by Greg Iles
The bullet, she thought in a haze of confusion. That’s my problem.
Bracing herself for further pain, she fought her way onto her knees and elbows, then crawled to the wall of the cypress trunk and sat against it, just beside the fissure.
What would Tom do if he were conscious? Call a fucking medevac chopper, that’s what. But the phones don’t work. So what else? He’d do what he could on the spot. The bullet obviously hit something important. The pressure’s increasing, so I must be bleeding. Unless my lung has collapsed. . . .
“Pneumothorax,” she whispered, recalling Tom telling her how he’d once saved a car accident victim on the side of a highway by punching a hypodermic needle between his ribs and reinflating the lung.
Sucking chest wound—
She stopped laboring to breathe and forced herself to listen. Then she slowly drew in a lungful of air. She heard no wheeze from the hole in her chest. Not my lung, she thought. Which is good, because I don’t have a needle anyway.
What else could it be?
The bullet had punched through her chest on the left side of what Tom had always called the “midline.” Caitlin was pretty sure the aorta lay under that hole, as well as her heart. If he’d hit my aorta, she thought, I’d be dead now. What else could the bullet have hit? I must be bleeding internally—
A wave of terror hit her as she imagined drowning in her own blood. She saw Penn looking down at her dead body, a froth of clotted blood on her face and chest. Seconds or minutes later she realized that her brain was wavering between consciousness and sleep. That’s not sleep, she realized. That’s death. Think, goddamn it. THINK!
A strange sound came from the interior of the tree. It sounded like a cat with something caught in its throat. An electric shock of possibility flashed through her. Could Tom be choking? If he was choking . . . he was alive.
Caitlin started to crawl back through the opening but found she couldn’t move. Tears of desperation flowed down her face.
“Hello?” called a rough voice from the darkness inside the tree.
“Tom!” she cried, sobbing with relief. “It’s Caitlin! Can you hear me?”
A moan of pain came from the opening. Then Tom said, “Where are you?”
“Outside! I can’t move! I’m in trouble. Can you get outside the tree?”
“I don’t know. My hands are tied behind me. Handcuffed, I think. Is anybody else out there?”
“No. And I’m shot. In the chest.”
Tom was silent. Then he said, “Hold on, darling. I’m coming.”
Half a minute later, Tom Cage knee-walked through the opening in the trunk of the cypress, his hands bound behind him. With his dirty gray face and bloody clothes, he looked like a man who’d just crawled out of his own grave. But to Caitlin he looked like an angel. Her angel didn’t waste time with small talk, either. His eyes were on her chest as he lurched toward her.
“How long ago did that happen?”
“Eight or ten minutes?” she wheezed. “I’m not sure. It was a .22 rifle.”
Tom tucked his chin into his chest as he studied the wound, but then he looked up at Caitlin’s neck.
“What is it?” she asked anxiously.
“Are you having trouble breathing?”
She nodded.
“And pressure in the neck?”
She nodded again, her fear blooming into panic.
Tom leaned forward and studied the right side of her neck. The second he did, she saw his eye darken.
“What is it?”
“Your jugular veins are distended. Touch your neck.”
She put her hand against the skin beneath her jaw, and the bottom dropped out of her stomach. Tom was right—one blood vessel felt like a hose filled near to bursting.
“What’s the matter with me?”
Tom laid his right ear against her chest and pressed it hard against her. “I can barely hear your heart. It’s pericardial tamponade.”
“What’s that?”
“The bullet probably nicked your heart.”
Caitlin shut her eyes tight, trying not to scream.
“Take it easy,” Tom said in his reassuring voice. “Not all heart wounds are fatal. When the heart is hit by something that doesn’t destroy its ability to pump outright, it bleeds into the pericardium—the protective sac around it. As blood flows into the sac, it creates external pressure on the heart, like a crushing fist. What you feel now is that pressure making it harder for your heart to beat.”
Caitlin’s stomach fluttered again. “How long until it stops altogether?”
