It started out simple enough. Kyra Manning, the third year general surgery resident on call, responded to the trauma alert and found the 38 year old male victim of a motor vehicle accident in no acute distress. The patient’s vitals were stable and all the X-rays were negative for any signs of fracture. Kyra was slightly disturbed by the evolving bruises across the patient’s belly that reflected the shape of the seatbelt, but the patient wasn’t complaining of any kind of pain.
After two and a half years of dealing with traumas, Kyra should have known that nothing was ever that simple.
Kyra had stepped outside the room for a few minutes to get information from the paramedics, when a nurse came over and tapped her on the shoulder rather urgently. “Dr. Manning, Mr. Gates’s blood pressure dropped to 85/30.”
It took a second for the information to register. “What’s his pulse?”
“One twenties,” the nurse replied.
“Fuck!” Kyra cried.
A minute later, the patient was being rushed to the OR. Kyra cursed to herself as she ran after the stretcher. This guy clearly had some kind of acute abdominal bleed, which should have been obvious from all the bruising on his belly. She was a third year resident and she couldn’t believe she had missed something as simple as that. That was intern stuff.
Outside the OR, Kyra tucked her long, blonde hair into a surgical cap and covered her delicate features with a mask. She felt her scrub pants slipping slightly on her slim waist and hastily tightened the drawstring. She knew this was going to be a bloody surgery, so she covered her pumps with blue disposable booties. At 5’10”, Kyra was still rarely the tallest person in an OR led by male surgeons, so she used the pumps to give her an extra two inches of height, no matter how much they hurt her feet during the six hour surgeries.
As Kyra quickly scrubbed in for the surgery, she felt an acute sense of aloneness. There were nurses helping her, as well as the anesthesiologist, but there were no other surgeons in sight. Dr. Potter was the attending on call tonight. Where the fuck was he? She was concerned she might need an extra pair of hands for this one.
The patient was having IV fluids infused rapidly when Kyra walked into the OR. Blood was being sent up from the bank and she was sure Mr. Gates was going to need it. “Where’s Dr. Potter?” Kyra asked.
“We paged him,” the nurse said, shrugging helplessly.
“Fuck!” Kyra yelled.
If Kyra had taken her own pulse, she wouldn’t have been surprised if it was beating faster than the patient’s. Adrenaline. As a surgeon, Kyra had always loved that rush of adrenaline, but now she felt terrified. This wasn’t the first time she had been in a situation like this all alone and it wouldn’t be the first time she’d lose a patient on the operating table. But every time it happened, she died a little bit inside. She couldn’t lose this patient.
“Dr. Manning?” The nurse was holding out the scalpel to her.
Kyra tried to smile confidently, but the muscles of her face betrayed her. She took a shaky breath before carving a vertical incision across the patient’s abdomen. She had no idea where the patient was bleeding from, so she had to expose the entire abdominal cavity.
As soon as she sliced through the linea alba, she saw how much blood she was facing. The patient’s abdominal contents were swimming in blood. Kyra called for suction, but the second the blood was suctioned away, a fresh wave took its place. Where the fuck was Dr. Potter?
“Pressure is 65 over palpable!” the nurse called out.
“Oh god,” Kyra whispered, sweating through her mask. A drop of sweat began to trickle down into her left eye, but she couldn’t wipe it away without breaking her sterile field. She blinked as the drop of saltwater burned her eye and blurred her vision. For a second, all she could see was red.
Kyra felt her hands trembling. She lifted them from the surgical field, trying to get herself composed. She looked up and saw a masked face at the door. When the door opened, she felt a sudden rush of relief. She recognized his light brown eyes right away, having seen them hundreds of times across an operating table.
“Need any help?” the masked figure inquired.
“Dr. Dergan!” one of the nurses exclaimed. “Aren’t you post-call today?”
Kyra could see by the creases under his eyes that he was smiling, despite the gravity of the situation. “You know I just can’t stay away from this place.”
Kyra didn’t even have to tell him about the patient—he already knew everything somehow. The nurses gowned and gloved him and a minute later, third year resident Joel Dergan was elbow-deep in Mr. Gates’s abdominal cavity. His hands didn’t shake; he didn’t hesitate for even half a second. “Clamp,” Joel said, holding out his right hand.
Kyra held her breath as Joel worked blindly. “Splenic rupture,” he murmured. “Damn, this is tricky.” The field was too bloody to see anything, so Joel kept his eyes on Kyra’s face as he worked. He winked at her. “I think I’ve got the bleeding vessel. Can we get some suction?”
Kyra watched in amazement as the blood disappeared from the surgical field. The other people in the room burst into enthusiastic applause. Kyra noticed one of the young scrub nurses was swooning a bit. “You saved the day, Dr. Dergan,” the nurse said, touching his arm.
