Death Flight

by Melissa Yi

  His face was frightening. Like a mask. "I'm thinking."

  "Okay. Let's switch for CPR. Switch!" The next volunteer was a beefy-looking guy with an artificial tan. He pumped on the chest with so much enthusiasm, it reminded me of a gay male nurse who told me that the way you do CPR mirrors the way you have sex.

  Tucker said, slowly and distinctly, "We both think this is tamponade. I can cut a pericardial window."

  "Tucker—" I was pretty sure he'd never done one. I'd never done it. Never even seen it. There aren't that many traumas in London, Ontario, where I did my medical school, and the traumas I'd seen in Montreal couldn't be solved like this.

  "It's not that hard. And if I open it up, I'll be able to see what I'm doing. I just need to crack the chest." He raised his voice. "I need the knife!"

  Pascale and Magda conferred for a second. "We don't have it—"

  "I need the knife!"

  Linda passed him the butter knife. "Yes, sir. Yes, doctor."

  I dropped to my knees and sprayed Mr. Money's chest and the abandoned stork scissors with brandy like I was an arsonist splashing gas on-site. Trauma team leader and trauma nurse rolled into one. If we were going to do this, we needed to do it full bore. No holding back. No doubts.

  When actor Carrie Fisher had a heart attack in the air, her family was grateful that the staff on board had managed to bring back spontaneous circulation by the time they hit the gate, and that they got a chance to say goodbye.

  Maybe Mr. Money had someone who wanted to say goodbye to him, besides his wife who was calling behind the curtain.

  Maybe he'd make a good organ donor.

  And even if he didn't, this was my Christmas present to Tucker. I couldn't give him all that he deserved, but I could give him a good code. Or as good as it got on the airplane flight from Hades.

  I'd thought our pericardial tap was our Hail Mary, our final attempt, but I was wrong.

  Opening the chest was the real Hail Mary pass.

  Tucker knelt too, and I whispered to him, "You know this will destroy all forensic evidence." I got my ass handed to me the last time I ran a code on a near-corpse. The coroner had lectured me for an hour when she called me in for an interview.

  "Life first," he said simply, and I nodded. That was what I'd told the coroner, too. Saving lives comes before saving forensic evidence. Life first. Live first.

  He brandished the knife. I poured brandy on both sides, which cut the smell of blood in the air.

  We couldn't land the plane, we didn't have any fully licensed doctors, but we did have brandy.

  "Stop CPR," I said. There was no way we could have a knife and CPR going at the same time.

  Tucker pressed on the xiphoid process, the small, pinky-tip sized bone hanging on the bottom of the sternum that you're not supposed to break off during CPR. Then he placed the knife beneath the xiphoid and pushed as hard as he could, leaning with his body weight, to puncture it.

  I sucked in my breath.

  He let up immediately, not wanting to fall through and stab the man, but it might be the most dangerous thing he'd done so far. He could easily lose control and fall through the diaphragm and hit the left lobe of the liver, or slide upwards and jab the heart or lungs.

  "Let me!" I shouted, pressing on the skin and pulling it apart to add tension. The first cut was the hardest, as Sheryl Crow and others have sung before us, and he didn't already have an incision made, like he had for the chest tube. My gloves, sticky with drying blood, still slid on his brandy-slick skin. This was a gong show.

  Yet somehow, with the tip of the butter knife, and me applying tension, Tucker managed to saw a small, vertical hole, no bigger than half my thumb. "Hope, retract for me!"

  I stuck my fingers in the hole and ripped it as wide as I could. That made it easier for him to cut. Also, the bigger the hole, the further my fingers were from his knife. It was a butter knife with laughable teeth, but it had cut through his skin and fat, and I'd already been sprayed by Mr. Money's body fluids. No need to get sliced, too.

  I could see black, clotted blood. That was about it, no matter how the people shone their phone lights.

  I leaned back to let Tucker get his head in there, because it was his case, but all I could see was blood. And truthfully, I'd never read up on how to do a pericardial window, because I'd never thought I would do one. We don't have that many traumas in Canada, and even in the ER, it's far more likely that the patient will get shunted upstairs to the OR, not get cut open in the ambulance bay.

