On the Edge

by Kerry J Donovan

  Hardy shrugged off his backpack and placed it on the ground at his feet. After a moment’s hesitation while he whooped in air, he opened the backpack and unzipped the padded bag protecting a battery-powered combined cardiac and BP monitor. He sliced open the casualty’s sleeve with the scissors clipped to the bag’s inner flap, unfurled the monitor’s integral blood pressure cuff, and strapped it to the man’s arm. As instructed in the pre-exercise briefing, he didn’t hit the power button.

  “What next?” Jensen asked, his voice calm and low, but carrying over the background noise of battle.

  Good question, darn it.

  The training. Remember the classroom training.

  “Pack the wound and secure the dressing in place,” she answered, panting hard and searching for one of the webbing straps—smaller versions of the ones a haulier would use—in her pack. The glutinous, slippery blood smearing the fingers of her surgical gloves made her actions more difficult, slower.

  Jensen nodded. “You’re the leader. Take charge.”

  Okay, okay.

  “Hardy, run the vitals while I check for other injuries,” she ordered.

  She turned to Jensen. “After we turn him, we’ll force in some fluids to counteract shock and keep the blood vessels open. Then we’ll attach an oxygen mask. Should keep the casualty stable while we’re awaiting evac.”

  As Lara spoke, she uncoiled the strap, wrapped it around the wound and over the dressing, and worked the ratchet until the blood stopped flowing. Not good for the leg over the long-term—restricted blood flow would compromise the tissue below the wound—but as a stop-gap, it would reduce blood loss and might save the casualty’s life.

  Three rifle shots cracked overhead in quick succession. She flinched, but kept working.

  After securing the strap’s locking mechanism, Lara simulated a search for other injuries, working from the centre out, vital organs first, then the extremities. No obvious signs of a headwound. The soldier’s helmet remained in place and was undamaged. No blood near the head or neck.

  Lara mimed checking the alignment of the cervical and thoracic spine. No obvious signs of vertebral displacement. She glanced up at Jensen.

  “No bones broken, no other external injuries. Agreed?”

  Jensen consulted the notes on his clipboard. “Confirmed,” he said and added a few marks to his assessment form.

  Hardy called out the vitals, reading from the cheat sheet pinned to the machine.

  “The patient is … tachycardic and hypotensive,” he said, “No response to questions, probable loss of consciousness.”

  “Numbers please,” Lara demanded—she needed to know how fast the heart was beating and how dangerously low the BP was.

  “Er …” Hardy ran a forefinger down the cheat sheet.

  “Now, Hardy!”

  “Alright, vrou,” he snapped. “Keep your panties on … Heart rate one-thirty-seven. Blood pressure”—he consulted the notes again—“seventy-five over thirty. That help at all, woman?”

  The insufferable fool grinned again, treating the exercise like a game.

  Bloody idiot.

  She tried pulling in another deep breath, but her lungs already burned with the stress of working hard and breathing real dust.

  Take it easy, girl.

  If she let the fool get to her, Hardy would end up becoming a real casualty in a simulated war. A casualty from her boot up his backside.

  While she assessed the patient, Lara took a second to run a self-evaluation. Breathing hard, sweating freely, sticky, blood-soaked fingers shaking. A total wreck. She finally had an understanding, a minor inkling, of what it might have been like in battle. How could anyone survive the real thing and stay mentally intact?

  Ryan and his men had done this for real so many times. It didn’t bear thinking about.

  Lara shuddered and, while the explosions boomed all around her, she drove the thought to the back of her mind. Analysis would come later, when things were quiet. When she could think clearly and examine her reactions.

  “Of course it matters,” she said, gritting her teeth once again. “Thank you.”

  “In short,” Hardy added, goading her, “you’re losing the patient, vrou.”

  “We’re a team, Doctor Krüger! We are not losing this patient. We need to turn him. Get a better assessment,” she said, looking up at Jensen again, once she’d finished drilling Hardy with a scowl. “We need at least one more for the turn. Are you allowed to help?”

