Open Fracture
Hedge Mage and Medicine Book 2
SA Magnusson
Copyright © 2018 by SA Magnusson
Cover art by Covers by Christian
All rights reserved.
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Contents
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Author’s Note
Also by SA Magnusson
1
A scream came from the end of the hall, surprisingly loud. There was a time when it would have shocked me to hear a scream so loudly from several rooms away, but the longer I worked in the ER, the more I was aware that walls could only keep in so much.
Looking up from suturing a long laceration, I glanced at Josh, the thirty-something-year-old nurse who was helping me. “Do you know what that is?” I whispered.
Josh shook his head.
When a scream came again, I made a point of continuing my work, trying not to rush through things, but there was something about the shrill scream that tugged at my heart. It was part of the reason I had gone into medicine in the first place. I hated seeing other people suffering, and from the nature of that cry, someone was definitely suffering.
“Only a few more, Mr. Jacobs.”
The man lying beneath the drape grunted. Given how intoxicated he was, he wasn’t likely able to do more than grunt. It was for the best. With his intoxication level, it was fairly straightforward to anesthetize the laceration, and he didn’t move too much, which made the act of suturing easier. Sometimes people thrashed around when they were getting sewn up, and it often didn’t matter whether it was a kid or an adult. Thankfully, this was a straightforward repair. It was a massive gash on his leg, supposedly from when he had stumbled and tripped into a table, though it didn’t have the same blunt appearance I would have expected from an injury as he described. It almost looked like a stab wound, though it wasn’t nearly deep enough. Given its location—as close to his groin as it was—I’d worried about vascular compromise, but there didn’t seem to be any. Now all he had to worry about was keeping it clean.
Another scream came, and I finished tying the last of the sutures, wiping the gauze across the surface of his skin. “You think you can put a little bacitracin on this and bandage it?”
“No problem, Dr. Stone.”
Stripping off my gloves, I patted the patient on the shoulder. “We’ve got you all sewn up, Mr. Jacobs. Those will need to come out in a week, so make sure you get in to see your primary doctor. Give them a call if you notice any redness or drainage, and avoid alcohol.”
“Why?” It came out as a mumble, as if his mouth were full of gauze or marbles.
“Quite a few reasons, really. Since you were injured while drinking, that would be reason enough to avoid alcohol for a while. When you’re dealing with an injury like this, alcohol can also act as something of a blood thinner. It’s best to stay away from it until you know you are on the mend.”
“How long?”
“A couple of days.” I frowned. “Is that going to be a problem?”
He was silent.
“How much do you drink, Mr. Jacobs?”
“Not much. Half a bottle.”
I waited for him to elaborate. Half a bottle could have been quite a few different things, depending on what his drink of choice was. I had seen plenty of people who drank a half-bottle of wine, and since I was occasionally one of those people, I knew that wasn’t all bad. Basically two glasses. A half-bottle of something harder meant a completely different thing.
“What’s your drink of choice?”
“Crown and Coke.”
“Yeah, you’re definitely going to want to avoid that for a few days.” He groaned and I headed toward the door, pausing for a moment. “Give detox a call and see if they can take him until he sobers up,” I told Josh.
He nodded while applying a dressing to the wound.
Back out in the hallway, I paused at the computer on the wall, logging in and preparing to enter a few orders and my note, when the scream came again.
This time it was shrill, but there was a note within it that suggested to me the patient was younger. Rather than taking the time to type my note, I hurried off down the hallway. Chances were that somebody else had already started taking care of the patient, but if they hadn’t, whoever was in there clearly needed something for pain.
When I reached the door and pushed it open, I quickly took stock of what was inside. A small form—likely a child—lay on the bed. There were two nurses on either side of the bed, each of them holding onto the child. Dr. Henry had his hands on the child’s left leg, and he was pulling. Two people stood near the child’s head, one of them sobbing.
“Do you need any help?” I asked Dr. Henry as I approached. He was a second-year resident, and perfectly capable, but the screaming was almost more than I could take. Considering how long it had been going on, I didn’t know if I could stomach listening to it over and over again.
Dr. Henry looked over at me, relief flooding across his face. “Dr. Stone. I’ve called ortho, but…”
I glanced down the leg, and understood the nature of the screaming. The boy had a femur fracture, and a sharp section of bone was jutting out through the skin, leaving blood trailing down either side. The fracture itself would be incredibly painful, but an open wound like this added to the complexity. This boy would need surgery, and a lot of rehab.
“They wanted me to put traction on the wound, to see if I could reduce the fracture beneath the skin,” he whispered.
“They asked you to do that?”
Dr. Henry nodded.
