Mile High

“Two GSWs incoming!”

The charge nurse’s announcement rises over the wail of the alarm signaling the arrival of an ambulance. A spike of adrenaline blasts through me. I’m not usually assigned to the pit, but when I am, some ghoulish part of my soul gets a thrill out of the true emergencies. Not just one, but two trauma patients are headed our way.

I tail Dr. Blanchard, UCLA’s trauma attending on duty, hyperfocused and ready to anticipate whatever she or the patients need when they arrive.

The doors sweep open, and a pair of gurneys rush in, one after the other, flanked by the paramedics who reel off a concise detailing of the victims’ ages, vitals, and injuries. Two men with gunshot wounds, one a lower abdominal wound, through and through, the other a chest wound with no exit.

All I see is blood-soaked gauze as my mind cycles through all the potential implications of both injuries.

Dr. B is on the abdominal, trotting toward the room they wheel the patient into. Behind her trails a half-naked gangbanger wearing nothing but purple silk boxers. His hands are covered in blood, a distraught look on his face. More blood is spattered across his tattooed torso. The sight is almost too surreal for me to catch Dr. B’s gift to me.

“Number two is a potential spinal injury, Nicolo. You’re welcome!” She lobs the comment at me just before disappearing into the room with her patient while I jump into action on mine.

“Sir, are you injured?” I overhear a nurse ask the tattooed companion who stands staring through the glass into the room I’m in. I just barely make out his response before a nurse closes the door. “I’m fine, just go help them. Don’t you dare let that man die. Maddox’ll never survive if his brother dies.”

The crack in his voice sends a twinge of pain through me, poking an old wound of my own. I do my best to ignore it as I jump into gear. I have no intention of letting anyone die, but I can’t fool myself. I saw the carnage as it blurred by and brace myself for the worst before I get a better look.

In between the burns are numerous darkening bruises with a uniform pattern that looks like he took a beating from someone with lead fists—brass knuckles, I’m guessing, just based on the company he keeps. Not even his numerous tattoos can obscure how grave the damage is.

“Maddox…” the man wheezes from behind the oxygen mask. He reaches out and grips my wrist, squeezing hard enough to hurt.

I cover his hand with mine and smile, determined to comfort rather than alarm him. “Is that your brother? He’s in good hands, I promise. So are you, but I need you to try to relax. Can you do that for me?”

The rigid cervical collar locked around his neck prevents his attempt at a nod, so he just slow blinks, his grip easing. “You do your thing, Doc. I’m not going anywhere. Especially since I can’t feel my legs.” The words are strained, and I think I catch a bitter half-smile behind the mask. But his lips have a bluish tint, and he begins struggling to breathe.

Cardio arrives at that moment, and I step aside. I move to his feet, which are bare and dirty, and test his reflexes there. The lack of reaction confirms Dr. B’s statement, and the patient’s, but we still need more tests. Tests that will evidently have to wait, since he goes into cardiac arrest and is rushed to surgery a moment later.

I’m standing in a daze when Dr. Yao, the neuro attending and my supervisor, pops his head in a moment later. “Nicolo, what are you doing? Get your ass up to surgery, you’re scrubbing in on this one.”

“But I need to get his history, and cardio…” I stutter, waving abstractly toward the door, then it hits me that this isn’t just a cardio case. “His spine. There was no exit wound and he couldn’t feel his legs.”

“Bingo. Come on, I’ll have one of the other residents get his history.”

I take a deep breath, wanting to take in every detail. All I get is a lungful of surgical mask, but my senses are heightened. The cardio surgeon already has the patient’s chest open and is repairing a perforated lung, relaying a subdued play-by-play as he works. An orthopedic surgeon and Dr. Yao stand at the ready. I tamp down the nervous energy in my belly as I wait and watch.

The surgery turns out to be straightforward and relatively quick. They marvel that the bullet missed his heart, but still don’t look optimistic when they turn him over to us. They’ve already taken an x-ray and determined that the bullet is indeed lodged against his eighth thoracic vertebrae. If this surgery doesn’t go well, he could wind up paraplegic.

We carefully position him face-down, the enormous C-arm imaging machine curving around and above the surgical field so we can have an x-ray visual of the procedure while it’s underway. His back is covered in a yellow surgical incise drape surrounded by another blue surgical drape. Through the transparent material is clearly visible a hyper-realistic tattoo of a black and white koi fish swimming through water.

“Impressive ink,” Dr. Yao comments. “Shame we have to cut into it.”

Of all the tattoos I caught glimpses of on his body so far, none were as striking as the tattoo that must cover a good portion of his back. When Dr. Yao makes the first incision down the center of the spine, I can’t help but wince at the slice that cuts straight through the side of the fish.

I lean in as Dr. Yao begins talking through the steps of the procedure. He glances at the x-ray image every few seconds as he deftly maneuvers his instruments into the incision to extract the slug of metal lodged there.

Out of the blue, he says, “Did you know that koi fish are symbolic? Black and white ones like this signify transformation. Rebirth.”

I nod in interest. I’ve watched Dr. Yao from the gallery, and he seemed like a fun surgeon to assist since he’s always spouting off random trivia in between teaching surgical technique. He goes on about what different colors of koi tattoos symbolize while I look on, soaking up every nuance of his movements.

