DAY 10: difficulty breathing
@febuwhump
When Fao’s phone rang in the middle of the night, he startled awake, fumbling for it in the dark. He’d been out for dinner that night, definitely wasn’t sober, but the adrenaline was already doing a pretty good job of fixing that. They didn’t give him much information over the phone, just that they’d got a GSW and their rough location, in code so they’d be safe if anyone else happened to be listening. They were too far out to get back to the basement, and Fao would need to meet them halfway to treat.
He woke Ely, gave her a quick update, and pulled on some clothes, the first thing he found on the floor, his shirt and trousers from the evening. He didn’t have time to go looking for anything else, and bolted out of the house. There was kit in his car, and he knew there was kit in the van. He wasn’t sure what he’d need, but between both he’d probably have everything he needed. He sped through the streets to the meet location he’d been given, ditched his car somewhere safe, and scrambled into the van.
“What am I doing? Talk to me.” He asked breathlessly.
Harrison had become combative as he deteriorated, struggling between conscious and not. It scared the men, and they'd all taken a step back, too uncomfortable to help.
Fao was a welcome sight, his reputation preceding him.
"Uh, Harrison got shot. He won't let us near him, so we haven't."
Fao’s heart sank. Of course it was Harrison. “Oh, good. Just him bleed out all over the van, then.” He snapped, quickly throwing his hair up into a bun. “I need proper light, one of you sort that.” His voice was cold, commanding, rolling his sleeves up and quickly looking Harrison over. It wasn’t hard to see where the blood was coming from, and he shifted his weight to brace himself as he grabbed gauze and put as much pressure on it as he dared. “You. Come here, take over the pressure.”
“I, uh, I…”
“Shut up, I don’t want to hear it. Cover my hands with yours and hold the pressure until I say otherwise. Unless you want to start an IV? No? Didn’t think so.” He snapped, as the other man took over. He wiped his bloody hands off on his shirt, and shifted over slightly to Harrison’s arm, eyes looking critically for a vein as he rifled through the kit.
The pain somehow got worse. Harrison wasn't sure how, but it did. He cried out through gritted teeth, trying to arch away. It took a moment to coordinate, but he started swinging, trying to get away.
Fao ducked out of the way, catching Harrison’s fist and gently forcing his arm back down. “Harrison? It’s okay, you’re okay. It’s Fao, I’ve got you. Try and relax, you’re safe now. I’m helping, alright? Let me help.”
"He's going to hit me!"
“He’s half unconscious, try harder to dodge him.” Fao shot back. “I’m working as fast as I can.” He gritted his teeth as he tried desperately to get a vein, struggling with poor light and Harrison’s struggling. He got one eventually, shouting triumphantly. It wasn’t enough, and he wanted more access, but he could at least get some pain relief in, hopefully settle him.
Harrison twisted as Fao shouted, whining as he tried to get away. His chest heaved as he struggled to get his breath, the feeling he was drowning all too much.
“Sorry, sorry.” Fao soothed. “You’re okay, I’ve got you. It’s gonna be okay, Hars. Just focus on doing that breathing, let me to do the rest. Giving you something for the pain, now, gonna make it easier.” He told him, quickly checking the drug before he gave it.
His shouts died down into cries, quiet whimpering softly to himself. The pain had started to ease slightly, making it easier to focus. It made breathing more difficult, though, and he couldn't stop the panic coursing through him.
“You’re okay, that’s it. Well done, keep breathing for me.”
He turned his head, looking towards Fao's voice. "Help."
“I’m helping, I promise.”
"It hurts." He managed, finally managing to focus on him.
“I know, I know. I’ve given you some painkillers, they’ll work soon.”
"'m dying."
“No you’re not. Just focus on your breathing for me, let me sort the rest.”
"I am."
“That’s it, good.” Fao reassured. There was so much blood, and he was really struggling to properly control it. The van went over a bump and jolted, and Fao tried to brace himself on his knees. “Fucking hell.”
Harrison whined, trying to pull away from the pain. It was everywhere, though, and there was nothing he could do.
“Well done, that’s it.” He soothed. “I’ve got you.” He stretched for his kit, rifling through to try and find what he needed. He needed a trained someone, anyone who he could trust. Not Harrison’s little team.
