Star Trek: Eventide 777 - surgical-ward

Having just barely made it into the surgical suite before being fired upon by yet more attackers storming the medical bay, Vialara had made her way into ward, closing and sealing the door behind her as her colleague was shot down mere moments away from making to safety, she took a step back away from the door and took a few deep shaky breaths before calling out to the computer. "C-Computer, summon EMH. I need their help as a priority."

Once again he had rematerialized to help in the ward. “You rang for me?” He said immediately getting to work in setting up the ward? Surgical trays were taken out and positioned around the commodore. He stopped to look at Vialara. “Doctor, are you alright?”

"The Commander... She's dead. Attackers in the main medical bay. I-I need help with the commodore, she needs emergency surgery." She said, wheeling the biobed further into the centre of the surgical suite.

“Believe me I’m well aware. Just tell me what to do, you aren’t alone.” The emh said calmly, he went back to preparing things. “Just tell me what to do, Commander.” He repeated as he made his way around the room. “I suggest we start with the basics, diagnosis wouldn’t you conquer?”

"Yeah, I need to know what's wrong with both patients... Start running diagnosis whilst I scrub in for surgery real quick..." She moved over to the side of the room and started prepping herself for surgery.

“Yes doctor, right away.” He said automatically flipping his tricorder and running just above the Commodore, in between he made several inputs into the device, and looked between the readings and the Commodore, this poor woman, well, both of them.

Diagnosis: not doing well for either host or symbiont. With the stab wound being to the abdomen the symbiont had taken a fair part of the blow, physically damaged and then having taken the brunt of being dematerialised and rematerialized via a transporter: something that symbionts didn't take well to at the best of times, and well known to be fatal if they were wounded. Low isoboramine levels and the damage to both were disrupting the connection between the two, something that neither host nor symbiont could survive with. The host herself wasn't doing much better either with the stab-wound having perforated her liver. Hypovolemia from the trauma seemed to be the main cause of the issues - and with her being unconscious, tachycardic, hypotensive and with a rapidly declining respiratory rate, it was evident that the patient was in peri-arrest.

“It appears as though we may need to divide and concur, the symbiont is in sever distress, there are low idk leaning levels, and the extensive damage is disrupting the connection between the two, that damn stab wound has perforated her liver, and she’s suffering from peri-arrest.” He was already contemplating what procedure to perform first. “We should stabilize the connection between the two, if the connection isn’t stable, they’ll both die.”

"I was thinking of separating the two and treating them as two separate patients. The symbiont is in shock, we need to repair the damage to the symbiont and stabilise it whilst we repair the damage to the commodore. Once the two are both stable enough we can deal with the rejoining, hopefully with the two stable they will be able to focus on re-establishing their connection... Thoughts?"

The emh looked at the Commodore, who’s heart rate was rapidly slipping, normally if you’d separated the two it would only be a few hours before both the host and symbiont died, and what are the chances if they’re both already slipping? Could it be done? So many questions so little time. “Once we separate them we’d have to move very fast, the two are already dying enough as it is, how can we be sure that they’ll survive the separation? I only know of a few cases where the symbiont was separated from the host for about two or three hours tops how long can they survive injured like this? I’m not sure we can take the chance.” (edited)

After properly scrubbing herself in she made her way back over to the Biobed. "I feel in this situation they're making eachother worse... They're two separate minds who are both injured and are not in a good way. We can't stabilise one without the other having an effect on it. If we separate them temporarily, just for a few minutes even then we can work on trying to get a solid connection between the two... I don't think the symbiont can focus on its recovery whilst connected to a dying host. I'm going to separate them and hope it doesn't make things worse."

“Sound analysis.” The EMH wheeled the proper instruments right to Dreaxa’s left hand side. “Laser scalpel, dermal regeneration device, the like. It’s all in this tray. I’ll begin preparing an apparatus to hold the symbiont, I would suggest a small tank with similar fluid composition to that of the Caves of Mak'ala?”

"Yes, the symbionts survive in that symbiotic fluid. Once you patch up the hole in the symbiont the fluid should hopefully help with its recovery, or at least prevent it from worsening any further... It'll give us enough time to patch up the commodore." She picked up the laser scalpel. "You ready? Once we pull the symbiont out she's going to start deteriorating. We're going to need to work fast."

