Work Text:
Car crash karma + nagisa
Hi, so this is a the pitt x assassination classroom fanfic however you do not need to know the pitt to read it if you know assclass because I will try and be more descriptive on the characters and you dont necessarily need to watch the pitt to read this as the characters from assclass are introduced. :3
Also yeah I know that I’m not the best at writing long extended scenes but I also like broken up stuff more than the longer ones because its more fun to be left on cliffhangers, I am working on this though ;)
Also do you know how much research I had to do for this fic… it was a lot… too much… BuT I had fun anyway!
m
I hope you enjoy!
…
The double doors of Pittsburgh Trauma Medical Center blew open with a violent metallic bang, throwing cold night air into the deafeningly louds sweltering heat of the ER bay.
"Two pediatric pedestrians struck, inbound now!" a paramedic screamed over the blare of sirens and the complaines of those in the waiting room. "High-speed haulage truck jumped the curb into two kids walking on the sidewalk! The driver seems to be heavily intoxicated!"
Dr. {Robby) Robinavitch was already snapping on latex gloves over his hands before the first gurney even cleared the threshold. "Assign rooms! What bays do we have?"
"Bay 1 and Bay 3!" Dana, the charge nurse (lady incharge of the whole er), barked out, her sharp voice instantly slicing through the chaos. "Whitaker, take Bay 1! Mel, Santos, on me in Bay 3! Clear the floor!"m
The first gurney hit the floor of Bay 1 at a dead run. On top of it lay a petite boy with light, matted blue hair, his frame swallowed by a rigid spinal board and a neck collar. His clothes shredded and soaked in a sickening mixture of gutter water and dark blood.
"Thirtteen to fifteen-year-old male, unidentified pedestrian!" the paramedic yelled, keeping pace as they pushed the bed. "Thrown twenty feet on impact! GCS fluctuating between six and eight! Unconscious on scene, woke up five minutes out and went totally wild! SBP eighty-two over forty, heart rate holding in the hundred-forties!"
"He’s fighting!" Dr. Whitaker shouted, dodging a wildly swinging, blood-slicked left leg as they transferred the boy onto the trauma bed.
The moment the boy felt the hard hospital mattress, a raw, blood-curdling shriek tore from his throat. He was awake, but he wasn't there. His eyes blown wide, pupils unequal and darting around the blinding fluorescent lights in pure, terror. He didn't know where he was. The world was a spinning vortex of jagged agony, harsh lights, and looming shadows.
"Get his legs down! Be careful!" Whitaker ordered, struggling to hold the boy's shoulders. "Watch his- oh god, look at that arm!"
The poor boy's right hand was clawing uselessly at the bedsheets, but his left arm was completely mangled from taking the initial impact of the truck's bumper. The humerus was visibly deformed beneath torn skin, the muscle bruised a deep, necrotic purple. Every time he thrashed, the shattered bone fragments ground together, sending fresh waves of white-hot shock straight to his brain.
"Aahggh! No! Stop!" He gasped out, his voice cracking into a panicked sob. He couldn't form coherent thoughts; his head felt like it was being split open by an axe where he'd slammed into the concrete pavement. Shallow, ragged hitches rattled in his chest, where broken ribs dug into his bruised lungs. "Let go! Let go!"
"Kid, I need you to calm down! You’re at the hospital, you’re safe!" Whitaker yelled, trying to secure a wrist restraint to keep the boy from ripping out his lines.
"Don't yell at him, Whitaker, he's terrified and hypoxic!" Dr. McKay pushed past, immediately placing two firm, calm hands on the sides of Nagisa's neck collar to stabilize his cervical spine. She leaned down, bringing her face into his blurred line of sight. "Look at me, sweetheart. Look at my eyes. I know you're in pain, but you have to stop moving, or you're going to hurt yourself worse."
Nagisa’s chest heaved violently, a sharp gasp tearing out of him as a doctor pressed down on his abdomen. "My head - it hurts!" he wept, hyperventilating. "I can't... I can't where… where am I?!"
"Hypotension is worsening, seventy-six over thirty-eight!" Jesse - a nurse- called out. "Breath sounds are diminished on the left side!"
"He's got a flail chest and a probable pneumothorax!" McKay shouted over Nagisa's terrified cries. "Get a chest tube tray ready! Whitaker, order a STAT head CT and run two bags of O-negative on the rapid infuser!"
…
Across the hall in Bay 3, the atmosphere was even darker.
"Pediatric male two, unidentified!" the second paramedic shouted as they slammed the gurney into place. "The truck pinned him directly against a concrete light pole before coming to a stop! Lower extremities were crushed under the front bumper for several minutes! Severe head trauma!"
Robby was at the bedside instantly. The boy on the gurney was taller than the other had been, with striking, pale red hair completely slicked down with blood pouring from a massive, star-shaped laceration on the left side of his skull. The temporal bone was visibly depressed - a sign of a crushed skull from slamming into the concrete.
"GCS is three! He's totally unresponsive!" Dr. Trinity Santos said, shining a penlight into Karma’s eyes. "Left pupil is blown wide and fixed! He’s herniating!"
"Get the bed to thirty degrees!" Robby commanded, his voice deadpan and razor-sharp as his hands moved with practiced, mechanical precision. "Give fifty grams of mannitol IV push right now! Mel, get the suction - he’s airway-compromised!"
