Chapter 10 #3
She pressed her fingers against the dorsalis pedis—the main artery that got blood to the foot. She searched for a pulse, her own pulse hammering in her ears as she waited to feel that telltale throb.
Weak. Thready.
She pressed on his toenail—watching the pink flush white beneath her thumb—then let go and counted in her head. One Mississippi. Two Mississippi. Three Mississippi. Four Mississippi.
The pink color took four seconds to return.
Far too long. Should have been two seconds. Three at most.
“How bad?” Alex’s voice was strained. She realized he was watching her face.
Meg forced her expression to stay neutral. “Your leg is broken. I need to splint it, but first I need to check a few things. This is going to hurt. I’m sorry.”
She ran her fingers lightly over his foot. “Can you feel that?”
“Barely.”
“Wiggle your toes.”
The movement was weak and made him gasp in pain.
She kept hoping for anything to point to something other than what it was. Some other explanation.
But he had all the classic signs of compartment syndrome.
The fracture had caused bleeding into the closed compartments of his lower leg. And the pressure was building. Like a tourniquet tightening from the inside. The soft tissue expanding within the unyielding fascia that wrapped around muscle groups.
Without intervention soon, the pressure would cut off blood flow entirely. And he would lose his leg.
He needed a fasciotomy.
The word echoed in her mind like a death sentence.
To relieve the pressure, she’d need to make long incisions through the skin and fascia and open the compartments to let them decompress.
It was a surgical procedure that required sterile conditions, proper instruments, anesthesia, and an operating room with bright lights and trained nurses and backup if something went wrong.
And she was in a cave with limited supplies.
Again.
She had a cave floor covered in grit and debris. A scalpel not much better than a pocketknife. And supplies meant for wilderness first aid, not field surgery.
But if she didn’t do it, Alex would lose his leg.
Or worse. If the dying muscle released its toxins into his bloodstream—possible rhabdomyolysis, kidney failure, death.
Meg’s hands were shaking as she pulled out her splinting materials. A SAM Splint—the thin aluminum and foam flexible enough to mold to any angle. Rolled gauze. Medical tape.
She needed to stabilize the fracture first, minimize any further damage, and keep the bone fragments from moving.
Then she needed to decide if she was brave enough to do what came next.
“Talk to me,” Alex said, his voice thin. “Tell me what’s happening. Please.”
Meg looked at his face—pale beneath the dirt, frightened, so young. He probably still lived at home with parents who were sick with worry right now.
And she made a decision.
The scariest thing is not knowing.
He deserved the truth. Deserved to understand what was happening to his body, what she might have to do to save it.
“Your leg is broken—definitely your tibia, probably your fibula too.” She applied the splint as she talked, her hands moving on autopilot. “But there’s internal bleeding, and the swelling is building up pressure inside your leg. If the pressure gets too high, it will cut off the blood flow.”
She paused and wrapped gauze around the splint. “In a hospital, we’d do a procedure called a fasciotomy to relieve that pressure.”
“But we’re not in a hospital.”
“No. We’re not.”
“So what are you going to do?”
Meg secured the splint and sat back on her heels.
She met his eyes. “I’m going to keep monitoring you.
And if the swelling gets worse, if your circulation deteriorates further, I’m going to have to make some incisions to release the pressure.
It’s not ideal. It’s going to hurt. But it’s better than the alternative. ”
Better than gangrene. Better than amputation. Better than dying in a cave while she watched helplessly.
Alex was quiet for a moment as his chest rose and fell with a few deep breaths. Then, surprisingly, he nodded. “Okay. Do what you have to do.”
The trust in his voice nearly broke her.
This boy who’d just woken up in a cave, injured and scared, in pain and facing the possibility of having his leg cut open with a camping knife, was putting his life in her hands.
I won’t let you down.
The promise formed in her mind even though she couldn’t voice it. Another promise that might be a lie. Another weight added to the crushing responsibility.
Meg checked her watch again.
Fifty-three minutes since Noah left.
She looked at Alex’s leg. At the swelling that seemed to be increasing by the minute. The skin was growing tighter and more discolored. The foot below looked pale. Too pale.
She might not have the luxury of waiting for Noah to return.
She might have to do this alone in the dark, in a cave that was fifty degrees and damp, with supplies meant for splinting sprained ankles and treating dehydration.
Meg pulled her medical bag closer and began inventorying her supplies with new eyes. Not as a medic treating minor injuries, but as a field surgeon preparing for yet another cave procedure that could end in disaster.
The scalpel gleamed in her headlamp beam—small, sharp, inadequate. But it was all she had. That and an ounce of courage.
And sometimes all you had was enough.
It had to be.