Hokey and Pokey were munching on the green grass that grew under the large sycamore trees in her mom's front yard. Rich picked up the horses' reins and started leading them to the upper corral.
Returning to the kitchen, Kelly threw the saddlebags over the back of a kitchen chair.
“I have some pain meds and antibiotics in here. I gave Jared some Rocephin yesterday, and I'll give him another one now.”
Kelly drew up a dose of long-acting pain medication and a dose of the antibiotic. The two medications couldn't be mixed together, so Jared would get two shots. “I also want to give some morphine intravenously right before the procedure so he gets quick relief. I don't have a saline lock; it will have to be a straight stick.”
“I haven't heard 'straight stick' in a long time,” said Emma. “It used to be routine for us to put medication right into a vein with just a syringe. I didn't know you young nurses even knew how to do it.”
“We do what we have to in field medicine,” Kelly said.
“Lynn, help me get his boots off,” Emma said.
Lynn stepped back, covering her mouth, then appeared to think about her reaction. She lowered her hand quickly and edged forward. She took one boot in her hands and pulled. Jared grunted softly. She stopped. Emma smiled at the teen and nodded, encouraging her to continue. Continue she did; she got the boot off and then the sock, even though Jared showed some discomfort.
Emma took off the boot and sock on her side.
Kelly positioned a sheet next to Jared from his waist to his ankles and undid the button on his uniform pants. The sheet was laid over Jared's body to provide privacy. Kelly and Emma stood across from each other with their patient between them. They worked in unison to lift Jared's legs at the knees while removing the upper part of his uniform pants. Next they both held the sheet at the top and reached under, pulling his trousers toward his feet. This was a dance that both nurses had performed countless times. Kelly had never nursed with her mother and was reassured to find that pants came off the same way for both generations of nurses.
The water was boiling vigorously and Emma returned to the stove. She put the instruments and a pair of very long, metal tongs into it. The tongs' handles stuck out of the boiling water. “The tongs are sterile where they're submerged, but non-sterile at the handles,” Emma said to Kelly.
“I know, Mom,” Kelly said, exasperated. She pursed her lips but then relaxed her face into a grin, and her mom smiled back.
“I forget,” said Emma. “To me, you're still an eighteen-year-old girl on her way to college. I wasn't around while you were becoming an accomplished nurse.”
Emma opened a package of sterile 4 x 4 gauze and placed it on a clean cutting board. “Lynn, I'm using these pads to make a sterile place to put the instruments. If I can't explain it to Kelly, I may as well teach you.”
“My mom loves to teach. By the way, Lynn, I'm Kelly, Emma's daughter.”
“I thought she was your sister,” Jared joked in a weak voice. “Is every female in your family a Navy nurse?” He let out a single puff of air that was meant to be a laugh but didn't quite make it, turning into a little cough.
“Yes, they are, sir,” Kelly answered, putting her face near his and raising her eyebrows playfully. Amazing how much more confident she felt now, being with her mother.
“You can meet Lynn and the rest of the 'lost patrol' properly later,” Emma said. “Right now, Kelly, we need a scalpel blade in the pot. It should be in that box.”
Kelly found the small box of blades without difficulty. She dropped a number ten blade into the boiling water. Different blade shapes and sizes had different numbers.
Emma stepped to the sink and began to wash her hands. Kelly joined her. Lynn watched, glued to every detail. Both women washed their hands and arms up to the elbows, paying special attention to their fingernails. Emma pointed to a drawer next to the sink and said, “Get two of those towels damp, would you, Kelly?”
Emma took a bar of soap from the back of the sink, then returned to her patient on the table. Kelly and Emma washed Jared's grimy neck and shoulders, then all the way to his waist. Kelly rinsed off the soap with the other damp cloth.
“Lynn, could you please get two clean aprons and two towels out of the kitchen drawer?” Emma asked as she dug through the cardboard box to get a pair of sterile gloves, a pair of non-sterile gloves, and two facemasks. The nurses pulled their hair back with ties and put on the masks. They washed and dried their hands and forearms again, thoroughly. Emma put on the sterile gloves. Kelly would be her mother's helper and didn't need her gloves to be sterile, just clean.
