Fic: Catching Fire, Ch. 20/22: Calling the Mayday (R)
Previous chapters: 1 2 3 4 5 6 7 8 9 10 11 12
13 14a 14b 15 16a 16b 17a 17b 18a 18b 19
WARNING for medical scenes and trauma to a main character
Chapter 20: Calling the Mayday
Day 1
Len was only vaguely aware of what happened after hearing on the radio that Jim was trapped. Even at a safe distance from the building, he could hear the sound of the alarm on Jim’s air pack that said he wasn’t moving-dweeeeee dooo, dwee doo; dweeeeee doooo, dwee doo-over and over and over. He saw Spock scramble up the ladder and take the child from Cupcake, who immediately returned to the tip of the ladder, lying on his belly, his head and shoulders disappearing into the window opening and then popping back out again.
Len’s brain filled with a replay of his last words to Jim: Just go away. The words played over and over, on autorepeat. Just go away. Just go away. The words merged with the sound of the alarm, until they were one and the same in Len’s mind. He put his hands over his ears, to drown out the sound of the alarm, and was left only with his own words. Just go away.
Two firefighters from Truck 4 ascended as soon as Spock was down, pulling an uncharged hose line up with them. Len couldn’t see exactly what they were doing, but within seconds the flames receded, and the color of the smoke changed from dark black to gray. The cloud of smoke and steam around the window Jim had collapsed under obscured most of what was happening, but Len saw Cupcake dive into the window again, and, just as Spock arrived in the safe zone with the child, a limp form was being half-shoved, half-pulled out the window.
Spock set the child down, and Christine immediately checked him over. He was unconscious, but breathing, albeit slowly and ineffectively. Len stared as Christine started assisting the child’s breathing with a bag valve mask, blowing puffs of oxygen-enriched air into his lungs. One of the policemen on the scene had moved the mother away from the scene, and sat her in the back of the ambulance.
“Leonard.”
Len snapped his attention to the voice. Spock.
“We need another rig. Now,” Leonard said, his voice flat except for the shaking.
“It is on its way. Captain Pike ordered a second ambulance as soon as Jablonski called the mayday. Leonard, you must attend to the child.”
Len shook himself, like a cat that had gotten sprayed with water, and turned his attention to the child. The sooner he stabilized the child, the sooner he could help Jim. But at the moment, there was nothing he could do for Jim. So he pulled himself together, and did his job.
“Hyperventilate him, Chris. I’m gonna drop a tube.”
Christine increased the rate of breaths while Leonard got the supplies ready to intubate the child. He clipped the fingertip sensor of the monitor onto the child’s index finger, and quickly saw that the child had elevated carbon monoxide levels. There was enough soot around the child’s mouth and nose that he was also worried about his possibly inhaling hot smoke, and damaging his airway. But he was able to place the endotracheal tube correctly on the first try, and Christine hooked the bag up to the end of the tube, and continued to ventilate him. Len checked the child for burns or injuries-he might have some first degree burns on his back, but there was nothing serious. He started an IV line in the child’s arm, for rehydration, and in case drugs were needed quickly, but there really wasn’t much more he could do for the child on the scene. He jotted some notes quickly and ripped the page off and taped it to the stretcher.
He risked a look up at the aerial ladder. One firefighter was holding a spray of mist over Cupcake and another firefighter as they stripped Jim’s gear off his limp body. His helmet clattered to the ground, and his turnout coat followed, plopping wetly onto the sidewalk. Len wasn’t entirely sure, but he thought he saw Jim’s arm move on its own as the men loaded him into the Stokes stretcher, maybe trying to push hands away from him.
“Chris, can you monitor him and keep bagging while I check Jim out?” Leonard said. His composure had returned, and he was as ready as he could be.
Christine nodded. “I’ll shout if anything changes.”
Spock, Cupcake, and two firefighters Len didn’t recognize brought the bright yellow Stokes over. Len was simultaneously relieved and terrified to hear the agonized sounds coming from Jim. Screams and groans meant he was alive, conscious, and breathing, though. As the four men set the Stokes down on the ground, Len first took a moment to take Jim’s face, which looked pale and frantic, but unburned, and make him look in Len’s eyes.
“Jim, darlin’, I gotcha, okay? I gotcha.”
“Bones … oh fuck … hurts so bad …” Jim said between panting groans. He reached for Leonard with an arm that was burned on the wrist, but the hand was intact.
“I know. I gotcha,” Len said, and then knew he’d already taken too much time with his reassurances.
“Spock, I need another set of hands here,” Len said, as he slipped the oxygen mask on Jim. He taped it down, as he could already see, even though Jim was mostly on his back, that the back of his neck was badly burned.
“You may have mine, Leonard.”
“Did he have his air on the whole time?” Len asked, as he started cutting Jim’s clothes off to assess the damage.
“Affirmative. He was on his right side, in a fetal position, with his anterior body against the wall. Less than five minutes elapsed between the mayday and the extrication.”
So airway burns were unlikely-a good sign, Leonard thought, as he steeled himself to see what was underneath Jim’s clothing. “More info, guys. Everything you’ve got.”
Cupcake spoke up. “I heard something fall just after he handed me the kid. Then he didn’t come out. When I got back in, there was a bookshelf on his legs.”
“Loss of consciousness?” Len asked. Pants were off-fronts of the legs looked fine.
“I don’t think so,” Cupcake said. “I could … uh … hear him … uh … the whole time-sorry-” Cupcake cut himself off as he ran to the gutter and vomited.
“Not … knocked out … just … down,” Jim gasped.
“Don’t try to talk, sweetheart,” Len said, as he zipped his shears up the front of Jim’s uniform shirt, and found that the front of his torso was fine. He checked Jim’s arms, and the right was less burned than the left-possibly because he’d been lying on it.
Ambulance 4 came in hot, and Frank McCarthy and Barney Sanford emerged.
“Who should we take, McCoy?” Barney said.
“The kid’s ready to go. Smoke inhalation, possible inhalation injury. Notes are taped onto the stretcher. Haven’t notified the hospital.”
“Got him,” Sanford said, and Leonard put all thoughts of the child from his mind, and returned his full attention to Jim.
“Spock, roll him to his right on three. One, two, three.”
Jim yelled as Len and Spock moved him. Len poured an entire bottle of saline over the back of Jim’s uniform shirt, and eased it away.
Even though Leonard knew what he expected to see, it didn’t make it any easier. Jim’s back was burned, from just below his waist well into his hairline, except for an imprecise rectangle in the middle of his back that Len thought must be where the SCBA tank afforded his skin some protection beyond what his turnout gear offered.
“God damn it,” Len swore, and gulped back the lump in his throat. He ripped open the burn pack and draped Jim’s back and neck with the sterile sheet.
“Spock, get me pulse and respiration,” Len said. He put the BP cuff on Jim’s upper arm, avoiding the burned areas as much as possible, and wrote down his reading on the back of his glove. Too low, as he expected.
“Pulse one hundred forty, respirations thirty,” Spock said a few seconds later.
“Blankets,” Len barked. “Cover him up, he’s getting cold.”
He snatched an IV pack off his pile of supplies he’d laid out for the burn patient he was expecting. He activated the lapel microphone on his radio.
“St. Luke’s from Ambulance 2. Please pick up for a burn patient.”
He started an IV while he waited for a response.
“Ambulance 2, go ahead.”
“I have a male firefighter, 28, conscious, alert, and breathing, with burns to approximately thirty percent of total body surface area following a five-minute entrapment in a house fire. SCBA was intact throughout, and there’s no evidence of inhalation injury. Burns are mostly second degree, with third degree localized to the back of the neck and lower scalp.” He reported the vitals, and requested the use of pain relief.
The doctor on the other end of the connection verified the information, and gave permission for narcotic painkillers-not a second too soon, as Jim was out of his mind with pain, and Len was out of his mind for Jim.
“Establish a second IV, and transport directly to UI. Monitor airway, and sedate and intubate at any sign of airway edema. We’ll alert UI that you’re on your way. Contact them with any change en route.”
The University of Iowa hospital, where Len would be starting his residency, had the only burn center in Iowa. It was farther away than St. Luke’s, but far better equipped to deal with Jim’s injuries.
Len repeated the instructions, and signed off. He opened his drug pouch, which never left his person except when it was under lock and key at the station, and set up to finally, finally take the edge off Jim’s pain. He pushed the morphine slowly into the IV, and felt something uncoil in his gut as Jim’s cries and anguished groans morphed into quieter moans. He started the second IV, and looked up for the first time since Jim was brought down.
“Let’s get moving,” Len said. “I need a lot of hands for this transfer, Spock. Four people.”
Spock found a fourth person to join himself, Len, and Christine in moving Jim from the Stokes to the stretcher. Len didn’t even notice who it was, as Jim yelled when they moved him.
