by Lou Cadle
The worst surgery was the first, a nasty compound femur fracture with vascular damage. Not only were they both uncomfortable about operating in the open air, where for all they knew a bat overhead might poop into an open wound, but a bad aftershock hit in the middle of the surgery. The surgeon backed off, his hands in the air, and Bash held on to the table to keep the patient from shaking off.
Without McKenna and Haruka, the evening would have been much harder. They refused to leave him alone, so one was always with him as the other scoured the ground for trash and for supplies to sterilize. They seemed to enjoy having something useful to do, and they actually were useful. They ran messages, they took instruments off to soak in bleach, and they brought new supplies. They were getting a nursing practicum without the benefit of the two years of education first. He wondered if either would go on to become a doctor, now, if this night was making them into something they hadn’t been yesterday.
Ridiculous. Of course it was. This night was making everybody over several hundred square miles into someone they hadn’t been at lunch. McKenna kept him updated on the news from outside that trickled in from the paramedics and from people with access to battery powered radios. She had sharp ears and a good memory for detail. Memphis, terrible shape, raging fires sweeping through downtown. St. Louis, better than that but bad enough. Paducah, bad. Even Little Rock and Nashville and Cincinnati had taken serious damage. As with the big quakes here of 200 years ago, it had rung church bells all the way out on the east coast. They’d felt it in Toronto. Millions of people had had their lives changed. Based on what they were seeing here, he imagined tens of thousands had died in the big cities.
The surgeon’s swearing brought his attention back to the moment. “Move the light, would you?” he said.
Bash grabbed a four-by-four package and used it to adjust the maglight in the makeshift lighting stand they’d rigged. Though he’d sterilized the flashlight’s case the best he could, he was taking as few chances as possible and not touching it directly with his gloved hand.
“Better.”
He put the package down and waited for the next instruction.
“I wish we could evacuate this one. This nerve damage needs an expert.”
“Morning, maybe, when helicopters can fly, they say.”
The surgeon snorted. “With all the injured in the big cities? We’ll be lucky if they notice us.”
“Oh, they’ll notice,” Bash said. He had faith that Gale would make their needs clear. The question was, were there resources to respond? Were there enough helicopters available in the whole Midwest to evacuate every serious case to a safe hospital, like in Chicago or New Orleans or Kansas City? He thought not. Not the first morning, at least. And every hour that passed, they were losing golden hours. Like with the head-injury girl, who still hadn’t woken. The pediatrician had his eye on her now.
They finished with the patient and took another, an abdominal injury. He was too busy to think as he set up the IV and prepped the patient while the doctor put him under.
As the surgery began, he wondered how Ms. Witherspoon’s labor was advancing. How Suze was holding up.
The surgeon’s voice cut through his reverie. “I said sponge.”
“Sorry,” said Bash, putting his attention back on the open abdomen ahead of him. He was losing focus.
“Fuck a duck,” snarled the surgeon, but not at Bash. “I’m not going to be able to save this spleen. And he’s going to bleed out if I don’t hurry. Prep for splenectomy.”
“Yes, doctor,” Bash murmured and snapped himself out of his mind-drifting. The next half-hour he worked alongside the surgeon — they were slowly finding each other’s rhythm — and they got the bloody organ out. He added it to a bucket — literally, a square white bucket that had once been used for potato salad at the sandwich shop — of human waste at the edge of their operating area. Forget pathology. This was meatball surgery of the worst sort.
They needed a roof for the surgery. A tent, a fold-up camping gazebo from Walmart. Something. They were out here visible to any passerby, not so much as a shower curtain hiding the patient’s internal organs from view.
The patient was almost done, the closing going quickly, the surgeon muttering about scars, again — poor guy, plastic surgeon, he wasn’t used to stitching with anything less than exquisite care. And that’s when he looked up and saw Gale, standing behind McKenna and Haruka.
He swallowed back a lump in his throat. He wanted to leap over there and hold his husband, to fall apart in his arms. But he couldn’t, not while he was in surgery. And not in public anyway. Still, the urge made him feel weak, set cracks in his carefully constructed fortress of competence and professionalism.
“I’m sorry, doctor, but I need a fifteen minute break after this one,” he said, as the surgeon backed off and ungloved.
“No. That’s fine. I need to take a whiz anyway.”
Now that he mentioned it, so did Bash.
He cleaned up after the surgery as quickly as he could. When he took off the plastic apron and tossed it in the trash, Haruka stood up, holding out her pan for the dirty instruments. He carried them to her, peeled off his gloves, and his mind drifted to the bloody bucket of human bits, wondering how the hell they’d dispose of the accumulation of those.
Then Gale was there, and they were hanging on to each other, and all thoughts of his responsibilities fled for precious seconds.
Gale pushed him away and studied his face. “You’re okay? I mean really okay?”
“Haven’t had time to be anything else,” he said, forcing a smile.
“Yeah, I know. Take care of yourself, too, while you’re taking care of everyone else.”
Bash nodded, but he didn’t know how he could. There were so many people to care for and so few to do it.
