Snow Day, part 11
May. 10th, 2009 09:10 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
"Avalanche rods, snowshoes, emergency medical kit, sleeping bags, 2 Stokes stretchers, rope and climbing gear, headlamps, helmets, ice picks, crampons, primus stove, water, food, and you've got on your long underwear and heavy boots, right?" Houlihan looked up from the pile of gear he had assembled on the living room floor, strapped neatly into the Stokes stretchers -- light aluminum stretchers designed for mountain rescue. "We may be up there into the night."
"I'm ready," Trapper said grimly.
"Ray's going to take the chopper to check the other roads into the park, but the pass road is ours. It'll take an hour for district to get anyone else up here, so we'll do the initial survey. Here, attach this to your coat, and when we get up to the avalanche area, all you'll have to do is string it out behind you."
Trapper looked at the long orange nylon ribbon with mixed emotions. If only Stanley and Gonzo had avalanche cords, the odds of finding them before the spring thaw would be.... He killed the thought. Time enough to give up when they had made the effort first.
Houlihan took the front end of the stacked stretchers and Trapper caught a hold of the back. "Are we taking the snowmobiles?"
"Yes, the Jimmy would never make it if we have to go up where the avalanche has crossed the road." Houlihan answered. He set a course straight for the shed, but Trapper, following behind, looked over his shoulder at the mountain. And stopped.
"Mike, Mike, look! Isn't that smoke?" The thin gray wisp rising from the trees was too low to be mist or fog, not on a cloudless day like this one.
Mike stopped too and looked, and his face showed surprise for one unguarded moment. "Yes! Yes, please God, this may be a rescue after all. Come on, Trapper!"
They ran for the shed, and got out the snowmobile that Houlihan had put away last night. The other mobile was still in the back of the Jimmy, and it took a frustrating five minutes to place the ramps and work it free and refuel it. Trapper was ready to climb on, but Mike explained that they needed to add towed sleds behind the snowmobiles, in case they had to try to bring back stretchers.
"Just because they've managed to start a fire going, doesn't mean they're in good shape," he warned.
"I know, I know," Trapper growled. "I was in Korea, I know how bad cold injuries can get and I've kept up with the research. I just wish I knew how long that fire's been burning while we've been sitting inside like a couple of lumps on a log."
Mike shook his head, "Yeah, I know. Put that hook down and wrap the wire and we're set. Have you ever gone fast over new snow on one of these things?"
"Yes."
"Good." Mike climbed aboard the lead 'mobile and gunned the engine. "Honk if you want me to slow down!" he shouted over his shoulder as he pulled his goggles into place.
"Not bloody likely!" Trapper shouted back, getting his own engine started.
They peeled out of the yard, taking the hard packed snow of the road like a race track, and pushing the snowmobiles to top speed while the engines were still complaining about being run cold. A couple of miles up the road Mike turned off and went around a locked rail gate and paused to take another look for the smoke.
Trapper pulled up alongside him. "What's up?"
"Trying to figure whether to bushwhack straight for the smoke or go by the road. Faster to bushwhack, but safer by the road." Mike said.
Trapper weighed his impatience against his good sense. "The road."
"Right."
A mile. Two miles. Trapper was beginning to wish they'd cut cross-
country when Mike suddenly pulled up to a halt. The question on Trapper's lips died when he pulled up alongside. There were footprints in the snow, coming in a wobbly line down the road and then wandering off of the road into a meadow. Trapper followed the line of tracks across the open space and his heart jumped into his throat when he saw a patch of bright blue and a patch of green on the ground near the edge of the trees. He pointed and Mike nodded. In a minute, the snowmobiles had carried them across the expanse.
For Gonzo, the growling of the motors sounded at first like the growling of a big cat, and he pulled himself up to a sitting position and tried to protect Stanley's inert form with his own body and hung on, waiting for the claws and teeth to strike. Trapper, seeing Gonzo curled protectively over Stan, felt a wave of adrenaline wash over him. He could see Gonzo moving at least, but there was blood on the snow. He cut off the engine of the snowmobile and jumped into the knee-deep snow, wading quickly over and putting a hand on Gonzo's shoulder. "Gonzo! Gonzo! Are you all right?"
"Trapper?" Gonzo did look up then, with a face that looked like raw hamburger from the nose up. "Look out for the lion."
"Lion?" Mike, who had gotten to them by then, repeated. "You ran into the lion?"
"Stanley chased it away," Gonzo said, peering through eyes that were inflamed and half closed by swelling. "Who's that?"
"It's Mike Houlihan," Trapper said. "What's wrong with Stan, Gonzo?"
"He hit his head." Gonzo reached out and Trapper took his hand, "You're really here."
"Yeah, we're really here," Trapper reassured him, trying to gauge the damage to Gonzo's face and eyes. It looked frightening, but he couldn't see any deep damage on the skin.
"Just don't faint on us yet," Mike said sternly.
"I'm not going to faint," he protested, although he was standing at an angle. "Trapper, Stan's got a fever. And he kept saying his feet were cold, but just before he passed out he said they hurt. His right side is weaker than the left, and he was really talking wild. He said his father didn't care enough about him to come back for the funeral. I think he hit his head the first time last night, but he didn't tell me about it till a couple of hours ago, and ever since then he's been getting worse fast. He went into convulsions after he passed out. It's probably a subdural hematoma. I did what I could, but I can't see well enough to tell if I did it right. I might have just made things worse."
"Okay, Gonzo. Now I'll take a look at Stanley, and you give Mike here a chance to assess you."
"Right," Mike said. ""Here, let me give you a look see while Trapper takes a look at your buddy, there." He took Gonzo's hand from Trapper and pulled the man to his feet to half-walk, half-carry him over to the snowmobiles, "Now, tell me what happened, and what you can see."
"I got burned when the engine blew up," Gonzo said, as if that were an explanation. "Stanley poured all the beer over them, but my eyes still aren't working right. I can only see blurs of light and darkness, and it hurts to open them."
Trapper kept half an ear on Mike and Gonzo, but found himself pleasantly surprised by the ranger's expertise -- it let him concentrate on Stanley. And he wasn't happy with what he found. Stanley was awkwardly spasmed, his muscles taut on one side, and his breathing was harsh in his throat. His pulse was thready, his wrist fever hot, and there were signs of frost nip on his hands. Trapper peeled off the parka hood and the effluvium of blood hit his nose and throat like a slap in the face. Gonzo had stuffed his shirt into the hood; it was soaked in blood, and under the coat, Stanley's hair was sticky where his scalp had been cut open and Gonzo had tried to cut a burr hole through his skull with an inadequate tool. The blood was still flowing. "Mike."
