Fallen

by Ann Simko

  Still staring at his hands, the kid whispered, "I won't go back." His chest heaved with a deep sigh as he slowly shook his head. His hands clenched into tight fists. He raised his eyes and glared at Dakota with fierce determination. "I won't."

  The finality of his statement shocked Dakota. Whoever, or whatever, this kid was running from, he was prepared to die rather than return—but not on his shift. "Just take it easy, all right? Listen to me. The only place I want to take you is to X-ray, capisce?"

  Fear swept across the kid's face again. "You're not safe. Nobody's safe. If they find out I'm here, they'll come for me." Panic returned to his voice. "I have to get out of here!" He struggled to get to his feet. "They'll come for me." He didn't get far, and with a groan, he slid back to the floor, leaving a smear of fresh blood on the previously white wall.

  Dakota could see the fight leave his eyes, and hurried to his side. "You're not going anywhere in your condition, man. Come on, you're safe here. We have a hell of a security team."

  Doris chuckled in the background, and he frowned over his shoulder, "Not helping."

  He turned back. "I won't let anyone hurt you. That's a promise." He felt for a pulse. The skin he touched had the icy-cold feel of someone in shock. "How 'bout letting me check you out, okay? I can help you."

  The kid's eyes dilated again, only this time, it wasn't from adrenaline.

  "Will you do that? Will you let me help you?"

  The kid leaned against the wall and closed his eyes. "Yeah...okay. Doesn't matter, I'm dead anyway."

  "Like hell you are. I don't remember giving you permission to die." He looped the kid's right arm around his neck, slipped his arm around his waist and helped him to his feet. "What's your name, kid?"

  He made a small sound of pain before answering. "Ricco, Michael, J., Private first class, U.S. Marines." He rattled off his sector code and a few other tags Dakota didn't recognize as they moved towards the exam table.

  "Come on pal, just make it to the table and I'll do the rest, I promise." Halfway there, the kid slipped in his blood and they both went down. Dakota called to his staff. "Now might be a good time."

  Doris pulled on a pair of latex gloves as she hurried in, carefully sidestepping the blood on the floor. She circled around Dakota, slid her arm around Ricco's injured side, and together they lifted him to his feet.

  He hissed in pain and leaned into her.

  "I gotcha honey. Just hitch your butt up here."

  Doris helped Ricco swing his legs up onto the narrow table, where he finally collapsed. Dakota grabbed another pair of scissors from the trauma tray and sliced what was left of Ricco's shirt off in one quick movement. He ripped open a package of gauze and pressed it over the still oozing shoulder wound.

  Ricco scrunched his face up in pain, but offered no more objections.

  "Get me two large bore IVs, Normal Saline, wide open."

  "Already on it." Doris palpated the large vein in the crook of his arm and expertly slid a needle into the vessel. She hooked up an IV and ran fluid as fast as Ricco's depleted system could take it.

  Dakota slid a bloody hand to his patient's neck. "Shit! I can't even feel a carotid."

  "IVs are in, saline running wide open in both of them. Want me to call blood bank?"

  "No, I need you here." He turned to the aide who was standing in the corner. She appeared as pale as Ricco. "Blondie, what's your name?"

  "Sandy," she whispered.

  "Sandy, I need you to go to the blood bank and tell them we have a trauma, okay? Tell them I need all the O neg they can give me, and stat. Have you got that?"

  She nodded, but just stood there, her eyes huge and focused on the blood covering the floor.

  "Then move it!"

  Sandy snapped out of her stupor and took off at a run.

  "Doris, get me a set of signs so I can see just how screwed this kid is."

  "Let me get him on the monitor." She ripped open a package of sticky monitor leads and clipped the cables on before slapping them in place on Ricco's chest.

  Dakota removed one hand from Ricco's shoulder and gently slapped the boy's face. "Hey, Michael, you still with me, man?" His eyes fluttered open and he managed a slight head nod. "You gotta help me out here. See, if you die, my reputation is toast around here." Ricco gave him a half-hearted smile before closing his eyes once more.

  Doris pressed a button and the monitor came to life, accompanied by the blare of low-limit alarms. "Shit."

  "Yeah," Dakota agreed. "Michael, you aren't even meeting me half-way, man."

