Disclaimer: See previous chapters.
A/N: This one will probably be short, sorry. I had my nieces the past two days and barely had time to sit and eat, much less write. However, I promised once every three days, so I'm aiming to keep my word.
A couple notes: A reviewer asked me what an MOS is. In this context it is a Member of Service. You hear Liv use it when she calls for help on the radio when she and Kathy were in the accident. She says Kathy is the wife of an MOS. Second, I am in no way a doctor, so the medical stuff may not be very accurate/factual. Most of what I know is from my own experiences of countless ER visits, nine surgeries, and ten lumbar punctures; and a bit from watching medical shows and documentaries. The psych ward that Elliot was in is drawn from my own week-long stay in one after I went 'round the twist—law school, all my medical issues, and finding my cat dead under my bed unexpectedly broke me down. So, I have intimate knowledge of the plastic furniture and monitored showers, hahaha. The school stuff is also drawn from my own experiences as an older, non-traditional student getting an associates and bachelor degrees and one and a half years in law school before my health forced me out.
Now, without further ado...
SVU—SVU—SVU—SVU—SVU—SVU—SVU
Chapter Five: The Dance and The Fight
Mercy General Hospital
The trauma team was racing against the clock. Their patient was quickly reaching the end of 'the golden hour', that critical first hour that can mean the difference between life and death. They rushed her into CT, which was thankfully not in use at the time. The chief of neurosurgery, the head trauma surgeon, and the chief of general surgery were there with the radiologist to get an immediate read on the scans. Time was critical. As the scans started coming up, the surgeons knew it would be all hands on deck. Their patient had suffered devastating injuries, any one of which could prove fatal.
"Okay, we've got a grade 3 subdural hematoma. That needs to be addressed immediately or fixing everything else would be pointless," stated the Dr. Sam Michaels, the neurosurgeon.
"And it looks like we have a pneumothorax and torn diaphragm. Heart and all major vessels look okay," continued Dr. Lewis Jones, the chief trauma surgeon.
"Do you guys see that? We've got major internal bleeding in the abdomen. Her liver is lacerated; her spleen is practically in two pieces; and her left kidney may have some sort of injury to it, as well. This all needs to be fixed. She has very little in there that doesn't need to be fixed. I don't like the look of that abdominal aorta, either. Does it look like it's bulging to anyone else?," asked Dr. Samantha Jones, the chief of general surgery and wife of Dr. Lewis Jones.
"You're right," he said. Looks like we will need cardio as well. Somebody page her stat to meet us in OR 1. We are all going to have to work in concert together to get her as stable as possible. We might not be able to fix everything before she becomes too unstable. Let's prioritize and coordinate our efforts now so we have a solid game plan before we cut into her.
"Dr. Michaels, obviously, that brain bleed is priority. You and your resident will do your craniotomy and get that bleed under control.
"Sami, that spleen needs attention pronto before she bleeds out. The liver lac looks pretty minor, so let's hold off on that until we've had the major issues taken care of. Check out that kidney, too, while you're in there. Coordinate with Dr. Stevens when she gets there to make sure you aren't in each other's way. She needs to get a look at that aorta before it progresses to a ruptured triple-A.
"As for me, I'll get that diaphragm tear sewn up, which will help with her ability to breathe on her own. The pneumothorax will be addressed with a simple chest tube.
"Let's remember people, that at any point we may have to stop and follow damage control protocol and pack her and allow her body to rest before we go at it again. Hopefully, it won't come to that. We have a great team, a great plan, now it's time for the dance," Dr. Jones wrapped up and all of the surgeons rushed to get scrubbed into surgery. It was going to be crowded, chaotic, and one of New York's finest's life was in their hands.
While the doctors were scrubbing, the OR scrub team prepped the OR and the patient for the battle that was about to happen. The anesthesiologist came in, reviewed the patient's vitals, had a rundown from a scrub nurse on what the surgical game plan was, and calculated how much anesthesia would be necessary.
The patient was brought into the OR, the anesthesiologist went to work. The patient was already unconscious; now he needed to make sure she stayed that way throughout this surgery and that she felt no pain. She was already intubated by the ER trauma team, removing one step from his procedure. He just needed to get her hooked up to the gas.
The scrub team flitted around, setting up trays of sterile equipment, placing the surgical drapes, making sure they had an adequate supply of blood on hand, gathering the laparotomy sponges (also known as laps) that the surgeons would be calling out for as they worked to keep the field as clear of blood as possible. One team member shaved a section of the patient's hair to prep the field for the craniotomy.
