The Edge of Death: (Sequel to ADRENALINE)

by John Benedict

  There was only one treatment for a tension pneumo. If he were wrong about the diagnosis, he would likely kill her. He had no CXR to go on, no pulse ox, no EKG, nothing. Not even a frickin’ stethoscope. Not to mention, he didn’t have any surgical equipment on hand.

  Laura’s eyes rolled up in her head as she lost consciousness. She slumped forward into his arms. He felt for a carotid pulse—it was very weak. And her jugular veins were horribly distended. All this fit with a tension pneumo.

  “What’s wrong with her?” the truck driver asked.

  “Not now,” Doug snapped, frantically searching for ideas. “Do you have any knives or sharp things,” he said, speaking so fast, his words ran together.

  “I don’t think so.”

  “In your truck?”

  “I’ll go look.” The man ran to his truck.

  “Hurry,” Doug called after him. He gently laid Laura down on the gravel shoulder. “Laura, hang in there—don’t you leave me.” But clearly, she wasn’t hearing him right now.

  The man came back with a fishing tackle box. “It’s all I could find.”

  Doug opened the box and rummaged through it. Not much of use. Lots of fishing lures and weights and bobbers and hooks and fishing line. No knife, though. Finally, on the bottom, he found needle-nosed pliers. He grabbed them.

  “Will that work?” the driver asked.

  “I don’t know.” Doug wiped some black grime from the pliers. With his left hand, he quickly searched around Laura’s side for a place in between her ribs where the most damage was. “Laura, this is gonna hurt a bit.” No response. He readied the pliers in his right hand.

  A large hand fell on his right arm. “What are you fixing to do?” the driver asked, voice taut with fear.

  “Leave me alone,” Doug said, staring down the man. “Haven’t you done enough harm for one day? I’m a doctor—I know what I’m doing.”

  “I sure hope so,” the driver said and released his arm.

  Me too, thought Doug. He inserted the tip of the pliers into her side and pushed hard until he felt a distinctive pop as he cleared the chest wall musculature. Nothing happened. Laura groaned, but this still wasn’t what he was looking for. Could he be wrong about his diagnosis?

  With the pliers still buried in her side, Doug opened them and twisted them back and forth, trying to make a bigger hole in her chest wall. This was the part that would either fix her or kill her.

  “Are you crazy, man?” the driver exclaimed, and looked away.

  Doug ignored him and continued to work with the pliers. Finally, there was a loud whistling noise as the trapped air came rushing out, confirming his diagnosis. Thank God—there was a tension pneumo and he had just relieved it.

  Thirty seconds later, Laura opened her eyes. Her blood pressure must’ve improved enough to allow her to regain consciousness. Her breathing also seemed much easier.

  “Well, I’ll be damned,” the driver said.

  Relief washed over Doug, but it was short-lived. Where’s that chopper? He knew Laura needed some real treatment—like a chest tube, for starters. He also knew the tension pneumo would just re-accumulate in short order.

  Several minutes later, he heard the thumping of helicopter blades in the distance, followed by the distinctive whine of the Life Lion’s enclosed tail rotor. Soon he made out the navy blue copter’s shape as it cut through the air toward them.

  “Hang on, Laura. Help is on the way.” She was laboring to breathe again and her eyes showed renewed fear and pain.

  The driver ran out onto the road and waved his arm, signaling the chopper. It set down in a nearby field. Two paramedics hopped out and ran over with a litter. They loaded Laura onto it. She had slipped back into unconsciousness.

  Doug accompanied them as they carried her to the chopper and loaded her on. “We’ll take it from here, sir,” one of the paramedics yelled to him over the engine’s roar. He started to close the helo’s side door. “Meet us at the hospital.”

  Doug grabbed the door. “I’m not leaving her side. She’s got a tension pneumo and a bad femur fracture with a tourniquet. She needs oxygen and a chest tube.”

  The older paramedic stared at Doug, then at Laura. “Bring him,” he barked. “We gotta move.”

