by Amy Ruttan
It was like a war zone almost.
“What happened?” Kiri asked, as she threw on gown and gloves.
“A school bus was in an accident. Multiple trauma,” the emergency doctor in charge said. “Most of the kids have minor injuries, but one of them is unresponsive. She’s in Pod Three.”
Kiri nodded and headed straight for Pod Three.
The little girl was unconscious and the code team was shocking her.
“We have a sinus rhythm,” the resident in charge of the team said.
Kiri rushed forward and jumped into the fray. “What do we have here?”
“She was thrown from the back of the bus when the accident happened and was hit by a car.”
Kiri cursed under her breath. “I need a CT scan stat. I want her checked for head injuries and internal bleeding.” She lifted the girl’s shirt and could see extensive bruising on her abdomen. She palpated and she could almost guarantee that there was internal bleeding and the girl would require a splenectomy.
She listened to her chest and could hear fluid.
“I need a chest tube tray,” Kiri shouted over her shoulder. It was handed to her and she inserted the chest tube, blood filling the tube as it drained from the lungs. “Let’s get this girl up to the CT now.”
“Right away, Dr. Bhardwaj.” The resident moved fast as they got the little girl stabilized and started to push her gurney through the havoc of the emergency room to get her a stat CT scan.
Once she had the scan she would know how to approach the surgery. Who she would need in there. They got her straight into the CT scan and Kiri waited as the scans came through. As they appeared on the computer screen she was glad to see that there was no intracranial bleeding, but there was a lot of free fluid in the abdomen as well as a few broken ribs, probably puncturing her lungs. She needed a cardiothoracic surgeon to work on her lungs while Kiri removed the spleen, which was the source of the internal bleeding.
“Page Cardiothoracic and let’s prep an OR,” Kiri said to her resident. “Get her ready.”
The resident nodded and Kiri headed straight for the locker room to change into scrubs. This little girl was going to be in surgery for some time.
And Kiri was going to make sure that the long hours that this girl was in surgery were going to be worth it. She was going to make sure this little girl lived to see another day.
CHAPTER SEVEN
“SUCTION, PLEASE,” SAID KIRI as she worked on the little girl’s spleen. There was no saving it and Kiri was in the process of removing it. The lungs had not been badly punctured and the ribs had been set. The lungs were patched. The cardiothoracic surgeon on duty, Dr. Robinson, was monitoring her, just to make sure that another leak didn’t happen.
“Kids are quite resilient,” Dr. Robinson said offhandedly. “I’m sure she’ll pull through. She’s a lucky little girl. Someone three times her age would have a harder recovery. If this accident had happened on the bridge she could’ve been thrown into the water or the ambulances might not have gotten to her in time.”
Kiri nodded, but didn’t respond to Dr. Robinson. She knew very well that this girl was lucky to be alive. She didn’t wish to engage in any banter, she just wanted to make sure this little girl was stabilized so she could update the parents, who she knew were in the waiting room.
And as she was working on the spleen she noticed there was damage to the kidneys, as well.
Blast.
“How is her urine output?” she asked over her shoulder.
“She hasn’t had any urine output,” a nurse responded as she checked the bag.
Dammit.
The kidneys were probably shutting down, which meant this girl might need a transplant if both kidneys were shot. That’s the last thing this poor girl needed after all she’d been through. Hopefully they could be repaired.
Though she didn’t want to see Alejandro again today, she needed him in the OR. She needed him to check on the girl and assess the kidneys while she continued to work on the spleen.
“Can someone page Dr. Valentino to come to the operating room? I want him to check out this patient’s kidneys.”
An OR nurse went to the phone and paged Dr. Valentino. She could hear the murmur across the room, but she ignored it. She ignored that her own pulse began to race at the thought of seeing him again.
Focus.
Kiri continued to work on the spleen, but then the left kidney began to bleed. “Hang another unit of packed cells. And suction, please. Where the heck is Dr. Valentino?”
Definitely kidney trauma and Alejandro needed to be here. She needed him.
The doors to the OR from the scrub room slid open and Alejandro, capped and scrubbed, came into the room.
“It’s about time,” she snapped.
“Dr. Bhardwaj, what seems to be the problem?” he asked as a nurse gloved and gowned him.
“We have a female, age ten, who has blunt-force trauma to the abdomen after she was thrown from a school bus during an accident. Her urine output has been nil and the left kidney has blood pooling behind it. I need your assistance as I’m working on the spleen.”
Alejandro nodded and took his spot across from her. “And the spleen is damaged beyond repair?”
Kiri nodded. “I’m performing a splenectomy. Her ribs were broken, but Cardiothoracic has cleared her of any trauma to her diaphragm, heart or lungs. There was a small puncture to her left lung but that was patched by Dr. Robinson. It’s all in her abdomen.”
Alejandro whistled under his breath. “It must have thrown her far to damage the kidneys.”
“She was hit by a car,” Dr. Robinson said.