“That depends on the rate of bleeding. Never, if I have anything to do with it. Do you have any tools with you? Anything?”
“Not much. What do you need?”
“In an ideal world? A six-inch needle to aspirate the excess blood.”
“Sorry, fresh out. Will anything else work?”
Tom bit his lip and looked around the muddy tussock beneath the tree. “We need a tube of some kind, the longer the better.”
“Like a reed?”
“In principle, but it has to be rigid. A reed wouldn’t be near strong enough.”
As he searched the edge of the water with his eyes, she dug into her pocket and fished out the multi-tool Jordan had given her when they parted. With spastic fingers she unfolded knife blades, screwdrivers, a bottle opener, scissors . . . everything but what she needed. Nothing even resembled a needle.
“What’s that you’ve got?” Tom asked.
“A multi-tool. Nothing hollow on it, though.”
“We can use that knife blade. We still need a tube, though. Without it . . .”
“I’m dead.”
Tom grimaced but didn’t argue the point. Instead, he kept searching the area around the tree, although what he hoped to find, Caitlin had no idea.
What else do I have? she thought desperately. A useless cell phone . . .
She remembered the handheld walkie-talkie Mose had carried, with its old-time metal antenna. If she’d taken that, she could snap off the antenna, shove the tube into the bullet hole, and ask Tom to suck the blood out of her pericardium like a gangbanger siphoning gas from a Mercedes. Of course, if she had a walkie-talkie, they could radio Danny McDavitt to airlift them out of this fucking swamp—the deus ex machina of her dreams.
She blinked in silent shock. Harold said he had a walkie-talkie.
Caitlin struggled to her knees, then scanned the ground like a strung-out addict hunting a dropped bag of crack. She saw nothing other than a cigarette butt near a footprint in the mud. No walkie-talkie.
“How’s your breathing?” Tom asked, turning back to her.
“Somebody’s sitting on my chest.”
“I want you to sit down. Your blood pressure’s going to drop as the pericardium fills. Do you feel light-headed?”
She went still, her panic morphing into something close to shock. As carefully as she could, she leaned back against the tree and sat down. She fell harder than she’d intended, scraping her back and landing on something that jabbed her right buttock. Leaning to her left so that she could reach whatever it was, her fingers touched hard plastic, then froze. Wedged tight along the vertical seam of her right pocket was the clear Bic ballpoint she’d borrowed from the waitress in the café.
“Tom!” she cried, taking it out and extending her hand to him. “I hope to God you can pull some kind of MacGyver shit with this thing.”
“Hallelujah!” he said, moving back to her. “It’s thick, but it’s about the best we could hope for.”
“You mean it’s thicker than the bullet hole?”
“We’ll find out. With a .22, the track through your body will have swelled shut, but not permanently. Which means . . .”
“What? Tell me!”
“To drain the pericardium, you’ve got to get the tip of that pen barrel to it. To get that tube to your pericardium, you’ll have to reopen the wound.”
“So?”
“The pain wi
ll be severe. And with my hands cuffed behind me, I can’t do the procedure.”
“Then tell me what to do!”
Tom stared at her for a few seconds, then at the wound. He shook his head slowly. When she began to sob, he sighed and said, “Take the ink tube out of the pen barrel and throw it on the ground. Then open that knife and get ready to use it.”
Caitlin stuck the pen’s point between her teeth, bit down, and yanked out the ink-filled insert. Then she slid a fingernail under the edge of the blue end cap and popped it out. What remained was a strong hexagonal tube about six inches long. Awfully thick for a needle, but better than nothing.
“What about sterilization?” she asked.
Tom actually laughed. “Infection is the least of our worries. You just worry about getting that Bic to your heart.”
“I’ll do it. Tell me what to do.”
Tom knelt before her, then allowed himself to fall onto his butt. As he coached her, his eyes moved constantly between her eyes and the bullet hole. Caitlin felt like she was about to climb Everest or jump out of an airplane, and Tom was the only instructor she would ever have.
