Fiction - He Had a Pulse by Karl L. Kruger

He Had a Pulse

by Karl L. Kruger

"You've got about twenty minutes, sir!" said the corpsman as he rousted me from my ramshackle, dust-filled room. "They've just put in the Nine-Line." He was referring to the message that is sent to the marine helicopter battalion that supported our medevacs. The helo usually took around twenty minutes to arrive. That would be just enough time to package up the patient and get him to the landing zone.

As I ran out of the barracks while zipping up my flight suit, I could see the chemlights that were emitting their dull red glow on the pavement. The marines would place these on the road that led to Fallujah Surgical-a guide to those who drove the humvees to where they could find help for their wounded comrades. I turned my head to the west to see how much sunlight I would have left.

The setting sun in Fallujah, Iraq had the potential for beauty. The light tan colored dirt that made up the bulk of the scenery had the tendency to linger in the air for hours before settling on anything or anyone beneath it. The October sun would still burn hot in its bright red hues through the dirt-filled haze before finally submitting to the horizon. It could be beautiful.

The hospital was nothing more than sixteen rooms connected by a long passageway; three operating rooms, three trauma bays, two wards, an X-ray room, a lab, and administrative spaces. As I entered the hospital, I rushed into the first door on my right-Operating Room 1.

"Hey, Will," I called out. The tall, good-looking thirty something man at the head of the table looked up and acknowledged with a quick wave. "What do we got?" The sharp smell of alcohol pierced my nostrils and I felt it on my eyes. The smell quickly went away, however, and left me with the unmistakable odor of human blood that lingered long and heavy in my sinuses, allowing me no escape from the stench.

"Twenty-two year old marine male. Gunshot wound...entry...exit," he answered. He pointed with his index fingers to his right armpit and left waistline indicating the path of the bullet. "Right between his SAPI's." Will was careful to step over the small river of blood that meandered through the length of the OR and gathered several tributaries before settling in a reflective pool near my feet.

The body armor-or SAPI's-that the marines wore was pretty tough. I had seen rounds still stuck into the dense material that covered their chest and back. The snipers were getting too good at shooting between the plates, however. This was not an unusual case for us.

Will was the anesthesiologist. He was a family man who had been in the Navy for only five years, or so. During the two months that he had been in Fallujah up to this point, I had seen him intubate patients without jaws, with holes in their throats, or with broken vertebra in their necks. They should have died. He wouldn't let them. When they couldn't breathe themselves, he would insert a tube into their windpipe and breathe for them. He fought death with all the passion of a sophomore wrestler with his parents in the stands. I had seen him cry before, though. Some deaths just touch you more deeply than others.

"You're going to earn your pay with this one," said the surgeon as he turned to one side and slid past me on the way out of the room. He patted me on my shoulder and added, "Severed Vena Cava. We tried to patch him up, but he's got to get to Baghdad." He walked away to the doctor's lounge with tired, slumped shoulders and a head that was hanging especially low.

I looked over Will's shoulder at the operating room's vital signs monitor.

Blood Pressure: 124/82 mmHg
Pulse: 84 beats per minute

I ran to the equipment room and hefted the heavy metal frame to which my monitors were affixed. Vital signs monitor, ventilator, oxygen tank...everything was fully charged and ready for flight. The corpsmen were still wrapping the patient in blankets and zipping up the "hot pocket" that we used for patient transport. Hypothermia did horrible things to patients while in flight. The hot pocket was nothing more than a body bag with a hole cut for the face. It would ensure that hypothermia was one more thing that was crossed out on my long list of worries.

"What's his name, Will?" I asked as I returned to the OR and bolted the monitors to the stretcher, covering the patients already enclosed legs.

"Let's see," answered Will while perusing through the trauma report that came with the patient. "Um...Corporal Ma..."

"No, his first name."

"Jonathon."

"Jonathon," I yelled out loudly. "We're gonna fly you to Baghdad where they can take care of you, okay buddy? I'm gonna be your nurse on the flight." I didn't look at the patient, concentrating instead on the multitude of cords and tubes that had to be managed. But despite the fact that he was medicinally paralyzed, unconscious, and heavily sedated, I was confident that he could still hear me. Within five minutes of my walking through the door, he was ready to be rolled out. The corpsmen had continued to assist me with placing the blood pressure cuff on his arm, the oxygen saturation monitor on his finger, and ECG leads on his chest.

"Give me a good port right by his left ear. Okay, Will?"

"You got it." Will took an access port in Jonathon's intravenous lines through which I would be able to administer drugs in flight and taped it to the outside of the hot pocket directly next to Jonathon's left ear. I would be able to find it quickly in the dark, if need be.

"What do you have for vent settings, Will?"

"Eight hundred times eight," he answered quickly. I adjusted the settings on my portable ventilator to deliver eight hundred milliliters of oxygen at a rate of eight times per minute. Then Will and I made the transition from his ventilator to mine. The machine would do the breathing for him until we landed in Baghdad. I made a quick assessment of Jonathon's vitals signs to make sure that the equipment was connected properly.

