by Nomad_Medic » Mon Aug 08, 2011 2:47 am
Dan caught up to Fred and Bill and helped them into camp. A lantern had been lit and the bed of the tailgate lowered. Water was heating on the stove and a wash bucket stood by.
Fred sat on the tailgate. The bleeding seemed to be well controlled with the dressings already in place, so Dan took a moment to look at the equipment he had available.
From the bottom of the bag he removed a nylon pouch marked ‘Wound Closure’. Inside he found a disposable suture pack containing a needle driver, scissors, and tweezers. According to the contents list, it also included several drapes, some gauze, and a pair of gloves. This was all sealed inside a sterile bag. Next to that were several pieces of suture. Dan quickly thumbed through the sealed envelopes and found sizes ranging from 5-0 up to 2-0 in both absorbable and non-absorbable. Also in the pouch he found a ziplock bag with several syringes and needles, alcohol prep pads, various steristrips, and even a skin stapler. Another bag held two multi-dose vials of lidocaine; one with epinephrine, the other without. As promised, a 500ml bottle of Hibiscrub, a chlorhexidine surgical scrub, lay next to a like sized bottle of iodine. An individually wrapped 60cc syringe rounded out the contents.
“Quite the setup you have here,” Dan said, “You know how to use this stuff?”
“Yup, at least for basic stuff. I had a buddy that helped me put that together and he was a bit more ambitious than me,” replied Fred.
Dan explained what he was doing as he gently removed the dressings. The bleeding had stopped though the blood began to ooze as he probed the edges of the wounds. Fred winced but didn’t call out as Dan separated the wound edges to determine what was involved. Whatever Miguel has used had struck Fred just above and to the outside of his nipple. It has sliced through the pectoral muscles, down the ribs, and through part of his obliques. It looked liked to Dan like the lats had been missed. The ribs had deflected the blade away from the major vessels and organs. Thankfully, the wound track was low enough that it didn’t involve any of the lymphatic system or the major nerves under the arm.
“Good news bad news time. Good news; he missed all the real important parts, you’re probably not going to bleed to death any time soon, and with your tools here, I think we should be able to get patched back up,” said Dan.
“Okay, that sounds good. What else is on your mind then?” asked Fred.
“Well, the thing of it is, I’ve put in lots of sutures but they don’t let me at the deep stuff. I know the theory and techniques to sew muscle, I just don’t have any experience with it,” confessed Dan.
Fred looked at him. “You say you’ve stitched up folks before?” When Dan nodded, he continued, “Well, that’s one up on me. I’ve stitched up ‘folk’ before, as in one guy, oh and a goat, but that don’t count. ‘sides, I couldn’t get at most of this if I wanted to.”
“Okay then, let’s get you numbed up so I can wash you out.”
The water had begun to boil on the campstove. Dan instructed Ann to keep it at a rolling boil while he worked on Fred but to turn it off after 30 minutes.
Dan spent the next little while injecting Dan with the local anesthetic. He knew he was administering a pretty large amount but it was well under the maximum safe dose of 7mg/kg. The numbers made him shudder. When used without the epinephrine, an addition that would tighten the vessels and virtually stop the tissue from bleeding, this would likely have cause Fred serious problems or death. Because of the risk of lidocaine toxicity and the introduction of so much epinephrine, Dan instructed Fred to tell him if he started to experience any ringing in his ears, visual changes, dizziness, chest pain, or confusion. Dan fully intended to keep him talking so he would notice if Fred started to slur his words. Of course, by the time symptoms began to show, there would be little Dan could do.
Because of the length of the wound, it took Dan several minutes to infiltrate the anesthetic along its whole length. By the time he was done, the water had begun cooling and the first area injected was numb.
He talked his way through what he was doing for Janice, who looked on with interest, as much as Fred. The first thing he did was add a small bit of chlorhexidine to the water. He then began to gently irrigate the wound using the large syringe from the kit.
“This is a nice straight laceration so it should close well. My two biggest concerns are infection and keeping the muscle together so it can heal properly. To fight the first, we’ll flush things out as best we can. I think these two pots worth should do the trick. Once I get you all closed up, we will put some of the antibiotic ointment on it. Do you have any oral antibiotics?” Dan asked, jerking his head towards the bag.
“Yup. Doc gave me a list of three or four to keep in there. I managed to get all of them, I think.”
“Good, I imagine we’ll be able to find something useful then. As far as the second goes, I’m hoping that between the sutures and the fact this arm is going to be immobilized, the tissue will heal well. So who is this ‘Doc’?”
Fred took a deep breath as Dan flushed the wound. “He’s a guy I was in the Army with.”
“I saw your patches Sarge. Special Operations, right? I was a Regular Army, 4-and-out, REMF, 91 Bravo. Got some good training but was CONUS the whole time. What was your story?” Dan asked.
