A/N: So I had fun writing this one. I would like to say, before you proceed, that I am not a doctor and I have not been to medical school, so some things might be erroneous, and those errors are on me. Some medical details have also been, stretched, exaggerated, or removed to expedite the story. Thanks for reading.
"8 minutes by ground, Nina, what do we got?" Doctor Jane Rizzoli shouted as she waved her pager in the direction of her trauma nurse. She powerwalked from the radio desk toward the resuscitation room of Boston Medical Center, and as soon as Nina Holiday hung up the phone, she watched the nurse pull up right beside her and keep pace.
"You're early, Doc. Were you nearby?" Nina commented, her flowery scrub top and purple scrub bottoms a juxtaposition to Jane's plain blues. The sallow light of the Trauma Bay and the buffered linoleum whizzed by them in a blur. The swish of Jane's white coat punctuated the few milliseconds of quiet between them each time they passed a room.
"Yeah. Doin' some post-op talkin' with the family of yesterday's TBI," Jane said. She looked forward as they ducked into the resus room.
"Well, EMTs said 45 year-old male in an MVA, falling blood pressure, erratic pulse," Nina listed the information the EMT read off to her on the call. They nodded to the two residents that had just arrived from down the hall. "He's conscious, but fluids were administered because they were delayed on route to the scene. Apparently he's also got trouble breathing."
"Alright," Jane assented, and walked to the sink to scrub her hands thoroughly, right, then left. "We got anybody in the operating theater right now?"
"Nah," Nina answered: their shifts had just begun.
"Good. I gotta feeling I'm going to be in there in… what was the ETA?"
"Four minutes now."
"In four minutes and some change, then," Jane smirked through the statement. Nina rolled her brown eyes. She and the trauma surgeon next to her stepped into protective x-ray gear and disposable aprons, and slowly they began to resemble one another more. Before slapping on gloves and surgical booties, they were wildly opposite: Nina with her dark skin and full lips and Jane with her olive tones and sharp zygomatic arches. Their hair curled, but Jane's flooded down her back in looping waves, and Nina's framed her head in tight ringlets, moving outward instead of downwards. Nina's body curved with softness; Jane's climbed and jutted with her muscled limbs and long bones. One was short, one was tall, but they both turned just as sharply when they heard the whine of the ambulance approach the bay behind them. "I'll have all the info on the board when you get back and I'll make sure to get on those residents for that bloodwork prep."
The doctor pointed to her as she retreated. "You're my lifeline, woman," she said, and Nina laughed. Two EMTs and security personnel appeared once Jane pushed the door open, and the trauma team assembled to hear the report.
Luckily, Nina had covered all the major bases, and Jane looked to her in thanks as they waited for the EMT to finish his explanation of prehospital procedures performed. "Ok, lets get this guy moved," she ordered, with a booming Boston-Italian voice. Nurses, residents, and another physician assisted Dr. Rizzoli and Nurse Holiday as they heaved the immobile man from the gurney to the x-ray table. After the gurney was freed, the paramedic and his team exited the resus room, and that left Jane to get to work.
Nina loved this part, naturally.
With the fluidity of both practice and natural physical prowess, Jane burst into routine. Flourescent lights never made anybody look good, but she somehow caught them in the right way when she slung the stethoscope low in her ears and pressed it to the patient's chest. Others bustled about; there was the shear sound of ripping clothes, the beep of a heart rate monitor, and one of the residents fumbled with the collection needle, juggling it while palpating for the patient's femoral artery. The trauma tech ran back and forth, grabbing samples, cross-checking names on vials of blood against the handwriting on the dry-erase board at the head of the bed. Nina even moved swiftly, inserting an IV for fluids, but she made time to watch Jane.
In the resus room, Jane hunted. On her face was an insatiable need for knowledge, for clues. Her eyebrows slid into the notch at what she heard - skeptical, she listened again: not in panic, not in haste, but fluid, and strong. Her fingers hovered over the chest as her patient groaned, fluttering as though she were playing a few quiet notes on the piano. Exploratory.
Nina smiled to herself, though, when she caught a glimpse of the tender touch to Mr. Rourke's, the patient's, shoulder. It was a touch not for exploration or for inquiry, but for comfort. That was the thing about Jane: she never advertised it, never flaunted it, but her care infused itself with her pursuit so as to leave no discernable difference.
"Alright, Mr. Rourke, I'm gonna need you to answer a few questions for me, can you do that?" the surgeon asked, and when he nodded through a grimace, she smiled at him. "Good. I take it you're in pain?" He nodded again, his fair hair sticking to his forehead by way of sweat. "Where at?"
"My chest," he grimaced, his vocal cords straining against the burst of air his lungs were loath to let go.
"Ok, any tenderness when I touch here?" She inquired as she pressed against his ribcage, and when he nodded, she moved all across his trunk. When he continued to nod, she curled her lip in sober recognition.
"'M I gonna be ok?" asked Mr. Rourke. His arms lay limply at his sides, and a tear escaped one eye.
"I'm gonna try my damndest to make it that way, alright?" when she said that, he closed his eyes in assent. "Those x-rays ready, Lopez?"
"Putting 'em up now, Doc," said the young man she called on, dressed in radiation protection and Boston Red Sox scrubs.
"Good, I'm comin' over," she barked. When she marched toward the x-ray station, her apron flowed at her knees, and all could hear the measured tap of her shoes despite the whir of activity all around.
