Trauma Center: Under the Knife III

(Two years after the events of Under the Knife 2…)

In the heart of Angeles Bay stood the most key location in modern medicine. The pinnacle of the definition of medical science as well as the frontmost team of surgeons and doctors on hand. Caduceus, the worldwide lifeline for the research dedicated towards harmful diseases and deadly pathogens was split into three divisions; U.S.A, Japan, and Europe.

Here, a now middle aged man under the name of Derek Stiles put his daily efforts into the patients that called for his expertise as well as the leading name of his employer, Caduceus. The once younger man under the wing of Hope Hospital several years ago has now grown into an almost unrecognisable doctor with skill that surpassed even the greatest surgeons on Earth with the help of his colleagues and a few traumatic experiences along the way. From removing glass from the arm of a motorcycle accident victim to eliminating an entire virus from the world, Derek keeps his cool under the harsh light and never wavers an inch when staring death in the eyes.

Of course, such a doctor would have quite the history with death and near-death experiences. For instance, his run in with Kyriaki and Paraskevi five years ago or his kidnapping just three years ago not even months following his literal warzone. Even the greatest surgeon makes mistakes and occasionally the patient is lost, as did Emilio Juarez, once a "Sinner" from several years ago.

Two years had passed since the events of Reina Mayuzumi, the retired president of Acropolis Pharmaceuticals. Patrick Mercer, the deceased president and co-founder of Hands of Acropolis, also known as HoA, passed away after a fatal firefight in the bottommost room in his secret compound off of the Pacific Ocean. Reina survived the flawless operation by Dr. Stiles and was arrested as well as tried in court for the several dozen patients that she harmed with the use of G.U.I.L.T. in her research and product division. Even after two years, Reina has stayed locked away as she will for the next several decades. Most of the Hands of Acropolis were released due to their mental state being compromised due to the illegal injection of G.U.I.L.T. related substances behind the scenes of the, "Ability Enhancement Program."

The young prodigy himself, Adel Tulba, returned to Costigar and carried out his duty for the people he grew up around and loved. Derek had spent a little less than a year in the U.S. teaching the African surgeon how the rich side of medicine tasted and the ways of harder tasks with increased technology. That is, until Adel collapsed due to an infection contracted from their stay in Costigar. Due to Derek's current mental state and his inability to trust himself fully, he was unable to carry out the operation and the President of Caduceus U.S.A. took over. Over the course of the next few months, Derek and Adel communicated less and less until the resigning of Dr. Adel Tulba to later work for Patrick Mercer in the Hands of Asclepius.

While the city of Angeles Bay had stayed roughly the same over the course of two years, Derek Stiles himself hadn't kept the same look. Finally, his hair returned to the same length it was in past times - nearly to his glasses and always brushed to his right. While being thirty-one-years-old, Derek Stiles didn't look a day over his early twenties due to high health and well aging on his father's side of the family.

As nice as he may look, the outside world didn't look so.

Dark grey and almost black clouds took over the skies of Angeles Bay which wasn't surprising at this time of year. Tourists flooded in almost as literally as the actual streets of the busy city. Rainfall would plummet the activity in some weeks while the following days could get as high as ninety. The weather on this part of California was highly unpredictable. Of course, Angeles City Beach drew thousands of seasonal tourists and visitors through every year which meant more potential patients and crowded streets.

A bassy rumble shot through the building as a brief flash of light echoed through the thick and moisture filled air outside of Caduceus U.S.A. Rain was pelting the streets below as the surgeon could see out of his office sitting on the third floor of the building. A quick glance at the clock on his desk confirmed that the day was nearing the end. Seven o'clock on the dot which meant he had one more hour before he could feel better about walking out of his office and driving home. Feel better, that is, because there was always a reason for him to stay.

Angela Thompson, the famous assistant of Derek Stiles who would literally walk through fire to ensure his safety was always the person lashing at him the most. But, it was Angie. So, it was perfectly fine. Had it been any one else they may not get off so easy. While his attractive blonde assistant wasn't in the office as of right now, he wasn't in the clear yet. If there was something he had learned over the past half-decade of working with this woman it was that there was never an escape. If he just tackles the problem at hand then maybe she won't lecture him. It also depended on Angie's mood but, that was less important.

