Chapter Text
October 2019
You head out of the elevator, yawning. It's just one of those days where there wasn't going to be enough caffeine in the world to help you, you can already tell. You'd only gotten four hours of sleep; the people at the condo were doing landscaping, and the sound of the weedwhackers had been louder than the rain sounds you'd been playing on your phone. Slouching past the nurse's station, you head toward the break room. You stop when you see the day shift charge wave at you. Kim passes you the war sheet, giving you an opportunity to look it over. It seems like you were assigned to rooms 31 and 32 tonight.
"Hey, Kim. Good day?" You say, smiling at her and tucking the assignment sheet in your pocket. The charge nurse isn't looking too ruffled tonight, which bodes well for you. If it was a shit show, you'd know.
"Decent. How's it going? You look rough." You snort. She doesn't mince her words, but she doesn't mean anything by it. You're well-aware you've got bags under your eyes. Nothing you can do about it.
Instead you sigh theatrically. "Living the dream. Still working on caffinating. What you got for me tonight?"
Kim's all business now. "You're getting a walkie talkie floor boarder in 31, probably will transfer after 8pm. They're also giving you the new trauma coming in. Haven't gotten an elevator call yet though."
"Hot mess express?" You take a generous swig of your coffee, mentally preparing yourself.
Kim scans the computer screen. "Let me see what I have so far...It's a Doe, motorcycle accident. Spines cleared. Looks relatively stable. In the OR now to repair a splenic rupture. Could end up with a splenectomy. Might also get a liver lac embolized before coming up. Trauma resident said it sounds like they're planning on keeping him intubated for the night, just in case they have to take him back to the OR in the morning."
So, translating the nurse speak: a patient with organ damage after an accident is in surgery to fix the damage, and will be coming back on intubated and sedated on a breathing machine. You're going to keep him nice and comfy on night shift, and if he's a Doe, he might not have any family coming to look for him. You mentally thank the health care gods for looking out for you; it sounds like an easy admit.
You yawn again. "Well, doesn't sound so bad. Probably will get a second admit later on then?" Maybe you'll be a little better caffinated by then. Maybe.
"Maybe, we'll try and keep your bed open. Depends how much this guy is bleeding post op."
"Hey, knock on wood. Don't jinx me. Thanks for the heads up though." You take a last drink of your coffee, going to dump your lunchbag in the fridge. You bring the same thing to work, every time: one peanut butter and jelly sandwich, plus two energy drinks. A girl has to stay awake all night, after all.
You punch in and go to find the day shift nurse for room 31; Cheryl had been working as a RN for thirty years, and gave bare bones report. You aren't too bothered. If you need to figure something out, you can just look in the computer later; you're not someone who stresses the little stuff. The patient had taken a little ground level fall and gotten a small subdural. He was on warfarin for his afib, so they just wanted to watch him a little closely the first day. He'd also flipped in RVR with the stress of the accident, so he'd needed some drugs. They'd liberalized his neuro checks and got his heart rate stabilized, so he could get shipped out of the ICU. He'll probably get to leave the hospital soon. You don't get many happy endings around here, so it's nice to see someone doing well.
You go into the patient room to say hello, doing a quick safety check and seeing if the patient or his wife need anything. The elderly gentleman is sitting in the bed, watching the news. There had been a shootout in a home in Chula Vista earlier that night, apparently. Five people are dead, and the assailants had fled. The reporter is suggesting it's gang activity, but they were still awaiting confirmation of the names of who had died.
"What's the world coming to," the patient sighs. You shake your head; if your job has taught you anything, it's that people have an endless capacity to hurt each other. You wish you could be shocked by this kind of thing any more.
"Pretty wild stuff. Hey, I'll be back with your meds in a few minutes, ok? I'll bring some more water." You made your escape, shaking your head. It's Halloween, and things are going bump in the night. Usually the holidays are relatively quiet, but apparently people were riled up out there. The ghosts and ghouls and vampires are roaming the streets, looking for trouble. As much as you would like to be one of them, you're working.
