SPIRIT OF CHRISTMAS by Michelle Creek (missy@ipax.com.au) AUTHOR'S NOTES: This story was put together just after the episode of 'Exodus' although it has been adapted to allow for some of the events which took place in subsequent episodes to the end of Season Four. All of the medical dramas were written directly after Exodus. I know there are a couple of ideas which are similar to following eps. I debated on removing them but they will be needed at a later stage. So forgive me for those. It is also written in an episodic style. It is set two nights prior to Christmas 1998 and the ER Department is still awaiting the appointment of a new Chief of Emergency Services. In the meantime, Dr. Kerry Weaver has continued in the position of Acting Chief. Dr. Elizabeth Corday has a new sponsor, namely Dr. Mark Greene (don't ask me to explain this - just an idea) and Dr. Doug Ross has been appointed Pediatric Attending on the basis that he obtains his Board Certification in Emergency Medicine. Characters appearing that you know: Dr. Mark Greene, Dr. Kerry Weaver, Dr. Doug Ross, Dr. Elizabeth Corday, Dr. Anna Del Amico, Dr. John Carter, Dr. Peter Benton, Dr. Maggie Doyle, Jeanie Boulet, Carol Hathaway, Haleh Adams, Conni Oligiario, Malik McGrath, Yoshi, Lily, Lydia Wright, Jerry Markovic, Randi Franzacki, DISCLAIMER: These are the property of Michael Crichton, Warner Bros, Constant Productions and Amblin Television and to the actors who so marvellously portray them. The following characters have been added for my own benefit: Dr. Ashlea Waters, Intern, Dr. Samuel Cheung, Chief Resident, Vikash Randivara, Medical Student, Kate McPherson, Physician's Assistant, Meredith Chandler and Amara Ngaru, Registered Nurses. Description of procedures and medications have been obtained from "The medicine of ER" by Drs. A. D. Ross & H. Gibbs, Blacks Medical Dictionary, Johns Hopkins Medical Manual, Medico-Legal Dictionary and the CDC, Atlanta USA. Any errors are my own interpretations. Now with all the legals over, here it is and I hope you like it. PART 1/? Chaos reigned in the Emergency Room Department of County General Hospital at late afternoon. Blizzard conditions over the past couple of days had resulted in an increase in out-patients. Snow continued to fall as a child cried, while the TV blared out its news coverage on the weather pattern. A frazzled mother tried to calm the screaming baby as her two older children raced each other around the chairs and over the feet of other waiting patients. Another middle aged woman moaned about her pains and the time being taken to see her. An elderly man, clearly showing signs of intoxication, belted out his slurred discordant rendition of 'Moon River' over the cacophony. With Christmas in two days, decorations adorned the walls and waiting area of the ER. One of the many food poisoning cases suddenly was overwhelmed by the pain and left the contents of his stomach on Lydia's shoes just as she walked past. Grimacing, she called out to Malik at the nurses station to call housekeeping to clean up the mess while she went to clean her shoes. "Carol, these are the last three food poisoning cases to be treated and hopefully that's it. We've had no further admits in the last hour." Haleh commented to Carol who was just beginning her evening shift, handing her the charts. "Weaver's allocated them to Carter and Anna and she'll be the attending." Dr. Kerry Weaver came to the administration desk, a completed chart in hand dropping it into the holder for completed cases to be made into official files. "Jerry, contact pharmacy and find out what's happened to the stock orders" she requested as she went across and cleared the patient's name from the admittance board. It would not be long before another patient's name filled the gap. At this time of year the admit board was always full and a full moon seemed to have only increased the workload. Jerry, on the phone to the labs chasing up blood work, nodded in acknowledgement of the request. "Busy day?" Carol asked. "Twenty-five cases of food poisoning" Lily commented as she went across to Kerry to have the case signed off by her as attending physician. "Nope, twenty-eight." Haleh corrected as she indicated to the final three charts. Jerry finished his call and dialled pharmacy. Finding a box of Yum Cha selections on the desk, he selected an pork roll. "I wouldn't be eating that unless you want to join the other food poisoning cases. " Kerry commented as she passed by Carol, collecting the three charts from her. Jerry's hand holding the roll froze, his mouth wide open ready to eat the tasty morsel. Mortified, he looked twice at the offending roll, debating whether to risk it, before tossing it back into