CHAPTER 11
RILA
— Attention everyone — the emergency room head nurse raised her voice so everyone there could hear her — There was a fire at a concert, and we have multiple victims arriving, many burned and people trampled. We will need all the help we can get. We’ll have to triage, you know how that works.
Shit. Rila hated this part of the job. When there were accidents with multiple victims, they needed to focus on saving as many people as possible, this meant not wasting resources on those who couldn't be saved.
The patients were classified as green, yellow, red, and black.
Green for those who had minor injuries and didn't need immediate help, yellow for those who could wait a while to be treated, and red for serious, life-threatening injuries that required immediate care.
And black, well, black was the classification no one wanted to give.
It seemed crazy and they should help everyone, but in these cases there were more patients than resources. While they spent time trying to save a patient who didn't have a chance of surviving or needed too many resources to do so, they failed to help three others who could stay alive.
It was fucked up, but it was what was necessary for moments like this.
It didn't take more than five minutes for the MedHarbor Hospital emergency room to start filling up with other professionals. Surgeries were postponed, stable patients were discharged, and everyone who was free to help showed up. Including Blake and Jessie.
— I hate this — the blonde was the first to speak while twisting her fingers in front of her body.
— Me too — the obstetrician sighed and kept her eyes focused on the automatic door that gave access to the ambulances, her expression full of concern.
— Yeah, today we're gonna need more than one drink after this — Rila spoke as she tied her hair into a tighter ponytail than usual. She would certainly have a headache later, but she wouldn't waste time with locks getting in front of her eyes.
— You know I'm in — Jessie didn't hesitate, knowing she was talking about their favorite bar. After all, it was Friday.
They turned to Blake. The blonde never accepted the invitations to go to The Secret, and Rila didn't know if it was because she wasn't that intimate with Jessie yet or if there was some other reason behind her reluctance.
— Alright — she agreed with a sigh at the end, and the emergency doctor had to control herself not to smile, afraid that it would make her change her mind — But I'm a lousy drinker, so if I end up talking too much, know that it's your fault.
— I can live with that — Rila patted the blonde on the shoulder twice before starting to walk away towards the automatic doors when she heard the ambulance siren getting louder — I hope you can sing.
— What? — Blake frowned in confusion, but Rila was already too far away to respond. She would understand later, when there was no longer a way to escape.
The automatic doors opened five seconds after Rila approached the rest of the team awaiting orders from the trauma chief.
— Woman with 15% of her body with third-degree burns and 40% of second-degree, Glasgow 13, hydration with one liter of saline started in the field and stable signs during transport — a paramedic spoke over the patient's screams as he pushed the gurney into the emergency room.
— Put a plastic surgeon with her in bed one — the chief spoke, gesturing to one of the nurses and keeping his gaze on the next victim.
Rila swallowed hard when she saw three other ambulances pulling up. God, there would be so many victims.
— Man found convulsing in the street outside, we stopped it with intravenous diazepam and he remained stable during transport — the rescuer quickly dictated his vital signs — He has a second-degree burn on the front of his left arm, but that's about it.
— Hill, this one is yours, don't let him die.
She wanted to roll her eyes at the idiot she was forced to call her boss. Dr. Purke was a trauma surgeon, which was ironic since his personality traumatized anyone who spent more than five minutes around him.
He was a big sexist, arrogant, and self-centered person who thought that women didn't do as good a job as men, and that's why he had to hound them all the time. And also because he wanted to fuck them and discard them as soon as they left it.
Rila didn't mind dealing with the man's extra rudeness after she rejected him in her second week at the residency. She didn't regret it, even when he made her do all the rectal exams that came for almost a month.
That idiot would never go near her vagina. It didn't matter how difficult that made her job.
— The airway is clear and breathing is good. I need a complete blood test, with kidney function as well — she said as she checked on the patient in bed and another person connected him to the monitor.
A nurse helped her open her clothes and look for bleeding, but there was none. Rila felt the pelvis, looking for any sign of fracture, which also did not appear.
— I need the ultrasound here — she asked anyone who could hear.
They had a system when it came to trauma — the famous ABCDE approach — and she needed to rule out internal bleeding. With that done, she moved on to the next step.
