Risk Factors, cont'd

Hendricks was cold, very cold. He couldn't move or even see anything. He began a recurrent dream from his childhood of being stuck in a road in deep, sticky molasses, and large, luridly colored cars with snarling faces and animal movements were bearing down on him, and he was unable to make any progress in struggling out of the way. He was frightened, frustrated, angry and agonizingly slow. Safety was only a few feet away, and out of reach. He lunged for the edge of the road, and a shocking buzz of pain snapped him awake, as his dream-lunge ground the broken ends of his upper arm bone together, and brought him sharply to fully awake and suffering.
He was hanging backwards at a 45 degree angle from his rope, his chest harness keeping him from being completely horizontal, and he was being inched downward in sharp painful jerks. His head rolled back, and an effort to lift his head resulted in another jolt of blinding pain, this time in his head and neck. He didn't understand why he was being tortured so. His face was a mess of clotted blood, and he couldn't focus beyond a few feet away, so only the wall of ice and sky, and blurry tree tops wheeled into view as he crept downward. He heard a murmur of voices and urgent orders from just below, and little jerks of the rope jiggled his wracked, hanging limbs and neck, and made him begin to cry out. The murmurs became louder and more urgent, and even closer, until he was being supported by a dozen arms, and eased onto a back board. Faces appeared above him, smiling artificial encouraging smiles as they did terrible painful things to his arm, his back, his neck. Hendricks understood none of it. A rigid collar was slipped around his neck, biting into his shoulder. he asked them to stop but they did not. His left arm was straightened a bit and he groaned a shuddering, deep groan. An inflatable splint was slipped over it. Each new pain overwhelmed the last one, and again his cries for peace were ignored. His head was sand bagged, his body strapped down, and a needle stuck into the crook of his right arm. Ice cold fluid flowed into his veins, and he shivered.
"I'm cold. So cold." he said.
"Hang in there, buddy, you're going to be OK. Keep talking to me buddy." A burly paramedic sat with his face near Hendricks' and continued an annoying pep talk in his ear. An oxygen mask was tied loosely over his nose and mouth, and a hiss of cold air blew over his blood caked nose and parched, cracked mouth, making him suddenly mad for water and to get the mask off. His left arm hurt too much to move, and even thinking of the arm reminded him that it hurt. The right arm was strapped down and useless also, so he was left, masked, unable to talk, unable to move or scratch or even see. He thought he would explode from the frustration of it. The backboard began to heave unsteadily down the path to the truck, but he was so bundled up that at least each motion was not another agony. He was head down on a steep hill, and lost in a world of pain and confusion. Suddenly red flashing lights were above him, and he recognized an upside down ambulance. He was loaded into an aluminum stretcher, and then into the van. "Good" he thought "I'm going to a hospital." For the first time he began to realize what was happening, and why he hurt so much. Then he began to be afraid. People with grave faces were taking his blood pressure and pulse, and calling very worrisome numbers over the radio as they wheeled out of the turnout and accelerated toward the hospital. He had been on many ambulance rides, and the driver seemed in a special hurry today. He thought he was dying, and at that point, he was.
"80 over palp is the best I get." said the attendant. "I can barely feel a pulse. He's cold, but still awake. Let's get there quick before we lose him."
I'm going quick. The ER just gave the go ahead on the MAST trousers why don't you get them going."
MAST trousers were inflatable pants, placed on the legs and torso of people who had lost a lot of blood and were in shock, to limit the flow of blood to the legs and increase the blood pressure. They were used in desperate cases of shock, and Paul knew he was exactly that. His belts were loosened, and black nylon pants were slipped under him and velcroed around him. They were pumped up one leg at a time, and his response seemed to hearten the EMTS.
"He's up to BP 110 palp, and the pulse is 120," said the attendant. That sounded more hopeful to Hendricks, and he felt a little stronger as well. Perhaps he wouldn't die after all. The sequence of events that got him into this sorry state flashed before him now and he winced at the reliving of the fear he felt at the instant he had peeled backwards off the face.
Colin must not have removed the rope from the screw in the middle of his climb, else they would both be dead now. Colin what about Colin? His heart flipped again with a moment of concern for his friend. He mumbled to ask his tormenters about his friend, but his words were lost in hissing oxygen and clear green plastic. Even that concern faded in a hierarchy of pain that each claimed attention then receded to more insistent messages from others. His neck hurt; his back was numb. The back board hurt where it contacted his back and buttocks. The straps cramped his thigh and the MAST trousers gave him pins and needles below the middle of his thighs. His nose itched and he couldn't scratch. That fact obliterated all the rest of his misery for a while, and the frustration caused him to sob, but he could make no tears and his mouth was bone dry. He fixated then on his thirst, and his tongue sticking to the back of his throat. It was coated with clotted blood, and his breath reeked of iron, so that it almost gagged him, but the cool hiss of oxygen gave him relief, like fresh air to a seasick sailor. A trickle of blood from his nose welled into the back of his throat periodically and he swallowed with great disgust. Spitting was an impossibility. The ride was endless, the activity around him a meaningless blur, the attendants anonymous torturers, not jeering, not mean, but causing him torment without explanation and without surcease.
