A Healer's War

Chapter 3 - A Healer's War

Chapter 3: A Healer's War

Time: 21:21

Location: Oates Children's Hospital, Portland, Oregon

The PICU wasn't large, only twenty rooms spread around the perimeter of the rectangular unit. Each small room had its own patient bed, monitors, infusion tower, futon in the back, bathroom, and to enter—a wall length sliding glass door. Only a thin beige and green checkered curtain provided any privacy from the pair of nurses' stations flanking the medication and supply room at the unit's center. While the unit wasn't as large as some bigger cities', it punched above its weight with high patient acuity and expertly orchestrated chaos.

Rory arrived, sweaty and nervous. Room 4 was already a flurry of activity. The stinging scent of cleaners carried in the dry, filtered air. Staff flowed in and out, bringing stacks of sterile gauze and catheter supplies. People packed the room, their shoes squeaked as they crammed around the bulky bed and blinking machines, reaching over one another to prepare the space. No one spoke. There was no need yet. They all knew what to do. Preparing was the simple part.

Above the bed, silent monitors were ready to scream, and beside them a respiratory therapist dialed in a boxy ventilator. In the back of the room, someone had already prepared the built-in futon with crisp, tucked sheets, pillows, an extra blanket, a new toothbrush, a towel if the family needed to shower, and lots of tissues.

The people and machines that couldn't fit in the room lined the hall outside. Resident physicians, still fresh from medical school, huddled close to their attendings, going over resuscitation scenarios. A nurse drew up medications from a red code cart, while another pair primed the lines for a tower of syringe and infusion pumps. Beside them, a stack of white Styrofoam boxes sat with enough ice inside to keep the donor blood cold until inevitably needed.

By the time Rory said hello to the team and situated himself, the attending physician, the one who'd run the code, gathered the team for a verbal report. It wasn't good:

"Welcome, everyone, and thank you for being here. The patient is an eight-year-old female named Octavia, Peds versus Auto. She's 27 kilograms. Unresponsive with sluggish pupils. Pulses x4, but thready. 64/25 after two boluses of crystalloid. Intubated at the scene and is being bagged on 8L at 50%. Suspected liver and kidney lacerations based on some bruising and blood in her urine." She adjusted her glasses on her nose, glanced up at the team, and returned to her notes.

We'll need more blood.

"Spine uncleared, C collared and back braced. Face, arm, and lower extremities lacerations. Suspected bilateral comminuted fractures of femurs, tibs, and fibs. Probable shattered pelvis is believed to be where the bumper struck first, according to eyewitnesses at the scene."

This is really bad. The attending took a deep breath and clenched her jaw.

"The driver of the car that struck the patient was drunk, blowing a 0.25 blood alcohol content after being caught trying to run with a suspended license." She pulled down her glasses and looked up.

Rory bristled. For fuck's sake... Angry murmurs and gasps rippled through the room. There were plenty of crazy stories in pediatrics. Most ended well, but the ones that didn't hurt. And the most painful were the genuine tragedies—those that were preventable. Like this one.

Society's sponge. Rory thought bitterly. The tension thickened as the staff talked in sharp whispers. A hot flush rushed up Rory's throat, but he quickly swallowed the heartache. It wouldn't do him, or his patient, any good right now.

Crossing the room to grab a pair of gloves and a face mask, Rory spotted two residents, a young man and woman in fresh white coats, huddled together, reviewing the code cards—flow chart directions on how to save a life—with pale expressions. Bell had taught him to recognize the face, what it meant, and how to help.

"Spiritus boni, everyone," Rory said, exhaling.

The two residents looked up and stared while the nurses and older doctors smiled. "Spiritus boni," they repeated.

"What does that mean?" The young woman asked, her dark blue eyes fixed on Rory. He was momentarily speechless.

A soft chuckle ran through the veteran staff.

Rory blinked, inhaled, and smiled at her. "It means breathing is good."

The man slowly frowned, but she smiled back and drew in a long breath, her color returning.

"They've landed," the attending announced. "Three minutes."

Conversations sparked about priorities and roles. Who would rotate on compressions? Who would record? Who would draw medications? Rory volunteered for compressions, and slowly, the tension drained from the room as everyone settled into their roles and their training took hold, providing a mental reprieve from anger in a comfortable autopilot.

They were ready. The patient was in the elevator.

Seconds later, a shrill alarm echoed down the hall, growing louder with each heartbeat.

Rory closed his eyes and filled his lungs with the dry hospital air. It made his mouth tacky, and he regretted not grabbing that last drink of water—a rookie mistake. He wouldn't get a break for hours.

When he opened his eyes, the blue-uniformed paramedics raced into the room, pushing a gurney between them. Rory met the medic's eye and glanced at the girl - Octavia. His chest tightened as his mind processed the grisly scene. Oh God.

"Who's the nurse taking over?" the medic asked.

Rory stepped forward, steady, as they prepared to move her off the gurney and onto a hospital bed.

The medic gave him a sympathetic nod. Rory understood. He felt the same way. They both knew they'd need a miracle to beat death today.

Focus, he told himself. Fear won't help her.

"My name is Rory," he told the medic. "I'll be her nurse."