The Damage We Do – Chapter 2
Hello! Another chapter and this is now definitely not a one shot. Thanks to the people who reviewed, it makes so much difference to know what you think! Thanks especially for the people who said I had Sam and Dylan in character because I do worry if I'm getting their voices right.
I'm still not a doctor or a member of the armed forces so please forgive any medical and army related mistakes. I've decided to put Sam and Dylan in Plymouth in the past as its not a million miles away from Holby but it's a fairly big place with a medical school.
Sam – present – normal text
Dylan – past - Italics
This update is up fairly quickly but the next one won't be tomorrow as I have clinic all day and then an essay to finish. Please read and review, thanks!
Plymouth, 2006
The two medical students trailed behind Dylan like ducklings, looking at the unfamiliar surroundings with interest as he sped past the busy hallways and bays. He glanced behind him, Sam was practically bouncing with excitement and the other student wasn't much calmer. He stopped in front of the reception desk and looked through the admission forms for something to give them to see what they could do.
"So do you two have any idea of specialties yet?" He said stiffly, trying to be formal.
"Yes," Sam replied instantly, "battlefield emergency medicine. I've already been accepted by the army for sponsorship and that's where I'm aiming."
He swung round to look at her, shocked. "That's a big commitment." A commitment that should have been mentioned before starting a relationship. If he hadn't asked how long would it have taken her to tell him?
She looked unapologetic. "Yes. Six years post graduation and guaranteed time abroad in combat zones. I'll probably serve in Iraq or Afghanistan, assuming we are still in there when I graduate."
Six years! He hoped his feelings weren't obvious on his face as he turned to his other student.
"What about you Miss Nugamu? Are you a thrill seeker too?" The other student looked between her colleague and the doctor sensing something wasn't quite right.
"Actually I think I would like to work with older people. I think sometimes they don't get the respect they deserve. I think I would find that fulfilling. But this is the first rotation I've done so I may completely change my mind between now and decision time." She spoke softly with a musical South African accent and Dylan decided the oldies would love her.
"Right. Good. First of all I'd like you to get some histories for me and we'll see how you do. The most important thing to remember about emergency medicine is that you are seeing the end result, one moment in time. Why do we take histories?"
"Because if you don't have all the information you can't make the correct diagnosis." Sam answered quickly.
"Good Miss Nicholls. Miss Nugamu, what is the main problem with relying on a verbal history as a diagnostic tool?"
"The patient may give you misleading or incorrect information." She was quick too, just not as fast as Sam. Satisfied they weren't complete idiots he beckoned to them to follow as he went to the board to check which cubicles were free. He led them to the waiting area and handed them each the blank patient forms and pre-admission forms.
"Call your patients." He said shortly. Both Sam and the other one looked at him in surprise and Dylan realised as this was their first placement they had never had to do this before. They shared an excited look at this milestone before putting on their professional face.
"Helen Stone?" The other one called and her patient, an elderly lady was helped to her feet by a younger woman, probably her daughter. She was clutching her arm and seemed to have a slightly antalgic gait, favouring her left side. Dylan didn't have to be Mystic Meg to see several x-rays in her future.
"James Wroblenski?" Sam called sounding slightly unsure of the unfamiliar name.
A man got up leading a young boy with a tea towel to a wound on his head. He would just need some stitches if there were no other complicating aetiologies or injuries.
He led them to adjacent cubicles and got them settled.
"Mrs Stone, I'm Dr Keogh and this is Miss Nugamu, she is a medical student and is going to ask you some questions to help with your treatment. I'll leave you with her and return shortly. "
He introduced Sam in the same way and went off to see another patient. Medicine prided itself on the sink or swim Darwinist approach and the best way to start was in at the deep end. Dylan thought observational placements were a waste of time and since the students were covered on his insurance he was getting the final vote. Besides, any idiot could take a history and Samantha at least was no idiot.
Holby, 2012
Sam heard the distinctive ring of the red incident phone and rushed to answer just sliding in front of Lenny and giving him a smug smile as she picked up.
"Holby City E.D?" She listened as Lenny stood in front of her and glared.
"Okay thanks I'll let them know."
Zoë and Tess appeared and Sam wasted no time. "Single vehicle R.T.C on the outer ring road. Three casualties, two en route, Female with Head injuries, query spinal and crush injuries to her hand. Female child around 10 with Spinal injuries and possible internal bleeding. E.T.A 10 minutes. Male still trapped with leg injury. Paramedics have requested a doctor at the scene."
She looked at Zoë expectantly who rolled her eyes and nodded. As Sam rushed to change she could hear Zoë placating Lenny with "She is leaving on Friday!" Lenny had no audible reaction to this comment which confirmed Sam's belief in Linda's almost MI5 level system of information gathering and dissemination. They all knew, good, one less awkward situation for her to sort out.