Blood Pressure: 122/82 mmHg
Pulse: 86 beats per minute

"Hey Will," I asked while looking at my watch. "Can you watch over him?"

"I got him," he answered while continuing to organize the yards of intravenous lines that led to three open ports in Jonathon's blood stream. The last of the nine units of blood that was transfused into him was running in through one of them.

I walked down the hallway while I tied my desert camouflaged bandana to my head. It may have looked a bit over dramatic, but it made my Kevlar helmet a lot more comfortable during the flight. I strode into the lounge where Jonathon's buddies were waiting for him to leave the OR.

"Hey, fellas," I started. The three of them all looked up at me in unison. Their eyes, reddened from the matchless emotion that came only from having a brother fighting for his life under the knife, were a stark contrast to the dirt and soot on their faces. "I'm gonna be flying with Jonathon to Baghdad. What can you tell me about him? Is he married?"

"No, sir," one of them answered.

"Girlfriend?"

"Yes, sir. Back home in Pensacola."

"Pensacola, eh? You know, I went to school in Jacksonville." They nodded slowly, their sullen, blank faces moving up and down without conscious effort. "Do you know her name?"

"Jenny, sir."

"Thanks," I offered while inserting my hearing protection and leaving the room. I heard the litter moving down the hall and turned back toward the three dirty marines. "Hey guys," I called back while donning my body armor. "Jonathon's on his way out the door." They all jumped up with a quickness that defied the fatigue in their faces. The M-16's that were slung about their shoulders clanged onto the spare lumber bench as they rushed over to touch his head once more and wish him well.

"Hey, Lindsey," I called out to the nurse who jumped out of the way of the rapidly moving litter.

"Hey there, Dead Sexy!" That was the name she always called me when I wore my flight suit. The name slapped me in the face that night. It hung on my shoulders like a heavy pack-or like an invisible Sword of Damocles over my head.

"Lindsey, I'm taking two morphines, a vecc, and a versed." Lindsey was the nurse that had the ward that night and so was accountable for all of the medications. If a controlled medication came up missing, she had to answer for it.

"Got it! Go!" She pushed me toward the front door as I was stashing away the meds in my cargo pocket along with four syringes. Moments later, both Jonathon and I were in the back of the ambulance. I looked out upon a dozen or so well-wishers, hesitantly waving their hands and saying, "Have a good flight." The looks in their eyes betrayed the smiles on their faces, though. They all worried about this one. Then the back doors of the ambulance closed and left the two of us alone with only the light of the monitors piercing through the darkness. As with all of my patients, I gently placed my hand on his forehead, bowed my head, and said a quick prayer for him before looking up at the monitors again.

Blood Pressure: 119/79 mmHg
Pulse: 92 beats per minute

The helo that came for us was a CH-46E. It was a large helo with twin rotors that, if configured correctly, could hold up to fifteen litters with patients. There was ample room for Jonathon and me. Three corpsmen helped me move Jonathon inside the helo. After his litter was secured in place, I immediately set to work getting bags of fluids hung on the inner frame of the helo. With patients that are more stable, I am able to sit down and merely watch the monitors. If the patient needed me, I would be there instantly to render aid. Not with Jonathon, though. I didn't have time to sit down. The corpsman to my left secured a harness around my waist as I lifted my arms. I looked at the corpsman to my right and wrote on Jonathon's chart:

UNSTABLE!! WE NEED TO GET TO BAGHDAD NOW!!

The corpsman nodded quickly and spoke into his commlink to the pilot. The helo soon took off and I turned the page in Jonathon's chart to record his take-off vitals.

Blood Pressure: 117/75 mmHg
Pulse: 96 beats per minute

Jonathon's pressure was a bit hypotensive. But that was exactly where I wanted him. If his Vena Cava was being held together by a few strands of silk, then having a low blood pressure was a good thing. The last thing that I wanted was for a stitch to pop and have him bleed out. My surgeon at Fallujah Surgical had already called the vascular surgeon at Baghdad and their team was ready and stood-by to take him. He just had to get there-just a thirty minute flight away.

"We're on our way, Jonathon!" I yelled in his ear. The corpsmen looked at me like I was insane, but I knew that he could hear me. "Hang in there for thirty minutes. That's all I ask."