  Jensen nodded and signalled to one of the crewman from Charlie Team, who scampered towards them, carrying a stretcher. He dropped it on the ground next to Hardy and raced back to his team.

  Bravo Team would have to turn the casualty with only three people. Not ideal, but possible and, in this scenario, essential.

  “I’ll take the head and call the actions,” Lara said.

  “That’s right, Gracie-girl,” Hardy said so quietly that Jensen, with his back turned as he crawled to the patient’s feet, might have missed it. “You take the head. Bet you’re real good at that, vrou.”

  Hardy’s accompanying snort and double eyebrow hitch annoyed Lara as much as anything he’d ever said. If his antics cost her the assessment, she’d slap the smirk off his smug face.

  Somehow, his improper use of her fake given name added injury to the intentional insult.

  Stroppy arsehole.

  Lara stabilised their patient’s head. Jensen straightened the man’s legs carefully. Hardy did the same with the casualty’s chest and right arm only—the left being pinned beneath the body and inaccessible.

  After a brief lull, the firing started up again, and a cascade of rifle bullets flew overhead. They smacked into the dirt and the sandbags around them. Impossibly, dangerously close. Hardy’s smirk disappeared as quickly as it had arrived. Even he could see the very real danger.

  All the while, Lara kept talking to the patient, explaining what they were doing.

  “Just relax. We’ve got you. Going to turn you onto your back now. Try to relax.”

  The casualty groaned.

  “Ready?” she called to her team.

  Hardy and Jensen nodded.

  “Rotate to the left on three. One, two, three.”

  She took the weight of the patient’s head and concentrated on maintaining its alignment with the shoulders all the way through the one-eighty-degree rotation. Working in concert, they had the patient on his back without incident. Hardy moved the casualty’s left arm to the side.

  Throughout the turn, Jensen kept his eyes on Lara, making sure their movements were correctly synchronised. His skill at handling the dual role of turning the casualty while monitoring the exercise impressed the heck out of her.

  “Stretcher please, Dr Krüger,” she shouted over another concussive roar.

  “Yes, boss.”

  Hardy grabbed the stretcher, freed the multiple retaining clips, and turned back, hovering over the casualty. Almost in slow motion, a huge splodge of sweat dripped from the tip of Hardy’s nose and dropped onto the prone man’s lips.

  The patient grunted and wrenched his head from Lara’s hands. He turned to the side, and spat into the concrete at Hardy’s knees. Hardy yelped and fell backwards, landing backside-first onto a jagged pile of rubble.

  “Damn it all to hell, man,” the casualty shouted, spitting again. “That’s rank, so it is.” He coughed and spat for a third time, splattering the thigh of Hardy’s camouflage trousers.

  Something about the cod Irish accent broke through the pounding artillery fire. She recognised the voice. Would have recognised it anywhere.

  “Oh, for pity’s sake,” Lara shouted, sitting back on her heels.

  Ryan.

  Her Ryan.

  Chapter 2

  Wednesday 13th April – Lara Orchard

  Aarhus, Denmark

  Lara snapped her mouth closed, trying not to gawp.

  For Heaven’s sake!

  What on earth was Ryan doing there? She’d l
eft him at the observation point, with instructions to rest his injured arm. He had no right to be lying in a pile of rubble in the open for everyone to see. What if he’d been recognised?

  During the turn, she’d been concentrating so much on the spinal alignment, Lara hadn’t looked closely at their casualty’s face. Even though he’d plastered it in green and brown camouflage makeup, she’d still have recognised Ryan anywhere. She prayed no one else on the course did.

  She also wanted to tear a strip off him for interrupting her test, but ground her teeth together and kept in character.

  Wait until I get you alone, Ryan Liam Kaine.

  There would be ructions.

  “Sorry, man,” Hardy said, changing from superior and obnoxious, to affable and cool, as he did with every white man he’d encountered on the course. “Didn’t reckon it’d be so hot in Denmark this time of the year.”

