Stress Over Strain (607 hits)
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Submitted by realpolitik (View user info) at 2009-07-14 00:15:45 EDT
Stress over Strain
Dr. Laurel Kytan was thoroughly enervated. Every since arriving in this plague ridden city she had been working herself near to the point of physical exhaustion. As a forensic pathologist she was used to this. Medical school had taught her to cope with exceptionally lengthy hours, and forensic pathology had accustomed her to never ending procession of corpses. The Navy, well, the Navy had made her tough. However, none of institutions to which she had belonged bequeathed her the most valuable skill in her repertoire - common sense. Though it seemed trivial, redundant even, Laurel had learned long ago to pace herself and most importantly to know her own limits. There was certainly a time and a place to test, and push, her intellect and skills, yet not when the future was uncertain. People who work in high tension situations tend to learn these maxims well, and learn them quickly. If they don't, something catastrophic normally happens.
She also recognized that extraordinary situations necessitate her adapting, bending, her rules. And there was no situation more exceptional than the one she was in. Death rates in Phoenix were climbing rapidly, with no slowdown in sight. The bodies were piling up, her shifts seemed longer each day, and she knew that they were quickly exhausting essential supplies. The politicians still were debating where to bury all the dead. Just dig a pit, throw 'em in, and toss in a GPS locator and when this whole thing is done we can sort it out, Laurel thought.
To her, that problem seemed especially real; she knew firsthand the rate of death. She was there each day to see the mortality rates ebb and flow like a tide gradually coming in. Now, just as every other day, she was occupying herself by recording times of death. Under normal conditions, the physician present during the last hours was tasked with macabre clerical chore. Every so often, in the event of a murder or other type of death which required the service of a forensic pathologist, a Medical Examiner would be forced to decry a time of demise from the corpses' physiological clues. Laurel was adjusted to this duty, though recently she had been doing it more than she expected. Initially, at the incipience of the epidemic, she had not noticed that it was her initials, the signature of a medical examiner, that were coming to occupy the important box which signified that someone of medical caliber had verified how and when a person passed. Driving through the city as the sun set, sheltered in her car from the heat that clung to the city until night brought cool relief, she noticed something: people were dying at home. No physician in their home to tell how and when they died, so the I get the honor . . . She was the first doctor to see them.
Regardless of how many times she looked at her watch and scribbled down the numbers in the column labeled TOD, the time was becoming less real and more abstract, even irrelevant. It was becoming an empty signifier and she no longer felt its value. She undid her tightly wrapped bun and let her flaxen hair fall shower her borrowed blue scrubs as it fell to just below her scapulas. She closed her eyes as she ran her hands through it, trying to steal but a moment of relaxation from world otherwise consumed with the war between microbe and man.
She glanced at her watch again, Screw it, she thought as she failed to comprehend what her analogue readout meant. I need to get some air. The stale air of the morgue was almost as oppressive as the midday heat. Why the hell would anyone in their right mind live here?! She was unprepared for the world of extremes that Phoenix presented, unaccustomed to the habits that made life in the desert bearable and even enjoyable. But like all creatures, her environment was forcing her to adapt. In her brief and dizzying amount of time in the desiccating city, she had discovered a few tactics to battle the heat. Bradford was native of this parched metropolis and he, in his typical poetic way of rambling and skirting around a point, had shared a few tips for desert survival. Like all who live in Phoenix during the summer, she was beginning to exhibit thermotaxis. She did her best to minimize the amount of time she was exposed to the oppressive heat: scuttling from an air-conditioned car to a climate controlled building like an insect terrified of the light. She also had recently discovered the cool and dry reprieve from the heat that was offered by nighttime in the desert.