I swore softly under my breath. There were times when some of the specialists who served the ER angered me, and this was one of them. An open wound like this in a child should be a reason for the trauma team to get activated, which meant that at a minimum, the ortho resident should be here. “What have you given him for pain?”
“Morphine, but I don’t know that it’s touching it.”
The bracelet on my wrist suddenly felt heavier. I wore it for several reasons. For one, it offered me a bit of protection, masking me from the magical things living within this city. As little more than a hedge mage, I wasn’t equipped to handle most things, mainly because of my limited magic, but partly because I had not known I had any magic up until a few months ago. I might have spent every day trying to master it, but I still hadn’t gotten to the point where I was as proficient as I wanted to be.
The other reason I wore the bracelet was because it allowed me to tap into power I wasn’t able to reach otherwise. Times like this left me wondering if I would ever be able to use it in the way I wanted. I had seen those with power—real power—use spells to heal injuries that should not have been possible otherwise. My best friend was a
mage—or something like it—with incredible power, who had managed to use her magic to heal others. If I could do something like that, I could easily imagine just how beneficial it would be for my patients.
But magic wasn’t going to be able to help this boy.
I hurried around the bed, grabbing the phone, and punched in the number for the nursing desk. When the other line picked up, I said, “Stacy, it’s Dr. Stone in room three. I’m here with a kiddo who needs stat attention. Can you call anesthesia down to the ER? And activate the trauma team if it hasn’t been already.”
“You got it, Dr. Stone.”
I hung up the phone. I glanced to the child’s parents—at least, the two I thought were his parents. They were young, perhaps no more than my age, so either they’d had this boy very young, or they weren’t his parents. “I should’ve introduced myself. I’m Dr. Stone, one of the attending physicians. We’re going to get him the help he needs. Can you tell me a little bit about what happened?”
It was always interesting to see who managed to have the most composure with difficult situations. I had long ago given up on guessing. Sometimes fathers were the calm ones when it came to children, but not always. I had seen more than my share of hysterical fathers and then it was the mother who managed to remain calm.
In this case, the father—or guardian—looked to be early twenties. He had tattoos visible around his collar, but none that extended up onto his face. A couple of days’ growth grazed his face, and his black hair was cut close to the scalp. He had his arms wrapped around the woman, holding her tightly. The woman was short, barely over five feet tall, and petite. Inky black hair spilled down her shoulders, and she looked over at me with red ringing her eyes.
“He didn’t want us to go,” she said.
“You don’t have to leave. We’re going to take good care of him,” I said. Where was anesthesia? If we could get them down here, we could at least get him comfortable, even if it meant we were snowing him with sedation. “But what happened to him?”
“He got behind the car,” the woman said. “I didn’t see him, and when we backed up…” She started sobbing again, turning herself into the man, resting her head on his chest.
Jesus. They had backed over the kid, and now here he was. That was the reason for backup cameras—this kind of thing shouldn’t happen with today’s technology, but here we were.
“Is he… is he going to be okay?” the man asked.
My gaze dropped to the injured boy. I had seen plenty of similar injuries over the years, enough to tell me pretty much how things would go. He would need surgery to repair the fracture, maybe even external stabilizers, and when he managed to recover, he would take a while before he was back on his feet. As long as the growth plate wasn’t disrupted, he should do pretty well.
“I think he’s going to be okay,” I said. “If it would be easier for you to wait out in the waiting room, you can do that. We will come for you when we know more.”
The woman shook her head. “I’m going to stay.”
I turned, and as I did, one of the anesthesia residents, a fourth-year resident I knew from medical school came in. “Hey, Jen,” Dr. Anderson said to me. Becky Anderson had been in my class, and I knew her to be fairly bright. Most who went into anesthesia were reasonably intelligent.
“Dr. Anderson,” I said, nodding briefly to the boy’s parents. “We’ve got a child with an open fracture who will undoubtedly need surgery—“
The door to the room opened and the ortho team came sweeping in. And they were a team. There were five of them, all but one having the look of a retired athlete, and even she had a muscularity to her.
“What do we got?” This came from the ortho attending, a bald man with thick glasses. I didn’t need to glance at his name badge to know who he was, even though I had never met Dr. Edwards. The others lined up behind him, and I glanced along the line for a moment before nodding to Dr. Henry.
“Dr. Henry can fill you in.”
“The resident?”
I nodded. I wasn’t about to diminish Dr. Henry’s role in the care of this patient, even if it would put him in the uncomfortable position of having to present in front of the entire ortho team. Empowering him would make it so he would have a little bit more authority the next time. One of the things we struggled with in the emergency room was getting specialists to take our assessments seriously. Too often they sent their interns or low-level residents to do assessments, when we needed the attending.
