Casting Stones
by: Satchie
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Disclaimer: The wonderful characters of the Emergency! universe belong to Mark VII Limited and Universal Television. I'm merely borrowing them again for my own devious purposes.
Acknowledgements: I am profoundly grateful to my medical consultants/betas, Julie Novakovic R.N. BScN and MamaSue (taking a deep breath...RN BSN COHN-S EMT ERT-Inst FFII FFD/O) for providing much needed assistance with different aspects of this "little project." I am also deeply indebted to Whisper for keeping my abuses of the English language to a minimum.
Note: I confess. Although I strive to portray technical aspects as accurately as possible, I "kinda sorta" took a few liberties in order to milk some serious angst. Therefore, certain inaccuracies are intended, and did not escape the exacting scrutiny of my wonderful betas.
Dedication: To dee_ayy, Peggy and Susan Proto, who inspired me to dabble in two fandoms, and provided a forum for a probie writer to post her first story.
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It was another hectic day in Rampart's emergency room, and Dr. Early's pounding headache showed no sign of abating. Despite his ingestion of aspirin three hours earlier, the pain was becoming increasingly intolerable. Considering how queasy he felt, he wondered if it would be prudent to take additional medication. However, as the unrelenting throbbing became worse, he decided to take his chances, and slowly headed toward the doctors' lounge.
Early reached into his lab coat for the now familiar plastic bottle and shook two of the white pills into the palm of his hand. Washing them down with a swallow of strong black coffee, he sat down on the couch and closed his eyes for a moment. Almost immediately, the nausea that had plagued him all morning became overwhelming. He bolted from his seat and raced to the men's room, where he proceeded to lose his valiant struggle and promptly emptied the meager contents of his stomach into the porcelain toilet bowl. His energy spent, Early leaned against the cool metal stall to support his weight. After the evidence was safely flushed away, he walked to the sink and splashed cold water on his face in a feeble attempt to revive himself. He took a deep breath and wondered how in the world he was going to make it through the rest of his shift.
Upon his return to the nurses' station, Dr. Brackett eyed him suspiciously. "Another headache?"
"Yeah. I haven't had this many migraines in years."
The senior physician probed further. "You've been vomiting again, haven't you?"
"Just a little bit."
"Hmm. Isn't that like being a little bit pregnant? You either are or you aren't." Brackett gestured toward his office. "Come on, Joe. We need to talk."
Reluctantly, Early followed his friend. Seating himself in one of the leather chairs in front of the imposing desk, he felt like an errant schoolboy being called into the principal's office. He braced himself for the lecture that was about to ensue.
"Joe, you've been having these headaches for a few months now. I'm worried about you."
"I appreciate your concern, but it's not necessary. You know I've had migraines off and on for years," Early tiredly replied. "They're more likely to recur when I'm stressed out. Ever since Administration, in its so-called wisdom, dramatically slashed our budget, I've been working these ridiculous hours and double shifts with very little time off. It's catching up with me, that's all." He wanly smiled. "I'm not a young resident, Kel. My body isn't accustomed to this abuse anymore."
Brackett sighed in frustration. It was true the recent staffing cutbacks seriously threatened to undermine the ability of his department to function at peak efficiency. Several employees had been let go in the interest of attaining an arbitrary budget objective, and those who remained were called upon to work longer hours with little extra compensation. Everyone's nerves were frazzled, and no doubt Joe Early wasn't the only person suffering from a stress-related illness. Heck, wasn't he himself eating antacids like candy? But his colleague was one of the calmest people under fire he knew. He was having trouble reconciling the two images.
"I wish I could offer you some time off," Brackett apologized.
"I know. Do you realize my last vacation was two years ago?"
"Has it been that long?"
Early slumped back in his chair. "I'm exhausted, Kel. I love working here, but I sincerely hope this situation is temporary. I really want to believe that some brilliant soul in the bean-counting department will experience an epiphany any minute and realize the error of his ways. I'm simply not sure I have the enthusiasm and endurance anymore to hang in there until things change for the better."
Seeking to reassure his distressed friend, Brackett forced a smile. "I have a meeting with the board of directors and Wayne Rivers from Administration next week. Hopefully we'll be able to make some progress then."
While leaning forward slightly, Early began massaging the back of his head.
"How long has it been since your last headache work up?" Brackett asked.
The question annoyed the neurosurgeon. "Kel, for crying out loud, these are just migraines or migraine variants. Trust me on this. I've certainly had enough of them in my lifetime to recognize the little monsters."
"You didn't answer my question."
"Oh, good grief! I suppose it was during the last year of my residency."
Folding his arms, Brackett responded, "I think you're a little overdue for a re-evaluation."
"You can't be serious!"
"Joe, maybe you're right, in which case I'll feel like a total idiot. But you of all people shouldn't outright dismiss your headaches as unworthy of further investigation."
Early shakily ran his fingers through his hair. He wasn't feeling well, and this conversation wasn't improving matters at all.
"No offense, Joe, but I'd like a second opinion," Brackett continued. "I can have Dixie schedule a CT scan with contrast and a neurology consultation with Antonio Garza. You can't keep working like this."
Resigned to his fate, Early merely nodded in agreement.
"Great, we'll get everything set up as soon as possible." Brackett glanced at his watch. "Joe, your shift will be over in a couple of hours. Why don't you head on home? I'll have Roger come in early to cover for you."
"Are you sure? I don't mind..."
Casting a stern look in his direction, Brackett answered, "I'm positive. Do you need anything for your headache or nausea?"
The white-haired physician shook his head. "No, I just need a dark, quiet room for a few hours. I'll be fine."
"Okay. I'll let you know when Dixie has everything arranged."
Early knew he was probably expected to say something like, "Thanks, Kel. I appreciate this," but he was profoundly irritated that Brackett was making a major production over his headaches. If some imbecile hadn't decided to reduce the emergency department to numbers on a balance sheet, he wouldn't be in this predicament. Unable to face his friend, Early silently stared at the floor as they headed back toward the nurses' station.
