Jessica Norse swallowed her mouthful of apple and took a quick swig of water before glancing at the clock. She had three hours left on shift before she could go home and cook the spinach and mushroom quiche she had promised herself. Until then, her snack would have to do. She yawned deeply; of the seven prank playing frat brothers brought in at the start of her shift she had finally manage to send four home, get two admitted for twenty-four hour observation and the last transferred up to Endocrinology for conformation and treatment of type two diabetes onset. Her pager went off and she reflexively pulled it from her pocket to check. Incoming RTA patients; two critical, one minor. Pocketing the pager, she downed the rest of her water, grabbed a palmful of hand sanitizer and ran back to the Emergency Room. As chief attending physician, she was responsible for decisions, delegations and actions in the ER that morning. Alec, her chief aide, met her at the door. Linda and Missy were prepping treatment bays.
"Zoe," called Jessica, naming a senior nurse, "take the minor patient when he or she arrives. Alec, page Doctor Lane, we'll need her."
"Already done," grinned the tall, lanky South African. The unloading doors hissed open and their first patient arrived.
"Male, fifties, unconscious since before our arrival, obvious shoulder injury, likely fractures to the same arm. Breathing uneven and shallow, oxygen saturation poor, heart rate high but steady. Possible chest injury, laceration to the head."
Jessica took the monitor readout from the second media and scanned it as her team hurried to hook the man up to their own machines. She snapped on latex gloves with practiced ease and stepped in to listen to his heart and lungs. Gently palpating his chest she found suspicions of at least two fractured ribs. His pupil response was good, and the cuts running through his scalp were superficial and would require nothing more than a good cleaning and stitches. His left arm and shoulder were another story. The clavicle was definitely broken, as was the wrist. Despite being a hardened veteran of trauma medicine, when she looked at the sickening deformity of the shoulder and upper arm Jessica felt her stomach churn slightly.
"Alec, I want a CT and neck, shoulder, arm and torso x-rays. We need to see what's going on in here. Linda, let's get him a unit of o-negative too; there's a lot of blood on him." For a moment, Jess watched the monitors, happy to see that the man was stabilizing nicely. Missy was cutting away the last of his clothes; she pulled a wallet from his jeans pocket.
"Gilbert Grissom," she read, "he's from Las Vegas. Fifty-four last month, organ donor card, photo of the wife, and one of a sonogram." Jessica and the others turned to stare at her. "It's dated from Tuesday, and it says thirty weeks."
Alec put down the phone and turned to Jess.
"CT's free; he can go up right now."
"Send him, and alert the OR, the next one is a possible pregnant female, thirty weeks gestation." Alec uttered a phrase Jess would normally scold him for saying, grabbing up the receiver again and tapping in the extension.
…
Candy was draped across her chair more so than sitting on it as she waited for morning meeting to get going. With her eyes closed and her purple hair in her face, she tried to pretend she was still as asleep as she felt. She had spent much of the previous evening and then night working on her banners for the fair, and then trying to keep the artwork flat and out of the way of her parents until it dried. Sinking further into the chair she sighed. Sara was late, which was unlike her, but so were Maria and Marissa, which made her think traffic was probably bad in town. Yawning, she thought of the cake in the fridge; Annie McKenzie made the best sponge cake, and had drawn a butterfly atop the icing when Candy had asked. Having skipped breakfast, that cake was looking more and more attractive by the minute thought Candy. She grinned at the thought of singing to her friend, and flexed her ankles as she waited.
"Never seen the like," came Marissa's voice down the hall, as she and Maria hurried into the room. Mary raised an eyebrow at them.
"Main Street is shut where it crosses with Church Road," said Maria, opening her locker and tucking her bag inside. "There are police everywhere, turning people around and diverting them."
"Why?" asked Mary.
"An accident," continued Marissa as she put her lunch in the community fridge. "A red van hit a car and took out a huge chunk of the churchyard wall. The car was practically obliterated, wrapped around the light pole and all crunched up." Candy looked at the clock on the wall; fifteen minutes past the start of the day. She sat up slowly, turning to the latecomers.
"What kind of car was it?" she asked.
"It was too mashed up to tell," said Marissa. "But it was silver, and I saw the Toyota logo on the road. I hardly had a chance to look; they were turning everyone around."
As Marissa whined about her lack of viewing Candy felt cold dread in the pit of her stomach. Sara drove a silver Toyota Prius, and she was fifteen minutes late.
…
Doctor Imelda Lane arrived in the ER at the same time as Simon and Jillian were unloading their patient.
"Female, late thirties, breathing shallow but steady, pulse slowly dropping. Oxygen saturation falling, estimated three pints of blood loss. She's roughly early third trimester pregnancy, serious RTA, unconscious, hemorrhaging, and contracting. Not responding to our attempts to stop it, multiple compound fractures to the lower right leg, deep penetrating wound to the left shoulder, object still embedded." Jillian paused to breathe deeply as Simon took his turn talking; they helped transfer the woman to the hospital bed and stepped aside as Imelda pressed the ultrasound sensor to the woman's abdomen and Jessica checked her airway and starting to push units of replacement blood.