  “Do that again, and I’ll be takin’ offence, so I will,” Ryan said, baring his teeth in a pleasant smile.

  “Wipe your face, Dr Krüger,” Jensen barked.

  Hardy glowered at the sergeant, but dragged a forearm across his face, drying the sweat on his sleeve and spearing his carefully applied camouflage makeup.

  The screech of a megaphone sliced through the air. “What’s the holdup over there, Sergeant Jensen?” the assessment co-ordinator’s deep voice boomed out over the PA system from the Centre of Operations.

  Jensen stepped away and spoke quietly into his walkie-talkie. A couple of seconds later, the sergeant returned.

  “We’re resetting to where you turned the casualty,” he said, addressing Lara, ignoring Hardy’s show of dumb insolence. “Please continue with the assessment, Dr Sloane. Your patient needs immediate attention.”

  Yes, he needs attention all right!

  With Jensen reprising his role as the third pair of hands and Lara barking the instructions, Bravo Team resumed the task.

  She held their casualty’s head steady while Hardy fitted a neck brace—and did it with surprising efficiency. Then they changed positions. Hardy took control of Ryan’s head, Lara supervised the next half-roll, and slid the stretcher into position. The three of them carefully manipulated the casualty into the correct, centralised position on the stretcher, and Lara strapped him in place in the correct order—hips, chest, slightly above the knees, and over the ankles. After checking their location and tension, she tightened the shoulder and chest straps. Finally, they placed foam blocks on either side of the head and held them in place with the two remaining straps, at the chin and forehead. Throughout the operation, Lara explained her moves to her patient and for the benefit of the assessment recording.

  For his part, Ryan lay absolutely still, eyes closed. He might well have fallen asleep again.

  “Confirm all secure?” she asked Hardy, who’d watched her fasten the restraints without getting in the way.

  He dipped his head into a nod.

  “Saline drip, please,” she ordered.

  After a moment’s hesitation, Hardy rolled up Ryan’s left sleeve, and examined the pink scar left over from his most recent injury—a compound fracture of his radius and ulna bones, eight centimetres up from his wrist.

  In the weeks since the latest attempt on Ryan’s life, the bones had knitted perfectly, and he’d recovered pretty much full range of motion.

  Without seeing it for herself, Lara would never have believed Ryan’s extraordinary speed of recovery. His powers of recuperation operated perhaps fifty percent faster than the average patient, which was a huge advantage in Ryan’s line of work. The only sign of the wound was the scar where the jagged ends of the fractured bones had burst through the skin, although it was barely visible against the paleness inside his forearm.

  Another rocket flew above their heads. Again, this one failed to explode. Duds.

  “Ready?” she asked, keen to move onto the next stage and finish the test. Tension had pulled the energy from her body. She was flagging.

  Hardy shot her a quick scowl before he simulated inserting a needled into the median cubital vein a few centimetres below the crook of the elbow, and securing it in place with medical tape. He also simulated squeezing the bag to increase the speed of flow of the saline solution.

  At least the conceited fool could do something right.

  “Saline initiated,” he said to Jensen, “full flow established.”

  Lara performed a visual assessment of the patient’s front before palpating Ryan’s chest for damage to the ribcage and his abdomen for signs of bloating which might indicate an internal bleed.

  She shot an enquiring look at Jensen. “Any other indications?”

  The sergeant flipped to the next page of his notes and read aloud. “The casualty has no signs of internal injury, and there is no damage to the thorax.”

  “Any change to the BP or heart rate?”

  “None,” Hardy answered.

  He strapped an oxygen mask over Ryan’s nose and mouth, but didn’t refer to the notes.

  Bloody idiot.

  Lara puffed out her cheeks. If the exercise instructions had allowed them to power up the monitor she’d have been able read the numbers for herself and not have to rely on Hardy to do his darned job properly. On the other hand, it was just as well the monitor was inactive since the machine would have thrown up a cacophony of warnings and given both Hardy and Jensen real cause for concern.

