by David Palmer
Couldn't afford collapse then; didn't have time for own problems. Victim about to lose leg—plus certainly in shock, doubtless sinking moment by moment: Even if somehow failed to die as direct result of injuries, shock could finish job—would, untreated.
Returned to bunk. Apprehensively called again upon unnatural strength. Found, to surprise, enough remained to lift foot of bunk one-handed; hold elevated while inserting prop (Gel-Coat kit—flameproofing goodies which should have been used to eliminate much drama from rescue). Would have been easier to elevate legs conventionally, with pillow; unfortunately, supine position unworkable due to wound location: Needed victim prone to treat.
Located Daddy's Number Two black bag, saline I.V. kit from medical supply locker. Rooted through bag; found stopwatch, sphygmomanometer. Took pulse, checked blood pressure: fast, strong, respectively.
Lifted eyelids, flicked sunlight across pupils with hand mirror. Were unequal, nonreactive; plus unmistakable twitching movements: nystagmus—concussed certainly.
Then froze, transfixed.
All this time—while examining in car, on sidewalk; lifting, dragging about, carrying; attaching tourniquet, checking vital signs—had dealt with discrete anatomical components. Never connected dots; never mentally assembled into whole person. Never saw face. Until then.
Was kid . . . !
Little, if any, older than self.
Comprehension dawned suddenly: Had thought was dealing with adult; carrying, in addition to own compact tonnage, perhaps three times again own weight (heft difficult to judge when heart is pure, strength is strength of ten). In fact, apart from peak efforts (unsticking door, traversing flaming moat with piggyback passenger), exertion level hardly more than doubled. Could have accomplished most heroics almost as well without metabolic short circuit. Well . . . maybe.)
However, with understanding came chilling realization: Clinical picture even less rosy than first appeared. Healthy blood pressure reading but snare, delusion in child when hemorrhage a factor. Young cardiovascular systems amazingly resilient when challenged; simply pump faster, harder as blood volume diminishes, maintaining adequate pressure the while.
Right up to sudden, catastrophic, final dissolution; total failure.
Viewed thus, pulse rate most disquieting: Suggested important fraction of total blood supply already gone. And quick review of wound confirmed loss still in progress, though slowed by tourniquet.
Agonized for endless moments, poignantly aware of limitations of own training; indecision compounded by mental processes blunted by physical, mental fatigue. Knew, of course, what needed doing; but shrank from unavoidable conclusion regarding by whom.
(Granted, possessed requisite knowledge. Inescapable, since Daddy [pathologist or not] one of only two doctors in town, often called upon to perform emergency-room care, usually in own home, invariably at odd hours when no one available to assist but Yours Truly. Watched closely then; listened attentively to accompanying lectures. Even, at proud paternal urging, acquired skill at certain limited surgical techniques, practicing on animal cadavers. But never—alone, unaided—so much as placed Band-Aid on person.)
However, time—blood—wasting. And own condition now serious impediment to concentration, precision work. (Maybe wasn't burning energy at quadruple usual rate; couldn't know what overload factor consisted of. But knew was exhausted; never experienced such fatigue before.) Nor without long rest, much nourishment, was condition likely to improve. Which ruled out usefully immediate future. Unless . . .
Weighed options carefully—shuddered. But saw no way out. Closed eyes, directed consciousness inward. Took deliberate, deep breath; held briefly; released slowly, exhausting tension with it. Then—for second time in only minutes—triggered hysterical tap.
Like magic, felt vision clear, hands steady, cramps abate. But not fooled: Heart still hammered; was still fountaining sweat; breathing, though no longer paroxysmal (regular now, slowed to point where wouldn't affect dexterity), still amounted to panting. Condition unchanged: Beneath veneer was still totally exhausted. Tried not to dwell on probable cost when came time to pay Piper. Hoped benefits of sufficient duration—surely wouldn't work third time.
