by Melissa Yi
An idiot who made the flight attendants scream as he cast himself upon Mr. Money. "Let him go!"
Mr. Money's upper half arched. I had to know what was happening, had to orient myself toward the circus going on behind me, so I twisted to glare at him over my shoulder.
Alessandro grabbed me from behind, babbling, "He'll hurt you, you have no idea ... "
"Fuck OFF!" I shouted at him, before Tucker bear-hugged him around the waist and wrenched him aside. Alessandro tripped and fell to the right, nearly crushing Pascale, who'd ducked into an aisle seat, and Linda said, "Leave us alone! You get out of here!"
Now it was Herc's turn to grab Alessandro and spin him toward Mr. Money’s feet.
Doughy guy ducked out of the way, releasing the ankles.
Mr. Money peeled himself off the carpet again, this time rocking his shoulders from side to side, trying to dislodge me.
No help for it. I rose into the air faster than him. Then I landed hard, on his belly, knocking the wind out of him. I felt his torso jolt in response. This was dangerous, especially in a gagged man, but he seemed to have enough energy for triplets.
He was bound by zip ties and gagged by a scarf. He had up to five people holding him down. What more did he need?
Just die already! Or at least stop moving around!
After my world wrestling smack down, Mr. Money shouted behind his gag, but he moved less. Which made my vertigo settle down from Mach 1 to hangover levels.
I took a deep breath and started to ease my hips in the air. People have died from chest wall hypoventilation, the inability to take a deep breath because they can't expand and contract their lungs. Now that Mr. Money was under control, I could stop acting like the human lap belt.
Alessandro pelted back toward me, screaming. Before Herc swung him behind the wall of men again, Alessandro howled, "Get off him! You're killing him!"
He startled me so much that I almost fell directly onto Mr. Money, but I managed to clench my quads in a squat position. What? I hadn't crushed his chest. He was still moving. He wasn't dead. I hadn't killed him.
Had I?
I yanked myself into full standing position, albeit with one foot straddling either side of his body.
Don't be dead. Forget what I said before.
The airplane dropped far enough that my stomach plunged toward my boots, a woman started praying to Jesus, and I stumbled when Mr. Money thrashed between my legs, whipping his body from side to side like an electrocuted eel.
A woman screamed, "He's bleeding!"
19
Who was bleeding? Tucker?
I swung my head, peering over my left shoulder. Double vision swelled up again, and I struggled not to vomit as Mr. Money bucked and kicked my ankle, making me drop down on my butt.
No! I'm trying not to kill him this time!
As I fell, I pitched my weight toward his southern end, not his chest. Herc formed a bumper wall, attempting to catch me, so I half-landed on Mr. Money's upper thighs.
"Watch out, Hope! He's bleeding on your pants."
That was Tucker. He was talking, and saying "he," so Tucker wasn't the injured party.
He must mean Mr. Money.
Mr. Money was bleeding under me. I glimpsed bright red blood on the back thigh of my mauve jeans.
Did I get my period for no reason?
No, I took my pill religiously.
How did Mr. Money start bleeding?
Did I break his ribs when I slammed down on him? Maybe I gave him a pneumothorax, popping a hole in his lung?
Oh, my God. I killed a guy. I mean, I've tried to kill murderers before, but this guy was only hitting us and throwing the dog off the plane. He didn't actually kill anyone that I know of.
Chill, Hope. If you gave him a pneumo, then put in a chest tube.
But how can I install a chest tube on an airplane with no equipment?
I heaved myself up with an arm rest. Herc tugged at my elbow to assist me, and I smiled at him in thanks even as I vomited a bit in my mouth. I swallowed it back down. No time to think about that. How and where was Mr. Money bleeding?
Tucker had ripped the guy's shirt upward. It was a button down, fitted black shirt. It didn't want to clear his nipples. I glimpsed a scarlet stain beneath Tucker's fingers. I yelled, "Get some gloves!"
I dug in the pockets of my red fleece jacket as I plunked down in Margaret Thatcher's seat to get myself out of the way. I only had one pair of hospital gloves on me, but I tossed them to Tucker. He was the one doing the bloodiest work, and he already had an open wound. He would need them.
