#userglow

It’s not a call that Michelle was ever expecting to get, or maybe it was something she just prayed would never happen. No amount of manifesting would prevent this, though, and Owen’s frantic tone over the radio had her heart dropping.

“Ladder 126, EMS needed immediately at our position,” Michelle wasn’t prepared for the words that followed, “Code 26.”

Injured firefighter, EMS required.

That had Nancy rushing for their bags from the rig, throwing them on the gurney as quickly as she could. Michelle was already running ahead, calling back for Tim to stay there and look after their patients, her own bag bouncing against her thigh with every movement. She cursed under her breath as she stumbled, worry for her crew clouding her awareness. Code 26, not an uncommon code in this line of work but certainly not one she had heard for a while. The last time she did must have been when TK was shot, which had been a whole other kind of chaos.

“Who?” she didn’t have any time for panic as she tried to depersonalize from it all, a hand falling on Judd’s shoulder to get his attention. The man looked at her through his visor, worry etched into his face as he pointed to where most of the crew was crowding around. This was just supposed to be a normal fire response, a small apartment complex with a fire on the third floor, and she was sure everyone had evacuated on time. She was only gone from the main scene for ten minutes, helping parents find their children and checking people for smoke inhalation and minor burns. They hadn’t had a firefighter injury in a while, this was such a minor scene she wasn’t sure how it had even happened. Judd seemed to be questioning the same thing but she didn’t have the time to consider how much his memories were haunting him at that moment.

“Marjan…”

Nancy had caught up with her by then and she nudged her Captain forward, though when their eyes met Michelle could tell she was just as worried. She could feel the pit of anxiety gnawing away at her stomach, her friend’s life at risk here. Still, they had to be smart about this, Marjan needed them and they would have to wait to feel later.

“Captain,” Michelle bounded over to the others, “What happened?”

Owen turned to look at her, standing up properly from his previously crouched position. Mateo was on the ground, looking like anxiety incarnate, and beside him was Marjan. Laying on the sooty asphalt with her turnout coat nowhere to be found and she looked worse for wear. Instead, her long sleeve was exposed and Michelle could see blood seeping from somewhere and covering the white fabric in a nauseating amount. She was on the ground with them in seconds, leaning over Marjan before Owen had even managed to speak.

“The ceiling,” it was TK who spoke instead, “She went back to get a kid… the building was unstable.”

“Someone decided it was a brilliant idea to take off her coat and cover the kid with it,” Judd interjected, “The smoke was disorienting and we couldn’t get to her in time. The lobby ceiling fell.”

Michelle was nodding but all of her attention was on Marjan, shining her penlight in her eyes and sighing when her pupils reacted properly. The woman in question was watching her weakly, her breathing unsteady but she was still alert enough to know what was going on. There didn’t seem to be any head or facial trauma, which was a relief, but her main worry was her abdomen.

“BP is high and she’s tachy,” Nancy told her as she leaned over with a stethoscope to confirm, speaking gently to Marjan before she did anything. Michelle was glad Nancy was there, her caring nature always helping to soothe their patients.

“Marjan, let me know if this hurts, okay?” She didn’t lift her shirt for the sake of her privacy and instead palpated the injured area over the soaked fabric. The gentle pressure had her crying out almost immediately, arms jerking up to cover her stomach. It was very un-Marjan like in nature, since she was always fearless and hated to seem weak. Michelle apologized gently but her concern was only rising with that reaction.

“Abdominal guarding and tenderness,” she turned to TK, “What fell on her?”

“A chair from the upper hallway along with a large chunk of the ceiling.”

“Damn,” she looked to Nancy again, “Notify the nearest hospital that we have an incoming patient with blunt force abdominal trauma. Looks like a couple broken lower ribs and I’m worried about her spleen.”

“Alright.”

“Request a female trauma surgeon if possible,” she added before looking back down at Marjan, “You with me, Mar?”

Never one to appear weak even on death’s door, Marjan nodded as much as she could, “Mhm.”

“Anything else hurt right now?”

“How a-about eve-everything…” she let out a shaky laugh, which only made her wince as it jostled her ribcage. That only solidified Michelle’s assumption about fractured ribs, which usually caused a rupture of the spleen in cases like this. She hadn’t seen anything pressing during her secondary assessment but she was worried about other internal injuries or shock setting in too fast.

“We’re going to get you on the backboard then, okay?” she motioned for Mateo to stand and grabbed the board from on top of the gurney, passing it over to Paul so he could slide it under her from his side. She crouched by her shoulder, catching her attention again.

“We’re going to roll you onto your side, you know the drill.”

