I stood up, and my nose throbbed more with the effort. “Do you still need me?” I nudged the doc. “Maybe that wasn’t water in Julie’s jug.”
I got no answer, so I waved to Mrs. Oda, who was still strapped in her seat, and turned to look at Isaac as he checked the tube in the child’s chest and then leaned back to observe the container on the floor, still bubbling the pinkish exhaust from the cavity in Amaterasu’s chest. “So, Doc, what’s the verdict?”
“Umm . . . Probably nothing.”
Stretching my facial muscles carefully, I massaged my eyes and looked at the small face inside the plastic tenting. “Not on this flight.”
As if on cue, the orange device began flashing its red light and beeping again.
The doc and I looked at each other. “It just keeps getting better and better, doesn’t it?”
Isaac ignored me, reached down and reset the machine again, and checked the tube he’d inserted in the girl’s chest as well, noting that it hadn’t changed position in the last thirty seconds. His hands then adjusted the tube leading into her mouth. “This makes no sense; the ventilator has been working fine since we took off . . .”
“What does it do?”
“It breathes for her.”
“We need that.”
“Yes, we do.”
“It’s broken?”
I watched him thinking as he had during the last crisis. “It’s possible, but not likely. There’s also the possibility that there is another pneumothorax on the other side of her chest, but that’s not likely, either.”
The alarm on the machine came on again.
This time the doc let it beep but readjusted the dials on the instrument panel, and I watched the red numbers leap to his touch. “There is a pump inside that sends out a predetermined volume of air through the tubing that runs through the endotracheal tube.”
“The tube in her mouth?”
“Yes.” He adjusted one of the controls. “We’re on CMV, which in English stands for Continuous Mechanical Ventilation, that allows me to control her respiratory rate or how many breaths per minute she gets.” He stared at the dial. “The average at her age would be eighteen to twenty-two, but it could be higher if she needs it, but why would that change now?”
I ventured an opinion. “We’ve had the tenting open; is it possible she’s responding to the cold, stress, altitude?”
“No, it’s something else.” The doc shook his head. “Tidal volume . . .”
I leaned in and could see the girl’s body moving under the blankets. “What?”
“Tidal volume is the amount of air entering her lungs by the breathful—usually about two hundred milliliters for her age and relative size.” He checked the valve on the tank at the bottom of the machine to make sure that it was on. “FiO2, fraction of inspired oxygen hasn’t been adjusted and she should be getting the proper amount . . . Peak End Expiratory Pressure is adjusted properly . . .”
“What’s that?”
“It helps to keep the slightest amount of pressure that the patient has to breathe out against; it keeps the smallest airways in the lungs open even when she is exhaling.”
I looked over Isaac’s shoulder and could read the red number five on the digital display. “Then the machine is all right?”
“Yes.”
“Then it’s her.” I watched as the girl’s chest heaved, and even I with my limited knowledge of medicine could tell that Amaterasu was in distress.
Isaac reached across the girl’s undulating chest and disconnected her from the machine. He reached into the hanging bag of miracles Velcroed to the gurney and produced what looked like a toilet plunger.
“What’s that for?”
“It’s a bag valve mask; if the machine can’t tell me what is wrong and she is not getting air, then I will have to breathe for her manually.”
He squeezed the bag in a rhythmical pattern, and I watched as he fought it for a while and then began using both hands. “What’s wrong?”
“This isn’t working either.” He held the small body as her chest raised and lowered again as if her lungs were attempting to escape. “It must be the tube; it’s obstructed.”
“So, what do we do, replace it?”
Isaac pushed the unused equipment away but handed me the bathroom plunger. “We need a laryngoscope to place the tube under direct visualization.”
“I bet we don’t have one.”
“We do not.”
I watched as our patient, the reason we were here on this mercy flight, began the business of actively dying again. “What do we do?”
Without missing a beat, the doc’s voice took on a drawl, not unlike my own. “We get western.” I watched as he pulled the tape from around her mouth and began carefully pulling the tubing from her windpipe.
