Warning – This is not a medical text book; this is a work of fiction designed to feature my favorite character, Dr Kelly Brackett.
Thank you to my dedicated beta Judie who spoon fed me during the making of this story, my friend Julie who was inundated with way too many medical questions during our recent holiday, Sheila for more medical back up and Kayaklady for the final read through and turning any Aussie-isms into Americanese.
Kelly Brackett made his way towards the nurses' station with his head down and a determined look on his face which didn’t quite match the awkward stride to his step.
"Morning, Kel," Dix said, leaning forward on the counter when she saw him approaching.
A quick glance to his right and an upward shift of his left eyebrow accompanied a brusque, "Hello, Dix."
Dix frowned, studying the way he was walking. "Kel, you're..."
Brackett held up a hand. "Don't say it." Then he disappeared into his office and shut the door.
"...limping," Dix finished to no one in particular.
Fine, she thought, and took another sip of her coffee. "But don't think you'll be able to spend the whole day hiding in your office," she mumbled under her breath.
Brackett dumped his briefcase beside his desk and dropped down into his chair with a gusty sigh. He brought his right leg up and crossed it over his left thigh, reaching down to massage his ankle.
Sometimes he wondered how he could be so skilled with his hands and yet so graceless on his feet.
With his left hand still resting on his foot, he reached his right hand into the desk drawer and pulled out a bottle of aspirin. He shook two of the little white pills onto his palm and then swallowed them dry.
With one last, annoyed reflection on his early morning clumsiness, Kel slid his chair under the desk and started shuffling through the mountain of paperwork piled next to his telephone. There were no pressing engagements in his diary, and if the ER could just stay quiet today, he might be able to make it through his shift without drawing unwanted attention to his injury.
There was a knock on the door. Kel swiped a hand over his eyes and cursed under his breath before irritably calling out, "come in."
"Not now, Dix... I really don't have time..."
"For what? Coffee?" Dixie McCall stepped tentatively within the inner sanctum of Kel’s office.
Brackett sighed and rubbed his temple, trying to force the encroaching headache back where it came from. He glanced up at Dix, who was holding one hand up in mock surrender and a steaming cup of coffee in the other. "Sorry, a coffee would be wonderful." He forced a smile and leaned back in his chair.
"Can I get you anything else? A donut, sandwich...crutches?" she asked as she handed him his coffee.
"Now, don't you start," Brackett said, taking a cautionary sip of the hot liquid.
"When the head of the Emergency Department limps into work, it does tend to rouse that nosy streak of mine," Dix said, only half joking.
Kel was determined to ignore her probing.
Dixie hitched one hip on the corner of his desk while Brackett studied his paperwork with the intensity of a brain surgeon prepping for major surgery.
No longer able to contain her curiosity, Dix decided to get straight to the point. "Okay, out with it. What happened?"
Kel looked up at the expression on her face and knew he had better explain if he wanted to get any work done today.
"I twisted my ankle, missed the last step down from my apartment building.” Brackett shook his head at his own carelessness. “And before you start telling me I ought to have it checked out...don't. It's not serious; at worst, a mild sprain. I'll be fine."
Doctors, Dix thought. They make the worst patients and the man sitting in front of her was the granddaddy of them all. She knew it would be a waste of time and energy trying to argue with him. "Ok, Kel, if you say so."
"I do. Now can you leave me alone, please? I need to get these run reports downstairs and filed sometime this decade."
A thought suddenly occurred to her. "Hey, don't you have that conference in Utah tomorrow?"
"Yeah, that’s why I’m trying to clear this paperwork, so I can get my notes ready."
"Okay, I'm leaving."
Dixie stood up and headed for the door.
Before she left, Kel called out, "Oh, Dix? Thanks for the coffee."
"You're welcome." With that, she went back to work.
Joe Early breezed down the hospital corridor. “Dix, have you seen Kel this morning?"
"Yep." She pointed at his office door. "In there."
"Thanks. I need his help with a patient in two. Is he busy?"
Dix shrugged. "Your guess is as good as mine. But I better warn you, he's like a bear with a sore head."
Joe laughed. "As opposed to what? He's like that every day."
"Yeah, but today the bear has a thorn in his foot."
At Dr. Early's puzzled expression, Dix just said, "You'll see."
Joe gave two quick raps on Brackett's door, then walked into the office. "Hey, Kel..."
Caught unawares, Kel was too slow to hide the fact that he’d been sitting with his elbows on the desk, head resting on his hands. It was with a loud smack to the wooden surface that he quickly let his hands drop and at the same time jerked his head up to meet Joe’s concerned gaze.
"Kel? Are you all right?"
"Yeah, I’m all right." Kel leaned back in his chair, still a little nonplussed at getting caught succumbing to the throbbing in his foot. "How can I help you, Joe?"
Joe studied his friend, taking note of the fine lines that stood out around his eyes and the stiff way he was holding his jaw. "You sure you're..."
"I said I'm fine. What’s Dix been saying?" Kel struggled to keep the annoyed tone out of his voice.
Joe glanced at the door in the direction of the nurses' station. "Why, what don't you want her to say?"
"Nothing." Brackett waved his hand in the air as if swatting his bad temper away. "I'm sorry, Joe; I'm snowed under here and I don't seem to be making any headway with this paperwork.” The quiet sigh that followed that statement was more out of frustration than anger. “Now, I assume this is more than a social call."
"Yeah. There’s a patient I'd like you to have a look at. Can you spare a few minutes?" Joe edged further into the room and leaned one shoulder against the wall.
"Sure, what have you got?" Kel pushed his chair back and went to stand up. But the sudden sharp pain in his ankle when he put weight on his right foot made him gasp and he had to grab the back of his chair to steady himself.
"Kel?" Joe straightened and took a step towards his friend.
"I'm all right, I'm all right,” Kel said, drawing in a quick breath.
But Joe could hear the sharp edge to his voice and it told him Kel was anything but all right. He watched with guarded concern while Kel worked at getting himself under control.
Brackett closed his eyes, took a couple of slow breaths and waited for the pain to subside, taking all his weight on his left leg.
Joe stood patiently by, ready to offer help if necessary, but he knew Kel wasn't going to share what was bothering him until he was good and ready.
It was only a few seconds before Brackett had regained his composure and eased his weight back onto his right leg. He grabbed his lab coat from the stand and shrugged it on, limping towards the door.
"What happened?” Joe asked, casually nodding towards Kel's foot.
"Ankle," Kel said, rather sheepishly. "Twisted it this morning."
"Have you had a doctor take a look at it?"
Yeah. Me. I'm a doctor, remember." Brackett pulled the door open and indicated Joe should leave first.
If there was one thing Kel hated, it was being the target of other people’s curiosity, and the fact that certain members of his staff were watching him limp down the hallway with abject fascination stretched his already frayed temper to the limit. Out of the corner of his eye, he glimpsed Nurse Sharon Walters approaching.
Kel stopped walking and gave the young nurse two fully loaded eyebrows and his meanest tight-set mouth, just daring her to mention his limp.
Sharon withered visibly, "Um, Doctor, I...um...never mind." With her eyes cast firmly towards the floor, Sharon made a beeline for the nurses' station.
Joe studied his friend with just a touch of amusement in his eyes. "You know, Kel, people are going to want to know what's wrong with you. You can't just stare them down every time they get inquisitive."
"Who says I can't? Now, are you going to tell me about your patient or not?"
The two men resumed their path to the treatment room. Brackett, wishing he could hold the wall for support but refusing to give any credence to his injury, stole a quick glance at his watch and hoped those aspirin would kick in soon.
"Kel, I've got an interesting one for you. The patient is a 52 year old woman. Brought in complaining of dizziness, weakness, some nausea. Blood pressure is a little on the low side. No apparent sign of injury. She says she was fine up until yesterday, then started to feel unwell."
The woman was lying on the treatment table; Carol, standing beside her, monitoring her blood pressure.
Kel hobbled over to the patient. "Hi, I'm Doctor Brackett.”
"Miss McCall? Is Dr. Brackett okay? He looked at me just now like he wanted to chew my head off. He hasn't looked at me like that for months, well, not since...you know."
Dixie sighed and climbed down off her stool. She threw a glance towards treatment room two. "What happened, Sharon?"