Soon she was making a regular habit of venturing forth from the frigid 60*F hospital into the demure nocturne. She decided that the dead could wait, and resolved to once again be hugged by the air which had been warmed by the cruel sun and cooled to the appropriate temperature now. She was excited to trade the cold morgue for the refreshing coolness of her 0200 hours stroll. The only time this city is nice . . . it is always freezing in the buildings and boiling outside . . . only at night is it beautiful. Across the parking lot she expected to see the tips of the cigarettes glint in the hazy sodium street light illuminated night. Why should the smokers get to have all the fun? Laurel asked herself playfully in anticipation of her ritual retreat into the night vespers. As she exited the small auxiliary door closest to the morgue, searing whiteness shot like quicksilver up her optic nerve. Instinctively, her arm flew up to form a shield over her face, behind which here eyes blinked incessantly. It wasn't 2 A.M., it was 12:00 P.M. Noon. How she hated it. She subconsciously registered, and subsequently ignored, the heat that accompanied the whiteness.
Next came the sirens. She scarcely had a chance to register the extremes that the nerves in her eyes and skin recorded than her ears were assaulted with the dissonant and cacophonic song of an approaching ambulance. She smirked. Not mine. Paramedics usually reserved their lights and sirens for times when they were transporting alive cargo. As a medical examiner alive passengers were not her area of expertise. Still, these were unusual times, she reflected silently to herself. It is sad really, EMTs are starting to become over glorified hearse drivers. Half of what they pick up is dead on arrival, hell most of them are dead when they arrive at the scene. People aren't suppose to call 911 to have their dead collected, they are supposed to call another number and be put on a waiting list! They are supposed to wait for an unmarked fridge truck to stop by the house and collect the remains for transport. Pain in my ass . . . who do you think has to lug the bodies to the freezer truck for storage before autopsy after the EMTs bring them in?! My orderlies, that's who!
Laurel sighed. I guess I can understand, what with the wait for the freezer truck gradually getting longer, and many find it...unnerving. . . at best to watch their love one decay in front of their eyes on the kitchen floor. So they get ambulance to come down, lying to the overworked operators at emergency dispatch. Others just don't know about freezer truck pickup and in desperation dial 911. On days with few calls for legitimate transports (i.e. alive patients) the emergency operators often find it easier to dispatch an ambulance then argue or explain the situation to the person on the other end of the phone. I don't blame them, its hard explaining to a person that their father's body won't be picked up until tomorrow. And once the ambulance arrives they can't just leave a dead body sitting in the living room . . . Of course, this is all fine on light days, but the hours on the road and the psychological strain takes its toll on the paramedics - makes the hard days so much longer.
Damn. I guess it is one of mine, thought Laurel as she saw the body bag on top of the gurney.
"You look like you could use a good night's sleep," Dr. Kytan said to the bedraggled man pushing the stretcher holding a heavy looking black bag.
She caught him off guard, an attractive women standing outside in the 110*F heat, up to now he had just assumed that she was one of the crazies that seem to be perpetually hanging around hospitals. In his fatigued state he hadn't even noticed her scrubs.
He nodded pathetically, wondering what took a nurse outside in the heat of the day.
"Unfortunately all I can offer is some coffee, cafeteria is down the hall and to the right, I'll handle the in-processing," said Laurel as she wheeled the stretcher down the long corridor towards the morgue which at one time had been used for the cheery business of endoscopies.
He was reticent at first about surrendering his charge to what he believed was an off duty nurse. "Thanks, I would love some . . . I gotta find the M.E. first and get him to sign for the body. . ."
It was a good natured mistake, but Laura hated it. "I am the M.E.," said Laurel dryly as she pursed her lips in displeasure.
The paramedic looked crestfallen. "I am so sorry . . . I didn't know . . . I just . . ."
"It's okay," she cut him off, she had heard this all before, "go get your coffee."
"Thanks," the paramedic replied sheepishly.
"No problem," she half muttered as she began to wheel the gurney inside.
Woah!" she couldn't help but mutter when she opened the bag. That's interesting. At Port Mortuary, Dover Air Force Base, she would not have been the person who cracked the bag. In Dover, there would be a good hour of processing before Laurel would even begin her examination. Here she circumstance forced things to be slightly different. It was bad enough that her biological clock was roughly 14 hours behind the real time, now she would have to do, by herself, all the chores required to prepare the body for its full autopsy.
