The sky was just starting to lighten when the call came through, though the fog had yet to lift. Looking out the window of the ambulance, Carol Hathaway could hardly tell where in the city they were. Shep seemed to have no problem navigating the streets of Chicago, though. He drove one-handed as he reached for the radio.
“This is Unit Forty-Seven, Dispatch, go ahead.”
“Forty-Seven, please respond to the scene of a single-vehicle accident in the southbound lane of the upper deck of the bridge on Lake Shore Drive,” the EMS dispatcher’s voice crackled through the receiver. “Multiple injuries have been reported.”
“On our way,” said Shep, setting down the radio. Then he looked at Carol. “Mind if we make a quick pit stop, Nurse Hathaway?”
Carol laughed. “Like I have a choice?”
Shep grinned. “Buckle up, baby; we’re goin’ for a ride.” With the flip of a switch, he turned on the lights and sirens. “Admit it,” he added, over the wail. “You like a little excitement on the way to work. Otherwise you’d’ve taken the train.”
“This is cheaper,” said Carol. Faster, too, she thought, holding her breath as he laid on the horn and sailed through a stoplight. She would never admit it to paramedic Ray Shepard, who was as cocky as he was charismatic, but she did like the excitement of his job. It made her feel alive.
That was a far cry from how she had felt last fall - like she was dead inside, like she wanted to be dead on the outside, too - but Shep didn’t know anything about her failed suicide attempt. He didn’t need to know, not yet. After all, she had only known him a few weeks. They hadn’t even slept together, though not for a lack of trying on Shep’s part. He had been pursuing her ever since she’d completed a paramedic ride-along with him and his partner, Raul Melendez, for her recertification as a registered emergency room nurse. At first, she had tried to turn down his advances - after all, it had only been four months since she’d split with her former fiancée - but Shep was persistent. He had wooed her with Ferris wheel rides and dinner dates and unnecessary radio checks in the ER. Now he was giving her rides to work in his rig. She could only imagine how Raul must razz him when she wasn’t around, but thankfully for Shep, his partner mostly kept his mouth shut in her presence. He rode in the back, occasionally poking his head between the seats to check on their progress.
“Where the hell are we?” Raul asked at one point.
“Almost to Lake Shore,” Shep replied.
“How can you tell? You can’t even see the street signs.”
Shep pointed out the windshield. “You see any buildings up ahead?”
“Man, I can’t see anything through this shit.”
“Well, look. There’s the lake.”
Carol peered out Shep’s window as he made a right turn onto Lake Shore Drive. Lake Michigan was hardly discernible through the gray fog. It wouldn’t be the last motor vehicle accident they saw that day, if this didn’t let up. She could only imagine what a nightmare rush hour was going to be. Traffic was already starting to pick up.
As they approached the double-decker bridge, she could see red and blue lights flashing through the fog. A police car was parked at an angle across the two outer lanes, blocking traffic. Just beyond it, Carol could see a large, silver van smashed against the guardrail on the side of the road. The momentum of the crash had carried it halfway up the cement barrier - a little more speed, and it might have flipped right over. Its right front tire was hanging over the edge of the embankment, as if someone had propped it there. “Looks like it could have been a lot worse,” she remarked, pointing this out to Shep. It was a long drop from the upper deck to the river below.
Shep pulled the ambulance around the scene of the accident and parked it in front. Before he and Carol could even climb out of the cab, Raul had the back doors open and was starting to unload equipment. Shep hoisted his medical bag into Carol’s hands and hurried to help his partner, while she ran ahead to start triaging victims. One of the police officers was talking to a woman who looked shaken and distraught, but otherwise unhurt. “The car in front of me must have stopped; I couldn’t see it until it was too late!” Carol heard her saying, her voice shrill and tremulous. “I guess I swerved. I don’t even remember; it all happened so fast…”
The other officer had managed to slide open the rear side door. “Hi, I’m Carol Hathaway; I’m an R.N. at County,” said Carol as she came up behind him, looking in over his shoulder. She quickly counted five people in the back and one front seat passenger.
“Glad you’re here,” said the cop, turning to talk to her. “Listen, the driver seems fine, but I’m not too sure about these guys.” He moved aside to let Carol in for a closer look. She was glad to see that many of the passengers were conscious. They were mostly young men - late teens or early twenties, she estimated. The blond boy in the back looked especially young.
“Hi, I’m Carol,” she called into the van. “Don’t worry; we’re going to get you out of here just as soon as we can. I just need to check and see how badly you’re injured. Sit tight, and try not to move.”
