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Over the course of your first year working at Med, you'd gotten to know everyone really well. You were the youngest doctor there and everyone seemed to take you under their wing. Being the "baby" of the ER meant that they had a soft spot for you. You didn't know that doing your residency at Chicago Med meant that you would gain a whole set of big brothers and sisters, but you were endlessly glad that it did. You truly love all of your colleagues and they love you too. You'd trust them with anything.
But there's one thing you've never told them. You didn't want them to know and it didn't seem all that relevant. You had it on a necklace, just in case. You don't know if anyone has ever even noticed that you have the same chain around your neck every day, the pendant tucked into your scrubs. After today, you may wonder if it was right to have kept it hiding away all this time.
"Dr. Rhoades," April quickly stopped him, tablet in hand, "Do you know if room 13 is being kept NPO? There's no diet order in their chart and I can't find Dr. Y/LN."
"Um, I'm not sure," Connor paused as he pondered the question, "I think she's in the doctor's lounge, let me go check with her."
"Thank you!" April replied gratefully.
Connor absently made his way over to the lounge, deep in thought about a surgery scheduled for later in the afternoon. He opened the door and was immediately sucked back into reality by what he saw.
You were lying in the middle of the floor, face down in a pool of blood.
"Oh shit," Connor murmured before calling over his shoulder to the first person he spotted, "Halstead, get in here now!"
Connor didn't wait for his response and was instantly by your side, dropping to his knees next to you.
"Y/N?" Connor called, "Honey, can you hear me?" He felt for your pulse, relieved to find one, but faltered when he didn't see your chest moving. He carefully rolled you onto your back, minding your c-spine.
Will and April were running into the room.
"Oh my god!"
"What the hell happened?!"
"I just found her," Connor replied quickly, "Get me an ambu-bag, she's not breathing."
April ran back out of the room to retrieve one and get more help.
"Y/N?" Connor tried again, rubbing your sternum.
"Where is all this blood coming from?" Will inspected your face and opened your mouth. It was easy to tell that it was filled with blood.
"Airway's obstructed," Connor observed, " We gotta roll her."
Will nodded, sliding to kneel behind your head, holding it steady. "On my count," Will directed, "1, 2, 3."
They moved you onto your side and Connor didn't hesitate to sweep his finger in your mouth, clearing out some of the blood.
"Okay," Connor said.
"Back down," Will locked eyes with Connor to match their timing, "Go." They carefully returned you to your back.
Connor unlaced his stethoscope from his neck and slid it down your top of your scrubs. He paused to listen.
April returned with an ambu bag as well as Maggie who was rushing a gurney and a team of nurses into the room.
Connor shook his head. "She's still not breathing," he reported and gestured for April, "bag her."
As Connor withdrew his stethoscope, the pendant of you necklace was pulled out.
Will immediately noticed the red symbol on it.
"She's got a medical ID," Will said as he switched spots with April, who took over ventilating. He flipped over the pendant and read it:
Y/N Y/LN
EPILEPSY
CALL (354) 555-2729
"She has epilepsy," Will announced, looking to Rhoades who was checking your eyes with a penlight.
"Pupils are slow," Rhoades nodded, "Think she's post ictal?"
"Definitely could be," Will said expectantly. He handed the necklace to the nurse behind him and asked her to call the phone number listed.
"Alright, I need a c-collar," Connor directed the staff in the room, "Get ready to board her and someone page Abrams."
"We got you Y/N," Will reassured you just in case you could hear him.
The team quickly had you secured to the backboard and on the gurney.
"Straight to Baghdad," Maggie instructed. They rolled into the trauma bay and hit the brakes.
"Someone get me suction please," April demanded. Another nurse appeared next to her with the suction.
"Get me an intubation tray and let's get a line going," Connor announced.
"I got an 18 going in the left AC," a nurse replies.
"Head to toe assessment is unremarkable," Will states.
