Chapter Two: Emergency

Nora turned the key and shoved the door open.

She quickly made her way to the treatment room, the hairs on the back of her neck standing up as a reminder of who was following her into the building. Before she could turn to switch on the lights, the Joker wheeled her around with one hand on the back of her head and the other holding his knife to her neck. Their faces were inches apart and illuminated by the red exit sign, making Joker look that much more frightening.

"No, uh, funny business, doc. We need to come to an… understanding. An arrangement. One that involves you handing over your phone and meee watching your ev-er-y move-ah," he panted. Nora choked on her saliva out of surprise from the sharp instrument that was now firmly pressed against her throat, but not hard enough to break skin.

She didn't want to nod her head out of fear of dragging the blade across her skin so she muttered out a quiet "Ok, yes."

"Phone. Noww." She slowly reached into her back pocket and pulled out the out-dated phone, bringing it up between their faces as they kept their eyes locked. Joker grabbed it and shoved it in his pocket. Removing the knife from Nora's throat, he glanced around the dark room.

"Any cameraas?" Nora shook her head. "After you, doll," he said, gesturing toward the blackness. Nora reached toward the wall and switched on the lights, flooding the room with bright, artificial light.

You can do this. She cleared her throat, "Um, Joker?" He turned to her, eyebrows raised and small grin forming on his scarred lips.

"Nice place ya got here, doc." His breathing was alternating between shallow breathlessness and longer controlled inhales that gave way to a small rasp. But he didn't show any sign of this battle for air on his face.

Nora stood up straight, trying to slow her breathing and not subconsciously match his rapid rhythm. She took a deep breath and said, "Um, yes. Uh, well it seems like you're having trouble breathing." Her whole body was buzzing with pins and needles.

He smiled, showing his teeth and said, "Ahh, there she is. What a doc-tor-ly observation." His tongue darted out to lick his lower lip.

Her feet felt like they were glued to the floor where she stood, staring at them. Nope, keep it together. This is not the time to crumble to pieces. Just treat him like you would any other chest wound. She brought her head up to look at Joker and said, "I need to get some supplies…um. Can I…?"

Joker said, "Go on, doc. Just know that my little, uh, friend here is watchin' ya," twirling the knife between his fingers and his grin falling into a scowl.

Ok, do it. Go. Nora steadily walked toward her desk, Joker's piercing gaze following her. She put her hands on the back of her desk chair and started wheeling it toward him. She struggled to keep from shaking as she got closer, locking eyes with Joker yet again.

She quietly spoke, "Y-You should sit down." Joker looked down at the chair then back at Nora. He started taking his purple coat off. He slid it off his left shoulder, a small wince flashed across his face when he shifted himself to remove his right arm. With a grunt, he slipped off the coat. This was the first time Nora saw him show any indication of feeling any of what must have been extreme pain. He laid the garment on the exam table. She watched him leave it there and he said, "Oh don't worry, I have plen-ty of other hiding places," his voice deepening and motioning to his abandoned coat that held what she knew must have been more than a dozen knives or other weapons within its pockets. She didn't know what else to do but quickly nod.

She removed her hands from the back of the chair as he sat down, as if touching him might burn her. They stared at each other while he took of his gloves, holding his knife between his teeth as he did so. Then he dropped them to the floor. Nora's eyes went back to the glass in his side. Her heart started pounding. Fuck, that's a big piece of glass. Reality rushed over her and left her with a new feeling of determination. Nora wanted to fix this. That's why she's a doctor. But she has never worked on a person before, she worked with animals because she felt they were better patients. Even if they tried to bite her, she's sure some people would do the same and she knows her patients deserved her care more. Plus, non-verbal communication was always her preference so she liked patients that don't talk.

Ok, if I'm gonna do this, I'm gonna do it right. She kept her eyes on him as she backed up and felt around on her desk for her stethoscope. Once she felt the plastic tube in her fingers, she lifted it and began walking back toward the Joker. He sat with both feet on the ground and hands on his thighs, the knife still in his grasp, following her with his eyes. She knelt down at his side and prepared to put the ear pieces in her ears, pausing with them resting on her jaw. The Joker was expressionless, leaving Nora unable to guess what he might be thinking. Her blood ran cold.

"I need to listen to your chest."

