PHANTOM OF A CHANCE (Part 4/?) By Missy (missy@lexicon.net) DISCLAIMER: The characters that you recognise from ER are the property of Michael Crichton, Warner Bros, Constant Productions and Amblin Television and to the actors who so marvellously portray them. Minor Season 5 spoilers up to and including Double Blind WARNING: This story does get rather gory and explicit in terms of injuries sustained. If you are under 15 years or have a weak stomach for details, I would think twice before reading. But then again, if you watch ER, you can't be too bad Many thanks must go to my editors Susan Drake and Carolyn Delaney for their tireless and marvellous editing and for providing me with wonderful suggestions for the story. PART 4/? "Where's Mark?" The new desk clerk looked up at the softly spoken woman before him. Vince Chiarelli had only been working in the ER for two weeks and he was still trying to put names to faces, without even trying to find out who was related to whom outside the ER. When he had applied for the temporary job, he hadn't associated the shooting with the ER department. There were so many shooting reports on the news, that no single incident stood out. It was only once he had the job and asked why it was only a temporary position, that the situation had been explained to him. "Mark Greene? He's in Trauma Two. But you'll have to wait in chairs." Vince indicated dismissively towards the rapidly filling waiting area. He was being very careful how he interacted with the patients and families after hearing of Jerry's injuries. Although Jerry had survived the shooting, he was still in the CCU recovering from major open heart surgery. Ever since the accident, relatives had been flowing through the doors, anxiously awaiting any details of the victims' conditions. Vince tried to be helpful but at an innocuous distance. Many families had more than one member involved in the accident and were grieving the loss of one relative while still worried about whether another would survive. "Hey Dr. Lewis. What're you doing here?" Randi asked as she returned to the desk. "I'm on vacation." "And you came to County?" Randi continued chewing on her gum. The action helped relieve the tension and didn't allow the nervousness and anxiety pervading the walls to get under her skin. "Man, you need to get a life." "Looks like you're busy." "Yeah. Multi-car versus tanker pile-up." Randi passed the lab results and x-rays she'd just tracked down on the patient in Trauma Two to Vince. "Take these to Dr. Greene immediately." "Randi, give them to me. Would you pass me a lab coat? I'll see if I can borrow a stethoscope. It looks like you're being inundated." Randi grabbed the lab results and x-rays back from Vince and pulled a lab coat from the container under the desk. "Here. I'll see about getting another stethoscope for you to use." "Thanks Randi." Expertly Susan slipped the lab coat on, automatically turning down the collar, and walked at a brisk pace towards Trauma Two. "Who was that?" "Susan Lewis. She was one of our top residents until she transferred to Phoenix a couple of years ago." "Are you sure she should be treating patients? She wouldn't be covered by the hospital's insurance, would she?" He asked the question as the phone began ringing, holding off answering it to hear Randi's reply. "Probably not, but that's not my problem.." She had just picked up the phone to chase down radiology when Anna came to the desk. "County General ER. How can I help you?" The congenial way in which he answered the phone had Randi rolling her eyes. In the short time Vince had been working, she had expected him to have cut short his diatribe when he answered the phone. So far, he had only dropped 'Vince speaking' from his introduction. Randi figured in three weeks and he'd have it down to just 'ER'. "Randi, have you received those x-rays for Stephanie Logan yet?" Anna asked. "No. I'm on them right now." Randi nodded her head, her eyes conveying clearly the thought that she couldn't do everything at once. "Let me know when they're here." "Do we have a Dr. Weaver here?" Vince asked putting the call on hold and spinning the receiver on it's cord while waiting. In the past two weeks, he couldn't recall anyone by that name working. "Yeah. She's an attending here. At the moment though, she's underneath that truck, " Randi said pointedly, referring to the WMCQ news broadcast which kept them informed with continuous coverage of the crisis that was quickly transferring to the ER. "So what should I tell this Brad Weaver who's on the phone?" Vince spun the receiver again, deftly catching it on the last spin around. "Brad Weaver? You're sure he said his name was Brad Weaver?" Randi's eyes narrowed and fastened on him, no longer splitting their attention between the chart, her phone call and Vince. "Yeah." "Give it to me. You had better take this call. I'm on hold to radiology chasing up films on Stephanie Logan." There was an exchange of receivers