by Lynne Norris
Violence Warning/Disclaimer: This chapter depicts scenes of violence, death and their aftermath. Some scenes may be explicit or graphic in nature. Readers who are disturbed by or sensitive to this type of depiction may wish to read something else.
The next day brought more snow and foul weather and the ER was busy again as people fell victim to their own carelessness and various other sundry afflictions. Regina walked out of one of the exam rooms and washed her hands for what seemed like the twentieth time today. Sheíd seen her tenth flu patient already and from the way things looked in the waiting room, nothing was going to change anytime soon.
Down the hallway, she saw Alex leaning over a man, listening to his chest with her stethoscope. The doctorís braid hung over her left shoulder and she brushed it back as she straightened up and wrote something in the chart that she then handed to one of the medical students, standing next to her.
Their eyes met as they both walked back toward the nurseís station and the resident swore Alex winked, as she got closer. "Crazy day, huh?"
"You love it when itís like this," Regina smiled up at the doctor, knowing how much Alex thrived on the chaos. Sheíd seen it time and again over the past few months; it was when things fell apart and life hung tenuously in the balance that the doctor was at her best.
Regina had seen in those moments a side to Alex that was devoid of all the emotional turmoil that haunted her subconscious. The blonde stole a glance up at her taller companion and wondered if what they had discovered in each other would be enough for Alex to let go of the past and allow them a chance at a future together.
The young residentís attention was drawn to Sandy as she spoke sharply into the phone. "Well, tell them we need the beds. Community Medical Center is already diverting major traumas so we have to take them." She slammed the phone down in aggravation and muttered under her breath.
"That bad?" Regina asked.
"Can that patient be discharged?" Sandy pointed to the chart Regina was holding.
"As soon as the IV is finished. The orders are already written."
"Good." She grabbed the chart from her and glanced up at Alex. "Dr. Mitchard was looking for you earlier and we have another patient the paramedics just brought in."
"What did she want?" Alex asked.
"She said sheíd find you later."
Regina glanced down the hallway toward the entrance of the emergency room and gasped. "Oh my God."
"What?" Alex turned to follow her partnerís gaze and saw a man standing just inside the door. She recognized the family resemblance and leaned closer to the blonde. "I take it thatís your father."
Regina nodded mutely. "Oh, shit. I canít believe heís here. IÖI told him I got off at nine."
"Well, you better go get him away from the ambulance bay doors before he gets run over by an overzealous paramedic," Alex advised her quietly. She watched as the younger woman stepped hesitantly away from the desk and walked awkwardly down the hall toward the man.
Regina felt her heart hammer rapidly in her chest as her father turned and focused on her. Oh this is not good. How is it that parents can reduce you to feeling like a little kid again just by the look they give you, Regina questioned herself as she walked closer.
"Dad?" Regina stopped, standing awkwardly in front of him. "IÖI still have an hour to go. I wasnít expecting you for a while yet."
He gave her an apologetic grin. "I know." He turned towards her and tucked one of her hands into his larger one.
Regina started at the unfamiliar gesture. "Dad, whatís wrong?"
"She wouldnít come with me. Iím sorry, Regina."
The blonde swallowed and averted her eyes to hide the pain from her father. Why did I think that she would? "It was a lot to expect that she would, dad. Sheís upset."
"Youíre her daughter." His voice was filled with hurt and anger.
Regina mustered her own reassuring smile when she met his gaze again. "Itíll be alright, Dad. She needs time." She turned back towards the desk. "Come on, at least you can get some coffee while you wait."
"So, this is where you work," he commented as he walked past several stretchers lined up against the wall.
"This is what I do, Dad." She replied and guided him past the exam and trauma rooms that were mostly filled with sick and injured in various stages of triage. The resident winced inwardly as she saw his eyes react to pain and suffering that was part of a daily routine to her now. It wasnít that she was immune to it, not by a long shot. In the months she had been here, she had developed her own defenses and learned to hang onto the successes, so the memories carried her along during the really bad traumas.