While Dr. Mel King cleared thick blood from Karma’s airway to prepare for intubation, Robby threw back the blood-soaked trauma blanket covering the boy's lower body. Even Dana, a veteran nurse of twenty years, let out a soft, sharp breath.
The kid’s legs were unrecognizable. The weight of the truck pressing him against the light pole had completely shattered both femurs, the left leg twisted at a grotesque, unnatural angle with bone breaking through the denim of his jeans. Deep, dark blood was oozing steadily from squeezed tissue - a classic sign of massive compartment syndrome and arterial damage from being pinned.
"No distal pulses in either foot," Robby stated coolly, feeling behind the boy's ankles. "Cold to the touch. He’s been ischemic for at least ten minutes. If we don't get him to an OR, he's going to lose both legs - or bleed out right here."
"Blood pressure is sixty over forty and dropping!" Mel called out, her tone flat, hyper-focused, and rapid-fire. "Heart rate is falling into the fifties - Cushing's triad! The brain swelling is shutting his heart down!"
"He needs an emergency burr hole or a decompressive craniectomy, but we can't move him to neurosurgery with a pressure of sixty!" Langdon snapped, panic covering his words, "He'll arrest on the elevator!"
"We do it here," Robby said bluntly.
"What?!" Langdon blinked. "Robby, we don't do bedside craniotomies in the bay - "
"We do today if you want this kid to see fifteen!" Robby snapped back. "Get me a drill, a central line kit, and four units of whole blood! Mel, intubate him now!"
Just then, two police officers wheeled a third gurney through the ambulance bay doors, pushing a heavily intoxicated, middle-aged man in handcuffs.
"Got the driver here for a blood draw and clearance!" one officer called out over the noise.
The driver sat upright, staggering slightly as he swung his legs off the gurney. Aside from a minor scrape on his forehead and a slight bruise on his arm where his seatbelt had caught him, he was completely uninjured. He slurred loudly, glibly complaining about the tightness of his handcuffs while smelling heavily of alcohol.
Dana turned toward him, her face hardening into absolute ice as she gestured to a security guard. "Put him in Bay 6, lock the door, and get his blood draw. He doesn't take a single second of attention away from these boys."
…
In Bay 1, the monitor was screaming a continuous, high-pitched alarm.
"He’s desaturating! Eighty-one percent!" Whitaker yelled, his hands shaking slightly as he held an oxygen mask over the blue haired boys face.
He was sobbing, his body shaking violently in shock. He cant really remember what happened why hes here, where here even is. All he knows was that his chest felt like it was trapped in a hydraulic press, and his left arm was radiating an agony so severe it was turning his vision pitch-black. "Tasukete... Karasuma-sensei... Koro-sensei..."
"He's speaking Japanese I think." McKay realized, leaning closer to him. "Shh, easy, honey. Easy. Hold still!" She turned her head towards Jesse. "Give him two milligrams of Lorazepam and a bolus of Fentanyl! We need his heart rate down before his lung collapses completely!"
"Prepping the chest tube!" Whitaker said, wiping sweat from his forehead as he painted Nagisa's left torso with brown Betadine solution. "I'm numbing the rib space now!"
The local anesthetic did little to dull the sheer sensation of pressure. When Whitaker made the small incision between his ribs to insert the chest tube, the kid let out a muffled, agonizing shriek against the oxygen mask, his back arching off the bed despite his shattered ribs. A thick gush of dark, trapped blood and air rushed out into the drainage canister.
THUMP-THUMP.
THUMP-THUMP.
The heart monitor slowed slightly as oxygen finally began rushing back into his left lung, yet his eyes remained frantic, rolling back into his head as the heavy pain medication hit his blosodstream.
"Pressure is stabilizing - ninety-four over sixty," McKaya panted, brushing the damp blue hair away from his forehead. Breathing was shallow, yet his thrashing had by now slowly subsided into weak, rhythmic twitches as the sedatives clamped down on his panic. "Good boy. Just stay with us. You're okay..."
…
"Tubed!" Mel called out from Bay 3, securing the plastic endotracheal tube in Karma’s throat. "He's completely dependant on the ventilator!"
"Central lisne is in!" Langdon called out, cranking the manual pump to blast blood directly into the dying boy's jugular vein.
Robby didn't wait. He held the medical drill, his eyes fixed on the left side of the kid’s shattered skull. "Pressure's back to eighty. It's now or never. Hold his head dead flat!"
The high-pitched whine of the bone drill whirred to life, cutting through the chaotic background noise of Bay 1's alarms. Robby pressed the bit firmly against the temporal bone, releasing the pent-up blood clot trapped beneath the skull. A dark spray of epidural hematoma released, instantly relieving the suffocating pressure on the zz brainstem.
"Heart rate is coming back up - seventy... eighty!" Mel reported, her eyes tracking the monitor. "Pupil is coming back down! It's responsive!"
"Don't celebrate yet," Robby grunted, tossing the drill onto the metal tray with a loud clatter. He looked down at the crushed legs, where dark blood was beginning to pool rapidly on the floor as fluids restored his blood pressure. "His legs are re-bleeding. Tourniquets on both thighs, high and tight! Call Ortho and Vascular down here immediately!"
…
As the roar of the ER bay slowly settled the 2 car crash injuries were stabilised both unconcious, both bruised, bloodied and still in the danger zone however as stable as they can be. It had been a long couple of hours.
In Bay 3, the red-haired boy had been whisked away to an operating room by a frantic swarm of Orthopedic and Vascular surgeons, his life hanging on a delicate thread of bypass grafts and bone plates.
