Triage
Title: Triage
Author: aelfgyfu_mead
Word count: 5400
Rating/Warning: G
Spoilers: Solitudes
Prompt: 90. Sam and Janet. After Antarctica, Sam asks for more medical training.
Summary: Sam and Janet review medical procedures-and what happened in Antarctica.
Now that she had discharged Colonel O'Neill, Janet could finish her notes and paperwork on his case. Thank goodness. She looked at Sam Carter's file, which she still had not closed despite having let her go two days earlier. She hesitated, then decided that she really was done. It was best that she never put on paper her concerns about the state of mind of a young female officer. As the concussion healed, Sam's outlook would improve, Janet was certain. And Janet didn't need notes to remember that she was a little worried.
A knock startled her. She put O'Neill's file over Sam's before calling out to admit her visitor, who turned out to be the very woman on Janet's mind.
"Captain Carter!" she said, not sure whether to be pleasantly surprised or simply concerned. "You're not due for a recheck until tomorrow. Are you experiencing any problems?" Sam's bland expression offered no clues.
"No," the other woman said. "I'm fine. I just wanted to talk to you." She closed the door quietly behind her.
"Okay, Sam." Janet hoped the informality would put her at ease. "What's on your mind?"
Sam smiled halfheartedly. "Days off are hard. I keep rethinking what I did and what I should have done." Her gaze stopped somewhere on Janet's desk.
"I thought the Colonel ordered you to stop that?" Repeatedly, in fact, in Janet's hearing.
"He can't order me to stop thinking." There, eye contact.
"You can't tell him that," Janet said. "But I think he has a point this time. You're both going to be fine. You just need some more rest for the concussion, and I discharged the Colonel this morning." Oh. "And that's why you're here now. So he won't hear this?"
"No. I mean, I checked on him and made sure he was really going home today, before I came to see you. And then I checked with Daniel, and Teal'c-"
"And waited to be sure that the Colonel was gone before you came to my office."
Sam's little laugh blew hair away from her forehead. "Well, he'd have given me a hard time if he knew I was coming to see you. He'd have thought I was checking up on him."
"Because you didn't do that at all these past few days." Janet smiled to soften her words. "You're beating around the bush, Sam, and that isn't like you."
"I want medical training," Sam blurted.
That was much more like her.
"I've had the standard Air Force first aid," she continued. "But I didn't remember it well enough, and I didn't know enough. I didn't check his internal injuries; I figured I didn't know how. But then I slept on top of him when he had a broken rib!"
"Whoa!" She needed to stop this right now. "We've been through this. You had a serious concussion yourself, the Colonel was concealing how badly he was hurt, and you couldn't even safely uncover him for a proper exam."
"But what would you have done if you had been there instead of me?" Sam challenged, her gaze direct.
Janet gazed back, unsurprised by the question. She'd already thought of it herself. "I'd have pulled rank on him because as a doctor-a medical doctor-I can do that. I'd have given him a slightly more thorough exam. I'd have splinted his leg."
"And hurt him less," Sam grumbled.
"I'd have made sure I knew which side had the broken rib, and I'd probably have strapped it because I couldn't keep him still," Janet admitted. She'd have fought long and hard to keep him still, because hypothermia victims could have heart attacks from too much movement. Jack O'Neill was one of the stubbornest men she'd even met, though.
"But you know what? That wouldn't have made any difference to the Colonel. His broken rib never pierced his lung; the hemoptysis was due to a pulmonary contusion, and strapping wouldn't have helped." Probably wouldn't have helped, she added silently. It might have reduced some of the bruising. They would never know. She hoped her technical term for "coughing blood" would slow Sam down.
Of course it didn't; Sam no doubt already knew the word. "I knew something was wrong, I knew he was keeping it from me, and I didn't know what to do."
"That's something you'll have to talk to him about," Janet replied. "If I had done better, it would only be because I scare him more than you do."
They both grinned at that, but Sam's smile melted away quickly.
"I want to review first aid, and then I want some medic training," Sam declared. "All my training has been for stabilizing casualties until the medics arrive or we can get the wounded back to help, and. . . . Well, honestly, I tried to take it seriously, but back then, I knew I was never going to be in combat. I might be in a plane crash, but if I crashed, I was going to be needing help, not giving it. So . . . I didn't study first aid the way I worked on statistical and quantum mechanics. I need to know more."
"Fair enough. But you do realize there's only so much you can do in the field? Don't ask me to teach you to do a field tracheotomy, like that young man on SG-5 asked the other day. No surgery at all, in fact."
Sam looked alarmed for a moment. "Fine." Oh, God, she had been going to ask that one. Why did everyone want to know how to do a tracheotomy? Too much television? She found it hard to imagine Captain Sam Carter watching action shows-but then, she still didn't know her as well as she'd like. Sam was handing her an opportunity to get to know her better, and Janet was going to grab it with both hands.
Janet nodded. "That's okay. We're going to be doing first-aid training for all the SG teams."
"Because of me?" Sam's eyes widened.
"No, in fact. There are other reasons." Janet hesitated, but it was important for Sam to know that Janet didn't think any less of her for her performance in Antarctica, so she went with the truth. "Don't repeat this, but the last straw was Teal'c picking up Major Castleman, putting him across his shoulders, and carrying him through the Gate with a neck injury. Thank God it turned out to be minor-Castleman will be fine. But I found out that not only did Teal'c not know how to treat injured . . . humans, Tau'ri, whatever he wants to call us, no one on the team was confident enough in their own training to tell Teal'c he was doing it wrong! They weren't under fire, they weren't injured, and they weren't even in a hostile climate." What Teal'c did might have worked for a Jaffa, but Castleman had no symbiote to heal him. Janet had been fit to be tied when she found out how Castleman had been carried. She had to calm down before she could talk to Teal'c. He didn't need any more guilt that day.
"Oh." Sam seemed genuinely surprised, but at least she believed Janet.
"So we're starting by going through the entire Air Force first aid manual. Again. Everyone. No exceptions. Not for aliens, not for archaeologists, not even for people who have been in combat before this posting."
"But I want more," Sam insisted quietly.
