three more weeks, your name is Gav or Gavin, take your pick.”
“Missouri Regional, this is 841, we are currently inbound for your facility….”
Cheyenne glanced at her watch, groaned, straightened at her desk, still fighting the nausea. “Go away,” she muttered. Twenty more minutes, and Brillhart would be here. Why hadn’t she asked Ardis to call him sooner?
“…Caucasian female, late twenties, class one trauma from an MVA. Patient’s car was struck in the driver’s side, had to be extricated. Patient is fully immobilized, responsive only to pain. We are attempting to establish IV at this time. BP sixty over forty by—”
“Coming here?” Ardis exclaimed. “Did you hear that? They’re bringing us a class one.”
Cheyenne reached for the ambulance radio and keyed the microphone. “Eight-forty-one this is medical control. Divert to University Hospital. We are not a designated trauma facility.”
“Missouri Regional this is 841, we copy but cannot comply. University and Boone are both on full trauma diversion at this time. ETA of five minutes.”
Cheyenne pressed the button again. “Eight-forty-one, this is medical control. We roger your last transmission. Please advise of any change in patient’s condition. This is medical control at Missouri Regional out.” She disconnected.
“Oh, my. What do we do now?” the secretary asked.
“Advise RT and X Ray we’ve got a hot one coming in fast.” Cheyenne turned in her chair. “Quickly, Deanna.”
“G-got it, Dr. Allison.” The secretary swallowed and jerked up the telephone.
Cheyenne nodded to Ardis. “Have Lab get four units of O-negative blood STAT. I want it in this department when the patient arrives. Then attempt to notify the surgeon on call for backup. Let him know what we have.”
Ardis went to work.
Cheyenne found the intubation kit in the trauma room and selected the appropriate size ET tubes. What a time to have the flu.
The radio came alive again. “Missouri Regional, this is 841. Be advised our patient is now in full arrest. I repeat, our patient is in full arrest. Following ACLS protocol. ETA less than two minutes.”
Cheyenne made eye contact with Ardis. They would do all they could, but the odds were against this patient surviving.
“Everyone get your protective gear on,” Cheyenne said.
“I hear the sirens now,” the secretary called.
“Make sure RT and X Ray are on their way down,” Cheyenne said. “Ardis, check on that blood.” The trauma room was ready. “Aprons, masks, gloves, everyone.”
Stepping to the window that overlooked the ambulance bay, Cheyenne caught sight of the red-orange-red-orange flash of lights as the van safety-sped into the lot. Tension thickened the air in the Emergency Department.
“We can do this,” she said. “Get ready.”
The RT tech came racing down the far end of the corridor pushing her supply cart.
Ardis hung up the telephone and swung toward Cheyenne. “They’re getting the blood ready, Dr. Allison.”
“Good. Come with me.” Cheyenne looked for the ER tech. “Rick, you too.” She led the way out to the bay, where the driver was yanking open the back doors of the ambulance.
The attendants pulled the intubated patient from the vehicle. Cheyenne’s first sight of the patient was the flash of red blood marring a half-naked body—the attendants had stripped her to check for all injuries.
“Rick, take over compressions,” Cheyenne ordered the tech. “What’s the rhythm?” she asked the attendant, standing back as they wheeled the stretcher toward the door.
“PEA,” the paramedic said.
Pulseless electrical activity. No surprise, judging by the apparent blood loss. The patient was unrecognizable.
“How much fluid have you given?” Cheyenne asked, following them through the door.
“We’ve only been able to give about a hundred cc’s,” the paramedic replied. “I could only get a twenty-two gauge IV started.”
Not big enough. “We need at least a twenty gauge.” She turned to Ardis. “I need you to establish a large-bore IV, have her ready for the blood when it arrives.”
“I’ll get right on it.”
They helped transfer the patient to the ER trauma bed while the respiratory tech took over bagging the patient, helping her breathe. Cheyenne moved to the patient’s left side to check for placement of the ET tube, leaving her right side accessible to Ardis.
No breath sounds over the abdomen. Good. That meant the patient had been intubated properly. Pressing the bell of the stethoscope over the patient’s bloody chest, she raised a hand for Rick to delay the next compression.
No heartbeat.
She nodded for him to continue.
As she removed the stethoscope from the patient’s rib cage, she saw a dark blotch on the skin. A large birthmark just below the left breast.
She looked at the face again, reached for the blood-matted hair.
Black. It was the length of…
She looked at the paramedic. “You said she was the driver?”
“Only person in the car. We pulled her from beneath the steering wheel.”
Cheyenne couldn’t catch her breath. “And the car? Did you notice what kind…?”
“Dark blue Sable sedan.”
The edges of Cheyenne’s vision went black and she felt herself slipping backward. It can’t be—I told her not to drive, she said she wouldn’t….
“Dr. Allison!” Ardis yelled.
“Oh, Susan. Oh, please God, no.” Cheyenne fought to regain her composure. “Where’s that blood!” she snapped.
“Right here,” Ardis said. “Hold on, Dr. Allison, I can’t get the large bore IV.”
“Have you heard from the surgeon?”
It couldn’t be Susan. She was only going to a neighbor’s house.
But her sister’s silhouette—the undamaged part—was obvious now.
“Our on-call surgeon is also on trauma call for University,” Deanna said. “We’re trying to reach someone else, but—”
“Ardis, get me a central line kit,” Cheyenne ordered. “She needs blood now. And get X Ray in here for a trauma series. Now!”
“Dr.
