Chapter 29: FIRST DAY
Maya's POV
Four years later (September 2011)
WARNING: GORE
"Hello Residents. Doctor Rorish will be here shortly but for now you've got me. I'm Jesse Salender and for the next three years, I'm your mamma. I'm the senior ER nurse and I can promise you there's nothing that goes on in this hospital that your mamma don't know about. Try finding something, your mamma will find out. You think you're smarter than your mamma because you got a MD well you are not. Your mamma knows when you're lying, crying or dying. It's not only my job to teach you right from wrong but to make sure you don't leave here in three years thinking you can do no wrong," The nurse in front of me says. I follow him quickly with the four other residents. He turns to a group of doctors working on a patient. "Can you clean this up please?"
"Thousands of newly-minted doctors like yourself apply every year to learn emergency medicine in Pacific Cathederal which you are about to enter. This is why you're here," He continues opening the doors in front of him. I take everything. "The most famous strip of hospital real estate in the nation. Where emergency medicine was born. Where the Secret Service reserves a trauma bed for the president of the United States when he is in Los Angeles. This is Trauma One Angels Memorial.
"This stalls round the perimeter called the sides are for the patients who could hold off dying for a few minutes and then this here, this is for the ones who are trying to die on you right this second. This ladies and gentlemen is centre stage. People come here for one reason and on reason only, to get one last miracle."
Every single one of us listens to him closely. This was it. The hardest residency to get in the country. The best place to learn trauma medicine. All I had to do was prove I was worthy of being here.
"Now in your Mamma's house there is a number one rule and in order that you properly obey this number one rule ask me all the questions you think is stupid. Why? 'Cause you're gonna be too afraid to ask Daddy, so better to ask me than to violate the number one rule which is you are not under any circumstances allowed to kill a guest in my house."
And with that he walks way.
"If he's Mamma who's daddy?" Doctor Layton says. Well I think its Doctor Layton. We were only introduced.
Before anyone can respond a loud siren goes and Nurse Salender followed by a female doctor rushes past.
"Homeboy drop off! Let's move!" She yells.
"That is."
We follow her quickly outside to a car left on the side of the road. In the car was an unconscious man with a gunshot wound to the neck. We move him quickly onto the gurney with Doctor Savetti pushing him with his legs. Doctor Pineda is quickly called into action to try and calm the bleeding. CPR is being carried out, blood being ordered, stats being yelled. We're barely in the centre stage before he's intubated. The vessel the bullet had hit was fried.
"It'll take a surgeon at least an hour to replace this vessel. This man has only ten minutes. We give him blood he dies," Doctor Rorish says. My jaw near hits the floor.
"You're going to let him die!?" I exclaim.
"What are you doing Leanne!?" A male doctor yells from across the room. It was chaos.
"Can anyone tell me what I'm doing? Anyone?" She yells. "I'm replacing all the patient's blood with ice cold saline, why?"
"The theory of cold blood infusion is that we can create a temporary suspension of animation through hypothermia buying the patient in theory the hour it'll take the surgeon to repair the artery," Doctor Lorenson says.
"Bingo! You are right!" Doctor Rorish grins then looks at me. "We are going to kill him. We're going to kill him to save him."
We stare at her in shock. This woman was nuts but this was why I came here. To study trauma medicine at its best. Medicine without barriers and let nothing stand in its way. But this however was nuts but it drew me in. I could do well here if I listened hard. Even despite the chaotic start.
And gosh was it a chaotic start.
I stand at the nurses' desk filling out a patient form between patients. We were in Code Red and the place was in chaos. Gosh way to start a residency. I look up when Doctor Savetti appears beside me.
"I haven't formally introduced myself," He says offering me his hand as he takes a file. "Doctor Mario Savetti."
"Doctor Maya Cameron," I say shaking his hands not taking my eyes off the file.
"Where did you study?" He asks.
"Harvard. Interned at Princeton Plainsbro," I reply taking another file.
"Ohh Harvard, what are you doing in a place like this?" He says. "You could have been in some fancy residency, why here?"
"I wanted to do trauma medicine, so I did trauma medicine. Simple as that," I say as I scan the file. Before he can reply Doctor Hudson comes up to me.