“91 Bravo; that was the old Combat Medic MOS wasn’t it? Me, I started as an 11 Bangbang and did time in Korea then at Bragg. Up there I hung out with a couple other boneheads and the three of us decided to try Selection. Both my buddies washed out but I made it through and went 18 Charlie, Engineer. We went…well like they say; we explored new places, made new friends, and blew them up. I ended up cross training with Doc a lot. Nothing too in depth, mostly combat casualty stabilization stuff.
“My unit was in Trashganistan in the beginning. That’s where I got hurt. We went into a hot LZ after a bird that had taken an RPG the day before during Operation Anaconda. We came under heavy fire and took a couple RPG’s as we inserted. Needless to say, we went in hard.
“The next thing I knew, I was in a hospital in Germany. They say when we crashed I broke my back, bruised my spinal cord, and got knock out cold. It took me three months of rehab back at Walter Reed before I could walk and another six before I was anywhere near up to speed. I guess they felt bad at how much of a cluster the operation at Takur Ghar turned into so they offered me medical retirement. At that point I had been active for 12 years and was pretty fed up with the system so I took it.”
Dan nodded as he finished with the last of the irrigation. The lidocaine was working well and he quickly began suturing the damaged muscles. Using the specialty stitches he had been taught, Dan drew the muscle tissue together. He used the entire supply of absorbable suture in Fred’s kit but after nearly an hour he was complete. Janice had continued chatting with Fred as Dan had focused on the unfamiliar task. When Dan stood erect after putting the final internal suture in place, he realized he was getting cold.
He looked up and realized Fred was wrapped in a blanket. He had been so focused he hadn’t noticed the temperature had dropped several degrees. Janice noticed his shiver and retrieved his jacket from the cab of the pickup.
“Okay, the next part should be easy,” he said aloud. “I just need to put in another 20 or so stitches and we’ll be finished.”
“Why not just staple me up? It’s not like I’m gonna be winning any beauty contests as it is, a few more scars are nothing,” asked Fred.
“You’re already numbed up so let’s save the staples until we really need them, “replied Dan. “This won’t take long.”
He was right. 30 minutes later Fred’s wound was completely closed, coated with antibiotic ointment, and dressed with clean gauze. Dan rigged a sling and swath that held Fred’s left hand to his chest and relieved tension from the wounded tissue.
A quick search through the ‘Meds’ pouch found what Dan was looking for. He instructed Fred to take one tablet of Augmentin, a broad spectrum antibiotic composed of two medicines, twice a day for the next ten days.
As Dan was picking up the medical equipment, Bill asked him to check on the wound repair they had done at the house.
“Oh wow Bill, I’m really sorry, I completely forgot about your head,” apologized Dan.
Bill smiled, “We’ve all been pretty busy and it seems to be healing just fine. It’s only that the hair is starting to pull up there and I was wondering if it’s okay.”
Dan looked and easily cut the glued pieces of hair away. Bill thanked him and relieved Ned on watch.
After a quick discussion, it was decided the Dan would spend the night sleeping in the cab of Fred’s rig with Fred and Festus in the sleeper.
The rest of the night was uneventful. Ned, Ann, and Bill completed the guard shifts for the night. Even after the events of the night, everyone was awake with the dawn and they all filtered to the camp where Ann was boiling water for coffee.
A fine layer of frost coated everything. On another day the landscape would have shone like a field of diamonds but on this day the sun was hidden in the slate grey sky. Colorado’s winter wasn’t quite ready to relinquish its grip on the land.
Everyone soon had a cup of coffee. Shortly after that, Ann was pouring hot water over oatmeal. She then added a dollop of peanut butter and handed each person a cup of the thick, calorie rich, gruel.
Fred spoke up between bites. “This sorta changes my plans a bit. It’s gonna be a while before I’m hump’n a ruck anywhere. I really appreciate the help you folks have given me, and I hate to ask but, do you think I could hitch a ride with you to Fairplay? I am sure I can layup there until I’m back on my feet.”
“Don’t be ridicules; you should come with us to my brothers ra…..” Janice said before she could stop herself.
Blushing fiercely, she continued, “I know Ned told you we were going somewhere in Fairplay but we’re not. My brother has a big ranch south of the highway outside Jefferson. I know he’ll have room; you should come with us.”
“I’m not really in a way to earn my keep but I might have something he’d take as payment. If you folks don’t mind me tagging along, I’d be willing to give it a shot. It’s not like I have any other pressing engagements.” Fred answered.
The group was silent for a moment. Then Ned shrugged his shoulders.
“I don’t see why not. And besides, I’d say we have another vehicle now,” he said, pointing across the road at the truck the two thugs had driven the previous evening.
“Thank you Ned. I have a few things in the rig. Before we split, we really ought to take the useful stuff outa the trailer; at least as much as we can,” said Fred.
