Thursday, July 26, 2007

Prologue


"One and two and three and four and five and breathe," Ryan Pierce directed as he rhythmically compressed the chest of the man lying on the floor. "Try tilting his head back a little more," he suggested.

Jeff Layton looked scared, but did as asked, and was rewarded by seeing the old man's chest rise. Ryan winked at his roommate. "There ya go. Just like that."

Ryan's voice was icy calm, even nonchalant, as he knelt there in the spilled coffee and broken dishes. The entire restaurant had gathered around, watching as the two boys did CPR, but Ryan barely noticed. He knew they were there, in a distant and detached sort of way, but the problem was lying there in front of him, an old man with pasty gray skin and a vacant, slack expression on his lifeless face. The old man's half-lidded, unfocused blue eyes stared up at him as he worked. The man's ribs crunched under the force of his compressions. Ryan's mind calmly reported the fact that the man's ribs were breaking, and his hands automatically adjusted their depth and position.

"Would you go call 911, Ma'am?" he asked politely, smiling at the waitress standing there consoling the man's wife. She stared dumbly at him for a moment, her eyes wide and frightened. Ryan broke the spell by firmly speaking the name engraved on the name tag pinned to her smock. "Joanie. Please go call 911. Tell them there is a man in cardiac arrest, and that CPR is in progress." The girl, not much older than Ryan, nodded nervously and scampered away.

It didn't occur to him to be scared. For as long as he could remember, he had been this way. When faced with a crisis, everyone else panicked or lost their temper, or simply froze. Ryan Pierce went into autopilot. The world around him drug on in slow motion, while Ryan's brain and hands moved in real time. He saw things almost before they happened, and reacted accordingly, without conscious thought.

It was nothing so trite as precognition, this gift of Ryan's, if indeed he took the time to realize that it was a gift. Ryan's brain simply functioned with clarity and precision in those times when everyone else operated in the fog of panic.

When he was six, his twin sister had fallen into a drainage ditch and nearly drowned. While the adults panicked and shouted, Ryan simply rode his bike downstream and waited near the water's edge. When the current swept Renee near enough to grab the front wheel, Ryan dug his heels in and waited for the grownups to arrive, speaking reassuringly to his frightened sister as she clung helplessly to the spokes.

He remembered the adults making such a fuss over his actions, and never understood what the big deal was. Ryan Pierce had simply known what to do. Didn't everybody?

Crisis management was nothing new to Ryan. He had been doing it as long as he could remember. When he was a child, he would take Renee into their playroom and comfort her when his parents argued, rocking her and crooning softly, hoping to drown out the screams with the whispered nursery rhymes of their childhood. It rarely worked.

Ryan often prayed that Renee could find the stillness in herself, the same stillness that comforted him and allowed him to cope. Like water trickling over a rock, Renee Pierce's tears slowly but surely eroded away her hope. At fifteen, the only feelings she had left were anger and pain. His parents, true to their nature, only noticed the signs of Renee's withdrawal and never bothered to wonder why. Their daughter was an embarrassment, a bad seed. Ryan was the achiever, destined to become a doctor like his father, a fine young man worthy of the Pierce name.

Ryan Pierce had other plans. Every honor roll, every leadership award, every achievement was another step on the path he had chosen that would take him away from home, away from his family. Ryan had no idea where that path might lead, only that it led away, and that was enough. At age twelve, he had made the conscious, cold-blooded decision to get away.

He would get away, but not like Renee, who escaped into anger and substance abuse. Renee was a lost cause, a sullen teenager already lost in the fog of drugs and mental illness. Ryan Pierce would follow the path his parents had chosen for him for as long as the path suited his needs. He would use his parents' name and affluence to succeed. He would use that stillness within him; wear it like a mask to convince them that he was still the dutiful son, until the day came when he knew he could succeed on his own. Then Ryan would break away, leaving his parents and their money far behind. Robert and Sylvia Pierce were immensely proud of their son's accomplishments, but they had no idea that he had become a stranger years ago.