You've been a nurse for three years. It's a decent gig, it pays the bills. You originally moved out to San Diego years ago because your high school boyfriend turned husband was a jarhead. The divorce was amicable enough; he joined the Seals and basically gave up on having a civilian life. After years of successive deployments, it wasn't even a shock when it happened. The two of you had grown apart for a long time; at least you'd not had kids together. You had always said that you wanted to graduate college first, and by the time that happened, the damage had been done.
Still, you actually liked San Diego quite a bit, so you stayed. It's a beautiful place. The weather's nice 99% of the year, the food is amazing, and the beach is never more than a thirty minutes drive.
You think you could probably die here.
After moving your other patient out to the acute care floor, you have some time to kill. You use this time wisely, looking up the story behind your new admission. Tracking down the MRN, you spend some time cruising through the notes. DOE, London Z is the name that they've assigned to him. He's been the unfortunate victim of a hit and run on the 805; there was a note from the ED social worker, which was an interesting read. Apparently the EMTs spoke to a witness who said it looked like another car had intentionally driven the motorcycle off the road. It also detailed the efforts that had been made to figure out who the patient was; no ID had been found at the scene. SDPD is involved, but this guy has so far been an absolute mystery.
That's spicy; it will be pretty interesting to hear what he has to say for himself when they wake him up tomorrow. No doubt he's going to have some crazy stories to tell. Your night shift charge lets you know that you have an elevator call, and you get the team assembled. They roll him up to your room, and you finally get a good look at this guy.
Oh, he's military for sure. You can spot 'em a mile away. Someone's CO is going to be pissed in the morning.
You get handoff from the surgical team. They didn't have to do a full splenectomy, but he still has some liver and renal lacerations. You're going to watch his hematocrit, and hopefully if he's stable overnight then they probably won't have to do any more surgical interventions. They didn't even leave his belly open, that's how confident they are. He got some blood and platelets in the OR, but hopefully that's the end of it. Nice, easy admit, you say to yourself, pleased. Maybe you'll have time to catch up on The Bachelorette later.
"Damn, this guy is huge," mutters Diana, one of your techs, echoing your thoughts. "I think we're going to need to get some more muscle in here to turn him. Let me grab Evan."
Your Doe is big, at least six foot. You have to measure him to check, and get a weight as part of your admission process. He's 132.6 kg of what you guess to be pure muscle. Damn. They brought him up on a super high dose of propofol; you bet when the paralytic wears off, he's going to be hard to sedate. Time to move fast.
With the help of some friends, you roll him in bed, doing your skin check and changing the sheets. He gets a little scrub down as you go; he's got a fair amount of road rash from the accident. He's got some incredible tattoos on his left arm skulls, guns, soldiers, guns, a bomb (???), more skulls, even more guns, etc.
"Think he's in a gang?" Diana stares at his tattoos with you, and you shake your head. You trace the outline of one with your finger, glancing up to see his heart rate spike a little. The paralytics are almost definitely wearing off.
"No way, girl. Look, dog tags. This is military if I ever saw it." You frown a little. "Actually, hey, can you check to see if they locked his belongings up in the ED safe? I'm sure they already looked them over, but we can double check to see if there's anything they can use to identify him."
Plus, you're sure he's going to want his shit tomorrow.
You finish the bath by yourself, cataloging old injuries. This guy has been shot and stabbed more than a few times, if the scars are anything to go by. It's enough to make you shiver. You clean off road debris and gravel, putting antibiotic ointment on the open areas. His abdomen is stapled shut from his surgery; yet another scar he's acquired. Taking some time to clean his face, you wipe off some nasty black grease paint he had over his eyes. He looks younger when you're finished with him, the sedatives keeping his face smooth and untroubled. He's blonde, with a few noticeable facial scars including one straight through his lip. When you check his pupils, they're brown, reactive to your penlight but still pinpoint from all the fentanyl he's gotten.
