Fighting the Flames for You

1. Under the Stars

Under the Stars

NORA

There's a saying that life is stranger than fiction because fiction has to make sense.

I'm not sure who said it first, but whoever coined it, they were right.

Because looking at my life, nothing about it makes sense.

Some people turn to religion for answers.

Others turn to philosophy. I look up at the stars.

The ER doors burst open. The medic was already talking.

"Thirty-eight-year-old male, construction site off Russell. Angle grinder kicked and a fragment caught him in the neck. Right side, long laceration, bleeding's been steady since we got to him. He's awake, talking, airway's clear. We've got pressure on it and two IVs running."

They had the gurney at a jog. Two firefighter-paramedics, one holding a bag of saline overhead and the other with a gloved hand pressed into the patient's throat. A third man in turnouts came in behind them carrying a hard hat that wasn't his.

"Trauma One, let's go." Dr. Harlan was at the head of the bed before the gurney stopped moving. "Gracelyn, you're running the floor. Kip, I need a Level 1 infuser and type-and-cross tubes. Nora, you're on the neck."

I was at the right side of the gurney before it locked. The paramedic had both hands pressed into a blood-soaked dressing on the man's throat. I slid my gloved hands over his, felt the warmth and the wet pressure underneath, and held.

"I've got it."

He lifted off. I pressed down.

The wound ran from below his ear almost to his collarbone. The blood that filled the gap between his hands leaving and mine arriving was dark. I pressed harder and leaned my weight into it.

"Sir," Harlan said. "Can you tell me your name?"

"Rueben." He sounded scared, but his voice was clear. "Is it bad?"

"We're going to take care of you. Keep talking to me. Tell me your full name."

"Rueben Antonio Salas."

Under my hands, the tissue that had been soft and giving was turning hard and tight.

Swelling from the inside, pushing up against my palms. The bleeding wasn't just flowing out anymore.

It was filling in, ballooning the tissue from within, and every second it grew, it pressed closer to his windpipe.

"His neck is swelling," I said. "It's pushing up against my hands."

Harlan moved fast. He checked the airway and looked at the monitor. His face changed as the monitor started chiming the alarm that meant his blood pressure was dropping.

"He's bleeding inward and it's closing his airway. He won't survive a scan. Call the OR. Tell Vascular we're coming in thirty seconds."

Everything moved at once. Kip hit the door buttons. Gracelyn grabbed the IV poles. I locked my elbows and braced my weight into the bed as we ran down the hall.

"Am I going to die?"

"No. Look at me. Don't try to talk. Keep your chin straight."

The surgical team was already scrubbed and waiting. They slid him from the gurney onto the table, while the anesthesiologist pushed something into his line. Rueben's eyes started to go heavy.

"I've got it. Step back." The surgeon stepped to my side.

I lifted my hands.

My gloves were soaked through. Underneath them my fingers were locked into the shape they'd been holding.

I peeled the gloves off, dropped them in the bin, and took my first full breath since the gurney had come through the ER doors.

My hands were shaking. They always do, after.

I went to the scrub sink and turned the water up. Soap to my elbows, blood from under every fingernail. I scrubbed until my hands were raw and the water ran clear.

Some of my classmates in nursing school used to ask me why I wanted the ER. A few of them ended up in labor and delivery, the NICU, floors where the patients were cute and small, and the outcomes were almost always good. They thought I was out of my mind.

I understood why they thought it was strange. I was the person who read my horoscope every morning and checked my birth chart when Mercury went into retrograde. I needed the universe to have a plan. Nothing about the ER looked like it had one.

But it did. There are protocols for everything. Steps to follow, roles to fill, decisions I've trained for. And the ending is always one of two things: you save them or you don't.

And between all the random, unpredictable things that life can throw at you, there is something deeply grounding about being the person who gets to tip that balance.

About knowing that your hands, your focus, your fifteen minutes of holding pressure on a stranger's neck might be the reason he goes home to his family.

Nothing else in my life has ever been that clear.

The two paramedics were finishing their paperwork at the desk when I came back out to the floor.

I looked at their necks. Their skin was clean and unmarked.

The one with the helmet caught me looking and gave me a nod. I nodded back.

I turned toward the terminal to start my trauma flow sheet.

Outside, tires screeched as a sedan braked hard at the bay doors. The back door opened. Two guys pulled a kid out by his arms and set him on the concrete. The door shut and the car was off the ramp before security got his radio up.

