Fic is the sequel to "San Francisco Snowstorm". It's a bit more grittier and not really on the mark as a PM story as I merged another storyline with this one...branching out into the medical/crime genre.
Jules is feeling bad about her recent behavior towards Matt. For his part, Matt has been abraded by Jules' rash behavior and he's rather wary of her motives. But professionalism overcomes all and our favorite internist helps Jules put together a treatment program for Braxton.
Jules spies Matt at the front desk chatting with Norman. She hesitates, unsure of how to approach him. He spies her out of the corner of his eye, but doesn't interrupt his conversation wtih Norman.
Harriet walks by Jules, pauses, looks to see what Jules is watching and understands what Jules is hesitating about.
Harriet nudges Jules.
H: "He deserves an apology and a thank you for that tough DI diagnosis."
J: "I know."
H: "So what are you waiting for?"
J: "I, uh, treated him rather badly. I don't know how to approach him."
H: "Approach him the same way you deal with the parents of NICU babies."
J: "Thanks." Harriet continues on her way and Jules walks boldly up to Matt. He affects not to notice her until she speaks to him.
J: "Good morning, Matt."
M: (in an even voice; Norman answers the phone) "Good morning."
J: "I wanted to apologize for my behavior lately."
M: "I see."
J: "I know we need to talk legal agreement but I can't deal with that now. Braxton and Tank and Duke are still much on my mind."
M: (cooly) "That's understandable. How are Tank and Duke doing?"
J: "No worse. No better." (she hesitates a moment). "And I wanted to say thank you for helping with Braxton's diagnosis."
M: (very professional) "I've dug up my notes on the infant I diagnosed with DI back in med school. You might be interested in looking at the treatment. There are some potential developmental delays and learning disabilities Braxton might have."
J: "Like what?"
M: "Simon didn't crawl or walk until he was 18 months. Speech was delayed, and Simon was eventually diagnosed with memory problems and ADHD. He got overheated easily and developed hand tremors."
J: (a bit of anguish has crept into her voice) "Braxton hasn't started crawling or talking and he's fifteen months!" (she runs her hand through her hair).
M: (in a reassuring tone) "Early hormone treatment helps."
Norman cuts in.
N: "Jules? Mrs Karlgaard has finally phoned back. She's made an appointment for tomorrow at 2."
J: "Is she still on the line?"
N: "No. She's in Tahoe. Her husband got into a ski accident. Broke his ankle."
J: "When she comes into tomorrow, show her to my office, not an exam room. And reschedule the rest of my patients after Mrs Karlgaard."
Norman: "Righty-o!" Matt smiles.
J: (to Matt) "Got those notes?"
M: "I'll leave them on your desk."
J: "Thank you."
A page comes across the intercom system for Doctor Matt.
Female voice: "Doctor. Matt. Slingerland. Please report to the ICU. Repeat: Doctor. Matt. Slingerland. Please report to the ICU immediately."
M: "That's my cue, and you're welcome, Jules. DI's so unusual, it's rarely tested for." (to Norman) "Hold my patients."
Norman: "Your next patient cancelled and you've no patients until after lunch."
M: "Thanks." (he tips his head to Jules) "See you later. Remember, we're all in this boat together."
J: "See you." (Matt quickly goes out the front doors of Presidio)
N: "So that's why Matt was telling me about DI."
J: "He was?"
N: "Yeah. You know that Matt's an internist."
J: "I know that."
N: "I meant that Matt likes to solve problems, which makes him a great diagnostician."
J: "He's also a pack rat, keeping those notes on Simon all these years."
N: "He's a great coordinator and likes organization."
J: "Matt deals with adult patients and DI's usually diagnosed in infants."
N: "Not from what Doctor Slingerland was telling me. He said that DI can be a result of an underlying illness, or a head injury, or meningitis, or even gestational."
J: "And he kept those notes should he encounter another DI case, even in an adult?"
N: "DI was the first rare disease he diagnosed. His instructor kept contradicting the diagnosis."
