“Scalpel.” She deepened the incision and revealed the taut fibers of the oblique muscle. Here, she had to change the orientation of the incision to be in line with the fibers of the muscle. This allowed for faster healing and a better recovery than cutting across the grain. The problem though, was that the fibers were damn tough.
Finally finished with the cut, she placed another set of retractors in the new incision. “Grady, I may need you for this one. Pull it slow, but as hard as you can.”
He nodded. There were no jokes now — they had fallen into a good, compatible rhythm. Unasked, Frannie took up Grady’s former position near the gas mask.
The open obliques revealed the transverse abdominis muscles. These fibers ran perpendicular to the oblique, in line with the original incision. Tish and Grady repeated the process after she made another cut, adding another set of retractors. Below the muscle was a translucent white layer of tissue.
“Peritoneum,” Tish breathed. “We’re in the homestretch, Grady. Forceps.”
She pinched the tissue to draw it away from the intestines below and not damage them when cutting through the seal. The peritoneum served as an organic satchel, keeping the abdominal organs together while lubricating them with a serous fluid to reduce friction from the movements of the abdominal muscles.
She made her final cut, a small line in the lifted-up section of membrane parallel to the axis of the main incision. Tish took a deep breath and handed the scalpel off to Grady. “Cross your fingers, kids,” she said. So far the interior looked clean and free of pus. If they were in time, the appendix hadn’t ruptured, and the risks of infection were not so high.
She swept her index and middle finger inside of the opening, searching. There you are!
Tish withdrew her fingers out of the incision with them hooked. This drew the appendix — it looked, for all the world, like a worm attached to the end of the large intestine — out of the incision in the peritoneum. At its base the organ was slim and a pale pink, but it bulged to twice its size in the middle and from there was a bright, angry red.
The rest of the surgery was a blur. Tish isolated the inflamed portion of the appendix from the large intestine by clamping it near the base with another hemostat. She tied off blood vessels in the membrane that ran between the large and small intestines and the appendix itself as she cut through the connective tissue. Once this was free, she knotted a stitch around the base of the appendix, below the hemostats. “Do the honors, Grady,” she said. “Cut it.”
He leaned forward and cut above the knot and dropped the infected tissue into a specimen tray proffered by Frannie. “Think Todd will want to take a look at it?” he mused.
“Bronze that sucker,” Frannie said. “We need to hang it on the wall of Tish’s office.”
“Ugh, no thanks,” Tish said. She cauterized the appendix stump and began tucking it down into the base of the large intestine. Though she’d sutured the stump, to avoid excess friction during healing, she needed to tuck it away inside a pouch of flesh. The pouch was then purse-string sutured to keep it secure.
If anything, completing the surgery was the trickiest part. Tish had a natural elation from removing the appendix, but she had to remind herself that she had to repair every bit of damage she’d created, one step at a time on the way up and out of the abdominal cavity. It was nerve-wracking, and she realized with a start as she began to lower the curved suturing needle into the surgical cavity that her hands were shaking.
“Let me suture,” Frannie offered. “Take a moment.”
Tish gave her a grateful nod and stepped back. “Thanks,” she said. She wanted nothing more than to scratch her nose, but then she’d have to scrub in again. After a moment, she forced herself to ignore it. Thinking about the itch was just making it worse.
“A resident, a nurse, and a dentist walk into an operating room . . . What kind of joke is this?” Grady announced. Tish laughed, and Frannie smiled as she continued stitching.
“A successful one, I hope,” she replied. “I assisted on a total knee back in the day. The surgeon was an interesting guy, he liked to have “One Piece at a Time” by Johnny Cash on repeat during his procedures.”
Tish shook her head. “If I did maybe a hundred more of those I’d feel comfortable enough to do something like that. Once you’ve got each step of the procedure down it tends to just flow.” Frannie pulled, then knotted and cut the suture.
“Done.”
“I’m good now,” Tish said. She took her place back at the table and eased the peritoneum back up and over the intestines and began stitching the incision closed. This was a methodical, time-consuming process as the stitches had to be quite small to be certain of a good seal.
