by Laura Iding
Bypassing the elevators, she took the stairs down to the emergency department, coming to an abrupt halt when she saw Quinn standing in the middle of the trauma room as the staff hurried to prepare for the new arrivals. Ridiculous to be nervous just because he’d kissed her. And because she’d let him kiss her.
Not just once but twice. Three times, if you counted that goodnight kiss. Which she didn’t.
He glanced at her and nodded in greeting. “Two victims of a motor vehicle crash, a father and his son. Hit a light pole going at a high rate of speed. Prolonged extrication at the scene for the adult.”
So he was going to keep things professional, which was good as he’d promised to be discreet. And a man interested in an affair wouldn’t necessarily ask for more than she could give. Not that she’d agreed to have an affair with him.
Yet.
She hid her flash of disappointment. This was exactly what she’d wanted, right? She glanced around the empty trauma room. “Why haven’t they brought the child in yet?”
“He’s on his way.” The words were barely out of Quinn’s mouth when the doors from the ambulance bay burst open, revealing paramedic personnel surrounding a small patient nearly lost in the equipment around the stretcher.
She stood back, watching Quinn take control of the situation. As a trauma surgeon she often assisted with trauma resuscitations but the ED physician was always the one in charge. Her role was mainly that of a consultant, up until the point that surgery was deemed necessary.
Then the patient became hers.
Quinn was impressive, giving orders in a calm, reasonable tone. The boy’s injuries didn’t appear as bad as she’d feared. Luckily he’d been saved in part by wearing a seat belt and by the passenger-seat air bag.
“Once he’s stabilized I’d like a complete head-to-toe CT scan,” she told Quinn. “I need to make sure he’s not bleeding internally.”
Quinn nodded, barely sparing her a glance. They’d pretty much taken care of the child when the double doors of the ambulance bay opened again, bringing in the adult victim.
Easy to see the adult, a male in his late thirties, had taken the brunt of the crash. The odor of alcohol emanating from him was overwhelming.
Quinn’s voice took on a frosty edge. “Get a baseline set of labs, including a drug and alcohol screen.”
Her brows rose. That wasn’t usually the first lab order to get on a multiple trauma patient, but she thought she understood Quinn’s frustration. No doubt the eight-year-old victim had reminded him of Danny.
And this man, the father, had nearly killed his son by driving under the influence of alcohol.
CHAPTER SEVEN
“VITALS?” Quinn asked, as soon as the nurse had drawn the necessary labs. In addition to the toxicology screen, Quinn had ordered the standard electrolyte panel and hemotology workup. Leila let Quinn take the lead on the trauma resuscitation, allowing him to get Carl Wolsky, the father of the eight-year-old victim, stabilized before she stepped in to evaluate him for surgery.
“Blood pressure is low, eighty-eight over forty-two.”
“Make sure you let me know what his hemoglobin and hematocrit is as soon as you get the results,” Quinn said. “He looks as if he sustained chest trauma from the air bag.”
Chest trauma meant possible surgery. She wasn’t surprised, considering the long extrication at the scene. Leila inched forward, checking to see if Carl showed signs of a flail chest. “I’d like to evaluate him when he’s stable enough.”
Quinn nodded, although his expression remained tense, his tone clipped with anger as he barked out orders. “I want a portable chest X-ray, stat. Do you have the urinary catheter placed yet? I need to know what his urine output is. And I want to know those lab results as soon as possible.”
“Including the drug and alcohol screen?” one of the nurses muttered sarcastically under her breath.
Leila winced, expecting a sharp response, but luckily Quinn ignored her.
“Dr. Ross?” Amy, one of the trauma nurses, came up beside her. “I think you’d better take another look at Trevor, the eight-year-old. He’s in a lot of pain and his abdomen has grown firm and tense.”
Alarmed, she nodded and quickly hurried over to the first patient, Trevor Wolsky. They’d stabilized the boy initially and had then ordered the total body CT scan. While he’d been undergoing the procedure, they’d turned their attention to Trevor’s father.