Mr. Money's chest wound looked bigger than anything from a broken rib. The good news was that it meant I was off the hook. My world wrestling move hadn't done that.
Meanwhile, I defaulted to the ABC's. A is for airway. I made my way to the top end of Mr. Money, although this time, I was the one clinging to seat backs to make sure I didn't trip.
"Cut the gag," I told Magda, who hovered around the head end, her hands in the air.
Reluctantly, she struggled with the gag's knots. Gladys must have put some oomph into it, because Magda could barely work her slender fingers between the scarf and the skin, and Mr. Money was gagging.
"Cut it!" I snapped as I used the seat back to maneuver behind her.
Magda gawked at me for a second. I got the feeling that English wasn't her first language before she answered, "I don't have scissors."
"Get a knife," Linda told Pascale.
I squished into some leg room area so Pascale could dash back to first class. The fetch and carry role is not glamorous, but totally necessary in a crisis.
As soon as she cleared the area, Linda and I shot back into the aisle.
"Land the plane," I told her.
"We can’t, in this weather,” she said. “I can connect you with the flight doctor through the interphone system—"
"What flight doctor?" I brightened up. There were real doctors on the plane?
"Pilots call them on the interphone system. We can't open the cockpit door during a crisis, so I'll have to relay the information between you—"
No way. I didn't have enough spare hands or brain cells to play telephone with Linda, the pilots, and a flight doctor on the ground.
Pascale rushed up behind us with what looked like a butter knife, with slightly sharper teeth, but better than nothing.
Magda immediately backed up so that I could start sawing the scarf with the knife. Although it took forever, I knew Tucker must be doing whatever he could for the bleeding at the chest. I could handle the airway.
I sawed with my right hand and kept tension on the fabric with my left. "Come on, come on," I muttered, and finally, the last filament of cheap polyester gave way. I dragged the ends apart from each other.
Mr. Money's mouth fell open. His chest heaved up and down.
Airway handled for now.
"Breathing?" I called to Tucker, while I checked Mr. Money's carotid pulse. Fast but firm. Good enough.
"I've got a 1 centimetre stab wound in his left anterior axilla and a 2.5 cm one in the left precordial area," he said.
I squinted. My double vision had settled down, but my head still felt like a raw egg being swished around inside a water thermos. It took me a good second to focus on the small incision diagonally below his left nipple. The one in the armpit was even smaller.
Small but deadly.
"That's the box," I said. In trauma, you worry about the heart if the victim got stabbed in the box formed by imaginary lines between the sternal notch on top, the xiphoid on the bottom, and the two nipples on the left and right.
"Yup," said Tucker. Technically, both wounds were slightly lateral to the nipple and therefore just outside the box, but no need to squabble about it. These were potentially dire blows to the heart as well as the lung.
If Mr. Money had been stabbed straight through the left atrium or ventricle, he'd probably have expired within seconds as the blood pumped directly out of his heart. Our t
imeline had expanded to minutes.
We'd have to put a chest tube in. If that didn't work, we'd have to drain fluid from around the heart.
With no ultrasound. No scalpel. Only one set of gloves. Nothing sterile.
"Give me the stethoscope!" I shouted. Someone shoved it in my hand, and I listened desperately, but all I could hear was the roar of the engine and a few distant barks from Gideon, no matter how hard I pressed it to Mr. Money's waxed chest. "I can't hear any breath sounds!"
His chest pumped up and down, so he was breathing even if I couldn't pick up the noise. I lobbed the stethoscope back to Magda.
His chest might have moved less on the left side. It was hard to tell. The best view is from the feet, the worm's eye view that we used for breast implants in plastic surgery. I wasn't flinging myself at his feet for that.
Tucker tried percussion, placing his right middle finger on the chest and tapping it with his left middle finger, but he couldn't hear anything, either. "Trachea's deviated to the right. Let's decompress the left lung," said Tucker.
