Safety In Numbers

AUTHOR'S NOTES: I want to thank my Safari partner for Zebra hunting with me, she knows who she is! I also want to thank my friend Detective Tom Rich, who allowed me to use his name and his personal CPR handicap, he hates to do it! The character was definitely based on him, and I thank him for his great sense of humor, and taking it "like a man" while I ripped on him! (Which I usually do when we share our 'war' stories, he's such a medical chicken! How he has been a cop as long as he has and can't stand the sight of blood is beyond me!) BUT we love you TOM!!!

DISCLAIMER: With the "Kacey Rule" first and foremost in my mind, I wish to convey my condolences for the physical injuries I have inflicted upon the characters in this story, namely, poor John Carter, M.D., secondarily my own creation Helen Nussbaum, R.N., both of whom have done absolutely nothing to deserve this, other than being in the wrong place at the wrong time. I make no money from this, darn it! And these characters will be returned to their proper owner, in similar condition as when I borrowed them, hopefully....Now onto the story.....


Haleh, keeping an eye on Jose, was putting his clothing in a patient belongings bag. She had contemplated keeping them at the desk, but didn't want to get herself into trouble. She shoved his shirt and shoes in the bag, and as the jeans were in her hands, she felt something hard in the leg that poked out at her. "What the?" Haleh mumbled to herself. Turning her back to Jose, who was presently preoccupied with the ophthalmologist, Haleh turned the jeans inside out. Strapped to the inside of the leg, toward the bottom, was an icepick, with at least a 7 inch stiletto. Haleh looked at the weapon with shocked surprise. "He brought this in here so easily," she thought reminding herself to check the pants of the hoodlums that cross through the doors. They really needed metal detectors, she would make sure it was brought to the attention of Anspaugh at her next Emergency Services Committee meeting. She carefully put the pants on the chair, and donning a pair of gloves, and a specimen bag, unstrapped the pick from the inside of his pants. There was blood on it. She quickly put the weapon in the bag, and made her way out toward the desk, her back to Jose the entire time. He was busy cursing at the ophthalmologist to "get on with it, my eye hurts!" Haleh thought to herself, "yeah, that ain't all that's gonna hurt when you get in prison boy!"

Mark was sitting out by the front desk, working on charts when Haleh walked up behind him.

"Mark, I found this in the kid's pants leg. It was strapped to the inside." Haleh held out the bag for him.

"Geez." Mark said examining the weapon. "Whose blood?"

"I don't know, but I didn't see any leg wounds on the patient, I can tell you that much." Haleh answered.

The phone rang, bringing both out of their thoughts. "ER" Mark said.

"Hi, this is Helen Nussbaum again, I was just wondering if anyone had gotten a hold of Dr. Carter yet?"

"Hang on." Helen heard Mark Greene say, and turn to what must have been Haleh, "Did you hear from Carter yet?"

"No, but tell her....never mind, hand me the phone." Mark handed off the call to Haleh.

"Hi Helen, no, we haven't heard, but I went ahead and sent the police over there to check on him...." Haleh didn't want to let Helen know about the wallet.

"The police? Do you think something is really wrong?" Helen asked worriedly.

"Uh....." Haleh stammered, "we found his wallet."

"Oh good, I'm sure he'll be happy to hear that!" Helen said, then a long silence followed, Haleh wasn't telling her everything. "Where did you find it?" Helen asked.

Haleh couldn't outright lie to this lady, "it was in the pocket of a kid brought through the ER."

"What does this 'kid' look like?" Helen asked. Her heart was beating faster, and her head was throbbing.

"He's about 5'10", maybe 16 or 17, black hair, long, ponytail...."

"Oh God..." Helen said covering her mouth with her free hand.

"Is this the guy?" Haleh asked.

"How did he get out so fast?" Helen asked.

"I have no idea Helen, you know the way the legal system works...."

********************************************************

Officer Tom Rich had seen dead people, bodies laying sprawled in every conceivable position, missing limbs, sometimes decapitated from traffic accidents, he'd seen about everything, and nothing much rattled him, as long as he didn't have to actually touch them. Usually, by the time he got there, there wasn't much he could do for them. He hadn't had to use his CPR training in years. He had never seen anyone the color of this guy, who was still alive. His lips were blue, his face was a shade that Tom didn't think they had a name for...his fingers were even bluish.

"Come on! Move him out here!"

John's body was dragged to the middle of the room. "Run downstairs and wave the ambulance in!" Tom yelled to his partner.

