’t had any pills you haven’t told us about, now, have you? Viagra or Cialis can really mess with the nitro.”
Reynolds chuckled. “Not unless Starbucks is slipping it into their cappuccinos.”
“Not a bad idea, right?” Lang shared a smile with him. “Maybe you should be in marketing.”
Keller continued her examination of Reynolds. Palpating peripheral pulses. Exposing his chest and abdomen. “Gotta check you head to toe, okay Mr. Reynolds? Make sure you’re not carrying any concealed weapons.”
He chuckled. Keller saw his oxygen sat was 94 percent now. No doubt he was feeling more comfortable. She auscultated his chest, running her stethoscope from one side to the other.
“Bilateral crackles to the bases,” she said and exchanged a look with Lang, then focused on Reynolds again. “You coughing anything up? Or felt like you had a cold or anything like that lately?”
“No… Haven’t had a cold since last winter.”
Lang raised an eyebrow. It might be that Reynolds was developing pulmonary edema. A weak left heart compromised by the developing infarction could backlog blood in the pulmonary circulation. If the backpressure was high enough, plasma would be forced into the alveoli, the tiny air sacks in the lung where oxygen exchange occurred, leaving the patient with increasing shortness of breath.
But a dose or two of sublingual nitroglycerin would help and they had CPAP if things got worse. The Continuous Positive Airway Pressure device EMS carried looked like something out of a Crackerjack box, but it worked wonders.
The firefighters came back with the stretcher and positioned it at the base of the front stairs. The newer power-lift stretchers were behemoths, heavy to the point of near uselessness on rough ground and there was usually little point trying to maneuver them inside houses, but theirs was close enough now that Reynolds could be carried to it with reasonable ease.
Mrs. Reynolds stood back, watching events unwind—watching a pivotal point in her life unwind, perhaps—clutching at her bathrobe, her mouth open as if to protest that none of this should be happening.
Keller turned to her. “Time for us to go. We’ll probably be going to the Foothills. Anyone you can call to drive you there, ma’am?”
“We have a car. I can meet you there.”
“Best not, ma’am,” Lang said, “unless you’re positive you’re up to it.”
“Call your sister,” Reynolds said. “Don’t want you driving upset.” He tried for a smile.
The woman blinked back tears and moved to retrieve her phone. “All right, I guess.”
Keller retrieved the nitroglycerin from their kit and checked it while Lang stepped back and checked the Regional Emergency Patient Access and Coordination system on the computer. “Good deal,” she said to Keller. “REPAC says Foothills isn’t super busy this morning.”
Miracle of miracles.
Lang raised her hand and mimed making a phone call. When Keller nodded, she stepped away to contact one of the emerg physicians at Foothills, with whom she would discuss getting Reynolds quick access to the Cardiac Catheterization Lab, where his clogged coronary artery could be dilated and a stent placed to restore its blood flow.
As Lang talked, Atchison retrieved a tarp from the stretcher and together with the firefighters, maneuvered Reynolds onto it. A half minute later he was on the stretcher proper, and they were pulling blankets up over him and securing belts around his torso.
“Don’t worry,” Atchison said, “we haven’t dropped anyone today.”
Keller’s cue to say, “Of course, you’re our first patient.”
Reynolds laughed outright this time. “You bastards.”
Thirty-Five
No matter how many renovations and redesigns the Foothills ER had undergone over the years—and there had been many—every time Keller drove into the ambulance bays, she imagined it as it had been the night of her first visit a dozen years prior as a paramedic student on her very first shift: blood and fear and anger, tart and thick in the air, crowding out the oxygen.
Still shiny, still under warranty.
Keller and Lang had brought in a forty-year-old woman with renal colic, and unfortunately, Foothills had gone from routine bedlam to true and literal chaos moments before they’d arrived.
Two Asian gangs had clashed in a 17th Avenue bar, leaving police and EMS with a genuine “four on the floor.” Four dead and three others still wiggling and bleeding all over the linoleum by the time EMS arrived, all of the latter in imminent danger of joining their pulseless brethren in the great beyond. Their friends, itching to continue the fight, had followed them to the Foothills, and the place was like a tinder-dry forest in a lightning storm by the time Keller and Lang wheeled their patient in. The cops had arrived just in time to keep the spark from being lit, but Keller had never forgotten the moment when the caregivers were grossly outnumbered by those who wanted to kill and maim. Wasn’t that the way of the world?
Damn, you were philosophical back then, she thought as they wheeled Reynolds’s stretcher out of the ambulance bay.
They’d administered three doses of nitroglycerin to Reynolds before they hit Foothills and his chest pain was easing nicely. If all went well, he’d be in a PCI lab in a few minutes. Percutaneous Coronary Interventions had always sounded like a halfway decent name for a grunge band to Keller, but the people in the cath lab never appreciated the observation. Too busy saving lives. Go figure.