  Doug climbed in and they shut the door. The pilot pushed the throttle to the max and the Life Lion spun its mighty rotors up to speed. “Hang on!” the pilot yelled back to them above the roar of the turbo-charged engine. He pulled back on the cyclic and the helo leapt into the sky. The trees and grass blew wildly in the fierce downdraft and Doug could see the driver below, shielding his eyes, looking up at them. Once they attained sufficient altitude, the helo tilted forward and the blue devil began its sprint to the med center. Within the chopper’s belly, Laura Landry fought for her life.

  C H A P T E R 2 2

  Friday, 3:00 p.m.

  Doug tried to ignore the queasiness he felt in the pit of his stomach. The Life Lion rocketed forward and the ground below sped by at an alarming speed. Best not to look out. The aircraft’s intense vibrations shook him to the core. He held Laura’s hand, but his eyes were glued on the pulse ox. It read a lousy 83%.

  Bob Kruger, the chief paramedic on board, also glanced worriedly at the monitor. He was talking over his helmet radio, but Doug couldn’t hear him. Kruger turned to him. “I’m afraid I’m going to have to intubate your wife,” he said loudly.

  Doug could barely hear him above the whine of the turbine jet engine and thump-thump of the rotors. “I don’t think that’s a good idea,” Doug said, trying to project his voice toward Kruger.

  “Her sat. is dangerously low,” Kruger said, nodding at the portable pulse oximeter. It now read 80% and was blinking in alarm status.

  “I see it.” Doug knew Laura was running out of time. He looked out the window and tried to get his bearings. Up ahead, not far, he spied the distinctive twin turrets of the Hotel Hershey. “We’re almost there,” Doug said, a glimmer of hope forming.

  “Look, I follow orders from my doc on the ground.” Kruger tapped his fingers to his radio headset. “And he’s telling me to tube her. Tube her now.” The paramedic reached for his intubation equipment.

  Doug grabbed his arm. “Listen to me!” he shouted. “You’ve got to listen to me.”

  The paramedic glared at him. “You promised not to interfere. That’s why I—”

  “I’m pretty sure she’s got a tension pneumothorax,” Doug said, leaning in as close as he could to Kruger. “If you tube her and give positive pressure ventilation, you’ll kill her. The tension will get worse.”

  “Tension pneumo . . .” Kruger became still, staring back at Doug. “If you’re wrong and I don’t tube her, she may die.”

  “I know,” Doug said. “Give her as much oxygen as you can—put her on a non-rebreather, if you have one. And tell the pilot to hurry and land this damn thing.”

  Kruger gave him a thin, grudging smile. “Sure hope you’re right.”

  C H A P T E R 2 3

  Saturday, 8:00 a.m.

  Chip navigated the confusing layout of the radiology department, following signs to the basement where the MRI suite was located. He could tell he was getting closer because the signs began to change. They now contained the stark warning, DANGER: HIGH INTENSITY MAGNETIC FIELD, coupled with pictographs of a cell phone and a pacemaker with red null icons over them. Looked serious.

  Finally, he found the MRI control office. He peered through its small window and saw Kristin, clad in a white lab coat, seated at the console. The door was slightly ajar; he knocked and stood in the doorway.

  Kristin turned to him and smiled. “Allison. Come on in. I’m almost finished.”

  Chip walked into the small control room. “You were right, this place isn’t so easy to find.” His eyes were drawn to the monitor, displaying high-resolution coronal slices of someone’s brain. “What’re you working on?”

  “Emergency CVA scan.”

  “Stroke?” He looked at the
black and white video observation monitor, saw a patient’s legs sticking out of the huge circular magnet in the scan room.

  “Right,” she said. “Trying to determine if it’s hemorrhagic or not, to see if they should anticoagulate the patient.”

  “Sounds important.” Chip studied the images on the screen to see if he could draw on his rudimentary neuroanatomy knowledge to identify familiar structures or abnormalities. Of course, he reminded himself, he hadn’t completed that course. He could make out the cerebral cortex and ventricles, but that was about it.

  “The scan should be complete in—” she checked the console “—about ten minutes.”

  “Good. Mueller’s expecting us at nine o’clock.”

  “What do you think he wants?” she asked.

  “He didn’t say exactly, but I’m sure it has something to do with his patient.”

  “Chandler, you mean?”

  “Yes, and what we saw,” Chip said.

  “Let me just set up the final scan protocol.” She fiddled with some knobs on her console.

