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“Biological spill!” Phillipa shouted, tossing the full-face oxygen masks to Mark, Sasha, Joey, Sarah, and Michaela as Jim’s blood fantailed away from him. Mark and Sasha pulled theirs on before the blood reached them, and the droplets spattered across the plastic eye shielding like paint hitting a wall.

Michaela’s mask bounced off her chest and floated away.

“Seizing has stopped!” Rafael moved in as soon as Jim’s jerks faded and he went limp, floating like a rag doll. Blood continued to ooze out of his eyes, bubbling against his skin and on the edges of the self-inflicted tears through his flesh.

“Houston, he’s not breathing.” Rafael pulled Jim’s head between his knees, opening Jim’s mouth and tilting his head back. “Possible airway obstruction. Michaela—” Rafael took one look at Michaela, pale and frozen against the bulkhead, and turned to Phillipa. “Phillipa, grab the ALS kit. Mark, brace me.”

Phillipa grabbed the red medical kit and unzipped it for Rafael. ALS gear was velcroed inside, airway adjuncts and a bag ventilator. Rafael grabbed a large adjuncts as Mark came around behind him to hold him in a bear hug. He hooked his feet into the secured loops on the bulkhead and steadied them both.

“Airway in, Houston,” Rafael said a moment later after threading the adjunct down Jim’s throat in a wet burble. A bubble of blood ballooned from the corner of Jim’s mouth, growing slowly as it trickled out of his throat and clung to his skin. “Beginning ventilations.” Rafael motioned Phillipa forward and fitted the bag valve over the airway, squeezing air into Jim’s lungs every three seconds. Blood spattered the inside of the bag.

“Vitals?” Dr. Nguyen asked.

“Pulse… shit, it’s dropping. Sixty beats per minute, Jesus. BP is climbing. One-seventy over eighty, Houston.”

“Check his ears and nose.”

Rafael grabbed a gauze square from the ALS kit and pressed it to Jim’s ear for a moment. When he pulled away, blood coated the gauze around a yellow halo in the dead center. “I’ve got the halo sign,” Rafael said, his voice low. “And he’s bleeding. It’s oozing out of his ears and nose now. And by the smell, he’s bleeding rectally from his GI tract, too.”

A glance at Jim’s crotch revealed a dark, spreading stain.

“He’s having some kind of massive internal hemorrhage. And he’s displaying Cushing’s Triad. He has a cerebrospinal fluid leak and increased intracranial pressure, Rafael,” Dr. Nguyen said.

“Sarah, grab the EKG and ultrasound.” Rafael turned to Sasha. “I need the restraint board. We need to strap him down.”

They moved fast, darting away fromUnityand back with the items Rafael needed. Michaela stayed still and silent like a wraith haunting the module. Mark held Rafael steady, bracing him and never letting go.

Sasha returned with the patient restraint board fromColumbusalongside Sarah, who was hauling the portable EKG monitor and ultrasound. He snapped the restraint board toUnity’s bulkhead and helped Rafael secure Jim. Blood smeared over Sasha’s hands, ran up his forearms and over his T-shirt.

Rafael cut Jim’s shirt away. His chest was mottled and discolored, vivid bruises coating his entire rib cage over his lungs and heart. “Houston, his chest looks like it caved in. Did he have any chest trauma we don’t know about? He’s got amassivehemothorax. I’ve only ever seen this in aviation crashes.”

“Get the EKG on.”

He slapped the leads on Jim’s chest, triangulating his heart, and flipped the machine on. Jim’s vitals transmitted simultaneously to the flight surgeon’s desk.

Parabolic arcs seesawed over the screen, violent trembles and rhythmless pulses.

“V-tach!” Dr. Nguyen called. His voice shifted from concern to panic.

“Sasha! Defibrillator, now!”

Sasha spun away, kicked intoZarya, and dashed back, the whole trip taking six seconds. He unfolded the defibrillator and charged the unit as Rafael grabbed the paddles.

“Clear!”

Jim’s body seized, jerking against the restraints as Jim shot 120 joules of electricity through him.

“No change!” Dr. Nguyen said.

“Turn it to 160!” Rafael shouted. “Sarah, grab the epi!”

Jim seized as another charge pulsed through him. Sarah disappeared and reappeared, a cardiac syringe filled with epinephrine prepped in her hands.

“He’s in V-fib! Sasha, begin compressions!”

Sasha twirled over the backboard and braced himself. He was in a handstand, his feet pressed against the top bulkhead and his head and his hands pointed down toward Jim. The EKG unit and defibrillator floated past his head, wires and tubes tangling and twisting against each other. Blood droplets continued to dance in the zero g, spinning delicately amid the chaos.

He took a deep breath, laced his fingers together, and pressed them against Jim’s black-and-blue chest. They’d practiced this on the simulator and in the Vomit Comet training plane, and in countless emergency scenarios. But those had been controlled. He’d been secure in the knowledge that it was only a drill, and Mark or Rory or Petra was fine; they would smile and float away at the end of the training exercise. He wasn’t actually trying to save his fellow astronaut. He wasn’t struggling through the surge of adrenaline in his shaking arms, or fighting against the pounding of his heart, or seeing the world through the cramped plastic of his face mask, listening to the echo of his own heavy, frantic breathing.