Across the hall in Bay 1, the immediate life-threats had been neutralized. The blue-haired boy’s crushed left arm was wrapped tightly in temporary splinting, his flail chest was stabilized by the gentle hiss of the chest tube, and the head CT had shown a massive concussion without an active bleed.
Now, the room was quiet. Soft light filtered over the bed, catching the tiny particles of dust hanging in the air.
Dr. King sat on a low rolling stool at the edge of the mattress, a pair of sterile metal forceps held securely in her gloved right hand. Beside her on a tray sat a small stainless-steel basin filled with saline, a stack of gauze, and a growing collection of tiny, dark asphalt stones.
Mel was in her element. While the high-octane screaming and blood of the initial trauma response demanded an exhausting amount of mental masking, this - the tedious, meticulous work of debridement - was deeply soothing. The truck's bumper had thrown the boy twenty feet across raw pavement, embedding fine road gravel deep into the dermal layers of his thighs and shins. Left untreated, it would cause severe infection and permanent tattooing of the skin.
Pick.
Drop.
Rinse.
The rhythmic clink of tiny stones hitting the bottom of the stainless-steel bowl acted like a metronome for her thoughts. She worked with absolute precision, her eyes focused entirely on a three-inch patch of scraped, raw skin on his lower leg. She didn't hurry. She didn't look at the clock. The repetition was a quiet anchor in the middle of a chaotic shift.
On the bed, a soft, ragged intake of air broke the rhythm.
Her forceps paused in mid-air.
The sedatives were finally wearing down. Beneath the heavy white blankets, the boy’s chest rose and fell in a tight, cautious pattern - careful not to stretch his broken ribs. His eyelids fluttered, heavy and dark-ringed, before slowly opening. The pale blue eyes beneath were unfocused, glassy with leftover narcotics and pure confusion, but the sheer terror from an hour ago had dulled into a dazed, heavy exhaustion.
Mel laid the forceps down on the tray with a soft clink, stripped off her outer gloves, and stepped closer to the head of the bed. She kept her posture relaxed, her voice dropping into a flat, steady, and unhurried register.
"You're in Pittsburgh Trauma Medical Center," Mel said directly, skipping unnecessary fluff. "You were hit by a vehicle. You have a broken arm, broken ribs, a chest tube, and a head injury. You are safe right now."
The boy’s head twitched slightly against the pillow, a faint crease forming between his brows. His lips parted, but his throat was too dry to force out a sound. His right hand - the uninjured one - twitched against the white sheet, fingers flexing as if reaching for an answer that wasn't there.
"Don't try to talk yet," Mel instructed calmly. She reached down and slipped her bare hand into his right palm, letting his fingers rest against her knuckles. "Your throat is dry from the oxygen mask, and talking will hurt your ribs. We are going to use hand squeezes."
She looked directly into his wide, hazy eyes, holding his gaze to keep him grounded.
"One squeeze means yes. Two squeezes mean no," Mel said, her voice completely devoid of panic, acting like a solid wall against his rising confusion. "Do you understand me, at all… McKay said you where speaking japanese but I hope that you can speak english as well right? We can get a translator if you cannot but can you?"
One squeeze. Yes.m
"Good," Mel said faintly, nodding once. "Are you in severe pain right now?"
The boy hesitated. His eyes shifted down toward his splinted left arm, then to his heavily bandaged chest. He gave two small, hesitant pressure squeezes against her hand.
Two squeezes. No. The heavy Fentanyl bolus was doing its job, holding the agony at bay for a little longer.
"Can you remember what happened to you on the street today?" Mel asked, her tone remaining completely neutral.
The boy stared up at the acoustic ceiling tiles. He tried to pull at the lock on his memory, but the moment he reached backward, a sharp, dull ache throbbed behind his forehead. The street, the dark, the lights, the reason he was even walking down a sidewalk - it was all completely wiped clean, hidden behind a thick wall of white noise.
His hand gave two distinct, rapid squeezes against hers.
Two squeezes. No.
"That is normal for a concussion," Mel explained smoothly, validating the fact without making a tragedy of it. "Your brain took a hard impact. The memory might come back later, or it might not. Don't force it."
She let the silence sit between them for a few moments, giving his sensory system time to process the quiet of the room.
"Do you know your own name?" Mel asked.
The boy went entirely still. The glassiness in his blue eyes sharpened just a fraction, pulling back from the cloud of drugs. He didn't squeeze her hand immediately. HInstead he lay there, listening to the quiet rhythm of his own pulse on the bedside monitor, searching the quiet room of his mind until a single piece of identity surfaced through the fog.
One squeeze.
Mel tilted her head slightly. "You know it?"
One squeeze.
"Can you try to say it for me?" she asked gently. "Just a whisper or any volume you can I know it may hurt but I’m sure it wont be too bad I promise its not I mean its shouldnt hurt much. I need to document who you are so we can tal;k to you and you know um contact you parents, sorry I know im rambling."
Ignoring her excessive rambling the boy swallowed hard, his vocal cords scraping together as if they were sandpaper. He shifted his head a fraction of an inch, his lips trembling slightly as he forced air past his dry throat.
"Na... gi... sa," he rasped out, the breath barely carrying across the small gap between them. He took a shallow, shaky breath, his chest rising carefully against the chest tube. "Nagisa... Shiota."
