Chapter Text
Chapter 1: The Piastri Effect
The first time Lando hears the name Oscar Piastri, he is elbow-deep in a trauma bay, trying to convince a nineteen-year-old rugby player that no, his ankle is not meant to point that way.
“Neuro called back,” Priya says, appearing at his shoulder.
Lando does not look up. “Lovely. Tell them I’m thrilled.”
“He said no surgical concern.”
“Even lovelier.”
“And that your management plan is appropriate.”
That makes him look up.
Priya is holding the phone away from her ear, eyebrows raised with the kind of expression nurses reserve for consultants, miracles, and men who faint during blood tests after insisting they are “fine with needles.”
“He said what?”
“Your management plan is appropriate.”
Lando blinks. “Neuro… said that?”
“Dr. Piastri said that.”
“Who’s Dr. Piastri?”
“New hire. And apparently, someone with taste.”
Lando gives her a flat look.
The rugby player groans from the bed. “Is my foot still there?”
“Yes,” Lando says, turning back to him. “Emotionally, it’s been through something. Physically, it’s attached.”
“Brilliant. Can I see it ?”
“I wouldn’t recommend that.”
Priya hangs up and passes him the chart. “He left a note.”
“Oh, did he now?”
It is, Lando discovers, barely a note.
No acute neurosurgical pathology. Continue ED plan. Escalate if deterioration.
Three sentences. Calm. Efficient. Almost rude in its lack of panic.
Lando stares at it for half a second too long.
Priya notices, because Priya notices everything. “Problem?”
“No.”
“You’re frowning.”
“I frown professionally.”
“You’re impressed.”
“I’m irritated.”
“Same face on you.”
Lando hands the chart back. “Tell Dr. Piastri his note was deeply moving.”
“I’m not telling him that.”
“Coward.”
“It’s Doctor Coward for you.”
The rugby player raises a hand weakly. “Can someone tell my mum I’m alive?”
Lando pats his shoulder. “Absolutely. We’ll leave out the part where you tried to tackle someone with your whole skeleton.”
The day continues.
The day, because it is an emergency department and therefore legally hostile, continues at speed and chaos.
There is a child with a bead in his nose, a cyclist with road rash in places Lando does not want described to him, an elderly woman who keeps apologising for “being a bother” despite having a fractured hip, and one man who claims he slipped in the shower in a way that involves both a ladder and an alarming amount of glitter.
By the time Lando remembers Dr. Piastri exists, it is because another note appears on another chart.
Reviewed imaging. No operative intervention. Sensible ED management.
Lando reads it twice.
“Sensible,” he winces.
Priya, who has materialised again, says, “That sounded painful.”
“He called me sensible.”
“He called the management sensible.”
“That’s worse. It’s indirect.”
“Do you want Neuro to flirt with your documentation?”
“I want Neuro to use adjectives like a normal person.”
“Careful. You’ll get attached.”
Lando laughs, because the idea is absurd.
Doctors do not get attached to other doctors through clinical notes. That is not a thing. That is what happens to people in books Priya reads during night shifts and denies reading despite leaving them face-down beside the drug cupboard and forbidding anyone from looking at the cover.
Still.
He checks the signature.
O.Piastri.
A neat name at the bottom of a neat plan.
That should be the end of it.
It is not.
By Friday, Lando has seen the name six times.
By the following Tuesday, ten.
By the end of the month, Oscar Piastri becomes less a person than a recurring weather condition.
There is the morning list.
The evening rush.
The man in bay four who insists chest pain is probably indigestion despite being the exact demographic invented to give doctors trust issues. He will not give further description.
And then there is Piastri.
Piastri replies quickly.
Piastri does not over-admit.
Piastri does not send back theatrical essays about why a referral is unnecessary.
Piastri does not, unlike certain specialties Lando could name but will not because he is trying to grow as a person (*cough Traumatology cough*) - behave as though the emergency department exists purely to ruin his day.
Piastri simply reviews the imaging, reads the notes, and writes something useful.
It is disconcerting, to say the least.
“Your neurosurgeon’s answered,” Priya says one evening.
