Anaphylaxis Page 2

  There wasn’t much time.

  “Dr. Michaels?” Thomas asked.

  I’d forgotten he was here, letting myself focus so much on my magic. I jerked my head up, meeting his eyes. “I need a scalpel. A gown. Sterile gloves. Now.”

  “What for?”

  I let my gaze linger on the dying woman and baby. “Because someone has to save one of these patients, and it might as well be me.”

  2

  Letting my connection to magic continue to swirl around the woman, I struggled to find a way to help her. The sense of emptiness was there, and I continued to try to push out with my magic, trying to find a way to save her. Not just the woman—I needed to save the baby, too. The cold reaching along my spine distracted me, making it difficult to focus on wrapping up the emptiness the same way I had done so before. If I couldn’t do that, if I failed at securing the emptiness, sealing it off and pulling both the woman and her child back from the brink of death, then what good was my magic? Never mind the fact that I had protected the Veil repeatedly. If I failed while using my magic on someone like this—someone who needed me to have both my connection to medicine and magic—then maybe I should do something different.

  “Where the hell are the attendings?” I asked, looking up.

  With Thomas having run off for the supplies I needed, there weren’t any nurses around, leaving me talking to myself. I couldn’t very well leave the patient here, but we had been left alone far too long here.

  If only my magic would help, but it didn’t seem that there was anything for it, and I didn’t dare reach for that cold sense, borrow from the magic drawn from the dying patients.

  Attempting to rescue Barden had taught me that I needed to somehow be both the healer and the mage, though it was difficult to figure out that balance. Maybe it would be easier when I finished my residency, when I was finally able to be out on my own, no longer worried about attendings or working with interns or, possibly, all of the traumas coming through. If I practiced in a more rural setting, I wouldn’t have to worry about any of that.

  Thomas returned, tearing those thoughts from me, letting me focus on the task at hand. Together we hastily set up a sterile field, opening the packaging, throwing the drapes across her belly. I scrubbed quickly at the sink before grabbing sterile gloves and tearing into them. After hurriedly scrubbing her belly with Betadine, I injected lidocaine across the likely incision point.

  Val returned, her eyes going wide as she joined me at the bedside. “What—”

  I waved my hand. “I need propofol for sedation. This has to happen quickly.”

  She ran out, grabbed something off the crash cart, hurried back with the milky white medicine, and administered the dose.

  It wouldn’t be much anesthetic, and unless we had someone come in to help with sedation, there wasn’t much that I could do. The propofol would have to be enough.

  “Are you really going to do this?” Thomas asked as I picked up the scalpel. Val watched me, hovering over my shoulder.

  I pressed my hands on the woman’s belly. Even through the gloves, I could feel life fading from both patient and child.

  The fetal monitor beeped, going silent. The baby was going to die if we did nothing.

  “All the specialties recalled,” Val said softly.

  I looked over at Thomas. “Surgery is not here. OB isn’t here. It’s just me.”

  Hopefully I had sedated her enough to make this as painless as possible. I hoped just as much that we could keep her blood pressure up, but until I got the baby delivered, I wasn’t going to worry quite as much about the mother. For now, she was stable.

  As I made the incision, a voice called out, “What is happening in here?”

  I glanced over at Dr. Roberts. “Uterine rupture. Fetal demise if we do nothing. OB, trauma, and general surgery have all been called. I could use an extra set of hands if you want.”

  He held my gaze for only a moment before hurriedly grabbing a gown and throwing it on. Dr. Roberts could be an ass, but he was skilled and he was on a trauma fellowship, so this was right up his alley.

  “We shouldn’t be doing this here, Kate,” he said softly, holding skin retraction.

  “We shouldn’t, but we don’t have that much choice. Fetal heart rate went from a hundred and ten down to nothing.”

  He glanced up at the monitor. “The mother is stable?”

  “For now, but there has been quite a bit of blood loss, and…”

  We got through the layer of fat and into the muscle layer. Roberts let me continue to cut, and he held steady traction, his hands on either side of the skin, drawing it apart.

  “Have you ever done anything like this before?”

  “I’ve been present during C-sections,” I said.

  “That’s more than I can say,” he said.

  “You didn’t do an OB rotation?” He had finished his ER residency, and we all spent time on OB for just this sort of issue.

  Well, maybe not this sort of issue, but for obstetrical emergencies and the possibility that we might have to deliver a baby urgently. Rarely did anyone ever have to. I imagine the attendings and Hennepin General could count on one hand the number of times they had actually had to deliver a baby. It was an advantage of being in a big hospital like this, especially one with an OB residency. There was always someone around who could take care of that.

  And where were they now?

  Val had said the OB floor was busy, but come on. It couldn’t be that busy.

  I got through the muscle layer, cutting as quickly as I felt comfortable doing.

  As Brad pulled back the layers, we saw the baby.

  “Holy shit,” he said. The baby was floating free within the abdominal cavity. “Previous C-sections?” he asked.

  “Not from what she said, and I didn’t see any scars.”

  “It’s pretty rare for there to be a rupture like this.”

