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whumpetywhumpwhump · 3 months

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Posting one of my actual (fandom-related) full fics on here... be nice!!

This is some good ol' intubation whump because it's my favourite.

(for slight context of character, see this old post)

When the call comes in, everybody in the ER is hoping it isn't Coop. Especially Neela.

Severe asthma attack. 26 year old male.

Somehow, because it's his day off and he really ought to be relaxing, it seems almost impossible for him to find himself back in the hospital as a patient. It just… isn't fair.

That doesn't stop the wheels of the gurney from rolling through the doors, though. Doesn't change the fact that Coop is laying half-conscious on top of it, his quick, shallow breaths fogging a nebulizer mask, his skin so pale it looks ashen.

“26 year old male,” the paramedic conducting the transfer restates. “Severe asthma attack with symptoms pointing to onset of status asthmaticus. Albuterol administered, as well as 0.5mg subcutaneous epinephrine, both to minimal effect.”

Dr Lewis, the attending on the case, moves to Coop’s side, slipping the chest piece of her stethoscope underneath his t-shirt as they continue to move into one of the trauma rooms. Her expression, when she withdraws it, is severe.

“His airways are pretty much closed up. He needs more epi now.”

Abby hurries to drag a crash cart in, and Neela follows the gurney all the way until it's positioned in the trauma room, at which point she starts readying an IV kit with shaking hands.

Coop does not look good. Even when compared to the time she almost killed him with epi. At least then he'd been alert, sitting up, and his skin hadn't lost all of its colour like it has now.

Dr Lewis returns from fetching some more equipment, and as she waits for Abby to arrive with the crash cart, she strokes Coop’s hair reassuringly.

“Hang on, sweetheart, we’re going to help you feel better. Just keep breathing for me, okay?”

Through weak wheezes that emerge from blue-tinged lips, Coop nods. His eyelids are heavy with exhaustion.

Neela hasn't seen an asthma attack this severe in person before, but she knows from med school how dangerous they can be- especially when the patient is as tired as Coop is. It isn't clear how long he's been struggling this much to breathe. The colour of his skin (or lack of, for that matter) tells her it's been too long.

If they don't work quickly, his body will run out of energy. He'll stop breathing, too exhausted to even inhale anymore. He'll lose oxygen.

He'll die.

“Neela, I need an IV of 100mg hydrocortisone.”

She turns to find Dr Lewis’ keen gaze on her. There's a thinly veiled panic in the attending’s eyes that quickly disappears as she turns back to Coop, gently trying to reassure him as he fights for air.

“I’m going to page Pratt as well, alright, Coop? He can get you some more albuterol so your nebulizer doesn't dry out.”

Neela can't see whether Coop replies, but if he does, it isn't audible. All she can hear is his terrifying wheeze and the hum of the nebulizer, shortly joined by a rapid beeping as a nurse finally helps him take off his shirt and hooks him up to a monitor. She doesn't dare turn around to look at his oxygen saturation. It's likely going to keep plummeting.

Instead, she focuses on setting up the cannula in Coop’s trembling arm, her left hand holding it steady while her right slides the needle in.

“There we are, Coop.” she murmurs. “You're doing so well, sweetheart.”

The pet name feels stranger coming from her lips than Dr Lewis', but at this point her slight blush is the least of their worries. While Coop’s this sick, it doesn't matter what she calls him. He just needs to start breathing properly again.

Once the IV site has been secured with a clear sticker, Neela measures out the dose of hydrocortisone. 100mg. When they're giving it as a steroid over a longer period of time, they prescribe 20-30mg a day, in two doses. The fact that they're pumping him full of this much at once is testament to just how emergent his case is.

“100mg hydrocortisone going in.” she announces. Connects the needle to the cannula. Pushes down on the plunger of the syringe.

Despite her accumulated knowledge surrounding medication, Neela still half expects the effects to be immediate. For Coop to suddenly relax, his airway opening up again, the colour gradually suffusing his cheeks. For the wheezing to fade as he breathes in properly for the first time in hours.

