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It was completely Buck’s fault, he could admit it.
He’d had it under control for a long time, he knew how to handle it. The “episodes,” as he calls them, had been a near constant in his life. One of the initial ones, at the age of fourteen, had sent him to the emergency room, pale and panting as his heart rate had spiked into the 140s. Buck had been frightened, but he left with bruises dotting the insides of his arms and a diagnosis of dehydration. His parents had been furious with him for wasting their time and money on something that could have easily been prevented and solved at home. Buck tried to explain that he’d had plenty to drink that day, but nobody had believed him.
The doctors hadn’t been helpful, but the diagnosis of dehydration had been the first clue. He upped his fluid intake even more after that, and even switched to drinks like Gatorade that had claims of hydration better than water. And later, in college, after eating almost nothing but cheap ramen for a week and having the first flare-free week in ages, Buck had also started to increase his sodium intake. Maddie had frowned at him adding salt to everything and warned him about the dangers of excess dietary sodium and hypertension being a “silent killer.” Buck had tried to explain to her that the more salt he took in, the better he felt, but Maddie was baffled by it. And very early on in his time in Peru, Buck also learned that heat was a big no-no. Thus, when he first thought about becoming a firefighter, he’d quickly dismissed the idea. However, a quick deep dive into google had him realizing how few fires he’d actually respond to, and besides, at this point in the game, Buck truly had a mastery of his condition. He made sure to hydrate as much as he could, preferably with electrolytes involved. He always kept extra water bottles on him, and stocked the station fridge with even more drinks. During summers, he also added a cooler of electrolyte popsicles to the mix, and wore ice packs under his turnouts during calls. The cooling towel tended to get in the way during rescues, but he always wore it during the ride there and back, and on the mostly medical calls where he didn’t do much. And he’d informed Bobby of his dietary needs, which had earned him an eyebrow raise, but Bobby had still come through, with soups in the winter and salted watermelon in the summer. Most people seemed unable to comprehend that someone could need more salt, not less, but he hadn’t asked Buck any further questions. Unfortunately, Bobby’s skill in the kitchen had led to the discovery of another trigger–carbs, or more specifically, any meal that went heavy on the carbs. Buck had been devastated, but at least nobody questioned him, a muscular firefighter who lived in the gym, cutting down on carbohydrates.
Buck had it strictly under control, sort of.
He’d had a few flares at work, but never during a call, and he’d simply laid down in the bunks and loaded up on fluids until it passed. He’d swap shifts with someone else whenever they coincided with very hot days, claiming that as a Pennsylvanian native, he simply couldn’t handle the California heat. And he’d always, always call out whenever the AC in the engine or the station went out.
Of course, he didn’t always follow his own rules. There were times when he’d simply breathe his way through more minor episodes, and he’d worked a few sweltering shifts. Once, the AC had gone out on their way to a call, and Buck had white-knuckled his way through it, removing his turnouts and the shirt beneath and dousing himself with the contents of his water bottle. Chim had cackled and Hen had been appalled but he managed to stay upright for the remainder of the ride.
The thing is, it starts out as a normal day. Sure, he has treated himself to a stronger coffee than usual, but that was an occasional treat that he was usually able to handle. And the AC isn’t broken, not entirely, just functioning poorly enough that most people were uncomfortable but not unwell, and he really has been staying on top of his hydration. But it soon builds up to be a perfect storm, triggers piling up on each other until his body is overwhelmed and simply can’t hold back.
They are on the way back from their fifth or sixth call of the day, Buck has lost count, when it starts. He’s scrolling on his phone, texting Maddie during her lunch break when he finds himself squinting and trying to zoom in to see better.
Great.
Difficulty focusing his eyes is often one of his first signs, and one of the components that makes him speculate about a potential neurological origin. Buck doesn’t panic just yet, chugging the remainder of his water bottle and grabbing another from beneath the seat. He fans himself with a packet of gauze and tries to slow his breathing, which has started to feel inadequate. The air around him starts to look fuzzy, like TV static, and Buck slowly gets to his feet when the truck stops. He has to be careful when changing positions, but honestly he’s too far gone at this point for that to matter. His legs feel heavy as he makes his way to the couch, the bunks would be ideal but Buck needs to be seated now. It feels as though the great big hose in the truck has wound its way around his chest, squeezing so tight as to cut off his lungs. His heart beats wildly against it, and his hands visibly shake as he uncaps his water for another desperate gulp. Buck knows he needs salt, that he really needs one of the bottles of Gatorlyte from the fridge, as he’d long since moved past Gatorade helping, but even though he’s gotten better at asking for help, this is one thing he keeps to himself.
“Buck, are you alright?” Buck is not alright, he’s rapidly sucking in tiny mouthfuls of air, seemingly unable to slow down if he tried. He’s starving for air and his brain has taken over. But Chimney doesn’t need to know that.
