Chapter 29

When the compressed air tank exploded, it threw a fragment of its high-grade steel into the chest of PFC Ken Meeker of 1st Platoon. When his buddy reached for it, Greta Chapman shouted "STOP!", and ran to knock his hand aside. "You and you -- get a grav stretcher. Sergeant Flynn, I want padding to go around the object." It was not clear where she had acquired the Command Voice as a 15-year-old, former delinquent concubine, but there was no question that she had it.

Arlene Clementine, the medic for 2nd platoon, saw that another Marine, her platoon leader, LT Curtis, also had gone down. Pieces of metal had hit his right leg. From the torn clothing, it was obvious that his knee had been shattered, and there were gashes in his thigh and protruding bones. He lay writhing on the ground. Using her medical controller, Arlene knelt and cut away his skinsuit, using a nanite-edge blade specific to the material. <<Picardo, establish IV access>> When she had access confirmed, she had the nanites inject fentanyl for his pain, and start standard to stop the bleeding.

She was relieved to find that his thigh was not spurting blood, but her training told her the femoral artery was still endangered by broken bones, even if it was not bleeding internally. Before focusing further on his leg, she assessed him, and found no other significant injuries. Pulling the field ultrasound probe from her aid kit, she called, <<Picardo. Guide me in a lower extremity FAST scan.>> While a full trauma evaluation would use FAST on his torso as well, since she knew he could be with a surgeon as soon as his leg was stabilized for the moment, that advanced procedure was not needed.

Picardo subvocalized, <<I will direct you in manipulating the probe. Doctor Kennedy will also hear this.>> It gave her detailed instructions, and then said, <<The femoral artery is leaking, with a rapidly growing hematoma. The hematoma is what's causing the worst pain. Nanites are reinforcing it, but there are not as many as we would need for a full repair. Give them 15 minutes, then immobilize his leg for transport.>>

"Lieutenant, we're going to stabilize you here, which includes controlling your pain. Once you're safe to move, we'll transport you to the ship, and, almost immediately, into a medtube."

As Arlene calmed Curtis, Greta knelt and pulled gel-saturated gauze from her field medical pack, and packed it around the penetration into PFC Meeker's chest, as Flynn and an engineer mechanically stabilized the metal. The engineer asked, "Should we try to cut it?"

"No! Unless there's no other choice, I don't want to try that if a surgeon isn't watching. Don't argue; we only can have one ground person running this -- although I want Major Benjamin to run the overall relief."

Back on the planet, Greta continued to give appropriate orders. She looked around, wondering if she should be asking for help for more junior people, letting the leaders lead. There wasn't time for philosophy of command.

"Sergeant Flynn! Get a path to take a stretcher through the transporter. Alert the ship that there's a chest trauma on the way." She subvocalized, <<Doctor Leanne, incoming chest trauma at the surface transport pad. It is an impalement and the foreign body will not fit into a medtube. It's high-grade steel so you might have trouble cutting it.>>

Aboard Jervis Bay, surveillance radar showed a Sa'arm scout flying in the general direction of the landing site. "Command, radar. Single small Sa'arm aircraft in the general vicinity of the landing site, possibly flying a ground search pattern. Our preliminary data says they try to launch three if they are concerned about something."

At the transporter, LTC Leanne Kennedy took one look. PFC Meeker was semiconscious. "How do you feel?"

He was confused. "Pain's getting worse. Hard to breathe. It didn't hurt too much, but it's getting worse--I guess shock is wearing off, doc?"

"Does it hurt anywhere beside the chest, and maybe your right arm?"

"No."

She adjusted the "We're going to put you on oxygen. You'll have a button in your hand -- squeeze it if the pain gets worse and you'll get nitrous oxide in the mask to relieve it. Tell us if it that doesn't hold it and we will do whatever you need. If the breathing gets hard, we may have to make you unconscious to treat it, but you're in safe hands now." She squeezed his left shoulder. Speaking aloud so the team would hear, "Picardo, I want the nanites to get IV access equivalent to a pair of IVs with 14gauge catheters. Have them infuse Ringer's Lactate and hetastarch keeping the blood pressure at 80 systolic for now." He grew drowsier with the fentanyl. "Ken, we're going to fix it now, so you're going to sleep for a while. Dan, please do a rapid sequence intubation, and then put him on surgical anesthesia. I think we are more concerned with respiratory than cardiac insult, so keep the opioids light."

"I'll still want at least one 18G access line that I can reach, unless, Picardo, you can give me an IV port in one of the arm bands. That will give me the option of injecting a quick bolus of a drug, whether or not the nanites stock it. You can give boluses of fentanyl as needed for pain. Get a CBC and blood gases. I'm going to do a handheld FAST ultrasound looking for internal bleeding. Damn – I really want an X-ray of this before going in, but the 'trust the medtube' doesn't give me one. While the medtube has X-ray and CT, I can't put him into it!

