The Queen of Hearts(7)
“There are two more incoming,” said our chief, as he ripped open a chest tube kit. He looked amused. “Get over to bay two and get ready for the next one. You can call it.”
Clancy shot me a hostile look and huffed out.
“Go ahead, Sadie,” said the chief. “Better hurry up. He’s dying.”
“Ah,” I said, panicked. No time to correct him on my name. “When you say ‘stab him in the chest . . .’”
“Well, it’s a little more nuanced than that.” He began squirting a brown antiseptic fluid over the patient’s chest wall. “I’m assuming you’ve got more sense than Clancy. Can you locate his nipple? And his armpit?”
“Yes,” I said, with complete confidence.
Dr. X, the chief, wheeled around to face a nurse standing behind us. “Eva,” he commanded, “throw us two packs of sterile gloves.” He grabbed one of my hands, which looked spindly and uncertain next to his. “Size six,” he evaluated. To me, he said, “We’ll do it together as soon as he’s intubated. Then the next one’s all you. Okay?”
I nodded, pleased. Insertion of a chest tube was a procedure I was anxious to learn.
Above me, a bank of monitors beeped hysterically. The room we were in—one of the emergency department trauma bays—had floor-to-ceiling shelves, which contained a slew of medieval-appearing implements: fat eight-inch needles to insert into the heart, instruments to slice open the chest and saw through ribs, IVs to thread into the central veins in the neck and chest and groin, and even horrifying giant needles designed to screw into the marrow of the bones. Hanging from the ceiling were swiveling cinema-quality spotlights. Who knew how many patients had regained consciousness with those blinding lights boring down on them, convinced they were facing the radiant blaze of the tunnel to heaven only to realize they were actually alive and naked in a roomful of strangers?
Only a few moments earlier, the EMTs had barreled in with a crushed, unconscious teenager. (“. . . Trauma code name is Silver,” one of them reported as he and his burly partner had heaved up the metal stretcher. “Young male, unbelted driver of a T-bone MVC, no airbag deployment, GCS 3 on initial eval, decreased breath sounds on the right . . .”)
I’d learned earlier in the day the hospital assigned random nouns as code words for the trauma patients—in this case, Silver—since some were unconscious without ID, some were in need of protection from whatever sinister force had caused their plight, and some were high-profile enough to require privacy. None of us yet knew Silver’s real name.
“Lidocaine, etomidate, succinylcholine,” the ER resident called out. He was a skinny guy with a prominent Adam’s apple, which bobbed up and down in nervous commiseration as he manipulated a breathing tube through Silver’s vocal cords and into his trachea. A respiratory tech attached the tube to a bedside ventilator, which began pumping air into Silver’s lungs, forcing his chest up and down at regular intervals.
Dr. Allison Kalena, our third-year surgery resident, held a stethoscope to Silver’s chest. She was trim and self-contained, with symmetrical features and hair bundled into a crisp, precise bun. I found her inscrutability a little worrisome. I’d known her only one day, but I’d yet to see her have an actual expression. Her onyx eyes were smooth and alert over her mask as she instructed an XR tech to shoot a film, but she didn’t bother to wait for the results to motion for Dr. X to set up the chest tube kit. I perked up. This confirmed his initial suspicion that something bad—maybe a big blood or air collection—was impeding Silver from expanding his lung on one side.
Reviewing my meager knowledge, I pulled the sterile gloves over my regular latex ones, being careful not to allow the outside of them to touch my skin. Trauma victims were evaluated according to the ABCs, starting with airway (A), breathing (B), and circulation (C). These were sequential actions taken to address life-threatening injuries, and the team had just handled the airway. Things were now hung up on B, because despite the breathing tube, he still wasn’t getting enough air. All the alarms were blaring: Low oxygen! Low blood pressure! Fast heart rate!
Silver was dying.
Dr. X spoke up. “Sadie,” he said to me. “Let’s do this.”
I nodded. He was directly behind me, guiding my hands as he talked me through the chest tube insertion. I watched, mesmerized, as my own hands performed the small operation: incising through Silver’s skin, just over a rib, punching through the muscle to his chest cavity, releasing an angry crimson splash, which sprayed the front of my yellow plasticized gown and dripped down past my shoe covers. The cellular dimming of Silver’s life reversed course as I piloted the tube in place through the gaping hole in his chest wall. An entirely new emotion surged through me: part exhilaration, part glorious relief, part absurd pride. I beamed at Dr. X, who stood assessing the action, his posture easy, arms folded loosely across his chest.
He gave me a thumbs-up. I was hooked.
From what I could see of him, Silver was young and slender. He’d been wearing jeans and a faded T-shirt with a picture of Stephen Hawking on the front, which puddled on the floor as the nurses finished clipping off his clothes with big shears. One of his shoes was missing, and the other was pointing almost backward, indicating a horrific fracture that seemed to have twisted his leg nearly off. I brought my gloved hand down gently to touch his broken face. A drop of fluid squeezed out of his left eye and ran down his cheek: a single bloody tear.