Laura Villenueve (stcosmas) wrote in paxletalelogs, @ 2017-04-05 20:32:00 |
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Entry tags: | apollo, marassa jumeaux 1 |
uhh another one huh? what we got
Who: Laura & Lucas.
What: The head RN on the afternoon shift oversees a new doctor's work in the ER.
Where: LA County Hospital.
When: Midday, April 5.
Rating: PG-13 for some gore.
Laura tucked a stray strand of hair back behind her ear; it seemed no matter how many times she wore a ponytail, something would get loose. She was bent over a patient, dressed in plain, blue scrubs, double checking vitals, killing time before the next ambulance arrived with more people who needed medical help. The afternoon had been mostly slow and quiet -- a rarity for the middle of the week -- and she couldn't help but feel that something was due to explode soon. It always was. It left her feeling on edge, and she promised herself she'd take a long, hot soak once she got home.
As though reading her thoughts, paramedics pushing a man on a stretcher into the ER. They walked leisurely, which meant it wasn't a serious emergency, but the fact that he had a CPAP mask on his face made Laura's brows draw together. She finished what she was doing and moved to intercept the paramedics for details.
"30 year old man, he's--"
"He wasn't wearing it to bed," a woman behind the stretcher suddenly interrupted. Laura glanced at her with an arched brow, then pulled her gaze back to the paramedic. The latina woman sighed, shrugging.
"It's glued to his face."
Laura's eyes widened; she'd seen and heard a lot in her time in the emergency room, but sometimes some stories were too weird to be believed. She looked back to the woman.
"What did you use?"
The blonde wilted a little under Laura's steady gaze. "Gorilla glue." Laura bit back a sigh, and waved the paramedics over to a nearby, empty bed. She glanced around, looking for the doctor on duty.
Lucas was with another patient a few beds down, who came in with a severe allergic reaction and was having respiratory problems. A slightly overweight twelve year old boy who was wheezing and covered in a bright red rash, being shadowed by his anxious mother. He’d already given the boy strong antihistamines, which made him slightly sleepy but relieved some of the itching, and an oxygen mask to help get his breathing under control, once he’d determined there was no swelling in his throat. “Did he eat anything different?” he asked the mother, but she shook her head, to worried about her son to really think straight. Lucas gave a meaningful look to the boy and then asked the question again. The boy looked suitably chastened and then pulled the mask down.
“I snuck a box of cookies into my room,” he wheezed, “and I ate all of them.” His mother’s eyes widened.
“But you’re on a diet!” she scolded. Lucas ignored her.
“What kind of cookies were they?” he asked patiently, but he was sure he already knew the culprit.
“Peanut butter.”
Lucas nodded and put the mask back on the boy. “Alright, I’m going to do some allergy testing to be sure, but I’m thinking this is pretty obviously a peanut allergy. We’ll know more in a few hours. Fortunately, it seems relatively mild compared to some peanut allergies...he should be fine.”
With a smile he left them alone, heading to the nurses station to make a note in the kid’s chart and directing one of the duty nurse to draw blood and up the dose of the antihistamines they were giving the poor kid. Once he was done he looked up and saw Laura looking for him. “Hey, what’s up?” he asked, closing the file.
The paramedics had transferred their patient to the bed, where he watched mournfully from beneath his mask. The woman, who Laura assumed was either a wife or girlfriend, took up a post near the bed as the medical team that had transported them left the scene in the ER staff's capable hands. The whole case honestly hadn't even merited coming this far, but Laura wasn't going to turn them away now that they were here.
"Adhesive to the skin, maybe for a few hours; could be through a few layers," Laura said. The man had been made comfortable, and Laura figured it was better to get a second opinion from another member of the staff before instructing her fellow duty nurses to go about removing the mask, and then carefully and slowly detaching the leftover tubing from his face. Plus she wanted to see what this Dr. Peters was made of. "Probably just needs a good soak, some repeated acetone application." She stepped back, giving Lucas the floor.
Lucas’s eyebrows rose slightly when he saw the patient, and then the woman he'd been brought in with, but not enough to seem rude. “Worried about his sleep apnea?” Lucas asked her without even consulting the chart. He glanced at the man’s vitals. He frowned, and on impulse took off his stethoscope from around his neck and plugged it into his ears, pressing the scope to the man's chest just under his shirt.
“Can you take some deep breaths for me?” he asked, listening hard as the man did as he asked, hearing exactly what he'd expected to on first glance. “Do you have any family history of lung disease or cancer?” he asked. The man shook his head.
“Not that I know of,” he said, his voice muffled from the mask. Lucas nodded, wrapping the stethoscope back around his neck. He leant in close to examine the skin around the mask, noting the irritation from the glue was only minor. He glanced at Laura. “Just like you said, acetone to get the mask off, and analgesics for the damaged skin. And get me a chest x-ray once it's off,” he said, turning to head back to the nurses station. “Don't let them leave until the results come back.”