  "Scissors!" called Tucker, and I swiped the stork scissors with a brandy-soaked towel before handing them to him. The brass flashed under the light like the last spark from a star.

  "Tweezers!"

  I shook my head. "I don't—"

  Pascale said, "Oh!" and handed me a pair of tweezers. I had no idea how or where she'd conjured them up, but I cleaned them and passed them on to Tucker.

  "I can feel it," said Tucker.

  My heart thumped. I wasn't sure what he was feeling. Blood? The heart itself? If he made a big enough incision, we could pull the heart out of the chest and inspect it for a wound posteriorly, like an Aztec sacrifice, only for a good cause.

  Instead of asking Tucker and distracting him, I watched his hands. What I could see of his hands looked like they knew what they were doing with those tweezers.

  Come on. Come on, I prayed from the bottom of my agnostic little heart.

  Blood.

  Burgundy blood leaked out of the wound.

  Tucker pulled out a quarter-sized clot. Blood poured briskly now, more than 5 cc's. Then he extracted another chunk, undamming a mini river.

  I did my best to mop it up with the brandy towels before I called, "Towels! More towels, please."

  Was this too much blood? No, because the river's trickle narrowed and stopped, and Pascale said, "His heart ... "

  I reached for Mr. Money's femoral pulse. His heart was beating again. The pericardial window worked.

  A smile bloomed across Tucker's face. "We did it."

  "You did it," I murmured.

  "No. We did it."

  I started to smile too. He couldn't have done it without me, just like I couldn't do it without the nurses and staff who saved my rear end every day. Sure, I wished I'd done the cool procedures myself, but we were a team.

  Not a perfect team, but a lifesaving team.

  The plane started to applaud. They whistled. A few of them stomped their feet.

  "That was amazing." Pascale's eyes were still huge.

  "Very well done, doctors,” said Linda.

  Gideon barked, which I took as his version of applause.

  Tucker grinned while I tried to take the BP. I couldn't really hear the Korotkoff sounds, which are the actual heart sounds, over the airplane buzz, but the needle twitched when it was beating. "The BP is coming up to 105."

  "Yes!" He tossed his hair, and—not going to lie—it was incredible that six weeks ago, he'd been the one on the precipice of death, and now he'd dragged another man back from pericardial tamponade. It made me want to sex him up all over again.

  Topaz's little voice climbed above the crowd. "Devaguru says, 'The successful warrior is the average man, with laser-like focus.'"

  What the hell? First of all, was she calling my man average when he'd pulled off the most incredible feat I'd ever seen?

  And secondly, wasn't that quote by Bruce Lee?

  "Now let's reduce the fluid. Just a 100 cc's at a time. I don't want him to bleed any more."

  Scary thought. Especially when Tucker was basically operating with almost no lights or equipment, on an airplane, on a man whose family owned a squadron of lawyers.

  Pascale looked confused. We didn't have a nurse, and we didn't have an infusion pump. I said, "If you want to be precise about fluid, we can draw it up and push it manually through the IV, 20 cc's at a time."

  "No, that's okay. You can just stop squeezing the bag and eyeball how much fluid he's getting."

&n
bsp; I glanced at the bag. It looked like it was down a third, so he'd gotten about 300 cc's so far. Not very much, but with a small needle, the fluid travels slowly. It's like trying to empty the world's biggest water balloon whose neck is the diameter of a baby's pores. No matter how much you squeeze it, it ain't gonna go fast. So with no one squeezing, we'd be at a standstill.

  Mr. Money had lost a fair amount of blood. On the other hand, infusing too much fluid is dangerous in tamponade. In trauma, we use the technique of permissive hypotension, maintaining the blood pressure only high enough to keep the brain going, not so high that their wounds open up again. So I let Tucker call the shots, but I leaned forward to place my finger on Mr. Money's carotid artery. It's more sensitive than the femoral, and I didn't want to hang around in that guy's groin area any more than I had to. “His pulse is 100 and strong.”

  "High five," called the guy in the red b-ball cap.