Janet nodded and pulled a notepad from the many piles of files and papers on her desk. "Let's make a list. You tell me what you want to learn, and I'll tell you what you've left out. Oh, and we're already adding to the first aid equipment each team carries. We hadn't sent warm packs with you because you were going to a warm planet, but now we know that you can end up on an entirely different planet. Or in a different climate zone."
It was only when Sam sat back in the chair that Janet realized how hunched Sam had been before, and that Janet herself was a bit hunched.
Sam told her, "I can live with not performing surgery."
"Now what do you else do you want?" she asked.
They brainstormed for a while. Janet had to shoot down some of Sam's ideas; she couldn't even give her an advanced field medic course in the time she and Sam had available. But she could add some things that weren't on the standard list: advanced training for hypothermia, heat stroke, and electrical burns. How to handle anaphylactic shock when you couldn't get back to the infirmary immediately. (Janet had made epi-pens and chlorphenamine standard equipment only recently; who knew what allergies might surface in alien environments?) How to diagnose problems was a big one: they'd already discovered that people could ingest nanites, be injured by weapons or sickened by diseases until very recently unknown on earth, have their memories altered, or be infested by a mind-controlling alien parasite. The most important thing was to know when someone wasn't quite himself. Or herself. Those weren't covered in the Air Force First Aid Manual. Janet would have to write her own supplement-when she had time. At the rate they were going, that would be about the time she wrote her memoirs.
As Sam ran through a list of scenarios she could imagine facing, Janet could hear the anxiety in her voice. That anxiety hadn't been there before Antarctica. Janet finally put an end to the list and told Sam to go home and rest. She wasn't even back on light duty yet; that would start tomorrow.
Sam looked at their list. "So I'll do better next time."
Janet shook her head. She wanted to say that Sam couldn't have done better, but she knew Sam would tell her all the things she thought she should have done. She could only give a little reassurance today, with Sam still looking tired from her ordeal.
So for now, Janet said, "I'll happily teach you what I can, because SG-1 seems to have a trouble magnet in your shoulder patches. But I want you to know that you did nothing less than the best you could with what you had in Antarctica. You think you failed. But the Colonel lived because you kept him as warm as you could, you kept giving him liquids, you splinted his leg so that he didn't make things worse when he insisted on moving-and you gave us the clues we needed to get you home. You had a serious concussion yourself, and you dug the Stargate out of a block of ice."
"The Colonel helped!"
Janet glared at Sam. "Yeah, I'm sure the man with the broken bones and the contused lung did most of the work."
"Well, okay, but-"
"Not finished, Captain. You dug the Stargate out and you dialed. You reset it and dialed again. You sent the signals you needed to get help. Yes, maybe you could have dialed another planet-don't think I didn't hear you wish you'd done that"-and a few other things besides-"but then you'd have had to drag the Colonel through the Gate, and that would have done its own damage, since you didn't have the equipment that the rescue team brought to secure him."
Janet took a breath. "The only one who thinks you messed up here, Sam, is you. And I'm happy to teach you, but I'd like my pupil to have a bit more confidence in herself before she starts."
Sam blew some air out between her lips, blowing her hair around again. "Yes, Doctor."
"Doctor?"
"Janet." If she couldn't get another smile out of Sam today, she could at least get her to go back to the first name basis they'd reached after saving the base from a Goa'uld.
***
Janet made Sam wait until she after she did the first aid review for everyone, telling her that it didn't make sense to teach her more advanced techniques until she'd had a refresher on the basics. Colonel O'Neill still had his leg in a cast and proved as ornery as she expected at the classes, but that had the unexpected benefit of distracting Sam from any blame as she tried alternately to soften the Colonel's wrath and stifle laughter at him. Janet suspected that this effect only encouraged the Colonel, who had given up arguing with his second-in-command about her actions in Antarctica.
The Sam who turned up ten days after that first conversation for private lessons with Janet seemed closer to the Sam that Janet had met when she first arrived at the SGC, a woman perhaps a little too eager to prove herself but more than capable of doing so. The bruises on her face were almost invisible, and she no longer had hollows under her eyes.
So Janet spent the morning running Sam through scenarios, asking her how she would treat various conditions with the specific teammates she had, not just how she would handle injuries or illness in the abstract. How would she handle hypothermia or hyperthermia if it affected the Colonel badly enough that he didn't believe her? How would she handle anything that hurt Teal'c? Janet had determined the best way to help Teal'c was to remove any foreign bodies and then let his symbiote do the rest, but she confided in Sam how wrong that felt to her.
"Sometimes, our instincts are insufficient; occasionally, they're downright dangerous," Janet told her. "We're going to make mistakes, all of us. We pray they're not irreversible, and we do the best we can."
Sam nodded solemnly; Janet was certain she was remembering that last mission.
Janet didn't push her luck in that session. She waited until the following morning to say what she needed to be said. She took Sam through some more practice with dummies; she was confident now that Sam had the muscle memory to do the basics even if dazed herself.
Janet then took her through what they knew about injuries from the ribbon device. How would she handle a disoriented teammate who didn't realize how disoriented he was?
"If it's anyone but the Colonel, I can enlist the Colonel. Daniel will argue with him, but if the Colonel and I both tell him he's not in any condition to keep translating a stele, and the Colonel orders him down, he'll do it." Sam paused. "I'm still not always sure what Teal'c thinks of me. He always looks to the Colonel, which makes sense, because he's the ranking officer. If he doesn't believe me, he'll believe the Colonel. Even if he thinks we're both wrong, I think the two of us can get him to do what I say."
"And if it's you?" Janet hadn't brought Sam into the scenarios as a patient before.
Sam's eyebrows disappeared into her hair. "Don't you mean the Colonel?"
"I'm saving him for last," Janet said with a grin.
"Oh. Okay. Well, I'd like to think that I'd be reasonable enough to accept the Colonel's judgment even if I were really out of it." She thought for a moment longer. "Honestly, I think I'm conditioned enough to follow orders that I'll do what he tells me unless I'm really far gone."
Janet nodded. "And the Colonel himself?"
Sam smiled. "That's where I have to bring out the big guns. I can relieve him of duty if I have cause to believe that he's compromised-that his judgment is compromised. And if he's out of it enough that he won't let me relieve him, well, then I'll have to win Teal'c over. Daniel should be able to help with that; he should know even better than I would if the Colonel wasn't himself, and Teal'c and Daniel . . . well, they have this bond."
