Chapter 180
"Sats are dropping, we're down to 82%" said Eric as the ambulance sped towards the hospital. "Stay with us Jeremy" said Amy. The heart monitor started screaming. "He's in V-Tach" said Eric looking at the screen. Amy had her fingers in Jeremy's neck again. "No output… Start compressions. Charging defib at 300" she said. "Noooo… come on Jer" wheezed Tegan through her tears. Eric was already busy pumping on Jeremy's chest again. "One of Epi" said Amy calmly. "We're charged, all clear" said Amy. Jeremy's body jumped up against the gurney straps. "Jeremy come on… please" wheezed Tegan.
Kate felt her pulse start to quicken as she saw the ambulance round the corner in the distance. "Okay guys, let's go!" she shouted as the ambulance stopped in front of the ER doors. She yanked the doors open and saw Eric pumping on Jeremy's chest. "Talk to me" she said loudly. "Single GSW to the chest. Probable serious pulmonary and cardiac damage. Patient was in full arrest when we arrived on scene, CPR commenced by his friend. Pulse restored after 5 shocks and needle decompressing the lungs, down time approximately 8 minutes. We started him on a bag of Saline and a dopamine IO infusion. Needed two adrenaline boluses to keep his pulse above 50. Pupils equal and reactive but sluggish. He arrested again about a minute ago, we just gave him three stacked shocks with no effect. Second round of Epi is in. Still VF on the monitor" reported Amy while wheeling Jeremy out. "I'll take over" said Kate calmly and climbed onto the gurney straddling Jeremy's body. She started fast compressions as the team started wheeling Jeremy into the Resus room. "Blood loss on scene?" asked Kate while compressing. "At least two litres" reported Amy. "Jeremy… Jer, I'm here" exclaimed Tegan out of breath, stumbling in behind them.
"Somebody get Tegan" said Kate calmly. "Jer I'm here" wheezed Tegan. The team ran the gurney with Jeremy and Kate on into the resus room. Kate jumped off the gurney but resumed compressions. "Let's move him on my count… nice and smooth... one, two, three" said Owen. "Help him" wheezed Tegan. The team swiftly lifted Jeremy onto the resus bed in one smooth movement. "Let's charge again at 360" said Kate and looked up at Tegan. "Somebody get her out of here… get her breathing under control and find out why she's covered in blood" said Kate talking as fast as a speeding train. "No, no… it's not mine" said Tegan looking down at her bloody white shirt. "Please… let me stay… please… I promised him… please" wailed Tegan. "Charged" said one of the trauma team. "Clear" shouted Kate and put the defib paddles onto Jeremy's chest. "Clear" shouted a nurse. "Shocking" said Kate and pushed the buttons on the paddles. Jeremy's body stiffened and lifted under her hands for a second and relaxed again onto the bed. Tegan flinched as she watched the current course through her friend. Kate looked up at the monitor in anticipation. "That's it… sinus rhythm. It's weak but it's there. I need an urgent portable chest x-ray, trauma series, Full bloods, type and cross match for 8 units. Start him on two bags of O neg in the meantime. Start a central line. Get theatre on standby" said Kate.
"Jeremy... hang on" wheezed Tegan. "Tegan come with me... come with me" said Abby trying to force Tegan out of the room. "No... I'm okay" wheezed Tegan. "Tegan you're not okay... you're struggling to breathe... let us have a look at you" said Abby. "I'm... okay" mumbled Tegan with her hand in her hair. "Tegan! You're in the way, let us help him!" said Kate loudly. "Uhh... oh God... please... help him" wheezed Tegan before her legs gave way under her. "I've got her, get a gurney" said Abby. She gently lay Tegan down on the floor. "Tegan open your eyes... open your eyes" she said rubbing Tegan's sternum. Kate was still barking orders next to Jeremy's bed. "Is she okay? Where the hell is Altman!" yelled Kate. "We've got this Dr. Morgan" said Dr Altman entering the room. "Dr Morgan! One patient at a time" said Owen. "Where's that blood guys, his pressure's not going to hold" said Kate.