"He was coming down the hall with Dr. Early and I only stopped to tell him that I found his stethoscope in the break room last night. Miss McCall, he didn't even give me a chance to speak." She placed the stethoscope on the counter.
"Don't worry about it, Sharon. Remind me to tell you about big, tough men and their ‘owies’ some day."
"Sharon, do me a favor and go and check on Mr. Jenkins. He's due for his shave." Dix smiled at the young nurse and gave her a reassuring pat on her arm. "Leave Dr. Brackett to me."
"Thanks, Miss McCall. I hope I didn't do anything to upset him."
"No. I'll take care of it. Go. Mr. Jenkins will be thinking we've abandoned him."
Dixie hopped back up on her stool and waited.
Forty minutes later, she heard the familiar voices of Joe Early and her prey, Kelly Brackett.
"Good call, Kel. At her age, an ectopic pregnancy isn’t something I would have considered."
"We were lucky, Joe. I think we caught it before any serious damage was done. We'll get a gynecological consult and that should confirm our suspicions. In the mean time, can I interest you in a coffee?"
Dixie watched the two men amble along the hallway noting, that Kel's limp was much more pronounced than it had been when he first arrived at the hospital. There was a tightness around his mouth as he negotiated his way between a gurney and a wheel chair. She even caught him reaching out to the wall for support when a particularly enthusiastic orderly wheeled a patient towards the elevator, forcing Kel to move quickly to the side to avoid a collision.
"Hey, Dix, we're going to grab a coffee," Kel said, leaning heavily on the counter. "Do you want to join us?"
"You two seem very happy with yourselves," Dix remarked, glancing between the two men.
Kel quirked an eyebrow at his colleague and Joe said," The patient in two? An ectopic pregnancy." Joe shook his head. "Fifty-two years old, already gone through the change of life. Kel made a great call, Dix."
Brackett shifted position, and neither Joe nor Dix missed the grimace he tried to hide as he attempted to move more weight onto his left leg.
"How's the ankle?" Dix asked, nodding her head towards his injured leg.
"I told you, Dix, I..."
Knowing what he was going to say, Dix cut him off. "Do you recognize this?" She reached under the counter and pulled out the stethoscope Sharon had given her.
"Yeah, I've been looking for that. Where was it?" Brackett put his hand out to take the scope.
"Not so fast." Dix jerked the equipment out of his reach. "Did you see Nurse Walters in the hallway...oh...about 40 minutes ago?"
Kel frowned. "Yes. She..."
"And did you cut her down with one of your ‘looks'?"
"Well, I wouldn't go so far as to say..."
Joe interrupted, hoping to defuse the situation. "You did, Kel. If looks could kill, she'd be pushing up daisies."
"Hey, whose side are you on, Joe?" Kel asked, his voice rising with indignation.
Joe just smiled at him and shrugged.
"Next time one of my nurses approaches you in the hallway, Dr Brackett, I'd appreciate it if you'd at least hear them out before you jump down their throat."
"I didn't say anything to her," Kel said, pulling himself up to his full height.
"You didn’t have to. One look from you would make King Kong run for the hills."
"I thought she...oh forget it. Can I have that?" Kel nodded towards the stethoscope and held out his hand.
Dix gave him a look of her own and handed it over.
"Next time I see Nurse Walters, I'll make a point of thanking her." Kel said, shoving the stethoscope in his pocket.
"Good." Dix gave her head a short, sharp nod. "Now are you going to be snapping at everyone for the rest of the day or are you going to let someone take a look at that foot of yours?"
"Dix, don't start. I told you...."
"Rampart Base, this is Squad 51. How do you read, over?"
"Saved by the bell," Kel mumbled under his breath as he made his way over to the radio. "Fifty-one, this is Rampart, go ahead."
Johnny’s voice crackled over the radio. "Rampart, we have a male approximately 35 years of age. He was unconscious but has since come around He is somewhat agitated and confused. Standby for vitals."
"Standing by, fifty-one."
Brackett could hear Johnny and Roy speaking to the man.
"Sir? Take it easy, we're not going to hurt you. We only want to help." The placatory tones of Johnny's voice floated over the air waves.
Brackett glanced at Dix and Joe.
"Rampart, blood pressure is 150 over 90, respirations 30, pulse 80."
"Fifty-one, is there anyone there who might know what happened to him? Are you at the patient’s home?"
"Negative, Rampart. We're in a park."
“Is there any sign of head injury?"
"Negative. No obvious sign of injury."
"Is he able to talk?"
"He is able to talk, but he doesn't seem to know where he is or what happened to him."
"Fifty-one, start an IV with D5W and transport as soon as possible."
"10-4. IV with D5W."
"Oh and Fifty-one, check his vitals again in 5 minutes. Let me know if there's any change."
Brackett turned to Dix. "Get a room set up and I want a portable x-ray on hand.”
"Right away, Kel. Three will be ready."
The Emergency doors burst open, Johnny and Roy accompanying the comatose patient with the ambulance attendants.
Dr. Brackett and Nurse McCall wasted no time escorting the team into treatment room three.
“What happened, Roy? I thought I told you to call me if his condition changed?" Brackett said.
"He just got like this now, Doc. As we were unloading him from the Ambulance. Went crazy and then passed out."
The gurney was pulled up beside the treatment table and the unconscious man moved across.
Brackett went around to the other side of the gurney, grimacing as he walked and using the table for support.
He checked the man's pupils and listened as Dix reported the latest set of vitals. "BP is 130 over 90, pulse 70, respirations 25."
"That's an improvement," Kel said, flicking his penlight over the patient's eyes. "Pupils equal and reactive" Then turning to the fireman, he asked, "Did he say anything before he lost consciousness?"
"Not really -- just that he wanted to get out and to let him go." Gage said, shoving his hands in his pockets.
“Would you guys mind sticking around awhile?"
"Sure, Doc," Roy said. "Can we do anything?"
"Just hang loose for the moment." Then turning to Dix, Kel said, "Draw some blood and send it to the lab. I want a full work up.”
Brackett went back to the patient and started a second examination, feeling around his head, behind his ears, the back of his neck. "Roy, take off his shoes and socks, will you?"
Brackett continued his examination of the man’s head and then moved down to the end of the table to help Roy. Once both shoes and socks were removed, Kel started to check between the man’s toes on his left foot, searching for needle marks. Finding nothing, he picked up the right foot and the man started to stir. Small, restless movements soon became more animated, gathering strength as he became more alert.
"Easy, fella, take it easy. You're in the hospital," Brackett crooned, still standing at the foot of the exam table.
The man saw Roy and Kel, one foot still clasped in both of Kel’s hands. "What are you doing? Who are you?" He shook his foot loose from Kel's grasp. "Get the hell away from me."
"You're in the hospital," Brackett repeated, but it didn't seem to be getting through.
"Get your hands off of me!"
"Dix, get Mike Morton in here." Brackett tried to restrain the man but he was thrashing wildly. "Johnny, give me a hand." Johnny leaned across the man's chest trying to keep him on the gurney.
Dix put the syringe back on the instrument tray and went for Dr. Morton.
"Hold him, Johnny. Roy, move up here and help Gage," Brackett said, trying to control the patient’s thrashing feet.
The man on the table weighed in at 250 pounds if he was an ounce, was well over 6 ft tall, and a dangerous prospect hyped up on his own psychosis. With one almighty heave, he pulled his right leg up and struck out blindly at whatever he could. Kel Brackett grabbed at the man’s foot, but the patient kicked up and out. Normally, Kel would have easily dodged the man’s flailing leg but as he attempted to avoid being kicked, he came down hard on his injured ankle. With a cry of pain, he gripped the end of the bed for support and was too slow to move away from the man’s right leg as he kicked out again. The thrashing foot caught Kel in the stomach, just below the left side of his rib cage. With barely a sound, Brackett collapsed to the ground and curled in on himself, struggling to take a breath.
Through a red haze of pain, Brackett was still vaguely aware of the commotion happening above him. He writhed on the ground, desperately trying to suck in air but unable to make his lungs respond.
Mike Morton and Dix pushed open the door to treatment room three. Dix took in the scene before her -- Johnny and Roy struggling to hold the patient still while the man’s legs thrashed uncontrollably at the air, Kel lying on the floor curled in a tight ball with his arms wrapped around his stomach. Dixie rushed to Brackett’s side as she yelled over her shoulder, "Security! We need help in here, now."