Regina had been trying to decide since last night if she was going to introduce her parents to Alex and if she did what she would say. Now as she neared the desk and saw the tall, statuesque woman, her dark hair pulled back in a thick braid, crouched in front of a woman who was sitting in a wheelchair, she knew her answer. I donít care what he thinks. Heís down here, this is who I am and that is the woman I love.
The resident waited as Alex stood up and motioned to one of the medical students to come over. She handed him the chart and gave him instructions before she turned the patient over to the tall, lanky man. The doctor stood with her hands on her hips watching the medical student disappear into one of the exam rooms. Her dark head turned and her chin lifted slightly as she met Reginaís gaze.
"Alex, this is my father." She saw the imperceptible softening in the blue eyes as Alex stared at her for a second then turned and offered her hand to the man.
"Mr. Kingston." She grasped his hand, her demeanor still guarded as they sized each other up. Next time, weíre going to have to discuss strategy before we do one of these impromptu introductions, my friend. "Youíre daughterís an excellent doctor."
"Itís Roger and I know she is."
Regina let out a breath as she saw both of them relax slightly. She heard an exaggerated cough behind her and turned to see Sandy standing behind the desk, arms crossed and a comical expression on her face "Well, I know where I rate now, huh Dr. Kingston? Good enough to work by your side in the trenches, but -"
"Sandy," Regina objected and then saw the nurse wink at her and reach over the desk to take her fatherís hand.
"Hello, Mr. Kingston. Iím Sandy. Donít let that tall dark-haired one fool you. She thinks she runs the emergency department. I just havenít let her in on the joke yet. How about I show you where we have drinkable coffee in this joint while they go save the world?"
Reginaís father smiled disarmingly as the curly, blonde-haired nurse walked around the desk and took his arm. "Thanks, I think I could use some. Itís cold out there tonight."
The blonde turned and glanced at the taller woman standing behind her. "Breathe, Alex."
Alex snorted from behind her. "I am." She watched Sandy walk down the hall leading Reginaís father into the lounge then grumbled something about going to check that the medical student was x-raying the correct arm.
Regina scratched her temple and blew out a breath as Alex brushed by her and headed down the hall. She let a smile tug at her lips as Sandy came up beside her a few minutes later and poked her in the back. "Thanks."
"Donít mention it. I really wasnít relishing the prospect of having to do CPR on the two of them right here in the middle hallway. Too much paperwork to fill out."
They both snickered and then started laughing as they looked at each other.
A moment later the radio crackled and came to life on the desk. "Aw shit. This canít be good." The blonde-haired nurse turned and quickly picked up the microphone.
Alex re-appeared from the exam room and stepped forward, listening to the garbled voice coming through over the receiver.
Sandy glanced up as she wrote down a few quick notes. "Motor vehicle accident. One critically injured. Theyíre five minutes out."
Alex stepped away from the desk, grabbed an isolation gown from one of the bins, and started slipping it on, her mind already running through all the clinical scenarios they might be up against. "Iím going to need your help, Regina."
Regina quickly followed, grabbing a pair of gloves from one of the wall boxes. She stopped one of the medical students as he walked out of the lounge.
"Michael, weíve got a trauma coming in. You need to be there to work on your procedures."
"I just have to run something down to the lab."
"Well, hurry up and get back here," Regina told him as she pulled her protective goggles on and ran toward the ambulance bay just as the paramedics banged through the emergency room doors.
"Weíve got a twenty-six year old male, ejected from his vehicle, and thrown approximately fifteen feet. We intubated him in the field. His pulse is thready, blood pressure is ninety." The litany continued as the doctors and paramedics rushed the patient down the hallway and into the trauma room.
They wheeled the stretcher up alongside the table and efficiently transferred the boy over. "Whatís his name?" Alex asked.
"Tim, Tim Johnson." The paramedic glanced down at his clipboard. He collected the backboard from the technicians and started walking slowly out of the room. He bumped into one of the medical students who barged through the door, tying his mask behind his head.