Mel picked up a dry dry-erase marker from the bedside counter and wrote the name neatly in the top corner of the white board at the bottom of the bed: NAGISA SHIOTA - 14-15 Y/O, alongside all the necessary medical information.
"Okay, Nagisa," Mel said, turning back to him. "That's a great start. We have a name for you now."
Nagisa’s fingers tightened slightly around hers - not a coded response this time, just a weak, human anchor holding onto the only person standing beside him. His hazy eyes darted toward the closed bay door, a subtle wave of tension returning to his small frame.
He didn't remember his school. He didn't remember why he was in America. But as his gaze drifted toward the hallway leading to the operating rooms, a heavy, unexplainable knot tightened in his stomach.
"Red..." Nagisa breathed out, his voice cracking on the single syllable. He looked up at Mel, his blue eyes begging for a simple truth. "The... the other... boy...?"
Mel looked at the small, fragile teenager lying in the trauma bed. She didn't lie to patients, but she didn't dump terrifying truths on concussed kids either.
"He is in the operating room with our best surgeons," Mel told him plainly, her grip remaining steady on his hand. "They are working on his legs and his head right now. Your job is to stay still so your lung can heal. Do you understand?"
Nagisa stared at her for a long moment, the heavy fog of the narcotics pulling at his eyelids once more. He didn't know who the red-haired boy was, but the mere image of blood on red hair made his heart ache with a deep, instinctual terror.
Slowly, his fingers gave one final, weak pressure against Mel's hand.
One squeeze. Yes.
His eyes slipped shut, his chest settling into a deep, rhythmic rise and fall as sleep finally reclaimed him. Mel watched his heart rate stabilize on the monitor above his head, then quietly picked up her forceps, sat back down on her stool, and went back to work.
Pick.
Drop.
Rinse.
…
Mel dropped the last fragment of asphalt into the steel basin with a soft, final clink. After nearly an hour of meticulous work, the blue-haired boy’s, no Nagisa’s scraped legs were finally clean, bandaged, and resting under clean blankets. He was fast asleep, his heart rate holding a steady, tranquil rhythm on the telemetry screen above the bed.
Stripping off her gloves, Mel stepped out of Bay 1 into the brighter, harsher fluorescent light of the main floor.
At the central nurses' station, a small crowd had gathered. Dana was leaning over a computer terminal while Robby, Dr. Langdon, and Dr. McKay stood nearby in low, intense conversation. Just beyond them down the hall, an orderly was wheeling the red-haired boy back from the operating room toward the ICU - his head heavily wrapped in white bandages, both legs encased in bulky external fixator frames and thick splints.
"How did he make it through a craniectomy and a double vascular repair without arresting?" Langdon was asking, shaking his head in disbelief. "His pressure dropped to fifty twice in the OR."
"Because he's a teen and built like a tank," Robby grunted, rubbing the bridge of his nose where his glasses had left deep red indents. "Ortho stabilized the femurs, but Vascular has a long road ahead. If the swelling in his legs doesn't come down, we’re looking at double amputations by tomorrow."
"And the scumbag who did it is sitting in Bay 6 complaining about a scratch on his elbow," Dana spat, her eyes glued to the screen. "PBT came back at .24. Triple the legal limit. He hit those kids at forty miles an hour on a pedestrian walkway and didn't even tap his brakes."
"Unbelievable," McKay muttered, crossing her arms tightly. "Two kids fighting for their lives, and the drunk driver gets away with a bruised knee."
Mel walked up to the edge of the desk, her expression characteristically flat and unreadable. "The kid in Bay 1 woke up," she announced smoothly, cutting straight through the heavy atmosphere.
Robby turned his attention to her immediately. "Is he coherent? Any signs of increased intracranial pressure?"
"He's cognitively aware enough to follow non-verbal commands," Mel said, tapping her fingers rhythmically against the counter. "Significant retrograde amnesia, which aligns with his concussion. He doesn't remember the crash or why he was on the street, but he knows his name."
Robby raised an eyebrow. "Did he give it to you?"
"Nagisa Shiota," Mel stated, pronouncing each syllable clearly. "He speaks fluent English or at least seems to, though he defaulted to what we have assumed is Japanese when he was thrashing earlier. Baked on that and his name I assume that he's Japanese but obviously could just be living here under japanese parents."
Robby exhaled a long, heavy breath, a rare spark of relief washing over his tired face. "Shiota... alright, that’s our first real lead." He looked over at Dana. "Dana, could you pretty please run a search through the national missing persons database and notify the Japanese embassssy. See if any fourteen-year-old Nagisa Shiotas were reported missing from a school group or a family trip, if not check in on ."
"Oh you know me Robby, I’m on it," Dana said, her fingers already flying across the keyboard.
Before Robby could ask Mel for a full neurological update, the high-pitched telemetry alarm in Bay 4 began to scream frantically, followed by a nurse calling out, "Robby! Bed four is going into SVT!"
"Right behind you!" Robby called back, snapping into motion. He pointed a finger at Mel over his shoulder as he jogged away. "Keep a close eye on hi- Nagisa's chest tube output. If he wakes up again, see if he can give us a surname for the red-head!"
"Nice work getting a name out of the kid, Mel," Langdon said, tossing an unopened bottle of water into his hand. He gestured down the hallway toward the ICU transit elevators. "I'm heading down to check on the red-head - make sure the transport nurse and orderly hooked up his vents and arterial lines correctly before Ortho takes over the floor. You want to come with?"