“This doesn’t look so bad.”
“Out is easy, in is hard.” He removed the end of the tube and gestured for me to come closer. “You’re going to have to breathe for her while I clear the obstruction in the tube.”
“Okay.”
“Place the mask over her mouth and squeeze the bag every five seconds.”
As the doc kneeled down, I did as instructed, trying to ignore the heaving of Amaterasu’s body and the tint of her skin. “Got it.” I squeezed the bag, but she continued to convulse. “Doc?”
“Keep squeezing the bag.”
“She’s turning blue.”
“Keep squeezing the bag! It’s probably that her throat is swollen, but we have to try. And talk to her—keep talking to her.”
“What do I say?”
His head whipped around, and he shouted in my face. “You’ll think of something!”
Words, I needed words, but my mind was a blank, black and empty as the Plexiglas windows on the sides of the bomber. Slowly, I became aware of my right hand crawling inside my coat and dragging the small, leather-bound book from my pocket—if I didn’t have words, I knew someone who had. The book fell beside her and popped itself open to one of my stalling spots.
I continued gripping the rubber balloon but lowered my face down to hers and read in a steady voice. “‘ “Oh! captive, bound and double-ironed,” cried the phantom, “not to know that ages of incessant labor by immortal creatures, for this earth must pass into eternity before the good of which it is susceptible is all developed. Not to know that any Christian spirit working kindly in its little sphere, whatever it may be, will find its mortal life too short for its vast means of usefulness.” ’” I could feel the emotion choking my voice as I pumped the bag. “‘ “Not to know that no space of regret can make amends for one life’s opportunity misused . . .” ’” She continued thrashing, and the tide of sentiment stole my voice, causing me to croak out the next words as my arm covered the book. “Don’t you do this to us; we’ve come too far and gone through too much for you to give up now.” I brushed the tears away from my eye with a coat sleeve. “Keep breathing. I know it’s hard, but you’ve got to do your part, little Shining Over Heaven.” I flexed the bag again, but her condition didn’t change. “Doc?”
“I’m working as fast as I can.” He reappeared with the tube, pushing a metal stylet into the clear plastic and bending it in the shape of a hockey stick. Isaac crowded in, and I stretched my arms so that I could continue to seal the mask over the girl’s face and pump the rubber bulb. He glanced back at me, and despite the temperature in the plane, I could see droplets of sweat forming on his forehead below the knit cap. “I’m not sure she’s going to survive this, Walter.”
I nodded and then felt my jaw lock with determination. “She’s not going to survive without it, right?”
He mirrored my expression. “No.” I turned, gently moving the mask away, and he began inserting his fingers down the girl’s throat, the play-by-play automatically mumbling from his own mouth. “I’m feeling for her epiglottis with my index finger; it’s a cartilage container flag that closes over the opening to the trachea when you swallow so that you don’t aspirate . .
.”
I could see Isaac was having trouble operating on the thrashing girl. “Is there another problem?”
He actually laughed. “Along with all the other difficulties involved in this process, the swelling to her epiglottis has made the structure something akin to a water balloon and nothing feels as it should.”
“Is there anything I can do?”
“Yes, hand me the endotracheal tube.”
Fishing the thing from around the doc, I placed it in his other hand. “I didn’t drop it.”
“Good.” He guided the tube between his fingers into Amaterasu’s mouth and threaded it down her throat into her trachea. Satisfied that it was in place, he removed his fingers and reached down to reset the ventilator again.
I stood there watching those red digital numbers and praying to God that the damned thing wouldn’t start flashing and beeping again. Laying a hand on the girl’s shoulder, I watched as she quieted and then lay still.
It seemed like forever with the two of us standing there breathing the exhaust of the bomber creeping through the cracks, watching the instrument display as the numbers remained steady. Isaac sighed deeply, and his voice was tired. “She’s breathing again.”
There was another shudder, and I was glad Steamboat had held off shaking us like fleas as I placed a hand on his shoulder. “Way to go, Doc.” He shook his head as he looked at the girl. “What?”
