Under pressure

UNDER PRESSURE 

Dr. Kim noticed. Of course she did. "You okay?"

"I just left my five-year-old son with a man I barely know."

"Damian Cole?" Dr. Kim raised an eyebrow. "His reputation is solid. Ruthless in business, but honorable. If he says he'll watch Jace, he'll watch Jace."

"That's supposed to make me feel better?"

"It should."

The ambulance screamed through the streets. I closed my eyes and tried to center myself.

Focus on the surgery. Focus on what I could control.

"Walk me through it… Everything," I said.

Dr. Kim pulled out her tablet, showing me the CT scans.

Large subdural hematoma on the right side. The blood was pushing his brain to the left, creating a significant midline shift. And the brainstem was compressed.

"Jesus," I breathed. His condition looked really bad. Really really bad. What really happened to him?

"GCS was six when they brought him in," Dr. Kim said. "They're intubating him now."

Glasgow Coma Scale of six. That meant he was barely responsive. Deep coma territory.

This kid was in really bad shape. There was no sugar coating the situation.

"How long ago was the accident?"

"About thirty-five minutes now."

Every minute counted. The longer the brain stayed compressed, the more damage occurred.

"And you're sure there's no other neurosurgeon available?"

"The on-call is at a conference in Chicago. Won't be back until tomorrow." Dr. Kim looked at me seriously. "It's you or nobody, Scarlet."

The weight of that settled on my shoulders like a physical thing.

I couldn't afford to fail this. A commissioner's son? Gosh! This was so much bigger than I thought. 

The ambulance pulled up to the emergency entrance. We jumped out and ran inside.

The ER was controlled chaos. Nurses rushing between rooms. Doctors shouting orders. Machines beeping incessantly.

A nurse saw us and pointed down the hallway. "OR Three. They're prepping him now."

We ran.

In the scrub room, I washed my hands while Dr. Kim briefed me on the latest vitals.

"BP is dropping even with pressure. Heart rate is tachycardic,” she sighed heavily. “His pupils are blown and fixed."

Blown and fixed pupils. That meant the increased pressure in his skull was causing his brain to herniate.

We were running out of time.

I finished scrubbing and backed into the OR, arms raised.

The nurses helped me into my sterile gown and gloves. I took a breath and approached the table.

Michael Chen lay there, intubated and motionless. He looked so young. Just a kid, really. Probably came home from college for Christmas break, went to a party, made one wrong turn on icy roads.

And now his life hangs in the balance.

"Let's save this boy," I said.

The surgery took six hours.

Six hours of intense, unwavering concentration.

I opened his skull carefully, using the craniotomy drill to create a bone flap. The dura underneath was tense and bulging from the pressure.

When I opened it, blood poured out.

"Suction," I said calmly.

Dr. Kim was already there, clearing my field of vision.

The subdural hematoma was massive. Blood had been pooling between his brain and skull, pushing everything out of place.

I worked carefully, evacuating the clot piece by piece. Too fast and I could damage healthy tissue. Too slow and he could die on the table.

Around me, the OR team worked in perfect synchronization. The anesthesiologist called out vitals. The scrub nurse anticipated my needs.

But I was also aware of something else.

The gallery above the OR had filled with people. Other surgeons wanting to watch. Hospital administrators. A few news cameras pressed against the glass.

Everyone wanted to see if the youngest Chief of Neurosurgery in the country was really as good as they said.

No pressure, Kim had said. But I couldn't help the way my hand shook as I navigated the boy's brain.

My job was on the line. This could be my breakthrough… or my downfall.

"ICP is coming down," the anesthesiologist announced. "Down to twenty-two."

Good. Normal intracranial pressure was under fifteen. We still had work to do, but we were moving in the right direction.

My mind kept drifting to Jace though.

Was he okay? Had he cried more after I left? Did Damian know how to comfort a scared five-year-old?

"Focus," Dr. Kim murmured, like she could read my thoughts.

I pushed everything else away. This boy deserved my full attention.

Finally, after what felt like an eternity, I removed the last of the hematoma. The brain tissue underneath looked pink and healthy.

"How's it looking?" Dr. Kim asked quietly. I could see I wasn't the only one who felt scared.

"Good. It's better than expected." She gave me a smile… telling me she trusted me.

I placed a drain to prevent reaccumulation of blood, then began the careful process of closing. Dura first. Then replacing the bone flap. Then closing the scalp in layers.

My shoulders screamed from hours of standing hunched over, but I kept going.

"Beautiful work, Dr. Scarlet. I knew you could do it. No one could have done this but you," Dr. Kim murmured as I placed the final stitches.

I stepped back from the table.

"He's stable," the anesthesiologist confirmed. "Vitals are good. Pupils are starting to react again."

Relief flooded through me. "Take him to the ICU. Neuro checks every fifteen minutes. Call me if anything changes."

The team moved Michael onto a gurney and wheeled him out.

I stood alone in the empty OR, suddenly exhausted beyond belief.

Dr. Kim put a hand on my shoulder. "You did it. You saved his life."

"We don't know that yet. The next forty-eight hours are critical."

"Always the pessimist,” she chuckled before leaving me to take care of myself.

I pulled off my gloves and gown, tossing them in the biohazard bin.

Through the OR windows, I could see the gallery was still full. People watching. Judging. Evaluating.

When I pushed through the doors, I was met with a wall of people.

At the front stood a man in an expensive suit, tears streaming down his face.

Commissioner Chen.

"Dr. Hayes," he said, voice breaking. "My son?"

"The surgery was successful. We evacuated the hematoma and relieved the pressure on his brain. His vitals are stable."

"He's going to live?"

"The next forty-eight hours are critical, but the signs are good."

Commissioner Chen grabbed my hands, not caring about protocol.

"You saved my boy's life. Thank you. God, thank you so much."

The reporters surged forward with cameras and questions.

My phone suddenly buzzed with a text. It was Damian. He had lodged a room for my son and I. The code to the door followed in his text.

I had to get back to Jace.

And I wished I had knew what was waiting for me at the other side of the hotel door.