It doesn't. None of this happens.

Minute by minute, Coop continues to deteriorate. Abby brings in the crash cart. Dr Lewis injects the epinephrine beneath the skin of his forearm and, unlike before, he doesn't even react to the needle. His eyes flicker like his awareness is slipping away from him.

By the time Pratt arrives to switch out Coop’s nebulizer, such a small intervention becomes pointless. Even if Coop were able to breathe properly, time has proven that albuterol, on this occasion, just isn't working. Pratt sets down the new nebulizer and instantly crosses to Coop’s bedside, brow furrowed.

“Coop, man, can I listen to your chest?”

A barely perceptible nod.

When Pratt presses the cold stethoscope against Coop’s heaving chest, it seems more of a confirmatory action than one that's actually necessary. He sighs, shaking his head. Coop, as evidenced by the blue tinge to his lips, his rolling eyes, the pallor of his skin, is officially status asthmaticus.

He's in respiratory failure.

Things suddenly grow a lot more urgent. Pratt gives Lewis a gesture that she reciprocates, and a nurse pulls the crash cart closer to the bed. Neela’s heart sinks just as Abby sinks into position right at Coop’s bedside, crouching next to him as she strokes his hair and updates him.

“Sweetheart, your breathing isn't where we need it to be, okay? You're not getting enough oxygen. We need to put you to sleep for a while… intubate you. Do you understand?”

Coop closes his eyes, humming in assent even as a frightened tear slips down his cheek.

“Ju-just… d-d-do… iiiiit.”

His voice is shot. Weak. Resigned to his fate.

It's the same phrase he used when Abby shocked his heart back into a regular rhythm a few months ago. Back then, though, it had simply been a plea to get things over with.

Now, it seems not only a desperate entreaty, but also a solemn reminder:

I’ve been here before.

Neela knows, just as the other staff do, that Coop’s been super sick a couple of times. He knows what it's like to wake up in the ICU feeling like you're breathing through a straw. He knows what it's like for weeks to pass in the span of a minute.

He knows that when he's tubed, he can breathe, and that’s all that matters.

“We’re going to look after you, sweetheart, I promise.” Abby says, her own eyes a little misty. She brushes the sweat-damp hair from his forehead and squeezes his hand. One of the other nurses adjusts the bed so it's laying flat. The tears, terrified, continue to stream silently down his cheeks.

Abby lifts his hand, pressing an almost motherly kiss to the back of it, while Pratt slots a syringe full of medication into the cannula of his other hand.

“Propofol and some muscle relaxants are going to go in now, man. Just relax and let yourself drift off- we’ve got you.”

As the syringe is pushed, Neela can see Coop’s grip on Abby’s hand loosen. The thick tears decorating his cheeks seem, in themselves, to slow down, the scared expression in his eyes melting away beneath the anaesthetic. He blinks once. Twice.

Gone.

There's something so unnerving about Coop being still. How, as Pratt brushes his index finger underneath Coop’s eyelashes, the latter doesn't stir at all to crack a smile. When Dr Lewis gets into position behind his head and adjusts her patient accordingly, he's limp and movable. Floppy.

“Pratt, can you get that nebulizer off?”

“Sure.”

There are red marks across Coop's face from where the straps of the mask dug into his skin for hours. Now, he doesn't breathe at all. He looks dead. According to the dropping numbers on the monitor, he may as well be dead.

“Laryngoscope.”

“Here. Laryngoscope.”

A nurse places the metal instrument into Dr Lewis' awaiting hand. Her other hand gently tilts Coop’s head back.

“Alright… sliding laryngoscope in… got slight cord visualisation. Tube?”

“Tube.”

Neela watches her angle the endotracheal tube in with bated breath- and for good reason.

“C’mon, Coop.” Lewis murmurs, desperately trying to gain access. “I need to help you breathe, sweetheart. Let me help you breathe.”

