“Oh, I will be in just a few minutes. Don’t you worry about that, Sweet Pea,” he replied coolly as he grabbed his junk.
She quickly wiped her eyes.
“Let me at least help him before you press your dirty sweaty flesh all over me!” With his view of Hoplite partially blocked, and his eyes trained on Heather and her pleas, the man didn’t notice Carlos slowly training his weapon. “Please!” she implored once more.
Without warning, the .45 caliber Sig snarled to life from between her legs. The sudden gust of warm air from the shockwave startled her to the point that she physically jumped.
When the echoes stopped, Hoplite declared, “Get his gun. Make sure he’s dead.”
Heather quickly ran over and removed the man’s pistol from his hand as he gurgled through his last remaining breaths. Without thinking, and full of fear, anger, and adrenaline, she hit him twice in the chest and once in the head.
Satisfied, she greedily grabbed the med supplies and sprinted back to Hoplite. She hastily went to her knees, opened the kit, and searched for the compresses and wraps.
She quickly applied a compress of gauze to his bicep and wrapped it with an ace bandage to keep it in place.
“This might hurt a little,” she declared as she rolled him up on to his side once again.
The torrent of expletives he let fly surprised her, but wasn’t all that unexpected. Moving just as methodically as she had been taught by Carlton and Basilia, she didn’t waste time trying to retract the bullet with the forceps. Heather tore his shirt open and applied a thick wad of gauze to the 9mm diameter hole.
“Hold this she declared,” and tucked his right hand under the left bicep to keep the absorbent material in place.
She didn’t want to have to move him again and decided to address the million dollar ass shot at the same time. Not bothering to find the scissors or a knife, she tore away the material of his pants. Heather efficiently packed the third injury site and prepared the elastic ace bandages. Then she turned her attention to the chest wound.
As she assessed the entry point, she paused. “I’m so sorry, Carlos. This was entirely my fault.”
“No it wasn’t,” Hoplite replied. “I didn’t scan the rest of my surroundings like an idiot and got hit.”
Turning her away from pity, Carlos removed the bandage. “Can you see the bullet? It might not have penetrated that deeply since it went through my arm and the side of my vest.”
“Your breathing is labored. It’s deep enough for me not to mess with.”
“Damn it!” he declared angrily. Thinking quickly, he asked, “Did Carlton put a chest seal in the kit?”
Heather searched through the contents rapidly.
“Should say something like Halo or Bolin on the package,” he instructed.
“Bolin chest seal kit, got it!” she decreed.
“Good girl. Now open that up and apply it to the wound. Place the three one way valves directly over the entry point. Then we’re gonna pray we can get back to the farm.”
Heather haphazardly tore open the packaging, removed the seal, and peeled away the plastic protecting the sticky surface.
“Ready?” she asked.
“Do it,” Carlos answered as he flung the bloody remnants he had been holding in place.
Through his gritted teeth, she pressed the adhesive into place, making sure it was secure, and then rolled him onto his back. After he was flat again, she quickly tied the ace bandage to secure the gauze on his butt.
He groaned in response as she jostled his body trying to get the wrap from underneath him, but managed to contain the vulgarity.
Heather knew nothing about human anatomy, but she knew enough to realize that the round was most likely in his left lung. After several minutes of terror induced treatment, she had successfully field dressed all three wounds and covered him with an emergency Mylar blanket to ward off hypothermia.
Her body didn’t know what to do with all of the emotions. Fear, panic, and relief all coursed through her veins. She’d been shot at, the man she loved was bleeding, she’d just killed a guy, and they were stranded in the middle of nowhere. She couldn’t decide if she was going to puke or cry. Thankfully, the rumbling in her gut subsided, but the tears started flowing.
Through the wetness of her eyes she asked, “Do you have anything in your kit for the pain?”
“Carlton issued all of us a fentanyl lollipop,” he winced.
She quickly went through the contents and found the sucker. When she turned back toward him, she saw Carlos staring at her longingly.
He half chuckled as the sun broke through the clouds above.
