Michael Palmer - Fatal

"No more sundaes for Fred," Matt panted.

At that moment, with a bansheelike screech, a figure flew from the darkness, off a tall pile of rubble, onto Nikki, sending her hurtling backward, shattering one of the lanterns.

Nikki cried out in pain as the attacker — a stocky woman — quickly set upon her, hands around her throat. From the remaining illuminated light, Matt could easily discern the dense growth of neurofibromas virtually covering the woman's face. He dove at her, hitting her shoulder-to-shoulder, and tackling her onto the cave floor. Growling and spitting, she flailed at his face and arms, landing several effective blows. Matt hit her in the face, first with an open hand, then full force with his fist. It was the first time he had ever punched someone that way in his life. Stunned, the woman sagged backward. Matt set his knee across her throat, tore off her cotton work shirt, and used one sleeve to tie her hands tightly together and the other to bind them to her ankles. Then he used adhesive tape from the first-aid kit to immobilize her more effectively.

"You okay?" he asked, turning to Nikki.

"My left ankle," she groaned, in obvious pain. "It went over when she hit me."

"Are you hurt anyplace else?"

"Not badly."

He knelt by her and examined the injury. Swelling had already begun across the outside of the ankle. In addition, there was impressive tenderness over the lateral malleolus — the bony prominence. If the end of her fibula hadn't broken, ligaments had surely torn. Either way, her mobility was, to all intents, gone. Nikki moaned softly as Matt wrapped the ankle with gauze. Then he activated a bag of chemical ice and secured it against the joint with an Ace bandage. A second Ace completed the bulky splint.

With great effort, Nikki rolled onto her hands and knees.

"Let's get to work on Fred," she said. "I don't know how much longer he can stay alive."

"You can do this?"

"I can try," she replied, wincing.

"I'm going to get that duct tape and do the other two while you check Fred out. I don't want a repeat of Tarzana, here, when they wake up. Jesus, what a mess we're in."

Moving slowly and painfully on her hands and knees, Nikki propped two lanterns on piles of rock, took two pairs of rubber gloves from an as yet unopened box, and set to work. Using a bandage scissors and her hands, she cut and tore away Carabetta's clothing. If he wasn't in shock yet, he was close — filthy, pale, bloodied, and sweating, with a pulse that was ominously rapid and faint. There were four or five lacerations over his fleshy body and tree-trunk legs, which were still oozing crimson, but the real trouble was a deep, three-inch rent in his groin, where dark blood was flowing freely.

Breathless, Matt returned from his task.

"Arterial?" he asked.

"I think venous. You're bigger. How about some pressure."

Matt set a wad of gauze pads over the wound and leaned down on it with all the strength he could muster. Carabetta's thick layer of saffron-colored fat made it difficult to apply enough force. Blood continued seeping from beneath the gauze.

Meanwhile, Colin Morrissey's stridor was worsening.

"We need more hands," Matt said again as Nikki crawled over to check on the man.

"We have what we have," she said over her shoulder. "Matt, this guy's in trouble, too. I don't think he's going to make it too much longer without a tracheotomy."

"Well, I can't maintain enough pressure to stop Freddy's bleeding. My guess, he's torn his saphenous vein."

"So what can we do?"

"Get some narrow gauze bandage underneath the saphenous and tie it off."

"Have you done anything like that before?"

"If you count my cat cadaver in comparative anatomy, I have. You?"

"Well, between my year of surgery and my job cutting up the unfeeling, I know the anatomy pretty well."

"That settles it. I first-assist and you take a crack at it."

"What about Colin?"

"Right now, he's breathing. If we don't stop this bleeding, Freddy's toast."

"Okay, okay."

While Matt kept pressure on the wound, Nikki opened the first-aid kit and extracted a roll of one-inch gauze and a pair of forceps — the pointy-tipped kind used for removing splinters.

"Any snaps?" Matt asked, referring to self-locking hemostats.

I don t see any.

"A scalpel?"

"Nope."

"Novocain? Xylocaine?"

"You wish. Wait, there is a disposable scalpel."

"Ah, something to be grateful for. Fred, can you hear me?"

"Help… me."

Matt abandoned the notion of a medical explanation. He leaned close to the man's ear.

"Fred, this is going to hurt," he said emphatically. "Nik, how's the ankle?"

"Numb. As long as I don't make any quick movements, it's bearable. I don't think I'm going to be able to stand on it, though."

"Well, I can keep pressure on this and hold the lantern, but you'll have to serve as your own scrub nurse."

"I'm afraid," she said suddenly.

"I know," Matt replied. "I wouldn't trust you if you weren't. Just do your best and do it fast."

"I think I need to open up the area better."

"Just do it."

Nikki shrugged and made a deep, four-inch incision at right angles to the middle of the gash. Blood oozed from the skin margins of the cut and from the bright yellow fat beneath it.

"Oh, Jesus!" Carabetta howled as the slice was made. "Oh, fuck!"

At the man's scream, Nikki pulled back, but Matt shook his head.

"You can do it," he said firmly.

"Okay," she replied, "put pressure below the cut — a lot of pressure. Look, it is the saphenous vein — almost chopped through. It's a miracle he's still alive."

"You're the miracle. Tie it off — top and bottom — then we can move on to he who cannot inhale."

Behind them, they could hear Colin's labored breathing getting worse.

"If that guy and the girl are anywhere near as crazy as Tarzana was, we'll have our hands full when they wake up," Nikki said.

"This guy, then that guy, then the girl," Matt said.

"Right."

Nikki used her fingers and the blunt end of the forceps first to spread the tissue around and under the torn vessel. Then she forced the ends of two twelve-inch lengths of gauze through the tunnel she had created. With each movement, Fred cried out, but his response to the pain was getting feebler. A large percentage of his blood volume was in his clothes and on the dusty floor. Unless his bleeding was stopped, he might have a minute or two before drifting into unconsciousness for good — maybe a little more, maybe less.

"You're doing great," Matt encouraged. "Get a knot in that lower tie, and I'll switch the pressure to stop the backflow. For someone who hasn't touched a live patient in years, you're pretty darn good."

"Come on, baby," Nikki murmured to the vein as she gently worked the second gauze tie into place, "don't tear apart on me now."

"You've got it! You've got it!"

"I hope so, because here goes."

Nikki pulled the gauze tight, and a moment later Matt released the pressure he had maintained through most of the procedure.

There was some oozing from the incision and the gash, but the area around the lacerated vein was dry. The saphenous was the vein usually harvested for cardiac bypass grafts. Collateral veins would take over the job of returning blood to the heart. If Carabetta made it through this episode and out of the cave — both enormous ifs — he might be left with little more than some periodic ankle swelling.

"Nicely done," Matt said. "Getting around that vein without ripping it in two was really something."

At that moment, Colin Morrissey's breathing seemed to become even more labored.

"We might need to trach him," Nikki said. "Can you go check him again?"

"I would, but Fred here still needs pressure on this wound."