Pratt steps up next to her, arms crossed. “Difficult airway?”

“Nearly impossible. Haven't seen this level of inflammation in a long time. Poor guy must have been so incredibly uncomfortable.”

The monitor continues to blare. Coop’s oxygen levels continue to drop.

Abby, still positioned right next to him, stroking his hair even as he lays there unconscious, glances worriedly at the screen.

“His sats aren't looking good.”

Dr Lewis sighs. “Yeah, I know, I'm just trying to- there.”

Her relief is palpable, and Neela knows at once that she’s finally in. She watches the tube slot into place before Lewis inflates the cuff, and Pratt connects everything up to the vent.

“Tube’s misting.” Abby says gently, as everyone begins to relax. “Looks like good placement.”

Pratt pulls his stethoscope out from around his neck.

“I’ll check.”

He moves to Coop's side and checks his breathing, first auscultating the left side of his chest, then the right. It's odd, Neela thinks, to observe how natural his breathing looks now, when only moments ago it was erratic and desperate- but of course, it isn't technically him breathing now at all. They've taken over for him.

After a few more checks with the stethoscope across Coop’s chest and neck, Pratt stands up, slinging the device back around his own neck.

“Bilateral breath sounds. You're in.”

Everyone in the room seems to relax at once, especially when the numbers on the monitor start to creep up to normal.

“Alright,” Dr Lewis breathes, turning to Abby. “Secure it, then we'll get him down to ICU. Keep him on max settings until we know it's safe to start weaning him off."

She moves back, as does Pratt, and Abby stands, giving Coop’s hair one last gentle run through with her fingers before she moves away to fetch the tube holder. Neela's eyes remain fixed on him, though. It's impossible not to when he's so completely still.

“You alright, Neela?” Abby asks gently as she returns a few moments later.

Neela nods. “Yeah, I just… it's so different when you know them. I didn't realise how sick it would make me feel.”

Abby gives her a small reassuring smile, then focuses her attention back on the packaging she's just picked up, tearing it open and pulling out the holder before she starts to peel off the tape on the pads.

“I know what you mean. It's not easy seeing somebody you care about like this, and it's somehow even harder with a person like Coop. He's always smiling, always moving, always there, and now…” She presses the first pad against his cheek gently, thumb brushing against it to secure it. “He's not. He's always there to take care of everybody else, and now…” She applies the other pad, movements just as careful and attentive. “He needs us to take care of him.”

Neela hums affirmatively, watching her secure the tube.

“There's just so much at stake. So much that could go wrong, and nearly did. Maybe it even has.”

Abby finishes, standing up fully again and adjusting things ever so slightly. Coop looks like the other patients in the ICU now, and it makes Neela’s stomach roll with anxiety.

“It isn't easy.” Abby responds. “But that's what the ER’s like, even if it happens with one of our own. It's fast-paced, it's risky, and sometimes the worst happens. Sometimes, we can't easily cure a patient, and we have to hope that they'll fight enough on their own to get through things.”

“Do you think he will? Coop?”

“There are no guarantees, but if anyone's going to, it's him.” She looks down at him with a mixture of affection and admiration. Her thumb strokes along the curve of his jaw. “He just needs to hang on long enough for the inflammation to go down. He just needs to do something which is pretty alien to him, and rest. Let us do some of the heavy lifting for a while until he's strong enough to do it on his own again.”

Neela nods. “He'll get through it.”

Abby smiles. “Exactly. He'll get through it… You’re a tough one, aren't you, sweetheart?” She brushes back some more sweat-damp and unruly hair from his forehead. “Let's get you somewhere you can rest, hm?”

Coop remains still, the only sign he's still there at all being the beeping of the monitor and the fogging of the tube. But somehow, as Neela helps Abby raise the railings of the bed ready for transport, she knows he's going to come out of this.

He always does.

#whump #sickfic whump #med whump #intubation whump #asthma whump #er 1994

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