by Radclyffe
“Hi,” the blonde said, stepping forward with a hand out. “I’m Zoey Cohen. You just took my place.”
“I see,” Syd said, shaking her hand. Interesting opener. Casual remark, subtle challenge, or warning? “Where did they move you?”
“Peds surgery.”
With Dani, Syd thought. Well, things are getting interesting fast.
“You’ll want this.” Zoey held out a pager. “Trauma beeper. Text messages aren’t always reliable in some areas of the complex. You wouldn’t want to miss an alert.”
“No, I wouldn’t. Thanks.” Syd took the pager, clipped it to her waistband, and motioned to Morty. “Come on, let’s get going. We’ve lost enough of the day already.”
“Right,” he said and ambled after her.
From behind her, she heard Zoey laugh but couldn’t make out Emmett’s answer. Not that she cared. They’d just rounded the corner to the trauma unit when the trauma beeper vibrated. She checked and stopped in her tracks. STAT trauma admitting.
She grabbed the back of Morty’s scrub shirt as he sailed past. “Change of plans, we’ve got incoming.”
She pivoted and ran back down the hall toward the stairwell they’d come up earlier, sorting out in her head the fastest route to the trauma unit. Emmett had gotten to the stairs first and held the door open as she and Morty raced up. She grinned at them.
“Looks like it’s going to be a busy day.”
Emmett rocketed down the stairs and Syd flew after her, Morty galloping in their wake.
Chapter Eight
The charge of adrenaline coursing through Emmett’s blood was the most exhilarating thing she’d felt all morning, even better than sex. She laughed inwardly. Sex was great fun, but the sensation only skimmed the surface—an electric shock, acute and sweet, dancing over her skin and swirling off into the air. Gone in a heartbeat. This excitement claimed every part of her, bubbling through every nerve ending in her body and injecting every fiber with anticipation. This call to action was her private pleasure, one that left her feeling lucky every single day.
Emmett slowed just enough to surge through the stairwell doors without knocking anyone down, and then she was running again. Shapes moved around her, people stepping aside, falling in line, rushing along with her to the brim of the same cliff. Slapping the button on the wall next to the wide double doors to trauma admitting was like screeching up to the edge of the abyss, teetering, about to fall and then…then she was inside and calm descended. As quickly as time had sped up during her dash to the trauma bay, now it slowed.
Bright lights, a milling throng, at first each body indistinguishable from the others, a cacophony of voices shouting, drowning each other out and yet each distinct through the utter stillness in her body and her mind. A long scan of the room—five beds occupied, one form beneath the tubes and wires and monitors smaller than the others. A kid.
In the eye of the storm, Honor Blake directing with the calmness and exquisite control of the seasoned conductor. Her voice somehow rose above all the rest.
“O’Brien, you’ve got trauma one—Kennedy, take two. Armand, take the child and call peds surgery.”
She spun, spied Emmett.
“McCabe—bed three, crush injury to the chest, possible head and intra-abdominal injuries. Bed four, multiple extremity fractures, airway compromise.”
“On it.” Emmett headed for the injured, pointing as she elbowed a few of the gawkers who always showed up for a trauma alert out of the way. “Zoey, take—”
Emmett slowed so abruptly she nearly stumbled. Right. Zoey wasn’t there. Her team had changed, and so had her responsibilities. Maguire had made that clear. Syd had to be brought up to speed on major traumas quickly. And Emmett, Maguire had pointed out with the merest tilt of her brow, needed more surgical teaching hours. Emmett was in charge, but the field was not entirely hers. She not only had to share, she had to play backup quarterback.
“Syd, take bed four while I check on bed three. I’ll be there in a minute.”
“Okay.” Syd nodded briskly, looking cooler than she probably felt. A multiple trauma at a level one trauma center with patients who’d sustained immediately life-threatening, multisystem injuries was a lot different than stable patients at a level two, where the team had a lot more time to assess and treat, and a lot less chance for fatal errors.
Emmett resolutely turned to the patient in bay three and snapped, “Morty, you’re with me.”
