Bloodstream

‘Here’s the epi,’ said the tech, handing Claire the syringe.

‘I can’t breathe!’

‘It’s okay, Katie,’ soothed Claire, uncapping the needle. ‘You’ll feel better in just a few seconds…’ She pierced the girl’s skin and injected a tenth of a cc of epinephrine.

‘I – can’t – breathe!’

‘Benadryl, twenty-five milligrams IV!’ Claire snapped. ‘Adam, give her the Benadryl!’

DelRay stared down with stunned eyes at the syringe the X-ray tech had just slapped in his hand. In a daze, he injected the drug into the line.

Claire whipped out her stethoscope. Listening to the girl’s lungs, she heard tight wheezes on both sides. ‘What’s the blood pressure?’ she asked the tech.

‘I’m getting eighty over fifty. Pulse one-forty.’

‘Let’s move her to ER, STAT.’

Three pairs of hands reached out to slide the girl onto the gurney.

‘Can’t breathe – can’t breathe –’

‘Jesus, she’s really swelling up!’

‘Just keep moving!’ said Claire.

Together they propelled the gurney out of X-ray and ran it down the hallway. They careened around the corner and banged through double doors into the ER. Dr McNally and two nurses looked up, startled, as Claire announced:

‘She’s going into anaphylactic shock!’

The response was immediate. The ER staff swung the gurney into a treatment room. An oxygen mask was pressed to the girl’s face and EKG leads clapped to her chest. Within minutes a hefty dose of cortisone was dripping into her IV.

Her own heart was still pounding when Claire finally left the room to let McNally and his staff take over. She saw Adam DelRay standing at the nurses’ desk, furiously scribbling in Katie’s hospital record. As she approached, he quickly shut the chart.

‘She never told me she was allergic,’ he said.

‘The girl is borderline retarded.’

‘Then she should be wearing a MedAlert bracelet. Why isn’t she?’

‘She refuses to.’

‘Well, I can’t guess these things!’

‘Adam, all you had to do was call me when she came in. You knew she was my patient, and that I’m familiar with her history. All you had to do was ask.’

‘The guardian should have told me. I can’t believe it never even occurred to that woman to –’

He was interrupted by the loud squeal of the ER radio. They both looked up as the transmission came crackling through.

‘Knox Hospital, this is unit seventeen, unit seventeen. We have gunshot victim en route, ETA five minutes. Do you copy?’

One of the nurses darted out of the treatment room and snatched up the microphone. ‘This is Knox ER. What’s that about a gunshot wound?’

‘Multiple victims en route. This one’s critical – more on the way.’

‘How many? Repeat, how many?’

‘Uncertain. At least three –’

Another voice cut into the frequency. ‘Knox Hospital, this is unit nine. En route with gunshot wound to the shoulder. Do you copy?’

In panic, the nurse grabbed the telephone and hit O. ‘Disaster code! Call a disaster code! This is not a drill!’

Five doctors. That was all they could round up in the building during the frantic moments before the first ambulance arrived: Claire, DelRay, McNally from the ER, a general surgeon, and one terrified pediatrician. No one knew any details yet, not the location of the shooting, nor the number of victims. All they knew was that something terrible had happened, and that this tiny rural hospital was not prepared to deal with the aftermath. The ER turned into a maelstrom of noise and activity as personnel scrambled to prepare for the injured. Katie, now stabilized, was whisked out and shoved into the hallway to free up the treatment room. Cabinets clanged open, bright lights flared on. Claire pitched in to hang IV bags, lay out instrument trays, and rip open packets of gauze and sutures.

The approaching wail of the first ambulance brought a split second’s hush to the ER. Then everyone surged out the double doors to meet the first victim. Standing among that crowd of personnel, Claire heard no one speak; they were all focused on the swelling scream of the siren as it drew near.

Abruptly the siren was cut off and the flashing red light swerved into view.

Claire pushed forward as the ambulance backed up to the entrance. The vehicle’s rear door swung open, and the stretcher rolled out with the first victim. It was a woman, already intubated. The surgical tape used to secure the ET tube obscured the lower half of her face. The bandage on her abdomen was soaked with blood.

They rolled her straight into the trauma room and slid her onto the table. A confusing chorus of voices was shouting simultaneously as the woman’s clothes were cut away, the EKG leads and oxygen lines connected, a BP cuff wrapped around one arm. A rapid sinus rhythm raced across the cardiac monitor.

‘Systolic’s seventy!’ a nurse called out.

‘Drawing the type and cross!’ said Claire. She grabbed a sixteen-gauge IV catheter off the tray and snapped a tourniquet around the patient’s arm. The vein barely plumped up; the patient was in shock. She stabbed the vein with the IV needle and slid the plastic catheter into place. With a syringe, she withdrew several tubes of blood, then attached the IV tubing to the catheter. ‘Another lactated Ringer’s going in, wide open!’ she called out.

‘Systolic’s sixty, barely palpable!’

The surgeon said, ‘Belly’s distended. I think it’s full of blood. Open that surgical tray, and get suction ready!’ He looked at McNally. ‘You’re first assist.’

‘But she needs to be in the OR –’

‘No time. We have to find out where the blood’s coming from.’

‘I’ve lost her BP!’ a nurse yelled.

The first incision was swift and brutal, one long slash down the center of the abdomen, parting the skin. With a deeper incision, the surgeon cut through the yellow layer of subcutaneous fat, and slit into the peritoneum.

Blood spilled out, streaming onto the floor.

‘I can’t see where it’s coming from!’

The suction wasn’t clearing the blood fast enough. In desperation, McNally stuffed two sterile towels into the abdomen and pulled them out again, soaking red and dripping.

‘Okay, I think I see it. Bullet nicked the aorta –’

‘Jesus, it’s gushing!’