arterial blood gas: an army tale
Shoulder reduction and ABG
Marc Willard was sitting shirtless on the cot in the medical tent, attempting—heroically and unsuccessfully—to pretend that his left shoulder was not hanging several centimeters lower than nature, God, or Army regulations had intended.
It was dislocated. Badly. Everyone knew it. Marc was still negotiating with reality.
“I’m just saying,” he muttered, jaw tight, “I’ve seen worse.”
Captain John Hank leaned against a supply crate, arms crossed, sipping coffee that smelled faintly of despair. “Lieutenant, your shoulder’s trying to defect. I’d stop talking before it files paperwork.”
Across from Marc, Dr. Elisabeth Hartley snapped a syringe onto a vial with crisp finality. The sound alone made Marc’s spine stiffen.
“Ten milliliters, two percent lidocaine,” she said calmly, drawing it up. “Intra-articular.”
Marc eyed the needle. It eyed him back.
“That needle’s bigger than my future,” he said.
“You’ll live,” Elisabeth replied sweetly. “Possibly.”
Behind her, Dr. Ethan Rodes stepped in, already gloved, already infuriatingly serene. “Posterior approach?” he asked, British accent smooth as a scalpel.
“Yes,” Elisabeth said.
Marc glanced between them.
“You coordinated that too easily. I don’t like it.”
Ethan smiled. “It’s called competence. Terribly unsettling, I know.”
Hank grinned. “Relax, Willard. This is foreplay. The screaming comes later.”
“I don’t scream,” Marc said.
Elisabeth finally looked up at him. “Marc, you once whimpered because I used cold gel on the ultrasound probe.”
“That was shockingly cold,” he said defensively.
She palpated the back of his shoulder, fingers precise, clinical—far too intimate for someone holding a medieval-looking needle.
“This will hurt less if you don’t tense.”
“I’m not tense.”
His voice cracked again.
Ethan stepped closer and gently but firmly steadied Marc’s arm. “I’ll hold him. He looks… jumpy.”
“I am not jumpy.”
“You flinch strategically,” Ethan said. “You mentioned.”
Hank snorted. “Officer material right there.”
Elisabeth positioned the needle. “Okay, darling. Steady. Big pinch.”
Marc opened his mouth to deliver a flirtatious retort.
The needle went in.
“—JESUS CHRIST — OWWH, fucking shit!”
The tent echoed with profanity.
Elisabeth didn’t blink. “Keep still”
“Still?” Marc gasped. “I’m being stabbed by someone I trust!”
Ethan held firm, voice maddeningly calm. “You’re doing splendidly. Only minor vocal distress.”
“Minor—?”
“Try breathing,” Elisabeth suggested, injecting steadily. “Oxygen helps.”
Hank wiped imaginary tears. “This is better than cable.”
At last, she withdrew the needle and capped it. “Lidocaine’s in. Give it a minute.”
Marc sagged, ragged breathing.
“You enjoy this.”
“I enjoy fixing you,” she said. “Your suffering is just a side effect.”
Ethan nodded approvingly. “Efficient philosophy.”
-
The Reduction.
A few minutes later, Elisabeth tested sensation. “Numb enough?”
Marc hesitated. “If I say no, will you wait?”
“No.”
“Then yes.”
“All right,” she said. “Captain, towel.”
Hank tossed it over Marc’s shoulder like a ceremonial shroud. “In case you pass out or cry.”
“Traitor.”
Ethan braced Marc’s torso, firm and immovable.
Elisabeth rolled her shoulders once, a quiet reset, then looked at Marc with the calm, unsettling focus of someone about to do something unpleasant for your own good.
“All right,” she said. “Lidocaine’s had time to work. We reduce now.”
Marc swallowed. “You say that like it’s a spa treatment.”
Ethan stepped in immediately, already positioning himself at Marc’s side. “I’ll take countertraction. Keep him from heroically flinging himself across the tent.”
“I am right here,” Marc protested.
“Yeah” Ethan said pleasantly. “That’s the problem.”
Hank perked up. “This is my favorite part. It’s where the screaming becomes educational.”
Elisabeth ignored them all, taking Marc’s forearm with controlled confidence. “Listen carefully. This works best if you don’t fight me.”
“I’m not fighting,” Marc said. “I’m emotionally opposed.”
She met his eyes. “Marc.”
He sighed. “Fine. I will cooperate under protest.”
Ethan braced Marc’s torso, one hand firm against his chest, the other stabilizing the upper arm. “Deep breath in,” he said, unexpectedly gentle. “Let it out slowly.”
“Oh, don’t get soothing now,” Marc muttered. “That’s worse.”
