get me a central line kit,” Cheyenne ordered. “She needs blood now. And get X Ray in here for a trauma series. Now!”
“Dr. Allison?” came a voice from the hallway. It was her replacement. Jim Brillhart. His tall, lean form filled the doorway. “How can I help?”
She looked up at him, felt the floor rock beneath her.
He rushed forward and caught her arm. “Are you okay?”
“I’m getting ready to do a central line on this patient. I’ll take the jugular so I won’t interfere with CPR.”
“You want me to do it?”
“I’ll be fine.” She refocused on her procedure, felt the sweat coat her neck and chest and trickle down the sides of her face as she tried to keep her hands steady
A tech reported on the CBC and Cheyenne prepared for a transfusion as the respiratory tech came into the crowded room with a report on Susan’s blood gas that deepened Cheyenne’s frown.
“That could be venous,” she said. They missed the artery and got a vein. “Take it again.”
“Dr. Allison, I really don’t think it’s—”
“One more time.”
The X-ray tech brought in the trauma X-ray series and mounted them on the view box.
It showed multiple left rib fractures with a massive collection of blood in the left chest cavity. Multiple pelvic fractures with a ground glass appearance on the X ray.
No, Susan. No!
“Get me a chest-tube setup. And wrap a sheet around her pelvis and tighten it as much as you can.”
Rick looked up from his compressions, though he continued in perfect rhythm. “You want me to stop doing compressions when you put in the chest tube?”
“Yes, but no longer than absolutely necessary. Get somebody fresh to spell you.”
“Let me do the chest tube,” Jim said, “then I’ll take over for Rick.”
“Check for fine V fib,” Cheyenne said as he placed the tube. Susan, baby, work with me. Don’t you dare die on me!
The monitor remained an agonal rhythm, but it now appeared more asystole.
Flatline.
No! She would not let that happen!
“Where’s that surgeon? I need him now.”
“I’m sorry, Dr. Allison, but he’s already been called to University Hospital for disaster code,” Deanna said.
“Then it’s up to us,” Cheyenne said. “Get me a thoracotomy tray.”
Jim looked at her in surprise. “Cheyenne, are you sure about this?”
“Push the epinephrine, Ardis,” Cheyenne said, ignoring him. The thought of opening Susan’s chest and massaging her heart was unthinkable. But it was her sister’s only chance.
“Ardis! Epi. Now.”
“Dr. Allison,” Jim said.
“I’ve got to try it,” she said softly. “This is my sister.”
He gave a shocked, “Oh, dear God no,” then, “Rick, take over back here.” Jim came around the bed to Cheyenne, placed a hand on each shoulder and tried to draw her away from the bed.
She resisted. “I’m still the doctor in charge, Jim. You can’t take me off this case.”
“I’m your director, Cheyenne, and your friend. Listen to me for a moment.”
She looked up at him. “Did you hear me? It’s my sister!”
“I know, but what if it weren’t? What would you do?”
She turned again to Susan’s side.
“She’s a blunt trauma victim, right?”
“That’s right, Dr. Brillhart,” said the paramedic.
“Pulseless for more than twenty minutes?”
“Twenty-five,” Rick said.
“Cheyenne,” Jim said gently. “You need to let her go.”
“I can’t do that. Ardis, push the epinephrine again.”
“You’ve done all you can,” Jim said.
No! I’m still in charge! “I haven’t called this code yet.”
“Cheyenne.” Jim leaned closer. He placed a hand over hers.
She jerked away. “Ardis, why are you waiting? Push the epi! Any word on the second blood gas?”
“Dr. Allison,” Jim said, this time with authority. “You have to call it. She’s gone. She wouldn’t want to come back, even if she could. There’s too much damage.”
Cheyenne felt the dizziness strike once more with blinding swiftness. She couldn’t bear it.
“I can’t call it,” she whispered.
“I’ll do it, then,” Jim said.
“No!”
Silence descended except for the sounds of the monitor, Rick’s labored breathing and the efforts that kept this hopelessly damaged body functioning.
Let her go? She’s already gone.
Cheyenne looked at her watch, then reached for Susan’s hand, covered in blood.
Everyone waited.
I’m so sorry, my baby sister.
“Time of…” Cheyenne swallowed, took a breath of air, which was strong with the scent of blood. “Time of…death, 18:14.”
Rick stopped compressions. The respiratory tech stopped bagging. Ardis set her equipment down and rushed around the bed to Cheyenne’s side.
As Cheyenne felt herself falling, felt hands catching her, she willed herself to descend into death with her sister.
Chapter Four
Dane found Cook in the pantry, sorting through institutional cans of tomato soup.
“Barbecue tonight?” he asked the bony old ranch hand.
“If I can find the molasses,” Cook said over his shoulder.
“If we’re out, I’ll make a run to town.” The boys loved that recipe. “Cook, did Blaze get into the medicine chest?”
The older man turned and frowned at him. “Why would he do that?”
“He had an injury out in the barn lot. Gordy got after us.”
“That blamed ol’ cow’s going to get somebody kilt someday. Since when did you start calling him Blaze?”
Oops. “Since three seconds ago. I’d better go see about him.”
Dane took the stairs and saw a spot of blood on the railing. He went to the closed door of the bedroom Gavin and Willy shared. When he pushed it open he saw Gavin in the center of the room, holding the end of a syringe against the bare flesh of his stomach.
“What are you doing?”
“I’m a bleeder.” The boy wiped a smudge of blood from his arm.
“What’s in the syringe?”
“A coagulant to stop the flow.” He rewrapped the syringe and set it on the top of his dresser.
“Nobody told me,” Dane said.
“Not a lot of people know.”
“How could you keep something like that a secret?”