Chapter Text
Chapter One: Transfer
New city, new place, new start.
John MacTavish had survived absolute hell in med school — countless exams, many a sleepless night, nightmare tutors — and two years as a resident in Glasgow. His third year meant more operating time, more responsibility, and the chance to prove he belonged in trauma surgery.
But this year, he’d made a pivotal decision.
His older sister, Margot, had called him an idiot for transferring, said, “You’ve finally got to a comfortable position, John. You’d be stupid to uproot and start fresh after everything you’ve been through.”
But a fresh start is exactly what John had wanted. He’d spent 26 years of his life in Scotland, but the temptation to spread his wings and carve a life out for himself in London had been too great, so he went for it.
Situated right in the middle of London, and being the city’s leading major trauma centre, St. Andrew’s University Hospital saw some of the worst cases in the country — RTCs, stabbings, industrial accidents, and sometimes even terrorist attacks. And that was one of the main reasons why John had chosen it.
He wanted to be a trauma surgeon, but not for the prestige, and not for the money.
He’d seen firsthand what losing a loved one did to a family.
If he could stop even one person from getting that phone call, then every missed meal, sleepless night, and miserable 36-hour shift would be worth it.
His first full day.
He’d been for a tour the week before to get a feel for the place and meet some of the staff he’d be working with. Most of them, anyway.
Today was different. Today was the day he’d either make it or break it.
St. Andrew’s was a huge glass-fronted thing, all impeccable architecture and grand design, overlooking the River Thames. His old hospital in Glasgow didn’t even come close.
John walked through the main entrance into reception with a flutter in his gut, nerves and excitement twisting his stomach into knots. Still, he kept his shoulders broad and his chest puffed out, wearing confidence like it was part of the uniform.
He didn’t feel it. Not really.
He was the outsider, the newbie, and thought he could earn his place here like everyone else. But there would be people who had spent years working here, who already knew the corridors, the consultants, and the unspoken rules.
He took a slow breath and carried on across the reception.
The hospital was buzzing with activity. A porter wheeled a bed past him in a rush. Nurses clustered around the central desk, trading handovers and clinical chatter. Overhead, a tannoy called for someone.
John couldn’t help but smile. Despite the nerves, despite the sweat in his palms and his heart beating a little too fast, he had no doubt that this was exactly where he wanted to be.
“Trauma team to A&E. Trauma team to A&E.”
John’s head turned automatically, then reminded himself that that wasn’t his call yet. He needed to find his attending first, report his arrival.
He followed the route he’d memorised during last week’s tour, taking the left corridor, then a right, then up to the third floor in the lift, towards the surgical wing.
He passed staff who looked as though they’d already lived an entire day before seven o’clock in the morning. A consultant walked by reading a patient chart without breaking stride. A junior doctor stood at a vending machine, staring at it like it had offended him.
It was strangely comforting. Hospitals, no matter where you go, all have the same heartbeat.
John scanned his keycard and dipped into the locker room, setting his bag down on a bench. No one else was there, and the quiet allowed him to gather himself properly.
He shrugged into his freshly pressed white coat, smoothing the sleeves and lapels before fastening the buttons. And there, on the breast pocket, was his name, embroidered neatly.
Dr John MacTavish
Surgical Resident
He’d earned it.
Every overnight shift. Every exam. Every patient he’d lost and every one he’d managed to save.
A sudden excited grin spread across his face as he glanced over at his bag.
He pulled out his phone, the Scottish flag on his lockscreen momentarily before he brought up the camera. He held it up in front of himself, getting the embroidery in the frame, and took a picture.
He knew he couldn’t stick around, didn’t want to look work-shy, but he sent the picture to his family group chat.
His mum had wished him good luck with an extravagant amount of emojis earlier, his dad had said very little but sounded proud of his little lad, and his sister had tried to make a joke but he could tell she was proud of him, too.
And then, just before he turned it off, one more message popped up on the screen.
Mum: Isla would be so proud of you, love xx 🥺
He paused, thumb hovering over the message. He gulped. But he couldn’t dwell on it, he had to push the thought aside before it could wander somewhere painful.
He forced a better smile, putting the phone back in his bag and closing the locker.
Work first. Everything else later.
He checked his watch, thankfully still on time.
Good.
