The ER was hopping as usual when Mark started his shift at 7. “Hey Jerry. Who all’s on today?”

“Morning Dr. Greene. You, Dr. Lewis, and Dr. McCrery are on, but Dr. McCrery isn’t here yet. Benton and Morgenstern on call for OR, and the usual gang for the nurses.” Jerry flipped through the charts and handed one to Mark. “There’s a GI bleed in Trauma 3.”

“Thanks. Let me know when McCrery gets here.” Mark turned to head towards Trauma 3 when he saw the Ambulance Bay doors open and Dr. McCrery make her way slowly into the ER.

“Hey! You made it.” Mark caught up with her as she headed towards the doctors’ lounge.

Sara looked at him with an un-enthused expression. “Yeah. Sorry I’m late.”

Mark looked at her more closely. This was not the usual dedicated, spirited gal he worked with. Sara seemed to be rather run-down, tired, and he thought that she looked like she was in pain but trying to hide it. “It’s okay. But you look like crap. What’s wrong?”

Sara sighed and let her head drop. “I didn’t sleep well last night. My stomach’s complaining, and I couldn’t find a comfortable position last night. I finally got a couple hours on the couch.” She stopped in front of her locker and started dialing the combination.

“Do you need someone to cover for you? You should rest, go home.” Mark started trying to think who could come in and cover for her.

“No, I’ll work my shift. Just don’t wake me if I fall asleep on the couch. I’ll be okay after some coffee and some Tylenol.” She put her bag in the locker and removed her ID, stethoscope, and lab coat. Carrying a set of scrubs, she shut her locker and looked at Mark. “I’m gonna go change, and then I’ll start the day.”

Mark watched her as she left, making a mental note to keep an eye on her. He could tell that she wasn’t telling him the whole story, but couldn’t do anything about it at the moment. Sighing, he headed towards Trauma 3.

Mark pushed open the door, revealing a 67 year old male already in a hospital gown with an IV established and a nasal cannula. Malik was already in the room. “Hello Mr. Julliard. What brings you into the ER today?”

“Doc, you gotta help me. I’m bleeding to death! I get up to take a dump, and wham! The toilet looks like I killed something in there!” Mr. Julliard was distraught.

Mark looked over at Malik. “BP 150/70, pulse 82, respirations 18.”

“Well, Mr. Julliard, let’s take a look. Can you roll on your side for me? Malik, get a guaiac card.” Mark and Malik positioned the man on his side, flexing one leg over the other. Mark donned a pair of gloves, and positioned himself at the patient’s backside. “Mr. Julliard, I’m going to perform a rectal exam on you. It will be a little uncomfortable, but only for a minute. With the addition of some lube to his gloved finger, Mark proceeded with the rectal exam, wiping the fecal material from his gloved finger on the guaiac card.

“Mr. Julliard, do you have problems with constipation and straining when you go to the bathroom?”

“Yes, Doctor, all the time.”

“And how would you describe the blood you saw today? Bright red, or dark and coffee-grounds?”

“Oh, it was bright red, doc. I thought I’d busted an artery!”

Mark removed his gloves and tossed them in the trash can. “Malik, go ahead and do a CBC, Chem-7, and hematocrit count. Mr. Julliard, you have hemorrhoids. Straining to go to the bathroom can cause them to break and bleed. We’re going to do some blood work just to be safe, but I’m going to prescribe you a stool softener to take. You also need to get more fiber in your diet. If your hemorrhoids continue to bother you, you need to see your regular doctor about a referral to have them removed.” Mark made notes on the chart, handed it to Malik, and headed out of the room.

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

Sara was miserable. She felt horrible. But she was determined to make it through her shift. She turned her attention back to the patient in front of her. “Okay, Corie, this will hurt for just a second, and then you won’t feel anything. Then I’ll get this cut stitched up and you’ll be good as new.” She patted the little girl’s arm reassuringly, and proceeded to inject the cut with lidocaine before putting six stitches in her leg. “There! The nurse will put a bandage on it, and you’ll be good as new.” Sara looked at Corie’s mom. “Mrs. Sloan, keep it clean and dry. The nurse will give you some more bandages to put on it. If it starts oozing or having red streaks, bring her back in, but otherwise the stitches can come out in 10 days.”

“Thank you, Dr. McCrery. I will.” Mrs. Sloan turned her attention to Corie and the nurse bandaging the leg. Sara jotted a couple notes on the chart, and left it with the nurse to complete the discharge paperwork.

She stepped out of the suture room, only to be intercepted by Carol, who threw a gown her direction. “Teenager involved in a car vs. pedestrian! Ambulance here in 2!” Sara without hesitation donned the gown and ran after Carol to the Ambulance Bay.

Paramedics hit the door running. “Talk to me!”

“17 year old male! Stepped out in front of a city bus! GCS 13, BP 102/40, pulse 120, respirations 20. Broken right tib-fib, abdominal guarding, decreased breath sounds on the right!”

The team pulled into Trauma 1. “Okay, on my count. 1, 2, 3!” They pulled the patient from the ambulance gurney to the trauma bed. The patient yelled as the jolt caused pain to ripple through his body. “Hey! I’m Dr. McCrery. I’ll be taking care of you. What’s your name?”

The team swarmed around the teen, removing clothing, setting up IVs, and drawing blood.

“It, it, I’m Josh.”

