Page 93 of Fire & Ice

“Lee,” Beau snaps, and when Leander looks up, he gets the sense that it’s not the first time Beau has called his name.

“I’m with you,” he replies quickly, as Beau looks on uncertainly, hand poised and hovering over the Mac 4 blade he’s set aside to use when intubating Tripp. Beau knows Leander’s lying, knows he shouldn’t be anywhere near Tripp’s medical care right now, but needs must, and EMS is always about doing the best you can with what little you have. Always about saving lives and making things happen,despiteyour own feelings about the situation, or the permanent lack of other people to rely on.

After a fleeting, scrutinizing second, Beau nods, back to business. “Give that lidocaine. There’s one hundred and twenty milligrams drawn up, check it if you want. I don’t know how hard Tripp hit his head, but I’m not taking any chances. Go ahead and flush once that’s in, then give the etomidate straight after. I started with thirty and we’ll switch to ketamine if needed. He might go easy—let’s see if we can avoid paralytics.”

“Do you want to switch?” Zosia asks quietly.

Leander sincerely considers it, but shakes his head ‘no’ in the end. As hard as this might be, relinquishing Tripp’s care to someone else sounds harder. If nothing else, Leander can take comfort in the fact that he’sdoingsomething, that he’s activelyworking to keep the man he loves alive. Heneedsto be a part of that right now.

So he gives the medications Beau requested, making sure to push the etomidate slowly so as not to lock up Tripp’s jaw and induce the need for a paralytic. It’s an easy order to carry out, because Beau drew up both medications earlier while he was waiting in the truck—along with a few others—just in case.

Anyother time, Leander would patently refuse to administer a syringe full of something that someone else prepared, but these aren’t exactly normal circumstances. Even if Leander didn’t trust him, or even defer to him as a physician, Beau's stakes in this might be even higher than his own. The bubble they’re in right now is just that.

The ambulance hits a bump as it turns, sirens wailing in the background that Leander barely hears. He sees Tripp’s sats on the monitor changing, watches him become even more floppy and lifeless than he previously was, watches as Beau springs into action when that happens. Smoothly and with practiced hands, Beau opens Tripp’s mouth and slides the lighted blade inside, sweeping Tripp’s tongue up and out of the way. He uses the handle of the blade to lift Tripp’s jaw from the inside, opening his airway structures so they can be properly visualized as Beau bends to squint into his mouth.

Leander finds himself wincing, despite having performed the exact same procedure many, many times by his own hands. It’s so much more brutal as a bystander, though—or maybe that’s solely related to who is lying on the stretcher today.

“Tube,” Beau says, extending his palm but leaving his eyes locked onto Tripp’s vocal cords. Zosia grabs the endotracheal tube Beau previously selected, prepared, and left sitting on top of the airway kit, half out of its plastic wrapping and covered in lubricant. Leander swallows the lump in his throat and triesnot to feel useless. He cycles the blood pressure cuff on Tripp’s arm, not overly interested in the results, and tries not to feel worried about the way Beau grunts and struggles to get the tube situated.

After what feels like hours but was really only seconds, Beau exhales a sigh of abject relief as he removes the blade and inflates the balloon that’ll hold the tube still in Tripp’s trachea, prevent it from becoming displaced. Zosia threads a tube holder around the back of Tripp’s head and screws it into place, ensuring their setup doesn’t move while Beau test-ventilates. In sync with his team, Leander gets his stethoscope into his ears and checks Tripp’s lung sounds.

“Pull it back a centimeter,” he suggests, when he listens to the left side of Tripp’s chest. “You’re deep.” Beau loosens the structures keeping the tube in place and does as Leander suggests, ventilating again as Leander listens and flashes a thumbs up. “It’s perfect.”

They go through the motions: attaching a carbon dioxide detection device that helps monitor for accidental displacement, checking Tripp’s vital signs, and assessing his awareness level. The whole entire thing, from med push to matching sighs of relief, takes less than five full minutes, which is about the time the etomidate lasts in Tripp’s system.

He starts to stir, groggy and irritated and lifting his hands up to his mouth almost immediately. Leander feels awful—while the meds they’ve administered mean that Tripp will likely have absolutely zero memory of this, he’s still in painnow. The tube is inevitably irritating his already sore throat, and he’s not awake enough to reason why it’s necessary to refrain from yanking it out on the spot.

