Sepsis

Looking up, you catch the beginning of the oath in its big black font on the hallway wall. Designed to remind us why we are doctors and who we service, you wonder if it even applies to this situation because "as a member of the medical profession, I solemnly pledge to dedicate my life to the service of humanity" is unrealistic and disregards a doctors service to themselves.

But we all took it.

The oath where we swear that we will solemnly pledge to provide good care and protect our patients from harm but is that even really possible when you're in the fray of politics and poor management?

What good care and who are we really protecting? The hospital? Ourselves? Who comes first? Because it certainly isn't our patients, especially when you've found one-half dead in triage waiting for treatment.

"Go! Go!" you shout, running behind Jin and Irene as you push a patient in a wheelchair through the triage waiting room.

"Is she going to be okay?" her partner yells after you.

"We'll try our best," Irene shouts out. "Stay in here, we'll keep you updated Drew!"

He stands there watching his beloved dragged away.

But you don't have time to worry about him.

Your sneakers squeak against the floor as you all run down triage hallways to the only empty cubicle in the emergency department. Since Taehyung had been taken off duty, your team had been pulled apart, each member pulled into where ever they could help.

Had Irene not found this patient, you fear just how worse off she would've been when someone else down the line, did.

"I can't fucking believe it. She's clearly unwell," Jin drips in perspiration as he pushes the wheelchair down the hallway with most of his remaining energy. "Excuse my language, but she looks ...like she's on deaths row."

"Don't use the d-word around me," you stammer, running over to the empty bed. "What's her name?"

"Her name is Hana and she's a 28-year-old woman with an infected left prepatellar bursitis. She was admitted to Forest Lakes following a high fever, I don't know what happened Dr. Y/N, she was transferred here from the Children's Hospital by her partner but was left waiting in triage."

"And her partner fell asleep beside her, so he was bloody useless getting help. So, why was she at the children's hospital anyway?" Irene holds the IV fluids as you all run to the nearest empty cubicle. "Why did they not treat her?"

"More importantly, why and how long was she in triage waiting for treatment," you ask, looking at the green ribbon wrapped around her bicep. "Whoever triaged her, needs a slap."

"She might not have been when they first triaged her," Irene responds. "I have a feeling that they ignored her at Children's because her temps 39.8 degrees and they wouldn't have known what to do, they're good like that. That's no excuse for us though, her respiratory rate is 26/min. She's hypotensive and tachycardic. Have we got any blood culture results?"

"She was sent to the wrong hospital. They were told we were closed earlier this morning, so they kept her but weren't all that helpful in treating her," Jin pulls the breaks on the chair before wrapping an arm around her waist and under her knees and picking her up. You all move, allowing him to lay her on the bed. "I have no idea if they took anything, feel free to check the system yourself though. Surely, they're on her file."

Brushing the hair falling in front of your face behind your ear, you scoff. "Well, obviously Jin but who told them we were closed?"

"I'm assuming Yoongi did?" he responds, "Last I heard, they were going to close our hospital but no say of when."

Irene runs to the nearest computer, in search for any chemistry or cultures lodged onto the patient's file.

"Who told you that?" you pause, looking up at him.

Everyone stops to look up, all wondering the same. "Namjoon..."

"And where did Namjoon hear that?"

"No idea. Assuming ...Yoongi?"

"Guys, giving the patient some pain relief," another nurse interrupts, thankfully reminding us of the reason why we were all together. "Can we please just, treat her?"

"Fine."

"Hana," Jin says, fixing a blood pressure cuff to her arm. "You're at Seoul Hearts Hospital in the Emergency Department, we're going to take good care of you from now on okay?"

"Oh good," she whispers, beginning to shiver aggressively. "I don't feel so good."

You place the diaphragm of your stethoscope over her chest as the medical intern starts placing ECG electrode pads on her chest. "She's diaphoretic, breath sounds are clear and equal but tachy, she's septic."

"She's septic?" Irene announces, pausing before inserting another cannula in her arm. "I'm going to insert a central line instead Y/N, so we can monitor central venous pressure."

"Let's not do that here, we need to move her to ICU. Remove the other cannula and I'll insert a new line for fluid resuscitation on her left arm if you put one on her right. We don't want to give her a septic shower if the line is another source of infection, so remove all lines and start again," you shout, quickly tying a tourniquet around her bicep. "I don't trust people anymore. Especially if she's come from another hospital who ignored her."

