It was not true chaos.
True chaos was shots being fired, people in a panic, trampling one another and falling to be trampled themselves. Chaos was smoke and flames and a thousand shouts from a thousand throats. Chaos was roofs being ripped from houses by winds of godlike wrath.
This was just one man, draped in blue and surrounded by people swathed in blue paper gowns and white gloves, who wouldn't stop bleeding.
Cas stood, useless, blood-soaked gloved hands folded in front of his chest as though keeping them sterile mattered. Disseminated intravascular coagulopathy, a disconnected, orderly corner of his mind supplied. An abnormal clot somewhere was using up all the clotting factors, leaving raw wound edges bleeding freely with no mechanism to stop. He watched, numb, as nurses attached bags of donor blood to IV poles, and as deep red flowed through the tubes into the patient on the table – but not as quickly as rivers of fresh, bright red seeped from the edges of the surgical wound, the endless tiny vessels in the subcutaneous fat…blood dripped from the edges of the drapes onto the white linoleum floor in tiny rivers of scarlet to pool in the cracks and indentations of years of hard use.
"Cas!" one of the surgeons barked. "Get in here and Bovie everything you see, and if it doesn't burn, clamp it!"
The tech was handing hemostats faster than Cas could keep track of; the circulating nurse had called in two more staff who had not even donned masks in their hurry, and they were opening additional hemostats onto the field as quickly as the tech passed them off to the surgeons.
Cas took up the electrocautery pencil and began wiping blindly with a sponge, trying to soak up the cascades of blood and see where it was coming from, and within seconds the sponge was sodden and limp in his hand, warm as the body from which the blood that soaked it had just escaped. He reached in with the pencil anyway and began cauterizing anywhere there might be a vessel in the subcutaneous fat, reasoning that there was little damage he could do there, and the most good.
"The clot's in his left renal artery," he heard dimly, and the words themselves made perfect sense, except that Cas couldn't make them apply to what was on the table before him. The tone of the Bovie sounded and the smoke plumed, and he moved on to another vessel.
There were chimes and long beeps and frantic motion at his elbow, and he continued, seeking another tiny seeping vessel and cauterizing it, a man with a bucket against the incoming tide, until one of the surgeons gently took the pencil from his fingers.
"It's done, Cas," she said, placing it precisely in its plastic holster. "We did what we could."
Cas looked at the man on the table before him and it slowly dawned on him that he was no longer bleeding.
He was, in fact, no longer doing anything.
Stricken, he looked at the surgeon, who was collecting the suddenly useless hemostats with a detached efficiency. "Just…just like that?"
"There wasn't anything more we could do," she replied. She looked sadly at the body on the table. "Sometimes it happens, especially in the heart room." She turned to him. "You're a resident, and this sort of thing is hard to see when you're fresh. But if this is going to be your specialty, you need to grow a thick skin. Because it will happen to you again, and it will be your table, and you will have to find a way to deal."