"Ah, Dr. Trivoli. I see that you made it a little earlier than I planned."
The surgeon swallowed the bile that was gathering in the back of her throat. "Yes, it seems that I’m a little earlier than planned for all around today." Garrett thought of the earlier surprise that made her aware of Danni’s condition. "I hope I’m not too early for you now."
"No, in fact, now is a good time. I just finished a case and I can show you around."
Garrett reached for her duffel bag and shouldered it. "Lead on," she said dryly and waited to follow him.
"First, let’s get you settled in." He motioned for her to follow and after a few quick turns down the hallway, they stood in front of a door. Producing a key, he opened the door and ushered her into the room. "This is my call room. I’ll let you put your things in here and this will be where you’ll sleep when you need to. I’ll use my office for the nights that I’m on call." He held out the key for her to take.
"Thanks," she took the key and then eyed the mattress as she laid her bag down on it. ‘I wonder if this was where…NO, I don’t want to go there now.’ "I won’t be spending much time in here, but thanks. Now, can you show me to the Emergency Department? That’s what you want me to cover, right?"
"Yeah," David noticed the changed expression in her eyes when she looked at the bed, "I’ll show you the way right now." He motioned for her to go through the doorway ahead of him. As she did, the man looked back at the single, made up bed and wondered just what Danni saw in this woman. She just seemed so cold and aloof to have someone like the blonde nurse be interested in her. He exited the room and closed the door behind him, hearing the click of the lock as it set in place.
"I’ll need to see the E.R., the O.R., and the Recovery Room." Her voice was all business as she followed him down the hall. "Maybe the Cafeteria, too." She added with the thought of Danni running through her head.
"I can do that." David chuckled. "I didn’t think that you were a big eater like Danni." He watched the expression on her face soften at the mention of the woman’s name. Yes, she had a soft spot for the nurse somewhere in that stoic heart.
"I’m not. I’m just used to asking, for her sake." She raised an eyebrow in challenge.
David smiled and nodded his head. "She grows on you after a while, doesn’t she?"
‘And I’m sure that you’re going to get first hand evidence of that in just a very short time.’ Garrett bit at her lip not wanting her thoughts to slip out. After all, it wasn’t her place to tell him he was a father in the making. No, that was strictly between Danni and him. The tall woman continued to follow his lead without commenting on his question, hoping to put an end to the small talk.
They rounded the corner and came to a door marked Stairwell No. 3. Opening it, David started on his rehearsed speech. "We’re headed down to the first floor now and the area right outside of the Trauma Room. The hospital is only providing services on a Level Three accreditation, that means we only receive and keep traumas during the hours of 7 in the morning until 7 at night when the full compliment of services are available."
"And what of the other twelve hours?"
"We stabilize and transport to a Level One facility, such as the one that you are on loan to us from."
Garrett wasn’t quite sure that she liked that thought, but it was one that she would have to live with for the next few days.
As they reached the bottom of the steps, David’s pager beeped as he reached for the door.
"Trauma Team Page Level One, Male mid to late 20’s with a single gunshot to chest, agonal breathing noted. ETA 2 minutes. This is a Level One Trauma Team Page."
David stopped short. He turned to the tall woman, his eyes pleading silently for help.
"Care if I scrub in with you, doctor? I’ll be able to get a first hand look at how your department runs that way." Her eyebrow arched as she waited for his acceptance of her help.
With a smile breaking at the corners of his mouth, he silenced the beeper. "Right this way, Dr. Trivoli. I’d be happy to have your assistance."
With a few twist and turns down the hallway, they soon found themselves in the newly arranged trauma room. The gathered nursing staff was dressing quickly in lead aprons, gowns and masks. The two surgeons followed suit, finishing as the medics wheeled the patient into the room.
Gasping, intermittent, labored breath sounds of the patient were noted as the stretcher passed in front of Garrett, alerting her of his dire straights. His skin was cool and clammy to touch while looking to be a pasty color of white.
