yet…there was something very familiar about her.
After stripping and throwing on a pair of thread-worn scrubs, he realized he only had his work boots for shoes. Looking around the room, he spotted some extra-large OR shoe covers and slipped them on over his boots. Tucking in and tying the waistband on his scrubs, he rushed toward Gavin Riordan, the man offering his ER and saving him three weeks’ intensive training in North Carolina. Along with everyone else, he waited at the ambulance entrance for hell to break loose as they all applied personal protective gear.
And there she was again, the nurse, waiting beside Gavin. Her height and oval-shaped face definitely reminded him of his high-school sweetheart. Some sweetheart she’d turned out to be. No sooner had he left for bootcamp then she’d torn his heart out of his chest and stomped on it. Focus, Braxton, focus.
One thing struck him about the ER: it was so much quieter here than in the field. Then, boom, the ambulance entrance doors flew open, and Gavin and the trauma team jumped into action around the gurney.
“Got the call a half hour ago,” the first EMT said.
“It’s a penetrating injury. Gunshot wound to right chest wall with possible pneumothorax,” the second EMT said, while assisting the semi-conscious young patient’s breathing with an ambubag as the team rolled the stretcher down the hall.
Beck remembered the term “the golden hour”, the most important sixty minutes in any trauma patient’s life if he was to survive. Though things might look chaotic, there was, in fact, a planned system by the attending doctor and his team for checking the ABCs—airway, breathing, circulation—and making primary and secondary surveys of the patient.
“No other obvious injuries noted.” The EMT gave them the run-down of vital signs and initial assessment while they made their way down the corridor. “A 16-gauge IV placed in left forearm, infusing normal saline at 150 cc per hr. Pressure dressing applied to point of entry wound.”
Bright motion-activated lighting snapped on the moment they crossed the threshold of the trauma room, illuminating all the gory details. Wine-colored blood covered most of the victim’s clothes. A C-collar had been applied at the scene as he’d fallen out of a truck. They’d attempted to relieve the apparent tension pneumothorax with a needle at the second rib below the collarbone. It may have saved the guy’s life.
On the count of three the team transferred the patient to the larger procedure room bed.
The familiar-looking nurse with the boxy glasses and shy attitude went right to work cutting off the patient’s clothes, using surprising force to rip the shirtsleeves open to speed up the process. Even her mannerisms reminded him of January. But she’d had so much more style than this woman. She had been bubbly and full of life. This woman seemed subdued and almost beaten down. But they called her Jan. Hmm. Could thirteen years change someone that much?
A chaotic dance ensued among two doctors and three nurses. Their hands and bodies worked together, stepping aside, sliding under, reaching over, around, and through to get an airway placed, the patient hooked up to monitors, and a second IV started.
Beck wasn’t sure whether to hold off or jump right in with the team, but followed his gut and helped Jan remove every last stitch of clothing and toss it to the floor. He kicked the wad of clothes at his feet toward the wall to prevent anyone from tripping on it.
Gavin gave instruction that the OR be notified then called out a list of orders, including labs, blood gases, X-rays and two units of blood, while he did what Beck remembered as the primary survey. It was a methodical approach to checking the airway, breathing and circulation. Gavin auscultated the patient’s lungs and mumbled, “Crepitus” then studied the wound more closely. “Luckily for him this bullet nicked a vein and not an artery,” he said, palpating the femoral artery on the same side before he uncovered another gunshot wound lower down the leg.
The patient’s cold, clammy skin made Beck suspect shock.
“Get me a chest tube drain with autotransfusion,” Gavin told the nurse beside him.
Beck knew that meant Gavin suspected hemothorax—blood surrounding the lung instead of air. Beneath the first-aid bandages applied at the scene, a quarter-sized crater erupting with thick dark blood was located in the right upper quadrant and became the center of attention. Until the lungs were stabilized, the second, less threatening gunshot wound could wait.
The overhead monitor alarm beeped rapidly as the initial vital signs registered. The oxygen sats had tanked, BP was 80/40 and the pulse 130. The youth’s heart was working like crazy in an attempt to maintain his body’s circulation, and with a pneumothorax his lungs weren’t getting nearly enough oxygen. If not stopped, it would be a deadly cycle.
“Let’s get that chest tube in now,” Gavin said, searching for and finding Beck. Their eyes met in wordless communication, and Gavin stepped back, allowing Beck to approach the man. Baptism by fire.
Jan magically reappeared and rolled over a tray with all the equipment he’d need. He flashed back to his training, then several tours of duty, and recalled each step of the process of inserting a chest tube. He’d done his share of them in the field. Feeling under a microscope here, with the world watching, he donned sterile gloves and, driven by adrenaline, hoped his hands didn’t shake too noticeably.
After prepping the skin with antiseptic, he draped it with a sterile towel. He palpated the space between the fifth and sixth ribs and reached for the large syringe Jan handed him. He inserted the needle into the bottle of lidocaine she held for him, and administered the local anesthetic, waited briefly then accepted the proffered scalpel and made an incision in the mid-axillary line. She dutifully handed him a sterile package she’d begun to open from the outside, which gave easy access to the inside tubing without contaminating it.
Beck glanced briefly into her eyes just before he took it. For one beat their gazes locked. At close range, her eyes were blue, just like January’s. Damn.
A mini-jolt of adrenaline helped him refocus. Using the rigid guide, he inserted the tube into the pleural cavity and aimed upwards as he slowly advanced it until he felt resistance. He pulled back a tiny bit and clamped the tube. With no sign of blood, the wounded young man had been lucky. Jan connected the tube to an underwater seal before he undid the clamp. A reassuring bubbling sound gave him the confidence to begin suturing the tube in place. Soon, with the trapped air removed and no longer pressing against the lung, the lung could reinflate and the man would be breathing a lot easier.
“OK, let’s get a chest X-ray to check positioning,” Gavin said as he clamped a hand on Beck’s shoulder. “Good job.”
To say Beck wasn’t relieved would be lying, but the knowledge of a job well done admittedly felt good. “Thanks. It’s been a while.”
Jan wrapped adhesive tape around the tube and affixed it to the patient’s chest wall, then Beck looped the chest tube and taped it snugly to the patient’s abdomen before applying the final dressing.
Once Beck stepped back after his part was finished, Gavin took over. He’d located the superficially lodged bullet and removed it, then plopped it into a plastic specimen container held by Jan.
“Fantastical,” she mumbled as she studied the bloody ball of metal while Gavin stabilized the patient and readied him for surgery.
Had she just said fantastical? That was it. The missing link. In the midst of chaos and saving a life, quick memories popped into his mind of the only other person he’d ever heard say “fantastic”
