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It's morning in September and Tiger and I are downtown, with Attila, and Emerald in my pocket watching all the street action. We're taking two hours off work. The early sun is friendly, and the noises and smells of auto traffic are not excessive. My pocket being occupied by someone who chews on toys, I have my light pack to hold my money, cards and keys. Tiger's pocket is vacant, but her uterus isn't, and yesterday evening Dr. Newman did the three month checks and pronounced both Tiger and Fox to be fit and healthy, pending the results of blood analysis. He also had the good news that Fox is genetically robust. And is male. Dr. Newman stayed the night, and we just sent him off, driving back to the Lion Foundation in his old Land Rover.
Here in the business district, our second job will be to buy Attila a game disc, ``Warrior Princess Slays the Purple Dinosaur'', which her little (human) friend has and which she was much taken with. We set Attila a task, to sand the claw-scratched and chipped paint off the seat board of one of the kitchen chairs we're refinishing. Since the paint is just around the edge this is a ten minute job for an adult, not enough to pay for a disc at fair market value, but it was a real challenge in attention span for such a little person, and we think the exchange is fair by her standards.
The first job will be to deposit the Xylogen dividend check in our brokerage account to cover a stock purchase we just made. We normally do this by mail but we also want to talk to a rep about a new mutual fund they have, and about a fund we have and aren't sure we want to keep.
Xylogen continues to boom. Its stock has split twice in four years, and is just about ready for another split. At the brewery we've put in a mezzanine over the whole property with sixteen vats, and the company is trying to buy a bigger site just outside the city limits. And in one of our vats we have yet another new bug. This one produces polyimide, and not only that, it secretes fibers, long ones, instead of making an inclusion body and dying when it fills itself to obesity. We're trying to optimize growth conditions, and to work out the obvious problem of separating long fine fibers from half-digested wood pulp in the oobleck. The inside information is very closely guarded, but perfectly legally we're positioning ourselves (and Charlie) awash in cash, ready to make a big open market purchase as soon as the new bug is formally announced. If we dump the poorly performing mutual fund, the proceeds will go into cash reserves.
Bear, Claude and Diamond are home studying with Mariposa. That term applies very loosely where Diamond is concerned. Mostly it means Mariposa or the computer reads talking animal stories to him, and then he plays action-reaction games or climbs and jumps off the cargo net or begs Mariposa to take them to the park.
Coyote got his general education diploma a year ago like a proper lion, and Mariposa will be ready soon to take the test. I'm very proud of Coyote. As a ``graduation'' present I was going to get him a gold chain, but he insisted in advance that any presents or similar items be checked with him, and when I told him about the chain he turned it down. Instead he whipped out a list of computer discs ranked in order of preference, and he said to take the money that would have gone for a chain and to spend it on discs. Tiger and I were floored. He was asking for his own copy of several of our discs, but a lot of them I had never heard of: one on trees of the world, for example, and the complete works of Lorca (in Spanish). Our Coyote is growing up. We felt it politically prudent not to get everything, but we got about two thirds, spending about twice the cost of the chain we had picked out.
This is a big day for Coyote. He's at the junior college registering for fall classes, his first quarter. I hope he's doing the right thing. I'm sure, and he's sure, that if he studied one more year off the lion disc he could get in to Brigham Young and do well. But he had a feeling about himself and spent a whole week last spring preparing a tentative study list and sneaking into the college classes. They weren't coyote. When he graduates he refuses to be trapped in an office pushing papers; he wants to get his hands on the real stuff. He's well aware of how a modern engineer works, having visited Xylogen often. He investigated manufacturing engineering, silviculture, paramedicine, and a number of other hands-on careers, and Brigham Young is just not the place to learn any of that.
Junior college is the place. Over the past year Coyote has had intern-type jobs in several fields, and he's kept a commitment of fifteen hours a week with Modesto Madera, a tree surgeon company. No, that's not the guy's real name. Coyote says he loves to climb trees since we taught him how, and he has the best basic foundation for tree work. That's kind of a coyote joke, but not entirely inaccurate. Consulting with me and Tiger -- what teenager ever does that? -- he planned out a program in silviculture and botany, with in addition several courses in business accounting and management, one in structural engineering for contractors, and the introductory part of the paramedic training, plus some get-a-life courses like advanced classical synth. Coyote playing classical music? You'd better believe it. Old Seņor Pedroza, the padron of Modesto Madera, asked Coyote to help out doing taxes last April, and that firmed up Coyote's ideas about what he would have to know to go into the tree business for himself in the not very distant future. And firmed up his appreciation of clean records and doing things before the deadline.
