By Denise Randall

Chapter One: The Accident

Steps echoed down the eerie and nearly deserted hall as a few nurses and interns moved about the floor, tending to the night’s patients. Occasionally, the silence was punctuated with the sounds of announcements and pages. Requests echoed in forlorn tones for doctors to report to a floor or room within the hospital. Coughs from the waiting room, some of boredom, some from actual illness, made a counterpoint.

Tom emerged from one of the triage rooms and paused in the junction between one hall and the next. His gaze was focused on the backlit tablet in his hand, his current patient load scrolled incessantly across the screen. He read quickly, well versed on deciphering his own scrawl as well as that of those who preceded him on the shift. The announcements didn’t interrupt his concentration.

Despite the chaos earlier in the shift, he was amazingly calm. That set him to wondering if he had been doing this job too long already – he thought he might just be getting jaded to the atrocities he saw on a daily basis. Perhaps it was just that the emergency room was experiencing its first lull since he took over the shift.

I’ll take downtime as I can get it. He knew it would never last.

Nurses passed by Tom sporadically, swerving to avoid him. He caught their movement out of his peripheral vision, noting that none of them came above his shoulder. At six foot four, even most of the interns and other doctors were shorter. The height might have been handsome, had he possessed heavier musculature to even out his stature. His whole life he had been tall and lanky. At first introduction, most people thought he might be clumsy for all that height. They found it down right shocking just how gracefully he moved.

Tom pressed his thin lips together and straightened, his back protesting the constant slouch he adopted to keep from knocking himself out on the doorframes.

Despite tonight being slower than normal night, he was already in a bad mood. He tried not to let his personal life affect his attitude at work, but getting into a one sided argument with Sherri just before coming on shift had put a damper on that professionalism.

Spouting how cold and uncaring he was, she had boxed her things and slammed the door to his house – her final comment on their ended relationship. Tom couldn’t even recall that there’d been a fight, wasn’t aware that he’d done anything to break the camel’s back so-to-speak. As far as he’d known, nothing was wrong between them.

Oh, he suspected the reason – fairly certain why she was leaving. After all, this was just another in a long line of potentials that had found him too withdrawn to be with for a “long term” relationship.

To this day he didn’t understand it. Women initially found him charming. He’d been raised to be polite to women, to be chivalrous and accommodating. Such consideration was above average in this society, and women found it hard to resist.

Initially.

His problem had always been with keeping them. For a reason he hadn’t yet overcome or pinned down, he found himself distant and unable to connect to them emotionally.

And for every time this happened, he realized, anymore, all he had to fall back on was his work.

Glancing up, Tom was forced to push one long, blond strand of his bangs back with the rest of his shoulder length hair. He knew he should probably take the time to pull his hair back, get it out of his way. He never followed through on such thoughts, using the length to hide his long and narrow face. Another attribute he wasn’t fond of about himself.

He frowned as he glanced over the waiting room, noting some of the people there had been there since seven – since he’d taken over the caseload. Consulting his watch, his frown deepened, his thin brows pinching down over blue eyes; it was nearly midnight. He never liked making the lesser cases wait for the bloodbath to be over with, but someone dying while the emergency room doctors tended lesser injuries wouldn’t go over well. Not with him, and certainly not with the board, who dealt with enough malpractice suits as it was.

Rubbing the stubble on his left temple and trying to will away a headache, Tom moved to the receptionist’s desk.

“Amy, I’ve got some time to look at our lesser cases. Upload a couple of their files and send them to examination room number two.”

“Sure thing, Dr. Martin.”

“Has Phillip come up for air yet?”

“As far as I know he’s still in Surgery One with that ruptured appendix.”

“How about Marc?”

“His last case just closed out, so he should be back to take a couple more waiters.”

“Good, see that he does. If we’ve got nothing pressing the rest of the night, leave him on these cases, okay?”

“Sure thing,” she repeated.

He smiled and nodded before stepping away from the desk. He stepped into examination room two, the lights coming on as soon as they detected motion. He called up the workstation and plugged in his tablet.