Before they reached their intended destination, the voice of a very frustrated paramedic caught their attention. John Gage was in the throes of a full-fledged rant, completely oblivious to Dixie's amused expression. Wildly waving his hands, Johnny bemoaned his tragic fate. "Oh, man! I can't believe this! I'll be stuck here all night at this rate, and Mike is cooking spaghetti for supper. There won't be a single crumb left by the time I get back to the station."
Brackett grabbed a chart from the desk. "Johnny, what's the matter?"
Blessed with a new audience, the young man straightened as he prepared to retell his tale of woe. "You know that last patient I brought in, the college kid with the busted ankle? Roy was supposed to follow me in the squad, like he always does. But on the way here, he heard a rattling sound under the hood, so he decided to have it checked out. Charlie, our mechanic, thought he had the part for it, so he told Roy to stick around for a few minutes. But it turned out that the box was empty and had accidentally gotten re-shelved. So after Charlie finished chewing some poor guy out about the mix-up, he disappears for about an hour to pick up what he needed. Anyway, after he went through all that trouble, it still didn't fix the problem. Now he says he thinks it might be something serious, so he's pulled the squad out of service. Roy was able to hitch a ride back to the station, but what the heck am I supposed to do? There hasn't been a call since I've been here or I would have begged a ride from one of the other squads. And wouldn't you know it? Mike hasn't made his world-famous spaghetti in ages. He's making garlic bread and everything. Shoot. There won't be anything left but a sink full of dirty dishes by the time I get back." Johnny stopped to catch his breath, sipping his now cold coffee.
Early scratched his chin. "Johnny, I'm about to leave for the day. I can drop you off at the station on my way home."
Johnny positively beamed. "No kidding? You mean I might actually make it back in time for supper? I'd sure appreciate it, Doc."
"Let me get my coat, and I'll be with you in a minute."
The paramedic's demeanor changed immediately. He scrambled to the lounge to rinse his coffee cup and bounced back to the nurses' station to await his personal taxi service. He impatiently transferred his weight from his heels to the balls of his feet. Finally, the doctor reappeared with his suit coat slung over his shoulder.
"Are you ready?"
A starving Johnny pitifully rubbed his stomach. "C'mon, Doc. Let's go!"
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In his enthusiasm to return to the station, Johnny initially didn't detect anything amiss. He excitedly told his captive chauffeur about the upcoming annual firefighter's picnic, and how he was almost tied with Charlie Dwyer for first place in raffle sales. This year's coveted prize was a brand new stereo, and Johnny was determined to win the contest. In fact, he was so assured of victory, he had already cleared a spot in his living room for the anticipated bounty.
Early mutely nodded periodically in response to his passenger's highly animated commentary. Eventually realizing he was carrying on a one-sided conversation, Johnny diverted his attention toward the construction site ahead. Now that he thought about it, Early had seemed preoccupied ever since he volunteered to give Johnny a ride. He frequently rubbed his temples as though he had a wicked headache. Realizing that might be the reason the doctor left before his shift usually ended, Johnny felt guilty for imposing upon him.
As they sat at the red light, the paramedic glanced to his right and snorted with disgust. Ever since the city had erected the concrete traffic barrier during a road reconstruction project, emergency personnel had to navigate back streets, adding precious minutes to their response time. Why in the heck couldn't they work on a section at a time, instead of blocking nearly a mile of one of the most heavily traveled roads at once?
Although it was already dusk, many cars still did not have their headlights turned on. Since some of the street lamps had been removed in preparation for widening the road to add an additional lane, lighting was less than ideal. Johnny anxiously drummed his fingers on his knee while they waited for the traffic signal to change. A few seconds later, the light turned green, and Early pressed down on the accelerator.
Just before they pulled into the intersection, Johnny realized the blue pickup approaching from the left was going to run the red light. With sickening clarity, he knew what was about to happen. He quickly shouted a warning to Early to stop, but the physician seemed dazed. They were sitting ducks for the impending disaster. The concrete barrier to the right eliminated one means of escape. Their only option was to speed through the intersection and veer to the left to prevent hitting the car ahead of them. But why didn't Early see that, and why in the hell wasn't he trying to move out of the way? Instinctively, Johnny leaned across the center console, twisting slightly sideways to turn the steering wheel.
Unfortunately, it was past time for evasive action. The Ford F-100 struck the front of Early's side of the car, dragging them across the lane and slamming them against the concrete barrier. For several seconds, there was a deafening crash of screeching metal and shattering glass. Then everything went mercifully pitch black as they descended into oblivion.
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Officer Vince Howard was only a few blocks from the scene when dispatch reported the accident. Grabbing the microphone, he acknowledged the call.
Upon his arrival, he quickly began assessing the situation. Vince shook his head as he peered inside the pickup. Empty whiskey bottles and beer cans littered the floor of the cab. The steering wheel was tightly jammed against the driver's chest; his eyes were wide open, and blood trickled from his mouth. Unable to open the door on the driver's side, Vince hurriedly ran around the bed of the pickup. After a couple of forceful tugs, he opened the passenger door and knelt across the seat. He instinctively pressed his fingertips against the driver's throat to check for a carotid pulse. Finding none, he sadly turned his attention toward the victims of the other vehicle.
Vince covered the distance to the driver's side of the black Mercedes Benz within a few steps, and shone his flashlight through the broken window. He inhaled sharply when he recognized the victims, and breathed a sigh of relief when the squad pulled up.
With a practiced calm he didn't feel, he motioned the paramedics to his side. "I couldn't find a pulse on the driver of the pickup." The police officer stared at the pavement to collect his thoughts. "Guys, the victims in the car are Dr. Early and Johnny Gage."
Bob Bellingham let out a low whistle. "Damn." Careful of the shattered glass, he looked inside the crushed Mercedes. He experimentally pulled on the left rear door, the only one accessible, but was met with disappointing resistance. Bellingham called out to one of the firefighters. "Paul, we're gonna need to pop this baby with a Halligan."
The burly man disappeared and returned with the pry bar. With one determined effort, Paul opened the door.
Crawling into the back seat, Bellingham discovered a semi-conscious Johnny slumped across the center console, desperately clutching the steering wheel. His fellow paramedic stirred when he checked for a pulse. "Hey, buddy. It's all right. We're going to get you to Rampart as soon as we can, okay?"
Johnny's eyes fluttered open. "What?"
