"Blunt trauma to the head and neck, headed to the resus room in 10," Nina, now in all burgundy scrubs, scurried toward Jane, cutting her off at the trauma desk. She handed the doctor her notes, and Jane snatched them.
Midafternoon hit the hospital like a category 4 – residents, attendings, nurses, and techs alike sprinted from point A to point B, and the squeak of their sneakers on the linoleum was the hurricane's staccato downpour. Some said most trauma patients arrived in summer, some said it was when the leaves turned, some said when the snow fell. If one asked Nina or Jane, they would say it never really fluctuated. Midday was midday in South Boston no matter the weather: catastrophe did not wait for the meteorology report before striking like thunder.
This enamored Jane Rizzoli.
When her colleagues bumped and herded around her, she fed off of their anxiety, their excitement, their scramble. The cold from her lunchtime walk had dissipated and storming through the wing with authority had replaced it with a sweaty gleam on her skin. "Massive facial trauma?"
"Total. Sounds like the guy was beat with a crowbar. They're having trouble establishing an airway, and tidal volume is slipping," Nina shouted over the din of ringing phones and arguing patient families. The confident look in her eyes hadn't left since their successful repair of Mr. O'Rourke's ruptured diaphragm, but her face was much more solemn.
Jane picked up on it. "They last called in five minutes ago?" she asked as she scrubbed vigorously at her hands. The fervor in her routine was merely that – routine, an excellence ingrained.
"Yeah, coming in from the North End," Nina replied. She shook the dry erase marker in her hand with the intent to draw out all the residual ink. It was when she finally uncapped it that Jane spoke again.
"Send him straight to the OR. I guarantee you if his breathing's as bad as your notes say, it's not going to get any better," Doctor Rizzoli said. Nina stood stock still for a heartbeat, two.
"You sure?" as soon as she asked, the nurse knew she'd just wasted seconds of their time: Jane never instructed her to do something that she needn't really do.
"Positive," the surgeon answered, brow curled and mouth in a flat line below her nose.
"Alright. I'll page EMS, tell them to go straight there," Nina said. She ran back the way they came, reabsorbing into the indeterminate hustle, her natural hair the only thing Jane could view as she looked back in the direction of the radio desk.
Not soon after, Jane bolted that way herself, hearing the scream of the siren. She took morbid comfort in its call – it reminded her of the agony within the wagon, lest she, in the haze of adrenaline, forget that she treated real people in real distress. She pulled up short in front Nina and the other trauma nurses near the phones: Two EMTs entering from the back bay tried desperately to bag valve resuscitate her patient as they shouted for a clear pathway through the hall.
The OR loomed still about a 30 second trek away, and the chest rise and fall of the man on the gurney slowed down with each millisecond: not good. Beyond not good – life-ending. Her eyes moved up to the mangled mess that used to be the man's face, the giant purple hematoma that used to be his neck, and made a lightening decision. "NINA!" her voice bellowed, and the nurse ceased every movement. "Page the ENT on call, NOW."
"Got it. Paging Dr. Isles now," said the head trauma nurse, sending the page with a cold shiver running down her spine. Jane locked eyes with her one last time, and as with every trying case, they infused each other with a shot of strength before the shit really hit the fan.
Apparently, that shit had reached its destination, because the chaos of the ER buzzed into oblivion for Jane when the bag valve malfunctioned right in the EMTs hand. The gurney was headed full speed in her direction with a functionally flatlining patient, so she readied her muscles for action.
Maura had just burst into the ER's swinging doors when she felt the excitement of Ethiopia for the first time since returning. Her heels, cacophonous in their trot down the halls, stuttered to a halt when she saw the gurney of the patient she presumed she was to consult on: nurses crowded it, guiding it toward the operating room, and EMTs raced behind, struggling to keep up and shout their particulars to the staff.
The most invigorating sight, however, was not the crowd around the gurney but the woman straddling the man atop it. Maura could see that even on bended knee, that woman would eclipse her if they stood side to side, easily by four inches, maybe five. She pumped at the man's chest, his blood covering her gloves, and Maura only saw her back, but that was enough. The broad shoulders cocked backwards; Dr. Isles watched life ripple from tricep to palmaris longus, then the intertwined fingers fired: repeatedly, and with fierce intention.
The bed and surgeon soon disappeared behind the operating room threshold, however, and Maura shook off her reverie. She made a sharp left turn into the wash room, changed into her scrubs and more sensible shoes, sanitized herself, and pushed her way through into the theater. The surgeon she had seen straddling their patient had since moved; she now stood to the patient's side holding a pair of spreaders. Nina, the nurse she had met on her first day by chance, fed a tracheostomy tube into the man's throat. Ah, she thought as she got the first good look at the area of the patient's face and neck, so this is why I am here.
