Deep Lacerations: Chapter 18
A/N: All of the medical stuff in here is fairly accurate, from the stages to hypothermia to how to care for someone rescued from really, really cold water; so if you find yourself in that situation, you'll know what to do. And yes, hypothermia sets in very, very quickly in cold water-even a strong swimmer without thermal protection would probably only manage to swim about 100 feet in 40 degree (F) water before losing consciousness.
Special Agent Sonja Gracy stiffened as her body hit the frigid water, every muscle tightening painfully, her mouth opening in a silent gasp, her mind barely able to tell her lungs not to attempt to draw a breath in the shock.
Although it felt like hours, less than a second had gone by before her mind caught up to the sensations of the cold water on her body. What the hell was I thinking? she asked herself angrily. Diving into the water without getting a clear visual was irresponsible, reckless, stupid—
And necessary, she finished her list, breaking the water's surface with that gasp she had denied herself seconds ago. There was another agent in the water, and for someone as well-trained as she was—a lifeguard since fifteen, EMT since eighteen, doctor since twenty-six—doing what she did was just reflex.
She scanned the surface of the water, looking for clues as to DiNozzo's location. Only a few feet to her right, she saw the tell-tale signs of bubbles breaking the surface. Drawing in another breath, she again dove below the surface, her eyes burning against the salt and oil of the water as she frantically searched for the submerged agent.
She finally caught sight of those bubbles again and followed them down a few feet to a slowly sinking Tony DiNozzo, his eyes closed, obviously unconscious. Not seeing any red water, she was confident that he hadn't been shot, which raised the question of why he was unconscious. Concerned about a concussion, or worse, a cervical spine injury, she put her arms around the NCIS in a C-spine rescue position—one hand on his jaw, the other at the back of his head, his body held between one forearm locked at his sternum and the other along his spine—and kicked toward the surface.
"Ziva!" she called as she surfaced, grimacing at how weak and shaky her voice sounded. She could feel her entire body shaking violently, aware that she wouldn't last too much longer before she lost consciousness due to hypothermia. It took her a few seconds of blinking the salty water from her eyes, but she finally caught sight of the dark-haired Mossad officer a few feet away. Trying valiantly to keep her own head, as well as DiNozzo's, above the surface while supporting him without a flotation device, she began to scissor kick toward the dock, her legs moving in a barely coordinated fashion.
"I can pull him out of the water," David called out to her as she reached down for her partner's shoulders.
"No!" Gracy replied. "He c-could have a C-spine in-injury. You p-pull h-him out, you c-could break his n-n-neck." She wasn't sure if Ziva had even understood her words until the officer slowly withdrew her arms, her face wearing an expression of panic, feeling hopeless in the situation. Gracy's eyes quickly scanned the length of the dock until she saw a familiar orange and white ring. "The lifesav-ver! G-grab it an-and throw it in." It didn't take a doctor to know that Gracy herself was in bad shape as Ziva tossed her the lifesaving device. It took three reaches before she was able to hook her arm around it, her body shaking so badly she almost dropped DiNozzo as she positioned it under him.
"Gracy!" Gibbs shouted from his sudden position next to David. "Get out of there!"
"I-I'm having so-so m-much fun," she managed, her words barely legible even to herself between the chattering of her jaw and the water that kept splashing into her mouth as she kept dipping below the surface, her legs too cold, too uncoordinated to keep both her and DiNozzo afloat.
She spit another mouthful of water out before attempting to speak again. "Zi-Ziva," she said, willing herself to speak clearly. "Sta-stabilize his neck," she said, managing to move close enough to the dock for Ziva to reach down. "Two-two hands, th-th-thumbs on his ja-jaw, fi-fingers a-at the b-back of his n-neck." She took a moment to catch her breath, a difficult task with her body shivering violently. "Gi-Gibbs, grab hi-his feet and lift to-to-together o-on three. One, t-two, three!" As one, the three agents—two on the dock, one in the water—lifted DiNozzo's still form from the water.
"Tony!" Ziva shouted, sounding uncharacteristically frantic.
"D-don't l-let go o-of his n-n-neck!" Gracy commanded.
"Give me your hands!" Gibbs shouted, reaching down, prepared to hoist her up. Her arms stiff with cold, she slowly raised them above her head, her body sinking lower into the water in response. Not wasting any time, Gibbs grabbed her wrists and pulled.
Barely out of the water for a second, Gracy's attention was already back on DiNozzo. "P-pulse?" she managed, her body still shaking violently. Ziva started to move her hand to check, but Gracy stopped her. "H-h-hold his n-neck!" she ordered. "G-Gibbs, ch-check the p-p-p-pulse."
"I think I feel it," Gibbs replied.
"He is not breathing," Ziva reported. Gracy nodded, but the motion was mostly lost by her shivering.
"R-r-resc-cue br-breathing," she managed. She made her way over to DiNozzo's head to confirm that he wasn't breathing. "Keep h-holding," she said to Ziva as she thrust Tony's jaw without moving his neck. "D-damn," she whispered. "Ha-hands numb." Before either Gibbs or Ziva could say anything, she bent down and gave two breaths. "Gibbs, ch-check p-pulse a-again." As he did so, she started struggling with the buttons of her shirt, trying to get it off.