After an hour, they had reduced the waiting room to a mere three patients, and Tom thought they might actually get ahead of the game for once.

He walked his most recent patient to the double sliding doors, giving her last minute instructions for the care of a bad laceration to the meat on her thumb, gave her a prescription slip and wished her well.

As he headed back for the receptionists desk once more, Phillip intercepted him.

“Last night, isn’t it, Tom?” He slapped Tom across the back, and the doctor rolled with the motion. He hated when Phil did that – he hated to be touched at all to be precise.

“Yeah.” He nodded not looking at the man, consulting his tablet once more to see if anything urgent had come up. “They’re tired of me trying to rearrange the staff’s schedule without board oversight.”

“I never understood why they would put their head surgeon on the night shift.”

Tom shrugged. “I volunteered?”

“Yeah, why don’t you like the day shift?”

“I don’t like dealing with the board – and they know it, which has to be why they’re forcing me back to days.”

Phil laughed as if Tom was making a joke. He wasn’t.

Tom had held the position as head surgeon for Concord General for two years now, ever since Turner gave up his position on the staff to head the board. There was a huge uproar about that, he was thirty-three at the time, and many said he didn’t have enough experience under his belt to be promoted that high. Tom himself had often wondered about the circumstances behind his fast track promotion schedule.

Pushing to be moved to a night shift, away from the politics of the day shift and in his element saving lives, Tom was happy. The shift was a tough one to be on, dealing with the aftermath of the Saturday night binges, the domestic disputes, and the gang shootings. Making life and death decisions everyday was high stress.

Tomorrow he was taking a day off. Damned be if he was going to work all night tonight and be expected to be functional all day as well. They had to concede him his point; he had to make preparations before facing such a change in assignments. For all the stress that was associated with his current job, he would certainly take it over what he had in store going back to days.

Sighing, Tom resumed his trek to the front desk. The board was forcing him back to days in order to straighten out the fiasco of the staffing. Henry had done his best. He was a great doctor, but he was no administrator. That meant Tom was returning to a Monday through Friday shift, 0600 to 1900. On one side of the coin he was looking forward to the hour change, especially after being a “vampire” for so long. However, he was not sure he wanted to deal with the people there. There were too many chiefs and not enough Indians. Politics reigned supreme – and he was no politician.

“Doc!” Amy uttered as he neared her station. “Evac 52 just called in. It’s bad, they want a net consult.”

Tom took the headset from her. “Evac 52 – Concord, what’s your status?”

“Auto accident, Doc, big rig lost its load of logs on top of a compact.” He had to decipher this from the background noise of siren, the din of the street, and the low moans of their victim.

Despite his want not to, Tom grimaced. “How many?”

“One’s DOS, coroner already called it. The other is fading fast. Transmitting stats now.”

They didn’t look good. He said as much to the paramedic on the other end.

“We’re not even sure how she’s survived this long.”

“You got her cuffed?”

“Sure do, IV’s started. Any other suggestions you can give us.”

“Pray.” Tom ran his palm over his left temple again, that headache was coming back swiftly. “What’s your ETA?”

“About five minutes.”

Tom held up his hand all five fingers extended. Amy was on the phone a split second following.

“Do what you can for her. See you when you get here.”

“Wish us luck.”

“I’ll wish her luck, how’s that?”

“Sounds good…see you in five mike.”

He double clicked the receiver and handed it back to Amy. His expression was expectant.

“Your team has been scrambled.”

“Thanks.” So much for the rest of the minor emergency cases. It sounded like he wasn’t going to be able to spare any doctors.

The doctor went into action that contradicted the calm he exuded earlier in the evening. He flipped a salute to Amy before making sure the surgery theater was ready to receive the incoming wounded. Once he’d finished that preparation he exited to the dock and waited for the ambulance to arrive. They were going to have to act swiftly if they were going to save her life.

He was bouncing on the balls of his feet in anticipation and anxiety when the blinding red and blue strobe lights announced the patient’s arrival. Paramedics disgorged from the back of the vehicle even before it had stopped rolling, dragging with them a bloody stretcher.

