Chapter 2: Farewells

May 28, 1989, Circleville, Ohio

"You have NO idea how badly I wanted to stick my tongue out at you at the banquet when I received my award," Clarissa declared when we stood next to each other at the snack table

"I saw the look on your face," I replied. "I can read you like a book!"

"And I can play her like a piano!" Tessa declared.

"Sassy as always!" I replied.

"High praise coming from a nut like you!" Tessa exclaimed.

"He may be a nut, but he's my nut!" Clarissa declared.

"You're lucky I share!" Kris said, coming over to the table.

"She's not interested in THAT!" Tessa teased.

"That I do NOT share!" Kris declared.

"Which works well for all involved, doesn't it?" I suggested.

"It does!" Kris declared. "At some point, the four of us need to talk."

"We do," Clarissa replied, turning serious. "But we have a few years before any decisions have to be made."

"When we come back from Tennessee, and you two come back from California, we'll have you over for dinner," Kris said.

"That sounds good," Clarissa replied. "Ten days in Napa Valley is exactly what I need before I start my Residency. We'll bring you a couple of bottles of California wine."

"It's OK for cooking, but not drinking," Kris said with a silly smile.

"Funny," I chuckled, "you were drinking California white the other night."

"You're supposed to be on my side!" Kris protested.

"Good luck with THAT," Clarissa smirked. "Petrovich is going to give you more grief than he gives me, and that's saying something!"

"Who? Me?" I asked innocently.

"Yes, you!" Kris and Clarissa both said simultaneously.

"I think I'm going to go hang out with the guys," I said. "It's safer!"

All three girls laughed, and I made a point of joining Bobby, Ghost, Jason, Elias, Subdeacon Mark, Robby, Peter, Gene, Chris, and Pete.

"Be about twenty minutes early tomorrow morning," Bobby said. "I'll meet you there then and get you set up with a locker and rack and check you out on your bunker gear and the squad."

"Mike Loucks as a fireman," Robby said, shaking his head.

"Mike Loucks is expressly prohibited from running into burning buildings!" I declared. "I have a provisional paramedic certificate based on my MD and passing the paramedic test, but I am NOT a firefighter!"

"Heck, I don't run into burning buildings," Bobby said. "That hero shit is not my gig!"

"But you would, right?" Ghost asked.

"To save someone if that was necessary?" Bobby responded. "Absolutely. That's why I had full firefighter training. But that's not my job any more than doing routine physicals is your job. That said, the rules expressly prohibit Mike from doing that. But to ride in the squad or on either truck, he has to be checked out in bunker gear. Just being near a fire can be dangerous, especially in farm country, where every fire is a potential explosion or chemical release."

"Bunker gear?" Peter asked.

"It's all the protective equipment we use," Bobby said, "including gloves, helmets, boots, trousers, and coats. Respirators aren't technically part of that because they weren't traditionally kept in a fireman's bunk, but we generally refer to everything we wear on our person as 'bunker gear'. It's all designed to fit over our uniforms, and the uniforms are designed to be comfortable at the station and eliminate the need for soft linings for the trousers and coats."

"Do you put them on for every response?" Peter asked.

"Paramedics usually don't. We keep our gear in the squad and put it on if we need it on-site. The guys on the truck, except the engineers, all put on their turnout gear before they get on the truck. The engineers' gear is in the cab of their vehicle, and they put it on once we get to the site. We discovered it's safer for them to drive in their station uniforms than wearing all the heavy gear, especially their boots."

"How do you get water when you're out in the boonies?" Peter asked.

"Some we bring with. We have a pair of engines which carry the firefighting crew and all the equipment they need, including hoses, ladders, saws, hooks, the 'Jaws of Life', and all the respiration gear. Each engine carries a thousand gallons of water on board. After that, they draw from any available water source - a hydrant, pond, river, swimming pool, or other water source up to two hundred yards away. The county can also dispatch up to five water tenders that carry three thousand gallons of water.

"In addition to those two, we have our rescue squad, which is a combination ambulance and what you might have seen on Emergency. For a fire, MVA, or HazMat, we respond with all three vehicles; for rescue or medical emergency, we respond with two. In addition to the water, we have extinguishers on all three apparatuses."

"What if the water source is too far away?" Peter inquired.

"A water tender will drive to the water source, fill up, and return. It will deliver the water into what's called a drop tank from which the engines will draw. It's not ideal, but we do what we have to do. We can also draw from cisterns. Some of the big houses northeast of town that aren't on city water and either don't have a well or don't have a reliable well, have cisterns they fill with rainwater or have water delivered, and we can draw from those, too."

"What will you do, Mike?" Jason asked.

"Mostly observe," I replied, "but I'm allowed to do anything I could do as a medical student. That gives me one advantage over Bobby, which is that I'm able to intubate a patient. The paramedics will be trained to do that over the next two years. Me going on a ride-along is the first step in a complete rethinking of providing advanced life support, starting with EMS response. The name change - Emergency Medical Services — finally acknowledged what paramedics do.