Joel shrugged, which was his usual response. “Can you handle it from here, Kyra?” he asked her.
She nodded. “Yes, I’ll be okay. Thanks, Joel. That was… amazing.”
He blinked and she could see that he was blushing underneath his mask. Joel wouldn’t admit it, but she knew her praise meant more to him than saving this man’s life.
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As a medical student, Joel Dergan had mastered tying a surgical knot in a record two minutes. They were being taught by one of the surgery residents, who was plainly shocked when Joel was able to tie a perfect knot with one hand without any instruction whatsoever. From the very start, Joel had a knack for surgery that was more intrinsic than the blood flowing through his veins. He had matched for residency in the top surgical program in the country and was elected “resident of the year” twice in a row now. He intended to train in vascular surgery after he finished his residency.
Joel not only had the talent, but also had a love of surgery that was unmatched by any other resident in the program. He felt an adrenaline rush in his veins when he plunged his hands into a patient’s bloody abdomen, found the problem, and fixed it. There was tremendous satisfaction in that.
And moreover, he loved the way Kyra looked at him when he saved that man’s life.
Joel had been dating Kyra Manning for almost nine months now. Kyra was the only female in their year and all of the other residents had a huge crush on her. She was beautiful without trying to be: very tall, always with her golden blonde hair pulled back into a hasty ponytail, her blue eyes almond-shaped and without make-up, the hint of perfect breasts under her green scrubs. And she was smart too, although this wasn’t the first time Joel had bailed her out of a bad situation.
Joel had been attracted to Kyra immediately, but he had hesitated to ask her out. He told himself that he didn’t have time for dating, which was certainly true, but that wasn’t what held him back. Every resident in the program lusted after Kyra and he had seen her shoot down several of his buddies—there was no reason for him to suspect that she’d treat him any differently. He didn’t want her to see him as just another loser with a crush on her.
Ultimately, it was Kyra who made the first move. She came over to his apartment to borrow a book from him and he remembered feeling her breath on his neck as he stood in front of his bookcase. At 5’10”, Kyra was only an inch shorter than he was, and he was able to look directly into her eyes as he held the book out to her. She had ripped it out of his hands and kissed him instead. He was shocked, but he figured Kyra didn’t get as far as she did by being reserved.
For the first two months, their relationship consisted almost entirely of sex. Neither of them had much free time, so they jumped into bed together whenever there was a free second, even if it was in the hospital call room. Joel was in heaven, but he was quickly realizing that the more he learned about Kyra, the more he was beginning to fall for her.
“I’d like to take you out this Saturday night,” Joel said to her one night, when they were lying in bed together.
“I’m on call Saturday,” Kyra protested.
“Friday then,” Joel said.
Their relationship grew from there. In addition to the physical connection they already knew they had, Joel discovered that he had never felt like he could talk to a woman the way he could talk to Kyra. She was his other half. They complemented each other perfectly and Joel often joked they could go into practice together someday—Joel was the genius with the scalpel and Kyra with her superior bedside manner. “You lure in the patients, I’ll cut them open,” Joel joked. Of course, Kyra was an excellent surgeon too and Joel was reluctant to admit that most of his patients adored him. They both had the potential to be at the top of their field. Together.
About two weeks earlier, Joel had decided that he was going to ask Kyra to marry him.
It was just a vague plan in his mind, but it was the only thing he had been certain of in his entire life, aside from his decision to become a surgeon. He wanted to spend the rest of his life with Kyra. He hoped to god she felt the same way about him. She’d say yes. She had to. She loved him too.
Joel was still on a high from the excitement of saving Mr. Gates when he went downstairs to the residents lounge to get his coat. He caught a glimpse of himself on a small mirror hanging above a sink in the lounge and noticed he was still wearing his scrub cap. He yanked the cap from his head and ran his hand through his short brown hair in an effort to keep it from sticking straight up. He took a closer look at himself and saw that his eyes were a little bloodshot. He looked exhausted.
The clock in the lounge read nine o’clock. According to the rules, residents weren’t allowed to work for more than thirty hours in a row. Joel had been on call last night so that would make this his fortieth hour in a row awake and on service. He was pretty tired, but Joel had never needed much sleep and he knew that in the old days surgical residents used to do forty hours in a row all the time. The new surgical residents got babied—they were soft.
More than once, Joel had been yelled at by the chief resident for the hours he kept, so he tried to abide by the rules but something always came up. Like today he was asked to first assist on a Whipple procedure and he couldn’t say no to that. By the time that surgery ended, it was after seven in the evening. Then he heard the trauma being announced over the intercom and he decided to check on Kyra to see how she was making out. Good thing he did.
Joel noticed a book of board questions lying on the couch in the lounge and sat down to flip through it. He had always been a good test-taker and found that surgery exams were no exception. He started doing some of the questions and before he knew it, Kyra came into the lounge.