Mel glanced at Bay 1, where Nagisa was still sleeping soundly under the warm blankets. "Sure. I need to make sure his post-op orders match his bay charts anyway."
They walked side by side down the long, brightly lit corridor, their rubber-soled shoes squeaking softly against the linoleum. The sudden lull in screaming gave the floor a strange, suspended atmosphere.
"You look tired, Mel," Langdon noted casually, cracking open his water. "Even more tight-lipped than usual. Everything okay?"
"I am fine," Mel replied in her characteristic, even cadence. "Just processing. My sister is leaving for a trip with her boyfriend next week. She’s been talking about it for a month."
Langdon raised an eyebrow, a small smile tugging at his mouth. "Oh yeah? Where are they heading?"
"The Oregon coast," Mel said, her eyes fixed straight ahead. "She wants to go tide-pooling and hiking. I told her to pack rain gear, but she thinks I’m overbearing. I just... do not like unpredictable environments."
"Sounds like you being a good sister," Langdon chuckled softly, bumping his shoulder lightly against hers. "Give her a break. Vacation is supposed to be unpredictable."
"Unpredictable leads to haulage trucks jumping curbs," Mel said flatly, though the faint tension in her brow softened just a fraction. "I prefer controlled variables."
They reached the recovery bay just as the orderly finished locking the brakes on the bed. The red-haired boy looked shockingly small beneath the towering mass of medical equipment. A thick web of clear tubing, blood bags, and monitor wires connected him to the wall, and heavy metal external fixator pins held his crushed legs in place, keeping the shattered bones immobile.
Langdon stepped up to the head of the bed, tracing the lines down to the IV pumps. "Vent settings look good. PEEP is at five, tidal volume is four-fifty..."
Mel walked around to the foot of the bed, gently lifting the sterile sheet covering the boy's lower extremities to check the vascular checks.
"Frank," Mel said quietly, her tone dropping into that razor-sharp, clinical focus.
"What's up?"
"Look at the tissue around the left calf."
Langdon stepped over, his casual demeanor instantly vanishing. The skin on the boy’s left leg was turning a mottled, pale purple, shiny and pulled terrifyingly taut like an over-inflated balloon. Mel pressed her gloved fingers against his foot.
"No capillary refill," Mel stated, her voice fast and tight. "The tissue pressure is spiking. Compartment syndrome is worsening."
Before Langdon could even reach for the bedside phone, the monitors above the bed erupted into a violent, high-pitched frenzy of alarms.
BEEP-BEEP
BEEP-BEEP!
"He's tachycardic - one-forty!" Langdon yelled, grabbing the Doppler stethoscope to listen for a pedal pulse. "Pressure in his leg is crushing the arterial graft! He's losing perfusion!"
"Vascular!" Mel called out to the floor nurse outside the room. "Get Dr. Aris down here now! We're losing the left leg!"
The ICU doors slammed open as the chief of Vascular Surgery rushed into the room, snapping on gloves while taking in the screaming monitors at a glance. "What do we have?!"
" Compartment pressures are completely blown!" Langdon shouted over the noise. "The swelling is strangling the bypass! If we don't open the fascia right now, we’re looking at an emergency amputation!"
The red-haired boy’s chest heaved erratically against the mechanical breath of the ventilator, his heart fighting a desperate, losing battle as the monitors screamed around him.
…
When Nagisa opened his eyes, the world t felt thick, as if he was trying to drag his consciousness through warm tar.
The harsh fluorescent lighting from before had been dimmed to a low, amber glow. A rhythmic beep... beep... beep... ticked in the corner of the room, precise and relentless. White noise hummed softly from the ceiling vents.
Pain arrived a second later, not as a sharp shock, but as a heavy, crushing anvil sitting directly on his chest. Every shallow breath pulled at something tight and metal buried deep between his ribs.
He lay still, his eyes tracking a thin crack in the acoustic ceiling tiles. Where...?
Then, the pieces began to drop.
First came the calm, flat voice of the blonde doctor with the steady hands. You are in Pittsburgh Trauma Medical Center... You have a broken arm, broken ribs, a chest tube... Mel. Her name was Dr. Mel. He remembered her face - unblinking, steady, holding his hand like a heavy anchor while she picked stones out of his skin.
Then, the heavy curtain of amnesia tore wide open, throwing him backward into a terrifying cascade of memories.
He remembered cold air on his cheeks. He remembered laughing - really laughing - at a sharp, sarcastic joke. He looked to his left and saw pale red hair, gold eyes shining with mischief beneath streetlights. Karma. They were walking side by side down a quiet sidewalk, paper cups of stale coffee cooling in their hands.
Then came the blinding white light. The roaring engine. The violent, metallic crunch that sounded like a collapsing building.
Nagisa remembered flying. He remembered the sickening, weightless second before the impact, the brutal slap of concrete, and the horror of looking up through shattered vision to see Karma - taller, stronger Karma - pinned like a doll against a stone pillar, a dark, crimson wave spilling over his red hair.
Karma.
The dam broke, and the rest of his life rushed back in a suffocating wave.
He was a student of Class 3-E.
He was an assassin.
He remembered Koro-sensei dropping them off in Pennsylvania just two days ago. Class 3-E had been split into pairs and scattered across different American states for a specialized reconnaissance trip, tasked with scouting locations and analyzing terrain to craft the ultimate assassination plan as well as being part of their pe assessments.