as Vince immediately followed Randi's instructions. He had heard that tone in her voice before and had so far managed to not be on the receiving end of it. "Brad Weaver?" An affirmative response had Randi continuing, "Dr. Weaver is not here at the moment. She is at the scene of a trauma accident. Can I get Dr. Weaver to call you when she arrives?" Vince noted that his negative answer obviously irritated her. "Well, I'm sorry but she is not here! If you turn on your TV to WMCQ, you can see that Dr. Weaver is at the scene of a major accident and is not available to speak with you at the moment." Vince could hear the irate voice on the other end of Randi's phone telling her to get his sister to call him when she did arrive at the hospital. The phone being slammed down reverberated in Randi's ear, but it was a satisfying feeling to have angered Brad Weaver. "What's up his nose?" "He didn't get what he wanted and I don't think that happens too often." Vince was curious about the story behind this Brad Weaver and the satisfaction Randi was showing at not letting him get his own way for a change. *** "Here are those labs for Katie Logan. Crit is 26 and haemoglobin is 8.2, platelet count is 115," Susan rattled off as she rushed through the open doors into Trauma Two. "Susan?" Carol, Maggie and Haleh looked across at her in astonishment, pausing momentarily in their actions. Lucy frowned at the stunned looks on their faces, unaware of who Susan was. She wore a doctor's lab coat and she read off the lab results like a pro. "Susan? What are you doing he......." Mark broke off as he slipped the stethoscope back around his neck. "Damn. It's Monday, isn't it?" "Uh huh. I thought I might find you here." Susan nodded with her back to him as she pulled the x-rays from their paper sleeve and placed them on the screen. "Randi told me about the accident. It looks like you could do with some help." "Susan, would you? We're swamped. Kerry's at the scene and Doug's still out, so we're short-staffed. What do the x-rays show?" Mark was relieved to have another fully qualified doctor working in the ER, especially one like Susan. She had exhibited outstanding diagnostic skills during her residency at County. Not only that, but he had also found a very special friendship with her, one that had not been broken despite the physical distance between them. "You've got a hematoma of the liver. CT shows a linear fracture across the major dural sinuses." Susan fingered the scans, checking each carefully. "There are lesions in the front temporal region." "Dr. Greene. We've got another six incoming traumas." Malik quickly passed the message on as he turned on his heel to leave and stopped. "Susan?" "Hi Malik. Isn't there an ambulance you should be meeting?" Susan's low tones gently chided him, indicating that they would talk later. "Mark, go meet the ambulances. I'll take over here." "You're sure?" "No problem, Mark. Go." Susan turned her back on Mark, already taking control of the trauma. "Where's the surgical consult? Have we got type specific yet?" "Maggie, come with me." Mark watched Susan a moment and he realised how much he missed her in the ER. After a quick word from Susan, Lucy passed over her stethoscope and Mark could see Susan introducing herself. She quickly was back in routine with Carol and Haleh, while taking the time to find out who Lucy was and use her in the trauma. A call from Malik spurred him into action and Mark stripped off his gown and gloves, tossing them in the hazardous waste basket. Grabbing another set of gloves and gown, he followed Malik down the hall, his long legs quickly catching up with the broad shouldered nurse. As he came alongside, Malik advised him of the incoming traumas. "There are four majors and two minors coming in. Three of the majors have multiple head and chest trauma, two adults; one child. Another child with seizures of unknown origin." As they passed the admit desk, Mark called out to Randi, "Where's Carter?" "Took that young boy in Trauma One up to surgery." "Page Carter and Del Amico. We've got four more majors on the way. Where's Jeanie?" "She's in Exam One with the baby." "Let her know what we've got coming in." By the time they reached the doors, the first of the ambulances were arriving. Mark had just finished slipping on his gloves. He cursed the rain silently as it splattered large blotches across his glasses, reducing his vision. Maggie's hair was quickly becoming a damp mass of curls in the rain. The back doors of the ambulance opened. "What've you got Elizabeth?" Mark was surprised to find her accompanying the patient. Her hair was wet, damp heavy ringlets that had escaped the gold clasp fell haphazardly around her face. "Eight year old male. James Pearson. BP's 100 over 55. Pulse 125. Five witnessed seizures, duration of one minute each. He's got two IV's wide open, saline and Ringer's. Two 10 cc's bolus of D50. Possible head trauma although no obvious sign of injury. Abdomen