Chapter Two

Monday, July 1, 11:47 P.M

"We've got a trauma coming in." Gabrielle said as she entered the exam room where Bree was watching Lynette perform a spinal tap on a six-week-old baby.

"What is it?" Lynette asked.

"Pedestrian versus car. It doesn't sound too bad. The paramedics report only a few cuts and bruises on the patient. They're ten minutes out."

"I'll be there as soon as I'm finished here. Until then, Susan can run it." Lynette said.

"You're the boss." Gabrielle said.

Lynette wasn't surprised when the charge nurse stayed to observe. It was obvious to Lynette that Gabrielle didn't trust her. Lynette inserted the spinal needle into the baby and the baby didn't react.

"Isn't she supposed to be crying or fighting?" Bree asked.

"Yes, its better that they have energy to fight when they're this young." Lynette answered. It was almost midnight and things had been pretty good during Lynette's first shift. Other than her earlier resuscitation, this baby was the sickest patient she had seen all night. Lynette withdrew the needle and let the spinal fluid flow into the collection tube.

"Push the antibiotics." Lynette ordered Gabrielle. She held up the tube to Bree. "What do you think?"

"It should be clear. Cloudy fluid like that shows meningitis." Bree said.

"Right, call the peds ICU and tell them we're sending a patient up." Lynette said.

"Do you think she'll be alright?" Bree asked.

"We got to her early." Lynette answered. They almost hadn't. Andrew had wanted to discharge the baby with a diagnosis of a cold but Lynette had stopped the family in time.

"I hope so." Bree said.

Lynette looked at Gabrielle who was watching from the doorway with her arms crossed over her chest but she nodded in approval.

"Bree, why don't you explain everything to the parents and wait with them until someone from the PICU gets here?"Gabrielle said.

"Of course," Bree agreed and walked away.

Lynette went over to Gabrielle, "About earlier—"

"Dr. Lindquist," Gabrielle interrupted, "I can't have communications breaking down in the middle of a trauma. It's my job to protect the patient—"

"I'm sorry; I should have made my thoughts clear. I apologize." Lynette replied.

Gabrielle relaxed a bit, "It was a good call. None of us are going to forget it anytime soon." A smile started to form. The two heard the sirens outside and jogged to the ambulance bay.

"What do we have?" Lynette asked.

A man strapped to a stretcher with his neck immobilized by a c-collar was being wheeled into the ER. The team, with Susan at the head of the bed in the position of command doctor was cutting off clothes with trauma shears. Lynette noticed the same paramedic, Tom Scavo, nearby.

"Twenty-eight-year-old pedestrian struck by a slow moving vehicle. Patient developed a loss of consciousness and respiratory distress en route." Tom announced. "Pulse ox was a hundred percent the entire time but then he started having difficulty breathing."

"So much for our nice, stable patient. Was he thrown? Hit his head?" Lynette asked, ignoring Susan's glare.

"Not according to witnesses." Tom responded.

Lynette assessed the patient's airway and breathing. He had a tiny cut on his face, nothing serious and no signs of anything he might have choked on. But he struggled to breath, taking irregular breaths.

"No collapsed lung or chest trauma. The only injuries I can find are a few scrapes." Susan said.

Lynette finished her exam and agreed.

"Okay, let's intubate. I'll do it." Lynette said.

Susan stepped to one side. Lynette raced through the different diagnosis of unconsciousness as she took control of the man's airway and help him get the oxygen he needed.

"He might have a head injury. Keep an eye on his vitals. Draw a trauma panel, tox screen, and a blood alcohol level. We'll get an arterial gas when he's tubed. Who's on call for surgery?" Lynette said.

"Carlos Solis is the resident on call for trauma. He hasn't answered his page." Gabrielle answered.

The trauma surgeon should have been here already, even though this was only a level two alert.

"Who's the trauma attending?" Lynette asked.

"Dr. Wilson."

"Forget Solis, get Wilson down here." Lynette ordered.

The trauma team ran around, following Lynette's orders. Lynette slid the laryngoscope to lift the patient's tongue. A pool of saliva blocked her view and she reached out for the suction tube a nurse was holding. After suctioning out the saliva she finished the intubation without any difficulty.

Lynette looked over at Tom, who was frowning as he looked at the monitor. Instead of improving, the patient's blood pressure dropped.

"Where's surgery?" Lynette asked. In New York they'd be already down there and working to help stabilize the patient.

"They haven't answered. I'll page them again." Gabrielle said.

"Susan, help me do a second examination." Lynette said. Together they examined the patient from head to toe searching for injuries. Lynette did an exam with the portable ultrasound to look inside his abdomen and chest and still didn't see anything causing his difficulty breathing.

Lynette laced her fingers through the patients' thick dark hair. No signs of a fracture, no reason for him to be comatose, unless there was a hidden brain contusion or bleed. Except if that was the case, his blood pressure would be high, his pulse low, the opposite of what was happening. An alarm sounded as his blood pressure fell some more.