As much as he - more or less - wanted to get started on the paperwork he was required to complete, the sure future moments of ambulances arriving at Caduceus due to overflow of accident patients in other hospitals throughout Angeles Bay was in the back of his mind. It could either be an excuse or a time passer. Either way, he needed to do something before his assistant comes back and finds him sitting on his hands.

"Hey, Derek." A familiar voice chatted in the doorway. It was Tyler Chase, the blonde surgeon who was working in Caduceus as well. Friends from medical school, Tyler was always the study monster but also the joker of his clique. Even now nearly a decade later, the man was quick to snatch the humor of anything and amplify it like a megaphone. Some love it, some hate it, but the patients seem to completely adore him. Because of that, Tyler Chase is likely the most respected doctor in Caduceus with patients.

Derek rose his eyes off of the small clock on the corner of his desk and looked up at the doctor standing in his doorway with his right shoulder leaning against the metallic frame. His left foot was leaning to the right behind his right leg with was standing out like normal. A standard relaxed body image was present from the optimistic surgeon and Derek gave a small smile.

"Hey, Tyler. What's up?"

Tyler used a bit of force from his shoulder to push off of the door frame to stand completely upright before stepping into the office space of Derek's. The room was dimly lit with only one tall wall lamp and a small lamp on Derek's Desk staying illuminated. The blinds were open fully and water dripped down the exterior of the glass in small streams. Thick clouds were now visible to Tyler who hadn't seen the sky in several hours. A small wave of disappointment swept over the surgeon as he frowned. Such melancholic weather for such a glitterful person.

"Just waiting for the impending storm of accident patients. You know, same thing that happens every time we get rain in Angeles Bay." Tyler muttered as he plopped himself down in Angie's office seat. Her desk was neatly kept, her laptop closed and the big monitor for her T.V. off but several yellow and pink sticky notes hung off of the bottom section of the monitor and the sides. One note was a reminder for inventory while two more were numbers of various patients. The drawers were all neatly cleaned and closed with very little clutter taking up her desk despite small paper shavings and pens. Compared to Derek's desk it was very neat and tighty.

Derek let out a chuckle as he leaned backwards in his chair and stared up at the ceiling above him. This was only for a short period of time before his balled his fits and rubbed at his eyes with the hilt of his hands.

"It's funny because I was just thinking the same thing." Derek muttered as he leaned forward once again. He tapped his Caduceus pen against the wooden frame of his desk three times in a rhythm. Clearly, he was either bored or brainstorming. Tyler paid little mind and just stared at the wall of pictures beside her desk. It was a large wooden post-it board with dozens of pictures tacked into the wood nicely. A picture of Angie posing with one of the leading surgical procedure developers of America was in the top left corner and a nice picture of Derek and Angie together on a bullet train in Japan was in the dead center. Way more smaller pictures were dominating the board but they were typical tourist pictures that the two would take together while they were heading in and out of different cities and countries.

The friendship that Derek and Tyler had was deeper than most. Fortunately for the two of them, they worked their loving job while being best friends so they were given a lot of time to goof off and discuss important matters.

The clicking of a familiar set of heels pulsated from down the hallway in a rhythmic pattern. It was obvious as to who this was walking towards their location on the third floor and unlucky for Tyler, if Angie Thompson was on the floor where their office was located it meant that he wasn't going to be able to make a mad dash out of the room because she would still see him. A silly fear he had because Angie would never do anything to physically harm him even if he acted like a complete idiot all day long. Still, he made sure that he wasn't going to be sitting in her chair. A small remedy but he had to do something. Soon after, Angie walked into the office with three binders in her arms all held tightly to her chest accompanied with a smile on her face. That is, until she saw the blonde doctor's hair sitting just behind the monitor of her computer. With a grimace and a quick eye roll, the elite nurse of Caduceus tossed her three binders onto the laptop in front of him which jolted him back. Derek just simply watched while this event unfolded, leaned back in his black leather chair with a wide grin plastered to his face.

