“Throw on some gloves. Behind you on the counter. Nurse’s station.”

Nathan ran over and grabbed a pair of light-green latex gloves from the box and pulled them on.

“When I pull the bicep aside, I need you to clamp the brachial artery as close to the tear as you can. The tear’s just above the radial and ulnar branch. I’m pinching it closed right now with my fingers.” The doctor looked at the mobile table containing instruments. “Shit, use the hemostats, they’re all I got. You’ll need to sponge the blood first. Ready?”

“Yes,” Nathan said.

With his free hand, the doctor reached into the woman’s arm just above the elbow, grabbed a handful of muscle, and pulled it aside. “Sponge,” he said.

Aware of Henning’s presence behind him, Nathan pressed the sponges into the opening, and watched the blood soak into them. He knew he had mere seconds to get the artery clamped before more blood would overflow the sponges and fill the cavity. “I see it,” he said, opening the hemostats. He inserted the tool into the wound and applied the needle-like pliers just above the tear in the artery.

“Not too tight,” the doctor said. “One click.”

“One click,” Nathan repeated. He pinched the hemostats to its first locking setting.

The doctor released the artery from his thumb-and-forefinger grip. “Good job.”

Nathan removed the sponges without being told and set them on the table.

The doctor let the muscle slide back into place, which overlaid the pinching end of the hemostats. He removed the tourniquet. “That artery will have to be repaired where it’s clamped. Crushing it with hemostats makes it susceptible to clotting at the crush point, but it’s the lesser of two evils. It’s better to damage the artery and repair it later, than to lose the arm.”

“How long can you leave it that way?” Nathan asked.

“Not very long. Ischemic time for muscle is two hours max. We have to add the tourniquet time to the clamp time so she’ll need a vascular surgeon within ninety minutes at the outset. Problem is, she’s tied up downstairs in the ER. We need to repeat this procedure for the other end of the tear to prevent back bleeding from collateral artery pressure. You ready?”

“Yes.”

“Okay, I’m going to pull the bicep aside again. Use another pair of hemostats on the other side of the tear. Clamp it as close to the tear as you can. Get ready with a sponge again. Here we go.”

Nathan had no trouble clamping the lower end of the tear. The bleeding was much less severe, but as the doctor had known, the lower end of the tear had been oozing blood from back pressure.