Chapter Text
The Emergency Department at Riverside General was, according to their track board, the new hot club in town. Despite the peeling ‘80s wallpaper, harsh fluorescent lighting, and yellowing laminate floors, 43 people had decided there was no place they’d rather be on a Friday night. Every bed was full, and the waiting room had multiple patients in varying states of fainting, vomiting, and complaining. Even the hallway was getting crowded, forcing the nurses to creatively weave and dodge as they raced to triage and treat.
“Room 10 is positive for fentanyl, cocaine, and benzos. Honestly I'm a little jealous, I’d like to be completely blitzed out right now.” Christine Chapel pulled off her bright yellow isolation gown which was freshly adorned with a suspicious brown streak.
Jim Kirk came out of the neighboring room, handed her a few tubes of blood, and peeled off his gory nitrile gloves. “I’d offer to trade, but my patient has a nasty wound, and I’m worried it’s nicked her intestines. Where did Dr. McCoy go?”
“No idea, Vocera him.”
Before Kirk could call the doctor, a commotion at the nurse’s station caught his attention. He moved quickly without running, a pace refined over years on the floor, mentally preparing himself for conflict. A middle aged man was currently screaming at the CNA covering the desk.
“I’ve been waiting for two fucking hours, I want to see a doctor!”
“Excuse me, sir.” Kirk wore his most placating smile, “As you can see, we’re a bit busy. If it’s urgent-”
“Of course it’s fucking urgent, why do you think I’m in the Emergency Room?”
“What’s his chief complaint, Janice?” He spoke directly to the CNA, ignoring the blustering man.
“Blood in his urine. We sent a sample down but haven’t gotten results yet.” Janice, to her credit, seemed relatively unbothered by the screaming. “Sir, as I told you before, there are patients with more urgent needs-”
“I’m pissing blood, you bitch, isn’t that urgent enough?”
Kirk’s hands twitched with a restrained desire to punch the man. “Sir, if you do not calm down, I will have security escort you out. Now please, sit down .”
The sternness took the man by surprise, and he blinked at Kirk, who met him with an unwavering gaze. A glint in Kirk’s eyes was like a warning shot over the man’s proverbial bow, a look of utter authority he wielded against particularly recalcitrant patients, and the man stopped gesturing wildly. Silence settled into a tense thread of anticipation as they glared at each other.
Janice’s voice broke the staring contest, “We’ve got results!”
“See? A little patience goes a long way. Now, sit down, I’ll call the doctor and see about our next steps.” He forced kindness back into his voice and the man returned to his seat, red-faced but placated.
“Thanks, Jim.” Janice said gratefully.
“Part of the job, Janice, I don’t get that sweet $2 an hour lead pay for nothing.” He winked at her, then pressed the button on his Vocera, “Call Doctor McCoy.”
The tiny communicator beeped for a few moments before a gruff voice came through, “McCoy here.”
“Bones, we’ve got one patient pissing blood and another who might have a gastric injury. Where the hell are you?”
“Trying to get an old lady into the ICU, but the transfer isn’t getting approved. Keep everyone alive, I’ll be over in a few minutes.”
It took McCoy a total of eighteen minutes to get back onto the floor, by which time Kirk had sent Christine to her first break and was gowning up to deal with Room 10.
“Picked a hell of a week to start on night shift.” McCoy’s Georgian accent had just enough twang to make the nurses forgive his rudeness, a soothing balm to Kirk’s frazzled nerves.
Kirk pulled a second pair of gloves on, then a face shield, “Seems like I brought the curse of day shift with me. Hang on, gotta deal with this. Go check the patient in room 11, she’s got an abdominal wound.”
Room 10 was in restraints now, since apparently he got a little too feisty on his homemade cocktail of drugs. Fentanyl was a beast sent from hell specifically to torment nurses, Kirk thought sourly. He got the stool sample without too much trouble, cleaned him up, then checked his vitals one last time before exiting the room.
