Day 29
I Think I Need A Doctor
Intubation | Emergency Room | Reluctant Bedrest
Bruce waited anxiously at the bottom of the ramp to the Quinjet, continuously scanning the area for any signs of movement. They said they were on their way, they said they'd be there in just a few minutes. If it were as bad as they said it was, they were going to need every second they could get…
"Bruce!"
Bruce's heart leapt up into his throat as the group finally came staggering into view. He scanned them all, automatically looking for injuries. Everyone seemed to have fared surprisingly well. If Steve and Tony hadn't been supporting Clint - whose head was hanging on his shoulder as if he couldn't hold it up - between them, Bruce might have been able to pretend the mission had gone off without a hitch.
"Hurry, get him up into the jet," Bruce urged as they approached. Tony and Steve stumbled up the ramp with Natasha behind them, Bruce falling into step beside her. "How is he?"
"There are no significant exterior injuries, but something is obviously very wrong," Natasha reported breathlessly. "He seems like he's barely getting enough air."
Bruce nodded. "Get him up on the cot," he instructed. Tony and Steve quickly did what they were told, carefully lifted Clint up and laid him out flat on the medical cot that Bruce had already set when he got the message that Clint needed medical attention. "We need to get the Kevlar off him."
Natasha was already working on undoing the clasps of the vest and just a moment later Steve lifted Clint slightly so that Natasha could pull it off. The movement drew a pained gasp from Clint as he wheezed in labored breaths. Bruce had a pair of medical scissors and quickly cut up the middle of Clint's shirt in order to get access to his chest. His right side was already purpling with painful bruising. Bruce grabbed his stethoscope from around his neck and put it into his ears, carefully placing the diaphragm onto Clint's chest. Everyone was silent and still as Bruce moved the diaphragm several times, listening carefully.
"He's likely got broken ribs and a collapsed lung," Bruce finally said as he straightened up. "Natasha, can you get the chest tube kit?" Natasha was already rushing away before he finished the sentence. Then Bruce turned to Clint, who was deathly pale - did his skin already have a slight blue tinge to it? - but his eyes were open and searching. "Clint can you hear me?" Clint eyes drifted over to Bruce, and Bruce took that to as close to an acknowledgement as he was going to get. "You've likely got a collapsed lung due to air or fluid in the pleural space. I'm going to place a chest tube to try to relieve the pressure. It's going to hurt for just a minute, but then hopefully you'll be able to breathe easier. Okay?"
As he continued to heave in horribly labored breath, Clint managed a very slight nod. That was more than Bruce had been expecting.
"Bruce," Natasha said, directly Bruce's attention to the small medical tray she had set up with the supplies he needed.
Not wasting any more time, Bruce pulled on a pair of surgical gloves. He grabbed the scalpel from the tray with one hand, locating the correct spot between Clint's ribs with the other. Natasaha had moved up to Clint's head, putting her hands on either side of his head for support. Bruce firmly sliced a three-centimeter incision into Clint's chest, ignoring the way that Clint's muscles tightened and spasmed against the pain that he knew he was inflicting. Next he grabbed the Kelly clamp and pushed it into the incision with some force, not acknowledging the choking groan that accompanied the popping feeling of the clamp entering the pleural space.
"Jesus," Bruce could hear Tony mutter in shock as Bruce pushed his fingers into the wound to make sure there wasn't anything to get in the way of the chest tube.
Then, Bruce was swiftly inserting the chest tube that was already hooked up to a collection bag. As soon as the tube entered the pleural space, air and blood came gushing out into the bag at the same time that Clint finally gasped in a deep lungful of air so suddenly that his back arched off the table.
"Thank fucking hell," Natasha sighed as she dipped her head down to place her forehead against Clint's. Tony and Steve also gave their own sighs of relief.
But Bruce knew they weren't out of the woods just yet.
Now that Clint was able to more easily heave air into his lungs, a deep, wet hacking cough tore out of his throat. Bruce immediately had the stethoscope back in his ears and the diaphragm back on Clint's chest, trying to listen through the noise.
"What's going on?" Steve asked anxiously.
"The lung may have reflated, but there's still obviously significant damage to his lungs and possibly some other organs around it," Bruce said tensely. "We've bought him some time, but he needs a hospital as soon as possible."
"There's a SHIELD base not far away, they'll have a med center," Natasha said.
"I'll pilot," Steve said, already hurrying up to the cockpit.
"Natasha, I need you to call ahead to the base, tell them to be ready to intubate as soon as we get there," Bruce said as he listened to Clint cough and wheeze weakly. "He'll also need a CT scan to figure out exactly what's going on and then he'll likely need surgery."