Two uniformed men entered the room, surveyed the situation and ran straight to the treatment bed to hold the man's legs."
Mike spared a quick glance for his downed colleague then moved beside the patient’s head. “Listen to me. You’re in the hospital. Now quiet down."
The man looked around wildly.
“Listen to me,” Mike said again. “You either settle down or we put you in restraints. Now what’s it going to be?”
Understanding slowly crept through the man’s addled brain. He stared at Morton and then seemed to take in his surroundings. “Where am I?”
“You’re in Rampart Emergency.”
The man slumped back on the exam table, “I don’t feel so good.” His eyes flickered and then closed. “I’m tired….” As his voice trailed off, so did his hold on consciousness.
There was a collective sigh of relief from everyone in the room...except for Kel who was now on all fours, still trying to suck in air.
Dix touched Kel’s shoulder. "Are you all right?"
Kel nodded his head and held up his hand, but still didn't try to get up. He would have liked nothing more than to let out a long groan, but he didn't have enough breath to make it happen. His stomach was cramping with the effort of just trying to breathe.
With her index finger, Dixie turned Kel’s head towards her. "Kel, look at me. Can you get up?"
He wasn't sure, but was determined to try anyway. He nodded his head.
"Johnny? Help me get him on his feet."
Johnny sank down next to Dix and Dr. Brackett.
“Do you think you can stand?” Dix asked, hooking an arm around Kel’s shoulder.
I think...so." He found his voice, but it didn't sound like his. The words came out in a hoarse whisper.
Mike stole a quick glance towards Brackett and then spoke to the security men. "Thanks, guys; I think we can take it from here."
Dix and Johnny helped Brackett to his feet. As soon as he tried to straighten, a sharp stabbing pain ripped through his stomach and lower ribs. He let out a short, hard gasp and doubled over again, his right knee buckling when he put weight on his ankle.
“Johnny, let's get him to a chair." Dix nodded towards the small black stool in the corner of the treatment room.
They got him seated, and he sat hunched forward, his hands still wrapped around his middle.
"Kel? Can you hear me?" Dixie asked, squatting down to get a better look at him.
Brackett nodded and held up a hand. "I'll... be all right," he wheezed, "I just got the wind...knocked out of me."
Johnny stepped back to take a good look at the Doc. His face was a sickly shade of gray and the fact that his mouth was compressed into a thin line told him Brackett was in a world of pain, even if he wasn’t admitting it.
"Kel, just let Joe take a look at you."
Brackett sat on a gurney in treatment room four, his white coat folded up next to him and his shirt sleeves rolled up. Dixie was wrapping a blood pressure cuff around his upper arm.
Kel was still berating himself for getting in the way of that flailing leg, but he really did feel better now that he had caught his breath. His stomach was still a bit tender and he knew he would have one hell of a bruise, but it was his ankle that was giving him the most trouble. Not that he was going to tell Dixie that. "I think I'll be okay, Dix."
Oh sure, Dix thought. He might be able to lie to himself but the deep lines around his eyes clearly showed he was in more pain than he was willing to admit. "Let's make sure."
"All right, all right. Where is Joe, anyway?"
"Are you looking for me?" Joe Early entered the treatment room and stood beside his friend. "So, it's not enough to be frightening the nurses; now you're fighting the patients, too?"
"Hah. Very funny."
"I caught a foot in the stomach, knocked the wind out of me, that's all. I think I'm okay."
"Why don't you let me be the judge of that?" Early turned to Dix. "What's his pressure?"
"110 over 80."
"That seems a little low. Kel, is that normal for you?"
"I don't know, I haven't had it checked for a couple of years. Haven't had the need."
"Take your shirt off and lay down."
“Joe, I don’t think…”
"You're a patient now. Do as you're told."
Brackett went to heave a deep sigh, but pulled up short and grabbed his left side.
"Are you in pain now, Kel?"
"Wouldn't you be if you'd just stopped a size 11 foot with your stomach?"
Joe chuckled quietly. "Yeah, I guess I would."
With the help of Dix, Kel unbuttoned his shirt and lowered himself down along the length of the treatment table, keeping his breaths short and shallow and his ankle as still as possible.
Joe and Dixie peered at the bruise already forming along his abdomen and across the left side of his ribs.
"Dix, let's get a portable x- ray in here."
Dix left the room and Joe gave Kel a long hard look. "Okay, Kel, just between us guys, how's the pain?"
Kel sighed heavily then grabbed at his stomach. "It hurts."
"On a scale of one to ten?"
Brackett gave a brief thought to his upcoming trip to Utah. He needed to be there; it was his testimony that would add weight to the campaign to get the new program up and running. Despite his earlier misgivings, the paramedic program was his baby now and it was important he be there to give his support. "Four."
Joe gave him a skeptical look and pulled his stethoscope from his pocket. He inserted the ear piece then placed the end on Kel's chest, listening. He moved the stethoscope over Brackett’s stomach. "Take a breath, Kel."
Kel did the best he could, but anything more than a shallow pant was like a knife driving though his ribs and abdomen.
Joe gave his friend a concerned look. "Another." Brackett tried, but a small gasp was all he could manage.
"Is that the best you can do?"
Brackett nodded his head and closed his eyes.
Joe continued to listen to Kel's breathing. He then moved the stethoscope along the lower left side of his ribs and was shocked when a hand shot out and swatted it away.
"Is that sore there?" Joe asked.
"What about here?" Joe palpated with his fingers higher up along the rib cage.
"What about here?" Joe moved his hands across Kel's, stomach.
Brackett let out a soft grunt. "No."
"Are you sure?"
"I said, no."
Dixie entered the treatment room with the portable x-ray and a technician.
Joe explained to the technician where he wanted the pictures taken and then both he and Dix stepped out of the room.
"How is he, Joe?" Dixie asked, leaning against the wall.
"Pretending like everything is all right."
"From what Johnny and Roy said, he took a pretty hard kick." Dixie glanced towards the treatment room. "He was in a lot of pain. And not just his stomach. Have you noticed he’s having a lot of trouble bearing weight on that ankle?” She looked back at Joe.
"I’ve noticed, but you know Kel; he's always got to be in control. And I know he wants to go to this conference tomorrow." Joe put his hand on Dixie's shoulder. "Let's see what the X-Rays tell us before we start jumping to conclusions."
The door to treatment four opened and the technician came out, pulling the portable x-ray with him. "All done."
"Thanks, Charlie. Can we get a rush on those?" Joe asked.
"Sure, Dr. Early. I'll have them brought down as soon as they're developed."
When Joe Early and Dixie entered the treatment room, Brackett was sitting on the edge of the exam table buttoning his shirt. There was a fine sheen of sweat across his brow and chalky pallor to his skin.
"Where do you think you're going?" Joe asked.
"Back to work."
"I'd like you to stay in here. At least until we get the x-rays back."
Knowing that was probably the sensible course of action, Kel nodded but said, "I can sit in my office just as well as I can sit here." He rolled down his sleeves and reached for his lab coat, grimacing when his stomach muscles pulled. He slid off the gurney with a soft grunt, careful to take most of the weight on his left leg and then limped towards the door.
"While you're here, why don't you let me take a look at your ankle?"
Kel glanced down at his foot then back at Joe and snorted. "Nice try. I told you, it’s just a sprain. Now, I don't know about you two, but I've got work to do."
Kel felt like the hallway had lengthened in the last 30 minutes and it was slow going as he limped his way back to his office. His stomach was still cramping, but he was sure that would ease once he was sitting.
It took a little bit of maneuvering around in his chair to find that comfortable position, but he was pleased to note that the cramping had eased off somewhat. Leaning back in his chair, Kel laid a hand across his stomach, feeling the discomfort of the bruise he knew was going to be a lovely shade of blue the next day.
An hour of uninterrupted silence allowed the remaining run sheets to be sorted into some kind of order, and once they were filed and ready to be sent downstairs, he was able to begin preparing his notes for tomorrow's conference.
"Dr. Brackett to Treatment room three. Dr. Brackett, Treatment three."
Kel jumped as the dispatchers voice chirped through his intercom.