"Ah! I'm s-sorry, Angie!" Tyler blurted as he stood up and backed away from her desk while also pushing the chair back with his upper thighs. The chair moved back until it hit the wall behind him which meant he was out of moving space. Angie just stood in the gap between hers and Derek's desk with an almost condescending look. She wasn't even the slightest bit mad at him but she apparently just needed to act like it in order to set him off. Amusement struck her soul as Tyler raised two hands up defensively and squeezed past her into the free space of the office that belonged to the original doctor and nurse. Derek finally couldn't contain it any longer and gave up a laugh as well seeing how afraid Tyler became. Now, the blonde doctor threw up a cursed middle finger and paced out of the room to find something to do.

Angie held up her right fist in front of her in a triumphant exclamation, celebrating the fact that she was now practically a people-mancer. She could just look at Tyler Chase and he would nearly fear pee all over the carpet. Thankfully, he didn't though.

"Sure doesn't take a whole lot for you to scare him does it, Angie?" Derek said with a smile as he stood from his place in the office.

"I guess not! Five years around me and Dr. Chase still doesn't actually believe that I wouldn't hurt him. I guess it's just because I work so closely with Leslie." Angie joked lightly as she tightied up her binders that she had thrown down to frighten Tyler before sitting down and grasping the slight overhang her laptop provided to open it via the monitor side up. A few keywords being pressed later and she was well into her computer and handling business matters - Derek didn't look or dare snoop out of respect for her work ethic. "Speaking of working, did you handle the task I specifically requested before I went to handle our rounds?"

Derek felt some sort of spotlight on him as he stopped dead in his tracks. Clearly his idea of fleeing the room before the discussion went towards his mound of paperwork begging for his attention didn't work out so well as he felt the molten hot glare of Angie sink deeper into his skin. With a small turn and a nervous chuckle, he racked his brain for some sort of excuse. "O-Oh! About that- You see, I got so busy with- uh, emails!" Derek was cut off by Angie sighing and practically facepalming in pure annoyance.

"Five years of us working together and you STILL can't handle your own responsibilities!?" Angie cracked at him with a spring to her feet. Her right hand rested on her hip as she rose an eyebrow expecting some sort of apology. It was just the way he was, forgetful, lazy, or a wreck. While she had whipped him into good shape over the half decade, he would still have his moments and it was one of his causes of downfall. "When are you going to learn that I won't always be your crutch when you forget things!?"

Derek placed a hand behind his neck and offered a pitiful smile to maybe help alleviate some of the heat he was getting from his nurse. Angie of course wasn't going to have it and instead of doing what she normally does; give him the benefit of the doubt and carry out whatever assignment he was responsible for, the blonde nurse simply stood up, walked over to the desk that belonged to Derek, pulled out his top right drawer and with it a large stack of stapled paper of several types and threw it onto the open space on his desk.

"Here! I'm not going to walk you through this again. You're a renowned doctor, if you can handle your patients inside the O.R., you should at least make an attempt at following up on their patient files!" Angie exclaimed before walking back to her desk. That is, before frantic footsteps came rushing up to their doorway. Derek was the first to notice as he turned to face the human entering their space. It was one of the trauma nurses downstairs with a fearful and dreadful look on his face.

"Dr. Stiles! Nurse Thompson! We need your assistance in the O.R.!" The young man blurted out as he fought to catch his breath. Deep intakes and outtakes created a sense of urgency with Derek and Angie who were both now paused in their positions and facing the doorway.

"What!? What happened?" Derek exclaimed as he head gestured for Angie to follow him which she did quickly, their movements nearly in sync as they rushed after the nurse who lead them down to the O.R.

"A car lost control on the highway and plowed into a city bus! Hope Hospital is overflowing with accident patients so we're being tapped to support!" The nurse exclaimed as they reached the bottom of the stairs. Frantic movements of adults and colleagues rushing about trying to usher patients on beds to O.R's and ambulance first responders weaving in and out of the crowd of people to get help on retrieving new beds for patients. It was a warzone. Some women were crying while some men and children were walking in a daze from the accidents.

"There's no time to lose! I'll get us a clear O.R., Angie! Go find us as many patients as you can prep for surgery!" Derek ordered as he took off down a familiar hallway towards to operating rooms. It was like old times, Angie along with her doctor, Derek Stiles were in charge of pulling these patients back from the brink of death. It all depended on how the operations went, but Derek wasn't worried.

Derek flushed Angie and the two beds with two patients on them into the operating room quickly. The hallways were a dangerous place so he didn't get a good glimpse at the external damage of any of the patients which meant he was only going off of what Angie was hopefully about to inform him.

