Thanks to all my readers. Special Thanks to the Three Stooges/Musketeers (NY Gal, Ragni and Anime) and an additional thanks to Krows Scared.
This early update goes especially for you four. Enjoy!
Chapter 73
Billy slipped my mind.
A fatal mistake.
He just slipped my mind.
I was taken over by the post-op and that kid with cracked ribs, he started having some shortness of breath and I was forced to unclamp his chest tube though I was not ready to apply suction just yet. His morning X-Ray was good but because of pain, he was unable to breathe deep enough. Advising one of the senior nurses to tell the new ones to provide him with a pillow or folded towels to breathe and cough against, I left mess tent again. Somewhere around 2am, Billy was shifted back to post-op and shortly after, his friend with imploring eyes. I was making rounds in the mess tent again, hoping the kid with cracked ribs did not develop pneumonia. I gave him an intercostal nerve block to help with pain and held off morphine unless needed.
When I got back to post-op, first of a series of unfortunate events welcomed me. Somehow, Billy's chest X-Ray was misplaced. Either that or somebody bungled my orders and no chest film was taken. I felt a cold shiver go up my spine.
"Look for the X-Rays, Kellye. I ordered them. I remember I did. Find me those X-Rays." I had an urgency in my tone that wasn't lost on her.
"Hawkeye! He is stable. And asleep. His vital signs stayed stable through out his stay in pre-op and during surgery. That's why Major Burns operated on him in the end." Frank changed his priority number? What the hell was he thinking? That it was my idea of a joke? And what was the matter with the chest film?
"Kellye! I have a bad feeling. Find me those X-Rays, will you?" I kept hearing in my head what that kid, Johnson's friend, said about how he incurred his injuries. That he was standing and one of our grenades went off. Maybe I was reaching but it seemed like the guy with the grenade was lying on the ground when that happened.
Billy's friend was still out cold.
And there were no X-rays.
"What is this? Calcata General? I want those X-Rays. Find them! Ask the technician in X-Ray if he even took the pictures or are we running after a ghost? And who told Frank to change patient priorities? Give me his chart!" I was getting angry now. Not only had Frank decided this kid did not need to be operated earlier, he hadn't asked for a chest X-Ray either. And to add injury to this insult, he was the surgeon of record.
"Its not Kellye's fault." Came the dulcet tone of not-so-dulcet Cate O'Hara.
"I know. Its Frank's fault." I snapped back, not appreciating this sucking up when stakes were so high.
"What is Frank's fault? Cpl. Johnson is doing fine, if his vital signs are any indication of his status." Again with the tone.
"Have you ever seen injuries from a grenade? The shrapnel flies, like a shot gun, only thing is, it has real sharp edges and they fragment real small. How was his liver? And stomach? And pancreas? I know you assisted him during the surgery."
"Read the notes." What the hell was wrong with her?
"Lt. O'Hara, when I ask a question, I expect an answer. I have read the notes and I advise you to read them too, once you are done telling me the inside story." I was now pissed!
"Liver had minor lacerations. Stomach had a rent too. There was no shrapnel entry site into retroperitoneum. That good enough?"
"Oh I feel peachy, Lt. Its this kid I'm worried about." I told her as I auscultated his lungs. Maybe she was right and Frank did do a good job. And there was nothing to worry about.
"You are being dramatic, Ben. He changed this soldier's priority number but he had good reason. He was stable and there were more seriously injured solidiers in pre-op."
"First, Its not soldier. He has a name. A rank. Considering you have worked on him, its not too much to expect, is it? Secondly, I did triage. I knew who was how badly injured. I ordered Johnson's chest X-rays. Where are they? Did the thought even cross your so-experienced mind that he had upper abdominal injuries, maybe some shrapnel entered his chest cavity? How about your ...How about Frank? Did he bother asking for a chest film? I hope he is right, Lt. But we don't work here based on hope and wishful thinking!" I did not know why I was getting so worked up about this kid except...That other kid, his friend, what he said something about Billy standing when the grenade blew. But it had been a few hours, right? If there were something wrong, something would have happened, right?
