"Dr. Trivoli," he started as she looked over at him. "We thought you might like to know that the forth victim was DOA." He unzipped one of the cargo pockets on his nomex flight suit, fishing out a Polaroid, he offered it to her.


Garrett accepted the picture for closer observation. Her keen azure eyes scanned the images; quickly noting the victim pinned behind the steering wheel. The classic signs of upper body and extremity engorgement and the distinct purple discoloration of the skin along with the animated fully thrusted tongue and bulging eyes screamed only one thing in her mind. "Hmmm," she nodded. "Looks like traumatic asphyxiation, wouldn’t you say?" Her eyes raised to his in question as she handed the Polaroid back to him.


"Yeah, I’ve read about it but never saw it before," his tone was sober. "Maybe, I hoped that I never would," his voice trailing off to a whisper.


The surgeon reached out and touched his shoulder; "None of us should ever have to." Her voice was reassuring, "Thank you for sharing that with me." She looked directly into his eyes saying, "If you need to talk about it…."


Closing his eyes, he simply nodded and slowly moved away from her, letting her hand slowly slide off of him. "Thanks, doc," he whispered.


"Dr. Trivoli, we’re ready to go," Danni informed her as the entourage of medical personnel slowly rounded the corner of the trauma room into the hallway escorting the gurney.


"Yeah, I’m with you." The tall woman pulled herself away from her thoughts that the Polaroid had brought to her mind and once again assumed her role as Trauma Fellow. "Let’s see what’s going on in that head." She turned and popped her head into the nearly vacant trauma room, "Karen, when Neuro..."


"When Neuorsurgery shows, I’ll send them into the scanner," the older nurse cut her off. "Now, go do your job, I’ll take care of mine," she said teasingly, and winked at the surgeon.


Letting a lopsided grin show, the raven-haired woman stated, "Mom, you’re the best." ‘I guess this bunch of nurses are quick learners. They seem to anticipate my thoughts before I can voice them.’ She was relieved that they had followed her way and not fought her demands. ‘I wonder if they know that they joined my team?’ She smirked at the thought of how McMurray would view this when he reviewed the tapes.


The painful screams that she heard coming from behind her made her think of Dr. Potter and the third trauma patient. She made a quick mental note to check on them as soon as she reviewed the head scan on her patient. Then using her long strides, she made off to the CT Scanner and her patient down the hall.


The air was thick with tension as the surgical team fought desperately to save the life of the woman lying on the table. The heat from the bright lights illuminating the field of operation and the anxiety of the surgeon was enough to bring a sheen of perspiration to his brow. He turned his head to the circulating nurse who hastily wiped his forehead free of the gathering sweat. His eyes never left his patient as his nimble fingers deftly worked to suture the jagged tear through the woman’s aorta. The flap of vessel was evidence to the traumatic nature of the head-on crash. It was a typical injury in an abrupt deceleration scenario. The effect on the large vessel filled with blood during the sudden impact was similar to that of a balloon filled with water. The continued kinetic energy in the forward motion had nowhere to go once the outside casing was halted, thus resulting in enough force to cause the walls to give way at their weakest points.


Kreger thought about what might be able to tip the scales into his patient’s favor. His mind trying to emulate that of his Trauma Fellow, Garrett Trivoli, he considered all of the tricks she had taught him that could possibly help in the circumstance that he now found himself. He did not want to fail his patient and let down the trust that was placed into his hands by the trauma fellow.


"Damn!" His voice was sharp; "This flap is so flimsy, it just continues to tear the more I try to repair it." He blinked several times in succession as though trying to clear his view. "It looks like the weakened area is extending up into the carotid artery as it branches off of the aorta."


What had started as only a small tear was now becoming more unmanageable as the seconds ticked on. He was losing precious time that would ultimately result in the demise of his patient.


Kerger bit at his lip nervously. His decision was being made for him and there was nothing he could do about it. Clearing his throat, he barked out, "Page Dr. Trivoli to the O.R., STAT!"