Coyote also has a mate, Linda. This was a pretty traumatic development for Mariposa, but with some intense negotiations orchestrated behind the scenes by us parents, Mariposa agreed that she would back up the two of them in their reproductive plans, and Linda agreed not to steal Coyote away from his family, specifically Mariposa, and to include us in activities. The pair are taking everything slow and responsibly. I don't feel comfortable coming out and asking Coyote and Linda, ``hey, did you two mate vaginally yet?'' But I have the feeling that they haven't, and also that they'll make some kind of announcement when they do. They want to make sure they'll stick together, and so far they're doing a good job.
Attila: Simba, Tiger! What's in that shop? It sure smells good. Sa-poo-si-no, is that it?
Me: Cappucino; in this word the C comes out as K, then as CH. It's a special kind of coffee, Italian. It smells good, but coffee gives lion people a headache. Too bad.
Attila: Is the software store close? This is taking an awfully long time.
Tiger: Close, yes, but remember, we're going to deposit our check first, then buy your game. This is good practice for your patience, isn't it?
Attila: Too good practice.
Tires scream. Carrying several pallets of cinder blocks on a flatbed trailer, a rapidly moving semi truck jackknifes. A parked Porsche is reduced to twisted bits as the tail rips through it, and a BMW becomes a ramp for the front end of the trailer, while the tractor is shoved sideways into a minivan. Raking shop windows, the trailer in slow motion slides along the sidewalk, then tips over sideways, preceded by its blocky gray cargo. There's no place to go but up, and I leap. The tide of blocks grasps and batters my feet and shins. Please, not the claws, not the claws! I wrench my heels and tail upward and get my hands on the side of the trailer. Is it going to roll further? It slams back to earth as the front end, kingpin ripped completely loose, finishes scraping the top off the BMW and drops to the sidewalk. Concrete blocks clank metallically as the last of them find their positions on the ground. I'm stopped in the middle of jumping over the trailer. Emerald is trying to pull my pocket in over his head. Silently; that means he's unhurt.
Attila: Yaaaah!
Her right arm is pinned under a pair of blocks which, together, weigh about as much as she does. She curls her legs over her, lets out the rage call, and slams the lower block, raising it enough to snatch her arm out, and she rolls to the side as the upper block topples. Then she's up and onto the pile, tail lashing, dragging blocks one handed. The right arm is tucked against her chest.
Attila: Simba, help! Tiger's under there!
Oh, no! I nearly jump down the unstable pile. Jeez, my right shin hurts! I mustn't make a mistake and injure myself further because Tiger needs me. I balance speed and care. There's a small patch of black fur visible. I hurl aside two rough gray blocks, one in each hand. Hold it! Goals, issues, action. The goal is to rescue Tiger. Issue: I can't do it alone.
Me: Attila! The restaurant with the good smell, run there and get them to call 911, and try to get people out here to help take off the blocks. 911, then helpers. Run!
Good kitten, she scoots without insisting on doing hands-on rescue work. Issue, we have to get Tiger out of there after the blocks are off, so they should be stacked neatly out of the way. Issue, avalanching blocks are a hazard; the slope must be kept not too steep, even though we have to move more blocks. Emerald pops his head out to see what happened.
Driver: I'm sorry, I'm sorry, the brakes just locked and I couldn't hold it straight. I'm sorry!
Me: Apology accepted and please take bricks off that side of the pile. Stack them out of the way so we have room to work.
I'm indefatigable in my desperation. The driver is soon gasping. I don't really care. People in suits start arriving from the restaurant and pitch in, taking my cue to stack the blocks without being told. Tiger's right arm is revealed. There's a pulse, weak and slow, but running. I redouble my efforts. Cinder blocks are rough, sharp and abrasive. Thanks to my designers for opal skin plates! Even so my palms and finger skin are going to be mostly used up by the time we get Tiger out. Several of the humans have bloody hands already. Attila is back, wisely staying away from feet, but pushing blocks with her hip and one arm into neat rows, as high as she can reach, so the stacks don't fall over. Good kitten. Tiger's head is coming into view, and the last block comes off wet with blood where it hit the left side of her head. I don't like the look of that wound. I can feel her breath moving shallowly. A human's breathing mechanism would be entirely useless under such a weight. I take off the blocks between her chest and the trailer. Oh, jeez, her left arm is under it! What are we going to do?
I plant my feet on either side of her arm and dig my claws into the splintered wood deck, now vertical. There's no point in even trying, because the trailer has to weigh at least two if not five tons, mostly concentrated at this end, where the wheels are. A crane? How many hours will that take? I look at Tiger's head wound. If the trailer can't be moved, and Tiger has to be moved, her arm evidently isn't going along for the ride. I feel where the arm goes under the trailer bed: the bone is clearly broken but good lion construction holds the pieces together. I again plant my feet, but this time I wedge my knuckles under Tiger's arm. I squat, pressing my cheek against the trailer deck, and heave with all my might. Something gives. I heave again, and the bone shears with the sound of fiberglass being shredded. Work on Tiger's feet comes to a stop.
Me: If anyone has a better idea to get her loose, you've got about five seconds to suggest it. Then look at the blocks you're stacking if you're squeamish, because I'm going to finish the job.
