Tomorrow We Die

by Shawn Grady

  TOMORROW

  WE

  DIE

  SHAWN GRADY

  © 2010 by Shawn Peter Grady

  Published by Bethany House Publishers

  a division of Baker Publishing Group

  P.O. Box 6287, Grand Rapids, MI 49516-6287.

  E-book edition created 2010

  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the prior written permission of the publisher. The only exception is brief quotations in printed reviews.

  ISBN 978-1-4412-1212-1

  Library of Congress Cataloging-In-Publication Data is on file at the Library of Congress, Washington, DC.

  This book is a work of fiction. Names, characters, businesses, organizations, places, events, and incidents either are the product of the author’s imagination or are used fictitiously. Any resemblance to actual persons – living or dead – events, or locales is entirely coincidental.

  Scripture quotations are from the New King James Version of the Bible. Copyright © 1979, 1980, 1982 by Thomas Nelson, Inc. Used by permission. All rights reserved.

  For

  Sarah Beth

  “If the dead do not rise, ‘Let us eat and drink,

  for tomorrow we die.’ ”

  – SAUL OF TARSUS

  Contents

  CHAPTER 01

  CHAPTER 02

  CHAPTER 03

  CHAPTER 04

  CHAPTER 05

  CHAPTER 06

  CHAPTER 07

  CHAPTER 08

  CHAPTER 09

  CHAPTER 10

  CHAPTER 11

  CHAPTER 12

  CHAPTER 13

  CHAPTER 14

  CHAPTER 15

  CHAPTER 16

  CHAPTER 17

  CHAPTER 18

  CHAPTER 19

  CHAPTER 20

  CHAPTER 21

  CHAPTER 22

  CHAPTER 23

  CHAPTER 24

  CHAPTER 25

  CHAPTER 26

  CHAPTER 27

  CHAPTER 28

  CHAPTER 29

  CHAPTER 30

  CHAPTER 31

  CHAPTER 32

  CHAPTER 33

  CHAPTER 34

  CHAPTER 35

  CHAPTER 36

  CHAPTER 37

  CHAPTER 38

  CHAPTER 39

  CHAPTER 40

  CHAPTER 41

  CHAPTER 42

  CHAPTER 43

  CHAPTER 44

  CHAPTER 45

  CHAPTER 46

  CHAPTER 47

  CHAPTER 48

  CHAPTER 49

  ACKNOWLEDGMENTS

  ABOUT THE AUTHOR

  CHAPTER 01

  I spent the day chasing the Angel of Death.

  Being a paramedic can be a hard life, living in an ambulance for twelve hours a day, parked on street corners, inhaling reheated 7-Eleven burritos and Red Bull. There are shifts that wear on you, when no matter what you do, even if you run calls as smoothly as possible and do everything just right, that despite all the king’s horses and all the king’s men . . .

  Death walks in without remorse.

  I’ve seen people’s spirits leave them before my eyes. And there is always something different in the room right then, something transcendental, as if unseen ushers are escorting a soul from this world. The entire week had been like that for my partner and me – always one step behind the Reaper.

  So you can imagine my surprise when we actually caught him.

  The harder my partner pushed on the gas pedal, the longer 395 northbound grew.

  I pounded on the dashboard. “Come on, you pig.”

  “That’s all she’s got. Governor’s kicked in.” Bones hunched over the steering wheel, bouncing his head to an inaudible rhythm.

  I felt our momentum level out at seventy-five miles per hour. The management made sure to keep our speed under control, among other things.

  I sat back in my seat, placing my right foot up against the dash and the door. “Is this our third cardiac arrest?”

  He nodded. “Just sifting with his scythe. Folks better break off a hyssop branch, if you know what I’m saying.”

  I had no idea what he was saying.

  But that wasn’t unusual.

