A/N This is a one-shot of Dr. Carlisle Cullen at work in the ER for a shift. At the request of Rhia and Sofia. This is my first real attempt at writing, as I am really a fan more than anything. And I know that it has a lot of medical terms, but that was kinda the point…
A Day in the Life of a Vampire ER doctor…by Wendy D ~Stalker Fan~
As usual, it was a rainy day in Forks, Washington. It wasn't really cold, just rainy and gloomy, the way our family liked it best. I pulled into the doctor's parking and headed into the ER for my 7A-7P, 12-hour shift. It would probably be a pretty slow day since Forks is such a small town, and this was good since I had a lot of dictation to catch up on after all of the time I took off getting Edward and Bella married and off on their honeymoon.
I walked through the glass sliding doors of the ER ambulance bay just thinking about my son and his beautiful Bella as they finally said their vows with all of their family and friends there, well almost all her friends. Her best friend, Jacob, almost did not make it and when he did, he almost made a total fool out of himself. Poor kid, he just was having such a hard time with his best friend marrying a vampire and an even harder time knowing that she would soon become a vampire as well. It wasn't just the fact that she chose Edward over him, but that she also chose to become like us. My thoughts were quickly interrupted by Nerissa, the charge nurse, calling my name. Nerissa has been the charge nurse in this ER for a couple of years now. She is young for a charge nurse, but she is a very hard worker and everybody here really likes her. She has shoulder length brown hair, dark chocolate eyes and a smile that lights up the room.
"Dr. Cullen, thank goodness you are here!", Nerissa cried. "We have a CPR in progress in trauma room 1 and a MVC (motor vehicle crash) about 7 minutes out!" "There was an accident on the 101 involving a motorcycle and a single driver, the driver of the car never saw him and was not injured." "The medic on MedTrans 2 said that they had an unconscious 17 year old appearing male, breathing on his own slow and shallow being assisted with BVM (bag valve mask) and Oxygen, but with obvious open right humeral fracture (right upper arm), double femoral fractures (upper legs, typical of a motorcycle accident where they go over the handlebars after hitting a car or stationary object), and signs of a head injury. He was not wearing a helmet."
Immediately, I went into doctor mode and started shouting out commands to get ready for the trauma that was on the way. I had not noticed Wendy right away. She is one of the new medic's we recently hired, along with her son, Chris. She was picking up my bag and putting it in the doctor's lounge out of the way. She was always thoughtful like that. I was happy to hear they had gotten hired. Everybody really took to her and her son. Their story was just too heartwarming to not get caught up in it. The both just graduated from paramedic school, him right out of high school and her finishing her dream 20 years later. They worked really well together and complimented each other, which made things go really efficient when they were here.
I walked into trauma room 1 and Sofia, a RN here in the ER, was keeping track of the medications and treatments being done on the patient they were doing CPR (cardiopulmonary resuscitation) on. "Somebody want to fill me in on where we are with this patient?" I asked. Dr. Bryant was the doctor that I was replacing this shift, but he was a little busy right now to finish his shift and be relieved. He was a young doctor, but very smart. He had short, curly brown hair and bright blue eyes, that seemed to get darker as he concentrated in a trauma..very interesting. He was of average height for a guy, about 5'9". The nurses and staff really liked Dr. Bryant. He always had a smile for everybody.
"Hello, Dr. Cullen", Dr. Bryant replied. "We have a 72-year- old nursing home patient who came in with a fever, altered mental status and very dehydrated brought in by MedTrans 1, the local ambulance service, about an hour ago. We were waiting on labs to get back after Wendy started an IV, got blood for her labs, and started her on IV fluids. We started noticing on the heart monitor she was throwing some PVC's (premature ventricular contraction) and her pressure was going down, despite the fluid boluses. We were just about to do a 12-Lead and she went into cardiac arrest. We have given her 3 epi (3 doses of 1mg of epinephrine), 3 atropine (3 doses of 1mg atropine) and 150 mg of Amiodarone, but she has not came back into a regular rhythm. The last time we shocked her, while she was in VFib, she went into PEA. She has been in PEA now for 5 minutes, and has been shocked twice. I was just about to call it, but before I do, do you have other suggestions?"
I looked over at the chart at vampire speed, noting that she had been given all the protocol cardiac drugs for cardiac arrest, and a thought popped into my head. "Have you given her any sodium bicarb (sodium bicarbonate), with her being septic and the down time during CPR, she could be acidotic.", I stated. Sofia was the first to answer, "No, Dr. Cullen, just epi and atropine." "Ok, then let's give an AMP of sodium bicarb, another 300 mg of Amiodarone and see if we can get this heart going again", I stated.
Rhia reached over and loaded the syringe and handed it to Chris, who was monitoring her fluids, pressure and pulse. Chris injected the sodium bicarb and then the Amiodarone as they continued CPR for another 2 minutes to circulate the drugs. Nerissa peeked her head in to make sure they did not need anything, while keeping an eye out for the trauma on the way in from the MVC.