Considering how much work had just been accomplished, it had only taken them mere minutes. When every minute counts, they knew they had to be on the top of their game.
The surgeons and residents started coming in to the OR from the scrub room. Members of the scrub team quickly gowned and gloved them and then the doctors arranged themselves around the patient according to their assigned jobs.
The dance was in full swing.
The sound of the pneumatic drill cut through the air as Dr. Michaels drilled into the patient's skull. The brain bleed was causing the patient's brain to swell. If they couldn't control that bleed and the swelling, her brain could herniate and the dance would be over. He and his resident worked calmly, efficiently, and with sure, steady hands to finish their job as quickly as possible.
While the neurosurgical team addressed the subdural hematoma, the trauma, general, and cardiothoracic surgeons cut into their patient from stem to stern. As soon as the abdominal aorta was in view, Dr. Stevens stepped up and started assessing.
"You were right. It has started to dissect. It's a miracle that we were able to catch this in time before it completely blew. I need clamps now. Let's head this thing off at the pass."
Dr. Stevens was well aware of the potential consequences of clamping the aorta distally and proximally, but there just wasn't time to attempt the intra-operative aortic perfusion that would keep the vessel perfused, providing blood flow to the spinal cord and the organs that were fed by the artery below the clamp. The quickest and easiest way to get her part of the job done was to just do the sequential aortic clamping and sew in a graft to stabilize the vessel. Her fingers flew as they sewed. If the clamps were on too long, the patient could be paralyzed, her organs could become ischemic.
As she finished up, the monitor keeping track of the patient's vital signs began to signal an alarm. Everyone looked up from their work, and one of the residents called out that the pulse was climbing rapidly and was up to 180. Then the waves became erratic, practically overlapping each other.
"She's in V-fib! Charge the paddles to 20!" Dr. Stevens was handed the internal defibrillator paddles and placed them on either side of the heart. "Clear!" And then a jolt. She looked back at the monitor. The patient was still in V-fib. If this rhythm wasn't corrected it would only be a matter of seconds before the heart stopped beating.
"Charge to 30! Clear!" Another jolt. The monitor alarm stopped going off as the heart rhythm dropped back into a sinus rhythm. Everyone in the room let out a breath they didn't even know they were holding.
"Okay, folks, let's make sure that's the only bit of excitement we have in here today. We still have a long way to go. Dr. Stevens, are we good?" asked Dr. Lewis Jones.
"We're good, LJ. The clamps are off, the graft is secure and holding, perfusion to organs looks good. I think my part here is—" before she could finish her sentence, a burst of blood splattered on her face shield.
"Damn it, it blew! Okay, we need blood running, get those clamps back on, and I need another graft." The monitor once again signaled an alarm, this time for rapidly falling blood pressure.
The dance had turned into the fight. The surgeons' fight to save this patient, and her fight to stay alive. It wasn't clear who was fighting the tougher battle.
Dr. Stevens once again sewed in another graft, and then two more, above and below the ruptured section, just to be extra cautious. She took the clamps off, and everybody once again held their breath. A minute later there was a simultaneous exhalation as the repair held this time.
Dr. Stevens stepped back from her place at the table, and took a minute to just breathe, and to observe her fellow surgeons as they continued to fight against steep odds. She had already had to be shocked back into rhythm twice, and they had only just started.
Back at the head, Dr. Michaels had grown increasingly concerned about the swelling he saw. The bleeder had been clamped off, yet the brain continued to swell.
"Alright, let's push some more mannitol. We've got to get this pressure under control. I think we need to remove the skull cap to allow more room for the swelling which should relieve the intracranial pressure some. We'll put in an intraparenchymal pressure monitor so we can continue to track the pressure after we wrap up in here." He and his resident started shaving a larger section of hair so they could pull back the scalp and remove a section of the top of her skull.
While Dr. Michaels worked to prevent brain herniation, the husband and wife team of surgeons were hard at work in the patient's torso. The tube to re-inflate the lung had already been placed, and the male Dr. Lewis was in the midst of sewing up the diaphragm.
"Doctors," came the voice of the heretofore silent anesthesiologist. "Her body temperature is 95 degrees and dropping."
The surgeons' eyes connected and their hope for this patient diminished by a degree. Hypothermia was the first gateway into the Trauma Triad of Death.