Tom descended on them before they had taken two steps.

The paramedic panted an update as they ran towards the emergency surgery, wheeling the gurney between them. Tom quickly assessed the patient, even as he kept an ear to the paramedic’s words.

They slid the mangled form onto the surgery table and Tom turned to a more in depth assessment of the girl’s condition. A mass of blood-matted, reddish brown hair covered a ruined face. He gingerly lifted one bloody lid, revealing a dark brown eye, and a pupil that was so dilated that it seemed almost black. He drew in a breath. It was hard to determine the extent of injuries just by looking at her; most of her body was covered in blood. Looking more closely, it became obvious that the features on her left side were flattened, and a light tactile exploration of the area was met with a spongy give that did not bode well – the bones had been crushed. Her left eye had been pulped, presumably by the force of the impact. She had the precautionary splint supporting her neck, but he was sure without even looking that there was going to be damaged. The left side of her chest was much the same as her face.

“Jesus,” the doctor whispered in spite of himself. He had seen bad cases before, dealt with his share of carnage, but this made them look like paper cuts. He forcefully pulled himself out of his catharsis, knowing that he…that she had no time for that. He began to snap orders to nurses, interns, and the several other doctors that were rushing to aid the emergency. “Type and cross ten units…IV with ringers STAT! Let's get her stabilized!”

******

The surgery was anything but textbook. The procedure turned into a frantic race, stopping one bleeding artery only to find five more. Even with the state-of-the- art robotic assistant, and microsurgery that was probably a decade ahead of any close-by hospital, they had difficulty staying ahead of death. It was close to dawn when they finally stabilized the young woman.

Wiping his sweating brow and still feeling as he had been showering in blood, Tom allowed himself into his spacious office. He called up the lights, his burning eyes straying over the Spartan appearance.

He wasn’t much for decorating. The prerequisite laurels hung on the wall behind his desk. There was a fake plant sitting in the corner, only on the insistence of his assistant Dora, and he could see how dull the fabric leaves had gotten from the dust gathered on each. A backlit digital clock glared at him from the wall, and opposite it was an interactive screen that gave him access to the medical library from the mainframe that was located in the basement.

There was not much else to the room, really. His desk was sparsely decorated as the rest of the office: a brass sculpture of an eagle, note pads, those archaic pencils he insisted on when he needed a quick way to jot things down. Imbedded into the surface of a clear plastic protector was a computer.

Dr. Martin called up the interactive screen on the wall, retrieving information from the database with sub-vocalized words. Glancing over them, he reaffirmed his possible courses of action, reminding himself that he already memorized them all and one was as tricky as the next. With a sigh, he moved past it, shutting it off again as he avoided the rolling chair facing his desk, slipped around the end of the furniture, and plopped tiredly into the plush padding of his own chair. He sympathized as he heard the leather squeak in protest at accepting his weight.

Rubbing the fatigue from his eyes, he pulled a mini, digital recorder from a constantly locked desk drawer and began making notes. His tired voice was barely audible and he had a hard time keeping his thoughts together long enough to put them on record.

“My newest trauma patient is going to be a challenge,” he began. His recordings always consisted of a collage of professional observation and personal opinion. That was a dangerous combination in the wrong hands and was the main reason the recorder and all of his memos were kept safely locked away. Tom did not want to get caught up in a “conflict of interest” suit or some such nonsense. He knew he could avoid the whole issue and just keep his thoughts to himself. At the end of the day or after a stressful session, however, he needed a way to get the frustration out.

“Hispanic female, approximately twenty-six, identified as Mira Stevenson. Her case is probably one of the nastiest I have had the displeasure of working on. Caucasian male, thirty, identified as Mark Dillon, was pronounced Dead on Scene and transported to the city morgue. Mr. Dillon’s side of the car took the brunt of the impact. No relation has been established between the two. For all I know, they were on their way to the mountains for a picnic.