Honestly, he's pretty good looking; if he also has emotional problems and a shitty personality, you'd say he's just your type. You wonder if your ex-husband knows him. Probably. It would be a massive breach of HIPPA to send him a text though. You shelve that thought, putting a clean hospital gown and some warm blankets on him. Restraints? An absolute must. You're not going to have a self-extubation on your watch.
Diana swings by again while you're putting some vitals into the computer, bringing some plastic patient belongings bags into the room. "This guy's got some weird stuff. They did find a gun and like three knives on him I guess. I think the police took those. This is the rest. Apparently, he had this odd mask on when the paramedics picked him up. It's in the belongings bag."
"Huh," you say, morbidly curious. Putting on some gloves, you pick up the white bag. Inside, along with the black shirt and jeans they had cut off him in the ED, there was a bloodstained skull superimposed over a black balaclava. You pull it out of the bag as you raise your eyebrows. "Freaky. Maybe it’s a Dia de Los Muertos thing?" Never mind that the holiday is still a few days off. Things blended together here, near the border.
"Or a gang thing," Diana mutters, giving you a significant look. You just shrug, putting it back in. Thanking her, you sit back down and catch up on your charting. Your patient's stable, and his vitals look great. His heart rate is in the 40's, but you (and the ICU team), aren't terribly worried. He's young and healthy, a super fit guy. Unlike your older patient from before, his heart's not the problem.
You stay on top of his pain meds and draw some labs, making sure his crit doesn't drop. He looks stable enough for you to take your lunch, but you double check his restraints and give him more fentanyl before you go. Something about you doesn't trust this man. Call it your nursing intuition.
Lunch is spent enjoying your peanut butter and jelly sandwich and scrolling social media. Night shift is usually pretty chill, and it pays a little better than days. The cons are, of course, that your sleep cycle is totally fucked. You'd try to take a nap, but you don't trust yourself to wake up again. Coming off your break, you crack open an energy drink and prepare yourself for another five hours of work.
When you come back though, something's wrong. There's an alarm going off on the monitors (which is typical; alarm fatigue is so real around here). When you look over, it's your room. Your break nurse has fucked off to who knows where, which is so typical of her. Suppressing an eyeroll, you check out the situation. Your patient's heart rate is sustaining in the 130's; shit fuck shit balls cunt. That's definitely tachycardic for him. You race over, energy drink still in hand. He's probably waking up.
You pause in the doorway, assessing the scene.
The ventilator alarms are going off as your patient is coughing around the tube down his throat. That's not especially surprising; they're uncomfortable, and one of the reasons you keep your patients fairly sedated is because no one really tolerates them too well when they're awake. No, what's surprising is that there was a man in a long white coat, fussing with one of the pumps. One of your pumps. He's leaning over the patient, saying something to him; you can't quite make it out.
You set down your energy drink on the windowsill and enter the room, sanitizing your hands and clearing your throat loudly. The doctor turns, startled, hand going into his pocket. He relaxes a little when he sees you. You give him a brief, tight smile, stepping up next to your patient's bed. You're not exactly marking your territory, but you're not not marking your territory. He's your patient; if something goes wrong in here, it's on you. ICU nurses get territorial that way. "Hi there. Are you with TICU?"
"Uh, yeah. How's our patient doing?" He has a slight accent, but you can't place it. Lots of people do; it's a teaching hospital, and people come from all over the world to work here. You're pretty sure you've never seen this guy before in your life. Again, it is a teaching hospital. There a lot of randos floating around. Maybe he's a new resident, just coming on service. You squint at his badge, but he has it turned around so you can't read his name. You narrow your eyes. Convenient.
"Pretty decent, saw he just got a little tachy. Might be pain. I'm going to give him some dilaudid. Did you have a question about his propofol?" You raise your eyebrows, pointedly glancing from the pump back to the resident. He smiles at you; it doesn't quite reach his eyes. For some reason, it leaves you uneasy. He steps around the bed, as if making to leave the room. Or he's stepping closer to you, maybe to talk. The alarms haven't stopped; you look at your Doe, concerned.
