The woman suddenly started writhing in her agony, and when her husband lost hold of her, two nurses had to grab her before she fell to the floor. Sage tuned everything out as they moved the child to the trauma bay, everyone doing their job like well-choreographed dancers. The nurses cut the rest of the child's clothes away and began looking for the damage while Sage began her exam at the head of the table.
She assessed neuro status, pupils, airways, calling out orders to the trauma nurse, making sure it was all getting documented. "Pupils are fixed and dilated." The girl had severe head trauma. But Sage wouldn't lose this child-she couldn't!
No. She had to keep her cool, had to do a full assessment. She couldn't think about losing the child; she just needed to look at each individual piece that had to be fixed. "I don't hear any lung sounds on the left side, and her ventilator pressures are high. We need a chest tube set up, stat."
As Spence placed the chest tube, Sage continued her assessment of the girl, and it wasn't looking hopeful, but she wouldn't think this way.
"She has a flail chest to her left side with multiple rib fractures bilaterally, distant heart tones indicating possible cardiac tamponade," Sage reported.
"Left side hemothorax," Spence called after inserting the left-side chest tube.
"I need two units of O negative. PRBC's, stat. Abdomen is distended with ecchymosis noted to bilateral flanks. Pelvis unstable; place a pelvic binder now to reduce internal bleeding. No obvious deformity to her lower extremities. Get me the fast scan so I can take a look at internal bleeding."
People continued moving and Sage wanted to shake, wanted to weep, but she wouldn't. There was a job to do and they would do it. There was no time for weakness.
Sage was on autopilot, calling out commands and working furiously with Spence to save the child. Then the room seemed to slow down as she looked up, his eyes connecting with hers. When it seemed there was nothing else she could do from her end, he spoke.
"What do you do next, Sage?"
What? What did he want her to say? She didn't know what to do. This wasn't a training moment. He needed to save the child. "We need to get her to surgery now, save her," she said.
"How, Sage? How do we save her? Take over," he commanded.
The force in his voice shifted something inside her. Not knowing how it was happening, she moved, shouting out orders, doing everything she could to heal this child's broken body.
The scan showed significant internal bleeding. "I can't see the source of this bleeding. It could be her spleen or liver. We need to get her to the OR, stat!" Sage commanded.
"They are ready for us, Dr. Banks," the ER nurse Mo said, the look in her eyes making her opinion obvious. She didn't think the girl would make it.
"Don't look at me like that, Mo. Don't give up on this girl."
"Please don't let my baby die. I didn't see her. I didn't see her," the mother wailed. A couple of nurses were holding her and whispering soothing words. Sage didn't have time to address the mother yet. All she had time to do was take care of this child.
Suddenly, the endotracheal tube disconnected and a groan came from the girl's throat before she coughed, spraying blood all over the front of Sage's gown.
"Suction her ETT now and tell the OR we are en route. Get two more units of O negative to the OR to prepare for surgery and keep those fluids wide-open," Sage commanded. "Let's go!"
They began moving and Sage noticed that Spence wasn't following. Why wasn't he doing something? He needed to help this girl, and he needed to do it now, before it was too late.
"Go, Sage. You have this," he said as they reached the elevator and rushed inside.
Sage looked back, seeing Spence standing in the hallway, watching them leave the bay. She didn't have time to analyze the look in his eyes-but it looked like sadness.
No!
He wouldn't be sad for this child, because she would live. Sage wouldn't allow her to die.
Nothing but a long, eerie tone could be heard in the room as the heart monitor indicated the patient's heart had stopped.
Sage stood there, her hands and scrubs bloodied, a single tear falling down her face. "Time of death, 6 p.m."
She turned and walked from the room. Despite all they'd done, nothing had worked. The little girl kept on fighting, kept on struggling to live, but where one problem was fixed, another had appeared. Her little body hadn't been able to endure any longer.
Finding her way to the locker room, Sage sat hard on the bench, no emotion, nothing able to break through. Spence had told her to save the child, and she had failed.
This little girl had her whole life ahead of her, and because of a stupid accident, her parents were being told right now that they wouldn't be taking their daughter home, but instead, they'd be saying good-bye to a cold corpse.
Finally, Sage stood up, moved to the showers, and stripped, then climbed in, not even able to tell whether the temperature was right. On days like this she hated her profession. This was when she wanted to quit. Why put herself through the hell of medical school and residency if she couldn't save the life of one small, precious child?
She didn't know how long she stood beneath the spray, but she eventually stepped from the shower and dressed. She couldn't say what she was wearing. Her night, which had looked so promising, had just crashed around her.
She just wanted to go home, curl into a ball, and let the tears out. She'd get over this-she had to. It might take a little bit longer than normal, of course. She could still see the bright blond curls, the pink jumpsuit. In her years in the medical program, she'd seen death, but it always seemed so much harder when it was a child.
As she emerged from the locker room, she spotted Spence, changed and ready to leave. She walked past him, not wanting to talk. Not wanting to talk to anyone. She just needed to escape from this place, get away before it consumed her.
"Sage . . ." He was following her, his voice quiet, hesitant. She didn't want his sympathy, didn't want assurances that everything would be all right. She just wanted to go home and forget everything.
"Leave me alone," she said, moving into the snow-covered grass beyond the parking lot. She gazed out at newly falling snow and wished she could just drift away in the wind.
She'd been trained for this, and had been told over and over that she mustn't and couldn't take it personally. There were more lives she would save than lose. And yet if all of that was true, why did her heart ache so badly right now? Had her instructors been lying to her? It sure as hell seemed like it.
"I'll give you a ride home," Spence said, his hand grazing her shoulder.
She shrugged it off. "I can get home myself." She didn't need him to look after her. She didn't need anyone. She was strong and independent. She was a doctor, a woman, and a person. She would survive.
Unlike the small child.
"You can't drive right now, Sage. This was a hard case," he said, wrapping his arms around her from behind. She tried to push him away, but he wasn't allowing it, wasn't letting her grieve. Damn him!
"I'm fine, Spence. It wasn't like this was a natural disaster with thousands of lives lost. This was one person-one . . . child. Yes, it's harder when it's a child, but it happens. Isn't that what we're taught? Of course, they can say what they like about not blaming yourself. They're teaching, not trying to save a life. I know we did all we could. I know we tested her, and fixed things. I know she was beyond help. None of that makes a difference, though, does it? Nothing we did saved her. Right before Christmas and she's gone forever. Her parents will get up on Christmas morning, wait to hear the sound of her excited voice, and only hear silence."
Sage tried desperately not to yell, not to cry, not to feel this all-consuming rage. It wasn't working. She was pissed and sad, and felt wretchedly vulnerable. She wanted Spence to leave, and she wanted him to hold her. Ultimately, she really didn't know what she wanted.
"Come on. Let's get you out of this cold," Spence said, his voice still low and level.
She allowed him to lead her off, and when they got to his pickup, she panicked. She didn't want to be inside a vehicle. What if the brakes failed? What if she fell out? What if she were run over and no one heard her cries?
She pulled back from him, slipped on the ice, and before he was able to turn back to her, she fell to the ground, her back stinging as she landed hard.