  Chip studied her as she worked. Her face was serious and it dawned on him that she wore no makeup—this would explain why sometimes he thought of her as plain. But other times, like when she smiled, he thought she had a natural, fresh-faced look with pretty blue eyes and nice skin. He leaned against the front wall and absently examined the weave of her braid; the pattern seemed different from what he recalled. Did she change it every day?

  “Hey, Allison! Be careful what you touch.”

  Startled, Chip stood up straight. “Sorry.”

  “That’s the emergency quench switch.” She pointed at a circular, palm-sized push button mounted on the front wall close to where his hand had been.

  “Does that turn it off?” he asked.

  “Yes, but it’s not the normal power down switch. It’s a safety cutoff used only in dire circumstances.”

  “Dire circumstances? Sounds a bit dramatic.”

  She flashed her blue eyes at him. “Look, I know the machine looks like a CAT scanner, but it’s really very different. Dangerous, in some respects.” She pointed at the observation monitor. “The big arched structure you see there houses the superconducting magnet; it’s cooled by liquid helium to just about absolute zero.” She tapped the temperature gauge mounted on the wall—it registered minus 270 degrees Celsius. “That’s the magnet temperature.”

  “That’s cold, all right,” Chip said. “What’s the redline indicate?”

  “The temperature above which superconductivity is lost. If the quench switch is thrown, the helium is vented to the roof and out to the atmosphere. Without the liquid helium to cool it, the ferrous/niobium magnetic core quickly warms up and is no longer superconductive. The resulting electrical resistance generates a tremendous amount of heat, causing the magnet to partially melt or suffer irreparable damage. The liquid helium itself costs $5,000 per charge. If the magnet is damaged, the expense may run into the hundreds of thousands.”

  “Holy crap!” Images of explaining that one to his father ran through Chip’s mind.

  “Exactly,” she said.

  “Hang on, though; back up a step. Why bother to use a superconducting magnet in the first place, if it’s so much trouble?”

  “It produces a much stronger magnetic field,” she said. “This one is rated at five Tesla—that’s about as big as they get. The bigger the magnet, the better the scan.”

  “All right, I get that,” Chip said. “But I still don’t see the big danger.”

  “Two things, really. There’s the helium itself. And then there’s the missile effect.”

  “Did you say missile?”

  “Yes,” she said. “If a ferro-magnetic object is brought into the magnet room, it will accelerate rapidly and fly through the air toward the magnet, becoming a high speed projectile, or missile.”

  “Yikes,” Chip said.

  “The patient or tech might be in the way and get pinned to the scanner—or worse, crushed.”

  Chip looked from the monitor to her. “Are you serious?”

  “I’ll show you pictures sometime. That’s what the emergency quench switch is all about—to deactivate the magnetic field as quickly as possible. But it’s only to be used in life-threatening situations.”

  “All right. But you said the helium is dangerous too.” Chip couldn’t help smiling as he added in a high, squeaky voice, “Makes you talk funny?”

  “Ha-ha. No.” She looked at him sidelong, her lips compressed as if she’d eaten something sour. “Remember, it’s liquid helium—it’s a completely different animal than gaseous helium, like in a kid’s balloon. First, it’s extremely cold—almost down to absolute zero. If the helium reservoir”—she pointed to the tank-like structures on either side of the magnet—“develops a leak or the vent malfunctions, the helium will rapidly boil out and lower the temperature drastically, potentially freezing anyone in the room. Second, a small quantity of boiling liquid helium will produce large amounts of gaseous helium, enough to displace the oxygen and asphyxiate anyone in the room. It also generates high pressure—enough to seal the door shut.”

  Chip gazed thoughtfully at the door. “Nasty.”

  The console beeped and Kristin hopped out of her chair. “Good, the scan is done. I wasn’t sure the patient would hold still enough, but he did. Want to help me move him back onto the litter?”

  “Sure.”

  Her expression turned serious again. “You can’t go into the magnet room with any metal.”

  “I’ll take my belt and watch off. And my cell phone.”

  “Cell phones are pretty useless down here anyway. There’s permanent magnetic shielding built into the walls, plus when the scanner is active, high level radio frequency interference is produced. You don’t have any internal metal clips or wires from surgery in your body, do you?”

