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Dennis blinks blearily at himself in the mirror. The bags beneath his eyes look bruised. The word gaunt comes to mind.
He isn't supposed to be on the eighth floor. Technically, no one is. It’s turning over into winter, now, and administration doesn’t waste money heating rooms they don't use. But they’ve had two months to find him, and they haven't done it yet, so he figures it’s probably safe, if a bit cold, to stay up here for a while. The ambient heat of the building keeps it around fifty, anyway.
If nothing else, it wakes him up. He takes two ibuprofen for the last of a lingering headache, washes down a granola bar with the last of his bottle of water, brushes the crumbs off his scrub pants, and fumbles to tighten the laces of his shoes. His hands never stop shaking these days. A spare set of scrubs and a change of clothes in his bag. A plastic bag of toiletries. He has yet to need a complete decontamination shower on rotation, but it’s only a matter of time. Flu season isn’t in full swing yet, but he’s expecting an uptick in projectile vomiting cases.
Chairs is already packed by the time he slips out of the stairwell, edging through the crowd as he scans his badge at the doors to the Pitt. He corrects himself: It probably never thinned out in the first place. Tuesday morning’s patients are Monday night’s, or Sunday’s, if they’re unlucky. He wedges his bag into his locker and goes to stand in front of the board, rocking back and forth slightly on the balls of his feet.
"Someone's in early," Dana comments, and he gives a tight smile, trying to pass it off as chipper instead of nervous.
"Oh, you know. Nowhere better to be." He wedges his hands into his pockets as he stares up at the board. One foot jitters absentmindedly as he eyes the case list. Broken bones and lacerations he’s done before. Infectious diseases he’d prefer not to do this early. No trauma cases yet.
“If you’re going to come in early just to cherry-pick, you can take that food poisoning patient out of Chairs and put her in Two,” Dana says after a while, one eyebrow raised, and Dennis winces. Decontamination shower, indeed.
“I’m—yep, sorry, on it.”
Intake on the patient goes unexpectedly smoothly, and he thinks he probably owes money to whichever nurse gave her a basin. Introductions. Fresh vitals. Labs and blood cultures, then fluids and an anti-emetic. Dr. Robby observes, quietly approves the course of treatment, and leaves Dennis to his charting. He’s been sitting down for all of thirty seconds when Dana calls out, “Motorcycle accident, ETA five minutes.” Dennis shoves himself up from his chair, stumbling slightly as he jogs toward the donning area, and beats Santos by a step as he grabs a trauma gown.
“Dibs on this one,” he says, slightly breathless as he ties it closed at the waist. “You got the pile-up on Friday.”
“You were the one who called out sick on Friday,” Santos shoots back. “I had to pick up your shift.”
That’s true; he’d had a migraine that lasted until four that afternoon. He fires back, “You still pulled up hungover on Saturday morning, so I don't think you missed your Friday night too badly.”
“Oh, yeah, laugh it up. You wish you were there.”
“No, I think I’m good. You looked like shit.”
“I still got the pile-up.”
“And I still get the motorcycle accident,” Dennis says, shooting her a winning smile.
“Alright, knock it off,” Dana calls from behind them. “Santos, go take care of your head lac in Seven. He’s ready for discharge.”
Santos groans good-naturedly. “Smells like a liquor store in there,” she whispers to Dennis as she ties the neck of his gown for him and leaves. “I should be the one on oxygen.”
Dr. Robby meets the paramedics at the doors to the ambulance bay, and Dennis follows after him, taking in the patient as the medics wheel him in. “Motorcyclist went headfirst into the side of a building,” Spratt says. “Blunt head and chest with agonal breathing. Couldn’t tube him, but we’ve got an IV. GCS six when we got him; now he’s a five.”
“Got a name?”
“Nope. Just John Doe.”
“Alright. Trauma Two. Let’s see what we’re working with.”
They fall into step like a well-rehearsed performance: Dr. Robby, sharp-eyed and observant, the interns and residents in identical gowns, moving around each other like clockwork. The medics pull the gurney up alongside the exam table, and Javadi takes up a position directly opposite Dennis as they lower it to table height. “Okay. One, two, three,” Dr. Robby says, and Dennis grabs a corner of the sheet to haul the patient onto the table, breathing hard.
"Let’s get oral suction going. Push 110 of ketamine. Whitaker, tube him," Mohan says, and he reaches for an intubation kit and a laryngoscope as she pulls out her penlight. “Javadi, you’re on E-FAST. Focus on the thoracic cavity; watch that flail chest.” The penlight clicks on as Mohan pulls gently at the patient’s eyelids. “Pupils are unequal with delayed response.”
“Okay,” Dr. Robby says, nodding. “Assume a brain bleed. Push four-factor PCC and get him to CT as soon as he’s stable.”
“They’re keeping one open for you,” Princess says as she hooks up the leads to the patient monitor. “You want blood?”
“Have two units of O-neg on standby. Whitaker, how are we on intubation?”
“I’m going to need that suction,” Dennis says, keeping his voice steady, trying to see past the blood welling up in the man’s throat. His right hand won’t stop shaking. Princess leans across the gurney to guide a suction catheter past the patient’s jaw. The blood in the back of his throat sputters as it’s drained away.
“We’ve got a hemothorax,” Javadi says, leaning back to see the screen of the E-FAST. “Jesus. Big one.”
“Garcia’s already on her way,” Mohan says, not looking up from the patient.
"Sats dropping," Princess warns. Shit. Dennis can feel himself sweating.
Mohan glances up, watching him closely. "You want me to take over?" she asks cautiously.
"No, I got it," he says, voice tight. He flexes his hand to steady the shaking. "Can I, uh. Can I get some cricoid pressure?"
Mohan reaches over to press against the patient's throat, and Dennis cranes his neck to peer down the laryngoscope. Good. Epiglottis. Arytenoids. Vocal cords in view now. Wait for an inhale. Push. Inflate the cuff just past the cords. "Got it," he says quickly, fumbling for his stethoscope. "Checking placement now."