“It’s okay, Josh. We’re going to take good care of you.” Sara looked at Lydia, who was drawing blood. “CBC, Chem-7, PT, PTT, Type and Cross 6 liters. Let’s get a Foley in place, and get OR down here. Where does it hurt, Josh?”

“My leg and my gut. It’s hard to breathe!”

Mark entered the room, followed by Morgenstern. “What do you have, Sara?”

“17 year old hit by a bus. He needs a chest tube, decreased sounds on the right. Right tib-fib, abdominal guarding. Get ultrasound in here!” Sara switched places with Mark on the patient’s left side, moving to his leg while Mark palpated the kid’s abdomen. Morgenstern started a chest tube on the right.

Sara glanced at the vital signs flashing on the monitor. “Okay, Haleh, give 10 mg Morphine IV push. Also start penicillin, IV.” She bent to examine Josh’s leg. “Looks like a straightforward break, approximated ends.”

“Chest tube is in and producing blood. We need to get that ultrasound of his belly and get him upstairs. Tell OR we’re coming up.” Morgenstern leaned over the patient to see what was showing on the ultrasound. “Okay, spleen looks good. But there’s definitely a bleeder somewhere in there.”

Sara looked up at Josh, who was turning white. “Mark! Roll him!”

Mark looked up, and grabbed to turn Josh, who was still attached to the backboard, onto his side. Josh vomited, and they rolled him back onto his back. “Haleh, add 5 mg of Compazine IM, and let’s insert an NG tube. Sara…” Mark looked around, bewildered. “Where’d Sara go?”

“I saw her run out when he puked, Dr. Greene,” Lydia offered. She started pulling off the leads to the room’s monitors.

“Okay people, let’s get upstairs.” Morgenstern looked quizzically at Mark, and headed out the door with his patient.

Mark stood there for a moment before stripping off the yellow gown and bloodied gloves. Heading out of the trauma room, he started looking for Dr. McCrery. As he passed the small women’s restroom, he hauled up short at the sound of vomiting. Mark knocked on the door. “Sara? Is that you?”

He heard retching again, and the door creaked open a little ways. “Yeah. Just… a moment… Mark.” She retched again. “Sorry about back there, Mark.”

“Hey! Carol, get me a wheelchair and find an open bed,” Mark asked as he knelt beside McCrery. Carol glanced at Sara, nodded, and returned with a wheelchair and an emesis basin.

“Here Mark. Four is available.” She helped Mark maneuver Sara into the chair.

“C’mon, guys, I’m okay. I just got a stomach bug. I’m okay, really!” Sara protested, even as she allowed herself to be guided into the chair and wheeled towards the private room.

“You’re not okay and you know it. C’mon, up here.” Mark patted the bed and offered a hand up. “Carol, will you get some vitals for me?”

“Mark… Carol. Is this really necessary? Look, I’ll go home and rest. This will blow over in 24 hours,” Sara protested, until Carol stuck a thermometer probe under her tongue.

“Yeah, well, that’s what they always say,” Mark replied. He took the empty chart Carol handed him. “What are her vitals?”

“BP’s 120/70, pulse 82, respirations 16.” The thermometer beeped, and Carol removed it from Sara’s mouth. “Temp is 99.4.”

“Well, a slight temp, but not bad. Carol, why don’t you start a line and…”

Sara interrupted. “No! I don’t want an IV. I’ll be fine. Just give me some Compazine and Tylenol and I’ll go home. It’s just a bug that I probably caught from one of the patients here.”

“You’re sure? We should at least do some labs, make sure you’re hydrated.”

“I’m sure. My throat doesn’t hurt, and I’ll push fluids. And keep up with the Tylenol.” Sara looked at him with pleading eyes.

Mark sat the chart down on the bedside table. “All right, but at least let me do a quick exam. Carol, would you go get 5 mg Compazine IM and 650 mg Tylenol PO? Thanks.”

Carol left the room while Mark helped Sara swing her legs up onto the exam bed. “Okay, lie back and let me look at you.” He ran her through the usual quick exam: heart and breath sounds, looked in her ears, eyes, nose, and throat. “Everything’s looking okay. Maybe a little postnasal drainage, but then you have allergies. What about your abdomen?”

Sara grimaced. “Pretty much hurts all over. Diffuse, no specific quadrant, probably a 3 on the 10 scale.” Mark palpated her abdomen. It was soft, with no specific area of increased pain, although maybe just a little more tender on the right side.

Carol returned with the medications. “Sorry, I got caught in the hall by Lydia.” She prepped to administer the injection.

As Sara turned over on the bed to allow access to her hip, Mark sat back down at the foot of the bed. “You’re right. I think it’s just a case of the stomach flu, although I’d really like to do some blood work to be sure.”

“Ouch! I told you. I just need to go home and ride this out. I’ll be okay, Mark. I’ll keep up the fluids and the Tylenol, and hopefully will feel better in the morning.” Sara rubbed her now-sore hip and took the proffered Tylenol and water. She swallowed the pills, and sat back up on the side of the bed. “Thanks Carol.”

Carol nodded as she cleaned up. “You’re welcome, Sara. Get to feeling better.”

Mark walked with Sara towards the exit. “If you need anything, call me. I’ll check on you in a few hours. And get some rest!”

“I will, Mark. Thanks. I’ll see you in a day or two.” Sara left the ER and headed towards her car. She knew that she’d better hurry home before the Compazine knocked her out. It always did.