38. Critical Condition #2
My voice stays level because Clay is a firefighter, because he'll understand every word I just said, and because there is no fucking reason to make him imagine anything worse than what is actually happening.
“I think she's in DKA. We don't have labs yet, so I don't know how bad.” I pause and take a deep breath. “Call me as soon as you get this. You can come if you want.”
I hang up.
My partner is still nearby. “You need anything?”
“No.” The answer comes immediately, then I correct myself. “I don't know.”
He nods like that's a perfectly reasonable thing to say.
“They’re bringing her here?”
“Yeah.”
“Go wait for her. We'll deal with everything else.”
I look down at myself.
Blood.
Fuck.
“I look like hell.”
“You look like you just worked an extrication.”
Cami is going to see me like this.
That thought hits strangely.
I usually change as soon as I get back to the station when something like this happens.
But thinking of Cami brings another picture to the front of my mind.
Her in the back of an ambulance, and I realize I could not give less of a shit what I look like.
I walk toward the ambulance bay.
Try to help my crew straighten our ambulance until they kick me out.
Then I pace.
Because standing still isn’t possible.
I listen to the tones and the overhead announcement about Cami.
No name, but it’s enough. She’s three minutes out.
There is a particular sound an ambulance makes backing into an emergency department bay.
The diesel.
The reverse alarm.
The change in engine pitch when the driver lines up with the doors.
I've heard it thousands of times.
Tonight it sounds completely different.
A team of nurses and one resident is waiting. I listen as they go through the report they already have.
Likely DKA.
Altered.
Type One.
Glucose beyond the range of the home meter and EMS glucometer.
Tachycardic.
Tachypneic.
Fluids running.
The charge nurse stands beside me—she knows who I am and why I’m here.
That might be helpful.
Someone from registration is hovering back far enough to stay out of the way.
I know everybody's job.
I know exactly what happens next.
And, yet, my hands will not stop shaking.
I cross my arms to try to stop them.
The ambulance turns into the bay.
Backs toward us.
Too slowly.
Then too quickly.
The brakes hiss.
The rear doors stay closed for maybe three seconds.
Feels like thirty.
One opens.
Then the other.
I recognize the medic immediately.
Haven't worked directly with him in a few years, but we've crossed paths enough.
He looks toward the receiving nurse first.
Then he sees me.
Something passes across his face.
Professional recognition.
Then understanding.
Ronan said my name enough times on the phone—he might have talked to Cami about me too.
“Griff,” he says in greeting.
I barely hear him but nod anyway.
Ronan looks pale and… scared, if I’m honest.
Cami is on the stretcher.
For one awful second, I don't recognize her.
Not really.
I know every piece of her face.
I've watched her sleep from six inches away.
I've seen her sick, exhausted, angry, drunk, laughing so hard she cried.
This is different.
Her skin looks washed out beneath the fluorescent lights. Her lips are dry. There are monitor leads across her chest and an IV running into her arm, the bag already partly empty.
And she's breathing too fast.
Each breath looks like work.
Everything medical in me catalogs it instantly.
Everything else in me wants to tear the back doors off the ambulance.
The medic releases the stretcher.
“Twenty-six-year-old female, Type One diabetic, insulin pump, known UTI diagnosed yesterday.
Family found her difficult to arouse after Dexcom read HIGH.
Home glucose and ours both above meter limit.
Initial heart rate one-thirty-eight, sinus tach.
BP one-oh-two over sixty-two. Respirations thirty-four, labored.
She's had seven hundred of normal saline. One episode of nausea, no emesis. Mental status improving slightly with fluids but still confused.”
I know this report.
I've given this report.
I know exactly which words matter.
I still barely hear him.
The stretcher starts moving.
Cami's eyes open.
Not fully.
Just enough.
They move past the nurse.
Past the ceiling.
Then find me.
Her forehead creases.
Recognition struggles through whatever fog she's in.
I step close enough that my hand finds hers as the stretcher clears the ambulance. “Hey, baby.”
Her fingers barely close around mine.
Her mouth moves. “Husband.”
One word.
Soft.
Dry.
Barely there.
