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Yet the coming emergency -- ''hard-core ICU," M.J. called it -- also energized her, in much the way the rush to a fire prepares firefighters for the hazards ahead.

''We're a trauma unit," said M.J. And a proud one: Some nurses in the Ellison 4 surgical ICU wear buttons that read ''the real SICU" to differentiate themselves from another Mass. General unit with the same acronym but fewer trauma patients. Some of Ellison 4's nurses went to Asia to help after last year's tsunami, and to Louisiana to treat survivors of Hurricane Katrina. ''If you don't like trauma, you tend to leave," M.J. said.

Julia was quiet, but, inside, she was nervous. Some of the most emotionally exhausting patients she had cared for in her first seven months at Mass. General were accident victims: the man paralyzed two weeks before his wedding, the teenage girl with terrible head injuries from a rollover. She remembered how piercing it had been when the girl's mother pulled out her daughter's prom picture, taken just before the crash.

''You can't stand there and cry with them, as much as you'd like to," Julia said. Each time she cared for a trauma patient, she wondered whether she had the inner reserves, the courage, to handle it.


Now Julia was about to admit the most severely injured patient of her career, and it was someone much like herself. The 35-year-old mother of two boys, Julia kept thinking about the baby who would be left behind if Sabrina died.

Julia had another reason to be pensive: How she conducted herself in the hours ahead would help show that she was ready to be on her own as an ICU nurse. With the end of her training near, Julia was anxious that everything go right.

None of Julia's previous patients had died in her care, remarkable considering that patients in Ellison 4 are so sick that nearly one of every six dies. Tonight Julia suspected her luck might end, that Sabrina might die, or, worse, survive with devastating disabilities. ''Her quality of life could be just miserable," Julia said.

But Julia also knew this about the ICU: Sometimes it is the patients who seem hopeless who walk out the front door. So she got to work, scribbling on a brown paper towel the things she needed to do to get Sabrina's room ready.

Julia and M.J. quickly assembled their weapons for the battle ahead: bags of fluid and lots of IV lines, blood pressure boosters called pressors, and epinephrine --

''levo," in nurse parlance -- to counteract shock. Outside the room, they left a ''bolt cart" for implanting a pressure monitor in Sabrina's skull, as well as defibrillator paddles to shock her heart back into rhythm. ''Boy, you're prepared," said Dr. Robert Crawford, an ICU fellow four years out of medical school who would direct Sabrina's care. Crawford, a friendly Virginian with a boyish face, was grateful for the help as he juggled seven other patients.

In the last minutes before Sabrina arrived, M.J. turned to her student with one more piece of advice. ''Your job is to keep your head above water and admit your patient," she said in a no-nonsense voice. ''The surgical team and our team are going to be in your face, so just be ready for that."

Just after 4:30 p.m., the elevator doors opened and the surgical team rolled in with Sabrina, slicing through a cluster of ICU doctors and nurses waiting to help. ''She's very unstable," said anesthesiologist Gregory Ginsburg, amazed that Sabrina had survived this long. The young woman's shaved scalp revealed a long red surgical scar. A drainage tube sprouted from the crown of her head to relieve swelling, and her eyes were shut behind transparent surgical tape. A gray brace encased her neck, and her left arm was wrapped in blood-stained bandages. The rest of her body, save for bare feet, was covered by a blue-green blanket. At the foot of her bed, a white-and-red cooler held blood for transfusion.

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  [1]  [2]  [3]  [4]  [5]  | This series:  [Part one]  [Part two]  [ Part three ]  [Part four]