TITLE: Invisible (pt. 5)
AUTHOR: Naomi Pardue
GENRE: LKo/Jane
RATING: PG13
TIMELINE: Mid-s11
DISCLAIMERS: They own it, I don't.
Dr Kovac breezed into the room. "Ready to present, Jane?"
Jane nodded. "Richard Mullins, age 34; restrained driver in a single
vehicle MVA. Alert and oriented. Vitals all normal; pulse 78, bp 134
over 80, resps 12, satting at 99. C-spine is clear, denies pain in
abdomen, chest and neck. Chest is clear,abdomen soft and nontender.
Only apparent injury is a 4 centimeter forehead lac. Neuro check is
normal and pupils are equal, round and reactive. But the paramedics
said that he vomited in the rig."
Luka smiled. "Excellent. What are your recommendations?"
"The nausea might indicate head trauma, so I think a CT would be
wise. If that's clear, we can just suture the lac. I already called
up to CT. They can take him whenever we're ready."
"Sounds good," Luka said. Jane knew he was complimenting not only
the diagnosis, but that she'd trusted her own judgment enough to do
what was necessary and call radiology without waiting to clear it with
him first.
"I can take him up now."
"No, there's another patient I want to show you. Sam, can you take
Mr. Mullins up to radiology?"
Sam looked up from her work cleaning some small abrasions on Mr.
Mullins' hands. "It's what I live for, Dr. Kovac." She stripped
off her gloves and shot Jane a look. And Jane gazed back at her
steadily ... defiantly. Whatever the problems were between Sam and
Luka, they had clearly begun long before she had entered the picture,
and it wasn't like she had done anything wrong.
After a long moment, Sam looked away. "Come on, Mr. Mullins. Let's
get you upstairs."
When Sam and Mr. Mullins had left, Jane took off her own gloves.
"Who's the patient?"
"She's in trauma 1. She's Dr. Lewis's patient, but I thought
you'd like to see her as well. Another MVA, possible cord trauma."
"Another MVA?" Jane had to chuckle, though it really wasn't
funny. "That's what ... the fifth one so far today? You'd think
Chicagoans would know how to drive in the snow. It's not like they
never get any."
Luka shrugged. "Summer is worse. When it's hot out we get 5 GSWs in
a typical morning, and the odd drowning or two. I prefer winter."
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Jane and Luka watched silently as the trauma surgeon took the patient
up to the OR.
"Do you think they'll be able to help her?" Jane asked.
"I don't know," Luka said quietly. "Dr. Omari is a good
neurosurgeon, one of the best in the city, but there's only so much
we can do for this kind of injury."
Jane could still hear, in her memory, the woman's sobs. She was so
young and pretty ... her whole life ahead of her. "I don't want to
be paralyzed ... why can't I move my legs?"
"How long does it take before you get used to it?"Jane asked after
a minute.
"Get used to what?"
Jane shook her head. "I think I'm going to love being a doctor ...
being able to help people in trouble. But all the patients we can't
help. How long is it before I get used to those ones? When do you stop
hating that ... helpless feeling?"
"You don't. If you're a good doctor, and you are going to be a
good one, you never get used to it. If you do, it means you've
stopped caring, and you never want to stop caring. But remember, Jane,
there is always something you can do. You're never really helpless.
The trick is, sometimes, to find that 'something.' Sometimes it's
just a matter of comforting a frightened patient, or breaking bad news
to the family member in the best way you can. And sometimes that has to
be enough."
Jerry called to them from the desk. "Jane, CT called. Mr. Mullins'
scan was clear. Sam will be bringing him back down in a minute."
"That's good." Jane sighed. At least he was a patient she could
really help. A few sutures, a taxi voucher, and he'd be on his way,
almost as good as new.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Mr. Mullins had been discharged, and Jane was struggling her way
through a long string of dull, minor cases. Every day up until now Luka
had managed to keep her occupied with interesting and exciting
patients. Every hour had brought a new skill to master, a new diagnosis
to observe. But suddenly it had all dried up. The best he could offer
her were sore throats and chicken pox, sprained ankles and minor
lacerations. Of course the attendings were just as bored as she was,
and she tried to keep in mind Luka's words the first day he'd
supervised her. 'All your patients are important, Jane. They are here
because they need our help. However, uninteresting their problems may
appear to you, they are very important to the patients, and every
patient deserves the best care you can provide.'
Jane went to the desk to find Luka and have him sign off on her last
chart. He took it from her and glanced over it. "Looks good," he
said, and graced her with another of his smiles.
Haleh turned quickly from the radio. "Dr. Kovac, six car pile-up on
the Kennedy. How many can we take?"
"Three majors, 10 minors," Luka said promptly, then added, under
his breath to Jane, "Which means they'll send us six majors and 20
minors." Then, more loudly, "What's the ETA?"
