topaz_eyes: (moonstar)
Topaz Eyes ([personal profile] topaz_eyes) wrote in [personal profile] rthstewart 2022-01-27 10:23 pm (UTC)

Emergency!/M*A*S*H, Pay It Forward

(Filling my own prompt. WARNINGS for medical/war imagery, minor character death.) Prompts used are M*A*S*H, any, midnight coffee and any, any, unexpected mercy Also, this ran away on me, so.

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(end spoiler space)

Second Lieutenant Dixie McCall, RN, newly arrived that very morning on her first military posting to the 4077th MASH in Korea, had already spent almost sixteen hours on her feet without a break when the young private was brought to the OR.

The entire day had passed in a blur of rushed introductions, triage, and meatball surgery. By one-thirty AM, halfway between darkness and dawn, Dixie had lost count of the number of injured patients she’d assisted with; she was running on fumes, but gamely pushed on, assessing their new patient. This soldier was a handsome, dark-haired beanpole of a boy who couldn’t’ve been more than eighteen, covered with a blood-and-saline-soaked sheet.

“Danced with Bouncing Betty,” one of the corpsmen remarked to the surgeon (Klinger and Hawkeye, she remembered later) as they placed the young man on the table.

“Bouncing Betty?” Dixie asked as she quickly changed to a fresh sterile gown and gloves.

Hawkeye turned from wisecracking and jovial to serious in an instant. “Anti-personnel mine. Triggered to launch and explode at waist level,” Hawkeye said quietly.

Dixie inhaled sharply. Glancing down, beneath the sheet the boy’s belly had been blown open from diaphragm to pubic bone. She forcibly suppressed a shiver.

The boy’s wide, deep brown eyes were glassy with fear and pain as he tried to speak. “Help me, Nurse, please help me--”

“Ssh,” Dixie said, hoping he could see her comforting smile through her surgical mask; “it’s all right, honey, save your strength. You’re in good hands.” He licked his lips and nodded, trusting her as the anaesthetist placed the gas mask over his face.

“What a mess,” Hawkeye muttered, once they’d removed the sheet to drape him and saw the full extent of his injuries. “How’d he even make it this far--?”

“Doctor, he’s crashing,” the anaesthetist said almost immediately.

“He’s bleeding out. I can’t see anything. Nurse, suction!”

Dixie complied; they worked as fast as they can, but despite their best efforts the young man died on the table only minutes later.

A hush fell over the adjoining tables as Hawkeye cleared his throat. “Okay, let’s call it. Time of death, one forty-two,” he stated.

Dixie knew she was supposed to note the death aloud as well to confirm it, but trembled as she realized she’d lost her first patient of the war. She couldn’t bring herself to speak; she simply stared wide-eyed and stunned at Hawkeye.

“Take ten, Nurse,” Hawkeye said. “Go get some coffee.”

She felt frozen to the floor. Hawkeye beckoned the circulating nurse to come over to relieve her.

“Take ten, Lt. McCall.” This, with the force of an order, came from Major Houlihan from the table beside her. “Now.”

That shook Dixie out of her shock enough to whisper “yes, ma’am,” and she stepped away, stumbling blindly out of the OR.

In the anteroom, in a daze she pulled off her bloody surgical gown and gloves, tore off her mask, and dropped them into the contaminated laundry. When she looked down at her front, the boy’s blood had soaked through her surgical gown to her scrubs.

Weak-kneed, she sank onto the bench just outside the door, passing a shaking hand over her face; she felt wetness there that wasn’t just perspiration.

Oh God. Her patient had just died and she didn’t even know the boy’s name. She raised her face to the ceiling, her eyes scrunched closed; bone-deep exhaustion rolled over her in waves.

This is what you signed up for, her inner voice whispered, and she wondered how she was going to get through all the heartbreak that was going to come.

She didn’t see the Major exit the OR, didn’t pay attention to the approaching footsteps, so she was startled by a no-nonsense voice a few minutes later. “Nurse McCall. I know we threw you in the deep end without any orientation, I know what you saw was shocking, but you are always expected to conduct yourself professionally--”

Dixie tried to clear her throat, a noise that sounded too close to a sob. Major Houlihan paused at that, and her tone lost its edge. “Was Private Davis the first patient you lost in the war, Lt?”

“Yes, ma’am,” she barely managed to whisper.

She heard a heavy sigh, then felt a warm hand pat her knee. “The first one is always the hardest.”

