SPIRIT OF CHRISTMAS by Michelle Creek (missy@ipax.com.au) DISCLAIMER: The characters of ER are the property of Michael Crichton, Warner Bros., Constant Productions and Amblin Television and the actors who so marvellously portray them. Any comments and/or constructive criticism will be gratefully received at the above e-mail address. PART 7/? "Everybody down and out of his way." yelled Mark . Those who hadn't been hit, fell to the ground or sought security from the shots in exam rooms away from his arc of fire. Mark went into Trauma One to contact security and the police from the extension. Silence temporarily reigned as he put down the phone. Chancing a look in the hall, he was relieved to find that the boy had run out of bullets from his two guns. As the boy tried to reload, he was tackled to the floor by one of the security guards, disarming him as two others stood by with their guns trained on him. Handcuffing him, they patted him down, discovering four more clips in his jacket. Jerking him to his feet, they took him down to their desk, away from the chaos that now existed in the waiting area and hallway. "How many victims have we got?" Mark immediately took control of the bedlam which now existed. Cries of pain emanating from victims, blood from gun shot wounds and flying glass splashed on the floor and across chairs and walls. Pulling herself upright carefully, wincing at the pain in her left leg, Kerry scanned the hallway. "Four GSWs in the hall" she reported noting the obvious entrance wounds on some of the bodies littering the hall in various positions. "Another three at least in the waiting area" Chuny said as she surveyed the mess of the waiting area. Shattered glass spilled over the seats and floor mixing with the blood of the victims. "That's without the superficial wounds from flying glass." "Carol, set up a triage." Mark ordered. "Call the blood bank, we're gonna need blood, lots of it." He surveyed the area, shaking his head in disbelief at all the people who had been either shot or injured from flying glass. However, he needed to maintain control, ensure that those who were injured received the best possible care that the ER could provide. Carol looked up from where she knelt beside Doug pressing on his abdomen, fingers of blood running over her hand. She didn't want to leave him but also knew she would not be able to treat him anyway due to her relationship to him. Carol knew from a theoretic point of view she would only be a hindrance but from an emotional one, she just wanted to be with him. "Go on Carol. We're going to need you out here. I'll take over." Carter said as he knelt beside her, snapping on the second latex glove on his hand. As she moved her hands from the site, Carter pressed down to also stem the bleeding. "Someone get me a gurney." "Love you." Doug slurred as he slipped his fingers brushed by her own. "I love you too." Carol whispered as her eyes brimmed with unshed tears. "Don't you dare leave me." "Not a chance. I would only haunt you anyway" Doug replied, his grin turning to a grimace as pain shot across his abdomen. "Carol, call dispatch and tell them we're closed to trauma." Kerry voice cut across the cries and bedlam beginning to reign. Shock was setting in with the victims and those who had managed to escape injury. "Where's Jerry and Randi? I need them to contact administration and arrange for surgical consults." Kerry shook her head. After Jerry's assurances following the chemical spill earlier in the year of being ready and fully organised in case of another emergency, she was disappointed that she was going to have to rely on the nursing staff to organise things. They really needed them to be treating patients, not making calls. The ER staff were in the process of organising themselves to treating the nearest victims to where they had dropped to avoid being hit by the rampaging teenager. Assessments were being made as to the severity of their injuries. "Please. Someone help me." Randi's distressed voice came from behind the admit desk, Kerry limped heavily in response to her call, finding Randi cradling Jerry's head in her lap with her hand pressed firmly on his chest, trying to stem the blood which continued to bubble from his chest and pool beside his broad body. "I've got another here. It's Jerry. I'm going to need Trauma One." Kerry called out to Mark. "Malik, get a gurney." Malik and Haleh grabbed the closest gurney, moving together they placed him on the trolley, rolling him straight into Trauma One. Randi was left looking at the blood