Lando looks up from the computer.
“My what?”
“Your neurosurgeon.”
“I don’t have a neurosurgeon.”
“You have that one.”
“I don’t.”
“You do.”
“I’ve never met him.”
“And yet.”
“There is no ‘and yet.’”
Priya places a coffee beside him. “He agreed with you again.”
Lando glances at the screen.
No further imaging indicated. ER plan appropriate.
He hates, slightly, the small private pleasure that rises in him.
It is not about Piastri.
It is about being right.
Probably.
“Stop smiling,” Priya says.
“I’m not.”
“You are internally smiling then.”
“That is not a diagnosable condition.”
“In you, it is.”
Lando takes the coffee. “I’m choosing to ignore you.”
“Healthy.”
“Thank you.”
“I was being sarcastic.”
“I’m choosing to ignore that too.”
Across the department, someone laughs. A monitor starts shouting. The doors open again.
Lando gets up before anyone calls his name.
As he walks away, Priya looks at the screen.
Then at the note.
Then back at Lando.
She says nothing.
Which is how these things start.
Not with any declaration.
Not with a rumour, exactly.
With a nurse saying nothing in a very specific tone.
By the second month, the emergency department has developed opinions.
This is not unusual. The emergency department develops opinions the way lungs develop breath. Immediately. Constantly. Often without consent.
The opinion, in this case, is that Dr. Norris and Dr. Piastri have a thing.
No one says “thing” at first.
That would be crude, and also too direct, and the hospital prefers its nonsense deniable.
Instead, people say:
“They work well together.”
“They’re always on the same cases.”
“Piastri answers him fast.”
“Lando trusts Neuro when it’s him.”
“Neuro trusts Lando when it’s him.”
There are worse foundations for emotional involvement, Priya thinks.
Lando, tragically, remains unaware of the plot.
Mostly.
He notices small things.
A junior doctor says, “Should I send this one to your guy upstairs?”
Lando says, “My guy?”
The junior turns red and drops a pen.
A porter delivering scans says, “This one’s for Piastri, yeah? Since it’s one of yours.”
Lando says, “Patients are not collectables.”
The porter says, “Sure,” in a way that suggests he did not, in fact, care one bit.
A radiology tech once rings down and says, “Your other half has already looked at it.”
Lando is silent for so long that Priya takes the phone out of his hand and says, pleasantly, “Thanks, Mark.”
When she hangs up, Lando says, “My other half?”
Priya says, “Radiology are under strain.”
“Radiology are starting rumours.”
“Radiology are always starting rumours. Probably the radiation frying up their brains.”
“Are they starting rumours about me?”
“Not everything is about you.”
“This appears to be.”
Priya checks the board. “Bay seven needs fluids.”
“Priya.”
“Lando.”
“Is there something happening that I should know about?”
She considers him.
There is a version of the truth she could offer.
That the staff have started referring to a clean, well-managed head injury as “a Norris-Piastri special.”
That someone in paediatrics asked if Dr. Piastri was “the quiet one Lando likes.”
That Callum from neurosurgery came down last week, collected a chart, and said, with the weary dignity of a man betraying his entire department, “Oscar said Dr. Norris already did the sensible thing.”
That the nurses did not recover for twenty minutes.
But he wasn’t emotionally mature enough to hear it from her.
Instead Priya says, “No.”
Lando narrows his eyes. “That no had furniture in it.”
“Bay seven,” she repeats.
He points at her. “I’m coming back to this.”
“You always say that.”
“I mean it this time.”
“You always say that too.”
He does not come back to it.
There is never time.
There is only the next patient, the next scan, the next call, the next note appearing in the system with O. Piastri at the bottom.
But the idea follows him.
Not fully formed.
Just present.
The way a name becomes familiar before a face does.
The way you start knowing someone’s habits through absence.
Piastri does not use exclamation marks. Never.
Piastri writes “reasonable” when he means “correct.”
Piastri writes “not unreasonable” when he means “I disagree, but politely.”
Piastri writes “discussed with ED” even when the discussion was one clinical message and the shared understanding that neither of them is an idiot.
Lando starts hearing a voice he has never heard.
