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Views: 2958 Created: 2014.08.19 Updated: 2014.08.19

A Pain in the Gut

PART ONE

It was a busy night. Most of the beds were full, the waiting room halfway occupied, and the team was rushing the MVA from Trauma 1 to the elevator to get him to OR.

Dr. Sara McCrery fought back a yawn as she stripped off her gloves and the protective yellow gown she wore. She looked at the messy room, a normal occurrence after a trauma such as this, and headed to the doctors’ lounge, chart in hand.

Doctors Mark Greene and Susan Lewis were already there. “Hey. How’s that kid?”

“He’s not doing great. Lots of internal bleeding, and some form of head injury. They’ll have to reassess if he makes it through the surgery.” McCrery flopped down on the couch. Reaching for her pen, she opened the chart and made a few notations. “At least I don’t have much paperwork on this one. That’ll be Benton’s job.” She flipped the chart closed and added it to the stack that was threatening to topple off the coffee table.

Carol breezed in with more charts. Groans emitted from across the room. Mark glanced her way. “Carol, if you have to bring them, could you at least take some of the completed ones?”

She studied the leaning tower of charts. “Sure, Mark.” She grabbed the top 3 and headed out the door.

Susan groaned. “There’s always a comedian. I’ll take them.” She started to get up, but McCrery waved her off.

“Nah, I’ll take them. Besides, I’m sure Jerry has another one in the queue, and I’m up.” McCrery grabbed the stack as it threatened to slide off the table, lifted it with a groan, and headed out the door. She passed several patients and nurses on her way to the desk and caught the eye of Jerry, the ER tech who kept things moving on well-oiled wheels. “Where do you want these?”

“Hey, Dr. McCrery. Are those finished?” He gestured to a clear corner of the otherwise cluttered desk.

“Yeah. We were about to have an avalanche in there. Anything new on the board?”

“Dr. Ross has a kid vomiting in 3, Carter’s stitching up a drunk in the suture room, 6 is waiting for EENT for a nosebleed, and Trauma 1 just went to OR. Otherwise, we’re good at the moment.” Jerry started flipping through the finished charts, pulling paperwork and sorting it for Medical Records.

“Ok. I think I’ll go for some coffee. Want anything?” Sara checked her pager to make sure it was on.

“Maybe a Danish? Some kind of red filling, if possible.” Jerry handed her a $5 bill. “And creamer, one sweetener.”

Sara took the $5 and stuffed it in her pocket. “I’ll be back in a few. I’m on my pager.” She rounded the corner from the desk and got ready to head out the Ambulance entrance when she spotted Mark walking down the hall. “Mark! I’m going for coffee. Want me to grab you something?”

“Actually, I’m headed that way myself. Hold on.” Mark stuck his head in the desk window. “Jerry, I’m headed across the street.”

“Ok, Dr. Greene. We’ll page if we need ‘ya.”

Sara and Mark headed out the doors together, running across the street through the lull in traffic to the small diner. As usual, it was ¾ full of people. They found a couple seats at the counter.

“So how’s life treating you these days? Any new news from the AHA?” Mark asked. He accepted the Styrofoam cup of coffee from the waitress and removed the lid, adding in cream and sugar.

“Not much going on. AHA is keeping the current guidelines, so nothing new there. I have 6 new trainers coming on board, so will be spending my weekend busy there, plus an upcoming ACLS and PALS class rotation for the med students in a couple weeks. Otherwise, not much new. Pay the bills, do laundry, and get the car in for an oil change sometime soon. How about you?” Sara sipped on her coffee, almost burning her tongue. She took the lid back off and blew on it.

“Oh, the usual. Rachel’s growing like a weed. We’ve got 3 more weeks with the med students, and I’m quite honestly looking forward to the break. This group has been tougher than most, mainly because we’re having to train them on everything.”

“Well, that’s kind of the point, isn’t it? Take a med student with no practical application and start teaching them how to apply 3 years’ worth of knowledge?” Sara selected a couple of Danishes and wrapped them in the tissue provided, and paid for the coffee and desserts.

Mark accepted his change and grabbed his drink. He held the door open as they walked out. “I know, but it’s the basic stuff that is causing so much of a curve. How to start an IV, how to do basic sutures, how to adjust flow to a nasal cannula… The bare-bones basics they need to know isn’t being taught in a skills lab, but rather in the ER. We don’t always have the time to teach that.”

“Hmmm. I see your point. But aside from griping to Morgenstern, it’ll never change. They’re kicking them out the door at us earlier every year, it seems.” Sara pushed her way through the Ambulance Bay doors and headed to the desk. “Here you go, Jerry. Raspberry today.”

“Thanks, Dr. McCrery.” He accepted his change, and bit into the Danish, coffee in hand. “By the way, Dr. Morgenstern was looking for you. I think he had some news about that trauma kid.”

