15 March 1995 - Wilmington, Massachusetts

“ ... connect the IV tubing ... tape it down using a Tegaderm and a chevron ... make sure I’ve released the tourniquet ... dispose of the sharp in the sharps container. Done.”

“Well done, Jeff,” Devon Aguilar commented. Devon was a paramedic for Wilberforce Ambulance Service, a family-owned company which provided service to many towns around Burlington, Massachusetts; he was the teaching assistant evaluating IV skills today.

“Thanks, Devon. It’s starting to feel like more of a natural process, less herky-jerky, when I start IVs. I’ll be interested to see how I do on real arms and not these practice ones.”

“That feeling, that’s your muscle memory getting up to speed with the skill, Jeff. You’ll have to adjust a little if your company switches equipment brands, or if you change companies and they use something different, but the process doesn’t change. These arms are good, but live arms are hard to beat. What else do you have to consider before you dispose of the sharp?”

Jeff thought for a second. “Do I need a blood sugar reading? I can take it off the catheter, right? So I don’t have to stick the patient again?”

“In most cases, yes. The monitoring strips some services still use are calibrated for capillary blood samples while most glucometers seem to give reliable readings from either capillary or venous blood sources. If a patient is peripherally clamped down, you may not be able to get a true ‘finger stick, ‘ while you can still get venous blood off the IV catheter. Anyway good job, head over to the next room for intubation practice with Tara.”

“Tara’s on the airway station today? Excellent!”

Devon laughed. “You might be about the only one in this class who is happy when Tara’s evaluating them. She’s tough as nails!”

“True, but I’d rather screw up a million times in front of her here than on one actual patient out there.”

“Right you are, Jeff. That’s why we don’t give you as much grief as your classmates, because you understand that. Go on, get going!”

Jeff gave Devon a wave while he exited. He stepped into the airway training room and Tara Bergeron glared at him; she did this to every student, so Jeff wasn’t concerned. Nine months into the class and some of his fellow trainees hadn’t figured that out.

“Alright, Knox,” she said without preamble, “I know you can handle oral intubation, so today I want to see you do a nasal intubation.”

“Right,” he answered in the same no-nonsense manner. “Unlimited helpers as usual?”

“Correct.”

“No trauma suspected?”

Tara shook her head. “None.”

“Okay, Universal Precautions,” he said as he pulled on a pair of gloves. He also donned a surgical mask with a clear face shield attached; it would keep the patient’s fluids out of his eyes and mouth. “Scene is safe?” Tara nodded. “Okay, first...” Jeff went through the process of nasally intubating the mannequin as he narrated the procedure. “My assistant keeps the patient oxygenated using high-flow O2 via non-rebreather. I check my equipment, preparing the appropriately-sized ET tube by lubricating it with two-percent Lidocaine jelly or sterile water-based lubricant; insert the tube into the larger nostril, usually the right; direct the tube straight back, perpendicular to the face; gently rotate the tube ninety degrees clockwise when I hit the back of the throat; listen for the patient’s breath sounds as I advance the tube; when I’m in the right position, advance as the patient draws a breath as the vocal cords will be open the widest; if in the proper position, the patient will attempt to cough and be unable to speak. Inflate the tube’s cuff, provide positive-pressure ventilations and coach the patient to breathe in time with me.”

“Well done. Good technique,” Tara said. “What are the contraindications to nasal intubation?”

“Absolute contraindications are suspected epiglottitis, midface instability, any form of coagulopathy, suspected basilar skull fractures and apnea or impending respiratory arrest. Relative contraindications include large nasal polyps, suspected nasal foreign bodies, recent nasal surgery, upper neck hematoma or infection, history of frequent episodes of epistaxis, prosthetic heart valves due to the increased risk of bacteremia during the insertion.”

“Why can’t you place a nasal tube when the patient’s not breathing?”

“You need the patient’s breath sounds to help you know you’re in the right place when you’re not performing direct laryngoscopy.”

“Why is a suspected basilar skull fracture an absolute contraindication?”

“Because you run the risk of the tube passing through the fracture and into the patient’s brain.”

“Which potential complication is common to both oral and nasal intubations?”

“Vocal cord damage.”

“What’s the most common complication?”

“Epistaxis, a nose bleed from abrasion of the nasal mucosa.”

Tara looked at him, narrowing her eyes. “‘What is the air speed velocity of an unladen swallow?’”