"You were in an accident. Do you remember?"
An odd expression crossed Johnny's face. "Accident?" Suddenly, an image of an approaching car invaded his disjointed thoughts, and he struggled to turn the steering wheel. "Gotta get...out of here!"
"Shhhhh. Settle down. We'll get you out of here in a few minutes. You know the drill." Bellingham tried to rouse the unconscious physician, without success. Despite his repeated attempts, Early remained unresponsive. Pulling the penlight from his pocket, Bellingham leaned between the bucket seats and examined the doctor's eyes. He frowned as he noted the sluggish and unequal pupils.
Brice approached the car and poked his head inside. "Do you need any help?" Noting his partner's inquisitive look, Brice whispered, "The driver of the other car is a Code F."
"Yeah. Think you can squeeze in here and check Dr. Early out?" Bellingham scooted directly behind Johnny to make room for the other paramedic.
Brice efficiently evaluated the doctor's airway, breathing and circulation, but further examination was impaired by Johnny's refusal to let go of the steering wheel. "Gage, let go. I need more room."
"No! Gotta move...now!"
Rapidly growing impatient, Bellingham pried stubborn fingers from the wheel. "Johnny, we'll take care of it. We'll get you out of here, okay? Just let us do our jobs."
"But the...other car!" In his confused and agitated state, Johnny tried to fight off the determined men. The sudden movement aggravated the sharp pain along his entire right side and pelvis, and several heart-wrenching screams tore from his throat as he slumped back against the seat.
Station 16's paramedics exchanged anxious glances. Bellingham gently squeezed Johnny's shoulder in a gesture of reassurance. "Um...it's not going anywhere. You're safe."
"Safe?" The word finally penetrated through the fog, and Johnny's vocalizations faded to an occasional gasp or whimper as he submitted to Bellingham's evaluation.
Captain Pearson rested his hand against the roof of the car. "Bob?"
"Yeah, Cap?"
"We're about finished hosing down the diesel from the ruptured fuel tank. A three-foot high construction barrier is blocking the passenger doors, so we'll need to cut the roof off to get to Johnny. Since we're not having any luck prying the door open on Dr. Early's side, we're going have to use the Jaws. I've dispatched two ambulances. The first one is already here."
Bellingham gently felt along Johnny's rib cage for fractures. "Great. I'll be done in a sec."
The intense pain on Johnny's right side was becoming unbearable. He rested his head against the leather interior and attempted to slip back into a blissful unconscious state. A sharp pinch to his earlobe startled him back to alertness.
"Don't you dare," Bellingham admonished. "Stay with me. Besides, your shift isn't over, and I'm sure Captain Stanley would have your butt for sleeping on the job," he teased.
Considerably more coherent than he was earlier, Johnny realized his colleague was right. Unfortunately, he wasn't thinking like a paramedic at the moment. All he knew was that he hurt, and badly. Searching for a diversion to distract him from his misery, he gestured toward Early. "How is he doing?"
"Brice is checking him out. Let's worry about you right now."
Johnny winced as Bellingham palpated his abdomen. "What about me?"
Trying to keep the mood light, Bellingham grinned. "What? Johnny Gage asking for my professional opinion? I thought you said it would be a cold day in hell before I could out-diagnose you!"
Rising to the bait, Johnny gritted his teeth and steeled himself for the challenge. "Okay...I guess I'll have...to show you how...it's done." He bit his lip in concentration while he mentally performed a quick inventory. "Um...oh, man. I don't remember it hurting...so much to do a prelim exam. Oh, wow. Okay. Uh...I have a broken femur...um, humerus...maybe messed up my knee. I think I hit it on the dashboard..." Johnny screamed when Bellingham felt for pelvic fractures. "Ooooow! You trying...to kill me?"
"Sorry about that." Bellingham quickly completed his assessment and applied a pressure dressing over the jagged leg wound. Mangled steel partially trapped Johnny's right side, obscuring the full extent of the fracture. However, the amount of slick, warm blood told Bellingham volumes about his patient's condition. He hastily scribbled Johnny's vital signs in his notebook before handing it to his partner.
Adjusting his glasses, Brice braced himself to begin the transmission. Even though he wasn't a close friend to either of the car's occupants, they were members of the Rampart family. Cradling the biophone's receiver against his shoulder, Brice consulted his notes. "Rampart, this is Squad 16, how do you read?"
Brackett's deep voice responded. "Squad 16, go ahead."
Summoning his resolve, Brice continued. "Rampart, we have three victims of a MVA, one is a Code F." The sound of an approaching wrecker briefly distracted him. "Victim #1 is unconscious, and is non-responsive except to painful stimuli. There is a 7-cm. laceration to the left frontal area, with significant swelling. Pupils are sluggish and unequal. Crepitus of the ninth and tenth left ribs is noted, as well as mild rigidity of the abdomen. The left radius and ulna are also fractured. BP is 108/84, pulse 112, respirations 22." Brice paused to review his partner's notes. "Rampart, Victim #2 is conscious, although there was some initial disorientation. No obvious sign of head trauma. There is a compound fracture of the right femur and simple fracture of the right humerus. Crepitus is noted along right ribs 4-6. Victim is complaining of pelvic and abdominal pain, as well as right knee pain. Vital signs are as follows. BP is 80/62, pulse 120 and respirations 26." Tapping his notepad with his pen, he hesitated. "Uh, Rampart...please be advised Victim #1 is Dr. Early and Victim #2 is John Gage."
Brackett's jaw dropped in stunned disbelief, while Dixie placed a comforting hand on his shoulder. "Understood, Squad 16. Start an IV of Normal Saline at 150 per hour on both victims, and administer 15 liters O2 by mask. Splint fractures as soon as possible, and take full spinal precautions. What is your estimated ETA?"
"We should have Victim #1 extricated in approximately 15 minutes. Estimate an additional 15-20 minutes before Victim #2 can be removed from the vehicle."
"Understood, 16. Keep us advised. Rampart out."
Brice motioned to one of the other firefighters. "Donato, I require your assistance. Bring two oxygen tanks with non-rebreather masks from the squad. Then we'll need a couple of long backboards and one short board." While Rick gathered the requested items, Brice quickly retrieved the rest of the needed medical paraphernalia and carried it to the car.
