If I Don't Ask, page 21
what turned out to be reactive postoperative hemorrhage and
we’d had to go back to the OR. I’d barely finished washing my
hands when the loud ring of yet another incoming patient call
started up. I rushed to answer it. Single incoming, GSW left
arm and multiple rounds taken in the torso, thankfully stopped
by his ballistic plates. Not so thankfully, I was already
imagining what we’d find. I sent John and Sabine out to meet
the Pararescue team so I could assign OR teams and chug
down a bottle of water before I collapsed with dehydration in
the middle of surgery.
As I rushed up the hall, the casualty was rushed through the
doors in a flurry of activity, including CPR. That was not on
the menu. The PJ squeezing the resuscitator blurted, “He
literally just arrested, right as we were getting him out.”
“Gotta be BABT,” John babbled excitedly. An odd thing to
be excited about, but fatigue adrenaline was a strange beast.
“Tamponade?”
Sabine’s forehead wrinkled and she mouthed the word.
Tamponade.
I moved past her, brushing along her side as I declared,
“I’m leading this one. Sabine, take over compressions. John,
get on the bag.” All she had to do were chest compressions,
simple and rhythmical, something she could do in her sleep.
Even if she wasn’t sleeping. My focus narrowed to the trauma
but I was still aware of everything swirling around me. Sabine
climbed onto the stretcher to straddle the casualty and once the
PJ had finished his cycle, she confirmed lack of pulse and
rhythm and began her compressions. Even if I hadn’t been told
he’d taken rounds in the vest as well as in the bicep, it was
obvious from the furious bruising on his left pectoral region,
spreading down over his abdomen. BABT strikes again.
Over the sound of the clinical exam and stats, I could hear
Sabine’s ragged breathing as she performed compressions. Her
expression was vacant, and she was muttering something to
herself under her breath. But it didn’t sound like anything I
needed to hear so I tuned it out.
“Okay, let’s move.” As we rushed through the halls, I kept
throwing out instructions. “Bobby, I want him under by the
time I’m at the sink.”
He grinned cockily. “Yes, ma’am.”
“Sabine, once he’s intubated, I want you scrubbed and back
in there assisting me. Remember the BABT case we had your
first deployment?” It was a long shot, but maybe reminding
her of something we’d done before, the first surgery we’d
every performed together might snap her out of…whatever
this was.
She nodded dumbly, shaking sweat from her chin to drip
onto the man’s face. I had to leave her to get sterile and I
rushed through my scrub, conscious of the rapidly winding
clock and the slim window we had to get in and repair. I
glanced up from my scrub in time to see Sabine cease
compressions, do a vitals check, and mumble a single word
before she resumed her compressions. Asystole. I was going to
have to get in there, no more messing around.
As I was gowned and gloved, I glanced at the images
which showed pericardial effusion and abdominal fluid.
Blood. “He’s been down for almost six minutes. We’re doing a
lateral thoracotomy.” If I wasn’t dealing with BABT and
potentially ruptured who-knows-what in there, I would have
just done a pericardiocentesis to relieve the tamponade. “Get
trays ready, please. Kathy, take over compressions. Sabine, go
scrub.”
Sabine transferred compressions to Kathy and climbed off
the man’s legs, shaking her arms out the moment she landed
on the floor. I heard her voice catch before she almost-
whispered, “What’s his name?”
For a second, everyone went utterly still. No word, no
sound.
My scalpel paused. “Daniels.”
Her relief was palpable. I met her gaze and knew all my
concern was in mine. “Do you need to be relieved, Sabine?”
“No, ma’am.” A quiet, husky response but she seemed
genuine enough.
“Okay, good. Get scrubbed, STAT.”
My thoracotomy was quick and not entirely neat. From his
position behind me, Bobby mused, “Sucks when the thing
that’s supposed to save you is what might kill you.”
Of all the ridiculous things to say. “Not the time for
speculation, Bobby,” I said quietly. I could have slapped him. I
incised the pericardium, suctioned blood and clots to provide
some visualization, and searched for obvious cardiac trauma. I
found none.
“Nice sensitivity, Rodriguez,” Sabine snapped.
It was like being in a locker room of bickering teens. I
pulled out my command voice. “Focus everyone.” I steadied
my tone and added calmly, “This is not good. Fleischer,
you’ve handled BABT with me before. Hurry up, please.”
Though she’d been out and scrubbed, and was now dressed
and surgically sterile, she didn’t move. She didn’t say a word,
just kept staring at the man on the table front of me. The man
whose heart was not beating. I slipped my hand in again and
began open cardiac massage. Sabine still didn’t move, and I
lost my grip on my frustration. “Sabine! I need you over here
right now.”