The entire procedure seems deceptively simple as it’s happening. My fingers can feel the weight of the instruments even though I’m not holding them myself, and when Dr. Yao surprises me with a question about the next step, rather than more tattoo trivia, I’m ready with the answer without even thinking. The corners of his eyes crinkle and he nods. “Good job, Nicolo. When ortho’s finished, see to the patient’s superficial wounds and stay with him in recovery to make sure he’s stable.”

I’m positive he can sense my wide grin behind my mask, but I only nod once to maintain the illusion of professionalism. “I’d be honored, sir.”

Once the bullet is out, I exhale, then step back and observe as ortho slips in to insert a pair of small screws, which are all that’s required to hold the fractured vertebra together. Then I watch with bated breath as they stitch the wound. I finally breathe easily once more when it’s done and the tattoo looks as well as it can with a line of stitches down the center of it. He’ll have a scar, but with an artist talented enough to create a work of art like this, he can surely get a touch-up that’ll make it look as good as new once the cut is fully healed.

The surgery a success, I float on an adrenaline-fueled cloud as I scrub out, then meet the patient in recovery. I finally have a chance to review his chart, and I learn his name is Julian Santos Jr. On the way there, I checked in on the other patient, his brother, Maddox Santos, who is zonked out on painkillers but otherwise doing fine, and I’m happy to have good news to tell Julian when he wakes up. Maddox’s wound was only a flesh wound, the bullet passing clean through the muscles over one hip.

He came in wearing only jeans, which were cut off shortly after he arrived. They likely protected his legs from damage, but I take a purely clinical peek beneath the sheet to check below the waist anyway. His muscular legs are unblemished, and I drop the sheet again quickly, face flaming though I can’t help the small smile at what appeared to be another very healthy and impressive feature that caught my eye.

I keep my gaze on the wound, focusing on the stitches because they’re through one of his more detailed tribal tattoos and I’m still at the stage where I need to be methodical about the steps. I don’t want to fuck this up, but it gives me an excuse not to look him in the eyes. “I’m a doctor, Mr. Santos. I checked out everything. You were in quite the fight today, weren’t you?”

He groans and his hands tighten into fists. The bandages I wrapped around his wrists stretch with the motion. He’d evidently been shackled too, and the bloody abrasions around both wrists were the first wounds I bandaged.

“Did they kill the bastard? Or is he at least maimed?”

I finish the suturing and sit up straight, reaching for a fresh bandage to cover the wound. His gray eyes are intense when I meet them, and I shake my head. “I don’t know who you mean. Your brother, Maddox, is fine though. Was there someone else?”

“Delgado. The asshole who did this to me.”

I vaguely remember a third gurney being wheeled in after his, but I didn’t keep track of that patient. “Give me five minutes,” I say, then stand and leave. I head to the nurses’ station, where I’m most likely to get a quick answer, and a few minutes later return with the information. He gives me an expectant look when I walk into the room. “Mr. Delgado has been admitted with a concussion and several broken ribs. He’ll be here overnight at least, then will be released into federal custody. Should I ask what your fight was about?”

He eyes me thoughtfully for a moment, then shakes his head. “Better if you stick with what you’re good at, Doc.”

“Fair enough, Mr. Santos. How are you feeling?”

“Like I lost a fight with a goddamn steamroller. But I’d feel better if you called me J.J. Mr. Santos is my dad. He could give the steamroller a run for its money.”

I let that comment slide, but somehow am not surprised that a man in his shape grew up with violence. Leaning down to check the wounds I just bandaged, my skin prickles, and I catch him staring at me, his gaze clearly aimed down the front of my scrubs.

“Do you have questions?” I ask, giving him a pointed look.

He blinks and clears his throat. “So, ah, what’s the damage here? Am I paralyzed? Is the equipment you were just admiring going to waste from here on out?”

“Your surgery went well, actually. The bullet perforated a lung and lodged against your spine, but managed to miss your heart. You were very lucky on that count. We were able to take the bullet out and repair the damage to your vertebrae. Your spine is intact, but there’s some swelling that will likely impact movement and sensation in your lower extremities until it recedes. With therapy, you should have a full recovery.”

“You seem pretty damn confident of that.” He trails off on a cough, then eyes me skeptically. A closer look at his face reveals the gray tinge to the skin that isn’t covered in mottled bruises and dried blood I haven’t had a chance to clean off yet. He’s tough, but not impervious to pain.

“I am. I’ve seen the scans. I won’t lie to you; it was close, but you were in good hands.”

His gaze drops to my hands and his eyebrows go up, his lips twisting into a half-smile. “Was I now?” he rasps. “Why don’t you make me a promise then? If you’re so confident I’ll be on my feet, let me take you out. As a thank you.”

My cheeks heat and I drop my gaze, gathering myself before giving him a direct look, heart fluttering and core heating under his intensity. This man clearly isn’t used to being turned down, but I know better.

“I wasn’t the one who performed the surgery, J.J. I’m a resident, so I only observed. UCLA’s neurosurgery department is one of the best in the country, and your injury was well within our capabilities to repair. That was all I meant. If you owe anyone a thank you, it’s the three excellent surgeons who actually saved your life.”

J.J. grins. “You didn’t say no.”

I purse my lips and give an exasperated shake of my head. “I need some fresh bandages so I can finish treating the rest of these cuts. I’ll be back soon.”

As I walk out of the room, he calls after me hoarsely, “That wasn’t a no either!”