Trauma Alert

by Radclyffe

  “How you doing?” Beau tried to sound casual as she tilted her beer bottle back and took a long swallow.

  “I’m fine. Stop worrying.”

  “Hey, I’m not—”

  Jilly smacked Beau on the shoulder. “Don’t play Ms. Cool with me. You’re my baby sister, remember? I know all your tricks.”

  “God, I hope not.” Beau grinned and Jilly laughed, the sparkle returning to her eyes. Beau draped an arm around her older sister’s shoulders and hugged her. Then she rested her cheek against Jilly’s hair. “You sure?”

  “I told you already. My tests are fine. It was the flu. Nothing more.”

  “I still don’t think you should have gone back to work—”

  “Beau,” Jilly said gently as they walked into the living room together. “It took me ten years to make partner. In case you haven’t noticed, the economy sucks. Even if I didn’t love my job, I’d still need to go to work.”

  “I know, I know. But why be a partner and still work twenty-four seven?” Beau dropped onto the sofa and patted her lap. Jilly stretched out at the opposite end and plunked her feet into Beau’s lap. She let out a groan when Beau started to massage her feet through her soft fuzzy orange socks.

  “Did you eat?” Jilly asked.

  “I grabbed a burger and fries at the McDonald’s in the hospital.”

  Jilly shook her head. “God, you’re going to kill yourself, the way you eat.”

  “Don’t worry, I burn it all off.” Beau grinned. “One way or the other.”

  “Now that you’re living here, I know you’re not fooling around all that much.” Jilly bounced her heel on Beau’s thigh. “Am I cramping your style?”

  Beau continued rubbing her thumb over the arch of Jilly’s foot. After a moment, she said, “Are you getting tired of having me around? When I got the transfer to Southwest, I know I said I’d only be here for a while and it’s been three weeks already. I can start looking for a—”

  “That’s not what I’m talking about and you know it. I like having you here. I’m asking if you’re not bringing women back here because we’re sharing the house.”

  “No. Well, I wouldn’t, but it’s not because of anything you did. I just wouldn’t feel comfortable making—” Heat rose up Beau’s neck. “Jeez, Jilly. Can we not talk about my sex life?”

  “You’re not nineteen anymore, Beau. You’re twenty-eight. You’re smart, beautiful, and caring—even if you don’t want anyone to know it. You ought to have a real girlfriend, not a string of one-night stands.”

  Beau groaned and dropped her head onto the sofa back. “Can you not sound like Mom, please? Besides, you’re almost forty. Where’s your girlfriend? Or boyfriend, or whatever?”

  Jilly’s face shuttered closed. “That’s not fair. You know why.”

  “That’s bullshit.” Beau gently shifted Jilly’s feet aside, stood up, and went to the kitchen for another beer. She returned and leaned against the mantel above the small, neat brick fireplace. “There’s no reason you shouldn’t have everything in your life you deserve.”

  “Right back at you.” Jilly gave Beau a tender smile. “So what’s your excuse?”

  Beau turned the beer bottle in her hands, wondering how to explain that she only felt alive when she was moving as fast as she could—from one crisis to the next, one woman to the next. That if she stopped, she’d lose it all. Again. She regarded her sister, her strong, brave, generous sister who had far more reason to be angry at fate than she did.

  “I guess I’m just not cut out for a relationship,” Beau said softly.

  “You’re wrong. You just haven’t met a woman you can’t forget in the morning. When you do, you won’t be able to help yourself.” Jilly rose and kissed Beau’s cheek. “Want to finish watching Avatar?”

  “Sure.” Beau followed her sister upstairs. Jilly knew her better than anyone in the world, but she was wrong about one thing. Beau had learned not to count on anything beyond the moment. And that included love.

  Chapter Three

  The station house alarm rang just as Beau was about to store her turnout gear. The last call had been for a forty-two-year-old runner who had collapsed while jogging in Fairmont Park. Now the radio dispatcher announced: Engine 36, respond to multi-vehicle accident at Thirty-third and Spring Garden off-ramp. She quickly pulled her bunker pants back on, grabbed her coat, and sprinted toward the medic unit. Bobby Sizemore caught up to her just as she climbed into the cab. By the time she had her seat belt buckled, they were rolling. When they went out on calls together, Bobby drove. She preferred concentrating on the upcoming scene rather than the logistics of getting there. For her, the job was all about the victims, and that was the only thing she wanted to be thinking about.

