Skidding to a halt, the boy said, “Please! Let me go!”
Her nails dug into his skin. “I can’t. I need your help. They need your help.”
She glanced around the boxy room that moments before had exuded the welcoming charm found in small-town cafés across the country. Blue chintz curtains still flounced in the windows, tables were still set with mason jars full of artificial sunflowers, and the requisite photo of the president still hung behind the counter, though knocked off center.
Only now the walls, once the color of summer corn, were airbrushed in blood. Cookie sprawled on the floor, clinging to the shiny aluminum base of a bar stool like a child on a carnival ride. Nevaeh curled in a fetal position, eyes opening and closing as she battled for consciousness. Center stage, the gunman lay prone. And Danny, oh God, Danny sprawled on his back, arms flailed to the sides—a bloody snow angel.
The kid with the hockey mask stopped fighting. He froze, trembled in her grip, gaped at her with a face that revealed not only fear, but a loss of innocence. Until today, evil must’ve been little more than a hypothetical construct to this boy. She wished she could return his innocence to him. She wished she could reclaim her own. The muscles in her throat spasmed around that desperate wish. It was too late for them both.
“What’s your name?” she asked the kid.
“Gabriel.” He stared at the trickle of blood oozing from the spot where she’d clawed his wrist.
Releasing his arm, she cupped his chin in her hand, nudged his head up. Despite the bright daylight in the café, only a thin ribbon of hazel ringed his black pupils. “Gabriel, you can do this. You’re stronger than you think.”
He retched, and a stream of golden bile spewed onto his shoes. His chest heaved a few quiet sobs. After wiping his mouth with his sleeve, he lifted his eyes to hers. “Okay. What do you want me to do?”
Brave boy. “You got a cell? Call nine-one-one.”
He nodded.
“After, go ask Cookie where he keeps his rubber gloves. Don’t touch anything—anyone—until you put them on. The blood could be contaminated. If you find extra gloves, bring them back here. Bring towels, rags—lots of them—and anything else you think we can use.”
Sometimes the clinic ran short of funds, and she moonlighted in the ER for extra cash. She was grateful for that now. And she had another thing working in her favor—she’d faced down evil before. Maybe she’d fallen apart the first time, but she was only a kid then. This time, she wouldn’t fall apart. This time she’d fight back.
Gabriel took off, and she surveyed the room again. Hard to know where to start. With so many injured, triage was the first order of business, and it was up to her to make the tough choices. Those most in need were Danny and the gunman. She headed straight for Danny.
Catching up with her, wearing a pair of latex dishwashing gloves, Gabriel said, “Only two pair.” Waving a flag of yellow rubber in the air, he handed her a wad of rags.
She stripped the second pair of gloves from Gabriel’s hands and tossed them to her brother. “Garth, I need you to watch Nevaeh. Monitor her level of consciousness, pulse, and breathing. Keep her head perfectly still—if her c-spine is injured, she could wind up paralyzed.”
Garth slipped on the gloves. “Got it.”
Kneeling astride Danny, she ripped open his shirt to expose his chest, shouting instructions to Garth and Gabriel as she worked. She bent her cheek near Danny’s lips, and a flutter of air grazed her skin. Good. Next she felt for a pulse in his carotid area. Nothing.
In one swift motion, she jerked Danny’s sweats and briefs down below his ankles and drove her fingers through the thick black hairs in his groin, feeling for femoral pulses. At first she didn’t detect any, but then a thready pulse rippled under her fingertips, and for an instant her heart mimicked the unsteady beat.
Quickly, she assessed Danny’s condition: Unconscious, breathing, faint pulse. Off to a good start. His body was bathed in blood, and she scanned him from head to toe looking for the source, or sources, of bleeding. She spared him nothing, searched every inch of his naked body without shame. As a doctor, this was the part where she was supposed to disconnect, view the patient as an object and move forward without emotion.
Maybe because of their conversation earlier, or maybe because he’d risked his life for her, for all of them, her disconnect switch wouldn’t trip. She looked at him—exposed, vulnerable—and she still saw Danny. She connected with his vulnerability, his humanity, and she wasn’t about to let that goddamn bastard take Danny’s life too.