Attila covers her eyes but I can see her peeking through her fingers. In a few weeks this is going to be humorous. I stand astride Tiger and bend double; I bite her arm with my Smilodon fangs. They cut with difficulty. I am not dismayed. Needlelike bone fragments harass my tongue. I am not deterred. My mate's blood tastes like my own.
The job is done. My muzzle is bloody. The human nearest me has a tie with colorful interlocking squares. He must have some medical knowledge for he takes it off, steps around Tiger's head, and ties a skillful clove hitch around what's left of her arm, which is oozing blood at a desultory rate. I hear a distant siren. Is that for us? Planning: what comes next? One item won't wait. I take the envelope gently from Tiger's pocket.
Me: Attila, keep this envelope in your pocket until a family member, Coyote or Mariposa or me, takes it back from you. We still have to turn it in, injuries or no, and it can't stay with Tiger, and I'll be too busy taking care of her. In your pocket, not playing with, OK?
I check Tiger gently. Her left leg is definitely broken, upper and lower both. The right one has been pummeled but seems to be in one piece. There's a bloody spot where the corner of a block was driven into her belly. If the force was enough to rip lion skin there has to be some major bruising inside, at least. Fortunately it's well above her uterus so Fox should be safe. I hope. One rib is clearly sheared off and likely its neighbors aren't in good shape. One can't be sure without x-rays, but it looks like she fell on her back or side and her spine was not in the way of the blocks. The head injury worries me the most. I'm not going to even touch it.
Paramedic: Step back, please. Clear a space. Bob, it's lion people! This is going to take the stretcher.
Me: Tiger has a major head injury. Left leg is broken. Likely abdominal injuries. Good chance no back injury. I have some EMT training.
Paramedic: Let me get her vital signs. Is this arm OK?
Me: OK. She's in shock and she's going to stay that way until bleeding is under control. That's how lion people are built. Let's take her to University Medical Center, promptly. Two other passengers: me and Attila, that's her, plus my pocket kitten, and Tiger's pregnant.
Paramedic: County Hospital is closer.
Me: Her medical records are at University Medical. Her veterinarian is at University Medical. Et cetera. Get the picture?
Paramedic: You're the boss. 50 over 35; heart rate 32. Atypical shock. Let's get an IV in her.
Me: You don't have a needle that will get through her skin. Besides, lion people in shock don't leak fluid like humans do. She'll snap right out of it as soon as I hit the button, when internal bleeding has been ruled out or patched. By the staff at University Medical.
Paramedic: I'll take your word on it. Can you lift her middle? Bob, hold up that leg, and I'll do the head. On three. One, two, three, lift!
We lift Tiger onto the cloth and wood stretcher, and the paramedics, hemmed in by the stacked bricks, carry it out to the wheeled gurney, and that into the ambulance.
Me: Attila, go in the ambulance and sit where they tell you. People, thanks to you all for helping stack blocks.
The humans from the restaurant wave and wish us luck. I turn to the paramedic, whose name I haven't been able to figure out.
Me: Where should I sit? Here? Do you have a phone in this thing? I need to have Tiger's medical kit brought to the hospital. It has carbide cutting tools.
Bob: Here, I've punched the buttons to make it work as a phone. Just dial your number.
I do so, as Bob drives off, siren wailing. The phone rings. Rings. Please let them not be at the park!
Mariposa: Hello, Simba and Tiger Leones, Mariposa speaking.
Me: Mariposa! Tiger has been badly injured. Attila and I are injured but on our feet. Emerald is fine. We need Tiger's medical kit. Who's there who's responsible, reliable and has a car? Ms. Alarcon? I think Mrs. Fisher is a little too old for this, but ask her if you can't get Ms. Alarcon. She should bring it to the University Medical Center emergency room, and I'll be there to collect it. You do not come; you stay there with the kittens until you're relieved. Repeat your instructions back.
Mariposa: Send Tiger's medical kit with Ms. Alarcon to the University Medical emergency room, and I stay here and take care of the kittens. How bad is Tiger?
Me: Pretty bad. We won't know until we get x-rays. Pray for her. I have to go. Any last questions?
Mariposa: Should I try to get Coyote back here?
Me: He can't help; by the time you find him and he gets somewhere he won't be needed. Don't screw up his life for nothing. He'll find out when he's done with registration.
Mariposa: OK. Good luck. I'm scared.
Me: So am I. Be steady. Bye. Bob, I need to call the Lion Foundation to get our doctor down here. What buttons do I press to do that?
Bob: Press phone, 91, then the area code and number.
Me: Got it. Hello, this is Simba, is that Mr. Lewis?
Mr. Lewis: Simba, good to hear from you! When are you coming to visit?
Me: Not for a long time. Tiger's badly hurt, and we need Dr. Newman to turn around and come right back here, to the University Medical emergency room.
