So sorry... if the prologue didn't make all that much sense, I promise it will all come together soon.
And as you all know, the whole "twilight" idea is not mine.
Chapter 1 – Making up for mistakes
- Tuesday 5pm -
"You remember how to get there right?" Clayton quarried.
"Yes, I just stay on Highway 26," Mumbled Lindy into the phone, as she reached into her pocket to retrieve her vibrating pager. "I have to go, there's a trauma one coming in."
"Mm'Kay, I'll see ya on Friday", Clayton slurred.
He must be very tired thought Lindy. "Be careful, please."
"Yes, of course always!"
Lindy hung up, and silenced her pager once again, she drug her tired feet back to the front desk of the Emergency room.
"What's commin' in, Marge?" Lindy asked the buxom, white haired triage nurse.
"A thirteen year old, cold water drowning- was under for 15 minutes-before his dad found him". Marge was already stamping name plates and preparing the preliminary paperwork.
"Where do you want to put him Lindy- I mean Dr. Daws?" Mitch, the medical assistant asked as he typed on the computer. "The ambulanced called and their ETA is in ten minutes."
"Trauma room one," Lindy mumbled as she scribbled her signature on a prescription pad, and handing it Marge. "Send Mr. Hanks home with this, and give him 500 milligrams of Gentamicin to get him started-"
"We put the drunk in room one," Mitch interrupted.
"Crap, is he still here? Is there anything still open?" Lindy dropped her clipboard in frustration.
"The eye exam room is the only one left. There's the migraine in room two, the ear infection in three, and of course Mr. Hanks in room 4… You'd better start discharging." Mitch smirked." Unless you want to use the obstetrics room?"
Lindy gnashed her teeth. "Well move the drunk to the eye room and clear room one."
"Yes, boss…"Mitch sniggered, dragging his foot, and using his best imitation of Igor.
Marge rolled her eyes." Do you want me to page Teresa from her break?"
"Oh, yeah, and have CT ready, and page respiratory."
"Speaking of respiratory, will we be seeing Clayton this evening?" Marge raised her eyebrows over her horn-rimmed glasses expectantly.
"No, he's backpacking with Jeff this week." Lindy couldn't help smiling remembering how Clayton had begged Jeff to go hiking around Mount Hood's rim. Jeff was not a big fan of the great outdoors, but as Clayton's friend, he had endured many outside excursions. Some of which resulted in a few fractured bones, and a nasty case of pneumonia. "I'm picking them up at the trailhead on Friday morning."
The sound of thick liquid hitting linoleum echoed form the eye exam room, followed by a stream of profanities from Mitch. The drunken patient was coughing, and sputtering as vomit splattered the floor.
"I'm here" yawned Teresa, a small dark-haired nurse. She reached into the front pocket of her scrubs to find a stick of chewing gum. "Where's the fire." Her nose wrinkled as she caught the sent drifting from the eye exam room.
"It'll be here any minuet," supplied Marge. "And there's our respiratory therapist."
Duncan was sneaking into trauma room one, flipping on the lights and preparing his respiratory equipment. "S'up?" he grunted as Teresa, and Lindy joined him.
"S'up wit you?" quipped Teresa in her Porto Rican accent.
Duncan grinned as he tested an oxygen flow meter, but he did not respond to Teresa.
A loud beeping echoed from the parking lot and the E.R. bay. Mitch bolted forward only to come to a screeching halt has his sneakers squeaked right up to the door. It pounded open and a stretcher, pushed by there EMTs came unsteadily through the door. Mitch grabbed the end of the stretcher and angled it towards trauma room one.
"Thirteen year old, male, found unconscious at the scene. His father reports pulling him from the lake, and then starting CPR. We continued as we transported him, about fifteen minuets in route we got a pulse back, but he still isn't breathing on his own. Taylor has been bagging him the whole way here. We can't get any IVs in him, Doug tried four times. His heart rate is 55 beats per minuet; his temp is 94 degree's Fahrenheit. His blood pressure comes and goes we haven't been able to get a good reading. We've been trying to warm him up, but he hasn't even started shivering yet." The report came from Alden a seasoned search and rescue volunteer and county EMT that Lindy had met on several occasions.
Lindy was already bringing her fingers to the boy's neck feeling for the carotid pulse. Duncan had taken the bag and mask the EMT had been using to push oxygen into the boys lungs. "On the count of three!" Lindy yelled. The EMTs and the ER staff lined up on either side of the stretcher to grab onto the sheet beneath the boy. "Ready Duncan? "
Duncan gave a curt nod. "One...two…three!" he barked and the boy was lifted from the stretcher onto the exam table.
"Teresa, get me some lines, as big as you can get in his veins! Mitch, get some warm blankets and some warm normal saline from the IV stock up! Marge, call ICU and have them bring a Ventilator down, Duncan can't breathe for this kid forever, we have to intubate." The last sentence came out much softer than the earlier commands. Lindy pulled her stethoscope from around her neck and listed to the boy's chest. It rose and fell as Duncan pushed oxygen into his lungs. They were wet and full of crackling sounds; he had inhaled a lot of water.
