SPIRIT OF CHRISTMAS by Michelle Creek (missy@ipax.com.au) DISLCAIMER: The characters of ER are the property of Michael Crichton, Warner Bros., Constant Productions and Amblin Television and the actors who so marvellously portray them. Any comments and/or constructive criticism will be gratefully received at the above e-mail address. PART 4/? Jeanie looked across the busy cafeteria, filled with a combination of hospital employees and visitors, and spotted who she was looking for. She made her way between the tables with her own tray to join Kerry and her niece in the far corner. Mark had spoken to her about what had happened with her brother and had been witness to what had occurred with Dr. Goldberg. Kerry noticed her coming in their direction and made room for her to sit at the table. Placing her tray down, Jeanie sat down beside Kerry. "How's it going?" "If you discount being left with a five year old and Craig Goldberg being here, pretty good." Kerry gave her a strained smile. The day was beginning to tell on her. Jess was concentrating on eating her dinner, sorting her meal out on the plate into where she wanted it to be before filling her fork. "Mark told me about Brad." Jeanie said softly. "Yeah. I can't reach Sarah so I left a message on her answering machine." Kerry looked at her watch. "It's almost time for me to finish my break." "Kerry, I can look after her while I'm on my tea break." Jeanie offered. "Are you sure? You do realise she's deaf." "Yeah. I know. Kerry, I worked as a physical therapist for many years dealing with all types of patients. I think I can handle a five year old." Jeanie smiled to soften her words. "Of course you can." Kerry apologised, sorry that she had questioned her abilities. She knew Jeanie had extensive knowledge in the care of people. She had a natural repoire with many of her patients, letting them be comfortable in a very disconcerting environment. "Thanks Jeanie." Gaining Jess' attention, she spoke to her in sign language and verbally. "Jess. I've got to go back to work now. This is my friend Jeanie and she will stay with you while you have dinner. Okay. Remember what we talked about. I love you." She gave her a kiss on the cheek. The little girl nodded and went back to her meal, still with the same intensity as before. "Kerry. Don't let Craig Goldberg's presence here affect you." Jeanie warned quietly. "I know." Kerry nodded, acknowledging her advice. She made her way out of the cafeteria, leaning heavily on her crutch, her left leg beginning to strain after the long day. - 0 0 0 - "How's it been today?" asked Dr. Maggie Doyle as she began her night shift. "We've been run off our feet." Jerry responded. "Three med students out with the flu and enough patients waiting with it." Maggie looked out at the room full of patients still waiting to be seen. It was going to be a long night. "Are there rounds?" "Don't know. We had the new Chief of Emergency Services appointed." "Weaver?" "No. A Dr. Craig Goldberg." "Dr. Goldberg. Not from White Memorial?" asked Dr. Sam Cheung, as he walked in the door, also about to start the evening shift. "One in the same. You know him?" Jerry asked interested for any gossip on the doc. "Of him. A friend of mine did his residency at White. Hopefully, he will spend most of his time in administration rather than down here." He stated without elaborating. "Now it looks like a busy evening ahead, what have we got?" - 0 0 0 - Two paramedics rolled in an agitated patient, suffering severe lacerations to her face, arms and legs. "Where's Zoe? What've you done with Zoe." She asked frantically trying to look behind her. "It's okay." one of the paramedics responded, indicated to Pat to go get Zoe. "Pat'll bring her in now we've got you taken care of." "What've we got?" asked Carter as he met the paramedics arriving, dropping his chart on the counter as he went past. He really didn't want this patient as he had had enough of psych cases for the day. "Emma Carides, 29 year old MVA victim. LOC at the scene, she also lost consciousness again on the way, A&O now, BP's 90 over 50, Resps 28, Pulse 54. Multiple lacs to face, arms and legs." "Why's she so agitated?" Carter asked, there was nothing in the bullet to indicate such a state. "She'll calm down in a moment." the paramedic responded with a knowing smile. "Okay, let's get her to Exam 2." Carter said. Conni joined Carter and they rolled the gurney into Exam 2. "Zoe..... where is she? Please..... she's okay, isn't she?" Emma asked, blood oozing down the side of her face, mingling with small glass fragments which had imbedded into her skin following the shattering of her driver's side window. "She's coming." Carter calmed her, not really sure who he was talking about. They moved her onto the bed in Exam 2 and the paramedic gathered up his equipment. A bark