"How did the kid with laceration and head injury go?" He says.
"I gave him stitches, staples and a tetanus shot. Sent him upstairs for overnight observation and called child services for a consult," I reply handing him the file.
"Good call with the consult," He says but before he can respond his pager goes off. He's away in seconds and I look up at him running to the emergency doors.
A man with a broken leg is rushed in and disappears into centre stage. Barely thirty seconds go by before Doctor Savetti is called in by Doctor Rorish. I'm about to walk over to another patient when Doctor Guthrie rushes past me.
"Maya you're with me," He says. I follow close behind without question as we run towards the emergency doors. They burst open.
I was not expecting the blood.
The blood runs off the gurney from his neck and face. The person lying there mustn't be much older than seventeen or eighteen.
"Seventeen year old male. Injured during ice hockey training. Damage to the chest and neck and probable broken ribs that have punctured his right lung. There's a very deep laceration on his neck and a broken nose. Due to the amount of blood we're unsure if the carotid was nicked. Due to this we weren't able to put on a neck support," The paramedic says as we run towards centre stage. "In and out of consciousness on the way here. Vitals are weak."
"What's his name?" Doctor Guthrie asks.
"Lucas Smith," he replies.
"Lucas, I need you to relax. I'm Doctor Guthrie and this is Doctor Cameron, we're going to help you," He says. "Maya I need you take over from our good paramedic friend here and apply pressure to Lucas' neck."
"Yes sir," I say moving round the gurney. The paramedic jumps off and I jump on applying pressure to the wound but not before getting splashed with blood. Gosh this was hands on.
"Please call me Doctor Guthrie," He says as we enter centre stage. He then turns to the two nurses and ER doctor following him. "I need two pints of O-Neg in here!"
Centre Stage is in chaos and I can just about concentrate as we move the teenager onto the other gurney with me still applying pressure but supporting his neck also. I stay in the same position as his body armour comes off (a lot of good it did) and his underclothes. His chest and torso are bruised and his ribs on the right side are definitely broken. He's finding it hard to breathe and his vitals are not good. Come on Lucas. Keep fighting.
"Maya I need you to check if the carotid artery has been damaged, can you do that?"
"Yes Doctor Guthrie," I say as I take away the padding I had been holding to his neck which to be honest was now useless.
I carefully put my gloved fingers in the wound and try not to throw up. Focus, focus. I finish my exam quickly and pull out. No major arteries or veins nicked. I replace the gauze.
"Carotid and Inferior Vena Cava intact. No internal bleeding up in the neck. Some minor nicks in the veins but no internal bleeding as they are practically destroyed."
"Good," He says. "Jesse get the stich kit over there and give her suction while she cleans it up."
"What!?" I exclaim as Nurse Salender rushes beside me. I'd done sutures before but this was nuts.
"We have to stabilise him to move him Maya," Doctor Guthrie says. "Stay calm young lady."
I take a deep breath as Nurse Salender hands me the gauze covered with the cleaning solution. I take away the bloody one and set it to the side and quickly but carefully clean the wound, taking the small pieces of dirt out obviously from the ice. As soon as I'm done I set the gauze aside. Nurse Salender hands me the prepped needle and suture thread but the wound was still bleeding heavily.
I take a deep breath and try to steady my hands. You can do this. You can do this.
"Can I have suction please?" I ask as I prep the needle to go in.
"Of course," He smiles. "Mamma is here to help. Now take a deep breath. You can do this."
I nod and get to work as soon as the area is semi-clear. My stitches are small and neat and unlikely to leave a huge scar. I did learn from the best. But that doesn't comfort me. One wrong move and I could nick the Carotid or Inferior Vena Cava then we'd be really screwed.
"You're doing great Maya," Nurse Salender says applying more suction. "You're sutures are perfect. Who taught you?"
"I did my internships at Princeton Plainsbro. At my time in diagnostics there was a fellow there called Doctor Christopher Taub who used to be a plastic surgeon; He taught me how to do stitches without leaving scars," I say still concentrating on the sutures. I knew Nurse Salender was trying to calm my nerves and it was working. "More suction to the left please."