"Okay let's push some warm fluids, and pack some warming blankets around any accessible area. We have to stabilize that temperature before we progress into coagulopathy. If we get to that stage, it's damage control time. She cannot slip into an acidotic state. How many units of blood have we given her so far?"
"Five, in addition to the two given in the ER," a nurse replied.
"Okay. Let's work faster, people."
Dr. Sami Jones called for laps after laps, as she tried to clear the field around the spleen. She already knew from the scans that there was no saving the organ, and that her first order of business was a splenectomy. She finally got a clear view, and clamped off the vessels that normally supplied the bloodthirsty spleen but were instead dumping blood into the patient's abdomen. She scooped out the mangled spleen, and set about tying off the vessels that no longer needed to feed the spleen. As she did so, she noticed the bleeding seemed to be increasing.
"Doctors. We have a problem," broached the anesthesiologist at the same time a nurse spoke out.
"She's got blood coming out of her nose," the anesthesiologist advised.
The nurse added, "and there is blood leaking through her IV site."
"Damn, damn, damn. That's it. Damage control time. Dr. Michaels, where are you at?"
"Just finished placing the monitor. All that's left on our end is to bandage up her head, and run test the plantar reflex since we had to clamp the aorta. We need to rule out any damage to the spinal cord.
"Sami, where are you?"
"I just have to finish tying off this last vessel. Didn't yet get to work on the liver lac or check on the kidney. I'm also seeing some damage to the gallbladder that will need to be addressed sooner rather than later."
"Alright, let's pack her up with some laps, and cover her with a sterile pressure bandage. As long as her vitals hold steady, we will monitor here in the ICU for the next 48 hours and then go in again. At that point, we will bring Ortho in to address these fractures," Dr. Lewis said.
The doctors wearily stepped away as the rest of the team packed up the patient with laps and the pressure bandage. While they were fueled by the adrenaline of the surgery which made it seem like time had flown by, it actually had been several hours since they first stepped into the OR. And even that hadn't been enough time.
Their fight was temporarily suspended, but their patient's fight continued.
Mercy General Hospital, Surgical Waiting Room.
Captain Donald Cragen paced the small lounge area. He had just arrived and been told that the patient suspected to be Olivia was in surgery at that moment. He was told that somebody would bring a photo of the patient out to him so he could make positive identification. His heart hoped that it was somebody else; that Liv was just running late that morning. Maybe in her scramble to get to work she forgot her phone at home, and that's why she wasn't answering. His head and his gut, though, knew that it was her.
Just then a nurse in scrubs came out of the restricted area and into the lounge. She had what appeared to be a Polaroid picture in her hand as she approached him.
"Are you here to identify the Jane Doe patient," she asked.
"Yes. My name is Captain Donald Cragen of the Manhattan SVU. If the preliminary identification was correct, then I am the patient's commanding officer and authorized medical representative until her designated emergency contact can be reached and brought here."
"Okay. Here's the picture we have of her," she held out the picture.
Captain Cragen grasped it, and said a prayer before he brought it up and looked down at it. There were all sorts of tubes, and wires, and a ventilator connected to a hose inserted in her mouth. But that face. He knew that face. He had praised and chastised its owner; he had seen that face full of happiness and he had seen it full of despair. It was, without a doubt, Olivia.
In all the years since he had gone sober, he never wanted a drink as badly as he did now. This woman was like a daughter to him. He wasn't sure how or if he could maintain his sobriety if she didn't make it. It was a battle that he hoped he wouldn't have to fight. Olivia simply had to pull through this. The alternative was simply unfathomable.
He sent up a prayer for the doctors who were involved in a delicate dance, fighting to save Olivia's life; and a prayer for Olivia that she fight with all the fierceness, determination, and bravery he had seen from her over the years.
He didn't realize that had let the arm holding the photograph fall to his side, his hand releasing its grasp on the picture until he heard an anguished cry. He snapped out of his thoughts, and turned to where the sound had come from. It was then that he noticed he had dropped the picture, and it had been picked up by the person who let out that anguished moan.
Elliot Stabler sat down in shock, the photo he had scooped up off the floor, clutched in his fist.
SVU—SVU—SVU—SVU—SVU—SVU—SVU
A/N: Poor Liv. She's not doing well at all. And it will only get worse for her, and for her friends. Send Liv your well-wishes via reviews!
-xoxoxoxoxo, Kim