They were supposed to be analyzing target sites. They were supposed to be calculating wind speeds, escape routes, and sniper angles.
They weren't supposed to be hit by a truck.
Panic slammed into Nagisa's chest like a physical blow. His heart rate spiked, the monitor above his bed instantly breaking its calm rhythm into a frantic, high-pitched BEEP-BEEP-BEEP-BEEP!
"Karma..." he gasped, the word tearing through his dry throat like broken glass.
He tried to sit up, but a blinding, white-hot agony flared in his left shoulder. Nagisa flinched violently, a choked scream caught in his throat as he looked down at his own body. His left arm was immobilised in a thick, rigid casing, bound tightly against his chest. It felt dead, heavy, and horribly wrong - an assassin’s primary tool, entirely useless.
Why does my arm hurt so much? What happened to Karma?!
"Karma!" Nagisa cried out louder, struggling against the heavy white blankets with his uninjured right hand, his sky-blue eyes wild with sudden, suffocating terror. "Where is he?! Karma!"
The glass door slid open with a sharp, heavy click.
Mel rushed into Bay 1 first, her keen eyes instantly locking onto the screaming monitor before sweeping down to Nagisa. Dana right at her heels, carrying a pre-filled syringe of sedative, just in casee.
"Nagisa, stop moving!" Mel said, her flat voice cutting through his panic like a blade. She stepped straight into his line of sight, placing both of her palms firmly over his uninjured right shoulder, holding him flat against the mattress. "You have a chest tube. If you twist your torso, you will dislocate the tube and collapse your lung again."
"No - let me go!" Nagisa gasped, his voice cracking violently. Sweat was pouring down his pale forehead, plastering his blue bangs to his skin. He thrashed against her hold, his right hand blindly grabbing at Mel’s coat sleeve. "Where is Karma?! Is he okay?! Tell me!"
Dana stepped up to the opposite side of the bed, her experienced, maternal hand pressing gently against the side of his neck to keep his spine aligned. "Honey, you need to breathe," Dana said, her voice a calm, low hum designed to counter his hyperventilation. "Look at me. Deep breath in. You're bleeding into your dressings because your blood pressure is spiking. You have to lower your heart rate."
"I can't - I need to see him!" Nagisa’s blue eyes were wide, brimming with helpless tears as the pain from his mangled left arm radiated all the way into his jaw. The realization of his own helplessness was terrifying. He was an assassin, trained to kill a supersonic creature, yet right now he couldn't even push himself out of a hospital bed. "My best friend... Karma Akabane... is he alive?!"
Mel stayed locked onto his eyes, refusing to flinch from his desperate gaze. She recognized the exact moment a patient’s full memory returned - the sheer, crushing weight of reality crashing down.
"Karma Akabane," Mel repeated, registering the name instantly. She looked at Dana. "That's the second boy."
Dana gave a quick, solemn nod, her thumb stroking Nagisa’s cheek to soothe him. "Karma is alive, sweetie. He made it through a very long surgery."
Nagisa’s chest heaved, a ragged sob escaping his throat. "Is he... is he okay? His head - his legs - "
Mel didn't sugarcoat it, but she kept her delivery steady, anchoring him. "He is in critical condition in the ICU. The surgeons are doing everything they can to save his limbs and keep him stable. But if you blow out your chest tube right now, I will have to put you under general anesthesia, and you won't be able to ask about him at all."
The directness of Mel's words hit Nagisa like cold water. He swallowed hard, forcing his trembling lower lip to still. He took one shallow, agonizing breath, feeling the sharp tug of the chest tube against his ribs, then another.
Slowly, the frantic BEEP-BEEP-BEEP of the telemetry monitor began to stretch back out into a steady, controlled rhythm.
"Good," Mel said softly, her posture relaxing just a fraction. She reached over and gently checked the radial pulse in Nagisa's shattered left arm, ensuring the splint hadn't shifted during his panic. "Very good, Nagisa."
"I... I need to call someone," Nagisa rasped, his right fingers tightening around Dana's scrub top. "Our teacher... Mr. Karasuma... he needs to know."
Dana exchanged a quick, guarded glance with Mel. "We’re going to contact the Japanese embassy right now, Nagisa. Now that we have your names and your guardian's name, we can find them." She gently patted his hand. "You just need to rest. Can you do that for me?"
Nagisa closed his eyes, fresh tears slipping down his cheeks onto the white pillow. He was marooned in an American hospital, crippled, hurting, and miles away from Class 3-E - but Karma was alive. For now, he had to survive long enough to reach him.
…
Karasuma stood in the sterile hallway of Pittsburgh Trauma Medical Center, his jaw clenched so tightly the muscles in his neck throbbed. Beside him stood a towering, absurd shape clad in an oversized beige trench coat, a tilted fedora, giant dark sunglasses, and a ridiculously wide fake mustache glued onto a flesh-colored rubber mask.
On any other day, Karasuma would have snapped at Koro-sensei for bringing such a humiliating spectacle into a public space. Today, he didn't care. He couldn't care.
"Mr. Karasuma?" Dana, the charge nurse, approached them with a clipboard, her sharp eyes flicking briefly over the giant in the coat before settling on Karasuma's crisp suit and official Japanese government badge. "I'm glad you aagot here so quickly. The embassy verified your credentials."
"Where are my boys?" Karasuma’s voice was dark, gravelly, and barely holding back a tidal wave of fury.
