by K. Darblyne
"Dr. Trivoli," he started as she looked over at him. "We thought you might like to know that the forth victim was DOA." He unzipped one of the cargo pockets on his nomex flight suit, fishing out a Polaroid, he offered it to her.
Garrett accepted the picture for closer observation. Her keen azure eyes scanned the images; quickly noting the victim pinned behind the steering wheel. The classic signs of upper body and extremity engorgement and the distinct purple discoloration of the skin along with the animated fully thrusted tongue and bulging eyes screamed only one thing in her mind. "Hmmm," she nodded. "Looks like traumatic asphyxiation, wouldn’t you say?" Her eyes raised to his in question as she handed the Polaroid back to him.
"Yeah, I’ve read about it but never saw it before," his tone was sober. "Maybe, I hoped that I never would," his voice trailing off to a whisper.
The surgeon reached out and touched his shoulder; "None of us should ever have to." Her voice was reassuring, "Thank you for sharing that with me." She looked directly into his eyes saying, "If you need to talk about it…."
Closing his eyes, he simply nodded and slowly moved away from her, letting her hand slowly slide off of him. "Thanks, doc," he whispered.
"Dr. Trivoli, we’re ready to go," Danni informed her as the entourage of medical personnel slowly rounded the corner of the trauma room into the hallway escorting the gurney.
"Yeah, I’m with you." The tall woman pulled herself away from her thoughts that the Polaroid had brought to her mind and once again assumed her role as Trauma Fellow. "Let’s see what’s going on in that head." She turned and popped her head into the nearly vacant trauma room, "Karen, when Neuro..."
"When Neuorsurgery shows, I’ll send them into the scanner," the older nurse cut her off. "Now, go do your job, I’ll take care of mine," she said teasingly, and winked at the surgeon.
Letting a lopsided grin show, the raven-haired woman stated, "Mom, you’re the best." ‘I guess this bunch of nurses are quick learners. They seem to anticipate my thoughts before I can voice them.’ She was relieved that they had followed her way and not fought her demands. ‘I wonder if they know that they joined my team?’ She smirked at the thought of how McMurray would view this when he reviewed the tapes.
The painful screams that she heard coming from behind her made her think of Dr. Potter and the third trauma patient. She made a quick mental note to check on them as soon as she reviewed the head scan on her patient. Then using her long strides, she made off to the CT Scanner and her patient down the hall.
The air was thick with tension as the surgical team fought desperately to save the life of the woman lying on the table. The heat from the bright lights illuminating the field of operation and the anxiety of the surgeon was enough to bring a sheen of perspiration to his brow. He turned his head to the circulating nurse who hastily wiped his forehead free of the gathering sweat. His eyes never left his patient as his nimble fingers deftly worked to suture the jagged tear through the woman’s aorta. The flap of vessel was evidence to the traumatic nature of the head-on crash. It was a typical injury in an abrupt deceleration scenario. The effect on the large vessel filled with blood during the sudden impact was similar to that of a balloon filled with water. The continued kinetic energy in the forward motion had nowhere to go once the outside casing was halted, thus resulting in enough force to cause the walls to give way at their weakest points.
Kreger thought about what might be able to tip the scales into his patient’s favor. His mind trying to emulate that of his Trauma Fellow, Garrett Trivoli, he considered all of the tricks she had taught him that could possibly help in the circumstance that he now found himself. He did not want to fail his patient and let down the trust that was placed into his hands by the trauma fellow.
"Damn!" His voice was sharp; "This flap is so flimsy, it just continues to tear the more I try to repair it." He blinked several times in succession as though trying to clear his view. "It looks like the weakened area is extending up into the carotid artery as it branches off of the aorta."
What had started as only a small tear was now becoming more unmanageable as the seconds ticked on. He was losing precious time that would ultimately result in the demise of his patient.
Kerger bit at his lip nervously. His decision was being made for him and there was nothing he could do about it. Clearing his throat, he barked out, "Page Dr. Trivoli to the O.R., STAT!"
The small form lay silent on the cradle of the CT Scanner, the only sounds coming from the room were that of the rhythmic cycling of the mechanical ventilator that forced air into his lungs and the whirring of the circling X-ray tube within the gantry of the scanner itself. The saying that "a picture is worth a thousand words" came to mind as Danni watched the grim faces of the doctors. The CT Technologist shifted her position to reach for some paperwork allowing the petite nurse to maneuver herself to get a look at the images that were appearing on the monitor screen. The nurse had seen enough scans in her career that she knew something was definitely wrong. The image that she saw on the screen was nothing like what she was used to seeing. Her eyes traveled to her electronic monitoring devices as she jotted down their readings onto the patient flow sheet making sure to note the time. It was 2047.
Michelle Payo, the Neurosurgery resident on-call for the night had arrived and was watching the last few images come up on the screen. She was of medium height and her pregnancy was obvious, compared with her rather small body frame, her white lab coat hanging open around the protruding form. Shaking her short brown hair, she let out a deep sigh. "May I see," she asked as she pointed to the screen.
