Chapter 25 #2
“I’m just saying,” the firefighter continues, “if we need someone to get in there and check his status, there might be just enough room for Dr. Chang to make it work.”
I pull away from Noah’s grip. “I’ll do it.”
“Holly,” Noah’s voice drops, pitched for my ears only. “It’s too dangerous.”
I turn to face him fully, keeping my voice level and professional.
“This patient has been inverted in a confined space for hours and is now in acute respiratory distress. I’m an experienced caver, and I’m the smallest medical professional on site.
” I hold his gaze steadily. “If it’s too dangerous, I’ll back out.
But we have to at least make the attempt. ”
I can see the struggle playing out across Noah’s face—the doctor warring with the alpha, the professional with the packmate.
Around us, the rescue team watches with curious expressions.
If Noah overrules me without clear medical justification, people will notice.
They’ll wonder why he’s so concerned about me specifically.
Finally, he gives a short nod. “Gear up. I’m coming in as far as I can behind you.”
Relief and determination flood through me as I quickly strip off my bulky outer jacket and exchange my medical bag for a smaller kit I can strap to my waist. One of the firefighters helps me into a climbing harness and helmet with a headlamp.
“The passage narrows about thirty feet in,” he explains, sketching a rough diagram in the snow. “That’s where Derek is stuck. You’ll need to squeeze through here—“ he indicates an impossibly tight section, “—to reach his upper body.”
I nod, mentally preparing myself. “Let’s go.”
The cave entrance is deceptively large, a mouth in the mountainside that quickly narrows into a twisting throat of stone. I move carefully, testing each handhold and foothold before committing my weight. Noah follows close behind, his breathing steady in the confined space.
The passage grows tighter, forcing me to turn sideways in places, my headlamp casting stark shadows on the rock walls. The air grows warmer—a reminder that these caves are connected to Heat Mountain’s hydrothermal system.
“Derek?” I call out. “Derek, my name is Dr. Holly Chang. I’m coming to help you.”
A weak voice answers, “Please…help…”
I push forward, ignoring the scrape of rock against my shoulders, the claustrophobic press of stone all around me. The passage takes a sharp downward turn, and suddenly I can see him—a man suspended upside down in a vertical chimney, his body wedged at an unnatural angle.
“I’m here,” I tell him, maneuvering as close as I can. “They’re still working on setting the pulley back up, but I wanted to check on you.”
Derek’s face is alarmingly red, his eyes bulging slightly from increased pressure. His breathing comes in short, labored gasps.
“Can’t... breathe...” he manages.
I reach for the oxygen mask in my kit, carefully securing it over his face. “This will help. Try to take slow, deep breaths.”
Behind me, I hear more than see Noah’s approach.
“How is he?” he calls.
“Conscious but in respiratory distress,” I report, my fingers finding Derek’s carotid pulse—rapid and thready. “Tachycardic, skin cool and clammy despite the ambient heat.”
I run my hands carefully along what parts of Derek’s body I can reach, checking for obvious injuries.
His position makes a thorough exam impossible, but I can see the problem clearly enough: the prolonged inversion and compression have caused fluid to build up in his lungs.
Without intervention, he’ll essentially drown in his own fluids.
“Noah,” I call back, “I think we’re dealing with pulmonary edema from his position and compressed chest.”
There’s a moment of silence, then his voice comes as a formless echo in the darkness. “Can you see any way to improve his position?”
I study the way Derek is wedged into the narrowing passage. “No. He’s completely trapped until the rescue team can pull him out.”
“Holly,” Noah’s voice is calm but serious, “have you ever performed a thoracentesis before?”
A thoracentesis—a procedure to remove excess fluid from the space around the lungs. My mouth goes dry.
“Yes,” I answer honestly, “but never outside of a hospital.”
“Well, now’s your chance.”
I swallow hard, looking at Derek’s increasingly distressed face. His lips are taking on a bluish tinge despite the oxygen.
“I don’t know if I can do this here,” I admit, voice low. “The space, the lighting, the position—it’s all wrong.”
“This is exactly the high-speed experience you signed up for,” Noah reminds me, his voice steady and confident. “And I know you can do it. You’ve got the steadiest hands in the clinic.”