She had decided long ago to skip all the forensic foreplay and move right into examinations. During epidemics, there was little need for photography, DNA identification, or fingerprinting that marked the start of the pathology process, allowing her to process a much large volume of remains. Most were the same, "Cause of death Influenza A/Phoenix/21-3713/2011 (H1N1)" - if the corpse showed no other obvious cause of death it was almost certainly the flu. She still did the examination, but her suspicions as to the culpability of the Orthomyxoviridae had so far always been confirmed.
"You didn't die of the flu." Dr. Laurel Kytan murmured as she gazed down at the landscape of bullet entry wounds of indeterminate caliber still oozing blood and other fluids. Between the bullet holes she could make out the remnants of a tattoo mural that had once covered this young man's chest.
That looks like gang ink. She snapped some pictures with a nearby digital camera and resolved to find one of the shadier tattoo artists in the Phoenix Metropolitan area to confirm her suspicions.
Dr. Kytan peered quizzically at his face, grateful it was free of bullet holes. She saw on his cheeks the telltale mountains and deep gorges Acne vulgaris left in its wake. Hypertrophic and atrophic scarring . . . this kid had bad zits. Laurel flipped though her autopsy notes to "Diagram E - Head, External." In the margin to the left of the picture of the head of a man bearing a completely vacant expression she messily noted, "Polonged Acne has resulted in long depressed fibrotic scarring evident parallel to both right and left zygomaticus major muscles." Poor bastard, the canyons of depressed fibrotic scarring was the most visible of all acne scars, tissue loss is never pretty. "Atrophic scarring secondary to Acne vulgaris also evident caudally to the procerus muscle." Laurel wrote to indicated heavy collagen filled mountains on his forehead. They looked like pustules ready to burst, and the young man probably thought they would eventually; they were composed of tissue, and any dermatologist could have told him that those garish outcroppings would be a permanent fixture above his brow.
Laurel's next noticed that the beginning of a mustache that had caught some of the blood spatter when he was shot. Not many forensic pathologists could deduce from a few bumps and chin hairs the age of a victim, but Dr. Laurel Kytan was that good. "Latino Male, age 17-25." Laurel confidently scribbled in the box marked "age" on the first page of the Autopsy report.
She pushed the corpse off the gurney, rolling it onto a makeshift exam table consisting of two mobile hospital beds lashed together. The man's back was a bloody pulp. No exit wounds, the whole back is one big dripping mess! She decided to temporarily postpone the arduous task of filling out the "Office of the Armed Forces Medical Examiner Firearm Wound Chart." This cumbersome ordeal entailed: (1) measuring and recording for each round the entrance and exit location, (2) the size of the hole it made when it entered and exited, (3) the distance of the exit and entry wound to from certain physiological landmarks, (4) where firearm residue was deposited, (5) the direction of the missile through the body, and (6) where exactly the missile was recovered. Crap, small caliber . . . only thing that does this kind of damage is hollow point. Her theory of gang involvement seemed all the more plausible. We are getting more of these each day. . .
In her preoccupation with the examination, she didn't notice how quickly the EMT, now clutching a small Styrofoam cup, returned.
"Busy day?"
"Yea, lot of dead-on-scenes."
Laurel scowled. "We have to fix that, we can't have emergency dispatch using you guys to collect . . ."
The paramedic cut her off "yea, it is a problem, but mostly it isn't even the operators' faults, we are so backed up that the person will be alive when they called but we can't get to them for a few hours. When we show up they will be already dead and we can't just leave them there! So we bring 'em to you and as a result we get more and more behind schedule."
"Vicious cycle. The longer the response time the more people die, you transport them, which causes you to get even further behind. We have to find a way for operators to gauge the urgency and dispatch you all to the patients most likely to survive." Classic triage, Bradford would be proud.
"Yea, but the operators can't just say 'how sick does your family member look - do they need help right now, or can they wait a few hours?"
"True"
"I just count myself lucky when a patient is alive when they get in the ambulance . . ." his voice trailed off as the EMT was struck with a moment of composure as the grim reality of the situation overcame his ordinary optimism. His eyes widened as he slowly, and somberly, continued ". . . though we are starting to run short of supplies and if we run out I can't guarantee they will be alive when they walk in the front door."
