a/n So, I promised this by Monday. It's Thursday. A few days early. LOL A treat for you!

This was not an easy chapter to write, however, my favorite nurse friend, SherryG, helped me through it with her medical expertise. I learned more about a trauma unit, and the particular procedures talked about herein, than I think I ever wanted to know. That said, my heart and respect go out to all of those who work in hospitals, trauma units, and ERs everywhere. You are true heroes.

So, in addition to SherryG, I need to thank the usual suspects; my group of supporters, you know who you are ladies, and my incomparable beta, Breath of Twilight.

I think I forgot to say it last chapter, but I own nothing Twilight. All of that belongs to Stephanie Meyer. Lucky duck!

CPOV

The trauma case is on its way into the hospital. This will be an opportunity for the residents to experience trauma medicine at its finest. Our trauma team is the best in the state, and we pride ourselves on also being a fine teaching hospital. I know that the unfortunate individual on their way in will have the best care possible. I focus myself to prepare for the breakneck pace that would undoubtedly hit as soon as the ambulance pulls into the ER bay.

The double doors to the ER open with a whoosh, and the voices of the paramedics and others inundate the room as they wheel the gurney into the prepared room, creating a cacophony of noise. I jot down the information I need from the paramedics on the leg of my scrub pants. I know I'll get hell for that from laundry but it's handy and I do it all the time. I write down the vitals, approximate age and gender of patient, obvious injuries and those that were suspected, as well as treatments that had already been started en route.

I have been looking at the patient in terms of the injuries and trying to assess what the next step needs to be; when I look up into the patient's face, my heart leaps into my throat. Oh, no. I can't believe this. I know this patient. It's my son's Bella. He loves her so much, if she doesn't make it his heart may never recover. And if his doesn't, both Esme and I will be devastated as well. I can't let her die; she has to live through this. I know I should recuse myself from this case, but she needs the best, and that's me. Right here, right now. I also know that I have to keep Edward out of this room at all costs. If I can keep him from recognizing who the patient is until I can sit down with him, even better. God, I hope it isn't as bad as it looks, and she'll be okay.

Bella is pale with drying blood covering nearly half her face from a jagged cut at her hairline. Her pupils don't contract evenly when I check them, pulling up her eyelid and flashing a penlight into her eye. Hmmm? Concussion? Definitely possible from the way she is presenting. My nurse slips the saturation monitor on Bella's finger, and it immediately begins ringing, blaring loudly, making it nearly impossible to hear what anyone is saying. 89%...that's not good.

"Increase the oxygen. Get x-ray in here STAT and silence that damn alarm," I spit out tersely.
Bella's eyes, which have been flying at half-mast, drift closed as she loses consciousness. I reach over and pinch her ear lobe, hard.

Leaning down close to her ear, I speak loudly, "Sweetheart? You gotta wake up. Don't go out on me now. Can you tell me your name? Come on, Honey," I shout at her, "wake up."

I glance up at the clock. "Where the hell is x-ray? Did someone call the blood bank? We need that O neg on standby."

Finally, x-ray is coming. I can hear the large machine being pushed down the hall.

"Where the hell have you been? This is a trauma here, not a broken leg. When I call for an x-ray stat, I mean STAT, not whenever you get around to it."

The technician tries to stutter out a reply, an excuse.

"I don't need excuses. I need you to do your job. Skull series, chest, left lateral decub and pelvis."

I look around at the mass of people in the room and point at the door. "Out. Let him do his job." With that, I left the nurses and x-ray techs to get the pictures.

Outside the room, I turn to address my residents. Edward lunges for the door, yelling Bella's name. I am just barely able to catch him in time, before he flies into the room. I grab him around the waist and tackle him to the floor. My heart is shattering, right along with his, as he sobs. I hold him tightly, speaking quietly to him, trying to calm him down before releasing him.

I call Dr. Weber over and ask her to take Edward out of the ER and find him someplace to rest. She'll need to assign one of the other residents to stay with him until we can get his mother here. I tell her all of this, and ask her to call Esme, quickly and as quietly as possible.

Edward is still struggling against me somewhat, but not nearly as violently as he was. I turn him to face me, and force him to look me in the eye. "Edward? I know this is a shock. I know that you want to be with her. I don't blame you. At. All. But you know you can't. At this point, you'll just be in the way. You know this. I'll take care of her. You know I will. And I'll send someone to you, just as soon as I know what we're dealing with. Okay?"

I know it's not okay with him. But, the doctor in him understands. He nods his head, the tears still streaming down his face. Dr. Weber takes his arm and pulls him to his feet, and begins walking with her arm around his waist away from the ER, talking quietly, reassuringly, the whole while.

I watch them walk away and sigh. Turning to the computer behind me, I start pulling up Bella's x-rays.

"Shit," I mutter. A pneumo on the left side. I hate left sided pneumo's. It's a bitch to put a chest tube in on the left side.

I turn the monitor so all the residents can see the screen. We are teaching, after all, and this is an unusual occurrence. Might as well use it to its best advantage to teach these kids.

"Okay, everyone looking right here. We're going to need to put in a chest tube. See this?" I point to a specific area on the picture. "That's a classic pneumo on the left. See the perfect bell shape?" Pointing to another area I say, "There's an area of white-out as well, so there's probably some blood collecting, too. These ribs are broken; here, here and here," I say, pointing to the fractures. "This isn't something you're going to see very often. It's called a flail chest. See how this section of the ribs is completely separated from the rest, they can move independently of the rest of the structure. With the fluid that's collecting, you can also see that the lung has already been punctured. We need to get her tubed and on a vent. Who hasn't put in a chest tube?"

