Lessons Learned
Part Two
By Kristen
kdarganin@hotmail.com

Archive: Yes, just let me know.
Disclamier: I do now own the characters of ER I am just borrowing them for fun.

Category: Story/Angst (JC/PB/LK/RR)

Thanks to Jackie and a special thank you to Debbie for all of my countless questions.



Carter ran into Linda, who was patiently waiting for his arrival. She was holding a chart, and handed it to Carter. "There's an elderly lady with facial pain in exam two," she told him without enthusiasm.

Carter nodded, and reached out for the door handle. He stopped when he felt a hand on his arm.

"Just to warn you, Dr. Logan is on the prowl and your Dr. Romano is not keeping him in a good mood. Just watch your step, okay? He wasn't very happy at the thought of having to work with people from County." She gave him a serious look.

"I'll try to stay out of his way," Carter answered glumly. He took a deep breath, attempting to calm his nerves.

Carter walked into Exam Two, where he found an elderly lady with the most beautiful silver hair he had ever seen. She was sitting on the gurney quietly, and glanced up when he entered the room. He saw tears running down her face, which she hastily dabbed away with a tissue. Carter hurried into the room and grabbed the chart off the bed. He scanned for her name, and smiled reassuringly.

"Good afternoon, Mrs. Cobb. I'm Dr. Carter, what seems to be the problem today?" Carter asked good naturedly. It upset him to see this woman in such distress.

"W-wellll, my face has been hurting f-f-for hours. I, I, I, I haven't b-been able to feel the left side since I woke up," Mrs. Cobb managed with great difficulty. She took her tissue and wiped her mouth as some saliva ran down her chin. Carter dug into his pants pocket and retrieved a clean cloth. He handed it to Mrs. Cobb, who took it gratefully.

"I-I am so sorry, dear. You're so s-s-sweet. Please call m-me Judith." She tried to smile.

"Don't worry about it Judith, let's just see if I can find out what is wrong, all right?" Carter gave her arm a gentle squeeze. "So, you have had pain in you face. Has it been localized to any side, or is it your entire face?" Carter asked, while examining her head. He gently placed his hands on her cheekbones.

"It hurts on the left side," She repeated.

Carter took out his pen light and peeled back each eyelid, watching her pupils dilate. He then took her left arm and lifted it up in the air. "Please hold it up for a few seconds," Carter gently instructed her. Judith nodded, and she kept her arm still in the air, as Carter repeated the procedure on her right arm as well. He had her squeeze his wrist with each hand.

"Could you please stand up for me?" he asked, while backing up to give her room.

She stood easily, but stopped momentarily to wipe away some more spittle that ran down from her mouth. She took Carter's hankie and wiped it away, obviously embarrassed. Her left eye was tearing again, and Carter gave her a few seconds to compose herself.

"You're doing fine, Judith. Now, could you lift up you right foot slightly?" Carter stood next to her, just in case she became dizzy and needed help. Judith lifted her right foot, and then repeated the exercise with her left. Carter flipped through her chart, noting the nurse's observations and vitals. Carter heard the door open, and Dr. Logan and Peter Benton walked into the room. He groaned inwardly, wondering if the hospital would ever get busy enough so the surgeons would have something to do.

Peter walked up to Carter's side, giving him a casual glance. "What do you have, Carter?"

"Well, this is Judith, 63 years old, complaining about pain at the left side of her face. No complaints of headaches, no numbness in her hands or legs, no dysarthria, and her upper and lower extremity strength is 5/5 bilaterally." Carter didn't look over at Dr. Logan, solely focusing on Peter.

Benton flipped through the chart as Dr. Logan took the stethoscope off his neck and listened to her heart. Peter finished reading over the chart and stared at Carter. "Go on," he said.

"As I was saying, blood pressure is only slightly elevated at 140/90, pulse is 110 and she is exhibiting left sided facial droop. I want to order some neuro tests to rule out Bell's Palsy, and maybe a CT," Carter replied.

Dr. Logan slid his stethoscope around his neck and spun around. "Maybe a CT, Dr. Carter? I think it's quite obvious that Mrs. Cobb most likely suffered a stroke and should be sent to radiology right away." He didn't even bother to hide the arrogance in his voice.

"I have to disagree, Dr. Logan. Her blood pressure isn't that high, she's responsive, and doesn't seem to have any problems with muscle coordination. I believe nerve conduction studies checks are in order." Carter stood his ground.

Dr. Logan shook his head. "There is no need to have such expensive tests in this case. Send her for a CT and go on to your next patient." Dr. Logan grabbed the chart from Benton and scribbled a few notes onto it.

