While she waited for her incoming gunshot, she reviewed the charts of the two patients currently being treated and looked over the shoulders of the residents and nurses as they worked. Every member of the trauma team was handpicked by Jane, and when recruiting, she didn't go for the Ivy Leaguer types necessarily although she was Harvard-trained herself. What she looked for were the qualities of a good soldier, or, as she liked to call it, the No Shit, Sherlock mental set: smarts, stamina, and separation. Especially the separation. You had to be able to stay tight in a crisis if you were going to W-Z the chute.
But that didn't mean that compassion wasn't mission-critical in everything they did.
Generally, most trauma patients didn't need hand-holding or reassurance. They tended to be drugged up or shocked out because they were leaking blood like a sieve or had a body part in a freezer pack or had seventy-five percent of their dermis burned off. What the patients needed were crash carts with well-trained, levelheaded people on the business ends of the paddles.
Their families and loved ones, however, needed kindness and sympathy always, and reassurance when that was possible. Lives were destroyed or resurrected every day in the chute, and it wasn't just the folks on the gurneys who stopped breathing or started again. The waiting rooms were full of the others who were affected: husbands, wives, parents, children.
Jane knew what it was like to lose someone who was a part of you, and as she went about her clinical work she was very aware of the human side of all the medicine and the technology. She made sure her people were on the same page she was: To work in the chute, you had to be able to do both sides of the job, you needed the battlefield mentality and the bedside manner. As she told her staff, there was always time to hold someone's hand or listen to their worries or offer a shoulder to cry on, because in the blink of an eye you could be on the other side of that conversation. After all, tragedy didn't discriminate, so everyone was subject to the same whims of fate. No matter what your skin color was or how much money you had, whether you were g*y or straight, or an atheist or a true believer, from where she stood, everyone was equal. And loved by someone, somewhere.
A nurse came up to her. "Dr. Goldberg just called in sick."
"That flu?"
"Yes, but he got Dr. Harris to cover."
Bless Goldberg's heart. "Our man need anything?"
The nurse smiled. "He said his wife was thrilled to see him when she was actually awake. Sarah is cooking him chicken soup and in full fuss mode."
"Good. He needs some time off. Shame he won't enjoy it."
"Yeah. He mentioned she was going to make him watch all the date movies they've missed in the last six months on DVD."
Jane laughed. "That'll make him sicker. Oh, listen, I want to do grand rounds on the Robinson case. There was nothing else we could have done for him, but I think we need to go over the death anyway."
"I had a feeling you'd want to do that. I set it up for the day after you get home from your trip."
Jane gave the nurse's hand a little squeeze. "You are a star."
"Nah, I just know our boss, is all." The nurse smiled. "You never let them go without checking and rechecking in case something could have been done differently."
That was certainly right. Jane remembered every single patient who had died in the chute, whether she had been their admitting physician or not, and she had the deceased cataloged in her mind. At night, when she couldn't sleep, the names and faces would run through her head like an old fashioned microfiche until she thought she would go mad from the roll call.
It was the ultimate motivator, her list of the dead, and she was damned if this incoming gunshot was going on it.
Jane went over to a computer and called up the low-down on the patient. This was going to be a battle. They were looking at a stab wound as well as a bullet in his chest cavity, and given where he'd been found, she was willing to bet he was either a drug dealer doing business in the wrong territory or a big buyer who'd gotten the shaft. Either way, it was unlikely he had health insurance, not that it mattered. St. Francis accepted all patients, regardless of their ability to pay.
Three minutes later, the double doors swung open and the crisis came in at slingshot speed: that Mr. Michael Klosnik was strapped to a gurney, a giant Caucasian with a lot of tattoos, a set of leathers, and a goatee. The paramedic at his head was bagging him, while another one held the equipment down and pulled.
"Bay four," Jane told the EMTs. "Where are we?"
The guy bagging said, "Two large-bore IVs in with lactated ringers. BP is sixty over forty and falling. Heart rate is in the one-forties. Respiration is forty. Orally intubated. V-fibbed on the way over. Shocked him at two hundred joules. Sinus tachycardia in the one-forties."
In bay four, the medics stopped the gurney and braked it while the chute's staff coalesced. One nurse took a seat at a small table to record everything. Two others were on standby to bust out supplies at Jane's direction, and a fourth got ready to cut off the patient's leather pants. A pair of residents hovered to watch or help as needed.
"I got the wallet," the paramedic said, handing it over to the nurse with the scissors.
"Michael Klosnick, age thirty-seven," she read. "The picture on the ID is blurry, but... it could be him, assuming he dyed his hair black and grew the goatee after it was taken."
She handed the billfold over to the colleague who was taking notes and then started removing the leathers.
"I'll see if he's in the system," the other woman reported as she logged onto a computer. "Found him - wait, is this... Must be an error. No, address is right, year's wrong."
Jane cursed under her breath. "May be problems with the new electronic records system, so I don't want to rely on the information in there. Let's get a blood type and a chest X-ray right away."
While blood was drawn, Jane did a quick preliminary examination. The gunshot wound was a tidy little hole right next to some kind of scarification on his pectoral. A rivulet of blood was all that showed externally, giving little hint of whatever mess was inside. The knife wound was much the same. Not much surface drama. She hoped his intestines hadn't been nicked.
She glanced down the rest of his body, seeing a number of tattoos - Whoa. That was one hell of an old groin injury. "Let me see the X-ray, and I want an ultrasound of his heart - "
A scream ripped through the OR.
Jane's head snapped to the left. The nurse who'd been stripping the patient was down on the floor in full seizure with her arms and legs flapping against the tile. In her hand she had a black glove the patient had been wearing.
For a split second everyone froze.
"She just touched his hand and went down," someone said.
"Back in the game!" Jane clipped. "Estevez, you see to her. I want to know how she is immediately. Rest of you get tight. Now!"
Her commands snapped the staff into action. Everyone refocused as the nurse was carried over to the bay next door and Estevez, one of the residents, started to treat her.
The chest X-ray came out relatively fine, but for some reason the ultrasound of the heart was of poor quality. Both, however, revealed exactly what Jane expected: pericardial tamponade from a right ventricular gunshot wound: Blood had leaked into the pericardial sack and was compressing the heart, compromising its function and causing it to pump poorly.
"We need an ultrasound of his abdomen while I buy us some time with his heart." With the more pressing injury ascertained, Jane wanted more information on that knife wound. "And as soon as that's done, I want both machines checked. Some of these chest images have an echo."
As a resident went to work on the patient's belly with the ultrasound wand, Jane took a twenty-one-gauge spinal needle and plugged it into a fifty-cc syringe. After a nurse Betadined the man's chest, Jane pierced his skin and navigated the bone anatomy, breaching the pericardial sack and drawing out forty ccs of blood to ease the pericardial tamponade. Meanwhile, she gave out orders to prepare OR two upstairs and get the cardiac bypass team on the ready.
She gave the syringe to a nurse for disposal. "Let's see the abdominal."
The machine was definitely misbehaving, as the images were not as clear as she'd like. They did, however, show some good news, which was confirmed as she palpated the region. No major internal organs appeared to be affected.
"Okay, abdomen appears sound. Let's move him upstairs, stat."