“Righto, there’s hemopericardium,” said Vegas, all her previous lassitude gone, “let’s open those IV’s up!”
“They’re at two twenty,” said Jack, words dropping harsh between the metallic rattle of the IV stands. He swore under his breath and reached up to squeeze both sides of the IV bag with his hands, forcing the liquid down.
Ethan grabbed for the ultrasound screen, hip knocking against the bed-rails. He tried to draw in breath, hoping to still his hands, but the echo of that pain was pressing harshly between his heart and breastbone. Get with it, thought Ethan furiously, this is what you’re here for.
“Pulses are gone,” said Lasya, voice very high.
“Ethan, how much?” snapped Vegas, elbowing her way around to his side of the bed, “how much?”
Ethan blinked hard, hands slipping on the touchscreen as he measured, “enough, definitely enough.”
“Pulses are gone —”
“Let’s start compressions and a milligram of epi!” said Vegas, voice clipped and clear, “we’ll have to do a thoracotomy – kit please, someone! Ethan?”
“Other views are clear,” he said, “she’s a firestarter so I don’t want to move her, not without physical dampeners…”
“Cross that bridge when we come to it,” Vegas finished for him, squeezing past Lasya doing the chest compressions so she could pour iodine across the patient’s chest. The empty bottle went on the ground.
“She might interfere with the machinery if we don’t get physical dampeners—” Jack interrupted.
“The heart’s going to kill her before that happens,” said Ethan, “and I can’t work with dampeners on. We’re gonna have to risk it.”
“I’ll lead re-suss and get the chest tube,” said Vegas, “Ethan, slow the hemorrhage. Thoracotomy.”
“Got it,” said Ethan, taking his scalpel.
Vegas made a chest tube incision along the patient’s fifth rib. Just as Ethan pressed the blade tip to skin, hands grabbed him by both sides of his face. It was Alice, unceremoniously wedging a visor over his mask.
“Oh,” said Ethan, sheepish, “thanks.”
He took a breath and braced himself, placing one hand slowly on the patient’s chest. The familiar filtered-sensation of hemorrhage seemed to flick at the nerve endings in his fingers, and Ethan felt his own muscles jump in response. He allowed himself another breath, and then another – until his hands were steady and his throat was calm.
He made the first cut.
Blood immediately spurted scarlet on his visor, right across the eyes, and Ethan spared a moment to thank the world for nurses. Gritting his teeth, he continued, the silver disappearing hand-deep into flesh and hitting rib.
“Rib spreaders: where are they?”
It was difficult to concentrate; and he almost wished he had gloves on. The more injuries there were, the harder it was to prioritise: the body knew how to heal, it wanted to heal, and every oozing hemorrhage frayed at the ends of his thoughts like a thousand hands pulling at thread. Arteries, thought Ethan, closing his eyes…there was no time to examine — from the rib fragments and bullet shrapnel — intercostal and mammary — the arteries, he could almost hear the sound of his own blood, slick-wet inside their veins.
The haptic sensor in his vitals’ monitor gave a warning jolt to his temple, designed to snap him out of a transfer.
Ethan gritted his teeth and ignored it.
“Chest-tube’s in,” came Vegas’ voice, from very far away, “another mill of Epi.”
His left hand was pressing hard enough into the patient’s skin that it was leaving bruises as fast as it was healing them. His right was knuckle deep, the pad of his index finger slipping on bone. But the damaged lung was stubborn, and Ethan knew the sickly dizziness that was curling behind his eyes.
“Hilum,” he bit out, “I need a clamp.”
He breathed out hard through his nose, risking a glance up. Everyone was staring at him.
“Someone clamp this, please: if I keep going, I’ll have nothing left for the heart.”
Instantly, a clamp was in his hand.
“We’re at pericardium,” he announced, eyes on his knuckles, buried between the patient’s ribs.
He flicked deftly upwards, knuckle first, not bothering to activate his visor. Ethan could feel, as if touching a photo negative, the split in the pericardial sac around the heart. It was like water bursting through a balloon. Everyone held their breath; the weight of their collective hopes as heavy as their gaze. In his periphery, Vegas was slowly feeding the last of the chest tube between the patient’s ribs.
Ethan gave it another moment. Then he shook his head.
“Cardiac activity’s shit,” he said, “just fibrillating. I’m taking over compressions.”
Vegas was already moving.
“Alice, did you call trauma surgery already?”
“Yes, it’s Mr Lim.”
“I’m just happy she hasn’t burned me to a crisp,” said Jack from the head of the bed.
