Two fics in two days! These boys won't get out of my head. This was meant to be a short one shot, but I got carried away. Probably three parts but possibly just two.
I have to be honest and acknowledge this isn't my strongest writing, but I just couldn't resist playing with the plot. I apologise if the medical stuff isn't very accurate. I'm sure anyone with any knowledge can tell I don't have a clue, but I promise I tried!
I have had to change a few minor details to necessitate Ethan being called out as well as Cal, but I hope it still seems realistic – well, as realistic as Casualty made it anyway, still not sure where all that sand came from!
Warnings in this chapter for goriness and bad language.
& finally, I'd love it if you'd be so kind to leave a review. It means so much to me :)
1.
Cal can feel his eyes prickling but he refuses to cry. How can he, when it's so obvious that Ethan's right? Since the diagnosis Cal's told himself the same thing at least three times a day, but he can't deny it hurt to hear it from his little brother's mouth.
All he wants to do is run from the hospital, preferably to locate several double whiskey and cokes. Yet, out of nowhere, he's developed a conscience and it's frustratingly telling him not to. It would be ungrateful of him to squander his good health for the easy option.
But he's desperate for a distraction and he can't even try to block the cruel truths by throwing himself into work. He really doesn't want to be around the hospital right now. He doesn't want to chance coming face to face with Ethan. It's impossible to know what would happen, but it's likely it'll end up damaging their relationship further.
Cal seizes the opportunity when he sees Iain coming round the corner, taunting his new partner. He approaches them with a smile.
"Alright, lads? How about me riding shotgun with you today?"
Iain shakes his head. "You reckon I'm gonna let you in my ambo again?"
"C'mon, mate, I said I was sorry!" Cal lowers his voice. "Look, I wouldn't ask if I didn't have to. I could really do with getting out of here today."
Iain laughs. "What have you done this time?"
Cal forces a grin. "So that's a yes?"
"Alright," Iain says, "but I'll have to clear it. And you're buying the pints later."
"Good man!" Cal claps both of them on the shoulder and steers them closer to the exit. The sooner he gets out of Ethan's sight, the better.
He always felt strangely at home in the ambulance and today's no exception. He thinks, not for the first time, that the thrill from being a paramedic would come a close second to being an ED doctor. He listens to the brief on the radio – building collapse following a gas explosion, one known casualty – and feels the familiar surge of adrenaline as the ambulance hastens, sirens blaring.
When they reach the scene, Cal's the first out of the ambulance. He looks around him, trying to decide where to start. His enthusiasm's soon quashed by Iain.
"Leave the talking to the grown-ups, boys."
Cal knows Iain must have sensed he was bursting to get stuck in, but now he can only listen while they're greeted by one of the firemen.
"What have we got?" Iain asks.
"Jimmy O'Connor. Around 40 years of age," the fireman tells them. "He's trapped on the first floor. According to locals, he's been squatting up there ever they started redeveloping. We think he was tampering with the gas mains and caused an explosion."
"Any danger of a secondary explosion?"
"We don't think so. The gas company have isolated the mains but there is some pretty serious structural damage. The impact brought down one of the beams, our guy is trapped beneath it."
"Okay," Iain says. "Let's get the bags and we'll be in there."
"What did I just say? Structural. Damage."
"Alright, calm down," Jez interrupts.
Cal thinks he could learn to like the new kid.
"I'll give you the nod once my men have secured the building," the fireman insists. "Bloody hot heads.
Cal shakes his head as the fireman walks away. The man's an idiot, trying to postpone three medics from reaching a patient. "So what do we do?" he asks. "Just wait?"
He's incredulous when Iain shrugs his response. The adrenaline is pumping now and can easily be redirected to making his colleague see sense. "That man could be dying while we're standing around doing nothing."
"Look, we have to follow instructions."
Cal raises his eyebrows. "Didn't have you down as a wuss."
