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“We’ve got incoming!” the charge nurse calls. “Trauma to resus room 1, ETA five minutes. Blunt force trauma to the chest.”
Fuck my entire life, Sophie thinks, because she’s the nurse in charge of resus room 1 and she was really hoping to not admit anyone tonight. But them’s the breaks in the Bludhaven General ER - not the busiest ER in New Jersey, but second only to Gotham General, which even Sophie isn’t masochistic enough to work at.
There’s a flurry of motion around the room. RT materializes out of thin air with the intubation kit - to ward off the bad spirits, she says with a wry smile - and somebody pages x-ray to be on standby. The night shift doc leans against the doorway with a haggard expression. Sophie gets meds ready, makes sure that the room’s got most of what she’ll need, and joins the doc against the doorframe.
What comes in is both everything and nothing like she expects. EMS brings their stretcher in, lines it up with the one in the ER, and says to the RT, “on your count.”
“One, two, three.”
And they move over a gasping and writhing patient, clearly struggling for each breath.
“Heart rate has been climbing since we picked him up, blood pressure is getting softer.”
Sophie hears the report, but she’s staring at her patient. Nightwing, the fucking protector of Bludhaven, is the one struggling for breath in the ER bed. She hears the paramedic add, “he doesn’t want us to take off the mask,” as she hooks up the ECG leads and loops a blood pressure cuff around his arm. Somebody cuts his suit straight down the chest, baring it to the room.
A blood pressure that makes her stomach flip pops up on the monitor just as the doc starts discussing if they need to intubate. Somebody’s asking where x-ray is. ER techs are lined up outside the door, hovering in case they’re going to need compressions.
“Get me a needle decompression kit just in case,” the doc says.
And then the RT adds, “I don’t have breath sounds on the right side.”
“BP is tanking,” Sophie says.
“Sir? Can you hear me?” somebody else asks. Presumably Nightwing can’t, because he does not respond.
Oh fuck. Of course this is how her night’s going to go. Sophie’s fingers fly up to his neck, checking for a pulse. On the other side of Nightwing’s neck, the doc is doing the same thing. At the same time, they look up, and agree that it’s absent.
“Start compressions,” the doc orders.
No matter how many times she’s done this before, it never gets easier to hop on a person’s chest. Knees up on the bed, locked elbows, back straight, hinging at the hips. There’s no airway in yet, so she counts them out loud. One hundred to one hundred and twenty beats per minute. Two inches in. Allow for full chest recoil. This isn’t Sophie’s first rodeo. She doesn’t bounce off the chest. It’s textbook, the haze of adrenaline taking over.
Somebody slips defib pads onto his chest.
The RT counts with her, bag-valve mask ready to give rescue breaths.
“25, 26, 27, 28, 29, 30.”
Then the two huffs of rescue breaths being delivered. Only the left side of his chest rises. Another pad is placed on the center of Nightwing’s chest. Sophie places her interlocked hands on it and goes back to compressions.
More people are filing into the room now to help. The doc announces, “PEA arrest, presumably tension pneumothorax. Where’s that needle decompression kit?”
Another doc works with the RT at the head of the bed to get ready for intubation.
It’s quick. The video laryngoscope is slipped into Nightwing’s mouth. Sophie doesn’t stop compressions.
“I need suction.”
Sophie keeps compressing. Nightwing’s sternum flexes beneath her hands.
“Do we have epi ready?”
“Got it here. Pushing 1 milligram epinephrine.”
“1 milligram epinephrine in at 0125.”
“Got a number eight ETT in at twenty-one. Good colour change.”
“ETT in at 0126.”
“Time for a pulse check.”
Sophie comes off the chest while someone else checks for a pulse. She’s breathing heavy, sweating buckets, just about ready to fall on the floor.
“Still no pulse. Restart compressions.”
The next person in line starts CPR. Sophie gets back to the end of the line, praying to god that they don’t end up needing to do compressions that long.
“Landmarked for needle decompression.”
“Go ahead.”
