Darla's Dilemma

"Blood pressure is 70/45, pulse is 138, respirations are 24, and temp is 37 degrees Celsius. Cardiac monitor shows sinus tachycardia, rate of 138 with occasional PVCs." PVC stands for Premature Ventricular Contraction and can be a possible precursor to cardiac arrest. "Patient is secured on a back board with c-collar. Extrication time was plus-20 minutes. ETA to the pad is approximately 2 minutes. Requesting trauma alert and personnel to meet us for a hot unload. How copy, Holy Family?"

"Good copy," Katie replied. "We've been monitoring the scene and a trauma alert has been called. Trauma and neurosurgeons' ETA's are less than five minutes. Personnel are standing by on the pad and awaiting your arrival."

"Good copy. Eagle Star out."

Gene once again brought the helicopter into a wide arc and Mara and I put our night vision goggles back on.

"Crew and mission equipment ready for landing?" Gene asked.

"Ready on the left," I replied. "Belts, doors and switches secure."

"Ready on the right," Mara confirmed. "Belts, doors and switches secure."

"Copy. Crew and mission equipment ready for landing." Gene flipped on the belly-mounted landing lights of the helicopter and illuminated the pad from above. We could see a gurney and four personnel ready to help us unload. Like always, Gene executed another flawless landing and brought the big ship down gently and dead-center on the pad. "Holy Family base, Eagle Star is back on the pad, time now."

"Copy, Eagle Star. Time is 3:17. Welcome home."

Mara immediately unbuckled and opened the clamshell doors at the back. The awaiting gurney crew made eye contact with Gene and was rushing over to meet us. All four of them were already donned in full trauma gear with gloves, gowns, masks, hoods, booties and face shields to protect them from blood and body fluids. We quickly released the cot and slid it towards the back of the ship. I grabbed the Propaq monitor and the IV bags and exited the ship as the patient was quickly placed on the gurney and rushed into the Emergency Department, all the while the ship was still operating at full power prior to shutting down.

We rushed into the main trauma room where two emergency department physicians and nearly twenty other personnel were waiting for us. Several units of O-negative blood had been brought down from the lab and were ready to be infused into the patient immediately. Portable x-ray machines were standing by outside the ED and CT technicians were on standby in the CT room ready to obtain more in-depth imagery when called upon.

A few minutes later Doctor Marcelino, a trauma surgeon, and Doctor Chandraskatta, a neurosurgeon, both arrived to direct their part of the situation. A respiratory therapist and the anesthesiologist on-call both arrived and a gastroenterologist had been paged and was expected shortly.

Within 5 minutes, we had another large-bore IV in place and the patient was actively receiving blood products. At the same time, the first radiology images had come in and confirmed that the patient did, indeed, have all of the fractures we had noted. Within another ten minutes, the CT scan had been performed and showed the remnants of the collapsed lung, along with the presence of a large amount of blood in the patient's pelvis and abdomen. Blessedly, the CT of her head and neck revealed no signs of a brain injury or spinal injury. Thank God for small miracles.

A surgical staff consisting of numerous surgical techs, nursing assistants, as well as trauma and surgical nurses, had assembled and prepped an operating room for emergency surgery. Within twenty minutes of touching down, the patient had been sedated and had a breathing tube inserted in her airway, as well as a chest tube placed, and she was rushed off to the surgical suite for emergency surgery.

Mara and I stood there as the last member of the trauma entourage left the trauma room. What had been an incredibly busy, noisy and bustling room only a few short moments before was now empty and took on an eerie silence. The trauma room was a total mess and would probably take the environmental services staff the better part of an hour to clean up, along with the nurses and ER technicians who would have to restock all of the supplies that were used.

Mara and I gathered up our own equipment and replaced all of the supplies that we had used on the scene and during the subsequent return flight. All of the adrenaline that had been coursing through my body moments earlier now seemed to be quickly exiting my blood stream and the energy was being replaced by an overwhelming sense of fatigue.

Gene had made it back to the flight crew dormitory before we did, after having plugged in the helicopter's battery charger and topping off the ship's fuel. With our medical supplies replenished, Eagle Star was officially back in service.