reverberated in the hall followed by a scrambling of feet as they sought purchase on the slippery linoleum floor. Heads turned in amazement. "Zoe's not....." Carter nearly had heart failure, knowing the health regulations and especially what Kerry Weaver would say about having a dog in the ER. The paramedic nodded. "It was the only way we could get her in the ambulance." He said indicating at the patient. An black and white American Cocker Spaniel came around the corner, sniffing the air, trying to locate her owner. "She's all yours." Pat commented, handing over the leash to a dumbfounded Carter. "But you can't leave a dog here." "It's not our responsibility anymore" Pat replied as they left, giving a wave to Carter, relieved to have gotten rid of the problem dog. "Zoe, here girl." Emma said. Zoe pulled Carter towards the bed, anxious to get up to her owner. The dog was panting heavily and restless, alternately sitting before anxiously standing once again. "We're going to have to call animal control to look after her until we can release you unless you have someone else that can look after her." "Not likely." Emma said forcefully, wincing as she pulled her legs over the edge of the gurney. "Hey. What are you doing?" Carter asked. "We need to keep you in for observation for that head wound and also clean and treat those cuts." "No time now. I'll do it once I've dealt with Zoe." As Emma stood, she swayed as the room spun before her eyes, changing colour and fading. She closed her eyes and held firmly onto the gurney waiting for the spinning to stop. "You're in no condition to leave. Those wounds will get infected, especially if you are handling a dog." The dog yelped in pain at Carter's feet bent over in a squat position. Carter was mortified. Not only did he have a dog in the ER but it was about to relieve itself on the floor as well. He didn't know how many health regulations were being broken but he was sure that Dr. Weaver would know each and every one. He could almost hear her now. "Don't just stand there. I need some haemotstats, scissors, and a hot water bottle. If you can also get a small cardboard box, it would be handy." Emma's voice jerked Carter back to the present. Having regained her equilibrium, she had grabbed a set of gloves from the box in the Exam cubicle and was quickly pulling them over her hands, ignoring the pain as they pushed some of the glass fragments further into the wounds. Pulling the blanket and sheet from the gurney she had just been on, she laid them on the floor. "Dr. .....Carter." She broke into his stunned silence as she got his name from his lab coat. "I need those now. Zoe is whelping a litter of pups." Conni and Carter were both shocked at what was happening in the Exam cubicle. Carter sent Conni to get what was needed as he watched in fascination as Emma assisted in the whelping of the first pup, giving the mother a chance to know the smell of the pup as she ensured the sac was broken and it was breathing. Her handling of the pup was gentle but firm, quickly breaking the umbilical cord and drying it off before placing it on the blanket alongside the cocker spaniel to get its first suckle from its mother as she gently nuzzled and licked it. "It shouldn't be long before the second is here. Zoe had just been given an injection of oxytocin before the accident. I was returning home from the vet when the other car side swiped me. I was lucky Zoe was in the crate or I would have lost them all." Emma didn't seem to be aware of her own injuries. "While we're waiting for the second, why don't I check you over?" Carter said. She didn't have a chance to even respond before the dog was on her feet moving around, anxiously looking at her tail. Emma quickly picked up the pup as it squawked at being away from its mother wrapping it in a towel and handed it to Carter. "Hold it. Keep rubbing it to make sure it's dry." Emma's instructions were as short and concise. This was her area of expertise. She may not know anything about medicine but after ten years of whelping litters of pups, there was not a lot she did not know. Carter looked down at the squawking bundle in his hands, its tiny legs pushing against his fingers in a struggle to get back to the warmth of its mother. A second pup was delivered. Emma once again broke the bag, however, the pup was not breathing. Clearing its mouth, she gave it a couple of short breaths, rubbing it vigorously before holding it firmly as she swung it in a downward arc. Conni returned just as she swung the pup downwards and looked across at Carter, her brow furrowed, querying Carter silently as to what was going on. He shrugged his shoulders in response but heard a gasp come from the pup as it took its first lungful of air. She began rubbing it, then handed it across to Conni. "Rub it 'til its dry, then put it..." her