"Yeah?" Mike was just putting the finishing touches on bandaging Gonzo's face.
"Can we get a chopper in here? One rigged for stretchers? "
"Sure, the chopper Ray's heating up is rigged for stretchers. Let me give district a buzz." Mike unlimbered the radio from the pouch on his belt. "Houlihan to district."
"District. Go ahead, Houlihan."
"We've found ‘em, district, alive but injured. Tell Ray to come to the meadow on bend three of the South Pass road, ready to fly for...standby district." He let up the key and asked Trapper, "Do you want to go to your hospital or to something nearer?"
"How long to San Francisco?"
"Forty minutes to an hour," Mike estimated.
Trapper shook his head. "No good. How long to the clinic in Willows?"
"Ten minutes, tops."
"Make it Willows," Trapper said.
Mike nodded and keyed the radio again. "District, advise Ray we will need to fly to Willows Clinic. And tell Willows we're bringing in a chemical burn case and a severe head injury. We're still assessing cold damage."
"Roger," District said. "Be advised Ray says the chopper will be there in 12 to 18 minutes. Get ‘em bagged and you can fly right out."
"Understood."
"Can I get a phone patch on that thing?" Trapper asked, finding a dressing for Stan's head in the first aid kit.
"Sure." Mike handed him the handset. "I'll wrap up his head."
"Not too tightly. Pressure on the brain would be bad." Trapper handed over the dressing and made himself concentrate on the radio. "District, this is Dr. McIntyre. Can you get me a phone patch to San Francisco Memorial Hospital? I need to speak to Arnold Slocum." He gave them the number and waited.
"No problem, Doctor. Just stand by one." After a long minute, the radio crackled. "All right, Mr. Slocum, go ahead."
"Trapper? Trapper, what's going on? Are they all right?" Arnold sounded like he was worried, but his obtuseness lit the ragged end of Trapper's fuse.
"No, Arnold, they are not all right," he growled. "They had a damn mountain fall on them. Now write this down. I want you to get a chopper in the air, stat. On that chopper you will have a neurosurgeon and at least six units of whole blood, Stanley's type. I think it's O-neg, but the lab will know, he donates often enough. Tell the neuro to bring whatever they need to handle a subdural or epidural hematoma, and plenty of sutures because I went through every damn inch of silk up here last night. If you can find an ophthalmological specialist throw him on board too, and tell him chemical burns, but the priority is the neurosurgeon. Send ‘em to the clinic in Willows. I'll have started the craniotomy by the time they get there."
"Can't you just fly back here?" Arnold asked.
"Stanley would be dead by then," Trapper said flatly. "Gonzo's eyes can wait, but I'm not sure the hypothermia can. Just do it, Arnold."
"Let me make sure I've got it right," Arnold conceded. "Chopper, neuro, ready for subdural or epidural hematoma, six units Stanley's type, opto ready for chemical burns. Send them to Willows clinic, stat. Anything else?"
"An EEG. I don't remember seeing one up here."
"Got it." Arnold might fuss sometimes, but he could be direct when circumstances required it. "Call me when you get the chance."
There was a click, and District came back on the air. "Any more calls, Dr. McIntyre?"
"Not right now. How soon for that chopper?"
"He just lifted off. District out."
"Is he that bad?" Gonzo, who had been listening from his position near the snowmobile, asked. "He was walking just a little while ago." The alarm in his voice was grating. "I thought I got to him in time!"
"I can't tell without getting in there," Trapper said. "He's still bleeding like a stuck pig. No, don't try to get up," he added when Gonzo tried to do just that. "You'll only get in the way. Mike and I can handle it."
"Right," Gonzo managed to get out, but Trapper had already gone to get the stretchers from the towed sled. Gonzo stayed put, but he listened anxiously as Trapper and Houlihan maneuvered Stanley into the sleeping bag and the stretcher. It wasn't right! Stanley's condition had deteriorated so quickly! Gonzo knew that head wounds had a way of going sour suddenly, and he had been forcing Stanley to exert himself, but it just wasn't fair for Stanley to be so desperately endangered when rescue was so close. Especially after Gonzo had taken the Swiss army knife to ... Gonzo crossed his fingers. "Come on, Stanley. You made it this far, just hang on a little longer."
With Stanley tucked into the warm bag and his head braced against bumping, Trapper and Houlihan turned their attention to Gonzo.
He was crying.
Trapper, surprised, looked at Mike to see if he knew what was wrong, and Mike gave a little shake of his head and said, "It's okay," in a very low voice. "We see this in rescue work all the time. People hold themselves together for days and then fall apart the minute they can let someone else take over. It's pretty normal. Don't give him a hard time, just talk to him normally so he has a reason to pull himself back together."
"Right." Trapper got the second sleeping bag and advanced on his protege. "All right, Gonzo, your turn. We've got to bundle you up for the chopper ride. Mike tells me that they've got stretcher rigs, but they're on the outside, and you'll need the protection."
Gonzo's shoulders shook all the harder. "Did I kill him, Trapper?"
Trapper took a deep breath, making himself sound calm, "No, Gonzo. You didn't hurt him. He'll be all right. We've got him tucked away like a caterpillar in a cocoon. And now it's your turn. Just pick up your feet a little." Between them, Trapper and Mike persuaded Gonzo into the bag and then picked him up and strapped him into the stretcher bodily.
They were just finishing tucking the last straps when they heard the chopper approaching. Trapper looked up and found that he still knew how to lead the sound with his eyes just right. For a moment his memory overlaid the Forest Service green with army green and he brought up his hand to shield his eyes from the down blast of the rotors the way he remembered doing it years before. At least this time he wasn't going to have to operate in a tent, but he suddenly wished he had Dago Red around to put in a fix.
"I'm getting too old for this," he told himself under the rattle of the slowing blades as the helicopter settled near the middle of the meadow. But he took one end of Gonzo's stretcher while Mike grabbed the other and they plunged quickly through the snow to the stretcher rack.
