She was pretty, and pretty smart. Well, that latter was kind of a given, being an ER nurse in a big city. We were in her department a half a dozen times a night, that being the nature of Big City EMS. We tucked our patients into her carts, gave report, and hung around, finishing our trip sheets and waiting for the next run.

We seldom had to wait long.

As one shift followed another, I began to seek her out, flirting and chatting her up. She, delightfully, reciprocated. One night, I got detailed out to another firehouse. When I returned, my partner, Doug, made a point of noting that Elsa had asked where I had been, on the night I was working across town. Good omen.

The bulk of EMS calls come in roughly between mid afternoon and early morning, like around 2 or 3 am. For that reason, the city opened a couple of houses as “power shifts”, going in service at 1400, and closing up shop at 0200 ( ... or so the crews hoped!). Surprisingly (or, not) ERs have a similar bulge in their census, and so also established their own 1400 to 0200 shifts. Elsa was on that schedule. Nice.

We continued to run in and out of Big City Health Center, and I continued to flirt with Elsa. Eventually, I steeled myself, and asked her out.

Her eyes twinkled, as she answered me, “When?”

I stammered, vapor locked that she would indeed consider going out with me, until she saved me.

Just as if I hadn’t turned red in the face, she continued, “Since we both ought to get off work about the same time, why don’t you swing by my place? I have some rum and Kahlua, and you could grab some vanilla ice cream. We could make Hummers, and watch HBO. We could decide where we’re gonna go on our second date, hmmm?”

I unlocked. “You bet!” She pressed an already prepared piece of paper into my hand, and directed me. “Here’s my phone number, and address. Give me a call once you break out of the firehouse. I’ll have my porch light on for you.”

I heard the tones for our truck go off, and turned to leave. “Gotta go! I’ll call you as I head out!”

We pulled up on the scene of our shooting after the police. (which, by the way, is my very FAVORITE sequence of events. I get kinda nervous, when I have to let dispatch know that our “sick person”, is ill due to unbluprinted holes, leakage of Good Red Stuff, and unknown whereabouts of the shooter. Bad times.) One of the officers waved us over to the victim, and we set to work, searching for and stopping the bleeding, assessing his ability to breathe, and attempting to sort out his particular catalog of woe, with an eye to determining how much care we would render at the scene, and how much would wait for transport.

We looked at each other, and nodded. Doug tossed me the handie talkie, and grabbed the medic bag. “Need a board? Or a collar?”

“Nope. Just diesel.”

He hot footed it over to the truck, returning with the gurney. Mr. Beenshot was eased onto the cot, and loaded into the rig. I heard Doug from the front, as he wheeled us through The City. “BCHC, from Medic 7, priority one. Approximately 35 year old male, GSW to chest and abdomen. ETA 6 minutes.”

I heard Elsa respond from the triage radio, “Vitals?”

“Wait one”. I bellowed the answer: “Palpable radial pulse, sat in low 90’s, breath sounds diminished on right!” Doug relayed this, and again I heard Elsa, “Copy, we’ll watch for you.”

Most of us think of choreography as being a dance thing. Perhaps, a movie thing (think about movie fight scenes, for example). Well, emergency services have choreography, as well. On a smoothly running EMS scene, the responders know what is needed, set about doing it, and step back, looking for the next needful thing. Similarly, and with better lighting, an emergency department has choreography. When you have a cadre of nurses who know their shit, keep current on it, and know each other’s moves, well, that dance saves lives, sometimes. The physicians adjust the flow, as the medical control determines this, or that, needs to be different, just so, from the routine, and the nurses identify unexpected findings, or responses, and communicate same to the physician, for further evolution of the dance.

Mr. Beenshot was rapidly undressed, multiply IV’d, and had a not inconsiderable amount of his blood sent to lab for analysis. Radiographers provided views of his chest, and belly, so the physician could determine why his breath sounds, on his right, weren’t what were expected.

So, it turns out, when you have a .351 inch hole in your chest, and another, perhaps 6/10 of an inch, on your back, the nigh-perfect theory of action The Architect designed into your breathing apparatus, doesn’t work so well. The loss of vacuum inside your chest and outside your lungs, allows the lung to flutter in on itself, and all the gasping and retching in the world is not going to convince that lung to inflate. If you are particularly unlucky, as was Mr. Beenshot, you can leak air into that formerly pristine void space, and it will not whistle out. With each breath, you will pump more air in, and more air, and more air, until the developing pressure shifts your heart and everything else, that belongs in the center of your chest, into the side that, otherwise, is working to oxygenate your blood.

That is unhelpful.

The treatment for this is a big tube, stuck between your ribs and into that void space, attached to low suction, and sealed to your chest. The lung follows the suction, drawing up tightly against the chest wall from the inside, and starts to oxygenate blood again. Good times. Except, of course, for the process of making that happen. As you might imagine, when you need it in a hurry, you are not anesthetized. Without anesthesia, it really, really hurts. In fact, I’ve been told that it hurts like a motherfucker. True story. Direct quote. On the other hand, the fact that my witness was able to draw enough breath to speculate upon my unusually close relationship with my mother, kinda meant that we all had done it right. (Sir, you’re welcome! And, mom says ‘Hi!’)

Once all the RFN drama had been addressed (ie, stuff that needed doing Right Fucking Now!), Mr. Beenshot found himself on the way to surgery, so Our Friends the Surgeons could give him the benefit of their own brand of magic.

Fortunately, for specific values of “fortunately”, all this excitement, as well as cleaning up and restocking from this excitement, took us past 0200. Elsa had been caught up in the activity, and so she found herself working past 0200, as well. Doug and I knew what we were about: we were about to head back to quarters, log out, and beat feet to Someplace Else, particularly someplace that did not smell like diesel fuel, or looming death. I caught the pay phone on my way out of the firehouse, and Else picked up on the third ring. “On the way! Still want that ice cream?”

“Oh, hell yeah! After tonight, I need to put my feet up, and not move for a while! You up to serving me?”

“I think I could be convinced. I’ll be there in a half an hour, and we’ll see.”

Once in the door, I unlaced and removed my boots. We meandered into the kitchen, where her blender and our efforts soon provided us with about a liter of Hummers.

We had a few drinks, told a few stories. She lay down, her head in my lap, and I massaged her scalp, her temples. She purred, and I wandered to her neck, her shoulders. We continued for a bit, and she roused herself, telling me, “wait here. I’ll be right back.”

When she returned, she had abandoned her scrubs, now in a bathrobe, She settled in on the couch, next to me, and told me, “your turn. Here, turn this way.” I complied, and she began to rub my back through my uniform. Didn’t work so well, through my kevlar vest. “What? Why are you wearing that?”

“I didn’t want to keep you waiting,. And didn’t stop to stow it in my trunk.”

She reached around me, flipping my buttons loose, and tugged my shirt off me and onto the floor. The vest was a bit more difficult, with the elastic panel carrier producing considerable friction. I wound up standing, and showing her the contortions required to remove it. She rolled my t shirt off, and drew me back to her. “That’s better”, kneading my back across my taut shoulders. Several minutes of that had my shoulders relaxed, and my johnston tight. I turned to her, and said “now it’s my turn, to do you.”