Laurel empathized, though she was powerless to render aid. As a medical examiner, this was not a new feeling, she was intimately familiar with it - for whenever she gazed upon whatever remained of what used to be a living, breathing, creature like herself, she felt a twinge of somber helplessness. Yet it was different now. She reached into her pocket for her cell phone almost instinctively, intent on dialing her mother's number. She would always vent to her mother whenever she felt emotional. Women are none to common in the world of forensic medicine, and even fewer in the small circle of military pathology; therefore, she prided herself in her unwaveringly stoic composure in front of her colleagues and superiors. The people she worked with thought her a robot, unfeeling and mechanical, yet she was far from it. What she did have was an extraordinarily effective coping mechanism: she would call her mother and talk about what she was feeling, venting the steam of frustration and anguish when it built up inside her. Her friends also thought she was a caffeine addict. They did not know her coffee runs were just excuses which bought her time to call mom. She guarded this secret carefully. She could not appear weak.
Now she needed someone to talk to -- she couldn't remember the last time she spoke with her mother, or anyone really. Here, during the epidemic, she felt guilty using a cell phone, most of the signal was now dedicated to relaying 911 calls or coordinating the response to the epidemic. Even if she could get through to her parents it would be no use, there was never enough privacy to talk freely.
She was at her breaking point, and in her hour of distress an odd equation ran through her head. She never really liked physics; in fact, she found all the sciences only barely tolerable. Her's was not a craving for knowledge, but rather a ruthless pursuit of a far off goal. She envied those who had enjoyed the sciences that all pre-meds were forced to learn as undergraduates. Unlike her knowledge-loving counterparts, what sustained her through the many years of schooling and subsequent training was a fierce and unyielding ambition to achieve her dream of becoming a forensic pathologist. She never fell in love with the sciences, but she prevailed through unfiltered determination of will. Which is why she was surprised when her subconscious insisted on presenting her with what she deduced to be an equation from the long forgotten arcane of physics.
G equals tau over gamma.
Simple, yet it says nothing.
G equals tau over gamma! Her brain seemed to be chiding her for quick dismissal of this Greco-scientific terminology as total irrelevancies.
G equals tau over gamma! G equals tau over gamma! G equals tau over gamma!
Relenting, turned briskly away from the corpse on the gurney before her and strode down the hallway, befuddled, yet still chatting, EMT in tow behind her.
He amicably prattled on until they came to the end of the hallway where Laurel's Navy-issued laptop perched precariously on the top of a small oven which at one time had been used for heating blankets.
"uh, I am going to run," the paramedic said awkwardly, "it was nice talking to you, thanks for the coffee."
"Oh, I am sorry," Laurel didn't even look up from her computer as she inserted her CAC and entered her PIN, "I am not ignoring you. . .I am hearing every word you say, please continue, I just need to quickly look something up."
"Oh, uh, alright," stammered the ambulance driver, trying to decide if she was sincerely interested or she was just being polite while secretly hoping he would leave, "so, uh, as I was saying, most times operators don't even know where to route us through, what with all the road closures and congestion . . ."
Laurel didn't hear a word he said as she opened an internet browser and typed in the cryptic equation.
Shear modulus. Damn. I knew it. She read the definition silently to herself, "shear deformation is the result of a pair of equal and opposite forces that act parallel to two opposite surfaces. E.g. a person pushing a book across the desk by applying force horizontally on its cover. . ."
She sighed as she quickly withdrew her CAC and logged off. Exactly how I feel right now. Having two parallel forces applied to me . . . and everything has a breaking point, I can feel mine. She shuddered.
"You alright Dr. Kytan?" The paramedic earnestly inquired.
"Fine." I just realized I am describing myself using terminology I learned over a decade ago and hated then - this is the kind of thing Bradford does. "just tired, that's all, caffeine is starting to make me jittery" and I have to find a way to unwind, to alleviate some of the forces on me, or I will probably shear in half. God I wish there were someone to talk to. "I am good, what about you?"
"I am fine, just a little tired, coffee helped though," the paramedic was practically beaming.
"Good." God I just want to be alone! I just want to sit down and, and, and . . . Laurel inhaled deeply, using all the tricks she had taught herself over the years to keep composed.
