Disclaimer: Characters and concept belong to Kevin Williamson and WB.

Note: This is how 'Breaking Away' might have worked out differently for the Capeside teens. Thanks to Joey P (no relation) for introducing me to Dave and Tim.
 
  One: The living end

Elena Owens tugged off her white coat, shoved it unceremoniously in her locker, and then slammed the door shut with a satisfied sigh. It had been a long stressful shift and all she wanted to do was go home and sink into a deep warm bath, perhaps with some Billie Holiday and a glass of wine. With her mind formulating these plans, she wandered over to the admissions desk to sign out, signifying that she was officially off duty. With her pen poised above the doctors’ log, she heard the words she dreaded.

“Lena? McGrath just called. He’s come down with some kind of stomach ‘flu,” reported Clarise Butcher, the formidable head nurse in the ER.

“That’s a real shame, Clarise. Be sure to give him my best,” Elena mumbled, intent on getting her name signed so she could leave. But the clipboard was snatched out from under her hand and the older woman fixed her with a no-nonsense stare.

“He’s not coming in. And Abraham's still in surgery, bowel resection. Looks like you’ll have to cover.”

“Can’t you get someone else?” whined Elena, but Clarise’s raised eyebrows told her not to even bother. No one would come in and work a graveyard shift at this late notice. Elena saw her daydreams of a long relaxing bath fade away into the sunset. She gave it one last shot. “I’ve just worked all day, I’m not doing the night shift too. I’m not an intern anymore.”

“What do you expect me to do then?” said Clarise Butcher in a tone that was annoyingly patronizing. She was the self-proclaimed boss of the emergency room, having worked there for the last 35 years. But it still irked Elena that she treated the doctors as inferiors, and expected them to do as they were told.

“Isn’t Devon still here?”

“I’m not having an intern here without a resident.”

She sighed and gave up trying to argue. Elena saw the self-satisfied gleam in the nurse’s eye and knew she was defeated.

“Fine, I’ll stay. But I’m going to the doctors’ lounge to have something to eat and then I’m planning to sleep. I don’t want to be disturbed for anything less than an all-out catastrophe. Let Devon handle the walk-ins and drunks.”

“Yes, Doctor,” smiled Clarise sarcastically. “I’ll be sure and do that.”

Elena ignored her mock submission and stomped back towards the lounge, settling for a soda instead of a good burgundy. She flopped into one of the armchairs and wondered what she had done to deserve a double shift. Determined to try and forget she was still on duty, Elena reached out for a magazine and settled back in her chair. After several minutes, just as she was getting comfortable, Clarise Butcher was at the door.

“We’ve got an MVA casualty coming in, ambulance is few minutes out,” she said perfunctorily.

“I’m not supposed to be here, Clarise,” Elena answered evenly, still flipping through the magazine.

“Suspected SCI. I thought you might want to take it instead of your intern.” Nurse Butcher snapped her head back and disappeared into the ER.

Elena sighed tiredly again, and shut her eyes for a few seconds. There were be no time to relax yet, not with a car accident victim to deal with. Spinal injuries were the worst. She had a feeling that it was going to be a long night.

* * *

Elena pulled on a fresh coat and gloves and joined the other staff waiting by the ambulance doors. Clarise Butcher had them all well trained for such emergencies, and all preparations had been made in the exam room to treat a suspected spinal cord injury.

“Have you warned them upstairs?” Elena asked as they waited impatiently, straining to hear the first sound of a siren that would herald the approaching ambulance.

“Of course,” replied Clarise indulgently. As if she needed reminding on ER procedures.

Finally they heard the ambulance and saw its flashing lights. The emergency medical technicians pulled open the doors and snapped to attention as the ambulance drove into the bay. Its back doors flew open and the paramedics were there to ease out the gurney with the prone victim strapped onto it. Elena immediately saw the backboard, neck brace and hand air pump, and looked around for any sign of the other doctor on duty.

The young intern ran up the corridor and panted a breathless apology to the resident, having been in the cafeteria when the call came in.

“Nice of you to jon us, Dr Devon,” Elena said dismissively as the ambulance officers wheeled in the gurney and began their rundown. “What have we got, Mike?”

“15 year old male, jeep he was driving was hit side-on by a truck. We had a helluva time getting him out. Blunt chest trauma, suspected SCI, possible broken ribs. BP’s down to 70 over 40, pulse 120. Accident happened about an hour ago and he hasn’t regained consciousness. Pupils are equal and reactive. Resps 16 and shallow, there are decreased breath sounds on the left, so we started bagging him in the ambulance. Multiple lacerations and abrasions. He’s had 20 mg of morphine on site and an IV of normal saline.”

By the time the paramedic had completed his report they were in the exam room, and the ER staff went about their respective duties automatically. They positioned themselves on either side of the back board in preparation to move him onto an ER gurney. Elena waited to see that everyone was ready.

