Ch. 17 – Protecting the Neighborhood

They had been operating nonstop, with no one to relieve them. That was the sad reality of treating a traumatic injury at a small mod shop. And the patient’s injuries had turned out much worse than expected. Managing the anesthesia while performing a surgery with only two people was the closest thing to hell Derrick had ever experienced.

“Suction, suction,” Tony said.

Derrick brought the suction tool inside the incision, vacuuming up the blood that was pooling inside the abdominal cavity so Tony could see what was going on. There was so much blood, more than Derrick had seen in a long time. The smell of smoke and burning flesh, melted by electrocautery, had long-since permeated his mask, and mixed with the smell of blood in the air. It was nauseating.

The patient’s organs had been shifted out of place to expose the renal aorta and kidneys, which branched off horizontally from the central abdominal aorta that was parallel to the spine.

“Hemostat,” Tony called out. He seized the artery, which was spurting out blood and wetting his gloves. The man’s life was leaking away. Derrick reached in the tool tray for a hemostat, and brought it up to the artery, clamping it between the metal arms of the hemostat.

“What the fuck is going on in here.” Tony said, shining the light on his headlamp into the cavity. “Laceration?”

They needed to obtain proximal and distal control of the artery: clamping above and below the broken part of the artery that was spurting blood. “Hemostat.” Tony pinched the other end of the artery between his fingers, and took a second hemostat out of Derrick’s gloved hand, before clamping it on the other end of the artery. “Rinse and suction,” Tony said.

Derrick cleared away more of the blood, and Tony cursed under his breath. “It’s not a clear laceration, of course it’s not. We’re gonna have to cut out the artery’s traumatized segment and suture together the cut ends.”

Colored lines jumped up and down on the multi-parameter monitor, used to monitor the patient during anesthesia. They painted the screen with green, blue, and yellow hills and valleys that displayed the patient’s vital signs. Steady readings meant the patient was still unconscious, and rapidly changing readings meant the patient was waking up, and in for a world of hurt. Just the thought of that happening made Derrick queasy, but the readings had miraculously been fine throughout the entire operation.

Tony had calculated the drug-mix according to the patient’s estimated body weight and other parameters. Derrick was watching the screen, but he had never learned how to adjust the drug mix to stabilize a patient. If there was a problem with the anesthesia, morale support and a pair of hands were the only help Derrick could give.

“Hold steady, Derrick. He’s made it this far, and we’re gonna take him to the finish line.”

#

Click. Click. The gentle sounds of the needle holder and forceps were the only noises in the room, as Tony put in the last of the sutures to close the surgical wounds from the incisions he made to access the patient’s abdominal cavity and repair the artery.

The patient was still unconscious, sedated by a mix of intravenous drugs. The endotracheal tube used to supply oxygen to his lungs was still sticking out of his mouth, secured to the lips with tape.

Tony glanced up at the multi-parameter monitor. “He’s been hemodynamically stable for a long while now,” Tony said. “Good job, Derrick.”

“Good job, Tony,” Derrick said in reply. Now that the surgery was over, a wave of exhaustion hit him. The idea of laying down on the stiff old mattress in his closet-sized room and drifting away to sleep had never been so appealing. “Do you want me to keep running through the ABCs with him, and then fire up the ultrasound again to check for free fluid in his cavities?” The greyscale video feed from the ultrasound device was able to non-invasively show the presence of fluid trapped between the patient’s organs. In the context of a gunshot wound, that fluid was most likely blood lost from an internal injury.

“Yeah, let’s do that after I finish up the sutures. I’ll take a break and get some water, and then I’ll come back to relieve you. For the ultrasound, check him now, and then again in a few hours. I hope I did that blood vessel repair right, but checking for internal bleeding will help me sleep at night.”

The new White Leopard, who had swapped with the first one to watch over the patient, tapped his foot on the tiled floor, slowly, like he was appreciating the sound of it. “How much longer are you guys going to take? We need to move him to a safer place, so sooner is better, if you don’t mind.”

No one replied, and the tension in the room built up as Tony went on finishing the sutures in silence. After tying the last knot, he sighed and set his tools down on the tray with a clank. “You guys can’t move him tonight,” Tony said.

“That’s not your choice to make,” the White Leopard said. He was playing around with a cigarette, weaving and twirling it between his fingers, but had the common-sense not to light it in the operating room. He looked around thirty, but already had prominent stress-lines on his forehead. He, and the other White Leopard leader, seemed older and more senior than the youngbloods of their gang, and stood in stark contrast to their shabbily-dressed comrades, who wore hoodies or wifebeaters. The well-fitting dress shirt clinging to his chest had partly dried. Between his open collar, and his slicked-back hair, which was slightly awry, he gave off a less severe aura than his buddy, who had been observing the patient at the start. Just a different flavor of psychopath, as all White Leopards were.

“Are you crazy?” Tony said. “We just spent hours fixing the damn guy, I’m not gonna let you throw all that work away. Where are you going to move him to?”