The silence was deafening. Nora waited for a response. Joker coughed loudly, causing her to jump. He let out a breathy giggle before nodding slowly at Nora, head tilted toward her. She could hear her heart hammering in her ears and her hands trembled as she held the bell of the stethoscope delicately in her fingers, moving it toward his chest. She took a deep breath in through her nose, the smell of fuel and fire burning her senses. The instrument, along with her finger tips, made contact and she could feel the warmth of his skin through the fabric of his shirt and waistcoat. The sound of her heart racing in her ears was replaced with his. So there is a heart beating in there. And it was beating fast, 140 beats per minute. She slid the device along his chest and listened for lung sounds. She could hear the quick in and out of his breathing over his left lung fields, it sounded clear. Her eyes glanced up and met his. He smirked at her, his scars stretching along his face, and winked. Nora swallowed hard, her mouth drier than it had ever been before. She moved to listen to his right lung fields. Nothing. No sounds of air moving in or out. Shit.

The Joker must had detected her sudden panic because he said, "Problem, doc?" She froze, staring at the glass between his ribs. It had air bubbles gurgling in it with each inhale. This is what she was afraid of when she first saw the wound and the way he had been breathing.

"I need to take an x-ray," she did her best to calmly reply.

Joker licked his lips and made a popping noise. "Well if you wanted to see what makes this specimen tick, all ya had to do was ask, doc." He tried to laugh but it came out as more of a cough. He gaze was no longer fixed and sharp but blank and distant. He was becoming somewhat delirious. At least Nora thought so.

Nora stood, throwing her stethoscope around her neck and started pushing the desk chair toward radiology. Joker's head rolled back so that he was staring upward at her as she pushed forward. "All business, I see," he said while he gazed vacantly at the underside of her chin. They stopped in front of the door in the darkened hallway. Nora opened the door revealing the digital radiology machine with a flat table and a transformer above it, ready to release the rays through its collimator. She promptly entered, pulling Joker along in his chair. Then she hit the button on the machine's panel and it responded by coming to life with a steady hum. Her adrenaline was at an all-time high. She bent down to grab the Joker's arm and pull him up.

"Ah ah ah, slow down there, doc," he lifted his knife in her direction. He had managed to hang on to it in the daze he was now fighting. She flinched and put her hands up in front of her. Still pointing the knife at her, he slowly stood from the chair. He inspected Nora with his eyes, up and down. Then he turned to the x-ray machine, he looked like he was thinking about something. Maybe whether or not her could trust her. But he already made that judgement call when he came to her door. She was his only option as it became more difficult for him to breathe. The Joker sat on the machine's table and made eye contact with Nora again, his tongue darting out to lick his lips and his expression blank again.

She took this as a sign of him seeking further instruction and said "Ok, now lay on your back." He leaned onto his back and swung his legs up on the table as she pushed a little button, illuminating a rectangular shape of light with a shadowed cross indicating the center. The table was designed with its use intended for companion animals so the Joker's feet dangled over the edge in a somewhat humorous manner. Nora grabbed hold of the transformer's handles and slid it along it's track to center the lit frame over Joker's chest. She made a few adjustments to the settings and started making her way through the door with the machine's foot pedal.

"And where might you be going?"

Nora turned and replied, "Oh, I, uh. I don't want the radiation exposure so I'm gonna take the image from out here."

"Well, we wouldn't want that, would we?" Joker replied, rolling his head to face her.

Before she could think better of it, she asked "Have you ever had an x-ray taken before?"

"Nooo I have no-t," he replied.

Relieved that he didn't somehow take offense to her question, Nora continued. "Oh, well I'll let you know when to hold still, then it'll take a few seconds to capture the image."

"I'm ready for my close-up, doc," a nasally voice replied from the table.

Nora stifled a giggle and took her place around the side of the doorway. Did the Joker really just make me laugh? "Alright, the machine makes a pretty loud sound. I'm gonna count to three and on three, exhale as much as you can then hold it… One, two, three." She hit the pedal with her foot and the machine whirred loudly until a beep was heard. The whirring died down and she re-entered the room.

"Ok, you can breathe," she said.

"Am I, uh, rad-io-active now, hm?" he replied, his respirations becoming more ragged.

Nora didn't hear him as she stared at the x-ray image of Joker's chest on the screen in front of her, her eyes wide. "You have a lot of air in your chest," she said, eyes still locked on the screen.

Joker sat up with a painful grunt and stood to look at the screen. "Uh, pardon?" he asked, his nose right next to Nora's ear.

"You have a pneumothorax. There is air in your chest cavity, outside of your lung. It's putting pressure your left lung and your heart," Nora said quickly, trying not to move with Joker's face so close to hers. "The glass in your side must be letting small amounts of air in when you inhale but not letting it back out." She could feel his breathless puffs of warm air against her cheek.

"And your solution, doc?" he replied, tilting his head to the side.

"Um, we have to let the air out. I need to stick a needle through your chest wall to decompress the buildup of air, then fix the wound."