"About 3 minutes until the first rigs arrive."
Jane felt a thrill of excitement. There hadn't been a big
multi-victim trauma in all the time she'd been working in the ER.
This was what emergency medicine was supposed to be, not chicken pox
and the flu. She glanced up at Luka, but he looked grim; grim but in
control. "Let's get ready, people. Sam, Chuny, make sure both
trauma rooms are ready. Haleh, Dr. Pratt, move or dispo everyone
who's in the exam rooms. Jerry, page Dr. Lewis, I think she's at
lunch.
Everyone scurried off to do as they were told. "What about me, Dr.
Kovac?" asked Jane.
"You're with me for now."
Already they could hear the first sirens pulling into the ambulance bay
and, a minute later, the doors flew open. A young boy on a gurney, his
face hidden behind an oxygen mask; a woman, her face covered with
blood, walking beside him. "Help him ... please!" she sobbed.
"Anthony Whaley," the paramedic said, "Eight years old.
Unrestrained rear-seat passenger. Head vs. windshield. Unresponsive,
GCS 4. Sarah Whaley, 30 years old, restrained driver, denies injury,
refused treatment on scene. Dad's in the next rig."
"Ok, Trauma 1," Luka said briskly. "Morris, take Mrs. Whaley to
sutures, check her over. Pratt, wait for the next rig." And, to the
paramedic. "How many more?"
"There were eight ambulances at the scene. This kid was about the
worst, but some others are pretty bad." His voice dropped. "A snow
day from school and parents think it's the perfect day to take their
kids out for a drive on the highway ...."
Mrs. Whaley looked back over her shoulder as Morris was trying to guide
her firmly to sutures. "Please... let me stay with him!"
"Dr. Kovac needs to be able to work," Morris said, "and I need to
check you for injuries. As soon as you're both stable, I'll bring
you in to see him."
The next half hour was a whirl of activity. Luka flew from room to room
as more and more ambulances arrived, and Luka's guess was proved
right. Dozens of patients, and only a handful could be considered
'minors.' Jane followed eagerly, but if she'd hoped to gain new
skills, she was disappointed. Luka had her start IVs, draw labs, and do
other simple things she'd already done a thousand times. Of course,
with so many victims to care for, there just wasn't time for more. He
couldn't take the time to teach, to let her try new things, or even
to explain.
Exam 4. Jane followed Luka into the room. Another young victim.
Jane's heart sank a little. Not only did she find it hard to see kids
in pain, she just wasn't very good with them. Maybe because she'd
never really had a childhood herself, she found it hard to talk to
kids, hard to relate to them.
Haleh was there. "Meet Summer Clearlake," she said. "Six years
old. "Vitals are stable."
Summer was crying. "Where's Mommy?"
"Dad's in the OR," Haleh said softly. "Mom's been called, but
she's driving in from Elgin. It may be a while."
"Mommy will be here soon," Luka said gently to Summer. "I'm Dr.
Kovac and this is Jane. Can you tell me where it hurts?"
"It just hurts a little ... here ..." Summer pointed to her side.
"I'm going to lift up your shirt and take a look," Luka said. He
lifted the shirt and Jane saw some bruising along her ribs. "Were you
in a booster seat, sweetie?"
"No, but I always wear my seatbelt."
"Good for you. You're a really smart girl to do that." He
listened briefly to Summer's chest. "Chest is clear, good breath
sounds bilaterally," he told Jane. "Could be a rib fracture from
the shoulder harness." Then, to Summer, "Does your tummy hurt?"
"No ... but I got blood all over my new coat, and my shirt. Mommy's
gunna be mad. I just gotthe shirtfor Christmas."
"It's a very pretty shirt," Luka said. "I like Bob the Builder
too. I'm sure Mommy won't be mad. She'll just be glad that
you're ok."
Jane felt a little jealous, listening to him. He was so good at putting
little kids at ease. She hadn't even noticed the shirt, just the
blood from several cuts on Summer's face and hands.
Just then the door opened and Sam poked her head in. "Dr. Kovac, the
lady in Trauma two is crashing."
"Where's Susan?"
"With an unstable patient in radiology."
Luka hesitated for just a moment. "I'll be right there." Jane
started to remove her gloves, but he went on. "Jane, you stay here
with Summer. Call radiology to see about getting an x-ray for her ribs,
and you can start cleaning and suturing the lacs." A quick,
encouraging smile; the first she'd had from him since the first
victim had rolled in, and Luka followed Sam out the door.
The room suddenly seemed very quiet. Summer was still crying a little
bit. Jane knew she should be proud and pleased that Luka trusted her
enough to leave her alone with a trauma patient, even one with such
minor injuries. But she wasn't good with kids. When the parent was in
the room she managed ok, but what to say to this child?
