Chapter Text
A/N: Hello! Back by popular demand: to the second installment of the Highs and Lows series! I recommend reading the first part, not just for plot, but because it includes some helpful background on diabetes that will make this story easier to follow.
I’ve worked as an EMT for years, so you can expect a fairly high level of medical accuracy in this fic. I included a brief medical guide below in case you want a reference point while reading. I’d recommend knowing what a sepsis alert and sepsis bundle are.
If you’re diabetic: feel free to chime in with a comment if you have any critiques! I do not have diabetes and I want to make sure you are properly represented!
Medical Guide
Macrobid and Bactrim: Common antibiotics used for UTI treatment.
Sepsis: A life-threatening condition caused by the body’s overwhelming response to an infection. Sepsis can progress to septic shock, which leads to critically low blood pressure, organ failure, and a very high risk of death.
Sepsis Alert/Code Sepsis: Because sepsis requires rapid treatment, hospitals use specific screening criteria to identify it early. If a patient meets enough criteria, a sepsis alert (sometimes called a code sepsis) is activated.
Criteria vary by hospital, but usually have to do with:
- Fever
- Low blood pressure
- Elevated heart or respiratory rate
- Altered mental status
- Abnormal lab values (especially elevated lactate)
Triggering a sepsis alert automatically activates a sepsis bundle.
Sepsis Bundle: A standardized group of tests and treatments designed to be initiated as quickly as possible.
Bundles typically include:
- Blood cultures
- Broad-spectrum IV antibiotics
- IV fluids
- Lactate measurement
Cefepime and Vancomycin (“cefepime and vanc”): A common first-line combination of broad-spectrum IV antibiotics used for sepsis.
Zosyn: Another broad-spectrum IV antibiotic often used for sepsis, especially pyelonephritis.
Pyelonephritis (“pyelo”): infection of the kidney. It usually begins as a bladder infection and goes up the urinary tract.
Meningitis: Infection of the membrane that surrounds the brain and spine. The hallmark symptom of this infection is pain when putting your chin to your chest
CT/AP: CT scan of the abdomen and pelvis
Chapter 1
When she really thought about it, the pain had started Sunday. It rudely interrupted her weekly RuPaul’s Drag Race viewing with Whittaker. Low key homophobic.
It was just a dull ache low in her abdomen. Easily dismissible. Her sugar kept riding higher than usual, but it was nothing a bit of extra correction couldn’t handle.
The next day, the pain grew teeth. The shooting, burning sensation was all very familiar.
UTI.
Literally the most annoying and benign infection. Some empiric antibiotics would be fine; it would clear right up, and she’d go back to business as usual. She sent in a script for Macrobid to a CVS across the city where no one would go sticking their nose.
It helped for a couple of days. And then it didn’t.
But she didn’t have time to constantly be ducking in and out of the bathroom when the board was stacked full of patients. And even when she did try to go, she couldn’t pee anyway.
She put herself on a clock. Every hour, she’d go, give herself two minutes, then get back out on the floor. No matter how she felt or how urgent it seemed, she stuck to the clock.
The system was definitely flawless.
Her glucose developed a mind of its own, spiking insistently regardless of intake or correction.
She started a strict regimen of Tylenol and Advil and nearly drowned herself in sugar-free cranberry juice—which was a disgusting excuse for a beverage, just for the record.
By Friday, she decided it might be time to try a different antibiotic. Bactrim this time. She could pick it up on the way home from work and be back in fighting shape by Monday.
By the end of the shift, she was running on fumes, and it showed. She stood bent over the desk, the closest she could get to comfortable. The pain radiated up her back now. She braced herself on her elbows, fingers barely reaching the keyboard as she finished her notes.
Abbott was taking report from Robby when he side-eyed her.
“You good, Santos?” he asked.
She turned her head, finding the two men looking at her with concern.
“I’m twenty minutes from watching TV on my couch,” she replied. “So—never better.”
She logged off the computer with a final click.
“Later, fossils.”
She fought with every muscle in her body to walk upright and evenly until she was out of sight.
She stopped to get the new prescription and dry-swallowed the first dose right there in the CVS parking lot.
After that, the weekend blurred.
She wasn’t exactly sure when the fever hit—only that it knocked her into a never-ending stupor of pain and nausea. Her sugar climbed, and she chased it with dose after dose of insulin, never quite catching up.
Once the vomiting started, the pattern collapsed entirely.
Each time she pulled out her meter, she spun the wheel of misfortune—high, low, dipping, peaking on a whim. She’d eat and throw it up, under-dose to avoid crashing, then watch the fever drive her glucose right back up anyway. Even calculating the dose became a herculean effort between the fog and waves of stabbing pain.
She was so sick, she almost wished Whitaker wasn’t at that stupid conference.
Almost.
The pain dredged up a memory from med school, from the cadaver lab. One body had been prepared to display the renal system. She remembered the ureters—thin tubes running from kidney to bladder. She’d never considered what they look like in her body.