J: "So Matt won out and Simon was diagnosed with DI. That explains his pride in keeping the notes all these years."
N: "You got it."
An SFPD officer (Li Cho) walks in the PM offices...he goes to Norman.
Li: "I'm here to see Doctor Lanning."
N: "Ah! For the private abortionist case?"
Jules cuts in.
J: "I've rounds to do in NICU if anyone's looking for me." She walks away while Norman nods as he pages Doctor Lanning. He speaks to Li Cho.
N: "If you'll follow me, I'll show you to her office."
Li: "Thank you."
The two men go off to Harriet's office, where she's waiting to see the SFPD officer. Norman introduces them and takes his leave. Li Cho comes in and sits down at Harriet's invitation. He takes out a notebook and a pencil.
Li: "Your patient said she received a private abortion from a man named Tylar down near Marina Green."
H: "That's right."
Li: "Did she give a last name for Tylar?"
H: "No. And I don't think he would have given one anyway with him being unlicensed."
Li: "Very true. Did you get a description of Tylar?"
H: "That I didn't get. Didn't Vivian tell you about him?"
Li: "Not before she was shot."
H: (shocked) "Shot?"
Li: "The shoot-out last night."
H: "I heard that on the radio this morning."
Li: "They brought her here to UMC. She was in surgery for six hours."
H: "Surgery is Nick Kokoris' department."
Li looks at his notes.
Li: "Doctor Kokoris was the surgeon who operated."
H: (breathing a sigh of relief) "She's in great hands with Doctor Kokoris."
Li: "And a Doctor Matt Slingerland from UMC treated her on the scene."
H: (surprised) "Matt was on the scene?
Li: ""According to the officer at the scene, yes he was."
H: "But I just saw him at the front desk."
Li: "I was in the ICU earlier trying to get a statement from Vivian, just in case she didn't make it."
H: "Isn't she going to survive?"
Li: "At this point, Doctor Kokoris is barely able to hold her condition stable. The only information that I was able to get from Vivian was that she went to a spray-painted warehouse near Marina Green."
H: "She didn't tell me...wait! A spray-painted warehouse? The one that's near Waterfront Street?"
Li: "There are many warehouses near Waterfront Street in Marina Green."
H: "That particular warehouse is a favorite for the graffiti artists. I've used that warehouse as a reference point many times when I give directions. I say, "go straight until you see a spray-painted warehouse, then immediately turn right on Waterfront Street."
Li: "A native secret to navigating Frisco?"
H: (smiling) "Something like that. I'll bet that warehouse is the one you're looking for."
Li: "I hope so. Because the best I can figure out is that we're looking for someone from England named Tylar."
H: "Why do you think Tylar's from England?"
Li: "Tylar's a British name. Did Vivian tell you anything else about Tylar?"
H: "Not much. Just that a few of her friends use him when the need arises."
Li: "Thank you for your time. If any of his other 'patients' come in, direct them to me."
Li hands Harriet his card. Harriet puts the card on her desk, waits a moment, then follows Li Cho out of her office. She goes across to the hospital ICU where Matt and Nick are standing outside the ICU talking quietly. Harriet walks up.
H: "Li Cho from SFPD told me you two have a patient of mine. Vivian Noombi. Is she going to make it?"
Nick hesitates; Matt answers for him.
M: "She was shot five times. Three times in the chest, once in the lower abdomen and once in the face."
N: "Matt came across the scene just after the shootout. If it wasn't for him, she would have died before getting to surgery."
Matt attempts to deflect Nick's compliment.
H: "But is she going to make it?"
N: (takes a breath, then in a solemn voice) "I went in twice to stop the bleeding. Removed most of the liver and one lung. Half her intestines are gone as is her uterus and one ovary. I repaired the aorta. Best I can say is the next 24 hours are very critical."
M: "Where's her family?"
H: "She's emancipated. SFPD didn't inform them?"
M: "Apparently not."
N: "Except for someone calling herself "Sunshine" no one's come to see Vivian."
H: "Can I see her?"