Bellingham eagerly accepted a c-collar from his partner and secured it around Johnny's neck. "The guys are chomping at the bit. They had the wrecker pull the truck out of the way while you were on the line with Rampart."
"I noticed that." After applying a c-collar to his patient, Brice slipped an oxygen mask over Early's face. "Has he shown any sign of regaining consciousness?"
"Nope. Nada. Zilch." Bellingham grabbed the second O2 tank and mask from the young probie, and began unfurling the plastic tubing. "Thanks, Rick."
Within minutes, the paramedics completed their tasks of starting IVs and splinting fractures. Rick and Paul carefully arranged a tarp over their injured colleagues to protect them from any flying debris. Once the Jaws' arms were tightly clamped around the door, they began to pull the mangled steel away from the car.
Bellingham squeezed through the space between the bucket seats, trying to calm his increasingly agitated patient. "Whoa, Johnny. Hold still. We're working on getting you guys out of here. They'll be finished with the Jaws in a couple of minutes." While Johnny occasionally flinched at the noise and vibration, Early remained unconscious.
Ten minutes later, the door was removed. Careful to keep the doctor's neck and spine properly aligned, the paramedics slid Early onto a backboard and moved him to an awaiting gurney. Brice double-checked the flow of the IV. "I can manage from here. Why don't you go back to the car and monitor Gage's condition?"
Unable to resist the opportunity to poke fun at his partner, Bellingham affectionately slapped him on the back. "Aw, Brice. I'll be sure to tell Johnny you care."
"Uh...it's merely a matter of protocol. Someone should stay with the victim during the extrication process."
"I could finish up with the doc and you could sit with Johnny."
Brice's eyes widened. "No, I think Gage would feel more comfortable with you."
Crawling back into the car, Bellingham grinned. "Hey, buddy. I'm back. I had to arm wrestle Brice for the opportunity to keep you entertained."
"Oh, man. Stuck with...Brice. Now that...would be painful." The tarp brushed against Johnny's hand as he tried to scratch his nose, exacerbating his growing claustrophobia. He was puzzled by his reaction. Of all the times he had burrowed under a tarp with a victim during an extrication process, it had never bothered him before. Then again, he hadn't been the victim on those occasions. He tried to take a deep breath to calm his frazzled nerves, but a sharp pain in his side discouraged the action. "Can't breathe," he mumbled.
Retrieving his stethoscope, Bellingham asked, "What do you mean?"
"Hurts to breathe. My ribs."
Bellingham listened intently. Was it his imagination, or were there slightly diminished breath sounds on the right side? He removed the earpieces and casually draped the stethoscope around his neck again. "Uh, we'll have you out of here soon. Hang in there."
A ghost of a smile danced across Johnny's features. "I know...both hands."
Once his patient was loaded into the ambulance, Brice jogged back to the car to update his partner. "Dr. Early is ready to go. I'm taking a couple of bags of NS and the HT, and I'll leave the biophone and drug box with you. I've already updated Rampart."
Without looking up, Bellingham acknowledged the message. "Great. I'll see you in a few minutes." As he watched Johnny try to brace his ribs with his uninjured arm, Bellingham sincerely prayed his suspicions about a developing pneumothorax were the merely product of his imagination. They did not need any more problems.
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It was a rare occasion for Mike Morton to see his boss flustered. As he passed by the base station, he saw Brackett pace back and forth, animatedly waving his hands and shouting. "I don't understand. How could this have happened?"
Daring to risk his superior's wrath, Morton ventured to ask, "What's wrong?"
Dixie bit her fingernail before replying. "We're getting a couple of patients from a bad MVA."
Not comprehending the significance, the intern removed his glasses and rubbed the bridge of his nose. "And?"
"The first one should be arriving in a few minutes. The fire department is still trying to extricate the other victim from the wreckage." Dixie was having difficulty maintaining her professional composure. "Mike, the patients are Joe and John Gage."
Morton's hand reflexively flew to his mouth. "Oh, my God!"
It suddenly occurred to Dixie that another group of people needed to be informed of the sad news. "Oh, dear. I need to make another call to the guys at Station 51. I told them Johnny was on his way, and they're expecting him to walk through the door any minute." Picking up the phone, she wondered when or if Johnny would walk through 51's doors again.
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"So anyway," Chet bragged, "this chick was so hot..."
Marco raised his eyebrow. "Obviously she wasn't with you."
"Hey, I can't help it if you're jealous of the Kelly charm."
"More like the Kelly curse," opined Mike.
The stocky firefighter was clearly exasperated. "Guys! I'm trying to tell my story."
Roy was amused by the antics of his single coworkers. He knew there was scarcely a shred of truth to these exaggerated tales, but they were usually entertaining. Sipping his coffee, he tried to keep a smile off his face as Chet prepared to regale them with his latest exploits.
A grim looking Captain Stanley walked over to the table. "Men, I need your attention for a minute. I have some bad news." He tiredly arched his back as four expectant sets of eyes focused on him. "That phone call was from Rampart. Johnny has been in a serious car accident."
The men began shouting questions at once.
"What happened?"
"How badly is he hurt?"
"Is he going to be okay?"
Motioning for the anxious men to sit back down, Cap continued. "Dr. Early was giving Johnny a ride back to the station, but on their way here, a car ran a red light and dragged them across an intersection. Dr. Early is already on his way to the hospital, but they're still working on trying to get Johnny out. They don't know how badly he's hurt yet. From what I understand, the car crashed against a concrete barrier on the passenger's side. But Dixie said he was conscious and talking to the paramedics." He paused and looked directly at Roy. "That's a good sign, isn't it?"
Roy could feel everyone staring at him, willing him to provide a glimmer of hope. "I don't know. He could be in shock and isn't aware of the full extent of his injuries yet."
Cap considered his next course of action. "Roy, since the squad is still out of commission, it might be helpful if you drove over in your car to Rampart to keep an eye on things for us. I'm sure they have more important things on their minds right now than providing frequent updates to a bunch of worried firefighters."
Roy mumbled a few words of thanks and hustled out the door.
"Be careful driving," Cap shouted after him. "I don't need two paramedics in the hospital!"
