Aftershock

“Oh no,” she breathed, noting his rapid pulse and low blood pressure. He’d been semiconscious; now he was completely out, his skin turning blue. His carotid artery and jugular vein were distended, screaming for oxygen.

“What is it?” Garrett asked.

“His lung collapsed,” she said, trying to stay calm. This was a life-threatening emergency. Placing the oxygen mask over his face, she increased the output levels. Then she searched her supplies for a large needle and a syringe. Cutting away the front of his shirt, she found the intercostal space above his third rib.

She tore an alcohol swab open and wiped the spot. Working quickly, she stabbed the needle straight down into his chest.

It was a clean strike, sinking into his pleural cavity. She drew back the plunger and watched the syringe fill up with blood.

Damn.

A collapsed lung failed to function properly because of excess air or fluid in the cavity. If the problem was too much air, the lung couldn’t contract on its own, but she could do needle decompressions to release tension. Although excess blood could also be removed, she wouldn’t be able to stanch the flow.

Dealing with severe internal bleeding was beyond her capabilities. Beyond the abilities of any paramedic under these circumstances. A patient with this kind of chest trauma was doomed unless he made it to a surgeon’s table.

But Lauren couldn’t just stand there and watch the man die, so she extracted as much blood from the lung cavity as possible. It was like trying to put her finger on the dam. Her patient expired within minutes.

Shaken, she set the syringe aside and picked up her stethoscope, listening for a heartbeat. Nothing. She pronounced him dead at 12:22 p.m.

He wasn’t the first person she’d lost, and he wouldn’t be the last. Emergency services personnel couldn’t afford to dwell on disappointments like this; they had to move on quickly. Lauren was good at that. Paramedics and EMTs didn’t do follow-up. Their focus was safe transport, not long-term care.

Despite her vast experience with death, this one wasn’t easy. They were trapped under several layers of freeway, so safe transport was out. She didn’t have the resources or the expertise for ongoing critical care.

Although Garrett had jumped to protect her during the aftershock, he made no attempt to comfort her now. He stayed back and gave her space. She appreciated his reserve; if he’d shown a hint of compassion, she might have fallen apart.

Letting out a slow breath, she covered the dead man with a towel. Her remaining patients were unconscious, but stable.

“Can you come with me to check on the others?” Garrett asked quietly.

“Sure,” she said, rising to her feet.

She donned her hard hat and accompanied Garrett on a final sweep of the cavern. He couldn’t evaluate the wounded as well as she could. Several people were suffering, but as he’d said, they probably wouldn’t survive being moved.

Lauren had never witnessed so much devastation. She prayed for her friends and colleagues, many of whom had families in San Diego. All Lauren’s relatives, including her mother, lived far away.

After six years as a paramedic, she knew how to hold herself at an emotional distance, but she wasn’t made of stone. Her heart ached for the victims. Thankfully, most of them were already dead, not writhing in agony.

She trudged alongside Garrett like an automaton, her eyes dry.

Lauren assumed that the destruction outside was far worse. The freeway sections had collapsed in layers, blocking all sides. During the short interim between the first quake and the initial aftershock, many motorists had been able to escape. Some on foot, perhaps. The massive pileups of cars were beyond the concrete walls, not within them.

“You need something to eat and drink,” Garrett said.

If anyone required sustenance, it was him. He’d been searching through the rubble and lifting heavy objects for hours. She took two bottles of vitamin water out of her pack, giving him one and drinking the other.

“Is there food in the RV?” she asked.

“Yes, but it won’t last more than a few days.”

She didn’t want to consider the implication of those words. Surely they wouldn’t be trapped here long enough to worry about starvation. Humans could survive for weeks without food. If they weren’t rescued within twenty-four hours, however, those with the most critical injuries would pass away.

Water was the larger concern for the survivors. It was hot and dusty inside the cavern. They needed a lot of fluids to stay hydrated. Ten gallons wouldn’t go far.

“We should search the cars.”

“I plan to,” he said.

As they reached the northeast corner of the structure, where she’d first met Garrett, she was struck by grief. The mangled half ambulance lay on its side, contents gutted. Joe’s body was buried beneath the broken wall. He’d been her partner for three years, but she hadn’t paused to mourn him. Guilt and sadness overwhelmed her.

She struggled to control her emotions, but it was a losing battle. After inhaling several ragged breaths, she burst into tears.

Garrett kept his gaze averted and his hands to himself. He didn’t offer her any comfort or tell her not to cry. She knew she wasn’t a dignified weeper. There was nothing pretty about a red face and runny nose.

He offered her a tissue from a box he found in the back of the ambulance. She thanked him in a strangled voice, drying her eyes.

“I’m wasting water,” she said. “The Fremen would be appalled.”

“Good thing we’re not on Dune.”

She smiled through her tears, pleased that he’d understood the literary reference. Joe had been a hardcore sci-fi fan. They’d discussed the Frank Herbert novel, and its classic movie adaptation, to exhaustion.

“My coworker...didn’t make it,” she said.

“I’m sorry.”

Choking back another sob, she searched his face. He’d seemed upset when they’d first met, but anyone would be in this situation. If he was grieving the loss of a loved one, it didn’t show. “Were you with someone you cared about?”

“No,” he said curtly, his expression closed.

His brusque response made her feel foolish. He didn’t want to have a heart-to-heart discussion when there was work to be done.

She shoved the tissue into her pocket and searched the back of the ambulance for any useful supplies. After she gathered a few stray items, they headed back. The acrid stench of cigarette smoke gave her pause.

“Do you smell that?” she asked, frowning.

He froze, placing his hand on her shoulder. The sound of men’s voices carried across the dark cavern.

“Hello?” she called out, turning the beam of the flashlight that direction.

Behind a large pile of rubble, there were two men sitting in the back of a pickup truck. One had a cigarette clenched between his lips. The other was drinking from a silver can. They both waved.

Lauren waved back and started walking toward them. Garrett proceeded with caution, which she found strange, considering how gung ho he’d been earlier. He’d shown more enthusiasm while investigating burning cars.

As they neared the pickup, she saw a third man stretched out in the back of the truck. His eyes were closed, and bruises darkened the sockets underneath, but he was alive. His chest rose and fell with steady breaths.

“How’s it going?” Garrett asked, his voice flat.

She realized that he had good reason to be wary of these men. There was an open case of beer between them. A half dozen empty cans littered the space, and a large bag of chips rested against the wheel well.