A Doctor's Reunion, page 11
The monitor began to alarm. Other nurses came over to help pull Joyce’s mother away, one of them shouting for security.
Holt tried to stay out of the Green Bay Hospital staff’s way, instead focusing on Kristin’s attempt to get the patient reconnected. “Is her heart rate really that high?”
“I don’t know.” Kristin’s tone was laced with frustration. “There’s too much artifact to get a good view of the EKG strip.”
It took four staff members and the security guard to pull Margaret off her daughter. Once they were clear, Joyce’s heart rhythm settled in.
“That’s better,” Kristin murmured. Holt nodded, taking note of Joyce’s pulse of 96 beats per minute. “Although her blood pressure has dropped a bit.”
Holt had no idea if the patient’s vitals were in response to her mother’s outburst or a symptom of something else. He turned toward O’Grady. “Have you needed vasopressors?”
“On and off, yes.” O’Grady frowned at the vitals displayed on their portable equipment. “I’ve been using vasopressin, but it’s been off for about three hours now. We can put up another bag for the transfer.”
“Yes, that would be good.” Considering the thirty-minute flight before them, Holt wasn’t about to take any chances.
It took another fifteen minutes for the vasopressin, the cryoprecipitate, and the fresh frozen plasma to arrive. Once Kristin had the vasopressin connected to Joyce’s IV, he gave the signal to go.
“We’ll infuse the platelets and cryo on the way.”
“Okay.” Kristin didn’t argue. She tucked the edges of a blanket securely around Joyce’s body, then gave the gurney a push. “I’m ready if you are.”
Together they wheeled Joyce out of the ICU and toward the elevator that would take them up to the rooftop landing pad. Thankfully, there was no sign of her mother, although he didn’t doubt the woman would be driving down to Trinity Medical Center as soon as possible.
Everyone handled grief differently, but it was hard to understand how a mother could put her daughter’s life at risk like that. Wasn’t his problem, but it would certainly impact Joyce’s care when she arrived in the ICU.
When it came time to lift the gurney through the back hatch, he took most of the weight in an effort to avoid undue pressure on Kristin’s injured knee. Five minutes later, they were in the air.
“Joyce, can you hear me? You’re in the Lifeline helicopter on your way to Trinity Medical Center.” Kristin’s voice was calm and soothing. “We’re going to take good care of you, okay?”
Joyce gave a faint nod. Talking wasn’t possible with her breathing tube connected to their portable ventilator. Her vitals had stabilized, giving hope that this would be an uneventful flight.
Kristin jotted notes on a clipboard, then began to infuse the platelets. Once those were in, she quickly hung the cryoprecipitate.
Just as he was settling back to enjoy the ride, Joyce began to cough. Kristin quickly opened a suction kit and began to help clear out the ETT.
But the secretions were bloody. His chest squeezed with fear, and he leaned forward to see better. He cued his mic, making sure the patient couldn’t overhear their conversation, then asked, “She’s bleeding?”
“Yes.” Kristin’s green-gray-brown eyes were grave.
“Let me suction her, you set up the two units of fresh frozen plasma.”
Kristin nodded and stripped off her gloves, then opened another sterile suction kit for him. She hung the fresh frozen plasma on the same line as the cryo.
More blood came from her ETT tube, and he quelled a flash of panic as he did his best to clear her airway. “Reese? What’s our ETA?”
“Twenty minutes, I’m bucking up against a stern headwind.”
Twenty minutes. His stomach knotted, and he felt sweat dampen his brow.
Joyce was bleeding from deep in her lungs, and there was nothing he could do to stop it.
Except hope and pray Reese got them to Trinity Medical Center before she went into full-blown cardiac arrest.
Kristin infused the fresh frozen plasma as fast as it would go, knowing there wasn’t anything else they could do to prevent Joyce from bleeding out.
Twenty minutes seemed far too long. “Reese, we may have to divert to the closest hospital.”
