All things considered, it didn’t hurt that much. Perhaps it was because of the head wound. Perhaps it was because I was heavily concussed at around the same time I had received the wound. Either way, the pain was not debilitating.
The woman screamed audibly, causing some of the people nearby to turn toward us. Slowly, I turned my head and tried to get a good look at my back. As I expected, the rebar jutted out my back in about the same place as the front. A small circle of blood had formed around the wound, but I could not see any active bleeding. The piece of rebar must have largely stemmed the bleeding while I was trapped under the rubble.
As I looked at the rod of pig iron that had impaled my side, the pain started to grow. Yep, it was definitely the adrenaline that had staved off the pain while I was under the rubble. Like a cartoon coyote looking down at the drop below, I only felt the pain once I fully comprehended the full extent of the damage.
I grit my teeth to stop myself from groaning in pain. I tried desperately to distract myself with triage. If I was going to survive this, I would need to undergo significant surgery. If the rebar did not hit my kidney directly, it had hit some of the important veins and arteries surrounding that organ. I would not be able to perform such significant surgery on myself. The piece of rebar would have to stay in place for the time being.
“Ma’am,” I said in the calmest voice I could muster. “Could you pass me my glasses?” As I spoke, I pointed to my pair of glasses that had fallen to the ground.
“What?”
“My glasses,” I said. “I can’t see very well without them. I’ll need them if I’m going to treat the wounded.”
With shaking hands, the woman retrieved my glasses and handed them to me. After placing them upon the bridge of my nose, I said, “That’s better.”
I started walking around the casino floor. As I walked, I looked for several things. I searched for an exit, looked for any medical supplies, and briefly considered the state of the most injured people.
The area I found myself in was about a hundred meters by thirty meters. Dozens of tables for blackjack and roulette filled one side of the casino floor, and the other was packed with hundreds of slot machines. Previously, there had only been two escape routes, and both had collapsed when much of the roof fell.
About a third of the room was completely caved in. It was my understanding that there were several floors above the casino floor that held hundreds of hotel rooms. Thousands of tons, and hundreds of corpses, were certainly pressed against the roof above. Occasionally, I heard shifting stone and falling dust, suggesting that the collapsed building above had not yet settled.
There were a few first-aid kits attached to the uncollapsed walls of the casino floor, though none of them contained painkillers or sutures. If I were to fully apply my medical training, I would need more advanced surgical supplies.
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As I walked around the casino floor, I briefly took stock of the most injured people. Years of experience had trained me how to determine a patient’s status at a glance.
Without slowing my pace, I was able to get a good understanding of the extent of the injuries. Not including myself, there were about two hundred people in the room, and nearly half of them were injured in some way. About two dozen of the injured would require medical attention, and three of the injured could not be saved no matter what I did. Five of the injured could be saved with extensive medical intervention, but there was no way I would be able to provide the required medical care to all of them. If only one of them was injured in such a way, I could save that patient.
I would have to focus my efforts on the twelve people who required non-extensive medical intervention. If everything went well, I could probably keep those twelve alive until rescue came. In order to maximize the number of people I could save, I would have to leave eight severely injured people to die.
This cold-hearted medical calculus was called “triage.” It was the nature of my occupation to save as many people as possible. To do that, sometimes you had to cut some patients loose. Sometimes, I had to make the patient comfortable and simply wait for them to die. I had done it hundreds of times throughout my career.
After a few minutes of searching, I found a small “nurse’s office” that was attached to the casino floor. With a heavy sigh of relief, I quickly began raiding the partially collapsed medical room. I retrieved some surgical supplies and swallowed a mouthful of painkillers with little hesitation. I looked down at my hands, which were trembling from the pain.
To hide the trembling from the woman who had followed me into the small medical room, I snapped two surgical gloves onto my hands. The painkillers would lessen the pain within an hour, and I could spend that time on preliminary treatment. Once the pain was gone, I would be able to begin direct surgical intervention where necessary.
“Hello, everyone! I’m a trauma surgeon, and I will be around in a few minutes to treat anyone who is seriously wounded! I will be with you shortly, just hold on!” I shouted for everyone on the casino floor to hear me.
“Do you need some help?” The woman looked at the rebar impaled through my kidney as she spoke to me. “I was an EMT when I was younger. I can probably help assist you.”
“I’d appreciate the help. Thank you,” I said with a tired smile. “What’s your name?”
“Liz,” the woman said simply.
“Nice to meet you, Liz,” I said. “My name is…”
A deafening sound filled the casino floor. It was the sound of shattering stone masonry and creaking iron latticework. Large chunks began to fall from the ceiling, and the cacophonous rumbling sound only continued to get louder as the seconds ticked past.
Everyone on the casino floor screamed in abject terror. For a moment, I thought we were experiencing an aftershock, a secondary earthquake after the first. Once I realized that the ground underneath my feet was not shaking, I knew that was not the case. No, the sound was caused by the collapse of the structure above us. The Cagliostro had given up. It had already died, and it was now merely falling to the cold ground below.
The surgical tools fell from my hand. There was no longer any use in resistance. I turned my eyes up toward the shattered roof above, and I accepted my fate. An unnerving sense of calm filled me in the half-second before that apocalyptic force landed upon my head. Perhaps, I thought, the afterlife would be peaceful.