"Sure, doc," the CT Technologist began cueing up the first image and slowly ran through them all.
"Well, what do you think, Michelle?" The surgeon was sure that the answer would not be good.
Looking up from the screen and out to the patient, the Neurosurgeon asked, "Did you give him any paralytics?"
"No, he hasn’t had any."
"How about the initial neuro exam, any stimulus?"
"No, nothing, not even decorticate posturing." The surgeon’s voice reflected the severity of the young man’s injuries.
Pursing her lips as she gently patted her pregnant belly, the small woman sighed deeply. "I don’t know of anything that we could do. It already appears that he has sustained an anoxic injury to the brain." She shifted her weight to the other foot, "With the extent of the skull fractures, I’d have to say that the only thing to do now is see if the next of kin will consent for him to be a donor." The young woman looked up to the tall trauma fellow; "There is really no hope for this kind of injury. The respirator will keep his body alive, but the brain will have no function whatsoever. I’d be pretty certain to say that he is brain dead."
Garrett looked away. Her face took on a disgusted scowl as she sucked in on her lips. Letting out a soft snorting sound, she shook her head. "Scan his chest and abdomen. Let’s see if there is anything going on with the vital organs."
The petite blonde nurse wrinkled her nose giving her a questioning look.
"Have the social worker find out if there is any family and contact C.O.R.E." The surgeon was disappointed, "There is nothing more we can do for him, Danni," she offered, "but maybe we can help someone else."
The nurse blinked her eyes to catch the small tear that was forming, "Alright, I’ll let the social worker know. I think that I saw Alex earlier tonight." She turned to the right and reached for the wall phone.
"Dr. Trivoli, Please report to O.R. #1 STAT!" The loud speaker blared, paused, and repeated again.
Garrett’s attention was grabbed as though someone had reached out and vigorously shook her without any warning. Almost immediately her pocket came to life with the sound of the pager beeping. She looked down and studied the number that was imprinted across the display screen. She looked over to Danni, "It’s the O.R., call them and tell them I’m on my way." The tall athletic body of the surgeon was being propelled though the doorway by her long powerful legs as
she spoke. She quickly made her way to the stairwell and taking the steps two at a time, she pushed herself up the two flights of stairs. The metal door at the landing slammed open as she launched herself down the hall in the direction of the O.R. entrance. Nearing the doorway she peeled off her trauma gown as she sidestepped her way past an X-ray Tech with a slow moving portable machine. Yanking the right side half of the double doors, she entered into the main desk area. She slowed only long enough to grab a blue hair bonnet and shoe covers, while dropping the lead apron to the floor. Snapping the bonnet down over her shoulder length hair with one hand, she leaned on the desk for balance. "What’s going on?" Her words were punctuated by heavy breathing. She leaned over and slid her foot inside of the covers. The older woman at the desk looked up only to see the back of the surgeon as she vaulted down the hall.
Through the window in the door, she could see the scurry of activity in the operating suite. Hastily she picked up a facemask and placing it on her face, pinched the small metal piece over the bridge of her nose. Pushing open the doors, she entered the surgical arena. The circulating nurse was holding a gown that Garrett thrust her arms through, and spun around so as to have the gown tied shut. The surgeon reached for the pair of sterile gloves that had been laid out for her use as the nurse swiftly tied the loose ends of the facemask to secure it in place.
Striding over to the operating table, the surgeon snapped her gloves into place. "What’s going on, Rob? What can I do to help?"
"She’s bleeding out." His speech was fast and frank. "For every piece of the tear that I get sewn up, another area rips more." He quickly glanced over at Garrett. "I’m losing ground here," he confided.
"Hemostats! Suture!" The instruments were promptly placed into her outstretched hand as she entered into the life or death battle allied with Dr. Kreger.
The screams of anguish heard earlier were now turning into whimpers of discomfort as the medication began to take effect. Having thoroughly examined the man and ascertaining that his only apparent injuries were indeed the multiple fracture sights of both his legs, Dr. Potter felt obligated to ease the patient’s pain. A thought brought a smile to the freckled face of the physician, ‘I wonder if I gave him that to relieve his pain or more to relieve the pain we are experiencing from listening to his screaming.’ Much to the pleasure of all concerned, the medication was doing its job. A quiet peace was once again coming to the trauma hallway and the staff that still remained with the patient in Trauma Room #3.
Jamie stepped outside of the room to look at the X-rays that had already been done. She cued the viewer and began studying the routine films that were part of the trauma protocol. Having seen nothing to alarm or concern her on the cervical spine, chest or abdomen films, she felt good about her choice in pain control for the patient. Her job was just about done, and now it would clearly be an orthopedic case. Still, with the severity of the accident and knowing the fact that one person had been killed at the scene, she thought that it would be best to at least get a CT Scan of his abdomen, just to be on the safe side. She pondered only momentarily the wrath that she might incur from the tall, gorgeous, and demanding trauma surgeon if she didn’t.
"Lori, call CT and tell them we’ll need an abdomen scan for this patient," she said leaning into the doorway of the trauma room.