The compliment steadies me. I take a deep breath and reach for my kit, mentally reviewing the procedure. In a hospital, we’d use ultrasound guidance, sterile fields, proper positioning. Here, I have none of those things—just my training, my hands, and a man who will die without intervention.
“Derek,” I say, meeting his frightened eyes, “I need to remove some fluid from around your lungs to help you breathe. It’s going to be uncomfortable, but it should provide relief. Do you understand?”
He manages a small nod, eyes wide with fear but also desperate hope.
I prepare my supplies—a large-bore needle, syringe, antiseptic wipes. My hands move with practiced efficiency despite the awkward position and limited space.
“I’m going to need to access your chest,” I explain, carefully cutting away his shirt with trauma shears. “Try to stay as still as possible.”
His skin is clammy under my gloved fingers as I locate the proper intercostal space. I clean the area as thoroughly as I can considering I’m kneeling on dirt-caked rock, mentally mapping the anatomy beneath the surface. One wrong move could puncture a lung or damage the intercostal vessels.
“Deep breath in,” I instruct, then realize the irony of my words given his condition. “As deep as you can manage.”
I insert the needle with steady pressure, feeling the slight pop as it passes through the pleural space. When I pull back on the syringe, cloudy fluid fills the chamber—confirmation that my diagnosis was correct.
“Got it,” I report to Noah, carefully withdrawing the maximum amount of fluid the syringe can hold.
Derek’s breathing immediately eases, the desperate gasping replaced by still-labored but more effective respirations.
“Better?” I ask him.
He nods weakly. “Yeah... better...”
I prepare for a second aspiration, knowing I’ve only removed a fraction of the accumulated fluid. “I’m going to do this one more time, then we’ll get you out of here.”
As if on cue, a voice calls from further up the passage: “Dr. Chang? We’ve got a new extraction system ready to go. How’s the patient?”
“We’ve bought him a little more time,” I call back. “But we need to move quickly.”
I complete the second aspiration, giving Derek’s lungs enough relief that his oxygen saturation improves to acceptable levels. Then, I secure the oxygen mask more firmly and prepare him for extraction.
“They’re going to pull you out now,” I explain, checking that the new harness they’ve lowered is properly secured around his legs. “It’s going to hurt, but try to stay as relaxed as possible. I’ll be right here the whole time. Just hold on.”
Derek nods, expression a combination of fear and determination as he gives a pained whimper. “Okay.”
I back up as far as the narrow passage allows, giving the rescue team clearance to begin the extraction. Noah’s hand finds mine in the darkness, a brief squeeze of reassurance.
“Good work, Dr. Chang,” he murmurs.
The extraction is slow and painful—for Derek and for everyone listening to his cries of pain. But this time, the equipment holds. Inch by excruciating inch, the rescue team pulls him from the vertical chimney that nearly became his tomb.
When he finally emerges into the main passage and is laid out on a field stretcher, I’m immediately at his side, checking vitals and preparing him for transport. The rescue team works around me, securing him to a specialized stretcher designed for cave evacuations.
“He’s going to make it,” I tell Noah as we follow the stretcher toward daylight. “If we hadn’t relieved that pleural effusion...”
“He would have died before they got him out,” Noah finishes. “You saved his life, Holly.”
The simple statement fills me with a quiet pride that has nothing to do with designation or pack dynamics or proving myself. This is why I became a doctor—to make a difference when it matters most.
As we emerge from the cave into the bright afternoon light, I squint against the sudden glare. The waiting paramedics take over, transferring Derek to the ambulance while I give a concise report of his condition and treatment.
Captain Reeves approaches as the ambulance doors close. “That was some impressive work in there, Dr. Chang. Not many physicians would have attempted what you did.”
I shrug, suddenly self-conscious under the praise. “Just doing my job.”
“You saved that young man’s life.” He extends a hand. “Heat Mountain’s lucky to have you.”
As I shake his hand, I catch Noah watching me, a mixture of pride and something deeper reflected in his eyes.
I can’t help but think myself that I’m just as lucky to be here.