With a weary sigh, Brackett pushed himself carefully to his feet, noting that while sitting was relatively comfortable, standing was no fun at all. It was with some effort that he forced his body into an upright position. When he put his right foot to the ground, he couldn't hold back the grunt of pain and he wondered idly whether this day could possibly get any worse. With that thought on his mind, Kelly Brackett limped his way slowly towards the door.
"Hey, Doc, how are..." John Gage was leaning on the nurses' counter as Brackett limped past. "Doc, are you okay?" Johnny glanced down at Kel's leg. "Did you hurt your leg when that patient kicked you?"
Brackett huffed indelicately. "No, that I managed to do all by myself. Twisted my ankle on the way to work."
"It hasn't been your day, has it, Doc?"
Brackett glared at him. "You could say that. Got to go, John; patient in three waiting for me."
"Sure. You take care."
Brackett waved a hand at the fireman as he continued his way down the hall.
Dix and Joe Early were waiting for him and the expression on their faces when he walked in told him he probably looked as bad as he felt. He glared at them, daring them to comment and they both looked away. "What have we got?" he asked, keeping his voice even.
Kel didn't miss the sideways glance between his two colleagues.
"Heart attack, Kel. Gage and De Soto just brought him in." Joe went on to explain the man's condition and what treatment he'd been given.
Brackett made his way to the treatment table, visually accessing his patient’s condition as he introduced himself. “Hello, I'm Dr. Brackett. What’s your name?"
“Don. Don Kowalski.”
“Don, how are you feeling?” Kel observed the man’s pasty complexion and the slight blue tinge to his lips.
"Not so good," Don Kowalski answered with a wince.
"Are you in any pain now?"
"A little. It…kind…kind of …feels like there’s an elephant…sitting on my chest."
Brackett didn’t like the way the man was having trouble speaking and turned to the EKG to study the screen.
"Doc, it's getting…worse." The man grabbed at his chest, his breathing coming fast and shallow.
"Don, take it easy. Try and slow down your breathing.” Brackett worked at trying to calm the patient while at the same time keeping a wary eye on the EKG screen.
Kowalski arched his back. “I…can’t…it…hurts.” He let out a quiet grunt, then passed out.
"He's in V Fib. Dix, paddles." Kel held out his hand to take them, but felt a sharp stab through his left side, and when he hunched over, he was unable to hide his gasp of pain.
"Kel?" Joe asked, noticing his friend’s discomfort.
"Paddles," Kel demanded, straightening up with a grimace. Dixie handed them to him and he placed them on the patient's chest. "Push it up to 400 watts."
"400." Joe said.
"Clear," Joe answered.
Kel zapped his patient and the man's body jolted.
The three of them studied the EKG.
"No conversion. Dix, one amp bicarb soda”
Dix handed him the ampoule and syringe; she and Joe stood by while Kel injected the medication.
“Hit him again. 400."
Kel held the paddles until Joe gave him the go ahead. Again, the man's body bounced up as the electric current shot through him.
They waited. It seemed to take forever until the screen displayed the first signs of normal rhythm.
Brackett let out a slow puff of air and handed the paddles back to Dix. He ran a hand across his brow and then wiped the sweat on his coat. “Start a Lidocaine drip at 2 milligrams and let’s get him up to ICU."
Dix prepared the man to be moved while Kel hobbled slowly towards the phone with the intention of calling up to ICU and warning them to expect another patient. He was half way there when the room seemed to shrink around him and he staggered, reaching out blindly for something to grab hold of.
“Kel?” Joe took hold of his arm. “What’s wrong?”
Brackett shook his head and gripped Joe Early's arm keeping his eyes shut. “I…I don’t know. I’m a little dizzy.”
Dixie continued to prep the patient to be transferred, but kept a concerned eye on Kel. She went to the phone and did what Brackett had intended to do, making a call first to ICU and then to the nurses’ station to arrange for two orderlies to come to the treatment room to move Don Kowalski up stairs.
“Kel, come and sit down.” Joe tried to guide Brackett to the same stool he had been seated on earlier that day.
“No. No, I think I’m okay now.” Brackett opened his eyes and looked at Joe and Dix. Both were wearing equally concerned expressions on their faces. “Really, I’m okay.” He gave a half-hearted laugh. “Darnedest thing.”
Shrugging off Joe’s supportive hand, Kel turned to Dix as he limped cautiously towards the door, “Dix, will you take care of Mr. Kowalski? If anyone needs me, I’ll be in my office.”
“What do you think, Joe?” Dix asked as she watched the door swing shut.
“I think I’m going to go and chase up those x-rays,” Joe said.
Two orderlies entered and Dix gave them instructions for Mr. Kowalski
Kel’s ankle was throbbing with every faltering step he took, and it was only his stubborn pride that was keeping him up. He had to admit to himself that the dizzy spell in the treatment room was not normal for him and he attributed that to the battering his body had taken earlier in the day. He decided he would head back to his office and take things easy for awhile and baby his bruised ribs and sprained ankle.
He made it back to his office and carefully eased himself into his chair just in time to answer his ringing phone.
“Dr. Brackett? This is Assemblyman Mike Wolski, I've got my colleague from Utah, Wayne Johnson, with me. He’s in town tonight and I wonder if you might have some time to talk about our plans for the conference tomorrow...."
Kel cursed quietly. He really just wanted to sit and rest his aching body, but that wasn’t going to happen now. He had no choice but to accept the invitation to meet with the Assemblyman and his colleague if he wanted the Paramedic Program to gain acceptance in Utah.
Brackett cringed at the thought of having to move from his chair but he agreed to meet the two men at a nearby restaurant. He forced himself to his feet, or at least to his left foot, and then stepped gingerly onto his right. As an afterthought, he grabbed a couple more aspirin from the bottle in his desk and swallowed them down with the last cold dregs of his morning coffee. If he was going to drive, he was also going to need some pain relief.
A few minutes later, Brackett had stripped off his coat, picked up his brief case and hobbled out of his office, headed to the nurses’ station. Sharon was behind the counter but, there was no sign of Dixie.
“Miss Walters? Where’s Miss McCall?” Kel found himself leaning heavily on the counter and readjusted his stance but was still careful to keep weight off his right foot.
“Oh, she’s in treatment three, Doctor, helping Dr Morton.”
“Tell her I’ve had to go out for about an hour, would you?”
“Sure, Dr. Brackett.”
Kel went to leave, then turned around again when he remembered his promise to Dix. “Oh, and Miss Walters, thank you for returning my stethoscope to me.”
Sharon smiled, “You’re welcome, Dr. Brackett.”
Kel attempted a smile, too, but it came out more like a grimace. Without another word, he hobbled towards the exit.
Mike Morton was just finishing up with his patient and Dixie was restocking the instrument tray when Joe Early opened the door to the treatment room. "Do either of you two know where Kel is?"
Morton shrugged and looked at Dix. “He said he would be in his office," Dix said.
"I just looked, he's not there."
"Coffee room?" Mike suggested.
"Who's at the nurses' station, Joe?" Dixie asked as she put the instrument tray on the stand and covered it with a sterile cloth.
"Gail, and no, she hasn't seen him either."
"Give me a second, I'll have him paged." Dix headed towards the door. "Where do you need him?"
"Send him to treatment three. Oh, and Dix, I want him there STAT. I just got his x-rays back."
Dix hesitated with her hand on the door. "Should I be worried, Joe?"
A cold lump formed in her stomach as Dix pushed the door open and hurried towards the nurses’ station to put out the call.
Kel impatiently tapped his fingers on the steering wheel as he sat watching the brake lights of the cars in front of him. He hadn't bargained on the traffic being jammed up for two blocks when he'd told Mike Wolski he'd meet him in 20 minutes. Brackett flipped his wrist and swore quietly under his breath. At this rate, he'd be lucky to make it in forty. The restless drumming of fingers on the steering wheel and regular glances in the rear view mirror did nothing to hurry the traffic on.
Sitting still with very little to occupy his mind was making him drowsy and his eyelids began to droop. A quick shake of his head forced his eyes to open, but the temptation to rest his head on the steering wheel was almost overwhelming. When he thought about it, he'd only had the one cup of coffee all day. He licked his lips and shook his head again. What he wouldn't give for a cup right now.
