Pennsylvania's Finest, page 27
The initial barrier impact caused the most brutal damage upon the occupants. Jennifer’s right knee hit the dashboard as the airbags deployed, sending a tremendous upward force through her thighbone. As the main ligament tore in the back of her knee, the femur bone of her thigh cracked along its mid portion. The jagged edge of the fractured bone then sliced through her quadriceps muscle prior to exiting the skin. Her right hip nearly dislocated, barely remaining in socket, as the force vented through the thigh gash. Jennifer appreciated the snap of the bone and a fearsome pain before the airbags hit her face, rendering her unconscious.
Dr. Knight was much less fortunate. The angle of impact transmitted an excessive amount of energy onto the driver’s side of the vehicle. Despite front and side air bag deployment, the excessive nature of the force transferred across his abdomen contents. His spleen and liver ruptured, immediately sending blood pulsating out of control into his abdomen. A portion of his small bowel was also lacerated by the sheer dynamics, adding fecal material into the peritoneal cavity. The exiting force then cracked a total of seven ribs while bursting two thoracic vertebral bodies. His spinal cord was spared, but his brainstem was not. The ferocity of the impact placed a sheer force across the arterial supply to his brainstem area, just below his cranium. An acute brainstem bleed occurred, which shut down his most basic life functions, including the ability to breath. Ten seconds after impact, Dr. Knight was in critical condition, having been rendered incompatible with life.
A dispatched EMT squad arrived on the scene ten precious minutes later. Both occupants were extricated and stabilized while being placed onto separate ambulances. A breathing tube had to be inserted in Knight’s airway to assist in ventilation. Jennifer became aware of her surroundings, however did not recall the impact of the collision. An incoming alert was put out to the nearest trauma hospital, that being the PGH. Each ambulance then sped back towards center city, rushing their patient to the awaiting medical teams.
Up until that point, it had been a quiet night of call at the PGH. Rambo III was being premiered in the Polk Lounge when Pete Larson’s beeper went off. He called the E.R. and spoke to the trauma triage nurse, who alerted him that two patients from a motor vehicle accident were three minutes away from arrival, one being critically injured. Upon hanging up the phone he gestured to Phil to accompany him to the E.R. immediately. Not wanting to be left out of the action, Rick Polk jumped off the couch to volunteer. All three then began the sprint upstairs to the trauma bay, dawning gloves and gowns upon arrival. Along with the nursing staff they anxiously awaited the two ambulances that were simultaneously backing up into the trauma bay.
“Adult male and female arriving,” cried the triage nurse over the ambulance engine whine. “Male in critical condition, blood pressure low with a tense abdomen,” was her next line. “Female stable with an open femur fracture.”
The rear ambulance door carrying Dr. Richard Knight burst open first, followed by a rush of exiting EMTs hoisting a gurney out of the vehicle. Pete knew by the frenetic action of the transport team that the patient was unstable.
“Adult male, high speed MVA,” said the head EMT to the awaiting trauma team. “No blood pressure or spontaneous breathing at the scene. E-tube inserted to assist ventilation. Pressure low, I.V. fluids running wide open.”
The fast moving gurney was then transferred to the nursing and physician team. The patient was rushed into an awaiting trauma bay. Phil was the first to recognize the victim as his chief resident was inspecting an increasingly expanding abdomen.
“Oh my God,” said Phil. “It’s Dr. Knight!” was his next cry as Pete quickly looked up at him. The breathing tube partially blocked his bloodied face, but the profile of his esteemed mentor was undeniable as he was wheeled into the trauma room. A team of orderlies began to cut the tattered Brioni tuxedo off his torso and extremities. Trauma nurses deftly hooked up EKG pads and secured a blood pressure cuff across his upper arm.
Chief resident Larson was suddenly rendered speechless as the reality of the situation set in. Lying in front of him was the most respected and vilified attending in the department of surgery, who was dangerously unstable and now under his emergent care. Overhead monitors triggered alarms as their readout displayed grossly abnormal values. Knight’s blood pressure was 80 over 30 and dropping. It was obvious to the team that severe internal bleeding was occurring, causing the drop in pressure. Within seconds an anesthesia resident arrived to maintain control of his airway and ventilations.
