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By dee_ayy
June 20, 1999
Disclaimer: If 1013 Productions and Fox want to borrow any of MY original ideas and characters, I'll gladly let them. Seems only fair, considering I borrow theirs on a regular basis. And I know they'll treat mine fairly and respectfully, with no harm intended, just like I do theirs.
Rating: PG. Just a little bit of swearing.
Spoilers: Nope.
Thanks: Are due to all sorts of people on this one, but most notably to Vickie Moseley, who convinced me to do what I knew had to be done, and take out my hatchet, so to speak. It really is okay if the story you actually write turns out to be something completely different than what you intended when you started. Also thanks to Keryn for her medical help (even though her computer problems left me high and dry at a pivotal point!), and to Christina for her usual fine-tooth-comb reading.
Archive: Any time, anywhere, but please let me know.
Feedback: Is like heroin! Please, I need a fix! dee_ayy@yahoo.com.
Summary: A young medical student encounters a very special first trauma
case.
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First Case
By dee_ayy
Lily Cho was anxious with nervous energy. Almost a week into her med school ER rotation they were finally going to let her take part in a trauma, and he was on the way. Mid-30's, white male unrestrained driver in a single vehicle accident. Broken arm, head and facial trauma. Vital signs steady, but victim was suffering from reduced LOC--level of consciousness. He was incoherent and uncooperative. He could have a serious head injury. He was bleeding from the nose and face.
She was excited, and that kind of disgusted her. Here was a guy with a potentially serious injury, and she was happy about it? No, not happy. It was just adrenaline. This is what the ER was all about, and she didn't know what to expect. Most of her knowledge of what happened in an ER trauma room still came from the TV show. She knew that all she would be expected to do was watch--see one, do one, teach one, and this was her "see one"--but that didn't dampen her anticipation. She looked at the other people in the room with her, an attending, a resident, a couple of nurses, all with their assignments in place. They were waiting much more patiently than she was, but still, they looked a little hyped up themselves.
She caught the eye of Alicia, the nurse standing next to her, and smiled slightly, shifting her weight from one foot to the other. Alicia leaned over and whispered. "This is the worst part. Anticipating. You just have the barest amount of information, so everyone wonders about what they'll have when he shows up."
They waited another few minutes, and then someone said "Here they come."
The two paramedics wheeled their patient into the room, and the first began to speak. "This is Fox Mulder. He's an FBI agent, unrestrained driver in a single-vehicle accident, car versus telephone pole, head-on. He was unrestrained, but the vehicle had airbags, which did deploy, and he was not trapped in the car. As you can see, he has a left radius and ulna fracture, trauma to the face, and head injury. Last BP was 98 over 82. He has been semiconscious most of our time with him, but agitated and confused. We've got him at a GCS of 12 right now. E3, V4 up from 3, and M5." Lily whipped out her cheat sheets, and looked up the Glasgow Coma Scale the medic was talking about. Eye response 3, opens to verbal commands. Verbal 4, conversant but disoriented; up from 3, inappropriate verbalizations. Motor response 5, withdrawing from pain. That was fairly high, Lily thought. She shoved the card back in her pocket. "His right pupil is responsive, but to be quite honest, we didn't want to mess with the left side of his face there. Thought it best to leave that to you." As he was speaking, the paramedic was helping to transfer Mr. Mulder from stretcher to hospital gurney.
The staff descended upon the patient, quickly removing his clothing, attaching him to monitors, and securing IV access. Josh Kessler, the resident Lily was assigned to, approached Mulder, and spoke very loudly. "Mr. Mulder? Mr. Mulder can you open your eyes for me please? Come on, open your eyes." Mulder groaned and tried to move his head away from the sound, but he couldn't. "Okay Mr. Mulder, I know you hear me. Open your eyes!" Mulder tried. The right eye opened pretty well, but the left eye opened only a fraction. Josh looked over to the nurse who was charting all of their actions. "Get a portable x-ray in here stat. And make a note--we're gonna need an ophthalmology consult eventually." He looked back at his patient. "Okay, Mr. Mulder, that's good. Do you remember what happened?"
Mulder's eyes rolled up in his head, and he closed them again. But after a moment Lily heard a barely audible "No."
"That's okay, Mr. Mulder. You were in an accident. You're at the hospital now, and we're going to take care of you. Do you understand?"
Lily watched the man slowly slide his good eye open. He said two things, "Hosp?" followed by what sounded like "skull" before he closed his eyes again.
"Stay with us, Mr. Mulder. Can you move your hands for me? Move your hands." Lily looked expectantly at the man's hands. She saw the fingers on his right hand shift slightly, but he didn't move the left at all. She smiled. Obeys verbal motor commands--add another point to his coma scale rating, she knew. She stole a peek at the card again to confirm what she thought. Yup, with a GCS of 13 now, his head injury on first assessment would be called "mild" instead of "moderate."
"How about your feet, Mr. Mulder, can you move your feet?" Lily had been so intent on following the attempts to communicate with the patient that she was almost surprised when she looked at his feet to note that the ER staff had covered him from the waist down with a light blanket. Someone lifted the cloth to expose his feet, both of which moved after a moment. This was very good.
"Mr. Mulder, can you tell me where you hurt? Do you have any pain in your chest?" Josh was pressing on the man's ribs and chest as he questioned. "Does this hurt?" Mulder didn't respond. "How about your belly? Is there any pain in your belly?" He moved his hand down and started palpating the man's abdomen. "Does any of this hurt?" Again Mulder didn't respond. Josh moved to Mulder's broken arm. "How about your arm, Mr. Mulder, does this hurt?" He lifted the splinted extremity, and Mulder yelped with pain. "Okay, that's a yes. Glad to know you're still with us, Mr. Mulder." The doctor then peered in his eyes and right nostril with a light, then addressed the recording nurse. "Negative for CSF." CSF? Lily racked her brain, and it finally came to her. Cerebrospinal fluid. It wasn't leaking from his ears or nose. More good news; more indication that the head injury was minor.