The surgeon heaved a sigh under her mask as she watched his breathing slowly return to a worrisome, but sustainable rate. Nina tapped her with her hip in solidarity, and Maura took the tiny reprieve as her time to step forward. "Dr. Maura Isles," she introduced herself by turning full on toward the tall woman who had just finished the airway procedure. "I'm the otolaryngologist on call."
"Well shit. You're certainly younger than Dr. Paulsen. Jane Rizzoli," the surgeon replied, nodding. "I'm the attending right now. This is Nina Holiday, our head trauma nurse."
"We've met," Maura said. Just as Jane was about to say something, she cut her off to continue. "Do you have x-rays of the patient's skull and trachea? I'm concerned about that bruising on his neck."
"Uh, yeah. Walk with me. We stabilized the cervical spine and there are fractures, but nothing devastating, nothing displaced. You've got to see that voicebox, though, right around C2," Jane replied, shaking off the gut feeling of having been disrespected. Surgeons were peculiar people, she had learned. They approached the x-ray results and Maura simply studied them. "Looks like a bomb went off in there."
Maura crooked her neck at the colloquial description of the damage. "I suppose it does," she offered. "I'm going to have to perform an open reduction and internal fixation – Mr. Brannon's thyroid cartilage has suffered catastrophic trauma: I see at least three vertical fractures. Are there any other injuries that take priority? If not, the sooner I can operate, the better."
"Nah," Jane answered, clearing everyone except herself, Maura, Nina, the anesthesiologist, and two other nurses. "The OMS will be here soon for his jaw, but securing the airway is most important: I won't let him work until we do that."
Maura nodded and walked back toward Mr. Brannon, who was still establishing a normal breathing pattern. They simply had to wait until he regained one stable enough to undergo anesthetic. Her fingers hovered just above his bloodied and swollen face. "What happened to him?"
"Met the wrong end o 4. Guy who beat him to a pulp got away; guess cops are chasing him down. Honestly, its probably all a mob thing," said Jane as they reapplied gloves for the new procedure.
"How could you possibly gather that?" Maura asked, incredulous.
"Gather what? That it's a mob thing?" Jane replied back, stopping to look Maura full in the eyes with her own. She smirked, her mouth open in confidence and more than a little amusement.
"Yes, that," Dr. Isles confirmed.
"Well, my brother's a detective in the organized crime department for BPD," Jane answered. "Maybe I have an insider's perspective, but it seemed like the logical leap to me."
"Well, I prefer not to do that," the shorter woman replied, thanking Nina for bringing over the appropriate tools to her side of the operating table.
"Do what?" Jane asked.
"Make leaps."
"Ah. I guess I can get that. But that's all good, Maura. It's why I'm trauma and you're a specialty," Jane offered, not at all in condescension.
Maura blushed. She couldn't have said why if anyone would have asked. She looked back to Mr. Brannon's throat, running a ghost of a palpation over his adam's apple, now deformed and swollen. Her eyes glanced at his stoma for the briefest of seconds. "Your tracheotomy is inspired. I look forward to working with you today, Dr. Rizzoli."
"Please. It's Jane."
"Dr. Rizzoli, would you hand me that oscillating saw?" asked Maura, non-dominant hand holding the thyroid cartilage of Mr. Brannon in place. Jane surveyed her – she moved in music with a blade in her hand: not the flowery twang of strings, nor the bellow of horns, but the drumming tempo and bass of percussion – simple and consistent added up to more than the sum of their parts to create something beautiful.
It was a puzzle to Jane, then, that for all the rhythmic beauty of her cutting, Maura seemed to prefer saws and lasers to the scalpel. The woman's use of 'Dr. Rizzoli' in the face of Jane's preference for her first name was just another piece of evidence for this detachedness; the surname belonged to her, yes, and it sounded professorial and crisp coming out of Maura's mouth, but 'Jane' was more intimate, more searing. In a life rife with little time and much disaster, Jane made genuineness with her colleagues her mission: better to be burned for feeling too much, for being too personal, than to be frozen by no attachments. It became clear, just from the knifework, that she and Maura were opposites in this way.
Not that the fact wasn't something to be celebrated. "Sure," Jane replied to the original question. She handed Maura the saw, and cringed at the burning smell when it sliced through cartilage. She had one weakness in her line of work and it was the smell created by the bone saw. Maura's nose didn't wrinkle, nor did her eyes water or her face grimace.
Jane found this newest contrast between them inexplicable. Enticing.
"You know, laryngeal fracturing is so exceedingly rare that I've only done a handful of these, maybe 3, before now," Maura commented in a voice that denoted talk of the weather.
