"Jesus." I muttered, looking at him.
He looked worse than Nina had led me to believe. His skin was not merely pale but was gray and ashen. Sweat was glistening off of him, his shirt was damp with it. His mouth was open and he was breathing rapidly, seeming to struggle to get air in. His right arm was massaging his left shoulder.
"What are YOU doing here?" Mrs. Blackmore, who was sitting next to him, asked sharply.
I ignored her. "Mr. Blackmore." I told him, walking over. "You need to go to the hospital. Now."
He looked up at me. "Bill," He said, shaking his head. "I think you'd better leave. Sorry to have to postpone your little date." This last was said quite sarcastically.
I reached down and grabbed his wrist, feeling for a pulse.
"You will LEAVE this house immediately!" Mrs. Blackmore told me, ripping his hand away from mine.
"I know what I'm doing." I said forcefully, meeting her gaze. We stared for a second and she finally dropped her eyes.
I took his wrist back, finding his radial pulse. It was beating rapidly and irregularly, sometimes not pulsating for as long as six seconds. I noticed that when I could not feel the pulsations, Mr. Blackmore's breathing became more ragged at the same time. Though I did not have a cardiac monitor on me, I had a pretty good idea of why this was happening.
"Nina," I said. "Go call 911 and get an ambulance here."
"What?" Mr. Blackmore said. "I don't think…"
"Do it now." I told Nina calmly and with unmistakable command in my voice.
She gave a quick glance towards her father. "No Nina." He told her. "I'll be all right."
"Do it Nina." I said firmly. "Tell them he's having a heart attack."
Nina was convinced. She rushed to the phone. Mr. and Mrs. Blackmore were not. They called once after her but quickly realized it was futile. When she was gone they turned to me.
"How dare you come into this house and…" Mrs. Blackmore started.
"What do you think you're…" Mr. Blackmore started.
"Quiet, both of you!" I barked. It had the desired effect.
"Mr. Blackmore." I said, looking at him. "Are you having chest pain right now?"
"No." He told me. "Just some indigestion. She made some spicy food tonight and it didn't agree with me."
"Uh huh." I nodded. "Why are you rubbing your shoulder like that?"
"It's sore." He said. "What business is this…"
"Show me where your chest hurts." I told him. "Point with your finger."
Rolling his eyes upward he put a finger right in the middle of his chest. "Right here." He told me. "It's just indigestion."
"Indigestion doesn't hurt right there." I told him. "It hurts down here." I put my finger just under his rib cage. "And it doesn't radiate up to your left shoulder either. And it doesn't make you short of breath or sweaty. It doesn't make you throw up. And it most definitely doesn't make your pulse irregular. Have you ever had heart problems before?"
"No!" He said.
"You're having them now." I said. "You're having a heart attack Mr. Blackmore and a very dangerous one if I'm right about what I'm feeling in your pulse. You need to get to the hospital, now."
"What the hell do you know about it?" He asked angrily. "You're just a kid."
I smiled, gazing at him meaningfully. "We've had this conversation before." I said. "Do we need to rehash it? I think you're having a heart attack. Go to the hospital with the ambulance when it gets here. If I'm wrong, then you'll get to say I told you so."
Before he could answer Mary Blackmore spoke up. "Jack." She said softly. "Why don't you do what he says?"
I looked over at her in surprise. She was the last person in the world I expected to have as an ally in this thing. I saw raw, naked fear in her eyes. I think she knew that I was right and she was terrified that she was about to lose her husband. So terrified that she was even willing to listen to me.
"Listen to your wife Sir." I told him. "You want to see your grandkids someday don't you?"
"Okay." He nodded. "Once again young man, you've stated your case well."
"You can't die Mr. Blackmore," I told him. "Until you learn to get used to me dating your daughter. I won't allow it."
He actually chuckled at that.
From outside came the sound of approaching sirens.
Chapter 12
The paramedic and the EMT that showed up were both strangers to me. Probably they were people that had worked briefly in the field and then had gone onto other things; the fire department, the police department, nursing, medical school. They came in the door shortly after the fire engine crew had barged in. I was glad to see that the paramedic took Mr. Blackmore's condition as seriously as I did. I stood back and said nothing, feeling confidant he was in good hands.
While the paramedic went through the routine questioning, questions I was very familiar with, his partner hooked up the EKG machine. It was an older model of the device, a model I was unfamiliar with since it had been replaced long before my debut in the medical field, but the display was the same. I saw the rapid complexes of his normal heartbeat intermixed with frequent premature complexes; beats that were not perfusing much blood, beats that were the telltale sign of a very irritated heart. Worse still was the fact that sometimes Mr. Blackmore would have fifteen to twenty of these premature beats in a row. This was known as ventricular tachycardia, or V-tach, in medical circles and it was very dangerous. It was, in fact, only a step above complete cardiac shutdown.
The paramedic, a young, blonde man whose hair was probably a little longer than was allowed, saw the display and tightened up almost inperceptively. He glanced at his partner for a moment and a look was passed between them; a look that the ordinary citizen would not have even noticed but which I was well versed in. It was a look that said "Holy Shit!".
"Set me up an IV." The paramedic told his partner calmly, as if this was a perfectly normal request. It wasn't. Usually IV's were not started on scene.
"Right." His partner nodded, going for their medical box.
"Put him on high flow oxygen." The paramedic told one of the firemen.
He went mechanically about the task of installing the IV line into Mr. Blackmore, speaking soothing words to him the whole time, telling him what he was going to be doing. On the other arm a fireman was taking his blood pressure. He shouted out the reading when he had it.
"Ninety-four over forty." He said.
The paramedic digested this, chewing on his lip thoughtfully for a second. That was not the greatest blood pressure in the world in relation to a cardiac event. Finally he plugged in the IV and taped it down.
He injected some lidocaine into the IV port and watched the display on the EKG. The lidocaine was supposed to numb the heart a little, making it less irritable and less likely to throw premature beats, go into V-tach, or, worst of all, go into fibrillation. The runs of V-tach slowed a little, becoming less frequent and shorter in duration when they did come. Not the best thing in the world but better. Hopefully it would be enough to deliver him to the hospital alive.
"Let's get him out of here." The paramedic said.
Mr. Blackmore was loaded up onto their gurney and rushed out of the house to the waiting ambulance. Mrs. Blackmore was placed in the passenger seat by one of the firemen. Another fireman climbed in the back with the paramedic.
Again this probably seemed routine to the average person and again it wasn't. A paramedic only took a fireman in with him when he thought that he might need an extra hand on the way to the hospital. In other words, when he thought there was a good possibility that CPR was going to need to be performed at some point. Runs of V-tach had a nasty tendency to degenerate into a full-blown cardiac arrest.