Made some fixes and spent some time editing. Sorry about the repost.
Annabeth Chase
The first one and a half hours of surgery passed very much as usual. In the beginning, it was frantic. Stopping or at least slowing the bleeding. Getting more blood into the patient. Cracking the torso to get better access. Seeing how fast a nurse could run from the OR to the blood bank and back. Realizing that the lung was a lot worse off than originally anticipated. Making sure that the patient wouldn't be going to the toilet in a bag hanging from his stomach. There was a lot of cursing and so on. But, as usual, in working trauma surgery, they went from damage control to repair at some point. Or at least, initial repairs so they could send the patient to ICU to regain some strength. Annabeth knew that the patient would have to be opened up at least twice after this.
The diaphragm had been shredded by shrapnel, and despite her patching it up, it would still need extensive repairs. Slowly but steadily, the ABG made her and especially Reyna want to scream a little bit less. The blood pressure went from Kidney offing low to low but somewhat acceptable and a nurse turned on the music. Annabeth's favorite Lost Frequencies album, while she would never admit it she was impressed by how good her nurses had gotten in handling her.
So, while Micheal Yew was working on the abdomen, cauterizing shrapnel damage to the liver, she and Brunner repaired the damage to the lung so they wouldn't have another Tension Pneumothorax within minutes or hours after closing him up again...or the old fashioned patient drowning on his or her blood. She ignored the puffing sound of the ventilator and beeping from the EKG.
Despite not being asleep right now, Annabeth's mood was uncommonly good. The little pest in her lower abdomen was for once not kicking the living shit out of her. Her patient was still alive and had brain activity, which she had been quite skeptical about, and she was working with Chiron Brunner, which she hadn't been able to do since becoming the attending.
That was when things went epically wrong. When Annabeth finally carefully lifted the right lung to inspect their work, she spotted the massive and pulsing Aortic Dissection on the height of the brachiocephalic artery. With the open cracked open chest cavity, she had a very good view of it. The beating heart with its fat tissue. Lungs and everything.
Annabeth sighed in exasperation, "Nurse Gardener. Take my phone and write Percy a message. Tell him I will be working late," Annabeth announced, fresh annoyance rushing through her as her eyes started to get wet. She had really been looking forward to the showering and then cuddling part that came after getting picked up.
"What's wrong," Chiron snapped.
"Look, we've got an AD."
"What were?" The chief of surgery asked, set down his instruments, and came around to look at the problem from her side and cursed.
"So, let me guess. I need to deepen the narcosis again?" Reyna asked. "Yep, ...:"
"Did we just get lucky catching this..." Dr. Brunner trailed off as they the aneurysm.
"I don't see him running around with that for very long...and there we go. Nurse suction!" He ordered. "What do you think, Annabeth?"
Annabeth stared at it intentionally. "Looks like a fragment from one of the hollowpoints damaged it," Annabeth mused, noting the damage and surrounding damaged tissue.
"Be it as it may, this needs our attention now. Rey, we need to put him on ECMO. Make it happen." ECMO or the Cardiopulmonary Bypass Machine was a machine that let you stop the heart while maintaining Oxygen supply to the body.
The Latina, who was watching their progress from over her side of the sterile barrier and groaned. "Damn, on it," she promised and pulled her hospital phone from her pocket and called someone. Then, on Annabeth's orders, she started giving mediation to lower both the blood pressure and heart rate.-
Annabeth glanced at the monitor and noted that the blood pressure had gone up surprisingly well, which was a salute to their work, only to have it lowered back to a systolic of seventy.
That was the moment shit hit the fan.
Just as she mused on how much it would suck if that Aorta went bust, a small explosion of blood spattered across her entire front, gown, face, just everything.
"Fuck. Rodriguez, can't see!" She snapped but she could hear the beeping of the monitor speeding up into a frenzy as blood pressure dropped to zero.
The nurse rushed up to her, pulled her protective goggles off, and put new ones on, just in time to witness a thick jet of blood rushing out of the aorta with every single heartbeat, flowing out of the chest cavity, only to splashdown from her operating table and join the already unnerving amount of blood on the floor.
"Oh, fuck!" Brunner cursed.
"Suction, now!" Brunner ordered, taking over as he was the vascular and cardiac surgeon and as such, this kind of thing was more up his alleyway than hers. Annabeth held the suction nozzle into the growing pool of blood, which was completely inadequate considering the catastrophic bleed.
"Rodriguez, two Artery clamps now!" Chiron snapped.
The two doctors went into action.
"Reyna! Where is that ECMO!" Annabeth demanded.
"ECMO 1 is being used in OR 3. ECMO 2 is out of order," She replied, after ending her call.
"Fuck, fuck, fuck. Okay, call the blood bank, tell them to keep sending up A+ type until we tell them to stop. Charles, what's the plan?" Annabeth asked.
"We'll clamp of the Aorta off first. Then the two of us will stitch it up as fast as possible. After that we will restore circulation!"
