Author: JD aka babygirljadewinchester
Author's note: Dean Wincherster AU, other characters will make appearances. I realize Crowley's first name is Fergus, I just can't get down with that so Mark Crowley it is! Yes I realize its a bit Dean meets Code Black meets Grey's Anatomy, its supposed to be. I've been a RN for 10 years, 8 of them spent in ER and Trauma Centers, the speech the nurse on Code Black gives in the opening, I've given similar speeches as a Charge nurse…the doorbell at the ambulance entrance for gang related shooting to drop off a patient, I've done that, but some stuff they just plain get wrong. Code Black means a bomb threat, so yeah…that's not real lol.
Chapter 1
"Sorry for the delay Dr. Winchester, my last meeting ran late." Dr. Mark Crowley came into his office where Dean Winchester, his new trauma fellow was waiting. He shook the hand of the former Marine and went to sit behind his desk, grabbing a folder and opening it to grab an ID card and hand it to the awaiting physician.
"No problem sir, gave me a chance to caffeine up before my first night." Dean indicated to his coffee in his hand with a smile, sitting back in the chair and waiting for instructions from one of the areas leading physician in emergency medicine.
"Yes, a good idea, Saturday nights tend to be…eventful. Call me Crowley, everyone does." Dean nodded and sat forward, listening as Crowley's went over his schedule for the next week. He knew he would be put through the paces in one of the busiest emergency rooms in the country and he knew he would be tested by Dr. Crowley, he was used to it and he enjoyed it, he liked the challenge.
"So that's it for next week, tonight you'll be paired with Mama…sorry, Mia St. John. She's our charge." Dean's eyes narrowed as Crowley sat back in his chair and looked up at him expectantly.
"Excuse me? I'm working with…a nurse?"
"Yes, I've found starting my new physicians with Mia is the most efficient introduction to how this ER runs. Every attending, fellow, resident, and intern that passes through my doors starts with Mia, once she approves, then you'll be paired with an attending."
"And if she doesn't approve?" Crowley sat back in his chair, a smile coming to his face.
"Well if Mama isn't happy…we're all unhappy. I suggest you get going, she appreciates punctuality." Dean nodded and stood, grabbing his white coat and throwing it on over his navy blue scrubs. His jaw set in a tight line he walked towards the emergency room, finding a nurse in all black scrubs waiting for him. She stood by the double doors, a stethoscope around her neck and Dean let his eyes wander down her tall frame. Her hair was pulled back in a messy bun on top of her head, her face was turned away from him and he could see a partial tattoo on her neck. Hmmm…a bad girl, he thought to himself as he took in her toned and tan arms. She had to be only a few inches shorter than him, with long legs that went on for days. He walked up behind her and cleared his throat as she turned to face him. Her full lips flattened into a thin line, her blue eyes narrowed and then she smirked at him, raising a perfectly arched eye brow as she spoke.
"Dr. Winchester?" He nodded and she shook her head with a sigh. "You're late and timing is everything. Lose the white coat, we don't have time to be pretty around here, follow me."
"Excuse me ma'am…who are you?" She rolled her eyes at him and took the white coat he was shedding out of his hands and pushed through the doors, the chaotic sounds of a ventilator going off and the ambulance radio crackling as he followed her to the command center of the emergency department. She tossed the coat on the chair and turned to look at him, eyeing him up and down and he had the distinct impression she didn't entirely approve of what she saw.
"I'm Mia…but you can call me Mama." She smiled and a few of the nurses in the station laughed as they passed by, one even turning to look at him with pity in her eyes. Dean put his hands on his hips and straightened his shoulders, feeling like he was in a stare down with his instructor back in boot camp.
"Nice to meet you Mama." He smirked, hoping for once that having a pretty face would work in his favor.
Mia took one look at his full lips and sparkling green eyes and squared her shoulders, she'd seen a hundred doctors just like him and every one of them had thought they were the best until they got here, St Angeles hospital.
"Save the smolder Dr. Winchester, it doesn't work on me. This is the command center, all ambulance calls, stroke alerts, STEMIs and trauma calls go through here. Learning to manage the flow of this place takes time, but that's my job. The doctors fix the patients, but the nurses…we decide who needs you more, who's life is hanging in the balance. We are your eyes, ears, and sometimes your hands when you don't have enough. St Angeles ER is where second chances are determined, we save lives and we do it under some of the worst conditions in the US. Often our resources are far outweighed by the number of patients and improvising is what we do best. Walk with me." Dean followed her, through double doors to a full waiting room, his eyes widening slightly when he saw the large crowd. Several nurses were out in the crowd, assessing patients and moving people to treatment rooms.
"ESI 3 or below wait, we have a bay of treatment areas that patient can be quickly triaged and care determined, simple procedures can be done out here when we are in Code Black."
"Code Black?" Dean interrupted, seeing the flash of disappointment in her eyes.
