Fired and Walking Home — Until Two Helicopters Landed Shouting “Where’s the Nurse?!”

Saving the Girl

They burst into the hangar. It was a chaotic scene. A mobile field hospital had been set up in the center of the vast concrete floor. Bright halogen lights on stands surrounded a gurney. Monitors were beeping frantically, the high-pitched rapid rhythm of a heart in distress.

Around the gurney, three people in military medical fatigues were working frantically. Blood-soaked gauze littered the floor.

“I can’t get the view,” one of them, a man with graying hair and sweat pouring down his forehead, shouted. He was holding a laryngoscope, trying to pry open the patient’s mouth to insert a breathing tube.

“There’s too much blood! Suction! I need more suction!”

“Suction is maxed out, Colonel,” a nurse yelled back. “Sats are 68. She’s bradying down. Heart rate is dropping.”

Madeline dropped her box on a supply crate and ran to the bedside. The patient was a little girl, no older than eight. She was pale, her lips a terrifying shade of violet. Her neck was swollen, bruised a deep angry purple—the sign of massive trauma to the trachea. She wasn’t moving.

Madeline didn’t ask for permission. She didn’t introduce herself. She stepped up to the head of the bed, right next to the colonel who was failing to intubate.

“Stop,” Madeline said. It wasn’t a suggestion.

The Colonel, Dr. Aris Vance, the chief flight surgeon for the Air Force unit, snapped his head up. “Who the hell are you?”

“I’m the person who’s going to tell you that you’re digging around in a shattered larynx,” Madeline said, her eyes locked on the girl’s neck.

“You keep trying to intubate orally, you’re going to tear the remaining tissue and she’ll never breathe again. Look at the subcutaneous emphysema.”

She pointed to the puffiness around the girl’s collarbone. “Air is leaking into the tissues. Her trachea is transected.”

Vance hesitated. He was a good doctor, a battlefield surgeon, but this wasn’t a soldier with a gunshot wound; this was a fragile child with a freak crush injury, and the pressure of the entire U.S. government was breathing down his neck. He was shaking.

“We need a surgical airway,” Vance said, his voice trembling. “But I can’t find the landmarks. The swelling is too severe. If I cut and miss…”

“You hit the carotid or the jugular,” Madeline finished for him. “And she bleeds out in 10 seconds.”

“I can’t do it,” Vance whispered, terror in his eyes. “I can’t see anything.”

Madeline looked at the girl. She looked at the monitor: heart rate 45, oxygen 60. She stripped off her wet jacket, revealing her blue scrubs. She snapped on a pair of sterile gloves from the open box on the tray.

“Give me the scalpel,” Madeline said.

Vance stared at her. “You’re a nurse.”

“I’m a trauma nurse who spent 10 years in the busiest ER in Chicago,” Madeline said, extending her hand. “I’ve done three of these in the parking lot. Give me the scalpel.”

Vance looked at the monitor. The flatline tone was seconds away. He slapped the scalpel into her hand. The hangar went silent. Even the Secret Service agents at the perimeter seemed to hold their breath. The only sound was the drone of the monitor beeping slower and slower. Beep… beep… beep.

Madeline closed her eyes for one second. She visualized the anatomy beneath the swelling. She pictured the thyroid cartilage, the cricoid ring, the tiny membrane between them. It was there. It had to be there. She opened her eyes. She reached out with her left hand, her fingers probing the girl’s swollen, bruised neck.

It felt like a water balloon. The landmarks were gone. “Come on,” she whispered. “Talk to me.”

She pressed harder, ignoring the fluid shifting under the skin. She felt a tiny ridge, a hardness amidst the soft trauma. The cricoid.

“I have it,” she said softly.

She didn’t hesitate. With her right hand, she brought the scalpel down. “Not a vertical incision,” Vance warned. “Too much bleeding.”

“I know,” Madeline murmured.

She made a horizontal cut, precise and confident. Blood welled up immediately, dark and fast.

“Suction,” Madeline commanded.

The military nurse moved instantly, clearing the field. Madeline used the back of the scalpel handle to separate the tissue. She was looking for a white flash of cartilage there, deep in the wound.

“Tube,” she said. “Size 4.0. Now.”

Vance handed her the pediatric tracheostomy tube. “I’m going in,” Madeline said.

She pushed the tube into the small incision. It met resistance. The cartilage was crushed. If she pushed too hard, she’d collapse the airway entirely. If she didn’t push hard enough, the tube would sit in the false passage and blow air into the neck, killing her.

She twisted her wrist, a corkscrew motion she had learned from an old Vietnam vet medic. The tube popped through the resistance. She felt the give, the sensation of entering the windpipe.

“Bag her!” Madeline shouted.

The nurse attached the Ambu bag to the tube and squeezed. Everyone watched the little girl’s chest. Nothing happened.

“No breath sounds,” Vance yelled, listening with his stethoscope. “You missed.”

“I didn’t miss,” Madeline gritted out. “It’s a mucus plug. The trauma caused a blockage.”

She grabbed a suction catheter, threaded it down the new tube, and applied negative pressure. She pulled it back; a thick clot of blood and mucus came with it.

“Bag her again.”

The nurse squeezed the bag. Whoosh! The little girl’s chest rose. It was a beautiful, symmetrical rise.

“We have breath sounds!” Vance shouted, the relief in his voice cracking. “Bilateral breath sounds. Good air entry.”

They all looked at the monitor. The numbers were sluggish at first, then they began to climb. Oxygen 70, 75, 85, 92, 98. The heart rate picked up. Beep, beep, beep, beep. The purple color in the girl’s lips began to fade, replaced by a faint, healthy pink.

Madeline let out a breath she felt like she’d been holding since she left the hospital. She secured the tube with the Velcro strap, her hands finally trembling now that the danger was over.

“Sedation,” Madeline ordered, falling back into her routine. “Keep her paralyzed. We need to minimize oxygen demand until you can get her to a surgical theater for reconstruction.”

“On it,” the nurse said.

Madeline stepped back from the table, peeling off her bloody gloves. Her knees felt weak. She leaned against the metal supply cart, wiping the sweat and rain from her forehead with her forearm.

Colonel Vance stared at the tube, then at Madeline. “That was the finest surgical airway I have ever seen. And I’ve seen a lot.”

Madeline managed a weak smile. “Just plumbing, Doctor. Just plumbing.”

She looked around for her box. She just wanted to sit down. She wanted to call… well, she couldn’t call Mark. She realized with a pang of sorrow that she had no one to call. She had saved the girl, but she was still unemployed. She was still the woman who had been walked out of St. Jude’s by security.