Cover

If I were to turn my face toward the clouds I would feel this mist as a cool caress; instead I keep my eyes on the face of the angry gentleman in the white Buick so insistent upon going around me onto the street beyond.

"I have an appointment." His voice is deep with frustration and a bit of anger. His eyes glow with self importance. Does that self image come with the accumulation of decades, I wonder? I estimate his age at approximately seventy-eight, weight close to two hundred and forty on a tall frame, barrel chest and nicotine stains on his hands but no smell of smoke. There's a slight tremor to his hands and a cane along his thigh at the center of the seat. Walking any distance in this rain will not be comfortable for him.

I don't move.

The rain has gathered to drip off the brim of my cap in a steady rhythm: 20cc's per minute. There is a chill of it along my nape where my collar gaps as I duck my head to speak into the car window.

This conversation is circular. He's informed me of his pending appointment for the third time, as if I am an idiot. "Yes sir." I nod, water finding its way past my hair and seeking new territory between my shoulder blades. I wish I had grabbed my rain gear, but it hadn't been raining just over an hour ago when I'd been paged. "I understand. If you'd like to park in the East lot and walk through the building, you may do so. Or, if you wish, you may wait here until the road opens and it is safe to proceed." Three times I've said these same words in exactly the same quiet tone.

I should be bored with this.

I should be pissed.

I should be sending this guy away with a terse comment and get back into the rig out of the rain.

I do not want to get back in that rig.

"74, we need you in the ER. Copy?" The voice is in stereo, the remote at my shoulder echoed at a greater volume from the loudhailer in the light bar off the rig. I reach inside my jacket to key the mic, the chord moving a bit along my back reminding me of a snake.

"74 copy. Need a replacement for traffic @ Drury and Fallwood to comply." My own voice now over the loudhailer. I don't speak loudly, but it carries. No feedback.

The man in the Buick narrows his eyes at me. He's gonna try to make a break for it and go around. It's in the set line of his jaw, in the superior nature of his seat on the wide leather padding Buick built just for him. I forestall him with a hand to the A post and lean into the window. "Sir, this roadway is closed for safety reasons. When the helicopter leaves, we will reopen it. In the meantime I ask you to either wait here or move into the East lot. I cannot and will not allow you to pass until it is safe to do so." The sour look on his face simply deepens.

"It's just sitting there, not even running!" he complained. "I'm not gonna hit it! I'll go around for Christ's sake! This is ridiculous!"

I'm fully aware of the chopper. I know it has sat there neither loaded nor running for the last twenty minutes. I know why, though I had left the controlled chaos of the ER twelve minutes ago as soon as I'd turned over my run sheets and briefed the air crew. I knew only one of those documents would be making the flight. I knew it in my bones, but now my head was catching up. I didn't want to think about that. I had left that behind as I left it to my supervisor to schmooze with the admin and air crew. I was here, in the rain, and there was nothing else for me to do in the here and now but to stop traffic and not think: a good plan. I decided to stick with it.

"No sir, It's not." I wanted to hear the rotors. I wanted to not wonder why I was being called back down there and clenched my teeth on the belief it just meant someone was too lazy to read my run sheets. I looked at the beads of rain on the glasses of the man in the Buick; at the darkened swatches of his shirt and the upholstery. I straightened and took my hand from its place on the A post. "You're getting wet. Please roll up your window and wait until it's safe to pass."

The look he shot me might as well have been a shouted obscenity, but he sealed his window and I took four steps backwards into the center of the slot the rig didn't block. When he flipped me off I didn't even blink. I used to be surprised when the elderly did rude or vulgar things. I'm not anymore. I didn't care. I was alone in the chill sound of the rain waiting to hear the rotors. It had been too long.

"91-74. Ten twenty two. Remain on station." Voices always sound lonely off the loudhailer in the rain; hollow and apart.

Mine was no exception. "Ten four." I'd done good; found a spot where my body was more valuable than someone else's whim. I had managed to buy myself a little peace.

