by Radclyffe
“My back. Somewhere—somewhere in my back.”
“Can you squeeze my fingers?” Syd slid her fingers into Cindy’s palms. Her grip was weak, but she had shoulder and upper extremity movement.
Syd lightly touched her upper chest. “Can you feel me touch you here?”
“Yes?” Cindy said, some of the fear seeping from her voice. “My fingers are tingly, though.”
“Okay, how about here?” Syd asked, slowly pressing points down the center of the girl’s body.
“You’re not touching me now, are you?” Cindy said.
Syd marked the spot on Cindy’s torso where the sensory deficit began. Reflexes and voluntary movement below that level were all absent. She straightened. “Did we hear from neuro?”
“Not here yet. CT’s ready for us, though,” the resident said.
“I think we should take her down.” Syd looked around for Honor or Emmett. Emmett was conferring with Quinn in bay four. Dani and Zoey were doing an abdominal tap in bay five. The curtains were closed around bay three.
“Dr. Blake?” Syd called as Honor strode by.
Honor pivoted in her direction. “Yes?”
“Probable spinal cord injury,” Syd said, stepping a few feet away from the bed so Cindy wouldn’t hear her. “Looks like high thoracic. She’s cardiodynamically stable, but we ought to get the CT as soon as we can.”
Honor moved to the side of the bed and listened to the patient’s chest before asking her resident, “Signs are stable?”
“No tachycardia. Pressure’s borderline low but steady. I’m pushing fluids.”
“All right, then take her down,” Honor said. “I’ll have someone page neuro again.”
Syd and the resident transferred all the lines to the portable monitors and pushed Cindy’s bed out into the hall and down to the elevators. While they moved, Syd explained the CT to her.
“I’ll see you when you’re done,” Syd said, moving to the booth to observe the scans as they were completed.
“Head and C-spine look good,” she murmured as the tech transferred the first images to the monitors.
Kos Hassan walked in just as the CT tech started the spine.
“We meet again, Dr. Stevens,” he said. “What have you got?”
“Cord injury from an ATV crash. Looks like…” She leaned forward as the computerized scans of the vertebral bones and spinal cord began to appear on the monitors. She pointed. “There. T4 fracture. The cord’s really swollen.”
“Hmm.” Kos studied the images a few more seconds. “I think that’s a hematoma pressing on the cord.”
Syd looked at the scan in the area of the fracture again. “I see it. You’re right. That’s blood, not edema. Damn, I missed that.”
“Well, you won’t next time. Treatment?”
“Bolus with steroids and get her to the OR. The spine needs to be decompressed, possibly fused, before she loses more function.”
“I agree. If we move fast, she may even regain quite a bit. Is the family here?”
“I didn’t see anyone yet,” Syd said. “What about an abdominal CT?”
“Symptoms?”
“No, but with a cord lesion it might be hard to tell.”
“Make it fast.”
“I’ll let the OR know we’re coming,” Syd said.
“I’ll see about family and meet you there. You are scrubbing, right?”
“Absolutely,” Syd said.
Emmett found her at the scrub sinks twenty minutes later.
“Hey,” Emmett said. “Heard you were up here. What have you got?”
“Spine fracture with cord compression.” Syd kneed off the water and held her arms up, letting water drip into the big stainless-steel sink. “You?”
“Ruptured subclavian artery. Clavicle fractured and tore right through it. Major hemothorax.”
Syd pictured the big artery behind the collarbone at the apex of the chest. Really tough place to get to. “You’re planning to repair it through an open thoracotomy?”
“Vascular thinks that’s the best way to get control. Quinn and I are going to open for them.”
“Nice case.”
Emmett nodded. “I’m taking Morty. You want Hank?”
“He should stay with you. He might not see another one. What about the rest of the injured?”
“One kid’s got a spleen and a liver lac. Peds is bringing him up now too.” Emmett grimaced. “The other boy has a brainstem infarct. Hassan said maintain life support for now, but he’s not going to recover. Might be a donor harvest by morning.”
“Oh, man, that sucks.”