Despite REPAC’s optimistic forecast, Foothills ER was chock full. That is to say, it was experiencing the normal number of patients, which was too many to handle. But these days the medics and the nurses and physicians who scurried down the crowded corridors were content if it was simply “too many” rather than “many too many,” such as occurred on bad Friday nights or at the height of flu season.
They parked Reynolds by the triage nurse who—behind a Plexiglas window—spent her shift like a contestant on a quiz show. “I’ll take undiagnosed aortic aneurysm for a thousand, Alex.” Triage sorted the truly sick from those who could wait—the folks with problems that might kill them quickly from those with simple food poisoning, indigestion, flu, and psychological emergencies. And occasionally addicts, seeking narcotics.
Many of these were skilled actors who knew just how to play the back-pain card. All ages too. Keller knew a Drumheller ER doc who saw the same seventy-year-old LOL in NAD (Little Old Lady in No Apparent Distress) every week. Hip pain, knee pain, foot pain. Sometimes halfway through the assessment, she would forget which one she was complaining about.
“She’s an addict, no doubt,” the doc had told her. “But what am I going to do? Fix her? She’s seventy, she’s lonely, and she probably is in a lot of pain.”
How everyone starts. Keller had known it for a long time by then.
They worked their way past the ambulance crews waiting in “EMS Park,” still caring for their patients in the hallway until beds became available. These w
ere people whose ailments likely weren’t going to kill them anytime soon. Minor fractures, renal colics, migraines. A lot of them would be in the hall for hours—in pain, unable to sleep, shitting in bedpans with zero privacy.
First class all the way.
The paramedics attending these patients did what they could to ease their pain and keep them clean until somewhere up the line in some faraway ward a patient was discharged or died and a bed became available so that a patient in an ER bed—who might also have been there for hours or days—could be shuttled upstairs. Then and only then, someone caught in EMS Park purgatory would be granted entry to the hallowed halls of the emergency room.
Keller saw that the triage nurse was smiling, a rarity in itself. The ER actually had monitored cardiac beds available; and miracle of miracles, the pipeline to the cath lab was running fast.
All kinds of good. If Reynolds got to the cath lab within the hour and the crew there hadn’t taken up Keller’s suggestion about starting a grunge band, they’d run a stent up into his blocked artery, anticoagulate him, and call it a win.
They cleared Foothills thirty minutes later and the rest of the morning was mostly uneventful. Proxima diverted them back into the northwest and dispatch fired them out to three more calls before noon. Fractured ankle—a sixty-year-old man who’d slipped off a stepladder cleaning his gutters. He decided his wife could drive him to urgent care and they’d cancelled on scene.
Then a low-speed Motor Vehicle Collision where no one was really hurt, no one knew who had called, and no one wanted anything to do with them.
“‘Motor Vehicle Collision,’” Lang said and shook her head as they climbed back into the unit. “Like the cars did it.”
“What’re you barking about now?” Atchison said from the back of the unit, a book splayed across his lap again.
“Don’t get her started.” Keller had heard this rant before.
“Used to call them ‘Motor Vehicle Accidents.’”
“Yeah, I’ve heard that,” Atchison said.
“It’s not PC anymore.” Lang shrugged. “‘All accidents are preventable’, right? So now we’re only allowed to call them collisions.”
“I guess I get that too,” Atchison said. “Some of the old guys still call them MVAs.”
“‘Old guys’?” Lang caught Keller’s eye and laughed. “You’re buying lunch for that one, shithead.”
“Hey, I’m a student. Why am I buying lunch?”
“That last guy?” Lang said. “On the ladder?”
“Yeah.”
“You think he had a ‘ladder–ground collision’?”
Atchison was silent.
“Or maybe just an accident?”
“Of course it was an accident.”
“That’s why you’re buying lunch,” Lang said.
But they didn’t get lunch.
On the next call of the morning, dispatch sent them to a murder.
Thirty-Six
It began even before the call came in.
In the old days, as Atchison might’ve said, the medics on any given ambulance had a constant sense of the rhythm of the city—what sector was busy, who needed help, which units were having a lazy night.
It was different now. Mostly because everyone was busy, all the time. You picked up a patient, the great god REPAC fired you toward the emptiest hospital, and when you arrived you hoped for a short-term sentence in a puke-yellow corridor with EMS Park.
When you cleared the hospital, Proxima’s AI shot you into an area that needed coverage. Except it didn’t always. Sometimes Proxima sent you to stations where another ambulance had already arrived. Sometimes you wound up running lights and siren right past other ambulances that could’ve made the call sooner. Most people didn’t pay attention anymore.
But Lang was old school, couldn’t help but keep that rhythm in her head. And Lang had mentored Keller, so Keller was attuned to it too.
“This is odd.” Lang tapped at the computer, looking at unit placements. “See this? Not a car in the whole northwest. And these?” She pointed at two incidents in the far southeast. “Multiple shootings? Strange. Good neighbourhoods.”
“What’s the big deal?” Atchison asked.