"Hey, how about we switch for a little bit?" Jeff's voice penetrated his reverie. Ryan looked at him appraisingly. Until this day, Jeff Layton had never done CPR. For that matter, neither had Ryan - not on anything other than a manikin, anyway.

"You sure you can do it?" Ryan asked, still keeping perfect rhythm. He waited until Jeff had delivered a halfway-effective breath, and his friend nodded. "Okay, switch and two and three and four and five and breathe," Ryan ordered, then shifted up to the man's head after Jeff delivered the breath. Ryan checked for a carotid pulse, found none, and nodded to resume compressions. The waitress ran back into the room, announcing, "The ambulance is on its way!"

Almost on cue, Ryan heard the sirens in the distance. As he bent over the man to deliver his next breath, the man's cheeks bulged and a stream of vomit erupted from his mouth. Ryan saw it coming and straightened up just in time, only getting spattered with a few drops. He rocked back onto his haunches and asked quietly for a towel. Taking the napkin someone pressed into his hand and he murmured his thanks, wiping the flecks of vomit and spittle from his forehead. He looked down at the man and sighed. Folding the napkin and turning the man's head to the side, he used it to rake as much vomit as he could from the man's mouth.

Jeff Layton had abandoned all attempts at chest compressions, and was now standing several feet away, gagging.

"Let's go," Ryan said, nodding at a spot next to the man's chest, "we're not done." Jeff, shaking his head in a mix of wonder and resignation, knelt reluctantly once again beside the man's chest. Shuddering inwardly, Ryan gave a breath and nodded for Jeff to resume compressions.

"Okay kid, we got it from here," a voice said. Ryan looked up to see two men standing behind him. One of them knelt next to Ryan, lowering his equipment box and defibrillator to the floor beside him. His partner smoothly bumped Jeff out of the way and knelt near the other side of the old man's chest. He ran a pair of scissors up the man's shirt from hem to neckline, opening the shirt in one smooth rip, and then smeared gel on the defibrillator paddles that his partner held extended at arm's length. The two men moved with smooth, practiced precision, with no wasted motion. "What happened?" the paramedic asked mildly, directing the question to no one in particular. There was no tension in his voice as he placed the paddles on the man's chest.

Ryan was the first to speak. "He was choking, and I did the Heimlich Maneuver on him. He coughed up a piece of sausage, took a couple of breaths, and then collapsed. Been doing CPR ever since," he finished matter-of-factly.

The paramedic looked at him appraisingly, one eyebrow raised and a half grin on his face. He turned to look at the monitor screen, announced, "v-fib, Jerry," to his partner, and then raised his voice, addressing the entire room. "Shocking here! Everyone stand clear!" The paramedic pressed the buttons, the defibrillator made a noise, and the old man's back arched in spasm. The monitor screen went haywire briefly, and then settled back into an ugly scrawl across the display, looking rather like a toddler had found a green crayon and doodled on the wall.

"Still v-fib, Jerry," the paramedic reported. "Charging to 300. Everybody clear!" He shocked the man again, and this time the arching spasm was followed by a steady series of beeps, accompanied by tall but regular blips on the monitor. The beeping got steadily faster, and the blips drew closer together, marching steadily across the screen.

"I got a pulse, Ray," Jerry announced, his fingers on the man's neck. "Looks like sinus tach at 120 on the monitor. Still ain't breathing, though."

"I need your spot, kid," Ray said gently, nodding to the place Ryan was kneeling. Ryan hurriedly stood up and stepped back a few paces as Ray slid into his spot at the man's head. He watched in fascination as the paramedic inserted a shiny metal instrument into the old man's mouth, peered briefly inside, and slid a plastic tube down his throat. "Hey kid, where did you go?" Ray asked, looking around. Ryan stepped back out of the crowd. "Still need your help here, partner," the paramedic told him, winking. "Hold this tube still while I tape it down. Then take this bag," he continued, laying a resuscitator bag on the floor next to Ryan's leg, "and squeeze it once every five seconds, just like CPR. Got it?"

Ryan nodded understanding and held the tube still while the paramedic wrapped several layers of tape around it, then all the way around the man's head several times, and finally back around the tube for several more wraps. When the paramedic's hands were out of the way, he attached the resuscitator bag and began squeezing, watching in rapt fascination as the old man's chest rose and fell and his color gradually changed from grayish-purple to pink.