I glanced down the hill at the sound of a muffled shout. There were more cars below; a cruiser's lights cutting through the mist in strobes of piercing white, red, and amber. The officer in the gap down there was yelling at the driver of a Honda. I could guess why. The airship sat forlorn and inanimate on the helipad not two hundred yards down slope of my own multi-hued flashers. I wished it on its way.

Over the radio came one terse call. "Loading now." There would be no response from those of us on perimeter.

I turned back to face the cars lining the blocked lanes. The man in the Buick glared. There were now four other cars behind him, waiting. I scanned the cars lining the side of the road that faced onto the pool and park. The faces of little kids and some adults peered through the foggy glass to catch a glimpse of the scene below. There is excitement in their expressions. Their eyes are large with anticipation, with curiosity and questions. I know what they are seeing. I know what they can't see. I can't look at them for very long. It makes me think too much, and I don't want to think.

When I hear the whine of the turbine starting, when the pitch of that sound begins to both climb and deepen, I scan the perimeter to make sure no one on foot is getting close. The rain helps. They stay in their cars. In the window of a small Nissan is a young toddler, his face pressed against the glass as his pacifier is worked furiously between pudgy lips. His eyes are round and very blue.

I look away.

The rotors are whipping the air into a froth below and I can hear the change in the echo as the ship begins to lift and angle up and over the road, away from the buildings. Its path takes it over my shoulder and then in an arc north east. I look below. Law enforcement is moving toward their cruisers. "Med Flight1, dispatch. Off the deck with one for Regions @ 1123hrs. ETA, twenty-seven minutes." The words boomed out over the rain soaked intersection, the pilots' report picked up as both the radio in the rig and on my hip scanned. There would be no catching the response from the dispatch in the cities: the distance too great for ground communications.

I shook my head and shoulders as I reached for the door, water sheeting off me as more gathered. It was senseless, a way only to delay getting back into this rig and the stench of trauma that yet clung to it. I climbed into the cab and let the echo of blood and fear and loss wash over me because there was nothing else to do.

The silence inside the cab was punctuated by the patter of rain and the soft flow of radio traffic as each unit went ten eight. I switched off the external speaker and glanced at the roadway. The old man in the Buick continued to glare. I put the rig into gear and rolled toward the ER entrance, shutting down the lights and calling in to dispatch to report this rig ten eight from traffic control/ten six at the ER. I still had paperwork to do and this rig wasn't ready for service. The diesel's clatter had a calming effect as I finished my three point turn and whipped tight around the corner toward the ER entrance. The high center of gravity made the van wallow like a galloping hippo in the tight turn, but there was no one in the back to worry about. There's a difference in how you handle a rig when it's loaded and when it's not. A little kid waved, smiling shyly from a rain streaked window. I waved back. I think I smiled. Reflex.

The bay area was full of vehicles, 270 was in the bay, doors wide, cot missing. I ran 271 up onto the side walk about twenty feet back and left it running. The route was clear for us to take 270 out if we needed. The big box was our primary rig, and closer into being in service than the van. 271 was our transfer rig, a van, sleeker, more fuel efficient, lighter and faster without the dualies or the interior room. They carried identical gear, were laid out much alike, 271 was just a tighter fit and took drifts better in blizzards.

I'd spent what seemed like years of my life in both rigs: Ten years, to be precise. I'd seen different iterations of each rig, we were on our fifth version of 270, and third of 271, had a third rig at the base (272), and they were talking a forth now that we kept a chopper and flight crew at the airport. For a town of 6000, we sure as hell worked our asses off. I guess being the only ALS company within a hundred miles and belonging to the only level one trauma institute in the cities had something to do with it. The rigs, the uniforms, the way we worked, it all set us at a high standard of care, but blood and distress smell the same no mater what you're wearing, and the stench in this rig was bad. I climbed out and hopped down relieved for a seconds' respite and the relatively clean wash of rain and diesel fumes as I walked through the open bay door.

