kept up this time.
“What have we got?” he asked the nurses and paramedics rolling with his new patient.
“He was standing, and when it jumped track, he flew. Person from behind him hit him right after.”
Crushing damage.
“Name?” Sabetta asked, reaching for the chart as they ran alongside the stretcher.
“Samuel Riggs.”
“Mr. Riggs?” she called in his ear but got no response. “How long has he been unconscious?”
“Since it happened, probably. Uneven pupils, he’s breathing too fast. Tachycardic,” one of the paramedics filled in as they wheeled into the treatment bay.
“Get his shirt off.” Lyons gloved and reached for his stethoscope.
She beat him to it, listening to the patient’s heart while the others in the team fell in, taking the steps he didn’t even need to order at this point. Get an IV started. Hook up the telemetry to monitor vitals.
A good sign, not freezing up as he’d half expected.
“Get a blood workup,” he ordered, joining her in listening to the man’s heart and lungs.
She’d grown a bit paler than she’d been, but that wasn’t unusual for first-timers.
“Thoughts?” That would tell him more than blanching.
“His pulse is far too rapid,” she answered, backing up the paramedic’s report. “And he’s heavily bruised. There’s also a substantial lump on his head that I can see. If his pupils are unreactive, he needs a CT.”
This was easier, working with a critical patient to take his focus.
Lyons listened again. Everyone breathed faster when tachycardic. The heart didn’t pump blood and circulate oxygen efficiently, which caused the body’s natural remedies to kick in, even if they couldn’t help. He breathed faster naturally because his heart beat faster, it just didn’t help.
“What’s his pressure?”
One of his nurses took it manually while another worked on the telemetry and read off numbers far too low for his liking. She’d gotten the obvious things, and this wasn’t a teaching hospital, but it was his hospital, and he needed to know his peers could handle themselves.
“What do you want to check?” He knew what he wanted to check, but he’d give her one shot since all the techs should be descending on the room any minute.
“Rapid heart and low blood pressure, along with all this bruising from the impact. I’d want to check for internal bleeding.” She shook her head as she said it, as if she knew the answer was wrong, but stuck with it. “The head trauma is separate.”
Right about the head trauma, wrong about the internal bleeding—which, while probably present, wasn’t the most immediate danger to life.
“Look at his oxygen levels.” He indicated with a nod.
A number in the high eighties; he could tell by her expression that she recognized it wasn’t good.
“What tests?” he asked, giving her another shot.
“Typing for possible transfusion, a CBC, maybe troponin levels?”
Sticking with bleeding, but with a twist?
“Testing for heart attack?”
Wrong.
“All heart damage causes the same enzymes to release.”
He waited for her to listen to the patient’s chest one more time, still not leading.
She placed the bell to the man’s chest and listened, but not to his lungs. Just his heart. It was the obvious symptom, the flashy thing demanding attention. When she commented again, it was on the speed, and shouldn’t they slow it down? She’d somehow managed to miss that distinctive crackling sound his lungs made upon inspiration.
She’d said she normally worked Urgent Care facilities, not places that saw much active emergency. She wasn’t ready for this, so out of her depth it was almost laughable. When he spoke to Backeljauw, he’d suggest she be shifted to the non-emergency cases.
“I want a CT, head and chest. Image and circulation.” He directed his team. “And a blood panel. At least one lung has been damaged. I want a D-dimer.”
“For clotting?” she asked.
“Go back to the station and wait.” He grabbed his comm to suggest to Imaging that they hurry the hell up, but as she stood, looking confused, added for her benefit, “I don’t have time to hold your hand through this. Neither does he.”
STICKING AROUND TO defend herself or make excuses would’ve taken valuable time away from the patient, so Belle did as McKeag growled at her, slipped quietly out of the room and found her way back to the nurses’ station.
Her central nervous system couldn’t decide how to react to that whole humiliating set-down. Her face alternated between burning at a temperature best measured in Kelvin and the stormfront of an approaching Ice Age any time she relived the joy of the actual rebuke, and the number of eyes on her, the team working as she failed her first patient.
Still, with the hospital in the throes of a large-scale emergency, standing there, observing the bustle and scurrying about without helping somehow could be nothing short of dereliction of duty.
She wasn’t a doctor. She wasn’t trained for this type of medicine or level of emergency straight out of the gate and had truly only offered her best educated guess when prompted, but it still felt the same when an expert—a peer—immediately found her lacking. Even one she knew to be unpleasant in other circumstances already.
Something about it had felt like a teaching moment, but, in retrospect, she could see it had been a test. An unfair test, the kind of test only a real jerk would lob at a new colleague in the first five minutes on the floor, but still a test she’d failed.
It wasn’t just pride that never wanted to fail a patient. Not everyone went into medicine for the right reasons, but Belle had. Her main role models had been Dad and Nanna, a city cop and a former Army nurse. Belle wanted to help people, it was a core tenet of her personality. Seeing the nurses who’d taken care of not only her dad as he’d lingered in the days between when the bullets had wrecked his insides and when he’d actually died, but also the fourteen-year-old girls who couldn’t leave his side, had solidified that need to help into a calling.
And she was just standing around, while other people helped eased suffering.
If this was just how things went in a large, metropolitan emergency department, she had to either get out now and make this a one-day affair or find that steel Sabetta core and a way to help.
Like a gift from a higher power,