“Jared, can you roll on your right side?” Emma asked.
Jared rolled gingerly onto his side. He wiggled a bit to make his weight-bearing hip and shoulder more comfortable. Kelly reached under the plastic pad and adjusted the pillows, and Jared gratefully sank into the pillows that now supported his head.
Emma stepped up to the table and placed her two hands on Jared's left shoulder, one on the front and one on the back. Methodically she felt around, fingers arched. They waltzed on the flesh around the entrance wound, then they tangoed on the skin of his back. Emma bit her lip and kept the pink flesh held captive there as her search continued. Heavy breathing accompanied the hunt. All of the sudden Emma squinted then closed her eyes tightly, lifting her chin. Her second and third fingers began to alternately tap the skin above Jared's shoulder blade.
Finally, “I think I've found it. Yes.”
That was Kelly's cue to inject the morphine. She put a tourniquet around Jared's upper arm and chose a nice, thick, hand vein for the injection. “Lynn, when I tell you, pull this end of the tourniquet until it pops off Jared's arm.”
Lynn moved to Kelly's side and set her face in a determined way, mimicking Emma. Sturdy girl, nursing material, Kelly noted. That was all she had time to think before her attention returned to Jared. “You aren't allergic to morphine, are you?”
Jared, eyes shut tight, shook his head no.
“I'll tell you before I stick you,” Kelly warned. “It will feel like a rush of warm liquid going through your body, then it will make you feel groggy, but won't make you unconscious. If I give you enough morphine that you don't feel any pain, your breathing would become too shallow. Getting this bullet out is gonna hurt.”
Jared did not change his expression. He didn't acknowledge Kelly in any way.
Kelly steadied the vein with her left hand and gave the skin a quick cleaning. “Okay, here we go.” One fluid movement put the tip of the needle into the vein. “Lynn, remove the tourniquet.” Lynn pulled on the dangling end until it popped, releasing its grip. The blue faded and the red returned to Jared's hand. Kelly pushed the plunger of the syringe slowly, injecting the narcotic.
Jared's eyes opened slightly, then became glazed.
Kelly pulled the needle from his vein.
“Hold right here, Lynn,” Kelly directed, placing a folded gauze over the injection site. “Press it hard so he won't bleed and bruise.”
Lynn reached out hesitantly. Kelly took her index finger and pressed it on the gauze pad. “That's right.” Lynn looked up from her finger to Kelly's face and smiled broadly. Kelly nodded in appreciation and encouragement.
“Looks like the morphine's working,” said Emma. Jared's eyes rolled upward into a strange stare before his eyelids closed softly. His facial muscles softened. “Get those instruments now, would you, Kelly?”
Kelly placed the instruments onto the sterile 4 x 4s. Emma picked up the scalpel blade and attached it to the scalpel handle. Her steady hand made a quarter-inch incision on the back side of Jared's shoulder. He moaned.
“Let's hope this is our new exit wound,” Emma mumbled. She picked up a pair of forceps—the medical name for tweezers—and inserted the tips into the incision. Jared visibly stiffened and held his breath. Kelly held her breath with him. It didn't take Emma long to find her target. Out came a bullet, a .22. Emma dropped the bloody slug onto a gau
ze pad. There was a collective sigh of relief.
“I've seen exploratories for bullets go on for a very long time,” said Kelly.
“Me too,” said Emma. “But this one practically jumped out at me.
“What luck—or should I say skill?”
“I would like to think a little of both.” Emma walked around the table and poked around in the entrance wound. She found two tiny pieces of fabric lodged there and removed them. “Get me some sterile towels to clean this up.” Emma looked at Lynn. “On second thought, maybe Kelly should do that.”
Lynn took a few steps back, putting both of her hands behind her, out of the way but ready to help.
Kelly went to the stove and threw two hand towels into the boiling water. After a few minutes, she used the tongs to take one out and let it drip into the sink until most of the water was out and it had stopped steaming. Emma stepped to the sink, took the towel from the tongs and wrung it out with her gloved hands. She went to Jared and washed the entrance and exit wounds. This made them bleed in earnest again. She placed gauze over the holes then held pressure.
