You cut light like you're the knife.

Posted on Mon Jan 31st, 2022 @ 1:42am by Ships Doctor Hiram Maitland M.D. & Evahnae Kohl & Beya
Edited on on Mon Jan 31st, 2022 @ 1:55am

Mission: Mission 14: Holoworld
Location: Sickbay
Timeline: Following "It doesn't look like anything to me." MD05 2200
2454 words - 4.9 OF Standard Post Measure

Hiram burst through the sickbay doors, shouldering them open with Eva laying limp in his arms, covered in blood and packing and a stasis strip that was holding her insides together precariously. He gently transferred her to the first available biobed and kicked the brakes off with his foot, grasping the end of it to push it through into the internal partition that designated the Rosie's makeshift surgical unit that he'd constructed upon his first pass through the medical unit. It was sterilized and held specialized equipment and that was about all he could hope for at the moment.

"Beya, I need you to scrub in. It's Eva, we've got a large penetrating abdominal injury-a serrated blade approximately six inches, with extended liver involvement-" he spoke as he flicked on monitors and moved to the back room once he'd hooked Eva into the large biosignal alarm that would alert them to any changes in her status so he could actually get scrubbed in.

It was fast, getting out of his bloody uniform and into a set of scrubs and a surgical gown, demeanor calm and poised, every movement deliberate and calculated even though most people aboard recognized that Hiram and Eva had become rather close friends over their brief period of time together on the ship, this did not translate into his professional demeanor. He entered the makeshift surgical suite a few moments later and consulted a tray of tools before selecting one.

"All right, let's get started," his rhythmic, metronomic gaze lifted to Beya's.

Beya was already standing at the surgical table, having already changed and 'washed' in the sonic after getting the alert on the bridge. She had the instrument arranged and in position and was trying really hard not to look excited - Eva was seriously injured and it would be wrong to be excited about the prospect of assisting and learning surgical techniques as she had back when Dr. Vinny was here (even though, truthfully, she was excited, just trying not to be a terrible person by showing it). "Ready, Doctor," she reported crisply. "I've pulled a unit of her blood type and started an IV."

"Excellent," Hiram encouraged her and they fell into reflective, sympathetic motion. The liver damage was the most significant injury, and such involvement always bled profusely. Eva was no exception, which meant that they both had to move quickly and precisely over the instruments. "All right, I need suction here," he murmured, his voice slow and steady in contrast as he leaned in, laser cautery in hand. The surgical techniques he would have to use were much older and less reliable than what one might find on a starship or facility in the 24th century, which made things trickier.

Hiram was good at his job, and was unclouded by panic or urgency, but he was limited by what was available. It meant that Eva was teetering, bio-signal monitors bleating their unhappy tune in the background. "We're looking at a laceration afflicting 25% of the left hepatic lobe with hemodynamic instability, so we're going to pack what we can and clamp off the hepatoduodenal ligament here," he gestured with the line of his scalpel. "Hemostat," he held out his empty hand for her to hand him the small scissor-looking tool.

"Yes, Doctor," Beya replied crisply, handing him the hemostat and standing ready to apply suction when needed. Watching the surgery was fascinating. Hiram might find the equipment below what he was used to on a starship, but to Beya it was as good as anything she had ever seen on other merchant or cargo vessels, so in some ways she felt as though she had a front row seat in a medical school operating theatre.

He guided her through a significant portion of the liver resection, a necessity to cut away the damaged tissue and slowly replace it with a regenerative marker that would facilitate natural growth of hepatic cells. This part of the surgery was very slow, and very steady. Hiram lingered, examined, considered before moving to make each cut efficiently and unflinchingly, describing his actions to Beya as he went. This was how you learned medicine. There were no shortcuts, no simulations, that could compensate for this moment. The moment you laid your hands into someone's guts.