Mr. Lewis: Oh, jeez! Will do. What happened?
Me: A truck turned over on her and she's got major head trauma, plus this and that. Dr. Newman will be tired; maybe someone could drive him back so he's rested when he arrives.
Mr. Lewis: Sure; we'll send someone. Are you OK?
Me: My leg is messed up. Attila's arm got crunched but I don't know if it's broken. Look, I want to see how Tiger's doing. Could you get things organized on that end? A box of supplies or something?
Mr. Lewis: Right, we're on it. Good luck.
The ride to the hospital is noisy and seems interminable. My shin bone stings inside every time I move my leg. Whatever the injury is, hard physical labor on it was definitely not the best treatment. I'm scared for Tiger. And what am I going to do with Attila and Emerald? What I'm going to do is to be steady. And Tiger may be the worst injured, but not the only one.
Me: What's your name? I'm Simba, she's Tiger, the one in front is Attila, and this is Emerald.
Paramedic: I'm Jason. Glad to meet you.
Me: Attila's arm is hurting her, and so is my leg. If you have two compression bandages I think it would do us a lot of good.
Jason: Keep an eye on Tiger and I'll get the bandages. Attila, can you hold out your injured arm so I can wrap it? I can see where it's swelling; this may hurt a bit.
Attila: A-a-ah!
Jason: Sorry, Attila, but that should start to feel better now. Let me make a little sling for you.
Jason cuts some gauze off a roll and ties it in a loop, and drops it over Attila's head. She puts her arm through it, and tries to find a comfortable position.
Jason: Spread the gauze, kid, so it's not pressing right on the bruise, and people find it more comfortable if you put it distally, that is, toward the hand a little bit.
Attila: Thank you. It does feel a little better now.
Jason: How's Tiger doing? She seems stable. Now your turn, Simba. Can you stick up your leg toward me? That's a bad one. Do you know what these white threadlike bits are? They look a little like fiberglass.
Me: Oh, great. That's bone. Do you have some erythromycin powder you could dust in that, before you tape it?
Jason: Sorry, we let them debride it properly in the hospital, then do antibiotics.
Me: OK, put a wad of gauze over it and wrap it up. I'll have it taken care of when Tiger's safe.
Jason: I wouldn't recommend that. I'd have that taken care of as soon as we get there.
Me: So would I; it's no fun walking. But I'm the only one around here who knows anything about lion medicine, and saving Tiger is more important than damaging my leg. And could I have another piece of that gauze? I got a mouthful of bone fragments and I'm having trouble getting some of them out of my lips and tongue.
Jason: Is your jaw broken?
Me: No, the fragments are from Tiger's arm. You may have noticed that it's still under the truck, and will be there for quite some time.
Jason: My God.
At the speed we're going it can't take more than ten minutes, but it seems like we're bouncing through downtown Salt Lake forever. Finally we drive under the emergency room's portico. The paramedics unload Tiger and wheel her up to the triage nurse.
Nurse, calmly: What's her injury?
Me: Major head trauma, possible abdominal injury, broken leg, broken ribs, likely no spine injury. She's pregnant, and tetracycline is fatal in lion people. I have EMT training. She's in shock and should not be revived until stabilized. The best move at this point would be x-rays. She is Tiger 6-3512 Leones, clinic number...
I extract everything from Tiger's pocket, and hunt for her clinic card. Voila! I hand it over to the nurse. From the codes on it they'll know what insurance company to bill. Bob the ambulance driver hands his paperwork to her also: very efficient, how they handle getting paid.
Me: Her doctor here is Dr. Macquarie. Could you have him called? And Dr. Newman from the Lion Foundation is driving down, but he won't be here for several hours. And since I'm the only person around here who knows about lion medicine, I'm going to stick real close to Tiger. OK? This is Attila. Attila, sit here and wait. I'm sorry I can't take care of you more, but Tiger comes first, right? And I may have to leave Emerald with you later. Whatever you need, ask, try to negotiate something satisfactory. And if you have to put yourself to sleep, make sure the nurse knows how to wake you up, OK? Are you scared?
Attila: Uh huh.
Me: So am I. Let's be steady, as lions should. They're taking Tiger away; I have to go. Be steady.
X-rays are not difficult, but I have to head off several nurses who approach with ordinary steel needles to plug in an IV hookup.
Nurse: Mr. Leones, there's a police officer outside with something for you.
Me: A cop? Oh, there he is. Thanks, nurse. Officer, I'm Simba Leones. Thanks for bringing over the medical kit.
Cop: A girl flagged me down and her story seemed kind of strange, but it is a set of medical stuff, and I figured she might not be ratfinking me and I'd better get it over here.
Should I dump Attila on the cop, or keep her here and have her arm treated? I open the medical kit.
