Critical Care: 1 (Mercy Hospital)

by Candace Calvert

  +++

  The ambulance crew swept past Claire and into the code room, two paramedics hustling the stretcher and a big firefighter in yellow turnouts trotting alongside, holding the IV bag shoulder-high.

  The patient’s face was covered in blood, her fair hair matted with it. A significant scalp wound likely. A stiff orange foam collar protected her neck, and much of her face was obscured by an oxygen mask attached to a high-flow bag. Her clothing cut away, she’d been partially covered by a silver foil survival blanket. A cardiac monitor lay wedged alongside her on the gurney. The woman’s skin, beneath the dried blood, was pale—sickly pale. And her small hands motionless.

  Claire’s pulse quickened. She watched from the doorway as Logan talked with paramedics before starting his exam. Erin attached the ER’s monitoring electrodes and switched the oxygen tubing from the portable tank to the wall source. Keeley took the IV bag from the firefighter and hooked it carefully onto a pole. Claire turned her attention back to the woman on the gurney, feeling irresistibly drawn and horrified at the same time. Her mouth went dry and leg muscles tensed as her heart rate accelerated—adrenaline, effective as an injection straight into her bloodstream.

  Claire focused, seeing nothing but the trauma victim who remained completely still, without response to Erin’s touch as she adjusted the oxygen mask. Claire leaned forward slightly, staring at the patient’s chest to be sure it was still moving. It was, thank goodness. If her chest hadn’t been moving, this poor, waxy-pale woman would look like she was already dead.

  Claire grabbed the doorframe against a sudden and crippling wave of dizziness. No, don’t. Don’t. I don’t know this patient. It’s not Kevin. It’s a stranger.

  “Logan!” Erin cried out. “This is Sarah!”

  Chapter Fifteen

  “Sarah?”

  Someone called her name, but Sarah didn’t dare lose her concentration. The bicycle was wobbling and the pedals so hard to reach. She needed to sit up tall, hold on tighter, steer with everything she had or she’d crash again. And the pain was too awful to let that happen. If only she wasn’t alone. Are you there, Daddy? Are you holding on to me?

  “Open your eyes, Sarah.” That voice again, deep, strong. And a touch, warm and gentle against her face.

  Daddy?

  “That’s my girl. I need to check your eyes now—hang in here with me.”

  Sarah squinted into the pinpoint light, struggling to focus. So bright. Too bright. It hurt her head and made her eyes water. She blinked and tried to see beyond. Blurry faces, people gathering around. More lights, glowing like . . .

  A sob rose in Sarah’s chest, setting off a spasm of pain, but she smiled anyway. The joy was far stronger than the pain. She shut her eyes, warm tears sliding down her face. Lights. Of course. The glow from a hundred brilliant candles. Emily’s birthday party.

  You didn’t forget us, Daddy.

  +++

  Erin watched as Logan left the code room. It had been forty minutes since Sarah arrived. It seemed like forty years. And it was killing her not to be at that bedside, but she’d had to delegate Sarah’s nursing care to Keeley Roberts. They were still on disaster status, and Erin was in charge. She was required to be free to oversee the department. As for Claire, Erin wasn’t sure what was going on with her. Except that she’d turned white as a ghost when the Code 3 ambulance arrived and then kept her distance from the resuscitation room like it was full of rattlesnakes.

  Erin looked up as Logan approached the desk. “Well? How’s Sarah doing?” she asked. Logan’s immediate frown nearly stopped her heart. “What? Has something changed?”

  “No, Sarah’s fairly stable. I don’t like her heart rate yet, and those rib fractures could be a problem, but the brain CT report is back—it’s normal.” Logan shook his head. “The concussion made her so blasted squirrelly. She asked me if her little girl was okay. I was thinking, her little girl? She doesn’t have a child. It really threw me until I realized she was probably asking about the five-year-old from the school van. The kid we treated for the wrist fracture. Sarah must’ve heard the medics talking about her.” He was quiet for a moment, a muscle bunching along his jaw. “She nearly killed herself to avoid hitting that van. You know how Sarah is about kids.”