"We're missing something. Did the surgeons answers?" Lynette was getting frustrated. Her patient was deteriorating and she had no idea why.

"Dr. Wilson is in the OR. He's sending a resident down." Gabrielle answered.

Lynette moved out of the way for the X-ray techs that were shooting films on the spine, chest and pelvis.

"I can't get a pressure." Susan said.

"Hang two units of O neg. DPL tray." Lynette ordered. "Is this the way you usually run your traumas?" Lynette snapped.

"Our doctors have the best resuscitation rate in the state." Gabrielle said a little coldly which reminded Lynette that she was the outsider.

Tom opened a lavage tray as Lynette put on a pair of gloves. Tom frowned but nodded in encouragement. Lynette dumped Betadine over the patient's abdomen and stabbed a lavage catheter into the space around the intestines, hoping the find a source of blood loss to explain his condition. The fluid she withdrew was clear. No help there.

"Heart rates going down." Susan announced.

The trauma looked at Lynette. She had no answers. Was it spinal shock? Lynette's stomach twisted as she thought of the possibilities. She was frustrated she couldn't figure out the injury killing her patient.

"Half a milligram of Atropine. Push the blood. Call CAT scan. We need head, spine, chest and belly." She ordered.

Gabrielle rushed to the phone as an X-ray tech came back with the films taken earlier. Lynette scrutinized the X-rays. They looked perfectly fine.

"Everything looks good. No pneumothorax, no widened mediastinum, no obvious spinal fracture."

Susan joined Lynette and nodded in agreement.

"So, what's going on?" Lynette wondered aloud. The patient looked healthy, like he exercised and took care of himself. No needle tracks or surgical scars.

"Labs are back, "Gabrielle announced. "They're all normal, blood alcohol is only .06."

Lynette had no answers. Everything she did seemed to make things worse. She must've missed something but what?

"I lost his pulse!" Susan called out.

Lynette rushed back to the patient's side and assessed his airway as Tom started CPR. The monitor showed a flat line—Lynette couldn't even shock it.

"Epi, push another unit of blood, let's needle his chest." If Lynette didn't move fast the patient would be dead. She spiked a large-bore catheter through the man's chest wall. Nothing—no rush of air indicating a collapsed lung. Susan did the same thing on the other side. Nothing there either. Lynette wasn't surprised. His oxygen level was still normal. She grabbed the labs.

"Dr. Lindquist, you should know who this patient is." Gabrielle spoke up holding the patient's driver licence.

"I don't care who he is. I just want to find out what's wrong with him so I can treat him." Lynette said, with her tone ruder than she wanted. Lynette had done ever standard resuscitation protocol. Time for the not-so-standard.

"High dose epi," she ordered. "Let's look at his heart again." She grabbed the ultrasound and stopped CPR long enough the scan the cardiac region. No evidence of fluid around the heart, it looked normal it just wasn't beating. She looked at the clock. She knew the patient had been down for too long. A body could only go without oxygen for a short time. She knew her patient was dead but she wished she knew what killed him.

"Stop CPR, check his pulse." She ordered. As Tom checked his carotid pulse, Lynette focused on the monitor wanting it to show a sign of life. Everyone in the room remained silent and backed away from the patient.

"No pulse," Tom announced after a minute.

"Is it okay if I call it?" Lynette asked, sounding surprisingly calm.

One by one the staff nodded Susan and Tom the only ones looking at Lynette. Susan looked pissed while Tom had a look of both sorrow and disappointment.

"Time of death, twelve fifty-six a.m."

Lynette reached over and disconnected the bag from the endotracheal tube. The nurses would do the rest.

"Why do you people keep paging me? Can't you handle a simple trauma?" A voice boomed from outside. A man approached the trauma room, still in his gear from the OR. His ID badge read DAVID WILSON, CHIEF OF SURGERY.

"What took you so long? Where's your resident? Why did no one answer our pages?" Lynette said.

The surgeon glared at Lynette, "Who the hell are you?"

"Lynette Lindquist, the new ER attending."

"Dr. Lindquist, my resident was called to a code in the ICU. Life-and-death situations trump traffic accidents with minor injuries."

"Well, you're too late to help the patient so we don't need your services, Dr. Wilson." Lynette said.

"If you don't need me, then why do you keep paging me?" Dr. Wilson snapped.

"I paged you, Dr. Wilson." Gabrielle said. She walked over to the two of them.

"I'm so sorry." She whispered and handed Dr. Wilson a black wallet. Lynette knew that tone. She'd used it more times than she could count. What was going on here?

Wilson took the wallet and looked inside. He took a ragged breath. The wallet fell from his limp hand and hit the floor.

"No, no, it's impossible!" He pushed past them into the trauma room.

"Nicholas!"

Lynette reached down and grabbed the wallet. The driver's license belonged to a Nicholas Wilson.

"His son." Gabrielle explained.

To Be Continued