There’s a brutal hiss of air from Nightwing’s chest. On the next rescue breath, Sophie tries to convince herself that there’s bilateral chest rise, now.
“Time for a pulse check,” the recorder informs. “And another epi, if we need it.”
“Push epi.”
“1 milligram epinephrine in.”
“1 milligram epinephrine in at 0128. Pulse check?”
Sophie waits with bated breath as they do another pulse check.
“I’ve got a pulse,” the doc says, and everyone in the room lets out a collective sigh of relief. “I want an art line, chest tube, an NG in to drain the stomach, let’s get a normal saline bolus and-”
The usual hustle and bustle of post-arrest care takes over.
“So do we like… call the Justice League?” Sophie asks the doc once Nightwing has been adequately stabilized. His blood pressure is better, RT seems happy with the vent, and they’re fairly certain that his biggest problem is a few broken ribs that caused the tension pneumothorax.
Doc Anderson shrugs. “You got a number for the Justice League?”
“Um. Do we think that Gotham General can contact Batman?”
“Maybe? I’ve got a friend who works over there, I’ll give her a call and see if she knows anything. I think it’s probably best if we keep this one under wraps.”
Sophie nods her agreement. The thought of anyone unsavoury discovering that Nightwing is laying helpless in the ER makes Sophie’s stomach turn. She’s never personally been saved by him, but he’s dropped off a bunch of overdose patients at the ER doors just in the nick of time.
She sits down to chart once Doc Anderson leaves. And then she pauses, staring at the Head-to-Toe section of Epic, and grimaces.
PUPILS:
Something tells her it’s probably a monumentally stupid idea to chart Other: patient wearing a mask. It’s not like she’s naive to the corruption within Bludhaven, and hacking the medical records of every John Doe in the ER is hardly a drop in the bucket for the mob. So instead of telling the truth, Sophie lies for the first (well, not the first, but a respiratory rate of eighteen isn’t a big lie) time in her charting.
PUPILS: EQUAL, ROUND, REACTIVE TO LIGHT AND ACCOMODATION. Is it realistic given his current condition? Maybe not. But she hopes his pupils are okay under that mask.
Doc Anderson comes back to the room a handful of moments later. “So my friend wasn’t sure how to get in contact with Batman,” she says. “Uh. She said we could try calling the GCPD? Talk to Commissioner Gordon?”
“I’ll give them a shout,” Sophie says.
It’s a relatively quick initial conversation: Sophie calls the GCPD and asks to speak to the Commissioner. The secretary asks why. Sophie says she’s calling from the Bludhaven ER regarding a patient. They say, “okay, one sec,” and then she’s put on hold.
“This is Commissioner Gordon.”
“Um. Hi. My name is Sophie, I’m an RN at the Bludhaven General ER and… I think I need to talk to Batman?”
At the hour mark, Sophie kind of figures that either Commissioner Gordon couldn’t get a hold of the Gotham vigilante, or he’s not showing up.
And then, all of a sudden, he’s there. In the corner of the resuscitation room. Like he’s always been there. As if sneaking into a brightly lit emergency department is just a regular fucking Tuesday.
“Uh,” she says, “hi.”
“What happened?”
Well. Straight to the fucking point, then. Sophie’s not really sure how HIPAA applies in regards to superheroes, and she didn’t really think this would be her problem, and now she’s not entirely sure what to do about having Batman hanging out in her ER.
Her mouth opens, shuts. Is she allowed to tell Batman about Nightwing’s sudden medical event? Calling him was kind of a shot in the dark. “Um. Obviously we didn’t take off his mask,” she says, “and… I’m not really sure if the Justice League has a protocol for this kind of thing? Is Nightwing a Justice League hero?”
Batman levels her with a look that makes her grimace.
“Look, he’s still got a right to privacy, okay?”
A tense moment passes. “He’s my son,” Batman says. “There’s a doctor in Gotham that we trust.”
Okay. The hospital has a protocol for transferring critical patients. That, at least, Sophie is familiar with. “A doctor as in a hospital, right?”
