by Radclyffe
“Kos Hassan, neurosurge.” As he spoke, he rapidly examined the patient. “You’re new.”
“Syd Stevens. Fourth year surgery resident.”
He straightened, tucked his tie between the buttons on his snowy white shirt, and smiled. “Ever done a burr hole at the bedside, Doctor?”
“No.”
“Well, you’re about to.”
Syd reached for a pair of sterile gloves, sweat trickling down the center of her spine. She’d actually only ever seen burr holes in the OR while observing brain surgery. But he hadn’t asked her that, had he? Her hands were steady as she pulled on gloves. She could do this.
Chapter Nine
“I heard a rumor you were getting started without me,” Quinn Maguire said.
Quinn’s words skipped over the outer reaches of Emmett’s awareness like stones on the mirrored surface of a pond, barely casting a ripple. Nothing registered except the instruments in her hands and the open incision above the beating heart.
“Hi there,” Emmett heard Honor say. “I thought you were scrubbed.”
“I was,” Quinn said, “till I got the message you were having more fun down here than I was. I left the fellow finishing up.”
Fun wasn’t exactly what Emmett had been thinking as she snipped away a postage-stamp-sized patch of pericardium from the underlying heart. Ordinarily, nothing separated the two structures except for a whisper-thin space. What she found now was a half-inch layer of congealed blood all around the heart. The buildup of clot constricted the heart in the closed space and prevented it from pumping normally. She was about to fix that by clearing away the clot. Only problem was, that blood had come from somewhere, and she had no idea if the bleeding had stopped. If she started the bleeding up again, what was she going to do down here in the trauma unit? Her pulse trip-hammered.
“Hey, Quinn?” Emmett cleared her throat. Crap, she sounded like a wimp. “Look at all this clot. There must be something big bleeding—a cardiac injury, maybe.”
Quinn moved up close behind her and braced her hands on Emmett’s shoulders. “Give me a look.”
“Can you pull on those retractors, Dr. Blake,” Emmett asked, leaning to her left to give Quinn a better view of the two-inch-square space she had made just below the patient’s breastbone. At the depth of the wound, the thick cranberry-colored clot filled the space.
“Yep,” Quinn said conversationally, “that’s impressive. I bet you’ll have to scoop some of that out by hand.”
“It might stir up fresh hemorrhage,” Emmett said. She didn’t sound as wimpy that time but a queasy sensation settled in her stomach.
“It might. But she’s not going to do well unless you get that out of there.” Quinn squeezed her shoulder. “Go ahead and clear it, and then I guess we’ll see.”
Emmett’s stomach cramped but the vomity feeling faded. Her legs were probably shaking, but since she couldn’t feel them, she wasn’t sure. Her hands, though, they didn’t fail her. They were steady and as sharp as her vision. Everything was super clear as her focus narrowed until only the surgical field remained.
“Suction,” she said.
“Here,” Honor said and passed her the thin, flexible catheter.
Emmett carefully sucked away at the clot. Her first glimpse of the heart, beefy red and beating rhythmically—thank everything that was holy—left her in awe as it always did.
“Pressure’s coming up,” Armand said. “Sinus rhythm, but still slow.”
“There’s fresh blood,” Emmett said as a trickle of new bleeding flooded into the field.
“Now’s the time we move,” Quinn said. “We’ve got a minute or two while she’s stable enough to get her to the OR. I don’t want to be handling a cardiac laceration down here.”
“I’ll call the OR and tell them you’re coming,” Honor said, stepping back from the table.
“And page the heart team,” Emmett called while pressing a sterile pad over the incision she’d made in the patient’s chest. No time to close that now.
Quinn grabbed the foot of the stretcher, Armand pushed from the front, and Emmett ran alongside, keeping the equipment and lines and monitors from tangling in the wheels or falling off. One of the ER staff raced ahead to hold the elevator.
“We’ll get things set up for the heart team,” Quinn said as the elevator doors opened. “But if they’re tied up, we’ll have to crack her chest.”