Kel reached for the window crank with the intention of sticking his head out to see what was ahead and get a little fresh air but stabbing pain tore through his left side. Instead of grabbing the handle, he grabbed at his stomach, pulling in quick shallow breaths. He started to shiver and that overwhelming weariness was back, forcing his eyelids down again. Maybe he'd just tip his head back against the headrest; the traffic wasn't moving anyway.
A loud blast from a horn jolted Kel awake, and for a split second, he wondered where he was until another long bleat from behind made him look up and realize that the traffic jam had eased. He accelerated forward as he waved a quick apology in the rearview mirror and then instantly regretted the action when another piercing pain shot through his side. He remembered the stabbing pain when he reached for the window crank a short time ago and knew that his side shouldn’t be causing him that much discomfort if the injury was a simple bruise as he had first thought.
Kel had a nagging suspicion that at least one of his bruised ribs was probably cracked and he should head back to the hospital, but this meeting was important. He figured he could get through the lunch if he didn’t make any quick movements that aggravated his injured side, and then he would let Joe and Dix tend to him, even if he did have to suffer through their ‘I told you so’ attitude. He wasn’t far from the restaurant now and the first thing he was going to do when he met with Mike Wolski was order the biggest cup of coffee on the menu, because he certainly didn’t feel like eating anything.
Sharon was finishing her notes on the patient's chart, recording blood pressure, pulse and temperature. She was pleased Mr. Jenkins seemed to be on the mend. He desperately wanted to go home for his grandson's first birthday, and with a bit of luck, he should be out of the hospital by the weekend.
"Dr. Brackett to treatment room three, Dr. Brackett treatment room three, STAT."
Sharon's hand flew to her mouth and she gasped sharply. "Dr. Brackett." she said under her breath. "Oh." She'd completely forgotten to pass on his message. Hanging the chart on the end of the bed, she quickly apologized to Mr. Jenkins and made her way to the nurses' station.
Miss McCall was standing by the base station, looking up and down the hallway. She was tapping her fingernails on the counter and the frown lines across her forehead told Sharon there must be something serious in three.
"Dix. Any sign of him?" Dr. Early came from the opposite direction to Sharon and they both arrived at the nurses' station at the same time.
"Miss McCall? Are you looking for Dr. Brackett?" Sharon asked looking at the doctor and nurse.
Joe took a step towards her. "Yes, Sharon, have you seen him?"
"I'm sorry, Dr. Early, Miss McCall. I was supposed to pass a message on to you from Dr Brackett...but things got so crazy..."
"Sharon, what did he say?" Dix cut in.
"He told me to tell you he had to go out for an hour."
"How long ago was that?" Early asked.
"About 30 minutes.” Seeing the worried expressions on their faces, she asked, “Miss McCall, is Dr. Brackett all right?"
"Why do you ask, Sharon?"
"He was limping; he looked like he was in pain."
Joe shot Dixie a look. "Did he say where he was going?"
"No, just that he'd be back in an hour."
"Did you notice anything else, anything unusual?"
"Apart from him limping?" Sharon gave it some thought. "Well, there was one thing...he thanked me for returning his stethoscope and I think he tried to smile. I thought that was kind of unusual for him." The young nurse shrugged and looked helplessly at both Joe and Dix. "I'm sorry, Miss McCall, that's all he said."
"Thanks, Sharon. You can go back to work now."
Nurse Walters bobbed her head once and then left Joe and Dix alone.
"What now?" Dix asked.
"We wait," Early looked at this watch, “and hope that Kel is as good as his word. Let me know as soon as he gets back."
The knot in her stomach tightened as Dix headed back to her seat behind the counter. If Joe's preliminary diagnosis was correct, time was something they might not have on their side.
Assemblyman Wolski checked his watch again and then looked apologetically at his colleague. "There could have an emergency at the hospital or anything," he offered by way of explanation. "Wait here, Wayne, and I'll make a call to Rampart and see if he's on his way. Why don't you order us a couple of drinks while I'm gone? I'll have an iced tea."
"Okay, but so far, this Doctor of yours doesn’t impress me."
"I'll be right back. I'm sure there's a logical explanation. Like I said, anything could have happened."
Mike Wolski made his way out into the lobby in search of a phone.
Dixie was staring at the clock on the wall, but wasn't seeing the time. Joe had shown her the dark shadow on the X Ray and explained what it could mean, and all she could think about was how Kel had been curled up on the floor and struggling for breath. When the phone rang, she jumped and grabbed at it with a clumsy swipe. "Nurses' station, Miss McCall."
"Oh, sorry. Hello, this is Mike Wolski. How are you, Dixie? I didn't mean to disturb you. I was trying to reach Dr. Brackett but his phone wasn't answering. The switchboard put me through to you."
Dix smiled when she heard the familiar voice of the Assemblyman." Hi Mike, nice to hear from you. I'm sorry, Dr. Brackett isn't here. Can anyone else help you?"
"Oh...No... He was supposed to be meeting me for lunch. I was expecting him 15 minutes ago. How long ago did he leave?"
"Dr. Brackett was meeting with you?" Relief mixed with fear washed over her and Dix had to grab for the stool and sit. "He left here a good 30 minutes ago. Where was he meeting you?" Dix covered the phone with her hand and called out to Gail. "Get me Dr. Early, Gail, and hurry."
"Sam’s Grill on West 215th Street."
Another quick check of her watch told Dix that Kel should have been there by now.
The Assemblyman was speaking again, "Well, I guess he just hit traffic or something. He shouldn't be far now. Sorry to bother you."
"Oh, Mike? Would you do me a favor? When Dr. Brackett gets there, would you have him call Rampart Emergency right away? It's urgent."
"Sure, Dix, will do. Have a nice afternoon." He hung up.
"What's up Dix?" Joe asked as he approached the nurses' station.
"Kel’s supposed to be having lunch with Mike Wolski at Sam’s Grill. He hasn't showed up yet."
The traffic was moving at a steady pace now. "About time," Kel mumbled. He was only about 5 minutes away, and with a little bit of smart driving, he might be able to make it in less.
Kel couldn’t believe his luck when he rounded the corner and pulled into a parking space right in front of the restaurant. Finally, something was going his way. With one arm wrapped protectively around his middle and the other clasping his briefcase, he made an awkward exit from his car, gasping when he put weight on his right foot. Having to keep his foot on the brake pedal for an extended period of time during that traffic jam hadn’t done his ankle any favors. He paused for a moment to gather his thoughts and then he straightened up as best he could, determined to make it through the meeting.
He locked his car and pulled his jacket tighter around him, shuddering against the sudden cool breeze. Brackett made a slow, ungainly path towards the restaurant and he'd almost made it inside, too, when he felt his legs want to buckle under him and the world begin to spin. He leaned against the door frame and rested his head on his arm, waiting for the black dots to recede. Once his vision cleared, he looked around unsteadily and tried to get his balance, squinting past the heavy thud pounding through his head.
Sometimes Kel didn't like to admit things to himself, but he wasn’t a stupid man and he knew he was in more trouble than he first thought. The doctor in him was mentally cataloguing his symptoms and starting to put two and two together and he didn’t like the answer. His gut instinct told him he should head straight back to the hospital, but the opportunity to meet with Assemblyman Johnson before the conference was one he didn't want to pass up. He could almost hear the lecture from Joe that would be waiting for him when he got back. Heck, he’d given it himself a number of times to his own patients, patients who had waited just that little bit too long before seeking medical help.
Wiping beads of sweat from the side of his face and regaining some of his composure, Kel came to a decision…he’d rush the meeting and then get himself straight back to Rampart and checked out properly. No longer feeling like he was going to pass out at any second, he pushed himself away from the door frame and continued on into the restaurant.
By the time he made it to the front desk, although no longer dizzy, he was having some trouble catching his breath. The man behind the desk gave him a dubious look and asked politely, "Can I help you, sir?"
"Yes, I'm meeting a friend here, Assemblyman Mike Wolski .Could you take me to his table?"
"Certainly, sir. This way." The waiter indicated that he wanted Brackett to follow. Taking as deep a breath as his bruised ribs would allow, Kel slowly limped after the waiter to a table in the far corner where Mike Wolski and another man were seated.
"Dr. Brackett." A wide grin split Wolski's face and he stood, putting his hand out in greeting.
