First Wish Page 5
Part of me listened to DeSean as he began to rattle through the list of meds they had pushed, but the greater part of me took in the patient. New residents tend to focus on the numbers—blood pressure, pulse, Oxygen saturation—but over the years I had learned to really look at the whole patient first, then move on to the numbers and the treatments. What I saw didn’t look good. The girl was thin and petite and at first glance could have passed for twelve or thirteen. But a closer look at her face and chest suggested she was probably fourteen or even fifteen. The broken arm and leg made her look like a worn rag doll, but weren’t too worrisome by themselves. They could wait. What mattered was her distended abdomen, suggesting an internal bleed, and the way her head looked slightly flat on the right side, the symmetry of her face gone awry. Not good was an understatement.
This is bad, I thought. Real bad...
The girl went into trauma bay one while Dicky and the father went straight through to A pod, one of the four pods that made up the emergency department. If there was any chance the father might come to again they wouldn’t want him anywhere near his daughter. That kind of drama would be good for no one.
Before I even started giving orders the girl was swarmed, nurses and a couple of techs flanking the sides of the gurney, where they started new IV’s and prepped for a central line. I took my place at the head of the gurney and got ready to intubate her. The airway was always first. Our job wasn’t to fix the girl but to stabilize her so that the trauma surgeons could take over. But getting an operating room ready always took time, even if it wasn’t a lot. Until then I had to keep the girl alive.
One of the nurses handed me the laryngoscope and tracheal tube and before I could even bend over my muscles locked up and I felt like I might vomit. I wanted to touch that girl about as much as I wanted to touch a viper. Normally I don’t hesitate to do my job, but my head was already full of voices that weren’t my own. Not metaphorical voices. Not tumor-induced hallucinations. Not some psychobabble problems from my past that expensive hours of therapy couldn’t banish. Real voices, not mine, but those of former patients who’d died while I was touching them. All of them with a last wish they wanted to lay on me, a wish I couldn’t refuse if I wanted to get them out of my head.
“Is something wrong, Dr. Davies?” asked the nurse who had handed me the laryngoscope.
Because of the frenzy that surrounded the girl the only other person that noticed my hesitation was the nurse who had taken over the bag valve mask. That level of activity made me want to run. The staff never put work like that into the average druggy, or geriatric on their way out—most of us didn’t invest much emotion in those patients. But it was always different with kids. The staff cared. You could tell. There was atmosphere in the room. They didn’t want her to die.
“Just taking a breath,” I said to the nurse, swallowing hot bile as I forced myself to bend near the girl. The other nurse removed the bag from the girl’s face and I took her chin in my right hand, opened her mouth, and inserted the laryngoscope.
I was just about to slide past the vocal cords when the Surgeon’s voice erupted in my head. Don’t tube the ‘goose!’
The laryngoscope blade slipped in my hand and I just barely avoided banging into the girl’s teeth as the Surgeon chuckled with delight.
Do you really think you can help this one? he asked. She’s a lost cause...
I ignored him as I inserted the laryngoscope again, getting it in place straight away. The tracheal tube in, I backed away so she could be hooked up to oxygen. I replaced the laryngoscope on its tray and went to the side of the gurney where the nurses shifted smoothly out of my way.
It won’t matter, you know, the Surgeon said. This one’s a goner.
The Surgeon was the worst of the three voices in my head, with all his advice and all his know-how. Always telling me how to treat my patients. Residents are an insecure bunch, so the last thing I needed was the most arrogant of specialists telling me how to manage my cases. I had learned how to tune him and the others out, but it required a focus that was difficult to maintain at the best of times, much less when I was treating a patient. It was far easier - though no small feat - to just ignore them.
“Pressure’s tanking,” the tech called out. “Eighty-five over fifty, doc.”
“Damn,” I said, suddenly afraid the Surgeon was right. No way are you going to die on me, girl...
That’s right, Linh! chimed in Amanda. God helps those who help themselves! You can do it!
I had no idea whether I believed in God or not, but I figured even if I was wrong he sure as hell didn’t have any interest in helping me out. But Amanda was right to a degree. The girl’s life was in my hands and I wasn’t going to let it slip away.
But if there was a God he was laughing at me right then because the kid started to drop. I knew what we could do—we could give her air, give her fluids, fill her up with someone else’s blood. And when that failed? What then? Shock her heart when it crashed. Maybe, if the case called for it, crack her chest and pump her heart by hand. But really, what good would that do? What would that result in other than bloody hands and a butchered body? And if I kept my hands on her and she died then I was going to get another voice in my head and then what would I do? I couldn’t forget what had happened the last time - the Surgeon. He’d been nothing but a disaster.
No, I thought. No, that won’t happen. I won’t let it happen. She may die, but she won’t die here with me. I can do this...
“Mannitol,” I said. “And two units uncrossed blood up, now. All we have to do is stabilize her long enough for the trauma surgeon to put her back together. I’ll get the central line in.”
Mannitol? Really? said the Surgeon. I think that ship has sailed, honey.
I could see the fear and the hope in the staff’s eyes as they complied with my orders. I started on the central line and said, “We can do this people. We’re okay.”
But we weren’t okay, because a second later her pulses disappeared and her heart rhythm changed and of course my hands were on her, touching her. The blare of the heart monitor cut through the air. It didn’t matter if the cause was a massive intra-abdominal injury or a traumatic aneurysm, either way she was toast.
“Shit,” I muttered, fighting the urge to cry or hit myself on the head, the fantasy of saving the girl slipping away.
There was more after that of course. More pumping, more drugs, more everything, because it was a kid and we wanted to bring her back. All of it useless. None of it mattered.
I told you! said the Surgeon as he cackled with glee.
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About the Author
M. D. Thomas grew up in the middle of nowhere Louisiana, a locale that let him spend most of his free time reading. When that got old he left, eventually earning a Ph.D. in Microbiology at the University of Virginia. He ditched a career in science a few years later, became a stay-at-home dad, and settled in Tidewater Virginia, where he’s been writing ever since. His works have won writers conference awards and were selected for the Pitch Wars mentoring program in both 2017 and 2018.
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