The pilot unfolded himself from the doorway and waved them off while he secured the first stretcher. Trapper ran back for Stanley, and Mike followed. While they were still adjusting their grips on the cold metal of the stretcher, Mike said, "You can ride in with Ray. I've got to go check on that smoke, and get the snowmobiles under cover for the night, but I'll come down to Willows later."
"Right," Trapper acknowledged as they made the bent over run. They got the stretcher to the second rack and Ray appeared to help fasten it down. Trapper and Mike, momentarily extraneous, stepped back, and Trapper stuck out a hand. "Thanks!"
"Just take good care of them. And next time I'll invite you all up in the summertime!" Mike shook his hand and then darted away from the chopper, back to the snowmobiles while Trapper climbed into the passenger seat.
Ray, satisfied that both stretchers were secure, folded himself back into the pilot's seat and waved an upraised thumb at Mike, who waved back at the chopper and crouched down behind the snowmobile for protection from the wind. Trapper was still getting his own harness fastened when the engine whined and the chopper lifted off.
For Gonzo, swaddled and strapped down, the trip had a nightmarish quality that he would never quite forget. His face burned under the new bandages and he could feel his pulse pounding wherever the straps were tight. The engine roar reminded him all too clearly of the sound of the avalanche coming down, and he wanted more than anything to be able to pull his arms clear of the straps and cover his head against the darkness and the noise and the tug of the wind against his body. His mind had divided itself into parts, like a chorus whose members had all decided to sing different solos, and he remembered Nam, slid down the mountain on plastic again, and relived the nightmare of trying to punch a hole through Stanley's skull by touch with nothing to work with but a Swiss army knife. And yet, all the while one corner of his mind was celebrating because Trapper had come and found them, just as Gonzo knew he would.
Trapper, who had ten minutes to remember everything he could about concussions, subdural hematomas and the surgical procedure for relieving bleeding against the brain, found himself contemplating an unacceptable future. If Gonzo's eyes didn't heal, he'd never be able to work as a surgeon again. If Stanley died... Trapper shook off that image. Stanley wasn't going to die, Trapper told himself. Not if Trapper's skill and strength had anything to do with it. The real threat was brain damage, and all the complications that involved. Paralysis, aphasia, memory loss; even with therapy, most of the possibilities would leave Stanley too uncertain of his decision making abilities to stay in Emergency medicine, and some would leave him unable to practice medicine regardless. Trapper tried to think of what Stanley would do if he couldn't be a doctor, and realized that all of Stanley's best qualities were tied so tightly to his identity as a doctor that what would be left was nothing but a shell.
Trapper took a deep breath and looked at his own hands, remembering other surgeries he had done, successful surgeries, and made himself calm down. Think about the bones, the blood, and the brain, not the patient, if you want steady hands. The posterior cranium is composed of ... And the chopper blades pounded in his ears like the vanguard of a nightmare army, reminding him of all the times when skill and strength had not been enough. ...beneath which lie the menenges, the best known of which is the dura mater...
Ray tapped his knee and signaled him to look out, and Trapper realized that they were coming into a landing in the parking lot at Willows. The clinic was three blocks down the road, but the lot there was too small. He could see Terry and Steve from the night before, standing next to a tall, white-haired man that he didn't recognize, and a handful of high school kids clustered behind them. Across the way, a county deputy was riding herd on a passel of smaller kids, and Trapper could see adults peering out through windows to see what was happening. As soon as the chopper touched down, the white-haired man led his contingent over, stooping under the swirling blades like an old hand.
Ray tapped Trapper's shoulder before he got out. "I've got to go back up to base," he shouted over the engine. "There's just enough daylight and word is more snow before midnight. Take good care of ‘em, and tell Mike to let me know what happens, okay?"
"Okay," Trapper agreed readily, and shook the pilot's hand. "Thanks for the lift."
"Anytime!"
The high school kids appeared to be the stretcher-bearers for the hike up to the clinic, and to judge by the way they took position while Terry and Steve undid the hookups, they had practiced this before. By the time Trapper had clambered out of the chopper, they were already on the way, with Terry riding herd on Stanley's stretcher while Steve strode along next to the team bearing Gonzo. The white-haired man had waited to shake Trapper's hand and lead him out of the way as the chopper lifted off.
"I'm Doc Elliott," he said, when the noise had abated a little. "Jim." He was younger than Trapper had thought from the hair, late forties at most, with a long craggy face and a ready grin. "You must be John McIntyre. Terry's been telling me about you." They followed along in the wake of the stretchers and Trapper found himself working to keep up.
"Trapper," he said, introducing himself briefly. "Is there any chance you've got surgical experience? I've only had two hours sleep in the past 36 and I could use some back up for some skull burrs and a craniotomy."
"I'm not primarily a surgeon," Elliott said, "but out here there isn't always time to wait for the experts and I've done half a dozen of the things. Successfully, too, which is what counts."
Trapper relaxed a little bit. Dr. Elliott had both the confidence and experience that he wanted the most in a case like this, and it made Stanley's prospects a lot brighter. "Glad to hear it. I've done a lot of them over the years, but lately that's the sort of thing we have a staff neurosurgeon to deal with. So don't be shy about speaking up. Especially if you know anything about cold injury complications."
Elliott grinned, "In that area I've had more practice than I want. We've got the tubs running already. But I understand you've got another surgeon on the way up from town."
"Hopefully," Trapper said. "But the sooner we get in there, the better Stan's chances."
The stretcher-bearers had reached the clinic and turned inside, and Trapper was grateful to follow them into the warmth. Terry and Steve had been joined by another, rather elderly, nurse and a young scarecrow of a man with a stiff new EMT badge on his sweater, and the four of them were working in teams to begin unwrapping Stanley and Gonzo. The high school kids began filing out, and Doc stopped the tallest girl on the way out. "Get some cars lined up around the parking lot with their lights on, will you, Jenny? There's another chopper coming; no patients this time, but probably a doctor and some equipment to bring up the hill, and I'd like them to land safely."
"We've got you covered, Doc. Just let us know what happens," the girl said, and waved her compatriots out the door.
"I will," Doc promised, closing the door behind them. He turned and started stripping off gloves and coat. "Dr. McIntyre, this is Mollie, and that one over there is Gary. He just finished his EMT course last week, top of the class, and Mollie's been taking care of folks up here since 1945, so we've got both education and experience on our side."
