Practicing Medicine: Chapter Seven
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2075 ROBCO(R)
LOADER V1. 1
EXEC VERSION 41.10
32K RAM SYSTEM
14302 BYTES FREE
HOLLOWTAPE LOADED: "THE-WORST-THING-EVER"
INITIALISINGâŚ.
SUCCESS!
STATUS
Battery Level: 42%
Wireless Signal: (?)
Operating Temperature: 92F
HEALTH
BP: 170/130
SPO2: 100%
Temp: 99.5F RR: 28
HR: 185
TIME
Day: 24 SEP. 2279
Time: 16:10
CLIMATE
Current Temperature: 76 F
Atmospheric Pressure: 750 mm
Background Radiation: 1.321 RAD
WARNING: Dangerous wasteland creature in range!
Yeah, no shit, Sherlock! Why don't you tell me my chance of survival as a percentage too!
I'd been tipping back in my chair when the wall exploded, so now I was sitting on my ass in a state of total mental shock, slowly butt-scooting my way backwards. The NCR soldier who I'd been sitting beside popped up, knocking his stool over in the process.
"Ayuda!" he shouted. He was shooting his rifle, but it wasn't making any noise. He screamed something about shit ammo and started yanking on the charging bolt.
Amongst the wreckage, Tandi tried to stand back up. How she survived an impact like that was beyond me, but I wasn't about to point that out. She turned her head to look at Gram.
"Gram, get the-" she started. Before she could finish, the big white reptile threw itself directly at her, knocking over the entire table and crushing Cook and Jas as Tandi rolled out of the way, trailing pink insulation foam behind her. Gram sprinted past me and started clambering up the stairs to the second floor, leaving poor Chomps sitting in stunned silence.
The deathclaw reared around to face Tandi, who had drawn a six-gun from her hip.
"Fuck off, cyka!" shouted Tandi, and emptied it directly into his face, shattering his jaw and blasting off his nose.
The gunshots, the shrieks of the injured beast, the dust that was gathering in the air... it was all so overwhelming! I'd never been so close to anything so dangerous, and my whole body was screaming at me to run for my life, but I just couldn't send the signals to my muscles. I couldn't move, couldn't shout, couldn't breath...
The beast lunged at Tandi again, and she caught him by his arm and snapped it against her leg, then grabbed onto his broken jaw and forced it into the back of his throat. He immediately swung his other hand at her, impaling her through her forearm and thigh. He probably would have disemboweled her in the next motion, but was interrupted by a sudden hail of gunfire.
My eardrums pounded as the soldier fired shot after shot from his now-functional rifle, striking the deathclaw all across it's back and arms, poking lots of inconsequential little holes in the thing. By the end of the magazine, I couldn't hear anything but a loud ringing, so I didn't even get to hear the soldier's scream as the Deathclaw reeled around and folded him against the wall, taking all the life out of his body and sending him tumbling to the ground in a way that made it clear that he'd not be getting back up. The beast stalked over to him...
And in Came chomps like a goddamn pro wrestler, swinging a stool over his head like a sledgehammer. The beast didn't even bother to turn around as it raked Chomps across his entire upper body with its good claw. I could see the blood running down his face as Chomps stumbled backwards into the fallen table and fell onto his back, trying to figure out which of his massive wounds to clutch as he writhed about with his legs in the air.
Then, the thing turned it's whole upper body to face me. Our eyes connected.
Have you ever been so scared that you choked on your own spit? Because, as the beast stared at me with its one remaining eye, I distinctly remember gagging so hard that I started choking on my own spit.
It started walking towards me- a big, ghost-white beast, stained all over with its own blood, all its parts hanging loose- and I involuntarily let out a mix between a wet cough and a squeal. More logic-defying noises escaped my mouth as I scrambled for the stairs, trying and failing to stand up in the process. But it wasn't me who the deathclaw was keying in on now- It was Gram, standing behind me on the stairwell with a laser gun.
