Lt Commander Foster - Medical Gambles

[Alora DeVeau]

OOC: I seriously think Jamie has us all fooled and is really a world famous surgeon writing under a pseudonym.  

IC:

((Main Sickbay – USS Narendra))

Why was it that every brain surgery came with a host of complications?  Wyn was sure that there were brain surgeons in Starfleet and the Federation who worked in nice, tidy, well stocked hospitals and only saw patients on a set schedule.  Wouldn’t that be nice?

And yet that was hardly ever true on a starship, especially for traumatic injuries and surgeries.  So much so that Wyn was starting to wonder if he could even function well in a nice, calm, proper hospital setting with a schedule and everything prepared.   

Foster: Good.  I need you to keep an eagle eye on the vitals, increase oxygen saturation as needed, increase life support if the heart rate tanks, and don’t worry if the lights get dim in here.

Maybe he was fed on raktajino, spite and high stress situations.  Or maybe it was making him old before his time.  Who knew?  It wasn’t something he was going to dwell on right now.

Harper: Yes sir.

Every tool was in place and he started to maneuver forward to make the primary incision that sliced through the skull.  No matter how small the tools got, the very act of punching through that dome that protected the most precious organ in the body was always a stressful moment.

Foster: you’ll see a blip, that’s the craniotomy.

Harper: Yes sir. 

He could hear her shuffle and settle herself in position as his antennae bent forward, fully absorbed in the delicate procedure of cutting and moving the tools forward into the cranial area.

Harper: How large of an incision?

Foster: As small as possible.  But the break is in a difficult to reach location.  I need to get the tools close enough to repair the artery and remove enough of the hemorrhage to take pressure off the brain.

Harper: Blood pressure holding.  .

Once the skull was open, the tools had to make their way to the damage.  This was done by navigation, making it quite like piloting a shuttle into the most fantastic region of all – a living body.  It would be nice if they could refine transporters enough to get the tools there without an incision, but the sterile fields that insure people didn’t beam down with insects or pollen inside their bodies also prevented transportation of other objects inside a body.

Wyn got quiet, navigating familiar pathways to get everything into place.  Part of him hated how much he felt comfortable working inside people’s heads the other part was glad he had the experience.

Foster: Alright, I found the break.  ::From his screen it looked like a massive oil spill of dark green blood.:: I need to drain some of the hematoma to get at the vessel.  Here’s where it gets tricky.

There was a delicate balance in this.  At the moment the internal bleeding had created an angry pocket of swelling that was affecting the brain tissue around it.  But, the swelling had also helped to pinch close the broken vessel, drastically slowing the bleeding.

That presented a terrible choice.  He could close off the vessel, starting the countdown to brain damage, but controlling the bleeding.  Or he could drain the hematoma, which would start the bleeding up again and likely cause a cascade-shock reaction.  He couldn’t operate as it was, the area was filled with blood making it not only difficult to see, but difficult to work cleanly.

Most surgeons would close the blood vessel and work keeping the body stable.  Wyn had tried that before.  Tried that with too many people who ended up changed after surgery, including one senior officer who had been his friend and after a difficult brain surgery where he had taken a similar option, arrogantly believing in his skill to be able to complete the procedure before brain damage set in, the man was irrevocable changed, and at one point stabbed Wyn in the back.

He would swallow his arrogance this time.  No counter.  He could repair a body.  He couldn’t repair brain damage.

As the pocket of blood start to drain the blood vessel pulsed back to life and the vitals responded almost immediately afterwards.

Harper: Blood pressure is dropping rapidly!  90/60!

Foster:  Administer a second dose of Konadine and prep full life support.

He was way too calm about this as he focused in the chaos on repairing the root of the matter. 

Harper: He’s going into cardiac arrest!

He knew.  That was the gamble.  He wished this didn’t happen with a cadet by his side.  A longtime nurse or fellow doctor, especially who knew Wyn’s personality would have likely reacted more calmly.  But Kherys was a sharp kid and this was a trial by fire that he had to believe she could handle.

Foster: I know.  ::Still too calm.:: Get a breathing mask on him and engage full cardiac support.  The computers gonna have to do the work for him for a minute.

Harper: ?

He trusted she was working everything correctly.  The brain still showed plenty of signs of activity despite the body fighting for life.  The patients head was locked down, making Wyn feel like a tiny ship in the eye of a great hurricane.  With one tool he was syphoning the blood away from the wound as it spilled into the surrounding tissue while with the other he slowly, carefully brought the break together and started to mend it.

Foster: You’re doing good, kid.  ::He offered with assurance.:: We’re almost there.

All he needed was the life support to carry this guy for a few more seconds, then the brain would be OK and they could work on the body.

Harper: ?

He could hear the rising panic in her voice.  Vulcan’s bodies were intrinsically connected with their brains.  And half Vulcans – which this guy was – had drastically unpredictable reactions.  His vitals were dropping, fighting, dropping.  Disheartening.

Wyn would love to say he wasn’t worried – he was.  He had lost plenty of patients in his time.  But he could watch the microscopic regeneration process complete, his focus away from the failing body.  Three breaths passed and the finally the blood vessel in the brain was whole.

Foster: Got it. ::He said with a note of victory, finally taking his focus up to check the vitals.  And for a moment he swore.  Harper had done a great job, but there was a mountain to climb yet.:: He’s hypovolemic.  Compounded by that blow he took on the leg.  We need to get blood in his system.

He hadn’t even worried about the leg injury yet – it was one of those minor ‘I got caught and crushed by a random piece of debris things that could be fixed in five minutes.’  Sometiems that laser focus on the root problem made him see only the trees and not the forest.

His dad chided him for that in life as well.  Crap.

Harper: ?

Foster: Keep him in life support, and get the computer to analyze and start replicating his blood type.  I have to get these tools out of his head and we’ll work on stabilizing his vitals and then patching that leg.

Harper: ?

Fortunately going out was generally much faster than going in.  There was a preset route to follow back.  He was careful to not bump, nick or touch any sensitive tissue, but he did start to move the process forward.

Foster: ::Calm.  The calm of someone who had done this too many times.:: You’re doing good kid.

Harper: ?

~*~
tags/tbc
~*~

Lt Commander Shar’Wyn Foster
Interim Chief Medical officer
StarBase 118 ops

"Why do we fly? Because we have dreamt of it for so long that we must"

~Julian Beck
E239010ST0

 

Edited September 19, 2020 by Alora DeVeau