Nick nods and Harriet goes to wash her hands at the foot-operated sink just to the right of the trio. She puts on gloves and a face mask before entering the ICU. Nick and Matt watch her quietly then Nick says:
N: "Guess we should check up on Vivian ourselves."
M: "Good idea." Nick and Matt also wash their hands. Gloved and masked, they enter the ICU and go to stand next to Harriet, who's looking down at Vivian.
Vivian's face is wrapped in bandages and tubes are everywhere. Nick adjusts the IV drip.
H: "Jackie is going to have some work to do."
N: "If Vivian survives."
H: "She's in a coma?"
N: "In and out."
M: (in a warning tone) "She's crashing."
Machines start bleeping insistently and nurses rush towards Vivian's bed. Harriet and Matt step back to allow Nick and the nurses try to stablize Vivian. They watch solemnly as one of the male nurses tries CPR but a thick stream of blood jets out of Vivian's mouth on the first chest push, the blood covers the nurse, the bed and the front of Nick's gown. Nick's mask and forehead are spattered with blood. He is shocked.
H: (softly, to Matt) "Flatline."
Nick realizes the same thing as blood starts to seep quickly through the sheet covering Vivian's legs, dripping off the sides of the gurney. Blood is still pouring out of Vivian's mouth as she flatlines. Nick and the nurses work frantically to save Vivian, cutting open the chest stitches, but to no avail--she's still flatline.
The ICU nurses are shocked, and they look to Nick for guidance. He shakes his head.
N: "She's gone. Too much blood loss." There is silence from the medical staff as the heart monitor steadily bleeps its flatline. Blood is dripping quickly and thickly from the gurney onto the floor in a steady stream.
Male Nurse: "Should we call?" (Nick waits a long moment)
N: "Time of death..." (he glances at the large clock on the wall) "9:16 am."
Matt is upset. Nick tries to comfort him as the ICU nurses cover Vivian and begin to mop up the blood. A nurse comes up to Nick with a sponge. She pats his forehead but Nick waves her away.
N: "She would have died on the street had it not been for you."
M: "I know. It's still hard to see her die."
H: "It's always going to be hard. The other day when I had to tell a woman I had to remove her uterus, it was the most difficult job I had to do that day."
M: "Will I ever get used to it?"
N: "We did our best." (to Harriet) "I noticed the dissolving stitches in her cervix when I removed her uterus. She was pregnant?"
H: "A 'private' abortionist. She was still bleeding so I put some stitches in."
N: "You might want to be look at the pathology report. She also had a small tumor on the ovary that I removed."
N: "Report hasn't come back yet. If it is cancer, any sisters she has need to be aware."
H: "I'll let them know. You did your best, Nick."
N: "Thanks." Harriet takes a last look at Vivian before the sheet goes over her face. She goes out of the ICU ahead of Vivian.
Matt is silently watching the ICU nurses wheel Vivian's sheet covered body out of the ICU.
N: "The bullets were the fragmenting kind. I took out as many as I could find. Vivian really didn't have much of a chance."
M: "So she was already dead the instant she was shot."
N: "That's about it."
M: "And bullet fragments got into her bloodstream?"
N: "Most likely. The autopsy report will tell us what happened. Let me get cleaned up and we'll catch some coffee."
Matt nods and allows Nick to lead him out of the ICU.
Later that day, Nick is talking to the pathologist (Carmen Nogales; in her late 40s) in the Pathology Lab.
N: "So, cancer and fragmenting bullets."
C: "She would have survived the cancer. It was just developing as Stage I." (Carmen goes to a tray on a table and holds up a large bullet fragment). "This is what killed her. Wormed its way into the arteries and ripped her aorta open a few inches from where you repaired it. By the way, excellent work you did on her."
Nick holds his gloved hand out for the bullet fragment and Carmen drops it into his gloved hand.
N: "Didn't help much. This evidence?" Carmen nods as Nick holds the bullet fragment up then drops it back into the tray.
C: "This was the worst GSW case I've seen yet. Where did you train?"