You hear commotion in the distance, but you remain far away, enjoying the darkness around you. The sound becomes louder, more irritating, as it draws nearer. The darkness begins to pull away slowly, like a sunrise.
You remain blissfully unaware of the many things being done to you. A blood pressure cuff is being wrapped on your arm, your scrubs are being cut away, cardiac leads are being stuck to your bare chest, and blood is being drawn from your arm.
The only thing you are aware of is the whirring noise above your face and the suffocating device that is occasionally forcing air into your lungs. You try to breathe against it, feeling like you're drowning under a vacuum seal.
"Dr. Rhoades, I'm getting a lot of resistance," April alerts him as she tries to continue to ventilate you. Connor holds your jaw, attempting to adjust your airway and the collar.
You feel your jaw being moved and weakly pull away.
Connor lets go of you and April pulls the mask away, both of them looking at you intently. They see your chest rising and falling.
"She's breathing independently," Connor says aloud, "Put her on a non-rebreather. Y/N? Can you hear me?" He tries, rubbing a knuckle on your sternum.
The insistent discomfort on your chest causes your eyelids to float open. You see blurs of bright colors swirling around you.
"Y/N, can you squeeze my hands?" Rhoades asks, placing two fingers in each of your palms.
You don't register the words he's speaking because you are suddenly aware of all of the things being done to you. The blood pressure cuff, the scissors, the sticker pads, your skin bare, the new mask over your face… The number of hands touching you far exceeds your comfort level. You have no idea where you are or what's going on. Everything in you tells you to escape.
You try to speak and manage a slurred sound, pushing Connor's hands away from you. Your arms feel weighted as you begin to pull at the wires attached to your chest.
"Y/N, It's okay," Connor tries.
You try to move more but your head is trapped, something hard is wrapped around your neck. You grab at the plastic with one hand and grasp at your IV with the other, crying out in panic.
Will moves in and grabs hold of your hands, stopping you from hurting yourself. You continue to weakly fight against him, starting to shift on the gurney and trying to sit up. Will looks at Connor and they silently agree that they won't be able to properly treat you like this.
"Get me two of Ativan!" Will commanded before putting himself into your line of vision. "Y/N, you're okay," he soothes.
Will's face becomes clear above you, breaking free from the swirls of color behind him. What is happening? Why are you practically naked? Why isn't he helping you? Why isn't he making them stop? You hold his gaze, silently begging for his help.
Will's heart breaks a little at the fear and confusion deeply set in your eyes.
"Can we get a blanket on her please?" He requested and one was quickly placed across your body. "I know you're scared sweetheart, but you're safe," Will reassured you, "We're gonna give you some Ativan to help you calm down, okay?"
You didn't understand his words, but tried to trust the calmness of his tone. All you could do is emit a pathetic whimper in response and absently continued to struggle.
"Two of Ativan going in," April stated.
You started to feel heavy and tired, but there was something pleasant about it. Maybe this was what Will was trying to tell you about.
"There you go," Will said quietly, placing your arms back down at your sides.
You become a passenger in your own body. You don't mind and watch the world happen around you. You noticed a throbbing pain on the side of your head.
"Y/N, can you tell me what year it is?"
You think Connor might be trying to talk to you so you try to pay attention but you're cut off by a horrible feeling rising in your throat. You realize you're about to choke, unable to move, and grab onto Connor's arm. He somehow understands.
"She's vomiting!" Connor directed them to roll you as he pulled your oxygen mask to the side.
April is right beside you with the suction, helping clear the fluid from your mouth. The metallic taste burns bright on your tongue. Everyone notes the dark red color flowing through the tubing, including you. Is that my blood?
"We need to find out where all this blood is coming from," Connor said, mostly to himself as they rolled you back down. "Y/N, I'm going to look in your mouth okay?" He warned you.
To his surprise, you willingly open your mouth.
"Following commands," Will noted, glad to see the improvement in your mental status.