“Ten-four. Just let me know when,” Reese answered.
“Divert to another hospital?” Holt glanced at her, frank hope lighting up his eyes. “That sounds like a good idea. What are we waiting for?”
She hated to burst his bubble. “We can divert to the closest hospital, but all the facilities en route will be small community hospitals, not tertiary care centers.” She shook her head. “Her best chance of survival is for us to get her to Trinity Medical Center. They have the most expertise with this kind of thing.”
He grimaced and nodded. “Understood.” He suctioned her one more time, then reconnected Joyce to the ventilator. Together, they watched her pulse oximeter hover in the high eighties.
“I’m not sure what else to do.” Holt’s frank admission surprised her. “If the platelets, cryo, and plasma don’t work, I’m out of ideas.”
“Look, she’s back up to ninety percent.” She hated seeing Holt so defeated. She didn’t know many residents who took their patients’ outcomes so personally. As if each one who didn’t do well was a personal failure on his part.
She admired his tenacity and dedication to his patients. A flashing light caught her eye, and she noticed Joyce’s blood pressure was dipping down again.
“Increase the vasopressin drip to keep her MAP at sixty.”
Following Holt’s order, she increased the drip. But the drop in blood pressure was concerning. It made her worry that Joyce was bleeding internally from other sources.
Moving the blanket aside, she did a quick abdominal exam. There were no obvious signs of bleeding, but she didn’t find that reassuring.
“What’s wrong?”
She forced a smile and shook her head. “Nothing. Just worried about internal bleeding.”
“Me, too.”
Kristin switched her mic to communicate with Joyce. “Joyce, are you feeling okay? Any pain?”
Joyce opened her eyes, but her gaze was unfocused. She shook her head, although Kristin wasn’t sure which question she was responding to, then her eyelids drifted closed.
“ETA fourteen minutes.”
Reese’s update didn’t help her relax. The time had never dragged by as slowly as it did now.
Joyce’s blood pressure dropped again, so she increased the drip.
“The vasopressin may help clamp down on any bleeders,” Holt murmured.
“Yeah, I know.” It was true, although she knew that there were side effects from being on high doses of vasopressors, too. Joyce’s hands were icy cold, so she tucked them beneath the blanket.
Come on, she silently urged. We need you to hang on just a little while longer.
Joyce’s blood pressure stabilized, but she didn’t dare breathe a sigh of relief. The minutes ticked by more slowly than ever before. When Reese informed them they were five minutes out, she glanced over at Holt.
“We can do this.” His tone was encouraging despite looking just as grim as she felt. “Reese? I’m requesting a hot unload. I’d like the ICU team to meet us on the helipad.”
“Ten-four.” Reese relayed the message.
Joyce’s blood pressure remained in the 90/60 range, but only because she was close to being maxed out on the vasopressin. “Should I get another vasopressor ready to go?”
Holt hesitated, then nodded. “Let’s start Levophed.”
She grimaced but prepared the drip as he’d requested. In the ICU, she and the other nurses often referred to Levophed as leave them dead because it was often used in a last-ditch effort to save a patient’s life.
But today, a touch of Levophed worked to bring Joyce’s blood pressure from 88 systolic up to 96 systolic.
Reese banked the chopper toward Trinity. As he brought the helicopter down gently on the landing pad, she could see a bevy of nurses and doctors waiting for them near the doorway.
Without wasting a second, Holt jumped down and ran around to the back. In moments, they had the gurney out of the helicopter and wheeling toward the healthcare team.
Holt updated Charles Ashe, the physician on duty, as to Joyce’s change in condition during the flight. When they reached the ICU, wheeling Joyce into one of the open bedsides, Kristin couldn’t deny a wave of relief.
They’d made it without losing her. Their twenty-six-year-old patient was still very sick, but Kristin knew deep in her heart that this was where she belonged. The team here at Trinity offered the best chance at survival.
They’d barely gotten her switched off the equipment when they received another call.