Princess eyes the monitor as he checks for breath sounds. "Yellow's mellow," she says. "Sats are up. Good save."
Good save. He’ll take it. Garcia arrives a few minutes later to place the chest tube, and Dennis stands to the side observing until the patient is moved up to radiology. Exhale. The high of adrenaline drains out of the room like air escaping for all except Mohan, who moves on with a pleased smile on her face. The rest of them move on to the doffing area.
Dennis’ track record with scrubs has improved since September. There were no casualties with his food poisoning patient this morning, and the blood from the trauma case is on his gloves and the sleeves of his gown where it should be, doffed and tossed into the biohazard bin. "Nice work on intubation, Whitaker," Dr. Robby says as he passes, one hand clapping his shoulder, and Dennis jumps.
"Oh, uh—thanks."
It didn’t feel like nice work. It felt like a near miss.
His food poisoning patient in Two has stopped vomiting, eyes heavy-lidded as the IV drip of saline and ondansetron does its job. He rechecks her vitals and returns to the Hub, craning his neck to see the board. “Hey, Mel,” he calls, and she pokes her head up from her station. “There’s a porcupine accident up here. The quills still need to be removed. Do you want it?”
She grins and gives him a thumbs-up. Santos leans on the counter next to him, scrutinizing the board. “You want to take the compound tibia-fibula fracture with me?” she asks.
“You only want it because it means you’ll get to call Garcia.”
She neither confirms nor denies that. “You’ve never treated a compound before, have you?”
His lips twitch. “I can third-wheel you if you want.”
“Shut up.”
“You know her personal extension.”
“It’s professional.”
“I’m sure.”
The compound fracture is . . . rough. There are very few things he’s seen, even in this line of work, that have made him cringe, but this one does. “What are you seeing?” Santos asks once the nerve block is in place and the aforementioned patient is suitably dosed with morphine.
“Comminuted spiral fracture of the tibia and fibula,” he says. “X-rays will confirm, but it’s definitely an issue for surgery regardless. Do you want me to step out while you call her?”
Santos shoots him a look. “You can go start charting if you’re going to be that way,” she says as she reaches for the phone, and he holds up his hands, grinning, as he retreats. “Put in the X-ray order while you’re gone!” she calls after him.
“You get to debride and irrigate it, if you’re kicking me out,” he calls back, and she waves her hand as she dials Garcia’s extension.
Both of his hands are trembling when he sits down at his station, and he balls his hands into fists for a moment to steady them, flexing his fingers. He catches Dr. Robby glancing over at him before his eyes return to the board.
Of course he noticed. He notices everything. Dennis doesn’t have time to dwell on that, though, because someone shouts his name from West and he jolts upright, scrambling for his stethoscope as he shoves his chair back.
And if Dr. Robby notices the way he stumbles and grabs at the edge of the desk to steady himself against the wave of dizziness that hits him as he stands up, he doesn't say anything.
∗ ∗ ∗
It’s barely ten o’clock when Dennis realizes he’s been staring at his patient’s chart without comprehending a word for nearly four minutes.
Idly, he runs through the list of all the conditions that could cause fatigue and absentmindedness. Hypoglycemia, hypothyroidism, sleep deprivation, nutrient deficiencies, dehydration, fibromyalgia, lupus. Lupus. As if. There are only two-hundred thousand cases in the United States, disproportionately black women, of which he is neither. It’s a statistical impossibility.
He still hasn't read a single word of his patient’s chart.
He pushes himself upright and paces half a dozen steps to try and get his head on straight before he abruptly stops and turns back to the Hub. "Can I bum a cigarette?" he blurts out, and Dana raises a brow.
"You doing okay?" she asks instead of answering.
"Me? Yeah, yeah, I'm great. Just, uh. Rough morning. You know how it is."
She stares at him for a long time, that eyebrow still raised, then turns to her station and reaches for her purse. "Don't make it a habit. Those things'll kill you," she warns flatly as she pulls a cigarette out of a half-empty pack and hands it to him. "You need a light, too?"
"Huh? Oh, no, I've got one. Thanks."
He can feel her eyes on him as he jogs toward the stairwell, but she doesn't say anything.
He shouldn't be smoking. He knows that. He also shouldn't be on the roof, he thinks as he dips under the railing and sits down on the gravel, leaning back against the post. Christ, it's like there's nowhere he's allowed to be. He should've stayed in Broken Bow. His right hand is still shaking as he fumbles with his lighter, cigarette between his teeth, cupping one hand around it to shield it from the wind. He can barely fumble effectively enough to light the thing.
When it’s lit he takes a long pull, coughing slightly, and brings his knees up to his chest where he sits leaning against the railing. The cold of the metal seeps into his back as he looks out at the city below. The roof is a little more than a hundred feet up. At this distance the people on the sidewalks are the size of plastic army figurines. He's shivering a little, but he can't tell how much is from the cold and how much is the anemia and how much is the withdrawal and how much is the stirrings of a panic attack that won’t shut him down, just tense every muscle in his body and render him unable to speak. Wellbutrin isn't even supposed to have withdrawal symptoms in the first place. Figures he'd get lucky.
Really, he thinks idly, it might have been better if he never got on it in the first place. Prescriptions are expensive, and so are the psychiatrist appointments to get them refilled. The only reason he could afford them in the first place was his undergraduate advisor’s pointed referral to the student clinic, where a nurse practitioner ran him through the PHQ-9 and GAD-7 and wrote him a prescription within the hour. He hadn’t known his head could feel like that until the Wellbutrin really kicked in a few weeks later, and now that he knows what he’s missing he’s not sure he could manage without it. He wonders if that technically qualifies as addiction.
He’s properly shivering, now. The wind goes straight through his scrubs. The metal of the cross around his neck is cold against his breastbone. Gravel digs into his skin. He pulls his knees in a little closer to his chest and lifts the cigarette back up to his mouth. Inhale, exhale. Lord Jesus Christ, have mercy on me.
