Trauma Center: Equestrian Opinion
Chapter Seven: A Healing Touch
Location: Ponyville Medical
Direct hastily stuffed his limbs into his set of surgical scrubs, using magic to pull the sanitized clothing up around his body and tie it off. Doctor Duty and the nurses were getting the filly set up in the Emergency Room, and he needed to be ready to operate as soon as possible. He had wanted to skip the sanitation to start the operation sooner, but Civil had insisted; this operation would be too delicate to jeopardize the patient's safety just for the sake of a few seconds. So here he was, trying to get properly prepared as quickly as possible.
Doubts oozed into his thoughts like blood from a wound, momentarily giving him pause. There's nopony here to fix it if I mess up this time, he recalled grimly. Quickly, he resumed his preparations. All the more reason to stay focused; I can't let anything distract me.
When Direct entered Emergency Room 3 less than a minute later, he was greeted with a scene of minor chaos. The heart monitor wailed out a steady, high-pitched note as the red vitals count number dropped ever so slowly.
Two nurses rushed around the room frantically, trying to find any way to revive the patient, while the third was reared up on her hind hooves, pink wings providing balance as she attempted chest compressions. On the other side of the table was Doctor Duty, her horn sparking faintly as she charged up a defibrillator spell. "Clear!" she shouted, and the nurse stopped compressions to allow her to touch her horn to the patient's chest, causing the filly's body to twitch slightly but not stopping the monitor's screeching. Immediately the nurse began compressions again, frantically trying to get a pulse.
Panic creeped into him at the scene, but he pushed it aside for the moment; he couldn't afford to doubt, not after he'd been given a second chance. He paused in the doorway, closing his eyes and remembering that Unicorn filly. The hope in her eyes, the sincerity of her question as she'd asked if he could help. I promised her, he remembered. I promised her that her friend would be okay. He opened his eyes again, his thoughts clearer, and with determination beginning to replace his earlier trepidation. Alright, the patient is undergoing cardiac arrest, so the first priority is getting a heartbeat. Thus affirmed, he started towards the table.
He charged up a defibrillator spell of his own as he approached, electrical energy running up and down his horn. As experienced as Doctor Duty was, at the end of the day she was an anesthesiologist; she'd learned the spell in med school but her classes would have focused on other spells and techniques. Direct, on the other hoof, had had the defibrillator spell drilled into his mind to the point that he was seeing the spell matrix whenever he closed his eyes. Adjust down for age, then double power for Pegasi...
He quickly strode the rest of the way up to the table, tapping the pink nurse on the shoulder. She jumped and nearly lost her balance, stepping aside in shock at the sight of the doctor. "Doctor Styles?" her voice wavered as she spoke.
Now that he was closer Direct could see tears shining on her face and in her reddening eyes. Clearly she wasn't taking her failure to resuscitate the filly very well. He shook as he recognized the distressed nurse as Nurse Temperament. Seeing her so upset now when he had last seen her furious nearly broke his focus, and he quickly turned and touched his horn to the filly's chest just over her heart.
A jolt of electrical energy coursed through the broken body, but the heart monitor continued its high-pitched wail. No! he must have lost control of the spell at the last second. The spell's failsafe prevented it from overcharging and harming the patient, but it did nothing to help restore a heartbeat. I'll have to try again.
Focus. Concentrate on the patient. Nothing else matters. Lightning arced across his horn again and time itself seemed to stand with bated breath for one infinitesimal moment as he touched it to the filly's chest for the second time.
Everypony fell silent as the heart monitor's whining cut out for a fraction of a second. Direct nearly had his own heart attack in the moment they waited before a beep resounded through the room, followed quickly by more. They had a pulse. The vitals number jumped up a bit but resumed falling almost immediately. They weren't out of the woods yet, not by any stretch of the imagination.
Everypony in the room released a deep breath. "You did it, Doctor Styles," muttered Doctor Duty, her smoking horn a testament to the number of times she had attempted the spell herself. Beside her, Nurse Temperament's gaze silently flickered between Direct and the patient.