The monitor blipped, and he looked up, stilling instantly. "Her pressure's dropping," he announced lowly, chin tipped upward. A moment to think, to consider, in the midst of those blaring alarms. "Let's get her on electrolyte crystalloid solution; administer in 250ml increments. We're also going to go for a balanced blood transfusion. That's 1:1:2 of plasma, platelets and packed RBCs. Make sure her IV is keyed to that and let's add aminocaproic acid as a chaser. Go," he directed firmly.

It was a lot of information in one go, but that was the nature of medicine. He waited to see if she understood her directions, because a mistake would be devastating at this juncture.

When Eva's pressure dropped, Beya's gut clenched, afraid she'd done something wrong that caused it. Was everyone right that someone like her had no place being in medicine? But she rallied at the doctor's orders. "Yes, doctor," she replied and ran to gather solution and replicate the correct transfusion, repeating the order to herself over and over as did so to be sure she wouldn't forget anything.

Rushing back, handed the doctor the transfusion bag, labeled for him to double check, as she set up the electrolyte solution to administer in measured doses.

Hiram didn't pick up on her internal musings, but he did sense a mild shift in the atmosphere in her harried movements, and he offered her a smile across the operating table. "You're doing great, Beya," he attempted to bolster her before returning back to his task. Cut, resect, cautery, sterile strip. Stasis strip. Growth factor. In neat, clean lines, repetitive and soothing. When the monitor shrieked again, about fifteen minutes later, this time it blared. "All right, she's tanking," Hiram muttered this time. "Beya, I need you on here to start compressions. Now, compressions," he directed her to the front of the table as the monitor began to sound off a long, droning flatline. He was already grabbing the tools he needed, but he had to leave her side to get the rest.

Beya jumped to get into position to begin compressions - this at least she knew how to do very well. It was the kind of emergency first aid she'd first been trained to do, and one she had used successfully more than once. "Come on, Eva," she whispered between compressions. "Don't let whoever did this win."

Hiram ran down the hall to locate the device that would deliver the necessary voltage if and when the time came, having not been prepared for this adventure, it wasn't in an easily reachable place, as this was not an actual surgical theater. It was a partition, sterilized, in primary sickbay. Hiram had set it up well, but there had still been things missing, codes for the medical replicator that hadn't functioned.

He blew through it all now, bypassing several major systems to unlock access in a maneuver that, in any other circumstance, would be extreme. In this circumstance, he considered it justified, and cobbled together the rest of the code stuck in the pattern buffer. The device materialized a moment later and he snatched it up and ran back-Beya could only keep doing compressions for so long. He switched out with her the moment he got back, locking his arms over her chest.

"OK, grab that epi up there and we're going to push 1mg through the central line every three minutes. The goal is to get her heart to a shockable rhythm," he waved the device in his hand before setting it down and checking her electrolytes-asystole with eletcrolyte imbalance was typically caused by-"hypokalemia, let's load her with potassium, too."

Making a mental note to be sure basic emergency equipment like AEDs were within reach everywhere in medbay, and other places on the ship, Beya grabbed ampules and pushed a dose into Eva with one eye on the clock to mark the timing of the next dose. As the patient's vitals hovered barely above flatline, it didn't feel like enough. "What else can I do?"

"There's the rhythm, we got her," Hiram told Beya, his expression unchanging from where in someone else, there might be a smile. "I'm going to get you to step away and then I'm going to hit her with the charged unit," Hiram said, meeting her eyes across the table. "OK, clear," he said it loudly and firmly, in the tone that suggested Beya had better be clear. The device pulsed and Eva jerked on the bed, but the monitor remained constant in its staccato, jerky melody. "Push more epi. Charge again. Clear."

It went like this for a while, with Hiram dictating Beya when to medicate her and when to step back, before the monitor began pulsing. "Got it. We got it, but she's still in v-tach." He cleared the central line and then added amiodarone to the mix, a delicate balance of drugs and monitoring prior to the continuation of their resection.

