by K. Darblyne
Danni studied the surgeon intently as the patient was wheeled into the room, the medics giving their hasty report. She could see the deeply furrowed brow that shadowed the lusterless blue orbs of her roommate. This was so unlike her friend. Her eyes had always held an air of excitement about them. She thought back to the first time she had gazed into those crystal blue pools of emotion and the feeling of Déjà vu that had come over her. For some reason, the spark in those eyes had set off a feeling so powerful that it had caused the young nurse to stand in awe of the figure in front of her. Somewhere in time she had known this woman before. Where or when, it didn’t matter. What did matter was that there was an undeniable bond between them, a bond that would become recognizant to them both in time. Danni put aside her thoughts when she heard the familiar tones of the surgeon signaling the transference of the patient to the hospital stretcher.
"Ready? On my count, one, two, three." The tall woman stepped back allowing the ambulance stretcher enough clearance to be removed, as the rest of the team converged on the patient, each with their own task to perform. The initial examination assuring the patient’s airway, breathing, and circulation was completed to the surgeon’s satisfaction. She then began her secondary survey of the young man before her. She explained what she was doing to him as she moved from body part to body part to ascertain whether or not he had sustained any injuries in the minor MVA. Working her way down his long body, it became obvious to her that the medical student on the right side was standing motionless with his hands resting on the young man’s groin. She followed the arms up until the face of the student was clearly visible. His eyes were closed and if she didn’t know better, she would have to say that he was asleep. It couldn’t have been worse if he had been a sentry caught sleeping on guard duty. He was going to be made an example of. There was no sleeping when duty called! No, not in her book there wasn’t.
"You," she pointed to the resident standing next to the dozing team member.
"Take him out into the hallway." Her voice was low as it rumbled across the room, commanding immediate obedience. "Then step in here and take his place."
The surgeon finished her examination of the injured man, finding only a few broken ribs to be the reason for his breathing problem. The chest x-ray had confirmed it. She felt justified in ordering the patient a twenty-three hour observation bed. She wanted to watch him overnight just to make sure that a pneumothorax did not develop.
Danni called in a report on the patient to the assigned floor that would watch him. Then the nurse readied his chart and made arrangements for him to be transported to his designated bed while Garrett addressed the medical student.
The raven-haired woman removed her mask, gloves, and gown as she stormed out of the room. The rest of the team had disbursed, leaving the lonely-looking figure standing in the hall. His face grew pale as the surgeon came closer to him. She motioned for him to enter the conference room ahead of her. She followed him in and closed the door. Pacing back and forth as she removed the lead apron, she gathered her thoughts. Relieved of its weight, the surgeon stood to her full height, slowly inhaling before she spoke. Her eyes surveyed the form before her.
"I’m sorry…I was trying to concentrate…" his thoughts were in pieces as he nervously tried to excuse his actions. "I didn’t mean to…I haven’t stopped all day."
Her brow raised as she listened to his jumbled attempt to justify his action. Each attempt only adding to her anger. Her feelings were screaming deep inside of her to rid the medical profession of this poor excuse for a doctor wannabe before he truly endangered a patient’s life. She held up her hand trying to put an end to his ramblings. "You’d do yourself more of a service if you would stop talking now." Her voice was low and unwavering.
His mouth dropped open as he stared at her menacing form.
"And just what field of specialty is it that you propose to be interested in, when and if you become a physician?" Her steel blue eyes were narrowed at him.
He gulped. His throat was dry, and he found it hard to speak. "Radiology, like my…my father," he stammered.
"I should have guessed as much!" She thought about the cushy job of a radiologist, where, once out of residency and fellowship years, the only tough subspecialty was that of an angiographer. They were often referred to as the "bankers" of medicine in their comfortable 9 to 5 work hours, where every night was filled with sleep. "You’ve got a long way to go before you can enjoy that life style. I suggest that you not fall asleep again in my presence during a trauma or I’ll personally see to it that you never get that title of Doctor." Her words were harsh and without feeling, like the metal of a sword cutting deep to the bone.
He opened his mouth but thought more wisely not to meet her threat with a rebuttal, simply nodding his head in understanding. Disgustedly, she waved her hand, dismissing him from her presence. After he had left, the tall surgeon leaned on the conference table, hanging her head in disbelief.
The petite blonde nurse had kept a cautious watch of her friend through the large glass panels that lined the hallway, allowing her a view of the conference room. She could see the tension on the surgeon’s face and in the movements of her body as she addressed the medical student. She waited until the confrontation was over before getting her patient underway to his final destination for the remainder of the night.
***************
Danni arrived back to the trauma room to see Rosie restocking the supplies that were greatly depleted from the overabundance of trauma patients. She put the stretcher in place and readied it with fresh linen. By the time she had replaced the heart monitor batteries with new ones, the trauma pager was again crying for attention.
"Trauma page, trauma page. Twenty-five year old female assaulted with a brick. Severe facial damage. The patient has an unsecured airway at this time. ETA four minutes via helicopter. This is a Level One trauma page."
