Lessons Learned - Or How Carter got out of the Burning Building!
Part Seven
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.

Note: This chapter would not have been possible without the help of Debbie who answered in my time of need with wonderful brilliance. Thank you so much Debbie! I am not a doctor, so the medical situations might not be totally accurate, but I do some research into the matter. This is fanfiction.

Warning: This contains some serious angst.

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

Notes: Thank you Jackie for all of your wonderful advice and editing!

Comments: Of course! Kdarganin@hotmail.com

If we need to get out of here, then it would be best if I carried Mrs. Cobb to help navigate the building. We need fast mobility, both the fire extinguisher and oxygen we will have to leave behind," Luka informed him.Peter sighed heavily and Luka went over to Carter, where his head was hanging down. "One more deep breath, Carter," Luka told him.

Carter breathed in and Luka took the mask away. The younger man groaned when Peter shifted him slightly. "Carter, just hang on man, I know this is hurting you, but we need to move fast," Peter told his former student softly.

"Sorry about this, Mrs. Cobb." Luka told the elderly woman, as he lifted her up and carried her in his arms. Both men mentally counted to three, and ran into the hallway one final time.



The dangerous trek back through the hallway was a struggle for Peter, as he tried to run while shouldering Carter's weight. He could not use the wall as a guide, and the only way he stayed oriented was by staying close to Luka. Peter kept his right hand wrapped around Carter's back and his left one around the doctor's legs. Peter tightened his grip on his co-worker when the group approached the site of their previous confrontation with the fire. The hole where the ceiling had caved in was like a gateway for the flames as they crawled along the ceiling. Peter had no choice but to unload his friend to the floor, or Carter could get burned from being in close contact with the ceiling.

"Wait a second," Peter called out. He waited until he heard Luka stop, then he bent down to slide Carter off his shoulder. The younger doctor could not stand on his feet, and Peter once again wrapped Carter's left arm around his neck.

"Okay," Peter said, and he pulled Carter with him, his feet practically dragging on the floor.

Carter wasn't able to keep up with Peter's pace. The surgeon took his right hand and grabbed hold of the side of Carter's pants, since the man wasn't wearing a belt. 'I never understood why you wore suspenders' Peter thought his mind trying calm him down with idle thoughts. Peter pulled on the fabric in an effort to lift the man up and encourage him to walk forward.

Luka managed to carry Mrs. Cobb without much difficulty, but he was on a constant look out for falling debris from the ceiling. Small parts of burning ceiling tile would descend to the floor, and Luka tried to dodge the toppling pieces as best he could in the blackness of the smoke.

The group trudged through the pile of rubble that was on fire earlier and valiantly avoided the flames above their heads. Peter's heart was racing, as he knew that they were near their escape now. He used this feeling to re-energize his resolve and pulled Carter along even faster than before.

Luka found the door and entered the stairwell. The smoke there was as dense as the floor they exited, and Luka prayed he could keep his balance as he descended the stairs in the dark. As he made his way down the first flight, he stopped to verify that his co-workers were behind him.

"Are you all right, Peter?' he asked when he noticed that he was alone on the landing.

"I'm coming!" Peter called back. Peter took a deep breath and rested for just a brief moment before lifting Carter up again over his shoulder. It would be easier and faster to haul the doctor down than it would be to continue to drag the man down the stairs. "God, Carter, you're heavier than you look." Peter complained under his breath.

"Thanks," was Carter's almost whispered reply.

With each flight of stairs Peter gradually felt safer from the danger. By the time they reached the third floor he could make out some of the steps through the haze. When he approached the second floor he stopped for a moment to catch his breath as he struggled to carry the other doctor.

For his part, Carter allowed himself to be hauled around. He wasn't quite sure how and why he was being carried over Peter Benton's shoulder. Carter was relatively confused about what was transpiring. He couldn't stand, he hurt all over, and he was having a hell of a time breathing. To top it all off, being carried upside down was compounding the horrible headache that threatened him with a cloud of blackness, beckoning him away from the pain he felt.

Peter reached the final flight of stairs and went through the door that was being held open by Luka. Both men carried their charges through the lobby and were startled when another explosion rocked the hospital. Luka looked behind him for a moment, and turned to face Peter.