Since the flight was a trauma call, it was my responsibility to write the patient care report. Most of our calls are medical calls that involve transporting patients from one hospital to another. On those flights, Mara took the lead in patient care. But since paramedics generally have more hands-on experience working scene calls for accidents, we generally took the lead in patient care on those calls. Make no mistake, though. As the Flight Nurse, Mara Kendrick was still ultimately responsible for patient care. She trusted me, though, and was more than confident in my abilities to provide excellent patient care. It also didn't hurt that I worked with her husband, Josh, in my full-time job as a firefighter and paramedic with the Red River Falls Fire Department. I only worked for Eagle Star about 2 or 3 shifts a month and they were usually only 12-hour shifts, whereas the full-time medics worked 24-hour shifts.

I finally finished documenting the call around 4:30 am. I decided to try and catch a few z's before I had to drive back home to my place in Royal Fork, which was about 45 minutes west of Red River Falls. Our shift on the helicopter starts and ends at 7 am, so I took advantage of the opportunity to catch some extra sleep. I'd have Mara look over my report before she left for home, just in case she had anything she wanted to add that I might have forgotten or overlooked.

Overall, I felt the call went really well. We were only on scene for ten minutes, had accomplished a lot of patient care on scene and during the flight back to Holy Family. The first responders and firefighters from Martindale did an excellent job cutting the patient out of that mangled wreck and the Mason County Deputies and state troopers on scene did an excellent job setting up the landing zone. I couldn't really see much room for improvement, though there were always things that we could do better.

But often enough, sometimes you can do everything right and bad things can still happen. And in this instance, it was one of those times. Stephanie Pinkerton and her boyfriend, Ziggy Alexopolous, had been partying with friends at the only operating bar in Martindale and had decided to race home afterwards. Both Stephanie and Ziggy had been drinking but Ziggy had way too much and had absolutely no business behind the wheel of any vehicle. But he wanted to show off for Stephanie and stretch his new-to-him Chevy Camaro to the limits and lost control of the vehicle. An autopsy would show Ziggy's blood alcohol content was 0.25 - over three times the legal limit by state law.

Less than 20 minutes after getting her into emergency surgery, Stephanie Pinkerton died on the operating table from massive internal hemorrhaging. She was a month shy of her 26^th birthday. She left behind a six-year old daughter and a three-year old son.

I live in the town of Royal Fork, which is about 45 miles west of Red River Falls, where I worked. I couldn't help but replay the entire call over and over in my mind and wonder if there was something I could have done or something I shouldn't have done that would have made a difference in the outcome. The smart part of me knew that there was almost nothing that really could have changed the result, especially when one considers the amount of trauma the young lady had suffered.

The emotional part of me, however, always desires and needs some kind of explanation for why a person dies instead of lives through a trauma. It is the way that most firefighters, paramedics, law enforcement, doctors and nurses are wired. We always want to believe that there was at least one thing that could have made a difference. I guess it is sort of an internal quality assurance process we put ourselves through.

I pulled into the driveway of my house, which is a mid-1970s split-level home with an attached two-stall garage. I parked my 2014 Taurus in the right hand spot. The left parking spot was reserved for my live-in girlfriend, Darla Jones. Darla had moved in with me about four months ago, along with her five-year old daughter Natalie and her three-year old little boy, Nathan. Darla's divorce from her husband of the previous seven years, Randy Jones, would be finalized in a little over a month.

Most of my friends had told me to beware of getting involved with a woman who was separated and not divorced yet - especially my best friend, Danny Larson. Danny was particularly vocal about his concerns, mostly because he had known Darla and Randy before I did. They had been together since their high school days and had a pretty rocky relationship the entire time. They had broken up numerous times in high school, only to eventually get back together again. Several other guys had been interested in Darla and probably would have treated her a helluva lot better than Randy ever had. But none of them could break Randy's spell that he held over Darla.

I had met Darla through some mutual friends of our down at the local watering hole here in Royal Fork, a bar called 'The Half-Pint'. I was immediately smitten with her. She was a natural and dark complexioned brunette with eyes so brown they were almost black. She was packed into a small 5-foot 1-inch frame with a spectacular set of D-breasts that gave her the most delicious-looking curves I had ever seen on a woman. She was short but she was an absolute dynamo of sex and beauty.

