Page 12 of Resuscitation

Chapter Ten

Sara placed a plastic basin of hot water mixed with betadine on the floor near her tween-aged patient’s grimy foot. Five years of residency training at one of the East Coast’s busiest trauma centers put to good use, she thought.

“Evan, we’ll need to let it soak for a while, soften the tissue around the ingrown toenail. Then I can take pack it with iodine gauze, and you’ll be set.”

The boy grunted, barely able to rip his eyes away from the game on his cellphone, and submerged his bare foot in the water. He winced and knifed a look at Sara, holding her responsible for his discomfort.

Sara returned a thin smile. Yet another satisfied customer. The bean counters at corporate HQ would be so happy.

Evan’s mom, wrapped in a puffer coat and sporting a pulled-down woolen hat bearing a team insignia, sat on a chair in the examination room, talking to someone on her cell.

Sara exhaled silently. Only a matter of time before this place, her clinic, followed the rest of the hospital into oblivion. She thought about the local people and all the patients who relied on this facility—the elderly, the working poor, those without transport.

How were they going to get to Potsdam when they needed urgent care?

The system had failed them, leaving the most vulnerable to fend for themselves.

She had to keep the clinic running as long as possible for the sake of the community that depended on it.

She wouldn’t abandon her patients, not without a fight.

“Ingrown toenail. No, he won’t be able to play, I don’t think. He can barely walk, it hurts so bad. Hang on…” The mom looked at Sara. “Doctor, how’s it looking? Will he be able to play hockey tomorrow?”

“Not tomorrow, but give it a few days and he’ll be fine,” Sara answered.

The mom shrugged and returned to her conversation just as Angie, the ward clerk, came rushing down the hallway. Sara stepped out of the treatment room to meet her.

“There’s a police car coming up the road, lights and sirens,” Angie said.

Sara frowned. “Here? They should definitely not be coming here. They know that.”

“I know,” Angie said. “Sorry.” She fled back to the waiting area.

Sara walked briskly down the hall and entered the EMS dispatch center inside the ambulance bay. The tiny, glass-walled office overlooked the ambulance entrance with a second door out to the large garage that held the EMS vehicles and a resupply area.

Wayne, the dispatcher, a man in his fifties, swung around on his gamer chair. His U-shaped desk had a stack of takeout coffee mugs with crumpled-up candy wrappers scattered around several computer monitors, a radio with a headset, and a multi-line phone.

“Wayne, did the cops radio in? What’s the emergency? Why are they coming here?”

He shrugged. “Just got off with Alyssa. Said there was some kind of incident and they saw a cop car headed our way, running lights and siren. Getting ready to call county dispatch?—”

Just as Wayne picked up his radio mic, the reflection of flashing red and blue lights in the office window grew stronger.

Sara leaned forward to hit the button to raise the garage door, the sheriff’s SUV barely clearing it as it roared into the ambulance bay and screeched to a halt.

Its doors flew open, and five figures clad in SWAT gear climbed out.

One shouted, “Hey! We need a doctor! Someone’s been shot.”

“Wayne, grab the gurney from the trauma bay and send everyone this way,” Sara ordered. The older man stared at her, mouth agape. “Do it, now!”

Once he rushed through the door leading into the ER— minor care clinic, she couldn’t help the mental correction, especially as it meant she was seriously understaffed and under-equipped to handle any kind of gunshot wound—Sara strode into the bay to meet her patient. “I’m Dr. Porter. What happened?”

The men parted, gesturing for her to look into the rear seat. She noted that they all held rifles at the ready, as if anticipating an attack. She’d done a stint as trauma doc for the SWAT team in Toledo where she’d trained. These men felt hardened, like them. Still, something felt off…

She ignored the itch to focus on the armed men behind her and approached her patient.

Mid-twenties, pale, diaphoretic, obvious penetrating abdominal trauma with significant blood loss.

Responded minimally to commands, maintaining airway, peripheral pulses thready and rapid.

Ignoring the blood on her hands from assessing him, she crawled out of the passenger compartment.

The driver stood in her way, cradling his rifle, his posture taut, challenging her. “He’s going to be okay, right? You have to save him.”