still dripping from her fingers into the pool of blood across and around her legs, suffering from shock of having Jerry's life blood oozing over her hands, the big man pale against the crisp blue jacket he wore. "Carter, take Doug into Trauma Two. Maggie, put Lydia in Exam One. Anna, your patient to Exam 4......." Mark continued to direct patients to rooms, calling out for the patients that had been treated earlier to be discharged or moved into other areas of the hospital. Carol arranged for supplies to be restocked and patients to be triaged, their name tagged with particular colours according to their urgent need for treatment. She pushed aside her worry about Doug, using all her will power and energy into making the injured as comfortable as possible. "Randi, are you okay?" Carol asked concerned that the vivacious and seemingly unflappable clerk was still on the floor. "Umm. Yeah. I'm fine" Randi responded uncertainly, still absorbing the impact of the invasion by the teenager. "Get changed into a set of scrubs and I could do with a hand organising things out here." Carol instructed gently. The suggestion redirected Randi from her introspective state and recharged her, almost tangibly pulling herself back together to help Carol cope with the flurry of people to contact and organise. Carol started placing calls to administration advising them of the shooting, arranging for surgical consults and the OR to be ready to accept patients as soon as they had been stabilised. "This is Carol Hathaway from the ER. We have an emergency situation down here. We need surgical consults for seven GSWs." News that surgery was not at full capacity due to a shortage surgeons because of a seminar in Florida was not received well by Carol. "Well, you had better call in some! We have had our own staff members shot by a gunman as well as other patients." Carol continued holding as the surgical receptionist absorbed the urgency of their need and the disaster which had just occurred. - 0 0 0 - Chuny cut away Jerry's shirt and removed his tie allowing them access to the site of the gun shot wound. Kerry listened to the breath sounds, gauging the severity of the damage to his heart and lungs. It was not good. "I need an intubation tray. 7.5 ET tube." Kerry called out as she moved around Malik who was in the process of checking Jerry's blood pressure. Taking the laryngoscope and tube Haleh handed to her, Kerry deftly inserted the ET tube, checking his breathing once again to ensure that it was inserted correctly. Malik quickly attached the bag and commenced regular compressions on the bag. "Call radiology for a portable chest and a CT." Kerry instructed succinctly. She had noted the bruising to his head while inserting the ET tube. "Six of O neg. on the rapid infuser. Two of saline wide open. CBC, Chem 7 coag panel, H & H, blood gas, type and cross for eight." "BP's 65 over 40." Malik reported IV's were expertly inserted in response to the instructions. Chuny affixed the electrodes to Jerry's chest as Haleh brought up the cardiac monitor for connection. "Tachycardia" There were different possibilities for the cause of the tachycardia. Kerry noted that Jerry's neck veins are distended. Once again, she listened to his chest. "I can't hear any heart sounds." "Asystole." yelled Chuny as the cardiac monitor began beeping its warning. She immediately started compressions on Jerry's chest. "Let's crack him" called Weaver, her steady voice keeping control of the situation. They were all too aware that it was one of their friends on the table before them now, making them all vulnerable and feeling the life- blood draining from him. They doubled their efforts in a frantic attempt to keep a tenuous grip on his life. Haleh had anticipated this once Kerry had warned of the lack of heart sounds and already had the thorocotomy tray ready. "Number 10 blade" her hand ready to receive the scalpel. She made a horizontal incision extending from Jerry's breastbone across to his left armpit. "Rib spreaders." They were in her hands as she finished her words. "Two more units of O neg stat." As she spoke she inserted the device between two of his ribs, spreading them wide enough apart to enable her to get both of her hands into Jerry's chest cavity. Kerry could see Jerry's heart attempting to beat below his fingers. The pericardial sac around his heart was bulging with fluid. "What have we got?" Benton asked as he rushed into the room. "Pericardial tamponade." Kerry responded. She cut the sac with the scalpel and blood gushed out. "Give