"Wait a minute. Picardo, conference this with Elaine, Rona, John and Barbara. Isn't there a portable X-ray unit in the forensics and materials MASINT lab?"

Picardo said "Yes, but it needs a human operator. Elaine is the only one qualified."

Leanne gave quick orders. "Elaine, turn over the dig to Joni and transport to the ship.

"Rona and John, set up in the transport area, do any necessary initial care, and get Curtis into a medtube.

"Damage control; get a couple of people to the medical area. First, you are going to need to cut off a protruding piece of metal in someone's chest. I may need you to do some further cutting when I extract it. "Since they were not in combat, they moved him to the operating room next to the medtube, rather than the backup medtube on the opposite side of the ship. Dan waited with respiratory support and anesthesia.

The FAST showed substantial bleeding in the chest. To the ship's physician assistant, LT Barbara Sims, she ordered, "Insert a pair of chest tubes, one for air, and one for liquid removal, at the appropriate right side level. Start some packed red cells; we'll watch the hematocrit for the rate, and have the nanites continue to measure total blood volume. "

Once her patient was insensible to pain, Leanne turned to the fragment and used tape and padding to further stabilize it. There was no air leakage around it. Once the shipfitters arrived, somewhat green-faced, she clamped the fragment tightly, and asked them to cut it to an inch above the skin.

Bolt cutters just slipped off the hardened metal. They started to clamp it and apply a power saw, but after a few seconds of vibration, Leanne ordered them to stop. "Picardo, can the nanites in the medtube remove a substantial piece of metal, or would it be better for me to do damage control chest surgery and then transfer him to the medtube?"

Picardo sounded a bit hesitant. "We are realizing that we don't necessarily have extensive trauma experience, but are much better at lengthy reconstruction. Also, every time you move him, that fragment can tear. I suggest you finish stabilizing it where it is, and then do the extraction in the operating room. Move him to the medtube rather than the normal post-anesthesia unit."'

Arlene transported on board, with her patient, LT Carl Curtis. Rona and John were the physicians that met them. As they prepared Carl Curtis for the medtube, they assured Arlene she had done superbly.

Rona grinned. "Now that he's in the tube, Arlene, you did everything right. What you did with the ultrasound, assessing both pure blood loss and the pain of a hematoma and incipient compartment syndrome, was excellent trauma judgment. Was this just instinct, or have you been studying at a very advanced level for a medic?

"Either way is great, but we'd like to know how you are learning, so we can encourage it."

Through Picardo, Leanne invited Greta and Arlene to watch the next procedure -- or feel free to rest. "I think you'd learn a lot from watching this. The simplest way is for you to watch it on video, mostly from the cameras mounted to track my eyes. That will probably give you a better view than actually being in the OR, although if you get fresh clothes and scrub in, you're welcome there."

The shipfitters surrounded the metal with plastic foam, and all moved the patient to the OR. Once positioned, she asked for X-rays, which showed small fragments, close to his diaphragm. They also showed that one side was embedded in a rib, and it had cracked the bone.

She made small incisions and inserted an operating endoscope. For working in the chest, this was recent Earth technology greatly improved by Confederacy resources. Rather than turning wheels or manipulating a simple hand Waldo, the AIs were able to provide even more miniaturized video cameras at the end of the endoscope, and a virtual reality viewing system for the staff. Medical AIs also could superimpose X-ray and other images over the directly viewed area.

Sliding the endoscope into place, she began to examine the injury, although she constantly had to suction blood out of her viewing field. "Barbara, increase the suction on the lower tube." When the bleeding slowed, Leanne had a clear look.

The metal had done a surprising job of avoiding vital structures. One side, however, was embedded in a rib. She opened the incision so the metal, as well as cut pieces of rib, could be lifted out. "I wouldn't cut out as much rib if there weren't a medtube to regenerate the bone. As it is, I'll connect the ends with a tube of absorbable material, and then close the chest. Now, I'd normally place a couple of chest tubes with suction, but, just for the trip to the medtube, I'll stay with the ones we have, and remove those just before he goes into the tube. Picardo, is it faster for me to support the rib with scaffolding, or have the nanites do it?"

"The nanites can't patch as quickly as you do, but they can do it more thoroughly."

Back on the planet, platoon leaders stayed with their units, pushing samples through the transporter. One Housecat launched decoys that would self-destruct; the decoys were intended to look like natural phenomena. Above them, Moe ordered, "Escorts, lock LPI radar onto the bandit. If it closes within 20 miles, kill it."

Seeing none, the last scouts pulled in their sensors. LT McDonald, with a small team and Joni, did a final walk-around, erasing obvious traces they had been there. Beatrice was the last to board the Housecat, which flew at low level to an area believed outside Sa'arm sensor range, and then climbed.

