As Lou checked Cap’s mouth, tongue, and airway, he flashed on a story the man had shared from when he was in his early teens and a group of thugs, all older than he was, kept beating and harassing him. In that neighborhood, there was never any way to avoid them. No place to hide for long. Cap’s solution was, no matter how bad the pummeling, to never let any of them know he was hurt. Before long, they lost interest and left him alone. Cap Duncan was tough then, and he had grown even tougher over the years.

Heart rate one hundred ten. Rib cage and sternum intact to palpation. Carotid, radial, and left femoral pulses all present, although not very strong. The right groin, where the femoral pulse could usually be felt, was already swelling, probably from blood working up from the fracture site.

Airway, breathing, and circulation. All check.

He gingerly worked Cap’s backpack off and opened it on the ground next to his. The man’s muted cries echoed forlornly off the trees, and momentarily reminded Lou of the remoteness of their location.

Stay focused!

Neck seems uninjured.

Just in case, Lou used one of the ACE bandages and an empty backpack to improvise a stabilizing cervical collar.

Time to stop the bleeding.

“Cap, it’s me. It’s Lou. Hang in there, buddy. Hang in. I’m going to press on your forehead. Here, squeeze my hand if you can hear me.… Cap?”

Lou took half the gauze pads to wipe the blood out of Cap’s eye and off much of his face. Then he used the same gauze to apply heavy pressure to the laceration.

“Cap, it’s me. It’s Lou. Squeeze my hand if you can hear me.” Perhaps a flicker. “That’s it, buddy. Squeeze again.”

Lou kept up a steady stream of patter as he maintained pressure with his right hand. With his left, he soaked another gauze square with water from his backpack and wiped Cap’s face clean. Comfort. Every bit of comfort he could produce for the patient and the doctor was a help. He worked some water between Cap’s lips and then squeezed a few drops into his mouth. Cap swallowed. As Lou moved through the process he had mastered over the years of training and ER work, the need to extend his examination and to improvise treatment became increasingly important.

“That’s it, big guy. Hang on. Just hang on.”

The forehead hemorrhage had largely abated. Lou set a square of hi-tech hemostatic bandage over the laceration. There would be time for a dressing later. Another small squeeze of water between Cap’s lips. Again, he swallowed.

Pulses slightly stronger. Abdomen non-tender and flat. Arms and hands intact.

“Cap, it’s me, Lou. Open your eyes if you can. You’re doing better. Better and better and better.”