Chapter 13 ~ Race against time

“Nothing wrong with shooting as long as the right people get shot” 

~Dirty Harry~

Daniel’s point of view 

We’re too late. 

Anita and I drove with Dad and Larry. We took the liberty of fast driving the first part of the way but as we approached Butler, dad made Larry turn off the sirens and slow down. Anita wanted to descend straight onto the farm blue lights and sirens and bring them down. “FUCK protocol! There are children out there in great danger!” she shouted and I silently agreed with her. We were leading our convoy of three vehicles and thankfully Larry made sure to drive pretty fast despite my father’s protests. It calmed her down somewhat. 

Dad and Larry tried to explain that we didn’t want to scare them off and if we barged into a scene without caution we might do more harm than good. That it was police protocol, to ‘proceed with caution’, and not show ourselves until we assessed the situation. I know my old man so I kept quiet. Anita was livid and made it clear with a range of explicits how little she thought of police protocol. Bottom line, we were not in charge so there was not much we could do. We parked the three cars about a quarter of a mile away on a track in the forest and Anita and I  together with Dad and the rest of the men carefully crept the rest of the way. The women stayed behind taking care of the cars. Samantha is pregnant and Erin and Becky do not have full training for an unsecure situation such as this one is likely to be.

I'm having mild flashbacks from Afghanistan. In the faint morning light, we hurry as much as we can towards the farm. Just as we begin to see the farm houses through the trees we are startled by an explosion, the screams are intense, the terrifying cries for help that people make when they’re on fire. Then, soon after that, we hear the first shot, then another one, then several more. The screams intensify but sound less human now, more like from frightened animals.  My father grabs hold on Anita and throws her down. 

“Stay down!  Don’t move!” He barks into his radio. “Call for backup. Armed and dangerous. Multiple gunshots” he informs Valery and the women staying behind.

I act on pure reflex. “I’m going in”

“NO!!” My father grabs me. “You don’t know what happened. They’ll shoot you too if you go there now.”

That right there is the difference between police security protocol and my personal ethics. I’d served in three wars, of course I know that I will be of less than no help injured or worse. But right now I know what I have to do. Anita looks me straight in the eyes. She's thinking the same. We hurry towards the farm ignoring my father’s cursing. 

I stop and try to assess the situation. I’ve served in conflict zones and this certainly resembles one. The house is consumed by fire. The smoke is almost thick enough to impair my view. The explosion. Smells a lot like gasoline here, so arson probably. At first glance, I see three bodies on the ground, they are all conscious and clearly in considerable pain by the sound of it. Through the smoke I see another figure, and this one is pointing a gun at me at me, he looks very young. He's standing next to the fourth victim who is rolled up in a fetal position on the ground. I see another weapon on the ground.

I raise my arms above my head. His hand is trembling, he won't shoot. I speak calmly to him. “Don't shoot buddy, we come in peace... I'm a doctor… we’re unarmed, let us help please.”

We slowly walk towards the three bodies on the ground. I’m about to tend to them when the boy speaks. “She has a gun, be careful.”

So he’s not aiming at us. He’s trying to protect themselves and us from this woman. I see a small handgun on the ground, pick it up, careful not to leave my prints on it and quickly make a show of emptying it of bullets. Then I throw it under one of the cars. 

“Put the weapon away son, the police are right behind us, they'll shoot you if the see you’re carrying, this is my radio, let me call them off” I grab my walkie talkie. “Unarmed. Everyone is unarmed. Don’t shoot!”  

The boy is still pointing the rifle at me.  “Help us first and I’ll put it down”

I can work with that. The lady on the ground is bleeding heavily and the men have burns but I’ll do what the boy demands. His actions do suggest the people next to me don’t deserve all that many favors. And besides, a rifle in my face trumps Hippocrates. The others should be coming soon, they can take care of these three. 

I slowly approach him, my hands held in front of me.  Anita is right behind me. 

“My name is Daniel, what’s your name buddy?

He puts the rifle on the ground. “Hunter… her name is Cynthia… she’s been shot…” his voice is shaking and he’s clearly trying very hard to keep it together. 