Took seat on campstool at bedside. Bent over leg; drew wound lips apart to assess damage extent, severity. Blood volume made visual structure identification impossible. Removed saline baggie from kit; extended I.V. tube, chopped off end. Squeezing bag to provide pressure, used as hose to irrigate, cleanse area. Worked pretty well, but relief only temporary: Adjoining tissues full of slowly oozing bleeders; and at very bottom of gash, visible now, gaped slice in femoral artery, welling gently afresh with each systole, reflooding area with bright red blood.
Which wouldn't do at all; had to see to work. Pondered briefly; then cranked another turn into tourniquet. Uncomfortable about solution: First Law of Tourniquets holds must be loosened every 12 minutes, 18 at outside. Failure to comply results in tissue death downstream, autolysis, ultimately gangrene.
But here question less clear: Two-inch rent in artery wall complicated equation; hydraulic principles demanded concern at least equal to other factors. (Probably more than equal, as continued to debate matter: Blood geysering out through least resistant path certainly of negligible value downstream—and even if somehow beneficial, advantages accruing to leg moot if body to which attached promptly expires as side effect.)
But knowledge that choice impending if artery repair not completed within time limit acted as incentive to speed work. Fell to; gathered, set out, organized equipment.
Hosed down wound again. Scrutinized closely; breathed sigh of relief: Tourniquet now achieving desired result; arterial flow stopped. Virtually imperceptible seepage remained from vascularity in surrounding tissues, but makeshift lavage spray adequate remedy.
Next juggled odds quickly, unhappily. Time most critical, true; but upon reflection, concluded potential shock consequences justified investing whatever time necessary to start I.V. before undertaking actual repair.
And if Daddy watching from Above, made him proud: Had I.V. inserted, taped in place, saline flowing—all within single minute. (Practice on long-suffering arm simulacrum [paramedic training aid] paid off: Found vein first try.)
Performed necessarily abbreviated scrub, using drinking water, soap, finishing off with alcohol slosh. Squirmed into rubber gloves with difficulty—not easy, solo, while maintaining asepsis.
(Mostly unworried about infection per se; Teacher's opinion holds H. post hominems immune to known human disease. But key words, even if Teacher's very own, are "opinion," "known," and especially "H. post hominem" [of which victim surely must be one—but don't know that]—and would be humiliating to perform repair successfully; then lose patient to toxemia through preventable gross sepsis. So within limits imposed by surroundings, did best to adhere to sterile procedure.)
Tore open first packet, containing prethreaded fine needle, suture (offered up silent thanks for modern medical technology as did so; would never make good stereotypical female—were own life at stake, couldn't thread needle in fewer than 20 tries).
Picked up two hemostats. Stared down into wound. Took deep breath. Seized needle with finely-pointed jaw tips of right-hand hemostat. Commenced.
Proved less difficult than feared. Following initial shock (as learned live patients warm inside), technical fascination took over, supplanted apprehension; permitted training to emerge, do job properly. Hemostats gripped needle surely; resultant control wonderfully precise, even down in cramped quarters at bottom of wound. Artery cleanly slit; edges straight; stitches went into place neatly, evenly, closely spaced, just as had when practiced similar repair on hog cadaver under Daddy's direction.
(Sure wish had practiced oftener; developed semblance of professional competence, speed—sealing high-pressure artery called for such tiny stitches; so little time remained and seam so long. . . .)
But wasted none glancing feverishly at watch; concentrated on task at hand. Mind
already made up, subconsciously at least: Would not risk boy's life to save leg. True, be nice if managed to save it, too—indeed, striving mightily to accomplish repair in time to prevent limb death.
(Mightily—but not quickly; never realized vascular surgery so time-consuming.)
For one thing, one-legged comrade poses significant liability in present-day survival-oriented environment. For another, despite pretensions toward calloused pragmatism, must confess to certain esthetic prejudice in favor of physically sound partner—perhaps even, should circumstances so devolve, mate.
(But repair was taking so long.)
Finally, even granting advantages intrinsic to performing amputation at leisure in Hopkins teaching hospital's modern operating theatre, amidst latest, most advanced medical wonders (who cares—lack even faintest notion of how to operate them), odds slim for patient surviving procedure. Above-knee amputation serious business, truly major surgery; approached with due respect by most veteran of doctors—likelihood of happy outcome, given amateur-level ministrations in procedure so intrinsically fraught, seemed less a question for serious assessment than object of gallows humor.