"I'm Trapper," he said, "and these are Gonzo Gates and Stanley Riverside," he waved a hand to indicate which was which. "They started up here last night and got caught by an avalanche up on Mendocino pass, probably a little after nine o'clock. How they got out from under it, I don't know. Gonzo told us that his face got burned by a car engine explosion, and Stanley's got a subdural or epidural hematoma which has been worsening rapidly over the course of the past hour or so. There are probably other injuries as well, so keep an eye open as you go. You should also remember that both of them are doctors, so be careful what you discuss when they can hear you. I need vitals, a CBC, and urinalysis on both of them, and a skull series on Stan. I'm going to do a craniotomy, by which time, with any luck, a neurosurgeon from San Francisco Memorial ought to be arriving to do the tricky part."
"We can get things started, all right, except we'll have to go with plasma instead of whole blood," Doc Elliott said. "Your glasses are back in the washroom, still. And there are spare sets of whites back there, if you want to get warmed up with a quick shower. It'll take us at least five minutes to get his head shaved and the x-rays ready, and it might help you feel more awake."
"True," Trapper said, although he found himself reluctant to leave Gonzo and Stanley to strangers. "Yell if you need me faster."
By the time Trapper had cleaned up and got back, Gonzo was soaking in a long shallow tub with a backboard supporting his head and shoulders above the water. He had a thermometer stuck in his mouth and a small towel covering what modesty required, but that was all except for light bandaging and Trapper had a clear view of the pattern of the bruises and scrapes that covered him from head to foot.
"Hell, he does look like a mountain fell on him," Trapper exclaimed.
"Looks to me like he fell off a mountain," Mollie said, from her position at Gonzo's head, monitoring his temperature as she gradually warmed the water. "It's the other one looks like the mountain fell on him. They've got him down the hall getting some x-rays of his skull for you to work from," she added, indicating the direction with a nod of her head.
Gonzo made a sound of protest around the thermometer and Trapper caught back his impatience and stopped by the tub to talk to the injured man. "What is it, Gonzo?" he asked, nodding to Mollie to take the thermometer out for a minute.
"Where are we?"
"A town called Willows. I'm going to operate on Stan, and you're going to cooperate and keep quiet until an ophthalmologist can get here and check your eyes." Trapper patted his shoulder where it wasn't quite as bruised. He'd have to finish scrubbing before he started on Stan anyway. "And if you don't cooperate I'll have Mollie here give you something to take your mind off things."
"I can't keep it on anything anyway," Gonzo said. "I feel awful, Trapper. My face is going to fall off and I wish it would hurry up and do it."
In this light, the blisters and broken blisters on Gonzo's face didn't look any better than they had on the mountain. Trapper reviewed the different painkillers in his head. "Mollie, have you got any percocet?"
"We certainly do. Half a pill to start with?"
"Yes, and if it hasn't helped in an hour, give him the rest of it unless the ophthalmologist has gotten here and says not to."
"Yes, Doctor," Mollie said and pulled out the key to the dispensary. While she went to get the pill, Trapper stayed with Gonzo to keep an eye on him.
"That'll help," Gonzo said. "Percocet will help." Then, as if the topic had reminded him, he said, "Trapper, I think Stanley took some acetaminophen, but I don't know for sure. He had a headache."
"Do you remember when, Gonzo?"
"Feels like days ago. At least three hours, though. It was before we tried to slide down the mountain."
"You tried to slide down the mountain? Whose bright idea was that?" Trapper could hardly believe his ears.
"It was sort of mutual," Gonzo said. "It was taking such a long time to walk down, and I knew you wouldn't be looking in the right place. We tried to make it out on our own. We really tried."
"I know you tried," Trapper said, wishing that Mollie would hurry up with the percocet. He was too tired to be soothing for very long. Right now he just wanted to take Gonzo by the shoulders and shake some sense into him. "You just about made it too. Only about three miles to go."
"We tried," Gonzo repeated. "And Stanley, he just kept going and going. He didn't tell me he was hurt, Trapper. He just kept on trying to get me to you. We really tried." Gonzo was beginning to shake with reaction, and Trapper looked around for a sheet or something to cover him when he heard the outer door of the clinic opening.
"Back here!" he called, hoping it was the neuro.
"John?" came Ernie's voice.
Trapper took the three long strides that brought him to the doorway and found Ernie standing in the entrance hall, still holding her purse in her hand. "Ernie? What are you doing here? I thought you were in Sacramento!"
"I had a feeling..." she said uncertainly, her dark eyes wide with worry. "I just thought I should come. And that deputy told me that they brought two patients in by helicopter a few minutes ago. Are they badly hurt?"
"Bad enough," Trapper started to say, but he glanced over his shoulder and saw that Gonzo was trying to lever himself out of the tub. "Gonzo, you idiot!" he roared, "Hold still!"
Ernie unbuttoned her coat hastily as she followed Trapper into the treatment room. Between them, they got Gonzo settled back into the water. Mollie had come too, at the sound of Trapper's shout, and she nodded approval as Ernie coaxed Gonzo into accepting the thermometer again.
"Friend of yours?" she asked Trapper.
"Mollie, this is Ernie Shoop. She's the best scrub nurse in San Francisco." Trapper said, unable to keep the relief of having Ernie around to help out of his voice. "Ernie this is Mollie."
"Mahoney." Mollie pulled a sheet from the cabinet and handed it to Ernie and they began to spread it over Gonzo like they had worked together for years. "Fort Dix, 53-54. And I was at the 5063rd while the pair of you were at the double Natural. I thought I remembered the name McIntyre from that football game, but I couldn't be sure."
"Old home week," Ernie said. "No, Gonzo, honey, don't try to use that hand, it's coming up blisters."
"The only thing we need now is for Hawkeye Pierce or Father Mulcahy to turn up," Trapper said. "His feet are blistering too."
"Blisters are good," Mollie said, "they mean the frostbite didn't go very deep."
"Trapper?" Terry leaned in the door. "We need you. He's convulsing."
Trapper wanted to kick himself for getting distracted by Gonzo and Ernie, but settled for swearing. "On my way. Ernie, get scrubbed! I'm going to need you in there."
Ernie watched Trapper vanish down the short hallway, and made herself stay outwardly calm as she stripped off coat and sweater and deposited them in a corner. "What happened to Stanley?"
"Head injury," Mollie said shortly. "The sinks are to your left, and there are clean whites in the ladies lounge, if you want them."