Ray and his partner inserted a needle in the old man's arm, and injected a bewildering array of medication syringes. By the time they were finished, the old man was trying to breathe on his own. Ryan, still squeezing with one hand, reached out and jerked the paramedic's sleeve.

"Breathing on his own now, Jerry," Ray announced to his partner. "Keep squeezing the bag, kid. Try to time it with his breaths," he ordered Ryan, who dutifully squeezed the bag as the two paramedics loaded the old man on the stretcher, and even as they rolled him outside to their ambulance.

"We got it from here, kid," Jerry told him as they loaded the stretcher. "Thanks for the help." He disconnected the resuscitator bag from the breathing tube and tossed it to Ray, who had settled into a seat in the front of the ambulance, directly behind the stretcher.

"Hey kid!" Ray called before Jerry could shut the rear doors. "What's your name, anyway?"

"Ryan Pierce," he answered.

"You did good, Ryan Pierce," the paramedic grinned and winked. "Catch you later, kid."

Jerry slammed the rears doors before Ryan could reply, and he watched silently as the ambulance roared out of sight, siren wailing. He felt an elbow dig into his ribs, breaking his reverie. Jeff Layton was standing next to him, grinning.

"Pretty exciting, huh?" Jeff asked, grinning. "I may have to attend more of these leadership conferences." Ryan and Jeff's faculty advisor, Terry Kirkpatrick, was standing in the doorway, beckoning them back inside. Ryan smiled back at his friend. Jeff was obviously pumped, still flush with adrenaline. Ryan wasn't even breathing hard, or visibly excited. He just felt...serene.

I handled that pretty well.
Maybe that's what I'm supposed to do, Ryan thought. Those guys are just like me.

Ryan didn't share his thoughts with Jeff. You don't use words like destiny when you're fifteen years old, at least not out loud. Instead, he just laughed and walked back inside the restaurant with his friend, joking around and playing grab-ass like teenaged boys are supposed to do. "The waitress thinks I'm hot," Jeff announced conspiratorially as they sat back down at their table. "Ten bucks says I can get her number."

"That's a bet," Ryan countered, only half listening. Ryan remembered the feel of the old man's ribs cracking under his hands. He ate the rest of his breakfast in silence, listening with one ear to Jeff's antics and laughing dutifully at all the appropriate points.

Later that evening, Jeff and Ryan walked through the hotel lobby on their way to the conference awards banquet. Judging from the way his faculty advisor had behaved, both of them were going to have their turn on the dais. Ryan was dreading the fuss, not because he disliked the attention, but because he truly didn't see what the big deal was. It was his nature to act in situations like the one he faced that morning. It wasn't like he had risked his life, like charging a machine gun nest, or rescuing a baby from a burning building. He had just done CPR on a man that needed it, just like he'd learned back in junior high school.

True to his nature, Jeff was thinking of the attention he was going to get.

Probably thinks it's going to get him laid, Ryan thought wryly. And knowing Jeff, he's probably right.

Jeff and Ryan came from similar backgrounds, and had been friends since grade school. Ryan was the class clown. Humor was his weapon. It made him one of the boys, made him accepted, and it kept everyone else at a safe distance.

Jeff Layton was the quintessential Big Man on Campus. Having grown up privileged and pampered, being fussed over was as natural to him as breathing. Success was Jeff Layton's divine right. He friend barged right through the doors to the ballroom, scarcely noticing the man in the blue uniform leaning against the wall. Ryan recognized him, though.

"One of the teachers told me I might find you here," Ray explained. "Got something for you, before you go in there and take your bows." His eyes twinkled with gentle amusement.

Ryan felt himself blushing. "That's really Jeff's thing," he explained. "Besides, he was doing CPR too..."

"But you were the one who took charge," Ray observed. "Anyway, I figured you'd like to know that our patient is in the ICU right now. The doctor says he's probably going to be okay. That wouldn't have happened if you hadn't been there."