She localized the source of bleeding: gunshot wound to the left chest. Winding a dishtowel around her hand, she rocked forward on her knees and applied pressure to the wound. Blood soaked through the first rag. She discarded it and started with another. No one tended the gunman. No matter how much she abhorred what he’d done, she couldn’t deliberately let him die. That would make them both the same, give evil the victory.
She pointed at the robber. “Gabriel! Check him for breathing and pulse.” God she hated to do that to the kid, but what choice did she have?
But Gabriel did have a choice, and he shook his head in a violent, repulsed refusal. “I’ll help. But not him.”
“Gabriel—”
“Switch!” It was Garth. “Nevaeh’s breathing easy, Sky. The kid can watch her, and I’ll take that sonofabitch.”
She’d wanted Garth to be with Nevaeh, but the gunman’s condition was more critical. Nevaeh was conscious, moaning. If Nevaeh’s status worsened she’d send Garth back to her. Besides there was no time to waste arguing, so she didn’t. She wound yet another dishcloth around her fist and pressed it against the hole in Danny’s chest to dam the continuing river of blood. Danny still hadn’t moved, hadn’t cried out. “Danny! Danny, can you hear me?”
No response. Keeping her wrapped palm flat against the gushing wound, she jammed the thumb of her free hand below the upper rim of Danny’s eye, felt along the underside of the bone until she reached the groove that housed the supraorbital nerve. Launching her weight forward, she ground her thumb against the notch. A stimulus painful enough to rouse the dead.
No response.
Come on, Danny. Please. She made a fist and rubbed her knuckles across his breastbone, wincing as her nails cut deep into her palm. Danny’s right arm jerked in extension. From his lips she heard a faint moan. That’s it. Stay with me, Danny.
From his position beside the gunman, Garth called out, “I got a pulse here, but he’s bleeding from…shit…looks like he’s bleeding from everywhere. What now?”
“Grab some rags. Look for the source and apply pressure. Just do your best to control the bleeding. He stops breathing, let me know.”
She turned to Gabriel.
He didn’t wait for Sky to ask about Nevaeh’s condition. “Still awake,” he said, his voice remarkably steady. Gabriel knelt with Nevaeh’s head immobilized between his knees, keeping his hands free, stroking her hair, holding her hand. Nevaeh whimpered, and Gabriel bent his head to hers, whispered in her ear.
The sound of Nevaeh’s soft cries reassured Sky. “You’re doing great, Gabriel. Keep talking to her. Let me know if anything changes.”
The rag around her fist was saturated. She started with a fresh one. Only a few seconds passed before it, too, soaked through. Where the hell were the paramedics?
Wailing sirens provided a welcome answer.
Staring out the window, she watched as emergency vehicles pull to the curb, but having beaten the police to the diner, the paramedics were unable to enter because the scene had yet to be secured. While the hollow beats of her heart counted down the seconds lost, the paramedics remained inside their rigs. Precious time was wasted, and three more rags were saturated before the first patrol vehicle arrived, and two uniformed officers finally entered the building with drawn weapons.
She called out to them, “All clear! We’re all clear! Please, get the paramedics in here.”
One of the men, a st
ocky red-haired fellow with acne scars, gave her a brief nod of acknowledgement, but the men didn’t lower their weapons, didn’t move to include the paramedics. They roamed systematically through the room, searching every corner, every crevice for a second gunman. When Scarface reached Sky and Danny, she heard a sharp intake of air. His face drained of color, and his knees buckled. Then his posture went rigid. Lowering his weapon, at last, he reached for his radio, and she heard his words crackle over the airwaves. “Clear! We’re clear! Get them in here now!” His voice broke.
“Officer down!”
As the wave of men in gray pants and blue jackets rolled into the building, Sky stayed with Danny. The bleeding from his chest wound had finally abated, and she tied together dishrags to form a makeshift pressure bandage. Evidence of his massive blood loss lay scattered on the ground in the form of sodden red towels.
But the arrival of the paramedics meant Danny had a chance—if they worked fast and got him to a trauma center in short order. With Danny still comatose, it was critical to protect his airway and supply his brain with oxygen. They should intubate right away. And he needed fluids—badly.