According to the rota pinned to the wall, he was attached to the Trauma Department under his attending, Dr Simon Riley.
The one consultant he hadn’t met yet.
And the most important one.
Dr Riley had been absent during his induction and tour, called away for what one of the administrators had vaguely described as “an emergency.”Given this was St. Andrew’s, that could have meant anything from a motorway pile-up to a helicopter transfer from the other side of the country.
John grabbed his ID badge and headed for the surgical ward.
He then paused outside the staff room when he heard voices inside.
“I’m telling you, they should’ve converted to an open procedure.”
“He would’ve bled out.”
“He was bleeding out.”
John peeped his head around the door without thinking about it.
Three young doctors stood around a table lined with patient notes and half-drank mugs of coffee, all of them looking slightly frustrated at something.
“Hi…” he said quietly, offering a small, apologetic wave. “Hope I’m not interrupting anything. I’m the new transfer resident.”
The conversation stopped, eyes turning towards him. John stepped in fully, bracing himself for some form of judgement.
“I was told Dr Riley would be in today. Has anyone seen him?”
Three smiles. Thank goodness.
A young dark-skinned man was the first to speak. “Oh, right! Yeah, they mentioned we were getting a transfer. Nice to meet you, mate.”
The blonde woman across from him gave a polite smile. “I’m Amy Wright. This is Marcus Bassey, and Kyle Garrick.”
“John MacTavish,” he grinned.
Apparently, Kyle was the guy currently shaking his hand enthusiastically.
Amy answered his question, “Riley’s in surgery right now. RTC, multiple rib fracs and a tension pneumothorax.”
Then she frowned, raising an eyebrow, “Have you… not met him yet?”
John glanced between them and shook his head slightly. “He wasnae in when I came for my induction last week.”
Marcus cleared his throat. “Should I tell him, or—“
“No,” Amy replied, a little coldly. “Let him find out himself.”
“…Find out what?”
Kyle patted him on the shoulder. “Nothing.”
“That sounded very much like something.”
“Honestly, mate,” Kyle said. “You’ll know once you meet him. The man’s got a reputation.”
Marcus drank the last of his coffee in one foul gulp before following Amy out of the room.
“Come on, then, MacTavish.”
“Since Riley’s occupied,” Amy started, “we might as well show you around properly.”
“I’ve had the official tour.”
Kyle snorted. “The tour doesn’t count, mate. That’s just admin pretending this place isn’t permanently on fire.”
Marcus gathered up a handful of patient notes from the desk and handed some to John. “We’ll start with the easy ones.”
They stopped outside the first room. Amy checked the chart.
“Room 315. Twenty-seven-year-old Alex Murdaugh. Recovering from an ileostomy.”
She looked up, now grinning ear to ear. “But, he shares his name with a famous true crime case! Pure coincidence, but isn’t that crazy?”
John blinked. “…Who?”
Amy stared at him in disbelief. “Who?”She turned to Kyle. “He doesn’t know who Alex Murdaugh is.”
Kyle lifted both hands. “Don’t look at me.”
Amy rolled her eyes. “Clearly not a true crime fan. Got it.”
John scratched the back of his neck. “Should I be offended?”
“No,” she sighed. “Just educated. Alex Murdaugh was a wealthy American lawyer whose entire family ended up at the centre of a murder investigation in 2023.”
Kyle groaned. “We’re in a hospital, Amy.”
“And?”
“And. I don’t know— If you wanted to be a detective or something, you’ve picked the wrong profession.”
John laughed at that. “I’ve only been here ten minutes. This is class!”
Kyle smirked. “You’ll get used to her.”
Marcus handed John another chart.
“Back on track. Room 317. Thirty-eight year old Francine Hitchin. She’s been vomiting all night, complaining of abdominal cramps. BP’s 140 over 90. Other than that, she’s pretty stable and booked in for surgery this afternoon.”
John glanced down at the paperwork.“Hmm… Thirty-eight, abdominal pain, vomiting, hypertensive…” His eyes flicked over the observations. “Appendicitis?”
Marcus nodded, impressed. “CT confirmed it this morning.”
“Appendectomy, then. What time?”
“Two. Dr March is doing it.”
“Poor lass… Two’s alright unless it ruptures.” He handed the chart back, glancing at the woman curled up on the bed. “I’ll check in on her later.”