"I'll take you to Nagisa first," Dana said softly, turning to lead them down the hallway. "He's awake, stable, and asking for you. Karma... Karma is up in the ICU. A team of orthopedic and vascular surgeons is with him right now. He's still in extremely critical condition."
As they walked, a cold, venomous rage burned in Karasuma's stomach. This whole nightmare was the fault of the United States military.
While Koro-sensei was supposed to be supervising Class 3-E's scouting trip across America -which had een approved by the us goverment, a rogue US task force had launched an unprovoked, surprise ambush mid-air - attempting to claim the ten-billion-yen bounty for themselves behind Japan's back. It had been a foolish, arrogant assault that Koro-sensei easily dodged, but the sheer volume of experimental anti-monster ordnance had tied the creature down in a high-altitude dogfight for five agonizing hours.
Five hours without a Mach-20 guardian angel.
Five hours where Nagisa and Karma’s GPS trackers suddenly shattered and went pitch-black over Pennsylvania.
Karasuma had been stuck in a car on the road tod Philadelphia rushing to the last known location before the tracker broeks, utterly powerless, screaming into a secure radio while US military commanders brushed off his demands. The second Koro-sensei broke free, the notification from the Pittsburgh hospital had finally flashed on Karasuma’s phone. Koro-sensei hadn't even hesitated - he had scooped Karasuma up and flown him across state lines at Mach 20 in under three minutes.
Dana slid open the glass door to Bay 1. "Nagisa? You have visitors."
The small boy in the bed turned his head slowly. He looked so frail - his left arm locked in a heavy, rigid chest casing, a clear tube snaking out from between his bandaged ribs, his skin pale and marred by purple bruises.
Nagisa’s wide eyes locked onto Karasuma's dark suit, then drifted to the absurd, trench-coated figure hovering right behind him. A breath caught in the boy's throat. The brave, terrified facade he had been holding up for the hospital staff completely crumbled.
"Karasuma-sensei... Koro-sensei..." Nagisa choked out.
A raw, helpless sob tears from his throat. Nagisa buried his face into his uninjured right hand, his small shoulders shaking violently as tears spilled onto the white hospital sheets. He was an assassin, a prodigy of execution - but right now, he was just a traumatized fourteen-year-old boy who thought he and his best friend were going to die alone in a foreign country.
Karasuma closed the distance in two long strides. Forgetting all military protocol, he reached down and placed a large, solid, warm hand gently over Nagisa's uninjured shoulder.
"I'm here, Nagisa," Karasuma whispered, his voice trembling slightly despite his best efforts. "I'm right here. You did good. You're safe now."
For the next s nearly two hours, the quiet rustle of hospital bedding and low, hushed voices filled Bay 1. Karasuma sat rigidly in the vinyl chair beside the mattress, holding Nagisa's uninjured right hand while the boy drifted in and out of a exhausted, medicated sleep. Beside them, Koro-sensei remained anchored like a silent, oversized shadow in his absurd trench coat, his hidden tentacles occasionally adjusting the extra blankets over Nagisa's small frame with feather-light care.
The heavy glass door slid open with a soft sigh. Dana stepped in, her eyes immediately finding Karasuma. "Mr. Karasuma," she said, her tone low and solemn. "Karma is out of the ICU operating suite. They've moved him into a private recovery room."
Nagisa’s eyes fluttered open instantly at the name, but Karasuma squeezed his hand gently, giving him a firm, reassuring nod. "Stay here with him," Karasuma commanded Koro-sensei softly, not needing to say more.
Underneath the floppy fedora and rubber mask, a small, choked sound escaped Koro-sensei's throat, but the creature gave a resolute nod, keeping a soft tentacle resting on Nagisa’s head.
Karasuma stepped out into the hallway, pulling the door shut behind him. Standing by the nurses' station was Dr. RObby,.
"Mr. Karasuma," Robby said, stepping forward and extending a hand. "I'm Dr. Michael Robinavitch, the ER attending who admitted the boys. I was also in the room for Karma's second procedure."
Karasuma shook his hand, his grip tight and unyielding. "Give it to me directly please, Doctor. What is his condition?"
Robby took a slow breath, leaning his lower back against the counter to steady himself. "Karma is stable, but he took the brunt of the crush impact against that concrete pillar. The swelling in his brain has plateaued, which is a massive victory, but his lower body..." Robby paused, selecting his words carefully. "The crushing force tore through the main popliteal artery in his left leg. The muscle tissue had been oxygen-starved for too long. Compartment syndrome set in, and despite our vascular team's best efforts, the tissue died. To save his life from toxic shock, we had to perform an above-the-knee amputation on his left leg."
Karasuma’s breath hitched. His jaw clenched so hard his teeth clicked, but he didn't break eye contact. "And the right leg?"
"We managed to bypass the blood vessel and place internal rods in the right femur," Robby explained, his voice grim. "It's still attached, but the crush injury was severe. The tissue is extremely compromised. Right now, it’s a fifty-fifty chance. If infection sets in over the next forty-eight hours, or if the nerve damage is total, we will have to remove the right leg as well."
"Is he conscious?" Karasuma asked, the words forced out like gravel.
"He's heavily sedated and on a mechanical ventilator to assist his breathing, but the paralysis medication has worn off," Robby said, gesturing down the quiet hall. "He can hear you. You can see him now."
Karasuma didn't wait. He followed Robby down to Room 412. When the door opened, the sight nearly brought the hardened government agent to his knees.