Kel shook the man’s hand, working hard to keep his features neutral as another burst of pain shot through his upper abdomen. "Assemblyman Wolski, good to see you again."
"Enough with the formalities; I think we've gotten past that. Call me Mike."
Kel nodded and smiled, hoping his face wasn’t betraying his level of discomfort.
"Dr. Brackett, I'd like you to meet Assemblyman Wayne Johnson."
“Hello, nice to meet you Assemblyman.” Kel shook his hand, biting back a grunt.
“I’ve heard a lot about you, Dr. Brackett. Mike here seems to think you can convince me to support the paramedics.”
Kel nodded and gratefully sank into the chair feeling instant relief as he was able to take the weight off his injured ankle. Now if he could only stop the pain in his side, he might make it through this lunch with a new ally for the program. He gathered his thoughts and said, “I’ve been where you are, Wayne, and I think I can help ease your concerns about the pros and cons of the Paramedic program.”
Once all three men were seated, a waiter approached the table. Kel ordered a glass of water and a cup of coffee. Jim and Mike already had drinks.
Brackett sat with one arm guarding his ribs and stomach, attempting to pay attention to Wayne Johnson’s doubts about the paramedic program. Running his tongue over dry lips, Kel tried to twist in his seat looking for the waiter and his glass of water but this only served to reawaken the sharp pain radiating along his left side. Breathing heavily, he looked back at his luncheon companions and endeavored to concentrate on what they were saying.
“So, Dr. Brackett, what was it that converted you to the side of the believers? Mike tells me you were against the program at first. Convince me of its merits.”
Kel noticed a strange grey fog creeping in around the edge of his vision and he seemed to be having trouble focusing on what the Assemblyman was saying. He scrubbed at his eyes, surprised when his hand came away slick with sweat.
“Sir? Your water.” The young man placed the glass in front of Kel who grabbed it and gulped down the contents without even coming up for air. “Dr. Brackett?”
“Yeah?” Kel blinked trying to bring the waiter into focus.
“There’s a phone call for you at the cashier’s desk. A nurse from Rampart Emergency, says it’s urgent.”
“Kel. I completely forgot. Dixie wanted you to call her as soon as you got here. Sorry.” Mike was studying Brackett as he spoke. Something didn’t seem quite right. His eyes had a dullness about them that undermined the man’s sharp intelligence and the fine sheen of sweat seemed unnatural in the restaurant’s cool air-conditioning.
Brackett nodded. “Excuse me, gentlemen. I better take this.”
Knowing that movement would probably increase the pain in his side and ankle, Kel carefully eased his chair back. Even though he was ready for it, the stabbing pain that cut across his ribs forced him back in his seat with a sharp cry as the dizziness he’d experienced earlier threatened to close in again and he struggled to stay conscious.
Mike leaned forward and tapped Kel on the shoulder. “Dr. Brackett? Are you okay?”
He wished he could say yes, but every breath was like a knife twisting in his side, reducing his breathing to short, shallow gasps while the room seemed to be tilting on its side. Kel knew he was in serious trouble. He bit his lip and waited for the spasm of pain in his side to pass. But when it didn’t let up, he knew it was time to ask for help.
“Mike…” and that was the last word he spoke before tipping sideways out of his chair and sliding to the floor.
Wolski and Johnson watched in shock as Kel curled on his side and hugged his stomach. They couldn’t quite tell if he was conscious or not.
“Wayne, stay with him. I’m going to take that call from the hospital.”
Mike found the cashier desk and picked up the receiver. "Uh...Hello? This is Mike Wolski. Is that you Dix?"
"This is Joe Early. Is Kel there?"
Joe heard an audible sigh from Wolski and when the man spoke again, Joe was certain he could detect a tremble in his voice. "Joe...listen...something’s happened, Dr. Brackett...he's sick...he...he just collapsed...I...we need an ambulance."
Wolski heard Joe Early speaking to someone in the background, "Kel's down, get an ambulance and the paramedics to Sam’s Grill on West 215th.” Then he was back on the phone, "What happened?"
"He got up to take your phone call and then...he kind of doubled over and grabbed his side; next thing, he was on the floor."
“Mike, is he conscious?"
"Yes...no... I don't know. He's on the ground, his eyes are closed and he seems to be having trouble breathing. It looks bad, Joe, I don't know what to do..."
"Just keep calm. I need you to elevate his feet and keep him warm. There's an ambulance and paramedics on the way."
"Okay...I'll see if the restaurant has a blanket or towel or something. My colleague is with him. I better go and see how he's doing."
"Mike? Did Kel have anything to eat or drink?"
"No, nothing...no, wait...just a glass of water."
"I'm going to stay on the line. If his condition changes, come and tell me, okay?"
When Mike Wolski returned to his table, Brackett was still curled up on his right side, hugging his stomach and it looked like he was shivering. He hadn't moved much since he fell. Mike could hear his labored breathing, but he still wasn't sure if he was conscious. "Hey! You." he called out to one of the waiters standing in the small crowd of onlookers. "Get me a blanket or something to keep him warm."
The waiter looked kind of pale himself, but did as he was told, weaving his way past the gathering patrons.
Mike dropped down next to Brackett, shrugging off his suit coat. "Dr. Brackett? Kel? Can you hear me?" He placed the jacket over Kel’s shivering torso and tried to turn him on his back, but Kel’s cry of pain as soon as Mike touched him stopped any attempt to change his position.
"Wayne, help me try and turn him; we need to elevate his feet."
The two men rolled Brackett onto his back, doing their best to ignore his moaning.
"Mike I'll go see if I can find something to put under his feet."
"Yeah.” Then turning his attention back to the man on the floor, Mike said, "Dr. Brackett. Can you hear me?"
A slight nod of his head and a flutter of eyelids told the Assemblyman that Kel was listening.
"I was talking to Dr. Early...at Rampart; he said we need to get your feet up."
"Yeah…" Kel trailed off and his eyes closed.
"Doc?" Wolski shook his shoulder but there was no response, just an awful wheezy sound to his breathing.
Wayne returned with two telephone books, and as they lifted his feet, Kel gasped. The two men looked at each other. "He was limping when he came in, Mike."
Wolski wiped his hand across his brow and through his hair. "Yeah, but Joe said we need to get his feet up. Just do it."
"Mike, listen. I can hear sirens.”
Within a few minutes, two paramedics had pushed through the crowd and were crouched at Brackett's side. The two Assemblymen moved out of their way. Mike pulled a handkerchief from his pocket and mopped at his sweat- soaked brow and said, "Boy, are we glad to see you."
Kel flinched at the touch of hands on his forehead and concentrated on trying to work out what had happened. He knew he was on the floor, but how the hell had he got there? There was a god-awful pain in his side and a dull ache in his stomach and a huge amount of confusion in his head. He tried to move but the stabbing in his ribs trapped his breath and halted all thoughts of changing position. There was vague awareness of activity around him…talking…his name…a familiar voice…”Doc, can you hear me?”
“Uh-huh.” Why was it so hard to breathe? He pushed further away from that dark place in his head, becoming more aware of things around him.
“It’s John, John Gage.”
Brackett tried to turn his head but even that small act shot agony through his side and the best he could do was cry out in pain. His eyes fluttered open halfway, refusing to focus at first.
Johnny…and Roy. He had to tell them what was wrong. He was fairly certain now that he’d cracked a rib, but what was really starting to worry him were his other symptoms…he’d heard them described by his patients often enough to know that he needed help.
“Roy…” His mouth felt numb and it was hard to talk and he was so damn cold. The voices were hovering above him, beside him; he could barely make sense of any of them.
“BP 90 over 60…pulse 130….respirations 28…skin is pale and clammy…”
Those words were familiar in a strange kind of way… “Johnny? Roy?”
“Take it easy, Doc. Just relax, okay?”
Kel had a brief sense of being smothered as something was placed over his face, then the cool hiss of oxygen filled the mask covering his nose and mouth and he sucked at it greedily. While the precious gas was making it somewhat easier to breathe, it had done nothing to relieve the agony in his side.
“…IV Ringers lactate…victim is in extreme pain…5mg MS IV push…”
A sharp stick in his arm elicited a weak protest, but he was powerless to do more than lie there and accept treatment he had no control over.