"There goes the ceiling on the fourth floor," he told the surgeon.

Peter didn't answer the man, knowing how close they all came to being caught on that floor when it finally gave in to the fire raging within its walls. Instead, Peter was more alert to the sounds of sirens that could be heard outside. There were several blurring noises and horns honking. He could see blue and red lights flashing through the windows, Peter hoped that there was an ambulance waiting for them when they went outside.



Robert Romano was a champagne cork ready to be popped. Pacing was not exactly what he was doing, more like he was wearing away the grass in the path from his constant nervousness and anger. He was furious that three of his doctors were in the middle of a burning hospital against his orders and he was close to going postal towards Dr. Chuck Logan.

After a few more strides over the grass Romano halted in his tracks and screamed out loud, "Son of a bitch!"

Many of the staff that was milling around looked up, startled from the outburst, and Romano did not bother to hold his composure. He locked eyes with Dr. Logan who was a few feet away, drilling a hole in the man's head with his intent gaze. The Grady chief of staff simply turned away, oddly intent with talking with the injured tech. Romano had about enough of the man's callous unconcern about his people and was about to unload holy Hell on the man when he heard sirens in the distance.

"About Godamn time!" He grumbled to no one. Romano went about explaining procedures to the gathered staff concerning patient transfers. He went over to where Dr. Logan was standing over Taylor Evans.

"I think he is our number one priority for transfer because of his injuries, I'll arrange for his immediate transport when the EMT's get here." Romano informed his nemeses.

"I'll oversee his care when he arrives in the ER." Logan told the balding doctor.

"I think you have more immediate concerns regarding this disaster and your lax in safety protocols, Logan." Romano told the Chief in a most accusing tone.

Logan walked right to Robert's face and peered down at him, using his height in some kind of intimating tactic. "I think the fact that one of your staff was in the very spot of the fire's outset is what you should be worried about, Rocket." Logan glared at the man with a slight smile tugging on his face.

"What in the world gave you that ridiculous notion?" Romano fired back.

"Well, according to Mr. Evans, he had to drag Dr. Carter out of a supply closet where evidently the fire started. It seems to me that your gimp of a doctor was probably the cause of the fire. Should teach you a thing or two about letting unqualified personnel on your staff." Logan replied.

Romano could feel his face turn several shades of red and he tried valiantly to control the tremors going down his arms and into his fists. Before he had a chance to channel his rage several EMT's ran up to the two doctors with a barrage of questions.

Romano cut away from his confrontation with Logan to ensure that someone took charge of Grady's patients. Just as he was overseeing Taylor's transfer onto an ambulance he heard a commotion and turned to see Luka Kovac and Peter Benton running out of the hospital. Both doctors were carrying people and Romano went into action.

"You!" He pointed to two EMT's. "Come with me!" Romano ran towards his co-workers meeting them half way towards the lawn.

Romano caught up with his doctors and helped Peter Benton lower Carter to the ground. Romano saw the kind of shape the young resident was in and wanted to make sure that the other two doctors were uninjured. Robert glanced at Peter to see if the man was all right. The man was breathing hard, but he wasn't struggling for breath, a sign of smoke inhalation. There were no signs of burns on either doctors and Romano assessed that Benton was simply winded from carrying Carter.

Luka Kovac put down Judith, who was able to stand on her own two feet. One of the EMT's, a very tall and thin, black man went up to her with an oxygen mask.

As soon as Peter had Carter settled on the ground he looked at a female EMT who's nametag read Jennifer. "This man needs oxygen right now!" Peter barked.

Carter lay on the ground unable to breathe properly. His face was flushed red and he was sweating profusely. Peter saw that the burn on his side was minor and now he had the chance to mull over the question whether Carter had damaged any of his previous injuries. There was no telling what the young man had gone though and Peter was frustrated at the fact that he could have caused further injury by hauling around like a sack of potatoes.

Jennifer brought out an oxygen mask and placed it on the wheezing man on the ground. The EMT then took out a blood pressure cuff and wrapped it around Carter's arm and took his pulse.

Jennifer yelled at one of her associates, "We need a gurney here right now!" She turned to Peter, "Pulse is 130, BP is 80/60." She said with concern.

"Why is his pressure so low, Peter?" Romano asked angrily after hearing the EMT's relay.

