The Culmination

Chapter 1

Chapter 1

An ominous alarm wails in the Trauma Center of the University Medical Center, signaling an incoming critical situation needing immediate attention. Gunshot wounds, two victims, gunshot wounds, two victims an announcement declares. At this Level I trauma center, response teams rush to the helipad on the 13th floor and watch as a U.S. Air Force helicopter lands.

“Tell me what happened,” a doctor says to the medics accompanying the victims.

“Sir, the woman was addressing a crowd of reporters at the base. The Admiral spotted the sniper and jumped in front of her just as the rifle discharged. The bullet hit one of his service medals, passed through him, and hit her. Neither is conscious. The medal is embedded. We were afraid to remove it because we feared he might bleed to death.”

The doctor darts forward as two gurneys are pushed to the aircraft and the motionless victims put onto the mats. “Get them to the Trauma Center now! Call for the cardiac team.”

Nurses scramble to help the victims. A medic applies pressure to the officer’s chest but is unable to stop the bleeding. As they move toward the elevator, the surgeon speaks to the medic, “Thank you, Airman, we’ll take it now.”

“You may have a crowd here soon, sir.”

“Why’s that?”

“Respects is all, sir. Respects.”

“From the looks of things, respect won’t be enough. If they hope to see these two healthy again, tell them to get on their knees.” The surgeon turns quickly and moves with the bodies.

The medic stands at attention and watches as they disappear behind the closing elevator doors.

Admiral Joseph Parker gets taken to a locked-down surgical unit. He has suffered massive blood loss. When the bullet penetrated his chest, it hit a service medal and pressed the decoration next to the left ventricle of the heart. The projectile then exited his body and hit the second victim. There remain no signs of life, no gasping respiration, and no palpable pulses.

The cardiac surgical team works at speed. One doctor intubates the Admiral and hooks up the ventilator. Others set up a central line and an arterial line. In a matter of minutes, the surgeons are ready to crack open the rib cage. They nod to one another and begin.

In an adjoining operating room, a second team works on the female victim, Julie Underwood. She is also unresponsive. Though she stood behind the Admiral, when the bullet exited him, it struck her shoulder and lodged next to the subclavian artery. She, too, has lost much blood. Suspected head injuries complicate her gunshot trauma. When the Admiral took the hit, he fell backward onto her. She hit the platform hard and got knocked unconscious.

The team moves swiftly to intubate her as she is not breathing. They insert a central line and an arterial line and then focus on the removal of the bullet. After they have recovered it, they close the wound. The lead doctor orders a CT scan of her head and spine to evaluate injuries to the vertebral column. Because she continues in a vegetative state, he suspects that the fall might have fractured her skull.

This locked-down unit treats patients at risk for retaliation. The surgical teams are accustomed to managing the worst of life, but this is the first time they have dealt with an attempted assassination at the Air Force base. They race against time, as the patients are not responding.

Finally, Julie takes a breath.

“We have a response!” a nurse shouts.

“Great job, team,” the surgeon responds. “Let’s get that CT scan.”

Down the hall in the other operating room, the Admiral’s heart begins to beat.

“Oh, my God, he’s alive. Let’s do this now.” The two cardiac surgeons work in concert with one another, cutting through the Admiral’s breastbone to open his chest. Once they have him hooked up to the heart bypass machine, they focus on the medal lodged near his heart.

An intern speaks over the intercom in the first operating room, “Doctor Aguirre, the President wants a status report on the Admiral.”

“Can’t you see we’re busy, intern?”

“Yes, doctor, but the President is insistent.”

“Who the hell does he think he is? The president of what?”

“The United States, doctor.”

Everyone looks at the intern through the barrier glass with disbelief. “Tell him we’re doing our best. The Admiral remains unconscious, but he has a heartbeat. We have no further updates.”

“Thank you, doctor.”

Dr. Aguirre notices the reaction of his team and responds, “Focus, team.” Everyone’s attention returns to the Admiral. They locate the medal and dislodge it.

Another interruption comes when the intern uses the intercom again. “Doctor, General Taylor, the Commander of Begert Air Force Base, wants an update on both of the patients.”

“This is not a zoo, intern! Tell him the Admiral is alive. I’m not sure about the female. She’s in the next operating room.” The intern starts to leave the observation area, and the doctor calls out.

“Intern …”

“Yes, doctor?”

“No more disruptions. I don’t care what the person’s title might be.”

“Yes, doctor. Understood. One more thing, the General said these two are lovers.”

“Lovers? Could be helpful information.” The doctor turns to his resident. “Try to get an update on the female.”

Within minutes, the resident returns and reports that she’s stable but still unconscious. “They’ve successfully removed the bullet, but the CT scan revealed a simple linear fracture of the skull, no compression or distortion of the bones. However, the scan of her spine uncovered a rapid cerebrospinal fluid leak along the thoracic vertebrae. The team is consulting with a neurosurgeon at Cedars-Sinai, who specializes in CSF leaks.”

Dr. Aguirre nods his approval and continues to focus on the Admiral. “Ahh, I’ve got it.” Proudly, he holds up the mangled medal for the team. “No damage to his heart. The rhythm is regular. Let’s close him up. Tonight, we all have much to celebrate. Great job, everyone.”

As the nurses prepare the Admiral for the Recovery Room, Dr. Aguirre goes to the other operating room.

“Is she going to be medevacked?”

“We can’t risk it. Our team is ready to proceed.”

“Can I observe?”

“Of course.”

The neuro team works efficiently. One surgeon makes an incision along the Thoracic 4, 5, and 6 vertebrae, while another spreads the wound to expose the bleed. They shave the spine to allow for the insertion of titanium clips to stop the spinal fluid leak. Once they’ve stitched her up, the lead surgeon acknowledges a job well-done and directs that she get taken to the Recovery Room, and if possible, to a bay next to the Admiral.