Resistant (8 page)

Airway, breathing, and circulation. All check.

He gingerly worked Cap’s backpack off and opened it on the ground next to his. The man’s muted cries echoed forlornly off the trees, and momentarily reminded Lou of the remoteness of their location.

Stay focused!

Neck seems uninjured.

Just in case, Lou used one of the ACE bandages and an empty backpack to improvise a stabilizing cervical collar.

Time to stop the bleeding.

“Cap, it’s me. It’s Lou. Hang in there, buddy. Hang in. I’m going to press on your forehead. Here, squeeze my hand if you can hear me.… Cap?”

Lou took half the gauze pads to wipe the blood out of Cap’s eye and off much of his face. Then he used the same gauze to apply heavy pressure to the laceration.

“Cap, it’s me. It’s Lou. Squeeze my hand if you can hear me.” Perhaps a flicker. “That’s it, buddy. Squeeze again.”

Lou kept up a steady stream of patter as he maintained pressure with his right hand. With his left, he soaked another gauze square with water from his backpack and wiped Cap’s face clean. Comfort. Every bit of comfort he could produce for the patient and the doctor was a help. He worked some water between Cap’s lips and then squeezed a few drops into his mouth. Cap swallowed. As Lou moved through the process he had mastered over the years of training and ER work, the need to extend his examination and to improvise treatment became increasingly important.

“That’s it, big guy. Hang on. Just hang on.”

The forehead hemorrhage had largely abated. Lou set a square of hi-tech hemostatic bandage over the laceration. There would be time for a dressing later. Another small squeeze of water between Cap’s lips. Again, he swallowed.

Pulses slightly stronger. Abdomen non-tender and flat. Arms and hands intact.

“Cap, it’s me, Lou. Open your eyes if you can. You’re doing better. Better and better and better.”

The leg was truly scary. Obscene to many. To a seasoned ER doc, it was just dangerous. The heavily muscled thigh was capable of holding literally quarts of blood—more than enough for someone to bleed out. The pain and internal bleeding had Cap hovering near shock. Lou had decided not to risk missing something potentially lethal by getting immersed too soon in the most obvious, spectacular injury. Now it was time to get to work on that.

He glanced back the way he’d come, wondering if he could possibly climb back up the cliff face to the trail. No chance. Besides, leaving Cap alone was something he could only bring himself to do after all other options had evaporated. For a half minute, while he collected his thoughts about the leg, he tried hollering for help. His cries were instantly swallowed by the dense forest. What about the river? If he could get Cap down there, perhaps he could fashion some sort of raft. But the woods were still shrouded in mist, and he could not even see the river from where they were.

Focus, Welcome. Focus!

The bleeding from the mid-shaft was continuing, and, if anything, seemed to be worsening. Lou checked for pulses behind each ankle and on the top of each foot. Left side, no problem. Right side, none. The femoral artery had almost certainly been torn. Big trouble.

It was then Lou realized Cap’s groans had stopped entirely. Again he went through the process—the A, B, Cs.

Pulse rate one fifteen.
Pulse strength down from four to three on a ten scale.

“Come on, pal! Stay with me. Stay with me.”

Time was becoming even more of an enemy. He had to put on a tourniquet near the groin. Cap was still moving air effectively. His pupils were midsize and equal. Was there hemorrhage between his skull and brain? It didn’t look like it, but if there was, Lou knew there was little he could do about it. It had to be first things first. He had to continue to stem the blood loss.

“Cap, it’s Lou. I’m here.”

The moaning began again—barely audible, then louder. Lou got to work on the fractured leg.

“Cap, you’re bleeding badly,” he said, uncertain if his words were registering. “I’m going to have to apply a tourniquet to stop the bleeding. It’s going to hurt. I need you to brace yourself. I’ve got to move your leg.”

From within his pack he removed the nylon rope and his Spyderco knife. He measured off an arm’s length of cord and was readying to cut it off when something made him stop.

Again, the process.
He had to remain focused, but at the same time stay cognizant of what might lie ahead.

