2130; March. Continent B. 

Jaax studied the pulsatile blood flow as it crept between her interlaced fingers, the red warmth gushing from the wound underneath her hands despite her best efforts to keep pressure. She was on her knees on top of the gurney, straddling the man’s body and using her full body weight to press against his carotid artery. Her knuckles turned white as Mark wheeled the gurney to the gerry-rigged trauma bay in a tented corner of the field hospital. His stethoscope bounced on his chest as he ran. The wheels bumped against the rough earthen surface, nearly knocking her off multiple times as they sped past the cots holding other wounded rebel soldiers. They didn’t so much as glance up at them as they passed. 

As she crouched over the man’s body, he stared up at her with the glassy eyes of a man going into shock. 

“Stay calm,” she said, but he was calm as he continued to slip in and out of consciousness. Maybe she said it more for herself than for him. He couldn’t talk as she held pressure against his shredded neck, his mouth agape and dry as a bone. But she could see him blink in response. His brown eyes locked onto hers for a moment of clarity before he slipped away again. 

“We’re taking good care of you, okay?” 

“Sal!” Mark screamed as they rushed into the trauma-bay; locking the cart’s wheels in the center of the room. He cut the man’s grey rebel uniform off and ripped it away, placing the AED pads for continuous cardiac monitoring, blood pressure cuff, and pulsoximeter for checking his oxygenation status. Everything happened simultaneously like a well-oiled machine, each part doing as it should.   

Jerusha wrapped a tourniquet around the man’s arm and grabbed the Vaber. Blue light emanated from the curved metallic wand, lighting up the vein’s in his arm like a Christmas tree. Once the Vaber locked onto a vein’s depth and angle, Jerusha pressed a button and it automatically slid a large bore IV into the man’s arm, flashing with blood return. Mark had already spiked and primed fluid boluses, and they began pumping him full of fluid and epinephrine to keep his plummeting blood pressure from tanking completely. Although they knew it was a temporary solution. They had to control the bleeding, and that was her job. 

She was like the calm at the center of the storm. As she leaned her entire body weight to put pressure on the man’s neck, she felt detached from the organized chaos around her. Her hands were cramping up, the bones creaking beneath her weight. Yet she stood above this man, holding his life in her hands.  

“Welds!” She screamed, her voice commanding through the chaos. Mark brought the portable rod that looked somewhat like a pencil, used to auto-cauterize arterial bleeds. She saw the field surgeon, Dr. Sal Voss, running to her, his brown canvas jacket already covered in blood from other patient’s wounds. Sterility and cleanliness be damned in a hell-hole like this. 

“What happened?” He asked as he stopped by her side, eying the bleeding wound beneath her hands.

“Laser Sniper,” Jaax replied. “Fucker took the shot right outside the hospital.”

Sal glanced up at her to see the blood splatter on Jaax’s face and uniform. He must know how close she’d been; how the beam had flashed past her and plunged itself into the man, this unknown rebel soldier. 

“Animals,” Sal said, taking the Weld in his thumb and forefinger like an artist. “Hold him.” 

Jaax pushed her elbow down against the man’s chest, leaning her weight into him even further to keep him still. She readied herself to take her palms away from the carotid once the metallic tip of the Weld was exactly where she thought he’d be able to stop the blood flow. 

“He’s coding!” Jerusha called. Jaax could still see the electrical activity of the heart on the EKG monitor, but Jerusha was holding onto his femoral artery, feeling for a pulse. “He’s in PEA!”

Pulseless electrical activity. That meant his heart was still trying to beat, but it wasn’t able to do so. There are multiple reasons this could happen, but for this man it was pretty straight forward. 

“That’s probably because he doesn’t have any blood left to pump,” Jaax yelled to the others, “Don’t start CPR yet!” 

“He’s lost a shit ton of blood,” she said more quietly to Sal. His blue eyes locked onto hers.

“We have to stop the bleeding first. Anything we give him will just come back out again,” She saw him visibly take a deep breath, internally prioritizing what to do in chronological fashion.

The man’s skin was becoming more and more translucent, like tissue paper, only a thin sheet between his insides and the outside world. His glass-like eyes were fading away, as the hypoxic state of his brain slowly settled in. 

And she felt it. The slow creep of death coming into the trauma bay. It hovered above her like a dark cloud, so thick she was almost tempted to look above her to ensure it wasn’t really there, brooding, waiting for her to move so it could come and snatch him away.