"I did an it, sure, but by the look of things we have a lot more 'its' to go," the stallion replied with his own sigh of relief. He began examining the Pegasus filly, once again noting all four of her broken limbs and a clearly collapsed ribcage. "What do we know about the patient's condition?"
"Not much beyond the obvious, unfortunately," one of the EMT nurses standing by the heart monitor replied, shaking her head. "Lots of broken bones and probably internal hemorrhaging, if cardiac arrest is anything to judge by."
"Going in blind, then. Nurse Temperament, pass me the Antibiotic Gel so we can get started." He faltered after a moment when his partner didn't respond. Glancing to the side he saw the pink mare silently staring at the patient as the heart monitor beeped a fast, staccato rhythm. Now that he was paying attention, he could see yet-unshed tears welling in her eyes and hear her rapid, shallow breaths. "Nurse Temperament..?"
"Get to work, Direct," Doctor Duty commanded as she rounded the operating table. She quickly approached the trembling nurse, putting a hoof on her shoulder. Direct began to object as the elder Unicorn began to gently push his assistant out of the room, but she gave him a pointed look and gestured towards their young patient. "I'll take care of this problem, you deal with that one."
"R-right," Direct mumbled as he hastily turned back to the operating table, accepting a vial of Gel from one of the EMTs who had stepped forward to act as his assistant. "Okay, we've got a lot to do, so let's get started." The EMT, an older, green-coated stallion, nodded as the doctor quickly spread the gel down the middle of the filly's deflated chest. "Scalpel." He was passed the indicated tool in short order, and made an incision almost down the full length of the patient's chest.
Direct flinched as the opening revealed a number of shattered bones embedded in mangled organs. Their view of the grisly scene was completely unblocked - as they had assumed, almost the entirety of the patient's ribcage had been shattered. The EMT unfazedly remarked, "Well, ain't she one lucky filly?" At Direct's shocked look, he elaborated, "Lucky ta be alive, that is. Only times Ah ever seen somepony this bad were when we called th' morticians soon's we arrived."
Direct grimaced. "That won't be happening this time." Turning his attention back to the matter at hand, he eyed the whole mess again and called for a pair of forceps. Taking them in his magical grip, he began carefully extracting the shards of shattered bone that had pierced the filly's heart, placing them on a sanitized tray. "We'll need to get these out of the way for now," he explained to his temporary assistant. "We might be able to fix the ribs later, but for now we should focus on the organs, starting with her heart."
The vital organ's erratic beating made removing the shards of bone difficult, and Direct feared that they may be causing even more damage on the way out. Still, he persevered, knowing that it was the only way the filly would ever recover. He alternated constantly between the forceps and sutures, trying to patch the holes that had been pierced into the filly's fragile heart.
"That takes care of the worst of it," he remarked several minutes later, as the automatic sutures tied the last hole shut. He wiped the sweat from his brow as the EMT stallion injected a syringe-full of Stabilizer. "Her pericardium's holding together, and none of those fragments went deep enough to do any serious damage."
"That's one organ down, 'nother half-dozen ta go," his temporary assistant pointed out, setting the syringe aside for re-sterilization and prepping the forceps once more.
He was right, of course, and the heart alone had taken longer than Direct would have liked. Still, he couldn't afford to be hasty, not after what had happened the night before and especially not with a filly's life in the balance. Nodding to the stallion beside him, Direct grinned with a mixture of anxiety and confidence. "Then let's not waste any time."
Doctor and nurse dove back into the operation, working as efficiently as they could to remove the pieces of bone from seemingly every vital organ in the abdominal cavity, carefully making their way down the body. Direct lost track of time, engrossed in the steady work. He remained oblivious to the world beyond the operating table until he pulled the last shard of bone from the unfortunate filly's large intestine. How'd it even get all the way down there? he mused as he placed the offending bone in the sanitized tray and finally looked around.