"We've come a long way in twenty years from 'scoop and run' ambulance service to paramedics being trained to do significant medical procedures. Eventually, we'll have specially-trained trauma physicians available to respond to 'mass casualty' events. I'll be one of the first qualified to do that. They're still working out the malpractice and liability insurance problems."

"Problems?" Robby asked.

"Lawsuits," I replied. "Firefighters are indemnified against basically anything they do by state law, so long as they follow procedures or specific orders from county officials, or in the case of EMTs, from doctors. Doctors, on the other hand, are not, even if they respond to the scene of an accident. We can still be sued, and as such, the hospital has to negotiate with their insurance company to cover me when I'm outside the hospital grounds. I have some coverage if I happen upon an accident or illness, but specifically responding as part of a rescue isn't covered."

Ghost nodded and added, "If there is any topic where you'll find physicians in complete agreement, it's malpractice reform. You can't sue a firefighter for failing to rescue you or for injuries sustained while rescuing you, but even the slightest adverse outcome can lead to a multi-million dollar settlement from a doctor or hospital, even if they weren't really at fault."

"There is," Doctor Gabriel interjected, "always a chance of adverse outcomes, no matter what we do. A perfect example is the drugs used for intubation. They are standard doses and have no significant contraindications. One person in 100,000 will have an adverse reaction to them, and one percent of those who have a reaction will die. There is no way to know in advance and no test we can run because intubation has to occur within ninety seconds for an airway obstruction. So we do it. And get sued if something goes wrong, even if it's beyond anyone's control."

"Has that happened?" Subdeacon Mark asked.

"Not since I've been at Moore," Doctor Gabriel replied. "We had one incident at Cook County, but it was never proved it was the intubation drugs. That said, we do have people who never come out of anesthesia, even with reversing drugs. And there's no way to know in advance. Ditto for pulmonary or cardiac arrest during anesthesia. Even testing can't tell you in advance when that will happen. Again, nobody is at fault, but we pay the price."

"So, what's the solution?" Subdeacon Mark asked.

I smiled, "My wife would say fully socialized medicine with the government paying all claims for actual injury."

"What about negligent doctors?" Elias asked.

"A different problem of a completely different character," Doctor Gabriel replied. "All of us, and I mean physicians and non-physicians, should work together to weed out negligent doctors. You don't need malpractice suits to do that, you need good oversight with a mix of physicians and regular citizens."

"And no lawyers!" Ghost added. "Shakespeare had it right!"

I shook my head, "When Shakespeare had Dick the Butcher say, 'The first thing we do, let's kill all the lawyers' he was speaking about how a tyrant establishes an autocracy. But I agree, no lawyers on any review board. And adherence to accepted best practices should be a complete and total defense to any claims of negligence or malpractice."

"What he said!" Doctor Gabriel replied. "Though Mike's idea that we currently have socialized medicine is non-conventional."

"Says the man who works for a government hospital which receives significant funding from taxes!" I countered. "Not to mention, the very point of insurance of any kind is to pool funds to socialize the risk. I have State Farm for my auto and home, and it's a mutual insurance company, which means at the end of a year, any excess premiums collected over losses and operating costs are returned to the policyholders, minus any money retained for reserves."

"That's not socialism!" Subdeacon Mark protested.

"No, but it's what people here mean when they say 'socialized medicine'. Most proposals do not call for every doctor to be a government employee or for all hospitals to be publicly owned. The proposals are almost always about 'single-payer' in the way Medicare and Medicaid operate — insurance funded by premiums collected as taxes. True socialism is common ownership of the means of production. That's a VERY different thing. Volvo and Ericsson, despite being Swedish companies, are publicly traded on stock exchanges."

"When did YOU start discussing politics in a serious way?" Ghost asked, sounding surprised.

"When he married Kris!" Robby exclaimed. "She's the 'Red' in his bed!"

"She'd reject that nod to the Soviets," I said. "She and my grandfather have the exact same opinion of the USSR and the Communist Party despite coming from basically opposite sides. He's a liberal, and she's a socialist, to put it in European terms."

Some of the guests began to leave, including Nadine, who was driving home before heading to California. I walked her to her car, where we exchanged a chaste hug.

"Thank you for everything," she said. "If you're ever in California, look me up at UCLA."

"Absolutely. I suspect you won't be coming back to Ohio anytime soon."

"If I'm going to fly for four hours, I'm going to Hawai´i, which is only five hours away!"

"I hear you on that! I'll make it to Hawai´i at some point, but that's probably ten years from now. As for California, after speaking with Clarissa and Tessa, Kris is interested in visiting Napa Valley, but that's what? Three hundred miles from LA?"

"Closer to four hundred, I think," Nadine replied.

"Let's keep in touch," I said. "You have my address and phone, so just call or write once you have yours. Fran, Clarissa, and I will all be in the area. I already have Peter's home address and phone number, as he plans to live with his parents for the first year. I have Maryam's apartment address, and she'll get me her phone number as soon as she's in Chicago. I'll make sure you get all the information for everyone and be the one to keep up with all the addresses and phone numbers."