Cate was looking indignant and surprised. I ignored her and decided to get a chest film soon as he was conscious again. Meanwhile, there were more people needing my attention. I saw her leave post-op and shook my head.
And to think she had promise only a few weeks ago!
Kellye had no luck with his chest films. I kept hovering around him and had a nurse keep a half hourly check on his vitals, drain and output.
After a couple of hours, when I began to relax a little, he woke up and started coughing. That was not an uncommon thing because of throat irritation due to endotracheal tube. What was unusual was that the veins in his neck stood out even after the bout of cough was over. Telling the nurse to check his vitals, I started auscultating his heart and lungs. What I heard wasn't good. There was fluid, in this case blood, around his heart. His BP was stable; for now! His heart rate, however, was climbing fast. I asked for and got a pericardial needle and did a pericardial tap. Blood! This was not good, not good at all. Forgetting the X-rays now, I silently ordered Kellye to arrange six units of cross matched blood and stand by for surgery if the fluid built up again. I could see what had happened in my head. My worst fears were confirmed. Some shrapnel probably cut through diaphragm and injured the pericardium. Only then did I remember Frank. He was required to be paged.
"Klinger!" I could never understand why this poor man always ended up with the night shift.
"Cap'n." He mumbled groggily.
"Wake up, Klinger. Page Frank Burns."
"Major Frank Burns?"
"No. Ms. Uijeongbo, Klinger!" I snarled at Klinger and immediately felt bad.
"You know the time, Cap'n Pierce?"
"I do. But Billy Johnson does not. Page him, Klinger. Its an emergency!"
And with that, I stormed out of outer office.
Billy remained stable when Frank finally arrived.
"What is the problem, Pierce?" Frank asked pompously. I could have punched him right there and then but controlled the urge because time was of the essence.
"He developed tamponade, Frank." I informed the bungler of record.
"Tamponade?"
"Yes, Frank. Tamponade." I pulled him away from the patient as I saw a tantrum coming along. "Blood around his heart? Ring a bell? You did not ask for his chest X-Rays before going in?" I knew it was pointless and could have waited but because of this dunce, a kid was probably going to be under knife again.
"There did not seem...Pierce! I will not tolerate this attitude from an inferior officer."
"Too bad I'm a superior surgeon, Frank. When I say he is priority one, he IS priority one."
"So you are the superior surgeon, huh? Well, you could have ordered the chest films if you were so good. Now he has a tamponade because you forgot to order a chest film and its my fault." The idiocy of this logic did not escape me but there were bigger fish to fry.
"Frank! Keep yourself available. He might need surgery again! I will page you and you be in the OR, alright?" I menacingly stated before moving back to Billy.
"I will not tolerate this tone anymore, Pierce! I will check him myself and decide the course of action. I am the surgeon of record." Frank was all business in his smug, high n mighty style. Was he scared too? I did not think so.
After a brief examination, Frank turned towards me, "Good job with the needle aspiration, Pierce. His blood pressure is good. No signs of tamponade. Good catch!" He clapped me on my shoulder. What the hell was that? Both the patient and his friend looked at us, relieved looks on their faces.
"What the hell, Frank? You know there is at least one stray piece of metal in that kids chest, most likely in the mediastinum. Its not as peachy as you made it look." I snarled trying not to alarm the Billy or his friend.
"You are an alarmist, Pierce. I can understand what is going on. With nobody paying any attention to the Crackerjack Pierce, you have to prove that you are still worth something. I won't lose any sleep over that soldier, Pierce. Like I said when I changed his status earlier, he is stable and you are just out of touch." And with that, he left post-op.
Lucky for him. And me. I would have punched that smirk off his face. And broken my hand at the same time.
"Page Potter!" I ordered Klinger as I returned to post-op, my heart beating in my throat. I hated losing patients and this one was just like sand slipping out of my hands.
Just then, I heard loud coughing and a frantic voice call my name.
Damnit BJ, where the hell are you?
P.S. Lots of medical stuff in this one. I hope you don't wanna know what it all means. Its all correct though, just so you know.