by Kahlen Aymes
The patient was gurgling, literally drowning in his own blood, and I took over pressing the gauze into the wound. It was quickly saturating.
“How long?” I asked as we wheeled him into the room.
“20:13,” Neil responded, hanging the IV bag on the hook above the gurney. I glanced at the clock. Time was short. Fucking Golden Hour; survival was more likely if we could stabilize the patient within an hour of the injury, and already 23 minutes of that was history. Adrenaline coursed through my veins and my team launched into action as Barry and Neil left the room.
I looked down at the kid. He wasn’t more than 16 or 17 years old, wearing gang colors, and now if his life wasn’t over, he might wish it was. Jane began slicing off his shirt and jeans, moving calmly and confidently, while another nurse stood hooking up the monitors. I had to stop the bleeding or he’d die within minutes. “Start a transfusion. Push two units of O negative.” Usually the attending resident would make that call, but he’d left the ER for his dinner break not ten minutes earlier. “Then page Wagner.”
The wound was a sucking wound—air wheezing sickeningly in and out of the hole in the kid’s chest. I stuck my gloved finger in the wound, trying to ascertain the extent of the damage. It felt contained, mostly penetration trauma with little cavitation. Jane pulled the fabric free of the boy’s body and began examining it. His lungs began to fill more easily, his breathing less labored with my finger sealing the wound.
“It appears to be a single exit wound, right shoulder blade, Ryan, so there should be no fragmentation. It looks clean.” It was too dangerous to turn him over to see what we were dealing with, but there was just a fraction of blood on the back of the shirt, so the majority of the damage appeared to be in the left lung. “Blood pressure is dropping, pulse is weak.”
“Push the fluids,” I began, suctioning as much blood as I could from the wound. Jane appeared at my side with the clotting medication. She set it on the tray next to me and then went to adjust the IVs.
Screams from the reception area warned us mere seconds before the door burst open. Everyone inside was startled as three young men rushed in. They were all banged up, one of them—a bulky black kid with his head shaved—was bleeding profusely. He had one hand holding the gash in his side as he fell weakly up against the wall near the door for support.
A smaller white kid’s face was bruised and swollen. He was nervous, tattoos covering both of his bare arms and neck, while a large Hispanic man wearing a black and white bandana pushed in front of the other two, waving a large butcher knife.
“Get away from that motherfucker, Doc! He deserves to die, and we’re gonna make sure he does. He dies, or you die!” The voice was brutally deep, cold as ice and unmoving; without remorse.
The surface of my skin ran cold and I paused for a split second, glancing briefly over my shoulder to assess the situation. The smaller man had a gun and was waving it around. My eyes met Jane’s across the patient’s body. She continued to squeeze the bag with barely a second’s hesitation in her rhythm and I grabbed the packet of Celox, preparing to continue with my job. Her face was pinched, I could see she was horrified at the young age of the patient; he couldn’t be more than 16. And she was terrified; it showed in the shaking of her hands. Still, she kept working.
“Please put the gun down,” I said. My gloved hands, covered in blood, had a difficult time opening the cellophane packet of medication.
Kari, one of the other nurses, moved forward to the boy by the door of the examination room, who was now close to falling to the floor. He was weak, blood seeping out of his wound to spread eerily over his shirt, a dark trail starting down his right thigh. His eyes were glassy and started to roll back in his head. Stupid fuckers! Such a waste. And for what?
“Get him on a gurney, Kari!” I instructed. “Take him into another examining room!”
There was shuffling outside the room and I could only assume that the staff was moving the other patients out of the ER. At least, I prayed they were.
“No! He ain’t going no where!” The gang leader shouted. He moved around the table where my patient lay, like a predator ready to pounce.
“He’ll bleed out in a few minutes if we don’t attend to him.” My eyes met his without flinching.
“He’s dead already.” The man dismissed his friend with deadly calm. “This little cocksucker stuck him in the gut. Killed my little brother, too, so he has to pay.”