Me: You did right. Nurse, now we can set up the IV you've been so anxious to jack in. See my arm, see under the fur; you can see lines on the skin that mark the veins. Tiger's are white. Right here is probably the best place for an IV. Shave the fur first since tape is useless on fur. Use the needle in this package. A bag of saline won't hurt and may help. Officer, your patrol territory is back around Casa Serena, right, so you have to go back there now? Could you do me a big favor? Take two children home, and leave them with the girl who gave you the medical kit. I can't care for them properly here, and neither can anyone else.
Cop: Sure, no problem.
Me: Nurse, here's the medical kit, and don't start slicing without me, OK? Officer, Attila is waiting right out here. Attila, how are you doing?
Attila: I'm scared and lonely.
Me: You have a right to be. I've asked this police officer to take you and Emerald home to Mariposa.
Hearing his name, Emerald pops his head up.
Attila: Not with you?
Me: You're not with me anyway. You're a lot better off with Mariposa, and Coyote when he comes home.
Attila: I have responsibility for Emerald?
Me: Scary, isn't it?
Attila: Yes. When he gets hungry, I haven't any milk to give him. I'm just a little kitten.
Me: Right, I thought of that. Give him the kind of milk you drink, and teach him how to get it out of a cup. And put papers under him because he'll spill a lot until he learns how to do it. Can you and Mariposa do that? I'll have to help put Tiger's head back together, and Emerald can't come in the operating room, and he'd get hungry here and there'd be nothing at all to give him.
Attila: OK, I'll be brave. How do I carry him, with one arm hurting too much?
Me: Try piggyback. I've seen you and him do that at home. Or maybe he'll walk.
Cop: I could carry him.
Me: He isn't familiar with you and won't let you touch him. Attila, show the officer what ``won't let'' means.
Attila does a threat display, but her heart isn't in it. Even so the cop jumps back.
Cop: Thanks for warning me.
Me: Attila, you put the seat belt around Emerald and make sure he stays in it. Hold his hand and stroke him. You can tell the officer our address, right? Is everyone set? OK, Emerald, I want you to go home with Attila.
Emerald can't understand words, but I accompany that speech with hand motions which Emerald follows with his eyes. I lift him out of my pocket and set him on Attila's shoulders. She walks toward the exit. Emerald looks back and starts wiggling. I see Attila trying to stroke him with her bad hand, while hanging onto his leg with the good one.
Me: Go home with Attila. Go home!
Emerald: Yaaw! Yaaw!
But he doesn't break Attila's firm grip, nor writhe definitely enough to knock her down. Attila is earning her name today yet again. Quickly they're out of sight and I go back to attend to Tiger. The x-rays are ready and two doctors are looking at them while leaning over Tiger.
Me: I'm Simba. Did you guys do a veterinary rotation?
First doctor: What?
Me: I guess not. That makes me your reference for lion physiology and anatomy. What's your name?
Doctor: I'm Sam Milstein; I'm the trauma neurosurgeon here. And you are...
Me: Simba Leones, EMT experience, and also experienced as a lion person. Not as a neurosurgeon. I plan to stick with Tiger, including the operation that's obviously going to be necessary. Our doctor is coming, but it's going to take several hours for him to get here. Dr. Macquarie on the hospital staff is familiar with us, but not at this level.
Dr. Milstein: Macquarie? I don't think he's going to make it; I think he's at a meeting in Atlanta. Look, I don't like civilians sticking their noses in my way. Just how much does your EMT training cover? Are you going to puke on my patient?
Me: Lion people don't vomit when they're emotionally upset. My main contribution to this team is knowing which tools to use to cut what. Think how you guys would deal with fiberglass repair. Also lion physiology, how to interpret vital signs. And I'm your anesthetist; lion people are a lot different from humans in that area.
Dr. Milstein: OK, what do we do about this? Her head should be shaved, I assume.
Me: Yes, shave.
Dr. Milstein: Nurse, see to that, please.
Me: What's the subgoal? I assume we're supposed to decompress the skull. You can do the skin flap thing same as on a human. Once the bone is exposed, one possibility is to use the nibbler to cut through the fracture area, and the disc of bone will pop right out.
Dr. Milstein: The way it's contused, the blow was heavy. I'm worried that may not be enough. Unless lion people are a lot different from humans, the brain is bruised and is swelling. I have to make room for that.
Me: I hadn't thought about swelling. OK, drill a hole and nibble a big circle. Then what?
Dr. Milstein: Then we let her brain air out like Darth Vader. We let the swelling go down and hope for a good recovery. We'll put some pins in her cranium loosely so the bone plate can lift out a certain amount to accommodate the swelling. When it goes down, then we fix the plate in place more solidly.
Me: It certainly sounds reasonable. Nonmagnetic pins, right?
Dr. Milstein: Of course: tantalum. It says here possible internal injuries.
Me: Right. That wound. If the block hit hard enough to cut through her skin, whatever is underneath isn't in good shape.
Dr. Milstein: Rex, you got that?
