ROUND ONE
OLLIE
“Pedestrian versus vehicle. Female. Early to mid-twenties. Motor vehicle won.” Paramedics crash a stretcher through the emergency room doors of a small hospital in an even smaller town in the middle of nowhere, bringing with them deafening chaos and transforming an otherwise calm, quiet space into something else entirely.
Because maybe this is an ER, and sure, hospitals are typically hectic places, but out here in Plainview, where the population barely exceeds six thousand, and I could list, from memory, every medical emergency every single resident of Plainview has experienced in the last twelve months, that means my ER is, for the most part, a snooze-fest six nights out of seven.
“Unconscious but breathing on her own.” Dara, one of two EMTs, steers the stretcher into a trauma bay and rushes around to stop on her partner’s left. “Heart rate is one-thirty-two. BP’s ninety over fifty-eight. GCS is 7.” On a silent count of three, both EMTs snag the patient’s spinal board and drag her off the stretcher, onto the waiting bed. And while they do that, I visually scan the woman laid out in front of me.
C-collar already in place, her face is smeared in blood and debris from outside. Gravel rash from her temple to her shoulder, a gash on her cheek, a shredded shirt, torn jeans, and lips glowing a dangerous shade of blue.
“Pupils are sluggish. No deformities in her chest or pelvis that I could see.” Not nearly as composed as usual, Dara swings frightened eyes my way. “She was tachy when we scooped her up, then she slowed right down in the rig. Now she’s back up.”
I approach the bloody, busted, half-frozen woman, and while the EMTs move their stretcher out of the way, I snag the penlight from my pocket and pull her eyelids open, one after the other. “Was she conscious at all since you’ve had her?”
“Nope.” Fidgety—entirely out of character for my calm-under-pressure colleague—Dara peels her gloves off and reveals shaking hands. “Stayed out from the scene to here.”
“Alright. I need to get her in for scans. We’ll also prep for intubation, just in case.” I fix my stethoscope over my ears and listen to her lungs, scanning along her too-thin frame over torn, well-worn clothes and an old shoe. Singular. The other is probably still wherever the car is. Her jeans are a size or two—or three—too big for her, held up by a belt circling her stomach twice. “No signs of pneumothorax—lucky for her. Looks like she hasn’t had a warm meal in a while, though.” I swing the stethoscope over the back of my neck and look around for my intern. “Let’s get her upstairs for CT, then to the OR. I justknowwe’re gonna find a mess in there.” I glance toward Dara. “Name?”
“Nope. No ID. No jewelry. No purse. She’s got a nasty lac by her ribs and a massive shard of glass still sitting in there that’ll need irrigation and closure. Didn’t see any obvious fractures in the field, but X-rays might tell a different story. No visible track marks.” Her eyes flicker across and warm the side of my face. “She looks the type, ya know? But I didn’t see any.”
“Head’s the worst of it, then?” I look to my right and meet my intern’s terrified gaze. Bleeding patients scare him, I think. “We’re headed upstairs. Let’s get some saline going. Then I wanna type and cross, get coags, CBC, and lactate. Then we need to look her over from top to toe to make sure we haven’t missed anything.”
“She lost blood in the field.” Dara scampers along beside us, wringing her hands and racing ahead to slap the elevator call button. “Doubt she needs a transfusion, though.”
“She’s young. Looks relatively healthy, if we ignore malnutrition and her war with a ton of steel. Can’t be more than…” I stare at the woman’s youthful face, the clear skin hidden beneath mud and blood. “Mid-twenties at the most. Who hit her?”
The ER doors burst open again, but this time, with a couple of cops and a little old woman I’ve known my whole damn life. “Barbara?” I slap my hand against the open elevator door to stop it from closing again. “What the hell happened?”
“She called it in, Ollie.” Dara stands outside the elevator, her eyes glittering with anxiety. “She sat with her until we arrived. No alcohol on her breath. Didn’t notice anything weird going on. She says the patient ran out onto the road, and Barbara had no time to stop.”
“She hurt?”
Dara shakes her head. “Not at all.”
“Alright. We’ll leave it with the police.” I back up in the elevator and wait for the doors to close, then I look to my just-about-to-hyperventilate intern. “Our patient is breathing on her own. She’s bleeding, but not profusely. She’s strapped to a backboard, and a C-collar is stabilizing her neck. Unconscious is bad, but it is what it is. What do we think?”
“Errr…” He looks down at our Jane and gulps. “I think she smacked her head real good.”
Real good.Fuck me.
“Sluggish pupils suggest the patient has suffered a head injury. CT will tell us how bad it is.”
“And the lac on her ribs?”
His eyes flare wide and drop to her bleach-stained shirt, the old, floppy fabric torn from overuse, then cut by the EMTs on the way here. He tears her shirt aside and reveals a creamy, flat stomach, ribs too easily counted, and a vicious gravel rash spreading from her hip to the underside of her arm.
Something tells me she left a whole bunch of skin on the road tonight.
“Glass, Doctor Darling.” He reaches shaking hands toward the inch-wide shard protruding from her side. “Oh, geez. Why didn’t the paramedics take that out?”
“Fuck’s sake.” I slap his hand away before he can pull it free. “No.”
Stunned, he whips horrified eyes back to mine.
“You don’t take that out till you know what the hell you’re working with.” I grab Jane’s bed and start pushing, timing my steps with the elevator’s arrival and the doors springing open. The wheels roll across the threshold, noisily announcing our arrival, then we cut left and make our way toward CT. “Don’t touch anything. Don’t spend time with the patient alone.” I wave him ahead. “The next time you try something so stupid, I’m sending you to the opposite shift and taking Dawes’ intern. She would never make that kind of mistake.”
“Y-yes, doctor. I’m sorry.” He runs ahead and shoves the next door open, avoiding my eyes as we pass. “We never get these kinds of cases, that’s all. She’s caught me by surprise.”