"We're going to monitor her life-signs, her fluids, try and keep everything as balanced as you can. Her readings should be within these margins," he gestured with his finger on the screen. "Any deviation and you adjust. We have to keep cutting, though, or she won't make it off the table. Are you good to continue?" he checked on Beya herself. Most sentient beings struggled with the prospect of death.

Emergency medicine was harrowing - a mix of anxiety, agitation, and elation all spiked with adrenaline - but it wasn't Beya's first experience. Not even her first experience of it on Mary Rose, though if she was honest the idea of losing someone so obviously close to the doctor had rattled her somewhat. But at his question, she calmed herself - she was Orion and there was such a thing as cluros after all - and straightened, lifting her chin. "I am fine to continue. Let's make sure she leaves the table alive."

Settling back into the rhythm of things, Hiram kept at it with Beya's assistance; fortunately they didn't have any more significant drops in vital signs, but only time would tell the extent the code had affected Eva. For the last little bit, he had Beya come around to his side of the table to watch him close her up, having Beya operate the dermal regeneration unit herself. "Everything looks good from here, these readings are all within acceptable margins," Hiram said as he consulted the monitors. "And her liver will make a full recovery. Now we just have to wait and see."

That was what it came down to sometimes, Beya thought, remembering all the times she had watched at someone's bedside, here and on previous ships, ready to respond to a crisis but more than anything simply watching for the signs that the patient had chosen to live ...or not. She didn't know Eva well, but her impression was of someone with a love of life about her, so she held hope there. "I'll keep an eye on her," Beya offered. The doctor was an odd man, but she liked him and however neutral he presented, she knew he and Eva were close. "You came straight up from whatever caused that, so you should rest, and get some food."

Hiram looked like he blerped for a moment and his hand found his own chest, his gaze still relatively expressionless, more like he was attempting to solve a particularly complicated math problem. "My pair is broken," he recalled belatedly. "I will need some assistance fixing it. In the interim, I'll need to be hooked up to a cortical monitor." Hiram looked up and over Beya's shoulder. This was the second time in less than week that he'd run into concerns after leaving Earth. It made him wonder how suitable he really was for this position. "We may need to go through what you would need to know to treat me if I have a respiratory crisis."

"Your pair?" Beya's brows rose. If the doctor had a medical condition, he had not shared it with her. She didn't know what a 'pair' was or how it related to his heart and lungs, but it sounded serious. She moved toward him, ready to catch him if necessary. "Tell me what to do, doctor."

"It's all right," he assured her first. "I have a Synapse implant. It's a phrenic nerve pacer to treat a condition known as MDS, medullary dysregulation syndrome. This means I'm unable to breathe on my own. The pair is designed to interface with the implant in the event that it needs adjusting. Without it, the implant will still function correctly-I am stable," he made sure to tell her. "But I'll need to be monitored just in case. I apologize for not alerting you sooner, it is a somewhat uncomfortable subject. Nevertheless, I was remiss."

Beya sighed inwardly, but she understood. "It's okay. I'm Orion. People not sharing anything that might be a weakness is practically a way of life. You can explain what I'd need to do for a respiratory crisis that's different from what I'd do anyway while I set up the cardiac monitor."

Hiram went through the basics of mechanical ventilation with neurological involvement-unfortunately anything further was simply not something the paramedic could be walked through without years of med/surg training, but they did have the time to at least cover this ground. The patient beneath them was a prime example, and Hiram assisted her with everything as they slowly moved to transfer Eva into the recovery unit. The life-sign monitors chirped a steady hum. "You did very well today, Beya," he told her with a nod. "I'll need to deal with this, however," he tapped his chest again. "My communicator is on standby, but Ms. Kohl should remain stable until it comes time to remove the vent. Let me know if anything changes, all right?" his smile to her was practiced, but easy enough.

"Thank you, Doctor. I'll keep an eye on her," Beya said, setting her PaDD to mirror his cardiac monitor. "And on you."

His eyebrows shrugged in a little nod before he stripped off his nitrile gloves and deposited them in the medical reclamator on his way out of the door.