“Please, help Brian first,” begged the man in the left middle seat. Gritting his teeth in pain, he pointed to one of the boys in the back, who was slumped against the window with his eyes closed. “He’s my cousin. I think he’s hurt bad; he hasn’t come to yet.”
Carol climbed into the van, stepping carefully over the passengers who were conscious to get to the one who wasn’t. She slipped a stethoscope into her ears and pressed the diaphragm to the boy’s chest, listening for heart and breath sounds. “What’s wrong with Brian?” she heard the young blond boy ask. “Is it bad?” Carol held up a finger, signaling for him to be quiet. She hoped her face hadn’t betrayed her. She tried to keep it blank as she listened to the victim’s chest, but what she heard was cause for concern. Although the boy was breathing, she had detected an obvious heart murmur, which could mean a serious injury. She knew it was one of the symptoms of an aortic dissection, and that if the largest artery in his body ruptured, he’d be dead in a matter of minutes.
Backing out of the van, she pulled Shep aside. “The boy in the back may have a tear in his aorta,” she told him in a low voice. “We need to get him out and transported ASAP.”
Shep surveyed the situation inside the van. “There’s no way we’re getting him out of there safely without extricating the others first.”
“Then let’s get these guys out as quickly as we can.”
With Raul’s help, they set about assessing the others’ injuries, starting with the boy sitting closest to the door. The right side of his face was a bloody mess from striking something, most likely the window. “What’s your name?” Carol asked him, looking into his big, brown eyes. One of them was already starting to swell shut, making it hard to tell if his pupils were the same size.
“Howie,” the boy replied shakily.
“Can you tell me what hurts, Howie? Any neck, back, or abdominal pain?”
“My head and neck, a little,” mumbled Howie, reaching up to rub the side of his neck. At least he could move his hand, Carol observed; that was a good sign. Still, his facial trauma suggested a possible brain or spinal cord injury, so they couldn’t be too careful.
“We’re going to put a collar around your neck to stabilize it while we get you out of here,” she told Howie. “Hold still. Shep, let’s get a C-collar on him.” Carol put her hands on both sides of Howie’s neck to hold it steady while Shep strapped on the cervical collar. Then she stepped aside while Shep and Raul worked together to unbuckle Howie from his seat and expertly slide him onto a backboard. This was another necessary precaution to protect his spine, but as she watched the two paramedics strap Howie to the board, a troubling thought occurred to her. “Make sure you monitor his breathing,” she told them in a low voice. “If there’s too much blood or swelling, his airway may be compromised.”
“Thanks for the tip, Nurse Hathaway,” said Shep, shooting her an impish grin. “How ya doin’, Howie, any trouble breathing?”
“No,” Howie replied uncertainly. His one open eye kept darting back and forth; he looked terrified.
“All right, let’s get him to the rig and check his pulse ox. We can suction him there and start him on oxygen if we need to,” Shep told Raul. “If he goes south, we’ll intubate.”
As they wheeled Howie off to the ambulance on a stretcher, Carol climbed back into the van to check the next passenger, the one who had told her to help his cousin first. “What’s your name?” she asked him.
“Kevin, but, please, help them first,” he insisted, jerking his thumb over his shoulder to indicate the three boys in the back. “I’m all right; it’s just my leg.”
He had an open fracture of the lower right leg; Carol could see his tibia poking through the torn and bloodied skin of his shin. An injury like that needed to be treated quickly in order to prevent infection or loss of circulation and salvage the limb. “You have a pretty serious injury, Kevin,” she told him. “We need to get you out of here first, and then we'll be able to get to the others. Are they your friends? Brothers?”
“Not by blood, but they may as well be my brothers,” Kevin muttered, closing his eyes as she checked his vitals. “We’re a singing group; we’ve been together for almost three years.”
“Oh yeah?” Carol raised her eyebrows. “Should I know who you are?”
He tried to smile, but he was in so much pain that it looked more like a grimace. “Not yet, but someday… someday, you will. We’re called the Backstreet Boys. Remember that name.”
“Backstreet Boys,” Carol repeated, as she inflated the blood pressure cuff around his upper arm. “Got it.” She slipped the stethoscope into her ears and pressed the diaphragm to the inside of his elbow, then slowly released the pressure in the cuff. As she strained to listen for the sound of blood flowing through his brachial artery, she could hear sirens approaching in the background.
By the time she and Shep had finished splinting Kevin’s leg, a second ambulance, along with a rescue truck, had pulled up to the scene. Grateful for backup, Carol climbed out of the van. “Doris!” she called, recognizing paramedic Doris Pickman, who often transported patients to County General.
“Carol?” Doris jogged over. “What are you doing here? Paramedic ride-along?”
