by Ilsa J. Bick
Cursing, Kahayn snatched up a large square of gauze. “Give me a hand here,” she said to the tech as she leaned down hard on the patient’s right arm and started scrubbing at the faceplate, “grab that other arm, get it out of my way. The rest of you, I need a crash cart, stat, and get me an ET tube. As soon as I get this clear, I want this guy wired for sound. Call anesthesia, get them down here, we’re probably going to intubate.”
“Stand down, Colonel!” said Blate. His bullish face was a mottled purple. “That’s an order!”
“You don’t outrank me, Blate.” Kahayn threw the nurses a look. “Go.”
This seemed to be all the nurses were waiting for; they moved fast, one nurse racing off for the crash cart, and the other whirling toward a wall-mounted comm.
“Arin.” Kahayn craned her head over her shoulder. “Did you check for explosives?”
“Colonel Kahayn!” Blate, again. “You are ordered—!”
“Shut up, Blate.” Kahayn tossed aside one stained gauze and wadded up another. Residue’s sticky like tar, like he’s been in a chemical fire, maybe a fuel depot that went up—but this suit, I’ve never seen anything like it. “ Arin, what about it, is he packed? What about contamination?”
“No.” Arin came alive. Taking the distance in three loping strides, he relieved the tech, leaning down hard on the patient’s arm. “Get me restraints,” he ordered, and then to Kahayn: “No explosives, and the suit’s not radioactive as far as we can tell.”
“What about scanners?”
“Colonel,” said Blate.
“Scanners are a nonstarter,” said Arin. The tech returned with brown leather restraints and Arin got busy belting down the patient’s left arm. “The suit’s impervious, maybe lead-lined. We can’t see anything.” Arin threw a restraint around the patient’s left leg as the tech took the right. Then Arin crowded next to Kahayn, threaded leather through a buckle and cinched down the right arm, tight, midway up the patient’s forearm. “Can’t call up anything on tomography, either.”
“We’ve got to get this suit off.”
“Yeah, but those lights, the ones going to red on his wrist, they bug me.”
“You’re thinking countdown?”
“Maybe.” Arin peered at Kahayn over his glasses. “No way to be sure, right? Except we crack it and hope we don’t go boom?”
“That is precisely why you must release this intruder to me,” said Blate.
“Forget it, Blate. Write me up.” She grabbed another gauze. The patient’s faceplate was smeary, but she caught a glimpse of a face. Almost there. “Better yet, arrest me. I haven’t had a decent night’s sleep in a week.”
“This isn’t funny, Colonel.”
“Blate, you idiot! You think the Jabari or an Outlier have the technical know-how for a suit like this? And this junk, this crud on his suit and faceplate, this is for real! This isn’t just charcoal smeared on for effect to trick a couple of your sentries. This guy’s been toasted; he’s been in some kind of fire, and…” She gasped, peered more closely at the faceplate then, cursing, fumbled up a pair of gloves and snapped them on. “Forget this, forget this, I need hands here!”
“Idit!” Arin said. “What about a bomb?”
“No, it’s the suit! Don’t you get it, Arin?” Frantic now, she was running her gloved fingers along the lip of the helmet searching for a catch, a way to get this thing off! “He’s been in a fire! This is a protective suit, and that means he’s had air, but look at the lights! He’s got no air! That’s what they mean! He’s out of air! Let go, let’s go, let’s get him out of this thing now now now!”
She’d found two nibs, felt them give when she pressed down, and gave the helmet a twist. Then she heard a hiss, barely a sigh of escaping air and a suck of suction, a wet sound eerily like the sound of a primate’s cranial cap being pulled away. And then she heard the man’s tortured, agonized wheezes; saw the open mouth and flare of bloodied nostrils as he worked hard trying to pull in air; and then the smell hit her, metallic and very strong.