Spock, quite uncharacteristically, caught Len by his shoulder before he could climb into the back of the rig. “Leonard. Do you require additional personnel during the transport? Captain Pike has stood down our ladder company.”
“I … yeah. Someone drive, and then Christine can help out in the patient compartment.”
“Very well,” Spock said. “I will drive, while Mr. Scott attends to the ladder truck.”
Leonard climbed into the back of the rig, and slammed the doors shut, and cranked the heat up to maximum. It seemed counterintuitive to warm a burn patient, but when one’s skin is gone over part of one’s body, heat is lost quickly. He figured he had a few seconds alone with Jim, and nothing needed to be done urgently. He took off his metaphorical paramedic hat for a moment, and put on his boyfriend hat.
“Jim, I …” Leonard choked back his tears.
“Shorry, Bonezh,” Jim slurred.
“No, no no no,” Len said, taking his hand, carefully avoiding the burns on his wrist. “No, darlin’. I’m sorry. I’m sorry started that stupid fight with you, and I’m sorry I told you to go away, and I’m so, so sorry this happened. But everything’s gonna be okay.”
“’s bad, righ? Don’ lie.”
“Yeah, it’s pretty bad. You have second-degree on your back, and your wrists. A patch of third degree on your neck. But nothin’ else. We’re takin’ you straight to the UI hospital, where they have a burn center. I’m stayin’ with you, darlin’, as much as they let me.”
“call … Mom. Sam.”
Leonard hardly noticed as Christine came in the passenger compartment, and the ambulance started moving.
“I will.”
“hurts … so bad.”
Len squeezed his eyes shut. A tear made its way out of the corner of each eye. “Lemme see what I can do. Try not to talk any more, sweetheart. I love you like crazy.”
“me … too.”
He hooked Jim up to the monitor to get a continuous readout of his vitals. He got back on the radio, and relayed Jim’s vitals, as well as his weight and his strong physical condition pre-injury, and they approved more medication.
He pushed the drug through the IV very slowly, over several minutes.
“Any better, darlin’?”
“yeah.” Jim’s voice was barely audible through the oxygen mask. His eyes closed, and even though the monitor was keeping track of his vitals, Len kept a hand on Jim’s chest to feel his chest rise and fall with each breath.
Ten minutes into the trip, the ambulance hit a large pothole, bouncing everyone hard. Jim was instantly more alert, and cried out in pain, despite all the drugs in his system.
“Bones! Fuck!”
Len hadn’t let go of Jim’s hand, but he gripped it tighter. He leaned down to be closer to face-to-face. “I’m here, Jim.” He stroked Jim’s cheek with his other hand. “I’ll always be here,” he said quietly. He continued holding Jim’s hand and stroking his cheek, while keeping an eye on the monitor. Jim’s blood pressure was lower than he liked, and he was whimpering in pain.
“Chris, squeeze that fluid through, will you please?”
“Sure, Len.”
Ten long minutes later, the ambulance pulled into the unfamiliar bay at the University of Iowa hospital in Iowa City. Two nurses and a doctor were waiting, and Len followed them in with Jim, giving the doctor-one of the attending physicians who he had met during his interviews-the rundown on Jim’s condition. Jim clutched his hand weakly the whole way, and Len made up for his weak grasp with his own strong one.
Dr. Palmer listened to Len while he started checking Jim over himself.
“All right. You did an excellent job, McCoy. We’ll take care of him from here.”
Len hesitated. “He’s my partner. I’d like to stay with him if I can.”
Dr. Palmer frowned. “I thought he was a firefighter-wouldn’t your partner be another EMT?”
Len hadn’t said anything about his personal life in the interview, because it wouldn’t have been either necessary or professional. “Not that kind of partner. My boyfriend. I need to stay with him, when it’s possible. Please.”
Dr. Palmer didn’t even blink. “All right. Sorry I misunderstood. You can stay as long as it doesn’t become a problem for either one of you. And-I’m glad to see you again, but very sorry about the circumstances.
“Thanks. I, uh, need to call his family. When would be the best time to do that?”
“Now. He’s remarkably stable at this point. We’ll get a Foley in, because we'll have to monitor urine output, and then they’re expecting him upstairs. The burn unit doctor is on his way down. I’ll explain your family situation to him, if you want to go ahead and call the rest of his family.”
“Okay,” Len said. The rest of his family, Palmer had said. Those, Len thought, were exactly the right words.
Len crouched down near Jim’s head, and spoke to him.
“Jim, I’m gonna go out for a minute, and call your mom and Sam, okay? I’ll come back as soon as they say I can.”
“’kay.”
Len squeezed Jim’s hand one more time, and got a faint squeeze in return. He left the curtained-off room, and entered the main area of the emergency department, to find Spock and Christine waiting.
“He’s stable. They’re transferring him up to the burn unit shortly. And I have to call his family.”
“Do you want us to wait with you while you do that?” Christine asked.
“I … I think I’d be better off with privacy. But thank you. Thank you both. And I’m obviously taking myself off duty at this point.”
“Nobody would expect anything else, Leonard,” Spock said.
“I’ll … be in touch,” Len said.
Len suddenly felt as if he had one of those cartoon ten-ton weights sitting directly on top of his head. He leaned on a nearby counter for support, and rubbed his brow.
“Len?” Christine said.
“Jesus. I’m about to call his mother, and I don’t even know what to say.”
Christine looked around, and zeroed in on someone to talk to. “Hang on a second, Len.” She strode over to the desk of the person she’d singled out, and talked to him for a minute, gesturing towards the room Jim was in and then to Len. The man nodded, and stood up.
“I’m Ben Ellison, the charge nurse for this shift. Would you like a private area so you can talk to family?”
Len nodded. “Leonard McCoy. And I’d appreciate that. Thanks.”
Christine clasped Len’s shoulder quickly before she and Spock left. “Call the station when you can, all right?”
Len nodded, and followed the nurse, who showed him to a small room containing nothing but a couch, table, phone, wastebasket, and box of tissues. Which Len knew he was going to need, as soon as he was on his own.
“Thanks very much-this is very civilized. Could you let Dr. Palmer know I’m in here?”
“Sure. Take as long as you like.” Ellison closed the door, leaving Len alone.
He sat there, experimentally, waiting to see if the tears would come. But no, the dam was firmly closed, but with the weight pressing on him more urgently as each minute went by, it would likely burst soon. He looked at his phone. Three in the morning.
Nobody ever calls at three a.m. with good news, unless a birth is involved.
Len steeled himself, and called Winona’s number. The phone range only twice before Winona picked up, sounding groggy and panicked.
“Hello? Who is it? What’s wrong?”
“Win, it’s Len. You need to come to the UI hospital, right now. Jim got burned in a fire. It’s not catastrophic, and he’s stable. But it’s bad enough.”
“Oh god oh god oh god I’m on my way. Can you call Sam? I don’t have a cell phone.”
“Sure. And Win, he’s in the best of hands.”
“What … what happened?” Len could hear the rustling of fabric in the background, and assumed he was on speakerphone while Winona threw clothes on.
“He was getting a little boy out of a fire. Something happened right after he handed the boy out, and he was stuck. Just for a couple minutes. He has burns on his back, wrists, and neck. We’ll know more after the doc from the burn unit looks at him.”
“I’m on my way. Uh, fifteen minutes.”
“I’ll be here. I’m not going anywhere.”
“Bye.” Winona hung up.
Len pressed the ‘end’ button on his phone, and steeled himself for a conversation that he knew would be harder than talking to Jim’s no-nonsense, level-headed mother. Sam was brilliant, but never struck Len as someone who would hold it together in a crisis. He pulled up Sam’s contact information, and pushed ‘send.’
“Len?” said a female voice. Aurora. Of course-she was up with the baby. “What’s wrong?”
“Aurora, Jim’s been hurt in a fire. He’s stable, but he’s got some bad burns. They’re about to take him up to the burn unit.”
“No, oh no,” Aurora said, tears springing in to her voice. “How bad?”
“About thirty percent of his body, on his back and neck and wrists. No other injuries to complicate things. He’s in a hell of a lot of pain, but he’s stable. Win’s on her way. I think Sam should come.”
“Of course, of course! Oh no, Len. This is …” Aurora couldn’t continue.
“Yeah, it is,” Len said, barely able to talk past the lump in his throat. “Listen. Try to get Sam to call me before he leaves. I don’t want him calling while he’s driving, okay? We don’t need any more Kirks in the hospital.”
“Okay.”
Len suddenly felt the dams opening. “I have to go,” he said hastily. “We’ll be in touch.” He pressed ‘end’ abruptly, and fell onto his knees, grabbing the wastebasket just in time and heaving into it. The tears came as fast as the vomit, and as violently.
When his stomach was empty, Len wiped his face angrily and grabbed a pillow off the couch. Still kneeling on the floor, he buried his face in the pillow and screamed into it, as hard as he could, repeatedly punching the couch itself until his knuckles were raw. Spent, he sat cross-legged on the floor, elbows on his knees, face in his palms, unable to do a thing.
