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Time was short, and M.J. Pender was impatient.
Upstairs in the Ellison tower of Massachusetts General Hospital, three surgical teams were struggling to save a young car-crash victim who had arrived by helicopter. But here in the surgical intensive care unit, M.J., a senior nurse, rocked on her clogs while the nurse she was training finished a report.
It was 4 on an early-spring afternoon, and the two had only 15 minutes to make sure an ICU room was ready for the grievously injured woman, who was likely to come out of the operating room needing blood, jolts of epinephrine and Lord knows what else.
''Write whatever I tell you," said M.J. as she strode alongside her student, Julia Zelixon, toward the empty, starkly lit room where the victim would soon be brought. Julia grabbed the patient record book from the table outside and began writing down a list of injuries whose horror was clear to the first-year nurse despite M.J.'s antiseptic language.
''Bilateral uncal herniation." Severe brain damage, Julia thought. ''Traumatic injury to her left arm. Extremity was blue. I don't know if she'll be amped." Her left arm might be amputated. ''Left tib/fib fracture." Both major bones of her lower leg are broken. ''Her GCS . . . was 4." Less than a 9 on the Glasgow Coma Scale indicates a serious brain injury; this patient scarcely reacts to anything, even pain.
Sabrina, 33, had driven head-on into a truck, which crushed the driver's side of her small car. By some miracle, her infant son in the back was not seriously injured, but Sabrina, bleeding profusely, had to be freed from the wreck by firefighters.
''I don't like ones like these," said M.J., whose 17-year career in the ICU has given her a habit of endlessly reminding her husband to buckle his seatbelt. ''Not pretty."