The youngster’s facial expression reflected pain but as he was on a ventilator he couldn’t talk. They’d given him a touch of pain medication earlier, but he obviously needed more. “Give him a milligram of morphine,” she ordered, as she stepped up to gently palpate the boy’s tense abdomen.
His expression got worse the moment she touched him. Definitely not good.
“Dr. Ross? Radiology is on line one for you.”
“Thanks.” She crossed over to the nearest phone. “Have you read Trevor Wolsky’s CT scan yet?”
“Yes, he has a large hematoma forming around his liver. There’s also a questionable area of bleeding around his spleen but it’s not as large as the liver laceration. His brain and his kidneys are clear.”
“All right. Thanks for letting me know.” Leila hung up the phone, realizing she’d need to get Trevor to the OR to explore his abdomen. “Amy, do you know if Trevor’s mother has been contacted? He’s going to need to go to the OR and if possible I’d like her consent before we go.”
“I think the social worker was trying to get in touch with her,” Amy said. “I’ll find out and let you know.”
Leila walked back over to Quinn, who was wearing a sterile gown and in the process of inserting a chest tube into the boy’s father. “Bleeding into his chest?” she guessed.
“Yes. I’m afraid he’s going to need a trip to the OR for a thoracotomy,” Quinn said from behind his sterile face mask. Sure enough, the moment he placed the chest tube, blood began pouring out at a brisk rate.
Leila’s heart sank. They weren’t a level-one trauma center, they only had two trauma surgeons on staff. It wasn’t as if she could call someone else in to help. They could send the patient elsewhere but that might take time, too, considering the bad weather. Of course, they were having the snowiest winter on record. “His son, Trevor, needs surgery, too. But it looks as if the father’s injuries are more severe. I should probably take him first.”
“No.” There was a moment of stunned silence as she stared at Quinn in surprise. “I can auto-transfuse this blood from his chest tube back into him while you finish up with Trevor,” he added slowly.
Her eyes widened at his implication. “You’re saying you want me to take Trevor to the OR first?”
Quinn nodded. “Children have a higher risk of dying from internal bleeding than an adult. He should go first. I can safely manage the father, keeping him stabilized, while you operate on his son.”
She hesitated, not necessarily agreeing with Quinn’s logic. Internal chest bleeding was usually a higher priority than a hematoma in the abdomen, but he was right—children were more susceptible to complications. Still, she couldn’t help thinking that the real reason Quinn wanted her to take the child first was because he didn’t think Trevor’s father was worthy enough. After all, the father had caused the boy’s injuries.
Yet standing around indecisively wasn’t helping either of them, so she nodded quickly. “Okay, I’ll explore Trevor’s abdomen first. But the moment I’m finished, I want Carl prepped in the OR, ready to go.”
“Agreed.” Quinn’s eyes held relief.
She spun away, catching Amy’s gaze. “Let’s get Trevor up to the OR, stat.”
“I’ve already called the OR team,” Amy acknowledged. “They’re expecting us.”
“Any word on his mother?” Leila asked.
“No, I’m afraid not. The social worker hasn’t gotten in touch with her yet.”
Maybe it was for the best, they didn’t really have much time to waste. As it was, Leila couldn’t help second-guessin
g herself as she headed up to the OR suites. Trevor did have bleeding around his liver. He did need surgery, just like his father.
As she scrubbed at the sink, prior to entering the OR, she found herself praying that Quinn would keep Carl alive long enough that she could have a good shot at saving both of them.
Sweat trickled down the back of Quinn’s spine as he continued to run the trauma resuscitation. He firmly believed in his heart that Carl would want them to save his son first. After all, he would do the same for Danny without a moment’s hesitation. But at the same time he knew that Carl’s condition was probably a little more tenuous than he’d led Leila to believe.
“Get the level-one fluid warmer going,” he said to the nurse, Melanie. She was relatively new but she’d gotten much more confident during the past two weeks, since they’d seen more than the usual amount of trauma patients. “I want two units of blood and two units of fresh frozen plasma given ASAP.”
