LITMIR.BIZ

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      She hurried towards the unit clerk’s desk but was brought up short when the doors to the trauma room burst open and two more bloodstained patients were brought in.

      Fleeting panic hit low in her belly. Never in her life had she ever faced such a massive influx of pediatric trauma patients at one time. She strove to remain calm, listening as the paramedics rattled off the pertinent details.

      “Ten-year-old male with multiple fractures, including his pelvis, long extrication at the scene, blood pressure low-eighties over forty.”

      “Do you have a name?” She wanted to know how many families they were dealing with here. So far they had the Duponts and the Browns.

      “Mike Winthrop.”

      Make that a third family. She filed that bit of information away for when the family members started coming in. “Start fluid resuscitation until Ortho gets here.” Naomi glanced at the second patient. With all the blood covering the child’s face, it was difficult to determine the gender. “What’s the story with this one?”

      “Crushing chest injury, and another long extrication at the scene. The car that hit them was on top of their car, crushing the victims in the back seat.”

      “Age and name?”

      “Emily Brown. We almost had to sedate her brother who wasn’t doing very well himself yet was still trying to crawl back into the car to get her.”

      Having just spoken to Tristan, she wasn’t surprised. Her gaze landed on Emily and she swallowed her fear, knowing the massive injuries stretched her limitations as a trauma surgeon. “Call the cardiothoracic surgeons, I need someone here to evaluate her asap.”

      One of the nurses scurried off. Naomi did a quick examination of Emily, but she could see the poor girl’s ribs flailing from the foot of the gurney. Dear God most if not all of her ribs were broken. She hated to think of the damage that had already been done to her small heart. Most of the trauma surgeons could do a little open-chest surgery, but she’d only done it a couple of times and never alone. Given a choice, she’d rather have the experts with her.

      “The CT surgeon is on his way in from home, but the weather may cause him to be delayed,” the nurse informed her a few minutes later. “He said he’d get here as soon as possible.”

      She blew out a breath. No choice. Emily was her patient. “Okay, we can’t waste any more time. Get those labs sent off and we’ll take her straight up to surgery.”

      “What about Mike Winthrop?” Missy, the charge nurse, asked, a harried expression on her face.

      “Get the ortho trauma team to write the admitting orders on both Tristan Brown with his multiple fractures and Mike Winthrop with his crushed pelvis. Get them ICU beds and either Rick or I will be up to see them as soon as we’re finished in the O.R.”

      “Okay.” Missy bustled off. Naomi didn’t waste any more time, but headed up to the O.R. with little Emily.

      The O.R. team had Emily prepped, draped and ready to go. Anesthesia was there, putting the seven-year-old to sleep and monitoring her labile vital signs. Naomi scrubbed at the sinks outside the room and then donned her sterile garb. Her stomach clenched and she was glad she hadn’t eaten much for dinner because she felt sick at the thought of doing this alone. Taking a deep breath, she entered the O.R. suite.

      “Ready?” she asked, taking her place at the patient’s chest. She wasn’t tall, and she generally used a step stool to perform surgery, which everyone had pretty much gotten used to by now.

      “We’ve been giving blood as fast as possible, but she’s not gaining any ground,” the anesthesiologist warned. His name was Matt Granger and she’d done many cases with him before.

      “Keep doing what you’re doing, and let’s see what we have.” Naomi reached for a scalpel and made the incision straight down the center of Emily’s small chest.

      Her ribs were a mess and she didn’t need to cut the sternum as it was already broken. “Suction,” she barked when blood gushed, obliterating her view of the heart. Sweat trickled down the center of her back. “I need to find the source of her bleeding.”

      “Need a hand?” a deep voice asked from behind her. She turned to see Rick standing there.

      She wanted nothing more than to have Rick’s help, but the other five trauma patients needed him, too. And it was possible that Emily’s heart was beyond repair. No sense in putting the other patients at risk by tying up both of them. “I’m fine for now. The CT surgeon is on his way in from home. You’d better go and check out the ICU admissions. All of the trauma patients have been admitted to the ICU, the ortho trauma team should be evaluating the two with major fractures.”

      “Sounds like everything is under control.” He gestured to the open chest. “Are you comfortable with this?”

      “I’ve only done open-chest procedures a few times,” she admitted, “but hopefully I’ll find the bleeder.” She turned back to her patient and examined the chest cavity as well as she could, thinking it was possible Emily had a tear in her inferior vena cava, one of the major veins carrying blood to the heart.

      “I’ll check on the ICU patients and then come back,” Rick said, his voice fading as he moved away. She didn’t bother to respond. If Emily’s vena cava was torn, things were going to get worse before they got better.

      More suction, and she still couldn’t quite pinpoint the source of the hemorrhage.

      “We’re losing her. I have maximum doses of three different vasopressors running with no response in blood pressure,” Matt informed her.

      “Give more blood.” Sweat pooled at the base of her spine as she fought to slow the bleeding. The vena cava wasn’t an artery but its proximity to the heart made things tricky. “Does anyone know when the CT surgeon will arrive?” she asked, hoping the tremor in her voice didn’t betray her.

      “I’ll check.” The circulating nurse left.

      There was way too much blood. If she didn’t do something to get the bleeding under control soon, this poor little girl would die. “I want her placed on the heart-lung bypass machine.”

      Matt’s gaze met hers over the supine body of their patient. “Are you sure?”

      “I don’t have a choice. I can’t fix the tear in her vena cava without additional support for her heart.”

      The second circulating nurse in the room wheeled in the heart-lung bypass machine. Naomi was out of her depth with the extent of this surgery and she knew it. “Call Dr Weber back, tell him I need help.”

      “I spoke with Dr Yulton, the CT surgeon on call. He’ll be here in ten minutes.”

      She wasn’t sure Emily had ten minutes to spare, but she nodded to indicate she’d heard. The techs set up the bypass machine while she began to cross-clamp the major arteries in preparation for the switch-over.

      “I’m here.” Rick’s voice had never sounded so good.

      “I’m losing her,” she said, her voice steady. “The CT surgeon will be here soon, but I need help now.”

      Rick didn’t say a word but helped her perform the switch to bypass. They managed to get Emily safely transferred to the heart-lung machine just as the pediatric cardio thoracic surgeon walked in.

      Naomi didn’t leave, but was more than happy to let the CT surgeon take the lead. Rick stayed too, and once Craig Yulton got Emily’s bleeding under control, she breathed a little easier.

      “I’ll take her from here,” Craig said, glancing up at Naomi from the opposite side of the patient. “I heard about the multi-car crash after the ballgame, so I’m sure you have other patients to see.”

      They did, so Naomi nodded gratefully and stepped down off her stool away from the table. Rick followed her out of the O.R. suite.

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