  Tucker laughed and waved his bloody, blue-gloved hands. "Maybe later, man." He turned to Linda. "We can land the plane any time." Still, he was smiling, relaxed now. He was in victory dance mode.

  She shook her head. "Thank you, doctor. The weather conditions haven’t improved, but we’re finding an alternative city. Are you able to talk to the flight doctor about what happened?"

  Tucker glanced at me.

  I nodded. Yes, I would hold the fort over the actual patient while he radioed in, but I was nervous. The pulse had picked up to 110. No, 120. "Heart rate 120."

  Tucker frowned and turned back to Mr. Money.

  My vision wobbled for a second before it stabilized, and then it seemed to happen again.

  The plane dipped. Its lights went out.

  I swore.

  The only lights left were in people's phones, and that wouldn't last long. The phone lights jigged as if they were swatted mosquitoes coming in for a second landing.

  The plane plummeted like a roller coaster ride.

  Everyone screamed around us.

  "Daddy?" called a little kid.

  The baby bawled.

  Gideon barked.

  But more importantly, I couldn't feel a pulse. I pressed as hard as I could without triggering a vagal reaction. Then I gave up and tried the other side.

  "Tucker, I lost his pulse! Start CPR."

  "No." He jabbed his hand into the left hand side of the neck, disbelieving.

  I threw myself at the chest, arms locked for CPR. "Just tell me if you're coming with the knife, because I can't see anything." Only two people were left with the lights, and the beams were more in our eyes than on the chest, but I didn't care. I was doing compressions. One-and-two-and-three-and-four-and-five—

  "No! I'll explore his heart! I'll cross-clamp the aorta!"

  "Do it," I yelled, trying not to lose count. And eight-and-nine-and-ten—

  "Get me the scissors! Get me the knife! I'm going in there!"

  Magda fumbled for the instruments.

  I stopped CPR when the scissors glinted in Tucker's hand.

  "If I could just get better light in here. If I could see—"

  "Light, please!" I barked, and more phones shone valiantly. The plane lights flickered and came back on, but dimmer than before.

  "Over my right shoulder," Tucker said. "No, damn it. More to the right! I can't see anything!"

  "Give him light!" I shouted.

  They tried their best, but their beams were feeble, and too many heads and shoulders blocked their way as more people crowded the aisle and the surrounding seats, trying to help.

  Tucker couldn't see. He couldn't move.

  While Tucker dug in the chest, I checked my watch. Mr. Money had been down for 43 minutes. Long enough that we were running out of CPR volunteers, and Tucker was trying to operate in a chest cavity in near-darkness.

  No one, not even lay people, thought that Mr. Money was going to make it.

  No one except Tucker.

  I let him burrow inside him for a while. Eventually, even his movements slowed down.

  "Dr. Tucker," I said.

  He was crying. His cheeks shone. He ignored that and looked up at me, almost too calm. "I'm going to call it. Time of death, 8:56 p.m., Pacific Time."

  23

  Magda covered Mr. Money's face and chest with a new, white towel.

  I turned my head and took a breath.

  The air smelled like iron. The blood was starting to coagulate on my gloves. If I wiggled my fingers, dried blood might peel off and fall to the ground like snowflakes made from fire and brimstone.

  Linda spoke in a low voice. "Return to your seats, please. Everybody, we appreciate your help, but you must return to your seats."

  A few people whispered. None of them knew what to do, especially with Mr. Money blocking everything from row 14 onward.

  Gideon whined and strained to get at Mr. Money's remains. The line of men held him back.

  Meanwhile, Tucker's stillness chilled me. I moved closer to him.

  He didn't react.

  I knew that, for forensic reasons, we should leave Mr. Money in situ, but there was no way we could abandon his remains in the aisle, even without Alessandro silently weeping at Mr. Money's feet, tears running down his handsome face.

  Staci Kelly called from first class, "Alessandro, what's going on? Where's Joel?"

  "Back to your seats. Please," said Linda, and her voice broke.

  I said softly, "Do you want help moving him first?"

  Linda's cheeks coloured. "Yes. Of course."

  "Where would you like to put ... Joel?" His name clogged up my throat.