  My partner, Thaddeus McCoy, had been called Bones for as long as I’d known him. The nickname seemed especially fitting, even beyond his surname, given that he wore black medic pants – not the dark navy blue like everyone else – and a black leather belt that wrapped around his front with no visible buckle on it. His pants tapered down near the top of his boots, giving his uniform a 1960s Star Trek appearance. He sported a wiry body frame with pale Germanic skin, closely cropped straw-colored hair, and a well-groomed moustache that, were it shaved any smaller above his lip, would bestow upon him a Charlie Chaplin–like countenance.

  Our call had come in as an “unknown man down on the sidewalk at First and West, in front of the church – unknown if conscious or breathing.” Which, at the risk of sounding jaded, was generally code for “drunk guy on the street corner.” But one thing I’d learned as a medic was to never judge too early. And based on the updated report we’d received from dispatch, this sounded like the real thing. A couple minutes into our response the dispatcher advised us that per an off-duty park ranger on scene, our patient was pulseless and apneic, and bystander CPR had been initiated. She also mentioned that the Reno Fire Department had a working structure fire just north of downtown and their next-in unit would likely arrive several minutes after us. If this guy had a chance, we were it.

  “Look, Jonathan,” Bones squealed in a high Mr. Bill voice, holding the radio microphone up by his side window, light posts and cars whizzing past, “I’m the fastest mic in the world.”

  I refused to respond to his impromptu puppet, knowing that if I so much as acknowledged it, I would find myself talking to a derisive plastic microphone for the rest of the shift. I turned my focus to the map book in my lap. “So you want to take Mill downtown and then jog over to First and West.”

  This time Bones spoke in the guttural voice he uses for our ambulance, Medic Two, which through the outpouring of his hyperactive imagination has also grown a sentient, albeit simpleton, personality. “Yes, Jonathan. That sounds good. . . . And I love you.”

  “That’s great.” I cringed with the realization that I’d just validated his anthropomorphic creation.

  “Jonathan,” in Medic Two’s deep, gravelly voice he continued, “I love you.”

  I patted the vinyl on the dashboard as if it were a horse’s neck. “Thanks, Medic Two.”

  “Jonathan?”

  “Yes?”

  “Do you love me too?”

  There was no escaping this now.

  “Yes, yes I do, Medic Two.”

  “More than Medic Seven?”

  “Yes, more than Medic Seven.”

  “Good. I love you too. . . . Jonathan?”

  I looked up at the ceiling of the cab. “Yes?”

  “I’m not a pig. I’m really fast.”

  “You’re right, Medic Two. My bad.”

  Bones greeted other vehicles in Medic Two’s voice as we wailed passed them on the freeway. “Hello. Hi. I love you.”

  At the Mill Street exit, we hit heavy traffic. Most cars pulled to the right, but one older model GMC pickup skidded to a stop in front of us. Bones locked up our brakes and laid on the air horn. I lurched forward in my seat, held tight by the shoulder belt.

  “Pull to the right!” Bones motioned with his hands, mouthing his words with exaggeration. “Pull. To. The. Right.”

  Getting imp
atient, I picked up the PA mic. “Pull to the right. Yes, you. Pull to the right.”

  The driver turned his wheel and rolled right, giving us just enough room to squeeze by on the shoulder to the left. Bones shot a friendly glance his direction as we passed. Already five minutes into our response, the chances of our patient surviving decreased exponentially with every second lost. With permanent brain death occurring after six minutes in cardiac arrest, time was running out.

  We shot past County Hospital and screamed west into the heart of downtown Reno. We wove between and around taxicabs and shuttle busses and passed weekly motels. The snow-covered Sierras disappeared behind the towering casinos. We swung over to First Street, and Bones killed the siren save for a couple whoop-whoops as he brought the box to a stop in front of the church. There on the sidewalk, in the shadow of a hundred-year-old vine-covered Methodist sanctuary, knelt a balding park ranger doing chest compressions on a pale man in a long black overcoat.

  “Medic Two’s on scene – no fire department,” I reported to dispatch and opened the door. The spring air felt brisk. I grabbed the defibrillator off the gurney in back and brought it to the patient’s side, kneeling by the park ranger. “Go ahead and stop compressions.”