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The assembled emergency team was waiting by the entrance when the Mayfair ambulance arrived. Brackett didn't bother to wait for the attendants and flung the door wide open. Brice automatically answered the doctor's unspoken question. "His vital signs are stable, but he's still unconscious."
Acknowledging the information, Brackett grabbed the foot of the stretcher and helped the attendants unload their precious cargo. As they rolled the gurney down the hall, he could barely comprehend that he had spoken to his friend less than an hour ago. Now it seemed like an eternity.
Once inside the treatment room, Morton applied the brake, and the team smoothly transferred their patient to the exam table. In the midst of the controlled chaos, Carol immediately began cutting away Early's clothes, while Dixie took an updated set of vital signs.
An impatient Brackett glanced in her direction. "How do they look, Dix?"
"BP is 116/90, pulse 100, respirations 20."
"That's some good news," Morton commented as he palpated his patient's abdomen.
As the senior physician checked Early's pupils, he addressed Brice. "You say he hasn't shown any sign of regaining consciousness?"
"No, not at all. He's been non-responsive except to withdrawing to painful stimuli."
Brackett examined the scalp laceration and localized swelling, and then proceeded to perform a quick neurological assessment.
Morton scowled. "Kel, looks like he has some bleeding in his belly."
"We'll need to do a peritoneal lavage." Looking over his shoulder, Brackett started issuing a series of orders. "Dix, get a portable x-ray down here. He's going to need plates of the c-spine, left forearm, chest, abdomen and skull. Carol, insert a Foley. I want a urinalysis, CBC, trauma panel, PTT, ABG, type and cross for 3 units." Then returning his attention to the paramedic, he pointed to the overhead cabinet. "Let's get an NG tube in." Brice reached for the requested item, while Morton set up a lavage tray.
If there was a silver lining to this evening's disastrous events, Brackett took small comfort in knowing his unconscious friend wasn't in pain. With Brice's help, he threaded the nasogastric tubing in place and attached it to the room's suction.
The senior physician watched as Morton made a small incision in the Betadine prepped area, and then threaded a trocar through the opening. There was an audible pop when the narrow tube-like instrument penetrated the fibrous tissue beneath the skin. Once the guidewire was properly positioned, Morton removed the trocar and attached a large syringe to the catheter.
Intuitively, Brackett knew what the results would be, but for one of the few times in his career, he hoped he would be proven wrong. Unfortunately, with unfailing certainty, blood flowed from the catheter into the attached syringe. "Damn," he hissed. "Dix, get Phil Mabry on the line and tell him we have a patient for him."
The x-ray technician opened the door. "Are you guys ready for me yet?"
Removing his gloves, Brackett hastily scribbled a series of orders. "He's all yours." Thrusting the chart at the technician, he added, "I need these views STAT. Let me know the minute the films are ready." He firmly squeezed his friend's uninjured arm, and whispered into his ear. "I'm so sorry, Joe."
Heading toward the door, Brackett turned back. "Mike, write up orders for a head CT scan. I don't want to overlook anything. If you need me, I'll be at the base station."
Everyone in the treatment room was eerily quiet. They knew which call Brackett was waiting for.
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After an agonizing twenty minutes, Station 16's firefighters had finished cutting away the roof of the Mercedes. Because of Johnny's severely fractured femur and the possibility of pelvic injuries, Bellingham wanted to minimize movement as much as possible. After positioning Johnny on the short backboard, he double-checked the IV, oxygen mask, arm splint and pressure dressings. Satisfied his charge was relatively stable, he shifted his position while Paul cut the seat braces.
The loud noise from the air chisel startled Johnny, and he reflexively struggled to move away from the ear-splitting cacophony. Lightly resting his hand on Johnny's chest, Bellingham tried to reassure his distressed friend. "We'll have you out of here in a minute," he shouted. "You doing okay?"
Johnny's eyes rolled back, and his lashes fluttered. "Hurts...wanna...sleep."
"No way, José. We've already had his conversation."
Although Bellingham tried to secure the seat as much as possible, the vibration from the equipment exacerbated the searing pain in Johnny's pelvic region and leg. After screaming an impressive array of profanities, the injured paramedic glared at his colleague.
Bellingham wryly muttered under his breath. "That's one way to get you to wake up."
A few seconds later, Paul severed the last brace, and the deafening noise mercifully ceased. He rested his gloved hand on the back of the seat. "Hey, Bob. We're ready to pull this out whenever you are."
"I'm ready." Bellingham playfully tousled Johnny's hair. "Okay, buddy. Just another couple of..." His voice trailed off as Johnny's eyes slid shut again. "C'mon, man. We're in the home stretch."
Paul removed the detached portion of the bucket seat with one seemingly fluid motion, while Rick stood by with the long backboard.
"Perfect. Ya done good, Paul." Directing his comments to the other man, Bellingham pointed to the space behind his now unconscious patient. "Rick? I need you to slide the board right here and prop the other end against the back seat." Bellingham was concerned about Johnny's deteriorating condition. As soon as they moved him out of the car, he was going to take another set of vital signs.
The two men slid Johnny up onto the long backboard, and then carefully lifted him onto the trunk. "Rick, I'm going to need..." Before he finished his sentence, the baby-faced probie was already handing him a cardboard leg splint. Bellingham inwardly smiled. If only Brice were so charming and pleasant to work with. Once the femur was splinted, Bellingham obtained a new set of vital signs. They were not encouraging.
He mechanically accepted the biophone receiver thrust into his hand. "Rampart, this is Squad 16..."
Brackett's voice interrupted his transmission. "Go ahead, 16."
Slightly unnerved by the doctor's extraordinarily prompt response, Bellingham continued. "Victim #2 has been extricated, and we have new vital signs. BP is 72/50, pulse is 130 and respirations are 36 and shallow. There appears to be slightly decreased lung sounds on the right side. Victim lost consciousness a couple of minutes ago, and is not responsive except to painful stimuli."
"10-4, Squad 16. Have you splinted the fractures yet?
"That's affirmative, Rampart."
An audible sigh echoed through the biophone's receiver. "What is your ETA?"
"About 10-12 minutes."