"Awesome. Thanks again, Mike. I hope to see you in my OR someday, but vertical, not horizontal!"

"The same for my trauma room!"

We hugged again, and she got into her car and drove away. The scenario repeated itself with Peter about ten minutes later, as he was flying home first thing in the morning.

"Thanks for being there for me for four years," I said.

"I was just about to say the same thing!" Peter replied.

"It was fortuitous that we met at the banquet and then were paired for CPR. I'm glad that happened, and I'm glad you were part of our study group."

"Again, I could say exactly the same thing. Come to Atlanta, and I'll show you some real Southern hospitality!"

"It'll be at least a year, for obvious reasons. I'm going to miss you."

"I'm going to miss you as well," Peter replied.

We hugged and slapped each other's backs.

"Take care and stay in touch," I said.

"You, too."

He got into his car, which he'd agreed to sell to a Second Year, and as he drove away, Maryam came out of the house. We'd already said what we needed to say, so we hugged carefully, Maryam smiled and kissed my cheek.

"I'll see you at your wedding, by hook or by crook," I said. "Have a safe trip."

"Enjoy your belated honeymoon!"

"We will."

Maryam got into her car, backed out of the driveway, and, with a wave, drove off. Once her car was out of sight, I went back into the house. The party wound down around 8:30pm, and several couples stayed to help us clean up. When we finished, they left, then Kris and I put Rachel to bed and went to bed ourselves.

May 29, 1989, McKinley, Ohio

On Monday morning, even though she didn't have school, Kris had been up early with me for our usual joint shower, to say morning prayers with Rachel, and to have breakfast. I'd kissed them both, then headed to Fire Station #2, which was about two miles from Moore Memorial Hospital.

"Morning, Doc!" Bobby said with a grin when he met me in the small parking lot behind the Fire Station. "Welcome to Station #2!"

"Also known as the Second People's Hospital for the Insane!" I said with a grin. "After all, only someone who was truly nuts would make a living by running into burning buildings!"

"You do realize we don't ACTUALLY do that very often, right?" a fireman said, coming over to us.

"Doctor Mike Loucks, Lieutenant Jim Greer."

"Lieutenant," I said, extending my hand.

"Doctor," he replied, shaking my extended hand. "Just call me Jim, please. Usually, only our captain is addressed with his rank."

"How many firefighters are on duty at any given time?" I asked.

"A captain, a lieutenant, two engineers, two firefighter-paramedics, and eight firefighters. There is a battalion commander, but he's responsible for three stations and only responds when multiple fire companies respond. He's based in Station #1."

"Let's get inside and get you settled," Bobby said. "A rack, a locker, and bunker gear. Did you get your steel-toed shoes?"

"UPS delivered them on Friday."

"Safety regs require you to wear those at all times, except in the shower or sleeping."

"Got it."

"Your uniforms are here and ready for you."

We went into the station, and Bobby was greeted by other firefighters, some coming on duty, some going off.

"What happens if a call comes in now? Or if the crews were on a call?"

"Until 7:00am sharp, the crew on duty would respond, and if they were out, they'd stay out until they finished the run or were relieved by another unit."

We went to the back of the station where the dormitory and showers were located, and Bobby showed me the rack and locker I'd been assigned.

"Let's get you into your turnout gear. Once I'm satisfied you know how to wear it, we'll store it in the squad with ours. Put your uniform on first."

I changed out of my 'street clothes' and put on the brand new uniform that was hanging in the locker. Once I had it on, I began to put on the bunker gear. I had reviewed my notes from the training class I had and mostly got things right. Bobby provided pointers as I put on the gear, especially about the flaps which covered the zippers on the turnout coat. Once he was satisfied I'd be able to put the gear on properly, I put on the new shoes I'd ordered. Once they were on, we took the gear to the squad and stored it behind the bench seat in the cab, along with my medical bag. Once we'd done that, he showed me where all the gear was stored in various compartments accessible from the outside, along with what was stored in the ambulance portion of the squad.

"One thing I wondered," I said, "is why you don't have the radio hookup they showed in Emergency where Doctor Bracket or Doctor Early would say 'send us a strip' to get an EKG."

"We didn't have the money LA County did when we started."

"What are your standards for defibrillating?"

"No pulse or no heartbeat. Basically, 'shock and see'. Our new ALS ambulance units will have EKG equipment and the ability to transmit, but that's next year before they begin delivery, and Moore needs to install the new radio and telemetry equipment."

"And for compromised airways, all you can do is bag at the moment, right?"

"Yes. You brought your bag of tricks with you, right?"

"Yes. I have everything I need for intubation in my medical bag. Has your training been scheduled?"

"No. That starts in September, but the individual schedules haven't been published. It's going to take some time to get eighty hours of training in."

"Not to mention the 'luck of the draw' with regard to patients needing intubation. You'll need to do six or eight before an Attending will sign off. Do you know how to read an EKG?"

"I think the correct answer is 'no' because other than what I learned in paramedic school, I have no experience."