— His pupils are responsive to light, but we'll need a CT scan to understand the seizure and rule out brain injuries, so put him on the radiology list, please.
— Doing it now — she heard Pippa say somewhere nearby — We need you in bed four, it's a tension pneumothorax.
— Coming — Rila took off her gloves and ran to where a teenage girl was panting on the stretcher — Hello, I'm Dr. Hill. I'm gonna need to decompress your lungs to help you breathe, okay?
The girl nodded fervently, her eyes wide and full of fear. Pippa appeared and stood opposite where Rila was preparing to begin the procedure and held the patient's hand, trying to distract her.
Another nurse handed over the large-caliber needle, poured antiseptic on the spot, and Rila didn't hesitate to push it against the space between her fifth and sixth ribs. The girl screamed when the needle entered, but her breathing normalized soon after.
— We need to place the chest tube now, but the worst part is over, okay? — she spoke to the patient, who murmured a confirmation.
After the second procedure, Rila helped an intern intubate a man and then led a resuscitation attempt on a teenager who flatlined during a shoulder reduction. He didn't survive. As well as four other victims she tried to help.
At seven p.m, when her shift ended, she had lost count of how many death certificates she signed.
— Days like this make me question if I really wanna keep this job — Rila confessed before drowning a shot of tequila that Mark had just brought.
— I'm sorry for your patients — said Blake, who was sitting on the stool on her left side.
— And I'm sorry for yours — she reciprocated with a sad sigh and looked to her right, finding Jessie with a tired expression like theirs — Has your pregnant woman with third-degree burns stabilized?
—Yeah, she and the baby are not out of danger yet, but they are alive — she ran her index finger along the rim of her empty shot glass — I heard you rebelled against Dr. Purke. Would you like to share the details?
Of course she heard, news like that spread quickly through the MedHarbor.
— It wasn't a big deal — Rila waved her fingers in the air at Mark, who responded with a short wave and started moving to get her a beer — My patient arrived with a history of seizures, neurological exams were all normal, but his kidney function was impaired in such a way that the possible trauma he experienced wouldn't be enough to cause this.
— The seizures must have happened because of the kidneys — Blake pointed out.
— Exactly what I thought — the bottle of her favorite beer landed on the counter and she thanked him with a smile and a wink — He couldn't confirm since he was unconscious, but I suspected he had chronic kidney disease and maybe he had ingested something he shouldn't have. So, I asked them to do dialysis.
The procedure would clean out whatever toxin was further damaging their kidneys, it was exactly what they needed. It was the right thing to do.
— Purke said I was nitpicking and should only focus on the trauma. I knew I was right, so I went to talk to the real boss.
The MedHarbor was managed by a board and one of the members was the Chief of Medicine — who she liked to call the Supreme Chief — who was the doctor responsible for all department heads. The person could be the head of trauma, but they still had to answer to the Chief of Medicine.
— You know Purke is gonna give you a lot of shit for this, don't you? — Jessie raised her eyebrows, a hint of concern passing through her dark brown eyes.
— Yes, but I can handle it — she shrugged — And my patient is alive, that's what matters.
— You were right then? — Blake asked beside her.
— He woke up shortly before the shift ended and confirmed that he has stage four chronic kidney disease.
He also said that two days ago he ate a star fruit candy that a friend brought back from a trip to South America — Rila exhaled a laugh and brought the beer to her mouth, speaking over the bottleneck — This little fruit is a slutty destroyer of kidney patients.
— You were incredibly smart on this one — the neurosurgeon smiled and lifted her glass of white wine, tapping it gently against Rila's bottle.
— I know I'm amazing, but our little Einstein saying I'm super smart? — she brought her free hand to her chest and let the drama flow through her words.
— Oh, please, I'm not that smart — Blake rolled her eyes, and Rila imitated the movement.
— Hm, excuse me miss “I'll be a neurosurgeon when I'm only thirty” — Jessica leaned against the counter to face the blonde.
— Actually, I'll be thirty-one when I finish residency — the neurosurgeon muttered, her shoulders slumping slightly and her eyes glued to the surface of the bar.