"Give me your brush hook!" Hatch yelled to the rescuer. Grabbing the stubby, machetelike implement, he took a deep breath and dove below the surface of the surging water. Feeling his way in the blackness, he worked his way down the right leg, located the cut, and quickly sliced through the remaining hamstring muscle with the hook.
"Try again!" he coughed the moment his head broke the surface. The rope jerked and this time the unconscious man came bursting out from under the water, blood and muddy water running from the stumps of his legs. The rescuer went next, and then a moment later Hatch felt himself hoisted toward the surface. Within seconds he was out of the dark, damp hole and crouching next to the man in a swale of matted grass. Quickly, he felt for the vitals: the man was not breathing, but his heart was still beating, fast and faint.
Despite his improvised tourniquets, blood was oozing from the savaged stumps of the legs.
ABC, Hatch recited under his breath: airway, breathing, circulation. He opened the man's mouth, cleared out mud and vomit with a hook of his finger, then rolled him on his left side, squeezing him into a fetal position. To Hatch's great relief a thin stream of water came from the man's mouth, along with a sigh of air. Hatch immediately began a stabilizing pattern: a ten count of mouth-to-mouth, then a pause to tighten the tourniquet around the left leg; ten more breaths; a pause to tighten the other tourniquet; ten more breaths; then a pulse check.
"Get my bag!" he yelled at the stunned group. "I need a hypo!"
One of the men grabbed the bag and began rummaging through it.
"Dump it out on the ground, for Chrissakes!" The man obeyed and Hatch fished through the scatter, pulling out a syringe and a bottle. Sucking one cc of epinephrine into the hypo, he administered it sub cu in the victim's shoulder. Then he returned to mouth-to-mouth. At the five count, the man coughed, then drew a ragged breath.
Streeter came forward, a cellular phone in his hand. "We've called in a medevac helicopter," he said. "It'll meet us at Storm-haven wharf."
"The hell with that," Hatch snapped.
Streeter frowned. "But the medevac—"
"Flies from Portland. And no half-assed medevac pilot can lower a basket while hovering."
"But shouldn't we get him to the mainland—?"
Hatch rounded on him. "Can't you see this man won't survive a run to the mainland? Get the Coast Guard on the phone."
Streeter pressed a number in the phone s memory, then handed it over wordlessly.
Hatch asked to speak to a paramedic, then quickly began describing the accident. "We've got a double amputation, one above, one below the knee," he said. "Massive exsanguination, deep shock, pulse is thready at fifty-five, some water in the lungs, still unconscious. Get a chopper out here with your best pilot. There's no landing spot and we'll need to drop a basket. Hang a bag of saline, and bring some unmatched O negative if you have it. But get your ass out here, that's the most important thing. This'll be a scoop and run." He covered the phone and turned to Streeter. "Any chance of getting those legs up in the next hour?"
"I don't know," Streeter said evenly. "The water will have made the pit unstable. We might be able to send a diver down to reconnoiter."
Hatch shook his head and turned back to the phone. "You'll be flying the patient straight through to Eastern Maine Medical. Alert the trauma team, have an OR standing by. There's a possibility we may recover the limbs. We'll need a micro-vascular surgeon on tap, just in case."
He snapped the phone shut and handed it back to Streeter. "If you can recover those legs without risk of life, do it."
He turned his attention back to the injured man. The pulse was lousy but holding steady. More importantly, the man was beginning to regain consciousness, thrashing feebly and moaning. Hatch felt another wave of relief; if he'd stayed unconscious much longer, the prognosis would have been poor. He sorted through his kit and gave the man five milligrams of morphine, enough to give him some relief but not enough to lower his pulse any further. Then he turned to what remained of the legs. He winced inwardly at the raggedness of the wounds and the shattered ends of bone; the dull blade of the ax was nothing like the nice, neat saws of the operating room. He could see some bleeders, especially the femoral artery of the right leg. Sorting among the refuse of his medical kit, he grabbed a needle and some thread and began tying off the veins and arteries.
"Dr. Hatch?" Streeter asked.
"What?" Hatch replied, head inches from the stump, using tweezers to fish out a medium-sized vein that had already retracted.
"When you have a moment, Captain Neidelman would like to talk to you."
Hatch nodded, tied off the vein, checked the tourniquets, and rinsed the wounds. He picked up the radio. "Yes?"
"How is he?" Neidelman asked.
"He's got a fair chance of survival," Hatch said. "Provided there's no screwup with the helicopter."
"Thank God. And his legs?"
"Even if they recover them, I doubt there's much chance of reattachment. You better review some basic safety procedures with your team leader here. This accident was entirely avoidable."
"I understand," said Neidelman.
Hatch switched off the phone and looked toward the northeast and the nearest Coast Guard station. In three minutes, perhaps four, they should see the bird on the horizon. He turned to Streeter. "You'd better drop a marker flare. And get this area cleared, we don't want another accident on our hands. When the chopper comes in, we'll need four men to lift him onto the stretcher, no more."
"Right," said Streeter, his lips tightening.
Hatch saw that the man's face was unnaturally dark, blood throbbing angrily in a vein on his forehead. Tough luck, he thought. I'll repair that relationship later. Besides, he's not the guy who's going to live without legs for the rest of his life, He glanced again at the horizon. A black speck was approaching fast. In a few moments, the dull thud of heavy rotors filled the air as the helicopter shot across the island, banked sharply, then approached the small group gathered around the pit. The backwash from the blades whipped the sawgrass into a frenzy and kicked dirt into Hatch's eyes. The door of the cargo bay slid back and a rescue platform came bobbing down. The injured man was strapped aboard and sent up, and Hatch signaled for the platform to be sent down again for himself. Once he was safely on board, the waiting paramedic shut the door and gave the pilot a thumbs-up. Immediately, the chopper banked to the right and dug its nose into the air, heading for the southwest.
Hatch looked around. There was saline already hung, an oxygen bottle and mask, a rack of antibiotics, bandages, tourniquets, and antiseptics.
"We didn't have any O negative, Doctor," the paramedic said.
"Don't worry," Hatch replied, "you've done okay. But let's get an IV into him. We've got to expand this guy's blood volume." He noticed the paramedic looking at him strangely, then realized why: shirtless, covered in a crust of mud and dried blood, he didn't look much like a Maine country doctor.
There was a moan from the stretcher, and the thrashing began again.
An hour later, Hatch found himself alone in the silence of an empty operating room, breathing in the smell of Betadine and blood. Ken Field, the wounded man, was in the next bay, being cared for by Bangor's best surgeon. The legs could not be recovered, but the man would live. Hatch's work was over.
He fetched a deep breath, then let it out slowly, trying to drain the day's accumulated poisons out with it. He took another breath, then another. At last he sank heavily onto the operating table, leaned forward, and pressed his balled fists tightly against his temples. This didn't have to happen, a cold voice was whispering inside his head. The thought of how he'd sat there on the Plain Jane, idly eating lunch and playing with the seagulls, made him ill. He cursed himself for not being on the island when the accident happened, for letting them proceed before his office and equipment were in place. This was the second time he'd been unprepared, the second time he had underestimated the power of the island. Never again, he thought, raging: Never again.