Chapter 17
Triage
Maxwell
Time is not a constant.
In the Operating Room, time is a resource I control. I can stop the heart. I can extend the ischemic window with cold cardioplegia. I can manipulate seconds into minutes.
But standing in the ambulance bay of St. Jude’s Medical centre, staring into the white void of the blizzard, time is a weapon. And it is bludgeoning me to death.
It has been twenty-two minutes since the radio went silent.
"Dr. York."
I feel a weight settle on my shoulders. A heavy wool blanket.
I turn. Nurse Ortiz is standing there. She looks small and frightened in the red glow of the emergency lights.
"You’re freezing," she whispers.
I look down at my hands. They are blue. I am wearing only my suit jacket. The wind chill is twenty below zero. I hadn't noticed.
"I am fine," I say. My voice is shards of glass.
"They... Fire Rescue radioed," Ortiz says hesitantly. "They got a winch line down to the bus. They’re bringing up the survivors."
"Is he one of them?" I ask.
Ortiz looks away. "They didn't say names, Doctor. They just said 'Casualties'."
Casualties.
The word hangs in the air, heavier than the snow.
I look back at the darkness.
I think about the Board. I think about my mother’s dinner table. I think about the perfect, sterile office I fought so hard to keep.
It all feels like ash.
If he is dead, I saved both our careers for nothing. If he is dead, the "York Legacy" ends with a lonely man in a penthouse apartment who never got to be with the one man who broke through his icy facade.
Come back, I plead silently. I will use every fork in the drawer. I will let you eat chips in the OR. Just come back.
A light cuts through the storm.
"Incoming!" a triage nurse shouts.
The heavy rumble of a diesel engine shakes the concrete. It’s not an ambulance. It’s a Heavy Rescue fire truck, chains clanking on its massive tires.
It backs into the bay, snow falling from its wheel wells in clumps.
I am running before it stops.
The back doors swing open.
A firefighter jumps out, his turnout gear covered in ice and mud.
"We have three!" the firefighter yells. "The girl, the driver, and the Doc!"
The Doc.
My heart restarts. It slams against my ribs with a violence that hurts.
Paramedics swarm the truck. They pull out the first gurney. The girl. Screaming in pain, but alive.
They pull out the second. The driver. Unconscious, intubated with the tube Jax placed. Alive.
They pull out the third.
The world narrows down to a pinpoint.
Jax is strapped to a backboard. He has a rigid C-collar around his neck. His eyes are closed. His face is a terrifying shade of grey-blue. There is a laceration on his temple that is bleeding freely, staining the orange head blocks dark red.
He is not moving.
"Jax!"
I shove past a paramedic. I don't care about protocol. I don't care who sees.
I grab the side of the gurney.
"Status!" I bark.
"Hypothermic!" the medic yells as we run toward the trauma doors. "Core temp is 32 degrees Celsius. BP is 80 over 50. Pulse is bradycardic. He took a hell of a ride, Doc. The bus rolled three times. He shielded the driver with his own body."
Of course he did. The idiot. The hero.
We burst into the Trauma Bay.
"Trauma One!" I command. "I want warm fluids! I want the Bear Hugger! Get X-ray in here now!"
We slide him onto the trauma table.
I am the Chief of Cardiothoracic Surgery. I do not treat blunt force trauma. I do not run codes in the ER.
But tonight, this is my OR.
"Scissors!" I yell.
I grab the shears. I cut through his leather jacket. I cut through the scrubs I watched him put on this morning. I strip him down to his skin.
He is shivering. Violent, full-body tremors that shake the table. That’s good. Shivering means he can still generate heat.
"Jax," I say, leaning over him. I cup his face with my frozen hands. "Jax, can you hear me?"
His eyelids flutter. They open a slit.
The hazel eyes are glassy, unfocused. Pupils are sluggish.
"Max?" he croaks. It’s barely a whisper.
"I’m here," I say. My voice cracks. "I’ve got you."
"The driver..." Jax mumbles, his teeth chattering uncontrollably. "Did I... did I secure... the airway?"
"You saved him," I promise. "The tube held. He’s alive because of you."
Jax tries to smile, but his lips are too frozen. "Good... perimeter... secure..."
"Stop talking," I order. "Nurse, get those fluids running! Wide open! He needs volume and heat!"
"Dr. York."
Dr. Sterling is suddenly there. He is standing in the doorway of the Trauma Bay, still wearing his expensive overcoat. "Dr. York, you are not a trauma surgeon. Step aside. Let the ER attending handle this."
I turn on him.
I am holding a pair of trauma shears. I am covered in melting snow. I am watching the man I love shake apart from cold.