There was a tap on the door. Len didn’t know what to say or do, so he didn’t do anything. He just sat there.
The door opened.
“Leonard,” a voice said quietly.
Len found the energy to look up, but he found he didn’t have to look up very far. Daryl Palmer crouched next to him.
“How can I help?” he asked.
“I … can I see Jim again? Please?”
“Of course you can. We’ve still got him down here. I ordered more pain medication, so he’s pretty groggy, but he’s more comfortable. I also gave him a little diazepam, because he was starting to get quite anxious. Understandably. Dr. Isaacs from the burn unit is having a look at him.”
“Okay,” Len said shakily. “Thanks. Uh, I puked in the trash.”
“Don’t worry about it. Happens all the time.” Palmer stood up, and reached a hand down to Len.
Len allowed himself to be helped up. He blew his nose, and wiped his face off.
“I think I’m ready.”
“All right. Mask up, please-as you know, infection is the greatest concern after hemodynamic stability.”
“Yeah.”
Palmer handed Len a surgical face-mask, and they went back into the room. Jim was glassy-eyed and limp, but made eye contact with Len before his eyes drooped shut again. Two nurses were supporting Jim across his chest as they leaned him forward, and a doctor that Len hadn’t seen before was checking his back carefully.
“Hey, darlin’,” Len said, resting his hand on Jim’s leg, which he knew was unhurt.
Jim opened his eyes and blinked slowly.
“Will, this is Len McCoy, Mr. Kirk’s partner,” Dr. Palmer said.
“Boyfriend,” Len added, to avoid having the same misunderstanding twice, even though his term of endearment should have made that clear.
“Mr. McCoy, I’m Will Isaacs, from upstairs in the burn unit. I’m just having a look at Mr. Kirk, here, so we can talk about what’s next.”
Len nodded dumbly. “Okay. What’s next?”
“Let me tell you what I see. Or, do you want to look? Some people prefer not to.”
“Not me. I mean, yes, I need to look.”
“Go around to his side opposite me. Good.”
Len blanched, as everything looked even worse than it had even half an hour ago. He knew that was often the case, but the devastation to Jim’s body was one of the hardest things he’d ever had to look at. He swallowed hard, and nodded to Dr. Isaacs.
“About half of the burn area-here, and this area here- is mid-partial-thickness, meaning about half the dermal layer is damaged. That’s also what we see on his wrists. Most of the other half-especially around the edges here-is superficial partial thickness, which accounts for his high level of pain right now.”
Len nodded.
Isaacs continued. “Here, on his neck, it’s more severe. He’ll need some grafting, for his neck to heal properly. Once we get him in the OR for debridement, which will be soon now, since he’s stable, I’ll be able to tell what other areas might need grafting. I suspect he’ll need some, in addition to the neck. Are you following this okay? I understand you’re a paramedic.”
Len nodded. “Yeah, I’m getting it fine.”
“As for the superficial partial-thickness areas, the best treatment is ointments and closed dressings. Ah, nurses, let’s lay him back again.”
The two nurses laid Jim gently back onto the nearly upright bed. His eyes opened again, and searched the room until he found Len. Len took his hand, very gently, avoiding the bandages on his wrists.
Len cleared his throat. “Uh, how long are we talking about?”
“I think, because of the extent of the burns, he’ll probably be with us for a few weeks. But barring complications, there’s every expectation that he’ll be completely healed up and feeling normal in under a year.”
“He’ll … he won’t be able to go back to being a firefighter, will he?”
“I can’t say one way or another right now,” Dr. Isaacs said. “And for now-we need to get him prepped for the OR. It’s best to do the debridement and close anything that needs to be closed with grafts as soon as possible.”
“All right. Uh, his mother will be here any second. She should … sign anything that needs to be signed.”
“All right. The burn unit has a nurse who goes over everything with the families.” Isaacs paused as he stripped off his sterile gloves and tossed them in the bin. “He’s got a lot going for him. He’s young, and strong, and in excellent shape. He got top-notch care at the scene-you can pass that along to whoever brought him in-which is probably why he’s so stable now.”
“Ah, Will, Leonard here brought him in. They work the same shift.”
Isaacs stared at Len. “You treated him at the scene?”
“I also would’ve preferred that it didn’t happen that way-believe me,” Len said. “But we knew it could happen, with us working on the same shift.”
“I’m not criticizing, Mr. McCoy. Just … well. I couldn’t have done it.”
“Yes, you could’ve, if you were the one who was there. As opposed to the alternative? Running away, or doing nothing? You could’ve,” Leonard said.
“I … yes, when you put it that way, I suppose so,” Isaacs said. “In any case: good work. And I’m sorry you both went through that. You can have a few more minutes, and then we need to get him to the OR, as soon as his consents are signed.”
“Thanks. Uh, can we have a few minutes alone?”
“Sure. He’s pretty sedated, but there’s no reason why not.” Isaacs gestured for the nurses to go with him. He closed the sliding glass door behind him, and Len was alone with Jim.
He had no idea what to do.
He settled for pulling a chair up to the side of the bed, taking Jim’s hand, and stroking his thumb over the back of Jim’s hand.
“Jim … I don’t think you can hear me. I kind of hope you can’t, actually. But …” Len blinked as his eyes filled with tears. “I love you so much. And I’m so sorry I picked that stupid, stupid fight with you tonight. And the last words I said to you before … this … were ‘just go away.’ You gotta know, darlin’, you gotta know I didn’t mean it. I don’t know what my problem was. But I don’t think I’ve ever regretted anythin’ as much I regret that right now. Because I really, really, really don’t want you to go away.”
He didn’t think he had any tears left, but he was wrong. The tears flowed freely, and Len rested his head on the bed next to Jim’s leg. After a minute or so, he felt a hand on his head.
“Don’ cry, Bones,” Jim said, his speech slurred and just barely audible.
“I’m sorry,” Len said reflexively, his eyes meeting Jim’s open but glassy eyes.
“’s okay. Know you din’ mean ih.”
“You’re gonna be okay, sweetheart. All right? They’re taking you in to the OR to start fixin’ you up, any time now. Your mom’s coming-she’s probably signing papers now-and Sam’s coming. We all love you, Jim. So just hold on, all right, darlin’?”
Jim smiled slightly. “Holdin’ on … t’ you.”
A few minutes later, the door slid open and shut again, and a nurse and an orderly appeared.
“Dr. Isaacs wants us to take him up to the OR now,” the nurse said.
“Okay.” Len gently squeezed Jim’s hand once more, and let it go. He stood up, and kissed Jim gently on the forehead. Jim opened his eyes.
“They’re takin’ you up for surgery, darlin’. I love you, and I’ll see you soon.”
He kissed Jim on the forehead, and Jim’s eyes drooped shut again. The nurse and the orderly pushed the bed out. Waiting outside the door were Winona and Sam.
“That’s his mother and brother. Can they just have a minute?” Len said.
“Sure,” the nurse said.
Winona caressed Jim’s cheek, and said something to him quietly. He opened his eyes just a bit.
“Mom.”
“Yeah, Jimmy; Sam and I are here.”
Sam moved so Jim could see he was also there, insofar as Jim could see anything.
“Sam.”
“Hey, bro. Take it easy, okay? Love you.”
“Tell th’ boys … I’m tough.” Jim’s eyes closed again.
“I will, Jim,” Sam said.
“We need to go,” the nurse said gently. “There’s a family waiting area just outside the burn unit. Your names should be on the list up there already. If not, just tell the nurse in charge that you’re his family, and they’ll set you up.”
“Thank you,” Winona said.
The three of them went upstairs to the family waiting area. There were tears. There were hugs. There were a lot of phone calls to other friends and family. Len called the station, and got Pike, who was devastated at the severity of Jim’s injuries, but was able to accept that he’d probably be okay, in time. It hadn’t occurred to Len that Pike would be feeling awful, having essential sent Jim into the situation that injured him.
“Len, if you’ll allow me to go into your locker with my master key, someone will bring your car to the hospital, and anything you want that you’ve left at the station.”
“Oh. Yeah.” Len hadn’t even thought about the fact that his car-and his car and house keys-were twenty miles away, even though his house was only a five-minute drive from the hospital. “Thanks. Uh, the car, and my keys of course, and my laptop. I think that’s in the ready room. That would be really helpful, if someone could do that.”
“Consider it done. What else can you think of that you might need?”
“Uh … to be honest, I can’t really think right now.”
“Understandable. But seriously: the second you think of something, call me or Christine. We’ll get it taken care of. And tell Winona the same. Any help she needs at the farm-it’ll be done.”
“Thank you,” Len said. “Thanks a lot, Chris.”
“You’re welcome. One more thing, and I’ll let you go. Where do I find you to give you your keys?”
“Family waiting area outside the burn unit. Third floor. Oh-we’re at the UI hospital in Iowa City.”