"Okay kid, hang in there!" Tom leaned over, and heard no sounds of breathing, nor could he feel a pulse. "All right, here goes...." Tom leaned John's head back slightly and breathed into his mouth, he had forgotten to pinch his nose shut, "Shit" He muttered, "I should have taken that damned refresher course!" He started again, pinching the nose shut this time, and John's chest rose slightly. Tom breathed more forcefully into John's mouth, his chest rising this time more considerably. He felt for the xyphoid process and measured two fingerbreadths up, then laced his hands together, being careful not to bounce, he remembered that, and not to push in too hard. As big as Tom was, he had difficulty not pushing with all his might, especially when his adrenaline was pumping. He depressed his hands onto John's chest and felt the bone give. It made a crunching sound, he knew he must have broken this guy's rib. He didn't think he had pushed all that hard. He quickly gave John another breath, then unbuttoned his shirt. "Holy shit!" Tom said. There was a shoe mark on John's chest, the kid must have kicked him in the chest, with a pair of distinctively soled shoes by the look of it. Tom noticed blood on the back of John's shirt, and turned him over slightly. There was a small hole about halfway between his armpit and his waist, he could feel the rib above and below the mark, it really wasn't bleeding now, but must have been at one time. Tom turned him back over, and blew into his mouth again, he had no idea what to do now. They didn't cover this in CPR class, and he doubted the refresher course would have. He figured the best he could do was continue breathing for him. Tom said a short prayer, for the ambulance to arrive and soon! He didn't want to have this guy die on him. That was definitely not in his game plan this morning, but he was pretty sure dying wasn't high on this guy's list of things to do today either.

He could hear sirens in the distance, and pretty soon he heard footsteps coming toward the door. "Thank God, they're here kid!" He said as he blew another breath in John's mouth.

****************************************************************

"Don't worry Helen, we've already notified the police. I have security outside his door. Besides, he's not going anywhere, he still needs a cast and he'll probably end up in surgery for his eye." Haleh informed Helen of Jose's condition.

"His eye? Where does he need a cast?" Helen asked, "John punched the kid a few times, but I don't think he broke anything."

"He came in here yelling about some maniac trying to blind him...." Haleh was cut off by Helen.

"Yes, I sprayed mace in his eyes, well, a lot of mace in his eyes."

"No, this is from, what he says, was a key...this isn't from mace." Haleh couldn't get a word in edgewise as Helen continued.

"What was broken? What key? Do you think he just found John's, uh...Dr. Carter's wallet in the garage?" She barraged Haleh with questions.

"I don't know Helen, I guess the police will find out. Now, why don't you just settle down and try to get some rest. I'll call you when I know more all right?" Haleh said trying to placate an obviously very distressed woman.

"I can't rest! I need to know what the hell's going on! I'll be downstairs in a few minutes"

"NO way! NO you don't, you stay put! I'll call you when we know Helen, no way you need to be wandering around the hospital. You have a concussion, and when we get a hold of Carter, he'll be pretty peeved that you've been wandering around the hospital."

Helen finally conceded that it was a bad idea, "you call me when you know anything!" Helen stressed the 'anything.'

"I told you I will, now you just relax. I'm sure everything is fine, and Carter'll be glad to get his wallet back."

Haleh looked up as the ambulance bay doors swung open, "I gotta run Helen, you promise me you'll stay put!"

"I will."

********************************************************************

"Thank God, I didn't think you guys would ever get here!" Tom said.

"How long has he been down?" The paramedic asked.

"I don't know, I wasn't exactly worried about looking at my watch okay?" Tom said sarcastically.

The paramedic went to start CPR, "Hey, you may not want to do that! I tried to do CPR and his chest just ain't right, it's making a noise, and there's no resistance." Tom attempted to demonstrate this with his hands, while the paramedics ignored his display. "Fine, never mind then. You'll find out for yourself." Tom stood back and let them work.

The two paramedics worked simultaneously, one putting on electrodes, the other starting the IV. Between the two of them, within a minute, John was intubated, an IV started and hooked up to a cardiac monitor. It never ceased to amaze Tom, how quickly these medical people worked. He looked over at the monitor, it was making spiky movements, and didn't look good. The one paramedic put something in the IV line, then said, "He's in V-fib..." The paramedic got out another piece of equipment, Tom had seen this before, the defibrillator or something like that. He watched as they charged up the machine and the guy's body came a good inch off of the floor.

"Okay, we got a rhythm...." They loaded him onto the gurney and rushed out the door, leaving Tom in the apartment with his partner.

The two officers poked around for a while, looking for any other incriminating evidence of foul play, and took some pictures of the hallway and the front door. They'd have to get that fixed for him.

They hung the yellow 'crime scene' tape in front of the door, and followed behind the ambulance to County, he realized he was interrupted earlier, and had never called County back. He felt bad about that, hopefully one of the paramedics would call it in.

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"How come you guys didn't call?" Mark asked as he ran to meet the gurney, he didn't recognize either paramedic, which was unusual, he thought he knew them all.

"Sorry doc, no time."

"What have you got?" Mark had yet to look at the patient.

"Police found this guy down, have no idea of how long, IV started and #8 ET tube at the scene, no spontaneous resps, was in V-fib, gave an amp of Epi, shocked him and got a rhythm, and took off for here....possible fractured ribs, the cop tried to do CPR, small wound between the third and fourth intercostal space....he's tachy at 120, decreased breath sounds on the right, pressure is 90 systolic."