"Sure thing, Dr. Potter." The insecure nurse was beginning to regain her composure. Her shyness was something that she had trouble with all of her life. She loved being a nurse, but felt at times somewhat overwhelmed by the emotional demands of her patients. Her conservatively styled blonde hair and tall shapely body made her look older, but when she smiled, the illusion was gone in an instant as the youthful appearance of braces glistened in the light.
Jamie was now watching, as the X-rays of the lower extremities were becoming available. Shaking her head at the multiple fractures that were very evident on the X-rays, she advised the young nurse, "It may be a while until Ortho has all of the splinting done. You may want to let them know in CT."
The nurse reached for the phone and did the doctor’s bidding. Hanging up, she informed the physician, "They’re just finishing up that second trauma now, so whenever we are ready will be all right with them."
"Good, and here comes Ortho now." She waited for the tall, lanky form to come closer to her before addressing him. "Hi! I don’t believe that I’ve met you," she held out her hand to him.
His large hand was gentle at the touch of the handshake. "I’m Dr. Armand Selep, I’m covering for your regulars tonight." His eyes held her in his gaze.
"Jamie Potter, E.R. Attending." She smiled pleasantly at him, her hand lingering in his grasp.
The young nurse looked at the two, feeling embarrassed by her intrusion on the intimate moment, she nervously coughed trying to bring them back to the realization of where they were. "Dr. Potter," Lori spoke softly. "CT Scan is waiting for the patient," she reminded her.
Surprised at her reactions to the tall dark-haired man, the physician could feel her face begin to flush. Trying as hard as she might to subdue her inner feelings, she quickly started rattling off a brief report of the patient’s mode of trauma and her findings. "Thirty year old male, unrestrained driver of a tractor trailer that was involved in a head-on crash with an SUV. Obvious deformity to the right leg and ankle, complaining of severe pain in both lower extremities." She pointed to the viewer where the X-rays of his legs were displayed. Clearing her throat, she continued. "There was a reported death in the SUV. We would like to have those legs splinted before he goes to CT Scan to check out his abdomen."
The tall doctor stood with his hand rubbing his face and the barely visible growth of beard, studying the X-rays. Blinking several times as he compared one view of the leg to the other, he began to shake his head. "Those are some pretty bad fractures." He paused and looked into the trauma room at the patient. "Seems pretty quiet for the likes of those injuries," he mused.
"Well, you should have been here when he first came in." Jamie chuckled, "We snowed him pretty good. He was disturbing the entire E.R. with his screaming."
"Yeah, I bet." Armand smiled down at the physician. "Let me get started splinting then," he said. "While he’s in the scanner, I’ll notify my attending. I’m sure he’ll want to take him to the O.R. tonight."
"All right, then." The red-haired doctor nodded in agreement. Adjusting her glasses on her face, Jamie watched as the orthopedic surgeon assembled his supplies to splint the legs.
The long, eerie-toned note was all that was heard, as the surgical team stood transfixed to the electronic monitoring devices. Garrett sniffed as she looked over to the large clock on the wall, "Time of death, 2113."
The anesthesiologist slowly turned off his monitoring devices. Suddenly the room became deafeningly loud with the silence.
She stepped back from the lifeless body on the operating table, snapping her gloves as she ripped them off of her hands and threw them into the waste bucket on the floor. She pulled at the mask on her face, ripping the ties with a strong yank of her hand. She spat into the waste bucket, using the mask to wipe her mouth and discarded it. Death always left a bad taste in her mouth, even if there was nothing she could do to prevent it.
Rob Kreger let his eyes fall into the gaping chest cavity that had been his center of attention for the last hour or so. He let his mind go over his actions and questioned the patient’s outcome. Perhaps he should have called sooner for the talented surgeon to assist him. Would that have made a difference? Had he allowed himself to become arrogant in thinking that he could do the job himself? Alone?
Slowly his hands busied themselves with the task of removing the rib spreaders that were used to gain access to the chest cavity and its contents. The draping was being removed from the face of the woman and he felt compelled to look at her features. He studied them intently, so as to burn them into his memory. This was the face of his first patient lost during an operation that he would call to mind during the rest of his career. He owed i
t to her and to all the patients he would treat in his lifetime. The lesson being to keep him humble, never denying to ask for help not for him but for his patient.
Long dark hair moved gently with the breeze as the tall form stood staring at the landing sight for the helicopter. The marker lights in the darkening twilight hours illuminated the helipad. Her back faced the trauma doors to the emergency area of the hospital, but she could somehow feel the presence of another human walking towards her. Sensing no danger, she remained absorbed in her thoughts.
The small hand reached out to touch her arm. "Gar…I mean, Dr. Trivoli,
Mom told me you were out here," Danni used her most comforting tone of voice.
"You were right the first time. I don’t much feel like a doctor right about now." She nodded absent-mindedly to herself.
"I’m sorry."
"No need to be, Danni." The surgeon turned to face her friend. "Some things just happen. We all tried the best we could." She shrugged her shoulders, "It just wasn’t meant to be."