She opened her eyes to a blurry visage of Maj. Houlihan crouching in front of her. The Major’s hard-nosed reputation had preceded her, but right now her eyes were surprisingly kind and even sympathetic. “The first is the one you’ll remember.”

Dixie nodded, sniffed and cleared her throat. “Do you ever get used to this, Major?”

Dixie saw the slightest shake of the Major’s head, no, and her shoulders slumped. “Never. The day you do, is the day you quit being a nurse.”

Dixie sighed heavily at that. “Here, drink this,” Maj. Houlihan added, and Dixie felt a warm tin cup pressed into her hand. “You’ll feel better.”

She automatically curled her fingers around the cup, and raised it with both hands to her lips. She made a face at the fragrance; she didn’t even like coffee, she preferred tea. But it was the first real sustenance since she’d arrived that morning, aside from sips of water or juice through a straw beneath her mask while standing at the operating table, so she sipped it anyway. The warmth pooled in her stomach and settled her a bit. The generous added powdered milk and sugar gave just enough body and flavour to cut through the bitterness.

“Thank you, Major,” she said, and she took another, longer sip. Maj. Houlihan nodded, gently appraising. Dixie clung to the coffee, and that small point of human contact to centre herself again.

“We need you back in five,” Maj. Houlihan said after another minute had elapsed, and she rose to her feet, gesturing at Dixie’s blood-soaked clothes. “Finish your coffee, then change and scrub in. You’ll assist Dr. Pierce again when you return.”

“Yes ma’am.” Dixie tilted her head, sensing the Major had gone out of her way to make sure she was all right going forward. “How do I– ?” Dixie asked, wondering how she could repay the Major’s unexpected kindness.

A brief, sad smile played on Maj. Houlihan’s lips. “You can pay it forward when the time comes, Nurse McCall.” She nodded at the clock. “Five minutes,” she repeated, raised her mask, and strode with purpose into the OR.

Dixie sighed, drained the remaining coffee in her cup, and forced herself to stand. This was going to be a very long tour.


* * *


Twenty years later at another one-thirty AM, Dixie McCall RN, Head Nurse of the Emergency Department at Rampart General Hospital, was perched at her supply desk by the communications centre filling out the interminable paperwork, when a Roy DeSoto shaped shadow fell across her papers.

“Hi, Roy,” she greeted the spectre without glancing up, “how’s it going?”

“Hi, Dix,” he said heavily, “I wish it were better.”

She looked up at him at that, taking in his somewhat haggard appearance, not just due to the time of night. “I heard the patient you and Johnny brought in earlier this afternoon died in surgery,” she said with sympathy.

“Yeah, the college kid that got shot with an arrow in the thigh during archery practice.”

“That was rough, I really thought he’d make it.”

“We thought so too. But the barbs on the tip shredded the femoral artery on the way out, I guess. Seems kinda senseless.”

Dixie nodded in agreement. People dying from what should have been survivable injuries had always been one of the hardest pills for her to swallow since Korea.

“Johnny’s not taking it well at all,” Roy added, jabbing his thumb in the direction of the staff lounge. “I’ve tried all evening but I don’t know, I just can’t seem to get through to him.”

Roy went to the cabinet behind her to collect medical supplies for the squad. By the set of his shoulders, Roy wasn’t looking copacetic about it either, but at least he appeared to be handling it. She heard the concern for Johnny in Roy’s tone. “Do you want me to talk to him?” she offered after a moment.

When Roy turned around to answer, the relief on his face was unmistakable. “Yeah, if you could, I’d appreciate it,” he said gratefully.

It was still early days for Johnny and Roy as full-fledged paramedics working without direct supervision in the field, just a week after the Wedsworth-Townsend Act had passed. “Sure,” she said, briefly patting his forearm, “no problem.”

“Thanks, Dix. Tell him I’ll be waiting in the squad.” Roy picked up his box of supplies and headed towards the ambulance entrance. “Just—don’t be too long, we gotta get back,” he called back, just before he rounded the corner.

“You bet.” Dixie slid off her stool and headed down the hall towards the staff lounge.

She opened the door to the lounge carefully to find Johnny sitting alone in the room, sunk into the sofa: elbows on knees, head dropped in his hands.

Dixie held onto the door as she regarded Johnny for a moment, remembering when she’d been in almost the same spot, halfway round the world; remembering a past act of kindness towards a young, idealistic nurse who’d just been slapped in the face by the reality of loss.

This was what Major Houlihan had meant when she’d told her to pay it forward when the time comes.