My chest filled painfully as I sucked air hard into my lungs. The smaller kid bounced back and forth on his feet, a small handgun dangling from his hand. I recognized his jittery demeanor and glazed over eyes. He was definitely high. The last thing we needed was for the gun to be dropped and go off with an errant bullet ricocheting around the room. “We might be able to save your friend but you have to let us try.”
“I said! He’s already dead!” The larger man shouted. The fifteen seconds that it took for all of it to go down seemed like a decade. I glanced at Kari, who was kneeling next to the frightened, wounded boy, trying to part his blood-soaked clothes with gloved hands, murmuring softly that he’d be okay. We all knew he wasn’t, even if they did let us treat him.
“What are your names?” I asked, trying to distract the men long enough to figure out what the fuck I was going to do. The kid on the table might live if I could finish what I’d started.
The barrel of the gun painfully nudged the base of my neck, pushing into my flesh and making it burn.
“I’m the Grim Reaper,” the smaller kid said over my shoulder with a cackling laugh. He was so close that his sour breath whizzed past my nostrils. He smelled of whiskey, sweat and blood. His voice was whiney and high-pitched. “If you know what’s fucking good for you, asshole, you’ll stop trying to save that worthless piece of shit. We ain’t fucking around! I’ll shoot you!” He jabbed the gun into my flesh again, harder this time. I couldn’t help but cringe, pain shooting sharply down my neck and shoulder. The leader’s eyes narrowed and his thin lips lifted in an evil grin.
“The doctor is just doing his job!” Jane said. The bravery she showed was admirable, but I could see the horror in her blue eyes, her brow pinched with immense strain. My own heart was thumping sickeningly in my chest as if counting down to my own death. I tried to focus on the kid in front of me, and getting the powder in the wound without attracting too much attention.
“And I’m just doing mine, bitch!” The leader moved forward and shoved her roughly to the floor. She screamed, then fell against the table with a grunt, sending some of the steel instruments clattering to the floor.
“Do you really think you can get away with this?” Jane asked, looking up at the man as she slowly rose to her feet with a wince and positioned herself back at my side. “This is a hospital. There are hundreds of people here. You can’t kill everyone!”
The man laughed, sneering maniacally, his tone sinister and his rotten teeth showing the black discoloration of a meth addict. “I can kill you and everyone in this room, bitch! After that, will you give a flying fuck? Will your family care that you saved this dirt-bag? You’ll be dead; lights out.”
I tried to fill the wound with the medication as inconspicuously as I could but my mind was on one person. I closed my eyes for a brief second and my soul seized.
Julia. Would the last time I spoke to her be an argument on the phone? I never answered her when she told me she loved me. I fucking hated myself in that moment.
For the first time in this nightmare, her beautiful face flashed before my eyes. Our entire relationship passed in front of me in a rapid series of stills. My heart thudded so loudly I thought it would burst from my chest, and my throat tightened, bile rising up until I thought I was going to vomit. I coughed and wiped at my forehead on the sleeve of my scrubs. I realized that if I let this boy die, I’d be breaking my Hippocratic Oath, yet, if I saved him, we’d all probably get killed. We’d probably get killed anyway, I acknowledged. I felt like I was suffocating and wanted to be rid of the
confining surgical mask and eye guard that was standard operating procedure when treating an open wound.
“Aren’t you listening, motherfucker?” A single shot rang out as the small man fired into the ceiling and the women screamed, all of us flinching in unison. The menacing laugh of both men echoed through the stark room. I glanced at Kari, still next to the kid on the floor. His blood was seeping around his lifeless body in a puddle. She shook her head. He was dead. I moved my head toward the door, silently telling her to get out of the room while the criminals were somewhat distracted. She stayed low and quietly opened the door, slipping outside the room.
“We’re listening,” Jane said, more softly now, working to keep the focus on us. Her eyes searched my face and she let go of the bag and began moving around toward the man with the knife. I shook my head at her, but she ignored me. She was so brave, yet my mind was screaming for her to stop. What the fuck was she doing? It’s okay, Ryan, her eyes pleaded with mine.
“Get out if you wanna keep breathing!” One of them said behind the handkerchief that covered the lower half of his face.