"Get out," I snarl.
Sterling blinks. "Excuse me?"
"This is my patient," I say. My voice is low, dangerous. "And if you interrupt my triage for one second, I will have security remove you for interfering with a critical resuscitation."
Sterling looks at me. He sees something in my eyes that makes him take a step back. He sees that the "company man" is dead.
"Proceed," Sterling says stiffly.
I turn back to Jax.
"Max," Jax whispers. He’s fading. The shivering is slowing down. That’s bad. That means he’s losing the energy to fight.
"Stay with me," I say, grabbing a warm blanket from the warmer and throwing it over him. I tuck it in tight. "Do not close your eyes, O'Connell. That is a direct order."
"Tired..."
"I know. I know you're tired. But you have to stay awake."
I grab his hand. It’s ice cold. I rub it between mine, trying to transfer my heat, my will, my life force into him.
"You promised me a date," I say, my mouth close to his ear. "Real date. Cheeseburgers. No parents."
Jax’s eyes drift shut.
"Jax!"
"I’m... awake," he slurs. "Just... resting... my eyes..."
The monitor beeps. His heart rate is dropping. 45 bpm.
"He’s bradying down!" Ortiz yells. "Doctor, should we push Atropine?"
"No," I say. "It’s the hypothermia. The heart is irritable. If we push meds, we risk sending him into V-Fib. We have to warm him up."
I look at the team.
"I want a peritoneal lavage," I order. "Warm saline into the abdomen. Core warming. Do it now."
We work.
For an hour, we work.
I watch the monitor. I watch the temperature probe climb, decimal by agonizing decimal. 32.5... 33.0... 34.2...
I don't leave his side. I hold his hand the entire time.
Around us, the ER is chaos. The other victims are being treated. The power flickers on and off as the generator struggles.
But in Trauma One, there is only the beep of the monitor and the sound of my own prayer.
Finally, the shivering stops. Not because he’s dying, but because he’s warm.
His heart rate stabilizes. 72 bpm.
His eyes open. They are clearer now.
He looks up at me. He sees the worry etched into my face. He sees the snow melting in my hair.
"Hey, Princess," he whispers. His voice is stronger.
I let out a breath that feels like a sob.
"You are," I say, stroking his hair back from his forehead, avoiding the cut, "the most stubborn, reckless, infuriating man I have ever met."
Jax grins weakly. "But did I die?"
I laugh. It’s a wet, choked sound.
"No," I say, leaning my forehead against his. "You didn't die."
"Good," Jax sighs, closing his eyes again. "Because I still... owe you... that burger."
He drifts off into a natural sleep.
I stand there, gripping the rail of the gurney.
"We’re moving him," Ortiz announces gently. "ICU Bed 4 is ready."
We wheel him out. The hallway is crowded. Residents, nurses, even Sterling are watching.
I don't care. I walk alongside the gurney, my hand still gripping Jax’s, my other hand resting protectively on the rail.
We reach the double doors of the ICU.
Sterling steps forward.
"Dr. York," Sterling says, his voice cold. "Visiting hours are over. And as you are not the attending physician on record, you need to clear the floor."
I stop. I turn to face him.
But before I can speak, a small, formidable figure steps between us.
Mama Ortiz crosses her arms. She is five feet tall, but in this moment, she looks like a bouncer at the gates of heaven.
"Visiting hours?" Ortiz asks, raising an eyebrow at the Chief of Surgery. "I don't see any visitors, Dr. Sterling. I see the Chief of Cardiothoracic Surgery conducting a post-operative consult."
Sterling scoffs. "He’s sleeping, Nurse Ortiz. What exactly is Dr. York consulting on?"
Ortiz looks at me. She looks at my hand gripping Jax’s. She winks.
"He is consulting on peripheral perfusion," Ortiz lies smoothly. "And possibly... cuticles. It’s a very specialized field. You wouldn't understand."
Sterling turns a shade of purple. "This is ridiculous. I am ordering—"
"You are ordering nothing in my unit," Ortiz snaps. "My patient is critical. He needs stability. And right now, Dr. York is the only vital sign that is keeping him stable."
She hits the button for the doors. They hiss open.
"Dr. York?" she says, gesturing inside. "After you."
I look at her. I nod, a silent message of profound gratitude.
"Thank you, Mama," I whisper as I pass her.
"Just don't fall asleep in the chair," she mutters, patting my arm. "Or I’ll draw a mustache on you with a Sharpie."
I walk into the ICU. The doors slide shut, sealing Sterling out.
I park the gurney in Bed 4. I transfer him over. I pull the chair up to the bedside.
I am not leaving him. Not tonight.