Now she could feel every inch of them. The precise trail, lit with throbbing fire. Her own renal system, glowing neon. Med students could cut her open for a perfect diagram.
Monday morning arrived.
5 a.m.
She could do this.
The antibiotic would kick in any second. She’d take some extra Tylenol for the fever. Maybe she’d even bolus some saline in the bathroom if she had to.
She’d be fine.
She showered. Ate breakfast. The food even seemed like it might stay down, so she corrected with insulin.
She pulled over on the drive to work to puke, wiped her mouth, got back in the car, and kept driving.
She made it to work without further incident. Took report. Then went on her “protected” (read: forced) break to check her sugar.
110.
A good number. Finally. She was turning the corner.
She popped more Tylenol while she was at it and went back out on the floor.
An hour later, it became clear the 110 hadn’t been a lasting number—just a single data point on a steep downward spiral.
The floor tilted.
Her hands shook.
Her thoughts lagged.
She stumbled toward the hub, looking for Robby.
Shit. Shit. Shit.
Instead, she found Dana.
Close enough.
Trinity made it to the desk.
“Dana.”
Dana answered without looking up. “Yeah?”
There was a pause.
Whatever Trinity had planned to say completely abandoned her.
“…Um.”
Dana’s head snapped up.
She saw it instantly—the pallor, the sweat, the way Trinity’s focus kept sliding instead of landing. Her grip on the counter had gone white-knuckled.
“Okay,” Dana said softly as she came around the desk. “Hey, honey. Come with me.”
She slipped a hand behind Trinity’s shoulders and guided her into the nearest empty room, the other hand steady at her elbow.
“Sit.”
Trinity dropped onto the edge of the bed like she’d made it just in time.
Dana stayed close, eyes scanning as she pulled on gloves. She pressed her hand against Trinity’s neck and frowned. The fever burning under her skin passed straight through the glove. Her pulse thudded quick against her palm.
“You look like death warmed over, kid. How the hell did you get past Robby this morning?”
“My cunning and wit,” Trinity answered.
Dana looked unimpressed. She grabbed the glucometer and set it on the sheets next to her.
“When was the last time you checked your sugar?” she asked, readying a test strip and lancet.
Trinity blinked, the question lagging.
“…Earlier.”
The lancet clicked. The glucometer counted down.
The number appeared.
“48,” Dana said.
She turned to a drawer, retrieved a tube of glucose tabs, popped it open, and tipped a couple into Trinity’s hand.
“Chew.”
Trinity obeyed, face twisting at the chalky taste.
Dana moved to the door and cracked it open. Robby was just about to sit down at the station.
“Robby,” she called quietly.
He glanced up.
“Need you in here.”
Robby tucked away his glasses as he strode over, slipping through the curtain.
He stalled for just a beat at the sight of Trinity perched on the bed.
Trinity looked at Dana.
“You told dad?”
“Sorry, hun,” Dana said, an unapologetic curve on her lips, as she slid the pulse ox onto Trinity’s finger.
Robby crossed the room, pulling on gloves.
“Someone’s looking a bit low,” he said, eyes flicking from the monitor to Trinity’s face.
Trinity gave him a weak glare.
“Glucose is 48,” Dana said. “Febrile. Tachy. Working on getting tabs in.”
Robby’s hand went to Trinity’s wrist, then her neck, confirming it himself.
“How long have you been sick?” he asked.
She shrugged. “Been taking Tylenol.”
“So—awhile,” he said, pointed.
Another half-shrug.
“You eat breakfast with your insulin today?” he asked.
“Yeah, but…” She looked away.
Robby shifted his weight, arms crossing.
“But?”
“I threw up,” she mumbled.
“Okay,” he nodded evenly. “We’ll get you some Zofran. Four milligrams ODT.”
Dana wrapped the blood pressure cuff around Trinity’s arm.
Trinity’s chewing slowed.
One of the tabs slipped from her fingers and clinked onto the floor.
Robby and Dana snapped back to her face. Her gaze had gone distant.
“Hey,” Robby said, steadying her shoulder. “Eyes on me.”
Trinity tried.
Missed.
“Santos.”
Her head dipped forward. He caught her by the cheek.
“That’s enough,” Robby decided. “Spit them out. You’re done with the tabs.”
She didn’t respond. Her weight sagged heavier into his hand.
“Shit,” he muttered. “Dana—access. Now.”
He guided Trinity onto her side by her shoulders, angling her head down.
“Trinity,” he said, firmer now. “I’m not letting you choke on those. Spit them out.”
Her eyes slid past him, unfocused.
“Okay,” he warned. “Then I’m helping.”
He didn’t hesitate—swept a gloved finger into her mouth as she gagged weakly, brushing chalky fragments onto the sheet.
“There you go,” he murmured. “Good.”
Dana was already threading the IV.
Robby reached into the drawer and came up with an amp of D50.
“I’m in,” Dana said.
He tossed the syringe across the bed.
“Push it.”
