The Limits of Medicine

BOOM... MMM!

The Bighorn Range seemed to shatter piecemeal beneath the artillery rain.

A violent shockwave struck the limestone walls head-on, dislodging clusters of gray dust and freezing snow.

Inside the shallow cave near the edge of the camp, the air hung thick with the acrid stench of black powder, distilled spirits, and the sharp, salty tang of fresh blood.

Elena knelt on the stone floor.

Her fingers were raw and chapped from the cold, matted in Running Deer’s deep red blood.

Her final titanium clamp pinched tightly onto a vessel branch with a torn adventitia.

Her supply of dissolvable sutures had completely run out. She was forced to rely on bison-tendon thread soaked in distilled spirits—the most primitive material Old Wind Woman had prepared—to tie off and secure the pleural space.

"Gauze! Hurry!" Elena growled softly.

Sarah offered the coarse strip of cloth with trembling hands.

Black Arrow maintained his iron grip on Running Deer’s shoulders.

The fierce warrior with the long scar across his cheek had slipped deep into an unconscious stupor, his face ash-pale like embers buried under gray dust. Yet his left chest had ceased oozing dark blood, his breathing faint but beginning to hold a steady rhythm.

The titanium scalpel blade in Elena’s hand trembled once.

Her medical supplies were entirely exhausted.

No anesthetic, no spare rubber drainage tubing, and the Betadine bottle held only a few dark brown droplets clinging to the bottom.

She had dragged Running Deer back from the jaws of death using every remaining shred of her twenty-first-century knowledge, but his life now hung as fragile as a trailing thread of smoke before a snowstorm.

"He is alive," Elena whispered in English, her voice torn with exhaustion. "But keep him absolutely warm."

Elena turned toward the opposite rock ledge.

The brief reprieve following Running Deer’s operation gave way to a spine-chilling silence.

A young Lakota warrior—the man bound with the black cloth strip around his wrist thirty minutes prior—lay motionless in a dark corner against the cavern wall.

There was no wailing. No agonizing screams.

He simply lay there, his dark eyes wide open, staring up at the soot-covered ceiling of the cave.

The blast-shattered pelvis gushing fresh blood had ceased bleeding, yielding to dark purple blood clots caked across the buffalo hide rug.

His agonal gasps slowed gradually, slowing... until they stopped entirely.

Elena approached him.

She uttered no word.

Her surgeon's mind remained flat as the ice over the Powder River, yet her chest constricted with a quiet, ruthless ache.

Dropping to her knees, she reached out a blood-stained hand, gently smoothing down the young warrior's eyelids, which still reflected the fading firelight.

A quiet closing of eyes in the heart of hell.

His blood clung to her fingertips, icy cold.

"Elena..."

A choked call broke from a corner of the medical station.

Sarah stood rooted beside the third hide mat.

In the eighteen-year-old girl's hand was a wooden bowl of warm water that had just spilled over its edge.

The patient lying at Sarah’s feet—a refugee Cheyenne woman struck in the chest by flying shrapnel—had drawn her last breath just as Sarah reached out to feed her a final sip of water.

It was the first life that had broken and extinguished directly within Sarah’s care.

The young girl did not weep immediately.

Sarah’s usually bright, freckled face was paper-white, her dark eyes open in bewildered shock, her thin lips trembling as she tried to speak, but no sound could cross her throat.

A psychological collapse before the ruthless limits of medicine was swallowing the young girl whole.

Elena stepped over.

She offered no empty platitudes. She placed her blood-stained hand over Sarah’s trembling shoulder, squeezing it firmly once.

"Look at me, Sarah," Elena said in a low, measured voice, yet hard as steel: "Do not look at the corpse. Look at the ones who are still breathing."

Sarah gasped, and a choked tear finally spilled from her lashes.

Elena pulled her hand back immediately, turning to walk away.

She could not pause to hold Sarah.

Outside the cave, two more horsemen were carrying in another casualty whose thigh had been torn open by shrapnel.

Field medicine permitted no one the luxury of sentimentality amid the bloody stream of a massacre.

Heavy, hurried footsteps treaded upon the powdery snow outside the cave entrance.

A tall silhouette burst inside.

Grey Elk.

The chief was covered entirely in dark soot, fresh blood mingled with frozen snow caked deep across his dark bear-hide tunic. His broad chest heaved rapidly, radiating a scorching heat alongside the heavy stench of artillery smoke.

He swept his deep amber eyes across the blood-soaked cavern scene.

His gaze rested upon Running Deer’s unconscious form.

Grey Elk took in the crude bison-tendon sutures on his brother's left chest, took in the faint yet steady rhythm rising and falling beneath the hide blanket.

He asked not a single question.

Grey Elk stepped toward Elena.

The chief dropped to one knee upon the cold stone floor.

His massive hand, heavily marked by bear scars and soot, reached out to gently cradle the back of her neck. He leaned down, touching his forehead against her cool, sweat-beaded brow—a brief, single touch overflowing with absolute trust and fierce love on the threshold of life and death.

Not a single word was spoken.

Amidst the roar of artillery cannons outside the valley, that touch of foreheads was a blood vow between the chief and his woman.

He pulled his forehead away from hers, his amber eyes looking deep into her ash-gray gaze for one final beat, then spun around and bolted out the cave entrance to return to the southern defensive ledge.

Elena stood rooted to the spot.

The warmth from his forehead remained upon her skin, chasing off the bone-chilling cold of the stone cave.

She looked down at her hands.

The long, graceful fingers of the cardiothoracic surgeon—the hands that had just saved his brother and closed the eyes of a young warrior—were trembling uncontrollably from utter exhaustion.

"Stop," Elena whispered in English.

She slammed her blood-stained hands hard against her thighs, forcing her fingers to cease their shaking.

A surgeon's iron-hard resilience swallowed physical fatigue once more.

Taking a strip of gauze soaked in distilled spirits from Sarah, she began wiping the dried bloodstains from her titanium scalpels.

Just then...

A Cheyenne warrior burst through the cave entrance, roaring with a raw, torn voice, his entire body peppered with shrapnel marks:

"Wakan Winyan! Prepare now!"

He collapsed onto the snow, exhaling thick plumes of white steam, his voice frantic:

"The blue-coats... They are dragging their cannons down the canyon slopes! The third cannon is set up at the narrow river bend!"

The warrior raised his head, his bloodshot eyes wild with panic:

"Whitfield is preparing a full assault! He intends to flatten the entire camp in this barrage!"

The field cave sank into a haunting stillness.

The distant artillery fire hushed abruptly for a single breath, like a wild beast drawing back to gather strength before leaping for the final kill.

Elena tightened her grip around the scalpel hilt in her palm.

Talon Ridge's most brutal battle had officially entered its ultimate hour of reckoning.