He saw McKenna staring at them, and moved a step away from Gale. “How’s it going, kiddo?” he asked her.
“Good,” she said.
He wondered if she’d ever seen two men embrace each other. Probably only on TV, if that. He supposed they should move into the dark and spare people the horror of seeing such forbidden love, screw their narrow little minds. He turned to Gale. “Can we leave Missouri, now?”
Gale laughed. “Not for a few days, at least.” He looked Bash up and down. “You need a new uniform. You’re bloody.”
Bash looked down at himself. “You’re right. I’m probably terrifying the patients.”
“Should I get one from home? I wasn’t thinking when I went there.”
“We still have a home?” His heart lifted for the first time in hours.
“Pretty much, yeah.”
“Because of you. How careful you were picking one, getting the geologist and all.”
Gale waved that off. “You sure you’re okay?”
“You sure you are?”
“Now that I see you, I’m much, much better.”
Bash saw McKenna out of the corner of his eye. “Let’s take a short walk.”
McKenna said, “That pregnant lady is asking for you.”
“Thanks, hon,” he said. “Please tell her I’ll be there as soon as I can.” He took Gale’s hand and tugged him toward the street, then over to the sandwich shop and behind it, out of the view of strangers. They stood, holding each other, rocking each other, for too few minutes.
“I’m sorry, but I have to get back in a minute,” Bash said.
“I heard. Pregnant lady. Take some time for yourself, too.”
“I’m lucky I can find time to take a sip of water.”
“Wear yourself down to nothing, and you won’t be able to help anyone.”
“I know. And the same to you. Have you slept at all? What time is it?”
“Quarter to four.” They walked next to each other, back toward the lights of the makeshift hospital. “And I had a nap until an aftershock woke me up.”
“Those!”
“Be prepared for worse.”
“You know something the r
est of us don’t?”
“I know that in 1811 and 12, they had three earthquakes of 8.0 in a few months. Don’t stand under a brick wall.”
“Is there a brick wall left?”
“Nope.” Gale laughed bitterly. “I’m two or three years late in getting these zoning laws changed.”
“You’ve only been here a year. And you tried.”
“Not hard enough.”
He grabbed Gale’s forearm and gave it a little shake. “Stop it. You did your best.”
Gale made a frustrated sound and led them back toward the hospital. They were nearing the reception area again. “There’s this term in earthquake-proofing a city.”
“Yes?”
“Hardening off. It’s a polite way to say, everything dangerous has fallen down already, and what’s left is pretty good construction.”
“Charming.”
“We’re hardening off here now. You have to go, I know.” Gale took his hand and gave it a squeeze. “Stay safe.”
“You too.” There were a hundred questions to ask, and no time to ask them in. “Can we set a time to meet?”
“I’ll pick you up at, say, two tomorrow afternoon, if you’re still here, or as near as I can make it. Sleep before that, however you can, but we’ll go home for an hour or two then and look around the house while there’s daylight.”
“Deal.”
“I love you.” He mouthed the words.
“Me too. I’m sorry I’ve been such a bitch lately.”
“You’ve been fine. You’re great. We’re great. Stay safe, love.”
“You too.”
Bash watched him walk away for ten seconds he didn’t have to spare, then he turned and wove his way back to his little maternity ward of one. He was going to be later than he promised for the next surgery, but he had to do this, too. And he desperately wanted to go around and give the staff pep talks and make sure no one was falling to pieces.
This first.
Mr. Witherspoon was dozing in his chair as Bash walked up. Melba was pacing still.
“You’ve probably walked a marathon by now,” he said to her.
“I sit down some. But it hurts more when I do.”
“How’re the contractions?”
“Like a session in Abu Ghraib.”
“Are you timing them?”
“That’s why I asked for you. I think I’m in transition.”
He dithered about how honest to be. “It’s been awhile since nursing school. Tell me how you mean.”
She began to tick off items on her finger. “One, I — “ and then she gasped a short breath and quit talking. Her arm shot out and Bash moved forward to give her something to lean on. Her face was set in obvious pain.
“Breathe,” he said, and she shot him a look, but she did take a shaky breath. Bash started counting, one thousand one, one thousand two. From the time he started counting, it lasted 68 seconds.
She blew out a sigh of relief. “Help me sit down,” she said.
He guided her to a chair and squatted down in front of her.
Her husband jolted awake. “You okay, hon?”
“I’ve been better.”
Bash said, “How often are they coming?”
“It dropped under five minutes between. That’s when I asked that girl to bring you over. And they’re hurting more.”
“What I’d give for a midwife,” Bash said.
“What I’d give for an epidural,” Ms. W said.
“Or an anesthesiologist,” he said. “I’ll ask the surgeon about pain meds, I promise, and if there’s anything safe for you and the baby in our stockpile, you’ll get it. This is your first?”
“My first baby, yes. I had an abortion about eight years ago, but real early.”
“We need to see how far you’re dilated. It might be hours yet, or it might be soon, and I don’t want you…” he searched for a nice phrase.
“Poopin’ a baby out on the sidewalk with no warning,” she suggested.