  The patient looked to be in his sixties, sporting a scraggly gray beard and wispy hair. Yellowish vomit oozed down the side of his face. His eyes were in a fixed and dilated stare. Bones cut off his shirt. I placed the defibrillator patches on his chest and looked at the monitor to examine his heart rhythm.

  “Coarse V-fib, Bones. Charging to one-twenty. I’m clear – everyone clear.” The park ranger held his hands up and glanced at his knees.

  I delivered the first biphasic electrical shock and watched the man’s body arch in tension and then relax again flat upon the concrete.

  “Still fib. Charging to one-fifty. Everyone clear.”

  I delivered a second shock. No change.

  “Charging to two hundred. Clear.”

  The Shock button glowed a fiery red, the air taut with the high-pitched whining of potential energy.

  God, just let me have this one back.

  My finger met the button. The man’s body surged upward.

  What followed was silence – and the long flat line of asystole.

  I exhaled and nodded to the park ranger. “All right. Let’s resume compressions. Bones, you want me to bag him while you set up to intubate?”

  “Yes, sir, I do.”

  I inserted a curved piece of plastic to hold back the man’s tongue from his throat. And after placing a mask over his mouth and nose, I squeezed the purple bag attached to it to inflate his lungs and breathe for him. “As soon as we get that tube, let’s drop some epi down – ”

  The monitor beeped.

  I waved off the park ranger. “Hold up.”

  The angled complexes of an organized heart rhythm graced the screen’s black background – like a repetitive drawing of a small foothill leading to a mountain peak that dropped into a valley on the opposite side. Slow at first, then more rapid.

  “Sinus tach. We got pulses with that?”

  Bones reached for a carotid pulse at the neck. “I got one here.”

  I felt the patient’s wrist. “Yeah, me too. I’ve got radials.”

  We’d gotten him back. Hope sprang forth in me. Only time would tell if we’d saved his heart but not his brain.

  He was still unconscious, so Bones zipped open the intubation kit and prepared to place a breathing tube down the patient’s throat.

  I wrapped a tourniquet tight around his arm. The only vein I could feel popped up in the crook of his elbow. I swabbed it with alcohol and inserted the needle. A burgundy flash of blood filled the needle hub. I advanced it just a tad more before threading the plastic catheter into the vein.

  “Sharp out.” I placed the bare needle flat on the sidewalk and hooked up IV tubing connected to a bag of saline.

  Blanket protocol for a patient on the streets like this involved a medication called Narcan to reverse the effects of possible heroin overdose. I administered the standard dose and squeezed the IV bag to flush it into his bloodstream.

  Bones clicked into place a curved steel blade on a cylindrical handle. He twirled the sickle-shaped laryngoscope in his left hand and pulled out the short piece of plastic that held back the patient’s tongue. He positioned the head and shined the light from the end of the laryngoscope blade down the man’s throat. With his opposite hand, he angled an endotracheal tube in toward the vocal cords.

  The park ranger stood wide-eyed, staring at the twisted progression of it all.

  I picked up the needle from the pavement and plunged a drop of blood onto a glucometer to check our patient’s blood-sugar level. The display flashed a normal reading.

  Bones withdrew the laryngoscope blade and picked up the bag mask. He seated it over the man’s mouth and squeezed. “I’m having a hard time seeing down there. I’ll give it another go.”

  He set the bag mask down and positioned himself for a second attempt. He squinted down the man’s gullet, his fist straining to keep the handle in position.

  Our patient bolted upright.

  Bones flipped on his back, the laryngoscope skidding away like a hockey stick on ice.

  The man flashed wild eyes, found me, and grabbed my shirt collar. He labored to breathe, staring with constricted pupils and sweat beading on his brow. His mouth trembled, trying to form a sentence.

  He found words with a winded, raspy voice. “Arepo . . . Arepo the Sower.”

  “Hey, it’s okay. We’re the paramedics. Here, let’s lay you – ”

  “Listen.” He grabbed the back of my neck, struggling to keep himself upright. His hands felt dirty and rough. “Arepo the Sower . . . holds the wheels at work.”

