Sonny Chambers knew it was serious the minute they pulled into the driveway of the modest suburban house. Engine 8 was parked in front, lights flashing. Next to it, Eight’s boss, Capt. Gauge, was waiting for them. Although not a trained paramedic, Gauge was an experienced veteran with good instincts who personally directed the critical first moments of an emergency call whenever his crew arrived ahead of the paramedics.

 Sonny frowned. Gauge was the sort of man who led from the front. Seeing him waiting for them out front meant there was something more serious than usual.

“Three-year-old boy, barely responsive. Lips blue,” Gauge said as Sonny and Vince started up the walkway with the medical kits. “Parents say there’s no medical history, so I’ve got a couple of the guys searching the kitchen, bathrooms and yard for toxins.”

Vince asked “Vitals?”

“Blood pressure’s normal, breathing’s fast,” Gauge said and handed Vince a piece of paper with the child’s blood pressure, pulse rate and respirations in several sets taken at three minute intervals. Vince glanced at it quickly then placed it in his pocket; he knew Gauge had taken each set of vitals himself.

The boy lay on the couch. An Engine 8 firefighter was at his head, holding an oxygen mask just above the boy’s mouth and nose, a huge hand keeping the head from rolling as gently as if the child were a paper doll. His eyes never left the boy’s stomach as he continued to count respiration rate. A second firefighter was stationed at the feet, leaning over and laying a finger against the wrist, counting the pulse. The parents stood to the side holding each other and crying softly.

Vince knelt beside the boy and in what seemed like instant had a pediatric IV setup in his hands. Without a word, the firefighter at the boy’s feet stood up, took the bag and held it at the ready. A moment later the needle was in place, fluid dripping slowly through the tubes. The boy’s face and lips were cyanotic as hell, even with the extra O2.

As Vince worked, Sonny talked to the firefighters, who had been searching for toxins. Nothing. The house was well childproofed and the dangerous substances stored away in childproof cabinets in kitchen, bathrooms and garage. He questioned the parents again about the child’s medical history but they were adamant that the boy was healthy and had no known medical conditions.

Vince placed the bell of his stethoscope on the tiny chest, front and back and listened. “Good breath sounds,” he said to Sonny.

Next he hooked up the LifePak V and printed out a 10 second ECG. Nothing. The boy’s heartbeat looked text book normal.

Sonny looked down at the child and said, “Capillary refill?”

“Great. Even the toes.”

“Gotta be a toxin, then.”

“This isn’t making sense.”

90 seconds had elapsed since the had walked through the front door. Two firefighters entered the front door with the stretcher they’d taken from the paramedic unit.

Tim Toole’s partner stretched and yawned and tried to wake up. The normal pink chubbiness of his face was decorated with sleep lines and his red hair – what was left of it – had the same color as the thick shag carpeting at their station. He turned bloodshot eyes toward Tim Toole in order to complain about being hungry and saw the magazine.

“Aw jeezus god, there you go reading that doctor shit again.”

“This is a good one, Douggie. Apparent pediatric poisoning. Notice my use of the word ‘apparent.’“

“Notice my ass instead. I thought you said you were gonna be watching for cars.”

“I did. I am.”

“No you’re not. You’re whacking off over that doctor shit while that ginch over there drives away.”

That’s Doug all over, thought Tim Toole. Give him the gift of an absolutely sure thing every single Saturday, he doesn’t have the slightest fucking idea what to do with it. All he does is toss ginch back at you. Tim Toole picked up the binoculars but it was too late. The car that had been parked farthest away, a Volkswagen bug, had scurried off while he was reading and was already pulling out onto the main road. He couldn’t make out the driver’s face and with the car now roadside to him, the tags were invisible. Shit!

“Was she good looking?”

Doug “Drugless” Rigs had taken a sugar donut from the Dunkin’ Donuts box, carefully broken it into equal halves and crammed one of them into his mouth. “Whathfuck you carifshe’s goolookin? You couln’t carelss.”