“Now, Melbs,” Mr. Witherspoon said.
Bash jumped in before she could snap back. Ms. W was not in a good mood at all, not that he could blame her. “I’m going to send the pediatrician over here to examine you. That’s as close to an OBGYN as we have.”
“Right here in front of every stranger in town, eh?”
“We could….” He cast his mind about for a way to ensure ten minutes of privacy. He stood up and felt the keys shift in his pocket. “I know,” he said, smiling at her. “Be right back.”
He turned and called “McKenna?”
“Yes, boss,” the voice came.
“I need you guys,” he said, walking toward the voice.
He dug into his pocket and found the two spare sets of car keys he had taken off the bodies of his coworkers. “Out there is the staff parking lot. Here are two sets of keys that match two cars, I don’t know which. Can either of you drive?”
“We don’t drive until we are eighteen in Japan,” said Haruka.
“I can if it’s an automatic,” said McKenna.
“Do you have a license?”
“Does it matter?”
He supposed not, since she’d only be moving it a few feet. “We’ll hope one of these is an automatic, then. Hit the panic button on each key, find the cars, pick the biggest. Drive it out into the driveway and park it over there, by the pregnant lady.” He pointed. “Slowly. And brake in plenty of time to avoid hitting anyone.” The car’s back seat would serve as a bed, and the open door would shield prying eyes. The pediatrician would have to figure out lighting by himself. “You guys are the best,” he said to the girls.
“Damn straight,” said McKenna cheerfully.
As they strode into the night, he wondered where the girl’s mother was. He hoped not dead. He hoped — well, too many people to do hoping for to get started down that road.
He detoured past the surgical area, where indeed Dr. Shah was looking pretty impatient. “Five minutes,” he called at him, and he went to look for the pediatrician. He explained the Witherspoon situation to him, and turned back toward the surgical area as an ambulance pulled up with lights flashing.
A paramedic jumped out. “Emergency here.”
Bash looked around. There was no one else but him to check and triage. He stepped forward. “What is it?”
“Crush injury, lots of bleeding,” said the fellow, a firefighter/EMT. He lowered his voice. “It’s an amputation situation, I think, if we want to save this one.” Bash followed him to the back of the van and watched as the two unloaded a teenaged boy, a tall kid, lean. He was moaning and tossing his head.
“Bring him directly over to surgery,” said Bash, once he had taken a look at the patient. Whoever was up next was going to have to wait. As he walked alongside the stretcher, he said, “We’re developing a medical waste problem. With an amputated leg, it’ll be beyond bad.” Another leg in the bucket, he thought, a little hysterically. “We have sharps, we have bloody bandages, we have a spleen, maybe a leg next. The medical waste service isn’t going to be driving up any time soon. So what do we do?”
“Shit,” said the other man, a fellow in street clothes. “We’ll call it in, see what the chief suggests.”
Bash should have mentioned it to Gale, get him started on it. But they’d had so little time. “We at least need sealable bags. Big ones.”
“Maybe it should be incinerated,” said the street-clothes guy.
“Where?” said the medic.
“Fuck if I know,” said the other.
They were at the surgical area, and the medic ran through the vitals and condition of the patient for Dr. Shah. Bash got ready to drug the poor kid.
An hour later, the teenaged boy was dead, bled out. The surgeon was tight lipped and angry.
“We need blood.”
“We need refrigeration for that.”
“Some way of taking a pint from relatives and getting it into patients.”
“How do we type and match it?”
Bash knew it was not directed at him. “It’s what it is,” he said.
“I hate that phrase.” He drew a deep breath and let it out. “Though I suppose it fits here. We can only do what we can do.”
“That’s right. You’re doing great.”
“I need coffee.”
“There’s some bottled iced tea from the sandwich shop.”
“That’ll have to do, too, I suppose.” He reached a hand up as if to scrub at his face then thought better of it. “Long night.”
Tell me about it, Bash said. He turned around and looked over the makeshift hospital. He thought there were twice the people there had been the last time he looked. He hoped some were visitors, looking for missing family members. Lights, but still no tent. He glanced at his watch. 5:36 “Dawn soon,” he said.
“Like being a resident again, this no sleep business.”
“I feel like I should check with Suze. She’s doing triage for us right now.”
“Sure, go ahead. I’ll get your errand girls to find me the tea.” He glanced over at where Haruka and McKenna sat. Haruka was asleep, her head on McKenna’s shoulder.
“We should let them sleep.”
“We should sleep. But, as you say, it is what it is.”
Exactly. He needed to check his staff and set up shifts. They’d go on 12-hour rotations, maybe. He’d find the best administrator or assistant available and work it out with her, then hold a five-minute staff meeting with as many as he could pull away from patients.
He thought this through as he cleaned up after the surgery, then realized he was staring at a dead body that had to be removed. Damn, he wished they could have saved the kid. He couldn’t be 18, and this morning he had had his whole life ahead of him. Bash would flag down the next fireman or medic and have them zip him into a body bag, and leave a few body bags here, too. He could feel himself detaching from the patients as people and hated it and welcomed it in equal part.
