"What's the story?" Matt asked, already into his examination.
The woman, thin, white, in her thirties, was unconscious and breathing ineffectually. Her dark hair was matted to her forehead. Her lips were purple. The officer was right to keep breathing for her, and Matt told him to continue. Her pupils were midposition, but did not react to a flash from his penlight — either the result of a technically limited exam, or a very grim sign. She wore jeans, sneakers, and a black T-shirt with a wavy musical scale on the front, and had a raw bruise and abrasion just above her left eye. There was also a long laceration, more of a gouge, along the hairline, just above her right temple.
The EMTs arrived and Matt instructed them to begin breathing her with a bag as soon as they could.
"These boys were fishin' here," the standing officer said, "when suddenly this lady came plungin' off the ledge from up above them. One of them, Percy Newley's boy Harris, swears he heard something like a gunshot just before she flew past him and into the water."
"Did they get her up on the first try?" Matt asked, listening to her chest with his stethoscope as he was speaking.
"Excuse me?"
"Percy's boy and his friend, did they haul her up on the first dive?"
The officer's sheepish expression said that he had just grasped the significance of the question he clearly hadn't asked.
"Harris, how many tries did it take for you to pull this woman off the bottom?"
"Two. Michael tried first, then we did it together. We hauled her up by the hair."
"Thank you," Matt said, already preparing for an intubation.
He estimated the submersion time at two minutes and hoped he wasn't giving the boys too much credit. Meanwhile, Gary was setting the triangular cup of the breathing bag in place over the woman's mouth and nose while Kirsten was inserting an IV. After the breathing tube was in place, the cup would be set aside and the bag connected directly to the tube.
"Normal saline?" Kirsten asked.
"Exactly," Matt said. "You're all doing great. Thanks to these heroes and the good mouth-to-mouth technique they did, this lady's going to make it. But she still needs our help. I'm going to put a breathing tube in so we can get some concentrated oxygen into her lungs. Let's put her on the stretcher, Gary, and lift her up. I'd rather work with a little elevation than stretched out on my belly with her flat on the ground."
In the hospital, the anesthesiologists were the royalty of intubation, having honed their skills hundreds of times in the operating room. During one of his residency electives, Matt had chosen anesthesia and "tubed" dozens of cases under their guidance. Over the years that followed, he had multiple reasons to be grateful for every one of those opportunities. The main rule he had learned was that if the caregiver performing the procedure wasn't absolutely comfortable, physically and mentally, the chances of a failed intubation were greatly increased. The most common disasters were intubating the esophagus instead of the trachea, thereby filling the stomach with air; tearing the tissues of the throat and causing bleeding, which made subsequent attempts that much more difficult; damaging the vocal cords by forcing the tube down without adequate visualization; and finally, inserting the tube too deeply and occluding one of the two main bronchial tubes.
Matt now did what had been taught to him and what subsequently he had taught to many students and paramedics — he took an extra few seconds to position his new patient and compose himself before proceeding. With the woman on her back on the stretcher, he tilted her head slightly downward, straightening her neck. Gary Lydon knelt beside him to hold her head steady in that position. Physically settled on one knee, and as confident as he could be given the circumstances, Matt slid a curved, lighted laryngoscope blade along the woman's tongue and pulled the blade straight up toward her chin. All he could see was lake water, welling up from her lungs. Trouble — maybe big trouble. In the ER there would have been suction to clear her airway. Not here. A blind thrust with the semi-rigid tube was possible, but treacherous. Doing so had to be a last resort.
Easy, now, easy.
The woman's color remained poor. Brain cells were being compromised every second. Soon, they would begin to die.
Come on, Rutledge. Stay cool and don't panic. You can do this… You… can… do… this.
Matt took a deep, calming breath, grasped the handle of the scope tighter, and pulled the blade upward another eighth of an inch. The move nudged the victim's tongue out of the way even more and lifted her epiglottis — the flap that protected the lungs from aspirating food or drink. The slight adjustment caused the pool of water to recede just enough to expose the two silvery half-moons of her vocal cords.
Yes!
Matt smoothly slid the tube between the cords.
"We're in," he said, trying for some matter-of-factness but missing badly.
There was audible relief from both EMTs and the police.
"Nice going," one of them said.
Matt used a large syringe to blow up the balloon fixed around the end of the tube, sealing it in place and preventing air from escaping around it. Kirsten Langham quickly attached the black latex bag to the tube and connected it to oxygen. In seconds, the mottled duskiness of the woman's complexion began to improve. She was almost certainly going to make it. How much of her brain would make it, too, remained to be seen.
Matt handled the breathing bag as the troupe awkwardly retraced their steps, pushing the stretcher along the path back to the ambulance. While the woman was being lifted into the back, Matt took the two teens aside.
"You guys did one heck of a job. In all likelihood, you saved this woman's life."
"Lucky we was there," one of them said.
"I'll say. You're Harris?"
"I'm Michael. He's Harris."
"Got it. Two things. First, tell me again. You were fishing and she fell into the water right in front of you."
"Yes."
"And sank?"
"She might of stayed on the top for a second or two," Michael said, "but otherwise that's the way it happened. I got down ta her, but I couldn't get a grip afore I ran out of breath. Then we did it together an' brought her up by the hair."
Two minutes, minimum, Matt estimated again. Four maximum, depending on when they started breathing for her and how well they did it.
"And you did mouth-to-mouth?"
"Harris did. I screamed for help."
"Harris, did you hold her nose closed?"
"I did, sir. And I tipped her head back, too."
"Where did you learn how to do mouth-to-mouth?"
"They taught us in Health, sir. We used a dummy to practice."
"Well, we sure are glad you were paying attention in that class," Matt said. "Now, about those gunshots."
"They weren't shots," Michael said. "They were too soft. They were branches cracking, probably. Maybe a car backfirin' out ta the road."
"Were, too, gunshots," Harris insisted. "Michael, I'm telling you, pistols don't sound the same as backfirin'. There were two shots, maybe three."
"Ready," Gary called out from the rear of the ambulance. "Kirsten's going to bag her with you. I'll drive."
"You guys did great," Matt said again. "Lots of people, doctors included, sometimes think they saved someone's life, when the truth is, they might not have. Take it from me, you two really did it."
He jumped into the ambulance and waved to the boys as Gary closed the door. Then he took a seat on the bench opposite from the EMT and, for the first time, took a careful look at the woman who had come so close to dying beneath Niles Ledge.
She was still unconscious. The swelling above her left eye was pronounced and beginning to discolor. But to Matt's touch, there was no evidence for a depressed skull fracture beneath the bruise. The linear gouge above her right temple certainly could have been from a gunshot. There were also scratches on her cheeks and chin, similar to those Matt had sustained just half a day ago. It wasn't a stretch to imagine her terrified, charging through the dense woods with someone shooting at her.