  “She fell down a flight of stairs.”

  Brad clenched his jaw.

  “I’ll hold the skin and you reach for the baby,” I said.

  We swapped places. I stretched the mother’s abdomen apart and he reached in, pulling the baby free. The child was blue, and we quickly clamped and cut the umbilical cord, and I glanced over at Roberts.

  “Can you resuscitate him?” I asked, looking at the baby.

  “I’ve got him, but—”

  “What the hell is going on here?”

  I jerked my head around. Dr. Locks stood in the doorway, his arms crossed over his chest. His gaze darted from me to Roberts before taking in both of our patients.

  “Uterine rupture. Infant dying. All trauma services, including OB called. No one responded. Now, if you want to help me stabilize this woman, that would be great, otherwise, the infant needs some attention.”

  Locks stared at me before his gaze darted over to Roberts, who was holding the baby. “Dammit, let’s get this kid over to a warmer.”

  The room had filled with people in the time since we had started. Someone had managed to bring a baby warmer. At least we had that. But still, no OB.

  After placing the baby in the warmer, Roberts and Locks raced out of the room and I stood with my hands inside this woman’s belly, the lining of her uterus visible, along with bowel. There was blood—so much blood—and no way of suctioning it out. I didn’t have the necessary surgical implements, and even in the trauma bay like this, there wasn’t anything that I could do.

  I didn’t feel comfortable closing her up, not without repairing the lining of the uterus and suctioning out the copious amounts of blood from her belly. For that, I wanted one of the surgery services to come.

  My help came in the form of general surgery, of all things. Thankfully, it was a resident I knew.

  “Nate, God am I glad to see you.”

  Dr. Nate Schneid was a large man, probably six foot four or five, and solid like only a former linebacker could be. He hurriedly gowned and gloved and joined me.

  “Christ, Kate.
What happened here?”

  “She came in at thirty-seven weeks after falling down the stairs. Her uterus had ruptured, and both mother and baby were dying.”

  “I don’t know that I ever heard of somebody operating in the emergency room like this.” He looked over at me. “And certainly not a resident.”

  “There wasn’t any choice.”

  “I get that, I’m just saying that… I guess I’m saying that you’ve got some pretty big balls.”

  I grunted. Val chuckled nearby. “Thanks, I guess?”

  “We can soak some gauze in saline and pack the abdomen. We can cover her up, then we can move her to the OR, where we have a more controlled environment,” Nate said.

  “You don’t want to just finish here?”

  “As much as I might enjoy operating here,” he said, looking around, “you don’t have everything that we need. I’ll let you know what happens with her.”

  “I’ll help you wheel her over.”

  We did as he suggested, packing her belly and then draping sterile drapes over it. When we were done, we hurriedly wheeled her over toward the operating rooms. Thankfully they were on the same floor, but they were quite a ways from the ER. When we got her in there, Nate’s attending, Dr. Balon, took one look and dragged her toward a free operating room, already hollering out to surgical techs.

  I stood, unable to move for a moment.

  After peeling off and disposing of my gloves and gown, I traipsed back toward the emergency room. My feet felt heavy, but I realized that I didn’t feel the sense of cold that I had detected before. It was there, but certainly not as it had been.

  Had we saved them?

  I would have known had the mother declined. I don’t know if I would have noticed with the infant. After Locks and Roberts had taken him away, it was possible that I wouldn’t have detected it.

  When I got back to the ER, I went back to the resident lounge and settled in there, taking a seat on the sofa, simply staring. After a trauma like that, I needed time to regroup.

  Roberts popped his head in the door. “The kid made it.”

  “He what?” I shook my head, trying to drag my thoughts back around and make sense of what he was saying.

  “He made it. We got him intubated and he pinked up. Peds got there and thinks he’s going to do okay.”

  Okay didn’t mean fine, and both Brad and I knew that. We also knew that with as long as he’d been oxygen deprived, there was potential for long-term consequences, but at the same time, the boy would live.

  “What happened with the mother?” Brad asked.

  “General surgery finally showed up.”

  “General surgery and not OB?” I nodded. “That’s going to make someone look terrible.”

  I smiled. “That’s on them for failing to respond in a timely fashion.”

  Roberts grabbed the desk chair situated in front of the computer and dragged it over. He sat with his legs on either side of the backrest, facing me as he leaned on the back of it. “That was pretty impressive what you did there.”

  “What?”

  “Deciding to operate. That’s a gutsy call, and I’m not sure that many others would’ve made it. Most would have been worried about whether they knew enough to do it.”

  “I’m sure you would’ve done the same thing.”

  “I don’t know. I might’ve tried to save the mother, but that wasn’t the right move.”

  “Are you actually complimenting me?”

  “Can’t I comment on the fact that you did well, Michaels?”

  I shrugged. It was odd getting a comment like that from Roberts. I’d known him ever since I started residency, and the two of us had never been close. I didn’t care for the arrogance I always saw from him, but maybe it was more that I didn’t care for the person he was, either. Not only was he arrogant, but he was somewhat slimy, especially when it came to the way he worked with the nurses.