"Start a second IV of Normal Saline and transport as soon as possible. Transmit new vital signs every five minutes or sooner as condition warrants."
Perhaps it was his imagination, but Bellingham could have sworn Brackett had aged about ten years since he last spoke to him. He confirmed the orders and signed off.
Accepting the ordered IV solution and paraphernalia from Rick, Bellingham spoke to his friend in hushed tones. "Sorry for turning you into a voodoo doll, man. Too bad you're not awake to observe my superior technique."
Unfortunately, Johnny wasn't able to appreciate the humor. Swabbing his friend's arm with an alcohol prep pad, Bellingham would have given anything for a snide remark. Instead, he was met with stony silence as he slid the needle into a vein.
Satisfied that the IV was flowing properly, Bellingham and the young probie gently transferred their injured colleague to the awaiting stretcher. Almost immediately, the gurney was in motion. Rick trotted alongside the attendants, carrying the drug box and biophone. When everyone was situated inside the ambulance, Rick handed the items to Bellingham.
"I'll drive the squad in for you," the peach-fuzz faced firefighter volunteered. "I'll let Cap know." Rick closed the ambulance door, giving it two emphatic slaps to signal the driver to proceed to Rampart.
In the harsh light of the ambulance, Johnny's dark hair and lashes contrasted starkly against his pale complexion. Preparing to take another set of vital signs, Bellingham noticed an alarming development. Not only were Johnny's breaths becoming labored, his lips had assumed a slightly bluish hue. Undraping the stethoscope from his neck, Bellingham silently cursed. As he listened to Johnny's lungs, he detected markedly diminished breath sounds on the right side. He instinctively looked out the window, mentally recalculating their ETA. They wouldn't reach Rampart for another six minutes. Picking up the biophone, he contacted the hospital to advise them of this latest development.
+ + + + + + + + + + + +
Dixie mutely stood at the doorway of the base station. Sensing her presence, Brackett turned his head. "I guess you heard."
"Yeah. And to think about an hour ago, we were talking to them like it was any other day."
The physician was conspicuously quiet.
"What's the matter, Kel?"
A thoroughly dejected Brackett folded his arms across his chest. "That's the problem, Dix. It wasn't any other day. I confronted Joe about his headaches this afternoon. I sent him home early, and it's my fault he was even in traffic at the time. If he hadn't been on his way home, and Johnny hadn't needed a ride..."
"Oh, Kel! You had no idea this was going to happen." Dixie lightly rested her hand on his arm. "Did you wake up this morning and say to yourself, 'I'm going to make my best friend have a car accident today?'"
"You're being ridiculous."
"I'm being realistic. You have a job to do, and you can't if you're preoccupied with a misplaced sense of guilt."
He grudgingly smiled. "I hate it when you're right."
Dixie unsuccessfully attempted not to appear too smug. "I usually am."
Rubbing his temples, Brackett asked, "Is Treatment Room 4 set up?"
"Yup. Even have several units of Johnny's blood type on hand, and Melinda has the portable x-ray ready to go."
"Great. Johnny is going to need a chest tube as soon as he gets here, so get that set up. Page Andy Talbot from orthopedics, and call Surgery to find out find out who's available..."
"Jake Greeley. Both are already on the way."
Pleased to see she had things under control, as usual, the doctor turned toward the door.
+ + + + + + + + + + + +
In a peculiar reprise, the emergency team awaited the arrival of another valued friend and colleague. The Mayfair ambulance had scarcely backed into the emergency bay when the staff descended upon it en masse. Once again, Brackett opened the door before the attendants scrambled out of the ambulance. However, this time, they weren't afforded the luxury of a patient in relatively stable condition. His first glimpse into the vehicle was that of Bellingham manually ventilating Johnny with a bag-valve mask.
Brackett jumped into the back of the ambulance. "What the hell happened?"
Without looking up, Bellingham answered, "He went into respiratory arrest as we were pulling in the driveway. Breath sounds on the right side are significantly reduced, and there's tracheal deviation."
Snapping his fingers, Brackett shouted to the attendants. "C'mon. Let's move it!"
The moment the stretcher's wheels hit the ground, the team was in motion. Bellingham rode on the lower railing while he continued to bag Johnny. Upon reaching their destination, the treatment room erupted into a flurry of activity as they transferred their patient to the hospital's gurney.
Morton bathed Johnny's right side in Betadine, while Dixie divested Johnny of his clothing. Carol took a new set of vital signs.
Pulling the prepared tray closer, Brackett's brow creased in grim concentration. "How do they look?"
Carol deflated the blood pressure cuff. "BP is 66/40, pulse is 130 irregular and weak."
Brackett rattled off a series of rapid-fire orders while he completed a cursory exam. "Hook him up to an EKG monitor, increase those IVs to wide open, then get a CBC, trauma panel, PTT and ABG. As soon as Dr. Morton finishes evaluating the pelvic injuries, put a Foley in and get a urinalysis. We're also going to need x-rays of the c-spine, chest, right humerus, right femur and pelvis. Oh yeah, get one of the right knee, too. Mike, start a central line, insert an NG tube and set up for a peritoneal lavage." Picking up a scalpel from the tray, Brackett glanced up at Dixie. "Jake's on his way, right?"
"Right. He should be here any minute."
Brackett grunted his acknowledgement. After making a three-centimeter incision between the fifth and sixth ribs, he inserted a curved hemostat to puncture the pleura and intercostal muscles. He stuck his gloved finger into the wound to confirm proper placement and separated the linings of the lung. Then he pushed the chest tube into the opening, forcing it through the layers of tough fibrous tissue until the resistance abruptly ceased. There was a loud pop, followed by a snakelike hiss of rushing air. Satisfied everything was in order, he attached the tube to a Pleur-Evac to allow air to escape from the pleural cavity, while preventing more from seeping in. By the time he sutured the tube in place and covered the wound with Vaseline-soaked gauze, Morton had the central line in place.
The treatment room door swung open, and Dr. Greeley's deep baritone voice boomed over the din. "What do you have, Kel?"
"Possible pelvic fracture and ruptured bladder. We haven't had a chance to get the films yet, but the patient was complaining of pelvic pain at the scene, and there's significant distention."