“Yes, Chief.” He jumped and was on her tail in an instant.
Points for him.
“So,” Emmett said, “what have we got.”
The ER resident, a second year, looked up, her eyes wide and just a little crazed. Adrenaline rush.
“Truck jumped the median, struck a passenger car head-on. This one’s the van driver. Forty-five-year-old male, restrained, closed head injury, crush injury to the chest, possible intra-abdominal deceleration injuries. Hypotensive in the field, resuscitated with fluid. Oxygen sats were low on arrival, and he’s unresponsive. I just intubated him.”
Pretty standard for a car crash. Emmett scanned the monitors. Heart rate in the 90s, pressure hovering around 100, oxygen saturations holding but lower than she’d like to see. His lungs probably took a beating from a direct blow or the aggressive fluid management or both.
“Morty, what’s first,” she asked as she stepped up to the bed.
“Check his chest for breathing tube placement and bilateral airflow,” he said. “CT of the head, chest, and abdomen if he’s stable.”
Quick and thorough. Another point for the skinny guy.
“Go ahead and listen and tell me what you think.” As Morty pulled out a stethoscope, Emmett listened for herself, turning her head to check on bed four as she worked. That patient was a woman, late thirties or early forties, cervical collar in place, an air splint on her right lower extremity. Emmett saw Syd shake her head, say something to Armand, who hurriedly grabbed a stethoscope and stuck it on the patient’s chest. Emmett needed to be over there, but she couldn’t leave this patient yet.
“Good breath sounds both sides,” Morty said. As he spoke, he palpated the unconscious man’s abdomen. “His belly is soft, strong femoral pulses. If he’s otherwise stable, he can go to CT.”
“Good,” Emmett said and checked his vitals again. His pressure was up a little from when she’d first checked, but everything else was about the same. She looked him over one more time—searching for that one thing she’d overlooked. The one thing that might make the difference between a save and a loss. “Any evidence of blunt head trauma?”
The ER resident shook her head. “No. No lacerations or contusions I could see. According to the paramedics, he was vocalizing but incoherent in the field.”
Emmett narrowed her eyes. “What about on arrival?”
The ER resident shook her head. “No, nothing.”
“Morty? What are we thinking?”
“He could have a deceleration brain injury. An intracranial bleed could cause his altered state of consciousness. Or it could just be a contusion.”
Emmett quickly checked his pupils. Both were sluggishly reactive. “He needs a head CT and a neuro consult to clear his head and C-spine. There’s nothing obvious in his chest and belly right now.”
“Can I take him down for the CT?”
“Not until neuro sees him. Morty?” Emmett said, already moving around the bed toward Syd’s patient. “What are you watching for now?”
“Drop in BP or O2 sats, change in heart rate. Further change in neuro status.”
She smothered a grin. He was a smart one. He looked like he ought to be an accountant. “Good. He’s yours. Stay with him. Make sure neuro sees him.”
His grin widened, and she caught a flash of the shark in his eyes. The one that swam at the outside of the herd, circling a school of smaller fish, waiting for the weak to fall away and then silently picking them off one after the other.
“Got it, Chief,” he said and turned back
to the ER resident. “Who’s the neurosurgeon on call? How do I get them?”
She might not have to worry about that one. Leaving Morty to handle bay three, she checked on Syd. “Stevens, what have you got?”
“She needs a chest tube,” Syd said.
Just like that. Not I think she needs a chest tube, or maybe she needs a chest tube, but clear and definitive. Emmett wasn’t surprised.
“X-ray?”
“They’re on their way, but her breath sounds are depressed on the right and her sats are not coming up on a hundred percent oxygen.”
Emmett listened to her chest, an eye on the monitors. “Not much air movement on the right.”
“Emmett, she’s got a tracheal shift now,” Syd said, a new urgency in her voice.
Emmett’s heart rate kicked up. The situation had just moved from a controllable one to an emergency. If the patient had a tension pneumothorax, no air or blood was flowing normally, and that was a setup for a major crash.
