Apartment 5Li Xiuying had showered and changed into her pj"s. She had, had a late lunch of steamed meat dumplings and some chicken soup. Then she decided to do something she hasn"t done since childhood; have a nap.
After her two hour nap, Li Xiuying was now laying on the sofa curled up like a lazy cat watching a doc.u.mentary about mayflies.
It wasn"t that Li Xiuying was particularly interested in doc.u.mentaries or insects; in fact after her crawling escapade she hated insects. She may have called on the powers of the caterpillar to drive her too success; but if she never felt an insect crawl on her skin again it would be too soon. Li Xiuying just found the voice of the broadcaster was particularly soothing.
TV: The life of a mayfly is the shortest on earth; only lasting for 24 hours.
Li Xiuying mumbled to herself. If I could only live for 24 hours what would I want to do?
While she was deep in thought her phone started ringing.
Li Xiuying: "h.e.l.lo"
Woman on the live: "Is this Dr. Li?"
Li Xiuying:"Yes speaking."
Woman: "Dr. Li, this is Dr. Yang Rong calling from the emergency department. We have a situation here at the hospital could you please come here as soon as possible? We"re desperate."
Li Xiuying: "What happened? How many patients?"
Dr. Yang Rong: "RTA, two males and a female in their 20"s. ETA 10 minutes."
Li Xiuying: "I"ll be there."
Li Xiuying grabbed a chocolate bar from the kitchen then darted to the bedroom for her ID in her briefcase. She ran to the foyer, put on her converses and pulled on her coat.
She headed down to the garage and to parking s.p.a.ce 5.
Li Xiuying stood for a moment to admire the thing of beauty that seemed to be in her a.s.signed parking s.p.a.ce. It was a sleek black Aston martin.
She snapped herself out of the loving moment and unlocked her car and slid into the front seat.
She patted the steering wheel.
Don"t worry; I"ll make time for you later.
...
Unity hospital - Emergency department
Dr. Yang Rong was panicking. The casualties were set to arrive in 1 minute 30 seconds, 1 minute 29 seconds, 1 minute...
Dr. Li where are you?!!!!!
Dr.Yang was told that the patients were members of the Xǔ family who owned the Orchid credit agency. The Xǔ family were being accompanied by Ren Longwei CEO of City bank and Ren Daiyu one of the best prosecutors in the country.
45 seconds... 44 seconds
Dr. Liiiiiiiiii where are youuuuu???!!!!!
Li Xiuying: "I"m here."
Dr. Yang Rong was so relieved she had tears in her eyes. She was only a first year resident. Her seniors had gone off somewhere and the consultant wasn"t here since her s.h.i.+ft started. She wasn"t equipped to deal with a RTA on her own.
Moments after Li Xiuying"s arrival the paramedics rushed in with three patients. Ren Longwei and Ren Daiyu were following behind.
Paramedic: "We have three causalities. Car A travelling at an estimated 100 mph crashed into car B, pa.s.senger side. The driver of car A was seen fleeing from the scene.
Xǔ Junjie 28 year old male was driving. He has suspected broken ribs, broken right arm and broken collar bone."
Xǔ Junjie "Look at them first! Luli! Enlai!"
Ren Longwei: "Junjie that"s Dr. Li, Luli and Enlai will be okay." Ren Longwei indicated towards Li Xiuying.
Xǔ Junjie quietened down and stared at Li Xiuying
It will be alright if it"s Dr. Li.
Paramedic: "Xǔ Luli 19 year old female front pa.s.senger seat, unconscious. She appears to have numerous fractures and lacerations.
Xǔ Enlai 18 year old male he was in the backseat driver"s side. He has a dislocated left arm and a broken right leg."
Li Xiuying: "Where are all the doctors here?"
She looked around and saw 6 first year residents, and three 3rd year residents. There were also nurses and healthcare a.s.sistants.
