Chapter 16
The Blizzard
Jax
Ican’t see the hood of the Jeep.
The headlights are cutting through the snow, but they’re just illuminating a wall of white moving at sixty miles an hour. The wind is hitting the Wrangler broadside, threatening to shove two tons of steel off the road and into the ravine.
I grip the wheel. My knuckles are white inside my tactical gloves.
"Come on, old girl," I mutter, downshifting to keep the traction. "Don't die on me now."
The heater is blasting, but I’m freezing. The cold out here is predatory. It seeks out the gaps in your armour.
I see a faint red glow ahead. Flares.
I slam the brakes, pumping them to avoid a skid. The Jeep slides, the back end fishing out, but the tires bite into the ice at the last second. I come to a stop inches from the back bumper of a snow-covered ambulance.
I kill the engine. I grab my bag.
I kick the door open.
The wind roar is deafening. It feels like stepping onto a tarmac behind a jet engine. Snow needles sting my exposed face.
I pull my scarf up and run toward the red lights.
The scene is a nightmare.
The bus is on its side, teetering on the edge of the embankment. It looks like a dead whale beached in the snow. Windows are shattered. Passengers are crawling out, blood staining the white drifts red.
Paramedics are huddled in groups, trying to shield victims from the wind.
"Who’s in charge?" I scream over the wind.
A paramedic in a heavy yellow parka turns. It’s Miller. He looks terrified. His eyelashes are frozen clumps of ice.
"Dr. O'Connell?" Miller yells, his eyes widening. "You drove?"
"Sitrep!" I bark, grabbing his shoulder. "Give me the numbers!"
"Twenty-four passengers!" Miller shouts. "Walking wounded are in the rigs. But we have three entrapments inside! The bus is unstable! Fire is five minutes out, but they can't get the heavy rescue truck up the hill!"
"Show me," I order.
We run to the bus. The smell of diesel fuel is overpowering. Miller points to a shattered window near the back.
"Female, twenties. Pinned by the seat frame. She’s conscious, but her BP is tanking. We can't get a tourniquet high enough. She’s bleeding out."
I climb up the side of the bus. The metal is slick with ice. I peer into the dark hole of the window.
Inside, it’s a mess of twisted metal and luggage. I see her. Blonde hair, pale face, trapped under a crushed row of seats.
"Help me!" she screams when she sees my flashlight. "Please, I can't feel my legs!"
"I’m going in," I yell down to Miller.
"Doc, the bus is shifting!" Miller warns. "If it slides, it goes over the edge!"
"Then hold it steady!"
I don't wait. I drop into the wreckage.
It’s claustrophobic. The world tilts on a forty-five-degree angle. Luggage is falling on me. I crawl over the ceiling—which is now a wall—shoving debris aside. I reach the girl. The metal has sheared through her thigh.
"Miller!" I scream up at the window. "I need the comms! Patch me through to the hospital! I need a consult on the extrication!"
Miller drops a radio handset down to me.
I grab it. I key the mic.
"Trauma One to Base. Do you copy? This is O'Connell."
Maxwell
The ER is bathed in red light.
The backup generators are humming, a low, ominous vibration. I am standing at the triage desk, gripping the console with hands that are shaking.
We have been waiting for ten minutes. Ten minutes of static.
Then, the voice cuts through the white noise.
"Trauma One to Base. Do you copy? This is O'Connell."
The relief that hits me is so violent my knees almost buckle.
"Jax," I breathe into the mic. Then I snap into protocol. "Base copies, Trauma One. Go ahead."
"Max," Jax’s voice is crackly. "I’m inside the bus. I have a female patient, roughly twenty-five. Complex entrapment. The seat frame has pinned her right thigh. High femoral bleed."
"Can you apply a tourniquet?" I ask, staring at the wall map.
"Negative," Jax says. "No clearance. The debris is too tight. I have to clamp it manually, but I can't see the source. I’m going in blind."
"Jax," I say, my voice steady. "If you cannot visualize the artery, you risk clamping the femoral nerve. You could paralyze her leg."
"If I don't clamp it, she dies in two minutes," Jax snaps back. "I need you to talk me through the anatomy. I’m upside down. My orientation is shot."
I close my eyes. I visualize the anatomy of the thigh.
"Okay," I say. "Locate the inguinal ligament."
"Found it."
"Move two centimeters distal. Palpate for the pulse."
"Pulse is weak. Thread-y."
"That is your landmark," I instruct. "The artery runs deep to the sartorius muscle. You need to go in manually. You will feel the tear."
"Copy. Going in."
Silence. I stare at the radio. I can hear him breathing. I can hear the girl screaming in pain.
"I have it!" Jax yells. "I have the vessel! Clamping!"
There is a grunt of effort.
"Bleeding is controlled," Jax reports. "Miller, get a line in her! Drag her out!"
"Good work," I say, exhaling. "Now get out of there, Jax."
"Negative," Jax says. "I have another patient. Driver. He’s pinned at the front. I’m moving forward."
"Jax, wait," I say. "What is the stability of the vehicle?"
"It’s... precarious," Jax admits.
"Do not move forward," I order. "Wait for Fire. If you shift the weight distribution, the bus could slide."
"The driver is crashing, Max," Jax interrupts. "I can hear the agonal breathing from here. I’m going."
Jax
I leave the girl with Miller’s team and crawl toward the front of the bus.