Marcus took the chart and tucked it under his arm.
Amy nodded further down the corridor. “Come on. We should probably introduce you to someone who’s actually awake.”
They carried on, the steady rhythm of the ward around them. Pagers chimed in the distance. A nurse hurried past with a medication trolley, offering the four residents a quick nod as she went.
They stopped outside the next room and Kyle checked the notes. “Room 321. George Ellis. Fifty-four.”
John glanced at the chart over his shoulder. “Emergency laparotomy?”
“Perforated gastric ulcer,” Marcus confirmed. “Came in two nights ago looking like death. Surgery went well. He’s doing a lot better, but he’s still grumpy.”
Kyle looked at John. “Also, be warned. He bites.”
“I do not,” a gruff voice called from inside the room.
Kyle grinned. “See? Grumpy.”
Amy knocked lightly against the open door before stepping inside. “Morning, Mr Ellis.”
The man in the bed looked up from the newspaper in his lap. He had greying hair, a pair of reading glasses balanced low on his nose, and the expression of someone who was thoroughly sick of hospital food.
“You’re back again.”
“Occupational hazard,” Amy said.
Then George spotted the unfamiliar face at the back of the group. He put the paper down and folded it. “Who’s the new one?”
John stepped forward. “Hello, George. I’m Dr John MacTavish. I’ve just transferred here. Thought I’d come and introduce myself.”
George looked him up and down, curiously. “Scottish?”
“Aye.”
“You lose a bet?”
John laughed. “No, sir.”
“Shame,” George muttered. “I’d have respected that more.”
Marcus opened the chart. “How are we feeling this morning?”
“Sore.”
“Any worse than yesterday?”
“No.”
“Nausea?”
“A little.”
Amy scribbled something onto the observation sheet at the foot of his bed. “And the pain?”
George shrugged. “I’ve had worse.”
John glanced at the monitor, then at the dressing covering the man’s abdomen. He reached for a pair of gloves from the dispenser on the wall. “Mind if I take a look?”
The man gave him a suspicious squint. “You know what you’re doing?”
Kyle covered a grin with his hand.
John shrugged lightly. “I’d certainly like to think so. I passed the exams.”
A reluctant smile tugged at the corner of George’s mouth.
John sanitised his hands, pulled on the gloves and carefully folded the blanket back just enough to expose the dressing. He was gentle, taking his time.
“Any increase in pain when you move?”
George shook his head.
John glanced once at Amy and Marcus before gently lifting one edge of the dressing.
The wound looked clean. No obvious redness. No fresh bleeding. No discharge. The stitches looked immaculate.
He pressed lightly around the site. “Tell me if that’s uncomfortable.”
“It’s uncomfortable that you’re touching it.”
“Aye, but any worse than before?”
“…No.”
John nodded, satisfied. He replaced the dressing and stepped back. “It looks good. You’re healing well.”
Marcus was already making a note. He cleared his throat. “Any bowel movements yet?”
George looked mildly insulted. “Can a man not shit in peace?”
“No,” Amy answered immediately.
“Nosy buggers.”
Kyle folded his arms. “We’ll leave you to your riveting financial section, then.”
“I want a magazine or an actual book. There’s nothing in here but crap about Trump’s war and Trooping of the Colour.”
Amy blinked and opened her mouth, but John beat her to it. “I’ll see if there’s anything in the shop downstairs. Later.”
George looked subtly pleased at that. Maybe he wasn’t so grumpy after all.
Kyle laughed as they left the room, giving John a side eye.
The door clicked shut behind them.
“Great bedside manner,” Marcus praised, “Another tick to your name. You’ve got our seal of approval, now you just need Riley’s.”
John shrugged. “I treat my patients the way I’d like to be treated if I was the one in the bed.”
Amy nodded. “You’d be surprised how many people forget to actually talk to the patient while they’re examining them.”
The morning slipped by faster than John expected.
There were medication reviews, post-op checks, blood results to chase and more names to remember than he thought possible, but luckily nothing major.
A senior nurse in her late thirties introduced herself as Louisa Ward and promptly handed Kyle a stack of paperwork. “You’ve been avoiding these.”
“I’ve been prioritising.”
“You’ve been hiding.”
“…That too,” he admitted, sheepishly.