She met his gaze, not liking his tone of command. “This isn’t an ER any more. We’re barely a minor care clinic. And he needs a Level One trauma center. The closest is Syracuse. With the storm, there’s no way the helicopter will be flying. We’ll stabilize him as best we?—”

He shook his head, leaned into her space. “Not ‘we,’ Doc. You. You will stabilize him, fix him up, do whatever he needs done. Here. Now.”

Sara wanted to shove him out of her way—she needed to get to work if her patient had any chance.

Before she could move, Wayne came rushing in with the gurney, followed by Nick, her physician assistant, and Kelly, her nurse.

The only other staff on the night shift were the desk clerk, an x-ray tech, and a security guard patrolling somewhere.

The cop turned, raised his rifle, pointing it at Wayne, who stopped short, raised his hands, the gurney rolling across the concrete floor. Two of the other cops caught it before it hit the SUV.

Sara wondered why they didn’t move to load their injured comrade onto it—and realized that was what had been bothering her: SWAT team members and most patrol officers were trained in basic trauma care, even had trauma kits with the tools to stop excessive blood loss.

Yet all these guys had done was to use someone’s bandana as a pressure dressing. These guys weren’t cops. Her mouth went dry as the adrenaline rush of a dealing with a GSW was overridden by the sheer, sudden terror that she was all that stood between life and death for everyone in the building.

The leader seemed to sense her distress. “Just so we’re clear,” he said, his rifle still aimed at Wayne. “You’re gonna have multiple traumas on your hands if you don’t save my brother.”

She lowered her gaze as if submitting to his authority. “No need for that, officer,” she said calmly. “We might not have much more than the basics here, but we— I will do everything in my power to save his life.”

The leader looked at her for a second as if in contemplation, then slung the rifle over his shoulder and nodded. “Good.” He stood aside as if inviting her to join a party. “Guess we shouldn’t waste any time, then.”

Sara and Nick wheeled the gurney to the SUV, and two of the armed men helped load the wounded patient onto it while the others watched, hands on their weapons.

“What’s his name?” Sara asked.

“Con…Officer Connor,” came the leader’s reply.

“Wayne, we need to alert any patients who are waiting that we’re treating a Code Black,” Sara said, making deliberate eye contact with the dispatcher, who nodded and hurried ahead of them through the double doors into the hospital.

If Angie could get the remaining patients through the waiting room exit and out of harm’s way, that would be a load off Sara’s mind.

“What the hell’s a ‘Code Black’?” the man asked suspiciously.

She looked at the man she assumed was the ringleader, as he had been doing all the talking and threatening. Did he know? Why would he if he wasn’t a real police officer?

She inhaled, kept her voice steady. “It means we’re treating a wounded police officer, and less urgent patients will have to wait or come back another time.”

“Right. We take priority.” He turned to one of his crew. “Hey, er, Officer Tyson, go help Wayne out, will ya? Make sure everyone stays calm and out of the doc’s way.”

Sara hid a grimace of disappointment. Her plan was toast already. But, on the plus side, they fell for her explanation of Code Black. It actually referred to an active shooter or hostage-taker.

As they began to wheel her patient, Connor, through the double doors, the ringleader ordered another one of his men to stay with their van. She overheard his quiet reply.

“Sure, Mercer.”

The remaining four men followed Sara, Nick, and Kelly as they wheeled the gurney into the former trauma bay.

Most of its equipment had been stripped out.

However, there were still items useful for minor emergencies, plus the crash cart, which contained emergency medication and equipment for advanced life support protocols.

But there was no banked blood, no ultrasound, and no ventilator, which was going to make treatment a challenge, to say the least. Sara and her tiny team scrambled into action.

“Monitor, and let’s get these clothes off,” Sara ordered as she moved to the head of the gurney, ignoring her armed audience. “Get me two large bore IVs going.”

As Nick moved to cut off Connor’s layers of clothing and Kelly grabbed the monitor and leads, Sara placed a non-rebreather mask over his face. She leaned over him—god, he looked so young—and brushed the hair away from his face. “Can you open your eyes? Tell me your name?”

His eyelids fluttered open, then shut tight against the bright exam light shining above him. “C-Connor,” he whispered.

“Good job, Connor. Tell me what hurts.”