"This is only the second one I've seen," replied Jane, a little surprised by her colleague's chattiness. But, she would roll with it. "The first Dr. Paulsen did, and boy, it was a mess. First time for both of us, I think. But we got it done. Girl eventually got her voice back." She took over the stabilization process as Maura set out on the laborious task of resetting the vocal folds. "How you think he's gonna do?"
"I really can't guarantee anything until this procedure is over and he regains consciousness," Maura warned, as though guessing would jinx her progress.
"Alright, alright," said Jane, raising her eyebrows since she couldn't raise her hands.
They worked there for two hours: Maura carefully resizing, approximating, stabilizing, Jane arranging, holding, spreading. "I'm going to need the miniplates here, soon, Nina," the ENT said.
"You got it Dr. Isles, handing them to Dr. Rizzoli now," replied Nina, coming up to Jane's left and giving her the tray of tiny instruments that would hold Mr. Brannon's throat together again.
"Thanks, Nina," Jane answered the action with some gratitude and a wink at her associate.
Nina's heart melted and it caused a smirk, dipped in a little bit of bashfulness, to creep onto her mask-covered face. "No problem, Dr. Jane," she said affectionately, with some sarcasm to send it down Jane's gullet with smoothness.
"Yeah, yeah. Dr. Isles, just from lookin' at him, he's going to need a PEG, isn't he?" asked Jane, referring to a percutaneous endoscopic gastrostomy tube, or a feeding tube placed directly into the stomach through an incision in the abdomen.
Maura took one miniplate to lay across the thyroid cartilage before her answer. "Given the state of his nose, yes."
"Ok, I'll handle that," said Jane, turning to the anesthesiologist. "Hey Miguel, give me another hour or so after she's done with this to put the tube in, yeah?"
Dr. Miguel Concepcion studied the patient's vitals before conceding. "Sure thing, Jane." After a beat, he added, "it's the least I can do since my tribe is gonna crush your sox this weekend."
"I'm sorry, has anyone cared about the Indians since 2007… when we kicked their ass in the ALCS?" Jane spat back, but Maura spotted humor in her rising cheeks.
If Jane marveled at Maura's precision and surgical grace, Maura marveled at the ease with which she bantered with her coworkers. There had been little of that in her lifetime, let alone in her stint with Doctors Without Borders: basically she formed a close bond with Ian and two other doctors she practiced with. Jane seemed to have a close bond with everyone she encountered.
"Yeah, yeah, Rizzoli. You take that attitude into tonight's game and wake up Sunday after you've been swept," Dr. Concepcion laughed, adjusting his patient's dose and oxygen intake.
"Ok, Miguel, you keep dreamin'," Jane replied, chuckling. Her laugh, accompanied by a small sigh, was wet and full and it crescendoed at the end. Maura felt the parabola swing in her gut, and she found herself wanting to be a part of it. Curious.
"Alright, we can begin to approximate the muscles, now, Dr. Rizzoli," she said, laying her tools down after having screwed the final plate into place. Her lizard brain flared in a timid possessiveness when she spoke, and her more developed cortex formed the primitive I would like you to speak to me now as a reasonable request from the primary surgeon to an assisting one.
Jane assented beautifully, turning to Maura, showing her the entirety of her front. "Perfect," was her only response, and once the muscles of the larynx had been placed, she smiled at the otolaryngologist, who had headed the surgery of nearly four hours. "You know what, Maura? I can close." She offered after a few minutes, and Maura looked to her in disbelief.
"Absolutely not. I'm seeing this all the way through," Dr. Isles insisted, and Jane shook her head with a soft laugh.
"Alright," Dr. Rizzoli acquiesced easily enough. They finished the sutures over Mr. Brannon's voicebox, and then she walked down toward his midsection. When Maura moved to follow, she held up her hand. "Uh uh. I got this. You've been in here for…" she stopped to glance at the clock, "almost four and a half hours now. Call it a day."
"So have you," Maura countered, secretly pleased with the feeling in her chest at someone showing her kindness.
"Yeah, but I was only assisting. You're the real MVP," Jane said. Nina laughed quietly in the background, and Maura wanted desperately to understand. "Plus, how many of these have we done, Nina? Hundreds?"
"Hundreds," said the head trauma nurse. She was already preparing the PEG tube and the necessary tools for the procedure.
"See? It'll take me twenty minutes. Tops," Jane smiled. Maura knew that it was meant to charm her into leaving.
But, she did it anyway. "Alright. Well, thank you for all your help today, Dr. Rizzoli. It was a pleasure working with you, as I knew it would be," she said over her shoulder on her way out.
Jane's cheeks colored pink. "It's Jane."