Crossroads

Chapter Twelve

Linda set her protein shake aside and picked up the ringing phone in the flight ready room. “Linda O’Malley. Go ahead.”

“This is State Trooper Anthony Alaqua. We need transport for a twenty-five-year-old female, motorcycle versus truck.”

Linda ignored the fluttering in the pit of her stomach. She hated motorcycle call-outs even more than the usual MVAs. The carnage wrought by machine versus man was so often devastating. But medevac runs were usually for major traumas or other life-threatening situations, and she was used to the shock of human tragedy by now. Still, she sometimes wondered if the horrors didn’t leave some invisible scar on her soul. Beside her, the printer spat out the location and details of the accident, logged in at the site electronically by the first responder, and she pushed the pointless musings aside. This was what she did, and she wouldn’t change it no matter the cost. “The coordinates are coming through now. Estimated flight time is twenty minutes.”

“Good. We already have one DAS.”

The roiling in her stomach surged. One dead at scene. Not just a minor bump and slide, then. “We’ll push it.”

“Roger that. Out.”

Linda hung up, grabbed the printout, and hurried across the lounge to the closed on-call room door. She knocked sharply. “Jett? We need to roll.”

The door opened and Jett McNally, the chief helicopter pilot, scrubbed a hand through her thick sandy hair. She’d been on shift six hours and had flown four times. She’d probably been catching a nap. “I heard the phone. What have we got?”

“Motorcycle accident. One to transport.” Linda scanned the details. “Looks like head injury and multiple extremity fractures. Her vitals are shaky.”

Jett’s full lips thinned and her jaw tightened. “Okay. Wheels up in two. Rally the troops.”

“Right. We’ll meet you up there.”

Jett, lanky and lean, yanked her flight suit off a hook in the cubby by the door and pulled it on over her black jeans and tight T-shirt. From the back she looked like a young guy, and she moved like a practiced soldier. She zipped up, grabbed her helmet, and disappeared. Linda liked and trusted all the helicopter pilots, but she secretly preferred flying with Jett. Unlike the others, who had come from civilian sectors, Jett had seen combat in Iraq and Afghanistan, and she was unflappable in an emergency. Linda loved being a flight nurse, but emergency medevac choppers often flew into unstable situations due to weather or terrain, and she flew easier knowing her pilot could handle anything. Especially now, with the baby coming. She pressed her hand to her abdomen, the fluttering settled a little, and she checked the on-call list hanging on the board behind the STAT phone. Good. Sammie Chu and Dave Burns, two of the easiest-going and solid members of the flight team, were up for trauma and anesthesia. After paging them with the code to report to the flight deck, she zipped into her own royal blue flight suit. The form-fitting suit was getting tight in the middle. She didn’t have too many flights left. As she collected the rest of her gear, the exhilaration of heading into the unknown caught her once again, and she headed for the elevator to the rooftop flight deck with nothing on her mind but the upcoming call.

When she reached the roof, Jett was beside the big EC145 Eurocopter with a clipboard in her hand, completing her preflight check. She shot Linda a thumbs-up and climbed into the cockpit. The rear double doors slid open, and Linda stepped aboard, settled into the pull-down seat behind Jett, and strapped in. The engine roared to life and the overhead rotors turned, caught, and whirled. The belly of the chopper trembled like a beast on a chain, hungry for freedom. Linda peered out the open bay doors and watched a short, thickset man with a bullet-shaped, shaved head and a taller brunette in hospital greens sprint across the tarmac. Not yet noon and heat shimmered off the black surface like fingers of fire. Dave Burns, the nurse anesthetist on flight call, and Sammie Chu, the senior trauma fellow, clambered aboard at the same time.

“Hiya, what we got?” Sammie asked in her deep alto, the Texas twang still evident in her voice despite six years at PMC. She took the other half of the double seat next to Linda and pulled on her helmet.

“Motorcycle victim.” Linda passed Sammie the field report.

“Hello, summer,” Dave said and dropped into a jump seat across from Linda and Sammie.