“My God, there’s blood everywhere. Arin, get a tube down him and bring up the tomos,” and then she and the tech were tugging at the neck of the suit, fumbling with catches, peeling the suit away, jerking them free of the restraints. She registered the clothes underneath, a uniform of some kind and an odd piece of gold jewelry on his left chest, but then she couldn’t think anymore about it because the nurse rumbled in with the crash cart. Whipping around, Kahayn tossed the tech a set of scissors. “Cut his shirt and trousers away, I want these clothes off; I’m going to throw in a CVP line; we need some access, let’s go, let’s go!”
“No!” It was Blate, just behind, and then she heard the unmistakable metallic snick of metal on metal. “Stand down, Colonel! Now!”
The room went so quiet that Kahayn could hear the slow drip-drip of blood from the helmet and the man in his death throes—and he was dying, he would die, there was no question because there was all that impossibly bright red blood, and the bulge of his jugulars and pink foam that frothed his lips. She saw the tech, who stood with his scissors caught in mid-snip; her gaze clicked to Arin, who’d gloved and stood, frozen, with an endotracheal tube in one hand, and in the other, a shiny metal laryngoscope with its curved blade out and locked into position. And then Kahayn turned, knowing already what she’d see.
She was right, but that was no consolation. Because there was Blate, of course, and there were his soldiers.
And there were three rifles centered on her chest, aiming right for her heart.
Chapter
9
Saad’s men lay on rough pallets of torn linen. One had multiple abdominal wounds; his green shirt was soaked through to a dull rust; and he moaned in deep guttural groans that were as regular as a basso foghorn. He was clammy to the touch, and his skin was very cold.
Losing blood fast; probably a lake in there; what have I done, what was I thinking? Lense knew in an instant that she couldn’t help him, and she’d been a fool to think she could. Operate here? In a cave? No anesthesia, no way to keep a sterile field, no tricorder to help with diagnosis, and his anatomy’s probably so different; I can’t do it, I can’t help, and if I can’t help, they’re going to kill me….
She concentrated on the other casualty. This one was sucking air in great gasps that sounded almost agonal, except he was conscious; his eyes bulged and his hands were clapped over a glistening splotch on his right chest. His fingers were streaked with dark chocolate-brown blood.
“Well?” Saad, just behind her left shoulder.
Lense felt sick. “There’s nothing I can do. The one with the gut wound. It’s too involved, and he’s lost so much blood, I don’t know…”
“Yes,” said Saad, his voice neutral as if he’d just been told nothing more interesting than the weather. Then he drew his pistol from his right hip holster in one smooth motion, and Lense froze. The pistol grip was stippled and blocky and fit easily in his huge palm; the metal was matte black and the barrel was square with a round bore. He bent, pressed the muzzle against the wounded man’s temple and pulled the trigger.
There was a tremendous bang that echoed off the walls, an orange spurt of muzzle flash, and the man’s head erupted in a fine brown mist of blood, brain and bone. The air was instantly saturated with the brackish odor of fresh blood, scorched hair, and burnt skin.
“What are you doing?” Lense cried, horrified. She scrambled to her feet. “What have you done?”
Reholstering his weapon, Saad looked at her with a bland, matter-of-fact expression. “You said you couldn’t help. I stopped his suffering.”
“But you don’t just…you can’t just kill a man! You’ve got to try!”
“And how do you suggest we do that? Look around you.” Saad spread his arms in an all-inclusive gesture. “This is only a forward camp, but this is very much like our home. This is who we are. This,”—he indicated an orange medical kit Mara had retrieved—“is all we have. You say that you’re a phy
sician. Then surely you can appreciate the cold calculus of life and death. We don’t have the luxury of pretending that it’s otherwise.”
“Death is never preferable.” She was trembling with rage. “It’s never just another option.”
Mara spoke, her tone dripping with contempt. “It is if life is a death sentence. Oh, but I forgot. You’re a Kornak, and a privileged one at that. No need for prosthetics, no scars…”
Saad hacked the air with his hand. “Enough. We’re wasting time. You, Elizabeth Lense, can you help this other man, or not?”
