“Excuse me,” he said stiffly, turning away at the same moment she’d snatched her hand back. Struggling to calm her racing heart, she stared at his retreating back, stunned by her unexpected, and unwanted, visceral reaction to the man she intensely disliked.
“Do you need anything else, Dr. Ross?” Susan asked, handing over the antibiotic she’d requested.
Leila successfully pulled her attention firmly back to the patient. “No, thanks, Susan. Let’s go.” Leila placed the chart on the bed and helped push Jimmy’s gurney upstairs, still slightly shaken by that brief, electrifying touch. No doubt she’d totally imagined it. She’d been physically and emotionally exhausted this past week, the anniversary of her husband’s death hitting her harder than she’d expected. Even though George had died two years ago, she still missed him.
She’d loved her husband, even if their marriage had been too brief. George Ross had been a wonderful, kind and gentle man. There was no way she was even remotely attracted to a guy like Torres. Absolutely not.
As they reached the OR, she left Jimmy in very capable hands while she took time to scrub, resolutely pushing those irksome thoughts away and focusing every iota of her attention on the patient who needed her care.
Refusing to waste another second thinking about Quinn Torres.
Leila finished operating on Jimmy Lawton, thankfully catching his engorged appendix before it ruptured, only to receive another trauma call. Wryly preparing herself for a long night, minus any sleep, she hustled back down to the ED.
She was surprised to see Quinn was still there. Hadn’t his shift ended at eleven? Apparently not, since he was currently giving orders in a harsh tone that reminded her of a marine drill sergeant.
“What’s going on?” she asked, stepping into the trauma bay. There was a lot of blood surrounding the male patient lying on the gurney, and she could tell he was bleeding from his head, nose and mouth, not to mention the places she couldn’t see, like internally. Two nurses pumped blood and fluid on a level-one rapid infuser while another one scurried to get blood for additional lab work.
“He took a swan dive off the roof of his parents’ two-story house, leaving behind a suicide note. He hit the concrete driveway from an estimated distance of twenty feet.” The pertinent details didn’t come from Quinn, but from the charge nurse. “Took the brunt of the force on his legs, which might be the only reason he’s still alive.”
Oh, boy, she hated jumpers. They were the worst because the trauma was often so severe there wasn’t much chance of survival. Why couldn’t he have hit the snow-covered ground instead? At least then he’d have a better chance.
What a horrible Christmas memory for his parents.
“Leila, he needs to get to the OR, stat,” Quinn said when he saw her. The grimly fierce expression on his face surprised her, no sign of his cool arrogance now. “He’s losing blood faster than we can pump it in and I’m certain he’s bleeding internally.”
She was certain of that, too, but this patient’s status as a viable candidate for the OR wasn’t quite as clear. “What’s the extent of his head injury?” she asked.
“Pupils fixed and dilated. He wasn’t found right away, not until one of his friends kept trying to get in touch with him and called the parents,” Mary, the charge nurse, told her. “Their bedroom is on the other side of the house and they didn’t hear him hit the ground.”
“Fixed and dilated pupils are a bad sign. He needs a neurosurgical consult,” Leila told Quinn.
“I’ve called them and they’re on their way, but he has skull fractures, so there’s a chance he won’t suffer brain death. He needs to go to the OR immediately.” Quinn’s intense insistence was very unlike him. Where was his cool detachment?
Upon examining the patient closer, she realized his legs appeared firm and unnaturally taut. Compartment syndrome, bleeding into the tissue around the bone, was a serious, life-threatening complication of multiple trauma. “What is his tissue perfusion pressure?” she asked sharply.
Quinn shook his head, indicating he hadn’t checked it.
Leila glanced at the nurse. “Get me the Stryker STIC monitor, we need to know what his tissue perfusion levels are.”
“Draw a myoglobin level and a lactic acid level, too,” Quinn added, quickly realizing the danger.
She set up the monitor and then inserted a needle into the patient’s muscle. Quinn leaned over to see the reading for himself.
“We’re losing his blood pressure,” one of the nurses running the rapid infuser warned. “Do you want more blood or saline?”
“Both,” Leila and Quinn responded at the same time.
“Two more units of blood and one liter of fluid,” Quinn clarified. “Make sure you have his vasopressors turned up as high as possible.”
“Tissue perfusion pressures are elevated at 38 millimeters of mercury,” Leila said, glancing at Quinn. “I’ll take him to the OR for a stat fasciotomy in both legs and I’ll explore his belly, too. But it’s likely that this massive fluid resuscitation isn’t helping his brain injury at all, so you must realize his prognosis is poor.”
“I know.” Quinn’s dark eyes were grim, haunted, as if he was taking this young man’s fate directly to heart. “I’ll talk to his parents. Please do your best.”
“I will.” Leila turned and quickly gave orders for the patient to be moved up to the OR.
Her adrenaline was pumping, heightening her awareness as she prepared for surgery. The young man’s name was Anton Mayer and as she finished her scrub and entered the OR, she noticed his condition wasn’t any better. In fact, if anything, he looked worse.
Feeling slightly sick to her stomach, Leila reached for her scalpel. She was going to keep her promise to Quinn and do everything possible, but she had an awful feeling that Anton was going to die.
Not yet, she reminded herself grimly, doing the fasciotomy to both lower extremities first and then preparing to explore his abdomen. He wasn’t going to die yet.
But after working on his legs, she moved to his abdomen and when she saw he had a severely fractured kidney, she knew things were worse than she’d feared. She took the damaged kidney out but the bleeding was profuse. She could barely see where the source of the bleeding was coming from in the sea of blood.
“We’re losing him,” Dirk Greenfield, the anesthesiologist, warned. “I can’t sustain his blood pressure.”
“Keep trying,” Leila said, praying she could find the source of his bleeder. Although there was likely more than one source. Sweat dampened the back of her scrubs, running down the sides of her face. She tried to tackle one emergency at a time.
“Blood pressure is gone, he’s in PEA.”
PEA was pulseless electrical activity, which basically meant the kid was bleeding to death. Or he’d already herniated his brain from all the fluids they’d given during the trauma resuscitation.
“Bolus him with epi, I found the arterial bleed.” At least she’d found one of them, though she suspected there could be more.
“I already bolused him with epinephrine several times. Now he’s in a wide complex rhythm.”
“No!” Leila didn’t so much as glance at the heart monitor, keeping her gaze focused on what she was doing. One more stitch and she’d have the artery closed off. Then she could take a look at his spleen. Maybe that was the other major source