Who: Remy 'Thirteen' Hadley doctor13 & Nina Pickering inner_wolf What: Collaborating on a case When: Monday, September 21, midday Where: St. Joseph Hospital Rating: Audience Discretion is Advised Warnings: Description of graphic medical care/maladies, a sick/dying pediatric patient, and general unpleasantness from Thirteen. Status: Closed/Completed GDoc
~*~
SBS (Short Bowel Syndrome aka Short Gut Syndrome) patients were becoming unfortunately common in the internal medicine field courtesy of things such as Irritable Bowel Syndrome and the upsurge in Crohn's Disease cases. Dr. Hadley had been specializing in internal medicine for so long, it was common for her to get referrals from other hospitals than UC Irvine inside the Orange County medical arena. She had taken the referral from St. Joseph's because it'd been a child.
Pediatrics weren't her main focus, but even she had a soft spot for children.
Swooping into the ER to grab the chart, she quickly ran through what was described while shaking her head, muttering, "Couldn't call me in for something easy, could they? Figures."
They tended to think she was still some kind of superhero when no one was a god. Medicine had its limits; this child was nearly at his. They needed a transplant if they wanted to save him, but intestinal transplantation was still not a common practice. Donors were incredibly hard to come by, especially for a child. This boy likely had enough adhesions from the seven prior surgeries he'd been through to where a transplant would be almost impossible to take. Thirteen wouldn't have wanted to take it on.
"Are you the nurse on the Merriman case? I'm needing to get going on what we can do to lavage him down, clean out as much as we can, keep him stable. I don't want to have to open this kid again. His prospects aren't good if we have to do another bowel resection."
Thirteen thought the nurse looked familiar. There was a capable look to her which was reassuring. It would be nice to be working with someone who was calm, collected, and could hold herself together while working with a child who was likely dying. She didn't expect to be able to make any miracles happen for the boy. The best Thirteen could manage would be to get the worst of his infection cleaned out, get him on some antibiotics to stabilize him, and make him comfortable while he healed.
It would be up to a higher power than her if he ever got well enough to leave St. Joseph Hospital again.
~*~
Being one of the senior nurses at Irvine General meant Nina saw a lot of patients and was usually overseeing a ward or area but sometimes she was called upon to assist with certain patients. She had worked on end of life wards for a long time and as such was usually the one requested when difficult cases came in. Which was how she found herself with the young boy who was facing almost certain death.
Nina had always been able to offer support and comfort to those dying or close to death, she wasn’t sure why but she was able to remain a calm influence on them and helped them to relax when they needed to. Nodding in response to the doctor’s question Nina listened as she was given instructions, “Yes doctor” was the response before she moved quickly and efficiently to do what was needed. There was no hanging about, this child needed them to be thorough and fast in order to help him and that was what Nina intended to be.
~*~
Thirteen was impressed with the nurse's efficiency. She took pride in her work which was obvious. There was no hesitation in her actions; she greatly appreciated knowing her patient was in good hands. The boy had two drains in his abdomen which they could lavage through easily enough. Normal saline was handed over to her perfunctorily. Thirteen got a huge lavage syringe to suction out the saline before beginning to run it through the boy's bowel. She pointed to the monitor for his vitals.
"Keep your eyes on his pulse. He's sedated, but this will be painful enough to where he might get shaken out of it. We? Don't want that. If his pulse goes above 75? You do whatever you have to do to get my attention."
She smiled at her to try to break the tension as much as she could.
"We're going to take care of him. This kid? Doesn't get to die today."
Healing him was something Thirteen couldn't do. She couldn't make him 'all better.' Her skills as a doctor were formidable, but she wasn't magical. His health was fragile from pre-existing conditions to the point her best chance would be to keep him alive, not try to save him. The nurse likely knew that already which was why she was working as diligently as she was on the case.
~*~
Hesitation could be a death sentence in the heated circumstances Nina faced therefore she was always sure about her actions. She knew what she was doing and undertook refresher courses regularly to ensure she stayed up-to-date on everything. She loved her job and cared about her patients, that much was obvious.
“Of course” Nina said, she knew what to look for and was prepared to do whatever was needed to get the doctor's attention should she need to.
She said nothing about the child not dying, Nina knew as well as anybody that at the end of the day in this situation it really wasn’t their call but they would do their best.
~*~
Silence was something Thirteen didn't get often in the ER. She was usually surrounded by people who wanted to talk their way through everything, almost as if words could ward away death. It was a nice change as far as she was concerned. There was a lot of pressure to say the right thing at the right time when it came to speaking to a patient's family; luckily for Thirteen, her patient's family was confined to the waiting room while her patient was sedated for treatment.
