With a flourish, Tristan pulls some vials out of his bag.
“Fuck yeah. I’ve got ceftriaxone. The not-fucking-around antibiotic. We’ll clear this right up.”
He throws the vials at me one by one, and I scrabble to catch them while he reaches in and pulls out some other things, throwing me more vials and syringes, seemingly at random.
“Here, reconstitute these while I check his blood sugar.”
I’m distracted for a minute, the vials clutched in my hands, because Tristan has so much shit. He puts a pulse ox on one of Tadhg’s fingers to check his blood oxygen. Then he throws a blood pressure cuff down next to him. Bags of saline and supplies for an IV go next to that.
He pulls up Tadhg’s closest hand, swiping a fingertip with a sterile wipe, poking it with a lancet, swiping one more time with the wipe and then squeezing until blood beads up. He taps the strip of a glucometer to it to check his glucose, and then taps it again with something else that looks almost identical.
My thoughts do a record scratch. Having a glucometer is one thing, because diabetic people all need one in their home, so you can buy them at a pharmacy. But beyond checking a blood sugar, we’re getting into the kind of stuff normal people don’t get to just own.
“Tristan, are you stealing equipment from your job? Where the fuck did you get a lactatometer?”
He gives me a flat look and shrugs. “Amazon.”
What the fuck?
Both machines beep, so I’m distracted from more questions by looking at him for answers. The amount of lactate in Tadhg’s blood is the quickest way to tell how sick he is; the higher it is, the longer his body has been degrading in its ability to cope with the trauma.
“Well, what are his values?”
“Fucked.” Thanks for not mincing words, I guess. But the fact that he’s not giving me actual numbers is freaking me out. “Here, dilute the cef in this.”
He throws a bag of D5W at me, which tells me the infection in Tadhg’s body is so bad it’s causing his blood sugar to crash, and we need to increase it. None of this is comforting me.
My hands shake a little as I reconstitute the powder in the vials with saline and then start setting up the infusion. Tristan clocks it, because he notices everything. That’s never happened to me at work before. I’m giving myself a pass because, technically, Tadhg is still my brother—kind of—and I don’t want him to die. Also, this has been a weird fucking day.
Without giving me the chance to protest, Tristan places the IV in Tadhg himself. When Tadhg barely stirs for the process, Tristan grimaces and places a second IV in the other arm.
“What’s the dose?” I ask him, assuming he does this shit all the time on the ambulance.
“I don’t know. Look it up.”
“What? You don’t know? I thought you knew what you were doing?”
He rolls his eyes at me. “Yeah, because we do so many hours-long antibiotic infusions on the ride to the hospital. You double-check shitty intern doctor math all day long. This is just leaving out the intermediary step. It’ll be fine.”
“Jesus fucking Christ,” I mutter under my breath, walking over to my wall of textbooks to try to find something helpful. While I’m flipping through a pharmacology book, something else occurs to me.
“Where did the drugs come from? Medical supplies are one thing, but I know you’re not getting IV antibiotics off Amazon. Please tell me you’re not skimming from the ER.”
“Hell no, I like my job.”
Tristan glances up briefly from where he’s pulled over my TV stand and jury-rigging it to serve as an IV pole, and then his eyes return to his work.
“When I got caught up with these fuckers”—the unmistakable tension in the room reminds me that they’re listening to everything we say—“part of the deal was sourcing supplies for my illegal assistance. Some stuff I can buy, some stuff is expired supplies that I take from work because no one cares about it, but for the meds, I made a contact at a vet’s office. I can’t get anything controlled, obviously, but shit with no street value like antibiotics and potassium, that’s all easy for her to pocket and sell to me under the table.”
I swear my mouth is hanging open, and my hands have frozen on a random page of the book.
“Excuse me? You’re putting animal drugs in my brother?”
Tristan laughs, still not interrupting his work as he turns to take a blood pressure.
“They’re all the same, dude. We’re all buying the same shit from the same pharmaceutical suppliers. Do you think big pharma is out there spending money on developing kitten-specific antibiotics? Hell no, they get our hand-me-downs and make it work. Unless it’s a food animal that our corporate overlords actually care about. It’s all the same stuff, but even more under-regulated than we are. Ergo, bootleg ceftriaxone. Oh, and I have pressers. You know, just in case he starts to circle the drain and we need to bring him back.”
The expression that crosses his normally impassive face makes me clench with fear, and I’m reminded again he never actually told me what the blood values were.
