In Case of Emergency by Courtney Moreno

Courtney Moreno reads an excerpt from her debut novel, In Case of Emergency, forthcoming in September from McSweeney's Books.

In Case of Emergency

When conducting the triage of a multi-casualty incident, start by taking charge. Consider the textbook example, based on the events of July 16, 2002, in Santa Monica, California. On a Wednesday afternoon, against the sparkling backdrop of summer sky and swaying palm trees, an 86-year-old man drove his burgundy 1992 Buick LeSabre down three blocks of Arizona Avenue’s crowded farmers’ market. He was going about 60 miles per hour. He killed eight people and injured forty, and by the time his vehicle came to a stop there was a body pinned under the engine, a body resting on the hood, and an empty pair of shoes on the roof.

It will take some time before you show up to a scene like that and feel comfortable. It will take even longer before your only thought is here we go as you snap on gloves and get to work. But if you happened to be there, standing on Arizona Avenue between the rows of produce, the bag of kale your girlfriend asked you to pick up still dangling from your wrist as the Buick shuddered to a stop, you wouldn’t have time to think. Just remember the golden rule of emergency medicine: air goes in and out, blood goes round and round, any variation on this is bad.

We find him lying face down on Western Avenue with a river of blood coming  out of his head. !ere’s no crowd. !ere is only the feeling that people are watching. Our patient, the cops tell us, is about 18 years old. Our patient is a heavily tattooed John Doe; our patient is presumably a gang member.

Police were on scene long before us and didn’t bother to call it in. They assumed he was dead. They staged out the area, put caution tape around two of the residencies, and started hunting for clues, witnesses, the killer and the weapon. At some point somebody noticed blood bubbles popping out of his mouth. He was still breathing.

The firefighters, William, and I descend on him eagerly—already I know a case of true trauma is a coveted event—and the officers watch with bemused interest. One of them gets a notebook ready in case our patient regains enough consciousness to reveal his assailant’s name. I am very much a rookie still, but even I could tell that cop to put his notebook away.

The bullet went through our patient’s occipital lobe in the back of his skull and the larger exit wound shows that it shot out of his left temporal lobe. It must have skirted his medulla oblongata because his ability to breathe remains, amazingly, intact. Slow to form and slow to pop, blood and spit continue to balloon out of his mouth below his swollen eyelids.

I pour sterile saline over his face and wrap his wounds. All his clothes get cut off; he has no injuries below his neck, and we cover him with a sheet and strap him to the backboard.

Once we begin our transport to the Santa Monica trauma center there is nothing to do but monitor his breathing. I’m in the back with the lead medic, who watches as I match our patient’s respirations with a bag-valvemask. Occasionally, he says, “Good. You’re doing good.” I’m not sure if he’s talking to me or to the patient.

His vitals are fine but we know they aren’t stable. We know we’re looking at a dying person, or at most a comatose one, but his body has yet to admit the obvious. When William hits a bump in the road, the trauma dressing slips from our patient’s forehead and a large geyser of blood gushes out of the exit wound. I yank my arms out of the way and slide my foot out from the new pool of blood. I have brain on my pant leg.

“Can you grab another dressing?” the medic asks.

I watch as my right hand reaches for a new multi-trauma dressing from the top cabinet. My left continues to hold the mouthpiece in place. My body moves as though it belongs to someone else.

The lead medic helps tape up the dressing and I resume the simple task of pushing oxygen into our patient’s lungs. I try to slow my own breathing even while I control his. It’s so strange to watch him. His body is warm and strong; he’s lying there oozing with life, impossibly alive. Somebody loved him. His mother, his girlfriend, his brother, his friend. Somebody thought he was invincible. He had thought he was invincible, clearly. The muscle memory in his body reeks of it.

The trauma team at Santa Monica meets us in the parking lot and we quickly rush him into a room. They draw a curtain around him, shouting to each other through their light blue masks as they work. They intubate him, pound on his chest, administer blood, fluids, drugs. He dies among the machinery. His vital signs don’t circle downward so much as plummet. Looking at him one last time, I see his body jostle limply on the bed from the team’s halfhearted resuscitation. All that yelling across his body; nothing anybody does seems related to him. Where is he in the midst of it? A John Doe dead. A policeman’s empty notebook page.

My partner William doesn’t think he was worth saving. He tells me this in the parking lot while rolling a cigarette up and down two long, plump fingers. Behind him, I see he hasn’t cleaned up yet. A narrow waterfall of blood drips slowly through the perforated aluminum bumper and on to the asphalt. Parked next to the rig, the gurney resembles a portable murder scene.

“It’s good,” William says, nodding. “He’ll be the perfect organ donor.”

Gangbangers are a cancer, he tells me. They should be rounded up in close quarters so as to more easily kill each other. As he talks I feel sick, but it’s not because of the slow drips of blood or the brain matter glued to my uniform. It’s because in this moment I hate my partner more than I’ve ever hated anybody, and we still have twelve hours together on this shift.

Dispatch gives us an hour at station to clean up and not take any calls. I take a shower and put on my clean extra uniform while William hoses down the rig. The two-car crew is gone, and the station feels cavernous as I listen to the sounds of running water out front. I use gloves to put my dirty uniform in a biohazard bag, not entirely sure how I will ever wear it again. Maybe I should help William scrub down the back, but instead I wander into the sleeping quarters. Muted sunlight diffuses through the blinds as I collapse onto one of the unmade twin beds. I start dreaming almost immediately.

My dream takes place in a clean white room: white walls, tile floor. John Doe lies on the floor, still naked but all cleaned up: no sign of blood or brain or even the wound for that matter, and his skin and tattoos gleam in the light. His eyes closed, he’s not yet dead but not alive either, and whatever life exists in him is in the form of coiled up, angry tension. Some part of him refuses to let go.

I get underneath him. Curled up in a ball, my head lowered, my breathing labored, I inch his torso into a sitting position by leaning my body weight into his back and pushing the ground away. It’s slow, meticulous work and he is unnaturally heavy. His arms hang loosely at his sides and his head tilts back, resting on my spine. His mouth is ajar and through the open channel of his throat comes a kind of smoke or light. Every time I nudge him, his body relaxes a little more, and a little more of that strange substance slides out and escapes, curling up into the air around him.

That smoke, that light, is grateful to be going. It’s grateful to be going, and the more it leaves his body the lighter and more relaxed his body becomes. No tension, no ugliness, no holding on. Just a body on a tile floor, with smoke and light in the air around it, and me crouched underneath.

Excerpted from In Case of Emergency with permission of McSweeney's Books. Copyright © 2014 by Courtney Moreno.