“Yeah, especially since he was one of the drivers and the other driver was his brother. They were showing off for their friends, I guess.”
Syd could picture it. “Stupid kids. God, I feel old. What about the last one?”
“She got lucky. Two fractured femurs. Ortho’s on that.”
Syd shook her head. Ironic how the one facing months of pain and rehab was the lucky one. “Sometimes this job sucks.”
“Yeah, I know.” Emmett hesitated. “Catch you later for a drink or something?”
Syd met Emmett’s gaze. The conflict there matched her own—she’d had to learn to accept the excitement of doing a challenging surgery when the reason for that enthusiasm was a tragedy. Sometimes the lesson still hurt. “Yeah, I’ll see you later.”
Chapter Seventeen
The overhead spots glinted off the metallic sheen of the titanium plates and screws spanning the fractures in Cindy’s spine. Syd blinked back a bead of sweat threatening to drop from her eyelashes. The tiny drop of salt stung for an instant. Her back ached from leaning over the incision. Sympathy pains, maybe.
“What do you think?” Kos asked.
“I think that’s it.” Syd’s voice sounded raspy. No wonder. No amount of swallowing soothed her parched throat. She’d give a lot for a cold bottle of water. Cold anything, really.
“I think you’re right,” Kos said. “Double-check that all the screws are tight, and remember, finger tight. That’s enough. Don’t strip them out of the bone now.”
“Okay,” Syd said, unable to even contemplate redoing the fixation devices at this point. Her brain felt like oatmeal. If she had to refocus to start the procedure again, bits of gray matter would leak out her ears. But of course she would start again if she had to—adrenaline was a powerful stimulant.
Gingerly, she worked her way up one side of the system of tiny struts they’d attached along the vertebrae to stabilize Cindy’s spine and down the other, cautiously setting each screw with a final twist. While she double-checked the hardware, Kos packed bone fragments into the crevices surrounding the fracture sites.
“They all look good.” Syd spared her first glance at the clock all afternoon. Six forty. Afternoon had come and gone. She’d been in the OR six hours, but like always, she never noticed time passing when the case was as demanding as this one. She never noticed she was hungry or thirsty. Now that the push was over, she’d feel it.
“How are you two doing?” Kos asked, directing his question to Dani and Sadie, who were working on Cindy’s hip. A little over an hour before, Kos had pulled them in from peds surgery to help out. He’d decided the safest route was to stabilize Cindy’s spine with everything they had available, including slivers of her own bone. Her fractures spanned several levels in the thoracic spine, and bone grafts would speed healing. Dani and Sadie had harvested the bone graft.
“We’re ready to close if you’ve got enough bone,” Dani said, cutting sutures for Sadie. “How do things look up there?”
“We’re good,” Syd said. “Thanks for the assist.”
“Anytime,” Dani murmured.
Kos said, “Okay, Syd, let’s close.”
Syd irrigated gently, taking care not to displace the bone grafts, and checked one last time for bleeding. When the field stayed dry, she looked over the drapes at the nurse anesthetist who’d taken over at shift change at three. “How’
s she doing?”
“Pressure’s still borderline low,” he said, “but vitals are stable.”
“Are you going to keep the tube in,” Syd said, “until we see how her lung function is post-op?”
“Was planning on it,” the anesthetist said.
“Okay then,” Syd said. “We’ll need about thirty minutes.”
“I’ll start lightening her up,” the anesthetist said.
Kos indicated Syd should close, and she worked quickly, suturing the deep tissue layers over the spine together. When she reached the superficial muscle layer, Kos stepped back from the table. “I think you can take it from here, Syd. My daughter’s got a softball game tonight, and I promised I’d be there. I’ve already missed the opening pitch, but I ought to still catch most of the game. Page me if you need me.”
“Okay, thanks.” Syd flushed with satisfaction. She’d felt at home doing this surgery, even though she had less experience with neuro cases. The anatomy, the structures, appealed to her. And Kos trusted her to take care of his patient. He wasn’t the sort of attending who left his patients at the first opportunity. More important than all of that, she might have given Cindy a chance to regain some of the use of her lower body. Possibly all of it.