“‘African or European?’” Jeff shot back. “And my favorite color is blue.”

Tara smiled. “‘Alright, we’ll call it a draw.’ Good job, Jeff. If I could, I’d recommend to Jacklyn that you start your clinical rotations now while we continue to beat up your classmates.” “Jacklyn” was Jacklyn Simmons, the program coordinator and lead instructor. She gave him a look. “You know you’re hurting my feelings, right? I intimidate every single student who comes through here for the six years I’ve been an assistant instructor and then BAM! you come waltzing in here and blow my reputation! You’re not intimidated by me at all!”

“Hell yeah I am! You scare the crap out of me!”

“Huh? I do?”

“Um, YEAH! But why do you think I always find the skill station you’re running when you’re here?”

“You like my sparkling personality?” she asked sarcastically. Tara knew her personality was often abrasive.

“Yeah, that’s it,” he snorted, answering in the same tone. “No, it’s the same reason you scare every single member of this class: you won’t accept less than perfection, and you won’t let us accept less than perfection, either. The consequences are the same in this job as they were when I was jumping out of airplanes for a living: death.”

“Skydiving instructor?”

“Paratrooper. No, the standard was: you do it the right way, every time. That’s the way you train... 300 maybe a good batting average in baseball but it’s a lousy percentage in this job!”

A week later and the class was practicing live IV starts on each other; if you wanted to stick someone, first you had to agree to get stuck. There was the usual hemming and hawing from any large group along with the folks who often stepped forward first, like Jeff.

Jeff was methodical while he prepared his equipment prior to the attempt. He donned gloves before tying a constricting band around a classmate’s forearm. A vein popped up and Jeff swabbed the area with alcohol. He pulled the protective cap off the catheter, lined it up, and inserted the needle. Jeff felt a slight “pop” as the needle pierced the vein he’d targeted; a small chamber attached to the needle filled with blood. He removed the band and occluded the vein as they’d been taught. He removed the catheter’s needle, leaving only the Teflon catheter and flushed the catheter with sterile saline.

“Nicely done, Jeff; very smooth,” Tara commented. “Harv, how’d it feel?” She was taking a gentler tone tonight. People were already nervous; very nervous people holding sharp objects was a bad combination.

“I barely felt a thing,” Harv replied.

“Okay, your turn. Jeff, your hand please?”

Jeff placed his right hand on the desk in front of him for Harv - Harvey Goldman - to perform his IV start. Harv’s gathering of equipment wasn’t as organized as Jeff’s was. Jeff could also tell Harv wasn’t as confident as he could be - his hands shook while he tied the constricting band around Jeff’s forearm; he got the tension in the band correct on the third attempt.

Jeff’s poker face was much improved from 1992; he hid his trepidation well while Harv swabbed his hand with alcohol. Harv identified the vein he was going to cannulate and swabbed that area again. Satisfied he put down the alcohol wipe and picked up the twenty-gauge IV catheter. The sound of the catheter cap being removed seemed quite loud to Jeff. Harv positioned Jeff’s hand and took a deep breath as he brought the catheter to bear.

Jeff bit back a gasp when the catheter tore through his skin. Harv hadn’t drawn the skin of his hand tight before making the IV attempt, so the needle didn’t pass through it cleanly. Harv didn’t hit the target vein on the first try, either; he fished for the vessel, moving the end of the needle back and forth under the skin. Sweat began to bead up on Jeff’s forehead as he fought not to cry out.

Jeff lost his battle when Harv tried to cannulate a tendon in his hand. Jeff could see the catheter bend when Harv attempted to enter what he thought was the vein. The pain was excruciating.

“And, you’re done!” Jeff yelled as he pulled his hand away. The catheter remained in Harv’s hand when Jeff’s jerked back. The needle tore open the vein Harv originally targeted when it exited. The tight constricting band allowed arterial blood to enter Jeff’s hand but blocked the venous return. That blood now poured out of his hand and onto the disposable absorbent pad on the desk.

Jeff tore the band off his forearm and slapped a wad of gauze over the puncture wound. He walked out of the classroom without another word while everyone watched. He continued down the hall to the building’s lobby; he sat on one of the benches there while holding pressure on his hand. His right ring finger twitched occasionally as he stared at it.

“Jeff? Are you okay?”