“Got it.” Melanie hurried to do what he’d ordered. He’d also requested that the auto-transfusion chest tube be set up, and Amy, the nurse who’d been taking care of Trevor, had come over to assist once they’d taken the child upstairs to surgery.
The device was working fairly well, but at a much slower pace than he’d liked. Which was why he’d ordered more blood to be given through the rapid infuser.
How much time would Leila need with the boy? An hour? Two? He didn’t want her to rush things with Trevor, but he also wouldn’t have many options if another trauma patient was brought in. Their team was stretched as it was, considering it was the week between the holidays.
“We’re not going to lose him,” Quinn muttered, as if trying to convince himself of that fact. “Amy, check another hematocrit and hemoglobin the moment those blood products have been given.”
She nodded. “He’s still pretty tachy,” she observed.
Right. As if she needed to tell him. Quinn could easily see the monitor readings for himself. Patients who were either dehydrated or volume depleted were usually tachycardic. Carl’s heart rate had been hovering in the 140s to 150s during the entire resuscitation. Of course, alcohol caused dehydration, too, so they’d been fighting an uphill battle from the start. The patient was both dehydrated and volume depleted from the bleeding.
“Give another two liters of normal saline.” Carl’s urine had a pink tinge to it, indicating he might have internal bleeding in his kidneys as well as his chest. If his belly became tense and distended, they’d be in real trouble.
Three strikes and you’re out.
Hurry up, Leila.
“Dr. Torres? We finally got in touch with Josephine Wolsky, the patient’s ex-wife and Trevor’s mother. She’s on her way in now,” Amy informed him.
Great, Quinn thought with a sigh. He would get to be the lucky one to tell the poor woman that her drunken ex-husband, whose blood alcohol level had been double the legal limit, had almost killed their son.
He was confident Leila would pull the boy through surgery. Trevor would be just fine.
“Let me know when she arrives.” Quinn didn’t take his eyes off Carl’s monitor. They weren’t gaining much ground with his blood pressure, not even with all the blood and fluid they’d given. “Amy? Any word on those labs?”
“I’ll check.” She crossed over to the nearest phone. Within seconds she was back. “Hemoglobin of 7.5 and hematocrit of 20. He’s only gained two points on each.”
Bad news. With all the blood they’d given to him, he should be up at least six points. “Give four more units of blood and two more units of fresh frozen. We need to get his bleeding under control.”
“Do you think it might help to check his coags? If he’s a drinker, his liver may not be functioning well to start with,” Melanie suggested.
“Good point. Send the coag panel.” His gaze narrowed on the heart monitor above Carl’s bed. “Has his rhythm changed?”
“Yes, I think it has.” Amy went over to the monitor and pressed a button to run a rhythm strip. “His ST segments might be slightly depressed.”
“Get a twelve-lead ECG.” Quinn hoped Amy was wrong, because if this guy had suffered a myocardial infarction, he was really out of luck. His chances of surviving surgery were growing slimmer by the minute. Quinn glanced at his watch. Nearly forty minutes had passed. Not nearly enough time for Leila to have finished with Trevor.
And if she didn’t hurry, it would be too late for Carl.
Leila extracted the hematoma from around Trevor’s liver, checking his spleen carefully to make sure there weren’t any hidden bleeders. Once she was satisfied there was no more bleeding, she washed out the entire abdominal cavity thoroughly with an antibiotic solution to minimize the risk of infection.
She began the process of closing Trevor’s abdomen, feeling good about the procedure. There was no reason the boy shouldn’t recover fully from his injuries.
“Call down to the ED,” she told the circulating nurse once she’d closed the muscle. “Let Dr. Torres know I’m ready for him to bring up the next surgical case, the boy’s father.”
“Will do.” The circulating nurse went to the phone hanging on the wall to make the call.
“Dr. Ross?” the nurse called. “Dr. Torres wants to talk to you.”
“I can’t. I’m not finished closing.” She didn’t take her attention away from the task at hand. “I’ll talk to him when I’m finished here.”
The nurse relayed her message. Then she said, “Dr. Torres wants you to know the father has EKG changes, indicating a possible MI.”