"Let's get a lateral c-spine, and a chest film just to be sure." The portable x-ray machine had arrived, and Josh was giving his orders. "We'll get the rest later. He's gonna need complete skull and c-spine series, underexposed submental and Waters views of the face, and the left forearm, including wrist and elbow. And I'd say a head CT is in order." He looked at Mulder's EKG monitor, watching the BP and pulse oximetry readings. "He's stable enough to take the time to get the bony structures for facial injuries during the head CT. I think we've got some fractures there. His abdomen is clear, though." He looked directly at Lily. "Let's step out while they take the x-rays."
Lily walked out and looked back through the window in the door as the x-rays were taken, and she was suddenly stunned. He'd been there for all of 15 minutes, and she had only witnessed a tiny fraction of his care. She had no idea, for example, what drugs he was being given if anything. She didn't think he'd been given anything, but she'd pretty much missed that completely. She didn't know if his BP was going up or down or remaining stable. And she was afraid to ask, for fear of seeming like she hadn't been paying attention. She'd have to be more attentive when she went back in. But she had no idea how these people did it, how they kept track of a thousand details that potentially meant the difference between life and death. It was overwhelming.
"LILY?"
She looked up, suddenly aware that someone had been talking to her. It was Alicia.
"Do you want to accompany him to x-ray and CT?"
"Oh, uhh, sure."
"First case. It's always useful to follow a your first few cases through the whole gauntlet, you know?" The x-rays were finished, and she nodded absentmindedly as she re-entered the room, with just Josh and Alicia and one other person whom she didn't know. Since it was apparent that the man's injuries were not immediately life threatening, most of the other people who had been present had gone off to find other people to help.
This time she was mindful to look around, and see what was going on. She looked at the monitor. His heart rate was strong and steady at 72 beats per minute, she could see. The oxygen saturation of his blood was at 97. It should be 100, but the bleeding from his nose was probably affecting it. Hey, when had someone put cotton in his nostril to try and stanch the flow? But 97 was good--they wouldn't worry unless it fell below 95, then they'd give him supplemental oxygen. She had learned something in her week of looking in on non-trauma cases here. His blood pressure was 98 over 72. Wasn't that low? She looked to the IV stand, and saw two bags hanging there. Just IV solution, though, no medication that she could see. One was probably precautionary in response to the slightly low BP. She decided to ask.
"Isn't his BP a little low?"
Alicia looked up from the blood she was drawing from Mulder's arm, and looked at the monitor. "Naah. With his build, it's quite likely his BP runs a little low--like it would for a runner. Why don't you see if you can clean a little of that blood off his face. When Josh gets back he's gonna want to examine his face for injuries."
Back? Where had he gone? God, she was hopeless. She went to the sink to dampen a cloth, and tentatively started to wipe the blood from Mulder's face. The loose cotton in his nose was doing no good at all--blood was still flowing slowly but steadily from his left nostril. His cheekbone, eyelid and brow were already swollen and discolored. She found a small semi-circular cut on his cheek.
"Ouch."
Lily jumped. Mr. Mulder had been lying there so quietly she had assumed he was unconscious again. "Oh! I'm sorry."
"Ssssawright." His speech was slow and slurred, and he didn't open his eyes. "Arm hurts."
Lily looked at Alicia, unsure what to do. The nurse nodded toward the patient, silent confirmation that it was okay to speak to him.
"It's broken. You broke your arm." She watched the man take a slow, deep breath.
"Oh."
Lily waited for him to say something more, but he didn't. Instead he slowly opened his good eye, and focussed his gaze on her. Lily didn't know what to do, so she just smiled somewhat sheepishly at him.
"Mr. Mulder? I'm Dr. Kessler." Oh, thank God, Josh was back. Lily didn't know what she was going to do if she'd had to tell the patient anything else. "Are you feeling a little better?"
It took a moment, but the patient finally responded. "No."
The doctor chuckled. "Well you are doing better. You're much more alert than you were just a little while ago. I just saw some of your x-rays, and they looked good." Josh took out his pen light and examined Mulder's right eye. When he turned his attention from right eye to left, Mulder gasped in pain. "Sorry about that. Can you tell me exactly where you hurt?"
"Everywhere."
"A little more specific, Mr. Mulder, please."
Mulder paused. "Arm. Face. Knees. Chest. Helluva headache."
Lily saw Josh's brow furrow. "Hmm. Your chest x-ray was clear--you don't have any broken ribs. Where on your chest? Can you show me?" He'd gotten no response from Mulder earlier when he'd felt his chest for injuries.
Mulder started to slowly pick up his right arm, as if he was going to point, but he only lifted it a few inches before he let it fall back to the bed, the effort clearly too much for him. Instead he spoke. "Middle."
"The middle of your chest? Here?" The doctor applied pressure to the middle of his patient's sternum, and Mulder gasped.
"Yeah."
"Okay, that makes sense. Your car had airbags, did it not?"
"Car?"
"Don't you remember what happened?"
Lily could see their patient thinking, trying to remember. He tried to shake his head, grimaced, and then said "no."
"I told you once a little while ago. Do you remember that?"
"No."
"Okay. Let's see what you do remember. Can you tell me your full name?"
"Fox William Mulder."
"What do you do for a living, Mr. Mulder?"
"FBI."
"What day is it?"
Lily could see confusion on his face briefly. "Tuesday?"
"That's right. How about the date?"
Mulder paused for a moment. "February 5."
"Good. And who is the president?"
"Hillary."
Lily laughed, and Dr. Kessler smiled. "That's an old one, Mr. Mulder. Do you know where you are?"
"Hospital."
"But where is the hospital?"