"That's when we become a sinking ship. This way." She rounded the corner and through another set of double doors, pointing to treatment rooms, fast track areas and finally coming to a long wall of trauma bays, all but one occupied. Across from the bays was a large area, completely open with four empty gurneys, a strip of red tape ran the length of the floor. Dean recognized the design, it was the same as any trauma tent in a hot zone. He looked up at Mia as she spoke, pointing to the empty gurneys.
"This is center stage, ESI 1 only. From here straight to surgery or the morgue. If stabilized enough they can go to staging, which is our old trauma bays here."
"Who designed this?" She put her hand on her hips, a steel blue gaze meeting his and he knew immediately she took his question as an insult.
"That would be me." He nodded, his eyes scanning the room, noting the gallery above for med students and interns. She paused a beat and continued.
"Questions?"
Just as he was about to reply a loud wail sounded and a red light flashed. Mia's head snapped around and she took off towards the ambulance doors.
"Move Winchester, it's time for you to show me what you got." He jogged after her, taking the gloves and yellow trauma gown she handed him and pulling them on as they went through the ambulance bay and saw a black SUV riddled with bullet holes.
"What the hell?" Mia tied her gown and headed for the SUV, calling out over her shoulder.
"Homeboy drop-off." Dean followed Mia to the car, his eyes darting around as several other staff members rushing a gurney out to the car as Mia pulled the passenger door open, swearing as she caught the body of a large man, blood cascading down her arm as she pushed him back in the car and her hand pressed on the wound in his right shoulder. She turned and Dean watched as she barked orders.
"GSW, 1 to the shoulder, heavy bleeder. Can't see any more holes. Call OR and blood bank and let's move people! Winchester! Time to get your hands dirty, he's your patient now, let's get him out and into center stage." Dean jumped to her side, his instincts kicking in as he grabbed the mans shoulders and they worked as a team to pull him from the car and onto the gurney, Mia staying with the patient and ending up on the gurney as she held pressure on the wound, continuing to assess the patient out loud as they locked the rails and pushed him inside.
"Pulse is thready, he's unresponsive. Get him on the monitor. Dr. Winchester, talk to me."
"ACLS protocol, prep for RSI, get me a central line kit." Mia shook her head and hopped off the cart.
"You don't have time for that, Cas IO gun and punch it." Dean looked up as the two nurses beside him cut the man's jeans and ripped them open all the way, a male nurse with shaggy brown hair grabbing an IO gun and drilling access into the man's leg in less than 30 seconds. He jumped to the head of the bed and Mia grabbed his hand, putting it on man's wound as she opened the med box. Dean looked down and swore.
"Fuck…shredded the subclavian."
"Clock is clicking Dr. Winchester. Etomidate and Sux is ready, Cas hold pressure on the wound while Dr. Winchester decides whether to intubate or stop this man from bleeding out." Dean gritted his teeth, his nostrils flaring slightly as he pushed Cas out of the way and spoke.
"Call vascular and get an OR ready, I need a clamp." Mia smiled and grabbed a surgical tray, pulling it open as the one she called Cas moved to the head of the bed.
"Cas, can you intubate?"
"Yes Mama." She nodded and heard Dean grunt as he struggled to find the wiggling artery, she answered him before he could ask. "Cas is a third year, he's got this."
"Then push the drugs. Cas tell me what you see."
"Airway is occluded, suction. I can see the chords." Dean nodded as Cas inserted the tube, locking the clamp as he turned to Mia.
"Artery is clamped, hand me the central line kit." Just as the words left his mouth the monitor alarmed and Mia reached over him to check a pulse.
"No pulse." She jumped on a stool and started CPR, Dean examining his patient and noticing the size of the wound.
"Ricochet." She looked up at him, her arms flexed and her eyes questioning.
"Most likely the bullet bounced off the clavicle, it could be anywhere, we need to look for an exit wound."
Dean reached around Mia, Cas handed the ambu bag to a nurse and examined the left side of the body.
"Here, left flank."
"Ultrasound machine, now." Dean bellowed and a Cas grabbed the machine, handing Dean the probe.
"Pulse check." Mia stopped compressions, switching out with Cas as Dean placed the probe on the man's chest.
"Cardiac tamponade, prep for needle decompression."
"No pulse, decreased right breath sounds. Vascular is here, OR isn't ready, we need a cardiothoracic surgeon." Dean shook his head, grabbing the betadine and pouring it on the man's chest.
"No, we need to crack his chest, prep for an EDT." Mia's eye's widened.
"Dr. Winchester I don't -"
"He doesn't have time for you to think." Dean's voice was low, his eyes narrowed and Mia looked up, seeing Dr. Crowley in the gallery who nodded his approval.
"Then let's do it." Dean watched as they moved quickly, Mia grabbing EDT tray and opening it on the neighboring gurney. She grabbed the surgical gown and held it open for him, her eyes avoiding his as she spoke. "Have you done this before?"
"Once, you?"
"Twice." Dean nodded and then grabbed another sterile gown.
"Then you assist." She looked up in surprise, her blue eyes flashing as she took the gown and put it on.
"Ten blade."