Chapter 7

It was Labor Day weekend. I was on the evening shift on Saturday night and Anita was on her regular 5P to 3A shift with Terry. It had been a relatively quiet evening with nothing major coming through the doors.

Four of us were standing at the nurse's station, trading jokes and gossip when a call came in on the radio.

EMS! EMS! This is ambulance 6! EMS!

I recognized Terry's voice. The triage nurse grabbed the mike and acknowledged, "This is EMS. Go ahead, ambulance 6."

I began getting my mind in gear because the ambulance generally didn't call us direct unless they had something major coming our way. Notification usually came through dispatch.

EMS, this is 6! We'll be there in about three minutes with a gun shot wound to the chest. Patient is conscious and alert but hypotensive at 76/40 and tachycardic at 116. I have two IV's in place and pumping saline wide open. I recommend you notify surgery.

"Copy 6! We'll be ready for you. Thanks for the heads-up!"

I heard the page go out for surgery as I hurried toward the trauma room wondering why it was Terry giving us notice when Anita was supposed to be attending. I guessed she must have her hands full.

I heard the siren and stepped out on the dock to help unload the patient. As the ambulance pulled in and swung around to back up against the dock, I could see there was a police officer driving and felt a profound dread in my chest. The moment I open the rear door, my worst fear was realize! It was Anita lying on the gurney!

Terry held the IV bag in his teeth as he unlocked the cart and pushed it my way. We lifted the gurney and locked it in place. He laid the IV bag on her chest and said, " .38 revolver, entry two inches below the left clavicle, no exit wound. Her pressure's dropping fast, Doc. I can't keep up with the saline. I'm pretty sure the bullet got one of the big vessels.

As I was pulling the cart through the sliding doors, Anita focused on my face and smiled weakly. We slid her off the gurney onto the table in Room 1 and the nurses began cutting her clothes off as I started my assessment. Marty Bateman, the chief surgical resident rushed into the room and said, "Talk to me, Ken! What's her status!"

"Not sure yet, Marty. It's a GSW to the upper left chest, probably got the left subclavian or the aorta. The paramedic says her pressure is falling quickly."

I looked up at Anita's face and asked her how she was doing. She didn't respond! "Shit! She's arresting! Give me a laryngoscope and a 7.5 tube!"

As I placed the tube in her trachea, Marty checked her for a carotid pulse and shook his head. He turned to the nurse and shouted, "Get me a knife and the rib spreader! We gotta crack her chest!"

A flurry of activity and everything appeared out of nowhere. Anita was quickly positioned on her right side, betadine solution was splashed over her ribs and Marty opened her in three slashing cuts. "Rib spreader!" he demanded. It was inserted and cranked, making an opening in her chest about six inches wide. Blood poured out onto the floor.

"Suction!" He moved her left lung to the side and told me to keep it retracted.

A few seconds later, "Yeah, here it is! The left subclavian artery's got a hole in it just above the aorta. Give me an arterial clamp! No, give me two clamps!" He closed one clamp over the subclavian to stopped the bleeding and another just above the diaphragm to keep her remaining blood available to her chest and her brain. The lower body would just have to do without for a while.

He looked up at me and asked, "Do you know her blood type, Ken?" He knew who she was.

"O positive."

He shouted at the nurse, "O positive, Lucy, and lots of it. Send it to the OR and let 'em know we're on our way! And hang another bag of saline!"

We headed for the elevators, pushing the table at a dead run. On the way, Marty asked, "I know it's asking a lot, Ken, but can you scrub in?"

I didn't even have to think about it. "Of course! What do you think her chances are?"

"Well, she's young and strong and the major bleeding's controlled. We can probably keep her brain perfused with what she's got so if we can get a few units into her and re-perfuse her kidneys before they go south, she has a decent chance. No promises, though!"

As soon as we burst through the operating room doors, the anesthesiologist took over. He and the nurses got her positioned on the OR table before he hooked her up to the machine and started passing gas, hyper-oxygenating her remaining blood and anesthetizing her.

Marty and I did a short scrub along with a tech and a nurse and entered the room to be gowned and gloved. There were already two units of blood being pressure infused.

Marty worked like it was an every-day thing. Within five minutes, he had her subclavian artery stitched and released the clamp to check for leaks. There were none. He looked up at the anesthesiologist and asked, "How's she doing, Sam?"

"Better than I could have hoped. Her pressure's 84 and her O2 sat is 88. You guys caught her in the nick of time. I think this one might live."

I felt a load slide off my shoulders and felt like crying, but we still had work to do.

"OK, Sam, I'm releasing the clamp on her aorta. Tell me what her pressure's doing!"

I watched Marty release the clamp and then watched the aorta below it begin pulsing.

"Pressure?"

Sam checked again. "It's OK. It dropped to 70 but it's coming back up again. I think she'll need at least six or eight units before we're done."

Marty looked at me over his mask with a smile in his eyes. "I think she'll be OK, Ken. Why don't you break scrub and go take a deep breath."

I nodded and said, "I definitely feel like doing that, but I've got an ER to see to. I shouldn't have even come up here."

"Oh, sure. Well, I just need to flush her chest with antibiotics and close her up. We'll come back and do the cosmetic stuff like digging out the bullet when we're sure she's doing all right. I'll keep you posted, OK?"

"Thanks you so much, Marty. You're definitely invited to the wedding."

I got the story from Terry. They'd been called in on an assault, probably a domestic squabble. Standard procedure is to wait for the cops if you get there first because you never knew what you were walking into. But just as they were pulling up to the curb, a woman came running out the door, being chased by some guy, and headed right toward them. Anita jumped out to help her. That's when her boyfriend fired a shot, missing his target and hitting Anita. The cops were already out of their cruiser and dropped the guy on the spot with half a dozen bullets in the chest. There was no need to transport him to the hospital.

Denise had been called at home and given the news. When she came running across from the parking lot, Terry and I were sitting on the dock, trying to make sense of it all. I stood as Denise ran up the ramp and into my arms. I'd never seen her cry before.

"How's she doing, Ken? Is she gonna make it?"

"We had to crack her chest but Marty says she's going to recover. They should be just finishing up in surgery, so she'll be in recovery before too long."

She held on tight and groaned, "God damn it! That poor woman's already had more than enough shit for one life! Why can't the world just fucking leave her alone!"

Then she took a deep breath and stood back. She looked at Terry and asked, How about you, McEnroe? You holding up OK?

I guess the emotion was catching up to him because he suddenly had tears running down his cheek. "Yeah, I'm fine. I don't have a partner so I guess I should probably just go home, if it's OK with you."

"Not 'til I get a hug."