“Get a bottle of wicking gauze out of my box, would you?” Emma asked Kelly.
Kelly opened the small bottle of gauze without touching the inside of the lid or its contents. She edged close to Emma and tipped the bottle up so that Emma could reach in and grab the thin gauze strip with forceps. Emma cut an eight-inch section with the other hand, using sterile scissors from the instrument tray. She neatly packed gauze into the front and then the back wounds. Jared breathed heavily again, clenching his teeth.
“Jared, this gauze wicks any fluids and infection out of deep wounds,” Emma said, but she was looking at Lynn. Lynn nodded to indicate that she understood. “Get two tablespoons of sugar, as clean as you can, please, Kelly.”
Kelly had only heard about packing wounds with sugar or honey to prevent and treat infection. She had seen some recent studies, though, where it was coming back into vogue. She went to the cupboard and got the table sugar. She poured some of it into her mother's hands. Emma packed the sugar into both wounds, entrance and exit, then dressed them with 4 x 4 gauze and tape.
Kelly helped Jared back onto his back. She squeezed his hand tightly. Jared squeezed her hand back.
“What does the sugar do?” Jared asked, slurring his words, not letting go of Kelly's hand. Kelly positioned the fingertips of her free hand in a small groove in Jared's wrist, where she could feel his pulse. She watched his chest rise and fall. “It acts as an antibiotic by drawing fluid out of the germs, in essence pickling them. You know how you can leave jam out on the table? The sugar content is so high that germs can't live in it. Plus, we are sweetening you up for later.”
Jared gave a weak smile.
“Everything went well,” Emma announced. “Kelly, take Jared's vital signs.”
“His pulse is 116 and his respirations are 20.” Kelly had already taken them.
“I need a temperature too.” Kelly stood and turned. She tried to pull her hand from Jared's, but he resisted. Kelly looked back at him and then gave several playful tugs, breaking his grasp.
Emma reached into her cardboard box and handed Kelly an antique mercury thermometer in a plastic case.
Kelly had never used one. She looked at it quizzically.
Emma stepped forward and took the glass rod from Kelly, motioning Lynn to her side as well. She raised it in the air and gave it a good shake in a downward motion, four or five times. She rolled the glass rod between her fingertips until she could clearly see the thin silver line of mercury between the two tiny scales printed on the glass. Satisfied that the line was resting below the 98.6 mark, Emma told Jared to raise his tongue, and stuck the bulbous end of the device under it. “Now try to hold it there and please don't drop it,” Emma urged. “I only have two. It will take three or four minutes to read.”
Jared was groggy from the morphine, but held it as he was instructed. “I could do this all day,” he mumbled to Kelly, “if you stayed and held my hand.”
Kelly took his hand and moved close. While waiting for the thermometer to register, she noticed his face. It was relaxed for the first time since she had met him, his brow no longer furrowed. His beard had grown as well. It was the same color as his hair: a nice, sturdy brown, not coppery, but a luxurious, medium brown. The stubble covered his strong chin up to his high cheekbones. It was a kind face.
After what seemed a sufficient amount of time, she removed the device and held it up to read it. The thin, silver line now reached 100.8. “It's one hundred point eight,” Kelly said proudly.
“That's about what I expected,” said Emma. “The morphine has relaxed him a little and he has a low-grade fever. Now all we can do is keep the wounds clean, give him antibiotics and fluids, and pray.” Emma wished she hadn't said the last two words out loud.
Kelly took care of the final bandaging and placing of a sling. Emma went to work making a bed in the living room, with Lynn in tow.
Emma found Dennis, Jose, Jess and Rich in the front room, looking like expectant fathers. “It's over,” she said to them. “The patient did very well and just gave birth to a .22. Why don't you wait for us on the porch or in the kitchen?”
Kelly helped Jared to his feet, keeping his sheet tucked around him. She guided him into the living room, nearly running into the guys as they came from the other direction. She helped Jared onto the couch.
“I'm going to clean up the kitchen,” Emma announced. She glanced over at Lynn as if to say, And you are coming with me, dear.
