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intubatedangel · 1 year

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Code Red : Chapter 6

The flu has pretty much gone, I didn’t get this done sooner thanks to a busy weekend. I’m glad so many of you are enjoying this and are invested in Anna’s story. Will she live or will the team lose her? I’d love to see your thoughts.

Story Index

Chapter 1 | Chapter 2 | Chapter 3 | Chapter 4 | Chapter 5

* * *

Carl's arms were starting to burn. He'd only been delivering the forceful compressions for 2 minutes. He was out of practice. He usually ran a code, giving the orders and performing procedures. He always had Anna on hand to give compressions. She was incredible, she could do compressions at a perfect depth and rate for over 5 minutes with ease. But she couldn't give those chest compressions to herself. Not when she was lying underneath his hands in full cardiac arrest.

Carl looked around the trauma room, taking stock of what needed done. They needed to start a central line to get the plasma and TXA into Anna's body alongside the cross matched blood that should all be arriving soon. With the rapid infuser and a surgeon on site they would hopefully get Anna's blood pressure back up, they'd need to constantly monitor that with an arterial line. There hadn't been any point up to now, messing around with a cuff would have wasted time just to tell them that Anna's BP was practically non-existent. Anna's abdomen would need sterilised too.

Next he checked who he had to work with. In the trauma room with him were four nurses, a paramedic, a surgeon and a cop. He liked Officer Jones, but at this point he wouldn't be of any use. Jessica still looked worn out. Mark was an option to take over, but Carl knew the nurse had been shaken by his own attitude. The situation was too important, Anna was too important, to put in someone he wasn't absolutely confident in. He struggled for a moment, his gaze drifting down to her face. Her eyes were closed, her skin ghostly pale. He could only see a small portion of her lips in the gaps of the tube holder, but what he could see was a bloodless grey. He shook his head. He couldn't dwell on it. Right now, she needed Dr Teague the professional. Not Carl, the man who loved her.

"Sarah." He said to the nurse closest to him, her hand squeezing the ambu bag every few seconds. "Take over after this cycle. Lucy, swap onto the bag." He told the paramedic, who swiftly skirted around to the head of the bed and took the rubbery blue bulb from Sarah. The nurse shifted into position opposite him, mounting the step attached to the gurney. "No pulse check, straight in." He told her. They all knew they would feel nothing. "3...2...1!" He pulled away, Sarah instantly taking over, her hands thrusting Anna's sternum down to the perfect depth.

Carl took just a moment to catch his breath, then launched into orders. "Trish, get an arterial line in her wrist, I want a constant BP on the monitor. Jessica, prep her abdomen. Mark, handle the blood order when it gets here, full units in the infuser, I'll set a central line for the others."

As he was grabbing the central IV kit he glanced over to the phone, where Dr Edwards was requesting equipment from upstairs.

"Just bring a variety of grafts down, I have no idea what I'm going to find, but I need to get in there now." She was saying. Her gaze lingered on Anna's belly as it popped and rolled from Sarah's efforts, as she listened to whoever was on the other end of the phone. "Now dammit! It... It's one of our own."

* * *

Carl had to locate the jugular vein mostly by touch, Anna's blood volume so low that the vessel was almost hidden. At least it gave something to concentrate on, instead of how deathly cold her skin felt, even through his latex gloves. He managed to find it, framing it between his fingers before he took the wide bore cannula and slid it through her skin, into the vein. As soon as it was in he took the included bandage and laid it over the needle and around the port, securing it. He finished the line with a 3 port connector, ready for the TXA, FFP and leaving a spare for quick drug insertion.

He was still leaning over when he looked up, checking the progress of the others. Instead, he got a full view of her breasts, wobbling and shaking each time her chest was forced down then recoiled. His tore his eyes away, clenching a fist. He closed his eyes tight, gritting his teeth as he tried to banish the images from the weekend before, when he'd made those breasts jiggle in far more pleasurable circumstances.

He failed, and in doing so all the other walls broke down. It wasn't the sexual element that shattered him. It was who it had become attached too. Thinking of that evening drew out the feelings he'd felt then. The depth of his love for the woman he'd spent it with. The woman whose heart had become so tied to his own. A heart that, were it not for the pounding compressions, would be laying unmoving in her chest.

From the moment he had seen her lying on the landing, drenched in her own blood, he had been forcing the fear away, attempting to contain it. To bury it. To focus on being the doctor. It was nowhere near enough. He had never loved anyone as much as he loved her. And now he was losing her. The grief was smothering him, punctuated by the persistent whine of the monitor.

