CHAPTER SIX
Tamsin Carver
Critical Condition
The trauma bay was controlled chaos, exactly the way I liked it. Controlled being the operative word.
"Talk to me," I said, moving to the head of the bed where Bryony Mikelson lay unconscious and broken.
My trauma nurse, Kelly, rattled off vitals while I did my own rapid assessment. "BP 80 over 50, pulse 120, respirations shallow at 24 per minute. GCS 6. Paramedics reported unequal pupils at the scene."
I lifted her eyelids, shining my penlight. Left pupil blown—definitely increased intracranial pressure. Right pupil sluggish but reactive.
"Get neuro down here now," I ordered. "And where's that CT scan?"
"Radiology is ready for her."
I moved down her body, palpating her abdomen. Rigid. Distended. Internal bleeding, no question.
"She's got a hot belly," I said. "We're going to need surgery to find the bleed. Kelly, call the OR and tell them we're coming up as soon as we get imaging."
Her left arm was obviously fractured—compound fracture of the radius and ulna, bone visible through the skin. But that was the least of her problems right now.
I listened to her chest. Breath sounds diminished on the right side.
"Pneumothorax confirmed," I said. "Get me a chest tube kit."
While Kelly prepared the equipment, I looked at Bryony's face. She was young—so damn young. Twenty years old with her whole life ahead of her, and now she was fighting for every breath.
What the hell had happened out there?
"Chest tube ready, Dr. Carver."
I prepped the site quickly, making the incision and inserting the tube between her ribs. There was immediate resistance, then a rush of air as her collapsed lung began to re-expand.
"Better," I muttered, listening again. "Breath sounds improving. Let's get her to CT now."
We moved fast, wheeling her down the hallway to radiology. I stayed with her, watching her vitals on the portable monitor. Her blood pressure was still too low, her pulse too fast.
She was bleeding somewhere, and we needed to find it before she bled out.
The CT scan took fifteen minutes that felt like an eternity. I stood in the control room, watching the images appear on the screen slice by slice.
There. Splenic laceration, grade four. Significant hemoperitoneum—blood in her abdominal cavity.
And the head CT was worse. Subdural hematoma, significant midline shift. The blood was pressing on her brain, and if we didn't relieve the pressure soon, she'd herniate.
"She needs surgery now," I said. "Both neuro and general. We're going to have to coordinate."
Dr. Rashid, the neurosurgeon on call, appeared beside me. "I saw the scans. That subdural needs to be evacuated immediately."
"And her spleen is shredded," I said. "She's bleeding into her abdomen. We can't wait."
"Then we do both," Rashid said. "You take the abdomen, I'll take the head. We work simultaneously."
It was risky—two major surgeries at once—but we didn't have a choice. If we didn't stop the bleeding and relieve the pressure on her brain, Bryony Mikelson would die.
"Let's move," I said.
We prepped her in the OR, working with practiced efficiency. I scrubbed in while the anesthesiologist intubated her and got her stabilized as much as possible.
"BP is 75 over 45," he called out. "She's barely hanging on."
"Then let's not waste time," I said, stepping up to the table.
I made the midline incision, opening her abdomen. Blood welled up immediately—dark, venous blood filling the cavity.
"Suction," I said, and my surgical tech responded instantly.
I worked quickly, finding the source of the bleeding. Her spleen was torn nearly in half, hemorrhaging freely. There was no saving it.
"Splenectomy," I announced. "Clamp."
I clamped off the splenic artery, and the bleeding slowed. Then I began the careful work of removing the damaged organ, tying off blood vessels, checking for other injuries.
At the head of the table, Dr. Rashid was working on her skull, drilling burr holes to access the subdural hematoma. I could hear the high-pitched whine of the drill, see the focused intensity on his face.
We were racing against time, both of us fighting to save this young woman's life.
"Spleen is out," I said after what felt like hours but was probably only forty minutes. "Checking for other injuries."
I examined her liver, her kidneys, her intestines. Everything else looked intact—she'd been lucky in that regard.
"I'm closing," I said. "How's the head?"
"Hematoma evacuated," Rashid replied. "ICP is coming down. But she's not out of the woods yet."
None of us thought she was.
I closed her abdomen in layers, working carefully despite the urgency. A sloppy closure could lead to complications later, and this girl had enough problems already.
"She's stable," the anesthesiologist said. "BP is 95 over 60. Pulse 100. She's holding."
"For now," I said quietly.
We finished up and transferred her to the ICU. She'd need close monitoring—her brain injury was severe, and there was no telling yet if she'd wake up or what kind of deficits she might have if she did.
I pulled off my surgical gown and gloves, suddenly exhausted. It had been a long surgery, and the adrenaline was wearing off.
"Good work, Dr. Carver," Rashid said, clapping me on the shoulder. "You saved her life."
"We both did," I said. "Now we just have to hope it was enough."
I walked out to the waiting room to update the family. There was a man there—late twenties, dark blond hair, pacing frantically.
"Are you family?" I asked.
He spun around. "I'm her husband. Henrik Mikelson. Is she—is Bryony okay?"
I studied him for a moment. He looked genuinely distraught, his face pale and his hands shaking.
"Your wife is out of surgery," I said. "She had significant injuries—a ruptured spleen that we had to remove, a collapsed lung, a broken arm, and a subdural hematoma. We've stabilized her for now, but the next 48 hours are critical."
"But she's alive?" His voice cracked.
"Yes. She's alive. But Mr. Mikelson, I need you to understand—her injuries are severe. She's in a coma, and we don't know yet when or if she'll wake up. Brain injuries are unpredictable."
He sank into a chair, his head in his hands. "This is my fault. I should have listened to her. She said someone was watching her, that something was wrong, and I didn't believe her."
I frowned. "Someone was watching her?"
"She kept saying she felt like someone was following her, that weird things were happening. I thought she was being paranoid." He looked up at me, his eyes red. "What if she was right? What if this wasn't an accident?"
That was a question for the police, not for me. But it sent a chill down my spine.
"You can see her in a few minutes," I said. "She's in the ICU, room 3. But Mr. Mikelson—she needs rest and stability right now. Whatever happened, whoever's responsible—that's for the authorities to figure out."
He nodded, but I could see the guilt eating him alive.
I walked away, heading back to check on Bryony one more time before I handed her care over to the ICU team.
She looked so small in that hospital bed, surrounded by machines and tubes. Her face was swollen and bruised, her head wrapped in bandages from the craniotomy.
But she was breathing. Her heart was beating.
She was alive.
And I was going to do everything in my power to make sure she stayed that way.