“I know; Christine and Spock told me.”
“Oh. Right. See? I can’t think.”
“Don’t worry, Len. Okay?”
“Yeah. I’ll try. Thanks, Chris.”
“You’re welcome. I’ll be by around eight or so with your car.”
“Thanks.”
Len took a quick breather after his talk with Pike. Then, for the first time in as long as he could remember, Leonard picked up his phone to call his mother for comfort.
“Hello? What’s wrong?”
“Ma, it’s Leo. I’m fine. But Ma … Jim.” The tears started again.
“Oh Lord, Leo-what happened?”
“He got burned in a fire. He’s supposed to get better, and be fine, but … it’s so bad right now.”
“Oh, Leo. I’m so sorry. I’ll catch the next flight.”
Len nearly said something like, no, you don’t have to do that, but he stopped himself. She had nothing urgent to do. And she cared about him, and it seemed like she cared about Jim, too. For her to say that she’d drop everything to come help in any way she could was … well, it was nothing short of miraculous.
“Thanks.
“Tell me, Leo. If you don’t mind talking about it. Tell me what happened.”
And he did. For the first time since he was a child, Len poured his heart out to his mother. And it felt good.
~!~!~!~
Three interminable hours after Jim was brought upstairs, Dr. Isaacs appeared in the family waiting area, in fresh scrubs. Len’s heart rate spiked, even though the expression on the doctor’s face was promising.
“Mr. Kirk did very well. He remained stable throughout the procedure, he tolerated the anesthesia perfectly, and we were able to place a full-thickness graft on his neck, and several partial-thickness grafts on some more severe areas on his back.”
Everyone sighed with relief.
“What now, though?” Winona asked. “What will it … be like for him?”
“First of all, he’s heavily sedated right now. You could call it a medically-induced coma. This will give his body the best possible chance for early healing. Because of the heavy sedation, he’s on a ventilator-to breathe for him. You need to understand, it’s not because he’s doing badly-he’s doing very well. But when you see him, he may look sicker than you’re expecting him to look, because of the ventilator, heavy bandaging, the IVs and catheter, and all the monitoring equipment. But he’s doing very, very well.”
“But when he wakes up?” Winona asked. “What then?”
“We do a good job with pain control here,” Isaacs said, “which is important. Right now, the priorities are to prevent infection, promote healing, and keep him as hydrated, nourished, and comfortable as possible. He’ll sleep a lot. And every moment he’s awake, we’re going to try to get him to eat. People with significant burns need huge numbers of calories for the healing process. He probably won’t have much of an appetite, but you can bring in anything he likes that’s high in calories.”
“That’s about all he likes,” Len said.
Winona and Sam both laughed a little.
“That’s my boy,” Winona said. “Never one for the empty fiber and vitamins.”
The tension ramped down a notch, as Len, Winona, and Sam started to actually believe that maybe everything would be okay.
“When can we see him?” Len asked.
“Once we have him set up in his room. You’ll need to wear a mask and a gown. Infection is the worst enemy at this point. And one of the nurses will come in and explain a little more to you about what to expect when you see him. Right now, I’m going to check on him again. But in an hour or two, you can spend a short time with him, one at a time,” Isaacs said.
The nurse came in, as promised, and showed some pictures of heavily bandaged patients with wires and tubes and ventilators. Len was accustomed to seeing such things, but knew it would still be hard to see Jim that way.
Sam seemed to be having the hardest time. He was pale, and had hardly said anything the entire time they were waiting. After the nurse left, Winona took a bathroom break, and Len saw his chance.
“Sam?” Len said. “How can I help?”
Sam shook his head. “It’s the boys. And-this is going to sound terrible, but you’re not a parent, so you wouldn’t really understand.”
“That’s true, about my not being a parent. But I’ve dealt with a lot of families who have had horrible things happen, so if you wanna try me, try me.”
“Okay,” Sam sighed. “Here’s the thing. The boys worship their Uncle Jim. And they’re both really sensitive. They’ve both asked me before if Uncle Jim would ever ‘get burned up in a fire.’ I didn’t lie-I said he could get hurt, or die, because of his job. George wouldn’t even speak to Jim for a week after we talked about that a couple years ago. So what do I even tell them, Len? I don’t even know!”
“I think,” Len said cautiously, “that you tell them the truth. I think you also don’t let them see him for a while-at least not until he’s off the vent, and can talk. Once they see he’s still himself, even though he has a lot of bandages, I think they’ll be okay.”
“That’s … I think that’s good advice. Thanks,” Sam said.
“I’d be happy to talk to them too. I won’t, however, tell them anything that would upset them. I was there, and it was pretty god-damned upsetting.”
Sam’s jaw dropped. “You were-Len, did you have to …”
“Yeah. We knew it could happen. It was … Sam, it was really hard.” Len broke down again, as he allowed himself to think of the endless minutes before Jim was extricated, and his screams of agony, and the not-knowing of so many things.
“Jesus, Len. But you obviously did a good job-I mean, the doc who talked to me first in the emergency room said something about the paramedics doing everything perfectly.”
“The thing is, Sam, there was hardly a damned thing I could do for him. Sure-oxygen, fluids, sterile sheet, as much morphine as I was allowed, and then I begged my bosses for more, and he got a little more-just took the edge off, really. And hold his hand. I could hold his hand,” Len said sourly.
“You could,” Sam said. “But nobody else who would’ve been able to treat him could do that. And let me tell you, if I was in that situation, I’d want all the hand-holding I could get.”
“Yeah,” Len said faintly. “Me too.”
“And Len,” Sam said, sounding more and more like himself. “You’re family. To me, and Mom, and Aurora, and the boys. Lean on us. Don’t feel like just because you’re not married, or because you’re a man, that counts for anything less. It’s so clear your his, and he’s yours, and we’re all here for you.”
“Thanks,” Len said gruffly. “That … really means a lot, Sam.”
An hour later, the nurse came back, and said they could go in, one at a time, for a few minutes each.
“You go first, Win,” Len said. “I had a lot of time with him already; I’ll go last.”
Winona nodded, and the nurse took her to get gowned up. She returned fifteen minutes later, red-eyed.
“Mom?” Sam asked, hugging her gently.
“He looks worse than before. I knew what to expect with the tubes and machines and everything, but I just wasn’t expecting him to look so … sick. He doesn’t just look like he’s sleeping.”
“He’s not, Win. He’s down way deeper than that. But it’s his best chance now-it’s a head start on healing that he desperately needs,” Len said.
“I know. I just wasn’t ready,” Win said. “Anyhow-your turn, Sam.”
Sam didn’t say anything for a few seconds. “I … don’t know if I can do it. I honestly don’t know. If he looks worse than before, I don’t know if I should go see him. I have a tendency to … get things stuck in my head, and then I can’t stop seeing them. I don’t want to have a picture of him like that stuck in my head.”
“You don’t have to,” Len replied. “He won’t know anyone’s there.”
“I know,” Sam said. “But I’ll know. I’ll know I wasn’t there. So I’m going.” He nodded to the nurse, who led him out.
They were back in five minutes, with Sam in a wheelchair, paler than a bleached sheet.
“Sam?” Win said. “What happened?”
“Fainted,” he mumbled. “Took one look at my little brother, and passed out cold.”
“That happens a lot,” the nurse said. “It’s nothing to be ashamed of. Some people just react that way.”
“I’ll try again later,” Sam promised.
The nurse led Len out for his turn. She helped him into a gown, shoe covers, gloves, and a surgical mask, and let him into Jim’s room.
“Can I touch him at all? Hold his hand?”
“Sure you can,” the nurse said. “Just don’t move him at all, okay?”
“I won’t.”
It was over eighty degrees in the room, and humid. And Winona was right. Jim looked like death warmed over. Which, Len thought, was a pretty apt description of a medically-induced coma. Semi-death.
The bandages were air-tight dressings, designed to keep bacteria away, keep the wounds moist with the ointments under them and promote healing. Len couldn’t see under the blankets, which he didn’t move, but he assumed there would be a new bandage wherever they used as a donor site for the grafts.
Len looked at the monitor. Everything looked remarkably good, considering what had just happened to Jim. Good, he thought. Looking good.
But then, Len realized he’d been looking at Jim through dispassionate medical lenses. He wasn’t in charge of that any more. That wasn’t his job. His job was to be Jim’s anchor, to get him through this hell as intact as possible. He took off the blinders he had to wear as a medical professional, and took Jim’s hand, ever so gently. For the first time since the beginning of the ordeal, there was no response at all. Nothing.
“How the hell am I gonna get through this, Jim?” Len said. “How?”
Except for the steady beeping of the monitor, Jim didn’t answer.
TBC
A/N: When a firefighter is trapped, injured and in urgent need of assistance, missing, or imminently out of air, s/he or his/her partner calls “Mayday, mayday, mayday” over the radio, and reports the situation. This is called “calling the mayday.” There are trainings on when and how to do this, which is something you never want to have to do, but have to know how to do.