"You're learning all my bad habits," Dr. Robby says from behind him, and he jerks his head around, wide-eyed as he scrambles to his feet.
"Oh—shit—I, uh—I was just—five minutes—"
"You're not in trouble," he says, waving him off. Dennis swallows hard, heart pounding.
"I, uh. Didn't realize this spot was reserved," he says after a long moment, the fingers of his free hand flexing on the railing.
"Usually I like to stay behind the railing," Dr. Robby says, something careful in his tone. "It's there for a reason."
"Oh, shit. Uh—yeah, sorry," Dennis says as he ducks in between the bars, hopping slightly to keep from faceplanting in the gravel. "The, um. The view is nice." He brushes the gravel off the back of his pants with his free hand. Neither of them speak for a long moment. It’s Dennis who grows uncomfortable enough to break the silence. "I, uh. I'm sorry about this morning," he blurts out. "I'm just—off today. I don't—I'm sorry."
Dr. Robby shakes his head, eyebrows raised. "It was a difficult intubation. Nothing to apologize for."
“No, I know that, it’s just—I feel like I’m off my game, and I wanted to—anyway. Never mind.”
Dr. Robby nods slowly. “Something you want to talk about?” he asks, mild and blandly inquisitive in the way he gets when he knows a patient isn’t being forthcoming about their medical history.
Dennis shakes his head quickly. “No, I’m—well, yes,” he admits. “Not really. I can handle it.”
"Tell me," Dr. Robby says, leaning back against the railing. "I've got nowhere better to be."
This is patently untrue—they were already down one intern with Dennis up here, and now they’re missing their attending—but Dennis’ brain latches onto the offer. "I'm off my meds," he blurts out without really thinking, and Dr. Robby tilts his head. Dennis can feel his face burning. "I, um. I've had my prescription waiting for like, two weeks, I just—you know. Can't afford to pick it up. That's—that's really the whole problem. Thirty-six dollars would solve, like, 80% of my issues."
"So it's withdrawal?" Dr. Robby asks, eyes sharpening slightly, and Dennis cringes.
"Okay, that sounds really bad. It's not—I'm not an addict. It's just an SNRI." He watches Dr. Robby's face twist slightly, brow wrinkling, and he hastens to add, "It's prescription, I swear, it's not—I mean, I'm not buying it off the street, or something, I just—"
"No, that's not—" Dr. Robby sighs, rubbing his forehead. "Jesus Christ, kid. How long have you been off them?"
"Um. A little more than a week. I can—I mean, the withdrawal should be tapering off now. I can manage."
"Whitaker, I found you up here on the wrong side of the railing. You're not managing."
"I wasn't—I wasn't going to jump," he argues weakly. "I don't smoke when I'm suicidal, just when I'm trying to—you know. Get my shit together."
"You're not helping your case a whole lot here."
Dennis doesn't say anything, just looks back out over the skyline and lifts the cigarette back up to his mouth, lips tight. Behind him, Dr. Robby sighs and reaches into his pocket. Dennis blinks and turns back to him as he pulls out his wallet and begins rifling through the bills there. “Here,” he says after a moment, pulling two twenties out of his wallet and extending them to Dennis. “Fill your prescription.”
Dennis’ stomach drops, and he pales, waving his hands. “Oh, no, I can’t—you don’t need to do that. It’ll only be a couple more days, and I’m off tomorrow, so it won’t—I mean, it shouldn’t affect my work. Seriously, I’m fine.”
"Did the meds help when you were on them?"
"Well—yes, but—"
"Then get your scrip filled." He can only blink dumbly, speechless, as Dr. Robby tucks the cash into the pocket of his scrubs and claps him on the shoulder. "Be down soon," he says. "You're still on the clock."
Dennis just stands there with the wind blowing through his scrubs as Dr. Robby turns to leave, staring down at the money in his shirt pocket and the cigarette in his hand. The nicotine hasn't steadied him at all.
∗ ∗ ∗
The day gets worse from there.
They send him out to Chairs for triage, into the ever-present wall of sound and irritation that thickens the air like humidity, and there goes his plan to slip the forty dollars back into the jacket hanging on the back of Dr. Robby’s chair in the Hub when he isn't looking. He’s worked Chairs a couple dozen times before, and never once has he had an opportunity to sit down. The number of people in the Pitt proper is manageable. The number of people in the waiting room is at least five times that number, and much less satisfied with their care.
He's only been there half an hour when a patient starts yelling at him in earnest. She's spitting on him slightly, and he flinches backward, but saliva isn't the worst thing he's ever gotten on his scrubs. He’s barely keeping up with the argument. He can’t even really follow what she’s upset about, though in all likelihood it’s the wait time. He’s resorted to the canned platitudes he uses on everyone waiting for a bed: Ma’am, everyone here is doing their best to help you and get everyone treated. We can get you to a room and have you checked out, but we need you to calm down first.
He can take a punch. He used to be able to, anyway, but he supposes he's out of practice.
He doesn't end up completely laid out on the floor when she lands a surprisingly accurate right hook, at least. He just stumbles backward into a wall of people, where Mateo grabs his arm to keep his knees from buckling while his feet find solid ground again. He presses one hand to the side of his face, ears ringing, blinking hard as security gets involved and Mateo grabs his shoulder and steers him off to one of the triage rooms. “McKay,” he calls over the noise, and her head pops up from somewhere within the mayhem. Mateo points to Triage Two, and McKay shoots him a thumbs-up, beginning to wedge her way through the crowd.
Mateo sits him down and gets a set of vitals, strapping a blood pressure cuff around his arm and clipping a pulse oximeter to his other hand. “You’ve got her ring imprints on your face,” Mateo says, squinting at him. “You want to press charges? We can pull security footage.”