“Absolutely,” Emmett said, as if it was just another day instead of one filled with firsts. She was suddenly responsible for a whole new crop of residents, currently in the middle of an emergency she’d never handled before, and constantly unbalanced by the presence of a woman from her past she’d never been able to forget.
* * *
Kos Hassan handed Syd a scalpel. “Do you know where you’re going with this?”
She pictured the diagram from her trauma text in her mind, thanking genetics or just pure luck that she had an excellent visual memory. “Two finger breadths in front of the ear and two finger breadths above.”
“All right. Where does that put you?”
“Temporal fossa,” she said instantly.
“And what do we have to worry about in there?”
“Everything?” Syd laughed and hoped the neurosurgeon had a sense of humor. “Besides the brain? On the left side, speech and motor function.”
“What else?” Hassan pointed at Morty, all the while arranging instruments on a tray with quick, efficient, seemingly automatic motions. “You, buddy, who are you?”
“Morty Weiss, sir.”
“And who would you be, Morty?”
“Oh.” Morty grinned that guileless grin. “A second year surgery resident.”
“What are you worried about?”
“Middle cerebral artery?”
“Very good. You two are from Franklin, right?”
“We were, yes,” Syd said.
Kos’s laughter was a rumble. “Good point. Well, don’t hit the middle cerebral artery, Dr. Stevens.”
“No, Dr. Hassan. I won’t.” She hoped. She pointed to where she intended to make the incision. “Okay to start?”
“Perfectly.”
Syd cut down directly to the skull, expecting the profuse bleeding that all scalp incisions made. “Morty, get those retractors in here.”
Morty had anticipated what she’d need and already had the narrow right-angle retractors in his hands. He slid them into the incision and pulled back, stopping the bleeders with pressure and saving her critical time. She swabbed the area and looked at the skull, gleaming white under the bright lights. She didn’t need a lot of exposure. The burr hole would only be about half an inch in diameter, and hopefully they’d only need one. Hopefully.
“Here you are,” the neurosurgeon said, handing her the drill with the broad bone burr on the end. Drilling through the skull was the same as drilling bone anywhere else in the body. Bone was a hard substance, and the drill head generated heat around it as it penetrated. Heat killed living cells, and as dense as bone might be, it was still alive, and they didn’t want to kill the skull. “Morty, you have to irrigate while I do this. Get a syringe of saline.”
“Just a second.” Morty sounded just a little bit breathless. “Okay, I’ve got it, Syd.”
Syd spared a glance at Kos. “I’m starting.”
“You’ve got the conn, Doctor.”
Syd smiled at the familiar phrase. Her father had been a Navy doctor and her mother a Navy pilot. They’d both been out of the service since Syd and her siblings were young, but they never lost the language. She wondered what they’d think if they knew what she was about to do and quickly chased the thought away. No time for that now. No time for that at all.
“Here we go.” Syd knew the principles. She knew there was an outer table of bone protecting a spongy vascularized middle and then another inner table of bone before getting to the tough fibrous tissue covering the brain itself. Not all that much protection, really, for the delicate spongy tissue packed wit
h nerve cells and microscopic fibrils that carried the impulses that made the heart beat and the muscles move, and formed the thoughts and emotions and, if there was one, probably the soul of the individual. She started the drill and set it to the bone. Small pulverized bits of white dust shot into the air. “Irrigate, Morty.”
The stream of saltwater washed away the minute particles and quickly turned pink when she hit the middle layer of the skull, and then clear again when she broke into the inner table. The resistance gave way and she instantly stopped the drill. The covering of the brain, a thick grayish envelope of dense tissue laced with blood vessels, instantly bulged into the wound.
“Quite a bit of pressure under there,” Kos said in a steady, even voice. “Go ahead and cut that and give the brain a little bit of room to breathe.”
Syd sliced into the dural lining and bloody cerebrospinal fluid gushed out. The CSF should be clear, not bloody, but the brain underneath pulsed in time to the patient’s heartbeat, pink and healthy looking.