Lifting the sheet draped across Johnny's naked form, Dr. Greeley examined the affected area. "Hmm. What do his vitals look like?"
"They've deteriorated since extrication. He suffered a pneumothorax, and was in respiratory arrest upon arrival. Since we put a chest tube in, his color has improved, the tachycardia is subsiding and he's trying to breathe on his own. Dix?"
"I'm on it." Dixie anxiously watched the bar of mercury fall. "Okay, BP is now 80/64, pulse 108 and regular, respiration rate up to 16 and being assisted."
"Earle's sign is positive. Probably a ruptured bladder." Dr. Greeley returned the sheet to its original position. "If his vital signs remain stable, I want to get a retrograde cystogram before taking him to surgery. Otherwise, we'll have to improvise."
Brackett was peeling off his gloves when the orthopedic surgeon arrived. "Hey, Andy. I was beginning to think you had forgotten about us."
The red-haired physician groaned. "Sorry, I was on my way to the stairs when I was intercepted. One of the new surgical nurses hasn't learned how to read my writing yet, and needed clarification of a post-op order."
"You mean those hieroglyphics? Geez, Andy. You're going to give doctors a bad name." Tossing the gloves into the waste receptacle, Brackett motioned toward the door with a toss of his head. "I was about to send the x-ray tech in. Do you want me to hold off for a minute?"
"Nah. Melinda can be taking pictures while you bring me up to speed." Dr. Talbot impishly added, "Besides, it will save me the trouble of having to read your handwriting."
Brackett opened the door to admit the x-ray technician, and saw three very worried paramedics waiting outside. The corners of his mouth twitched as he addressed the physicians. "Guys, why don't you wait for me at the nurses' station. I'll be there in a minute."
Roy was the first to step forward. "Doc? What's going on? How are they?"
Leaning against the wall, Brackett collected his thoughts. "Joe's still in surgery. He sustained a broken radius and ulna, rib fractures, internal bleeding and a head injury. I haven't seen the CT films yet, so I don't know whether we're dealing with anything more serious than a concussion at this point."
"What about Johnny?" Bellingham asked. "Did you have to put him on a respirator?"
"No, once we got a chest tube in, his vital signs improved. As soon as the x-ray tech is finished, Johnny will be heading to surgery."
"Did he fracture his pelvis?"
"Probably. We'll have to wait for the results of the x-rays to be sure. Dr. Greeley is reasonably certain the bladder has ruptured." Brackett crossed his arms. "Excuse me, gentlemen, but I need to meet with the orthopedic surgeon before the films are ready."
Brice fumbled with the HT. "Thank you, Dr. Brackett."
After the doctor left, the three men awkwardly stared at the floor. Roy was the first to break the uncomfortable silence. "Um, guys. Thanks for everything. I really appreciate it."
Bellingham slumped against the spot Brackett had recently vacated. "Yeah...well... I just hope everything turns out okay, you know?"
The fair-haired paramedic nervously rubbed the back of his neck. "What do you mean? What else is wrong?"
"Uh...he has a broken humerus and a couple of broken ribs. You heard about the pelvis." Bellingham hesitated. "Man, the femur was a bloody mess. Compound fracture. It was ugly."
Brice weighed in with his professional opinion. "From what I understand, either the fractured pelvis or femur could be a career-ending injury."
Roy's face reddened. "Johnny is going to be okay."
Firmly pulling Brice by the arm, Bellingham scolded his partner. "Didn't your mama ever teach you, 'If you can't say anything nice, don't say anything at all'? C'mon, we need to report in and head back to the station before you say something else stupid. If you can behave yourself on the way back, maybe I'll let you re-alphabetize the drug box again."
Her task completed, the x-ray technician pushed the door open and wheeled the equipment into the hall. Roy waited until she reached the corner before he surreptitiously entered the treatment room. His heart sank when he saw his injured partner buried under the vast array of wires and tubes. Even though he was an experienced paramedic, it was always different when the victim was someone you knew and cared about. Roy couldn't decide whether Johnny really looked that young and fragile, or if he himself had aged that much over the past hour.
A familiar noise startled him, and he quickly turned around. Brackett re-entered the room, flanked by the two doctors he saw earlier. The emergency room physician reluctantly delivered the news. "Roy, we need to take care of a few things before we send Johnny to surgery. You'll need to step outside. You can wait for Johnny upstairs, okay?"
No, it wasn't okay, but Roy knew the rules. He reached through the side rail and tightly squeezed Johnny's hand. "You're going to be all right, Johnny." Roy wasn't sure which one of them he was trying to convince.
+ + + + + + + + + + + +
Physically and emotionally drained, Brackett sank into his chair and propped his feet on his desk. Both of his friends were in surgery, and he felt helpless waiting for information from the confines of his office. Normally, he'd try to arrange for someone to cover for him so he could scrub in and observe, but the department was already working with a skeleton crew. He was sipping a cup of steaming hot coffee when a persistent knock on the door interrupted his respite.
Annoyed at the intrusion, Brackett set the ceramic mug aside and practically growled his response. "Come in."
A young man in scrubs man cautiously approached the exhausted physician. "Dr. Brackett? I brought the CT films of Joe Early that you requested."
Rising to his feet, the physician accepted the large brown envelope. "Thanks for saving me a trip."
Brackett snapped the films onto the light box and flipped on the switch. Scanning the images, his eyes drifted toward an abnormality in the occipital lobe. For a fleeting moment, a wave of nausea washed over him. Under the circumstances, he had assumed the scan might have detected a subdural hemorrhage or other evidence of head trauma. He certainly didn't expect to see this. His fingers absently traced the large dark mass. What the hell was it, a tumor? And if so, was it malignant?
He recalled their last conversation about Early's headaches, and seethed with anger. Damn it, the man was a neurosurgeon for crying out loud! How could he have so glibly discounted the significance of his symptoms? Before automatically diagnosing himself with migraines, he should have ruled out other more serious possibilities.