Dan thought for a moment. “How’s this sound for a plan? Bill, Janice, and Mom, can you guys break down the camp and get us ready to roll? While you’re doing that, Ned, why don’t you take a look at that other truck and see if it’s even worth trying to taking? We sent a whole lota bullets in that general direction last night. Fred, I’ll help you get your stuff out of the truck then we can see what is in the back. Sound good?”
Everyone agreed and started on their tasks. When Dan, Ned, and Fred, reached the vehicles in the turnout, they realized another task had to be addressed first. The bodies of the two men that had attacked them had been left where they fell in the night. If the group, especially the women, were going to be working around the semi, the bodies needed to be moved.
Dan rolled the rifleman onto his back. He had taken several rounds to the chest and neck. His clothing was soaked with blood and frozen to his body. Dan checked his pockets and found a Zippo lighter and a pack of cigarettes. As he started to drag the body towards the ditch, Fred stopped him.
“I think these might fit you,” he said, kicking the dead man’s foot.
Dan looked and realized Fred was right. The leather logger-style boots looked to be close to his size. While the lightweight cross-trainers he had been wearing for his trip were adequate, they wouldn’t hold up much longer in the world in which he now lived. After only a moment’s hesitation, he stripped the boots off the man and set them aside.
Knowing that in his current state he’d be more of a hindrance than a help, Fred left Dan to his task and picked up the gun the man had dropped. It was a blued steel lever action rifle. Fred was able to set the safety but with only one hand he was unable to unload it. Keeping it pointed in a safe direction and taking care to keep his fingers off of the trigger, he looked at the markings stamped into the barrel. Marlin Classic Model 1895 .45-70. It wasn’t something he recognized.
“That’s what he got you with,” Ned said, standing next to the other body.
Dan rejoined them as they looked where Ned pointed. Fred handed the rifle to Dan and bent to pick up the object on the ground.
“Shoulda figured, a punch knife. They’re no good for anything but cutting people. This one isn’t even decent, ‘Made in Taiwan’,” Fred read. “You fellas want this?” When they shook their heads ‘No’, he tossed it into the brush.
A quick check of Miguel’s pockets found two more knives. One was a cheap Balisong that was also thrown away. The other was a razor sharp, six inch, fixed blade Buck in a custom leather sheath. Fred used it to cut the dead man’s belt and set the sheath and knife on the step to his rig.
Fred indicated the rifle in Dan’s hand with a nod of his head. “What do you make of that?”
“This? A leaver action .45-70 Government. They’re an old cowboy gun from back in the day. Marlin sort of ‘re-introduced’ them a few years back and when I lived in Alaska a lot of the Guides were buying them as backups for client hunts. I had a buddy with one and they are a lot of fun to shoot. Factory ammo is a 300 grain bullet that flies like a shot-put; a trajectory that looks like a rainbow, a functional range around 150 yards, but a wallop when it gets there,” explained Dan.
“Interesting, not my speed, but interesting,” was Fred’s reply.
Dan worked the action but found only one shell in the rifle. He looked around and picked up the three empty shell cases he found and slid them into his pocket. A quick look through the cab of the truck found a box with 12 shells on the seat. A half full thermos of coffee, an empty whisky flask, and the miscellaneous detritus you would expect in a farm truck rounded out the contents of the cab.
While Dan was checking the cab, Ned had opened the hood. When Dan went to join Fred in the semi, Ned turned the key in the ignition. The truck turned over and after a few seconds, came to life. After listening to it idle for a minute, he drove the 30 feet to the trailer, shut it down, and began working under the hood.
In the semi, Dan was helping Fred get his things ready to move. It didn’t take Dan more than two seconds to see that Fred was well prepared for an emergency. Dan, a gear geek, noticed that the main bag Fred was trying to wrestle single handedly out of the sleeper bore the same distinctive red lion logo with ‘LBT’ written below it. The bag was covered with pockets and had several MOLLE additions. It was clear where the Medical Bag would attach and be held securely to the main bag. Dan stepped forward and lifted the bag first to the front seat then down to the ground. Fred also removed a LBV that was heavily laden and passed it forward. This joined the backpack outside the truck. Finally, Fred removed a key from his neck and slid it into what looked like a seam in the carpet. He turned this and a door opened. From inside he withdrew two weapons. The first was a Benelli M4 12 gauge shotgun. The autoloader had a bandoleer sling filled with shells, Tritium ghost ring sights, an integrated flashlight on a pressure switch, and oddly enough a vertical foregrip. Next, he passed out a rifle chambered in .308. It was obvious that a lot of work had gone into the weapon. The Nightforce scope rode atop an action set into a Choate Tactical Stock mated to a heavy barrel. This was followed by the ammo cans whose weight suggested they did indeed hold ammunition.
“Fred, sorry to pry here but how did you expect to carry all this stuff through the hills?” asked Dan.
