as she examined the twins, ordered a few precautionary X-rays and lab tests, as well as a bottle of formula for each, she found herself impatient to return.
Funny thing how Ethan’s training and previous experience as a general pediatrician seemed to surface from out of nowhere as he examined his young patient. Apparently it was true that some things, like riding a bike, just weren’t forgotten, because from the moment Ethan saw the bruises on Tommy’s torso, the abdominal rigidity, cool clammy skin and shocky vital signs, he knew what to do. Grateful that he wasn’t in over his head as much as he’d feared, he relaxed a bit and mentally ran through the diagnostic protocol.
“I want cervical and lumbar spine X-rays, as well as chest and abdominal films,” he told Nancy, guessing that the two people lingering in the background were the lab and X-ray techs. “A CBC, basic chemistries, liver enzymes, renal function, amylase, type and cross-match for two units, coag studies, and a urinalysis. Stat. Any chance we can get a CT scan?”
Nancy shook her head. “Sorry. We’ve been trying to raise money for a scanner, but haven’t yet.”
The scan would have ruled out intra-abdominal or peritoneal bleeding, but if one wasn’t available then he’d have to depend on other tests to make his diagnosis. For the first time since he’d left St. Louis he realized how fortunate he’d been to have every resource available.
He stepped aside to allow the techs to work, remaining nearby to watch Tommy’s monitors, guess at his weight and double-check his mental calculations for the amount of fluid replacement.
By the time Ivy rematerialized he’d run a nasogastric tube and ruled out a stomach injury, gotten a baseline hemoglobin level from the lab, studied the films and decided the spine immobilization could be discontinued—although he’d feel better if a radiologist had given his seal of approval.
“Reinforcements have arrived,” she said cheerfully. “What can I do?”
“Find a surgeon in the next thirty minutes.”
“I wish. What’s the problem? Internal bleeding?”
Ethan pulled her aside. “I think his spleen’s ruptured. I don’t have a second hemoglobin level yet, but he has all the signs, especially abdominal pain and tenderness, pain in his left shoulder, and being shocky. The question is, do you want to observe him here and then Medevac him out when we know for certain, or move him close to an O.R. now, before he needs one?”
“Do you really have to ask?” Her tone was wry.
“I’d vote to move him out now, but this is my first day on the job,” he reminded her. “I’m still learning your protocol.”
“The only protocol I have is that I make a point never to gamble with my patients’ lives. I’d rather give them an unnecessary helicopter ride than hold them here until it’s too late.” She met his gaze. “Do you have a problem with that?”
“Not at all,” he admitted. “I’d hoped you’d agree with me.”
“Then I’ll make the arrangements.”
“As an FYI,” Ethan mentioned before Ivy got too far, “Ben said they were using the Jaws of Life to free this Marybeth person, so she might need to catch a chopper ride, too.”
“I’ll notify the air dispatch.”
After making the flight arrangements, Ivy ran into Jed outside the trauma room. The same age as Walt, Jed was looking as haggard as Ivy felt.
“Busy day for you, too?” she commiserated.
He smiled. “I haven’t worked this hard in years. How Walt did it all by himself is a mystery. Not to mention downright miraculous.”
Ivy chuckled. “I have to agree.”
The ambulance bay doors whooshed open and the E.M.T. crew wheeled in another victim. At the same time the main doors at the other end of the department flew open, and a crowd of frantic adults rushed through.
“Have fun with that group,” Jed murmured, before he sprinted toward the incoming gurney and disappeared inside the trauma room where Ethan and Tommy already were.
Immediately Ivy was surrounded by parents asking after their children. After trying unsuccessfully to get a word in edgewise, she gave an unladylike whistle.
Complete and utter silence followed.
“Who belongs with Suzy and/or Emma?”
A young couple and a single woman raised their hands.
“Tommy?”
“He’s our son,” another couple said.
Ivy smiled. “Dr. Ethan is with him right now, but I’ll let him know you’re here. The rest of you—” she glanced at the other parents “—come with me.”
She led her group to a nearby treatment room, where she paused in the hall. “Both Suzy and Emma are fine,” she told them. “They have some bruises and bumps, and will be sore for a couple of days, but nothing that a few hot baths and plenty of rest won’t cure.”
“Are you sure?” The woman who’d identified herself as Emma’s mother asked.
“Absolutely. But if they complain about anything new in the next couple of days, be sure you bring them in. In the meantime they can have acetaminophen to ease their aches and pains.”
“Thanks, Dr. Ivy.” Suzy’s father pumped her hand. “We appreciate this.”
“Can we take our girls home now?” Emma’s mother asked.
“Absolutely.” Ivy opened the door and the two girls inside jumped up and ran to their parents. Amid hugs and tears and sniffles, the two chattered like a pair of blue jays as they described the accident.
Happy to send those two on their way, Ivy peeked into the room where the twins slept in the baby beds that someone had robbed from the medical ward, clearly worn out from their experience.
Determined to let Ethan handle the other set of waiting parents, she found him next to Tommy’s bed. “How’s he doing?” she asked, ignoring Jed and the nurses surrounding his patient for the moment.
“Stable, for the moment. His second hemoglobin level has dropped, though.”
“ETA for the helicopter, twenty minutes. Which was at least…” she checked her watch “…seven minutes ago.”
“Good.”
“His parents are waiting outside. I thought you should talk to them as you know his condition better than I do.”
He hesitated, as if hating to leave Tommy’s side.
“I’ll stay,” Nancy offered. “His vital signs haven’t changed in the last fifteen minutes. I’ll let you know if they do.”
Ivy accompanied Ethan to the nurses’ station, where the Weathers were still waiting. From the worry on their faces, they obviously expected to hear the worst.