The two nurses flew out of the room, grabbing lead aprons and securing them quickly to their bodies. It was as though the two were in a race, as each moved efficiently to dress in the trauma gowns and masks. The overhead page now was breaking their concentration. "The Flight Crew is requesting a Physician on the helipad for intubation."
Danni grabbed a set of gloves and made for the door leading to the helipad. Converging on the door from the opposite end of the hall was the E.R. Attending for the evening, Dr. Potter, with her coat tails trailing behind her. Marianne, the Aide, had met them at the door with the bright orange intubation supply bag that they would need. Without hesitation, the door slid open and the trio stood outside, watching the helicopter gently touch down on the ground. Crouched over and shielding their eyes from the dust and debris that the propeller blades kicked up, they made their way to the aircraft. The long, red hair of the physician whipped wildly about her head as the crew door opened to the ship. Battling to keep the hair out of her face, Dr. Potter quickly climbed onboard.
The blood-soaked, swollen face of the women was barely recognizable as that of a human. The nurse and aide worked hastily to assemble the necessary equipment out of the bag. Jamie positioned herself as she pulled on a pair of gloves. She held out her hand in anticipation of the laryngoscope and the endotracheal tube. The blade on the handle was snapped into place producing a bright white ray of light to guide her once inside of the patient’s mouth. The welled-up pool of blood visualized inside of the oral cavity was making it impossible to place the tube.
"Give me some suction," the physician yelled above the noise of the slowing overhead blades. The flight medic immediately complied, evacuating the bright red liquid.
Knowing that time would be short before the build-up would occur again, Dr. Potter acted with confidence as she positioned the tube into the woman’s trachea and inflated the cuff at the end of it, securing the patient’s lungs from further liquid impingement. The flight medic attached the ambu bag to the end of the tube, enabling the patient to be oxygenated with artificial breaths. Danni offered the physician h
er stethoscope to assure the proper placement of the tube inside of the patient’s trachea. Jamie listened intently for the sound of air rushing in and out of the patient’s lungs. Checking both sides of her chest, the physician gave a thumbs-up sign and the tube was secured in place.
Marianne hastily repacked the equipment into the orange bag and found herself breathing a little bit easier now. She was relieved that the patient was successfully intubated but she was even more ecstatic that the blades of the helicopter’s propeller were slowing down to a stop. The whirling "blades of death", as she thought of them, had always scared her from the first day of the flight safety class. She loved the emergency medical setting but she didn’t want to lose her head over it either.
The physician climbed out of the crew area. She was concerned about the patient and the possible long-term effects the difficult intubation could have further down the road in the patient’s recovery. She handed the stethoscope back to Danni as they made their way to the rear of the helicopter to assist with the unloading of the patient. The pilot had already opened the doors and begun the removal of the stretcher onto the hospital gurney, which the security people had standing by. Dr. Potter quickly fell into the position at the head of the patient and accepted the ambu bag as it was handed out to her. Falling in step as the flight crew made their way to the trauma doors with their precious cargo, Danni offered up a silent prayer on the injured woman’s behalf.
Inside, the team of trauma personnel awaited the arrival of the patient, each going over the duties of their positions and praying that they would be able to do everything right. It was evident to them that the night was going to be a long hard battle of conscious effort if the traumas continued to come in the way they had all day long.
Once again, the blaring of the overhead speakers broke the silence of the emergency room. "Trauma’s in the department, Trauma’s in the department."
The Trauma Fellow rolled her head from shoulder to shoulder, trying her best to loosen the tense muscles of her neck and upper back. "Okay, people, let’s just do our jobs and sooner or later this night will be over." Her gaze passed from one to the next around the roomful of people. As if on cue, she turned and looked at the entrance to the trauma room just as the assembly of Flight Crew and E.R. staff came into sight. An arched eyebrow appeared on her face at the sight of the unruly red hair of Dr. Potter.
Looking up from her position at the patient’s head, their eyes met in a moment of silent communication, transmitting the concern that Jamie had for the patient she was administering to. As fast as the gaze had locked with the surgeon, it was now gone, as the Flight Crew turned the stretcher to advance into the trauma room headfirst.
The well-rehearsed ease with which the patient was transferred onto the trauma room gurney was not lost on the unsuspecting eyes of the social worker, which waited patiently outside of the room in the hall. It would be her job to try to find the family or a friend of the battered woman. Alex sighed as she thought about the pain and suffering that the patient would go through to recover from the assault. Absent-mindedly she shook her head at the sight of the intubated woman as her clothing was efficiently removed to allow the trauma team to examine her body for any further injuries.
Alex quietly accepted the remnants of discarded clothing and began rummaging through them with her gloved hands in search of any form of identification. The only clue to the woman’s identity was the small nametag that simply read, ‘Sunshine’. The social worker closed her eyes and sighed in disappointment, then turned to find the members of the Flight Crew.
"Do any of you know her name?" Alex prayed that they could help her find a starting ground for the search into the woman’s relatives or friends.
