YESTERDAY, TODAY, FOREVER (PART 4/?) by Michelle Creek (missy@ipax.com.au) Started: 28/8/98 DISCLAIMER: 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 Kerry read the words on the letter once again. Tightly screwed up balls of paper littered the table in front of her. Usually she had no trouble coming up with the appropriate words for any of her work but today was different. Her letter of resignation held such a finality and reflected the change in direction she had chosen for her life. It took on a life of its own, reminding her that she had the opportunity within her grasp to become one of the youngest Chiefs of Emergency Medicine. The door to the lounge swung open. "Hey Kerry." Receiving no response to her greeting, Jeanie looked back over her shoulder at Kerry's hunched shoulders, chin resting firmly in the palm of her hands and her gaze fixed on the paper in front of her. Jeanie was perturbed by they slump in her shoulders and the intensity of her concentration. Kerry had been overjoyed since she had arrived that afternoon, answering questions willingly and being surprisingly friendly with all. Leaning over Kerry's shoulder, she caught a glimpse of the words and she realised what was bothering Kerry. "Kerry, you had talked about this before you got allocated." She gently reminded her. Kerry jumped visibly. "Oh, Jeanie." She automatically sat up straight in her chair and removed her glasses. "Have you made an appointment to see Dr. Anspaugh to give him the letter?" Jeanie asked. "Tomorrow." Kerry answered shortly, hoping Jeanie would discontinue the discussion. "Is there any way you could continue with your application to be Chief and adopt?" Jeanie sat down in the seat beside Kerry. "That's not fair, either on Alemsehay or myself." Kerry folded up the letter with sharp, forceful strokes. "While the hours would be better than as an attending, the administrative work eats into my hours at home. I can't compromise her emotional well-being for my desire to be Chief." "Do you really want to be Chief?" "I thought so. But now....... I don't know." Kerry played with the edge of the writing pad, dog earing the pages one by one and then straightening them once again. "Even without adopting, I'm not sure if I really want the position. I would lose my patient contact and....... I don't like playing the politics involved." Kerry's mouth twisted in distaste. "I thought being at the top would enable me to bring about improvements and changes to the ER but, if you don't play the game, then there's no chance. I'm better off being down here and making a difference on a small scale than being at the top and only getting rejected." Jeanie smiled. "You've complained of that before now." "I know. I suppose I thought if I wasn't just 'Acting' Chief but actually 'Chief', it might make a difference. Now, this has made the choice for me." "Are you sure it's the choice you want?" "The more I think about it, the more I'm sure of it. It's probably best for both Alemsehay and myself and probably for the ER itself." Kerry slid the letter into the envelope and, with a flourish of her pen, addressed it to Dr. Anspaugh. Jeanie got up to make herself a cup of coffee. "Kerry, do you want another coffee?" "Is it busy out there?" "No. Relatively quite for a Monday night." "I'll have another then." Kerry said, beginning to pick up the balled paper from the table. It grated on her sense of neatness to leave it there, even for a short period of time. Carol opened the lounge door "Kerry, we've got an MVA coming in." "How long?" "One minute." Kerry threw the balls of paper into the bin as she followed Carol out the door. "Seven year old MVA victim. He was knocked off his bike. Head, pelvic and leg injuries." "Where's Mark?" Kerry asked as they went to the central work station. "He just finished his shift. Carter's on." "Lydia, find Carter and make sure Trauma 1 is ready. Call for a surgical consult." The lights of the ambulance arriving lit up the waiting area. Carol and Kerry pulled on gloves as they moved to the doors to meet the gurney coming in. "Seven year old boy, Jason Mitchell, hit by a car while riding his bike. Head and leg injuries. LOC at the scene, approximately ten minutes. Good breath sounds bilaterally. BP's 100 over 60. Pulse 125. GCS 3-4-6." The paramedic spurted the boy's vitals succinctly as they moved him through to Trauma 1 where Chuny was waiting for them, taking the chart from the paramedic as they entered. Carter and Lydia followed the group in. "On my count. 1, 2 and over." The boy's small body was easily moved over onto the trauma room gurney. His back and neck were supported by a back board and c-collar. "Two units of saline and two units of O neg on standby." Kerry instructed as she began to examine the boy. Carter inserted the IV stylus and connected a unit of Ringer's Lactate and D5W. "Okay, we've got bilateral wheezes. Get a mask on him." "Pulse ox is down to 90" Carol warned as Lydia slipped the oxygen mask on the boy. "Pulse is at 130, Resps 35" "5 mics per minute prednisolone IV infusion and an amp of salbutamol by nebuliser." Kerry gave out the instructions and noticed the boy's frightened eyes. "Hi Jason. Do you know where you are?" The boy tried to nod but the collar held his neck still, his breaths coming rapidly and shallowly. Carol attached the prednisolone solution to the already running IV while Chuny prepared the nebuliser. "We're going to give you something to help you with your breathing." She gave his hand a firm squeeze of support and continued with her exam. "CBC, Chem 7, coag panel, ABG, type and cross for four and dip the urine." "Good peripheral pulses. Can we chase up that surgical consult and also get an ortho consult." Carter asked as he palpatated the boy's abdomen. "Stan. head CT, cross-table CT spine, pelvic and lower extremily films." Kerry instructed as she finished checking the boy's eyes and reflexes. Kerry met Carter's eyes and he confirmed that there was abdominal trauma and when the results of the dip were positive, they were not surprised. "5 mics of ketamine. DPL tray" Carter said. Lydia swabbed the lower abdomen ready for Carter to perform the peritoneal lavage. Carter made the small incision. Elizabeth pushed open the double doors as he inserted the small catheter into the boy's abdominal cavity. "What've we got." Kerry gave her a quick run down of the history and vitals. The boy's asthma attack was under control. Carter held up the results of the lavage. "Lavage is positive." "Call the OR, let them know we're bringing him up. Have we got a cross-match yet?" Elizabeth asked. "No." Carol responded. "One unit of O neg." Elizabeth began examining the boy for herself. "It looks like it's the liver. Have we had an ortho consult for his legs?" "We're still waiting." "They'll have to come up to the OR. Let's get him up." Elizabeth said as they pulled up the sides of the gurney. Trays were moved out of the way and the gurney rolled out of the trauma room leaving behind Carol and Kerry as the other staff pushed it towards the elevators. "I'm definitely making the right decision." Pulling off her gloves, Kerry dropped them in the contaminated waste basket, leaving Carol with a puckered brow as she contemplated the meaning of her words. End Part 4/? I apologise for any errors in the medical case but I haven't had time to go check my books to make sure I'm correct. So what did you think?