Every time I move, the bus groans. Metal screeches against rock. Gravity is trying to pull us down the ravine, and the wind is helping.
I climb over rows of crushed seats. It’s like a jungle gym made of razor blades.
I find the driver.
He’s a heavy-set guy, suspended upside down in his seatbelt. The front of the bus is smashed in like an accordion. The steering column is crushed against his chest.
He’s turning blue.
"Base, I’m with the driver," I yell into the radio, wedging myself between the dashboard and the roof. "Male, fifties. Cyanotic. He’s gasping."
"Check the airway," Max’s voice comes back, crystal clear in my earpiece.
I rip the driver's shirt open. His chest isn't moving on the right side. His neck veins are bulging like ropes.
"Trachea is deviated to the left," I report. "Absent breath sounds on the right. Subcutaneous emphysema. It’s a tension pneumothorax. His lung has popped, Max. The pressure is crushing his heart."
"He needs immediate decompression," Max says. "Can you reach the second intercostal space?"
"Barely." I reach into my Go Bag. My fingers are numb, but muscle memory takes over. I grab a 14-gauge angiocath needle. "I’m going to needle him."
I locate the spot on the man’s chest. I jam the needle in.
Hiss.
A rush of trapped air escapes. The driver sucks in a desperate, ragged breath.
"Decompression successful," I pant. "But his sats aren't coming up. His airway is crushed. I need to intubate."
"Jax," Max warns. "Intubating upside down in a darker environment with no suction? The risk of aspiration is—"
"I know the risk!" I shout. "But he’s obstructing! I have to secure the tube!"
I grab the laryngoscope. I click the light on.
"Open wide, buddy," I mutter.
I pry the driver’s jaw open. It’s a mess of blood and broken teeth. I can't see the vocal cords.
"I can't visualize," I say, sweat freezing on my forehead. "It’s a difficult airway. Grade 4 view."
"Don't force it," Max says. "If you stimulate the gag reflex, he’ll vomit. He’ll aspirate."
"I’m doing a digital intubation," I decide. "I’m going in by feel."
"Jax, that is ancient medicine."
"I’m an ancient kind of guy."
I stick my fingers into the man’s throat. I feel the epiglottis. I feel the opening of the trachea. I guide the tube over my fingers.
" advancing the tube," I narrate. "Through the cords... now."
I push. The tube slides in. I inflate the cuff. I attach the bag-valve mask and squeeze.
The chest rises.
"I’m in," I say, leaning back against the shattered windshield. "Good color return. He’s stable."
Suddenly, the bus lurches.
It’s not a small shift this time. It’s a drop. The front end—where I am—slides three feet down the slope.
"Jax!" Max screams over the radio.
"I’m okay!" I yell, bracing my legs against the dashboard. "Miller! Get a rope down here! We need to haul the driver out!"
"We can't!" Miller yells from outside. "The wind is pushing it over! Doc, you have to get out! Now!"
I look at the driver. He’s unconscious, breathing through the tube I just placed. If I leave him, he falls with the bus.
I grab my knife. I slash the driver’s seatbelt.
He drops. I catch him. He’s heavy, dead weight.
"I’ve got him!" I yell. "Pull us up!"
I drag the driver toward the window. The floor is tilting steeper. It’s sixty degrees now. The metal is screaming.
I shove the driver toward Miller’s outstretched hands.
"Take him!"
Miller grabs the driver’s belt. They haul him out the window.
I scramble to follow.
My hand touches the window frame.
And then the world falls away.
The bus groans, a deep, structural failure. The ground beneath us gives way.
"Jax, get out!" Max’s voice is the last thing I hear.
The bus slides. It tips past the point of no return.
I try to lunge for the window, but the angle is too steep. I slide backward, tumbling down the length of the bus as it rolls.
The radio handset flies out of my hand.
I hit the back wall hard. Darkness spins. The sound of crunching metal and shattering glass is deafening.
Then, we are falling.
Maxwell
"Jax, get out!" I scream.
There is a sound over the radio that will haunt me for the rest of my life. The screech of metal tearing. The roar of snow.
And then, silence.
Static.
"Jax?"
I press the button. My thumb is white.
"Jax, report!"
Nothing.
"O'Connell!" I shout, my voice cracking. "Answer me!"
The radio is dead.
I stand there in the red light. The silence in the ER is absolute. The nurses have stopped moving. Mama Ortiz has her hands over her mouth.
I stare at the radio handset in my hand.
He’s gone.
The bus went over.
I drop the headset. It clatters on the desk.
"Dr. York?" Ortiz whispers.
I turn around.
I feel a cold, terrifying clarity wash over me. The panic is gone. There is only the mission.
"Prepare OR 1," I say. My voice sounds like it’s coming from someone else. "Call the blood bank. Initiate Massive Transfusion Protocol. Get the perfusionist here now."
"Sir?" Ortiz asks, tears in her eyes. "They said... they said it went over the edge."
"He is not dead," I say fiercely. I look her in the eye. "He is the best trauma surgeon in this state. He survived Afghanistan. He survived me. He is not allowed to be dead."
I walk toward the ambulance bay doors.
"When they bring him in," I say, "I want everything ready. No delays. No mistakes."
I walk out into the cold bay. The wind is still howling, mocking me.
I stand there, staring into the whiteout, waiting for the lights.
Come back, I think, projecting the thought into the storm. Come back to me, Jax. I don't care about Sterling. I don't care about the Board. Just come back.
I wait.