Gracelyn was already shouting. "Gurney! Now!"

The kid was crumpled on the pavement. He looked about seventeen, maybe younger. Both hands clamped around his upper thigh. His jeans were soaked with blood.

I dropped to my knees on the concrete and drove both hands into the soft groove of his inner thigh where the artery runs close to the surface. He screamed.

"I know. I'm sorry. I have to hold this."

Gracelyn anchored his head as we lifted him onto the gurney.

Inside Trauma Two, the kid lost it. He was thrashing, swinging, kicking with his good leg, trying to shove every hand away.

Gracelyn stepped directly into his line of sight.

"Look at me. Stop kicking or you are going to bleed out right here. What is your name?"

His whole body was locked tight. His breath came in short pulls, but he stopped fighting.

I cut through the blood-soaked denim from the knee up with shears and peeled the fabric away.

"Can you tell me your name?" Gracelyn asked again.

"Go to hell!" he spat.

"Fine. You're John Doe."

Dr. Harlan came through the bay doors. His eyes went to my hands, to the blood pulsing through my fingers.

"Tourniquet."

Gracelyn put the strap in my hands. I looped it high on his groin and cranked the plastic rod. One turn. Two. The dark pulsing slowed. Three turns, and it stopped. The kid gave one last ragged shriek and went limp against the bed.

I locked the windlass in place and finally lifted my hands. They were slick to my forearms.

Harlan pressed the cold ultrasound probe against the kid's hip. He watched the screen. "Two units O-neg on the rapid infuser."

Gracelyn hooked up the blood bag. I spiked the IV lines.

Within two minutes, the frantic shouting died down. The only sound left in Trauma Two was the rhythmic chime of the heart monitor and the thud of the rapid infuser.

The entire team stepped back in a single breath. The kid lay on the gurney. The floor around him was a mess of cut denim, open plastic wrappers, and bloody gloves.

Josie stepped into the bay, clipboard in hand, unbothered by the mess.

"Called Metro. Security's pulling the driveway cameras, but the sedan was gone before the doors shut." She looked at Harlan. "Another dump and run."

Harlan barely looked up from the screen. "Order a leg CTA and alert Vascular. Let's get him moved up before Metro gets here."

I took a breath and peeled off my gloves.

"What a day." Gracelyn pulled her scrub top over her head and tossed it into the hamper. "Why, of all the cities in America I could have ended up in, did I choose Las Vegas?"

"The weather," I said. "And the glamour."

She laughed. "The glamour. Yes. That's exactly what I was thinking while I had my hands on that kid's head."

Gracelyn was the eldest of five. Every time her salary came through she'd sit in the break room with her phone calculator and figure out what her family needed back in the Philippines.

Rent for her mother, school fees for her youngest sister, whatever medical bill had come in that month.

She did the math before she spent a cent on herself.

Some shifts I'd watch her push through twelve hours of impossible rooms knowing she'd go home and do her numbers, and I'd think: if she can do that, I have no excuse.

Gracelyn sat down on the bench and started changing her shoes. "I feel like I deserve something after today. You want to grab dinner before we head home?"

I pulled my phone out of my locker. One text from Ian.

IAN

Working on a project at Jesse's. Home late.

Ian wasn't usually the type to text ahead. I appreciated it when he did.

"My brother's out late tonight," I said. "Working on a school project. So I guess I don't have to rush home and make dinner."

"Perfect." Gracelyn grinned and pulled her other shoe on.

We ended up at a diner off Charleston, one of those 24-hour places with sticky menus and vinyl booths that Las Vegas has on every other block. Gracelyn slid into a booth by the window and I sat across from her. The waitress dropped two menus on the table and disappeared.

"I want something hearty tonight." Gracelyn flipped through the menu like she was looking for something specific. "Something that makes me forget about all the blood I had to deal with today."

I turned the pages and stopped on a picture of chicken tenders.

"Chicken and waffles." Gracelyn closed her menu and set it down with both hands, satisfied. "That's it. That's the one."

"I'm surprised you're not looking for something with rice."

"This is close enough."

"How is chicken and waffles close to rice?"

"There's protein and carbs. That's a Filipino plate."

"If you say so."

The waitress came back. "Ready to order?"

"I'll have the chicken and waffles with a side of fries, please," Gracelyn said.

"And I'll have the chicken tenders, please. Do those come with ranch?"

"I can get you some."

"Thank you."