“You don’t need to know.”

“So you don’t have a place in mind, huh? If you were forced to come here, then you probably can’t take him to the hospital, and you don’t have your own doctor, either. He needs to be watched and hooked up to a bazillion gadgets, at least for a day or so. We just did a major blood vessel repair. Those tiny things can get blocked up, or bust open again.”

The White Leopard coughed dryly into his elbow, and cleared his throat. “We can’t wait that long. A bunch of dangerous gangsters are still the area, so, really, staying put is the most dangerous thing for everybody here. Not to mention our bosses are getting antsy. You know how it is, orders are orders.”

“Do any of you bozos know how to take care of this man? How to use the equipment?” Tony yelled. “If you stick him in a car and start racing down the streets while you’re having a shoot out, he’s going to be in bad, bad shape, boy. And look at this!” Tony pointed to the patient’s forehead, which was covered in bloody bandages. “He was shot in the head and the calf. We stopped the bleeding, but he needs to be watched for complications: not tossed around like a sack of potatoes.”

The White Leopard switched to Chinese.

Tony spat.

The surgeon’s chair shot off to the side as Tony got up and stomped around the operating table towards the Leopard, jabbing a finger at him.

He pointed at Derrick.

Derrick said. Everything Tony said was true, and Derrick knew it better than anyone else. It would feel so good to help Tony beat that Leopard’s face into the ground. But there was a group of armed men in their shop, and Tony had already failed to kill them. This wasn’t the time to pick a fight and get gunned down like fish in a barrel. Derrick’s feet skidded across the ground as he tugged on Tony’s arm, but the man was a hundred pounds heavier; it was like trying to hold back a bull.

The White Leopard stood up and reached in his bulging suit pocket.

Someone pounded on the door to the operating room. a man yelled. He rattled the doorknob, but couldn’t get in, as Derrick had kept the room locked after Tony kicked out all the other Leopards so they could concentrate on the surgery.

Tony growled and shook Derrick off, sending his left arm swinging into the shelf near the wall, which rattled from the impact. Derrick winced. Goddamit Tony, that’s going to hurt tomorrow.

Shit, how am I going to snap him out of this? Right, that Sally girl.

A few feet from his target, Tony stopped in his tracks. His massive back heaved up and down as he stood there, glaring at the Leopard.

The White Leopard slowly took his hand out of his suit pocket.

Tony tsked, stomped over to the surgeon’s chair, and dragged it back to the operating table.

The White Leopard checked his watch—a luxury timepiece with a cream leather strap—and ruffled his hair. “Let’s wait a few hours then,” he said, switching back to English. “After that, we’ll take him out of your hands, and you won’t have to be stressful about this anymore.”

“Fine. And don’t forget.”

“Forget what?” The Leopard raised in eyebrow.

“My payment, dumbass. You think all this shit was free?”

“Ah, yes. We will compensate you. Our finance guy is in the other room. He’ll pay you whatever you want, as long as it’s reasonable. Thank you for saving this man’s life.”

Tony sighed, and took his gloves off, tossing them in the hazard bin. “Keep an eye on the bozo while I’m gone, Derrick. He might try to strangle the patient to death, with how he’s so eager to move him around and kill him. I’ll be back, going to get some water and sit down for a bit.”

“Alright. Take your time, Tony. And good job,” Derrick said.

The White Leopard unlocked the door, and waved down his buddy, who had been pounding the door for a while.

Tony pushed past them both, and then the door shut again, leaving just Derrick and the White Leopard in the operating room. The patient had, of course, been unconscious through the whole argument, and was seemingly unperturbed. Though Derrick did wonder how he would’ve reacted if he was awake.

Derrick sat down in the surgeon’s chair and sighed. When would this stop? The gangs seemed to grow more violent and destructive every year. The tidal wave of refugees from the flooded coasts, and areas vulnerable to storm surges, only made things worse, since they brought more gangs with them. It would be better if Chinatown had any sort of government authority keeping order, but New Shore City didn’t give a fuck about them. For all they cared, everyone here could just rot. But what could drive the gangs out? As long as they could make a buck extorting the poor souls who had no choice but to live here, they would stay latched on, like parasites. If only the gangs would just eat each other and leave the rest of them alone . . .

Derrick tossed his dirty gloves in the hazard bin and donned new ones. He had to live, if he wanted to see a safe Chinatown, so it was time to finish the job.

Alright, let’s go through the ABCs again. He’s already intubated, and we’re seeing a good carbon dioxide profile on the monitor, so that should be fine—

“So, your name’s Derrick?”

The White Leopard was seated again, and smiling.

“Uh, yeah.” What did he want? He seemed way too calm for someone who had almost gotten into a fight with Tony.

“It’s rare to see a new mod-doctor in Chinatown. I’ve stopped by this part of the neighborhood and seen Tony before, but not you.

“My name’s Theo, by the way. It’s nice to meet you.”