Putting gloves on, you palpate for a good vein before cleaning her skin and inserting the needle catheter. Irene does the same.

Another nurse stands beside you, taping the line down as you withdraw the needle and activate its safety mechanism. "I need blood, urine and sputum cultures team," you announce, watching the nurse flush the line and then bolus fluids through it. "Good work team."

Jimin stands at the end of the bed. "Hey, how's her blood pressure?"

"It's 91/49 and temps now 40.1 degrees," Jin announces, "She's still hypotensive, a fluid bolus is running through now. We need to improve the perfusion and maintain mean arterial pressure, what do you think of a vasopressor Y/N?"

You push to the other side of the patient, shining your pupil torch in her eyes. "Good idea. I want a shot of norepinephrine and an IV antibiotic. Her pupils are equal and reactive to light until we know what grows from her blood cultures, we all need to treat this patient as though she has sepsis."

"Sepsis?"

"Yes, sepsis. She has an infection and all the symptoms. Gotta get it early before it's too late," Grabbing the mask off the wall, you place it on her nose and mouth before tying it around her head. "I'm putting her on oxygen, Hudson mask 2L for now. Monitor oxygen saturation levels. I want IV paracetamol hanging and I want ice packs in pillowcases behind her knees, on her abdomen and on her neck for 15-minute rotations on and off."

Irene nods. "Which antibiotic?"

"Y/N, we have results," The student announces, having waited for Irene to load the computer. "Blood cultures are still growing. Her cRP is elevated, liver function seems to be impaired. Lactate levels are incredibly high... white blood cell count is super high too-

"-tissue hypoxia?" Irene interrupts. "Holy cow, so it is sepsis?"

"Give her meropenem," Smiling at Irene, you nod, impressed. "Damn, you're good. I'm keeping you."

She smiles back at you. "Happy to be kept."

"Ah sepsis so early in the morning, ladies and gentleman. Welcome to the throwdown," Yoongi stands at the foot of the patient's bed with Sunny on his back. "Let's move her to ICU and prep her for theatre. Irene and Y/N return to your own trauma team, this is mine."

"Oh, how nice of you to finally join us Yoongi," Jin says, adding with a sigh. "It's not like we've been wondering where you have been all morning or anything and had to grab Dr. Y/N to help but whatever, you heard the man, let's move it."

They all move around you as you stare at the man.

"What?" he shrugs. "I had to make phone calls and Sunny wanted to know what I do."

"I don't care what you were doing. You and I need to have a talk," You frown, stepping forward and pulling a tired Sunny from his back. "You better not be closing this hospital."

He lets you peel her off him. "That has nothing to do with Hana."

"But it has everything to do with all the patients here and all the incoming patients who need our help," you grit your teeth as Sunny wraps her feet around your waist. "If you need help, you can ask me Yoongi. I can help you."

"I'm not about to let you dictate my workplace Y/N when you've just exposed your child to millions of potentially dangerous microbes by touching her after your septic patient,' Yoongi shouts as the air around you suddenly gets tense. "Stay out of it, just get some rest and then take Sunny home. You don't get to add your opinion when you don't even work here."

Jin pauses. "Don't talk to her like that Yoongi."

"Oh shut up Jin," he rolls his eyes, "You have no idea what you're talking about either. Focus on the patient."

"Closing this hospital, when you know it's the last one open is unethical and wrong Yoongi. We swore an oath to protect humanity and humility. If you close this hospital Yoongi, you will lose all my respect."

You drag Sunny away as he begins pushing the patient's bed towards ICU.

"I don't need your fucking respect," he simply responds. "It's not just my call Y/N, you'll never understand unless you've been put in the same situation as me. It's something that needs to happen to protect both us and our patients."

"And don't tell me how to parent Yoongi," you snap, pushing past him. "You do not have a say in that."

He rolls his eyes. "Then don't tell me how to do my job and I won't tell you how to do yours. We're closing the hospital, you have no sway in that decision. Go home."

You don't bother responding. You would never make that decision and no matter how idiotic Yoongi was being, you don't feel like anything you want to say right now is productive and professional.

Because you wouldn't close it. You would demand military aid for resources and keep those damn doors open.

You would help people.

You wouldn't lock them out.

"Come on Sunny, let's go find Uncle Jimin." She stirs in her sleep, snuggling her little face into your neck.

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