is soft, non-tender with no distension. GCS is 6." Elizabeth's voice was choked, as she struggled for breath. The fumes from the petroleum at the scene had filled her lungs and clogged her throat. "Take him through to Trauma One." Mark stayed with Elizabeth, wanting more information on what was happening out in the field. Carter and Anna arrived at their sides, both still fresh and ready for any trauma. Mark knew that it would only take a few more hours before they would be looking forward to the end of their shifts. From the look of the accident, it would probably also be their first chance to put up their feet and have something to eat. "We've got another three majors and two minors following. Carter, why don't you join Dr. Corday on this case. Maggie and Anna, take the next one. I'll be out with you in a moment." Maggie and Anna stopped pushing the gurney and headed back to the ambulance bay. The spring in Carter's step made Mark feel every second of his thirty-something years. Mark could remember the challenges he felt as a young intern, but he could never remember having Carter's zest and confidence at such a young age. "Elizabeth, where is Kerry?" Mark asked as they rolled the young boy into Trauma One, pushing the gurney alongside the trauma table. "On my count. One, two and three." They all moved the young boy gently over to the trauma room gurney, careful not to exacerbate his injuries. "She is still in the van underneath the tanker. CBC with lytes, BUN and creatinine, serial blood gases, PT, PTT, U/A, type and cross for six. Run in fifteen migs per kilo dilantin." Elizabeth had dismissed Mark's questions, giving the boy her full attention. "They haven't gotten her out yet?" Mark was worried. He had seen the precarious position of the van Randi saw Kerry enter. "BP's 90 over 50," Malik reported. "Start an arterial line and get a transducer to monitor the intracranial pressure." Elizabeth pulled the stethoscope from around her neck. "No, Mark, they haven't got her out yet. The tanker has crushed the van further but the fire department have got cabling supporting it now. They said it would take about an hour before they could get them out." Elizabeth placed the ends of the stethoscope in her ears and listened to the boy's breathing. Carter started the arterial line, shooting glances between Elizabeth and Mark. Her tone was enough to give a warning to Mark to let her get on with her work without the way she was clipping her words, yet Mark seemed oblivious. "How is she?" "Pulse ox. is 87," Conni inserted, giving Mark a questioning look. "She is perfectly fine, Mark. Carter and I can handle this." Elizabeth's last words were taut, cutting short the conversation. She didn't need the distraction of his questions. Her worry about Kerry at the scene and not monitoring the boy had caused enough problems. She wasn't about to do it twice. Raising his eyebrows in surprise at the rebuff, Mark pushed his way through the adjoining door to Trauma Two as Katie Logan was being pushed out toward the elevators. Susan was stripping off her gloves and housekeeping was already clearing the debris from the floor, ready for the next trauma. "How's it going? We've got more coming in." "Romano's taking her up to surgery now. He decided the liver hematoma should be managed surgically." Susan's tone held her obvious disagreement with his assessment. "He's a bombastic bastard, isn't he? I'm amazed no one has strung him up by his testicles." They made their way out of Trauma Two and walked at a steady pace back to the ambulance bay. "You may have to get in line. I think Corday, Weaver and Doyle have been drawing straws as to what part they want to remove first." Susan laughed. "Who's Corday?" "Elizabeth Corday was a fifth year surgical fellow from England, studying here with Romano's sponsorship. She has been lowered to the status of surgical intern after Romano cut off her sponsorship. Maggie, take him into Trauma Two," Mark instructed as they both pulled out of the way against the wall to allow the gurney containing an unconscious man in his mid-forties to be rushed passed them. The paramedic was spurting out his vitals while continuing evenly paced compressions on the ambu-bag. Mark noticed Lucy Knight coming down the hall, another stethoscope in her hand. "Lucy, go in and help Dr. Doyle." The young medical student gave him a quick smile of appreciation. Her start in the ER had been a rough one after a grating relationship with her teacher, John Carter. The girl showed promise and Mark was making sure he kept a close eye on all the medical students and their teachers, ensuring that all were being trained and there would not be a repeat of the debacle. "Can I ask why?" Susan inquired, pulling Mark back into the conversation on Elizabeth Corday and Romano as they reached the admit desk. Susan grabbed another set of gloves, ready for the next trauma which was just coming through the door. "She hasn't said but it wouldn't