by Gwen Hunter
I opened her shirt and cut away her bra with shaking fingers. Her chest was livid with bruises and bright with blood. The man from the hill crashed through the underbrush behind me, joined almost instantly by another.
"I’ll tie off the car. You help Ash." Welcome words. From above, more headlights illuminated the scene as more vehicles turned off the road and stopped.
On the woman’s chest I saw bubbles in the blood, appearing each time she breathed out. A sucking chest wound. Something I could help. Throwing open the jump kit, I ripped open the foil package of a Vaseline gauze dressing. Without touching the sterile gauze or the inner foil, I placed both dressing and foil package over the bubbling wound and pressed gently, leaving a tiny opening for escaping air. Quickly, I added an entire package of 5x9 gauze over the foil and taped it all into place with two-inch-wide clear body tape, careful to leave the tiny space that could prevent the total collapse of her lung.
Sucking chest wounds are caused when some object penetrates the chest cavity and into the lung, creating a hole through which air seeps when the patient breathes. Dangerous, but a manageable wound.
Voices sounded above. Shouts. Suggestions. Conflicting orders and confusion. Help had arrived. Thank God. Thank God. The shaking in my hands eased a bit. I pulled out my stethoscope and inserted the ear pieces so I could listen to my patient’s chest.
The smell of gas grew stronger, blanking out the sweet smell of wildflowers. The battery of the overturned car spat and spluttered just feet away from my head—the positive battery cable resting against the metal body of the car, a common problem at accident scenes.
Gas and sparks. Lovely. Just lovely.
Beneath the bent A-pillars of the windshield was a human foot. Bare. Garish in the uncertain light. I cleared the woman’s airway again, followed the foot to the ankle with my eyes and up ripped pants to a knee as I listened to the woman’s breathing and heartbeat. Above the knee was a bloodied leg with a bone sticking through skin and fabric at mid-thigh. Femur bone. Compound fracture. Blood welled, pulsing slightly from the wound in weak but rhythmic gouts, looking bright but thin in the sharp glare of my flash. A briefcase was open at his side, bloody papers scattered in the mud.
I smelled vomit beneath the sharper scent of gasoline. Gray eyes met mine. Blood ran from his forehead, obscuring his face. He wiped at the trickles running down his right eyebrow.
"Guns and Roses," someone said beside me, using the old band’s name as curse words. "How many are there?"
"Three, so far," I said. "We need to get the car off her. Call Med-evac and get a chopper here stat."
"Yeah, right. I got this one. You’ll have to take the man."
I glanced up quickly. It was Irene Rodgers, on her knees beside me in four inches of mud. She was right. Irene would never fit beneath the car. I was the skinny one on this call. I went back to my patient.
Someone spoke into a radio, relaying the need for a chopper and another wrecker. With the muddy conditions it might take two tow trucks to remove the overturned car, especially if one became mired in the muck.
A second stethoscope searched the woman’s chest. Another pair of gloved hands reached for the cervical collar. A third pair steadied the woman’s head as the brace went into place. A pen light checked her pupils. An old Leardal—a battery-powered suction machine—came on with the soft sound of air pumped by a plastic piston. A stiff tube cleared the woman’s airway better than I had been able to do alone. Hands and helpers. The cavalry had arrived. The woman groaned.
"She’s got a sucking chest wound. Pulse one-forty-five and thready. A probable hemo-pneumothorax. Respiration’s twenty-four and shallow," I said without looking up. "I haven’t checked her blood pressure."
"Got it," a voice said above me. A third body joined me, knees in the mud.
The car was upside down, hood pointed directly at the creek water roiling only feet away. The back part of the roof was crushed down to the seat tops, trapping the woman. The man was lying on the roof at the front of the car, his broken leg beside him. His other foot was over his head, wedged into the dash. The steering column was bent, the wheel pushed up against the dash between us. A woman’s shoe was caught in the twisted metal and plastic.
"My wife." The words were whispered, barely audible in the confusion. "My wife." My eyes snapped into the cavity of the car, meeting the gray eyes of the man with the compound fracture. "Is she—" he started.