"It's there, but really slow. Should I give CPR?" He frowned as he noticed her actions. "What are you doing?"
"G-getting out o-of w-wet clothes," she replied. "O-only way t-to get w-w-warm. N-no CP-PR. C-could dam-mage h-heart. T-take off hi-his clothes."
Before starting that, Gibbs shrugged out of his own jacket and tossed it over DiNozzo to the CID agent. "Get warm," he ordered. Even with DiNozzo lying unconscious in front of him, he was concerned about her; with the exception of those freckles across her nose and cheeks, her face was ghostly pale, icicles were hanging from loose tendrils of hair, and her fingers where they had rested at DiNozzo's jaw were literally blue at the tips.
"S-sure," she said, rolling her eyes and not bothering to argue. She continued to struggle with her shirt, not seeming to be able to move her arms properly to get it off. Her sleeve caught on the brace on her right wrist, which she stared at as if confused about why it was there. "Wh-where are the p-paramedics?"
"On their way," Gibbs replied, reached over to yank the shirt from her arm. She blinked heavily a few times, still looking confused. She looked far too cold and weak to even fully sit up, but continued to lean over DiNozzo, a clumsy hand attempting to open his eyes to check his pupils.
"You are not shivering as much," Ziva commented, watching Gracy, who sure enough, was beginning to calm from the violent shaking, her color still on the blue side of pale. She shook her head.
"That's not a good thing," she informed her after giving two more breaths. "I need to check for a p-pulse." She pressed her fingers to DiNozzo's neck and frowned. "It's th-there, but thready. What does that mean?" She frowned, trying to remember. "I think it means CPR?"
"I thought you said no CPR," Gibbs stated with a frown.
"Right. No CPR. Fragile myocardium, c-could cause V-fib. Brady t-tolerated." Gibbs and David shared a concerned look, not missing the fact that the one person who knew what to do was becoming more and more confused by the second. Fortunately, it wasn't long before the familiar sound of wailing sirens approaching, followed closely by paramedics running toward their position, already shouting questions.
"What've we got?" one asked as he all but pushed Ziva out of the way, ignoring her homicidal glare.
"Male, l-late thirties, severe hypothermia with a possible C-spine injury," Gracy explained as quickly as possible, watching the men carefully position DiNozzo on the backboard. She frowned, trying to remember. "He was shot at and went in the water. I d-don't think he was shot."
That paramedic gave one brisk nod as he stuck a long piece of tape across the NCIS agent's forehead, stabilizing his head between the large foam cushions of the backboard. The other politely moved Gibbs aside, forcefully cutting through DiNozzo's remaining clothing. Ziva grimaced slightly at the sight of the grayish pallor of her partner.
"He will not be happy about his clothes," she muttered to herself. Gracy looked up sharply at her.
"He won't care if he's dead," she shot back bluntly before returning her attention to the paramedics. "Do you have a 12-lead? Check f-for J waves, bradycardia, and...there's more," she said, her voice trailing off as she tried to remember.
If the paramedics noticed her confusion, they gave no indication. The one at DiNozzo's head held up the toolbox-sized machine, complete with defibrillator paddles. "We have it covered, ma'am. If you could step aside…?"
"I'm a doctor," she said bluntly, glossing over the fact that while she was practicing, her patients were already dead. "He has symptomatic bradycardia and needs cardioversion—at least, I th-think he needs c-cardioversion..."
"He needs to be warmed up," the medic interrupted, even as he attached the leads. He stared at the small screen for a second before shaking his head. "He's not in V-fib. Pulse is thirty and irregular. Get an IV going, we need to hook him up to warm saline." He looked up at Gracy. "The nearest hospital is only about five minutes away—"
"He needs to be transferred to Bethesda as soon as he's stable," Gracy interrupted. "He's a federal agent, NCIS. That's Naval-"
"That's a three and a half hour drive!" the paramedic protested.
"Shorter if you use a helicopter," Gibbs replied, thinking about their commute there less than two hours before.
The paramedic looked at them both as if they were insane, but shrugged a shoulder. "Take it up with the docs at the hospital," he replied. "Let's roll."
"Wait," Gracy said, rising to follow them and stumbling over her own feet in the process. She picked herself up, barely. The rush of adrenaline that had been keeping her going since she dove into the harbor was beginning to ebb. "I need to go."
"We got it," the younger paramedic replied, rolling his eyes before climbing into the driver's seat. She turned to face him.
"Who do you think got him out of the water?" she shot back. "I'm at least moderately hypothermic—I think..."
"You're not even shivering!" he said, even as his partner reached down from his position in the back of the ambulance to help her up.
"Why do you think I said moderate?" she said, her voice weak and almost drowsy. "Look it up—cessation of shivers is one of the clinical—clinical distinctions between mild and moderate hypothermia." Her eyes fluttered closed for a second before opening again. "I need passive external and active external and active internal rewarming—Bair huggers, warm IVs, and maybe a warm peritoneal lav—scheisse!" she managed, doubling over in pain as the massive headache hit her all at once. She struggled to stay conscious, barely registering the man next to her yelling at the driver to step on it. By the time he got a bag of warm saline running into her vein, she had already lost the battle.