Rex: I'm in here; I'm prepping the scope.
Dr. Milstein: Regina, get the patient prepped, and shave a patch for Rex to do a laparascopy. Any particular spot?
Me: Our livers are bigger than yours. Anything lower than about here should be fine.
Dr. Milstein: And Orval, when Rex is out of the way you can work on her skeleton. What's your name, Simba? Why aren't we seeing her chest move more?
Me: Our ribs are constant volume, when not broken, and our diaphragm acts on the lungs differentially. That's the only reason Tiger could breathe underneath a ton of bricks.
Dr. Milstein: Weird. OK, people, let's get scrubbed up, and Simba, could you get that blood off your face? Did you get hit in the mouth?
Me: No, my leg. The blood on my muzzle is Tiger's. Notice her arm is still at the accident scene?
Dr. Milstein: Shit! I'm glad you didn't try brain surgery. Scrub in here.
Human cleaning rituals are a joke for a lion person, because of all our fur, but at least I won't have my hands inside wounds. I go along with being covered with rubber gloves. We have to wait a few moments while the surgical nurses finish smearing Tiger's shaved head with vile-looking antiseptic.
Me: Dr. Milstein, Tiger is pretty unconscious, but I'm going to program half an hour of anesthesia just in case. And what's her blood pressure?
I press Tiger's shoulder button four, ensuring that she'll stay asleep. I usually sleep an hour per button press when I'm shedding, but what we're going to be doing to Tiger will be a lot more painful and I plan to hit the button every half hour.
Nurse: Blood pressure is 60 over 35, heart rate 37. The blood oxygen monitor doesn't work; her skin is black or brown everywhere and the light won't go through.
Me: See if it's any good on her tail tip. I don't like the pressure; it should be 50 over 35. I think she's bleeding internally. Nurse, can you get 300 ml of fluid into her fairly fast, and then let's see if the systolic pressure goes down.
Dr. Milstein gets started with his part of the surgery, and Rex, whatever his last name is, uses a second carbide cutter to make a small slit for the laparascope to go in. There's a dirty nurse who takes tools out of the medical kit and pulls open the wrappers, so the clean nurse can remove the sterilized tool from inside and pass it to the doctor.
Dr. Milstein: What's in this skin? It feels like I'm cutting through thin bone.
Me: The carbide blade is breaking the opal skin plates. Lion people are well protected. As you can see, steel tools would be useless.
Dr. Milstein: I hope the skin isn't glued to the cranium; I wouldn't like to have to scalp her.
The skin peels off without difficulty, fortunately. Now it's time for the drill. Actually a hole saw is used, and Dr. Milstein advances the depth stop cautiously so as to saw through the bone but not into the brain. A plug of bone comes out stuck in the saw.
Dr. Milstein: Boy, that's swollen. Irrigate, please. I kind of chewed up the dura on that last cut; it was pressed hard against the cranium. Nibbler's next. With carbide teeth, of course.
Me: Of course. Watch the bone chips, and don't get them stuck into your fingers. They're sharp.
I really don't like the way Dr. Milstein has to shove the nibbler into the hole, but he gets the baseplate to grip inside the skull and begins chewing. Tiger's brain must be really swollen to exert that much pressure.
Me: Vital signs, please?
Nurse: 55 over 35, rate 35.
Me: The fluid helped. Could you put in 300 ml more fluid?
Rex: There's a fair amount of blood in here. I'm going to have to siphon it out before I can find where it's coming from.
Me: Likely close to that laceration on her abdomen. Possibly a quick look there would find the source if it's not underwater.
Rex: Might find one of the sources. But it's a good idea. What is all this junk in here, duplicate organs? Well, there's a hole in her peritoneum and blood is coming out of that. I can go right through it. There's one of the culprits. An artery in the mesentery got creamed. I'm going to staple both sides shut. I'd like to cut a section out and splice, but that would take open work and I have a feeling that's not advisable, not for this. Anastomosis will take care of the blood supply. Zot, that's the end of you! I'll start siphoning blood and see what else is leaking.
It takes about fifteen minutes to cut a big disc of bone, which pops out audibly when Dr. Milstein finishes the circle. Tiger's brain is visibly bulging.
Dr. Milstein: That's relieved the pressure, and as far as I can see there's no gross hemorrhage. Give me the irrigator; I want to get all the bone chips out of there. Simba, is it going to work if I just press the depressed area back into the ring of sound bone?
Me: In theory. The fibers won't go back perfectly and you're probably going to have to force it into place, to get the inner surface even. If that doesn't work, nibble out the fracture zone, perhaps partial arcs.
Dr. Milstein has some tools, all sterilized, that you'd think more characteristic of a machine shop than a surgery. I'm waiting for the portable anvil and sledge hammer to come out, but a peculiar knobbed pliers and a crowbar are sufficient to reseat the panel of bone bashed in by the concrete block.
Me: Vital signs please, and how long has it been since we started?
