#attwcc

Our first case that we see in this chapter is a man in septic shock due to a strangulated inguinal hernia, which basically means that a section of his intestines has pushed through a weakness in his muscles by his groin, been squeezed so much that it’s basically died and is now leaking bacteria into his bloodstream.

One thing to know is that people can live with hernias for a long time; there’re only really dangerous when they become strangulated as in the case of our patient. Therefore through this, I wanted to illustrate Yolanda’s longstanding and severe emotional constipation. She has in a sense lived with this “hernia” which is her ideas on what love and relationships should be, and only now following on from her situation-ship with Trinity , has it become “strangulated”. The next case is the woman with a traumatic stab wound. It’s a bit more complex so I’ll try to explain in a way that is clear. But basically, our patient has two things we’re worried about, a haemothorax (blood in between the layers of the lung) and cardiac tamponade (blood in between the layers of the heart), and the way to treat both of these is to drain the blood so that our organs can stretch fully with air and blood respectively.

Where my symbolism comes into play is the argument that Yolanda has with Al-Hashimi concerning the best way to manage the tamponade. With this and the chapter as a whole, I wanted to present Al-Hashimi as a foil to Yolanda. Yolanda enters the room and rightly states that the patient needs to have surgery to open up the chest and directly relieve pressure. Al-Hashimi agrees with this and suggests they should attempt to do this in the ED, and this is when they start to argue. Yolanda wants to do what is basically a “stop-gap” in this instance, whereas Al-Hashimi does not.

Chapter 6 and our first time jump of the story! We move forwards two months from that week of the fourth, and our day at the hospital opens with a mass causality incident. Lowkey a lot happens in this chapter, but I will focus on two cases, the first one with the intubation and the last with Henry Park.

before we delve deeper into them, I want to discuss a little why I chose to one: do an mci and two: have it be a fire. At this point, trinity and Yolanda’s relationship seems unsalvageable to Yolanda, she recognises that trinity needs to become more assured in herself, though she poses this less kindly when she berates trinity for accepting just the crumbs Yolanda offered in the previous chapter, she also recognises that she herself needs to become someone who is not an “unfeeling monster”. Anyway, they both need to do quite a lot of growth, and imo start from a fresh new beginning. The fire was meant to be symbolic in that sense, burning everything to the ground so they can rebuild slowly and better this time.

but yeah onto the cases. With the intubations we see Yolanda do in canon, anytime things get tricky (like the laryngeal fracture from s1) Yolanda wants to quickly move on to a crike (basically slash a quick hole in the neck so you can have direct access to the windpipe). My read of this is that this shows her impatience, she’s not someone willing to slow down and push through the hard bits when there’s an easier (though more violent) way out just like how she behaved with trinity. Anyway, trinity does persuade her to try again and Yolanda succeeds.

then we move on to Henry park. Yolanda is surprised to find that Trinity’s leading the resus, and she’s surprised by how much trinity has grown as a doctor. During the moments leading up to their breakup, (both in canon and in the previous chapters) Yolanda was the outwardly stoic one while trinity seemed most affected and now the roles are reversed. She’s also surprised by how much trinity doesn’t seem to need her assurances anymore and it makes her mournful. Anyway, patient ends up having compartment syndrome because one I wanted to mirror the forearm fasciotomy scene from s1 and two because it’s another way I chose to show blowing things up so we can start from the beginning again.

This chapter represents a bit of a turning point for Yolanda, a come to Jesus moment in a sense. In chapter 4, we left her off with a bit of hope about her relationship with Trinity. Yolanda thinks maybe there’s a chance, not at something serious quite yet, she hasn’t examined things that far. She comforts herself with the lie that maybe she and Trinity could just go back to casual but better this time, ignoring almost everything that has happened thus far that makes going back to casual impossible.

I mirrored this wilful blindness in the case of Palmer and the splenic rupture. I explained a little bit in the chapter but what I was going for was patient is sick with mono which can cause your spleen to become enlarged and thus increase the risk of it bursting due to trauma. Yolanda walks in and excludes anything surgical without a true investigation, in chapter 2 we hear her tell off the surgical intern, tell him to remain at the patient’s bedside and do a thorough clerking, none of which she does in this chapter.

As a result, Palmer worsens and ends up needing more invasive surgery.Yolanda unfortunately takes away from this case that her distraction- Trinity, is the reason for the failure, ignoring the fact that Trinity was the one to eventually put the strings together and without her, it might have gone unnoticed for even longer.