C: "They abetted your natural talent damn well. Hope your skills cut down on my own workload."
N: "So do I."
C: "A fragment sliced the femoral artery and I found fragments in her remaining lung. She didn't have a chance."
N: "That's what I told Matt." Nick and Carmen look up when the doors to the Pathology Lab open and Doctor Matt walks in as if on cue.
C: "I thought you'd be swinging by here, Doctor Slingerland. I've got the pathology report. Heard you got her into Kokoris' hands alive. Great job on the scene." She hands Matt the report. He reads it solemnly.
M: "This explains her last words."
Carmen raises her eyebrow. Matt continues.
M: "She said..." (his voice cracks slightly) "Vivian said to me, 'you won't have much work to do. I'm dead already.' Then she lapsed into unconsciousness."
Nick looks away, a pained look on his face. Carmen looks pained as well.
C: "Crap. I was hoping she didn't know how bad it was. That she was unconscious after she was shot."
N: "She came around briefly just after the second surgery. Just long enough to talk to SFPD."
M: (quietly) "Then she crashed."
C: (sensing Matt's need to see what killed Vivian) "Matt, I know it's rather morbid, but would you like to view what killed Vivian? I haven't closed yet."
Matt hesitates then nods. The three docs walk to a table where a sheet-covered body lies. Carmen starts to pull back the sheet from the face, then changes her mind and pulls the sheet up from the waist, exposing an open chest. Carmen indicates with a gloved hand where Nick's stitches are plainly visible in the aorta and the two inch cut located just a few inches above Nick's sutures.
C: "That's what killed her. That and a slice into the femoral artery."
M: (is silent a moment as he doesn't know what to say. Finally he comments blandly:) "That's a long cut."
N: "Nothing anyone could have done, Matt. We all did our best."
C: "This type of bullet fragments and it's hard for any surgeon to get all the pieces."
M: "They should outlaw this kind of bullet."
C: "Criminals love these bullets. Does more damage that way."
N: "Makes more work for me."
C: "And more work for me."
Carmen pulls up the left lung, which has numerous cuts clearly visible to the naked eye.
N: "How many fragments in the lung?"
M: "Thanks for doing what you could, Nick."
N: "It's what I do."
Matt turns and leaves the pathology lab. He is still upset.
C: "His first shoot-out?"
N: "I think so."
C: "It won't be his last. Nor your last. Hard welcome to Frisco."
N: "Truth be told, it was my first shoot-out as well."
C: "Aren't you with Doctors Without Borders?"
N: "Yes...I'm on rounds in a few. Thanks for your assistance."
C: "Not a problem. Hey, tell Harriet to call me about the pathology report."
N: "Will do."
Nick leaves the pathology lab as Carmen begins to suture the y-incision.
In the cafeteria of UMC, Nick comes across Arleatha Dawson. She is lunching by herself; Nick comes up and sits across from her.
N: "I really appreciate your help in the OR, Arleatha."
A: "You're welcome. You were great but I heard she passed away despite all efforts."
N: "Fragmenting bullets."
A: "Know the type. Saw them all the time at General."
N: "Ever consider a career as a surgical nurse?"
A: "Not until earlier today."
N: "I can schedule you to assist with a few routine surgeries if you'd like. Just to test the waters."
A: "You know Doctor Howland prefers I work with her."
N: "Better use of your skills if you work in the OR."
A: "She's not fond of you."
N: "Nor I of her. What do you say?"
A: "I'd like that. I'd like that a lot."
N: "Good. Tomorrow morning, easy procedure: feeding tube. Scrub in at 7."
A: "That will make my shift a double one but it will be worth it."
N: (standing up) "See you then. Have a good day."
A: "Till tomorrow. And thanks! I have been considering another change."
N: "7 am sharp."
A: (she laughs) "Taskmaster!"
N: "In the OR, yes."
A: "I'll make it 6:59."
N: "Make it then. Good day."
Nick takes his leave of a smiling Arleatha, leaving her to enjoy her lunch.