“Quickly,” said Ethan, “It’s going to hurt so I’m.. I’m going to cross over her. C-can’t slip.”
He moved to swing his right leg onto the bed.
“Wait!” said Vegas, suddenly very close. Her eyes flashed under the white fluorescence, and she grabbed Ethan by the chin, heedless of her bloody hand. She tilted his head to look at his monitor.
“You…no! The fuck, Ethan? Get off, you’re Red, I can do this —”
Ethan shook her off and climbed onto the bed, straddling their patient’s knees and bracing himself with one hand. The woman’s face was almost entirely obscured by the blood in her tube. Her hair was a pool of white on the blue plastic, and there was no colour in her cheeks.
She looked like the cadaver she was going to be if Ethan wasn’t fast enough.
“Go brief Lim,” said Ethan, locking his knees and closing his hand around the patient’s heart.
It filled his palm, and weighed only as a life could: heavy and still. Ethan was holding his breath – it was one of the only physical triggers he had for staving off the pull of secondary healing. And it wasn’t going to last for much longer.
“Fine,” said Vegas, mouth tight, and then she was gone from the room.
Ethan squeezed his hand around the heart, gently, gently, consciously dragging a familiar melody to the front of his mind. Seventy beats per minute. Steady does it. Steady does it. One. Two. Three. Four.
On the second bar, Ethan breathed in, and the room disappeared from his periphery. His back bowed to an arch: the clamp that was still valiantly doing its job, a heart that wasn’t beating. He squeezed, trying to synch his own heartbeat to the one in his hand. It was trying to shrivel up, seizing in its bath of adrenaline.
Ethan felt half blind, soaked in the feedback loop and the numbness of his hand.
Steady does it, steady —
Localised healing was hard enough without bullet shrapnel still embedded in the organs, the ribs, the skin…there was a large bump at the back of her head, deep scrapes across her left cheekbone and the side of her jaw, dirty with gravel. No similar scrapes on her hands – she didn’t break her fall.
He kept squeezing, mouth open in laboured gasps behind his visor and mask. Twenty, twenty-one, twenty-two…
Ethan’s own heart lurched like a bubble of air trying to pop, beating a staccato in rebellion of his exhaustion. He wasn’t aware of the people moving around the bed, but he heard the thud of double doors; voices either side of him; the faint tremor of the bed as it was wheeled out of the ER.
“Systolic at 50!” someone called.
Good, he thought, distracted — and in that moment Ethan felt the thoracotomy incision trying to heal close around his wrist; the viscous pull of the gunshot wound starting to close over.
No, too soon…it’s too soon.
Ethan choked on a breath, eyes focusing too close on the blood splatters on his visor; wrenching his lucidity taut. Fifty, fifty-one —
Then suddenly the lights shifted and they were through another set of doors; a nurse he didn’t know was bearing a scalpel.
“Hhngh,” said Ethan wetly, still squeezing the heart even as the scalpel sliced through newly healed flesh.
One of the surgery registrars steadied him by the shoulder, and somewhere between sixty-two and sixty-three, Ethan extricated his hand so that the other doctor could replace him.
“Sixty-four,” said Ethan, “sixty-five —”
“Careful,” said a nurse, and Ethan let himself be helped off the bed, realising he had been reciting out loud.
Immediately the patient was slid from the ER bed to the surgical table and promptly disappeared behind surgical sheets and blue-gloved hands. Ethan’s own hand was dripping red, and he caught Lim wincing at the bare skin. Ethan rotated his wrist, trying to loosen the tension by curling and uncurling his fingers. They did not seem his own.
“Doctor Faulkner,” said a nurse, “I have your gown and gloves. You’re a size eight?”
“Yeah,” he breathed, yanking his face-shield off.
Ethan wiped sweat from his hairline with the heel of his hand before remembering too late that he was covered in blood.
“…two seconds,” said Ethan.
He stumbled away from the table, crossing the room to scrub in at the huge sink just outside. He moved to his internal metronome: glasses, visor, skull cap. A new mask, scalding water, a sandpaper sponge between his fingers and under his nails, scrubbing all the way up to his elbows. He was wordlessly helped into a gown.
The lead trauma surgeon — a man with greying hair and ageless hands — turned to Ethan. It had been a while since they had worked together. Lim’s eyes were narrowed with concern as they took their places either side of the patient; two partners sizing up for a dance.
“Didn’t I see you in here earlier?”
“You’re red. How long?”
“Barely a minute,” said Ethan, “we ran here. Elevated heart rate threw off my VM. I’ll be fine.”
