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Venom
Venom
Venom
Ebook287 pages4 hours

Venom

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Dr. Fiona Tyler is an Emergency Department physician with an unusual problem. A technoshaman who thinks Fiona is his soul-bride is proving his love for her by dropping dead people in her Redwood County hospital. Redwood County is a beautiful place with a high weird to rational ratio but this is beyond quirky.
Fiona’s first challenge is a child who despite her best efforts dies as the result of an apparent attack with VX, a lethal agent employed by bioterrorists.
The situation is immediately confused by an influx of poorly attentive mushroom ingesting refugees from the local Fungus Fair. People who once believed that mushrooms were delicious and nutritious and that mushroom hunting was healthy exercise are now harboring grave doubts.
Fiona’s goal is to heal the sick and raise the dead. She has a strong need to understand what’s happening, take control, adapt to and overcome challenges. Surprises and complications from a mysterious admirer that affect her professional competency are not the way to her heart.
The west coast has four seasons: flood, earthquake, drought, and fire. This is the rainy season, complete with floods, mudslides, and power outages. During the next power outage, someone clonks Fiona’s medical student on the head and drops in another celestial transfer.
A live victim is seeing yellow and smelling dry desert sand, sage. She thinks she’s a snake. Her respirations are shallow, heart rate fast, blood pressure climbing dangerously, skin pink and sweaty. Whatever she was exposed to contaminates another doctor, who gets positively silly. He sees canary yellow singing stars.
In a confrontation, the technoshaman accidentally overdoses himself. Fiona wonders what glorious visions he is experiencing. When he wakes up, will they all be gone? Will he still see her as his soul-bride? Fiona kisses him lightly on the forehead. Poor wizard.

LanguageEnglish
PublisherTwist Ranger
Release dateMar 30, 2016
ISBN9781311380067
Venom
Author

Twist Ranger

Twist Ranger is like a lively and elegant wine: bright, rich, rounded with an energetic red fruit top note and purple forest ending.

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    Book preview

    Venom - Twist Ranger

    Chapter One

    Dr. Fiona Tyler looked at Billy Clark with dismay. The boy was wet with snot and puke, piss and poop. He looked like he’d been caught under a particularly incontinent cow. Cows must have come into Fiona’s mind because of the tiny cowboy boots he was still wearing. His blue pants were down around his ankles and his striped t-shirt had been cut in two down the middle so it hung precariously from his thin bony shoulders. The child was about three years old. He was all alone on the gurney in room Four, sobbing hopelessly. Pitiful little guy. Not the kind of baby anyone but a devoted mom tied by hormones and genetics would want to clutch to their bosom and comfort. Fiona didn’t have the luxury of motherhood but she did have a responsibility and a duty. She just wondered why her responsibilities and duties were never to clean, healthy, cute babies with dry diapers and blissful smiles.

    Billy’s sobs rose to a sudden shriek as Fiona entered the room in Redwood County Hospital’s only powered air purifying respirator. In addition to the PAPR she wore all the rest of the personal protective equipment deemed necessary by the bioterrorism boffins. Of course the rule was you had two people in, two out, and two in reserve, but Redwood County was so small they only had one PAPR.

    A disembodied, double-gloved hand pulled the door open wide for her. The olive drab butyl rubber hood of the PAPR suit impeded her peripheral vision, and the hood of the yellow tyvek suit under the PAPR was slipping down over her forehead. She couldn’t take the chance of reaching a hand up under the rubber to adjust the tyvek. She couldn’t hear anything short of a jet taking off over the roar of the belt-mounted blower. The heavy outer gloves were duct-taped to her sleeves and the tyvek booties were duct-taped to her drooping pants. She could barely move.

    In disaster life support training in Augusta, Georgia on a 100 degree day it had taken fifteen minutes and the fear of imminent collapse from heat exhaustion to move her forward against the claustrophobia of the suit. There was a kid dying here; she shuffled towards the gurney. Given the amount of crud on the kid, maybe the personal protective equipment wasn’t a bad idea. At least she couldn’t smell anything past the filters in the respirator.

    Billy’s open mouth and heaving chest told her he was breathing fast and irregularly. His skin was profusely sweaty and mottled, a sign that his circulation was badly impaired. Suddenly his eyes rolled, he fell backwards and began to seize. His body flailed convulsively, arms and legs battered against the side rails of the gurney, head banged against the mattress.

    Fiona grabbed for a dose of Versed from the crash cart. It was nearly impossible to pop the lids on the preloaded anti-convulsant and screw the syringe into the barrel with the neoprene gloves taped over latex gloves, she had no manual dexterity whatsoever. There was no time to establish an intravenous line even if she could see well enough to find a vein or feel anything with the thick gloves. She took the child’s scrawny arm in a bruising grip while she injected the drug intramuscularly and hoped for the best.