Laura waved the duty nurse assigned to the station over, walking the younger woman through the steps necessary. Cottons swabs and a bottle of what smelled like nail polish remover were quickly acquired and she oversaw the younger nurse's application for a few minutes before she moved away, checking on a few other patients until she finally wound her way back to the nurse's station.
"Certainly not the weirdest thing I've seen here, but stuff like that helps break up the monotony," she commented toward Lucas as she moved through colorful files in a neon blue tray atop the desk. In their line of work, there was little time for chit-chat between patients, and she hadn't had a chance to get to know the new doctor on staff on a more personal level. At least his calm demeanor meant he knew what he was doing, or he at least thought he knew. "Is this busier or slower than where you came from?"
He glanced up from the file he’d been making notes in and smiled at her. “LA is definitely more busy, but we got our fair share of strangeness up north too,” he said with a little smile. “We actually had a tally sheet in the ER break room of all of the most interesting foreign objects found in...various places,” he said with a chuckle.
“There’s also a different vibe in the staff here,” he added thoughtfully, pausing writing in the chart in front of him. “I’ve found that the people here are more businesslike and to the point than in a smaller town. We used to all go out after work for dinner as a group sometimes just to decompress, or laugh or cry about the day. People here...keep to themselves more.” He paused, and then thought about what he’d just said. “That’s nothing against the staff here,” he said quickly, as if to alleviate any possibly bruised feelings, “it’s just...different, that’s all.”
Her head bobbed, reminded of how people helped one another out more in New Orleans. Los Angeles was certainly a different beast.
"How long have you been here now? LA, in general. It's definitely an adjustment, though this line of work helps." She gave a light shrug. "It'll definitely weed out the ones who can't handle the harder days."
Lucas smirked a little, looking back down at the chart in his hand. “And you’re trying to find out if I’m one of them, I take it,” he observed easily, looking back up to meet her eyes with a knowing smile. “I appreciate that, but you have nothing to worry about. I’m glad you run a tight ship around here though, every ER needs a head nurse like you.
“I’ve been in LA less than a month, but I moved here for the job, because I was requested. You can look into my credentials if you like, but I’m here because I want to be. And in my experience, people who do the job because they believe in what they do make the best doctors. And nurses,” he added with a nod of respect to her.
Laura smiled as congenially as she was able, glancing up from the folders she was putting into order. "I can read all day, doctor, but theory is very different from experience. And this is a high-energy, quickly moving ER. Don't be offended, I'm just making sure the ship doesn't sink just because the captain swapped out." She finished, then leaned back against one side of the station, crossing her arms defensively over her chest. "Is that why you got into medicine? Because you want to be here?"
“I’m not at all offended,” he said, “this is your ship,” he emphasised. “I may take over while I’m here, but you and your staff are the constant crew. I’m here to work with you, not rock the boat,” he added with a little grin.
He paused for a moment to consider her question. “I became a doctor because I like to help people,” he said, and then realised just how generic that answer was and smiled at himself. “Wait, is that a little too stereotypical?” he asked her. “I became a doctor...because I wanted to try to make other people’s lives a little bit better for my having been in them. If I see someone suffering, and have the ability to take that away for them, that’s what makes my job worth it. That’s why I’m here.” It was still far too oversimplified, but it was the best he could do on short notice in a busy ER. “What about you? Why nursing?”
"My mother died of leukemia when I was 18," she replied, blunt and to the point as ever. It wasn't a story she hid; neither was it something she necessarily advertised, but he'd asked her directly and such a thing deserved the same in return. Laura met his gaze evenly, not searching for sympathy or rejecting it, merely watching his reaction. He met her gaze, steady, compassionate, but attentive. She followed that statement with a shrug. "Things just went from there. So yeah, I guess you could say I like to help people."
She pushed off the counter, dropping her arms to the sides; her attention was drawn away by another stretcher, this time pushed by paramedics covered in blood. Laura instantly abandoned the nurse's station to get details. Lucas looked over just as she did, following her towards the newcomer like a moth to a flame.
"A gunshot wound, blunt force trauma to the head; it looks like a through and through," one of the EMTs responded to her unspoken question for information. The man on the stretcher had the majority of his clothes cut off, plaid flopping on either side of the stretcher; he had a face mask being pumped by one of the paramedics, which was then swapped over to a duty nurse as Laura directed them into a makeshift surgical room meant for incidents like this.
The man started groaning, a hand rising from the stretcher. "How is he conscious?" One nurse muttered, her eyes a little too wide at the sight of all the blood. Lucas, having already pulled on gloves directed the woozy nurse with a gentle hand to start an IV on the patient to give her a second to recover herself.
"Stay focused," Laura advised, pulling on gloves and grabbing swabs to start making some sense of where the wound lay and what they needed to do. "Dr. Peters? Now would be a great time.”
