David Palmer - Emergence

Right up to sudden, catastrophic, final dissolution; total failure.

Viewed thus, pulse rate most disquieting: Suggested important fraction of total blood supply already gone. And quick review of wound confirmed loss still in progress, though slowed by tourniquet.

Agonized for endless moments, poignantly aware of limitations of own training; indecision compounded by mental processes blunted by physical, mental fatigue. Knew, of course, what needed doing; but shrank from unavoidable conclusion regarding by whom.

(Granted, possessed requisite knowledge. Inescapable, since Daddy [pathologist or not] one of only two doctors in town, often called upon to perform emergency-room care, usually in own home, invariably at odd hours when no one available to assist but Yours Truly. Watched closely then; listened attentively to accompanying lectures. Even, at proud paternal urging, acquired skill at certain limited surgical techniques, practicing on animal cadavers. But never — alone, unaided — so much as placed Band-Aid on person .)

However, time — blood — wasting. And own condition now serious impediment to concentration, precision work. (Maybe wasn’t burning energy at quadruple usual rate; couldn’t know what overload factor consisted of. But knew was exhausted; never experienced such fatigue before.) Nor without long rest, much nourishment, was condition likely to improve. Which ruled out usefully immediate future. Unless…

Weighed options carefully — shuddered. But saw no way out. Closed eyes, directed consciousness inward. Took deliberate, deep breath; held briefly; released slowly, exhausting tension with it. Then — for second time in only minutes — triggered hysterical tap.

Like magic, felt vision clear, hands steady, cramps abate. But not fooled: Heart still hammered; was still fountaining sweat; breathing, though no longer paroxysmal (regular now, slowed to point where wouldn’t affect dexterity), still amounted to panting. Condition unchanged: Beneath veneer was still totally exhausted. Tried not to dwell on probable cost when came time to pay Piper. Hoped benefits of sufficient duration — surely wouldn’t work third time.

Took seat on campstool at bedside. Bent over leg; drew wound lips apart to assess damage extent, severity. Blood volume made visual structure identification impossible. Removed saline baggie from kit; extended I.V. tube, chopped off end. Squeezing bag to provide pressure, used as hose to irrigate, cleanse area. Worked pretty well, but relief only temporary: Adjoining tissues full of slowly oozing bleeders; and at very bottom of gash, visible now, gaped slice in femoral artery, welling gently afresh with each systole, reflooding area with bright red blood.

Which wouldn’t do at all; had to see to work. Pondered briefly; then cranked another turn into tourniquet. Uncomfortable about solution: First Law of Tourniquets holds must be loosened every 12 minutes, 18 at outside. Failure to comply results in tissue death downstream, autolysis, ultimately gangrene.

But here question less clear: Two-inch rent in artery wall complicated equation; hydraulic principles demanded concern at least equal to other factors. (Probably more than equal, as continued to debate matter: Blood geysering out through least resistant path certainly of negligible value downstream — and even if somehow beneficial, advantages accruing to leg moot if body to which attached promptly expires as side effect.)

But knowledge that choice impending if artery repair not completed within time limit acted as incentive to speed work. Fell to; gathered, set out, organized equipment.

Hosed down wound again. Scrutinized closely; breathed sigh of relief: Tourniquet now achieving desired result; arterial flow stopped. Virtually imperceptible seepage remained from vascularity in surrounding tissues, but makeshift lavage spray adequate remedy.

Next juggled odds quickly, unhappily. Time most critical, true; but upon reflection, concluded potential shock consequences justified investing whatever time necessary to start I.V. before undertaking actual repair.

And if Daddy watching from Above, made him proud: Had I.V. inserted, taped in place, saline flowing — all within single minute. (Practice on long-suffering arm simulacrum [paramedic training aid] paid off: Found vein first try.)

Performed necessarily abbreviated scrub, using drinking water, soap, finishing off with alcohol slosh. Squirmed into rubber gloves with difficulty — not easy, solo, while maintaining asepsis.

(Mostly unworried about infection per se; Teacher’s opinion holds H. post hominems immune to known human disease. But key words, even if Teacher’s very own, are “opinion,” “known,” and especially “ H. post hominem” [of which victim surely must be one — but don’t know that] — and would be humiliating to perform repair successfully; then lose patient to toxemia through preventable gross sepsis. So within limits imposed by surroundings, did best to adhere to sterile procedure.)

Tore open first packet, containing prethreaded fine needle, suture (offered up silent thanks for modern medical technology as did so; would never make good stereotypical female — were own life at stake, couldn’t thread needle in fewer than 20 tries).

Picked up two hemostats. Stared down into wound. Took deep breath. Seized needle with finely-pointed jaw tips of right-hand hemostat. Commenced.

Proved less difficult than feared. Following initial shock (as learned live patients warm inside), technical fascination took over, supplanted apprehension; permitted training to emerge, do job properly. Hemostats gripped needle surely; resultant control wonderfully precise, even down in cramped quarters at bottom of wound. Artery cleanly slit; edges straight; stitches went into place neatly, evenly, closely spaced, just as had when practiced similar repair on hog cadaver under Daddy’s direction.

(Sure wish had practiced oftener; developed semblance of professional competence, speed — sealing high-pressure artery called for such tiny stitches; so little time remained and seam so long…)

But wasted none glancing feverishly at watch; concentrated on task at hand. Mind already made up, subconsciously at least: Would not risk boy’s life to save leg. True, be nice if managed to save it, too — indeed, striving mightily to accomplish repair in time to prevent limb death.

(Mightily — but not quickly; never realized vascular surgery so time-consuming.)

For one thing, one-legged comrade poses significant liability in present-day survival-oriented environment. For another, despite pretensions toward calloused pragmatism, must confess to certain esthetic prejudice in favor of physically sound partner — perhaps even, should circumstances so devolve, mate.

(But repair was taking so long. )

Finally, even granting advantages intrinsic to performing amputation at leisure in Hopkins teaching hospital’s modern operating theatre, amidst latest, most advanced medical wonders (who cares — lack even faintest notion of how to operate them), odds slim for patient surviving procedure. Above-knee amputation serious business, truly major surgery; approached with due respect by most veteran of doctors — likelihood of happy outcome, given amateur-level ministrations in procedure so intrinsically fraught, seemed less a question for serious assessment than object of gallows humor.

(But not laughing; was going to find out unless got move-on — taking too long!)

And didn’t want to cut kid’s leg off! Even if somehow managed to avoid killing him in process, would never be able to meet eyes without cringing inside. Yes — despite full knowledge that dummy’s own maniacal driving brought on disaster; that consequences on his head alone; that own role limited to saving fool life — would still feel guilty…