David pressed his finger deep into the nail bed of the patient’s thumb then released it. The poor blood return allowed the whitened nail to remain that way for a lengthy period of time. "Let’s hang two units of blood." Looking up to the heart monitor he could see the slowing complexes signifying the outcome of a dying man. "Let’s check for pulses," he directed his staff.
Both surgeons felt for pulses, Garrett at the neck and David at the groin. After several seconds had passed by, they met each other’s gaze. The look in their eyes became cold and steely, as each of the surgeons knew what had to be done.
"Set up for a thoracotomy tray, we’re going to open his chest." David gulped. This wasn’t something that he had done on an almost daily basis anymore. The last time had been in his last week of residency back in Pittsburgh with Danni at his side. His thoughts drifted to the petite blonde nurse that he had come to adore but were quickly turned back on the task at hand when he saw the orange-brown splash of Betadine across the now bared chest to prep the area. ‘Thanks, Danni, for telling me that Dr. Trivoli was the one to steal your heart. And for her being here at this moment.’ He thought as he looked at the intensity on the face of the woman surgeon across the table from him. It gave him a newfound confidence as he forged on. "Let’s give a dose of Epinephrine."
The crash cart was pulled into place and opened, revealing the drugs necessary to work a cardiac arrest with ease. The expertise of the dark, curly-haired nurse betrayed her look of youth. This was something that she was evidently deft and well rehearsed at over the years. With a calm air about her, she readied the prefilled syringes, giving each one in succession as she called out the drug and time that it was administered as well as location of intravenous line used.
With a flurry of feet a new person entered the arena. "I’m here now, what is it that you…" the anesthesiologist suddenly realized that his skills were indeed needed immediately. "Let me through, I’ll need a curved blade on that laryngoscope and set up a size 8 endotracheal tube." He called out his orders, making his way to the head of the patient. Grabbing a set of gloves from out of his pocket, he readied himself to intubate the hardly breathing patient. With skilled hands that had a lifetime of practice, the physician started to place the tube. "Damn! I need suction, he’s got vomit blocking the airway." A suction catheter appeared in the hand of the male nurse standing by his side. After a few quick passes to remove the obstruction, the vocal cords could be visualized, allowing the intubation to be completed successfully. He remained at the head of the patient, manually breathing for him with the large oxygen-filled bag attached to the endotube, holding it in place while the nurse secured the tube from dislodging. The anesthesiologist watched as both sides of the patient’s chest rose as he squeezed the oxygen into the patient’s lungs. Convinced that the tube was properly positioned, he gave a nod to the surgeons to begin.
Garrett stood poised and ready with a scalpel in her hand; after all, it was her side of the chest that had been penetrated by the bullet. "Okay, everybody ready?" She began to make the incision down the length of the ribs cutting hastily through the tissue to bring the contents of the chest cavity into view.
"Rib spreaders," David commanded, his hand held out ready to accept them.
The nurse held up two pieces, looking at him with horror in her eyes. "I don’t think these are going to do anything, Doc."
"Shit! What the hell…" his mind raced with thought. "Get me another rib spreader."
Garrett acting in her normally cool, in control manner didn’t let the moment of failed equipment stop her from obtaining her goal. She would just use what she had at hand. "You and you," she motioned with her head to the two people on either side of her. "Each one of you grab on a rib and separate them until the rib spreader comes."
The two nurses jumped at the command, not knowing what else to do as the aide took off down the hall for the spare set of rib spreaders. When enough space was gained, the sinewy, gloved fingers of the surgeon gently pushed aside the expanding lobes of lung, revealing the inner contents of the cavity.
The nurses peered down into the chest, realizing that their own hands were literally now a part of the procedure.
David adjusted the large surgical spotlight above them as they looked to see the extent of the damage caused by the small 22mm bullet.
"I have the rib spreaders!" The aide came dashing back into the room as she tore open the sterile packaging.
Taking the intact spreaders, David worked to put them in place. "Okay, you can let go now, thanks." He watched as the hands of the nurses withdrew, making sure that the hands of the other surgeon were not encumbered in any way.
"Get an abdominal X-ray, there seems to be hardly any blood in this chest cavity. She looked over the muscle that pumped the blood throughout the body. Instead of a full, well-rounded and beating heart, there was a contracted and non-moving mass. "We’ve got to expand his volume. Give him two more units of blood and open up the other lines with Lactated Ringers’ going." She began to gently massage the firm muscle, trying to get the chambers to open up and accept the newly replenished volume of life giving fluid. A moment or two passed by until she could feel the muscle begin to beat of its own accord. She withdrew her hands as both surgeons bent over the opening, looking for any source of bleeding and injury.
"Here! It looks like a hole in the diaphragm." David saw it first.
"Suture, please." She responded immediately to his words. "Call the O.R. and tell them that we need a room, we’re coming up." The words rolled out of her mouth before she realized what she was saying. Her eyes flashed over to David, in hoping that he realized the critical nature of the patient. "Don’t you think, Dr. Beckman?"
"Yes, definitely." He hurried to assist her with clipping the suturing thread after it was knotted. "Get us an elevator to the O.R. Pack up, we’re moving in a minute." He threw down the surgical scissors onto the pile of utensils that they had used and draped a sterile blue towel over the still exposed chest.
He stepped back long enough for the nursing staff to attach the patient to a portable monitor and accumulate the bags of hanging intravenous fluids onto the one-wheeled pole that the blood infuser was on. The quantity of activity in the room was mind boggling as every person readied the patient for the trip to the operating theater.
"The elevator’s here," someone announced.
Garrett motioned to the surgeon across from her, "Lead on, I’m right behind you." She ripped off her gloves and grabbed a fresh pair as they left the room, David in the lead. She stopped momentarily as the X-ray of the patient’s abdomen was being hung on the view box. She sighed deeply, knowing all too well that the extent of the patient’s injuries lay within that area. She fell instep behind the entourage as it started into the elevator.
"Who else would end up in the O.R. assisting on a Trauma Case during an orientation?" She shook her head in disbelief, making a mental note to tell her roommate of her adventure. She could see her already, her mouth open and wanting to know why she wasn't along for the ride. A smile hid itself under her masked face as thoughts of the blonde nurse danced through her mind. She found that happening more and more. ‘Better learn to squelch that now, before it becomes a habit, Trivoli. She’ll be his dreams now.’ The tall woman looked ahead to David, slowly resigning herself to that fate.