That answer wasn't at all what Janet expected in more ways than one, but she focused on the most practical problem: "What would Teal'c do that you couldn't?"
"Sit on him. Anywhere he's not injured, of course."
Janet laughed, and Sam made no attempt to stifle her own laughter this time.
"I want to ask if you're serious, but I'm afraid the answer is 'yes,'" Janet said, trailing off into a giggle.
Sam's smile was a little wry this time. "I've had to give it some thought." She looked at the floor. "Ribbon devices aren't the only thing that can make someone not himself, you know."
Major Kawalsky had died while Janet's transfer to the SGC was still in process, but she had read enough about his case to be a little glad she hadn't been there for it.
Time to move on. "We've already been through the protocols for suspected Goa'uld infestation more than enough, and I know you'd have your teammates' support for that. But one of the trickiest injuries that way can be a concussion."
She'd surprised Sam again. Good.
"Some concussions cause loss of consciousness, and that makes them easier to diagnose. When Daniel came flying through the Gate and hit his head hard enough to knock him cold for minutes, we knew he was concussed. When you woke up in Antarctica, did you realize that you were concussed?"
"Yes. I knew, but I didn't have time to worry about it; the Colonel was still out, and I knew that I hadn't suffered any other injuries, but he-" Sam was talking faster and her voice was rising.
"Good. You recognized it, even if you couldn't do anything about your concussion right away." Janet brought her firmly back to the present.
Then she asked, "Did you know that people can get concussions without being knocked unconscious?"
Sam looked mildly disgusted. "Yeah-yes."
"Oh, don't cut yourself off on my account. Maybe you were going to say something about how the dozen or two times I said it during the group training kind of brought it home?"
Sam's face relaxed again. "Maybe."
"Sam, it's just you and me. You can say what you think."
That brought no response.
"And you know how to diagnose a concussion without loss of consciousness? Take me through it. Let's say it's Daniel."
"First, I'd ask him some questions about the last few minutes. I'd see if he lost any memories in that time and listen carefully; if he has forgotten anything or his speech is slurred, he could be concussed. Then we'd need to-"
"We'll get to treatment in a moment. What else are you checking?"
"I'm looking at his eyes to make sure that the pupils are the same size and responsive to light; if I have any doubts, I check first one, then the other with a flashlight. If they're not equal and reactive, or if he shows unusual sensitivity to light, we may well be looking at a concussion."
"Good. Anything else?"
"I ask whether he has a headache, but I know Daniel, so I know he might not even notice if he's worried enough about . . . someone else."
"His wife?'
"Especially his wife. Or anyone, really."
Janet nodded. "You've given this a lot of thought."
Sam laughed and shrugged. "I had some time off recently, and I wasn't allowed to bring any work home."
"Oh, God. Tell me you didn't spend time watching medical dramas on tv."
"I might have turned on the tv a few times," Sam said playfully. "But I know better than to try to learn anything from them. For concussion, I know to watch for unusual drowsiness, poor coordination-which in Daniel's case means I have to watch carefully, because he can get distracted enough to walk into doorways when he's fine, but he has very quick reflexes when he's paying attention. Of course, confusion or loss of consciousness later is a big clue."
Janet nodded. "Anything else?"
"I must be forgetting something. Well, seizures. Oh-and vomiting. Concussions can cause vomiting."
Janet nodded again. "That it?"
Sam frowned in concentration. "Eyes, speech, memory, coordination, vomiting. I can't think of anything else."
"Those are the usual indicators. Some clues are a lot harder to identify. At a previous posting, I saw a man who was having sudden 'behavioral problems'; the MPs brought me to sedate him." Even having planned out this little speech, Janet couldn't keep herself from putting scare quotes around the phrase the man's CO had used. "I refused to sedate him until I'd taken a history. He'd been knocked out in some stupid prank the day before, and no one had ever checked him for concussion. He very suddenly developed what his superior told me was 'a serious anger management issue.'" Janet dropped her voice in a parody of his.
"I had to go over his head to get the poor enlisted man on medical leave," she added.
"But you won?"
"Yeah. I got him a few days. It wasn't enough. It took him months to recover, and I don't think he really believed me until he was pretty much through it. When I first examined him, and he finally calmed down, he told me how wrong he was to have yelled at the officer-who was a bastard anyway-and would hardly stop apologizing. Any one blow-up, and he'd tell me his reasons, and then he'd tell me why he shouldn't have handled it that way. He just wouldn't put it all together and say that he wasn't acting like himself because he'd been hurt."
Janet could see Sam turning the story over in her head, but she thought Sam wasn't quite there yet. She continued, "Uncontrolled anger can be a concussion symptom. The usual barriers in the mind just aren't working right. That's the sort of erratic behavior you have to notice and correlate with any head injuries a teammate may have had."
Sam nodded. "Got it. Anything else?"
"Impulse control in general may be affected. Frustration may prove hard to handle. Inhibitions may drop. When you tackled the Colonel in the locker room after visiting the Land of Light? Concussion was the first thing I checked you for. That was wrong, but obviously we were right to check you."
Sam was still blushing all this time later. Damn. Janet should have realized she was still sensitive about the incident.
"Hey, not your fault! Right?"
"Right." Sam nodded vigorously. "I know that now; I just don't always feel it."
"So if one of your teammates suddenly has trouble controlling his anger, or he hits on you. . . ."
"I make sure the rest of the team knows, I check for other signs of a concussion, and I get him back to the infirmary as soon as I can."
"Excellent. Now suddenly poor impulse control would probably be really noticeable in anyone on your team. You'd notice if the Colonel went from sarcasm to downright verbal abuse, or if Daniel suddenly hit on you, or if Teal'c . . . got wordy on you."
That won a little snicker.
"The most subtle symptom of a concussion is probably depression. We're still learning about how the brain handles injury; I know of some studies in progress right now. We think there may be long-term effects, but that's not something you can handle in the field. Just try not to get any more concussions." Janet paused so that they could exchange rueful looks. "More importantly for you, there's at least anecdotal evidence of an increased risk of suicide after a concussion."
Sam held up a hand to stop Janet. "So you're saying a head injury could even cause suicide? And it can cause trouble handling impulses? So if, say, Daniel hit his head, his already poor sense of self-preservation could leave him entirely?"
