Fall, or SLF. TBIs—traumatic brain injuries—appear in twenty-five percent of all SLFs. Roughly thirty percent of victims experience what’s called an uncontrollable shift—so by degrees, you’d get a spiral fracture in the wrist, or a hip fracture, or a TBI. Ten percent of victims rotate one-eighty. The center of gravity falls outside the supporting area of the trunk and feet. Damage is due to absorbed energy at the time of impact, so kinetic energy equals body mass and speed, which is related to the height of the fall.”
Jeffrey nodded thoughtfully, more for the expert goat-roping than a fundamental understanding of what Sara had said. He tried, “Her left foot stopped, her body kept moving forward, she spun around mid-air and slammed the back of her head into the rock.”
“Possibly.” Sara knelt down by the body. She pressed open the girl’s eyelids. Then she rested the back of her hand on the girl’s forehead.
This seemed odd to Jeffrey, the kind of old-wives’ tale that led mothers to think they could tell if their kids had a fever. Sara was extremely scientific, sometimes to a fault. If she wanted to check for a fever, she used a thermometer.
She asked Lena, “You were first at the scene?”
Lena nodded.
Sara pressed her fingers to the side of the girl’s neck. Her expression went from concern to shock to anger. Jeffrey was about to ask what was wrong when Sara pressed her ear to the girl’s chest.
He heard a faint clicking noise.
Jeffrey’s first thought was that an insect or small animal was responsible. Then he realized the sound was coming from the victim’s mouth.
Click. Click. Click.
The noise slowly tapered off into silence.
“She stopped breathing.” Sara jumped into action. Up on her knees. Hands pressed against the victim’s chest. Fingers interlocked. Elbows locked as she started compressions.
Jeffrey felt panic stab into his brain. “She’s alive?”
“Call an ambulance!” Sara yelled. Her words jolted everyone into action.
“Shit!” Frank had his phone out. “Shit-shit-shit.”
Sara told Lena, “Get the defibrillator!”
Lena scrambled under the yellow tape.
Jeffrey dropped to his knees. He tilted back the girl’s head. He looked into the mouth to make sure the airway was clear. He waited for Sara’s signal, took a breath, then exhaled into the girl’s mouth.
Most of the air came back into his own mouth. He checked the throat again, making sure nothing was lodged in the back.
Sara asked, “Is air getting through?”
“Not much.”
“Keep going.” Sara resumed compressions, counting out each rapid push. He could hear her panting from the effort as she tried to manually pump blood through the girl’s heart.
“Ambulance is eight minutes out,” Frank said, “I’ll go down and flag it.”
Sara finished counting, “Thirty.”
Jeffrey gave two more short breaths. It was like blowing through a straw. Air was going through, but not enough.
“Half an hour,” Sara said, starting another round of CPR. “Lena didn’t think to check for a fucking pulse?”
She wasn’t expecting an answer, and he couldn’t give one. Jeffrey waited for Sara’s count to hit thirty, then leaned over and breathed out as hard as he could.
Without warning, vomit spewed up into his mouth. The girl’s head jerked forward, smashing into his face with a hard crack.
Jeffrey reeled back. He saw stars. His nose throbbed. He blinked. There was blood in his eyes. Blood on his face. In his mouth. He tried to spit it out.
Sara started slapping the front of his pants. He didn’t know what the hell she was doing until she pulled the Swiss army knife out of his front pocket.
“I can’t clear her airway.” Sara flicked open the blade, telling Jeffrey, “Keep her head still.”
Jeffrey shook off the dizziness. He braced his hands on either side of the girl’s head. Her skin was no longer pasty white, but purple-ish blue. Her lips were turning the color of the ocean.
Sara found her mark, then opened a small, horizontal incision along the base of the girl’s neck. Blood seeped out. She was performing a field tracheostomy, bypassing the blockage in the throat.
Jeffrey took a ballpoint pen out of his pocket. He unscrewed the barrel and got rid of the ink cartridge. The hollow plastic bottom of the pen would act as a tube for the girl to breathe through.
“Shit,” Sara hissed. “There’s—I don’t know what this is.”
She used her thumbs to make the skin gape around the incision. The fresh blood gave way to a grainy mass packed inside her esophagus. Jeffrey could see streaks of blue among the red, almost like the girl had swallowed dye.
“I’ll have to bypass the blockage.” Sara ripped open the girl’s thin T-shirt. The sports bra was too thick to tear, so she sawed at it with the serrated blade until she could rip the material the rest of the way open.
Jeffrey watched Sara’s fingers press into the top of the sternum, just below the tracheotomy incision. She counted down the first few ribs the same way she had counted off compressions. The girl was so thin that Jeffrey could see the outline of the bones under her skin.
Sara pressed the thumb of her left hand just below the clavicle. She layered the heel of her right hand over it, then pushed down with all of her weight.
Her arms started to shake. Her knees came off the ground.
Jeffrey heard a sharp crack.
Then Sara did the same thing again, but lower.
Another sharp crack.
“That was the first and second rib,” Sara told him. “We have to work fast. I’m going to dislocate the manubriosternal joint with the knife. I’ll have to lift the manubrium and push down on the sternum. Then I need you to use the top part of the pen to carefully move the vein and artery out of the way. I can access the trachea between the cartilage rings.”
Jeffrey couldn’t follow the instructions. “Just tell me when to do it.”
Sara pushed back her shirtsleeves. She wiped the sweat out of her eyes. Her hands remained steady. She used the small, sharp blade on the knife to make a four-inch vertical incision down from the previous one.
Dark blood welled over the edges of the opening. His stomach recoiled at the bright white of bone inside the body. The sternum was flat and smooth, maybe half an inch thick, about the size and shape of an ice scraper. Jeffrey had a football player’s understanding of anatomy. He knew all the bad places to get hit. The breastbone had three sections, the stubby top, the long middle and a short tail-like