Elisabeth began slow, steady traction, pulling in line with the humerus, her movements precise and deliberate. No yanking. No drama. Just controlled force and anatomy.
“Gentle,” she murmured. “Rotation next.”
Marc’s jaw clenched. “Define gentle.”
Hank leaned in. “Lieutenant, if you pass out, I get your boots.”
“Sir—”
Elisabeth rotated the arm slightly externally, watching Marc’s face, feeling for resistance.
“There,” she said quietly. “Muscle’s starting to let go.”
Ethan nodded. “I’ve got him. You’re clear.”
Marc’s breathing went shallow. “This is the part where I regret every life decision, isn’t it?”
“Yes,” Elisabeth said. “But only briefly.”
She adjusted her grip, applied a final measured traction—
Clunk.
The sound was unmistakable.
Marc blinked. “Oh.”
Ethan froze, then slowly eased his hold. “And… we’re back in business.”
Hank clapped once. “Ladies and gentlemen, that’s what we call a happy ending!”
“You should reconsider your romantic life, Cap.” Ethan snorted, deadpan.
Elisabeth tested the joint gently, rotating just enough to confirm stability. “Reduction successful. No crepitus. Neurovascular intact.”
Marc let his head fall back against the cot. “I would like to file a formal complaint.”
“To whom?”
“God. The Army. You.”
Elisabeth allowed herself a small smile as she immobilized the shoulder. “You did fine.”
“I screamed.”
“Internally,” Ethan said. “That’s progress.”
Hank stepped closer, peering down at Marc. “You know, Willard, some people pay good money for this kind of attention.”
Marc cracked a weak grin. “Next time, I’m requesting sedation.”
Elisabeth secured the sling, firm but careful. “Next time, don’t dislocate your shoulder.”
“Ah,” Ethan said. “The elusive preventative medicine.”
She gave Marc’s arm one last careful check, then met his eyes. “Pain better?”
Marc nodded slowly. “Yeah. Still hurts. But… better.”
“Good,” she said softly, then straightened, professionalism snapping back into place. “Let’s keep it that way.”
Ethan stepped back, hands on his hips. “Textbook reduction. Smooth, efficient, terrifying.”
Hank shook his head in mock awe. “Remind me never to get injured around you two.”
Marc exhaled, exhaustion creeping in. “Remind me why I’m dating a woman who can casually dislocate and relocate me in under ten minutes.”
Elisabeth leaned in just enough for him to hear. “Because I put you back together afterward.”
And despite everything, despite the pain and the needles and the relentless sarcasm, Marc smiled.
-
The ABG torture.
Elisabeth stood at the foot of the cot longer than necessary, eyes fixed on Marc’s chest as it rose and fell. Not frantic. Not dramatic. But measuring.
Marc noticed. Of course he did.
“You’re doing the thing,” he said.
She didn’t look at him. “What thing?”
“The quiet staring. The ‘I’m about to invent something really uncomfortable thing.”
Ethan glanced up from his clipboard. “Ah. Yes. That one.”
Hank sighed theatrically. “Boys, boys. When Hartley gets that look, the laws of medicine bend to her will.”
Marc Willard was half propped against a pillow, pale but alert enough to be complaining.
“Breathing’s… a bit off,” he said between shallow breaths. “Feels like someone’s sitting on my chest. A very judgmental someone.”
From the other side of the tent, Dr. Elisabeth Hartley looked up from her notes immediately. The softness in her eyes betrayed a flash of worry before the professional mask reassembled itself.
“Could be the cracked ribs,” she said evenly, standing. “Or you could have a minor pneumothorax. Let’s not take chances.”
Ethan Rodes, clipboard in hand, appeared behind her with his usual, maddening calm. “Relax, Hartley. His oxygen’s fine, pulse’s steady. Probably just rib pain and a touch of self-dramatization.”
Marc grinned weakly. “I heard that.”
“I was counting on it,” Ethan said.
Elisabeth ignored them both, already pulling open a tray. “I want an arterial blood gas.”
Marc’s brows drew together.
“ABG. Quick check on how well you’re oxygenating.”
“Arterial? As in artery? As in the stabby, painful one?”
“It’ll sting,” she admitted, reaching for a heparinized syringe from the tray.
“But it’s quick. You’ve survived worse.”
“Barely. Like your chili.”
“That was a culinary experiment.”
“It was a war crime.”
Elisabeth smirked. “Don’t tempt me to ‘accidentally’ use a larger gauge.”
Marc looked at her with disbelief. “C’mon Hartley! I don’t need… that” glaring at the menacing instruments of torture.
Elisabeth ignored him reading the kit, then finally spoke. “Your breathing’s shallow.”
“My shoulder was just forcibly relocated,” Marc said. “Forgive me if I’m not doing yoga.”