Sara groaned as she looked at the clock. “He didn’t make it. No way would surgery be done in under an hour. Ok, Jerry, I’ll keep my eye out for him.”

Mark looked at her askance. “You knew he was pretty beaten up. Yet you sound surprised.”

“Surprised isn’t the word for it. But I had hoped. He was only 16.” She rounded the corner to the doctors’ lounge and plopped back down on the couch. “It’s Morgenstern. He’s got something up his sleeve, and I’m not sure I want to find out. He’s been bugging me about the current AHA training sessions we have in place.”

“Think he wants to expand it?”

Sara snorted. “Well, if it’s anything like our med student skills lab, he probably wants to shorten or remove it altogether. Or it could be something completely different. He’s been mentioning the need for another surgeon on trauma rotation. He might be trying to pull me back to surgery rotation. I don’t know.”

“Do you want to go back on the surgery rotation? More pay, more prestige.”

“More hours, erratic sleep, fatter egos and fighting over kidneys and colons and aortic repairs… I’m not that anxious or hard-pressed for excitement, thank you. I get enough of that here in the ER,” she countered. “Besides, the ER rotations allow me the opportunity to keep up with my AHA classes and orientations. I find it rather rewarding without having to become a full-time professor. I like having my toes in both ponds.” Sara yawned. “So, how late are you on tonight?”

“I’m on ‘til 10, back on at 7A. You?”

“Same here. At least I’ll have time to go home and sleep.” Sara yawned again, leaned back her head and closed her eyes. “Not that I wouldn’t mind a head start, but…” Pagers started going off, and Malik popped his head into the room.

“We’ve got 2 GSWs on their way in by air. Chopper’s 5 out.” Mark and Sara hopped up and hurried for the stairs to the helipad, donning the impervious yellow gowns and goggles they were handed. Susan Lewis joined them on the stairs.

“We’ve got 2 GSWs coming in, 19 year old and 15 year old. Gang related. OR’s been put on alert.” The teams pulled out 2 gurneys and waited for the chopper to land. Once on the pad, the teams ran up under the rotor wash and started pulling the patients out while straining to hear the flight medics’ report.

The first patient out of the chopper was in full arrest. Medics had been doing CPR, but the first team took over for them. Sara hopped onto the side of the stretcher and began doing chest compressions. “What have we got?”

“15 year old male! GSW to the abdomen, right arm, upper chest! He was conscious on scene, but coded 2 minutes ago! He’s in v-fib; we’ve defibrillated twice, no conversion! 2 IVs, normal saline. 2 amps epi, 2 of atropine, will be ready for drugs again in 2 minutes!” The medic stripped off a bloody glove and laid it on the gurney near the patient’s head. “There’s your drug timeline!”

Sara nodded. “Okay, let’s go! Alert OR and get Respiratory paged! Trauma 1!” The team headed the gurney towards the elevator, but bumped the wall with the gurney due to rotor wash. “OOF!” Sara exclaimed, as the bedrail dug into her stomach and her back smacked the wall. “Watch it!”

They proceeded to load the elevator and move down to the ER and into Trauma 1. “Give me another 1 mg atropine, and charge to 360!” Paddles were handed to Sara and she listened to the defibrillator whine as it charged. Placing the paddles on the young man’s bare chest, she glanced at the team backing away from the patient. “Clear!” She pressed the buttons on the paddles and watched the patient’s body give a small jerk as the current ran from one paddle to the other.

“No conversion!”

“Resume CPR!” Sara rounded towards the patient’s head as Malik resumed chest compressions. “Laryngoscope, straight 5 blade, 7.5 ET tube.” A laryngoscope was handed to her, and she locked the blade open. She inserted it into the patient’s mouth and looked for vocal cords. “Suction please. I can’t see anything in here!”

Lydia inserted a Yankauer suction catheter into the patient’s mouth, suctioning out saliva and blood. Sara reinserted the laryngoscope and was able to visualize the cords and pass the ET tube through. She inflated the distal balloon, secured the tube with tape, and listened to breath sounds and over the epigastrium while Lydia bagged the patient. “Time!”

“2 minutes since last drug and shock.” Malik traded places with Carter, who had entered the room with Benton.

“What have you got?” Benton asked.

“Push 1 mg epi and prepare to shock, 360 joules. 15 year old male, GSW to abdomen, right arm, upper chest. Full arrest on arrival. Third round of drugs, shocks. ET tube dropped and confirmed placement. V-Fib. Clear!” Sara shocked the patient with the paddles again, and saw that the monitor had changed to asystole. “Crap!”

“Crack the chest?” Benton prepared to reach for a thoracotomy tray.

“No, let’s roll him first; see what the back looks like.” Carter stopped compressions and helped log roll the boy.

