Whispers in the Fog

The radio crackled at 2:14 am, reporting a four-car pileup on the seven-eight overpass. Six patients were inbound, two critical, and the first ambulance was eight minutes out.

Imogen pulled on her gloves while the dispatcher finished relaying the details, and her stomach dropped as she ran through the injuries that came with that kind of impact. Chest trauma, internal bleeding, head injuries, crushed limbs. Eight minutes gave them enough time to clear bays and get blood ready.

“Get these bays cleared out.” Imogen yelled as she pointed across the nurses’ station, and two of the other doctors moved toward the open rooms. “I’ll take the first critical. Page Nathan and get trauma blood in critical bays.” She checked the clock over the desk, then headed toward the ambulance entrance.

Red light swept across the pavement outside at 2:21, followed by another flash farther down the drive. Imogen watched the first ambulance turn toward the doors and took a deep breath.

The doors opened as the first stretcher came through fast with a paramedic at the rail. “Forty-two-year-old male, restrained driver, T-boned on the passenger side. GCS eleven on scene, nine during transport. Maintaining his airway. Pressure sixty over palp and dropping.” He kept pace beside the gurney while the second paramedic held an oxygen mask over the man’s face.

Imogen grabbed the opposite rail and moved with them. Blood had soaked through the man’s hair at his left temple, his skin was gray around his mouth, and each breath lifted the right side of his chest higher than the left. She reached for his wrist, and found a weak pulse.

“Wallet identified him as Michael Hollaway.” The second paramedic worked the tubing free as they entered the trauma bay. “His ten-year-old daughter was in the back seat. She was conscious on scene, vitals stable, and went out in the second ambulance. We haven’t reached their family yet.” He helped shift Michael across to the hospital bed while the nurses moved in around them.

“Michael, I’m Dr. Baker, and you’re at the hospital.” Imogen rested her hand against his shoulder as the team settled him onto the mattress. “We’re taking care of you.” His eyelids remained closed, and she watched the shallow movement of his chest while the nurses cut away his shirt.

She listened to both sides of Michael’s chest, then checked his pupils, glancing at the monitor. Air moved clearly on the right, but barely registered on the left. The pressure reading came up at sixty-four over thirty-two, his pulse remained weak beneath her fingers, and the gray around his mouth had deepened since he came through the doors.

“Bring me the ultrasound and start trauma blood.” Imogen moved back to Michael’s left side while the nurse connected the first unit. “Activate massive transfusion and page Nathan again. Tell him I need him down here, now!” She took the ultrasound probe and pressed it against Michael’s chest as another pressure cycled on the monitor.

The E-FAST showed a large collection of blood around his left lung. Imogen continued through the rest of the exam, checking his abdomen and the space around his heart, then returned the probe to the left side of his chest. The amount of blood around the lung, the weak movement on that side, and his falling pressure confirmed the hemothorax and he needed the chest tube now.

“Chest tube kit. Open it here.” Imogen set the probe aside and reached for fresh gloves while the nurse opened the kit beside her. “Keep the blood running, page trauma surgery now, and get a portable chest X-ray ready for after the tube is in.” She positioned herself and counted the ribs beneath her fingertips.

Nathan came through the trauma bay doors with his coat hanging from one shoulder as Imogen cleaned the insertion site. His eyes moved from Michael to the monitor, then to the blood already running through the IV as he pulled his coat free and reached for gloves.

“Large left hemothorax, pressure sixty-four over thirty-two, and massive transfusion is running.” Imogen briefed him as she reached for the instruments. “I’m putting the tube in. I need you on his heart.”

“Got it.” Nathan took the ultrasound probe and moved to Michael’s right side while Imogen made the incision. He found a cardiac view and studied it through several beats, then shifted the probe to get another angle. “Pericardial space is clear. His ventricles are underfilled, and they’re contracting hard. He’s lost a hell of a lot of volume.”

Imogen worked the tube through the chest wall, and blood drained rapidly through it into the collection chamber. The resident tracked the output while the transfusion continued. Close to a liter collected within the first few minutes as Michael’s left chest began to rise more fully.

“Pressure’s climbing. Ninety over fifty.” Nathan kept the probe against Michael’s chest through the next cycle, watching his heart fill with the blood going in. “His filling’s improving. Keep the transfusion running.”

Imogen secured the chest tube and checked the movement of Michael’s left chest again. His next breath lifted more evenly beneath her hand, and some of the tension in her shoulders eased as the pressure held through another cycle.

“Portable chest X-ray is ready.” The nurse moved the machine into position while Imogen cleared enough space around Michael for the image. Nathan stayed beside the monitor and kept one hand near the ultrasound as the tech positioned the plate.