Janet agreed solemnly. "It's especially dangerous for an SG team. If a kid can kill himself after too hard a hit in football, how much easier would it be for one of your teammates to just not do enough to save his own life? Concussions interfere with judgment, with reasoning, and with the ability to handle emotions."
She let Sam work through it for a long moment, and Sam didn't disappoint. "So when the Colonel said he was dying, and I believed him because I didn't know how bad his internal injuries were, that might have been the concussion talking?"
Janet nodded. "It's good that we didn't find him much later than we did, but he wasn't on the point of death. His concussion may have made him give up more easily than he otherwise would."
Janet could see the moment where Sam realized why they were going into such detail about concussions. She could see anger and hope flash across the other woman's face.
"Janet? Did you set-" Sam shook her head and looked away.
Janet figured there was no point in holding back any longer. "Do you know how many times I heard you say 'I should have just dialed another planet?' You were fixated on that the whole time you were in the infirmary! And fixation like that can happen when the mind is compromised by a concussion. We're not even getting into the effects of hypothermia on your mental state here."
Sam looked briefly confused. "So you're just saying that I'm blaming myself because of a concussion?"
"Right. I'm saying that you fixated on that one missed option because of your concussion. You recognize that as a fixation, right?" She remember Tuttle's inability to recognize his anger and hoped Sam wasn't that badly off.
"Maybe." Sam huffed a little in frustration. "I still think I should have known. But I realize it's not helpful to get caught up in what I should have done."
"So you fixated after we got you back."
"All right."
"And before we got you back, you were fixated too: you were fixated on dialing the SGC."
Sam pulled her chin down defensively. "I knew you were going to say that."
"Sure. But do you know I'm right?"
"No! I mean. . . ."
Janet didn't give her time to build an argument. "The colonel was there just like you. He has been on even more missions than you have." Here Janet had to talk over Sam's muttered "one more." "He didn't think of dialing another planet either. You were both injured, and you focused on getting home, and that made absolute sense. So you overlooked one possibility. Both of you."
Sam's glare didn't let up.
"Meanwhile, we had scientists and technicians here who weren't injured, who had food and water and heat, and not one of them even considered that you could be on the same planet, or even that you might not be able to dial in. It took Daniel Jackson not just the concussion and sleep deprivation that you suffered but a good deal too much caffeine to come up with the idea that you'd made it back to Earth."
Sam looked less angry and more thoughtful now.
"So maybe if you'd taken the time to prepare some coffee," Janet said gently, "you'd have thought of an alternative. But more likely you wouldn't have, because your brain was injured."
The lines in Sam's face were relaxing, and Janet pressed her advantage. "I tried to explain this to you when we first got you back to the SGC, but you were still so exhausted and injured that you weren't taking it in. Then you got resistance up because, well, you were still somewhat depressed, and you were looking for reasons why you felt the way you did. I've got to hand it to you, Sam: you came up with really rational reasons. You're really good at thinking your way around a concussion."
"Is that a compliment?" Sam asked. She seemed to have let her guard down again, if only in confusion.
"Yes. You didn't have time to treat your own concussion. I'd love to tell you that if you're the one who is hit by a ribbon device, or you're the one who's concussed, you can recognize that and just let your teammates take care of you. But I know that sometimes you can't just let your teammates take care of you. That's why you're here working with me, after all: so that you can take better care of them."
Sam opened her mouth to object, but of course Janet had left her without anything to object to. She mentally gave herself a point. It was hard to win a battle of wits against Sam Carter.
"So you're saying I should just let go," Sam said. "Like the Colonel has been telling me."
"I suppose. But I've got better reasons than the Colonel."
That brought another snicker. Janet had heard the Colonel throw "because I said so!" into one of the conversations in the infirmary.
"This isn't some touchy-feely 'you have to forgive yourself' stuff," Janet continued, although that had its place. "I'm telling you what I know about concussion. And it's very hard to recognize that your own behavior may result from injury, especially when the only other person around is in worse shape and can't recognize it for you. But if you see Daniel fixating after a head injury, or the Colonel being even more stubborn than usual after losing consciousness, now you know what might be happening."
"But how do I tell that from their normal behavior? I'll be suspecting head injuries on every mission!" Sam's voice sounded serious, but her face didn't quite match.
"I didn't say that this training would make life easier, Sam. I promised to teach you more than the manual did, and I think we've done that."
There was a long pause as Sam took in everything they'd said. Janet didn't have any more arguments, so she hoped Sam was out, too.
"But you're still not going to teach me to do a field tracheotomy?" Sam asked, and Janet knew the argument was over-for now, anyway.
"How about if I just let you watch if you're around next time I do one?" Janet answered.
Sam pretended to consider. "All right. How often does that happen?"
"So far? Never. And that's why we're going to discuss anaphylactic shock next: because I never want to do a tracheotomy, either."
The rest of the morning flew past. Sam was a quick study, and Janet enjoyed working with her. By the time Sam was leaving, Janet would almost swear there was full confidence back in the young officer's walk. She was sorry that she didn't really envision any more training sessions.
"Sam?" She stopped her friend at the door. "Next time you want to watch some bad medical drama, if I'm free, give me a call? You've got to have someone there telling you what they're getting wrong."
Sam's grin was wide. "Only if I get to tell you what science they're getting wrong."
"Deal."
Head injuries could take a while to fade. Sam might well not be entirely back to normal yet. But she was close enough. Janet would sooner put her money on Sam Carter on a bad day than almost anyone else on a good day.
And she was looking forward to watching bad science and worse medicine with Sam.
FIN
Author's notes: Many thanks to Brilliant Husband (dudethemath) for proofreading and giving me a ittle, and to redbyrd-sgfic for a beta on a story she only got at the last minute.
I think we know more about concussions now than we did in 1998, when "Solitudes" first aired; I assumed Janet would be close to the leading edge of research at the time. I think word still needs to get out about the effects on mood and behavior, both short-term and long-term. I read "Game Over" by Patrick Hruby about the effects of concussions on football players; that's where I got Janet's mention of the boy who killed himself a day and a half after a concussion in high school football. That happened well after 1998, but I'm sure there were similar stories earlier.