Connor nodded optimistically as his penlight illuminated your mouth.
"Can I get a four by four?" Connor requested as he inspected the area. The gauze was passed to him and he slid it underneath your tongue. "Looks like you got a pretty good bite there, Y/N," he said apologetically, "bleeding's stopped though." He withdrew away and replaced the mask onto your face.
Something about the taste in your mouth felt familiar...
You felt it coming. You know this feeling. Oh god, this can't be happening. You can't have a seizure, not here. Your right arm fades away and you feel sick. You cut off the patient in front of you who is complaining about the wait.
"Um," you hesitate, "I'll go—I'll go check on that. 'Scuse me."
You barely managed to form your last couple of words as you hurried out of the patient's room and made a beeline for the lounge. By the time you get there, you feel completely lost. You had no plan to get help. You didn't even know where you were. What were you doing? What was happening? You think maybe you're about to fall so you decide to sit down, but suddenly you're already on the ground.
And then you're gone.
"Con-," You tried to find your voice, needing to tell him this new information. No one knows I have epilepsy, you think to yourself in a panic, I have to tell them. You slip the oxygen mask onto your cheek. "Connur?" you slur.
"Hey Y/N, I'm right here," He nodded, moving to put the mask back on. You shook your head microscopically and he paused.
"'Hadda seizurl," you exhale, your words blended but your message clear.
"Yeah? You remember feeling a seizure coming on?" Connor repeated back.
You nodded as much as you could, "Ep'lepsy."
"Your medical ID helped us out with that one," Will said with a small smile.
"Have you been taking your medication regularly?" Connor asks and you nod. "What do you take?" He asks.
"Tri—" you attempt but have to start over, "Trileptal."
"When was the last time you had a seizure?" Will chimes in.
"Med school," you reply.
"Well, Dr. Abrams is on his way down to take a look at you," Connor explained before looking to April "Let's do a head and neck CT-"
"Don't need it," You protested, "Just clear m' c-spine." You were used to people always overreacting when you would have seizures. Seizures were just a part of your life sometimes-you have epilepsy. You hate it when people treat you differently and that's probably why you hide it from everyone in the first place.
"Did you fall or hit your head?" Connor asked. Will starts to feel around your head for any injuries.
"No, 'm fine," you denied.
It's clear when Will touches an angry bruise, tucked just behind your hairline. You can't help but slam your eyes shut with gasp, trying to pull away from his touch.
"Yep, you're definitely going to CT," Will said conclusively.
You sighed in defeat, knowing full well that they were right.
"You guysr the wurst," you murmur as your bed slides into motion.
"We love you too, Y/N," Connor chuckled.
A/N: Let me know if you want me to continue. Time for the medical scoop!
"Do you know if room 13 is being kept NPO?"
Patients constantly ask if they can have something to eat/drink when they're in the ER. NPO is an abbreviation for the latin phrase "nothing by mouth" (AKA no eating or drinking) and we keep most patient NPO in the ER in case they end up needing surgery. Eating/drinking before surgery can cause aspiration (choking on your own vomit), hence why it's a no go.
"Y/N?" Connor called, "Honey, can you hear me ?" He felt for your pulse , relieved to find one, but faltered when he didn't see your chest moving .
When you have an unconscious patient, the first thing you do is check their level of responsiveness. Then you move on to what's called ABC's:
Airway: open their mouth—is there anything blocking it?
Breathing: feel for air and look at their chest—is it rising and falling?
and Circulation: check their pulse—is it there and is there any life-threatening bleeding?
These three components are always checked and treated first because if one of them isn't in working order… well, you won't have a patient anymore! You can see Connor does them a little out of order—there's actually been a shift in the medical community to CAB, where circulation is checked first. This is because you can survive a heck of a lot longer without air than without a pulse! The next thing they do after this paragraph is check your airway, clear it, and start ventilating you, so there you have it. ABC's are checked and treated accordingly.