The patient thought for a long moment, then resigned himself. "Not sure."
"That's okay. Do you remember what you were doing this morning?"
"Giving a deposition." Suddenly he remembered. "In Delaware. Don't remember leaving, though."
"That's perfectly normal, and it's not surprising. You sustained a pretty substantial blow to your head. You were in a car accident. Your car hit a tree head-on, from what I understand. The pain in your chest is no doubt from the force of the airbag deploying. It's probably just a bruise."
"Really hurts."
"Okay." Josh stuck his stethoscope in his ears and placed it on Mulder's chest. "Take a deep breath for me?" Mulder did, and the doctor moved the stethoscope. "Again." He did. Josh popped the apparatus out of his ears and let it settle around his neck. "Is the pain constant, or is it associated with your breathing?"
"Constant."
"That's actually good, Mr. Mulder. Do you feel any pain associated with breathing?"
"My nose hurts."
"Right. I mean in your chest?"
"No."
"Good. Like I said, probably a bruise. I don't expect to find anything with what we're about to do, but we need to roll you onto your side so we can check the rest of your spine for injuries. Let us do all the work, okay? Just lie still for us." He turned his attention from patient to student, and looked right at Lily. "You can help. Get in the middle and follow our lead, " and then he addressed the others. "Looks like his left side took the brunt of it, so let's roll him onto his right." The four people took position and log-rolled Mulder onto his side. From her place in the middle, Lily was terrified that she'd hit the broken arm, and was therefore of little help. Mulder only grunted slightly at the movement. Dr. Kessler pressed on each one of the man's vertebrae, asking the patient to tell him if he hit something that hurt--Mulder remained silent.
When they were done and it was time to return him to his back, Lily just let go of Mulder's arm, which she had been holding, and let everyone else do the work. Idiot. When she glanced up she saw Josh looking at her reproachfully. She'd do better next time.
Josh turned his attention to Mulder's knees. He picked up the sheet to expose the lower half of both legs. His knees did not look swollen. "Can you bend your knees for me, Mr. Mulder? One at a time." Lily watched the man lift first one knee, then the other, slowly sliding his heels up the bed a bit before he let them slide back down.
"That's good." Josh picked up Mulder's right leg at the knee, and tested the joint's range of motion. It appeared normal to Lily, but she did see the man wince at certain motions. Dr. Kessler repeated the exercise with the left leg, and then put it down and replaced the blanket. "Your knees probably hit the dashboard on impact. I don't see anything wrong, but we'll take some x-rays to be sure. I know you are in a good deal of pain, Mr. Mulder, but I want to get a CT scan of your head to make sure it's nothing more than a concussion, okay? You were pretty out of it when you got here. And we'll get some pictures of your arm and your face, as well. It won't take long. Think you'll be okay?"
The man sighed loudly, and allowed his eyes to slide shut. "Ohhhh, yeah."
The doctor smiled. "We'll send Lily here along with you to keep you company." The student watched her assigned mentor pick up the phone and dial. "Mr. Mulder in trauma room one is ready to be taken to CAT scan. . . . No, he's not critical, but he needs to get in there soon--rule-out head. Yeah, okay." He replaced the phone and turned back to Lily. "We're on hold for a couple of minutes. The CT machine is in use--someone in ICU went sour."
"Can't they take the x-rays?"
The young doctor shrugged. "They said five minutes tops." He approached his patient again. "Mr. Mulder, you'll be going to x-ray in a couple of minutes. In the mean time, let's take a look at your face, okay? You banged the left side of your face pretty hard." Lily took out her small notebook, ready to take notes. She'd never watched a facial exam before. Josh went to the head of the gurney, and stood over Mulder's face, looking straight down. Mulder met his gaze and silently stared back at him with the one eye that opened. Josh's brow furrowed; he reached over, released the straps on the cervical collar and removed it. "This is in the way, but do me a favor, Mr. Mulder, and don't move your neck too much." He looked again.
"Now I'm going to feel for fractures in the bones in your face. If I hit something that hurts, let me know, okay?" Josh began to press against Mulder's brow bones, from the center out. Then he started to palpate the sides of his face and down to and including his jaw. Lily watched with rapt attention, and the doctor noticed.
"Lily, it's very common to intubate a victim with facial injuries to keep the airway secure. Why wasn't this done for Mr. Mulder?"
Lily was taken by surprise, but only for a second. "Because he was vocalizing. As long as a patient can speak, that indicates a secure airway."
The resident looked up briefly with a grin. "Right. But what is the risk, and what do we do?"
"Ummmm. Risk is that swelling can block the airway, in which case a tracheotomy will be necessary, so a tray should be at the patient's side at all times." She gained confidence in her answer as she gave it, and she saw Alicia smile at her and point to the trach tray at-the-ready not a foot away from the gurney.
Josh looked up again and smiled. "When did you study up on facial trauma?" He turned his attention back to Mulder. "I'm going to press along your cheekbones now, and your left cheek is very swollen. So it's probably going to hurt a bit, okay?"
"Yeah."
The doctor pressed along the bone, and at one point Mulder did grimace, but not too badly. "Okay, good. That wasn't too bad, I hope. Now I'm going to manipulate your jaw." Lily watched Josh gently hold Mulder's lower jaw, and move it up and down and side to side, watching his patient's face the whole time. He repeated the exercise while holding Mulder's top teeth.
"Do you feel any numbness anywhere on your face?"
Mulder thought for a moment. "Don't think so."
What about your eyesight? Any double vision?"
"No."
"Things a little fuzzy?"
"Well . . . Yeah. Wear glasses to read."
"Oh, okay. Can you read my nametag?" Josh stood over his patient and held the tag in Mulder's line of sight.
"Too close."
Josh unclipped it from his pocket and slowly started moving it away from his patient's face.
"Joshua Kessler, M.D."