Peter couldn't remain silent. "Maybe Dr. Carter, can send her for a head CT to rule out a stroke, and then if it is negative, he can perform the necessary neurological tests." Peter glanced up at Carter to let him know he had some support in his corner. He saw Carter shift from foot to foot, something he often did when trying to channel nervous energy.

"Fine, you want to waste hospital money, go ahead." Dr. Logan snarled.

"Can we take this outside please?" Carter asked, nodding slightly towards the patient, who was nervous enough as it was without worrying if her diagnosis was in question. It was the last thing on his mind, and should be the last thing on his patient's mind. He was always worried about the standard of care for elderly patients. It really aggravated him when doctors didn't do necessary testing just because their patient was old. It was like they thought the elderly patients didn't deserve the same standard of care.

"Fine, Dr. Carter, but if you want to do neuro conductive testing, you'll have to search for the equipment upstairs where it is stored. The technicians are gone for the day, and I won't authorize you to page a tech to come in for this unnecessary testing. Most of the equipment has been packed away for a supply transfer. And when she comes back with CT results indicative of a stroke, I want you to explain to Dr. Romano why expensive testing was administered to a Medicare/Medicaid patient, and I'll make County absorb the cost."

"Fine by me. Which floor is the equipment stored on?" Carter tried to hide his irritation from his voice.

"On the Neurology floor, Doctor. Do I need you to draw you a map? Maybe Dr. Benton can hold your hand as you try to find it." Dr. Logan gave both men a sneer, and left.

Peter sighed heavily, and watched the door close in his face. "The most likely explanation is a stroke, Carter, but not everything is as it appears. Besides, that man needs to have an attitude adjustment." Benton patted Carter on the back, and continued the annoying task of following Grady's Chief of Staff around.

Carter returned to the exam room to let Judith know what his plan of action was. He saw her sitting there, her hand clutching the hankie that he had given her. She still seemed frightened. Judith looked up at his return, as Carter pulled up a chair and sat next to her. She grabbed his hand, in need of strength.

"Dr. Carter, I didn't mean to get you in trouble with your boss," she told him.

"Judith, you didn't do anything. It's my job to take care of you, which I am going to do." Carter smiled and took his other hand and placed it on top of her's. "I want to rule out something that could be causing you some pain. I need to go find the tests that are needed. Okay?"

"I trust you, young man. I just don't want your boss to yell at you over me," She replied sincerely.

"That's easy, Judith; he's not my boss." Carter rose from the chair and walked out into the hallway to call for a nurse. He saw Sally acknowledge him, and went back to talk to his patient.

"While I go search for those tests, you're going to go to the fourth floor to have a special x-ray called a CT, a scan of your head. It's just a precaution, and it won't hurt a bit." Carter extended his hand to help her stand, when Sally came in with a wheelchair. Judith was situated and taken to radiology.

Carter slumped back down to the chair. He calculated his actions, knowing that what he was doing was proper procedure. He had been right with tricky diagnoses before, and wasn't about to let his patient's care suffer because of Dr. Logan's smugness. Carter carefully stretched his back, it had been aching ever since the previous trauma. Today promised to be long and tiresome, and he needed to pace himself without garnering attention from his co-workers.

He headed for the elevator to track down the needed equipment. Carter stood in front of the elevator for a very long five minutes, passing the time by watching the activity of the staff. The hospital really lacked spark of life or care. He missed County, and couldn't wait to return. Carter glanced up at the elevator again, noticing that the fourth floor light was still lit. It hadn't moved. Carter was becoming impatient when he noticed Luka walking towards him.

"Hey, Carter," he said listlessly.

"Hi, Dr. Kovac, I'm just waiting for this stupid elevator."

"Yeah, I saw you standing there. I just received a call from maintenance, it's having difficulties and it won't come back down," the other doctor told him with a hint of amusement.

"You've got to be kidding!" Carter exclaimed. "I just sent a patient up there for a CT." He looked back at Luka to see the other doctor laughing.

"What's so funny?" Carter asked, currently not seeing anything humorous about the situation.

"I'm sorry, Carter. Your patient made it up there, its just that you can't see to catch a break today. They said it'll only be a few minutes." Luka controlled his laughter, noting that Carter wasn't amused. The day had been intense, and watching Carter endure one setback after another wasn't really something to laugh about, but he couldn't help it.

"Both of them are out of order and we're an emergency hospital; I'm glad I'm not a patient with an urgent need," Carter said sarcastically. "I'll take the stairs," he told Luka, frustrated, and left the man before he could be chastised for being impatient.