“Open up all the fluids,” yelled Larson. “Type and cross for stat blood, hang two units,” was his next order. “Stat x-ray of his cervical spine and pelvis. Get his abdomen prepped for a tap.”
Phil immediately responded by opening a sterile tray behind him in preparation for the abdomen tap. While pouring betadine over the blotted abdomen of Dr. Knight, Phil suddenly heard his name cried out by Rick Polk, who was behind him, peering into the chaotic scene from the adjacent trauma bay.
“Phil, get in here,” was Polk’s cry. “Now!”
Phil briefly looked at Polk with an incredulous glance, then shaking his head in the negative, returning to the task at hand. With each passing second the clamor in the room increased, both by volume and personnel.
“Phil!” was his cry again. Polk was waving his arm frantically at his fellow intern. Drummer looked up again now concerned as to why Polk was making such a demand at such a time.
“Go Phil,” yelled Larson, “He needs your help next door.”
At that moment Phil appreciated another body pushing him to the side, away from Knight’s body. It was medical student Roden, who was on an emergency room rotation that month. Roden was dressed in a trauma gown with protective glasses on. He rapidly began to arrange the peritoneal tap instruments for Larson. Phil again looked up towards Polk who by then vanished back into the adjacent trauma bay. Stepping backwards he bumped into the portable x-ray unit being positioned by the technician for an x-ray. A trauma nurse then slid between him and Knight, further pushing him towards the back of the table. Turning to his left he maneuvered himself through the mob towards the exit. The kinetic energy within the room then catapulted him towards the adjacent trauma bay. Upon entering the adjoining room, the young doctor was unprepared for the shocking scene that was unfolding.
He immediately recognized Jenna lying on the trauma table with a hard cervical collar on and frightened look upon her face. She was moaning in pain as an anesthesia resident administered narcotics into an intravenous line connected to her right arm. Surrounding her head was a gaggle of nurses, adjusting tubes and wiping blood from her face and earlobes. Radiographic technicians were positioning an x-ray unit above her pelvis, while bumping into a team of orthopedic residents. Junior resident O’Keefe was examining her abdomen, which appeared soft and nondistended. Lance, the muscled orthopedic resident stood beside her damaged right thigh, wearing his trademark tight green scrub outfit. Surrounding him was a team of junior orthopedic residents and interns, all with seemingly chiseled jaws and athletic builds. They were formulating a plan for the open gash in Jenna’s thigh that exposed her jagged femur. Phil then looked down at the end of the table where Rick Polk was holding axial traction on the extremity, per the direction of the chief orthopedic resident. Phil rushed into the room while visualizing the remainder of her body, thankful to see no other obvious visual deformities. He fought his way towards the head of the bed, noting that her face was spared the bane of any trauma.
“Jenna!” was his cry, “Jenna!”
She looked up with a glaze in her eyes and recognized the approaching intern. Pain prohibited her from speaking but she was able to hold up her left hand as Phil approached.
Phil grabbed her bloodied hand and held it as he stood to her left side. He squeezed it tightly and appreciated her warm responsive grip.
“Jenna, you’re O.K.,” said Phil while looking up at the overhead monitors. Her vital signs were all stable.
“Phil, I’m sorry,” was her weak response.
“Just try to relax Jen, breath in and out slowly,” was his reply while looking down towards the orthopedic team. Lance had knocked Polk out of the way and was now holding Jenna’s angulated extremity while looking at the anesthesia resident, who had just administered more intravenous narcotics. The anesthesiologist then nodded in assent, prompting the bone doctor to pull forcefully down on the crooked extremity. The reduction maneuver straightened out the thighbone, causing Jenna to scream in pain. The remaining orthopedic interns then placed heavy sandbags around the damaged bone, maintaining its corrected alignment. A smile came upon Lance’s face as he approached the head of the table with a swagger.
“Ma’am, you broke your thigh bone and it came out of the skin,” was Lance’s introduction to Jennifer. A deep voice matched the physicality of his body. “We need to go to the operating room, wash it out and place a steel rod down the bone.”
