After the brief break in the cafeteria with Natasha, Pepper and her friend said their goodbyes, each heading to their respective areas in the hospital. Virginia dove headfirst into her responsibilities, starting with rounds with the residents, not having time to absorb the news she had received that morning about the possible promotion. She spent time teaching them, sharing her experience, and guiding them through the cases they were handling.
Soon, the redhead left them to supervise the interns so she could continue with her busy day. She reviewed cases, conducted consultations, and in the early afternoon, performed a relatively simple cardiac surgery, a coronary angioplasty.
After the procedure, a call awaited her in the pediatric ward. It was a challenging situation involving a five-year-old child with a severe heart condition. Unfortunately, the diagnosis indicated that the girl would need a heart transplant to survive. As Pepper examined the little one and discussed the case with the medical team, she couldn't help but think of her own children.
Whenever she encountered a case like this, images of Eleanor and Theodore popped into her mind as if she were a character in a computer game, similar to "The Sims," with her actions and fates being controlled by invisible forces.
In the midst of her worries and responsibilities, a message from her friend Donna flashed on her phone. It was a request to take the twins to the movies with her kids, Ivy, aged 4, and Reed, aged 6, after their swimming class.
Pepper always felt a tinge of concern when leaving the little ones in the woman's care. Looking after four children could be a challenging task; she knew how exhausting it could be. However, Donna always swore that Theo and Ellie were no trouble and that she actually loved having a house full of children, just like Harvey.
Her friend believed that the contagious energy of the little ones made the house more lively and that the joy of having them around outweighed any fatigue that might arise. She had a special way of handling them and somehow always managed to keep the situation under control.
Over time, Pepper came to understand that it wasn't a bother for Donna, and as a result, she agreed to the woman's desire to spend time with the children, knowing they were in good hands. And that's exactly what happened that day; she quickly replied to her friend, informing her that the nanny would pick up the twins as soon as they returned. But she didn't have time to check the response; she barely sent the message when her pager informed her of an emergency.
Not only that, the call came from Tony Stark at 3:26 PM.
He shouldn't even be in the hospital anymore. His shift had ended at 3 PM.
Hastily, she descended the three floors to the sector where she had been paged. Upon arrival, she found the scene busier than usual; after all, it was Halloween, and on that date, it seemed a prerequisite to do stupid things. Sighing, a trail of blood led her directly to room 2, where a tremendous commotion was occurring. Nurses were moving around the space, fetching requested supplies and medications, paramedics were maintaining the oxygen ambu at the correct flow, and residents were trying to check the patient's data.
"What happened?" the redhead asked those present.
"Unidentified teenage girl. She was in a car accident and got trapped in the wreckage," Tony reported while performing chest compressions on the girl, who looked to be between 15 and 18 years old. "We tried to intubate on the way here, but we couldn't."
"Oxygen saturation at 92 and dropping!" one of the residents, Katherine, alerted.
"We'll take it from here," Pepper said to the paramedic who was providing respiratory support for the patient. "Administer 20 of etomidate and 100 of succinylcholine." The first would help with the anesthesia process, and the second with intubation.
"I want the full trauma series, scans, and at least 3 units of O negative blood," Tony requested. "Ryes, take over the chest compressions until the rhythm stabilizes, the skull was crushed, and I need to assess the situation." He asked to switch places with one of his interns.
"Serious injury to the left forearm, multiple lacerations on the face," another resident, Steve, noted down in the chart. "We'll need plastics."
"Start the antibiotics and begin cleaning these wounds!"
"The heart is stopping again!" The cardiac monitor suddenly sounded, indicating the third arrest in a short period.
"I need everyone to step back!" Pepper spoke over them, positioning the electrodes on the chest of the unknown girl. "Give another dose of epinephrine. Use the defibrillator, now! Clear!"
"Charging to 200."
"Damn it! Why is this cardiac arrest happening now?" The monitor continued to show a green flat line, no reaction.
"Charging to 300. Clear!"
"Still no response!"
"Charge to 360."
"Nothing."
"One more time!"
"We have a heartbeat, but the rhythm is slow."
"Administer a vial of atropine and intubate her."
"Her pupils are dilated, get a drill, I need to perform an emergency trepanation!" Tony shouted to the nurses. "She's losing consciousness."
While the equipment was brought to him, the intubation was performed. Seconds later, the surgical procedure was carried out, and the intracranial pressure was relieved.
"She has cardiac tamponade, we need to take her to surgery immediately."
"There's an open pelvic fracture; we need to operate," orthopedic surgeon Cameron Kutner informed.