"Good, We'll have an ophthalmologist check you out properly, though. Make sure you didn't injure your eye." Josh then turned his attention to Mulder's nose. He gently felt down the bridge and along the sides, and then along Mulder's eye sockets. He hit a spot under Mulder's left eye, and the patient gasped. "Oh. Sorry."
"S'alright. Nose broken?"
"Doesn't look like it. But it is still bleeding a little bit, which is cause for some concern. Open your mouth for me?" Mulder did and the doctor pointed his flashlight down his patient's throat. "Well, I see some blood in the back of your throat, which means the bleeding is probably coming from your nose, which is good because"
"Dr. Kessler?" Lily didn't want to interrupt, but she'd just been told radiology was ready for him. "They said we can bring him to radiology now."
"Well by all means. Take him away." Josh turned to Mulder. "You'll be coming back here after we get our pictures, and then we'll get you fixed up, okay?" An orderly released the brake on the gurney and started to wheel it away. Lily watched it go, until someone poked her in the ribs. It was the nurse.
"Go. Go!"
The student snapped to attention and ran after the bed. She caught up to it and fell into step along its right side.
"What's your name?" Her patient was talking to her.
"Oh. Uh. Lily. Lily Cho. I'm a medical student here at UMD Med School."
"Younger every year."
Lily smiled. "Don't worry, Mr. Mulder, you're gonna be fine."
Lily saw a small smile pass across her patient's lips. "I know. UMD. University of Maryland?"
"That's right."
"Baltimore?"
"Yup."
"So that's where I am. Made it half-way, anyway."
"What?"
"Half way home. To D.C."
Lily smiled again. She liked this guy. "I guess so." The trip to radiology was a short one, and they had arrived. Mulder was taken into x-ray first, since the CT room was still occupied. Lily went in and watched the first few pictures being taken, flinching with her patient as the technologist moved his body for the pictures. He tried not to hurt him, but sometimes it was unavoidable. After a while, she waited outside.
When Mulder came out of the x-ray room he looked agitated to Lily. He was being moved next-door to CT Scan, but he obviously had something on his mind. He was looking around for something, Lily thought, and when he saw her she knew it was actually some_one_. Her. "Lily? What about the van?"
"What, Mr. Mulder?"
"I remember a school van in front of me. Did I hit it? Are the kids okay?"
"I don't know anything about that, Mr. Mulder, but they said your accident was a single-vehicle, car versus pole. They didn't bring anyone but you in, so I'm sure they're fine."
"Check for me?"
"Hey, I'm supposed to stick by you."
They had reached their destination, and the orderly was trying to move Mulder into the scan room. "Wait!" The orderly stopped. "Lily, I'm okay. Please?"
"We can find out when we get back to the ER, Mr. Mulder. There's nothing to be done about it now, anyway."
"I need to know." Even with his face battered, Lily could see a look of desperation there, and his tone was pleading.
How could she refuse? As he was being rolled into the scan room, Lily gave her answer. "Okay, I'll make a call. I'll try to find out." She went out into the hall and picked up the nearest phone to call back to the ER. Alicia happened to answer the phone.
"Hi, this is Lily. Mr, Mulder, the MVA I'm with in CT scan? He remembered something about the accident; said there was a school van involved. He asked me to check to make sure no kids were hurt."
"It was a single MVA, Lily. No other injuries. But let me check the paramedic's report." Lily listened to the "hold" music for about 45 seconds until Alicia came back. "No, it says here 'Swerved to avoid spin-out, hit telephone pole' If it was a school van that was spinning, he must have missed it."
"Thanks. He'll be glad to hear it."
"This could have waited until he got back, Lily."
"I know, but he was pretty agitated."
Alicia chuckled. "I see. Getting under your skin, is he?"
"No, no. He was just worried, that's all. Thanks." She hung up the phone. The very idea embarrassed her. She liked him--he seemed like a nice guy; she felt sorry for what he was going through, but he wasn't under her skin. She went into the CT scan control room to watch the rest of the test.
When it was done, and Mulder was wheeled out, she told him about the van. He was relieved, but he had more questions for Lily.
"What happened with my weapon, do you know? I know I was carrying it."
"I don't know, Mr. Mulder. I don't think you had it on you when you arrived."
"I can't lose it. That's a huge no-no."
"I'm sure someone has it; that it's fine."
"How long was I out of it?"
"I don't know that for sure, either. You were able to give one-word answers to questions from the moment you arrived here. But I don't know about before you got here. Why?"
"Was my next of kin notified? Or the Bureau?"
Lily smiled at him. "I don't know that, either. Do you want us to call someone for you?"
"No. Not yet."
"I'll ask at the desk if anyone was notified, okay? And about your gun."
"Thanks, Lily." They were back in the ER, and as Mulder was deposited in a regular treatment bay--he no longer required the services of a trauma room--Lily peeled off and went to the ER desk clerk.
"I need to check a few things for a patient, Mr. Mulder?"
The clerk looked up. "Yeah?"
"First, he's an FBI Agent, and he wants to know what happened to his weapon."
"Beats the hell out of me. But that cop over there," the woman nodded toward a uniformed Maryland State Police Officer leaning against a wall, "is waiting to talk to him. Maybe he knows."
"Okay, thanks. And also, has anyone been notified for him? Family, next of kin?"
The clerk flipped through her paperwork. "Nope, doesn't look like it." She looked up at the young woman in front of her. "That's usually something someone like *you* takes care of, isn't it?" She winked at the student and walked away. Lily sighed and approached the cop.
"Excuse me, you're waiting on Fox Mulder, the FBI Agent?"
"Yeah, that's right. How's he doing?"
"He's banged up, but he's doing okay. Mr. Mulder was asking about his gun."
"Oh yeah. I got it, and his FBI badge, too. We notified the Baltimore Regional Office. Someone was supposed to meet me here and relieve me of them in case he couldn't take them back himself. But I haven't seen anyone. So can I talk to him about what happened?"