Layer by layer, stitch by stitch — they moved with methodical, machine-like precision. Surgery was a dance with death at the best of times. Maybe their current situation made things a little more difficult with lack of resources, but the challenge had always been there. Speed, in this case, killed.
Finally, the surgery was complete. The long row of stitches running down the McBurney’s point on Todd’s side proclaimed where they’d been and what they’d done. Look on my Works, ye Mighty!
If all went well, one day he’d be an example they could use for the next generation. “Here it is. The first appendectomy we did after Z-Day.” The great irony to that, of course, was that if they made it that far, this landmark would be unknown to many and appreciated by few. Tish could live with that possibility if it meant a world closer to what they’d had before.
“Nice work, people,” Tish said as she removed her gloves. “Now, let’s all pray that Buck and the guys bring us back some goodies because the cupboard is starting to look a little bare.”
“Listen up,” Buck said. “We’re burning daylight, and I want to get started.” The salvage crew clustered between the pair of Army trucks, awaiting their orders.
Donald Grayson gave a lazy wave of his hand before speaking. “You think that’s the best idea, boss?” Buck’s second-in-command was of average height and build with a thick beard and retreating hairline.
“I do indeed, Donnie. We’ve been watching for hours and seen next to no activity, but we can’t count on that to last. We’re going to move the trucks over to the dock and start loading them up. Things stay clear, we’ll hoof it back over to the house and hole up here for the night.”
A handful of voices interjected, and Buck raised his hands to calm them. “Yeah, yeah, not a good tactical decision, I get it. But these damn Army trucks are loud as hell. I’d like to reduce the number of times we fire up the engines as much as possible. So. We hoof it across the road unless you feel like crashing out in the warehouse. There should be plenty of cotton balls in there if you want to make yourself a pillow.” He grinned.
The voices that been complaining moments ago began chuckling. Vir had to smile, himself. Buck exuded confidence and was able to push that same confidence onto his people. It was one of his strong points. He turned to one of the two women on the crew, his wife, Allie.
“Babe, I want you to take Joey and Melanie. Try to control yourself around the womenfolk, Joey-boy.” Most of the group chuckled roughly. Joey turned a bright pink. “Vir, you’re with Donald and me. Let’s saddle up, cowpokes.”
Vir walked around the front of the truck Buck headed for and opened the passenger door. “I call shotgun, newbie,” Donald called as Vir began to step inside.
He resisted the urge to roll his eyes. Instead, he gave a tight nod and replied, “As you will.” The truck didn’t have a rear seat, and the two front seats consisted of narrow benches with a gap in the middle. Vir was going to have to balance a cheek on either side and hope they didn’t go over too many bumps. On the bright side, the truck had an automatic transmission. He wouldn’t have to worry about an errant stick shift hitting him in the crotch. He wedged his Mossberg behind the front seats and sat. After a moment of thought, he braced his arms on the headrests to keep from flopping aro
und.
Buck frowned as the other two men climbed up into the cab with him. “Donnie, you called shotgun. You get to take out the roamers as we pull in.”
“Whatevs, boss-man,” Donald said. Vir kept his face blank.
Buck cranked up the truck’s big diesel and all three of them winced. The exhaust systems were well-maintained, but still loud. When it came to quieting such big engines, there was only so much you could do. Their best bet was to keep the duration of operation to a minimum. In that regard, lighting the engines back up only when they were ready to go made a strange sort of sense. The sound of the engines would rile up any biters in the vicinity. When the noise stopped, they’d fall back into their quiescent mode until roused again. It was contrary to every standard operating procedure they’d refined over the years. If you weren’t behind secure walls, stay mobile. In this case, Vir could understand the logic. Even if the thought of a thousand-yard walk from the warehouse back to the house made his skin crawl. Maybe he should have brought his rucksack along after all.
