He didn’t look at graves. He looked at the chart at the end of the bed. Right, Sterling said, checking his gold watch. Mr. Graves, septic shock markers are rising. White count is through the roof. The necrotic tissue in the right thigh is extensive. He snapped the chart shut and looked at Graves for the first time.
We’re scheduling you for surgery at 1,400 hours. We’re going to amputate at the mid thigh. The room went cold. Excuse me, Graves said his voice low and dangerous. It’s the only viable option, Sterling said breezily, already turning to leave. The infection is deep. Attempting to salvage the limb would require aggressive debridement skin grafts and months of hyperbaric therapy with a low success rate.
Amputation is clean, it’s quick, and it gets you out of this bed in 3 weeks. I am not losing my leg. Graves growled. I came in here for treatment, not butchery. Sterling sighed the sigh of a man dealing with an unruly toddler. Mr. Graves, this is a va subsidized bed. We have protocols. We don’t waste resources on lost causes.
Your leg is dead. If we don’t cut it off, you die. Sign the consent form or we discharge you against medical advice. Sterling nodded to a resident to hand over the clipboard and turned to walk out. Dr. Sterling. The voice came from the corner. It was Sarah. She had been changing the IV bag silent until now. Sterling stopped and looked at her over his glasses.
Nurse Mitchell. Is it? Do you have something to add? Sarah stepped forward. She wasn’t standing like a nurse anymore. She was standing with her feet apart, hands loose at her sides, a combat stance. “The patient has palpable pedal pulses,” Sarah said clearly. “I checked them 10 minutes ago.
He has sensation in the toes. The necrosis is limited to the fascia latter. It hasn’t penetrated the muscle belly yet.” Sterling scoffed. And you know this how did you run an MRI with your X-ray vision? I know it because I probed the wound last night when I changed the dressing. Sarah said the infection is tracking along the scar tissue from his 2004 shrapnel injury.
It’s a pocket doctor, not systemic gang green. If you perform a facotomy and install a wound vac, you can save the leg. Amputation is lazy medicine. The room went dead silent. The residents looked between the chief of surgery and the nurse, eyes wide with horror. Nurses did not speak to chiefs of surgery that way. Not ever.
Sterling’s face turned a shade of red that matched the colonel’s infection. “Lazy,” Sterling whispered. “You are a nurse. Your job is to change bed pans and follow orders. You do not diagnose. You do not suggest surgical procedures. And you certainly do not contradict me in front of my team.
He turned to the charge nurse, Brenda, who was hovering in the doorway. Brenda, get this woman out of my sight. I want her written up for insubordination, and I want her off this floor permanently. No. Graves boomed. Graves tried to sit up, fighting the dizziness. She stays. If she goes, I go. And if I go, I’m going straight to the press.
I’m going to tell them that saint Judes prefers to chop up veterans rather than treat them because it’s cheaper. Sterling narrowed his eyes. You’re bluffing. You’re septic. You wouldn’t make it to the parking lot. Try me. Graves snarled. Sterling looked at Graves, then at Sarah. He saw the defiance in both of them.
He was a bureaucrat, and bureaucrats fear one thing above all, bad PR. Fine, Sterling, said his voice icy. You want to play Dr. Nurse Mitchell? We’ll do the fasciottomy, but I’m not doing it. I won’t waste my hands on a procedure that is doomed to fail. He pointed at a terrified looking young resident. Dr. Evans will do it.
He needs the practice. Sterling leaned in close to Sarah. But know this, when the leg fails, and it will fail, and the infection spreads to his blood, his death is on you, and I will make sure you lose your license. I will make sure you never work in healthcare again. Not even walking a dog. I’ll take that bet, Sarah said without blinking.
Sterling stormed out his entourage, scrambling to follow. When the door closed, the adrenaline crashed, Sarah leaned against the wall, her hands trembling slightly. “You just tanked your career for me,” Graves said, staring at her with awe. “Why?” Sarah checked his vitals monitor. Her face was pale. Because in the Kurangal Valley, you carried me 2 miles on a broken ankle when the evac chopper couldn’t land.
You don’t remember it because you had a concussion, but I remember. You didn’t leave me behind, Silus. I’m not leaving you. Graves looked at the ceiling, fighting back tears. He had spent 10 years thinking the world had forgotten him. He had spent 10 years thinking his war was over and that he was just debris left on the battlefield of life.
But he was wrong. The war wasn’t over. It had just moved to room 402. Dr. Evans, Graves mused. That kid looked like he was 12 years old. He is, Sarah said, forcing a smile. But he’s got good hands. I’ve seen him stitch and I’ll be in the O with him. You can do that. I’m going to scrub in, Sarah said. Sterling thinks I’m just a nurse.
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