Chapter 15 - Cat
Cat
I’ve already finished my first cup of coffee by the time I scan the list of current cases. There are fifty-three patients in our care. Busy weekend. People underestimate the combination of alcohol and a full moon. I am not superstitious, but the numbers do climb during those nights.
I do a quick triage pass. There are several stab wounds, rib fractures, and even two skull fractures. I open up the notes from the night team and a quick glance is enough to confirm my suspicion.
Overnight events:
Room 101 – Nguyen
Stable. Pain controlled.
ICU 1 – Smith
Chest tube output: 120 mL overnight.
Oxygen saturation stable at 92%. Awaiting thoracic consult.
Room 109 – Ortega
Hemoglobin dropped from 11.3 → 9.8.
Repeat labs ordered.
Room 114 – Johnson
Awaiting ortho consult.
My eye lingers on the hemoglobin drop. I click the patient’s file to check their vitals. There is a clear increase in heart rate while the blood pressure slowly declines. I make a note to see this patient first so that I can check for internal bleeding.
I am about to open Smith’s file when there is a knock at the door. It swings open before I can answer, and Carmen rushes in. Her cheeks are flushed, and her eyes are wide. I am up before she even says a word, leaving the charts where they are, right as my buzzer starts to beep.
“Talk to me,” I order while I take off my heels and slip into the sneakers I keep in the office.
“Multi-vehicle collision on the I-95. Possible tanker explosion. Twenty criticals reported so far. Mostly burn victims. First heli is on its way, ETA two minutes. It’s bad, Cat.”
I nod and follow her out into an already buzzing ER.
Soon, staff will be everywhere, in need of directions.
The sudden pressure pushes at me from all sides.
What if I can’t do this? What if they realize I am the wrong person for this job?
Enough, Katherina. Focus. There is no time for this now.
I inhale deeply and silence that inner voice as the overhead speakers crackle to life.
“Attention, all personnel. Mass casualty incident declared. Emergency Department activation. All available trauma personnel, report immediately.”
The robotic voice draws the attention of the staff around us, and I know it’s go time. I nod at Carmen, who is already waiting.
“Prep for triage. Put Whitman in charge. Have Wilder prep the exam rooms, and alert the OR. You are in charge of patient tracking.”
She nods and darts off toward the desk. I gaze over at the waiting area, where about two dozen patients are waiting.
With at least another twenty coming in, most of them will be here all day.
I have to check if we can divert some of the less critical patients to other hospitals.
We are already working above our max capacity.
Only more proof that the current system isn’t working.
I walk up to the desk as I quickly scan the room.
We can move a few patients to other floors, opening up a room or five.
We have eight vents available, max. Too few.
There is always a shortage. A quick glance at the board shows that most of the night-shift surgeons are still in, and half of the morning staff are already prepping for rounds. Good timing.
I pick up the phone and get the hospital operator on the line. His voice is calm, already prepared.
“Wilson.”
“Wilson, Durand. Activate disaster protocol. Page additional staff.”
“Will do. Good luck out there.”
I hang up as Carmen mouths something from the other side of the floor. Heli incoming. I need to run.
I make it to the trauma bay at the same time as Whitman. Her hands are wrapped tightly around the color tags, and she gives me a stern nod. We’ve been here before. She is my first line of defense in the mess that is—
The elevator doors slide open, pulling me from my thought, and instantly there is noise everywhere.
Everything in me stills as I zoom in on my surroundings.
The residents shuffle as the paramedics rattle off the injuries.
Whitman bends forward and presses her fingers to the patient’s neck.
Her voice follows, loud and clear, my cue.
“Red, hypotensive.”
My eyes scan the victim. I knew it would be bad.
Airlifted patients always are. His shirt is soaked in blood that seems to be oozing from his side.
He is dying. My fingers itch to help him, but I know I can’t.
If I put on gloves, if I touch a single patient, I’ll be leaving the staff to their own devices.
It’s the only part I absolutely hate about my job.
I feel like a helpless bystander, even though I know I am not.
I am helping them in other ways. But still, when I see people like him, bleeding out in front of me…
“Trauma One. Activate MTP. Call anesthesia.”
I keep my commands short and clipped. Any extra words are time lost and could cause confusion.
The gurney disappears down the hall as the doors slam open and the next one is rolled in.
The patient is screaming in pain. Her clothes have melted into her skin, which is now a war zone of blisters, blackened flesh, and dripping plastic.
The smell of gasoline wafts toward us. I catch Marcella raising an eyebrow, but she doesn’t comment.
“Yellow. Burns, stable airway,” Whitman drones.
“Burn Unit. Bay Three. Start Parkland fluids. Respiratory standby. Keep the hallway clear.”
Her screams ring in my ears, and I am tempted to order immediate pain relief for her, but it’s not my task. Not now.
“Green, waiting area,” Whitman declares, and another woman is guided away.
The victims flood in now, one after another, crowding the small area.
Their cries and screams become louder, and within minutes, it feels like we are in the middle of the hot zone.
