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First Do No Harm - Part 4

Posted on Wed May 9th, 2018 @ 8:01am by Lieutenant Ashley Callahan & Specialist Jamie Perth
Edited on on Thu May 10th, 2018 @ 1:08pm

Mission: Traitorous Endeavours
Location: Sickbay - BS Solaria
Timeline: MD 16 - 10:45

"Make sure you've got the guidewire with your other hand. And with your dominant hand, push the dilator ahead in a twisting motion up until the hilt."

Jamie nodded, trying his hardest not to have his gloved hands tremble. The mask covering his nose and mouth, along with the large blue surgical gown he wore and the hot light beaming from the lamp mounted above, raised his temperature to the point where he was beginning to sweat. He did exactly as he was instructed, his hands moving slowly and intricately.

"Okay," Dr Callahan said from behind him, watching over his shoulder. "Now next, you'd want to pull the dilator out quickly. Once it's out, hold a set of gauze over the puncture site, 'cause it's gonna bleed quite a lot. Make sure you only retrieve the dilator, and not the guidewire."

He hesitated, taking a moment to visualise his next step. "Yep," he answered simply.

Jamie had never expected to learn how to insert a central venous line, as such a procedure was only to be performed by medical doctors. But considering their desperate situation - namely a lack of doctors across the Fleet - expanding the scope of practice for any of the medical staff would be beneficial. The usual laws restricting non-doctors from performing certain procedures would have to be set aside for now.

A boy's startled cry came from below the large blue sterile drapes, which covered him entirely save for the window exposing a small area of the right side of his neck. A thin metal wire emerged from a puncture site, streaks of blood over the skin around it. Jamie then carefully introduced the catheter through the wire, which had been inserted earlier directly into Taron's internal jugular vein.

"Sorry mate," Jamie said. "Almost done. You're doing really well..."

Dr Callahan nodded. "That's it. Now push the CVC in just like you did with the dilator. Stop once you have about give centimetres of the line left exterior to the insertion site."

Taron gasped, then let out a moan of discomfort as the large catheter was pushed in, done swiftly to minimise the duration of pain. Soon it was all over, with the line secured by several stitches and a clean dressing applied over top. Jamie flushed each of the four lumens with saline from a syringe, before pulling the suffocating mask and surgical gown off of himself.

"Well done," Callahan nodded in approval. "Next time you can do one on your own."

Jamie felt his heart sink a little, unsure if he should be award that level of confidence when he certainly didn't find it in himself just yet. "Maybe," he said quietly.

Taron's clinical condition had deteriorated, his blood pressure steadily dropping despite adequate intravenous fluids. The pneumonia was spreading well beyond the lungs, his body's inflammatory response spilling over to involve his vascular system, causing it to leak fluid beyond its walls and into the tissues. The only medications to counteract such a process could only be given through a larger IV, thus the need to insert a central line.

Jamie told the boy again that he had 'done well' - an expression almost all healthcare workers universally express to their patients during painful procedures. Strictly speaking, the patient would almost always be doing nothing, but it was more a form of encouragement and reassurance, that tolerating the the temporary suffering was in itself a bold act.

After disposing all his sharps appropriately and cleaning up his equipment tray, Jamie shuffled over to where Dr Callahan was. "He's not getting any better, is he?"

"Sadly not," she half said, half sighed. "His FIO2 requirements go up each time I check on him. He's slowly getting more hypercapnic, more acidotic and his lactate's rising. Managed to keep his saturations steady the past few days but I might have to place him on high-flow nasal prongs to give him a little bit of PEEP. He's starting to get a serious VQ mismatch."

Jamie nodded, understanding most of what she had said, although perhaps not to the same extent that the doctor - an emergency and intensive care physician - might. "But he's gonna be all right, right?"

Dr Callahan looked up, then in a quieter voice. "It's not a good sign if you've got a chest infection and need noradrenaline to keep your MAP up." Then after a pause. "But look, he's young. He's got a slightly dodgy heart thanks to backwards Sagittaran thinking. But hopefully his age will pull him through."

And with that, the doctor turned back to her other work, walking away.

Jamie looked over at the young lad - propped up on the bed with a few pillows, sweat over his scalp, his breaths laboured, in and out of his mouth as the flow through his nostrils simply wasn't enough to stop the feeling of drowning on dry land. The large computer screen above his bed displayed various waveforms and a set of numbers in different colours, some of which were concerning - a high heart rate, borderline blood oxygen saturations, a less-than-ideal blood pressure.

The boy opened his eyes, looking ahead. "Thank you," he suddenly said, referring to the central line that now stuck out from a dressing over his neck.

"No, thank you for being so patient with me," Jamie said, stepping forwards. He rested a hand over Taron's shoulder. "You're probably the bravest guy in the room. Escaping from your father, finding your way onto another ship... And then coming to us, all while you were feeling so unwell. I can't imagine how scary that must've been."

"Desperate times..." Taron said, before taking another deep breath. "Desperate measures." He seemed to pull whatever strength he had to simply keep his eyes open, and alongside that gave a weak smile.

Jamie returned the smile. "Stay strong, buddy."

 

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