Frustrated and tired, he started fighting against the other man. He got a solid elbow in their ribs, the relief of pressure against his side just bliss.
“I know, I know.” Fao murmured, moving to try and pack the wound.
He twisted again, curling away from Fao. His scream died on his tongue, his hands pushing against Fao's.
“I’m sorry, I know it hurts.” Fao muttered. He was happy enough with the packing, and moved to try and get a listen to Harrison’s chest. It was loud on the van, and he struggled to keep his balance as he listened, swearing to himself.
Harrison could feel himself slipping, the ceiling of the van swimming in and out of focus. Even the pain couldn't keep him conscious, his head lolling.
Fao’s stomach twisted as Hars lost consciousness, but he was relieved in a way. At least he wasn’t in pain. He didn’t like what he was hearing at all from his chest, and dug in his kit to find what he needed for a chest drain. It certainly wouldn’t be perfect, but it would do. He didn’t even bother talking to the other men as he grabbed a scalpel, found his landmark, and made the cut.
He definitely felt that, and he cried out again, but he wasn't with it any more. The men beside Fao retched, especially as blood quickly poured from the drain.
Fao rolled his eyes as the men retched. What he wouldn’t give for Steve or Finn or someone. Trying to manage this completely on his own wasn’t working. He took a set of obs as best he could, blood soaking his trousers and making them cling to him. The numbers he got back were more than a bit concerning, despite his interventions, and they weren’t getting any better. Fuck.
Harrison coughed and choked, spots of blood on his lips. His resps were through the roof, his heart rate doing its best to compensate for his blood pressure circling, for his blood volume pooling on the floor. He managed to catch Fao's eye, and he met his gaze with panic and fear in his eyes.
Fao locked eyes with Harrison. “I’ve got you, Tomcat. You’re gonna be okay.” He told him firmly. Things were just consistently getting worse, though, and Fao felt considerably out of control. He gave as much TXA as he felt he could, but it wasn’t close to enough to help the bleeding.
“How far out are we?” He snapped, asking whoever cared to listen.
"We've still got at least fifteen minutes."
“Fuck’s sake.”
Hars could feel himself slipping again, missing parts of the conversation. He grabbed for Fao's top, his hand leaving more bloodied streaks across it.
"I want Steve."
“We’re gonna be with him really soon, Hars.” Fao murmured. “He’s gonna be waiting for us at home.”
He shook his head. "I'm not gonna make it."
“As if I’m giving up on you. I’m gonna make sure you’re okay, alright? Hold on for me.”
He knew Fao was trying his best, and he’d continue to do nothing but. He trusted Fao with his life, and they unfortunately kept ending up in situations where it was tested. It didn’t take a genius to know he wasn’t okay, and the small bit or working brain he had left had worked out it probably wasn't going to end well.
He forced his eyes open again, though he didn't remember closing them. "It's okay."
Fao’s repeat set of obs were no better. In fact, they were worse. He swallowed thickly, digging around in his pocket for his phone. He needed to talk to Steve, needed someone medical he could talk to, to reassure him he wasn’t completely out of his mind.
He chucked it on the floor of the van on speaker as it rang, and he prayed he’d answer.
"Fao, talk to me. I heard the call for medical."
“It’s Hars, and it’s bad. We’re still miles out, in the back of a shitty van, and all I have is my kit.”
Hars stirred again. "Steve?"
"Hey, Hars. You causing problems for Fao, eh?" He tried to sound light for him, but even he could hear the waver in his tone. He cleared his throat. "What's happened with him? Head to toe, obs, and what kit do you have?"
“GSW, it’s gone just under his vest, entry is the abdo but exit is further up into the chest. Haemothorax on the right. I’ve got a drain in but it’s putting out so much fucking blood. Pulse 138, BP 76/50, SpO2 94 on high flow, Resps sitting at 36, he's still not getting chest rise on the right. He's with it enough, but he's starting to pass out and stay out. I've given the TXA but it's just not stopping. The floor is covered, I'm covered. It’s my kit, it’s decent. Airway kit, ket, paralytics, TXA. I’m just out of my fucking depth here, nobody else knows a fucking thing and I feel like I’m going insane.”
Steve took a moment. Well, fuck. "Right. Take a breath. Reassess, keep going ABCs. You need to get on top of that bleeding. He's not going to be able to compensate forever. Have you got anything to give? Will they follow instructions?"