Jeff looked up to see Tara Bergeron standing there with a look he’d never seen on her face: concern. He knew that thought was unfair to Tara; by all accounts she was an amazing medic and cared deeply about her patients, often visiting them in the hospital after transporting them days before.

“I’ll be fine, Tara, thanks.” His finger picked that moment to twitch three or four times.

“He didn’t try to cannulate the tendon did he?”

“I’m afraid so. Don’t be too hard on him, Tara; he’s a good kid.”

“‘Kid?’ You’re all kids to me! Why, how old are you, Jeff?”

“Okay, so I’m only twenty-five. I feel old beyond my years sometimes, though.”

“Your knees must hate you after jumping out of planes like you did.”

“I only did one hitch with the Army, so they’re not as bad as they could be, but I do run to keep in shape. I’m sure that won’t help in the long-term. Really, Tara, I think I scared Harv enough; don’t go all ape-shit on him on my account, okay?”

“Christ, I’m getting soft in my old age,” she muttered while she shook her head. “I’ll play nice. I won’t even yell at him!”

“I’m sure that’ll be a first.” His right arm went numb when Tara punched him in the shoulder.

“So how much longer do you have left for medic school? Five months?” Sean asked one night in early April.

“Until we test, yes. I’ll be done with didactic the middle of next month, have two weeks off, start clinicals the first full week of June, and should start my ride time after July Fourth if everything goes well.”

“Have they told you how fast you’ll get your medic schedule once you pass the test?”

“What’s up, Sean? You trying to get rid of me?”

“No, I’m coming off the road the week before Labor Day,” Sean told him.

“‘Off the road?’ Where are you going?”

“I’ll be a management trainee after the holiday, Jeff. I’m stepping out of the shadows and gonna start working with my Dad.”

“Are you worried about possible backlash?”

“I’m sure there will be some. Luckily I’ve only worked with you, so I don’t have to worry about having worked with some of the malcontents here. I don’t have to worry about you screaming that I was just working the road to spy on folks.”

“No, you won’t. Not if you pay me you won’t.”

“Such the comedian you are!”

“So, we’ve only got those five months on the farewell tour then, huh?”

“Yeah, though it’s not like either of us are going far, Jeff. We’ll still both be working for Brophy.”

“Yeah. Hey, maybe once I’m out of medic school I’ll finally be working some day shifts. It’s not like we won’t run into each other, right? How are things going with Beth anyway? Keiko and I haven’t seen you guys much since New Year’s.”

“I asked her to marry me last night, Jeff.”

“Dude! Sean, that’s awesome! I can’t wait to tell Keiko tomorrow! Congratulations!”

“Thanks, Jeff. Would you mind being my Best Man?”

Jeff was stunned. “Sean ... Sean, I’d be honored. I’m not realistically going to be able help plan much until September, though.”

“I know. We haven’t talked about a date yet, but neither of us want a very big wedding; we have talked about that. We’ll probably have a small group of friends in our back yard, and that’s it.”

“That would mean sometime between late-April and late-October then.”

“It’ll likely snow no matter when we have it.” The two friends laughed; every time the two couples tried to get together over the winter it had snowed at least three inches. “Something else, Jeff. I’m changing my name.”

“What are you going to go with? Sinead? Sarah? Siobhan? Where are you having the surgery done?”

“Very funny; don’t quit your night job. No, I’m changing my name to Sean Brophy.”

“Why change now?”

“When folks talk to the president of Brophy EMS, they expect that person’s last name to be ‘Brophy.’ I hope to take over for Dad. When I do I’ll be the third generation Brophy to run this company. I know I have a lot to learn, but that’s the plan.”

“At least you know you have things to learn, that you don’t know everything. That’s not often the case.”

Jeff’s shoulders were screaming; he was pretty sure the shoulder joints weren’t designed to be in the position they’d been in for the past few minutes. The pain matched that of other joints in his body; they’d been forcibly manipulated before his shoulders.

“Why are we doing this again?” he gasped.

“Your strength is excellent, Jeffrey, but your flexibility has suffered because of it,” Keiko said while she held his arms in position. “If you restart your study of karate this will be a severe liability. These stretches will become easier if you do them regularly.”

Jeff grunted in disbelief; it felt as if Keiko was twisting him into a pretzel. Still, she’d continued to tell him she wished to get him back into karate, that it would help to augment his current workout routine and keep him safer around potentially violent patients. She was not amused when he reminded her that “he who fights and runs away, lives to fight another day.” Some people had no sense of humor.