He carefully rolled you onto your back, minding your c-spine.
C-spine is short for cervical spine, which are the bones in your neck. We take very special care to immobilize the neck when we suspect a head/neck injury because it is possible to worsen the injury if it moves. Anytime someone is found unconscious, we assume that there was trauma and take precautions to stabilize the c-spine. In this case, Connor finds you bleeding from your face, which makes him think a trauma has occurred. So why does Connor move you before immobilizing your head with a collar? The only time we move a suspected head/neck/back injury without immobilizing them first is if they are in immediate danger (ie. in the middle of a busy street) or if their ABC's are jeopardized. It's a matter of life over limb and in this case, the fact that you weren't breathing kind of trumps a spinal injury.
Get me an ambu-bag, she's not breathing.
An ambu-bag (also called a bag-valve mask or BVM) is a mask attached to a "bag" (that fat bottle shaped thing that they squeeze). We use it to ventilate the patient, forcing air into their lungs, like an artificial breath.
"Y/N?" Connor tried again, rubbing your sternum.
Why does Connor rub your sternum? This is called a "sternal rub" and it hurts (try rubbing your knuckle hard on your breastbone, you'll see)! There are different levels of consciousness we use this to help determine how unconscious someone is. If it takes a painful stimulus to rouse a patient, we would deem them "alert to painful stimuli." In this scenario, you can see that you are still unresponsive even to painful stimuli, so we'd just deem you "unconscious and unresponsive to painful stimuli." That is obviously not good. 10 out of 10 would not recommend.
Will nodded, sliding to kneel behind your head, holding it steady. "On my count," Will directed, "1, 2, 3."
Okay, so a couple of things happen right here. Will moves to hold your head or what we call "holding c-spine." To do this, you would kneel behind the patient's head and put one hand on each side of their head, sort of like covering their ears. That way, their head won't move, preventing any damage.
The other thing that happens here is how Will counts to roll you. But why Will specifically and not Connor? The person holding c-spine always directs the roll because they are stabilizing the most important (and arguably the most unstable) part of the body.
They moved you onto your side and Connor didn't hesitate to sweep his finger in your mouth, clearing out some of the blood.
Okay, so this maneuver is called a pinky sweep and it is frowned upon. When we do a pinky sweep, we risk pushing an obstruction further into the airway, we risk getting bit by the patient, and we risk making the patient gag and potentially aspirate (choke on their own vomit). I think in this case, Connor would do it. He's close with the patient (you're not going to sue him and it's not likely that you have transmittable diseases), there's no reason to believe that there is anything in your mouth other than blood (he's not going to push an obstruction farther in), and he had no other options to immediately clear your airway. Since it's a liquid, you would think that the blood would just come out on its own once you are on your side, but it starts to clump and clot when it's sitting in your mouth. The pinky sweep is a judgment call in this case, and I would do it if I were in that situation.
"She's still not breathing," he reported and gestured for April, "bag her."
Idk why we say this because it sounds so weird to me, but when you ventilate someone with the ambu-bag it becomes a verb: "to bag"
Checking your eyes with a penlight.
You probably see doctors checking their patients' pupils all the time. They check to see if the Pupils are Equal, Round, and Reactive to Light, or PERRL (pronounced pearl) for short. The size, shape, and activity of the pupils can serve as indicators of what is happening in the brain. For instance, opioids make the pupils very small, so a patient with pinpoint pupils may be experiencing an opioid overdose. Another common example is when the pupils are uneven, which might be a sign of increased pressure inside the skull.
"Think she's post ictal?" Rhoades asked.
So they've discovered that you have epilepsy. Epilepsy is a neurological disorder that causes someone to have seizures. Let's breakdown the phrase post-ictal. The term "post" means after and the word "ictal" is latin and refers to seizure activity. Hence, "post-ictal" is the period of time after a seizure. Your neurons are trying to recover from a crazy lightning storm, so patients are understandably pretty out of it. When people are post-ictal, they might be unconscious, aggressive, disoriented, unable to speak properly, etc.
