Vortex, page 4
“His leg doesn’t have a pulse. I think he has compartment syndrome,” Bianca named the very dangerous traumatic injury where the tissues inside a tight space like the calf swelled, cutting off blood supply to the leg. Usually the patient would lose the limb and possibly their life if it wasn’t corrected. “See how pale it is?”
“We can’t treat him here. We need help.” Casey tried to call but got the ER clerk again.
“Yes, right. Compartment syndrome? That sounds bad, but not as bad as the guy whose aorta is transected by a lightning rod. As long as he isn’t unstable, you’ll have to wait.”
Bianca patched herself in. “Get me orthopedic surgery. I’ll take Dr. Joel Glazier or any other ortho attending you have in the ER.”
The ER clerk was surprised. “You want to talk to Glazier on purpose? He’s down here in Curtain 6.”
Odd noises and voices could be heard for a few seconds before a voice growled, “Who the hell is this? I’m reducing an open fracture in a curtain. What do you want?”
“It’s Bianca Sunshine, Dad.”
He started laughing. “No kidding. Where the fuck have you been for months?”
“I joined the fire department. Right now, I’m stuck outside in triage. I’ve got a guy with a compound right tib-fib fracture from an MVA. His foot did a full twist, including a triple axel. We’ve splinted him, but he’s developed compartment syndrome. It has been an estimated three hours since his injury.”
“He needs a fasciotomy. Put some pressure on the damn bleeding.” Glazier seemed to be yelling at someone else.
“No kidding. Wanna come out and do it yourself? Or spare me a resident who can do it.”
“Fuck you,” Glazier said. “No, not you, Sunshine. That’s for the dummy who isn’t holding enough damn pressure on my damn bleed. How stable is he?”
“He’s unconscious in a c-collar. Probably concussed, pupils were equal and reactive.” Casey shone light in his eyes again. “We’ve got him on oxygen cannula and an IO in his right arm.”
“He should be intubated with a head injury. And he needs a head CT.”
“Dad, if you keep a CT in your pocket and a vent for my basic EMS Medic, you’re welcome to be in charge,” Bianca said, trying and failing to palpate a pulse near the heel.
“I’ve heard enough. Prep for a fasciotomy.”
“Great, you’re sending me a resident?” Bianca could only feel relief.
“Nope, I have zero to spare. You’re doing the fasciotomy.”
“What?” Relief immediately flipped to terror. Bianca had not expected that from Glazier.
“You want my newbie rookie to do a fasciotomy?” Casey asked, channeling the grumpy bear vibes he had used on and off all day.
“She’s not any random rookie. She was my scrub tech. Her training program was done with the ladies from Rescue Alpha, so she’s much better than your average Neanderthal.”
“You’re a scrub tech, and he’s your dad?” Casey asked in disbelief.
“I was a scrub tech, and Glazier’s not my dad. It’s an inside joke,” Bianca said, having gone numb inside from Glazier’s request.
“Forget the jokes. Get yourselves suited up. You’ll need face masks, gowns, gloves, goggles, and whatever you can find to cut.”
“Are you sure? We can bring him into the hospital or get supplies from there,” Bianca suggested, watching the leg get even paler.
“Best of luck on that. The supply room is being stripped bare, and it’ll be twenty minutes before you even get through the doors to the ER. Time is tissue, so get cracking.”
Bianca steeled her nerves, never imagining she’d do this alone. During her training, she’d practiced on cadavers, she’d seen it done, but to do it on her own…
“Dr. Glazier, I’m Casey Jensen, her current supervisor. You are giving medical permission for us to perform a fasciotomy in Medic 15, even though we’re seventy feet from the hospital.”
“Seventy feet might as well be seventy miles. If it were anyone else but her, no way in hell. So you have medical permission to do it. I’ll even talk you through the whole thing, same as I do in the OR. Tourniquet the leg.”
At least the last part was comforting. She’d had always followed his commands in the OR, so this was the same… other than the whole not being in an OR, having no blood, no anesthesia, and the long other list of everything she lacked.