surprise me if Elizabeth rebuffed his advances. Romano's not backward in his approach." "That's sexual harassment." "Yeah, but you've got to be able to prove it. "You have to remember that he's their rising star." Their discussion was halted as they met the paramedics and gurney coming around the corner. "40 year old female. Jenny Pearson. Complaining of severe shortness of breath, BP's 80 palp, Pulse 130. Diminished breath sounds bilaterally. Head and chest injuries, compound fractures to both legs. Two units of saline in the field. She's lost approximately a litre and a half of blood." The blonde haired woman was crying, tears rolling down her face. Her constant questions about her family were being muffled by the oxygen mask over her nose and mouth. She stretched out her hand and caught Mark's arm at the side of the gurney. "Please. Save my children. Don't let them die." Mark's eyes met with the paramedics pushing the gurney. A quick shake of their heads answered his unspoken question. She had already lost a child. Mark gave the woman's hand a small squeeze of reassurance with his right hand before disengaging her tight grip on his left arm. "Susan, take her into Curtain Two." Mark called out after them. His Chief Resident, Sam Cheung, had just returned from delivering one of the patients to the OR. Mark was about to call out to him to go assist in the trauma rooms but Sam was already pushing open the doors to Trauma One. The hallway was quickly becoming an obstacle course. A maze of gurneys holding patients with minor injuries lined the walls in between the carts containing linen and supplies. As he passed by, he noted the varying reactions of the patients. An occasional patient would grab at him when they recognised his white coat, the pain and fear in their eyes reinforcing their cry for help. Others just lay on their gurneys, a dull acceptance of their pain and the time that it would take to be treated. Some days it was harder to go past these patients without being tempted to give them at least something. Years of experience had taught him to not give into these sentimentalities. The triage system was there for the patients and any breaking of the system would only lead to havoc. Before he could dwell any longer on this thought, another patient was being rushed in. "Eight year old male. Joshua Pearson. BP's 75 over 40. Pulse is weak and thready. Head and chest injuries. He's had one litre of saline in the field. He's got two large bore IVs, Ringer's and normal saline." The dark haired boy looked small, strapped onto the backboard. His head firmly held in place by the yellow cushioned padding on either side of his head. Anna was in control of the ambu-bag, listening intently to the vital statistics while also observing the boy for herself. Mark allowed himself to be swept up with the trauma. Gina and Yosh immediately stopped their non-urgent cases to assist. "Where to?" asked the paramedic. "Exam One." As they were pushing the gurney into Exam One, Jeanie came alongside. "Need any help?" "Of course." "Ready everyone? One, two and over. Get a CBC, Chem 7, ABG, coag panel, H&H, six units of O-neg., type and cross for four," Mark instructed as he began his assessment of the young boy. Jeanie checked the boy's reflexes, commenting on the results as she did so. Gina and Yosh completed the transfer of the IV bags and drawing blood for the lab work just ordered. "I've got diminished breath sounds. I'll tube him. Size 5.5 ET tube." Anna commented as she draped her stethoscope once again around her neck, hand ready to receive the laryngoscope to enable her to insert the endotracheal tube. - 0 0 0 - "Mannitol, five migs per kilo," Carter instructed. "I need to intubate him. Get an ET tray. Where is the radiologist? Call them and find out what's taking so long." Elizabeth's instructions were short and to the point with no room for any discussion. All the staff moved quickly in response, although the darting glances at the sodden surgical resident were mixed with concern and surprise. "Size 5.5 ET tube." Elizabeth instructed. She gripped the laryngoscope and endotracheal tube a bit more firmly as her hands shook lightly from the cold. Bending over and maneuvering the boy's head into the right position, she sighted the vocal cords and fed the endotracheal tube in. Pulling the laryngoscope out, she removed the stylet allowing Conni to attach the bag. As Elizabeth straightened, it seemed that the room moved before her eyes. Gripping the side of the gurney, she closed her eyes for a moment, hoping it would help, only to find that it exacerbated the problem. Her vision dimmed and faded rapidly. "Dr. Corday?" Conni asked, noticing the sudden tight grip she had on the gurney. The words were only just out of her mouth when Elizabeth collapsed forwards, her face catching the side of the gurney, on her downward spiral to the floor. Her collapse stunned everyone for a moment before Carter took action. End Part 4/?