“No, it’s—I’m alright. It’s not that bad. It’s not,” he insists at Mateo’s skeptical look. "It’s—I mean, she threw a pretty good hook, but I’ve been punched harder than that. And it’s a bad look when we start suing patients.”
“It’s an even worse look when patients think they can get away with assault,” McKay says, pulling on a pair of gloves as she shuts the door behind her. “How are you feeling?”
"I'm fine," he insists, trying to tilt his head away even as McKay grabs his chin to shine a penlight in his eyes. "She didn't hit me that hard."
"Pupils look good," she says, still frowning. "Jesus, you're bruising already. That's gonna be a good one.”
"I'm fine," he repeats, wincing as she presses against his cheekbone, palpating the left side of his face from jaw to temple. "No LOC, no vision changes, no memory loss, no slurred speech. Unless I can't tell."
"You're talking fine," McKay says, rolling her eyes. "I'll order a head CT to make sure your skull isn't imploding."
"No, you won't," he says instantly, face hot, pushing her hands away. "I'm good. I'm—seriously, this isn't the worst I've had. I've broken my nose before. This is no problem."
“Oh, no you don’t,” McKay says sharply, grabbing his shoulder and pushing him back into the chair as he tries to stand. “Sit down. You’re not going anywhere.”
“It’s not that bad,” Dennis insists. Mateo is leaning against the counter, arms crossed, looking extremely unconvinced. “It isn’t! There’s—it’s not bad enough to warrant all this. I’m fine.”
“It’s just a liability thing,” McKay says in an attempt to appeal to reason, trying to keep him from removing the blood pressure cuff from his arm.
“It’s not like I have a skull fracture.”
“Not that we know of, maybe.”
“Listen, I’ll come back if I start getting double vision or migraines or anything,” Dennis says, tone tipping over into pleading. “Okay? I can take care of myself.”
McKay is stubborn, but Dennis is worse, and in the end McKay sighs, makes him sign a Refusal of Treatment form to cover her bases, and sends him back to the Hub. "Twenty minutes on, forty minutes off," she says, handing him an ice pack. "Tell Javadi to come replace you."
Javadi startles at his appearance, but practically lights up at being asked to join McKay in Chairs, handing off her patients to him with cheerful enthusiasm as he returns to the Hub. “What the fuck happened to you?” Perlah asks as he begins looking over Javadi’s charts, and he reddens.
“It’s nothing,” he mumbles. “Just a patient getting confrontational.”
“With their fists?”
“Yeah. Well, just one. And their rings, I guess.”
Perlah winces. “Built-in brass knuckles. You good to keep working?”
“Yeah,” he says quickly. “Yeah, I’m good. It looks worse than it is.”
The pain isn't even the worst part, really. There isn't a single person he passes that day who doesn't ask him about it—what happened, who started it, who won. Mortifyingly, that includes patients, in particular Javadi’s patient in Fourteen with a concussion from a well-aimed fastball. “Hey. Twinning,” she says, bumping his fist, and he manages a weak joke about occupational hazards as he walks her and her mother through her CT results. The pain in his cheekbone is easing, but his chest still curls with mortification every time someone double-takes in his direction.
The one person who doesn’t ask any questions is Dr. Robby, who must have already heard what happened, because he doesn't say a word as Dennis exits Fourteen and brushes past him to help Mel with a patient that looks like they’re about to pass out or throw up or both. Mel has lowered them gently to the ground and guided their head between their knees, and Dennis snags a wheelchair from next to the elevator as he approaches. “Been better?” he asks, and the patient mumbles something he can’t make out as he locks the wheels. He and Mel help them upright and into the chair, and Dennis forces himself to breathe evenly. He shouldn’t be out of breath from that—he’s lifted heavier patients—but he still has to fight a brief wave of dizziness as he straightens. His thighs burn like he’s just jogged the full eight flights to the roof. “You want an extra pair of hands?” he asks Mel, keeping his voice casual and even.
“No, I’m alright,” she chirps. “Thanks for the porcupine, by the way.”
He manages a sheepish half-bow at that and starts back toward the Hub. The back of his neck prickles as he does, and when he looks over his shoulder Dr. Robby is watching him, brow slightly furrowed. He mouths a “You okay?” across the floor, and Dennis shoots him an awkward thumbs-up. Dr. Robby nods, then points at his cheek and mouths “Ice,” and Dennis groans silently, face burning as he sits down at his station.
The ice pack has been lukewarm for a while now, but he still holds it to his face and types painstakingly with his free hand. The effort lasts all of a minute and a half before he gives up and drops the ice pack back on its place on the desk so he can chart with both hands. There’s a low whistle from across the counter, and he looks up, half-startled. "You're bruising up good," Dana comments, and he cringes, reaching up to prod at the tender spot on his cheek. "Sure you don't want to go home?"
"No, I'm good," he says quickly. "I'm okay. I've only been here a couple hours."
“That means you've got the majority of your shift to finish,” she says, one eyebrow quirked almost imperceptibly. “You sure you’re up for it?”
“I’m good,” he insists. “I’m fine. Seriously. How’s that motorcyclist?”
“Still waiting on an ICU bed upstairs. You missed a triple GSW earlier, too.”
He throws himself back into the swing of things.
He’s fine. He really is.
∗ ∗ ∗
Occam’s razor says it’s probably just hypotension.
Dehydration and malnutrition are the most probable causes. It’s early afternoon, after all. A dip in blood sugar can be expected on the best days. After that he should rule out cardiopulmonary issues and head trauma first, then endocrine and neurological disorders.
But really, Dennis can summarize it by saying he stands up too fast, and his vision swims, and he knows he stands swaying on his feet for several long seconds before he wakes up on the floor to the sound of tinnitus and muffled shouting, as if from underwater.
When he pries his glued-together eyelids apart it's to groan in pain and try to roll away from Santos' hand as she knuckles at his sternum. "Welcome back, Huckleberry," she says in her usual brusque tone, but there's an edge of real concern to it. She pats his chest once as if in apology for the sternum rub. "How're you feeling?"