Nurse: 50 over 35, rate 32. Elapsed time, 40 minutes.
I hit upper button four again to renew the anesthesia. The extra saline is diluting her blood, but it's giving her heart something to work on. Blood pressure regulation is complicated, but adequate blood volume is absolutely required.
Dr. Milstein: I'm going to put the lid back on now.
Rex: There was another smaller leaker that I stapled. Her bowel is badly bruised, and I think we should have a GI guy look at the pictures and think up a treatment plan, but as far as I could see it isn't perforated. The upper corner of one kidney also got bruised. Unless anyone has anything they want to check, I'm done.
Dr. Milstein: OK, staple up your hole and give her to Orval.
Me: I'd like to raise her blood pressure, but I don't want to blow up her brain like a balloon. What would be a good value?
Dr. Milstein: You make it sound like turning a knob. OK, dial in 70 over 50.
By briefly pressing shoulder button two I raise the pressure step by step as the nurse reads the numbers off the monitor. Dr. Milstein's fingers on the loose skull plate monitor how Tiger's brain is reacting to the pressure.
Dr. Milstein: Cool, that button business. That should be enough to keep her perfused but should let the swelling go down. Rex and I are going to clean up. Let's leave you two to Orval's tender mercies. We'll leave her down here for let's say half an hour, and I'll keep an eye on the swelling, then take her up to intensive care.
Orval goes to work manipulating Tiger's sheared-off rib back together. He makes a small incision and puts one big staple through it into the rib bone to hold the ends together, then two little staples to close the incision. He takes the necktie off Tiger's arm, which has been shaved, pushes the flesh back, and takes off a piece of the remaining bone using the small saw from the medical kit. He rounds off the edges, and irrigates off the chips. Then he cuts away the meat that lost its blood flow for over an hour, cauterizes newly bleeding vessels, and staples the skin closed over the arm's end. On Tiger's left leg above the knee he again makes a small incision on each side and drills into the bone. He attaches hooks using screws into the predrilled holes.
Orval: Simba, the femur is going to need traction, but for the tibia and fibula I assume the right treatment is wrap and splint.
Me: Right. Are we about done?
Orval: As soon as I get her wrapped.
Me: Afterward, could you have a look at my shin? I didn't get a good look, but at minimum one of the blocks cut to the bone, and it hurts whenever I step on it. I worry about infection.
Orval: Well, then, you shouldn't be stepping on it, and well you might worry. Regina, I'm done. Let's get Tiger onto a bed and into observation. Simba, come on into the scrub room and get your gloves and gown off. Yes, put it in the bag. Now you sit in that.
Me: A wheelchair? I've never used one of these things before. Hey, I forgot my pack.
Orval: I got it. From now on, keep your weight off the leg, and I might add, your dressing needs to be changed because it's oozing. Roll into the x-ray room. Now, one legged, up on the table. Marco, I'm going to want to see this leg, two directions. I'll take the dressing off. Oh, yuck, who debrided this?
Me: Nobody. I think some antibiotic might be helpful, and erythromycin is safe for lion people. Tetracycline isn't.
Marco: Slide your leg onto the paper, in the center. Hold still... zap. Now I'll rotate the machine, hold still... all done, no pain.
Orval: I can't say as much for my job. Get your leg out of that thing and sit back in the wheelchair while I look at the printout. I'm glad that's not my leg. And I wouldn't have been walking on it. Roll into the next room and get up on the table. This would have been easier when you were first injured.
He slides a shallow pan under my leg and starts squirting, prodding and scraping. It hurts a lot. There's no point for me to make noise because he's not going to stop. I squeeze my eyes closed and struggle to keep my claws retracted. Finally Orval puts a row of staples in to close the gash; among his various activities he's managed to shave an area of fur around it.
Orval: I've saved the best for last. Whatever hit you knocked your fibula out of line, and you won't be able to twist your leg properly. I propose to simply straighten it, give it a shove.
Me: Jeez, which secret police academy did you train at? Seriously, when our bones break the fibers won't go back like a clean break would, and the bone ends up longer. There's a recommendation that in a case like this, we put weight on it and pound the ends down until the bones are equal length. That sounds like a real fun experience. Speaking of which, I wonder how different Tiger's legs are going to end up, in length.
Orval: Let's take care of you first. Stay on the table while I straighten. This is going to hurt.
Me: A-a-ah! Torturer!
Orval. Well, it's reasonably straight now. Big John, come in here, would you? Simba, stand down, and get your arm around John's neck so you don't fall over. I'm going to hold the bone straight with my hands, and you do your treatment. I can feel in your ankle joint that it needs at least a millimeter of flattening, if not two.
I support myself on Big John and he gets me in a kind of bear hug, while Orval holds my lower leg. I shift my hips sharply to raise my body and drive down the leg. A-a-ah, that hurts!
Orval: That got half a millimeter off it. Do it again, harder.
