Ask, Tell, page 2
smoke alarm. I feel it like fingers gripping the back of my
neck, forcing me to respond. I can’t ignore or sleep through
the sound. No matter how tired I am after thirty-seven hours
running on adrenaline, bad food and coffee, I will wake up
and I will respond. Some of the more experienced team
members tell me they can feel the helicopters approaching
before they hear them. Maybe on my next deployment I’ll
somehow gain this extra sense but for now I have to rely on
regular old hearing. I stop, hold my breath and strain to
listen for the heavy thrum of the helicopter rotors.
Mitch shields his eyes, pointing out toward the horizon. “I
hear the birds over yonder.” This means we have maybe
seven minutes. He breaks into a sprint just before I do and
our feet leave heavy prints on the dusty ground as we race
one another again, only this time it’s not for fun. Fucking
assholes. Goddamned fucking assholes. I’ve already been in
surgery for over eight hours today. I’m hot, sweaty and
tired. I should be getting ready to enjoy some personal
tension relief in a shower cubicle.
The air-conditioning shocks me when I burst into the
building and a deep shiver builds at the base of my neck. I
tug at my shirt as we jog through the hallways among other
Medical Corps personnel. Most of them are also pulling
pieces of uniform off as they move. My sweaty shirt sticks to
my skin as I try to yank it over my head. I grunt as I wrestle
with it, my hip hitting the wall. Frustration burns in my
throat but I push it back down. I need to be calm, focused
and professional. Not some idiot ranting about a T-shirt.
Bobby Rodriguez, one of our anesthesiologists, and John
Auger, a general surgeon like Mitch and me, reach the pre-
op prep room as we do. I pause to let them pass and
Rodriguez looks at me, wearing his best shit-eating grin.
Outside the theater I am fair game, but once inside he
wouldn’t dare. I greet them breathlessly. “Bobby. John.”
“Hey runners.” Rodriguez drags his words out. “Timely
interruption. Wouldn’t want you two getting even hotter out
there.” The joke is old and tired.
There are rumors on base about Mitch and I being
involved. We do not confirm, or deny because it’s easier to
maintain a charade than to risk exposure. Sex is everywhere
here, and yet it is nowhere. It’s something we talk about
constantly, but at the same time it’s not allowed.
Bobby and John grin at us. Mitch rewards them both with a
hard back slap. This ritual is some unspoken bro code that I
can never be part of. Every night, men all over the world sit
in bars, get physical with each other and discuss their latest
conquests.
“Did you fuck her?”
“You fucking bet I did. She could suck a melon out the
tailpipe of a sixty-five ’Stang.”
Cue masculine laughter, more back slapping and another
round of beers.
If women had a ritual, it would probably be the age-old
question asked over a glass of wine: “Did he make you
come?” A wry smile would be the response. No. Of course
he didn’t.
The grin I give the boys is forced. See? I’m part of the
game too. Mitch holds the door so I can slip through. He
turns to me, his blue eyes wide and I suppress a laugh. Yes,
Mitch, I know it’s an act for you. I leave him and cross the
room without looking at anyone else.
I’m an automaton. My equipment locker is orderly,
everything organized within easy reach. I quickly unfasten
my thigh holster and leave my weapon on the shelf. Hop
around to pull boots off, wet wipes to get rid of dust and
sweat, back into scrubs. Chug some water, wristwatch off
and drag my hair into an even tighter bun. The ends feel
ragged, like it’s dangerously close to being out of
regulations. Tomorrow I will go to the base salon to have a
few inches lopped off.
I catch sight of myself in the mirror stuck to the back wall
of my locker. My dark eyes appear almost black from the
reflection of shadows nestled under them. I look tired. Is
that a line near my nose? I lean closer, rubbing at my face.
No. Good. Thirty-five is too young to have wrinkles.
The room has filled in the three minutes I’ve been in here.
Conversation hums around me. Doctors. Nurses. Men.
Women. All in various stages of dress and undress. All pay
grades. All ranks. No wandering eyes. In here, we’re sexless.
Anticipation and adrenaline, and perhaps profound fatigue
cause a slight tremor in my knees, but not my hands. My
hands are surgeon’s hands. They do not waver. I pull on my
scrub cap and tie a tight double knot.
The door connecting the prep room to the scrub area and
theaters swings open. “We have three incoming, ETA five
minutes. IED. Four lower amps, one upper. Blast trauma.
We’ll know more when they arrive.” Her voice. Cultured.
Mellow. Sexy.
Stop it Sabine.
Lieutenant Colonel Rebecca Keane stands in the doorway
holding her cap. She now has everyone’s undivided
attention, which isn’t difficult. Perhaps ten years older than
me, she has an empathetic yet commanding air. Her
manner is straightforward and confident, but never
belittling. I classify all of these as important qualities for a
boss and team leader. I also classify her as extremely
attractive.