Author: aelfgyfu_mead
Word count: 5400
Rating/Warning: G
Spoilers: Solitudes
Prompt: 90. Sam and Janet. After Antarctica, Sam asks for more medical training.
Summary: Sam and Janet review medical procedures-and what happened in Antarctica.
Now that she had discharged Colonel O'Neill, Janet could finish her notes and paperwork on his case. Thank goodness. She looked at Sam Carter's file, which she still had not closed despite having let her go two days earlier. She hesitated, then decided that she really was done. It was best that she never put on paper her concerns about the state of mind of a young female officer. As the concussion healed, Sam's outlook would improve, Janet was certain. And Janet didn't need notes to remember that she was a little worried.
A knock startled her. She put O'Neill's file over Sam's before calling out to admit her visitor, who turned out to be the very woman on Janet's mind.
"Captain Carter!" she said, not sure whether to be pleasantly surprised or simply concerned. "You're not due for a recheck until tomorrow. Are you experiencing any problems?" Sam's bland expression offered no clues.
"No," the other woman said. "I'm fine. I just wanted to talk to you." She closed the door quietly behind her.
"Okay, Sam." Janet hoped the informality would put her at ease. "What's on your mind?"
Sam smiled halfheartedly. "Days off are hard. I keep rethinking what I did and what I should have done." Her gaze stopped somewhere on Janet's desk.
"I thought the Colonel ordered you to stop that?" Repeatedly, in fact, in Janet's hearing.
"He can't order me to stop thinking." There, eye contact.
"You can't tell him that," Janet said. "But I think he has a point this time. You're both going to be fine. You just need some more rest for the concussion, and I discharged the Colonel this morning." Oh. "And that's why you're here now. So he won't hear this?"
"No. I mean, I checked on him and made sure he was really going home today, before I came to see you. And then I checked with Daniel, and Teal'c-"
"And waited to be sure that the Colonel was gone before you came to my office."
Sam's little laugh blew hair away from her forehead. "Well, he'd have given me a hard time if he knew I was coming to see you. He'd have thought I was checking up on him."
"Because you didn't do that at all these past few days." Janet smiled to soften her words. "You're beating around the bush, Sam, and that isn't like you."
"I want medical training," Sam blurted.
That was much more like her.
"I've had the standard Air Force first aid," she continued. "But I didn't remember it well enough, and I didn't know enough. I didn't check his internal injuries; I figured I didn't know how. But then I slept on top of him when he had a broken rib!"
"Whoa!" She needed to stop this right now. "We've been through this. You had a serious concussion yourself, the Colonel was concealing how badly he was hurt, and you couldn't even safely uncover him for a proper exam."
"But what would you have done if you had been there instead of me?" Sam challenged, her gaze direct.
Janet gazed back, unsurprised by the question. She'd already thought of it herself. "I'd have pulled rank on him because as a doctor-a medical doctor-I can do that. I'd have given him a slightly more thorough exam. I'd have splinted his leg."
"And hurt him less," Sam grumbled.
"I'd have made sure I knew which side had the broken rib, and I'd probably have strapped it because I couldn't keep him still," Janet admitted. She'd have fought long and hard to keep him still, because hypothermia victims could have heart attacks from too much movement. Jack O'Neill was one of the stubbornest men she'd even met, though.
"But you know what? That wouldn't have made any difference to the Colonel. His broken rib never pierced his lung; the hemoptysis was due to a pulmonary contusion, and strapping wouldn't have helped." Probably wouldn't have helped, she added silently. It might have reduced some of the bruising. They would never know. She hoped her technical term for "coughing blood" would slow Sam down.
Of course it didn't; Sam no doubt already knew the word. "I knew something was wrong, I knew he was keeping it from me, and I didn't know what to do."
"That's something you'll have to talk to him about," Janet replied. "If I had done better, it would only be because I scare him more than you do."
They both grinned at that, but Sam's smile melted away quickly.
"I want to review first aid, and then I want some medic training," Sam declared. "All my training has been for stabilizing casualties until the medics arrive or we can get the wounded back to help, and. . . . Well, honestly, I tried to take it seriously, but back then, I knew I was never going to be in combat. I might be in a plane crash, but if I crashed, I was going to be needing help, not giving it. So . . . I didn't study first aid the way I worked on statistical and quantum mechanics. I need to know more."
"Fair enough. But you do realize there's only so much you can do in the field? Don't ask me to teach you to do a field tracheotomy, like that young man on SG-5 asked the other day. No surgery at all, in fact."
Sam looked alarmed for a moment. "Fine." Oh, God, she had been going to ask that one. Why did everyone want to know how to do a tracheotomy? Too much television? She found it hard to imagine Captain Sam Carter watching action shows-but then, she still didn't know her as well as she'd like. Sam was handing her an opportunity to get to know her better, and Janet was going to grab it with both hands.
Janet nodded. "That's okay. We're going to be doing first-aid training for all the SG teams."
"Because of me?" Sam's eyes widened.
"No, in fact. There are other reasons." Janet hesitated, but it was important for Sam to know that Janet didn't think any less of her for her performance in Antarctica, so she went with the truth. "Don't repeat this, but the last straw was Teal'c picking up Major Castleman, putting him across his shoulders, and carrying him through the Gate with a neck injury. Thank God it turned out to be minor-Castleman will be fine. But I found out that not only did Teal'c not know how to treat injured . . . humans, Tau'ri, whatever he wants to call us, no one on the team was confident enough in their own training to tell Teal'c he was doing it wrong! They weren't under fire, they weren't injured, and they weren't even in a hostile climate." What Teal'c did might have worked for a Jaffa, but Castleman had no symbiote to heal him. Janet had been fit to be tied when she found out how Castleman had been carried. She had to calm down before she could talk to Teal'c. He didn't need any more guilt that day.
"Oh." Sam seemed genuinely surprised, but at least she believed Janet.
"So we're starting by going through the entire Air Force first aid manual. Again. Everyone. No exceptions. Not for aliens, not for archaeologists, not even for people who have been in combat before this posting."
"But I want more," Sam insisted quietly.