The flight felt bumpier than usual. It may have been because the pilot felt the urgency of this case and flew accordingly. It may also have been because that was the first flight in which I remained standing during the take-off. Or it may have been the feeling of my own pulse beating in my throat. I placed two gloved fingers over the exhaust port of the ventilator tubing and soon felt the warm air of Jonathon's expiration passing through them. Jonathon answered my declaration in the only language that he had available:

Blood Pressure: 96/65 mmHg
Pulse: 114 beats per minute

"Jonathon! Listen to me!" I yelled into his ear. "You need to stay calm! You can do this!" I motioned to the corpsman on my right to help me in unzipping the hot pocket. I placed my gloved hand onto his chest and felt it rising and falling with each inspiration and expiration of the ventilator. I turned on my flashlight and placed it into my mouth. Its green emission would then shine wherever I turned my head. It needed to be green so it wouldn't interfere with the gunner's night vision. I roughly removed the blankets around Jonathon's waist and shoved my gloved hand under his back, beneath his buttocks, in his groin. I removed my hand and placed it into the green light, turning it back and forth, looking for the tell-tale black-looking fluid that would confirm my theory that he was bleeding out. There was none. The corpsman looked at what I was doing and believed that my clean glove was a good sign. Indeed it would have been-if Jonathon's vitals looked better. Jonathon answered:

Blood Pressure: 89/58 mmHg
Pulse: 123 beats per minute

"Jonathon!" I yelled again after removing the flashlight from my mouth. "I hear what you're saying, but I know that you can hold on! Just a little longer!" I ran my fingers through his hair with my right hand while feeling his abdomen with my left. It was progressively growing more firm. The flashlight, again in my mouth, illuminated my hands as I showed the corpsmen my hands positioned first together, then slowly expanding outward. They immediately understood. Jonathon was bleeding internally. They instantly increased the rate of fluids running into the large cordis that was inserted into Jonathon's left femoral vein. If Jonathon was going to bleed out, I would have much preferred that it was from a wound on the outside. There was no hole in which to stick my finger or apply a pressure dressing to stop the blood. I looked at my watch-ten minutes to go. Jonathon's reply:

Blood Pressure: ???
Pulse: 143 beats per minute

"Dammit, Jonathon!" I screamed. "You pull out of this! Jenny is waiting for you! Don't you dare give up!" My voice was getting hoarse from the effort. The conversation between Jonathon and me was getting increasingly more one sided and I was praying for a positive response-some kind of answer from Jonathon to my plea. The third liter of Lactated Ringers was almost finished as the corpsman held up three fingers and mouthed, "Three minutes!" It had been the longest twenty-eight minutes of my life. As the helo touched down, I looked at the monitors to record Jonathon's vitals on his chart.

Blood Pressure: ???
Pulse: ???

"Alright Jonathon!" I shrieked with a cracked voice. "We made it buddy! We're in Baghdad now and these guys are gonna take great care of you!" I pressed the fingers of my left hand deep into the flesh of Jonathon's left thigh and moved it up toward his crotch. There, within the warm, flaccid sponge of muscle, I felt a flutter of a pulse.

We rushed through the doors of the emergency room and all I could think to do is call out, "A-positive! A-positive!" Once Jonathon was safely in their care, I gave a full report to the on-call physician who immediately began transporting him to their surgical team. The corpsmen and I ran back to the waiting helo and took off to deposit me back in Fallujah.

The flight seemed slow and the helo rocked back and forth sadly, as if it were a pall bearer delivering the casket of an old fallen friend. The corpsmen and I were exhausted-physically and emotionally drained. We returned to Fallujah without incident and I waved lazily as I watched the helo disappear into the black night, leaving behind only the loud thump, thump of the rotors and the angst in my gut.

The marine ambulance driver met me at the landing zone and drove me back to Fallujah Surgical.

"How was your flight, sir?" he asked.

I continued to stare at the black imitation leather landscape out of the window. "He had a pulse."

Upon arriving at the hospital once more, I was met by the corpsmen that worked on Jonathon before his surgery.

"Hey, sir!" one of them said excitedly with a smile. He exaggerated his movements and spat out, "Did you wrestle with the Reaper?" and held out his fist to me.

"Yeah, we rumbled," I answered as I returned his smile and touched my fist to his. "I kicked his ass." I walked away and immediately regretted what I had said. I wanted to take those words back-to stuff them back down my throat and instead pass something more palatable. I returned my monitors to the equipment room and worked to ready them for the next flight when Will popped his head through the door.

"How'd it go?"

"He had a pulse."

"Pressure?"

I shook my head and tightened my lips together into a scowl. "The cuff couldn't read it."

"Maybe it was just an equipment thing," Will said, blatantly trying to improve my spirits.

"Yeah, we were bouncing around quite a bit." I turned my back to the door and fidgeted with my gear, pretending to make minor adjustments. Will quietly turned away and walked down the long hallway that led out of the hospital and back to the barracks. I walked into the doctor's lounge and slumped into the black imitation leather sofa with the broken legs. I closed my eyes, leaned my head back, and fell asleep with tightly clenched teeth while listening to the second hand of the wall clock strike like a hammer.

Karl L. Kruger was born and raised in Minnesota, Canada's fair neighbour to the south. He is an active duty officer in the U. S. Navy Nurse Corps and stationed in San Diego, California. He is currently deployed as a Trauma/En Route Care Nurse in Fallujah, Iraq.