instructions were cut off as she fell to the ground, losing consciousness. Carter dropped down on his knees beside her, placing the pup to suckle on his mother. As he got beside Emma, her body began to convulse. "I need Ativan, 5 migs." Carter instructed as he held her on her side. Conni raced to get the meds, calling for Maggie and Carol to come and help. - 0 0 0 - "Hey Jess. Did you enjoy your tea?" Kerry asked and signed, as she caught sight of her niece coming back from the cafeteria, hand in hand with Jeanie and a spring in her step. Kerry smiled. It was the first sign of happiness that she had caught from her niece since Jess had been foisted upon her. Not that she didn't enjoy looking after her niece but it was impossible for her to work and ensure that she was safe. Five year olds were apt to get into mischief and an ER department provided an active mind with a lot more opportunities than her own apartment would. "Yeah. Jeanie got me some ice cream with chocolate sprinkles on top." Jess gave her a big grin, accentuated by a smudge of chocolate at the corner of her mouth . "Thanks for looking after her Jeanie." Kerry said as she bent down in front of Jess, pulling out a handkerchief and wiped the smudge of chocolate from her face. She gave her a quick kiss as she stood up again, Jess leaning back against her legs and grabbing hold of both her hands. "No problem Kerry. She was a delight." Jeanie said. "See you munchkin." Jeanie tousled Jess' hair as she went to leave. "Jeanie, if anyone needs me I'll be in the resident's room." Kerry said. "Okay kiddo. Let's see what we're going to do with you." - 0 0 0 - Maggie and Carol raced into Exam 2 finding Carter on the floor beside Emma whose convulsions were reducing. "What happened?" asked Maggie as she rushed through the door. The three of them lifted Emma onto the bed, Carol grabbing the oxygen mask and slipping it over her face. Carol's eyebrows raised a notch, absorbing the scene of a dog with two pups nestled in the ER's sheets and blankets under the gurney. "She collapsed after giving birth to two pups." "Should we call the Guiness Book of Records?" Carol asked with a grin, easing the tension in the room. "You know what I mean." Carter said glumly, then gave them the bullet. "Emma Carides, 29 year old MVA victim. Vitals were slightly lower than normal range but she was alert and oriented. I didn't get a chance to examine her before the dog began whelping and she was assisting." Conni returned with the ativan and Maggie inserted the IV line and administered the dose while Carter checked her breathing. "BP's 90 over 50 and Pulse is 45 and regular." "That's low." Maggie commented. "I know. CBC, Chem 7, cardiac enzymes, 12 lead EKG and a unit of saline." Carter ordered. "Maggie, have a listen to her chest." Maggie placed the stethoscope on Emma's chest and listened at various positions across her chest. "Conni, could you hand carry those to the labs." Carter asked as she finished drawing the blood for the tests ordered. "Sure" Carol returned with the EKG. Carol and Carter connected the twelve leads deftly to the round patches affixed to the skin at the twelve different points. "So what do you think?" Carter asked as Maggie put her stethoscope back around her neck. "It's a difficult call. Once we've got the EKG results, we'll know for sure." "I'm still here, you know" Emma interrupted them as they discussed her case over her head. She was a bit disconcerted by the way they had her connected at so many different places to the EKG machine. "What're you doing?" Carter noticed her he skin was flushing now she had regained consciousness, losing its slightly bluish tinge. "Emma, we need to find out why you passed out." Carter said gently as Maggie started the EKG machine. "I bumped my head. It's just a delayed reaction." Emma replied sarcastically. "We'll just make sure of that with these tests." Carter said. "Emma. Have you been fainting?" Maggie asked as she looked down at the resuls. "A few times. Why?" She was puzzled. Her mother had suffered from fainting and light-headedness for years, she just accepted it as the norm. "We suspect that you have actually been suffering from Stokes-Adams Syndrome." Maggie informed her. "What's that?" "Basically, it's a fancy name for when your pulse slows to such a rate in which it causes you to lose consciousness." Carter inserted gently. He didn't think she was quite ready for the total cause of her faints yet. It would be better for her to absorb this first, then to be informed of the severity of her condition. "Can you fix it." "Yes. Now, I will just have to go get an attending to speak with you about the procedure. I'll be back in a moment." Maggie replied. - 0 0 0 - "Aunt Kerry, tell me about Africa again." Jess was lying down on one of the stretchers reserved for catnapping