I look away and force myself to focus. IED. Improvised
Explosive Device. When I first heard the term, I imagined
someone hastily cobbling a bomb together with whatever
they had lying around. I mused to myself about how bad it
would really be if they put some effort into it.
Now on my second deployment, I know better. Improvised
doesn’t mean a fucking thing. Four lower and one upper
from three casualties. I do the math. Today, a soldier might
have lost both legs and possibly an arm. War. What is it
good for? Not much it would seem.
“Captain Fleischer!”
I straighten, turning toward Keane with my chin lifted.
“Ma’am?”
Keane keeps her eyes on me. “You, Auger and Rodriguez
take casualty A with Thorne for ortho.” She assigns all the
other surgeons into teams as I’m pulling shoes back on. I
finish my laces then look up in time for the last of her
briefing. “…you all know the drill. Nice and steady, no
mistakes.” Keane’s eyes sweep the room, lingering on me
for a moment before she exits.
Wait. I have a brief moment of panic as I mentally run
through my past three days in surgery. Does she think I
made a mistake this morning? That was unavoidable.
Nobody could have saved him. I can’t think of anything else.
All my reports are completed and I’ve only lost one patient
this week. Less than everyone else. Shit.
I pause, tuck a wisp of hair into my cap and rush after her,
intending to ask if there’s anything amiss. Mitch grabs my
arm before I reach the doors. “Good luck,” he says, eyes
bright.
My gaze moves to the swinging doors. Keane is gone.
“Luck is for suckers.” It’s our standard response. I pull my
arm free and leave him to assemble with the members of
his team.
Chapter Two
Hot wind sweeps in from outside as three casualties are
rushed through in a flurry of bloodied uniforms and rank
body odor. I finish pulling on disposable gloves and quickly
tie my gown in the back. This crew is one I’ve never met
before. I throw a hurried introduction at them. “I’m Doctor
Fleischer. Bring A into this bay here please.”
One of the Combat Pararescuemen—PJs we call them—
turns to me. “ALOC since the blast, been given packed
blood. Below knee and partial arm amp.”
Altered Level of Consciousness could mean anything.
Seems this guy is very new and needs his hand held a little.
“Has he been conscious at all?” I ask.
“Briefly ma’am, at first contact.”
“Okay, let’s roll him on.” We transfer the casualty onto the
gurney, careful not to dislodge the lines attached to his
body. He is extremely pale, his torso heaving with ragged
breaths. Hello shock, hello massive hemorrhage.
I run my hands over the man on the stretcher and make
mental assessments while more stats and details of drugs
administered are thrown at us. The fetid tang of blood and
voided bowels from the patient’s hastily-removed uniform
hangs in the air. Facial trauma, one arm, one leg and two
messy stumps. What shitty fucking luck. I almost let out an
audible sigh, but catch myself and cover it by clearing my
throat. We rush through the rest of our checks and he is
taken from the assessment bay to the theater.
Bobby is already in there when I bump up against the
scrubbing sink and reach for a mask. I fit it carefully, tying it
with more double knots. The disposable nail pick digs into
the sensitive skin of my nail bed. My nails are short and
scraped many times a day. Nothing ever accumulates under
them.
My gaze moves between my hands and the window in
front of me where I can see nurses unpacking sterile kits
and placing instruments onto trays. My favorite nurse Sarah
pauses to respond to a question from Bobby then rushes
away to keep prepping.
After many months of operating with me, they all
understand how I like my trays laid out. When I walk into the
theater I know my forceps will be set at the perfect angle
against my clamps and I’ll have exactly the right scalpels
and needle holders. Mitch calls it OCD. I call it organization.
The iodine impregnated scrub sponge has an odor that
sticks to the inside of my nose. The scent will stay there for
at least ten minutes, assuming nothing more noxious
invades my nostrils. Nate Thorne and John Auger step in
beside me, reaching to pull a mask each from the box on
the shelves above us.
“I fucking hate IEDs.” John’s Boston accent is more
pronounced than usual. He’s upset. “Give me a bullet any
day. Something we can fix. Not this chop and drop bullshit
and a ‘Sorry we couldn’t fix your limbs because some prick
blew them off and they are God knows fucking where’
speech at the end.” The muscles of his cheeks bulge as he
vents and he finishes with his molars clamped tightly
together.
John loathes injustice and hates to be ineffectual. Lately it
feels as though these two things are in steady supply
around here. His ranting is nothing new and I’ve heard it
almost every day for the nine months we’ve been deployed
together. Ninety-two days left on this, my second
deployment, until I am rotated out. Ninety-two more days of
listening to him going on and on about things which are out
of our control. You can do it, Sabine.