The small form lay silent on the cradle of the CT Scanner, the only sounds coming from the room were that of the rhythmic cycling of the mechanical ventilator that forced air into his lungs and the whirring of the circling X-ray tube within the gantry of the scanner itself. The saying that "a picture is worth a thousand words" came to mind as Danni watched the grim faces of the doctors. The CT Technologist shifted her position to reach for some paperwork allowing the petite nurse to maneuver herself to get a look at the images that were appearing on the monitor screen. The nurse had seen enough scans in her career that she knew something was definitely wrong. The image that she saw on the screen was nothing like what she was used to seeing. Her eyes traveled to her electronic monitoring devices as she jotted down their readings onto the patient flow sheet making sure to note the time. It was 2047.


Michelle Payo, the Neurosurgery resident on-call for the night had arrived and was watching the last few images come up on the screen. She was of medium height and her pregnancy was obvious, compared with her rather small body frame, her white lab coat hanging open around the protruding form. Shaking her short brown hair, she let out a deep sigh. "May I see," she asked as she pointed to the screen.


"Sure, doc," the CT Technologist began cueing up the first image and slowly ran through them all.


"Well, what do you think, Michelle?" The surgeon was sure that the answer would not be good.


Looking up from the screen and out to the patient, the Neurosurgeon asked, "Did you give him any paralytics?"


"No, he hasn’t had any."


"How about the initial neuro exam, any stimulus?"


"No, nothing, not even decorticate posturing." The surgeon’s voice reflected the severity of the young man’s injuries.


Pursing her lips as she gently patted her pregnant belly, the small woman sighed deeply. "I don’t know of anything that we could do. It already appears that he has sustained an anoxic injury to the brain." She shifted her weight to the other foot, "With the extent of the skull fractures, I’d have to say that the only thing to do now is see if the next of kin will consent for him to be a donor." The young woman looked up to the tall trauma fellow; "There is really no hope for this kind of injury. The respirator will keep his body alive, but the brain will have no function whatsoever. I’d be pretty certain to say that he is brain dead."


Garrett looked away. Her face took on a disgusted scowl as she sucked in on her lips. Letting out a soft snorting sound, she shook her head. "Scan his chest and abdomen. Let’s see if there is anything going on with the vital organs."


The petite blonde nurse wrinkled her nose giving her a questioning look.


"Have the social worker find out if there is any family and contact C.O.R.E." The surgeon was disappointed, "There is nothing more we can do for him, Danni," she offered, "but maybe we can help someone else."


The nurse blinked her eyes to catch the small tear that was forming, "Alright, I’ll let the social worker know. I think that I saw Alex earlier tonight." She turned to the right and reached for the wall phone.


"Dr. Trivoli, Please report to O.R. #1 STAT!" The loud speaker blared, paused, and repeated again.


Garrett’s attention was grabbed as though someone had reached out and vigorously shook her without any warning. Almost immediately her pocket came to life with the sound of the pager beeping. She looked down and studied the number that was imprinted across the display screen. She looked over to Danni, "It’s the O.R., call them and tell them I’m on my way." The tall athletic body of the surgeon was being propelled though the doorway by her long powerful legs as she spoke. She quickly made her way to the stairwell and taking the steps two at a time, she pushed herself up the two flights of stairs. The metal door at the landing slammed open as she launched herself down the hall in the direction of the O.R. entrance. Nearing the doorway she peeled off her trauma gown as she sidestepped her way past an X-ray Tech with a slow moving portable machine. Yanking the right side half of the double doors, she entered into the main desk area. She slowed only long enough to grab a blue hair bonnet and shoe covers, while dropping the lead apron to the floor. Snapping the bonnet down over her shoulder length hair with one hand, she leaned on the desk for balance. "What’s going on?" Her words were punctuated by heavy breathing. She leaned over and slid her foot inside of the covers. The older woman at the desk looked up only to see the back of the surgeon as she vaulted down the hall.


Through the window in the door, she could see the scurry of activity in the operating suite. Hastily she picked up a facemask and placing it on her face, pinched the small metal piece over the bridge of her nose. Pushing open the doors, she entered the surgical arena. The circulating nurse was holding a gown that Garrett thrust her arms through, and spun around so as to have the gown tied shut. The surgeon reached for the pair of sterile gloves that had been laid out for her use as the nurse swiftly tied the loose ends of the facemask to secure it in place.