Several of the residents, if not all of them, raise their hands. "Alright, Dr. Yorkie, let's go put in a chest tube. Everyone else, stand against the wall, out of the way, and observe."

I notice that Stacey, a seasoned ER nurse, has my size eight sterile gloves ready.
"Dr. Yorkie, what size gloves do you need?" Stacey asked.

"Sevens, please," he replies.

"Alright, Dr. Yorkie," I say, looking at him slightly askance. "What are we going to do first?"

"Um..." he stutters.

"We don't have time for that. This is a trauma unit. Our patients are counting on you knowing what you're doing. We don't have time for indecision.60mg of Morphine, IV, now," I order. "Now what, Dr. Yorkie?"

"Set up the tray?"

"Very good. Next, what size tube will we need to be using?"

"16 gauge?" he guesses.

"Not this time. A 16 gauge would be correct if this was a simple pneumo, but this is a trauma and our patient will be ventilated, which will increase her risk of having air leaking around the tube. In a trauma case you want a large bore chest tube. 26 to 28 gauge."

I watch as the young man sets up his tray, my fingers twitching with the need to do this myself. His slowness is annoying the hell out of me. Turning slightly, I watch as the nurse administers the Morphine.

"Remember, people, Morphine is a depressant. We need to watch our patient's respirations and make sure she doesn't stop breathing. Alright, Dr. Yorkie, let's do it."

I watch as he meticulously preps Bella's chest with Betadine, makes his incision and positions the trocar on the chest tube. Man, that thing is nasty looking. The exceptional nurse that she is, Stacey positions herself opposite Dr. Yorkie so she can hold Bella in place and provide resistance for the procedure.

"Alright, son, this part takes force. When you push the tube into the chest cavity, through the chest wall, you will feel a pop, as will Stacey over there. Be prepared. I don't want to have to catch you if you fall over. Oh, and be careful, don't miss and hit the heart. That would be bad. Very bad," I say, chuckling on the inside as I look at him. I remember inserting my first chest tube, and hearing those exact same words uttered to me.

The boy takes a deep breath and pushes forcefully. I can tell the exact moment he feels the pop; his eyes widen and he pales dramatically. I automatically step behind him, just in case I need to catch him.

"Very good," I say, smiling at him by way of congratulations. "Now, apply the Kelly clamps and hook the tube up to the Pleurevac." I watch Bella's saturation levels slowly start to creep up with the chest tube attached to the suction. I breathe a sigh of relief.

"Alright, Dr. Yorkie, suture that in," I tell him, all business again. "Get x-ray back. We'll make sure we got this right. Next step is to get her intubated. We can check that tube placement, as well, when they do the x-ray. Who wants to intubate?"

Thirty minutes later, I peel my gloves off and flip them into the trash. Bella is stable for now. Critical but stable. Flail chest is something I haven't seen in years. It will make her recovery longer, but I definitely think she has a fighting chance. Certainly, if she makes it through the night, I will be guardedly optimistic.

I grab the chart, look down at the information I've written on my scrub pants and start writing orders and notes.

I walk to the doctor's sleep room and tap on the door. Edward is sitting in a straight backed chair facing the door; his mother, my wife, is sitting in a chair next to him, her arms around him and a worried expression on her lovely face. There are black circles under his eyes, and his expression is haggard. I grab another chair and sit down opposite him.

"Alright, Son. We're done, and she's on her way up to ICU. She's critical. Stable . . . but critical. As you well know, the next 24 hours will tell the tale. If she makes it through the next 24 hours, I think she has a good chance at a full recovery. She has a pneumo and a flail chest injury. The CT of her head looks okay. She has a pretty serious concussion, but no fracture, and so far, no swelling. Her spine looks good. We got Dr. Harriman from plastics to suture the scalp wound, so I don't think there will be a scar. Her pelvis is severely bruised, but no fractures there."

He nods, and releases a deep breath. "How did this happen, Dad? Did you hear what happened? Why was she in uniform? She doesn't work nights. What's going on?" He stands slowly, his voice rising until he is roaring at me, his hands clench into fists, and his face is a mask of fury and pain.

I stand, as well, and reach out and place my hand on his arm, attempting to calm him. I know he wants to get to Bella as soon as possible, and I want him there. It seems to help trauma patients to hear loved ones talking to them, but in this state, he's going to be more harmful than helpful.

"Calm down, Son. I don't have all the details, and really, it doesn't matter right now. It's something we can figure out later. Right now, we need to concentrate on helping Bella, and in order to do that we all need our heads on straight. Going into ICU with your current attitude and being this upset, all you'll do is upset Bella, and that won't help."

e/n So? Whaddaya think? Is Bella going to bounce back? Is Edward going to pound someone into dust? Is Bella going to be able to go on their little 'getaway' with Edward? What was Edward planning, anyway? Will Bella be able to go to Thanksgiving at the Cullen's, or will they be bringing Thanksgiving to her in the hospital? So many questions . . .

Let me know what yours are. You know how. It's right next to that little speech bubble. LOL

Until next time, bbs!