We both kneel to check her. “Hello Cynthia, I’m Daniel, this is Anita, can we take a look at you?”  The girl is obviously in pain and she’s holding her side but I see that her light colored shirt is stained by blood which is already seeping through her fingers. 

I reach into my bag to grab a compression gauze. “Come on sweetie let Anita lift up your shirt, I want to place this on your wound.” I press the gauze to the entrance wound. 

“I’m fine. I’m FINE. Help Brian!” I ignore her but Anita rises immediately. Brian, that’s the boy she talked about earlier. 

“Where is Brian?” She asks, and Hunter motions to a vehicle parked next to us. “They’re behind the truck” 

They? As in how many? 

“Hunter, can you press the wound really tight...?” His hands are on the compression before I even finished my question. 

As I get up Anita calls my name. She has walked a few steps further and is looking past a pickup truck parked in my line of vision. “Daniel! Come quick!” She disappears behind the truck. 

As I follow her I turn around but don’t see the others. The smoke is really too thick so I can’t tell if they are here already. I grab the walkie talkie again. “Dad, take care of the two kids, she’s been shot” 

I get behind the car. Anita is already on her knees next to two boys. There is another person behind them, shot in the head, it’s too late for him. 

“Brian! I’m Anita, do you remember me sweetheart? I put the cast on your arm when it was broken. This is Daniel, he’s a really good doctor. Let us help your friend please.” 

Brian is not willing to let go. He’s talking a mile a minute. “He hit us, h-he... kept hitting us... there's so much blood. I can’t stop it. He needs to go to the hospital. Please take him to the hospital… He has a fever. He’s been sick for a long long time. And.. and… he’s allergic!! Tell the hospital he’s allergic! ...to tylenol and penicillin… and uhm… codeine”

I lay my bag on the ground and pour out all the envelopes of sterile gauzes. I help her pry Brian’s fingers off the other boys head. We quickly dress the wound the best we can. His skull is definitely fractured. Anita is handing me her jacket and I fold it twice over to use as a temporary neck stabilizer. He needs to get transported soon. 

My father is with us now. “Larry got the girl, Do you need my help over here?”

“Yes, thanks. How long is our wait for transport”. He doesn’t reply immediately. 

“Dad?!”

“They… there is a delay. There’s been a bus accident on I-79, apparently it’s very serious. All local emergency crews have been dispatched there, we’re getting paramedics from Pittsburg. 

I hear his radio hiss. I can hear Valery’s voice on his radio. “I have two airlifts. They’re about twenty minutes away from you now. We have four ground ambulances heading your way too… but that’s gonna be 35 minutes at least.” 

Not good enough. The return drive is at least 40 minutes even if they go fast. 

“The girl’s chest wound needs priority. This head wound is our first priority though. I want the two choppers for them” 

The distress calls of the animals and the furious explosive sounds from the blaze are too loud. 

Do you know the condition of the others?” 

“No, the guys wanted to move them away from the fire, I don’t think they know yet. The burns might be serious, but you’re the doctor Son, you’re gonna have to make that call. The girls are bringing the cars… they should be here any minute. We could bring some of them in. We have oxygen and blankets… but we can’t afford to lose the manpower, we’d need to send at least 2 with each patient. But we have stretchers in the cars, we really should move them out of the smoke...” 

Brian is still kneeling next to us. I zone my father out. The boy is silent now. Too silent. Oh no… oh fuck! How could I miss that? I fell for the stupid rule that the quiet ones need attention first. He was acting so brave I missed the signs that are screaming at me now. Talking too much, hyperventilating, a little too pale, sweating, his fingers freezing cold when we pulled them off his friends head, his skin is pale. 

“Brian, are you in any pain?” He doesn’t answer, just keeps staring forward, but he’s not focusing on Justin anymore. Yeah, something is hiding here. He is definitely injured too. 

He’s breathing very fast. Some of this blood is probably his. I grab his wrist to feel for his pulse and he whimpers painfully and pulls his hand away. But not so fast that I didn’t see it. 

His fingers are covered in blood from holding his friend’s head so I hadn’t noticed before. His fingers are swollen, probably broken, his fingernails are missing! Oh my God... 