the container and dumping the entire contents into the trash in disgust. Carter came through minus his bouncy step, his face decidedly free from his usual grin after having to treat an unusual proportion of food poisoning cases, several charts in his hand, grateful to be able to have them signed off as completed. "Carter, Weaver's got the last of the cases in Exam 4. I think she's waiting for you." Lily advised with a grin. Dropping the charts in her hands, he gave a pained look before heading to Exam 4 as he was directed. "Help me, please" cried a distressed woman as she rushed through the emergency room doors carrying a young boy. He was in obvious respiratory distress. "He's having an asthma attack." Carol came around to the mother, taking the child from his mother's arms as she quickly took charge, placing him on a gurney. "Jerry, call Doug immediately to Exam One." Carol called out as she and Lily pushed the trolley to Exam Room 1. Jerry handed over a clipboard with the usual forms to Lily as she went past and sending a passing med student to get Dr. Ross to Exam Room 1 stat. As the trolley was wheeled into the exam room, they put it into a sitting position to help the boy breath easier, immediately grabbing the oxygen mask to assist him with his breathing. "What's his name?" Carol asked. "David, David Collins" Mrs. Collins replied her voice choked with suppressed tears, distressed by her son's condition. Lily connected the pulse ox monitor while Carol placed her stethoscope on the boy's back. "David, I want you to take a deep breath in and then out when I say so, okay." Carol said gently. The small boy nodded his head, still struggling to breathe, obviously frightened but willing to trust Carol who seemed to be controlled and calm as opposed to his frantic mother. "Okay, now breathe in" There was a brief pause before she continued "And out." As she listened, she could hear the congestion he was having with his expiration of the air. "What medication is he on?" Carol asked. At that moment, Doug Ross came through the door followed closely by Ashlea Waters, an intern. "Ventolin morning and night by nebuliser." Mrs. Collins answered quickly, pulling out a note from her bag which set out his medications and handed it over to Carol. Carol gave him a quick rundown of the case and he checked David's breathing also. "Resps 35, Pulse 145, Pulse Ox is down to 88." Lily reported. "Is he on any other medication?" Doug queried after consulting the list. "No" she replied shaking her head. "Okay. Give him 5 mics per minute prednisolone IV infusion and an amp of salbutamol by mask." Doug instructed writing out the meds on the chart and signing it off. Ashlea inserted the IV into David's arm talking to him gently as she did so. Lily passed her the dose of presnisolone which she injected as Carol prepared the nebuliser affixing it to the oxygen mask, placing it back over his mouth and nose. "It won't be long before your feeling better." Doug said as he touched the boy on his arm, giving him reassurance with a gentle smile. "Ashlea, keep a close eye on him. In fifteen minutes, check his volume." "Mrs. Collins could you come with me to complete the rest of the forms." Carol firmly guided her towards the admit area, accompanied by Doug, and left her in the admit area with Jerry. At the nurses desk, Doug slipped his arms around her waist, resting his head on her shoulder, murmuring to her. "So how many have we got coming tomorrow night?" "Would you believe that everyone is coming with the exception of my mother." Carol replied. "What's wrong that she won't come. She normally loves Christmas celebrations. Did you include Havier on the invitation? I think she would be disappointed to miss this year's one and we would never hear the end of it." Doug said with a knowing smile. Carol turned around to face him, her face puckered with worry. "Yes I did. Do you think we should tell her?" Slipping his arms back around her waist, he reassured her. "Give her a call and see if she's coming. If she says no, then tell her. But don't let her say anything to anyone else." Carter returned to the nurses desk, still laden with charts. Doug released Carol and she sat down in the chair, pulling out some management documents she needed to complete. "What did you do to get on Kerry's wrong side?" Doug commented, indicating to Carter's handful of charts of scut work combined with the food poisoning cases. "Three med students are out with the 'flu" he replied. "I hear a rumour that the Chief of Emergency Services is to be appointed today." "Yeah. I'd heard it to but I'd be surprised if it is. It's already after four o'clock. They would have announced it by now. The odds have been in Weaver's