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‘What is it, Kath?’
‘Emergency call just came through on the field phone. Infantry soldier, penetrating chest wound, possible thoracotomy, and Clark is already in Theatre. You’re the next best choice.’
Wordlessly, Mattie rounded her desk and raced down the corridor with Kath to the HEMS area, knowing every precious second counted. Such severe injuries on exercise weren’t common, but this was a live firing exercise and so accidents weren’t unheard of.
As a specialist cardiothoracic surgeon, Clark was the go-to guy for this, which was why they had tried to incorporate this training into some of the exercises recently. But this wasn’t one of her scenarios. This was a real-life trauma, and if a thoracotomy was going to be performed in the back of the helicopter and Clark wasn’t available, she was the best person to do it. She had been on more tours and had more experience than anyone else here.
‘Cole, Nilson, Jones, with me,’ she commanded, grabbing her gear and heading to the door.
There would be a full thoracotomy pack on board, but she grabbed an emergency serrated wire, clamps, scalpel and heavy scissors.
They had minutes to get their kit on, helmets, body armour, pelvic protection, knee pads, and to sprint to the helicopter with their gear. But it was a drill Mattie knew well, and all too quickly the chopper was dipping as it sped through the skies, reached the zone and landed.
At least with an exercise things could be halted, which meant that if surgical intervention was necessary she would be able to do it on the ground, and not in the back of the chopper whilst it was on the flight back.
If the injured soldier hadn’t gone into cardiac arrest she would keep him stable on the flight back. But if he had, the maximum time for surgical intervention following the loss of cardiac output would be ten minutes. And the flight out would take up a hefty chunk of that.
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She just had to fight off any paralyzing thoughts that the infantry soldier she was flying out to try to save could, so easily, be Kane.
* * *
By the time the helicopter landed and Mattie’s team was leaping off the back, the combat medics already had the injured soldier intubated and were ventilating him. And it wasn’t Kane.
This time, a tiny voice needled.
‘Get full IV access and get him into a supine position,’ she ordered her team.
A rapid application of skin prep would have to do—there wasn’t time for full asepsis. Taking the scalpel and forceps, she felt for the fifth intercostal space and made a series of deep midline lateral incisions, then waited. If tension pneumothorax decreased, and cardiac output returned, she wouldn’t continue with the procedure.
There was no change. Dammit.
‘Okay, let’s push on. Scissors.’
Nilson handed her the scissors and Mattie connected the thoracostomies, then she inserted two fingers to hold the lung safely out the way whilst she cut through the all the layers of intercostal muscles and pleura, leaving only a narrow sternal bridge between the anterolateral thoracotomies.
‘Saw,’ she demanded. The scissors were taken from her and the serrated wire placed into her hand instead.
Time to cut through the sternum.
She worked as quickly as she could, cutting with long, smooth strokes from the inside out. There would be retractors in the full thoracotomy pack but there was no time for that.
‘Grab here...’ she indicated to Cole ‘...and open up the chest cavity as far as you can. I need access. Scissors.’
Then, tenting the pericardium to minimise the risk to the nerves that ran through the lateral walls of the pericardial sac, Mattie made a longer midline longitudinal cut with the scissors, evacuated the blood and clot and began inspecting the heart for the site of the bleeding.
Her hope was that the heart would spontaneously restart, with a return of full cardiac output. Her fear was that it would remain in asystole. She held her breath and continued her rapid but systematic inspection.
And then the heart flickered. Began to pump again. Slowly. Too slowly.
‘We have a heartbeat,’ someone—Cole possibly—exclaimed.
Mattie shook her head,
‘Reduced output. We need to find the wounds and close them, then try massaging the heart. Wait... I think I see the hole.’
It was small. Thank God.