Jeez, what am I supposed to be, a masochist? I get a drop into it this time. Yaaa-aa-ah!
Orval: That was a good one; it's close enough that your joint can take up the slack, and I kept the bone straight while you were doing it. You want to lay down for a while? Bone repair can be pretty stressful. Get up on the table and I'll wrap that thing. And I don't want you walking on it. Come back in a week and have it checked and the staples removed, and then the regular guy will decide how long you have to stay off your feet.
He puts a wad of clean gauze over the cut, and wraps it up again with the elastic bandage.
Orval: All done. I put some erythromycin in the wound, and here's a prescription for pills. You want to rest a while?
Me: I want to get back to Tiger. Lion people don't go into shock the way humans do. And could I get some crutches instead of the wheelchair? I don't feel very maneuverable, and I'll need to move around my house.
Orval: OK, John, could you set him up with crutches? You've been a very brave patient. And on Tiger, I'd better recheck her tibia-fibula length, but since they're both broken, probably I won't have to adjust them. I straightened them already. On the total leg length it's inevitable that she'll gain a few millimeters, given the way your bones respond. That shouldn't noticeably mess up her gait, though. If it does we can deal with it, maybe saw out a section, but I doubt that will be necessary. It's been about half an hour, so I'll take Tiger up to intensive care and set up her traction, and you can practice keeping up on those crutches. I'll use the minimum traction that will keep her femur straight, to minimize stretching.
It's a real pain walking on crutches; it uses muscles I hardly knew I had. I struggle along after Tiger as the orderly rolls her through the corridors. Heads turn, as they always do when a lion person is in a hallway. The intensive care staff get Tiger installed and hooked up to their own monitors. Drs. Milstein and Freeman -- that's Orval; he has a name tag on his regular clothes -- breeze in just as the preparation is finished, as if they know just how long to trail a patient. Orval strings ropes and a stack of weights to pull Tiger's femur into alignment against the spring force of her leg muscles.
Dr. Milstein: She's looking good at the head end. Let's see if we can get the blood pressure up to 85 over 60.
Standing one legged beside the bed, I work upper button two to achieve the requested pressure.
Dr. Milstein: And she could use a catheter. I'll bet her bladder's about to pop with bloody urine.
Me: A catheter isn't the most wonderful idea for a lion person. Nurse, do you have a dish or something that she could urinate into? That a human male could urinate in? Who's going to be doing this when I'm not here? These crutches are in the way! Hold it between her legs with one hand, and feel gently in the crotch area. On the side, feel those four lumps? Make sure you have the right one, and press the first one firmly. Right, catch her clit in the spout and hit button two. Voila, you did that like a lion person. Every four hours or 300 ml will keep her comfortable. If her bladder fills up she'll wet herself automatically. Um, Dr. Milstein, you said she's looking good. What should I be expecting?
Dr. Milstein: What I meant was, her brain isn't swelling any more as a result of the blood pressure. She's going to be in a coma for some time, at least until the swelling goes down. I'm going to be turning the case over to a staff neurologist and he'll talk to you about the long term prognosis. That depends a lot on how hard she was hit and what structures actually took damage, and how resilient the particular patient is. And since she's a lion person that makes it even harder to predict what will happen. I expect you'll have to wait for the edema to go down and recovery to begin, and then do functional tests, before you'll really know what to expect. Sorry I can't be more specific. And thanks for keeping out of the way in the operating room. I know it's hard for a husband to see his wife all banged up and me nibbling away at her skull. I've had medical students who were less helpful and more opinionated.
Me: Thank you, doctor. We'll take the three of you out to dinner, sometime when we're able.
Dr. Milstein: Thanks, I'll put it on my calendar. Bye now.
Now what? I flop in the chair next to Tiger's bed. Ouch! I'd better cut out the flopping for a while. I ache all over, though my leg leads the pack of biters. After the frantic activity of the last, jeez, I don't even know how long it's been. And I don't really have the energy to look for a clock. After all the activity I can see that the next step is going to be wait, wait, wait, and the vacuum of action is leaving a hole in my spirit. Tiger isn't going to die; of that I'm thankful. But how much permanent brain damage will she have? Has her brain turned into cooked cauliflower? Well, like Dr. Milstein said, we won't be able to find out for a while, probably several days, if brain bruises are anything like body bruises, with which I'm familiar.
Tiger has to wait now. Who's next in line? Well, actually, I think I am. I'm no use to anyone with my spirit in tatters. I sit myself up as best I can in this closed back chair, with my tail wrapped around me and my leg at the least painful angle I can manage. I clear my mind of all thoughts, particularly worries about Tiger, and I feel the space around me, radiating from my center. I set a fifteen minute timeout; I think I need a good long dose of this. Worries and aches prod at my consciousness. I let them go by, biting only a few hairs of my fur. Soon their number decreases, and my own radiance steadies and brightens.
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