Joker let out a wheeze of a laugh. It quickly turned into a cough that shook his ribs, causing him to growl with pain. He clapped his hands together and said, "Wellll then, what are we waiting for, hm?"

"Come with me," Nora said, her heart pounding in her chest. She left the dark little room and headed into the surgical suite. She switched the lights on and turned around to come face to face with Joker. He looked her in the eyes, she could see what looked like a hint of worry in his expression.

"I-If you could lay on this table, I'm gonna get some things I need."

Joker looked at the surgical table, large mirrored lights from the ceiling above it. "No funny business, doll," he replied, staring at the table. Nora quickly left the room to get some supplies from the treatment, making a mental list as she went.

Ok, I need a large over-the-needle catheter, extension set tubing, a three way stopcock, and a 30, no, 60 ml syringe. Then I'll need to remove the glass, clean it, and close the wound. Saline, sterile gloves, 2-0 nylon suture, needle drivers. Shit, what can I do about the pain? I don't know how much Hydromorphone to give a grown man! Fuck it, he can handle it.

As she gathered all of her materials, she looked up to see the Joker approaching the surgical table slowly. He stepped up and sat on the cold steel surface. He made eye contact with Nora and flicked his tongue over his lower lip before laying down. Then Nora came back into the room and laid her arm-full of medical equipment onto an instrument stand. Ah! Oxygen! She scurried to the corner and grabbed a small oxygen tank on wheels, rolling it up to the table. After turning the wrench on the valve with a hiss, she handed a bell-shaped mask to the Joker and said "Here this might help."

He took it and replied, "How though-t-ful."

Nora turned but stopped in her tracks when she realized that she wasn't sure what landmarks she needed to know to guide her needle. A quick internet search was her only choice. She sat on a stool and pulled up the laptop on the cart in the room, opening the browser.

"What did I say about funny business, doc?" Joker said, his voice muffled by the plastic mask.

A nervous flutter ran through Nora's stomach. "I just need to look up where to place the needle. I-I don't know that extent of human anatomy."

Joker coughed out a chuckle and rolled his head to the side, seemingly unable to deliver the punch line.

Ok, decompressive thoracentesis. Second intercostal space, just over top of the third rib, mid-clavicular line. Got it.

"Joker," she looked to his face, his eyes where closed and he was starting to gasp with each little breath. He dropped his knife. "Joker? Stay with me!"

"Mmm," was the response she got. She had to act fast. She stood to loosen his tie and unbuttoned his waistcoat, then his shirt, carefully sliding the material over the hole in the fabric created by glass shard without disturbing it. Second intercostal space, just over top of the third rib, mid-clavicular line. She felt for his ribs below his right collar bone, along its mid-line. First, second, third. There. Joker tensed up and his eyes flew open when he felt the cold antiseptic scrub on his skin.

"Keep concentrating on breathing, ok?" Nora said as she removed gloves from their sterile package and slid them on her hands. She readied a 14-gauge catheter in her hand, "This is gonna hurt."

She pushed the needle into the skin between his ribs, at the top of his chest. A loud shout erupted from Joker's mouth while he kicked his feet and balled up his fists, but she had to keep going. She advanced the needle until she heard a *pop* indicating she made it through the chest wall. Then, she withdrew the needle, leaving the catheter in place. Joker growled in pain while she attached tubing to the catheter hub that lead to a large syringe, the two connected by an adjustable valve. She quickly pulled on the syringe's plunger, instantly drawing out air. Once the syringe was full, she turned the lever on the valve and pushed the air out into the room through the valve. Adjusting the lever again, she continued to pull air out of the Joker's chest. 60 milliliters, 120 milliliters, 180 milliliters, 240 milliliters. Nora kept pulling out air until Joker suddenly gasped and his chest expanded, his lung re-inflating.

"AHH!" he growled, sneezing his eyes shut and twisting his face with agony. He started to breathe deeply, pulling in as much air as he could with each inhale. He sounded like he just ran a marathon. Then he opened his eyes and started to laugh, "WOO-ha ha HAA!" His cackling died down to a giggle before going quiet, staring wide-eyed at the ceiling.

A toothy grin still pulled at his cheeks as he turned his head to look at Nora. She had stopped pulling out air as soon as she felt resistance against the syringe's suction and was standing at Joker's side, the device in her hands. She carefully placed it beside him, the tubing still connected to his chest, and ripped the stethoscope from around her neck. She listened closely, the sweet sound of air rushing in and out met her ears. Nora sighed and let her eyes close with relief.

Both of their breathing slowed and their gazes met. "Ow! Ha ha ha! See, I knew you had it in ya, doc," Joker said with a smile.

Nora couldn't help but smile too.

Song for this chapter: My Iron Lung by Radiohead