The Surgeon's New-Year Wedding Wish

Refusing to waste another second thinking about Quinn Torres.

Leila finished operating on Jimmy Lawton, thankfully catching his engorged appendix before it ruptured, only to receive another trauma call. Wryly preparing herself for a long night, minus any sleep, she hustled back down to the ED.

She was surprised to see Quinn was still there. Hadn’t his shift ended at eleven? Apparently not, since he was currently giving orders in a harsh tone that reminded her of a marine drill sergeant.

“What’s going on?” she asked, stepping into the trauma bay. There was a lot of blood surrounding the male patient lying on the gurney, and she could tell he was bleeding from his head, nose and mouth, not to mention the places she couldn’t see, like internally. Two nurses pumped blood and fluid on a level-one rapid infuser while another one scurried to get blood for additional lab work.

“He took a swan dive off the roof of his parents’ two-story house, leaving behind a suicide note. He hit the concrete driveway from an estimated distance of twenty feet.” The pertinent details didn’t come from Quinn, but from the charge nurse. “Took the brunt of the force on his legs, which might be the only reason he’s still alive.”

Oh, boy, she hated jumpers. They were the worst because the trauma was often so severe there wasn’t much chance of survival. Why couldn’t he have hit the snow-covered ground instead? At least then he’d have a better chance.

What a horrible Christmas memory for his parents.

“Leila, he needs to get to the OR, stat,” Quinn said when he saw her. The grimly fierce expression on his face surprised her, no sign of his cool arrogance now. “He’s losing blood faster than we can pump it in and I’m certain he’s bleeding internally.”

She was certain of that, too, but this patient’s status as a viable candidate for the OR wasn’t quite as clear. “What’s the extent of his head injury?” she asked.

“Pupils fixed and dilated. He wasn’t found right away, not until one of his friends kept trying to get in touch with him and called the parents,” Mary, the charge nurse, told her. “Their bedroom is on the other side of the house and they didn’t hear him hit the ground.”

“Fixed and dilated pupils are a bad sign. He needs a neurosurgical consult,” Leila told Quinn.

“I’ve called them and they’re on their way, but he has skull fractures, so there’s a chance he won’t suffer brain death. He needs to go to the OR immediately.” Quinn’s intense insistence was very unlike him. Where was his cool detachment?

Upon examining the patient closer, she realized his legs appeared firm and unnaturally taut. Compartment syndrome, bleeding into the tissue around the bone, was a serious, life-threatening complication of multiple trauma. “What is his tissue perfusion pressure?” she asked sharply.

Quinn shook his head, indicating he hadn’t checked it.

Leila glanced at the nurse. “Get me the Stryker STIC monitor, we need to know what his tissue perfusion levels are.”

“Draw a myoglobin level and a lactic acid level, too,” Quinn added, quickly realizing the danger.

She set up the monitor and then inserted a needle into the patient’s muscle. Quinn leaned over to see the reading for himself.

“We’re losing his blood pressure,” one of the nurses running the rapid infuser warned. “Do you want more blood or saline?”

“Both,” Leila and Quinn responded at the same time.

“Two more units of blood and one liter of fluid,” Quinn clarified. “Make sure you have his vasopressors turned up as high as possible.”

“Tissue perfusion pressures are elevated at 38 millimeters of mercury,” Leila said, glancing at Quinn. “I’ll take him to the OR for a stat fasciotomy in both legs and I’ll explore his belly, too. But it’s likely that this massive fluid resuscitation isn’t helping his brain injury at all, so you must realize his prognosis is poor.”

“I know.” Quinn’s dark eyes were grim, haunted, as if he was taking this young man’s fate directly to heart. “I’ll talk to his parents. Please do your best.”

“I will.” Leila turned and quickly gave orders for the patient to be moved up to the OR.

Her adrenaline was pumping, heightening her awareness as she prepared for surgery. The young man’s name was Anton Mayer and as she finished her scrub and entered the OR, she noticed his condition wasn’t any better. In fact, if anything, he looked worse.