  “I do,” Erin said, remembering Sarah coming in during that night shift to help with the babies. The same day she fell asleep at work and Erin sent her home—after she’d had a bout of near fainting and that strange late arrival for work. Erin’s stomach twisted against another wave of guilt. Something had been going on with Sarah, and she hadn’t paid attention. Could I have prevented this? Could her judgment be trusted at all these days? Look at the fiasco with Brad; didn’t that prove it? Erin pushed the thought aside. If she started down that path, she’d be worthless, and today everyone had to be right on target. She sighed, thinking out loud. “I should go relieve Keeley.”

  Logan’s frown returned. “Do better. Replace her. She’s slow. And indecisive too. . . .”

  Erin narrowed her eyes. “Give me one concrete complaint.”

  “I don’t trust her.”

  “It’s Keeley’s second day. She’s completely qualified. And she’s doing great considering we’ve thrown her in on a critical trauma when she was supposed to spend several days in orientation, following Sarah around.” The irony of the situation hit her like a punch in the gut.

  Logan flattened his palm on the desk. “My point exactly. It’s Sarah in that bed. One of the few nurses I’d trust completely with a critical patient is that critical patient. If things go south, I want a nurse assigned to Sarah I can count on. Make that happen.”

  “I don’t have anyone to offer right now. Look, I’ll be with Keeley as much as I can. I promise. You know how much I care about Sarah. But I’m also responsible for troubleshooting out here, answering the radio, and overseeing triage until our disaster status is cleared.” She pressed her fingers to her forehead. “Merlene thinks she might be able to pull a nurse from ICU, but until then I’m afraid you’ll have to deal with—”

  “Give me Claire,” Logan said abruptly. “Put her in with Sarah. Keeley comes out here with you. Problem solved.”

  Erin hesitated. How could she tell Logan that forcing Claire back into critical care nursing might be the worst solution of all? “I don’t know if she’ll agree to that. I could ask, but—” She halted midsentence, turning toward the nurses’ station as the medic radio began to shrill.

  “Sierra Mercy, this is Medic 5. We’re coming in Code 3 with a bystander from the accident site. Seventy-year-old male in third-degree heart block. Hypotensive, diaphoretic, and complaining of chest pain.”

  Erin’s mouth sagged open. “Unbelievable.” She turned to Logan, a game plan already whirling in her brain. “Okay, it’s like this: we set up cart two with the backup crash cart; I’ll page respiratory therapy.”

  Logan nodded, the look on his face defying argument. “Assign Claire to Sarah. Right now.”

  +++

  “Sarah? It’s Claire. You’re going to be all right. I’m here.” Claire studied the overhead monitors, her heart leaping to her throat. Sarah’s pulse rate was fast—114. Why was it climbing? How many liters of oxygen were running? Claire’s gaze flicked to the oxygen gauge on the wall beside the bed, then back to Sarah’s chest to count the rate of her breathing. Twenty-eight. Had it always been that labored? Was her skin paler than before? You know I can’t do this, Lord. It’s so far outside the plan.

  Claire fought the image of Kevin’s face, his suffering in that trauma room, and the unbearable memory of how helpless she’d been to save him. And now she was expected to . . .

  Calm down. Claire breathed through her nose, willing her own pulse to slow and her shaky hands to steady, reminding herself that Sarah’s condition had improved. That in fact she had been stabilizing. Logan would never leave her bedside if she were still in danger. Wrong. Dead wrong. Claire’s stomach sank. Logan left because he had no choice, because he had anothe
r critical patient coming in. So he chose to trust Claire. With Sarah’s life. Trust this pathetically weak link.

  Claire’s gaze darted toward where Erin, Logan, and Keeley were working on the cardiac patient some twenty yards away. Even from here, she could see the anxiety on the new nurse’s face as she struggled to follow Logan’s rapid-fire orders. It had to be a nightmare situation for a nurse who’d been out of commission for months, caring for a dying sister. Keeley was good, more than good, but she was recovering from a tragedy. Claire knew that feeling only too well. Even two years after Kevin’s death, the Sacramento physician’s overbearing criticism was branded into her memory. And today was a nightmare day for everyone. Especially Sarah. A dedicated nurse on her way to work in this very ER, waylaid by a tragedy she could never have imagined.