A small mountain of fragments covered in blood and the occasional chunk of red flesh quickly filled the tray. Two EMT nurses tended the various machines around the room while the third was in deep conversation with Doctor Duty, who must have returned at some point while he was working. His brain slowly connected the dots as he looked to the pony standing beside him, and he jumped slightly at seeing Nurse Temperament taking her normal place beside him. "Uhh, how long have you been back?" he asked before he could think better of it. "And, uh, are you feeling, you know... better?" he tacked on rather lamely. Her eyes were still a bit red and her blonde mane was a mess, but she seemed to be back to normal otherwise.
His assistant smiled slightly, "Long enough to see you in action, Doctor Styles, and I'm feeling much better. Civil's very good at... encouraging. " Her smile faltered, "Doctor Styles I-" She cut herself off and her gaze dropped until she was staring at the ground, fresh tears welling up. "I- I want to apologize for how I acted earlier today, and really for how I've treated you ever since-"
"Hey, hey!" Doctor Duty shouted across the room, cutting off Nurse Temperament's apology. "It's great to see you two clearing the air and all, but priorities! Save patient now, kiss and make up later!"
The two ponies standing by the table blushed and looked away from each other. Clearing his throat and trying to forget about what the older doctor had just said, Direct turned back to the table. "Right, well, let's continue the operation then. Normally we'd have to get the bone fragments cleaned before we could replace them, but there isn't time for that right now. We'll just have to apply an extra coating of Gel to sanitize them as well as we can."
Nurse Temperament hastily nodded and began sorting through the pile of fragments, searching for the largest pieces to start with. "Hope you like jigsaw puzzles, Doctor Styles. This won't be easy, but..." She paused and bit her lip, eliciting a glance from Direct. She met his eyes for a brief moment, her expression conveying her emotions better than words ever could. She was afraid and nervous, but under it all ran a glimmer of hope. "But I believe you can do it," she whispered just loudly enough for him to hear before she turned away. "You have to." The last word was almost covered by an involuntary sob, and Doctor Duty cut off her conversation again to cast a worried look their way.
Nurse Temperament recovered after a moment, and the pair turned their attention back to the nearly-boneless chest cavity before them. "Right. Back to this, then."
Direct, though a bit worried about his assistant, nodded. "Okay, this is going to be tricky. We'll be rebuilding almost her entire ribcage from these pieces, and we can't afford to make any mistakes. Any preference on where we start?" he asked, looking over the large shards of bone Nurse Temperament had set aside as the most likely places to start.
"Try this one," the pink Pegasus replied, indicating the largest shard of rib bone. "Those edges look like they line up with the break pattern there," she pointed at a small nub sticking out from the sternum – what was left of the patient's upper-left-most rib.
Studying the break Direct had to agree; aside from a chip or two it looked like the two fit together perfectly. "As good a place as any. Try to find one that matches the break on the other side of this one while I reattach it."
"Got it," she affirmed with a nod, placing the Antibiotic Gel on the edge of the cart nearest the doctor before scouring the tray for a matching fragment.
Direct left the nurse to her work and focused on his own job. Taking both the bone fragment and the vial of Gel in his magical grasp, he carefully lowered the shard into the patient's body until it hovered right next to the nub it had broken off from. Aligning the two ends as closely as he could, he covered both ends in a healthy dose of gel, still holding the fragment in place as the miraculous substance went to work. It was too small for him to see, but he knew that the Gel was seeping into the bone's exposed marrow, helping to create more chondroblast cells which, in turn, would generate new bone. Meanwhile, on the surface of the fragments, the outer layer of gel hardened, holding the pieces in place and allowing Direct to release his magic.
Nodding in satisfaction when the bone stayed in place without his magic supporting it, Direct turned to Nurse Temperament, finding that she had already prepared the next bone shard for him: another large piece that looked like a perfect fit to reconnect the first fragment back to the spinal column, completing the first rib.
Once more grasping the bone and the Gel, Direct repeated the process he'd used on the last shard, quickly securing it in place to begin healing.
