Chandler didn’t stop moving. “His sats are collapsing. Lung’s gone. We need a chest tube NOW.”
The green surgeon blanched. “I-I’ve only done a few… in my fellowship. I always got my resident to do them.”
Keating snapped, “Then you’re not doing this one.”
The surgeon froze, eyes wide with shame and fear. Ford shoved a satellite phone toward Chandler. “Chase Command on the line. Dr. Patrick Hedges, trauma lead out of Denver.”
Chandler grabbed it with one hand, still bagging Dante with the other and the help of a nurse. “Hedges, this is Chandler. I have a male combatant, thirty-two, polytrauma, chest tube indicated, but we’ve got minimal equipment and no imaging.”
The speaker crackled. “Chandler, I’m with you. Tell me what you see.”
He leaned over Dante’s chest, sweeping away blood with a towel. “Patient is hypoxic. Sat at 82. Right lung… breath sounds diminished. Flail right chest. Trachea midline for now, but pressure’s climbing. He’s gonna tension.”
“Then we’re not waiting. You’re going in.” Pat paused. “Do you have lidocaine?”
“Negative,” Chandler said. “We’re raw.”
There was a pause—a single, heavy breath over the satellite connection. “All right. He won’t feel it anyway. Landmarks?”
“Fifth intercostal, mid-axillary line. It’s part of the flail segment.” Chandler was already prepping the area with iodine. “Scalpel, Kellys, chest tube thirty French, if we can find one.”
A nurse scrambled through the supply crate. “We’ve got a twenty and a twenty-eight. Nothing larger.”
Chandler swore.
“Use the twenty-eight. If he survives, Hunt can yell at me. Go nipple line. That’s the fourth ICS. Better than the moving one.”
Shannon swayed as her vision dimmed. Ford steadied her with a hand at her elbow. “Shannon, stay with me. You can’t go down too.”
Chandler positioned the scalpel. Keating and Jackson held Dante steady.
Hedges’ voice sharpened. “Deep breath. Make your incision on your exhale. Don’t hesitate.”
Chandler cut. Dante didn’t react. He was too far under, too far gone. Blood welled instantly.
“Spreading.” Chandler inserted the Kelly clamps, twisting them open to separate muscle and tissue. Shannon winced at the wet, hollow sound. A young nurse gagged in the corner.
“Tube,” Chandler commanded.
The head nurse slapped it into his free hand. “Advance on his exhale,” Hedges said. “Angle posterior. Air will vent first. You’re looking for fluid or air return.”
Chandler pushed the tube inward. For a moment, nothing happened. Then WHOOSH. A violent rush of trapped air exploded through the tube, followed by a wave of blood, spattering the ground. “Doc, we have air and blood. A lot of blood.”
Dante’s chest rose. The monitor beeped stronger.
Keating exhaled in relief. “We’ve got chest expansion. Pressure in the chest is dropping.”
“Good,” Hedges exhaled. “Secure the tube.”
Nurses taped it down. A makeshift Heimlich valve was attached, improvised from a cut glove finger and medical tape. Chandler sagged back on his heels.
Hedges’ voice softened over the sat phone. “Good work, Chandler. You just saved him. For now.”
Chandler scrubbed a bloody hand over his face. “Surgeon better get here fast.”
“ETA five hours,” Hedges said. “Hold the line. I’ll stay with you as long as the signal holds. How much blood do you have?”
Ford pressed the phone to his ear. “Command, confirm you heard? He’s still alive.”