“Pulse is coming up,” the ER resident said in a rapid staccato, her voice an octave higher than it had been earlier. “Pressure is coming down.”
“Well, isn’t that a pretty sight,” Kos said.
Syd leaned against the table, her knees a little weak. She took the first breath she could remember breathing for what felt like an hour. “Is one hole enough?”
“It is for now, but we have to assume there’s a clot somewhere. If it’s epidural, we’ll need to evacuate it. Since you’ve got such a nice, pretty little hole there,” he said, “we might as well put in an intracranial pressure probe so we can monitor his brain pressures. If you don’t mind, Dr. Stevens, I’ll do the honors.”
Syd chuckled. “I don’t mind at all.”
He already had the probe, a long thin needle connected to a transducer, in his hand. He threaded it through the hole in the skull, through the brain matter, and into the ventricle, the space deep in the brain where fluid cushioned the delicate organ as it moved about in the skull. He handed off the leads for the ER resident to connect to a monitor.
“Normal pressures,” Syd said, watching the readout. Now she really could breathe again.
“I think we can take him down to CT now. If you’re free, you can come along.”
Syd checked the surrounding beds. Emmett and the woman Syd had been taking care of were gone. A tall redhead in a white lab coat and baby blue scrubs was conferring with Sadie and Zoey over the child in the last bay, and the ER residents were busy at the other two beds. “It doesn’t look like they need us down here. I’d like to see this through.”
He smiled, his eyes approving. “Well then, Doctors, shall we?”
Syd glanced at Morty, whose mouth tilted up into a triumphant grin. He was having fun. So was she.
* * *
In the surgeons’ lounge, Syd collapsed in an overstuffed chair that had seen better days. Actually, better decades. The dun-colored upholstery was worn black in places, some of the stuffing was coming out along the seams, and the arms sagged after undoubtedly serving as leg rests for generations of surgeons. The damn thing was so comfortable, she never wanted to get up. Morty handed her a can of Diet Coke and a bag of chips.
“Thought you might be hungry,” he said, dropping onto the ugly mustard-yellow sofa adjacent to Syd’s chair.
“Starving. Thanks.”
“Me too,” he mumbled around a mouthful of something orange that she thought might be cheese curls, but she didn’t really want to think about.
“Are you like…” Morty laughed. “Are you like high right now?”
Syd dropped her head back, stared at the dingy gray tile ceiling, and laughed. “Totally.”
“I mean, how cool was that?”
“Cool,” Syd agreed. This feeling, this euphoric sense of invincibility, was what made all the misery worthwhile. Oh, sure, it didn’t last, but like with any drug, at least so she imagined, just knowing the high would come again was addicting.
Morty swallowed another mouthful of totally non-nutritious artificial food. “And did you happen to see what Emmett was doing?”
“Oh, yeah,” Syd said dryly. Emmett had moved in on her patient with the lethal efficiency of an apex predator—sleek and beautiful and deadly. And stolen her case. Forget the beautiful part too. The fact she was so damn easy to look at and charming and sexy just made it worse. “I saw.”
“We were doing major procedures in the trauma unit.”
“Well, we’ve done that stuff before.”
“Sort of.”
He was right. Sort of. She’d certainly put in any number of chest tubes in the OR and in the intensive care unit, but usually under much more controlled circumstances. She’d injected intracardiac epi during codes. But she’d never done what she’d done today. She’d never operated under extreme circumstances to save a patient’s life. Circumstances when, if she’d failed, the patient would’ve died. She’d grown as a surgeon today in a way she never had before. She sighed. She’d known what she might have been giving up when she’d decided to go to Franklin, and she hadn’t cared. Maybe her parents had been right. No. They weren’t. She’d made the right decision then. The only one she could.
“You did really well today, Morty,” Syd said. “You picked up what was going on with that patient, and if you hadn’t—”
Emmett came through the door, a vending room sandwich in her hand. Her smile was bright. The energy emanating from her practically glowed.
“Hey, I was just about to call you guys.” Emmett sat on the coffee table in front of Syd. Their knees nearly touched. Her dark hair was ruffled and a little sweaty. Syd blinked. Emmett looked good and the fact that she noticed was different. Different and totally not what she wanted.