These moments robbed Nina of her comfort in her heterosexuality and made her curse it in the same breath. If Dr. Jane Rizzoli were to name a time and a place, she would be there – how could you deny the authority of that rough voice and severe gaze? It was a gaze never pointed at her people here in the trauma bay, only at the pieces of the puzzle she had yet to find a place for. In this environment, one not only had to be competent, they had to have a love affair with competence, with excellence, even. Jane was so smitten, and Nina admitted to herself that she might be little bit smitten, too – passion was the cocktail of the ER that all of them drank to some degree.
"Hey, Dr. Chahal," Jane waved a short and stout Indian woman over, pointing to the x-rays of Mr. Rourke's chest and abdomen. "Can you tell me what that is?" She pointed to a large white spot near his lung and heart.
"It looks like something ripped in there. Is that his diaphragm?" Dr. Chahal finished her statement with a question, never having seen something like it in her short few months in her trauma rotation at BMC.
"I'm thinkin' you're right. That's gotta be why he's got so much chest pain. Let's get him to CT and see if we can't figure out exactly what's pushin' on his heart," Jane looked toward Nina as she said it, and the most senior nurse nodded before sending the tech to page radiology. Dr. Chahal moved to help the others prep Mr. Rourke for another gurney, and Dr. Rizzoli approached Nurse Holiday with a question. "You the anesthetic assistant today?"
"Yes ma'am. Heather's out today," the woman replied, clearing the patient's IV for movement.
"Thank god," Jane sighed theatrically, and Nina just shook her head.
"You thinkin' you're gonna have to open him up?"
"It's lookin' that way. We'll take up to CT, but my guess is I'm gonna have to repair a hole in his diaphragm.
Nina winced. "It must be like swallowing knives every time he takes a breath," she commented.
"Yeah, or like a semi rollin' over his heart," Jane offered as she strode away to open the door for her team. Three others wheeled Mr. Rourke out of the resus room and into the radiology department.
"Yup, that diaphragm's got a nice big tear in it," Jane said, slightly hunched toward the computer monitor that displayed her patient's results. Her hair, now pulled into a ponytail, hung in a few wisps about her cheeks. She ran a hand over the top of her head in thought. "We gotta be lookin' at his colon right there, and possibly his stomach," she pointed at the spot, "nice job, Dr. Chahal."
The new doctor nodded and blushed at the commendation. She, Jane, and another resident stood around the technician for a few silent moments. "So… what's the plan, Dr. Rizzoli?" she asked.
"We're gonna go with laparoscopy," Jane said. She stood tall again, hands crossed in front of her hips. She was thinking. "He'll go to the OR from here. I'll let you know if I find any other tears."
She left the viewing suite and entered the radiology area, and put a hand on Mr. Rourke's shoulder again. "I think I found out why you're in so much pain, Mr. Rourke," she said through a small smile.
"Oh?" was all he managed.
She didn't blame him. "Yeah. From the looks of your CT scan, I'm thinkin' you've ruptured your diaphragm. You know what that is?"
He shook his head no. She continued. "It's a muscle that separates your chest and your gut. It was probably ruptured in the force of the crash. Now, that means that organs that originally stay housed in your abdomen have quite possibly traveled up near your lungs and heart. That could be why you're having so much pain. The diaphragm is also the most important muscle for inhaling. If it's damaged, it would explain why you can't breathe all too well. So our next step is to get you to the operating room and see if I can't get you all stitched up in there, ok?" Jane explained, a softness in her eyes reserved for the hurting.
"Ok," Mr. Rourke choked out, hoarsely.
Two orderlies stood by, and Jane walked up to them – young fresh-out-of-high-school students aspiring to be in her Nike Frees. "Wheel him up to the O.R. as soon as the tech clears him, yeah?"
They both nodded, and Jane thanked them.
"Long time no see, partner," Jane regarded Nina as she walked into the operating theater, hands up from just having sterilized them. As she suited up, the other woman monitored the patient's vitals.
"Never long enough," Nina snarked, and Jane smirked lazily. The laugh that bubbled in her throat never really made it into the atmosphere, and Nina understood.
Jane Rizzoli had entered the zone.
The spoke very little, did Jane, Nina, the residents and the anesthesiologist, except for in truly necessary times of the procedure. Dr. Rizzoli's surgical habits were more than well known at Boston Medical Center and she preferred her contact with other, non-anesthetized humans brief when she wielded her instruments. Her demeanor, rough and warm, outside the theater contradicted this entirely. Out there and on her own time, she thrived on the camaraderie of the trauma bay; she fed off of the energy it injected in her. She laughed loud, argued louder, talked more than any of the other surgeons Nina knew. But, within these particular four walls, she was a Doberman too consumed with her pursuit to be bothered by those around her.
Her hands held a carnal grace in them, an opposite to her blustering personality. She maneuvered the laparoscopes with ease in Mr. Rourke's belly; steel puncturing stark white skin rarely seen by the sun. Her eyes never left the monitor in front of her, it adjusted higher than for most other surgeons on account of her height. The flipped and reverse images on her retinae synapsed along nerves to her brain, and that brain mandated that her hands move along a smooth plane. To those who observed her, her precision seemed too perfect, too un-Jane, to be anything but instinctual.
"There was a bowel perforation. Tiny, but there – that's what was causing his blood pressure instability before he got here. We're gonna need to get him started on some antiobiotics right away. Just gotta pull this last bit of the stomach down, and then we'll suture," she said, finally, after one and a half hours at the table.
It was so much in one statement after long minutes of silence that the other team members nearly jumped at the sound of her voice. She paid it no mind other than a little grin on one side of her mouth, but it was behind her mask and gone as soon as it came. She repaired the diaphragm, had the patient removed to be taken to recovery, and discarded all her surgical garb in the proper bins.
On her way out, Nina threw a smile back at her friend. "Just a day in the life, huh Doc?"