    The boy had been rinsed off hastily at the scene and given atropine in the ambulance. Fiona gave another 10 milligrams of atropine intramuscularly in his thigh, a huge dose to load what looked like a 20 kilogram child but his skin was still beaded with sweat and frothy saliva ran profusely from his mouth. She turned him on his side in rescue position. The anti-convulsant took hold and the body became flaccid. Drool dripped in a steady stream onto the mattress and over the side of the gurney onto the floor, which was already puddled by various body secretions and excretions.

    What was doing all this? The root cause had to be a cholinergic agent, but what? The child could have been playing in pesticide-sprayed fields. Gotten into malathion in a garden store? Fiona wanted to do a better wet decontamination to remove any physical contaminant remaining on the skin but where would the water go? This wasn’t like Georgia where the military dug a pit in the ground and had enlisted men bag up the sand afterwards. She took a big surgical sponge from the sink and started rubbing his head with plain water, letting the splatter go on the floor with everything else. The water splashed her legs and darkened the yellow tyvek fabric. Would it soak through her protective coverall? She had to get the contamination off the kid. She wrestled with the tiny cowboy boots and stripped the boy naked so she could wash from the top down. She was monitoring his breathing, feeling his heart flutter as fast as a bird’s under her hand as she sponged his chest.

    The frail little boy shuddered in one more convulsive movement and went still. Too still. The frantic beat of his heart hiccupped and faded away. The thin chest quit moving. Fiona quickly flipped the patient on his back and shoved a short wood board between the limp body and the slippery mattress.

    Arrest! Dr. Fiona Tyler called out. She couldn’t judge the volume of the sound she was producing past the noise of the respirator blower but when she looked up she saw the Code Team watching helplessly through the square glass panel in the door to room Four. The team knew kids in respiratory trouble led to kids in cardiac arrest so they were standing by, but they couldn’t come in without Level A suits of their own. This pediatric cardiac and respiratory arrest was all her own to manage.

    Fiona gave a quick precordial thump, which she knew good and well was nothing more than a superstitious behavior. She didn’t even have a cardiac monitor on the kid; the ambulance crew said they had tried but couldn’t get the leads to stick on his slick slimy skin. She dropped an oral airway in Billy’s mouth, fitted a pediatric ambu bag to it and started to force air into the lungs with one hand while she held the mask in place with the other. She couldn’t use a stethoscope while she was in the protective suit but she could see the patient’s chest rise with the forced inhalation and passively fall with the release. OK, so the airway was at least patent. She dropped the ambu bag to do chest compressions. It was incredibly awkward to do compressions, stop compressions to check for a pulse, suction fluids, resume CPR. One-armed paper-hanger syndrome.

    A litany of advanced life support interventions ran through her brain. IV access, epinephrine, more atropine, 2-PAM chloride, an endotracheal tube, none of which she could do under the circumstances. This was the first time she had ever done what the military called austere care. Battlefield medicine. She didn’t like it. It wasn’t working. Medicine that didn’t work was insufficiently distinguishable from torture.

    She gave the resuscitation five minutes by the wall clock. Shoot, made it ten. There was no response to anything she tried. Her mantra of heal the sick, raise the dead wasn’t working. She took a precious 15 seconds to swipe at the chest with soapy water and harshly rub tender child skin with a 4 x 4 gauze to get the EKG patches to stick. Flat line. She knew that. She wished she knew what caused it. She hoped the whole neighborhood of kids wasn’t out there getting into whatever this one had got into.

    The Code Team, nurses, technicians, and an anesthesiologist, were all still glued to the window. The team couldn’t see her face through the hood; she didn’t know herself if it was wet with tears or sweat. Her armpits were wet. Her groin was wet. She glanced at the extra preloaded syringes of atropine on the crash cart. She hoped she hadn’t been contaminated.

    Fiona backed away from the bedside. She banged the door open with her hip and checked; the staff had covered the hall floor with surgical drapes. Gloved and gowned handlers reached out to guide her all the way into the hallway and keep her on the paper. They helped pull the butyl rubber hood over her head, a huge relief. Someone reached around her waist to the back and snapped the switch off on the blower. Sound returned to her universe.

    There was a firefighter in turnouts and full self-contained breathing apparatus taking up the space of three staffers in the crowded hallway.

    Next time we need a harness on her so we can pull her out when she collapses, the firefighter said.

    Next time?

    When she collapses?

    Chapter Two

    Danny, the Emergency Department technician, was headed straight into room Four and Dr. Fiona Tyler put out a hand to stop him.