"Don't worry about a thing, Summer," Jane finally said. "My
name is Jane, and I'm going to take good care of you."
"I want to see Daddy."
"Other doctors are taking care of your daddy. You'll be able to see
him as soon as you're both feeling a little better."
Jane quickly called radiology, and was told that it would be a while
before they could take Summer. There were other patients far worse off.
She started to gather her suturing supplies together. "It's really
good that you were wearing your seatbelt, Summer," she told her.
"It helped keep you safe."
"Daddy always makes me wear it. He says the car won't go unless I
buckle up." She giggled a little. "I know he's just kidding
though." Then the giggles stopped. "He wasn't wearing his ... he
was hurt so bad ... I could tell. The ambulance people looked so
worried ... they were doing all kinds of stuff to him. I kept asking
them what they were doing, but they wouldn't tell me."
"I'm sure he'll be just fine," Jane said gently. "There are a
lot of really good doctors here."
"Are you a really good doctor?"
"Of course I am." Jane smiled at her. "Now, this is going to
sting just a little. You can yell if you want to."
Jane started to inject the lidocaine, and Summer yelled out "Ouch!"
and then giggled again.
"All done," Jane said. "That will keep it from hurting when I sew
up your cut. She started to daub at the more minor cuts with
disinfectant and Summer's giggles turned again to whimpers. "Does
that hurt?"
"Feel funny ..."
"Funny how?" Jane dropped the gauze. Summer looked very pale
suddenly. She wasn't hooked up to a monitor, not even a pulse ox.
There was a hep-lock, but no IV. The child had been fine a moment
before. A reaction to the lidocaine? Rare, Jane knew, but not unheard
of. Jane quickly pulled out her stethoscope to listen to Summer's
chest. "Take a big breath for me, Summer."
"Can't ..." Of course, if her ribs were fractured it would hard
to take a deep breath. But her heartbeat was much too rapid now.
Something was going wrong, but what? There were no breath sounds on the
left. Luka had said her chest was clear? Had he missed it? Or had
something changed? Summer looked scared now; it was clearly getting
harder to breathe.
"I need to find a nurse. I'll be right back," Jane said.
"Scared ..." Summer gasped.
"I know, sweetie. I won't go anywhere, just to the door." Jane
managed a reassuring smile through her own worry, and ran to the exam
room door. Sam was just passing by, her arms loaded with supplies.
"Sam!" Jane called, opening the door. "I need help."
"I'm busy, Jane," Sam snapped. "Your patient isn't the only
one."
"Please ... get Luka. Tell him I need him."
Again, the cold, hard, stare. "Deal with it, Jane!" And Sam
vanished around the corner, leaving Jane to stare in disbelief. The
bitch ...
She'd have to go herself. Luka would come once she told him the
problem. But she couldn't leave Summer. She'd promised she
wouldn't leave her alone. The child was barely whimpering now, barely
breathing. She had to do something now!
Deal with it. She could deal with it. Summer obviously needed a chest
tube. She had put in chest tubes before. Well... once anyway. It
wasn't that hard. Again, the thrill of excitement washed away her
fear. She could make a difference for her patient. She could save her.
It was what Luka would expect her to do, she was sure. He'd be so
proud, she could shine. She could use the skills he'd taught her;
display her newfound confidence and initiative. After all, in the time
would take to run down the hall and get help, she could do it herself.
Jane ran back to Summer's side. First she needed oxygen. She should
have taken care of that first thing. It took just a moment to get the
O2 running, and the pulse ox attached. Only 83 percent. Then the chest
tube tray.
"Ok, Summer. I'm going to help you now. Everything's going to be
ok."
Fresh gloves. Local anesthetic. Ok. Now the scalpel. Cut just above the
rib. A faint moan from Summer, there hadn't been time for the
anesthetic to work, but there was no time to wait either. Now guide the
tube in ... it wouldn't go in ... why wouldn't it pass? Jane pushed
her fingers into the tract, widened it a little. Another gentle push.
Still nothing. "Damn it ...." What was wrong? Another push, just a
little harder. And the tube slipped in. Jane started to breathe a sigh
of relief, then gasped as blood suddenly gushed out of the tube. A
hemothorax, of course. That would make blood come out the tube. But
there was more blood, and still more. It wasn't stopping. And Summer
.... she was suddenly too still. The numbers of the pulse ox were still
dropping. Jane checked her pulse. God ... why couldn't she find a
pulse! The stethoscope. Listen for a heartbeat, for breath sounds. Only
silence. Oh God ... only silence.
Jane ran to the door and opened it. "Please!" she screamed, hoping
someone would hear her. "I need help! Someone help me, please!"
Then back to her patient to begin CPR, all too aware that more blood
was gushing from from the tube with every compression.
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