Janet nodded and pulled a notepad from the many piles of files and papers on her desk. "Let's make a list. You tell me what you want to learn, and I'll tell you what you've left out. Oh, and we're already adding to the first aid equipment each team carries. We hadn't sent warm packs with you because you were going to a warm planet, but now we know that you can end up on an entirely different planet. Or in a different climate zone."
It was only when Sam sat back in the chair that Janet realized how hunched Sam had been before, and that Janet herself was a bit hunched.
Sam told her, "I can live with not performing surgery."
"Now what do you else do you want?" she asked.
They brainstormed for a while. Janet had to shoot down some of Sam's ideas; she couldn't even give her an advanced field medic course in the time she and Sam had available. But she could add some things that weren't on the standard list: advanced training for hypothermia, heat stroke, and electrical burns. How to handle anaphylactic shock when you couldn't get back to the infirmary immediately. (Janet had made epi-pens and chlorphenamine standard equipment only recently; who knew what allergies might surface in alien environments?) How to diagnose problems was a big one: they'd already discovered that people could ingest nanites, be injured by weapons or sickened by diseases until very recently unknown on earth, have their memories altered, or be infested by a mind-controlling alien parasite. The most important thing was to know when someone wasn't quite himself. Or herself. Those weren't covered in the Air Force First Aid Manual. Janet would have to write her own supplement-when she had time. At the rate they were going, that would be about the time she wrote her memoirs.
As Sam ran through a list of scenarios she could imagine facing, Janet could hear the anxiety in her voice. That anxiety hadn't been there before Antarctica. Janet finally put an end to the list and told Sam to go home and rest. She wasn't even back on light duty yet; that would start tomorrow.
Sam looked at their list. "So I'll do better next time."
Janet shook her head. She wanted to say that Sam couldn't have done better, but she knew Sam would tell her all the things she thought she should have done. She could only give a little reassurance today, with Sam still looking tired from her ordeal.
So for now, Janet said, "I'll happily teach you what I can, because SG-1 seems to have a trouble magnet in your shoulder patches. But I want you to know that you did nothing less than the best you could with what you had in Antarctica. You think you failed. But the Colonel lived because you kept him as warm as you could, you kept giving him liquids, you splinted his leg so that he didn't make things worse when he insisted on moving-and you gave us the clues we needed to get you home. You had a serious concussion yourself, and you dug the Stargate out of a block of ice."
"The Colonel helped!"
Janet glared at Sam. "Yeah, I'm sure the man with the broken bones and the contused lung did most of the work."
"Well, okay, but-"
"Not finished, Captain. You dug the Stargate out and you dialed. You reset it and dialed again. You sent the signals you needed to get help. Yes, maybe you could have dialed another planet-don't think I didn't hear you wish you'd done that"-and a few other things besides-"but then you'd have had to drag the Colonel through the Gate, and that would have done its own damage, since you didn't have the equipment that the rescue team brought to secure him."
Janet took a breath. "The only one who thinks you messed up here, Sam, is you. And I'm happy to teach you, but I'd like my pupil to have a bit more confidence in herself before she starts."
Sam blew some air out between her lips, blowing her hair around again. "Yes, Doctor."
"Doctor?"
"Janet." If she couldn't get another smile out of Sam today, she could at least get her to go back to the first name basis they'd reached after saving the base from a Goa'uld.
***
Janet made Sam wait until she after she did the first aid review for everyone, telling her that it didn't make sense to teach her more advanced techniques until she'd had a refresher on the basics. Colonel O'Neill still had his leg in a cast and proved as ornery as she expected at the classes, but that had the unexpected benefit of distracting Sam from any blame as she tried alternately to soften the Colonel's wrath and stifle laughter at him. Janet suspected that this effect only encouraged the Colonel, who had given up arguing with his second-in-command about her actions in Antarctica.
The Sam who turned up ten days after that first conversation for private lessons with Janet seemed closer to the Sam that Janet had met when she first arrived at the SGC, a woman perhaps a little too eager to prove herself but more than capable of doing so. The bruises on her face were almost invisible, and she no longer had hollows under her eyes.
So Janet spent the morning running Sam through scenarios, asking her how she would treat various conditions with the specific teammates she had, not just how she would handle injuries or illness in the abstract. How would she handle hypothermia or hyperthermia if it affected the Colonel badly enough that he didn't believe her? How would she handle anything that hurt Teal'c? Janet had determined the best way to help Teal'c was to remove any foreign bodies and then let his symbiote do the rest, but she confided in Sam how wrong that felt to her.
"Sometimes, our instincts are insufficient; occasionally, they're downright dangerous," Janet told her. "We're going to make mistakes, all of us. We pray they're not irreversible, and we do the best we can."
Sam nodded solemnly; Janet was certain she was remembering that last mission.
Janet didn't push her luck in that session. She waited until the following morning to say what she needed to be said. She took Sam through some more practice with dummies; she was confident now that Sam had the muscle memory to do the basics even if dazed herself.
Janet then took her through what they knew about injuries from the ribbon device. How would she handle a disoriented teammate who didn't realize how disoriented he was?
"If it's anyone but the Colonel, I can enlist the Colonel. Daniel will argue with him, but if the Colonel and I both tell him he's not in any condition to keep translating a stele, and the Colonel orders him down, he'll do it." Sam paused. "I'm still not always sure what Teal'c thinks of me. He always looks to the Colonel, which makes sense, because he's the ranking officer. If he doesn't believe me, he'll believe the Colonel. Even if he thinks we're both wrong, I think the two of us can get him to do what I say."
"And if it's you?" Janet hadn't brought Sam into the scenarios as a patient before.
Sam's eyebrows disappeared into her hair. "Don't you mean the Colonel?"
"I'm saving him for last," Janet said with a grin.
"Oh. Okay. Well, I'd like to think that I'd be reasonable enough to accept the Colonel's judgment even if I were really out of it." She thought for a moment longer. "Honestly, I think I'm conditioned enough to follow orders that I'll do what he tells me unless I'm really far gone."
Janet nodded. "And the Colonel himself?"
Sam smiled. "That's where I have to bring out the big guns. I can relieve him of duty if I have cause to believe that he's compromised-that his judgment is compromised. And if he's out of it enough that he won't let me relieve him, well, then I'll have to win Teal'c over. Daniel should be able to help with that; he should know even better than I would if the Colonel wasn't himself, and Teal'c and Daniel . . . well, they have this bond."