“What?” she asked in reply.
“Look at that. You brought me sunshine and gunpowder. Best birthday ever.”
“I’ll give you a birthday present,” she declared as she leaned over and passionately kissed him on the lips.
When she withdrew, he decreed with a devilish smile, “Got the girl too.” Then he promptly passed out.
Heather traced her fingers across the side of his face, memorizing every line and scar. When they were resting on his rising chest she quietly wept. Not sure if he would ever see the light of day again, she leaned into his ear. “I love you,” she whispered gently.
“Tape the lollipop to the back of his hand,” her father stated from behind her. “He’s going to wake up as soon as we move him and we’ve got a twenty plus minute ride to the farm.”
His daughter started balling with relief.
* * *
“Clear the room!” Carlton declared as he, Josh, and Heather carried Hoplite into the farmhouse.
When the call came in from the checkpoint, he and the Martinez family, along with Joss all worked quickly to clean and sterilize the kitchen as best they could. The table had been scrubbed, dried, and draped in fresh linens. Any devices running or charging on the marine batteries were removed from Bryan and Chester’s ‘mini-grid’. Tools, instruments, tubing, and bandages were laid out neatly. Every light, regardless of wattage, was relocated to aid in the pending emergency surgery. All that had been missing was the patient.
No sooner had the limp body turned the corner as Basilia grabbed Heather and Josh and whisked them to the living room recliner and couch.
“Hey!” she extolled the doctor. “I need to be with him!”
Calmly, the matriarch replied, “You want to save his life?”
“Yes!” she decreed emphatically.
“Good, then sit here while I draw some blood. We might need it and we might not. Either way, it takes time… and that’s something we don’t have.”
“How do you know we even match?” she stated confused.
“What do you think we’ve been doing out here for the last six months? Just sitting around dolling out lemon balm?”
Heather shrugged.
“Young lady, we’ve typed and cross matched every single person living on this farm, most of the residents in town, and about a third at the lake. As soon as they said it was Carlos we knew who would match and who wouldn’t. Now sit there and let us work,” she concluded forcefully. Then Basilia sighed at her lack of compassion and bedside manner. “You’ll be standing by his side in about twenty minutes, okay?”
“This is what we have to work with, Carlton,” Joss declared as she waved her hand over the piles set neatly on the kitchen counter.
There were separate stacks of pre-packaged sterile instruments, bandages, tubing, various gauge needles, bottles of betadine and Chlorhexidine solution, as well as small vials of numbing lidocaine and antibiotic creams.
“Got a chest tube in any of that crap?” Carlton asked as he walked over and began inspecting Basilia’s stash.
Joss reached into the mostly unpacked tub labeled ‘Medical Supplies’ and produced four.
“Okay, let’s get to it.”
As Josh’s arm was being prepped, he called out to the corpsman, “You guys seen Lt. Stokes or Gregg?”
“Eustace is at the pa
rk and Gregg and James are training recruits at Fox. Why?” Carlton asked.
“Get him fixed up quick, then grab some shut eye,” Josh declared. “I have a feeling it’s going to be a long couple of days.”
The two looked at him quizzically through the cased opening. Josh motioned to the pair. “Don’t stare at me. Do your job!”
Shaking it off, Carlton looked over at Heather and said, “We’ve got this.” Then he looked back at Joss. “Ready?”
She nodded.
“Do exactly what I tell you. We don’t have time for twenty questions during the procedure, so save ‘em for later. Go to the sink and scrub everything up to your elbows like you’ve never scrubbed them before. Then I want you to remove his body armor. Here,” he declared, “Take these scissors and cut off his shirt after the vest is removed.”
Then Carlton paused and began mentally ticking off the tools he’d need. Alright, time to show them my smash and grab routine. One scalpel with an 11 blade, one chest tube, a bucket, a four foot length of rubber tubing, three pairs of Kelly clamps, 1.0 or greater silk sutures, gauze, and a pump of some kind if I can find one.