The transfer was painful for everyone, with Marjan unable to hide her agony at being moved in such a way. They hated seeing her like this, knowing they were only causing her more pain, but it was necessary. She cried out as they slid the board under her body, allowing Michelle a second to check for any injuries on her back. Getting her up onto the gurney was less of an event, though her stats had dropped enough in the move for Nancy to get worried.

“Captain Blake,” she said, “BP dropped and O2 stats in the 80’s.”

“Okay, we need to get going, I’ll run oxygen in the bus.”

With that they transferred her across the parking lot, back to the safe area that had been designated for the civilians to gather. Tim was waiting among them, rushing over to ask what had happened. Michelle was preoccupied with talking to Owen, trying to tell him as simply as she could how her prognosis looked.

“She’ll need a CT to confirm but I think there’s a good chance her spleen ruptured,” she told him, “I know you needed to move her from the building but I do hope you all didn’t jostle her too much.”

“We were as careful as possible but I couldn’t risk anyone getting trapped,” he rubbed a hand over his face, “Take care of our girl, Michelle.”

“We’ve got her,” with that she hoisted herself into the back of the ambulance, beside Nancy who was already getting the oxygen mask situated for Marjan. Tim checked from the front to make sure they were ready and then started the rig, lights and sirens on the second they pulled out of the parking lot.

Michelle busied herself with starting an IV in her arm, knowing she would need fluids if they wanted to keep her stats relatively stable. Her oxygenation had improved but her blood pressure was still worrying, not to mention how thready her pulse seemed when Michelle pressed her fingers to her wrist momentarily. That was never a good sign, especially with the way her eyes unfocused and her response to stimuli had decreased.

“Marjan,” she leaned a bit closer to meet her glassy eyes, “You stay awake for me.”

“T-trying…” she murmured, “Hurts.”

“I know,” looking at her crewmate she asked for a dose of morphine that would hopefully help until they got her to the ER. Nancy administered the painkiller as quickly as she could, reminding Marjan that she was doing well and they would get her help.

When the other woman leaned towards the front to ask Tim about their ETA, Marjan reached out weakly. She caught Michelle’s hand, making the EMT look at her with concern.

“I-” she took a shaky breath and tried to blink away the tears that clouded her vision, “I don’t w-wanna… die this way.”

“Hey, don’t say that,” Michelle told her firmly, “We’ve got you. You never let anything stop you before, Marjan, you can get through this.”

“M… Michelle?”

“I’m right here, Mar.”

Marjan was born with a leg length discrepancy (LLD)

(this is inspired by her actress Natacha Karam’s own story )

This means her right leg was much shorter than her left, an issue that was caught soon after she should have started crawling but couldn’t stay balanced and wouldn’t put weight on her knee

The doctors originally thought she would grow into it, since some babies are just lopsided, but she never did

X-rays and an MRI showed that Marjan was actually missing one ligament in her knee and another was considerably weak

On top of that, her right leg was more than 3 inches shorter than her left, which was only worsening as she went through her biggest growth spurt as an infant

This caused issues with her knee, hip, and spine because she had to alter the way she crawled and eventually walked

Over the course of her childhood, Marjan endured countless surgeries and hours upon hours of physiotherapy

She was wheelchair bound for much of her early adolescence and often needed forearm crutches when she was walking

Her surgeries included breaking bones and realigning them, lengthening of her femur, surgeries on her tendons and ligaments, and multiple plate and rod insertions for support

At home, school, and within her childhood mosque, Marjan was coddled and treated like glass

She hated this, as all she wanted to do was be “normal” and play with the other kids

But she was often stuck with the adults and kept away from games and trips to protect her

That didn’t stop Marjan from trying to run and play but unfortunately this caused more problems

On top of being called disobedient and reprimanded for “acting out”, a few times Marjan had tried to play soccer or roller skating with her friends had ended in accidents

She ended up tearing her weakened MCL ligament when she was playing soccer at 12 years old

This was excruciating and she was in the hospital for a week after a surgery to repair it

Marjan was always told she had to be good and think about her future; she could look forward to being with Salim and having a life with him

Honestly they just hoped she would settled down and pace herself so she could hopefully have children safely in the future (though her weak hip made this unlikely unless she was to have a caesarian)

Marjan didn’t want that

Since she was 13, she dreamed to become a firefighter

She was told that was impossible, she couldn’t even walk for more than an hour without needing her crutches, and it was far too dangerous

But Marjan pushed it because that was everything she wanted in life

She worked so hard in physiotherapy, started discussing surgeries and treatment plans with her surgeon the second she could go to appointments alone as a teen, she worked on her upper body and core strength like crazy to compensate for her leg weakness