“Lab’s on the phone for you!” Janice called over.
Kirk groaned while stripping off his PPE, then rushed over to pick up the phone. “This is Jim, go ahead.”
“This is Spock in the lab.” The voice was new to Kirk, a low and crisp tone, “I have a critical for room 11: her hemoglobin is 5.7.”
“I’m not surprised, she bled all over my floor. I’ll let the doctor know.”
“What is your three by three?”
“Jamkir3.”
“Thank you.” The line went dead.
“So, are you regretting taking the job now?” McCoy had finally emerged from the room, rubbing sanitizer into his hands and glancing at Kirk.
“Ask me again next week.” Kirk took a drink from his tepid coffee, grimacing at the bitterness. “The lab called, she has a hemoglobin of 5.7.”
“I think she’s bleeding internally, that wound went deep. I’ll see about sending her to the OR. Let’s get a couple units in her before she completely crashing out, though.” McCoy studied his friend with a diagnostic eye. “Have you eaten anything today? And no, coffee doesn’t count.”
“I had a granola bar on the way to work.” The coffee had done its job of revitalizing Kirk, and he grinned at the doctor. “Glad to know you still care, Bones. I’ll take a break when Christine gets back.”
“Make sure you do, I can’t have my charge nurse dropping like a sack of bricks because he can’t take care of himself properly.” McCoy left to sign orders, grumbling about his job bringing him one step closer to his grave.
Kirk sat at the nurse’s station and took a few deep breaths, trying to center himself in the midst of the chaos. When he’d accepted the night shift charge nurse position, it had seemed like a natural step in his career. San Francisco had been a little too exciting: too many gunshots, overdoses, and insane ex girlfriends. Iowa City, meanwhile, was close to his sleepy hometown of Riverside, and had his old college friend, Leonard McCoy. Either his memory was faulty or the tiny Iowan town had rapidly increased in issues since he last visited. Their single hospital served the entire city and surrounding rural communities, the only trauma center for miles. It was barely more than a critical access facility, but the Emergency Department was a beast with 20 beds and not enough staff scheduled to cover all of them. Still, night shift had its perks, Kirk thought, as he sipped his coffee and devoured a packet of stale peanut butter crackers at the desk. Management wouldn’t be breathing down his neck anytime soon. A ringing phone interrupted his moment of peace.
“ED, this is Jim.”
“This is Spock in the lab. Room 8 has a critical troponin of 127.”
“Critical trop 127, room 8.” He jotted down a note for Bones. “Understood, I’ll tell the doctor.”
The line went dead without another word. Night shifters are grumpy no matter the department, Kirk reasoned.
The shift continued in the harried manner, chaos reigning over the entire ED. As soon as a patient was discharged or admitted to the floor, the room was cleaned and ready for another victim. Kirk and Chapel, assisted by three other nurses, ran the floor with expert precision. Despite being such a recent addition to the team, he was pleased by their efficiency. Bones had promised the night shift was competent, a critical stipulation when he’d first learned about the job, and his old friend hadn’t been lying. Even the shitty staffing matrix wasn’t as upsetting as it should be. 3am rolled around, and Kirk was sitting at his computer trying to finish charting when the phone rang, again.
“ED, Jim.”
“Lab, Spock.”
“Let me guess, Mr. Spock, you’ve got a critical for a patient.”
“Room 8, critical troponin delta of 578.”
“Critical trop delta 578.” Kirk jotted down the number then frowned, “Wait, you called about his critical trop earlier, right? So which sample is this?”
“One hour troponin, according to the chart. The earlier critical was for the random troponin ordered upon admission. His zero hour troponin was also critical, but did not need to be called based on our policy.”
“Yes, of course, thank you Mr. Spock.” Kirk rubbed his eyes with the heel of his hand.
“You’re welcome, Jim.” The words were stiff, almost formal, but still kind.