Buck put the truck in gear and headed down the driveway. He glanced over at Vir and commented, “So what do you think so far, Singh? You like scavenging better than wall duty?”
“It is not as tedious,” Vir said in a dry tone. “Thus far, I have no complaints.”
Donald grunted a laugh from the passenger seat. “You’re an interesting cat, fella. Most of the wall guys seem pretty content to sleep in a warm bed every night instead of bunking out in the Wild.”
Vir gave him a tight smile. “Are you familiar with the tenets of Sikhism, Donald?”
The other man gave him a wary glance. Vir’s arms tightened as the truck bounced over the railroad tracks near the end of the drive. On the bright side, he didn’t lose his balance. It would have been a little comedic given the serious nature of what he was about to say.
“Well, can’t say that I am, fella,” Donald replied.
“In my faith, there are five principles. These consist of honesty, equality, fidelity, meditating on God, and never bowing to tyranny. It occurred to me that, in a way, we exist under the tyranny of the dead. There are none of us free to live our lives as we choose. We cannot go for a walk on a beautiful day such as this without a weapon at hand, or a companion to watch our backs. There is honor in standing watch on the wall, so that others might rest well in their beds. But to be Sikh is to be a warrior.” Vir shook his head. “The community has provided a safe harbor for my wife and children. How can I call myself a true warrior if I’m not willing to defend it?”
The other two men in the truck were silent for a long moment. Buck made the left turn into the industrial park and Donald let out a low whistle. “Well damn, son. I thought you just wanted to pick up some extra coffee rations or something. Here you are, all philosophical and shit.”
“The first of the five principles — honesty,” Vir intoned and winked. “That doesn’t mean I don’t tell jokes, by the way. And I adore cheeseburgers.”
Buck burst out laughing. “Hell, Donnie, I may have found your replacement. He’s made me laugh more today than you have all week.”
“Funny, boss,” the other man muttered. He slid a pistol out of a holster on his hip and a suppressor from a pocket on his tactical vest. He assembled them and leaned out the window. “Come get some, rotter!”
One of the biters outside the warehouse had zeroed in on the sound of the diesel engines. It staggered through the empty parking lot in their direction. Donald waited a moment until the range was close enough, and squeezed off a pair of rounds. One round hit the biter in the chest and the other hit it in the head. It was enough, and it collapsed like a puppet with cut strings.
“Going to walk back later and police that brass?” Buck said as he steered around the corner of the warehouse and headed for the loading dock. There were a couple of dirt-encrusted sedans parked in the back lot. A semi with a faded store logo on the side of the trailer sat in front of the docks. “The Crow will have your hide if you don’t bring back reloading materials.”
“Fuck that cripple,” Donald spat, and Vir raised an eyebrow.
Interesting.
Buck laughed again. “I’ll note for the record that you didn’t say that anywhere in that old boy’s effective range.”
“Yeah, yeah, yeah. He can give me crap on his next salvage run. The way I hear it, he drinks more coffee than the next ten people inside combined. As long as I’m being Starbucks for his ass, he can kiss mine.”
Buck pulled the deuce-and-a-half to a stop. He waved his arm out the driver’s side window to beckon the other truck forward. It pulled up beside, and he said, “Back up to the dock on the other side of the semi-trailer. Give me a space between.”
His wife flashed him a thumbs-up. She pulled her truck into a tight, three-point turn, and backed out of sight beyond the trailer. “Game face, Donnie,” Buck mumbled, and the other man nodded. The team leader glanced over at Vir. “You good to go, Singh?”
“I am ready,” Vir replied, and the other man nodded. He took his foot off the brake and pulled the truck forward. Shifting into reverse, he executed the same maneuver as his wife and backed up to the dock. He slowed as they neared the pads at the dock but the truck still jerked as he pulled into them.
“Oof,” Buck muttered. “Let’s do it.” He opened the driver’s side door and slid out. While Vir waited for Donald to get out of the way, he took a moment to retrieve the Mossberg. He lay it down in the foot well and stepped down to the ground. Once down, Vir grabbed the shotgun and slung it over one shoulder. Donald was already clambering up the side of the dock. Vir made an annoyed noise in the back of his throat. Bloody hell, I’m starting to wonder about these people.