13 14a 14b 15 16a 16b 17a 17b 18a 18b 19
WARNING for medical scenes and trauma to a main character
Chapter 20: Calling the Mayday
Day 1
Len was only vaguely aware of what happened after hearing on the radio that Jim was trapped. Even at a safe distance from the building, he could hear the sound of the alarm on Jim’s air pack that said he wasn’t moving-dweeeeee dooo, dwee doo; dweeeeee doooo, dwee doo-over and over and over. He saw Spock scramble up the ladder and take the child from Cupcake, who immediately returned to the tip of the ladder, lying on his belly, his head and shoulders disappearing into the window opening and then popping back out again.
Len’s brain filled with a replay of his last words to Jim: Just go away. The words played over and over, on autorepeat. Just go away. Just go away. The words merged with the sound of the alarm, until they were one and the same in Len’s mind. He put his hands over his ears, to drown out the sound of the alarm, and was left only with his own words. Just go away.
Two firefighters from Truck 4 ascended as soon as Spock was down, pulling an uncharged hose line up with them. Len couldn’t see exactly what they were doing, but within seconds the flames receded, and the color of the smoke changed from dark black to gray. The cloud of smoke and steam around the window Jim had collapsed under obscured most of what was happening, but Len saw Cupcake dive into the window again, and, just as Spock arrived in the safe zone with the child, a limp form was being half-shoved, half-pulled out the window.
Spock set the child down, and Christine immediately checked him over. He was unconscious, but breathing, albeit slowly and ineffectively. Len stared as Christine started assisting the child’s breathing with a bag valve mask, blowing puffs of oxygen-enriched air into his lungs. One of the policemen on the scene had moved the mother away from the scene, and sat her in the back of the ambulance.
“Leonard.”
Len snapped his attention to the voice. Spock.
“We need another rig. Now,” Leonard said, his voice flat except for the shaking.
“It is on its way. Captain Pike ordered a second ambulance as soon as Jablonski called the mayday. Leonard, you must attend to the child.”
Len shook himself, like a cat that had gotten sprayed with water, and turned his attention to the child. The sooner he stabilized the child, the sooner he could help Jim. But at the moment, there was nothing he could do for Jim. So he pulled himself together, and did his job.
“Hyperventilate him, Chris. I’m gonna drop a tube.”
Christine increased the rate of breaths while Leonard got the supplies ready to intubate the child. He clipped the fingertip sensor of the monitor onto the child’s index finger, and quickly saw that the child had elevated carbon monoxide levels. There was enough soot around the child’s mouth and nose that he was also worried about his possibly inhaling hot smoke, and damaging his airway. But he was able to place the endotracheal tube correctly on the first try, and Christine hooked the bag up to the end of the tube, and continued to ventilate him. Len checked the child for burns or injuries-he might have some first degree burns on his back, but there was nothing serious. He started an IV line in the child’s arm, for rehydration, and in case drugs were needed quickly, but there really wasn’t much more he could do for the child on the scene. He jotted some notes quickly and ripped the page off and taped it to the stretcher.
He risked a look up at the aerial ladder. One firefighter was holding a spray of mist over Cupcake and another firefighter as they stripped Jim’s gear off his limp body. His helmet clattered to the ground, and his turnout coat followed, plopping wetly onto the sidewalk. Len wasn’t entirely sure, but he thought he saw Jim’s arm move on its own as the men loaded him into the Stokes stretcher, maybe trying to push hands away from him.
“Chris, can you monitor him and keep bagging while I check Jim out?” Leonard said. His composure had returned, and he was as ready as he could be.
Christine nodded. “I’ll shout if anything changes.”
Spock, Cupcake, and two firefighters Len didn’t recognize brought the bright yellow Stokes over. Len was simultaneously relieved and terrified to hear the agonized sounds coming from Jim. Screams and groans meant he was alive, conscious, and breathing, though. As the four men set the Stokes down on the ground, Len first took a moment to take Jim’s face, which looked pale and frantic, but unburned, and make him look in Len’s eyes.
“Jim, darlin’, I gotcha, okay? I gotcha.”
“Bones … oh fuck … hurts so bad …” Jim said between panting groans. He reached for Leonard with an arm that was burned on the wrist, but the hand was intact.
“I know. I gotcha,” Len said, and then knew he’d already taken too much time with his reassurances.
“Spock, I need another set of hands here,” Len said, as he slipped the oxygen mask on Jim. He taped it down, as he could already see, even though Jim was mostly on his back, that the back of his neck was badly burned.
“You may have mine, Leonard.”
“Did he have his air on the whole time?” Len asked, as he started cutting Jim’s clothes off to assess the damage.
“Affirmative. He was on his right side, in a fetal position, with his anterior body against the wall. Less than five minutes elapsed between the mayday and the extrication.”
So airway burns were unlikely-a good sign, Leonard thought, as he steeled himself to see what was underneath Jim’s clothing. “More info, guys. Everything you’ve got.”
Cupcake spoke up. “I heard something fall just after he handed me the kid. Then he didn’t come out. When I got back in, there was a bookshelf on his legs.”
“Loss of consciousness?” Len asked. Pants were off-fronts of the legs looked fine.
“I don’t think so,” Cupcake said. “I could … uh … hear him … uh … the whole time-sorry-” Cupcake cut himself off as he ran to the gutter and vomited.
“Not … knocked out … just … down,” Jim gasped.
“Don’t try to talk, sweetheart,” Len said, as he zipped his shears up the front of Jim’s uniform shirt, and found that the front of his torso was fine. He checked Jim’s arms, and the right was less burned than the left-possibly because he’d been lying on it.
Ambulance 4 came in hot, and Frank McCarthy and Barney Sanford emerged.
“Who should we take, McCoy?” Barney said.
“The kid’s ready to go. Smoke inhalation, possible inhalation injury. Notes are taped onto the stretcher. Haven’t notified the hospital.”
“Got him,” Sanford said, and Leonard put all thoughts of the child from his mind, and returned his full attention to Jim.
“Spock, roll him to his right on three. One, two, three.”
Jim yelled as Len and Spock moved him. Len poured an entire bottle of saline over the back of Jim’s uniform shirt, and eased it away.
Even though Leonard knew what he expected to see, it didn’t make it any easier. Jim’s back was burned, from just below his waist well into his hairline, except for an imprecise rectangle in the middle of his back that Len thought must be where the SCBA tank afforded his skin some protection beyond what his turnout gear offered.
“God damn it,” Len swore, and gulped back the lump in his throat. He ripped open the burn pack and draped Jim’s back and neck with the sterile sheet.
“Spock, get me pulse and respiration,” Len said. He put the BP cuff on Jim’s upper arm, avoiding the burned areas as much as possible, and wrote down his reading on the back of his glove. Too low, as he expected.
“Pulse one hundred forty, respirations thirty,” Spock said a few seconds later.
“Blankets,” Len barked. “Cover him up, he’s getting cold.”
He snatched an IV pack off his pile of supplies he’d laid out for the burn patient he was expecting. He activated the lapel microphone on his radio.
“St. Luke’s from Ambulance 2. Please pick up for a burn patient.”
He started an IV while he waited for a response.
“Ambulance 2, go ahead.”
“I have a male firefighter, 28, conscious, alert, and breathing, with burns to approximately thirty percent of total body surface area following a five-minute entrapment in a house fire. SCBA was intact throughout, and there’s no evidence of inhalation injury. Burns are mostly second degree, with third degree localized to the back of the neck and lower scalp.” He reported the vitals, and requested the use of pain relief.
The doctor on the other end of the connection verified the information, and gave permission for narcotic painkillers-not a second too soon, as Jim was out of his mind with pain, and Len was out of his mind for Jim.
“Establish a second IV, and transport directly to UI. Monitor airway, and sedate and intubate at any sign of airway edema. We’ll alert UI that you’re on your way. Contact them with any change en route.”
The University of Iowa hospital, where Len would be starting his residency, had the only burn center in Iowa. It was farther away than St. Luke’s, but far better equipped to deal with Jim’s injuries.
Len repeated the instructions, and signed off. He opened his drug pouch, which never left his person except when it was under lock and key at the station, and set up to finally, finally take the edge off Jim’s pain. He pushed the morphine slowly into the IV, and felt something uncoil in his gut as Jim’s cries and anguished groans morphed into quieter moans. He started the second IV, and looked up for the first time since Jim was brought down.
“Let’s get moving,” Len said. “I need a lot of hands for this transfer, Spock. Four people.”
Spock found a fourth person to join himself, Len, and Christine in moving Jim from the Stokes to the stretcher. Len didn’t even notice who it was, as Jim yelled when they moved him.
Spock, quite uncharacteristically, caught Len by his shoulder before he could climb into the back of the rig. “Leonard. Do you require additional personnel during the transport? Captain Pike has stood down our ladder company.”