/

"Are we ready to operate?" Derek asked with a last second room preparation, kicking on the overhead light to get a greater view of the patient… as well as the massive chunk of glass, most likely windshield glass, skewered into the chest of this man.

"Logan O'Brien is a thirty three year old male in critical condition. He wasn't wearing a seatbelt and when his vehicle hit a patch of extremely slick water, he spun out of control and crashed into a city bus." Angie admitted as she pointing towards certain locations of the shards. "The chest took most of the impact… as you can see. A massive chunk of glass is extending out between the stomach and lower left and right lungs. First responders sterilized the wound but immediate surgery will be required to remove the glass."

Derek nodded, keeping his cool although inside he was questioning how this man was still alive.

"Understood. I take it this man is top priority?" Derek asked as he received a nod from Angie.

"Patient number two has a broken arm and lacerations on the back. But, that won't be too hard for you, Dr. Stiles." Angie finished with a small smile. The mood crushed any sense of friendly pokes of humor as Derek looked back to the glass. It looked like a shattered window - thousands of fractures and cracks decorated the glass like a broken window which meant this whole operation was riskier than it looked.

"I see. Then, we'll perform the operation on this patient first. Prepare the forceps as well as the sutures. We'll remove the glass in smaller pieces… I fear just pulling it all out at once could damage blood vessels and cause internal bleeding." Derek brainstormed out loud, Angie picking up and taking in the knowledge directly after.

"The glass also looks weak… if we're careless, the glass could crumble and spill thousands of tiny glass shards into the body. This will require complete concentration, Dr. Stiles."

"Right! Then, let's begin the operation!"

/

Upon better detail the skin of patient one was already cursed with dozens of smaller shards of glass. Thankfully, they were easy to remove and only required forceps and sutures.

"It looks like there were more injuries than we expected." Angie muttered as she reached for the forceps and sutures as well as a drain machine just in case. "Use the forceps to remove the smaller shards of glass surrounding the main chunk. But be careful to pull them in the direction of your forearm slowly. Any hand jerk could damage tissue and create internal bleeding!"

With her advice reminding Derek that he needed to proceed with immense caution, he gripped the forceps and began dragging small fractions of glass out of the top layer of skin. Angie supplied a metallic grey tray which the glass would be stored in. A metallic tang sound would radiate out from the tray with every glass shard dropped inside. Small incisions lined the skin outside of the massive chunk of glass which required smaller solutions than sutures.

"I'm going to need the antibiotic gel for these smaller lacerations. Using the sutures would take too much time and we're already risking enough." Derek said to nobody in particular unless it was the request for gel. When a panel filled with antibiotic gel was provided at the left of his position, he dipped two fingers into the gel and retracted them before layering them into the small wounds. Now they were disinfected and clear to recover quickly. All that remains was the large chunk of glass which was begging for his expertise.

If he pulls at the glass even the slightest bit too hard then the glass will shatter and likely skewer the insides of the patient. So, he would do it in fractions. The idea was to break off bits and pieces of the glass in order to shrink the risk of glass entering the body in smaller quantities.

"Dr. Stiles, the glass is completely shattered! If we plan on removing it, we'll need to use the forceps to break off smaller portions for extraction." Angie said matter of factly, supplying Derek once again with a metallic forceps. This time, they were larger and more firm. Obviously, smaller forceps weren't going to do the trick.

"Understood. Beginning glass removal." Derek said calmly as he placed his left hand on the base of the glass piece. His right hand was holding the forceps which he used to get a grip around the top third portion. He wiggled his right hand back and forth slowly to encourage a break. However, he really needed to be careful with his left hand or else the glass would rip apart his glove and terminate the sterilized environment. After the fifth session of titling his hand over and over, the glass finally broke away and three tiny shards pierced the skin around the initial wound.

"One third of the glass has been removed!" Angie exclaimed before noticing the tiny shards sticking out of the skin below. "On the contrary, small shards of glass have pierced the top layer of skin. Once these glass shards are dealt with we can continue extraction on the large chunk!"

Derek nodded in confirmation, not wanting to break his concentration. The glass made it to the tray provided by his assistant and his forceps gently retrieved the outcast glass shards. Quickly following this, Derek rubbed some antibiotic gel to disinfect the wounds before continuing his session with the dangerous piece.