Then they stopped, and the insistent beep beep beep of the backup warning sounded, and the doors opened to a blast of cold air and an upside down view of the bright veiling lights and more anxious faces. He was lifted again, reminded of slumbering agonies of arm, neck and back, and wheeled rapidly, dizzily into the ER.
A nurse he knew well, one for whom he had a certain mutually acknowledged attraction, appeared above him, nearly weeping, while saying falsely reassuring things. She looked awful. Hendricks was embarrassed to be here, dependent, helpless, is injured in so ridiculous a pursuit. He spoke her name into the green plastic mask, and she squeezed his hand and patted his chest. Then other faces converged above him, and he was shifted over to a table in the trauma treatment room of the emergency department. It was a place he knew well, but from a different perspective. Normally he would be standing to one side while an injured person was wheeled in and Hendricks would be concentrating on the first steps of a vital ballet that would follow, and wisecracking to the nurses to relieve the tension. The unfortunate would rapidly be transferred from the stretcher to the treatment table, under a huge blazing disk of lights, and surrounded by monitors, oxygen and suction tubes leading to a column at the head of the bed. He would then be beset by determined and skillful people, bent on stopping the leaking away of this life, and each working rapidly, ruthlessly on a preassigned task. And so it was with Hendricks. But no one was there wisecracking. He was one of their own, and too near to dead to allow for that. Hands pulled at clothing and sheavy hears cut away his jacket and shirts, leaving his bruised chest exposed and cold. EKG monitor tabs were slapped onto exposed skin, and a familiar bleep bleep bleep gave testimony to the beating of his heart, testimony also to the urgency, because the rate was very high, and the heart working overtime to circulate the blood not yet lost. Lights shined in his eyes as needles were jabbed through his skin withdrawing blood for lab samples, and placing IV lines, and now warmer fluids were felt coursing into his right arm. His name was called out several times, and then Peter Klein's face appeared above him, impassive, even calm.
I'm going to have to intubate you, Paul" he said. You have a flail chest and a hemopneumothorax, and you need help breathing." Paul flicked his eyes open wider indicating his understanding but he became more frightened still. The medical shorthand he had just heard meant that many ribs were broken, and the wall of his chest sufficiently battered that it was ineffective and even counterproductive in his efforts to breathe. Further, there was leakage of blood and air into the chest cavity, and the lung was collapsing and being replaced by clot and air bubble. One could lose a lot of blood into a chest cavity, enough to cause death, so this was not good news. Even as Paul mulled these thoughts he heard Klein say "open your mouth" and a cold steel blade was slid along his tongue to the very depth of his throat, causing an overwhelming gagging. A hissing suction wand was rattled around his throat, and in an instant, a clear plastic tube forced through his vocal cords and into his airway. Speech became impossible but at least the hateful tongue blade was removed, and the urge to vomit passed. Air was now being forced directly into his lungs by a young respiratory therapist with a pert nose and adolescent acne. Each squeeze of the bag by her delicate hands brought a charge of pain to his left chest. He heard numbers being called out from preliminary lab, and again they sounded terrible, like numbers of people who ultimately don't make it. He thought now of Helen and the kids, and a vicious pang of grief and guilt shot through him, a rending sense of loss his, theirs, and he tried to cry out, but couldn't. His sobs were met with oxygen being forced into his lungs, and with more painful activity at every surface. Peter Klein appeared over him, and said "I'm going to place a chest tube now, Paul." Cold antiseptic was sloshed over his broken chest, and a needle of burning local anesthetic jabbed repeatedly over his ribs. A sharp blade in a gloved hand flicked painlessly through his skin, opening a two inch long incision to the bone, and was drawn back bright with Paul's own blood. A shining kelly clamp came next and Paul braced for a sharp pain he knew would come, knew could not be muffled by local anesthetic, and had to come anyway. Even so, the shock of it was overwhelming. It was a deep visceral pain, a touching of a nerve unlike anything he could ever predict, nor ever again describe. He clenched his jaw around the breathing tube, his hands around the cloth at his sides, his back and his buttocks, and writhed in a stunning orgasm of pain, and then as quickly as it came, it was gone, leaving only a dull ache in its wake. A thick tube was slipped into the hole, a hose, really, and the contact with his inner surfaces gave him a sharp reprise and a strong urge to cough. He wished he could sleep or die or something but his adrenalin and fear kept him sharply awake, and monitoring the pain, the bits of clinical information be heard, and seeing the familiar faces overheard. The tube was hooked to a plastic water trap, and then to suction, and the familiar bubbling noise joined the din in the room. Two bags of blood arrived and were hung above his head in pressure bags, threaded through a warmer, and then pumped into his arm. He felt the warmth travel right up his arm. An xray tech taped a film cassette next to his head, and everyone scurried out except the brave respiratory therapist, who donned a lead apron between him giving him breaths. More pictures of chest, arm and pelvis followed, and then the MAST trousers were loosened slowly. His heart had slowed in response to the blood and fluid, replacing the untold amounts he had lost already, and blood was allowed to return to his legs. He now noticed for the first time in a while that they were numb, and soon enough they burned and tingled miserably. Hendricks took a grim satisfaction from that. At least his neck was not broken, he would not need a wheelchair or worse if he survived this day. He heard a nurse call out that there were 1200 ccs of blood in the collecting bottle from his chest tube, and a call for two more units of blood to the blood bank from Peter Klein. The situation remained desperate and Hendricks knew it.