Feeling slightly sick to her stomach, Leila reached for her scalpel. She was going to keep her promise to Quinn and do everything possible, but she had an awful feeling that Anton was going to die.

Not yet, she reminded herself grimly, doing the fasciotomy to both lower extremities first and then preparing to explore his abdomen. He wasn’t going to die yet.

But after working on his legs, she moved to his abdomen and when she saw he had a severely fractured kidney, she knew things were worse than she’d feared. She took the damaged kidney out but the bleeding was profuse. She could barely see where the source of the bleeding was coming from in the sea of blood.

“We’re losing him,” Dirk Greenfield, the anesthesiologist, warned. “I can’t sustain his blood pressure.”

“Keep trying,” Leila said, praying she could find the source of his bleeder. Although there was likely more than one source. Sweat dampened the back of her scrubs, running down the sides of her face. She tried to tackle one emergency at a time.

“Blood pressure is gone, he’s in PEA.”

PEA was pulseless electrical activity, which basically meant the kid was bleeding to death. Or he’d already herniated his brain from all the fluids they’d given during the trauma resuscitation.

“Bolus him with epi, I found the arterial bleed.” At least she’d found one of them, though she suspected there could be more.

“I already bolused him with epinephrine several times. Now he’s in a wide complex rhythm.”

“No!” Leila didn’t so much as glance at the heart monitor, keeping her gaze focused on what she was doing. One more stitch and she’d have the artery closed off. Then she could take a look at his spleen. Maybe that was the other major source of his bleeding.

Finishing with the artery, she quickly switched the focus of her exploration on the area of his spleen, cutting the splenic artery in an effort to minimize the blood loss. But once the artery was open, she realized the blood wasn’t pulsing at all, but simply oozing at a slow rate.

Horrified, she glanced up at the monitor, realizing it was too late.

“Didn’t you hear me, Leila?” Dirk asked. “I said he’s gone.”

She momentarily squeezed her eyes closed and dropped her chin to her chest. She hadn’t heard, hadn’t wanted to believe what her professional eyes were telling her. After taking a moment to compose herself, she lifted her head and glanced at the clock. “Time of death 1:32 a.m.”

There was nothing more they could have done. She knew it, yet that didn’t make the prospect of telling Anton’s parents that their seventeen-year-old son was dead any easier.

When she returned to the ED, Quinn immediately crossed over, although he stopped abruptly when he saw by her expression that the news wasn’t good.

“I’m sorry,” she said in a weary tone. “I did the bilateral fasciotomies, but he had a severely fractured kidney, a ruptured spleen and so much other internal damage along with his head injury that I just couldn’t save him.”

Quinn stood there for a long moment, his jaw clenched, his gaze dark and resigned as he gave a brief nod. “I’ll talk to his parents.”

She wasn’t sure why, maybe because he seemed to be taking the news so hard, but she reached out to touch him. “I’m the surgeon of record. I should do it.”

As still as a statue, he stared at her hand on his arm as if it was something he’d never seen before and then finally raised tortured eyes to hers. “We’ll both go,” he said in a low, gruff voice.

Surprised by his acquiescence, she simply nodded and walked alongside him to the small private waiting room he’d given to the boy’s parents, not far from the larger public one.

His mother took one look at them and promptly burst into tears.

Quinn opened his mouth, but no sound emerged from his throat. He swallowed hard and sent Leila a silent plea for help.

Leila stepped up. “My name is Dr. Ross. I took Anton for emergency surgery, but he had too many injuries, to his spleen, his kidneys and his brain. I’m so sorry to tell you, he’s gone.”

“No-o-o,” wailed the mother, collapsing onto her husband for support. When Anton’s father broke into harsh sobs, his large shoulders shaking with grief, Leila felt her own eyes well up, too.

This part of her job never got any easier. Never.