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his three-hundred-plus pounds to come up and kick around in
the confines of the cabin. The starless dark streamed by around
us at 160 knots, and we were aided by a tailwind, but we were
still at least fifteen minutes out from the light and warmth of
the trauma center. Erin popped IV #3 into a vein on Mr. Doe s
upper right arm. She had the fluids wide open.
222 Jennifer Culkin
At 0300, when he d hit the tree doing thirty-five, the guy
took the steering column of the pickup to his chest. No seat belt,
and no air bags, of course the truck was too old for that. The
nauseating sweet smell of semi-digested beer hung in the air
around us. I threw a tube down into his stomach and attached
suction; what was left of who-knows-how-many gurgled into a
bucket at my feet. Mr. Doe, if he had been awake, would have
said, It was just a couple of beers. I d love to have a dollar for
every time I ve heard those exact words.
Without imaging or other diagnostics, unavailable at the
side of the road, we couldn t be sure what his injuries were ex-
actly. But he had obvious fractured ribs on both sides, including
the first two on the left. It takes exceptional force to break the
first and second ribs. Blood in his lungs, a hit to his heart, large
volumes of air and blood in the space around his lungs com-
pressing his heart all of these were possible. Likely.
Air had certainly dissected out from his lungs to where it
doesn t belong. We could feel it popped up like bubble wrap
under the skin of his chest, a condition known as subcutaneous
emphysema. It was almost certain that air had also leaked inter-
nally, compressing one or both lungs pneumothorax, the rea-
son for the flutter valves. His oxygen saturation, measured by a
probe on his finger, bore this out. After we placed the needles,
it improved from the low 80s, very worrisome, to a near-normal
96 percent.
Our guy was awake and talking right after the accident, be-
fore the chest injuries led the medic to put a tube in his trachea
and mechanically ventilate him. He wasn t making complete
sense, so he d probably taken a little hit to his head. Still, talking
is high-level activity, a good sign for his brain, and the report of
it cheered both Erin and me. He probably wouldn t be cabbage-
patch material if we could just get him to the hospital.
The problem for us was that whenever we took our hands
off the steel needles, Mr. Doe began circling the drain. His oxy-
A Final Arc of Sky 223
genation and blood pressure both dropped through the floor.
His heart rate fell. He tried to die.
My heart was pounding, but Erin looked thoughtful. She
was as solid and unflustered as ever. He s a big boy, she said,
and he has all this subcutaneous air in his chest. I think our
flutter valves are a little too damn short.
I knew she was absolutely right. I mentally went over the
contents of our bags. Tough shit, I said. There s nothing else
we can use. We don t have anything longer.
We each pushed the needle in a little harder, and sure
enough, oxygenation and blood pressure improved after a few
seconds. Erin and I both grinned. I could feel relief, that rare
liquor, seeping through my veins. I forgot all about nausea and
exhaustion. We were wearing helmets and talking via radio over
the thunder of the engines, but if it were possible to bend our
ears down to the needles, we d have heard the hiss of unwanted
air escaping whenever we applied pressure. When the tips failed
to reach their intended target, air reaccumulated around the
lungs and collapsed them. It also compressed the big blood ves-
sels leading into and out of the heart, so there was no blood flow
and no blood pressure. It was a simple mechanical problem,
basically.
It would have been a stupid shame for that kid, not much
older than my sons, to die from a simple mechanical problem.
Well, from drinking and driving, no seat belt, and a simple me-
chanical problem.
Hey, whaling on these things works for me, I said to Erin,
gesturing to the decent numbers on our monitor.
Yeah! she said, laughing. How about that? Hands on,
we re living the good life. Hands off, we re in deep, deep shit.
I eyeballed the drip chambers under the IV bags, made sure
we still had plenty of fluid flowing into him. He was probably
bleeding inside someplace. As long as we pushed those flutter
valves into his chest, though, his blood pressure stayed up. He
224 Jennifer Culkin
couldn t have been gushing from anywhere inside. We just had
to keep him going another few minutes.
Our pilot set it down light and sweet on the hospital s roof-
top. Erin held pressure on the flutter valves while I unplugged
a bunch of things and got the patient and equipment ready to
move. A couple of security guards helped us heave-ho the portly
Mr. Doe and his backboard onto the hospital stretcher, and Erin
and I wondered aloud for the hundred thousandth time how
long our backs would last in the job.
I slung a bag over my shoulder and shoved what I had come
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