"Sorry," Michael mumbled.
"Tim, can you hear me?" Alex called out. She bent over, flashing her penlight over his pupils. "His right pupil is fixed and not reactive."
Regina rubbed the knuckles of her fist over his sternum. "Heís unresponsive to pain."
"Letís get a CBC, type and cross match for four units of blood. Do a drug and alcohol screen. I need two more IV lines, sixteen-gauge with normal saline. Hang a Dopamine drip and get a catheter in him, now. Letís move people! Get his clothes off." Alex barked orders, as she ran skilled fingers over his skull and face. Probing gently, she felt a depression in the back of his head. "Heís got a depressed skull fracture."
As Sandy reached around Alex hooking the tube coming from his mouth to the ventilator,
one of the ER techs was already on the phone calling the OR and another was quickly cutting away the boyís clothes.
Regina listened for breath sounds, moving the stethoscope deliberately over his chest. "Iíve got decreased breath sounds on both sides. Check the position of the tube."
Alex bent over and pulled the endotracheal tube out a couple of inches. "Anything?"
Regina shook her head, still listening with the stethoscope. "Decreased breath sounds, both sides. I need two chest tube kits."
"I got it." Sandy grabbed the kits out of the cabinets. Ripping the covering off of them, she dropped the kits on the instrument tables then reached over and handed Regina a scalpel.
Regina grabbed the instrument from the nurse and quickly made a six-centimeter long incision between the boyís ribs. Using her fingers, she spread the hole and inserted the tube until she felt it break through the outer lining of the lung. Working quickly, she sutured the wound closed.
"I got the lines in," Michael announced moments later, as he hung the bags up on the IV pole. He backed up and bumped into the instrument tray, knocking it over with a loud crash.
"God damn it, watch what youíre doing," Alex growled as she made a quick incision and pushed her fingers inside, making the hole wider. "Sandy, get me another kit, now."
Embarrassed at his clumsiness, Michael skulked behind the attending and picked up the tray stand, setting it upright. He stood at the foot of the stretcher watching awkwardly at the two doctors working feverishly over the patient. Sandy shoved a plastic kit in his hands. "Make yourself useful and catheterize him."
"Thomas," Regina called to the technician. "Dress this wound for me." Moving around him, she grabbed the portable ultrasound unit and performed a scan of the patientís abdomen. "Heís got blood in his abdominal cavity. The aorta is torn."
One of the technicians watched the automatic cuff around the patientís arm inflate and measure his blood pressure. "His pressureís ninety and dropping."
The door to the trauma room swung open and one of the nurses stuck her head in. "Dr. Margulies, weíve got another trauma on itsí way."
"Page Dr. Washington and Dr. Jack. Weíre busy," Alex snapped, without looking up from the patient as she inserted the tube into the chest wall. "Give him point five of atropine and open up the IVís all the way." Alex looked up at the monitor. Shit, weíre losing him.
"They are," the medical student said.
"Then squeeze the bag in," Alex ordered. "Heís losing volume as fast as weíre putting it in."
One of the nurses ran into the room and handed Sandy the four units of blood. "Here, check it with me." Sandy said, pulling her back. Quickly they compared the labels with the patientí blood type, then Sandy hung the bags and piggybacked them to the IV lines.
"Thereís a hundred ccís of blood in the bag," Regina said, as she held up the catheter bag.
"Heís bleeding out. Do we have the O-neg yet?" Alex demanded
"Itís already going in," Sandy told her.
One of the surgeons, still in his bloodied surgical scrubs from his last case, ran into the room pulling on a mask. Whatíve we got?"
"Blunt abdominal trauma, closed head injury, internal bleeding, blown pupil, his blood pressure is ninety over palp," Sandy quickly reported.
Moments later, outside in the hallway, they heard a frantic voice calling the boyís name. Alex glanced up as the manís voice drew closer. "If those are the parents keep them the hell out of here. They donít need to see this."
One of the other nurses stepped out of the room and looked down the hallway. She cursed under her breath and jogged in the direction of the police officer and the two people she guessed were the kidís parents. She heard the fatherís question as she came up alongside them.