Cal expects Iain to take the bait, but instead of sneaking them through a back door, he just paces after the fireman and demands a plan to get inside.
The fireman scowls but smooths a floorplan of the building onto the top of a container. "Your man is on the first floor, around here."
"So you don't know how badly injured he is?" Jez asks.
"No. I've got officers to accompany you up, but moving the beam he's under isn't an option without compromising the entire structure."
"Okay." Iain turns to Cal and grins. "You know, no-one's gonna think badly of you if you wanna back out."
Cal scoffs. "No chance!"
"Tread carefully," the fireman warns. "Let's get you in and out safely."
It only takes two steps into the building before Cal begins to feel his heart beating against his rib cage. It's dark, even with the light from multiple torches, and so dusty that he can immediately taste it in his throat. A creak from above alerts him to how unstable the building is and he's glad he was forced to wear a helmet.
As his eyes adjust to the light, he can just about see the silhouette of a man on the floor, but it's too dingy to assess how severely injured he is. The giveaway is the forced calmness to Iain's voice as he greets the patient.
"Hello mate. My name's Iain and I'm a paramedic."
"My name's Jimmy," the man replies "and I'm screwed."
"Well, we're going to do everything we can." He crouches beside Jimmy and checks over his shoulder to ensure the others have caught up. "This is Jez and Cal, my glamourous assistants."
The rubble blocks Cal getting as close as he would like but he's already beginning to see it's not looking good. The man's arm is splayed to the side and completely trapped beneath the beam.
"Let's get some fluids in please," Iain says, thrusting his medical bag at Jez.
"Where's Sarah?" Jimmy murmurs.
"Who?"
"My girlfriend, where is she?"
Iain frowns. "Was she in here with you, mate?"
"Yeah," Jimmy grunts in pain. "Please. Find her."
Iain turns back to face him. "Can you have a scout around?"
Cal picks his way across a pile of rubble. It's uneven and he nearly loses his footing as the brick he stands on tumbles to the bottom of the pile. He shouts out in shock and hears a warning to be careful coming from his colleague. The reply remains unsaid, as he's just laid eyes upon a limp wrist sticking out from under another mound of bricks.
He drops to his knees and grips the wrist, praying for a pulse. He finds one, but it's frighteningly feeble.
"Iain, I've got her!" he shouts. He lifts a few bricks and dusts away some debris so that he can clear her face. She's incredibly pale but for the bloody lacerations across her forehead. "I need some help over here, it's not looking good."
"Nah, Cal, mate, I need you here to look at Jimmy."
Cal ignores him in favour of placing his cheek alongside his patient's mouth to see if he can feel a breath. There's barely anything. "Sarah? Sarah?" She doesn't respond.
It's with shaking hands that he pulls and oxygen mask out of his bag and places it over her mouth. He's as cautious as he can be as he loops the elastic behind her head, aware that even the slightest movement could be fatal if she has an existing neck or back injury.
"Cal?"
"I can't leave her," he growls. "Can you radio for another doctor?"
"We're gonna have to!"
Cal registers Jez speaking to control but his priorities remain on the woman in front of him. Now that he's cleared the loose rubble away, he can see that a beam has fallen across her chest, no doubt the reason why her pulse is so weak and her breathing restricted. He suspects a pulmonary contusion but he can't examine enough of her to diagnose.
The frustrations enough to make him want to hit something; there's a seriously ill woman in front of him and all he can treat is one wrist and the side of her head. He can't help her if he can't reach her. Yet even if he was strong enough to move the beam, he knows he can't. The sudden release of pressure would put Sarah at extreme risk of ischaemia and he needs far more people and equipment around him to stabilise that. And that's not to mention putting the building in danger of further collapse.
Cal manages to free a bit more of Sarah's arm and cleans it frantically with an antiseptic wipe. He taps the joint but it's a struggle to locate a vein. Eventually he manages to insert a cannula and attach some much needed fluids. It's not enough to save Sarah, but it should buy her more time.