  “Thanks,” I said.

  “You keep up with things like that and they’re going to force you to do the trauma fellowship.”

  “Now you are going on about it too?”

  Roberts frowned. “Why?”

  “It seems that most of the attendings are trying to talk me into a fellowship.”

  “You don’t think they should? God, Michaels, you’re one of the best residents we’ve had come through here. I’m not so full of myself that I can’t recognize that. Hell, you push me to do better in trauma and you’re still just a third-year resident.” He got to his feet and pushed to the chair back into place. “Anyway. I just wanted you to know about the kid.”

  “Thanks. And thanks for your help. I was only thinking about getting into the belly. I wasn’t planning for resuscitating the baby.”

  Robert stared at me for a moment before he started to laugh. “Are you kidding?”

  “I wish that I was. I suspect the nurses would have helped had you not showed up, but then I don’t know if the baby would have pulled through.”

  “Maybe you keep that little tidbit to yourself,” Roberts said.

  “You don’t think that will impress anyone?”

  “Probably not, and it takes away some of your mystique.”

  Roberts headed out, leaving me staring at his back.

  The door to the lounge opened again and Jen entered, glancing over her shoulder at Roberts. “What was that about?”

  “Possibly the strangest thing to have happened today.”

  “Why is that?”

  “Because Roberts complimented me.”

  Jen looked back toward the door. “Oh, no. Kate, don’t go shake off your sadness about Aron by screwing Roberts. That’s something even I wouldn’t do.”

  “Are you sure?”

  “Fine. Anymore. But just because I made the mistake doesn’t mean that you should.” She threw herself down on the sofa and looked over at me, arching a brow. “Why are you covered in blood?”

  I looked down and saw that my white coat was splattered. I leaned my head back, sighing. “Only the second strangest thing to have happened today.” I told her about the trauma and what we had done, and she sat silent until the end.

  “Damn. I guess I can see why Roberts came in to compliment you.”

  “He didn’t come in to compliment me. He came in to tell me that the baby pulled through.”

  “That’s the best part of that story,” Jen said.

  “It’ll be better if the mother pulls through, too.”

  “You gave them every chance they could have.”

  “That’s just it. I don’t know that I did.” I glanced over at the door before setting my gaze around the inside of the lounge. We were alone. “If I had more control over my magic, I might not have needed to have done any of that. I could have healed her. I could’ve saved the baby. And I could have—”

  “Didn’t you tell me your magic can’t do everything?”

  I stared at Jen, nodding slowly. I’d been through quite a bit that my magic wasn’t able to do. Most of my failings had come in situations like this. I’d lost a patient that I had wanted to save, the vampire familiar who might have provided the information I needed before Barden had been abducted, and yet I hadn’t been able to do anything for him.

  “I want to understand it better. I want to be able to use it so that I can help when it comes down to situations like this.”

  “It sounds like you will. You just need a little bit more practice. I thought you were working on that.”

  I squeezed my eyes shut, taking deep breaths. “I have been working on it. It’s just that it’s not entirely easy.”

  “Nothing’s easy. I mean, did you find medical school easy?” She shook her head, smiling. “Don’t answer that. I already know.”

  Maybe that was part of my problem. Medical school had been easy for me, at least relatively so. I graduated near the top of my class, a member of the honor society, and hadn’t really even struggled once I reached residency. The only struggle I had encountered involved trying
to balance my connection to magic rather than trying to master the art of medicine.

  I still struggled with parts of medicine. Every so often, I was reminded of my need for empathy. It was a lesson that one of my earliest friends in the ER, a nurse named Derick, had attempted to remind me of. He had seen enough residents come through who had lost their empathy, and had wanted me to make certain that the same didn’t happen. There were times when I struggled with that, despite my best intentions.

  Occasionally, I would see attendings like Dr. Allen and be reminded of how far I still had to go. It was in the simple things. Not jumping to conclusions about patient motivations. Caring about every reason a patient was in the emergency room. Remembering that their visit was probably the most important thing they might do that day, while spending time in the ER was just another day at work for me. Those were the messages I needed to give myself.

  “I’m going to keep working. I don’t really have much of a choice, especially if I want to help Aron.”

  “How is he?”

  “Not much different. The council doesn’t really know what happened, and other than finally acknowledging that something has changed with him, they aren’t entirely certain what it will take to bring him all the way back, if it is even possible.”

  I swallowed the lump in my throat. I had been developing a connection to Aron when he had nearly died. It might be because of me that he still lived, but what life did he have? He wasn’t the same man he had been before.

  “Are you going to go see him?”

  “Probably not today.”

  “Because your shift was chaotic?”

  I rolled my head over and cocked an eye open. “Chaotic doesn’t really quite explain my shift today.”

  Jen shrugged. “I don’t know. Earlier in the day wasn’t too bad. And if you wouldn’t have gone running into that trauma the way you did, you might not have had such an interesting day.”

  And if I hadn’t done that, it was likely that the mother and baby would both be gone.

  Jen watched me, the hint of a smile at the corner of her mouth suggesting that she knew that as well.