And I can't do anything with this smiling idiot in my face! Laurel felt crippled by the need to be strong. Just leave me alone! Her pale complexion was now flush and she struggled mightily to hold back tears.
"I'm sorry," said Laurel stately, "I need to get back to my patients."
As the paramedic left he wondered why every doctor couldn't be as nice as the beautiful navy pathologist.
User Reviews
Submitted by kaos-king (user info) at 2009-07-19 03:19:37 EDT (#)
Ranking: 2
Submitted by Berty (user info) at 2009-07-14 04:57:09 EDT (#)
Ranking: 2
Submitted by cheerios (user info) at 2009-07-14 02:21:22 EDT (#)
Ranking: 2
Submitted by sandmantate (user info) at 2009-07-14 01:08:34 EDT (#)
Ranking: 2
This was really long. I didn't read it. This is a +2 for effort and obvious formatting.
Submitted by viciousness63 (user info) at 2009-07-17 16:48:31 EDT (#)
Ranking: 2
I could swear to god I know you in real life.
Submitted by inion_de_trua (user info) at 2009-07-14 16:28:56 EDT (#)
Ranking: 2
No Comment
Submitted by RoadSong (user info) at 2009-07-14 15:50:22 EDT (#)
Ranking: 2
"She was unprepared for the world of extremes that Phoenix presented, unaccustomed to the habits that made life in the desert bearable and even enjoyable. But like all creatures, her environment was forcing her to adapt. In her brief and dizzying amount of time in the desiccating city, she had discovered a few tactics to battle the heat. Bradford was native of this parched metropolis and he, in his typical poetic way of rambling and skirting around a point, had shared a few tips for desert survival. Like all who live in Phoenix during the summer, she was beginning to exhibit thermotaxis. She did her best to minimize the amount of time she was exposed to the oppressive heat: scuttling from an air-conditioned car to a climate controlled building like an insect terrified of the light. She also had recently discovered the cool and dry reprieve from the heat that was offered by nighttime in the desert."
Fine words for me to see since I am on my way to Phoenix!
Submitted by BLITZKREIG_BOB (user info) at 2009-07-14 13:22:10 EDT (#)
Ranking: 2
I was expecting a long dissertation on Young's Modulus.
Submitted by skrapmetal (user info) at 2009-07-14 08:17:56 EDT (#)
Ranking: 2
I read it. It is good.
Submitted by monkeyswithguns (user info) at 2009-07-14 07:43:15 EDT (#)
Ranking: 2
No Comment
Submitted by EmissionImpossible (user info) at 2009-07-14 05:16:32 EDT (#)
Ranking: 1
Submitted by Berty (user info) at 2009-07-14 09:57:09 BST (#)
Ranking: 2
Submitted by cheerios (user info) at 2009-07-14 02:21:22 EDT (#)
Ranking: 2
Submitted by sandmantate (user info) at 2009-07-14 01:08:34 EDT (#)
Ranking: 2
This was really long. I didn't read it. Im not interested. This is a +1 based on previous submissions and the fact I have a tiny penis.
Submitted by Berty (user info) at 2009-07-14 04:57:09 EDT (#)
Ranking: 2
Submitted by cheerios (user info) at 2009-07-14 02:21:22 EDT (#)
Ranking: 2
Submitted by sandmantate (user info) at 2009-07-14 01:08:34 EDT (#)
Ranking: 2
This was really long. I didn't read it. This is a +2 for effort and obvious formatting.
Submitted by cheerios (user info) at 2009-07-14 02:21:22 EDT (#)
Ranking: 2
Submitted by sandmantate (user info) at 2009-07-14 01:08:34 EDT (#)
Ranking: 2
This was really long. I didn't read it. This is a +2 for effort and obvious formatting.
Submitted by sandmantate (user info) at 2009-07-14 01:08:34 EDT (#)
Ranking: 2
This was really long. I didn't read it. This is a +2 for effort and obvious formatting.
Submitted by X54 (user info) at 2009-07-14 00:59:03 EDT (#)
Ranking: 2
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