"What happened the hospital called and said my son was in an accident?"
Derrick pulled his cap of and scratched his head. "Sir, a drunk driver hit your sonís car."
"Heís all right, isnít he?" The womanís voice trembled and she clutched her husbandís arm.
"Sir, please come with me." She glared up at the officer, angry that he had told them about the drunk driver. "The doctors are taking care of him right now."
The father turned and stared down at the nurse, who had spoken to him. "Whereís my son?" he demanded, pushing abruptly past the nurse. "The officer just told me a drunk driver hit my son. I want to see him. Now, dammit."
"Sir, please, the doctors will be out to speak to you when they can." The dark haired woman dressed in blue scrubs, tried to guide him toward the waiting area but he shrugged her hand off his arm.
"Where is he?" he demanded, wrapping an arm around his wifeís shoulders as she stood beside him.
The nurse had the couple almost past the trauma room when the doors behind them crashed open and the paramedics, followed by two more police officers, rushed the driver of the other car into the emergency department.
Dr. Washington ran past the nurse in the direction of the paramedics. "Letís go," he said, pointing with his finger. "Room three is open."
The man turned, watching the stretcher disappear through the doors and then his eyes were drawn to the movement in the room adjacent to him.
Inside the chaotic trauma room, Alex looked up at the monitor and watched the short bursts of abnormal heartbeats. "Heís throwing PVCís. Give him a loading dose of Lidocaine."
Regina reached behind Sandy and grabbed the vial of medication from the med cart. Quickly drawing the medication into the syringe, she grabbed the IV and jabbed the needle into the port, depressing the plunger.
Everyone watched the monitor as the medication at first controlled his heartís wild contractions and then gave way to the failing muscle. The monitor alarmed shrilly as the boyís heart rate suddenly flat lined on the monitor. "Asystole. Give him one milligram of epinephrine, now." Alex leaned over him and started compressing his chest.
Regina grabbed the defibrillator paddles from the code cart, charging them to two hundred-seventy joules, and brought the paddles down onto his chest. "Clear," she said, and Alex backed away, raising her hands from the body. She pressed the buttons and watched as the body convulsed on the stretcher from the intensity of the current.
Alex met Reginaís eyes briefly in a knowing glance. They were in a battle against time and it was quickly running out on the boy lying beneath them on the stretcher. They repeated the sequence two more times, increasing the drugs and charging the paddles higher each time in an attempt to restart the boyís heart.
"What about a thoracotomy and cross-clamping the aorta?" Regina asked, as she stood by with paddles charged and ready, watching as Alex pumped on his chest. She wasnít ready to give up just yet.
The surgeon shook his head as he watched with growing detachment what was going on at the table. "The mortality rate is ninety percent with a blunt abdominal trauma. Thereís too much damage; nothing we can do."
They worked on the boy for several more minutes, desperately trying to bring him back from deathís door, but to no avail. Finally, Alex straightened up, looking up at the flat line on the monitor. She hated admitting defeat. "Time of death Ė eighteen forty-five."
She ripped her gloves off and threw them on the floor in disgust.
The surgeon shook his head and walked back outside the room. "What a waste. The kid never had a chance."
Outside, the father shoved the nurse away from him and grabbed the door as it started to swing closed. "No! Why are you giving up? You canít stop."
Everyone in the room stood still rooted in place, shocked at the sudden, unexpected appearance of the man and woman, both obviously the boyís parents.
Regina who was the closest to the distraught father, hesitantly stepped closer, putting a hand on his arm. "Mr. Johnson, Iím sorry, your son sustained a severe head injury and massive internal damage to his organs. We used all our resourcesÖ"
The woman who had been standing mutely, clinging to her husbandís arm, buried her head against his chest and let out a low, keening wail.
Regina looked into the manís face wishing desperately that she didnít have to say the next part. "Iím sorry, Mr. Johnson, but we couldnít save him." Regina clenched her jaw nervously watching the anguished expression she saw on the manís face.
