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Rachel and Trudy both look at the monitor as the ambulance comes to a halt.
“Good God, we’ve got a heartbeat, Trudy.”
Trudy grins and goes past me to open the rear doors.
Rachel says, “I’m not God, but at times like this, I amagod. Let’s go.”
I jump out first to give them room, and the two paramedics take Alex out on the gurney and move him briskly through the automatic sliding doors of the emergency department.
Trudy and Rachel know where they’re going, and we pass a nurses’ station and go through another set of automatic sliding doors into a two-bed trauma bay filled with medical equipment and about eight or nine emergency personnel, all dressed in gowns and masks.
One gowned nurse notes my detective shield and says, “Jack, get the detective here dressed.”
Rachel says in a loud and clear voice, “Male gunshot victim, entry wound left middle side of chest. No apparent exit wound. Blood pressure eighty over forty, heart rate one forty, and respirations twenty-six. Inbound, the victim was in distress and showed signs of a tension pneumo. The victim went asystolic approximately ninety seconds ago, and we did a needle decompression. He’s now back in sinus rhythm.”
As Rachel talks, the ER personnel move through their tasks smoothly, like a troupe performing a well-rehearsed dance. Alex is taken off the firefighter’s gurney and placed on the trauma-bay bed, his shoes are pulled off and put away, and two ER techs with large shears cut away his remaining clothing. Sensors attached to electrical leads are slapped on his chest, and other equipment is moved in close around him.
The gowned man named Jack steps up to me, rips open a plastic package, takes out a surgical gown. I extend my arms and Jack does his best to fit me, but I’m so large he can’t even fasten the ties at the rear. I put on my mask, swing my attention back to Alex, and listen to the quick, professional conversations.
I realize the two paramedics—Rachel and Trudy—are gone.
I didn’t even have the chance to thank them.
Chapter
20
As I standthere, only able to see Alex’s feet, I remember the times I’ve spent in this same trauma bay with countless other gunshot victims. I’ve forgotten most of them, but this one I’ll never forget.
Alex.
I want to go hold his hand, but there’s no room. An ED resident once gave me a tour of the trauma bay, and I remember what he taught me about the algorithm for advanced trauma life support. The mnemonic isABC,and the protocol is always followed.
Ais for airway—you have to make sure the patient’s airway is clear. One ED physician at Alex’s head says now, “Airway is patent.”
Bis for breathing—assessing whether the patient is moving air. Another physician, stethoscope in hand, says, “Right lung is clear, but there are no breath sounds on the left. Definitely a pneumothorax. Let’s get a chest tube in, and type and cross him. Tell the blood bank we’re going to need a lot of units, ASAP.”
A phone call is made and one of the gowned nurses rolls up a slim piece of medical equipment with empty hooks on the top, and within seconds, someone races into the trauma bay with a hand cooler that’s filled with IV bags containing blood.
Rapid blood infuser, I remember from a previous visit. To replace massive amounts of blood and—
A physician inserts a chest tube into the left side of Alex’s chest. The tube is attached to suction to remove the air in the chest cavity and allow the collapsed lung to reinflate, but a flood of blood exits the chest cavity as well.
“Okay, okay,” someone murmurs. “Let’s get the blood going.”
Cis for circulation, and given how much blood he’s lost, more has to be pushed in. The nurse hangs a unit of blood on the infuser, starts another IV in Alex’s right arm, and the new blood starts to flow.
“X-ray?” someone says.
A portable X-ray machine is brought in; there’s a click and hum, and then the X-ray machine is pulled back. It has a display screen, and two of the doctors look at it.
“There’s the bullet, right there. Looks to be in an okay place, but shit, that lung is torn up. How’s his belly look?”
On the other side, a tech is doing an ultrasound. With a thick wand pressed against Alex’s abdomen, the tech says, “All clear, no blood pooling.”
I stand still and watch them work.
Tears in my eyes.