Jett’s voice came over the comm channel. “Flight crew, make ready. Wheels up in twenty seconds.”

“All clear,” Linda said into the mic in her helmet.

Everyone settled back, the doors closed, and the chopper lifted off.

Linda watched out the window as Jett made a lazy circle over the hospital and then arrowed northeast toward Route 309, the site of many of their vehicular call-outs, especially during the summer season. Eighteen minutes later, the crash scene came into view—a clot of vehicles blocking the northbound lanes. Fire trucks, police cruisers, and ambulances had all converged in a ring across the three-lane. A pickup truck was canted onto the median, its front end crushed, the hood popped open and steam billowing out as firefighters coated it in flame-retardant foam. Some distance away, dark skid marks snaked up the highway to where a big touring motorcycle lay on its side. A blue tarp covered a shapeless mound twenty feet farther down the road. A clump of people gathered nearby, presumably tending to the survivor.

A state trooper waved a flashlight, directing Jett to a makeshift landing site on the highway, and the helicopter descended, touching down with the barest of jolts despite the winds that had picked up as they’d flown.

“Clear,” Jett signaled over the radio channel.

Linda released her safety belt and grabbed the med kit. Sammie and Dave grabbed their gear boxes, and they all climbed out and raced toward the circle of emergency responders.

Several people moved aside and Linda and Dave knelt by the patient. Sammie talked to a middle-aged man in a paramedic uniform a few feet away. The girl on the ground was slight, maybe five-one, a hundred pounds if that, dressed in jeans and a yellow, scoop-neck T-shirt—not exactly biker gear—and the lightweight clothes hadn’t offered her much protection. Her left shoulder was raw with road rash and her arm was clearly fractured just above the wrist. Fortunately, her helmet, a minimal affair with no face or chin protection, was still in place. An open fracture of her left femur was obvious from the inch of bone protruding mid-thigh through a ragged rent in her torn jeans. The EMTs had already started an intravenous line in her right arm and splinted the fractured leg. Linda checked her vital signs while Dave assessed her airway.

“She’s nonresponsive to verbal commands,” Dave said, “and she’s not moving much air.”

Sammie squatted across from Linda and pressed a stethoscope to the girl’s chest. “The truck changed lanes and didn’t see them. Reports are this girl and the driver were ejected from the bike on impact.”

“Was she ever responsive?” Linda asked, documenting the first set of vitals on her notepad.

“Unconscious when the EMTs got to her.” Sammie frowned and moved her stethoscope an inch to the left. “Breath sounds are decreased on the left.”

Linda said, “Her pressure’s been all over the place, but it’s steadily tailing down.”

“What’s hanging in the IV?”

“Normal saline.”

“Run it wide open.” Sammie draped the stethoscope around her neck and looked at Dave. “How’s the pulse ox?”

“Crappy. 72 and drifting lower.”

While Dave and Sammie conferred, Linda checked the positioning of the splint on the girl’s leg and moved down to assess the pulses in her foot. The foot was mottled, faintly purple, and cold. “We’ve got no blood flow here, Sam.”

“Looks like several broken ribs, possibly a hemopneumothorax too.” Sammie grimaced. “Dave, you’re going to need to tube her.”

“You have to take this helmet off,” Dave said. “I can’t get to her airway this way.”

“All right.” Sammie duck-walked around the girl’s prone body until she was leaning over her head from above. “Linda—stabilize her neck while we get this helmet off.”

“Right.” Linda bent over and held the girl’s shoulders and neck in line with her spine while Dave and Sammie eased off the helmet. The position was awkward, and a muscle twinged in her lower back. She ignored it, concentrating on preventing the girl’s neck from flexing. If her cervical vertebrae were unstable, too much motion could crush her spinal cord.

“Okay. Linda—hand me the C-collar,” Sammie said.

Linda passed the molded plastic neck support to Sammie and straightened, trying to massage the cramped muscle in her back with the heel of her hand.

“You okay?” Sammie asked.

“Fine.”

“I’m gonna have to get that tube in now,” Dave said. “Pulse ox is 68. There’s a number seven right on top in my box, Linds.”