It smells like burned flesh, blood, and sweat.
There is glass everywhere. People are crying for their mothers, and spouses are holding on to each other for dear life.
Bodies shake from pure shock, and fluids are no longer contained. This is war. And I am its commander.
Only fifteen minutes have passed between Carmen barging into my office and the arrival of the third airlifted patient. I am assessing a young boy with facial fractures when the doors slide open.
“Female, twenty-one. BP one hundred over fifty, heart rate one thirty and climbing. Abdomen distended, worsening tachycardia. Suspected intra-abdominal bleed. Stabilization attempted in the field.”
At the report of her injuries, my head already snaps up. Whitman’s eyes find mine. Jim and A?da are both in trauma, and this patient needs urgent care.
“I’m taking her to the OR. Whitman, stay on triage.”
“Yes, Doctor.”
My hand finds the side of the gurney, and we race the patient to the first available OR. Her skin is so white it’s almost see-through. A stark contrast to the blood-soaked shirt she is wearing. One of the nurses cuts it off her body in two smooth snips, revealing her torso mottled black and blue.
“Transfer on three. One, two, three.”
We slide the patient onto the operating table, her head lolling to the side. Roberts pushes through the doors, taking his position without my having to ask.
“Two large-bore IVs. Type and crossmatch. Initiate MTP.”
My eyes flick over her once. So young. This moment will define the rest of her life, however long or short it may be.
“Prep and drape. Midline.”
“Pressure ninety over forty,” Roberts says calmly. “Intubating. Pushing ketamine.”
His voice is a steady anchor as her abdomen is prepped with Betadine, giving it a strange brown hue. A nurse gowns me within a beat and snaps my gloves on.
“Scalpel.”
The instrument is pressed into my hand, the cold weight a familiar feeling.
“Midline incision.”
I slice into her, my hand steady and my breathing even.
The room is quiet except for the machines at work.
Inside me, I go completely still for a moment.
It feels like somebody pressed the pause button, but then suddenly everything speeds up.
The incision opens, and blood pours out, flooding the field.
“BP dropping,” Roberts warns, even though it is obvious.
“Suction.”
Somebody sticks the tube into the field, but it is still a mess.
“Lap pads. Pack all four quadrants.”
The nurse on my right is already stuffing the sponges into the abdominal cavity before I can finish my command. I have to remember to ask her name. Outstanding work.
“Another unit in.”
Everyone tenses, our movements precise. Practiced. This is the system that works. My system.
“Now, where is it?”
I focus on my breathing before I remove the pads. What a difference between this woman and Maisy. There are no shredded organs, only what seems to be a torn vessel near the bowel.
“There you are,” I whisper. “Mesenteric bleed. Clamp,” I state calmly.
The hemostat finds my outstretched hand, and I clip the serrated jaws around the vessel. The bleeding slows down almost instantly. The rupture has uneven edges. Suturing will be a challenge. Even though the vessel is small, it is causing severe hemorrhaging.
“Let’s cauterize.”
“Another ketamine bolus,” Roberts instantly orders, and I smile softly behind my mask.
I stretch out my hand for the LigaSure. The nurse does not disappoint. Good. My eyes briefly meet hers, and I see her cheeks flush instantly. Modest, too. Very good. I want her on my regular team.
“BP stabilizing. One hundred over fifty.”
My whole chest opens at those words, and it feels like everyone around me sucks in a breath at the same time. She stands a chance. This girl actually stands a chance. I have to take in another breath to slow my heartbeat down before I start closing the vessel.
After a grueling three hours, the patient is closed up and wheeled off for imaging. There were no other visible bleeds, her BP stabilized, and her heart rate came down. She’ll make it. If her brain is fine and nothing weird happens in the coming days, she’ll walk out of here relatively unscathed.
“Good work, Doc.”
I nod at Roberts.
“Thank you.” I look around the room. “All of you.”
It’s all I can manage at this point. My body aches, and my eyes prickle from exhaustion. I am completely spent, and the day has just begun.
There are a few careful smiles around me, but most of the faces are tense. The quiet is almost palpable. None of us are ready to step out of here, back into the madness of the disaster. Still, gowns are being pulled off, and scrub-out procedures are being initiated.
I stand in the OR a beat longer than I have to, fighting the hollow feeling in my chest. My fingers tremble at my sides. My breathing is shallow and uneven. If only you could have done the same for Maisy. I feel a sob rising in my chest, and I quickly shake my head.
No. I can’t think like that. This patient made it. That is what matters. But saving one life does not erase losing another, does it?
I turn on my heel while trying to fight the dreadful feeling in the pit of my stomach, the heavy silence in my mind, and the emptiness in my body. This job takes everything out of me. Cases like this always have.
The sound of running water brings me back to myself, and I realize I’m scrubbing out without any memory of getting here. My hands are shaking, and I’m freezing cold. The adrenaline is wearing off. I hate this part most, but for the very first time, I find myself aching for comfort.
I shiver again when I realize it.
I crave comfort in the shape of Mary’s arms around me.
Dios mío.