Lim raised his eyebrows. His accent was barely there; a smudge on a newly cleaned visor. His hesitation, however, was crystal.
“If I don’t take care of her lung, she’s going to suffer that for the rest of her life,” said Ethan.
“Just don’t faint in my OR,” said Lim.
Being fast tracked through the conventional medical education did strange things to one’s status and hierarchy within the hospital.
Five years in the system as a healer, and Ethan was being paid as a consultant where his fellow graduates were still junior registrars. From the beginning, he had had the luxury of more theatre hours than his peers, first pick of specialties and his choice of rotations…it wasn’t exactly a formula for making friends. But all those theatre hours — coupled with being one of only three healers in a nine hundred bed hospital — made for good stamina.
Judging by the cold sweat on the back of his neck and the woozy feeling between his eyes, however, Ethan knew he was rapidly approaching the end of his.
“How’s the apical lobe feeling, Doctor Faulkner?”
“Almost fully regenerated” said Ethan, and winced at the dry thread of his own voice.
He cleared his throat.
“I won’t be able to handle the ribs.”
There was a soft click of metal against plastic.
“No need, you can be on stand-by until we resettle the heart. It’ll be good if you can give it a boost though.”
“Emily, pass me the scanner and show me the imaging,” said Lim to his junior, “is this the last of it?”
“I think so. Here.”
The junior registrar expanded the holographic scan across the operating site. It pooled around Ethan’s wrists, latticed water around stone. Everything looked a little greyed out, the scanner this close to his hand felt like a burst of static on his nerve-endings. It was getting harder and harder to ignore the screaming, persistent pull from fragmented ribs and the midline sternotomy: a phantom ache that made Ethan take shallow, rapid breaths. He was having trouble breathing from his abdomen, and Ethan knew himself well enough to know he had mere minutes before he was going to lose his grasp on lucidity. It wasn’t pain, exactly, but that often how the brain interpreted it.
Ethan watched, pleased despite his exhaustion, as they proceeded to re-inflate the lung. He kept the pad of his thumb pressed against it, checking for remaining thoracic haemorrhage. Nothing – no doubt healed by virtue of prolonged contact and his thread-bare concentration.
“Okay, taking off the cross-clamp,” said Lim, “Ethan?”
“Your VM is at a red six,” said the nurse.
“Can’t feel if…clamp is in the way,” said Ethan, “just take it off.”
The rush of blood, when it came, dragged a high noise from the back of Ethan’s throat and into his mouth. His power flared in response to the trigger, instinctive, and was helpless in the face of the open incision sites. It tore loose from the lungs and overwhelmed with the other injuries, the still sluggish head wound, the broken skin… And it would have been fine if Ethan hadn’t come straight from a three hour operation followed by a thoracotomy.
He felt like he was going to throw up, and Ethan gagged violently. His hands were locked at the elbows.
Lim’s gaze shot up in alarm.
“Get his hands off right now — no, Em, stay where you are!”
The room darkened, like someone had applied a film to it. Ethan felt gravity list to one side… and suddenly he was staring up at the surgical lights from the floor.
Ethan didn’t remember falling.
He lay there for a moment, stunned; aware of the painful bump at the back of his head that was already rapidly swelling. The floor was freezing compared to the heat of the lights, and the abrupt change almost made his eyes roll back in their sockets. His hands were shaking.
A shadow fell across his face. Then someone was palming his cheek, shining a white pin-light in his eyes, calling his name.
“Pulse?” Lim was saying from where he remained opposite Emily across the surgical table, “check his pulse, is he breathing?”
“I’m okay,” said Ethan, words slurring, “I’m okay, I’m okay —”
“Good god. Get him out of my OR,” Lim said, voice tense, “make sure he’s not going to crash, get him out of here right now. Em, let’s prep. I don’t want to keep her on bypass any longer.”
The room spun as Ethan struggled to his feet. The nurse held him steady by the arms and shoulder, and as soon as he was upright, Ethan regretted it. Don’t throw up, he thought wildly, don’t throw up.
“The heart —”
“You’re no good to me like this,” said the surgeon, “Jesus Christ Faulkner, I’m not having a healer die mid-op, do you want my head on a spike? Get out!”
It was like being slapped in the face. Ethan swallowed hard.
“Come on,” said the nurse, and none-too-gently shoved Ethan towards the doors. He slipped, limbs numb, and she just carried him through the stride with that supernatural strength all nurses seemed to conjure at need, “that’s it, keep your eyes open okay? Eyes open.”
“I’m fine, I —”
The nurse sat him down in the nearest chair, fingers at his throat. She was checking over his monitor, lips thin.