  She glanced up and down the aisle, and I puzzled over her dilemma. He couldn't go in the cockpit with the pilots. First class would mutiny, especially Mr. Yarborough, who was yelling about going home again. We didn't want Joel in the cheap seats, with the maximum number of people gawking. Taking up a bathroom could cause a problem later on, and the galley kitchen would be gross.

  Linda's expression cleared, and she pointed toward the back of the plane.

  Of course it would be near row 33. It should be row 666.

  "I'll help," said Herc, and I felt a twinge of sadness that I didn't know his real name. He'd been so kind. Everyone had given their ultimate, Tucker most of all.

  Tucker stood at Mr. Money—Joel's—feet, watching the blood soak through the new towel on the man's chest. Tucker didn't move aside to let them pick up the body. He did nothing.

  This was worse than him pacing like a lion.

  "Dr. Tucker," I said. If he'd join in the last task of moving Joel's body, maybe he wouldn't feel so helpless.

  He didn't respond.

  "Joel?" called Staci Kelly. "You know I don't want to go back there with that dog, but ... are you okay?

  Alessandro stood up. "Don't come in."

  Staci Kelly's white high heels clicked toward the curtain.

  "Staci, don't come in!"

  Staci Kelly ignored him, tearing the curtain aside. She stood framed in the doorway, and then she screamed so long and loud that all the hairs on my arms jumped to attention.

  The newborn sobbed.

  The Portuguese kid cried out in his own language, covering his ears. His mother clamped hers over his, providing makeshift double ear muffs.

  And still Staci Kelly screamed.

  "Stop it." That scream could provoke a riot. It drilled my eardrums, but I couldn't shield them with my bloodstained hands. I couldn't get through to her because I'd have to climb over Joel J. Firestone’s body to shake his widow. I waved at Pascale, exaggerating my mouth movements in case she could lip read. "Get her out of here! I'll see her in front!"

  Pascale nodded frantically as the plane roiled.

  Staci Kelly fell to her knees, still screaming. Pascale plucked at her arm, but Staci Kelly was larger than she was.

  Then Alessandro stepped forward, picking his way over Joel. I stepped into some leg room to give him space. Tucker still didn’t move, but Alessandro managed to edge by him so he could wrap Staci Kelly in h
is arms and lift her to her feet.

  Her scream warbled and stopped.

  Our ears rang in the sudden silence.

  Slowly, Alessandro guided her back to business class. She tottered ahead of him before she seemed to find her feet, almost like a baby giraffe.

  Pascale followed them and pulled the business class curtain closed after herself.

  And still the crowd didn't speak. They were watching. Waiting.

  Only the airplane's engine roared, and Gideon barked.

  The people's gaze turned to Tucker, me, and the dead man at our feet. Their eyes felt like a physical weight.

  Screw them. I grabbed Tucker's left bloody glove with my right.

  He let me, but he didn't meet my eyes. His face was blank. His spirit had flown away.

  I shook his hand. "Life first. Remember?"

  No answer.

  I gripped his fingers, trying to urge sensation back into them, and more importantly, the spark back into his brain and his heart and his soul. "John Tucker. Our job's not done. We have to help the widow now." I couldn't touch the rest of his body, because we were both spackled in blood, and I didn't want to talk when people were watching and probably filming us, so I tried to speak to him wordlessly.

  Where are you? Come back to me.

  I love you.

  I'm not done with you.

  Come back.

  At last, Tucker turned and stared at me, unspeaking, for a long and terrible second.

  Tucker was my "Weebles wobble but don't fall down" guy. Was he losing it in front of my eyes?

  You can't, Tucker. I need you. The plane needs you.

  I love you.

  You are not allowed to lose it.

  You hear me?

  At last he shook himself, like a dog shaking off water. He squeezed my hand, released it, and reached for Mr. Money's remains.

  My mouth opened.

  Before I could object, Tucker grasped the scissors and the butter knife in his left hand.

  Oh. He was taking the sharps to protect us. It was the first purposeful thing he'd done since declaring the time of death, and it was so like him that I might have cried if my eyes had any tears left.