“Hold still, Doc…we’re just going to put an IV in then we’ll give you something for the pain, okay? You should start to feel better…”
Roy. Kel recognized Roy’s voice and managed a small nod of his head. Lethargy sat on him like a heavy blanket and he could feel himself start to drift off. He closed his eyes, resting, fighting the urge to sleep without success.
There was a vague awareness of lifting, sliding, the sound of sirens, voices; it all merged into a cacophony of noise and confusion. But for Kel, it was that searing pain in his side that really caught his attention. He tried to turn over but there was something tight across his chest, his legs; he couldn’t move. “Roy? John?”
“Don’t try to move, Doc. It’s Roy; we’ll have you at the hospital in a few minutes. Now take it easy, okay?”
“Doc, Doctor Early’s got it under control. You relax and let us take care of you, okay? ”
Kel was too tired and too sore to argue, and the persistent fog in his head was making him sleepy. As much as he wanted to stay awake, he just couldn’t. The sound of the siren grew fainter and the voices around him were just a buzz until he finally stopped fighting and just plain passed out.
When the paramedics arrived at Rampart, Joe Early and Dix were waiting for them.
“Treatment three,” Early said as the team followed behind.
Joe had only caught a quick glance at his unconscious friend, but it was enough to tell him Kel was in a bad way. He stood back as the ambulance attendants moved the doc onto the treatment table.
The firemen stepped back and let the medical team take over.
While the spark of romance had dwindled over time, the flame of friendship still burned brightly for Dix. Seeing Kel on the exam table so pale and still, Dix had to dig deep to maintain an air of professionalism. Joe had his penlight out and was checking Kel’s pupils, Gail was at his feet removing his shoes and socks and Dix was wrapping a BP cuff around his arm.
“Gail, go easy on his right foot; he hurt his ankle this morning,” Joe said.
Dix was grateful to have Joe Early heading up Kel’s treatment. His cool, calm manor as he methodically worked on his patient was a steadying influence, helping to keep Dix focused on her job and not the fact that it was Kel lying on the treatment table looking so miserable.
“Doctor Early, Dr. Brackett’s ankle has a lot of swelling around it.”
“Can you get an ice pack on that, Gail? Dix, what’s his BP?”
“BP 90 over 60,” Dix recited. Still too low.
“Hang another bag of Ringers.” Joe had removed Kel’s tie and unbuttoned his shirt, but when he pushed his undershirt up it was all Dix could do to stop herself from gasping at the sight of the ugly, purple bruise covering his abdomen and rib cage.
Joe pulled out his stethoscope and listened to Kel’s chest. “Reduced breath sounds on the left side. Dix, I want a portable…Dix?”
“I’m okay, sorry.” She mentally pulled herself together as Joe continued.
“Hang that Ringers then get a portable x-ray in and I want an OR on standby.”
Dixie did as she was told.
The door to the treatment room swung open and Mike Morton entered. “I just heard, Joe. How is he?”
Joe looked at him and it was enough for Morton to know it wasn’t good. “Mike, I want blood for type and cross matching, CBC, blood gases, and get me a new set of vitals.”
Joe swallowed hard; it wasn’t easy to see one of their own on the treatment table, especially when it was someone who had been his friend for a good 10 years or more. He removed the oxygen mask from Kel’s face. “Kel, can you hear me?”
Kel felt someone pat the side of his cheek. That someone was talking to him but he found it hard to concentrate on what they were saying. “Mmm.”
“Joe?” Kel forced his eyes open but he felt as though he was hearing and seeing everything from under water. “What happened?”
“You collapsed at the restaurant. What do you remember?”
“Wolski…” Awareness started to seep into his muddled brain. “Mike Wolski…Aah…” He tried to sit up and felt every inch of his body scream in protest.
“Don’t try to move.” Joe put a restraining hand on Kel’s shoulder. “Can you tell me where you’re hurting?”
Breathing shallowly, because it just hurt too much to do otherwise, Kel tried to concentrate. “My side hurts…and…my stomach. I have…pain in…my left…shoulder radiating down my back…it’s…hard…to breathe.”
Joe started to palpate along the upper left quadrant of Kel's abdomen, frowning when his fingers met a tight resistance. He also found some swelling just below the rib cage. Joe put both hands over Kel’s ribs, noting the uneven rise and fall of his chest as he struggled to breathe.
Joe’s gentle pressure was almost more than Kel could stand. He screwed his eyes shut and tried breathing through his nose as the pain in his side grew to a new level; all he wanted was for the examination to be over and for Joe do something to stop the pain.
When Kel could focus on something other than his own agony, he realized that Joe was covering him with a blanket, obviously finished his examination. The pain was a lot less with no one prodding him, yet he was still finding it hard to keep his eyes open. Despite the urge to just give in and sleep, Kel wasn’t quite ready to relinquish control. He needed to make Joe understand what was wrong with him. “Joe, I’ve…experienced…some dizziness and extreme thirst. Exhibiting…all the…signs of…hemorrhagic…shock…maybe pnuemothorax…”
Joe leaned over his friend, trying hard to hide his concern and gently patted his shoulder, “Hey, no self-diagnosing. You’re a patient now. Let us do the work.”
Kel nodded and allowed his eyes to close. He hated to admit it but he knew Joe was right; he was a patient now. Not something he was comfortable with but he trusted Joe. Then just as he was starting to relax, he felt his heart begin to beat faster and it was hard to take a breath. "Joe...it’s… really… hard… to…breathe.”
Kel felt the oxygen mask being replaced over his face.
“Mike what are his vitals?”
“BP still low, 90 over 50, pulse 120, respirations 30 and shallow.”
Kel had felt worse in his life, but he couldn’t quite remember when. He was shivering and the movement hurt his chest, but the worst thing about lying on the treatment table in his own Emergency department was that his brain had already decided what was wrong and he knew what lay in store for him.
Dix came back into the treatment room in time to catch the last set of vitals. She looked anxiously at Kel and saw his eyes close halfway but then watched as he forced them open again. Damn him, why couldn’t he just let them get on with their job and not fight his body’s need to rest? Dix directed the technician to Dr. Early, then went over to Kel. She was worried about how pale he looked, and his labored breathing was setting off all kinds of alarm bells.
Joe was speaking to the technician, “Charlie, I want pictures of his chest and abdomen, and while you’re at it, get one of his right ankle, too.”
Dix stepped back to give Joe some room.
It was Joe; Kel knew that, but his voice sounded like it was coming down a long tunnel. “Mm.”
“We’re going to get some more pictures of your abdomen and chest.”
Kel nodded. At least that was his intention, but he wasn’t sure he pulled it off. Everything was difficult. It was hard to breathe, it was hard to concentrate…to get warm…and he tried to make Joe understand through the oxygen mask. “Cold...I’m cold, Joe.”
“Gail, get me another blanket,” Joe said, turning to the nurse by Kel’s feet. Then to Dixie, he said, “I want 2 milligrams Lidocaine and a wide bore needle. Set me up for a Peritoneal Aspiration. Let’s see where this bleeding is coming from.”
Despite his best efforts, in the end Kel couldn’t stay awake. He closed his eyes and let himself drift…just for a minute…that’s all...he’d just take a minute…
The next time Kel woke, it was to see Dix hovering over him and Joe masked and gowned up. There was a brief moment of panic while he sorted through his memories of what had happened to him. The words ‘Hemothorax’ and ‘ruptured spleen’ were being casually discussed between Joe and someone else that Kel couldn’t see.
Kel was aware enough to know that he hated what was happening to him. He hated being sick, he hated not being in control. With his right hand, he reached up and pulled at the oxygen mask. “Joe?”
“Joe, he’s awake,” Dix said.
Joe’s head came into view. “Hey, Kel, how are you feeling?”
“You were close with your diagnosis. You have a Hemothorax and I suspect a ruptured spleen. I don’t have to tell you what that means.”
Yeah, he knew all right. “A chest…tube…surgery…wonderful.”
“I’m afraid so. I’m getting ready to insert the chest tube now -- that should help your breathing -- and then we’ll prep you for surgery and stop that bleeding.”
Kel nodded, resigned to the fact that he was going to be a patient in his hospital for some time. He was also resigned to the fact that he just blew his chance to convince Wayne Johnson from Utah of the benefits of the paramedic program, and more importantly, that he wouldn’t be able to attend the conference and add his support. He had failed and that wasn’t something he was used to or handled well.
