"Call it. What's the patient’s status?" Adrenaline and fear bubbled within her.
"Thirty-six-year-old male, unresponsive. Difficulty maintaining an airway. Labored breathing. Flail chest, rigid abdomen. Signs of a GI bleed. Lower extremity paralysis. No IV access. Twenty minutes out."
Elizabeth pressed her tongue to the roof of her mouth. "Ten units of O-neg. Page Hedges. Prep the room. Reserve an OR." She walked to the bay, designating tasks to the arriving team. Julian stayed on her heels.
A man covered in a blood-soaked ambulance sheet was wheeled in by two paramedics and two corrections officers. One of the medics was having trouble assisting the patient's breathing. The mask couldn't hide his battered and bruised face. Elizabeth spotted handcuffs. "Un-cuff him now." When the CO didn't respond, her voice rose again, "Damn it. Now!"
Lonnie Cowan opened the handcuffs, and the nurses removed the blanket and began cutting his clothing clear. Elizabeth bit the inside of her cheek when she saw the patient's chest and flanks were dark purple. Her head tilted. "Wait. Julian, shoot a picture of this." She focused on the corrections officers. "Which one of you assholes redressed him? His coveralls are on inside out. Roll him."
"Dr. Reed?" her name stuck in Connor Caine's throat. The patient had suffered a brutal sexual attack.
Elizabeth took a breath. "Page neurosurgery, maxilla-facial, thoracic, urology and orthopedics, STAT. Dr. Caine, I need a central line. Saline wide open. Hang four units O neg on the rapid infuser." She ordered tests associated with every trauma patient as well as tests for sexually transmitted diseases and called for a sexual assault nurse. "We need those samples before the OR." She also called for massive doses of three antibiotics.
Elizabeth's hands moved down the patient's body, finding his ribcage was crushed. His chest was only able to move with the help of the paramedic breathing for him. "George, put a chest tube on the right. Try to raise that lung. Connor, after the central line, try the left for another chest tube. Tell CT we’re coming. Patient's name?"
"Royce Mills," Tim Lampton said.
"Royce, can you hear me? Julian, step in. Take over breathing for the patient.” At the changeover, Elizabeth ran her fingers over his cheekbones. His eyes opened with an agonized moan. "Royce, I'm Dr. Reed. You're safe now."
A tattoo mottled in bruises was inked across his right pec:God will judge our enemies. We will arrange the meeting.The words surrounded a map of Greece with a drawing of the Goddess Athena buried in the center. A memory of Tate's story shimmered in her head. She bent down, her mouth at his ear. "Troy, I'm going to bring you off this mountain."
His weak hand pawed her wrist. The two COs took a protective step, and she waved them back. His eyes met hers before losing consciousness again.
"Dr. Reed, I can't find the landmark," George Keller said, having trouble inserting the tube on his right side. Connor Caine was having equal difficulty on the left.
Patrick pushed into the trauma room. "Patrick, flail chest, please assist George."
Patrick gloved up and inserted the tube. "His ribs are shattered."
"We are moving to CT after I intubate. Royce, time to take a nap. I'll see you when you wake up." The swelling was so severe, she struggled to place the breathing tube.
Patrick cataloged the injuries aloud. The mask concealed the pain of recognizing one of his own.
"Pat, I'm assisting." Elizabeth feared making an error, but she wasn’t going to leave him. She caught Patrick and Julian sharing a brief nod as they left the room.
"Thirty-six-year-old Royce Mills. Unknown medical history.” The circulating nurse announced all the potential procedures.
Dr. Karen Williams started to repair his facial bones and fractured jaw. "What was he hit with? He's a jigsaw puzzle."
Dr. Clive Richey, a thoracic surgeon, began work on the crushed chest. Troy was placed on the operating table with his arms at ninety-degree angles to his body. "Every rib is broken. Did someone stomp him?" he asked, frustrated. "Page the second thoracic on call. These ribs are each going to need plates. I will attempt to repair the organs first. Can't save the lower right lobe. His heart has visible bruising. Draw cardiac enzymes. If he makes it off the table and stabilizes, I want a cardiac perfusion study. There is too much damage for ECMO."
"Scalpel." Patrick made the first abdominal incision. Blood flowed freely.
"Pat, the spleen is ruptured; I can't save it." Elizabeth’s hands flew.
"Parts of his liver look like ground beef; I’ll try to salvage as much as I can. Hemodynamic status?" Patrick asked.
Warren Chen checked his monitors. "Ninth and tenth unit flowing. His vitals are fluctuating. Hurry."
"His colon is ruptured. Keep irrigating. Warren, full antibiotics," Patrick said as he and Elizabeth started on opposite ends, checking every inch. "Beth?" A long piece of Troy’s bowel was beyond repair.
She shook her head. "We need to clamp and cut. He's not going to survive more table time tonight. We need to initiate damage control procedures and go back in tomorrow. Clive, how are you doing?"
"Sternum is stabilized and every other rib on the right. He can move oxygen."
"Dr. Reed, who did this to him?" a very young surgical nurse, Jackie Clemente, asked.
"I don't know their names, but I'm sure it was the guards and not the prisoners."
