I flip the vitals monitor so he can see the display. “We’re going to work on lowering your blood pressure too. This top number,” I say, pointing to the screen. “It’s too high. We’d like it around one twenty; I’d even take one forty if you have a history of high blood pressure and haven’t been on medications lately. I’ll put in orders to have the nurses give you some medications through your IV, and we’ll re-check it every fifteen minutes.” I push out a breath, letting my hands fall to my hips. “That was a lot of information. What questions do you have for me?”
His eyes are still fixated on the monitor, and I can hear the cuff inflating as it checks his blood pressure. The numbers blink on the monitor, and when he sees that the reading is fairly high, he cringes. “You’re not going to make me stay here overnight, are you?”
I hand him his call light and explain how to use it. “Let’s hope not. If all tests come back normal, I could send you home with medications and a promise that you’ll find a new doctor to follow up with, as long as you promise to hang out with us until we get some answers.”
He winks, taking the call light from my hand. “You got it, Doc.”
***
“Is the CT ready yet?” I look down at my watch and grimace. Harry has been here for three hours already. Most of his labs came back normal, with the exception of slight anemia and the start of kidney disease, but with his age and overall health history, I was impressed with his results. We had him on telemetry for two hours without any report of a pause in rhythm or an irregularity. He’s getting antsy and has been pacing in his room for thelast hour, continually coming to the nurses’ station to see when he’s allowed to go home.
Savannah, the tech working with him, grimaces. “Not yet. They finally got it fixed, and now they’re working through the list of people waiting. It sounds like they bumped some non-emergent ones to get our patients through, but it’ll probably be another hour or so.”
I reach back, gripping my shoulder with my palm, pressing down and trying to work out the knot that’s been plaguing me all day. What started out as a decent shift turned into a madhouse. As soon as we discharged someone, the room was barely cleaned before it was full again, and the waiting room is packed with at least thirty people in need of care.
Each case I see bleeds into the next. Asthma exacerbation, bike accident with head laceration, teenage girl here for med clearance before going to a psychiatric ward.
“I don’t feel comfortable discharging him without a CT. We could probably discontinue telemetry at this point.”
She nods, leaving the station to head in the direction of his room just as the double doors to the ambulance bay swing open, slamming into the wall. “Gurney coming through!” a paramedic shouts. I’m up, racing around the nurses’ station and down the small hall, grabbing the endof the gurney and pulling it into trauma bay one. Another doctor and a team of nurses and techs follow behind me.
“What do we have?”
The chaos ensues; with the amount of blood on the patient’s clothing and gurney, we start gowning up. A tech holds a gown open in front of me, and I shove my arms through, reaching to slip on a pair of gloves as they tie the strings together across my back.
“Nasty car accident on I-23. Driver fell asleep and ran head-on into a minivan of five. Sixteen-year-old woman with lacerations to her face and arms, complaints of abdominal pain.”
I look down at the patient, taking in her face for the first time, and my heart seizes in my chest. She’s a woman, yes, but she’s a teenager, a child, with pretty auburn hair and a Des Moines North Volleyball emblem on the side of her black shorts. “What’s your name, sweetheart?” I ask, leaning down so she can hear me. I keep my tone as calm and soothing as possible despite the chaos around us.
“M-M-Morgan,” she finally grits out, grimacing with the effort.
"Morgan, I’m Dr. Carrington. There are going to be a lot of questions thrown at you, and I just need you to answer the best you can, okay?”
Her eyes flutter shut and a small tear squeaks out. “Where’s my family?”
I look to the paramedic for answers. “Parents were routed to Mass General, her two siblings are on their way, two minutes out.”
I keep my eyes glued to him, hoping to subliminally learn they’re going to be okay.
He looks down at Morgan who is focused on the tech at her side as they place an IV. “This one is the worst,” he says, pointing down at her.
My stomach lurches, and I swallow hard, pulling in a deep breath through my nose. You’re a doctor, Holly, I remind myself. Stay focused. As much as I want to kneel at her bedside right now and hold her as she cries, I have a job to do.
“Morgan,” I say again, leaning over. “Your family is receiving the best care right now. I promise to find out how they’re doing, okay? But I need you to tell me where it hurts the most.”
“My … my stomach.”
I do a quick assessment, gently running my hands over her stomach, not feeling any broken ribs. But when I move my hands lower, she winces, and I can feel how swollen and tender she is. “Right there?” I ask, and she nods her head.
“What’s her blood pressure?”
“Eighty over forty,” someone responds. “Heart rate one-thirties.”
I look over my shoulder, calling out for any tech who will listen. “I want lab here immediately. The second they’re done, let's get her to CT. I don’t care what they say. And call OR for a STAT consult.” The tech scrambles to the wall phone, and I look to the tech still standing nearby. “Can you go check on room four? Make sure he’s okay? I’ll be here for a while.”
Once the tech runs off, I point to the ultrasound machine across the room. “Get me the ultrasound, please.” I have a feeling CT still won’t get us in, and I’m wondering if she needs to go straight to the OR.
One of the techs wheels over the cart. I turn on the machine, and lift Morgan’s shirt, doing my best to gently clean her stomach before squeezing cold gel onto it.