The two continued like this for what simultaneously felt like both a few hours and a few minutes. The pile of fragments steadily shrunk as they worked, Nurse Temperament sorting the intimidating mountain of work into neat groups as Direct fit the pieces into the jigsaw puzzle that had been the filly's ribcage. Eventually, the last of the ribs was repaired, a tiny fragment finishing the bottom-right-most floating rib.
"Uhh, Doctor?" Nurse Temperament asked uncertainly as Direct wiped the sweat from his brow. "It looks like we aren't quite done here yet."
"What do you mean?" Direct asked, turning to face the nurse... and the tray that still held a pile of bone fragments. "W-what? But that was the last rib!"
Nurse Temperament nodded slowly. "I was just thinking about that. The patient is a Pegasus, right?" Direct nodded; he recalled seeing the filly's wings buzzing at high speed as she flew by him. "Well, I think these bones might be the remains of her keel." At the doctor's confused look, she sighed. "It's the bone structure that pegasi flight muscles attach to. Normally, it's located just below the ribs," she gestured to an empty area of the filly's chest cavity, and on closer inspection Direct could see the damaged ends of two pairs of muscles that wrapped around behind the vital organs, as well as a pair of broken bones sticking out from the spinal column a short ways below the ribs, "right around there. Those muscles connect to the wing's shoulder joint and allow Pegasi to flap their wings."
A bit overwhelmed at the information flood, Direct shook his head. "We'll need to wait for a specialist to reattach those muscles, but we can at least reassemble the bone structure while we're here. Pass me the first piece."
And so they returned to that same routine, quickly reassembling the keel from the remaining fragments, until– "Well that's strange," Nurse Temperament remarked. "We're all out of fragments, but there's still a piece missing." She gestured to the nearly-completed bone structure, where there was clearly a fragment missing. "Are you sure you got all of them earlier?"
Doctor Styles shook his head, "I thought so, but apparently not. I'll have to use an Ultrasound spell to search for it." He immediately prepared to do just that, but a shout from one of the EMT nurses drew his attention.
"Doctor!" the nurse called out, "The patient is undergoing v-fib!" Direct inwardly cursed. He'd thought they were done with heart problems. Ventricular fibrillation was serious, and often accompanied full-on cardiac arrest, more commonly known as a heart attack.
The heart monitor beeped out a weak, irregular rhythm as doctor and nurse turned their attention to the spasming heart. The red mass was host to a number of zig-zagging sutures from the earlier treatment, and different parts of it contracted out of sequence with each other, leaving the distinct impression of a shaking bowl of gelatin. Direct began charging his defibrillator spell, only to stop as it struck him that he couldn't safely use it directly on the patient's heart. Nurse Temperament seemed to have come to the same conclusion, letting out a sigh. "Looks like we get to do this the old-fashioned way, Doctor."
Direct took pause at that remark. "'Old-fashioned'? I wasn't aware there was an 'old-fashioned' way to stop cardiac arrest."
Despite the situation, Nurse Temperament still shot the doctor a smirk. "I suppose they wouldn't have bothered teaching it to you Unicorns, but we had to learn how to fix a lot of issues without magic. Open-heart defibrillation is simple enough."
Genuinely impressed, Direct stepped back from the table. "Well, in that case, have at it," he gestured to the unconscious filly.
Her bravado faltered as she was called out, but Nurse Temperament quickly regained her courage. She'd done this many times before, and while getting the right timing was tricky, the technique was not too difficult. Nodding in affirmation, she retrieved a pair of sterilized hoof-gloves from the supply cart and reared up onto her hind legs. Slipping the gloves over her forelegs, she reached a hoof into the filly's chest until she made contact with the quivering mass of blood-pumping muscle. It's so... squishy, she noted absently, yet also firm. It was quite a strange, contradictory feeling. "O-okay, beginning the heart massage treatment."
