The ER tech took off at sprinter’s pace to fetch the blood and splints.
“Oh two SAT’s ninety-three percent on a non-rebreather.”
“Fine. Fine.”
The phlebotomist got Dr. Gerber’s attention. “Trauma panel is set and ready… CBC, CHEM-7, coagulation profile, and tox screen. We’ll also type and screen for blood transfusion and liver function. Any other special orders?”
“No, that’s good,” Dr. Gerber said. “We’re going to finish this survey quick and get him to the OR.”
“Agreed,” Dr. Benton said. “With the blunt chest trauma and blood in the pericardium, I’m concerned about aortic injury.”
Dr. Gerber’s focus shifted from the abdominal area to a soft-tissue assessment. Dr. Kapoor conducted a neurovascular exam of Sam’s open leg fracture, which would eventually require surgery.
“Left leg bleeding has slowed,” Dr. Kapoor announced. “Maybe minimal arterial damage.”
“Even so, I’d like to start him on cefazolin, two grams IV, right away. We’ve got infection risk with that open fracture, after all,” Dr. Gerber said. “Can we get pulses?”
“I’ll do it,” Dr. Kapoor said. The head nurse left the trauma room in a hurry to get the medicine Dr. Gerber had ordered. The ER tech returned with the splints. The scene was similar to the kinetic choreography at the accident site, only with a larger ensemble.
“Let’s get the FAST exam done,” Dr. Benton said. “Arthur, can you please set up the ultrasound?”
The ER tech ran to the corner of the room and wheeled the ultrasound machine over to the exam table. He got the machine powered on while a nurse set to the task of splinting Sam’s many fractures.
“Radial pulse is ninety-eight, weak and thready, equal on both sides,” Dr. Kapoor announced. “Carotid and femoral same. Nineties. Weak and thready. Equal on both sides.”
The scribe recorded all this information into the computer as it was presented.
“Finish the neuro check, please,” Dr. Benton said to Dr. Kapoor.
Standing at the curtain opening, Julie watched Dr. Kapoor peer over Sam’s mangled limbs in search of some body part she could use for the evaluation. She settled on Sam’s big toe and gave it a hard squeeze. Julie bit the knuckle on her thumb. Anxiety seized her and would not let go. It was ironic that with all the advanced machinery hooked up to Sam, all the medicine he received, it was the outcome of this one simple test that would determine so much.
Squeeze the big toe and…
Julie closed her eyes tight and listened.
Please… please…
She prayed for Sam, she prayed to God as so many families of her patients did. She prayed harder than she ever had done before. It was not God who would save Sam; Julie understood this all too well. It was the amazing doctors and nurses who were treating him. Yet in Julie’s heart, she knew that what she really prayed for was a miracle.
Dr. Kapoor spoke up. “No response in any extremity.”
A sob burst from Julie’s lips as the first wave of grief hit like a tsunami. It’s still early, she told herself. It can change.
“Okay, FAST exam now, Riya,” Dr. Benton said.
With the equipment prepped and ready, Dr. Kapoor had the first view up in less than a minute. She kept the probe marker pointed toward Sam’s head to get the clearest picture, and started in the upper quadrant between the seventh and eleventh rib interspace.
Dr. Benton peered at the monitor and put her finger on something that bothered her. “Looks like some free blood in the intraperitoneal space.”
Julie could visualize the black line on the monitor between the liver and kidney that signified the pooling blood.
“And there’s free fluid at the lower tip of the liver,” Dr. Gerber observed.
Dr. Kapoor moved the probe to show the right diaphragm and right pleural space.
“Pericardial sac still has fluid.” She moved the probe quickly onto Sam’s abdomen. “Liver is clear, spleen is fine… seeing some fluid in the pelvis.”
This was the only bit of good news Julie had heard.
“What’s our list of injuries?” Dr. Benton asked.
“Broken radius and ulna each side,” Dr. Gerber said. “Possible fracture of the left olecranon, open fracture left leg.”
Sam had not moved; he had yet to speak.
A nurse leaned over him. “Sam, can you open your eyes?”
Please, open your eyes, Julie begged.
Nothing. No movement at all.
Julie felt the floor give way.
“Glasgow is a six,” a nurse announced.
Dr. Gerber shined a penlight into both of Sam’s eyes. “Pupils equal and reactive,” he said.
The scribe was recording this when the nurse with the long ponytail and Julie’s phone bounded over with a clean pair of scrubs.
“Paul and Trevor are on their way,” she said, handing Julie back her phone. “That was the message.”
“Thank you,” Julie said. She clutched the scrubs in her hands and squeezed hard.
A six, Julie thought. The Glasgow Coma Scale was a simple but effective test of consciousness and nervous system status. Sam needed to be at a thirteen, and he was at a six.
Dr. Gerber put his penlight away and unsheathed a sharp needle from a sterile package. He moved the needle against the heel of Sam’s foot up to the soft part of the pad. Though he was unconscious, Sam’s large toe extended upward, as did the other toes, to a lesser extent. It was Babinski’s sign. The reflex was normal in children up to two years old, but went away with neurological maturity. In an older child or an adult, it was an indication of a spinal injury or brain damage.
Something was very wrong with Sam.
The second survey began as Dr. Gerber called for the portable X-ray unit. Dr. Kapoor and Dr. Benton reviewed the images from the FAST exam while two nurses rechecked Sam’s vitals.
The X-ray technician inserted a plate underneath Sam’s body and set about placing the films. Silence descended as Julie heard the familiar revving sound of the X-ray machine. The technician worked quickly, moving from several shots of the spine to the pelvis.
Dr. Benton and Dr. Gerber stepped over to view the display. They pulled up the images and studied them intently. Dr. Kapoor looked at the films as well.
“C4 burst fracture!” Dr. Benton called out.
Dr. Gerber’s composure cracked, revealing alarm in his eyes and voice for the first time. He turned to the nurse closest to him. “Two point seven grams IV Solu-Medrol, stat!”
Julie’s heart sank. All she wanted to do was collapse, but she was too numb to move.
Dr. Gerber, grim-faced, eyes downcast, emerged from the trauma room and took a single step toward Julie. She could see that he was forming the exact words to say. He didn’t have to say anything: Julie knew the significance of a C4 burst fracture.
CHAPTER 12
The furniture in the modest waiting room on the first floor of the Saunders Building was upholstered in fabric but not very comfortable to sit on. The tissue boxes were equal in number to the dog-eared magazines. Off to the side were small consultation rooms where distraught family members could speak privately with a patient’s surgeon. Sam had been in surgery for six hours. In that time, Julie had seen a number of people go into those rooms and emerge looking utterly destroyed.
What sort of expression will I have? Julie asked herself. No big smiles, certainly; Sam was too badly injured for that. She still hoped for good news, though the odds were not in their favor.
C4 burst fracture! Julie could not stop hearing Dr. Benton’s voice.
The wait was unbearable. No matter how much water she drank, Julie’s throat was persistently dry, her chest drum-tight. The guilt came and went in waves.