  “Not even eight o’clock yet,” Bobby said as he drafted in the wake of the big engine just ahead. “Gonna be one of those days.”

  “Looks like.” A hard rain streamed from a steely gray sky that harbingered the advent of winter. Up ahead and to the right, a black smudge obscured the outline of the art museum just across the Schuylkill River. “Ah, hell. We’ve got a fire.”

  Bobby’s jaw tightened and he picked up speed.

  Beau’s pulse hitched and then settled as she took a deep breath and readied herself. Vehicle fires were a dreaded consequence of multi-vehicle accidents. Smoke and flame were quick killers and left precious little time to extract the victims. Often, firefighters and emergency medical personnel had to work under the threat of imminent explosion in and around unstable vehicles. These were the moments when every decision counted and there would be no second chances. These were the moments Beau felt most alive.

  Bobby positioned the squad in tandem with the engine already parked diagonally across the twisting two-lane road that bordered the river. Together the rigs barricaded the scene from oncoming traffic and protected the firefighters during the rescue operation. A swarm of firefighters pulled hoses and equipment from the engine. The incident commander stood by the side of the truck with a radio in his hand, giving the on-scene report. A red SUV with oily black clouds pouring from under the hood lay on its side in the middle of the roadway. Beau scanned a trail of flattened shrubbery and torn-up grass adjacent to the highway that led toward the water’s edge. The rear of a hatchback protruded above the embankment.

  “There’s another car in the water,” she told Bobby. “I’ll take that one. You check the one in the road.”

  “Don’t forget your life vest,” Bobby grunted.

  “Yes, dear.” Beau jumped from the rig and unlocked the back. She grabbed her gearbox, snagged a life vest, and ran across the chewed-up ground to the second vehicle. The front end was already submerged up to the windshield. From what she could see from the riverbank, the rear seat of the midsize four-door hatchback was empty. The driver was slumped against a partially deflated airbag. There might have been a front seat passenger, but the airbag on that side hadn’t deployed. She flicked on her radio.

  “IC, this is Cross. One vehicle partially submerged and going under rapidly. One victim confirmed in front driver side, a second possible in front passenger side. We need tie lines down here now.”

  “Cross, this is Incident Command confirming you need tie lines. One victim, driver side. Possible second front-seat passenger.”

  Protocol dictated she wait until the vehicle was secured before she approached it, but in the scant seconds it had taken her to assess the situation, the car had slid a few more feet into the water. In another minute it would overbalance and go under completely. Beau yanked off her turnout coat and pants. The heavy heat-retardant material was worse than useless in a water rescue situation. Icy rain and glacial wind whipped her long-sleeved uniform shirt around her body like a flag on a pole. Bracing herself for the shock of the near-frigid water, she waded into the river toward the driver’s door while pulling on the life vest over her shirt. She slapped the Velcro straps down to secure the vest as frigid water rose to her waist. A quick scan of the rear seat c
onfirmed it was empty. Moving into chest-deep water, she pulled on the driver’s door handle while peering into the front passenger compartment. A woman whose long blond hair was densely matted with blood slumped over the steering wheel, her face obscured by the airbag. Beau could just make out a motionless child of about six held upright by a seat belt on the passenger side. Judging by the level of the muddy brown water inside the car, the child would be underwater if the vehicle slid much more. She keyed her shoulder mic.

  “This is Cross. We have a second victim—an unconscious child in the front passenger compartment.”

  The driver’s door didn’t budge. Beau braced her leg against the side of the vehicle and tugged harder. Arms and back straining, she kept up the pressure with no success. She switched to the rear door where the water had not yet reached the level of the window and prayed it wasn’t locked. One sharp tug got it open and she leaned inside, quickly feeling for a pulse in the driver’s neck. Thready and weak, but present. She heard shouts from shore but didn’t bother to look back, knowing other firefighters would be attaching cables to the rear of the vehicle. The water had reached the child’s neck. She eased out of the vehicle. Water swirled up to her shoulders and her boots slid on loose rock and mud. She grabbed the roof to keep from going under.