That answer wasn't at all what Janet expected in more ways than one, but she focused on the most practical problem: "What would Teal'c do that you couldn't?"
"Sit on him. Anywhere he's not injured, of course."
Janet laughed, and Sam made no attempt to stifle her own laughter this time.
"I want to ask if you're serious, but I'm afraid the answer is 'yes,'" Janet said, trailing off into a giggle.
Sam's smile was a little wry this time. "I've had to give it some thought." She looked at the floor. "Ribbon devices aren't the only thing that can make someone not himself, you know."
Major Kawalsky had died while Janet's transfer to the SGC was still in process, but she had read enough about his case to be a little glad she hadn't been there for it.
Time to move on. "We've already been through the protocols for suspected Goa'uld infestation more than enough, and I know you'd have your teammates' support for that. But one of the trickiest injuries that way can be a concussion."
She'd surprised Sam again. Good.
"Some concussions cause loss of consciousness, and that makes them easier to diagnose. When Daniel came flying through the Gate and hit his head hard enough to knock him cold for minutes, we knew he was concussed. When you woke up in Antarctica, did you realize that you were concussed?"
"Yes. I knew, but I didn't have time to worry about it; the Colonel was still out, and I knew that I hadn't suffered any other injuries, but he-" Sam was talking faster and her voice was rising.
"Good. You recognized it, even if you couldn't do anything about your concussion right away." Janet brought her firmly back to the present.
Then she asked, "Did you know that people can get concussions without being knocked unconscious?"
Sam looked mildly disgusted. "Yeah-yes."
"Oh, don't cut yourself off on my account. Maybe you were going to say something about how the dozen or two times I said it during the group training kind of brought it home?"
Sam's face relaxed again. "Maybe."
"Sam, it's just you and me. You can say what you think."
That brought no response.
"And you know how to diagnose a concussion without loss of consciousness? Take me through it. Let's say it's Daniel."
"First, I'd ask him some questions about the last few minutes. I'd see if he lost any memories in that time and listen carefully; if he has forgotten anything or his speech is slurred, he could be concussed. Then we'd need to-"
"We'll get to treatment in a moment. What else are you checking?"
"I'm looking at his eyes to make sure that the pupils are the same size and responsive to light; if I have any doubts, I check first one, then the other with a flashlight. If they're not equal and reactive, or if he shows unusual sensitivity to light, we may well be looking at a concussion."
"Good. Anything else?"
"I ask whether he has a headache, but I know Daniel, so I know he might not even notice if he's worried enough about . . . someone else."
"His wife?'
"Especially his wife. Or anyone, really."
Janet nodded. "You've given this a lot of thought."
Sam laughed and shrugged. "I had some time off recently, and I wasn't allowed to bring any work home."
"Oh, God. Tell me you didn't spend time watching medical dramas on tv."
"I might have turned on the tv a few times," Sam said playfully. "But I know better than to try to learn anything from them. For concussion, I know to watch for unusual drowsiness, poor coordination-which in Daniel's case means I have to watch carefully, because he can get distracted enough to walk into doorways when he's fine, but he has very quick reflexes when he's paying attention. Of course, confusion or loss of consciousness later is a big clue."
Janet nodded. "Anything else?"
"I must be forgetting something. Well, seizures. Oh-and vomiting. Concussions can cause vomiting."
Janet nodded again. "That it?"
Sam frowned in concentration. "Eyes, speech, memory, coordination, vomiting. I can't think of anything else."
"Those are the usual indicators. Some clues are a lot harder to identify. At a previous posting, I saw a man who was having sudden 'behavioral problems'; the MPs brought me to sedate him." Even having planned out this little speech, Janet couldn't keep herself from putting scare quotes around the phrase the man's CO had used. "I refused to sedate him until I'd taken a history. He'd been knocked out in some stupid prank the day before, and no one had ever checked him for concussion. He very suddenly developed what his superior told me was 'a serious anger management issue.'" Janet dropped her voice in a parody of his.
"I had to go over his head to get the poor enlisted man on medical leave," she added.
"But you won?"
"Yeah. I got him a few days. It wasn't enough. It took him months to recover, and I don't think he really believed me until he was pretty much through it. When I first examined him, and he finally calmed down, he told me how wrong he was to have yelled at the officer-who was a bastard anyway-and would hardly stop apologizing. Any one blow-up, and he'd tell me his reasons, and then he'd tell me why he shouldn't have handled it that way. He just wouldn't put it all together and say that he wasn't acting like himself because he'd been hurt."
Janet could see Sam turning the story over in her head, but she thought Sam wasn't quite there yet. She continued, "Uncontrolled anger can be a concussion symptom. The usual barriers in the mind just aren't working right. That's the sort of erratic behavior you have to notice and correlate with any head injuries a teammate may have had."
Sam nodded. "Got it. Anything else?"
"Impulse control in general may be affected. Frustration may prove hard to handle. Inhibitions may drop. When you tackled the Colonel in the locker room after visiting the Land of Light? Concussion was the first thing I checked you for. That was wrong, but obviously we were right to check you."
Sam was still blushing all this time later. Damn. Janet should have realized she was still sensitive about the incident.
"Hey, not your fault! Right?"
"Right." Sam nodded vigorously. "I know that now; I just don't always feel it."
"So if one of your teammates suddenly has trouble controlling his anger, or he hits on you. . . ."
"I make sure the rest of the team knows, I check for other signs of a concussion, and I get him back to the infirmary as soon as I can."
"Excellent. Now suddenly poor impulse control would probably be really noticeable in anyone on your team. You'd notice if the Colonel went from sarcasm to downright verbal abuse, or if Daniel suddenly hit on you, or if Teal'c . . . got wordy on you."
That won a little snicker.
"The most subtle symptom of a concussion is probably depression. We're still learning about how the brain handles injury; I know of some studies in progress right now. We think there may be long-term effects, but that's not something you can handle in the field. Just try not to get any more concussions." Janet paused so that they could exchange rueful looks. "More importantly for you, there's at least anecdotal evidence of an increased risk of suicide after a concussion."
Sam held up a hand to stop Janet. "So you're saying a head injury could even cause suicide? And it can cause trouble handling impulses? So if, say, Daniel hit his head, his already poor sense of self-preservation could leave him entirely?"
