Chromatic Aberrations

A medical student's first real-world rescue attempt in a whimsical winter park goes horribly wrong due to a critical misdiagnosis.

"Is he breathing?" a voice sliced through the air, thin and sharp as an icicle. It wasn't directed at me, not yet, just a general broadcast of panic into the frozen twilight.

I was already moving. My sketchbook, a detailed but soulless rendering of a squirrel ice sculpture, hit the snowy bench with a dull thud. Pencils scattered like tiny, broken bones. For three years, I’d been a ghost in a lecture hall, a disembodied brain absorbing pathways and protocols. Now, flesh and blood and a real, actual emergency. My heart hammered a frantic, textbook tachycardia against my ribs. A-B-C. Airway, Breathing, Circulation. The mantra started, a familiar, comforting rhythm in the chaos.

He was on the ground, a heap of dark coat and faded jeans sprawled at the base of a particularly saccharine snowman made of twinkling wire and light. He’d gone down with a sort of theatrical flair, a slow, boneless crumple that looked less like a medical event and more like a bit of street performance. One moment he was shuffling along the salted path, humming something tuneless and loud, the next he was a marionette with its strings cut.

I knelt, the frozen ground biting through the thin fabric of my leggings. The cold was a clinical fact, a variable to be logged. Ambient temperature, approximately -12 Celsius, with wind chill. My mind was a whirring diagnostic engine, spitting out possibilities. Syncope? Cardiac event? Seizure?

"I’m a medical student," I announced, the words feeling heavy and fraudulent in my mouth. They were meant for the small crowd of gawkers that had formed a respectful, useless perimeter. But they were also for me. A reminder. An incantation.

His eyes were open, wide and strangely unfocused. They were a pale, washed-out blue, and they were fixed on the string of fairy lights woven into the snowman's cheerful grin. A smile was plastered on his own face, a loopy, disconnected thing. It was entirely wrong for the situation. He looked blissful. Intoxicated.

"Sir? Can you hear me? My name is Angie." My voice was clipped, professional. The one I practiced in front of the mirror for OSCEs. "Can you tell me your name?"

He giggled. Not a laugh, a high, airy giggle that dissolved into a string of slurred syllables. "Jared… Jared loves the… the shiny snow-friends." His speech was thick, syrupy. Each word was a struggle to form, like his tongue was too big for his mouth. Classic sign of intoxication. Or perhaps a stroke. I quickly dismissed the latter. His facial muscles were symmetrical, no visible drooping. Occam's razor. The simplest explanation is usually the right one. It was a Saturday evening in a public park. Ergo, drunk or high.

I put my fingers to his neck, searching for the carotid. The skin was cold, clammy. But not as cold as I expected. His pulse was thready, but fast. Tachycardic, just like mine. I leaned closer, trying to check his airway. His breath puffed out in a visible white cloud. And with it, a smell. It was faint, almost imperceptible beneath the crisp, sterile scent of the winter air. It was sweet. Cloyingly sweet, like overripe pears or cheap bubble gum. He must have been drinking some kind of godawful flavored vodka. It fit the picture. Young guy, probably in his early twenties, acting bizarrely in public.

"Okay, Jared, we need to get you warmed up," I said, my diagnostic path solidifying. Hypothermia, exacerbated by alcohol. Alcohol is a vasodilator. It makes you feel warm while your core temperature plummets. Paradoxical undressing was a classic symptom, though he was still fully clothed. His blissful state, the confusion—it all tracked. The textbook pages flipped in my mind. Severe hypothermia presents with neurological symptoms that mimic intoxication.

I started rubbing his arms, trying to generate friction, to stimulate blood flow. It was what you were supposed to do, wasn't it? My hands were freezing, the contact a shock to my own system. "Someone call 911!" I shouted over my shoulder, not breaking my rhythm. "Tell them it's a possible case of severe hypothermia!"

A woman with a phone already pressed to her ear nodded, her face a mask of anxious concern.

"Shiny…" Jared murmured, his eyes still locked on the lights. He wasn't shivering. That was a bad sign. A very bad sign. Shivering is the body's attempt to generate heat. When it stops, it means the body is giving up. The core temperature is dropping to critical levels. I had to act.

I unzipped my own expensive, down-filled parka, the one that was my only defense against Winnipeg winters. The frigid air hit my sweater like a physical blow. I draped the coat over him, a futile gesture against the crushing cold. His body was limp, unresponsive to my efforts. He felt like a mannequin, a collection of limbs with no animating force.