“We have a femur fracture. Looks to be midshaft. Penetrating the skin. We have given him a total of eight milligrams of morphine, but he’s still in a lot of pain,” Dr. Henry said.
I smiled to myself. Good for him.
“Call anesthesia—“
“We did.”
Dr. Anderson raised her hand. “I’m here. I’m giving him a little propofol to get him comfortable.”
It was also good for ortho to see they had taken too long to get here. Maybe the next time they would hurry down when they were called.
“We’ve got this,” Dr. Edwards said. He stepped over to the side of the bed, taking hold of the child’s leg. “Now, young man, why don’t you tell me what you like to do?”
I looked over to the boy. He was sobbing, every so often whimpering, but the attending kept his hands on the boy’s leg, simply holding him in place.
“Soccer,” the boy whimpered.
“Soccer? I think you mean football. Who’s your favorite team?” Dr. Edwards continued to hold onto the boy’s leg, barely moving.
“Barcelona,” he said.
“Ah. A Messi fan. Can’t say I blame you. I’m more of a Liverpool man myself, but that’s only because I’ve been watching them since I was a boy. Played a little in college, but I was never any good.”
Dr. Edwards was pulling gentle traction as he talked to the boy. I could see the bone beginning to retreat. I couldn’t help but be impressed by the way he was working.
“Do you ever get to see any of our local boys play? They might not be all that competitive yet, but I think in a few years they will be. It’s nice for us to have a professional team to follow.”
The boy was nodding.
Dr. Edwards glanced up to Dr. Anderson. “Are you done yet?”
“The propofol is in.”
Dr. Edwards continued to watch the boy. “What position do you play?”
“Mid…”
The boy didn’t finish. He fell asleep, breathing loudly, and Dr. Edwards made a quick movement, and the leg straightened. Thankfully, the boy didn’t wake up.
He glanced over to the boy’s parents. “We’re going to need to take him to surgery. One of my residents will talk to you about what that involves. It should only take an hour or two, and when we’re all done, we’ll come out and talk to you about what we need to do. He’s going to need to stay in the hospital for a day or more, and it’s going to be quite a bit of work for you at home.” He glanced down at the boy, shaking his head slightly. “Unfortunately, he’s going to miss the season.”
I took that as my opportunity to slip back out into the hall. I should have known better than to judge Dr. Edward so quickly—and harshly. He was widely regarded as one of the best orthopedists at Hennepin General, and there was usually a good reason for a reputation like that.
Heading back to the nursing station, I took a seat and leaned back in a chair, resting my head on the backrest, staring up at the ceiling.
“Tough patient?”
I rolled my head to the side to see Brad Roberts watching me. He leaned against the wall, his arms crossed over his chest, his blue eyes unfortunately appealing. I knew better than to fall into that trap—now, at least. “Just a kid with a nasty break.”
“How nasty?”
“Femur fracture. Through the skin.”
Brad winced. “Yikes. How old?”
I shrugged. “I came into the middle of it. He was probably ten or twelve.” Though from the screaming, he could have been much younge
r. The poor boy was going to be miserable for a while.
“I was about that old when I broke my arm,” Brad said, tapping his forearm. “We were playing tag at my house, and I got a little aggressive, and tripped, going down. I tried to brace myself, and… Well, you know how it goes.”
We had seen injuries like that often enough, I knew how easy it was to break a bone from such a seemingly minor fall. It was a wonder people didn’t break things more often. “I’m shocked,” I said.
Brad frowned at me. “That I would fall?”
“That you were aggressive at anything.”
He chuckled. “Touché.” Looking around the ER, he asked, “What are you doing after your shift?”
“Likely heading home. I’ve got to work again tomorrow, and 8 o’clock comes early.”
He laughed again. “You fellows have it so easy.”
“As if your shifts are any different.”
“I suppose they’re not. God, I hated the twelve-hour shifts we had to do when we were residents. It’s bad enough some days with eight. I guess that’s why we make the residents do them when they’re younger so they can appreciate the shorter shifts when they’re done.”
“There’s that and the fact we don’t expect residents to carry as many patients as we would expect from an attending,” I said.
“Don’t you go trying to confuse me with logic, Jen.”
I shook my head, logging into the computer. I had a couple of notes to type up, and it was almost 6 o’clock, which meant I was nearly able to get out of here. If another trauma or something significant rolled in, that might delay me, but otherwise things were looking good to leave on time. It was rare enough that I wanted to take advantage of it whenever I could.
Open Fracture Page 1
