Michael Palmer - Extreme Measures

"No," Eric said, unable to conceal how startled he was. "No I don't."

He hesitated, and then added, "Dr. Darden, I think you should know that over our years of working together, Reed and I have developed a pretty deep respect for each other. Even if I did know something damaging about him, which truthfully I don't, it's doubtful I would be able to share that information with anyone even if it meant losing out on the job."

"Well said!" the chief exclaimed. "That's precisely the response I wanted from you. And you have my apology for even bringing the subject up. Call it a final test if you want to, and consider yourself to have passed with flying colors. Just keep up your good work, Eric.

I'll do what politicking I can. Then we'll cast our chips on the table and let them fall where they may."

Before, Eric could respond, there was an insistent knock on the office door.

"Eric, it's Kristen."

"Time to get to work," Haven Darden said, opening the door. "We'll talk again."

The nurse was breathless.

"Eric, Reed wants to see you in Trauma Two right away.", "Go," Darden said. "I'll help Miss'!-he read the nurse's name tag-"Baker plow through that waiting room."

Eric hurried past the medical chief and down the hall to Trauma Two. He could smell the blood and feel the chaos and desperation in the room the moment he cleared the door. Reed, an intern named Stuart Spear, and two nurses were clustered about a litter bearing a woman who appeared to be in extremis. She was propped bolt upright and was gasping for breath through the blood cascading it-from her mouth.

"What gives?" Eric asked, noting Reed Marshall's pale, wide-eyed face.

Reed motioned the intern over to the head of the bed and handed him the rigid suction catheter.

"Just keep sucking her out," he ordered. "Jill, get me three units. I don't care if they're cross-matched yet or not. I'll sign.

Also, tell the respiratory therapist to get in here."

He hurried over to where Eric stood.

"She took the steering wheel in her neck," he whispered. "At first there was just a trickle, but all of a sudden she erupted."

"She's drowning," Eric murmured. "Her larynx has probably been fractured."

"I tried calling ENT down to tiach her, but they're in the O.R.

"I don't think it's wise to put her head back and cut on her neck.

Just paralyze her and put a tube in."

"But… but what if I paralyze her and then can't see past the blood to get the tube in?"

"Of course you can get it in. I'll work the suction."

"I… I'm not so sure that's the right thing to do," Reed said.

Eric glanced over at the patient and the two who were working on her.

The respiratory therapist entered the room and began preparing his Ambu breathing bag.

"Reed," Eric said softly, "it doesn't look like you have much time. A trach win be dangerous, messy as hell, and probably take too long. The balloon on the tube you put in will tamponade the bleeding.

Call for the succinylchohne. You can do it. I know you can.

I've seen you tube a hundred people."

"Not like her. You do it."

"You can do it, Reed," Eric whispered. "I'll be right there with you.

Just order the sux."

Marshall turned to the nurse.

"Give her sixty of succinylchohne IV, plekse, and have respiratory set me up with a seven-point-five tube." He looked back at Eric, who shook his head a fraction. "Make that a six-point-five," Reed said.

He crossed to the woman, whose respirations were growing less and less effective. "Mrs. Garber, we're going to put a tube in to help you breathe. In order to do that, we're giving you medicine that will make it impossible for you to move. Try not to be too frightened. Youll be breathing better in just a minute."

Moments after the rapidly acting paralytic was injected, its effects began. The woman's muscles, including those that were enabling her to breathe, began to twitch, writhing without coordination or pattern.

Then, in seconds, they all went slack. Eric set the litter back flat.

Instantly, blood welled up in the woman's mouth. He took the suction and moved to Reed's right hand. The monitor pattern remained rapid and steady.

"Go for it," he said, hunching next to Marshall's ear. "Just think of the anatomy. Look for your landmarks, and concentrate."

Reed slid the broad blade of the laryngoscope along the edge of the woman's tongue as Eric stabilized her head with one hand and sucked the blood clear with the catheter in his other.

"Take your," Eric whispered, craning to see what Reed was looking at.

"I… I can't see."

"Wipe off the laryngoscope light and do it again.

It's only been ten seconds."

Out of the corner of his eye, Eric saw the monitor rate begin to drop.

Reed wiped the blood off the light at the tip of the blade and inserted it again. His left hand, clenched about the laryngoscope handle, was beginning to shake.

Eric reached up and depressed the woman s larynx a bit.

"There, look," he said. "That's her epiglottis right there. Just come up underneath it. Easy does it. That's it, that's it."

Marshall began to nod excitedly.

"I've got it… I've got it," he said, slipping the polystyrene tube into place. "Sweet Jesus, I've got it."

Quickly, the respiratory therapist blew up the balloon on the tube, attached the breathing bag, and began a series of rapid ventilations.

Eric checked the woman's chest with his stethoscope to ensure the proper placement of the apparatus. Then he looked up at Reed and smiled.

"Hell of a good shot, old boy," he said.

Almost immediately the flow of blood began to abate. The woman's color improved. The relief and elation in the room were nearly palpable.

"Yes, sir," Eric said, patting Reed on the shoulder, "one hell of a shot."

"What gives?"

The team turned toward the doorway, where Dr. Joe Silver stood appraising the scene.

Unable to contain her enthusiasm, the nurse rushed over to him.

'Dr. Silver," she gushed, "you just missed it. Reed just intubated this woman through a massive hemorrhage. One minute she was dying; the next..

She gestured at the patient, who now was being ventilated quite easily.

"Nice going, Reed," Silver said, striding to the bedside.

"Actually, I don't think I could have done it without-"

"What was it? Steering wheel to the neck?"

"Exactly."

"Gutsy move."

"Eric here was the one who-"

"Does she have any other injuries?"

I've only had time for 'C-spines and a chest film, but they were normal."

"Excellent, Reed. Really fine work. well then, why don't you get on with your secondary survey of her." He turned to Eric. "It's a madhouse out there.

Your stand-in, Dr. Darden, has apparently forgotten how frantic our kind of work is. He left to examine his patient after seeing about three people in the time we see ten."

I,ll get on it now," Eric said.

"It doesn't look as if you ever had to leave."

Eric started to respond, then just nodded and left the room.

The flow of patients into the E.R. slowed, then virtually stopped.

With Joe Silver pitching in, Eric was caught up in less than two hours.

The E.R. chief gave no indication that he knew of Eric's role in the Garber woman, s resuscitation. Instead, he told almost anyone who would listen about Reed Marshall's heroics. Eric was sure that Reed had spoken up for him, but it was clear that Silver had heard only what he wanted to hear.

With a few final words to the triage nurse, Eric headed down the hall to his office, his back and legs aching from the long day. He glanced back at the front desk, where Joe Silver was orchestrating the care of what patients remained, and tried to imagine what life would be like for him should he be forced to leave White Memorial.