“I’ll let the family know how’s she doing.” Kos pulled off his gown and gloves. “Nice job, Syd. Thanks, everybody.”
“Thank you,” Syd said again.
As he walked out, Dani said, “Sadie, you can give Syd a hand closing.”
“Sure,” Sadie said flatly, sliding up into Kos’s empty place.
Dani dropped out also and quickly stripped off her gown and gloves. “Page me when you’re done. We still need to make afternoon rounds.”
“Okay.” Sadie reached for the retractors but Syd picked them up first.
“Go ahead, Sadie,” Syd said, motioning for the scrub nurse to pass Sadie the loaded needle holder. “Three-oh Vicryl on the fascia.”
Sadie’s eyes above her mask widened for an instant and a second passed. She held out her hand, and the slap of the needle holder into her palm seemed to jump-start her. “Thanks.”
They worked in silence, Sadie suturing and Syd cutting for her. Syd was tired, and she didn’t know Sadie well enough to chat. Things didn’t look as if they’d warmed up much between Dani and Sadie, but Syd had to give Dani credit. She’d let Sadie do the harvest and the two of them had managed to work together pretty seamlessly. Dani was a good teacher, and from what Syd could see from her occasional glance at their field, Sadie had good hands. Not surprising. All the PMC residents were sharp. But then, so were the ex-Franks.
“Let’s do a running subcuticular Prolene on the skin,” Syd said.
“Staples would be faster,” Sadie said.
“I know, but it’s a long incision and the scar will be better.” Maybe it was the memory of Cindy’s terrified voice in the trauma bay or maybe knowing what a long road Cindy had ahead of her even with the best-case scenario, but Syd wanted to at least give her the best scar she could. “You can manage to do it in under half an hour, can’t you?”
Sadie snorted. “Like five minutes.”
“That’s what I thought. Go ahead.”
As Syd expected, Sadie quickly and efficiently completed the skin closure. After they’d applied the sterile dressing, Syd said, “Is the bed in here? Make sure there’s a gel pad on it.”
“It’s right outside,” the circulator said. The ICU team had sent the special spinal care bed over, making it unnecessary to transfer Cindy more than once.
“Sadie, help her get that,” Syd said.
Once Sadie and the OR team maneuvered the bed up next to the OR table, anesthesia took the lead. Syd and everyone else followed his instructions. At this point, the airway was the most important thing to protect. Cindy was not breathing on her own, and if her endotracheal tube became dislodged, she could arrest.
At anesthesia’s command, they tilted her onto her side, her back toward the bed, placed a roller board along the length of her body, gently returned her so she was lying on the board, and slid her into the bed. Throughout the transfer, Syd kept a careful watch on how they moved Cindy’s legs, hips, and torso to be sure they didn’t place undue strain on the spine. Everyone waited while anesthesia double-checked the airway and made sure she was ventilating on both sides. Once he was satisfied, the team ensured all the lines were moved onto the bed and nothing remained attached to the OR table or the IV stands that might be pulled out as they exited.
Syd guided the foot of the bed, Sadie pushed with a hand on the side rails, and anesthesia kept watch on the breathing tube as they pushed Cindy out into the hall. The five-minute trip from the OR to the TICU was as critical as any part of the procedure they’d just performed, and Syd didn’t relax until they were inside the unit and the ICU staff converged on the bed.
The anesthetist gave his report and Syd heaved a sigh, the tension draining from her shoulders. Thirty minutes later, she was satisfied that Cindy was stable. She reviewed the post-op orders, took one more look at Cindy, and decided she could actually leave. She was exhausted and exhilarated at the same time. She was also starving.
As she was leaving the unit, Dani and Zoey came in on rounds.
“Hey,” Dani said. “You done?”
“Yes. Oh, hey—” Syd hesitated, considering how much she wanted to say in front of Sadie and Zoey. Well, they’d find out soon enough anyhow. “I didn’t get a chance to tell you earlier. I think I’ve got us a great place to live. If you’re up for it when you’re done, I’ll tell you about it.”