“Poor girl.” Alejandro began his examination. “The left kidney is torn, but it can be repaired. I’ll place a shunt.” Then he looked at the other kidney. “Minor tear in the ureter. Let’s get this girl on bypass so toxins don’t build up and I’ll get to work.”
“I’m almost done the splenectomy then I can get out of your way,” Kiri said.
And she wanted to get out of his way.
“You’re not in my way, Dr. Bhardwaj. I can work around you,” Alejandro said without looking at her as he got to work on the patient.
She couldn’t help but admire his dedication to the task. How he was able to repair such a small organ. Those strong hands so delicate as they worked on the young girl. They moved in unison, not needing to speak as they focused on their work. It was like they had been operating together for a long time. She hadn’t had this rapport with another surgeon since she’d worked with Dr. Vaughan.
“Do we know her name?” Alejandro asked, breaking the silence.
“Casey,” Kiri said. “Why?”
“I like to know.” He glanced up at her. “It helps me to connect to my patients and I like to talk to them, to let them know that they’re going to be okay. And, Casey, you’ll be okay.”
Tears stung her eyes as he talked to the little girl so gently.
“You have a way with kids,” she said.
“I like kids,” Alejandro answered as he worked.
“Yet you don’t want kids?”
His brow furrowed over his mask. “Liking kids and wanting kids are two different issues. Something I don’t want to discuss.”
“Hey, I’m just trying to get to know my colleague better.”
“It’s a very personal question,” he said.
“It’s no different from you grilling me about my lack of significant other the first time we operated together.”
Alejandro’s eyebrows popped up and he chuckled. “Touché.”
“Wrong use of that word, my friend.”
“How so?” he asked.
“It means to touch. We’re not touching.” And then her cheeks heated when she realized what she’
d said. Those dark eyes of his twinkled behind the surgical mask but he didn’t say anything else to her.
“Casey, you’re doing great,” he said. Kiri smiled.
What was with him and names?
And it reminded her that she’d never named her baby boy. Their baby. She’d planned to name a boy after her father. She shook her head. She couldn’t think about that right now.
As she finished the splenectomy Alejandro was still working on the damaged kidney and shaking his head, which made her heart sink.
“There is nothing I can do,” he said. “I’m going to have to do a nephrectomy.”
“And the other kidney?” Kiri asked.
“The ureter isn’t that damaged and the kidney is intact and not bleeding. It will be fine. We’ll keep her in the hospital and I’ll monitor her and give her the right medicines to help with elimination until the ureter on the right kidney heals. A shunt will help.” Then he stared at her. “And if her parents can’t pay to keep her here, will you ship her off to County?”
It was a pointed barb. And as she’d be the one to sign off on it, she was powerless to stop the board’s will.
“You know that’s beyond my control. And she has parents. She’s not a ward of the state.”
“Good, because I would do everything in my power to keep her here if she was going to be shipped off. She’s my patient.”
“You can’t pay for every child.”
He grunted in response. What she wanted to tell him was that she’d try her best to keep Casey here so that Alejandro could monitor her, but that was beyond her control. It was bad enough that the Buena Vista board of directors was seriously considering shutting the ER doors, because they were tired of vagrants and those who couldn’t pay coming to their hospital, but that was for the head of trauma to deal with. Not her.
In this case of the school bus accident they had been the closest hospital and they were a level-one trauma center. Whether the board liked it or not, they couldn’t close their doors to those who were hurt.
Especially not children.
Perhaps that was how she could persuade the board of directors to allow Casey to stay if her parents weren’t able to pay the hospital bill. It would be good press for the hospital if they allowed the young girl who was hurt in a school bus accident to be treated by their world-class physicians.
Like Dr. Alejandro Valentino, who was saving this girl’s life by operating on her kidneys and probably saving her from going on the already taxed and full UNOS list.
And then she thought about little Gervaso. He was priority, but she was worried that he wouldn’t make it to get his heart transplant and what would that do to Alejandro? She knew the pain of losing a child.
“I’m finished with the splenectomy,” she said. “I’ll go give the parents an update about her condition.”
Alejandro nodded. “Thank you, and let them know that once I’m done with the nephrectomy I’ll come out to speak with them.”
“All right.” Kiri headed to the scrub room and peeled off her gown and gloves. This was her least favorite part of the job, telling parents who were scared beyond belief the status of their child. Telling them their child was ill and undergoing a serious surgery to save their life.
At least Casey would probably pull through.
Casey would probably live.
* * *
The nephrectomy and the ureter repair took longer than Alejandro had anticipated, but the bleeding in the cavity where the damaged kidney was had stopped and the ureter had been repaired. Casey was producing urine again, thanks to a shunt and some elimination medicines that would help her as she healed. At least Casey still had a viable kidney. She didn’t have to go on UNOS. She was broken, but she could be repaired and go on to live a full life.
You can too. You can have a full life. You’re just scared.