"Nngh," he manages as he starts pushing himself upright, but the hand on his chest presses him warningly to the ground.
"Stay down, cowboy," she says sharply. "You're not going anywhere except the line for CT. Hey, can we get a gurney, please?"
"Oh, Jesus," he groans breathlessly. "That's not—I don't—need that."
"Oh, yes, you do. You were stupid enough to refuse care for that punch in the first place."
“You can’t—I can refuse treatment. You can’t keep me here.”
“Sure, if you want. We can send you home.”
He groans as he drops his head back against the floor. It thuds against the tile, and he winces. "Fuck," he whispers.
"Don't hurt yourself," she says. "Or—you know. Don't get worse. Look straight ahead, please."
"I don't need a gurney," he says again, voice slightly steadier as she flashes her penlight across his vision. "I can at least get to a chair."
"We'll see," she says. The light clicks off. Her fingers press against his wrist, her eyes fixed to her watch. "A little tachy," she says. "Not surprising."
"It's just low blood pressure," he says, staring up at the ceiling tiles bleary-eyed. "I'm fine. Oh, fuck," he groans as Perlah arrives with a wheelchair, which is at least better than the alternative. "You don't—this isn't—"
"Take the help, Huckleberry," Santos says dryly, reaching down to haul him up from the floor.
"What the hell?" he hears Dr. Robby say from across the Hub, footsteps rapid against the tile as Perlah helps Dennis upright and into the wheelchair, and he cringes. "I leave for five minutes—Santos, what happened?"
"Just the consequences of his actions catching up with him," she says, and Dennis manages a weak glare in her direction. "He's not getting out of a full exam this time. Dana, how long's the wait for CT?"
"Forty minutes, but I can push him up the list," she says.
"Do not do that," Dennis says, louder than he means to, and winces at the headache it produces, pressing the heel of his palm to his forehead. "There are car crash victims on that list; do not bump them for me."
"Well, let's make sure you haven't had an intracranial hemorrhage brewing since eleven A.M.," Dr. Robby says, motioning to Dana. "Push him up. Any LOC?"
"Ten, maybe fifteen seconds," Santos says. "Pupils equal and responsive. He's alert enough to try and refuse treatment again. Where can I—"
"Put him in Ten," Dr. Robby says, grabbing a pair of gloves off the wall. "Let's make sure he doesn't die on the clock, or Gloria will have my ass."
“I can take him from here. Thank you, Perlah,” Santos says in a low voice as she grabs the handles of the wheelchair and steers him towards Ten. Then, as she helps him onto the exam bed despite his insistence that he doesn’t need it, "Hey, maybe I’ll ease off Javadi for a while. Your crash was much more dramatic, in my opinion."
“You can make fun of him all you want post-exam,” Dr. Robby says as he enters the room, pulling on his gloves. "He's second in line for CT. Order a blood count, metabolic with electrolytes, and CRP, and get an IV started just in case. Whitaker, can you tell me what happened?"
"I stood up too fast," he says, face burning as Dr. Robby hooks him up to the blood pressure cuff and pulse oximeter. Santos slips out of the room to order his labs. "I'm—genuinely, I'm fine. I didn't hit anything on the way down. I'm probably just dehydrated."
"Well, we'll make sure that's all it is," Dr. Robby says in the calm, professional tone he uses for difficult patients. “Mind if I take a look at that bruise?”
Dennis sets his jaw, but doesn't complain at the exam, remaining stubbornly silent as Dr. Robby probes at his cheekbone, admittedly more gently than McKay had. The blood pressure cuff inflates on its own. He answers questions about his mental status, proves he knows the day of the week and the current president, recites the alphabet backwards like a field sobriety test. No, he doesn't have any memory loss. No, he doesn't have any relevant symptoms beyond the headache and dizziness.
"Any tenderness? Soreness?"
"It's . . . the normal amount for a right hook."
"Scale of one to ten?"
Dennis sighs. "Two," he says. "Five if you push on it."
“How about that med you’re on?”
Dennis closes his eyes briefly. “Three-hundred milligrams of bupropion extended-release.”
“How’s withdrawal treating you?”
“It’s . . . fine,” he says after a moment. At Dr. Robby’s raised eyebrow, he elaborates, “Anxiety. Tremors. The headaches and insomnia are over; it’s mostly restlessness now.”
“What were you taking it for?”
Dennis' teeth dig into his lower lip. “Persistent depressive disorder,” he says after a moment. “Plus ADHD. And maybe a panic disorder. But they never really gave me a straight answer on those two.” Dr. Robby nods as he taps in at the computer on the rolling cart in the corner. “Are you charting this?” Dennis asks in disbelief, sitting up straighter.
“Whitaker, you’re in line for CT,” Dr. Robby says. “You’re getting charted. You can’t get out of it this time.”
“I have patients,” he says, leg jittering. “There’s an animal bite in Six that needs rabies PEP, and someone needs to finish the discharge paperwork for the concussion in Fourteen.”
“Well, we’re currently ruling out a concussion in Ten, so Fourteen’s going to have to wait,” Dr. Robby mumbles.
“I’m not concussed,” Dennis insists.
“All signs and symptoms say otherwise.” Dr. Robby glances up at the monitor as Dennis' vitals blip unobtrusively onscreen. “Pulse ox looks fine, though. Blood pressure’s a little low. A little tachy.”
“That’s what I said,” Santos says as she reenters the room with a tray. “We’ve got a STEMI coming in, ETA three minutes.”
“Shit,” Dr. Robby sighs, pushing himself up from the chair. “Okay. Dr. Santos, you take over here.”
For once, Santos doesn't complain about being taken off an interesting case. She just nods and reaches for the box of gloves on the wall.
“CT line’s moving faster than usual today,” she says. “You want me to step out while you change?”
"I'm not getting into a gown," he says flatly. "My scrubs are fine.”