“A doctor.”
“Look. Batman. Respectfully, your son is intubated. He’s got a chest tube in. Transferring a critical patient is kind of a whole thing, okay? I need to know that the facility accepting him is qualified to take over his care. I do enjoy having a nursing license, you know.”
To her genuine shock, Batman deflates almost immediately and scrubs a hand over his face. He looks, suddenly, much older. “What happened?” he asks again, hoarse.
“Blunt force trauma to the chest,” Sophie says, turning off the frustration and switching on the part of her that’s good at dealing with families facing crisis. “It caused a tension pneumothorax. That’s when-”
“I know what a tension pneumothorax is.”
“Unfortunately, when he arrived in the ER, he was doing quite poorly. His oxygen was very low, and he was struggling to breathe. During our initial workup, he went into cardiac arrest.”
Batman sucks in a sharp breath.
“We were able to decompress the pneumothorax and get his pulse back after four minutes of CPR. He was intubated during the cardiac arrest. His initial chest x-ray shows that his right lung is reinflating well now that the pneumothorax is draining, and his chest tube is letting out less air than it was an hour ago, but it’ll have to stay in a while longer.”
There’s no chair for him to collapse into, considering that the room is still a bit of a disaster from the active resuscitation not even two hours ago, so Sophie offers Batman the one she was sitting in to chart. He falls into it heavily, and buries his face in his hands.
“He wasn’t down for very long,” Sophie says, which she hopes is reassuring. “Once we got the air out of his chest, we were able to get his pulse back and his oxygen levels up very quickly. He’s on some medication for his blood pressure still, but we’re weaning down on that.”
When Batman says nothing, Sophie continues. “I understand why you don’t want him to stay here. It’s a risk of his mask getting taken off, right? But he needs ICU level care. Not just a clinic, not just one doctor who you trust. So… I don’t know if the Justice League has access to that kind of thing, or-”
“Arrangements can be made,” he says, and then takes a deep breath. “I-”
“You can stay with him a while,” Sophie says, “I’ll get you a comfier chair.”
Batman does stay a while. He stays, in fact, until it’s almost light outside, then whispers something under his breath that Sophie doesn’t quite catch. Sophie hasn’t got a way to verify that he’s actually Nightwing’s dad, but he definitely acts like it, what with the hand-holding and general air of worry surrounding him.
“An associate of mine will be coming to make sure he’s ready to be transferred shortly,” Batman says.
Sophie nods blankly. “Um. Okay. My shift is over in like, two hours. So… is day shift going to deal with that transfer, or?”
“It’ll be done by then,” Batman says. “Thank you, Sophie. For making sure someone called me.”
“Of course,” Sophie says.
And then a moment later, fucking Superman shows up, somehow also able to sneak into the ER like he’s not wearing bright blue. “Oh, jeez,” he says, and lays a hand on Batman’s shoulder. “I got everything set up for him. We can take him soon.”
“So who am I giving report to?” Sophie asks. “Do they have a phone number, or-”
“His electronic chart has already been sent,” Batman says, like that’s not absolutely insane. “Again, Sophie, I really appreciate your help.”
“Yeah. No problem. Let me just get Doc Anderson, she can make sure you’re all filled in.”
“That would be appreciated. Thank you.”
Sophie hightails it out into the hallway, barely remembering to shut the curtain behind her, and finds Doc Anderson at the nurses’ station with a cup of coffee and a faraway look in her eyes. “Is everything okay?” she asks. “I’m holding off the ICU transfer just in case, y’know…”
“Um. Yeah. So if, hypothetically, the Justice League said they were going to be taking him to their own medical facility, how does one go about preparing for that transfer?”
“You’re joking.”
“Nope.”
Doc Anderson leans in closer and hisses, “did fucking Batman show up?”
“Uh huh. And Superman. No big deal, right? That’s… super normal.”
She leads Doc Anderson back into resus room 1, then stares, open-mouthed, at the empty bed where her patient used to be.
“You’ve gotta be shitting me.”