Monday, July 1: 6:45 PM
July 1st. The most dangerous day of the year. Transition day, the day newly graduated medical students arrived to begin their internships and they were absolutely no smarter than they were on June 30. Dr. Lynette Lindquist knew all about the dangers of Transition Day. She knew people died on Transition Day. She knew starting her new job today was not a very good idea. But here she was. Standing outside of Fairview Memorial Hospital. She tried not to imagine running through Central Park as the leaves on the trees went from green to orange and red as fall approached. She'd left New York City behind. Fairview was home now. She took a deep breath before going inside the ER's main doors.
Lynette could remember her own Transition Day back in New York. What she had never understood until now was that as scary as medical school, internship and residency were, nothing was as terrifying as becoming an attending physician was. She was the boss, the person in charge. If anything went wrong she was the one who would be blamed. An air-conditioned breeze came through the ER's open doors and brought with it familiar sounds of an ER. Lynette felt excited. Whether she was ready or not, this was her new life.
As Lynette was getting the sign-out from Adam Mayfair, the attending the she was relieving, a petite Latina women in her late twenties joined them. "We've got a trauma coming in. Fourteen year old in full arrest."
"I'll stay and help you." Adam said to Lynette.
"No Adam, go home." Lynette said. He looked exhausted from working a 12 hour shift. Lynette knew she could handle anything Fairview had to offer. And she wasn't alone. She had residents, other attending, and a hospital full of doctors. "I'll be fine."
"Okay," Adam said with a shrug. He turned to the Latina and made introductions. "This is Gabrielle Solis, your charge nurse for the night. Gabby, have you met Lynette Lindquist? She's the new ER attending."
"It's nice to meet you, Dr. Lindquist."
"Call me Lynette."
Gabrielle nodded to Adam, making it clear that she would personally supervise the new attending's first big case.
"This is yours, then." Adam said, handing Lynette the trauma pager that came with all shift changes. "Call if you have any problems." He said before walking away.
Lynette clipped the small pager into the belt of her scrub pants and started jogging to the ambulance bay to meet the paramedics and her first patient.
"Fourteen-year-old female found in full arrest at Fairview playground." A paramedic called out as they rushed a dark-haired teen strapped to a stretcher, down the hall. The other paramedic was on top of the gurney, straddling the girl, performing chest compressions. They arrived in the trauma room and Lynette helped her team transfer the patient to the ER's bed. The first paramedic-Thomas Scavo according to his name tag-was bagging oxygen into the girl's lungs. He switched places with Lynette so she could check breath sounds with her stethoscope. Lynette loved it when resuscitation was almost effortless. As if Tom read her mind he handed her the ophthalmoscope before she needed to ask for it.
"Her friends said she was fine and suddenly got a frightened look on her face and collapsed. One of her friends started CPR at the scene. We found her in v-fib, shocked her with no result, one round of epi, shocked again and gave her lidocaine." Tom's tone was grim, with good reason. The prognosis of an arrest unresponsive to epi and defibrillation was bad.
"Drug use? Any past history?" Lynette asked, gliding her hands over the teen's body as she searched for any trauma or other reason for her sudden collapse.
"Friends said no, but we saw a couple empty bottles of vodka. They said she's healthy."
"Shock her at 360," Lynette ordered. "Then give her amiodarone."
"She's needs another round of epi." Tom's partner said as he pushed the stretcher out of the room. Lynette felt Tom's and Gabrielle Solis's gazes on her as she finished assessing the teen. Lynette backed up from the bed to gain a better perspective. A nurse delivered the shock. No change, still v-fib.
"Her name is Allison Brown." Gabrielle announced taking a wallet out of the girl's purse. Lynette glanced at the charge nurse. She was much shorter then Lynette's 5'5 frame and looked too young to be running and ER this size.
Lynette watched the monitor as the amiodarone was pushed followed by another shock to the girl's heart. The girl's irregular heartbeat soon went into a normal pattern.
"V-tach, is there a pulse?" She announced.
"No pulse," Tom replied. Tom's partner resumed CPR, relieving the nurse. Lynette sucked in a deep breath. Ventricular tachycardia was better than ventricular fibrillation but no pulse was still dead. She thought of the possible causes of arrest. For a healthy teenager, drugs were high on the list. Until the tox screen came back there was little she could do except run the cardiac arrest protocols.
"How long has she been down?" Lynette asked.
Tom looked at the clock, "About seven minutes."
Lynette squeezed one hand tight into a fist and then released it. She hated losing and even worse was losing a kid.
"Hang an amiodarone drip, defibrillate again at 360 and give another round of epi." She moved to the head of the bed, brushing against Tom.
After a jolt of electricity went through the patient, Lynette started reassessing the patient. The odds were against her and her patient. Full arrest in the field, not responding to electricity or meds. Lynette knew this wasn't good.
"She's back in v-fib." Gabrielle announced.
Lynette knew she was losing the patient. She leaned forward to listen to her breathing again. Then, she stopped listening. What was that smell? Lynette looked at Allison's face. Around her face and mouth a red rash was starting to form.
"Hold the epi." Lynette said to Gabrielle. "I need one milligram of propranolol."
The room went silent and Lynette saw everybody staring at her. She saw Gabrielle give her a hard glare.