She drove there feeling a familiar anticipation and energy rush through her. This was what she missed of the army sometimes. But there were good things about a civilian hospital too, even apart from the fact your failures didn't make the six o'clock news.
You were much less likely to have to treat a friend here. It was more than that though, she felt she got to know people and help them in a way she couldn't when she was Major Nicholls. Dr Nicholls was a different animal, able to get closer to her patients. Sam hoped she didn't completely disappear when faced with Helmand again.
As she approached the crash site she was happy to see her favourite paramedic pair, Jeff and Dixie, were the ones looking after the male. The car was a right mess perched on the side of an embankment with a steep slope below. Sam didn't want to dwell on how the little girl was doing after being in the car when that happened and she also didn't want to dwell on how lucky they were the car wasn't already at the bottom of the slope.
"Hi Jeff, I was hoping to see you two." She said falling into step beside him as he came to meet her.
"Aw you know you're our favourite too, princess." He shot back, continuing "The fire service say it will take at least an hour, maybe 2. His B.P. is 140/90, G.C.S of 13 and he's had 10mg of morphine. He's trapped by his left leg and has a compound fracture tib and fib. The position of the car is unstable. They've managed to secure it so we have access but the minute they try and free him… They are waiting for some specialist equipment. Truth be told you might have to amputate. It's a bit of a mess but he doesn't seem to have lost too much blood yet, but as you'll soon see it's rather difficult to tell."
"Hiya love." Dixie looked round as she approached and moved out of Sam's way.
"David, this is Samantha, she's a doctor, she'll look after you."
"Don't leave!" David said quickly sounding stressed and Dixie exchanged a look with Jeff.
"That's alright, I'm not going anywhere, I've just moved so the doctor can get a better look."
Sam assessed him rapidly, she quickly realised the leg was a lost cause. The best course of action would be to amputate and get him out of there quickly before shock sent his B.P. into the toilet.
"David how are you doing?" She asked, wishing she was speaking to a soldier instead of a civilian.
"Ok. Do you know how Sam and Laura are?" Sam looked at Dixie and she shook her head and said out loud.
"They both got to the hospital okay but I don't know anything else. The doctors are busy assessing them. I'll see if Jeff can find out how they are doing. Samantha?" she gestured and Sam slithered out of her position on the roof of the car and followed her a little distance away where Jeff was talking on the radio.
"You were right." Sam addresses Jeff. "That leg is gone. I need to amputate and we need to get him out of there before he crashes. He seems to trust you Dixie. Help me convince him?" Dixie nodded and Jeff started off in the direction of the ambulance. "I'll start getting ready and let the firemen know."
"Have you done this before?" Dixie asked.
"Yeah." Sam replied trying not to think of the last time she had performed this procedure.
"Okay David, I've had a good look at your leg and it's trapped and badly crushed. The bones are broken in a few places. I know you have had pain relief and you might feel okay but we are afraid that your blood pressure is in danger of dropping so much it will make you very ill. It's your leg that's keeping you here."
"What do you mean?" He cried out anxiously "Do you mean you want to… to chop it off?" He choked on the words.
"Yes," Sam started and David started moaning "No, No."
Dixie was there immediately, "David love, you have to calm down please, calm down, listen to what Samantha is saying."
He looked pained but he went quiet.
"The leg is very badly damaged. I think the best course of action is to amputate here. That will free you and we can get you straight to the hospital where Sam and Laura are."
"Samantha is my daughter's name you know. We call her Sam though. God, it's all my fault. We were having an argument, Laura and I and I let my attention wander for a second, what have I done? I've wrecked everything, first my marriage and now this. Please can you find out how they are?"
"Listen David, what happened was an accident but your wife and daughter need you now. Will you agree to the operation?"
"I don't know. I don't, have you done this before?"
Sam swallowed a sigh. "I've done this ten times before, I'm an army doctor. The last time was in Nahr-e Saraj in Afghanistan in the middle of an American air strike. Look, you'll be okay, but you have to trust me when I say this is your only hope."
His breathing was becoming distressed and he shook his head then nodded. "Yes, alright, for Sam. Please don't make me watch though."
"That's great David. Of course you don't have to watch." She beckoned Jeff over.
"That's a go." She said and prepared her instruments and David, letting Dixie monitor his vitals while Jeff assisted her.
She went for a below knee amputation, conscious that it would need to be tidied up in a real theatre anyway and wanting to give them more viable tissue to create a stump. The surgeons would probably retreat to above the knee as it tended to be easier to fix prosthetics.
"I've been such an idiot. Laura and I, we've been having problems and it was like she didn't even care anymore. I only asked for a divorce to get a reaction from her, anything. I didn't want her to say yes." David was obviously frightened but his monologue was cutting a bit too close to home for Sam, distracting her. She tried to give Dixie a pointed look but the paramedic was occupied and didn't see her.