"Jared, stay with me," I urged, my voice losing its clinical edge, fraying into something closer to a plea. My own teeth were starting to chatter. My movements became more frantic, less controlled. I was rubbing his chest now, my gloved hands moving ineffectually over the thick wool of his sweater. The sweet smell on his breath seemed stronger now, a sickening perfume.

He wasn't responding. His breathing was becoming shallow, rapid little puffs. Kussmaul breathing? No, that was for… for acidosis. Metabolic acidosis. This wasn't that. This was cold. The world was cold, the ground was cold, he was cold. It was the only variable that mattered.

Then, it started. A fine tremor in his jaw. At first, I thought it was shivering, a good sign, a victory. But it wasn't. The tremor spread, a violent shudder that racked his entire body. His back arched, his limbs stiffened. His jaw clamped shut with an audible click. A seizure. This wasn't on the hypothermia checklist. This was wrong. Everything was wrong.

My brain stalled, the diagnostic engine seizing up with a shower of sparks. This wasn't in the flowchart. My carefully constructed diagnosis crumbled into dust. Panic, cold and absolute, flooded the space where my confidence had been. I was out of my depth, a child playing dress-up in a doctor's coat.

I could hear the distant, rising wail of a siren, a sound that had always been an abstraction, a part of the city's soundscape. Now it was a lifeline. A confession of failure.

The paramedics arrived with an aura of weary competence. They moved with an economy of motion that made my frantic efforts look clumsy and pathetic. One of them, a woman with tired eyes and a no-nonsense haircut, knelt beside me.

"What have we got?" she asked, her voice calm, a low rumble that cut through my panic.

"Male, early twenties. I think… I thought it was hypothermia. He was confused, slurring his words. Then he started seizing." My voice was a thin squeak. I felt my cheeks flush with heat, a bizarre counterpoint to the freezing air.

The second paramedic, a tall man with a calm demeanor, was already cutting away Jared's sleeve, prepping an IV. He didn't even look at me. The woman leaned close to Jared's face, sniffing the air, just as I had. Her expression didn't change, but I saw a flicker of understanding in her eyes.

"Get me a glucometer," she said to her partner. She turned to me, her gaze not unkind, but appraising. Clinical. "Did you notice the smell on his breath? Fruity?"

"I… yes. I thought it was alcohol," I stammered.

She gave a small, almost imperceptible shake of her head. "Ketones." It was a single word, but it landed like a physical blow. It rearranged my entire reality. Ketones. The byproduct of fat metabolism when the body can't use glucose. The hallmark of DKA. Diabetic ketoacidosis. A first-year textbook diagnosis. The Kussmaul breathing, the confusion, the sweet breath—it was a symphony of symptoms, and I had heard only a single, wrong note.

The glucometer beeped. The number on the tiny screen was an obscenity. Over 600. Critical.

"Severe DKA," the man confirmed, already pushing insulin into the IV line. "Good thing we got here when we did. He was about to go into a coma."

They worked in seamless unison, loading Jared onto the gurney. The woman paused for a second and looked at me, seeing my parka still draped over the gurney. She pulled it off and handed it to me. It felt impossibly heavy.

"Your intervention… trying to warm him up," I began, the question dying in my throat.

She gave me a tired, neutral look. "You kept him from freezing, I guess. But you delayed the correct diagnosis. Every minute counts with this stuff. Next time, just keep them stable and wait for us." She didn't say it with malice. It was just a fact. A correction on a test I didn't even know I was taking.

Then they were gone. The ambulance doors slammed shut, the siren screamed back to life, and the red and white lights painted a frantic, retreating pattern on the snow-laden trees. The small crowd of onlookers, their brief moment of drama concluded, dissolved back into the evening.

I was alone. The park was suddenly silent, save for the hum of the festive lights and the whisper of the wind. I stood there, clutching my coat, the lingering, sweet scent of ketones still in my nostrils. It was the smell of my failure. The cold I had been fighting against on his behalf now seeped into my bones, a deep, unshakeable chill that had nothing to do with the temperature. All my books, all my lectures, all my meticulously memorized facts—they had amounted to nothing. Worse than nothing. I had stood between a dying man and the help he needed, armed with nothing but my own lethal arrogance.

And I was left alone in the glittering, indifferent park, with nothing but the cold and the certainty that I had almost killed a man.