"Okay, let's get him moved over, on my count one, two..." Mark stopped momentarily, dead in his tracks as he gazed upon the patient's face, "Oh man...."

"Randi! Randi!" Haleh yelled, as she made her way into the trauma room, "Do NOT let the patient in Exam 2 leave! You call the cops, get them in here now!"

Randi moved toward the phone, but didn't even need it as the cops were coming in through the doors, "Hey, you guys I was just getting ready to call you."

"We just wanted to see how that guy was doing? Is he gonna be okay?"

"Which guy?" Randi asked.

"Mr. Carter." Tom replied.

"Mr. Carter? Oh, you mean Dr. Carter?" Randi asked, "Why, what's up?"

"Oh, well, uh...he got into it with someone, he's kinda banged up. I think I might have broken a rib or something trying to do CPR..." Tom looked at the floor, "Great" He thought, "I broke a doctor's ribs, good one Rich!" He made a mental note, not to come to County ER if he needed anything, this doc would probably be pretty pissed when he woke up.

"What did you need us for?" Tom asked.

"The guy in Exam 2, he isn't supposed to leave, let me get the nurse, I'm not really sure what's going on, which isn't unusual, but hang on, lemme see what she wants." Randi left the desk and went to the doors of the trauma room. A little banged up was an understatement, "couldn't Carter ever catch a break." Randi thought as she went through the trauma room doors.

Mark rattled off orders, "I need a portable chest, 12-lead, type and cross for four, cbc, trauma panel...."

"His pulse ox is down to 86 Mark..."

"Keep bagging and get respiratory down here!"

"Decreased breath sounds on the right...he has a wound between the third and fourth intercostal space, looks like...some kind of stab wound...." Abby said, trying her best to be helpful and not in the way.

"Shooting!" The x-ray technician called out, and everyone stood back for a moment.

"Set up for a subclavian...Abby ever done one of these?" Mark asked.

"No."

"Come here." Mark said making room for Abby to observe, "Haleh, give a gram of Cefotetan."

Abby watched as Mark inserted the subclavian line, and the films were brought back into the room.

"You need some help in here?" Luka asked as he stepped into the room, gowned and gloved.

"Yeah, can you set me up a chest tube?"

"No problem."

Mark slapped the films into the light box.

Luka inserted the chest tube, and watched as blood filled the thoraseal bag.

"Mark, his pressure's down to 80 palp." Haleh called.

"Set up two units on the rapid infuser." Mark said.

He looked up at the films, and pointed out to Abby what was pretty obvious, "see this opaque area, and the shift of the mediastinum to the left?" He asked Abby, "what's your diagnosis."

"Uh... hemopneumo....looks like a sternal fracture too."

"Good, exactly right." Mark said, "Now what are you going to do."

"Mark he's still tachy at 120!" Haleh called, "he's in v-fib!"

"Okay, give another amp of Epi, and start a Dopamine drip, charge to 200 and clear!" They shocked his heart for the second time that day, Mark listened to John's chest with his stethoscope, "heart sounds are muffled."

"We have a rhythm."

"He's got 1,600 cc of blood out of chest tube, set up for thoracotomy." Luka called out.

"He's still hypotensive at 80 palp." Haleh said, looking quickly away from the obvious foot print on her co-workers chest. She made a mental note, to look at the shoes of the kid in Exam 2.

"Okay Abby, what do you think?" Mark asked.

"Uh...." Abby stammered, "cardiac tamponode?"

"Right again, now what do you do?"

"Pericardiocentisis."

"Right." Mark set up to do the procedure while Abby looked on wide eyed. She didn't know if she'd ever get used to the pace here.

Mark extracted the syringe full of blood from John's chest. "What's his pressure?"

"He's at 90/60." Haleh called back.

"Okay, call surgery, we need to get him sent up."

Elizabeth gowned and gloved, came in through the doors, "What have you got?" She looked over at the x-rays, "sternal fracture, this patient has had a previous chest surgery." Elizabeth said in her clipped British accent.

"Elizabeth," Mark said, "it's Carter."

"What the hell happened?" She asked.

"I don't really know."

"Call up to get the OR ready, let's take him up." Elizabeth called as she unplugged the cables and rolled the gurney down the hallway toward the elevators, with Haleh at her side. Haleh wanted to stop by Helen's room and tell her personally what happened.

She looked down, and noticed Carter's eyes were opened, he stared at the tiles of the ceiling in the elevator.

"Carter, can you hear me?" Elizabeth asked, "Blink if you can hear me."

John blinked his eyes, then held them tightly shut. He couldn't really feel much of anything right now, but his chest. His chest felt like an elephant was sitting on it. It didn't really hurt, just a constant pressure that made it hard to breath.

****************************************************************

Haleh left John at the OR, and told Elizabeth to call her as soon as he was out of surgery. Haleh had two things on her mind, get that kid's shoe, and get to Helen's room, before she called downstairs again.



Part 6
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