We took our time getting to know one another, especially since she was in the process of going through a divorce. Somehow, I managed to win her over and we began dating exclusively. About three months into our relationship, we decided to move her and the kids out of Darla's parent's house and into mine. I have three bedrooms and two full bathrooms so it seemed to make perfect sense. Plus, I was absolutely crazy about Natalie and Nathan and quickly began bonding with them from the moment we first met.

I hadn't even met Randy Jones. Shortly before Darla served him with divorce papers for his chronic drinking and womanizing, he supposedly took off for one of the burgeoning oil fields up in North Dakota and got a job as some type of laborer for one of the oil companies. Darla hadn't heard from him the entire time we have been together. The divorce proceedings were largely uncontested, up to this point, and Randy's attorney consented to the terms, which essentially meant Darla could have all the furniture and whatever was in the checking account, which wasn't much. The judge issued a temporary custody agreement and Randy was ordered to pay a miserly $200.00 in child support each month, which had been based off the income of his last known steady job, which was working as a clerk at one of two large convenience stores in Royal Fork, the Pump-N-Shop.

I entered the house from the garage, went upstairs to the kitchen and put my overnight bag and keys on the kitchen table. Immediately, something caught my attention. It was extremely faint but it was undoubtedly the smell of cigarette smoke. I walked around the upper floor and into the kids' bedrooms and finally the master bedroom trying to locate the source of the smell. Nothing seemed out of place in any of the rooms. I couldn't tell where it was coming from but the smell was unmistakable. Someone had been smoking in my house.

I stepped out onto the deck and looked around for cigarette butts. I saw nothing at first but decided to check further. I walked down the stairs to the bottom of the deck and looked underneath it. There on the ground were four cigarette butts. Marlboro Lights. I knew Darla didn't smoke and I hadn't had anyone else over to my house, such as a repairman or delivery man. Judging by the smell of the cigarettes inside the house, I could only conclude that someone had been smoking on the deck and then entered the house, bringing some of the smoke with him or her.

No one was at home right now other than me. Nathan was at daycare and Natalie went to a morning pre-school and afternoon daycare with Nathan. Darla was at her job over at Callahan Manufacturing. Callahan was the biggest factory in Royal Fork and one of the biggest employers. Darla worked there on the first shift from 8 am to 4 pm. Callahan's made a variety of trailers - everything from flatbed semi-trailers, to cattle and horse trailers, to car haulers and a bunch of smaller utility and landscaping trailers.

I couldn't think of anyone that Darla might have had over. None of her immediate family smoked and neither did any of her friends, at least not that I know of. I decided to put the thought out of my head and grab a shower to wash the funk of a 24-hour shift off of me. I felt more human again after the shower and decided to tinker on a few projects around the house until everyone got home.

Darla and the kids got home shortly after 4:15 that afternoon. Darla looked tired and the kids were both rambunctious. But Natalie and Nathan both ran up to me and gave me a big hug. The two little ankle biters were really starting to grow on me. I was quickly getting to the point where I couldn't imagine my life without the two of them and their mom.

Darla looked exhausted from her day on the job. Believe it or not, she was a welder on one of the main assembly lines. I went ahead and got dinner started, which was just a simple casserole of Mac-n-Cheese and chicken along with jello, which the kids loved. It wasn't fancy but it was filling. I really enjoyed sitting around the table with Darla and the kids.

After dinner, Darla helped me clear the table and I washed the dishes. She had been getting on my case ever since she moved in about getting a dishwasher installed but I hadn't found it necessary yet. Besides, when I was still "batching" it, I never really used enough dishes on a regular basis to warrant one.

"So, how was work today?" I asked.

"Oh, the usual for the most part," Darla replied, drying the casserole pan. "It sounds like they are actually planning on adding some new people, so we might be able to cut back on some of the mandatory overtime."

"That'd awesome! Maybe you, the kids and I can actually take off for a whole weekend some time soon."

"Well," she hesitated, "probably not until school lets out for summer in a few weeks."

"Yeah, I suppose," I said. "Say, just out of curiosity, did anybody stop by yesterday while I was gone?"