“How far away?” Dani asked instantly.
“Six-minute walk.”
“It’s not a trailer, is it?”
Syd laughed. “No, it’s a house. Emmett, Zoey, and Hank live in the other half of the twin.”
Dani grinned. “Well then, hell, yeah. Because you know, we’re all just one big happy family.”
Sadie didn’t say a word, but her expression suggested she’d like to bite someone. Definitely territorial, although maybe that was more about the ex-Franks moving in than whatever she had—or didn’t have—going with Emmett. Zoey was harder to read. She didn’t look ecstatic, more calculating, as if she was trying to figure something out. Whatever it was, Syd wasn’t going to worry about it. None of the tangled relationships that somehow all led back to Emmett were her concern.
“If you see Jerry, tell him I want to give Emmett a decision by the morning. It’s a prime place and we don’t want to lose it.”
“Hell, Jerry will be fine with it if we are. Say yes,” Dani said.
“Okay, I will. I’ll text you the address if you want to drive by later.”
“You want a ride home? We’ll be done here in half an hour or so.”
Syd hesitated. She was more than ready to go home. She was off call, her patient was stable, and she’d had one long, hard day. But she’d told Emmett she’d see her later. Then again, Emmett wasn’t even around. She could be in the OR doing another case for all Syd knew. She should just go home. “Page me before you go. I’ll let you know.”
“Sure,” Dani said, motioning to the others. “Come on, let’s finish up.”
Syd headed to the locker room to get out of her scrubs. She had the place to herself while she washed her face and took a minute to repair some of the damage done to her hair by six hours of being stuffed into an OR cap. When she was dressed in jeans, sandals, and a short-sleeved T-shirt, she had no more reason to procrastinate. Leave or… She checked her phone. No text from Emmett.
Emmett was probably in the OR, so involved in some great trauma case she hadn’t even thought about Syd at all. Or maybe she’d left. She probably forgot.
Before she could change her mind, Syd rapidly texted, Still around?
She got an instant reply.
Just coming to find u. U done?
Yes. Syd paused. Waiting. This was a bad idea, wasn’t it?
Still on for a drink?
Syd stared at t
he screen. Her thumbs moved.
I’m in the locker room.
Don’t go.
Syd slipped her phone into her back pocket. Well, decision made. No point second-guessing herself now.
Emmett showed up two minutes later. She’d already changed into tapered navy khakis and a pale blue button-down shirt with the sleeves rolled up. Along with her sockless loafers, she looked downright hot. Syd smiled.
“What?” Emmett said.
“Nothing.”
“Come on, something.”
“You wore that same outfit for your interview. Do you have anything in your closet besides blue shirts and navy pants?”
Emmett stared, a flush rising in her neck. “How do you remember that? I don’t even remember it.”
Syd felt an answering blush come over her. What the hell had she just said? “I don’t know, I just remembered, I guess.”
“Yeah?”
For a second, Emmett looked like she was going to say more, and Syd’s stomach tightened. She was tired, tired from the day, tired, she realized, for a long time. She just wasn’t ready to do anything about it.
“I think you owe me a beer,” Syd said quietly.
“You’re right, I do.” Emmett let out a breath, some of the intensity bleeding from her gaze. “I was thinking cheesesteaks to go with it.”
“Is there actually a decent place around here to get one?” Syd recognized Emmett was backing off, giving her some space. She ought to be happy Emmett was accepting her limits, respecting the boundaries she’d set, and she was. She was. She just needed to move. She needed out of the confines of the locker room, out of the hospital. When was the last time she’d really wanted to leave? She pushed out into the hall, Emmett following.
“Believe it or not,” Emmett said, holding the stairwell door open for her, “there’s a little place a couple blocks over on our way home. Makes great cheesesteaks and pizza. Sound good?”
“Yes.” Syd didn’t think too long about the idea of home suddenly being the same place for both of them. “Let’s get out of here.”