Janet agreed solemnly. "It's especially dangerous for an SG team. If a kid can kill himself after too hard a hit in football, how much easier would it be for one of your teammates to just not do enough to save his own life? Concussions interfere with judgment, with reasoning, and with the ability to handle emotions."
She let Sam work through it for a long moment, and Sam didn't disappoint. "So when the Colonel said he was dying, and I believed him because I didn't know how bad his internal injuries were, that might have been the concussion talking?"
Janet nodded. "It's good that we didn't find him much later than we did, but he wasn't on the point of death. His concussion may have made him give up more easily than he otherwise would."
Janet could see the moment where Sam realized why they were going into such detail about concussions. She could see anger and hope flash across the other woman's face.
"Janet? Did you set-" Sam shook her head and looked away.
Janet figured there was no point in holding back any longer. "Do you know how many times I heard you say 'I should have just dialed another planet?' You were fixated on that the whole time you were in the infirmary! And fixation like that can happen when the mind is compromised by a concussion. We're not even getting into the effects of hypothermia on your mental state here."
Sam looked briefly confused. "So you're just saying that I'm blaming myself because of a concussion?"
"Right. I'm saying that you fixated on that one missed option because of your concussion. You recognize that as a fixation, right?" She remember Tuttle's inability to recognize his anger and hoped Sam wasn't that badly off.
"Maybe." Sam huffed a little in frustration. "I still think I should have known. But I realize it's not helpful to get caught up in what I should have done."
"So you fixated after we got you back."
"All right."
"And before we got you back, you were fixated too: you were fixated on dialing the SGC."
Sam pulled her chin down defensively. "I knew you were going to say that."
"Sure. But do you know I'm right?"
"No! I mean. . . ."
Janet didn't give her time to build an argument. "The colonel was there just like you. He has been on even more missions than you have." Here Janet had to talk over Sam's muttered "one more." "He didn't think of dialing another planet either. You were both injured, and you focused on getting home, and that made absolute sense. So you overlooked one possibility. Both of you."
Sam's glare didn't let up.
"Meanwhile, we had scientists and technicians here who weren't injured, who had food and water and heat, and not one of them even considered that you could be on the same planet, or even that you might not be able to dial in. It took Daniel Jackson not just the concussion and sleep deprivation that you suffered but a good deal too much caffeine to come up with the idea that you'd made it back to Earth."
Sam looked less angry and more thoughtful now.
"So maybe if you'd taken the time to prepare some coffee," Janet said gently, "you'd have thought of an alternative. But more likely you wouldn't have, because your brain was injured."
The lines in Sam's face were relaxing, and Janet pressed her advantage. "I tried to explain this to you when we first got you back to the SGC, but you were still so exhausted and injured that you weren't taking it in. Then you got resistance up because, well, you were still somewhat depressed, and you were looking for reasons why you felt the way you did. I've got to hand it to you, Sam: you came up with really rational reasons. You're really good at thinking your way around a concussion."
"Is that a compliment?" Sam asked. She seemed to have let her guard down again, if only in confusion.
"Yes. You didn't have time to treat your own concussion. I'd love to tell you that if you're the one who is hit by a ribbon device, or you're the one who's concussed, you can recognize that and just let your teammates take care of you. But I know that sometimes you can't just let your teammates take care of you. That's why you're here working with me, after all: so that you can take better care of them."
Sam opened her mouth to object, but of course Janet had left her without anything to object to. She mentally gave herself a point. It was hard to win a battle of wits against Sam Carter.
"So you're saying I should just let go," Sam said. "Like the Colonel has been telling me."
"I suppose. But I've got better reasons than the Colonel."
That brought another snicker. Janet had heard the Colonel throw "because I said so!" into one of the conversations in the infirmary.
"This isn't some touchy-feely 'you have to forgive yourself' stuff," Janet continued, although that had its place. "I'm telling you what I know about concussion. And it's very hard to recognize that your own behavior may result from injury, especially when the only other person around is in worse shape and can't recognize it for you. But if you see Daniel fixating after a head injury, or the Colonel being even more stubborn than usual after losing consciousness, now you know what might be happening."
"But how do I tell that from their normal behavior? I'll be suspecting head injuries on every mission!" Sam's voice sounded serious, but her face didn't quite match.
"I didn't say that this training would make life easier, Sam. I promised to teach you more than the manual did, and I think we've done that."
There was a long pause as Sam took in everything they'd said. Janet didn't have any more arguments, so she hoped Sam was out, too.
"But you're still not going to teach me to do a field tracheotomy?" Sam asked, and Janet knew the argument was over-for now, anyway.
"How about if I just let you watch if you're around next time I do one?" Janet answered.
Sam pretended to consider. "All right. How often does that happen?"
"So far? Never. And that's why we're going to discuss anaphylactic shock next: because I never want to do a tracheotomy, either."
The rest of the morning flew past. Sam was a quick study, and Janet enjoyed working with her. By the time Sam was leaving, Janet would almost swear there was full confidence back in the young officer's walk. She was sorry that she didn't really envision any more training sessions.
"Sam?" She stopped her friend at the door. "Next time you want to watch some bad medical drama, if I'm free, give me a call? You've got to have someone there telling you what they're getting wrong."
Sam's grin was wide. "Only if I get to tell you what science they're getting wrong."
"Deal."
Head injuries could take a while to fade. Sam might well not be entirely back to normal yet. But she was close enough. Janet would sooner put her money on Sam Carter on a bad day than almost anyone else on a good day.
And she was looking forward to watching bad science and worse medicine with Sam.
FIN
Author's notes: Many thanks to Brilliant Husband (dudethemath) for proofreading and giving me a ittle, and to redbyrd-sgfic for a beta on a story she only got at the last minute.
I think we know more about concussions now than we did in 1998, when "Solitudes" first aired; I assumed Janet would be close to the leading edge of research at the time. I think word still needs to get out about the effects on mood and behavior, both short-term and long-term. I read "Game Over" by Patrick Hruby about the effects of concussions on football players; that's where I got Janet's mention of the boy who killed himself a day and a half after a concussion in high school football. That happened well after 1998, but I'm sure there were similar stories earlier.