He couldn't do this. He opened his eyes, looking down at her face. Her hair was spread out around her head like a dark halo, framing her pale and lifeless features. He didn't have the strength to fight his hand as it reached out and stroked her head, his fingers gliding across the silky smooth locks of deep auburn. He felt the tears stinging the corners of his eyes as he leaned down and kissed her forehead.

She needs you.

I can't watch her die.

Then don't. Save her! Take that fear and use it!

It was similar to what he had told her, when she was struggling with the interest they shared. When it was distracting her from the work at hand. Don't fight it. Don't bury it. Utilise it. Let it become an enhancement to your efforts.

His eyes snapped open, letting a tear splash down onto Anna's cheek. He took a deep breath as he pulled himself back together. He was Carl, the man who loved her. And Dr Teague, the professional. Both of them together, ready to do anything to save her.

* * *

Trish managed to establish the art-line in just a handful of seconds. As diminished as Anna's blood vessels were, the radial artery was easy to find. It was the one they palpated for a pulse, they all knew it by heart. They could find it, even if there was no heart beating.

Trish inserted the needle and hooked the line up to the monitor within just a single minute. She looked up to Carl for further orders. That was when she saw the clear conflict within him. She felt like an absolute fool. She'd come so close to losing her head, so close to falling apart completely. She was Anna's best friend.

Carl was so much more than that. The kiss he gave her was so tender, his tears so painful to see. Then she saw the shift in his manner. He stilled, the shuddering fear disappearing in an instant. He straightened up, looking straight at her, his eyes ablaze with something new. It took her a moment to realise that fire within him was determination. As frantic and desperate as the situation was, Trish felt a core of steel settle within herself.

By then Carl had already looked at the cannula in Anna's wrist, then the trace it reported to the monitor, a gentle bump each time Sarah's hands caved in Anna's ribs, squeezing her heart and pushing blood through her body. The flashing reading beside it was grim. 37 on top, a pair of dashes below. And that was with nearly four full units pushed in by the rapid infuser.

Trish followed his gaze as he then looked at Anna's bloody abdomen. Jessica had taken a bottle of iodine and had liberally splashed it over Anna's belly, an orange brown flood washing over the lingering scarlet swirls and becoming a deep dirty brown as it mixed with the fresh blood that trickled from the wounds each time Sarah sent an artificial pulse through Anna's body. The nurse used a small swab on a stick to spread the disinfectant, creating a wide area of yellow tinged skin for the surgeon. No one bothered with drapes, there wasn't time. What was necessary had been done, that was all that mattered.

Dr Edwards rolled over a trolley loaded with surgical instruments, not a full complement, but what they kept in the cupboards of the trauma room. For situations that were at least similar to this. Not even those bureaucratic types who managed and planned the trauma rooms would ever have expected the tools would be used to try and save the life of a nurse who had been stabbed in the very hospital she worked in.

It was a moot point now. One of their nurses, their best even, their colleague and their friend, was lying on that trauma bed, her heart stilled in her chest because she had lost so much blood. They couldn't allow it to stand. They had to do everything in their power to stop the bleeding, to get that small heart in that petite chest to beat once more.

Edwards had scrubbed up and donned a pair of cream latex gloves that reached almost to her elbow. In her hand was a gleaming scalpel. "Have that suction ready," she said, looking at the steady rivulet of blood being forced out by the compressions. "Two units at least." She told Jessica, who had just finished adjusting the large articulated lights over the trauma bed. The nurse quickly pulled a different trolley over then rushed through a pair of connecting doors to fetch a matching unit from Trauma 1.

Trish watched as Edwards stepped up to the side of the bed, taking a deep breath. It was clear that she could feel the tension in the room. "Hold compressions while I make the first incision." She said aloud. As soon as the rhythmic distending stopped she lowered the scalpel to Anna's belly, the insanely sharp blade seeming to meet no resistance as it cut through skin and flesh, drawing a thin red line across Anna's yellow stained abdomen.

* * *

Carl motioned to Lucy and Sarah to switch places, then watched as the surgeon cut through flesh and muscle, the thin red line rapidly thickening as she got through the final layer, the free blood in Anna's abdominal cavity rushing out. "Resume compressions!" Edwards commanded, then glanced to Jessica. "Hand me the retractors." Anna's belly began to bulge again as Lucy started to thrust down on her sternum, each compression forcing a gout of blood from the incision. The scarlet flow doubled when Edwards inserted the retractors, cranking them open to create a gaping hole into Anna's abdomen. Blood cascaded down her side, the existing stain on the white sheet beneath her shorn scrubs expanding in seconds, saturating the fabric to the point that Anna's blood began to drip off the side onto the floor.