Nurse Salender quickly complies and a few seconds later I've finished I take the needle off and set it down grabbing the scissors as I do so. I cut off the excess thread and then set the scissors down. I clean away the blood surrounding the stitches and quickly tape the gauze to the wound. I then move round and take the cervical collar off Nurse Salender and gently put it around the boy's neck to avoid causing more damage.
"Neck stabilised," I say but I barely get it out before there's a high pitched whine.
"He's going into respiratory distress!" Doctor Guthrie yells. "Maya I need you to do the incubation. We're still trying to get the chest tube in!"
Now I really thought I was going to throw up.
"I… I…" I stutter.
"You have done one before right!?"
"Yes sir," I stutter taking the equipment off Nurse Salender. Chaos was still going on beside me with the man with the broken leg and the boy with the head injury. Calm, Maya. Calm.
"Maya, breathe. You can do this," Nurse Salender says as I shakily do the procedure.
Singing helps you concentrate. It helps me. Aunt Ali's words ring through my head. I take a depth breath.
"This is gospel for the fallen ones, locked away in permanent slumber, assembling their philosophies from pieces of broken memories," I sing under my breath as I find the line. I see Nurse Salender smirk out of the corner of my eye.
I ignore the whine and a few seconds get the line in the middle of the chorus.
"Got it," I say grabbing the bag. I quickly attach it and start to do a squeeze every ten seconds. The whining stops and the beeping turns regular again.
"And that's the tube in," Doctor Guthrie says. "Nice work Maya."
The room has calmed a little and I can hear the crying over the phone Doctor Rorish was holding. A round of applause sounds through the room and I would join but I was breathing for this boy. Doctor Guthrie pats me on the back and smiles at me even though the clapping was for Christa.
"There's an OR free," Someone yells. "There'll be another one available in ten minutes."
"Doctor Guthrie your patient needs it more," Doctor Rorish says. "I'll get the next one."
I quickly move as the gurney is wheeled away letting someone else takeover. I let out a sigh of relief. Gosh that was intense. And crap it was only the first day.
By the time the shift is over I felt like I was dead on my feet. I lazily pull my belongings out of my locker into my backpack and then pull my jacket on. The last thing I pull out is my helmet and visibility bands. I look round when the door opens behind me. It's Christa.
"You cycle?" She asks. "That's gonna be hell after that shift."
"I don't like cars, buses in LA are terrible and there's no direct train route. Cycling is the next best thing," I say closing my locker.
"Fair enough," She says. "I heard you did quite a job on the ice hockey player."
"And I heard you did a C-section in an ambulance," I smirk back.
"See you at seven Maya," She chuckles.
"See you at seven," I say walking out.
I just about make it to the staff exit before my phone goes off. I answer it quickly knowing exactly who it is. "Hi Aunt Ali!"
"Maya!" She exclaims happily. "I tried to call earlier but there was no answer."
"I was still on shift," I say. "I do night shifts for the trauma department remember?"
"Which I'm still not happy about," Ali retaliates back.
"It's a residency for trauma medicine what do you expect?" I was now sitting on my bike, the helmet on the handle bars.
"Your migraines…"
"My migraines are controlled by strict diet and I sleep during the day," I cut off. I balance the phone on my right shoulder as I put the visibility bands on. "I'm fine."
"I still think you should have taken the residency in Chicago…"
"And what would they think, huh? They'd think I was there due to nepotism as my aunt was the head of the ER," I point out. "And anyway this is the best place in the country to learn trauma medicine."
"Chicago has better hours…"
"I didn't do it for the hours and neither did you," I say my helmet now being on.
"You know I'm saying all this out of worry right?" She says quietly.
"I know. But I'm fine Aunt Ali. If I need anything Gran and Paps are here," I say. "I'm where I belong and I just need to learn to be more confident and I can't do that in Chicago."
"I know Maya, I know. Just be careful."
"I will Ali," I reply. "Now can I go home now? You know I cycle everywhere and it's kinda been a long shift."
"Of course," She says. I can hear the smile in her voice. "Speak to you later Maya."
"Bye Aunt Ali," I say and with that I put my mobile in my bag and clip my helmet.
I put my feet on the pedals and push off in the direction of my apartment. It was time to go home.
