The heart transplant was more complicated than Kate and her team expected so she only stepped out of the OR a little after 3 in the morning. She stood against a wall for a second and could suddenly feel the fatigue that was masked so efficiently by adrenaline during surgery.
"Hey, you okay?" asked Dr Jane McKenzie, the cardio-thoracic surgeon who assisted Kate with the transplant.
"Yeah… Just tired. That was a tough one" Kate said and straightened.
"Good job in there. Go home and get some rest. I'll stay and get him through post-op"
"Nah, I'll stay. I have rounds at 7. I'll go speak to the parents"
"Thought you had today off?"
"I do. Was planning on coming in for rounds anyway. I have some really sick ones this week"
Jane shrugged. "Suit yourself. I'll be here anyway"
"Thanks Mac"
Kate walked out to go talk to the boy's parents. Her back ached, her eyes felt gritty and she felt queasy from a mix of fatigue and hunger. After a lengthy conversation with Aaron's family she went back into the post-op ward to go check on him. His vital signs were suddenly all over the place so Kate spent another 90 minutes stabilising him. She sat down to finish charting in the doctor's lounge. A few minutes later she was asleep with her head in her hand next to a table.
Karev came crashing in 5 minutes later talking loudly to a junior resident. Kate jumped when she woke up knocking over her coffee in the process. "Son of a bitch" she mumbled getting up. Her scrubs were soaked with coffee.
"Oh sorry, did we wake you?" asked Karev. Kate just gave him a dirty look.
"That's why you have an office you know. Damn I wish I had an office" Karev laughed.
Kate didn't reply, she got up to go take a nap in her office.
"You look like crap, go to bed" said Karev.
"Thanks" Kate mumbled sarcastically.
Kate was halfway to her office when her pager went off. She felt like crying. She threw her head back and uttered a frustrated "fuuuuuck"
Almost two hours later Kate was finishing up early morning rounds, still wearing her coffee soaked scrubs. Sax joined the group to discuss a trauma patient.
"Do you want to start removing the drains Dr Morgan?" Sax asked. Kate looked out in front of her clearly not paying attention.
"Kate" Sax said softer directly to Kate.
"Sorry, what did you say?" Kate snapped out of it.
"The drains?" Sax asked again with a raised eyebrow.
"Oh… yes, we can remove the chest drain. Leave the abdominal in for now"
"You heard her, thanks everyone" Sax said and the group dispersed.
"Can I treat you to breakfast and a coffee, looks like you need it?" Sax asked as they left the PICU. It didn't escape her notice that Kate looked pale and exhausted.
"Maybe a coffee and a quick muffin thanks. I need to get home but I'm fucking starving"
"Rough night huh?" asked Sax.
"Yeah something like that"
A few minutes later Kate and Sax sat down in the hospital coffee shop with their coffee and muffins. Kate had only taken one bite when both her and Sax's pagers went off.
"Mother fucker" Kate mumbled under her breath.
"Code green – all available trauma and backup personnel to the ER please" the message came over the intercom. Kate looked at her pager and got up.
"Go home, you're not on duty" said Sax getting up too.
"It's a mass casualty Sax. It's all available hands on deck, you know that"
"We'll manage – go home you look like shit" said Sax walking fast to the ER. Kate was keeping up with her"
"There's nothing I'd like more, but you know I can't go when there are people that need me. I'll just check what's going on. If they can do without me I'm outa here, promise" said Kate.
"If you're not absolutely needed you're out of here okay?"
"Absolutely" Kate nodded.
"What have we got?" Sax asked as she barged into her Trauma department.
"School bus went down an embankment, took two cars with it. ETA on the first wave about 10 minutes. They say it's really bad, we're going to get swamped, brace yourself"
"Who do we have available and who's on call?" Sax asked, already making a mental list of what they were capable of dealing with.
Kate listened to the desk clerk's response as she pulled on a trauma gown, gloves and goggles. She knew they did not enough trauma surgeons available. They had a few general surgeons and she hoped the cases they got would be manageable. Kate took a deep breath and closed her eyes. She was exhausted, she had a terrible headache and felt shaky. She hadn't eaten anything decent in ages.
"You okay Kate?" asked Sax walking up to Kate where she stood waiting in the ambulance bay.
"I'm fine thanks"
"I'll get you out of here as soon as possible" said Sax after taking in just how pale and tired Kate looked.
"I've got it, don't worry" Kate smiled as numerous ambulances carrying their first patients raced towards them.
For the next hour Sax tried her best to send the cases that required urgent surgical intervention to the OR with the surgeons actually on duty after Kate stabilised them. The trauma rooms were absolute chaos with multiple critically injured adults and teenagers streaming in non-stop.
"What have you got?" Sax asked Kate pulling on a fresh set of gloves.
"Shit" Kate cursed trying to control the bleeding squirting out of an abdominal wound in a girl of about 16.
"Major internal injuries, belly is full of blood. Massive chest injuries, both lungs down. Her pulse has not been stable for more than two minutes at a time. Came in in full arrest, got her back after about 5 minutes. She's hypoxic, BPs 45 over 20. We're really struggling to stabilise her. Don't think we'll be able to get her to CT. We'll move straight to the OR"
"She's throwing PVCs again" a nurse yelled.
Kate shoved a chest tube into the girl's pleural cavity between her ribs.
Sax briefly looked up at Kate who looked pale but focussed.
"Sorry Dr Morgan, every available surgeon that can handle a trauma is operating already. I have a patient up in CT now. I might be able to take over here soon, but I'll give you a hand until my patient is back. If he's stable we can switch"
"Thanks" Kate breathed while not taking her eyes off the field.
A few minutes later Kate took a deep breath. "Okay let's get her to the OR, let's move people she doesn't have time". All elective procedures for the day had been cancelled due to the mass casualty. There were enough operating rooms, just not enough surgeons.
"Kate, I'll be in a few to take over" Sax said.
"Dr Sinclair, your patient just crashed in the elevator on the way back from CT. He's peri-arrest"
"Shit! Call the OR tell them we're coming up with another one" Sax yelled.
"Kate, Roberts is on his way in right now. I'll have them send they to you as soon as he gets here"
"They'll need him down here. They're still bringing in more patients"
"Less critical, the residents can handle things down here"
"Another P1, 15 minutes out guys" the trauma co-ordinator yelled.
Kate shrugged. "I've got her Sax. Don't worry. Let Roberts run things down here"
"I'll try and make a plan okay"
Kate just nodded as the elevator doors closed. She truly felt like shit. She didn't feel up to operating, especially not on a critical case like this but she had no choice. They were out of attending surgeons and this kid needed a surgical god.
At the scrub sink Kate threw water over her face and took a few deep breaths before starting her scrub procedure. "Keep it together Morgan. You can do this" she gave herself a pep talk as she scrubbed her palms.
"Dr Morgan, you need to hurry things up here she's becoming unstable again" the resident yelled around the corner.
"Gonzalez" Kate called to an intern eagerly waiting to scrub in and observe her hero operate. "Please get Annie to call my wife and tell her I got stuck in an emergency. I'll be home as soon as possible"