"She can't go through two surgeries now, let alone three," Tony observed.
"But if we don't get her into the OR now, she dies."
"We need to come up with a plan; if we do everything, she dies, but if we do nothing, she dies too." The brunet looked seriously at the redhead, then directed his gaze to the other doctors in the room.
"Great, let's do the card..." Pepper started, imagining they would have another pointless argument, just out of spite. But given the whole situation, they didn't have time for that. She just wanted to ensure the girl had a chance to fight for her life as soon as possible.
"We'll do the cardiac surgery; she won't survive without a heart," Tony interrupted her, surprising her. "If she responds well, I'll perform the craniotomy, and we can immobilize the fractures until she's strong enough to withstand the orthopedic surgery."
"Sounds good to me," Cameron commented.
"I agree!" Still surprised, Virginia affirmed. "I want all urgent tests for surgery, allergies, pre-existing medical conditions, and medications. Call the on-call trauma surgeon; we need to control the bleeding in the liver and spleen."
"I'm going to scrub in; you'll need extra hands." Removing his gloves and discarding the garments in the designated trash, Tony announced. "I want two complete teams and call in the on-call residents; we may need more help!" He directed the others.
In the operating room, the bright lights illuminated the environment, creating a halo of expectation. The medical team was gathered, each member prepared for the task at hand. The teenager lay on the gurney, her breathing regulated by the rhythmic motion of the respirator.
As the patient's heart continued to beat, the assistant connected her to the heart-lung machine, taking over the vital role of the organs during the surgery. The heart was paused, allowing Pepper an unobstructed view of the problematic area.
With precise care, she opened the pericardium, exposing the young girl's heart, performed a pericardiocentesis to relieve the cardiac tamponade, and repaired the damage to the heart valves.
The procedure took about five hours, and after a successful correction, the heart was restarted, and the heart-lung machine was turned off. The operating room filled with a collective sigh of relief as the monitor indicated the restoration of normal heart rhythm. Pepper then closed the patient's chest with careful sutures and allowed Tony to take over along with the plastic surgeon, staying in the room to provide necessary assistance, as there was still the risk of arrhythmias or heart failure.
With his characteristic precision, Tony began by making a careful incision in the scalp, exposing the patient's skull. Under the bright surgical lights, the young girl's delicate brain was revealed, vulnerable and injured.
Imaging studies showed intracranial hemorrhages pressing on the brain tissue and skull fractures requiring immediate attention. Tony addressed the injuries, carefully removing the clots to relieve the pressure on the patient's brain. With every move, the team monitored the teenager's vital signs closely, as the fine line between life and death was being negotiated.
"How's the arm?" the redhead asked when the monitor showed a slight fluctuation in the heart rate.
"The nerves are intact; I'll just need to redo the vascularization," replied Isabella Adam, the plastic surgeon.
"Can we immobilize the pelvis yet?" Cameron asked.
"I'm almost done with the more severe internal injuries; the pelvis will be all yours shortly," trauma surgeon Jesse Laurie informed.
"I think we only have about two more hours; I'm not sure if the heart can handle much more."
The hours passed slowly, with the operating room being a stage of intense concentration. As the abdominal damage was repaired, Tony performed a craniotomy and, with extraordinary skill, repaired the skull fractures, protecting the patient's brain from further damage.
Finally, after an arduous effort, the neurosurgeon closed the patient's skull and sutured the incision in the scalp. At the same time, the trauma surgeon completed his part, providing the necessary space for the orthopedic surgeon to immobilize the patient's pelvis, as subjecting her to additional surgeries would be too risky.
Although part of the critical moment had passed, the young girl's future remained uncertain as she was transferred to the intensive care unit to begin her recovery journey.
Before she could leave the corridor separating the operating rooms from the rest of the hospital, with a giant "authorized personnel only" sign on the doors, Pepper found herself uneasy, an unknown fact lingering in her mind.
"Hey, Stark…" she called as Tony began to disappear from view.
"What?" He turned to her with little enthusiasm.
"Why me?"
"What?"
"You could have paged anyone, but you called me. Why me?" she repeated.
Tony paused for a second; she could have sworn she saw his mouth open and close a few times, as if he had something to say but kept changing his mind.
"Good night, Virginia." He said finally, leaving her standing there while she thought about what had just occurred.
He could have been straightforward, given some stupid excuse involving her being on call, being the head of cardiology, or the gravity of the situation… But he didn't.
He simply shook his head slightly, gave a small smile, and said goodbye.