Prologue
The double doors to the ambulance bay at Ridgeway Medical Center swung open with a bang, followed by a pneumatic hiss. A team of paramedics steered a stretcher through, wheels rattling over the threshold.
“Eighty-two-year-old male found unresponsive at a memory care center,” the lead paramedic called out. “BP’s tanking, heart rate one-twelve. GCS was three at scene.”
“Three? Shit.” The charge nurse trotted alongside the stretcher. “We’ve seen him before. Any meds?”
“Metformin, lisinopril, aspirin.”
“The family with you?”
“Nah. Brookside said granddaughter was out of town. They left a message.”
“Copy that. We’ll take it from here.”
The patient was a slight, elderly man with paper-thin, sallow skin. His mouth hung open, jaw slack, eyes half-closed. A bag-valve mask sat crooked on his face, fogging with each forced breath.
“On my count,” said the nurse. “One, two?—”
The team lifted him from the stretcher and lowered him onto the hospital bed. The man weighed maybe a hundred and thirtypounds, but an unconscious body was dead weight. Monitor leads snapped onto the hospital system, EKG pads stuck to his chest, and a blood pressure cuff cinched his arm. A cacophony of beeping and chirping filled the room.
The attending pressed his fingertips into the patient’s abdomen. “Distended, rigid, no bowel sounds. Abdomen’s full.” He straightened then ordered, “Get me a full trauma panel. Type and cross-match for six units. And page Vaughn. We might need the OR.”
A nurse drew blood while another started a second IV line. The respiratory therapist leaned over the patient’s face, grasping his fingers. “Sir? Can you hear me? Squeeze my hand if you can hear me.”
Not even a flicker.
“Let’s do an ultrasound.”
The resident grabbed the probe and squeezed gel onto the patient’s exposed belly, then pressed the transducer against the taut skin as gray shapes appeared on the screen. The probe moved slowly, searching, and then there it was—a column pulsing on the monitor with a dark irregular shadow ballooning outward at its base.
“Ruptured aortic aneurysm,” the attending called out.
The trauma bay surged into motion—a nurse barked into the phone, her voice rising just enough to convey urgency; another lunged for the crash cart and yanked open drawers while yet another sprinted toward the hallway to hold the elevator.
“Any info on this gentleman?” the attending asked.
The nurse scrolled the chart on the tablet in her hands, her head shaking slowly. “He’s a frequent flier. Family is out of town. The facility left a message that he was being transported here.”
“See if you can reach them.” He paused and glanced at the monitor. “Tell them we’re taking him to surgery.”
“Do we need approval?—”
“We can’t wait. Let’s go.”
They pushed the bed toward the open bay doors. In less than a minute, the ER was back to its normal hectic flow. The intake note was updated, capturing every note of the patient’s care.
Next of kin contacted 13:52. No response, message left. Informed patient admitted to surgery to repair rupture of abdominal aorta.
In the OR, the anesthesiologist worked quickly to insert a tube, secure the airway, and begin the drip of drugs that would keep the patient unconscious while they tried to save his life.
The doors swung open and the surgeon stepped in, mask and goggles on. A surgical tech helped him into his gown and snapped gloves onto his hands before he moved to the table with his eyes on the monitors first, then the patient, taking in the scene.
“What do we know?”
“History of diabetes, hypertension, dementia. Presented with distended abdomen, ultrasound shows a AAA.”
“Ruptured aneurysm? We need to get in there.”