“Both were trapped under the load of logs for more than forty-five minutes, and to be honest, I'm with the paramedics…I don’t know how Ms. Stevenson survived. Though the car took the brunt of the weight and Mr. Dillon’s side of the car was the hardest hit, Ms. Stevenson was crushed between the frame of the car and her seat. She suffered extensive lacerations and contusions on the face; further exploration has revealed that the left brow, temple, cheek, and jaw have been crushed, splintered beyond normal surgical repair. It is unclear at this point the extent of damage to the frontal lobe. Chances of her being a vegetable from all this is greater than I care to think about.

“Her left eye was beyond repair, and was removed. Sixth vertebra sustained damage, with slight bruising on the fifth and seventh. Her brace will remain in place until a course of action has been discussed and settled upon. Her reactionary signs are encouraging; both feet and her right hand respond to stimulus. I am not setting hopes too high however. That could deteriorate at any time.

“Ms. Stevenson’s left arm was severed in the accident and attempts to reattach the limb proved unsuccessful, it does not respond to stimulus and the appendage shows no signs of circulation. The arm will gangrene and therefore must be removed again, and as soon as possible. I was forced by necessity to call an emergency meeting of the surgical staff to discuss the severity of Ms. Stevenson’s injuries. I do not wish to go into this case on my merits alone, and opened the floor to opinions of the other doctors. There is still some discussion on the process to use in reconstructive surgery, and the limb will remain in place until a decision is finalized. However, I am going to have to limit debate and begin to rehabilitate her or else her condition is going to become critical.

“Her left chest was the hardest hit in this accident. Like her face, the bones were splintered beyond repair and will probably be removed in favor of artificial ribbing. Her collarbone, we were able to repair, and it is showing signs of healing properly. Exploratory surgery has revealed pretty much what I was expecting, massive internal bleeding, though as it turns out it was mostly the result of the punctured left lung. We removed the organ. The damage was irreparable. Most other vital organs, though badly bruised, are in relatively good shape, for which I am grateful. To prevent further injury to the organs still intact, the chest has been inflated and we have inserted a drain to bleed off excessive fluid buildup in the chest cavity.

“She is and will be on full life support until we have consulted with her relatives on possible courses of action. I can only hope that she lasts until her relatives can be contacted. I will have to see how it went on Monday.”

Tom shut off the recorder, tossed it back in the drawer, and sighed heavily.

A knock at the door interrupted any thought he might have had about just laying himself out on the desk and taking a nap.

“Come!” He focused on the door as it swung in.

“I thought you were going home early tonight.”

“Henry? What the hell time is it?” Tom brought his watch up seeing that it was already 0730. The hand fell with a thump on the desktop as he regarded his friend.

“Rough night?”

“Emergency room duty? I mean, aren’t they all?”

Henry smiled and seated himself in the chair opposite Tom’s desk.

Tom shook his head, swiveling his chair first one way and then another. “Had an early morning trauma surgery this morning. I haven’t been sat down more than half an hour.”

“Yeah I saw her on the caseload. What do you plan for her?”

“At the moment just making sure she doesn’t kick it.”

Henry nodded with a knowing expression.

“I have a pretty good idea what I want to do to reconstruct the damage, but I haven’t nailed it down yet. If they can keep her going until Monday, I should have all the details laid out. The team’s already getting logistics started for materials.”

“Good. I’ll do what I can to keep her with the world for you.”

“I’d sure appreciate it.”

“So,” Henry looked at him with that too knowing expression again. “Day shift, huh? You ready to take on the bears?”

Tom looked away. “Maybe after the weekend. I don’t think I could handle it if they’d had their way and started me today instead of Monday.”

“I imagine not.” Henry rose from his seat again. “C’mon, I’ll buy you breakfast.”

Tom smiled warmly at his friend, realizing all at once that he hadn’t eaten all night. “You know, I’d like that.”

“And then you need to get your butt to bed.”

A/N: Thank you to Cuenta for pointing out some of the errors I seem to have blinders for, they are corrected here along with some other things I wasn't happy with in how they read!

NEXT UP: Monday, Monday

Tom returns to the hospital Monday morning in order to assume greater responsibility that comes with his position. Only he doesn't get the time to do what he's been asked. The board has news to impart regarding his newest trauma patient...