“He’s hemorrhaging! Anita, get over here. We need to find where he’s bleeding from. Dad, take over the head wound. Now!

“Dad! I changed my mind. Larry takes the girl to meet the first ambulance right now. Erin goes with them. The two helicopters are mine for these two. Get the girls over here! Bring me all supplies you have stat!” My dad is quick on the radio to give orders. 

“Brian, Look at me son, can you hear me? Talk to me, have you been hurt?”

“Juss-tin...” he whispers and actively evades my touch.

“Yes! Justin is in good hands. My father is taking good care of Justin.” I softly place my hand on his shoulder and try to get him to trust me. “Look at me Brian. Can you do that? Don’t be afraid. I’m gonna help you. You are safe. Justin is also safe.  

“H... h… he…”  He’s pointing at the other boy and panting as if he’s been running. “Ah...llergic… hospital… phh...…” then his hand drops and he falls forward into my arms. He doesn’t have enough energy to hold himself up anymore. Where the fuck is that wound?

“Brian, can you hear me buddy? I need you to stay with me. Tell me where you’re hurt. His pants are wet but cold, there doesn’t seem to be any bleeding. “Nooo… don’t touch me...” He faintly protests. I exchange looks with Anita, he sounds so broken. “I’m... uhh… I’m sso c..cold…”

“Brian! Look at me! I’m gonna put my hands on you now. I’m going to help you now” He’s shaking so much now, I worry he might be going into shock. I quickly feel my way around his shoulders, back and chest to his abdomen. 

Found it. 

His abdominal area is hard and as I lift his shirt I see it looks swollen, particularly his left side. I could measure him but I don’t have to. His heart rate is way too fast for his pressure not to be falling. I’ve seen this before too many times. He’s nearly unresponsive now. 

Becky and Sam are with us now. Good. “Becky, help Dad, Sam get over here”. She places the equipment case next to me and Anita takes out the oxygen tank and places the mask on Brian. “I’m going back for the stretchers,” Sam says, “we should move them, there’s too much smoke here it’s not safe you guys.” I notice that now. 

We don’t see the boy until he speaks. 

“Did I shoot him?“ It’s Hunter. He casts a worried look in  Justin’s direction. 

I see the scenario in my head. The dead guy next to us was hitting Justin with the crowbar which he’s still holding in his fist. He’s been shot directly in the face. And Hunter had a rifle earlier. So he’s the shooter. I can understand why he thinks his bullet may have hit Justin. 

“No, Buddy… you saved him. They would both be worse off without you”

I’m not sure if my words have relaxed him, he still looks very scared. We don’t know what has happened to these kids but I have my suspicions.  Neither Brian nor the girl wanted to let me touch them. And if the girl I treated this evening came from here... well... I can’t be thinking about that now.  

“What should I do?” he asks quietly. 

Great question. 

The right thing to do would be to wrap him in a blanket, tell him to relax, hold him and convince him that everything will be alright, because do we really place further responsibility on a 15 year old who’s just lived through traumatic events that might be far worse than we know about? But we have our hands full and maybe it’s good for him to have something to do. 

“Yes Hunter, we need your help.  Can you help us find a place away from the fire to wait for the helicopters? We need a lot of space, is there a field behind the farmhouses? I want to move Brian and Justin away from the smoke.” 

“We should go behind the cowhouse. There is plenty of space there. “ 

Sam and I place Brian on the stretchers. We pick him up, the kid hardly weighs anything.  Anita is supporting the oxygen and the three of us follow Hunter through the cowhouse. 

It’s all more than a little surreal. The animals which were much louder just minutes before go nearly quiet as we walk in. They’re grouped together as if to seek comfort from one another, staring at us suspiciously as we walk through. 

“It’s ok... it’s ok. It’s just us. Brian’s getting help now, don’t worry..." Hunter talks to them in such a calming way and I can almost believe him myself.  