“He needs to be sedated again,” is what Leander says out loud. Beau nods, standing and beckoning for Zosia to take hisplace with the bag ventilations while Leander restrains Tripp’s wandering hands gently, down near his stomach.

Attempting to change positions in the small space has the two other medics doing an awkward dance that involves Zosia standing on the narrow seat across from Leander and Beau half-hanging from the pole that runs the length of the ceiling overhead. It’s the kind of thing Tripp would have laughed at, would have cracked some kind of inappropriate joke about, just to break the tension and lighten the mood.

Once they’re situated, Beau reaches over and takes the ketamine from next to Leander’s hip, dosing it correctly and pushing it himself. “We’ll get him through with this ‘til we’re inside. Probably start him on a propofol drip then, depending on how he does and whether or not he’s going into surgery. Speaking of which…”

Bypassing the radio completely, Beau pulls his phone from his pocket and swipes it open. Choosing a contact, he dials, and within minutes is giving report and consulting with one of the ED physicians. When he hangs up, Leander has questions.

“You’re the trauma surgeon on call,” he says bluntly. “If it’s necessary, will you..?”

“I don’t think so,” Beau answers, still poking at his phone but nevertheless anticipating Leander’s concern without him having to voice it. “When I left to come down to the scene, they called Aliyah in—she’s my boss, Chief of Trauma. Hey, you know she’s Cornell’s sister, right? Your medical director?”

Leander squints up at him in confusion and disinterest. Beau rambles when he’s nervous. He’s no less competent for it, though, crouching down to insert a second IV line in Tripp’s other arm and securing it effortlessly, like it’s second nature for him to do so.

“Anyway, I think they knew I’d be useless for the rest of my shift. Short of something crazy happening, if Tripp needs surgery, I won’t scrub, but I’ll watch from the balcony—keep you updated.”

At that, Zosia leans over and touches Leander’s shoulder again. “No one expects you back, either,” she says gently. “We called in county support to hold down rehab at the fire, and I talked to Chief Maxwell personally. He’s going to recall C Platoon to come in right away, tell them to bring one of the other trucks down to the scene. He said you can give him a call when you figure out what kind of time you need off.”

“That’s uncharacteristically generous of him,” Leander mutters. “What is the catch?”

“I wouldn’t make plans for Christmas,” Zosia snorts, and Leander sighs, because she’s probably right. The last time Maxwell was on an actual bus was when Leander was riding the yellow one. Being that out of touch tends to make him a particularly unreasonable negotiator when it comes to time off, but that’s Future Leander’s problem.

The truck’s backup alarm sounds and Leander starts, surprised to look up and see that they’re arriving at the hospital. He cycles Tripp’s cuff so they can have fresh vitals for the trauma team, and then helps Beau prepare Tripp to be taken inside while Zosia continues to ventilate.

Oxygen tubing comes off the wall adapter and attached to a portable tank, the cardiac monitor goes in-between Tripp’s legs. Since he continues to be well-sedated, Beau and Leander clip the stretcher’s chest-level seatbelt over both of Tripp’s arms so that they can’t drop. All the while, Leander averts his eyes from Tripp’s face, unable to decide whether it’s harder to see him sedated and looking barely alive, or anxious, confused, and uncomfortable.

As their somber group wheels Tripp’s unmoving form through the doors to the ER, security is waiting to direct them immediately into Trauma One, or “The Bay.” Inside, a mass of gowned and gloved personnel are lined up and waiting, all kinds of equipment fired up and at the ready. Surprisingly—or maybe not so much—Leander feels nothing but relief at handing over Tripp’s care for good.

Right now, heneedsto be a nervous, scared family member, not a healthcare provider. He needs to hold Tripp’s hand, to be spoken to slowly and kindly by professionals who use small words and careful phrases, who treat him like a lay person who doesn’t understand what’s happening and needs compassionate guidance to do anything.

Beauveryclearly does not feel the same, transitioning immediately into full-on, hardcore doctor-mode. As Leander watches the trauma team descend on Tripp, Beau is in the thick of the fray, ordering films and a battery of blood tests, alongside an assortment of medications that EMS doesn’t have access to in the rig. Having absolutely no desire to join him, Leander glances around.

---