Darla didn't look at me but kept drying a plate. "No, not that I remember. Why do you ask?"

"Just curious. I thought I could smell a whiff of cigarettes smoke when I came home this morning."

"Well, the only person in my family who smokes is my Dad but he didn't stop over yesterday."

"Yeah, I know," I said, pensively. "Besides, your dad smokes Camels."

"What does that have to do with it?" She still wasn't looking at me.

"Aw, nothing. I just found a few Marlboro butts underneath the deck out back." As I said that, I noticed Darla inhale deeply. It was obvious that she knew something but was holding it back.

"I dunno," she said. "It was probably just one of the utility meter readers or something. I'm sure it was either the water or electricity guy. Both of those meters are under the deck, you know." I could see her relax a bit with that answer.

"Hmm. Possibly," I answered. "But those guys are on a schedule and move pretty quickly. I doubt either of them would stop to have a cigarette under my deck. One maybe, but probably not four."

Darla quickly put away her drying towel. "I'm gonna go get the kids started on their baths," she said heading towards their bedrooms.

"Kinda early for baths, isn't it?"

"Yeah," she called back. "But they were both up kind of late last night and I want to get them to bed a little early tonight. Besides, you know how they both hate baths."

Yes, I did know. But she usually never made them take a bath until right before bed, which was always 8:30 sharp so they were in bed by nine at the latest. She was obviously avoiding me. Darla gave the kids their baths and we all just kind of vegged out in front of the TV the rest of the night watching a couple of kids shows on Netflix. Darla said very little to me before we went to bed and seemed overly engrossed in the children. But I sensed she was intentionally ignoring me.

We both stayed up to watch the news, not that I would remember any of it with the 800 pound elephant in the room. I was the first to crawl into bed and waited for Darla. She came to bed wearing a simply one-piece night shirt. It never ceased to amaze me who she could look sexy in just about anything. She got into bed, gave me a quick kiss goodnight and then immediately rolled over facing away from me. I slid over and spooned in behind her and immediately began roaming my hands over her body, which was my silent way of initiating sex. Darla grabbed my hand and pulled my arm around her in an embrace.

"Sorry, babe. It's just been a long day and I'm really wiped out," she said.

"No problem," I answered, deflated. "I understand."

Truth is, I didn't understand. In the entire time we have been together, that was the first time that she had ever refused me sexually. That's not to say we had sex every single night we were together, obviously. But that was the first time she had ever refused me when I tried to initiate it. I laid there and just cuddled her but I knew she was having just as much trouble falling asleep as I was. Something was obviously not right. And the cigarettes were a major clue.

*****

I got up at five the next morning, got cleaned up and ready for work. I kissed Darla on the forehead at 5:45, got into my car and headed for Red River Falls. She barely stirred when I kissed her and I sensed that she was only feigning sleep.

I got to the fire station a little after 6:30 and got my gear ready for work. My job title is actually that of a firefighter but I'm assigned as a senior paramedic to one of three ambulances we staff. Our fire coverage is only for the city of Red River Falls but we provide ambulance coverage for almost all of Mason County. Most of the smaller towns in Mason County, such as Martindale, have a fire department with a few members who are certified as First Responders. Therefore, they are the first ones to arrive on the scene of a medical emergency while an ambulance gets dispatched from Red River Falls.

A couple of the bigger towns, like Royal Fork, have their own volunteer ambulance services. There are six members of the Red River Falls Fire Department who live in Royal Fork. Unlike a lot of other departments around the country, we are not required to live in the city we serve. Since we provide EMS coverage or assistance to most of Mason County, we are allowed to live anywhere within Mason County.

I chose Royal Fork because it was more than just a wide spot in the road. It was an actual town with local shops, gas stations and even a grocery store - unlike the folks in Martindale, population 300, who had to drive over 15 miles just to get a jug of milk. Royal Fork had about 4500 people and a fairly active main street with a good number of local businesses. The school district was centered there and actually managed to gain a few students this last school year. I especially liked the fact that I could find a decent house in Royal Fork. I only paid about $100,000 for my split-level but I would have paid another twenty or thirty grand for the same house in Red River Falls.