She pinched his loose skin, and when she released her fingers the skin held its tented shape. The gray, chicken-wire appearance of the vasculature, the milk-white translucency of his flesh meant that Danny’s blood was turning rancid in his veins. But if they could get a line going fast, the fluids would correct that.
Now that she had the bleeding under control, she noticed her thighs burning from crouching over Danny’s chest in a single position. Her hair tickled her face, but she didn’t dare touch it and risk further contamination of Danny’s wound. This might not be a sterile environment, but she wanted to keep as clean as possible.
Arching her back, she lifted one leg doggie-style and eased it to the side so that she now knelt beside, rather than astride, Danny. Her hip popped as she reared back on her haunches and saw the pair of super-sized ankles planted before her. She looked up. From her angle, the paramedic looked like Paul Bunyan minus his axe—gigantic, Flagstaff to the max, and very, very welcome.
“Thank God.” She figured she’d fire off a report. They’d intubate, run fluids, and get Danny out quick. Working together, they could accomplish things a lot faster. “Pulse is thready, around fifty. He’s breathing on his own… Respers are shallow at ten breaths per minute. GCS—”
“I’ll take it from here, ma’am. Step away from the victim, please.” The paramedic shooed her with his hand.
She remained on her knees. She’d neglected to identify herself to Mr. Bunyan. “I’m a doctor and—”
“You a trauma surgeon?”
“No, but—”
“Then get the hell out of my way, sweetheart.” The paramedic’s equipment hit the ground with a thud, and as he stepped forward, she took a knee to the face.
Surprising them both, she landed a karate chop to his ankle. “Shut up and listen! I’m a family doc, but I pull three shifts a month in the ER. I know what I’m doing, and I’m not leaving this man’s side until he’s stable for transport. Now, are we gonna screw around arguing turf, or are we gonna save lives?”
“Save lives.” From behind her came a familiar voice.
Twisting her neck around, she nodded her gratitude when she saw Mac. Steven McDougal, “Mac”, had been around a long time. He and Sky had worked together often, and when Mac had decided to take a shot at med school, she’d written him a recommendation. Just last week he’d gotten his acceptance, and to celebrate he’d taken her for a ride in his rig, showed off all his latest gadgets to her.
“Ignore Paul. He’s a prick. You’re a bloody mess, Doc. You hurt?”
Another time Sky might’ve been amused by the irony of the big guy’s name, but not today. She reached for the gloves and disposable stethoscope Mac held out to her and gave a quick shake of her head. “Not hurt.”
“Hey asshole, show Dr. Novak a little respect,” Mac said.
“Dr. Skylar Novak? Aw hell.” Paul turned his palms upward. “I’m sorry, Doctor.”
Sky noted Paul’s expression change from one of impatience to one of admiration, but at the moment, she didn’t give a damn. “GCS is five. We need to intubate, now!”
“Let’s move. Paul, you tube him. I’ll grab a pressure and find a vein. Doc, you listen for placement,” Mac said.
And just like that they were a team. It takes a strong ego to make life and death decisions. Sky understood that. At the bedside, any gentle waffler might do, but in the trenches, give her the arrogant prick.
Paul wasted no time. Taking care to minimize movement of the cervical spine, he positioned Danny’s head, inserted his laryngoscope and slid in an endotracheal tube. Sky heard a metallic click and a soft curse. In his haste to intubate, Paul had nicked Danny’s teeth with the steel blade of the laryngoscope.
“Atta boy!” Mac called out.
Paul managed to flip Mac the bird as he hooked up the Ambu bag, seemingly without breaking concentration. Sign of a healthy working relationship.
The rise of Danny’s chest brushed soft hairs across the palms of Sky’s hands. She slid her stethoscope over the lungs, and the steady hiss hiss hiss of artificial breaths reassured her. “We’re all good. Sats ninety-four percent.”
But seconds later Mac yelled, “I still got no pressure and no IV! That’s three strikes for me. This guy’s veins are shut tighter than the wife’s thighs on poker night. I say we roll.”
Sky’s shoulder blades jammed close together. “He’s crashing! We need a line.”