“And your respiratory rate’s elevated.”
“I’m surrounded by you people.”
She turned then, eyes sharp. “Marc.”
That was it. Tone shift. Girlfriend slipped under the medic just enough to be dangerous.
Ethan cleared his throat. “Objectively speaking, his sats are fine. No tracheal deviation. Chest expansion’s symmetrical.”
Hank nodded. “In soldier terms: he’s whining, not dying.”
Elisabeth crossed her arms. “Cracked ribs can mask things. So can adrenaline. I want an ABG.”
Marc closed his eyes. “No.”
“Yes,” she said immediately.
Ethan raised a hand. “Before we commit a perfectly good artery to this ordeal—”
“I’m worried,” she cut in.
That did it.
Hank straightened. “Right. ABG it is.”
Marc opened one eye. “You didn’t even try to defend me.”
Hank shrugged. “Son, I’ve seen her stare down artillery. Your wrist never stood a chance.”
Elisabeth was already pulling the tray closer. Marc watched each item appear like a prophecy of pain.
Heparinized syringe. Alcohol swabs. Needle.
“That needle is obscene,” he said quietly.
Ethan leaned over, inspecting it. “It is a bit aggressive. Like it’s proud of itself.”
“I don’t want this,” Marc said.
Elisabeth softened, just slightly, as she took his wrist. “I know.”
That somehow made it worse.
Ethan chuckled. “Her aim’s impeccable. Her bedside manner… we’re still working on.”
Elisabeth shot him a look somewhere between weary affection and mild threat.
She palpated carefully, fingers warm, pulse strong beneath her thumb. She frowned—not at the anatomy, but at him.
“Big breath,” she said gently.
Marc laughed once, hollow. “You always say that right before hurting me.”
“Yes,” Ethan agreed. “It’s a well-established pattern.”
“Keep talking, Rodes, and I’ll practice on you next.” Elisabeth said, picking up the syringe. “Let’s get on with it. Hand out, palm up.”
Marc extended his arm with the air of a man approaching a firing squad. “Feels like the wrong kind of date.”
She swabbed the area with chlorhexidine — three neat outward strokes, never back — and let the air dry. She methodical, slower than usual. Girlfriend, not medic, buying herself one more second.
“That cold burn is the disinfectant,” she said, tone almost conversational. “Hold still when the real sting comes.”
“Oh, splendid. I was worried this might be relaxing.”
Beth positioned his wrist, slipped a gauze pad beneath it, and angled the needle precisely: thirty to forty-five degrees, bevel up.
“Don’t flinch,” she said softly.
“I will absolutely flinch.”
She positioned the needle.
Ethan sighed. “For what it’s worth, Marc, I did try.” “I appreciate that,” Marc said.
“Sharp pinch,” Elisabeth warned.
The needle went in.
Marc made a sound that defied military decorum. “—OWWWH! fucking hell, Hartley!
“Good boy,” Hank flinched with sympathy.
Elisabeth didn’t move, didn’t blink. Bright red blood pulsed into the syringe, rhythmic and unmistakable.
“Textbook arterial flow,” Ethan observed. “Lovely color. Really screams ‘excellent perfusion.’”
“I hate you,” Marc hissed. Eyes shut, pearls of sweat at the temples.
“Yes,” Ethan said calmly. “That’s normal.”
After a seemingly endless few seconds, Elisabeth finally -finally!- withdrew the needle smoothly and immediately pressed gauze to the site. “Pressure. Hard. If you bleed out, I will be extremely annoyed.”
Marc clamped down, wincing. “You say the sweetest things.”
“I’m multitasking,” she replied, capping the syringe and labeling it with swift strokes. “Pain now, answers in two minutes.”
She turned toward the analyzer.
Marc slumped back, breathing carefully, wrist throbbing. “Please tell me that was necessary.”
Ethan tilted his head. “Define necessary.”
Hank grinned. “On the bright side, son, you survived lidocaine, reduction, and arterial sampling. The enemy’s got nothing left.”
Marc eyed his wrist. “I’d like hazard pay.”
“Denied,” Hank said. “But you do get bragging rights.”
A few moments later, the analyzer beeped.
Elisabeth returned, scanning the values. Her shoulders relaxed just slightly.
“pH normal. PaO₂ good. CO₂ fine,” she said. “No pneumothorax. No respiratory failure. Just bruised ribs and a dramatic personality.”
Marc closed his eyes. “I knew it.”
Ethan smirked. “Congratulations. You’re medically sound and emotionally exhausting.”
Elisabeth adjusted Marc’s blanket, voice softer now. “You’re okay. Breathing’s fine.”
He opened his eyes, meeting hers. “You worried.”