"I don’t know. I wish I could tell you," I lied. I had never learned the art of telling the truth to accident victims. But I wasn’t very good at lying either. I changed the subject. "How many people were in the car with you?" I tucked my stethoscope down into my shirt, grabbed a handful of supplies from the jump kit, stuffing pockets. Added a fresh pair of gloves.
"Three of us," he whispered.
"Any children?"
"No." His pants were soaked crimson.
"Are you sure? Tell me how many people were in this car." It might sound cruel to badger the man, but he was shocky. Confused. He might not know what he was saying. I reached for my flash, pulled it close.
"Three," he said.
"Just three? All adults?"
He nodded.
"What’s your name?"
"Alan. Alan Mathison."
Other hands were caring for the woman. Still others were positioning cribbing and bringing in the Jaws of Life and the generators: one generator for the jaws, whose massive spreader arms would force apart the mangled metal of the car’s body, one generator for the lights. The accident scene began to grow brighter as the squad’s oldest generator roared to life.
The first wrecker was sliding down the hill to the creek bottom. I had been working for less than half an hour. If the woman was to live, we had to work faster.
Pushing my flashlight in front of me, I wiggled through the broken side window, across the ruined roof and the mud that had scooped into the car as it slid toward the creek. I was wet to the skin. And if the A-pillars—the front roof support struts—gave way, I’d be crushed.
Moving Alan’s bloody hands away, I found the pressure point in his groin and pressed. The bleeding in his thigh wound stopped instantly.
"No pulse down here, Ash. Foot’s cold."
I knew what that meant. Alan could lose both his wife and his leg.
Keeping pressure on the man’s groin, I checked his pulse, listened to his chest. His heart and lungs were clear. "Respiration’s forty-five and shallow," I called back, "pulse one-thirty."
"Got it," a fresh voice answered from the far side of the car. It was Phillip Faulkenberry, Jack’s second in command, in charge of the squad now that Jack was gone.
"Sending in a blanket and a cervical collar. All we got’s a large. You make the call?"
I couldn’t see who I was talking to but the voice was familiar. "Yeah," I grunted, reaching up for the blanket. My fingers closed on the loose weave of the cloth and I pulled it to me, opening it one-handed, covering Alan as best I could.
"No shit. What happened?"
With those words, I identified the voice I had first heard on the hill above me. Mick Ethridge. One of the Ethridges’ of the long departed township, a young, gung-ho kid who started any meaningful conversation with the words, "No shit." He had hardly started to shave and he was up to his elbows in axle grease and mud and Alan’s blood that had flowed out of the car and down toward the creek.
I could hear Alan’s wife breathing. It was an awful sound, but better than a silence. I struggled with the cervical collar. Managed to get it around Alan’s neck. The leg wound started bleeding again as I shifted against his side, but I couldn’t help it. There wasn’t room for another body inside the car.
"Mattress in the road," I said, grunting with the effort. "They were going too fast to avoid it and make the curve. Lost it."
"This place needs some warning signs."
"Jack asked the county for some last year," Phillip said.
The sound of my husband’s name st
artled me. I searched around in my pockets for the supplies I needed. My hands were shaking again.
"They got put on the county’s wish list," Irene said, her voice too angry to be merely wry.
I glanced up at Alan; he was out cold. His color was bad, pale and bluish around his lips. His respirations had increased, as had his pulse. He was very shocky. He had lost a lot of blood.
"I need some hands in here," I called up to Phillip. "Somebody has to hold this pressure point. This guy needed an IV yesterday. And he’s out. See can someone get a splint on his leg while he’s unconscious."
An arm snaked up into the car through the hole where the windshield once rested. Rounded bits of glass rained in upon me. I ignored them.
I guided the hand to the pressure point above Alan’s wound. The helper’s hands were warm on my icy fingers. A Citadel ring pressed against the blue of the wearer’s trauma gloves. Bret McDermott’s hand.
For an instant, I remembered the list of investors from Jack’s office and the scrap of letter talking about murder. Bret could be involved. . . . My mind clicked back to my patient.
Other hands pulled at Alan’s broken leg, positioning it in the stiff splint. Velcro made it snug, and a hand air pump provided padding, supporting the limb.