  Ricco didn't comment. He had slipped into unconsciousness.

  "Those numbers are ugly." Dakota pushed a lever on the side of the table, and tilted it so Ricco's head was down and his feet were elevated.

  "Let's start him on pressors, and— Where's Blondie with my blood?"

  Sandy ran into the room and set a box holding a dozen units of blood at Dakota's feet. "Here."

  "Sweet, but my hands are a little full." He looked pointedly at his bloody gloves keeping pressure on Ricco's shoulder.

  Sandy mumbled an embarrassed, "Sorry."

  "I'll take them, honey." Doris spiked another bag of saline as Sandy slid the box of blood over to her.

  "Doris, let them fly as fast as he'll take them, then prep him for a central line."

  Ricco grunted as Dakota leaned into his shoulder, but didn't open his eyes.

  "Let's get this kid warmed up."

  Doris simply smiled. "How are you doing there, Sandy?"

  Sandy appeared as traumatized by her ordeal as Michael Ricco was by his.

  Doris must have understood the signs, because she gave her a reprieve. "Good, I need you to run down to distribution and bring up a thermal unit. They should have one ready for you, okay?"

  Sandy left the room at a trot, obviously grateful for the chance to leave the gory sight.

  Doris grinned and shook her head. "I was never that young." She finished programming the IV pump. "Okay, pressors are running at five mcgs. You want to look for an exit wound?"

  Dakota released the pressure on Ricco's shoulder and removed the saturated gauze. He took a fresh square and wiped the wound. Blood still oozed out the ragged hole, but at a much slower pace. Ricco's body was either doing what it was supposed to and clotting off the injury, or his pressure was so low it couldn't pump anymore blood. Hoping for the former, Dakota left the wound open to air. "Yeah, let's roll him."

  Together they rolled Ricco on his side. Doris held him there while Dakota opened a bottle of sterile water and spilled it over Ricco's back. As the blood washed away, Dakota took a good look at the bullet hole. "Well, that's nice."

  Doris' hands slipped on the blood covering Ricco's body, and she re-adjusted her grip. "Sorry. What you got?"

  Dakota frowned as he examined the wound again. "Our exit wound is an entrance wound. Someone shot this kid in the back." Dakota shook his head. "What the hell is a Marine private doing out at Beaver Dam in the middle of the night, and who the hell did he piss off?"

  "I'm sure I don't want to know." Doris sounded indifferent, but Dakota could see the concern in the way she held the boy, and in the way she told him it would be all right, even though she knew Ricco couldn't hear her. Doris wasn't fooling anyone, least of all, Dakota. "You want to roll him back?"

  "Yeah, but gently, I think his shoulder joint is pretty messed up."

  Together, they eased Ricco down until he lay flat on the table once more. The front shoulder wound had started bleeding again. Dakota sighed and pressed more gauze over it. "Okay, get me a stat H&H on him so I know how low his tank is. Titrate the pressors for something that at least compatible with life, okay?"

  "I can try." Doris smiled and reached for the ringing in-house phone. She listened for a moment, and then tucked the receiver under her chin. "X-ray's ready for him, you want them to wait?"

  Dakota glanced at the screen again and rubbed the back of his neck. "Yeah, I want him a little more stable, and I want that
line in."

  "You got it." Doris relayed the order. She'd just hung up when Sandy returned with the thermal unit. "Do you know how to set one of these up?"

  "Yeah, it's easy. Just take the plastic cover and insert the hose here." She pointed. "Then all you do is turn it on, and hot air blows up the blanket. It's called a Bahr Hugger. Pretty lame, huh?"

  "As long as it warms him up," Doris said. "Just cover his lower half. Doctor Thomas is going to place a central line in his chest."

  Sandy nodded and began setting up the Bahr Hugger.

  Dakota retrieved a trauma procedure kit from the storage bin Ricco had hid behind and tore open the seal. "Can someone kill those alarms for me? They're giving me a headache." Sandy silenced the alarms as he fanned opened the sterile pack on a tray table. "Thanks, much better." He stepped to the sinks to scrub for the procedure. In the ensuing silence, he said to Sandy, "First week?"

  She shrugged as she flipped the switch to turn on the thermal unit. "Second, actually. Does it show that much?"