"That's not up to me. You need to talk to Dr. Kessler about that. But Mr. Mulder doesn't seem to remember much at the moment. What did happen, if you don't mind my asking?"
"Looks like a van hit some black ice and spun. This guy, Mulder, swerved to avoid it, hit the ice, and BAM. That's how it looks anyway."
"Was it a school van?"
"Yeah, how'd you know that?"
"That's all Mr. Mulder seems to remember. He was worried about the kids on the van."
"It was empty. So where's this Dr. Kessler? I want to get out of here."
"I'll try to find him for you." Lily left the policemen, and returned to the patient. She walked in on a doctor she recognized as an orthopedics resident examining Mulder's broken arm, and stood back quietly until he was done.
"Okay, now I want you to make an 'OK' sign with your thumb and index finger." Lily saw Mulder do it, but with a grimace. "Good. Now I want you to separate your fingers one at a time against the resistance of my hand." Lily knew these tests were designed to check for nerve damage. Mulder could do them all. She looked at the x-ray on the lighted board on the wall. It looked like a nondisplaced fracture of the radius and ulna. The chance of nerve or vascular damage with a simple break like that was pretty slim, she knew.
"Well, everything looks good, Mr. Mulder. The fractures look stable and the deformity is minor, so it looks like you're going to avoid surgery. A few weeks in a cast and you should be good as new, I'd say."
"How big a cast?"
"Above your elbow to your hand, I'm afraid. We need to immobilize both your elbow and your wrist so you don't rotate the bones and keep them from healing. Are you left-handed?"
"No."
"Well, then, it should only be a minor inconvenience for you. I know they have a few more things to check out, but I'll see you eventually in the cast room, and we'll get you straightened out, okay?"
"Yeah, thanks." The doctor patted Mulder's thigh paternally, and left. Lily approached the bed.
"Hey, Lily. What'd you find out?"
"No one has been called for you yet. And there's a cop outside waiting to talk to you who has your weapon and your badge."
"Let him in. I'm okay."
"Oh, no. Not without the doctor's okay. He's not going anywhere. How are you feeling?"
"Sleepy. But I know, no sleeping until head injury is ruled out. So keep me awake, okay?" He grinned tiredly.
"Have you been through this before, Mr. Mulder?"
He sighed. "More times than you know. Comes with the territory. Do me another favor?"
Lily feigned annoyance. "Now what?"
"Drop the 'Mister.' My friends call me Mulder."
Was he simply charming her, or did he truly mean to imply that she was his friend? Well, Lily realized, she was probably the friendliest face he'd seen here. Most patients aren't lucky--if that was the right word--enough to have one staff member stay with them through their entire time in the ER. She knew that. So for now she guessed it was fair enough for him to consider her a friend.
"Okay, Mulder."
"Okay, Mr. Mulder!" Dr. Kessler breezed through the curtain of the enclosure, and Lily smiled at the formality of address that she'd just been relieved of. He was holding what she recognized as a cold pack in his hand. "I've seen your x-rays and your scans. Let's sit you up at last, and we can get rid of this thing." He adjusted the gurney until Mulder was at a 45-degree angle, and removed the cervical collar. "You want to hear the news?"
"Can't wait."
"Okay, the scan of your brain looked fine. You suffered what I would classify as a moderate concussion, though my friends in neurology would probably want to call it mild. But you have the headache, you know how you feel."
"I've had worse."
Dr. Kessler smiled. "You don't say. Okay, the break in your arm is clean, should heal" Mulder cut him off.
"Know that. You just missed orthopedics."
"Wow, already? They're fast. Okay, so you know about your arm. Your knees are fine. Nothing skeletal. It's probably just bruises, but if they continue to hurt, you should consult your own doctor" Mulder cut him off again.
"I know. That's orthopedics too."
The doctor smiled again. "They're fast *and* thorough. Good for them."
"Now for your face. You did break a bone in your face, called the maxilla, which is the thin flat bone under your left eye. You can't feel it, it's behind the hard bone you feel under your eye. Basically, it's the bone that forms the floor of your eye socket. The break is called a blowout fracture, which sounds much worse than it actually is."
"So what do you do for it?"
"Absolutely nothing, besides some ice and keeping your head elevated to keep the swelling down." To emphasize that point, the doctor pulled on the cold pack to start the chemical reaction that would make it cold. He kneaded the bag while he continued to speak. "It should heal by itself. I'll have an ENT or plastics guy come speak to you tomorrow about the possible complications, but you shouldn't worry."
"Tomorrow? I can't leave?"
Josh smiled. "Nope, sorry." He tapped his temple with his finger. "Head injury. We want to watch you for 24 hours, just to be sure."
"Damn."
The young man wrapped the cold pack in a light towel, and suddenly realized that Mulder couldn't hold it in place himself because of his arm. He gently placed the cold pack on Mulder's face himself. "You're going to be hurting for a few days at least. Spend the night here, and get your recovery off to a good start. Speaking of which, I'll have a nurse give you something for your pain, finally, too." The doctor looked at Mulder's face and scowled. "Is your nose still bleeding?" He pulled the loose cotton out of Mulder's left nostril, and sure enough, blood continued to trickle out of it.
"Hmmm. This is probably going to hurt, but I need you to blow your nose to remove any clots you may have in there, okay?" He held a cloth under Mulder's nose for him.
Mulder scowled at the man, and took the cloth himself with his good hand. He took a deep breath in through his mouth, and blew through his left nostril. He did it only once, and handed the cloth to the doctor without so much as a look. "Ohh, shit. I'm seeing stars." Mulder used his finger to press on his nostril in an effort to stop the pain.