Your patient has his eyes open and he's staring at you. They're wide, his nostrils flaring; he looks spooked. To be fair, he just woke up in a strange place, tied down, with a whole bunch of lines and tubes in him. Anyone in his shoes would be frightened. You reach over and press the call light, laying your hand firmly on his shoulder. His muscles are straining as he starts waking up, and you're sure the soft restraints aren't going to hold him for long. "Hey, relax. It's okay, I'm your nurse. You're in the hospital. I'm here to help you."
His eyes flick behind you, and you turn to see the doctor, standing a little too close for comfort. "Hey," you say stiffly, losing your smile. "I can take it from here, thanks."
"We'll see about that-" the weirdo begins, hand in his pocket again. Your patient tenses beneath you.
Fortunately, your charge comes in quickly to answer your light, as do a few other nurses. The doctor steps away, just as your patient pulls free of his soft restraints; you're immediately distracted. You grab his shoulders, throwing your weight on top of him to try to keep him in bed. Diana comes running with the locked restraints before things get too crazy; she's your ride or die for a reason. You do a few prop boluses and push some drugs to help him relax, or as close to relaxed as you can get him. He stays intubated, and you manage to wrestle him back into bed with some help from your friends. You did NOT sign up for any excitement tonight. When you look around to maybe get some extra medication orders from the doctor (or to get his name and report him for messing with your shit), he's disappeared. Hmm. Mysterious.
Once things settle down, you check Epic, and the resident signed in for him overnight is a woman. She was there during the surgical handoff, actually. Maybe he wasn't from the trauma ICU team, and you just got your wires crossed? Still, it leaves you feeling a little uneasy. Your patient's heart rate has gone down on the monitor; he's more in the 60-70's, but his blood pressure is slightly more elevated than before.
Still, he looks calmer. You're suspicious though. Your nurse senses are tingling, and they're not wrong very often. It's time to do your four am neuro check anyway; it sounded like he had bumped his head really good during the accident. You get the flashlight, ready to shine it in his eyes. He opens them when you touch his eyelids, giving you a seemingly exasperated look; he's definitely still awake. You chuckle.
"We're you playing opposum with me young man?" You say, amused. His facial expression doesn't change. You click off the flashlight and set it aside. Leaning over his bed once more, you take his hand. "Squeeze my hand if you can hear me." His fingers twitch, then he squeezes. Damn, that's a strong grip. You grin; this is excellent. "Good job! Squeeze my hand if you know where you are right now. I told you a little while ago, but it's okay if you don't remember." His hand flexes, but doesn't quite squeeze. Whoops, that's on you.
"Sorry, let me ask you more specific questions. Squeeze my hand if we're in Mexico." No squeeze. His fingers twitch once more, but don't move. "Sorry, just a little test. Are you in the US?" A solid squeeze once more. Perfect. "That's right. Do you know what kind of building you're in? Are you....at home?" He gives you a look like you're a dumbass, his hand limp in yours. You laugh a little, reaching over to pat his shoulder. "Sorry, another test. Are you in a hospital?" He squeezes. You nod, beaming. "Right! Squeeze my hand if you remember how you got here. Was it a car accident?" His hand tentatively squeezes yours, though his eyes are narrowing again.
You nearly roll your eyes, but this time it's at yourself. You've had a lot of patients in car accidents lately, young men driving too fast and getting ejected because they're not wearing seat belts. Everything starts to blur together after awhile. "Sorry, my bad. I was the one with memory issues this time. Was it a motorcycle accident?" Very firm squeeze this time. You laugh. "Okay, wow, strong grip. I'll stop asking you so many questions. You have a breathing tube in, to protect your airway. You were pretty drowsy after the accident. They'll probably take it out tomorrow. You also had surgery to fix your spleen. Some had to be taken out. You're going to be okay though; you got really lucky. It could have been a lot worse."
He seems like he doesn't want to let you go; his grip is really, crazy strong. You pat his shoulder once more. "Hey, it's okay. Really. You're safe, you're in the hospital. Are you having any pain?"