(But not laughing; was going to find out unless got move-on—taking too long!)
And didn't want to cut kid's leg off! Even if somehow managed to avoid killing him in process, would never be able to meet eyes without cringing inside. Yes—despite full knowledge that dummy's own maniacal driving brought on disaster; that consequences on his head alone; that own role limited to saving fool life—would still feel guilty. . . .
(Damn—taking too long . . . !)
Stole glance at watch—at least 16 minutes gone (guestimating from crash) and good half inch yet unrepaired. What to do . . . !
Discovered mind not made up after all. Convictions wavered, crumbled at moment of truth. Should continue repair, cross fingers for dispensation from immutable metabolic laws? Or gamble on holding blood loss to tolerable minimum with local pressure now that wound largely closed?
(But how much is tolerable minimum—considering losses to present; mitigated by, thus far, just under pint of saline? Further, how effective is local pressure apt to be on femoral spurting—even if wound largely closed?)
Wait. Perhaps another way out. Not cornered—maybe. With luck.
Solution required judicious hemostat placement: Was necessary to grip, pinch together remaining open edges of sliced artery walls with curved jaws; lock handles, sealing shut.
Now could ease tourniquet temporarily, safely . . .
. . . If hemostat secure.
. . . If stitches adequate.
. . . If no other significant bleeders in wound.
. . . If abruptly releasing balance of blood supply into previously substantially drained extremity didn't trigger final shock collapse through major blood-pressure drop. . . .
. . . If—oh, hell! Simply couldn't stand it any longer—released tourniquet, poised to take action as required.
Wasn't. So glad.
Took time then for breather, suddenly aware of first hints of returning fatigue. Peeled off gloves; finished Gatorade, soup.
Removed patient's shoes, socks; inspected toes as circulation resumed. (Should have at outset: color, temperature key clinical signs to circulation status in leg, foot.)
Sat back, eyes closed, relaxed; breathed deeply, modulating oxygen intake just at fringes of hyperventilation symptoms, hoping to get running start on replacing stores before disintegration set in in earnest. Knew wouldn't really help, but beat waiting idly for collapse—for which still didn't have time.
After five minutes, retightened tourniquet, donned second pair of rubber gloves, released hemostat. Lavaged site again, flushing away seepage accumulated from surrounding tissues. Resumed needlework.
And marveled: Delicate stitchery, tiny knots suddenly easy—now no longer racing clock, impeding own efforts through tight-collar syndrome.
Soon last stitch in place; femoral repaired. Only closing-up chores remained, housekeeping incidentals: Rejoining severed muscles, closing skin layers; assembling, installing homemade pressure bandage incorporating splint to prevent knee flexion during initial healing process. Much easier going—nothing life-or-death. And could use larger stitches.
Then followed quick, apprehensive review of own condition. No serious portents detected; so stripped limp body (yes, completely; potentially fastest bleeding tissues on male body concealed by shorts; no shrinking damsel I—besides, modesty lousy reason to lose patient through negligence); examined head to foot, identified additional serious (relative term, this, compared to femoral) lacerations; closed with stitch here, tuck there, bandage where appropriate. Finished by covering with blanket, slipping pillow under head, connecting fresh saline baggie to I.V.
Whereupon, quite without warning, found self facedown next to bunk, viewing world through darkening, flickering mists (viewing two worlds, point of fact), while breathing transformed abruptly into agonizing gasps, heartbeat stabilized at tachycardiac level, every muscle in body knotted into single huge cramp. Couldn't even cry out. And wanted to.
Could have ended pain by triggering posthypnotic relaxation sequence; but sleep—akin to coma—sure to follow immediately and couldn't afford yet; important details remained undone:
Van's right-side double doors gaped wide; driver's door hung open, too, just as had left it when leaping out. Knew must remedy before letting go: Bound to be dogs in area (have not forgotten [will never forget] dog-pack encounter shortly after emerging from shelter); pooches would be pleased indeed to discover van standing open—and ready access to three helpless occupants.