"I don't know!" Peter replied miffed.

Peter looked at his friend. "Carter, hey Carter? Were you exposed to anything in the fire? Any chemicals?" Peter asked frantically.

Romano watched the younger doctor shake his head confusion evident on his face. Carter placed his hand on his chest while he continued to struggle to breathe despite the oxygen.

Peter was persistent as the other EMT's placed a backboard under the younger man and loaded him on a stregher. Peter ran along side it hoping to get his former student to answer him. "Come on man, try to think?" Peter pleaded.

Carter locked eyes to see the worry and panic on Peter Benton's face. He had only seen that look on very rare occasions and he tried to think hard. His head was killing him, making his mind all fuzzy. Deep inside Carter felt like he couldn't let his mentor down and tried to recall the events that transpired. After concentrating, the circumstances of the day started flashing through his mind and Carter understood what was happening to him and what he had done. Carter struggled to pull the mask off his face. He vainly tried to gasp for breath and managed to choke out a word.

"Benzene." Was his panicked reply. Carter looked at Peter with a sad expression hoping the surgeon would not be too mad at him for keeping this information from him.

Peter felt two totally unmistakable emotions at once. He was experiencing utter fury at the fact that the younger doctor knew he was exposed to Benzene fumes and recklessly disregarded his own health for the sake of a patient. He also felt overwhelming fear knowing the medical effects it would have on him.

"Damn it! Carter!" Peter watched his former student being loaded into the ambulance.

Luka, who had been observing Judith's care decided to chime in on the information.

"Could be the reason he appeared confused earlier." Luka said trying to be helpful.

"I know that, Dr. Kovac!" Peter bitterly snapped at the other doctor.

Peter placed his hand on the ambulance door as it was about to be closed in his face. "I'm riding with him, now scoot over!" Peter ordered the female EMT who didn't seem to want to argue knowing how limited their time was.

Robert Romano and Luka Kovac stood silently by as the ambulance drove away and as fire trucks starting pouring into the parking lot. Both doctors looked at each other and ran over to the ambulance that was transporting Mrs. Cobb. Romano strode overt to the EMT who was heading to the driver's side door.

"Hey, have all the patients been transported to County?" Romano asked the medic.

"All cases were picked up while we were attending to these victims. The only people transported to County was the man with the injured pelvis, your guy and we're sending this lady there." He answered obviously in a hurry.

"Well then the two of us are riding with you. Dr. Kovac and I will be needed and I'm not taking no for an answer." Romano told the driver pointedly.

"Fine, one in the front, one in the cab. Now let's go." The medic replied annoyed.



Peter could not sit aside in the ambulance, instead he stayed close to the head of the gurney as the other medic, Steve, worked feverishly to establish Carter's vitals. Carter was very pale and his burns covered a larger area on the lower part of his chest then Peter first noticed in the hallway.

Steve looked to the surgeon, "BP is down to 80/50, pulse still 130, his respiration's are 9. I'm setting up an IV."

Carter looked at Peter expectantly while fighting to catch his breath on 100 percent oxygen. Carter was gasping for air as well as struggling to tell Peter something as he weakly signaled him with one of his hands to come near him.

Peter placed his hand on the gurney as he leaned in close to Carter's face. "Carter, don't fight the mask, come on now, calm down." Peter tried to relax the resident who maintained fighting for the air needed to tell Peter something.

Carter violently grabbed Peter's shoulder and pulled him down with more strength than the surgeon gave him credit for. Carter swiped the mask away and lifted his head up to his friend's ear.

"Sorry." Carter managed to rasp out between gasps, startling Benton as he fell back to the gurney and his eyes rolled back in his head. Peter placed his hand on Carter's shoulder, "Don't do this to me, man!"

Peter looked down at Carter panicked as Steve went to action. "Carter!" The surgeon called out to his unresponsive friend. Peter instinctively grabbed the man's hand and squeezed it.

"Resps are down to 6, I need to establish an airway." Steve went to intubate Carter and glanced at the shocked surgeon. "Start another IV, Doc!" the EMT commanded.

Peter went to start an IV on Carter's left arm. He was in the midst of injecting the needle when Carter's arm jerked away, ripping it out. "Damn it!" Peter cursed as blood started to trickle from the wound.