If things went as he hoped, the rope and the other ACE bandages would be needed intact for something else entirely—getting out. Setting the cord aside, he pulled off his sodden shirt and, using the knife, cut and tore off two strips. Next, as gingerly as he could manage, he knotted them together, slid them around Cap’s thigh inches below the groin, and tied the ends tightly at the skin.

At the first movement of his leg, Cap screamed. Then he screamed again, and thrashed his head from side to side as much as the makeshift collar would allow.

Lou hated the way his friend came to, but was ecstatic that he had. The odds of pulling things off and saving his life had just improved. For one thing, the man was light—awake or at least responsive to deep pain. For another, the cervical spine was almost certainly intact. If Lou needed the ACE bandage for what he had in mind, he would use it. He took what remained of his shirt, and blotted the perspiration that had suddenly materialized on Cap’s face and bald pate.

“Sorry to hurt you, pal. Your leg is broken, and I have to stabilize it. Do you understand?”

Silence.

“Cap, can you hear me?”

Suddenly a faint nod, followed by a coarse whisper.

“I … hear you.”

Yes!

“Squeeze my hand, big guy. That’s it. That’s it. Now the other hand … Perfect. Cap, try to just lie still and concentrate on your breathing. Deeply, now. In and out. I’ll explain everything in a few minutes. For now, I need to tighten this thing on your thigh. It’s gonna hurt.”

“Go … for … it.”

The hemorrhaging was starting to slow, but only marginally. The tourniquet, arterial spasm, or diminishing volume? It was impossible to tell. He had to add torque. Lou crawled in an arc until he found a hefty stick, two feet or so long. He slipped it under the makeshift tourniquet and slowly rotated it clockwise. Cap cried out, but he didn’t scream. Instead he grabbed a fistful of soil and squeezed it tightly.

“Fuck,” he groaned. “… Oh, fuck.”

His breathing remained steady.

After two full turns, the bleeding was reduced to a slow ooze. Lou used the hi-tech, hemostatic bandage to finish the job.

“Cap, stay with me. Stay strong.”

From his pack, Lou retrieved his cell phone, not at all surprised to see there was no signal.

“Help!” he hollered. “Someone please help!”

It felt as if his voice had traveled only a few feet through the heavy air.

Another check of Cap’s pulses. Still palpable, but down to a two.

Lou sat back and wrapped his arms around his knees.

Either he figured out something to do, and soon, or Cap was going to die.

It was as simple as that.

CHAPTER 9

           To place economic security in the hands of the government is quite literally a return to our medieval ancestry where feudal lords took responsibility for the economic survival of the serfs working their estates.

        
—LANCASTER R. HILL,
Climbing the Mountain
, SAWYER RIVER BOOKS, 1941, P. 18

Lou estimated they were five miles from the lodge, assuming they had averaged ten minutes per mile over the uneven terrain. The concierge had warned him that cell phone signal strength in the mountains was spotty at best. After failing to get a dial tone, Lou checked the time. He had a new concern. It could take two hours to get back to the lodge and return with help—probably not much less even with an ATV. By that time there could be severe tissue damage caused by the tourniquet. The other potential danger was one he could not shake from his mind—severe shock and cardiac arrest.

Despite what Cap had said right before he stumbled and fell, he was never hot about making this run. Lou had talked him into it. Now there was no way he could allow him to die. The tourniquet had to be loosened as soon as hemorrhaging had clearly been stopped. Somehow, someway, Lou would get the man out of these woods without leaving his side.

“Listen, buddy,” he said, his voice managing to stay even. “This is going to be the tough part.”

“Do … what has … to be … done,” Cap answered, stopping between words to breathe.

With a few decent sips of water, and the bleeding slowed to an ooze, the physical evidence of shock had begun to ebb. As Lou had done with the tourniquet, most of the tools he needed to complete the next phase of the process would have to be improvised. Most medical schools and hospitals, Eisenhower Memorial included, offered a variety of continuing education classes on a regular basis. Six months back, Lou had taken a two-day wilderness emergency medicine course. Ironically, his decision to do so was inspired by his newfound passion for trail running. The class, taught almost exclusively by incredibly competent paramedics and specially trained EMTs, with a few ER docs sprinkled in, was well organized and terrifically informative. With two jobs and a kid, courses and lectures were often triggers for him to catch up on sleep. But fortunately, not that one.

