Turned Upside Down - Grey's Anatomy

Chapter 8 - Großhadern

The doors to the ER opened and the entire busyness of the ER was presented to the team that brought in the young injured American woman. Patients were parked in beds in the hallway. It was one of those nights. Meredith exhaled loudly still pressing the gauze to the cut on her forehead. She directed them to the trauma CT room where a team was already waiting for them. They transferred the patient onto the CT bed and connected her to the ventilator. Everyone went quiet when Meredith started her report:

"Okay everyone, patient name is Alyssa Brown, 20. She got pushed off a bench and hit her head at the metal railing. Initially lost consciousness, regained it momentarily but wasn't coherent. Initial GCS was ten, before intubation it was seven. The right pupil is fixed and dilated. Left side closed skull fracture. We treated a seizure with pheno. She is currently on pheno and RSI regiment and fentanyl for pain. She had two to four Maß to drink but her friend couldn't remember how much exactly. Initial assessment showed no other obvious injuries," Meredith finished, "Where the hell is neurosurgery?" The trauma team started their own quick overall assessment before they started the scan.

"They're busy," a nurse told Meredith.

"They're busy?"

"Yes. They're sending a second-year down whenever he has the chance to leave the unit."

"Great. Let's just get the scan and see how bad it is," Meredith sighed and followed the team into the viewing room. Derek watched interestedly how they did their trauma protocol.

At Seattle Grace patients never went straight to CT, the first stop was always the trauma room in which they assessed their patient and decided on further steps. Another big difference was that they had much more treatment-relevant information since an emergency physician had been with the patient since the scene. He had watched how Meredith had heavily sedated the patient en route, had intubated her and treated her with medication before they even reached the hospital. That allowed them to bring the patient straight to CT to get a better understanding of her main injuries. At home he or one of his colleagues would have to order a scan after they had assessed the patient, hoping that a scanner would be available for the trauma case. Here they had a dedicated trauma CT which was staffed with a radiologist who could give the preliminary report right then and there.

Meredith stared at the screen waiting for the CT scan to come up, still pressing the blood-soaked gauze to her wound.

"Do you usually stay and wait for the scans?" Derek whispered in her ear.

"No. But it's not like I can go back out there, can I?" Meredith answered, looking at the CT scan that just came up on the screen.

"That's not good," Derek stated, looking at the same image.

"No, that is not good at all," she agreed with a deep sigh before telling the team that she was going to figure something out.

The trauma team transported the patient into a trauma room to be monitored until neurosurgery was able to look at her. Meredith followed with Derek right behind her. She went to the computer and logged herself in to see who could be available to operate on her patient. All on-call attending neurosurgeons were in the OR and had senior residents assisting them. One of them was nearing the end of their procedure.

"Let me think. We have three second years, two fourth years and Hannes. If we ..." Meredith thought out loud.

"She needs to be in an OR now or at least needs to get some burr holes," Derek blurted out.

"I'm aware. That's what I'm trying to figure out. If we can avoid, her getting burr holes and get her into surgery instead, I would prefer that, " Meredith told him picking up the phone to call the only available option. "Hannes, I need you to come to Shock room 2 ASAP. ... No nothing pediatric. And hurry." Meredith hung up and was already on the phone trying to reach the surgical floor. Lost in thoughts she opened a cupboard and took out some gauze, dressing, tape, saline and cotton pads.