On the ship, with both casualties now safe in medtubes, Greta and Arlene let their faces show their tension and responsibility. <<Rona? Your two did fantastically. Would you and John join me in my quarters?>> Beatrice looked warmly at them and said, "I don't know if I'm going to do this as your commander, mother, lover, or friend. Well, it isn't in the line of command. Greta, you acted decisively and perfectly to something, frankly, that I was surprised you could do at your age. One last comment as commander: I'm recommending you for a combat medal. I cannot imagine that the AIs won't move you to Sponsor level immediately, and I'll bet Arlene is close if not there.

They arrived at her quarters. Rona and John met them, smiling, having put out a spread of nibbles. "How about starting you and Arlene with a nice cleansing shower, then to a relaxing bath where you're going to get pampered, and also, if you want, talk about what happened. It's your call what happens next. Believe me, while you did everything right, this was traumatic, and you will need to talk about it, at your own pace. First, let me give you a hug.

"I know you two. Sex is comforting for you. At any point in this, you can have whatever you want." She removed her insignia of rank. "That wasn't a hint, but just to let you know that I'll do anything you would like from me -- or nothing at all. If you want a gang bang, say the word."

"Oh, gee, Beatrice -- I'd love a playful shower with you and Arlene. Just to start."

"Arlene, I know this was pretty stressful for you too, and everything available to Greta is available to you." Arlene was one of the few women that did whatever necessary to maintain big hair in a skinsuit, although her lush, dark red hair definitely needed maintenance. Beatrice appreciated her curvy build even more than she admired Greta's sleekness.

"Mmm, Beatrice. My ass welcomes whatever you two want to do. Maybe I could lick Greta while you use your toys on me?" Greta nodded enthusiastically.

Two weeks later, the ships were back at the Blue Light. There was no internal bay large enough to welcome the crews, so an all-hands video teleconference had to serve. both for the welcome, and for part of the detailed debriefing. Just before, Terry spoke to Vice Admiral Hawkins, commander of the 17th Naval District, and his companion and executive officer, Major Dolores Stein. "Mary did an impressive job commanding the mission. I had my concerns, although she was backed by our best technical people and had excellent ship captains and a naval group commander."

Meanwhile, Rona went to Dolores. "Pick your brain a bit?"

"Sure."

"You know that I have two supernumerary concubines, Greta and Arlene. I took them into my household from treatment. Pre-Confederacy, they were in juvenile trouble for being hypersexual at 14, almost 15, but in our rules, they might keep the sex but get back into the mainstream of our society. In any event, they both did a superb job, as medics, on this mission.

"I'm asking you to get involved with mentoring them. From various things you've mentioned, am I assuming properly that you were put into sexual situations from a very, very early age? That it would damage many but you managed to deal with it?"

"That was very much the case, Rona. I was in my twenties when I started to realize I could be both a slut and productive. It's too bad that Terry, who is a bit younger, met me then and was too intimidated. Fair is fair -- I was overlooking him as well.

"Just a hunch, Rona, but are you thinking of sending them to Terry?"

"How did you guess? Yes. He's got a big issue with the young but legal women, but he knows these two can do as well, in crisis, as any adult. At some level, he also knows that they are as sexually experienced as lots of twentysomethings."

Dolores observed, "Terry's not very good at telling ages, but I know that these two, especially Greta, can look older. Perhaps we could help them look more mature, both with medtubes as well as with dress. Arlene is not as well-spoken as Greta, but that may be upbringing more than intelligence. Greta's from a fairly wealthy background, where she's rebelling, if I guess correctly?"

"Exactly. Both of them had managed to get into trouble with the juvenile authorities. They were the stars of a then-underage orgy, but both were rebelling in their individual ways. Arlene made slight use of recreational drugs as a sexual adjunct, but didn't use them otherwise, but Greta didn't touch them.

"Neither has had much medtube cosmetic change, yet they're damn good looking, in very different ways. Greta does tend to have a slim, leggy, very polished look when she's not writhing in the sack. Arlene is closer to a fertility goddess, but with obvious hard muscles and taut skin in her substantial hips and legs -- nothing at all wrong with them. I wouldn't mind making it with either or both. I'll bet they like even larger groups, right?"

Rona agreed. "How'd you guess?"

"Tends to go with the territory of young and wild, playing with older people, which I got as an intuition. As long as I'm being intuitive, let me project more."

"Both their faces can become more mature, and they also can work on their dress. Greta reminds me of some women that get second looks in professional offices. Her favorite outfits seem to be all, or almost all, a green that looks great against her Nordic blonde hair and green eyes. Since she wears green hose and either green boots or pumps, you don't immediately realize how short her skirts are. If she did nothing but go to nude or tan hose, every eye would be on her legs. Even better, if she got a tan, it would show off her hair -- and yes, keep a landing strip.