  “Throw me a cervical collar,” she yelled. Straining against the current, she plodded a few feet back toward shore and caught the wide padded collar as it flew through the air toward her. With her back against the vehicle to keep her balance, she worked her way back to the open rear door and secured the support around the woman’s neck from behind. She needed to get to the child, but she couldn’t go around the front of the submerged vehicle. If she tried slogging back to shore and wading down the other side of the vehicle, she’d lose precious time. She was slowing down and her legs were numb from the penetrating cold. Her fingers weren’t working right either. If she was this impaired so quickly, both victims must be severely hypothermic by now.

  “Do you have the lines on?” she shouted.

  “Getting ready to winch,” a firefighter responded.

  “I’m going inside.”

  “Give us another minute.”

  “Don’t have one,” she called and climbed all the way into the rear seat, hoping her added weight wouldn’t plunge them all beneath the surface of the river.

  *

  Ali sutured the subclavian line into the skin beneath the teenaged gunshot victim’s collarbone and taped down a sterile dressing. She checked to see that blood was flowing through the large-bore intravenous catheter and cast an eye over the monitors. Pulse and blood pressure stable. O2 sats excellent. He’d gotten lucky. One bullet fractured his skull but didn’t penetrate his brain. Another passed through his thigh without severing anything vital. He’d live to fight another day.

  “Okay,” she said to the waiting trauma intensive care nurses. “You can take him for a CAT scan and then up to the unit. I’ll tell neurosurg where to find him when they get here.”

  “Thanks, Ali,” the male member of the team said as he and the second nurse pushed the stretcher toward the double sliding glass doors of trauma admitting.

  Ali pulled off her gloves, untied her impermeable paper cover gown, and tossed everything into the trash. She’d gone from one trauma alert to the next since she’d come on duty at 7:00 a.m. Considering it was only Friday morning and she was on call until Saturday at 8:00 a.m. and backup call on Sunday, it was going to be a very long weekend. She sat at the narrow counter along one wall and quickly completed the trauma admitting form as the unit clerk assembled the patient’s chart.

  “Doing anything special on Thursday?” Tony Chang, the other trauma fellow in Wynter Thompson’s year, inquired.

  “I’m on call.” Ali had volunteered to work on Thanksgiving, as she did most holidays. She couldn’t see any point to spending the day at home when one of her colleagues could be spending it with family. She’d be perfectly happy to eat leftovers with Ralph and Victor the next day. “You?”

  “Going up to my girlfriend’s parents’ place in Manhattan.”

  “Nice.” Ali handed a stack of papers to the unit clerk, noting that the pale young woman, whose spiky black hair was tinted with random swaths of vibrant purple, had a new piercing in the corner of her right eyebrow. At least Ali thought it was new. She might have missed it among the impressive array of hardware adorning the girl’s face. Absently, Ali wondered how in the world she managed to kiss anyone without inflicting damage to herself or her partner. “Here you go, Trish.”

  “Thanks, Dr. T. I’m going for some coffee. You want?”

  “Oh yeah, most definitely.” Ali fished a ten dollar bill out of the pocket of her scrub shirt. “Here. Get something for Tony and Cass too. My treat all around.”

  Trish flashed Ali a sparkling smile. “You rock. Thanks.”

  “Yeah, Ali, you rock!” Cassie Jones, a red-haired veteran trauma nurse, stood restocking one of the crash carts on the far side of the room. Small and buxom in baby blue scrubs, she wiggled sculpted brows at Ali.

  Ali rolled her eyes and grinned. “I’m going to head up to the unit and—”

  The base phone rang and Ali, who was closest, picked it up. “Trauma admitting. Torveau.”

  “Rescue 19 inbound with two patients from an MVA,” a female reported. “ETA five minutes.”