“Fabric will obscure the imaging, Huckleberry. That’s radiology 101.”
“Well, I don’t have a hat on, so I think I’m good.” Santos stares at him, decidedly unimpressed, but he just shrugs. “You can always cut them off me later if I start seizing.”
Santos rolls her eyes, sighs, and shakes her head. "You're one stubborn son of a bitch," she mumbles, eyebrows raised as she peels open the IV kit.
"Your bedside manner leaves much to be desired."
"So does your sense of self-preservation. Your jewelry's going to have to come off either way."
"That's not—" He grits his teeth and reaches up to fiddle with the clasp of the cross around his neck, tossing it onto the foot of the bed with his fifteen-dollar watch. "Fine. Happy?"
"Sure. Any preference for which arm the IV goes into?"
He sighs again and offers up his left. Santos inflates the cuff on his upper arm, swabs the crook of his elbow with alcohol, and sticks him successfully on the second try, ignoring his grumbling about stabbing him on purpose. "Maybe if you took care of yourself," she says, fixing him with a hard look as she deflates the cuff, "I'd actually have veins to stick."
"I take care of myself fine."
Santos doesn't dignify that one with a response, just rolls her eyes and reaches for a roll of medical tape. Dana knocks twice on the door frame as she tapes the IV port in place. "Radiology's ready," she says. "Maxillofacial without contrast. You're up."
"Am I allowed to walk there?"
Dana levels him with a flat look. "Could've just said no," he mumbles.
"You're lucky it's a wheelchair and not a gurney." She gestures sardonically to the chair. "Let's go."
“And you don't have anything better to be doing than carting me around to Radiology?”
“Shut up before I push ten of propofol just for fun,” Santos says.
“Oh, medical malpractice. Very funny.”
“Dennis, get in the chair.”
He does.
∗ ∗ ∗
Dennis sits on the edge of the exam bed in Ten and counts the ceiling tiles for half an hour after the CT until Dr. Robby knocks twice on the door and opens it, looking a little like he didn't expect Dennis to still be there. Neither of them speak while Dr. Robby taps in at the computer in the corner, eyes flicking through his chart.
“So how long do I have?” Dennis asks finally, and Dr. Robby gives a little half-chuckle that sounds more uncomfortable than anything.
“Well, your CT looks okay," he says carefully, and it's in the tone of voice that means there's more coming. "No hematoma, no intracranial bleeding, no skull fractures. But—" There it is. "Your labs are a different story. Your albumin is low. Low hemoglobin. Low triglycerides. Low blood sugar." He's looking at Dennis intently, and a shallow pit opens up in his stomach.
"Is this a pop quiz?" he asks, and Dr. Robby sighs, pulling up a chair to sit down next to the bed.
"Do I need to spell this out for you?"
"Low albumin can be caused by inflammation," he defends half-heartedly.
"Whitaker, you're clinically malnourished." Shit. "When was the last time you ate?"
"Um," he says eloquently, mind racing to come up with a believable lie. "About two hours ago."
"Try again." Shit.
"I—okay, I had a granola bar this morning." That part is true.
Dr. Robby sighs. "I'm not talking about granola bars," he says. "When was the last time you had a full meal?"
Dennis falls silent. What counts as a full meal? Five-hundred calories? "I don't think you're going to like the answer to that," he says after a while.
"Okay, ballpark. Are we talking days or weeks?"
Silence again. He wracks his brain, trying to find an answer that won't sound as pathetic as he feels, but he's pretty sure the truth will sound pathetic no matter how much he sugarcoats it. "Probably, um. Two months." His voice is much quieter than he meant it to be.
Dr. Robby blows out a breath, leaning back in his chair. "Jesus, kid," he says quietly, dragging a hand over his face. The conversation shifts. Dr. Robby begins drilling him on his health. Yes, he’s lost weight in the last six months. No, he doesn't know exactly how much. He knows that he’s had to start poking new holes in his belt, but he doesn't mention that part. Dr. Robby is scrutinizing him, as if doing the math on his body fat percentage, trying to guess how worried he should be based on how much his clavicles stick out or how pale his nail beds are.
Dr. Robby exhales, leaning forward in his chair. "You've got a lot of promise, Whitaker," he says. "You're a fantastic intern. You're smart; you're a quick learner; you're good at your job. I know you can go far. There are programs that can help you.” Silence. Then, “We can get Kiara involved here, if you want."
"I'm not a charity case," Dennis says instantly, palms sweating. Jesus Christ, he’s going to lose his internship. "I'm—that's not—you don't need to do that."
"Okay, so what do you need?" Dr. Robby presses. "Whitaker, there are people here who want to help you. You just need to tell us how."
"You can't," Dennis snaps, and Dr. Robby falls silent. "Okay? You can't. My stipend covers my student loans and a P.O. box, and that's basically it. I live—" He swallows hard. "I live on the eighth floor, okay?" His voice cracks. "I live on the eighth floor, and before that I was shelter-hopping, and during college I lived in a corner of the library where nobody bothered me. So I'm—legally, I'm homeless, or unhoused, or whatever the fuck I'm supposed to call it in Pittsburgh. Okay? That's what the problem is. And I'm—I need to get my shit together, because if I lose this internship then I'll end up two-hundred grand in debt with no hopes of ever paying it off. Okay? I'm fine. I'm managing."
Two slow knocks come from the open door, and Dennis turns his head. "Um," Santos says, looking like a deer in the headlights. "I can come back."
All the fight drains out of him like water in his hands. His face burns. Mortifyingly, he can feel his eyes stinging. He looks up at the ceiling as if an escape hatch will appear there. He clears his throat. "It's . . . fine," he says after a long moment, throat tight. "What do you need? More blood?"
"Um, nope. No more blood. I come bearing gifts," she says as she walks into the room, slipping quickly back into brisk professionalism as she hangs a bag of saline with one hand and tosses a juice box and a sandwich at him with the other. "We're out of anything good. It's just egg salad."