"Thank you," Ernie started to go and then paused. "Mollie, is there a priest in this town?"
"I'm ready," Trapper said grimly.
"Ray's going to take the chopper to check the other roads into the park, but the pass road is ours. It'll take an hour for district to get anyone else up here, so we'll do the initial survey. Here, attach this to your coat, and when we get up to the avalanche area, all you'll have to do is string it out behind you."
Trapper looked at the long orange nylon ribbon with mixed emotions. If only Stanley and Gonzo had avalanche cords, the odds of finding them before the spring thaw would be.... He killed the thought. Time enough to give up when they had made the effort first.
Houlihan took the front end of the stacked stretchers and Trapper caught a hold of the back. "Are we taking the snowmobiles?"
"Yes, the Jimmy would never make it if we have to go up where the avalanche has crossed the road." Houlihan answered. He set a course straight for the shed, but Trapper, following behind, looked over his shoulder at the mountain. And stopped.
"Mike, Mike, look! Isn't that smoke?" The thin gray wisp rising from the trees was too low to be mist or fog, not on a cloudless day like this one.
Mike stopped too and looked, and his face showed surprise for one unguarded moment. "Yes! Yes, please God, this may be a rescue after all. Come on, Trapper!"
They ran for the shed, and got out the snowmobile that Houlihan had put away last night. The other mobile was still in the back of the Jimmy, and it took a frustrating five minutes to place the ramps and work it free and refuel it. Trapper was ready to climb on, but Mike explained that they needed to add towed sleds behind the snowmobiles, in case they had to try to bring back stretchers.
"Just because they've managed to start a fire going, doesn't mean they're in good shape," he warned.
"I know, I know," Trapper growled. "I was in Korea, I know how bad cold injuries can get and I've kept up with the research. I just wish I knew how long that fire's been burning while we've been sitting inside like a couple of lumps on a log."
Mike shook his head, "Yeah, I know. Put that hook down and wrap the wire and we're set. Have you ever gone fast over new snow on one of these things?"
"Yes."
"Good." Mike climbed aboard the lead 'mobile and gunned the engine. "Honk if you want me to slow down!" he shouted over his shoulder as he pulled his goggles into place.
"Not bloody likely!" Trapper shouted back, getting his own engine started.
They peeled out of the yard, taking the hard packed snow of the road like a race track, and pushing the snowmobiles to top speed while the engines were still complaining about being run cold. A couple of miles up the road Mike turned off and went around a locked rail gate and paused to take another look for the smoke.
Trapper pulled up alongside him. "What's up?"
"Trying to figure whether to bushwhack straight for the smoke or go by the road. Faster to bushwhack, but safer by the road." Mike said.
Trapper weighed his impatience against his good sense. "The road."
"Right."
A mile. Two miles. Trapper was beginning to wish they'd cut cross-
country when Mike suddenly pulled up to a halt. The question on Trapper's lips died when he pulled up alongside. There were footprints in the snow, coming in a wobbly line down the road and then wandering off of the road into a meadow. Trapper followed the line of tracks across the open space and his heart jumped into his throat when he saw a patch of bright blue and a patch of green on the ground near the edge of the trees. He pointed and Mike nodded. In a minute, the snowmobiles had carried them across the expanse.
For Gonzo, the growling of the motors sounded at first like the growling of a big cat, and he pulled himself up to a sitting position and tried to protect Stanley's inert form with his own body and hung on, waiting for the claws and teeth to strike. Trapper, seeing Gonzo curled protectively over Stan, felt a wave of adrenaline wash over him. He could see Gonzo moving at least, but there was blood on the snow. He cut off the engine of the snowmobile and jumped into the knee-deep snow, wading quickly over and putting a hand on Gonzo's shoulder. "Gonzo! Gonzo! Are you all right?"
"Trapper?" Gonzo did look up then, with a face that looked like raw hamburger from the nose up. "Look out for the lion."
"Lion?" Mike, who had gotten to them by then, repeated. "You ran into the lion?"
"Stanley chased it away," Gonzo said, peering through eyes that were inflamed and half closed by swelling. "Who's that?"
"It's Mike Houlihan," Trapper said. "What's wrong with Stan, Gonzo?"
"He hit his head." Gonzo reached out and Trapper took his hand, "You're really here."
"Yeah, we're really here," Trapper reassured him, trying to gauge the damage to Gonzo's face and eyes. It looked frightening, but he couldn't see any deep damage on the skin.
"Just don't faint on us yet," Mike said sternly.
"I'm not going to faint," he protested, although he was standing at an angle. "Trapper, Stan's got a fever. And he kept saying his feet were cold, but just before he passed out he said they hurt. His right side is weaker than the left, and he was really talking wild. He said his father didn't care enough about him to come back for the funeral. I think he hit his head the first time last night, but he didn't tell me about it till a couple of hours ago, and ever since then he's been getting worse fast. He went into convulsions after he passed out. It's probably a subdural hematoma. I did what I could, but I can't see well enough to tell if I did it right. I might have just made things worse."
"Okay, Gonzo. Now I'll take a look at Stanley, and you give Mike here a chance to assess you."
"Right," Mike said. ""Here, let me give you a look see while Trapper takes a look at your buddy, there." He took Gonzo's hand from Trapper and pulled the man to his feet to half-walk, half-carry him over to the snowmobiles, "Now, tell me what happened, and what you can see."
"I got burned when the engine blew up," Gonzo said, as if that were an explanation. "Stanley poured all the beer over them, but my eyes still aren't working right. I can only see blurs of light and darkness, and it hurts to open them."
Trapper kept half an ear on Mike and Gonzo, but found himself pleasantly surprised by the ranger's expertise -- it let him concentrate on Stanley. And he wasn't happy with what he found. Stanley was awkwardly spasmed, his muscles taut on one side, and his breathing was harsh in his throat. His pulse was thready, his wrist fever hot, and there were signs of frost nip on his hands. Trapper peeled off the parka hood and the effluvium of blood hit his nose and throat like a slap in the face. Gonzo had stuffed his shirt into the hood; it was soaked in blood, and under the coat, Stanley's hair was sticky where his scalp had been cut open and Gonzo had tried to cut a burr hole through his skull with an inadequate tool. The blood was still flowing. "Mike."
"Yeah?" Mike was just putting the finishing touches on bandaging Gonzo's face.