"Get that thing out of my way!" hissed Teresa, as she pushed her way around the EMT's stretcher, to search for a suitable vein. Marge disappeared as she pulled the curtain closed. Mitch had taken off running and left more rubber from the sole his sneakers streaked across the floor.
Two of the EMTs, pulled the stretcher, and followed Marge to the front desk. The last remaining EMT was very young, perhaps nineteen.
"You… put the heart leads on him," Lindy directed the pale EMT.
"You new 'round here?" Teresa asked cracking her gum. She was tapping on the boys forearm trying to get the veins to stand up.
The tall, clean shaven, EMT nodded. "Is he going to be okay?"
"We'll do our best," Lindy said in her most confident voice. Please… be okay. She prayed in her heart, you're too young to die like this.
Out of the corner of her eye she saw Teresa wink at the young EMT and saw him swallow. "It's all in the angle you use, and finding the right vein," Teresa educated the EMT. "Take this vein for example you can see how it gets wider in some spots-those are valves they are really hard to start an IV through. But this one… now that's a good one."
"Teresa! just get me a line," Lindy could feel her blood pounding in her temples. She wished she could make the boys blood move like that. "Duncan, how is he oxygenation."
"He's at 87 percent, and I have to give him a lot of pressure to keep his lungs open." Duncan was a tall, bald African American, who had moved to Oregon after a divorce. He was thin and well muscles; he was a hard-core cyclist. On weekends Clayton would sometimes join him for his stints up and down the coast, on their bikes. Lindy grimaced as she remembered the unseemly sum of money Clayton had spent on his new road bike.
"I'm going to have to tube him," Lindy said as she gathered her equipment.
Duncan nodded; he already knew what was coming, and what he would be needed to do.
"Easy Peasy!!" announced Teresa, indicating she has successfully placed an IV. "Where's Mitch? I need that IV fluid. Hey… be a peach, and get us some warm blankest from Marge would ya?" She cooed at the EMT. He disappeared around the curtain, his arms shaking.
"Ready?" Lindy looked at Duncan.
"You can do this," Duncan nodded.
"Yeah… you're right… I know I can," her voice shook slightly. Lindy placed her scope in her left hand and the breathing tube in her right hand.
It had been over a month ago…when she had last intubated a patient. It had been a drug overdose; he was obtunded and completely unresponsive. She had attempted to pass the tube, but his mouth was clouded with saliva. She had put the tube into his stomach instead of his lungs. He had vomited all over and sucked it into his lungs as Clayton had pulled out the misplaced tube. It took two more tries until she was properly able to place the tube. The vomit he had inhaled had given him pneumonia, and he had spent two weeks in the ICU, before he was able to breath on his own. "Everyone has an off day," Clayton had said. Lindy didn't have off days; she made it a point to be at the top of her game all the time. It was the first intubation she had missed in her three years at the hospital. The disappointment she had carried around made her cranky and quick to snap at people. Clayton had still stood by her, even when she threw his jacket at him and ordered him from her house.
Lindy took a deep breath, and swallowed. She nodded at Duncan, and he pulled the mask away. The throat was dark and moist as she shined the light attached to the scope into the boy's mouth. "I need his head tilted back," and Duncan immediately pulled the head back so the boys closed eyes were pointed to the back wall not the ceiling. He was so cold, but then she felt something warm brush her and that held the boys jaw, Teresa was spreading blankets across the boy. "Cricoid pressure" Lindy whispered. Duncan placed his strong hand on the front of the boy's throat. Then she saw it the white lines in the front of the throat, the vocal cords, and the gateway to the lungs. She slid the flexible rubber tube into the crevice, and pulled the scope out of the boy's mouth. Duncan immediately attached the breathing bag to the tube.
Please be in!! Please be in!! She silently chanted as she listed to his lungs once more. There was a course sound of rice crispies at his chest as fluid swirled around, and… the sound of air moving through congested airways. "It's in," she announced with a sigh of relief.
She looked up to see Duncan smiling, and caught a wink from Teresa. Mitch stooped next to her, his hands on his knees breathing hard; the warmed IV fluid was running into the boys left arm.
"His heart rate is up and his oxygen is up to 99 percent," mused Marge from the doorway. An orderly bumped into her large backside, as he pushed bulky ventilator into the room. Duncan gratefully hooked the ventilator up to the tubing and started making adjustments to restore the boy's lungs to their maximum volume. Teresa was pulling out a thermometer to recheck the boy's temperature.
"Marge why don't you page Dr Clark, in ICU and let him knows we have a patient coming up to his floor?" Lindy asked with a smile. "I'm sure he won't mind coming for a case like this."
"You bet sugar," Marge turned on her heel." Oh, yeah, and the boys parents are in the waiting room, wringing their hands with worry."