Page 27 of Crossing the Line
"Captain Jennifer Walsh, thirty-two, trapped under debris for approximately fifteen minutes. Chest impact, possible rib fractures, erratic cardiac rhythm noted during transport."
Carmen's hands moved to the patient's chest, feeling for breath sounds while her eyes tracked the cardiac monitor. The rhythm was irregular, concerning but not immediately life-threatening. Beside her, Harper appeared with cardiac monitoring equipment, anticipating Carmen's needs without being asked.
"Heart rate fluctuating between ninety and one-twenty," Harper reported, deftly adjusting the monitor leads. "Oxygen saturation is improving with supplemental oxygen, but we're seeing frequent PVCs."
Carmen nodded, impressed despite herself. Harper was reading the cardiac patterns with accuracy under extreme pressure that went beyond basic training. "Probable cardiac contusion from the chest impact. We need an echo to assess wall motion."
"Already ordered," Harper said, her voice steady despite the controlled chaos around them. "ETA three minutes."
They worked in seamless coordination, Carmen handling the primary assessment while Harper managed cardiac monitoring and anticipated equipment needs. When the echocardiogram machine arrived, Harper had the transducer ready and the patient positioned optimally for imaging.
"There," Carmen said, pointing to the screen as she moved the probe across the patient's chest. "See the decreased wall motion in the anterior segment? Classic contusion pattern."
Harper leaned closer, studying the images with genuine fascination. "The irregular rhythm is secondary to the cardiac bruising. Should we consider anti-arrhythmic medication?"
"My thoughts exactly. What would you recommend?"
"Low-dose amiodarone to stabilize the rhythm without compromising cardiac output," Harper replied without hesitation. "Then we monitor closely for improvement over the next six hours."
Carmen found herself nodding in approval. Harper's assessment was not only correct but demonstrated understanding of the delicate balance required in cardiac trauma cases. "Agreed. Draw up twenty milligrams amiodarone, slow IV push."
As Harper prepared the medication, Carmen continued her examination. The firefighter's breathing had stabilized, and the cardiac rhythm was already showing signs of improvement. Around them, the trauma bay hummed with efficient activity—other medical teams handling the remaining casualties, nurses managing IV lines and medications, the controlled urgency of emergency medicine at its finest.
"Dr. Méndez," Dr. Hassan called from across the bay. "How's Captain Walsh?"
"Stable. Cardiac contusion is responding well to treatment. We'll need overnight monitoring, but the prognosis is good."
"Excellent. Can you assist with the civilian burn patient? There’s possible airway compromise."
Carmen glanced at Harper, who was meticulously documenting the firefighter's vital signs and medication response. "Can you handle Captain Walsh's continued monitoring?"
"Absolutely," Harper said, her confidence genuine rather than boastful. "I'll track cardiac rhythm and watch for any changes in her respiratory status."
Carmen moved to assist with the burn patient, but part of her attention remained on Harper's careful management of the firefighter. She watched as Harper adjusted oxygen flow based on saturation readings, noted changes in cardiac rhythm, and communicated updates to the nursing staff with clear, professional language.
Twenty minutes later, as the immediate crisis was resolved and patients were stabilized for transfer to appropriate units, Carmen returned to check on Captain Walsh. Harper had maintained perfect cardiac monitoring, documented every intervention, and established rapport with the conscious patient despite the traumatic circumstances.
"How is she?" Carmen asked, reviewing Harper's notes.
"Her cardiac rhythm has stabilized completely. Oxygen saturation is holding at ninety-eight percent. She's been asking about her team members."
Carmen looked at the cardiac monitor, seeing the steady, normal rhythm that indicated successful treatment. Harper's documentation was thorough and professional, noting every detail that would matter for continued care.
"Excellent work," Carmen said, meaning it completely. "Your cardiac assessment was spot-on."
"Thank you," Harper replied, but her attention remained focused on their patient rather than seeking praise. "Should we continue amiodarone monitoring through the night shift?"
"Yes. And I want hourly cardiac checks for the first six hours." Carmen paused, studying Harper's focused expression. "You handled that beautifully. Your understanding of cardiac trauma protocols is impressive."
A slight flush colored Harper's cheeks, but she maintained her professional demeanor. "I've been studying cardiac emergency medicine off-hours. It's fascinating how quickly the heart responds to appropriate intervention."
Carmen felt something shift in her chest, recognition mixing with respect in ways that made professional boundaries feel increasingly artificial. Harper hadn't just performed competently; she'd demonstrated natural instincts for cardiac surgery that couldn't be taught.
"Dr. Méndez?" Dr. Hassan approached with discharge paperwork. "Captain Walsh is ready for transfer to cardiac monitoring. Outstanding collaboration with your intern."
Carmen nodded, watching as Harper efficiently prepared their patient for transfer. Every movement was purposeful, every interaction professional. This wasn't the defensive young woman who'd challenged her on Monday. This was a surgeon who belonged in cardiac medicine.
As the trauma bay emptied and normal hospital routine resumed, Carmen watched Harper efficiently complete the patient transfer documentation. The professional emergency was over, but the personal complications had become exponentially more complex because now Carmen had seen Harper's genuine surgical abilities, her natural compatibility with cardiac medicine, and her mature approach to patient care.