She looked right at me. “He’s been shot in the arm too.
Why hasn’t anyone done anything about it?”
John almost choked on his incredulity. “No shit. We’ve got
bigger issues here.”
“Fleischer!” The word came out more sharply than I’d
intended but she seemed to be spiraling into something and my
previous attempts to get her attention had failed.
Thankfully something in my tone seemed to register and
she looked up from where she’d been staring at her feet.
“Yes?”
“Please step out.”
“Pardon me, ma’am?” Sabine’s voice was so husky and
rough with her unchecked emotion that it was almost breaking.
My attention was on the man whose dying heart I had in
my hand and I didn’t look at her when I said, “Leave the OR.
You’re relieved.” I knew what I’d just done to her, knew that
perhaps I’d made things worse for her. But my priority was
patient care, even as that knowing voice at the back of my
head murmured this was a lost cause. I had one chance to
repair this trauma. I could repair Sabine’s fragility later.
After almost half a minute I heard the snap and rip as she
stripped off her gloves and gown, the thudding whoosh of the
door. But I couldn’t look at her, even as I wanted to. “John, get
in here right now and control this hemorrhage. I can’t even tell
where it’s coming from with all this blood…spleen, liver, just
find it and stop it.”
From the corner of my eye I saw Sabine on the other side
of the glass, watching us. Our eyes met and a flash of
annoyance and frustration and upset sped through me. I jerked
my chin toward the main door, indicating in no uncertain
terms that she was to leave as I’d told her to do. Her mouth fell
open. And then she was gone.
Even with the internal bleeding somewhat controlled and
every life-saving measure we threw at him, we were unable to
resuscitate, and I left the room with an unusual feeling of
anger on top of my usual disappointment. It wasn’t Sabine’s
fault—his prognosis was always very poor—but the fact she’d
frozen so spectacularly was indicative of a problem far deeper
than I’d imagined. And I hadn’t seen what was right there.
Sabine was unraveling, as if she was pulling at threads here
and there and breaking them off. Little things at a time, not
enough to make her fall completely apart, just enough to make
her unstable.
I’d avoided pushing at her too much because I didn’t want
to insert myself into a personal matter that I’d expected her to
overcome with the help of her friends here and her family back
home. It was clear that I needed to intervene now, and that I
should have done so days ago. I’d screwed up and let her
spiral further than she should have because my better
judgment had been clouded by my sensitivity to her unique
needs. But I could fix that now.
I found Amy in the rec room playing chess with Conway.
Kicking his ass at chess more accurately. “Peterson, a word?”
She stood immediately. “Of course, ma’am.” To Conway
she said, “You got lucky, sir.”
Amy followed me out and around a corner where we would
have some privacy. She stood impassively, clearly curious but
just as clearly not concerned she was about to be disciplined.
“What can I help you with, ma’am?”
“Do you know where Sabine is?”
“No, I don’t.” The pause before she answered, and her
slow, careful tone suggested she knew what had happened. “I
haven’t seen her since before that trauma alarm.”
So she was hiding, which made me even more concerned. I
resisted the urge to slump against the wall and rub the fatigue
from my eyes. “Amy…you have permission to speak freely.
What’s going on? I know she’s struggling, but it’s now
abundantly clear that it’s more serious than I’d thought. Can
you shed any light for me?”
Peterson didn’t hesitate, and despite her forthrightness, it
was obvious she was upset. I didn’t know if she was upset that
I’d pushed her into telling on her friend and roommate, or
upset because Sabine’s mental and physical health had
declined to barely functioning. “She’s not sleeping, or if she is,
it’s not in our room. She’s hardly eating, or if she is—I’m not
seeing it. I’ve tried to help her, tried to be there as a friend so
she can talk but it’s like she’s just got this barrier up. I don’t
think it’s intentional, but it’s there. I even offered to sign off on
something to help her sleep, but she said she didn’t want it,
that it made her groggy. Like…groggier than not sleeping?
Whenever I wake up during the night, she’s not there and
pardon my French, ma’am, but she looks like fucking shit.”
Amy’s assessment confirmed what I’d observed, and the
truth of what I’d just heard made me feel like I’d dived into an
ice-cold pool. I only just suppressed my shudder. “Thank you.
Can you find her, please, and have her come to my office
immediately.”
Her eyes widened. “Yes, ma’am. Will do. Right away.”
She turned to walk away and I called her back. “Amy?”
“Ma’am?”
“Thank you for your honesty. You did the right thing.”