Although there was help aplenty from beyond the broken out windows of the crushed car, no one joined me inside. Gas fumes burned my throat and eyes, bringing tears.
Alan started shaking. Opening his eyes, he gagged and vomited off to the side, struggled against the cervical collar, his movements further hampered by the steering wheel over his head.
"What’s your wife’s name, Alan?"
He licked his lips. The car settled further into the mud. The metal groaned like a ghost in a nightmare, a long and piercing screech. I pulled my legs in a bit, but there was nothing I could do to protect myself if the car’s front roof supports gave way. The back supports—the C-pillars, in squad lingo—were flattened against the car’s body.
"Marjorie. My . . . Margie," he added.
"Margie what?"
Alan looked puzzled. "My wife?"
"Right. Her last name. Your last name. What is it, Alan?" I had asked that one before, but I wanted to assess his mental condition and repetitive questions were my only tool.
I reached back for the IV set being pushed up the length of my body and grabbed it. Resting my elbows in a thin layer of mud, I untangled the IV’s plastic line, setting it on the briefcase I had noticed earlier.
"Alan Mathison. Margie . . . Mathison. My wife. She wants a . . . divorce," he added, his face devoid of emotion. I didn’t respond to his statement. "She’s leaving me for . . . somebody else if I don’t. . . ." His voice trailed off.
"Ash, we’re getting cribbing and a couple jacks in place to stabilize the car. Then we’re going to cut away the A-pillars and lift the car off her." Phillip bent over to speak to me through the passenger side window opening. I nodded my understanding. I had never been inside a car before as the jaws went to work. But I’d heard about it. I took a deep breath.
Alan shifted and pushed at the unfamiliar hands, cursing softly under his breath, though his eyes didn’t open. His lips were blue. "She’s going to take everything . . . all the money," he whispered.
"I’m sorry," I said. And I was.
He tried to focus on my face. His eyes settled instead on my nametag swinging in the light of the flash. He frowned, and then the frown slipped away.
"Jesus . . . I hurt." It didn’t sound like a prayer. Alan was confused and getting angry. Quick swings of emotion were expected in a trauma patient, but I had to keep him calm and still. Cooperative. "I hurt."
"Alan, I need you to make a fist." I touched the hand pushing at McDermott’s. "I need to put an IV in. And my friend here’s going to hold you still so I don’t hurt you. Okay? Alan, do you understand?"
"My wife . . . doesn’t want me anymore."
Bret’s other hand slipped in beside mine and steadied Alan’s against the briefcase in the mud as I tightened a tourniquet around his arm. I swabbed Alan’s hand with an alcohol pad. Beside me and to my rear, sledgehammers slammed into the cribbing, driving the blocks of shaped 4x4s into the openings around the roof, supporting the A-pillars. The sounds were like cannons exploding in the confined space. The entire frame of the car sang and vibrated.
Alan had no veins. I milked blood up the arm, trying to restore enough volume to find an IV site. Nothing happened. Alan’s arm was a pasty bluish gray.
Saying a quick prayer, I opened a number eighteen Jelco angiocath and picked a spot on his arm almost at random. "Alan, I’m going to stick you with a needle now. Hold still."
"Yeah. Okay. . . ." He licked his lips again. "Water. I want some water. No. Iced tea with lot’s of sugar. Get me some tea," he commanded.
I inserted the needle, missing the vein. Pulled back and tried again, repositioning. On the fourth attempt to pierce the vein, I got a slight flashback—a show of blood at the back of the needle letting me know I was in the vein. I removed the steel part of the Jelco, flipped down the plastic security device, and dropped it on Alan’s once-white shirt. Starched. Expensive looking. Carefully I pushed the IV’s plastic sheath up into his vein. Popping the tourniquet off, I shoved the IV line into place and thumbed the valve wide open on the IV solution. Held it up in the air so gravity would force the fluid into the arm.
"Not bad," Bret McDermott said in his slow, calm way. I grinned over at him, flushed with success. "They teach you that in nursing school?" I laughed, the sound shaky, and taped the IV line and the Jelco to Alan’s arm. He was out again. The sledgehammers beat into the body of the car like a giant intent on vehicular vandalism.