In fact, Tim Toole couldn’t care more. But he knew from experience that this was a dead-end argument. Rigs was always telling him that he would fuck anything in a skirt, including a highlander if he was pointed in the right direction. Even without the highlander part it wasn’t true, of course, but try telling Rigs that you could want quantity and quality at the same time.

“So what the fuck’s a ginch?”

“A ginch? You know who Kookie Burns was? Never mind. You don’t know who Kookie Burns was.”

“Is this a test or something?”

Drugless Rigs swallowed the bolus of dough that had most recently been a powdered sugar donut and snorted. “You ought to wish it was a test, because God’s giving you the answer right now. That,” and he pointed a gnarled finger covered with crumbs and white powder toward the parking lot of the Matrix Social Emporium and Spirits Shoppe – “That there, my boy, is a ginch.” And he lay back in the seat and closed his eyes.

 Like all paramedics, Vince never gave less than 100% to any emergency. But there always seems to be that extra effort when the victim is a child and Vince was working with that now, trying to discover what he and Sonny had overlooked, or what they’d seen and failed to understand.

Next to him Gauge’s rookie was updating the boy’s blood pressure. Vince checked the O2 flow and made sure the IV was secure. It was then that his eyes settled on the IV site itself. On the small patch of gauze between the cannula and the skin was a tiny drop of blood. He checked to see that the tape was still keeping the line safe from being jostled. Then he looked up to make sure the bag of D5W was dripping as slowly as possible but still dripping.

Then his eyes went back to that drop of blood on the gauze. He looked at it closely. Then he pulled a 20 gauge IV needle from a cabinet above the stretcher and pricked the pinky finger on his left hand. He let a drop of his blood drip onto the gauze next to the boy’s blood. The rookie looked at him in surprise but said nothing. Vince waited a moment then examined them side by side.

“Sonny. The boy’s blood. When it dries it isn’t red. It’s got a definite chocolate color. I just now compared it with mine.”

He waited for Sonny to digest this. Sonny said, “We looked everywhere. I don’t see how … but that’s really the only explanation.”

“We’ve got to find out for sure.”

“Capt. Gauge’s crew’s going to have to go back to the house and keep looking until they find it.”

Vince grabbed his clip board and on the back of a medical form wrote a couple of sentences. He told Sonny to pull over and when he did saw that Engine 8, which was following them to the hospital in order to collect the rookie once they’d arrived, was also pulling over. He handed the note to the rookie. “Take this note to the Cap. He’ll know what to do.” Then he opened the back doors and the rookie ran back to the engine. A moment later it did a U turn and headed down the street in the direction they’d come from.

Vince said, “Now let’s get dispatch to call the house. The parents may still be there. We need to ask them a question before they head to the hospital.”

A moment later the voice of the dispatcher came over the speaker. “Rescue Nine, OCD.”

“Nine go.”

“Parents are on the line.”

Sonny said to the dispatcher, “Ask them where they keep the fire arms.”

[Stop reading for a moment and let’s review what we know so far. A three-year-old boy with a very depressed LOC and distinct perioral cyanosis. There are no signs of trauma. His breathing is rapid, but on auscultation there is no evidence of lower airway constriction. Pulse and blood pressure are normal, as is the 10 second rhythm strip. Both Vince and Sonny think it must be a poisoning but a thorough search of the house and yard have turned up nothing.

Now imagine that you can look over Vince’s shoulder at the IV site. What might he have seen? (As you may have guessed, it has to do with the color of the small blood stain.) And what might that have to do with the presence of fire arms in the house? – Dr. Aron C. Rescue]

There was a pause while the question was relayed to the parents. “There’s a hunting rifle in the master bedroom,” said the dispatcher. “But it’s under lock and key.”

“Tell the parents that the fire crew is coming back and that they should look nearby the gun case.”