It didn’t matter. She would do what she had been told as she had been trained.
This is why she was here. She’d quit her old job to be here, in the field, saving lives.
And she would do what had to be done.
Chapter 7
They put a tourniquet up near the femoral artery, and she instructed Casey to prepare to pack the wound with towels and gauze.
“I’m ready,” she said after ransacking the supplies. “Iodine on. Masks on, face shield on. I have a disposable scalpel and a pair of Iris scissors.”
“Okay, Sunshine. I guess that’ll have to do. Make the lateral incision into the anterior compartment of the calf. The most bleeding is probably going to be there from the anterior tibial artery. Pack it with whatever you have.”
Time is tissue. Time is tissue. Time is tissue. Bianca repeated in her head, gritting her teeth, and made the first cut.
“Making a twenty-centimeter lateral incision and widening it with the scissors. Gauze.” Bianca requested as she revealed a large collection of blood and flecks of bone. Casey handed her a big wad of gauze, which she shoved into place. “I need more packing.”
“You need to pack it tight and make the second cut,” Glazier said between giving a completely different set of orders to someone else. “Rotate the leg to make the medial incision on the inside.”
“Yes, sir,” she said, finding a place of calm by pretending she was in the OR, following his orders. This patient was going to need a full reconstruction in the OR anyway. “Beginning second incision now.”
The second incision was faster with less blood, and Casey was on hand with more packing. She rechecked the foot and said, “Sir, the foot isn’t pinking up, and we’re having a lot of oozing in the anterior compartment.”
“You probably have a laceration of the anterior tibial artery if his legs is as smashed up as you say. Not even the tourniquet can stop that. Have any hemostats?” Glazier asked.
“Hemostats?” Casey asked, likely unfamiliar with the term.
“Yes, clamps. Needled drivers, hemostats. Even Neanderthals know what those are,” Glazier said over the airwaves.
“Be nice, Dad. Don’t make me use my angry voice on you. He’s my only help, and he hasn’t fainted yet. So no, our BLS ambulance doesn’t have any clamps.”
“Then you’ll have to do it by hand. Remove the gauze and find the bleeder with your hand. Plug the hole.”
“Here I go.” Bianca pushed the gauze aside, steeled herself, and felt something pulsating under her finger. It stopped. “I think I have it.”
Casey examined the leg. “Pinking up a little.”
Bianca breathed a sigh of relief. “Wow. We did it. What now?”
“You stand there until an actual ortho surgeon takes over for you. No ER docs, no random medical students with God complexes.”
“Okay, good. I can do this.”
Glazier wasn’t done. “Sunshine, how’s the other leg?”
“The other leg?” Her heart froze.
“You pulled this guy out from a smashed dashboard. You think only one leg is broken?”
Casey sidled around her to the left side; his eyes darkened and brow tight. “There’s no pulse, and it’s pale.”
“No,” Bianca denied, panic suddenly overcoming her.
“You know what you have to do, Sunshine.”
Bianca couldn’t believe what Glazier was asking. “We should do the other side?”
“There is no ‘we’ in this,” Case said into the radio. “I am not doing a fasciotomy, and she’s busy with her hand on somebody’s artery keeping them from bleeding to death.”
“Ah, finally a man who knows the limits of his intellect. If only all Neanderthals were so intelligent. I don’t want you to do the fasciotomy. Tourniquet him and switch spots with her so she can do the other side,” Glazier instructed. “It’s a walk in the park after doing the bad side.”
“Are you sure I have to… I’ve already done more than I usually would,” Bianca pleaded one more time. Casey had excellent valid points about why she didn’t need to do this.
Glazier’s voice went cold. “You will do this. You’re already in. Untreated compartment syndrome is fatal. If you do nothing, he will bleed to death. He will die within feet of the hospital. Believe me, if I had any better choices, I wouldn’t ask this.”
Casey put his hand on her shoulder. “You can do this.”
For a second she thought he was being comforting, but then she realized he was waiting to take her spot.
