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Kiril was deathly pale, his lips taking on a faint bluish tinge. Mara led the way, as she and Mikkarn heaved the stretcher into motion. When they wheeled Kiril into the ER at breakneck speed, several nurses turned to Mikkarn for instructions.

“Get Dr. Jensen whatever she needs.” Mikkarn hooked Kiril up to various monitors as Mara cut away the rest of his clothes to look for more injuries.

“I need the chest cart.” Detaching herself from everything but her patient, Mara didn’t glance up. She needed to know exactly what she was dealing with, and she needed to do it effectively. No distractions of any kind.

“What’s she going to do, Doctor?” The fresh-faced nurse watched in fascination as Mara gowned up.

“Just do what she says. Seconds count.” Mikkarn was actually wondering the same thing. He couldn’t fault the nurse for asking.

“Okay.” Mara turned to Mikkarn. “Here’s the deal. Kiril’s most obvious injury is an open pneumothorax. The bullet caused an opening in the pleural space and his right lung has collapsed, making adequate air exchange impossible.”

“I know what it is, Mara. How do we fix it?”

Mara felt her face heat up in her embarrassment. “Sorry.” Moving to a cart in the corner of the room, she started looking for the supplies she needed. Thisarchaicequipment was the only thing that could save Kiril now.

“We have to drain the air and blood, if there is any, so the lung can fully expand again.”

Mikkarn rolled his eyes skyward. “Again, that’s obvious.Howdo we do it?”

“Lighten up! If you had paid attention to me when I built this damned cart, you’d know,” Mara snapped. Taking a deep breath, she rolled her shoulders to relieve the tension. “I’m sorry. You’re right. I’m a bitch in a crisis.”

Mikkarn smiled. “Just tell me how to help you.”

“I want a thirty-eight French chest tube. I think there is only a pneumo, but if there’s blood in the pleural space, the larger tube will be helpful.” Turning to the nurse at Mikkarn’s side, Mara said, “I need some Betadine, size six sterile gloves, and a local anesthetic.” She pressed a button to raise the stretcher to a comfortable level for her to work. Leaning close to Kiril, she brushed her lips to his. “Hang in there. This will hurt, but when I’m through, you’ll be able to breathe easier.”

Kiril managed a weak smile. “I trust you. Do what you must.”

A rush of tears threatened to spill from her eyes. She absolutely could not lose this man. Looking to Mikkarn, she realized the same was true of him. She would be lost without either of them.

Taking a deep breath, Mara spoke to the nurse again. “Do you remember how to ready the Pleur-evac? I’ll need you to do that while Mikkarn and I put in the chest tube.”

The nurse nodded her head and pulled out the sheet of instructions, fumbling with them as she tried to set up the equipment. Thank God the English to Gothe’maran translation had been included in the package. Checking for the correct amount, the nurse filled the atrium with sterile water and hooked it to the suction device.

Mara nodded her head in satisfaction. At least someone had paid attention to her.

“Raise your right arm over your head, Kiril. Mikkarn, glove up.” Mara put on her gloves as well and carefully cleansed the proper area, explaining herself to Mikkarn as she went. “Imagine there is a line from the very center of his armpit running the length of his side to his waist. We’ll call this the mid-axillary line. We want to make an incision horizontally slightly in front of this line. Count the spaces between his ribs. You want to go into the sixth space, which should be at about nipple level in a man.”

“Would you two please stop talking about me like I’m a piece of meat?” Kiril looked annoyed,feltannoyed. “I’m not some cadaver for you to practice on, Mikkarn. Let Mara do it.”

Mikkarn chuckled. “What? You don’t trust me?”

Kiril snorted. “Sure I do. But I trust her more at this instant.”

Mara tested the syringe of anesthetic. “You’re going to feel a stick, then a stinging sensation. This will numb you locally. Once I make the incision, you’ll feel some discomfort as the tube goes in, but it should be bearable.”

Kiril nodded. His breathing was becoming more labored and his oxygen saturation was dropping slowly, but steadily.

Mara made her cut. Quick, clean. She carefully broke through the subcutaneous tissue over the rib and punctured the tissue inside with her clamp. She swept just inside the incision with her finger to check for organs or adhesions in her immediate path. Taking the plastic-like tube in her clamp, she inserted the blunt end until about half the tube was inside Kiril’s chest. In a few seconds, condensation formed inside the tube and Mara released a breath she didn’t realize she had been holding. The placement was successful.

Hooking up the suction device, she waited a few minutes. It didn’t take long before the bluish tinge to his lips and fingernails began to pinken, and his skin was less clammy. “Are you feeling any better?” Mara stroked her hand down the side of Kiril’s face.

“Maybe. A little, yeah.”

“His color is coming back.” Mikkarn held the tube firmly while Mara made a few sutures to hold it securely.

“And that, ladies and gentlemen, is the low tech way to fix a pneumothorax.” Mara smiled, supremely pleased with herself.

It wasn’t long after that the guards brought their fallen comrade into the room beside Kiril’s.

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