“I … yeah. Someone drive, and then Christine can help out in the patient compartment.”
“Very well,” Spock said. “I will drive, while Mr. Scott attends to the ladder truck.”
Leonard climbed into the back of the rig, and slammed the doors shut, and cranked the heat up to maximum. It seemed counterintuitive to warm a burn patient, but when one’s skin is gone over part of one’s body, heat is lost quickly. He figured he had a few seconds alone with Jim, and nothing needed to be done urgently. He took off his metaphorical paramedic hat for a moment, and put on his boyfriend hat.
“Jim, I …” Leonard choked back his tears.
“Shorry, Bonezh,” Jim slurred.
“No, no no no,” Len said, taking his hand, carefully avoiding the burns on his wrist. “No, darlin’. I’m sorry. I’m sorry started that stupid fight with you, and I’m sorry I told you to go away, and I’m so, so sorry this happened. But everything’s gonna be okay.”
“’s bad, righ? Don’ lie.”
“Yeah, it’s pretty bad. You have second-degree on your back, and your wrists. A patch of third degree on your neck. But nothin’ else. We’re takin’ you straight to the UI hospital, where they have a burn center. I’m stayin’ with you, darlin’, as much as they let me.”
“call … Mom. Sam.”
Leonard hardly noticed as Christine came in the passenger compartment, and the ambulance started moving.
“I will.”
“hurts … so bad.”
Len squeezed his eyes shut. A tear made its way out of the corner of each eye. “Lemme see what I can do. Try not to talk any more, sweetheart. I love you like crazy.”
“me … too.”
He hooked Jim up to the monitor to get a continuous readout of his vitals. He got back on the radio, and relayed Jim’s vitals, as well as his weight and his strong physical condition pre-injury, and they approved more medication.
He pushed the drug through the IV very slowly, over several minutes.
“Any better, darlin’?”
“yeah.” Jim’s voice was barely audible through the oxygen mask. His eyes closed, and even though the monitor was keeping track of his vitals, Len kept a hand on Jim’s chest to feel his chest rise and fall with each breath.
Ten minutes into the trip, the ambulance hit a large pothole, bouncing everyone hard. Jim was instantly more alert, and cried out in pain, despite all the drugs in his system.
“Bones! Fuck!”
Len hadn’t let go of Jim’s hand, but he gripped it tighter. He leaned down to be closer to face-to-face. “I’m here, Jim.” He stroked Jim’s cheek with his other hand. “I’ll always be here,” he said quietly. He continued holding Jim’s hand and stroking his cheek, while keeping an eye on the monitor. Jim’s blood pressure was lower than he liked, and he was whimpering in pain.
“Chris, squeeze that fluid through, will you please?”
“Sure, Len.”
Ten long minutes later, the ambulance pulled into the unfamiliar bay at the University of Iowa hospital in Iowa City. Two nurses and a doctor were waiting, and Len followed them in with Jim, giving the doctor-one of the attending physicians who he had met during his interviews-the rundown on Jim’s condition. Jim clutched his hand weakly the whole way, and Len made up for his weak grasp with his own strong one.
Dr. Palmer listened to Len while he started checking Jim over himself.
“All right. You did an excellent job, McCoy. We’ll take care of him from here.”
Len hesitated. “He’s my partner. I’d like to stay with him if I can.”
Dr. Palmer frowned. “I thought he was a firefighter-wouldn’t your partner be another EMT?”
Len hadn’t said anything about his personal life in the interview, because it wouldn’t have been either necessary or professional. “Not that kind of partner. My boyfriend. I need to stay with him, when it’s possible. Please.”
Dr. Palmer didn’t even blink. “All right. Sorry I misunderstood. You can stay as long as it doesn’t become a problem for either one of you. And-I’m glad to see you again, but very sorry about the circumstances.
“Thanks. I, uh, need to call his family. When would be the best time to do that?”
“Now. He’s remarkably stable at this point. We’ll get a Foley in, because we'll have to monitor urine output, and then they’re expecting him upstairs. The burn unit doctor is on his way down. I’ll explain your family situation to him, if you want to go ahead and call the rest of his family.”
“Okay,” Len said. The rest of his family, Palmer had said. Those, Len thought, were exactly the right words.
Len crouched down near Jim’s head, and spoke to him.
“Jim, I’m gonna go out for a minute, and call your mom and Sam, okay? I’ll come back as soon as they say I can.”
“’kay.”
Len squeezed Jim’s hand one more time, and got a faint squeeze in return. He left the curtained-off room, and entered the main area of the emergency department, to find Spock and Christine waiting.
“He’s stable. They’re transferring him up to the burn unit shortly. And I have to call his family.”
“Do you want us to wait with you while you do that?” Christine asked.
“I … I think I’d be better off with privacy. But thank you. Thank you both. And I’m obviously taking myself off duty at this point.”
“Nobody would expect anything else, Leonard,” Spock said.
“I’ll … be in touch,” Len said.
Len suddenly felt as if he had one of those cartoon ten-ton weights sitting directly on top of his head. He leaned on a nearby counter for support, and rubbed his brow.
“Len?” Christine said.
“Jesus. I’m about to call his mother, and I don’t even know what to say.”
Christine looked around, and zeroed in on someone to talk to. “Hang on a second, Len.” She strode over to the desk of the person she’d singled out, and talked to him for a minute, gesturing towards the room Jim was in and then to Len. The man nodded, and stood up.
“I’m Ben Ellison, the charge nurse for this shift. Would you like a private area so you can talk to family?”
Len nodded. “Leonard McCoy. And I’d appreciate that. Thanks.”
Christine clasped Len’s shoulder quickly before she and Spock left. “Call the station when you can, all right?”
Len nodded, and followed the nurse, who showed him to a small room containing nothing but a couch, table, phone, wastebasket, and box of tissues. Which Len knew he was going to need, as soon as he was on his own.
“Thanks very much-this is very civilized. Could you let Dr. Palmer know I’m in here?”
“Sure. Take as long as you like.” Ellison closed the door, leaving Len alone.
He sat there, experimentally, waiting to see if the tears would come. But no, the dam was firmly closed, but with the weight pressing on him more urgently as each minute went by, it would likely burst soon. He looked at his phone. Three in the morning.
Nobody ever calls at three a.m. with good news, unless a birth is involved.
Len steeled himself, and called Winona’s number. The phone range only twice before Winona picked up, sounding groggy and panicked.
“Hello? Who is it? What’s wrong?”
“Win, it’s Len. You need to come to the UI hospital, right now. Jim got burned in a fire. It’s not catastrophic, and he’s stable. But it’s bad enough.”
“Oh god oh god oh god I’m on my way. Can you call Sam? I don’t have a cell phone.”
“Sure. And Win, he’s in the best of hands.”
“What … what happened?” Len could hear the rustling of fabric in the background, and assumed he was on speakerphone while Winona threw clothes on.
“He was getting a little boy out of a fire. Something happened right after he handed the boy out, and he was stuck. Just for a couple minutes. He has burns on his back, wrists, and neck. We’ll know more after the doc from the burn unit looks at him.”
“I’m on my way. Uh, fifteen minutes.”
“I’ll be here. I’m not going anywhere.”
“Bye.” Winona hung up.
Len pressed the ‘end’ button on his phone, and steeled himself for a conversation that he knew would be harder than talking to Jim’s no-nonsense, level-headed mother. Sam was brilliant, but never struck Len as someone who would hold it together in a crisis. He pulled up Sam’s contact information, and pushed ‘send.’
“Len?” said a female voice. Aurora. Of course-she was up with the baby. “What’s wrong?”
“Aurora, Jim’s been hurt in a fire. He’s stable, but he’s got some bad burns. They’re about to take him up to the burn unit.”
“No, oh no,” Aurora said, tears springing in to her voice. “How bad?”
“About thirty percent of his body, on his back and neck and wrists. No other injuries to complicate things. He’s in a hell of a lot of pain, but he’s stable. Win’s on her way. I think Sam should come.”
“Of course, of course! Oh no, Len. This is …” Aurora couldn’t continue.
“Yeah, it is,” Len said, barely able to talk past the lump in his throat. “Listen. Try to get Sam to call me before he leaves. I don’t want him calling while he’s driving, okay? We don’t need any more Kirks in the hospital.”
“Okay.”
Len suddenly felt the dams opening. “I have to go,” he said hastily. “We’ll be in touch.” He pressed ‘end’ abruptly, and fell onto his knees, grabbing the wastebasket just in time and heaving into it. The tears came as fast as the vomit, and as violently.
When his stomach was empty, Len wiped his face angrily and grabbed a pillow off the couch. Still kneeling on the floor, he buried his face in the pillow and screamed into it, as hard as he could, repeatedly punching the couch itself until his knuckles were raw. Spent, he sat cross-legged on the floor, elbows on his knees, face in his palms, unable to do a thing.