Carter was on his third flight of stairs when he realized he was losing steam. His back screamed in pain. He should have waited for the elevator and saved himself some aggravation. He was heading for the fourth flight of stairs when his left foot slipped slightly. He grabbed the railing fiercely for balance, and stood there for a second, simply concentrating on breathing. Sweat dripped down his face, and Carter shakily wiped it away. God, he hoped no one decided to use the stairs this very moment, he knew he would probably frighten them with his instability.

Carter carefully composed himself and ascended the final flight to the fifth floor. He entered a quiet hallway, almost out of breath. He scanned the area in an effort to find the right storage room, and spotted the one just a few feet down the hall. He searched for a light switch, and was surprised to discover how large the room was.

There were dozens of metal shelves stuffed with countless boxes of supplies. Crates were stacked up against the wall, and boxes just sat in the middle of the room collecting dust. The ceiling tiles looked like they were about to come crashing down, and the area as a whole was in complete disarray.

"Just great, this place hasn't seen organization in years. It's a dumping ground for unused equipment," Carter said out loud. He saw gallon-sized containers of chemicals in the far corner stacked against the wall. Searching, Carter started with the bottom shelf, and could tell it contained various cardio supplies. He went through three more tiers until he came upon the fourth one. It held some neuro equipment, but mostly EKG pads. There were bottles of chemicals that lacked proper labels. He decided that the few pieces of neurological equipment that were here indicated that his test might be lurking in one of the nearby boxes.

Unable to reach anything beyond the fourth shelf, Carter glanced around the room and noticed a ladder. He grabbed it, and slowly dragged it over to the storage units.

Carter gazed ominously at the ladder, debating the logistics of climbing it. The neuro kit he needed was probably somewhere on the top shelf that he could not reach. The entire storage area was totally miscatergarized and basically a mess. Sighing with contempt, Carter took hold of the ladder and shook it to verify that it was stable. It didn't seem to be wobbly, so he locked it into place and carefully scaled its steps.

The metal shelves were dusty, and Carter scanned the various unlabeled boxes for its contents. Each box contained unused vials of chemicals. In fact, the fifth and sixth shelves were full of containers of iodine and betazine. 'No wonder this place is being shut down,' Carter mused. You didn't place large containers of chemicals on the higher levels of a shelf. Since the bottom ones were packed with boxes, some lazy person just placed them in the first empty space.

Feeling a bit uneasy, Carter looked down to see that he was up pretty high, and hoped that his back wouldn't pick this very moment to spasm. Concentrating on the task in front of him, Carter rummaged through more boxes until he came across the neuro test that was needed.

Ironically, this box was perfectly labeled, and Carter reached out to grab it. Forgetting momentarily about the condition of his back, he reached out slightly too far, causing a sharp pain to run down his back and into his left leg. Carter gasped and involuntarily let go of the box in order to grab a steadying hold of the shelf. As his hand violently secured itself on a part of the shelf to prevent him from falling, it caused the steel structure to shake from the commotion.

This quickly caused a set of reaction chain of events. The shelf shook, which startled Carter enough that he grasped it more firmly to steady himself while the pain subsided. By doing so, Carter lost his balance, causing the ladder to lurch from the shift in weight. Carter tried to prevent the inevitable fall by lashing out at the metal structure in front of him, but was at a loss for control. All he managed to do was wrap his fingers around part of the shelf as he plummeted downward.

Carter crashed to the floor in a heap, and the ladder fell sideways, hitting the shelf. The result was a thunderous crash as boxes of chemicals and supplies clattered against the floor. Carter covered his face with his hands as falling bottles of iodine shattered near him; he removed his arm after verifying that there was no more flying debris.

Carter craned his neck to verify the mess that was created by the lack of his finesse. He remained sprawled on the floor as he mentally went over various parts of his body for damage. He had landed on his right shoulder which was throbbing, but he knew that he hadn't broken anything. He had not hit his head, and after a moment came to the conclusion that he was just momentarily stunned.

Carter brought himself up into a sitting position; unconsciously rubbing at the soon-to-be-sore muscles in his back. He stood up slowly and only felt a slight twinge from the movement; he had been pretty lucky. He hadn't actually fallen that far, but in his condition he had to be careful. He would keep this little incident from the others. They didn't need to worry, especially with all the hell going on downstairs.

Not wanting to leave the mess, Carter knelt down; bending with his knees. There was a pool of liquid spreading over the floor, leaving purple blotches. Some of the caps of the betazine containers had popped off somehow, too. That chemical was colorless, so it was difficult to tell where it had spilt. Carter searched for something to soak the chemicals with, and noticed the crates in the corner. There were several rags sitting on top, and he made his way over to retrieve them.