Trinity tried to turn onto her back.
The movement barely started before it stopped—her body locking mid-turn as a sharp, broken sound tore out of her. She sucked in a breath she couldn’t quite finish, her glassy eyes squeezing shut.
Robby paused.
“Trinity,” he said, lowering himself into her line of sight. “Are you in pain?”
She didn’t reply. Just stared straight through him.
“Okay,” Dana said, setting the empty amp aside. “Done.”
Robby nodded once and kept moving.
“Hang fluids and a D10 drip,” he said, tapping the monitor. “Let’s get a full set of vitals.”
He grabbed the thermometer off the wall.
“See how high this temp is.”
“If anyone would come to work a twelve-hour shift septic, it’s Santos,” Dana muttered as she hung a liter of saline.
“Couldn’t agree more,” he replied.
“101.8,” Robby read as the thermometer beeped.
“Maybe the Tylenol didn’t stay down,” Dana said.
“Between the fever and vomiting, the low’s no mystery.”
Robby tilted his head to catch Trinity’s gaze. Her eyes found his, sluggish.
“You back?”
She blinked twice, struggling to focus.
“Give it a second,” he said. “You’re alright.”
“You know,” Dana said quietly, “she came and found me at the desk.”
He glanced at her.
“Think we’re looking at a little character growth,” she added.
“Who would’ve thought.”
“You must’ve given one hell of a come-to-Jesus.”
“For a Jewish guy,” he shrugged.
Dana snorted.
“I…” Trinity began slowly. “Feel like shit.”
“Yeah,” Robby said, resting a hand on her arm. “I’m glad you asked for help when you did.”
She groaned dramatically.
“You think you’re going to throw up?” He guided her shoulder forward on reflex.
“No,” she slurred. “You. You’re nauseating.”
Dana failed to hide her laugh.
“Sorry,” Robby said dryly. “I’ll keep the validation to myself.”
“Thank you,” Trinity murmured.
“Did you take the Tylenol before or after you vomited?” he asked, fingers gentle as he checked her lymph nodes.
“After,” she said. “At like…eight?”
“Your fever’s still 102,” he said. “Even with Tylenol on board.”
“Heart rate’s 136,” Dana added. “Resps 22. BP’s 88 over 50.”
Silence fell as Robby and Dana exchanged a look.
Trinity caught up to the numbers.
“No,” she said, shaking her head. “Don’t you dare.”
Robby held her gaze.
“It’s just the low,” she pleaded.
He shook his head.
“Low or not, you meet criteria. Call a sepsis alert.”
“There’s going to be so many people,” Trinity protested.
“I’ll let you choose,” he said. “Two nurses.”
“Princess and Perlah.”
“The Tagalog triplets,” Dana smirked, picking up the phone.
Robby leaned into the hall and caught their eyes.
“Perlah. Princess.”
They came immediately.
“Hypoglycemic,” he primed. “Sepsis alert.”
They took one look at Trinity on the bed.
“Loka ka talaga,” Princess sighed.
You look ridiculous.
“Sabi ng expert,” Trinity muttered.
Says the expert.
“Hang D10 at 200,” Robby directed. “Two lines, wide open. Trigger the sepsis bundle—hold acetaminophen. Four of Zofran IV. Q10 glucose checks.”
“Your attending voice is too loud,” Trinity complained. “My head feels like it’s going to explode.”
“Chin to chest for me.”
“I don’t have meningitis, idiot.”
“That’s your one free insult,” he said evenly. “Only because you’re obtunded.”
“You’re obtunded,” she echoed.
“She’s spicy today,” Dana chuckled. “Pharmacy’s on their way with cefepime and vanc.”
“Thank you,” Robby said. “Santos—when did you start feeling sick?”
“Sunday?”
“Yesterday?”
“No.”
The room paused.
“Last Sunday?” he clarified. “Eight days ago?”
She nodded.
“Jesus. Symptoms besides vomiting?”
“It was just a UTI,” she said. “Took Macrobid. Then Bactrim.”
“Let me guess—neither worked,” he said. “You didn’t get a culture. You ignored it—and now you have pyelo.”
“You are…so good at this whole doctor thing.”
“And the pain is severe enough that you can’t roll onto your back.”
Her mouth opened as everyone noticed she was still curled on her side.
She looked at Perlah and Princess.
“That’s witchcraft. I don’t know how he knew that.”
Robby exhaled.
“Dana—call downstairs, see if pharmacy wants to switch to Zosyn. Add a CT A/P with contrast. We’ll send her once she’s stable.”
He looked back at Trinity.
“You? Rest. And for the love of God—say something if you feel low between checks.”
She gave a sloppy salute.
Princess leaned toward Perlah.
“Medyo cute siya kapag galit.”
He’s kind of cute when he’s angry.
"Oo nga?!" Perlah chirped.
Right?!
“Oh god,” Trinity groaned. “Push the Zofran faster.”
Princess and Perlah dissolved into giggles.
Robby, wisely, did not ask.