He slowly shakes his head side to side. You squint a little at him, wondering if he's lying to you. Maybe he just doesn't want to sleep again. "Okay. I'll keep asking, just to make sure. I want to make sure you're comfortable. I'm not going to let anything bad happen to you, okay?" You tell him your name, remind him of the hospital he's at, then straighten up again. He reluctantly lets go of your hand.
You sit down at the computer in the room where he can see you, deciding to do your charting in there. For the rest of the night, whenever you look over at your Doe, he's looking back at you. At least he doesn't look angry. With some people, you can tell that they're trying to swear at you even though they're intubated. You get the gist of what they're mouthing at you around the tube, nasty things they're trying to shout at someone who just wants to help them. They'll throw in a few rude hand gestures while they're at it. This guy doesn't. He just watches, which is alright, if a little intense. He doesn't sleep the rest of the night; you put on some TV for him, some soccer matches from across the pond, but he mostly just watches you. His eyes are wary, untrusting. You take some extra effort to explain what you're doing in his room, just to try to gain some trust.
He reluctantly lets you brush his teeth in the early morning; you promise to be gentle. It's strangely intimate. He stares at you unblinkingly the whole time. You know it's weird, having someone taking care of you like this. It's like being a baby all over again, where you can't do anything for yourself. You get the feeling he's probably the type of guy who doesn't let anyone take care of him, ever (which also definitely reminds you of your ex). When he coughs, you suction him out, soothing him through the process. He continues to refuse pain medicine, which you tell him you think is a bad move, but you let him refuse. Near the end of your shift, when you're adjusting the pillow behind his head, he gestures to his belly. You look down.
"Your stomach? Something wrong with it?" He shakes his head. "Hmm. I've never been good with charades. Let me check." You pull the blanket back a little bit, lifting his gown and checking the island dressing over the staple line. It looks fine, no additional bleeding or swelling. You gently press around it to be sure; it seems a little early to be developing surgical complications, but you never know. London Z Doe shakes his head, gesturing again. "Wait, higher? Or...lower?"
He nods, frowing. Oh, you know what he's asking about. You arrange your expression into one of sympathy. "Yeah, I'm sorry. You have a Foley in your bladder." He gives you a confused look, brow furrowing. You sigh. "It's a tube that goes into your penis and drains the pee out." The horrified stare he gives you is actually kind of funny, but you manage to keep your face straight. "I know, I know - it sucks. Hey, if they don't need to take you back to surgery today, they'll pull it out, okay?"
He shakes his head firmly, and you do laugh a little bit then. "I'm sorry. No one likes them in. I promise, as soon as we can, we'll take it out. Um, also, nothing got damaged in the accident. You're all intact down there, okay? Just try to get some rest." Listen, you had to do a skin check. That means checking every inch of your patients' skin. It's totally impersonal, but it needed to happen. He doesn't seem super reassured by this, but you tried the best you could. You rearrange the blankets, covering him back up to try to give the illusion of privacy. The rest of the night is, fortunately, uneventful.
When seven in the morning rolls around, you give report to the oncoming nurse; she takes one look at him and tells you she would have started with the locked restraints. Even laying in bed, tied down, Mr. Doe looks pretty intimidating. It makes you snort. Maybe you're just a risk-taker. You like a bit of excitement, whatever you tell yourself.
Leaning over your patient's bed, you tell him you're leaving for the day. His eyes widen once more, ever so slightly. "Look, the doctors will be in soon. This is Anh, she's an amazing nurse. She'll take great care of you, I promise. We'll get everything taken out. Yes, everything." You laugh at his raised eyebrows. He looks more resigned than anything at this point. "I'll be back tonight, okay? Be good, don't give your nurse any trouble." He almost rolls his eyes and you laugh once more.
You feel his intense gaze following you out the door; you think about it when you crawl into bed that morning, exhausted. That was a weird shift, you admit to yourself, in the safety of your own bed. Tonight? Tonight is definitely going to be interesting.