“I know he won’t compensate forever.” Fao snapped. “I’ve got saline but no blood. They’re fucking useless, hadn’t touched him at all when I showed up. Not even put pressure on.”
"Fucking hell. Okay. Fluid bolus, see if that helps his pressure at all. He's not going to hold his airway by himself if he goes, so just be careful."
Fao quickly set up the fluids, wiping his hands on his trousers as he struggled with the connectors. Fluids running, he forced himself to breathe. “Alright. Fluids in. I want to sort his airway before it becomes a problem.”
"If you're thinking RSI, you need to trust they can help."
"Steve." Harrison interrupted again, apparently unaware of the conversation.
“I don’t think I’m going to have a choice, Steve. I’m watching him deteriorate in front of me, and we’re still miles out.”
"You can see him, not me. Do what you think is best."
Unimpressed by Steve's lack of response, he shoved at Fao with a frustrated grunt. "Steve."
Fao huffed. “Thank you, Hars.” He muttered under his breath. “He’s very insistent that he wants you, Steve.”
"Hars, we're just trying to help you."
"No." He shook his head, though Steve couldn't see, and Fao wasn't sure he didn't realise that.
“We are, I’m doing my best right now Hars. Focus on breathing like I said.”
He sniffed, setting himself off coughing again. The pain exploded again, despite the morphine, and, once more, slipped under.
God, it was just getting worse. He hated watching Harrison slip into unconsciousness again, powerless to stop it.
"Fao, talk to me." Steve's tone was tense, and Fao could hear him pacing.
“Unconscious again, I’m repeating obs.” Fao replied, his own tone similarly tense.
"Come on, Hars. Don't do this." Steve murmured, wishing he was there with them.
The blood pressure cycled, protesting at the numbers. It continued tightening, way into the two hundreds, and Harrison gave a whine. He tried to pull away from it, panicked.
“Hey, hey, it’s okay. Just give it a minute, I know it’s uncomfy.” Fao murmured, but it wasn’t a good sign. He knew full well it wasn’t high enough to need that kind of pressure - it was just struggling for a read full stop.
Harrison, of course, didn't listen. He twisted away, an unintelligible shout in both pain and frustration.
"Hars, listen to Fao. He's looking after you."
“It’s alright, it’s okay.” Fao tried vainly to soothe. But sure enough the blood pressure gave up, failing to get a read, and Fao’s stomach dropped. “Fluids haven’t done shit. It won’t even read, just cycles until it gives up.”
"You're going to have to give more, you can't RSI that low. Has he got a radial?"
It took Fao a moment. “No. Nothing.”
"Give him fluids."
“I might as well just pour them on the fucking floor.” Fao muttered, but swapped the bag over to give more.
"Just try."
“Yeah, they’re running.”
Harrison screwed his face up, managing to squint at Fao. He was sure he'd heard Steve too, but the huddle of men behind Fao were too small to be him.
“That’s it Hars, you’re alright.” Fao said softly, half as reassurance for himself.
"Where's Steve?" He slurred, more of a mumble than anything.
“On the phone with me.” Fao replied.
"Right here, Hars."
“Both of us are looking after you.”
"Sorry."
“Don’t apologise.” Fao said firmly.
Harrison lapsed back into silence, somewhere between conscious and not. As the blood pressure started again, he whined once more, but didn't pull away.
Harrison’s blood was drying on his hands, as Fao waited for the machine to read, praying it would give him something. Just a number would be better than the endless cycling.
Harrison's breath caught in his throat again, and his frown deepened. He knew Fao was looking after him, and Steve was there too, somewhere. He could see Fao leaning over him, doing things in slow motion. Which left Steve..
"Dad?"
Fao’s stomach twisted, and the noise Steve made over the crackled phone line was less than dignified.
“I’m right here, Hars. I’m right here, I’ve got you.” He replied, his voice wavering. “You’re going to be okay.”
He seemed to have a sudden rush of energy, though his observations were still terrible, and his prognosis even worse.
"Thank you." He muttered softly.
Fao sucked in another deep breath, forcing himself to re-focus. He had to keep doing this. “Blood pressure is a little less shit. I’ve at least got a number.”
"That's good." Steve managed.