Damn. Damn! How on earth was she going to successfully operate on a man who was already having an acute myocardial infarct? Yet what choice did they have? His heart attack was likely a result of the powerful air bag deployment, and if she didn’t fix the bleeding, his cardiac status would only get worse. With the way he was bleeding, they couldn’t afford to send him for a cardiac catheterization first.
“Bring him up anyway,” she said. “And hurry. I’m almost finished.”
She’d felt good about the positive outcome of Trevor’s surgery, but as she stripped off her sterile gown and gloves and headed back to the sinks to scrub up again, she tried not to think about how Carl might not have suffered the MI if she’d taken him to the OR first.
There was nothing she could do to reverse her decision now. All she could do was continue on the path she’d taken, providing the best possible care to Carl once he arrived from the ED.
And live with the consequences of her decision if he died.
Leila swept off her sterile garb and tossed it into the laundry bin, her knees feeling weak. She was exhausted. It had taken three grueling hours, but she’d managed to repair all of Carl Wolsky’s traumatic injuries. Because he was still in critical condition, she’d sent him to the ICU.
He was alive and relatively stable at the moment, although she couldn’t be certain he’d make it through the rest of the night. Especially if his heart injury didn’t get any better. The first thing she’d do would be to contact the cardiologist on call to get his opinion.
After heading into the women’s locker room, she changed her scrubs, and then drew on her lab coat. She needed to head into the ICU to check on Carl to make sure the intensivist and the cardiologist had been in to examine him, but she took a moment to pull herself together, sitting down on the small sofa and closing her eyes.
It was a toss-up which ached worse, her head or her feet. Spending hours in the OR tended to be a strain on her body in more ways than one. With a sigh she rested her head back against the cushion, trying to ease the tense muscles of her neck.
The last time she’d been in this lounge, Quinn had kissed her. She wondered where he was now. Still down in the ED? Maybe. She’d lost track of time, but she knew it was late. The second shift in the ED was normally over at eleven o’clock.
At the rate she was going, she might end up spending the night there. Depending on how well Carl did postoperatively. And depending on what the cardi
ologist’s opinion was regarding his myocardial infarction.
She wasn’t an open-heart surgeon, the lung surgery she’d done on Carl was about as close as she got to operating on the heart. She could do some chest procedures but they didn’t have a heart bypass machine. If Carl needed open-heart surgery, he’d be transferred to Trinity Medical Center in Milwaukee.
After her five-minute break, she stood and walked out of the lounge, taking the elevator to the ICU. Carl Wolsky’s room was still full of personnel—two nurses, an ICU tech and the anesthesiologist from the OR, along with the intensivist on duty.
She stood in the doorway for a moment, watching Carl’s vitals on the heart monitor. He wasn’t doing too badly, considering everything he’d been through.
“Wean him off his vasopressors if his blood pressure stays above one hundred systolic,” she told them.
“Dr. Ross, his ex-wife is downstairs in the family center. She’s waiting to talk to you.”
So they had finally gotten a hold of Trevor’s mother. “Okay, I’ll go talk to her after I check on Trevor’s condition.”
“He’s doing very well,” Carrie, one of the ICU nurses, said. “We’ve been checking on him, too.”
She smiled, understanding the nurse’s concern. Between the father and son, they were treating a family. She went down to the pod of ICU beds they used for pediatrics, located on the other side of the room from the adult side, and found Trevor. He did look great. No fever, vitals stable, and breathing comfortably on the vent.
They could probably wean him off the ventilator in the morning, but for now his young body was still under the effects of anethesia. After writing a follow-up note in his chart, she went down to the family center to find Mrs. Wolsky.
Leila found her right away. She’d obviously been crying, and yet she jumped to her feet the moment Leila walked in. “Dr. Ross?”
“Yes, I’m Dr. Ross. Your son Trevor is doing great, we’re hoping to get that breathing tube out in the morning. I’ve also just completed surgery on your husband, Carl. He’s still very critical. His heart may have suffered a little damage, but he’s stable at the moment.”