  As a former Royal Marine and Special Boat Service operative, a day rarely passed without Ryan undertaking some form of extreme physical activity—when he wasn’t actually in combat, fighting for his life, defending members of The 83, or saving someone else equally as deserving. As a result of his life-long exercise, Ryan’s resting heart rate matched that of an Olympic triathlete, as did his BP and maximal oxygen uptake. At the very least, the battlefield monitoring system would have flashed up a “low cardiac function” warning—bradycardia. In terms of WHO standards, the reading would have been off the scale, but for Ryan Kaine and the rest of his crew, she would have considered it standard, and indicative of extraordinary aerobic fitness and power.

  Ryan had demonstrated his astonishing force of will during his recent period of rehab. Even with his arm recently broken and in a cast, he’d insisted on working the rest of his body, ignoring her advice for caution. As his self-appointed medic, she’d argued against such an early resumption of his training, but he’d overruled her. He’d been so single-minded in his determination to maintain his overall fitness levels, that three weeks after she’d reset his arm, he challenged her to a race over the assault course they’d created in the dunes surrounding their villa. She’d fully expected to finish ahead of him.

  As it turned out, he completed the tough assault course within thirty seconds of his average time. Lara could hardly believe how fast he’d been. She’d beaten her own record by three seconds, but still finished two hundred metres behind him.

  When it came to physical preparedness, Ryan Kaine took no chances.

  “The numbers please, Doctor Krüger!” Lara insisted.

  Hardy sighed and read the corresponding numbers from his cheat sheet. They told her the casualty was weak, but stable.

  “Thank you.”

  “Next step?” Jensen asked, again looking to Lara for the answer.

  “Call for an evac, stat.”

  Jensen pursed his lips. “Really?”

  Lara searched her memory. Had she forgotten something? No. she’d followed protocol. Safety first, stem the bleeding, the most significant source first, assess the patient, monitor the vitals, and stabilise. Then strap into a stretcher. After that, evacuate to the safety zone.

  She cast her eyes over Ryan, the most familiar patient who would ever be under her care until another recorded explosion shattered her thoughts.

  “Yes,” she said with confidence. “The patient is stable and needs more medical care than we can give him here.”

  Jensen scratched his strong chin. “And if medical transportation is unavail
able?”

  “Dr Krüger and I will stretcher the patient as far from the danger area as possible, while maintaining obs and continuing to pump in the fluids. If he regains consciousness, I might consider analgesic medication.”

  “Intramuscular morphine?”

  Lara shook her head firmly. “Only if I had no alternative.”

  Hardy jerked his head up to stare at her. One eyebrow lifted past his usual frown and disparaging sneer. He opened his mouth to speak, but seemed to think better of it. The arrogant fool probably wanted her to keep digging her own grave and, thereby, fail the assessment. It would confirm all his biases, and he wouldn’t be shy about broadcasting the fact.

  She wasn’t about to let that happen.

  “Because?” Jensen asked.

  Finally, the gunfire stopped again. Lara lowered her voice to answer.

  “IM morphine is too slow-acting for serious trauma, which can lead to delays in effective pain relief and serious side-effects. In the past, medics have repeated and increased the dosage to speed up the onset of analgesia, and patients have died from overdose as a result.”

  Hardy snorted and shook his head, although he still kept his mouth shut tight.

  Jensen made yet another note on his pad. “What is your preferred course of treatment in battlefield conditions, Dr Sloane?”

  Lara glanced down. The corner of Ryan’s mouth twitched in encouragement. She hesitated for a moment. What happened next would likely be the morning’s defining moment.

  “Well … the US Army’s 75th Ranger Regiment has had significant success with their TOA approach.”

  Hardy slumped onto his haunches, closed his eyes, and shook his head slowly. He all but sighed. There was no doubt, the heavily muscled South African didn’t agree with her treatment strategy.

  “TOA?” Jensen asked, making another note. “Continue.”