"Give him the propranolol." Lynette repeated.
"That's not protocol, Dr. Lindquist." Gabrielle said. She seemed nervous. A nurse didn't out trump a physician, especially an attending. "There are guidelines for a pulse less arrest."
Fairview nurses were no different from New York nurses. They all believed in protocols. Lynette grabbed a vial of propanolol from the crash cart and filled a syringe.
"We don't have time to argue."
"Epinephrine is the proper drug—"
Lynette cut her off, "If you give her epi, she's dead."
Bree Van De Kamp was a physician's assistant who had started taking on extra shifts in the Emergency Department in addition to shifts in the Pediatric ICU to get more money when her husband Rex, passed away. By now it was familiar territory. She felt relieved she knew everything as she watched the new interns stumbling and bumbling through their first shift.
"Do you know where the suture sets are?" An intern asked Bree. The intern turned out to be her son Andrew. He had wanted to be a doctor just like his father and had managed to get through medical school and decided to do his internship and residency at Fairview Memorial.
"Come with me." Bree said and led Andrew to a storage room, filled with supplies.
"What are you sewing?" Bree asked.
"Head lac, I need five-oh nylon." Andrew answered.
"Here," Bree said, giving him the proper supplies. "How are you getting along?" She asked, seeing that he already looked exhausted.
"Mom, you're a P.A. You should be the one sewing this drunken person up." Andrew said.
"I'm assisting doctors on my own cases." Bree said.
"But I outrank you." Andrew said, rudely. He had been doing that ever since he started medical school.
"And I outrank you."
Bree and Andrew both turned and saw Susan Mayer standing there. She had no lab coat on, just scrubs with her pager and ID badge clipped on her waist.
"Andrew, you're supposed to be suturing Mr. Evans." Susan said. "Do you know how to do a plastics closure?"
"But—" Andrew protested.
Susan glared at Andrew again. He was definitely in for a night of scut work.
"Andrew, you're in a real hospital now. Every patient is a person and every person gets the best care possible. Got it?" Susan said.
"Yes," Andrew answered seriously.
"So, go. Now!" Susan snapped.
Andrew's eyes widened and he sped out of the room. Susan leaned against the wall, laughing.
"You didn't need to torture him like that!" Bree said, defending her son.
Susan smiled, "Sure I did. Those interns need to know whose boss. Especially Andrew."
The two of them noticed a crowd gathering outside one of the trauma rooms.
"What's going on?" Bree asked a nearby nurse.
"The new attending. It's her first code and she's killing the patient."
"Why didn't anyone tell me there was a code?" Susan asked, walking into the trauma room. "I'm the other attending on duty."
Lynette reached for the patients IV with the propranolol in her hand. She was well aware a crowd had gathered and she was getting nervous.
"What's going on?" Susan asked as she grabbed the patient's chart to read Lynette's orders. She looked at Lynette.
"I'm Susan Mayer. The other attending on duty. I usually run the codes. And I know how to follow protocol."
Gabrielle and Susan were standing side by side, blocking Lynette from Allison's IV. The redhead who had entered the room was hovering in the background looking scared.
"Get out of my way." Lynette demanded in a deep voice.
She was surprised when Tom helped her out. He touched Gabrielle's arm and nodded. "Its okay let her give it."
Gabrielle took some steps to the side, looking stiff.
"Dr. Lindquist, I will be reporting this to Dr. Mayfair. If this girl dies, I will not let myself or the other nursing staff be involved."
Lynette ignored Gabrielle and pushed the cardiac medication into her patient's veins. She focused on the heart monitor across from her. [i]Come on[/i]. Twenty second passed with no change.
"I'm giving the epi." Susan announced.
"No," Lynette ordered with her gaze locked on the monitor. Susan reached for the IV but Lynette batted her arm away.
"That epi will kill her." Lynette said to Susan. "Look at that rash. Smell her clothes. She's an inhalant abuser. The solvents make the heart too sensitive to epi. Her adrenaline is poisoning her."
Tom's eyes were fixed on Lynette's face as normal heart beats appeared on the monitor.
"There's a pulse!" the redhead announced.
"Check her blood pressure and start an IV drip." Lynette ordered. The team rushed to follow Lynette's orders now energized.
"I don't think we need this." Lynette said, taking the syringe of epi from Susan. Susan exchanged a glance with Gabrielle before she left the room. When the rest of the trauma room had cleared out Lynette leaned against the counter. She took a deep breath and released it as she tried to calm down. She heard the door open as Tom returned. "Forgot some equipment. Nice call, doctor." He said.
"I was lucky." Lynette said.
"Well, it was still a good call." Tom said.
Lynette didn't believe in luck. She believed in skill, knowledge and facts.
"It was a good save." Tom said as he was about to leave the trauma room.
He was right. Lynette should be grateful she saved the patient.
"Thanks." She said.
"No problem. See you around."
Lynette didn't try to hide her smile as she watched Tom leave. At least she had earned the respect from one medic in Fairview. He was a handsome one, too. Lynette's smile got bigger as she basked in the glow of her success. After growing up with an abusive mom, getting through NYU medical school and thriving during her emergency medicine residency at the busiest hospital in New York City, Lynette was ready for anything Fairview had.
She was more than ready. She was gonna knock 'em dead!