“I’ve got it.” Linda pulled the curved plastic tube from Dave’s kit and held it by Dave’s left hand as he opened the girl’s mouth and inserted the laryngoscope. She said to the first responders still crowded around, “Anyone got suction?”

“Here.” The EMT who’d briefed Sammie passed a thin, flexible catheter to Dave.

“Thanks.” Dave cleared saliva and blood from the girl’s throat. “E-T tube?”

“Here you go.” Linda positioned it in Dave’s hand so he could slide it down the trachea.

He took it without shifting his focus from the oropharynx and eased the tube alongside the blade of the laryngoscope, past the base of the tongue, and into the trachea. Linda quickly checked for breath sounds. “Nothing on the left, Sammie.”

“Yeah—I hear that,” Sammie said, also listening for breath sounds. “She’s got tracheal shift to the right. That left lung is down. Linda, open up a cut down tray and get me a number thirty chest tube.”

Linda’s pulse jumped. This was bad. The girl was too unstable to even get into the chopper, and the longer they were in the field, the worse her chances became. Quickly swiveling around on her knees, Linda reached for the surgical field trauma kit. The muscle in her lower back cramped again, harder, and she caught her breath, battling a wave of nausea. Ignoring the pulling sensation, she lifted the instrument pack from the bottom of the trauma box, extracted the two-foot-long chest tube, and tore open the clear protective wrapper. After folding open the outer layers of the sterile cut down tray, she pulled on a pair of surgical gloves, snapped the blade onto the handle of the scalpel, and waited for Sammie to ask for it. When Sammie did, she passed it, handle first, across the girl’s chest, and Sammie made a two-inch incision between the fourth and fifth ribs in the anterior costal line.

“Kelly,” Sammie said.

Linda slapped the oversized hemostat into Sammie’s palm and got the chest tube ready.

Sammie pushed the Kelly through the thin muscles connecting the ribs and into the chest, spreading as she went to make room for the tube. “Okay, I’m in.”

“Here you go—number thirty,” Linda said.

Sammie twisted the tube through the hole she’d made in the chest wall and a minute later blood poured out onto the ground. While Sammie sutured in the chest tube and Dave hand-ventilated the patient, Linda ran back to the chopper to get a Pleur-evac drainage container from the storage bin. She sprinted back, the cramp in her back escalating with every step. The nausea worsened and she had to drop onto her knees next to Sammie to fight the light-headedness.

“Linds? What’s wrong?”

“Not sure,” Linda gasped, panting for breath. “Pulled something in my back.”

Sammie connected the sucking chest tube to the vacuum container. “Head back to the chopper. We’re about ready to transport.”

“I’ll sta—” Pain shot through Linda’s lower abdomen. “Oh God. That felt like a contraction.”

“That’s it,” Sammie said. “Go lie down, Linda. We’re all right here.”

Carefully, Linda stood, pressing her hand to her belly. She couldn’t be in labor now. It was way too soon. Heart racing, she walked carefully back toward the chopper, afraid any sudden movement might make things worse. She signaled to Jett, who jogged toward her.

“What is it?” Jett asked.

“They’re about ready to transport and they might need help.” Linda grasped Jett’s arm as another wave of pain rolled through her abdomen. “God. I’m having contractions.”

“I’ve got you.” Jett gently slid an arm around Linda’s waist. “Let’s get you inside. I’ll radio ahead and tell them we’re coming in. You’ll be fine. We’ll be back there in just a few minutes.”

Linda glanced over her shoulder. Dave and Sammie were loading the trauma patient onto a litter. “She’s in bad shape, Jett.”

“Don’t worry about her, that’s Sammie’s job. She’s got it.” Jett lifted Linda into the chopper and climbed aboard after her. “What do you need me to do?”

“I just need to lie down right now.”

Jett guided Linda to one of the fold-down stretchers along the wall. “Okay, here you go. Sammie will be here in a second. Don’t worry.”

“Call Robin,” Linda said as Jett strapped her in. She tried to keep the rising panic at bay. She wasn’t going to lose this baby.