“I owe you and your mom big time,” said Jared once they had gone.
“Don't be silly,” said Kelly. “We would have done it for anyone.”
“But you didn't do it for anyone, you did it for me.”
“Well. You are truly welcome. Now, my sleepy friend, off to bed with you.”
“No one has ever uttered such sweet, sweet words,” Jared said as he sank into the couch and pillows. His eyes closed one last time.
Kelly sat on the floor by the sofa. She watched Jared breathe slowly in and out. She brushed a wisp of hair away from his face, letting her fingers linger a bit at his hairline. Be well, she thought. She remembered doing the same for a young soldier in Iraq. She hoped Jared's outcome would be better because she didn't think she could take another young man's death, at least not one she had started to care for. Kelly's face flushed slightly as she remembered her night with Jared in the sleeping bag. She stayed for a few minutes longer.
Chapter 5
Kelly went back into the kitchen to help with cleanup. Her mother had been canning food when they came in, and went right back to her work when the surgery table had been dismantled and disinfected. Kelly walked to the counter and started washing canning jars.
“Now, I wish I had brought a couple of liters of IV fluid from the hospital. He could use it,” said Kelly.
“We can make do with oral rehydration solution and broth for the rest of the day,” Emma said.
“We should let him sleep a few hours first, don't you think? Poor boy looks spent. He'll be back to eating and drinking normally in no time. How many doses of antibiotic do you have?”
“I brought a flat of twenty Rocephin vials from the hospital and a good selection of oral antibiotics too,” replied Kelly. “So we have plenty.”
Rich was the first of the men to speak. “I hope lover boy is asleep.”
“Shhh!” Kelly shot him an exasperated glance. She had always thought that Rich, her mother's neighbor, spoke much too freely and with little reverence to her mother and her. She did as she always did and ignored him.
“What I want to know is, what happened?” asked Emma, looking at Kelly. “It's rare enough I see you with a boyfriend; did you have to shoot one to bring him home?”
“Mom, I need you to sit down.”
“Well, of course, my darling,” Emma said in an apologetic tone.
The men and Lynn sat at the kitchen table. There were six chairs total
; that left them one short. Seeing Kelly needed a chair, Dennis popped up and held his chair for her, then held the empty chair for Emma. Emma sat facing Kelly and took her hands in her own. Everyone else sat quietly, Dennis finding a place on a step stool in the corner.
Sweat trickled down Kelly's temples. She reached up and wiped it away with her sleeve, then unbuttoned her shirt, revealing a T-shirt underneath. She slid one arm and then the other out of her shirt.
Emma gasped, “What happened to your arm? You have bruises everywhere!” She reached out and grasped Kelly's elbow. There were multiple small lacerations surrounding a large, three-inch gash in Kelly's right, upper arm. “Did somebody beat you up?”
“No, Mom. Let me explain.” Tears welled in Kelly's eyes as she told about the terrible plane crash and fires, the EOC, and the hospital burning down. They were riveted by her every word. She continued her story about her trip on the Beeline, finding Jared and shooting the man on the road. Emma stared, aghast. Kelly tucked her head into her mother's shoulder and sobbed.
“I'm so sorry, my darling. I didn't mean to make light of your situation. We have only been inconvenienced here. We had no idea that it could be so bad in town. I am sorry that you went through that.”
“Mom.” Kelly directed her words directly at Emma. “I'm afraid. I don't think there is going to be anything to go back to.” Her lips quivered as tears rolled down her face.
“It's okay now, my baby. You're safe at home.” Emma kissed Kelly on the forehead. Everyone was quiet.
Finally Rich spoke, hanging his head and wringing his hands. “I was afraid of that.”
Lynn burst into tears. Kelly looked up quizzically. Yes, this did affect everyone profoundly. She didn't know if she could deal with everyone else's grief right now.
“Mom,” she said, staring blankly, “I'm so tired I can hardly stand. I'm going to take a nap, then I'll come back and help you.”
“I'm going to wash up that arm of yours.”
“Aren't you going to suture that?” Rich asked Emma.
Post Grid: An Arizona EMP Adventure Page 9