  "It gets easier, promise."

  "God, I hope so."

  Dakota finished scrubbing, dried his hands, and said to Doris, "I'd like to give him something for the pain, but I don't think his pressure can handle it. Just get me some local, and have anesthesia standing by in case we need them."

  "Already done."

  He pulled the procedure gown from the pack, slipped his arms through the sleeves, and turned his back to Doris so she could tie it for him while he put on a fresh pair of sterile gloves. "Were did you work before coming to Caliente?"

  "L.A. This is nothing. How about you?"

  "Mt. Sinai, New York."

  "Ewww, give me L.A. any day. The blood is the same, but the weather is way better."

  Dakota chuckled as he prepped Michael's chest with green-tinted antiseptic. "Can't argue with that. What made you leave?"

  "I got tired of fourteen-year-olds killing each other over a perverted sense of loyalty and the latest trend in footwear."

  "I hear that." Dakota flushed the line and got it ready for insertion.

  Doris held out a bottle of saline to prime the syringes. "What about you."

  "That's easy, this is home. I grew up here. Hey, look." He motioned to the monitors. "Nothings alarming and his pressure's better. Way not to die on me Private Ricco. Maybe I will give you a little pain med after all. Doris, please give the man fifty mcgs of Fentanyl, and Sandy, call x-ray and tell them they can have him as soon as I get this line in."

  Dakota covered Ricco from head to toe with sterile blue paper drapes, leaving only the right side if his chest uncovered. He slid the needle in just under the clavicle and got an immediate blood return.

  "Nicely done, Doctor. I think you've done one or two of these before."

  Dakota smiled under his mask and capped off the line. "He made it easy—he's skinny. Slap a dressing on it, and let's get him to X-ray."

  Doris picked the sharps off the sterile field, removed the drapes. Ricco hadn't budged throughout the whole ordeal. As Sandy helped X-ray usher him away, Dakota looked up and caught Doris staring at him. "What?"

  "I think you just saved his life. Not bad for a country boy."

  He smiled as he peeled out of the procedure gown and mask. "He's not out of this yet, and besides, I didn't do it alone. Nice work."

  "Right back atcha." She glanced around the room at the blood all over the floor and smeared down the wall. "He sure made a mess of my trauma bay, though."

  Dakota chuckled as he tossed the gown and mask into the trash receptacle. Then he remembered something. "Hey, did you find any ID on him?"

  "No wallet." She reached behind her where the tattered remains of Ricco clothing lay. "Just these." She handed him a set of dog tags.

  He took the tags, turning them over in his hands. They appeared to be standard military I.D. tags—rectangular aluminum discs embossed with his name, birth date, blood type, social security number, and bordered by a rubber frame to keep them from making noise—but something didn't look right. "That's weird." He brushed both the dried and fresh blood off the tags with a gauze pad, held them in the light and read them again.

  Doris paused from cleaning the exam table. "What is it? You've got that look on your face."

  He raised his eyebrows. "I've got a look?"

  "Oh, yeah. Every time something doesn't add up, you get it. You've got it now."

  "I didn't know that." He glanced down at the dog tags again, then back to Doris. "It's probably nothing. Just a typo, I bet."

  She waited for an explanation.

  "The dog tags." He felt stupid bringing it to her attention, but she was right. It bugged him when inconsistencies couldn't be explained.

  "What about them?"

  "The birth date isn't right. It's got to be a clerical error. It's the only explanation for it."

  "Hang on. Let me see." She washed her hands before taking the tags. "What the hell? These say he was born in April, 1898."

  "Like I said, it's a mistake."

  Doris nodded, but her expression didn't agree. "Yeah, maybe."

  "Maybe?"

  "Well, yeah, it has to be, but I don't know."

  "Now you're the one with that look," he said.

  "This is weird. I was in the military for ten years. I mean, God knows they make mistakes, but not like this. These are usually the one thing they get right."

  "Looks like they got it wrong this time."

  "Obviously." She handed him the tags.

  "Yeah, well, mistake or not..." He tossed the dog tags up in the air, caught them in a tight fist, and smiled at Doris. "At least these make him easy to find."

