Plus or Minus an Arm

### November Jensen, India Williams

Blood, guts, and gore are all part of a normal day in the life for me, so when a young woman, probably not even of legal age, walked into the ER with a blood soaked cloth wrapped around what was left of her arm, I barely blinked.

Being a trauma surgeon at Grey Sloan Memorial Hospital, I’m used to the unique and often bizarre cases we are known for. I looked around for any emergency personnel that might have escorted her in, paramedics, police or family, but she appeared to be alone.

“Hello, my name is Dr. Kepner,” I introduced myself, escorting her to the nearest bed.

The young woman’s eyes were constantly scanning the room, as if looking for someone or something. The blood covered cloth around her arm did not look new. My best guess was that it was at least a day or two old, and most definitely infected. Why had she taken so long to come in for treatment?

“Can you tell me what happened?” I asked, reaching to the wound.

She forcibly flinched away from my touch.

“It’s okay, you’re safe here.”

There wasn’t fear in her eyes, but rather something like mistrust.

Fear of a doctor is something I have seen often, in everyone, from little kids to seniors.

“I can’t help you if you don’t let me look at your injury.” It had been a long day, and impatience was leaking into my voice. I slowly reached my hand out again. My patient was on the verge of passing out, and if all the blood on her clothing was her’s, I was surprised she hadn’t passed out ages ago.

Quicker than I could process, her other hand darted out and grabbed my wrist. The strength she was able to exibit surprised me.

“November,” she muttered, “November Jen..” her voice trailed off.

It took a moment for me to process what she was saying.

“Are you looking for Dr. November Jensen?”

She nodded weakly.

Dr. Jensen was a resident a year below me. He mostly kept to himself, but over the last couple of years, had started to open up a little. There still seemed to be a lot of secrets surrounding him, though. Maybe this girl was one of them? Or maybe she was just one of his former patients. Either way, I needed to page him fast.

“What’s the hold up?” Dr. Avery asked, coming up behind me. Despite being a plastics surgeon, he still spent a fair amount of time in the ER.

“She is looking for Jensen, any idea where he is?”

Avery raised an eyebrow,’

“He’s in surgery - but she needs care before he gets out.”

My patient, apparently paying close attention to our conversation, shook her head.

“Only November.” Even with the lack of volume, the intensity was clear.

Avery and I looked at each other, not quite sure how to proceed. I had had patients refuse care before, and even refuse a specific doctor, but never walk into the ER, bleeding out, and refuse to at least be looked at.

Dr. Avery pulled up a chair.

“Can we at least ask you a couple questions, so that it’ll be easier for Dr. Jensen to treat you when he gets here?”

She didn’t answer. I hoped that meant she was about to pass out. Passing out meant implicit consent to provide care, but no such luck. Her eyes were still constantly tracking us and scanning the room.

Avery went through the normal questions we ask every patient: name, medications, what happened, but got no response.

Finally, he sighed,

“Page Jensen again, tell him it’s an emergency. She’s not going to let us help her, nor does it look like she’ll let herself black out anytime soon.”

THe 5 minutes it took Jensen to get from the OR to the ER were the longest I had felt in a long while. Because he was still a residency, there was an attending who was able to step in and finish his surgery. But only in emergencies, and judging by the lack of colour and the laboured breath of this young woman, this qualified.

Jensen arrived at the ER out of breath, and relief flooded my body. When he saw who the patient was, a flash of panic flashed across his face, ut it was gone as quickly as it had appeared and in it’s place, his trademark half smile that seemed to have the ability to put every one around him at ease.

“Patient came in with unknown upper torso and arm injuries,” I began to report, but Jensen didn’t appear to be listening as he did a visual scan. His first question to the patient surprised me.

“Are you okay?”

What sort of question is that to ask someone who just walked into the hospital and is likely bleeding to death? The same though apparently crossed Avery’s mind, as he opened his mouth, but before he could say anything, the patient nodded weakly.

“Coure,” she mumbled with a shadow of a smile. Then she passed out.

“Kepner, I need a … kit and scissor,” Jensen was in full doctor mode now.

Whether he knew this patient or not, no longer mattered. He unwrapped the blood soaked cloth, with practiced skill and …

It was one of the most infected injuries I had ever seen. The arm appeared to have been hacked off several inches below her elbow, but the rotting flesh went a good 6 inches higher. How she had still been conscious, I had no idea.

Avery got a page from the burn unit, leaving me with Jensen, a patient on the brink of death, a ton of questions.

Everything went like clockwork getting her into the OR. It wasn’t until I had scrubbed and was tying my mask that I realized we still didn’t know anything about the patient. I assisted until Ortho came and I had to clear out. Jensen hadn’t said a word aside from medical instructions the whole time.