Despite all the doubts and her parents’ dislike for the idea, Marjan made it through the academy and became a kickass firefighter

She also started roller derby in Miami at 21, regardless of the huge risk it posed in comparison to non-contact sports

She was doing everything she ever wanted and she couldn’t slow down

So when Owen Strand offered her a place at the 126, she thought about it for a while

This was a chance to make her mark somewhere else, away from the pitiful looks and coddling

People in Austin wouldn’t have to know about her LLD, she could be seen as able bodied and capable as long as she was careful

So she made the move and it was perfect

The department did inform Owen about her disability and the implications/risks of her being out on calls because they had to

But Marjan made him swear to keep it between them

She wants to be the best firefighter she can be and she already feels like people doubt her so the last thing she needs is to appear weak around her new crew

Hindsight is always 20/20, unfortunately, and Marjan tends to learn that the hard way. Realistically she knows better, yet every time she pushes herself too far she finds herself frustrated with her body’s limits. She shouldn’t still hurt like this, she reasons with herself, it shouldn’t be this hard.

She said that but she knew it was the opposite in reality. She already did things doctors told her she would never be capable of doing, and she did them on the daily. That comes with clear risks, of course, but Marjan didn’t worry about them. Not in the moment, anyway, because all she really wanted to do was help people. She was in it for the fulfilment of her childhood dream and the need to help others, though she would also admit the adrenaline rush is pretty great too.

Marjan should be more careful, it's what her parents and friends back home tell her constantly. They’d seen all her videos and the risks are evident but Marjan never listened too hard. She’s Firefox for goodness’ sake, one doesn’t go viral by being careful or by being treated like glass. That's what she told them every time and it's what Owen needs to be reminded every time he expresses his concern. She knew they nag because they’re worried but she’s 25; one would think Marjan could take care of herself by that point.

That’s what she muttered to her captain when he nudged her on their way back to the rig. She was limping, she could feel it in the way her body instinctively favoured her right side. Something wasn’t right and Marjan knew that but she had hoped no one would notice. Usually capitan Strand was too preoccupied with his own thing to really notice, but that wasn’t the case on this day.

“Marwani, you okay?” His voice was lowered, thankfully, and Owen waited until Paul had gone off to help Mateo with the hose before he spoke. They had an agreement that Marjan would keep him updated on her condition so long as he didn’t let the rest of the squad know. Considering the amount of things he kept a secret from his son in the past, she hoped he could apply that to the whole 126 this time around.

“Fine, Cap,” she answered as she went to hoist herself back into the truck, trying to hide her flinch when she leaned too much on her leg.

“Marjan.”

“Just a strain,” she promised, settling down in the seat she usually claimed. A quick glance out the other window told her the others were coming into the rig. Giving Owen a look, Marjan went to fiddle with her seatbelt in an attempt to avoid eye contact, hoping he would take the hint. Marjan didn’t need the concern and she certainly didn’t want the rest of her crew to know anything was wrong. Nothing was wrong, after all; or at least that’s what she told herself.

Even still, she had to admit paying attention to any conversation was extremely difficult. Actually, Marjan was having a hard time focusing in general, her brain feeling like it was stuffed with cotton. All she could think about was the amount of screaming pain her leg was in at that point, the ligaments in her knee being particularly bothered. Any movement sent harsh tugging motions through the connective tissue, making Marjan grit her teeth and hide her flinch as the rig came to a less than gentle stop in the station.

She was the last one out of the truck, pretending to fix her scarf and tugging on her undercap a bit. The boys didn’t bother her or look in her direction whenever she did that, something she was always grateful for. In that situation it gave her some time to have them disappear to shower or change, leaving Marjan mostly alone so she could relax for a moment.

That was the idea, anyway, but it was easier said than done. Even after sitting and trying to relax her muscles for a moment, Marjan could only feel pain. A gentle hand pressing on the back of her knee through her gear felt like she was being hit with a baseball bat, causing her to stifle a pained sound. She had to stand up, though, because her staying in the rig for this long was already a cause for concern.

Holding onto the handle for support, Marjan lowered herself out of the seat, praying she didn’t fall off the step with how unstable she felt. Her head was spinning, an uncomfortably familiar sensation caused by her adamance to push through the pain. Even as she tried to regain her footing, she knew she pushed herself too far this time.

She had declined Paul’s offer to be the one to rappel into that building, insisting it was her turn and hooking her harness to the rigging system before he could argue. She had been fine all day, through the walking and heavy gear and even while carrying a little boy out of a house fire. She miscalculated her stability during the rappel down, though, and a stumble when going to break a second floor window with her boots had her knee buckling. The initial pain was bad but the aftermath made it feel like a pinprick in comparison. She wasn’t sure what she had done but the way she had to grit her teeth with every bend of her knee told Marjan it was way more than just a strain.