  Claire checked the overhead monitor again, quickly noting Sarah’s heart rhythm and oxygen saturation, and watched the drip rate of the IV solutions before glancing back down. Though Sarah’s face had been cleaned, there was still dried blood in her nostrils beneath the prongs of the translucent green oxygen cannula. Her forehead and the bridge of her nose had swollen, and below the thick gauze bandage wrapped around her head, her left brow was already eggplant purple. She looked battered and fragile and achingly childlike. Claire’s heart tugged, remembering the tough-cookie impression she’d had of this hardworking young nurse that first day they’d met at the CISM interviews. Sipping her Diet Coke and shrugging. Then dismissing the incredible pain of her day by saying, “I’m a nurse. I do what needs to be done. Then I come back the next day and I do it all again.”

  Claire moved forward as Sarah opened her eyes and attempted to speak.

  Her weak voice was interrupted by shallow breaths. “Please . . . tell . . . him . . .” Sarah’s eyes, startlingly blue against her too-pale skin, drifted upward, then focused again. Her lashes fluttered and she licked her lips, tongue touching the tidy sutures Logan placed at the corner of her mouth. “I’m so . . . sorry.”

  Claire leaned close. “Who? Tell who?”

  “Logan.” Tears welled in Sarah’s eyes. “Tell him . . . I . . . tried . . .”

  Claire’s brows drew together with confusion. “What?”

  Sarah moaned. “Couldn’t . . . sleep. Bad nights.” She gulped a breath and her eyes opened wide. “I tried . . . to get here. Can’t be . . . late. Tried . . . so hard. The pills . . . shouldn’t have . . .” Her tears spilled over as a ragged sob left her lips. “I’m . . . sorry. Tell him that . . . please. I let Logan down.”

  Let Logan down? Claire blinked with disbelief. She gently stroked Sarah’s pale cheek. “Don’t worry. Oh, sweetie, don’t worry about anything like that. All that matters now is that you get well.”

  Claire drew back, acutely aware that Sarah’s breathing had become labored. Far more labored. Like a fish flopping on a riverbank. Gulping, struggling. And not only because of the emotion and tears. Claire checked the pulse oximeter on Sarah’s fingertip; then her gaze darted to the digital display on the monitor overhead—92 percent. Her blood oxygen saturation had dropped significantly, and her heart rate was rising to . . . 124. Oh no. Claire punched the button to start the blood pressure reading and lifted her stethoscope from around her neck. She squeezed Sarah’s shoulder. “Sarah, talk to me. What’s going on?”

  “Pain . . . too . . . much . . . pain. My . . . chest.” She stared at the ceiling, her pupils dilating, pale skin dotting with perspiration.

  Claire swept Sarah’s gown aside and pressed the stethoscope against her chest, noting with sickening dread the deepening bruises over her rib cage and how one side of her chest seemed out of symmetry somehow. Something was desperately wrong. Claire listened first to the right side of Sarah’s chest: rapid air exchange, normal; and to the left side . . . nothing, no air moving. Claire shifted the stethoscope and listened again, pressing the circular plastic disc flat against Sarah’s clammy skin. Her heart wedged into her throat. No breath sounds. Lung collapse?

  Claire dropped the gown, her eyes riveted to her patient’s face. Sarah’s eyes were closed, nostrils flaring, respiratory rate rising, neck veins becoming more and more prominent, lips chalky gray. All symptoms, Claire suspected with mounting anxiety, of pressure from trapped air in the chest cavity around the collapsed lung. Pressure capable of pushing major vessels, even the heart, toward the opposite side of the chest and causing circulatory collapse. Tension pneumothorax?

  Claire quickly replaced the oxygen cannula with a high-flow mask, fitting it over Sarah’s face, cranking the oxygen to full flow, and watching the reservoir bag inflate and distend in response. “I’m making it easier for you to breathe. Sarah?”

  Sarah opened her eyes, but they drifted upward, showing too much white as she fought to speak. “It’s . . . Emily’s . . . birthday,” she whispered. “I’m . . . sorry, Logan. Daddy, please . . . help me.”

  Claire’s breath stuck in her throat. Please, God, don’t let Sarah die. She swallowed hard, her heart thudding inside her ears. I can do this, Lord. I can do it . . . if you help me. She jabbed her finger against the bedside alarm, then shouted through the doorway, “I need help in here. Hurry!”

