the same age at sixteen, was shot in the chest. We intubated him in the field but his vitals are deteriorating rapidly. Fluids going wide open through two peripheral antecubital IVs.”
Of the two, the chest wound was by far the more serious and required immediate attention. Jillian raised her voice. “Call for a cardiovascular surgery consult, stat.”
“We already did, when the call about a gunshot wound to the chest first came in,” Bonnie, one of the trauma nurses, quickly explained. “They were finishing up in surgery and planned to send a surgeon down.”
“I don’t see anyone yet. Call them again,” Jillian ordered.
Another nurse picked up the phone to send a second page.
“Blood pressure barely 70 systolic and heart rate irregular and tachy at 120,” Bonnie called out. “Looks like he may be trying to go into a wide complex rhythm.”
Jillian wasn’t surprised to see one of the paramedics kneeling on the gurney beside the second victim, keeping pressure on the chest wound. As the nurses fell into their respective roles on each side of the gurney, she donned sterile gloves and moved closer to examine the severity of the wound.
“Thanks, I have it now.” She waved a hand, indicating he could let up on the wound. A flash of silver on a badge caught her eye and belatedly she realized the man holding pressure wasn’t a paramedic at all but a cop.
He released pressure and immediately blood pooled in the center of the young man’s chest. The cop slammed his hands back down, covering the gaping wound and leaning his weight over the area. “Dammit, he’s going to bleed to death before the surgeon gets here.”
Jillian couldn’t argue—the brief glimpse she’d had of the injury told her it was bad. She snapped out orders. “I want four units of O-negative blood running through both IVs for a total of eight units, using the rapid infuser. Get this kid’s blood pressure up before we lose him. I also want a portable suction unit here so I can examine this wound.”
Marianne, another nurse, wheeled over a suction unit. Grabbing a pack of sterile gauze off the instrument table, Jillian turned back to the patient. She glanced up at the cop, registering a flash of recognition as she met his intense dark green eyes. “Let up on the wound again and this time stay off.”
His expression grim, he nodded.
When he lifted his hands she shoved the sterile end of the suction catheter into the area to clear most of the blood. Using the gauze to soak up the remaining blood, she examined the wound.
“The bullet must have gone through the pericardial sac and injured his heart.” The injury to the boy’s chest was bad, but he had youth on his side. The young could survive a lot more than your average older adult. “Where’s the surgeon?”
“He’s on the way,” Bonnie responded.
“Blood pressure continuing to drop despite the blood transfusions,” Marianne informed her in a terse tone. “We’ll need to start CPR.”
“Give me another minute.” Jillian continued sucking the blood from the wound, and then carefully packed the area with gauze, hoping to buy the kid a little more time.
“Dr. Raymond from CT surgery is here.”
Finally.
“We lost his pressure!” Marianne cried.
No! Jillian stared at the monitor then glanced down at the boy. “Start CPR.”
The cop still kneeling on the gurney placed his hands over the center of the kid’s chest and began giving chest compressions. Blood continued to seep from the wound. She didn’t waste time telling him to get down—for one thing the strength of his compressions were better than most, and for another, if they didn’t fix the hole in this kid’s heart soon, their efforts would be futile anyway.
“A bullet punctured the pericardial sac and grazed his myocardium.” Jillian quickly gave the surgeon the details. “He’ll need to go to the OR.”
Todd Raymond shook his head as he glanced at the vital signs displayed on the heart monitor. “It’s no use. He won’t make it to the OR, he’s lost too much blood.”
Jillian couldn’t believe his caviler attitude. Was he really going to give up that easily? She held onto her temper with an effort. “Are you telling me you’re not even going to try?”
He shrugged. “What do you want me to do—open his chest here?”
“Get the chest tray, stat!” Jillian knew their efforts might be useless but this was a teenager, for heaven’s sake! Didn’t this child deserve every chance possible? “I’ll give him some sedation.”
When the tray was open and ready, the cop stopped giving compressions and jumped down from the gurney, knowing without being told that his assistance was no longer needed.
The alarm on the monitor overhead went off as the kid’s heart rhythm went straight line without the aid of CPR. Jillian wasn’t a surgeon but she didn’t flinch when Todd drew his scalpel down the center of the boy’s chest, meeting up with the open area left by the bullet.
“Hand me MacMillan forceps,” Todd said as he opened the ribs to inspect the damage to the boy’s heart.
She did as he asked, but at that moment the fingers of her right hand went numb and tingly, causing her to drop them. For a split second her horrified gaze met the cop’s. Good thing the forceps had dropped onto the sterile field. She quickly picked them up again and handed them over.
“His left ventricle is severely damaged,” Todd muttered as he used the forceps to trace the path of the bullet. Jillian stuck more gauze into the blood-filled cavity. “The right lung is also a mess—the bullet tore through both the middle and upper lobes.”
“Try open heart massage,” Jillian demanded. “Maybe if we can get his blood circulating long enough to get him on the heart-lung bypass machine…”
Todd Raymond did as she asked and massaged the heart, coaxing it back to some semblance of normal function, but even as they all stared at the straight line where the heart rhythm should have been on the monitor, she knew it was too late.
“It’s over.” Todd removed his hands from the kid’s chest and turned away. “I’m sorry. But with the injuries he’d sustained, his chance of survival was less than five percent.”
He wasn’t a percentage, he was a child! She wanted to scream, rant and rave at the tragic death but held herself in check. This boy wasn’t the first patient she’d lost and unfortunately she doubted he’d be the last. She opened and closed the fingers of her right hand, trying to shake off the strange sensation. “Thanks for coming down, Todd.”
“Sure.” The surgeon stripped off his bloody gown and gloves, tossed them in the red-trash bag and left.
Jillian forced herself to turn her attention to the team of personnel working over the first victim. She’d left her senior resident in charge, using her expertise on the sicker of the two patients. “How are things going, Jack?”
“Fine. He’s stable. The trauma surgery team is taking him to the OR to repair the damage to his intestines.” Jack Dempsy seemed to have everything under control. As she watched, the surgeons packed up the gurney and wheeled John Doe number one away.
“Good.” At least they hadn’t lost them both. Losing one young man was bad enough.
When she turned back to the first victim, she saw the cop still standing there, staring down at the kid, seemingly unaware of the nurses who were clearing equipment out of the way.
When Marianne moved to pick up the remains of the boy’s bloody shirt and pants, the cop held out his hand. “I’ll take those.”
Marianne glanced at Jillian for confirmation and she nodded, granting her permission. The nurse dropped the bloody clothes in a plastic bag and handed them over. He took the bag