She pushed the saline through the boy until it was moving out of the drains clear once more. His abdomen was still distended which indicated there was some kind of either kink in the bowel or a minor obstruction. A major obstruction would have resulted in the saline being forced out of the same drain rather than going through clearly. Thirteen wasn't concerned over a leak either. That would have been more apparent through elevated temperature -if not outright fever- or no stability in the vitals.
Thirteen tapped the back of one of the nurse's hands and pointed to the boy's abdomen, "Massage gently while I push more saline. I'm thinking there's either a kink or a minor obstruction. If it's a kink, we may be able to massage it out. You'll feel a segment of hard bowel or a knot under the surface in that case. Obstruction should just be a warmer area on the belly where the cool fluid isn't pushing through as fast. Okay?"
~*~
Nina wasn’t one for unnecessary talk, she tended to adapt her nursing style to the doctors she worked with as much as possible and Nina could tell that this doctor wasn’t the chatty sort. Had the family been around she would have reassured them but since they weren’t and their patient was unconscious silence seemed fine.
Nina had noticed the distended abdomen too and was considering the same things when the doctor asked her to massage gently on the stomach, nodding she did as instructed, checking his vitals as she pressed. “Here” she said, feeling the change under her fingers, “It’s harder here” her fingers worked gently over the area but with enough pressure to try and help relieve the kink.
~*~
Feeling in the area the nurse had found, Thirteen nodded, "Kink. You just keep massaging it the way you're doing. I'll push fluid until it's smoothed out. Shouldn't take too long. I think we're going to get lucky with this little guy."
They could take care of a kink. It was life-threatening if not seen to by someone attentive enough to handle it, but they had a great staff on hand. Thirteen knew between her and the nurse, they would be able to see to it being worked out with no surgical intervention required. She was worried the bowel had gotten stiff enough to kink without warning. Didn't bode well for the boy's future. The parents had seemed overly concerned which meant they were unlikely to have fed him something wrong.
Spontaneous kinks or blockages usually indicated they were going to start seeing another degradation of the bowel.
"I don't know how much luck he's got left in him, but today? We may get to see the last of it."
~*~
Nina nodded and continued to massage it, “Well I think he could use a little luck” she said with a small smile glancing at his young face before checking his vitals once more.
She knew as well as the doctor what a sudden onset kink could mean, it wasn’t good news and they’d need to keep an eye on him. Scans would probably reveal the beginnings of deterioration and the beginning of the end of his parents' hope.
“Today then he can be lucky. We can give him that much”
~*~
"Everyone deserves one last lucky day."
Thirteen hoped she got to see her last with a hot brunette splayed out over her naked---possibly on a beach somewhere. There was something comforting about being in the warm sand. It got everywhere. Sand was an inevitable thing on the beach and people took it for granted, but not her, not Lucky Thirteen. She remembered what made up the sand, all those things which had died and deteriorated to become the silt at the bottom of the vastless ocean. One day? She'd become so much silt, too.
She hoped when it happened, whoever traipsed over her thought to enjoy the steps they were taking. Too many people didn't appreciate the lives they were given.
Somehow?
She imagined this boy and his family weren't on that list. They were the kind who appreciated every moment.
"He's one of the lucky ones. You can tell," Thirteen pointed to his vitals where they were improving as the water flushed clear and fast through his drains, "He appreciates every moment we can give him. We're lucky, too, today. We get to catch a glimpse of his luck. Can you get his parents? It'll be a while before he wakes, but he's stable now and who knows when we'll get a bed."
~*~
Nina appreciated almost everything in her life and tried not to take anything for granted but then being around the sick all day kind of made you have a good appreciation of things. She knew she was a lucky one being fit and healthy with no need for any hospital stays so far. She hoped to keep it that way too.
She knew the doctor was right about them catching a break today, it could have been so different. But they'd take that luck.
"Of course" she said, with a nod. Stepping back and removing her gloves. "I'll check the bed status and get a couple of chairs for them" It was usually safer to set them up like that so they were positioned where the doctor wanted them instead of hovering.
~*~
"Thanks again for being a fantastic help. It's not every day I get to work with someone like you."
Thirteen gave a small smile before turning back to her patient, fussing over him to clean him up, closing his drains and settling his blankets around him so his parents wouldn't have to see how close they'd come to losing their son. They were likely smart people. She had no doubt they had been made aware of their son's situation. It didn't mean they had to have it rubbed in their faces. Everyone deserved hope even if it wasn't anything more than a beautiful pipe dream. Thirteen knew better than anyone what the absence of hope could do to a person.
She wouldn't take it away on this kid's lucky day.
She wasn't that kind of person.
This would be his last lucky day in a while if not ever. She'd make him look as good as she could and hope his parents could embrace what time they had left with him. There wasn't anything more she or the nurse could do for them.