“I’m sorry about the dirt, the draining is bad here. It’s better on the other side of the gate,” Hunter apologizes as we exit the building, as if it’s his fault. It’s not the fault of a fifteen year old kid if a farm is badly managed.  My shoes certainly sink into the manure in the pen but there’s no time to worry about that. The pen is only about 10 meters across and we quickly make it to a gate which he holds open for us to pass through. “Hunter, go back and help the others find their way over here with Justin, I want him here too.” 

Like he promised the ground on the other side is much dryer. We carefully place Brian down and I count his pulse again. It’s weak and fast, not that I expected anything else. 

I unzip the main compartment of my trusted bag, pull out the stethoscope and cuff kit and quickly start inflate it on Brian’s arm. Anita has stolen my stethoscope form me, already has the eartips in and is taking over. 

“Sam, How long until the chopper is here?”  

“I imagine 10-15 minutes.“  I can't believe it’s less than 10 minutes since we found the boys.  It feels like half an hour at least. 

So we wait?  The transport back takes at least 25 minutes. So 40 minutes until he gets to a hospital. 

The air is still slipping out of the cuff, Anita hasn’t said anything, we’re both staring expectedly at the sphyg. 

“Systolic 74…”  No. We don’t have the luxury of waiting. I need to take a look inside. If it’s his spleen it needs to come out. He has lost way too much blood already, the poor boy hasn’t got long. I swear that Anita is reading my mind. And why shouldn’t she. She was with me performing medical procedures in tents in the desert without so much as running water. “... there, 74 over 50… ” She releases the cuff. 

“Right. We’re gonna stop the bleeding.” I knew he was low but this is just too low. Anita nods. I was right, she’s not the least bit surprised. 

“What do you have in your bag Sam? I want to see everything you have.”

I take off my jacket and lay it on the ground next to us, then zip down the front section of my bag on top of it. It’s one of those smart foldable bags with see through compartments lining the inner space so everything is organized. Everything you’d expect to find in a regular first aid kit, but then some more. Gloves, wound covers, bandages, A small bottle of iodine, various kits and tools, medications. It turns out Sam’s bag has more of the large scale items, blankets, bandages, rescue gear... Oh! a bag of saline. I grab it and lay it against my chin, fuck… it’s too cold. It’ll do more harm than good. I give it to Anita. And she places it under her arm. 

I reach into the compartment where I keep the tools. Shit. The only scalpel I have is a 15# blade, it’s no good. I have that tiny thing for it for dealing with small pieces of glass, splinters and small wounds. I’m an idiot, My mind goes back to last weekend, to a stupid impromtu BBQ where nobody remembered to bring a knife. I used my 24# blades cut steak. The ER-doctor saved the day… and then I forgot to replace it.  Great. 

“Sam, do you have a scalpel?” No. Fine, I’m gonna have to make do with the 15#. 

The distinctive sound of a metallic spring catches my attention. Hunter is back holding out his hand with a knife in his palm. “Uhm… maybe… I don’t know if this one works? It’s sharp though.”

This kid is a lot tougher than I gave him credit for. "Well… that's… yes, I can probably use that. Cover both surfaces with this and leave it on until I need it." I hand him the bottle of iodine. There's no time to ask him what he’s doing with a contraband, that’s the least of our troubles right now.  And besides Anita has located my own dirty little secret. 

"Humph…  Fentanyl? In a first aid kit? Really...?" She gives me a look of disbelief. 

"Yeah, well, I was sure I was gonna need it someday... and bloody hell if that day hasn't arrived…"  I fill a syringe with the contents of the small vial.

"Anita, I want you to give him one third now and the rest if he moves when we start. Bloodpressure is so low that I’d rather not, but I don’t want to torture him either."

“Are you sure Daniel?”

“Yes, I’m sure! It’s much easier to do it here... The chopper shakes too much. I've done this before.” 

“Did he survive“

“Some of them did.” 

I put on gloves and silently curse the fact I'm about to open the kid up as if he was a farm animal, without decent equipment.  I get the iodine back from Hunter and smear it on Brian's abdomen and the rest of the equipment.

“Ok then, Hunter, give me the knife,  and grab that flashlight over there and hold it still.”  Sam, you manage the oxygen… 

Anita, you… well everything else. Let's do this" 

And so I cut him open. Sometimes I hate being right.

-   - -