The doctor took the cloth and handed the cold pack to Lily. She didn't care to look at the results, either, so she held the pack back against Mulder's cheek. The doctor then started rifling through drawers, found what he was looking for, and returned.
"That started it flowing again, didn't it? Let me take a look." He lowered the head of the bed again, causing Mulder to grimace, placed a small lighted speculum in his nostril, and looked. "I see it. Broken vessel, that's all, but a pretty big one. We'll get that stopped in no time." The doctor removed the instrument and sat Mulder back up.
"Everything about my nose is pretty big, it seems." Mulder gave his doctor his best sardonic grin. Lily laughed, and could see that their patient was pleased by her response.
Kessler grinned slightly and pushed the curtain aside. "I'll be right back."
Lily watched Josh leave, trying to decide which treatment option he would go for, when Mulder's voice brought her back to earth.
"Umm, Lily?" She looked at him and saw that the blood was now running around Mulder's mouth and reaching his chin, and he was trying to stem the flow with his good hand. Lily took the towel off the cold pack and placed it under his nose.
"Think you can hold this?"
Mulder shook out the IV tubing on his right arm a bit, and held the towel in place. "Sure, no problem." She re-wrapped the ice pack in another cloth and placed it back against Mulder's cheek.
"Do you really think that's doing any good?"
She smiled at him. "Well, it's not hurting," then it occurred to her that maybe it *was*. "Is it?"
Mulder sighed. "No more than anything else."
Lily was suddenly chagrined. "Right. Sorry."
"Don't worry about it. I've felt worse. MUCH worse." He paused. "So, let me take a wild guess. You cut my clothes off me."
"Uh huh."
"Okay, so putting aside the thought that that means you've seen me in my altogether, it means I don't have anything here, not even underwear, right?"
"Right. And I didn't peek, honest." Lily winked at him, and then couldn't believe she'd done it. Was she flirting with him? She wasn't a flirt! She could tell by the expression in his eyes (well, to be technical, eye) that he was smiling.
"Well, then, Lily, I guess I'll be having to call someone after all."
"Do you want me to do it?"
"I can, can't I?"
"Yeah, sure. As soon as that nose of yours is taken care of we'll get you to a phone, okay?"
"Spiffy."
"Spiffy? What kind of word is spiffy?" Oh, God, she *was* flirting!
"Hey, it's a good one. It should be used more often." And was he flirting back? This, Lily knew, was probably unprofessional behavior.
"Hey, Mr. Mulder, your nose still bleeding?" It was the nurse, Alicia, and she was carrying a tray with several things on it. She put it down, took the towel from Mulder's hand, and looked. "Sure enough. I'll take care of that. Dr. Kessler was actually called in on another trauma. But he also authorized this" and she held up a needle. "Demerol, IV. Also known as instant relief. About time, huh?" She punched the needle into one of the ports on Mulder's IV, and pressed the plunger. "Now, about that nose. What we're going to do is put some cotton soaked in an anesthetic in your nostril for a few minutes. It should stop the bleeding. I need to lay you down for a minute." She lowered the head of the gurney.
"I hope you brought enough cotton."
Alicia laughed at her patient's joke. "You betcha. But your nose ain't nothing. You wouldn't *believe* some of the noses I've seen! Yours is a very nice nose. This might be uncomfortable for a minute, but I need to get it all the way in." Lily watched her take a strip of cotton out of a liquid on the tray, and use a pair of forceps to insert it in the nostril.
When she was done she leaned in to Mulder's ear and whispered. "Between you and me, Mr. Mulder, I wouldn't be consenting to any drug tests for a while. I just stuffed your nose with topical cocaine! Don't inhale, either. . . ." She winked as she stood up. "I'll take that out in fifteen minutes and see where we are." Alicia turned and breezed out of the enclosure.
Well, if Lily had been flirting, then so had Alicia been, right? But maybe it wasn't really flirting, but rather merely making the patient feel comfortable. Mr. Mulder seemed to respond well to the playful banter, so that's what he got. She had a lot to learn about bedside manners, she realized.
"Hey Lily, sit me up. Lying flat makes my face throb." His voice suddenly sounded very congested--like his nose was as stuffed as it was.
Lily obliged. "Do you want to make that phone call now?"
"Guess so." Lily went to the phone on the wall, dialed the digits for an outside line, and the number Mulder gave her. As soon as she finished, she handed to phone to her patient and listened to his end of the conversation.
"Hey Scully, guess where I am. . . . How'd you know? Oh, right, I do sound a little funny, huh? I think I totaled my car." Lily saw him look to her for confirmation, and she didn't know, so she shrugged. "I'm okay. Just some bumps and bruises, pretty much. I did break my arm, but it's the left one, luckily. . . . I don't know how. I don't remember what happened. I hit a pole. . . . It's a minor concussion, Scully. My voice? I banged my face on something. They stuffed something up my nose to get it to stop bleeding, and don't you say a word about my nose. . . . I don't know. . . . I don't know that either. . . . Yes, I *was* paying attention to the doctor, but that stuff doesn't sink in with me. You know that. . . . No, my nose isn't broken, but he said something about a blowout. . . . That's it. Blowout fracture. Said it sounded worse than it was. . . . I don't know Scully. Yes, just overnight they said. A precaution. . . . Oh, wow, you know, I don't know. Somewhere in Baltimore--I was on my way home from that deposition. Hey, you think I can sue the guy who filed that lawsuit and made me go to Wilmington in the first place? . . . . Just trying to add a little levity, Scully. But seriously, I just called because I need you to go over to my apartment and bring me some clothes tomorrow and give me a ride home. . . . I told you, I don't know. Is there a University of Maryland Medical Center?" Again Lily saw him look to her for confirmation, and this time she nodded. "Jackpot, Scully. UMD Medical Center in Baltimore. . . . No, Scully, you don't have to come tonight. I'm still in the ER. They haven't cast my arm yet, but they did give me the good stuff, and I'm already two-and-a-half sheets to the wind here. Besides, I have Lily here to keep me company. I'll see you tomorrow. . . . Who's Lily? She's my personal med student--calmer of fears, holder of icepacks, dialer of phones, and all around good egg."