They looked at each other and slowly shrugged their shoulders, almost in unison. "All we can tell you is that she was found next to a building in a small alley in Washington County. We picked her up at an "LZ" a couple of blocks away. Sorry, but there was nobody that recognized her and we didn’t find a purse either." The Flight Medic hung his head slightly, "They were questioning whether it was a simple assault or a possible rape at the scene."
The social worker’s eyes opened wide at this last revelation. "Thanks for you help," she hastily returned and propelled her body back toward the trauma room. "Dr. Trivoli…Dr.Trivoli!" She gasped for a breath as she waited for the surgeon to look her way. In a low voice that was professionally driven, Alex stated, "There is a question of rape at the scene."
The tall surgeon closed her eyes momentarily, in self-condemnation. ‘Damn, I should have thought of that possibility!’ Regrouping her thoughts, Garrett began firing off orders. "Can you put each article of clothing in a separate bag?" The social worker nodded in agreement. "Thanks, Alex." The surgeon turned to the right getting the attention of the nurses, "Rosie, Danni, we’ll need to bag her hands for possible evidence. Mom, we’ll need a rape kit and camera."
"Gotcha one already coming," Karen replied.
"Dr. Potter, did you suction her mouth before you intubated?" The surgeon was looking steely-eyed at the E.R. Attending.
"Why…yes, there was too much blood and fluids to see the cords." The look of realization flashed across her face. "It could have contained possible evidence," Jamie rubbed her forehead in thought. "I’d better get the Flight Crew to retrieve it from the helicopter and label it." She left to find the Flight Medic who had handled the task of suctioning for her.
Garrett’s attention now turned back to the exposed body before her. The skilled eyes of the observant surgeon slowly studied the woman’s body, noting any small scrapes, lacerations, or signs of discoloration that she could find. Burning into her memory anything that could possibly be a sign of force, she verbalized what she saw for the videotape that recorded the events in the trauma room. The upper torso appeared to be pristine until she gently raised the woman’s voluptuous left breast to see all aspects of it.
"Shine that light over here." The surgeon motioned with her head to the lateral aspect of the body. Rosie quickly reached up and positioned the large operating room light to illuminate the area. Moving closer to get a better look, Garrett began to describe what she saw. "There appears to be a faint purple discoloration in the shape of a semi-circle…no, make that two semi-circles opening to each other. I get the impression of a possible human bite mark with no visible opening in the skin." Out of the corner of her eye she could see the medical student fussing with his gloves as he began to go toward the patient’s upper thigh. "Everybody freeze right where you are!" Her low, throaty growl was ominous. She straightened to her full height as she turned to stare directly at the medical student, "And what are you about to do?" Her eyes were like a swirling blue ocean readying to unleash a raging storm at the thought of a man invading this patient’s private area once more. "Answer me!" The anger in her voice was evident as the people around the medical student now edged away from him, trying as they might not to evoke her rage on them also.
His eyes grew big, as he became aware of the attention he had drawn to himself once again. He had pissed her off but good this time. He tried to swallow, but he was so scared that his mouth could produce no saliva. He looked down at his hands, then back up to the surgeon. "I…I …was just going to put in the …the Foley Catheter," he stuttered meekly. Then he defended his action, "It’s my job."
"Get out of my eyesight! I want you to think about what you were about to do!" Her voice was cold and edged with disgust. Her steely-eyed gaze followed him as he slowly retreated out of the trauma room. Once out in the hallway, he snapped off his gloves and reached for the mask covering his face, ripping it off in anger. Then, grabbing the gown with both hands at his chest, tore it from his body, and cast it to the floor as he strode down the hall, away from the menacing surgeon.
"Any more bright ideas here?" Garrett looked around the room at the shocked team.
"Rape kit is here, Dr. Trivoli," Karen’s soft-spoken words seemed to put an end to the tense situation. She handed the pa
ckage to Danni.
The surgeon paused to review the electronic monitoring devices showing the patient’s vital signs. The woman was holding her own. "Karen, call CT Scan and see how long before we can get in. We’ll need a head and abdomen scan." She let out a breath as she tried to calm herself.
"Already did. It will be another 20 minutes before there is an open scanner."
Garrett nodded her head, "Danni, set up the Rape Kit." She stripped the gloves from her hands, and walked over to the waste receptacle for hazardous materials by the entrance where she disposed of them. Reaching for the curtain that shielded the trauma room from the rest of the E.R., she bowed slightly, showing the way out, "Now, if you will excuse us…." The team of medical people filed out into the hallway, not wanting to see a replay of the surgeon’s wrath.
The last one in line was the intern who paused and questioned the dismissal. "How are we supposed to learn, this way?" He motioned to the group standing in the hall.
The surgeon’s eyebrow raised in warning, "By reviewing the tape at Trauma Conference," her voice barely above a whisper. She looked down on the smaller stature of the man, "Think about how you would feel if this were your mother, daughter, or significant other. Hmmm?"