Armand announced, “BP’s falling, guys. We need to do something here.”
“Somebody let Dr. Blake know this one’s probably headed for the OR,” Emmett said to the ER nurse before glancing at Syd. “You called it.”
Pulling on gloves, Syd was already in motion. “I need a chest tube tray and a twenty-four French chest tube.”
“What else?” Emmett’s hands itched to do what needed to be done. Damn it, but teaching was hard.
“Fourteen-gauge Angiocath,” Syd said, splashing Betadine onto the patient’s right chest. “Where are they?”
“I got it,” Emmett said and opened the sterile package, offering the needle to Syd.
Syd took it, pushed it between the fifth and sixth ribs along the patient’s right side, and air whooshed out. Her pulse came down, her pressure started to come up, and her oxygen saturation rose.
“Nice,” Emmett muttered.
Syd grinned for half a second before refocusing on the patient.
Honor appeared at the foot of the table. “You two on top of this?”
“Just about to put in a chest tube,” Emmett said. “I wouldn’t trust the Angiocath in this situation.”
“Agreed,” Honor said.
“She’ll need a stat chest CT once that’s in,” Emmett added. “I’ll call an attending.”
Syd looked over at them. “Can we get a bedside portable ultrasound, look at her heart and great vessels? She could have a mediastinal injury. Save us some time.”
Honor nodded. “Good call. Let’s do that first before we let her go anywhere else. You’re putting in the tube, Doctor…?”
“Stevens,” Syd said. “Syd Stevens.”
“Honor Blake.” Honor turned as someone called her name. “Go ahead.”
“You got that?” Emmett said quietly.
“I know how to put in a chest tube,” Syd said softly.
“Right.” Emmett gave her some space, checked to see that Morty’s patient in bay three still looked okay, and glanced over her shoulder when she heard Zoey’s familiar voice.
“The peds attending is in the OR,” Zoey said to a small, intense-looking woman resident with slicked-back jet-black hair. “He said we can take Eddie here to CT if Honor says we’re good to go.”
“Anything for trauma?” Emmett asked, walking up to the bed.
Zoey laughed. “It’s a peds case, Emmett.”
The dark-haired woman gave her a questioning look.
“Emmett McCabe. I’ve got the trauma service.”
“Dani Chan. We’ve got this here. Uh…thanks.”
Emmett had a feeling that thanks pained her a little bit. She understood. Trauma surgeons had a reputation for moving in on other people’s cases. Of course, that’s because they were probably the best at handling whatever was going on. But she knew better than to step on the peds surgeons. Their chief took no prisoners.
“If you need a hand—”
Dani Chan straightened. “Nope. All good.”
“Okay then.” No thanks this time. Emmett nodded and caught Zoey’s smirk. Couldn’t hurt to try.
“Emmett.” Syd’s voice cut through the low level of conversation. Something in her tone—not panic, just a sharp warning—gave Emmett a jolt. She spun around. “What have you got?”
“Her pressure’s falling,” Syd said, lifting her stethoscope to her ears. “And look at her neck.”
The veins in her neck bulged, and Emmett quickly checked the chest tube Syd had inserted. That looked fine.
Syd straightened. “Her heart sounds are muffled. I think she’s tamponading.”
“Fuck,” Emmett muttered under her breath and listened for herself. She could barely make out the heartbeat. Fluid around the heart would do that. “We need that ultrasound.”
Armand said, “I’ll get it.”
“Move, and get Dr. Blake.”
“She’s crashing,” Syd said, and the beeping monitor and the flatline heart trace confirmed it. Instantly, she climbed onto one of the short stools near the stretcher and began chest compressions.
“What’s going on,” Honor said, rushing back to the bedside.
“Pericardial tamponade.” Emmett grabbed the ultrasound gel from the cart and squirted it onto the chest for the ER resident, who slid the probe over the patient’s chest.
“Armand,” Honor said to her resident, “what do you see?”
“Um, just a second…wait, there!” He repositioned the probe and pointed to a dense layer around the heart. “Looks like blood in the pericardial sac.”