Lily blushed.
"Yeah, okay." Lily saw Mulder holding the phone toward her, and she could feel panic creeping in, the same feeling she used to get in Dr. Monaco's lecture-slash-torture sessions when she hadn't finished the reading and she was *certain* he was going to put her on the spot. "She'd like to speak to you, Lily." As Lily reached for the phone, he whispered "I hope you've been paying better attention than me." Lily took the phone, and gave herself a moment to make her voice calm and authoritative. She'd be doing a lot of this type of thing in the future, she knew.
"Hello?"
"This is Lily?"
"Yes, Lily Cho."
"What year are you?" The woman's tone was no-nonsense; almost gruff.
"Excuse me?"
"In med school. What year?"
"Third."
"Good. My name is Dr. Dana Scully. I am Agent Mulder's partner, and I am also a medical doctor. Can you please tell me what his condition is?"
"I don't know the official classification, but I'd say he's in good condition. Couldn't you tell?"
"Frankly I don't trust him. He's been shot before and just told me it was a bruise. What exactly are his injuries?"
"I'm sorry, Dr. Scully, I can't talk about his condition in detail without Mr. Mulder's consent." Lily watched Mulder waive his right arm at her wearily, a gesture obviously meant to convey that consent. He had his head back on the gurney and it was leaning toward his right shoulder. His eyes were closed and he didn't open them. "Which he just gave me. Well, he has a concussion and"
"Was a CT scan done?" Lily suspected interruptions would be commonplace with Dr. Scully.
"It was, and it was clear."
"How severe did the neurologist rate the concussion?"
"Mr. Mulder's ER physician said he'd rate it as moderate, but neurology rated it as minor."
"Why the discrepancy?"
"I don't really know."
"Was he conscious on admission?"
"Somewhat."
"What does that mean?"
"He was semiconscious-responding, but slowly. Paramedics rated him with a GCS of 12 at the scene. By the time he arrived to us he was at 13. Within half an hour he was at a full 15. Okay?" Lily was getting a little annoyed at the grilling, and it came through in her voice.
"I'm sorry." She said it, but it didn't sound like the woman meant it, and why should she? Lily knew she just wanted to know how her partner was. Another thing for Lily to work on, the young woman realized.
"That's alright. Look, maybe you should speak to his doctor?"
"No, no, you're doing fine. Continue."
"He apparently hit his face on something, causing the blowout fracture of the maxilla under his left eye, which was diagnosed through both x-rays and CT scan. He has not yet been examined by plastics or ENT, but he will be before he is released."
"And his eye?"
"No difficulty noted on exam, but an ophthalmology consult has been ordered."
"His arm?"
"Simple, non-displaced fracture of the radius and ulna at mid-forearm. He has been seen by orthopedics, who found no arterial or nerve damage. As Mulder told you, it hasn't been cast yet." She'd figured out the secret--anticipate as many questions as possible, and head them off.
"And what other injuries does he have that he forgot to tell me about?"
"Really, that's it, pretty much. He has bruises on his chest and knees, a small cut on his cheek, nosebleed."
"No nasal fracture?"
Hadn't this woman just asked Mulder that? "No."
"What happened?"
"I don't know the details. Seems he swerved to avoid another vehicle, hit some ice, and his car hit a telephone pole."
"Tell him I'm on my way."
"But he said you didn't have to come until morning." She saw Mulder nod his agreement to that sentiment, and looked at her watch. "Visiting hours are almost over." Mulder was calling for the phone again with his hand. "He wants to talk to you again."
"Thank you, Lily, you were most helpful." Lily handed the phone back.
"Tomorrow, Scully, I'll see you tomorrow. Understand? I'm half asleep anyway. I'm fine. . . . Thanks. 'Night." He handed the phone to Lily, who put it to her ear. Scully had hung up, so she did the same.
"Sorry about the third degree. We don't get to do a whole lot of interrogating in our work, and she likes to keep in practice." He spoke with his eyes closed.
Lily chuckled. "It's okay. Good practice, actually! Keeps you on your toes."
"Well, she sure as hell keeps me on mine."
The curtain swung open and it was Dr. Kessler, not Alicia as they had been expecting. "That trauma was less traumatic than yours, Mr. Mulder, so I thought I'd check on that schnoz myself." Mulder arched his eyebrow slightly at the turn of phrase, and smiled slightly, but said nothing. The doctor donned a pair of gloves, and removed the cotton from his patient's nose. He had Mulder tilt his head back, and looked in the nostril with his light. He watched for a moment. "I think you're cured." He looked at Mulder's chart, and wrote some notes. "We need an ophthalmologist to give you a once-over, and we need to get a cast on that arm. Then we'll settle you in a room and you can get some sleep. Long afternoon for you, huh?"
Mulder nodded. "But I've had longer." He's felt worse, he's had longer. Lily wondered what he possibly could be alluding to. But then, he was an FBI Agent.
Josh's next words made Lily's heart sink a bit. "Well, I think you've seen Mr. Mulder through to a logical conclusion, Lily. You've done time in the casting room, after all. You have a few hours before your shift is over, I'm sure we can find another interesting case for you to follow. Why don't you go check with the desk and see what's up on the board."
"Oh. . . . Okay." She could hear her voice, and she hoped it didn't sound as crestfallen to others as it did to herself. She put her hand on top of Mulder's and gave it a squeeze. "You take care, Mr. Mulder, okay?" She wouldn't dare address him familiarly in front of the doctor.
"Yeah, thanks, Lily, for everything. I really appreciate it."