The former corpsman confidently grabbed each of the items and began setting them off to the side. As he prepped everything they’d need for all Hoplites wounds, he solved his own issue by flipping the medical supplies bin over, emptying its contents, and placing it under the table as a bucket. She watched in amazement as his hands quickly located the spot for the chest tube.
“I’m gonna go quick so pay attention.”
Joss nodded.
“Beginning at the collar bone, start counting ribs on your way down to the mid-axillary line... one, two, three, four ribs. This area right here,” he declared as he gestured, “This is the triangle of safety. There’s nothing major in here. Typically we insert the tube between the third and fourth intercostal space. However, he’s already got a hole near there so I’m going between the fourth and fifth. Pick a spot on the mid-axillary line that relatively aligns with the nipple and mark your spot.”
Carlton grabbed the unconscious man’s left hand and moved it up to place it under his head.
“And don’t forget arm placement,” the former corpsman concluded.
“First things first, sterilization. We need gloves, some gauze, and the Chlorhexidine solution.”
Joss ripped two pairs from the box and handed him one. The duo quickly inserted their hands and seated their fingers. She then removed the pads and grabbed the bottle of Chlorhexidine solution. He took the items as she produced them and set everything on the sterile table.
“Okay, slowly remove the Bolin chest seal,” he ordered as he busied himself with removing items from their packaging.
“Shit!” she declared and quickly stuck her finger in the hole that was now seeping bloody fluid. “He’s leaking!”
“Mother –!” Hoplite hollered as her finger was jammed in.
“Carlos!” Heather shrieked. “You’re awake!”
“Yeah I’m awake!” he retorted as he started to move his arm out from behind his head.
“Leave that up there, Captain,” Carlton commanded. “We’re gonna insert a chest tube and drain that excess fluid out.”
“The bandage was holding all of that in, Joss,” Basilia said compassionately from the other room.
“Go ahead and remove your finger,” the corpsman whispered as he reassured her.
Hoplite hollared in protest.
No sooner had she removed the plug as Carlton inserted his own into Carlos’ frame.
“What the hell, doc!” the patient screamed.
“Just feeling around a bit,” the former medic replied and then paused. “Well I’ll be a monkey’s uncle. I can feel the bullet, gimme some forceps.”
Joss grabbed the instrument and slapped it in his palm efficiently.
“Could I get you to wipe away some of this blood,” he asked as he prepared to remove his digit.
Hoplite whimpered in reply.
She did as instructed, threw the now soaked pads in the tub, and then adjusted a flexible lamp down toward his hand. Carlton slowly removed his finger and let the wound drain on to the table. Eventually it found its way to the improvised bucket.
“Let’s have some of this come out on its own for a few seconds and then I’ll go in after the bullet.”
“Do you mind?” she asked as she motioned at the prone Hoplite.
“Not at all,” he replied and stepped back.
Joss moved in closer and picked up the gauze she had handed him previously. She carefully wiped away some additional blood from around the wound. Before she inserted her own finger to feel for the bullet, she inspected the site.
“I think the entry point is too ragged for re-use. We’ll have to go ahead and do the blunt dissection at a different spot,” Carlton offered. “Sometimes we got lucky, but I already marked the spot I want between the fourth and fifth rib mid-axillary.”
“I agree. Where’s the bullet?” she asked as she looked up at him.
“Run you finger along the third rib posteriorly,” he replied. “Looks like it hit the bone on the way in and went down toward the bottom of the cavity.”
“This might hurt a little, try to stay still, Carlos.”
“Sure thing. Whatever you say, Nurse Ratched,” he answered.
Carlos gritted his teeth as she entered his chest again.
Joss followed Carlton’s instructions and declared, “Got it,” she decreed and slowly removed her finger.
“We should probably remove it before we drain him while the lung is still collapsed and out of the way.”
“What the hell?” Hoplite moaned. Then declared, “This sucks!”
“That’s why you had a hard time breathing, honey,” Heather clarified from afar. “I didn’t want to scare you.”
