The ambulance stopped, and they wheeled Elizabeth into the trauma room. Patrick Hedges, Louella Miranda, and Pete Walter stood waiting, along with a complete resuscitation team, including Elizabeth's senior fellows. Martin leaned against the wall for support.
Patrick took a step back as Kenny aired out his report. Dr. Miranda stood at the foot of the bed and called out orders. The team in the room performed their assigned tasks. "Dr. Perry, page cardiology to the bedside now. Dr. Caine, insert that central line. Decontaminate her skin." Elizabeth's heart rate hovered in the upper forties. "We need that pacer now."
The clock ticked down minutes. "Keith, where's cardiology?" Patrick took over, patience gone. Martin blinked faster, as if trying to figure things out.
"The fellow is in the cafeteria." Keith twitched.
His tone deepened. "You told him our patient was critical?" The frightened intern nodded. "Get that son of a bitch on the phone now. Bring me a kit." The speaker connected. "This is Dr. Hedges; with whom am I speaking?” He gritted his teeth.
“Dr. Morton.”
“How long have you been a fellow?”
“July first.”
“Today is July fourteenth.”
“Dr. Hedges, I’ve been up for thirty hours. I needed a cup of coffee to fight back the fatigue. I’ll be there as soon as I’m done.”
“Tired, you needed a cup of coffee." He crooked a finger at Josh. "Here's how this is going to play out, and you can tell me what you choose. You can carry yourself and your coffee to the emergency room in the next thirty seconds, or I can send a persuasive Navy SEAL to find you, carry you here, and when you finish my consult, I will tie you to a stretcher and give you a coffee enema." As the line disconnected, the room let out a collective breath.
"I'm not waiting. Let's do this." A nurse set up for the procedure.
In silence, the Chase medical team took over, crowding out the residents. Pete stood ready to assist while Kenny breathed for her. Patrick gowned, scrubbed his hands, and gloved. A nurse applied the disinfectant three separate times to Elizabeth's neck. Louella held the sonogram wand on her chest for Patrick to use as a guide to insert the wire through her right jugular vein into her heart. The only sounds were the ping of the monitor, the squeeze of air into Elizabeth’s lungs, and the breathing of those in the room, though even that was depressed.
"Set to eighty and two volts." Pete turned the dials. The pings became more regular as the device captured her heart. Patrick gave a firm nod, then secured all connections and sutured the wires in place. All heads turned to the panting man in the doorway, Josh's hand firm on the man's shoulder. "Dr. Morton, I presume?"
Doctor Howard Morton approached Elizabeth's bedside. "Dr. Hedges?"
"This is Dr. Elizabeth Reed. She is suffering from refractory high degree heart block due to what we believe is an unknown toxin." The patronizing expression on Dr. Morton's face provoked a growling sound from Patrick.
"Can I examine the placement please?" Morton's tone was mocking.
Patrick placed a firm hand on the fellow's crotch. "I will not ask who influenced your practice of medicine until today, but when the emergency room calls to ask for your assistance for a critical patient, you move. I just placed a pacer wire, thanks to your tardiness, in through her right internal jugular. If you do anything to disrupt it, I will perform an adult circumcision."
The fine sweat on Morton's brow confirmed he got the message.
Steven Keys ran into radiology. "I couldn't believe the page. How is she?"
"I think she was poisoned and seized, causing her to fall and strike her head." Patrick ran down the other possibilities he was considering and the interventions performed since Elizabeth was found.
The technician interrupted, "Full body scan, Doc?"
"Yes," Steven and Patrick responded in unison.
The radiologist sat beside the technician running the scan. "Here we go. The occipital deformity is an old depressed skull fracture. She has a leaking fusiform aneurysm."
"Page Hoyt, stat," Steven choked out.
"Moving down." Images entered and exited the screen as the camera moved down her body. "The good news is her C-spine is fine. She's got pulmonary edema and considerable swelling of her GI tract, liver, and kidneys. I will do a hard read, but load the frames into the system for neurosurgery now," the radiologist instructed her technician.
"The brain bleed goes first. We are pulling straws here if this is a poison?" Patrick rubbed the back of his neck.
"I'll start high dose antibiotics and steroids." Louella left to write orders.
"I think we can try activated charcoal and antacids," Patrick threw out his thoughts. "Bathe her again."
Sterling Hoyt, a neurosurgeon, walked into radiology. "Let me view the films first, and then we will talk. He tapped the screen. "Damn, she's had a previous fracture. No choices here. I have an OR on hold. Steven, do you want to scrub in?"