"The ED are sending someone now," Jez calls.
"You told them it's urgent, right?"
"Of course, mate!"
Cal hopes Jez isn't lying. "How's Jimmy doing?"
"The limb's pulseless and cold," Iain shouts back over. "We're looking at massive soft tissue loss. I could really do with you over here, Cal!"
He looks back at his patient. He wants to monitor her thoroughly until help arrives, but realistically he knows there's little he can do until the beam is moved off her. At the angle she's lying at he wouldn't even risk intubation, he could paralyse or her worse. All they can do is keep her stable.
"Right," Cal shouts. "Jez, you're going to have to take over here."
The new paramedic arrives clumsily and in a lighter situation, Cal might have laughed. But he notices shock written across Jez's face and suspects he's never experienced something this scale during training.
"Okay?"
Jez takes a deep breath. "Yeah."
"Good. Now listen. Sarah's almost fully buried in the bricks but if you look here you can see what's causing the biggest problem." Cal indicates the heavy beam across her chest. "Resp rate is very low, pulse is faint but only slightly tachy. I've got some fluids going in, but it might be worth pushing them and attaching another bag as soon as you can. I want you to keep an eye on her respiratory output and shout for me if anything changes." He takes one last look at his patient and groans. "You got that?"
Jez nods. Cal's not convinced but he can't waste time waiting for a better answer and stumbles across to Iain as fast as he can. Jimmy's barely conscious. Cal greets the patient but a flicker of Jimmy's eyelids is the only response.
"Iain?"
Iain shakes his head. "I've tied a tourniquet but his BP's dropping and GCS is nine down from twelve. I'm worried he's going into shock."
"I think you're right," Cal says. "We need to push the fluids." He crawls on the dusty floor to reach the side of Jimmy that is trapped. He knows what needs to be done. His eyes flicker to Iain's. "I'm going to have to amputate."
Iain winces. "You sure?"
Cal exhales through his nose. Medically, he's sure. Morally, he's inflicting a life changing injury on someone without their consent. How can he ever be sure of that? "That arm's clearly not viable," he says "and we're looking at potential massive blood loss. We can't move that beam without further risking further collapse… we don't have a choice."
"Okay. What do you want me to do?"
"Right," Cal says, trying to focus himself. "It's a transhumeral amputation. I'm going to have to make an incision all around the brachium before I can sever the bone." He glances at his colleague. "I need you to watch his vitals and keep me in the loop."
Cal administers the anaesthesia. While they wait for Jimmy to go under, neither man speaks. Cal can faintly hear Jez reassuring his own patient the other side of the room.
"He's out."
"Sats are good," Iain confirms.
Cal traces his fingers over Jimmy's arm, identifying how much of the arm he can leave. When he's sure he picks up the scalpel and presses it into the flesh. Drops of red blood ooze out and he winces. Cal never intends to become a surgeon and it's rare that he's the one causing wounds rather than fixing them. He continues to slice an incision the full circumference of Jimmy's arm and he can feel every muscle and every vein that he carves.
Once the arm is prepared, he takes the saw from Iain but he hesitates, the blade remaining inches from Jimmy's bloody limb. He's only done one amputation before this and he recalls the most harrowing part as the noise from splintering bone. It's a creak from the ceiling that refocuses him and he places the saw within the cut of the flesh.
Eventually he slides the blade across the appendage. On first saw he doesn't press hard enough, but when he increases the pressure and feels the bone breaking from his work, bile surges into his throat. He spits onto the dirty floor and ignores his colleague's concerned look.
He's still only half the way through the procedure where he hears Jez's frantic call.
"Guys, Sarah's stopped breathing, I need some help!"
Cal and Iain exchange a fleeting glance. Neither can move without serious disrupting Jimmy's chances of survival. Yet Sarah stands no chance if Jez remains without back up.
"Guys?"
"We're amputating a fucking arm, Jez!" Cal lets out a yell of frustration. "What's this bloody doctor doing, crawling here?!"