Nothing boring about this shift, that was for sure.
The call was related to a high-speed crash on the interstate, leaving one driver dead and the other severely injured.
The flight to the crash scene didn’t take too long. Her right knee gave a sharp twang when she jumped down from the helicopter. It hadn’t been too sore this morning, but she could tell it was swelling as her shift went on.
“Hurts?”
Holt was far too observant. She shrugged. “A little, but nothing I can’t handle.”
As they ran the gurney over to where the firefighters and paramedics were gathered, she could see they were still attempting to free the driver from the vehicle that was squashed like a bug.
“Can I help?” Being smaller than most of the guys, she was often able to get into vehicles to offer assistance where they couldn’t.
“Would be nice to get a set of vitals,” the paramedic to her right said.
“Okay.” She began to crawl in through the busted window on the passenger side. The driver was unconscious but breathing on his own, a good sign.
There wasn’t much room, but she managed to kneel on the passenger seat to place her fingers along the driver’s neck to feel for his pulse. It was fast and thready. She counted the beats, then reported, “He’s tachy at one sixteen; he needs fluids.”
“Can you start an IV?” Holt was at the passenger window with their duffel bag of supplies.
“I think so.”
He handed her the IV catheter. She placed the IV in the driver’s forearm, then connected the tubing Holt handed to her. “Thanks. Now I need a blood pressure cuff.”
Holt handed the manual cuff through the broken window. Kneeling like this wasn’t easy, but she ignored the pain. This guy needed her, and she wasn’t going to let him down.
“BP is ninety over forty-eight.”
“Open the fluids, he needs volume.”
She did as Holt requested, then had to shift a bit to ease her weight off her knee. The team of firefighters worked with crowbars and buzz saws to get the driver’s door open. She continued monitoring the driver the best she could, despite the noise.
After what seemed like forever, but was only about twenty minutes, the driver’s side door abruptly opened, falling to the concrete with a loud clatter. The firefighters stepped back to give the paramedics room to work. They brought over the Lifeline gurney and moved the driver gingerly into position.
Holding the IV up with one hand, she managed to climb out behind the patient. Holt came around to meet with her, and together they performed a quick exam.
Less than a week of flying together, but they had a great working relationship, each easily falling into their respective roles.
This transport was uneventful, and when they had their injured driver safe in the trauma bay, she watched for a few minutes as the team took over.
“I can’t stop thinking about Joyce,” Holt said in a low voice. “Maybe we can stop up to check on her in a while.”
“Of course.” Some transports haunted you more than others. For her, it had been Barbie Martin. It was the first time she’d ever had a patient who died of anorexia.
She hoped and prayed Joyce Winter fared better. It wasn’t good to lose a patient, but the younger ones were always so much harder to handle.
It made you face your own mortality. And forced you to realize that life is precious and should be lived to its fullest since you never knew what might happen down the road.
Surely Joyce hadn’t considered she might need a bone marrow transplant, and worse that her own immune system would turn against her.
“Are you ready to go?” Holt’s voice brought her back to the present. “It’s been close to three hours since we dropped Joyce off in the medical ICU, and I’m curious to find out how she’s doing.”
“I’m ready.” She took one end of the gurney. “We need to return this to the chopper first and let Reese know our plans. He may want to take the time to refuel.”
“Good idea.”
The trip up to the helicopter didn’t take very long. They had to climb inside to tell Reese their plans, and he agreed to use the time to refuel the chopper.
Holt jumped down first, then offered his hand. She took it, mostly because her knee was throbbing in earnest now. Climbing into the passenger seat of the car had taken a toll.
Doing her best not to limp, she followed Holt into the MICU. Then nearly walked into him when he suddenly stopped.
“YOU!” a familiar screech echoed through the unit.
She stepped to the side just in time to see Joyce’s mother come running toward Holt, her hands raised, fingers fisted. She attacked Holt, punching and kicking like a wild animal. “You killed my baby!”