Linda cut away blood soaked clothing for easier IV and monitoring access while Missy concentrated on the shoulder, packing the wound to slow the bleeding until the doctor's had a chance to remove the glass. The heart monitor suddenly burst into a rising squeal of bleeps signaling tachycardia.
"Heart rate's gone up like a rocket," said Linda, eyes on the monitors.
"Blood pressure is falling," Missy called, voice tight.
"Contractions are slowing," said Jessica, biting her lip in concentration. "Hypovolemic shock is setting in." The ultrasound beeped and Imelda stared at the image.
"Surgery, now!" she barked, kicking off the brakes on the bed. "Uterine rupture; the baby has moments left, if that. Move, now!"
"Alec, get onto the OR," ordered Jessica, squeezing the bag and pushing blood through the IV by hand as they ran for the elevator. "Missy, we need more blood ten minutes ago; she's hemorrhaging internally as well." The doors slid open as they approached, Linda steering at the head of the bed, Jessica and Imelda on either side, applying pressure, forcing more blood and praying for the OR to be ready. Linda clutched equipment in a death grip as the three of them shot out through the doors and thundered down the hall.
Doctor Jacob Fielding stuck his head out of theatre three and waved them in; Linda handed over the monitors and their care to a theatre nurse as Imelda and Jessica took turns rattling off their information. Jacob nodded as one of his team came forward, holding a gown ready for Jacob to slide in to. By the time the three women were backing through the doors of the operating suite, iodine was dripping from the patient's abdomen, and Jacob was sliding his scalpel over her skin.
…
After half an hour Candy could take the tension no more. She walked into Mary's office trembling all over; the other woman looked up at her.
"Go," said Mary, her voice gentle, her eyes tense with worry. "Call me!" Candy nodded, and fled.
…
Jessica trudged back into the ER with Imelda and Linda; a tension headache beginning to worm its way up behind her eyes.
"Blood has gone down to the OR," Missy informed them.
"We know who she is," said Alec. Jillian held up the purse she had rescued from the foot well as they pulled the woman from the car.
"Her name is Sara Grissom," she read out, "Nevada license. Her birthdate is… damn, she's thirty-nine today."
"That sucks," groaned Simon and Alec in unison.
"Photo of the husband with a grasshopper in his hair- that's different- and one of the baby." She held up the matching sonogram picture. "Also, an alert card for a shellfish allergy." Simon scrolled through the phone.
"Her ICE is Gil Grissom," he said.
"He's upstairs in x-ray at the moment," replied Jessica. "He didn't have a phone on him, just his wallet." Linda picked it up and began to search more thoroughly. She pulled a card of emergency details from under the license.
"Sara Grissom," she told them. "There's nothing else here."
"So there's no one else to contact," sighed Imelda, tossing her gloves and raking her hands through her short red hair.
Jillian began to wipe down the stretcher with antibacterial cloths, readying it for the next patient. Simon checked their portable equipment with a sigh. He looked at the ER staff, and shook his head.
"You should have seen the car," he told them. "I've never seen anything like it. I honestly don't know how we got them out of their alive."
"The van took out a brick wall AFTER it hit them," added Jillian, spreading a fresh sheet over the gurney. As if on cue, the pneumatic doors hissed open and in rolled the third patient, sound asleep and cuffed to the bed. A police office trailed behind the two medics; all three professionals looked grim.
Imelda gagged as the overwhelming stench of human sweat mixed with sour alcohol pressed on the group from fifteen feet away. Rage pounded behind Jessica's eyes as her headache worsened. They all stepped back as Zoe took charge of the man. Their reports given, the two medics joined the others.
"What of the two in the car?" asked the woman, her eyes betraying the disgust she was trying to hide from her face. Seeing their stony faces, she sighed. "He was asleep in the roses; a few skin pricks from the thorns and a face full of airbag chalk."
The police officer stepped from behind the curtain, shifting his heavy belt to a more comfortable position at his waist.
"Vehicular manslaughter," he said, hands thrust into his pockets with resigned gloom. "The wall he hit crushed a pensioner putting flowers on his wife's grave." Jessica turned away, shutting her eyes for a moment, before she went to update her patient notes. Imelda caught up to her as the CT scan came up on the monitor.
"He's got a serious concussion," murmured Jess. Imelda stared at the screen, lips pursed in concentration.
"No bleeding though, he's lucky there. Have you got the x-rays yet?" Jessica moved the mouse and right clicked a few times. "Ouch," hissed Imelda. They stared at the shoulder.
"That's going to take some serious work," said Jessica, eyeing the shoulder images. Imelda gestured for the rest of the chest films as she pulled her glasses out of her pocket and peered closely at the screen.
"Pneumothorax," they simultaneously noted.
"Small, but we need a chest tube anyway," noted Imelda.