Resting the IV bag on the underside of the car seat above me, I checked Alan’s pulse once more, using the carotid. It was fluttery and indistinct. About one-sixty. Way too fast. McDermott handed me a blood pressure cuff and helped me get it around Alan’s other arm. I couldn’t find the pressure. There was no blood pressure at all. I was losing him. I pulled the ear pieces of my stethoscope back out and draped the device over the steering wheel above me.
A second blanket was shoved at me, and then a third. "Cover up Ash. We’re ready to cut the A-pillars," McDermott said.
The roar of a second generator followed by the scream of the scissors against metal interrupted my response, putting an end to both conversation and any chance I might listen to Alan’s chest. I pulled the blankets over me and over Alan’s head. Our faces were inches apart, tented in white cotton and moving shadows and the din of destruction. He licked his lips again, his eyes on me. He smelled of vomit and gasoline.
I needed more room. If the weight on my legs eased a moment, I could pull them into the car, perhaps saving a broken bone or two should the car collapse on me.
Reaching over Alan, in the tent of blankets, I found the briefcase at his side, fumbled it shut, and pushed it toward the broken windshield. Alan grabbed my hand. "No!" he mouthed. His face was twisted in anger. "No."
"Sorry, Alan. I need more room." I pushed again and the briefcase slid through the mud and out of the car, giving me a few inches of leg space. Alan glared. "Sorry," I repeated.
The noise was unbelievable. A raucous, screaming roar of dual generators and the sound of pry bars and hammers forcing cribbing beneath the car.
The A-pillar on the passenger’s side gave way. The car above me settled again, resting a bit of weight on my legs. I pulled the blanket off, gestured to McDermott, and pointed to my legs. He yelled something back over his shoulder.
Hands were at my legs almost instantly as someone muscled a stair-step-shaped block of 4x4s in beside me, following it with the jaws. Though the Jaws of Life did the work of forcing apart twisted metal, huge scissors, like deformed, overgrown toenail clippers, did the actual cutting, the short, power driven blades snapping through misshapen metal with ease.
The jaws went to work near my legs, forcing up the top of the car at the passenger’s side wi
ndow through which I had entered. As the car moved, I pulled my body inside, taking up the inches left by Alan’s briefcase. The rear roof supports—the C-pillars—were thick, giving way to the scissors with a grinding shriek. The noise of the rescue operation was incredible from inside the car. A ton of bent metal rocked over my head. I was in a cage with a dying man.
McDermott suddenly appeared beneath the white blankets, pulling himself head first into the car, carrying a pry bar. "Want company?" he shouted, grinning at me. I had never been so glad to see a human face. "We’re supported. Let’s get him stable and get some pants on the girl."
He handed me a second IV kit and bag of fluid. This one was normal saline; unlike lactated ringers, saline wouldn’t help with my patient’s blood volume problem, but normal saline was the preferred fluid for giving medications. The doctor in the ER would need it for that purpose. Pumping up the pressure cuff on Alan’s arm, Bret pointed to a vein, cleaned it with an alcohol wipe and steadied the flaccid arm.
My hands were shaking so badly I could hardly hold the needle. With no finesse at all, I shoved it beneath Alan’s skin, attached the line, and taped off the long plastic tubing as my helper opened the valve. Alan groaned, his voice buried beneath the sound of the jaws.
His gray eyes focused on me. He had nice eyes, clear and bright in a blood smeared face. "Ashlee. Ashlee Davenport," he murmured.
I started, and then remembered the nametag I still wore clipped to my scrub top. I smiled at him and patted his hand. It was even colder than mine. "Right." Alan closed his eyes again, saying my name twice more before he slipped into unconsciousness.
The jaws finally stopped. Silence roared in my ears, the aural echo of dueling steel. Using a pry bar, Bret beat at the dash casing prisoning Alan’s foot beneath the bent steering column. The casing, made of high impact plastic, cracked and Alan’s bruised foot fell free. McDermott and Mick Ethridge pulled him from the car, hands supporting his back and broken leg.