Sandy grabbed Alexís arm and directed her to the adjacent door. "Jon needs you next door. Iíll help Regina with the parents. Go."
Alex could hear the commotion coming from the trauma room as soon as she stepped through the adjoining doors. Her gut clenched as she heard the struggle that was going on with the patient on the table.
"Let me go, damn it. Youíre not taking my clothes off."
"Thomas, hold her down." There was a struggle as the woman on the stretcher fought against the doctor.
Two quick steps brought Alex up beside the stretcher and she grabbed the womanís arms and pinned her down to the stretcher. Her eyes widened as she realized for the first time who was lying on the stretcher. "Dana, shut up and stop fighting with them."
"Let go of me, you bitch." She spat in Alexís face.
"Whoa, Jesus Christ, get that!" Jon grabbed Danaís arm as she reached inside her coat.
Alexís ears picked up the clatter of metal on the tile and her brain slowly registered the fact that a gun tumbled from Danaís hand and rattled across the floor. Quickly retrieving it, she handed it to the technician.
"Make sure this gets into the lock box and call security," she growled as she shoved the butt of the gun into his hands. The technicianís eyes bulged as he gingerly took hold of the shiny, black handled weapon and ran out of the room.
Jon grabbed Danaís hand and pinned it to her side, quickly tying it in a restraint. "Sheís got a tender abdomen and she needs to go to the OR for an exploratory laparotomy."
"Fuck you! Let go of me," Dana growled.
"Shut up, Dana." Alex leaned over the struggling woman, helping him tie the other arm down. "What happened?"
"She broad sided the kid you were working on."
"Shit." A wave of revulsion swept through Alex as she stared down at Dana in disbelief. She yanked the restraint tight around her wrist and glared down at the wild-eyed blonde, struggling to contain her anger at the senseless loss of life that Dana had caused. "Letís get her to CT scan, now." Alex jerked the rails up on her side of the stretcher.
There was a loud crash just outside the door, followed by several cries of alarm as a supply cart slammed into the wall and tipped over, sending boxes and plastic bins scattering across the floor.
"What the hell is going on out there?" Alex heard angry shouts and then the door to the trauma room slammed open behind her.
"Let her die."
She felt a prickly sensation on the back of her neck as her hair stood up at the sound of the voice.
The two doctors looked up at the same time and stared at the man pointing the gun at the woman lying on the stretcher. Outside the door, they caught a glimpse of the technician pressing his hand against his jaw and Sandy leaning over him.
"She didnít give my son a chance. She doesnít deserve one."
Alex straightened up slowly, aware that Jon was now moving the stretcher toward the side door away from the man with the gun. "Itís not our decision to make, Mr. Johnson. Give me the gun, no one wants anyone else hurt tonight." Alex slowly reached her hand out.
The man stepped closer, his hands trembling as he held the gun in front of him. "Youíre not taking her anywhere."
"Mr. Johnson." Regina stepped through the door behind him, holding her hands up in front of her as he whirled around pointing the gun at her.
"Regina, get out of here," Alex hissed at her.
The resident shook her head and held the manís gaze as she stepped closer. "Please, Mr. Johnson, your wife just lost her son, she doesnít need to lose her husband, too."
"Alex, weíve got to move her. Her pressure is dropping." Jon set the portable monitor on the end of the stretcher and hooked the EKG wire to it along with the pulse oximeter.
"No!" The man spun around now holding the gun on Jon as he worked on the injured woman.
"Get a dopamine drip started and push another liter of fluid, Jon." Alex didnít take her eyes off the distraught father.
"That bitch killed my son!" He stepped closer to the stretcher, his whole body shaking as he started to squeeze the trigger.
"I know." Regina stepped up beside him and held her hand out. "Give me the gun, Mr. Johnson. You donít want to do this."
He turned part way around and stared down at the blonde pleading with him.