Amy nodded and I left her to go run the errand for me
while I ran an errand of my own. I was going to have to do
something I didn’t want to, but it was something I felt
necessary for Sabine’s wellbeing. She’d probably despise me
for it, for my insistence and my involvement. I almost didn’t
care. She’d refused help when it’d been offered in good faith
from a friend and medical professional. Sabine wasn’t stupid,
but she clearly wasn’t thinking clearly right now. And now it
was on me to think for her until she could do so herself.
I stopped by the dispensary to fill the script I’d hastily
scribbled out in my office. While I waited, I leaned against the
wall and wondered if this really was the right course of action,
if I was doing the right thing. Questioning myself was rare.
Doubting myself was even rarer. But now I had the uneasy
feeling that this could change the dynamic between us forever
and jeopardize all the trust she’d placed in me so far.
The dispensary nurse interrupted my runaway thoughts.
“Colonel Keane?”
“Mm? Yes, sorry.” I made myself smile as I took the bottle
from her and signed for the pills. “I must be a million miles
away. Thank you.”
The faint rattle of pills in my pocket as I walked back to
my office gave me the answer. This was the right thing for
Sabine. She needed help, and her continuing as she had been
was a danger not only to patient care and team cohesion, but to
herself. I could help her and if it came to it, I’d wear whatever
anger or frustration or distrust she wanted to throw at me as a
consequence of doing what was best for her.
The knock on my open door wasn’t a surprise, but its
promptness was. I’d expected it to take Amy a good half hour
to find Sabine. When I glanced up, she threw a sharp salute.
“Good afternoon, Colonel.” Sabine’s hair was obviously wet,
and though in its usual bun, was as unruly as I’d ever seen it.
I rose from my chair and returned her salute. “Come in,
Sabine. Close the door please.”
She pushed it closed, then gave it another nudge as if
ensuring it was properly secured. She moved quickly to stand
in front of my desk at rigid attention, her gaze fixed on the
wall behind me.
“At ease,” I said as I lowered myself down into my chair. I
almost invited her to sit but considering this was technically
part-disciplinary meeting, I left her to stand with her hands
behind her back. And I hated it. I hated feeling like I’d failed
her. I hated feeling like I had to hurt her in order to help her.
And I hated this feeling of just wanting to hug her, of wanting
to hold her in the hope that it might ease some of her struggle.
I turned my pen over and over, trying to find the right
words. Death wasn’t a new phenomenon to any of us, but for
some reason I cared about how she’d react. Everything about
her from her body language to her expression screamed
distress, panic, fear. Eventually, I went with a simple, “We
were unable to resuscitate.”
She exhaled an audibly shaky breath.
I raised my eyes to meet hers, stunned by their pure, raw
panic. I’d never seen an expression like it, not from her. It was
almost like I’d just given her the worst news of her life, which
considering the horrible news she’d received less than a week
ago, was saying something. “Is there anything you’d like to
say, Captain? Do you understand why I asked you to leave?”
Sabine nodded, her mouth working open and closed before
she croaked, “I—” And that was all that came out of her
mouth. She nodded again.
I frowned, still turning the pen over in my fingers.
“Sabine…I’m concerned about you, as are other people on this
base.” Concerned barely touched the surface of what I felt
right now, but it felt like the softest way to tell her I was so
worried for her I could hardly think of what to do.
For some reason, she kept staring at my left hand and the
intensity of her focus made me self-conscious, because the
only thing that could be drawing her attention there was my
fake wedding band. I opened my drawer and pulled out the
bottle of pills I’d had dispensed, along with Sabine’s medical
file.
I set the bottle on the desk and opened her file, using the
time to collect my thoughts before passing the script for seven
zolpidem—Ambien—ten milligrams across the desk to her.
“Peterson told me she offered to write a script for something to
assist you with your insomnia. And you refused.” She gave me
no clue as to how she’d taken this revelation.
Until she answered me. She looked and sounded as if she
was barely managing to hold on to her indignance. “Colonel,
with all respect due, I didn’t ask for this.”
“I know, Sabine. But you will take one now and go back to
your room immediately. Peterson will keep an eye on you.
You’re also cleared for one day of sick leave tomorrow,
confined to barracks.”
“And if I decline?” After a brief pause she added,
“Ma’am.”
“Then I will have to give you a written reprimand, Captain.
You may consider this an oral admonishment.” I paused, and
gentled my tone a little. “Sabine, please stop arguing. You’re
exhausted, stressed, and you need to sleep. Part of my job is
ensuring that people under my command are fit and able to
fulfill their duties. Anything less compromises the unit and
casualty care. You’re struggling.” I had to bite back my
emotion. “Please, let me help you.”
A nerve twitched in her eyelid and she blinked hard as if
that might stop the spasm. But she said nothing. She didn’t