“How’s your patient?” Emmett asked, unwrapping her sandwich.
“Which one?” Syd said before she could stop herself. “The one I started with or the one I finished with?”
“Ah,” Emmett said, taking a bite and looking as if the white bread and thin layer of turkey took effort to get down. She chewed, looked around, and Syd offered her soda.
“I’m done with it,” Syd said, “if you don’t mind sharing.”
“Like I’m worried.” Emmett rolled her eyes, took the can, and swallowed several gulps. “Thanks.”
Seeming not to have noticed Syd’s sarcasm, Emmett said, “The guy with the head injury.”
“He’s great,” Morty said, sitting up straight. “The CAT scan showed an intradural hematoma, and Dr. Hassan is going to watch it for now. He’s going to get a repeat CT in six hours if his ICP is stable.”
“Did I see you getting ready to do burr holes over there?”
“Yep. Syd did emergency burr holes,” Morty said. “Well, one, and Hassan put in an ICP monitor.”
“Sweet.” Emmett grinned at Syd, a spark of excitement and a little envy in her gaze. “Awesome, really.”
Emmett’s envy made Syd feel just a little bit better and exhilaration bubbled in her chest. Sure, she hadn’t gotten to do the pericardial window, but she’d seen Emmett do it and knew she could. Instead, she’d done something she’d never done before, had never even seen under emergency circumstances. So as far as she was concerned, it was really a win-win. Not that she was going to say so to Emmett.
“Morty made a great save,” Syd said quietly.
Emmett balled up the cellophane and cardboard wrapper from her sandwich and tossed it at the trash can. It hit the rim and fell onto the floor. Undaunted, she tossed the Coke can after it. “Two points,” she said, standing and brushing crumbs from her scrubs. She picked up the wrapper and trashed it. “Morty, Hank is in the TICU checking on post-ops. Why don’t you catch up with him and he’ll go over the rest of the patients with you.”
“On it.” Morty was already on his feet and headed toward the door. He looked at Emmett the way he sometimes looked at Syd, as if he was a young, unseasoned hunter and she was the leader of the pack. But then, Syd thought ruefully,
Emmett was his leader now.
“So,” Emmett said, dropping into Morty’s spot on the sofa and propping her feet on the coffee table. “We should talk.”
Chapter Ten
Syd looked wary, and Emmett didn’t blame her. Usually when someone started a conversation with we should talk, it didn’t end up being a happy exchange. She ought to know—she’d had plenty of those the last five years. More often as time passed, and she’d usually been the one to start the conversation. She’d learned the safest route to avoiding misunderstanding and more drama than she ever wanted to experience was to be super clear right from the get-go. Even if sometimes she felt like an ass and a bit shallow saying she wasn’t looking for anything except a friendly, mutual good time. She knew the reputation that approach had earned her—player about summed it up. She couldn’t argue, even if she didn’t agree. After all, actions meant a whole lot less than words, at least from the outside looking in.
Of course, Syd couldn’t be expecting that talk, although she obviously expected something unpleasant. Emmett probably should have chosen a better way of leading into all this. But really, she hadn’t even realized she was going to say anything until she’d picked up on Syd’s reaction to what had gone down during the trauma alert. That and the niggling dissatisfied feeling she had too.
She hadn’t been paying all that much attention in the moment—everyone was focused on doing their jobs, exactly as they should be. No matter what was going on personally—jealousies, relationship issues, healthy or unhealthy competition—when it came to taking care of patients, everyone worth anything at all set those things aside. Syd had done that, and Emmett had no doubt she’d keep on doing it. Just like she would. But the faint look of disdain and maybe anger Syd had directed at her, however briefly, had stung. Coming from someone else, even someone she cared about like Zoey, she might not have been as bothered. Throw a bunch of alpha dogs in the ring, and a little fur was bound to get ruffled. It wasn’t her responsibility to smooth Syd’s bruised ego, but she wanted to.