Breathless, Matt returned from his task.
"Arterial?" he asked.
"I think venous. You're bigger. How about some pressure."
Matt set a wad of gauze pads over the wound and leaned down on it with all the strength he could muster. Carabetta's thick layer of saffron-colored fat made it difficult to apply enough force. Blood continued seeping from beneath the gauze.
Meanwhile, Colin Morrissey's stridor was worsening.
"We need more hands," Matt said again as Nikki crawled over to check on the man.
"We have what we have," she said over her shoulder. "Matt, this guy's in trouble, too. I don't think he's going to make it too much longer without a tracheotomy."
"Well, I can't maintain enough pressure to stop Freddy's bleeding. My guess, he's torn his saphenous vein."
"So what can we do?"
"Get some narrow gauze bandage underneath the saphenous and tie it off."
"Have you done anything like that before?"
"If you count my cat cadaver in comparative anatomy, I have. You?"
"Well, between my year of surgery and my job cutting up the unfeeling, I know the anatomy pretty well."
"That settles it. I first-assist and you take a crack at it."
"What about Colin?"
"Right now, he's breathing. If we don't stop this bleeding, Freddy's toast."
"Okay, okay."
While Matt kept pressure on the wound, Nikki opened the first-aid kit and extracted a roll of one-inch gauze and a pair of forceps — the pointy-tipped kind used for removing splinters.
"Any snaps?" Matt asked, referring to self-locking hemostats.
I don t see any.
"A scalpel?"
"Nope."
"Novocain? Xylocaine?"
"You wish. Wait, there is a disposable scalpel."
"Ah, something to be grateful for. Fred, can you hear me?"
"Help… me."
Matt abandoned the notion of a medical explanation. He leaned close to the man's ear.
"Fred, this is going to hurt," he said emphatically. "Nik, how's the ankle?"
"Numb. As long as I don't make any quick movements, it's bearable. I don't think I'm going to be able to stand on it, though."
"Well, I can keep pressure on this and hold the lantern, but you'll have to serve as your own scrub nurse."
"I'm afraid," she said suddenly.
"I know," Matt replied. "I wouldn't trust you if you weren't. Just do your best and do it fast."
"I think I need to open up the area better."
"Just do it."
Nikki shrugged and made a deep, four-inch incision at right angles to the middle of the gash. Blood oozed from the skin margins of the cut and from the bright yellow fat beneath it.
"Oh, Jesus!" Carabetta howled as the slice was made. "Oh, fuck!"
At the man's scream, Nikki pulled back, but Matt shook his head.
"You can do it," he said firmly.
"Okay," she replied, "put pressure below the cut — a lot of pressure. Look, it is the saphenous vein — almost chopped through. It's a miracle he's still alive."
"You're the miracle. Tie it off — top and bottom — then we can move on to he who cannot inhale."
Behind them, they could hear Colin's labored breathing getting worse.
"If that guy and the girl are anywhere near as crazy as Tarzana was, we'll have our hands full when they wake up," Nikki said.
"This guy, then that guy, then the girl," Matt said.
"Right."
Nikki used her fingers and the blunt end of the forceps first to spread the tissue around and under the torn vessel. Then she forced the ends of two twelve-inch lengths of gauze through the tunnel she had created. With each movement, Fred cried out, but his response to the pain was getting feebler. A large percentage of his blood volume was in his clothes and on the dusty floor. Unless his bleeding was stopped, he might have a minute or two before drifting into unconsciousness for good — maybe a little more, maybe less.
"You're doing great," Matt encouraged. "Get a knot in that lower tie, and I'll switch the pressure to stop the backflow. For someone who hasn't touched a live patient in years, you're pretty darn good."
"Come on, baby," Nikki murmured to the vein as she gently worked the second gauze tie into place, "don't tear apart on me now."
"You've got it! You've got it!"
"I hope so, because here goes."
Nikki pulled the gauze tight, and a moment later Matt released the pressure he had maintained through most of the procedure.
There was some oozing from the incision and the gash, but the area around the lacerated vein was dry. The saphenous was the vein usually harvested for cardiac bypass grafts. Collateral veins would take over the job of returning blood to the heart. If Carabetta made it through this episode and out of the cave — both enormous ifs — he might be left with little more than some periodic ankle swelling.
"Nicely done," Matt said. "Getting around that vein without ripping it in two was really something."
At that moment, Colin Morrissey's breathing seemed to become even more labored.
"We might need to trach him," Nikki said. "Can you go check him again?"
"I would, but Fred here still needs pressure on this wound."
"I'll do that," a voice beside them said. An older woman, battered as the rest of them, had crawled over from some part of the cave they had yet to inspect. "You go check the boy," she said. "I'll do my best here. My name is Ellen. Ellen Kroft."
CHAPTER 32
Nikki knew her ankle was broken. She had felt the crack of bone and the explosion of pain when the woman Matt was calling Tarzana — 160 or 170 pounds — blindsided her. Now she simply bit at the inside of her lip and did her best to cope with the pain. They were in a fearsome predicament with a finite air supply and no obvious way out of the cave. The last thing the others needed was to worry about her.
The newcomer, Ellen Kroft, essentially uninjured, kept pressure on Fred Carabetta's wound while Matt used his ear as a stethoscope to examine the lungs of Colin Morrissey.
"I think he's moving enough air," he said, "at least for the moment. His coma seems to be getting a little lighter, too."
"Let's hope he's sane when he wakes up."
"With his larynx swollen nearly shut, I don't think he's going to pose much of a problem. How's your leg?"
"Fine," Nikki said perhaps a bit too quickly, adding, "It aches some."
"Think you can put weight on it?"
"I… I doubt it."
"I watched you working on this man from over there," Ellen said, gesturing toward the darkness to her right. "You're both doctors?"
"I'm Matt Rutledge, an internist from Belinda, and this is Nikki Solari from Boston. She's a pathologist."
"How many others are there in here besides us?"
"Do you know of any?"
"No. I was tied up here for a time, then injected with something that knocked me out. When I came to, I was covered with dust and pieces of rock. I assume Grimes untied me while I was unconscious, then blew up the cave. He's the police chief here."
"Oh, we know who he is. You assume right about him. In addition to that guy and the four of us, there are two people — a woman and a girl — with lumps on their faces like his. They don't seem to be badly hurt, but the woman is pretty wild. We've tied her up for now. The girl's still unconscious." Matt lowered his voice. "Then there are two security guards from the mine over there. One of them's dead, the other probably paralyzed."