Taking a deep breath to calm herself, Nurse Temperament gently pressed down on the heart with her hoof, slowly beginning to knead the organ in a regular rhythm. As she moved her hoof around the heart, pressing in on different spots in time with the heartbeat she sought to achieve, she felt something strange. One spot resisted her push, holding hard and unyielding in contrast to the rest of the organ's firm squishiness. Moving on, she felt nothing strange with the other areas she worked, but when she returned to that spot again... her rhythm faltered and her massage ended as she once more felt that strange, hard spot. Ignoring the strange looks from Doctor Styles and the EMT, she began gingerly feeling around the spot, quickly discovering a long, thin hard area surrounded by normal, squishy heart.
Now what could this be..? she wondered, before her eyes widened as realization struck her like a runaway cart. "D-doctor?" she stammered without moving. "I think I found our missing piece."
Direct shot her a curious look, but charged up his horn, pinging the area Nurse Temperament had been examining. Sure enough, he felt a shard of bone somehow stuck inside the patient's heart. "I... guess that explains the fibrillation." A bit taken aback, he paused for a long moment before retrieving a scalpel from the cart. "We'll have to reopen the heart and retrieve that fragment."
"Right," Nurse Temperament affirmed, disposing of her gloves and taking her place by the doctor's side.
Pinging the Ultrasound spell one more time to confirm the location of the bone shard, Direct carefully made his incision, easily slicing through the pericardium and several layers of myocardium before reaching the bone shard. With his target in sight, Direct drew the scalpel along the embedded bone, creating an incision just slightly longer than the fragment. Swapping his scalpel for the forceps Nurse Temperament had prepared for him, he carefully extracted the exposed shard. Placing it on the tray, he allowed himself a sigh of relief when he noticed that it looked like it would fit perfectly in the keel structure, filling in the one remaining gap.
"Well that's a relief," Nurse Temperament commented, having noticed the same thing.
Doctor Styles nodded tiredly. "Let's close this back up so we can- WOAH!" Direct cut himself off with a yell as the incision he had made, so small originally, suddenly lengthened. What had once been less than a centimeter long had nearly tripled in length.
"It's the fibrillation!" Nurse Temperament realized. They had failed to completely fix the issue due to the bone fragment, and the spasming had returned with a vengeance. The monitor beeped irregularly as the heart quivered violently, the rapid motion tearing the incision ever wider and threatening to burst the other sutures. Suddenly, it gave one almighty spasm, tearing the whole muscle mass along the line of the incision.
"No!" Direct distantly heard somepony shout in his voice. He barely noticed it, though. The room around him melted away, leaving only the patient in front of him. That little orange Pegasus filly, her friends were probably still waiting in the lobby with Pinkie Pie. He'd promised them that their friend would be okay, and here he was, watching her heart tear itself open in slow motion. I won't let you die! The words flashed through his mind, and with them he clearly saw a blue pentagram trace itself over the filly's heart; his Cutie Mark.
Without thinking, he acted. Grabbing the enchanted suturing needle off the table, he didn't bother activating it as he drove it into the flesh of the filly's heart, which seemed to have stopped moving mere millimeters from tearing itself in half. Using the needle the old-fashioned way, he moved as fast as he could without causing more damage or compromising the sutures' integrity. Manually sewing the gigantic incision closed, he pulled the broken heart back together.
The moment he finished tying off the sutures, he nearly collapsed as the world came rushing back in; sights, sounds, and colors overwhelming his senses along with a sudden feeling of exhaustion.
"What the!?" His assistant's voice sounded far too loud in his suddenly sensitive ears, causing him to jump slightly. "Doctor Styles, are you alright? And what just happened!?" Her ears and voice dropped suddenly and she looked at the floor. "The patient... I thought she was going to... but then... What was that!?" Suddenly she was back in his face, seemingly not noticing his discomfort. "I thought I saw you move, but it was all over so fast..."
Wincing, Direct fought the urge to cover his ears and steadied himself. "I'm... not sure," he answered honestly, the clarity from only moments before now long gone. "It's all kind of a blur..." The screeching heart monitor brought him back to the moment, and he turned to Nurse Temperament. "The patient! We still need a pulse!"
"Oh, right!" Not quite satisfied with what she knew about what had just occurred, she nevertheless turned her attention back to the filly lying on the table. Quickly obtaining a new pair of sanitized gloves, she resumed her heart massage treatment while Direct tried to puzzle out his recent memories.
