As the 206L-4 LongRanger IV helicopter circled the farm field a second time, the MedAir-12 crew knew they had a bad one waiting. In direct radio contact with the paramedic team on the ground, they surveyed the scene below and wished they were somewhere else. Amy Gibbs, the flight nurse, had had enough of the “bad ones.” Her run-in with the “LA Rapist” three months earlier had shown her what she thought was the worst of what one person could do to another. She didn’t want this case, or any case, to prove that wrong.
“They’re setting up the LZ now,” said Sanders, their new pilot on loan from MedAir-24, into the com system. Lyle Henderson, the crew’s regular pilot, remained benched from the bilateral femur fractures suffered during the helicopter crash they’d experienced during that earlier, traumatizing case.
Amy gazed at the fallow field below. The remnants of an earlier light snow framed the fencerows where the wind could blow it no further, and that day’s sun had not melted it. In the dimming light of dusk, she could see a wide figure-eight etched into the dirt. At one end, the lights of the sheriff’s cruisers and EMS vehicles lit up the field. Not far from them, she saw the first flare ignite. Within two minutes, all four flares illuminated the makeshift landing zone and Sanders touched down with the typical finesse of a MedAir pilot.
Upon entering the aurora of the headlights, Amy noticed that tire ruts formed the figure-eight in the rich, partially thawed topsoil of the Cuivre River floodplain. She saw the county paramedics working on the victim and hesitated. She saw no person there, just a mangled form. Images from three months earlier flooded her mind. She had to focus. The young woman needed her care, but nothing visually told Amy that this victim was female. She took a deep breath and fought the fear rising within. Her shrink had told her she was returning to work too soon after her ordeal. Until now, she’d thought Doctor Lange was the crazy one.
“Hey, Amy. As we radioed, young female here. Can’t tell her age. Feet were bound and it appears she was dragged behind a truck for who knows how many laps around this field. Farmer was moving some equipment and saw headlights in his field. Thought it was joy-riders. Found her when he came to investigate. Saw a dark pickup leaving.”
“We got here within five minutes of the call. Blood pressure was forty systolic. Pulse barely discernible. Shallow breathing. Found one arm vein for an 18-guage line. Had to do an I.O. into the marrow on the opposite side’s tibia. We’ve squeezed in two liters of saline so far. Third and fourth are running. Blood pressure, maybe sixty now. Difficult reading it. Intubation was tough. Blood filled her throat every time we managed to clear it. But, Jazz there managed to snake in a seven. She’s circling the drain and needs to get out of here STAT if we have any chance of saving her.”
“Thanks, Paulie. Injuries?” A quick glance showed her that fluids were running easily into the cephalic vein of the woman’s arm, as well as into the intraosseous line, the catheter going into the bone marrow of her tibia.
Amy saw the form of a young woman but little else to identify the gender. Her hair had been shorn. Face, scalp, and exposed extremities appeared like ground beef, not human flesh. The generic jeans and t-shirt were as mangled as the flesh. Right femur appeared broken and angulated, as did the left upper arm. The wrists revealed wounds consistent with coarse bindings of some sort. Amy saw little oozing from the wounds, a good indication of the low blood pressure … and of a body shutting down. Amy held little hope that this girl would even survive to the trauma center.
“Quick, let’s get these extremities splinted. Reid, get the …” She stopped when she saw that Sanders had brought their stretcher to them and was preparing it for their patient. “Get the ventilator and hook her up.”
Amy took her penlight and lifted the girl’s eyelids. She gasped. The globes were flaccid, the corneas gone. She returned her focus to starting her initial assessment while the others immobilized the girl. The airway was good, but the lungs sounded full of fluid. Heart sounds were muffled. Tamponade? Her condition made the usual clinical signs of fluid collecting in the sac around the heart unlikely. Amy had little choice but to put a needle into the pericardial sac and check. To miss a tamponade would guarantee the girl’s death while relieving one could prove the turning point in her resuscitation.
She grabbed an 18-guage needle and pulled open the tattered shirt. Again, she startled. A large incision in the right upper quadrant of her abdomen gaped open, its sutures torn amidst the battered flesh. What had this girl gone through?
Amy’s pulse quickened and her breathing seemed labored. Focusing on the patient became harder. Reid brought her back by swabbing the area just below the woman’s breastbone with antiseptic. He’d read her mind. Amy unsheathed the needle, inserted it just below the xiphoid, the lower bone of the sternum, and angled it at roughly forty degrees toward the heart. She felt the needle puncture the pericardial sac and immediately saw a return of fluid. With a large syringe, she removed fifty milliliters of serous fluid.
Amy felt mixed emotions. Were they going to save this girl to a life of disability? Blind and who knew what else. She slipped the plastic catheter off the needle and left it in the pericardial sac, burying the hub in a wad of sterile 4x4’s to absorb further drainage in route.
With the victim’s extremities splinted and her neck immobilized, the team gently rolled the girl to her side. The ripped shirt fell away from her body except in the areas where it had been ground into her skin. Amy gagged at the site of two more gaping incisions, also torn apart by the trauma of being dragged behind the truck, the frayed ends of their sutures barely visible above the macerated skin.
Amy jumped up and ran, fighting the bile rising into her throat. Tears welled up and cascaded down her cheeks. As she neared the helicopter, she bent over and began to puke. She couldn’t take it. She emptied her stomach, but the retching continued. Why? What had this poor girl done to deserve this? She kneeled, sobbing. What? The question would go unanswered.
She turned to see Reid and the others loading their patient onto the bird. Sanders had started the engine. She knew she had to join them, do her job, but she couldn’t move. Reid came, pulled her up, and helped her inside. By habit, she strapped in and donned the headset, but the tears continued as Reid managed the patient.
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