"Cover your ears, Boy!" He shouted over the ringing, and I followed his advice. I pressed my hands against my ears and shut my eyes.
Next thing I felt was heat on my skin- wasn't no light, but there was heat alright! Heat and a noise like a can of sarsaparilla taking a fifty cal right in the center! Drops of hot liquid splashed across my skin.
Next thing that hit were the smells. Burning fat, a delicious dinner and clouds of gunpowder, pools of coagulating blood and bodily fluids; The sounds- screaming, shouting, sobbing, and there was that damn ringing in my ears! My head hurt too, and my skin was all hot and prickly. I swear I could feel my chest caving in, I was breathing so hardâŚ
"Isaac! Isaac, get moving, people are dying! ISAAC!"
Someone hit me in the back of the head, so I turned around and bit them as hard as I could. I could taste blood so vividly, as they pulled their hand back, putting them off balance. I grabbed the wrinkled, bleeding hand and yanked it forward, pulling its owner down the stairs and onto the floor. Someone walked up to me and tried to say something to me so I started screaming as loud and hard as I could, until they backed away.
Then it struck me- the deathclaw was dead. It's head had been hollowed out, pieces scattered all over the room. No one was even paying attention to me as I beat the ever living shit out of Gram, who had probably just saved my life. They all had their own problems.
I was hyperventilating, I realized, and it was making my vision go dark around the edges. I tried to regulate my breathing as I scanned the room, wondering what the hell I was supposed to do first. But it was hard- so, so hard with all the ringing, and the prickly hot feeling on my skin and the static in my head!
Where to start? I started compiling a mental list of all the problems that I had to fix, or "doing triage," as my father would have said. In my head, it looked something like this:
I'd hurt Gram after he hit me in the back of the head, but he was already getting back up.
Cook was lying underneath a table, wheezing and trying to get it off her chest- she was probably having trouble breathing, but Jas was helping her at the moment, and she was making noise so it couldn't be that bad.
The NCR soldier was in a bad way, probably got his back broke. I couldn't tell if the blood all over his back was his or the deathclaws, which warranted a closer look, but there was still air going through his body so I'd put him on the back burner for now.
That left Tandi and Chomps, the two with the nastiest wounds. If the claw had hit his throat, Chomps would be dead very soon, if he wasn't dead already. I decided to deal with him first. Ignoring Gram's muttered insults, I stalked across the room and fell down on one knee beside the old man. There was a frightening amount of blood pooling around his head, and my heart rate picked up when I dragged him on his side and gave him a quick once over.
Three parallel gashes- One deep wound across his stomach, one relatively shallow one across his upper chest and collarbone, and one across his forehead that was bleeding profusely but which had stopped at the skull. I saw no signs of life-threatening bleeding, though his intestines were poking out through the stomach wound. I motioned towards Gram.
"Gemme a wet towel." In spite of what I'd done to him, he didn't argue with me, disappearing into the kitchen without a word. I looked back at Chomps. I'd been an idiot and left my medical kit in the cart, so my emergency treatment was going to have to be improvised. I didn't like that, but I wasn't about to leave any of the people in the room to go get the kit. I'd have to make do for the moment.
First step would be to remove the clothes around the evisceration. How was I going to do that? I couldn't just pull off his overalls. I'd have to cut through them. What options did I have for cutting? My utility knife was in my medical pouch. But, when they'd set the table, there had been steak knivesâŚ
Find a steak knife, I told myself, and started scanning the floor. I could faintly hear the back door open as Gram headed outside to pump water on a towel, which I'd use to dress the evisceration. Steak knife, steak knifeâŚ
Amidst the debris, I found a fork and steak knife lying together, so I took both just in case I ended up needing the fork for something. After putting a quick gash in the pale, unfeeling strip of skin on my forearm to get a feel for the knife's cutting edge, I leaned back over Chomps and slid the knife against his blood-soaked denim. It took a bit of force, but once I had cut through the tough edge, it became a lot easier to run my knife through the worn material. I cut out a rough square of cloth all around his chest, and carefully peeled it off his sticky, bloody skin. Poor man was conscious, I noticed, but he wasn't saying nothing. Just watching.