My clipboard and run sheets were where I'd left them in the ambulance bay along with the other rig. The spray of a hot water hose rumbled out of the module of the type three filling the bay. A half heard shout called my name in greeting from within. I waved at the two inside scrubbing; used sign to inform them of the other rig's location and walked out of the path of the spray. I was wet enough.

My partner was scrubbing down the cot, a bucket of hot water and Buecoupe already mixed and a mop in the wringer, waiting. She tossed me a smile as I walked in, nodded toward the transformer cage where I prefer to write my reports. It was warm there, and out of sight of everyone, including the surveillance cameras.

"It's cleaned. So's your pen," she shouted over the din. "I'll get Scooby and scrappy doo to start on Bravo . . ." I could've kissed her for that small kindness, but even as I started to thank her, she interrupted me, her eyes grave behind the smile. "Elliot's looking for ya."

I nodded, knowing what she didn't want to say, yelled a 'thanks' over the sluicing whoosh of the hose and continued on past the transformer box where I snagged my clip board and pen and on to the double doors leading into the service hall.

The relative quiet here was like a hammer. Too much can escape you in that kind of quiet. I hurried through into the relative chaos of the hospital's emergency area where the families were beginning to gather. Tiny knots of distressed and bereft persons, some alone while others clung tightly to one another, formed an unintentional obstacle course through which I threaded my way. I was suddenly very conscious of my soaked uniform jacket and the numb stares I now drew.

One woman, near my own age, met my eyes with a bare and desperate longing too deep for a soul to survive. She stood over a weeping man, her husband, slowly stroking his back while she looked out onto a world she no longer recognized. I knew her. She had a seventeen year old daughter and a three month old grandson. I'd taken the daughter north on a transfer four months ago due to pre-partum bleeding . . .

A flash of silver off to the side and my eyes darted to catch and catalogue. One of the big fish in the aquarium, flat, round, and oblivious. I watched it dart after something I couldn't see from this distance and wondered what the hell Elliot needed.

. . . Amazing what the mind will do to protect itself.

I kept walking as the knowledge took up residence. I don't like to be caught still by revelations. Movement gives me the illusion of will.

As I turned the corner I spotted Elliot. Covered in dust, his uniform bloodied and torn, he was being herded into x-ray: his hands swollen, the right one deformed. There was a firefighter beside him in much the same shape, though his turn out gear had survived intact. Elliot saw me and nodded me over, his expression lost behind thick glasses.

As they strode into imaging I followed, closing the door behind. He hung back to close in, his back and my lack of height affording us each a modicum of privacy within the small anteroom. "Say . . . I need for you and Terri to cover as duty crew the rest of this shift for me if you could. Allen and I are both pretty banged up. Would you do that for me please?" He didn't meet my eyes as he spoke. He never did. Just as he always used more words than necessary to convey his thoughts. He preferred a roundabout approach to life that had taken me years to learn to ignore.

"Of course." I looked at his hands as he spoke. The gravel had been sharp, the deformities abraded and white with dust.

"They took out the mom. You knew that, right?" This is why he'd been asking for me. He didn't want me to hear from one of the others. They were young: too young to understand what had happened. Still invincible in shiny new gear, still pumped with the adrenaline of the be-knighted, they would have been examining each step of the run, each angle. They would have been feasting on their own pride. I'd been there once, a decade ago.

After a decade, pride is a waste of my time.

"I guessed." My voice sounded normal. What an amazing thing, to feel nothing. What a truly disturbingly inhuman thing . . .

He was watching me, those oblique glances taking in every nuance. He knew me well enough after all these years to think he knew when I needed prodding. I don't suffer prodding well. "The passenger is going out by ground to St Jo's. You'll be leaving in about a half hour. Fractured pelvis and bilateral femur fractures. We had her in MAST. They're still up. She was unresponsive when we were digging her out, but she's been pretty oriented since so the docs aren't really worried. I'd watch it with her though."

I nodded. He was saying things I already knew. What else was he working up to?

"Transfer rig isn't back in service yet. She's gonna take awhile." The rigs are always "she." I wouldn't trust a rig that wasn't.