"Can we get a chopper in here? One rigged for stretchers? "
"Sure, the chopper Ray's heating up is rigged for stretchers. Let me give district a buzz." Mike unlimbered the radio from the pouch on his belt. "Houlihan to district."
"District. Go ahead, Houlihan."
"We've found ‘em, district, alive but injured. Tell Ray to come to the meadow on bend three of the South Pass road, ready to fly for...standby district." He let up the key and asked Trapper, "Do you want to go to your hospital or to something nearer?"
"How long to San Francisco?"
"Forty minutes to an hour," Mike estimated.
Trapper shook his head. "No good. How long to the clinic in Willows?"
"Ten minutes, tops."
"Make it Willows," Trapper said.
Mike nodded and keyed the radio again. "District, advise Ray we will need to fly to Willows Clinic. And tell Willows we're bringing in a chemical burn case and a severe head injury. We're still assessing cold damage."
"Roger," District said. "Be advised Ray says the chopper will be there in 12 to 18 minutes. Get ‘em bagged and you can fly right out."
"Understood."
"Can I get a phone patch on that thing?" Trapper asked, finding a dressing for Stan's head in the first aid kit.
"Sure." Mike handed him the handset. "I'll wrap up his head."
"Not too tightly. Pressure on the brain would be bad." Trapper handed over the dressing and made himself concentrate on the radio. "District, this is Dr. McIntyre. Can you get me a phone patch to San Francisco Memorial Hospital? I need to speak to Arnold Slocum." He gave them the number and waited.
"No problem, Doctor. Just stand by one." After a long minute, the radio crackled. "All right, Mr. Slocum, go ahead."
"Trapper? Trapper, what's going on? Are they all right?" Arnold sounded like he was worried, but his obtuseness lit the ragged end of Trapper's fuse.
"No, Arnold, they are not all right," he growled. "They had a damn mountain fall on them. Now write this down. I want you to get a chopper in the air, stat. On that chopper you will have a neurosurgeon and at least six units of whole blood, Stanley's type. I think it's O-neg, but the lab will know, he donates often enough. Tell the neuro to bring whatever they need to handle a subdural or epidural hematoma, and plenty of sutures because I went through every damn inch of silk up here last night. If you can find an ophthalmological specialist throw him on board too, and tell him chemical burns, but the priority is the neurosurgeon. Send ‘em to the clinic in Willows. I'll have started the craniotomy by the time they get there."
"Can't you just fly back here?" Arnold asked.
"Stanley would be dead by then," Trapper said flatly. "Gonzo's eyes can wait, but I'm not sure the hypothermia can. Just do it, Arnold."
"Let me make sure I've got it right," Arnold conceded. "Chopper, neuro, ready for subdural or epidural hematoma, six units Stanley's type, opto ready for chemical burns. Send them to Willows clinic, stat. Anything else?"
"An EEG. I don't remember seeing one up here."
"Got it." Arnold might fuss sometimes, but he could be direct when circumstances required it. "Call me when you get the chance."
There was a click, and District came back on the air. "Any more calls, Dr. McIntyre?"
"Not right now. How soon for that chopper?"
"He just lifted off. District out."
"Is he that bad?" Gonzo, who had been listening from his position near the snowmobile, asked. "He was walking just a little while ago." The alarm in his voice was grating. "I thought I got to him in time!"
"I can't tell without getting in there," Trapper said. "He's still bleeding like a stuck pig. No, don't try to get up," he added when Gonzo tried to do just that. "You'll only get in the way. Mike and I can handle it."
"Right," Gonzo managed to get out, but Trapper had already gone to get the stretchers from the towed sled. Gonzo stayed put, but he listened anxiously as Trapper and Houlihan maneuvered Stanley into the sleeping bag and the stretcher. It wasn't right! Stanley's condition had deteriorated so quickly! Gonzo knew that head wounds had a way of going sour suddenly, and he had been forcing Stanley to exert himself, but it just wasn't fair for Stanley to be so desperately endangered when rescue was so close. Especially after Gonzo had taken the Swiss army knife to ... Gonzo crossed his fingers. "Come on, Stanley. You made it this far, just hang on a little longer."
With Stanley tucked into the warm bag and his head braced against bumping, Trapper and Houlihan turned their attention to Gonzo.
He was crying.
Trapper, surprised, looked at Mike to see if he knew what was wrong, and Mike gave a little shake of his head and said, "It's okay," in a very low voice. "We see this in rescue work all the time. People hold themselves together for days and then fall apart the minute they can let someone else take over. It's pretty normal. Don't give him a hard time, just talk to him normally so he has a reason to pull himself back together."
"Right." Trapper got the second sleeping bag and advanced on his protege. "All right, Gonzo, your turn. We've got to bundle you up for the chopper ride. Mike tells me that they've got stretcher rigs, but they're on the outside, and you'll need the protection."
Gonzo's shoulders shook all the harder. "Did I kill him, Trapper?"
Trapper took a deep breath, making himself sound calm, "No, Gonzo. You didn't hurt him. He'll be all right. We've got him tucked away like a caterpillar in a cocoon. And now it's your turn. Just pick up your feet a little." Between them, Trapper and Mike persuaded Gonzo into the bag and then picked him up and strapped him into the stretcher bodily.
They were just finishing tucking the last straps when they heard the chopper approaching. Trapper looked up and found that he still knew how to lead the sound with his eyes just right. For a moment his memory overlaid the Forest Service green with army green and he brought up his hand to shield his eyes from the down blast of the rotors the way he remembered doing it years before. At least this time he wasn't going to have to operate in a tent, but he suddenly wished he had Dago Red around to put in a fix.
"I'm getting too old for this," he told himself under the rattle of the slowing blades as the helicopter settled near the middle of the meadow. But he took one end of Gonzo's stretcher while Mike grabbed the other and they plunged quickly through the snow to the stretcher rack.
The pilot unfolded himself from the doorway and waved them off while he secured the first stretcher. Trapper ran back for Stanley, and Mike followed. While they were still adjusting their grips on the cold metal of the stretcher, Mike said, "You can ride in with Ray. I've got to go check on that smoke, and get the snowmobiles under cover for the night, but I'll come down to Willows later."
"Right," Trapper acknowledged as they made the bent over run. They got the stretcher to the second rack and Ray appeared to help fasten it down. Trapper and Mike, momentarily extraneous, stepped back, and Trapper stuck out a hand. "Thanks!"