Once he was finished with the smaller shards he was finally able to pay mind to his progress on the shard piercing the abdomen of his patient. He wasn't in the clear yet but with progress like this, there wasn't much holding him back.

"Let's continue! I'll need the forceps once more." Derek stated out loud, getting the tools asked for provided to him shortly after. Again, he held his left hand around the base of the exposed sheet of glass while his right carried out a rocking motion to try to split the glass in half. In ten seconds the glass had separated and a small fraction remained in the abdomen while Derek held onto the final part sticking out of the body. Placing it back in the tray where it belonged, he also took notice as well as care of the smaller lacerations formed by the removal.

"The vitals are dropping, Doctor! Inject stabilizer before they drop too low." Angie exclaimed with a slightly louder voice than normal. When in surgery it was her seriousness that got his attention and thus was nothing short of another situation where her attention taking skills were on full display. With that, he requested stabilizer as well as an empty and clean syringe. Two syringe filling later and the vitals were raised back to a solid eighty.

Now, he just needed to pull away at the remaining chunk still visible from outside of the body. This was a good thing because it meant he wouldn't need to perform an in-depth surgery just to remove this. Good for the patient, good for Derek.

Taking the same forceps, he lowered the forceps into the wound and gripped onto the final shard of glass.

It was stuck.

"Is the glass stuck!?" Angie shrieked. "We can't risk pulling too hard incase we break the glass… or worse! We'll need to perform an open abdomen surgery-"

Derek cut off his assistant with his firm yet soothing voice. Being the one who cracks the least under pressure, his taking of order here was the best bet. "There's no time. Give me the antibiotic gel, we can try to lubricate the glass to do less damage to the flesh while also disinfecting the wound!"

Angie took a moment - surprised that she hadn't come up with such an idea before hand. Still, the patient had a greater chance with this so, she supplied the vile of antibiotic gel. Derek placed a large amount in the wound and gave it a few seconds to let the gel smooth out the glass from inside and out.

After the time was up, he pulled at the glass and found it almost easy to contract in the end. No smaller glass pieces split off as well which made his job quicker and easier.

"Excellent! That looks like all of the glass. Now, we just need to suture that large laceration on the abdomen. Obviously, our sutures are too thin to be able to pull such a wound together. However, the forceps may be able to act as a staple for the time being!"

Angie spoke excellent words of advice so Derek followed her orders to the T. His forceps gripped one side of the wound and pulled it slowly across to the second one. It looked easier than it really was, in fact it required delicacy and slow movement so that he didn't tear the skin further. Once pinned together, he used the sutures to fasten the wounds together and tightened them.

Now, the operation was over and it was onto the next patient.

"Nicely done, Dr. Stiles! I'll prepare the next patient for operation."

/

After the hellish scenario wrapped up and the last of the ambulances arrived and the surgeons finished their surgeries, Derek and Angie were ready to call it a day. They were off at eight o'clock but… it was nearly ten. The surgeries they performed were draining to say the least. A total of six accident patients required their attention and had they not been there that night who knows if they would have survived.

Regardless, the two were ready to leave for the day.

"So, you ready to go?" Derek said as he threw on his jacket. It was still raining outside but he parked close to the entry. Angie was standing by her desk, signing out of her laptop and computer as well as turning off the lamp on Derek's desk that he managed to forget somehow.

"Yes! Sorry, I had to turn off the lamp that someone forgot." Angie said with a half serious half sarcastic tone. Derek picked up on it right away and chuckled as he shut off the light to their office and locked the door with his keys after closing up. On their way out, they waved to several of their employees and even stopped by to tell Tyler and Leslie that they were on their way. Of course, the two were too busy to talk for long.

On the way out of the building a streetlight nearby illuminated and shimmered light off of a ring…

A ring on Angie's hand.

"We did great together today, Angie." Derek said with a smile. "Come on, I'll drive us home!"

With a giggle, Angie grabbed onto the forearm of Derek's and allowed him to walk her to his car where they ventured out and away from Caduceus. It was the end of another hectic day only to start the next.

But, it was better this way.

For those of you who felt like UTK2 wasn't original enough, I'll make it all better! I hope you enjoyed this pilot chapter of UTK3!