Ignoring the dock, Vir eased the truck’s door shut and moved to the front of the semi. Keeping most of his body out of sight, he peered around the front of the truck and studied the industrial park. For a long moment, there was nothing, but he finally detected slow movement. He grunted to himself in satisfaction.
“Hey! Quit lollygagging, fella!” Donald called out. Singh turned to him and gave him a hard stare. He said nothing in reply, but brought a finger up to his lips. The other man purpled in anger.
Vir turned back and looked back around the front of the semi. Still just two. They staggered toward him at a pace more languid than the norm. Perhaps the end of the trucks’ movement and sound had confused them, but he knew they’d home in at some point. Once they were paying attention, the smallest of sounds attracted them. He needed to take them out of the equation. The shotgun was too loud, and the team had not bothered to give him a suppressor to go along with his handgun. Fair enough. He waited a moment to ensure no more came out of the woodwork, and then he stepped out to meet them.
The men who stood guard didn’t have much use for guns. Oh, they had them in abundance, in the bunkers spread across the eastern and western walls. Gary West had designed and built those walls. Now he led the men and women who guarded them — and what he had hammered into them above all else was the need for silence. No suppressor was perfect. This was particularly true of the field-expedient ones they’d fabricated to increase their supply.
The obsession with noise control ended in the face of larger hordes. For those, they had several ‘appropriated’ National Guard heavy machine guns. Vir had only been on the wall for one of those engagements, and he’d been glad to have the noise. Even so, as soon as the majority of the horde was out of action, they’d reverted back to quieter methods. As Gary put it, “Our first job is making sure the wall stays secure. Job one-A is making sure we stay quiet while doing it.”
Which made it a position well-suited for Vir. Growing up in India and the United Kingdom he’d not had much exposure to firearms. He’d learned quite a bit out of sheer necessity. Though he’d never become more than a middling shot with a rifle, he was quite good with a pistol. Like many others in the settlement, he carried one with him at all times. But the go-to weapons for the m
en and women on the wall were as old as mankind itself.
The materials might be different, but the sturdy iron-pipe spears were effective enough. As a result, when it came down to it, Vir felt odd killing a biter with anything but a blade.
The closest was the second one he’d spotted. It was in good condition; still clothed though the garments were sun-faded. It’d been a man once, and from the clothing perhaps a delivery driver. Perhaps even the driver of the semi he’d lurked behind, if not one of the other parcel companies. Vir unslung the shotgun and ensured it was on safe. He ducked under the biter’s questing arms, then hooked the stock of the Mossberg behind one leg and pulled. Off balance, it tumbled onto its back. Vir kept one eye on the other biter as he dropped a knee onto the first one’s chest to pin it. He drew his kirpan from its sheath. He aimed and with a grunt of exertion stabbed the blade into the thin bone at the thing’s temple. It jerked as though Tasered and fell still.
Vir pulled the blade out, stood, and waited for the next one. It came on, heedless of the fate that had just befallen its compatriot. Its half-life ended in the same fashion. As he stood, Vir looked down and noted the filth on his kirpan. He wiped it several times on one of the biters’ trousers before securing it back in its sheath.
He waited a moment, but no more were forthcoming. He gave a slow, satisfied nod, and turned on one heel to walk back to the parked vehicles. The rest of the team stood watching, having moved out from the loading docks, and all looked stunned.
“There now,” Vir said. “No need to look gob-smacked. Just covering our six, right?”
After a pause, Buck cleared his throat. “Right. The show’s over, let’s get a move on.”
The team turned and moved back to the docks. There was a metal staircase between the two trucks. Vir hid his smirk; the staircase made Donald’s climb onto the dock even more ridiculous. Some of his mirth must have shown — the other man gave him a hard look as he stepped up.
A Place Outside The Wild Page 9