“Just a little dizzy,” he chokes out. “Think I’m dehydrated, mind getting me one of my drinks from the fridge.”
“Blue or red?” Hen calls from the kitchen and oh god, are they all staring at him right now. She brings him both before he can answer, and he’s dully aware that a concerning amount of time must have passed. Buck is trembling too badly to crack one open, his hands weak and tingly, and Eddie has to do it for him. He shudders as icy blue liquid splashes down on his shirt, soaking through the cotton.
“No offense, man, but there is no way you are dehydrated. You’ve always got that water bottle and you’ve peed like, a million times this shift.” Eddie’s voice is light, but he isn’t smiling, and he takes Buck’s wrist in the palm of his hand. His other hand finds his pulse with practiced ease, and it must be bad judging by how his brown eyes widen.
Buck wants to laugh, to reassure him that he’s just had a Celsius too many, even though everyone knows that Buck doesn’t do energy drinks, his boundless hyperactivity being all natural. He wants to wave him away and sip his drink and just breathe through it. He hates how they’ve crowded around him with concern in their eyes, looking at him like he’s ready to break.
And yet he does.
His vision fades from fuzzy to grey, and he can hear the steady, slow whoosh of blood in his ears. Each gasp feels like a monumental effort, chest so tight he can hardly squeak out a breath. One second his arms and legs are tingling and feel as though they weigh a thousand pounds, then next they are gone and he’s just a body, floating, floating, and floating.
Buck had never fainted before, at least not from this. At least that’s what he tells himself, although he’s had a handful of questionable moments where he isn’t entirely sure if he slipped away or not.
Once, the AC in his Jeep had given out, and he’d had too much coffee and not enough water. He was startled by the screech of the rumble strip and narrowly avoided hitting a mile marker. Buck told himself that he’d been overtired, but ever since then he’d always kept at least three full bottles of water in the car, and if the AC was on the fritz, he’d carpool with Eddie or Maddie.
Another instance happened on the job, and it was honestly mostly embarrassing. It had been the start of his shift, and he’d just finished his morning cup of coffee and retreated to the bathrooms for well, what everyone does after they've had their coffee. One minute he’s seated, staring at the stall door, and suddenly his vision starts to blur and before he can question whether he should have had that second shot of espresso, he’s slumped over, nearly hanging off the seat as his dangling arms brush the questionably sanitary floor. The tones are blaring and Bobby is shouting for him to finish up and get in the truck. He endured weeks of jokes about falling asleep on the crapper, being caught with his pants down at such an inopportune time, and he smiled and joked back and gave as good as he gets, but after that he limited himself to nothing more than a small cup each morning and tried to take those sorts of bathroom breaks in the privacy of his own home.
The most recent incident had been back when Buck had been with Taylor. He stood at the foot of her bed, and she knelt before him, helping him relax after a long shift. He’d just gotten home, and the Panda Express he’d picked up on the way home, including the extra packets of soy sauce, was growing cold on the bed. Taylor had all but eagerly ambushed him as soon as he’d entered her apartment, and Buck’s libido made him forget his appetite. One moment his head was tilted back, and he was massaging circles into the back of Taylor’s head, and the next he lay crumpled on the bed, pale and jittery. Blue eyes swam over him, full of worry, and it wasn’t until he heard the sound of tapping that he sat up, ignoring the way his head still hadn’t caught up with the rest of his body. He all but begged Taylor to put her phone down, insisting against an ambulance or ER trip. He’d just been tired, just needed to lie down. Taylor was a headstrong girl, and she’d only cracked when he explained that he was still dealing with the lingering bills from the truck bomb- the ambulance, the surgery, the PT, and the later embolism. Of course, she had no idea that almost all of that had been covered under workers’ comp, but afterwards, Buck never had sex on an empty stomach or without his water bottle on his nightstand, and he often sucked down packets of soy sauce on the drive home from work.
Buck wakes to the all too familiar sensation of a backboard beneath him. As his vision returns, he finds himself staring at the ceiling of an ambulance. A gloved hand prods the crook of his right arm, then his left, before moving to the back of his hand with a sigh.
“Buck, you really are dehydrated.” Chim sounds confused. “It isn’t even that hot out.”
Eddie’s voice comes from behind him. “And this doesn’t seem like your classic heatstroke.”
“He has POTS,” Hen’s voice is matter of fact. “I don’t know why he didn’t think to tell us. Bobby, did you know anything about this?”
“No, the only medical history he disclosed to the LAFD was a naproxen allergy and being a bit lactose intolerant. “ Bobby’s voice sounds further away. Distantly, Buck realizes he’s in the front, driving, and only then does it occur to him that they’re moving.
Buck wrinkles his forehead. “I’m not, I’m not smoking pot.”
Hen scoffs, then her face drifts into Buck’s line of sight. Her glasses look huge, floating above him and seeming to see right through him.
