Photo Credit: iStock.com/Muhammad Gunawansyah

This medical fiction takes place in a chaotic ED where a nurse is assigned an impossible case. As the patient defies all odds, a shocking crime unfolds.

This tale is one of a collection of stories that are like “Final Destination” meets “The Monkey’s Paw” (W. W. Jacobs, 1902). As such, they are tragedies that appeal most to readers who enjoy the inexorable pull of a story arc that leads to doom. The technical details surrounding the event are drawn from real cases in the US OSHA incident report database or similar sources and are, therefore, entirely realistic, even if seemingly outlandish.

My name is Julia. I am a nurse practitioner at St. Barts Hospital, where I am “The Keeper of the Coffee Cabinet Keys.” This is my story.

I mainly work in the emergency department (ED), and at the time of this case, I was assigned to shadow high-risk patients until they were either transferred to another facility or discharged. It was an experimental policy to have nurses function as case managers and was meant to reduce the effects of siloed care and gaps in handoff. I loved the idea, but in practice, it was grueling. Being the bridge between different shifts, units, and specialties meant many people walked over you, and even when they didn’t mean to be aggressive, that is often how it felt when you were the one nagging about all the little elements that can be so important: updating the chart, ordering a lab, asking when the lab will be done, bugging people about when the scan will be interpreted, and on and on and on. It also meant that I had to close the cases of patients who died. Nobody is enthusiastic about finalizing reports and paperwork when hope has flown. Because most of my cases were high-risk or highly complex, the ones that needed a case manager the most were also the cases with the highest mortality rates. So, of all the nurses on my floor, I was the one who saw the most deaths in their patient pool.

There were some surprises, though. I have had some patients who surprised me by leaving the hospital on their own two feet. Sometimes, the human body is just amazingly resilient, and sometimes, a patient who seemed hopeless when they came in would walk out happily whistling a few days later. But holy guacamole, Shannon was different. She was an astonishing case. She was one of those patients who came into my ED in a state that made survival completely unlikely and whose situation was so incompatible with life that her recovery was almost unbelievable. What happened between admission and discharge was even stranger still; I’m pretty sure she murdered a visitor.

Saving Shannon

It was one of those miserable spring Friday nights when winter wanted to show everyone that it still had teeth. A freezing drizzle blew into the atrium every time the sliding doors hissed open, and it left the rubber button tiles in the ED entrance glistening and slippery. The ambulance service had radioed ahead that they had three patients from a single motor vehicle accident: a driver with a dislocated thumb, an EMT with a lacerated hand, and a woman, 20-25 years old, estimated to be 5 feet, 4 inches, and 138 pounds, with lots of injuries. The list of injuries for the woman was diverse—hand, forearm, lower leg, upper leg, chest, face—but it was the other thing that got everyone in the ED lifting their heads and explaining why the ambulance crew had wanted to radio ahead. “We don’t think her skull is attached to her spine,” they said.

Dr. Jo Gallegos had shot out a hand and shouted back: “Repeat that last, her what is not attached to what now?” The message was repeated: yes, they thought her skull was not attached to her spine because her chin was touching her chest between her breasts, and her head was unstable. The doctor stared up at the stained ceiling tiles for a moment and exhaled, and then there was an absolute flurry of orders. “Julia, case manage this; Abby, call neuro; Glen, wake up radiology; you, get me orthopedics and ask for their best tech to be woken up and hauled here; you, get out the tools, we need all the splints, extenders, cutters, screws, and old spine boards you can find. This is going to be a custom job, and we are fighting very very long odds, GO! … GO! … GO!” That was the start of a frenetic and very weird prep for a very unusual case, but nothing prepared me for seeing Shannon when the EMT was hauled into the ED.

The EMTs brought the stretcher in like it was packed with explosives. They were half-carrying and half-rolling it, taking care of every tiny bump. I was the first nurse at the patient’s side and continued the transfer of information. Car into truck, frontal impact, no airbag. Shannon had hit the dash face first, and the hand and arm injuries were possibly from guarding. She had slid down and into the footwell, and then the impact deformation had pinned her there. The EMTs had used at least six of those foam blocks to keep her head still and her neck from moving and even strapped her up so her shoulders and torso couldn’t move. They had inserted a plastic airway, and her whole body was strapped to a scoop stretcher, so if she needed to be moved or tilted, her entire body moved in one piece. That made shifting her to the hospital bed much simpler, too. One lucky thing was that the EMT with the hand laceration had been in this accident, and long after his team had left, he could still answer questions. Shannon dipped in and out of consciousness as we got her stable, secured her head, and sent her for a CAT scan.