There was the sound of footsteps running down the hallway and more shouts of alarm as two uniformed police officers raced towards the trauma room. Alex edged closer, thinking she had the best chance to grab the gun away while he was focused on Regina. Out of the corner of her eye, she picked out the blur of blue fabric as the officers filled the doorway.
"No!" Alex waved them back. She could sense the manís resolve crumbling as he stared at Regina, the hand holding the gun slowly lowering to the floor.
Startled by the officersí appearance, the man cried out and spun back around, pulled the gun up and aimed it at Dana lying on the stretcher. At the same time, Alex darted forward; her outstretched hand grabbing for his wrist. For one instant, Regina met Alexís eyes as the doctor struggled to wrestle the gun from the fatherís hands; the younger womanís cry was drowned out by the sharp staccato report of a gun firing.
A look of surprise registered on Alexís face as the sensation of being punched in the chest stole her breath away. She stumbled, her legs collapsing underneath her, and she fell to her knees. Far away, she heard voices shouting as pandemonium broke out around her.
She dropped face down on the floor, feeling the cold tile on her face and her hands. The two police officers barreled through the door, knocked Regina aside, and tackled the man, knocking him into a code cart that crashed to the ground, its contents spilling across the floor.
As Jon pulled the stretcher with Dana on it out of the room and into the hallway, Regina scrambled forward, dropped to her knees, and grabbed Alex by the shoulders, rolling the injured doctor over. A dark red stain was blossoming over the front of doctorís scrub top.
"Regina." Her voice was little more than a whisper as she slowly focused on the blonde haired woman bending over her.
"DÖDonít say anything, Alex. Just hold on." Reginaís hands were trembling as she grabbed a package lying on the floor and ripped it open, slapping the pressure bandage over the ragged hole in Alexís chest, and pressed her hand over it, slowing the flow of blood. She looked around frantically. "I need help in here!"
She could hear Jon in the hallway barking out commands as he turned Danaís care over to a surgical resident and a nurse. In front of her, the officers were dragging the man to his feet, stumbling and tripping over contents of the code cart as they hauled him out of the room.
"Sandy! I need help."
The nurse bumped into the officers as she ran into the room, followed by one of the techs. "Oh my God! I told them he had a gun."
"Help me," Regina pleaded, still pressing her hand down over the bloody wound in Alexís chest. "Weíve got to get her on a stretcher."
"On three - one, two, three." Regina directed and together they quickly lifted the attending off the floor and onto a stretcher. Alex groaned and passed out as a wave of intense pain exploded inside her chest.
Meanwhile, Jon raced back down the hallway and caught Maggieís attention, as she talked frantically into the phone.
"No, I canít hold on, just tell them to be ready. I donít care who they have to bump, tell them itís one of their own doctors dammit!" She slammed the phone down and caught up with Jon as they got to the trauma room. "The ORís on standby."
"Good. Thomas," Jon called to the technician as he ran out of the trauma room across from them. "I need four units of O Ė negative blood."
"I gotta get something for one of the residents."
"Just get me the damn blood," Jon snapped, as they turned the corner into the room.
"I needed a blood pressure on her." Regina turned around to grab a pair of gloves and bumped into one of the police officers coming back into the room. Shock registered on her face as she recognized who it was.
"Move, Derrick." She shoved him out of the way.
"I have to get the gun and the shells." He shoved past her and then got stopped short as Jon grabbed him with both hands and hauled him away from everyone.
"Get the hell out of here!" he ordered, shoving Derrick out of the room. "Move!"
Regina looked up as Marcus ran breathless into the room, from having been stat paged overhead. "Marcus, get over here and help us."
"Son of a bitch," his voice cracked as he saw Alex lying covered in blood on the stretcher. "What happened?"
"Blood pressure is one-hundred over fifty," Sandy reported.
"Good breath sounds bilaterally," Regina said, as she listened to Alexís chest with the stethoscope.
"Sheís losing volume. Get two 16-gauge lines in now and start a Dopamine drip," Jon ordered.
