Chapter 5
Rapid Sequence
The kid on the ground was going to die if Dom didn't put a tube in his throat in the next four minutes, and that, at least, was a problem Dom knew how to have.
Motorcycle versus a left-turning sedan on Halstead, and the bike had lost the way bikes always lost — the rider thrown, helmet cracked but on, which was the only reason there was anyone to work at all.
Young. They were always young, the bikes.
Twenty, twenty-two, facedown on the asphalt in a spray of safety glass and engine fluid, one boot gone, the sedan slewed sideways twenty feet up the road with its front end folded and its horn stuck on, a long flat note under everything.
A crowd of horrified strangers had pulled back into a loose ring the way crowds did, close enough to film, far enough to feel clean about it.
A woman was screaming somewhere in the ring that she hadn't seen him, she hadn't seen him, oh God, she hadn't seen him — the sedan driver, Dom clocked, not his patient, upright and walking and therefore not his problem, and he filed her under someone else's and let her fall out of his attention entirely.
Scene size-up took Dom about a second and a half, the way it always did.
Traffic's stopped both ways, fire's got the block, no fluid on fire, one patient, mechanism's bad, helmet's on.
Then he was moving, and the size-up narrowed to the only thing that mattered, which was the specific wet rattle coming off the kid on the ground — the sound of an airway filling, the sound of a clock that had already started, the sound Dom could have heard across a four-lane road in his sleep.
"He's not moving air," Jonah said, down beside him, hands already going, and his voice was in the flat clean place, all the way in it now, no hairline. "Blood in the oropharynx, he's got facial trauma, I can't — Dom, I can't get a seal, he's—"
"Suction. Then we tube him. On the ground, right here, we're not moving him first." Dom was already reaching for the kit, and his hands were steady, his hands were always steady when it was somebody else's clock, that was the sick joke of his whole life. "You're driving this one."
Jonah's eyes came up. Just for a half-second. Me?
"You heard me. RSI. I'll push, you pass the tube. You've done it in the sim a hundred times." Dom held his gaze for exactly one beat, long enough to hand the kid his own steadiness through the air the way you'd hand off a line. "You don't get to be scared right now. Be scared later. Suction."
And the kid — Jonah — took it. Took the fear and folded it somewhere and got to work, and what happened over the next three minutes was the closest thing to a miracle Dom had watched in eighteen months, which was two people becoming one set of hands.
Because that was the thing nobody who hadn't done it could understand.
A good field intubation with a partner you're synced with isn't two people doing a procedure.
It's a conversation with no words in it.
Dom got the suction going and cleared what he could and it kept filling, and he said "we push on my count" and Jonah had the meds drawn and labeled before Dom's hand was out, and that was the first thing that snagged in Dom's mind even in the middle of it — the kid was fast, the kid was so far past where a second-week medic had any right to be.
They pre-oxygenated as best they could off a bad seal.
Dom pushed the sedation, then the paralytic, and called it out, and Jonah counted the seconds under his breath, low, watching the kid on the ground go slack, watching the jaw loosen, one hand already on the blade.
"Sats are dropping," Jonah said. Flat. Not panic. Information. "Eighty-eight. Eighty-four."
"You've got a window when the meds are on. You'll know it. Suction's right here." Dom put the Yankauer in the kid's peripheral vision so he wouldn't have to look for it. "I'm not going to talk you through it. You don't need me to. Just tell me what you see."
There was a silence then that Dom would remember for a long time — three, four seconds, the horn droning, the crowd murmuring, a helicopter somewhere far off that wasn't for them — the silence of a young man with a laryngoscope in a stranger's mouth deciding, in real time, whether he was the thing he'd spent his whole life training to be.
"I see cords," Jonah said. His voice had gone very quiet and very sure. "Passing the tube."
And then the moment — the one window, the ten seconds where the whole rest of a stranger's life balances on a single motion — and Jonah's hands did not shake.
Dom watched them. The kid's hands were rock steady on the blade, better than steady, and he slid the tube home clean, first pass, and said "I'm in" in a voice that cracked right at the very end because he was twenty-four and he'd just done the hardest thing in the job on the ground in the street.
Dom had the bag on it before the words were finished, squeezed, watched the chest rise even and both sides, listened, confirmed.
Bilateral. Good color coming up already, the terrible gray going out of the kid's face by degrees, sats climbing off the floor — eighty-eight, ninety-one, ninety-five — a live human being breathing through a tube because the two of them had made it happen together in the four minutes they'd been handed.
"Good," Dom said. Just that. But he meant it down to the floor of himself, and Jonah heard it, Dom watched him hear it, watched the word land on the kid like the only thing he'd ever wanted.
They packaged him. Ran him hot to Sacred Heart with the trauma team already spinning up in the bay.
The ride in was the quiet kind. Jonah bagged the kid in the back, steady now, focused, counting his rate out loud in a low murmur, and Dom drove and watched him in the mirror, and neither of them said anything about what they'd just done together because there wasn't language for it yet, there was only the doing of the next thing — vitals, a line, the radio report Dom called ahead so clean and calm you'd never know his second-week medic had just tubed a man in the street.
That was the other thing nobody told you about the job.
Sometimes it handed you a stretch of perfect wordless competence with another human being, twenty minutes of two people being exactly good enough at the exact same time, and it felt, God help you, like the best thing love could ever be, and it wasn't love, it was just work, except that on the nights it was both you were finished, you were done for, there was no coming back from having felt it.
They handed off a patient who was alive, who had a chance, who an hour ago had been a guy on a bike who didn't see a sedan and now had a chance because of a rookie's steady hands in the street. The doors swung shut behind the gurney and the trauma team swallowed him and it was, abruptly, over.
And then there was the after.
***
Nobody tells you about the after.
They tell you about the calls. The blood, the codes, the bad ones — everybody's got a version of the warning, it's hard, you'll see things.
Nobody tells you about the twenty minutes after a save, when the adrenaline that turned you into a machine has nowhere left to go and starts eating you from the inside, and your hands, quiet the whole call, finally start to shake, and every color in the world goes too bright, and you are more alive than a human being is built to be for any sustained length of time.
Dom knew the after. Twenty years of afters.
He'd learned to ride them out alone in the front seat of the rig, jaw set, breathing through it, letting it burn down to ash before he let himself feel anything, because the after was when men said things they meant, and Dom had made a career out of not saying the things he meant.
But he'd always ridden it out alone.
They were in the far corner of the ambulance bay, out past the last rig, where the light didn't reach and the sound of the ER was a wall away, and Jonah was pacing — actually pacing, three steps and turn, three steps and turn, both hands shoved in his hair, coming apart at the seams in the specific way a young medic comes apart after their first real save, when the thing they did is too big to fit inside their body.
"I got it," Jonah kept saying, half a laugh in it, half something breaking.
"First pass. On the ground. In the street.
I've never — that was — did you see his sats come up?
They came up. He was gonna die. He was actually gonna die and I put the tube in and he—" He stopped.
Turned. His eyes were huge and wet and bright, all the way lit up, no mask anywhere on him, nothing between Dom and the whole of him. "I did that. We did that."
"You did that," Dom said. "I pushed drugs. You put the tube in a man's throat in the street on your second week. That was you."
"I don't—" Jonah pushed both hands through his hair again, gripped, let go, started pacing again.
He was flying and crashing at the same time, the way you do, the body not knowing which.
"I keep — my hands won't stop, look at them, why won't they stop, I wasn't even scared during, I was scared before and I was fine during and now I'm—" A broken laugh.
"Is this normal? Tell me this is normal. This feels insane. I feel insane."