There was a tap on the door. Len didn’t know what to say or do, so he didn’t do anything. He just sat there.
The door opened.
“Leonard,” a voice said quietly.
Len found the energy to look up, but he found he didn’t have to look up very far. Daryl Palmer crouched next to him.
“How can I help?” he asked.
“I … can I see Jim again? Please?”
“Of course you can. We’ve still got him down here. I ordered more pain medication, so he’s pretty groggy, but he’s more comfortable. I also gave him a little diazepam, because he was starting to get quite anxious. Understandably. Dr. Isaacs from the burn unit is having a look at him.”
“Okay,” Len said shakily. “Thanks. Uh, I puked in the trash.”
“Don’t worry about it. Happens all the time.” Palmer stood up, and reached a hand down to Len.
Len allowed himself to be helped up. He blew his nose, and wiped his face off.
“I think I’m ready.”
“All right. Mask up, please-as you know, infection is the greatest concern after hemodynamic stability.”
“Yeah.”
Palmer handed Len a surgical face-mask, and they went back into the room. Jim was glassy-eyed and limp, but made eye contact with Len before his eyes drooped shut again. Two nurses were supporting Jim across his chest as they leaned him forward, and a doctor that Len hadn’t seen before was checking his back carefully.
“Hey, darlin’,” Len said, resting his hand on Jim’s leg, which he knew was unhurt.
Jim opened his eyes and blinked slowly.
“Will, this is Len McCoy, Mr. Kirk’s partner,” Dr. Palmer said.
“Boyfriend,” Len added, to avoid having the same misunderstanding twice, even though his term of endearment should have made that clear.
“Mr. McCoy, I’m Will Isaacs, from upstairs in the burn unit. I’m just having a look at Mr. Kirk, here, so we can talk about what’s next.”
Len nodded dumbly. “Okay. What’s next?”
“Let me tell you what I see. Or, do you want to look? Some people prefer not to.”
“Not me. I mean, yes, I need to look.”
“Go around to his side opposite me. Good.”
Len blanched, as everything looked even worse than it had even half an hour ago. He knew that was often the case, but the devastation to Jim’s body was one of the hardest things he’d ever had to look at. He swallowed hard, and nodded to Dr. Isaacs.
“About half of the burn area-here, and this area here- is mid-partial-thickness, meaning about half the dermal layer is damaged. That’s also what we see on his wrists. Most of the other half-especially around the edges here-is superficial partial thickness, which accounts for his high level of pain right now.”
Len nodded.
Isaacs continued. “Here, on his neck, it’s more severe. He’ll need some grafting, for his neck to heal properly. Once we get him in the OR for debridement, which will be soon now, since he’s stable, I’ll be able to tell what other areas might need grafting. I suspect he’ll need some, in addition to the neck. Are you following this okay? I understand you’re a paramedic.”
Len nodded. “Yeah, I’m getting it fine.”
“As for the superficial partial-thickness areas, the best treatment is ointments and closed dressings. Ah, nurses, let’s lay him back again.”
The two nurses laid Jim gently back onto the nearly upright bed. His eyes opened again, and searched the room until he found Len. Len took his hand, very gently, avoiding the bandages on his wrists.
Len cleared his throat. “Uh, how long are we talking about?”
“I think, because of the extent of the burns, he’ll probably be with us for a few weeks. But barring complications, there’s every expectation that he’ll be completely healed up and feeling normal in under a year.”
“He’ll … he won’t be able to go back to being a firefighter, will he?”
“I can’t say one way or another right now,” Dr. Isaacs said. “And for now-we need to get him prepped for the OR. It’s best to do the debridement and close anything that needs to be closed with grafts as soon as possible.”
“All right. Uh, his mother will be here any second. She should … sign anything that needs to be signed.”
“All right. The burn unit has a nurse who goes over everything with the families.” Isaacs paused as he stripped off his sterile gloves and tossed them in the bin. “He’s got a lot going for him. He’s young, and strong, and in excellent shape. He got top-notch care at the scene-you can pass that along to whoever brought him in-which is probably why he’s so stable now.”
“Ah, Will, Leonard here brought him in. They work the same shift.”
Isaacs stared at Len. “You treated him at the scene?”
“I also would’ve preferred that it didn’t happen that way-believe me,” Len said. “But we knew it could happen, with us working on the same shift.”
“I’m not criticizing, Mr. McCoy. Just … well. I couldn’t have done it.”
“Yes, you could’ve, if you were the one who was there. As opposed to the alternative? Running away, or doing nothing? You could’ve,” Leonard said.
“I … yes, when you put it that way, I suppose so,” Isaacs said. “In any case: good work. And I’m sorry you both went through that. You can have a few more minutes, and then we need to get him to the OR, as soon as his consents are signed.”
“Thanks. Uh, can we have a few minutes alone?”
“Sure. He’s pretty sedated, but there’s no reason why not.” Isaacs gestured for the nurses to go with him. He closed the sliding glass door behind him, and Len was alone with Jim.
He had no idea what to do.
He settled for pulling a chair up to the side of the bed, taking Jim’s hand, and stroking his thumb over the back of Jim’s hand.
“Jim … I don’t think you can hear me. I kind of hope you can’t, actually. But …” Len blinked as his eyes filled with tears. “I love you so much. And I’m so sorry I picked that stupid, stupid fight with you tonight. And the last words I said to you before … this … were ‘just go away.’ You gotta know, darlin’, you gotta know I didn’t mean it. I don’t know what my problem was. But I don’t think I’ve ever regretted anythin’ as much I regret that right now. Because I really, really, really don’t want you to go away.”
He didn’t think he had any tears left, but he was wrong. The tears flowed freely, and Len rested his head on the bed next to Jim’s leg. After a minute or so, he felt a hand on his head.
“Don’ cry, Bones,” Jim said, his speech slurred and just barely audible.
“I’m sorry,” Len said reflexively, his eyes meeting Jim’s open but glassy eyes.
“’s okay. Know you din’ mean ih.”
“You’re gonna be okay, sweetheart. All right? They’re taking you in to the OR to start fixin’ you up, any time now. Your mom’s coming-she’s probably signing papers now-and Sam’s coming. We all love you, Jim. So just hold on, all right, darlin’?”
Jim smiled slightly. “Holdin’ on … t’ you.”
A few minutes later, the door slid open and shut again, and a nurse and an orderly appeared.
“Dr. Isaacs wants us to take him up to the OR now,” the nurse said.
“Okay.” Len gently squeezed Jim’s hand once more, and let it go. He stood up, and kissed Jim gently on the forehead. Jim opened his eyes.
“They’re takin’ you up for surgery, darlin’. I love you, and I’ll see you soon.”
He kissed Jim on the forehead, and Jim’s eyes drooped shut again. The nurse and the orderly pushed the bed out. Waiting outside the door were Winona and Sam.
“That’s his mother and brother. Can they just have a minute?” Len said.
“Sure,” the nurse said.
Winona caressed Jim’s cheek, and said something to him quietly. He opened his eyes just a bit.
“Mom.”
“Yeah, Jimmy; Sam and I are here.”
Sam moved so Jim could see he was also there, insofar as Jim could see anything.
“Sam.”
“Hey, bro. Take it easy, okay? Love you.”
“Tell th’ boys … I’m tough.” Jim’s eyes closed again.
“I will, Jim,” Sam said.
“We need to go,” the nurse said gently. “There’s a family waiting area just outside the burn unit. Your names should be on the list up there already. If not, just tell the nurse in charge that you’re his family, and they’ll set you up.”
“Thank you,” Winona said.
The three of them went upstairs to the family waiting area. There were tears. There were hugs. There were a lot of phone calls to other friends and family. Len called the station, and got Pike, who was devastated at the severity of Jim’s injuries, but was able to accept that he’d probably be okay, in time. It hadn’t occurred to Len that Pike would be feeling awful, having essential sent Jim into the situation that injured him.
“Len, if you’ll allow me to go into your locker with my master key, someone will bring your car to the hospital, and anything you want that you’ve left at the station.”
“Oh. Yeah.” Len hadn’t even thought about the fact that his car-and his car and house keys-were twenty miles away, even though his house was only a five-minute drive from the hospital. “Thanks. Uh, the car, and my keys of course, and my laptop. I think that’s in the ready room. That would be really helpful, if someone could do that.”
“Consider it done. What else can you think of that you might need?”
“Uh … to be honest, I can’t really think right now.”
“Understandable. But seriously: the second you think of something, call me or Christine. We’ll get it taken care of. And tell Winona the same. Any help she needs at the farm-it’ll be done.”
“Thank you,” Len said. “Thanks a lot, Chris.”
“You’re welcome. One more thing, and I’ll let you go. Where do I find you to give you your keys?”
“Family waiting area outside the burn unit. Third floor. Oh-we’re at the UI hospital in Iowa City.”
“I know; Christine and Spock told me.”
“Oh. Right. See? I can’t think.”