me some suction." Benton immediately suctioned out the area. There was still blood filling the sac. The bullet had damaged the heart. Kerry placed a cross clamp on the descending aorta. She placed her hand gently around the heart and located the source of the bleeding. Placing her finger over the bleeding hole Benton called for sutures and a needle. Working as a team with Benton, she sewed four large sutures into the wound. The blood has stopped leaking and Benton slowly released the clamps grip on the descending aorta. "I've got a pulse." called Chuny. "BP's 90 over 60" confirmed Haleh "Contact the OR and let them know we are bringing him up." Benton instructed. "Chuny, call the blood bank and have them send up eight units type specific to the OR." Kerry directed. "Everybody ready. Let's get him up." Benton said as the sides of the trolley were pulled up and they pushed Jerry out of the Trauma Room. - 0 0 0 - Mark passed the central work station and ducked his head in. "You've contacted surgery?" "Yep. They're calling in all their residents and on-call staff but it may take time for them to arrive." Randi replied, now dressed in green scrubs. "Mark, how's Doug?" Carol asked quietly. "I'm just heading there now. I'll let you know." Mark responded. "Here's the charts for the patients I've discharged. The DOH has called in their own staff to assist with the Ramesh family in quarantine." Mark handed Randi two other charts. "Can you arrange for John Carter and Emma Carides to be transferred to the cardiology. Tell them it's urgent." Walking through the hallway, glass crunched beneath his shoes. Housekeeping had begun the arduous task of cleaning up the mess but it was going to take quite a bit of work before the area was back to normal. Entering Trauma Two, Carter was just finishing inserting the endotracheal tube down Doug's throat. "How's he doing?" "Pulse ox is down to 86. BP's 75 over 50 and his cap refill is poor." Carter commented as he concentrated on listening to Doug's breath sounds following the insertion of the ET tube. "Portable chest." "Sinus tach is 150." Yosh put in. "CBC, Chem 7, H&H, ABG and coag panel, type and cross for six." Mark instructed. "Already done." Meredith informed him as she overheard his instructions, returning with the units of blood. "Dip the urine for blood." Mark finished. Carter proceeded to do the dip, getting a catheter. Mark checked the entrance wounds looking at the havoc the small missile had caused. Doug had managed to get shot not only once but twice, the bullets piercing the abdomen in the left lower region. "What've we got?" Elizabeth Corday asked as she breezed into Trauma Two, fully aware that the patient on the table could be someone she knew and she steeled herself for this possibility. "Doug. Two gunshot wounds to the left lower region." Elizabeth looked closely at the wounds. "Can we roll him?" Between the five of them, they gently rolled Doug on his side so that Elizabeth could determine if any of the bullets had exited. "Okay, we've got one exit wound. It looks like that's hit the spleen." "Dip is positive." Carter reported. "Let's get him up to the OR." Pulling up the sides of the gurney, IVs and blood hanging from the IV poles above Doug's head, his face pallid, they all took the trolley down to the lifts where Carter, Elizabeth and Meredith accompanied Doug to the surgical floor. - 0 0 0 - Carter exited the lift with Meredith, having returned from the surgical floor just as he saw Jerry being wheeled into the lift to go up. "How's Jerry?" he asked Kerry as they met outside the lifts. Kerry still wore the yellow protective clothing, the front of which was covered heavily in blood from her mid chest down to her knees. She stripped the gloves from her hands and tossed them into the hazardous material bin to the right of the lifts. "He's holding his own at this stage." she replied. "We had better all cross our fingers and just hope everything goes okay. How's Doug?" She continued stripping the protective clothing from about her body, the tapes catching on her crutch. As she bent over to release it, the room rolled before her eyes. "It looks like it was just a spleen." Carter replied. "Hey, Dr. Weaver. Are you okay?" Carter was concerned how the colour had suddenly drained from her face. "I'm not..........." Kerry began and then collapsed. Carter caught her before she hit the floor. It was only now that he noticed she was bleeding profusely from her left thigh. Checking the wound, he was alarmed to find it was from a gun shot wound. PART 7/?