She was going to say that she would try when one look at Mara let her know that she’d better do more than that. So she said nothing. She squatted before the kit and stared into a jumble of medical supplies, most of which she didn’t understand and had never seen. Her eyes roved over packets of gauze and bandaging materials, and thank heavens, she knew what they were, and there were brown vials of liquids—antiseptics and alcohol, she imagined, and other drugs, antibiotics, painkillers…she didn’t know. Gloves, of course, hard to mistake those. Intravenous needles in sterile plastic packets, plastic and glass syringes: stuff from a history of medicine class to which she’d paid almost no attention.
Twentieth century equivalents, maybe twenty-first. Or nineteenth, they had rubber by then but not plastic, I think. I just don’t know; what have I done?
A voice over her left shoulder. “Well?”
“It’s fine,” Lense lied. Yeah, right, so get going. Swallowing her panic, Lense knelt by the man with the chest wound. “I need some hands here,” she said, grabbing the man’s shirt. “Someone get over here and take his hands out of the way.”
Two of Saad’s men dropped to either side of the man’s head and took an arm. Lense ripped open the shirt and hissed in a quick breath through her teeth. “Oh, God…”
A projectile wound, about as big around her thumb and forefinger, punched through the right chest just beyond the nipple and over the sixth rib. Some blood dribbling but not a lot. Skin retracting between his ribs with every breath, so he was working very hard, pulling in air past an obstruction or through resistance. Her eyes clicked to his throat; his Adam’s apple was pushed left of center, and the large veins of his neck, his jugulars, were fat around as purple-brown worms. The man’s nail beds were even bluer than Mara’s, and his lips had shaded to a muddy plum. She brought her ear level with the wound, listened hard, didn’t hear air escaping. That’s when she noticed tiny blebs beneath the skin of his chest and when she pressed them with her fingers, they made tiny crinkly sounds, like bubbles in a plastic polymer.
Crepitus, deviated trachea, right lung, probably a pneumothorax…
“Turn him onto his left side a second,” she said and then she quickly scanned his back. No exit wound, so the bullet was still in there.
That’s bad; how am I going to get that out? She thought a moment. First things first; he builds up much more pressure in there, he’s not going to last long enough for me to worry about that.
Turning aside, she riffled in the kit with only a vague sense of what she was looking for. Her fingers walked over packets of suture materials and gauze packs, tape and vials. Then she fished out an instrument: two flexible tubes connected to curved metal prongs surmounted by perforated plastic nibs at one end and a heavy dual-function metal contraption at the other end—something with a drum on one side and a bell on the other.
Earpieces, diaphragm, bell…they called it a…a stethoscope, used for magnifying sounds…
She’d never listened to a heartbeat in her life. She’d never heard breath sounds. Although she knew on general principle that tympanic meant hollow and something that sounded dull was either fluid or something solid, she had no idea, really, what meant what. Everything she’d ever done as a physician had been through a filter of gadgets that did the thinking for her: screens that spat out data; algorithms that ticked through possibilities and whittled down the available options; a tricorder that told her what was invisible beneath the skin. Sure, there was clinical judgment. There was guesswork. But it was really hard to argue with a computer that thought a thousand times faster than she could, whizzing through data on thousands of species, humanoid and otherwise.
She screwed the earpieces of the stethoscope into her ears, didn’t hear a thing for a moment, then realized that ear canals canted forward. Forcing her fingers to steady, she removed the earpieces, twisted the prongs until the earpieces aimed forward and away, then popped them into her ears. This time she heard plenty, and it was so startling that she froze for an instant, then fingered the instrument’s diaphragm. There was a loud rasping sound like fingernails running over paper or cloth, and she heard a faint background roar that she realized was the sound of air filtering through the cave but magnified tenfold.
She put the diaphragm over the man’s chest, and she heard the rapid thudding of his heart—going a kilometer a minute, sounds like . . like three sounds, not two, and they’re so loud—but she heard virtually nothing over the right chest, only a hollow pull of air. Just to be sure, she checked the left side and was confused for a second when the heart sounds faded—and then she realized that the man’s heart was in the very center of his chest just beneath the sternum. Right then, she didn’t know if that was good or bad.