"Sonia... open your eyes... it's okay, you're safe" said the doctor that took over Sonia's care. Sonia's eyes snapped open and she looked around startled. "Do you know where you are right now?" asked a nurse. "Um... hospital... the kids, where are the kids?" said Sonia. "They're okay, they're safe. Just take nice deep breaths for us" said the doctor while checking Sonia's pupils. "Pupils equal and reactive" said the doctor. "BP's stable, pulse up to 105" said the nurse. "Just relax now Sonia. Everything's fine. You're okay" said the doctor. "Are they really okay?" asked Sonia. "Yeah, they're fine" smiled the young, male doctor. "Can I see them?" asked Sonia. "They're bringing them in now. You just relax" said the nurse. "Where's Tegan?" asked Sonia trying to get up. "Sonia... we'll keep you updated, calm down. Deep breaths" said the doctor. Sonia took a deep breath and closed her eyes. "I'm Dr West... you can call me Dan" said the doctor. "What... what happened" mumbled Sonia.
Tegan was wheeled into the next room and medical personnel were swarming around her immediately. "Let's get her nebulised and on 100% oxygen, see if we can open these airways... there's a lot of wheezing and crackles" said Dr Altman. "Teddy, BP's only 80 over 50, pulse is 135" reported Abby. "Okay Tegan breathe for us... get her cannulated" said Teddy with her hand on Tegan's forehead. "O2 sats struggling, 79%" said another nurse. Tegan seemed to be struggling more to breathe. "She's not moving much air" said Teddy listening to Tegan's chest again. "Portable chest x-ray, let's bag her... I want to avoid intubation if we can" said Teddy.
Abby removed the oxygen mask and put another mask with an ambubag attached to it onto Tegan's face. "There we go Tee... just breathe with it" she whispered. "I need a 12 lead ECG" said Teddy. "Got it" said the nurse and started unbuttoning Tegan's blood soaked shirt. "Get that cannula in her and start her on a litre of normal saline with an albuterol infusion" said Teddy before shining a torch into Tegan's pupils again. With that Tegan woke up and started thrashing around weakly. "No... let me go... Jeremy" she wheezed. "Breathe Tegan" said Abby calmly holding the oxygen mask up to her face again. Tegan had her shaking arms over her chest and slapped people away.
"Tegan you need to let us treat you" said Abby. "I need... to see... Jeremy" wheezed Tegan. "Tegan the trauma team is working on him... they're taking good care of him... relax and breathe" said Teddy looking into Tegan's eyes. "No.. no" said Tegan trying to get out of bed, clearly disorientated. The medical team pushed Tegan back onto the bed. "Nooo... Jeremy!" Tegan wheezed again. "Tegan... listen to me... we'll be the first to know if there's any news, I promise you this. You need to let us take care of this breathing... when Jeremy wakes up he won't want you back in ICU" said Abby holding Tegan down. "BPs still dropping... 75 over 45. Sats slightly up 85%" said a nurse. Tegan seemed to be losing steam fast. "Uh... okay" wheezed Tegan. "Abby's just going to help you breathe... just breathe with her when she pushes the air down your lungs" said Altman. "Can somebody hold her arm still or there's no way I can get her cannulated" said a nurse holding Tegan's shaking arm. Another nurse held Tegan's arm still as the nurse inserted the IV line. "Run a fluid bolus wide open" said Teddy. "Can we get those leads on now!" said another doctor. A nurse unbuttoned the rest of Tegan's shirt revealing Tegan's tense abdominal muscles. Abby looked down and spotted a dark red stain on her own shirt.
