“Mark, I’m sorry, but I need you to help us.”
He nods, courage and dignity to the last.
I use a sneaky persuasion technique, stating facts in the future tense as though they’re already agreed.
“You’re going to climb into the cage with me and we’re going to get out of here.”
And he does, with a face screwed with effort and agony he hauls himself on all fours into the box.
They slam the gate on the two of us and with a scream of running cables and the creak and ping of chains taking the strain, we climb into the sky with a lurch.
I’m stood over Mark, watching the rock face pass in front of our faces, the lake below us receding away, workmen around it staring up, their hands over their eyes to shield the sunshine makes them look like they’re saluting.
I don’t mind heights. I rather like them in fact, but a coat of cool sweat runs over my back as we climb, I’d been unprepared for the fact that we’re lifted not only out of the quarry, but over the buildings and machinery at the surface.
Fuck me, we’re a long way up in a metal box on the end of a rope.
Mark is still coughing up blood but when I squeeze his wrist his pulse holds up.
“You doing ok?”
He nods, but it’s not very convincing.
“You’re doing great, pal. We’ll get you down to the ambulance and deal with your pain in two minutes, k?”
He nods again, peels the bloody mask from his face, leaving a smeared ring around his mouth and nose.
Don’t thank me yet, mate…
On the ground below us I can see my colleagues laying a vaccuum mattress out ready to lift Mark, a fire appliance pulls into the yard and a white-hat jumps out, casting about for something to do.
Too slow, boys…gotta get up faster than that.
The crane operator touches us onto the deck with the gentlest of touches and we’re all focussed on Mark immediately. Later I’m disappointed we didn’t get a chance to thank the guy who ran that crane, without him his colleague would have surely died in that pit.
With his last grains of strength and resolve, Mark hauls himself out of the cage and onto the mattress on the floor, we set to securing him into it with straps and blocks before recruiting a couple of firefighters to help us lift him onto the trolley.
Into the back of the ambulance and the crew’s eyes swing to me – laughable in truth – they were both paras long before I even joined the service.
“Your patient – what do you want?”
“Analgesia, please and a proper set of obs. I think we can cancel the trauma team too, since we’re out already.”
They get on with it while I reassess Mark from the head down – things are largely the same, but that right lung simply isn’t shifting air like I want it.
“How’s your breathing feeling, Mark?”
“Painful? Or hard work?”
He has to breathe in between the words of his answer.
I tap his chest with my fingers, listening for the toom-toom-toom that would suggest air trapped in his chest cavity or the fd-fd-fd that would tell us it’s full of blood.
When I was a techy, a colleague once taught me – “If you think it, do it…if you’re questioning in your mind, chances are it’s your gut telling you the right path.”
And then later a doctor in the ED backed that up – “If you suspect pneumo-thorax, just treat it – hell, once it’s in, you’ve caused one anyway.”
Because here’s the thing. Your lungs are two balloons inside their own respective, surrounding balloons. When blood or air gets trapped in the space between a lung and its surrounding tissue, the lungs becomes too compressed and the best treatment is to remove that trapped blood or air.
In the hospital they’d stick in a chest drain, a long plastic tube that’s inserted (with the assistance of a scalpel and your fingers (no, I’m not kidding)) into the patient’s side and stitched in. I’ve discussed emergency chest drains in the desert with senior medical staff (they can be improvised with a scalpel (but any sharp knife will do) and an ET tube) in extremis.
Clearly, that’s not an option here.
In ambulances, we have the option of an “emergency chest decompression” where we insert a needle through both the lung and its surrounding pleura, allowing any trapped air an easy route out into the atmosphere and hopefully reducing the effort required to breathe for the patient.
It’s ultra-low-tech, there is little clever about the procedure.
But I’ve never done it before and, when I turn to my two colleagues and say “I’m considering decompressing this, guys…thoughts?” they both say.
“If you think so.”
I stare at Mark’s chest for a second. That right side is simply not moving as much as his left.
If you think it, do it.
Slight stumbling block, though – how do you explain the procedure to a patient without saying “Dude, I’m going to stab you in the chest now, hold tight.”?
I plump for “Mark, I’m going to give you an injection between your ribs to help your breathing, ok?”
I get the feeling I could tell him I was going to remove his liver with a corkscrew and one fist and he’d just go with it.
One of my colleauges calls over my inner monologue.
“How much morphine d’you want, Kal?”
“What’s his BP?”
Mark’s fit and healthy and in horrible pain, I figure he can both handle and probably do with a big bang of opiates right about now.
“Give him the lot for now.”
“You got it.”
I open the drawer and pull a brown cannula from the boxes inside. They’re the biggest we carry, horrible wide ended fuckers, about the same size as the tip of a ball point pen.
“You ready, Mark?”
I wonder if I’m asking him or me.
A quick wipe off of over the site between the ribs high on his chest, place the point on the skin and remember why you’re doing this.
I’m going to stab my patient in the lungs.
And so I do.
There’s a little resistance, a pop and then a series of short ‘gives’ as the needle proceeds through layers of tissue. I whip the sharp out, leaving the plastic tube in place. I’m a little disappointed there’s no dramatic inner-tube hiss, but in a few minutes it’s clear that it’s done its job. Mark’s breathing is easier – still not great, but undoubtedly easier and when I listen with my steth over the stricken lung, I’m encouraged by the extra air I can hear whooshing about in there.
The back doors suddenly whip open and the ED’s trauma team stand silhouetted against the noon sun, their orange jumpsuits gleaming. The consultant hops up into the vehicle with us.
“I know you cancelled us, but we were just round the corner and figured we’d come say hi anyway.”
“No bother, we were calling you for extrication, really.”
“Meh – it’s always nice to keep us running, at the very least we can come in and cheer you on.”
I run her down the patient and she nods along.
“You get much out of that?” she asks, nodding at the needle in his ribs.
“No rush, but he’s improved since.”
She nods thoughtfully before calling for a chest drain set and poking a new hole in Mark’s side. Bright bubbly blood trickles out into the bottle.
Pally drove the trauma team down from the hospital and he’s leaning against The Van with a traffic cop.
“These boys want to know if you want an escort.”
A parade of emergency vehicles leaves the quarry, traffic car in front, then the ambulance, then Pally in The Van and me behind them in the RRU – passers by stop and stare at the blue-light-flashing convoy that snakes through town. It’s a lot of noise and disruption for one man, but I’m happy when I walk away from resus half an hour later that Mark’s prognosis is good.