No time for niceties, during her chat with Glazier, Casey had already prepared the other leg with iodine, a tourniquet, and the gauze was ready for her. He’d wiped off her scalpel and pair of scissors for a second use. The patient, so out of it from blood loss, still had stable vitals, but was fortunately unconscious.
“Okay, follow my hand to the spot. As I pull out, you’ll feel the pulse under your finger,” Bianca said.
He nodded and followed her instructions. His much larger hand plugged the hole, and she drew back. No big rush of blood.
“Got it, sir.”
“Do the next one,” Glazier said as he gave orders to other staff members behind him. As usual, he ruled her Medic and whatever curtain he was in with an iron fist. No one dared question him. One could have called it hubris, but Glazier actually was that good and confident he didn’t need to play nice. If he believed she had to do this, the situation inside the hospital must have been dire indeed.
The second time was easier. Her cuts were more confident, and Casey kept reaching across the patient to hand her the gauze she needed at the right moment. When she found the bleeder the second time, it was much smaller, and the foot immediately pinked up.
“Talk to me. Did you two die in there? Or the patient?” Glazier asked.
“No, sir,” Casey answered. “Patient’s vitals are stable, and we have two open legs here. Rookie’s catching her breath.”
“I’ll send someone as soon as I can. Just stay put and call for help if he starts dying.”
“That’s comforting,” Casey said as Glazier hung up
“He’ll send a resident or come himself. Dad is like that.”
“Dad? You said…”
“He’s not my dad. He’s a six-four bald White guy. Definitely not my dad, but when he started calling me ‘Sunshine’ in the OR, I started calling him ‘Dad.’” Bianca shrugged as far as her shoulders would let her without moving her hand.
“About that, you actually were a scrub tech at MetroGen?” Now that they were alone with their hands inside a body, he somehow had relaxed.
Like he’d been given a purpose and was on solid ground again.
“Not for very long. I did a one-year training program and had been Glazier’s regular scrub tech for about six months before I left,” she said.
“You left? Why? Doesn’t sound like you had a problem on the job.”
“It’s not too weird. There was a guy in the last academy class who used to be a doctor,” Bianca said. She’d have bet the firefighter running triage for Firehouse 15 was the same guy.
“Not an answer to my question,” Casey said.
She should have expected they’d end up going down this road, and she very much wanted to know where it would lead. “Do you remember the blizzard over Veteran’s Day last year?”
“Yeah, Royce and I ran Medic 19,” Casey said.
“Did you… Did you save me?” she asked the question that had been on her mind since he turned on the phone in the locker room.
“Save you? What are you talking about?” His eyebrows raised behind the mask.
“During the blizzard, I stupidly decided to drive to work because I thought I was essential personnel to the hospital. But a tree fell on my car, and I almost froze to death.”
“The rescuers getting rescued is never good.”
“Yeah, Glazier actually stayed home for the morning. When he got to work, he reamed me out later for getting my butt saved. Was it you?” she asked tentatively.
His gray eyes looked at hers over her mask, softer than he’d been to her before. “Why do you think it was me?”
“Somebody from the fire department pulled me out in the snow. I don’t know who. I woke up in MetroGen being rewarmed. The only thing I remember is the shadow of someone who could be you. Blonde hair and blue eyes. In the locker room when it got dark, your eyes were the right color.”
He was quiet for a couple seconds. Finally he said, “It wasn’t me. I didn’t save you. I was at a nursing home fire. I was in part of the convoy bringing burn victims to the ER.”
“So it wasn’t you.”
“No, it wasn’t. But I think I saw you there. You were in a curtain in the trauma pod. So maybe that’s it.”
The mystery remaining unsolved wasn’t the end of the world. “Too bad. I always imagine giving my rescuer a big kiss.”
His gray eyes heated up, “Are we flirting with our hands inside a body cavity?”
“Yeah, haven’t you seen any of those firefighter or doctor TV dramas? This is totally a thing. Seriously.”
“It is not,” he had a teasing note in his voice.
“Oh, it is so legit. One of us worked at MetroGen, and it wasn’t you, Casey.”