Silly, huh?

"Go ahead and take 270. We've still got the third in town too so we'll be covered." His face twitched into a mask of thought. Here it comes. "I want you to take Jeffers with you and FTO him on the run. He needs the experience."

I didn't react to that. Why should I? Babysitting is part of my job and the new kid had to get wet sometime. Of course, this particular new kid was all ego and had neither life experience nor labial governance . . . This was his first big MVA. He was going to be insufferable.

Elliot looked at me more closely, actually meeting my eyes. He has nice eyes, grey but slightly bewildered. "He screws up; I want you to step on him. I've already had a few words with him myself."

"Not a problem." I didn't really care for the scrutiny. "Any family going with?" This was a one way trip. Terri and I would be listening to Jeffers blow wind out his face all the way home. Lovely! Now I needed to know if I had to muzzle him for the route north. In three weeks the kid had managed to piss on and off virtually every member of the crew. If I don't kill him, he'll be lucky.

"Her dad." Elliot was back to scanning the cinderblock walls. There was apparently some interest in the call box. His eyes remained glued to the light there. "He's in with her now. Ask Sandy for an estimate on the times. Should be soon. She has the insurance info on all three . . ." He was drifting. There was still sweat beaded on his forehead.

"Get those hands taken care of," I said, wanting out of this room, out of this place. "Can't hold a brew till ya do." An old jab, but true. Once he got a crew lined up as our second he'd peel off that uniform, climb into sweats and tip a few back until he was blind and numb. I didn't blame him. I didn't emulate him either. I step outside myself in other, less socially accepted ways . . .

"Christ, isn't that the truth!" The laugh he managed was weak, but it was there. We've been doing this too long. Today we both seem old with the weight of it.

Leaving was what I wanted now. I turned to go but a stage whisper from him slowed me.

"Try not to kill him, okay?"

I looked back at Elliot, at the half cocked smile he was giving the call box, and felt a pang of genuine fondness. He began to chuckle in earnest when I raised a brow and grinned. He was still laughing as the door closed softly behind, I could hear it as I strode down the hall.

The ombudsman and mental health had arrived. The families were gathered in a tighter grouping in the waiting area--'all but the one mother and her husband. They remained as before, silent. Her eyes staring strait ahead as the MD spoke softly in tones of careful neutrality and compassion. I didn't have to hear the words. What he didn't say was echoed in her face. She was seeing the truths he wouldn't give; looking out on a life now framed by the unthinkable. Her daughter's chances of physical survival were slim. The girls' mind, however, had already opted out. It had been approximately twelve minutes from impact to retrieval from beneath all that gravel. Her skull had been depressed, her face sheared loose beneath the skin. CSF had pooled in the creases of the head block with blood and emesis as I'd worked her en-route. She'd had a weak, irregular pulse. Her breathing had been spontaneous. The catalogue of injuries continued on far below the chin . . .

I do not want those eyes on me.

I stuck my head into cube 3 and caught the nurse's eye. Sandy flagged me in, began a quick verbal rundown of the patient's condition and handed me a sheet with insurance info. The conversation was brief. Not once did we really look at one another. As she spoke my eyes assessed the young woman on the ER bed, watched the interaction she shared with her parents. She was tiny, almost lost in the volume of the inflated MAST. Two lines were running TKO, one in each AC. One unit of normal saline was nearly dry, the other held 500cc's. I'd be locking off one of the sites on the way. The morphine they'd given her would complicate assessing her LOC and play hob with her respiratory drive. We'd be bagging her the whole way. She'd taken a hell of a hit when the car had slammed into those gravel trucks.

I allowed myself a moment to picture the scene: the crushed and buried Nissan, the trajectories of the driver and the infant as they were ejected. "How long till we can roll?" They'd be waiting for the CT scan. As soon as it was read we'd have road to cover.