"Don't try and move. Your guts weren't ripped, but they might be if you start squirming. No matter how much it hurts, you gotta stand still," I said, tearing off the loose strip of overalls and bunching it up into a makeshift rag for later. It wasn't sanitary, but it'd have to do.Â
Gram came back in shortly after, carrying several ragged towels soaked in water. I gave him a nod of acknowledgment and held my arms out for Gram to drop the towels into. Not stopping to check his trajectory, Gram tossed the load in my arms, and continued walking until he reached Tandi. He knelt down beside her.
"Toss me the pip boy!" He shouted. I was confused for a second, then remembered the medical profiles I'd created. Quick as I could, I logged off the pip-boy, and tossed it underhanded to Gram. I didn't wait to see if he caught it.
"Remember: Don't move," I said, laying the wet towel across Chomps's jutting intestines. He winced as the towel touched the wound, but he didn't squirm. Don't think there was much that could've made Chomps squirm.Â
"You're doing great!" I told him, securing the towel around the edges. I checked the rest of his wounds. His airway was swell, and the leaks in his forehead and chest weren't gonna kill him. Which means he was as stable as he was going to get, without a stimpack. "I'll come back to you soon. I need to check the soldierâŚ"
"No, Fuck that guy! Tandi's been thrown through a goddamn wall!" shouted Gram, but it sounded quiet next to the ringing in my ears. I rubbed my temples. Jas had gotten the table off of Cook, and was doing what I guessed to be a misguided attempt at CPR on her, for some reason. Probably because she was complaining about breathing? First things first, I needed to put a stop to thatÂ
"Jas, does Cook have a pulse?" I asked, barely able to hear my own voice. Jas nodded.Â
"Yeah, but she says that she can't breathe, so I'm doing-"
"Stop doing that! CPR is for dead people!" Jas didn't complain no more, instead standing up and going to examine the NCR soldier. If Gram was telling the truth, I didn't have time to worry about how Jas was going to screw him up, so I ignored her and hurried over to Tandi. Surprisingly, she was still conscious. She gave me a weak middle finger as I sat down.
"Helmet off- stop moving it if she complains about her neck," I said. Gram complied immediately. Tandi didn't have anything to say as the helmet came off, revealing her sweaty, mutilated face. There were no new injuries there, though it was still as shocking as ever.
"Where's it hurt, Tandi? Is your back okay?" I asked. She looked up at me like I was stupid.
"No, I'm completely paralyzed. Dumb whore..." I rolled my eyes.
"Surely, I am as dumb as they come! But, the pip-boy says you've got internal bleeding, and it's still figuring out where. Where're you hurtin' at?" Tandi laughed a little.
"Internal? Then it's in the right place." I shook my head and inspected her pip-boy image. There were so many warnings that it was impossible to try to interpret them all. I suddenly really wished I could read, even just a little more.
"Tandi, this is life or death! Where did it-" Suddenly, the image on the screen changed. The pip boy beeped, and a blinking warning sign appeared dead in the center of her character's chest. The BP stat, I noticed, was down from the last measurement.
"Y'have no idea how often people say that. Anyways, he hit me-" she started. I began to pull off her coat. I elbowed Gram in the shoulder, and pointed at the stricken woman.
"Strip her down. Tandi, please help as much as you can!" She gave me a suspicious look.
"And what if I don't want you exploring all up in my nooks-and-crannies?"
"Tandi, something is very fucking wrong! Help me take the armor off!" She clutched her wounded leg and growled at me.
"...Aggghhh, Fine! But I'll kill you afterwards."
Gram worked on taking off the armor supporting her back, while I removed her dented chest-plate. Once I'd gotten that free, I took off her shirt, Gram removed her baggy jeans, and we got to work freeing her armor harnesses. When one of the clips got stuck, I picked up my steaknife from the ground and sliced through the whole strap. It was surprisingly easy to cut through, I guess for emergency situations like this. Once I got that off, Tandi was left in her sportswear. I removed her chest wrapping on account of some bruising in that area. Her knickers weren't covering nothing up, so I left those alone.
