Do No Harm

A bent piece of rebar protruded nearly two feet from the man's chest on the left side. Strapped to a backboard, the man's head was secured with a C-collar. His visible flesh was pale blue.

David held up his hands, the chain tight between his wrists. "Uncuff me. Now."

"They were blasting out a section of the building across the street," the other paramedic said. "Someone forgot he was in there and let fly."

"Release him immediately. This is no time to fuck around," Diane yelled over her shoulder as she ran toward the gurney, meeting it halfway, only to turn and run with it toward Trauma One. David jogged after her into the resuscitation suite, handcuffs jingling, and the two cops reluctantly followed. Diane moved alongside the body. "No spontaneous respirations, no pulse, and he's cyanotic."

David reached his cuffed hands out and felt the man's stomach, pushing gently. It gave with a soft crunching sound, as though he were pressing on a bag of Rice Krispies. Air had escaped from the man's lungs and moved beneath his skin. "Crepitance," he said.

Several hands grabbed the backboard when they reached the wider hospital gurney.

"On my count," Diane yelled. "Three, two, one." They slid the man safely over onto the new gurney, and the paramedics backed out to make more space.

By the time David glanced up at the man's face, Diane already had him intubated and hooked up to one hundred percent oxygen. She helped the nurse scissor off the man's clothes. "We're gonna have to open him up. Someone get me a thoracotomy tray!"

People scurried about the body. The superficial veins had collapsed; they had a rapid infuser going on the right arm. Jenkins watched them working on the body, his face angry and distant.

"Someone find a line in the femoral," David said. A junior nurse responded, digging in the hip with a needle. She got a flash of blood in the syringe. "Good," he said. "Now feed a guide wire through the needle. Right, right." The nurse slid a blue number-eight French catheter over the guide wire into the vein. "Don't let go of the guide wire."

Six units arrived from the blood bank. Diane pulled on a gown and gloves. "Switch the saline for O-neg."

David turned and shoved his hands at Jenkins. "Enough already. Take these things off me. Now." Lab techs and nurses darted around them to get to the gurney.

The thoracotomy tray arrived, swathed in blue towels. Pulling the towels aside to reveal a forceps, rib spreader, rib cutter, and an array of gleaming scalpels, Diane paused and turned to the officers. David's hands were inches from Jenkins's chest, but Jenkins didn't so much as look down at them; he kept his cold, hard gaze locked on David's face.

Diane crossed her arms. "I can't do this without him," she said. "Get ready for a lawsuit."

The activity around the body seemed to stop. For an instant, all eyes were on David and Jenkins. Bronner broke the silence, stepping forward to unlock the cuffs. Jenkins tried to restrain him, but Bronner shoved him away fiercely. "You'd better settle down there, pup," he growled.

Jenkins's face was alive with emotion-rage, frustration, humiliation. He glared at Bronner, then turned and banged out through the doors. Bronner quickly unlocked David's cuffs and walked out also, his boots creaking.

David had his stethoscope off his shoulders and into place immediately. He set the bell over the man's left lung, then his right. Miraculously, there were no decreased breathing sounds-neither lung had collapsed. "What are our three major concerns with a penetration to the mediastinum?" he asked.

"Tension pneumothorax, pericardial tamponade, lacerated aorta." Using a squirt bottle, Diane doused the man's left side in Betadine, the antiseptic falling across the ribs like an orange drape. Her gloved fingers felt their way into position on the man's side, finding his fifth intercostal space. Using a scalpel, she sliced downward from the man's sternum, carving an arc that ran the length of his ribs. Blood gushed over her hands, coating her white gloves crimson as she continued to cut down to the muscle.

Jill's patterned scrub top, a cheery Amazon green number decorated with frogs, seemed oddly discordant. She leaned over with the spray bottle to clear the wound for Diane. A spurt of blood caught a poison arrow frog across the face.

A flash of aqua green scrubs to David's left. "Surgeon's stuck in a mess of an appendectomy," he heard the clerk say. "The junior surge resident is on his way down."

Diane finished scissoring through the intercostal muscles, then wedged a rib spreader into the bloody gap. The pronged tool was silver and ratcheted, and she flipped out the handle and cranked it like a winch. The man's ribs stretched, then snapped, sending a splattering of blood across her surgical gown and Jill's face.

"How's the left lung?" David asked.

Diane peered into the hole in the man's body. "Looks fine."

"Now feel your way in there. Check to make sure the aorta isn't lacerated."