The next few hours saw all the imaging, labs, and tests come back, and sure enough, her top vertebra had torn away from the base of her skull and had quite miraculously squeezed her spinal cord a bit but didn’t cut it. By the time the team had built a metal cage with bone anchors and myriad adjustable joints, she looked like something out of a nasty science fiction movie I once saw, and the KitKat I had slipped into my bra for a snack was a melted soggy mess. While the tech was fussing about making more adjustments to the cage with some sort of screwdriver, I sat in the corridor on a garbage can and fished bits of chocolate out of the packet with a tongue depressor. Dr. Jo walked past and laughed in that throaty way she had. “You go, girl! Keep that blood glucose up; it’s still going to be a while.”

From ED to Orthopedics

She was right. It took many more hours until Shannon was moved out of the ED and admitted to a telemetry bed in the orthopedic ward. As the case manager, I moved with her, and so did some of the ortho techs responsible for her skeletal cage that kept her head and spine together and aligned. I had seen them around before, but now I was face to face with the sort of stuff they constructed, and it was fascinating but also toe-curling. I’m a nurse, and I’ve seen many things, but steel rods going into a patient’s skull, neck, and collar bones were something else. Even days later, they were still tweaking the tension and depth of some of those rods. I don’t mind telling you, it made me cringe for Shannon’s sake. Quite often, they left tools or connectors behind, and I would pack them neatly into her bedside unit drawer or at least arrange them neatly on the tabletop.

After a couple of days, we settled into a routine. I would visit Shannon in the morning, afternoon, and evening before I left. If I was on the night shift, I would check in after she was sleeping. Shannon turned out to be a scream. She was funny, clever, and dropped f-bombs in ways that made me snort-laugh and sometimes earned me a raised eyebrow from the nurse manager. Her eyes had crossed because of the brain injury, and sometimes, she would close one eye, fix me with the other, and say something so inappropriate and funny that I had to leave the room. The whole scene was just so otherworldly and funny but also incredibly poignant and sad. Sometimes, I would leave her bedside laughing but be in absolute tears by the time I reached my car. I knew how unlikely her long-term survival was, how incredible her survival had already been, and balancing that knowledge with how alive and vibrant she was every waking moment sometimes just left me sobbing. Most of the nurses were affected that way by Shannon, and I swear I once caught Dr. Jo wiping away a tear.

Unwelcome Visitors

Shannon’s visitors were a whole different crowd and honestly didn’t fit the image of the young woman I had come to know. That’s where things got weird one day. Her boyfriend was a jerk. He had been one of the three patients that came from the accident. He had strained a thumb on the steering wheel, the EMT had sliced open his hand on jagged metal on the car, and here was Shannon with a steel construction keeping her head on. He came in with a bunch of noisy buddies, most of whom stank of weed or booze or both. They weren’t witty, or clever, or even artsy. They were just messy assholes, and the other nurses and I had to tidy up after them. I had to leave when the boyfriend started going on about how he was the victim. If I had stayed, I would have hit him in his stupid face with a kidney basin and lost my job.

When I came back after visiting hours were done, Shannon was sleeping because the IV drug machine had delivered a dose of painkillers. She looked almost angelic lying there still and peaceful, with her steel halo, but then I saw blood spatters on the floor and the crumpled heap of her boyfriend. I rushed to see if I could deliver care, but the torque screwdriver sticking rigidly out of the nape of his neck told me that he was far beyond my help. I checked their vitals; a carotid pulse was absent, there was no sign of breathing, and his pupils were blown. I hit the code button on the wall to call the crash team, and I tried to do chest compressions, but the handle of the torque driver sticking out the back of his neck complicated it. The crash team doctor called the time of death pretty soon after. It was ironic that he died right next to Shannon from almost the same injury that she had survived.

The cops were all over the place for a while, and the rumor was that they were after two of the boyfriend’s buddies who had visited that day. One of the nurses said there was something about an argument over drugs, that two of them had been caught smoking dope or shooting up right there in the hospital. The story went that both had died in a gang fight a few weeks later, but I don’t know about that. When Shannon left the hospital, she still had her cage, but they had simplified it a lot, and after a few more weeks of healing and bone regrowth, it was removed.

Bouncing Back

I saw Shannon a few more times over the next 3 years. I wasn’t doing case manager work anymore, but I just wanted to see her again. The squint was mostly gone, but she needed a tracheostomy. The last time I saw her, she had a trachea that looked like a choker necklace, a few more tattoos, and her hair was multicolored, but she was otherwise still hilarious and full of bounce. I don’t think I will have many patients like her in my life, and I treasure those moments.

My name is Julia. I am a nurse practitioner, and as Dr. Jo or Shannon might say, that was my story.

Click here to read “Shannon, Part 1: Growing a Spine,” in which you learn about the details of Shannon’s accident—and the days leading up to it—from Shannon’s point of view.

Editor’s Note: This is a fictionalized tale that is based on a true story.