"With what?" And then I answered my own question. The fastest thing was a needle decompression. Puncture the chest wall and the lung lining, and all the air would whizz out. "Give me the biggest needle you've got! And a pair of gloves!"
Pascale thumped the entire medical briefcase on the nearest seat. I pawed through it. "All I've got are 23's and 25's to do injections. And what are these, one inches?" Fine needles hurt less, but they'd get clogged up by blood and tissue if I stuck them in the chest. The small calibre isn't a big enough tube to let air out, and an inch long needle might not make it through the average North American chest wall. I did find a pair of blue latex-free gloves, which I slid on.
"Those won't do any good," said Tucker. He was still calm. He might even have been smiling when he raised his eyes to mine. "Let's do a chest tube. We've got a knife."
Yeah, a butter knife. I raised my voice. "Does anyone have a pocket knife?" Probably not allowed, but I could always try.
"Yeah!" Compton dug into his back right pocket and extracted a white plastic fast food knife.
Tucker's hand withered in the air. "Ah, thanks, man. I'll use this one instead."
"Your loss," said Compton, carefully replacing the knife into his pocket. That was one weird dude.
Tucker ignored him, holding up the butter knife to the light. "Brandy. I need alcohol to sterilize everything. Give me the highest alcohol content you've got." Pascale rushed to nab a bottle from first class.
"'I am a knife,'" murmured Topaz, and a woman moaned.
Tucker ignored them. "Get me some oxygen tubing and some oxygen," he told Magda. Brilliant. Oxygen tubing would work for the chest tube, not to mention preoxygenation.
When Magda took off, he said to Linda, "Hanger. A coat hanger."
She bit her lip, but she nodded and headed upstream to find one.
"Give me the Penrose," Tucker said to me.
I hesitated. I knew that was the name of a drain in the OR, but not what it looked like or why he needed one now.
"We need to make a one-way valve. Give me the tourniquet!"
That, I knew. I scanned the medical kit for those blue rubber bands that you tie around someone's arm to make the veins stand out. I handed it to him. He stretched it around the oxygen tubing, but the tourniquet was too big. It flopped around the mouth of the tubing.
Now I understood what he wanted to do. Once, as a medical student, I'd treated a small pneumo with my one and only chest tube. The resident had set it up for me, but I remembered the floppy white rubber bit at the end that acted as a one-way valve. When the air whooshed out of the patient's chest, it fluttered open, but when room air tried to rush back into the patient's thorax, it shut tighter than Gretel closing the oven door on the Hansel-trapping witch. This one-way valve would be even more important on an airplane with precarious cabin pressure.
"I need tape to seal this on. Otherwise, we have to make our own three bottle system!"
Whatever that was, we didn't have time for it. "Tape!" I called, but as the flight attendants scrambled, I told Tucker, "Hang on." I hurried to the front, searching for a little girl wearing a black dress with green trim—and more importantly, the mom with a blue balloon, although there was no sign of it in their laps.
"Excuse me. I need a skinny balloon," I told the mom.
She stared at me.
I tried again, in French. "J'ai besoin du ballon, s'il vous plaît. C'est urgent." It always takes twice as long to say something in French, and culturally, it's very rude to run up and start yelling at a francophone, but it couldn't be helped. Tucker was probably taping a Penrose drain to the patient's makeshift chest tube right this very second. "Et si vous avez un ballon propre, ça serait encore mieux."
The mom stared at me from under heavy brown bangs. She clutched her daughter to her chest, and they looked identical in their fear and incomprehension. It was quite possible that they spoke a third language. I frantically mimed blowing up a balloon, looking like a puffer fish, and the girl stifled a giggle in her mother's arm.
At long last, the mother reached between them, poked around in her shiny, black purse and handed me a cylindrical blue balloon.
"Merci! Thank you!" I dashed back to Tucker, who said, "You are a goddess," as I snapped the balloon's mouth onto the end of the oxygen tubing and sawed off the other end.
Since my head was rolling around like a Zodiac on a stormy sea, I didn't feel like a goddess, but I dredged up a smile for him anyway. Tucker would make me feel better on my death bed.
