#Whereas cardiac surgery patients might need blood… or they’re just vasoplegic… or their heart sucks…

[skyloftian-nutcase]

Ok Wild Angsters, you wanted a continuation, so here you go :)

Four already knew what he would be walking into. His phone had been blowing up for hours. He’d come in to work early. Whether he was assigned to take care of Wild or not was another matter - Vaati loved to try and take all the admissions, convinced he was the best nurse on the unit. If Four could just keep Vaati out of Wild’s room, he’d consider it a success.

When the charge nurse told him he would be admitting the trauma alert, he knew who he was getting.

Pre-admission jitters always made Four anxious, but this was an entirely other level of fear. He almost wanted to request a different assignment, but it was too late now. What if he couldn’t take caer of him because he was his friend? What if that impair his decision making? What if he just wasn’t skilled enough to handle it? He knew Ezlo wouldn’t give him an assignment he couldn’t handle, wouldn’t be there to support him, but still…

Four went over the supplies in his room once more. Safety checks were fine—they had suction, they had a bag valve mask, the code card was nearby—and he had all the supplies he needed. It was just a waiting game.

Four paced the unit at least three times before he looked at the OR status board again. Wild was still in surgery. He poked in his chart, glancing at injuries, looking at vital signs and anesthesia notes. The last update he saw was that Wild had gotten another unit of blood. Estimated blood loss so far was around 2200mL.

2200mL. That… wasn’t too terrible, Four supposed. He’d… seen worse.

Please don’t get worse.

Four knew for certain that Wild had been mass transfused in the ED. Warriors, his primary nurse when he was there, had told him as much. Between that and the multiple blood products he’d gotten in surgery, as well all the crystalloids he was likely getting as well…

Four took a breath. Then another. He grabbed his phone, texting Warriors. You doing ok?

Wars didn’t reply.

Four wasn’t entirely sure where everyone was at this point. Hyrule had stayed at the hospital, lingering in the emergency department and then the operating room waiting area, but Four hadn’t seen him since he’d clocked in. Warriors and Legend should be getting off shift now, but whether they were going to stay up was another matter. Time was obviously in the OR (Wild’s wreck had been around 10pm, he’d arrived in the ED around 10:45, and he’d been stabilized for surgery and gone to the OR by around midnight - it was 7am now… he wasn’t sure how long this was going to take, but it couldn’t be much longer). Malon should be getting on shift now as well - she had come in last night when everything had gone down, alongside Twilight. Wind had been cautiously left out of the loop until Wild had gone to surgery, simply because nobody had really had much information at the time, so no one wanted to worry the kid until they could figure things out. Everyone had their hands full as it was. But by now, Four knew Wind was either in the OR waiting room, harassing every respiratory therapist he knew, or in the hospital library pacing anxiously. As for Sky, the last Four heard he was bouncing between different people, checking in on everyone.

He clicked through more anesthesia notes, looked at flow sheets for blood products. There wasn’t much to go on, as charting was sparse. What Four did know was that Wild had been obtunded, got mass transfused, had gotten a chest tube, had been intubated, blood was evident in his abdomen, and he had an open femur fracture. He’s been taken to Time’s OR for a ex-lap. Head CT had shown a bleed, and they were monitoring it. That was all the information Legend had told the group when he’d had a moment to spare.

Four’s vocera activated, telling him he had a call from the charge nurse. When he answered, he was told Malon had called and said they’d be finishing up in about thirty minutes and were likely to come up open.

Why was he coming up with his abdomen open? When had they gone from exploratory laparotomy to a full on open abdomen?

Ten minutes later, Malon called back to give report. When Four answered, the first thing he asked was, “How’s he doing? Is he okay? Are you okay?”

“I’m fine,” Malon said, even though she sounded exhausted. “And he’s… hanging in there. I’ve seen worse, I’ll say that. I’ll give you the full rundown, okay?”

Four listened as Malon gave report, feeling his heart settled into his stomach, which was tying itself in knots. Multiple spots of bleeding, possible compartment syndrome in his abdomen, a likely kidney injury due to compression from the bleeding on some major vessels, a small hematoma in his brain… they’d had to call neurosurgery to do an emergency craniotomy out of overt concern of swelling, given that Wild had apparently had previous head trauma, based on what they saw in the OR.

Open abdomen, craniotomy, ICP monitoring, bleeding, one chest tube… this was a disaster. Four swallowed as he wrote, feeling his hand shake a little as his heart raced. He was not qualified enough to be admitting this. He was not.

But the turnaround on his unit was pretty insane, and he was the most experienced nurse on the unit today. At least Ezlo was charge; he knew he’d be well supported.

This was a nightmare. But Four had dealt with nightmares, and he would deal with this. He wasn’t going to screw up taking care of any patient, but especially his friend.

Sighing, he hung up the phone after thanking Malon, pushing worries for her and Time aside, trying to focus on what he would need, who he should grab to help him, and how he should prep his room.

It was time to get to work.

When everyone arrived from the OR, Four made brief eye contact with Time. He couldn’t read much from the man, who was stone faced, aside from the exhaustion evident in the dark circles under his eyes. Four got to work quickly, assessing Wild from head to toe as he looked to see what IV medications he was on. A coworker wrote the note while Ezlo helped detangle his lines (the OR always brought up a mess, after all). Time gave an overview of the surgery, and Four listened along as he checked pupils, as he zeroed the arterial line and the ICP monitor, as he listened to lung and heart sounds, as he checked the chest tube and stripped it with his fingers to ensure patency, as he checked peripheral pulses, as he looked at the abdominal dressing to get a baseline in case there was swelling from bleeding later. One of the techs connected the chest tube to wall suction, and Four looked over his drips. Only having levophed at 2 wasn’t terrible, and he was getting a unit of red blood cells, which was in a transfusion set that was y’d to some lactated ringers fluid. He was on propofol for sedation. Another nurse grabbed a blood gas from his arterial line and sent off labs. His foley he had was temp sensing, and Four quickly ascertained that Wild was cold, so he set up the blanket warmer and covered his friend up.

His friend. His friend.

Four shook his head. He had to focus.

As Time left the room, he put a hand on Four’s shoulder, making him freeze. The surgeon didn’t speak, just locking eyes with him. Four wasn’t entirely sure if it was for his own benefit or not. But he had no more time to let his emotions make any decisions for him. He nodded to the doctor, who nodded in return, and then the two went their separate ways.

This was going to be a long day.