Harrison reached for Fao’s hand, for a moment of comfort in his desperation.
Fao squeezed his fingers. “I’ve got you.” He murmured. He laid out his airway kit with the other hand, leaving smears of blood all over it, though he didn’t notice. He needed the blood pressure up a bit more before he could fully RSI, but it never hurt to prepare.
The squeeze managed to help, a tiny hint of a smile gracing Harrison's blood-splattered lips. He tried his best, his fingers twitching in Fao's before his eyes rolled. It didn’t take long for things to go south, as Hars took a breath and then stopped.
“Fuck.” Fao muttered, snatching up his kit. He couldn’t put this off any longer now, he needed control of his airway. Unsure just how conscious he was, having watched him flick in and out, Fao chatted away to him as he sorted it, half to keep himself from losing it. “Alright Hars. That’s you finding your limit, hmm? It’s okay, I’ll take over from here. Got some meds to get you off to sleep now, so you can have a nap whilst I do the hard work.” He quickly pushed the ket, watching him carefully. There were men clustered around Harrison’s head, and Fao snapped at them to move, which they did. Happy with his sedation, he pushed his roc, bagged until he was happy with it, and snatched up his tube and laryngoscope. He was rusty with his intubations, of course, so what better time to practice than in a dark, moving van covered in blood? But Harrison, for all he made Fao’s life difficult, apparently wasn’t a difficult airway, and Fao got it first time. He shouted triumphantly, checked his placement, and then secured it.
“Tube’s in, airway’s secure.”
Steve let out a shaky breath. "Good. Well done."
Fao couldn’t breathe for Harrison forever, not if he was going to continue to manage the bleeding. “Which one of you lot is the most competent here? Who’s not a complete idiot?” He asked.
They were all quiet, slightly afraid of Harrison and definitely afraid of Fao. After a moment, one of them stepped forward.
"I can help. What do you need?"
Fao looked up. “Are you capable of breathing?”
"For him?"
Fao huffed. “Essentially, yes. Every time you take a breath, I want you to squeeze this to breathe for him, too. Can you do that?” He asked, demonstrating. “I can’t sit here and do it, I’ve got other stuff to do.”
Panic flashed across his face. "Okay. Yeah." He swallowed, taking a moment. It was Harrison. He'd got him out of shit so many times before, it was only fair to return the favour. "I can do that."
“Just whenever you breathe, breathe for him too. Just got to think about breathing. Okay?”
"Okay." He moved to take Fao's place. "I can do that."
“Shout if you get stuck.” Fao murmured, and moved away, to carefully take yet another set of obs, praying they were better than before.
Steve hated being so far away, so unable to do anything. "Fao, talk to me."
“I’m taking obs.” Fao shot back. “I’ll tell you stuff when I know it.”
"You just went silent. I need to know what's happening."
“I’m trying to concentrate!”
"Fine, hurry up."
“Going as fast as I can.” He muttered. For once, Harrison’s obs had trended slightly upwards, and Fao was glad of it. “A bit better. SpO2 has come up, as has his BP.”
"Good. The tube will be helping with his sats."
“Yeah, that’s why I did it.” Fao said flatly.
"I just mean that he's not going to be resping at fifty or some shite."
“Yeah.”
"How's the bleeding doing?"
“Still fucking bleeding.”
"I've put a call out for more blood, you just need to get back."
“I’ll need the whole trauma setup.” Fao muttered, doing his best to manage the bleeding. “Can you go up and wake Ely? I’m going to need her.”
"Everyone's up. They're just sorting the basement out."
“Good.” Fao was relieved he had a team waiting for him.
"If the second lot of fluids helped, you can give him another 500 bolus."
“It’s helped, but I don’t know for how much longer. I’ve got no pressors, and limited fluids.”
"You just need to get him back. If he's still got pressure, give it."
“Giving it now.” He muttered, trying to push his hair out of his face.
"Give me a run down of his obs once you've done that."
He finally got it connected and running, discarding the spent bag. His ‘assistant’ was doing well ventilating, surprisingly, and so he quickly started on obs. He hated having to do this in such an old fashioned manner, he missed his hospital conveniences and continuous monitoring.
But as he started, he just knew it was wrong, and when he didn’t find a pulse, his stomach twisted. “Oh, fuck. Fuck, fuck, fuck.”