“I may have just robbed this young girl of the gift of speech.” He cleared his throat, probably in empathy. “With the predisposition of having a swollen airway because of the inhalation burns, the swelling from the endotracheal tube, and her small size—there was a great deal of trouble forcing the tube through the space between trachea and the vocal cords.” He looked up at me—“She may never speak again.”
The lights on the ground became more sporadic through the cloud cover, and the condition in the air had done nothing but get worse. On orders, I was in the bubble in the front that had been reserved for the bombardier and spoke to both Lucian and Julie on the headphones that I found there. “I don’t like this; I almost fell out of this thing once and I don’t particularly like being in its glass nose.”
Static. “Hell, its nose is in better shape than yours.”
We had passed both the airport in Greeley and the one in Fort Collins while I had been physician’s assistant, so here I was looking through the panes at the rapidly appearing and disappearing clouds somewhere between here and there. “I can’t see anything; can I come back up now?”
Lucian’s voice sounded like it had when he’d trained me back in the seventies. Static. “Keep looking.”
“There’s nothing . . .” As I spoke, a perfect picture of the ground below opened up, and I could see a few lights leading out in front of us. “I can see lights. Is that the airport?”
Static. “Nope, that’d be I-25, which is just what we’re looking for. In conditions such as this I use IFR.”
Julie’s voice came over the headset. Static. “Instrument Flight Rules?”
The Raider laughed over the com. Static. “Hell no—I Follow Roads. We’ll just trail along the interstate the best we can and then veer off to the left when we get closer to Denver.”
I was transfixed by the view and just kneeled there looking out the glass at the frozen surface of I-25. The road was mostly covered with snow and there was no traffic, but just as I had that thought, I could see the illuminated blue tracers of a Colorado Highway Patrol car parked on an overpass, probably near the Estes Park off-ramp.
In that instant I saw the poor guy open the door and step out, probably looking for what it was that was making all the noise. I can pretty well imagine the effect of opening your car door and having a Mitchell B-25 fly over you at night, trailing a couple of metric tons of snow behind it like diffused vengeance.
He dove for the door of his car as we thundered over and then veered left, dumping what must have seemed like a couple of hundred pounds of snow in there with him as he desperately tried to get the door closed.
Static. “You can come back up now.”
I crawled back through the hole in the floor and reseated myself as the old Raider removed the pipe from his mouth and casually banged it on the side of his seat, a noise I was used to hearing, even though I couldn’t.
“Check in with Stapleton Approach Control, Toots; it’s possible that they can hear us and get us oriented. And remind them we are LIFEGUARD with low fuel.”
Julie’s voice called out into the darkness above Colorado, and we all waited in hopes that someone, anyone, would answer.
Static. “LIFEGUARD Raider Lima Charlie—Stapleton Approach Control—confirm you have Stapleton Airport in sight.”
I imagined the muscles on the side of Lucian’s face bunching in his trademark, shit-eating grin. “Roger Stapleton Approach—LIFEGUARD Raider Lima Charlie—in sight.”
Static. “Raider Lima Charlie—Stapleton Approach Control—cleared into Class B airspace, maintain six thousand eight hundred.”
Steamboat’s nose pointed toward the sky like Pegasus, and we climbed back up.
Julie peered at the gauge that was becoming my least favorite instrument, right after the one for hydraulic pressure; she raised her horn-rims and stared more closely at the gauge, finally dropping the glasses back on her nose. “Lucian, we are now, officially, out of fuel.”
He reached up and tapped the instrument in front of her face. “By God, look at that, we are out of fuel; let’s hope Rick gave us more than we thought and that those gauges read low.” He glanced at her. “One-sixty, Toots.”
She stared at him for a moment, and then I felt the nose of the Mitchell slowly dip as she leveled Steamboat and looked at him. “Now what? Click my heels and say there’s no place like home?”
“Lower one-quarter flaps.”