"Hopefully he won't need ventilating," replied Jessica, crossing her fingers for a moment. Alec came up behind them.
"They're sending him back down," he told the women. "Thistle can take him in an hour; she's wrapping up a knee replacement right now." A slight smile crossed Jessica's lips at this news. Andrea Thistle was a tiny woman with icy blue eyes and rage inspiring red hair. Her personality was as prickly as her name, but she was the best orthopedic surgeon in the state.
"Let's get him as stable as we possibly can then," she smiled.
…
Jacob Fielding and his team were grim with battle. Their sleeves, gowns and gloves were stained dark red. Empty bags of donated blood were thrust into an unceremonious pile, needles darted quickly with precision efforts to stop the bleeding and Jacob tried to outrun nature with medicine as the goal post inched ever farther away.
"Enough," he ordered the head of his surgical team. "We have no choice, she'll die otherwise. We can't stop the bleeding.
…
The team worked on Mr. Grissom with gentle care and renewed hope when he arrived back in the ER. Linda set to work on his scalp; cleaning and stitching the two gashes running through his hair. Jess rattled off orders to Alec and Missy as she listened to his chest; his breathing was still labored and shallow. She altered the flow of oxygen through his mask, hoping to raise his blood oxygen saturation. The x-rays had shown three fractures, and the huge bruises already spreading across his torso and side showed the impact from the air bag, as well as the side impact to the vehicle that had put pressure on his organs. Imelda concentrated on the chest tube, going through the armpit on his uninjured side. She smiled tightly with success and stitched it in place before checking the one-way valve and then cleaning and dressing the area. By the time Thistle was ready to take their patient for shoulder surgery, Jess and Imelda were satisfied that he was doing well. Another x-ray had confirmed the drain was correctly placed, his breathing had improved somewhat, and despite the blunt trauma to his organs, his systems were functioning relatively well.
"Good luck," murmured Jess under her breath as she watched the orderlies wheel him away.
…
Candy parked two streets over from Annie's Bakery and ran the rest of the way, dodging traffic, people and officials. She ducked under the arm of a gesticulating police officer and scrambled up the trellis on the side of the toy store next to the bakery. Scanning the crowd her gaze found the person she was looking for. She dropped to the ground and pulled her cell phone from her pocket; fingers flying as she tapped out a text message. Inching around a pair of squad cars, she sidled up to the tape, waiting. Detective Iris Peters walked over to her cousin, phone still in her hand.
"Hey Candy," she nodded. "What's wrong?"
"The second car," said the girl, tears in her eyes as her gaze fell of the crumpled ruins of the silver Toyota. "What happened to the passengers?"
Iris frowned in confusion.
"Please Iris," begged Candy, trying her best not to look at the scene. "Sara is my friend, I work with her." Iris stared at her cousin, thinking.
"The calculator lady? The one who helped you with math?"
"Yes," said Candy tears falling freely now. Iris sighed.
"They were taken to Lebanon," she told Candy, "both in critical condition." When Candy began to cry harder, Iris stepped closer and wrapped her up in a hug. "The van driver went there as well, but there's nothing wrong with him that a cup of strong coffee and time won't fix."
"He was drunk?" cried Candy, outraged. "And he just walked away?"
"He'll go down for a long time; you remember old man Thomas Casper?" When Candy nodded her recollection of the eighty-seven year old former police chief, Iris continued. "He was putting flowers on Eliza's grave when the van knocked the wall over; it crushed him instantly." Iris' voice was cold with fury at the death of the past head of her profession. She sized her cousin up. "Are you going to be ok? I have a job to do here." Candy nodded and sniffed. Iris produced a tissue from her pocket and another quick hug, before heading back over to the other officers.
After blowing her nose and wiping her eyes, Candy jogged back to her car. A quick call to Mary and couple of tearstained tissues later, she put the car in gear and headed for the Dartmouth-Hitchcock Medical Center in Lebanon, trying to ignore the knowledge that it was the only Level One Trauma Center in the state.
…
Rachel Harrison had just finished her latest series of patient checks when a surgical nurse and an orderly came rushing into the Neonatal Intensive Care Unit pushing an incubator. The baby was tiny and still smeared with blood. Doctor Shawna Feather, a blue eyed blonde woman with the calmest and kindest of dispositions who had become a neonatal specialist after discovering she had been born without a womb, was with them, having been paged by Doctor Fielding fifteen minutes before.
It was only much later, after the baby was stabilized and settled in the incubator, connected to tubes, wires and monitors, and encased in just the right amount of heat and humidity, that Rachel had the chance to look at the card hastily shoved into the pocket at the end of the bed.
Name: Baby Girl Grissom
Date/Time: Sept. 16th 10:07am
Weight/Height: 3lbs 1oz, 14 ½ ins.
Mother: Sara Anne Grissom
...
...
I have no medical training beyond emergency first response and oxygen administration for diving injuries, so any mistakes are regrettable and wholly unintentional. Thanks for all the awesome reviews, please keep them coming. Your thoughts are so inspirational.