“I don’t care how cute you are. I’m not kissing you with my hand on an artery.” Now they were staring into each other’s eyes. “But maybe later.”
“I live in hope.” She batted her eyelashes to break the intensity. “Know any good tornado jokes?”
Chapter 8
By the thirty-minute mark of standing with his hand inside a person, Casey was certain of several things.
First of all, he was definitely not meant to be a doctor. Or a surgeon for that matter. He’d take a roaring inferno any day over this.
Two, the staff of MetroGen were a different breed if this was normal. The way Bianca breezily chatted throughout the wait demonstrated this strongly, though he suspected it would be a different story if the patient became unstable.
Third, her mojo was working on him because he definitely found her utterly and completely kissable. Judging by the way she had talked to Dr. Glazier, she knew exactly how to handle guys who were rough around the edges.
A kiss in the current circumstances would have been rather difficult with the face shield, masks, gowns, open body cavity, and the fact that Royce would certainly have an unholy conniption. Not to mention them being stuck inside the almost windowless box of the Medic. It had taken coordinated near hand-holding to change the last normal saline bolus.
So no kissing.
Even if this ray of sunshine who’d entered his life could make him smile over an open body.
“I hear people,” Casey said. “I hope they’re for us this time.”
A Filipino doctor opened the doors to the back of the ambulance. The doctor, who seemed to be in his early thirties, exclaimed, “You really freaking did it!”
The group behind him was a mixed bag of MetroGen nurses and a woman who appeared to be from the paramedic group Rescue Alpha. Royce was standing in the back of the group.
“Navarro, we’re at least three hours since the patient’s initial crush injury from an MVA. Obvious shattered right tib-fib with rotational injuries, unclear on the left. We lost pulses, and Dr. Glazier had me perform bilateral double flap fasciotomies, decompressing two large hemotomas, and we currently have plugged the anterior tibial artery and vein manually,” Bianca stated calmly with her hand not moving from the man’s leg.
“I thought Glazier was joking.” Dr. Navarro examined Bianca more closely. “It is you, Sunshine.”
“Good to see you, Jon,” she said, apparently quite familiar.
“You got skinny,” said ‘Jon’ as if he could tell despite her mask and gown. “I wondered what had happened to you.”
Royce was quite an odd shade of white from his spot in the back. “You cut him open and shoved your hand inside? On both sides?”
“She’s a scrub tech,” Casey said, not liking Royce’s implication they’d gone rogue.
“Dr. Glazier gave us permission and was on the phone the whole time,” little Ms. Sunshine said as if this was a normal occurrence, which it was NOT.
“She was Glazier’s fav Ortho surgical tech.” The doctor was inclined to defend them while he examined the incisions. “She did pretty well for a chop job with a flimsy scalpel. If it hadn’t been an emergency, we’d have done this with him intubated and transfusions available.”
Royce said, “Okay, fine,. Our rookie is a superhero with a scalpel. Now what?
Navarro said, “First, we’re going to run to the CT scanner to clear his head and neck. They’re giving us a ten-minute window to figure out how many doctors we’re gonna need in the OR. How long since his last neuro check?”
“None, since we did the procedure thirty minutes ago,” Casey said. “I can’t reach his head from over here.”
“We’re going to have to move now. So I hope you enjoy your hands exactly where they are.”
“Are you sure no one can take our place?” Casey asked, noting Bianca remained unbothered.
“Every single other person here has a job other than the one you are doing. We’ll trade you out when he’s intubated in the OR, and we have blood on hand.”
“So we’re going to move to CT now and then the OR?” Royce asked.
“Yeah, let’s get rolling.” Dr. Navarro winked at Bianca, and Casey suppressed his urge to bristle. “Sunshine, honey, you aren’t pregnant, are you?”
“Hmm, sadly no after we got so hot and heavy after that staged front-back spinal revision.” She winked back through her mask.
“Pleasure and action makes the hours seem short,” Navarro said, and a new rumble appeared in Casey’s chest. Whatever moment she’d shared with him faded in the light of her relationship with Dr. Navarro.