"Can someone page Anesthesia to this room, STAT," her voice rose above the din of the room. Her ever-observant eyes caught sight of small pool of blood on the left side of the stretcher sheet. "Cut his shirt off on the right side of his body and across the left shoulder and sleeve, we’ll need to keep that left side intact for the police."
David pressed his finger deep into the nail bed of the patient’s thumb then released it. The poor blood return allowed the whitened nail to remain that way for a lengthy period of time. "Let’s hang two units of blood." Looking up to the heart monitor he could see the slowing complexes signifying the outcome of a dying man. "Let’s check for pulses," he directed his staff.
Both surgeons felt for pulses, Garrett at the neck and David at the groin. After several seconds had passed by, they met each other’s gaze. The look in their eyes became cold and steely, as each of the surgeons knew what had to be done.
"Set up for a thoracotomy tray, we’re going to open his chest." David gulped. This wasn’t something that he had done on an almost daily basis anymore. The last time had been in his last week of residency back in Pittsburgh with Danni at his side. His thoughts drifted to the petite blonde nurse that he had come to adore but were quickly turned back on the task at hand when he saw the orange-brown splash of Betadine across the now bared chest to prep the area. ‘Thanks, Danni, for telling me that Dr. Trivoli was the one to steal your heart. And for her being here at this moment.’ He thought as he looked at the intensity on the face of the woman surgeon across the table from him. It gave him a newfound confidence as he forged on. "Let’s give a dose of Epinephrine."
The crash cart was pulled into place and opened, revealing the drugs necessary to work a cardiac arrest with ease. The expertise of the dark, curly-haired nurse betrayed her look of youth. This was something that she was evidently deft and well rehearsed at over the years. With a calm air about her, she readied the prefilled syringes, giving each one in succession as she called out the drug and time that it was administered as well as location of intravenous line used.
With a flurry of feet a new person entered the arena. "I’m here now, what is it that you…" the anesthesiologist suddenly realized that his skills were indeed needed immediately. "Let me through, I’ll need a curved blade on that laryngoscope and set up a size 8 endotracheal tube." He called out his orders, making his way to the head of the patient. Grabbing a set of gloves from out of his pocket, he readied himself to intubate the hardly breathing patient. With skilled hands that had a lifetime of practice, the physician started to place the tube. "Damn! I need suction, he’s got vomit blocking the airway." A suction catheter appeared in the hand of the male nurse standing by his side. After a few quick passes to remove the obstruction, the vocal cords could be visualized, allowing the intubation to be completed successfully. He remained at the head of the patient, manually breathing for him with the large oxygen-filled bag attached to the endotube, holding it in place while the nurse secured the tube from dislodging. The anesthesiologist watched as both sides of the patient’s chest rose as he squeezed the oxygen into the patient’s lungs. Convinced that the tube was properly positioned, he gave a nod to the surgeons to begin.
Garrett stood poised and ready with a scalpel in her hand; after all, it was her side of the chest that had been penetrated by the bullet. "Okay, everybody ready?" She began to make the incision down the length of the ribs cutting hastily through the tissue to bring the contents of the chest cavity into view.
"Rib spreaders," David commanded, his hand held out ready to accept them.
The nurse held up two pieces, looking at him with horror in her eyes. "I don’t think these are going to do anything, Doc."
"Shit! What the hell…" his mind raced with thought. "Get me another rib spreader."
Garrett acting in her normally cool, in control manner didn’t let the moment of failed equipment stop her from obtaining her goal. She would just use what she had at hand. "You and you," she motioned with her head to the two people on either side of her. "Each one of you grab on a rib and separate them until the rib spreader comes."
The two nurses jumped at the command, not knowing what else to do as the aide took off down the hall for the spare set of rib spreaders. When enough space was gained, the sinewy, gloved fingers of the surgeon gently pushed aside the expanding lobes of lung, revealing the inner contents of the cavity.
The nurses peered down into the chest, realizing that their own hands were literally now a part of the procedure.
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