Then he felt like he was floating and there was no awareness of pain. He knew what was happening and decided he couldn’t fight it, so he allowed himself to slip away.
Dix held his hand until she felt him relax, saw his eyelids slide shut and his head loll to one side. She checked the monitor and nodded at Joe to let him know that they were ready to insert the chest tube and move him to surgery.
Dixie’s shift had just finished and she made her way to the surgical ward. The last three hours had seen the staff assigned to the Emergency department run off their feet. One near drowning, three traffic accidents, two cliff rescues and one heart attack. She couldn’t decide if she was grateful for the distraction or resentful because she hadn’t had a chance to stop by Recovery and see how Kel was doing.
A few minutes later had Dixie standing by Kel’s bed, the nurse in her checking the chest tube snaking its way down from his left side and the IV pole beside the bed making sure the saline drip was operating correctly. She ran her fingers down his arm, letting them rest in the crook of his right elbow where his pulse beat steady and strong.
She picked up his chart and read the latest recorded vitals. Everything was looking as well as could be expected under the circumstances. Placing the chart back on its hook, she looked down at the man lying so quiet in the bed. There was a fine sheen of perspiration on his face, skin that was as bleached of color as the pillow he was resting on. To Dix, Kel looked like a little boy sleeping, with his hair mussed up and those ridiculously long eye lashes casting small shadows on his cheeks.
She loved Kel in her own special way, and despite his hard-headed, stubbornness, and sometimes egocentric ways, she knew that inside was, well, maybe not an old softie, but a man with a kind heart. When it became clear that they were never going to make it as a couple, Dix had been content for the relationship to shift into one of close friendship.
“He’s doing well, Dix.”
She turned to see Joe standing by the door, his blue eyes twinkling as he smiled at her.
“I didn’t expect anything else.”
“When we went in, the bleeding had stopped; it was just a matter of removing the clot, so there was no need to take the spleen. We’ll keep the drainage tube in for couple of days just to make sure it stays that way, and then in the morning I’ll get another set of chest x-rays. Barring any complications, we should be able to take the chest tube out tomorrow. He’ll be sore for a few days and that fractured rib is going to keep him quiet, but I expect him to make a full recovery.”
Dix nodded. “Thanks, Joe.”
“Oh, and his ankle -- grade 2 ligament tear. At least he’ll be off it for a few days. In fact, it might be a blessing in disguise. It will certainly curtail any thoughts he might have of getting back on his feet before he’s ready.”
“He’s not going to be happy about missing the conference.”
“No. Let’s hope Mike Wolski has enough sway to make that Assemblyman see reason.”
Kel snatched at the remote control from his bedside table, began the cycle of channel surfing for the fourth time in fifteen minutes and once again came up empty. He couldn’t remember the last time he’d been forced to watch daytime television. He tossed the remote back on the cabinet in disgust and tried to maneuver himself into a comfortable position.
The mattress was hard, the pillow too soft, the food atrocious, and the wound in his abdomen alternated between throbbing and itching. He couldn’t even take a deep breath without pain. Kel would have gotten out of bed and paced if Joe hadn’t refused to give him crutches for another 48 hours. He hated being a patient. He hated everything about hospitals from this side of the bed.
“Kel?” Joe pushed the door to Brackett’s room all the way open and walked in. “How are you feeling?”
“I want to get out of here.”
“I know. And you will. All in good time. It’s only been two days.”
Kel punched his pillow and sighed, dropping his head back to stare at the ceiling. He was well enough to be bored, but still too tired and sore to concentrate on anything for more than an hour or two.
“How’s your pain, Kel?”
“That’s not an answer. Are the pain meds helping?”
“Most of the time.”
“Kel, the pain relief is there; if you need it, say so. Don’t suffer in silence.”
“I’m not the silent type, in case you hadn’t noticed.”
“That’s true when you’re dealing with your patients and staff, but not so accurate when it comes to yourself.”
“I blew it, Joe,” Kel said, eyes still fixed on the ceiling.
“What are you talking about?”
“Wayne Johnson from Utah. I just needed a little more time and I think I could have convinced him to vote in favor of the paramedic program. After my little performance the other day, I imagine my credibility as a spokesperson for the program has taken a serious nose dive.”
“On the contrary, Kel. What happened the other day couldn’t have been better timed. Not that I’m condoning what you did…” Joe shook his head, still unable to believe that a man of Brackett’s intelligence could have let himself get so sick without taking action.
“What are you talking about, Joe?”
“I came in to tell you. Mike Wolski just called; apparently the bill passed this morning, unanimously in favor of the program.”
“You’re kidding me?”
“Nope. It would seem that your little stunt at the restaurant and watching the paramedics in action convinced the good Assemblyman of its merits.”
“Hah. Well, I’ll be darned,” Kel said, shaking his head.
“Yeah, but I’d prefer that from now on you didn’t take those kind of chances to prove a point. You were pretty sick, Kel.”
“If it makes you feel any better, it wasn’t intentional. The symptoms really didn’t start to add up until I got to the restaurant. By then it was too late.” Kel knew his argument was weak, and as a doctor, he should have known better, but at the time he thought he was doing the right thing.
“You know, if you’d let me treat your ankle when I first offered and gone home and rested, then you might not have been in that treatment room and in the position to get kicked.”
“Yeah, and if we all had a crystal ball, wouldn’t life be wonderful.”
“Maybe. But Roy said if you hadn’t landed on your ankle wrong, you would have been able to get out get out of the way of that kick.” Seeing his friend about to argue again, Joe sighed and held up a hand to ward off Kel’s attack. “All I’m saying, Kel, is that sometimes you need to let go. You don’t have to maintain that hard-nosed Chief of Emergency persona all the time. If you need help, it’s okay to ask.”
“Okay, okay…I get the message.” Kel shifted position, Joe didn’t miss his grimace of pain and the way he grabbed at his side.
“I’ll get you something for that,” Joe said, glancing at Kel’s stomach, “then I want to examine your incision.”
Kel nodded and closed his eyes. “Thanks, Joe, it is kind of giving me some grief.”
Joe smiled, knowing that hadn’t been an easy admission for Kel.
Four days post op and Kel was ready to climb the walls. His pain was manageable and he’d slept more in the last 72 hours than he had in the past month. Yesterday, he’d finally succumbed to daytime television and halted his surfing on the image of an egg timer. Kind of ironic, he thought, to land on a TV show that started with sand slipping through an hour glass. Time was something he had way too much of at the moment and he was going quietly stir-crazy confined to his bed.
When the door burst open and Dixie waltzed in, Kel couldn’t hold back a grin. He was grateful for any distraction that would break the monotony of the endless hours of staring at the four walls of his hospital room. “Hey, Dix. Boy, am I glad to see you.” He pushed himself up straighter in the bed.
“Well, Doctor Brackett, it’s nice to see a smile on your face. My nurses have been drawing straws to see who gets stuck with Brackett-duty,” Dix said, straightening out the blanket covering her patient.
Kel quirked an eyebrow and slanted a lopsided smile at her. “I’m not that bad.”
Dix shot him a look, leaving him in no doubt that he was indeed that bad. “How are you feeling?”
“Well, that’s good; you must be on the mend.”
“Where’s Joe? I want to know when I can get out of here.”
“Dr. Early’s in surgery; he said to tell you he’ll be in this afternoon to see you.”
Dix wheeled his meal tray away from the bed and started to close the curtains around him.
“What are you doing?”
“Your bath,” Dix said, not making eye contact.
“Hey, wait a minute. I’m well enough now to take care of my own bathing needs.”
“Hospital regulations, Doctor.”
The door opened and Sharon Walters walked in, wheeling a trolley laden with what looked suspiciously like bathing equipment.
“Miss, Walters,” Dix said. “I see you drew the short straw today.”
Kel didn’t miss the conspiratorial smile that passed between Dix and the young nurse.
“Good morning, Doctor Brackett. Are you ready for your sponge bath?” Sharon asked as she dropped a washcloth into the large dish of water on her trolley.
“I’ll be back to see you in an hour,” Dix said, heading for the door.
As she walked out, Dixie turned around and gave Sharon a wink.
Kel leaned his head back against the pillow and groaned.
God, he hated hospitals.
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