She dared to squeeze his hand again. "It's been a pleasure." As she was about to go she turned back. "Oh, there's a state cop outside waiting to talk to Mr. Mulder. Can I send him back, Dr. Kessler?"
"It's okay by me if it's okay with Mr. Mulder" The agent perked up considerably, and nodded his head.
"Okay, I'll send him in." Lily left, found the cop, and gave him directions to Mulder's cubicle.
+ + + + + +
Lily looked at her watch. 11:18pm. Her shift had ended 18 minutes ago! Mr. Szymanski's nebulizer treatment was done, and his asthma attack was under control. She was sure she could leave. She wished the old man well, left his cubicle, and went to the desk.
"Mr. Szymanski just needs to be checked by a doctor before release, and I'm done." She paused for a moment, and decided to ask. "That MVA from earlier, Mr. Mulder? Can you tell me what room he ended up in?" Alicia was writing in a chart, and she looked up and smiled. "Thought you said he didn't get under your skin?"
"No, no, it's not. . . . It's just. . . ." She was stammering and the longer she tried to come up with an excuse, the dumber she'd sound, she knew. "Just tell me the room okay?" She got the information and left.
+ + + + + + +
Lily paused outside the door for a moment, then opened it slowly. The sliver of light from the hallway spread across his inclined form in the bed as she did so, and she silently cursed herself. She hoped she didn't wake him.
"Oh, hey Lily."
Apparently not. "You should be asleep." The door clicked shut, enveloping them in darkness, so Mulder pulled the string at his right hand, turning on the lamp behind his head.
"Would you believe I just got here a little while ago? My cast is still wet."
She knew he was exaggerating about that, but she made notice of the white fiberglass cast on his arm, which was propped up on his lap with pillows. "You didn't pick a color? I'm disappointed."
He smiled wearily. "Tempting. But hot pink is not approved in the official FBI dress code. I actually fell asleep while they were putting it on, though."
Lily smiled. That wasn't uncommon. "They give you a local?"
"Yeah, deadened the whole arm. It's starting to wake up, though. It tingles."
"How are you feeling?"
"Oh, great. They just gave me more drugs. Guess they felt sorry for making me suffer for so long. Sit down."
"Oh, no, thanks. I just wanted to check in. How's your eye?"
"Totally fine. The eye doctor said breaking that bone probably protected my eye."
"That's good. Did you get your gun back from the police?"
"No, there's all sorts of crap about that. Another agent showed up and took it before the officer saw me. I'll have to track it down tomorrow. He did tell me what happened, though."
She knew what happened--hadn't he heard her tell his partner? He probably didn't remember that, she realized. "Yeah."
"Black ice, apparently. Unavoidable."
"I know. The cop told me, too. The bus was empty."
"Yeah, thank God. Learned a lesson, too."
"What's that?"
"Wear your seatbelt, Lily. The cops think I broke my face with my arm, which was in front of the airbag as it was deploying. Something like that. The cut?" Mulder motioned to the semi-circular cut on his cheek that was now closed with steri-strips. "From my watch. Since I wasn't belted I was too close to the airbag when it went off, and this is the result. So buckle up."
She grinned at him. She always did. "I will. Do you need anything?"
"Above and beyond. Lily, above and beyond. Don't you go being this nice to all your patients. You'll burn out in a week. I'm fine. I don't need anything. I bet you need to go home, though?"
"Yeah, I'm on my way. You sure you're okay?"
He held up the call button that was sitting on the bed next to his right hand. "Anything I could possibly need is just a push away. Thank you, though."
"It's okay. You were my first 'trauma case,' you know. I'm glad you weren't more seriously hurt, but I'm sorry we had to meet under these circumstances."
"Better than not meeting at all, eh?" Maybe for her, Lily thought, but she didn't see how that could possibly be true for him.
The sliver of light spread on the bed again, and Lily turned to see who was at the door--it was a petite woman with red hair. Lily turned back to her patient, and saw Mulder's face light up in a broad smile.
"What time is it, Scully? Took you a little longer than usual to decide to come--or was traffic bad."
The woman cocked her head. "It's slick out there, Mulder. I had to drive carefully--didn't want to spin out and hit something." A small smiled played on her lips.
"Very funny. I knew you'd come. I'd like you to meet the ubiquitous Lily, Scully. Lily, this is my partner." Lily turned and extended her hand, which the woman shook firmly. "Lily here did a fine job pinch-hitting for you. But it's time for her to go home. Run, Lily, before Scully thinks up more things to grill you about." Lily's back was to Mulder, but she smiled, and she noticed that Scully returned that smile. She turned back around to face the man, and held out her hand, which he shook.
"I'm off tomorrow, so hopefully this is goodbye. You'd better _not_ be here Thursday, anyway. Recover well, Mr. Mulder." She felt Mulder shift his hand, changing their shake into a gentle hold.
"I will. And thank you again."
Lily extricated her hand and turned to leave. As the door was swinging shut behind her, she could hear the woman talking: "Look at you, Mulder! How do you manage to get yourself into these." The last words were lost as the door clicked shut.
+ + + + + + + +
EPILOGUE: One week later.
Lily was early for her shift, she knew, but not that early. Why was everyone smiling--almost laughing--at her? She approached the desk and saw the vase sitting there, with at least a dozen lilies in it. Surely they weren't for her?
When Alicia saw her, she smiled, too. "Looks like you got under his skin, too, Lily!"
"What?"
"Just read the card."
She picked up the card, and saw that her name was clearly printed on the envelope. She glared at the staff watching her, all of whom had obviously read the contents already. There were no secrets down here, that was for sure. She pulled out the note.
Lily,
Thanks for being the lone bright spot in an otherwise shitty day.
You may need more schooling, but your bedside manner is already top-notch.
Best,
Fox Mulder
Lily put the card back in the envelope, stuck it in her pocket, and tried not to blush.
<THE END>