"Get that suction in there!" Edwards shouted at Jessica, who had been momentarily stunned by the sheer scale of the flow. She started, grabbing the suction tube in one hand, flicking on the machine with the other, before plunging the end of the suction in to the turbulent crimson pool. The machine hummed, quickly drowned out by the slurping sound coming from the tube itself. Carl knew that much blood had to mean a completely severed artery. He felt his fear rising again but took it and pushed it towards action. He was moving towards the second suction unit when the door opened, drawing his focus.

It was the blood order. He diverted away from the suction, meeting the tech halfway, snatching the bag out of his hands. He took it to the counter, grateful to see Mark already moving over. He pulled open the bag, taking out 4 red bags and handing them off to Mark, who went to swap the near empty bags. There was another 6 units of blood still in there, along with 2 trios of different bags. He took one of each of those, spiking them with an IV line. While walking back to the bed he looked over at the tech. "Is there another batch ready to go?"

The tech nodded, but also shrugged, drawing an arch look from Carl. "We've got another full batch, but that's it."

"What? How?" Carl had to fight to contain the flare of anger. This was a major trauma centre, they should be carrying much more than 20 units of a single type.

"This is the third trauma patient in 2 hours with that type, plus a dozen surgeries through the day." He shrugged again, speaking with a blasé tone. "It's just bad luck."

Carl let his anger come through. He spun the tech to look at the bed. "That is one of the best nurses you'll ever see. One of the best people you'll ever see." The tech paled as he realised who was on the bed and saw the state she was in.

"We...we've already called the regional bank, a resupply is coming in an hour or so." The tech told him, dragging his gaze away from the intensive resuscitation efforts.

"Not good enough." Carl said. The regional blood bank was only 10 minutes away at a normal driving speed. "Call them again, tell them to have matched blood ready to go. Jones!" He called to the police officer who had until now been keeping out of the way of the medical professionals. "You know where the blood bank is?"

He nodded. "Donated there myself just last month." He said, already moving for the door, giving Lucy a quick glance before disappearing. The paramedic was too focused on compressions to acknowledge him. The tech was still stood there.

"Go!" Carl's voice wasn't loud but carried enough command to send the tech scurrying to comply, almost crashing into a green scrubbed young man pushing a cart through the doors.

* * *

Edwards stayed out of the discussion about blood, silently wondering if Carl's overstepping was going to cause trouble in the future. Not that she disagreed with anything he had done. The damage inside Anna's belly was severe. She was going to need a considerable amount of surgery to fix everything that had been caught by the knife and it would require a substantial amount of blood products. That was a secondary concern right now. Edwards didn't need to fix everything. She just needed to repair the worst of it and reduce the bleeding enough to get the nurse's heart beating again.

If only it was that easy.

The single suction unit was barely keeping up with the blood being forced out by each compression, it didn't have a chance of clearing the field. Edwards was able to make some headway with large gauze swabs, plunging them in and removing them seconds later, having already reached their limit. She was finally getting a half decent view when there was a commotion at the door.

"Steady on!" A voice she recognised exclaimed. She raised her head to see one of the surgical department's trainees dodging around the tech, finally arriving with the requested equipment.

"Zach! Get that tray over here then scrub in to assist!" She called, before turning back to the mess of Anna's insides. She hadn't cleared all the blood, but she had enough visibility to identify one of the major bleeds. Carl had come over and hung the additional bags running into the central line and was now looking to her. "Renal artery has been completely severed." She told him, before looking at Jessica. "Hand me a vascular clamp." The nurse kept the suction in place with one hand, reaching for a clamp with the other. "Next one along." Edwards told her, prompting the nurse to hand her the more suitable metal device. Delving deep with her fingers into the pulsating sea of blood, she followed the spilling vessel back enough to give her plenty to work with, then guided the clamp along the back of her digits and secured it on the artery, reducing that flow to a trickle.

Zach stepped up to the table opposite her, immediately operating the second suction unit, poking the end of the tube deep into the surgical opening. Edwards waited for a few moments. With two suction units removing blood, and the major artery no longer spilling it, the field should be clearing. The level of blood reduced somewhat. But not enough. Fresh blood was still pumping into Anna's abdominal cavity. Clamping the renal artery had only served to redirect it.

Edwards looked up at Carl, shaking her head. "There's another major bleeder, maybe more than one. It's just too much. I can't stop what I can't see."

Carl didn't say anything, couldn't say anything. The monitor continued to scream, the ecg showing an unbroken asystole. The blood pressure reading had barely changed, the line showing only small bumps. He looked at the clock. 3:57. Anna's heart had stopped 15 minutes ago. She was running out of time, and he was running out of options to do anything about it.

#Resus Writing #CPR #Defib #Anna Swift #Asystole #Dark Cardiophilia #Medical Drama #Intubation

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