It was dark and eerily quiet around her. Blinking her eyes, Alex heard a rushing noise in her ears, then a searing pain exploded in her chest and her world spun around her as a blinding light assaulted her eyes. Above her, she could hear disconnected voices shouting frantically.
"I need a larger needle." She heard Reginaís strained voice and she stared up at the blonde through the oxygen mask that covered her face. From a distance, someone shouted back at Regina and she pulled away out of Alexís line of sight.
"I donít care what size. Just give me a larger needle."
Cool air hit her skin as scissors ripped away her scrub top to expose her chest. Something cold and wet swabbed her neck and Alex felt a prick in her arm and then a burning pain in the base of her neck as another line was inserted.
"Alex," Regina was staring down at her now. Setting her hands on either side of her head, she leaned over her.
"RÖRegina?" Alex asked hesitantly, trying to focus through the pain and the confusion. It hurt to breathe; everything was all jumbled in her mind and she couldnít remember what happened, only knew that something went terribly wrong.
"Alex, look at me." Blue eyes drifted away, then slowly tracked back to meet Reginaís. "Do you know where you are?"
The doctor nodded her head slowly. "Hospital. IÖIím sorry."
"Donít say that." Regina shook her head fighting back tears. "You stay with me. Youíre going to be ok, I promise."
"CÖcold." Her teeth were chattering and everything seemed to be fading, getting farther away and harder to hold onto, as she tried desperately to stay focused on Reginaís face. A swirl of red, blue, and green lights danced in her peripheral vision and then everything started to go a fuzzy white. Oh God, please not here. Not like this. Mercifully, the drugs injected into the IV pulled her down into a blissful indifference as the opiates coursed through her veins.
"Pulse is one-twenty."
"Whereís the blood?" Regina demanded.
"It just came in." Sandy grabbed the units of blood from Thomas and pushed him over to the table. Jon helped Sandy hang the blood, piggy-backing the lines and slipping the pressure sleeves over the IV bags to force the fluid in faster.
"We need to move her, now," Dr. Washington said, as he watched the monitor.
The doors to the room banged open and Dr. Kelly, one of the surgeons, ran in pulling on a gown and gloves. "What the hell happened?"
"Gunshot wound to the chest. Weíve pumped in two liters of fluid and sheís on her first unit of O Ė neg blood," Jon told the surgeon.
Sandy pointed to the catheter bag. "Sheís bleeding out. Thereís another one hundred ccís in the bag. Her systolic pressure is dropping."
"It couldíve hit one of the kidneys," Regina said, as she searched for another vein in Alexís arm. "She needs volume. Squeeze in another bag of fluid." Regina jabbed another needle into a vein and set up another line.
"Letís go, letís go," Dr. Washington ordered, pulling up the rails of the stretcher.
The surgeon stopped the stretcher. "No, she wonít make it to the OR." He turned and grabbed a clear plastic package from the shelves behind him. "We have to stop the bleeding. Intubate her and prep for a thoracotomy, now," he ordered, as he tore open the plastic wrapping and pulled out the sternal saw.
There was a split second hesitation as everyone realized what they were about to do. Sandy grabbed a large sterile bundle off one of the shelves and broke the seal, setting the instruments on a tray that was next to the surgeon.
"Give me an amp of epinephrine and a number eight endotracheal tube," Jon barked as he slipped up to the head of the stretcher. He ripped open the package of tubing and tilted Alexís head back. Seconds later the tube was hooked up to the ventilator, pumping oxygen into Alexís lungs.
Regina quickly moved to the side of the table, shrugging into the sterile gown that one of the techs shook open. She glanced up at the monitor and saw the rapid heartbeat displayed on the monitor. "Sheís tachycardic."
One of the nurses squirted Betadine down the center of Alexís chest, lengthways between her breasts, and then hastily laid the sterile drapes that one of the techs handed to her, around the site. By the door, Thomas slammed the phone down. "The ORís waiting for us."