    Wait, she said. Her voice was too loud, still trying to shout over the blower, or just ragged from emotion, pick one. Column A, she thought. At least the poor kid was out of it, his suffering ended. So not B. We are professional, we don’t indulge our emotions at work. Dead kids pulled everyone’s heart strings, though. She should make sure her staff debriefed, got a dose of critical incident stress management.

    A blue neoprene outer glove dangled from her wrist. The duct tape that had been holding it took on a life of its own and grabbed the yellow tyvek suit fabric. She flapped the glove irritably at one of the nurses who was trying to get the possibly contaminated PAPR off her. The problem was to get her undressed without spreading any potential agent into the Emergency Department, onto anyone else, or of course onto her own precious body. That was the point of the whole exercise in personal protective equipment. Which seemed to have been successful so far, if she didn’t screw it up and touch the outsides of the gear.

    She let the nurse unzip the tyvek and peel the suit down, held her feet up one at a time for the booties to be cut away from the pants legs with bandage shears. She stepped into a clean paper mat. The gowned and gloved nurse bundled the whole mess into a red isolation bag and tied it off.

    Fiona shook out her long blonde hair, which had been plastered to her head by the hood, and used a forefinger-thumb pinch to get some space between her lanky body and the sweaty light green scrubs she was wearing. She blew a quick breath down her shirt front. Tyvek doesn’t breathe. That’s the point.

    Danny paused with the door open a few inches.

    Leave it alone, Fiona said. It’s a coroner’s case. Don’t move him or clean up yet.

    Don’t you want me to clean the floor? Danny asked. He waved a wet mop at her. Soap and water, ten percent bleach.

    She glanced through the gap. Dirty. No question it was a dirty floor. Potentially lethal, if she’d been successful in getting the contamination off the kid and onto the deck, and if whatever killed the kid retained its magic when displaced.

    No. The medical examiner can wade, she said. Let the Sheriff’s Office figure out how to access the scene. It was an unexplained death, which made it a coroner’s case. There was something tickling at the back of her mind, or maybe that was the hairs on the back of her neck rising. Was it a crime scene? She didn’t know.

    Let’s not deal with the insoluble. What do we have on our plate we can handle?

    Where are the parents? she asked the nurses.

    The mom’s in the quiet room, Patricia said. They’re looking for the dad. The mom has her sister with her, and a younger baby. They’re very frightened.

    The younger baby okay? Fiona asked. Mom okay? What about the ambulance crew?

    Fine. The ambulance is out of service for decontamination. Everybody was smeared with stuff and the fire guys got them all cleaned up. The firefighters said there’s a Hazardous Materials team coming to check out the potential contaminants. Patricia said.

    I need to talk to the parents. What else is happening in the emergency department? Is Jon here? The call had gone out to retrieve another ED physician when she committed to treating the child.

    Jon’s on his way.

    What’s that?

    An ambulance crew came blasting in the door with a patient who was bucking against the straps that held him only partly to the backboard. The patient howled and fought against the restraints, snapped his teeth at the hand of the paramedic, and arched his body like a bow. Danny moved to help. The technician put a big gloved hand on the patient’s chest and pressed down gently. When nothing happened he shrugged and leaned. The patient collapsed back onto the gurney with a whoof of expressed air. The paramedic gave Danny a thumbs up sign.

    Bump on the head, I haven’t gotten a good look at it yet, he’s a bit combative. We’re having a little trouble keeping him in C-spine. He was involved in an altercation with a baseball bat, the paramedic said conversationally.

    Baseball bat? Isn’t that out of season? Fiona peered at the patient’s head from a safe distance. The wild man practically flipped the gurney in his zeal to get away. Everybody grabbed for it to steady it back down onto its wheels.

    Always open season on PCP, Danny said. He sounded cheerful.

    He was probably right. Danny had a good eye for the signs and symptoms of recreational drug use. The whackier the patient was acting, the more accurate his diagnosis. Of course in Redwood County, last vestige of the hippies, he had lots of chances to practice. They all did.

    Call security, Fiona said. Four point leather restraints before he hurts himself or us flapping around like that. Put him in the trauma room and I’ll be right there.

    Fiona kicked the paper mat on the floor aside and started to follow the patient only to be blocked by two firefighters and a fire captain in full gear. Firefighters take up a lot of room in turnouts, boots, and self-contained breathing apparatus. Three of them were excessive. She was reminded that their fire engine took up a lot of room in the ambulance parking lot, too. Maybe she could get rid of them soon.

    Why the costumes? We’ve had Halloween. Not to mention that the emergency was over. Dead was dead. There was all the time in the world now to figure out why little Billy Clark died.