Li Xiuying: "One 3rd year resident with each of the patients, do an a.s.sessment and stabilize. I will then come and rea.s.sess. From left to right you are all A,B,C,D,E,F. A, B with Xǔ Junjie. C, D, with Xǔ Luli and E, F with Xǔ Enlai. One of you need"s to establish peripheral venous access, 2 cannula"s if possible I"ll need a set of bloods. Someone please get me a set of obs on all the patients, repeat every 5 minutes. All the patients need morphine."
Li Xiuying rushed over to Xǔ Luli.
Li Xiuying: "Get me a radiographer. I need an emergency X-ray of the chest and abdomen for Xǔ Luli. Someone go and book me three operating theaters. "
Li Xiuying "3rd year report on Xǔ Luli."
Xǔ Luli"s 3rd year: " I"ve inserted an airway. She has decreased respiratory rate of 7, no signs of..."
He was nervous and his palms were sweating.
Li Xiuying: "Stop talking; get me a chest drain now."
Li Xiuying grabbed a stethoscope and listened to Xǔ Luli"s chest. There were no breath sounds on the right hand side. She felt the patient neck and found that the windpipe was deviated. Li Xiuying checked the monitor"s; patient had increased breathing rate, high heart rate and low blood pressure. She listened to the Xǔ Luli"s heart; the heart sounds were quiet.
Li Xiuying turned to one of the nurses: "I need a 16 G intravenous cannula for emergency decompression."
The nurse immediately ran over to collect the equipment and handed it to Li Xiuying.
Li Xiuying completely tore off Xǔ Luli"s top inserted the needle into the second rib s.p.a.ce, mid-clavicular line. She connected a syringe and started removed the air. Li Xiuying listened to Xǔ Luli"s chest again.
Li Xiuying: "D Bring me the echocardiogram or an ultrasound machine. 3rd year get a Pericardiocentesis kit, a nasogastric tube kit and 6 ampules of Lidocaine 1%. Someone get 4 sets of sterile gloves size 6, sterile drapes and chlorhexidine solution."
A nurse came forward and pushed a trolley containing the items Li Xiuying had asked for. The 3rd year resident and D had also returned with the kit and echocardiogram machine.
Li Xiuying was grabbing items as she asked: "D, Xǔ Luli"s 3rd year. What is beck"s triad?"
D: "Hypotension, increased venous return and quiet or m.u.f.fled heart sounds."
Li Xiuying: "3rd year what am I worried about."
Xǔ Luli"s 3rd year: "Pericardial effusion."
Li Xiuying: "First the insertion of a chest drain for her tension pneumothorax, then I"ll drain the fluid around the heart."
Li Xiuying sterilized Xǔ Luli"s entire chest. She injected lidocaine around the 4th and 5th intercostal s.p.a.ce then used a scalpel to make an incision between the two ribs. She proceeded to insert the chest drain and secured it in place. She listened to the chest. Breath sounds improving. She removed the first needle she had inserted.
Li Xiuying then positioned Xǔ Luli"s bed at 45 degrees. She inserted a nasogastric tube.
She used the echocardiogram machine to confirm the presence of the effusion around the heart. She made a small scalpel incision approximately 8.5 cm from the sternum between the left 5th and 6th rib. Li Xiuying then inserted a needle connected to a 60 ml syringe containing 5 ml of saline; she maintained a 45 degree angle. Li Xiuying advanced for exactly 5 cm; fluid immediately started filling the syringe. When the needle filled, she stabilized the needle and replaced the syringe with an empty one. The 2nd syringe filled half way and stopped. Li Xiuying removed the needle.
The radiographer finally arrived and was shocked to see a chest drain in place.
Radiographer: "Dr. Li you are not meant to insert..."
Li Xiuying deadpanned: " Tension pneumothroax. If I waited for you, the patient would be dead now."
The radiographer shut his mouth and took an X-ray of Xǔ Luli"s chest and abdomen.
Li Xiuying sighed.
If I only had 24 hrs to live I would not be here.