Lou performed a quick, repeat physical. Cap was going to need all of his will and his strength just to survive the pain of what was about to be done to him. The exam offered Lou a whisper of confidence that his friend could endure what lay in store for him without slipping back into shock. Looking over the leg, the ugly bent angle, twisted like a wrung-out dish towel, the bone splintered and frayed at the edges, Lou questioned his own ability to inflict the required amount of pain. But the leg had to be straightened or the chances of saving it were negligible.

No matter how hard he tried to reason away the guilt, it kept gnawing at him. If only he had been less insistent. If only he could have been less exuberant.

If only …

Lou forced those thoughts to the back of his mind. For Cap’s sake, he had to stay in the moment, fully focused and committed to the process.

“I’ve got to straighten out your leg so I can splint it,” Lou heard himself say, his voice actually breaking between words.

Cap’s gaze seemed to sharpen. He eyes locked with Lou’s. There was no trace of doubt or fear on his handsome, bloodied face.

“You do what has to be done, Doc,” he managed.

“Actually, Cap, to do what has to be done, I’m going to need your help.”

Cap brushed the back of his hand across the damp bandage on his forehead.

“Tell me,” he said.

The misty rain had largely let up, but the world was still slippery and cool. To make matters more difficult, bugs had reappeared and were beginning to attack Lou’s face and naked back.

“Straightening and splinting your leg is a two-person production. Unfortunately, you’ve got to be one of those people. I’m going to get a couple of thick branches to be the splint. Then I’m going to tie the rope around your right ankle and loop it around that tree by your foot. When I say push, I’m going to need you to push your left foot against the tree with all your strength.”

“And you’re going to pull the rope.”

It was a statement, not a question.

Lou nodded. “If together we have the strength to do this, we’re going to pull the two segments apart and line them up the way they should be. Then I’ll keep the tension on by wrapping the rope around the tree, and you keep the tension on by pushing. Got it?”

“Sounds like fun.”

“When I get the rope tied around the tree, I’ll use our bandages and maybe your shirt to hold the splint in place. The setup will make sure those sharp bone ends don’t cut anything they haven’t cut already.”

“Got it.”

It sounded straightforward enough, but the truth was, Lou had serious doubts whether or not the two of them could pull it off. They had to overcome the tight spasm of the quadriceps group, the strongest muscle in the body. Just how strong Cap’s quad was would become clear in a few minutes.

Splint ’em where they lie,
Lou thought, recalling one of the lessons from the course.
Splint ’em where they lie.

It took five minutes of tromping through mud and old sodden leaves before Lou found a suitable pair of branches, each about a foot longer than Cap’s leg. One of them had a fork at the end, which was going to be helpful. Lou did not have enough ACE bandage to secure the splint in place, so he cut the backpacks and Cap’s shirt into strips that, along with some excess rope, would do the job.

But first, they had to straighten out his leg.

Lou glanced over at his AA sponsor, who mercifully appeared to have drifted off.

“Buddy, you got to get ready,” Lou said, gingerly securing the rope around Cap’s right ankle. Even the slightest movement of the leg induced a groan. This was going to be bad.

“I’m ready,” Cap said.

Lou released the rope and felt around the ground for a sturdy stick, which he gently slipped between Cap’s teeth.

“Here you go, pal. Just pretend you’re on a Civil War battlefield and bite down on this anesthesia machine when it hurts.”

“It already hurts.”

“I mean
really
hurts,” Lou said.

“Swell.”

“I got no whiskey like they had at Gettysburg, but I promise that if I did, I’d let you have as many swigs of it as you wanted.”

“Just do what you need to do.”

“Okay, this is it. Five … four…”

The rope tightened around Lou’s wrist as Cap preempted the countdown by jamming his foot against the tree. Lou gave the rope another wrap around his own wrist and wedged his foot against a boulder to help with leverage.

“Three…”

“This wasn’t your fault,” Cap said through the stick. “I wanted to come on this run.”

“Two…”

“Let’s do this!”