It almost fucking kills me.
“Yeah.” My voice cracks. “I'm right here.”
Her eyes close again.
The receiving nurse moves beside the stretcher.
I let go.
Every cell in my body screams not to.
I do it anyway.
Because I'm not her medic.
I'm not part of this team.
And the fastest way to get myself thrown out of my own wife's room is to forget that.
I know the mechanics of this encounter. That doesn’t mean I get to control the roll.
Ronan climbs out behind them.
I catch his shoulder as he passes. “You okay?”
His face says no.
His mouth says, “Yes.”
The ER room fills quickly.
Not chaotically.
There's a difference.
Chaos means nobody knows what is happening or what needs to be done.
This is controlled motion.
Monitor transferred.
Second IV.
Blood drawn.
Venous gas.
Chemistry.
CBC.
Beta-hydroxybutyrate.
Fluids wide open.
Urine when they can get it.
Catheter if they need it.
Questions.
How long has she been diabetic?
When was her last insulin?
What antibiotics?
Any vomiting?
Any known kidney disease?
Any pregnancy possibility?
“No.” That answer comes out sharper than the others.
The nurse glances at me.
“She has an IUD.”
“Okay.”
Cami opens her eyes again while they're removing the Pod.
She flinches.
“Sorry,” the nurse tells her. “We're taking this off.”
I move close enough that she can see me without turning her head. “I'm here.”
Her eyes settle on mine.
She looks scared now.
More awake.
Maybe that's worse.
“What happened?” Her voice is barely more than air.
“You got really high.”
She frowns.
“I corrected.”
“I know.” That comes out too quickly.
I put my hand around hers. “I know you did.”
Her eyes fill.
Fuck.
“No.” I lean closer. “You did everything right.”
I need her to hear that.
Maybe I need to hear it too.
“You checked. You corrected. You checked ketones. You told me. This isn't because you fucked something up.”
Her lower lip trembles once.
“Was it the pod?”
“Maybe.”
The nurse has it in her gloved hand.
She turns it slightly. “Huh.”
Every part of me snaps toward her. “What?”
She looks at the cannula. “It may have kinked.”
“May?”
“Could've happened during removal. Could've been partially displaced before. Hard to tell.”
She doesn't overstate it.
Good.
I appreciate that.
Also hate her a little for not being able to give me certainty.
“So we don't know,” Cami clarifies.
“No.”
Her eyes close again.
I squeeze her hand. “Doesn't matter right now.”
It might matter eventually.
Not now.
Now the monitor says her heart rate is still in the one-twenties.
Now another liter of fluid is hanging.
Now the lab results start coming back.
I’m grateful that even as busy as the ER is tonight, they were able to get those back quickly.
The physician stands at the computer.
I know what he's looking for before he says anything.
Glucose.
Bicarbonate.
Anion gap.
pH.
Potassium.
Ketones.
His expression changes in exactly the way I don't want it to.
“She's definitely in DKA.”
I nod.
Because of course she is.
I knew that before the ambulance arrived at the house.
Knowing doesn't make hearing it easier.
“How bad?”
He looks at me.
Not at the paramedic—at the husband.
“Significant. Her glucose is six-eighty-nine. She's pretty acidotic and very dehydrated. Potassium is high right now, which is common at presentation, but we're going to be watching it closely because that can shift quickly once we start insulin.”
My brain translates automatically.
Six-eighty-nine.
Acidotic.
Gap open.
Potassium temporarily high because everything is in the wrong place.
Fluids first.
Then insulin.
Repeat labs.
Replace electrolytes as they shift.
Watch the heart.
Close the gap.
I know the sequence.
I've stood exactly where that medic stood and explained to terrified families that DKA is serious but treatable.
I've said, “She's where she needs to be.”
I've said, “They're doing exactly what they're supposed to do.”
I've said all the right fucking things.
None of them mean anything when the patient is my wife.
“She's responding appropriately so far,” the physician continues. “Her pressure is improving with fluids. She's protecting her airway. We're starting the insulin infusion once we've confirmed her potassium trend, and she'll need ICU-level monitoring.”
ICU.