"Got it," Natasha said as she hurried after Steve.
"Tony, get me the Ambu bag," Bruce said.
"The what?" Tony asked blankly.
"The bag valve mask, the balloon looking thing with a mask attached," Bruce said quickly, pointing. Tony scrambled over and grabbed the device just as the Quinjet was whirring to life. When he came back, Bruce carefully placed the mask part over Clint's nose and mouth and then motioned for Tony to take the bag portion of it. "Squeeze it at regular intervals. No, too fast, make sure the bag fully deflates and then inflates again. Okay, good, just like that, keep going."
After his initial coughing and gasping after reinflating his lung, Clint's breathing had waned again as he struggled to take in precious oxygen. The Ambu bag seemed to help, but Clint was starting to blink tiredly. It could be that the whole situation was finally catching up to him… or it could be his brain not getting enough oxygen.
"I need you to hang in there, Clint," Bruce pleaded as he grabbed a blood pressure cuff so that he could start taking vitals. He glanced up and for a moment was able to meet Clint's gaze. "We've got you, but I need you to keep fighting until we can get you to the hospital. Okay?"
Bruce wasn't sure if he imagined it or not, but he could have sworn he saw Clint nod ever so slightly.
Almost twenty minutes later, they finally landed at the SHIELD base, where the med team was thankfully waiting for them. Bruce and Steve rushed the gurney down the ramp, with Tony still working the Ambu bag.
"Dr. Banner, I am Dr. Scorborough," the lead man said immediately. "What's the situation?"
The med team took over the gurney, including the Ambu bag and as they trooped into the building Bruce quickly got Dr. Scorborough up to speed with Clint's current condition.
"I'm going to need you to wait here," Dr. Scorborough told the other Avengers before they moved deeper into the hospital.
At a glance, Bruce could see the pain felt by the other at having to leave Clint's side.
"It's okay, I'll watch over him," Bruce assured them quickly before he followed the rest of the team.
They had moved Clint into a private room stocked with what looked like ICU equipment. Doctor's rushed around Clint, hooking him up to monitors and IVs and taking his vitals. Bruce managed to slip in and move to Clint's side. Clint's eyes were still open and darting around anxiously, clearly at least somewhat aware of what was going on. As his gaze landed on Bruce, his gaze finally relaxed somewhat.
"We need to secure his airway," Dr. Scorborough said. "I need an intubation kit. Run succinylcholine and ketamine into the IV."
Bruce knew that they were giving Clint both a paralytic and a general anesthetic in an attempt to make this process as easy as possible. But as Dr. Scorborough was already prepping the Laryngoscope because time was of the essence, Bruce also knew that they wouldn't kick in quite quickly enough to spare Clint the discomfort of this procedure.
"It's okay, Clint," Bruce said, putting his hand on Clint's arm and drawing his attention as the staff got ready to intubate. "Try to relax and don't fight it. It'll be over before you know it."
Bruce had to hand it to Dr. Scorborough. He inserted the Laryngoscope into Clint's mouth quickly and smoothly, carefully threading the tube down Clint's throat and then expertly hooking up the tube to the portable ventilator. The whole thing took less than twenty seconds… but it was still painfully obvious the way Clint's muscles tensed and spasmed even as he blinked heavily, gently pulled into unconsciousness by the ketamine.
"Okay," Dr. Scorborough said with a sigh. "He's under and we've secured the airway. We'll get him to the CT so we can pinpoint exactly what's wrong before we take him to the OR." The doctor looked at Bruce. "Thank you for taking such good care of the patient, Dr. Banner. If you'd like to rejoin the others, we can take it from here. We'll update you as soon as we know anything."
"Thank you," Bruce said sincerely.
He stood and watched as the team wheeled Clint away, disappearing through another set of doors. Even after they were gone, for a moment he just stood there and breathed. In his life before becoming the Hulk, Bruce Banner had never once considered becoming a physician of any sort. It wasn't until his time in India that he started studying practical medicine. While he was hiding there, he felt like he was able to go good and also pay penance if he was able to help impoverished people with medical assistance. He had taken to it more easily than he thought he would.
His time with the Avengers had only furthered Bruce's medical knowledge. When the Hulk wasn't needed, Bruce had fallen into the role of field medic. It was never what he imagined he'd want to do with his life and it was never a path he had considered traveling before the Hulk incident.
But as he headed back out to the waiting room where the other Avengers were waiting, knowing that he had helped save Clint's life that day, it was yet another reminder than he had ended up exactly where he needed to be.