"Ok, let's shock her one more time," I suggested. Sofia kept recording all the drugs and treatment, while watching for any change on the monitor. Angylle, another medic/RN in the room, yelled "Clear!" and gave the patient another shock. Next thing we heard was that wonderful "beep, beep, beep" of the heart monitor. "Chris, do we have a pulse?", Dr. Bryant asked. "Yes, it is, slow, weak and thready, but it is here," he said.
"Great job everybody, let's keep her closely monitored; vitals every 5 minutes and let me know if there are any changes. Also, let's repeat her labs and let me know when both sets are back," I requested as I walked out to the nurses station to check on the trauma that was coming in.
I got pulled out of my thoughts again as Nerissa said that the ambulance was 5 minutes out now and the male motorcycle driver was having a seizure. Things were fixing to get crazy real fast.
"Chris, you need to get the RSI kit out and make sure that we have everything ready to get a line started as soon as they arrive, " I said.
"Yes, Dr. Cullen," Chris said with a smile. "Where is your mom, we need her here too," I asked.
"Rhia sent her to get repeat labs drawn in Room 7, she should be here in a minute", he said. Rhia is another RN in the ER. She has been here for several years and was really good at keeping the flow going.
I stood there, calmly, waiting on the motorcycle victim to arrive and listening to every patient , nurse, doctor, tech and family member sizing things until they arrived. It still amazes me sometimes how well I am able to control my thirst around all these humans. Sometimes, I think that part of it is the fact that the "sickness" smell helps to mask the alluring smell of normally healthy blood. In my 400 years of existence, I have worked very hard at being a better man. I may have been damned to this existence, however, I don't have to let it damn me. I can be a good man and make something good out of this life and be an example to my lovely wife, Esme, and all my children. Edward, and now Bella; Rosalie and Emmett, Alice and Jasper. We are vegetarians by choice, because we respect human life. We chose to only live on the blood of animals and not be what was expected of us, but be something different, better, redeemable.
"Good morning Dr. Cullen", Wendy said as she came over to wait for the incoming trauma. She smiled as she looked at me, longer than most humans. Chris and her did all of their ER hospital rotations here in the ER while they were in school and quickly became an easy fit and even came in voluntarily after they were done if we were shorthanded. Everybody here liked them. I caught her watching me several times during their shifts, but never really thought much of it. Now, that they are working here, I wonder how much she has really noticed. She reminds me of Bella in this sense, noticing things that most humans just pass right over. I will have to keep an eye on this. I may have to get Edward to make a visit to the ER when they are here and "hear" what she is thinking when they get back from their honeymoon.
I, again, was pulled from my thoughts at the sound of the sirens and ambulance backing into the ambulance bay. The motorcycle victim was here. All activity moved into trauma room 2, with the trauma team moving into action.
At this point, everything gets crazy. The medic's on MedTrans 2 come running in, ventilating the patient with a BVM and Oxygen, a large bore (16g needle) was started in his left arm with IV fluids flowing wide open, and the 12-lead EKG monitor was clipping away as they wheeled him in. He was strapped down on a long spine board, with a C-Collar (cervical collar) to protect his head and spine, and ensure no movement in case of a spinal injury.
"Okay, on my count", said the medic that was at the patient's head. "1, 2, 3…and four people moved this huge kid over onto the ER bed. Chris was already working on getting another line in and getting some blood for labs, Wendy was checking his blood sugar level while Angylle was getting him transferred from their monitor to the ER's monitor. I noticed there was something very familiar about him, his scent. With the large amount of blood and medication in his system, it was a little masked, but it was still very familiar. I moved closer and realized I did know him. Oh, no! It was Jake!
I listened as the medic gave his report….."we have what appears to be a 17 year old male who was involved in a MVC approximately 35 minutes ago. Upon arriving on the scene, the driver of the car that hit him stated that they never saw him, he was going so fast, weaving in and out of traffic that when he clipped their bumper and went over the bike into the ditch, there was nothing they could have done. He was found unconscious lying supine on the ground, breathing 9-10 times a minute, slow and shallow. He was bleeding from his head and right upper arm. We immediately secured C-spine and onto a long backboard, securing both legs to the board. We moved him to the "box" (ambulance) and started a large bore IV and fluids in his left AC (antecubital) vein, and fluids wide open. We assisted his breathing with a BVM and 100% Oxygen. About 2 minutes after putting him in the box, after getting him on the EKG monitor, he started having a seizure. We then administered 10 mg of diazepam and this controlled the seizure. Amazingly, he did not have another seizure after that. Once he we stabilized him, we began transport and arrived in the ER approximately 17 minutes after arrival on scene. " "We would have called for a helicopter, but it was unable to fly due to the weather", the other medic stated.
My phone in my pocket started vibrating, and I wondered who it could be. I did not have time to check, they would have to wait.
Immediately, my thoughts went to how can I take care of Jake and keep his true identity hidden. Blood could not go to the lab, and I had to set his bones much quicker than a normal human, or they would heal wrong, yet, there is protocol in the hospital.
"Sofia, call down and get portable x-rays here, STAT! I also need to get him in for a CAT scan of his head, chest and abdomen STAT!