“Crap! There’s a hole here as big as the state of Kentucky. Okay, roll him back.” Benton rolled the boy back onto his back. “He’s gone.”

Sara nodded. “Time of death… 8:59 PM.” She stripped off her gloves as nurses shut off machines and monitors, unhooking various IVs and oxygen tubing. “Do we know if family has been notified?”

Haleh watched as Benton and Carter headed to Trauma 2 to assist. “Not that I’ve heard. We got this, Dr. McCrery. Go get some coffee.”

“Thanks Haleh. I believe I will.” Sara stripped off the impervious gown and tossed it into a waste can. She stepped into the hall, pulling short as the team raced the 19 year old from Trauma 2 towards the elevators.

Mark met her in the hall. “Didn’t make it, huh?”

Sara grimaced. “My track record isn’t too great tonight. Yours gonna pull through?”

“Should. Are you okay? I saw you hit the wall when the gurney was pushed into the frame of the elevator.” Mark peered at her with concern.

“I think so. I’m a little sore, but don’t think I damaged anything.” She tugged him back into the empty Trauma 2.

“Mind if I check your back?” Mark asked. At her nod, he lifted the back of her scrub top while she peeked under the waistband of her scrub pants. “No bruising. Does this hurt?” He palpated her mid-back.

“Maybe slightly tender, like an abrasion, but nothing major. No bruises from the railing. I think I’ll live!” Sara smiled as she tugged her top back into place. “Thanks Mark.”

“No problem. Glad to help. Coffee?” He led the way towards the lounge at her nod.

Sara accepted the cup he offered as he poured them each a cup from the pot in the lounge. “Well, at least we’ve only got one more hour.” She suddenly grimaced and bent over at the waist. Coffee sloshed from the cup onto her fingers. “Ow!” She switched the cup to the other hand as she flung her wet hand, trying to get the hot liquid off and her fingers to cool.

Mark retrieved the cup from her hand, setting it down on the table. He bent over to look at her. “Sara! Are you okay?”

She straightened back up and reached for the roll of paper towels by the coffee pot. “Yeah, I’m okay. Just a cramp. I sometimes get them before my cycle, and it caught me by surprise, is all.” She looked at her hand. “Doesn’t look like I burned myself. That coffee’s hot!”

“You’re sure?”

“Yeah. Besides, the rail hit up here,” she stated, indicating a spot up towards her diaphragm, “and the cramp was definitely much lower down. I’m fine, just surprised me.”

Mark still didn’t look convinced, but he let it pass as he took a sip of his coffee. Sara was right – it was rather hot, and he didn’t want to burn his tongue.

“I’m gonna go see if there’s any suture jobs waiting. I’d rather be working on something of my own choosing and get out on time rather than catch something in the last few minutes of my shift. Later, Mark.” Sara smiled at his noncommittal wave and headed to the desk.

“Jerry, anyone need stitches?” Sara studied the board.

“Mr. Kyrowoski is waiting for sutures in Curtain 3. You gonna take him?” Jerry handed her the chart.

“Sure. Gotta make this last hour go by, you know.” Sara laughed and headed to Curtain 3, snagging a suture kit as she went.

“Mr. Kyrowoski? I’m Dr. McCrery. What happened?” She set her kit down on the nearby Mayo stand and started examining the wound on his hand.

“Please, make it Chad. I was cutting peppers at the pizzeria, prepping for tomorrow, and the knife slipped. Now I must clean everything from the blood and redo all the prep. I’m such a klutz!” He winced when she palpated the cut in the palm under his right thumb.

“Well, we should be able to take care of this in no time, Chad. You’re left-handed?” She donned sterile gloves and proceeded to deaden the area with Lidocaine before starting to suture the cut closed.

--------------------

Sara drove home, trying to let the stress of the day fall behind as she traveled. It had been a hard day, and she was tired. The muscles in her neck and her feet had tensed during the day, and the throbbing let her know that it was time to either replace the insoles in her shoes or the shoes themselves. Maybe a shower would be helpful, she decided.

She unlocked the door to her apartment, listening to the L rumble by as she made her way into the living room, turning on lights and locking the door behind her. Her work bag was dropped beside the door, keys went into the bowl on the credenza, and her jacket and shoes near the overstuffed armchair in front of the TV. Mail was flipped through and placed on the kitchen island, and the phone checked for messages – there weren’t any.

Within 15 minutes of being home, Sara was in the shower, enjoying the feel of the warm water flowing over tired muscles and steaming up the mirrors in the small room. Suddenly, she felt strong pangs in her lower abdomen. “Ow!” She doubled over, up against the shower wall, clutching her stomach. They only lasted a couple minutes, but it was enough for her to be very uncomfortable and nonplussed. She hurried through the rest of her shower, now just wanting to finish and go to bed.

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