Soon his fury abated, only to be replaced by guilt. If only he had pressed the issue months ago. He should have known something was wrong, and should have insisted Early undergo a thorough evaluation. To some degree, he was also at fault. How could he have ignored his friend's symptoms for so long? After all, Early worked under his supervision on a daily basis. How could he have overlooked the chronic headaches merely because he was loath to disrupt the fragile status quo of the understaffed emergency department? Had he essentially sold his soul by sacrificing Early's health in order to meet a budget requirement? And what about public safety and liability issues? Considering he wasn't always functioning at a hundred percent, was the neurosurgeon's judgment ever impaired? If so, the hospital could have been sued out of existence.
Brackett turned off the light box. With the damning evidence no longer illuminated to accuse him, he returned to his desk and searched for some tedious chore to take his mind off his dilemma.
+ + + + + + + + + + + +
Dixie gently nudged Brackett, who had fallen into a light slumber over a pile of dictation on his desk. "Kel?"
"What?"
"Phil's here to see you."
The emergency room physician was chagrined to have drifted off. "Sorry about that. I guess catching up on charts would put anyone to sleep."
Dr. Mabry laughed. "No kidding. It's certainly more effective than Seconal."
"So how is Joe?"
"He's doing fine. His spleen was badly ruptured, so I had to remove it. As you know, he also had a simple fracture of his left radius and ulna, which orthopedics is handling now. After that, he'll be going to recovery."
Brackett hesitated. "I take it you received the report from radiology regarding the head CT?"
Dr. Mabry removed the paper surgical cap and ran his fingers through his hair. "Yeah. That was a total surprise. Considering the size of the mass, I'm surprised he hasn't presented with symptoms."
Shifting uncomfortably, Brackett lowered his eyes. "I'm not looking forward to telling him."
"I don't envy you. I wonder if being a neurosurgeon is going to be a blessing or a curse in this case, you know? I mean, you're not going to be able to bullshit him if the tumor is malignant."
"I've thought about that. On the other hand, he's seen some remarkable recoveries during his career. Hopefully the mass will be benign, and we won't have to cross that bridge." Brackett wasn't sure whether he hoped that statement was true for his friend's benefit, or for the sake of his guilty conscience.
+ + + + + + + + + + + +
The evening stretched on interminably, prolonging Brackett's exercise in self-flagellation. Part of him wanted to go home and burrow under the covers for at least a week and try to pretend this wretched day had never happened. Paradoxically, he felt numb and yet painfully aware of his transgressions. To his consternation, Dixie intruded upon his misery and insisted that he consume something besides black coffee. Although he didn't feel hungry, he managed to drink a container of orange juice and nibble a few bites of the roast beef sandwich she had managed to scrounge up despite the late hour.
Somewhat appeased, Dixie moved a stack of charts aside and sat on his desk. "Kel, I just called the OR about Johnny."
Brackett regarded her warily. "And?"
"Jake has repaired the ruptured bladder, but they've had a difficult time keeping him stabilized. There was a significant amount of bleeding from the fractured femur. Andy is still working on the orthopedic injuries. Looks like he's going to have to hold off on fixing the knee until Johnny has had a few days to recover a little."
Glancing at his watch, Brackett tried to suppress a yawn. "My shift ends in precisely two minutes. I think I'll wander upstairs and scrub in for a bit, and then check in on Joe."
Dixie collected the remnants of the barely touched meal and tossed them into the wastebasket. "Want some company?"
He shook his head. "It's late, and you're working a double shift tomorrow. Why don't you go home and get some sleep."
"Excuse me, but so are you."
"Your point being?"
She placed her hands on her hips, striking an imposing figure. "Kel, I appreciate the clumsy attempt at chivalry, but I've been known to survive on a few hours of sleep now and then. Doctors don't have the market cornered on stamina and pigheadedness."
Despite the circumstances, he grinned. "I think I've just been insulted!"
Dixie exuded the picture of innocence. "C'mon, Superman. Grab your red cape and let's head upstairs." As she stood up, she winked at Brackett. "But be careful, I understand the coffee in the waiting room is far more dangerous than kryptonite."
+ + + + + + + + + + + +
A haggard Roy was anxiously pacing the floor of the surgical waiting room when Dixie and Brackett exited the elevator. The worried paramedic rushed over to greet them. Nervously rubbing the back of his neck, Roy addressed the new arrivals. "I haven't heard anything since Dr. Greeley came out to talk to me. That was about an hour ago. He said Johnny was keeping them on their toes for a while. Now the orthopedic surgeon is reducing the leg fracture."
Dixie took his hand into hers and smiled reassuringly. "Andy Talbot is the best orthopedist on staff. Johnny couldn't be in better hands."
"Yeah, but...uh...it sounds like Johnny is in rough shape. I'm afraid one day his luck is going to run out. I just hope that day isn't today."
Brackett stuffed his hands into the pockets of his lab coat. "Oh, I'm sure Johnny will be feeling better and chasing nurses again in no time."
Rolling her eyes in mock exasperation, Dixie agreed. "Knowing Johnny, he'll manage to finagle a date with Cookie before he's discharged from ICU."
Roy's brow furrowed as he tried to place the name. "Cookie?"
"Uh huh. Johnny's latest obsession."
Noting his puzzled expression, Dixie explained the mystery. "Her real name is Cathy Mercer, but everyone calls her Cookie."
A light bulb went off in Roy's head. "So that's the nurse he's been swooning over for the past two weeks. He's been driving me stark raving bananas. During the last shift, I was almost hoping he'd be stricken with laryngitis so I could have some peace and quiet." A lump formed in Roy's throat. "I should have been more careful about what I wished for. It's going to be a long time before he's back at work." An uncomfortable silence ensued.
Dixie lightly wrapped her fingers around Roy's arm. "Kel's officially off-duty now, so he's going to scrub in and observe. Why don't you come downstairs with me? I'll bet you haven't had a bite to eat all evening. And the couch in the doctors' lounge is much more comfortable than these awful chairs. Maybe you can sneak in a quick nap."
"No thanks. I need to be here for Johnny."
"I was trying to make that sound like a suggestion," Dixie teased.
Brackett smiled. "There's no use in arguing with her. She's going to win." Understanding Roy's reluctance to leave his partner's side, the physician gently squeezed his shoulder. "Look, Johnny is probably going to be in surgery for a while. I promise I'll be there as soon as there's any news."
Grudgingly, Roy followed the nurse to the elevator, but not before casting one more glance at the doors to the OR.