"About ten minutes I would think. They have the radiologist on-line." She was writing up the physician's cert. It was quiet; the pandemonium of the previous hour now spent off into an exhausted calm all too familiar. The rest of the docs and nurses had wandered back to their usual places on the floor or in the specialty departments. Some would be taking a moment of quiet in hiding.

I realized as my eyes scanned the room, that I was looking for something . . . someone and shook my head in disappointment. She wouldn't have stuck around, her emotions too raw to be exposed and stay together if I walked up on her. She wasn't like me, couldn't shut down, shut off like I did. She worked in a stable environment where politics never rested and no one watched your back. Not acceptable.

It sucked to be the other woman.

How the hell had I ever gotten into a spot where a married woman held my heart anyway?

Moron.

Picking up the paperwork, I tossed a nod to Sandy. "I'll be in the bay." I left without speaking to my new patient. There'd be plenty of time for introductions and questions.

The family had been led away to the chapel. As I passed the waiting area, it was now occupied by a young kid with a towel wrapped around his foot. There was blood seeping through the pale peach bundle and a tall, sour-faced woman sat beside him, scowling. She was filling out the forms for admission, and even as I glanced around, Sandy emerged from the cube to head in their direction.

Not my problem.

I went through the double doors of the access corridor with purpose.

And there by the grating where we kept the O2 cylinders, wrapped like a little girl in her own arms, stood a tall, shadowed figure I couldn't mistake if I tried. Half of me wanted to turn around and give her the privacy I know she wanted, the other half knew why she'd parked herself here. This was my area of the ER, the gear here was for the use of EMS and cleaning only. I didn't even slow down.

"Hey Nat." I wanted her to know it was me. I shouldn't have doubted she already did.

"Baby didn't make it." She had straightened, and wasn't allowing the tears in her eyes to fall.

"I heard." I bent to pick up a new E-cylinder, signed it out on the clip board, and tucked it under my arm like a football. "You alright?"

She shuddered, rubbing her upper arms. It was cold in the passageway, dark and it smelled of old wet mops and solvents. "God this is an awful place." She wasn't talking about the passageway.

"It's just a place, Nat."

"You're taking out the transfer?"

I nodded, wondering where this was going.

"I'm here until eleven-thirty. Come find me?"

We were going to the cities, a five hour round trip if we pushed it, and we would. That brought us back for clean up and restocking some time around eight oclock. She'd be charge, which meant she was going to be working the ER. I nodded agreement.

She'd grown very still, her eyes down, locked onto something below my waist. A look down showed I was scuffed and covered in wet clay dust from the pile we'd been digging in. "You're boots need to be shined," she said quietly, then walked away in the direction of the ER.

She was right, they did. I hit the grab bar on the exit with more attitude than I really needed, pissed at myself, at life, at death, who knew. I was just pissed. That was something I couldn't really afford right now, so I swallowed it.

The rigs had been switched. They had the cradle and locks out of the transfer rig. The sound of a mop had replaced the hose and the shouts of the three at work echoed in the concrete cavern. Terri was re-supplying the first in bags. She didn't look pleased. I could guess why.

She looked up when she spotted movement. I signed for eight minutes, mouthing the words since I am loath to shout. With a roll of her eyes, she angled her head toward the rig where male voices could be heard in outrageous claims. The face she pulled was perfect.

I grinned. Jeffers may think he's god's gift, but slime mold wasn't appreciated even when it came gift wrapped. It was going to be a long transfer.

My job now was paperwork. I took up residence at the transformer box and began filling out an incident report. As I settled in, my foot kicked at something out of place, something that crunched and slid aside. Not thinking, I glanced down. There, next to the wall as close to the doors as possible to be out of the way, lay the crushed and bloodied remains of an infants car seat. Stained white with gravel dust, streaked red and brown and an unlikely black, it bore little resemblance to its former shape. The white background with its happy pattern of rainbows and suns and bouncing baby lambs lay in mute testimony to former promise.

I took a moment to let that simple picture inhabit me as the sound of rain pattered over the thumps and comments as 271 was cleaned.

Then I turned back to my work, picked up my pen, and began to write.