Suddenly Carter's arm starting twitching and his body began to shake. "He's having a seizure! Hold him down!" Peter yelled at he put his arms on Carter's chest, careful of his burns.

The medic removed his intubation kit; "I can't establish an airway; he's moving around too much! I'm bagging him now!" Steve grabbed the oxygen and started forcing the air into Carter's lungs.

Steve looked over at Benton and gave him a stern warning. "We'll be at County in less than a minute, DO NOT give this man any cardio stimulants because of the Benzene toxicity!" Steve locked eyes with Peter and noted his apprehension. "Trust me, I handled these cases before. The Benzene is blocking the oxygen receptors in his red blood cells." Steve told the other doctor as they pulled up to County.

Peter nodded and whispered to Carter who had not stopped convulsing. "You're not letting some chemical defeat you man, you're so much stronger then that!"



Dave Malucci was walking by the admit desk when he saw Dr. Chen looking over a chart. He never understood why the other resident never came around to his charm, but that was something he could not think about right now.

"Hey, did you hear that the guy in exam one was in a fire over at Grady Memorial?" Dave asked.

Chen looked up from her paperwork, a look of worry across her face. "There's a fire there?"

"Yeah, the doc that's with him is ordering Dr. Greene around like he's running the trauma. Abby's still there and Greene sent me out here for two more victims."

"Where's Dr. Weaver?" Chen asked as she started to get gowned for the incoming units.

"She went home, its you, me, Dr. Greene and Elizabeth is coming down." Dave replied.

"Aren't Benton, Kovac, and Carter at Grady?" Chen asked.

A gurney came crashing through the bay doors with Benton racing along side it. Dave's answer to Chen was cut off as he saw Carter laying on the gurney in the midst of convulsions. He experienced a horrible feeling of deju vu at the sight of his co-worker being transferred to a trauma room for the second time in three months. Dave thought Chen looked to be as shocked as he felt.

"Chen, go get Dr. Greene!" Dave told her anxiously, trying to snap the young woman out of her shock.



Green burst into the trauma room after sending Dave and Chen to attend to the injured tech. He approached the gurney, shocked to see Carter even though both Dave and Chen warned him ahead of time.

They moved Carter over to the trauma table. His color was ashen, and he was barely breathing. His body was in the throes of a violent seizure; it took every hand in the room to keep his body on the table.

"B/P 70/40, pulse 140, respiration's 4, GCS 5, lost the IV en route, unable to secure an airway, bagged him by mask en route, burns over the lower third of the chest." Steve rattled off quickly. "Started seizing about 3 minutes out." He pointed out two IV sites, one on either arm. The left arm still copiously bleeding from the site.

"We need an IV here! And prep for a central line." Mark called out.

Haleh moved in with the IV kit, she was the best around with hard sticks. She secured Carter's arm between the table and her hip. "Got it." She called.

"Get his head to the side!" Mark yelled. "Move, MOVE!" They moved his head over to the right as a stream of saliva made its way from his mouth, almost black in color, tinged heavily with blood.

"We need to get him intubated now!" Mark moved to the head of the table, attempting to hold John's head still to intubate him.

"Mark, he's tachy at 150." Lydia called out. "He's in V-fib!"

"An amp of Epi!" Mark called for the drug.

"No! No Epi!" Peter yelled.

"Why not, Peter?" Mark asked.

"He inhaled Benzene, so no cardiac stimulants." Peter replied.

"He's in asystole!" Lydia looked nervously at the monitor.

"Move the cart over here now! Let's move!" Peter took hold of the paddles. John's body lay perfectly still on the trauma table, the seizure had ceased.

"Charge to 200 and CLEAR!" Peter yelled. John's body was lifted slightly off of the table from the shock, his arms dangling limply over the sides.

"Nothing!" Lydia confirmed that the monitor showed flatline, no cardiac activity whatsoever. The deafening whine of the cardiac monitor filled the room.

"Again, charge to 250 and CLEAR!" His body lifted a good two inches off of the table.

"Still in asystole!" Lydia called.

"Oh God, come on Carter, don't you die on me, man!" Peter pleaded as he placed the paddles to his former student's chest.

"Again, to 300 and CLEAR!" Peter yelled.

