Tess Gerritsen - Ice Cold

“I’ll be right back,” said Maura. “Stay with him.”

“Where are you going?”

“I saw a sled in one of the garages. We can drag him back on that.” She left them and started running toward the village, her boots slipping and sliding in the ruts left by the Jeep’s ascent. It was a relief to leave behind the bloody snow and her shell-shocked companions, a relief to focus on a concrete task that required only speed and muscle. She dreaded what came after they moved Arlo back into the house, when they’d be forced to confront what was left of his leg, now little more than mutilated flesh and splintered bones.

The sled. Where did I see that sled?

She finally found it in the third garage, hanging on wall pegs alongside a ladder and an array of tools. Whoever lived here had kept an organized household, and as she pulled down the sled, she imagined him hammering in these pegs, suspending his tools high enough that young hands couldn’t reach them. The sled was made of birch and had no manufacturer’s label. Handmade, it had been crafted with care, the runners sanded smooth and freshly polished in readiness for winter. All this she registered in a glance. Adrenaline had sharpened her vision and made her reflexes hum like high-voltage wires. She scanned the garage for anything else she might need. She found ski poles and rope, a pocketknife and a roll of duct tape.

The sled was heavy, and dragging it up the steep road soon had her sweating. But better to labor like a draft horse than to kneel helplessly by your friend’s mangled body, agonizing over what to do next. She was panting now, struggling up the slippery road, wondering if Arlo would be alive when she got there. A stray thought slipped into her head, a thought that shocked her, but there it was nonetheless. A little voice whispering its cruel logic: He might be better off dead.

She yanked harder on the towline, pitting her weight against the drag of snow and gravity. Up the road she trudged, hands cramping around the rope as she curved up hairpin turns, past pine trees whose snow-heavy branches hid her view of the next stretch of road. Surely she should be there by now. Hadn’t she been climbing long enough? But the Jeep tire tracks still curved ahead, and she saw the shoe prints she’d left when she’d run down this same road a short time earlier.

A scream pierced the trees, a pain-racked shriek that ended in a sob. Not only was Arlo still alive, he was now awake.

She rounded the curve and there they were, exactly where she’d left them. Grace was huddled by herself, hands clasped over her ears against Arlo’s sobs. Elaine cringed back against the Jeep, hugging herself as though she were the one in pain. As Maura dragged the sled closer, Doug looked up with an expression of profound relief.

“Did you bring something to tie him to the sled?” he asked.

“I found rope and duct tape.” She positioned the sled beside Arlo, whose sobs had faded to whimpers.

“You take the hips,” said Doug. “I’ll move his shoulders.”

“We need to splint the leg first. That’s why I brought the ski poles.”

“Maura,” he said softly. “There’s nothing left to splint.”

“We have to keep it rigid. We can’t let it flop all the way down the mountain.”

He stared down at Arlo’s mutilated limb, but could not seem to move. He doesn’t want to touch it, she thought.

Neither did she.

They were both physicians, pathologists accustomed to slicing into torsos and sawing open skulls. But living flesh was different. It was warm and it bled and it transmitted pain. At the mere touch of her hand against his leg, Arlo began to scream again.

“Stop! Please don’t! Don’t!”

As Doug held down the struggling Arlo, she insulated the leg with folded blankets, cloaking shattered bones and torn ligaments and exposed flesh that was already turning purple in the cold. The limb now cocooned, she taped it to the two ski poles. By the time she’d finished splinting the leg, Arlo was reduced to quiet sobs, his face streaked with glistening trails of drool and mucus. He did not resist as they slid him sideways onto the sled and taped him in place. After the agonies they had put him through, his face had paled to the waxy yellow of impending shock.

Doug took the towrope, and they all started back into the valley.

Back toward Kingdom Come.

WHEN THEY BROUGHT ARLO INTO THE HOUSE, HE HAD FALLEN UNCONSCIOUS again. It was a blessing, considering what they had to do next. With pocketknife and scissors, Maura and Doug sliced away what was left of Arlo’s clothing. He had emptied his bladder, and they smelled the ammoniacal stench of urine that had soaked into his pants. Leaving only the tourniquet in place, they peeled off shredded and bloody scraps of fabric until he lay stripped, his genitals pitifully exposed. It was a view unsuitable for a thirteen-year-old girl, and Doug turned to his daughter.

“Grace, we need a lot more wood for the fire. Go out and get some. Grace, go!”

His sharp words snapped her back to attention. She gave a dazed nod and left the house, admitting a cold draft of wind as the door shut behind her.

“Jesus,” murmured Doug, turning his full attention to Arlo’s left leg. “Where do we start?”

Start? There was so little left to work with, just twisted cartilage and torn muscles. The ankle had been rotated almost 180 degrees, but the foot itself was bizarrely intact, although it was a lifeless blue. It might have been mistaken for plastic were it not for the thick and all-too-real callus on the heel. It’s dying, she thought. The limb, the tissue itself, was starved of circulation by the tourniquet. She did not have to touch the foot to know that it would be cold and pulseless.

“He’s going to lose the leg,” said Doug, echoing her thoughts. “We’ve got to loosen the tourniquet.”

“Won’t he start bleeding again?” asked Elaine. She remained at the other end of the room, her gaze averted.

“He’d want us to save his leg, Elaine.”

“If you take off the tourniquet, how are you going to stop him from bleeding?”

“We’ll have to ligate the artery.”

“What does that mean?”

“Isolate the torn vessel and tie it off. It will interrupt some of the blood flow to the lower leg, but he still might have enough alternative circulation to keep the tissues alive.” He stared down at the leg, thinking. “We’ll need instruments. Suture. There’s got to be a sewing box in this house. Tweezers, a sharp knife. Elaine, get some water boiling.”

“Doug,” Maura said. “He’s probably ruptured multiple vessels. Even if we ligate one, he could bleed out through the others. We can’t expose and ligate them all. Not without anesthesia.”

“Then we might as well amputate it right now. Is that what you’d have us do? Just give up on it?”

“At least he’ll still be alive.”

“And missing his leg. That’s not what I’d want if I were him.”

“You’re not him. You can’t make this decision for him.”

“Neither can you, Maura.”

She looked down at Arlo and considered the prospect of slicing into the leg. Of digging through flesh that was still alive and sensate. She was not a surgeon. The subjects who ended up on her table did not spurt blood when she cut into them. They did not scream.

This could turn into one big, bloody mess.

“Look, we have two choices,” said Doug. “Either we try to save the leg, or we leave it the way it is and let it necrose and turn gangrenous. Which could kill him anyway. I don’t see that we have a lot of options here. We have to do something.”

“First do no harm. Don’t you think that applies here?”

“I think we’ll regret not acting. It’s our responsibility to at least make an attempt to save that leg.”