It stunk of feces, paraffin, and rotting flesh. A man with a gaunt face was on his knees beside the mattress, praying. Past his shoulder, newspaper was taped over a window. An Arabic slogan had been scrawled in black paint across the wall.
If this is where the ISIS leader is planning attacks against the West, the West has nothing to worry about, Crocker said to himself.
Al-Kazaz stood beside him and pointed to the swaddled figure on the bed.
Ibn, he whispered.
Crocker thought it meant “son.” He nodded. Whoever it was, he was clearly important to al-Kazaz, who knelt beside the gaunt-faced man alongside the bed and started to pray with him. Their low voices merged into one.
The still figure lay on his back, his face and head covered with towels. A simple brown blanket had been draped over his torso and legs. Kneeling beside al-Kazaz near the head of the bed, Crocker started to remove the coverings.
As he did the smell grew thicker and more intense. Setting aside layer after layer, he reached dried blood and the boy’s badly damaged and swollen face. His neck had been injured, too. He appeared young, maybe early teens, with thin wisps of mustache and beard.
First thing Crocker noticed was that the kid’s breathing was very shallow, because whatever had hit him had entered his neck, damaging his larynx. As with other gunshot wounds to the face he’d seen, there had probably been a substantial loss of blood. This was confirmed by the kid’s rapid, thready pulse and low body temperature. Fortunately, his cervical column and major arteries hadn’t been compromised. Still, he was a mess.
Crocker took a step back to assess the damage. Compressible hemorrhage, tension pneumothorax, airway and ventilatory damage were the leading causes of preventable combat death. He would have to close the wound, clean out the infection, and remove the bullet or shrapnel that seemed to be resting near the boy’s temporal bone along his right jaw if the kid were to have any chance of surviving.
It would be a delicate procedure, and judging by the kid’s weakened condition, there was a high likelihood that his body wasn’t strong enough, or he had lost too much blood, to withstand it. Also, since he was working with a DA-Med bag, the tools he had were limited. Nor was he in an operating room.
Al-Kazaz stopped praying and rested a hand on Crocker’s shoulder. “Labass?” (What do you think?)
There was no point trying to explain the challenges. His Arabic wasn’t good enough for that. Besides, he had accepted the assignment and had no choice but to see it through the best he could.
“Bad-a.” (I start.)
“Inshallah.” (By the grace of God.)
“I need clean towels and hot water,” he said in English, pointing to the aluminum sink in the corner and the dirty towel hanging beside it.
“Tahir! Tahir!” (Clean! Clean!) Crocker growled, grabbing one of the towels. “And the water…Harr.” (Hot.)
Al-Kazaz nodded.
“You understand?”
He nodded again, then barked orders at the gaunt-faced man, who hurried off on bare feet and came back five minutes later holding a basin of near-boiling water.
Crocker washed his hands, donned nitrile gloves, and proceeded. Using the cervical collar he had in his kit, he tilted the boy’s head back and held it in place. Then he used a clamp to hold his mouth open and inserted his middle and index fingers to sweep the mouth and throat for bone fragments. He located several broken teeth, removed them, and in the process noted that the kid’s tongue was swollen, indicating that it had probably been injured, too.
Crocker faced more immediate challenges.
The boy’s pulse remained rapid and his body temperature low, indicating that he was on the verge of going into hypovolemic shock. That meant he had to get some fluids into him, fast.
Among the supplies al-Kazaz had purloined from the Sprinter were several hypertonic saline solution drips. Saline wasn’t as effective as blood or plasma, but it would have to do. He hooked up one of the drips to a vein in the boy’s left forearm and monitored his pulse, which slowly started to stabilize.
“Hasan” (good), Crocker said, handing the bag to the gaunt-faced man and showing him how to hold it.
“Alhamdulillah” (thanks to God), al-Kazaz said.
Given Crocker’s limited supplies, the best he could hope to achieve was to remove the bullet, disinfect everything, and close up the wounds to the face and neck, providing adequate drainage. After that, systematic doses of penicillin and the body’s natural defense and healing mechanisms would have to do the rest.
What he didn’t want to do was tax the kid’s system to the point that he succumbed right in front of him. In part because of the lack of ventilation, Crocker had already sweated through his black shirt and pants.
A tall man offered him a glass of tea and another glass with water. Crocker downed the water, nodded to the man, and replaced the glass on the tray. “Shukran” (thanks).
The man bowed and backed away.
Crocker replaced the nitrile gloves with a fresh pair and considered the next problem-closing up the wound to the kid’s larynx. He decided to sew it up before he administered morphine, because of the respiratory-depressing effects of the drug. Inserting a rubber shuttle in the kid’s mouth, he showed al-Kazaz how he wanted him to hold the patient down by the shoulders.
With the kid immobilized on the bed, Crocker carefully cut away the damaged tissue around the larynx. Luckily, the cartilaginous skeleton was stable and the only serious damage was a fracture to the thyroid cartilage. Given the poor light, it was impossible to determine whether the projectile had done any damage to the kid’s vocal cords or the larynx nerve.
There was no wire in the basic Tac Med surgical kit contained in a pocket of the Med Pack, so Crocker used a needle and strong nonabsorbable CRS suture to repair the cartilaginous fracture. He wasn’t a surgeon, but he closed the fractured cartilage as well as he could.
Then he stood back and watched with satisfaction as the kid’s breathing returned to near normal. So far, so good.
He mopped the sweat from his own brow, then administered a shot of morphine, waited for it to take effect, and used a smaller-gauge suture to close the larynx skin. That completed, he took another drink of water and started working on the boy’s face, a chore that was much more painstaking. The projectile had traveled along the hard palate and done damage to the soft tissue along the jaw.
Crocker had to perform a surgical debridement to remove as much dead, damaged, and infected tissue as he could. As he did, he was careful not to dislodge any blood clots that might result in significant new blood loss. It was difficult, tense work. The closest experience to this he’d had was working on an injured goat when he attended Special Forces medical lab at Fort Bragg, North Carolina.
The light wasn’t ideal and the conditions sucked, but Crocker worked his way along the palate to the mandible bone, where he located the bullet, a.22-caliber probably fired from a pistol and more or less intact. He disinfected everything and started to sew up the wound, al-Kazaz beside him, praying in Arabic, whispering encouragement, and even using a towel to mop the sweat from Crocker’s brow.
An hour after he started, he applied the last bandages to the boy’s face and neck, and rechecked his pulse and breathing. Both had improved. When he tried to straighten up, his neck barked. He cracked it, left, then right, and flexed his shoulders.
Miraculously, the kid appeared to be okay. Some luster had returned to his eyes. But the chances of him surviving in his current location were minimal at best.