The EMH was indeed efficient, using the emergency power of the station, he had already accessed the replicator files, and in coordination with transporter control had beamed a fully assembled tank right off the side of the commodore for easy transfer. He had already filled the tank with fluid also replicated, and at a perfect temperature too. “I’m ready to receive the symbiont as soon as you remove it.” He said bracing for his part in the operation. “Should we operate while the symbiont is in the fluid? That may begin its healing faster.”

"A dermal regenerator should do a sufficient job in repairing the wound to the Symbiont. The fluid should stimulate the healing process and also hopefully help calm the symbiont down from whatever shock it's going through from the transporter. I'll need you to keep an eye on its tricorder readings as we work on the commodore. You'll be able to receive the readings in real time, perks of being a hologram." She moved forward, using the laser scalpel to make a few clean cuts around the commodore's uniform for easier removal before she went back to her abdomen. Making a gentle incision with the laser scalpel just below the entrance wound, she opened up a section of her abdomen big enough for the symbiont to be removed and to examine the internal damage more closely. Vialara slid a gloved hand to where the symbiont was, nimble fingers gently prying the tendrils from where they were delicately intwined with the Commodore's spinal cord. Barely holding on due to the failing connection. "Can you start on the dermal regeneration for the wound to the symbiont?"

“Right away.” He said already getting the dermal regenerator from the table, and running it over the wound. “We’d better get it into the take right now.” He had finished the repair promptly. “That’s it, I’ve done it. I reckon it’s still in shock who was the one who transported this creature and the Commodore, I’m pretty sure they weren’t a transporter operator, this was a way too close.”

"Agreed, I'm almost finished the separation. Once we separate the two, we need to fix the damage to the Commodore's liver. Can you work on that first?" As she moved her hands, she finally managed to free all the tendrils from the connection to the commodore, gently lifting the symbiont from her abdomen and gently placing it into the tank of symbiotic fluid.

“Absolutely.” He was already on the liver, now that the abdomen was accessible, the Doctor went ahead and activated the cytoplasmic stimulator once again, running it over the liver, but not before expanding the operating site first. The doctor had used a technique perfected by a doctor on trill who had done a similar procedure, but instead of the patient and the symbiont dying, it was actually a routine liver transplant, the stimulator was used to speed up growth of the liver’s tissue cells which were already incredibly regenerative. (edited)

"We'll need to transfuse the lost blood and run a regenerator over any additional sources of blood loss. Can you replicate the patients required blood type and set up a transfusion please? I'm going to try and get her breathing and heart rhythm back into normal range again." She moved to the tray and picked up the hypospray and loaded one of the cartridges, pressing it to the woman's neck and administrating the dose. After a few moments she tapped the biobed to get readings on heart rate and breathing.

“Understood.” The emh disappeared into further into sickbay where the replicators could be found, and accessing the Commodore’s medical file, fabricated the proper blood. He then reappeared in the surgical ward, then set up a whole-blood transfusion, perhaps there was a more advanced way to transfer blood between the patient and the bag, but the EMH was programmed with the classic method of using a small needle and inserting it into the vein of the right arm, no need to over complicate things. “The transfusion is holding.”

"Thank you... We need to insert a breathing tube to help stabilise her breathing. That and bringing her low blood level should help bring her heart rate back to an acceptable range." She moved over and grabbed a breathing tube before moving back to insert the tube and hook her up to oxygen. "How's our symbiont doing?"

Flipping open a tricordor, he ran his scans, but visually inspecting the creature, it seemed the treatment he had applied had still been holding. “I would say the regenerator has healed the wound, but I won’t know if the creature has taken well to the procedure until the scans return.“ (edited)

"At what point do we consider the rejoining? The longer they're separated they worse chance we have of a successful operation, but if we rejoin them too soon it might make things worse again?" She said, tricorder in hand as he tried to judge how stable the commodore was.

“It would be very sound to wait for the stability of the commodore herself before we proceed with the rejoining, and I think it might be logical to rejoin them that may even strengthen the chances of recovery for the both of them, luckily the rejoining process isn’t as complex as the separation. However if the commodore doesn’t survive and the symbiont does, we may need to contact the trill to consider our next steps, but I we won’t stop trying.“ He made his calculations by pressing several keys on the tricorder itself.

Status: surprisingly not deceased. Observations seemed to be in less dire parameters than they were before (although still hardly perfect), but whether a rejoining was a good idea or not was entirely guesswork. Joined Trill were finicky.