"Hang on... I think there's active bleeding coming from somewhere. This must have happened when I caught her going down" said Abby. Teddy pulled the shirt away further and spotted the soaked through gauze taped to the wound in Tegan's side. "Bingo" she said and pulled away the dressing. "Looks like a deep lac... possible stab wound. There's plenty of blood on her pants and shirt, dressing's soaked through... who knows how much she's lost" said Altman. "Tegan what happened to your side?" asked Abby still helping Tegan breathe. She took the mask away for a few seconds. "Tegan, what happened to your side?" she repeated. "I... don't know" mumbled Tegan. "Tegan do you know what day of the week it is" said Abby. Tegan stayed quiet for a second. "Sunday" she mumbled throwing her hands up annoyed. "Nice try... it's Tuesday" said Abby. "X-ray's here" said the nurse. "As soon as this is done and we have her breathing under control I want an abdominal and chest CT please. Let's type and cross... get 2 units of O neg and 2 of type specific on standby just in case" said Teddy. "Got it" said a nurse. "Let's get her flat and log roll her to check for other injuries" said Teddy. A nurse swiftly let the head of the bed down. "I need to go now" mumbled Tegan. "Shhhh... just stay as still as you can we're going to roll you" said Abby holding Tegan's head and neck in place. "On my three... gently... one, two, three" said Teddy and the team gently rolled Tegan onto her side. Teddy started inspecting Tegan's back. Tegan was moaning and mumbling something inaudible through her wheezes. "No other obvious injuries to the back... let's do a top to toe, cut the pants off" said Teddy. "Let me go" moaned Tegan.
Kate and the trauma team were working feverishly to stabilise Jeremy. "Hang another bag of platelets" said Kate using the ultrasound on Jeremy's chest. "God... he's got a chest full of blood. Chase up the X-ray. I want chest tubes, both sides, stat" breathed Kate. "BP's falling, 50 over 30... he's throwing PVCs" said a nurse. "Stay with me Jeremy" said Kate working as fast as she could. Two nurses cut into Jeremy's chest wall and pushed the chest tubes in. Both started squirting blood out immediately. "We need to get him up to theatre" said Owen as monitors were blaring everywhere. "We don't have time. Prepare a thoracotomy tray" said Kate. "You want to crack his chest right here" said Owen. "We don't have much of a choice! He's bleeding out, there's no way we're going to get him stable enough for theatre" said Kate. "Thoracotomy tray" Owen nodded at the nurse. Jeremy was still bleeding profusely and nurses were throwing towels onto the floor where Kate was standing to soak up the blood. "Sats still dropping, we're down to 60" said a nurse. "Third bag of type specific going in through the rapid enfuser and we're on our third bag of saline" said a nurse. "Come on Jer... stay with me" said Kate. "Somebody contact next of kin" said Owen. "Already checked, next of kin listed as Tegan Quin" said a nurse.
"Tegan" said Sara jogging up to Tegan's bed. Tegan seemed to be breathing a bit easier after the drugs and oxygen and she lifted her head when hearing her sister. "Tegan! Is she okay?" said Sara sounding petrified. "She will be" smiled Abby. "Sar... the kids" said Tegan, still with a bit of a wheeze. "They're right next door Tee... they're okay, the paediatrician is with them right now but they say they're going to be just fine" said Sara taking Tegan's hand covered in dry blood. "Mom?" said Tegan. "Mom's okay too Tee, just relax" said Sara. "Tegan... deep breaths" said Abby. "Go... be with them" said Tegan after a deep breath. "They're okay, you need me now" said Sara. "I need you... to go... check on Jer" said Tegan out of breath, looking into Sara's eyes. "Ultrasound machine" said a nurse entering the cubicle. "What are you doing... why... what's wrong with her?" said Sara looking shocked as the nurse lifted the sheet exposing the temporary dressing on Tegan's side. "Come with me" said Abby and led Sara out of the cubicle.
"What the fuck is wrong with her... why's she bleeding?" said Sara breathing fast, looking pale. "Sit down Sara" said Abby. "I don't want to sit down, I want you to tell me what's wrong with Tegan" yelled Sara. "Sit down!" said Abby strongly and pushed Sara's shoulder down. Sara plonked down into the chair. "Jeremy... is he okay? What's happening?" asked Sara. "Sara, Tegan had a severe asthma attack. We seem to have that under control now" said Abby. "The bleeding" mumbled Sara. "She seems to have some sort of stab wound to her side, from what we can tell right now it doesn't look too deep but she's obviously been moving around quite a bit and she seems to have lost quite a bit of blood as a result. We're doing an ultrasound right now to see if there's any internal bleeding. We'll also send her up for a CT soon to make sure. She's okay though... she's going to be okay... I promise" said Abby. Sara burst out into tears with her head in her hands. "It's okay Sara" said Abby with her hand on Sara's back. Sara sat back up and took a deep breath. "Jeremy?" she asked. "Sar... Jeremy came in with very serious injuries" said Abby. "I know that... I assumed it wasn't good when I saw my sister giving him CPR" snapped Sara. "He's got one of the best trauma teams in the world working on him... they're doing everything they can to save him" said Abby. "Is... is Kate with him?" asked Sara softly, looking down to the floor. "She is... he's in good hands Sara" said Abby.