“I hear you, Doc, and you’re welcome to try. But we gotta move. Scoop and scoot.” Mac’s brows drew together. “I spend more than five minutes in the field with a GSW, and my ass gets chewed. And more importantly, this guy’s odds of staying alive drop from zero to less than zero. He’s got one foot on the bank of the river Styx and the other foot on the ferry as it is.”
A bitter tasting liquid burned the back of her throat. She swallowed it down. No point calling Mac out on his lack of sensitivity. Humor in the field was a defense mechanism, and maybe these guys needed the jokes to stay sane. Biting back a harsh retort, she kept her voice easy. “He’s not a statistic.”
She had to believe that. She refused to give up on Danny. But Mac was right; the odds were not good. They couldn’t afford to waste time with an IV. Then she remembered something Mac had showed her last week.
Bingo.
“You got that fancy new toy with you?” Sky asked.
Digging through his equipment, Mac pulled out a blue contraption that looked like a power drill. It was a power drill—for bones. “I like the way you think, Doc. You do the honors. But a gunshot wound…we gotta get him out of here in five minutes, and we’ve already been here three. I’ll give you two minutes more—after that there’s no point anyway.”
She grabbed the bone drill from Mac’s hands. Fingers spread wide, she palpated the bone below Danny’s kneecap until she located the hard bulge she sought—the tibial tuberosity. Just below lay the flattest plane of the tibia. There, the bony cortex was thin and the surface level. Perfect for drilling. Bone marrow was not only rich in vasculature, it would be easier to hit by far than Danny’s closed off veins. If they ran a line through the bone, fluids would flood Danny’s system and restore perfusion.
The drill came with a needle attached. She wedged its beveled edge between her fingertips, angled the drill, and bore down until she felt the needle pop through the cortex of the bone. No time to aspirate for marrow, but it didn’t matter. The needle stood at attention—she was in. “Hook me up!”
Mac whistled admiringly. “Thirty seconds! How do you want your ringers?”
“Wide open.” She rocked back on her heels. With a minute and a half to spare, fluids up, and breathing supported, she allowed herself to raise her head and bat the hair—which had been sticking to her face for the past eternity—out of her eyes. That small movement of her arms set every muscle in her body trembling. Full-bo
dy exhaustion swept over her and her shoulders slumped. Then her gaze fell on Danny’s face, snapping her spine back to a ready posture.
“On three!” Mac said.
As she helped Mac load Danny onto the gurney, Paul squeezed the Ambu bag hard and fast. Out of the corner of her eye, she caught sight of the pulse oximeter. The reading disappeared for a moment, and when the numbers reappeared she squinted in disbelief. Whatever could go wrong… “Wait!”
She auscultated the chest with the stethoscope again. It was quiet, too quiet.
Paul followed her movements with his eyes and shook his head. “What the hell?”
Maybe Paul had pushed the ET-tube in too deeply. A poorly positioned breathing tube could collapse the left lung, mimicking a pneumothorax. But if that wasn’t the case, if the tube was positioned properly, then the gunshot wound had caused a tear—a real pneumothorax—a far more deadly condition. Danny needed to catch a break.
Just let it be the tube. “Pull the tube back,” she ordered.
Paul eased the tube back. But Danny’s sats continued to dive, his pulse rocketed, and his pressure disappeared. No break for Danny today. She was going to have to wing it.
Sky relaxed. She was good at winging it.
“It’s not the tube.” She made a platform of her extended fingers and used her thumb to percuss Danny’s lungs like a drum. “Hyper-resonate sounds on the left. He’s popped a pneumo. Give me a large bore needle. How much time I got?”
“Thirty seconds. Fourteen gauge okay?” Mac held out his offering.
She accepted and jammed the needle in at the mid-clavicular line. A whooshing noise confirmed her diagnosis. A real pneumothorax. Air had accumulated in the pleural space, squashing the heart and lungs. The needle let the air escape and allowed the lungs to re-expand. Danny’s heart rate slowed, and his oxygen saturations climbed. A thrill of hope accelerated the beat of her heart. She threw her hands in the air. “Get the hell out of here!”
First Do No Evil: Blood Secrets, Book 1 Page 3