“Sure does.” Honor called to a nearby nurse, “Cliff, stat page cardiac and trauma. This one’s got something going on in her chest.”
“We ought to aspirate that,” Emmett said.
“Yes.” Honor nodded to Emmett. “Want to take Armand through it?”
“Sure.” Emmett rummaged through the crash cart and came out with a large bore spinal needle and handed it to the ER resident. “Ever done one?”
“Seen one,” he replied.
“Then you’re ready,” Emmett said. “Syd, hold compressions.”
Syd relaxed, her gaze alternating between the resident who inserted the long needle into the patient’s chest and the ultrasound that tracked the course of the needle advancing beneath the breastbone, angling up toward the shoulder, into the space around the heart. The EKG stuttered and spiked, no discernible rhythm, the electricity of the heart erratic.
“Runs of V-tach,” Syd said.
“Okay, pull back just a little,” Emmett said.
“Clear,” Syd said as a normal EKG wave appeared.
“There you go,” Emmett said as the needle pierced the sac surrounding the heart and entered where there should be no fluid, but there now was a layer of blood preventing the heart from functioning normally. “Aspirate that.”
Armand pulled back on the syringe and a few cc’s of thick dark fluid aspirated. “I can’t get anything else out.”
“Clotted,” Syd murmured. “BP still forty palp.”
“Trauma here yet?” Honor called to no one in particular.
“Not yet,” Cliff called back, appearing at the bedside. “You need an instrument tray, Doc?”
“Looks like it. We’re going to have to do a window.” Honor sounded as calm as if she hadn’t just suggested they were going to cut a hole into the patient’s chest right in the emergency room. “Emmett, you’re up. Ready for this?”
“Yes.” Emmett snapped on fresh gloves and pictured the landmarks in her mind. Syd watched her. Honor watched her. Hell. Everyone was watching this.
“Take your time. We don’t need to put the other lung down,” Honor said, pulling on gloves to assist.
“Right,” Emmett said tightly. No pressure. Right. She made the incision and spread the thin layer of fat and muscle right under the breastbone.
“Emmett,” Morty called from the adjacent bay. “I think you need to see this.”
“Can’t,” Emmett said without looking up from the incision she’d ju
st made in the patient’s chest. “Syd, go help Morty.”
“Right,” Syd said.
Syd disappeared just as Emmett snipped away a portion of the protective layer around the heart.
* * *
“Morty,” Syd said, trying not to be aggravated about missing out on the amazing procedure that Emmett somehow ended up doing on her patient. “What do you need?”
“His heart rate’s down, and his pressure’s up again.” Morty shook his head. “Something’s going on.”
Syd assessed his vitals. If Morty had been anyone else, she wouldn’t have been impressed. Everything was near normal at first glance. “Fill me in.”
Morty quickly gave her a rundown of the patient’s history and treatment so far. “But here’s the thing—he was awake in the field.”
Alarm bells rang. Almost before he’d finished speaking, Syd had her penlight in hand to check the pupils.
“His left pupil’s enlarged and nonreactive.”
“It wasn’t a minute ago.” Morty’s voice climbed. “Crap, Syd, he’s bradying down. Heart rate is fifty.”
The ER resident instantly cranked up the head of the bed and said, “Starting hyperventilation.”
“He’s got a bleed,” Syd said. “Did you call neuro?”
“Yes, he said he was on his way, but…”
“I don’t think we can wait very long.” Syd half turned. “Dr. Blake, this patient has an intracranial bleed, and he’s—”
The patient seized, and Syd called, “Valium, I need ten mg of IV Valium stat and start a Dilantin drip.”
A flurry of people gathered around the bed.
“Fill me in,” a man with a deep baritone voice said from behind Syd.
She looked over her shoulder into the steady, dark eyes of a man who at first glance might’ve been Jerry’s brother, a little bit older, and thirty pounds heavier. “Closed head injury. Recent, rapid onset of signs of intracranial bleeding. Left pupil’s blown.”