"Hey there kiddos" said a handsome, older male doctor coming into the cubicle where Lindsey was sitting with both her kids on her lap. Both kids looked tired and miserable, both moaning softly with their heads on Lindsey's shoulders. "Hi, I'm Jack" he introduced himself to Lindsey. "Nice to meet you... I'm Lindsey. This is Casey and Ryan. Please tell me they're okay" said Lindsey sounding scared. "Well, the nurse tells me that their vitals are looking okay but I'm going to check them out really well for you" smiled Jack. "Who's first?" he smiled. Casey buried her face into Lindsey's neck. "I guess that leaves you big guy" he smiled and took Ryan from Lindsey. Ryan's bottom lip started quivering. "It's okay honey, mommy's here. The nice Doctor's just going to give you a once over" said Lindsey moving closer so she could hold Ryan's little hand. The doctor listened to Ryan's heart and lungs before checking his glands, his pupils, his temp, BP and palpating his stomach. "They've both vomited and they have runny tummies" said Lindsey.
"Mmm... everything seems okay, pulse is a bit fast and his BP is low though, his abdomen is a bit tight and there's a big old bruise on his thigh where that injection must have gone in. It's probably that causing the vomiting and diarrhoea. We're not sure what was in that injection so I'm going to play it safe. I suspect I'm going to find the same with Casey. I'm going to run some fluids into them intravenously so we can flush out those toxins as fast as possible and replace the fluid they've lost through the vomiting and loose stools. I'm going to take some blood so we have a better idea of what we're dealing with. In the meantime... and please don't worry too much about this, it's just a precaution, I'm going to get them both on cardiac and O2 sats monitors" said the doctor. "Oh my god... this isn't good" said Lindsey and started crying. "Everything's fine Lindsey. We just want to monitor them for a while and make sure we're not missing anything. We're just being thorough" said the doctor. "Oh... okay" sniffed Lindsey. "See if they'll take a bottle. We'll know more once the bloods are back okay" said the doctor and proceeded to examine Casey who was crying all the way through it. "Okay sweetheart... okay" cooed the doctor. "Lindsey, try and distract him while I get the IV line in" said a nurse. "Okay" sniffed Lindsey. Distracting Ryan didn't work at all and he screamed his lungs out and vomited before the nurse could finally get the cannula for the IV line into him and take some blood.
"Hey Ryan... could hear you all the way down the hall" smiled Sara as she entered the room and took him from Lindsey in order for her to try and calm Casey down. "What's happening? Are you being a brave little boy?" cooed Sara and bounced Ryan up and down. "The sound proof walling of the paediatric room not that effective huh" smiled the doctor. "Not really" said Sara. Ryan seemed to be calming down and had his head on Sara's shoulder. "Sar... what's happening?" asked Lindsey softly. "They're working on Jeremy. No news yet" said Sara softly. "Where's Tegan, is she okay?" asked Lindsey. "She's okay" lied Sara and turned around as to not expose herself. "Sonia?" asked Lindsey. "She's okay too. She's awake and she's doing great. I'll go see her as soon as we have things under control here" said Sara. "Is it okay if they sleep?" asked Lindsey. "Let's just wait for those blood test results... after that I'm sure it's okay for them to sleep. If they can't I'll give them something to relax them" said the doctor. "Thank you" said Lindsey sincerely. "You're welcome" smiled the doctor. "Twenty minute neuro obs please, get those bloods to pathology asap and page me when you get the results" said the doctor.