"Are you married?" Sam made the first cut and wished she could lie but she couldn't do that to Dylan in front of Dixie and Jeff.
"Yes I'm married but it's difficult." David shifted, obviously just about keeping his panic under control. She had to keep him calm.
"Why is it difficult?" He asked.
She considered how much she was willing to share. "It's hard for him." She hesitated. "I made a commitment to the army before I met him. It's not easy to watch someone you love risk their lives and it's even harder to watch them go off to a war zone for six months leaving you on your own. He never said anything but I knew, every phone call, every knock on the door, he was waiting. He doesn't watch the news anymore."
"He must be proud of you though." David said.
Sam shook her head then remembered he couldn't see her face. "No. He doesn't care about that stuff. He thinks it isn't worth it. The first time I told him he said I was just a thrill seeker."
Sam was surprised how much it hurt to admit that out loud. Sensing how this conversation was distracting Sam, Dixie stepped in, asking David about his daughter.
Sam worked calmly and rapidly, conscious that with every second David's crash was getting closer and that if that happened they needed to be able to scoop and run. At last she was finished and they were able to get David out of his seat and onto the spinal board and into the ambulance where their luck ran out. He crashed and his heart stopped and she and Jeff spent the ambulance ride doing compressions. They finally got him into a shockable rhythm outside the E.D.
When Sam, Zoë and Tess had David stabilised and waiting for the surgeon to see him, Sam stayed with him as he returned to consciousness. Dylan and Lloyd were still with David's wife in Bay 2. Sam knew she should go and find out how his daughter was but she couldn't leave him. He would probably make it; unlike the last man she had performed this procedure on, a 19 year old with his whole life ahead of him.
It hadn't been her fault he had died, he had been severely injured when his vehicle hit an IED and Sam was not one to go looking for guilt, but some patients just stayed with you. She had liked him and had tried to keep him talking, told him all about her grumpy sweet husband and his mischievous dog. He had told her all about his girlfriend and how he planned to leave the army and go travelling with her after his tour. Australia, New Zealand, the great barrier reef. She put her head in her hands. Sometimes she really missed being normal.
Plymouth, 2006
Dylan was already halfway through a bottle of wine when his doorbell rang. He usually refused to answer the door because it was never for him, but the person was persistent and he vaguely remembered Jack saying he was staying over at a friends tonight.
He swung open the door, expecting to have to disappoint some ex of Jacks that had come seeking some fun. Instead Sam was standing there, her arms crossed in front of her. She looked nervous.
He stared at her for a moment, and then moved aside for her to enter.
"I thought we already got our stories straight." Dylan said, sitting down on the sofa heavily and reaching for his glass of wine.
She tilted her head and regarded him coolly. "So you're a quitter are you?"
He looked at her in astonishment. "You don't seriously expect to continue our relationship after today, do you?"
"Why not?" She challenged. "I'm only with you for three weeks, the hospital is unlikely to find out and as far as I can see we are both consenting adults."
"What about the fact that you failed to mention you've signed away your life for the next 8 years?" Dylan exploded without warning.
Sam took off her coat and threw it onto a chair. "It's not that bad is it? I didn't sell my soul or anything. Most of my friends would love to take my cadetship off my hands."
"Most of your friends are twenty-one. They don't know how they'll feel in three or four year's time, when they want to build a career, a relationship and a family." Dylan fell silent and took a big gulp of wine, embarrassed at his outburst.
She walked off into the kitchen and came back with a glass. She poured herself some wine and sat next to him on his sofa like she belonged there. She seemed to be struggling with what to say.
"Listen Dylan, it was exactly what I needed, and by the way just signing up to medical school commits you to god know's how much training so it's not that different. Given the field I want to specialise in it made sense. And, the salary… look I'm not one of those public school, Daddy pays for everything kind of girl, okay. I needed this. I worked hard, I made it past unbelievably tough selection and I'm proud of it. Don't you dare and try and make me feel like its wrong."
She was angry now and Dylan suddenly felt like a bastard because that was exactly how he had been trying to make her feel. Being with her had felt like a beginning where everything was possible and now it seemed her future was already decided, he had to decide whether to fit in or not.
He put the wine glass down and sat there staring at the dead TV, trying to decide what to do. She let him think in silence, putting her own wine down after a couple of sips.
"It's not weird is it?" He finally came out with.
"What?" She asked, confused.
"I'm ten years older than you. You're not secretly lusting after some student with a love for indie music baggy jeans and gelled hair are you?"
She laughed and hit him on the arm, her anger forgotten as soon as it had come.
"I'm here aren't I?" She said leaning into kiss him softly on the lips. She pulled away.
"I hope you're not always this grumpy." Then she laughed and pulled him back to her.