They frantically searched for the Aorta's end, and once they found it, they clamped it off, arresting the blood flow but also choking the heart off until it finally gave out with a tremble and stopped beating. The monitor went from beeping into a continuous tone until Reyna turned it off.
"Cardiac arrest," Annabeth announced for Reyna, who started the clock and noted it in her protocol, while Brunner clamped off the other side of the Aorta to stop reflow. On the bright side, the patient was no longer bleeding. On the not-so-bright side, the brain had stopped getting the Oxygen it needed.
The two of them and Yew struggled to suture up the large open gash in the body's largest blood vessel. They worked frantically. Yew took over the suction tube from Annabeth, who scrambled to assist Brunner in repairing the ravaged blood vessel, the tear leaving it only connected by a thin piece of tissue.
Annabeth called Chris Rodriguez over, and with pliers, they held the vessel in position while the Chief of Surgery hastily sutured the blood vessel back together. Despite their best efforts, it took a while, every second feeling like an eternity. The Aorta was a big vessel, almost an inch in diameter and it took a while to repair. In the end, their frantic efforts paid off. After only four minutes, they had repaired the vessel, for now at least. If he lived, he'd need another round of surgery just for that.
Once that was done, Annabeth took over again. "Rythm?" she asked.
"Asystole," Reyna replied darkly.
Annabeth grabbed the heart and started compressing it with both hands. "Reyna, note. Beginning ALS now. Tirthy too two algorithm. Push one milligram of Epi." Annabeth ordered and went to work.
From this point on time seemed to creep on. They took turns with compressing the open heart. From now on things were very easy. Either this would work, or it wouldn't. Their eyes kept shooting back at the clock every few seconds as first five, then ten, and finally fifteen minutes passed.
One hundred compressions a minute and double respiration every thirty compressions. Every two minutes a short pause for analysis. No shockable rhythm? No ROSC. Back from the beginning. Every three minutes a round of Epinephrin and so on. She and her colleagues, the Chief of Surgery Dr. Brunner and the on-call resident Dr. Michael Yew were still working on their patient. Still, at this point, it was more a salute because after the Aorta had signed off the heart had pumped most of the body's blood right out of the body in that spectacular eruption that had had almost doused her from head to toe. Annabeth knew that Reyna didn't like her chances either. The Latina was watching them from over the sterile barrier. Her eyes were dark and sad but she kept her opinions to herself. If this were just anyone from the road, Annabeth would have called it by now.
Her OR looked like a battlefield and she knew that the nurses would have a field day cleaning it up again. This was the part most people didn't understand about their job. In movies, this was the most dramatic it got. Resuscitating a patient, even with his chest cavity wide open and ribs removed, was as simple as her job got. There was little drama, and it was very clinical. The drama, shouting, and cursing had been earlier. Now was just basic protocols and algorithms that she had learned in Medschool. Especially for her.
Autism was a spectrum, and Annabeth knew that she was further down it than most. She liked working off algorithms.
Her operating table was surrounded by a large pool of blood and dozens of sterile towels, sponges, and discarded blood bags.
"Time?" Annabeth asked without looking up.
"Thirty-five minutes," Nurse Katie Gardener announced.
"Status?" she asked Brunner and Yew.
"Aorta is secured. No leaks, no more major bleeders."
"Got the abdominal wound secured for now.
Annabeth looked over the chest cavity. Both halves of the lung looked like patched up sieves thanks to the fractured bullet.
"Epi ready for you, doctor Arellano," Nurse Gardner announced and handed Reyna a syringe who immediately hooked it up to the central line.
"O2 at sixty-two," she remarked. "Pupils are blown."
"To much damage to the lungs," Annabeth growled. "And the heart," Brunner added. "There will be tissue damage. "And he barely has any of his original blood left inside him. There is just no way I can keep up with an Aortic rupture," Reyna announced and nodded at one of the nurses who was squeezing blood into the body through an IV port straight from the bag.
"..and mark. Stop compressions," Reyn cut in, and Annabeth released the heart and raised her hands out of the chest cavity.
They all stared at the EKG for a few seconds.
"Asystole," Reyna announced. "Continue compressions. Pushing one milligram, Epi?"
Annabeth sighed deeply. "No, stop. I'm calling it. Does anyone have any ideas or suggestions?" she asked and looked around at her colleagues, nurses, and her mentor. They all stayed silent, all eyes on her. "Time of death, four-thirty two," Annabeth announced, feeling incredibly tired all of a sudden. Even her little brat had the decency of not putting up a fuss.
Seeing as they all had the open heart in front of them, clearly not moving, Annabeth didn't bother checking for a pulse. Sammy Valdez had left this world slightly more than a half-hour ago when his brain had died due to Oxygen deprivation after the body rapidly pumped out most of its blood out of the body. That was when the pupils had gone wide and the monitoring EEG had shown an arrest of all brain functions. Annabeth would have preferred to get him back just to allow Hazel and the young man's family to turn off the machines after bidding their fair wells, which was why she had continued so long, but you couldn't have everything.