The other two nurses looked at me with wide eyes and I nodded. “Go. You, too, Jane.”
She shook her head, her eyes wide and frightened, but determined, as she continued to move around behind me, while I kept my finger in the wound in the patient on the table.
“Come on, let’s take it easy. You’re right.” Jane tried to reason with the unreasonable. “Is he worth any of our lives? What about you? Don’t throw your lives away. You can leave. We won’t call the police.”
I kept my movements to a minimum, trying to thwart any attention to myself so I could continue to work, but it was difficult with no help.
The man laughed bitterly. “Jack, she says she won’t call the cops. I think she wants to be our friend. Maybe she wants to party.”
He grabbed her roughly by the arm and pulled her mask from her face, grabbing her chin roughly and tilting her face. She winced in pain but didn’t make a sound. I paused for a split second but didn’t turn around. “Leave her alone,” I commanded softly.
The man named Jack shoved me roughly and I stumbled and fell hard against the wall. “My boy said stop working, Doctor Do-gooder! Are you fucking deaf?”
I stopped what I was doing and whipped around, knocking the gun away from my neck. The rest of the instruments fell with a clatter on the floor and the gun went off when it clattered to the floor. My heart seized. I was unsure, at first, if I’d been shot or not, as adrenaline raced through my veins.
The young man staggered back and away from me, and the air whooshed from my lungs as the other man put a fist in my kidney, doubling me over. I grunted as intense pain shot through my torso. I fell to my knees, shaking in agony.
“Ryan, stay down. He’s not worth it,” Jane pleaded softly. “Please.” I could see her chest rising and falling with the effort of her breathing, her arms at her side, palms face up as her eyes begged me to do as she asked. I couldn’t. These men were insane with hatred. They didn’t value the life of their friend who bled to death in front of them. They sure as hell weren’t going to listen to reason.
It was all a blur after that as I stumbled to my feet and a flash of steel appeared before me. Jane yelled my name and ran forward, shoving me away with all her might, making me fall off balance and fall backward.
Jane’s scream pierced the air just as pain sliced through my shoulder and right arm. I slammed heavily into the wall with a loud bang.
My vision blurred as resentment and anger welled up inside me. Who the fuck did these bastards think they were? What gave them the right to decide whether any of us would ever see anything outside of these walls? If Jane, now lying on the cold tile floor, her lower abdomen ripped open and pouring out blood, would survive more than this minute or the next? Who the hell were they to decide if I would ever lay eyes on Julia again or if she’d be made a widow on this night?
Sirens screamed outside in the ambulance bay as I crawled over to Jane. Her body jerked and her eyes glassed over, starring up into nothing, blood quickly saturating her scrubs.
“Jane!” I moved over her and lifted the material away. The shirt of her scrubs was slit open and a large cut was made in her pants below her waist. “Jane, you’re gonna make it. Look into my eyes. Stay focused on me, Jane!”
She blinked and opened her mouth but nothing came out. Her pupils were huge and dilated. I knew they’d be unresponsive if I tested them. I pulled off my gloves and reached for a box of gauze bandages from one of the counters and pulled out handfuls of it to press to her wound. She was cut on her lower torso, below her belly button; the huge, gaping slash full of blood that seeped in again as soon as I could mop it up, gushing in time with her heartbeat. Fuck, it was bad. It had to be the abdominal aorta or the uterine or common iliac artery for that kind of pulsing rhythm. There was no time for new gloves, but I didn’t concern myself with the risks. She needed surgery and stat. Sweat was starting to bead on my brow and drip down into my eyes. I wiped at the sting with my sleeve but it did nothing to alleviate the problem and only succeeded in smearing my own blood across my face.
I struggled to keep my voice from shaking. “C’mon, Jane, stay with me.” My heart stopped, her eyes that were staring up at me were fading fast. She wouldn’t make it to the OR at this rate. I had no access to instruments and even if I did, blood was filling the cavity too quickly to see where the artery was cut so I could get a clamp on it. She was bleeding out, her blood seeping down her body and onto the floor, into the knees of my scrubs.