Dry.
Precise.
Probably Australian, though that may be because Callum from Neuro once complained loudly that Oscar said “I’ll give that a miss” after denying a ridiculous referral, which Lando found devastatingly funny for reasons he refused to examine.
Then comes the case in bed twelve.
Seventy-four-year-old woman. Fall at home. On anticoagulants. Mild confusion, which her daughter insists is new and her son insists is not, and both of them insist with the intensity of people who are not arguing about medicine at all.
The CT shows a small bleed.
Small, but real.
Lando reviews it, checks her again, reads the observations, and feels the familiar internal shift.
Not panic.
Attention.
He sends the referral himself.
Small traumatic subdural. GCS 14, fluctuating confusion. No focal deficit. On apixaban. Reversal started. For neurosurgical review.
He is still at the desk when the reply comes.
Seven minutes.
Priya whistles softly.
Lando does not look at her.
Plan appropriate. Continue reversal. Repeat CT in six hours unless deterioration. Admit under medical team locally. Neurosurgery aware.
Then, beneath it:
Good catch.
Lando goes still.
It is ridiculous, the effect of two words.
They are not grand words.
They are not even especially warm words.
They are the sort of words one doctor says to another in a corridor while already moving away.
But on the screen, beneath the clipped efficiency of Piastri’s usual notes, they feel almost expansive.
Priya leans in.
Lando closes the chart.
“Don’t,” he says.
“I didn’t say anything.”
“You inhaled. You were about to.”
“I need air to live.”
“And rumours to thrive.”
Priya smiles.
Lando stands up too quickly. “I’m going to check on bed twelve.”
“Of course.”
“It’s my job.”
“Of course.”
He leaves.
Behind him, Priya opens the chart again.
Good catch.
She smiles, then very carefully says nothing.
The problem with hospitals is that silence travels faster than speech.
By the end of the shift, Maya from triage knows.
By the next morning, Callum from neurosurgery knows, though his version is apparently that Oscar wrote “Good catch” and then stared at the screen for a full ten seconds like his hands had betrayed him.
By lunch, someone has drawn a tiny heart beside the words “repeat CT” on the staff room whiteboard.
Lando sees it at 14:37.
He stops in the doorway.
Priya, seated at the table with soup, says, “Before you react—”
“Is that a heart?”
“It might be anatomical.”
“It has an arrow through it.”
Lando turns slowly. “Who did this?”
Four nurses, two junior doctors, one healthcare assistant and a physiotherapist suddenly find their lunches fascinating.
Maya says, “Could be anyone.”
“Probably Trauma dept.”
“They don’t come down here. And it’s next to ‘repeat CT.’”
“Common phrase.”
“And the initials L.N. and O.P ?”
“Also common.”
Lando stares at her.
Maya looks at Priya. “Too much?”
Priya nods. “Slightly.”
Lando points at the board. “I have never met this man.”
“That does make it more compelling,” says the physiotherapist, who has no survival instinct.
Lando turns to him. “You’re from MSK. Why are you involved?”
“I came for a spoon.”
“Leave without one.”
Poor Physiotherapist backs up through the door with hands raised in surrender.
Priya hides her smile in her yoghurt.
Lando takes the marker and wipes the board clean with unnecessary force.
“This,” he announces, “is a professional workplace.”
Somewhere in the department, someone shouts, “Who put a urine sample in the staff fridge and labeled it ‘good soup’?”
There is a pause.
Maya says, “Mostly.”
Lando leaves.
For the rest of the day, nobody says Piastri’s name around him.
This is worse.
They say “Neuro.”
They say “upstairs.”
They say “your pen-pal” once, and Lando nearly walks into a bin.
By evening, he has decided that everyone in the hospital is sleep-deprived and unwell.
This is both true and not the point.
At 22:16, a consult comes through.
Not from Lando.
From a junior doctor who has written the kind of referral that makes Lando close his eyes and briefly consider farming.
Headache. ?neuro. Please advise.
Lando only sees it because the junior has also accidentally attached his name as supervising physician.
He groans.
“No,” he says to the computer. “No, no, no.”