The full picture was distressing, real distressing. Amongst Tandi's considerable collection of old scars, there were several huge, rapidly swelling patches of yellow, purplish skin all over her body, the biggest of which was right over her heart. I pulled my stethoscope off my neck and plugged it into my ears- had em backwards, got them in the right way and then checked around for her heartbeat, and got back a faint, muffled noise. Combined with her wormlike neck veins and the fact that I couldn't even get a pulse on her femoral at this point, that made Beck's Triad. Father always told me I'd never be able to diagnose tamponade like that on a real clinical exam, but here were all three symptoms, sticking out like a compound fracture.
"Oh no," I breathed. I tried to compose myself, but panic was already overtaking my mind. Before I even spoke, I could hear my voice cracking. "Jas! Get- uh, break into the wagon out back, and grab the orange bag and the other one, the other emergency-looking one. Bring em back fast!" Jas looked at her fallen companion, who she had sat up against the wall, then at the door, then at me. Slowly, she stood up, walked away from the unconscious soldier, and exited out the back door, picking up speed as she went.
Preparing myself for what came next, I placed the cold knife against Tandi's bare, swollen chest, and started counting ribs. One, two, three, four, five... The tip came to a rest beneath her right breast.
"What are you doing?" She asked. I pressed the knife a bit harder, seeing how hard I'd need to press to cut her sweaty skin. Not very. A drop of blood seeped out from under the knife.
"There's blood gathering in the lining around your heart, Tandi. I gotta open your chest up to fix you." Tandi's eyes opened wide.
 "What- NO!"
I felt her grab onto my wrist, but she was late; I'd already abandoned any doubts that might've been left in my head and punched my knife through her chest, right by her sternum. A primal scream filled my ears as I dragged the blade through the layers of skin and fat, all the way to her shoulder blade. I shoved my hand into her intercostal space.
"Spread her ribs and hold 'em," I grunted. Gram made a face.
"Oh, Christ..." Tandi continued to shriek in pain and squeeze my wrist as Gram spread the wound like a clam shell. I tried to wrap my fingers around her pulsating heart, but couldn't quite get at it. I pushed her lung aside.
"Stop it! Da idi ty, fuck you! Otvyazhis'!" Tandi cried, but I didn't stop. I couldn't. It had to be done, or her pericardium would fill up with blood and squeeze her heart til it stopped beating. I kept digging around as the blood coursed over my hands and arms; I was slick up to the elbows with it.Â
"Anyone got a flashlight?" Gram shook his head. I swore and spit on the ground. That was gonna make this next part a lot harder.
Tandi kept on hollering and thrashing as I tried in vain to get a grip on the pericardial sac without also grabbing the throbbing heart inside. My fingers were too slippery to pinch it, so I pulled the dinner fork out of my pocket and hoisted the sac up that way. It slipped off the fork a couple times before I could get it in a good position, but once I had it pulled taught, I didn't waste any time opening it up between the phrenic nerves- Tandi was dying quick. She looked like she'd been drained by a vampire, and her shrieks of pain had already quieted down to confused sobbing.
"Ah hell Isaac, I don't know how long I can hold this! Could you hurry up?" grunted Gram. I could see the muscles straining beneath his skin, bulging in his face and neck. His arms were quaking.
"Yeah, sure! Now help me turn her overâŚ" I put my hands on Tandi's back and worked with Gram to move her on her side, so the blood could leak out of her cavity. The floor was covered in the stuff by now, and it had streaked and smeared where she'd been struggling. I tried to ignore it as I got down on my hands and knees and stared into her wound. "Great. I'm gonna peek down here again, try and figure out where it's-"
Before I'd even finished my sentence, a gout of bright red blood sprayed out the cut I'd made in the pericardium, all over my chest and face. It dripped down my glasses like some sort of cheesy horror-movie effect.