She didn’t deny it. “Someone has to be.”
Hank cleared his throat loudly. “Right. Touching moment over. We’ve got a war to lose tomorrow.”
Ethan gathered his clipboard. “Well done, Lieutenant. You endured pain, sarcasm, and my presence.”
Marc smiled weakly. “Honestly? The last one hurt the most.”
Ethan nodded approvingly. “He’s learning.”
The tent settled again, generator humming, rain fading. Marc breathed steadily now — sore, stitched, stabbed, but alive — surrounded by people who expressed care primarily through mockery and needles.
In the army, that counted as love.
-
Pain management, Hartley style.
The night shift had a way of shrinking the world.
The generators hummed low, the tent lights dimmed to a glow just bright enough to read vitals without waking the wounded. Somewhere far off, boots crunched gravel, but inside the medical tent everything felt suspended—paused between disasters.
Marc lay on his cot, eyes closed, absolutely not asleep.
Elisabeth sat beside him, not charting, not watching monitors. Just there. One boot hooked around the rung of the stool, arms loosely folded, watching his chest rise and fall.
“You know,” Marc murmured without opening his eyes, “normal people sleep at night.”
“Normal people don’t dislocate shoulders for a living,” she replied softly.
He smiled faintly. “You’re still here.”
“I’m on duty.”
“That’s not what I meant.”
She sighed, the sound barely there, and leaned forward, resting her forearms on her knees. “You scared me today.”
“I was fine.”
She shot him a look. “You were not fine. You were bleeding, crooked, and making jokes.”
“Classic signs of wellness.”
Her hand found his, fingers warm against his cooler skin. For a moment, neither of them spoke.
The tent breathed around them.
“I hate when you’re the patient,” she said quietly.
“I kind of enjoy the attention.”
She huffed a soft laugh. “You enjoy being stabbed with needles?”
“I enjoy you hovering.”
She squeezed his fingers. “Idiot.”
He shifted slightly, careful—but not careful enough.
His breath caught. Just for a second.
Elisabeth felt it immediately.
Her hand stilled.
“…Marc.”
“I’m okay,” he said too fast.
She sat back, eyes narrowing—not alarmed, not tender. Assessing.
“How’s the pain.”
“Present.”
“That’s not an answer.”
He opened his eyes at last, meeting hers. “It’s… more.”
The warmth vanished.
She was on her feet in one smooth motion, already reaching for the supply drawer.
“Why didn’t you say something?”
Because every time I do, you stab me.”
“That is deeply unfair,” she said, pulling open a drawer. “Sometimes I inject.”
Marc watched the syringe appear and groaned. “Beth.”
She pulled out a syringe and snapped a vial free with practiced efficiency. “You’re overdue for an anti-inflammatory.”
Marc groaned. “I knew this moment was too peaceful.”
“You’re guarding your ribs, your shoulder’s going to swell overnight, and you’re clenching your jaw,” she said briskly. “This is happening.”
“I could take it orally.”
“No.”
“I could wait.”
“No.”
He watched her draw up the medication. “You switch personalities terrifyingly fast.”
She glanced over her shoulder. “You dating me knowing that.”
He blinked. “…Touché.”
She turned back to him, already snapping on gloves. “Turn onto your side.”
Marc frowned. “Why.”
“Better absorption.”
His eyes widened. “Wait. No. Beth.”
“Yes.”
“That’s not—”
“Oh yes. This goes in that hot ass of yours. Also known as gluteal muscle,” she said calmly. “Large. Well perfused. Efficient.”
He stared at the cot like it had betrayed him. “You are enjoying this.”
“I am. Immensely.”
He rolled onto his side with exaggerated resignation. “I hope you know this ruins the romance.”
She cleaned the site quickly, efficient but not unkind. “You still have a cute butt.”
“That’s… inappropriate, Hartley!”
“Big breath, Lieutenants.” she said.
He sighed. “You always say that like it’s reassuring.”
“It’s a warning. This is going to sting.”
The injection went in.
Marc hissed sharply, gripping the sheet. “Ouch—That is deeply unpleasant.”
“Anti-inflammatory injections usually are,” she said evenly, steady hand, perfect placement. “Still.”
“I am still.”
She finished, withdrew the needle, and pressed gauze into place. “All done.”
Marc collapsed back onto the cot, face buried in the pillow. “I hope you know I’m holding this against you emotionally.”
She stripped off her gloves and sat back down, gentler now, brushing her fingers through his hair. “You’ll feel better soon.”
He peeked at her. “You promise?”
“Yes.”
“…Worth it,” he admitted.
She smiled—small, tired, fond—and stayed with him as the pain ebbed and the night settled again, the field doctor gone, the girlfriend quietly back on duty.