He would have smiled at her slight condescending words if he wasn’t so focused on the patient. A glance told him the bullet had most likely punctured his lung. “Help me roll him on his side, carefully,” he said, pushing him gently over to look for an exit wound, which he found below the man’s right shoulder. “Okay good, it went through,” he said, glancing up at Laura, “get pressure on that,” he said, and then over his shoulder called out “and we need two units of O Neg,” he called to whoever happened to have free hand, glancing up at the monitors to check blood pressure and oxygen stats. He turned to a nearby drawer and pulled out an empty syringe, pulling the stopper out of the end and swiftly but carefully stabbing it into the man’s chest between two ribs. There was a soft hissing sound among all of the other noises as the air in the chest cavity escaped and his lung reinflated. On the monitors, the man’s stats improved slightly.
Satisfied that the most pressing issues had been dealt with at least for the moment, he focused on the patient himself, noting that he was, unbelievably, still awake. Lucas leant over his head, pulling out his penlight to check his pupils. “Hey buddy,” he said, not yet knowing the man’s name, “my name is Dr. Peters, you’re at the hospital, can you hear me? Can you say your name?” he asked him loudly and clearly. He glanced over his shoulder to search for one of the paramedics, “you guys get his ID?”
They shook their heads; Laura moved immediately, going through the man's pockets with a free hand. She pulled out a leather wallet, within a card stating his name was Marcus Teller and he was an organ donor. She sincerely hoped it wouldn't come to that.
"Marcus, you're in the ER at LA County," she said sternly, her eyes watching an IV setup along with the blood transfusion being prepped for once the wound itself was dealt with. "We're taking care of you but we need you to stay calm."
The man was still moving on the stretcher a little, clearly confused. Then he struck out at the nurse trying to pump air into his re-inflated lungs, an arm that Laura reached forward over him to catch as she struggled to maintain pressure on his chest.
"I think we need to knock him out, for his safety and ours," Laura said, directly to Lucas; as the physician on staff, it was his call, though she could always bend the rules and do it herself if need be. A nurse came up behind Lucas with an operating tray for closing the wounds once they were sure interior bleeding was under control; another tray behind that was prepped with dressings. "He could go into hypovolemic shock if we don't stop the bleeding, and we can't do that if he's fighting us. Ativan through the IV would do it, but we need to hold him down."
Lucas nodded to her, agreeing with her. He was busy holding down the patient's right side, keeping him from starting the sutures on the bullet wound. “Start the IV,” he said, waiting until he could feel the arm under his hands start to slacken before letting him go and taking the surgical implements from the tray to start to close the wound.
He worked quickly, but his hands were steady. As soon as he was done and the patient’s chest was dressed with a compress he directed them to roll him onto his side, doing his best to close up the much larger and messier exit wound. He kept an eye on the monitors, making sure his blood pressure and oxygen stats weren't getting any worse. Soon enough he was finished and another dressing was applied to the patient's back.
He took the time then to finally have a look at the head wound, though it didn't look nearly as bad as the rest of him. “I want a CT scan of his head and chest, to make sure we didn't miss any internal damage,” he said, pulling off his gloves and mask now that the patient was stable. He sighed some of the tension out of him and left the nurses to finish up, issuing a few last minute instructions before leaving them to it.
“Make sure that gunshot is reported, if it hasn't been already,” he said to the nurse on duty at the desk.
She handed him another chart...the one for the guy with the mask. He pulled out the film from the lab and held it up to the light, sighing when his suspicions were confirmed. Tiny blobs in his lungs, causing the shortness of breath he'd been complaining about. Fortunately, they were small, though he'd need a consult to know what type they were dealing with.
Laura was finishing up with the gunshot victim, wondering if they would need to handcuff him to the bed. Doing that always nagged at her; he was a victim, not a perp, at least, not within the confines of the ER. But if he was a danger to her nurses, she'd do it without a second thought. Hedging on the bet that he was more anxious than dangerous, she supervised the vitals survey, ensuring everything was in order before she circled back with Lucas.
"Nice catch," she offered, her brows rising. The words were bereft of any real respect, but it was clear she was impressed with him having thought to go that far for a simple anaphylactic reaction. "And good work with the gunshot. If you haven't guessed by now, we get a lot of those."
“Thanks,” he said distractedly, tucking the film back into the chart. His eyes finally met hers and he smiled. “Good work in there; it’s good to know when I’m in the ER I’ll have backup I can count on.” He held up the chart in his hand, edging around her, “now if you’ll excuse me, I’m gonna call in a consult from oncology, and tell the patient’s wife she may have saved her husband’s life by gluing a mask to his face,” he said with a slight grin, walking slowly backwards towards the elevators.
Laura just nodded, watching Lucas disappear toward the elevators, before turning back to continue her usual rounds. With so much to do and hairpin turns at any moment, there was never a dull day in the ER.