Besides, Terry's water, food dishes not filled since leaving Harpers'; no telling how long oblivion might last. Plus urgent need to stoke own fires before going under; nourishment deficit almost as critical as fatigue.
All of which posed problem:
Body on strike. Brain apparently still operating at what passes for normal function, but commands ignored as burnout reaction intensified, symptoms worsened. Try as might, couldn't elicit so much as purposeful twitch from any voluntary muscle, even unto least finger.
Too busy twitching involuntarily; spasming, in fact: Body jerked, convulsed, shuddered in response to multiple random cramps attacking, releasing, attacking again from head to toe. Ravages flopped body about like chicken recently deprived of head (uncomfortably apt simile; brain quite as unable to communicate with body as if physically separated).
Thrashed for timeless, endless interval. Several seconds at least. Then subsided into gently quivering heap, face up, limbs intertwined in Gordian disarray; cramps abated, muscles relaxing, going limp—pain easing toward residual ache. Would have sighed with relief if such possible, but breathing not among voluntary functions then.
Besides, knew relief was only fool's paradise: Could feel heat; knew face was flushed. Could feel perspiration volume increasing, sweat streaming from entire body; dripping where possible, collecting in hollows elsewhere—one pool quickly threatened to overfill valley formed by nose, cheek; invade eye. And breathing rate such that nose began to run.
Suspected was not pretty sight. But not encouraging to realize Terry, intently peering down from stand, actually had nothing to say. Just made big, round, worried eyes; stared first one eye, then other. And know what it takes to dismay my brother.
But worry surely nullest of exercises. Understood problem; knew only solution was food, sleep. And knew must finish chores first.
So again turned perception inward. Concentrated. Groped for ki within soul. Felt it stir. Created channel, felt flow begin. Gently guided into right arm. Willed dead meat to move.
Terribly pleased to note response. And not a little amazed.
Expanded control zone. Levered body into sitting position; then rolled over onto hands, knees. Moving most carefully (nothing worked without painstaking, step-by-step supervision), crawled forward to driver's seat.
Where paused momentarily, mulling options, calculating odds
. Shortest route involved climbing into seat to reach door handle. But never seriously considered as solution (as well might have been mountaintop). Or could go around; between seats, past engine cover, under steering wheel. Farther to travel. But level.
Even so, had to stop en route, rest. Twice.
Eventually, however, fingers closed limply around door handle. Marshaled forces for effort—pulled door shut hard enough to secure latch. Barely. (Noted, gratefully, front windows rolled up far enough for safety; all others swing-out construction, couldn't open far enough to pose security risk.)
Then—somehow—managed to turn around under steering wheel, avoiding getting snagged on pedals in process; set off on return trip amidships.
Arrived in due course within reach of side door handles. Again assembled energies (what remained), swung door shut—even remembering to close in proper order: Rear first, then front, so overlapping latches engaged instead of rebounding, negating efforts. Experienced profound thrill, sense of accomplishment, from having done it right.
Considered taking brief time-out for rest but realized wouldn't help. So heaved self upright on knees, ignoring tendency for surroundings to orbit own vertical axis. Scooped up saucer full of parrot seed mix from container on counter; lumbered (still on knees) to stand, prepared to dump contents into sibling's food cup.
And stopped, confused: Was full. As was—now visible at far end of perch—water cup.
Set down saucer carefully. Tried to think problem through, but not easy: Data input too fast; of such anomalous, almost contradictory nature; mind functioning so slowly. Shook head—regretted at once: No one in such condition should move head quickly. Ever. Pain obscured vision momentarily. When receded, found self leaning against side doors, head resting against window glass, eyes closed.
Solution obvious, but reached only after labored deliberation: Of course food, water untouched: Had embarked from Harpers' this morning—several lifetimes prior—something under an hour ago! (Indeed, Albert knew whereof spoke: Time is relative; truly flies when having fun. . . .)