On a nod from Annabeth Reyna turned off her machines and the patched-up lungs inflated one more time before slowly deflating when Reyna disconnected the tube from the respirator.
Once Reyna had removed the sterile barrier Chiron tapped the young man's shoulder, leaving a bloody handprint. "Sorry, mate. We tried."
Annabeth suppressed the urge to roll her eyes. Sentimental old fool.
The four doctors and half dozen or so nurses just stared at the young man for a few long moments. "Come on, let's close him up," Dr. Brunner finally suggested.
She and Yew nodded. "Nurse Rodriguez," Annabeth ordered her male OR nurse.
"Yep," The young, bulky man asked.
"Get me a three-millimetre wire and some 0.2 sutures?"
The nurse nodded and retrieved the two tools.
They worked for another fifteen minutes, wiring the rib cage back together, and then stitching the skin back up to make him at least somewhat representable. Then they covered his body with a large blanket and turned off the large lamps.
"Nurses, would you be so kind as to clean him up a little. I'll go inform Hazel and any next of kin," Annabeth announced and stepped back.
Katie helped her strip out of her blood-drenched gown and gloves and then she tore off her mask, goggles, and cap. Then she left the surgical theatre and walked over to the line of sinks and washed the blood off that had splattered onto the exposed parts of her face.
Suddenly Chiron and Michael appeared on either side of her. The two surgeons began scrubbing out themselves.
"Should we join you?" Chiron asked.
"That would be much appreciated," Annabeth said gratefully.
Once they were somewhat cleaned up they met Reyna, who awaited them at the double doors and then the four doctors headed out of the Surgery area where they found Hazel and Officer Piper Mclean waiting from them in the waiting room along with Silena. Hazel's eyes were red and puffy and it looked like she had been crying for the past few hours which she probably had.
The waiting parties rose when the three doctors appeared. Silena's expression darkened, realizing that they were back way too early for this to have taken a happy ending.
Hazel just stared at them expectantly. "And?"
She sighed deeply. "As you know I am Doctor Chase, the attending Trauma Surgeon. This is Doctor Chiron Brunner, our Chief of Surgery and this Doctor Michael Yew, one of our surgical residents. The injuries Mr Valdez received were very heavy."
"So? He'll be alright?" Hazel asked.
"We tried everything possible, but there wasn't enough time. Sammy Valdez died from his injuries during surgery. He didn't make it."
Hazel froze, all color draining from her face. "How?" Hazel stuttered. "Aren't you like the best?"
Annabeth kept her face completely emotionless and her voice flat. "He was very heavily injured. There was considerable damage to multiple organs and heavy blood loss before we got to the OR. Unfortionatly he also had an Aortic Dissection, which ruptured before we could address it. That was followed by catastrophic bleeding from which he didn't recover. He went into Cardiac arrest as we tried to patch it up again. We resuscitated him for more than half an hour but after exhausting all options, I pronounced him dead."
Hazel would have collapsed then and there if the police officer and nurse hadn't caught her.
Back when she had become a doctor Annabeth had had problems with this. She had always had problems reading the room and judging the people around her, especially emotional outbursts. As the young nursing student completely broke down in front of her and almost collapsed Annabeth's mind was already drifting off towards more pressing matters. A nice warm bed. Percy picking her up at six. Someone had mentioned doughnuts earlier. She also needed to find a toilet stat.
Half an hour later she was back in the ER, in front of her computer, catching up on paperwork and signing a death certificate for one Sammy Valdez. Paperwork was the worst part of patient death. Being dyslexic paperwork, in general, was an issue for her. Will had delivered on the doughnuts, which she was currently happily consuming with barely any chewing. Will Solace, her fellow attending, was also doing his paperwork while their interns and residents were bustling around and treating patients, trying to steer clear of the two more senior doctors.
Just when Annabeth was dared to look forward to getting off shift punctually that red phone rang and the fax came in. "Car accident. Patient female. Twenty-one. Suspected DUI. Pelvic fracture with inner bleeding," Silena summarized after picking up the sheet of paper.
"You!" Silena pointed at one of her nurses. "Warm-up Trauma one. Call upstairs and get an OR ready," Silena roared. "We'll be center stage here."
Annabeth sighed deeply and pinched the bridge of her nose. "Goodbye. Sleep. Hello, overtime," Will groaned.
"Page Reyna. If I get no sleep, she doesn't either," Annabeth growled.
"Hey, I am right here, you know," The Latina complained from the opposite side of the table where she was finishing her own paperwork. "Pregnancy has not made you nicer, nor skinnier," Reyna remarked.
"I might be fat but at least I am still getting laid and girl my boobs look amazing," Annabeth jabbed back.
"Well, I slept with your man before you did," Reyna countered.
"Darling," Annabeth mused in her best impression of Silena. "It isn't about who has him first but who gets him last."
Reyna pointed the finger at her and then hesitated. "I've got nothing on that."
Here we go. I hope you enjoy yourself. This is just me experimenting. The plot would start the next chapter. Still, leave reviews if you want. I am also happy to answer any questions.