If I wanted to save her, I had one choice. I reached inside her, using my fingers to search for the flow of blood and when I found it, I used my fingers to pinch it off. I needed both hands to secure the artery on both sides of the wound. It was a fumbling remedy. At best, blind and slippery, but it was all I had.
“Jack, let’s go! The cops are coming. Kill that fucker so we can get out of here!”
Somewhere in the back of my mind my subconscious reminded me that the police were already on the scene and that the boy on the table was close to death as well. Worse, that I could be the ‘fucker’ they were planning on killing. In the split second it took for the two men to move around me and plunge the knife into the chest of the kid on the table, I prayed. Prayed I’d be alive. Alive to try to save Jane and to make sure Julia knew how much I loved her.
The kid jerked violently, and I did, too. My first instinct was to jump up and try to stop them, but given my current circumstance at Jane’s side, it was impossible. Jack pulled the knife brutally from the boy’s chest and the air wheezed out of my lungs like I’d been the one stuck. I was helpless. All I could do was listen to them leave and then pray that someone would come through the door. I couldn’t move. To do so would mean Jane would die for sure. My own blood was soaking the sleeve on my right shoulder and running in streams down my arm and mingling with hers. I barely noticed.
“Kari! Kari, get in here! Bring a gurney and get Caleb and Dr. Wagner! Stat! Jane is hurt badly!” I shouted. Kari and Jared burst into the room, followed by three other nurses and the attending.
“Holy shit, Ryan. Have you been stabbed?” Caleb asked as he and a wide-eyed Kari ran forward.
“Forget about me. Jane is critical. Kari, grab some clamps! Tell Dr. Wagner we’ll need Jameson. She needs emergency surgery.” The madness of a scuffle and several gun shots that popped just outside the doors reminded me that it was not over as the police dealt with the gang. My heart felt like it would fly from my chest. I wasn’t sure if the pulse in my hands was mine or Jane’s. This wasn’t some stranger whose life I held, literally, in my hands.
Caleb frantically pulled on some gloves and moved to my side, ripping open the sterile package containing the surgical tools which would contain the clamps, as another group of nurses and doctors rushed in and Dr. Wagner got on his phone and assembled Dr. Jameson and the surgical team. “Oh, my God!” he said.
“Clamp just above the
fingers on my left hand and below them on the right.” I was breathless. “A little higher.” He pushed the open clamp into Jane’s wound. “Higher! Got it? Now the other.”
My colleague clamped off the other side and the others lifted her to a gurney and began working on stabilizing her.
I sighed heavily. I was covered in blood, not sure if it was Jane’s, the kid’s, or my own. My knees felt weak and Kari helped me to a chair, while the others scrambled around Jane.
Caleb ordered fluids and blood, the nurses were rushing around hooking up the equipment and doing CPR. They were in overdrive, and if Jane had a chance, I was confident our team would make the most of it.
“Fuck! Fuck! Fuck!” Guilt crashed over me. Was it my fault that kid was dead? Or that Jane was barely alive? My head tried to wrap around what happened. She moved in front of me just after my shoulder was sliced. No doubt, without her intervention, it would be me fighting for my life.
“Call time of death.” I flushed, thanking God it had come from the other side of the room. It was a hollow, wooden echo that got lost behind the din of the discussion over Jane. Jane would be prepped as soon as they had her stable and rushed in for emergency surgery.
I glanced to my left. The boy didn’t make it; they were pulling a sheet up over his body. Somewhere he had a mother who had just lost her sixteen year-old son to a senseless tragedy.
“Caleb, how bad is she?” I asked hoarsely, but loud enough for him to hear me. I winced. My shoulder was on fire as I gingerly tried to move it. It felt sticky, the blood beginning to clot and crust in the streams down my arm. It was a sign it wasn’t too deep. I’d need stitches, but no major arteries or veins were struck and the muscle, though protesting, worked. I grunted in pain.
“Not good, Ryan. She’ll probably need a hysterectomy. Her insides are like hamburger.”
I had no words. In light of my own weekend quest to make a baby with Julia, and the miscarriage we suffered, I felt Jane’s loss and felt it hard.