This failure of Yolanda’s to allow herself to see things also parallels their canon argument over Langdon. As far as we know, in canon, Yolanda knows very little about Langdon’s and Trinity’s argument on that first day, despite Trinity’s attempts to talk to her about it, it’s all “trouble” and so she doesn’t want to be involved. Just as she refuses to properly treat Palmer, she refuses to see the signs with Trinity. When she does find out from Langdon’s apology, the guilt becomes overwhelming. The same guilt she feels when confronted with Sloane, and so she retreats towards anger instead in both situations. More clearly, anger at trinity.

In this chapter, we get to meet the Garcias! But before we do, there is an emergency onboard the flight. At this point, Yolanda is desperate for a distraction, she normally escapes into her work, but without it, she has nowhere else to go but home.

My goal for this chapter was to highlight Yolanda regressing in a sense. She has now acknowledged that the relationship with Trinity was unhealthy, but she concludes instead that this was simply because of who she is rather than her actions. Her retreat home, as well as her choice last chapter to hit up her teenage situation-ship, represents a step backwards for Yolanda, which I wanted to reinforce by showing all her siblings moving on with their lives.

My choice to have the medical emergency be simple hypoglycaemia was to further drive this state of childish regression across, because as Trinity might say, comparable to the cases Yolanda as a trauma surgeon normally deals with, managing simple hypoglycaemia is a medical student question.

Apart from representing Yolanda’s character in relation to Trinity, since I was exploring Yolanda’s background, I decided to have the patient be of an immigrant Latin American background. When coming up with my headcanons for Yolanda’s character, I was inspired by AMetz’s statement that Yolanda comes from a high achieving family. I thought to myself that that might make Yolanda, who is technically a first generation immigrant, view said title as “stolen valour” to some extent. She sees herself in Jorge, her patient (who is also our first named patient, another choice I made to have Yolanda not really acknowledge the humanity of her patients aside from viewing them as patients), while at the same time, knowing that due to her class, she has immense privilege compared to him.

There’s no explicit clinical stuff in this chapter but following on from last chapter, I purposely had the cardiothoracic surgeon, Dr Ojo, asks Yolanda why she chose not to do a thoracotomy. This was to kind of reflect the fact that Yolanda’s behaviour surrounding her relationship with Trinity is very unusual for her, she’s normally quick to call it off definitively. And we see that at the end of this chapter, when she realises that what her and Trinity are doing needs to come to an end for her own good.

I did weave in some bits about the anaesthetic triad which I think would be fun to discuss because I mirrored it in the end smut scene. Just briefly to make things clearer, but to put someone to sleep for surgery, you need to make sure that 1. they are asleep, 2. they are paralysed and 3. they are not in pain. The first two are more intuitive to understand, in my opinion, but giving unconscious people pain meds is necessary because they can still feel pain and so trigger their stress response.

Our first chapter takes place entirely outside of the hospital, so there is no case per se, but I still wanted to weave in some clinical imagery from the start. Our story opens with the line,“thick globules of … gel”. Through this use of the symbol of alcohol based hand gel, my goal was to establish Yolanda’s state of mind following on directly from the season 2 Fourth of July canon.

Yolanda asserts that this hand gel represents the way she likes to view relationships in her life: temporary and with an obvious end date. The gel spills all over her hands and her scarred foot, but in the next moment, it evaporates like nothing had ever happened. There is no impact; no mess left to clean, the gel is in a sense “casual” as a result. At this point in the story, Yolanda views relationships that do not follow this model as unnecessary distractions from what really matters, since it is impossible for her to have “both”.

However, following on from that first line about the gel, Yolanda notices that the gel settles into the “chapped and peeling crevices” of her palms. Here, I wanted to explore the unreliability of Yolanda’s internal monologue. She asserts that this hand gel, which represents her previous relationships, including what she had with Trinity, has left her unchanged. And yet, we can see that her hands are worn in a way that “no hand cream… could fully heal.” With the inclusion of this, I wanted to indicate that Yolanda is and has been changed, has been scarred, by her relationship with Trinity, and all the relationships we will later explore. My aim with the section of the gel spilling over her foot, and her gasping even though as she acknowledges the injury from the scalpel in her foot has long since healed over, was to really drive home the fact that Trinity has left her with something permanent she can never erase. I purposely used verbs like “worm” and “burrow” to sort of evoke parasitic imagery to reflect how Yolanda Trinity at the moment.