Thursday the following week started out as the days before. Meghan, with Kelsey’s help, had gotten up, dressed, and made her way into the living room. Mitch, who was on duty in the ER that day, had already gotten up and headed into work, leaving Meghan and Kelsey to their own devices.

Lunch had come and gone, and the sisters had opted for Food Network on the TV while Meghan knit and Kelsey worked on cutting up lettuce and tomatoes.

Meghan relaxed on the couch, splinted leg propped on pillows, enjoying the cooking show she and Kelsey were watching. The sock on her knitting needles was slowly growing, the self-striped yarn turning the simple knit stockinette into a very colorful pattern, indeed!

Meghan turned to ask her sister a question. “What’s for dinner tonight, sis? I love the Food Network, but this is making me hungry!”

Kelsey picked up her cutting board and set the chef’s knife she had been using on top, and headed for the sink. “I was planning for tacos.”

Suddenly, Kelsey tripped. The chef’s knife slid on the board and pierced her right wrist. Meghan saw blood spurt and surged off the couch. “Kelsey! Are you…” She saw the arterial spurting and grabbed the nearest kitchen towel. “Here, let’s put some pressure on that.” She wrapped the towel around her sister’s wrist and applied pressure.

“OW!” Kelsey was starting to shake and was becoming pale.

Meghan was doing some quick thinking. “Hon, can you hold this? I just need to grab my phone.” Kelsey gave a jerky nod and went to hold the towel over her wrist. Meghan hopped back to the couch to pick up her phone and hopped back to her sister, grabbing another tea towel on the way. She had just reached Kelsey’s side when Kelsey passed out. Meghan caught her and awkwardly lowered her to the floor. “Kelsey! Kelsey, you need to wake up, sis. C’mon, wake up!”

Unable to rouse her sister, Meghan left her on the floor and hopped to the kitchen door, unlocked it, and threw the door open. She then made her way back to her sister and lowered herself onto the floor beside her.

Without pressure on the towel, Kelsey’s arm bled freely, blood spurting with each heartbeat. Kelsey was very pale, her skin clammy and cold. Meghan placed one hand back on the towel on Kelsey’s wrist and used the other to dial 911. She crammed the phone between her ear and her neck and grabbed for Kelsey’s injury.

911, what is your emergency?

“Address is 1991 Montrose Circle, 1991 Montrose Circle. I have a 42-year-old female with an arterial bleed. Pale, cool, clammy. I need EMS here as soon as possible!” Meghan wrapped the new towel over the first and applied direct pressure to Kelsey’s wrist.

“I have two towels over the injury and am applying direct pressure, but it’s not really staunching the flow. She’s unresponsive but still breathing.” Kelsey wasn’t responding to anything Meghan was doing, and it frightened her.

Keep pressure over the wound. I have EMS responding to your location. Do you have a blanket or towel you can put over her, and elevate her feet?

“I can’t let go, and I can’t move well enough to get stuff. I know she’s in shock.” Meghan started hearing sounds of emergency sirens. “I’m starting to hear sirens. Let them know the back door is wide open and we’re in the kitchen.”

She soon heard the whoosh of a diesel engine braking and sirens suddenly cutting out. “Back here! Come back here!” she yelled.

As the firefighters entered the house, she looked up and then back at her sister. “Hey, guys. No time to chat. I’m fine. I need to get her covered and her feet elevated. Get me a set of vitals, and whatever you carry for pressure bandages. Start her on oxygen, 12 LPM via nonrebreather mask.”

They quickly scurried to do as she bid, having worked with Meghan for many years. The shift Captain, Roy Burch, came to squat beside Meghan as the others worked. “Meghan, I was wondering what had happened to you. But now’s not the time. What happened here?”