Priya looks over. “Bad?”
“It says headache, question mark neuro.”
She winces. “Ah.”
“That’s not a referral. That’s a cry for help. A very embarrassing one.”
“Technically—”
“No.”
He opens the chart, reads the actual presentation, checks the observations, reviews the examination, then rewrites the referral himself.
Forty-six-year-old male. Sudden-onset severe headache during exertion. CT pending. Neuro intact currently, photophobia, vomiting. Concern for SAH if imaging negative. Please review once images available.
He sends it.
Then immediately regrets caring what Piastri thinks.
Which is stupid, because this is patient care.
Only patient care.
Obviously.
The reply comes twelve minutes later.
Agree concern. CT first. If negative and clinical suspicion persists, LP at appropriate interval. Keep under ED observation. Call if deterioration.
Then:
Thank you for clarifying.
Lando reads it.
Once.
Twice.
The words are neutral.
Professional.
Still, he feels heat crawl up the back of his neck.
Priya says, far too gently, “Good?”
“Fine.”
“Useful?”
“Yes.”
“Devastatingly polite?”
He logs out. “I’m going home.”
“You have two hours left.”
“I’m emotionally going home.”
“That’s been true since 2019.”
Lando grabs a new chart and walks away.
He does not look back at the screen.
If he had, he would have seen Priya take out her phone.
She does not type anything incriminating.
Only:
He said thank you.
The reply from Maya is immediate. A flurry of heart emojis and crying gifs.
This is escalating.
Priya looks across the department, where Lando is already talking to another patient, smiling like he has not been awake for fourteen hours, making someone laugh while checking their pulse.
Then she looks at the closed neurosurgical note.
Maybe, she thinks.
Or maybe it already has.
Upstairs, though Lando does not know this, Oscar Piastri is also looking at the same chart.
He has already signed off.
There is no reason to reopen it.
He reopens it anyway.
The clarified referral is careful. Specific. Anticipatory without being dramatic.
Oscar appreciates good medicine.
That is all.
Callum appears beside him, holding a vending machine coffee with the expression of a man who knows it will hurt him and has accepted the terms.
“Is that Norris again?”
Oscar closes the chart. “Yes.”
Callum smiles.
Oscar says, “No.”
“I didn’t say anything.”
“You were about to.”
“I was going to say he writes excellent referrals.”
“That is true.”
“And you answer them very quickly.”
Oscar stands. “I answer clinically urgent referrals quickly.”
“That one wasn’t marked urgent.”
“It was clinically urgent.”
“Mm.”
Oscar looks at him.
Callum sips his terrible coffee and says nothing with great enthusiasm.
Oscar leaves.
He has patients to review.
He has scans to read.
He has a department to run through with the particular quiet exhaustion of neurosurgery at night.
He does not have time to think about Dr. Norris.
Which is why, when another ED referral comes through at 01:03, he is annoyed to find himself checking the name first.
Not Norris.
He feels nothing about that.
Obviously.
Downstairs, Lando finishes his shift at 01:41.
He is halfway into his jacket when Priya says, “You know, you could just meet him.”
Lando stops.
He does not turn around.
“Who?”
Priya laughs once. Softly. Kindly. Terribly.
“Goodnight, Lando.”
He turns then, but she is already walking away.
The department is quieter at this hour. Not quiet, never that, but softened around the edges. The lights seem harsher. The floors too clean in some places and not clean enough in others. Somewhere, a patient is snoring behind a curtain. Somewhere else, someone is sleep talking.
Lando looks toward the corridor that leads to the lifts.
Neurosurgery is upstairs.
Oscar Piastri is upstairs.
A person, presumably.
Not a note.
Not a signature.
Not three sentences and the occasional unnerving compliment.
Lando stands there for one second too long.
Then his pager goes off.
Of course it does.
He looks down.
Possible head injury arriving in five.
Lando exhales, shrugs his jacket off, and tosses it back onto the chair.
“Right,” he says to no one.
The ambulance doors open.
The hospital inhales.
And upstairs, three floors above him, Dr. Oscar Piastri receives the alert at the exact same time.