A glance into the chart showed an elevated BNP as well, and Kirk called McCoy, letting him know room 8 was definitely having a heart attack. Sure enough, a code STEMI was soon called, and Kirk watched the patient get wheeled to the cath lab. He didn’t have time to ruminate over the excitement, thankfully, since the new inhabitant of room 3 needed an IV and the baby nurse was struggling.
“It’s alright, Pavel, I’ll take it from here.”
“Thank you, sir.” The young man looked close to tears as he disposed of the numerous dirty needles.
“The name’s Jim, formality isn’t necessary when we’re both up to our elbows in body fluids. Ma’am,” he spoke to the thrashing woman, “Hold still for just a moment so I can get the line in.”
“It hurts!” She was sobbing and clutching her abdomen.
“I understand, but if we get this IV placed then we can administer painkillers and it will help.” Kirk placed a gentle hand on her arm and tried to let his smile soften into his tired eyes. The moment of contact seemed to work: she settled down just long enough for him to get the needle in, then Kirk stepped aside to let the younger nurse hook up a banana bag. Painkillers would have to wait for McCoy’s signature, unfortunately, but the patient didn’t need to know that. He helped Pavel draw labs and dropped them in the tube system on his way back to the desk. After drinking the last sips of his coffee, Kirk was ready for the night to end, and tried not to let his mind wander to thoughts of bed. Those new sheets, a gift to himself after moving into his new apartment, were incredibly soft, swaddling him like a newborn. He shook off the thoughts, slapping his cheek to keep himself sharp. The next shift would be arriving soon, he reminded himself, so close to freedom.
Soon was a relative word, of course, and the morning calmed down enough for the last few hours of his shift to drip along like cold honey from a shitty squeeze bottle. Day shift appeared, carrying their expensive Stanley tumblers of coffee and yawning. He gave report to the charge nurse, who was bright eyed and neatly coiffed despite the early hour.
“Sounds like a hell of a night, sorry Jim.” Una had the decency to look sympathetic. “The shift was usually pretty calm for Chris, hopefully it gets better.”
“Busy shifts make the time go faster, and keeps me awake.” He chuckled. “It’s the end of my week anyway, I won’t be back until Wednesday.”
“We’ll see you then, have a good weekend.”
Kirk gathered his things and caught up with Christine as she was clocking out, “Breakfast?”
“Can’t, sorry, I promised my partner we’d spend some time together before I crash out. I’ll catch you another day?”
“Sure, I’m not going anywhere.”
Which was true, Kirk reflected on his drive home, he wasn’t going anywhere anytime soon. There was a certain amount of resignation with moving back to Iowa, a curdling in his stomach at the realization of his age and lack of ambition. When he’d graduated nursing school, he’d ditched the Midwest to take travel contracts along both coasts, floating through different emergency departments before settling in San Francisco. The adrenaline of his twenties meant he could work night shift no matter how busy it got, and still have time to explore during the day. He’d hiked nearly the entire state of California, learned to surf in the chilly waters of the Bay, and attended college courses with the goal of getting his doctorate. There had been dating, too, awkward coffees and dinners and hookups in his shabby studio apartment. But no relationship had survived his hellish work schedule, the women (and a few men) fading into ghosts like fog on the coast when the sun finally appears. And now, he was back home in Iowa. Close to his parents, which they appreciated, right back where he started. The only difference was the tiny crows feet around his eyes and a weariness in his bones.
Kirk tried to banish the gloom from his thoughts as he parked at his apartment complex. He’d splurged for a reserved parking spot this time, and it was worth every penny. Fighting for parking after working a twelve hour shift was a particular circle of Hell Dante never had to visit. He tried to stay up to let his body adjust, working out in the small apartment gym and making an overly complex breakfast, but by noon, he had given up and crawled in bed. Circadian rhythms are much more malleable in one’s youth, he reflected, and promptly passed out, swaddled in his soft sheets.