She snarled, bearing down on his neck and speaking under her breath, “You can’t take him.” 

She made eye contact with Sal, and he nodded. Only then did she cautiously peel one of her hands away. A single surge of blood gushed onto her arm from the built up pressure in the artery, but the pulsatile nature of the blood flow had gone away, since the man’s heart was no longer beating. Sal found and artfully scalded the end of the carotid artery within moments. Blood boiled and blackened around the site as the Weld sent tendrils of smoke curling into the air, permeating the trauma bay with the smell of burning flesh.

Once the major source of the bleeding was controlled; she knew they had to start CPR. Sal continued to scald the oozing wound as Jaax interlaced her fingers over the man’s sternum and used her full body weight to compress his chest. Her long black pony-tail, caked with sweat and blood, dangled in front of her face as she pounded against the man with full force. With each compression, pulsations of blood spewed from the neck wound, showing Sal exactly where he still needed to embolize.  

Sweat dripped down her face, into her eyes and lips and onto the man’s vacant face before her. Her back, chest, and forearms ached, and her own heart was pounding so hard she thought it may burst out of her chest. Her forearms started to bow beneath her from the strain, her elbows starting to bend with each compression. 

“Let’s switch,” Mark said, readying himself to take her place.  

She’d already been holding pressure on his neck for so long, her arms were already giving out. He nodded and she jumped off at the end of a two minute cycle. Mark took over, a brutal six foot five man who had no need to get on the stretcher or stand on a stool. He towered above the man and pounded on his chest with his palms; his arms straight and his face furrowed with intensity. She heard the man’s ribs crack. A technician was at the head of the gurney, pushing air into the man’s lungs during the small break between chest compressions using an Aerator bag. The bag’s mechanical base whirred as it sucked oxygen from the environment and concentrated it, blowing nitrogen out the other side as a waste product. Jerusha clutched his femoral artery, feeling for a pulse as if someone’s life depended on it. And it did. 

“Get some Synth,” Sal yelled, but Jaax was already on it. She went to the cooler in the corner of the room; finding 15 bags of synthetic blood stacked on top of each other. 

Synth was invented in 2100, before The Fall of 2127, when scientific advancements were still at an all-time high. It had been used as a supplement to blood in the intensive care unit she’d worked at before The Fall. But since then, Synth is really all they’ve had. When every major continent had plunged into the Dark War, everything had changed. Giving real blood was extremely rare. With Synth, the cellular beads swell up in the veins to keep volume, but carry minimal amounts of oxygen compared to a real red blood cell. While the red blood cell’s oxygen carrying capacity is almost 100%, Synth’s is about 40%. But still, it was all they had.

Jaax spiked and primed a bag, watching the creamy white fluid fill the clear plastic chamber and slither down the tubing until it had gone all the way through. She put it into a pressurized IV pole, which rapidly compressed the fluid bag and sent it shooting into the man’s veins within a minute. She got another bag ready. 

“We’ve got ROSC,” which meant his heart had started effectively pumping again: return of spontaneous circulation, or ROSC for short because everything medical had to be abbreviated. Mark felt for a pulse himself before jumping off the gurney, sweat dripping from the bridge his nose and beading down his forehead, breathing heavily.     

“Blood pressure is 50 over 25, MAP’s in the 30’s.” 

“How many bags of Synth are in? Fluid?” Sal asked, stepping away from the man’s neck for a moment and flicking the Weld between his fingers. 

“We’ve given 5 liters of LR, 2 bags of Synth are in, third one is going now,” Jaax replied. 

Sal slumped his shoulders. The creases in his face held more sweat and grime than any medical professional before The Fall ever would have imagined. Jaax, Sal, Mark, Jerusha. None of them would have seen themselves working in this kind of environment.

“Give one more; then start levophed, epinephrine, anything you need. We have a limited supply of Synth and we can’t use it all on one person who doesn’t have good chances anyway.”

She bit her lip, looking at the stripped, blood covered soldier on the gurney. 

“Got it,” she said. 

He was right, though she didn’t think four bags of Synth was going to be enough for this man. She felt the cloud of death hovering again, foreboding like a shadow of things to come.

 

 

To be continued….

 

 

 

-Copyright: Jennifer K. Fuka

Image found at: https://www.celinatent.com/rapid-deployable-tactical-military-shelters/