"Just take good care of them. And next time I'll invite you all up in the summertime!" Mike shook his hand and then darted away from the chopper, back to the snowmobiles while Trapper climbed into the passenger seat.
Ray, satisfied that both stretchers were secure, folded himself back into the pilot's seat and waved an upraised thumb at Mike, who waved back at the chopper and crouched down behind the snowmobile for protection from the wind. Trapper was still getting his own harness fastened when the engine whined and the chopper lifted off.
For Gonzo, swaddled and strapped down, the trip had a nightmarish quality that he would never quite forget. His face burned under the new bandages and he could feel his pulse pounding wherever the straps were tight. The engine roar reminded him all too clearly of the sound of the avalanche coming down, and he wanted more than anything to be able to pull his arms clear of the straps and cover his head against the darkness and the noise and the tug of the wind against his body. His mind had divided itself into parts, like a chorus whose members had all decided to sing different solos, and he remembered Nam, slid down the mountain on plastic again, and relived the nightmare of trying to punch a hole through Stanley's skull by touch with nothing to work with but a Swiss army knife. And yet, all the while one corner of his mind was celebrating because Trapper had come and found them, just as Gonzo knew he would.
Trapper, who had ten minutes to remember everything he could about concussions, subdural hematomas and the surgical procedure for relieving bleeding against the brain, found himself contemplating an unacceptable future. If Gonzo's eyes didn't heal, he'd never be able to work as a surgeon again. If Stanley died... Trapper shook off that image. Stanley wasn't going to die, Trapper told himself. Not if Trapper's skill and strength had anything to do with it. The real threat was brain damage, and all the complications that involved. Paralysis, aphasia, memory loss; even with therapy, most of the possibilities would leave Stanley too uncertain of his decision making abilities to stay in Emergency medicine, and some would leave him unable to practice medicine regardless. Trapper tried to think of what Stanley would do if he couldn't be a doctor, and realized that all of Stanley's best qualities were tied so tightly to his identity as a doctor that what would be left was nothing but a shell.
Trapper took a deep breath and looked at his own hands, remembering other surgeries he had done, successful surgeries, and made himself calm down. Think about the bones, the blood, and the brain, not the patient, if you want steady hands. The posterior cranium is composed of ... And the chopper blades pounded in his ears like the vanguard of a nightmare army, reminding him of all the times when skill and strength had not been enough. ...beneath which lie the menenges, the best known of which is the dura mater...
Ray tapped his knee and signaled him to look out, and Trapper realized that they were coming into a landing in the parking lot at Willows. The clinic was three blocks down the road, but the lot there was too small. He could see Terry and Steve from the night before, standing next to a tall, white-haired man that he didn't recognize, and a handful of high school kids clustered behind them. Across the way, a county deputy was riding herd on a passel of smaller kids, and Trapper could see adults peering out through windows to see what was happening. As soon as the chopper touched down, the white-haired man led his contingent over, stooping under the swirling blades like an old hand.
Ray tapped Trapper's shoulder before he got out. "I've got to go back up to base," he shouted over the engine. "There's just enough daylight and word is more snow before midnight. Take good care of ‘em, and tell Mike to let me know what happens, okay?"
"Okay," Trapper agreed readily, and shook the pilot's hand. "Thanks for the lift."
"Anytime!"
The high school kids appeared to be the stretcher-bearers for the hike up to the clinic, and to judge by the way they took position while Terry and Steve undid the hookups, they had practiced this before. By the time Trapper had clambered out of the chopper, they were already on the way, with Terry riding herd on Stanley's stretcher while Steve strode along next to the team bearing Gonzo. The white-haired man had waited to shake Trapper's hand and lead him out of the way as the chopper lifted off.
"I'm Doc Elliott," he said, when the noise had abated a little. "Jim." He was younger than Trapper had thought from the hair, late forties at most, with a long craggy face and a ready grin. "You must be John McIntyre. Terry's been telling me about you." They followed along in the wake of the stretchers and Trapper found himself working to keep up.
"Trapper," he said, introducing himself briefly. "Is there any chance you've got surgical experience? I've only had two hours sleep in the past 36 and I could use some back up for some skull burrs and a craniotomy."
"I'm not primarily a surgeon," Elliott said, "but out here there isn't always time to wait for the experts and I've done half a dozen of the things. Successfully, too, which is what counts."
Trapper relaxed a little bit. Dr. Elliott had both the confidence and experience that he wanted the most in a case like this, and it made Stanley's prospects a lot brighter. "Glad to hear it. I've done a lot of them over the years, but lately that's the sort of thing we have a staff neurosurgeon to deal with. So don't be shy about speaking up. Especially if you know anything about cold injury complications."
Elliott grinned, "In that area I've had more practice than I want. We've got the tubs running already. But I understand you've got another surgeon on the way up from town."
"Hopefully," Trapper said. "But the sooner we get in there, the better Stan's chances."
The stretcher-bearers had reached the clinic and turned inside, and Trapper was grateful to follow them into the warmth. Terry and Steve had been joined by another, rather elderly, nurse and a young scarecrow of a man with a stiff new EMT badge on his sweater, and the four of them were working in teams to begin unwrapping Stanley and Gonzo. The high school kids began filing out, and Doc stopped the tallest girl on the way out. "Get some cars lined up around the parking lot with their lights on, will you, Jenny? There's another chopper coming; no patients this time, but probably a doctor and some equipment to bring up the hill, and I'd like them to land safely."
"We've got you covered, Doc. Just let us know what happens," the girl said, and waved her compatriots out the door.
"I will," Doc promised, closing the door behind them. He turned and started stripping off gloves and coat. "Dr. McIntyre, this is Mollie, and that one over there is Gary. He just finished his EMT course last week, top of the class, and Mollie's been taking care of folks up here since 1945, so we've got both education and experience on our side."
"I'm Trapper," he said, "and these are Gonzo Gates and Stanley Riverside," he waved a hand to indicate which was which. "They started up here last night and got caught by an avalanche up on Mendocino pass, probably a little after nine o'clock. How they got out from under it, I don't know. Gonzo told us that his face got burned by a car engine explosion, and Stanley's got a subdural or epidural hematoma which has been worsening rapidly over the course of the past hour or so. There are probably other injuries as well, so keep an eye open as you go. You should also remember that both of them are doctors, so be careful what you discuss when they can hear you. I need vitals, a CBC, and urinalysis on both of them, and a skull series on Stan. I'm going to do a craniotomy, by which time, with any luck, a neurosurgeon from San Francisco Memorial ought to be arriving to do the tricky part."