Carlton and Joss changed places. Carefully and deliberately, the corpsman slowly retraced his fingers path with the forceps through the parietal pleura. Once he was into the chest cavity, he opened the tool’s jaws.
“This would probably be a lot easier with some x-rays to look at,” she stated.
Carlos’ legs started twitching as he tried to keep from screaming in agony.
“Yeah well, you do what you can with what you’ve got,” he answered in reply. Then he called out, “Basilia, find a belt or something to strap him to the table.”
“Oh, oh,” he declared as he closed the tool and captured the foreign brass.
“Remind me not to play ‘Operation’ with you,” Joss deadpanned.
Carlton slowly withdrew the forceps with the bullet locked in his grip. As the bulk of the offending object exited his body through the entry wound, Carlos began slamming his boots on the table. Before she knew what she was doing, Joss dove on top of them.
“Okay. Alright,” the corpsman said calmly. “The worst is over,” he concluded and then dropped it in his hand to inspect it.
“Looks like it’s intact, very little mushrooming. Your boyfriend is one lucky guy,” he declared as he directed the comment at Heather.
“He’s my fiancé,” she corrected as she smiled at Carlos.
Tears were streaming down Carlos’ cheeks from the pain, but he managed to smile back.
“Sorry, Dad,” she offered to her father sheepishly. “It just kind of happened.”
“I know. I was there… remember.”
“But don’t worry, he’ll still totally take Papaw’s test,” she clarified.
Josh smirked.
The Martinez matriarch stood up and decreed, “Alright, you two are good to go. Sit here til the bag is full, about twenty five minutes. I’m going to observe the procedure.”
Carlton adjusted the light over his open hand to review the object further, then he placed in Joss’ open palm.
“Okay, time to numb it, make the incision, and insert the tube,” he said as she stared at the blood coated mass.
“Here’s your belt,” Basilia declared as she strapped Hoplites legs
together.
“Can you check his pulse and BP?” Carlton asked then turned to his nurse assistant. “Here we go. I’m gonna numb the site. That’s the skin, sub cutaneous tissues, deeper tissue layers, parietal pleura, and periosteal surface of the rib below the insertion point. Before I do that, I need you to wipe the area down with the Chlorhexidine solution.”
Carlton then handed her a clamp with gauze captured in its grip and the solution bottle. Without asking for direction, she dumped a healthy portion on the sterile fabric and coated half his pectoral muscle and most of his side. The medic busied himself by loading a syringe with lidocaine.
When he turned around and saw what she had done he exclaimed, “Whoa! I think we’re good!” Then he shifted his attention to the patient. “Sorry buddy, but this might hurt a bit.”
Carlton injected the site in a wheel pattern while Carlos fought through the pain and held on for dear life. In less than sixty seconds it was all over. He checked his watch, then began preparing the chest tube, scalpel, and sutures.
After two minutes passed, the corpsman pinched Hoplite. “Feel that?”
“Only pressure,” he replied.
“Excellent,” he declared. “I’m gonna make a two centimeter incision between the fourth and fifty ribs along the mid-axillary line. Then I’ll take a curved Kelly clamp and began dissecting the subcutaneous tissue and intercostal muscles. I’m basically clearing a path for the tube.”
Joss watched on in amazement as Hoplite remained still and unaffected.
After efficiently working his way through the outer layers, he reached the chest wall. “Now, I gently pushed the clamp on the parietal pleura until it gives and I enter the pleural cavity.”
Setting the instrument down, he inserted his finger. “I do this as a double check to ensure that the lung isn’t stuck against the side.”
Satisfied that it wasn’t, he removed it. More fluid followed. Carlton quickly picked up the 24 French sized tube that he had clamped at both ends.
“Now, for a hemothorax condition, which is when there’s blood between the chest wall and the lung, you want to guide the hose basally, or down,” he instructed as he slid one end in and detached the leading clamp. “If it were a pneumothorax, that’s air, aim it up. Always make a mental note of the measurement on the side once it’s inserted. That’s the fasted method to tell if the tube is moving.”
By the Dawn's Early Light Page 22