  She lifted the head of the bed to aid Sarah’s breathing, all the while continuing to pray. Help me, Father. Help me to help her. Claire’s heart pounded and she held her breath, and a comfort—almost like floating on still water—washed over her, steadying her hands and replacing the crippling anxiety with . . . peace. Unparalleled and amazing peace. Along with a feeling of being guided, almost like a parent’s hand helps a child to write. Suddenly Claire knew that everything—every single thing—was going to turn out all right. No matter how ugly the numbers were on the monitors and how terrifying the sound of Sarah’s lungs, Claire could do what needed to be done. All the help she needed to make this incredible miracle happen was right here with her. As close as her own heartbeat.

  Claire leaned forward and looked into Sarah’s eyes, nodding with calm assurance. “We’ve got you covered—hold on to that.”

  +++

  Logan jogged through the door and saw in an instant why Claire had called him. Sarah’s condition had deteriorated dramatically. She was barely conscious, eyes swimming and lips dusky. He met Claire’s gaze as he lifted his stethoscope from around his neck. “Vital signs?”

  “Pressure 92 over 40, heart rate 128—sinus tach—respirations 40, pulse ox—” Claire glanced at the display—“89 percent on the nonbreather mask.” Her lips pressed together for an instant. “I can’t hear any breath sounds on the left, Logan. And her neck veins—”

  “Full,” he agreed, lifting the stethoscope to his ears. “I’ll take a listen, but I think it’s tension pneumo. Let’s be ready. Get me an 18-gauge needle; I’ll need to decompress this before her heart’s compromised. And go ahead and set up for a chest tube to follow.” He looked at Sarah’s face, deathly pale behind the translucent green mask. His gut wrenched. I’ll fix it, Sarah.

  Logan listened carefully to both lungs as Claire gathered the necessary equipment. Sarah moaned as he turned her to listen at the back of her chest . . . grating from the rib fractures, no air moving. “Sarah,” he said after nodding at Claire, “I’m going to needle your chest to help you breathe. No time for anesthetic. I’m sorry. But hang tough for me, okay?”

  She nodded almost imperceptibly.

  In seconds he’d pulled on a pair of surgical gloves and, holding the needle in one hand, used his other fingertips to locate the intended puncture site on Sarah’s hastily prepped chest. He counted ribs and felt the spaces between, easier than most patients because she was thin. Harder than any patient before . . . because she’s Sarah. Logan pushed the emotion aside, found the site—second intercostal space at the midclavicular line—and without hesitation plunged the needle through her skin. He guided it over the second rib to avoid the vessels beneath, advanced it carefully deeper and toward the pleural space, holding his breath, until . . . there was a sudden hiss of escaping air accompa
nied by a fine spray of blood. Yes!

  Sarah groaned, Logan breathed, and on the other side of the gurney Claire whispered over her efficiently organized chest tube tray, “Thank you, Lord.”

  +++

  Erin closed her eyes, weak with gratitude. By the time she’d been able to leave Keeley and the cardiac patient, Logan had inserted a needle into Sarah’s upper chest to relieve the dangerous pressure, then followed it with a sutured-in chest tube. A portable X-ray taken afterward confirmed her lung was re-expanding. And now, twenty-five minutes after the crisis, Sarah dozed with her heart rate and oxygen level markedly improved.

  Erin looked down at Sarah, her mind still tumbling with a frightening list of what-ifs. What if the lung collapse had proceeded further? What if Sarah had stopped breathing and her heart rhythm deteriorated? What if . . . ? “Thank goodness you were in here,” she said, turning to Claire. “You caught the tension pneumo just in time. I don’t know what I’d have done if you . . .” She choked against a rush of tears.

  “You know how hard I was praying. But—” Claire’s expression grew troubled as she looked down to where Sarah dozed—“Sarah kept apologizing. She said something about having bad nights . . . not being able to sleep and that she couldn’t be late and couldn’t disappoint Logan. And something about . . . oh no.” She pressed her hand to her chest, her eyes wide. “Where are Sarah’s belongings?”

  “Over there.” Erin pointed toward a plastic bag in the corner of the room. “What’s wrong?”

  “Something else she said,” Claire explained, grabbing the bag and dumping its contents onto a chair. “I just remembered.” She poked through Sarah’s purse, then began checking the pockets of the scrub top, snipped away by the paramedics and speckled with dried blood. “Sarah mentioned something about pills and . . . oh, boy.”