all that matters

part four

Seven hours later, she was still in labour; she felt like she had been forever. She was convinced that the gas and air was the only thing stopping her from collapsing from her pain. She was only 5cm dilated and she was finding it increasingly hard to hide both her physical and mental pain from her doctors, though, she did know, she was going to be here for quite a long time. She just hoped that her husband would be awake and able to come to her, in whatever manner that would be, by the time it came to deliver their daughter. Meredith and Arizona were still observing her although she was now up in Maternity; Meredith, to make sure her liver laceration didn't cause any problems, and Arizona, to monitor the baby.

He was still in surgery. Amelia was carefully working her craniotomy and evacuating both his epidural and subdural bleed. She'd deal with his skull fracture after the surgery by giving him a tetanus toxoid with sulfisoxazole and fluids. She'd hope that it would heal on its own from then; he'd already suffered enough head trauma, and he didn't need any additional unnecessary surgeries doing more harm than good. She could tell that he had had a previous head injury, but luckily at this stage in his surgery and recovery, it hadn't caused any more problems.

They'd managed to resolve his ACS with fluid resuscitation and a blood transfusion, but after surgery they'd have to put him on a course of dobutamine and he'd have to be monitored intensively through the night. Richard had also stitched up his liver lacerations without any complication. They didn't like this feeling; the feeling that such a dangerous surgery was going all too well. Something was bound to go wrong and the wait to know what it is was killing them. Richard had finished and sutured and closed his abdomen and began scrubbing out, giving room for Maggie to surgically intervene with his pulmonary oedema and TVSD, seeing as the antibiotics they'd put him on whilst Richard and Amelia were operating seemed to no longer have effect. She knew she'd have to fix his defects eventually…but she was unsure of whether he could take this much trauma. They were all confident that he would be fine though…so, against her own wishes, she went with the popular opinion.

Maggie had always been regarded as an amazing young cardiothoracic surgeon and with such a difficult trauma case they'd all expected her to live up to her full potential; she was sure as hell not going to let this man die and she was going to find the best way to save him. She pushed nitroglycerin and furosemide first, in the hope that his pulmonary oedema would resolve naturally, with the help of the antibiotics, with no need for surgical intervention. Thankfully, she didn't need to put this poor man through more trauma than was needed; again, she wasn't sure how much he could take. She debated closing him up and using more antibiotics to stabilise him and take him into surgery at some point, but she knew his fragility, and knew that if she left him with an injury as serious as a TVSD, his chances of ever recovering would rapidly plummet.

"I need to fix his TVSD. He needs to be put on bypass". She said, knowing the normal course of treatment for this; she'd operated on a TVSD many times, just not in a trauma case of this magnitude. She began preparing herself to open him up as the OR nurses put him onto bypass; she went through every conclusion in her head and saw this as the best course of treatment. She still felt so much sorrow for this poor man; his recovery would be so long, and his wife was pregnant too – she couldn't lose her husband and the father of her baby. That's just cruel.

The OR nurse began to hook him up to a machine as a second thought crossed Maggie's mind as she glanced at Amelia, who was still in the OR in case his brain suffered a re-bleed.

Luckily, Amelia was there.

The OR nurse began to push heparin to put him under, and Maggie realised what she had done. She prayed she wasn't too late to stop it as she was too obsessed with her own individual thoughts to realise that heparin was needed for bypass; it would make his brain re-bleed and he may never wake up with that much neurological damage. She needed to do this percutaneously, why did she forget that? Why didn't she think of this earlier? She mentally scolded herself for this, for screwing up this man's chances of survival, oh why could she not think of this? Why did she forget? Could she have killed this man?

"No no no no no…." She said, watching Amelia, whose face was painted with confusion, and Maggie turned around, like a slow-motion movement in an action movie.

"Stop! Don't push the heparin!" She shouted, darting her eyes towards the nurse.

But it was too late.

The monitors suddenly flatlined and the OR nurse immediately disconnected him from the bypass machine. Amelia stepped forwards towards him, Maggie shaking with fear.

"Maggie…what is it…what's wrong…what's happening to him?"

"The heparin…his brain….it would…"

"Re-bleed. I need to open him back up. You need to fix his TVSD, he can't wait any longer." She thanked herself that she had decided not to scrub out so she could begin operating him without a delay. That would make up his chances, at least.

"It's too dangerous…." She saw the strain the simultaneous surgery had put on him earlier, and surely he couldn't take it again. Maggie was sobbing uncontrollably at the thought that maybe, just maybe, she would have contributed massively to the death of this man, because of her stupid, irresponsible mistake.

It only took Amelia four words to calm Maggie down though, and set her back into work mode; she had to save this man's life. He couldn't end up like Derek. They both knew that.

"It's our only shot."