Chapter Twelve
Blows landed on his chest, his face, his shins, his abdomen, but Holt couldn’t move, not even in an attempt to block her fists. The fury radiating off Joyce’s mother battered his soul worse than her physical assault.
Security staff and nurses yanked Margaret off of him, holding her arms to her sides while the police were called. Still Holt didn’t move, the soles of his feet seemingly glued to the floor.
Joyce had died. All-too young at twenty-six years old, she’d died two and a half hours after being transported from Green Bay to Trinity Medical Center. At some level, he couldn’t blame Joyce’s mother for being angry.
“Are you okay?” Kristin’s voice permeated the fog of horror surrounding his brain.
“Yeah.” He’d have bruises in the morning, but nothing like the heaviness that weighed on his heart. He turned toward Charles Ashe, the provider he’d spoken to when they’d brought the patient in. Before he could ask what had transpired in the time he’d been gone, Joyce’s mother started up again.
“I can’t leave my baby!” Margaret shrieked as the police officers began leading her away.
“Ma’am, you’re under arrest for assault and battery,” one of the officers informed her.
“No.” Holt stepped forward, lifting a hand in protest. “It’s fine. I don’t want to press charges.”
“Why not?” Kristin asked in a hushed tone. “She attacked you.”
“Out of despair and grief.” He glanced at her. “Arresting her won’t change anything.”
The two cops glanced at each other as if unsure of their next steps. Charles Ashe took over, giving a resigned nod. “She can spend five more minutes at her daughter’s bedside, but then she’ll need to leave.”
A subdued Margaret was walked by the police over to her daughter’s bedside. All the equipment had been disconnected, and Holt had to admit Joyce looked at peace. Her mother’s sobs echoed loudly through the unit, and no one spoke for several long moments.
Finally, the officers led Margaret away, escorting her off hospital property.
Holt looked at Charles Ashe. “What happened?”
The physician sighed, his expression weary. “She began to bleed from her rectum and from her mouth. We instituted the massive transfusion protocol, but we couldn’t get her stable enough to do a GI procedure. She coded, and we ended up calling it after ten minutes.”
He nodded thoughtfully. There was no point in giving a never-ending supply of precious blood products if you couldn’t cauterize or treat the source of the bleeding. Frankly, he would have done the same thing if he’d been the ICU attending on duty.
“Understandable. Thanks for letting me know.” Holt turned toward Kristin. “We should head back to Lifeline.”
She fell into step beside him as they left the unit. “Are you sure you’re okay?”
He shrugged, then rubbed a hand over his cheek where one of the blows had landed. “It’s hard losing a patient. And when you look at it from her mother’s perspective, we transported her child only to lose her shortly thereafter. It’s a two-hour drive from Green Bay, she probably arrived just as Joyce was bleeding out in front of her eyes. That would shock anyone.”
“I know, and I understand she was grieving, but it’s not right that she attacked you like that.” Kristin jabbed the button for the elevator. “What would you have done if she’d physically assaulted me?”
The thought brought him up short, and he realized he’d have absolutely responded differently. Not only would he have grabbed the woman and yanked her off Kristin, but he likely would have pressured Kristin into pressing charges.
“Okay, you made your point. But I can’t bear to add to her stress level right now.” He was anxious to change the subject. “Let’s stop for lunch on the way back.”
“Sounds good.”
He wasn’t terribly hungry, but grabbing a bite to eat offered a nice diversion from the scene in the medical intensive care unit. Never in his life had a patient’s family member physically attacked him, and he hoped that was the first and last time he’d experience something like that.
“There’s a deli across the street from Lifeline that offers a nice variety of sandwiches,” Kristin said as they made their way through the hospital lobby. “There’s also a pizza joint.”
“Let’s try the deli.” He lightly rested his hand in the small of Kristin’s back as they walked into the cool October air. The clouds dotted the sky without the threat of rain.