When Keiko finally released his arms five minutes later, Jeff lay on the floor immobile catching his breath. He was exhausted and he didn’t feel he’d done anything. He decided he needed a good massage, preferably from a nice steamroller; that might feel better.

“Tomorrow we shall see if we can increase the time spent stretching,” she said glibly. The damn girl hadn’t even broken a sweat!

“You’re trying to kill me.”

“I am saving that for when you step on the mat with me, Jeffrey,” she said, smiling at him.

“Why do I feel like a mouse looking at an approaching cat?”

“Hey, Jeff, it’s Harry Ouellette. It’s Monday, May eighth at one-thirty in the afternoon. Give me a call when you get the chance; I know you’re in school, so no rush, but call me by Friday if you can. Thanks, Jeff. Talk to you soon. <BEEP>”

With Jeff’s class final tomorrow, the ninth, he’d been out running errands on this rare free Monday; Jacklyn told him to skip the review sessions, that he was ready. He must have just missed Harry’s call, since it was only 1:45. He put the groceries away before returning the call.

“Law office of Harry Ouellette. How may I help you?”

“Hi, Jeff Knox returning Attorney Ouellette’s call?”

“Of course, Mr. Knox. One moment.” There was a pause as he was announced. “Jeff?”

“Hey, Harry, how are you? How are Sarah and the kids?”

“Good, everyone’s good, thanks. Do you have study hall now or something? I thought you’d be tied up now.”

“‘Study hall?’ What, am I back in high school, Harry? No, our class final is tomorrow and my instructors told me I didn’t need to come to the review session; I’ll study a little later. What’s up? Is this a last minute pep talk before our court date next week?”

“No, WREMS offered you four million today.”

Jeff wasn’t sure he’d heard his lawyer correctly. “Harry, you know it’s not nice to tease people.”

“Jeff, I shit you not, their lawyer couriered over a formal offer to settle out of court for four million dollars not an hour ago. No non-disclosure.”

“Holy shit,” Jeff whispered, his head spinning. “They blinked!”

“And how! The court date must have scared them into acting. The offer also states they’ve hammered out the details with the IRS and Massachusetts’ Department of Revenue so you’ll have no tax liability on this.“

“They’re payin’ the freight on this, too? Holy shit, Harry!”

“And court costs, Jeff. You get the whole four million!”

“Um, Harry, per our agreement, I believe I get three million and you get one...”

“If you want to get technical about it, Jeff, you’ll get the money then give me the twenty-five percent we agreed on.”

“What about you, Harry? Are they going to tax you?”

“Nope, that’s in the agreement, too.”

“Pull the trigger, Harry; make the deal. Will I need to come out there to sign anything? I’ll have some time before I start my clinical rotations for paramedic school.”

“No, our agreement covers my being able to sign for the check. Just let me know the routing number and account number at your new bank, and I’ll have it sent there. Once that’s done, you have them send a certified check to my office and we’re square.”

“Unbelievable. Thanks for your hard work on this.”

“Don’t thank me till you get the check, fella.”

Jeff inhaled the clean, late spring air while he admired the view before him; it wasn’t often that non-firefighters got to see the view from the top of a fire watchtower, but the person who’d arranged his visit to the top had some pull locally. The only thing better would be the view when the sun started to set later. He doubted he’d still be up here, though.

“Don’t jump! You have too much to live for!”

“Like the moment when you stop telling terrible jokes, Jack?”

“Thou woundest me, sir!” quipped Jack Dwadczik.

“Stop already, would ya?”

“Okay, okay! Everyone’s a critic! So, are we doing this when she comes back?”

“Yeah. Can you get a good shot if I stand here?”

“I just checked, and it should be perfect. The light should hold for another hour or so, so unless she gets lost between here and the ladies room...”

“Again with the jokes. You can stop anytime, Jack. Really, I won’t mind.”

“Mind what, Jeffrey?” Keiko asked as she rejoined him.

“Your boyfriend doesn’t have a good sense of humor, Keiko. He said he won’t mind if I stop telling jokes.”

“I do have a good sense of humor, Jack; you’re just not funny.”