“My sister,” Meghan said, watching as a couch coverlet was draped over Kelsey. Meghan used one hand to help tuck it under Kelsey’s shoulder. “She was cutting up vegetables for dinner at the counter. She set the knife on the cutting board and was heading for the sink when she tripped, the knife went flying and punctured her wrist. It’s arterial and not stopping.” Meghan accepted several large gauze squares and a roll of kerlix. “Thanks. Help, Roy?” Roy nodded. Meghan poised the stack of gauze over her hand, then quickly lifted her hand, which released the pressure on the artery. Blood spurted. She quickly pressed the gauze down and wrapped kerlix around it. It slowed the bleeding but didn’t stop it. Securing the kerlix, she applied pressure over the dressing she had just made. “Someone give me an ETA on that damn ambulance!”

She heard a radio being fired up and a brief conversation. “They're two minutes out, Meghan.”

She nodded. “Thanks. What’s her vitals?”

“Respirations are 20, Pulse is 144 and thready, and BP is 78/40.”

She then heard a shout. “Back here, guys!”

The next moment, Jerry and Bill, EMS 21’s crew, were entering the room. “Bill, I need IVs now! Lactated Ringers.” Bill nodded and started setting up IV supplies.

Jerry assessed both Kelsey and Meghan with a glance. “What have you got, Meghan?”

“My sister, stabbed with her chef’s knife when it slipped. Right wrist, arterial bleed. She passed out, I’m thinking hypovolemic shock. I can’t let go of pressure or it’s bleeding out through the dressings. BP’s crap. We need to get her volume up and get her to the ER.”

Bill handed Jerry a prepped IV setup. “Okay, let’s get an IV in and get going. Go get the stretcher.” Bill stood up and went to grab the stretcher. One of the firefighters was already ahead of him and had the stretcher staged by the door.

“Stay here and set up whatever you think they’ll need. We’ll get her on the stretcher.” Bill waved in thanks and started setting up for the cardiac monitor and more IV fluids.

Inside the house, Jerry taped down the IV and started it wide open. “Do you want to tourniquet that arm?”

Meghan shook her head. “Not if I can help it. Let me see if using a brachial pressure will get it slowed.” She shifted positions so as to come at a better angle to apply pressure. That’s when one of the firefighters noticed her splint.

“Meghan, are you injured? Your splint…”

“Yeah, broken leg. Someone grab my crutches – they’re by the couch.” Somebody went to retrieve them while others got under Kelsey and lifted her onto the stretcher that had been brought in. Jerry looked at Meghan. “It looks like the brachial pressure is working…. Hop on the cot.”

“Huh?”

“Hop on the cot. You can’t let go, and you can’t walk. Hop on the cot.” Meghan nodded, and worked herself onto the cot, straddling Kelsey’s body.

The firefighters lifted the cot into an upright position and wheeled them to the ambulance, Meghan ducking under the doorframes of both the house and the cot. The cot was slid into position, locked, and Jerry and Bill took over. Captain Burch assigned Firefighter Parker Meadows to ride in with them to assist. Oxygen was switched to the ambulance supply, while Kelsey was placed on the heart monitor. The rapid waveforms assured Meghan that her sister was still alive, but she knew the urgency of getting her to treatment. “Let’s go, guys! Do whatever else en route.”

Jerry nodded and shouted at Bill, who was waiting for the word go. “Let’s get out of here, Bill, post haste. County Medical.”

The ambulance started forward, sirens blaring. Meghan shouted forward. “Bill, call the ER and give them a heads up. Kelsey here is Dr. Branston’s wife. He’s the Attending in the ER today.” Bill gave a thumbs-up and reached for his phone.

Jerry and Parker were keeping busy in the back. Jerry secured a second IV in Kelsey’s right EJ (external jugular). Meghan winced as he was putting it in, but she knew that it was the best location for a second IV. Volume replacement mattered, but she knew that a blood transfusion was in her sister’s future.

“How are you doing, Meghan? Hanging in there?” Jerry asked.

Meghan nodded. “My hands are cramping, but I’m hanging in there.” She focused on Kelsey’s face again. She startled when something clamped on her right pinky. “Hey! What the…”

Jerry shook his head. “Humor me, okay?” He looked at the pulse-ox he had placed on her finger, then removed it. He shook his head but said nothing.