"We can get things started, all right, except we'll have to go with plasma instead of whole blood," Doc Elliott said. "Your glasses are back in the washroom, still. And there are spare sets of whites back there, if you want to get warmed up with a quick shower. It'll take us at least five minutes to get his head shaved and the x-rays ready, and it might help you feel more awake."
"True," Trapper said, although he found himself reluctant to leave Gonzo and Stanley to strangers. "Yell if you need me faster."
By the time Trapper had cleaned up and got back, Gonzo was soaking in a long shallow tub with a backboard supporting his head and shoulders above the water. He had a thermometer stuck in his mouth and a small towel covering what modesty required, but that was all except for light bandaging and Trapper had a clear view of the pattern of the bruises and scrapes that covered him from head to foot.
"Hell, he does look like a mountain fell on him," Trapper exclaimed.
"Looks to me like he fell off a mountain," Mollie said, from her position at Gonzo's head, monitoring his temperature as she gradually warmed the water. "It's the other one looks like the mountain fell on him. They've got him down the hall getting some x-rays of his skull for you to work from," she added, indicating the direction with a nod of her head.
Gonzo made a sound of protest around the thermometer and Trapper caught back his impatience and stopped by the tub to talk to the injured man. "What is it, Gonzo?" he asked, nodding to Mollie to take the thermometer out for a minute.
"Where are we?"
"A town called Willows. I'm going to operate on Stan, and you're going to cooperate and keep quiet until an ophthalmologist can get here and check your eyes." Trapper patted his shoulder where it wasn't quite as bruised. He'd have to finish scrubbing before he started on Stan anyway. "And if you don't cooperate I'll have Mollie here give you something to take your mind off things."
"I can't keep it on anything anyway," Gonzo said. "I feel awful, Trapper. My face is going to fall off and I wish it would hurry up and do it."
In this light, the blisters and broken blisters on Gonzo's face didn't look any better than they had on the mountain. Trapper reviewed the different painkillers in his head. "Mollie, have you got any percocet?"
"We certainly do. Half a pill to start with?"
"Yes, and if it hasn't helped in an hour, give him the rest of it unless the ophthalmologist has gotten here and says not to."
"Yes, Doctor," Mollie said and pulled out the key to the dispensary. While she went to get the pill, Trapper stayed with Gonzo to keep an eye on him.
"That'll help," Gonzo said. "Percocet will help." Then, as if the topic had reminded him, he said, "Trapper, I think Stanley took some acetaminophen, but I don't know for sure. He had a headache."
"Do you remember when, Gonzo?"
"Feels like days ago. At least three hours, though. It was before we tried to slide down the mountain."
"You tried to slide down the mountain? Whose bright idea was that?" Trapper could hardly believe his ears.
"It was sort of mutual," Gonzo said. "It was taking such a long time to walk down, and I knew you wouldn't be looking in the right place. We tried to make it out on our own. We really tried."
"I know you tried," Trapper said, wishing that Mollie would hurry up with the percocet. He was too tired to be soothing for very long. Right now he just wanted to take Gonzo by the shoulders and shake some sense into him. "You just about made it too. Only about three miles to go."
"We tried," Gonzo repeated. "And Stanley, he just kept going and going. He didn't tell me he was hurt, Trapper. He just kept on trying to get me to you. We really tried." Gonzo was beginning to shake with reaction, and Trapper looked around for a sheet or something to cover him when he heard the outer door of the clinic opening.
"Back here!" he called, hoping it was the neuro.
"John?" came Ernie's voice.
Trapper took the three long strides that brought him to the doorway and found Ernie standing in the entrance hall, still holding her purse in her hand. "Ernie? What are you doing here? I thought you were in Sacramento!"
"I had a feeling..." she said uncertainly, her dark eyes wide with worry. "I just thought I should come. And that deputy told me that they brought two patients in by helicopter a few minutes ago. Are they badly hurt?"
"Bad enough," Trapper started to say, but he glanced over his shoulder and saw that Gonzo was trying to lever himself out of the tub. "Gonzo, you idiot!" he roared, "Hold still!"
Ernie unbuttoned her coat hastily as she followed Trapper into the treatment room. Between them, they got Gonzo settled back into the water. Mollie had come too, at the sound of Trapper's shout, and she nodded approval as Ernie coaxed Gonzo into accepting the thermometer again.
"Friend of yours?" she asked Trapper.
"Mollie, this is Ernie Shoop. She's the best scrub nurse in San Francisco." Trapper said, unable to keep the relief of having Ernie around to help out of his voice. "Ernie this is Mollie."
"Mahoney." Mollie pulled a sheet from the cabinet and handed it to Ernie and they began to spread it over Gonzo like they had worked together for years. "Fort Dix, 53-54. And I was at the 5063rd while the pair of you were at the double Natural. I thought I remembered the name McIntyre from that football game, but I couldn't be sure."
"Old home week," Ernie said. "No, Gonzo, honey, don't try to use that hand, it's coming up blisters."
"The only thing we need now is for Hawkeye Pierce or Father Mulcahy to turn up," Trapper said. "His feet are blistering too."
"Blisters are good," Mollie said, "they mean the frostbite didn't go very deep."
"Trapper?" Terry leaned in the door. "We need you. He's convulsing."
Trapper wanted to kick himself for getting distracted by Gonzo and Ernie, but settled for swearing. "On my way. Ernie, get scrubbed! I'm going to need you in there."
Ernie watched Trapper vanish down the short hallway, and made herself stay outwardly calm as she stripped off coat and sweater and deposited them in a corner. "What happened to Stanley?"
"Head injury," Mollie said shortly. "The sinks are to your left, and there are clean whites in the ladies lounge, if you want them."
"Thank you," Ernie started to go and then paused. "Mollie, is there a priest in this town?"
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Date: 2009-05-10 01:56 pm (UTC)(no subject)
Date: 2009-05-11 03:35 am (UTC)(no subject)
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Date: 2009-05-11 03:36 am (UTC)(no subject)
Date: 2009-05-12 02:37 am (UTC)I loved Father Mulcahy! Growing up Catholic, I always wished our parish priest could have been more like him!