As Peter introduced another shock to his friend Luka Kovac and Robert Romano burst into the room.

"We have a rhythm!" Peter shouted with relief.

Luka forced his way to Carter's side with a glance at Romano, who remained in the doorway nervously watching, but staying out of the way knowing that the three doctors were handling the crisis.

"We have to get him intubated now! How long was he down at the scene?" Mark asked those present, "How long?" He asked more forcefully then he intended. He was greeted by a momentary silence.

"I'm not sure?" Peter answered gravely.

Mark gazed gravely at his colleagues, mentally ticking off how long it had taken them to transport, and the down time in the trauma room, he may regret intubating him if he was never to come of the vent again, or worse suffered brain damage from hypoxia.

Dave Malucci slipped into the room nervously and whispered something to Romano. The administrator's face reddened with anger. He gritted his teeth and nodded his head. "Help them out!" Romano ordered him pointing to the team working on Carter and then Romano left the room.

"I can't see the cords, I need some light here!" Mark attempted to intubate; "I'm not getting through, what the hell? His trachea is constricted!"

Luka grabbed the fiberoptic scope and a pediatric endotracheal tube. "I need some cricoid pressure!"

Mark moved to the side, assisting Luka with the intubation. Dave went to Carter's left side unsure on how to help.

"Tachycardic at 160! What do you want to give him?" Lydia asked.

"Hang on a second, one thing at a time!" Mark and Luka called almost simultaneously.

"Okay, Luka's in! Bag him! Somebody get respiratory in here, we need to get him on a vent!" Mark ordered.

"Good job Luka." Mark said quietly. "Can somebody call chemistry?"

"Get a central line in! Malucci! Get over here, we need a central line now!"

Dave quickly grabbed the tubing needed, grateful that he was doing something.

"Mark, he's still in V-tach!" Lydia informed him urgently.

"Peter any ideas?" Mark asked. The phone rang, answered by Peter, it was chemistry. He explained the situation and waited their instructions. The only thing Peter knew for sure was no epi or cardiac stimulants, and the only reason he knew that was because the paramedics told him that on the ride in.

"We can't give Epi or any other cardiac drugs, it'll interact with the benzene, hang on." Peter continued a short conversation; "We need to set up for a tap water lavage, normal saline catharsis." Peter moved to the head of the table and massaged the carotid arteries; they all watched the monitor closely as the heart rate decreased to a more acceptable level.

"Okay, we got 110." Peter alerted the others, relieved that he was feeling more in control.

The respiratory therapist moved in quickly, setting up the portable vent. She listened intently to his lungs, "I'm hearing rales 3/4 of the way up, both lung fields. He's awfully tight, do you want Albuterol?"

"Do you think it'll help?" Luka asked the therapist.

"Can't hurt." The respiratory therapist set up for a combination Albuterol and Atrovent treatment. Mark watched with horrid fascination, as the arm that had dangled limply over the table just moments previously, starting jerking and twitching, followed by the other arm, and both legs. The seizure came on again, with no warning. John's body started jerking violently and rhythmically, almost dislodging the ET tube from his throat.

"Luka hold onto that ET tube!" Mark called. Luka moved again to the head of the table, and held John's head as firmly in place as he could. "Give 5 mg of Diazepam!"

"I've lost the IV access!" Haleh called as the IV tubing swung to the floor, the site bleeding copiously. Haleh attempted to stop the flow with some 4 x 4's and pressure, but his arms were jerking so violently by this time it was all she could do to just wipe at it.

"God but he's strong!" Haleh was unable to hold the arm down and was content to tape a 4 x 4 over the bleeding site.

"Malucci! Get that central line in now!" Mark snapped at the resident.

"I'm trying, I can't do this when he's moving around!" Dave replied frantically as he struggled to insert the tube.

Luka was struggling to hold John's head and neck in place so the ET tube wouldn't become dislodged. "Give it IM then!"

Haleh drew up the med, and sunk the needle into John's thigh as she held onto him, she didn't want to break the needle off in the process.

Peter didn't have any patience anymore and felt compelled to get things set up at a faster rate. He had no time for foul ups or excuses. "Get a portable chest in here. I want that central line in, then a chem-20, trauma panel, CBC, and electrolytes and a benzene level!" Peter ordered, not willing to give up all control to Mark during the trauma.