    The Captain held out a two inch wide strip of paper which looked like it had been cut off a roll of packing tape. The serrated edge was turning bright red. Red streaks were extending up the strip of paper.

    What’s that?

    M-9 paper, the Captain said. He sounded like Darth Vader behind the self-contained breathing apparatus mask.

    What’s it for? She told herself for all she knew the paper was a test strip for strep throat. They used rapid tests for any number of things, strep, flu. Either would explain his raspy voice. It wasn’t anything esoteric. He just wanted a free diagnosis, like people at a Christmas party telling her their gruesome gastrointestinal symptoms over the eggnog, which was a fine culture medium for those sorts of bugs and really put her off the festive beverage no matter how much brandy was in the mix.

    All detectable agents, the Captain said. He shook out a small sheet of another paper, which was a dark shade of blue-black, almost an indigo color. Denim.

    And the one that looks like a patch for blue jeans? We are in control here, she thought firmly. We don’t panic.

    M-8 paper. The man’s voice rose.

    Which means? Patience is a virtue, she thought. Too bad it’s not one of mine.

    VX.

    Okay, now we panic.

    Chapter Three

    VX was a potent nerve agent. The whole V-series was. V for venom. The series of agents that could kill you instantly if you breathed them straight in, or that could take hours to do you if you just got a little on your skin.

    Fiona frowned. It was incredibly improbable. Terrorists had nerve agents. There were no terrorist targets in Redwood County, and for god’s sake what terrorist would target a three year old kid? More to the point, if there was a terrorist incident, where were the rest of the victims?

    She glanced at the status board. The ED was full to the gills, but only with the expected sorts of patients: flu, belly pains, lacerations, kidney stone, back pain, another flu. Some of the chemical/biological weapons gave people initial symptoms of flu-like illness, she pondered. They were having a special on flu, but it was the winter rainy season, what would you expect? Two more ambulances inbound, a chest pain and a general body weakness. Nothing to do with nerve agents. No.

    FBI, the fire Captain said. Homeland Security. Incident Command Post. FEMA. Unified Command. Emergency Operations Center. Strategic National Stockpile. Code Black.

    There were probably intervening words between the incantations but Fiona didn’t hear them. Maybe not. The man seemed to be reciting them as a kind of ritual. Casting a spell.

    One of the firefighters nearby had been motionless too long and his suit alarm sounded. They all jumped, including the perpetrator. The other two firefighters reflexively shook their arms and legs to assure the suit motion detectors that they were alive and well. Too bad they didn’t have motion detectors on their brains, Fiona thought.

    Hold it. We are not all lying on the ground twitching and drooling. Whatever it is you’re detecting … she looked askance at the red paper and the dark blue paper, it’s not a present danger. Here is not the problem.

    And if you do have any of it on that paper, don’t wave it at me, she thought belatedly. How much did it take? Micrograms?

    VX! the Captain said forcefully. This is a problem no matter where it is!

    Okay, okay. Fiona focused on the words in the spell she understood. We don’t need to go Code Black. There’s no reason to shut the whole hospital down. We could go Code Red and divert ambulances.

    Radio babble from the three portable radios on the firefighters.

    The Hazardous Materials team is on their way, the Captain said.

    Isolate and deny, that was a key HazMat phrase she remembered from disaster life support class. That was the ticket.

    Then you gentlemen need to go outside and meet the HazMat team and re-direct them to the patient’s home. It’s critically important to find out where this substance came from and keep anyone else from coming in contact with it.

    Samiyat rushed by with a very pregnant woman in a wheelchair. Samiyat was a tiny nurse. The woman was wearing a gray fuzzy parka and looked like a small mountain. Samiyat was struggling to overcome inertia and panting. The mountain was heaving.

    Labor and Delivery, Samiyat called.

    Crowning? Got to go, Fiona told the fire team.

    When you hear hoof beats, think horses, she reminded herself. VX would be a zebra. With a unicorn horn. Farting rainbows.

    Chapter Four

    Thank god for Dr. Hershberger, the prototypical kindly old obstetrician. Hersh wasn’t old but he was shaved bald, so that sort of counted. Kind wasn’t exactly it, either, with his contagious hyperactivity. His bedside manner was more mania than manna, but maybe that helped in Labor & Delivery, pushed things along, so to speak.

    To Fiona’s relief Hersh clomped into the delivery suite in blue jeans and clogs and took the laboring woman’s care off her hands well before any actual infant poked any part of its body out into the cold cruel world.

    Fiona wasn’t into babies. Oh, it was nice to be on the optimistic end of the care continuum once in a while, all fresh hope and great prospects, treating a patient with a psyche and body as unscarred as their perfect baby skin, but it wasn’t realistic. For her. Her lot in medicine seemed to be at the other end

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