A familiar cough startles him and the saw nearly slips.
"I got here as fast as I could," Ethan says.
Cal can sense the iciness in his brother's tone and yet he's never been gladder to see him.
"Ethan," Cal breaths. "Jez needs you over there. Female, mid-thirties, severely trapped. Just lost respiratory output."
"Okay, I'm on it."
Ethan doesn't even meet his eyes before he scuttles across to the other side of the room but Cal pushes their fallout to the back of his mind. He's got the rest of Ethan's life to worry about him, but right now he's got a patient to save.
Cal continues to slice the blade back and forth through the bone and eventually the saw snaps through the final piece. "Pass me a swab." Cal demands from Iain. He stems the bleed as best as he can and bandages the stump quickly.
"Okay to move him?"
"Yeah. Yeah let's get him out of here pronto," Cal says. He straightens his back and squints across the room. It's too dark for him to see his brother. "Ethan, how are things?"
"Not looking good," his brother shouts. "I could do with a hand?"
"Sure. Jez, swap back," Cal shouts. He turns to his unconscious patient before he stands. "Jimmy we're getting you out of here, mate."
He passes Jez mid route and they exchange a wary smile. The kid's clearly shaken but Cal admires his determination to stay positive. He cannot say the same for Ethan, who's breathing heavily and doesn't even turn his head to greet Cal.
"Still nothing," Ethan says as he continues to pump the oxygen bag. "She could crash any minute and we have no way to resuscitate with that on her chest."
"Shall I find out how long it'll be before they're safe to move the beam?"
"No point. I asked on my way in. They're hours off stabilising the building and Sarah doesn't have that long."
Cal sighs. He hates to be the one to call this, to tell his little brother the bad news. "All we can do is make her as comfortable as possible."
"We can't give up!"
"We're not giving up," Cal says. "There's nothing more we can do. You said it yourself, we can't resuscitate if we've got no access to her chest."
"I need 2mls of adrenaline," Ethan says. He huffs when Cal doesn't pass it to him. "I'll get it myself, shall I?"
"Ethan!" Cal warns. He places a hand on his brother's shoulder "That would only prolong her suffering, you know that."
Ethan makes a small whimpering noise and turns back to his patient. He checks her pulse. "It's okay, Sarah," he murmurs. "It's okay."
Cal watches his brother smooth Sarah's hair from her ashen forehead. He suspects Ethan's oblivious to the creaking ceiling and splinters of dust falling from above them.
"Mate, we need to go."
"I'm staying with her."
Cal sighs as he tries to reach a decision. He can see Sarah's only got minutes left and he wants to support his brother on this at least, yet he's desperate to return to the fresh air and safety of outside.
Ethan's fingers rest against Sarah's pulse point. "Forget it. She's gone."
"I'm sorry, bro" Cal says. He climbs to his feet and holds a hand out to Ethan. "Come on, we need to get out of here." He removes his hard hat.
"I can manage," Ethan snaps. He unclips his helmet
"Just trying to help."
Ethan takes a few paces towards the exit and then turns around to face him. "Why are you here anyway, Caleb?" he asks. "Shouldn't you be at work?"
"I dunno," Cal retorts. "I go where I like, whenever I like."
Ethan bows his head and Cal knows he recognises the words and understood the hint that he overheard the conversation with Lily.
"I heard what you said," Cal clarifies. "About… me deserving it, not you."
Ethan sighs. "I was angry. I didn't mean it."
A loud creak comes from above. The both looking up to the ceiling but there's nothing more than a few flakes of debris.
"Yeah, well, you were probably right."
"No!" Ethan starts. "No, it's not true. You don't deserve this. No-one does!"
Cal opens his mouth to reply, to remind his little brother of his exact words. He may not deserve it, but he deserves it more than Ethan.
But before he has chance to form the sentence there's a loud bang and the floor disappears beneath him. He lasts a second of freefall before everything goes black.