"That's fine. Egg salad's—fine. Thanks."
"Saline to help get your fluids up," she says as she leans over him to hook the line up to his IV port. "Start with the juice and the sandwich for your blood sugar. If it doesn't improve in fifteen minutes we can get you some dextrose tablets."
“I won't need dextrose tablets.”
“Okay,” she says, eyebrows raised. “Prove it.”
He can't even muster a proper glare as he begins peeling apart the plastic wrap on the sandwich. The saline drip makes the back of his mouth taste like metal, briefly replaced by egg salad as he takes a bite. Santos doesn’t say a word until the second bite is in his mouth. “Dana finished up the discharge paperwork for your concussion patient,” she says. “Mel’s taking care of your animal bite. It’s too bad we don’t do the testing here. Would’ve been fun to see its head cut off.”
“Fantastic lunch talk,” Dennis mumbles around the sandwich in his mouth. “He didn’t bring in the raccoon, anyway. Apparently most of its brains are splattered across his front lawn.”
“Oh, I’m the one with fantastic lunch talk. Clearly you’re not squeamish.”
Dr. Robby clears his throat. “If I remember correctly, you’ve got patients besides Whitaker,” he says, fixing Santos with a pointed look, and she dips her head with enough decency to look contrite.
“Point taken. Hey, don’t die while I’m gone,” she says to Dennis as she turns to leave. “I call dibs on resus if you collapse again.” Dennis, with incredible manners and restraint, doesn’t flip her off as she closes the door behind her.
When the door closes, he’s left alone in uncomfortable silence with Dr. Robby. After a long moment Dennis clears his throat. “I, um. I’m sorry for yelling. That was unprofessional of me.” And stupid, he amends silently. Barely fifty feet from the Hub and he decided to have a breakdown in a room with the door open, as if collapsing in the middle of the hallway wasn't bad enough.
Dr. Robby just shrugs, unconcerned. “It’s not the worst thing I’ve heard from a patient. Or an intern.”
“It’s still not—” Dennis sighs. “I know that you’re—you’re trying to help. And I appreciate that. But I’m not—I’m not a charity case,” he says, closer to a whisper than he means it to be. He swallows. “I don't—I can find a shelter that's not the eighth floor, okay? I know no one’s supposed to be up there.” He’d have needed to move anyway; he doesn't know how many people overheard him. Holy shit, he’s really going to lose his internship.
“I don’t care about the eighth floor, Whitaker,” Dr. Robby says, easy and straightforward. “I care that you’re not putting yourself or anyone else at risk while you’re here. You’re good at the work, but you have to keep yourself alive to do it.”
“I can take care of myself,” Dennis says. He’s been the only one keeping himself alive for seven years.
“Sure, but you don't have to,” Dr. Robby says gently. “That’s what I’m trying to get through your head. You don’t need to do this by yourself, Dennis.”
The use of his first name startles him. He swallows. “I don't need anyone’s help,” he says again, but his voice is thin and hollow and he doesn't think Dr. Robby believes him at all. Neither of them speak.
“If you change your mind,” Dr. Robby says after a while, “you can always come talk to me. Or Kiara.”
“I won’t,” Dennis says bluntly. Dr. Robby sighs and nods like he expected that answer.
“Do you still want to stay until the end of your shift?”
“Yes,” Dennis says instantly. “I’m good to work. I’m fine.”
Dr. Robby sighs again and rubs his forehead like he expected that too. “Finish your sandwich,” he says eventually. “Take your time. Come back to the floor when you’re ready. When you’re ready,” he repeats sharply when Dennis moves to get up. “Santos will come back to check your sugar. There’ll still be plenty of patients when you get back.”
∗ ∗ ∗
Santos comes back twenty minutes later with a lancet and a glucometer, and Dennis lets her prick his index finger without complaint. Her gaze flicks back and forth from the reading to his face. “Your sugar’s back up,” she says after a long moment of side eye. “116 is still lower than I want, but it’s technically within a normal range.”
Dennis is already pulling his watch back on and fastening the cross back around his neck. “Do I have any post-visit instructions beyond ‘don’t get punched again’?” he asks.
“Maybe eat something more substantial than a granola bar,” Santos says. Then, fumbling for a gauze pad as Dennis peels the tape off his IV port and removes the catheter, “Fucking Christ! Can you not wait thirty seconds?”
Dennis sighs as she presses the gauze to the crook of his arm. “I didn’t need to wait thirty seconds,” he says.
“I know a dozen people in a ten-meter radius that would wholeheartedly disagree.”
“They’re biased.”
“In favor of your health, yes. What kind of stupid Band-Aid do you want today?”
“I get a choice?”
“No,” Santos says, reaching into her pocket for her personal supply. “It’s Pokémon this week. You’re getting Diglett.” She lifts the gauze slightly to make sure Dennis isn’t bleeding out, then replaces it with a Band-Aid. “Bet the kids will love you today.”
“They love me every day.”
“Right. Well, you’re not going to love me for five minutes,” Santos says, reaching behind her to grab a stapled packet several pages thick. “This isn’t your summary of care, this is the incident report we need your signature on. Gloria found out that you collapsed mid-shift, and that looks bad for legal, believe it or not.”
Shit. “Fine,” Dennis says, reaching for the incident report with one hand and digging in his pocket for a pen with the other. “Have I been fired yet?”
“What, for being hypoglycemic?” Santos asks pointedly, with the reassuring subtext that Gloria doesn’t know anything about the rest of it. “You’re already off tomorrow,” she says. “If your concussion symptoms don’t improve—”
“Call out, I know,” Dennis says, scribbling his signature at the bottom of the form without really reading it.
“I was going to say come in and get checked out,” Santos says dryly, “but I get the feeling that asking you to seek medical attention for anything is a losing battle.”
“Yep,” Dennis says shortly, handing the packet back to her. “Can I go?”
“Jesus, fine. Eager beaver over here.”