"Doc! Hey, Doc, I've got the stuff!" I looked over my shoulder to see Jas stumbling in through the back door, carrying both the stimpack bag and my medical bag in her arms. I motioned for her to set them down next to me. "Um, there's a few stimpacks here, which should I-"
"Fuck it! It don't matter!" Something like a laugh rattled through my chest as I snatched the syringe out of Jas's hand. Tandi's heart coughed out another gob of blood, but I'd already moved to the side, and soon my hand was in the clamshell wound again. My fingers clawed for the source of the blood.Â
"I'm hurting bad!" grunted Gram. I started probing with my stimpack.
"Well don't let go, use a- I don't know, use anything!" I was hardly paying much attention to Gram at this point. I could feel the blood coursing over my fingers as they brushed over some artery, can't say which one, and I figured pretty quickly where the rupture was. I jabbed the stimpack in.Â
And Missed.
I tried again, and missed. Which gave me that sinking feeling that you get in your stomach when you realize that you've not got much time, and your body just isn't the right machine for the task. Usually that came with a certain embarrassment, that telltale hotness of the skin, but not this time. This time, the hair on my arms stood up straight, and the sweat on my skin grew cold.
 I looked over at Gram. His eyes were jammed shut, he'd bit through his upper lip- and his hands, shaking more than ever. My hands were shaking too. The animalistic energy that'd been carrying me through this had gone. For a moment, I was just a kid again, in over his head and scrambling for a way out.Â
But it was only a moment. Like a lumberjack throwing all his weight behind an axe, I took three more passionate stabs with the needle before piercing the artery. I had no hope of suturing it now, so I just hoped to high hell that pushing stimpack juice through the pipe and pinching the rupture shut with my nails would actually work. I'd made so many choices based on pure hope already, what was more on the pile?
The moment I pulled my hand out and discarded the empty stimpack, Gram grunted and collapsed on top of Tandi. He'd stopped holding the site open, but his fingers were still buried in the bleeding wound. His lungs rattled with each jagged breath.
"What- what should I do? Do you need help with her?" panted Jas, and I waved her away. I was panting too, panting and hot and covered in sweat and blood and god knows what else. I could feel my heart beating in every crevice of my aching body.
But was Tandi's heart still beating?
Her eyes were open and unreactive, her skin was pale and waxy. Seemed like she was breathing, but the hairs on my arms still stood up as I prodded around for a pulse near her groin; there was nothing at first, then a faint squirming beneath my fingertips, and then nothing again. The skin felt cool as glass. I put my hand on Gram's back.
"What's her- check the pip boy, what's her BP say?" Gram lifted his head up just slightly to look at the pip boy screen.
"Seventy six and fifty." There was a solemn silence. "Is that�"
"That's good. Better, I mean.
I wiped some of the sweat off my brow again. It was pointless, seeing as how I probably deposited a bunch of blood when I did it, but I had to let out all that relief somehow. I hadn't even been able to get a femoral pulse when I'd checked last time, which meant that her pressure had been somewhere below seventy. A jump back up to seventy six was good news.
Of course, Tandi's troubles weren't over- her pericardium was slit, she still had herself a gaping hole in the chest, and the cavity was still full of blood in spite of my efforts. I grabbed my hand-suction pump from out of my bag and hooked up the reservoir, plunged in the tip, and got to work squeezing. An onlooker might have thought that I was still putting in my all, but at this point, my mind was elsewhere. I glanced over my shoulder.Â
"Jas, you wanna be helpful, right?" I asked. I didn't wait for a response. "Prepare the worker's quarters for all these patients. I want beds, I want chamber pots, whatever we can get. And when you're done with that, you and me are gonna haul these folks upstairs."
Jas might've said something to me after that, but I couldn't hear it over the fuzz in my head, the static of stress. I looked around the room one last time, and I don't think I have to tell you the specifics of what I saw; just that I could tell right then that this would be, without a doubt, the longest night of my life.
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