Karma - always so cocky, always so full of fierce, terrifying energy - lay pale and motionless in the middle of a massive hospital bed. His head was swathed in thick white bandages, a clear plastic tube ran into his mouth, and a rhythmic, mechanical whoosh-click of the ventilator filled the room.
Beneath the thin hospital blanket, the right leg was encased in a bulky metal external fixator frame. On the left side, the blanket lay flat halfway down his thigh.
Karasuma walked to the side of the bed, his chest aching with an unbearable weight. He slowly reached out, placing a firm, trembling hand over Karma’s cold, bare shoulder.
"Karma," Karasuma whispered, his voice cracking beneath the weight of his grief. "I'm sorry I wasn't there. I'm so sorry."
Karma’s heavy eyelids fluttered open, dark lashes casting long shadows against his stark, ghostly pale skin. The golden sheen in his eyes was muted, clouded over by a dense fog of high-dose morphine, but as Karasuma’s hand rested on his shoulder, the boy's gaze slowly drifted over.
He couldn't move his head - the thick white gauze wrapping his shattered skull anchored him down - and the plastic endotracheal tube strapped between his teeth choked back any attempt at a sound. Yet his eyes locked onto Karasuma's face, following the agent's every movement with a glassy, unblinking focus.
"Don't try to move, Karma," Karasuma said softly, stepping closer into the boy's limited field of vision. He kept his grip on Karma’s shoulder firm and steady, offering a physical anchor in the middle of the heavy haze. "You're out of surgery. The doctors are taking care of you."
A faint, slow pulse registered on the heart monitor as Karma’s pupils narrowed slightly, struggling to process the sight of his teacher standing over him in a foreign trauma center. The razor-sharp, sadistic spark that usually defined Karma Akabane was buried deep under layers of shock and heavy narcotics, leaving behind only the vulnerable, quiet gaze of a severely hurt fourteen-year-old.
His golden eyes tracked Karasuma's face, searching it with desperate intensity. He couldn't feel his lower body - the heavy nerve block and pain medication had rendered everything below his waist a void of cold numbness - and the mechanical whoosh-click of the ventilator dictated every breath he took. But seeing Karasuma’s familiar, dark-suited figure anchored him.
"Nagisa is alive," Karasuma added quickly, reading the unasked, terrified question floating in Karma's glazed eyes. "He's down the hall. He has a broken arm and a few ribs, but he is awake and he is going to be fine. Koro-sensei is with him right now."
At the mention of Nagisa's name, the intense tension in Karma’s eyes visibly eased. His eyelids dropped halfway, a long, heavy breath expanding his chest as the ventilator clicked through another cycle. He couldn't speak, couldn't ask about his legs, couldn't voice the terrifying confusion lingering in his mind, but his gaze remained fixed on Karasuma - refusing to let go of the one familiar thing in the dark.
Karasuma stayed by Karma’s side until the heavy cloud of morphine finally pulled the red-haired boy back down into a deep, dreamless sleep. With a final, gentle squeeze to Karma’s shoulder, Karasuma stepped out into the quiet hallway, pulling the door shut with a soft click.
He walked back down the corridor to Bay 1, stepping inside to find Koro-sensei still standing guard. The tentacled creature had shed his ridiculous trench coat and mask, revealing his natural, round yellow face. His color had shifted to a deep, somatic black - a rare, terrifying sign of pure, unbridled fury held tightly in check.
Nagisa was resting quietly, his eyes half-closed, but his breath hitched slightly when Karasuma walked in.
"Karma?" Nagisa whispered, his voice small and trembling.
Karasuma walked to the side of the bed, his expression softening just enough to comfort the boy. "He's out of surgery, Nagisa. He's heavily medicated, but he's resting, and he knows you're safe. I just came from his room."
A massive, shuddering sigh of relief escaped Nagisa’s chest. The tight knot of panic that had been suffocating him since he woke up finally unraveled.
Koro-sensei stepped closer, a soft, warm tentacle gently patting Nagisa’s blue hair. The creature's face smoothed back into a gentle, subdued yellow. "You both survived," Koro-sensei said softly, his usual high-pitched tone dropped into a deep, reverent quiet. "That is all that matters. I promise you, Nagisa... no one will ever harm Class 3-E like this again. I will personally see to it."
Over the next two days, Pittsburgh Trauma Medical Center became an impromptu fortress for the Ministry of Defense. Karasuma handled the diplomatic fallout, ensuring the drunk driver faced the absolute maximum penalty under American law while keeping the US military far away from the hospital.
When Karma finally woke up enough to have his breathing tube removed, the road ahead was terrifying - rehabilitation, learning to walk with a prosthesis, and waiting to see if his right leg would recover. But the day Nagisa was finally cleared to sit in a wheelchair, Karasuma wheeled him straight into Room 412.
Karma was sitting propped up against a mountain of pillows, pale and battered, but when his golden eyes met Nagisa's blue ones, a faint, unmistakably sharp smirk touched his lips.
"You look terrible, Nagisa," Karma rasped out, his voice dry and hoarse.
Nagisa let out a tearful, quiet laugh, leaning forward in his chair despite the ache in his ribs. "Look who's talking, Karma."
They were broken, scarred, and thousands of miles from home - but as Koro-sensei hovered quietly in the background and Karasuma stood guard at the door, Class 3-E’s top duo knew they wouldn't have to face the long recovery alone.