Jon made the incision down the length of Alexís sternum with the scalpel. The moment he lifted the scalpel away, Dr. Kelly leaned over Alex and pressed the blade of the reciprocating saw against the bone, then pressed the trigger. Regina physically recoiled at the high pitched buzzing sound and the sight of the serrated blade ripping through the length of the glistening white bone, spraying a mist of bone dust and blood into the air. It shattered what was left of her control.
The resident grabbed hold of the stretcher to steady herself, fighting back a wave of nausea, as she looked down in disbelief at the ashen face lying swathed under blankets and medical equipment. Voices swirled around her as she struggled desperately to get her bearings. Her mask was damp and she realized that she was crying as she watched on in horror.
As all this was going on, Jon grabbed the rib spreader from the tray. He inserted the tool between the space in the breastbone and rapidly turned the crank and locked it in place, opening the area so the surgeon could see inside the chest cavity. He held it steady and moved back a step to give the surgeon room.
Dr. Kelly bent over the open cavity of Alexís chest. "Dammit, give me more suction. I canít see a goddamn thing with all this blood."
Marcus reached over and the sound of the suction gurgled loudly, almost drowning out the sounds of the ventilator as it whooshed and beeped at the head of the table. As he was doing that, Sandy ripped open the sterile packaging around a stack of sterile gauze towels and shoved them inside. She quickly pulled out the blood soaked towels and threw them on the floor, then repeated the process several more times.
Regina watched as the surgeon groped inside, desperately trying to find the source of the bleeding. They were losing her. Regina could feel it happening. A strong sense of dread filled her and she fought to control her fear. Oh God, no, please donít let this happen. Hang on Alex, please, just hang on a few minutes more.
The resident stepped forward. "Youíre taking too long," she said, through clenched teeth. She grabbed a pair of sterile gloves from the box behind her, tore open the package and quickly shoved her hands into them.
The surgeon glanced up at her. "Youíre not a surgeon, Dr. Kingston," he grunted, as he continued to search futilely with his hands.
"Weíre losing her. Let me at least try." Regina didnít hesitate as she stepped forward and leaned over Alexís body. She grabbed a sterile towel from Sandy and reached inside, stopping the flow of blood with the pressure, then watching for the split second when the damaged vessel uncompressed and started to pump out the crimson colored blood again.
"There it is." The surgeon moved his hands, exposing the torn vessel.
"I see it," Regina said, as she searched around with her hands. "Give me a clamp." She grabbed the instrument from Sandyís hand and clamped the large vessel. "I need three-o silk. Hurry up, dammit."
"Jon, I need more resection," Regina ordered, and waited a moment as the doctor cranked the rib spreader, allowing her more room. "Thatís it, good. Hold it there." Regina worked quickly, sewing the hole in the vessel closed.
"Good, good," Dr. Kelly said, as Jon applied more pressure to the rib spreader and held it in place.
Sandy glanced up at the monitor. "Her pressure is stable: one hundred over fifty and holding."
"Ok, letís move, now."
"Here," Dr. Washington threw several layers of sterile gauze over the open wound in the doctorís chest and poured sterile water over it to keep the exposed tissues protected and keep from drying out on the short trip to the OR.
"Come on, letís move." There was a flurry of activity as the team unhooked the myriad of lines and tubes.
"Donít forget the drug box," Sandy called out, as she backpedaled pulling the stretcher with her towards the door.
"I got it. Watch the lines!" Thomas rescued one of the IVís from snagging on a med cart.
Jon grabbed the supply cart and hauled it upright. With Marcus at the head of the stretcher, squeezing the ambubag, Regina and Sandy pulled the stretcher into the hallway.
At a dead run down the hallway, the surgical team met the stretcher half way to the OR. "We got her from here guys."
Regina stared after the stretcher as the doors swung closed behind her. The silence in the hallway was deafening as they stood there without a thing to do now but wait. Reginaís breath went ragged as she collapsed back against the wall. She slid to the floor as she finally let go of the rigid control sheíd been holding during the whole ordeal. She felt two pairs of hands take hold of her arms, lifting her up, then her vision narrowed suddenly and she knew only darkness.
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