Now the rest of his clothes were cut away, and his pale mottled body exposed to the glare of lights and the gaze of his co workers. His poor shrivelled penis was seized by a gloved hand, and his downward gaze confirmed it was Jane, his favorite nurse, and subject of occasional fantasy and flirtation who had hold of him. She shot him a sidelong look that said "It's OK and I'm sorry" at the same time, and slid a foley catheter through his penis into his bladder. That hurt, but relieved a certain urgency he felt, and again he took grim satisfaction from the conclusion that his kidneys were still working. He also knew that things would never be the same between himself and Jane. She would be fine about it all, but he would always feel that helpless feeling that swept him now.
More cold anesthetic was being slopped over his lower abdomen, and then another stinging injection, just below his navel. More hands, more instruments and then a tube bearing fluids was introduced into his abdomen to drain back out and check for bleeding. Again there were concerned looks all around, and he took that to mean more trouble ahead.
Now Peter Klein's face appeared beside his check, speaking softly and intently, betraying much of the concern they all felt.
"Paul, I must take you to the operating room." he said. "You have lost a lot of blood, and your belly tap is quite positive. We must find the source of that blood, and stop it."
Hendricks blinked rapidly to indicated he had heard, and tried to mouth "OK" around the silvery breathing tube. He had the first pang at that instant that all would not go well in the operating room that he would not come back, and then came the shivering blow of doubt that Peter Klein would do all that he could. He seemed intense, appropriate, and his usual skillful self, but had recent events given Klein reason to fail? Paul's eyes widened and he stared intently at the impassive face, a panic rolled over him, and he felt weak, cold, powerless. He felt as if that panicky thought had just then been telegraphed to Klein, and yet his face remained unmoved, his eyes offered no warmth, no reassurance. It would be so easy, so easy to let a slippery artery retract away, pumping blood into dark, unreachable spaces. So easy to leave tear in the bowel unclosed, or a necrotic loop in place like a ticking bomb, sure to rear up as fatal sepsis soon after surgery. So easy with shining blade and flashing scissor to cut an ureter, nick an aorta, and lose him on the table, despite heroic efforts. So easy to do everything "just right" and yet fail.
He longed for Helen, and that thought was rewarded with the sight of her beautiful weeping face, materialized out of the haze of the periphery of the room. The light from above caught her brown curls like a halo, and she bit her upper lip and sniffed before saying his name.
"Paul, Paul we haven't got much time before they take you upstairs. I love you Paul. Hang in there Honey. I need you. You're going to do fine." She turned her face down into his shoulder, not in time to prevent a tear from falling and striking his cheek. Paul's eyes welled hot with tears, and his heart ached beyond all the pain he had felt that day. Helen was so calm so loving, so kind. He felt undeserving, guilty, regretful all at once. He tried to speak, but couldn't, tried to say I love you, tried to believe that the murderer who was about to take him to the operating room and cut him open would see what was between him and Helen, and spare them, spare her, spare his poor children. He felt less and less certain of that as female hands pulled at the shoulders of his weeping wife and drew her face out of the glare and away from his circle of light and pain. He tried to fix her face in his mind, but it faded from him like a dream fragment, and he felt totally alone.
Monitors and bags were heaped on the bed around his feet, and the bed began to move toward the operating room. The respiratory therapist squeezed and released the amber breathing bag monotonously, and looked around the room, appearing bored. Jane re appeared and mopped some blood from his nose and cheek. She smiled thinly and vanished also.