“Do you want to call in report?”

Meghan shook her head. “No hands available for the mike. Tell them we need someone to clamp this off when we get there.”

“EMS 21 to County Med, EMS 21 to County Med, how do you read?”

County Med to EMS 21, we read you loud and clear.

“EMS 21 to County Med, incoming patient report, Trauma Alert.”

Go ahead with your report, EMS 21. Trauma Alert.

“County Med, I have a Level One Trauma Alert. 40s-year-old female, cooking at home and knife accident, stabbed right wrist with bad arterial bleed. Patient is unconscious. Pale, cool, clammy, suspect hypovolemic shock. Bleeding currently under control with pressure bandages, direct pressure over the wound, and brachial artery pressure. We will need someone on standby to clamp this. Any letup of pressure starts spurting bleeding. Patient is on O2, 12 LPM via nonrebreather. IVs times 2, Lactated Ringers, wide open. Cardiac monitor shows sinus tach in the 140s. Vitals are: respirations 22, pulse 146 and thready, BP initially 78/40, now up to 86/38. ETA is 7 minutes. Also, be advised we will be calling via landline with more info.”

Report received EMS 21. ETA 7 minutes. Trauma Team notified. Will have someone on hand to clamp arterial bleed. Head for Trauma Room 1 on arrival. County Med out.

As they rounded the corner for the hospital, Jerry and Parker switched out the Oxygen tanks, moved the cardiac monitor to the cot, and readied to get Kelsey in the ER as soon as they hit the doors. Meghan was a sweaty mess and was trying to keep a steady monologue going to reassure her sister, even though she knew Kelsey was unconscious.

She felt the stop of momentum when the ambulance parked in the bay and glanced at the men with her.

“Keep your head down, now,” Jerry warned. Meghan nodded, and the cot was released from its secure mooring in the ambulance and pulled out. Wheels dropped down and locked in the upright position. Hands grabbed onto the rails, and they were wheeled into the ER and into Trauma Room 1.

**********

Jerry was giving report, nurses and techs were doing what they could around Meghan and Kelsey. But Meghan focused on Dr. Steve Shultz, who had come to the bedside next to her.

“Meghan, what have you got?”

“This is my sister, Kelsey, Mitch Branston’s wife. She was cutting vegetables, carried the knife on the cutting board, tripped, and the knife plunged into her wrist. It’s an arterial bleed, spurts without direct pressure. I can still feel the pulse. When I let go, you’re going to need to clamp it.”

“Okay, Meghan. Let’s get set up for that and get you off there.” He turned to the nearby nurse and asked that the clamp pack be set up. “I want labs, CBC, Chem panel, Type and Cross for 4 units, and someone do a fast hematocrit! Get a pack of platelets hung STAT. X-ray, when we get this clamped, I want films. And someone have a wheelchair on standby for Meghan.” He glanced at her. “Yes, I noticed the leg splint.” He turned away from her. “Someone call Dr. Rick Brant and tell him he has a patient in the ER he needs to see.”

A nurse signaled Dr. Shultz, and he turned back to Meghan. “Okay, let’s get that vessel clamped. I want you to keep brachial pressure, but when I tell you, I want you to move your hand from her wrist. Okay?” Meghan nodded. Dr. Shultz grabbed an appropriate clamp. One of the nurses reached around and used shears to cut the kerlix along one edge, so the entire dressing could just be peeled back instead of needing to unwind it. “Here we go. One, two, three.”

Meghan let go of her sister’s wrist. Blood immediately welled up bright and started dripping on the floor. A nurse used a suction tube to suction blood from the area to give Dr. Shultz the best view possible. He dug into the wound and found the bleeder. Seconds ticked by, but then a metallic ratcheting sound was heard, followed by “Got it!”

“Okay, I got it. Slowly reduce pressure on that brachial artery…Good, good. A little more…Let go completely… I think we got it! Okay!”

Meghan sat up, hands in her lap, for the first time.

