Thinking in the Box

Contributor: David L. Nye

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“Ambulance needed at corner of Murphy and Seven. 82 respond.”
It always starts with a call.
The driver tears toward the location and, before I know it, we have the patient loaded in the back and I’m trying to keep him going as we fly to the emergency room.
This time, it’s a car crash victim and I’m pumping fluids into his veins to replace the blood still leaking from his thigh.
I’m focused, clear-headed.
I’m off my medications.
The meds keep the voices away but they make it almost impossible to treat patients. I lost a man because I couldn’t work through the fog, never again.
“Ten minutes,” Ben, the driver says.
I check the bandage again; the bleeding seems slower but I can’t tell for sure without removing it. I check the blood pressure… too low.
I increase the IV flow, the saline will increase the volume of his blood. I check his pupils and…
“What’s that?” the priest asks.
He sits, as he usually does, in the empty chair for family members to ride to the hospital.
“It’s nothing, just a burst vessel in his eye.”
“How can you be sure? Do you think the devil announces his presence? No, we must always be wary of the signs he approaches.” The priest is rotating the rosary beads as he speaks.
The patient’s face twists to one side and his mouth flies open; a moan escapes.
“There!” the priest points at the man and I hear not just the moan of one man, but of thousands. The priest is right…
“Seven minutes, man.” Ben’s voice sends the priest and the demon running, and it’s just the patient and I again.
The bandages are doing their job. I reassess my interventions, a practice they taught us in school. Always check, again and again. Bandages are good, saline line is good.
“Hey, buddy?” the patient doesn’t respond to my voice. Not good, he reacted when we picked him up. He’s falling further…
“Why wouldn’t he respond?” Father Todd asks.
“He could be sinking deeper into shock, or he’s lost more blood. He’s still bleeding.”
“Why else?”
I remain silent.
“Why else wouldn’t he respond, Scott?”
Father Todd leans in to me, he whispers in my ear.
“Why else would he be unable to respond? What if he is no longer in control of his body?”
I try to ignore him as I work, but his question nags at me. The patient is not bleeding heavily enough to be losing consciousness, and the shock should be wearing off. He should be responding more easily, not less.
I check my interventions again. Bandages are good, saline is good, patient does not respond to sound or touch.
“Check him, check to see if he responds to pain.”
Father Todd is right, it’s the next level of patient consciousness, and I need to check.
I rub his sternum, my knuckles digging into the soft, tender flesh on top of his ribs. His skin is crushed between his own bones and my knuckles.
His eyes flash open.
“Mary, mother of Jesus!”
Father Todd’s voice echoes through the cramped back of the ambulance but I barely hear it over my own heart. My heart hammers in my ears as I stare into the patient’s eyes, now full red. Both eyes. Not even a pupil is visible.
“Father, what do I…” I start to ask, but Ben interrupts me.
“Four minutes, almost there.”
The priest is gone, it’s just the patient and I again.
I close my eyes and count to ten.
Check the interventions.
Saline is good. Bandage is good. Bleeding seems to be under control, either slowed to a trickle or ceased. I can’t tell through the bandage.
I don’t want to look.
I check blood pressure again.
I don’t want to look.
I scribble on the chart.
I don’t want to look, but I do.
His eyes are closed.
I speak to him again.
“Hey, bro?”
His eyes flutter open this time, but it is not the patient in charge of them.
“Father!?” I whisper, panicked, into the closed air. “Father! Oh, please don’t leave me here.”
“I see it, son.” The priest is back.
“It can’t be.”
“It is, and you must stop it,” Father Todd says, calmly. I listen to his voice, my only sure thing in this world. I thank God he got on with us, at the crash site. I’m so thankful there is a priest to help me. If I was the only one in the ambulance, I don’t now what I’d do.
“You must kill him.” My stomach twists at Father Todd’s words.
“I can’t, Father. I can’t. He’s my patient.”
“No, no longer. He’s…”
“Two minutes, get ready to offload him!” Ben’s voice cuts through the back of the ambulance. I shake my head to clear it and do a final check of the interventions. All good. I go to check the restraints.
He grabs me; his hand has an unnatural grip on my arm. I can feel heat searing through my flesh and my bones crunching in his strength.
“Do it! You have to stop him! You’re the only one!” Father Todd screams into my ear.
My eyes well with tears from the pain, but I get my free hand to the bandages and pull them away. There is a clot underneath; I peel it free of the skin. I punch the soft flesh, clearing any clots inside the tissue. Crimson spurts onto the bandage as I get my arm free of the weakening grip. He won't survive that blood loss.
I feel the ambulance coming to a halt and push the bandage back into position.
The doors open and ER nurses take the beast away.
I climb from the ambulance and look at my wrist.
The skin is flawless.
“Burn victim at Oak and Jackson, 82 respond!”
It always starts with a call.

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A former paratrooper and military journalist in the U.S. Army, David is a creative writing student in Florida.
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