Jenna was in near shock from the pain, unable to speak. She nodded her head in no particular direction while continuing to squeeze Phil’s hand. Sweat was beading up around her forehead. Her hand suddenly became a bit cooler.
“Do you have any questions?” was Lance’s next blunt line.
There was no response from the patient as Lance looked up at Phil, asking him his role in the matter. A brief exchange occurred as Phil was able to provide information to contact Jennifer’s family, in order to obtain consent for the surgery. Lance then left the room to call Jenna’s father, while the medical team prepped her for emergency surgery. Phil continued to comfort Jenna as the narcotic medication finally took effect, rendering her near unconscious.
At that moment a shrill cry came over the hospital’s intercom system: “Code Blue, trauma bay one, Code Blue, trauma bay one, Code Blue trauma bay one!” Phil looked up to see Rick Polk dart into the adjacent room. A compassionate nurse tapped Phil on the shoulder while telling him Jenna was fine, prompting him to following Polk. The doorway into the adjacent room was suddenly blocked, causing Phil to detour into the hallway. He was overwhelmed by the swell of people amassing outside of Dr. Knight’s room. Present in the crowd was a concerned Dr. Barnes and CEO Rineman. A squad of Philadelphia police officers was strangely adjacent to them.
For the next twenty minutes an all out resuscitation effort occurred over the damaged body of Dr. Knight. The frantic endeavor was successful in returning a cardiac rhythm. Once temporarily stabilized, the critically injured surgeon was then rushed to the operating theatre, in an emergent attempt to stop the abdomen bleed.
Then, as quickly as the mob amassed, it dispersed. All medical personnel involved with the efforts accompanied the injured parties to the operating room. The trauma bays were in disarray as a cleaning crew arrived on the bloodied scene. Outside of the rooms remained a distraught Howard Rineman and Dr. Barnes. It was 6 PM when Dr. Barnes looked down at his watch, suddenly wondering if anyone had notified Mrs. Knight of the mishap. The answer to his question was an inexplicable no. The shock and chaos of the past sixty minutes had crippled the hospital’s standard communication protocols. Barnes was irate as he picked up a hospital phone, calling Mrs. Knight. There was no answer at her home, but a second call to a cell number did garner a hello.
When her cell phone vibrated, Mrs. Richard Knight was in the lobby of the swank Rittenhouse Hotel, greeting the rich and famous to her evening fundraiser. The vibration bitterly reminded her that her esteemed spouse, who promised to be there, was not. She fully expected yet another pathetic reason from her husband regarding his tardiness or absolute inability to attend the event that evening. Initially she was shocked by the news given to her by Dr. Barnes. The chairman explained the magnitude of the event, yet settled her concerns with words of encouragement and confident expectations. However, shock suddenly turned to anger as the forthright chairman mentioned injuries to his passenger and former physician assistant. Her memory quickly flashed back an image of the sultry blonde sitting with her legs crossed in the Manayunk restaurant, being so young and inviting. Mrs. Knight then politely thanked the chairman for the call while coldly consenting to all medical care. She then terminated the call and graciously returned to the gala’s receiving line.
CHAPTER 24 The V.I.P. Patient
Doctor Knight survived his emergency surgery. Three hours in the surgical suite cost him his spleen, left liver lobe and four feet of small bowel. Most devastating of all was his nonoperative brainstem bleed, which by CAT scan criteria was extensive. Postoperatively he was admitted to the surgical intensive care unit in critical condition. Unable to spontaneously breathe, he remained attached to a mechanical respirator, with a breathing tube down his trachea. A combination of narcotic analgesics and sedatives dripped into his veins, easing the pain and swelling throughout his damaged body.
New Year’s morning found Dr. Barnes and Mrs. Knight besides his SICU bed. Barnes was fatigued, having assisted in the lengthy surgery that saved his colleague’s life. Mrs. Knight was also physically spent, now gravely aware of the injuries her adulterous husband had sustained.
“He will survive the abdomen injuries,” said Barnes. “The question is the brainstem bleed, that will take time to declare itself.”
“Is any more surgery necessary?” asked Mrs. Knight.