“Don’t worry, Len. Okay?”
“Yeah. I’ll try. Thanks, Chris.”
“You’re welcome. I’ll be by around eight or so with your car.”
“Thanks.”
Len took a quick breather after his talk with Pike. Then, for the first time in as long as he could remember, Leonard picked up his phone to call his mother for comfort.
“Hello? What’s wrong?”
“Ma, it’s Leo. I’m fine. But Ma … Jim.” The tears started again.
“Oh Lord, Leo-what happened?”
“He got burned in a fire. He’s supposed to get better, and be fine, but … it’s so bad right now.”
“Oh, Leo. I’m so sorry. I’ll catch the next flight.”
Len nearly said something like, no, you don’t have to do that, but he stopped himself. She had nothing urgent to do. And she cared about him, and it seemed like she cared about Jim, too. For her to say that she’d drop everything to come help in any way she could was … well, it was nothing short of miraculous.
“Thanks.
“Tell me, Leo. If you don’t mind talking about it. Tell me what happened.”
And he did. For the first time since he was a child, Len poured his heart out to his mother. And it felt good.
~!~!~!~
Three interminable hours after Jim was brought upstairs, Dr. Isaacs appeared in the family waiting area, in fresh scrubs. Len’s heart rate spiked, even though the expression on the doctor’s face was promising.
“Mr. Kirk did very well. He remained stable throughout the procedure, he tolerated the anesthesia perfectly, and we were able to place a full-thickness graft on his neck, and several partial-thickness grafts on some more severe areas on his back.”
Everyone sighed with relief.
“What now, though?” Winona asked. “What will it … be like for him?”
“First of all, he’s heavily sedated right now. You could call it a medically-induced coma. This will give his body the best possible chance for early healing. Because of the heavy sedation, he’s on a ventilator-to breathe for him. You need to understand, it’s not because he’s doing badly-he’s doing very well. But when you see him, he may look sicker than you’re expecting him to look, because of the ventilator, heavy bandaging, the IVs and catheter, and all the monitoring equipment. But he’s doing very, very well.”
“But when he wakes up?” Winona asked. “What then?”
“We do a good job with pain control here,” Isaacs said, “which is important. Right now, the priorities are to prevent infection, promote healing, and keep him as hydrated, nourished, and comfortable as possible. He’ll sleep a lot. And every moment he’s awake, we’re going to try to get him to eat. People with significant burns need huge numbers of calories for the healing process. He probably won’t have much of an appetite, but you can bring in anything he likes that’s high in calories.”
“That’s about all he likes,” Len said.
Winona and Sam both laughed a little.
“That’s my boy,” Winona said. “Never one for the empty fiber and vitamins.”
The tension ramped down a notch, as Len, Winona, and Sam started to actually believe that maybe everything would be okay.
“When can we see him?” Len asked.
“Once we have him set up in his room. You’ll need to wear a mask and a gown. Infection is the worst enemy at this point. And one of the nurses will come in and explain a little more to you about what to expect when you see him. Right now, I’m going to check on him again. But in an hour or two, you can spend a short time with him, one at a time,” Isaacs said.
The nurse came in, as promised, and showed some pictures of heavily bandaged patients with wires and tubes and ventilators. Len was accustomed to seeing such things, but knew it would still be hard to see Jim that way.
Sam seemed to be having the hardest time. He was pale, and had hardly said anything the entire time they were waiting. After the nurse left, Winona took a bathroom break, and Len saw his chance.
“Sam?” Len said. “How can I help?”
Sam shook his head. “It’s the boys. And-this is going to sound terrible, but you’re not a parent, so you wouldn’t really understand.”
“That’s true, about my not being a parent. But I’ve dealt with a lot of families who have had horrible things happen, so if you wanna try me, try me.”
“Okay,” Sam sighed. “Here’s the thing. The boys worship their Uncle Jim. And they’re both really sensitive. They’ve both asked me before if Uncle Jim would ever ‘get burned up in a fire.’ I didn’t lie-I said he could get hurt, or die, because of his job. George wouldn’t even speak to Jim for a week after we talked about that a couple years ago. So what do I even tell them, Len? I don’t even know!”
“I think,” Len said cautiously, “that you tell them the truth. I think you also don’t let them see him for a while-at least not until he’s off the vent, and can talk. Once they see he’s still himself, even though he has a lot of bandages, I think they’ll be okay.”
“That’s … I think that’s good advice. Thanks,” Sam said.
“I’d be happy to talk to them too. I won’t, however, tell them anything that would upset them. I was there, and it was pretty god-damned upsetting.”
Sam’s jaw dropped. “You were-Len, did you have to …”
“Yeah. We knew it could happen. It was … Sam, it was really hard.” Len broke down again, as he allowed himself to think of the endless minutes before Jim was extricated, and his screams of agony, and the not-knowing of so many things.
“Jesus, Len. But you obviously did a good job-I mean, the doc who talked to me first in the emergency room said something about the paramedics doing everything perfectly.”
“The thing is, Sam, there was hardly a damned thing I could do for him. Sure-oxygen, fluids, sterile sheet, as much morphine as I was allowed, and then I begged my bosses for more, and he got a little more-just took the edge off, really. And hold his hand. I could hold his hand,” Len said sourly.
“You could,” Sam said. “But nobody else who would’ve been able to treat him could do that. And let me tell you, if I was in that situation, I’d want all the hand-holding I could get.”
“Yeah,” Len said faintly. “Me too.”
“And Len,” Sam said, sounding more and more like himself. “You’re family. To me, and Mom, and Aurora, and the boys. Lean on us. Don’t feel like just because you’re not married, or because you’re a man, that counts for anything less. It’s so clear your his, and he’s yours, and we’re all here for you.”
“Thanks,” Len said gruffly. “That … really means a lot, Sam.”
An hour later, the nurse came back, and said they could go in, one at a time, for a few minutes each.
“You go first, Win,” Len said. “I had a lot of time with him already; I’ll go last.”
Winona nodded, and the nurse took her to get gowned up. She returned fifteen minutes later, red-eyed.
“Mom?” Sam asked, hugging her gently.
“He looks worse than before. I knew what to expect with the tubes and machines and everything, but I just wasn’t expecting him to look so … sick. He doesn’t just look like he’s sleeping.”
“He’s not, Win. He’s down way deeper than that. But it’s his best chance now-it’s a head start on healing that he desperately needs,” Len said.
“I know. I just wasn’t ready,” Win said. “Anyhow-your turn, Sam.”
Sam didn’t say anything for a few seconds. “I … don’t know if I can do it. I honestly don’t know. If he looks worse than before, I don’t know if I should go see him. I have a tendency to … get things stuck in my head, and then I can’t stop seeing them. I don’t want to have a picture of him like that stuck in my head.”
“You don’t have to,” Len replied. “He won’t know anyone’s there.”
“I know,” Sam said. “But I’ll know. I’ll know I wasn’t there. So I’m going.” He nodded to the nurse, who led him out.
They were back in five minutes, with Sam in a wheelchair, paler than a bleached sheet.
“Sam?” Win said. “What happened?”
“Fainted,” he mumbled. “Took one look at my little brother, and passed out cold.”
“That happens a lot,” the nurse said. “It’s nothing to be ashamed of. Some people just react that way.”
“I’ll try again later,” Sam promised.
The nurse led Len out for his turn. She helped him into a gown, shoe covers, gloves, and a surgical mask, and let him into Jim’s room.
“Can I touch him at all? Hold his hand?”
“Sure you can,” the nurse said. “Just don’t move him at all, okay?”
“I won’t.”
It was over eighty degrees in the room, and humid. And Winona was right. Jim looked like death warmed over. Which, Len thought, was a pretty apt description of a medically-induced coma. Semi-death.
The bandages were air-tight dressings, designed to keep bacteria away, keep the wounds moist with the ointments under them and promote healing. Len couldn’t see under the blankets, which he didn’t move, but he assumed there would be a new bandage wherever they used as a donor site for the grafts.
Len looked at the monitor. Everything looked remarkably good, considering what had just happened to Jim. Good, he thought. Looking good.
But then, Len realized he’d been looking at Jim through dispassionate medical lenses. He wasn’t in charge of that any more. That wasn’t his job. His job was to be Jim’s anchor, to get him through this hell as intact as possible. He took off the blinders he had to wear as a medical professional, and took Jim’s hand, ever so gently. For the first time since the beginning of the ordeal, there was no response at all. Nothing.
“How the hell am I gonna get through this, Jim?” Len said. “How?”
Except for the steady beeping of the monitor, Jim didn’t answer.
TBC
A/N: When a firefighter is trapped, injured and in urgent need of assistance, missing, or imminently out of air, s/he or his/her partner calls “Mayday, mayday, mayday” over the radio, and reports the situation. This is called “calling the mayday.” There are trainings on when and how to do this, which is something you never want to have to do, but have to know how to do.