He shook that thought away. There was no time to feel sorry for himself. He was here to give an update to his patient’s parents.
As he walked into the waiting room he was surprised to see that Kiri was still sitting there with the parents, talking with them.
Kiri saw him first and gave him an encouraging smile then stood up, which caused Casey’s parents to jump up and stare at him with terrified hope.
There was no other word for it. He knew that look too well.
“You must be Casey’s parents.” He held out his hand. “Dr. Valentino.”
“How is our daughter?” Casey’s mother asked, clearly terrified, not taking Alejandro’s hand after her husband had shaken it.
“She’s fine. She’s in the pediatric intensive care unit. She sustained multiple injuries to her abdomen as well as several broken ribs. As Dr. Bhardwaj told you, we had to remove her spleen and one of her kidneys.”
Casey’s mother covered her mouth with her hands and was trying not cry. “Is she going to be okay?”
“Yes, she will be. People can live with one kidney. I’ll refer her to a nephrologist, who will monitor her over time. We’re going to keep her in the hospital for at least a week so I can monitor her progress and watch to make sure that the shunt I placed doesn’t slip. She will be on some medications for some time to help her eliminate urine and aid in the healing process.”
“Can we go see her?” Casey’s dad asked.
“Of course,” Alejandro said.
“I’ll take them up there,” Kiri said. She walked by and squeezed Alejandro’s arm in thanks as she led the parents out of the waiting room. He was exhausted and he had to find a good strong coffee and take his own medication.
Just like he did every day at this time. The antirejection medication so he wouldn’t lose his father’s heart.
It’s your heart now.
Only it wasn’t. Alejandro knew it was his dad’s and that was why he was living. The ultimate gift from his father. Which was why Alejandro had dedicated his life to surgery.
He wanted to give back.
For as long as he could, because who knew how much longer he had? How much time his father’s heart would beat for him?
He grabbed his wallet out of his locker and then headed outside where there was a coffee cart that sold particularly strong Cuban coffee day and night. The sun was just setting. The city was full of gold and red and he wished that he was back at his apartment, watching the sun set over the ocean.
This was his favorite time of day.
When the world slowed down just a bit. When he could thank the powers that be for another day on earth. Another day of saving lives.
Of course, in South Beach the world didn’t slow down all that much and the nightlife would be gearing up. The clubs would be pumping out loud music and hordes of people would be wandering the streets.
Tourists mostly, but still the streets hummed with a different pulse and it had been so long since he’d gone there to feel life, the energy flowing through the music. It had been so long since he’d danced.
“What will it be tonight, Dr. Valentino?” the barista asked.
“Tall and dark with two shots of espresso, please.” Alejandro opened his wallet and pulled out the money.
“Coming right up.”
Alejandro rolled his shoulders. They were stiff and sore from the surgery, but the pain was worth it. That little girl would go on to live another day. Even if she was minus a couple of organs.
She had another shot at life.
The pain on the parents’ faces, though, had been too much to bear for him. Which just affirmed his choice not to have a family.
“Here you go, Dr. Valentino.”
Alejandro took the coffee and paid the barista. He wandered over to the row of benches just outside the main hospital doors and sat down. He closed his eyes and listened to the city.
His city. When he’d danced, he’
d been working all over the country, but Miami was his home. It always would be, even though he’d lost his parents here and had even lost a brother who’d gone off and joined the army for a time, he still loved it. He would always come back here.
His parents were gone, but at least Santiago had come back.
There was just something about this place that spoke to him. Miami had a hold on him. It was his first love.
His only love.
Is it?
And then he couldn’t help but think of Kiri. After their time in Las Vegas he’d tried to find out more about her. He’d wanted to get to know her, but Ricky hadn’t had that information or at least hadn’t been willing to share it.
Ricky had been a bit difficult that way and he had not been happy when Alejandro had decided to leave.
“You’ll come back. You’ll need money and you’ll come back. They always come back.”
Alejandro had promised himself he would never go back to dancing like that. Which was why it was imperative that no one found out about his past.
Of course, that had never concerned him until Kiri had shown up. It was good Ricky had never shared that information. He had no right to get attached to her. To lead her on when his time was limited.
“Can I join you?”
Speak of the devil.
He opened his eyes to see Kiri standing there. She looked as tired as him. He should tell her to leave, but he couldn’t. He was lonely.
“Of course.” He slid over and she sat down, slumping over.
“I was not prepared for a splenectomy today,” she said.
“Who is prepared for splenectomies?”
“I am, when I plan the surgery because of a preexisting condition, but an accident like that? It’s something I’ll never get used to.” Kiri shook her head. “So much trauma.”
“You’re a surgeon, you have to live for the moment.” He took a sip of his coffee; it was bittersweet, just the way he liked it, and it woke him up.
“I know, it’s just... It’s so hard watching a kid go through that. I sometimes wonder why I chose to work with kids.”