  I shook my head and lifted his arm away. “He’s delirious. Here, you need oxygen.”

  He slipped back toward the concrete.

  “Here, yeah, lie back. Bones, let’s throw him on some O’s.”

  Bones reached for an oxygen mask. The man tensed and winced, his heart rhythm oscillating on the heart monitor.

  Bones shifted the screen to see it. “He’s throwing runs of V-tach.”

  The man reached inside his coat and, with a trembling hand, produced a folded piece of notebook paper. He grasped my forearm and forced it into my palm.

  “Martin.” His eyes locked with mine. “Give this to Martin.”

  CHAPTER 02

  The defib alarmed.

  Color drained from his face.

  I squeezed his shoulders. “Wait. What? Who’s Martin?”

  Bones picked up the laryngoscope. “He’s bradying down.”

  The man slumped to the sidewalk. On instinct I rolled him away from me. It wasn’t five seconds later that he spewed yellow chunks all over the park ranger’s shoes.

  Bones cleared the man’s mouth with the portable suction catheter.

  A vigorous sternal rub didn’t wake him.

  Bones reset his intubation equipment and talked to himself. “GCS less than eight. Intubate.”

  A fire engine siren blared a couple blocks out.

  Things moved too fast to process.

  Slow down . . . stick with ABCs.

  Airway.

  His respirations were shallow and slow. His skin felt cool and sweaty. I held his wrist but couldn’t find a radial pulse anymore, only a thready carotid on the neck at thirty beats per minute. Bones placed his stethoscope in his ears one-handed, the other hand holding an inserted tube at the man’s lips. He listened to lung sounds to make sure his tube was good.

  Airway secured. Progress. The rumble of a fire engine exhaust brake sounded behind me, followed by the squeak and hiss of an air brake.

  We needed to get our patient’s heart rate up before it stopped beating again. “Bones, I’m gonna try to pace him.”

  I set the defib to deliver sequential minishocks of electricity to our patient’s heart. The pectoral muscles in his chest twitched. Hea
rtbeats flicked faster on the display. “Okay, we’ve got electrical capture.”

  Bones nodded. “And I’ve got radials with that.”

  A firefighter walked up. “Where you guys at?”

  “Let’s grab a quick blood pressure and then load and go.”

  The fire captain clipped a radio mic to his shirt. “Saint Mary’s?”

  “Yeah, that’ll be closest. Mind if we take two of your guys?”

  “Not at all.”

  One firefighter moved to the man’s head to squeeze the bag now attached to the breathing tube. The other pumped the handle of a blood-pressure cuff with a stethoscope in his ears.

  He bled off the air. “Eighty-two over fifty.”

  “Okay.” I blew out a quick breath. “Let’s roll him on the flat and get him loaded onto the gurney.”

  We buckled the patient on the bed. My eyes met the park ranger’s. “Thank you.”

  He gave a nod.

  I climbed into the back of the ambulance.

  Bones looked back through the doghouse, the small opening between the cab and the patient area. “All set?”

  “Let’s roll.”

  He flicked on the siren and set off for the ER. I found myself wishing I had gathered more history on scene. Had our patient been complaining of anything before he passed out? Did he simply go into spontaneous cardiac arrest? Had the Narcan helped at all?

  I turned my focus to a vial of amiodarone and inserted a needled syringe to draw it up. The medication would deter his heart from going back into a lethal rhythm. I flicked the bubbles to the top of the syringe and injected the contents into a second IV bag I’d hung from the gurney pole.

  The siren shut off and the ambulance jostled into the parking lot. It turned, the back-up alarm sounded, and through the back windows the emergency room doors drew closer. The firefighter across from me reported another blood pressure similar to the first.

  Questions about the patient abounded in my mind.

  What happened to you?

  What were you trying to tell me?

  I took a last listen to lung sounds to ensure the breathing tube was still in place, then stood up and organized the myriad wires and IV tubing aboard the gurney.

  “All right. Monitor, O2 bottle, tube’s secure, IV bags and tubing . . . we’re all set.”