“You’re not going back in there,” she said, “I don’t care if I have to tie you to a wheelchair and put you in a taxi home, but I’ll do it. You hear? Now follow my finger, please.”
“I just lost control for a second,” said Ethan, aggrieved, “I was…i-it’s been a long day.”
“No concussion, good,” said the nurse, as if he hadn’t spoken. She tutted, putting the penlight back in her pocket.
“I’m amazed Mr Lim let you assist. There’s a traffic light system for a reason. God, forget the patient’s heart, I almost went into cardiac arrest when you collapsed like that. Just. Down you went. Poor Emily, I think you gave her the worst shock of all.”
Ethan stared at his red hands, nails filed down to the quick. It was still just enough to trap a thin crescent of congealing blood and failure.
His heart was still thumping, irregular and nauseous, low in his chest.
Ethan got up slowly, made his way to the sink to wash off the blood. He could see Lim and Emily’s silhouette through the glass panel. They were resetting the ribs – which must mean the heart had restarted with no more complications. Ethan squeezed his eyes shut for a moment, letting the scalding water run a little longer than was proper. Then the timer cut it off.
The nurse had taken his glasses, but he was suddenly grateful for the mask. He reached for a clean towel, just as someone’s footsteps rounded the corner. They both looked up.
“Holly, the patient’s brother has been demanding an update, he’s really being — oh, Doctor Faulkner! Is it over?”
“No, I stepped out,” said Ethan before the trauma nurse — Holly — could say anything, “I believe Mr Lim and Emily are finishing up soon.”
“Can you go brief ICU? One of the Aptee wards is free, I already checked,” said Holly, handing the other nurse a tablet, “I need to stay and make sure Mr Lim doesn’t need anything last minute.”
“Sure. Doctor Faulkner, would you mind speaking to the brother? He’s very…upset.”
“This one needs to go home,” said Holly.
“I’ll talk to him,” said Ethan, rubbing his eyes, “you’re both busy. I’ll bring him to ICU.”
The nurses exchanged a look. With a sigh, Ethan wiped his hands on his scrubs and left them for the OR waiting room at the end of the long corridor.
At one thirty in the morning, the waiting room was relatively calm. The chairs were occupied by stressed and miserable faces, some resigned, others actively upset; all were tired. Ethan scanned the room quickly, and came to land on a man who was standing off near the vending machine, arguing with Caroline. From the back, all Ethan could see was sharp, broad shoulders and a head of white-blond hair.
The nurse’s eyes widened with relief when she spotted Ethan walking over. As he neared, Ethan could hear a strident baritone, hushed in deference to the others in the waiting room.
“— said it before, but this is absolutely ridiculous! Do you know who I am? What’s going on? It’s been hours, I want to know who her consultant is!”
Oh, thought Ethan, his well-oiled cynicism kicking in by default, you’re one of those relatives.
The man wore a heavy wool coat over expensive but haphazard clothes, as if they had been put on in a hurry: a bright silk shirt, dark slacks, and what appeared to be actual leather shoes. No one wore leather outside these days, unless you were both very rich and very careless.
“Sir,” said Caroline, “here’s Doctor Faulkner, who can tell you more…”
Ethan took off his surgical mask unhurriedly, followed by the cap. He came to a stop next to the two.
“— because I am transferring her out of this absolute dump so she can get —”
Ethan took off his visor and glasses next, and folding them with exaggerated care before tucking them into his top pocket.
“— some actual competent medical…care…”
When he looked back up, Trustfund was staring at him with a comical, deer in the headlights gaze. He had trailed off completely.
“Yes?” said Ethan, raising his own eyebrows.
His brain had clearly given up on all higher functions at this point, because Ethan’s immediate thought was: huh, nice cheekbones.
But then he thought of the woman lying on the ER bed, of warm blood as he tried to keep her heart beating in the palm of his hand. It had been almost a full minute. It would be a good few hours before his hand would feel empty again. He replayed the words competent medical care in his head.
Ethan didn’t bother smiling.
“I… uh,” the man cleared his throat, “um.”
He was clutching at his left wrist with his right hand, still wearing the expression of someone who had been struck unexpectedly in the face. His eyes were red rimmed and bloodshot, face flushed from crying. Ethan felt his irritation waver. He blamed the post-operation crash for his sudden onslaught of empathy. That and the general floaty state he entered whenever he had been working over-hours.
“You were saying something about my incompetence?” Ethan prompted, “thanks Caroline, I can take it from here.”
© Frances Wren 2019, all rights reserved.