“What?” There was a backfire as one of the engines stumbled for a second. “Right engine’s going—I told you, we’re out of fuel!”
The old bachelor’s eyes checked mine again. “I don’t think the phrase I told you is ever very far from a woman’s lips.” He turned and made the adjustment himself, the wing flaps forcing the nose of the bomber down into a more level flight, different from the way we’d been flying in the somewhat nose-high attitude before. He leaned forward and looked past his copilot as the right engine sputtered again and then caught and settled out. “Fuel outlet is located in the forward portion of the tank.” He sat back in his seat and winked at her. “Bingo, just gave you at least forty more gallons.”
She shook her head and smiled. “Any other secrets about this Pterodactyl that you’d like to share with us?”
“There might be a few.” He smiled back at her. “We’ll see what pops up.” There was some chatter in all our ears, and Lucian repositioned his headset. “At least the Denver VOR reception is getting stronger on our navigation receiver.”
Static. “Raider Lima Charlie—Stapleton Approach Control—contact Denver Tower.”
Lucian adjusted his mic. “Hey there, Stapleton. This is Raider Lima Charlie requesting Runway 26 Left or Right. We’ve got a low fuel situation and I’m not liking the crosswinds we’ve got on Runway 35.”
There was silence in the headsets, and then ATC spoke again. Static. “Raider Lima Charlie—Stapleton Tower—Runways 26 Left and 26 Right are closed due to drifting snow, can you land at another airport?”
Lucian laughed. “Like what, the Denver Stockyards, or have you got that closed, too?”
Static. “Raider Lima Charlie, the length of Runway 26 Right is blocked by drifting snow. Runway 26 Left has a snowplow stuck with only two thousand feet cleared on the approach end, braking conditions nil. I’m going to have to reroute you . . .”
Lucian shook his head, assiduously. “Son, I told you I’ve got a medical emergency and a fuel situation here and rerouting is not an option; get that plow cleared ’cause we’re comin’ in hot, and by God we’re comin’.”
Static. “Raider Lima Charlie,
are you declaring an emergency?”
“Damn right I’m declaring an emergency, and I’m telling you to clear that plow on 26 Left.”
There was a momentary now-familiar sputtering in the engine to our right, the same noises it had made when it had begun running out of fuel before. Julie turned and looked at Lucian. “You have some more tricks up your sleeve?”
“Not for that.”
I watched as he spun the yoke, taking Steamboat into a turn, Julie looking at him, incredulous. “Lucian, you can’t steep-turn this aircraft with an engine about to quit!”
“Just keep our speed above one-forty-five and we’ll bring her in on Runway 26 Left ahead of that plow: two thousand feet. Hang on.”
She sounded exasperated as she cupped her mic to her mouth and warned the back. “Isaac, make sure you guys are hanging on back there.”
The doc’s voice on the com lacked enthusiasm. Static. “Gott helfe uns.”
Lucian’s head inclined, defying the airport not to be there as he glared out the windshield. “Follow my lead with that pretty left leg of yours, Angel, and we’ll be A-okay.”
It felt like we were wallowing in the air, and I was sure that at any moment we were likely to stall and fall to the earth like a ten-ton feather. As we got lower the field seemed to get hazier as the powder drifted across the lights.
The Tower controller broke in again. Static. “Raider Lima Charlie, you are not cleared to land Runway 26 Left!”
Lucian straightened out Steamboat and began his descent with what felt like my stomach leading the way. “Stapleton, I am on final approach to Runway 26 Left.”
Static. “Raider Lima Charlie—Stapleton Tower—we have plows and emergency services vehicles on that runway. I repeat, you are not cleared for landing on Runway 26 Left!”
I watched as he reached down to the console between him and Julie and pulled a lever, locking it with a wire basket bracing. The engine on the right sputtered and then caught again as the nose lowered with the movement of the landing gear. Two out of three triangular lights appeared on the dash. “Well, you need to get out of my damn way ’cause I’m lowering my landing gear and heading in.”
The Spirit of Steamboat Page 10