“Carry it, no way. I was gonna strap it to Festus, you don’t think I keep him around for his odiferous emanations do you?” Fred answered with a straight face as he slid past Dan and out of the truck.
Dan simply shook his head and climbed out himself, setting the weapons and ammunition with the other gear.
Bill, Ann, and Janice joined the others at the newly acquired pickup. Ned had made a few minor adjustments and replaced a couple easy to get at hoses. He pronounced the rig fit to travel but wasn’t willing to use it as a tow truck without going over it more closely.
The group gathered Fred’s things and put them into the back of the truck, though the weapons went into the rack in the rear window. The pickup was then backed up to the rear of the semi trailer and the doors were opened.
Bill and Ned left to prepare the other vehicles for the road. They would fuel them, check coolant levels, and swapped out batteries. When they were finished, they would join the others.
Inside the trailer, several shrink wrapped pallets had been opened. Dan remembered Fred saying he had scavenged items from the truck for his fishing setup. Dan stepped up from the pickup bed into the trailer then helped Ann, Janice, and Fred in.
Pointing at the beefiest hand truck Dan had ever seen, Fred said, “That’s my cargo hauler.”
Looking closer, Dan noticed the hand truck was much different than the average Home Depot version. All the components of this one were larger, especially the tires. These were inflatable and Dan suspected foam filled. They gave would give it several inches of ground clearance when it was tilted. Fred removed a retaining pin and the handle telescoped out an extra 3 feet. He explained that used in conjunction with a carry belt that rested most of the weight on his hips, he could easily tow the cart like a travois. There were several lashing points on the cart that an elastic cargo net could be secured to. He told Dan that he had carried all the gear they removed from the sleeper over a hundred miles to see if he could do it. He had developed the system when he realized his back injury would not allow him to use a regular ruck.
“A lot of this stuff isn’t worth taking but some is worth its weight in gold,” called Ann from the other end of the trailer.
“Yup. Hardware stores now a day’s carry a lot of junk. If we had all kinds of space, I’d say we bring it all, but since we’re limited….” Fred trailed off.
They began organizing and sorting the goods. The first pass, they simply tried to set the ‘junk’ aside. Things like lawn ornaments, wind chimes, and water toys went into this pile. After everyone agreed on the trash, the next step was to set aside the essentials. The three cases of vegetable and flower seeds that had been distend for three separate stores started the pile. A case of Coleman fuel, a box of assorted fishing supplies, the Old Timer knife display and stock, a 50 pound box of 16 penny nails, two cases of plastic tarps in assorted sizes, and 100 feet of 3/8” chain in a transport barrel made up the rest of the pile. This was moved directly to the pickup.
Ned and Bill rejoined the others and lent a hand. The rest of the morning was spent adding and subtracting items from the final pile of goods to be loaded. In the end, they had all had items they argued for rejected by the group and others accepted. They somehow managed to get it all secured in the rigs and covered with tarps. The final item loaded into the pickup, which was strapped into the middle of the bench seat in the cab, was the 50 pound tote of Festus food Fred had secured behind the sleeper.
By the time the group was finished they were all hungry for lunch. It had taken all morning to get things organized and secured but they were ready to depart. As they ate, they discussed what they hoped would be the final leg of the journey for most of them.
Janice and Bill explained that James’s property was about 20 miles outside of Jefferson. The route was mostly south though the last 5 miles took them east. The majority of the ride was over paved county roads with several miles of ranch road at the end. They described a mostly flat landscape with the ranch tucked at the head of a valley in the foothills. No matter what they did, they would be visible for miles around.
Because getting lost on the back roads could spell disaster, they agreed that Janice should be in the lead vehicle. This would also allow her to make first contact with the ranch when they arrive. Bill argued that he should rid with her until Ann pointed out that if something happen to the truck they were both in, Hannah would be orphaned. Paling, he agreed to ride in another vehicle.
They soon had a marching order worked out. Dan and Janice would go first in the new pickup. They would be followed by Ann driving the other pickup with Fred and Festus as passengers. Fred’s injury would severely limit him in a firefight but they felt the lead and tailing vehicles could lend fire support if need be. He would have his shotgun as a last resort though he didn’t want to think about firing it one handed from inside a moving vehicle. Ned, Bill, and Hannah would bring up the read with the Blazer towing the trailer.
The final discussion was a short one. They all agreed it would have been best to depart first thing in the morning. The pregnant clouds, cold breeze, and the unmistakable smell of snow in the air all argued against staying in the pass any longer than they had to. Nobody objected when Ned suggested they get on the road.
After no more than the expected jockeying, everyone was loaded and the vehicles ready to go. With a solemn nod from Janice, Dan started down the pass.
The living are higher than the lifeless, and the thinking are higher than those that can merely draw breath.
Marcus Aurelius
Mechanical Issues