“No,” replied Barnes while arching his stiff back.
“Can he hear us?” asked Mrs. Knight. “I mean does he know we are here?”
“Its difficult to say,” said Dr. Barnes looking up at the above bed monitors. “We have him on a lot of medications to keep the brainstem swelling down. He is also being sedated. If he is able to hear us, he wouldn’t be able to respond.”
Their conversation continued at the bedside that bleak and somber holiday morning. Through it all, Dr. Knight was partly privy to the discussion. His cerebral cortex intermittently collected short bits of voice recognition and information. He briefly heard that a Philadelphia police officer was stationed outside his room that morning. A discussion of brainstem injuries and their prognosis registered in piecemeal fashion. Strangest of all was his acute olfactory awareness, which appeared heightened by the trauma. An aroma from a single rose in his room was bursting in his nasal passages. His wife’s perfume, once thought old and stale, was now overflowing with life and pleasure. The intermittent nearness of ICU nurse Cruise penetrated him with a pheromone rush. Despite the pain, sedation and neurologic injury, the smell of life invigorated the subconscious of Dr. Knight. Then, like a supernova, an image of Jennifer Ranier exploded into his mind, capturing all of his emotions. Her perceived presence saturated every cell of his being, providing comfort in a time of need. Certainly all would be well thought Knight, as long as Jennifer was at his side.
Dr. Barnes then stepped closer to the bed saying loudly, “Richard, just want to let you know the Chronicle article came out this morning.” Barnes paused and looked back at Mrs. Knight with a proud smile, then leaned closer to his patient’s ear. He continued saying with a grin, “You beat everybody else in town, terrific numbers.”
“He would be so happy,” said a tearful Mrs. Knight dabbing a tissue to her eye. “So very, very happy.”
“Congratulations Richard,” said Dr. Barnes loudly. “Your numbers are the best. You are the best darn CT surgeon in all of Philadelphia. I’m so very proud of you.”
“It meant so much to him,” said Mrs. Knight with a sob. “So very, very much.”
Both visitors then paused and continued to look at the body lying in front of them, hoping for a gesture of understanding. There was no physical response whatsoever. It was unclear to them as to whether or not the long anticipated news registered in Dr. Knight’s mind. Silence engulfed the room in wait, only broken by the exact tone of overhead monitors, which closely recording the situation. Sadly, they turned away, leaving the room to continue their conversation out of earshot.
Earlier that morning Dr. Barnes informed Mrs. Knight of the series of unexplained deaths within the hospital setting. Due to the magnitude of all the recent events, he failed to use the term “murder”, not wanting to further burden the surgeon’s grieving wife. Mrs. Knight did however agree to meet with the Philadelphia police detectives, along with Dr. Barnes, that afternoon. As they parted company that morning, words of condolence and hope were exchanged, bringing solace to each party.
The atmosphere in Jennifer Ranier’s room was not as grim. Her medical status was stable, and her prognosis good. Several bouquets of flowers already adorned her room on the orthopedic floor, which had a spacious view of the city below. Lance and his crew of musclemen had already rounded on their postoperative patient that morning, expressing great success with regards to their surgery. Jennifer’s femur bone was stabilized with an internal rod, and her thigh gash was repaired and loosely closed together. Physical therapy would help to get her out of bed that morning in order to sit in a chair. She would require intravenous antibiotics over the next 48 hours and then be discharged from the hospital. Her father and brother had already visited and set out for breakfast, allowing Phil to enter the room in his post call state. Jennifer had a vague memory of the motor vehicle accident from the night before. However she had no specific recall of the events or conversation leading up to it, a product of her traumatic concussion.
“Why the policeman outside?” asked Phil as he approached Jennifer.
“Don’t know,” said Jennifer as she received a soft hug from the intern. “I’m having a little trouble remembering the crash and everything about it.”
“Probably a good thing,” said Phil sitting next to her bed. “A picture of the car was on the news this morning, you’re lucky to be alive.”
“All I remember is the cold rain, darkness and an awful noise from the crash,” said Jenna. “Then you holding my hand in the E.R., that’s it.”