Amy disappeared briefly to chase some path results, while Marcus spent ten minutes explaining where to find absolutely everything in the department, only for John to forget half of it immediately.
By the time the clock crept towards one in the afternoon, his stomach was reminding him that he’d skipped breakfast.
Kyle stretched with a loud yawn. “Wanna get lunch?”
“Aye, I could eat a horse,” John agreed.
Marcus sighed and looked at the notes in his hand. “I fear we’ll regret it.”
“We’ll regret not eating more,” Kyle scoffed.
Amy was already strutting down the corridor, glancing over her shoulder. “Well, no one’s dramatically bleeding out right now, and I’ve had my eye on that Caesar salad since yesterday.”
Kyle pointed at her, accusingly. “You’ve said it now.”
“Said what?”
He jogged to catch up to her. “You never tempt fate.”
Marcus stayed a few feet behind them with John, in no rush. He chuckled, “Last time she said that, we got two RTCs and a runaway patient.”
John looked amused. “Correlation isn’t causation.”
A tannoy crackled overhead. Everyone stopped walking. The silence lasted a few seconds.
But nothing happened. Amy smiled smugly. “See?”
Kyle looked back at him. “She’s still learning.”
The canteen was busy, a few doctors trying to stuff a sandwich in before the next call out, but mostly just patients and non-medical staff.
John balanced a tray with a ham sandwich and a small tub of fruit while the others found a table.
He looked around the room after a moment, effectively working up to the question on his mind. “So…”
Three heads turned towards him as they sat down.
“What’s the deal with Dr Riley? You know, before I meet him… I don’t exactly like surprises.”
Marcus glanced up at him, almost worriedly, but tucked into his sandwich like a man starved.
Amy took a sip of her coffee, then sighed. “He’s… difficult. Early to mid thirties, serious as hell, and very rude.”
“Right…” John nodded slowly. “I had a tutor like that in med school. Absolute arsehole of a man, but he was a good teacher. I learned more from him than the rest of the faculty.”
Kyle snorted. “Oh, he’s a good teacher, alright. Just not a good personality.”
Marcus finally spoke. “He expects perfection. That’s not a good thing. People naturally fail every so often, and people are going to die in your hands. He works like he thinks he’ll save everyone.”
John looked between them. “So he expects a lot.”
Amy shook her head. “If you’re late, he’ll tell you. If you’re wrong, he’ll tell you. If you make the same mistake twice…” She let the sentence die.
Kyle took over. “You know what, why don’t we change the topic? Tell us about yourself.“
John blinked. “There’s not much to tell.”
Amy sat forward, folding her arms on the table. “Come on, there must be something. Favourite film, favourite food, what’s your family like, do you have any pets, what was Glasgow like—?”
“Alright, alright, one at once.”
Kyle snorted into his drink.
Amy ignored him, watching John like she was conducting an informal but very intense assessment.
John leaned back slightly in his chair, sandwich forgotten for the moment.
“Right,” he said, thinking. “Favourite film… I don’t really sit and watch much, if I’m honest. If I’ve got time off I usually sleep.”
Amy gave an indignant scoff. “That’s practically illegal. Everyone has watched at least one movie.”
John gave a short laugh. “Favourite food’s easier. I like Mexican food and deep-fried mars bars.”
Marcus looked up at him, disgusted. “So you’ve got the palate of a student.”
“Basically, aye.”
John took a bite of his sandwich, considering the next question properly this time.
“Family…” he said, a little slower.
The table shifted almost imperceptibly. Not awkward, exactly, but attentive in a different way. John noticed.
“They’re still in Glasgow. Mam, dad… older sister.” He paused heavily, then added, lighter, “Margot. She thinks I’ve made a terrible life decision moving to London.”
Kyle smiled. “She’s probably right.”
“Aye, but I wanted to spread my wings a bit, ye ken.”
“Okay, what about pets?” Amy continued, steering it back.
“Had a dog when I was younger, a Lab. Nothing at the moment, I wouldn’t have time to look after it.”
Marcus nodded. “My girlfriend works from home, that’s the only reason we have a dog.”
John sat back. “You’ve got a girlfriend?”
“Yeah, been together three years. You?”
He shrugged, looking down at his tray. “Never had much time for dating… Most guys on the apps don’t want commitment anyway.”