  “Go ahead, 19.” Ali grabbed a pen off the counter and pulled an intake form from a file folder thumb-tacked to the wall by the phone.

  “White female, approximately forty years of age, unresponsive, hypotensive, with intermittent cardiac irregularities. Second patient is a six-year-old male with a closed head injury. Unresponsive, vitals stable. Both severely hypothermic.”

  “Send me a cardiac rhythm strip on the adult,” Ali said. “What’s their respiratory status?”

  “We intubated the adult. O2 sats one hundred percent. Assisting the child by mask. Pulse ox ninety-seven.”

  “Fine. We’re standing by.” Ali hung up and quickly tore off the cardiac rhythm strip sent from the remote terminal while she’d been talking. Short runs of V-tach. Tony and Cass looked at her expectantly. “Two on their way. Call respiratory and page neurosurg again. Both have head injuries and are hypothermic. Cass, throw a couple of liters of normal saline in the microwave and break out the warming blankets.”

  “Got it.”

  “Tony, call down to CAT scan and tell them they need to bring in another tech. We’ll have two more for them in about twenty minutes.”

  Ali gowned up and pulled on her gloves just as the doors slid open and a paramedic in the trademark navy blue cargo pants and polo shirt pushed a gurney bearing a young child through the door.

  “Status?” Ali directed the burly blond she recognized from the TER-OPS session toward one of the three adjustable treatment tables occupying the center of the large square room.

  “The boy is stable,” he told her. “The mother dropped her BP about a minute ago.”

  “Tony, take the boy. Get Peds surgery to look at him.” Ali pointed to the trauma table closest to her as the second stretcher bulleted through the door. “I’ll take her over here.”

  “You got it,” the medic guiding the stretcher said. “BP sixty palp. Heart sounds distant. She’s got a hell of a contusion in the center of her chest.”

  Ali glanced up from the patient for just a second as the husky voice struck a chord. Beau Cross’s face was flushed and her blue eyes danced with excitement. Ali gave herself one brief second to appreciate the very striking picture before blanking her mind to everything except the woman on the stretcher. A five-inch diagonal laceration slashed across her right upper forehead. Her face and hair were covered with copious amounts of congealed blood. Face and scalp lacerations always bled impressively, but there didn’t appear to be enough blood loss to account for the profound hypotension. An ET tube protruded from her mouth, connected to a small portable respirator that sat on the end of the bed delivering oxygen from a cyli
ndrical green tank. Ali ran her stethoscope over the woman’s chest while the respiratory tech switched the breathing tube over to a permanent ventilator.

  “Heart sounds are muffled.” Ali looked up at Beau who stood at the foot of the bed. “Diagnosis?”

  “Closed cardiac contusion. Possible chamber rupture with tamponade.”

  “Good call. Cassie, roll the portable ultrasound over here.”

  Beau edged closer, captivated by the way Ali directed the multiple trauma alert with crisp, practiced efficiency. She’d seen plenty of trauma surgeons work in the hospitals in the northeast division she’d covered before. Most of them she liked and respected. She hadn’t seen anyone as utterly and completely in control as Ali Torveau. She was the calm in the center of the storm and everyone in her orbit seemed anchored by her certainty. Even Beau felt grounded by her, enough that she could ignore her own discomfort. Her feet and legs were so cold she was having trouble maintaining her balance, but concentrating on Ali helped block out the pain. The sensation was foreign but surprisingly pleasant.

  Ali took the probe the trauma nurse extended with one hand and simultaneously squirted a dollop of ultrasound gel into the center of the patient’s chest. “Cass, call upstairs to the unit and get a couple more nurses down here.”

  “Right away.”

  “I can help,” Beau said. “Just tell me what you need.”

  Ali glanced up, nodded once, and tilted her chin toward a closed instrument pack on a nearby tray. “Open that tray and prep her chest. I’m going to tap her.”

  “Right.” Beau slowly folded back the flaps on the sterile tray and then looked around for gloves. She found a pair of eights and, despite the stiffness in her hands, managed to pull them on. She opened the Betadine packs inside the tray. “Okay for me to go ahead?”