“Marjan?” Mateo was behind her all of a sudden, a gentle hand on her elbow when she teetered on her unstable legs. She winced because she wasn’t sure how to avoid the truth but this wasn’t a situation she could hide from them. She was hurt, that was clear, and she couldn’t smile her way out of the concern of her crewmates.

“I’m fine, Probie,” she replied before he could ask, “Knocked up my knee a bit is all.”

“I’ll get Tommy.”

“Mateo, no,” Marjan said quickly before her friend could run off to find the paramedic capitan. She tried to shake her head, meaning to put on a brave face and promise she was just fine, but that was a mistake. The rapid head movement only worsened her vertigo caused by the discomfort, the room spinning and her leg threatening to buckle under her. Mateo must have noticed because he grabbed her again, quick to help support her right side because Marjan was clearly having trouble.

Physician notes:

Ms. Bekker was transferred to my care after she expressed discomfort with seeing a male physician. She has been seeing me three times a week for three weeks now, though we have not made much progress until now. The patient was admitted as high risk after a C-PTSD attack during a shift at a hospital she worked for as a surgeon. Bekker became agitated and fearful, striking one of her coworkers after he tried to restrain her. She refuses to share what triggered that particular attack, though I have managed to get some information on her history to infer.

Bekker was diagnosed with BPD after a suicide attempt when she was nineteen. She has been on and off many medications, including anticonvulsants and antipsychotics. Her comorbid symptoms of anxiety/paranoia, major depressive disorder, and compulsions have led her to be an interesting case. She often has trouble sleeping, claiming her memories get “too loud” during the later hours of the night. After our 6th session, I prescribed 1 mg of Ativan to be administered under supervision as needed. The low-dose is to ensure no interactions occur with her pre-existing treatments, however they do seem to have helped her with relaxing situations Bekker deems to be stressful.

Today the patient was in a relatively good mood. She spoke cheerfully to me and was pleased to mention that Nurse Sexton took a group of patients out to the gardens for a time. She enjoys being outdoors, though she is still considered a flight risk so her exposure to the gardens has been limited. I do notice an improvement in her demeanor in comparison to our last session, where she was visibly agitated and non-compliant. I believe outdoors may be a much needed change in pace and scenery and I will be discussing with my attending whether I can do a future session outside to monitor her attitude.

We were able to discuss how her medications make her feel, where the patient agreed that the lorazepam is helping her calm down during mini-episodes. She does state that she has experienced digestive upset as of recently, which makes me assume her sertraline is increasing nausea after the last 50 mg dose change. I have placed in her chart that this medication will now be given to the patient with her dinner, to ease any stomach upset that may come about. She does not have anything to say about the risperidone, aside from her usual complaints that she “isn’t crazy” and does not need to be on antipsychotics. They do seem to ease her irritability and make her less paranoid, so the risperidone will continue.

Bekker tells me that she has worried about her relationships with fellow patients. She has always exhibited anxiety over friendships and is scared to upset or lose her acquaintances. This manifests as clinginess and has led to a few meltdowns when people did not respond the way the patient wished. She has been known to guilt and/or manipulate others, trying to gain their good graces and affection in whatever way she can. She does not realize this can be seen as manipulative and rude, as she merely wishes for people to like her. She does not like to be alone and has told me many times that she preferred when she had a roommate, however it is still uncertain whether she is stable enough to be roomed with another patient at this time.

Bekker is still unable to tell me much about her childhood, she freezes up upon mention of her foster families and will not talk much about South Africa. She was adopted when she was sixteen and moved to America soon after, a transition she describes as “hell” and “horrible”. Her adoptive family were well equipped to handle a troubled teen but tell me she often acted out and ran away. I am unsure as to whether Bekker is uncomfortable sharing details of her childhood, which I have concluded are the likely cause of her C-PTSD, or whether she simply cannot remember them.

Bekker has frequent episodes of depersonalization, which may be connected to her trauma. She shuts down and is quite unresponsive in these moments, though we keep her under close supervision. I would like to do an EEG in the near future, to track her responses to certain phrases and stimuli. I believe she is experiencing trauma-related derealization, so she may not be able to recall her childhood as an unconscious defence mechanism. I will tread this area gently but wish to test if I can help Bekker navigate her memory gaps to better heal from her past. I will not be adjusting her medications any more at this time, though I will note that her DBT should go from once a week to twice, while still doing general sessions with me three days a week.

- Sarah Reese, MD