This time, the treatment went off without a hitch, the organ's erratic beating falling in rhythm with Nurse Temperament's kneading. Before long, the heart monitor chirped a happy tune in time with the filly's regularly-beating heart.
"Glad it worked this time," she remarked, disposing of her used gloves with a smile. "Ready to finish up this operation, doctor?" She turned to find Doctor Styles staring off into the distance, lost in thought. "Doctor?" She called, jolting him out of his reverie.
"Huh? Oh, yeah. Let's finish up here." He returned to the table sluggishly, his mind unfocused and his body somewhat unresponsive. Shaking his head so hard it made him dizzy helped to clear out the cobwebs, and he grabbed the Antibiotic Gel and the last bone fragment in his magic, unceremoniously placing the shard in its place with a generous heap of Gel to keep it there. "Are we done for real this time?" he deadpanned, feeling far too tired to keep going.
"Well," Nurse Temperament began guiltily, noticing her partner's weariness, "there's still the matter of four broken limbs, and possible wing damage, plus we still need to close up our entry incision..." She grinned sheepishly as the doctor's face fell, but an unexpected interjection drew her attention.
"Oh no you don't. Direct, you're way too tired to be operating." Doctor Duty strode up to the table with an air of authority. "Nurse Temperament, take Doctor Styles to the ward down the hall and put him in a bed to rest. The Techs and I can finish up in here."
"Civil," the pink nurse protested, "no offense, but you're an anesthesiologist, and this is a delicate orthopedic operation we're talking about here."
Growing impatient, Civil grabbed Direct in her magic, picking him up and depositing him on Nurse Temperament's back, a position he hastily scrambled to remove himself from. "That's why they're here," she said, gesturing to the EMTs behind her. Calming a bit, she added with a smirk and a wink: "Besides, I dated an Orthopedic Surgeon in med school. It'll be fine, trust me."
Nurse Temperament rolled her eyes but nevertheless accepted her friend's decision. "Come on, Doctor Styles, let's get you to bed." Gently laying a wing over the tired doctor's back, she led him out of the operating theater. Blushing a bit at the contact and his own sudden weakness, Direct stumbled along.
Slowly down the hall they went, stopping several doors down at the ward. Like the many other wards in the hospital, it was a long room with a number of beds spaced along the wall, with curtains and small bedside tables at each. Nurse Temperament led Doctor Styles over to the nearest bed, awkwardly helping him get in. Once he was settled, he looked back at her. "Thank you," he mumbled through a yawn.
She nodded and smiled, her cheeks turning a bit pinker. There was a long pause, then: "Y-you did good today, Doctor Styles. You saved her life."
Doctor Styles smiled back, but his brow furrowed. Something didn't sound right with that... Shaking his head, he corrected her. "We saved her life."
Nurse Temperament's smile grew wider and her blush a bit deeper. "We saved her," she agreed, then turned to leave.
Doctor Styles watched her go, again feeling like something was missing. He jolted up in bed as he remembered their conversation from earlier. "Nurse Temperament!" He called, wincing as he realized he'd shouted at a mare standing not ten feet from him. With her attention back on him, he shrunk back a bit, but pressed on. "I just- uh, well..." His train of thought derailed as soon as it left the station. He rubbed the back of his head with a hoof, his own blush turning his cheeks purple. "A-apology accepted," he finally said, "and, well, I'm, you know, sorry for how I acted, too." He met her eyes, now, "Do you think you can forgive me, Nurse Temperament?"
The nurse in question was a bit taken aback at first, but once she realized what he was saying, she beamed back at him. "Of course, Doctor Styles." Turning to go once more, she opened the door, but paused in the doorway. Looking back over her shoulder at the stallion lying in bed, she added with a small smile: "Oh, and by the way, my friends call me Angel."
Smiling back and blushing a bit more, he replied, "And mine call me Direct."
"Then, goodnight, Direct."
"Goodnight, Angel."