favour." Doug referred to the sweepstakes that was often placed on who was getting these positions. "Did Mark apply?" "What's all this whispering in the corner, guys?" Mark asked as he logged in on the computer. "Have you heard anything about the Chief of Emergency Services being appointed today?" Doug asked. Carol decided to leave them to have their discussion. Having attained equal footing with Kerry and Mark, Doug was loath to be insubordinate to Kerry once again and she knew he would be scrounging for any news about the appointment of the new Chief. "Uh, yeah." Mark commented shortly, now wanting to cut the conversation short. "So, is it Weaver?" Carter injected. "Anspaugh will be down within the hour to announce the position." "And you're not going to let on who it is." Doug stated. "Doug, you know my position." Mark retrieved the information he needed from the computer, jotting it down on the chart. "Look, you will all know soon." "He doesn't seem to happy about the appointment?" Carter asked watching the retreating figure. "No. I wonder what it is all about?" Doug's brow furrowed as he thought about it a moment, before deciding he had better get on with seeing his patients going to the admissions board to find his next patient. Carter followed and gave Randi some of his charts to chase up the labs he was waiting on. The radio beeped before a distorted voice came over the air "County General over" "Loud and clear over" responded Carol, the line crackling as she released the button on the side. "Two hit and run victims with head, chest and leg trauma. Aged 6 and 5 years, ETA two minutes." The information was brief and to the point preparing the staff for the urgent treatment of the victims. "Over" Carol finished the call. Carol came over to where Doug had just collected another file. "Doug, six and five year old hit and run victims with head chest and leg trauma. ETA two minutes." Carol relayed. "Okay, call Mark and Kerry and get the Trauma Rooms ready. Stat." Doug responded. Turning to Carter, he directed "Call for a surgical consult and find Anna." A flurry of controlled activity took place as staff quickly made sure that everything was in order and ready for the emergency arrivals to give the victims the best chance of survival. Sirens heralded the arrival of the ambulance, flashing lights bathing the waiting area in a kaleidoscope of blue and red. Doug, Carter and Haleh met the paramedics as they came crashing through the ER doors, rushing alongside. Doug immediately took over the control of the ambu-bag as the paramedic spurted the current state of the injured boy. "Six year old boy, head and chest trauma. Last BP was 90 over 60. Pulse 60. Diminished lung sound on the right. GCS 3-3-5." The gurney was quickly moved through the jumble of the waiting area, down to Trauma One. Mark followed them in with Malik and Lydia already waiting in the trauma room and immediately took control of the situation as attending physician. Pulling the gurney level with the Trauma room trolley, Mark called out "On my count, 1, 2, 3." In well rehearsed syncopation, the young boy was moved efficiently to the ER trolley, the paramedics quickly moving their gurney out of the Trauma room with their equipment to allow the ER staff to save the boy's life. "Two more units of saline" Doug instructed. Haleh took over bagging the boy as Doug and Mark conducted their own examinations. Carol connected the pulse ox monitor as Carter inserted IV's of Ringer's Lactate and D5 into the boy's arms. "CBC, H&H, Chem 7, coag panel, type and cross for six" Mark called out immediately. As Doug listened to the lungs, he knew there was a problem with the right lung, which the paramedic had disclosed on arrival. "5.5 ET tube" he directed as he moved to the head of the blond haired child. "Portable chest. CT spine, stan. head CT, pelvic and lower extremity films." Carol immediately has the tube ready for Doug to place down the boy's trachea. Haleh removed the bag as Doug removed the oral airway and quickly inserts the tube down the boy's trachea. Haleh had the ambu- bag ready and connected it to the tube. "BP's 60 palp, Pulse ox is 85" Malik informed them. Mark looked across at the boys trachea and noticed how it was being pushed to the left confirming his suspicions. "Tension pneumothorax. Give me a size 12 needle." Carol handed the needle to Mark. He quickly stabbed the needle into the boy's upper chest allowing the air to evacuate his chest. Making a small incision in the skin, Mark dissected down into the pleura cavity around the lung, passing the tube, which Carol placed into his hand, through the pleura into the chest cavity. "BP's 80 over 60 and rising." Malik reported. END PART 1/?