She’d had variations of this conversation with a few nurses over the intervening years; it certainly appeared like the moment had now come for Johnny. She entered the room, strode to the coffee machine, and poured a cup of steaming hot joe, musing wryly how that first day in Korea had marked the start of her own coffee addiction.

She moved to the couch and crouched to one side of him, the cup in her hand. “Tough day, huh?” she began gently.

Up close she noted the fine tremor that moved in waves from his shoulders down. He inhaled deeply, but didn’t answer.

“I heard you and Roy lost a patient earlier tonight,” she said, and shifted the cup to her other hand, laying the first against his jacketed forearm. “Your first since the Act was passed if I’m right.”

Johnny mumbled something indecipherable into his hands.

“What was that again?”

Johnny raised his head, his hands rubbing downwards to wipe his face before he looked at her, his expression forlorn. “I said, what’s the point of being a trained paramedic if you can’t save them anyway?”

He seemed so discouraged that something in her heart broke. “We can’t save them all, Johnny,” Dixie said, remembering the young soldier lifeless on an operating table in Korea all those years ago. Private Davis. Help me, nurse, please help me.

“It shouldn’t’ve happened. We did everything right, Dix, he was fine when we brought him in, his vitals were good. He shoulda lived.” He clenched his fists and slammed them against his thighs.

Dixie closed her eyes briefly and she squeezed his arm in sympathy. “I know.” When she opened them again Johnny was looking down at his lap, exhaustion lining his youthful face.

“Sometimes a patient will look stable but something unexpected happens, or they’re already too far gone by the time you get to them,” she added, knowing it was cold comfort at best.

“That – that doesn’t really help me here,” Johnny said, sounding like he was struggling to keep it together.

“It’s the truth, Johnny. One we have to learn to accept to work in this business. Look, all we can do is give our patients the best chance we can. The rest – well, it’s out of our hands.”

Johnny looked devastated by her answer, and he fell silent for a moment, considering. “Tell me, Dix, do you ever get used to losing your patients?” He stared directly at her.

She knew the answer would not be what he wanted to hear; but he needed to hear it, as she’d had back in the day. “Not in the slightest. The day it becomes easy is the day you leave the profession and do something else.”

Johnny only sighed heavily and looked down at his fists, then unclenched them. Dixie proffered the cup. “Here, drink this.”

Wearily he took the cup from her and sipped. “Coffee,” he said, “not like I’m gonna sleep again tonight anyway.”

“Oh, you’d be surprised,” Dixie said, recalling all the days and nights she’d drunk a full pot of coffee in Korea and still managed to pass out after twenty-hour sessions in the OR. “I bet you’ll be snoring the minute your head hits the pillow at the station.”

He huffed at his cup. “You’re probly right.”

Dixie stayed crouched at his side as he drank, her hand moving from his forearm to pat his knee. Johnny didn’t waste time, though, downing it as quickly as he could as if he knew he was on the clock.

He still didn’t smile, but he looked more settled when he drained the last dregs from the cup, and he laid his hand on top of hers. “Thanks, Dix,” he said quietly.

“Anytime.”

“I guess you’ve given this pep talk a lot, huh.”

“A few times,” Dixie said, “I learned from the best.”

He raised an eyebrow, his interest piqued. “Yeah? Who was that?”

“My commanding officer in Korea. My first day assigned to a MASH unit.”

“Oh.” It was Johnny’s turn to give Dixie a soft look. “You musta seen a lotta heavy stuff over there.”

“I sure did,” Dixie confirmed. “But you know, it’s the people you worked with that you'll remember best.”

They shared a smile, and Johnny glanced at his watch. “I, uh, gotta go, Roy’s waiting for me, probly wondering where I am,” he said, and she rose to let him up. He passed her the empty cup and headed to the door.

At the threshold Johnny turned and faced her, gesturing between them. “How—how do I—?”

Dixie’s mouth twitched in a wry smile at the echo of her question, asked in an anteroom half a world and half a lifetime away. “Just pay it forward when the time comes.”

Johnny peered at her for a brief moment in puzzlement, then nodded, thoughtful. “Yeah, pay it forward when the time comes,” he said, “I’ll do that. See ya.”

“Have a good night, Johnny,” she replied.

He pivoted and quickly disappeared from sight. Standing in the middle of the staff lounge, Dixie closed her eyes for a moment, her hands curled round the empty cup. She wondered where Major Margaret Houlihan was now, what she was doing; she silently wished her well, then washed the cup and returned to her desk.

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