“Buck, you really don’t know what I’m talking about, do you? I take it you’re undiagnosed?”
Buck tries to talk, but a straw is shoved in his mouth and a hand behind him gently pushes him into a seated position. The monitor begins to beep rapidly with the change in position.
“Drink up, Buckaroo, you’re dry as a bone.” The liquid is cloudy and somewhat salty, and Buck really tries, but after a few sips he’s pushing the cup away.
“I really can’t, I’m too-”
Hen’s fast, but not fast enough and by the time she’s stuck a blue bag under his chin, the majority of it has hit the floor. Thankfully it's mostly water, and the vinyl ambulance floor is easy to clean, having seen much worse over the years. Hen swipes at his mouth with some gauze and lowers him back down. The relief isn’t exactly immediate, but it’s enough for him to somewhat doze for the remainder of the ride.
The ER isn’t terribly busy, and Buck is taken back quickly and given a bag of fluids and electrolytes. The nurse doesn’t have better luck with his veins, and as usual, they are forced to bring in the ultrasound machine. He’s also given Zofran intravenously, and a cup of apple juice sits on his tray, for when his stomach has settled enough. Hen, Chimney, Eddie, and Bobby are all in the room, Maddie on her way, and it should feel crowded, but it’s truly the opposite. Chim immediately steals his pudding cup, and is laughing through a mouthful of chocolate. Bobby has the remote, and is flipping through the channels on the tiny TV, trying to find something they can watch. Eddie gives him his turnout coat to use as a blanket, because now that he’s finally feeling better, the hospital is freezing. Hen is sitting next to him, frantically texting updates to the others. He recalls she’d seemed familiar with his condition earlier, had called it a pot something?
“Hey Hen?”
Her thumbs immediately stop, and she’s giving him her full attention. “Feeling alright?”
“Yeah, much better, but what was that thing you were talking about earlier, in the ambulance? Some sort of pot?”
“POTS,” she corrected. “It stands for Postural Orthostatic Tachycardia Syndrome. It’s a condition of the autonomic nervous system. It causes an inappropriate activation of the sympathetic nervous system in response to various triggers such as heat, position changes, etc.”
“And you think I have that?”
“I’m not a doctor, Buck. I can’t say much on it, but based on what I saw today, I’d say there is a good chance you do, or at least you have something similar, some other dysautonomia. It all makes sense now–the way you steer clear of caffeine and carbs, how you are always going to such lengths to stay cool, why you are always so on top of your hydration, why you’re always peeing. You drink a lot, yes, but POTS can come with bladder symptoms.”
Chimney pauses in the middle of licking the lid of the pudding. “Wait, is this why he conked out mid-shit that one time?”
Buck cringes at the memory, but Hen just nods, her tone matter-of-fact. “Having a bowel movement can also be a trigger, yes.”
“Explains the diet,” Bobby adds. “Gotta say, I’ve never had a firefighter tell me he needed more sodium. Sure made cooking for you easier, don’t need to tell me twice to go ham on the seasonings. Still, didn’t know the whole time it was my low carb mac and cheese keeping you upright.”
“How long has this been going on?” Eddie moves from behind his bed to beside it, and his dark brown eyes look straight into Buck’s blue, probing deep. Buck does his best to look away, focusing very hard on his hospital band.
“A long time, but it’s nothing. As you’ve noticed, I’ve created a system over the years. I know how to handle this.”
“You passed out,” Bobby points out, rather unhelpfully. “That’s not handling it. What if we’d been on a call?”
“But we weren’t. And today was an anomaly. I’ve never passed out before.”
“Except on the toilet,” Chim reminds him.
“No, that wasn’t passing out, I just got a little fuzzy is all. That was a glitch. I just need to refine my system.”
“What you need is to see a doctor,” Hen insists.
“And you think I haven’t? I’ve seen three doctors so far, four if you count the ER trip around when this first started. I was fourteen and my parents were pissed at a hospital bill for something as stupid as dehydration. And all the doctors I’ve been to make me wear a stupid monitor for a week but never really look at the results. One asked if I’d tried therapy.”
“It won’t be like that this time.” Hen’s voice is firm. “I know people, I’ve kept up with some of my old classmates and professors. My neuro teacher specialized in dysautonomias, did her dissertation on it.”
“We can also help you at the firehouse, Buck.” Bobby’s tone is careful. “You are a great firefighter and I don’t see why this could change that. We can keep a cooler and fan in the rig, have you be man behind when it comes to hotter days. We can find ways to accommodate you, if that’s what you were worried about.”
Buck feels frozen, overwhelmed with emotion from finally not just being listened to, but heard. He isn’t aware of the tears running down his face until Eddie wipes him away with his thumb.
“Hey, none of that. We’ve got you now. Buck, you can breathe.”