“For fuck’s sake, Joel, what are you doing here?” Kyra exclaimed.
Joel smiled up at Kyra—he loved that she was the most foul-mouthed resident in the program. He held up the book. “Questions.”
“You’re post-call,” she pointed out. “You’re supposed to leave the hospital by one in the afternoon. It’s almost ten now!”
Joel checked his watch, even though he knew very well what time it was. “I’m not working. I’m just hanging out.”
Kyra sighed and sat down next to him. Even though it was late and she had been here since 4:30AM, Kyra still looked fantastic. Joel couldn’t suppress a smile when she rested her head on his shoulder. What would she say if…
If I asked her to marry me right now?
The thought passed through Joel’s head, but he quickly dismissed it. If he was going to ask, he had to do it right, with a ring and everything. She deserved a really romantic proposal. You don’t ask a girl like Kyra to marry you when you’re half asleep in the resident’s lounge.
“You know…” Kyra said, her hand gently tugging at the belt holding his scrub bottoms up. “We never did it in the lounge before…”
“I’ve always been regretful of that,” Joel replied earnestly.
“Why have regrets?” Kyra said, gazing up at him with her big blue eyes.
Her lips met his and his heart pounded the way it did when he was holding the scalpel. No woman had ever driven him crazy the way Kyra did.
The kiss was broken by the sound of Kyra’s pager going off. She checked it and cursed. “Sorry, Joel. Gotta go.”
Kyra was out the door before Joel even had a chance to say goodbye. He sighed and struggled to his feet. He supposed he ought to go home and get some sleep if he had to wake up at 4AM the next morning (his usual wake-up time).
Joel lived a twenty minute drive from the hospital. He would have preferred to live closer, but the area around the hospital was affluent and Joel couldn’t afford the rent. He also couldn’t afford a decent car, which was why he drove an old Ford that he had inherited from his dad. The car needed a major overhaul, but Joel couldn’t afford it right now, considering he was deep in debt from college and med school, and now he was saving up to buy Kyra a ring.
The roads were wet from a rain earlier that day. Joel was having trouble seeing and rubbed the windshield to clear his view—until he realized that his eyes were blurry, not the windshield. Shit, I’m tired, he realized.
Joel’s “bed” consisted of a mattress lying on the floor, but he longed for it right now. As much fun as it would have been to fool around with Kyra, he really needed to get to sleep right now. He thought of how nice it would be to crawl between the covers, rest his head against that soft pillow…
Joel didn’t realize he was drifting off until he saw he was headed straight for the road divider. He felt that familiar adrenaline rush and spun the steering wheel, hoping to avoid a collision. He heard the old tires squeal, but the slickness of the rain kept him from getting any traction. Joel felt the world moving in slow-motion as his car slammed full speed into the concrete divider.
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Joel wasn’t sure how long he had lost consciousness for, but when he woke up, he was lying on the wet cement ground and there was a crowd of people surrounding him. His head hurt worse than any headache he had ever had. He tried to open his mouth to speak, but he only coughed up blood.
“Hey, buddy, you okay?” one guy said, shaking his shoulder.
The details of the crash came back to him and he felt very dizzy all of a sudden. He had been going very fast when he hit that divider. I’m still alive though, he told himself. I survived. The worst is over. Of course, he knew from all the traumas he had seen that this was far from accurate. The pain in his head was worrisome and the fact that he was conscious didn’t rule out an intracranial bleed.
“Can you get up?” the guy asked him.
“Don’t move me,” Joel managed to say. He didn’t want to exacerbate any injuries he had before the paramedics got here. He could hear the sirens in the distance. “Got to keep my C-spine immobilized.”
Joel saw a flash of dark red in his vision and realized that blood was leaking into his eyes. He lifted his hand to wipe it away.
“What are you—some kind of doctor?” that same guy was asking him.
“I’m a surgeon,” Joel replied, but as he said the words, he realized that those days were probably over for him. He felt very nauseated all of a sudden, but he didn’t want to move his neck to throw up. He was seized by the sudden wish that he’d aspirate his vomit, choke, and die.
The ambulance parked a few yards away from him. As the paramedics unloaded the stretcher, Joel recognized Ron, one of the EMTs. He knew they were going to bring him right back to the hospital he had just come from.
“Holy shit! Dr. Dergan?” Ron’s bushy eyebrows furrowed, clutching the cervical collar. He hesitated before placing it around Joel’s neck.
“Put the damn thing on,” Joel said. “I’ve got a spinal cord injury, probably around C7 or C8.”
“How do you know?” Ron asked.
He didn’t answer. He couldn’t speak the words out loud. To say it would mean that it was true and it couldn’t be true. Because if it was true, his career was over:
Joel couldn’t move his hands.