"I just did CPR, that's all. You guys were the ones who -"

"Let me explain something to you, Ryan," Ray interrupted. "You kept your head and remembered your training when a whole restaurant full of adults didn't. You kept that old man alive until we got there. And never turn down a pat on the back when you've got one coming. The chance doesn't come around all that often."

"Okay," Ryan replied simply, not knowing what else to say.

"Anyway, I thought I'd tell you that, and give you this," Ray winked, reaching up and removing a blue enameled pin from his left collar point. He pressed it into Ryan's palm, punched him on the shoulder and walked away. Ryan looked at the blue, six-pointed star in the palm of his hand.

"What is it?" he called to the paramedic's retreating back.

"They call it the Star of Life," Ray called back over his shoulder, without breaking stride. "All paramedics wear 'em. You earned it this morning."

Ryan Pierce looked down at the blue pin in his hand for a long time, then put it carefully in his pocket and walked into the ballroom to join his friend.

35 comments:

Babs RN said...

I like it. ;)

Kyle J. said...

more!!! I demand more.

Mr. Fixit said...

Good.

Mr Fixit

Fyremandoug said...

AD you need to continue this tale....its good

dr. nic said...

cool. If you can find a publisher I'd buy it.

Canadian ER doc said...

Ditto that. Can't wait for the next chapter. Write, dammit, write (visions of Misery...) :-)

Ron said...

AD,
Just recently found your blogs. Amazing writing. Gonna look for your first book and keep visiting this site to see Ryan's transformation into an EMS professional.

Scott said...

I can only echo Kyle's demand:

more!!! I demand more.

Beaker said...

WOW

John said...

AD,

From a 29 year Lifer in Medicine- write Bro--write like hell and teach. Those are your God given gifts. It's easier on the back than Tech work- Yes??? ;_)

John

Brandon said...

It's pretty good AD.

MedicMatthew said...

AD, you've got to publish this. John said it best- write and teach brother, these are your gifts.

Pseudo_Doctor said...

anything that made me want to go refresh CPR again and quit medical school to become a paramedic definitely is a great read...chapter 1 next please would be nice..

Stacey said...

Keep writing!!!!!!!

Anonymous said...

Amazing story, great writing please post more

Epijunky said...

I can't wait to read more... Thanks for sharing it with us :)

Bob@thenest said...

Ohhhh, YES!

The Bad LT said...

The publisher's cool on this?!? You've GOTTA be kidding me! This is great stuff! Almost makes me want to be a paramedic! Oh, wait...I am!

Loving Annie said...

AD,
I will buy it ! Please continue !

Loving Annie

SpeakerTweaker said...

NEXT.

CHAPTER.

PLEASE.



tweaker

Dixie Amazon said...

Excellent!

Ralphd00d said...

Keep it going, AD. I wouldn't mind buying another book.

betsy said...

Keep writing! I like your characters and want to know what's next... Don't worry if it's rough, that's what drafts and editors are for.

Strings said...

Cool AD... great stuff...

Now, a word of warning: you make this go like Law Dog's Pink Gorilla story, and I WILL find where you live... >:)

BuckeyeEMT said...

Ok...so who do I make my check out to?????????

Keep going.....we all want more!!!

knitalot3 said...

More, please! Don't sweat the publisher. There's always pdf downloads. More soon.

Walrilla said...

For the 20 some-odd that have commented, there's another 80 some-odd that have read this, liked it, but have not commented.

Write it, AD!

Mr. Publisher, you make with the publishing when it's done!

We'll buy it!

Walrilla

Angell said...

Excellent job hon. I can't wait to read more.

Incredibly descriptive without going overboard.

Dirk said...
This comment has been removed by the author.
Dirk said...

Nice work. More, please.

Angela said...

I am hooked~! Get busy AD and finish it please i am in limbo waiting to find out what happens with Ryan

Old NFO said...

Nice work AD- thanks.

Pseudo_Doctor said...

starting to really like the characters AD...keep it going and publish the book

Anonymous said...

Kept me reading till the end. What's next?

Medicmarch. said...

Hey. I know you're being all lovey dovey and all...but put up a new damn chapter!

-MMjuvyf