residents on their long shifts in the ER. However, with the steady stream of patients coming into the ER that night, it was unlikely that a resident would need a bed. Kerry sat with her left hip resting on the edge of the bed, her right leg balancing her. "The large round sun came up slowly across the African plain, its bright rays shining over the broad land below. The green trees blew in the gentle morning breeze and a springbok turned its head to sniff the air as it stood beside the waterhole. What does it smell?" "Danger" Jess said ominously. She always enjoyed her Aunt's stories. They were so different from the one's that were in her bookshelf. "What sort of danger?" Kerry asked. Jess and Kerry had played this story many times and it had taken many different directions depending upon Jess' mood. Kerry had taught Jess about the different animals in Africa and the people. From these they created their own fantasies, the endings of which were never the same. Jess was an intelligent child and had a remarkable affinity with words. As they continued their adventure through the African wilderness and unique villages, Jess' voice began to falter, tiredness wilting her determination to stay awake as a flower droops in the hot sun. Kerry took over the story, speaking at a volume where Jess could still hear her but not jolt her back into full alterness again. As her niece dropped into an even and steady sleep, Kerry quietly tucked the blankets around her small body, brushing the lock of raven hair that slipped across her brow. The door opened and Maggie Doyle appeared, silently beckoning for her to come. Grabbing hold of her crutch, Kerry followed Maggie out of the room, quietly closing the door after her. "What is it?" "We've got a 29 year old female in Exam 2 with heart block. Here's the EKG. We're still waiting for the lab results. Conni hand carried the tests to them." Kerry looked over the chart as they made their way towards Exam 2, noting the results and the patient's vitals. "Have you told her?" "Only about the Stokes-Adams Syndrome." Pushing open the door to Exam 2, Kerry was ready to inform the patient about her condition when she noticed the bundle of fur underneath the gurney. "Carter, would you like to tell me why there is a dog in the ER?" Carter blushed with embarrassment. He had been hoping to get rid of the dog before Dr. Weaver found out but he had run out of time and ideas. "It's mine." Emma informed her. "Zoe was about to whelp a litter of pups when my car was hit. The paramedics insisted that I had to go to the ER and I insisted that Zoe needed me. I guess you could call this a compromise." Emma gave a small smile. "Well, I'm afraid she can't stay." Carter waited for Emma to start pulling off the heart monitor connections, insisting to leave. "My sister can come pick her up now she's had the pups." Emma calmly replied. "You could have said this earlier." Carter reprimanded her. "She hates whelping, so I had no other choice." "Carter, could you take care of your 'other' patient." Kerry then turned to the patient. "Miss Carides, I would like to discuss the results of your EKG with you." - 0 0 0 - Doug and Mark found a corner table available in the cafeteria. "How are you and Carol going with the wedding arrangements?" Mark asked as they sat down. Both Carol and Doug had been rather quiet over the arrangements. "Her mother's pushing for a church wedding with all the trimmings. Carol's getting sick of all the wedding catalogues that her mother's put her name for." Mark grinned, remembering the frantic arrangements for his own wedding many years ago. Jen had nearly gone crazy with all the fuss of the arrangements. "You can grin. You don't have to try to live with it all." "What about you?" "Me. You know I'm always organised." Doug said flippantly Mark was sipping his coffee and had to swallow a very hot mouthful to stop himself from choking. "And who was in my flat, using my computer to complete his PCA report in the early hours of the morning?" Doug grinned. "So Are you bringing her along. The invitation was 'and friend'." "Bring who?" "The lady with the husky voice whose been ringing lately." Doug said, leaning an accent heavily on the word husky. Mark grimaced. "Doug, you can really made the most innocent thing sound lurid." "Lurid?" Doug gave a smothered laugh. "Maybe if you weren't so secretive......" "Leah and I have decided we want to take it slowly. The last thing I need to do is bring her to a Christmas party with all the ER staff." "You'd think we gave everybody new who attended the third degree." Doug said innocently. "You think we have nothing better to do than gossip about your private life?" "Ha ha." Mark responded sarcastically. His pager went off, closely followed by Doug's. They left the cafeteria in tandem to return to the ER. END PART 4/?