He cursed at his horrible luck and the resulting catastrophe; he had not even been able to find a simple test. Carter didn't see the spilled liquids spreading over to the wall. If he had looked up for just a moment, he might have noticed the bundle of electrical wiring that was hanging from an unprotected outlet to the left of the shelf. The corroded wires quickly came into contact with the chemical mix, resulting in a spark. A series of little bits of blue, sparks, jumped from wire to wire, and finally a shower of electric current spark, igniting the chemical spill.

After gathering some of the soaked linen, Carter turned around and saw flames spreading across the floor. He was momentarily in shock, watching in horrid fascination as the pools of liquid soon had flames dancing upon it. It was like one of those little fires one saw on television, being fueled by an oil spill or something similar. Carter's shock and awe subsided when the flames quickly spread from the chemical spill over to where several boxes still remained on the ground.

Carter swore under his breath. "Why does this is always happen to me?" he shouted to nobody in particular. He ran over to the shelves and tried to smother the flames with his soaked rags. Only after a few moments he realized that this was not the proper way to douse a chemical fire, and looked around for some flour.

'There's not going to be any flour in the middle of a storage room!' He chastised himself. Instincts right. Location wrong. Panic started to take a hold of him when the fire engulfed the cardboard boxes, growing larger and more menacing as a result.

"All right, get rid of the source of fuel. No problem," Carter spoke to himself, trying to keep his panic at bay. Unfortunately, the flaming boxes contained other sets of chemicals, and one of the boxes exploded as the fire ignited the contents. The explosion startled Carter, as he stepped away from the growing flames. The entire set of shelves were being consumed by flames as the fire spread from shelf to shelf, eating up boxes of chemicals and various paper products.

The shelves became a virtual wall of flames, lapping upwards, searching for more fuel. When the fire first ignited Carter thought he could quickly put it out, since he recalled not seeing a soul that could have aided him in this emergency. Forgetting how fast chemical fires spread, he was overwhelmed by its intensity, and he knew he had no choice but to leave the room in search of help. He looked across the room to the door he had originally entered, and was about to make a run for it when he made a startling discovery. Only a few feet away from the shelving units were stacks of oxygen tanks.

"Oh god, if they ignite the tanks..." He gasped out loud as he ran his hand through his hair. Carter began searching for a fire alarm. Clouds of white smoke were beginning to fill the room, and Carter's throat was becoming scratchy. Breathing lungs full of poisonous smoke was not a healthy thing to do, but it was better then being caught in an explosion if the fire reached the oxygen tanks.

Carter was desperate; he ran to the other side of the room, past the tanks, in search of a fire extinguisher. Scared and panicked, he began to throw boxes out of the way that were blocking parts of the wall. There had to be an extinguisher somewhere in this room. Finally, out of the corner of his eye, he spotted a red tank mounted by one of the closet doors. It appeared to be years old, and looked dauntingly heavy.

Carter picked it up with a groan, realizing it weighed a ton. He had already climbed a ladder and fallen, it didn't matter that he was picking up a heavy object. He knew Dr. Benton would not be very happy with all the risks he had taken already, he mused. The extinguisher weighed about twenty pounds, and his back seared in pain from the effort of carrying it back across the room.

The flames had jumped from one shelf to the other, and so on. The fire was not engulfing the walls since they were fire resistant, however, the floor was covered in chemicals from the spill and the fire was growing larger from it. Moving towards larger sources of air, it rose towards the ceiling, turning the tiles black. White smoke was filling the room completely and Carter wondered why there was no alarm, and why no one noticed the smoke coming from storage facility.

He dragged the fire extinguisher across the littered floor and aimed the hose at the flames in front of him. His eyes were burning, and tears streaked down his face causing his vision to blur. Trying to breathe as little as possible, Carter took his other hand and put his nose and mouth under the collar of his shirt. He then stepped as close to the growing wall of fire as he dared, and squeezed the trigger of the hose.

For a few moments a white mist made contact with the flames, beating it back towards the shelves, but the air pressure from the repellent quickly sputtered and the mist ceased. Carter looked down at the extinguisher in defeat, and decided now was the time to make a dash for the exit. The wall of fire was now spreading over the ceiling above his head. Carter knew that the fireproof walls would trap the flames in the room, causing it to build up and explode. After a giant explosion, there was nothing he could do to stop it from setting the rest of the hospital ablaze.

Carter dropped the useless extinguisher, and limped heavily towards the door, as a spasm tore through his back. Just as he was about to reach the door handle, there was a giant explosion; its force painfully knocked Carter into the wall. Flames roared behind him as the heat in the room rose dramatically. Carter hung onto the wall for support as the fumes and smoke caused him to cough and gag. Knowing he was a dead man if he didn't move, Carter slid to the floor and crawled out of the room.

The last thing he heard, as he valiantly tried to scramble away, were a series of small explosion as the fire hit the rest of the oxygen tanks.