The X-ray confirmed the large left hemothorax and showed the chest tube in place. Imogen looked from the image to the blood continuing to collect in the chamber, and the amount coming out kept her attention fixed on Michael’s pressure.

“Update trauma surgery. Tell them he’s close to a liter out already and he’s still bleeding.” Nathan checked Michael’s pressure again and looked at the blood collecting through the chest tube. “He’s responding to the transfusion, but we’re still losing volume.”

Michael’s eyelids moved as she reached for the dressing. They opened slowly, and his gaze traveled across the ceiling before stopping on her face. Fear came into his eyes the moment he registered the lights, the people around him, and the equipment attached to his body.

“Sophie.” Michael swallowed, and his fingers dragged across the sheet beneath his hand. “Where’s Sophie?” His voice barely carried over the monitors, and his eyes moved quickly across the room before returning to Imogen.

Imogen kept one hand against his shoulder to hold him still. “Sophie made it to the hospital. She was awake when they brought her in, and she’s being taken care of.” She leaned closer so he could hear her clearly. “Stay with me and keep your eyes here.”

“My daughter.” Michael tried to raise his head, and Nathan steadied his shoulder against the mattress. “Sophie’s my daughter. She’s ten.” His fingers closed around the sheet, his breathing growing labored.

“She’s here, Michael, and she’s alive.” He relaxed a little, and she watched the next pressure cycle come up on the monitor.. “Right now I need you here with me while we take care of you.” Imogen reached for the dressing and secured the tubing while Michael’s chest continued rising beneath her hand.

“Imogen.” Nathan’s attention moved from Michael’s pressure to the collection chamber as the blood continued climbing inside it. He reached for the ultrasound probe and brought it back to Michael’s chest while Imogen checked the tube.

“We’re at fourteen hundred and still climbing.” The resident kept his eyes on the markings along the collection chamber as another pressure cycled on the monitor.

Nathan moved through the cardiac views and watched several beats. “His filling’s dropped again. Pericardial space is still clear.” He looked toward the blood continuing through the chest tube. “He’s bleeding out.”

“Update trauma surgery. Tell them his pressure’s crashing and we’re moving now.” Imogen checked Michael’s pulse while the nurse reached for the phone. The improvement they had gained minutes earlier was disappearing, and his fingers had gone slack against the sheet after gripping it while he asked about Sophie.

“Seventy over thirty.” The nurse tightened the cuff and watched the next reading cycle through. Her hand moved toward the medication cart as the alarm changed pitch. “Fifty over ten.”

“We’re losing his pulse.” Nathan pressed two fingers against Michael’s carotid artery while his eyes stayed on the monitor. A few seconds passed before his hand came away. “I’ve got nothing.”

“Start compressions and keep the massive transfusion running.” Imogen moved closer to Michael as the resident began CPR. “Where’s trauma surgery?”

“Coming in now.” The nurse stepped aside as the trauma surgeon and the rest of the team came through the doors.

Nathan grabbed the ultrasound probe during the first pause in compressions and found the cardiac view. “There’s still cardiac activity. Pericardial space is clear.” He looked across the bed toward the trauma surgeon. “This is hemorrhagic arrest.”

The trauma surgeon called for the resuscitative thoracotomy tray while another unit of blood ran through the rapid infuser. Imogen stayed with Michael through the resuscitation as the room filled around the bed again. Minutes earlier his eyes had been open and fixed on hers while she told him Sophie was alive, and now every number on the monitor continued moving in the wrong direction.

The trauma surgeon performed the emergency procedure while the team continued replacing blood and checking for any return of circulation. Nathan stayed on Michael’s rhythm and cardiac status while Imogen followed each change from the head of the bed.

Michael’s heart failed to regain effective activity. Imogen checked his carotid pulse during the final assessment, her fingers remaining against his neck for several seconds as she watched the monitor.

Nothing.

She looked at the clock.

“Time of death, 2:59 am.” Imogen lowered her hand from his neck to the mattress and kept it there for a moment.

The nurses silenced the monitors while the team began disconnecting equipment. Imogen moved to the foot of the bed looking at Michael.

A heavy sadness bloomed through her chest, making her put her hand to it, subtle enough that no one noticed, and swallowed the lump in her throat. She didn’t have time for emotions, because she had to go break the hearts of his family by telling them she couldn’t save him.

Nathan stripped off his gloves and dropped them into the waste bin. Staying beside the bed while Imogen walked back over and pulled the sheet higher over Michael’s chest. Neither of them moved toward the door until the nurses had finished clearing the immediate equipment.

Imogen walked out of the trauma bay with her arms hanging loose at her sides and her eyes fixed on the replay of that room. People crossed in front of her, phones rang, carts rolled through the corridor, and she stopped outside the room. She stared down at nothing while the last half hour continued moving through her in pieces she had no energy to sort through.

