A very tall man stood in the corner, his hands moving like an orchestra conductor, his orders directing residents and interns. Inside the tent, the cries of patients and the smells of burns tore through her. Harper made her way over to the man. “I’m Harper Rousselle, CCRN; where do you need me?”
“Thom Walton, agency MD. What a way to spend my first shift. How much burn experience do you have?” he asked.
“Enough to get through the first forty-eight hours. Trauma assessment, oxygenation or intubation, assessment, percent area and depth, Parkland fluid formula, foley, vitals, mental status and a good prayer.”
Thom’s eyes twinkled. “Harper, you’re my charge nurse. Don’t let the interns murder anyone.”
She swallowed hard. “I’ll try.”
Suddenly she doubted every skill she had. And more, she worried about the doctor on his first shift. Grabbing a box of gloves from a case, she stuffed her pockets and made it to the corner Thom assigned to her. A nurse’s aide covered in soot stood beside a woman lying on a stretcher, her eyes empty and filled with fear.
“Hi, I’m Harper. How are you doing?” she directed her question at both the patient and the aide.
“It was so fast. I dragged her off the third floor. The flames were everywhere. So many couldn’t get out,” the nurse cried.
“You’re safe now. As soon as I’m done assessing your patient, I need to treat the burns on your hands.” Harper slid down the sheet covering the patient. It was easier for her to assess the amount of skin that wasn’t burned. “I’m going to start an IV and give you something for the pain.”
Harper smiled and went to work. She managed to find a vein behind the woman’s right knee, then she waved over a resident. “I need pain meds for my patient. She has burns over ninety-five percent surface area. You’ll need to sedate and intubate her after we find out if she wants to say goodbye.”
“I don’t understand,” the new doctor said.
“Those burns aren’t survivable.” Harper chewed her cheek to hold back the tears.
She gave her patient the ordered meds and helped the woman call her daughter. The doctor didn’t have to intubate the woman. She died peacefully, holding the hand of her nurse from the home.
Harper moved from patient to patient. Airway, breathing, circulation, depth and percent burned, fluids, output, vitals, repeat.
As she was treating a man in his eighties, a nurse’s aide ran to his side. “Mr. Voorhies, I’m so glad you made it out,” the young woman said.
The man joked, “Takes more than a bonfire to keep me down. Serving in our great US Army, I’m telling you, this was no accident.”
“Why do you say that, sir?” Harper asked as she worked.
“Color. Flames were blue-green. Phosphorus. Nasty stuff.”
While the nurse’s aide and Harper tended to the old man’s wounds, paramedics rushed in a nurse’s aide from the facility. One she recognized as Sam Robison, one of Kip’s people. “Harper, this is Emma,” he said.
She immediately went to work on the young woman. Her red hair was burned off in places, and soot powdered her nose and mouth. Her hands and arms were both burned; tears poured from her irritated eyes. Harper yelled for help to remove her rings as her left hand was swelling. Then she applied oxygen and started another IV. Sam had started the first one.
A young resident ran to her side. She’d helped Harper with six other patients already. The doctor ordered pain medication and assessed her breathing. “Harper, her airway is burned. We need to intubate her.”
“Get Dr. Walton,” Harper whispered and began to wrap Emma’s arms.
“I couldn’t save any more. The fire, it was everywhere,” she cried. “The whole fourth floor. They’re all dead.”
“Emma, let them help you. Kip called your husband. He’s on his way.” Sam stayed beside her.
Harper started nebulized oxygen. “Sam, he better get here quick; her airway is going.”
Sam nodded knowingly.
“Emma, worry about you now. You need to conserve your breathing effort,” she said.
Thom Walton joined the bedside. Harper watched and listened to Thom explain that he was going to place a tube in her airway. But it was the look on his face as he examined a small burn on her ankle that frightened her.
“Please, I need to speak to my husband,” she pleaded.
“Honey, we can wait five minutes. I’ll let Harper record the message,” Thom explained. “Harper, soak a bunch of trauma dressings in saline and bring them to me.”