"I need that lavage set up, and somebody get a Foley in!" Mark called out. John's body was still jerking but not quite as violently as before. The nasogastric tube was passed through his nose into his stomach.

"No gag." Luka quietly announced.

Peter set up the lavage, as Malucci finished up the central line, "Got it!" Malucci called, proud of the accomplishment, which was difficult even under the best circumstances.

The portable x-ray was wheeled into the room and they all moved back a bit from the table as the film was shot.

"I want those back stat!" Mark yelled. Lydia continued to watch the cardiac monitor as she finished cutting John's pants away to prep for the Foley. It didn't seem so long ago that she had done much the same thing. "Foley's in." This time at least, Lydia thought, he didn't have to feel the pain. She looked sadly down into his ashen-colored face, and noticed John's eyes opening.

"Mark!" She called, "His eyes!"

"Carter, Carter? Can you hear me?" Mark called out to him. John's eyes stared blankly ahead. The scleras were bright red, and there was no recognition in his eyes.

Peter moved to the head of the bed, "Carter? Carter!" He squeezed his friend's hand, "Squeeze my hand if you can hear me!" John's eyes continued to stare up at the ceiling tiles, as his hand jerked free of Peter's, his body again jerking rhythmically, starting out more slowly than the last seizure, but turning into a violent tonic clonic seizure. John's eyes widened, pupils dilating and constricting, dilating and constricting and finally dilating so far that they couldn't even see the iris'.

"Another 5 mg of Diazepam IV, and set him up for a phenobarb drip." Mark called, as they all manned their stations, attempted to keep all of the tubes in place.

"I think you may want to up that to 10." Luka called as John's head jerked violently to the side, the NG tube working over time suctioning the tap water out of his stomach. The saliva was foaming over the ET tube, and the blood was coming at an alarming rate.

"Okay, give him 10 mg of Diazepam." Mark called, watching as John's body finally relaxed with only an occasional twitch marching from his shoulders to his hands, which were blackened with soot from the fire.

"Where the hell is all this blood coming from?" Luka asked. The respiratory therapist looked gravely up at Luka, meeting his gaze. It was left unsaid. They both knew that between the benzene and the smoke inhalation his lungs were probably seared. The x-ray tech moved quickly into the room and handed the films to Mark. He slapped them quickly up to the light box, and let out a heavy sigh. Luka noted his colleague's obvious distress, and looked back at the films. The room was silent as those present looked at the results. His lung tissue was damaged and it was hard to tell how permanent the results would be.

"We need to get him up to ICU, let's move, people!" Peter barked as most of the staff followed the gurney out into the hallway.

Peter led the gurney into the elevator with Lydia faithfully along side. The elevator doors closed on the silent staff that remained. Mark sighed heavily realization dawning on him at how close they came to losing Carter. He looked over to Luka with anger.

"What the hell happened out there!" Mark demanded an explanation from the foreign doctor.

Luka looked down at his feet trying to crush the feelings of confusion and exasperation from his mind. Before he could answer, Robert Romano stormed out of trauma one and marched over the assembled doctors.

His eyes were darting from each person in the hallway, his nostrils flaring. It was apparent to Luka that the man could barley control his shaking and the balding doctor's face was turning beet red.

"Where the hell is Dr. Logan!" Romano demanded to know. The administrator whirled around, staring at each doctor as his fists clenched and unclenched.

"I haven't seen him since I left his patient to attend to Carter." Mark replied, unsure as to why Romano was fuming.

"Is Carter all right?" Romano asked, his voice lowered an octave.

"We stopped his seizures and his lungs appear to be seared from Benzene poisoning and smoke inhalation. Peter took him to ICU" Mark replied solemnly.

"If you find Dr. Logan, call security then call me. Don't you dare call the police until I get there. I want the chance to kill that son of a bitch before they can stop me!" Romano told the group and went down the hall to the stairwell, obviously not wanting to wait for the elevator.

Mark and Luka stared at each other in confusion. Dave wiped the sweat off his brow and turned to his colleagues. "I guess that tech had something important to say to Dr. Romano." Dave relayed to his friends in amazement to Romano's reactions.