"Sara" said Abby popping her head into the room. "Yeah" said Sara and handed Ryan back to his mom. "I'll just be a minute" said Sara to Lindsey. "Outside" said Sara and exited the room. "Tegan's abdominal ultrasound is clear. There's no internal bleeding. We're replacing her fluids and we'll do a CT to make sure but it looks as if she was very lucky" said Abby. Sara let out the breath she's been holding and sighed. "Thank you... but I'd hardly call it lucky" said Sara. "This could have been much worse Sar... We're just going to clean the wound and stitch her up, she'll be fine. Anyway, thought you'd want to know" said Abby. "Thanks" said Sara. "Abby... any news on Jeremy?" asked Sara. "Yeah... he's critical... but he's hanging in there. Kate's just starting on a procedure to... fix what she can" said Abby. "What procedure?" said Sara emotionless. "They need to open his chest to get access to the heart and lungs to fix the damage" said Abby. "Oh my god... I think I'm going to be sick" said Sara. "Stay positive Sara... he needs all the positive energy he can get right now" said Abby. "What are his chances?" asked Sara. "I don't know Sar... as I said, he's critical. I don't know if you're the praying kind but if you are... I think you should start now" said Abby and gave Sara a sad look.
"I need to see him" said Tegan after her CT scan. Her breathing was almost back to normal and she was hooked up to a nasal oxygen line instead of the mask. "I'm sorry Tegan, they're still working on him. There's no way you can see him now" said Abby. "What's happening... just tell me what's happening" begged Tegan. "They're doing everything they can for him Tegan" said Abby. "Is he in the OR yet? Please just tell me" cried Tegan. "Not yet Tee... come on just breathe. We'll know more soon" said Abby. "This is bullshit!" shouted Tegan and pulled out the nasal prongs and started ripping off ECG leads. "Just calm down, lie down Tegan we need to stitch up that wound" said Abby. "Stay still or you'll agitate it" said Teddy sternly. "No!" yelled Tegan and ripped out her IV line. Blood started squirting out of the exit wound. "Get me some medazalam" said Teddy. "Don't you fucking sedate me... I know what that shit does" screamed Tegan. "Tegan!" said Sara loudly entering the room. "Calm down... relax... breathe" said Sara. "Sar... Is he okay?" asked Tegan, tears rolling down her cheeks. "Honestly, we don't know yet. They're working on him. So far, he's hanging in there. Kate's going to operate now. You need to calm down and let them treat you Tegan. There's nothing you can do for him now" said Sara. Tegan sobbed with her arm over her eyes. "It's okay... just try and calm down" said Sara softly as the medical team re-attached the leads, bandaged up her hand and started another IV line in the other arm. "This is all my fault" mumbled Tegan. "What? Don't you ever say that again Tegan. This is not your fault" said Sara. Tegan just sobbed some more. "Have you seen Violet Turner around today?" Teddy asked Abby. "Saw her in the cafeteria over lunch" said Abby. "See if you can get her or somebody else down here for a psych consult" said Teddy softly.
"Are we ready with that thoracotomy tray?" asked Kate while fastening a mask over her face. "He's prepped, we're ready when you are" said a nurse. "BPs crashing again" shouted a nurse. "V-tach... he's arresting" said Owen. Kate immediately started chest compressions. "Not again... come on Jer" mumbled Kate. "We're charged with 300... stay clear" said Owen. Kate gave two more hard thrusts before lifting her arms into the air. "Clear" she said. Jeremy's torso jumped again and Kate's eyes flew to the monitor. "No change... go again... 360" said Kate pumping again. "Charged, clear" said Owen. Kate's arms flew into the air again, Jeremy's body jumped into the air. The monitor started beeping. "Got him, sinus tach. Let's go, let's go. Scalpel" said Kate. A nurse handed Kate a scalpel. She placed it in the middle of his chest and started cutting down towards his navel. "Hang more platelets" said Owen. "I'm in... sternal saw" said Kate calmly. Owen handed her the saw. Kate breathed fast holding the saw above Jeremy's chest. "You okay Dr Morgan, I can do it?" said Owen. Kate didn't answer, she simply blinked hard and started sawing through Jeremy's sternum. After a few seconds the noise stopped and Kate handed a nurse the saw. "That's it, rib spreaders" said Kate. She swiftly placed the rib spreaders into Jeremy's chest. Owen started prying them open revealing the badly damaged contents of Jeremy's blood filled chest cavity.
A/N: Crazy hectic chapter huh. I feel a bit sick to the stomach after just writing it. Will Jeremy be okay? Check back soon and remember to REVIEW please!