The leader, Mercer, suddenly grabbed Nick and wrenched him away. “Leave it!” he ordered, grabbing the pistol Nick had taken from Connor’s belt. Then Mercer turned to Sara. “He’s been shot in the belly. What the hell are you playing at?”

“ABCs,” she said in a quiet tone, meeting his gaze easily.

“Bullets don’t stop once they’re inside the body, they can go anywhere.

I need to assess everything, starting with his airway, breathing, circulation, mental status…

Want me to recite the full advanced trauma resuscitation guidelines, or shall I return to saving my patient’s life? ”

Without waiting for an answer, she turned back to Connor.

Mercer grabbed her arm, leaning next to her ear, whispering, “ Your patient, my brother. Don’t forget that.” He nudged her between the ribs with his gun.

“You want me to save your brother, you need to give us room to work.”

He stepped away and waved his men back, the guy with the ugly mohawk bending down to remove the weapons and ammunition Connor had carried along with his ballistic vest.

Nick cut away Connor’s shirt, allowing Kelly to apply the monitor leads. One eye on the display, Sara palpated his cervical spine, then ran her hands down both sides of his chest, assessing for possible rib fractures and crepitus—signs that the bullet damaged a lung.

“You’re doing great, Connor,” she continued in a soothing tone. “Anything hurt up here?”

Connor shook his head.

“How about here?” She pressed on his belly, starting with the upper left quadrant. Connor winced, and again when she moved lower, then gave out a loud groan when she pressed in the area near the bullet wound.

“Christ,” Mercer shouted, “give him something for the pain.”

She wished she could, but there was nothing she had here to give him—the clinic didn’t keep any injectable narcotics on site. “Kelly, how we doing with those IVs?”

“First one running.” Kelly crossed behind Nick, who was cutting away Connor’s pants, leaving him totally exposed.

“Let’s roll him, then we’ll get the second one going and a Foley.

” Sara glanced at Mercer, who had turned away from his brother’s naked body.

He was going to like the idea of a Foley catheter—a tube inserted in the urethra—even less, but without an ultrasound or CT, her diagnostic options were limited.

In the background, the intercom crackled into action, announcing, “Attention all patients. The staff is busy with a Code Black at this time. Please move to the waiting room. Thank you.”

Carefully, they rotated Connor to his side. As Sara searched for an exit wound, she felt relief. Wayne must’ve bamboozled Mercer’s guy into believing her Code Black explanation. Between him and Angie, maybe they could still get the patients out.

“No exit wound,” she announced. They rolled Connor back.

“That’s good, right?” Mercer asked.

“No. It means the bullet spent all its energy inside his body. The bleeding you see here is only the tip of the iceberg.” Sara turned to Nick.

“I saw some surgical sets left behind. They’re in the storage closet.

Grab anything labeled ‘trauma’ or ‘vascular’ and bring them.

Oh, and grab as many towels as you can. I might need to open his belly. ”

Nick’s eyes went wide at that. “On it,” he said, moving toward the door. One of Mercer’s men, the one with the mohawk, joined him, gun drawn.

“Kelly, open those packs of Kerlix and the widest Ace you can find, let’s get a pressure dressing on this.” Sara began packing the wound with saline-soaked sterile gauze, applying firm pressure that made her patient moan in pain. His breathing became more rapid and shallow.

“Hey, Doc, what’s this about a Code Black?”

Sara glanced back at the door to see Luca, the security guard.

Time stopped.

Sara opened her mouth to warn him, but no words came.

Luca frowned at Sara, then his eyes darted to the other men. He froze, taking in the sight of three armed guys in SWAT gear staring back at him.

One of the gang moved first, raising his weapon.

“No!” Sara shouted.

Luca went for his sidearm. It wasn’t even a gun, only a taser.

A rapid volley of gunfire erupted, deafening in the confined space.

Kelly screamed.

Luca jerked, bounced against the door jam, his taser falling, unfired, hitting the floor a second before the bulky weight of his body followed.

Sara ran to him, checking for vitals. One of the shots had blown out half his skull—the impact of automatic weapon fire at such close range was devastating. She hadn’t seen anything this bad since leaving Toledo.

She sat back on her heels. “He’s dead.”