“In a clinical setting we’d have an ultrasound machine to guide the needle. You’re going to have to go by feel. But first you have to widen the hole. You’re going to insert the point of the blade, then work it along the track of the bullet by touch—widening the track as you go. It won’t be easy—first because it will hurt like hell, second because the point might hang up in tissue all along the way. You’ve got to ignore the pain, but not altogether, because if you blot it out totally, you might go too far and hurt yourself worse, or pass out.”
“I understand. How do I keep from going too far?”
Tom considered this question. “That’s my job. I’m going to watch you closely. Once you have the blade halfway in, you’re going to guide the pen barrel along the blade, then push both toward the pericardium. Don’t be surprised if you get a squirt of blood. There’s quite a bit of pressure in that sac right now.”
“Won’t there be blood the whole time?” she asked.
“Not that much. When you reach the pericardium, you’ll know.”
She had a feeling he was underplaying the horror she might soon experience.
Tom tried to smile. “All right, let’s do it. If you pass out, this isn’t going to get done.”
Dropping the Bic between her legs, Caitlin picked up the multi-tool and looked at the knife blade. Three inches of tempered steel with a glittering edge . . .
“Don’t think about it,” Tom said. “Just do it.”
As she contemplated shoving that blade into her chest, something froze her hands. She was thinking of a scene from The Texas Chainsaw Massacre in which a character slices open his own palm with a pocketknife.
“Cait . . . ? Come on, girl. You can do it.”
“I know. Fuck it.” She grabbed a twig from the mud, stuck it between her teeth, and bit down as hard as she could. Then she shoved the point of the knife into the bullet hole and pushed it slowly but steadily toward her heart. The twig flew out of her mouth when she screamed. She saw keen empathy in Tom’s eyes, but also resolve.
“Keep going,” he urged. “If you stop, you won’t start again.”
She pressed the blade deeper, and fire seared her chest. When she wiggled the blade in the wound, the pain was nearly unbearable.
“Back it out a little,” Tom advised. “The point’s probably buried in tissue.”
She did as he advised, and blessed relief was her reward.
“Okay, back in. You’ve probably got another inch to go.”
She shut her eyes and drove the knife deeper into the wound track. It was like threading a catheter into your bladder, only a catheter that had been heated to a thousand degrees Fahrenheit.
“Stop,” Tom said. “It’s time to put the pen barrel in there.”
Christ, she thought, shivering from adrenaline. She picked up the clear barrel of the Bic and held it along the knife handle, its narrow end near the bullet hole.
“Be deliberate,” Tom said.
The pen barrel actually hurt worse than the blade, because of its thickness. She groaned and screamed each time the tube penetrated deeper into her chest, and as it disappeared, she realized that her breathing was even more difficult.
“That’s as far as I can go without cutting more,” she gasped. “What’s the fucking problem?”
“Stay still. I want to try something.” Tom bent at the waist and put his gray lips around the pen barrel. After taking a deep breath through his nose, he began sucking as hard as he could.
How can he do that? she wondered. And then she realized something that brought tears to her eyes. Tom loved her. Her, and the child that she carried within her. This procedure was a brutal act of self-preservation, not for themselves alone, but for each other and for their family.
“Keep going,” she urged, as Tom’s face reddened.
Despite his effort, nothing darkened the clear tube. At length, he pulled back his head, gasping for breath. “I’m light-headed. You’ve got to go deeper . . . and faster. I think my sugar’s bottoming out again.”
“Did you finish that peppermint I put in your mouth?”
“I didn’t know I had one. All I knew was I was choking on something.”
“You should find whatever’s left so you can eat it. That’s all I had with me.”
“I’d better look. Getting to the pericardium is only half the job.”
A blast of panic went through her. “What are you talking about?”
“Take it easy. Now, what’s keeping your heart from bleeding out—probably the left ventricle in this case—is the pressure of the blood in the pericardium. Since we have no way to plug the hole in your heart, if we drain too much blood from the sac around it, there’s no more pressure to hold in the blood. You understand?”
