San Diego, CA
Four Years Ago
The Emergency Department of County General didn’t have half the hi-tech gadgets found in the hospitals with university affiliations and it certainly didn’t have even a quarter of what the hospitals under the umbrella of large networks had. Fifty years ago, when County General was first built, it had been cutting edge, but now it still had the same paint from five decades ago. Patients who didn’t have anywhere else to go landed in County’s admitting. Usually by no decision of their own, but because the ambulance driver took one look at patient and decided County General was their only option. As such, the residents of County General could handle overdoses, gun shots, and knife wounds like no other resident from any other hospital.
Residents jumped from patient to patient where they were needed most or where the attending assigned them. It wasn’t a glamorous job. More often than not, their scrubs were either covered in blood or vomit. And if they were lucky and had a good shift, they avoided the attending yelling at them. If they were unlucky and had a bad day with a patient ending up in the morgue instead of being admitted or sent home, the residents bobbed and weaved in an attempt to avoid the objects the chief of medicine hurled a foot away from their heads. To be fair, it had been five months since the last time the chief of medicine chucked a clipboard at a bumbling first-year, mostly because the head of emergency was really good at defusing the chief’s temper and not because the chief had taken some miracle anger-management course.
A large reception desk cut the emergency room into a front area that served as a waiting room and took up one third of the space and a back area where patients were treated. The facility was dulling-edge and could have been improved upon in almost every area except for staff, but the hospital relied on donations. Big donations went to the other hospitals and the few donors who threw pity money at County General wanted their money to go to areas that got media coverage. The only time the ER made the news was on slow news days and the media decided to use gang violence as a filler. Or when a major pileup happened on the 5 or 15 and there was more space for a reporter and camera in front of County’s doors instead of the university hospital with valet parking.
The middle of the ER housed four cramped trauma rooms that shared equipment and doctors. Along the three walls, the ones not taken up with the massive reception desk manned by the lone desk clerk, curtained off areas were used for every other case.
Maddie Concolor spent most of her life inside the emergency department. As a third-year resident, she breathed, ate, and slept in the ER. It helped that she didn’t have a life outside of medicine, but that was by choice. When she left home to go to school, she severed all ties with most of her family and clan. Not having a life outside of work made it more likely no one would track her down and drag her back to the Steyr Clan. It also helped that Maddie loved the ER, even when she had to pull double shifts, which happened more often than not because of the aforementioned no life.
“Hit and run. ETA three minutes.” The desk clerk called out to the attending, Gunner Stirling.
Maddie looked up from the patient chart she’d been looking over. A frequent flier and alcoholic. Wine money was made from the blood alcohol content pools of frequent fliers and Gordy’s levels defied nature. It was a medical miracle he was still alive with the amount of alcohol in his system and correctly estimating his BAC was more art than a science. An art form Maddie excelled at. “Put me down for 465.”
Gunner looked over at Maddie and grinned. “Gordy?”
“He hasn’t been under 400 since I’ve been here.”
“Gordy hasn’t been under 400 since the chief was a first-year resident here.” Gunner winked and bent his head toward the ambulance bay doors. “Come on, let’s see if we can’t save a life tonight.”
Two fourth-year residents glared at Maddie as soon as Dr. Stirling walked away from the desk.
“Are you two waiting for an invitation? There are plenty of patients waiting to see a doctor.” The only chief resident, Dr. Tommy Carson, came up behind the glaring fourth-years and slapped his meaty palms against their shoulders, effectively jolting them from their resentment and pushing them back into action. “Maddie, I believe Dr. Stirling assigned you to a patient.”
Dr. Carson had been the only resident who opted for a fifth year. He’d initially planned on specializing in surgery, but when he didn’t get the fellow he was competing with another resident for, Tommy opted to stay in emergency instead of moving away from County General. Tommy Carson was a lifer. A track Maddie followed without the ambitions to become a surgeon distracting her.
“Scoop and run.” The desk clerk added before Maddie hurried toward the ambulance bay. “And let Dr. Stirling know severity is probably a 6.”
A severity score of six on the abbreviated injury scale meant the patient was untreatable. Five was critical and just as likely to end with the patient having injuries that were non-compatible with life as surviving. The difference between a patient being graded a five or a six could come down to a matter of the minutes it took to transport the patient to a trauma unit.
But even with an AIS severity score of six, a doctor like Dr. Stirling, wouldn’t give up. He’d exhaust himself and his team to try to save the patient’s life.
“Strictly speaking off the record, Dave says the AIS is probably a six.” Maddie looked down at the ground, closed her eyes, and breathed in deep three times to help prepare her for the patient’s arrival.