“That’s it. I’m outta here. Keiko, if you decide to push this humorless bastard off the tower, I don’t want to know about it, okay? It’ll be justifiable homicide in my book.” Jack walked away shaking his head.

Jeff smiled as he watched him leave. “I can’t believe I’ve been friends with him for a dozen years.” Keiko looked up at him while she hugged him, not saying a word. “Jack helped me get started with my workout routine the summer before high school, back in ‘83. He’s helped me out a couple of different times, especially when things blew up at CRVA.”

“I’m a lucky guy in so many ways, Keiko. I’ve been blessed with a large, caring family, with many friends across the country and with many more here. The biggest blessing I’ve received, however, was on the day your brother introduced me to you. I fell in love with you the moment I looked into your incredible brown eyes, Keiko. I’ve been falling deeper and deeper in love with you every moment I’m with you. With you in my life I’ve never been as happy as I am now and there’s only one thing that could make me happier...”

Jeff knelt while he removed a small box from his pocket. He gazed up at Keiko while he opened that box, revealing its contents.

“ ... and that would be if you would agree to be my wife.”

Tears of joy streamed down Keiko’s face while she nodded. “Yes!” she exclaimed. Jeff pulled her engagement ring from the box and placed it on her finger; it was a perfect fit. He gathered his fiancée into his arms and kissed her. She beamed at him when he released her, then looked down at her hand to admire the ring he’d chosen for her.

“The ring is beautiful, Jeffrey. It is even more beautiful to me because you chose it for me. It fits my hand as perfectly as we fit each other. I look forward to being your wife even more than I have been since the day we met.” They kissed again before walking into the firefighter’s observation area hand-in-hand. Jack Dwadczik greeted them with applause when they entered. Keiko favored him with a hug and kiss; Jeff limited himself to only shaking his friend’s hand after a congratulatory hug.

“Did you get some good shots?” Jeff asked.

“Think so,” Jack confirmed while he held out a film canister. “I fired off a roll of thirty-six exposures; one of them’s gotta be good.”

“Where’d the firefighter go?”

“He made himself scarce once I came back in; he walked down the stairs for a bit of exercise. Thanks for letting me be a part of this, Jeff,” Jack said.

“Thanks for helping me score a unique place to propose. Well, we’ve gotta go down the hill and tell a couple of folks about this.”

“Of course. Off to see your folks now?”

“Yep. Gotta set Mom to cryin’.”

The newly-engaged couple held hands while they descended the stairs together; people taking in the views from the public observation platform gave them curious looks as they came down from the restricted upper platform. Keiko and Jeff saw none of those looks; they were too busy grinning at each other.

“I am so happy, Jeffrey,” Keiko said while they pulled out of the observation tower’s lot.

“As am I, Keiko. I love you.”

“And I you, Jeffrey. I cannot wait to call my parents.”

“They kind of already know. I spoke with your father and got his blessing while they were in town for your graduation two weeks ago.”

“I should have known you would; you would have done so regardless of who you wished to marry. Thank you for speaking with him.”

“Keiko, before we get to Mom and Dad’s there is something we have to discuss.”

“Yes, Jeffrey?” she asked, sounding less happy than before.

“Nothing bad, don’t worry. You know that law suit I had pending?” She nodded. “The week before your graduation, I received an offer to settle out of court. I accepted that offer and the check arrived this week.”

“I am glad you no longer have to worry about the suit. May I ask if the offer was sizable?”

“Of course, Keiko. We are going to be husband and wife; there will be no secrets between us in our household. Well, except for presents and things like that. The reason I brought it up was that I want us to buy a house together, one that will be convenient to any job you get. And, yes, it was sizable.”

“The public school year has not yet ended, but I have a job offer I wish to accept.”

“It’s your career, Keiko. Whatever commute I need to make, I’ll make; driving is a fair portion of my job, you know?”

“As you have said, Jeffrey, we are to be partners. The job would be in Shirley, at Devens Regional High School, which is next to the military installation there.”

“If you want the job, take it. There’s some nice land out there. We can afford just about any house we like out there, or we can build something. We’ll start looking around right away.”

“Jeffrey, you still have not told me how ‘sizable’ the agreement was.”

“Four million dollars, Keiko. After paying my lawyer I’ll net three million.”

“‘Net?’ What about taxes?” she gaped.

“Paid, by the company we sued, along with the court costs. We’ll own a home we can fix to suit us and raise our family in.”