  “Not that I know of,” Chip said, placing his metallic items on the desktop.

  “Pacemakers or defibrillators?”

  “No,” Chip said, but then he saw her smirk.

  Kristin swiped her badge and opened the thick metal door, which swung on oversize hinges. She led him into the magnet room and closed the door behind them. Chip heard a lock engage automatically and raised his eyebrows at her.

  “That’s so no one can wander into the magnet room by mistake when I’m in here tending to the patient,” she said. Kristin pushed one of the buttons on the magnet housing and the gantry with the patient slowly retracted from the magnet. Chip fought off a wave of claustrophobia as he noticed how snugly the patient’s body fit into the tunnel inside the magnet. Finally, the patient—an old man with a grizzled growth of beard—completely emerged. He stared up at them with unseeing eyes, drool leaking from one side of his mouth. Chip shuddered and looked away.

  The two transferred the frail old man back onto the litter; it was easy—his body was rigid and he couldn’t have weighed more than 120 pounds. But, as far as Chip was concerned, he couldn’t leave this nasty place soon enough. Maybe it was just the tight quarters, packed with the whirring hi-tech equipment that he had gained a newfound respect for—or maybe it was the sickly smell wafting up from the man. He couldn’t put his finger on it, but something about this MRI room was definitely unsettling.

  C H A P T E R 2 4

  Saturday, 8:00 a.m.

  “You gave me quite a scare back there.” Standing by her bedside, Doug squeezed Laura’s hand; it felt limp and cold within his fingers. The ventilator continued to hiss and whoosh regularly, her chest rising and falling in time with it. Multiple monitors beeped quietly in the background. Wan light seeped through the window as the eastern sky brightened with the approaching dawn.

  They would be coming for her soon.

  Doug’s eyes kept sliding back to Laura’s monitors; the art-line registered a beautiful pressure waveform and the pulse ox was also a reassuring 98%. He massaged his sore neck—collateral damage from his earlier attempts to catch a few zees on the cramped fol
dout recliner bed.

  The events of the last twelve hours were little more than a nightmarish blur in his mind. The helicopter ride had been especially tense; Doug had been terrified that Laura was going to die. In the ER, he’d watched a number of surgical doctors attend to Laura in rapid succession, starting with one of the CT surgeons, who confirmed the diagnosis of a tension pneumothorax secondary to fractured ribs. He placed a chest tube, which finally stabilized Laura’s breathing, and pulled Doug aside afterward.

  “I’ve never seen a tension pneumo diagnosed in the field and treated successfully with a pair of fishing pliers,” the veteran trauma surgeon told him. “Gutsy move, man. Hope she doesn’t die of infection.”

  The vascular boys came in next, and determined that Laura had a lacerated femoral artery that needed immediate attention. They did remark that the belt around her thigh had been life-saving. The orthopods also evaluated Laura’s leg and said they would book the case first thing in the morning to repair the fractured femur after her vascular issues had been addressed.

  Then Laura had been whisked off to the OR and spent half the night in surgery while they performed the delicate femoral artery repair. She’d been returned to her bed in the ICU around three in the morning. Doug had been waiting for her. She was still heavily sedated, intubated, and on a ventilator. She also sported a new art-line and central line. Blood hung alongside wide spectrum antibiotics. The medical doctors said she had lost a fair amount of blood and they were transfusing her. But her BP had stabilized, her kidneys were responding and she was making good urine. All in all, things had gone about as well as could be expected. They’d told him she had a good prognosis. All that remained was to fix her fractured femur.

  The sun peeked above the distant ridge, bathing the valley in golden light. Doug squeezed Laura’s hand again. “You need to get better, Laura. Don’t worry about the kids. I’ve got it all taken care of. Teddy said he’ll do all the housework and Steven promised to keep his room neat.” Doug felt a lump growing in his throat. “And Anthony said he’d take care of the cooking as soon as he gets home from kindergarten.” He bent over and whispered in her ear, “I don’t know what we’d do without you.” The tears came now, but he wasn’t finished. “I don’t know what I’d do. You know I love you.” His voice broke and he squeezed her hand tightly.