Nate says nothing. He’s shy, one of those people who
blends into the background, and he rarely talks unless it’s to
ask for something during surgery. I stay silent too, but nod
to show I’m not ignoring John. His words fade out into
background noise and my mind wanders. My hands and
forearms are now stained yellow-orange. I think of Oompa
Loompas. I think of watching movies with my younger sister.
When I was fifteen, I decided I wanted to be a surgeon. My
sister Jana was the first person I told. I expected
encouragement but instead, she laughed at me. When she
was done, she asked me how someone so prone to random
thinking could manage to focus long enough to perform
surgery. Some days I’m not even sure how I do it myself. On
days like today, days when someone dies, I almost feel like
I’m just playing at being a doctor.
“Doctors?” Sarah stands at the window in front of us, her
voice soft behind the glass.
Nate glances up, and John and I answer together. “Yes?”
“Are you ready to get going?”
She’s telling you to hurry up, Sabine. I splay my fingers
and scrub harder. John resumes talking. I think I catch the
word occlusion. He must think about surgery constantly. I’m
not really listening, so I don’t know what to say in response.
I make a musing sound. Good enough. When I’m not in the
operating room, I want to think about anything but surgery. I
want to think about my pets, the beach, skiing, dancing and
drinking. Maybe my girlfriend. My family.
I became a surgeon because it was what I wanted. I joined
the army because my family boasts three generations of
military service before me. My great-grandfather fought and
died in World War I, leaving a young son for the second.
After he’d done his duty in World War II, my grandfather
grabbed his pregnant wife and they left Germany for
America. Oma and Opa produced three sons who the New
Homeland gobbled up eagerly for the Vietnam War. Only
one was regurgitated. My father.
I once gave a brief summary of my family background to
Mitch and watched with amusement as he made the
connection. During both World Wars, my family fought for
the other side. I told him I’m proud of my heritage. I didn’t
tell him how as a surgeon, the literal translation of my
German last name to The Butcher delights my dark sense of
humor.
Anguished wails from the operating room beside mine
startle me out of introspection. It’s something I’ve never
quite got used to, listening to them before they are
anesthetized. No doubt, I’d be making similar noises if our
situations were reversed. Be honest, Sabine, you would be
louder.
I glance at the clock on the wall, bump the faucet handle
with my elbow and bend to get my arms under the flow.
“See you in there.” Before either of them answer, I push
backward through the door to the theater.
When I spin around I come face-to-face with Sarah,
holding a ready towel. While I dry my hands and arms, my
gaze drifts to the table where the patient has been settled
prior to being knocked out. Everyone bustles around me.
Another nurse wrestles with the x-ray and CT machines,
trying to get images up for us to work with while Bobby runs
another vitals assessment. I’m tempted to speak up to tell
Bobby my expert medical guess is that the patient’s vitals
are present, but unimpressed with current body conditions.
He probably wouldn’t find it funny.
Sarah already has my gown ready and I slide forward into
it with arms outstretched. I turn for her to tie the straps and
when I rotate back around she offers a right glove ready for
me to dive into. I give my fingers a quick wiggle to seat
them before she hands me my left glove. We dance this
dance many times a week and she knows my routine so well
it’s like she lives inside my head. Poor woman. My fingers
interlace, ensuring the thick latex is snug against my skin. I
lean forward so Sarah can fit protective glasses over my
eyes. She smiles when I wink at her.
Each moment we wait increases the risk, but I can’t begin
until the patient is intubated. Time is written on his stumps
in black marker, telling me when tourniquets were applied.
They have been on those limbs for almost an hour and a
half. I fidget. “How’s it going, Bobby?”
“Can’t get him yet, Sabs. His larynx is ground beef, not
much left of his mandible,” Bobby responds. “Glidescope
please, I’m going to video-assisted.” Sweat is beading along
his sideburns. Bobby rarely sweats. There is no point
demanding he hurry up. I know from experience that being
pushy gets us nowhere.
One of the nurses turns to me. “Images are up.”
“Thank you.” I glance at Bobby one more time, then stride
across the linoleum to the monitors. I’m impatient, which
makes everything feel like it doesn’t fit right. I roll my
shoulders to shift the gown, wrinkle my nose against the
material of the mask and make a conscious effort not to
check the progress of the intubation. He won’t go faster if
you’re leaning over his shoulder, Sabine.
I focus on the images in front of me, tracing organs and
structures quickly with my eyes. His intestines are a mess,
but repairable. I don’t think you’ll need a colostomy, sir.
Moderate internal blunt force blast trauma. Lucky man.