A nurse found Imogen as the room cleared. “His daughter’s in bay three. Mostly bruising and a cut over her eyebrow, but she’s okay.” The nurse shifted the chart against her chest and glanced toward the triage corridor. “She’s been asking for her dad. Her mom’s on the way.”

Imogen nodded, her fingers tightened around the chart as the nurse handed it to her. She checked on two other patients while they waited, reviewed a set of labs with a resident, and returned to the nurses’ station each time the ambulance doors opened.

A woman came through with her coat buttoned, one hole skipped entirely, and her purse swinging rapidly against her hip, her eyes moved across the nurses’ station until they found Imogen, and she rushed to her.

“Where’s my husband?” She crossed toward her and tightened both hands around the strap of her purse. “Michael Hollaway. They told me he was brought here.” Her eyes moved past Imogen toward the trauma bays.

Michael’s voice came back with Sophie’s name, and Imogen nearly threw up. “Come with me, Mrs. Hollaway. We can talk in here.” She guided her toward the family room and closed the door behind them.

“Please tell me what happened.” She gripped the back of a chair and searched Imogen’s face.

Imogen stayed near the door and met her eyes. “I'm so sorry, Mrs. Holloway. Michael passed away from his injuries.” This was the one part she hated most about her job. This one though, hit too close to home for her. “We treated Michael as soon as he arrived, and we kept working on him when his heart stopped.”

Her knees bent and she caught the chair with both hands as she lowered herself into it. A hoarse cry broke from her throat, and she covered her mouth, doubling over.

Imogen pulled the second chair closer and sat beside her. Michael’s face stayed with her while his wife cried. Her own eyes burned, and she wiped the tears away with her fingers.

“Where’s my daughter?” The woman lowered her hands after a minute and wiped both cheeks. She pushed herself upright and caught the back of the chair when her legs shook beneath her.

“She’s in triage three. I’ll take you to her.”

They walked through the corridor and stopped outside triage three, and stared through the window next to the door. Her hand rose to her mouth as she looked at Sophie sitting inside.

“I’ll stay right here.” Imogen opened the door and stepped aside while Mrs. Holloway crossed the room toward her daughter.

Sophie lay in the hospital bed, eyes wide when her mom walked in. She was wearing sneakers with pink laces and a sweatshirt that covered part of her hands. A small bandage covered the cut above her eyebrow, and bruising had begun to darken along the side of her face. Sophie watched her mother’s face while she spoke, her fingers slowly closing around the blanket as she explained what happened.

Imogen gripped the edge of the window as the fluorescent lights above Sophie pulled her back to another hospital. Suddenly, she was back in that vinyl chair sticking to the backs of her legs, the white tile beneath the ruby slippers she’d been obsessed with, and Aunt Marge’s hand resting on her shoulder.

She turned toward the staff corridor and walked to the on-call room. Her hands began trembling after the door closed behind her, and she sat on the edge of the bunk bed with the hem of her scrub top twisted between her fingers.

Imogen bent forward and covered her face with both hands. Her shoulders shook as tears filled her palms, gasping for a breath that she knew wouldn’t soothe anything in her anytime soon.

Nathan opened the door and crossed the room, sitting down beside her. He pulled her into his arms and rubbed her back as she cried harder.

“I couldn’t save him.”

Nathan moved his hand to her shoulder and turned toward her. “You gave him every chance we had.” His eyes searched hers while she wiped another tear from her cheek.

Imogen looked down at her hands, her fingers still trembling against her thighs. “She’s only ten years old.”

“I know.” Nathan leaned back enough to see her face fully, tucking a couple of stray hairs that had fallen out. “Go home and get some rest.” Nathan pulled her back in and rested his chin on the crown of her head. “I’ve got the floor and because I like you enough, I’ll even do most of the charting.”

“You still owe me from last week anyway.”She rested her head against his chest, laughing as the heart ache bled through again. “I’m really glad you were here, Nate.”

Nathan rubbed her back, hugging her tighter. "Yeah, me too."

She had met Nathan with Arya in med school, and somewhere between impossible exams, overnight rotations, and the years that followed, the three of them had become family. Nathan had been there through everything with Aunt Marge, including the years Imogen spent fighting to get away from her. Having him beside her now, when holding herself together had become this difficult, mattered more than she knew how to tell him.

After a few minutes, they stood as Nathan’s pager beeped. “Duty calls. Text me later okay?” Nathan waited for her nod then walked out the door.

She went to the sink and patted her face with a cool, wet paper towel then returned to the workstation. Documented everything from her side of the situation as fighting back tears. When everything was entered, she signed the chart, and headed to the locker room.

Imogen grabbed her things and left through the employee entrance as the sky began turning gray above the buildings. Cold morning air hit her damp cheeks, and she pulled her coat tighter while she headed home.