Doesn’t matter; look at how much bluer he is; he’s only got a few more minutes, I’ve got to move, move!
Quickly, she pulled the earpieces out, started pawing through the kit. “He’s got a tension pneumothorax. It’s a one-way air leak,” she said, riffling through packets, chattering, thinking out loud as much to them as herself, talking herself through the problem. Mechanics, it’s simple physics, you can do this. “Either he’s got a collapsed lung and air’s escaping into the chest that way, or there’s only this puncture wound so that every time he breathes in, the negative pressure created in the chest is pulling air into his thoracic cavity. Either way, there’s air in there that can’t get out.”
Negative pressure, air going in one way not coming out, need a tube. “I have to vent the thoracic cavity, let the air out, then make sure it can’t get back in.” Tube, I need a tube and then something flexible to make a valve…
Then she found them: packets of needles, some covered with plastic tubes and some not. Different gauges, and she knew that the lower the gauge, the bigger the bore of the needle. Needle, I can use the needle and now all I need is something for a flutter valve; yes, a glove! She pulled out a paper pack of unopened latex gloves, ripped open the packet, pulled out a glove and snipped off the middle forefinger.
“What are you doing?” asked Mara. She sounded more curious now than angry, almost intrigued. “What is that?”
“A flutter valve,” she said, poking the needle through the snippet of pale beige latex. “It’ll relieve the pressure but keep the air from getting back in.” She pulled the glove finger all the way to the flange, then rooted around for a syringe, opened the packet, and fitted the needle onto the syringe. Moving fast now, she ripped open another packet of gloves, then packets of antiseptic swabs. Gloving, she splashed rust-colored antiseptic onto the man’s ribs, thinking furiously: Which rib is it, second or third; third’s in line with the nipple, but does it matter which one? She couldn’t remember; the computer usually did all this for her. Hell, she’d never had to manually evacuate air from a tension pneumo in her life. Walking her gloved fingers over his ribs, starting at the armpit, working her way down. Heart’s in the center, what does that mean? And what about the intercostal artery? Is it running above or in the groove along the bottom of the rib, same as humans? She was sweating now; her lips tasted like salt. She stared for a long moment at the space between the man’s second and third rib.
Do it, just do it; either they’ll kill him, or he’ll suffocate, just do it!
“Hold him still,” she said then jabbed the needle through his skin. The man flinched, but she was pushing now, guiding the needle over the top of the third rib. She felt the needle pushing thr
ough muscle, scraping over bone, and she winced, clenched her teeth, kept pushing, pushing…
She felt it go through at the same moment there was the sensation of a tiny pop—and then there was air gushing, hissing out of the end of the needle. She breathed out a sigh of relief as the snippet of glove fluttered. “Got it.” She looked up at Saad and Mara and then said, with fierce satisfaction, “I got it.”
Saad cocked his head to one side. “That will help?”
She nodded. “It should. I just have to cover over this wound…the bullet hole here, so I can stop him sucking air in that way.”
There was no way to probe for the bullet, and there was no exit wound either. So there was a nice dirty bullet floating around in this man’s chest and unless she could do exploratory surgery in a cave, it was going to stay there. Later, later, one disaster at a time…Quickly, she snipped up the rest of that one glove, removing the fingers and then filleting it open until it lay flat. Then she cleaned up the wound as best she could, let it air-dry and then taped the latex flap over the wound on three sides, leaving the fourth free as another relief valve.
It was only when she’d finished that she realized the man’s gasps had diminished. She put the stethoscope to his right chest, heard air going in, saw that both the flutter and relief valves she’d made were limp. The air pressing against his lung was gone. His face was less blue, and his trachea had returned to center.
I did it. She felt limp. My God. I really did it. She sat back on her heels. Stripped off her gloves and pushed to her feet. Her hands were streaked with white talc and felt sticky.
She looked up at Saad. “I got it,” she said again.