  They busied themselves with the mess in the ER until X-ray returned with Ricco. Doris made sure all her IV's were still intact, while Dakota inspected the boy and checked the numbers on the monitor. "All right, his pressure's better. That's a good sign, for a change. Keep a close eye on him, call me with the lab results, and keep that pressure above ninety. I'll be at the desk if anything changes."

  Doris paused from charting. "What are you going to do?"

  "I'm going to find out who's missing a Marine private." He picked Ricco's dog tags off the desk, took a step, and then stopped. "Wait, what about the gunshot wound? Who notifies the police, me?"

  "Usually, yes, but EMS called them the minute they realized what they were dealing with. Cal should've been here by now."

  Dakota looked up at the name. "Cal... As in Sheriff Calvin Tremont? Jesus, is he still alive?"

  Doris smiled as she went back to recording Ricco's vitals. "Don't let him hear you say that."

  "Well, it's too goddamn late for that!" A fifty-caliber voice echoed down the hallway.

  Dakota turned to find a vision that as a teenager had sent ice coursing through his veins. In a moment, he went from competent trauma doctor to a fumbling mass of insecurity.

  Cal Tremont stood six-feet-six, and in his prime had weighed well over two-fifty. Dakota guessed the scales probably groaned at three hundred pounds when he chose to step on them these days. Most of the muscle he remembered Cal having had rendered to fat, but the voice that approximated the sound of rumbling thunder still served to intimidate him. Even after all these years, Sheriff Tremont was a formidable sight. He strode into the ER, wearing a pair of Carhartt overalls over his pajama top and knee-high muck boots that smelled like the inside of a cow barn. He'd left a trail of manure in his wake.

  "Doris, what the hell is so goddamn important that you have to drag my ass out of bed in the middle of the night?"

  "Gunshot wound, Cal," Doris said, without looking up. "And it's not the middle of the night. It's not even one in the morning."

  "It's the middle of the night when your day starts at 4:00 a.m.." He ran a hand through gray, thinning hair and sighed. "All right, I'm awake. Let's get this over with. Who's the attending doc?"

  Dakota stepped from around the desk and let out a breath. "That would be me." Dakota felt those eyes appraise him. H
e was an adult, he reminded himself, and not a sixteen-year-old high school student caught drinking beer after hours behind the football stadium.

  "Dakota Thomas. By Jesus, they're not too particular who they let practice medicine anymore, are they?" Then to Dakota's infinite surprise, he laughed and held a hand out to him. For a moment shock overwhelmed him, but then one of Cal's meaty hands swallowed his smaller one. "Don't look so surprised to see me still breathing boy. Come on, I'd like to get another hour or two of sleep before I gotta get up again. What ya got?"

  It took Dakota another three seconds to get back up to speed. "Uh, yeah. Marine private found out near Beaver Dam State Park. Gunshot wound to his left shoulder."

  "Is he dead?"

  "No, not yet. Couple more hours and yeah, maybe, but I think we got to him in time."

  "Damn, it's easier when they're dead. You got a name?"

  "Private Michael J. Ricco, U.S. Marines."

  Sheriff Tremont took a pad of paper out of his overall's pocket and wrote down the information. "Okay, fine you reported it. Who's his C.O.? Let him handle this."

  Dakota shrugged. "I was just about to find out. Oh, and Sheriff, you might want to have a look out by Beaver Dam. That's where EMS found him after a couple of campers called it in."

  "Yeah, Doc, I'll get right on that," he yawned. "Don't worry, Dr. Thomas, I'll send my deputy out there in the morning. Doris, I'm going home. Try not to wake me up again tonight."

  Dakota watched the Sheriff walk away, adding to the trail of manure, and shook his head in awe. "Man, has he mellowed."

  "Kind of scary, huh?" Doris said. "Now what?"

  "Now, I find out who the hell Michael J. Ricco is. If we're lucky the Military Police can handle it and we won't have to worry about Cal having a coronary."

  "Works for me," Doris said. "I'll tell you one thing, though. If I remember anything about the Marines, you can bet your ass Private Ricco is in one hell of a lot of trouble."

  As Dakota searched the kid's face once more, the fear he had seen in Ricco's eyes came back to haunt him. Michael Ricco was scared to death and running from something.