“You’re telling me that if we somehow succeed at this, I’m going to bleed to death.”
“No, you’re not. The trick is to drain out enough blood to let your heart pump well, and get your blood pressure back up, but not so much that you bleed to death. We can do that by plugging the end of the pen barrel with a finger. Okay?”
“Okay.”
“But to do that, at least one of us has to be conscious.”
Caitlin gritted her teeth against the fire in her chest. A runnel of blood slid down her bare belly. She looked up at Tom, her jaw set tight. “Go find that goddamn peppermint.”
While Tom knee-walked into the Bone Tree, Caitlin gingerly held the knife and pen barrel as steady as possible in her chest. She feared that any second a jet of blood would burst from the tube, and she would die. To block out that image, she focused on the pain, which reminded her of going to the dentist when she was a child. Her father had always taken her to an elderly practitioner who seemed not to have heard of Novocain. He took forever to fill teeth, and she always felt like he was drilling directly into a living nerve. Ice and fire living together in the heart of a tooth: that was what she felt now beneath her breastbone.
“I couldn’t find it,” Tom croaked, falling beside her again. “Most of it probably melted before I came to. How do you feel?”
Caitlin nodded, unwilling to waste breath answering.
Tom gave the buried steel an appraising look. “Time to try again.”
She took a deep breath, then drove the steel and plastic still farther toward her heart. When she’d probed as deeply as she dared, Tom leaned down again to begin sucking, but before he could, dark blood spurted into his eyes.
“Oh, my God!” Caitlin cried, as the blood kept coming. “Oh, shit. I’m sorry!”
Tom pulled away and shook the blood out of his eyes. “Cover the end with your finger! We’ve got to control the flow!”
The jet had slowed to a dribble by the time she capped the pen with her fingertip. As she leaned back against the cypress trunk, she realized that Tom was right: unless one of them remained conscious, she would ble
ed to death through a Bic pen. Why couldn’t that waitress have kept the freaking blue cap on it? she thought, picturing a chewed-up pen cap from her junior-high days.
At that moment she remembered the tiny flat end plug she had dropped on the ground. She could see it in the mud between her thighs. If she felt light-headed, she could plug the tube with that.
“How do you feel?” Tom asked again, studying her neck. “Your venous distension looks a lot better.”
She hadn’t thought about the result of her efforts, beyond the blood. But the very fact that she hadn’t must mean that her condition had improved.
“It’s better . . . everything’s better. But what do we do now? If we’re going to get out of here, one of has got to climb high enough up a tree to get cellular reception, so someone can pull us out.”
She thought of Carl Sims and Danny McDavitt and their beautiful JetRanger. How easily they could drop down and lift both her and Tom out of danger—
“Tom?” she cried, suddenly afraid.
He’d started coughing violently, and as she gaped in horror, he rolled onto his back, fighting for air.
“Tom! Roll over on your stomach!”
He didn’t seem to hear her. Caitlin tried to push herself off the ground and go to him, but she didn’t have the strength to change positions, especially while holding the pen in place. If she wasn’t careful, she’d fall over and not be able to get up again.
Tom had finally stopped coughing, but he was no longer moving either. His face was gray except for where her blood still marked it, and his eyes were closed. A chill like the one Caitlin had felt inside the tree when she first recognized him went through her again. Only this time, she feared she was right.
“Tom?” she said, almost pleadingly. “Tom, say something.”
He didn’t move.
“Tom, please!” she screamed. “Don’t leave me! TOM, WAKE UP!”
CARL ASSURES ME THAT Danny is pushing the envelope as far as he dares, but the JetRanger slides over the tops of the cypress trees at a maddeningly slow pace. Ever since I learned that Caitlin left the service station with a young black man, I’ve tried to convince myself that she knew what she was doing and that she’s all right. But every neural fiber that drives my instinct tells me she’s not. In the heat of chasing a story, Caitlin sometimes loses the judgment that serves her so well the rest of the time.