“Something like that.” Carefully avoiding eye contact with Shep, Carol said, “Shep and I just finished splinting a man with an open tib-fib fracture. He’s conscious and alert; vitals are good. Can you transport him? We’ve already got one in our rig; Raul’s monitoring him.”
“Why don’t you guys go ahead? We can take it from here,” offered Doris.
Carol glanced back into the van. “If you don’t mind, I’d like to stay. I’m worried one of the boys in the back may have an aortic injury, and I want to stick around long enough to see him through. Are there more units coming?”
“Should be. Dispatch said there were multiple injuries.”
“Good. Can you take our guy?”
“You got it,” said Doris. She and her partner loaded Kevin onto a backboard and moved him out of the van, making way for Carol to reach the passengers in the back.
Squatting in the narrow aisle, she started with the boy in the middle. “Can you tell me your name?”
“Alex… AJ,” he replied hoarsely. She had to lean close to hear him over the crashing and crunching noises coming from the front of the van, where the rescue squad was using the Jaws of Life to pry off the mangled passenger door. “What’s that noise?”
“Just the firefighters trying to get to the man in the front seat.”
“Lou? Is he okay?”
“Sorry, I’m not sure. What about you, AJ? Are you in any pain?”
“A little.” He grimaced. “My lower back and belly. But... I can’t really feel anything below that. It’s like my legs have gone numb.” As he looked at her, Carol could see the barely-controlled panic in his wide, brown eyes. Her own eyes dropped to the lap belt buckled across his middle. The seatbelt had kept him restrained in his seat, but it may have also done irreparable damage to his spinal cord. She had seen similar injuries before, usually in kids.
“Okay, AJ, I want you to hold really still while we get a collar on you,” she said softly, trying to keep him calm. “Shep?” Again, Shep put on the C-collar while Carol stabilized the boy’s neck. They made a good team, she thought, as she helped maneuver a backboard behind the boy and slide him onto it. “Is there room in the rig to transport more than one?” she asked Shep.
“We can if we strap one to the bench.”
“Should we? Do you think it’ll jostle him too much?” Carol wondered, concerned about worsening a possible spinal cord injury.
Shep shrugged. “It’s a last resort. Look, let’s just move him out of here and reassess the situation outside. There should be more units responding.”
They lifted AJ out of the van and lowered the backboard carefully to the ground. Immediately, the woman who had been driving came running over, screaming, “My son! How badly is he hurt?”
“Hey, Mom,” said AJ, managing a smile.
“Oh, thank God you’re all right, Alex!” cried his mother, dropping to her knees beside him. “What about the other boys? The police wouldn’t let me go back to the van.”
“They took Howie and Kevin. Nick and Brian are still inside. Nick seems okay, but I think Brian’s hurt bad. Hey, Mom, what about Lou? Have they gotten Lou out yet?”
Carol followed the mother’s eyes to the front of the van, where the rescue squad had finally managed to open the passenger door and were working on pulling out the man inside. She could see it was going to be a struggle, as he was obese and unconscious, by the look of it. She hurried over to them. “Need any help here?”
One of the firefighters glanced over at her. “You EMS?”
“I’m an R.N. at County.”
“Maybe you can help. We’re having trouble getting a set of vitals on this guy. He’s too fat - no one can find an artery to check his pulse.”
“I can. Move aside, please.” Carol stepped forward, slipping her stethoscope into her ears once more. “His resps are rapid and shallow… diminished breath sounds on the right,” she said, as she listened to the man’s chest. “Heart sounds are muffled. He’s tachy, and his rhythm’s off. We need to get him out of here and on a monitor.”
She stood back as the firefighters strained to pull the man out of the passenger seat and onto a stretcher. “Let’s put him on fifteen liters 02 by mask,” she suggested, strapping a non-rebreather mask to the man’s flabby face. As she stooped to adjust the flow on the oxygen tank, she heard Shep’s shout.
Carol looked up to see a truck careening towards them. She stumbled backwards, flattening herself against the guardrail, as the firefighters scrambled to drag the stretcher out of the way. She heard the squeal of brakes on the wet pavement, but the truck couldn’t stop in time. It smashed into the police cruiser blocking off the scene, sending it spinning out of control. The squad car struck the wrecked van, its front fender wedging underneath the van’s back bumper. The momentum catapulted the van up off the ground. Carol could only watch in disbelief as the van teetered on the edge of the guardrail, just a few feet from where she was standing. Time seemed to stand still as the van hung there, suspended in mid-air, but it must have only been a split second before it continued over the rail and plunged forty feet into the river below.