to the advance reports coming from the life flight crew, this boy, too, balanced on the edge. On the one hand, he was young and strong and in a good general health. But on the other, he had suffered a devastating injury and had lost a lot of blood. If the shock didn’t kill him, sepsis or secondary injuries could.
“They’re bringing him down now,” the lead trauma nurse reported.
“Get ready, people,” Jack added. The trauma chief worked the team like a drill sergeant, preparing the high-tech bay with painstaking attention to detail—airway, IV, monitoring equipment, essential personnel, lab and radiology backup. With everything in readiness, the area resembled the inside of a strange, futuristic cathedral, the bed in the center like an altar where victims were brought forth to appease a pantheon of wrathful gods.
The last moments were silent, team members’ minds weighted by the tension of expectation while their bodies were physically weighted by the heavy purple X-ray vests. Everyone was alone with their thoughts—the team leader, primary physician, airway team, nurses and patient care techs, radiology tech, CT, pharmacy, recorder, support staff, chaplain. Reese imagined that some were praying. She herself clung to her mantra: do right.
The team members stood poised in their designated positions. Reese felt a surge of adrenaline course through her, starting in her chest and spreading like a drug through her neck and shoulders, arms and legs. She understood the physiology of the human body, but no textbook could adequately describe certain things—the heady rush of anticipation, for one thing.
Stone-cold fear, for another.
During this rotation, she was learning that in a trauma situation, there was almost no time to think. Though her head was crammed with facts and procedures, she shut down everything except that which would help the patient. In a trauma, she didn’t feel hunger or fatigue or even the need for the bathroom. She got so focused that she didn’t even feel emotion, which worried her.
Mel said it was a good thing. When a patient was coded, the doctor needed cold algorithms, not empathy. He’d told her to consider a residency in trauma, but she had dismissed the suggestion. That wasn’t where she was headed.
But in moments like this, she caught herself reconsidering.
“Keep an eye on Jack,” Mel murmured in her ear. “Watch and learn. He is the maestro.”
Reese nodded. There were a few more moments of breath-held anticipation, tingling with the awareness that everything was about to change. Then the wire mesh doors exploded open with a loud thud, and the patient arrived.
“Coming through,” someone said, walking backward and pulling the gurney along a hallway marked with a red line on the floor and the words All Trauma. “Clear a path.” More paramedics ran with the stretcher between them, preparing for the transition into the trauma bay. Reese craned her neck but couldn’t see the boy amid the cluster of personnel and equipment—just an oversize C-collar and two vacu-splints painted with fresh blood.
Behind the stretcher was a man so large he dwarfed everyone else. His shirt and hands were covered in blood. Beneath a dramatic wave of golden blond hair, his expression was a mask of agonized worry—a guy facing every parent’s worst nightmare.
The stretcher was angled into the middle of the trauma bay and the team went to work.
“How’s he holding up?” Jack asked, positioning himself at the foot of the bed.
“Not so hot.” Irene, the life flight nurse, stepped back from the rig, consulted dual tablets, and gave a swift MIVT report—mechanism, injuries, vitals, treatment. She stated that the boy had been given blood agents to lower the risk of hemorrhage. Monitors beeped and screeched off-key as the patient was transferred to the X-ray table. In the corner, a server’s lights flashed green and gold.
Reese tried to make out his features with the clear mask cupped over his nose and mouth. Deep lacerations slashed one cheek, as though he’d been clawed by a huge bear. His eyes were blue, darting from side to side.
“Dear God,” she whispered. “He’s conscious.”
“Been that way since it happened,” Irene said. “You’re an amazing guy, Jonah. You’re doing great.”
“I’m Dr. Tillis,” Jack said, looking straight down into the kid’s face. “We’re going to take good care of you.”
The boy’s lips moved inside the mask, fogging the plastic. He wasn’t crying. Reese suspected that shock had pushed him well past that point.
“Right,” said Jack. “Let’s have a look at that arm.”
The field dressing was removed and the arm exposed, and even the seasoned members of the team gaped in awe at the injury. It was a ragged horror of a wound, the tissue and bone and bloody dressing so tortured that it hurt just to look at it.
He never even lost consciousness, Reese thought. What the hell kind of kid was this?
“Jonah, can you move the fingers of your left hand, buddy?” asked Dr. Tillis.
The hand lay unresponsive.
“How about a thumbs-up or an okay sign,” Tillis suggested. “Can you do that?”
The boy’s eyes narrowed in pained concentration, but there was still no response. Everything had been shredded or severed. “Completely ablated,” someone nearby murmured. “Oh, man …”
“Get in here, Powell,” said Dr. Tillis. “Move in closer. This is something you don’t see every day. Let’s have you remove the lower-extremity clothing and do the blood draw.”
Most of the kid’s clothes had already been removed, cut or ripped off by the EMTs, or maybe in the accident. His skinny chest and pelvis looked as pale as marble. He wore jockey shorts, plain white turned gray from laundering, which she scissored away, looking for further injuries to report to the lead doctor. “No sign of bruising or trauma to the pelvis,” she said.
Then she prepped the site with Betadine and palpated the femoral artery with her fingers. “You’ll feel a pinch, Jonah,” she said, then felt ridiculous warning him about a pinch while his arm was hanging in shreds. She inserted the needle at a right angle. The slender curl of tubing filled with bright red blood, filling the syringe. While another student applied pressure to the site, Reese carefully labeled the blood draw and handed it off to a lab tech.
Jack rapped out orders for further assessments and pain management along with X-rays, piles of warm blankets, a Foley for urinalysis. Reese had a powerful urge to touch the boy—somewhere, somehow—but focused instead on following instructions. IVs were connected, and the surge of fluids and drugs worked quickly. Reese wasn’t sure whether or not she imagined it, but she thought the boy looked directly at her as she leaned forward to check a line and a monitor. Then his eyes fluttered closed. She wished she’d touched him.
The work of prepping Jonah Stoltz for surgery was done swiftly, each member of the team playing a part. They debrided and dressed wounds, scanned and tested the slender, broken boy, stabilizing him as best they could and seeking secondary injuries. Three floors up, the surgeons of the OR scrub team were already gearing up for the most likely outcome—amputation. The mobile bed was pushed out into the gleaming stainless-steel maw of the elevator.
With a rubbery squeak, the doors whisked shut
