The Grind: Chapter 3

📊 Global Attending Consensus

The team voted to: Mitch leaves his finger in Bed 2's neck to maintain the stoma, and verbally guides Frankie through a blind femoral cutdown from across the room, risking Frankie dissecting the femoral vein by mistake.

Mitch keeps his left index finger buried to the knuckle in the apprentice's slick cricothyroid membrane. "Frankie! Scalpel! Vertical incision, two centimeters below the inguinal ligament!" Mitch barks, his voice slicing through the Belmont's shrill, failing alarms. "Don't think, just cut! We need that REBOA sheath in the artery now!"

Frankie, hyperventilating and dripping sweat, grips the #10 blade. He slashes down on the machinist's right groin. But his hands are vibrating with terror. The blade slips laterally. Dark, non-pulsatile blood instantly erupts, pooling into a massive venous lake. "I hit the vein!" Frankie shrieks, dropping the scalpel onto the bloody drapes as if it burned him. "I transected the femoral vein!" Tara violently shoves him aside. "Congratulations, Frankie, you found the venous system. Now grab some Kerlix before he bleeds out from the top and the bottom!" she snarls, plunging her fist into the wound to pack it.

But it's too late. The machinist’s monitor flatlines into a sluggish, wide-complex rhythm. Heart rate 28. No palpable pulses. "PEA," Donna announces, her voice devoid of panic as she preps a massive epinephrine push. But chest compressions on an empty heart are a fool's errand; without proximal aortic occlusion and massive volume, he is dead.

At Bed 2, the apprentice violently bucks. Warm mucus, aerosolized iron, and gastric contents bubble up around Mitch’s knuckle, spraying his face—a visceral, olfactory nightmare that instantly flashes Mitch back to the COVID wards. Safiya is still frozen, staring at the suction catheter in her hand like it's an alien artifact. "Safiya, snap out of it!" Mitch growls, wiping blood from his eye with his shoulder. Bed 1 is officially dead without an immediate, miraculous intervention, and Bed 2 is drowning in his own secretions. Mitch has to make the ultimate triage call.

What are your orders, Doctor?

Mitch abandons Bed 2 (leaving Safiya to blindly hold the stoma open) and sprints to Bed 1 to salvage the REBOA access himself, risking the apprentice losing his airway completely.

Execute Option 1

Mitch stays at Bed 2 to definitively place the Shiley tube, ordering Tara to perform a desperate, blunt-trauma Resuscitative Thoracotomy on Bed 1 to cross-clamp the aorta, despite the abysmal survival rate.

Execute Option 2

Mitch declares Bed 1 a futile blunt trauma arrest and orders the team to stop the code, focusing entirely on definitively securing Bed 2's airway, accepting the machinist's death to save the apprentice.

Execute Option 3

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