"Observations seem to be on the better side? I suppose we just risk rejoining and see if we can kickstart their connection again... If both of them sense eachothers condition is improving hopefully they can calm eachother down now? Why are joined trill so difficult to operate on..." She turned back to the EMH. "Prep the symbiont for rejoining."

“Yes, right away.” He said flipping his tricorder shut. He reset the instrument trays, shifting the used tools for brand new uncontaminated ones, then he made his preparations with the creature. “I do not believe anesthesia is necessary for the symbiont in fact it may lessen the chances of re-establishing a safe connection. The creature is prepared for rejoining.”

"I'm not sure how a symbiont successful goes about rejoining with a host... Especially in a condition such as this. I just hope that once I position the tendrils in the suitable location that they will attempt to reconnect to the host?" She moved around to the other side of the table, before taking the symbiont from the EMH. "Here goes nothing..." Taking the symbiont from the EMH, she gently nestled the creature back into the Commodore's abdomen. Delicatly moving past the newly repaired liver to deposit the symbiont where it resided at the base of the spinal column, allowing its tendrils to reconnect to the host.

The EMH waited for something, vitals to stabilize, the Commodore to spontaneously wake. At this point any sign of life other than the same noises from the EKG readings would be amazing. “Assume I’m holding my breath in anticipation.”

She nodded and took a step back, looking down at the biobed readings... Just waiting for some sort of change. For the symbiont to re-establish the connection. "Come on little guy, you got this. I want to see those neural readings spiking... You can fix this."

There was nothing for a good few seconds, and then the biobed's dual set of readings displayed the brain wave patterns of host and symbiont seemingly becoming in-sync again.

She looked at the biobed readings in shock for a brief moment before shouting out with excitement. "Yes! That's it! You're doing great! It's actually working... I think we might have saved them."

The EMH was taken aback, he drew in a shaky ‘breath’ before looking toward Vialara. “Congratulations Doctor, you’ve done it! Atleast.. partially there is still much we need to do before we can call them saved, but I believe this is a great start. Again congratulations.”

She nodded and moved over to the tray of surgical tools. "Let's get this incision patched up, we'll need to have her under observation for the next few days, but I think we can call this surgery a success..." She took a deep breath and gave the EMH a smile, before picking up the autosuture and dermal regenerator and began healing the surgical incision.

“The ICU has already been prepared for our use.“ The EMH had come to the ACMO’s side once again, handing her the proper tools. “Nice technique.” The EMH commented, attempting to brighten the room it seems by at least a little smidge.

"Thanks, I spent a good amount of time training to be a surgeon. I would like to how my technique is up to your standards." She said with a light chuckle, as she pulled the stained gloves from her hands as she set the tools down. Moving over to disinfect herself. "Can you move her through to the ICU whilst I clean up? Have a few nurses set her up for monitoring and adminster the correct post-op fluids and medication. Thank you for your assistance, Doctor."

There was a nod from the EMH. “I’ll get it done, and I’d like to say thank you and congratulations again.” The EMH was already moving onto the systems, moving them to back up power, it would be best to not interrupt the support. The EMH then went ahead and moved the station’s CO to the ICU without skipping a beat.

Moving past the tray of surgical tools, Vialara deposited her used gloves into the biohazard waste and swiftly made her way over to wash her hands. As she started the running water, she stared blankly at her hands as the wash and disinfection cycle ran over her fingers and re-sterilised her for the rest of her shift, letting out a deep sigh before she turned and leaned back against the wall... Gently sliding down until she hit the floor beneath her, and letting out one last shaky breath. Taking a few minutes to gather herself again before she was ready to face what was left of her sickbay. The one she would now be in charge of with the recent passing of her chief medical officer. Vialara knew she had to be strong for her team, but she didn't know if she was ready to face them yet.

The two rematerialised in the surgical ward. Vialara made her way over to the side of the room to scrub in for surgery whilst the EMH started preparing the patient.

Just as ordered, he prepared the patient for surgery, setting up the proper IV, he also set up a monitor to permanently display Connor’s ECG and whatnot while they performed the operation. “He’s ready when you are.” He called to the other side of the room.

[D] Over the course of the next hour or so, both Vialara and the EMH had managed to complete the surgery. Having repaired the majority of the damage to the officer, far from fully healed, but it was a step in the right direction.