Free The Doctor and Mr. Dylan by Rick Novak

inch deep into the pulp of the giant neck. The constant bleeding distorted and disguised all normal anatomy, and the windpipe was nowhere in sight.
    Castro’s efforts looked futile to me. “Do we have a fiberoptic laryngoscope?” I said.
    “I’ll go get it,” a second nurse said.
    We couldn’t wait any longer. I selected a breathing tube from the anesthesia equipment cart and said, “Let me try something.”
    I inserted the tube into the patient’s right nostril and advanced it through his nose. This maneuver wasn’t without peril. If the man had fractured enough facial bones, the breathing tube could spear right through the nose and enter his brain. I rolled the dice—the threat of cardiac arrest was a powerful motivator.
    I lowered my ear toward the man’s face. The rasping sound of his labored breathing crowed through the lumen of the tube. The patient was sucking for his final breaths, like the fish in Dom’s kitchen the night before. Every inhalation was an act of desperation.
    At the moment when he sucked in his next breath, I pushed the tube hard into his nose. The patient inhaled the breathing tube into his windpipe, and a lungful of exhaled air shot out through the tube. I connected it to the oxygen circuit and began ventilating the man’s lungs. His chest moved up and down, and the oxygen saturation climbed to 99% in the next minute.
    A life saved.
    My gamble had worked. It had been as much luck as skill. We’d come so close… too close…to the specter of brain death and cardiac arrest. The patient’s oxygen level had been low for only a few minutes. This guy’s brain would survive. I looked down at his right leg, and diagnosed the next crisis. The man’s femur was deformed into an L-shape, snapped like a twig. Blood was drenching the bed sheets and dripping onto the floor tiles. His thigh was swollen to the size of a small beer keg.
    I looked over at Mr. Dylan. His face was washed out and white. He avoided making eye contact with me, and said nothing. Dylan knew how close he’d come to disaster, and how inept he’d been during the crisis. He knew I’d saved his ass.
    “You’re going to need to get some blood into this guy fast,” I said. “He’ll bleed his entire blood volume into that thigh before you know it.”
    Dylan’s blank, clueless look did not change.
    “Do you have some blood coming? From the Blood Bank?”
    Green Eyes said, “The E.R. typed and crossed him for four units of blood, but the blood isn’t ready yet.”
    “O negative,” I said. “Just get four units of O negative blood in here now. Pump it into this guy before he arrests, or you’ll be doing CPR on an empty heart.”
    “Call the Blood Bank,” Dylan blurted out. “Get me four units of O negative.” The nurse anesthetist had snapped out of his stupor, and was showing signs of life and leadership at last.
    “Do you guys have a Massive Transfusion Protocol?” I said.
    “What’s that?” Dylan said.
    “It’s standard stuff at a trauma center. An MTP pack contains four units each of O negative blood, fresh frozen plasma, and platelets. You transfuse the MTP pack in straight away if the patient has massive bleeding. It saves lives. Trauma patients can bleed to death in the first hour.”
    Dylan shook his head. “We don’t have anything like that here.”
    “You need to have it. I’ll work it out with the Blood Bank for the future. Right now, fire in four units of O negative blood and get the FFP and platelets up here as soon as you can.”
    “I will. Thanks,” Dylan said.
    “I’ve got a patient asleep across the hall,” I said. “You going to be OK?”
    “I’m good. Go.” Dylan clamped five bony fingers across my shoulder and said, “Thanks, Doctor. I owe you.”
    “No problem.” I went back to my own operating room. Nothing had changed. My patient was stable. I looked at my written record for the timing of my last documentation. I had been gone for ten minutes.
    Ten minutes that felt like