“Okay? On my count, people, nice and gently. One… Two… Three… Lift.” The transition went smoothly and the staff flew into action once more. Elena had to admit that even though Clarise Butcher was a tyrant, she ran an extremely efficient unit. She gave the boy the once over herself while keeping her eye on the intern who was checking reflexes and the nurse confirming vitals.

“Devon?”

“No reflexes.”

“Breath sounds are poor. Intubate him and start another line, continue normal saline.”

“BP’s still 70 over 40, pulse ox 85.”

“Do we have a name?” Elena addressed the paramedics again.

“Pacey Witter, resident of Capeside.”

“As in Witter, the sheriff?”

“I guess.”

“Karen? Contact his next of kin,” Elena said to an EMT. Turning her attention to the patient, she tried for a response. “Pacey? Pacey, can you hear me?”

When there was no response, she began firing off rapid instructions to various staff. “Do a cross-table c-spine and get Donnell down here. Tell him we’re looking at a possible cervical-thoracic injury and collapsed lung. Start him on dexamethasone on an IV push and order a CT scan. Do some blood work... CBC, Chem-7, type and cross-match. Start him on some O Neg, we don't know about internal injuries yet. We'll also need a catheter... Devon?”

“I’m in,” the intern reported, having completed the intubation. "GCS is 5."

“Okay, put him on the vent. We expecting any other victims?” she asked the nearest ambulance officer.

“Truck driver’s okay, 15 year old passenger in the Jeep has lacs and a suspected concussion. Roberto’s bringing her in now. She wouldn't come until we brought this one in first.”

“Devon, you take her,” Elena said brusquely as the portable x-ray machine was wheeled forward. As the ER staff donned lead vests, she nodded to the paramedics that they could go.

Tom Devon backed out of the room as he ripped off his gloves and trotted down the corridor to meet the next ambulance. A dark haired girl was wheeled into the ER, fully conscious and looking completely petrified over her neck brace. The right side of her face was covered in blood but even from a first glance he could see her injuries were minor compared to the driver’s. He allowed the paramedic to go ahead with his report.

“Josephine Potter, 15 year old passenger in the MVA. Facial lacerations and multiple abrasions. Says she lost consciousness briefly after the accident. Possible concussion, BP’s 110 over 80.

“Let’s get her into Exam Two.”

They moved the girl onto a hospital gurney and Devon smiled down at her.

“Hi, Josephine, I’m Dr Devon. How are you feeling?” He shone a light into her eyes and inspected the gash on her forehead without waiting for a response.

“Is Pacey all right?”

“He’s fine, they’re taking care of him next door. What about you, Josephine?”

“Joey.”

“Huh?” he murmured, checking her head for any other lacerations.

“My name… Joey.”

“Sorry, Joey. Do you know what day it is?”

“Sunday.”

“Good. Can you tell me where it hurts?”

“Is he really okay? He didn’t wake up after…” Joey’s words trailed off as she regarded the doctor carefully, looking for contradiction in his eyes.

“Pacey’s injuries are serious, but we’re doing everything we can to make sure he’s all right,” Devon replied calmly. Joey didn’t seem to believe him and he wished he was a better liar. “Let me worry about you for a moment, then I’ll go and check on him for you, okay? Where does it hurt?”

Joey stalled her response, but then decided to trust the doctor. “My head.”

“Anywhere else?”

“My chest, a little.”

Devon cut her shirt away and inspected the bruising on her tanned skin. He could see the oblique red mark from the seat belt she had been wearing. After carefully prodding her abdomen he concluded she was very lucky, there didn’t appear to be any internal injuries.

“Get the portable x-ray after Owens is finished with it, I still want a CXR," he said quietly over the gurney to the nurse who was opposite him. He turned his attention back to Joey, and gently eased the cervical collar off. Another nurse began cleaning the blood off her face.

“Okay, Joey, we’re just going to make sure you don’t have any broken ribs or anything else. That cut on your head is going to need some stitches and we’re going to keep you here to make sure you don’t have a concussion.”

“Can someone call my sister?” she asked softly after digesting the news.

“Sure, sweetie,” the nurse said kindly. “What’s her number?”

Joey told her who and where to phone. She tried not to think about how Bessie would react when she got a call from the hospital in the middle of the night. She was too busy worrying about Pacey anyway, and turned her attention back to the young doctor.

“You said you’d find out how Pacey is.”

“We’re going to take an x-ray of your chest first, Joey, then—”

“Please,” she interrupted him, her dark eyes pleading. Devon softened, seeing her frantic worry, and acquiesced.

“Okay, I’ll go and find out how he’s doing. But then the x-ray and stitches, all right? No arguments.”

“Okay.” Joey smiled weakly at his friendly tone, but it didn’t alleviate the fear in her heart. She remembered looking over at Pacey in the car and seeing his body slumped against the door like a rag doll. She had called his name repeatedly but he didn’t answer her… Joey blinked back tears as the doctor smiled back at her and walked away. She had to know he was all right.