“It’s a weird vibe,” Lang said.
Keller peered at the screen. Lang was right. The city’s northwest was emptying.
“Yeah, but we can get coffee number two and chill, right?” Atchison said. “And I get to study for once.”
“Good for you, Medschool.” Lang was still examining the map when the call came in.
“One Alpha Thirty-Six, One Alpha Thirty-Six. Got you at Shaganappi and Crowchild. Take a hard left. Call coming in.”
The computer chimed and details flashed up on the screen. Charlie response for an abdominal pain at 43529 Bearspaw Close Northwest. Sixty-three-year-old male with history of gall bladder problems complaining of abdominal pain.
Lang grabbed the mic. “Roger that—switching to channel two.” She adjusted the radio, then called back in. “Dispatch, Thirty-Six responding. Details clear here? No need for police? Backup?”
Empty static for a few seconds, then… “One Alpha Thirty-Six, I’ll send you anything you want, but no indication of hazard. Over.”
The voice was quizzical, and Keller could see why. According to the computer, EMS had been to the same house for similar complaints three times in the previous year.
“Roger that.” Lang looked at Keller and shook her head. “Sorry. I’m being silly.”
As Keller made the recommended hard left onto John Laurie Boulevard and put her foot down on the accelerator, she glanced at the screen again. They were the only EMS unit north of 16th Avenue and west of Shaganappi Trail; the only ambulance in nearly fifty square kilometres.
They sped on up Crowchild Trail, and then up into Bearspaw.
The sun was high and the sky blue.
Thirty-Seven
It was just past 1400 when Keller guided the ambulance up a long, paved driveway that twisted up toward the house proper, branching into a circle in front of the three-car garage. The house was surrounded by lush, well-tended gardens and had ivy covering its red-brick walls. She slid the unit into park and Lang punched the Arrive button on the computer.
Peering through the passway between the front and back of the unit, Atchison whistled. “Calgary version of a castle.”
“We bring everything in,” Keller said, stepping out of the unit.
Atchison sighed as Lang nodded. Keller knew medics who walked into chest-pain calls empty-handed, for God’s sake. It was lazy. Together the three of them shared out the O2, the various kits, and the cardiac monitor.
The front door was hanging open like a wound, giving Keller pause as she walked up the front path, the others behind her.
Are you nervous because you’re broken or because there’s actually something to be nervous about?
She traded looks with Lang, who shrugged as Atchison leaned against the eight-foot, hand-carved cedar doorframe, cupping his hands around his mouth to call out, “EMS. Ambulance. Hello?”
There was no response, which was unusual but not so far out of the ballpark as to be disconcerting. Abdo pain meant the guy might be busy puking his guts out in the bathroom.
Keller pushed passed Atchison and stepped inside, Lang on her heels. “What’s this guy’s name again?”
“Louis Herzog.”
The foyer was wide and circular, with a pale marble floor crisscrossed by inky veins. Two oval mirrors framed in copper hung on opposite pastel walls just inside the door, casting repeating reflections of the three of them backward into eternity.
“Mr. Herzog.” Keller raised her voice when she got no response. “Mr. Herzog?” To their right was a dining room with a long mahogany table at its centre and an enormous china cabinet at its far end. To their left, an anteroom with two chairs.
Atchison moved to the base of the wide stairs that curved upward to the second floor, and a third floor beyond that, if
Keller judged correctly. He tipped his head back and called Herzog’s name loudly.
Lang moved into the hallway behind the stairs, where another passage offered glimpses of sunlight glinting off aluminum appliances. The kitchen.
Keller stepped into the anteroom and called again, then looked through a doorway to her right and saw a shadowy living room about the size of her whole house. There were windows on the north and west sides, but the curtains were drawn, though she could make out the familiar shapes of bookcases, sideboards, sofas, and the flat black stare of a widescreen TV. And there was a familiar smell coming from the room. Shit, and beneath that, blood.
A human form sat in the middle of an easy chair before the TV.
A shiver ran up Keller’s spine as she groped for a light switch.
“Mr. Herzog?”
The light flickered on and the room fell into sharp relief.
Louder. “Mr. Herzog?”
The man’s form didn’t move and a chill rippled through her hindbrain. But how could this be happening again? The farm had been an anomaly, that once-in-a-lifetime event. But that wasn’t really how the universe worked, was it? Lightning did strike twice; in fact sometimes dozens of times in the same place, if the storm were bad enough.
“Herzog?”
The figure in front of the TV hadn’t so much as flinched at her voice.
Keller heard the soft echoes of her partners calling out as they moved through adjacent rooms and knew she should alert them, but something kept her quiet. A crazy thought that she’d sailed through insanity once and so was somehow immune to drowning in it now.
Then she saw the message on the wall above the slumped figure in the easy chair, scrawled in bright-red smears of blood.
She stepped toward the bloody scrawl in a daze. The form in the chair was still unmoving, and now she saw why.
The Beast in the Bone Page 17