"Alright, I need a c-collar and get ready to board her."
So back to c-spine precautions: a c-collar is the plastic/foam brace (usually blue and yellow in color) that we use to immobilize the head. When Connor says they are going "to board" the patient, he means immobilizing them on a backboard. They're very uncomfortable. 10/10 would NOT recommend being strapped to one.
"Someone get me suction please," April demanded.
We use suction for a few different things, but in this case April is asking for someone to suction the patient's mouth. You want to make sure the airway is nice and clear.
"I got an 18 going in the left AC," a nurse replies.
This nurse is referring to an IV catheter's needle size. An 18 gauge needle is one of the largest sizes, so it's good for getting meds/fluid/blood into the patient quicker. The "AC" is a vein (the antecubital vein) in the bend of your elbow. So basically this nurse is saying "I am putting a big-ass IV needle in her left arm."
"Head to toe assessment is unremarkable," Will states.
A head to toe assessment is exactly what it sounds like—after a trauma, you essentially pat down your patient, examining every part of their body with your hands. EMTs and paramedics are taught an acronym of all the things we should be looking for when we do a head to toe assessment (deformities, contusions, abrasions, penetrations, burns, tenderness, lacerations, swelling). So a translation of what Will said is "I have examined all of her body and I don't see any signs of trauma."
"Put her on a non-rebreather."
This is a type of oxygen mask that covers your mouth and nose. It delivers more oxygen than the kind that just has little tubes that go in your nose (called a nasal cannula).
"Dr. Rhoades, I'm getting a lot of resistance," April alerts him as she tries to continue to ventilate you. Connor holds your jaw, attempting to adjust your airway and the collar.
If you are trying to ventilate someone and their airway is blocked, you can feel resistance when you squeeze the bag. When someone is truly unconscious (not just sleeping), all of the muscles in the mouth/throat relax, causing them to sag into the airway and block it. It's noted that Dr. Rhoades is trying to adjust your jaw because sometimes if you can position the jaw forward, it lifts all that tissue out of the way.
"Can we get a blanket on her please?" He requested and one was quickly placed across your body.
Even though it is important to get a critical patient completely naked, especially if they're unconscious, we do try to preserve their dignity. If the important stages of the exam are complete and we don't need the patient to be exposed anymore, we try to cover up the patient as best as we can as soon as someone is available to grab a blanket. Covering your patient is also beneficial because it help prevent/treat shock.
"Get me two of Ativan!"
If you watch medical shows, you've heard of this for sure. Ativan (also called lorazepam) is a drug used mainly for sedation and seizures.
"Following commands," Will noted, glad to see the improvement in your mental status.
The ability to follow commands is another measure of the patient's level of consciousness.
"Can I get a four by four?"
A four by four (4x4) is a gauze pad that is 4inx4in, hence four by four.
You know this feeling. Oh god, this can't be happening. You can't have a seizure, not here. Your right arm fades away and you feel sick.
Some people have a warning before they have a seizure. This "warning" could be just about anything—a smell, numbness, tingling—and is called an "aura" (NOT the same thing as a spiritual aura about your energy having a certain color). Auras vary widely from person to person and some people don't have one at all. So if someone with epilepsy tells you that they are having an aura, tell them to lay the fuck down so they don't fall.
"Don't need it," You protested, "Just clear m' c-spine."
"Clearing c-spine" is when we can confirm there is no spinal injury and you don't have to stay in that awful brace anymore. We can clear it by examination in some cases, but the gold standard is by imaging (CT/x-ray).
"Yep, you're definitely going to CT," Will said conclusively.
If someone who is already diagnosed with epilepsy has a seizure that is typical for them (ie of a normal length and type), it's true that they don't need a CT scan. However, head trauma is an indication for a CT scan, especially if the patient is experiencing symptoms of slurred speech like in this fic.