Dennis is careful when he stands, but there’s no lingering dizziness. He brushes off his scrubs with hands that don’t shake, blows out a breath that doesn’t make him lightheaded, and carefully smooths his expression into the politely neutral one he wears on public transportation when he doesn’t want to talk to anyone. Half a dozen pairs of eyes glance in his direction as he leaves the room. He avoids eye contact with any of them as he returns to his station.
He’s allowed to finish the shift, but no one lets him work trauma. He tries once to jump in on an incoming construction accident, but Mel quietly and efficiently maneuvers him out of the way and takes his place, shooting him an apologetic look and following up with a pointed nod toward the ice pack abandoned at his station, which he finds has been replaced with a cold one.
Instead of trauma, he’s relegated to the simple, routine cases: localized abdominal pain (appendicitis); an infant who won't stop crying (hair tourniquet); fever and earache (otitis media); a kitchen accident (eight-centimeter laceration, eleven stitches). He runs on muscle memory, smiles at the patients, makes the same jokes about Nair and swimmer’s ear and falling knives as he does every time he handles one.
They’re comforting, in a way. He knows the protocol and the routine. There’s no heavy lifting. He hasn't changed his scrubs all day. He feels competent, and also wholly underutilized.
And the worst part is that the sandwich and juice worked, and this is the most clear-headed he’s felt in weeks.
“Here. Eat while you can,” Dana says an hour later as he charts his thought process on the appendicitis patient in Seventeen, and he looks up to find her dangling a protein bar over his station, one he recognizes as one of the expensive brands that don't taste like sawdust, and Jesus Christ.
"Oh, no, that's okay," he says, laughing nervously. "I just ate."
"Save it for later, then," Dana says, gesturing with the protein bar. "You're built like a salt stick. Take it."
No one tells Dana no twice. The protein bar (cranberry-almond-dark chocolate) joins the forty dollars in his scrub pocket.
Dana is far from the last person to offer him food that day, and with every gift of Snickers bars and beef jerky he realizes with a growing pit of dread in his chest that everyone on the floor has heard how completely fucked he is. Javadi quietly leaves another juice box at his station. Princess and Perlah switch to Tagalog when he passes by. A Post-It with his name on it appears on the whiteboard and is very quickly removed by a tight-lipped Mohan before anyone can start placing bets. Quietly, he sinks further into his chair, fixes his eyes on his monitor, and charts with an excess of detail that would irritate even Gloria.
Santos is startlingly devoid of sarcastic comments, at least in Dennis' direction, and when she speaks to him it's uncharacteristically sincere. "For the record," she says later that afternoon from the station next to his, not looking at him as she talks. "I have a spare room. If you want it."
"Oh," he says. "I, um. I can't pay rent."
"I didn't ask."
"Oh,” he says again, eloquently, voice slightly hoarse. “Um. Okay."
Santos doesn't push him on it. That's one thing he appreciates about her, that she knows when to drop things.
For some reason, it makes his chest hurt more than the forty dollars or the day’s worth of cheap snacks do.
∗ ∗ ∗
Every day ends eventually. This one, miraculously, ends without further incident.
“Good work today,” Dr. Robby says as Dennis hands off the last of his patients to the night shift, and Dennis raises his eyebrows and says nothing. “I’m serious. You’ve got good patient ratings. Keep it up.”
“It’s not hard to keep patients happy when I’ve been treating cases like theirs since I was an MS1,” he half-jokes, trying to keep the bitterness out of his voice.
"You do them well," Dr. Robby says firmly, and Dennis presses his lips together, silent. "This job isn't easy on the best days. You're doing fine, Whitaker."
Silence. Finally Dennis nods, and Dr. Robby turns to greet Dr. Abbot as he comes in through the ambulance bay, and Dennis heads for the lockers and pulls on his sweatshirt. It won't carry him all the way through winter, but it might get him most of the way there. He's had lean years before, anyway.
"Yo," Santos says, leaning against a locker a few feet down the row. "You coming?"
He looks at her wide-eyed, frozen in the act of shoving the contents of his pockets into his bag. "Huh?"
"You coming?" she repeats, eyebrows raised. "I bet my water pressure's better than the eighth floor."
He can only stand there and blink for a long moment. “Yeah,” he manages, swallowing. “If that’s—you know, if the offer still stands.”
She rolls her eyes. “Yeah, Huckleberry, it does.”
“Oh. Um, great. Okay.”
“Okay?”
“Okay.”
She jerks her head toward the door. "Then hurry up before I change my mind."
“Uh—yep, yeah, coming!” He slings his bag over his shoulder, hurriedly shoving his locker shut with his shoulder as he follows her toward the exit.
A hand lands on his shoulder as he passes the Hub, and he stumbles back a step. “Hey,” Dr. Robby says softly, and Dennis turns his head to look at him. “Get some rest,” he says. “Come back Thursday. The first trauma’s all yours.”
Dennis nods, throat tight, and Dr. Robby squeezes his shoulder and lets him go.
Santos has stopped to wait for him, one eyebrow raised, but he still has to jog to catch up with her as she crosses the parking lot. "Keep this on the down-low, by the way," she says as she unlocks the car, a slightly beat-up sedan that nonetheless looks like it won't blow up when it starts. "I have a reputation to uphold as a stone-cold bitch."
"Uh—yep. No problem on that one. You can do that without my help."
"Oh, fuck you," she says, but there's no real venom in it. She jerks her head toward the passenger side. "Get in before I change my mind."
Dennis ducks his head and squeezes himself into the passenger seat, trying not to shove the car door into the van on their right, and pulls the door shut behind him as Santos starts the car. He wedges his bag between his feet and fumbles for the seat belt, setting his jaw to keep his teeth from chattering as the cold of the vinyl seats seeps through his scrubs.
Santos glances over at him and turns on his seat warmer without asking, and if she notices the way he swallows and blinks fast to keep from crying, she doesn't say a word.