They all glanced at him at that. Amy gave a short smile, “Apps are a waste of time. Everyone’s either emotionally unavailable or pretending they aren’t. Trust me, been there, done that. I’ve ‘got the t-shirt’ as they say.”
For the next five minutes, they ate in companionable silence, focused on getting enough food in before the next inevitable call.
Then the pagers went off.
The whole room stilled and went silent as staff checked the message.
TRAUMA IN A&E — ETA 2 MINUTES — INDUSTRIAL INJURY
Amy was on her feet before anyone else finished reading the alert. Marcus shoved the last piece of his sandwich in his mouth and hustled his chair back.
Kyle slapped John on the arm. “Come on, mate. First big case.”
In seconds, they arrived in A&E, footsteps hurried, eyes already scanning for the patient.
Flashing monitors. Doctors and nurses lined up ready to help.
And then all of a sudden, a gurney was being pushed through the entrance, two paramedics shouting patient details.
“Twenty-four year old male,” the first paramedic called, his voice strained. “Rebar through the left anterior thorax from an industrial scaffold collapse.“
Even before the details registered properly, John’s brain locked onto the shape. A short length of steel rebar protruded through the man’s chest at an angle that made something in his stomach drop. Blood soaked through torn clothing. He stepped closer.
“Intubated on scene,” the second paramedic continued. “GCS was six. Needle thoracostomy performed on scene for suspected tension pneumothorax. Two large-bore IVs in. One gram TXA, and fentanyl.”
John was already looking at the monitor. He thanked the paramedics and immediately started calling out stats. “Heart rate’s 148. BP’s 84 over 52. Saturation’s 82 and dropping despite ventilation.”
Amy checked the man’s eyes, shining a light. “Pupils equal and reactive, but slow to respond.”
Kyle moved around to the other side, checking the patient’s limbs. “Cyanotic, delayed capillary refill, cold extremities. He’s in shock.”
Marcus was already pulling the ultrasound machine in. He spread gel across the man’s abdomen and pressed the probe into place.
The screen flickered and everyone stopped talking. Amy looked over his shoulder, her eyes going wide. “Shit. That’s a lot of free fluid.”
Marcus slid the probe across the right upper quadrant, scanned the diaphragm and liver. More black pooled across the image. Everywhere.
“Positive FAST! He’s haemorrhaging! Get Riley in here, now!”
“Open Theatre 2! Let’s move!”
The bed was already moving, brakes off, wheels squeaking.
“Massive transfusion activated!”
“Call anaesthetics!”
John and Amy reached for the side rails, pulling them up.
Then a voice cut cleanly through the noise. “What have we got?”
John turned.
Beside him stood a very tall, blonde-haired man in dark blue scrubs, already pulling on gloves and a mask.
He didn’t need to be told who that was.
Dr Simon Riley.
Riley looked once at the monitor, then at the rebar, already calculating trajectory and which organs had been hit. Then he looked at the ultrasound and the blood pooling in the man’s whole abdominal cavity.
“Sir, positive FAST,” Marcus said.
Before the surgeon could respond, a woman’s shouting echoed down the corridor.
“Jamie!”
She burst through the doors, tears streaming down her face, flanked by security and three nurses trying to keep her from reaching the bed.
“Jamie! No, let me through! Jamie! Please! That’s my husband!”
John glanced at her automatically, the shrill of grief piercing through him.
“Jamie! Please!”
The surgeon finally looked up at the residents. “Wright, Bassey, you’re with me.”
Amy and Marcus moved without a word.
“Garrick, go to the wife.”
Kyle’s face fell a fraction, but he nodded. “Yes, sir.”
And finally, Dr Riley’s eyes settled on John.
A stranger. A transfer. Someone he’d never worked with.
“You.”
John met his gaze, “Aye, sir?”
He nodded his head towards Kyle. “Go with him.”
For a moment, John didn’t move. But the surgeon held his stare.
“I gave you an order, Doctor.”
John swallowed. “…Yes, sir.”
The lift doors opened. Everyone fell in around the bed automatically.
Then they were gone.
Kyle was already walking towards the sobbing woman.
John followed, his jaw tight and his own steps slower. He huffed a breath through his nose and straightened his back.
Focus, John. The wife is a patient too.