Pascale held a dark bottle that looked expensive. From the look and smell of it, they'd already poured brandy over Tucker's gloved hands, his knife, and the wound, and on the ground, which was gross, but this carpet—this entire plane—would be forensic evidence as soon as we landed anyway. I held out my hands so that Pascale could immerse me in alcohol, too.
Tucker had set the oxygen tubing on Mr. Money's somewhat sterile chest and was trying to hack the other end off it. I pulled on the tube to make it slightly easier to cut and said, "A Foley catheter would be stiffer." Oxygen tubing is pliable, to make it more comfortable to fit around ears and up one's nose, but it would collapse between ribs.
Tucker raised his eyebrows. "You see a Foley anywhere, be my guest."
I glanced at the relatively useless medical kit. "We could ask for a catheter volunteer."
He laughed at my joke. One poor guy on board probably had a Foley catheter draining urine into a leg bag, but you wouldn't stick a contaminated catheter in someone's chest unless you were nuts.
The tubing was now about two feet long and ready to go.
Magda had reappeared with a few white towels. I laid them down, making a keyhole around the base of his sternum. Ideally, we would "prep and drape" Mr. Money, sterilizing the skin and draping the rest of the body to shield it from surrounding microbes, stray vomit, or dog hair.
"This is crazy," a woman muttered.
Topaz's breathy voice answered, "Devaguru says, 'Here's to the crazy ones. The misfits. The rebels ... '"
That was Steve Jobs, but since Tucker and I were both hella crazy misfit rebels, I let it slide.
"I think it'll work as long as I get a trochar," Tucker told me.
Right. If Tucker tried to push oxygen tubing alone inside the guy's chest wall, it would bend all over the place. ("Like a limp dick," a surgeon once pointed out.) Tucker needed metal to keep the tubing rigid as he forced it between the ribs. Hence the coat hanger.
Now my brain was whirling with thoughts of limp dicks and coat hangers. I wanted to puke. Again. I tried to block out Topaz piping, "'... glorify or vilify them. About the only thing you can't do is ignore them ....'" by eyeballing Mr. Money's chest. He was still breathing, but fast and shallow. I took his pulse: same, and at 120. He had his ABC's, but not for long. If this didn't work, he'd die. No pressure.
Come on, coat hanger. What are they, attached to the first class closet or something?
I told Tucker, "The last pneumo I saw was yours."
His face split into a grin because this time, he was the one doing the saving.
Linda rushed up with a metal coat hanger in her hands. I said, "I'll bend the trochar for you."
"Bend it like Beckham," he said, which is also the name of a movie I love, so that earned him a few more points. I know it sounds weird that we were joking, but this wasn't a TV show like ER where you get to cut out all the boring bits. We had to set up properly before cutting open a man's chest.
I reached for the coat hanger. The wire was a lot stronger than in the dry cleaner ones, which made it even harder to manipulate. I needed pliers.
"I'll do it," said Herc. "What shape do you want?"
I beamed and thrust it at him. "A hockey stick. A straight line with a hook at the end, so it doesn't fall into the patient's chest. Thanks."
One of the onlookers made a horrified face, and I realized that I was used to working in hospitals, where minimal civilians overhear me during a code. I'd have to censor myself. I shut my mouth and settled myself on the patient's right, leaving the wounded side to Tucker.
On the upside, Herc was already bending the coat hanger into a hockey stick. Life hack #2: if you're not born Herc-sized, get one on your team to do the honours. One of the orderlies at St. Joe's jokingly calls himself an ogre. Kindly ogres are essential in times of crisis. In the meantime, I took the brandy back from Pascale and baptized the hockey stick hanger before handing it to Tucker. While I rewashed my gloved hands with alcohol, he threaded our trochar through the oxygen tubing and re-bent the wire so it was the correct length.
He whispered, so that only the two of us could hear, "I'm ready."
20
Tucker picked up the knife. He was left-handed, which made it more awkward to operate on the left hand side of the patient. I itched to grab the blade, but I resisted the impulse.