“Let’s get you down from there, Meghan.” A couple of techs reached out and assisted Meghan down from the cot and into a waiting wheelchair. The medical team swarmed Kelsey’s body as Meghan was pulled back from the room and into the hallway. A kindly older nurse took over from the tech and started wheeling her down the hall. “I’m Beverly, Meghan. We’ve worked together, but I don’t think we’ve ever been formally introduced. I’m going to wheel you down to the women’s locker room so we can get you cleaned up.”

Meghan looked down at her hands. They were painful, cramping, and covered with blood. She gulped. “Yes, I think I would like to clean up.”

Beverly pushed the wheelchair into the locker room and pushed it up to a sink. “Just a moment, dear, while I grab you a washcloth and some towels.” Meghan waited while she grabbed the linens. Beverly set them on a nearby bench, then turned on warm water and lathered up a bar of soap. She reached for Meghan’s hands and started scrubbing at the blood there. She washed Meghan’s arms as high as she could, rinsing them off with another cloth, and handing Meghan a towel to dry them off. “Honey, you’ll want to wash off your face and neck. If you’ll do that, I’ll go grab you some scrubs. Do you know what size?”

“Large pants and medium top. Thanks.” Beverly exited the room to get the garments, and Meghan washed off her face and neck. So much blood! She was drying off when Beverly returned. The nurse helped her change, since putting on pants over a splint isn’t easy. “What do you want to do with the clothes, hon?”

Meghan thought for a moment. “Just trash them. I don’t really want to wear them again, after…” she trailed off. Beverly patted her leg, understanding. She carried the clothes to a waste bin and dropped them in. She did the same for Meghan’s slippers at her request, then brought over some of the grippy hospital socks and slid them on Meghan’s feet. “The only thing I can’t help out with is your hair, dear, sorry. I’m not set up to help you wash the blood out.”

“It’s okay, Beverly. Thanks for all you’ve done.”

“I’m going to wheel you back to the ER. I think the EMS boys have your crutches, so I’m sure you’ll want to retrieve those.” Beverly wheeled her back to the ER, where Jerry was chatting by the nurse’s desk.

“Hey, there, squirt. I think you’ll want these.” He held out her crutches.

“Sure thing!” Meghan accepted the crutches, stood up from the chair, and fitted them under her arms. “Are Parker and Bill still outside?”

“Yeah, cleaning up.” Meghan started for the ambulance bay, Jerry on her heels. She made her way to the back of the ambulance, which had the back double doors thrown open. Bill and Parker were still restocking, but the ambulance had been cleaned of blood and the cot freshly made with white sheets. The odor of disinfectant was still pretty strong.

“Hey, guys. Thanks.” She said by way of greeting.

“No problem. Glad we could help.” Parker swung out of the ambulance, hopped down the back step, and landed on the floor to stand next to her. “By the way, if you don’t mind me asking, what happened? We were wondering about it at the station just the other day. You suddenly disappeared!”

Meghan laughed. “I apparently played road chicken and lost to an SUV about 2 weeks ago. Broke my tib-fib and had to have a couple of pins put in, plus a bit of a concussion.”

“Sorry to hear that. But glad you’re doing better. Sorry to have to meet up again this way.”

Meghan nodded. “Yes, and I was just starting to enjoy my forced vacation.” The smell of the disinfectant was making her queasy, so she shifted away from the end of the truck to get away from the smell.

Bill hopped out of the ambulance to join them. He had a towel in his hands and was wiping them on it. “How long do they have you out for?”

“Not sure, but probably 6-8 weeks if everything heals normally. I’m supposed to have my stitches out next week and then transition to a cast. Crutches suck.” Meghan was starting to feel a little lightheaded.

“Well, take it easy. We need you back soon on rotation,” Jerry started.

“Yeah, it’s eating into his social life,” Bill teased, as Jerry poked him in the ribs. “Whoa, catch her!” he exclaimed.

Meghan had passed out. Parker caught her and eased her to the floor as Bill ran inside for a gurney.